VI. Human Rights Impacts

Forestry sector corruption has widespread spillover effects on governance and human rights. The individuals responsible for the losses are rarely held accountable by law enforcement and a judiciary deeply corrupted by illegal logging interests, undermining respect for human rights. In addition, the ability of citizens to hold the government accountable is curtailed by a lack of access to public information. And the opportunity costs of the lost revenue are huge: funds desperately needed for essential services that could help Indonesia meet its human rights obligations in areas such as health care, go instead to line the pockets of timber company executives and corrupt officials.

Failures of Justice

Even with the establishment of the Anti-Corruption Commission, the majority of corruption cases in Indonesia, including those involving illegal logging and related forestry crimes, continue to be heard in regular criminal courts. There the record is far worse.

 Justice is still too often a commodity for sale, particularly in cases involving the sums of money at stake in logging cases. In 2003 the United Nations rapporteur on judicial independence decried corruption in the judiciary in Indonesia as “among the worst I have seen.”[98] The World Bank noted in 2006: “A tragic combination of low professional standards and widespread corruption compromises the sector’s ability to deliver on its mandate. Indonesians see the key justice sector agencies as among the most corrupt and least efficient organizations in the country.”[99] Officials charged with enforcement continue to be part of the problem. As if to prove this point, the inspector general of the public relations office of national police headquarters, Gen. Sisno Adiwinoto, threatened in 2007 not only to sue Transparency International Indonesia (TI) for libel for naming the police among the country’s most corrupt agencies,[100] but to use police intelligence capabilities to identify who had participated in the anonymous TI survey, “to ensure that they are not extremists, paid by corruptors” and further implied that the survey results indicated “foreign influence.”[101]  

Efforts to address corruption by reforming the judiciary have also been lackluster. Apart from the KPK reforms discussed above, efforts at judicial reform have been half-hearted and delivered few results. A plan to reform the AGO announced in July 2008 has been called “nothing more than a fantasy’” by the Commission for Public Prosecution (a body established in 2005 by a Presidential Decree, reporting directly to the president). One member complained, “The plan doesn’t show any effort to reform its internal body, which is overshadowed by briberies, extortions and non-service oriented officials.”[102]

Although in recent years there have been some high visibility arrests and seizures of stolen logs, Indonesia’s record in bringing illegal logging cases to trial and winning convictions continues to be abysmal. Moreover, it is the lowest-level (often impoverished) laborers who most often bear the brunt of enforcement actions. The Indonesian environmental activist group Telapak, which monitors the timber trade and illegal logging cases, reports that, “Despite Indonesia’s much-vaunted clampdown on illegal logging, virtually no significant timber criminals have been found guilty by the courts.”[103] 

Evidence substantiates the claim that those most responsible for illegal logging are allowed to walk free or given only light sentences. In one high-profile crackdown in Kalimantan and Papua in 2005 code named “Operation Everlasting Forest II” (Operasi Hutan Lestari or OHL II), 186 people were arrested, including 18 senior military and police officials. While the government claims it spent over US$1 million on the operation, only 13 people were ultimately convicted of any crime, with the longest sentence being two years. No senior officials were convicted.[104]  

In fact, many suspect that the enforcement operations are often used as a ploy for even more corruption, either for extracting bribes from the accused or for rigging auctions of seized timber. A senior official at police headquarters in Jakarta admitted that auctions of seized wood had raised just Rp40 billion ($4 million) rather than the target of Rp2 trillion ($220 million), in part due to police involvement in rigging the sales.[105] Some locals reportedly joked that police involved in OHL II “came with M-16s and left with 16-Ms” (meaning millions of dollars).[106] 

Activists also note that illegal logging operations are sometimes used as political weapons to target the reputation and finances of opposition figures, a motive that many suspect was behind the timing of the so-called Ketapang operation (described in the previous West Kalimantan box) that effectively removed one powerful challenger for district office. One investigator noted:

In resource-rich areas, you always see an increase in illegal logging during election time. Logging is used as a bank account to fund campaigns. The heads of campaign “Success Teams” (Tim Sukses) are often very closely associated with illegal logging operations. And of course if the campaign is successful, the logger stands to win some “gratification” from the new official.[107]

In total, there have been seven major illegal logging crackdown operations in Indonesia since 2000. Yet even these aggressive field enforcement actions have done little to bring legal accountability to the sector and therefore have had little lasting effect in either recovering or preventing loss of illegal revenue. NGOs that monitor the court cases report that out of some 3,000 suspects captured in these major crackdowns, only a handful have actually been convicted of any crime.[108]

Further, trial evidence shows that it is low-level laborers, often local residents desperate to make a living, who are most often snared in these crackdowns. The economic and political backers behind the operations—those most responsible and who derive the greatest benefit—often escape field enforcement actions. Indonesian Corruption Watch reports that of the 205 logging cases they monitored between 2005-2008, 156 of the prosecutions (76 percent) were against low-level laborers. Of the 49 cases against government officials or high-level businessmen, 35 (71 percent) were acquitted. Of the 14 high-level actors who were convicted, nine received sentences of two years or less.[109] 

Impunity continues to reign for the actors who benefit most from illegal logging. Telapak noted that while Minister Kaban listed 19 high level timber tycoons as suspects in a submission filed with the AGO in 2004 (a list that later reportedly grew to 59), five years later not one has been arrested.[110]At one point, following the acquittal of a high-profile logging boss against whom there was substantial evidence, a frustrated Minister Kaban urged NGOs and citizens to monitor the court cases of accused illegal loggers because he observed that, if charged at all, they were routinely acquitted.[111] 

In one high-profile case in West Kalimantan’s Sintang district, timber boss Tian Hartono (alias Bun Tia) had been for years widely suspected of illegal logging, including cutting in conservation areas. The District Forest Service filed an investigation report with the police on these accusations but apparently no action was taken. Local activists maintain this is due to Bun Tia’s close connection to law enforcement and parliament.[112] Finally, local NGOs conducted their own investigation and submitted their findings to the provincial prosecutor, which resulted in charges of illegal logging and use of unlicensed heavy machinery. Bun Tia was initially found guilty in 2006 and sentenced to 10 years and Rp2 billion (some $200,000). However, on appeal the illegal logging conviction was overturned and the sentence for use of heavy machinery was reduced to 16 months and Rp1 billion ($100,000).

In another well-known case, Indonesia’s Financial Intelligence Unit (PPATK) presented the court with evidence of suspicious transfers over the course of 14 months into accounts held by Marthen Renouw, a police commissioner in Sorong, a district in West Papua where illegal logging is especially rampant. The suspicious transfers totaled Rp1.06 billion ($120,000) and were determined to be from the directors of two logging companies that were later raided as part of OHL II and were in possession of some 15,000 cubic meters of illegal wood. Seeing that he was caught, Renouw admitted receiving these transfers, but claimed they were “donations” to pay for operational costs of anti-illegal logging sweeps. The court took this explanation at face value and, claiming that the disappearance of a key witness compromised the evidence against the defendant, acquitted Renouw. The prosecutor failed to file an appeal within the required 14-day time limit, causing the appeal to be denied.[113]

Yet another notorious logger, Prasetyo Gow (alias Asong) was arrested in West Kalimantan in 2005 for loading 13,000 cubic meters of timber (worth more than $2.5 million) onto ships without legal documentation. Prosecutors asked for a four-year sentence but Gow was acquitted of all charges because, according to the judge, “Legally he was not guilty because the ship had not sailed at the time of his arrest.” However, the judge admitted that the defendant did not have the required documents in his possession at the time the timber was loaded, which Indonesian forest law experts point out is a clear offence under the forestry law.[114] Upon hearing the verdict, Minister Kaban complained, “I suspect foul play. I suspect they have deviated from the law.”[115]

However, the minister has also demonstrated worrying inconsistency in enforcement. For example, Kaban has intervened at times on behalf of illegal loggers on trial. In several court cases against logging bosses accused of cutting timber outside of their concession—in one case within the boundaries of a national park—the minister intervened, arguing that, according to his controversial interpretation of article 80 of the Basic Forestry Law (see text box below), individuals who possess a legal concession license should only be required to pay administrative penalties for any illegal acts, not face any criminal charges.[116]

As already noted, however, Indonesia’s KPK, using the anti-corruption law, has had some success in pursuing the financiers and high-level officials who most benefit from illegal logging. A former member of the Indonesian House of Representatives (Dewan Perwakilan Rakyat, or DPR), Al Amin Nur Masution, was sentenced to eight years in prison and a fine of Rp250 million ($23,000) for allowing the logging of protected forests in the Banyuasin area of South Sumatra by facilitating a change in its zoning designation.[119]Four other legislators who sat on the Parliamentary Commission IV (overseeing forestry, agriculture, and fisheries) were charged for their roles in the case.[120]In presenting his defense, one of the legislators, Sarjan Tahir, who played a prominent role in setting up payments between the developers and parliamentarians, could only muster that “In the House it is common to accept money from someone in exchange for a favor.... If I didn't take the money, my friends [in the DPR] would question why, accusing me of taking all the money for myself.”[121]

Although sporadic field enforcement actions have had some deterrent effect, particularly among lower-level operators who have borne the brunt of the enforcement, the results in terms of legal accountability and recovery of state assets from those most responsible for forest crime have proven disappointing. Telapak’s analysis of the recent spate of enforcement actions is bleak, concluding, “The main lesson from OHL II is a salutary warning to those who think the present judicial system in Indonesia is capable of catching the timber barons—bitter experience shows that it is clearly not fit for this purpose.”[122]

Failures of Transparency

The ability of citizens to know what is going on and scrutinize government actions is critical to curbing corruption. Indonesia took an important step in improving transparency with the long awaited passage on April 3, 2008, of the Freedom of Information Act (FOIA) after eight years of negotiation in the DPR. Yet citizens wishing to hold their government accountable continue to be routinely obstructed. In one case described below, a local public interest lawyer was even denied access to the Supreme Court decision that mandated public access to Supreme Court decisions.

When citizens have access to information about how much money the state has received for budget items or has pledged to spend, they are better equipped to press for accountability. In Uganda, for example, when NGOs publicized the budgets of local schools, communities successfully pressed for improved spending and delivery of education services.[123]

In Indonesia, recent research reveals that corruption in district-level spending is rife, with local businesses and officials routinely conspiring to create fraudulent and inflated project budgets and to manipulate procurements.[124] Local activists are increasingly undertaking oversight but complain that they can only get access to budget and spending information through leaks or surreptitiously photographing or even stealing copies of budgets.[125]

In the judicial sector, transparency is critical because public scrutiny of legal cases, particularly where there is a history of corruption in the judiciary, helps ensure accountability and fair application of the law. In Indonesia, such monitoring is blocked by the lack of public access to indictments, trial documents, and judicial decisions, which are available only to “parties” (prosecution, defense, and judges) except through informal back channels. Many civil society organizations rely on press accounts for information about trials.

One public interest lawyer told Human Rights Watch, “Judicial monitoring is extremely difficult unless you have the time and staff to attend every day of trial for every case. If you are unable to do that, getting access to trial documents without an inside connection is not possible.”[126] In one especially ironic example of lack of transparency in the judicial sector, a local environmental lawyer recounted to Human Rights Watch that he went to the Supreme Court to obtain a copy of the very decision that made court records publicly accessible,[127]and was informed, after hours of waiting, that he could not have access to the document because 1) the decision was “political;” 2) there had already been a lot of requests for it; and 3) it was very lengthy.[128] Although the judgment itself is certainly a step in the right direction, implementation clearly remains a significant obstacle.

In the forestry sector, although the minister signed a directive on transparency,[129] compliance with the directive is incomplete at best. Activists and advisors inside the ministry complain that there remains a resistant “internal culture” in many parts of the ministry and provincial and district offices that favors opacity as a means of avoiding critique. Activists, academics, and professionals who work in the sector repeatedly described to Human Rights Watch being denied information that should be a matter of public record, both through unapologetic denials from officials and more passive obstruction and avoidance of information requests. As described below, Human Rights Watch researchers themselves experienced the same obstacles.[130]     

Although there are discussions around improving provincial “Forestry Information Centers” in which to house and make publicly accessible all forestry data, one of the advisors to this process says, “They still resist the concept of ‘public’ information, open to all. They want to exclude people who do not have a ‘legitimate’ reason for requesting the information. They do not want their data to be used to criticize them, especially on sensitive issues like clearcut permits and zone changes and revenue. They see that as their right.”[131] Another advisor put it more pointedly, “Many in the department are interested, in principle, but it comes down to what level of information you want access to. Some are very conservative about what they want to release, and it has to be said, there are many who are in fact involved in illegal logging and don’t want anyone examining their books.”[132]

In West Kalimantan, Human Rights Watch researchers visited district forestry offices in four districts (Ketapang, Sambas, Sintang, and Kapuas Hulu) and the provincial office in Pontianak, in an attempt to access data on annual forest production in the province’s major wood industries (roundwood, sawnwood, plywood, veneer), legal timber supply from land clearing licenses and plantations, and forest revenues received by the government. In three districts, local researchers were denied access to any data, and in one district (Sintang) access took several days to negotiate. In the end, the forestry office did not provide any data on clearcut permits or forest revenues, if such data even existed, only providing the annual allowable cut for one logging concession—written out by hand. Forest officials in Ketapang were especially hostile and resistant to information requests because there had recently been the well-publicized illegal logging operation mentioned above that led to the arrest of the head of the district forestry office.

Officials used avoidance tactics such as claiming that the appropriate person to release the requested data was not in the office. Repeated visits to the office on subsequent days and attempts to contact the mobile phone of the official proved unsuccessful. In other districts, excuses were that officials did not have time to provide the information because of an impending ministerial visit (Kapuas Hulu), that the information had been lost in a fire or was moved to an inaccessible archival location (Sambas). Ultimately, we were able to obtain some limited information through informal channels using social networks with those inside the office.

Another local researcher confirmed that such experience is the norm, particularly in district forestry offices. He stressed the importance of personal relationships and outright bribes in order to access what should be public information about government management of national assets and revenues. One difficulty in relying on personal relationships, of course, is that they are vulnerable to political change. He recounted:

In my experience, to get data we have to have a personal relationship with someone inside the office who trusts us and has the same vision that we do. The only other way is to pay someone on the inside to help by “stealing” the data. If we arrive at the office, as a “guest”—that is, to meet with someone not already known to us—then we will certainly be asked for a formal letter of request from our employer explaining why we want the information. Even then, it is not certain they will provide anything. My last experiences with the district offices of revenue and forestry in East Kalimantan last year were that even when I brought those letters, I still wasn’t able to get the data. We were told we had to wait for approval from the appropriate authority, who was not available in the office at the moment, and it was not clear when they would return. In the end, I could only get data from old friends in the department, who are reform-minded. Even then, it was not without obstacle, as it was obvious there are people in the office who were unhappy about it ... Eighteen years ago I could get data from the district office just with a letter from my NGO in Jakarta, because in those days people were respectful of people from Jakarta. But now people in local government don’t respect people from Jakarta anymore. If you ask me, transparency has gotten worse. Maybe because everyone is afraid of being caught by the KPK.[133] 

In a recent forestry sector assessment, the World Bank notes that its own calculations regarding current forest management and future scenarios are deeply hampered by a lack of reliable data. The Bank acknowledges that:

Many stakeholders believe that a key element hindering progress with issues of governance and corruption is a lack of reliable, accurate and up-to-date information on Indonesian’s forest and timber resources. This situation has resulted in divergent views about forest loss and degradation rates, timber production, illegal logging, forest conversion, forest management, community development needs, lack of agreement on next steps and priorities and forest use conflicts. Poor information has also hampered the [Ministry of Forestry’s] ability to implement good forest governance, promote transparency, carry out effective law enforcement, issue appropriate forest policies, and to use forest resources to reduce rural poverty and promote sustainable development.[134]

The Bank report goes on to assert that this shortcoming will be addressed through the ministry’s Forest Monitoring and Assessment System (FOMAS) to improve management through improved access to information. FOMAS was a project in the Planning Agency of the Ministry of Forestry (Badan Planologi, or BAPLAN) involving compiling and publishing all available forestry data, including maps of forest zoning, logging concessions, and plantation holdings, with the aim of both improving the management capacity of the ministry as well as improving transparency. After almost three years, all of the data housed at the Planning Department was compiled on a CD, and 300 copies were made for public distribution.

However, after a few limited copies of the FOMAS data CD were “pre-launched” in the ministry in October 2008, other agencies within the ministry made it clear that they did not want this information made public. The CDs therefore remain in their box. The ministry has renamed FOMAS the Forest Resource Information System (FRIS), removing all reference to “monitoring” and “assessment.”

In a presentation to a workshop on transparency in the forestry sector, an expert advisor to the minister updated those present on the progress of the minister’s transparency initiatives, and illustrated the prevailing guarded suspicion regarding which “public” would have access to which type of data. The advisor admitted that one of the major obstacles was “internal bureaucratic culture.”[135] While he stressed that this was a characteristic of “bygone times,” in describing the process of implementing access to forest information he failed to explain how decisions would be made about what information would be excluded from public access,[136] who would be involved in the decision making, and whether there would be an appeals process. In particular, the advisor noted that information that posed a “threat to the national economy” would not be made available. He specifically mentioned that one type of data in this category is information regarding “forest potential.”[137]That is, the ministry position seems to be that publicly documenting the amount of timber available for legal harvest, a basic fact that could affect how much bidders would be willing to pay for concessions, is a threat to the national economy. This comment is worrying as it suggests that the bidding process for concessions either will be distorted or there will be no open bidding process, with the attendant dangers of corruption, nepotism, and further loss of revenue to state coffers.

Admittedly, a significant lack of institutional capacity is at the heart of some of the transparency problems. Sometimes data are not available because they are not systematically collected and recorded in a fashion to be easily and quickly accessible. In addition to crippling citizen oversight and ability to hold their government accountable, this failure to systematically collect and store data on the use of the nation’s forests and the revenues they produce renders the ability of the ministry to soundly manage these assets held in the public trust haphazard at best. 

One international advisor with decades of experience in the Indonesian Forestry Ministry commented, “It’s like my mother’s attic. There may be something of value in there, but who knows where it’s stored. Without some attention to raising technical capacity, full transparency won’t necessarily get you what you want either,” since often data are missing or inaccurately recorded.[138] 

While this is certainly true, many working closely with the ministry suspect that many of these “difficulties” are intentional. This same advisor, after noting the capacity problem, also immediately commented that, “the lack of capacity is in the interest of some in the ministry. There is at times what seems to be a deliberate lack of effort to improve record keeping.”[139] Indeed, the lack of capacity, particularly after years of international capacity-building assistance, can arguably be read as an indicator of a lack of political will. It is worth noting that this lack of political will is not uniform throughout the ministry, but reform-minded officials are often marginalized in the institution. Another long-time forestry sector advisor noted that, “there are officials within the ministry who see the value of increasing transparency, but unfortunately, they are not the ones who are promoted to any positions of power.”[140]

This lack of transparency undermines Indonesian citizens’ ability to enjoy their right to information as enshrined under article 19(2) of the International Covenant on Civil and Political Rights (ICCPR) which states, “[E]veryone shall have the right to freedom of expression; this right shall include freedom to seek, receive and impart information and ideas of all kinds, regardless of frontiers, either orally, in writing or in print, in the form of art, or through any other media of his choice.”[141]The right to information is also enshrined in the Indonesian Constitution.[142] The current lack of transparency systematically undermines the enjoyment of other rights by obstructing the ability of citizens to hold the government accountable for decisions and policies that affect them.

While strong in many respects, the new Freedom of Information Act (FIOA) contains several problematic aspects:

• Criminal sanctions (including prison terms) for undefined “deliberate misuse” of information;[143]
• Requirements to reveal the sources for public information used for publication; [144]
• Criminal sanctions for granting or receiving information categorized as not disclosable;[145]
• Some members of the Information Commission that must be established by the law would be government officials, thereby compromising the commission’s independence.[146]

The provisions for sanctions pose a particular danger to whistleblowers who would expose government wrongdoing, and according to some transparency advocates, are unprecedented in freedom of information legislation elsewhere in the world.[147]Further, this progress toward transparency is also threatened by the State Secrecy Bill, which is under debate in parliament and may attempt to classify large amounts of state information to keep it from being released under the new FOIA. Although officials mouth the words of “transparency,” the results for civil society seeking access to public information remain unrealized.

The obstructive behavior of officials who are the gatekeepers of information, in addition to the language in the new FOIA outlining penalties for “misuse” and “unlawful use” of public information, indicates that much of the resistance to the idea of transparency may stem from a conflation of critique of the government with slander. It is unlawful to use public information to make false accusations against individuals or agencies; yet a free society does not address this problem by denying access to information, but rather by ensuring that there is a functioning and impartial legal system that can fairly adjudicate such accusations. Further, given the clear tendency to obstruct and intimidate those who would seek such information for fear that they will use it to critique the government, agencies should endeavor to make information available in a proactive fashion, rather than reactive, allowing users to obtain information anonymously.

Funds for Essential Health Services Line the Pockets of Illegal Loggers and Corrupt Officials

There are significant opportunity costs in Indonesia’s continuing failure to root out corruption and mismanagement in the forestry sector. Funds that could be going to improve public welfare and advancing Indonesia’s obligations to “progressively realize” economic and social rights are instead being siphoned off to enrich a handful of individuals.

Public health services best illustrate the point. Indonesia has very poor health indicators and its poor performance is directly linked to inadequate funding for the sector. If current trends persist, Indonesia will not meet its Millennium Development Goals (MDG) in maternal mortality and malnutrition,[148]shortcomings the World Bank has specifically attributed at least in part to lack of accountability in the public health sector, inadequate and inefficient public spending, and lack of skilled staff in rural areas outside of Java.[149]

Health experts say that by nearly every measure Indonesia is under-investing in health care. The World Bank observes, “Spending levels coupled with health outcome indicators show that Indonesia is not yet prioritizing health spending, nor achieving the results that are needed to achieve its MDG targets.”[150]

Indonesia spends the lowest percentage of government revenue on health of all countries in Asia (breaking 1 percent of GDP for the first time only in 2007) except Burma. In contrast, most of Indonesia’s neighbors spend more and score better on most conventional measures of health outcomes, such as DPT (diptheria, pertusssis, and tetanus) and measles vaccinations, as well as on child and maternal mortality rates.[151] For example, despite similar GDP per capita, the Philippines has roughly half the number of maternal deaths (per 100,000 live births) that Indonesia reports, and Vietnam, whose GDP is half of Indonesia’s, has one-third the number maternal deaths (see Table 2).

Table 2: Select Regional Comparison of Maternal Mortality Rates

GDP per capita	Maternal Mortality (per 100,000 births)	Percent of births attended by a medical professional
Malaysia	4,970	62	100
Thailand	2,720	110	97
China	1,740	45	98
Philippines	1,290	230	60
Indonesia	1,260	420	69
India	730	450	48
Vietnam	620	150	90
Cambodia	430	540	44

Source: World Bank, Health Expenditure Review, p 19. Compiled from World Health Statistics, UNICEF, World Development Indicators, and Lancet (2007). “Estimates of maternal mortality worldwide between 1990 and 2005: an assessment of available data,” vol. 370, pp. 1311-1319, October 13; World Health Organization Statistical Information System, http://apps.who.int/whosis/data /Search.jsp.

The annual loss of some $2 billion in forest revenue is especially significant when viewed in light of these low spending and poor performance figures. Indeed, the annual losses due to forest mismanagement, illegal logging, and corruption are actually greater than Indonesia’s total national budget for health (Rp16.8 trillion or $1.8 billion in 2008).

Indonesia ranks poorly on many other health indicators. The number of available health services and medical professionals is the lowest in the region, even when compared to countries with lower GDP than Indonesia.[152] The World Bank found that the average local health center (Pusat Kesehatan Masyarakat, or Puskesmas) serves around 23,000 people within a service area of 242 km. These centers also often lack basic infrastructure such as clean water, sanitation, or regular access to electricity. Furthermore, ensuring sufficient stocks of basic medicines, medical supplies, and equipment remains problematic, especially in remote areas.[153] This lack of availability of health care is even more severe when broken down by province. Available data show that most rural areas have less than one Puskesmas (which is typically staffed by a nurse, not a doctor) per 100,000 and in some areas (for example, West Nusa Tenggara, Banten) there is not even one hospital to serve one million people.

Table 3: Regional Comparison of Access to Hospital Facilities

Country	Hospital beds/10,000 people	Year
Sri Lanka	30	2001
Thailand	22	2000
Malaysia	18	2001
Vietnam	14	2002
Philippines	12	2002
Laos	9	2002
India	7	2002
Cambodia	6	2001
Indonesia	2.5	2005

Source: World Bank, Health Public Expenditure Review, p. 31.

Indonesia also performs the worst in the region for the density of doctors, with a reported average of just 13 doctors and 36 medical professionals (including nurses and midwives) per 100,000 people, compared to 58 physicians per 100,000 in the Philippines, which has a similar GDP. Again, when broken down by province and district, the disparities are even more serious, especially for the poor who depend on public service doctors. In some provinces, the reported ratio is as low as six doctors per 100,000. Papua, East and West Nusa Tenggara, and West Kalimantan rank among the lowest in the country for doctor coverage, all less than 10 per 100,000 citizens.[154] In West Kalimantan, for the poor who cannot afford private doctors, there is on average only one public service doctor per 600 square kilometers.[155] These shortages are compounded by a lack of medicines in health posts and a high rate of absenteeism of health workers, which in turn is attributable, at least in part, to low pay and the need of practitioners to seek additional income through private practice. These problems are particularly acute in rural areas. In random checks, health workers were absent without cause during normal work hours 40 percent of the time,[156]again among the highest rates among countries that were surveyed (higher than Uganda, Peru, and Bangladesh).[157]

Table 4: Regional Comparison of Density of Doctors

Source: World Health Organization, http://apps.who.int/whosis/data/Search.jsp;

* West Kalimantan Statistics Bureau, http://kalbar.bps.go.id/tabel/

Tabel %205%20Sehat.htm (accessed September 29, 2009).

Poor women in remote areas often do not have access to essential reproductive health services and emergency obstetric care. In Papua, West Nusa Tenggara, and West Kalimantan, less than half of all births are attended by medical personnel and in some districts of West Kalimantan the average reaches as low as 34 percent, compared to 67 percent for the national average.[158]Available data[159]suggest that maternal mortality in these areas is significantly higher than the national average, and eight times the Millennium Development Goal of 100 per 100,000.[160]

Costing exercises by experts at the World Bank and Indonesia’s Ministry of Health calculated that an annual basic health package for the poor—including basic preventive and curative care and special allocations for challenges faced by geography, sanitation, or increased incidence of infectious disease in poor communities—would cost only about nine dollars per capita.[161] To put it concretely: in one year the loss of revenue due to corruption in the forestry sector alone could easily provide basic health care for Indonesia’s more than 100 million poor.

Money alone, of course, will not solve the problem if healthcare management systems are not also improved, and if greater attention is not paid to making healthcare investments better serve the needs of the poor, especially rural women who are disproportionately affected by lack of health care. Without reforms, the lack of accountability, inefficiency, and regressive spending that primarily benefits the richer sectors of society are likely to dampen the impact of increased spending on overall health indicators.[162]

Although accountability and management issues must also be addressed to improve health care, increasing expenditures by capturing needlessly lost logging revenues could have an immediate and dramatic effect on the nation’s 100 million poor who are especially hard hit by poor health care. Spending on other important determinants of health outcomes—such as improved water and sanitation, female literacy, and early child nutrition—would also improve health outcomes in Indonesia.

Human Rights Watch does not as a general matter make prescriptive recommendations on how governments should weigh competing funding priorities. However, we believe it is proper to document clear evidence of gross mismanagement and theft of public assets that divert resources away from the realization of human rights.

In his keynote address for the draft law on the 2008 budget, President Yudhoyono declared, “Bringing greater prosperity to the people is a top priority and key to the advancement of the nation. The national budget and government expenditures play a vital role in improving the welfare of our people.”[166] With 49 percent of Indonesia’s population—over 100 million people—living on less than $2 per day,[167]the needless loss of forestry sector revenue that could otherwise bolster national, provincial, and district healthcare budgets is unconscionable. At a minimum, capturing lost revenue could create significant resources for the government to progressively realize the right to health. By failing to do so, the government has failed in its obligations as a party to the International Covenant on Economic, Social and Cultural Rights (IESCR).

The Right to Health under International Law

The Indonesian state’s failure to provide sufficient expenditure for health care, when there are resources available to it, is a failure of its obligations under international law to fulfill the right to the highest attainable standard of health care. The International Covenant on Economic, Social and Cultural Rights (ICESCR), to which Indonesia became a party in 2006, requires states party to take steps individually and through international cooperation to progressively realize the right to health via the prevention, treatment, and control of disease and the creation of medical service for all.[168] The right, like all human rights, imposes on states obligations to respect, protect and fulfill the right. The Covenant does recognize that this right is subject to “progressive realization” according to the maximum resources available, but demands of states party a “specific and continuing obligation to move as expeditiously and effectively as possible towards the full realization of [the right].”[169]Additionally, the Indonesian Constitution obligates the state to provide sufficient medical care.[170]

According to the Committee on Economic, Social and Cultural Rights, the monitoring body for the ICESCR, states party to the Covenant must guarantee certain core obligations as part of the right to health, including ensuring non-discriminatory access to health facilities, particularly for vulnerable or marginalized groups; providing essential drugs; ensuring equitable distribution of all health facilities, goods, and services; adopting and implementing a national public health strategy and plan of action with clear benchmarks and deadlines; and taking measures to prevent, treat, and control epidemic and endemic diseases.[171]

In defining how to meet the obligation to fulfill the right to health, the Committee has also advised states that a violation of that obligation can occur when there is “insufficient expenditure or misallocation of public resources which results in the non-enjoyment of the right to health by individuals or groups, particularly the vulnerable or marginalized.” [172]

Similarly, the Maastricht Guidelines on Violations of Economic, Social and Cultural Rights state that a violation “through the acts of commission” of the ICESCR can occur if a government engages in the “reduction or diversion of specific public expenditure, when such reduction or diversion results in the non-enjoyment of such rights and is not accompanied by adequate measures to ensure the minimum subsistence rights for everyone.” [173]  

The World Bank recently noted that “while it is not possible to directly relate Indonesia’s macro spending performance to the health outcomes previously discussed, it is plausible to argue that its mixed health outcomes may, in part, be due to insufficient, inequitable, or inefficient spending on health.”[174]

Equal Access

The Committee on Economic, Social and Cultural rights identifies availability and accessibility as essential components of the right to health.[175]Availability refers to the existence of health services, personnel, and materials in “sufficient quantity.”[176]Accessibility refers to both physical and economic accessibility, and includes non-discrimination in access.[177]As the Committee has noted, “with respect to the right to health, equality of access to health care and health services has to be emphasized.”[178] It has also explicitly set out state responsibility relevant to economic accessibility as “ensuring that these services, whether privately or publicly provided, are affordable for all, including socially disadvantaged groups. Equity demands that poorer households should not be disproportionately burdened with health expenses as compared to richer households.”[179] 

The disparities in access to health care and services experienced by those living in rural communities such as West Kalimantan calls into question whether Indonesia is taking appropriate steps to meet its responsibilities to ensure equal access. Its low ranking in the number of available health services and medical professionals and provision of substandard healthcare centers indicate a failure to meet its responsibilities in these essential areas.

Women’s Right to Health

According to Article 12 of the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), to which Indonesia is a party, “States parties shall take all appropriate measures to eliminate discrimination against women in the field of health care in order to ensure, on a basis of equality of men and women, access to health care services.”[180] CEDAW specifies that “States parties shall ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation.”[181]While both men and women may experience deficiencies in access to Indonesian medical care services and consequent health risks, certain deficiencies are discriminatory due to the disproportionate impact they have on women.

Indonesia’s high maternal mortality rate, which the World Bank attributes at least in part to underfunding, reflects the government’s failure to use resources available to it to provide adequate health services for women.[182]

Further, the core obligations outlined in General Comment 14 state that “In determining which actions or omissions amount to a violation of the right to health, it is important to distinguish the inability from the unwillingness of a State party to comply with its obligations under Article 12. A State which is unwilling to use the maximum of its available resources for the realization of the right to health is in violation of its obligations under Article 12.... It should be stressed, however, that a State party cannot, under any circumstances whatsoever, justify its non-compliance with the core obligations [including the equitable distribution of all health facilities, goods and services] ... which are non-derogable.” [183] Based on the magnitude of funds lost to forest corruption, the inattention of law enforcement to reduce this loss, and the disproportionate effect on the rural poor, especially women, there is clear evidence to suggest that Indonesia is unwilling to take the steps necessary to make sure sufficient funding is available to ensure realization of the right to health. Such failings would constitute a violation of its treaty obligations.