The National Health Insurance Implementation Research: Experiences of Midwives in Jakarta and Bandung
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Current Project / Maternal Mortality Rate / Women & Health
In order to reduce maternal mortality rate, the government provides a healthcare insurance for both labour and postnatal care through the National Health Insurance (JKN). Following the ratification of Law No. 40/2004, JKN was launched on 1 January 2014, operated by the Social Security Agency (BPJS).
In the effort to support the success of the programme, it is imperative to have competent and adequate health workers (WHO, 2005; UN, 2012; ICM, 2013). In reducing the number of maternal mortality, midwives hold the main role as the spearhead of the national health services.
Midwives are not only expected to overcome challenges in the implementation of JKN, but also to be responsible in reducing maternal mortality rate and achieving universal access to reproductive health. Due to the importance of midwives in the implementation of JKN, the Ministry of Health issued supporting laws: the Minister of Health Regulation No. 69/2013 on the Standard Fees of Healthcare Services and the Minister of Health Regulation No. 71/2013 on Healthcare Services in JKN. Because the two regulations are related to the midwifery services of independent midwives, the Indonesian Midwives Association also issued Circular Letter No. 117/2014 on Midwifery Services in the National Health Insurance era.
Based on this problem, Women Research Institute (WRI) conducted a research to identify the challenges, obstacles, and changes faced by midwives since JKN was implemented and its impacts on female reproductive health.
Apart from involving midwives as the main focus, this research also included relevant stakeholders. Therefore, prior to the research WRI also carried out a Multi Stakeholder Forum (MSF) in Jakarta, with another one planned in Bandung, as WRI’s scope of research. The stakeholders included include observers of women’s reproductive health and other parties involved in the implementation of JKN.
The Multi Stakeholder Forum is held to obtain preliminary information in identifying changes, both positive and negative, as well as challenges and obstacles that midwives have been facing in providing midwifery services since JKN was introduced. This forum is also expected to result in a commitment to monitor the implementation of JKN. It also functions as a medium to build a joint understanding, especially in reducing maternal mortality rate in Indonesia. The outcomes of MSF serve as the preliminary information which will be used as a basis in formulating the guidance for Focus Group Discussions and in-depth Interviews in October 2014.
After collecting data through FGD and Interviews and analysing research findings, WRI will hold a second Multi Stakeholder Forum to present the research findings and set up follow-up actions.***