Collaborative Efforts in Expanding Health Coverage in Mandailing Natal and Barru 

A group of civil servants holding a book of action plans for accelerating the Human Development Index (HDI) in West Kalimantan Province for the years 2023-2025
Caption: A recipient of BPJS Kesehatan in Barru, South Sulawesi, is availing her health benefits at the nearby puskesmas.
Caption: A recipient of BPJS Kesehatan in Barru, South Sulawesi, is availing her health benefits at the nearby puskesmas.

Since 2014, the Indonesian government has implemented the National Health Insurance (Jaminan Kesehatan Nasional, JKN) scheme. To ensure the poor are covered by the system, the central government provides premium subsidies funded by the National State Budget. Complementing this initiative, several local governments (LGs) allocate JKN premium subsidies from their local budgets for those not covered by the central government’s support. The LGs of Mandailing Natal (North Sumatra) and Barru (South Sulawesi) aim to achieve “universal health coverage” (UHC) of their citizens. 

USAID ERAT supports the LGs in expanding JKN coverage within the districts by synchronizing data to identify eligible citizens without JKN premium subsidies. In Mandailing Natal, three data sources managed by three central government institutions were synchronized: the Targeting for Acceleration of Extreme Poverty Elimination (P3KE) database managed by the Coordinating Ministry for Human Development and Culture, Integrated Social Welfare Data (DTKS) managed by the Ministry of Social Affairs, and JKN membership data managed by the Social Security Administrator for Health (BPJS Kesehatan). Meanwhile, in Barru, lack of access to the databases forced the LG to mobilize the village governments to collect data about the communities, to be overlaid with the BPJS Kesehatan, P3KE and DTKS data. 

The data analysis in Mandailing Natal estimated that 16.3 thousand eligible citizens in Mandailing Natal have yet to receive subsidies. To cover all the poor in the district, the LG needs to allocate IDR 55 billion (about USD 3.54 million). In 2023, the Mandailing Natal government secured an allocation of IDR 17.1 billion (about USD 1.10 million) from the local budget to cover premium subsidies for the poor, marking a 29% increase from the 2022 budget of IDR 13.3 billion (about USD 0.86 million). For 2024, the LG has secured an even higher budget for JKN subsidies, totaling IDR 46 billion (USD 2.97 million). 

In Barru, based on the data collected from 42 villages/wards (76% of the total), about 30.4 thousand citizens do not have any health insurance or their memberships are inactive. About one-third of that number (10,239) represent poor citizens. While not all of these are classified as poor people, the LG increased the 2024 budget allocation for JKN subsidies from IDR 44.05 billion (USD 2.84 million) to IDR 45.4 billion (USD 2.93 million).  

In addition to closing the financing gap to cover non-insured citizens, the LGs need to identify other resources to achieve the UHC, since they are not allowed to subsidize non-poor. For people without any health insurance but working in the formal sector, their employers are actually obliged to cover their premiums. Both LGs of Mandailing Natal and Barru approached private companies operating in both districts to comply with this requirement. In Mandailing Natal, more than five private companies have signed memorandums of understanding (MOUs) with BPJS Kesehatan to cover their employees. In Barru, the number of complying companies increased from 42 in 2022 to 55 in 2023.  

Particularly for the “near poor” who do not have any health insurance and are unemployed or working in the informal sector, USAID ERAT facilitated a collaboration between the local BPJS Kesehatan office and philanthropic organizations such as the local office of the National Zakat Agency (Badan Amil Zakat Nasional, BAZNAS) to subsidize their premiums. Through a MOU signed in May 2023, BAZNAS officially supports the JKN premium for 400 Mandailing Natal residents. In Barru, the local BAZNAS office has agreed to cover the premiums of near-poor individuals who have outstanding JKN premium payments.  

This story reflects the need for collaboration in improving access to health services—between central and local governments to subsidize the JKN premiums for the poor and with the private sector and philanthropic organizations to cover other segments of the population. USAID ERAT will continue supporting the Government of Indonesia in ensuring equitable access to healthcare services for all citizens. 

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