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.