How Malinau Achieved Universal Health Coverage

Malinau Regency faces no small challenge in realising Universal Health Coverage. Its territory stretches to the Indonesia–Malaysia border, characterised by mountains, tropical rainforest and great rivers. Some villages can only be reached by river or air transport.

Bordering Malaysia directly, Malinau Regency must contend not only with difficult terrain but also with the challenge of ensuring all residents obtain health protection. Some communities live in villages separated by rivers and mountains, while others depend on subsistence farming for their livelihoods.

In areas far from urban centres, the cost of treatment is often the first consideration before someone decides to visit a health facility. When illness strikes, daily income often stops as well. Health issues in Malinau have therefore never been solely about hospitals or medical staff; there is a more delicate underlying problem, namely people’s ability to pay for healthcare.

That story, however, is slowly changing. In the waiting room of Long Loreh Community Health Centre (Puskesmas), a middle-aged man pulls a BPJS Kesehatan card from his worn wallet and hands it to the staff without much fuss. A few years ago, the situation might have been different. Before setting out for treatment, he would first have counted the money in his pocket, borrowed from relatives, or simply chosen to wait for the illness to get better on its own.

The change is thanks to a step taken by the Malinau Regency Government, which guarantees the payment of National Health Insurance (JKN) premiums through BPJS Kesehatan for residents who meet the stipulated criteria. This measure was taken amid geographic challenges as a border regency in North Kalimantan, and it has not always been easy fiscally. Through this policy, the regency government ensures that economic capacity is no longer a barrier preventing residents from obtaining healthcare.

The regency government’s commitment to guaranteeing access to healthcare is reflected in the rising trend of its health insurance budget each year. In 2024, the government allocated Rp 11.96 billion to fund residents’ participation in the National Health Insurance Programme. A year later, the allocation rose to Rp 13.96 billion, an increase of 16.73 per cent. The rise continued into 2026, with the budget reaching Rp 14.46 billion. Over two years, the total budget increase reached nearly Rp 2.5 billion, or 20.86 per cent, demonstrating the sustained commitment of the regional government to ensuring that residents, including those living in remote and border areas, continue to receive health financing protection through the National Health Insurance scheme.

The results are beginning to show. Malinau Regency has achieved Universal Health Coverage (UHC), the condition in which at least 98 per cent of the population is registered as a National Health Insurance participant. This achievement is not merely a number; behind it lies a shift in how communities view healthcare. People now come to health centres or hospitals confident that access to services is no longer determined by the contents of their wallets. With the regional government’s commitment to the JKN Programme, Malinau Regency won the Universal Health Coverage Main Category award in 2024 and 2026.

However, UHC is not the finish line of health development. High membership status does not automatically guarantee that people receive optimal services. The membership card is only the entry point. Beyond that, service quality, the availability of health workers and medicines, the referral system, and ease of access to health facilities determine whether the right can truly be enjoyed by the public.

Data on JKN membership coverage in Malinau Regency in 2025 shows that the regency successfully maintained its Universal Health Coverage status throughout the year. This is evident from membership coverage that consistently stayed above 100 per cent, ranging between 100.56 per cent and 102.75 per cent. Coverage above 100 per cent can occur because some residents are registered but not yet counted in the BPS population projections, or due to updates in BPJS membership data.

Meanwhile, the percentage of active participants fluctuated throughout the year. Although it stood above 92 per cent at the start of the year, it declined to its lowest point of 94.80 per cent in July, before rising again to 97.99 per cent in December.

Based on data on Universal Health Coverage and JKN Participant Activity in Malinau Regency for 2026, covering the January–July period, the regency government has been able to maintain its UHC achievement well.

The indicator that best reflects people’s real access to healthcare is the percentage of active participants. The data shows an upward trend in participant activity between January and July 2026. The percentage of active participants rose from 95.46 per cent in January to 96.44 per cent in July, despite a dip to 93.21 per cent in February. After that, participant activity rose gradually again, reaching 96.14 per cent in June and 96.44 per cent in July. This increase indicates that more and more participants hold active membership status and can access healthcare without administrative obstacles.

Even so, JKN membership removes the barrier of medical service costs but does not entirely eliminate geographic barriers. For this reason, the BPJS Kesehatan premium financing policy does not stand alone. The regional government complements it with various efforts to strengthen primary healthcare, improve the capacity of community health centres, refine the referral system, and even provide air referral transport financing for emergency patients from extremely remote areas. This combination of policies shows that health protection cannot be built on a single programme, but rather through a mutually reinforcing system.

The regional government’s decision to fund BPJS Kesehatan premiums also reflects a new perspective on public spending. The health budget is no longer positioned merely as routine expenditure, but as a social investment. When people receive healthcare earlier, the likelihood of complications can be suppressed, productivity rises, and the economic burden on families caused by illness can be reduced.

UHC is a commitment to ensuring that every resident can obtain quality healthcare without financial hardship. That commitment must be maintained through sustainable financing, quality services, and governance that adapts to people’s needs. For Malinau Regency, the policy of guaranteeing BPJS Kesehatan premium payments carries a meaning far broader than merely meeting a national target. In a region where much of the population lives far from service centres, health insurance provides the reassurance that illness is not synonymous with a cost burden that must be borne alone. The state is present from the start, even before a person enters the consultation room.

The success in achieving Universal Health Coverage shows that health development does not always have to begin with constructing new buildings. The regional government’s policy of protecting people from health financing risks has become the very foundation that enables healthcare to reach every layer of society.

Ultimately, the true measure of UHC’s success is not the membership percentage recorded in annual reports, but the reduction in residents who postpone treatment for financial reasons, the growing public trust in health facilities, and the firm belief that anyone, wherever they live, has an equal right to decent healthcare. In a border region such as Malinau, that is the true meaning of the state’s presence in the health sector.