Hi, this is Natasha from the Think Tank (research team)! I’m currently living in Tokyo, Japan. Under this current pandemic situation, knowing that Japan has significantly more hospital beds per 1,000 people than any other industrialized economies (OECD members), for a while, I felt secure for being in Tokyo in case I got infected and needed hospitalization. Also, Japan has essentially more ICU hospital beds (for acute care) with 13.5 ICU(s) per 100,000 people compared to European countries such as France (11.6 ICU(s) per 100,000) and Britain (6.6 ICU(s) per 100,000).
However, I found out in a recent newspaper that Japan is experiencing a shortage of hospital beds for COVID-19 patients in the Tokyo Metropolitan Area. A medical representative even described the situation as ‘on the brink of collapse just like a dam that is on the verge of bursting’. The hospital beds secured for COVID patients have been fully occupied since the beginning of the year leaving them no choice but refusing COVID patients at times.
That information certainly doesn't add up given the hospital beds ratio in Japan is among the highest in the world. Besides, the number of COVID infection cases in the country has been considerably lower than in Western countries. So, what exactly caused this shortage?
There are at least two reasons I could understand. First, 70% of hospitals in Japan are private. And, only 18% of private hospitals are willing to accept COVID 19 patients while 70-80% of public hospitals are willing to do so. Private hospitals have been worried about accepting COVID 19 patients, fearing possible cluster generation within their hospital which ultimately might affect their reputations. Second, small and midsize hospitals with <200 beds make up 70% of all hospitals in Japan. And, data says that only 20% of small and midsize hospitals had accepted COVID 19 patients. In total, only 4% of total ICU beds are secured for COVID 19 patients which is obviously not proportional to the number of patients.
From the Japanese medical system, I learned that it is impossible to tell a country’s situation based on only one indicator. There is certainly much more beyond GDP to tell countries’ economic performance and much more beyond the number of hospital beds per capita to tell countries’ medical systems.
This brought me to think of the achievement that Indonesian government has been so proud of: achieving nearly a 99% electrification ratio. I was so happy knowing that only ~1% of the Indonesian area needs to be electifried. However, considering the hospital bed ratio in Japan that doesn't say much about the whole situation, it raised a new question: does 99% electrification say much?
Unfortunately the answer is no. No, it doesn’t say much. According to a briefing paper by IESR entitled: Status of Sustainable Energy Access in Indonesia 2020 (Status Akses Energi Berkelanjutan di Indonesia 2020 in Bahasa Indonesia), although electrification ratio is almost 100%, there is still wide variation in the quality of electricity. Electrification programs performed by the government or other organizations in Indonesian rural areas mostly rely on generating electricity through micro or mini hydro generators which give low power output less than 200 W. Besides, there is also Solar Home System (SHS) which was distributed in 2017-2019 to 1.6-1.7 million people could only provide lighting with 4 LED lamps for 10-12 hours and mobile phone charging. In the table below, the concept of multi-tier framework is summarized. And, electrification quality in a number of rural villages in Indonesia has only achieved tier 1 and tier 2. Meanwhile, people who live in urban areas can already enjoy tier 4 or tier 5 electricity.
Gaps in quality affect the outcomes or benefits of using electricity. Energy access is closely linked to people’s ability to perform productive activities with commercial/economic purposes, to perform health care services, to conduct educational activities, etc. This tells me that having 100% electrification is not enough. We should focus more on improving the quality of electricity especially in rural areas to allow them have a better quality of life.
The same thing also applies to small-scale biogas. Having a high installation rate shouldn’t be the only goal. Having a high installation rate and high utilization rate, for instance, would be a better goal. Having farmers having biogas digesters installed at their yards is obviously not enough, yet having them fully benefit from their biogas reactors is what we expect. su-re.co has worked on improving the sustainability of biogas uses among farmers in Bali and Flores. Currently, we are expanding to carbon offset to maximize the incentive for farmers which will ultimately improve the continuation of su-re.co's biogas reactors.
The Japan News, Sunday, January 10, 2021. Kiyohiko Yonemaya; Masanori Tonegawa. COVID-19 pandemic exposes weakness of medical system.
Fabby Tumiwa, IESR Briefing Paper: Status Akses Energi Berkelanjutan di Indonesia 2020 in Bahasa Indonesia