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Table 1.18 Association Between Jampersal and Institutional Deliveries

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Table 1.18 Association Between Jampersal and Institutional Deliveries A STUDY ON THE IMPLEMENTATION OF JAMPERSAL POLICY IN INDONESIA Public Disclosure Authorized DISCUSSION PAPER SEPTEMBER 2014 Endang L. Achadi Anhari Achadi Eko Pambudi Public Disclosure Authorized Puti Marzoeki Public Disclosure Authorized Public Disclosure Authorized A STUDY ON THE IMPLEMENTATION OF JAMPERSAL POLICY IN INDONESIA Endang L. Achadi, Anhari Achadi, Eko Pambudi, Puti Marzoeki September 2014 Health, Nutrition, and Population (HNP) Discussion Paper This series is produced by the Health, Nutrition, and Population (HNP) Global Practice of the World Bank Group. The papers in this series aim to provide a vehicle for publishing preliminary results on HNP topics to encourage discussion and debate. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank Group, to its affiliated organizations, or to members of its Board of Executive Directors or the countries they represent. Citation and the use of material presented in this series should take into account this provisional character. For information regarding the HNP Discussion Paper Series, please contact the Editor, Martin Lutalo at [email protected] or Erika Yanick at [email protected]. © 2014 The International Bank for Reconstruction and Development / The World Bank 1818 H Street, NW Washington, DC 20433 All rights reserved. ii Health, Nutrition, and Population (HNP) Discussion Paper A Study on the Implementation of Jampersal Policy in Indonesia Endang L Achadi,a Anhari Achadi,a Eko Pambudi,b Puti Marzoekib a Center for Family Welfare, University of Indonesia b Health, Nutrition, and Population Global Practice, the World Bank Group, Jakarta Office, Indonesia Paper prepared by the World Bank Group and supported by funding from the government of Japan through the Japan–World Bank Partnership Program for Universal Health Coverage (P125669). Abstract: Indonesia launched Jampersal in 2011, a nationwide program to accelerate the reduction of maternal and newborn deaths. The program was financed by central government revenues and provided free and comprehensive maternal and neonatal care with an emphasis on promoting institutional deliveries. Jampersal providers were public and enlisted private facilities at the primary and secondary levels. In 2013, the World Bank and the Center for Family Welfare, University of Indonesia conducted a qualitative and quantitative study to assess the implementation and impact of the program in Garut District and Depok Municipality in West Java Province. The study found that Jampersal utilization was highest among women who were least educated, poor, and resided in rural areas. Utilization was also high among women with delivery complications. The study showed Jampersal only had an impact where institutional delivery coverage was still low such as in Garut District. In this district, women were 2.4 times more likely to have institutional deliveries after Jampersal. The finding suggests implementation of Jampersal policy may have to be adjusted according to the utilization pattern for efficiency and effectiveness. The government discontinued Jampersal with the launching of the National Health Insurance Program (JKN) on January 1, 2014. The study’s findings indicate the merit in reevaluating the policy to terminate the program, given that Jampersal helped increase institutional deliveries while voluntary participation in JKN remains low. Keywords: Jampersal, comprehensive maternal and neonatal care, national health insurance Disclaimer: The findings, interpretations, and conclusions expressed in the paper are entirely those of the authors, and do not represent the views of the World Bank, its Executive Directors, or the countries they represent. Correspondence Details: Puti Marzoeki at [email protected]. iii Table of Contents Table of Contents .......................................................................................................................................... iv ACKNOWLEDGMENTS ............................................................................................................................. vi PREFACE ..................................................................................................................................................... vii ACRONYMS AND GLOSSARY ................................................................................................................ viii LIST OF FIGURES .......................................................................................................................................... x LIST OF TABLES ...........................................................................................................................................xi EXECUTIVE SUMMARY ............................................................................................................................... 1 PART 1: BACKGROUND .............................................................................................................................. 4 PART 2: OBJECTIVES .................................................................................................................................... 7 PART 3: JAMPERSAL PROGRAM DESCRIPTION ..................................................................................... 8 3.1. Program Target......................................................................................................................... 8 3.2. Benefit Package ......................................................................................................................... 8 3.3. Financial Scheme .................................................................................................................... 10 3.4. Socialization ............................................................................................................................ 11 PART 4: STUDY FRAMEWORK ................................................................................................................. 12 PART 5: METHODOLOGY ......................................................................................................................... 14 5.1. Study Design .......................................................................................................................... 14 5.2. Population and Sample Size .................................................................................................. 14 5.3. Study Limitations ................................................................................................................... 14 PART 6: RESULTS ........................................................................................................................................ 15 6.1. DESCRIPTION OF THE STUDY AREAS ............................................................................. 15 6.2. Implementation of Jampersal Policy (Findings from the Qualitative Study) ..................... 16 6.2.1. Organizational Arrangement .............................................................................. 16 6.2.2. Financing .............................................................................................................. 17 6.2.3. Verification, Claim, and Reimbursement System .............................................. 18 6. 2. 3. 1. Primary Care Level ......................................................................... 18 6. 2. 3. 2. Hospital Level ................................................................................. 20 6.2.4. Provider Payment Scheme .................................................................................. 21 6. 2. 4. 1. Primary Care ................................................................................... 21 6. 2. 4. 2. Hospital Level ................................................................................. 21 6.2.5. Socialization ......................................................................................................... 22 6.2.6. Monitoring and Evaluation ................................................................................. 23 6.2.7. Supply-Side Capacity .......................................................................................... 23 6. 2. 7. 1. Human Resources ........................................................................... 23 6. 2. 7. 2. Public Health Facilities ................................................................... 23 6. 2. 7. 3. Private Providers ............................................................................. 24 6.2.8. Commitment to Jampersal .................................................................................. 25 6.2.9. Garut’s Dilemma in Implementing Jampersal Policy ....................................... 26 6.3. Results of the Household Survey .......................................................................................... 27 6. 3. 1 Respondent Characteristics ................................................................................. 27 6. 3. 2 Community Understanding about Jampersal Program .................................... 28 6. 3. 3 Jampersal Utilization ........................................................................................... 30 6. 3. 4 Utilization of Maternal Health Services ............................................................. 31 1.3.4.1. Antenatal Care................................................................................. 31 1.3.4.2. Delivery ..........................................................................................
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