The Indonesia Universal Health Coverage (UHC): Initial Assessment of Challenges and Opportunities for Maternal and Child Health Care

Advisor:
Coordinator:
Team Member: Sri Budiyati, Nurmala Selly Saputri, Yudi Fajar M. Wahyu , Kartawijaya , Asep Kurniawan
Completion Year:
2015
Area:
Jawa Barat, Yogyakarta, Sumatera Barat, Nusa Tenggara Barat, Maluku Utara, Gorontalo, Kalimantan Selatan
Topic:
Gender, Health, Social Protection

Collaborating Partners

Funding body:
UNICEF

 
 

Description & Progress

This study intended to provide an initial assessment on its early implementation, focusing mainly on maternal and child health (MCH) issues, in an attempt to provide policy recommendations at the national level.

 

Description

On 1 January 2014, Indonesia embarked on major health insurance reforms as part of its efforts to acheive Universal Health Coverage (UHC). The health insurance is projected to gradually provide coverage for 257.5 million people by 2019. By the end of 2014, around 65% of the population was covered by some form of health insurance, while the remaining 35% still did not have access to any form of health insurance.

While it is agreed that the UHC can be considered a work in progress, Indonesia is still facing significant challenges in achieving the Millenium Development Goals (MDG) 4 and 5, especially in reducing maternal and infant mortality rates through preventive and curative efforts. With the current UHC implementation, existing free health service programs for the poor were apparently being merged into a single national program administered by BPJS Kesehatan. This should not be a problem if maternal and child health (MCH) are addressed properly as part of the UHC program. Unfortunately, it is unclear and difficult to determine whether MCH services remain a major concern within the UHC program. Despite the UHC being a work in progress, this study intended to provide an initial assessment on its early implementation, focusing mainly on MCH issues, in an attempt to provide policy recommendations at the national level.

 

Methodology and Data

The study mainly adopts a qualitative approach, supported by relevant quantitative data to generate an accurate and comprehensive picture of how key MCH interventions were delivered through UHC service delivery systems. The data was gathered from secondary sources including existing documents, interviews at the national and local level, and FGDs at the district and village level. Field studies were conducted in Kota Bogor and Kabupaten Sleman (in November 2014), and Kota Padang Panjang, Hulu Sungai Utara, Lombok Utara, Gorontalo Utara and Halmahera Barat (in March 2015).

 

Research Highlight

The research report highlights that JKN’s capacity to protect pregnant women and newborns, in particular those from low income communities, is lower than Jampersal. In general, the MCH services in JKN cover all MCH needs. However, more  concern needs to be placed on the quality of MCH services in order to reach the expected outcomes.The JKN scheme could be effective in solving financial barriers to accessing MCH services, particularly in relation to direct (medical) costs. However, there is still evidence that poor residents are required to pay out-of-pocket expenses to access some services. Moreover, JKN does not protect poor pregnant women and newborns from indirect costs involved, which can amount to the equivalent of the direct costs.

 

Dissemination

The team presented the study findings to UNICEF on 9 and 19 June 2015. The final report and summary findings were presented to the MoH by a UNICEF team. In addition, the research team submitted three abstracts extracted from the research report to the Fourth Global Symposium on Health System Research (HSR) 2016 held in Vancouver, Canada in November 2016. Two abstracts was selected to be poster presentations.

Link for e-posters:

  1. Protecting Poor Pregnant Mothers and Newborns in the era of Universal Health Care Scheme: Case of Indonesia
     
  2. Universal Health Care Scheme Consequences on Local Health Financing: Indonesia’s Experience