Abstract

Prior to the COVID-19 pandemic, Indonesia's health system was already facing some daunting challenges: the increasing burden of non-communicable diseases (NCDs), including mental disorders, that threatens to drain the financial sustainability of the universal health system, and the persistent problems of maternal health, and infectious and nutritional diseases. Health and economic costs of NCDs from labour supply and productivity loss are likely to be high and increasing. This chapter discusses the channels through which the COVID-19 pandemic may have medium- and long-term impacts on NCDs and their risk factors. The immediate and long-term effects of the disruption of services, the ‘long-haul’ effects and the effects on mental health may further increase the burden that NCDs place on the Indonesian health system. Indirect effects through income loss and job loss, and long-term tolls on health workers, present challenges for those with NCDs to access services. The effects of the pandemic on NCDs are likely to be heterogeneous across socioeconomic gradients and may exacerbate the existing health inequities.

Introduction

At the end of August 2020, Indonesia was in the midst of a health crisis, with the COVID-19 pandemic showing no clear sign of slowing down. Official figures reported the number of positive cases had surpassed 120,000, with more than 7400 confirmed deaths. Several key economic indicators have also shown that the crisis has hit the economy in full force. By the first quarter of 2020, gross domestic product (GDP) growth had slowed markedly, and official poverty numbers had risen from 9.2 per cent in September 2019 to 9.8 per cent in March 2020 (Olivia et al. 2020). A number of non-representative rapid surveys have suggested that the employment shocks have been severe (Windya 2020; Purnamasari and Sjahrir 2020).

But the pandemic was first and foremost a health crisis. It has challenged the resilience of health systems in countries around the world, including Indonesia. By many accounts, the Indonesian government's immediate health response in dealing with the pandemic has been inadequate (Djalante et al. 2020; Olivia et al. 2020). The delayed response, lack of data transparency and logistical bottlenecks surrounding protective equipment and testing plagued the initial response and continued to be a problem even until August 2020.