Center for Reproductive Health

Family Planning

PELAYANAN KONTRASEPSI DALAM SISTEM PELAYANAN DI ERA BPJS

Laporan Penelitian Bagian I

Pelayanan Kontrasepsi dalam Sistem Pelayanan Kesehatan di Era BPJS:
Cost-Utilization

Siswanto Agus Wilopo
Althaf Setiawan
Firdaus Hafidz
Pusat Kesehatan Reproduksi
Fakultas Kedokteran UGM

Setahun sebelum penelitian ini dilakukan, saya mendengar pidato salah satu pejabat Negara bahwa pelayanan KB di dalam program Jaminan Kesehatan Nasional (JKN) perlu mendapat perhatian khusus karena kebutuhan untuk membeli kondom saja mencapai 11 trilun. Meskipun barangkali ucapan dalam acara Seminar Nasional tentang Kebijakan Kesehatan di Surabaya tersebut sambil bergurau, saya menanggapinya dengan serius. Pelayanan kontrasepsi sebagai bagian pokok dari program Keluarga Berencana Nasional ternyata tidak menjadi isu penting dalam pelaksanaan JKN di Indonesia. Saya menangkap bahwa masalah KB tidak menjadi isu serius seperti halnya dalam program ‘Obama Care’ di Amerika Serikat.

Oleh karena itu, saya sebagi Ketua Perhimpunan Dokter Kesehatan Komunitas dan Kedokteran Komunitas (PDK3MI) dan Ketua Pusat Kajian Kesehatan Reproduksi, Fakultas Kedokteran, Universitas Gadjah Mada memprakarsai untuk melakukan diskusi tertutup dengan para pemangku kepentingan dalam Program KB dan JKN dengan agenda membahas tentang ‘pelayanan kontrasepsi dalam sistim pelayanan kesehatan di era BPJS’. Pertemuan tersebut dihadiri oleh Bapak Prof. Ali Ghufron Mukti, sebagai wakil Menteri Kesehatan, Deputi KB-KR BKKBN dan jajarannya, Perwakilan PT Askes Pusat, PT Jamsostek, Ketua IDI, AFP the Johns Hopkins University, POGI, para Guru Besar UGM dan pengurus pusat PDK3MI. Pertemuan ini sebagian pendanaannya dibantu oleh ‘Project on Advance Family Planning’ dari the Johns Hopkins University, Baltimore, USA.

Dalam pertemuan tersebut tersirat bahwa program KB tidak memperoleh perhatian sama sekali, karena sebelumnya PT Askes tidak menanggung pelayanan KB, kecuali pelayanan kontrasepsi mantap yang telah disepakati dalam panduan tertulis antara Direktur PT ASKES, Dirjen Yanmedik dan Deputi KB-KR yang kebetulan saya sebagai pejabatnya pada waktu itu. Selama persiapan JKN sebelum pertemuan tersebut, BKKBN secara resmi tidak pernah/jarang sekali diundang dalam proses pembahasan tentang pelaksanaan JKN. Padahal, dalam UU nomer 40 tahun 2004 tentang BPJS ditegaskan bahwa pelayanan KB adalah salah satu benefit dalam asuransi nasional.

Sejak pertemuan tersebut, Pusat Kesehatan Reproduksi dan pengurus Pusat PDK3MI bersama BKKBN melakukan serangkain pertemuan konsultasi dengan para pemangku kepentingan dalam program KB untuk membahas ‘pelayanan kontrasepsi dalam pelayanan kesehatan di era BPJS’. Selain membahas arah kebijakan, kami secara khusus merancang penelitian tentang pembiayaan pelayanan KB dan ‘cost-effectiveness’ dari program KB untuk BPJS Kesehatan dan Pembangunan secara nasional.

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Annotated Bibliography: Selected Researches on Family Planning in Indonesia 2005-2015

Annotated Bibliography
Selected Researches on Family Planning
in Indonesia 2005-2015

International Conference on Family Planning,
Nusa Dua, Bali, 25-28 January 2016

National Population and Family Planning Board (BKKBN) of Indonesia, Center for
Reproductive Health-Faculty of Medicine UGM, UNFPA and USAID

Indonesia is well known for the success story in promoting and implementing family
planning program nationally since 1970s. Prior to the introduction of the family planning programme in the 1970s, the total fertility rate (TFR) is 5.6. Over the subsequent period, the adoption of contraception along with changes in people’s perceptions regarding the ideal number of children and ideal age for marriage caused a dramatic decline in fertility levels. During this period, the TFR declined from 5.6 in 1968 down to 2.6 births per woman in 2012, or a drop of around 50%, while the contraceptive prevalence increased from miniscule to 61.9 percent. As the family planning programme expands various studies, best practices and literatures are developed by various institutions including government institutions, research institutions, academicians, development partners and individual researchers.

The main objective of compilation and development of this annotated bibliography of
family planning is to document the recent studies and best practices in Indonesia during the period of ten years, from 2005 to 2015. The majority of the studies and best practices are those accepted for oral or poster presentations at the International Conference on Family Planning, Nusa Dua, Bali, 25-28 January 2016. All of these studies and best practices are compiled into one cohesive annotated bibliography. It is expected that this document serve as a reference for researchers and programme managers from various sectors within the Government of Indonesia, as well as international community.

This Selected Researches on Family Planning in Indonesia 2005-2015: an Annotated
Bibliography is produced by the National Population and Family Planning Board (BKKBN) of Indonesia in collaboration with National Sub-Committee of Scientific of the International Conference on Family Planning 2016, UNFPA and USAID. The papers contain useful information that will enrich the understanding of the family planning trends and issues in Indonesia. However, I would like to note that the opinions, findings and recommendations contained within the studies are solely the views of each individual researcher/writer, and may not necessarily reflect the views or policies of BKKBN, UNFPA and USAID.

I extend the appreciation and unbounded thanks to UNFPA Indonesia and USAID for
their support. Similarly to the team of writers and all parties for their assistance in
preparing this publication. May this publication motivate our courage and efforts to
develop the better program in the future for Indonesia, as well as colleagues from various countries and development partners to get more useful information.

Head of National Population and Family Planning Board,
Dr. Surya Chandra Surapaty, MPH, Ph.D

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Levels , Trends and Determinants of Informed Choice in Family Planning in Indonesia

Summary
Informed choice is an integral part of family planning service. Informed choice refers to whether women are provided adequate information when choosing a family planning method. This specific information becomes one of indicators in FP2020 global commitment to family planning and is known as Method Information Index (MII). Informed choice implementation will help government guarantee that family planning service are being delivered with good quality and according to right-based principles. Maximizing informed choice is hoped to help reduce discontinuation rates, unmet need, and a skewed national method mix.
Background
Family planning (FP) enables everybody to decide their choice on sexual life and reproduction. FP also represents women and children opportunity to achieve higher education and participate on social life. It makes family planning decision making very important and should be based on accurate information on type and informed choice. Health service providers and government are responsible to provide facilities that will help everybody to decide their reproductive life through FP counseling and education.
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Understanding “All Women” Family Planning Program Indicators in the Context of Trends in Marriage: Indonesian Case Study

By: Siswanto Wilopo, Robert Mangani
Background
In order to emphasize the principle that all women and their partners are entitled to access to family planning and other reproductive health services, many of the FP2020 “core” indicators are being measured for all women of reproductive age (WRA) as opposed to only among married women (MWRA) as has been traditionally done. Notable among indicators affected by this refinement are the Modern Contraceptive Prevalence Rate (mCPR) and the Number of Additional Users of Modern Contraception, two of the “headline” FP2020 core indicators.
While being based upon sound human rights principles, interpreting trends in key indicators measured for all WRA can be confounded by changes in the proportion of women of reproductive age that are married (and presumably exposed to risk of pregnancy). In cases where marriage patterns in a given country are changing rapidly, it can become challenging to determine what share of observed changes in mCPR is due to changes in contraceptive
behaviors, which is the intent of the indicator, versus changes in population composition with regard to proportions WRA that are married.
Such a scenario arose recently in Indonesia when the results of the 2015 PMA2020 survey revealed a modest increase in mCPR after many years of stagnation, but at the same time a marked increase in the proportion of women of reproductive age that were married. The relevant data are shown on the table 1. As may be observed, the mCPR increased by 1.6 percentage points from 2012 to 2015 among MWRA women and 3.1 percentage points among WRA. However, the 2015 PMA2020 revealed an increase in the proportion of women of reproductive age that were married from 73% to 76%.
When this increase is taken into account, the change in mCPR among WRA that is due to changes in contraceptive behaviors falls to 1.2% (with remainder being due to the increase in the proportion of women of reproductive age that were married).
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