Transparency and Participation in Health Data (ID0093)

January 2019 - December 2020
Commitment Description
Lead implementing
agency/actor
Ministry of Social Service
Law Number 40/2004 on National Social Protection
System and Law Number 24/2011 on Social
Protection Administration Body mandate the
government to enforce the implementation of National
Health Insurance. One of the programs is the Health
Contribution Assistance (HCA) for the poor. However,
the data of HCA is not accessible for users and it often
not in accordance with the actual condition. For
instance, as some recipients might have already
passed away, moved away, had a double identity
number, or had changes in financial circumstances
that allowed them to pay the contribution. The
inconsistency in the HCA recipients’ data happened
because people could not verify and validate the data
as they are not aware of the data platform.
On the other hand, the Minister of Social Services
Regulation Number 5/2016 on Recipient of Health
Contribution Assistance (Revised) mandates the
government to implement the mechanism of data
verification and validation participative. According to
the regulation, the public could participate in updating
HCA data through sub-district consultation forum.
However, it is not as effective as the data is not
accessible and the monitoring of its implementation
remains low. This Action Plan is committed to
empowering the participatory data update. It also
encourages the Ministry of Social Service to inform
the HCA data through an application system.
What is the public problem that
the commitment will address?
The commitment aims to support the development of
the application system and people’s participation in
updating the data. This application system will provide
the recipient’s personal information. In addition to that,
all the process of updating data will be implementing
by sub-districts. This commitment also encourages the
involvement of women group, marginalized
community, and indigenous people. The result of the
participatory data updates will be doing with the
issuance of a ministerial decree.

2. Transparency and Collective Participation in Renewed Data on Recipient of Health Contribution Assistance

Language of the commitment as it appears in the action plan:

The commitment aims to support the development of the application system and people’s participation in updating the data. This application system will provide the recipient’s personal information. In addition to that, all the process of updating data will be implementing by sub-districts. This commitment also encourages the involvement of women group, marginalized community, and indigenous people. The result of the participatory data updates will be doing with the issuance of a ministerial decree.

Milestones:

1. Information system application on social welfare provides all the process of updating the data as a result from the online verification. As a data platform, the system also provides accurate and valid data, enriched with their export and import features.
2. The implementation of public consultation meeting through city/village forum or any other platform for renewed data on Recipient of Health Contribution Assistance.
3. The availability of twelve ministerial decrees on renewed data of the HCA’s recipients based on citizen participation inputs.

Start Date: January 2019                                                               End Date: December 2020

Context and Objectives

In January 2014, the Government of Indonesia established the Social Security Agency for Health (BPJS Kesehatan) to continue efforts to ensure comprehensive, equal, and fair universal healthcare ^[28] for all citizens. BPJS Kesehatan succeeds Askes, a now-defunct government health insurance program which was only available to civil-sector members.

BPJS Kesehatan categorizes insurance recipients into two categories ^[29] based on their economic backgrounds. The government covers the premium for those who live in poverty through a premium assistance beneficiaries (PBI) ^[30] insurance scheme. Those who do not meet the qualifications to be included in the PBI scheme are required pay their own premium. However, the law does not specify the poverty criteria in this context.

For the fiscal year of 2019, ^[31] the government increased the number of PBI recipients to 96.8 million from 92.4 million in 2018. Consequently, the budget allocation also went up from 25.5 trillion rupiah (1.8 billion USD) to 26.7 trillion rupiah (1.87 billion USD). The government based this decision on the data provided by the Ministry of Social Affairs who collaborated with the Ministry of Home Affairs at the national level and Civil Registry Offices across the nation at the local level. According to the Ministry of Social Affairs, their data are updated on a yearly basis through a verification and validation process to ensure accurate distribution of PBI. ^[32]

However, studies conducted by MediaLink, a civil society group, in East Java (Wonosobo and Sidoarjo Regencies), Central Java (Brebes Regency), and the Jakarta Special Capital Region ^[33] suggest that the PBI program does not always benefit the intended recipients. Representative from MediaLink ^[34] detailed the following issues:

• Lack of transparency: The Ministry of Social Affairs does not regularly publish data on premium assistance beneficiaries, making it difficult to monitor its distribution.
• Lack of citizen participation: The Ministry of Social Affairs does not involve citizens at any stage of its yearly data verification and validation. The studies found multiple reports of duplicated, deceased, and unidentified recipients.
• Unclear methodology and criteria to determine poverty: The Ministry of Social Affairs does not disclose the methodology or criteria it uses to collect valid data of premium assistance beneficiaries. A major criticism has been that the Ministry uses the same criteria to determine poverty across the nation, which is not feasible considering the various factors that play into the fulfilment of basic needs in different locations.

President Joko Widodo himself has publicly criticized his own cabinet for providing conflicting data on poverty rates. ^[35] The Central Bureau of Statistics (BPS) reported only 25.95 million people (9.82% of the total population size) ^[36] living in poverty in March 2018—much lower than the 92.2 million figure from the Ministry of Social Affairs and the Ministry of Health to allocate the PBI program. Minister of Finance Sri Mulyani suggested that the BPS’s statistic was the lowest poverty rate recorded in Indonesia’s history. ^[37] In contrast, however, the number of PBI recipients categorized as living in poverty by the Ministry of Social Affairs has consistently increased every year. [38]

The Chief Statistician at the BPS has publicly admitted the government’s statistical inconsistency. In an article released in October 2018, ^[39] the Chief Statistician explained that the Bureau measures poverty data using a standardized methodology based on the World Bank’s Handbook on Poverty and Inequality. Meanwhile, the government collects data using a different methodology. This has resulted in the publication of contrasting figures as the government tends to see poverty relative to the relevant programs. However, this practice should not continue as it can hamper the efficiency and effectiveness of government programs and public service delivery.

This commitment has the potential to provide a solution to a long-running problem in Indonesia. Successful implementation could provide the government with a policy framework to use in other similar areas. Statistical incoherence is not a problem that is exclusive to poverty data. For example, in 2016, the Ministry of Agriculture ^[40] reported a surplus of 13.03 million tons of rice. However, the BPS ^[41] reported a surplus of only 2.85 million tons. Beyond confusion, data discrepancy can misdirect the government into enacting policies that do not meet the needs and demands of the citizens.

These inconsistencies are problematic in many ways. A portion of the poor population risks not receiving the much-needed assistance intended for them. It also opens up possibilities for people to trick the system, as indicated by findings of invalid entries of recipients included in the list of beneficiaries. Additionally, given the magnitude of budget allocation for the program, invalid beneficiaries data can result in corruption by public officials to direct funds for unintended recipients or uses.

This commitment intends to address all three aspects of these problems. The development of an information system application will allow citizens to access PBI recipient data with a built-in online verification feature to enhance the efficiency of the government’s data validation process. To support this, the government has committed to incorporating citizen participation elements in the data verification and validation process through existing consultation mechanisms such as the development planning forum (Musrenbang) as well as village forums (Musdes). This will allow citizens to provide feedback to the government by proactively reporting invalid entries and indicating those who live in poverty but have been excluded from the recipient list. To ensure continued improvement, the Ministry of Social Affairs committed to issuing a Ministerial Decree verifying an updated data of PBI recipients on a monthly basis.

With proper implementation, this commitment carries a moderate potential to prevent corruption and mismanagement of public funds. By making the process transparent and involving citizens, the government can ensure that those who benefit from the premium assistance actually qualify as recipients. By the end of this action plan cycle, this commitment might trigger some changes to the management of universal healthcare provision in Indonesia, especially with the government’s commitment to update the recipient list on a monthly basis, a progress compared to the existing yearly update.

Next Steps

In order to properly address the problem that this commitment seeks to solve, the Ministry of Social Affairs should disclose the methodology and criteria that it has been using to assess poverty. The stark contrast between the Ministry’s figure and the one reported by the BPS suggests that the two institutions are using different methodologies.

Public data discrepancies has also been one of the reasons behind the development of the One Data Indonesia policy with its three principles: one data standard, one standard metadata, and data interoperability. ^[42] However, despite the draft having been complete for years, ^[43] the Presidential Regulation on One Data has yet to be signed into effect.

In implementing this commitment, the government could consider focusing on the following aspects:

• Publish premium assistance beneficiary data (including allocation and distribution) to ensure transparency throughout the process;
• Optimize existing avenues of citizen participation such as village forums (Musdes) and development planning forums (Musrenbang) as well as public consultation forums (FKP) rather than develop a new mechanism;
• Proactively engage vulnerable and marginalized communities to ensure their inclusion in the premium assistance scheme; and
• Coordinate with the BPS as the authoritative government statistical bureau to streamline the methodology and criteria used in collecting poverty data.

[28] Social Security Agency for Health, “Sejarah Perjalanan Jaminan Sosial di Indonesia” (2018), https://bpjs-kesehatan.go.id/bpjs/index.php/pages/detail/2013/4.

[29] Government of Indonesia, “Undang-Undang No. 40/2004 tentang Sistem Jaminan Sosial Nasional” (2004), http://www.depkes.go.id/resources/download/general/UU%20No.%2040%20Th%202004%20ttg%20Sistem%20Jaminan%20Sosial%20Nasional.pdf.

[30] Premium Assistance Beneficiaries (PBI) is the common translation used by multiple official documents to refer to the government’s “Penerima Bantuan Iuran” insurance scheme (see National Team for the Acceleration of Poverty Reduction, “The Road to National Health Insurance (JKN)” (2015), http://www.tnp2k.go.id/images/uploads/downloads/FINAL_JKN_road%20to%20national%20health%20insurance.pdf.) The English translation of Indonesia’s fifth action plan’s original text refers to this term as “Health Contribution Assistance,” a translation that is not found in any other publications. In this report, the IRM researcher uses “Premium Assistance Beneficiaries” (PBI) to refer to the same subject matter.

[31] CNN Indonesia, “Jokowi Tambah 4 Juta Orang Miskin Penerima Bantuan Iuran BPJS” (9 Jan. 2019), https://www.cnnindonesia.com/ekonomi/20190109131334-78-359541/jokowi-tambah-4-juta-orang-miskin-penerima-bantuan-iuran-bpjs.

[32] Ibid.

[33] Darwanto (MediaLink), interview by IRM researcher, 7 Mar. 2019.

[34] Ibid.

[35] Hendra Kusuma, “Jokowi Pertanyakan Simpang Siur Data Kemiskinan” (Okezone, 2016), https://economy.okezone.com/read/2016/04/26/20/1372844/jokowi-pertanyakan-simpang-siur-data-kemiskinan.

[36] Central Bureau of Statistics, “Persentase Penduduk Miskin Maret 2018 Turun Menjadi 9.92 Persen” (2018), https://www.bps.go.id/pressrelease/2018/07/16/1483/persentase-penduduk-miskin-maret-2018-turun-menjadi-9-82-persen.html.

[37] BBC, “Empat Hal di Balik Angka Kemiskinan Indonesia yang Disebut Mencatat ‘Sejarah’” (18 Jul. 2018), https://www.bbc.com/indonesia/trensosial-44861258.

[38] CNN Indonesia, “Jokowi Tambah 4 Juta Orang Miskin Penerima Bantuan Iuran BPJS.”

[39] Hendra Kusuma, “Kepala BPS Blak-Blakan Soal Data dan Fakta Angka Kemiskinan di RI” (Detik Finance, 2018), https://finance.detik.com/wawancara-khusus/d-4160586/kepala-bps-blak-blakan-soal-data-dan-fakta-angka-kemiskinan-di-ri.

[40] Samuel Pablo, “Data Beras BPS dan Kementan Berbeda, Ini Penjelasannya” (CNBC Indonesia, 2018), https://www.cnbcindonesia.com/news/20181025105653-4-38964/data-beras-bps-dan-kementan-berbeda-ini-penjelasannya.

[41] Ibid.

[42] Open Government Indonesia National Secretariat, “Sosialisasi Rancangan Peraturan Presiden tentang Satu Data Indonesia” (2017), https://ogi.bappenas.go.id/news/223/sosialisasi-rancangan-peraturan-presiden-tentang-satu-data-indonesia.

[43] CNN Indonesia, “Pemerintah Terbitkan Perpres Satu Data Akhir Tahun Ini” (27 Nov. 2018), https://www.cnnindonesia.com/ekonomi/20181126142128-92-349299/pemerintah-terbitkan-perpres-satu-data-akhir-tahun-ini.