Analysis of the HIV-Sensitive Social Protection Schemes in Indonesia

Although nationally the HIV epidemic in Indonesia is still concentrated on vulnerable populations, the negative impacts of AIDS for infected people and their families have the potential to become catastrophic because the infected people are mostly economically productive and HIV and AIDS in Indonesia are disproportionally experienced by poor families. A variety of attempts to reduce mortality rates related to HIV and AIDS have been undertaken, however, the attempts to mitigate the impact of HIV and AIDS on families have not received sufficient attention from AIDS program in Indonesia. Lack of concern regarding social protection of the PLHIV and their families in turn will impede the government’s attempts to reduce poverty and provide universal access to health care.

Social protection is basically all efforts that are directed to provide income or consumption to the poor group, to protect the vulnerable groups from various risks that affect their welfare, and to strengthen the social rights and status of the marginalized groups. The goal of social protection is to reduce social and economic vulnerability of the poor and marginalized groups. As a means of social protection endeavors, different kinds of social insurance and social assistance have been promoted in Indonesia. In particular, Public Health Insurance (Jamkesmas) has been developed as a national social insurance that aims to overcome economic impact of health care cost for poor communities in Indonesia. Additionally, a number of local governments at the provincial and district/municipality levels have developed local health insurance (Jamkesda/Jamkesos) as a form of local government’s responsibility in health decentralization.

Social and health insurance for certain groups have been implemented by some state-owned companies such as PT Jamsostek for private workers, PT Askes for civil servants, PT Asabri for armed and police forces personnel and PT Taspen for old age (pension for former workers in their old age). For those who are more fortunate, there are more options for health insurance provided by an array of private insurance companies in Indonesia. Unfortunately, the largest proportion of workers in Indonesia i.e. those who work in informal sector have not yet benefited from any type of health insurance neither from state nor private companies.

Existing social and health insurance and social assistance in Indonesia have not particularly addressed HIV and AIDS issue, however, by content these schemes have considerable potential to reduce the catastrophic impact to individuals and families who are affected by HIV and AIDS, because most of them come from poor and marginalized groups in the community. A number of studies have shown that social protection developed in other countries with high HIV prevalence have contributed to reduction of poverty caused by HIV and AIDS, improved families’ capability to earn income and enhancing access to education and health.

Seeing the considerable potential that the social protection schemes, particularly in social health insurance and social assistance, in Indonesia has to reduce the impact of AIDS to individuals and households, it is critical to see how far the various social protection schemes in country have given benefits to PLHIV. This study aims to map the array of social protection schemes in Indonesia, to identify different types of services that have been used by PLHIV and to assess the possibility of having a social protection policy that integrates the needs of PLHIV in its services.