Indonesia's poor can't even afford to wash hands
Source: The Jakarta Post
Date: 11 April 2020
Amid the current pandemic and in the absence of effective vaccines and antiviral drugs, preventive measures are essential to reduce the spread of COVID-19. Numerous scientists, health professionals, officials, teachers and parents are tirelessly reminding the public about the importance of preventive measures such as 20-second hand-washing with soap and clean running water as well as staying at home or social/physical distancing. They also keep encouraging people to more consistently employ these essential preventive activities to protect themselves from the new coronavirus.
However, people's capability to apply these protective actions vary based on their socio-economic circumstances. Indeed, inequality should be seriously taken into account since it frequently hinders people's ability to apply preventive measures. Indonesia's current 0.38 Gini ratio which means high inequality, reminds us of among our most challenging socio-economic problems. Inequality across the archipelago directly or indirectly shapes people's health and wellbeing particularly in the pandemic since it influences their ability to comply to preventive measures on a daily basis.
We can start with looking at access to clean water and its consequences for maintaining health. Hand washing is still considered the best tool against the new coronavirus strain and may reduce 40 percent of the risk from various infectious diseases. Unfortunately, millions of Indonesia's citizens face significant barriers to adhere to this simple but essential preventive activity.
In fact, only 74 percent of citizens have access to clean drinking water with an even lower percentile in rural areas according to Statistics Indonesia in 2018. Furthermore, none of Indonesia's population across 34 provinces have 90 percent access to clean water; even in the capital the figure is only 73.18 percent.
Additionally, people in the archipelago's eastern part have even poorer access to clean water than those in the western part of the country. In 2019 merely 76.07 percent of Indonesia's population had access to public hand-washing facilities that provided soap. Unsurprisingly Papua, the poorest province, had the lowest figure with 35.55 percent of its population having access to such facilities, followed by East Nusa Tenggara with 51.92 percent. Even in the western half of the country in Aceh province only 64 percent can access clean water.
The grim reality related to lack of access to clean water is found both in rural and urban areas, in the nation's epicenter of the pandemic, which is the capital, and the capitals of other densely populated provinces which follow Jakarta in their high number of confirmed COVID-19 cases such as Bandung in West Java, Surabaya in East Java and Semarang in Central Java; as well as Medan in North Sumatra and Makassar in South Sulawesi, the two major cities outside Java.
Low-income families in the above metropolitans face daily challenges in maintaining hygiene since they can hardly afford to frequently wash their hands, let alone obtain and secure access to drinking water. As a result, they are highly vulnerable to the new coronavirus infection or other germs infections.
Indonesia's latest Basic Health Survey (Riskesdas) in 2018 clearly demonstrated that though the country is increasingly experiencing epidemiological transition in which non-communicable diseases such as diabetes mellitus and cardiovascular diseases become the most lethal health problems, communicable diseases such as water-borne infections remain a huge threat to people's health and wellbeing.
Another dimension of inequality that hinders key prevention measures — physical and social distancing — is our dominant informal economy which accounts for some 57 percent of the workforce. Common characteristics are lack of protection for non-payment of wages, retrenchment without notice or compensation, unsatisfactory occupational health and safety conditions and an absence of social benefits such as pensions, sick pay and health insurance.
Migrants, women and other vulnerable groups who are excluded from other decent job opportunities have little alternatives but to take informal, low-quality jobs available in rural and urban areas in Indonesia. Additionally, many people who are too poor to be unemployed have no choice but to work in hazardous circumstances in the informal economy.
The nature of their work usually requires close physical interaction and they cannot afford to stay home owing to limited savings, if any. Many of these informal workers in cities like Jakarta have already returned to their villages in neighboring provinces because of the economic slowdown. Returning to their villages is a kind of coping strategy that they regularly employ in the time of economic hardship — even though considerable transportation costs are involved. Such circumstances will increase the risk of COVID-19 in the country's hinterland.
Hence the urgency of safety nets for food, rent and access to clean water, among other needs, to reach such informal workers to enable social or physical distancing and to adequately wash hands. The government had recently announced social safety net programs to support the people working in the informal sector as part of policies on "large scale social restrictions" and the public health emergency.
Though these decisions mark crucial progress in the fight against COVID-19, the government should pay attention to the details such as securing reliable data and mechanisms that allow them to deliver the aid as fast as possible to the people in need. The devil, as always, is in the details.
The pandemic has brought us serious lessons about the importance of policies to decrease inequality in Indonesia. Investment in improving basic needs such as access to clean water as well as decent and secure jobs will enable us to reduce health problems and improve people's quality of life.
Written by Sudirman Nasir, senior lecturer and researcher at the Faculty of Public Health, Hasanuddin University (Unhas) and a member of the Indonesian Young Academy of Sciences (ALMI).