HEALTH BUDGET & INVESTMENT FOR NCDs PREVENTION & …p2ptm.kemkes.go.id/uploads/VHcrbkVobjRzUDN3UCs4eUJ0dVBndz09/2018/04… · Kementerian Keuangan 8 Source: Rachel Nugent, Melanie

Kementerian Keuangan

Copenhagen, 9-11 April 2018

WHO Global Dialogue on Partnerships for Sustainable Financing

of Non-communicable Diseases Prevention and Control

HEALTH BUDGET & INVESTMENT FOR NCDs PREVENTION & CONTROL IN INDONESIA

P Purwanto Director of Budget for Human & Culture Development Directorate General of Budget Ministry of Finance of Republic Indonesia

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How Government Spending Budgeted

• According to the constitution, minimum 20% of central government budget

and 20% of regional (provinces & districts/cities) budget must be allocated to

education sector,

• According to laws:

• minimun 5% of central government budget and 10% of regional budget

must be allocated to health sector,

• Minimum 25% of central government net revenues (taxes & nontaxes)

must be transfered as general grants to regional governments,

• Minimum 10% of funds transfered to regions must be allocated to

villages (village funds)

• Other spendings: salary, interest payments, subsidies, specific allocation fund

for regions, poverty reduction/social assisstance, and other sector spendings

(defence, infrastructure, agriculture, tourism, etcc)

• By Law, general government budget deficit must be maximum 3% of GDP,

(reality: always under 3%) and debt to GDP ratio maximum 60% (now about

29%)

With these earmarks, it is very challenging how to:

• Spending Better, Spending more effectively

• Spending more on priority program/sector

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Indonesia’s level of public expenditure is relatively low

Y-axis: General government spending, percent of GDP, 2016; X-axis: log GDP per capita in 2011 PPP

…primarily due to its low revenue to GDP ratio

Y-axis: General government revenue, percent of GDP, 2016; X-axis: log GDP per capita in 2011 PPP)

Revenue to GDP Ratio

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Spending for Health increases

significantly in the last two

years... % of general

government budget

(US$ 8.2 billion)

However, Indonesia is still one of

the countries that spends the

least o health i the world…

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Indonesia also underspends on

social assistance compared to

other emerging economies

• In 2014, total spending for health was 3.6% of GDP, lower than the average of lower-middle income (5.9%) • OOP was about 45 % of total spending

(ideally 20-30 %

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Spend more on priority program: infrastructure, health, and social assisstance

How to spend better, spend more effectively: reallocating energy subsidies to priorities

% of Central Government spending (excluding transfers to subnational governments)

% of CGDP)

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Source: Rachel Nugent, Melanie Y Bertram, Stephen Jan, Louis W Niessen, Franco Sassi, Dean T Jamison, Eduardo González Pier, Robert Beaglehole, 2018, Investing in non-communicable disease prevention and management to advance the Sustainable Development Goals, The Lancet Taskforce on NCDs and economics 1, Published Online April 4, 2018 http://dx.doi.org/10.1016/ S0140-6736(18)30667-6

Source: Louis W Niessen, Diwakar Mohan, Jonathan K Akuoku, Andrew J Mirelman, Sayem Ahmed, Tracey P Koehlmoos, Antonio Trujillo, Jahangir Khan, David H Peters, 2018, The Lancet Taskforce on NCDs and economics 2 Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda, Published Online April 4, 2018 http://dx.doi.org/10.1016/ S0140-6736(18)30482-3

NCDs & SDGs

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• Consolidate relevant programs targeting the poor, because NCD & Stunting mostly

caused by poverty :

• inter-line ministries & agencies,

• Using the same data on poverty: integrated data based (by name & by

addresses)

• Coordinated action (planning & implementation) under the coordinating

minister of social welfare affairs & the Vice President (TNP2K/the National

Unit for Poverty Reduction),

• President will do some site-visits to check the progress

• inter central and regional/local governments

• Stunting Eradication Program

• Prioritise regions with high degree in malnutrition and poverty

• 100 regencies/cities @ 10 villages total 1000 villages of 74.954 villages (2018)

• 160 regencies/cities @ 10 villages, total 1.600 villages(2019)

• Improve the management & governance of the programs

• Investment in MIS (internet of things)

• More qualified social workers

• Focus also on urban life & middle-higher income families, as NCD is prevalent not just in

rural or poor family

Spending Better, Spending more effectively in health and

social assisstance

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Spending Better, Spending more effectively,

& Spend more on priority program:

Health & Social Assisstance for the Poor

Note: Rp1 trillions is about US$74 million

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LINE MINISTRIES’S INTERVENTION IN STUNTING ERADICATION NUTRITION-SPECIFIC BY MINISTRY OF HEALTH, 2018

Programs Billion Rp

Food assisstance program for chronic under-nutrition pregnant mother 403.5

Food assisstance program for under 5 year old under-nutrition children 505.9

Pharmacies & Health supplies for mothers & children 746.9

Community Movement for Healthy Life Campaign 197,0

Community-based sanitation 193.0

Filiarisis Control 148.9

Improvement of Regional goverment’s in the management from ante-natal to neo-natal services

66.5

Others 713.5

TOTAL (in billion Rp) 2,975

(~US$220,4 millions)

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LINE MINISTRIES’S INTERVENTION IN STUNTING ERADICATION NUTRITION-SENSITIVE BY OTHER MINISTRIES, 2018

(~US$5.1 billion)

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TRANSFER TO REGIONAL GOVERNMENT THAT RELATED TO HEALTH SECTOR, 2018

(~US$6.9 billion)

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1. Programs targeting at Pregnant Women:

Supplementary feeding of pregnant women to overcome chronic energy and

protein deficiencies

• Programs to overcome iron and folic acid deficiency

• Programs to address iodine deficiency

• Provision of worm medicines to cope with worms infestation in pregnant

women

• Programs to protect pregnant women from Malaria.

• Providing childbirth/delivery assistance by health personnel

This inludes

• administration of folic iron supplementation of at least 90 tablets,

• support to pregnant women to perform the examination of pregnancy at

least 4 times,

• providing Tetanus Toxoid immunization (TT),

• supplementary feeding in pregnant women,

• providing mosquito nets and treatment for pregnant women who are malaria

positive.

NUTRITION SPECIFIC IN STUNTING REDUCTION PROGRAM

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2. Programs targeting Breastfeeding Mother and Children 0-6 months

• encouraging early breast-feeding / giving colostrum

• ensuring the mother to continue to provide Exclusive Breastfeeding to her child.

• Providing basic immunization, monitor growth regularly every month, and

treating sick babies appropriately.

3. Program aiming at breastfeeding moms to continue breastfeeding until the baby is 23

age of months

4. Programs aiming at children under 5 years of age, including supplementary feeding

for toddlers, basic immunization, and training for mothers in giving care & education

for toddlers/kids

NUTRITION SPECIFIC IN STUNTING REDUCTION PROGRAM

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VILLAGE FUNDS CAN BE USED FOR SOME NUTRITION-SENSITIVE STUNTING REDUCTION PROGRAM

Integrated health service post Maternity home

Access to primary health care & hospitals

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• Consolidating programs & budget of various programs, central & regional,

that actually have the same ultimate goal: healthy & productive human

being.

• Improve the efficiency, effectivenes, and value for money of the

programs

• Consolidating campaign to improve efficiency & effectivity. In term of

popularity:

• poverty reduction - very popular

• stunting eradication - ew co er

• NCD control - what?!

• Widening the implementation of new, innovative program & financing,

working with private, donors, and NGO sectors

• New program: controlling the consumption of sugar, salt, trans-fat etc

• Public private partnership in dealing with NCD

• Promotion & campaign of anti-NCD

• Improving government revenue (tax & nontax) and spend it to finance

priority programs pursuing SDG targets

WHAT NEXT

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THANK YOU