Health Policy Plus (HP+)
Consultant Scope of Work for National-level Policy Interviews on JKN
Position Title: Consultant for PSE in Indonesia’s National Health Insurance (JKN)
Introduction
USAID’s Private Sector Engagement (PSE) policy and other global agencies such as the World Health Organization recognize the private sector’s contribution to the development agenda, which includes the private sector’s vital role in strengthening health systems and achieving universal health coverage. Several low- and middle-income countries are already integrating private for-profit and non-profit facilities in government health insurance schemes (GHIS) for providing primary and secondary care, e.g., Ghana, Kenya, Nigeria, India, Indonesia, the Philippines, and Vietnam (Cotlear, 2015).
This integration demonstrates an important evolution of the government’s stewardship of the private sector and willingness to increase capacity, choice, and coverage. On the other hand, it requires that payer agencies managing the schemes have processes to accredit and contract private providers, set appropriate reimbursement rates, and hence complete more steps than needed when only working with public sector facilities. This often impacts scheme expansion and creates operational challenges. Each of the critical steps in this process—ranging from accreditation to reimbursement, quality assurance, and verification and audit—all represent potential operational roadblocks that can stall effective integration.
This cross-country study aims to identify the most critical operational barriers for priority public health services and develop a framework and key recommendations for addressing them in countries that have initiated this important process. Helping government address these challenges in working with the private sector in both contracting of providers and enrolment of members will be critical to supporting countries in their journey to self-reliance (J2SR). This is because private sector integration within government supported health insurance schemes can expand the range of options for affordable access to and use of quality RMNCHAH services, serve as market-shaping opportunities for accredited private provider networks, and increase the scale and sustainability of PSE.
Indonesian Context
Indonesia’s national health insurance scheme (JKN) is a relatively mature scheme that currently contracts with private providers and covers family planning services. At primary healthcare facilities, capitation payments from JKN cover FP counseling and FP commodities such as pills and condoms. Fee-for-service payments cover IUDs, implants, injectables, and sterilization. Indonesia case-based group payments cover postpartum sterilization and male sterilization at hospitals.[1] National and local governments are also involved in FP commodity procurement and JKN’s administrator, BPJS-K, must coordinate with these entities. Private midwives are not directly contracted through JKN to provide FP services even though many women access FP services through private midwife centers. Currently, private midwives must contract with a JKN-accredited primary healthcare center in order to receive JKN reimbursement, contributing to delays and uncertainty in JKN reimbursement for private midwives. Other disincentives to join JKN include lower payment rates than what women are willing to pay out of pocket for reproductive health services. Many women also access FP services from private primary care providers that may or may not be empaneled by JKN and thus face out-of-pocket costs for FP services.
Benefits to Indonesia from this activity. Given the maturity of Indonesia’s JKN scheme, the study will provide important policy findings and recommendations regarding key barriers to private sector contracting (empanelment, reimbursement rates, quality assurance, and verification), which would support ongoing discussions in-country around JKN contracting for RMNH services with private midwives in Indonesia.
Assignment Overview
HP+ is seeking a consultant to support in-depth interviews of key stakeholders related to understanding the critical operational barriers to an increased role of private providers in the provision of FP services. This is a deliverable-based contract. The Consultant will report to Cindi Cisek – Senior Technical Adviser and work closely with other HP+ Indonesia and HQ-based staff to ensure accuracy and completeness of interviews the data collection exercise and documentation.
Scope of Work
The Consultant’s work will occur in two phases: (1) preparation and conduct of interviews; (2) documentation of interviews and list of recommended stakeholders to participate in expert meetings.
Phase 1: Preparation and conduct of in-depth interviews
The consultant will develop the list of government and private sector stakeholders to be interviewed (approximately 10 interviewees across Indonesia’s BKKBN, JKN, provider associations and other relevant organizations) with their names and contact information based on a stakeholder category list provided by HP+. The consultant will be provided interview instruments developed by HP+ and work closely with HP+ to develop additional interview guides as needed. The consultant will be responsible for scheduling and conducting in-depth interviews, which are anticipated to take between 60-90 minutes to conduct. If follow-up information is required, the consultant will support by soliciting clarification or additional emails either through telephone, email, or other communications media.
Deliverable: The deliverables for this phase of the study will be the list of stakeholders to be interviewed along with their full contact information, draft interview guide, and tentative schedule.
Phase 2: Interviews and Data Collection
The consultant will be responsible for scheduling and conducting interviews with stakeholders. The interviews will be recorded and transcribed and translated to English (using google translate with review of terms/consistency).
Deliverable: The deliverable for this phase of the study will be the interview notes (transcribed in English), which will be submitted within 5 days of each interview conducted.
Deliverables
The following deliverables will lead to payment for the amount of time spent to complete the assignment. Each deliverable must be submitted by agreed upon date, and HP+ will review and approve, or send back with comments for consultant’s further refinement within five business days.
1. Preparation: List of stakeholders to be interviewed, tentative schedule, as well as any suggested modifications to the instruments.
2. Data Collection: 1) final list of interviews/points of contact, 2) completed transcript in Bahasa and translated English version.
Period of Performance
Approximately 7 weeks from mid-August to October 2021 for preparation and interviews
Illustrative timeline
Activity | Week 1 | Week 2 | Week 3 | Week 4 | Week 5 | Week 6 | Week 7 |
Consultant signs agreement | X |
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List of key contacts to be interviewed and interview guide (1st deliverable) |
| X |
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Conduct interviews |
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| X | X | X |
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Document interview notes |
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| X | X | X |
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Transcribed interviews (Bahasa) and English translation |
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| X | X | X |
Requirements
* Master’s degree in a public health, policy, health financing or other related discipline
* At least 10 years professional work experience
* Strong familiarity with Indonesia’s family planning program and national health insurance scheme (JKN)
* Experience developing interview questionnaires, and conducting interviews with senior level officials
* Fluency in Bahasa and English and strong writing, communication, and reporting skills
* Excellent interpersonal and communication skills
* Ability to work within tight deadlines
* Flexibility, adaptability, and resourcefulness
How to Apply
Interested applicants should submit their CV and proposed rate to complete this assignment to Stefana Ruri (Stefana.Ruri@thepalladiumgroup.com) by July 21st, 2021.
[1] Teplitskaya, L., R. Ross, and A. Dutta. 2018. Has Indonesia’s National Health Insurance Scheme Improved Family Planning Use? Washington, DC: Palladium, Health Policy Plus.
