Ditulis oleh Raden Mas Try Ananto Djoko Wicaksono
Universitas Gadjah Mada
A pandemic is an epidemic that occurs on a global scale. The severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) which causes Corona Virus Disease 19 (COVID-19) has become a serious global problem (Porta, 2008). The World Health Organization (WHO) through The International Health Regulations Emergency Committee finally declared the COVID-19 pandemic as a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 (Li X, 2020). COVID-19 is the latest example of a new emerging infectious disease accompanied by complex threats to human life. COVID-19 appears amid other health threats such as antimicrobial/antibiotic resistance and the increasing number of non-communicable diseases, which are very difficult challenges for humanity.
On 30 June 2020, the total number of coronavirus cases in Southeast Asian countries has reached 150,571 with most cases reported in Indonesia (Hospita, 2020). The regions’s tally is still far off the hundreds of thousands compared to the US and some European nations (Lee, 2020). The impact of COVID-19 has led global economy to shrink. The Asian Development Bank forecast for Indonesia is -1.0 % for 2020. Even though economy of Indonesia is under pressure, the Statistics Indonesia (Badan Pusat Statistik/BPS) in the first quarter (Q1)-2020 announced Indonesia’s GDP expanded by 2.97 percent year-on-year (y/y) (ADB, 2020).
The COVID-19 pandemic is impacting emerging markets through an unprecedented mix of domestic and external shocks whose combined effects are very hard to predict. Through this analysis, the author tries to explore the Indonesian goverment policy priorities in dealing with COVID-19. Not every issue can be the government’s top priority. Additionally, the priorities of government can change rapidly and dramatically with focusing events. Focusing events are significant episodes or experiences that catapult particular issues to prominence on the public agenda. By looking for focusing events, it can help us to better understand movements on public policy issues (Furlong, 2019).
The expert divides the policy agenda into two types, namely the public agenda and the official/government agenda. Starting from here, a number of scientists initiated a number of models for the public policy agenda. Initially Cobb & Ross (1976) put forward the idea of a public policy model based on the political regime or political system adopted by a country. They put forward three models or archetypes of the policy agenda.
First, the Outside Initiation Model is a policy agenda model that is widely adopted by liberal pluralist societies. The basis for this model is that groups outside the government have a key role in proposing a policy agenda because the issue comes from interest groups outside the government (Non-Governmental Groups). Second, the Inside Initiation Model, where groups that have special access or linkage to the Policy Maker submit policy proposals without first being disseminated to the public. Third, Model Mobilization, means the government or policy-making authority develops an issue. In this model, issues are discussed first by the government (placed on the formal agenda).
Michèle Flournoy (2020), the head of geopolitical risk at Beacon Global Strategies, believes Public Health System, critical decision-making, and border issues are the factors determine coronavirus containment. Therefore, examining the three factors will help in finding a realization of competing priorities and focusing events from Indonesian government.
Public Health System
The World Health Organization defines a health system, as a system that:
[…] Includes all activities, which the basic purpose is to promote, restore or maintain health… and includes patients, health service's workers… inside organizations and in the community, and the health politics environment in which all health related activities happen (Kotler, 2010).
The impact of national public health quality movement will be multifaceted. It will promote quality along all dimensions of the system with a special focus on population, increase desired health outcomes and conditions in which the population can be healthy, and foster health equity (U.S. Department of Health and Human Services., 2008). Poor nutrition has many other consequences, too many to quantify, including effects on the cognitive capacity of the population (Rubalcava, 2004).
According to data submitted by the Johns Hopkins Center for Health Security, it is not clear the daily increase in fluctuations in the incidence of COVID-19 cases in Indonesia. The Indonesian government only reports the number of data on the addition of infected people, the number of recovered patients, and the number of patients who died generally. This of course will make it difficult for Indonesia itself to develop a surveillance strategy to break the chain of transmission and also to handle the COVID-19 outbreak. Therefore, the discourse that encourages transparency of data and the widest possible disclosure of COVID-19 data in Indonesia is getting stronger in society (Johns Hopkins, 2020).
According to clinical studies, the symptoms of COVID-19 commonly felt by infected patients are fever (83-98%), cough (59-82%), shortness of breath (19-55%), and muscle aches (11-44%). These clinical symptoms are similar to those of SARS and MERS, so this also makes it difficult for health workers to make a precise and prompt diagnosis of COVID-19 patients. However, in some cases the patients were asymptomatic, meaning there were no typical complaints felt by them, but positive results were found from supporting examinations such as routine blood tests and chest X-rays (Huang, 2020).
This then underlies the grouping of patients according to the Ministry of Health's Document on Guidelines for the Prevention and Control of COVID-19 (27 March 2020), namely Patients Under Supervision (Pasien dalam Pengawasan/PDP), People Under Monitoring (Orang dalam Pemantauan/ODP), and People without Symptoms (Orang tanpa Gejala/OTG). The criteria for classification depend on the examinations carried out by health workers. Due to the wide spectrum of clinical symptoms of COVID-19, research on biomarkers for precise diagnosis and clinical criteria that can be used to predict prognosis is currently a top priority to allow distinguishing cases requiring further intervention in the early stages of disease.
Coping with this pandemic, countries that plan for and invest in preparedness will do far better than those that do not. According to figures provided by the Ministry of Health in January 2020, Indonesia currently has only about 321,544 hospital beds to serve a population of about 270 million people (Indonesia Investments, 2020). This explains about 1.2 hospital beds/1,000 population, significantly lower than neighboring economies such as Malaysia, Thailand, and Vietnam. Similarly, the ratio of physicians to population stands at only 0.38 physicians per 1,000 populations, less than half the number for Vietnam and Thailand and only about a quarter of that for Malaysia and Philippines (see Figure 1).
Figure 1. Ratio of hospital beds to population and Ratio of physicians to population
Source: (World Bank, 2020)
According to Deloitte (2020), there are three key aspects of Indonesia’s health care capacity constraints have been identified. First, shortage of manpower and facilities. Even with the designation of 132 hospitals as COVID-19 referral hospitals across Indonesia’s 34 provinces, Indonesia still has one of the lowest testing rates in the world (Cahya, 2020). Second, lack of personal protective equipment (PPE). The lack of PPE also puts health care workers at risk. As of 19 April 2020, 29 physicians have died since succumbed to COVID-19. Two primary causes of their deaths are the lack of appropriate PPE and dishonest disclosures by patients about their medical and travel histories (Katadata, 2020a). Third, operational-funding issues. The 14-day claim period, including a 7-day verification period required by BPJS Kesehatan, has been considered too lengthy by the Indonesian Health Law Society (Masyarakat Hukum Kesehatan Indonesia/MHKI) as it may result in hospitals facing business continuity issues if they run out of operational funding (Pranita, 2020). This implies that Indonesia is likely to have far higher number of COVID-19 cases than it has reported. It is estimated only about 21% of the overall population is covered by surveillance and testing, with about 15% of them eventually testing positive for COVID-19 (Katadata, 2020b).
Gary Klein describes the Recognition-Primed (or intuitive) decision-making model in his books titled “Sources of Power” and “Intuition at Work” (Klein, 1999). This model assumes experience is the primary source of wisdom in decision-making, and the results of many observations and studies of real-life cases of people actually make time-critical decisions in the real world, rather than in laboratory conditions. It generally applies to crisis situations where time is very limited, such as an emergency room or fire fighting, rather than situations where time is not limited and careful consideration is possible (Ogilvie, 1998).
President Joko Widodo signed Presidential Decree Number 7 of 2020 concerning the Task Force for the Acceleration of Handling of Corona Virus Disease 2019 after 11 days of announcing the first case. On March 20, 2020, the President issued Presidential Decree No.9 of 2020, which gave the governor the authority to direct and evaluate the handling of COVID 19 in their respective regions.
Before a positive case was found in Indonesia, the President issued four instructions as a step to anticipate the impact of COVID 19 on the economy, namely by increasing domestic conference activities, MICE (meetings, incentives, conventions, and exhibitions) increasing tourism promotion to tourists who canceled visiting China, South Korea, and Japan, as well as preparing 72 billion to pay influencers in promoting Indonesia as a tourist destination. This shows that the Indonesian Government has an economic developmentalist sense in dealing with the COVID-19 Virus (Almuttaqi, 2020) which means there is state intervention in economic and social institutions in order to achieve development (Theresa Wong, 2017).
From political economy perspective, by using a neo-classical approach, we can argue that in order to overcome weaknesses and imperfections, the government should have intervened in the economic affairs of Indonesian society. One of the policies that can be carried out by the government in terms of political economy is to overcome various weaknesses due to the COVID-19 by cutting the state budget (Anggaran Pendapatan dan Belanja Negara/APBN) and provincial budget (Anggaran Pendapatan dan Belanja Daerah/APBD) which are not expenditure priorities, reallocating the budget to each region to ensure the availability of staples by ensuring the purchasing power of the people is in a state of safe, and emphasizing and intensifying the socialization of the Social Distancing policy. This policy is considered the most effective in handling COVID-19 in Indonesia rather than imposing a lockdown system.
Meanwhile, the government of Indonesia has launched social aid disbursement“Direct-Cash-Assistance” (Bantuan Langsung Tunai) amidst the COVID-19 crisis. However, this program has been criticized due to its data inaccuracy in distributing the aid to the intended beneficiaries (Gorbiano, 2020a). Besides, the government also increases the budget for the “Family Hope” (Keluarga Harapan) program by 25%, basic food cards by 33%, and for pre-employment cards from 10 trillion rupiah to 20 trillion rupiah. The government waives electricity costs for around 24 million users of 450 VA electricity and provides a 50% subsidy to 7 million users of subsidized 900VA electricity for 3 months. Then, the government will provide incentives to low-income people of 175 thousand rupiah for a quota of subsidized houses and budget for IDR 25 trillion for logistics to finance basic food and basic needs of the community (Kemensetneg, 2020).
The government’s unpreparedness also exposes the bad governance due to the lack of reliable data for targeted recipients, as well as lack of coordination between regional and central governments (Gorbiano, 2020b). Besides, another criticism has pointed out the pre-employment (Prakerja) program launched by the Indonesian government in early May (Rahman, 2020). The critics against the pre-employment program emphasized that the scheme does not align with the priority during the crisis. These criticisms also underline that people who have lost their jobs due to the pandemic should be given direct cash assistance instead of online classes and skills training which could be easily found freely in other learning platforms.
Considering the Entire Country
According to Michèle Flournoy (2020), countries that have applied policies nationwide or have thought the implications that regional policies could have for the entire country, have done better than those that have not done so. According to Bayu Krisnamurthi, who headed the National Committee for Avian Flu Control and Pandemic Preparedness in Indonesia, the terms lockdown and community quarantine are synonymous in that both are used interchangeably to refer to a type of quarantine in which all citizens in a certain region are prohibited from going in and out of the territory without official permission from authorities (Fachriansyah, 2020).
The regional quarantine policy is contained in Law No. 6/2018 concerning Health Quarantine. Article 9 states that quarantine is carried out to protect the community from diseases and/or other causes of public health risks. In the quarantine policy, the Central Government and Local Governments will ensure that the community remains healthy and is responsible for meeting community needs. Lockdown and social distancing policies can be the right solution to deal with the COVID 19 virus (Mukharom & Aravik, 2020). This policy is considered to be able to minimize the spread of the COVID 19 virus (Yunus & Rezki, 2020). However, there are different perceptions and reasons in seeing the policies for handling COVID-19 in Indonesia, so some are obedient and many are not.
President Joko Widodo has argued that the economic and social cost of a complete lockdown is unfeasible. Even though the Ministry of Law and Human Rights No 11/2020 on temporary travel bans for foreigners who enter territory on 2 April 2020 (International Science Council, 2020). Still, these local lockdowns cannot offset the economic fallout from the pandemic. Many Indonesians have expressed frustration with the government for failing to deliver promised aid packages (Varagur, 2020).
Therefore, Indonesia adopts the partial lockdown which requires offices, schools, places of worship, and public spaces to close. Local administrations imposing the Large Scale Social Restriction (Pembatasan Sosial Berskala Besar/PSBB) can limit transportation capacity within a region but are not given authority to close inter-regional transportation services (Sutrisno, 2020). According to Achmad Sukarsono, a senior analyst at Control Risks, the implementation of stricter social distancing in Jakarta is not effective as many businesses are allowed to remain open. If the policy wants to be effective, it needs to have strong enforcement (Listiyorini & Suhartono, 2020). Until now, the Government has not taken a draconian lockdown policy as has been done by other countries. The government seems to be implementing policies in stages to avoid drastic economic impacts.
The government in general made mistakes on a priority scale in handling the COVID-19 pandemic, namely related to protecting economic stability in the near future and fears of civil unrest if economic conditions deteriorate. The low number of diagnostic test coverage for Indonesian citizens has made COVID-19 surveillance data, such as the percentage of the possibility of local transmission in Indonesian territory, is unclear.
The economic environment is the factor that affects the context of policy-making for Indonesia. The politics of the moment is only a piece of the policy environment, however, economy is a major factor for Indonesia. Money plays a large role in these situations. When the economy is not performing well, the leaders often focus on “fixing” the economy rather than prioritising the country or the citizens.
The lockdown period helps pausing the burden on the healthcare system and provides the government an opportunity to use the time to build the extra capacity needed for reopening. To ensure that the lockdown is not being lifted prematurely, it is crucial to significantly ramp up the capacity of the healthcare system. If this is done, when the number of cases surge once the lockdown is lifted -which most experts believe will likely happen- the healthcare system will be able to ensure that people do not die due to their inability to access medical services.
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