Making Services Work for the Poor in Indonesia : A Report on Health Financing Mechanisms in Kabupaten Purbalingga, Central Java : A Case Study

Purbalingga is the first kabupaten in Indonesia to start implementing its health insurance scheme for the poor, as a replacement for the JPS-BK scheme (Social Safety Net Program Health Sector). Poor families (Gakin) receive a range of health insurance services that are subsidized by the government free-of-charge, while better-off families pay a premium of only 50% or 100%. They are categorized as participants in Gakin Levels I, II and III. The aim is to achieve universal coverage for all citizens in Kabupaten Purbalingga, those who are poor as well as those who are not. Kabupaten Purbalingga is considered unique in the scope of its health services, because it not only includes poor families in its scheme, but also non-poor families. The local government of Kabupaten Purbalingga considers the health insurance scheme to be one of the main pillars of the poverty reduction effort in the region. They want the management of this scheme to become more independent and less dependent on DinKes (the local government health agency) so the program can be managed more efficiently and with more accountability. What is rather interesting is that DinKes plans to arrange a health insurance scheme that will be autonomous and sustainable for all better-off members in the future. They intend to slowly increase the premium until it reaches the real cost of the assistance package. According to DinKes, the cost should be approximately Rp92,000 per family per month. From the perspective of Bapel, an autonomous scheme with that level of premium definitely has potential, however they will always depend on the premiums to be paid by the government. It needs to be noted that the Community Health Insurance Scheme (JPKM) initiative in Kabupaten Purbalingga is almost entirely the initiative of the government as its moving force. The main protagonists are government (Regent, DinKes and Bapel), public service providers (public hospitals and puskesmas), the local parliament (DPRD) and other government agencies.JPK- Gakin, Purbalingga, health, poverty program

Making Services Work for the Poor in Indonesia : A Report on Health Financing Mechanisms in Kabupaten Tabanan, Bali : A Case Study

Based on the notion that good health is one of the basic right of all citizens, the Government of Indonesia (GoI) has promoted programs on health care financing for the poor. One of these programs is the Jaminan Pemeliharaan Kesehatan (JPK). In 2003, the pilot project on JPK for the poor (JPK-Gakin) started in 15 districts and two provinces, and was expanded to additional regions the following year. Since April 1 2004, PT Askes, a profit oriented private insurance company, was assigned as the insurer of the nonprofit health insurance scheme for the poor (the JPK-Gakin) in district Tabanan. With respect to PT Askes it is important to see in what ways does the prominent role of PT Askes influence the dynamics of health service delivery and how different is PT Askes from other insurers (the non-profit - public institutions) in managing the JPK-Gakin scheme. The Tabanan case demonstrated that the supervision and monitoring by the Dinas Kesehatan (DinKes) of an insurer like Askes runs the risks of being less effective because PT Askes is a relatively well-established institution that is totally independent of the DinKes. Moreover, there is a difference in the level of expertise and experience between PT Askes and the Dinkes regarding the management of insurance schemes. Therefore, the supervision and monitoring of PT Askes by the DinKes tends to be formal instead of actual. This difference in the level of expertise and experience can also be a barrier for the DinKes to negotiate the cost and coverage of the scheme with PT Askes. PT Askes as the insurer is also barely involved in the promotion and socialization of the program and the identification of the poor as their potential clients. Obviously, the JPK-Gakin scheme can secure primary health care for the poor (the gakin) at the puskesmas, but this does not necessarily mean that the poor will receive good quality care. In general, the health care at the puskesmas is quite limited both in term of quality and variety. The implementation of the JPK-Gakin scheme including adequate capitation for the puskesmas from this scheme would certainly not change this condition easily as it relates to more complex factors such as the availability of good medical staffs, instruments and facilities. The most positive effect of the JPK-Gakin scheme on the provision of health care for the poor is the possibility to get secondary and tertiary health care that is usually unaffordable for the poor. Nevertheless, for a range of different reasons, the majority of Gakin patients are not referred to the hospital. There are cases where the poor refused to be referred to the hospital although it was necessary because they were insecure about the additional costs that were not covered by PT Askes. Thus, although the JPK-Gakin scheme does secure the right of the poor to get medical treatment at the hospital, it cannot secure the actualization of it.health care program, financing mechanism, insurance scheme, stakeholders, health services

Making Services Work for the Poor in Indonesia : A Report on Health Financing Mechanisms in Kabupaten Tabanan, Bali : A Case Study

Based on the notion that good health is one of the basic right of all citizens, the Government of Indonesia (GoI) has promoted programs on health care financing for the poor. One of these programs is the Jaminan Pemeliharaan Kesehatan (JPK). In 2003, the pilot project on JPK for the poor (JPK-Gakin) started in 15 districts and two provinces, and was expanded to additional regions the following year. Since April 1 2004, PT Askes, a profit oriented private insurance company, was assigned as the insurer of the nonprofit health insurance scheme for the poor (the JPK-Gakin) in district Tabanan. With respect to PT Askes it is important to see in what ways does the prominent role of PT Askes influence the dynamics of health service delivery and how different is PT Askes from other insurers (the non-profit - public institutions) in managing the JPK-Gakin scheme. The Tabanan case demonstrated that the supervision and monitoring by the Dinas Kesehatan (DinKes) of an insurer like Askes runs the risks of being less effective because PT Askes is a relatively well-established institution that is totally independent of the DinKes. Moreover, there is a difference in the level of expertise and experience between PT Askes and the Dinkes regarding the management of insurance schemes. Therefore, the supervision and monitoring of PT Askes by the DinKes tends to be formal instead of actual. This difference in the level of expertise and experience can also be a barrier for the DinKes to negotiate the cost and coverage of the scheme with PT Askes. PT Askes as the insurer is also barely involved in the promotion and socialization of the program and the identification of the poor as their potential clients. Obviously, the JPK-Gakin scheme can secure primary health care for the poor (the gakin) at the puskesmas, but this does not necessarily mean that the poor will receive good quality care. In general, the health care at the puskesmas is quite limited both in term of quality and variety. The implementation of the JPK-Gakin scheme including adequate capitation for the puskesmas from this scheme would certainly not change this condition easily as it relates to more complex factors such as the availability of good medical staffs, instruments and facilities. The most positive effect of the JPK-Gakin scheme on the provision of health care for the poor is the possibility to get secondary and tertiary health care that is usually unaffordable for the poor. Nevertheless, for a range of different reasons, the majority of Gakin patients are not referred to the hospital. There are cases where the poor refused to be referred to the hospital although it was necessary because they were insecure about the additional costs that were not covered by PT Askes. Thus, although the JPK-Gakin scheme does secure the right of the poor to get medical treatment at the hospital, it cannot secure the actualization of it.health care program, financing mechanism, insurance scheme, stakeholders, health services

Making Services Work for the Poor in Indonesia : A Report on Health Financing Mechanisms in Kabupaten East Sumba, East Nusa Tenggara : A Case Study

Kabupaten Sumba Timur is one of 29 kabupaten/kota that were included in the test piloting of the JPK-Gakin program. Since 2003, the local health agency (Bapel) has been quite successful in managing this program. The program that is funded by the government from fuel subsidy allocations has already touched the poor whose numbers are quite significant (75% of the population are poor families) in Sumba Timur. Since 2005, the government has appointed PT Askes as the only implementing body for the JPKGakin program, while Bapel still operates this program. The involvement of two managers as JPKGakin implementers made the government issue a policy on the division of the puskesmas service area.. This transition period provided an opportunity for the local government to undertake an evaluation of the implementation of the program. There are several differences in the type and extent of health services offered by the two of them. The outcome of the findings shows that puskesmas and hospitals have responsibility for the patient costs of all poor families. However, the number of referrals of the poor to hospitals is small although Bapel provides transport allowances for patients who are referred to the hospital. There are quite a lot of limitations that are faced by the poor who live in a wide area across Sumba Timur. These limitations are the communitys very poor socio-economic conditions, endemic malaria, minimal numbers of health workers in rural areas and the long distances of peoples homes from health services. The manager of JPK-Gakin needs to give proper attention to the handling of health in Sumba Timur, the majority of whose people are poor.JPK-GAKIN, Sumba Timur, health, poverty program

Making Services Work for the Poor in Indonesia : A Report on Health Financing Mechanisms (JPK-Gakin) Scheme in Kabupaten Purbalingga, East Sumba, and Tabanan

The government of Indonesia has started the implementation of locally based healthfinancing schemes based on health insurance principles. This scheme is commonly known as JPK-GAKIN, which is a health-financing scheme through which the poor can access health care in public facilities, including primary and secondary health care. Due to the perceived success of JPK-GAKIN pilots, the government has decided to provide JPK-GAKIN in all districts in Indonesia from January 1, 2005. This study looks at the effects of different characteristics of JPK-GAKIN program on healthcare service provision, utilization of health care services, quality of healthcare provision, and how insurance characteristics can influence the relationships between stakeholders. Three districts were selected for the case studies : Purbalingga (Central Java), Tabanan (Bali) and East Sumba (Nusa Tenggara Timur). We found that compared with previous health financing schemes, JPK-GAKIN scheme has achieved better results in providing access to adequate health care coverage to members of the population, especially the poor. However, we found several problems associated with the scheme, such as : there is a need to improve its targeting and efficiency, it needs stricter financial monitoring and auditing, and it needs to increase stakeholders involvement in the governance of the scheme. We will elaborate on these concerns and recommend possible policy options to resolve them in this paper.local health financing, JPK-GAKIN, public health, poverty, Indonesia

EFFECT OF TEMPERATURE AND PARTICLE SIZE ON THE ALKALINE EXTRACTION OF PROTEIN FROM CHICKEN BONE WASTE

Chicken bone is a waste of chicken meat processing industry and restaurants that has not been used widely, even though it contains valuable organic compounds that are functionals, such as collagenous and non collagenous protein. This research was conducted to investigate the effect of temperature and particle size on the protein extraction from chicken bones using dilute sodium hydroxide solution. Controlled parameters in this study were the solvent in the form of sodium hydroxide solution, extraction time for 1 hour, pH 10.5, the ratio of chicken bone powder: solvent (1:4 w/v), and stirring speed 200 rpm. While the operating variables included the extraction temperature of 30C, 55C, and 80C, and particle size of 150 and 250 μm. Experiments were carried out by heating of 300 mL of sodium hydroxide solution with pH 10.5 in a three-necked flask equipped with Leibig condenser, thermometer, mechanical agitator and sampling device to reach the desired temperature (30C, 55C, and 80C). Then, a total of 75 g of chicken bone powders with desired particle size (150μm and 250μm) was introduced into the sodium hydroxide solution and the stirrer was operated at speed of 200rpm. At every 10 minutes interval, as much as 10 mL samples were withdrawn for total protein analysis using Lowry-Folin method. The experiment was terminated after 1 hour. The results show that both increase in temperature and particle size caused an increase in the amount of extracted protein. Highest concentration of protein extracted was achieved at 630.99 mg/L, when the extraction was carried out using 250μm bone particles and temperature 80oC

REDUKSI KALSIUM OKSALAT DENGAN PEREBUSAN MENGGUNAKAN LARUTAN NaCl DAN PENEPUNGAN UNTUK MENINGKATKAN KUALITAS SENTE (ALOCASIA MACRORRHIZA) SEBAGAI BAHAN PANGAN

Kebutuhan akan pangan terutama beras dan gandum di Indonesia semakin meningkat dengan bertambahnya jumlah penduduk, sehingga impor beras dan gandum di Indonesia juga terus menigkat. Untuk menekan ketergantungan pada impor gandum dan beras maka dilakukan upaya pemanfaatan bahan pangan lain seperti talas sente (Alocasia macrorrhiza). Salah satu kendala dalam penggunaan talas sente sebagai bahan pangan adalah adanya rasa gatal yang disebabkan oleh adanya senyawa kalsium oksalat. Dalam penelitian ini untuk mereduksi kalsium oksalat dilakukan dengan perebusan dalam air dan larutan NaCl. Tujuan dari penelitian ini adalah untuk mengurangi kandungan kalsium oksalat pada talas sente. Penelitian ini dilakukan dengan cara sebagai berikut: bahan baku berupa umbi sente dikupas kulitnya, dicuci dengan air sampai bersih dan dipotong dengan ukuran 2 x 3 cm kemudian dilakukan analisa proksimat. Dua ratus lima puluh gram umbi direbus dalam larutan NaCl pada suhu 80ºC, 90ºC, 100ºC dan konsentrasi 0, 2%, 3%, 4%, 5%, 6%. Setiap 5 menit sampel diambil sebanyak 12 gram untuk dianalisa kadar kalsium oksalat dan kadar airnya. Perebusan dilakukan sampai 30 menit. Setelah didapatkan kondisi optimum, umbi sente rebus dikeringkan dalam oven pada suhu 105ºC sampai berat konstan kemudian ditepungkan. Tepung dianalisa proksimat, bakteri dan logam berat. Pada penelitian ini diperoleh penurunan kandungan kalsium oksalat paling tinggi pada perebusan dengan larutan NaCl 6% pada suhu 80°C selama 30 menit yaitu mampu menurunkan kandungan kalsium oksalat sebesar 60%. Namun, pada perebusan dengan larutan NaCl 6% akan menyebabkan perubahan rasa pada tepung talas. Pengambilan titik optimum pada penelitian ini adalah pada perebusan dengan larutan NaCl 2% pada suhu 80°C selama 30 menit yang mampu menurunkan kandungan kalsium oksalat sebesar 49,38%. Kandungan kalsium oksalat pada tepung talas sente yaitu 648 mg/100g, sedangkan kadar oksalat yang diizinkan sebesar 71 mg/100g (Sefa-Dedeh and Agyir-Sackey, 2004). Sehingga tepung talas sente ini belum layak untuk dikonsumsi

Modifikasi Tepung Dari Umbi Gadung Menggunakan Ekstrak Rimpang Jahe Sebagai Bahan Makanan Fungsional

This research aims to study the modification of gadung (Dioscorea hispida Dennst) flour using ginger oil as cross linking agent following dispersion methods to meet the standards of the physicochemical properties of wheat. In keeping with that purpose, will be investigated the influence of molar ratio of ginger oil with of gadung flour (1:2 and 1:3), reaction time (30, 60, 90 and 120 minutes) and temperature (30, 40 and 50oC) on water solubility and swelling power properties of the modified gadung flour. This research begins by mixing the suspension of gadung flour and ginger oil on the condition appropriate to the variable, then the product was dried and analyzed the swelling power and water solubility. Ratio of Ginger oil : gadung flour (1:3) with a temperature at 30oC and 60 minutes is the best condition of modification obtained from this study, where the modified gadung flour obtained has a very similar water solubility and swelling power properties with American wheat flour, which were 7.28 (g/100g) and 7.9 (g/g), respectively.The weakness of modified gadung flour was only the presence of the remaining ginger aroma

Extraction and Modification of Gum from Cashew Tree Exudates Using Wheat Starch and Glycerine

Penelitian ini bertujuan untuk mengekstrak getah pohon mete dan memodifikasi sifatnya untuk dapat digunakan sebagai senyawa pembantu proses pengeringan menggantikan fungsi getah Arab. Dengan menggunakan getah mete termodifikasi dari penelitian ini, permasalahan biaya pada proses pengeringan jus buah dengan spray dryer dapat diatasi. Getah pohon mete dipungut dan diendapkan dari larutan hasil penyadapan dengan bantuan etanol sebagai antisolvent. Dalam penelitian ini gliserin dan pati gandum digunakan sebagai bahan tambahan untuk memodifikasi sifat getah. Hasil penelitian menunjukkan bahwa getah pohon mete termodifikasi yang dihasilkan memiliki kualitas yang baik dan kesamaan sifat dengan getah Arab. Kata kunci : getah pohon mete, getah Arab, modifikasi, pati, gliserin The objectives of this research were to extract cashew tree gum (CTG) from cashew tree exudates and to modify it into a new drying aid, which can act as a substitute for Arabic gum. The cost problem faced in the spray drying of fruit juices is expected to be solved with the use of modified CTG as a replacement of Arabic gum. The CTG was extracted and precipitated from its raw cashew exudates solution with the help of ethanol as antisolvent. Glycerine and wheat starch were the additives used in the modification of the gum. The good quality of modified CTG was obtained based on their close similarity to Arabic gum properties. Keywords: CTG, Arabic gum, modification, starch, glycerin