By 2019 Indonesia wants to achieve universal health coverage for its citizens! A wonderful goal, but also challenging. Around 60% of the population isn’t covered yet and the out-of-pocket payments remains high even for those that are covered. Furthermore, many Indonesians that aren’t covered are in the informal sector. Another challenge is to ensure acces to quality health services in the remote areas of the country, which are the rural areas in particular. But, Indonesia isn’t afraid for some challenges!
So first an overview in the development of achieving universal heath coverage in Indonesia. A very promising goal to help all the citizens of Indonesia, especially as the rising double burden of disease (due to the rise in NCDs and CDs) and the double burden of malnutrition means more demand on health care.
So in 2005, the “Asuransi Kesehatan untuk Yang Miskin” or “Askeskin” was launched. At the time, this was a new Social Health Insurance for the Poor program. Let’s continue to 2008. In that year “Askeskin” evolved into an even broader program of health insurance, with wider coverage and the lessons Askeskin were incorporated as well! The program was also known as Jamkesmas. So in 2010, yet another new program was added. Why? It was needed to reduce maternal and child mortality. And the program provided coverage for all pregnant women. The program was a very good initiative don’t you think? Because a healthy mother increase the changes of a healthy baby! The program was called “Jaminan Persalinan” or “Jampersal”.
So how is going with the universal health coverage goal as of today?
In the final years the preparations of the launch of the new Jaminan Kesehatan Nasional (JKN) was up and running. And the Government is now trying to design the JKN in such a way that the multiple programs (mentioned above) will consolidate under one national administrative, management and service system. At the same time the Government will try to identify the gabs that are there and “fill those gaps” in coverage. The JKN was launched in 2014.
What will universal health coverage bring?
It will improve equity and raise the quality of services. Something that is very much needed as you will realize when reading trough all our blogs. So a “road map” for continuing expansion of JKN will be made to the eventually try to achieve universal health coverage by 2019.
The development of JKN was based on ﬁve core principles:
- The spirit and practice of gotong royong, meaning mutual support.
- Mandatory membership for all Indonesians by 2019.
- “Portability” of the right to service: members of JKN are entitled to service anywhere in Indonesia.
- Principles and best practice of social health insurance to guide the management of JKN.
- Medical service is equal for all JKN members; however, members paying all or a portion of their own membership can choose to pay for a higher level of in-patient service
So in order to achieve this the following key challenges of building and implementing JKN need to be tackled according to the the Ministry of Health:
- Regulatory infrastructure for both service delivery and management
- Finance, transformation, and integration of programs and institutions (from former programs)
- Health facilities, referral, and infrastructure
- Human resources and capacity building
- Pharmaceutical and medical devices
- Socialization and advocacy
So big challenges indeed! And you know what I think? That in this case very close collaboration between other ministries is needed. This is not only a job for the Ministry of Health, since it encompasses areas that fall under other ministries.
Written by Jessica
Mboi, N. Indonesia: On the Way to Universal Health Care.Minister of Health of the Republic of Indonesia, (2012–2014). Health Systems & Reform. Retrieved 08 December. Retrieved from: http://www.tandfonline.com/doi/pdf/10.1080/23288604.2015.1020642?needAccess=true
Pandu Harimurti, Eko Pambudi, Anna Pigazzini, and Ajay Tandon. UNICO Studies Series 8 The Nuts & Bolts of Jamkesmas, Indonesia’s Government-Financed Health Coverage Program for the Poor and Near-Poor. The World Bank, Washington DC, January 2013.