Questions/Answers

It often happens that poor people in Banyumas who suffer from chronic diseases are not able go to the hospital because of the cost, transportation, assistance and basic needs (food and drink) while waiting in a hospital. Because they cannot afford treatment,they sometimes turn to alternative (non-medical) treatment which can make the disease worse. For the poor who do not have health insurance, they are afraid of going to the hospital and even those who have health insurance cannot go to the hospital, because it is too much expense. Late and slow responses for poor people with chronic diseases make patients develop more severe illness, and become frustrated and begin to despair which increases the risk of suicide. If the condition of the disease worsens without immediate treatment, poor people become viral in mass media and social media and then new efforts are made by the medical team and other relevant agencies. The poor is facing unclear communication channels for social problems when suffering from chronic diseases. Who should they report to? Who can help? How can they report? When will the treatment be carried out?These issues happen to poor people when they suffer a chronic illness and they often cannot do anything, due to lack of economic capacity, understanding, level of education and information. This innovation provides an easy channel of communication for the poor and the community so that they can get rapid, responsive and complete assistance to get the treatment forchronic illnesses despitebarriers such as ownership of population identity, health insurance, costs while waiting at hospital, ambulance transportation costs, costs for patient shelter, social and psychosocial assistance, basic needs for food, drink and post-treatment assistance from the hospital.

This innovation provides inclusive and fair services for all poor people who suffer from chronic illness. The service does not differentiate religion, ethnicity, race, gender, including displaced people. The assistance provided is tailored to the needs and priority of the patient. For example,Laris Sitanggang, a resident of Karangmangu Hamlet in Panusupan Village, Cilongok Sub-regency, a nostril tumor patient requires radiotherapy treatment costs in a private hospital but is not covered by health insurance (BPJS) which costs IDR.20,000,00. This innovation service is quick, responsive, and completely without any discrimination.

This innovation is in line with the SDG global goal number 1, that is, no poverty, with an indicator of the percentage of the population living below the poverty line. The number of poor people in Indonesia is currently 25,950,000 people. From the population of Central Java Province in the period March 2019 there were 3,743,230 poor people. Out of861,633 poor people in Banyumas Regency, only 850,370 have a social protection program (have health insurance). Thus, there are 11,263 people who do not have health insurance andas many as 369 or 1.3% of people can be helped through this innovation. This innovation is gradually increasing in assisting the poor people who suffer from chronic illness: in 2016 as many as 15 people, in 2017 as many as 80 people, in 2018 as many as 127 people and in 2019 as many as 147 people. The efforts to prevent the poor who suffer from chronic diseases from becoming increasingly poor become one of the indicators of this innovation’s success. If the innovation is not carried out, then the potential of the community tolive below the poverty line continues to increase.

Socially, this initiative obtains massive support from the local citizen. Indicated by the increasing number of community who participates in this social movement, including the university student volunteers as part of campus social responsibility program. This number has increased from time-to-time. In 2016 this initiative had only 15 volunteers but it has jumped into 1,323 in November 2019. Economically, this social participation has also generated financial support from public and private sectors. This financial support has complemented the local government budget for this initiative. Several private and state-owned companies have allocated their corporate social responsibility (CSR) to this initiative.

The poor people in Banyumas Regency number 861,633 people and only 147,503 have social security and 850,370 have health insurance. Of the number of poor people who have social security and health insurance, there are still 11,263 people or 1.3% who do not have health insurance. It often happens that poor people do not have up-to-date population identities, so they are not recorded in an integrated database and are threatened with no social security and health insurance. The government has not been able to provide social security and health insurance to all poor residents recorded in the Integrated Social Welfare Data (DTKS). This innovation helps with assistance in the form of population administration advocacy, medical costs that are not covered by government health insurance, ambulance transportation, accommodation (food, drink and patient shelter), psychosocial support and basic needs after treatment in hospital. It also provides fast, responsive and complete services that are carried out in an integrated manner by elements of government and local government, elements of private sector and civil society organizations.

This innovation provides advisory services for the poor without differentiating gender from infants to the elderly. Poor people who have social, economic and health problems because they suffer from chronic illness and need help are the basis of this innovation service. This innovation helps provide assistance to poor people in the Banyumas Regency and displaced people found in areas with chronic illness without differentiating the gender, ethnicity, religion, race, class and origin of the person.

The target groups of this innovation are poor who suffer from chronic pain who do not have health insurance and this innovation provides advisory services for them. If there are poor people who have health insurance but cannot go to the hospital because they cannot pay the transportation fee (ambulance), cannot pay the accommodation cost (food and drink) for the family who are waiting for them while in hospital, they are still given assistance according to their needs. If this innovation did not exist, then the poor who seek treatment at the hospital will bear two burdens: namely a disease that does not heal and the burden of the costs borne to pay bills during treatment. Also without this innovation displaced people would also not get complete service. This innovation provides solutions for poor people who originally did not dare to go to the hospital, became willing to go to hospital, and from 2016 to 2019 as many as 369 people were assisted, significantly decreasing the rate of chronic illness.

This innovation has been going on since 2016 and was preceded by the Social Service and Health Service elements by cooperating with an ambulance alert organization of 6 social organizations, 2 Amil Zakat Institutions and 5 social communities. In line with helping the poor, in 2017 this organization increased to 60 members, in 2018 it increased to 99 members and in 2019 it became 139 members. In the assistance period that has been carried out through this innovation, in 2016 there were 15 people, in 2017 there were 80 people and in 2018 there were 127 people and in 2019 there were 147 people. The key factor for this innovation was implemented with the policies of the Banyumas Regency government through the Decree of the Regent of Banyumas No. 460/1075/2017 regarding the Pattas Sosial Mitra Kurir Langit Public Service and budget support through the Banyumas Regency APBD. Providing services to the poor uses a partnership model between elements of government/regional, private sector and civil society organizations in Banyumas Regency to solve social problems. Monitoring and evaluation in mentoring is done through Whatsapp Groups on the condition of the client being handled. Monitoring and evaluation is carried out by group members for assessment, administration, during treatment and for post-hospital care. Evaluation from the community is done through suggestions and input via Facebook, Banyumas reports and SMS. External monitoring and evaluation is carried out by the Ministry of Social Affairs every year in July, when monitoring the implementation of social rehabilitation services. Monitoring and Evaluation of the Central Java Provincial Social Service is carried out every 3 months in conjunction with the implementation of the Central Java Provincial Social Service program activities in providing input and suggestions on the implementation of this innovation.

This innovation assisted in transporting patients with chronic diseases from their house to the hospital, combatting the issue of the road condition which cannot be passed by an ambulance. Another obstacle is problems with poor population administration that have not been updated in e-IDs and are not included in the integrated social welfare database (DTKS), so people must use public channels and pay cash with a total bill of up to IDR 20 million (USD 1,429) at private hospitals. This innovation also grants access to all level of societies using Whatsapp and social media by creating an Android-based application.

The limited budget of the central and regional governments, including Banyumas Regency,in health service means many integrated efforts must be done through innovation. This innovation provides: Fast service: to report health problems through direct reports via village apparatus, SMS,Whatsapp and other social media to the integrated Pattas Social Mitra Kurir Langit service center. Responsive service: to respond to community reports through assessment by the Team at the location of the client's address. Complete service: to provide assistance services from the management of population identity, social assistance during care and post-care, ambulance transportation, and urgent basic needs.

This innovation arises from the constraints and obstacles faced by Dinsospermasdes when solving problems of poor people who suffer from chronic illness,limited budget allocation, lack of synergy between local government, private sector and civil society organizations. Summarizing the existing constraints and obstacles, this innovation emerged by embracing elements of government and local government, private sector and civil society organizations in the Pattas Sosial Mitra Kurir Langit Partner. The joint task in this innovation is to provide assistance to help poor people who are chronically ill from pre-hospitalization to post-hospital care.

This innovation has been replicated by several regencies/cities after conducting a comparative study in implementing this innovation. This is also based on the type of poverty problem which is almost the same in every regency/city. This innovation is easy to implement in every regency/city government. The commitment of regional head support is one of the keys to this innovation being implemented. Through the innovation,collaboration and synergy between elements of government, private sector and civil society organizations are realized to help address social problems. The regencies that have replicated this innovation are Purbalingga, Cilacap, Banjarnegara and Kebumen. The factors that facilitate this innovation can be implemented in each regency/city are the potential of human resources in each regency/city which can do mutual assistance in helping the poor,and the mutual cooperation culture that exists in our community key to resolving social problems. Building a caring attitude and empathy of each citizen to help people who are in distress or have difficulties become the basic capital of this innovation that is easy to implement.

As mentioned above, this initiative has being adapted by several local governments and localities.

To implement this innovation the local government of Banyumas Regency provides an annual budget allocation of IDR 175,000,000 (USD 12,500) which is used for operational costs and transportation assistance. Providing ambulance transportation facilities consist of local government ambulances (40 vehicles), ambulances of civil society organizations (47 vehicles), and private sectors vehicles(15). This innovation can stimulate the private sectors and civil society organizations to help the poor reach 1.5 billion IDR (USD 107,143) per year in the form of cash, food and beverage, medicine, ambulance transportation assistance and other needs of the poor who suffer from chronic illness.

This innovation has been going on since 2016 with as many as 15 institutions as service partners, which in 2017 increased to 60 institutions, in 2018 increased to 99 institutions and in 2019 to 139 institutions. This innovation gets an annual operational budget allocation through the Social Affair Office (Dinsospermasdes) which averages around IDR 175,000,000 (USD 12,500) per year, while the operational costs of the work partners are sourced from the budget allocation of each element of the OPD, Private Sector and civil society organizations both for operational costs and assistance to clients suffering from chronic disease.

Yes

This innovation is evaluated periodically every 3 months through a coordination meeting of all members in the Pattas Sosial Mitra Kurir Langit. In the coordination meeting an evaluation of the leadership and members present will be carried out to provide input suggestions for further service improvement. Internal evaluations are also carried out at any time when there are social issues need to be resolved immediately, carried out through WhatsApp groups from representatives of the affiliated institutions so that the handling of problems are quickly handled immediately without having to conduct a direct coordination meeting.

Poor people who are chronically ill often used to be viral in the mass media, social media and othermedia. By having this innovation, there are no more poor citizens who are viral in the mass media. Complaints about the problem of managing chronic diseases directly, through letters, social media, mass media and other media have no longer appeared which need and an assessment and follow-up solution.

The evaluation results found the need to fulfill the improvement of the Pattas Sosial Mitra Kurir Langit service room, patient shelter, human resources (Psychologists, Nurses, Social Volunteers), mobile social service vehicles and the need for Android-based application technology. The challenges faced in implementing this innovation are a reduction in the allocation of the health insurance budget for the poor and a plan to increase independent BPJS for the poor who are not covered by government health insurance. This innovation makes it easier to handle social problems in the community, combatting as much as possible the neglect of the poor who suffer from chronic diseases. This innovation is a model for handling partnership-based social problems and is easily replicated in each regency/city. If this innovation is implemented, poverty alleviation will be realized soon. However, if this partnership-based social problem handling model is not implemented, the impact of poverty will increase and the neglect of the poor will continue to increase.

This innovation is carried out in an integrated manner that synergizes elements of the central and vertical government:, each institution has a role in this innovation such as the Ministry of Social Affairs through the Social Rehabilitation Center as a place to refer people with mental disorders that require social rehabilitation, and the Police, through 27 existing Sector Polices that conduct quick response assistance. The military resort command (Koramil) at the sub-regency level helps if there are residents who need to be evacuated on a stretcher and joins the social community in helping the poor. Horizontal partnerships such as the Health Service become a reference in medical solutions such as health insurance arrangements and medical steps that must be taken by providing PSC 119 services, namely network emergency ambulance services. Local government police (Satpol PP) helps in the evacuation of displaced persons in chronic illness conditions submitted to the innovation service post. Regional hospital provides assistance in managing people with chronic diseases with health insurance and without health insurance, supported by public Health Center which provides referrals to regional public hospitals. Other agencies and offices involved in this innovation provide assistance in accordance with their duties and functions, facilitated by this Innovation Team.

This innovation uses a partnership-based social problem handling model, thus emphasizing collaboration and synergy between elements of local government, the private sector and civil society organizations. Stakeholders in this innovation are involved in designing, implementing and evaluating the performance program of this innovation. Stakeholders of government/regional government, the private sector and civil society organizations involved in this innovation partnership continue to increase from year to year, where at the start of the pioneering there were only 15 Institutions in 2016, and in 2017 this became 60 institutions, which in 2018 increased to 99 institutions and then to 139 institutions in 2019. The stakeholder elements involved in this innovation are government institutions, State-Owned enterprises, education institutions, Hospital, NGOs, Private sectors, Business Association and the community.

The innovation uses a partnership-based social problem handling model for the poor who suffer from chronic pain as one model for handling poverty that is in line with the concept of SGDs. Synergy, Collaboration, Partnership and Mutual Cooperation among stakeholders are key for this innovation, so it can be implemented to solve poverty issues. This innovation changes the paradigm of handling exclusive social problems to be inclusive of sectorial egos by each service / agency / institution. Cross-sector coordination, which so far has only been a theoretical concept and is difficult to realize, can through this innovation be implemented to help the poor. This innovation is needed by the society, particularly for the poor who are suffering from chronic diseases. Therefore, this innovation must be continued must be sustainable to achieve the SDG of no poverty in 2030. Through this innovation, the collaboration of elements of government, private sector and civil society organizations must collaborate to manage poverty alleviation both in the context of regional and state regions to improve the quality and quantity of services in helping the poor who suffer from chronic pain as the key to increasing this innovation in the future.