Inclusive Development in Health Sector for Persons with Disabilities: A

Case in Jakarta City

Jane Kartika Propiona

Research Centre of Public Health and Nutrition, National Research and Innovation Agency (BRIN),

B.J. Habibie Building, MH. Thamrin No.8 Central Jakarta, DKI Jakarta, Indonesia

Keywords: Inclusive Development, Health Policy, Health Services, People with Disabilities.

Abstract: Everyone has been guaranteed their rights including people with disabilities to access health services. The

Indonesian government has ratified The United Nations Conventions on The Rights of Persons with

Disabilities (CRPD) through Law Number 19 of 2011. That still limited access to health services. The main

cause is double cost, limited health workers, limited infrastructure, and limited health insurance. The aims are

to understand the implementation of health policy provides easy access as a form of inclusivity in the

development of Jakarta. This writing is based on research about inclusive development in the health sector

for people with disabilities in Jakarta. The purpose is to understand the implementation of health policy

provides easy access as a form of inclusivity in the development of Jakarta. This research used the qualitative

in-depth interview. One of the findings is that Jakarta has had KPDJ (Kartu Penyandang Disabilitas Jakarta)

since 2019 in the form of cash assistance for the disabled poor. Challenges that limit health services physique

accessibility for disabilities and there is no program like daycare and home care. Although so many

weaknesses this implementation of Law Number 10 of 2011 can be successful because of the government's

political will to make better health services. It brings change to the development of an inclusive society in the

health sector for persons with disabilities. It is expected that Jakarta will be friendly to disabilities, and no one

left behind.

1 INTRODUCTION

The existence of persons with disabilities in a

compound community is often not visible because of

their small number compared to other community

groups. The small number and ignorance of voicing

his rights as a citizen resulted in his being

marginalized in various aspects of life. When people

with disabilities want to improve their capabilities,

they must fight twice as hard to get their rights. The

state legally guarantees equal rights for all citizens

without exception through the 1945 Constitution. In

2007, the Government of Indonesia signed the

Convention on the Rights of Persons with Disabilities

(CRPD) and passed it into Law Number 19 of 2011

concerning ratification of the Convention on the

Rights of Persons with Disabilities. Then, the

Government made changes to the laws and

regulations of Law Number 4 of 1997 concerning

Persons with Disabilities which are no longer by the

Convention through Law Number 8 of 2016

concerning Persons with Disabilities. The

terminology "disability" is very closely related to the

condition of damaged goods into disabilities which is

not only limited to physical functioning, but disability

occurs due to a form of social exclusion carried out

by society towards people with disabilities.

DKI Jakarta Province is one of the regions that

have adopted it through the DKI Jakarta Provincial

Bylaw Number 10 of 2011 concerning the Protection

of Persons with Disabilities. BPS DKI Jakarta

recorded the number of persons with disabilities in

2015 amounting to 6,003 people. This data

experienced a significant increase in 2019 when DKI

Jakarta launched the Jakarta Disability Card (KPDJ)

program. The recipients of KPDJ phase 1 in 2019

amounted to 7,137 people from the total number

recorded in the Integrated Database (BDT) of 14,459

people. One of the criteria that accept KPDJ has been

set out in the Unified Database (BDT). This means

those who get KPDJ with a low economic level. The

total number of people with disabilities in DKI

Jakarta in 2019 contained the meaning of more than

14,459 people. Specific data on persons with

Propiona, J.

Inclusive Development in Health Sector for Persons with Disabilities: A Case in Jakarta City.

DOI: 10.5220/0011663300003608

In Proceedings of the 4th International Conference on Social Determinants of Health (ICSDH 2022), pages 199-203

ISBN: 978-989-758-621-7; ISSN: 2975-8297

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

199

disabilities are also not visible in DKI Jakarta

Province.

After the ratification of the CRPD, the issue of

inclusive development is growing, including in

Indonesia. One of the inclusive indicators is

disability-friendly cities. Jakarta as the capital of the

country, the provincial capital as well as the business

center in Indonesia certainly needs public facilities

that can be accessed by all its citizens. DKI Jakarta

until 2019 was declared as a "City of Human Rights

Care" by Permenkumham Number 34 of 2016. There

are several indicators for determining cities care

about human rights, one of which is the development

of accessibility for persons with disabilities. Fair and

non-discriminatory public services have been stated

in Law Number 25 of 2009 concerning Public

Services. This public service law is an effort to realize

inclusive services based on equal rights, participation,

non-discrimination, and facilities for vulnerable

groups including persons with disabilities. The

availability of physical infrastructure that is friendly

to people with disabilities can improve their

capabilities, including the fulfillment of Rights, one

of which is getting health services. However, the

fulfillment of health services often clashes with

disability conditions due to a lack of humane

acceptance. The limitations that exist in them cause

negative effects on the surrounding environment

which results in mercy (Lowell, 2013).

Some of the results of previous studies have

shown that health services in Community Health

Center (Puskesmas) have increased but not for people

with disabilities. The results of the Indonesian

Corruption Watch (ICW) survey in 2019 in four cities,

namely Bandung, Solo, Makasar, and Kupang with a

total sample of 800 respondents obtained results (1)

of 74.1% of respondents rated health workers in

Community Health Center (Puskesmas) as unable to

accommodate the needs of people with disabilities;

(2) 58.4% of respondents rated that in the health

center there was no handrail; (3) 34.5% of

respondents still rated that wheelchairs were not

available in the health center; (4) 50.9% rated in the

health center that there was no computer reading

sequence number; (5) 90.5% of respondents rated in

the health center that braille information was not

available; (6) 72.2% of respondents rated in the

Community Health Center (Puskesmas) there were no

toilets specifically for disabilities and (7) 85% of

respondents rated in the Community Health Center

(Puskesmas) as no special lanes (including guiding

blocks). Accessibility to public facilities is a necessity

for people with disabilities to be able to act and

participate fully in social life. The absence of

accessible public facilities for them leads to exclusion

in the community. Accessibility in Community

Health Center (Puskesmas) for people with

disabilities is still not optimal (Firdaus and Iswahyudi

2008).

Another problem is the issue of disability is data

collection. Until now, Indonesia does not have

definite data on the number of people with disabilities.

In 2018 two national surveys collected data on

persons with disabilities, namely the National Socio-

Economic Survey (Susenas) 2018 (Ministry of Social

Affairs) and Riskesdas 2018 (Ministry of Health).

However, the two surveys produced significant

differences. The figures that Basic Health Research

(Riskesdas) produces are much higher than the

National Socio-Economic Survey (Susenas) figures

in all age categories (Hastuti et al. 2020).

The problem of fulfilling health services for

people with disabilities has become complex with the

pandemic. People with disabilities are at four times

the risk of getting COVID-19 and even dying than

people without disabilities. This is because it is not

because of the vulnerability factor but because health

policies have not accommodated their needs (Pineda

and Corburn, 2020).

2 METHOD

This research uses the qualitative descriptive method.

Data collection techniques were carried out with

interviews, observations, and literature studies on

regulations and policies, research results, and disability-

related articles. This research was conducted in DKI

Jakarta Province by taking the location of South Jakarta

due to the implementation of the PSBB. This

qualitative research was conducted in 2 Public Health

centers (PHCs) in South Jakarta. The data were

collected in January 2022. The informants were chosen

using the data from Non-Government Organization

(NGOs). They also use PHCs. The informants in each

PHC consisted of one head of PHC, and 3 staff who

managed the health program. Therefore, the total

number of informants in this study was 15. The data

were collected through in-depth interviews. Semi-

structured interview guidelines were made before the

data collection. The interview guidelines were aimed to

explore the adequacy of local regulation

implementation on PHCs program for people with

disabilities.

The objectives of this study are (1). Knowing data

on persons with disabilities in Community Health

Center (Puskesmas) by tabulating the number of

persons with disabilities who choose Community

ICSDH 2022 - The International Conference on Social Determinants of Health

200

Health Center (Puskesmas) as their health facility; (2)

Knowing the health services provided by the

Community Health Center (Puskesmas) to persons with

disabilities. In this case, health services not only cover

health but also physical health services, namely in the

form of accessibility in the Community Health Center

(Puskesmas); (3) Knowing the commitment of

stakeholders in DKI Jakarta by making improvements

to the revision to Regional Regulation Number 10 of

2011.

3 RESULT AND DISCUSSION

At the policy level in DKI Jakarta, there has been a

local regulation that regulates persons with

disabilities. This bylaw is the starting point for a form

of local government concern. Then the provincial

government issued Gov. reg. (per-gub) Number 24 of

2019 concerning the Provision of Social Assistance to

Meet the Basic Needs of Persons with Disabilities.

The issue of disability is multisectoral. The health

Office also has a hand in fulfilling access to health

services for people with disabilities. The disability

program has not stood alone in the existing health

program in the Community Health Center

(Puskesmas). Usually, the program involves the

elderly group or reproductive health for adolescents.

So, the Community Health Center (Puskesmas) do

not have data on the number and type of disabilities

in their area. The lack of data makes it difficult for

Community Health Center (Puskesmas) to map needs

and develop programs for people with disabilities.

This is in line with the results of research conducted

by Haryono, Kinasih, and Mas'udah (2013) that

women's reproductive health promotion activities for

people with disabilities have not been a priority for

the program. The delivery of information on

reproductive health is incomprehensible to persons

with disabilities. For example, a hearing disability

resource person asked about how condoms are used,

explaining to health workers by giving an example on

the index finger. So, there is a miscommunication by

wearing a condom on the forefinger when going into

contact. For the provision of aids such as crutches or

proteases, the average answer does not know the

information. Technically, it has been regulated by the

National Health Insurance for at least five years after

experiencing a disability. The majority have known

and registered with the Health Insurance PBI but do

not know the exact one covered by BPJS Kesehatan.

Regulations already accommodate the rights of

persons with disabilities but are not accompanied by

health programs. The fulfillment of health services

has become increasingly limited during the COVID-

19 pandemic. There are fundamental information

barriers as health protocols such as washing hands

(some sinks are still not accessible for wheelchair

users), difficulty keeping their distance because some

need accompanying staff or because they are in the

home environment, there is a need to touch or feel for

visual disabilities and the high cost of transparent

masks for hearing disabilities. In addition to the

availability of information during the pandemic,

people with disabilities also need a home visits and

Integrated Service Post (Posyandu) services so that

their health services are still fulfilled.

Persons with disabilities have the right to access

health services. In terms of health service needs, the

speakers with disabilities stated that there was a need

to improve disability-friendly physical facilities in

Community Health Center (Puskesmas). This is by

what Demartoto (2005) said that people with

disabilities have four major problems, namely: (1)

mobility limitations; (2) time wasted due to ongoing

health problems; (3) stereotypes; and (4) the

perception of inferiority.

Accessibility to public facilities is a necessity for

persons with disabilities to be able to act and

participate fully in society. The absence of accessible

public facilities causes exclusion for them (Firdaus

and Iswahyudi 2008). Related accessibility in public

buildings has been regulated by Law Number 28 of

2002 concerning Building Buildings. The policy was

then followed up with a more operational policy in

the form of Regulation of the Minister of Public

Works Number 29 / PRT / M / 2006 concerning

Guidelines for Building Technical Requirements and

Regulation of the Minister of Public Works Number

30/ Prt/ M/ 2006 concerning Guidelines for Technical

Accessibility in Building Buildings and their

Environment. In the regulation, there are several

elements of public buildings that must be accessible

to technical provisions, including (1) parking areas;

(2) pedestrian lanes and the existence of guiding

blocks;(3) clear signs;(4)accommodating toilets and

handrails; (5)an elevator whose space is large enough

for wheelchair users including elevator buttons for

vision disability; (6)building furniture; (7) building

equipment and equipment such as alarms, emergency

buttons, and lighting; (8) entrances and (9)ramps,

roadways that have a certain slump instead of steps.

National Socio-Economic Survey (Susenas) 2020

data collected by the Ministry of Social Affairs shows

that the expenditure on health costs is double with

households that have family members with

disabilities located in DKI Jakarta Province, with an

expenditure of Rp. 264,125. The double health costs

Inclusive Development in Health Sector for Persons with Disabilities: A Case in Jakarta City

201

incurred by people with disabilities are certainly

much greater than what the DKI Jakarta Provincial

Government provides. Persons with disabilities in

Jakarta who are recorded in the Integrated Database

get a Jakarta Disability Card (KPDJ) with an amount

of Rp. 300,000 per month. If it is related to the

number of coverage rates regarding health insurance

(JKN), in the 2020 National Socio-Economic Survey

(Susenas) data, DKI Jakarta has the largest number of

people with disabilities with JKN holders.

Technically, it has been regulated by the National

Health Insurance for at least five years after

experiencing a disability. The majority have known

and registered with the Health Insurance PBI but do

not know the exact one covered by BPJS Kesehatan.

Regulations already accommodate the rights of

persons with disabilities but are not accompanied by

health programs.

The basic needs of persons with disabilities for

health services include availability (health care

facilities, health programs), accessibility (physical

access, economic access, and access to information),

acceptance (accepted in medical ethics, gender

sensitivity, and quality of health services. In the DKI

Jakarta Provincial Bylaw Number 10 of 2011 Chapter

V, there is an explanation of the accessibility of the

first part of Article 44 that local governments, legal

entities, business entities, and the community are

required to provide accessibility for persons with

disabilities. The next stage that needs to be done in

addition to data collection is the availability of

accessible physical facilities for people with

disabilities such as guiding blocks, ramps, running

text, disability toilets, and parking areas.

However, whether with a modern urban area and

claiming to be an inclusive city and a human rights

city, all city residents have access to quality health

services, especially people with disabilities. Whether

health service disparities also occur in urban areas

that in this study site still bear the status of the

national capital. Seeing the possibility of problems in

fulfilling health services for people with disabilities

in urban areas, this study will try to conduct research

on access to health services for people with

disabilities in urban areas on how the health service

process for people with disabilities in the city of

Jakarta. And how is the commitment from the DKI

Jakarta provincial government when implementing

Regional Regulation Number 10 of 2011 concerning

Persons with Disabilities? In this study, we will

examine several indicators of health services for

people with disabilities and strategies for improving

health services for people with disabilities by

combining elements of social determinant health and

health services according to Yeoh (2021).

The basic needs of persons with disabilities for

health services include availability (health care

facilities, health programs), accessibility (physical

access, economic access, and access to information),

acceptance (accepted in medical ethics, gender-

sensitive and quality of health services. In the DKI

Jakarta Provincial Bylaw Number 10 of 2011 Chapter

V, there is an explanation of the accessibility of the first

part of Article 44 that local governments, legal entities,

business entities, and the community are required to

provide accessibility for persons with disabilities. The

next stage that needs to be done in addition to data

collection is the availability of accessible physical

facilities for people with disabilities such as guiding

blocks, ramps, running text, disability toilets, and

parking areas.

The number of Community Health Centers

(Puskesmas) in the DKI Jakarta area until 2020

amounted to 321 Community Health Centers

(Puskesmas). Based on the self-assessment carried out

in 2018, there were 106 Community Health Centers

(Puskesmas) (33%) that were by accreditation

standards, 50 Community Health Centers (Puskesmas)

that were not by the standards, and 234 Community

Health Center (Puskesmas) that had not carried out

self-assessment. This assessment is one of the

indicators of Community Health Center (Puskesmas)

accreditation where the accreditation criteria include

elements of disability. There are 16 villages in DKI

Jakarta that do not have Community Health Center

(Puskesmas), namely Kebon Kacang, Gondangdia,

Cikini, Senen, Gunung Sahari Selatan, Kemayoran,

Gambir, Duri Selatan, and Tanah Cereals (Liputan 6,

2019). Researchers observed four Community Health

Centers (Puskesmas), namely the Community Health

Center (Puskesmas) Pasar Minggu Subdistrict, The

East Pejaten Village Health Center, the Kebagusan

Village Health Center, and the Jagakarsa Village

Health Center. In the Community Health Center

(Puskesmas), the element of accessibility is still

lacking, both in the Community Health Center

(Puskesmas) building and its facilities. One of the

health centers has two floors and for treatment, and

payment counters, the laboratory is on the second floor

(steps). So it does not allow access for wheelchair users.

In the parking lot, there is not enough area available.

At the registration counter for calling queues through

speakers, some are already using computers with

queue sequence numbers. The guiding block also does

not look installed, there is a ramp, and toilet facilities

do not support accessibility. The availability of

Community Health Center (Puskesmas) personnel who

ICSDH 2022 - The International Conference on Social Determinants of Health

202

can understand the needs of disabilities is also not

available at the Community Health Center

(Puskesmas).

4 CONCLUSIONS

From the results and discussions, it can be concluded

that the implementation of DKI Jakarta Regional

Regulation Number 10 of 2011 concerning the

protection of persons with disabilities has not run

optimally, especially in the four Community Health

Centers (Puskesmas) in the South Jakarta area. Data

collection of persons with disabilities needs to be

carried out at each Community Health Center

(Puskesmas) to map needs and compile programs.

The involvement of persons with disabilities in health

programs began to be included to fulfill access to

information. Local governments have an important

role to play in providing disability-friendly public

facilities because the physical infrastructure in

Community Health Center (Puskesmas) is still not

accessible. The pandemic can be a lesson to make

Jakarta a healthy city for all its citizens. So that there

is a need for continuous efforts from the DKI Jakarta

Regional Government to provide a comfortable and

disability-friendly city. The role of the respective

actors in the implementation stage needs to be

maximized. Socialization about accessibility in

development needs to continue and there needs to be

an evaluation from policymakers regarding

accessibility in inclusive urban development. And

further research studies are still needed more broadly

on accessibility and health services in Community

Health Center (Puskesmas) to reach all Community

Health Center (Puskesmas) in DKI Jakarta. The study

can ultimately provide input to policymakers.

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