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Š‡ ‘••ƒŽ •–‹–—–‡ ˆ‘” Ž‘„ƒŽ ‡ƒŽ–Š
SOCIAL PROTECTION FOR PEOPLE
WITH DISABILITY IN INDONESIA
Internship Report
With the Nossal Institute for Global Health
Written by
Sihar Alaris Sinaga
ID No: 614585
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ƒ„Ž‡ ‘ˆ …‘–‡–•
Acronyms …………………………………………………………………………………………………………..………….…….3
Executive Summary.................................................................................................................................5
Social Protection for People with Disability in Indonesia........................................................................7
Introduction.............................................................................................................................................7
Methodology.......................................................................................................................................8
Disability in Indonesia .............................................................................................................................8
Disability Social Protection Legal Frameworks in Indonesia.............................................................13
Social Protection Strategies and Programs in Indonesia.......................................................................13
Insurance-based Social Security........................................................................................................14
Health Insurance ...........................................................................................................................15
Social Insurance.............................................................................................................................16
Non-Insurance based Social Protection ............................................................................................17
Social Assistance............................................................................................................................17
Health............................................................................................................................................18
Education.......................................................................................................................................20
Employment ..................................................................................................................................23
Accessibility ...................................................................................................................................24
Non-Governmental Community Care ...........................................................................................25
Challenges .............................................................................................................................................25
Opportunities ........................................................................................................................................28
Conclusion.............................................................................................................................................30
References.........................................................................................................................................32
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Acronyms ƒn† A„„r‡˜‹ƒ–‹ons
Askes National Health Insurance for Government Workers
Asabri Insurance for Military Personnel
ASEAN Association of South East Asian Nations
Askesos Social Insurance for Informal Sector Workers
Balitbang Government’s Research and Development Agency
Bappeda Local Development Planning Agency
Bappenas National Development Planning Agency
BLT Unconditional Cash Transfer
BPJS Badan Penyelenggara Jaminan Sosial (Implementing Agency for Social Security)
BPS Centre for National Statistical Agency
CBM Christian Blind Mission
CBR Community Based Rehabilitation
CRPD United Nations Convention on the Rights of Persons with Disability
DAK Dana Alokasi Khusus (Specific Allocation Fund)
DAU Dana Alokasi Umum (General Allocation Fund)
Gerkatin the Deaf Welfare Movement
GIZ Gesellschaft für Internationale Zusammenarbeit
HWPI Indonesian Association for Disabled Women-Himpunan Wanita Penyandang Cacat
Indonesia
IKIP Institute for Education
ILO International Labor Organization
Jamkesda Local Government Health Insurance
Jamkesmas National Health Insurance
Jamsostek National Social Insurance for Private Employees
JSPCB Social Assistance for People with Severe Disability
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Komnas HAM National Commission for Human Rights
MDGs Millennium Development Goals
MoEC Ministry of Education and Culture
MoMPT Ministry of Manpower and Transmigration
MoSA Ministry of Social Affair
NAP National Action Plan
PBI Social Assistance for Health Insurance
Pertuni The Blind Union
PKH Family of Hope Program
PPCI Indonesian Disability Union -Persatuan Penyandang Cacat Indonesia
PPDI Indonesian Disabled People Association-Perhimpunan Penyandang Disabilitas
Indonesia)
Prolegnas National Legislation Program
Puskesmas Community Health Center
RAD Rapid Assesment of Disability
Riskesdas Basic Health Research
RPJMN Medium-term National Development Strategy
SJSN National Social Security System
Susenas National Economic Survey
Taspen Government’s Workers Retirement Fund
UNESCAP United Nations Economic and Social Commission for Asia and the Pacific
UNESCO United Nations Educational, Scientific and Cultural Organization
WG Washington Group Disability Statistics
WHO World Health Organization
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Executive Summary
This report provides a review and analysis of social protection policies for people with
disability in Indonesia. The purpose is to identify the challenges and opportunities of current
strategies and programs for the realisation of disability rights in Indonesia.
A review of the literature, as presented in this report, shows that structural prejudice
against people with disability, combined with conflicting legal frameworks, inconsistent
implementation of regulation, and poor law enforcement, present major challenges to the
realisation of disability rights in Indonesia. There is a general failure to implement national
disability protection policies at the provincial and district levels of government, which
combined with statistical invisibility, a lack of demand for evidence-based policy, and
ongoing budget constraints, leads to poor monitoring and follow up of disability action
policies.
The Indonesian approach to disability is paradigmatically framed in terms of charity
and medical models of disability, which are apparent in various legal frameworks and
policies. Existing legal frameworks cover political and social rights, including access to
health care, pensions, social assistance, education, public facilities and infrastructure;
however, disability is still influenced by medical discourses in which it is regarded as a
biological or psychological defect, rather than a socially mediated condition that is enabled or
disabled by social policies.
Indonesia’s recent commitment to implement the United Nations Convention of the
Rights of Persons with Disabilities (CRPD) and to establish a universal social protection
system for health and employment are positive developments. Current policies to reallocate
the fuel subsidy fund into a ‘productivity and human development’ welfare program and to
revitalize the role of balitbangs (research and development agencies) for the development of
evidence-based policy, if properly pursued may overcome one of the major challenges to the
formulation of disability policy, namely the lack of adequate data.
Opportunities for future development of social protection policies for people with
disability include:
• Implementing a robust disability measurement to overcome data
inconsistency;
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• Greater involvement of balitbangs for improved policy formulation and data
collection measures.
• Enabling greater participation of Disabled People’s Organisations (DPOs) for
the development of more inclusive policies and programs;
• Reforming existing legal frameworks to reflect a rights-based approach to
disability;
• Improving law enforcement and implementation of disability action policies
between different levels of government;
• Increasing the coverage of disability health benefits to include long term care
and affordability and accessibility of assistive devices
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Social Protection for People with Disability in Indonesia
‘…people with disabilities in Indonesia are at a disadvantage. They are poorer, less educated, less employed,
and more isolated and at times feel they are a burden on their family. To ensure full rights for all of its citizens
Indonesia needs to pursue inclusive policies in line with the goals of the UNCRPD and Ministerial Declaration
on the Asian and Pacific Decade of Persons with Disabilities, 2013–22’ (Adioetomo et al., 2014, p. xviii).
Introduction
Social protection is understood as every strategy, policy, or program which aims at assisting
individuals, families, and communities ‘against shock and risk’ (de Haan  Conlin, 2000, p.
36). It involves extensive government policies and programs aimed at responding to the
problem of poverty and the potential of risk and vulnerability faced by community, including
those with a disability (Conway, Haan,  Norton, 2000). Broadly, social protection
emphasises a government’s attempt to guarantee security of living and access to basic
services such as food, water and sanitation, alongside social services such as pensions,
healthcare and education for all its citizens (Yulaswati, 2014). It has two dimensions: policies
and programs aimed at ensuring universality of protection based on risk and vulnerability,
and specifically targeted programs that progressively increase the living standards of the poor
and marginalised (de Haan  Conlin, 2000; Yulaswati, 2014). Instruments of social
protection can be divided into the three elements of ‘insurance-based policies, social
assistance, and other instruments’ (Conway et al., 2000, p. 12).
Social protection for people with disability is not limited to cash transfer social
assistance and insurance-base social security. Rather, it covers sectors such as education,
health, employment and so forth.
Disability is a complex issue and can change overtime. Disability is conceptualised by
the CRPD as:
…an evolving concept…[that] results from the interaction between persons with
impairments and attitudinal and environmental barriers that hinders their full and effective
participation in society on an equal basis with others. (United-Nations, CRPD Preamble,e)
It is essential that social protection for people with disability is based in a government
approach that includes ‘political will, appropriate legislation, economic resources and
implementation mechanisms’ (Mleinek  Davis, 2012, p. 6).
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This paper aims to document Indonesian social protection policies for people with
disability, including strategies and programs, challenges andopportunities for further
development..
Objectives:
• To analyse social protection policies, strategies, and programs for people with
disability in Indonesia
• Identify key challenges and opportunities for the realisation of disability rights in
Indonesia.
Methodology
This paper is developed primarily through a literature review of key documents on disability
in Indonesia produced by Indonesian government agencies and international governmental
bodies. Literature reviewed included documents from the National Development Planning
Body (Bappenas), the National Team of Acceleration of Poverty Reduction (TNP2K), the
Australian Department of Foreign Affairs and Trade (DFAT), the International Labour
Organisation (ILO), the World Health Organization (WHO), the World Bank, and the United
Nations Economic and Social Commission for Asia and the Pacific (UNESCAP). Journal
articles, online publications and newspaper articles were reviewed as part of an extended
literature review, and are used in this report to support theoretical perpectives on disability
and social protection. All literature was published in English or Indonesian. Where possible,
the review has been supplemented with personal communication with individuals currently
working with people with disability in Indonesia.
Disability in Indonesia
Indonesia has the world’s fourth-largest population with an estimated 250 million people
living in the archipelago of about 17,000 islands. The island geography of Indonesia and its
cultural diversity is often cited as one of the main challenges to governing the state and
meeting national goals such as social justice for people with disability. Social protection for
people with disability in Indonesia is primarily framed by the charity and medical models of
disability, which underpin legal frameworks of disability protection. The legal terms used to
refer to people with disabilities emphasise the person’s physical and/or mental abnormality
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relative to people without disability (Irwanto, Supriyanto,  Yulianto, 2013). The term
penyandang cacat, used in Disability Law No.4 of 1997, for example, refers to a biological or
psychological defect, of a state of being that is less than an ideal - imperfect, whereas
kelainan, another term for disability, means more simply abnormality. These terms reflect
how disability is culturally understood in Indonesia, and hence the assumptions that underpin
legal frameworks governing disability policy, which parallel how charity and medical models
tend to frame disability. The charity model, for example, understands disability as the
individual’s problem; disabled persons are therefore treated as either subjects for charity,
inspirational individuals, or subjects to be pitied (Mannan, 2014). This understanding is
sociologically categorised as personal tragedy (Anastasiou  Kauffman, 2011).
The medical model, by contrast, focuses on the individual’s bodily dysfunction from a
healthcare perspective. The emphasis of this model is therefore on ‘fixing’ the body so that it
can function without broader social or environmental adjustments having to be implemented.
Both of these models focus on the individual as the site of disability and hence ‘defect’. Both
models tend to ignore the social dimension of disability, and the role of social attitudes in
creating barriers to the full inclusion of people with disability (Anastasiou  Kauffman,
2011). These models result in a paternalistic approach to disability marked by segregation
and discrimination (Mannan, 2014). These models underpin Indonesian government policies
and community attitudes towards people with disability. People with disability are culturally
stigmatised, which reinforces discriminatory disability policy (Colbran, 2010). There is still a
rampant belief amongst Indonesians that disability is caused by a curse for an ancestor’s sin.
As a consequence, many people with disability are hidden away from society, with families
often feeling a sense of shame for having a family member with a disability. Disability is also
often associated with weakness and the incapacity to be independent; it is therefore perceived
as a family burden (Kusumastuti, Pradanasari,  Ratnawati, 2014).
Indonesia is a signatory of the United Nations Convention on the Rights of Persons
with Disabilities (CRPD), signed in 2007, and ratified in 2011. This recent development
signifies the Indonesian government’s commitment to mainstreaming and integrating
disability as a cross-cutting issue for sustainable development with the obligation to protect,
respect and fulfil the rights of people with disability (United-Nations, 2006). Disability Law
(1997 articles 17 and 18), prior to the 2011 ratification of the CRPD, focused solely on the
bodily functions of a person with disability and on their rehabilitation via the provision of
medical services, assistive devices and education and training. Yet under this law there was
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little recognition of or consideration given to the broader social context that either enabled or
disabled a person with a disability to have wider participation in the community. Indonesia’s
signing of the the 2007 CRPD is therefore considered to represent a paradigmatical shift in
the government’s understanding and approach towards disability. The draft of a new
disability law has been submitted to the Program Legislasi Nasional (Prolegnas - the
National Legislation Program) commission and is expected to reflect the principles of the
CPRD ratified by the Indonesian government (Kemenkumhamnas, 2010). The drafting of this
law has involved the intensive participation and contribution of an extensive list of
stakeholders, including the Human Rights Commission, universities, civil society groups and
DPOs (FAT, 2015). However, due to national political tensions the Parliamentary Law and
Local Government Election Laws were prioritised in 2014 and the legislation of Disability
Law has been deferred to 2015 (Nursyamsi, 2014).
The World report on disability in 2011 estimates that 15 per cent of the global
population lives with a disability (WHO, 2011). However, most governments in developing
countries report to have about 4.6 per cent of people living with disability (UNESCAP,
2013). This may be an under-estimation due to the lack of a common definition of disability
as well as a lack of reliable data collection methods. Like many other developing countries,
Indonesia has a lack of reliable data on disability. Reports suggest that unreliable statistical
data on disability impedes the formulation of quality policies and programs (Adioetomo et
al., 2014; UNESCAP, 2013). A study conducted by Gesellschaft für Internationale
Zusammenarbeit (GIZ) suggests that social protection programs might not meet the needs of
people with disability because data collection and measurement techniques are not
specifically designed to identify the needs of people with disability (Mleinek  Davis, 2012).
The statistics on disability prevalence in Indonesia are inconsistent and vary between
agencies. There are three main data sources on disability in Indonesia. These are the National
Statistical Agency (BPS), the Basic Health Research Survey (Riskesdas) conducted by the
Ministry of Health, and the National Economic Survey (Susenas). The 2010 BPS national
census, which adapted the Washington Group (WG) short set questions, found an overall
prevalence of disability is only 4.3 per cent, which is extremely low compared to countries
using similar data collection measures. The 2010 BPS national census asked the first three
questions of the WG and modified the rest. The responses were reduced from the standard
four categories (No, no difficulty; Yes, some difficulty; Yes, a lot of difficulty; Cannot do
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at all (United-Nations, 2014)) into three categories (None; a Little; a Lot) (Adioetomo et
al., 2014). The questions for the BPS 2010 census were:
1. Do you have difficulty seeing, even when wearing glasses?
2. Do you have difficulty hearing, even when using a hearing aid?
3. Do you have difficulty walking or climbing stairs?
4. Do you have difficulty remembering, concentrating, or communicating with others
due to a physical or mental condition?
5. Do you have difficulty in self-care?
By contrast, the standard questions recommended by the WG are:
1. Do you have difficulty seeing, even when wearing glasses?
2. Do you have difficulty hearing, even when using a hearing aid?
3. Do you have difficulty walking or climbing steps?
4. Do you have difficulty remembering or concentrating?
5. Do you have difficulty (with self-care such as) washing all over or dressing?
6. Using your usual (customary) language, do you have difficulty communicating, for
example, understanding or being understood? (United-Nations, 2014)
The BPS (2010) and Riskesdas (2007) have similar data on the types of disability and
of those disabilities associated with aging, alongside a breakdown of disability as it
corresponds with gender and geographic residence. Vision and physical impairments are the
most common forms of disability (Adioetomo et al., 2014). The cause of impairments were
mainly reported to be due to congenital factors, poor health care, and accidents (Adioetomo
et al., 2014; WHO, 2012a). The association between aging and disability is a major
contributing factor to the overall prevalence of disability. Indonesia is in demographic
transition such that the number of persons above 60, as indicated in the National Census
(2010), has reached 18.1 million. The forecast is that there will be 29.05 million people aged
60 and above in 2020 and 35.96 million in 2035. In 2018 this will mean that 10% of the total
population will be aged over 60 (Adioetomo et al., 2014). Figure 1. below demonstrates the
prevalence of disability across the Asia-Pacific as reported by each government. Different
disability measurements were used by each state to assess the prevalence of disability
(UNESCAP, 2013).
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Figure 1. Disability across the Asia-Pacific (UNESCAP, 2013)
The BPS survey (2010) found that people over the age of 10 years had a disability
prevalence of 4.74 per cent. Females reported a higher rate of disability (4.64 per cent)
compared to males (3.94 per cent). However, the National Economic Survey (Susenas) of
2012 found disability prevalence to be less than the 2010 census, with a prevalence of only
2.45 per cent (Pusdatin-Kesehatan, 2014; Pusdatin, 2014). By contrast, the Riskesdas (Basic
Health Research, 2007) found disability prevalence to be around 11 per cent in Indonesia.
Adioetomo et al. (2014) estimate that disability prevalence is between 11 and 15 per cent
based on a metaanalysis of existing statistical data.
The Riskesdas 2007 survey was very comprehensive; it adopted International
Classification of Functionings (ICF) questions that addressed functional and activity
limitations. This was similar to the Riskesdas 2013, which adopted WHODAS (WHO
Disability Assessment Schedule). It showed that people above 15 years have a disability
prevalence of 11 per cent, excluding vision impairment (Pusdatin-Kesehatan, 2014).
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Legal frameworks:
• Government Regulation No. 25 of 2000 regulates the obligations of central and local
governments in respect to people with disability.
• Law No. 40 of 2004 on the National Social Security System (Sistem Jaminan Sosial
Nasional or SJSN) provides a legal basis for universal social protection that includes
people with disability (Priebe  Howell, 2014).
• Law No. 11 of 2009 on Social Welfare contains subsequent regulations for social
assistance, particularly the articles 4 and 5 (Priebe  Howell, 2014)
• Government Regulation No. 101 of 2012 on Eligibility of Social Assistance for Health
Insurance Premium (Penerima Bantuan Iuran-PBI) for BPJS Kesehatan
Disability Social Protection Legal Frameworks in Indonesia
The 1945 National Constitution, Article 27, Chapter 10, states that, “without any exception,
all citizens shall have equal positions in law and government and shall be obliged to uphold
that law and government. Every citizen shall have the right to work and to a living, befitting
for human beings” (WHO, 2012a, p. 68). Article 34 of the constitution stipulates it is the
State’s obligation to provide welfare for those who are destitute. The article expresses the
inherent value of social justice for all Indonesians. However, the main legal instrument for
disability protection is Law No. 40 of 1997. As argued above, this law reflects a charity and
medical model of disability that frames disability in individualistic terms as a biological
deficit. Current laws embody this understanding, failing to reflect a social and right-based
approach to disability as embraced in CRPD (Colbran, 2010).
Social Protection Strategies and Programs in Indonesia
Social protection strategies for people with disability are outlined in The National Action
Plan (NAP-Rencana Aksi/Renaksi) as part of Rencana Pembangunan Jangka Menengah
Nasional (RPJMN-Medium-term National Development Strategy), but the implementation of
this plan has been less than satisfactory (Adioetomo et al., 2014). NAP is strategic for it
brings together all stakeholders of disability, including the National Police, Ministries of
Justice, Social Affairs, Education, Health, General Work and Public Housing, Manpower,
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Transportation and others. The 2004-2013 National Action Plan for People with Disability
was developed as a follow up to the 2002 ministerial meeting in Otsu-Shiga, Japan. The NAP
aimed to implement the Millenium Biwako Framework by prioritising areas such as
employment and healthcare. Included in healthcare are early detection measures, prevention
through education, poverty alleviation through social security and capacity building,
accessibile public facilities, and provision of assistive technologies. The presence of DPOs
and carer support for children with disability alongside access to reproductive healthcare for
women with disability are detailed in this framework (Adioetomo et al., 2014).
The draft NAP 2014-2019 aims to establish and strengthen NAP implementing
institutions, educate people with disability about their rights, and synchronize legal
frameworks on disability. It aims to strengthen the civil and political rights of people with
disability, allowing for their full participation in social, economic and cultural arenas. The
NAP also aims to improve data collection, monitoring and evaluation of NAP programs,
which will be reviewed on a 5 year basis (Bappenas, 2014). Overall, NAP 2014-2023
emphasises civil and political rights and the fulfilment of economic, social and cultural rights,
alongside accessibility and the provision of accommodation (Kemenkumham, 2014).
However, the emphasis of NAP 2014-2023 is on human rights rather than being specific to
the rights of people with disability.
Insurance-based Social Security
Despite socio-political and economic challenges, the Indonesian government has nevertheless
developed a universal social security system covering healthcare and pensions and people
with disability. Passed as Law No. 40 of the National Social Security System (SJSN) in 2004
and followed in 2011 by Law No. 24 on the implemention of social security (Badan
Penyelenggara Jaminan Sosial-BPJS), universal social security law came into effect in
January, 2014. Law No. 24 (BPJS) consists of BPJS Kesehatan (Health Insurance) and BPJS
Tenaga Kerja (Pension). The BPJS is accessible to every Indonesian who either makes an
individual contribution to the scheme, or whose employer does so on their behalf. SJSN is an
important step toward comprehensive integration of existing social protections (Suharyadi,
Febriany,  Yunma, 2014; Yulaswati, 2014). Prior to the implementation of BPJS, there
were several social insurance agencies including Askes (Government’s Workers Health
Insurance) Taspen (Government’s Workers Retirement Fund), Jamsostek (National Social
Insurance for Private Employees) and Asabri (Insurance for Military Personnel), which
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offered employment based social security. These agencies were unified under Law No. 40,
forming the BPJS.
In order for people with disability to be able to access these funds they would have
had to have been formally employed prior or consequent to acquiring their disability (Irwanto
et al., 2013). For people with a disability acquired early in life or due a congenital condition
there are few social protections, given that social insurance is tied to the ability to make
payments to the insurance fund. Further to this, social protection for people with disability in
the healthcare sector is problematic (Adioetomo et al., 2014) because benefit schemes do not
cover the extent of disability rehabilitation, and they are not disability specific (Kusumastuti
et al., 2014). Adioetomo, et al., (2014) suggest the establishment of a specific provision such
as a Disability Insurance Scheme that is designed to provide comprehensive cover for people
with disability, including long-term care and access to medical assistance, assistive devices
such as wheelchairs, prosthectics, hearing aids, and so forth.
Health Insurance
Government Regulation No. 101 of 2012 on Recipients of Financial Assistance for Health
Insurance (PBI-Penerima Bantuan Iuran) regulates the health insurance premium covering the
poor, including people with disability. This is funded through the national budget. This
regulation stipulates eligibility for government support. The recipients of this form of support
must be defined as very poor with an inability to maintain their basic needs, or be able to
meet their basic needs, but cannot pay the premium for his/her and family (Hukum-Online,
2013). The criteria for eligibility is determined by the Ministry of Health in coordination with
the Ministry of Finance based on data and identification provided by the BPS. The data is
verified and validated every 6 months (Government Regulation No. 101 of 2012 Article
11:4).
One problem of the BPJS is that the government’s contribution towards the poor, as
part of the PBI, is unsustainable. The contribution was set as IDR 19,225 (A$1.9), which is
lower than the contribution of individuals making payments to the BPJS, which is IDR
27,500 (ADY, 2013). (Triyono, 2014). Irma Suryani, a member of parliament, who rejected a
budget increase for the BPJS Kesehatan, expressed criticism of how the PBI data concerning
recipients of the BPJS had been collected. She argued that figures estimating the number of
future PBI recipients were inaccurate because they could not reliably be based on past
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recipient numbers, as there would be a significant change these within the 3 years between
2012 to 2015 (Hidayat, 2015). Moreover, she argued that it was unclear how six monthly data
validation and verification procedures would be conducted, as emphasised in the Government
Regulation No. 101 of 2012 Article 11:4. In practice, the validation and verification of data as
stipulated in the 2015 National Budget did not eventuate because the PBI was based on
outdated Susenas 2012 statistical data (Hidayat, 2015).
Before the BPJS, there was a national health insurance scheme (Jamkesmas) for the
poor as well as many local health insurance schemes (Jamkesda). While Jamkesmas was
transformed into BPJS Kesehatan, there was no specific articulation on how local health
insurances (Jamkesda) would be syncronised into the BPJS (Suharyadi et al., 2014).
Nonetheless, a government report showed that many of Jamkesda insurances have been
integrated into BPJS by which local governments fill the contribution gaps of PBI
beneficiaries (BPJS, 2014b). This demonstrates that the gap between government
contributions to the poor as part of the PBI has been filled through the integration of the local
health insurance schemes with the BPJS.
Social Insurance
Social insurance managed by BPJS Employment is designed for employees and covers old-
age savings, work accidents, pensions and death (Suharyadi et al., 2014). BPJS Employment
has been expanded to cover individuals who work independently, such as contract-based
construction workers (BPJS, 2014a). Since many people with disability work independently
(Adioetomo et al., 2014), as masseaurs, technicians, and in other informal sectors, BPJS
Employment needs to incorporate them into the program.
Askesos (Askesos-Social Insurance for Informal Workers) is another social insurance
scheme based on employment, which is programmed and administered by the Ministry of
Social Affairs (MoSA), and provides benefits such as income maintenance to poor people
who work in informal sectors (Habibullah  Muchtar, 2009, p. 24). Membership is based on
income, which must be no more than IDR 300,000 (Adioetomo et al., 2014; Martabat, 2013).
Membership may vary depending on the insurance poles. Some insurance poles also offer
microfinance (Habibullah  Muchtar, 2009).
There is limited data on the future of the Askesos, and whether it will be integrated to
BPJS Employment, or remain under the management of the Ministry of Social Affairs
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(MoSA). Moreover, it is unclear whether independent people with disability have access to
BPJS Employment or Askesos due to data limitations.
Non-Insurance based Social Protection
This section will outline non-insurance based social security protection schemes that
emphasize the importance of increasing living standards and social and economic
participation.
Social Assistance
Social Assistance for people with disability is the responsibility of the MoSA, which aims to
maintain basic income for the poor. Current MoSA programs include social assistance
through an oil and gas subsidy, food assistance, Usaha Ekonomi Produktif (Economic
Productivity Scheme) and Social Assistance for People with Severe Disability (JSPCB-
Jaminan Sosial Penyandang Cacat Berat). These social assistance programs operate through
cash transfer, with payments made by institutional services to families. Unconditional Cash
Transfer program (BLT-Bantuan Langsung Tunai) and food assistance are often used as tools
during economic crises, particularly with when there is an increase in global oil prices. BLT
is used as a program to protect the poor due to high inflation and economic uncertainty
(Miranti, Vidyattama, Hansnata, Cassells,  Duncan, 2013).
JSPCB provides a monthly support of IDR 300,000 to people with severe disability
funded by the national government to support food and health expenses (Roebyantho,
Jayaputra,  Sumarno, 2012). According to Rev. Osten Matondang, the director of Hephata
Disability Home and coodinator of Community Based Rehabilitation (CBR) program in
North Sumatra, food assistance for people with disability who live in the institutions is IDR
2,100 funded through the provincial budget, with some amount received from the national
budget depending on the provincial budget allocation (Matondang, 2015). The amount of
money varies among provinces. For example, in South Sulawesi food assistance is IDR 3,000
financed through the combination of local and national government budgets (Tira, 2010).
A report by the World Bank revealed that the JSPCB has a very restricted budget,
which limits the implementation of the program, effecting fund/budget allocation, data
collection, monitoring and evaluation. A lack of practical guidelines in identifying and
prioritising the beneficiaries makes the decision solely up to local government officials and
facilitators (World-Bank, 2012). Nonetheless, the families of people with disability who
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receive cash transfer social assistance gave positive feedback about the program, stating that
it reduced their economic burden (Roebyantho et al., 2012). However, other people report
that cash transfers were misused by the family of the person with the disability (Adioetomo et
al., 2014).
Program Keluarga Harapan (PKH-Family of Hope Program) is a another social
assistance program that offers a conditional cash transfer for health and education for very
poor households as part of a program aiming to reduce poverty, to increase basic education,
to achieve gender equality and reduce infant and mother mortality, as per the Millennium
Development Goals (MDGs). In the short-term, this program aims to reduce the economic
burden faced by families and in long-term break the intergenerational poverty cycle. It aims
to target 3.2 million households by 2014. The program had reached 2.3 million households in
2013 (TNP2K, 2014). In order to access this form of social support children must be enrolled
in school; however, ingrained cultural prejudice and stigma against people with disability
combined with geographical barriers often prevent families from enrolling a child with a
disability in education.
Health
The provision of adequate healthcare for people with disability is hindered by a lack of basic
healthcare services for both the prevention and rehabilitation of disability, problems with the
supply of assistive devices, a general insufficiency of funds, and a lack of trained health care
workers, particularly in rural areas. Puskesmas (Community Health Centers) are the
backbone of primary health care in Indonesia, but there is critical shortage of doctors
servicing these centres. The ratio of doctors to people is 2.9 per 10,000 people. According to
Legal frameworks:
• Ministry of Health’s Regulation No 28/2011 guarantees accessible health services for
persons with disabilities
• Ministry of Health’s Regulation No. 75/2014 on Community Health Centre articles 10
and 11 stipulate the importance of accessibility in accordance with the Law of
Government Building. The ministry of health has also produced regulations on
prosthetics, occupational and speech therapy (Kemenkes, 2012).
19 | P a g e
a World Bank Report in 2013, there about 2,250 Community Health Centres of which 25 per
cent were without a doctor with most of these located in remote areas (Suharyadi et al.,
2014). WHO (2012) reported the ratio of physicians to patients as one of the lowest among
ASEAN countries (Indonesia, Development, Affairs, Council,  Sciences, 2013; WHO,
2012b).
Most rehabilitation services are available in Rumah Sakit Umum (The District level
Public Hospital) and Rumah Sakit Umum Pusat (the provicial level Public Hospital). Early
prevention of disability is provided by Puskesmas and and Bidan Desa (Village Midwife)
(WHO, 2012a). However, due to a lack of awareness many do not pursue medical
rehabilitation as it is an embedded cultural belief that disability is the result of sin, a reliance
on traditional healers in rural areas, and a lack of resources to prioritize lifesaving measures,
rather than the effects of inadequate healthcare (Kusumastuti et al., 2014).
Kusumastuti et al., (2014) found that the Ministry of Health’s medical rehabilitation
program for people with disability mainly focused on leprosy, while rehabilitation facilities
such as physiotherapy, speech therapy, occupational therapy, vocational therapy and
prosthetics are limited to Central Hospitals located at the capital cities (Kusumastuti et al.,
2014). There are lack of health facilities in rural areas with most concentrated in urban areas.
There is also a lack of capacity amongst government staff, a lack of human resources for
health workers, and a lack of funds to cover assistive devices. The financial coverage level
for assistive devices is very low and often depends on the local government’s ability to secure
monies from the national budget allocation and the ability of DPOs to access this form of
support (Adioetomo et al., 2014).
20 | P a g e
Education
Inclusive education is very complex as it requires extensive resources, and the concept itself
is still under debate because some types of disability cannot easily be integrated into
mainstream schools, which require additional funding and school resources to meet a wide
range of individual student needs. Specially trained teachers and teacher’s aides as well as
modifications to assessment and to the physcial school environment are often required for
successful integration of children with disabilities into mainstream schools. This is an
ongoing challenge for schools with limited resources. Nonetheless, education is one of the
main channels to employment and broadersocial participation, and is often considered the
gateway to an inclusive society.
In Indonesia inclusive education is mainly practiced at the primary and secondary
level where each district/city government is madated to implement a policy of inclusive
practice. The Government’s Circular Letter No. 380/G.06/MN of 2003 represents a
significant move towards Inclusive Education (Adioetomo et al., 2014). It was embraced with
great enthusiasm by the 2004 Bandung Declaration and 2005 Bukit Tinggi
Recommendations. In 2007, the Directorate on Special Education and Directorate on General
Elementary and Secondary Education produced a standard of operation for inclusive
Legal frameworks:
• Law No. 20 of 2003 of the National Education System stipulates the obligation to
administer special and equal education for people with disability.
• Government Regulation No. 10 of 2010 states that education must admit students
without discrimination, including discrimination on the basis of their physical and/or
mental condition.
• The Government’s Circular Letter No. 380/G.06/MN of 2003 mandating inclusive
education (Adioetomo, Mont,  Irwanto, 2014, p. 25).
• The Minister’s Regulation on Inclusive Education No 70/2009 (Kemendiknas, 2009)
requires districts to have at least one inclusive school. Education is divided into two
curricula of national standardised tests and a pass/fail local standard.
• Law No. 12 of 2012 on Higher Education, article 32 guarantees equal rights for people
with disability, embracing the principle of equity or reasonable adjustment
(Kemendikbud, 2014).
21 | P a g e
education. This covers the philosophy of inclusive education, which includes alternative
approaches to curriculum development, dependent on a child’s learning needs, and alternative
measures for assessing achievement, including grading procedures (Adioetomo et al., 2014,
p. 25). It is supported by Government Regulation No. 10 of 2010, which prohibits
discrimination against people with disability at all level of education (Irwanto, Kasim,
Fransiska, Lusli,  Siradj, 2010).
A recent report from the Ministry of Education and Culture (MoEC) revealed that
about 70 per cent of children with a disability had no access to education. Children with a
disability acquired earlier than 15 years of age are five times more likely to not enrol in
elementary education in comparison to those whose disability was acquired after the age of
fifteen years (Adioetomo et al., 2014). Limited capacity to implement inclusive education is
obvious within the Indonesian educational system. In Sukoharjo, for example, inclusive
education accomodated only 10 per cent of children with disability; they were educated at
public and private schools (Irwanto et al., 2013).
According to a recent report, Indonesia has 2,500 inclusive schools at primary and
secondary levels with most of these in West Sumatra. By comparison, there are 1,720 special
schools in Indonesia at the primary and secondary levels. Of the special schools, 70 per cent
are privately owned. (Adioetomo et al., 2014). At the same time, most of the budget for
inclusive education goes to public schools (Irwanto et al., 2013). In general, this indicates the
importance of involving private schools and encouraging them to become inclusive. Special
schools are reported to be inefficent and unfeasible. This is because special schools
technically often cover a larger area than regular schools. This seggregated setting is costly
for it requires a sufficient transportion system, which in turn increases educational fees.
Moreover, the existence of the special school reinforces stigma and exclusion as well as
reducing the pressure for non-special schools to adopt and implement a policy of disability
inclusion (Adioetomo et al., 2014).
Inclusive education is far from being fully implemented. One of the reasons for this is
that inclusive education entails integration or normalisation, which requires the acceptance of
standardised tests and curricula (Minister Regulation No. 70 of 2009 on inclusive Education).
In line with this, many teachers think that the inclusion and integration of children with a
disability means simply to bring them into the standard school setting and apply the same
standards of assessment. However, this approach is unlikely to result in equal outcomes for
students with disability without student specific disability adjustments and modifications
22 | P a g e
being made. Structural barriers to education are another reason given for low attendance for
students with a disability. For example, many government education officers and teachers
believe that children with intellectual disabilities are uneducatable (Adioetomo et al., 2014).
Moreover, inclusive schooling is often perceived as degrading a school’s academic
performance. Contributing to this is parental perception who see inclusive eduaction as
potentially jeopardising the standard of education received by their non-disabled children
(Adioetomo et al., 2014).
At the tertiary level, inclusive education is very rare and limited to particular courses.
For example, the University of Sebelas Maret-Solo has implemented inclusive education,
supported by UNESCO, but only for education courses (Rustam, 2012). Moreover, the role of
national and local governments’ in promoting inclusive education at the tertiary level is
unclear. Both national and local governments have been unable to respond to the on going
discrimination at the tertiary education. For example, a student was accepted into a course by
the faculty of construction at IKIP (Institute for Education) Yogyakarta, but when it was
revealed that he had a vision impairment, the university suggested he enrol in Special
Education Teaching degree. The student refused and finally dropped-out (Colbran, 2010). A
complaint to MoEC was addressed by the National Commission of Human Rights (Komans
HAM), but there was no response. The educational department of the local government also
failed to respond. It is therefore likely that it is up to tertiary institutions to develop inclusive
programs in the absence of government intervention. Even though there are inclusive
education programs at the tertiary level, there are barriers to full implementation. According
to Adioetomo et al., (2014) there are three major concerns surrounding the implementation of
inclusive education at the tertiary level. These include the inaccessibility of education
facilities, which discourage people with disability from enrolling, a bias in the selection
system, a lack of protocols for liasing with prospective students with disability, and a lack of
awereness amongst educational practioners, administrative staffs and lecturers about the
needs of people with disability (Adioetomo et al., 2014).
23 | P a g e
Employment
By law, Indonesia guarantees the rights of people with disability to employment. However,
there are almost no existing programs to meet the 1 per cent of 100 quota for people with
disability to be employed, including in the government sector (Irwanto et al., 2010).
Moreover, there is a contradiction in employment laws. On the one hand, some laws stipulate
the rights of people with disability to employment, such as the Law No. 4 of 1997 and Law
No 13 of 2003 on Manpower, which states that people with disability cannot be dismissed
based on their illness or disability. However, an employee can be dismissed if they are
incapable of carrying out their duties for up to 12 months (article 153 and 172). The Joint
Decree between the Ministry of State Apparatus and Ministry of Internal Affairs
No.01/SKB/M.PAN/4/2003 and No. 17/2003 also provides a legal basis for terminating or
rejecting an applicant based on their disability (Adioetomo et al., 2014). The Joint Decree
reflects the rampant discrimination against people with disability (Irwanto et al., 2010) and
conflicting legal-frameworks (Colbran, 2010; Nursyamsi, 2014). In addition, disability is also
often used as a means to terminate family relations (Adioetomo et al., 2014). Law No. 1 of
1974 on Marriage and Government Regulation No. 9 of 1975 enables a divorce based on
disability (Irwanto et al., 2010).
Programs to equip people with disability with working skills are mainly the domain of
the MoSA, which has established various vocational training schemes in the form of social
rehabilitation. Programs are designed to develop skills in tailoring, computing and electrical
work, mechanics, massage, carpentry and so forth. Similarly, vocational training was also
Legal frameworks:
• Law No. 40 of 1997 asserts the obligation of companies to employ 1 per cent of people
with disability for every 100 employees.
• Minister of Manpower’s Decree No 205/MEN/1999 on Training and Work Placement of
Persons with Disabilities emphasises the role of government in establishing training
programs for people with disability.
• Law No. 13 of 2003 on Manpower article 19 highlights the importance of adjustment in
job trainings for workers with disabilities and the prohibition of work termination based
on illness and disability up to 12 months unless the persons unable to carry out the duties.
24 | P a g e
provided by the Ministry of Manpower and Transmigration (MoMPT). However, many
vocational trainings centers are not inclusive in practice due to the recruitment process and
the inaccessibility of buildings and educational materials (Irwanto et al., 2013).
Accessibility
Irwanto et al. (2013) argues that accessibility is one of the most essential steps, if not the first,
to inclusion of people with disability. Accessibility sustains the necessary supports for
independence and mobility so that everyone can physically move and participate in the
community (Irwanto et al., 2013).
Local governments are essential to implementing accessible buildings. There has been
some improvement in the accessibility of public facilities due to pilot projects in 255
locations targeting education, health and government facilities (Irwanto et al., 2010).
Legal frameworks:
• Law No. 28 of 2002 on the Construction of Buildings stipulates that facilities must be
accessible for people with disability (ILO, 2013). This was followed by a Minister
Regulation of Public Work No 30/Prt/M/2006 on Technical Guidelines for Facilities and
Accessibility (Kemenpu, 2006).
• Law No. 1 of 2009 on Aviation, particularly article 134 ensures the rights of persons with
disabilities to travel on aircraft.
• Law No. 23/2007 on Railway requires accessibility for persons with disabilities.
• Law No. 22/2009 on Roads and Transportation requires accessible roads and public
transport for persons with disabilities
• Law No. 24/2007 on Disaster Response article 55 stipulates the priority for the most
vulnerable groups, including people with disability.
• Law No. 12 of 2003 highlights the political rights of people with disability to have equal
rights, stressing access to and provision of accessible ballot papers for people with vision
impairment.
• Ministry of Health’s Regulation No 28/2011 guarantees accessible health services for
persons with disabilities
• Minisitry of Health’s Regulation no 75/2014 on Community Health Centre articles 10 and
11 stipulate the importance of accessibility in accordance to the Law of Government
Building. (Kemenkes, 2012).
25 | P a g e
However, observations in major cities such as Jakarta and Bandung also show that many
public facilities and infrastructure are not disability friendly (Irwanto et al., 2013). In Jakarta,
for example, people with disability experience difficulties to social participation due to
uneven pedestrian ways, inaccessible public transportation, inaccessible religious facilities,
public toilets and baths (Adioetomo et al., 2014). Reports indicate that disability protection
laws and regulations are poorly enforced with sanctions rarely applied, even when there is a
failure to comply with the laws and regulation. Moreover, there are almost no procedures for
lodging complaints if disability accessibility laws are not implemented in practice (Colbran,
2010; Irwanto et al., 2013).
Non-Governmental Community Care
According to Irwanto et al. (2013) community care is traditionally provided by local people
for children with disability and the elderly. This aligns with the Community-Based
Rehabilitation (CBR) approach, which aims to help local communities be inclusive to people
with disability by delivering community based support programs. As recommended by WHO
and the CRPD, CBR is a substantial strategy for protection of people with disability (WHO,
2010). Sukoharjo is an example of a local government that has legislated local regulation to
support the CBR Program (Irwanto et al., 2013).
As reported by UNESCAP, the Indonesian government runs CBR programs in 16
provinces (WHO, 2012a). However, it is not clear whether the programs still exist. It is likely
the CBR program mostly developed through the work of CBM (Christian Blind Mission) in
collaboration with local and national service providers with limited support from various
local governments.
Challenges
In general, as quoted by Oddsdottir (2014) and Rohwerder (2014), there are persistent
challenges to the inclusion of people with disability into social protection programs in
developing countries. The first challenge is a lack of data and hence understanding of the
needs of people with disability, which leads to expensive and unreliable targeting of program
initiatives. Secondly, there is a lack of proper assessment and monitoring, which emphasises
the costs associated with research and the implementation of rigorous data collection
processes. Thirdly, many of the beneficiaries of social protection schemes spend more time
26 | P a g e
trying to access their benefits due to a lack of an effective administration system,
geographical barriers, and lack of accessible transportation, than actually receiving them.
Many people with disability are also not aware of the social protection schemes that exist and
therefore do not know how to access them. Fourth, budget constraints and the challenges
involved in resource allocation that flow from this can trigger social tensions due to
perception of the uneven distribution of benefits. Lastly, if the eligibility to claim social
assistance is framed by the ‘incapacity to work’ there is a disincentive to participate in the
labour market (Oddsdottir, 2014; Rohwerder, 2014).
Ongoing challenges to social support for people with disability include:
1. General prejudice toward people with disability
The charity and medical perpectives of disability still underpin policy approaches to
people with disability in Indonesia. These perspectives are entrenched in legal frameworks as
well as in the the perceptions of government staff and the broader community (Adioetomo et
al., 2014).
2. Conflicting Legal Frameworks and Law enforcement
Despite extensive disability protection laws, programs actually enhancing the life of
people with disability are scarce. This is because there are conflicting legal frameworks that
‘in some cases discriminate against people with disability’ (Colbran, 2010), as is the case in
disability employment laws. While the Disability Law and the Ministry of Manpower
stipulate the right to employment, other ministries such as the Ministry of Government
Apparatus dicriminates against people with disability. The discrimination is apparent in the
process of selection for government employees in which one of the criteria of eligibility is
based on being physically and mentally healthy (Adioetomo et al., 2014; Nursyamsi, 2014).
On the other hand, many of the existing legal frameworks are not well-enforced.
GIZ’s evaluation of social protection policy in Indonesia maintains that awareness of
disability is still very low despite the existence of legal protection frameworks for disability.
Aviation Law obligates that commercial airflights and airport facilities meet the needs of
people with disability, but in practice they are still not allowed to travel unaccompanied by a
person without a disability. If a person with disability is accompanied then the aviation
carrier is not responsible for any damage, loss or accident (Colbran, 2010).
There is demand for the establishment of governing and monitoring bodies to enforce
the implementation of legal frameworks (Colbran, 2010). Sudibyo Markus, an ILO
27 | P a g e
commissioner, described a similar observation in which Indonesia had advanced in its legal
instruments, ‘but that implementation was significantly weak’ (Irwanto et al., 2010, p. 3).
Equally, Vernor Munoz, UN Special Rapporteur on the Right to Education, made a report
that the Indonesian Government ‘lacked the political will to achieve the universal goal of
inclusive education’. Munoz observed that there are huge gaps between the availability of
resources and the normative framework for enforcing the rights for inclusive education
(Irwanto et al., 2010).
3. Decentralisation and lack of resources
The structure and culture of policy making, especially in the context of
decentralization (Sutmuller  Setiono, 2011), impacts Indonesia’s inclusion of people with
disability (Adioetomo et al., 2014). Ministerial regulations, for example, are often in conflict
with local legislation (Irwanto et al., 2010). These legal tensions contributes to low
integration of people with disability in social suport programs. Moreover, programs are
highly dependant on the political will of local leaders such that a lack of local government
understanding on disability rights limits the scope of the translation of national policy into
provincial, district and municipal programs.
District and municipal governments spend up to 80 per cent of their budget on wages
(Indonesia et al., 2013), leaving little for program and policy development. Therefore,
disability programs are reliant either on the availability of national funds from the Specific
Allocation Fund (DAK-Dana Alokasi Khusus) or the ability of local governments to generate
sufficient revenue (Miranti et al., 2013).
4. Statistical invisibility and marginalisation of knowledge sector
Statistical invisibility is apparent given that government data varies between
departments, units and agencies. There is sectoral distrust of local government bodies on
statistical data due to the incapacity of Bappeda’s (Local Development Planning Agency) to
conduct monitoring and evaluation, resulting in the reuse of old data, and continuation of
reproduction of outdated programs designed around this data (Sutmuller  Setiono, 2011).
The lack of disaggregated data establishes a disparity for adequate policy in enhancing the
living standard of people with disability (Adioetomo et al., 2014; Irwanto et al., 2010), which
has serious implications for how to deal with disability ‘in the post-MDG era’ (Liu  Brown,
2015).
28 | P a g e
The utilisation of research in policy formulation is very rare in Indonesia, especially
when it deals with the decentralization (Sutmuller  Setiono, 2011). As studied by Sutmuller
and Setiono the knowledge sectors are often marginalized from policy design. The
knowledge sectors in government, known as Balitbang (Research and Development Agency),
are important but are apparently are ill resourced with researchers having, ‘low qualifications,
low skill levels and low remuneration’(Cislowsky  Purwadi, 2011, p. 2).
5. Low DPO participation
DPOs are not well resourced and are poorly represented at the national and local level
in Indonesia. They generally have low capacity to bring about change for people with
disability due to low management and advocacy skills, networks and limited financial
resources (Alliance, 2012). The identified national DPOs are limited to the Indonesian
Disability Union (PPCI-Persatuan Penyandang Cacat Indonesia), Pertuni (The Blind Union),
Indonesian Disabled People Association (PPDI-Perhimpunan Penyandang Disabilitas
Indonesia), Disabled Peoples’ International, Indonesian Association for Disabled Women
(HWPCI), the Deaf Welfare Movement (Gerkatin), and the Perhimpuan Jiwa Sehat
(representing persons with psychiatric disability or mental health problems in Indonesia). The
rest consist of national and local disability services that provide institutionalised and
community-based services.
DPO involvement in research, planning, monitoring and evaluation of disability social
protection is very rare. Yet the involvement of DPOs is indispensable in the construction and
implementation of inclusive programs, as opposed to their design by professionals in a ‘top-
down, charity-like, professionals- know-best’ approach (Albert, 2006, p. 2; Swartz, 2009).
Opportunities
1. Comprehensive disability rights-based legal frameworks
The ratification of the CRPD is considered to be the corner stone for the full inclusion
of people with disability in Indonesia. Future legislation on disability law must accord with
the principles of the CRPD.
29 | P a g e
2. Strengthening the existing social security system
The existing social security system has been very useful in protecting society from
shocks and risks. However, people with disability are still less well integrated into social
protection policies and programs. Nonetheless, Joko Widodo’s policy on welfare, which
scraps budget waste of petrol subsidies and allocates it to targeted programs in education and
health and improved productivity measurements, can be seen as a step toward the
development and strengthening of disability social protection programs.
3. BPJS Employment
BPJS Employment has expanded its program to target independent workers. This
could be a gateway to including people with disability. However, this opportunity requires
the involvement of other stakeholders such as MoSa and MoMPT to improve the capacity
of people with disability to gain employability skills.
4. New Decentralisation Law
The newly enacted Local Government Law No 23 of 2014 reshapes the position of
local and national governments, giving local government less power so that the national
government can fully implement national agendas, policies and programs. However, given
this is a very recent development, futher research on its impact on social protection programs
and the inclusion of people with disability is required.
5. Revitalising the role of Balitbang (Agency for Research and Development)
The existence of Balitbangs in government will help leaders make informed decisions
based on reliable data and research, informing the development of future policies and
programs aimed at the better inclusion of people with disability.
6. Wider Stakeholders Participation
Many local and international organisations share similar interests in mainstreaming
disability in developing countries. It is also in the interests of foreign government agencies to
acknowledge disability as a cross-cutting issue in inter-government cooperation and
30 | P a g e
partnerships. The role of private enterprise in supporting socially inclusive programs also
offers future opportunities for increasing the social participation of people with disability.
7. DPOs participation
There is greater opportunity to empower DPOs to act in the interest of people with
disability. Involvement of DPOs is essential in order to develop the most reliable system and
effective policy for removing physical barriers to the full participation of people with
disabilities.
Conclusion
The situation of people with disability in Indonesia is very challenging. The challenges are
entreched in legal framewoks, disability statistics, social and cultural perceptions of
disability, political motivation, government structures, powerless DPOs and the scarcity of a
budget. Overcoming these challenges will involve implementing a robust disability data
collection measure and aligning existing legal frameworks for disability protection by
implementing the principles of the CRPD at all levels of government. As part of this,
adequate protocols for the enforcement of disability rights, including increasing the coverage
of disability health benefits, implementing inclusive education practices and continuing to
work with DPO’s on the development of social protection programs, are necessary future
steps. The involvement of research-based bodies to assist in data collection, monitoring and
evaluation is critical to the continued innovation of disability programs and policies. The full
inclusion of people with disabilities is a necessary part of Indonesia’s commitment to
development and to delivering national goals as mandated in the constitution.
31 | P a g e
32 | P a g e
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Report on Indonesia's Social Protection for PwD

  • 1. 1 | P a g e Š‡ ‘••ƒŽ •–‹–—–‡ ˆ‘” Ž‘„ƒŽ ‡ƒŽ–Š SOCIAL PROTECTION FOR PEOPLE WITH DISABILITY IN INDONESIA Internship Report With the Nossal Institute for Global Health Written by Sihar Alaris Sinaga ID No: 614585
  • 2. 2 | P a g e ƒ„Ž‡ ‘ˆ …‘–‡–• Acronyms …………………………………………………………………………………………………………..………….…….3 Executive Summary.................................................................................................................................5 Social Protection for People with Disability in Indonesia........................................................................7 Introduction.............................................................................................................................................7 Methodology.......................................................................................................................................8 Disability in Indonesia .............................................................................................................................8 Disability Social Protection Legal Frameworks in Indonesia.............................................................13 Social Protection Strategies and Programs in Indonesia.......................................................................13 Insurance-based Social Security........................................................................................................14 Health Insurance ...........................................................................................................................15 Social Insurance.............................................................................................................................16 Non-Insurance based Social Protection ............................................................................................17 Social Assistance............................................................................................................................17 Health............................................................................................................................................18 Education.......................................................................................................................................20 Employment ..................................................................................................................................23 Accessibility ...................................................................................................................................24 Non-Governmental Community Care ...........................................................................................25 Challenges .............................................................................................................................................25 Opportunities ........................................................................................................................................28 Conclusion.............................................................................................................................................30 References.........................................................................................................................................32
  • 3. 3 | P a g e Acronyms ƒn† A„„r‡˜‹ƒ–‹ons Askes National Health Insurance for Government Workers Asabri Insurance for Military Personnel ASEAN Association of South East Asian Nations Askesos Social Insurance for Informal Sector Workers Balitbang Government’s Research and Development Agency Bappeda Local Development Planning Agency Bappenas National Development Planning Agency BLT Unconditional Cash Transfer BPJS Badan Penyelenggara Jaminan Sosial (Implementing Agency for Social Security) BPS Centre for National Statistical Agency CBM Christian Blind Mission CBR Community Based Rehabilitation CRPD United Nations Convention on the Rights of Persons with Disability DAK Dana Alokasi Khusus (Specific Allocation Fund) DAU Dana Alokasi Umum (General Allocation Fund) Gerkatin the Deaf Welfare Movement GIZ Gesellschaft für Internationale Zusammenarbeit HWPI Indonesian Association for Disabled Women-Himpunan Wanita Penyandang Cacat Indonesia IKIP Institute for Education ILO International Labor Organization Jamkesda Local Government Health Insurance Jamkesmas National Health Insurance Jamsostek National Social Insurance for Private Employees JSPCB Social Assistance for People with Severe Disability
  • 4. 4 | P a g e Komnas HAM National Commission for Human Rights MDGs Millennium Development Goals MoEC Ministry of Education and Culture MoMPT Ministry of Manpower and Transmigration MoSA Ministry of Social Affair NAP National Action Plan PBI Social Assistance for Health Insurance Pertuni The Blind Union PKH Family of Hope Program PPCI Indonesian Disability Union -Persatuan Penyandang Cacat Indonesia PPDI Indonesian Disabled People Association-Perhimpunan Penyandang Disabilitas Indonesia) Prolegnas National Legislation Program Puskesmas Community Health Center RAD Rapid Assesment of Disability Riskesdas Basic Health Research RPJMN Medium-term National Development Strategy SJSN National Social Security System Susenas National Economic Survey Taspen Government’s Workers Retirement Fund UNESCAP United Nations Economic and Social Commission for Asia and the Pacific UNESCO United Nations Educational, Scientific and Cultural Organization WG Washington Group Disability Statistics WHO World Health Organization
  • 5. 5 | P a g e Executive Summary This report provides a review and analysis of social protection policies for people with disability in Indonesia. The purpose is to identify the challenges and opportunities of current strategies and programs for the realisation of disability rights in Indonesia. A review of the literature, as presented in this report, shows that structural prejudice against people with disability, combined with conflicting legal frameworks, inconsistent implementation of regulation, and poor law enforcement, present major challenges to the realisation of disability rights in Indonesia. There is a general failure to implement national disability protection policies at the provincial and district levels of government, which combined with statistical invisibility, a lack of demand for evidence-based policy, and ongoing budget constraints, leads to poor monitoring and follow up of disability action policies. The Indonesian approach to disability is paradigmatically framed in terms of charity and medical models of disability, which are apparent in various legal frameworks and policies. Existing legal frameworks cover political and social rights, including access to health care, pensions, social assistance, education, public facilities and infrastructure; however, disability is still influenced by medical discourses in which it is regarded as a biological or psychological defect, rather than a socially mediated condition that is enabled or disabled by social policies. Indonesia’s recent commitment to implement the United Nations Convention of the Rights of Persons with Disabilities (CRPD) and to establish a universal social protection system for health and employment are positive developments. Current policies to reallocate the fuel subsidy fund into a ‘productivity and human development’ welfare program and to revitalize the role of balitbangs (research and development agencies) for the development of evidence-based policy, if properly pursued may overcome one of the major challenges to the formulation of disability policy, namely the lack of adequate data. Opportunities for future development of social protection policies for people with disability include: • Implementing a robust disability measurement to overcome data inconsistency;
  • 6. 6 | P a g e • Greater involvement of balitbangs for improved policy formulation and data collection measures. • Enabling greater participation of Disabled People’s Organisations (DPOs) for the development of more inclusive policies and programs; • Reforming existing legal frameworks to reflect a rights-based approach to disability; • Improving law enforcement and implementation of disability action policies between different levels of government; • Increasing the coverage of disability health benefits to include long term care and affordability and accessibility of assistive devices
  • 7. 7 | P a g e Social Protection for People with Disability in Indonesia ‘…people with disabilities in Indonesia are at a disadvantage. They are poorer, less educated, less employed, and more isolated and at times feel they are a burden on their family. To ensure full rights for all of its citizens Indonesia needs to pursue inclusive policies in line with the goals of the UNCRPD and Ministerial Declaration on the Asian and Pacific Decade of Persons with Disabilities, 2013–22’ (Adioetomo et al., 2014, p. xviii). Introduction Social protection is understood as every strategy, policy, or program which aims at assisting individuals, families, and communities ‘against shock and risk’ (de Haan Conlin, 2000, p. 36). It involves extensive government policies and programs aimed at responding to the problem of poverty and the potential of risk and vulnerability faced by community, including those with a disability (Conway, Haan, Norton, 2000). Broadly, social protection emphasises a government’s attempt to guarantee security of living and access to basic services such as food, water and sanitation, alongside social services such as pensions, healthcare and education for all its citizens (Yulaswati, 2014). It has two dimensions: policies and programs aimed at ensuring universality of protection based on risk and vulnerability, and specifically targeted programs that progressively increase the living standards of the poor and marginalised (de Haan Conlin, 2000; Yulaswati, 2014). Instruments of social protection can be divided into the three elements of ‘insurance-based policies, social assistance, and other instruments’ (Conway et al., 2000, p. 12). Social protection for people with disability is not limited to cash transfer social assistance and insurance-base social security. Rather, it covers sectors such as education, health, employment and so forth. Disability is a complex issue and can change overtime. Disability is conceptualised by the CRPD as: …an evolving concept…[that] results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis with others. (United-Nations, CRPD Preamble,e) It is essential that social protection for people with disability is based in a government approach that includes ‘political will, appropriate legislation, economic resources and implementation mechanisms’ (Mleinek Davis, 2012, p. 6).
  • 8. 8 | P a g e This paper aims to document Indonesian social protection policies for people with disability, including strategies and programs, challenges andopportunities for further development.. Objectives: • To analyse social protection policies, strategies, and programs for people with disability in Indonesia • Identify key challenges and opportunities for the realisation of disability rights in Indonesia. Methodology This paper is developed primarily through a literature review of key documents on disability in Indonesia produced by Indonesian government agencies and international governmental bodies. Literature reviewed included documents from the National Development Planning Body (Bappenas), the National Team of Acceleration of Poverty Reduction (TNP2K), the Australian Department of Foreign Affairs and Trade (DFAT), the International Labour Organisation (ILO), the World Health Organization (WHO), the World Bank, and the United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP). Journal articles, online publications and newspaper articles were reviewed as part of an extended literature review, and are used in this report to support theoretical perpectives on disability and social protection. All literature was published in English or Indonesian. Where possible, the review has been supplemented with personal communication with individuals currently working with people with disability in Indonesia. Disability in Indonesia Indonesia has the world’s fourth-largest population with an estimated 250 million people living in the archipelago of about 17,000 islands. The island geography of Indonesia and its cultural diversity is often cited as one of the main challenges to governing the state and meeting national goals such as social justice for people with disability. Social protection for people with disability in Indonesia is primarily framed by the charity and medical models of disability, which underpin legal frameworks of disability protection. The legal terms used to refer to people with disabilities emphasise the person’s physical and/or mental abnormality
  • 9. 9 | P a g e relative to people without disability (Irwanto, Supriyanto, Yulianto, 2013). The term penyandang cacat, used in Disability Law No.4 of 1997, for example, refers to a biological or psychological defect, of a state of being that is less than an ideal - imperfect, whereas kelainan, another term for disability, means more simply abnormality. These terms reflect how disability is culturally understood in Indonesia, and hence the assumptions that underpin legal frameworks governing disability policy, which parallel how charity and medical models tend to frame disability. The charity model, for example, understands disability as the individual’s problem; disabled persons are therefore treated as either subjects for charity, inspirational individuals, or subjects to be pitied (Mannan, 2014). This understanding is sociologically categorised as personal tragedy (Anastasiou Kauffman, 2011). The medical model, by contrast, focuses on the individual’s bodily dysfunction from a healthcare perspective. The emphasis of this model is therefore on ‘fixing’ the body so that it can function without broader social or environmental adjustments having to be implemented. Both of these models focus on the individual as the site of disability and hence ‘defect’. Both models tend to ignore the social dimension of disability, and the role of social attitudes in creating barriers to the full inclusion of people with disability (Anastasiou Kauffman, 2011). These models result in a paternalistic approach to disability marked by segregation and discrimination (Mannan, 2014). These models underpin Indonesian government policies and community attitudes towards people with disability. People with disability are culturally stigmatised, which reinforces discriminatory disability policy (Colbran, 2010). There is still a rampant belief amongst Indonesians that disability is caused by a curse for an ancestor’s sin. As a consequence, many people with disability are hidden away from society, with families often feeling a sense of shame for having a family member with a disability. Disability is also often associated with weakness and the incapacity to be independent; it is therefore perceived as a family burden (Kusumastuti, Pradanasari, Ratnawati, 2014). Indonesia is a signatory of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), signed in 2007, and ratified in 2011. This recent development signifies the Indonesian government’s commitment to mainstreaming and integrating disability as a cross-cutting issue for sustainable development with the obligation to protect, respect and fulfil the rights of people with disability (United-Nations, 2006). Disability Law (1997 articles 17 and 18), prior to the 2011 ratification of the CRPD, focused solely on the bodily functions of a person with disability and on their rehabilitation via the provision of medical services, assistive devices and education and training. Yet under this law there was
  • 10. 10 | P a g e little recognition of or consideration given to the broader social context that either enabled or disabled a person with a disability to have wider participation in the community. Indonesia’s signing of the the 2007 CRPD is therefore considered to represent a paradigmatical shift in the government’s understanding and approach towards disability. The draft of a new disability law has been submitted to the Program Legislasi Nasional (Prolegnas - the National Legislation Program) commission and is expected to reflect the principles of the CPRD ratified by the Indonesian government (Kemenkumhamnas, 2010). The drafting of this law has involved the intensive participation and contribution of an extensive list of stakeholders, including the Human Rights Commission, universities, civil society groups and DPOs (FAT, 2015). However, due to national political tensions the Parliamentary Law and Local Government Election Laws were prioritised in 2014 and the legislation of Disability Law has been deferred to 2015 (Nursyamsi, 2014). The World report on disability in 2011 estimates that 15 per cent of the global population lives with a disability (WHO, 2011). However, most governments in developing countries report to have about 4.6 per cent of people living with disability (UNESCAP, 2013). This may be an under-estimation due to the lack of a common definition of disability as well as a lack of reliable data collection methods. Like many other developing countries, Indonesia has a lack of reliable data on disability. Reports suggest that unreliable statistical data on disability impedes the formulation of quality policies and programs (Adioetomo et al., 2014; UNESCAP, 2013). A study conducted by Gesellschaft für Internationale Zusammenarbeit (GIZ) suggests that social protection programs might not meet the needs of people with disability because data collection and measurement techniques are not specifically designed to identify the needs of people with disability (Mleinek Davis, 2012). The statistics on disability prevalence in Indonesia are inconsistent and vary between agencies. There are three main data sources on disability in Indonesia. These are the National Statistical Agency (BPS), the Basic Health Research Survey (Riskesdas) conducted by the Ministry of Health, and the National Economic Survey (Susenas). The 2010 BPS national census, which adapted the Washington Group (WG) short set questions, found an overall prevalence of disability is only 4.3 per cent, which is extremely low compared to countries using similar data collection measures. The 2010 BPS national census asked the first three questions of the WG and modified the rest. The responses were reduced from the standard four categories (No, no difficulty; Yes, some difficulty; Yes, a lot of difficulty; Cannot do
  • 11. 11 | P a g e at all (United-Nations, 2014)) into three categories (None; a Little; a Lot) (Adioetomo et al., 2014). The questions for the BPS 2010 census were: 1. Do you have difficulty seeing, even when wearing glasses? 2. Do you have difficulty hearing, even when using a hearing aid? 3. Do you have difficulty walking or climbing stairs? 4. Do you have difficulty remembering, concentrating, or communicating with others due to a physical or mental condition? 5. Do you have difficulty in self-care? By contrast, the standard questions recommended by the WG are: 1. Do you have difficulty seeing, even when wearing glasses? 2. Do you have difficulty hearing, even when using a hearing aid? 3. Do you have difficulty walking or climbing steps? 4. Do you have difficulty remembering or concentrating? 5. Do you have difficulty (with self-care such as) washing all over or dressing? 6. Using your usual (customary) language, do you have difficulty communicating, for example, understanding or being understood? (United-Nations, 2014) The BPS (2010) and Riskesdas (2007) have similar data on the types of disability and of those disabilities associated with aging, alongside a breakdown of disability as it corresponds with gender and geographic residence. Vision and physical impairments are the most common forms of disability (Adioetomo et al., 2014). The cause of impairments were mainly reported to be due to congenital factors, poor health care, and accidents (Adioetomo et al., 2014; WHO, 2012a). The association between aging and disability is a major contributing factor to the overall prevalence of disability. Indonesia is in demographic transition such that the number of persons above 60, as indicated in the National Census (2010), has reached 18.1 million. The forecast is that there will be 29.05 million people aged 60 and above in 2020 and 35.96 million in 2035. In 2018 this will mean that 10% of the total population will be aged over 60 (Adioetomo et al., 2014). Figure 1. below demonstrates the prevalence of disability across the Asia-Pacific as reported by each government. Different disability measurements were used by each state to assess the prevalence of disability (UNESCAP, 2013).
  • 12. 12 | P a g e Figure 1. Disability across the Asia-Pacific (UNESCAP, 2013) The BPS survey (2010) found that people over the age of 10 years had a disability prevalence of 4.74 per cent. Females reported a higher rate of disability (4.64 per cent) compared to males (3.94 per cent). However, the National Economic Survey (Susenas) of 2012 found disability prevalence to be less than the 2010 census, with a prevalence of only 2.45 per cent (Pusdatin-Kesehatan, 2014; Pusdatin, 2014). By contrast, the Riskesdas (Basic Health Research, 2007) found disability prevalence to be around 11 per cent in Indonesia. Adioetomo et al. (2014) estimate that disability prevalence is between 11 and 15 per cent based on a metaanalysis of existing statistical data. The Riskesdas 2007 survey was very comprehensive; it adopted International Classification of Functionings (ICF) questions that addressed functional and activity limitations. This was similar to the Riskesdas 2013, which adopted WHODAS (WHO Disability Assessment Schedule). It showed that people above 15 years have a disability prevalence of 11 per cent, excluding vision impairment (Pusdatin-Kesehatan, 2014).
  • 13. 13 | P a g e Legal frameworks: • Government Regulation No. 25 of 2000 regulates the obligations of central and local governments in respect to people with disability. • Law No. 40 of 2004 on the National Social Security System (Sistem Jaminan Sosial Nasional or SJSN) provides a legal basis for universal social protection that includes people with disability (Priebe Howell, 2014). • Law No. 11 of 2009 on Social Welfare contains subsequent regulations for social assistance, particularly the articles 4 and 5 (Priebe Howell, 2014) • Government Regulation No. 101 of 2012 on Eligibility of Social Assistance for Health Insurance Premium (Penerima Bantuan Iuran-PBI) for BPJS Kesehatan Disability Social Protection Legal Frameworks in Indonesia The 1945 National Constitution, Article 27, Chapter 10, states that, “without any exception, all citizens shall have equal positions in law and government and shall be obliged to uphold that law and government. Every citizen shall have the right to work and to a living, befitting for human beings” (WHO, 2012a, p. 68). Article 34 of the constitution stipulates it is the State’s obligation to provide welfare for those who are destitute. The article expresses the inherent value of social justice for all Indonesians. However, the main legal instrument for disability protection is Law No. 40 of 1997. As argued above, this law reflects a charity and medical model of disability that frames disability in individualistic terms as a biological deficit. Current laws embody this understanding, failing to reflect a social and right-based approach to disability as embraced in CRPD (Colbran, 2010). Social Protection Strategies and Programs in Indonesia Social protection strategies for people with disability are outlined in The National Action Plan (NAP-Rencana Aksi/Renaksi) as part of Rencana Pembangunan Jangka Menengah Nasional (RPJMN-Medium-term National Development Strategy), but the implementation of this plan has been less than satisfactory (Adioetomo et al., 2014). NAP is strategic for it brings together all stakeholders of disability, including the National Police, Ministries of Justice, Social Affairs, Education, Health, General Work and Public Housing, Manpower,
  • 14. 14 | P a g e Transportation and others. The 2004-2013 National Action Plan for People with Disability was developed as a follow up to the 2002 ministerial meeting in Otsu-Shiga, Japan. The NAP aimed to implement the Millenium Biwako Framework by prioritising areas such as employment and healthcare. Included in healthcare are early detection measures, prevention through education, poverty alleviation through social security and capacity building, accessibile public facilities, and provision of assistive technologies. The presence of DPOs and carer support for children with disability alongside access to reproductive healthcare for women with disability are detailed in this framework (Adioetomo et al., 2014). The draft NAP 2014-2019 aims to establish and strengthen NAP implementing institutions, educate people with disability about their rights, and synchronize legal frameworks on disability. It aims to strengthen the civil and political rights of people with disability, allowing for their full participation in social, economic and cultural arenas. The NAP also aims to improve data collection, monitoring and evaluation of NAP programs, which will be reviewed on a 5 year basis (Bappenas, 2014). Overall, NAP 2014-2023 emphasises civil and political rights and the fulfilment of economic, social and cultural rights, alongside accessibility and the provision of accommodation (Kemenkumham, 2014). However, the emphasis of NAP 2014-2023 is on human rights rather than being specific to the rights of people with disability. Insurance-based Social Security Despite socio-political and economic challenges, the Indonesian government has nevertheless developed a universal social security system covering healthcare and pensions and people with disability. Passed as Law No. 40 of the National Social Security System (SJSN) in 2004 and followed in 2011 by Law No. 24 on the implemention of social security (Badan Penyelenggara Jaminan Sosial-BPJS), universal social security law came into effect in January, 2014. Law No. 24 (BPJS) consists of BPJS Kesehatan (Health Insurance) and BPJS Tenaga Kerja (Pension). The BPJS is accessible to every Indonesian who either makes an individual contribution to the scheme, or whose employer does so on their behalf. SJSN is an important step toward comprehensive integration of existing social protections (Suharyadi, Febriany, Yunma, 2014; Yulaswati, 2014). Prior to the implementation of BPJS, there were several social insurance agencies including Askes (Government’s Workers Health Insurance) Taspen (Government’s Workers Retirement Fund), Jamsostek (National Social Insurance for Private Employees) and Asabri (Insurance for Military Personnel), which
  • 15. 15 | P a g e offered employment based social security. These agencies were unified under Law No. 40, forming the BPJS. In order for people with disability to be able to access these funds they would have had to have been formally employed prior or consequent to acquiring their disability (Irwanto et al., 2013). For people with a disability acquired early in life or due a congenital condition there are few social protections, given that social insurance is tied to the ability to make payments to the insurance fund. Further to this, social protection for people with disability in the healthcare sector is problematic (Adioetomo et al., 2014) because benefit schemes do not cover the extent of disability rehabilitation, and they are not disability specific (Kusumastuti et al., 2014). Adioetomo, et al., (2014) suggest the establishment of a specific provision such as a Disability Insurance Scheme that is designed to provide comprehensive cover for people with disability, including long-term care and access to medical assistance, assistive devices such as wheelchairs, prosthectics, hearing aids, and so forth. Health Insurance Government Regulation No. 101 of 2012 on Recipients of Financial Assistance for Health Insurance (PBI-Penerima Bantuan Iuran) regulates the health insurance premium covering the poor, including people with disability. This is funded through the national budget. This regulation stipulates eligibility for government support. The recipients of this form of support must be defined as very poor with an inability to maintain their basic needs, or be able to meet their basic needs, but cannot pay the premium for his/her and family (Hukum-Online, 2013). The criteria for eligibility is determined by the Ministry of Health in coordination with the Ministry of Finance based on data and identification provided by the BPS. The data is verified and validated every 6 months (Government Regulation No. 101 of 2012 Article 11:4). One problem of the BPJS is that the government’s contribution towards the poor, as part of the PBI, is unsustainable. The contribution was set as IDR 19,225 (A$1.9), which is lower than the contribution of individuals making payments to the BPJS, which is IDR 27,500 (ADY, 2013). (Triyono, 2014). Irma Suryani, a member of parliament, who rejected a budget increase for the BPJS Kesehatan, expressed criticism of how the PBI data concerning recipients of the BPJS had been collected. She argued that figures estimating the number of future PBI recipients were inaccurate because they could not reliably be based on past
  • 16. 16 | P a g e recipient numbers, as there would be a significant change these within the 3 years between 2012 to 2015 (Hidayat, 2015). Moreover, she argued that it was unclear how six monthly data validation and verification procedures would be conducted, as emphasised in the Government Regulation No. 101 of 2012 Article 11:4. In practice, the validation and verification of data as stipulated in the 2015 National Budget did not eventuate because the PBI was based on outdated Susenas 2012 statistical data (Hidayat, 2015). Before the BPJS, there was a national health insurance scheme (Jamkesmas) for the poor as well as many local health insurance schemes (Jamkesda). While Jamkesmas was transformed into BPJS Kesehatan, there was no specific articulation on how local health insurances (Jamkesda) would be syncronised into the BPJS (Suharyadi et al., 2014). Nonetheless, a government report showed that many of Jamkesda insurances have been integrated into BPJS by which local governments fill the contribution gaps of PBI beneficiaries (BPJS, 2014b). This demonstrates that the gap between government contributions to the poor as part of the PBI has been filled through the integration of the local health insurance schemes with the BPJS. Social Insurance Social insurance managed by BPJS Employment is designed for employees and covers old- age savings, work accidents, pensions and death (Suharyadi et al., 2014). BPJS Employment has been expanded to cover individuals who work independently, such as contract-based construction workers (BPJS, 2014a). Since many people with disability work independently (Adioetomo et al., 2014), as masseaurs, technicians, and in other informal sectors, BPJS Employment needs to incorporate them into the program. Askesos (Askesos-Social Insurance for Informal Workers) is another social insurance scheme based on employment, which is programmed and administered by the Ministry of Social Affairs (MoSA), and provides benefits such as income maintenance to poor people who work in informal sectors (Habibullah Muchtar, 2009, p. 24). Membership is based on income, which must be no more than IDR 300,000 (Adioetomo et al., 2014; Martabat, 2013). Membership may vary depending on the insurance poles. Some insurance poles also offer microfinance (Habibullah Muchtar, 2009). There is limited data on the future of the Askesos, and whether it will be integrated to BPJS Employment, or remain under the management of the Ministry of Social Affairs
  • 17. 17 | P a g e (MoSA). Moreover, it is unclear whether independent people with disability have access to BPJS Employment or Askesos due to data limitations. Non-Insurance based Social Protection This section will outline non-insurance based social security protection schemes that emphasize the importance of increasing living standards and social and economic participation. Social Assistance Social Assistance for people with disability is the responsibility of the MoSA, which aims to maintain basic income for the poor. Current MoSA programs include social assistance through an oil and gas subsidy, food assistance, Usaha Ekonomi Produktif (Economic Productivity Scheme) and Social Assistance for People with Severe Disability (JSPCB- Jaminan Sosial Penyandang Cacat Berat). These social assistance programs operate through cash transfer, with payments made by institutional services to families. Unconditional Cash Transfer program (BLT-Bantuan Langsung Tunai) and food assistance are often used as tools during economic crises, particularly with when there is an increase in global oil prices. BLT is used as a program to protect the poor due to high inflation and economic uncertainty (Miranti, Vidyattama, Hansnata, Cassells, Duncan, 2013). JSPCB provides a monthly support of IDR 300,000 to people with severe disability funded by the national government to support food and health expenses (Roebyantho, Jayaputra, Sumarno, 2012). According to Rev. Osten Matondang, the director of Hephata Disability Home and coodinator of Community Based Rehabilitation (CBR) program in North Sumatra, food assistance for people with disability who live in the institutions is IDR 2,100 funded through the provincial budget, with some amount received from the national budget depending on the provincial budget allocation (Matondang, 2015). The amount of money varies among provinces. For example, in South Sulawesi food assistance is IDR 3,000 financed through the combination of local and national government budgets (Tira, 2010). A report by the World Bank revealed that the JSPCB has a very restricted budget, which limits the implementation of the program, effecting fund/budget allocation, data collection, monitoring and evaluation. A lack of practical guidelines in identifying and prioritising the beneficiaries makes the decision solely up to local government officials and facilitators (World-Bank, 2012). Nonetheless, the families of people with disability who
  • 18. 18 | P a g e receive cash transfer social assistance gave positive feedback about the program, stating that it reduced their economic burden (Roebyantho et al., 2012). However, other people report that cash transfers were misused by the family of the person with the disability (Adioetomo et al., 2014). Program Keluarga Harapan (PKH-Family of Hope Program) is a another social assistance program that offers a conditional cash transfer for health and education for very poor households as part of a program aiming to reduce poverty, to increase basic education, to achieve gender equality and reduce infant and mother mortality, as per the Millennium Development Goals (MDGs). In the short-term, this program aims to reduce the economic burden faced by families and in long-term break the intergenerational poverty cycle. It aims to target 3.2 million households by 2014. The program had reached 2.3 million households in 2013 (TNP2K, 2014). In order to access this form of social support children must be enrolled in school; however, ingrained cultural prejudice and stigma against people with disability combined with geographical barriers often prevent families from enrolling a child with a disability in education. Health The provision of adequate healthcare for people with disability is hindered by a lack of basic healthcare services for both the prevention and rehabilitation of disability, problems with the supply of assistive devices, a general insufficiency of funds, and a lack of trained health care workers, particularly in rural areas. Puskesmas (Community Health Centers) are the backbone of primary health care in Indonesia, but there is critical shortage of doctors servicing these centres. The ratio of doctors to people is 2.9 per 10,000 people. According to Legal frameworks: • Ministry of Health’s Regulation No 28/2011 guarantees accessible health services for persons with disabilities • Ministry of Health’s Regulation No. 75/2014 on Community Health Centre articles 10 and 11 stipulate the importance of accessibility in accordance with the Law of Government Building. The ministry of health has also produced regulations on prosthetics, occupational and speech therapy (Kemenkes, 2012).
  • 19. 19 | P a g e a World Bank Report in 2013, there about 2,250 Community Health Centres of which 25 per cent were without a doctor with most of these located in remote areas (Suharyadi et al., 2014). WHO (2012) reported the ratio of physicians to patients as one of the lowest among ASEAN countries (Indonesia, Development, Affairs, Council, Sciences, 2013; WHO, 2012b). Most rehabilitation services are available in Rumah Sakit Umum (The District level Public Hospital) and Rumah Sakit Umum Pusat (the provicial level Public Hospital). Early prevention of disability is provided by Puskesmas and and Bidan Desa (Village Midwife) (WHO, 2012a). However, due to a lack of awareness many do not pursue medical rehabilitation as it is an embedded cultural belief that disability is the result of sin, a reliance on traditional healers in rural areas, and a lack of resources to prioritize lifesaving measures, rather than the effects of inadequate healthcare (Kusumastuti et al., 2014). Kusumastuti et al., (2014) found that the Ministry of Health’s medical rehabilitation program for people with disability mainly focused on leprosy, while rehabilitation facilities such as physiotherapy, speech therapy, occupational therapy, vocational therapy and prosthetics are limited to Central Hospitals located at the capital cities (Kusumastuti et al., 2014). There are lack of health facilities in rural areas with most concentrated in urban areas. There is also a lack of capacity amongst government staff, a lack of human resources for health workers, and a lack of funds to cover assistive devices. The financial coverage level for assistive devices is very low and often depends on the local government’s ability to secure monies from the national budget allocation and the ability of DPOs to access this form of support (Adioetomo et al., 2014).
  • 20. 20 | P a g e Education Inclusive education is very complex as it requires extensive resources, and the concept itself is still under debate because some types of disability cannot easily be integrated into mainstream schools, which require additional funding and school resources to meet a wide range of individual student needs. Specially trained teachers and teacher’s aides as well as modifications to assessment and to the physcial school environment are often required for successful integration of children with disabilities into mainstream schools. This is an ongoing challenge for schools with limited resources. Nonetheless, education is one of the main channels to employment and broadersocial participation, and is often considered the gateway to an inclusive society. In Indonesia inclusive education is mainly practiced at the primary and secondary level where each district/city government is madated to implement a policy of inclusive practice. The Government’s Circular Letter No. 380/G.06/MN of 2003 represents a significant move towards Inclusive Education (Adioetomo et al., 2014). It was embraced with great enthusiasm by the 2004 Bandung Declaration and 2005 Bukit Tinggi Recommendations. In 2007, the Directorate on Special Education and Directorate on General Elementary and Secondary Education produced a standard of operation for inclusive Legal frameworks: • Law No. 20 of 2003 of the National Education System stipulates the obligation to administer special and equal education for people with disability. • Government Regulation No. 10 of 2010 states that education must admit students without discrimination, including discrimination on the basis of their physical and/or mental condition. • The Government’s Circular Letter No. 380/G.06/MN of 2003 mandating inclusive education (Adioetomo, Mont, Irwanto, 2014, p. 25). • The Minister’s Regulation on Inclusive Education No 70/2009 (Kemendiknas, 2009) requires districts to have at least one inclusive school. Education is divided into two curricula of national standardised tests and a pass/fail local standard. • Law No. 12 of 2012 on Higher Education, article 32 guarantees equal rights for people with disability, embracing the principle of equity or reasonable adjustment (Kemendikbud, 2014).
  • 21. 21 | P a g e education. This covers the philosophy of inclusive education, which includes alternative approaches to curriculum development, dependent on a child’s learning needs, and alternative measures for assessing achievement, including grading procedures (Adioetomo et al., 2014, p. 25). It is supported by Government Regulation No. 10 of 2010, which prohibits discrimination against people with disability at all level of education (Irwanto, Kasim, Fransiska, Lusli, Siradj, 2010). A recent report from the Ministry of Education and Culture (MoEC) revealed that about 70 per cent of children with a disability had no access to education. Children with a disability acquired earlier than 15 years of age are five times more likely to not enrol in elementary education in comparison to those whose disability was acquired after the age of fifteen years (Adioetomo et al., 2014). Limited capacity to implement inclusive education is obvious within the Indonesian educational system. In Sukoharjo, for example, inclusive education accomodated only 10 per cent of children with disability; they were educated at public and private schools (Irwanto et al., 2013). According to a recent report, Indonesia has 2,500 inclusive schools at primary and secondary levels with most of these in West Sumatra. By comparison, there are 1,720 special schools in Indonesia at the primary and secondary levels. Of the special schools, 70 per cent are privately owned. (Adioetomo et al., 2014). At the same time, most of the budget for inclusive education goes to public schools (Irwanto et al., 2013). In general, this indicates the importance of involving private schools and encouraging them to become inclusive. Special schools are reported to be inefficent and unfeasible. This is because special schools technically often cover a larger area than regular schools. This seggregated setting is costly for it requires a sufficient transportion system, which in turn increases educational fees. Moreover, the existence of the special school reinforces stigma and exclusion as well as reducing the pressure for non-special schools to adopt and implement a policy of disability inclusion (Adioetomo et al., 2014). Inclusive education is far from being fully implemented. One of the reasons for this is that inclusive education entails integration or normalisation, which requires the acceptance of standardised tests and curricula (Minister Regulation No. 70 of 2009 on inclusive Education). In line with this, many teachers think that the inclusion and integration of children with a disability means simply to bring them into the standard school setting and apply the same standards of assessment. However, this approach is unlikely to result in equal outcomes for students with disability without student specific disability adjustments and modifications
  • 22. 22 | P a g e being made. Structural barriers to education are another reason given for low attendance for students with a disability. For example, many government education officers and teachers believe that children with intellectual disabilities are uneducatable (Adioetomo et al., 2014). Moreover, inclusive schooling is often perceived as degrading a school’s academic performance. Contributing to this is parental perception who see inclusive eduaction as potentially jeopardising the standard of education received by their non-disabled children (Adioetomo et al., 2014). At the tertiary level, inclusive education is very rare and limited to particular courses. For example, the University of Sebelas Maret-Solo has implemented inclusive education, supported by UNESCO, but only for education courses (Rustam, 2012). Moreover, the role of national and local governments’ in promoting inclusive education at the tertiary level is unclear. Both national and local governments have been unable to respond to the on going discrimination at the tertiary education. For example, a student was accepted into a course by the faculty of construction at IKIP (Institute for Education) Yogyakarta, but when it was revealed that he had a vision impairment, the university suggested he enrol in Special Education Teaching degree. The student refused and finally dropped-out (Colbran, 2010). A complaint to MoEC was addressed by the National Commission of Human Rights (Komans HAM), but there was no response. The educational department of the local government also failed to respond. It is therefore likely that it is up to tertiary institutions to develop inclusive programs in the absence of government intervention. Even though there are inclusive education programs at the tertiary level, there are barriers to full implementation. According to Adioetomo et al., (2014) there are three major concerns surrounding the implementation of inclusive education at the tertiary level. These include the inaccessibility of education facilities, which discourage people with disability from enrolling, a bias in the selection system, a lack of protocols for liasing with prospective students with disability, and a lack of awereness amongst educational practioners, administrative staffs and lecturers about the needs of people with disability (Adioetomo et al., 2014).
  • 23. 23 | P a g e Employment By law, Indonesia guarantees the rights of people with disability to employment. However, there are almost no existing programs to meet the 1 per cent of 100 quota for people with disability to be employed, including in the government sector (Irwanto et al., 2010). Moreover, there is a contradiction in employment laws. On the one hand, some laws stipulate the rights of people with disability to employment, such as the Law No. 4 of 1997 and Law No 13 of 2003 on Manpower, which states that people with disability cannot be dismissed based on their illness or disability. However, an employee can be dismissed if they are incapable of carrying out their duties for up to 12 months (article 153 and 172). The Joint Decree between the Ministry of State Apparatus and Ministry of Internal Affairs No.01/SKB/M.PAN/4/2003 and No. 17/2003 also provides a legal basis for terminating or rejecting an applicant based on their disability (Adioetomo et al., 2014). The Joint Decree reflects the rampant discrimination against people with disability (Irwanto et al., 2010) and conflicting legal-frameworks (Colbran, 2010; Nursyamsi, 2014). In addition, disability is also often used as a means to terminate family relations (Adioetomo et al., 2014). Law No. 1 of 1974 on Marriage and Government Regulation No. 9 of 1975 enables a divorce based on disability (Irwanto et al., 2010). Programs to equip people with disability with working skills are mainly the domain of the MoSA, which has established various vocational training schemes in the form of social rehabilitation. Programs are designed to develop skills in tailoring, computing and electrical work, mechanics, massage, carpentry and so forth. Similarly, vocational training was also Legal frameworks: • Law No. 40 of 1997 asserts the obligation of companies to employ 1 per cent of people with disability for every 100 employees. • Minister of Manpower’s Decree No 205/MEN/1999 on Training and Work Placement of Persons with Disabilities emphasises the role of government in establishing training programs for people with disability. • Law No. 13 of 2003 on Manpower article 19 highlights the importance of adjustment in job trainings for workers with disabilities and the prohibition of work termination based on illness and disability up to 12 months unless the persons unable to carry out the duties.
  • 24. 24 | P a g e provided by the Ministry of Manpower and Transmigration (MoMPT). However, many vocational trainings centers are not inclusive in practice due to the recruitment process and the inaccessibility of buildings and educational materials (Irwanto et al., 2013). Accessibility Irwanto et al. (2013) argues that accessibility is one of the most essential steps, if not the first, to inclusion of people with disability. Accessibility sustains the necessary supports for independence and mobility so that everyone can physically move and participate in the community (Irwanto et al., 2013). Local governments are essential to implementing accessible buildings. There has been some improvement in the accessibility of public facilities due to pilot projects in 255 locations targeting education, health and government facilities (Irwanto et al., 2010). Legal frameworks: • Law No. 28 of 2002 on the Construction of Buildings stipulates that facilities must be accessible for people with disability (ILO, 2013). This was followed by a Minister Regulation of Public Work No 30/Prt/M/2006 on Technical Guidelines for Facilities and Accessibility (Kemenpu, 2006). • Law No. 1 of 2009 on Aviation, particularly article 134 ensures the rights of persons with disabilities to travel on aircraft. • Law No. 23/2007 on Railway requires accessibility for persons with disabilities. • Law No. 22/2009 on Roads and Transportation requires accessible roads and public transport for persons with disabilities • Law No. 24/2007 on Disaster Response article 55 stipulates the priority for the most vulnerable groups, including people with disability. • Law No. 12 of 2003 highlights the political rights of people with disability to have equal rights, stressing access to and provision of accessible ballot papers for people with vision impairment. • Ministry of Health’s Regulation No 28/2011 guarantees accessible health services for persons with disabilities • Minisitry of Health’s Regulation no 75/2014 on Community Health Centre articles 10 and 11 stipulate the importance of accessibility in accordance to the Law of Government Building. (Kemenkes, 2012).
  • 25. 25 | P a g e However, observations in major cities such as Jakarta and Bandung also show that many public facilities and infrastructure are not disability friendly (Irwanto et al., 2013). In Jakarta, for example, people with disability experience difficulties to social participation due to uneven pedestrian ways, inaccessible public transportation, inaccessible religious facilities, public toilets and baths (Adioetomo et al., 2014). Reports indicate that disability protection laws and regulations are poorly enforced with sanctions rarely applied, even when there is a failure to comply with the laws and regulation. Moreover, there are almost no procedures for lodging complaints if disability accessibility laws are not implemented in practice (Colbran, 2010; Irwanto et al., 2013). Non-Governmental Community Care According to Irwanto et al. (2013) community care is traditionally provided by local people for children with disability and the elderly. This aligns with the Community-Based Rehabilitation (CBR) approach, which aims to help local communities be inclusive to people with disability by delivering community based support programs. As recommended by WHO and the CRPD, CBR is a substantial strategy for protection of people with disability (WHO, 2010). Sukoharjo is an example of a local government that has legislated local regulation to support the CBR Program (Irwanto et al., 2013). As reported by UNESCAP, the Indonesian government runs CBR programs in 16 provinces (WHO, 2012a). However, it is not clear whether the programs still exist. It is likely the CBR program mostly developed through the work of CBM (Christian Blind Mission) in collaboration with local and national service providers with limited support from various local governments. Challenges In general, as quoted by Oddsdottir (2014) and Rohwerder (2014), there are persistent challenges to the inclusion of people with disability into social protection programs in developing countries. The first challenge is a lack of data and hence understanding of the needs of people with disability, which leads to expensive and unreliable targeting of program initiatives. Secondly, there is a lack of proper assessment and monitoring, which emphasises the costs associated with research and the implementation of rigorous data collection processes. Thirdly, many of the beneficiaries of social protection schemes spend more time
  • 26. 26 | P a g e trying to access their benefits due to a lack of an effective administration system, geographical barriers, and lack of accessible transportation, than actually receiving them. Many people with disability are also not aware of the social protection schemes that exist and therefore do not know how to access them. Fourth, budget constraints and the challenges involved in resource allocation that flow from this can trigger social tensions due to perception of the uneven distribution of benefits. Lastly, if the eligibility to claim social assistance is framed by the ‘incapacity to work’ there is a disincentive to participate in the labour market (Oddsdottir, 2014; Rohwerder, 2014). Ongoing challenges to social support for people with disability include: 1. General prejudice toward people with disability The charity and medical perpectives of disability still underpin policy approaches to people with disability in Indonesia. These perspectives are entrenched in legal frameworks as well as in the the perceptions of government staff and the broader community (Adioetomo et al., 2014). 2. Conflicting Legal Frameworks and Law enforcement Despite extensive disability protection laws, programs actually enhancing the life of people with disability are scarce. This is because there are conflicting legal frameworks that ‘in some cases discriminate against people with disability’ (Colbran, 2010), as is the case in disability employment laws. While the Disability Law and the Ministry of Manpower stipulate the right to employment, other ministries such as the Ministry of Government Apparatus dicriminates against people with disability. The discrimination is apparent in the process of selection for government employees in which one of the criteria of eligibility is based on being physically and mentally healthy (Adioetomo et al., 2014; Nursyamsi, 2014). On the other hand, many of the existing legal frameworks are not well-enforced. GIZ’s evaluation of social protection policy in Indonesia maintains that awareness of disability is still very low despite the existence of legal protection frameworks for disability. Aviation Law obligates that commercial airflights and airport facilities meet the needs of people with disability, but in practice they are still not allowed to travel unaccompanied by a person without a disability. If a person with disability is accompanied then the aviation carrier is not responsible for any damage, loss or accident (Colbran, 2010). There is demand for the establishment of governing and monitoring bodies to enforce the implementation of legal frameworks (Colbran, 2010). Sudibyo Markus, an ILO
  • 27. 27 | P a g e commissioner, described a similar observation in which Indonesia had advanced in its legal instruments, ‘but that implementation was significantly weak’ (Irwanto et al., 2010, p. 3). Equally, Vernor Munoz, UN Special Rapporteur on the Right to Education, made a report that the Indonesian Government ‘lacked the political will to achieve the universal goal of inclusive education’. Munoz observed that there are huge gaps between the availability of resources and the normative framework for enforcing the rights for inclusive education (Irwanto et al., 2010). 3. Decentralisation and lack of resources The structure and culture of policy making, especially in the context of decentralization (Sutmuller Setiono, 2011), impacts Indonesia’s inclusion of people with disability (Adioetomo et al., 2014). Ministerial regulations, for example, are often in conflict with local legislation (Irwanto et al., 2010). These legal tensions contributes to low integration of people with disability in social suport programs. Moreover, programs are highly dependant on the political will of local leaders such that a lack of local government understanding on disability rights limits the scope of the translation of national policy into provincial, district and municipal programs. District and municipal governments spend up to 80 per cent of their budget on wages (Indonesia et al., 2013), leaving little for program and policy development. Therefore, disability programs are reliant either on the availability of national funds from the Specific Allocation Fund (DAK-Dana Alokasi Khusus) or the ability of local governments to generate sufficient revenue (Miranti et al., 2013). 4. Statistical invisibility and marginalisation of knowledge sector Statistical invisibility is apparent given that government data varies between departments, units and agencies. There is sectoral distrust of local government bodies on statistical data due to the incapacity of Bappeda’s (Local Development Planning Agency) to conduct monitoring and evaluation, resulting in the reuse of old data, and continuation of reproduction of outdated programs designed around this data (Sutmuller Setiono, 2011). The lack of disaggregated data establishes a disparity for adequate policy in enhancing the living standard of people with disability (Adioetomo et al., 2014; Irwanto et al., 2010), which has serious implications for how to deal with disability ‘in the post-MDG era’ (Liu Brown, 2015).
  • 28. 28 | P a g e The utilisation of research in policy formulation is very rare in Indonesia, especially when it deals with the decentralization (Sutmuller Setiono, 2011). As studied by Sutmuller and Setiono the knowledge sectors are often marginalized from policy design. The knowledge sectors in government, known as Balitbang (Research and Development Agency), are important but are apparently are ill resourced with researchers having, ‘low qualifications, low skill levels and low remuneration’(Cislowsky Purwadi, 2011, p. 2). 5. Low DPO participation DPOs are not well resourced and are poorly represented at the national and local level in Indonesia. They generally have low capacity to bring about change for people with disability due to low management and advocacy skills, networks and limited financial resources (Alliance, 2012). The identified national DPOs are limited to the Indonesian Disability Union (PPCI-Persatuan Penyandang Cacat Indonesia), Pertuni (The Blind Union), Indonesian Disabled People Association (PPDI-Perhimpunan Penyandang Disabilitas Indonesia), Disabled Peoples’ International, Indonesian Association for Disabled Women (HWPCI), the Deaf Welfare Movement (Gerkatin), and the Perhimpuan Jiwa Sehat (representing persons with psychiatric disability or mental health problems in Indonesia). The rest consist of national and local disability services that provide institutionalised and community-based services. DPO involvement in research, planning, monitoring and evaluation of disability social protection is very rare. Yet the involvement of DPOs is indispensable in the construction and implementation of inclusive programs, as opposed to their design by professionals in a ‘top- down, charity-like, professionals- know-best’ approach (Albert, 2006, p. 2; Swartz, 2009). Opportunities 1. Comprehensive disability rights-based legal frameworks The ratification of the CRPD is considered to be the corner stone for the full inclusion of people with disability in Indonesia. Future legislation on disability law must accord with the principles of the CRPD.
  • 29. 29 | P a g e 2. Strengthening the existing social security system The existing social security system has been very useful in protecting society from shocks and risks. However, people with disability are still less well integrated into social protection policies and programs. Nonetheless, Joko Widodo’s policy on welfare, which scraps budget waste of petrol subsidies and allocates it to targeted programs in education and health and improved productivity measurements, can be seen as a step toward the development and strengthening of disability social protection programs. 3. BPJS Employment BPJS Employment has expanded its program to target independent workers. This could be a gateway to including people with disability. However, this opportunity requires the involvement of other stakeholders such as MoSa and MoMPT to improve the capacity of people with disability to gain employability skills. 4. New Decentralisation Law The newly enacted Local Government Law No 23 of 2014 reshapes the position of local and national governments, giving local government less power so that the national government can fully implement national agendas, policies and programs. However, given this is a very recent development, futher research on its impact on social protection programs and the inclusion of people with disability is required. 5. Revitalising the role of Balitbang (Agency for Research and Development) The existence of Balitbangs in government will help leaders make informed decisions based on reliable data and research, informing the development of future policies and programs aimed at the better inclusion of people with disability. 6. Wider Stakeholders Participation Many local and international organisations share similar interests in mainstreaming disability in developing countries. It is also in the interests of foreign government agencies to acknowledge disability as a cross-cutting issue in inter-government cooperation and
  • 30. 30 | P a g e partnerships. The role of private enterprise in supporting socially inclusive programs also offers future opportunities for increasing the social participation of people with disability. 7. DPOs participation There is greater opportunity to empower DPOs to act in the interest of people with disability. Involvement of DPOs is essential in order to develop the most reliable system and effective policy for removing physical barriers to the full participation of people with disabilities. Conclusion The situation of people with disability in Indonesia is very challenging. The challenges are entreched in legal framewoks, disability statistics, social and cultural perceptions of disability, political motivation, government structures, powerless DPOs and the scarcity of a budget. Overcoming these challenges will involve implementing a robust disability data collection measure and aligning existing legal frameworks for disability protection by implementing the principles of the CRPD at all levels of government. As part of this, adequate protocols for the enforcement of disability rights, including increasing the coverage of disability health benefits, implementing inclusive education practices and continuing to work with DPO’s on the development of social protection programs, are necessary future steps. The involvement of research-based bodies to assist in data collection, monitoring and evaluation is critical to the continued innovation of disability programs and policies. The full inclusion of people with disabilities is a necessary part of Indonesia’s commitment to development and to delivering national goals as mandated in the constitution.
  • 31. 31 | P a g e
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