Health Situation
in
Indonesia, Singapore, Brunai Darussalam,
Philippines, and Japan
Dr. Tjandra Yoga Aditama
Bagian Pulmonologi Fakultas Kedokteran Universitas Indonesia/UPF Paru
Rumah Sakit Persahabatan, Jakarta
PENDAHULUAN
Asia is the most populous continent in the world. With a
population of more than 2.000 million, developing countries in
Asia surely faced a lot of problem in economic growth,
education as well as health services. On the other hand Japan as
one of Asian country, have already enjoyed a very high level of
health status.
This article will deseribe the health situation in several
Asian countries, including Japan.
INDONESIA
The total of Indonesian population in 1985 was
164,046,988.
(1)
. The total population estimate in mid 1986 was
163.366.000 with annual rate ofincrease (1976-1986) of 2.2%
and density 86 person/sq.km.
(2)
In 1988 the estimated total popu-
lation is 179,275,400 and in 1990 the estimated total population
will be 187,616,900.
(3)
In 1985, 39.3% population were below
15 year of age, and 13.1% were below 5 years of age.
The crude death rate in 1980 was 12.5 and the crude' live
birth rate in 1980 was 35.4 per 1,000 population.
(2)
The Ijouse-
hold Health Survey found that in 1986 the crude death rate was
7,000 per 1,000 population and the infant mortality rate was
71.8 per 1,000 live births.
(4)
The ten leading causes of death in 1986 were : lower
respiratory tract infection, diarrhea, cardiovascular diseases,
tuberculosis, measles, tetanus, malaria, diseases of the nervous
system, certain conditions in the perinatal period and bronchitis-
asthma-emphysema. On the other hand, the ten leading morbi-
dity in 1986 were acute respiratory infection, skin diseases,
diseases of the oral and gastrointestinal system, other infection,
bronchitis-asthma-other infection of the respiratory system,
malaria, diseases of the nervous system, cardiovascular
diseases, diarrhea and tuberculosis.
(4)
Life expectancy at birth in 1971 was 45 years for male and
48 years for female. The estimated life expectancy at birth in
1981 - 1985 was 51.9 years for female and 48.9 years for male.
The estimated life expectancy at birth by the year of 2000 will
be 60 years old.
(5)
The annual government health budget in 1980 was about
1.5 - 2.5% of the total national budget. In 1980, around 3% of
the GNP was used for health activities.
0)
Hospital activities
(government and private) takes around 30% of the total health
budget. The developmental health budget for Ministry of
Health in 1987/1988 is Rp. 34,584,901,000.
(6)
The number of hospital in 1987 was 1,436 with 112,328
beds. There are 5472 health centres and
,
12,562 health sub-
centres throughout Indonesia. The ratio .pf health centres and
population served is 1 : 30,000. Number of physicians in 1986
was 18,610 so the ratio was one physician for 8,800 population.
(1)
SINGAPORE
The total population for Singapore in 1987 was 2,612,800
with a population growth rate (1985 - 1986) of 1.1%. By age
grouping, 23.4% of the population were below 15 years old,
68.4% were 15 to 59 years old and 8,2% were 60 years and
over. The population comprises 76.1% Chinese, 15.1% Malay,
6.5% Indian and 2.3% other ethnic groups.
(7)
The crude death rate in 1987 was 5.0 and the crude birth
rate in 1987 was 16.7 per 1,000 population. The infant morta-
lity rate in 1987 was 7.4 per 1,000 live births and the maternal
mortality rate in 1987 was 0.1 per 1,000 live births & still
births. The life expectancy at birth in 1987 was 73.9 years old,
for male it was 71,4 years and for female it was 76.3 years.
(7)
The ten leading causes of death in 1987 were cancer,
ischaemic & other heart disease, cerebrovascular diseases, pneu-
monia, accidents-poisoning & violence, diabetes mellitus, hyper-
tensive disease, nephritis-nephrotic syndrome & nephrosis, tu-
berculosis and bronchitis-empysema & asthma.
(7)
The main
Cermin Dunia Kedokteran No. 76, 1992
38
causes of hospitalisation for male in 1986 were accidents and
disease of the circulatory and digestive system. For female,
other than pregnancy and childbirth, the most common cause of
hospitalisation in 1986 was diseases of genitourinary system.
(8)
The Ministry of Health's total recurrent expenditure in
fiscal year 1986 was S$ 374 million. Hospitals continued to be
the largest user of the health budget, consuming S$ 258 million
or 69% of the total current expenditure. Primary Health Care &
Health Education Division consumed S$ 36 million, only about
10% of the total recurrent expenditure in 1986. The Ministry of
Health collected S$ 129.7 million in revenue in fiscal year
1986. The bulk of the revenue S$ 108.7 million (83.8%) came
from the hospitals. (8) In 1987 the current health expenditure
was S$ 396 million, S$ 52.9 million of this were for
development health expenditure. The current health
expenditure in fiscal year 1987 was 0.9% of the GNP, and the
total government health expenditure per person was S$ 172.
(7)
Number of hospitals in 1987 was 22 with 10,185 beds, one
hospital bed for 257 persons. There were 24 Community Health
Clinics and 23 Maternal and Children Health Clinics. Total
number of doctors in 1987 were 2,939, so it was old doctor fix
889 persons.
(8)
BRUNEI DARUSSALAM
The total population of Brunei Darussalam in 1986 was
226,000.(
9)
By age grouping, 13.5% of the population in 1985
were below 5 year old and 4.59% were 60 years old and over.
The natural increase in 1985 was 5,887, which is 2.62%.
(10)
Malays form a majority of the population but it is
estimated to be some 70,000 non Malays, including Chinese
and others; there are small communities of Britons, Dutch,
Americans and Australians who work in the oil and gas
industry and commerce.
(11)
In 1985, 63.95% of the population
were Malays, 20.19% were Chinese, 8.47% were indigenous
and 7.39% other race.
(10)
Brunei.Darussalam continues to enjoy health norms com-
parable to those of developed countries, with an infant
mortality rate in 1986 of 9.67/1,000 live births and a life
expectancy for men of 70.E years and 72 years for women.
(11)
The crude death rate in 1985 was 3.54 per 1000 population and
the maternal death rate in 1984 was 0.47 per 1.000 births
(10)
Morbidity due to diseases associated with affluence and
changing life styles, such as diabetes and hypertension is rising
and death due to road traffic accidents, cardiovascular diseases
and malignancy rank high among the causes of adult mortality.
Upper respiratory infection and gastro enteritis are the most
common cause of morbidity among children.
)ll)
During 1985
not a single case of diphteria, tetanus, pol,iomyelitis or viral
encephalitis is reported. Malaria has been eradicated and 17
December 1988 is the day of Commemoration for the achieved
eradication of malaria in Brunei Darussalam.
In 1985, 3.5% of the National Budget is allocated to health.
The health budget forms 1.24% of the Nation's Gross Domestic
Products. Per capita health expenditure in 1985 wis about B$
450.00, which is one of the highest in the world.
(10)
Allocation
of current expenditure for Ministry of Health Services in 1986
was B$ 114 million.
There are 550 bed in central referral hospital in Bandar Seri
Begawan (RIPAS hospital), 185 bed hospital at Kuala Belait
city, another hospital at Tutong city and another 50 bed hospital
at Temburong district. There are 56 Primary Health Care clinics,
three of them were at Kampong Ayer or the water village.
Remote villages in the interior of the country are served by Flying
Doctor Service. In 1986 this service made 151 flights, goes to
14 areas which are inaccessible by land, and treated 4,243
patients. In 1986 there are ten Bruneian doctors in addition to
contract staff doctors and speciallist from overseas.
(11)
PHILIPPINES
The estimated total population in the Philippines in 1987
was 57,356,042.
0
) The annual rate of increase 1976 - 1986 was
2.5%. The population includes 111 cultural and linguistic
groups. Filipinos are basically of Malayo-Polynesian origin,
though in the traditional trading areas there is an evidence of
Chinese, Indian, Arab, Spanish and North American influence
in varying degrees.
The crude death rate in 1985 was 6.1 per 1000 population
with the infant mortality rate of 38 per 1000 live births and
maternal death rate of 1 per 1000 live birth.
(14)
Life expectancy
is 63 years for males and 66.5 years for females.
(12)
The crude
birth rate in 1985 was 26.3 per 1000 population and the fetal
death rate was 10.2 per 1000 live births.
(14)
The ten leading causes of death in 1985 was pneumonia,
diseases of the heart, tuberculosis, diseases of vascular system,
malignant neoplasm, diarrhea, accidents, measles, avitaminosis
& nutritional deficiency and nephritis. On the other hand, the
ten leading causes morbidity in 1985 was bronchitis-
emphysemaasthma, diarrhea, influenza, pneumonia,
tuberculosis, malaria, accidents, diseases of the heart, measles
and malignant neoplasm.
(14)
The number of hospital in 1986 (government & private)
was 1846 with 89.081 beds, giving a bed : population ratio of 1
: 628. Total number of RHU (rural health unit) was 1962 and
there were 8844 Barangray health station. There were 9,599
government physicians in 1986 with 11,585 nurses, 10,396
midwifes and 375,889 Barangray health worker.
(15)
The total
health budget in 1987 was US $ 213,976,350.
(1)
JAPAN
Japan is an island country stretching along the northeastern
coast of the Asian continent. It consists of four main island-
Hokkaido, Honshu, Shokoku and Kyushu-from north to south-
and more than 3,900 smaller islands. With a total land area of
377,765 square kilometers, Japan accounts for less than 0.3%
of total land area of the world
(16)
Of the total entire land area, 73% is mountainous and the re-
maining 27% is relatively flat.Japan in characterized by complex
topographical features, with a prominent "spine" of mountains
in Honshu, including Mt. Fuji with an elevation of 3,776
maters. Since Japan islands stretch from north to south, the
climate zones range from the subarctic zone to the subtropical
zone. District changes of climate follow the rotation of the four
seasons and this contributes to the wide variety of vegetation.
Cermin Dunia Kedokteran No. 76, 1992 39
The population of Japan at the end of 1985 was 121
million, ranking seventh in the world, and about 2.5% of the
world population. The population density in 1985 was 325
persons per square kilometer; Japan is the fourth most densely
populated country among the countries with more than 5
million people (16) The estimated population of Japan for the
year of 2000 will be 131,192,000 and by the year of 2085 it
will be 124,066,000 people.
(17)
The gross national product of Japan constitutes nearly 10%
of the world GNP, and both its GNP and its national income
rank second among the free economic countries, next to the
United States. On a per capita basis, the gross domestic product
of Japan is expected to amount to US $ 10,445 in 1984
(16)
Japan has now become one of the countries in the world
where people live longest. The average life expectancy at birth
for men immediately after the Second World War in 1947 was
50.06 and for women it was 53.96. By 1986 these figures had
jumped to 75.23 and 80.93 respectively." The aging population
is thus steadily progressing, so that in 1986 the proportion of
the eldery (the ratio of people aged 65 and over to the whole
population) reached 10.6%. By the year of 2000 the proportion
will be 16.3% and this aging process will subsequently peak in
2021 at 23.6%, when one person in 4 will be at least 65 years
old.
(18)
The mortality rate in 1947 was 14.6, and this was reduced to
6.2 in 1986, while the infant mortality rate dropped drastically
from 76.7 to 5.2 between those same years (per 1000 population).
In the past, tuberculosis and other communicable diseases
constituted the main causes of death in Japan. However, after
the war, the occurence of such diseases declined and in 1951
cerebrovascular diseases occupied the top spot. After this, cancer
and heart disesaes have taken the top position, and over recent
years, with these three as the most important ones, the so-called
degenerative diseases have come to the account for the larger
part of all deaths. With regard to the trends in patients receiving
medical care, there has been a marked increase in
cardiovascular diseases like hypertension, cerebrovascular di-
seases and heart diseases. Moreover, there has been a consi-
derably increase in the case of mental disorder.
(17)
At the end of 1986 there were 191,346 doctors in Japan,
giving a ratio of 157.3 per 100,000 people. There were also
22,050 public health nurses (18.1 per 100,000 people) and
another 672,249 nurses and assistant nurses (558.3 per 100,000
people). There were 9,699 hospitals at the end of 1986 with
1,533,877 beds, and there were 76,369 clinics at that time X18)
These number of doctors and hospital beds have now reached
the levels prevailing in the western advanced countries
(17)
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Tjandra Yoga Aditama. Indonesia, In : Country Report for the Group
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2.
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Philippine Brief. Mabuhay 1987 : 69.
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The Philippine's Manual National Tuberculosis Control Program. Ministry
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Data from Chest Clinic, Raja Isteri Pengiran Anak Saliba (RIPAS)
Hospital, Bandar Seri Begawan, Brunei Darussalam, 1988.
12.
Health Intelligence Service - Department of Health Republic of the Philip-
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