Your Excellency Minister of Health Dr Suyudi,
Your Excellencies Ministers,
Ambassador Torgersen,
Senior Officials,
Ladies and Gentlemen,

This has been an exciting day. I have had interesting discussions with you, Dr Suyudi, and with your staff. We have visited a Community Health Centre and an Integrated Health Post where I met with several mothers with small children. I had a very inspiring and positive conversation with His Excellency the President. And I was pleased to launch, together with the President the Indonesian initiative for "Making Pregnancy Safer".

I would like to thank all of you here today who have helped in organising it.

Indonesia is a great exhibit for the argument that public health works. At Independence, the country had few trained health personnel and very weak health services. It is safe to say that the impressive economic growth the country experienced over a 20 year period was preceded and reinforced by an improvement in health which increased life expectancy, slowed population growth and increased productivity.

We all know Indonesia has gone through three difficult years, and we should have no illusions about the coming years. They will certainly also be challenging. As usual in times of economic hardship, the poor suffer more than anyone. A large number of people who had just managed to lift themselves out of the worst poverty have been pushed back down again.

It is crucial that the hard-won health gains of the past decades must not be lost. As the government makes difficult priority choices, it is essential that the health sector is protected. It therefore is reassuring to hear that health spending is on the rise and is likely to continue to increase in the coming budget.

It is also important that priorities within the health sector are made on programmes and interventions that benefit the vast majority of people, in particular in rural areas, who struggle the most to make ends meet.

This would not be an act of charity. Over the past few years, we have gained strong evidence of the link between health and economic growth. The main diseases of poverty not only prevent those living in poverty from improving their lives. They also function as significant breaks on the economic development of countries.

Making Pregnancy Safer is exactly such an initiative that – if successful – will increase equity. I am very pleased about the whole-hearted support this initiative has received from the President himself. This signals the strong commitment to health I have sensed during this visit.

Fortunately, the strong health infrastructure built up around the health centres and health posts remains, and this structure facilitates the further development of the health system as it is being decentralised.

It is important that sufficient resources are secured and that strong signals are given from a central level about the need to prioritise health in local government. I wish you success in the work that lies ahead.

As you know, the year’s World Health Report focussed on health systems performance. The way health systems are designed, managed and financed seriously affect people’s lives. The performance of a country’s health system is as important as the absolute amount of money spent.

Whatever standard we apply, it is evident that health systems in some countries perform well, while others perform poorly. That performance in the United Kingdom exceeds that in parts of sub-Saharan Africa is hardly surprising.

That there is a 25 year difference in life expectancy between two countries that spend similar amounts on health should, however, give us real pause for thought. The difference between a well-performing health system and one that is failing can be measured in death, disability and despair.

It is becoming clear that health systems which spend less than $60 or so per capita per year have difficulties even delivering a reasonable minimum of services. However good the structure is – as long as you can’t afford to pay your doctors and nurses proper salaries and fill the shelves with essential medicines and vaccines, a health system will not be performing at a reasonable level.

Indonesia is interesting because its expenditures lie just on that border. If you put estimated public and private health expenditures together, Indonesia spends $56 per capita per year. At that level of spending, a country can make a real difference in the way it uses its resources. Our data show that any increase in health spending should be accompanied by a detailed measurement of performance and a health sector reform process based on the evidence of what gives the best outcome.

WHO will strengthen its support to Member States in their efforts to assess their health systems performance.

I am pleased to hear about the progress being made with the proposed law to ensure better and fair financing of health care. Research from a number of countries has shown that not only are systems based on prepayment a more equitable way to finance health care – it is also considerably more cost-effective than out-of-pocket arrangements. I appreciate the difficulties you face in introducing such legislation – and executing it – in a society with a large informal sector. But I am encouraged by the commitment I have seen to make these proposals succeed.

Let me end by again thanking you, Dr Suyudi, and the Indonesian government for the warm reception during this visit and for our fruitful co-operation to improve the health for all Indonesians.