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A Double Savings 

Cost-benefit analysis in Indonesia ensures a lasting Jhpiego legacy in postpartum family planning

Providing postpartum family planning services to women immediately after birth results in significant savings for every dollar invested in the lifesaving intervention, a cost-benefit analysis by Jhpiego found. 

The analysis, conducted in Indonesia to address financial barriers to private facilities providing postpartum family planning (PPFP), showed an estimated $70 saved for every $1 invested. The study findings have strengthened Jhpiego’s advocacy efforts to expand access to PPFP in private Indonesian health facilities, where more than 60 percent of facility births occur.  

In addition to showing economic savings, the analysis highlighted the opportunity to save lives. Reimbursement of PPFP at the hospital level could save maternal and newborn lives by helping women to more safely space pregnancies and avoid 41,411 unintended pregnancies every year, the analysis found. 

Jhpiego shared the cost-analysis with the Ministry of Health as part of its ongoing advocacy efforts to increase access to PPFP. As a result, in 2020, the government of Indonesia started reimbursing the costs of PPFP services to hospitals under the budget of the National Family Planning Board, known as the BKKBN. 

Future plans to have PPFP services covered by national health insurance are underway . . . Because of Jhpiego’s efforts, we have proposed it for inclusion in the BPJS financing scheme.”  

Eni Gustina, Deputy for Family Planning and Reproductive Health of the BKKBN

While a majority of facility deliveries in Indonesia occur in privately-owned centers, the ability of these facilities to offer PPFP to mothers has met challenges. “The government has focused on improving the quality of service in public facilities, but we know the private facilities have a large proportion of services,” says Dr. Siti Nurul Qomariyah, Research and Evaluation Director for Jhpiego in Indonesia. “If we ignore the private sector, we will lose a lot.” 

BPJS Kesehatan, the government agency that administers the country’s national health insurance scheme, has historically not reimbursed hospitals—either public or private—separately for family planning services after birth. PPFP has instead been considered part of the labor and delivery package, so private hospitals have had little financial recovery (and therefore incentive) to offer it during the immediate postpartum period. This reimbursement structure essentially forced the private sector to eliminate its profit margin when offering PPFP immediately after birth. 

Postpartum family planning—family planning services provided to women during the first year after childbirth—is a critically important intervention: the few months right after a woman gives birth is when she most wants to avoid pregnancy but often is not using any form of contraception. Jhpiego’s Indonesia team won a STARS innovation award for their advocacy and analysis work to expand access to PPFP.

Since 2015, Jhpiego has been working with the government of Indonesia to scale up access to PPFP services in private hospitals in order to help the government meet their FP2020, and now FP2030 goals. The cost-benefit analysis was conducted under the Bill & Melinda Gates Foundation-funded PPFP Choices project (2016–2020). 

“This cost-benefit analysis is our legacy,” says Qomariyah. “Because of this modeling, we were able to demonstrate to the government the huge financial [benefit] to offer PPFP services everywhere, including private hospitals. BKKBN now has a tool they can use to advocate with the Ministry of Health to ensure future PPFP reimbursement is included in the national health insurance program.” 

Leanne Gray is a Senior Communications Specialist for Jhpiego. 

Jhpiego believes that when women are healthy, families and communities are strong. We won’t rest until all women and their families—no matter where they live—can access the health care they need to pursue happy and productive lives.

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