Challenges Faced in Purchasing Family Planning and Maternal, Newborn and Child Health Services in Indonesia, Kenya and the Philippines

30 July 2019

“PhilHealth offers neither a carrot nor stick approach to convince private midwives to provide family planning services,” shared Dr. Marife Yap, during a session at the 2019 iHEA World Congress in Basel, Switzerland. Dr. Yap discussed the experience in the Philippines to expand access to family planning (FP) services by encouraging private providers to expand their service offering, and explored the constraints private providers face, especially with respect to access FP commodities.

Dr. Yap’s presentation was part of the session “Strategic Purchasing of Sexual and Reproductive Health Services on the Path to Universal Health Coverage in Low and Middle-Income Countries.” The session showcased experiences and challenges associated with strategic purchasing of FP, and maternal, newborn and child health (MNCH) services in Indonesia, Kenya, and the Philippines, as part of ThinkWell’s Strategic Purchasing for Primary Health Care (SP4PHC) program.

Dr. Hasbullah Thabrany described the process of using Jaminan Kesehatan Nasional (JKN) – the single national health insurance scheme in Indonesia – to promote quality of maternity services through private midwives, who currently face significant barriers to participation in the scheme including an onerous contracting and claims reimbursement process.

In Kenya, Dr. Nirmala Ravishankar explained the fragmented purchasing landscape in the context of a newly-devolved system of government in the country, and how the signal from the Linda Mama free maternity scheme is diluted by purchasing practices at the sub-national level.

The audience engaged in discussion around the findings and work in each of the three countries. The issue of fragmentation in purchasing and its implications for individual purchasers drew comments from audience members, who identified this as a common problem across most low- and middle-income countries. A large delegation from Indonesia, which included representatives from the Ministry of Health, were keen to use this work as a starting point for exploring how Badan Penyelenggara Jaminan Sosial (BPJS-K), which administers JKN,  engages with a broad range of private providers.