“Get Ready to Grow Old”
A Review on
Ageing Policy Approaches in Indonesia
Introduction
The world is
ageing. As a global phenomenon, population ageing is taking place in nearly all
over the world, at the developed and developing nations. Several studies, including United Nations and
WHO reports, point out that ageing population will affect all societies, but
rapid ageing will be become more an issue in developing economies (Kisella and He, 2008, Nations, 2003, Organization, 2007, Nations, 2013). Unlike
developed countries, which grew old after they became rich, in the developing
countries, are growing old before become wealthy. As according to the World
Economic Forum (WEF) report in 2012, it states that currently around 12% of the
world population are those aged 60-plus. This number will significantly
increase to about 25% by 2050. Majority of those large share of older people
are currently living in developing countries.
However, in contrast to the readiness in developed countries where wide
range of behavior changes and public policy responses to population ageing,
people in developing nations still having a lack of awareness and
socio-economic support to enhance the quality of life for people when they
reach their older ages. Bloom, Mahal and Rosenberg in “Design and Operation of
Health Systems in Developing Countries” warn that ignorance and “business-as-usual” approach to the
changes toward population ageing will result the nations into inadequate
healthcare supply and systems, insufficient human resources and greater health
inequality (Forum, 2012-14). Therefore, given to this reality it is important for government
and societies in developing countries to design and adjust their policy and
social structures to address the challenges and get ready over their health-care,
employment, social security and welfare, and environmental systems to be
equipped to handle this demographic change.
This paper will review the ageing policy and its approaches in Indonesia,
and will critically assess its implementation and impact in providing old age
security for the elder Indonesians. As the fourth biggest population country in
the world, currently, Indonesia ranks as the seventh largest country with its
number of older people (Kreager, 2006). Whereas in Asia, the total number of Indonesians elderly is just
below China and Japan (Jones, 2007). As according to the United Nations Population Funds (UNFPA) by
2050 the number is projected to reach about 75 millions or about 25% of its
total population (Makelew, 2013), and this potentially will create a massive burden, economically
and socially, which the nation has never faced before.
Portrait of The Ageing Population
in Indonesia
The Family Planning program, started in the mid-1970, had
successfully reduced the number of population size in Indonesia. Prior to the
program, majority of Indonesian would have four to six children in the family.
The program then introduced for the maximum of two children. Together with the
declined on birth-rate, Indonesian life expectancy has also dramatically
increased from 45 to 69 years old, between 1970 and 2012 (UNDP, 2013). As a consequence, this change leads to the increase number of
older Indonesians aged 60 years from 4% of the population in 1971 to about 11%
approximately in 2011 (Statistik, 2011). As according to the reports produced by ILO and UNFPA, it is
estimated that about 25% of Indonesians in 2050 would be those aged 60 years and
older, and majority of them would live in rural rather in urban areas. Furthermore,
the study done by Arifin et al. (2004) point out that due to urbanization, rural districts in Indonesia
tends to age faster than urban areas. Currently the largest oldest populations
are concentrated in the Central and East Java provinces, Bali and West Sumatra.
About 8 to 10% of their populations respectively are the elderly. The study
also found out that half of them are still working at the agricultural and
informal sector, and earn a very low income of about USD 55 per annum. This is
definitely not sufficient to support their daily lives, and made them rely on
their children or other family. Moreover, the old age support ratio shows
significant decrease from 1970 to 2010 (Makelew, 2013). From previously 20 decreased into 9 working age adults supporting
one older person. The number is projected to gradually decline into 5 workers
by 2030.
Ageing
population comes with major social and economic challenges to the state,
society, family and individual lives. Like in many other less-developed
countries, older Indonesians have higher risk to fall into poverty, especially
as the social security system coverage is still very limited. In Indonesia, being
old means becoming dependent to the younger generation. Being old means no
longer can actively work at the labor market, or when it does, it means low or
unpaid, and it may not recognize in the national economy. In addition, growing
older and become ageing means have higher risk to disability and
non-communicable diseases. As the family structure in Indonesia change with
fewer children and migration phenomenon to urban or overseas to achieve better
income, this has also affected care support that can be given to the elderly. Unlike
their previous cohort the current older generation is at the crossroad and started
on the rise of an issue of who will take-care of them at their old age. Woman
in the family may also no longer available as primary care giver, due to their
participation in the labor market. Whereas culturally, majority of elder
Indonesian still prefer to live together with their families instead of at
nursing or aged home-care. This is all bringing more burdens and struggling as
people getting older in Indonesia, to the elderly but also to the younger
generation and the state, as potentially lost on number of taxpayers.
Ageing Policy Instrument in
Indonesia
Currently there has been a set of social policies instruments that
specifically address the issue to the ageing population in Indonesia. The first
legislation was created in 1965 during the administration of the first
President Sukarno. However, Law No. 4/1965, which aims to provide some form of
public assistance to the older Indonesians, was never implemented due to
political turmoil in the country and the changes of the presidency to next
regime under Suharto (Arifianto, 2006). Under the new regime, old age was not seen as priority. Another argument
on this is because of the smaller portion of population that classified as
elderly during that time. Therefore the law, together with others written
during the regime, was basically remaining inactive, until the next regime arose
in 1998.
Under
the new democratic regime, several pieces of legislation and presidential
decrees were designed to provide assistance and social welfare to the elder Indonesians.
Those are as below:
No.
|
Law #
|
Law ID
|
Objective
|
Authorized Agencies
|
1
|
Law No. 6/1974
|
The Social Welfare Law
|
The Right for Indonesian citizen to a decent standard of social
welfare and to participate in social welfare activities.
|
Ministry of Social Affairs
|
2
|
Law No. 3/1992
|
The Worker’s Social Security Law
|
Creation of social security benefits for workers eg. Injury,
death, retirement, and healthcare.
|
PT Jamsostek
(a state owned company).
|
3
|
Law No. 13/1998
|
The Old Age Welfare Law
|
As a replacement of the former Law No.4/1965 that stipulates on
the equal rights to elderly towards public services including to religious
services, healthcare, employment, education and training, social protection
and assistance, and special privilege in using public utilities and legal
services.
In response to this law, the government also sets 29 May as the
National Elderly Day in Indonesia.
|
Relevant Government Ministries.
|
4
|
2003
|
The 5 year National Strategy to Improve the Welfare of the
Elderly
|
As a response to the enactment of the Law No.13/1998
|
Coordinating Ministry of Social Welfare
|
5
|
Presidential Decree No. 52/2004
|
The Creation of the National Committee on Ageing
|
A mandate to coordinate the implementation of the National
Strategy to Improve the Welfare of the Elderly
|
A committee consists of 25 members from various government
agencies, CSO, Universities and the Private Sectors.
|
6
|
Law No. 40/2004
|
The National Social Security System
|
Creation of universal social security schemes for citizens: old
age pension, old age savings, national health insurance, work injury
insurance, and death benefits.
|
Relevant Government Ministries.
|
Health and Care Support
The
enactment of Law No. 40/2004 states that at latest by 2015 all Indonesian will have
health insurance through the National Security System. In response to this, one
of the responsible ministries, the Ministry of Health defines its strategic
plan to prioritize the improvement of both financial and physical access to a
better quality of health services throughout the country. Whereas specifically
to the elder poor, the ministry and several local governments have taken
initiative to fund the cost to health services in the health centers, this is
as an effort to improve the affordability of the poor to health services. In
related to older Indonesians, from total about 9,000 health centers across the
country, 437 categorize as older people friendly health centers. As mandated by
the law, they are responsible to provide health services to the older persons, which
include promotion, prevention, curative therapy, and rehabilitation.
Presently,
however, only about 15% from total Indonesian elderly are covered by the health
insurance scheme, provided by either government or private sectors (Noveria, 2012). Majority of them are former civil servants or those who had
worked at the private formal sector. From all of the insurance coverage for
elderly, only less than 2% is under the social safety net program. This means
many poor and vulnerable older persons in Indonesia are still uncovered and
have no access to health services. Those registered under the social assistance
program receive a monthly cash of about USD 30 per month for a year. This
condition force the poor elderly to remain working, despite employment
opportunity are also very limited, and heavily live dependently to their
families.
Despite several
policy instruments on ageing that have been enacted, government’s commitment to
execute the law also seems still questionable. This can be seen at the low
priority of government’s budget allocated for social welfare. For example even
after the law 2004 issued, government only allocated an amount of less than AUD
250,000 to cover social welfare, which may not be sufficient enough to address
the needs of the elderly in Indonesia (Makelew, 2013). Furthermore, the new social security laws, which putting
government as the central player in executing the law and exclude other
stakeholders from playing important role may potentially endanger the
effectiveness of the policy. From the implementation of past social security
programs, it has been shown that lack of accountability and serious governance
problem due to systemic corruption and weak capacity of the Government. Designing
policy where government alone monopolize the delivery of services, including in
managing the fund, may not be a workable model any longer in Indonesia.
Different arrangement, which involve and encourage partnership with others,
such as NGOs and CSO groups, private sectors and including the senior citizens
associations, may need to facilitate the improvement in people participation
and government’s accountability. This strategy may also contribute to an
increase in broader social awareness and culture of sharing responsibility in
managing population ageing.
In regards
to the care support, a study found that most of elderly still prefer to receive
care from their own families instead of entering nursing home (Noveria, 2012). However due to changes resulting from the smaller family size
and more formalized relations based on financial rather personal needs, the
current elderly Indonesian have more difficulty to get appropriate and personal
care. In fact, many of them, especially from the middle-income background, have
now needed to purchase care support from third party, outside their own
families, such as domestic helper or nurses. While government provides some
schemes to the old age nursing home, but the facilities and services are still
very limited and given only to a very small number of poor people. In the
future, to induce family to provide care to their elder family, Indonesia might
need to consider introducing tax incentives to reduce family’s financial
burden. Indonesia could also learn from a neighbor country like Singapore,
which provide property deduction price for registered taxpayer to buy a flat
and live together with their ageing parents.
Employment Opportunity
It
is clearly stipulates under the old age welfare law of 1998 that elderly
Indonesian have equal rights in regards of employment services and
opportunities. The law ensures the elderly Indonesian to keep active and working
to produce goods and services, and maintain healthy life. However, the law is
not clearly defined on what kind of specific programs and services could be
designed and offered to achieve those aims. From the current programs
implemented to improve the welfare it is still unclear and show lack of support
and commitment, especially in attempt to promote active and productive ageing. Pension
age policy would be one example of contradictory to the current ageing policy,
which hampers the promotion of active ageing at the labor market.
Because
of the pension age policy, older workers in Indonesia tend to be eliminated
from the labor market. They face challenges to remain participating in the
workforce as they reach age of about 50s, or to seek employment by that age.
There are structural and cultural barriers that they have to deal with to stay
in the market. Structurally, the current retirement policy contributes in
eliminating their existence to remain active in the labor market. In Indonesia,
the set retirement age is still relatively young, at about 57-58 years. Very
often, elder workers also discriminated by the employment criteria that put age
limits as one key condition. Even when the older workers already in the labor
market, they tend to be vulnerable to economic shocks, and potentially opt out
first whenever crisis hit. In addition, they also subject to stigmatization,
that as they get older means can no longer be productive and suffer with
illness and disabilities. Whereas to those work at the informal sectors, very
often their contribution do not counted in the national economy due to self-employed,
low-paid and even unpaid whenever they work providing care support to their
family, like in the case of a majority of older woman. However Koesobjono and
Sarwomo (2003) present interesting finding in their study, that half of the
total senior citizens in Indonesia are actually still work and active in the
labor market. But they mostly work in the informal sector such as agricultural
and unfortunately, many of them earn very low income and have difficulty to
independently finance them-selves. In this context, it also shows on a very limited
employment alternative available when people getting older in a country like
Indonesia. Job transition to retirement and part-time work are still not fully
recognized in the labor market, but may nee to be adopted in the future to give
wider employment opportunity for the senior Indonesians.
In addition,
a research in three different rural communities in Indonesia highlights to the
significant financial contribution of the older people during the economic
crisis hit Indonesia in the late 90s (Butterfill, 2004). The research found that many pensioners and agricultural workers
become their family breadwinners, especially at the time when their children
loosing job and have no income due to high unemployment that struck in Indonesia
for several years. This shows that
regardless of age limitation may have, many elders can actually still provide
care and support to their family, and they may not as fragile as commonly
deemed.
How Ready and Friendly the
Environment
Under the Old Age Welfare Law no. 13/1998 and follow with
Government Regulation No. 43/2004 on Older Person Welfare Improvement Effort,
it stipulates to the provide and protect the right of elderly Indonesian to
access public and infrastructure facilities such as public buildings, roads,
parks, transportations, and recreational areas. In the reality, unfortunately, Indonesian
cities and their public facilities are still far from being ready to be known
as age-friendly cities, as defined by the WHO in its 2000 report. In one
evaluation study found that key factors such as safety, security, comfort and
accessibility are hardly to be found in the 14 cities used as sample of the
study (Suriastini et al., 2013). Whereas special services that recognize the respectable position
of senior Indonesians are also still not offered, such as tax incentives,
discount cards, or special transportation tickets can be used for life.
However, Indonesia has made progressive improvement in the area of healthcare
facility. Despite the numbers of health centers are still very limited and
majority are concentrated in the dense provinces (Jakarta, Central Java, East
Java, and Bali), but today Indonesian elderly could access “older-person-friendly
health centers” and have special treatment in accessing health services. In the
future, other than just adding number of health center designed for the
elderly, Indonesia might need to consider to incorporate adequate access and
services to health care for the old age as an integral part of the overall
health care systems across the country. Whereas in regards of age friendly
environment, Indonesia may need to start to adopt the guideline introduced by
the WHO to ensure that the development of the cities could be designed to serve
the needs of all citizens, from time to time, by different generations,
including the senior citizens.
Conclusion
In general Indonesia has built its awareness and commitment to
anticipate the rapid movement to ageing population. This can be seen in the
number of policies that have been enacted and specifically addressed the issue
on ageing. However Indonesia needs to continue its policy and priority
direction that can be focus to integrate ageing issues into the mainstream
development process in each areas such as healthcare system, equal employment
opportunities, provision of social welfare and security benefits, and creating
environment that can support the welfare and better life of older persons in
Indonesia. Healthy, active, productive and successful ageing should be the
target in all ageing policies and its activities in the country.
Author:
Melbourne, Autumn 2014
Lia Marpaung-Abidin
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