health saving accounts for maternal health

Maternal mortality andinfant mortality is an important indicator for assessing and prosperity of a country and community health status. The Indonesian Maternal Mortality Rate (MMR) in Indonesia is very high comparing to the other countries in South East Asia. Maternal Mortality Rate in Indonesia was 240/100.000, it’s very high then other countries around, Vietnam 56/100.000, Malaysia 31/100.000, and Singapore 9/100.000 live birth. [1] One of the main causes of this high MMR is due to expensive health costs, resulting in weak ability of the society to pay ante, intra, and post natal care expenses.

The Indonesian government through Health department then introduced “Tabulin“ program, a program in which the societies voluntarily deposit their own money as a preparation to pay expensive health cares.[2] TABULIN, an acronym of Tabungan Ibu Bersalin is a comprehensive community‐based program that was initiated in February 1998, where all pregnant women and would‐be mothers who want to join pay a nominal fee (which stays in the community) to obtain the minimum maternal health care services necessary to deliver safely.

Thus, therole of community participation is very required in order to suppress the Maternal Mortality and Infant Mortality. [3] Indonesian Midwives Association (IBI) and BKKBN support the program through socialization and dissemination. In addition, Tabulin is not for only delivery fees, but also postpartum care. Since Indonesia has JAMKESMAS (national health insurance for the poor) and JAMPERSAL (free delivery care), why there is still need of Tabulin? In remote area such as in Ujung Ganteng Village, it was very hard to reach hospital due to distance.[4] How is the mechanism of Tabulin? Tabulin are based on RW (sub village) or Posyandu (integrated Health Care). If there are four Posyandu, then it will be four saving accounts. Sometimes, they were rejected in hospital also due to full occupied.

They start to saving since the women detected pregnant positively until the time of delivery. Amount of payments were depend on the capability of each family. In Ujung Ganteng village, village midwives collect 1,000 IDR per pregnant women per day.[4]The money was deposited by the village midwife. If the saving account cannot cover all cost of delivery by midwife – with expense of 300,000 IDR – 500,000 IDR‐, then the mother can repay the remaining after giving birth.[5] In addition, there are two important things regarding to successfull Tabulin:[2]

Sociodemography factors significantly influence the ability to pay for Tabulin. Those factors are the education level of husbands and family income. 1. The internal and external factors also significantly affect willingness to pay for Tabulin. Those factors are antenatal care, the kinds of persons who will help the delivery process (such as midwifes and phycians), perception on costs of delivery, and the amount of delivery costs.

Sustainability is the biggest challenge of this program. It will be very hard to keep it in the long run, if there is no midwife in the village or any community volunteers who can be trusted and always active to collect the payment.