Indonesia has held the highest rate of Maternal Mortality Rate (MMR) in South East Asia since 2007 (UNFPA, 2012), with 228 deaths per 100,000 live births. In 2012, only five years later, Indonesia’s Demographic and Health Survey shows that the MMR in Indonesia reached 359 deaths per 100,000 live births. This number is still exceedingly far from the 5th target of the Millennium Development Goals, which is to reach a number of 102 deaths per 100,000 live births by 2015.
The Indonesian Government’s effort to reduce the high rate of MMR, among others, is by implementing the National Health Insurance (JKN) programme. With the ratification of Law No. 40/2004 on the National Social Security System (SJSN) and Law No.24/2011 on the Social Security Agency (BPJS), on 1 January 2014 the National Health Insurance programme, or JKN Indonesia, was officially launched.
As such, it is necessary to monitor the implementation of JKN to identify the programme’s impact on both the people and healthcare workers, particularly midwives. In order to analyse the performance and effectiveness of the programme’s implementation, Women Research Institute (WRI) carried out a research in two cities with high maternal mortality rates, namely East Jakarta and Bandung City. The objective of WRI’s research is to identify:
- Challenges faced by midwives, as the spearhead in reducing MMR, in giving maximum prenatal, labour, and postnatal care; including family planning health services, and
- Challenges faced by women during pregnancy, labour, and postnatal period in receiving necessary healthcare services, including family planning health services, during the current implementation of JKN.
Based on the findings of the research, this Policy Research recommends the following amendments to a number of JKN-related laws and regulations:
- Revise the Minister of Health Regulation No. 71/2013 on Healthcare Services in the National Health Insurance Article 8 paragraph (3) letter c, by adding a provision on BPJS Health’s active role in facilitating the collaboration between independent midwives with the First Level Health Facility network.
- Revise the Minister of Health Regulation No.71/2013 on Healthcare Services in the National Health Insurance Article 9 until Article 12 by adding that complete equipment and other facilities in each healthcare facility, among others, is required to collaborate with BPJS Health.
- Revise the Minister of Health Regulation No. 71/2013 on Healthcare Services in the National Health Insurance and Minister of Health Regulation No. 28/2014 on Guidelines for the Implementation of JKN to explicitly state that requirements for registering to and selecting the First Level Health Facility do not include the area of residence stated in one’s Identity Card or Family Card.
- Elaborate the explanation on special circumstances for patients who are exempted from bureaucratic referral procedures, particularly regarding medical emergency cases (Article 14 paragraph (3) and Article 15 paragraph (4)), geographical considerations (Article 15 paragraph (4)), and specificity of the patient’s health conditions (Article 15 paragraph (4)) in the Minister of Health Regulation No. 71/2013 on Healthcare Services within the National Health Insurance. ***