Social Capital, Health Insurance, and Community Action: Toward Universal Health Coverage for Informal Workers

Background: This project developed an intervention study to enhance palm sugar farmer's knowledge and attitude regarding national health insurance program through a comprehensive and intensive health education and promotion, and also to increase the number of enrollment among such workers through "palm sugar saving" model. Method: The project had been conducted in the district of Banyumas, Central Java, Indonesia particularly in two sub-districts of Cilongok and Somagede. A quasi-experimental research with the mixed-methods approach by combining quantitative and qualitative studies had been employed. Results: The results showed that there was a significant improvement in knowledge and attitude of health insurance mechanism and benefits among palm sugar farmers after the intervention using several health promotion media such as a short movie, leaflet, and booklet. This intervention had been implemented through health cadre's involvement and participation. Moreover, the adoption of "palm sugar saving" innovation had shown a positive response and support from the workers as well as internal and external stakeholders such as Palm Sugar Cooperation, National health insurance (BPJS Kesehatan) branch office, and primary health care center. Conclusion: Cross-cutting strategy in health insurance program campaign among informal sector especially palm sugar farmers will make an adequate information dissemination. These study results can be extended to the other informal sector population for which universal health coverage is a policy option. Future research is needed to expand the work to explore the effectiveness of innovative intervention to increase National health insurance (BPJS Kesehatan) enrollment among the informal sector.