Based on WHO data (2015), the maternal mortality rate in Indonesia reached 190 per 100,000 live births. This rate is higher than most countries in Southeast Asia, such as Singapore is 18 per 100,000 live births. Based on the same source of data, life expectancy in Indonesia (i.e. 71 years old) is quite low compared to other countries. Some developed countries, such as Japan, Singapore, The United Kingdom, and Germany, have a life expectancy of over 80. Meanwhile, the malnutrition percentage in 0-59 months old children is 14.4% (Ministry of Health, 2017). This percentage is above the threshold set by WHO, i.e. 10%.
Besides those health conditions, there are also problems need to be solved regarding health workers in Indonesia. First, the number of health workers is not sufficient for the national level, i.e. only 33 doctors per 1,000 inhabitants (the minimum ideal amount is 40 doctors per 1,000 inhabitants). Second, many health workers do not meet the required level of education of Diploma III (DIII). Third, the distribution of health workers is uneven. About 30% of 7,500 puskesmas in remote areas do not have doctors.
Based on those problems, the Ministry of Health of the Republic of Indonesia focuses its policy on strengthening the primary health care. In Indonesia, primary health care is generally conducted at community health center (Pusat Kesehatan Masyarakat/Puskesmas). As one of the program to strengthen the primary health care, the Ministry of Health launched the Nusantara Sehat (hereafter referred as NS) Program, i.e. by distributing health workers to Areas of Disadvantaged, Borderlands ,and Islands (Daerah Tertinggal, Perbatasan dan Kepulauan/DTPK) that designed to support the implementation of the National Health Insurance (Jaminan Kesehatan Nasional/JKN) and Healthy Indonesia Card (Kartu Indonesia Sehat/KIS).
NS Program was implemented in 120 puskesmas in 48 of 143 DTPK. By 2016, NS program was distributing 1,421 professional medical personnel. Nevertheless, the NS Program also faces various problems, i.e. (a) unequal treatment between local staff and NS team regarding the incentives, facilities, and attention from the central government; (b) low interest of the doctors to join the program; and (c) problems of contract arrangements. Initially, in 2015, the contract was made as a team-based arrangement. Later, since 2017, individual contracts are used based on Minister of Health Decree No. the 16 Year 2017. Both team-based and individual contracts are used by the Ministry of Health.
There is a need to study whether NS Program stimulates processes that can improve the health of people in DTPK. From the demand side (community), the processes mean changes in health-related behaviors and changes in people’s utilization of health services. Meanwhile, from the supply side (puskesmas), the process relates to administrative and operational procedures. In order to evaluate the impact of the NS Program on public health, the National Team for the Acceleration of Poverty Reduction (TNP2K), the Ministry of Health, and DEFINIT conducted a study “Survei Nusantara Sehat”.
This study was conducted in 3 provinces, i.e. Bengkulu, South Sulawesi, and East Nusa Tenggara, consist of 18 sub-districts that were categorized as DTPK. The information was collected from two sides, i.e. demand side and supply side. For the demand side, we interviewed households, as those who need health services. Meanwhile, for the supply side, we interviewed puskesmas as health service providers, which could be represented by the Head of the Puskesmas and/or Head of the Administration Puskesmas.
The study is expected to provide evidence-based policy recommendations about NS Program. In addition, the study also expected to provide evidence-based justification for budgetary items related to NS Program. The study is also the initial step in building a baseline database as part of the impact evaluation of NS Program.