Questions/Answers

In the world there are 100 million people living with disabilities at productive age, 80% experience disabilities because of social risks and 60% live below the poverty line. 67% of workers with disabilities earn less than other workers. In Indonesia, 21.84 million people, or 8.56% of the total population, are persons with disabilities. In the period 2012-2014, there were 397 work accidents/day which caused 25 cases/day of functional/anatomical defects, 1 case/day of permanent disability, and 9 deaths/day. We should restore the dignity of disability workers as human beings and save them from poverty by re-empowering to contribute to the nation’s productivity and economic growth. BPJS Ketenagakerjaan Work Accident Security Program - Return to Work (JKK-RTW Program) is the answer. BPJS Ketenagakerjaan is the national social security administration office for employment with 325 branch offices and 11 regional offices, can reach workers in both big and small cities as well as in industrialized areas. The JKK program provides care and medical treatment, wages for unemployment, disability compensation, orthoses/protheses, compensation for death due to work accidents, reimbursement of transportation costs for work accidents and scholarships for workers' children who experience work accidents. Meanwhile, the RTW program provides additional benefits because medical treatment, assistive devices/function replacement and monetary compensation are not sufficient to save the dignity and livelihoods of workers with disabilities in the long term, so it is necessary to empower workers with disabilities to prevent from losing their jobs and falling below the poverty line. The main focus of the RTW program is the empowerment of workers with disabilities due to work accidents. The RTW program is run using case management, consists of assistance, recovery and empowerment of workers who experience work accidents which cause disabilities/potential disabilities, starting from accidents, physical and mental recovery, competency development to returning to work.

This program provides access to get quality rehabilitation services so disability workers can return to work. The program collaborates with various parties, such as participating companies for their commitment, hospitals for health services and facilities, recommendations from labor advisory doctors and the government for vocational training centers to prepare for returning to work. The family support the confidence of workers with disabilities and the role of trade unions support them in the workplace. A digital application to report accident helps in reducing the severity of the accident. The needs of disability workers are the main focus of this innovation.

This innovation is in line with the SDGs target 1.3 by implementing a social security program for workers, in the form of the RTW program, to provide protection for disability workers and opportunities to work again so that disability workers can earn income and their families avoid poverty. This innovation also supports the SDGs target 3.6 with the existence of a digital application to report work accidents can reduce the level of the disability and the death rate in work accidents that occur on the highway, because the golden hour of accidents is very short so this application helps medical management becomes more optimal. The SDG target 8.5 can be applied by re-empowering disability workers. The RTW program has ensured that 823 workers with disabilities due to work accidents can return to work, either in the company where they worked before, or in other companies so that disability workers will have decent and productive jobs that support economic growth. In implementing the SDGs target 10.3, the RTW program provides disability workers equal opportunities in the labor market, as well as restoring the dignity of disability workers, thereby reducing inequality (no one left behind).

In 2019, work accidents resulted in disabilities are 2,970 cases, partial anatomical defects are 2,801 cases and permanent disabilities are 30 cases. This program keeps disability people regaining a healthy life and feasible livelihood. There is a research showing that disability people who are still employed show high motivation to work and show good performance. Companies can also save money and time to train other people to have the same skills and experience as workers who have been injured, that is why at least 70,054 companies are committed to support RTW program and willing to re-employ disabled workers.

The RTW program is a new paradigm from limited protection for work accidents, which only provides medication, care and prostheses/orthoses for disabilities, into empowering workers who have had work accidents and resulted in disabilities. This innovation is very important because it fills in the absence of similar initiatives by the Government to empower disability workers. As a result of this lack of initiatives, disability workers are no longer working, whereas the RTW program re-empowers these disability workers so they can return to work, either in their previous work fields or in new fields of work. Through mentoring, the case managers ask for commitments from companies to accept disability workers back when they are ready to return to work. Through recovery, the case managers monitor the progress of care and treatment of workers who have experienced work accidents at the trauma center hospital and if they have a disability, the case managers monitor the progress of rehabilitation and the need of orthoses/prosthetic. Through empowerment, the case managers collaborate with the vocational training center to provide training and/or new skills for disability workers. The RTW program can increase productivity rates because the unemployment rate due to work accidents or disability will decrease.

Work accidents can happen to anyone, regardless of men or women, likewise with disabilities experienced due to work accidents. The RTW program ensures gender equality in its implementation. Male and female workers who experience work accidents and result in disabilities are given the same treatment. As of September 2020, as many as 822 people from the 969 RTW program participants have returned to work or 85%. There is one case of RTW program which needs at least 6 months after healing to return to work. Of the 969 participants, 141 were female workers or 14.55% of all RTW participants.

The Return to Work program is a development of the BPJS Ketenagakerjaan Work Accident Security Program aimed at workers who have the potential to experience disabilities due to work accidents or occupational diseases. This program runs with the approval of the BPJS Ketenagakerjaan participating companies and the results of the assessment of a competent doctor in the field of occupational health on the participant's eligibility to take part in a series of rehabilitation programs which are a series of RTW program. The biggest hope of the RTW program is an increase in workers’ productivity after experiencing work accidents or occupational diseases. The achievement of significant benefits obtained by BPJS Ketenagakerjaan participants has encouraged the government, companies/employers, health facilities to make changes and improvements in order to support the sustainability of the implementation of the RTW program in Indonesia. As of 2020, there are 70,054 employers who have expressed their commitment to support the RTW program by providing opportunities for disability workers to return to work.

PLANNING STAGE April 2013 International Technical Workshop: Rehabilitation and Return to Work, in Jakarta by PT. Jamsostek (Persero) September 2014 Inauguration of 11 Work Accidents/Occupational Diseases Case Managers First Batch October-December 2014 2 persons Certified Disability Management Professional (CDMP) by Deutsch Gesetzliche Unfallversicherung – the social accident insurance body for Germany in collaboration with National Institute of Disability Management and Research Canada (DGUV-NIDMAR) November 2014 Workshop of Return to Work Implementation for 11 persons Work Accidents/Occupational Diseases Case Managers batch I, in cooperation with SOCSO Malaysia TAHAP PENERAPAN December 2014 Implementation of the Return to Work Program in 11 Branch Offices April 2015 Declaration of BPJS Ketenagakerjaan Return to Work Program in Indonesia June 2015 Inauguration of 25 Work Accidents/Occupational Diseases Case Managers 30 June 2015 The passing of the Return to Work Program in Government Regulation Number 44 of 2015 2015 1. Health facilities and rehabilitation centers and vocational training centers throughout provinces 2. Integrated health facilities e-Service 3. MOU with the Ministry of Health, Ministry of Manpower, Ministry of Social Affairs, Vocational Training Centers November 2015 International Recognition from International Social Security Association (ISSA) as the new initiatives approach to start the Return to Work Program EVALUATION PHASE 2016 1. Increase in the number of Work Accidents/Occupational Diseases Case Managers in almost every branch office 2. Case Manager training and workshops 3. Expansion of the health services network and vocational training centers 2017 Internal Education and Training for Work Accidents/Occupational Diseases Case Managers 2018 Training 7 Case Managers in Malaysia 2019 1. 4 Case Managers Certification in Malaysia 2. ISSA Certificate of Excellence in Social Security Administration for Return to Work Program from International Social Security Association (ISSA) 2020 1. Increase the number of Work Accidents/Occupational Diseases Case Managers, a total of 81 people 2. Expansion of cooperation with rehabilitation centers

The obstacle in implementing the RTW program is that some companies are not yet willing to accept disability workers. However, with regular guidance and socialization by the case managers, as of 2020 there are 70,054 companies that have stated their commitment to support the RTW program by accepting disability workers to be placed in the same field of work or in the new field of work. Other obstacles are limited medical rehabilitation facilities to support restoring physical abilities and limited vocational training facilities at certain areas. However, government support through laws and regulations can help overcome these obstacles.

The scope of the RTW program starts with victims of work accidents receiving medical care, then being provided with assistance during rehabilitation until recovery. Furthermore, workers are given modified mobility aids to restore their ability to work. Then, vocational training is given to improve their skills prior to re-employment. This initiative is innovative because there has never been a program that provides care and assistance for disability workers until they are fully capable, including restoring their dignity, developing their competency and re-employing them. This supports the government in increasing the nation’s productivity, building the economy, and eradicating poverty.

Return to Work program is a development of the benefits received from Work Accident Security program managed by BPJS Ketenagakerjaan. The Return to Work program itself is a practice that is also carried out in social security in the world which is then adopted and modified by BPJS Ketenagakerjaan according to conditions in Indonesia. The success of BPJS Ketenagakerjaan in implementing Return to Work program has even been recognized by the International Social Security Association (ISSA) at the World Social Security Forum in 2019, through the ISSA Certificate of Excellence in Social Security Administration for Return to Work (RTW) Program.

In terms of reporting work accidents, RTW Program provides a digital application that can be used by companies to report work accidents. This application helps in providing the first medical treatments and care of the accidents, especially during the golden hour, where fast medical treatments are given to workers who have a work accident which will reduce the severity of the disability level of workers who have a work accident. Similar applications can be replicated for other cases, such as in the case of motor vehicle accidents on the road. That way, this innovation participates in driving digital government.

In the initial stage, the Return to Work program was implemented in 11 work areas as a pilot project. This implementation has successfully helped 21 workers to return to work in 2015. This success was followed by the implementation of Return to Work nationally through a policy issued through the Minister of Manpower Regulation Number 10 of 2016. As of 2020, the Return to Work program has officially been implemented for five years in all BPJS Ketenagakerjaan work areas at 325 BPJS Ketenagakerjaan Branch Offices throughout Indonesia.

At the Asian Workers Compensation Association (AWCA) activity in South Korea, the RTW program received positive responses from the participants of the activity and said they wanted to learn more about the success of the RTW program, especially in collaborating and coordinating with 1,535 hospitals, 1,292 clinics, 2,157 health centers, 45 joint doctor practices and 45 rehabilitation centers and vocational training centers spread across Sumatra, Java, Bali, Nusa Tenggara, Kalimantan, Sulawesi, Papua and Maluku. There are plans for visits from representatives of Ghana, Vietnam, Laos and Cambodia to study the implementation of the RTW program in Indonesia, but due to the pandemic's constraints, only representatives from Laos have made visits to see rehabilitation centers that are collaborating in the RTW program. The RTW program pays attention to psychological aspects in providing assistance so that workers with disabilities due to work accidents or occupational diseases remain eager to return to work.

Return to Work program requires the active role of the Work Accident/Occupational Diseases (KK-PAK) Case Managers who has attended comprehensive training to carry out their duties in assisting disability workers. Currently, there are 81 Work Accident/Occupational Diseases (KK-PAK) Case Managers spread across 325 Branch Offices and 11 Regional Offices throughout Indonesia. The funding comes from contributions of the Work Accident Security participants, with a range of 0.24-1.74% of the reported wages, depending on the level of work risk and fully borne by the employer. Its implementation adheres to humanitarian principles, the benefit principle and social justice for all Indonesian people.

The sustainability is due to regularly funded and in collaboration with employers, workers and related parties. There are several laws and regulations, such as law which requires the employment of disability persons 2% in government and 1% in private institutions, regulation concerning Implementation of Work Accident Security and Death Benefit Programs, regarding Procedures for Granting RTW Program and Promotive and Preventive Activities for Work Accidents and Occupational Diseases, regarding Terms and Procedures for Giving Awards in Honoring, Protecting and Fulfilling the Rights of Disability Persons, regarding National Disability Commission and regarding Adequate Accommodation for Disability Persons in Judicial Processes.

Yes

Evaluation is carried out in stages by the BPJS Ketenagakerjaan branch offices, regional offices and head office on employers that committed to support the RTW program by ensuring the availability and feasibility of facilities for disability workers. Evaluations are also carried out on hospitals, clinics, health centers and joint doctors' practices that provide trauma centers for victims of work accidents or occupational diseases by ensuring the availability and appropriateness of the health facilities in order to provide optimal care and treatment. Furthermore, the availability and feasibility of rehabilitation centers and vocational training centers that have collaborated is also evaluated.

There are several parameters as indicators of success, namely the number of mentoring cases, the number of workers who return to work and the number of companies that are committed to support the RTW program which is an important factor in the successful implementation of the RTW program. As of 2020, there are 70,054 employers who are committed to support the RTW program and a total of 823 disability workers have returned to work. Another parameter that is also related to the application of Return to Work is brand equity as a measure of public perception of BPJS Ketenagakerjaan.

From 2015 to 2020, the numbers of companies that committed to support the RTW program has reached 70,054 companies, through assistance by 81 Work Accident/Occupational Diseases (KK-PAK) Case Managers, with the following evaluation results: 1. In 2015: 125 RTW participants, 21 returned to work. 2. In 2016: 304 RTW participants, 182 returned to work. 3. In 2017: 570 RTW participants, 452 returned to work. 4. In 2018: 683 RTW participants, 543 returned to work. 5. In 2019: 901 RTW participants, 758 returned to work. 6. September 2020: 969 RTW participants, 823 returned to work. The brand equity value of BPJS Ketenagakerjaan is increased where in 2014, before the implementation of RTW program, was 65.4, whereas since RTW program was implemented, it has increased synergistically to 82.9 in 2018. The case managers monitor disability workers who have returned to work for 3 months after re-employment by ensuring the company has provided supporting facilities for disabled workers, including installing holders in toilets, making ramps for wheelchairs, providing disabled parking spaces. The challenges are convincing companies that the disability workers are fit to return to work and encouraging companies to be willing to modify the workplaces according to the needs of disability workers.

Return to Work program aims to provide adequate protection for workers and their families, provide fast and precise handling of cases of work accidents or occupational diseases, reduce the level of disability from work accidents or occupational diseases, increase productivity by re-employing disability workers, participate in nation’s development, increase the standard of living of workers and reduce poverty, rehire trained workers so as to achieve cost efficiency and make them become inspiration and motivation for other workers. The RTW program is supported by collaboration with various parties and has been proven by statements of support and commitment from 70,054 companies that willing to accept disability workers to return to work. Collaboration with hospitals/clinics/health centers/practicing doctors together with rehabilitation centers and vocational training centers is also ongoing. As of 2020, a memorandum of understanding has been carried out with 1,535 hospitals, 1,292 clinics, 2,157 health centers, 45 joint practice doctors and 45 rehabilitation centers and vocational training centers. Hospitals during this pandemic, apart from being a trauma center in terms of treatment and care as well as a medical rehabilitation center, are also centers for enforcing cases of occupational diseases and Covid -19 is stated as occupational diseases for medical personnel.

The success of the RTW program is largely determined by the involvement of various interested parties. This requires good socialization and coordination of several stakeholders, namely: 1. The company that has committed to the implementation of the RTW program. They provide support for the success of the RTW program, also provide opportunities and guidance to workers undergoing the RTW program. The company also helps design/modify safe workplaces for disability workers so that it is possible to return to work as soon as possible, for example making a ramp for wheelchairs. 2. Work Accident Service Centers (Health Facilities & Medical Rehabilitation Centers) and Return to Work Service Centers (Vocational Training Centers) have very important roles in assisting the implementation of the RTW program. 3. The Work Accident/Occupational Diseases Case Managers make plans for disability workers, from the therapy plans according to the results of coordination with the treating doctor, rehabilitation process until re-employment. 4. The government issues laws and regulations that support disability persons and provides medical advisors and labor inspection staff. 5. Labor organizations/labor unions play a role as a supporting element in the workplace by supervising companies’ commitments and providing support from fellow workers.

RTW program should be implemented comprehensively, including promotive, preventive, curative and rehabilitative efforts. The medical first aid is given to injured workers during golden hour to reduce the death rate and the level of disability. Likewise, rehabilitative management optimize the return to function of injured or potentially disabled limbs and minimize the level of disability, so injured/disability workers can return to work. This certainly can restore the dignity of disability workers as human beings, so that they can contribute to the economy of the family, society and nation. The RTW Program is given Certificate of Excellence in Social Security Administration for RTW Program by ISSA in 2019. Benefits that can be obtained for workers participating in the RTW program: 1. Protection from the risk of work accidents/occupational diseases; 2. Unlimited treatment according to medical needs; 3. Compensation of unemployment wages (100% in the first 12 months and 50% thereafter); 4. Compensation for death due to work accidents is 48 times the nominal wages reported; 5. Educational scholarship for 2 children of participants who died or suffered permanent disabilities due to work accidents, a maximum of IDR 174 million; 6. Support to participants who experience work accidents or suffer occupational diseases, starting from participants entering hospital for treatment until they can return to work.