AIPHSS Program Design Document

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:

  • Key policy directions from the National Five Year Mid Term Development Plan (RJPMN)
  • Analysis conducted as part of the Health Sector Review (HSR)
  • Decentralisation legislation for health functions
  • Minimum Service Standards (MSS) for primary health care.

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 current functional distribution is not consistent with the health system functions as stated in the Perpres-72/2012 on the National Health System (SKN);
  • The functions do not meet the needs of all population segments;
  • The Minimum Services Standard, as listed in the Minister of Health Decree-741, does not provide comprehensively cover for essential health needs of communities;
  • In many districts the recruitment of the District Health Officer by the local government (Bupati/Walikota) is not competency or merit based.

Human Resources

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:

  • There is no strategic plan on the number, competencies and production of health workers, the quality and production of the health workforce is not in aligned with the changing demand for services.
  • There is no strategy on how to produce “primary health care physicians” as stated in the Law on Medical Education (UU Pendidikan Kedokteran (Medical Education)).
  • Mal-distribution of the health workforce, and insufficient availability, quality and low productivity of public health workers.
  • Lack of accessible and up-to-date information on human resources for health.
  • The quality of graduates in many cases does not meet the standard criteria, especially for midwives, and there is a general mismatch in the recruitment and placement of health workers.
  • There is no career development pattern for the health workforce.

Health Financing

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:

  • JKN membership to include non-PBI[1] participants, especially workers in the informal sector
  • Guidelines for a benefit package/clinical pathway and procedures of use
  • Cost sharing by participants at service points
  • Development of cost control and quality control systems
  • Efficiency and effectiveness of payment of health services provider (provider payment).
  • Defining the basic package of public health and clinical services and ensuring it is costed
  • Strengthening planning and performance-based budgeting
  • Strengthening MoH capacity in health financing policy analysis.

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.

[1]    PBI is the subsidy for the poor which is administered by PPJK in the MoH


Download Program Design Document (Reform Agenda)