October 2016 RE-ENVISIONING MATERNAL AND NEWBORN HEALTH IN INDONESIA How the Private Sector and Civil Society Can Ignite Change Suggested citation: Rajkotia, Y., J. Gergen, I. Djurovic, S. Koseki, M. Coe, et al. 2016. Re-envisioning Maternal and Newborn Health in Indonesia: How the Private Sector and Civil Society Can Ignite Change. Washington, DC: Palladium, Health Policy Plus. ISBN: 978-1-59560-146-9 Health Policy Plus (HP+) is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-15-00051, beginning August 28, 2015. HP+ is implemented by Palladium, in collaboration with Avenir Health, Futures Group Global Outreach, Plan International USA, Population Reference Bureau, RTI International, the White Ribbon Alliance for Safe Motherhood (WRA), and ThinkWell. Re-envisioning Maternal and Newborn Health in Indonesia How the Private Sector and Civil Society Can Ignite Change OCTOBER 2016 This publication was prepared by Yogesh Rajkotia,1 Jessica Gergen, 1 Iva Djurovic, 1 Sayaka Koseki,2 Martha Coe,1 Kebba Jobarteh, 1 Carol Miller,2 and Sujata Rana2 of the Health P olicy Plus project. 1 ThinkWell, 2 Palladium The information provided in this document is not official U.S. Government information and does not necessarily represent the views or positions of the U.S. Agency for International Development. CONTENTS List of Figures and Tables ......................................................................................................... iv Acknowledgments ...................................................................................................................... v Executive Summary ................................................................................................................... vi Context ....................................................................................................................................... vi Private Sector ............................................................................................................................ vii Civil Society, the Media, and Research Institutions .................................................................. xi The Intersection of Civil Society and the Private Sector ............................................................ xv Conclusion ................................................................................................................................xvii Abbreviations ........................................................................................................................ xviii Introduction ............................................................................................................................... 1 Maternal and Newborn Health in Indonesia .............................................................................. 3 The Private Sector and Civil Society Hold the Key to Igniting Change on Maternal and Newborn Mortality ...................................................................................................................... 5 Purpose of this Landscape Assessment ....................................................................................... 6 Leveraging the Private Sector Finance and Market Opportunities........................................... 9 Private Financial Sector Landscape ........................................................................................... 12 Theme 1: Scale Successful Private Facilities to Improve Access ................................................ 17 Theme 2: Technology Solutions to Improve Communication for Service Delivery .................. 24 Theme 3: Transportation Solutions ........................................................................................... 31 Theme 4: Improve the Quality of Midwifery Care Through Private Sector Training Institutions ................................................................................................................................ 36 Theme 5: Tailor Financial Products for Maternal and Newborn Health .................................. 42 Engaging Civil Society and the Media in Maternal and Newborn Mortality ............................ 50 Introduction .............................................................................................................................. 50 Component 1: Internalization of Maternal and Newborn Mortality as a Problem ................... 52 Component 2: Alignment of Social Actors for a Movement ..................................................... 58 Component 3: Enabling Environment for Civic Engagement .................................................. 62 Component 4: Mobilizing Financial Resources to Support a Social Movement ...................... 67 Opportunities at the Intersection of Civil Society and the Private Sector............................... 71 Conclusion ............................................................................................................................... 77 Annex A: List of Interviewed Organizations ............................................................................. 78 Private Sector Assessment Interviews ...................................................................................... 78 Civil Society/Media/Academia Assessment Interviews ............................................................ 83 Annex B: Financial Terminology .............................................................................................. 90 Annex C: Provincial Snapshots ................................................................................................ 92 Annex D: Key Resources ....................................................................................................... 143 References ............................................................................................................................ 146 iii LIST OF FIGURES AND TABLES Figure 1: GDP Growth in Indonesia, 2013–2018 ............................................................................ 1 Figure 2: Health Expenditure as Percentage of GDP, Select Countries ......................................... 2 Figure 3: Location of Delivery, by Urban-Rural Breakdown and Quintile..................................... 4 Figure 4: Map of Private Sector Interviewees ................................................................................. 8 Figure 5: Maternity Services Package Reimbursement Rates, Cost Breakdown (BPJS versus JAMPERSAL) ................................................................................................................................10 Table 1: Five Private Sector Opportunity Themes ......................................................................... 11 Table 2: Matrix of Financial Actors and Catalyst Opportunities, by Theme ................................. 12 Figure 6: Foreign Direct Investment (FDI) Trends in Indonesia .................................................. 15 Figure 7: Hospital Expansion in Indonesia, by Total Facilities and Private Facilities ................. 18 Table 3: Recent Hospital Expansion Plans in Indonesia ............................................................... 19 Figure 8: Primary Patient Transportation Method to Primary Clinics, by Province ................... 32 Figure 9: Transportation Options ................................................................................................. 33 Figure 10: Breakdown of Facility-based Deliveries, by Province ................................................. 37 Figure 11: Map of Civil Society Interviewees ................................................................................ 49 Table 4: Four Elements for Civil Society and Media Actors .......................................................... 51 Figure 12: CSO Interviews, by Sector ........................................................................................... 52 Figure 13: Maternal Mortality in Southeast Asia, by Country ...................................................... 56 Figure 14: Primary Sources of Civil Society Organization Funding (self-reported) ..................... 67 iv ACKNOWLEDGMENTS The Health Policy Plus team would like to express its deep appreciation to all of the key informants who voluntarily participated in interviews. Their insights into the current landscape were invaluable, as were their future projections of catalysts for engagement of the private sector, civil society, media, and research institutions. Our most sincere appreciation is due to the Women’s Research Institute; Arin Dutta and Taylor Williamson of Health Policy Plus; and local consultants Yustina Sari, Noor Alam, and Palupi Widjajanti for assisting in the design of the study and collection of data. A big thanks to those who reviewed the report and provided analytical inputs: Stephen Rahaim, Oliver Mathieson, Marcus Pitt, Caroline Philly, and Elizabeth McDavid. Finally, we would like to thank Zohra Balsara, Pak Edhie Rahmat, and Thomas J. Cody at the USAID Indonesia Mission for their support and guidance in the design of this scoping review and in the preparation of this report. v EXECUTIVE SUMMARY Context Indonesia is a country undergoing growth in a multitude of sectors. The country’s middle- income 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