SP4PHC in Indonesia

SP4PHC is focused on improving the ways in which primary health care services are purchased by the Government of Indonesia (GOI), both through its national health insurance scheme, Jaminan Kesehatan Nasional (JKN), and other GOI mechanisms. The SP4PHC team in Indonesia is continuing to support the GOI to analyze and improve how JKN purchases primary health care (PHC) services from public and private providers and fostering the integration of telemedicine into PHC purchasing arrangements. Building on this, the team is currently supporting the GOI to set up and coordinate a catalytic learning platform, called the PHC Consortium. This will enable key national and subnational government, academic, and other partners to work together to diagnose and improve primary health care purchasing, with an increased focus on the subnational level and performance management.

ThinkWell’s accomplishments in Indonesia

  • Supported the Center for Health Financing and Decentralization Policy (Pusjak PDK) to lead policy discussions on how to make JKN more sustainable. Our analysis of JKN’s effect on OOP payments provided key analytical insights to the Minister of Health’s team about the benefits of JKN versus its increasing costs.
  • Partnered with the University of Gadjah Mada to implement a mixed-methods study on why private midwives largely operate outside of The team, in collaboration with the USAID-funded Health Financing Activity (HFA) and the GOI’s Maternal and Newborn Health (MNH) Technical Working Group, used the findings from the study to test a new way for JKN to pay MNH provider networks that include private midwives.
  • Assessed the effect of JKN on FP services, and reviewed how FP claims are managed and utilized.) We partnered with the University of Gadja Mada (UGM) to map how funds flow for FP from the national level down through the districts to providers and users. This is contributing to the design and implementation of BKKBN’s fund for those FP services that are not covered by JKN (BOK-KB), and into the design of a new case-based payment for PPFP.

Current strategies and activities

Strategy One: Support Ministry of Health’s Consortium to Strengthen Integrated Primary Care Service

  • Identify the sources and types of funds that flow to facilities, potential bottlenecks, and usage of these funds.
  • Build capacity and provide technical assistance for local institutions to support public financial management and PHC financing.
  • Develop a PHC learning platform (called a Consortium) that conducts studies based on MOH priorities and informs evidence-based policy recommendations to improve health outcomes.

Strategy Two: Improve how JKN purchases PHC services

  • Revise the JKN tariffs for capitation and case-based group payments.
  • Generate evidence on how JKN members can be redistributed between public and private PHC facilities to cover a more integrated set of services.
  • Analyze how special allocation funds affect maternal and infant mortality rates.

Strategy Three: Foster integration of digital health into purchasing arrangements for PHC services

  • Generate evidence around how the GOI can better integrate telemedicine into its health system.
  • Test solutions around telemedicine within a regulatory sandbox in collaboration with the Digital Transformation Office (DTO).

More information can be found in this project overview one-pager.

Country Factsheets

These three factsheets below serve as a reference and aim to visualize the latest data and trends on purchasing family planning, maternal, and 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                     Maternal, Newborn, and Child Health                Family Planning

Featured Learning Products

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

Although 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. This journal article published in July 2022 in PLOS Global Public Health analyzes how JKN is influencing OOP payments, especially among poor and rural people, at a range of public and private PHC providers and hospitals across the country.  While the results show that JKN has a protective effect, especially for the poor, it still needs to better engage the private sector (especially in the east) to further reduce OOP payments and improve the quality of services to ensure effective coverage.

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 incentivize private midwives to enroll in the scheme. Strategic purchasing techniques can then be used to improve quality of care, increase access to affordable services, and strengthen coordination within the service delivery system.

Minding the gap between utilization and coverage of maternal and newborn services in Indonesia 

This brief summarizes findings from our study in Indonesia on the use of JKN for maternal and neonatal health (MNH) services. This study found that JKN has not been used optimally for all MNH services. The brief presents a summary of our findings, and offers policy recommendations for how the Government of Indonesia, particularly Badan Penyelenggara Jaminan Sosial Kesehatan (BPJSK) as the administrator of JKN, can strengthen the system both on the demand- and supply-side to reduce maternal health risk factors and potentially reduce the number of maternal and neonatal deaths.

Other Learning Products

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.