The 'Madrasah of Empathy' in Healthcare Services during the Era of Universal Health Coverage
REPUBLIKA.CO.ID, By: Dr. dr. Merita Arini, MMR (Master’s Program in Hospital Administration, Faculty of Medicine and Health Sciences, University of Muhammadiyah Yogyakarta)
Ramadan is not just about abstaining from food and drink, but a ‘madrasah of empathy’. It cultivates sensitivity towards limitations and encourages support for the vulnerable. This value is relevant in understanding the dynamics of healthcare services, including the issue of deactivation of membership for recipients of the Jaminan Kesehatan Nasional (JKN) contribution assistance program (Penerima Bantuan Iuran/PBI).
When administrative issues affect patients with kidney failure who require routine hemodialysis, we are reminded that behind the system, there are lives that depend on the continuity of services.
Indonesia has achieved more than 95 percent JKN membership—a significant achievement towards Universal Health Coverage (UHC). However, UHC does not stop at administrative coverage. It encompasses three dimensions: population coverage, quality services, and financial protection. Justice is not measured by the number of cards, but by the equality of health outcomes between regions and social groups.
Inequality is still evident. In the Papua Mountains, geographical barriers and limited health workers have a negative impact on low coverage of complete basic immunizations, far below the national target. Programs are available, but distribution and the sustainability of implementation are challenges. Justice means the system’s ability to reach the most remote and most difficult areas.
In East Nusa Tenggara, the prevalence of stunting is still around 37 percent, far above the national average which has decreased to 19.8 percent. This issue is not just about the availability of food, but the nutritional quality of mothers, feeding practices, sanitation, and health literacy. Without changes in behavior and strengthening family knowledge, medical interventions are not optimal.
Gunungkidul shows another side. Access to delivery by health workers and antenatal visits has been high. However, the challenges have shifted to the quality of interventions, such as adherence to iron tablet consumption and prevention of Chronic Energy Deficiency in pregnant mothers. Inequality is not always visible in access, but in the depth of impact.
The paradox of UHC emerges when the system is administratively inclusive, but the impact is not entirely equitable. Ramadan teaches that justice is not uniformity, but proportional support for those most in need. Strengthening affirmative actions for areas with geographical barriers, distribution of health workers, utilization of telemedicine, and community-based services should be a sustainable strategy.
On the other hand, health justice is a collective project. Nutritional literacy, immunization, and therapy adherence require support from families and communities. Ramadan provides a social space—religious lectures, zakat (alms), and sadaqah (charity)—to convey health messages based on the values of trustworthiness and social responsibility.
If Ramadan is truly a ‘madrasah of empathy’, then the measure is the commitment to reduce inequality. UHC achieves its true meaning when broad coverage is followed by equitable impact—when those who are left behind are truly prioritized. Health service justice is not just a policy agenda, but a shared mandate.