Participants of the Pangkep Collaborative Governance Working Group hold a workshop to develop a strategy and work plan addressing maternal and child health issues.
In Pangkep, MADANI Lead Partner Lembaga Demokrasi Celebes (Lekrac) and the MABACA (acronym for Honest, Brave, and Smart) Learning Forum have improved access to public healthcare services for impoverished women and children. Under the 2020-2024 national medium-term development plan, maternal and child health (MCH) is a key priority for the Government of Indonesia. Nevertheless, in 2021, the prevalence of stunting in the District of Pangkep was 33 percent, far higher than the national average of 24 percent. In the same year, Pangkep also recorded several cases of maternal and child mortality that, with proper care, could have been prevented. Furthermore, healthcare providers often insist that patients complete complicated administrative requirements before receiving services, which can result in delays and negative health impacts. To make matters worse, many families in Pangkep do not have health insurance.
The national health insurance program (BPJS) covers most Indonesians, including the poor, using a cross-subsidy system. However, findings from a multi- stakeholder collaborative monitoring revealed that some low-income families in Pangkep are denied the subsidy because the local population register failed to properly classify them as such. This is despite that these families earn less than or equal to $1 per day – the regional poverty line – and are too poor to afford the monthly BPJS installments.
Since 2021, Lekrac, MABACA, and other stakeholders have been working together to improve access to public health services through the citizen-led Healthy Village Collaborative Working Group (PKDS). Reflecting this collaboration, Hj. Herlina, Head of the Pangkep District Health Services, commented: “We are committed to involve all stakeholders to address stunting and MCH issues in the district.”
Lekrac, MABACA, and other stakeholders have been working together to improve access to public health services. Bringing together village governments, district agencies, women and youth groups, businesses, and healthcare centers, PKDS aims to create consensus-driven solutions to maternal and child health challenges. Through PKDS, volunteers provide support to pregnant women, helping them to receive care at community healthcare centers (Puskesmas). In addition, PKDS builds trust and strengthens cooperation among stakeholders and optimizes civil society’s role in addressing development challenges.
Representatives from Lekrac and Baznas Pangkep brainstorm on options to cover outstanding BPJS fees for unaccounted poor households – as a follow-up to the MoU on August 8, 2022.
On August 8, 2022, Lekrac, MABACA, and the Pangkep branch of Indonesia’s largest philanthropic entity, the National Alms Agency (Badan Amil Zakat Nasional or Baznas), signed a memorandum of understanding (MoU) with the District Social Welfare Agency and village governments. In the MoU, Baznas agreed to improve vulnerable households’ access to public healthcare services by covering unpaid or outstanding BPJS fees: “This assistance is within our annual workplan,” said Usman Amin, the Baznas Pangkep Commissioner. Amin continued: “We want to help address the BPJS arrears that has been the stumbling block from poor families in accessing health services.” However, for this plan to be successful, Baznas needed improved and more accurate population data.
In response, MADANI partner CSOs, in collaboration with village governments, deployed a team to collect additional data at the community level. The team narrowed down the list and identified 31 households in the two project focus areas that are eligible for Baznas’ assistance – poor households that are unaccounted for in the BPJS system that should have received the subsidy program. This approach was meant to be a stopgap measure until the local government updates Indonesia’s Social Welfare Integrated Data (DTKS) to include the newly identified residents and register them into the BPJS’s state subsidy program.
The collaborative governance working group experience suggests that health issues can only be solved by engaging all relevant stakeholders. This approach improved teamwork, vertical and lateral communications, and response time across government agencies. Furthermore, the working group’s experience also illustrates the importance of public-civil society partnerships, and how the government plays a crucial role in creating the space for such collaboration.