As shall be seen, these are also two of the most malarious provinces in Indonesia. The highest illiteracy rates occurred in Papua (23% rural 32% and urban 2%) and West Nusa Tenggara provinces (18% rural 20% and urban 13% Departemen Kesehatan, 2008). The government’s Household Health Survey estimated an illiteracy rate of 7%, with more females (10%) than males being illiterate (4%) and with higher rates in rural (10%) than in urban areas (4% Badan Pusat Statistik, 2007b). Life expectancy at birth for Indonesians increased from 52 years in 1980 to 69 years in 2007 ( Departemen Kesehatan, 2008). The age distribution of the population was 30% young (0–14 years old), 65% productive age (15–64 years old) and 5% old age (≥65 years old). More people live in rural (57%) than in urban areas (43%). Sixty percent of Indonesians live on Java and Bali, representing only 7% of the land area of Indonesia. The population density on Java and Bali (977 people/km 2) was much higher than on other islands (50 people/km 2). The annual population growth rate was 1.3% ( Badan Pusat Statistik, 2007a). Census authorities in 2007 estimated a population of 227 million people, with an average density of 118 people/km 2 ( Departemen Kesehatan, 2008). Since decentralization of government power in 2000, Indonesia has been considered to consist of 33 provinces, 465 districts/municipalities, 6093 sub-districts and 73,067 villages ( Departemen Kesehatan, 2008). The archipelago comprises seven main islands: Sumatra, Java, Kalimantan, Sulawesi, Maluku, the Lesser Sundas and Papua. The country consists of 17,504 islands (only 6000 of which are inhabited), covering a land area of 1.9 million km 2 (Departemen Dalam Negeri, 2004, 2008). The Republic of Indonesia in Southeast Asia makes up most of the Indonesian archipelago that straddles the equator and stretches 5200 km from west Malaysia to Papua New Guinea ( Fig. We examine prospects for malaria control in contemporary decentralized and democratized Indonesia with multidrug-resistant malaria and greatly diminished capacities for integrated malaria control management programs. We detail important methods of control and their impact in the context of the political systems that supported them. This chapter examines malaria and its control in Indonesia, from the earliest efforts by malariologists of the colonial Netherlands East Indies, through the Global Malaria Eradication Campaign of the 1950s, the tumult following the coup d’état of 1965, the global resurgence of malaria through the 1980s and 1990s and finally through to the decentralization of government authority following the fall of the authoritarian Soeharto regime in 1998. Social, economic and political dimensions contribute to these complexities. A complex mosaic of risk of infection across this 5000-km-long archipelago of thousands of islands and distinctive habitats seriously challenges efforts to control malaria. The country is also home to over 20 anopheline vectors of malaria which transmit all four of the species of Plasmodium that routinely infect humans. Approximately 230 million people live in Indonesia.
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