Spatial and socioeconomic inequalities in the availability of community health centres in the Jakarta region, Indonesia

Submitted: 27 January 2021
Accepted: 8 June 2021
Published: 19 October 2021
Abstract Views: 1222
PDF: 505
HTML: 153
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

In the late 1960s, Indonesia established community health centres (CHCs) throughout the country to provide basic healthcare services for the poor. However, CHC expenditures and investments vary widely at the sub-provincial level, among administrative areas known as cities and regencies, raising concern that facilities and services do not correspond to population needs. This study aimed to examine spatial and socioeconomic inequalities in the availability of CHCs in the Jakarta region. We used spatial and statistical analysis methods at the village level to investigate these inequalities based on CHC data from the Ministry of Health and socioeconomic data from Indonesia Statistics. Results show that CHCs and the healthcare workers within them are unevenly distributed. In areas with high need, the availability of CHCs and healthcare workers were found to be low. There is a mismatch in healthcare services and delivery for low-income, unemployed populations at the village level that needs to be addressed. The findings discussed in this paper suggest that Jakarta Department of Health should coordinate with local public health districts to determine locations for new CHCs and assign healthcare workers to each CHC based on need as this would improve access to essential health services for the low-income population.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Acharya LB, Cleland J, 2000. Maternal and child health services in rural Nepal: does access or quality matter more? Health Policy Plan 15:223-9. DOI: https://doi.org/10.1093/heapol/15.2.223
Anselin L, 1995. Local indicators of spatial association - LISA. Geograph Anal 27(2). Available from: https://dces.wisc.edu/wp-content/uploads/sites/128/2013/08/W4_Anselin1995.pdf Accessed: June 2, 2021.
Awoyemi TT, Obayelu OA, Opaluwa HI, 2011. Effect of distance on utilization of health care services in rural Kogi State, Nigeria. J Hum Ecol 35:1-9. DOI: https://doi.org/10.1080/09709274.2011.11906385
Badan Pusat Statistik (BPS)/Indonesia Statistics, 2015. Jakarta Dalam Angka 2014 (Jakarta In Figures, 2014).
Badan Pusat Statistik (BPS)/Indonesia Statistics, 2020. Provinsi DKI Jakarta Dalam Angka 2020 (Jakarta In Figures, 2020). Available from: https://jakarta.bps.go.id/publication/2020/04/27/20f5a58abcb80a0ad2a88725/provinsi-dki-jakarta-dalam-angka-2020.html Accessed: June 06, 2021.
Brauner-Otto SR, Axinn WG, Ghimire DJ, 2007. The spread of health services and fertility transition. Demography 44:747-70. DOI: https://doi.org/10.1353/dem.2007.0041
Environmental Systems Research Institute (ESRI), 2017. How kernel density works. Available from: http://pro.arcgis.com/en/pro-app/tool-reference/spatial-analyst/how-kernel-density-works.htm Accessed: September 2, 2017.
Entwisle B, Rindfuss RR, Walsh SJ, Evans TP, Curran SR, 1997. Geographic information systems, spatial network analysis, and contraceptive choice. Demography 34:171-88. DOI: https://doi.org/10.2307/2061697
Frederick WH, Worden RL (eds.), 1993. Indonesia: a country study. GPO for the Library of Congress, Washington, DC, USA.
GeoDa, 2017. Download GeoDa software, GeoDa release. Available from: https://geodacenter.github.io/download.html Accessed: September 15, 2017.
Guagliardo MF, 2004. Spatial accessibility of primary care: concepts, methods and challenges. Int J Health Geogr 3:3. DOI: https://doi.org/10.1186/1476-072X-3-3
Hart JT, 1971. The inverse care law. Lancet 1:405-12. DOI: https://doi.org/10.1016/S0140-6736(71)92410-X
Heywood P, Harahap NP, 2009a. Health facilities at the district level in Indonesia. Aust New Zealand Health Policy 6:13. DOI: https://doi.org/10.1186/1743-8462-6-13
Heywood P, Harahap NP, 2009b. Public funding of health at the district level in Indonesia after decentralization - sources, flows and contradictions. Health Res Policy Syst 7:5. DOI: https://doi.org/10.1186/1478-4505-7-5
Heywood P, Choi Y, 2010. Health system performance at the district level in Indonesia after decentralization. BMC Int Health Hum Rights 10:3. DOI: https://doi.org/10.1186/1472-698X-10-3
Higgs G, 2004. A literature review of the use of GIS-based measures of access to health care services. Health Serv Outcomes Res Methodol 5:119-39. DOI: https://doi.org/10.1007/s10742-005-4304-7
Hoseini B, Bagheri N, Kiani B, Azizi A, Tabesh H, Tara M, 2018. Access to dialysis services: A systematic mapping review based on geographical information systems Iran. Geospat Health 13:577. DOI: https://doi.org/10.4081/gh.2018.577
Indonesia Data Portal (IDP), 2017a. Jakarta number of people by type of occupations per village. Available from: http://data.go.id/dataset/jumlah-penduduk-berdasarkan-jenis-pekerjaan-per-kelurahan-dki-jakarta Accessed: October 17, 2017.
Indonesia Data Portal (IDP), 2017b. Jakarta number of people under the poverty line per village. Available from: http://data.go.id/dataset/jumlah-penduduk-miskin-menurut-kabkota-dki-jakarta-2006-2010/resource/1547511f-3482-406e-ade2-d02cfc4efa89 Accessed: October 17, 2017.
Indonesia Ministry of Health GIS Portal, 2017. Point data of community health center in DKI Jakarta Province. Available from: http://gis.depkes.go.id/ Accessed: September 1, 2017.
International Labor Organization (ILO), 2015. Indonesia: trends in wages and productivity. Asia-Pacific decent work decade 2006-2015. Available from: https://www.ilo.org/wcmsp5/groups/public/---asia/---ro-bangkok/---ilo-jakarta/documents/publication/wcms_343144.pdf Accessed: January 20, 2020.
Jamtsho S, Corner R, Dewan A, 2015. Spatio-temporal analysis of spatial accessibility to primary health care in Bhutan. ISPRS Int J Geo-Inf 4:1584-604. DOI: https://doi.org/10.3390/ijgi4031584
Macharia PM, Ouma PO, Gogo EG, Snow RW, Noor AM, 2017. Spatial accessibility to basic public health services in South Sudan. Geospat Health 12:510. DOI: https://doi.org/10.4081/gh.2017.510
Mahendradhata Y, Trisnantoro L, Listyadewi S, Soewondo P, Marthias T, Harimurti P, Prawira J. 2017. The Republic of Indonesia health system review. Health System in Transit Vol. 7, No. 1: Asia Pacific Observatory on Health Systems and Policies.
McGrail MR, Humphreys JS, 2015. Spatial access disparities to primary health care in rural and remote Australia. Geospat Health 10:358. DOI: https://doi.org/10.4081/gh.2015.358
Ministry of Health (MOH), 2014. Community health center (CHC) basic data, DKI Jakarta Province based on December 2013 Dataset. Center for Data and Information (PUSDATIN).
Mulyanto J, Kunst AE, Kringos, 2019a. Geographical inequalities in healthcare utilisation and the contribution of compositional factors: A multilevel analysis of 497 districts in Indonesia. Health & Place 60:102236. DOI: https://doi.org/10.1016/j.healthplace.2019.102236
Mulyanto J, Kunst AE, Kringos, 2019b. The evolution of income-related inequalities in healthcare utilisation in Indonesia, 1993-2014. PLoS One 14:e0218519. DOI: https://doi.org/10.1371/journal.pone.0218519
Paul J, Edwards E, 2018. Temporal availability of public health care in developing countries of the Caribbean: an improved twoâ€step floating catchment area method for estimating spatial accessibility to health care. Int J Health Plann Mgmt 34:536-56. DOI: https://doi.org/10.1002/hpm.2667
Ranga V, Panda P, 2014. Spatial access to in-patient health care in northern rural India. Geospat Health 8:545-56. DOI: https://doi.org/10.4081/gh.2014.44
Ruktanonchai CW, Nilsen K, Alegana VA, Bosco C, Ayiko R, 2018. Temporal trends in spatial inequalities of maternal and newborn health services among four east African countries, 1999-2015. BMC Public Health 18:1339. DOI: https://doi.org/10.1186/s12889-018-6241-8
Rushton G, 1988. The Roepke lecture economic geography location theory, location-allocation models, and service development planning in the third world. Econ Geogr 64:97-120. DOI: https://doi.org/10.2307/144118
Shah TI, Bell S, Wilson K, 2016. Spatial accessibility to health care services: identifying under-serviced neighbourhoods in Canadian urban areas. PLoS One 11:e0168208. DOI: https://doi.org/10.1371/journal.pone.0168208
Shaw S, Sahoo H, 2020. Accessibility to primary health centre in tribal district of Gujarat, India: application of two step floating catchment area model. GeoJ 85:505-14 DOI: https://doi.org/10.1007/s10708-019-09977-1
Shi X, 2010. Selection of bandwidth type and adjustment side in kernel density estimation over in homogeneous backgrounds. Int J Geogr Inf Sci 24:643-60. DOI: https://doi.org/10.1080/13658810902950625
Shields L, Hartati LE, 2003. Nursing and health care in Indonesia. J Adv Nursing 44:209-16. DOI: https://doi.org/10.1046/j.1365-2648.2003.02785.x
Strasser R, Kam SM, Regalado SM, 2016. Rural health care access and policy in developing countries. Ann Rev Public Health 37:395-412. DOI: https://doi.org/10.1146/annurev-publhealth-032315-021507
van de Walle D, 1994. The distribution of subsidies through the public health services in Indonesia, 1978-87. World Bank Econ Rev 8:279-309. DOI: https://doi.org/10.1093/wber/8.2.279
Watt G, 2002. The inverse care law today. Lancet 360:252-4. DOI: https://doi.org/10.1016/S0140-6736(02)09466-7
Woldemichael A, Takian A, Akbari Sari A, Olyaeemanesh A, 2019. Availability and inequality in accessibility of health centre-based primary healthcare in Ethiopia. PLoS One 14:e0213896. DOI: https://doi.org/10.1371/journal.pone.0213896
World Bank, 2019. The World Bank in Indonesia. Available from: https://www.worldbank.org/en/country/indonesia/overview Accessed: January 30, 2020.
Xiong X, Li Luo L, 2017. Use of geographical information systems for delimiting health service areas in China. Geospat Health 12:486. DOI: https://doi.org/10.4081/gh.2017.486
Yang D, Goerge R, Mullner R, 2006. Comparing GIS-Based methods of measuring spatial accessibility to health services. J Med Syst 30:23-32. DOI: https://doi.org/10.1007/s10916-006-7400-5
Yao J, Murray AT, Agadjanian V, Hayford S, 2012. Geographic influences on sexual and reproductive health service utilization in rural Mozambique. Appl Geogr 21:601-7. DOI: https://doi.org/10.1016/j.apgeog.2011.07.009
Yao J, Murray AT, Agadjanian V, 2013. A geographical perspective on access to sexual and reproductive health care for women in rural Africa. Soc Sci Med 96:60-8. DOI: https://doi.org/10.1016/j.socscimed.2013.07.025
Yusvirazi L, Ramlan AAW, Hou PC, 2018. State of emergency medicine in Indonesia. Emerg Med Australas 30:820-6. DOI: https://doi.org/10.1111/1742-6723.13183

How to Cite

Winata, F., & McLafferty, S. L. . (2021). Spatial and socioeconomic inequalities in the availability of community health centres in the Jakarta region, Indonesia. Geospatial Health, 16(2). https://doi.org/10.4081/gh.2021.982