Carol Warren

This chapter focuses on the factors influencing Mekong Delta farmers’ satisfaction with health insurance services in the context of agricultural practice. The study identifies three key factors affecting farmers’ satisfaction with health insurance services: participation and payment procedures, hospital service quality, and the support of hospital and social insurance staff. Statistical analysis indicates that these factors significantly impact farmers’ satisfaction levels, with women rating health insurance services higher than men. Moreover, the study underscores the importance of improving access to quality care and enhancing client satisfaction to address the challenges faced by farmers in accessing healthcare services. The research employs a mixed-method approach, including surveys, interviews, and focus group discussions, to gather empirical data from 180 farming households in An Giang, Can Tho, and Soc Trang provinces. The chapter recommends policy reforms to address the socio-economic and environmental changes in the Mekong Delta, advocating for the integration of technological innovations such as telemedicine and artificial intelligence (AI) diagnostic tools to enhance healthcare accessibility. The study’s implications extend to the Vietnam Ministry of Health and Social Security Agency, providing insights to identify areas for improvement in health insurance policies and social security systems. The research contributes to the ongoing discourse on enhancing healthcare services for rural populations, with implications for policymakers, healthcare providers, and social security agencies.

As we finalised this volume, the COVID-19 pandemic bore down on Indonesia and disrupted the picture of declining rural poverty discussed in earlier chapters. To reflect on the implications for rural livelihoods and the scenarios we identified, we conducted interviews and reviews of available reports. Here we offer some preliminary thoughts on the impacts of the pandemic and consider how COVID-19 has triggered changes within the scenarios outlined in Chapter 2. We also reflect on the role of social assistance during this crisis.

The scenario approach applied in this volume understands rural transformation as a diachronic process, where contextual and relational mechanisms interact dynamically with political, institutional, economic, social and environmental structures and social relations to produce discernible patterns of agrarian change over time. A path dependency is at work in each scenario: as proximate and relational processes have converged with structures to shape a scenario over historical time, these patterns work causally, setting the conditions for possible outcomes into the future. However, change is not predetermined. When a contingent event occurs, such as a pandemic, it may reinforce pre-existing patterns, reproducing or deepening the effects. Yet, the contingent event may also trigger reactions and changes that can shift livelihood trajectories in new directions. As we will argue below, the pattern of change will depend upon how the contingent trigger (for example, a pandemic) plays into processes and structures characteristic of the specific scenario. In this epilogue, then, we set out to explore how the COVID-19 pandemic works as a contingent trigger exerting pressure on existing patterns of rural change, and intensifying the insecurity of the most vulnerable, producing both winners and losers.

This chapter examines the impact of environmental decline on local livelihoods in a west Balinese coastal community, as a case study of the precarity arising from resource degradation affecting many rural communities in Indonesia and beyond (Rigg et al. 2016). Alongside vulnerability to life cycle crises of illness, death and disability, precarity for the population of Perangkat (pseudonym), a fishing community in the district of Jembrana, west Bali, arises from a number of serious anthropogenically induced environmental challenges, leaving villagers with limited prospects of a “sustainable” future to support livelihoods in their home community. More broadly, this case study is a harbinger of longerterm vulnerabilities, exploring the under-recognised looming threats to food security and economic development posed by natural resource degradation. The new precarities are starkly evident in the fisheries sector, but represent a wider issue driven by unsustainable production practices in agriculture and other sectors of intensified natural resource extraction. The paradox in these cases is that the same market expansion and capitalist accumulation processes that underpin “development” trajectories are ultimately undermining them. The fishing village of Perangkat was officially classified as a desa tertinggal (left-behind village) during the Suharto Era. The progression out of poverty over the 1990s and early 2000s and the subsequent unravelling of the local economy as a consequence of the collapse of the Bali Strait fishery since 2010 do not fit neatly into conventional agrarian transition models or stages of poverty scenarios. The primary focus of this chapter is on the impact of resource decline and the complexity of interpreting questions of poverty, food security and social protection in settings where an ambiguous sense of “precarity” poses so many shades of grey in the measurement and assessment of community and household livelihood trajectories, presenting a scenario of reversal precipitated by resource degradation.

The conflict over land on the island of Gili Trawangan, Lombok, is one of the many intractable cases inherited from the late New Order. It evolved in the context of rapid value transformations in the local, national, and global economies, as smallholders competed for land with commercial plantations, then resort development, and more recent incursions of the international property market.The case involved repeated government land clearance campaigns, reclaiming actions of local settlers, and emerging social divisions among the islands

No one seems to realize that Indonesia is entering a period of social revolution. The signs are there. It can be seen in the farmers who, having had their land stolen from them during the New Order, are now taking it back by force. It can be seen in the protests by farmers outside regional assembly buildings. It can be seen in the attacks on hundreds of police and military posts . In the past, these very same people would have let themselves be robbed of their voices, but now they are fighting back. Whether they realize it or not, they are the vanguard of a social revolution. - Pramoedya Ananta Toer