A child receives dental care at the ASRI Clinic in Borneo, Indonesia.
In many parts of Indonesia, a medical emergency can cost up to a year’s wages and means traveling hours or even days to reach a hospital or clinic – and often the only way to get that money is to log local forests, over-fish a a reef or otherwise deplete a natural resource.
But in the village of Sukadana on the edge of the Gunung Palung National Park in western Borneo, the community has teamed up with health experts to reduce deforestation and provide equitable access to healthcare.
Kinari Webb, a medical doctor and founder of Health In Harmony and Project Alam Sehat Lestari (ASRI) was studying orangutans in Gunung Palung and saw first hand the link between health and the degradation of the environment.
“The people there are reasonably self-sufficient when it comes to food, but a healthcare emergency can cost a year’s wages,” she said, “Getting married, building a house or buying a motorcycle, you can plan ahead for these expenses, but that’s not possible for healthcare emergencies.”
After completing her medical residency in the United States, Webb returned to Indonesia to find the right place to solve this problem. After an exhaustive search, Health In Harmony began operations at Sukadana in 2007, where there were still remnants of low-land forest as well as a relatively stable and receptive local government.
According to Webb, the vast majority of that community understands that intact forests mean more water is retained for crops and there are better outcomes all around when forests are preserved – but farmers are often forced to turn to their local environment to get the sudden cash infusion needed in an emergency.
“If your own child is going to die, you don't have a choice,” Webb said.
Monica Nirmala is an Indonesian dentist who is now a masters student at Harvard’s School of Public Health. She is also a former director of the ASRI clinic in Sukadana and is now on the clinic’s board of advisers.
People who live in and around the forest realize the usefulness of the forest, but the forest is also their 'savings account' for emergencies.
“I have a neighbor who cut down a lot of trees, 60 trees, so that his family could pay for a c-section,” she said.
Nirmala said that even though Indonesia implemented a universal social healthcare system in 2014, out of pocket expenses remains high and access in remote areas remains difficult.
“Although the government covers most of the direct costs, people still have to pay out of pocket for transport costs and the cost of being away from their farm or business,” she said, adding that because Indonesia is a sprawling archipelago of 17,000 islands, access to a hospital or clinic can mean long travel times and significant expenses.
Health In Harmony figures show the number of logging households in the community has dropped by 89% over the last 10 years and in the first five years of the program infant deaths per 100 households declined 70%. The community now also has an ambulance.
Webb said one of the big challenges in implementing the project was giving access while ensuring that the community members retained their independence, adding that her team conducted 400 hours of “radical listening” interviews before getting the project underway.
“We’ve found that people don’t value things given away for free,” she said, “so we allow people to pay with seeds, handicrafts and other non-cash payment options.”
Webb said Health In Harmony gives discounts on healthcare to families that no longer log and also buys back logging equipment like chainsaws so it is taken out of circulation.
Although there is still a dearth of data when it comes to the full impact of the methods used, Webb says Health In Harmony is already getting underway in Madagascar and Brazil, where they hope to bring the same benefits to those communities.
