Indonesia

Information last updated: 8 April, 2020

Sources: TheWorld Bank and WHO (Population over 65 years old, Informal employment , GDP-PPP , Hospital beds).

Status

Border closures in Tegal (from 30 March to 31 July) and restricted access into and within Maluku, Papua, Jakarta and Yogyakarta.

Plus, large scale social distancing norms are being implemented all across the country.

Response set up and capacity

The Ministry of Health and the National Board for Disaster Management are two of the institutions in charge of overseeing Indonesia’s COVID-19 response, including the development of a national response plan. They are part of the Government’s COVID-19 operation task force.

With regards to capacity, the MoH has approved all regional laboratories to prepare to be able to test for COVID-19, and has assigned ~ 100 hospitals for COVID-19 referrals. The ratio of hospital beds in Indonesia is 1.17 per 1,000 population and the number of doctors in 2019 was 81,011, mainly concentrated in Java (DKI Jakarta with 11,365 doctors, East Java 10,802, Central Java 9,747, and West Java 8,771). In terms of medical equipments, Indonesia has a total of 8,158 ventilators and 105 isolation rooms with ventilators nationwide.

OCHA as coordinator of humanitarian aid, is currently collecting information from their partners about activities in response to COVID-19 in Indonesia through their 3W (Who does what where) form. The form was developed based on the WHO COVID-19 Strategic Preparedness and Response Plan pillars.

Stakeholder Mapping

Entities / Organizations

• Ministry of Health
• National Disaster Management Authority (BNPB)
• Ministry of Communication and Informatics
• National Police
• Ministry of Transportation
• The Financial Services Authority (OJK)
• Ministry of Trade
• Ministry of Finance
• Ministry of State-Owned Enterprises
• Ministry of Foreign Affairs
• Coordinating Ministry of Human Development and Cultural Affairs (PMK)
• National Resilience Council
• National Team for the Acceleration of Poverty Reduction (TNP2K)
• Regional Governments

Additional actors

UN AGENCIES
• World Health Organization
• United Nations Development Program
• United Nations Children Education Fund
• World Food Program
• Office for coordination of Humanitarian Affairs (UN-OCHA)
• Population Fund (UNFPA)
• International Organisation for Migration (IOM)

ACADEMICS
• University of Indonesia
• Institut Teknologi Bandung
• Universitas Gadjah Madah
• Eijkman Oxford Clinical Research Unit (EOCRU)
• Lembaga Ilmu Pengetahuan Indonesia (LIPI)

CIVIL SOCIETY
• Kawal Covid 19
• Kawal Rumah Sakit
• Indonesia Medical Association

LOCAL NGOs
• Indonesian Society for Disaster Management (MPBI) • SMERU

PRIVATE SECTOR
• HaloDoc, Grab, Bukalapak, GOJEK , Tokopedia, Ruangguru

HUMANITARIAN CLUSTERS

Mitigating factors - What is being done?

February 2: Indonesia stops all flights going in and coming out of hotspot areas in Mainland China, and temporarily banned all travelers coming from China to enter and transit in Indonesia.
March 5: Travel restrictions are further extended to travelers arriving in from hotspot areas in Italy, South Korea and Iran.
February 29: BNPB issues a letter to extend a national emergency situation as a result of the COVID-19 pandemic. This emergency goes until May 29 and stipulates that the national budget is on standby for COVID-19 response.
March 19: The President announces seven critical points (mass rapid tests, incentive for medical personnel, involves religious leaders, stops medical equipment exports, stops holidays, provides incentive for small and medium enterprises, increases food stocks) in response to COVID-19 pandemic. The Ministry of Health orders 500,000 rapid testing kits from China, which have now been distributed throughout the country (34 provinces in Indonesia). In fact, people are now allowed to take these rapid tests by themselves in the hospitals (CNBC Indonesia, 2020)
March 20: the Governor of Jakarta declares a state of emergency for two weeks in the capital city, which is also the hotspot for the pandemic. He advises the suspension of all activities involving large gatherings. The city of Tegal (in Central Java), and the province of Papua follow suit, and enforce similar lockdown measures in their territories.
March 23: A COVID-19 makeshift hospital in Jakarta is inaugurated by the president. The government also plans to construct COVID-19 hospitals on existing refugee islands (Galang Island, Batam, Riau Islands). In addition, the President’s office issues a decree calling the COVID19 pandemic as a national health emergency, and enacts a law that lifts the state budget deficit cap of 3% to 5%, and allows an allocation of ~ 25 billion USD from the State budget to combat the epidemic. This includes allocations of IDR 75 trillion (~ USD 4.5 Billion) for the health sector, IDR 110 trillion (~USD 6.5B) for social safety net, IDR 70.1 trillion (~USD 3.5 B) for tax incentives and credit stimulus, and IDR 150 trillion (~ USD 9.5B) to fund national economic recovery programs. The decree also includes expansions to the existing social safety net, such as provision of free electricity (for ~ 24 million households) and discounts (~ 50 percent discount for 7 million households) for the poorest, for the next three months starting 1 April 2020.
April 2: The Ministry of Law and Human Rights announces a ban on entry and transit of foreigners into Indonesia, until the end of the pandemic; The president has proposed a replacement Idul Fitri holiday with another national holiday in the later part of the year.
April 3: MoH announces that it will join the International Solidarity trial examining the potential effectiveness of different drug regimens to treat COVID-19.
April 4: MoH issues guidelines, which state that large scale social restrictions (Pembatasan Sosial Berskala Besar or PSBB) will be put in place in order to restrict spread of COVID-19. The guidelines establishes criteria on whether a region can or should apply PSBB.

Additional economic measures taken include:

Ministry of Manpower issued a letter on Worker/Labor Protection and Business Continuity in the Context of Prevention and Control of COVID-19, to protect the wages of laborers due to the pandemic.
The Finance Ministry issued a regulation that manufacturers, importers and their employees will be exempt from tax starting 1 April 2020, for the next 6 months. The national financial regulatory body Otoritas Jasa Keuangan (OJK) has also loosened credit payment obligations to the banking sector and financial institutions.

Risks, vulnerabilities, obstacles

A global study published in February 2020, using air travel data estimated at least five COVID-19 cases in Indonesia, even before the first official announcement of COVID-19 outbreak in March 2020. Post the official announcement, there are concerns that under-reporting of COVID-19 cases continues to be a challenge, which has therefore complicated various epidemiological modelling efforts.
Another study published by the London School of Hygiene & Tropical Medicine estimates that only 2% of total COVID-19 cases have been reported in Indonesia, showing further evidence of under-reporting.
Despite issues with under-reporting, our search identified three COVID-19 modelling studies, all of which used different methods, parameters etc. to build model estimations.
Researchers at Institut Teknologi Bandung (ITB), used a relatively simple Richards curve based estimation model, to estimate that the number of COVID-19 daily cases would peak in the middle of March 2020 (highest estimated at ~ 600 positive cases/day), and are estimated to end by mid-April 2020.
A team from the Eijkman-Oxford Clinical Research Unit (EOCRU), used a geometric sequence model, to study the time it will take to double the number of cases in Indonesia. The estimations from this study reveal that by the end of April, Indonesia will have somewhere around 11,000 – 71,000 COVID-19 positive cases, with a doubling time of 3 days. The study further suggests that in the absence of a shutdown, 50% of the population is at risk of being infected in 50 days after the identification of the first case.
A joint study by the Ministry of Planning and Investment and University of Indonesia showed that with no intervention, the country could experience between 47,984-240,244 deaths, and 2.5 million positive cases by April, without taking into account any medical and treatment interventions. With stringent social distancing measures, the country could still witness ~ 12000 deaths and 50000 positive cases due to COVID-19. The report also showed that the doubling time in Indonesia is four days, and each case could infect two other cases. Based on this report, BAPPENAS recommended mandatory social distancing to the government.
Professor Iqbal Ridzi Fahdri Elyazar, who led the modelling study from EOCRU, opined that if the government is able to provide information about places visited by COVID-19 patients in a transparent manner, there will be higher chances to curb the spread of COVID-19 in such areas. However, the Indonesian government decided not to disclose basic information related to COVID-19 cases, so as to prevent panic among the public.
Staggered information release from the government to the public, poses a risk for spread of COVID-19 related misinformation. To counter this, the government has set up a special section called “Hoaks Buster” on their website dedicated only for COVID-19 pandemic related information. Despite these hoax busting efforts, public speculation is still active. For instance, March 2020 data released by Jakarta funeral service showed a significant increase in the number of burials in the city, raising concerns that these could be related to COVID-19 (Reuters, 2020)
To date, Indonesia has had the highest death rate of 9.1%, among all other Southeast Asian countries. Problems such as limited capacity of health systems, higher proportion of comorbidity induced deaths, and limited large scale testing have been attributed to these high death rates. In relation to comorbidity induced COVID-19 deaths, Indonesia stands at a higher risk as the 2018 basic health survey shows that 11% of Indonesian adults have high blood sugar levels, and 63 % of adults smoke . This risk is despite the fact that ~ 40% of the population in Indonesia is in the 25-54 years age bracket.
With regards to short term risks, as the number of COVID-19 related cases increase, public (and private) health systems resources are being stretched, and its impacts are being felt on both hospitals and the patients. Lack of protective equipment has resulted in an increase in the number of deaths among hospital staff and other frontline workers. Limited hospital resources (such as intensive care units), are preventing COVID-19 patients from receiving timely medical care. There are several active civil society groups across the country, which together with the government are developing solutions to manage patient surge on one end, and limited hospital resources on the other. These various initiatives are being implemented in parallel, without any cross coordination.
The government also recognises the impacts of COVID-19 on the economic condition of the population, in response to which the government has reorganized their budget expenses. For example, a food price update report from the World Food Program (WFP), showed that the COVID-19 pandemic has caused an increase in prices of Garlic and Sugar across the country, compared to the same last year. However, the challenge now is to identify populations that are most impacted, such that assistance can be delivered efficiently and directly to those in need.

Potential actions and demands

Conflicting instructions have been provided between local and central government on locking down regions, and a number of regions have acted independently (e.g. Papua) in suspending commercial passenger flights to the region. On the other hand, the central government is seeking to support the direly affected tourism industry including air transport, by supporting discounts for flights as well as accommodation to tourist destinations from all regions in Indonesia.
Despite public statements that supply of protective gear across the archipelago is sufficient, the government urgently requires support in purchase of required medical equipment, ranging from masks through to ventilators.
SMERU, a reputable Indonesian think tank has also recommended actions to be taken by government, including:
- - Support and incentives provided to Small and Medium Enterprises (SME). This requires integration of government datasets between the SME registration data and the Social Welfare dataset in order to be able to better target assistance. Incentives could include coverage of fees required by online platforms for products sold, and improving terms of repayment of loans. Also tax incentives and ensuring supply of raw materials.
  - Cash transfers for the poor will also be undertaken by the government. SMERU recommends improving data collection processes to provide easier access and also to ensure social distancing is maintained. Selection of recipients can be undertaken through the combination of data from the Ministry for Social Welfare, direct registration for informal workers and from data of online platforms such as Gojek and Grab Indonesia of their registered vendors.Collaboration will also be required with Indonesian telecommunication providers to send messages to encourage registration.

Key resources

Contributor(s): Pulse Lab Jakarta.

INDONESIA