Claudia Rokx

Health Financing in Indonesia: A Reform Road Map

Indonesia is at a critical stage in the development and modernization of its health system. The government of Indonesia has made major improvements over the past four decades, but struggles to maintain and continue to improve important health outcomes for the poor and achieve the Millennium Development Goals. Nevertheless, some key health indicators show significant progress. Infant and child (under five) mortality rates have fallen by half since the early 1990s, although the speed of the decline appears to have slowed since 2002. Maternal mortality rates show a declining trend, but remain among the highest in East Asia. Indonesias population program is one of the worlds most successful: fertility rates have declined impressively since the 1970s and continue to fall. Previously declining malnutrition rates among young children have, however, stagnated. The slowing down of progress may be explained by a poorly functioning health system as well as by new and ongoing challenges posed by demographic, epidemiological, and nutrition transitions, which require new policy directions, a reconfigured and better performing health system, and long-term sustainable financing.

Effectiveness of a community-based intervention to improve nutrition in young children in Senegal: a difference in difference analysis

There are few studies of community growth promotion as a means of addressing malnutrition that are based on longitudinal analysis of large-scale programmes with adequate controls to construct a counterfactual. The current study uses a difference in difference comparison of cohorts to assess the impact on the proportion of underweight children who lived in villages receiving services provided by the Senegal Nutrition Enhancement Project between 2004 and 2006. The project, designed to extend nutrition and growth promotion intervention into rural areas through non-governmental organisation service providers, significantly lowered the risk of a child having a weight more than 2 sd below international norms. The odds ratio of being underweight for children in programme villages after introduction of the intervention was 0.83 (95% CI 0.686, 1.000), after controlling for regional trends and village and household characteristics. Most measured aspects of health care and health seeking behaviour improved in the treatment relative to the control.

Positive returns: cost-benefit analysis of a stunting intervention in Indonesia

Would investing to reduce stunting reap economic benefits that outweigh costs? We investigate this question by conducting a cost-benefit analysis for a large-scale integrated nutrition programme to reduce stunting in Indonesia, using actual rather than stylised data on costs. The gains are assumed to accrue from productivity enhancement from reduced malnutrition, productive earnings from deaths averted and household savings from diarrhoea costs avoided. The programme extends to six provinces over 5 years covering seven cohorts. Using a discount rate of 5 per cent, the benefit–cost ratio is 2.08. The study finds positive net benefits through the productivity impact of lower malnutrition even with sensitivity analysis that excludes the benefits of mortality reduction.

Actuarial costing of universal health insurance coverage in Indonesia : options and preliminary results

This series is produced by the Health, Nutrition, and Population family (HNP) of the World Banks Human Development Network (HDN). The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. The cost of a health insurance program will largely be determined by the size and composition of the covered population, the benefit package, cost sharing arrangements, the current and future supply of health care providers and facilities, and the provider payment mechanisms used. This note summarizes in broad strokes the subset of the possible Universal Coverage (UC) transition scenarios and their related costs in Indonesia. These scenarios were selected based on initial discussions with key stakeholders, and further broad-based discussion with stakeholders will be needed to finalize the design, financing and transition options. This note shows how decisions regarding the transition steps, benefit package and the choice of eligible population affect public Health Insurance (HI) expenditures as Indonesia transitions to UC. This work follows closely the earlier World Bank report health financing in Indonesia; a road map for reform.