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 and one pager. To see how our SP4PHC team in Indonesia has helped its government respond to Covid-19, view our Covid-19 response page.

Our Strategies

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.


These three factsheets below serve as a reference and aim to visualize the latest data and trends on purchasing family planning, maternal & newborn health services, and a broader overview of purchasing in Indonesia.  Each factsheet also highlights some of the activities the SP4PHC country team is working on with local stakeholders within that topic area.  These factsheets are updated annually (latest in May 2021).                   Health Purchasing Factsheet                Maternal, Newborn, and Child Health Factsheet             Family Planning Factsheet

Upcoming & Latest Events

From September 21-24, 2021, the SP4PHC team in Indonesia will present four abstracts at the Indonesian Health Economics Association (InaHEA)’s seventh biennial scientific meeting in Bandung, Indonesia. This year’s meeting is entitled “Protecting People: Indonesia’s Lessons from the COVID-19 Pandemic, Health Economic Point of Views.”  The abstracts include:

  • How Jaminan Kesehatan Nasional (JKN) coverage influences out-of-pocket (OOP) payments by vulnerable populations in Indonesia; presented by Nirwan Maulana, Senior Analyst at ThinkWell Indonesia.
  • How is the disease that JKN “purchased” compatible with the Doctor’s Clinical Practice Guide at Primary Health Care; presented by Halimah Mardani, Senior Analyst at ThinkWell Indonesia.
  • Assessing the readiness of Puskesmas in the completion of disease management; presented by ThinkWell partner Harimat Hendrawan, Researcher at the National Institute of Health Research and Development within the Ministry of Health.
  • The effect of JKN coverage on paying OOP for family planning services in Indonesia; presented by Nadhila Adani, Data Analyst at ThinkWell Indonesia.

Stay tuned to learn more about the key takeaways.

Featured Learning Products

The effect of national health insurance on out-of-pocket payments for family planning services in Indonesia

Although family planning (FP) services are included in the benefits package provided by the national health insurance, Jaminan Kesehatan Nasional (JKN), many Indonesian women still go to private providers who are often not contracted by JKN and charge them out-of-pocket to access FP services. A recent pre-print study aims to understand how JKN influences out-of-pocket payments for long- and short-acting contraceptives—especially those used among subsidized and unsubsidized JKN member groups—across all types of public and private providers. These findings hope to extend universal access to FP benefits in the country.

How JKN Coverage and Supply-side Readiness Influences Out-of-Pocket Payments Across Indonesia

This brief, published in January 2022, summarizes findings from a study on how Indonesia’s national health insurance coverage and the supply-side readiness of providers influence out-of-pocket payments, as well as how that relationship changes across the different provinces of Indonesia. In addition to reviewing the study findings, this brief also offers policy recommendations for how the Government of Indonesia can improve both its demand-side and supply-side financing to expand affordable access to high-quality health care across all its islands.

What can Bangladesh and Indonesia’s COVID-19 response teach us about the importance of public financial management?

In a new blog for P4H Global, ThinkWell’s teams in Bangladesh and Indonesia shine a spotlight on how upstream public financial management (PFM) obstacles restricted how front-line responders could respond to COVID-19. These insights draw from the experience of Bangladesh and Indonesia, where the authors have been working closely with their respective governments to identify and address some of these challenges.

Maintaining Essential Services During the Covid-19 Pandemic in Indonesia

How did the Government of Indonesia try to maintain essential health services (EHS) in the midst of a pandemic? This policy brief focuses on how upstream financing challenges at the national and district levels affected frontline providers to effectively respond to Covid-19 and maintain routine EHS for Indonesians. The brief also offers policy recommendations on improving these processes for inevitable future crises.

How Jaminan Kesehatan Nasional (JKN) coverage influences out-of-pocket (OOP) payments by vulnerable populations in Indonesia

While the Government of Indonesia introduced a national health insurance scheme (JKN) in 2014 and coverage has grown to over 80% of the population, Indonesians still spend significant sums out-of-pocket (OOP) for their health care – over 30% of current health expenditure. This study aims to better understand how JKN is influencing OOP payments, especially among the poor and rural, at the range of public and private PHC and referral-level providers across the country.


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.

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