ELDERLY HEALTH POLICY

IN INDONESIA
A CASE STUDY ON POLICY IMPLEMENTATION ON ELDERLY
CARE
IN LOMBOK , WEST NUSA TENGGARA PROVINCE,
INDONESIA

Wahyu Sulistya Affarah2, Hamsu Kadriyan2, Ketut Artastra2,3 Astri

Ferdiana2,, Jun Kobayashi1

1Department of Global Health, Graduate School of Health

Sciences, University of Ryukyus, Japan
2 Faculty of Medicine, University of Mataram, Indonesia
3 Provincial Health Office "Center for Health Personnel Training"
 Outline
 Background
 Methods
 Results
 Conclusion
Background
• Indonesia has entered
the era of ageing
population

• Elderly population 8.97%

(23.4 million) (2017)

• The elderly population is

projected to reach 15% in
2035

Source:
BPS, SP 1971, 1980, 1990, 2000, 2010
BPS, SUPAS 1985, 1995, 2005
BPS, Indonesian Population Projection (2015 –
2035)
 Growth Projections of
Elderly Population in Indonesia
Source: National Socioeconomic Survey, 2015
• The elderly population
ratio has risen to 14.02%
in 2017
• Elder who lives alone 10 %,
• Women is higher on
percentage (14.3%; 4.75%)
 vulnerable groups
• Morbidity rate in 2017
26.72%

• Out patient : 52,43%

5% don’t seek any

treatment.
42,38 %self treatment
25,96 % go to health care

• In- patient 7,68 %

Elderly Population in Provinces
 Socioeconomic situation

Source: BPS and National Socioeconomic

Survey, 2017
 Social and health insurance
• Elderly Households Who Have / Receive Social
Insurance12,63%
• Elderly households that have been registered /
are recipients of Conditional Cash Transfers 
4,25%
• 63.24% of the elderly have health insurance
• Contribution recipients33,47 %
• Non contribution recipients  17,08 %
• Local government contribution  12,88 %
 AIM of the study
This case study explore more on:
- How is the implementation after health policy
reformed?
- What is changing on the policy of elderly
health in Indonesia? PUT IN THE
BACKGROUND (how is the reformed?
decentralization, etc)
Methods
• Mixed methods approach case study methods (documentary reviews,
interview (key informant), any quantitative data from existing source,
Photos)
• Documentary review: focus on document in this Lombok island, ie: annual
report, NGO publication, archives from website.
• Qualitative data were obtained from key informant interviews. Target of
area by systematically selection. Check the government chart.
• Target of interview: Provincial and district site preliminary study.
Curative line-public health line—welfare line
• In one institution should choose 1 in charge person in elderly
• Policy maker
• NGO related activities
• Private hospital, private clinic  compare to government based health
services
• Quantitative data were gathered from related documents---as
complementary information
• Participant Observation for community level, such as: health service
infrastructure, elderly program activities, etc---as complementary
information develop research note
• Photos
 Analyze
Technique Test the validity of the data
1. Reduction of Data TRIANGULATION
2. Present Data • By technique
3. Verification/Draw the • By source
conclusion
 Key informant interview question
item---USAID modify model
1. Is there any policy decision to reform current healthcare service delivery
system to adapt to the ageing society?
2. Does it aim at integration of healthcare and long-term care?
3. Does it aim at integration of healthcare and welfare services?
4. Does it aim at more community-based care?
5. Name of service delivery model
6. What kind of services are provided through the model?
7. Unit of a service delivery system
8. Which service delivey models were used as a reference to develop the
service delivery model?
9. Who developed the model?
10. Type of financial source for the services
11. New information system introduced for the model
12. New information system introduced for the model
 In-depth interview question item
13. New coordination mechanism introduced to facilitate collaboration
between health care service providers and welfare service providers
14. Name of the policy document to introduce the model
15. Issuing body/institution
16. Date of officially approved
17. Policy goal
18. Policy objective
19. Policy timeframe
20. Name of the strategies
21. Name of the laws or decrees
22. Name of the program
23. Source of finance for the program
24. Incentive to implement the policy
25. M＆E system to check implementation status of the policy
Results
 • Presidential Decree on the National Day of Older
Persons, 29 May 1996
• Legislation on the Social Welfare of older persons,
Law no 13, 1998
• Presidential Decree no 52, 2004 on the National
• Commission Ageing
• Legislation on People’s Welfare, Law no 11, 2009
• National Plan of Action on Ageing, 2003-2008 Reformed
(renewed every 5 years) • The Law National Social
• National Social Security System Legislation no. 40 / Security System, 2004
2004 • The Regulation on Elderly
• Minister of Home Affairs Decree no. 60/2008 on
National Commission, 2016
Formation of Regional Commission on Ageing
• Legislation on Health Care no 23/1992 and
Legislation no 36/2009
• National Social Security System, Legislation no
40/2004
• Minister of Health Regulation no. 67/2015
concerning Implementation of Elderly Health aims to integrate :
Services at Health Centers.
• health care and long-term care
• Republic of Indonesia Minister of Health
Regulation no 79/2014 concerning the
• health care and welfare services
organization of geriatric services in hospitals community-based services
 Results
• UHC can’t be reached by 2019
• Cross sector coordination mechanism have not
been well established
• Health Center (Puskesmas) has an important role in
the implementation of community-based service
programs
• pelaksanaan kesejahteraan sosial lebih mengemuka
 not full protection
• absence of social protection schemes contribution-
based pension funds contribution-based long term
care
 Implementation at Health Center
(Puskesmas)
• Puskesmas:
 health center at sub-district level
 Supervise approximately 10,000 population
 More focus on preventive medicine
activities
• Program for Elderly: Outdoor and Indoor
 Outdoor Program

Integrative post
Health Physical Exercise of Elderly
Home Visit
Promotion Community
Integrative Post for Elderly Community
• An Integrative efforts of puskesmas for elderly
health
• Each puskesmas has different policy for its
implementation:
How many sub-village served
Schedule
• Operator: health officer and some cadres
• Participant rate: around 70%,not well-recorded
Integrative Post for Elderly Community
Activities
1. Registration
2. Measurement of height, weight, and blood
pressure. Screening on cholesterol, blood
glucose, and mental disorder.
3. Recording activities using Lansia Card
4. Health counseling based on Lansia Card and
giving supplementary food
5. Medical services
• Not much activities in indoor program, but
medical services
• Puskesmas that have specific SOP in serving
elderly will get an award, namely Puskesmas
Santun Lansia (social incentive)
 Financing source

• Capitation payment system---The National

Social Security System
Local government
CSR
 Province Public Hospital
• Most are curative efforts
• According to Republic of Indonesia Minister of Health
Regulation no 79/2014, Geriatric service in Province Public
Hospital is classified as the complete type consists of at
least outpatient care, acute hospitalization, and home care
(exception)
• Have no specific service for elderly, but registration counter
priority.
• Have no particular health personnel for elderly
• Financing source:
 The National Social Security System---INA CBG’s
 Local government
 Public Nursing Home
• The only one in West Nusa Tenggara Province Province
• an institution that provides services and protection for
neglected elderly people
• Main service:
– Regular services: Conciliation, Funeral, Clothing,
Medical examination, Counseling, Social and
religious guidance, Reunification, Skills for free time,
sports activities, Recreation and entertainment
– Day care service : similar activities, member are
pensionary, need payment
– Emergency service : social protection for the elderly
found on roads, residential areas or other places
 Elderly criteria
• at least 60 years old,
• do not have infectious diseases,
• are neglected,
• and come from poor families
 Adequate capacity
 not yet complete the functional workers such as: doctor, psychologist,
therapist, etc ---as mentioned in Regulation of the Minister of Social Affairs of
the Republic of Indonesia number 106 / HUK / 2009 concerning Organization
and Work Procedure of Social Institutions in the Ministry of Social Affairs
 Source of Financing
• Start from 2004, there was reformed policy
that the source of financing come from Local
Government Budget only (before: Social
Department)---decentralization system
• Donation, were not well recorded
 Conclusion
1. Integrated approach is highly needed in
terms of improving long term care and
welfare services for elderly.
2. Community based programs have need of
strengthen recording and reporting,
monitoring and evaluation activities.
3. Reviewing factors that affect community
participation