Development of Indonesia’s political culture of health: the Sukarno era, 1949–66
By Vivek Neelakantan
My doctoral work examines the way Indonesia’s political culture of health was shaped in the Sukarno era, 1949–66. While substantial research has been undertaken on the development of preventative healthcare in the Dutch East Indies – and more recently on population health in post-colonial Indonesia and health policy during the Suharto era, 1966–98 – the health policy of Indonesia during the Sukarno era has largely escaped the attention of historians of medicine.
This era, in many ways, provides valuable insights into health policy in the early years of independence. My thesis investigates the influence of social medicine and international health emanating from the WHO in the formation of post-colonial Indonesia’s political culture of health.
The post-colonial state’s vision of health was embedded in the idea of ‘nation building’: disease eradication to build a strong and healthy nation. Indonesia’s approach to social medicine was shaped by a profound concern for eugenics, i.e. production of a healthy population. The First Five Year Plan, 1956–61, was riddled with contradictions. While it acknowledged that a high birth rate neutralised the fruits of economic growth, it expressed reservations about the use of birth control for family planning. Dr Johannes Leimena, Minister of Health, was the architect of the nation’s health policy. He saw that poverty and disease mutually reinforced each other in the form a vicious circle. His Bandung Plan was a pioneering step of integrating preventative and curative health through health centres at the regency level. In the 1950s, pilot projects with an emphasis on rural health, environmental health, water supply and sanitation were launched in the province of West Java, embracing the regency of Bandung. However, a shortage of funds prevented nationwide expansion of these projects.
The ‘language of revolution’ permeated all aspects of Indonesian public life, including health. Leimena observed that three indicators of health were life expectancy, mortality of the population and infant mortality rate: better health increased the life expectancy of the population, lowered infant mortality and raised the chances of population explosion. Therefore Indonesia was seeking to increase population through intensification of agriculture and large-scale migration from densely to sparsely populated areas of the Indonesian archipelago. Social paediatrics and obstetrics, in Leimena’s vision, were important pillars for the attainment of healthy motherhood and joined the Indonesian revolution with the hope that children could reap the benefits of a better society. In the ‘language of revolution’, child health that embraced the physical, mental, moral and psychological development of the child was perceived as reconstructing the whole nation. Indonesian physicians such as Dr Seno Sastroamidjojo perceived social medicine as an important component of maternal and child health.
The Sukarno era could be interpreted as the ‘period of optimism’ in Indonesian public health, with planners focusing on building national capacity through health development and building Indonesia’s self-sufficiency in the implementation of public health programmes. The Sukarno era could also be seen as the ‘era of unfulfilled aspirations’, as the nation was unsuccessful in its ambitions of eradicating malaria and establishing a health centre/general hospital in every district. My research is currently based on an extensive analysis of primary sources in Bahasa Indonesia such as Madjalah Kedokteran, Berita Kementerian Kesehatan and Madjalah Kesehatan Angkatan Darat. I will be consulting the archives of the WHO’s Regional office for South East Asia in New Delhi and its Country Office in Jakarta for a critical assessment of the role played by the WHO in shaping the political culture of health.
Vivek Neelakantan is a doctoral candidate at the Unit for the History and Philosophy of Science, University of Sydney, Australia.