Welcome back to New Perspectives (Perspektif Baru),
I’m Jaleswari Pramodhawardani and I’m here with Zely
Ariane, an activist from the Perempuan Mahardhika
National Network. Today we will be speaking about an
issue that is of concern to us all, the urban poor.
We have all been shocked by the huge jump in cooking
oil prices as well as the scarcity of milk on the
market. It began in 2005 with the fuel prices
increases and so forth, then the National Statistics
Agency released figures that we thought were quite
significant, that is on the percentage of people in
Indonesia living in poverty, which totals around 40
percent.
Rather than discussing the number of poor, we will be
discussing something more concrete and I think that
Zely is the most competent person to talk about the
issue of poverty. At least in terms of the Poor
Peoples Struggle Coordinating Posts (POPRAM) that she
has been working with.
The following is an interview between Jaleswari
Pramodhawardani and Zely Ariane.
I would be interested to hear some anecdotes or some
brief information about you. Since 2003 you have been
involved with issues concerning the poor, women and
activists in various organisations such as the
Perempuan Mahardhika National Network (JNPM). Perhaps
you could tell us a little about this.
I’m from the Perempuan Mahardhika National Network.
JNPM is a coalition for women who are already involved
in a mass organisation, but it also represents women
who are not part of an organisation, but essentially
it is mostly about empowering the consciousness of
women in order that they can become more independent,
political and understand what is taking place around
them, and what impact this has upon them.
Who can join?
Anyone can join, civil servants, teachers, doctors,
even journalists, we also network with the Alliance of
Independent Journalists, individuals and the like.
What is the main focus of its activities?
Currently we are focusing on the empowerment of women
from the urban poor. Because as it happens, the ones
who are most active in the women’s struggle at the
moment are in fact housewives from urban poor
communities. It turns out that it is wrong for us to
view women as inconsequential, particularly women who
are poor, that they had no power. On the ground, under
conditions that are becoming more difficult, it is
precisely women of limited means in the group that are
playing an increasingly useful role.
What survival strategy is being put forward for poor
households?
Yes. Particularly so that they understand their
rights, then to take action to address what can be
done to improve their future.
What is the focus of the programs to empower these
urban poor households?
Concretely what we have been doing is handling
healthcare advocacy, before we were dealing with
advocacy for Direct Cash Assistance (BLT) and Raskin
(cheap rice program, rice for the poor). More recently
it has been Gakin (welfare cards for poor households)
and Askeskin (health insurance for the poor), as means
to obtain free health services at hospitals working
jointly with the government.
What is the difference between Askes (state-owned
health insurance company), Gakin and Askeskin?
With Askes you have to pay a premium, which is
deducted from each month’s wage, while Gakin or
Askeskin is different. Gakin and Askeskin are provided
by the government to poor communities with very low
incomes so that they can obtain access to free health
services. In advanced countries there is actually no
differentiation between free health services, services
are valid for all social layers, however in Indonesia
this is still the case.
Exactly what issue are you taking up, because the
general view, right, is that if it’s free it means
different services?
In practice it is indeed different. With Gakin or
Askeskin the medicines provided are generic drugs.
Although research has demonstrated that generic drugs
are not poor quality drugs, this already represents a
differentiation of those people being treated with
ordinary drugs or through Askes. And the services are
different, in the hospitals are special Gakin and
Askeskin service counter. And even then it’s not easy
to obtain services, even if you already have a card it
doesn’t automatically mean that everything becomes
free, hospitals usually come up with particular
reasons to make things difficult, which we often find
ourselves fighting against, because everything should
be free for Gakin and Askeskin card holders, so poor
communities are not afforded their rights. That’s also
discrimination.
Do they actually understand these rights?
The most recent experience, about a week ago, was an
appeal or instruction from the Jakarta healthcare
office about a program to produce 6,000 cards for poor
families.
Why only 6,000, there are much more than 6,000 poor
people [in Jakarta]?
There was no explanation, but okay we went ahead with
this figure of 6,000. We explained it to residents, go
ahead and apply for a card, go to the RT (neighborhood
association), the RW (community unit), the Kelurahan
(political district administered by a village chief),
the Puskesmas (community healthcare centre) for
verification and so on. But even at the level of the
RT there were obstacles, they said, we didn’t know
there was an instruction for 6,000 cards, or that we
had to pay and so on. There were huge obstacles, from
just this one example, it turned out that a program
that should have been a good one, become one that was
not implemented properly because there was inadequate
socialisation, the funds were too small and there were
deductions here then deductions there, at various
levels of the bureaucracy, so for residents it was
less than effective.
How do you go about obtaining a card?
First you go to the RT and RW to get a document
certifying that a family is entitled to government
assistance (SKTM). The RT should already know what has
to be done. Later the RT verifies it. Then it’s taken
care of again at the RW, then the Kelurahan. The
Kelurahan provides a reference letter certifying that
the applicant is poor. Then they are given a letter
for the Puskesmas, so there are two stages in the
verification. A verification through government
administrative channels, in this case the RT, RW and
Kelurahan, then verification through the healthcare
office, in this case the Puskesmas.
What is verified?
They look at the living conditions of the poor, a kind
of survey. This is a big problem, because the
indicators used to measure poverty make absolutely no
sense. Actually they have several views of what is
categorised as poor. If it is from the World Bank it’s
clear, if their daily income is under US$2 or 19,000
rupiah a day they are poor. Now, in Indonesia its not
like that, there are all kinds of categories. Aside
from an income of less then 200,000 rupiah a month,
there are 14 other criteria such as do you own a small
house, is the floor tiled; if you have to use public
bathing, washing and toilet facilities but own an
electric fan, then you are not included as poor. So
it’s a big problem.
I think that this is a problem inherited from earlier
times right, if we talk about the IDT (a presidential
instruction on a program for least developed villages)
the criteria is also rather “foolish”. If this
criteria is agreed to we should obtain a card, right?
It should be like that, moreover we shouldn’t need to
because it is the responsibility of the RT.
What do you think is the main problem on the ground?
First of all, there has been no initiative from the
government administration to collect information on
the poor, or bring poor residents into the program.
Where there has been, there have been lots of gaps,
where those who have been registered are people they
know. Not residents that are actually poor. The second
problem is that there have been obstacles in terms of
payment. They have to pay to obtain the cards.
How much do they have to pay?
It’s like an illegal fee. Not official, but there are
all kinds of fees. In order to qualify as SKTM, they
ask how much do you want to pay? If you pay, I’ll make
out an document qualifying you for SKTM. What can also
happen for example is that those who are not poor are
able to pay to qualify as SKTM. That is the biggest
problem. The other problem, is that even after you get
a Gakin it doesn’t immediately follow that the process
will be easy. After obtaining a Gakin they say please
go and get treatment at a hospital that is cooperating
with the government. There is a list of hospitals that
are given a subsidy to accept poor patients.
Are they informed about this from the start?
As far as I know, based on the people we have been
dealing with in Jakarta and Makassar (South Sulawesi),
they didn’t know there was any such program, they
didn’t know which hospitals had been designated. This
should be the responsibility of the RT, RW and
Kelurahan. But it doesn’t work, so if there are other
social organisations that want to conduct a
socialisation program please go ahead. This would be
really good, as we have been doing.
In this context, what have your colleagues at the
POPRAM been doing?
Although we were established in mid 2004, we have only
been focussing on the issue of Gakin and Askeskin
since mid 2006. The first thing we do after obtaining
documents from the social healthcare offices is
distribute them to the residents we are assisting, the
residents we are working with. Then we say, go ahead
and process the Gakin and so on. If there are
obstacles, report it to us and we will find a
solution. Everyone experienced problems. In the end we
carried out advocacy at the RT level. There was no
other choice, in the end demonstrations become the
only choice at the Kelurahan level.
In 2006 we went visit the Coordinating Minister for
People’s Welfare and also the president. Putting
pressure on the closest, that is on the Kelurahan. We
were forced to to undertake this method. Our
experience was that only after doing this was the SKTM
or Gakin issued. Now, after it had been issued, we
asked residents to get their own treatment, be treated
at a cooperating hospital. There were more obstacles,
it even turned out that hospitals declared that they
could not [cover] the full 100 percent.
What things do poor households have to confront in to
obtain their rights to healthcare services at
hospitals?
After you’ve got a Gakin card, or a SKTM card, you are
confronted by the hospitals stating that they cannot
get the full 100 free services.
In this case which one is correct. Is this announced
from the start or is the regulation actually like this
but not carried out?
The regulations, for Gakin, Askeskin and SKTM card
holders is they have the right to 100 percent free
healthcare services. The cost of medicines, treatment,
tests, 100 percent free. It is regulated like this in
the ministerial decree, the hospitals should know that
there are funds to cover these things. Afterwards the
hospitals only have to submit a claim with [the
state-own insurance company] PT. Akses. The second
most common statement that is encountered is saying
“we have no wards”. Poor households that have Gakin or
SKTM cards are allocated third class wards, if they
have to be treated. Very often the information we got
was that there were no third class wards. These are
the two main obstacles that are invariably confronted
by participants in the program. There are only two
ways [to confront this], first explaining that it is
untrue that they have to pay, we have to negotiate at
this point. Everything is free. We once even advocated
for free life-long kidney dialysis. Successful
examples of our advocacy, a premium of as much as 125
million rupiah was successful, free. Two hundred and
fifty million, we successfully advocated a heart
transplant. This is included as a right under Gakin
and so on.
There is a view that poor people only get sick with
coughs, get colds, its not true, they also suffer from
the same illnesses as other people who are better off,
and this must be guaranteed, because this is public
health right?
Generally. So far there have been around 1,200 or so
cases that have been successfully advocated. From
minor to major cases such as the 250 million rupiah
premium that was able to be obtained free. This is of
course impossible when resident go themselves, because
when the poor are given the ultimatum "it cannot be
free, click!", usually they are frightened and don’t
say anything. It is because of this that they must be
helped.
Without our being aware that there is discrimination
against friends from poor households, where should
they lodge a complaint aside from with POPRAM
comrades? Are there coordination posts throughout
Jakarta? In Indonesia?
Currently there are POPRAM in five of Jakarta’s five
municipalities, the Thousand Island covered yet.
Outside of Jakarta there are POPRAM in Yogyakarta,
East Java, Central Java, South Sulawesi, Central
Sulawesi and North Sumatra (Lampung). The telephone
hotline numbers are 021-92859600 or 0852 13575382.
Your colleagues at the POPRAM integrate directly with
friends in the poor households, have the comrades from
POPRAM ever held discussions directly with the
healthcare actors, doctors, the health office, talking
about the problems at the lower levels?
We obtained this kind of information in mid 2006,
because we organised monthly discussions in each urban
residential area in turn. The theme of health problems
was one of them. We invited the health minister, there
was a staff member who came, there was also a
representative from the House of Representatives
Commission IX, a representative from PT. Askes also
came. We were able to obtain a memorandum of
understanding (MoU) through this dialogue, an MoU that
POPRAM is legal and can conduct healthcare advocacy.
We were able to obtain this access because of
organising this dialogue. So the healthcare
stakeholders would come to know that these problems
that are occurring are real, so they were unable to
consider them of no importance. In terms of other
forms of dialogue, were even able to meet with the
director of PT. Askes, the Hospital Association, where
they related the parties’ individual problems. The
hospitals for example, stated that there was a problem
with claims that were issued late by Askes, so they
delayed providing services to the poor. This has
become an ongoing problem nagging healthcare problems.