Health and education levels have improved, but their effects have not been felt by the entire population. Maternal and infant mortality remains high. The capacity of health workers, maternal referral systems, management of maternal and child health services, as well as reproductive health services have not been running optimally. The use of modern contraception (Contraceptive Prevalence Rate/CPR) decreased from 57.9% (IDHS, 2012) to 57.2 (IDHS, 2017).
The adolescent birth rate (Age Specific Fertility Rate/ASFR) aged 15-19 years also remains high due to the low understanding of adolescents about reproductive health, high rate of child marriages, lack of preparation for family life. Parental understanding regarding good parenting, environmental health, and the ability to provide adequate nutrition is also still low, which has led to a high prevalence of stunting.
The prevalence of major communicable diseases (HIV/AIDS, tuberculosis, and malaria) remains high, and is accompanied by the threat of emerging diseases due to high population mobility.
Unhealthy lifestyles increase risk factors for diseases such as obesity, high-blood pressure, high rate of smoking, and lack of physical activities, which lead to an increase in non-communicable diseases
such as stroke, heart disease, and diabetes. Environmental conditions are exacerbated by air pollution, water pollution, bad sanitation, and hazardous and toxic waste (B3) that have not been managed properly. The proportion of households that have access to livable housing is 54.1%, with access to safe drinking water at 87.8%, and proper sanitation at 74.6% (BPS, 2018, compiled by Bappenas in 2019).
The health service referral system is not optimal due to long waiting times for patients. Community health centers (Puskesmas) and private Primary-Level Health Facilities (FKTP) have not been able to optimally function as gate keepers. The issues include: lack of medication and vaccines, and irrational use of drugs still occur; high dependence on imports of raw materials for pharmaceutical preparations and of medical devices; and food and drug control systems that are not optimal.
Inequalities in health system performance between regions also remain high, for example, there is low complete basic immunization coverage in the eastern region of Indonesia.
Accredited health service facilities and health workers are still focused in Java- Bali and in urban areas.
In education, in 2018, there were 4.4 million children aged 7-18 years who were out of school. Out of school children (OOSC) is due to lack of cross-sectoral efforts in minimizing social, economic, cultural, and geographical barriers, as well as inadequate learning models that are suitable for children with disabilities, street children, neglected children, children facing criminal charges, children in marriage/teenage mothers, and working children/child labor. Education participation at the level of Early Childhood Education (PAUD) and higher
education/university also remains remarkably low at 36.06% and 30.19%
respectively (National Socio-Economics Survey (Susenas), 2018). Education disparity between economic groups also remains a problem and is becoming wider as the level of education increases.
The gross enrollment ratio (GER) of the poorest 20% of the population compared to the richest 20% at secondary and tertiary levels in 2018 was 0.67 and 0.16, respectively. The education inequality among regions is also still high.
Figure 4.2
Top 10 Disability-Adjusted Life Years/DALYs in 1990 and 2017 in Indonesia
Source: Global Burden of Disease, 2017.
Quality learning has also not been running optimally and evenly between regions. The efforts made have not been
able to improve the quality of learning that fosters higher order thinking skills.
The results of the Program for
Communicable/maternal, neonatal, and nutritional disease Low Back Pain
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International Student Assessment (PISA) showed that the proportion of students who were above the minimum standards
of competence in mathematics, science, and literacy, in the 2006-2018 period, still showed low development.
Figure 4.3
Disparities in Education Levels Among Regions by the Average Years of Schooling of Persons 15 Years and Above by Province in 2018
The PISA 2018 results also showed that the proportion of students who were above the minimum standard of
competence in mathematics was far lower than other countries in the ASEAN region.
Figure 4.4
Proportion of 9th Grade Children Above Minimum Standards of Competence in Mathematics, Science, and Reading on the PISA Test
In addition, the results of the Competency Assessment for Indonesian Students (AKSI) showed that student competencies in various regions were still far behind. This was indicated by the low
minimum competency limit, such as in West Sulawesi for reading (20.92%), Maluku for mathematics (12.19%), and Gorontalo for science (13.52%). The quality of educators was a major factor
Source: National Socio-Economics Survey, BPS.
Source: PISA, 2018
Figure 4.5
Comparison Among Several Countries Regarding the Proportion of Children Below Minimum Standards of Competence in Mathematics on the PISA Test
Source: PISA, 2018.
The results of the Teacher Competency Test (UKG) in 2015 showed an average score of 53.02, lower than the minimum competency standard of 60.0.
Meanwhile, at the tertiary level, only 14.1% of 290,687 lecturers had doctoral degrees (Ministry of Research and Technology, 2018).
The quality gap among higher education institutions is a crucial problem in Indonesia. The large number of tertiary institutions, namely 4,650 institutions, has caused governance efforts in tertiary education to not run optimally. The issue of quality is also closely related to the
unrealized differentiation of the mission of tertiary institutions in carrying out the three pillars of higher education, which are teaching, research, and community service. At this time, universities have not been focused on carrying out these three functions, whether as a research university that emphasizes aspects of knowledge production through multi- disciplinary and cross-disciplinary research; as a teaching university that focuses on learning and community service, or as a vocational university that emphasizes partnership with industries and preparation of skilled graduates.