Indonesia's COVID-19 Emergency: Where the Local is Central.

• Author: Meckelburg, Rebecca

The earliest responses to the social, economic and health crises caused by the COVID-19 pandemic in Indonesia came from local community initiatives. Around the country, local community groups, neighbourhoods and villages worked to organize community lockdowns, providing personal protective equipment (PPE) for health workers, and food and goods for people who had lost income. Within weeks, local governments responded by closing schools, implementing work-from-home policies and imposing local and provincial movement restrictions. These efforts effectively slowed the spread of the virus in the first half of 2020, providing a window that should have allowed the national government to mobilize adequate resources to establish the effective testing and contact-tracing infrastructures which international epidemiological guidelines and experience have shown are critical to containing a pandemic.

Central Failures, Local Responses

The central government largely failed to capitalize on this opportunity. From the start, it paid limited attention to improving testing capacity beyond Jakarta, largely leaving strategic public health planning to local and provincial authorities and requiring them to reallocate funds from their own budgets. Instead, the national government focused on mitigating the economic impacts of the pandemic. Over time, it became increasingly obvious that the national health response was slow, inadequate and often incompetent. (1) The consequences became visible in January 2021, when Indonesia faced an escalating pandemic crisis, with hospitals reaching full capacity across Java and Bali, (2) record new case numbers being set daily and rapidly rising mortality.

In the early months of the pandemic, there were numerous conflicts among different levels of government over public health strategies and resource deployment. (3) By January 2021, it was clear that local governments and communities were bearing the burden of the response. Whether a particular locale managed to contain the spread of the virus largely depended on whether its local government had the capacity to mobilize sufficient budget resources and work with the community to mitigate spread, provide acute and community healthcare and help those affected by the economic crisis.

Jakarta Province is the only region in the country that has some measure of adequate testing and medical facilities. With roughly 3.5 per cent of the national population, Jakarta consistently makes up 30 per cent or more of the national tally of people being tested each day. While Jakarta has a Polymerase Chain Reaction (PCR) testing rate of over 200,000 tests per one million people, the testing rate for Indonesia as a whole is only 18,531 per one million people. (4) But despite Jakarta's relatively well-functioning testing regime, the contact-tracing system remains limited. In September 2020, there were reports of only two contacts per positive patient being traced in most regions including Jakarta, rising to four contacts by January 2021. As a result, even the greater Jakarta area has not been able to control the spread of the virus.

Meanwhile, the central government has not deployed national budgets or human resources to provide regional areas with the kind of testing capacity available in Jakarta. With relatively few people being tested, positivity rates regionally have ranged between 15 and 50 per cent since August 2020, (5) with 30 per cent positivity rates reported nationally on the first two days of 2021--pointing to a pandemic that is out of control. The alarmingly low levels...