Child access to health services during the economic crisis: An Indonesian experience of the safety net program

Child health has been a serious problem in Indonesia for several decades. The prolonged Indonesian economic crisis in 1997 had a tremendous impact on poor children who suffered due to malnutrition. In 1998, the Indonesian government launched a broad social safety net program to protect the poor from becoming poorer. In the health sector this took the form of Jaring Pengaman Sosial Bidang Kesehatan (JPS-BK) or the Social Safety Net in Health Sector program. Adopting the model of health services utilization of Andersen and Newman, I examine the extent to which JPS-BK contributed to better health services for poor children in four provinces, by using a simplified version of Andersen and Newman's model of health services utilization which emphasizes the importance of contextual determinants. Variables used in the study included child outpatient visits, health card possession, household income, and poverty status. Using data sets from the JPS-BK longitudinal study, I compared utilization of health services between baseline data collection at Rounds One and Three, which was taken a year afterward. In addition, I used the Village Potentials data set from the Indonesian Bureau of Statistics and employed factor analysis to raise one variable representing the village/neighborhood developmental level. Basic statistics were used to examine possible changes between study rounds and logistic regression was used to examine the effect of health card possession on child health services utilization. Two significant improvements occurred during the first year of the program: (i) more sick children visited outpatient facilities and (ii) more children lived in households possessing health cards. The JPS-BK increased the "potential access" that was demonstrated by the significant increase in health card possession regardless of the visit, and "realized access" that was demonstrated by the significant increase in child outpatient visits regardless of health card possession. Further research needs to be undertaken to explore the dynamics of outpatient visits and the actual use of health cards.