Lessons from Indonesia’s 10-year journey towards universal health coverage

Ali Ghufron Mukti, President Director of BPJS Kesehatan, identified the following key lessons on how JKN managed to stride towards UHC:

· Coordination among government institutions that requires a multisectoral approach.

· Increasing commitments between the local and central governments on various aspects of UHC, including supply side and financing support.

· Strengthening primary health care, with promotion and prevention being essential to deliver quality healthcare services and control health expenditure.

· Routinely educate society about the importance of the community’s role in UHC and maintaining community health.

· Find additional sources for funding program activities such as domestic resource mobilization, and multisectoral coordination with other governments and private institutions.

Another essential factor for success that cannot be forgotten is political will. Successive governments in Indonesia have fully supported the JKN program. Indeed BPJS Kesehatan, which administers the national health insurance program, answers directly to the President of Indonesia rather than to a ministry.

“Social health insurance in Indonesia emphasizes the presence of the state of Indonesia to provide a real safety net to each and every Indonesia resident,” Dr Mukti said.

International partnership also plays an important role in supporting the country’s progress towards UHC. Collaboration with international agencies, development partners, and governments can help build health capacity and foster support for reforms. The World Bank and its partners, including the Australian government through the Advance Universal Health Coverage Multi Donor Trust Fund, were pivotal in providing analytical inputs and technical assistance for Indonesia’s health system reform. Early analytical work such as the Health Financing System Assessment (2016) and Primary Health Care Supply-side Readiness Assessment (2018) set a valuable foundation for later investments in the health sector, including the current Health System Strengthening Project. Early analysis on health spending was also instrumental in the government setting up the Indonesia – Supporting Primary Health Care Reform (I-SPHERE) project in 2018. It improved the quality of primary health care, health information systems, and financial management capacity at the subnational level.

Despite all it has achieved in the last 10 years there are still many challenges facing the health system including inadequate primary healthcare outlets and capacity, uneven distribution of secondary and tertiary health facilities, laboratory reform, shortages and uneven distribution of doctors, risk of natural disasters and health emergencies (such as COVID-19), and digitization and health technology to improve access to services in remote areas.

Asnawi Abdullah, Director General for Health Policy, MOH, and Prastuti Soewondo, Senior Advisor to the Health Minister, spoke to these challenges at the congress.

“Indonesia launched its Health System Transformation agenda in 2022 to address these health challenges and affect desired health outcomes,” Prof Abdullah said.

Dr Soewondo added: "The transformation is being pursued through priority programs across six pillars: strengthening primary and secondary healthcare, building system resilience, ensuring sustainable financing, developing human resources, and leveraging digital health.”

Indonesia is actively transforming its health system to address global health issues and national challenges to close existing health gaps, particularly for underserved vulnerable populations. This transformation effort and the invaluable lessons from its 10-year experience in implementing the JKN National Health Insurance scheme can serve as useful models for developing nations in their own journeys toward providing UHC for their populations.