Re-envisioning Maternal and Child Health in Indonesia: How the Private Sector and Civil Society Can Ignite Change

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Indonesia is a country undergoing growth in a multitude of sectors. The country’s middleincome population is on the rise, its democracy continues to become more open, and its economy continues to grow, making Indonesia the largest economy in Southeast Asia with a gross domestic product (GDP) over US$861.9 billion (World Bank, 2016a). Despite these positive developments in the country’s economic landscape, it has yet to take a similar lead on many health issues. One area of health that performs poorly on major indicators is maternal and newborn health. The maternal mortality ratio has been estimated at 359 deaths per 100,000 live births by the Demographic and Health Survey, much higher than both the Millennium Development Goal 4 target ratio of 110 and the ratio in regionally or economically comparable countries (Statistics Indonesia, 2013). The decline in child deaths (Millennium Development Goal 5 target) remains stalled—primarily due to the lack of reduction in neonatal mortality, which has remained around 19 deaths per 1,000 live births over the last two decades.

The government of Indonesia has not traditionally put high levels of funding into healthcare. However, the inauguration of Jaminan Kesehatan Nasional (JKN), a national health insurance scheme scheduled to reach national coverage by 2019, has signaled a change in priorities. As of April 2016, 164 million Indonesians were covered under JKN (Jong and Parlina, 2016). In 2015, Badan Penyelenggara Jaminan Sosial (Social Security Management Agency for the Health Sector, or BPJS) received US$3.7 billion in premiums (Jong and Parlina, 2016). This included US$2.1 billion (57% of the total) from participants and another US$1.6 billion (43%) from the state budget for covering the poor and vulnerable, civil servants, and members of the military (Ernst and Young, 2015). Current public sector health infrastructure cannot keep up with the growing number of people gaining financial access to care. Partnership with the bustling private sector would allow the government of Indonesia to meet its universal health coverage goal, and the Indonesian market is primed for such an opportunity.

The growth of Indonesia’s economy has led to growing interest from investors, which, importantly, also includes investment interest in health markets. The establishment of JKN has signaled to the market that the government is committed to financing healthcare and increasing access for its citizens. At the same time, the middle class is growing, estimated to reach 135 million people by 2030, and utilization of private facilities and pharmaceuticals is expected to increase as more people acquire additional resources (Oberman et al., 2012).

Indonesia’s civic space is equally experiencing an expansion. Since 1998, the growth of civil society entities has been explosive, from the national to the local level, with an estimated 65,000 registered civil society organizations (CSOs) as of 2014. Donor programming for democratization and governance reforms has been substantial (Scanlon, 2012). Regional autonomy and decentralization have created new opportunities for CSOs and organized citizens to engage directly with government in public affairs. Legal protections of assembly and speech have been established and the government is committed to continue opening this space. A composite index of civic space scores puts Indonesia on par with Malaysia and well ahead of Thailand, and shows improvement over the last five years (The Economist, 2016).