Situational Analysis of the Extending National Health Insurance Coverage to Informal Sector in Indonesia: A Case Study among Palms Sugar farmers

Background : To explore the situation of national health insurance coverage among informal workers and to identify the enrollment strategy for such workers. Method : This study used the descriptive qualitative method. Participants were eight palm sugar farmers and fi fteen stakeholders of national health insurance in the district of Banyumas, Indonesia. This study included a semi-structured informant interview and open-ended questions. A thematic framework analysis was applied to guide the interpretation of the data. Data analysis was facilitated by using MAXQDA 12 software. Results : This study highlighted several interesting issues regarding the efforts to extend health insurance coverage among palm sugar farmers. First, the nature of palm sugar cultivation possesses a higher risk of injury and work-associated diseases, including falls and seasonal diseases. Second, health insurance possession is crucial, but farmers face the problem of how to ensure the continuity of the premium payment amid the uncertainty of palm sugar business revenue. Third, multi-stakeholder initiatives, bringing together government, business, and civil society will solve coverage expansion challenges among these workers. Conclusion : This study suggests that extending health insurance coverage among informal workers needs various and innovative approaches by considering their characteristics to maintain a sustainable membership. This study identi fi es the important role of cross-cutting collaboration between the government with other stakeholders to assure informal workers ’ coverage under the national health insurance program. Further research is needed to explore alternative ways of maintaining the sustainability of health insurance membership.