Written by Kristian Yudhianto, Winner of IPAS Indonesia Foundation’s Reproductive Justice Writing Competition.
Recently, the Indonesian government announced a budget efficiency policy that resulted in savings in program spending in a number of Ministries and Agencies, including local government spending.1 In the health sector, the Ministry of Health through SE No. HK. 02.02/A/548/2025 has actually emphasized that budget efficiency only targets restrictions on operational costs such as office support facilities and has no impact on health services.
However, when referring to the Circular Letter of the Minister of Home Affairs Number 900/833/SJ concerning Revenue Adjustment and Efficiency of Regional Expenditure, Regional Governments are required to adjust APBD expenditures sourced from Transfers to Regions (TKD).2. Consequently, the Puskesmas budget originating from the Provincial APBD and Regency / City APBD has been reduced due to TKD budget efficiency.
Puskesmas is a very important health service for the community. Puskesmas is the health service closest to the community and provides health services ranging from treatment and rehabilitation to health promotion and disease prevention.
However, if we discuss health rights for victims of sexual violence, their needs certainly cannot be equated with the general public. Sexual and gender-based violence as well as various forms of sexual harassment and exploitation, make women and girls a high-risk group for physical and mental trauma and experience unwanted pregnancies and sexually transmitted infections, which ultimately have an effect on mental health disorders that require special attention.
Given the increasing trend of sexual violence cases in Indonesia, health centers should act as the closest means for survivors to obtain health rights, especially mental rehabilitation. This is in accordance with the mandate of Law No. 12 of 2022 concerning Criminal Sexual Violence which emphasizes that victims are entitled to medical and psychosocial support as part of their recovery.
However, in fact, only a few health centers in Indonesia provide mental health services. The Director of Mental Health at the Ministry of Health stated that by 2024, only 38 percent of Puskesmas will have such services, and most of them are concentrated in big cities.3.
In terms of the number of psychologists, the ratio of active clinical psychologists in Indonesia also shows alarming figures with a ratio of 1 psychiatrist per 250,000 population and 1 clinical psychologist per 90,000 population.4 This ratio is far below the WHO standard, which states an ideal ratio of 1 psychiatrist and 1 clinical psychologist per 30,000 population.
This condition is certainly a debt that needs to be resolved, considering that Indonesia signed and adopted the Beijing Declaration and Platform for Action (1995) and the Beijing +5 Political Declaration and Outcome Document (2000) where the government is obliged to integrate mental health services into the primary health care system and train primary health workers to recognize and treat girls and women of all ages who have experienced various forms of violence, especially domestic violence, sexual abuse, or other violence due to armed and non-armed conflict.
Unfortunately, budget efficiency policies that prioritize main expenditures on the Free Meal Program and the defense sector have made the issue of mental health needs for victims of sexual violence increasingly marginalized. In fact, the Ministry of Health has sought to expand independent mental health screening that can be accessed online through the SATUSEHAT Mobile application. However, of course, this intervention is not effective for high-risk groups such as victims of sexual violence who need intensive and long-term assistance. In addition, the use of online applications is also still not effective in reaching people living in underdeveloped, frontier and outermost (3T) areas with low internet and technology access.
Government budget efficiency should not sacrifice essential steps in supporting public health rights, especially the right to comprehensive health services for victims of sexual violence. Puskesmas should be at the forefront of rehabilitative efforts and mental health assistance for victims of sexual violence. In addition, local governments also need to be more sensitive to the special needs of victims in terms of mental health assistance.
One example of good practice can be seen from Purbalingga Regency with the innovative program Puskesmas Peduli Penderita Jiwa (PUSPITA). Through this program, Puskesmas are encouraged to provide mental health services such as the formation of mental cadres, counseling, and home visits for patients with mental disorders. This program is proven to bring mental health services closer to people in need and improve the tracking of new patients. Innovations like this are proof that despite budget efficiency policies, the government must still come up with creative solutions to ensure closer and more inclusive access to health services, especially for high-risk groups such as victims of sexual violence.
- Presidential Instruction (Inpres) Number 1 of 2025, “Efficiency of Expenditure in the Implementation of the State Budget and Regional Budget for Fiscal Year 2025”, March 24, 2025, https://peraturan.bpk.go.id/. ↩︎
- Circular Letter (SE) Number 900/833/SJ, “Revenue Adjustment and Regional Expenditure Efficiency in the FY 2025 Regional Budget, March 24, 2025, https://jdih.kemendagri.go.id/ ↩︎
- Only 38 Percent of Health Centers Provide Mental Health Services”, March 24, 2025, https://www.tempo.co/ ↩︎
- Mental Health Management in Indonesia”, March 24, 2025, https://berkas.dpr.go.id/ ↩︎