Abstract
Since the early 1990s, the Government of Indonesia has addressed high maternal mortality by attempting to ensure skilled attendance at delivery through access to trained village midwifery services in every village. Yet access to skilled services at delivery continues to prove problematic, with low levels of skilled attendance and high mortality. Making use of a funding flow analysis and population-based survey in two districts, we investigate to what extent funding allocated for maternal services enables access to skilled services by rich and poor households. The results suggest that, although resources reach remote poor areas, the poor obtain unequal access to skilled delivery services. Because rural midwives must earn a significant fraction of their income from private fees this acts to deter women from seeking their help. A new system of targeting poor women utilising the existing state insurance company (ASKES) is an important step in helping to reduce these barriers, but may not be sufficiently generous to protect all those that are considered vulnerable.
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Notes
This policy was announced towards the end of 2004 and Rp2.1 trillion was set aside to provide free services for up to 36 million poor Indonesians (see Ministry of Health Indonesia http://www.depkes.go.id/en/0509re.htm). The responsibility for health centre services for the poor was briefly transferred from Askes to the DHO in 2005 but has now returned to Askes.
Rp. = Indonesian Rupiah, valued at around 9,200 to the US dollar during the period of the study.
Midwives also receive various festival and incentive bonuses, which constitute just under a quarter of public income.
Excludes any out of pocket spending on private services, such as medicines, private clinics or hospitals.
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Acknowledgments
We are grateful to the many government officials that gave up valuable time to complete interviews. Field work on the various surveys was conducted and coordinated by the PUSKA, University of Indonesia. This work was undertaken as part of an international research programme—Immpact. See: http://www.abdn.ac.uk/immpact, funded by the Bill and Melinda Gates Foundation, the Department for International Development, the European Commission and USAID. The funders have no responsibility for the information provided or views expressed in this paper. The views expressed herein are solely those of the authors.
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Ensor, T., Nadjib, M., Quayyum, Z. et al. Public funding for community-based skilled delivery care in Indonesia: to what extent are the poor benefiting?. Eur J Health Econ 9, 385–392 (2008). https://doi.org/10.1007/s10198-007-0094-x
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DOI: https://doi.org/10.1007/s10198-007-0094-x