Indonesia, home to approximately 260 million people, has seen significant economic growth in the last two decades, yet nearly 2 million people are being pushed into poverty because of out-of-pocket healthcare expenditure. Further, maternal and newborn mortality rates are high, particularly for the region, and coverage of HIV services such as antiretroviral therapy remain low.
Despite these challenges, opportunities exist to advance Indonesia's health indicators through national implementation of an ambitious universal healthcare plan. In 2014, the government introduced Jaminan Kesehatan Nasional (JKN), a single payer national health insurance scheme that covers over 84 percent of the population (as of November 2019). Indonesia’s government is also promoting healthy lifestyles to prevent illnesses from occurring and worsening, thereby reducing the cost of medical treatment. The government is exploring private sector partnership as one avenue to rapidly roll out this unprecedented healthcare initiative and looking toward civil society to take on a greater role in policy advocacy, accountability, and transparency for improvements in maternal and newborn health, HIV, and other health areas.
In Indonesia, HP+ is generating critical data and evidence in close partnership with the Government of Indonesia that could be used by policymakers, key stakeholders, civil society, and the private sector to improve the development, implementation, and monitoring of the government's priority policies around maternal and newborn health, HIV, and health financing. Our activities include:
Analyzing maternal and newborn health risk factors: HP+ is partnering with the Ministry of Health Research Institute (Badan Litbang Kemenkes) to understand the determinants of health-seeking behavior and access to and quality of services related to the continuum of care for maternal and newborn health. Through a variety of workshops and working sessions, HP+ is developing the capacity of Badan Litbang Kemenkes to conduct quantitative analysis to help inform evidence-based policymaking.
Supporting the implementation of the health minimum service standards policy: HP+ is working with Indonesia’s Ministry of Health and the Ministry of Home Affairs to implement the recently enacted minimum service standards policy, which gives districts the main responsibility of providing certain essential health services. To better equip districts in budgeting and planning to implement this policy, HP+ is costing the minimum service standards and refining the district budgeting tool, while also improving financial and performance monitoring tools at the national level.
Assessing national and subnational HIV resource requirements: HP+ generated comprehensive resource needs estimates for the national HIV response using updated targets and revised, province-specific unit costs and explored sustainable domestic financing options for HIV. At the subnational level, HP+ is working in Jakarta and Papua to analyze the cost and health impact of scaling up HIV services to improve prevention and treatment cascades. To support the flow of additional funding from the government to civil society to expand HIV preventive and promotive services, HP+ developed a budgeting tool customized for the Indonesian HIV context.
Building private sector partnership for health: Building on the landmark study on private sector, civil society, and media’s role in addressing maternal and newborn health issue in Indonesia, HP+ is supporting the Government of Indonesia to create a more enabling environment for private sector partnerships for health. HP+ is developing a non-infrastructure public-private partnerships policy for health and conducting feasibility studies to identify viable partnership opportunities so that private financing can be deployed to scale quality health services and products in Indonesia.
HP+ partnered with the National Team for the Acceleration for Poverty Reduction, known as TNP2K, and other actors within the Government of Indonesia to conduct a comprehensive assessment of JKN. The assessment considers the impact of JKN from four perspectives—the payer, patient, provider, and private sector.
Indonesia Video Highlights Maternity Waiting Home Public-Private Partnership
March 2022 —
A new HP+ video tells the story of a cooperative partnership among national and local governments, private sector businesses, and civil society to open a maternity waiting home in Gowa District, South Sulawesi, Indonesia. Combining health expertise, educational outreach, and technical and practical resources from the private sector, the home provides a safe environment for pregnant women living far from modern health facilities and engages the women and the local community in classes on safe birth, mother and child nutrition, income generation, and healthy lifestyle practices.
Regulation on Public-Private Partnerships for Health Approved in Indonesia
March 2022 —
Indonesia’s Minister of Health approved a regulation for public-private partnerships (PPPs) in the health sector in mid-February 2022. HP+ supported the ministry’s Center for Health Financing and Decentralization Policy in spearheading the development, adoption, and sensitization process for the regulation. PPPs are helpful in mobilizing the private sector to address gaps in health services within the public health sector. This regulation, which focuses on non-infrastructure needs within the health sector, will allow private companies and organizations to address government health priorities through various contracting and partnership mechanisms. This is expected to contribute to sustainable and equitable scale-up of those services. Read our report on Building the Foundation for Public-Private Partnerships for Indonesia’s Health Sector.
Indonesia Launches Public-Private Partnership to Improve Maternal Health
January 2022 —
The Indonesian government launched its first health-related public-private partnership (PPP) to support a maternity waiting home in South Sulawesi in November, 2021. The move is a pilot of a new regulation by the country's Ministry of Health on non-infrastructure PPPs for health. The partnership, which includes the government, a private company, and three local nongovernmental organizations, was facilitated by the Gowa district government and the USAID-funded Health Policy Plus project. The PPP and resulting maternity home, aimed at addressing Gowa’s high rates of maternal deaths, will serve as a model for other districts in South Sulawesi and throughout the country for how to engage the private sector in improving maternal health. Speaking ahead of the event, USAID/Indonesia's Deputy Director of Health, Daryl Martyris, reflected that these types of initiatives are proof that collaboration between the two sectors is a good way to address local problems with local solutions.
HP+ Experts Present at Global Digital Health Forum
December 2021 —
HP+ experts showcased digital health solutions that promote sustainability, equity, and private sector engagement at the Global Digital Health Forum, held December 6–8, 2021, under the theme of Improving Health Through Digital Transformation. For HP+ Mozambique, Marcel Saraiva presented efforts to transition a digital planning and budgeting module to the government as part of a panel on “Cultivating Successful Transition of Digital Systems to Government for Long-term Sustainability,” which was moderated by HP+’s Allison Connolly. Presenting HP+ Indonesia’s work, Adhiatma Akosah was part of a session on “Making Healthcare Fairer and More Equitable,” in which he highlighted the unique challenges faced by a local technology company delivering maternal and newborn digital care tools in the COVID-19 context. Lastly, HP+’s Bryant Lee presented on “Using Blended Finance to Mobilize Private Capital for Digital Health Enterprises” to share recommendations and opportunities to leverage new financing for affordable health in lower- and middle-income countries
Staff and Partners Share HP+ Results and Lessons Learned at the International Health Economics Association Meeting
July 2021 —
Sessions on presenting evidence and ideas on public financial management, the health impacts of COVID-19, and health insurance financing were among those delivered by HP+ researchers at this year’s International Health Economics Association (iHEA) online congress. Representatives from HP+ Kenya, Malawi, and Nigeria hosted an organized session on the need for a strong public financial management system and the challenges faced by many countries in delivering better spending in their journeys toward universal health coverage. HP+’s Rebecca Ross collaborated with the London School of Hygiene and Tropical Medicine to convene an organized session, presenting results from a mixed method study on the impact of Indonesia’s national health insurance scheme on the competitive landscape of public and private healthcare providers. View HP+’s sessions.
Indonesia Adopts Policy to Boost Public-Private Partnerships
June 2021 —
Indonesia’s public and private sectors have come together to endorse a policy that will provide a legal framework, institutional arrangements, and reporting requirements to catalyze health public-private partnerships. Representatives from both sectors endorsed the Public-Private Partnership Policy for Health Services in early May, following a series of HP+-supported workshops on the topic. The policy is now considered final, and the Ministry of Health is charged with its administration and implementation. In a preliminary example of how the partnerships can play out, a new partnership was created to address early-childhood immunization. It involves a vaccine manufacturer, a health technology provider, a consumer goods company, and district-level government. The new policy is expected to open up similar opportunities for partnerships between public and private actors to expand access to healthcare. For additional background, listen to our webinar covering this topic.
Advancing Indonesia's Equitable Health Policy through Strategic Capacity Strengthening Partnerships
June 2021 —
HP+ Indonesia hosted a webinar on June 4, Advancing Indonesia's Equitable Health Policy through Strategic Capacity Strengthening Partnerships, to highlight a nearly a six-year collaboration with the government of Indonesia to support its ambitious health reform agenda and improve the policy, financing, and regulatory environment to promote positive outcomes in primary healthcare, maternal and child health, and HIV. The discussion, with special guest speakers from the Ministry of Health’s Institute for Health Research and Development, the Center for Health Financing and Insurance, and the Ministry of National Development Planning explored advances made in creating fiscal space for health, data analysis, and private sector engagement with an emphasis on capacity strengthening and addressing challenges of decentralization. Pamela Foster and Jack Langenbrunner from USAID’s Indonesia Mission joined the discussion on the collaboration and the need to sustain health sector gains in a post-COVID-19 era.
Budgetary Space Master Class Trains Ministry Officials in Indonesia
February 2021 —
HP+ helped officials in Indonesia assess their available budget space for family planning and other health interventions. HP+ conducted an initial budgetary space analysis with the Ministry of Finance to validate macroeconomic, provincial, and district government spending as well as key financial projections. The techniques offered as part of the analysis can push policymakers and health planners to identify and tap into additional sources of funding by re-prioritizing health budgets, identifying efficiency gains, increasing health-specific resources, and managing health sector grants and assistance. The fiscal space analysis was followed by development of a manual and a class on the process in early December attended by 50 representatives from the National Development Planning Agency, the Ministry of Finance, and the Ministry of Health. The manual will be hosted on the University of Indonesia’s website, allowing access by all government representatives.
HP+ Blog Outlines How to Accelerate HIV Epidemic Control in Indonesia
December 2020 —
Last week, in conjunction with World AIDS Day, HP+ published a blog outlining recommendations detailing how Indonesia can accelerate its advancement toward HIV epidemic control. Based on their technical assistance experience, the authors explain how changes to service delivery models, populations targeted, and payment mechanisms can reduce costs while improving HIV-related outcomes. The blog was first published by the Infectious Diseases Society of America’s Science Speaks Blog and later cross-posted on Viewpoints.
Indonesia Launches Improved Planning and Budgeting Platform to Advance Minimum Service Standards in Health
December 2020 —
HP+ is supporting the Government of Indonesia to advance subnational performance geared toward achieving the Minimum Service Standards in Health (SPM) for 12 primary healthcare services, including services for pregnant women, delivering mothers, and newborns, as well as family planning education and services. In partnership with PPJK, HP+ improved the planning and budgeting platform for SPM by decreasing complexity of the user interface, designing an error detection system to identify cost outliers and improve data collection from primary healthcare facilities, and enabling the platform to be interoperable with other information systems. HP+ also supported the development of e-learning modules, which are critical to the successful national rollout of the revised platform. The improved platform will equip district health officials across the archipelago with the budgeting and planning tools needed to estimate resources required to achieve SPM targets and improve allocation of resources for health to achieve better health outcomes. The revised platform was officially launched this week in Jakarta by the Secretary General of the Ministry of Health for all 514 districts across Indonesia.
Public-Private Partnerships for Health: Nuts and Bolts from Policy to Practice – Highlights from India
November 2020 —
On November 12, HP+, in conjunction with USAID and Indonesia’s Ministry of Health’s Centre for Health Financing and Insurance (PPJK), hosted a global practice webinar. “Public-Private Partnerships (PPPs) for Health: Nuts and Bolts from Policy to Practice—Highlights from India” is the fourth webinar in a series focused on strengthening health sector stakeholders’ understanding of global best practices in scaling up high-quality health services through PPPs. With over 100 participants hailing from government, academia, and the private sector, the webinar explored the rationale and benefits for creating PPPs, approaches to identifying opportunities for collaboration, and the tools, resources, and institutions necessary to design and implement partnership approaches. Examples were taken from India’s experience in expanding private sector engagement and blended financing mechanisms in pursuit of better health outcomes, including the Utkrisht Development Impact Bond model applied to maternal and newborn health programs. Speakers, who included representatives from PPJK, the Gates Foundation, USAID/Washington, and USAID/Indonesia, inspired the audience to think beyond traditional corporate social responsibility, toward innovative ways to harness new collaborations between the public and private sectors.
Strengthening Local Government Planning and Budgeting for Essential Health Services in Indonesia
September 2020 —
HP+ conducted a costing study in 24 districts across the five major island groups in Indonesia to support the government to implement minimum service standards (SPM) for 12 primary healthcare services. Data from the study has been used to improve existing SPM budgeting and planning tools used by local governments. This will alleviate administrative burdens on districts and support 514 district health offices in better planning to achieve SPM targets by improving allocation of resources for health. HP+ is providing virtual technical assistance on use of the tools and will develop e-modules to strengthen local government capacity to use them.
Webinar Features Fiscal Space Analyses of Indonesia and the Philippines
August 2020 —
Since the emergence of COVID-19, the debate on whether health should be re-prioritized in government budgets with explicit allocations and earmarks has re-emerged. On July 27, an HP+ webinar featured recent analyses of fiscal space for health conducted by USAID’s ProtectHealth project in the Philippines and HP+ in Indonesia. In “Fiscal Space for Health in the Era of COVID-19: Constraints and Choices in Preserving Gains for Indonesia and the Philippines,” speakers—including high-level finance ministry officials from both countries—highlighted current fiscal constraints, government budgetary responses to the COVID-19 crunch on revenues, and possible avenues through which additional financing could be raised.
Can Decentralization Accelerate Countries’ Journey to Self-Reliance?
August 2020 —
Why do countries decide to decentralize their health sectors? What challenges do they face in assigning functions appropriately and agreeing on stewardship roles? Does financing follow function? An HP+ webinar on July 29 tackled these complex questions and more. Featuring the experiences of two countries that have engaged in large-scale attempts at decentralization of health sector financing and governance—Kenya and Indonesia—“Health Sector Decentralization: Can it Still Deliver?” focused on the essential question of whether decentralization can accelerate countries’ journeys to self-reliance. Among the presenters was Meral Karan, a Senior Governance Adviser at the Center of Excellence on Democracy, Human Rights, and Governance.
AIDS2020 Virtual Satellite Session Showcases the Role of Data in Improving HIV Service Delivery
July 2020 —
A virtual satellite session—"Data Matters: The Role of Local Stakeholders and Data in Influencing HIV Services and Programs”—was held on July 8, as part of AIDS2020. The session showcased how HIV service delivery is improved when stakeholders generate and use local evidence and data to inform community-level programs. Representatives from the International Treatment Preparedness Coalition joined Palladium and HP+ colleagues Ron MacInnis and Ratna Soehoed, who discussed the use of province-level cost and epidemiological data for HIV planning and budgeting in Jakarta, Indonesia. A recording of the session will be available to the general public next week.
Journal Article on Cost Delivery Services in Indonesia Published
July 2020 —
HP+ Indonesia’s partnership with Badan Litbangkes has resulted in a second article being accepted in the journal PlosOne. “The Influence of Jaminan Kesehatan Nasional (JKN) on the Cost of Delivery Services in Indonesia” aimed to identify the association between use of Indonesia’s national health insurance (JKN) and out-of-pocket expenditures in accessing delivery services. The study found that use of JKN is associated with reduced out-of-pocket expenditures for delivery as well as reduced risk of incurring catastrophic delivery expenditure, though some out-of-pocket expenditures for delivery services still exist among mothers enrolled in the scheme.
Indonesia Public-Private Partnership Technical Guidelines Move Forward
July 2020 —
Indonesia’s Secretary General of the Ministry of Health expressed support for the swift adoption of new technical guidelines on public-private partnerships (PPPs) and encouraged national and subnational stakeholders to engage in implementation and budgeting for the new guidelines. HP+ has been working with the Indonesian government to develop a blueprint for how to engage in PPPs in non-infrastructure endeavors, such as the training of healthcare workers, management of healthcare facilities, and community-based prevention and promotion activities. The guidelines, which apply to the whole health sector, will soon be finalized and presented to Ministry of Health leadership for adoption.
HP+ Uses Assessment Tools to Strengthen Indonesian Health Care Referral Company
May 2020 —
In March, HP+ conducted a strategic planning and business viability assessment for SijariEMAS Teknologi Inovasi (PT STI)—an information and communication technology private sector start-up focused on improving health sector referrals for pregnant mothers and newborns in Indonesia—using an adaptation of Palladium’s Strategy Execution Bootcamp. As a result of the assessment, the start-up was able to successfully identify key areas to strengthen. HP+ will continue to support PT STI to make strategic adjustments regarding scale-up and expansion of the referral network to new districts, improve marketing and pricing strategies, streamline procurement and contracting processes, and diversify resources.
Journal Article on Influence of Pregnancy Classes on Maternal Health Services in Indonesia Published in BMC Public Health
March 2020 —
This month, HP+ supported researchers from Indonesia’s National Institute for Health Research and Development (Balitbangkes) to publish a journal article in BMC Public Health. HP+ strengthened capacities of the researchers to analyze data about potential risk factors for adverse maternal and newborn health (MNH) outcomes and write and submit five academic articles to peer-reviewed journals. Balitbangkes’ research will contribute to the dissemination of MNH scholarship among learned communities, inform a wide audience beyond technical subject-area experts about key MNH risk factors in Indonesia, and support the development of informed decisions by policymakers.
2020 Prince Mahidol Award Conference
February 2020 —
Representatives from HP+ Cambodia and Indonesia teams participated in the Prince Mahidol Award Conference 2020, adding to discussions on universal health coverage with case studies on HIV financing, social protection, and private sector engagement. HP+ collaborated with USAID to host a well-attended satellite session entitled Harnessing the Private Sector for UHC through Smart Policy, with participation by Elaine Menotti and Pellavi Sharma of the Office of Population and Reproductive Health.
HP+ Disseminates Subnational HIV Cost Results in Jakarta
November 2018 —
On October 10, in Jakarta, HP+ disseminated cost results from its subnational HIV activity to an audience of more than 50, composed of attendees from the Indonesian government, civil society, and development partners. HP+ collected primary cost data from 19 civil society organizations and “puskesmas” (community health clinics) in Jakarta to identify the unit costs of delivering critical HIV interventions, disaggregated by key population reached and service delivery model. Detailed, updated unit costs are needed to improve estimates of the total resources required to meet provincial HIV targets and to explore the feasibility of increased financing of the HIV response through local government and greater integration into the Jaminan Kesehatan Nasional benefits package—the country's single-payer national health insurance scheme. As a result, the Provincial Health Office for Jakarta, which presented at the dissemination event, committed to using HP+ cost results in its annual budgeting and planning for HIV activities.
Strengthening Financial Sustainability of Indonesia’s National Health Insurance Scheme
October 2018 —
Indonesia's MoF and other ministries have an interest in understanding whether Indonesia’s national health insurance scheme—Jaminan Kesehatan Nasional (JKN) - delivers a positive and equitable impact on Indonesian’s health and welfare. HP+ worked with the MoF to design a M&E framework for health and with the Government of Indonesia to conduct a comprehensive assessment of JKN. The assessment considers JKN’s long-term financial sustainability and the impact of JKN from various perspectives, including on private health providers' investment decisions, competitiveness, the efficiency of healthcare service delivery, and the impact on the private health market overall, including labor gains. These findings are being used to inform continued investment in JKN and changes to the legal framework for health in the country. In October, HP+ was recognized for ‘Excellence in the Use of Theory of Change’ by the USAID Mission in Indonesia for their work on the JKN comprehensive assessment.
