Universal Health Coverage for the informal sector

This project will assess whether Indonesia’s National Social Health Insurance is able to provide Universal Health Coverage to households in the non-institutionalised employment sector (informal sector) through which 60 percent of Indonesian households earn an income, most of whom are ineligible for subsidized NHSI fees and cannot be enrolled through formal sector payroll contributions. The investigation will assess NHSI enrolments, identify barriers to self-enrolment and determine how quality and availability of health care supply affects insurance uptake. This will inform potential policy recommendations for mandating the informal sector to participate in the NHSI.

Project Team

Dr Robert Sparrow

Dr Robert Sparrow

Fellow, Arndt-Corden Department of Economics

Australian National University

Dr Teguh Dartanto

Dr Teguh Dartanto

Director of Undergraduate Program in Economics

Universitas Indonesia

Dr Arianto Patunru

Dr Arianto Patunru

Researcher

Australian National University

Partners

Cluster

Health_Header

Innovative approaches to address primary prevention of Non-Communicable Diseases

Across the world, non-communicable diseases (NCDs) have overtaken acute infectious diseases to become the leading cause of morbidity and mortality globally. In addition to mental disorders, NCDs such as cardiovascular disease, diabetes, chronic lung disease and cancers share the common lifestyle (behavioural) risk factors of tobacco use, unhealthy diet, harmful use of alcohol, and physical inactivity. The World Health Organization estimates that by 2020, NCD deaths will increase by 15%. The rise in NCDs is accompanied by prolonged economic impact; the cumulative lost economic output for 2011-2025 is estimated at more than US$7 trillion in low and middle income countries alone.

In Australia, 91% of deaths are now attributed to NCDs. In Australia, diabetes alone affects at least 1.1 million and is the 4th largest contributor to overall disease burden. The total costs associated with diabetes are estimated to be as high as $14 billion. Rising rates of obesity will only increase the prevalence of diabetes in Australia so it is not surprising that a new government taskforce has been established to prioritise national responses including prevention efforts and addressing the impact in the community. In Australia, NCDs and NCD risks (eg smoking, obesity) are most commonly experienced in the most disadvantaged communities, including in Indigenous communities.

While NCDs were once perceived as diseases of rich people in rich countries, the influence of the underlying drivers of NCDs (globalisation, urbanisation, powerful transnational corporations, economic development and ageing populations) is increasingly also being felt in emerging economies such as Indonesia. As in Australia, addressing the future burden of NCDs is a feature of all recent health plans that relate to Indonesia. For example, within the WHO Country Cooperation Plan Strategic Agenda for Indonesia (2013-17), 3 of 5 Strategic Priorities relate to NCDs. For example, Strategic Priority 2 is about promoting public health approaches to preventing and controlling NCDs. Strategic Priority 3 is about promoting policies and strengthening programmes to improve child, adolescent and reproductive health including primary prevention of NCDs.

While the burden of NCDs falls most acutely on adults, the risk factors that contribute to NCDs have their onset in early life, including during pregnancy (eg. gestational diabetes), in early childhood (malnutrition) and in adolescence (smoking, physical inactivity and obesity). It is for this reason that prevention strategies to address adult NCDs must commence during these early years.

Strategic research vision:

To reduce the burden of NCDs through innovative approaches which address primary prevention of NCD risks.

Heath and Medicine Cluster goals:

  • To increase understanding of the importance of reducing NCD risk factors in the early years in both Australia and Indonesia; and
  • To influence policy and practice in effective primary prevention of NCDs in Indonesia and Australia.

Brochure

Cluster Leadership

Professor Susan Sawyer

Professor Susan Sawyer

Chair of Adolescent Health in the Department of Paediatrics

The University of Melbourne

Dr Budi Wiweko

Dr Budi Wiweko

Lecturer

Universitas Indonesia

Associate Professor Kirsty Foster

Associate Professor Kirsty Foster

Associate Dean (International) and Head, Office of Global Health

The University of Sydney

Dr Achmad Romdhoni

Dr Achmad Romdhoni

Lecturer

Universitas Airlangga

Strategic Research Projects

Small Projects