As the Covid-19 pandemic surges in Indonesia, the central government and regional administrations must ensure frontline health workers receive their promised incentive payments on time and in full, Amnesty International Indonesia said today.
“Health workers have been among the hardest-hit groups during this pandemic and even more so during the recent surge in cases and hospitalizations across Indonesia,” Amnesty International Indonesia Deputy Director Wirya Adiwena said. According to the Indonesian Doctors Association (IDI), at least 545 doctors and 445 nurses have died of COVID-19 as of 18 July 2021, with 114 of those deaths coming in July alone.
“Repeated delays in the payment of promised incentives to these workers, who often carry out multiple shifts without breaks due to increasing staff shortages, is unconscionable and reflects the government’s neglect of this key group of workers as well as public health more generally.”
“We urge the government of Indonesia, as well as regional administrations at the provincial and municipal level, to ensure prompt distribution of promised incentives to health workers. Staff who speak out about delayed payments must also be protected and listened to, not intimidated.”
Delayed and inadequate payments across the country
Following the first surge in Covid-19 cases in the country, the Indonesian government enacted several regulations and policies to provide incentives and compensation for health workers who treat Covid-19 patients.[1]
The implementation of those regulations and policies, however, has been patchy at best. According to monitoring by Amnesty International Indonesia, at least 21,424 health workers across 21 provinces have experienced delays or even cuts to incentive payments since June 2020, when the payments were first authorized. Amnesty obtained this data by confirming media reports and reports received by independent data initiative LaporCovid-19[2] with the local branches of IDI, the Indonesian Nurses Association (PPNI), and other medical professional associations.
In Tanjungpinang, Riau Islands, for example, as of 21 July 2021, at least 2,900 health workers have yet to receive any incentives since January 2021, while in Kendari, South Sulawesi, 327 health workers across 15 community health centers and 27 hospitals have not received incentives since September 2020.
Several other organizations have reported similar findings. A survey conducted by LaporCovid-19[3] from 8 January to 5 February 2021 found that 2,754 out of 3,689 health workers surveyed – around 75% – said they had not received any incentives at all. Around 6% of the respondents who said that they had received incentives reported that they experienced problems such as delays, cuts, and miscalculations.[4]
In addition, Harif Fadhillah, the head of the Indonesian National Nurses Association (PPNI) told Amnesty International Indonesia on 19 March 2021 that many health workers, especially nurses working in various regions outside Jakarta, have not received any incentives at all since January 2021.
In response to some of the problems the Ministry of Health also issued Regulation 4239/202, aimed at ensuring that incentive payments are directly transferred to health workers’ bank accounts, whilst stating that workers would receive any delayed payments by the end of May 2021.[5] However, data collected by LaporCovid-19 from April to May 2021, still revealed 84 additional complaints of unpaid incentives from health workers in various regions across Indonesia.
The scale of the continuing problem is illustrated by the fact that on 20 June 2021, Finance Minister Sri Mulyani stated that only 5.7% of the total budget of Rp 7.6 trillion (approximately US$527.5 million) for health workers had been disbursed as of 12 June 2021[6]. Although several regions have now begun to accelerate the distribution of incentives, Sri Mulyani says the disbursement has not yet reached 20 percent of the total allocated budget by the middle of this year.[7]
Upholding international rights obligations
Providing timely and adequate incentive payments is one way to fulfill health workers’ right to receive just and favorable working conditions, which should include “fair wages and equal remuneration for work of equal value without distinction of any kind” as stipulated in Article 7a of the International Covenant on Economic, Social and Cultural Rights (ICESCR) which has been ratified by Indonesia. The UN Committee which monitors the treaty’s implementation makes clear in its General Comment on Article 7 that wages do not only refer to salaries but also include “additional direct or indirect allowances in cash or in-kind paid by the employer to the employee that should be of a fair and reasonable amount”. The General Comment further elaborates that “a fair wage is not static, since it depends on a range of non-exhaustive objective criteria, reflecting … the impact of the work on the health and safety of the worker, specific hardships related to the work and the impact on the worker’s personal and family life.”[8]
For some medical workers, such as those volunteering at the Wisma Atlet Emergency Covid-19 Hospital in Kemayoran, Jakarta, these incentives are the only source of income they have. For many others across the country, the incentives are an important source of supplementary income as many hospitals have cut wages due to lower revenues during the pandemic.[9][10]
Data problems and distribution irregularities
Amnesty has identified several reasons for the delayed payment of incentives, the most prominent of which are data inconsistencies and bureaucratic hurdles.[11] F, a LaporCovid-19 volunteer, told Amnesty on 7 June 2021 that, in many cases, to ensure their data is properly recorded, health workers need to go directly to the Ministry of Health’s office in Jakarta, which impedes access to around 1.4 million health workers who live outside of the capital including around 768,000 health workers who live outside the island of Java.[12]
“We received a report from a health worker who was experiencing delays because their data was incorrect, so they tried to fix it. They said the [Health Ministry] officials were friendly and helpful,” F said. “But imagine how many health workers across Indonesia [have to go to Jakarta] just to fix the data. Even then, their incentives might not be immediately disbursed. They don’t know what to do. If they complain to their hospital, they feel vulnerable because they are employees who may be subject to repercussions (see below), but if they want to complain to the Health Ministry, they have limited access.”
LaporCovid-19 also found that when health workers receive their incentives, the payments are at times subject to many cuts[13] carried out by the hospitals employing them without adequate explanation.
Harif Fadhillah of the PPNI also received complaints that incentives offered to individual health workers were sometimes reduced so that all healthcare employees in a hospital could be covered. This is because the government only provides incentives for healthcare staff directly working in a hospital’s Covid-19 unit when, in reality, all healthcare workers in the hospital, particularly nurses, focus on Covid-19 care.
Intimidation and threats to those who speak out
The situation is worsened by the fact that some health workers who speak out about the delayed payments have become victims of intimidation and threats.
The most prominent case occurred in the Wisma Atlet Emergency Covid-19 Hospital in Kemayoran, Jakarta. LaporCovid-19 reported that, as of the start of May 2021, at least 500 health workers – around 75% of the workforce – at Wisma Atlet had yet to receive any incentive payments since December 2020.[14]
In May 2021, several health workers at Wisma Atlet planned to release a statement to the press detailing the delayed incentives, yet were forced to cancel their plans after allegedly being intimidated by the military and police officers.
One of the health workers, Fitri*, told Amnesty on 3 June 2021 she was interrogated by security forces for allegedly violating the institution’s code of ethics by conducting a survey on incentive payments among her fellow health workers and planning to hold a press conference. She said she was questioned in a room where she was surrounded by at least 15 military and police personnel.
“I was forced to sign a statement canceling the press release. At first, I refused, but because there was so much pressure … and they are from the military and police, I felt I had no choice but to sign the letter,” she said. “Then [I was also forced to sign] a letter of apology to the hospital for lowering the credibility of the leadership. I argued with the police because I didn’t think I did anything wrong, so why should I have to apologize? I was yelled at. They felt that I had to obey them.”
Moreover, the intimidation Fitri experienced at Wisma Atlet was not an isolated incident.A, a LaporCovid-19 volunteer, told Amnesty on 7 June 2021 the organization’s volunteers often receive similar threats when trying to follow up on reports of delayed incentive payments with regional health agencies.
“In one case, a health worker reported that a certain Puskesmas [community health center] had not received any incentives at all,” she said. “We tried to contact the local health agency, but instead of listening to our input, they threatened to track our team down.”
The Indonesian authorities must protect health workers’ right to free speech, especially when making public comments about their pay and working conditions such as the delayed incentive payments.Freedom of expression is an vital right for workers and essential for any society. The right to free speech of all Indonesians is protected under Article 19 of the International Covenant on Civil and Political Rights (ICCPR), a treaty that Indonesia has ratified.
Furthermore, health workers’ right to collectively defend their common interests is protected under freedom of association in Article 22 of the ICCPR as well as Article 8 of the ICESCR. In the case of Wisma Atlet, staff tried to peacefully exercise this right by organizing meetings and press conferences. The response of the authorities’ by intimidating and threatening these health workers violated their fundamental rights.
Protect health workers to protect everyone
Ensuring the right to just and favorable working conditions for health workers will not only fulfill the rights of the individual health workers but also improve the quality of the health sector as a whole.
With a population of more than 270 million, Indonesia has only 0.4 doctors and 2.91 nurses per 1,000 people, according to data released by the World Bank in 2019 – the second-lowest figure for this category in all of Southeast Asia.[15] If the rights of Indonesia’s health workers are not protected, these numbers could shrink even further as people leave the profession and others are dissuaded from joining. Thus, ensuring the prompt and full payment of incentives to health workers can also plays an important role part in guaranteeing all Indonesians can enjoy their right to the highest attainable standard of health under Article 12 of the ICESCR.
“Health workers are at the frontline of this pandemic and if their rights are not fulfilled and protected, all of our rights are at risk,” Wirya said. “Ensuring that they are adequately compensated and have the means to provide for themselves and their families is extremely important not only for their rights but for the sake of public health.”
*Several names have been changed to protect identities.
[1] Based on Ministry of Health Decree Number HK.01.07/MENKES/392/2020; the amount is further elaborated on in the Ministry of Finance Letter issued on 24 March 202, Number S-239/MK.02/2020.
[2] LaporCovid-19 is a coalition of citizens who built an independent citizen-reporting platform to share COVID-19 information and related events in Indonesia. Using a crowdsourcing approach, LaporCovid-19 utilizes public participation to record COVID-19 figures.
[3] LaporCovid-19 is a coalition of citizens who built an independent citizen-reporting platform to share COVID-19 information and related events in Indonesia. Using a crowdsourcing approach, LaporCovid-19 utilizes public participation to record COVID-19 figures.
[4] https://laporcovid19.org/post/siaran-pers-perlunya-perbaikan-tata-kelola-penyaluran-insentif-dan-santunan-kematian-bagi-tenaga-kesehatan
[5] https://fokus.tempo.co/read/1462908/menanti-insentif-tenaga-kesehatan-hingga-lebaran-tiba/full&view=ok
[6] https://www.cnnindonesia.com/ekonomi/20210621000619-78-656997/menkeu-pencairan-insentif-nakes-daerah-baru-57-persen
[7] Ibid.
[8] https://www.escr-net.org/resources/general-comment-no-23-2016-right-just-and-favorable-conditions-work
[9] https://www.thejakartapost.com/news/2020/05/21/bonuses-slashed-pay-cut-indonesian-nurses-fight-pandemic-financial-hardships.html
[10] https://tirto.id/bayang-bayang-pemotongan-upah-nakes-yang-kerja-berlebih-dan-lelah-f9Zx
[11] https://kabar24.bisnis.com/read/20210420/15/1383847/insentif-nakes-2021-belum-cair-penuh-kemenkes-beri-penjelasan
[12] https://bppsdmk.kemkes.go.id/info_sdmk/info/
[13] https://laporcovid19.org/post/pemenuhan-hak-insentif-dan-perlindungan-tenaga-kesehatan
[14] https://www.cnnindonesia.com/nasional/20210219124213-20-608332/laporcovid-19-temukan-75-persen-nakes-belum-dapat-insentif
[15] https://databoks.katadata.co.id/datapublish/2020/04/02/rasio-dokter-indonesia-terendah-kedua-di-asia-tenggara