Addressing barriers to healthcare access for migrant workers in Indonesia: a legal and policy analysis of sexual and reproductive health rights

¹Faculty of Law, Universitas Diponegoro, Jalan Dr. Antonius Suroyo, Tembalang, Semarang City, Central Java 50275, Indonesia

^&Corresponding author
Aga Natalis, Faculty of Law, Universitas Diponegoro, Jalan Dr. Antonius Suroyo, Tembalang, Semarang City, Central Java 50275, Indonesia

To the editors of the Pan African Medical Journal    

The purpose of this letter is to address the challenges and gaps in Indonesia's legal and healthcare frameworks regarding the protection of migrant workers, particularly their access to healthcare and sexual and reproductive health rights (SRHR). While constitutional provisions, national legislation, and international treaties establish these rights, enforcement remains inadequate, especially for migrant workers in the informal economy or those without proper documentation. Healthcare providers in this context face poor working conditions, low wages, and occasional violence, which negatively impacts.

SRHR services, further exposing women to adverse health outcomes [1]. The 1945 Constitution of the Republic of Indonesia establishes the fundamental legislative framework for health and social protection. Article 28H, paragraph (3), ensures the entitlement of every individual to social security, encompassing the right to healthcare. This constitutional assurance emphasises that all citizens, including migrant workers, have the right to obtain health care that upholds dignity and well-being. Furthermore, Article 34, paragraph (2) stipulates that the state must establish social security institutions that protect disadvantaged individuals, underscoring the government's obligation to support vulnerable groups, including migrant workers [2,3].

Law No. 18 of 2017 on the Protection of Indonesian Migrant Workers is another significant piece of legislation pertinent to the health rights of Indonesian workers overseas. Article 29 of this legislation explicitly underscores the necessity of providing social security to migrant workers, including access to healthcare services, thereby affirming the government's obligation to safeguard their health and safety. Nonetheless, the enforcement of this legislation is frequently insufficient, especially for individuals employed in informal or unauthorized circumstances [4]. The National Social Security System Law of Indonesia, established under Law No. 40 of 2004, provides social security benefits, including health insurance, to its inhabitants. This law serves as a fundamental basis for universal health coverage in Indonesia; yet, it inadequately addresses the requirements of migrant workers, particularly those employed in the informal economy or lacking documentation [5]. The omission of migrant workers from Indonesia's National Health Insurance Program underscores the deficiencies in healthcare coverage for this demographic, resulting in several migrant workers without vital services, especially in sexual and reproductive health.

International law significantly influences Indonesia's healthcare policies for migrant workers. Indonesia is a signatory to the worldwide International Labour Organization (ILO) Convention No. 102 on Social Security, which establishes worldwide benchmarks for the provision of social security, including health insurance, for migrant workers. This agreement stipulates that all workers, irrespective of their status, must have access to healthcare services that maintain their health and dignity [6]. Furthermore, Indonesia adopted the International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families in 1999, thereby enhancing the legal framework for the protection of migrant workers. Article 28 of this convention ensures that migrant workers are entitled to sufficient healthcare and safeguarded against discrimination in the provision of health services [7]. Notwithstanding Indonesia's adherence to these international accords, substantial deficiencies persist in the effective implementation of these safeguards, especially regarding illegal labourers and individuals employed in the informal sector.

Regarding SRHR, it is essential to implement laws that guarantee the complete realization of these rights for migratory workers, particularly women. The National Health System, as stipulated in Health Law No. 17 of 2023, ensures the safeguarding of sexual and reproductive health within the framework of the right to health. This regulation does not specifically cater to the distinct needs of migrant workers, especially those in precarious situations. Indonesia's Sexual Violence Law (Law No. 12 of 2022), while a progressive measure in combating gender-based violence, inadequately addresses the interplay of sexual violence, migratory status, and access to reproductive health services for migrant women [8].

A critical issue facing migrant workers in Indonesia is the lack of protections for undocumented workers, who often face discrimination and fear deportation when seeking medical assistance. This vulnerability severely limits their access to essential healthcare, particularly in sensitive areas such as maternal health and family planning. As Sezer Kisa and Adnan Kisa [9] have noted, undocumented migrant workers often encounter numerous barriers when seeking emergency medical care, such as legal issues, economic constraints, language differences, and cultural disparities. These barriers lead to delays in receiving treatment, which in turn exacerbates health inequalities. Many undocumented migrants are forced to rely on emergency services as a substitute for primary healthcare due to limited access to health insurance and a lack of knowledge about alternative care options. Moreover, healthcare providers face challenges in delivering adequate care, particularly when conditions worsen due to a lack of earlier access. To address these issues, a comprehensive approach is needed, including policy reforms, increased awareness among healthcare professionals, and community-based interventions. The government must ensure that all migrant workers, including those without documentation, have guaranteed access to healthcare by removing existing barriers such as the fear of deportation and discrepancies in health policies.

In addition to healthcare access, it is essential to tackle cultural and linguistic barriers by training healthcare providers in cultural competence and language proficiency [10]. Gender-sensitive approaches should also be prioritised, particularly for female migrant workers, ensuring they receive adequate sexual and reproductive health services. By implementing inclusive policies, expanding social security, and addressing the legal vulnerabilities of undocumented workers, Indonesia can promote equitable healthcare access for all. This will fulfil the country's human rights obligations and foster social justice. While Indonesia's legal framework offers important protections for migrant workers' healthcare and SRHR, significant challenges remain, particularly for undocumented workers and those in vulnerable employment situations. Strengthening the enforcement of these laws is crucial to ensuring that all migrant workers, regardless of their legal status, have equal access to healthcare. This can be achieved by expanding social security benefits, incorporating migrant workers into the National Health Insurance Programme, and providing gender-sensitive, culturally competent healthcare services. Addressing these gaps will improve health outcomes for migrant workers, particularly women, and help fulfil Indonesia's human rights obligations. The public health community must advocate for these changes to create an equitable healthcare system that upholds the rights and dignity of all workers.

Competing interests    

The authors declare no competing interests.

Authors' contributions     

All the authors have read and approved the final version of this manuscript.

Acknowledgment     

We would like to express our sincere gratitude to Universitas Diponegoro for their support and funding for this research through non-APBN funding for the fiscal year 2025. Our thanks also go to the Research and Community Service Institution of Universitas Diponegoro for their guidance and approval, as well as to everyone who contributed to the success of this project. Your assistance has been invaluable.

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