2017年-世界发展银行全球_Revealing_the_Missing_Link___Private_Sector_Supply-Side_Readiness_for_Primary_Maternal_Health_Services_in_Indonesia_102页_1mb

Summary of Private Sector Supply-Side Readiness for Primary Maternal Health Services in Indonesia

Core Content

This policy paper explores the readiness of private sector providers to deliver primary maternal health (MH) services in Indonesia, highlighting the role of the private sector in addressing the country's high maternal mortality ratio (MMR) and supporting the goal of universal health coverage (UHC) under the Jaminan Kesehatan Nasional (JKN) scheme.

Main Findings

• Maternal Mortality Ratio (MMR): Indonesia's MMR remains high (126 per 100,000 live births in 2015), despite economic growth and progress towards UHC. The MMR is higher than that of regional and economic peers such as ASEAN and BRICS countries.
• Private Sector Role: Approximately 54% of all deliveries in Indonesia occur in the private sector, indicating its significant role in service provision. However, the overall rate of institutional deliveries is still below the target.
• Service Readiness: Private providers generally have lower and more variable service readiness compared to public sector pushkesmas. Single practitioner providers show lower readiness than those with multiple practitioners. Empanelment under JKN is associated with higher service readiness.
• Geographic Coverage: Private providers are concentrated in urban areas, particularly in Java, and do not significantly expand geographic access to MH services. Only one-third of private providers are empaneled under JKN, limiting their inclusion in the formal health system.
• Patient Satisfaction: Public providers are generally more satisfactory to patients due to lower fees and perceived fairness, although private providers are often seen as offering more personalized care and better facility supplies.
• Public-Private Partnerships (PPPs): The private sector should be engaged more through PPPs, not only for capital investments but also for service delivery and training of health workers.

Key Policy Implications

Badan Penyelenggara Jaminan Sosial (BPJS)

• Advance Strategic Purchasing: BPJS should move beyond claims administration to actively engage in strategic purchasing, improving service quality and coverage.
• Empanelment and Contract Renewal: Strengthen the empanelment and contract renewal process for private providers, ensuring it is progressive, verifiable, and transparent.
• Reimbursement Reforms: Reform provider payment mechanisms (PPMs) and tariff rates to improve service content, effectiveness, and equity. Reimbursement should not match out-of-pocket (OOP) rates.
• Geographic Analysis: Identify underserved areas through geographic analysis and incentivize private investment to improve service availability in these regions.
• Public-Private Collaboration: Use both supply-side (e.g., DAK) and demand-side (e.g., BPJS) financing to improve MH outcomes and reduce disparities.

Ministry of Finance (MoF)

• Invest Strategically: MoF should invest in MH services, especially in high-priority districts, to support sustainable purchasing systems and improve outcomes.
• Conditional Investment: Ensure that investments are conditional on BPJS enhancing its strategic purchasing capabilities and moving away from passive claims administration.

Ministry of Health (MoH)

• Clarify District Selection: The selection of high-priority districts should be based on both MMR and the absolute number of maternal deaths, not just MMR alone.
• Define Roles of Polindes/Poskesdes: Clarify the role of polindes and poskesdes in MH services, possibly limiting their role to antenatal care (ANC) and community-based activities to promote institutional deliveries.
• Integrated Care: Strengthen referral systems across the public and private sectors to improve care continuity and reduce complications.
• Training and Education: Involve private providers in in-service training and ensure preservice training includes competency-based education and adequate clinical practice.
• Voluntary Certification: Promote voluntary certification schemes like Bidan Delima to raise quality standards and complement formal regulatory processes.

Conclusion

The paper emphasizes the critical role of the private sector in improving MH service access and quality in Indonesia. It calls for reforms in BPJS's strategic purchasing, MoF's investment approach, and MoH's policy clarity and integration of care. These measures aim to align private sector readiness with national health goals and reduce disparities in maternal health outcomes.