AIPHSS Reform Agenda
The Reform Agenda acts as a guiding framework for the MoH partners in the selection and implementation of AIPHSS program activities. It provides a problem analysis and current challenges faced by the national health system to respond to sectoral reforms to meet changing health care demands of communities. It was formulated based on consultations with MoH officials taking into account the following:
The implementation of the Reform Agenda through the AIPHSS program aims to strengthen the health system at the national and subnational levels while contributing to the implementation of RPJMN and the new five year MoH National Health Strategic Plan (RENSTRA).
The Reform Agenda identified the following weakness in health policy related to the four AIPHSS focus areas:
Governance and Decentralisation
Decentralisation laws and regulations between the different tiers of government (central, provincial and district) require revision for the following reasons:
The human resource policy direction provided RPJMN 2015–2019 and the MoH Strategic Plan 2015–2019 is “improving the availability, distribution and quality of human resources for health”. The rationale for seeling significant improvement in this area is based on the following:
The Health Sector Review identified a range of important policy and systems challenges in health financing which informed the RA. These include amongst others a severe underfunding of public health services, which in the long term will have a negative impact on the National Health Insurance Scheme (JKN) financial burden by not addressing prevention and promotion services to address risk behaviour. In addition, there is a need to find innovative and alternative sources of health financing to ensure public health programs are funded.
The RA highlighted other areas that need addressing:
Primary Health Care
The RA follows the GoI definition of tasks of a Puskesmas is “improving area wide/sub-district health status” through: (1) promoting community participation and empowerment; (2) implementing public health programs; (3) providing individual clinical health care services; and (4) encouraging health oriented development (healthy public policy). Since 1 January 2014, the Puskesmas has a new function as the primary health care provider for the national health insurance members and now must be equipped to respond to the treatment of 150 different categories of health conditions which focus the Puskesmas on curative care. This requires Puskesmas reforms related to human resources, management, equipment, financing, information systems, accreditation, referral and reporting systems. These all need to be tested at the district level requiring collaboration between government at the provincial and national levels.
 PBI is the subsidy for the poor which is administered by PPJK in the MoH