Health

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The health component of the safety net program, the Health Sector Social

Safety Net program (Jaring Pengaman Sosial Bidang Kesehatan or JPSBK),

was an extremely broad set of measures consisting of a number of

separate sub-components that aimed to provide subsidies for medical

services, operational support for health centers, medicine and imported

medical equipment, family planning services, supplementary food and

midwife services. Unlike the other safety net programs, only a limited part

of the JPS-BK program was actually targeted directly at the poor. As we

shall see, this restricted the effectiveness of the program as an anti-poverty

measure and also made the monitoring and reporting process diffi cult.

At the onset of the Crisis there were serious concerns that falling real

incomes and sharp increases in the cost of both medicine and medical

services would place modern medical services out of reach for poor

households, contributing to a general decline in public health and reversing

all the improvements in this sector over recent decades. Data from the 1999

SUSENAS certainly indicated a sharp decline in the use of modern health

care facilities between 1997 and 1998, especially in the public sector (see

Figure 3.2).

In an attempt to overcome these problems, the government established the

JPS-BK program, inaugurated by the Minister of Health in August 1998.

Funding for the program, Rp 1.4 trillion for the fi scal year 1998/99, came

from the Asian Development Bank and the State Budget.38 The separate

components of the JPS-BK included the following:

• improvement of nutritional standards through the provision of

supplementary foods for babies, young children, and malnourished

and pregnant women.

• support for midwifery services,

• support for community health centre (Puskesmas) services,39 and

• a Community Health Care Guarantee program (Jaminan Pelayanan

Kesehatan Masyarakat, JPKM), with funding administered through

district-level committees.

The funds for most of the JPS-BK program were paid directly into the

accounts of the Head of Puskesmas and the village midwife at the local

post offi ce. In addition to the above, there was also a hospital referral

program, with funding distributed directly to all public hospitals at the

district (kabupaten) and provincial level.

Although the essential aim of JPS-BK was to reduce the adverse impact

of the Crisis on public health for the poorest sections of the community,

there were two major problems with the design of the program which

created diffi culties for both implementation and analysis. Firstly, for a crisisinduced

emergency safety net program, JPS-BK was far too complex and

cumbersome, with numerous separate sub-programs and no simple message

that could be communicated directly at the community level. Secondly – and

most importantly – the poor were not the immediate recipients of most of

the program benefi ts. The only parts of the program targeted directly at

the poor were the scheme to distribute Health Cards to poor households,

and the nutrition component. The other parts of JPS-BK delivered funding

directly to health care service providers (Heads of Puskesmas and village

midwives), and the benefi ts of these components of the program could be

Source: Pradhan et al. (2002: Figure 1).

Figure 3.2 Proportion of people that consulted a health care provider at

least once, on an outpatient basis

indirectly shared by anyone who used these facilities, poor and non-poor

alike. Hence, in terms of targeting performance, we are only able to consider

the effectiveness of the Health Card and the nutrition components.