Optimising Primary Care Deliveries: Midwives as Frontline Guardians of JKN Sustainability
In commemoration of National Midwife Day, the strengthening of maternal and child health services is being driven through collaboration between BPJS Kesehatan and midwives as a network of first-level health facilities (FKTP). Under the National Health Insurance (JKN) scheme, midwives play a vital role as the frontline for services ranging from pregnancy checks to deliveries, including in remote and hard-to-reach areas.
BPJS Kesehatan’s Head of Public Relations, Rizzky Anugerah, affirmed that partner midwives form the backbone of primary care. “Midwives as BPJS Kesehatan’s FKTP network have a significant role in strengthening primary services, from pregnancy checks to normal deliveries, including reaching remote areas,” he stated on Friday (19/06).
He explained that between 2021 and 2025, normal delivery services at FKTPs remained a mainstay, with 4.14 million cases and total financing of approximately IDR 3.19 trillion. However, the utilisation of delivery services in hospitals also remains considerably high. BPJS Kesehatan data shows that the number of caesarean deliveries has been consistently high in recent years.
“In 2021, approximately 1.04 million caesarean delivery cases were recorded, gradually increasing to 1.16 million in 2022, around 1.34 million in 2023, 1.35 million in 2024, and reaching approximately 1.40 million cases in 2025, with total financing over five years reaching more than IDR 36.2 trillion,” Rizzky detailed.
He added that this trend indicates that hospital utilisation remains high, particularly for caesarean procedures, although the increase is gradual. This is a concern in the push to optimise delivery services at the primary level.
Furthermore, the utilisation of delivery services in hospitals is also classified as high. Vaginal deliveries in hospitals reach hundreds of thousands of cases annually, while caesarean deliveries continue to dominate services at the referral level.
Observing this trend, Rizzky stressed the importance of strengthening the role of midwives as a solution. “The utilisation of hospital deliveries can actually be reduced by strengthening the role of midwives in primary care. If normal delivery cases can be handled optimally at FKTPs, referrals to hospitals can be more selective and based on medical indications,” he revealed.
He also added that a policy evaluation is needed going forward, including regarding service tariffs. “The rationalisation of tariffs, which will be evaluated by the Ministry of Health, is an important part of ensuring delivery services run more effectively and efficiently according to the level of service,” he continued.
According to Rizzky, the effective utilisation of delivery services will have a broad impact on the sustainability of the JKN Programme. “If the utilisation of delivery services is effective, meaning cases that can be resolved at the primary level do not need to be escalated to hospitals, this will indirectly strengthen the Social Security Fund (DJS) for Health and maintain the continuity of the JKN Programme in the future,” he asserted.
BPJS Kesehatan data up to 2026 also shows substantial service network support by midwives, with 8,698 network midwife practices and 159,873 midwives in cooperating health facilities.
Midwives as the Frontline for Continuous Care
The Chairperson of the Central Board of the Indonesian Midwives Association (IBI), Dr. Ade Jubaedah, asserted that midwives are the frontline of maternal health services. “There are around 600,000 registered midwives in Indonesia, and 400,000 are registered with IBI, with about 70% working in primary care. Midwives are the frontline and gatekeepers of JKN, because around 80% of maternal and child complaints first come to a midwife,” Ade explained on Thursday (18/06).
She added that midwives also provide continuity of care from adolescence, pre-marriage, pregnancy, to delivery and the postpartum period. This effort is crucial given the high rate of anaemia among Indonesian women, which is around 26% in adolescent girls and 48% in pregnant women.
“With optimal screening and early detection, normal deliveries can be increased and complications prevented, thereby reducing maternal and infant mortality rates,” she stated.
Cross-professional collaboration is also an essential part of ensuring safe deliveries. Midwives work together with general practitioners, obstetricians, and other health workers. “Going forward, strengthening primary care through midwives is expected to balance delivery trends, improve financing efficiency, and ensure the sustainability of the JKN Programme,” Ade said.
Amid the rising trend of caesarean deliveries, midwives continue to educate the public on the importance of normal delivery when conditions allow. An independent practising midwife conveyed that normal delivery has many advantages, from faster recovery to a lower risk of complications.
In the field, midwives also face the dynamics of community preferences. Midwife Dewi Pristie (34) from Temanggung Regency revealed that the choice of delivery method among mothers is currently quite diverse. “In this digital era, the tendency is fairly balanced. Many mothers strive for a normal delivery because they understand the benefits, but many also end up undergoing a caesarean delivery due to medical considerations and the safety of the mother and baby,” Dewi said on Friday (19/06).
According to Dewi, education is key to reducing mothers’ fear of normal delivery. She emphasised that the main advantage of a normal delivery is the faster recovery process. “Mothers after a normal delivery can usually mobilise immediately, sit, walk, and most importantly, can start Early Initiation of Breastfeeding (IMD) more comfortably,” she explained.