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Written by Kristian Yudhianto, Winner of the IPAS Indonesia Foundation’s Reproductive Justice Writing Competition.<\/p>\n
Recently, the Indonesian government announced a budget efficiency policy that resulted in program expenditure savings across several Ministries and Institutions, as well as regional government expenditures.1<\/a><\/sup> In the health sector, the Ministry of Health, through Circular Letter No. HK. 02.02\/A\/548\/2025 had already affirmed that budget efficiency only targets the limitation of operational costs, such as office support facilities, and would not affect health services.<\/p>\n However, according to the Circular Letter of the Minister of Home Affairs Number 900\/833\/SJ concerning Regional Revenue Adjustment and Expenditure Efficiency, Regional Governments are obligated to adjust their Regional Budget (APBD) expenditures sourced from Transfers to Regions (TKD)2<\/a><\/sup>. Consequently, the Puskesmas budget, originating from Provincial Regional Budgets (APBD Provinsi) and Regency\/City Regional Budgets (APBD Kabupaten\/Kota), faced reductions due to TKD budget efficiency.<\/p>\n Community Health Centers are very important healthcare services for the community. They are the healthcare services closest to the community and provide healthcare services ranging from treatment and rehabilitation to health promotion and disease prevention. <\/p>\n However, when discussing healthcare rights for victims of sexual violence, their needs certainly cannot be equated with those of the general public. Sexual and gender-based violence, as well as various forms of sexual harassment and exploitation, place women and girls at high risk of experiencing physical and mental trauma, unintended pregnancies, and sexually transmitted infections, ultimately leading to mental health disorders that require special attention. <\/p>\n Given the increasing trend of sexual violence cases in Indonesia, Community Health Centers should serve as the most accessible means for survivors to obtain health rights, especially mental rehabilitation. This aligns with the mandate of Law No. 12 of 2022 concerning Sexual Violence Crimes, which affirms that victims are entitled to medical and psychosocial support as part of their recovery. <\/p>\n However, in reality, only a few Community Health Centers in Indonesia provide mental health services. The Director of Mental Health at the Ministry of Health stated that as of 2024, only 38 percent of Community Health Centers have such services, and most are concentrated in large cities3<\/a><\/sup>. <\/p>\n In terms of the number of psychologists, the ratio of active clinical psychologists in Indonesia also shows a concerning figure, with a ratio of 1 psychiatrist per 250,000 population and 1 clinical psychologist per 90,000 population.4<\/a><\/sup> This ratio is certainly far below the WHO standard, which states an ideal ratio of 1 psychiatrist and clinical psychologist per 30,000 population.<\/p>\n This situation undoubtedly constitutes a governmental obligation that requires resolution, considering that Indonesia signed and adopted the Beijing Declaration and Platform for Action (1995) and the Beijing +5 Political Declaration and Outcome Document (2000), which obliges the government to integrate mental health services into the primary healthcare system and train primary healthcare personnel to identify and care for girls and women of all ages who have experienced various forms of violence, especially domestic violence, sexual abuse, or other violence resulting from armed or non-armed conflicts. One example of good practice can be seen in Purbalingga Regency with its innovative program, Puskesmas Peduli Penderita Jiwa (PUSPITA) (Community Health Centers Caring for Mental Patients). Through this program, Community Health Centers are encouraged to provide mental health services such as the formation of mental health cadres, counseling, and home visits for patients with mental disorders. This program has proven to bring mental health services closer to communities in need and improve the tracking of new patients. Innovations like this demonstrate that even with budget efficiency policies, the government must still provide creative solutions to ensure closer and more inclusive access to health services, especially for high-risk groups such as victims of sexual violence. <\/p>\n [\/et_pb_text][et_pb_text _builder_version=”4.27.5″ _module_preset=”default” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":" Written by Kristian Yudhianto, Winner of the IPAS Indonesia Foundation’s Reproductive Justice Writing Competition. Recently, the Indonesian government announced a budget efficiency policy that resulted in program expenditure savings across several Ministries and Institutions, as well as regional government expenditures.1 In the health sector, the Ministry of Health, through Circular Letter No. HK. 02.02\/A\/548\/2025 had already affirmed that budget efficiency only targets the limitation of operational costs, such as office support facilities, and would not affect health services. However, according to the Circular Letter of the Minister of Home Affairs Number 900\/833\/SJ concerning Regional Revenue Adjustment and Expenditure Efficiency, Regional Governments are obligated to adjust their Regional Budget (APBD) expenditures sourced from Transfers to Regions (TKD)2. Consequently, the Puskesmas budget, originating from Provincial Regional Budgets (APBD Provinsi) and Regency\/City Regional Budgets (APBD Kabupaten\/Kota), faced reductions due to TKD budget efficiency. Community Health Centers are very important healthcare services for the community. They are the healthcare services closest to the community and provide healthcare services ranging from treatment and rehabilitation to health promotion and disease prevention. However, when discussing healthcare rights for victims of sexual violence, their needs certainly cannot be equated with those of the general public. Sexual and gender-based […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"\r\n Ditulis oleh Kristian Yudhianto, Pemenang Lomba Menulis Keadilan Reproduksi Yayasan IPAS Indonesia.<\/p>\r\n\r\n Baru-baru ini, pemerintah Indonesia mengumumkan kebijakan efisiensi anggaran yang berdampak pada penghematan belanja program pada sejumlah Kementerian dan \u00a0Lembaga, termasuk juga belanja Pemerintah Daerah.1<\/a><\/sup> Pada sektor kesehatan, \u00a0Kementerian Kesehatan melalui SE No. HK. 02.02\/A\/548\/2025 sebenarnya sudah \u00a0menegaskan jika efisiensi anggaran hanya menyasar pada pembatasan biaya \u00a0operasional seperti sarana pendukung kantor dan tidak berdampak pada layanan kesehatan.<\/p>\r\n\r\n Namun, jika mengacu pada Surat Edaran Menteri Dalam Negeri Nomor 900\/833\/SJ tentang Penyesuaian Pendapatan dan Efisiensi Belanja Daerah, Pemerintah Daerah wajib melakukan penyesuaian belanja APBD yang bersumber dari Transfer ke Daerah (TKD)2<\/a><\/sup>. Konsekuensinya, anggaran Puskesmas yang berasal dari APBD Provinsi dan APBD Kabupaten\/Kota mengalami pengurangan akibat efisiensi anggaran TKD.<\/p>\r\n\r\n Puskesmas merupakan layanan kesehatan yang sangat penting bagi masyarakat. Puskesmas adalah layanan kesehatan yang paling dekat dengan masyarakat dan menyediakan layanan kesehatan mulai dari pengobatan dan rehabilitasi hingga promosi kesehatan dan pencegahan penyakit.<\/p>\r\n\r\n Namun, jika kita membahas hak kesehatan untuk korban kekerasan seksual, kebutuhannya tentu tidak bisa disamakan dengan masyarakat pada umumnya. Kekerasan berbasis seksual dan gender serta berbagai bentuk pelecehan dan eksploitasi seksual, menjadikan perempuan dan anak perempuan sebagai kelompok risiko tinggi mengalami trauma fisik dan mental serta mengalami kehamilan yang tidak diinginkan dan penyakit infeksi menular seksual, yang ujungnya berefek pada gangguan kesehatan mental yang membutuhkan perhatian secara khusus.<\/p>\r\n\r\n Seharusnya, dengan melihat tren peningkatan kasus kekerasan seksual di Indonesia, Puskesmas harus berperan sebagai sarana paling terdekat bagi penyintas untuk mendapatkan hak kesehatan, terutama rehabilitasi mental. Hal ini sesuai dengan amanat UU No. 12 Tahun 2022 Tentang Pidana Kekerasan Seksual yang menegaskan bahwa korban berhak mendapatkan dukungan medis dan psikososial sebagai bagian dari pemulihan<\/p>\r\n\r\n Namun, faktanya, hanya sedikit Puskesmas di Indonesia yang menyediakan layanan kesehatan jiwa. Direktur Kesehatan Jiwa Kementerian Kesehatan menyebutkan bahwa hingga 2024, baru 38 persen Puskesmas yang memiliki layanan tersebut, dan sebagian besar terpusat di kota-kota besar3<\/a><\/sup>.<\/p>\r\n\r\n
Unfortunately, budget efficiency policies that prioritize major spending on the Free Nutritious Meals program and the defense sector have further marginalized the issue of mental health needs for victims of sexual violence. In fact, the Ministry of Health has endeavored to expand independent mental health screening accessible online through the SATUSEHAT Mobile application. However, this intervention is undoubtedly not effective for high-risk groups such as victims of sexual violence who require intensive and long-term assistance. Furthermore, the use of online applications is also still ineffective in reaching communities living in underdeveloped, frontier, and outermost (3T) regions with low internet and technology access.
Government budget efficiency should not compromise essential steps in supporting public health rights, especially the right to comprehensive healthcare services for victims of sexual violence. Community health centers (Puskesmas) must be at the forefront of rehabilitative efforts and mental health assistance for victims of sexual violence. Additionally, Local Governments also need to be more sensitive to the specific needs of victims regarding mental health assistance. <\/p>\n\n