Indonesian Health Minister Terawan Agus Putranto has largely failed to come to grips with Indonesia's Covid-19 epidemic. Image: Facebook

It’s not clear to many Indonesians why President Joko Widodo has maintained faith in Health Minister Terawan Agus Putranto, the military doctor who initially sought to play down the coronavirus threat and has since been missing in action in battling the pandemic.

It’s all the more baffling considering that the Health Ministry is home to the largest virus cluster in the capital with 252 confirmed cases, followed by the Transportation Ministry (175), the Anti-Corruption Commission (106) and the Food and Drug Monitoring Agency (89), according to Jakarta city administration data.

Although at least 107 doctors and 74 nurses have died from Covid-19, the Health Ministry infections are all among bureaucrats at the ministry’s headquarters in Jakarta’s Kuningan district and appear to suggest that the government is not practicing what it preaches.

In fact, ministries and state agencies fill 12 of the top 20 clusters in Jakarta. The rest include two suburban mosques, a church and an unrelated Catholic seminary, a women’s prison and PT Samudera, Indonesia’s largest shipping company.  

Senior officials aren’t immune. Jakarta city government secretary Saefullah died of the disease last week, and General Elections Commission (KPU) chairman Arief Budiman, who had been preparing for December’s regional elections, is undergoing treatment.

Previous victims have included Transportation Minister Budi Karya, who by most accounts was fortunate to survive a disease that has so far killed 9,600 people and infected more than 244,700, most of them on densely-populated Java island where social distancing is often difficult.

The number of daily infections topped the 4,000 mark for the first time on September 19, only days after Jakarta Governor Anies Baswedan caused consternation in the business community by introducing new social restrictions many initially thought amounted to a new lockdown in an effort to contain a renewed surge in cases.

An officer measures the body temperature of a driver on the highway during large-scale social restrictions to curb the spread of coronavirus in Pekanbaru, Riau Province, Indonesia. Photo: AFP via Anadolu Agency/Dedy Sutisna

While the blame inevitably falls on the government, it belongs in large part to a lack of discipline among workers who fail to wear masks or take other precautions in air-conditioned offices, where the virus is known to spread more quickly.

In recent days, the government has brought in military personnel as additional manpower to reinforce 50,000 police officers deployed across Jakarta’s suburban neighborhoods to compel people to comply with health protocols, including the wearing of masks and physical distancing.  

State companies may appear to have borne the brunt of the latest surge in cases, but private companies haven’t been spared either since work at home rules have been slowly relaxed, bringing office workers back into close contact.

One small Jakarta office owned by an oil and gas company has been devastated by the disease, with the Indonesian CEO and his Australian deputy both dying within days of each other and another seven of the 19 staffers also infected.

Shipping line Samudera counts three employees among the dead, but most of the 51 other workers who contracted the virus have recovered, according to Shanti Poesposoetjipto, chairman of the firm’s board of commissioners.

Samudera has more than 6,000 employees spread across 64 locations in Indonesia and another 58 offices and sites in 27 countries, providing it with a greater challenge than most Indonesian companies. 

Health Minister Putranto has been a source of controversy from the start. When he was first appointed to Widodo’s second-term Cabinet last October, the Indonesian Medical Council (IDI) pointed out that he was under scrutiny for a breach of medical ethics.

Specializing in radiology, the three-star general was accused of championing a so-called “intra-arterial cerebral flushing” treatment for stroke patients, popularly known as “brain-flushing,” which had not been scientifically proven to be safe.

Health Minister Terawan Agus Putranto is no stranger to controversy. Image: Facebook

Employing digital subtraction angiography, normally a diagnostic tool, Putranto had instead used the procedure as a form of therapy, which had become widely accepted by his patients because there had been no reported side effects.

In his defense, Widodo pointed to Putranto’s experience in managing budgets and human resources as former director of the Gatot Subroto Army Hospital (RSPAD), now one of the main hospitals caring for critically ill coronavirus patients.

Ironically, the president also noted the 56-year-old general’s ability in handling endemic diseases, a claim that has come under increasing scrutiny over the past six months as Indonesia has struggled to contain the spread of the coronavirus.

When he formed the National Covid-19 Task Force last April, Widodo chose another general, Doni Monardo, head of the National Disaster Relief Agency, to head the body in what appeared to be a vote of no-confidence in his health minister.

Officials involved in the pandemic response say they are puzzled as everyone about why Putranto remains at his post, particularly after Widodo complained bitterly at a June Cabinet meeting that only a tiny fraction of the annual $5.2 billion health budget had been spent.

“It’s a big difference between working in a hospital and in a ministry,” says one official, who recalled Putranto complaining to a senior Cabinet member that he was not getting enough co-operation from some of his upper-echelon bureaucrats.

More recently, retired general Luhut Panjaitan, the coordinating minister for maritime affairs and Investment, has been tasked with managing the pandemic in Jakarta and the worst-hit provinces of West, Central and East Java, Bali, North Sumatra, South Kalimantan, South Sulawesi and Papua.

Irma Hidayana, a doctor in public health and one of the founders of the Community Coalition for Covid-19, a private coronavirus reporting center, says if Putranto had done his job from the outset, the virus could have been brought under control.

Indonesian people queue to get on a train bound for Jakarta from Bogor station by applying protocols for the Covid-19 coronavirus in Bogor on August 3, 2020. Photo by AFP/Adek Berry

Certainly, as a medical professional, Putrantro’s sense of urgency has always been missing. When Covid-19 took a grip on the Chinese city of Wuhan and spread into Southeast Asia in late February, his first response was to ask Indonesians to pray.

“If there are other nations protesting our approach, just let them,” he said, noting that Indonesia at the time had recorded no official cases of the disease. “It is our nation’s right to rely on the Almighty.”

More worrying for scientists were his comments that the surge in demand for face masks was an over-reaction and that not all of the suspected coronavirus cases in Indonesia had been tested because of “budget efficiency.”

Only when the Health Ministry came under pressure because of the lengthy time lapses necessitated by having to send test samples to Jakarta that it allowed provincial laboratories to take a hand in the routine testing program.

Suspicions began to emerge that efforts were being made to play down the pandemic when official data appeared to differ from information supplied – and sometimes leaked – by state hospitals run by the ministry itself.

Even today, there is widespread skepticism about the official figures the ministry trots out each day, with some epidemiologists warning that the real number could be five or even 10 times greater.

Meanwhile, little has been done to increase the testing capacity of the healthcare system, which remains far below the 267,000 polymerase chain reaction (PCR) swab tests a week that are required to meet the World Health Organization’s standard of 1,000 per million population.

Despite concerted efforts, journalists have so far been unable to determine what money the central government has set aside for testing or to find any other financial breakdown that may provide a clue to where spending priorities lie. 

This picture shows tombstones at a burial site for victims of the Covid-19 coronavirus in Jakarta on September 11, 2020. Photo: AFP/Bay Ismoyo

More than 87.5 trillion rupiah (US$5.9 billion) was allocated for healthcare in a 695.2 trillion ($47.2 billion) stimulus package announced last June. Next year, if all goes to plan, the government will have the additional burden of paying for a vaccine for about 93 million Indonesians on the lower end of the social scale.

Epidemiologists say it is important for the government to change strategy and focus all its resources on testing in the red zones of the nine provinces which together have contributed to 177,000 of the nationwide cases.

Jakarta leads the way with 60,000 cases and 1,500 deaths, followed by East Java with 40,000 infections.