Reducing Maternal and Neonatal Mortality in Indonesia Saving Lives, Saving the Future (2013) / Chapter Skim
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Chapter 7 Strengthening the Financing of Maternal and Neonatal Health
Chapter 7 Strengthening the Financing of Maternal and Neonatal Health
Pages 75-90
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From page 75... ...
The sources included: government budget and expenditure accounts; relevant household survey results such as those from the Indonesia Demographic and Health Sur vey (IDHS) and national household health and expenditure surveys; available studies and analysis of MNH expenditures such as reproductive health subaccounts; provincial- and district-level health accounting studies; and other studies and reports deemed relevant.
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From page 76... ...
All reviewed data sources associated with MNH financing and expenditure, in addition to the relevant national and district health expenditure, are listed in the references. Total Health Expenditure Indonesia's total health expenditure is relatively low compared with that of other East and Southeast Asia countries.
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From page 77... ...
Programs that support health‐related activities FIGURE 7-2 Overview of Government Health Resource Flows. NOTE: Core functions are foreign affairs, defense, security, justice, financial affairs, and religion.
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From page 78... ...
For the noncore functions funding channel, the central government has three categories of financing that can be used to support the direct and indirect costs of various health programs, including MNH at the provincial and district levels: Deconcentration fund (Dekon)
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From page 79... ...
The discussion that follows on district health accounts provides further details. Ministry of Health Financing of MNH Services In 2010 Indonesia's Ministry of Health had a budget of Rp 23.8 trillion (US$2.6 billion or about $12 per capita)
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From page 80... ...
Budget, Ministry of Health, 2010 -- $2.6 billion Social health insurance -- $0.79 billion Social health insurance for the poor (Jamkesmas) -- funding provided for MNH services such as antenatal, delivery, and postnatal care for pregnant women Medical services -- $0.76 billion Payment for health staff and facilities that provide MNH services in hospitals Human resource development and training -- $0.29 billion Training for health workers who provide MNH services Secretary general -- $0.28 billion Indirect costs for policy analysis and support Public Health Service -- $0.17 billion Immunization programs for newborn babies Nonhospital clinical services for deliveries, newborns Center for Disease Control and Environmental Health -- $0.16 billion Research and surveillance relevant to MNH Pharmacy and medical supplies -- $0.11 billion Drugs, medical supplies, and equipment related to MNH Health Research Center -- $0.03 billion Evaluation of MNH funding initiatives such as the BOK program Inspector general -- $0.01 billion Indirect costs associated with accountability of funding SOURCE: Ministry of Finance (2011)
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From page 81... ...
These services are offered in health centers and hospitals, both public and private, that have a memorandum of understanding with the district health office. This program was designed as part of an effort to help reduce maternal mortality by reaching out to women who were not already covered for pregnancy and delivery-related services under other insurance schemes, particularly the insurance program Jamkesmas that was initiated in 2008 and aimed at the poor and near-poor,2 as well as older programs serving public sector employees, formal sector workers, and individually purchased schemes aimed mainly at the better-off.
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From page 82... ...
Even so, the availability of this kind of social insurance remains a potentially positive motivation for women to seek better care, and it remains one of a multitude of efforts that should be made available to help address the social and economic issues affecting the choices women and communities make about maternal health care. As for the general extent of coverage itself, a 2009 national household survey reported that 43.6 percent of households had some sort of health insurance (Badan Pusat Statistik, 2010)
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From page 83... ...
District budgets allocated 2.8-9.1 percent of their total health budgets to public health activities, with MCH services accounting for 17 percent of those public health budgets. On average, districts allocated Rp 3,250 per capita to the MCH expenditure per capita (5 percent of the Bappenas target)
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From page 84... ...
Impact of Government Financing Initiatives on MNH Services Information on the effectiveness and impact of various MNH funding initiatives in Indonesia is limited because it is very difficult to link specific sources of funding to specific services. Another study by Gani et al.
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From page 85... ...
may not be sufficient to achieve rapid improvements in actual spending, especially in more remote areas. Private Financing of MNH Services Private financing still accounts for about half of Indonesia's total health expenditure, and it is likely that this kind of financing is a significant source of overall funding for MNH services.
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From page 86... ...
Unfortunately, it was not possible to obtain the specific breakdowns of household spending that would allow a more detailed analysis. Nor was it possible to obtain information that would illuminate how much of private health spending supports private MNH providers, such as the private maternity hospitals that are widely present in Indonesian towns and cities.
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From page 87... ...
The government of Indonesia has made significant efforts in recent years to increase its health spending and to focus on spending more on the poor and on priority health needs, which include reducing maternal and newborn mortality and improving maternal and child health. These efforts are evident from the growing government health spending relative to private spending and also from the number of new programs such as Jamkesmas and Jampersal that are intended to increase access to MNH services.
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From page 88... ...
It is likely that a large part of MNH expenditures are fi nanced by out-of-pocket payments, even though health insurance coverage is expanding. MNH services are provided widely on a private basis, including through midwives and physicians in pri vate practice as well as private maternity hospitals (rumah sakit bersalin)
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From page 89... ...
2010b. Indonesia Health Sector Review -- Accelerating Improvement in Maternal Health: Why Reform Is Needed.
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