SP4PHC in Indonesia
SP4PHC is focused on improving purchasing through the national health insurance program in Indonesia, Jaminan Kesehatan Nasional (JKN), which covers over 80% of the population. Due to its escalating costs, there are growing concerns about the scheme’s long-term financial sustainability. Additionally, Indonesia has a high maternal mortality rate and family planning progress has stagnated. SP4PHC’s goal is to improve how JKN uses purchasing as a lever to increase access to and quality of family planning and maternal, neonatal, and child health services through the full range of public and private health providers. For more information, view our Indonesia overview presentation, one pager and factsheet. To see how our SP4PHC team in Indonesia has helped its government respond to Covid-19, view our Covid-19 response page.
SP4PHC has four key strategies to strengthen primary health care access and quality in Indonesia.
Strategy 1: Strengthening the purchasing of maternal, newborn, and child health (MNCH) services
Indonesia suffers from stubbornly high maternal mortality. One contributing factor is that private midwives, a crucial source for delivering reproductive and MNCH services, largely operate outside of the country’s national health insurance (JKN) system. SP4PHC is collaborating with the Ministry of Health, Social Insurance Administering Body for Health (BPJS-K), and USAID Health Financing Activity to test policies that improve how quality MNCH services are purchased and to influence ongoing JKN reform decisions.
Strategy 2: Strengthening how district health offices purchase services from primary health care providers
Indonesia currently has multiple, fragmented channels for funding health services. Although decentralization gave districts greater autonomy over health programming and budgeting, they lack the capacity and guidance to manage these funds to maximize allocative efficiency. SP4PHC is collaborating with District Health Offices to understand the types of funds given to districts, what purchasing signals they are sending to facilities, and policy options needed to strengthen the public financial management capacity of District Health Offices.
Strategy 3: Improving how family planning services are purchased
Progress on increasing the modern contraceptive prevalence rate and total demand satisfied has stagnated in Indonesia. Specific challenges include both low utilization of family planning services throughout JKN and limited access to family planning commodities by private providers. SP4PHC is collaborating with Universitas Gadjah Mada to map the family planning funding flows and to develop policy recommendations for government stakeholders on increasing access to family planning through the private sector.
Strategy 4: Aligning purchasing in the time of Covid-19
The national government’s response to Covid-19 has implications for service delivery. Issues include how funding for routine essential services (family planning, MNCH, nutrition, and immunization) was impacted and how a lack of public financial management capacity at District Health Offices affected their ability to utilize health funds effectively. SP4PHC is collaborating with the Vice President’s Office, the Ministry of Health, and District Health Offices to identify opportunities to improve purchasing mechanisms, which will help the government respond to the current pandemic and prepare for future crises.
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Missing Midwives: A Significant Source of Maternal Health Services is Overlooked
Midwives provide a substantial proportion of reproductive and maternal services in Indonesia, but few are contracted under Jaminan Kesehatan Nasional or connected to local provider networks. This animation, published in January 2020, illustrates the barriers midwives face when participating in JKN and how specific SP4PHC strategies plan to address these challenges.
Bringing Private Midwives into Indonesia’s National Health Insurance Scheme
ThinkWell and Universitas Gadjah Mada’s Center for Reproductive Health conducted a landscaping assessment to better understand why private midwives are not joining JKN. This report, published in July 2020, also has policy recommendations for JKN administrators to incentive private midwives to enroll in the scheme. Strategic purchasing techniques can then be used to improve quality of care, increase access of affordable services, and strengthen coordination within the service delivery system.
SP4PHC aims to improve how governments purchase primary health care services, with a focus on family planning and maternal, newborn, and child health. SP4PHC is supported by a grant from the Bill & Melinda Gates Foundation.