The social, political and economic events that characterized the 1930s influenced the hospital developments of that period. A strong influence could be attributed to the Great Depression, which involved large cuts in the government budget. As the government subsidies were curtailed, the health care budgets were cut as well. Besides the measures needed to deal with the economic crisis, efforts were needed to restore law and order, as the nationalist opposition took aggressive actions. The opposition played the game of non-cooperation, when elected in local, regional and national councils.
The developments in the field of epidemiology were discussed: the plague continued to make victims, especially in West Java and the Public Health Service agencies that screened the youth at schools, discovered many cases of tuberculosis. More efforts were made to record leprosy cases and to motivate these patients to accept voluntary isolation. The history of a leprosy institution in the Moluccas was presented. The disease took a threatening form in this part of the NI, but even more on the islands of Bali and Lombok.
After the political and general health care developments, the situation of hospitals was discussed. In this last episode, four developments that characterized the period 1930-1942 were discussed. The first was the process of decentralization that had a large impact on public hospitals, but also on other services of the Public Health Service. At first sight, decentralization was a logical step on the road towards emancipation and au-tonomy. In the different provinces and regencies, the population could decide on the social, educational and health facilities that it wanted. But the process was centrally arranged. So, the population did not decide on questions such as the financing of a hospital, a school or a community centre, but had to deal with decisions, accomplished by other bodies in former times. The government public hospitals already existed in the towns and regional cities, which in the 1930s received the financial burden that was involved with the transfer of ownership. Admittedly, the central government at first tried to persuade the lower public agencies to take over voluntarily, but when the takeover stagnated, the issue was forced by Government Decree.
The second development discussed, was the sudden increase of health care activities from the side of Roman Catholic missionary congregations. At first, these organizations were handicapped by the lack of missionary doctors and, therefore, missed the necessary encouragement by government subsidies. But from about the mid-twenties and more so in the 1930s, this handicap was overcome and many hospitals, auxiliary hospitals and outpatient clinics were established. Most of them were located in the Outer Provinces.
The third development was the founding of health facilities in the sugar belt of Java (East Java and the Principalities of Djokjakarta and Soerakarta). The sugar barons took notice of the Djokja hospital developments and the Deli experiences and decided to join in the interest of the workers, but mostly in order to improve the operational reliability of their annual campaigns. Sometimes this participation took the form of joint ventures with other private organizations, like missionary societies. Often, the hospitals, auxiliary hospitals and outpatient clinics were combined efforts of a group of sugar plantations. In this way, 28 hospitals and 64 outpatient clinics were established and 16 other hospitals were subsidized.
Finally, the specialized hospitals too witnessed expansion during the 1930s. Especially the sanatoria for tuberculosis patients expanded in number and capacity, but the facilities for leprosy patients and for eye patients also grew in number and capacity and this despite the economic depression.
As for the availability of hospital capacity, efforts were made to position this variable in relation to areas and populations serviced. For reference a combination of two examples was taken: the vaccination circles introduced by A.E. Wasklewicz and the principle of British Indian hospitals to aim at serving populations within a circle with a radius of 10 miles from the establishment. An area of about 800 km² around a hospital might be con-sidered within reasonable distance of the population to be served (having a radius of 10 miles from the establishment). As such only the Residencies on Java (Priangan, Jogjakarta) and the province of East Java had hospitals established within reachable distances on average. For the Residencies in the Outer Provinces: Celebes (2.137 km²) and West-coast Sumatra (3,111 km²), the areas served were about 3 to 4 times acceptable levels. Even the plantation belt of the Eastcoast of Sumatra, often mentioned because of its rational planning and efficient hospital management, did not meet the standard and had an average area serviced per hospital of 1,970 km².
On balance a lot of treatments was given in outpatient clinics, the dispersion of these settlements should be taken into account as well. In British India the picture was rather positive: the areas covered by hospitals had a square mileage of 135 on average (the reference point of 314 miles² being the equivalent of 800 km²) and only 2 provinces (Sind and Baluchistan) exceeded the reference, but then all facilities were taken into account,
including dispensaries without accommodation for in-patients. If we also take into consideration the outpatient clinics in the Outer provinces together with the hospital establishments, the average value would be much more acceptable.