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National Health Insurance participatory monitoring tool


PRAKARSA is a think tank that was founded in 2004 based in Jakarta, aiming to develop and improve the quality of policy and welfare through independent research and scientific development. Since its inception until now, health issues have become one of the issues on the advocacy agenda. We believe health is an important investment to support economic development and poverty reduction.

Since 2014 the Government of Indonesia has implemented the National Health Insurance (JKN) program which is part of the National Social Security System (SJSN). JKN is a form of Indonesia's commitment as a member of the World Health Organization (WHO) to achieve Universal Health Coverage (UHC). JKN has been proven to be effective in increasing access to health for the community, especially the poor and near-poor in Indonesia. However, until now JKN is still being improved in terms of coverage and quality, considering that there are still problems, including: 1) the high number of JKN participants who have to buy their own medicine has resulted in out of pocket public health, 2) public access to health facilities is still limited, 3) the quality of health care services is not evenly distributed, and 4) the potential for fraud and moral hazard.

In 2018, PRAKARSA resumed JKN monitoring as a continuation of the previous project. This is because PRAKARSA believes that the JKN program needs to be continuously monitored and evaluated. JKN monitoring and evaluation has been regulated in Law no. 40 of 2004 and Presidential Regulation no. 111 of 2013. The policy has stipulated that the Minister of Health is responsible for monitoring and evaluating the implementation of JKN as part of the implementation of the JKN quality control system and cost control. Then, the authority of the DJSN to monitor and evaluate the implementation of JKN aims to maintain the continuity of the implementation and sustainability of the program.

DJSN already has an Integrated National Health Insurance Evaluation Monitoring System (Sismonev JKN). This system looks at 6 aspects, namely participation, service, organization, fees, payment and finance. The integrated JKN Sismonev contains data and information presented using distribution maps, graphs and numbers. DJSN continues to encourage CSOs to be more involved in monitoring the JKN program. DJSN also has a media monitoring system that is processed to track JKN developments in various regions. However, the analysis is still limited to positive and negative analysis, even though it should be used as a policy basis.

The community as one of the elements in JKN still does not have a strong position compared to other elements in JKN. The community has not been able to be actively involved in a systematic and organized manner to provide input on improving the JKN program. So far, community involvement in JKN monitoring has been limited to submitting complaints in one direction through various existing complaint channels. However, in fact JKN participants still have difficulty in submitting complaints or complaints related to the health services they receive, especially the community at the regional level. Although BPJS Kesehatan also has a public complaint channel regarding JKN services. However, there is no system that can know the response or follow-up to the settlement of cases or complaints that come in. This is because there are no channels that are integrated with other systems in JKN. A participatory approach is needed in monitoring the JKN program, to obtain information about the conditions and attitudes of the community towards JKN.

Judging from the potential for digital development, the number of internet users in Indonesia in 2020 was recorded at around 175,5 million people out of a total population of 268 million people (Kominfo, 2020). PRAKARSA considers that the use of internet-based technology can be an opportunity to involve the community in monitoring JKN directly through a mobile application. Although this can also be a challenge for areas that do not yet have good internet access. However, we will continue to conduct direct monitoring based on social audits involving all stakeholders to complement the monitoring efforts carried out. So that in the first stage, PRAKARSA will develop a monitoring tool that can be used by the community and integrated with the existing system.

Based on the above background, PRAKARSA sees the need to contribute in creating a tool that specifically monitors JKN in a participatory manner. The objectives of making this participatory monitoring tool include:

  • As a participatory monitoring channel for the JKN program
  • Presenting integrated and integrated JKN Sismonev data
  • See the achievements and impacts of the program firsthand

The outputs of the activity of making participatory monitoring tools are:

  • Participatory JKN monitoring apps
  • Media analysis sourced from DJSN

Expected results
The expected results from this participatory monitoring tool include:

  • Monitoring tools will be used by all JKN participants easily (user friendly)
  • As a medium for public information regarding the development of JKN (participation, services, organization, fees, payments and finances) which is translated from the DJSN Integrated Sismonev into apps
  • Integration of reports or public input related to JKN from various existing and newly created channels
  • The results of monitoring can support efforts to increase the transparency of program governance, encourage the achievement of social justice, and improve the quality of services.
  • The added value that may arise is the increased commitment of local government budgets to health as a result of the disclosure of information.
  • At the end of the project, it is hoped that DJSN can take over the participatory monitoring tool as a sustainability effort.

Design of participatory monitoring and evaluation tools:

1. Principles/user requirements participatory monitoring tools:

  • It is participatory, involves multi-stakeholders, is objective, oriented to program goals, and is sustainable.
  • Strengthening the position of the community in involvement in the JKN program.
  • This tool will be integrated with the integrated JKN Sismonev.
  • This tool is integrated with the complaint channel from JKN mobile and other JKN service complaint applications
  • Monitoring tools are expected to target the entire community, regardless of socioeconomic status, age, gender and region.
  • The indirect beneficiaries of this participatory monitoring tool are people who are included in the category of contribution assistance recipients (PBI).
  • The data presented includes information on JKN developments, participant satisfaction, and seeing the quality of services provided by FKRTL and FKTP.
  • JKN participants can directly report everything related to the health services they receive.
  • Software development according to user experience and carried out periodically according to the results of the evaluation of the tool.
  • In the development of tools to see JKN mobile apps as a benchmark, we will answer things that mobile JKN cannot answer in terms of accessibility and data utilization. So that easy access to integrated data is needed.

2. Applied application details:

  • The tool will be developed in the form of apps for iOS or Android and easy to download or install
  • Design apps use features that make it easy for users to navigate (user interface), equipped with features download and
  • Provides features online offline, is intended for areas with unstable internet signal and no signal.
  • Apps are not paid, can login using social media.
  • Apps have good security.
  • Have a certain user level.
  • Easy to update.
  • Has ease of maintenance, management and repair.
  • Subscriptions on iOS and android will last for two years.

3. Application Documentation:

  • Document Operation manual for program usage (user guide)
  • Printed Document from source program (source program listing)
  • Document Results from program planning or explanatory information containing program information, for those related to the program.

Tool development process
The following are the stages of developing a participatory monitoring and evaluation tool:

  • Conduct vendor selection
    PRAKARSA will openly select a professional Apps developer or software house.
  • Development of participatory monitoring and evaluation tools
    FGDs were conducted for the development of design apps that fit the needs. This discussion involved CSOs, academics, Ministry of Health, Bappenas, DJSN and other stakeholders. The results of the discussion will be stated in the design of the apps and will be consulted again with stakeholders to get input.
  • Socialization of participatory monitoring and evaluation tools
    PRAKARSA will go to a number of areas and cooperate with local governments in conducting socialization. Beneficiary groups from this activity will also be directly involved.
  • Test tools at the regional level
    Tests will be carried out to ensure the accuracy of the tool and will be carried out in at least six PRAKARSA partner areas namely Medan City, Pandeglang Regency, Semarang Regency, Mamuju Regency, Bogor City and Kupang City. In addition, the City of DKI Jakarta was also chosen as the location for the test tool as a representative of national heterogeneity. The simulation training will be held in Jakarta and attended by collaborating local CSOs. The local CSOs will then disseminate the tools in each area to the community. Local CSOs will be the main agents in promoting the tool in collaboration with service provider staff.
  • Online and offline based promotion
    Promotion of the tool will be done through online and social media and offline through public discussions with JKN participants. It is hoped that at least people in each area will use the apps as soon as they receive health services.
  • Optimization and use of tools at national and local levels
    After the tool is piloted and finalized, training will be conducted for local partners to socialize the use of the tool to the community in each area to reach the village level.
  • Processing of monitoring and evaluation results
    After the tool is used by the community, then data processing will be carried out. This is done to determine the trend of service quality. The results of monitoring and evaluation will be submitted in the form of reports and action plans to the government at both national and regional levels to improve health policies. The raw materials taken from the server will be analyzed by the PRAKARSA team and consulted with experts.
  • Repair tools based on recommendations from monitoring results
    Once the tool is used at the national and local levels, the tool will be developed based on the recommendations from the evaluation process.
  • Dissemination of monitoring and evaluation tools
    Monitoring results will be disseminated at the national level (DJSN, BPJS Kesehatan, Ministry of Health, Commission 9 in the National Parliament) and at the regional level. This discussion will be held in at least six selected areas for dissemination of monitoring tools and results to stakeholders and the community as a continuation of the use of participatory monitoring tools from the community in monitoring the quality of health services.
  • Submission of participatory monitoring tools (Sustainability)
    After all the previous series have been carried out, the participatory monitoring tools will then be handed over directly official to DJSN as the institution authorized to monitor JKN.

Time frame
The following is a timeline of activities:

No Activity Time
1 Developing ToR 4 – 20 January 2021
2 Conduct vendor selection 1 – 19 February 2021
3 Vendor interview and winner determination 19 – 23 February
4 Initial discussion with selected vendors 25 February 2021
5 Stakeholder FGD 26 February 2021
6 Making participatory monitoring tools February 28 – March 19, 2021
7 Socialization of participatory monitoring tools to stakeholders (DJSN) and CSOs (FGD) to get feedback March 22 2021
8 Monitoring tool revision 23 – 29 March 2021
9 Online and offline based promotion 30 March – 15 April 2021
10 Optimization and use of participatory monitoring tools at national and local levels 16 - 23 April 2021
11 Processing of monitoring and evaluation results 24 - 28 April 2021
12 Repair tools based on recommendations from monitoring results 29 April – 3 May 2021
13 Dissemination of monitoring and evaluation tools May 4, 2021
14 Tool submission May 4, 2021

*if the vendor can make a faster timeline it will add to the assessment

Vendor expertise and capacity
PRAKARSA is committed to being able to support the government in monitoring the JKN program, therefore the vendor capacities needed include:

  • Is an expert in the IT field or application development as evidenced by a CV and contact recommendations
  • More than 5 years of experience in IT and application development
  • Can identify data integration opportunities
  • Able to translate the purpose of making tools in an application
  • Have good communication skills, courtesy and friendliness.
  • Can create Program Documentation
  • Can work according to target time
  • Responsible for making revisions
  • Have an understanding of the JKN program
  • Committed to supporting the improvement of the quality of the JKN program

Contents of Apps Developer Offer
For app developers who have the interest and competence in evaluating this project, we hope to be able to offer us as a form of transparency and accountability for the selection of consultants. The offer includes, among others:

1. Individual CV or CV of all personnel involved (if team)
2. Technical/specific proposals:

* A brief explanation and justification of the apps to be made;
* Technical application creation and schedule;
* A specific description of how relevant cross-cutting issues need to be considered by PRAKARSA.

3. Financial details:

* Includes details of all costs within the scope of making apps including maintenance costs and app sustainability for the next 2 years
* Costs related to transportation, consumption, accommodation, taxes and contributions will be part of the consultant fee

4. Other provisions:

* Consultants are willing to hold meetings both online and offline if needed (offline in Jakarta)
* Consultants are willing to go to the field or region to conduct socialization accompanying PRAKARSA (details will be discussed later regarding fees, operations and technicalities)
*Other terms will be stipulated in the contract

Incoming offers that match the qualifications will then be included in the interview process. Offers received no later than February 19, 2021

Contact person
Thus we convey this terms of reference, if there is information that is not clear and needs to be asked, please contact:

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