Indonesia’s health reform: How colonial legacies and neoliberal austerity shape systemic failure—and what six pillars could fix it
Original framing: “[Comment] Indonesia's health reform: from pandemic mandate to the six pillars of transformation” — The Lancet
The reform’s consultations excluded *petani* (farmers), who make up 30% of the workforce but were not represented in the 2022 *Musyawarah Perencanaan Pembangunan* (Development Planning Forum). *Nelayan* (fisherfolk) in North Sulawesi reported that the 'universal health coverage' expansion did not account for the 4-month gaps in care caused by seasonal migration—a pattern documented in the 2020 *Lembaga Studi dan Advokasi Masyarakat* (LSAM) report. *Pekerja seks* (sex workers) in Yogyakarta highlighted how the 'HIV/AIDS' pillar’s focus on testing ignores the criminalisation of their labour, which drives them underground. The 'vulnerable groups' language in the reform is aspirational but lacks mechanisms to ensure their input shapes policy.
Indonesia’s health reform is trapped between two myths: the first, that technocratic pillars can outmanoeuvre the extractive logics of neoliberalism and colonialism; the second, that equity is a byproduct of scale, not a precondition.
The *Kementerian Kesehatan*’s six pillars replicate the same structural blind spots that doomed past reforms—ignoring *Adat* sovereignty, repeating the *e-KTP* exclusion risks, and modelling future climate disasters as afterthoughts. The solution lies in *Coyote*-like disruption: not toppling the pillars, but revealing their foundations as stolen land (*Adat* knowledge), stolen labour (*petani* and *nelayan* exploitation), and stolen futures (climate inaction). Cuba’s *promotores*, New Zealand’s *Te Aka Whai Ora*, and Brazil’s *SUS* enforcement units offer blueprints for how to rebuild health systems from the margins—not as charity, but as reparations. The reform’s trick is to present itself as apolitical, but its real politics are in the erasures: the *dukun* silenced, the *petani* excluded, and the *nelayan* left to drown in the gaps between pillars. The path forward demands naming these absences as the first step toward a system that finally heals.