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Table 3.1 – Patterns of public expenditure on health in selected countriesAs % of GDPAs % of Total HealthExpenditurePer capita annual(US$)IndonesiaPhilippinesThailandSri LankaAll low & middle income countriesEast Asian & Pacific0.61.61.91.72.51.820.044.431.748.647.240.07.616.435.514.134.920.4Notes: For Indonesia, the estimate is for 1996-1997. For other countries, the data are for years between 1995 and 1999.Sources: Except for Indonesia, all estimates are derived from the World Bank’s World Development Indicators. For Indonesia, the estimates arebased on the World Bank’s estimates of total public health expenditures along with Marzolf’s (2002) estimates of the share of public expenditurein total health expenditure.the rich and the poor. This divide is manifested in infantmortality rates which are three times higher for the poorestfifth of the population than for the richest fifth. While thisdivide is evident in most countries it also tends to be moremarked in Indonesia than in other developing countries(Table 3.3).It should be noted that a similar health divide is alsoevident between regions in Indonesia with the better offregions far outperforming the others in respect of healthachievements. Infant mortality in West Lombok, forexample, is more than four times higher than in manyother districts.Just as in health, there is also a divide in education,though this is less marked. Educational outcomes willdepend to some extent on family influences, particularlyon the education levels of parents and on the pressuresfor children to leave school early to start work. But publicTable 3.2 – Percentage shares of the poorest andrichest 20% of population in private healthspending and in total household expenditureSpending directed to private health careproviders*Of which:HospitalsPrimary careTotal household expenditure**Poorestquintile6%2%8%12%Richestquintile49%66%39%29%Notes: The reference year for health expenditures is 1998 and that fortotal household expenditure is 2002. * Includes expenditures on drugs.** Health and non-health expenditureSources: Susenas, 1998 and 2002; Knowles and Marzolf (2003) andLanjouw et al (2001).expenditure also has a powerful impact. In the case ofeducation, public expenditure tends to have a strongerequalizing effect in Indonesia since most primary andsecondary-level education is in the public sector. As aresult at the primary level there is now very little differencein enrolment between different income groups. Howeverthere are still marked differences at the secondary level.Thus, 72% of children in the richest fifth are enrolled injunior secondary as opposed to 50% of children in thepoorest fifth of the population. Many also drop out beforefinishing primary education. 23 These differences are alsoreflected in literacy rates: in 2002, the male literacy rateof the poorest group was 87% as opposed to 98% for therichest group. The female literacy rate in 2002 was 76%for the poorest group and 94% for the richest group.Underinvestment in education has been reflected inthe declining quality of public education. Thus althoughthere are many more public secondary schools than privatesecondary schools the results of state examinations findthat among the top ten schools in each category there areonly four public junior high schools and three public seniorhigh schools. The quality of school education has been acause for concern for some time – even before it wasfurther undermined by the financial crisis.To some extent the failings of public provision in healthand education have been offset by the contribution ofcivil society organizations. Indonesia has a rich traditionof community involvement in social services. Religiousassociations in particular have been very active in runningschools, health centres, and orphanages. As of 2001, oneorganization alone, Muhammadiyah, had 9,527 educationalinstitutions of various types, and 3775 health and welfarerelatedcentres. 24 Yayasan Indonesia Sejahtera is anothercommunity organization that operates a broad spectrumof community development programmes with a centralfocus on public health and related training and education.23 LPEM-FEUI (2004, p. 2).24 For detailed breakdown, see UNSFIR (2001).26National Human Development Report 2004