Evaluating The Impact of Health Card Program On Access To Reproductive Health Services: An Indonesian Experience

EVALUATING THE IMPACT OF HEALTH CARD PROGRAM
ON ACCESS TO REPRODUCTIVE HEALTH SERVICES:

AN INDONESIAN EXPERIENCE

ERLANGGA AGUSTINO LANDIYANTO

A THESIS SUBMITTED IN PARTIAL FULFILLMENT
OF THE RQUIREMENT FOR
THE DEGREE MASTER OF ART
(POPULATION AND REPRODUCTIVE HEALTH RESEARCH)
FACULTY OF GRADUATE STUDIES
MAHIDOL UNIVERSITY
2009

COPYRIGHT OF MAHIDOL UNIVERSITY
Thesis
Entitled


........................................................................
Mr. Erlangga Agustino Landiyanto
Candidate

........................................................................
Assoc. Prof. Yothin Sawangdee, Ph.D.
Major Advisor

........................................................................
Assoc. Prof. Bencha Yoddumnern-Attig, Ph.D.
Co-Advisor

............................................................
Prof. Banchong Mahaisavariya, MD.
Dean
Faculty of Graduate Studies

........................................................................
Asst. Prof. Panee Vong-Ek, Ph.D.
Chair
Master of Arts Program in Population and
Reproductive Health Research
Institute for Population and Social Research
Thesis
Entitled


was submitted to the Faculty of Graduate Studies, Mahidol University
for the degree of Master of Arts
(Population and Reproductive Health Research)
on
August 17, 2009

.........................................................................
Mr. Erlangga Agustino Landiyanto
Candidate

.........................................................................
Asst. Prof. Pimonpan Isarabhakdi, Ph.D.
Chair

.........................................................................
Assoc. Prof. Yothin Sawangdee, Ph.D.
Member

...................................................................
Asst. Prof. Ngamlamai Piolueang, Ph.D.
Member

.........................................................................
Assoc. Prof. Bencha Yoddumnern-Attig, Ph.D.
Member

...................................................................
Prof. Banchong Mahaisavariya, MD.
Dean
Faculty of Graduate Studies
Mahidol University

.........................................................................
Assoc. Prof. Sureeporn Punpuing, Ph.D.
Director
Institute for Population and Social Research
Mahidol University

ACKNOLEDGEMENTS

Thanks be to Allah SWT, after many trials and tribulations finally this thesis is
done. I am delighted to be supervised by Assoc. Prof. Yothin Sawangdee, Ph.D., my
major advisor and Assoc. Prof. Bencha Yoddumnern-Attig, Ph.D., my co-advisor who
give me a lot of constructive guidance and great helped me to complete this thesis. I
also say many thanks to my thesis examination chair Ass. Prof. Pimonpan Isarabhakdi,
Ph.D and my external examiner Ass. Prof. Ngamlamai Piolueng, Ph.D for their
valuable comments and suggestions.
I would like to express my gratitude to all Arjans of IPSR and guest lecturers
for their devoted and valuable teaching in their expertise fields as well as their
guidance. Special acknowledgement is really due for Ms. Luxana Nil-Ubol for her
endless efforts from the commencement to ending of this program. Thanks also for
Ajarn Tom Blair for his support to improve my English.
I am extremely thankful to the MEASURE Evaluation project, Carolina
Population Center, North Carolina University, USA for granting me this prestigious
fellowship which made me possible to carry out this program.
Its my pleasure to extend my heartiest appreciation to my classmates, Wali,
Sook, Ngia, Zula, Farid, Viroz, Gana, Son, Cuong, Tjip, Linda and Hoa. I am very
happy to study with all of you. I also thanks to M.A. Thai students and Ph.D. fellows
for making this study period enjoyable and memorable.
I am obliged to thank my parents, Dr.Landijo and Dra. Endang Sri Untari,
Apt, my lovely wife, Arie Ratna Agustien, my beloved son, Mifzal Hamizan
Landiyanto and my sister, Diandra Noverly, who sacrificed their love and support for
the period of my study at Mahidol.
Fac. of Grad. Studies, Mahidol Univ. M.A. (Pop. & Repro. H. Res.)/iv
EVALUATING THE IMPACT OF HEALTH CARD PROGRAM ON ACCESS TO

REPRODUCTIVE HEALTH SERVICES: AN INDONESIAN EXPERIENCE

ERLANGGA AGUSTINO LANDIYANTO 5138375 PRRH/M

MA (POPULATION AND REPRODUCTIVE HEALTH RESEARCH)

THESIS ADVISORS: YOTHIN SAWANGDEE, Ph.D., BENCHA YODDUMNERN-
ATTIG, Ph.D.

ABSTRACT:
Health card program aims to protect the poor in Indonesia during the Asian economic
crisis. Health cards were targeted and allocated exclusively to the poor that would
provide free access to public health services. The impact of health card program to
reproductive health services was rarely discussed by previous studies that pay more
attention on health card utilization for both inpatient and outpatient. Using Indonesian
family life survey data (IFLS) from RAND Corporation that was constructed as
balanced panel dataset, with consideration of sample selection bias, this study aims to
evaluate the impact of health card program during 1997-2000 Asian economic crisis
on access to reproductive health services and answer the question whether the poor
who had health card really have better access to reproductive health services.
Discussion in this thesis limit on antenatal care, place of delivery and contraceptive
use which are only reproductive health components that covered by health card
program. Using combination between descriptive analysis and multivariate analysis,
this study found that the health cards were not well targeted and distributed. Cross
tabulation results show that the health cards were not distributed to the poor only and
there are significant numbers of higher income households who received health cards.
The logistic regressions, comparison of six different levels modeling for each
outcomes variable, found that there is no significant effect of health card program,
which are detected through health card ownership and interaction, to access to
adequate antenatal care and delivery at public health facility. Additionally, the health
cards ownership have positive significant effect on utilization of modern contraceptive
although there is no interaction effect of health cards ownership and program
intervention periods to modern contraceptive use. Good targeting, monitoring and
evaluation system as well as social marketing and community are very important to
improve the effectiveness of the further social safety net program.

KEY WORDS: HEALTH CARD/ ANTENATAL CARE/ CONTRACEPTIVE/
PLACE OF DELIVERY

45 pp

CONTENTS

Page
ACKNOWLEDGEMENT
ABSTRACT iv
LIST OF TABLES vii
LIST OF FIGURES ix
LIST OF ABBREVATIONS x
CHAPTER I INTRODUCTION 1
1.1 Background of study 1
1.2 Statement of the problem and importance of the study 3
1.3 Research question 4
1.4 Research objectives 4
CHAPTER II LITERATURE REVIEW 5
2.1 Theoretical and empirical discussion 5
2.1.1 Economic crisis and reproductive health access 5
2.1.2 Protecting access to reproductive health services. 7
2.2 Social Safety Net-Health Card Program In Indonesia 8
2.2.1 Program Design 8
2.2.2 Distribution and Implementation 9
2.3 Previous study 10
2.4 M&E framework and research conceptual framework 11
CHAPTER III DATA AND METHODOLOGY 13
3.1 Data 13
3.2 Operational Definitions 13
3.3 Methods 18

Fac. of Grad. Studies, Mahidol Univ. M.A. (Pop. & Repro. H. Res.)/vi
CONTENTS (CONT.)
Page
CHAPTER IV RESULT AND DISCUSSION 19
4.1 Descriptive analysis of health card ownership and utilization 19
4.2 Multivariate analysis 23
4.2.1 The Impact of health card ownership on antenatal care 26
4.2.2. Impact of health card ownership to place delivery 31
4.2.3. Impact of health card ownership to contraceptive use 36

CHAPTER V CONCLUSION AND RECOMMENDATION 44
5.1 Conclusion 44
5.2 Discussion 45

BIBLIOGRAPHY 46

ANNEX 50

LIST OF TABLES

Page
Table 3.1 Dependent Variables 13
Table 3.2 Intervention Variables 14
Table 3.3 Control Variables 15
Table 4.1 Tabulation between wealth quintiles 20
and health card ownerships
and health card utilization for inpatients
and health card utilization for outpatients
Table 4.4 Tabulation between Health cards ownership 22
Table 4.5 Tabulation between health cards ownership 22
Table 4.6 Sampling Selection Bias Test for Each Data Set 24
Table 4.7 Sample characteristics of antenatal care dataset 27
Table 4.8 regression coefficients and standard errors from 29
multiple regression analysis of the impact of health card
ownership on antenatal care.
Table 4.9 Sample characteristics of place of delivery dataset 32
ownership on place delivery.
Table 4.11 Sample characteristics of place of contraceptive dataset 37

Fac. of Grad. Studies, Mahidol Univ. M.A. (Pop. & Repro. H. Res.)/viii
LIST OF TABLES (CONT.)
Page
ownership on utilization of modern contraceptive.
Table 4.14 Interaction effect between health cards Ownership 41
and year dummy

LIST OF FIGURES

Page
Figure 1.1 the Map of Indonesia 1
Figure 2.1 Effect the Economic Crisis to Reproductive Health Access 6
Figure 2.2 Monitoring and Evaluation Framework 11
Figure 2.3 Research Conceptual Framework 12
Figure 4.1 Interaction effect 42
Figure 4.2 Z-Statistics 43

LIST OF ABBREVATIONS

ie Interaction Effect
IFLS Indonesian Family Life Survey
Chi2 Chi Square
LR Likelihood Ratio
Std.dev Standard deviation
Min Minimum value
Max Maximum value

Fac. of Grad. Studies, Mahidol Univ. M.A. (Pop. & Repro. H. Res.)/1

CHAPTER 1
INTRODUCTION

1.1. Background of Study
The republic of Indonesia consists of approximately 17,000 islands. The
Indonesian archipelago located between Asia and Australia. Most of Indonesian areas
are covered by water. There are five major islands: Sumatra, J ava, Kalimantan,
Sulawesi and Papua. The remaining groups of island are Maluku (running from
Sulawesi to Papua) and Nusa Tenggara (running from Bali to Timor). The other
islands are small and mostly uninhabited. The large number of islands and dispersion
of them over wide areas have risen to be a diverse of culture and ethnic group which
mostly have their own language. This is basis of the national motto Bhineka Tunggal
Ika that means Unity in Diversity (BPS, 2003)

Figure 1.1 the Map of Indonesia

Source: United Nations, 2009
Erlangga Agustino Landiyanto Introduction/2
Administratively, Indonesia is divided into provinces. The numbers of
Indonesian provinces are 33. Each province subdivided as kota and kabupaten.
Altogether, there are 91 kota and 349 kabupaten. The next Indonesian lower
administrative unit is kecamatan and the lowest administrative unit is desa and
kelurahan. There are 5263 kecamatan, 7113 kelurahan and 62806 desa (Indonesian
Ministry of home affair, 2009).
Since independence in 1945, Although experienced several political shifts,
faced several political problems including the adoption of a multiparty system (which
resulted in political and economic instability) and rebellious uprisings caused by
ideological, ethnic, and racial differences, Indonesia was successful build national
identity and foundation of the nation during Old Order Government under President
Sukarno. The history of the Republic of Indonesia had a turning point after an aborted
coup by the Communist Party in September 1965. In 1966, President Suharto began a
new era with the establishment of the New Order Government, which was oriented
toward overall development (BPS, 2003).
After more than 30 years under the New Order Government, Indonesia has
made substantial progress, particularly in stabilizing political and economic
conditions. The stabilization and economic growth positively affected health
development in Indonesia. The community health centers reached rural area, wide
immunization coverage, successful of family planning program, substantial increase in
life expectancy and great progress in reducing infant mortality (World Bank, 2008;
AUSAID, 2002; BPS, 2003)
All of these successes ended in mid-1997 when the Asian economy collapsed.
The Indonesian economic crisis began in 1997 when the rupiah depreciated rapidly
and brought Indonesia into the economic crisis of 1998. The devaluation of the rupiah
increased levels of debt of private companies as well as increased operational cost
resulting in bankruptcies. These conditions stimulated a reduction in labor demand,
rising unemployment, and, indirectly, a loss of social security coverage. Prices of
goods and services increased greatly during the year, which decreased quality of life
the lower income population as well as pushed lower middle income population to be
below population line (Strauss et al, 2002; Frankenberg et al, 2002; Pritchett and
Suryahadi, 2002; Sparrow, 2006).
The crisis negatively affected the health sector from both supply and demand
sides. For the supply side, WHO (1998) and AUSAID (2002) reported that the
Indonesian provinces and district health offices experienced a reduction in operating
budgets, which resulted in a cut in the budget for preventive programs. According
water et al (2003) and AUSAID (2002), health services providers faced the increasing
in operation costs, extraordinary increasing in pharmaceutical and medical supplies
costs, and reduced supplies of modern health services. On the demand side, the
severity of the crisis affected households health care utilization and expenditures.
Frankenberg et al. (2002) and AUSAID (2002) found that household consumption was
going down in 1998, with decreasing investments in human capital (health and
education) as well as decreasing utilization of modern health care services.
In response to the crisis, there were a series of publication about social safety
net programs that were initiated or reconfigured in Indonesia. Some of programs were
designed to reach all population and some were targeted to reach the poor only
(Strauss, 2002). The health component of the Indonesian Social Safety Net program,
the health card program, was started in September 1998 and initiated to protect the
poor from the effects of the economic crisis through a targeted price subsidy and a
public spending component. The health cards entitled all household members to the
price subsidy at public health care providers. (Saadah et al, 2001; AUSAID, 2002;
Sparrow, 2006; Somanathan 2008)

1.2. Statement of the Problem and Importance of the Study
Most of previous studies on the impact health cards for protecting the poor
during Indonesian economic crisis focus on targeting of health cards distribution
(Lanjauw et al 2001; Pritchett and Suryahadi, 2002; Sparrow, 2006; and Sparrow,
2008) and utilization of health cards and its impact to outpatient (Saadah et al, 2001;
Sparrow, 2006; Saadah et al, 2007). Other studies focus on the impact of health cards
on childrens health care (Somanathan, 2008) and health care consumption (J ohar,
2007).
Protecting access to reproductive health services, especially those related to
maternal care and contraceptive, were some of the purposes of the health card
Erlangga Agustino Landiyanto Introduction/4
program. This issue was rarely discussed in previous Indonesia cases studies.
Therefore, this thesis focus on the impact of the health card program on access to
reproductive health services like contraception, pre-natal care and assistance at birth.
Base on discussion above, we can hypothesize the health cards were distributed
accurately to targeted beneficiaries and used it as purposes. We also expect that who
received health cards should have better access to reproductive health services.

1.3. Research Question
My thesis will focus on to answer the following question:
Did the poor who had health card really have better access to reproductive health
services? If so why? If not, Why not

1.4. Research Objectives
From the research questions, we can identify the research objective as follow:
General Research objective: Evaluating the impact of the health card program
on access to reproductive health services like access to contraception, pre-natal
care and assistance at birth.

Specific Research Objectives:
o Measure the performance of health cards targeting and distribution.
o Exploring the utilization of health card for reproductive health services.
o Evaluating whether the poor who have health card have better access to
reproductive health services or not.

1.5 Research Hypothesis
o Health cards were received by the poor only.
o Health cards utilized by the poor as intended.
o The poor who have health card have better access to reproductive
health services.

CHAPTER II
LITERATURE REVIEW

2.1. Theoretical and Empirical Discussion
2.1.1. Economic Crisis and Reproductive Health Access
According Water et al (2003) and Hotchkiss and J acobalis (1999), more than
half the pharmaceutical and raw materials of local drug manufactures were imported
from abroad. The depreciation of the rupiah directly increased the price of
pharmaceutical and medical supplies as well as the price of medical treatment at
Indonesian government health center.
The crisis decreased the purchasing power of households and access for health
services. Based on Indonesian National Socioeconomic Survey (Susenas) data, Water
et al (2003) found that households, particularly poorer households, who faced with
diminished purchasing power parity and allocated a smaller percentage of their total
budgets to heath related purposes. It decrease the proportion of households that
accessing care from a modern health care provider decreased. This decrease was
similar for males and females, which is occurred at all educational levels.
Health care utilizations also were affected by crisis. Strauss et al (2002) found
that during the economic crisis, health care utilization stayed nearly constant for
adults. For children, utilization of community health center (puskesmas) was
unchanged, but the use of integrated health post (posyandu) fell dramatically. Strauss
et al (2002) also have finding that consistent with the reduction in health services
utilization. According Strauss et al, (2002) service availability in posyandu and various
dimensions of service quality fell sharply by the end of this period.
The crisis also changed the demand pattern on health care provider for
accessing heath services. Achmad and Westley (1999) found that because of financial
constraints, young people were using the less-expensive government services or were
purchasing medications from pharmacies and treating themselves rather than using
Erlangga Agustino Landiyanto Literature Review/6
expensive private services. On the other hand, Frankenberg et al (1998) have different
findings. They found that users of health services were shifting away from the
community health center (Puskesmas) to private providers and traditional
practitioners.

Figure 2.1. Effect the Economic Crisis to Reproductive Health Access

Source: Adapted from Waters et al, 2003

An increase of the supply prices of health services affected to reproductive
health access. According Frankenberg et al, (2003), based on wealth status, women in
poorer households were considerably less likely to obtain their contraceptive pills from
government or private sources (relative to community health posts) than women from
wealthier households. Actually, it is happened because poorer household have lower
purchasing power than wealthier household. Under budget constraint, poorer
household is more likely to pay more attention on primary needs.
The price increase is also shift the demand of contraceptive. Frankenberg et al
(2003), Achmad and Westley (1999) and Straus et al (2002) that women switch the
sources of contraceptive to the cheaper providers. It is related with maximization of
utility under budget constraint on economic theory.
Related with relationship between contraceptive supply and utilization,
Frankenberg et al (2003), Achmad and Westley (1999) and Straus et al (2002) found
that family planning supplies at public providers declined over that period.
PrivateDebtIncrease
Bankruptcies
CapitalFlight/DecreaseForeignExchange
GovernmentDebtIncrease
PublicFinancingDecrease
Priceofreproductive
healthservices
increased
Unemployment
Decreasesocial
Protection
Decreasesupplyof
reproductivehealth
services
Decreasehousehold
purchasingpowerfor
accessing
reproductivehealth
services
Decreasereproductivehealthaccess
Fortunately, according the finding of Strauss et al (2002) and Frankenberg et al (1999),

the declined of contraceptives supply on public services provider did not affect a lot on
the change of contraceptive uses. It might happen because there is substitution effect
of contraceptive supply from public provider to private providers
The stability of contraceptive prevalence and unmet need in the face of
dramatic changes in both the economic and service environments indicates that
Indonesia couples have strong demand for family planning services because of their
fertility plans and preferences for small families.
The comparison between Indonesian demographic health survey (IDHS) 1997
data with 2003 show that there was a slightly increasing in antenatal care provided by
a nurse, midwife, or village midwife and a decreased in the percentage of women who
received no antenatal care (BPS 2003). Indonesian demographic health survey data
(IDHS) also show that the percentage of deliveries in a health facility (40 percent) was
substantially higher than that reported in the 1997 IDHS (21 percent) (BPS, 2003). But
the result might be bias because there is different classification about health facility in
both dataset. The data also dont able to show the impact of the economic crisis to
antennal care and place delivery.

2.1.2. Protecting Access to Reproductive Health Services.
In broad terms, any health care financing system has three goals: protect
consumers against the financial risk of health expenditures; promote efficient and
effective health care services; and to be fair to consumers and providers (Ellis and
McGuire, 1993). Price subsidy is one kind of effective health care financing to protect
the poor for accessing reproductive health services (Bhatia et al, 2006). There are two
alternative to provide subsidies to the poor, demand side or supply side subsidies (Ellis
and McGuire, 1993).
Base on explanation from Bhatia et al (2006) about supply side subsidy, can be
defined that Supply side subsidy for reproductive health access is providing support on
input (pharmaceutical and medical supply), capital and operational cost of health care
provider to decrease the prices of reproductive health services that will let the poor
access the services. Bhatia et al (2006) and Ellis and McGuire (1993) mentioned that
supply side intervention has limitation in efficiency and equality. A lot of funds need
to be secured to provide subsidy to all providers. Subsidy also will be received by who
dont need it.
Bhatia et al also stated that demand side subsidy is selective support to the poor
who actually need that for giving them access reproductive health services (Bhatia et
al, 2006). Usually demand side subsidy is supported by targeting approach to indentify
those should be got subsidy and reduced misallocation of subsidy (Lanjouw et al,
2001).
According to Saadah et al (2001; 2007) and Sparrow (2008), targeted prices
subsidies for outpatient medical care are often considered as effective way to increase
access of the poor on medical care under governments budget constraints during the
crisis. Price subsidies from demand side which apply only to the poor are promoted as
a cost effective way of ensuring access to reproductive health services for the poor
within economic countdown than supply side interventions.

2.2. Social Safety Net-Health Card Program In Indonesia
2.2.1. Program Design
The health component of the Indonesian Social Safety Net program (J PS-BK),
health cards program, was designed to prevent the decline of health and nutritional
statusasaresultoftheeconomiccrisis.Thecommunityhealthcenters(Puskesmas)and
the village midwives are the key actors of the program. The health card program was
designed to allow poor households to obtain at least basic health care services. As
demand side intervention, the health card provides access to health services to the
program beneficiaries by the use of a health card (Strauss et al, 2002; Sparrow, 2006).
Health cards are distributed at the household-level and entitled the owner and
family members to get free services at public healthcare providers. J PS-BK also
provides funds to health services providers like community health center and to
specially chosen village midwives to improve local health services and supporting
health cards program for ensuring the providers have resources to provide services to
health cards owner. Service providers got compensation for the additional workload
by a lump sum transfers that based on the number of Health cards allocated to the
district (Strauss et al, 2002; Sparrow, 2006).
According Saadah et al (2001) Strauss et al (2002) Sparrow (2006), the types

of services covered by the health card include:
a) Basic health services, medical attention as first treatment or referrals, family
planning services, immunization and other basic health services.
b) Basic maternal health care and referrals for pregnant mother, delivery care,
post and neo-natal natal care.
c) Nutritional improvement through food supplementation to undernourished poor
families. The target recipients of the services are children aged 6-59 months,
pregnant mothers, and post partum women from poor families who are
undernourished.
d) Eradication of communicable diseases such as malaria, tuberculosis and
diseases that could be prevented through immunization. The target recipients of
the services are persons infected by the diseases and for immunization the
target are children age less than 12 months, pregnant women, primary school
children, women of reproductive age and persons who are getting married.
e) Revitalization of Posyandu (integrated health post), a health post improvement
program to prevent negative effects of the crisis on the nutrition and health
status of mothers and young children.

2.2.2. Distribution and Implementation
The health card program followed a partly decentralized targeting process,
involving both geographic targeting at district level and community based individual
targeting at village level. Households that were categorized as vulnerable to economic
shocks were targeted to receive health cards. (Saadah et al, 2001; Sparrow, 2006)
The amount of subsidy for public health care providers to be distributed across
districts and number of health cards to be issued base on National Family Planning
Coordinator Agency (BKKBN) headcounts per-district. The headcount was calculated
based on the survey data to investigated number of poor. . (Saadah et al, 2001;
Sparrow, 2006)
At the district level committees were formed to deal with the allocation of
funds to the health clinics, community health center (Puskesmas) and village
midwives. The district committees were also responsible to allocate health cards and
BKKBNs poverty measurement criteria guidelines to villages where the village
leaders headed village allocation committees (Saadah 2001; Sparrow, 2006).
The poverty measurement criterias of BKKBN to identify targeted households
is called prosperity measurement status (Sparrow, 2006) that identifies the poor
based on who meet with one of the following criteria (Strauss, 2002; Sparrow, 2006),
such as:
Unable to have 2 meals a day
Unable to afford health services
The head of the household lost his job due to retrenchment
Households with school age children drops out due to the crises
The village committees (consisting of village staff, family planning workers,
village midwives, and community activists) distributed to the villagers base on the
BKKBNs poverty criteria above. The identified poor households are given health
cards signed by the head of the community health post (Posyandu) and the head of the
village. This card is valid for one year and can be extended as long as the households
meet those criteria (Strauss, 2002; Sparrow, 2006)

2.3. Previous Study
Studies that were conducted by Saadah et al (2007), Sparrow (2006), J ohar
(2007) in Indonesia found that there is weak link between delivery services to health
card owners and financial compensation. Their studies not also found weak link
between health card ownership and utilization. The poor benefited only from the
program if they received a health card, as the results indicate that they did not benefit
from the supply impulse (Sparrow, 2006).
From targeting and distribution perspectives, it was found that the poor have
higher probability to get health cards (Saadah et al, 2001, 2007; Sparrow, 2006, 2008),
but considerable numbers of Health Cards move to richer quintile (Sparrow, 2006,
2008). And unfortunately, some health card owners did not use their health card when
obtaining care from public service providers (Sparrow, 2006, Fadiah et al 2001, 2007)
Additionally, Sparrow (2006) and Saadah et al (2001; 2007) there are large
substitution effects away from the private sector to the public sector, with a net
increase in the overall use of outpatient medical services because of the health cards
intervention. Opposite with Sparrow (2006) and Fadiah et al (2001, 2007),
Somanathan (2008) found that there is no significant impact on use of private sector
services, especially children care case.
In children case, the use of public sector outpatient services declined less for
children with health cards (Somanathan 2008). The protective effect of the health card
on public sector use was concentrated among children aged 0-5 (Somanathan 2008).

2.4. M&E Framework and Research Conceptual Framework
Because this thesis is a evaluation research, the monitoring and evaluation
framework of the health card program (figure 2.2) is designed in order to develop
research conceptual framework for this thesis. There are four components of
monitoring and evaluation frameworks. First is programs input and process that
provide summary of program activities (more detail information about health card
program can be found at chapter 2.2), second is programs output, third is programs
outcomes and fourth is programs goal.

Figure 2.2. Monitoring and Evaluation Framework
Programs Input
and Process
Programs Output Programs
Outcome
Programs Goal

1.Established
districtslevel
committeeand
allocatedfundat
districtslevel.
2.Districtlevel
committee
allocatedfundto
healthcare
providerand
distributehealth
cardtovillage
committee.
3.Thecommittee
distributedthe
cardsbasedon
thecriteria
HealthCard
arereceived/
ownedbythe
poor
HealthCardare
utilizedbythe
poor(Inpatients
andOutpatients)
ThePoorwho
havehealth
cardhave
betteraccess
toreproductive
healthservices
BKKBN
Poverty
Criteria
InfluencingFactors:
EconomicFactors
Sociodemographic
Factors
Unobservable
Factor
On the figure 2.2 can be seen that this thesis focus on evaluating whether the
health card program achieve the goal for improving access to reproductive health
services or not. This thesis is also investigating the program output (health card
targeting and distribution) and the program outcomes (health card utilization) as well
as the effect of the program output and program impact for achieving the program goal
controlling by some independent variables.

Figure 2.3. Research Conceptual Framework

Figure 2.3, research conceptual framework, shows the hypothetical relationship
between dependent variables (program goal), program variables (program outcomes
and program output) and independent variables.
Dependent Variables
Antenatal Care
Place for delivery
Using modern
contraceptives
Independent Variables
Health Card
Ownerships
Year Dummy
Interaction Variables
between health card
ownership and year
dummy
Control Variables
a. Socio-demographic Variables
Number of Household Members
Highest Grade Completed by head
of households
Highest Grade Completed by
spouse of head of households
b. Health facilities knowledge
c. Economic Variables
Drinking water sources
Sanitation
Economic Variables
House ownership status
Have Television

CHAPTER III
DATA AND METHODOLOGY

3.1. Data
The major data source for this thesis is Indonesian Family Life Survey (IFLS)
from RAND Corporation in Santa Monica, USA. The data is longitudinal survey data
at household and community level. In this thesis, data at the household level is used
because this thesis focuses on analysis from side. To investigate the impact of the
health card, IFLS second wave (1997) is used as baseline data before intervention and
IFLS third wave (2000) is used as post-intervention year. The sample size of IFLS
second wave is 7619 Households and IFLS third wave is 10435 Households. For
multivariate analysis, panel data are constructed from the longitudinal data.
For analysis, there are four versions of datasets with different unit of analysis.
First is data set for descriptive analysis. The data is raw data set for univariate and
bivariate analysis. The first data set is exclusively work on IFLS third wave (2000).
The unit analysis of first data set is households. Second data set is panel data for
indentifying the effect of independent variables and control variables to antenatal care.
The second data set work on IFLS second wave (1997) and third wave (2000). The
unit analysis of third data set is women who had pregnancy three years prior second
wave (1995-1997) and three years prior third wave (1998-2000). Third is panel data
set for indentifying the effect of independent variables and control variables to place
delivery at public health facility or the others. The third data set work on IFLS second
wave (1997) and third wave (2000). The unit analysis of third data set is women who
deliver their baby three years prior second wave (1995-1997) and three years prior
third wave (1998-2000). The fourth is panel data set for indentifying the effect of
independent variables and control variables to utilization modern contraceptives. The
fourth data set work on IFLS second wave (1997) and third wave (2000). The unit
Erlangga Agustino Landiyanto Data and Methodology/14
analysis of fourth data set is married women more than 15 years old during the second
wave.
3.2. Operational Definition
To investigate the impact of health card program, we classify variables as
three. First are dependent variables, second are intervention variables and third are
independent variables

Table 3.1 Dependent Variables
Dependent
Variables
Description Level of Measurement
and Data
Management
Prenatal Care This variable identifies women
who get adequate prenatal care.
According Indonesian Bureau of
Statistics (BPS, 2003), adequate
prenatal care means that women
receive minimum four times of
prenatal care during pregnancy
which are one time prenatal in
first three month, one time
prenatal care in second three
month and two times prenatal
care in third three month. Total
prenatal care is calculated from
summation of prenatal care at
first three month, second three
month and third three month.
Nominal
1=at least one time or
more for each three
month during
pregnancy
0=less than three
Delivery Place This variable identifies whether
the women gave a birth at public
facility or at other facility. The
emphasis of this study is to
women give a birth at public
facility because the health card
provides access for the poor to
get free access for birth in public
facilities. Therefore, who give a
birth at public facility are denoted
as 1 and who give a birth at
private facility or at home are
denoted as 0
Nominal
1 =Public Facility
0= Private Facility or at
Home
Currently control
pregnancy using
modern
contraceptives
This variable investigates women
who are currently controlling for
pregnancy. The attributes were
classified as arent controlling
Nominal
1=Use modern
contraceptives for
control pregnancy
pregnancy, use traditional

methods and use modern
contraceptives. The emphasis of
this study is to women who are
controlling pregnancy using
modern contraceptives, therefore,
women who use modern
contraceptives for control
pregnancy are denoted as 1 and
women who use traditional
methods or dont control
pregnancy are denoted as 0
0=Use traditional
Methods or dont
control pregnancy
Table 3.2 Intervention Variables

Intervention
Variables
and Data
Management
Health Card
Ownerships
This variable is for assessing
whether the households own
health card or not. Who have or
received health card are denoted
as 1 and who dont have health
card are denoted as 0
Nominal
1=Yes
0=No
Year Dummy This variable emphasizes post
health card interventions. Base on
the data set, post intervention is
data of 2000 that denoted as 1 and
pre intervention is data of 1997
that denoted with 0
Nominal
1=2000
0=1997
Interaction
Variable
This variable is shows interaction
between Health card ownership
and year dummy to assess
program effect.
Nominal
1=Get intervention at
2000
0=No
Table 3.3 Control Variables

Independent
Variables
and Data
Management
Health facilities knowledge variables
Know where is
public hospital
This variable assesses whether the
respondents know that public
hospital available and know how
to reach or not.
Nominal
1=Know
0=dont know
Know where is
private hospital
respondents know where private
hospital available and know how
to reach or not.
Nominal
1=Know
0=dont know
Know where is
Puskesmas/Pustu
(public/ auxiliary
health center)
respondents know where
puskesmas/ pustu (public/
auxiliary health center) available
and know how to reach or not.
Nominal
1=Know
0=dont know
Know where is
private clinic
respondents know that private
clinic available and know how to
reach or not.
Nominal
1=Know
0=dont know
Know where is
private physician
respondents know where private
physician available and know
how to reach or not.
Nominal
1=Know
0=dont know
Know where is
midwife
respondents know where midwife
available and know how to reach
or not.
Nominal
1=Know
0=dont know
Know where is
nurse
respondents know where nurse
or not.
Nominal
1=Know
0=dont know
Know where is
traditional birth
attendant
traditional birth attendant
or not.
Nominal
1=Know
0=dont know
Know where is
traditional
practitioners
traditional practitioners available
and know how to reach or not.
Nominal
1=Know
0=dont know
Know where is
pharmacy
pharmacy available and know
how to reach or not.
Nominal
1=Know
0=dont know
Know where is
posyandu
(Integrated health
post)
posyandu (Integrated health post)
or not.
Nominal
1=Know
0=dont know
Socio-demographic variables
Number of
Household
Members
This variable measures number of
household member according
household definition. According
Ratio

Indonesian central bureau of

statistics, households means who
living in one place together and
use one kitchen
Highest Grade
Completed by head
of households
This variable refers highest
formal school attended head of
household. In Indonesia, basic
education is nine years education
(graduate from junior high school
of equivalent).
Nominal
1=have minimum basic
education
0=not achieve basic
education

Highest Grade
Completed by
spouse of head of
households
This variable refers highest
formal school attended by spouse
of head of household or oldest
family member for female head
of household. In Indonesia, basic
education is nine years education
(graduate from junior high school
of equivalent).
Nominal
1=have minimum basic
education
0=not achieve basic
education

Economic Variables
Using electricity Using electricity is one of proxy
indicators for measuring poverty.
Nominal
1=Using electricity
0=Not using electricity
Have television Using electricity is one of proxy
indicators for measuring poverty.
Having television also related
with information access.
Nominal
1=Have television
0=dont have television
Drinking water
sources
Improved drinking water sources
classification follow the United
Nations standards (United
Nations, 2003) which classifies as
household connection, public
standpipe, borehole, protected
dug well, protected spring and
rainwater collection. The variable
focus on improve water sources,
therefore the household who have
access to improve water sources
denoted as 1 and who have un-
improved water sources denoted
as 0
Nominal
1=Improved water
sources
0=Not Improved water
sources
Sanitation According United Nations (2003),
facilities such as sewers or septic
tanks, poor-flush latrines and
simple pit or ventilated improved
pit latrines can be categorized as
improved sanitation. The variable
Nominal
1=Improved Sanitation
0=Not Improved
Sanitation
focus on improve water sources,
therefore the household who have
access to improve sanitation
denoted as 1 and who have un-
improved water sources denoted
as 0
House ownership
status
This variable assesses house
ownership of respondent.
Households who own house are
denoted as 1 and households who
dont have house are denoted as
0.
Nominal
1=Self Owned
0=Others

3.3. Methods
Two methods of analysis we employed in this study. Fist, descriptive statistics
described the individual and households characteristics, the descriptive statistics
cover univariate and bivariate analysis. Second, Inference statistics cover bivariate and
multivariate analaysis.
The multivariate analysis focuses on examining the effect of intervention and
independent variables on dependent variables. The major approach for multivariate
analysis in this thesis is identifying difference-in-difference estimator.

CHAPTER IV
RESULT AND DISCUSSION

This chapter presents the interpretation and discussion from data analysis. Part
three is divided as two parts: 4.1 provide descriptive analysis of health card ownership
and utilization and 4.2 provide multivariate analysis of the impact of health card
ownership to antenatal care, place delivery and modern contraceptive.

4.1. Descriptive analysis of health card ownership and utilization
As discussed on chapter two, the health card program followed a semi
decentralized targeting process. Households that were categorized as vulnerable to
economic shocks were targeted to receive health cards. It means health card allocated
for the poor households to protect them from the effect of crisis (Saadah et al, 2001;
Sparrow, 2006).
Additionally, chapter two also mentions that health cards program is household
level intervention, which is targeted intervention for the poor households. Therefore,
this section focuses on post intervention analysis using Indonesian family life survey
data 2000 for evaluating the accuracy of targeting and allocation of health card
program. Based on the target recipient is household, the unit of analysis of this section
is also households.
Wealth quintiles are used to identify the poor and non poor households. The
poorest and second poorest quintiles are categorized as poor households, the rest
quintiles are non poor or wealthier households. Wealth quintile in this study was
constructed from economic variables such as using electricity, have television, own
house, access to improve water, access to improve sanitation, asset and expenditure.
Those variables were combined using principal component analysis.

Table 4.1 Tabulation between wealth quintiles
Erlangga Agustino Landiyanto Result and Discussion/20
and health card ownerships
Total
0.No 1.Yes
Poorest N 2159 272 2431
% 88.81 11.19 100
Second N 2011 420 2431
% 82.72 17.28 100
Middle N 1996 434 2430
% 82.14 17.86 100
Fourth N 2022 409 2431
% 83.18 16.82 100
Richest N 2075 356 2431
% 85.36 14.64 100
Total N 10263 1891 12154
% 84.44 15.56 100
WealthIndex
Quintiles
hhshavekartusehat
ChiSquare:Significantat0.001
Table 4.1 shows that only 11% of the poorest and 17% of second poorest got
the health cards. On the other hand, the table also shows mis-targeting that there is
significant part of health cards were distributed inaccurately to wealthier quintiles. The
mis-targeting might be happen in local level when head of village that have rights to
select who should receive health cards, gave health cards to head of villages relatives
or friends.

Total
0.No 1.Yes
Poorest N 25 10 35
% 71.43 28.57 100
Second N 56 6 62
% 90.32 9.68 100
Middle N 72 3 75
% 96 4 100
Fourth N 128 1 129
% 99.22 0.78 100
Richest N 188 0 188
% 100 0 100
Total N 469 20 489
% 95.91 4.09 100
WealthIndex
Quintiles
UseHCforInpatient
Table 4.2 shows that only 28% of the poorest and 9% of the second poorest
households who have inpatients use health cards to get subsidy. Additionally, there are
some wealthier households, who dont have rights to use health cards, use health cards
for inpatients.

Total
0.No 1.Yes
Poorest N 288 24 312
% 92.31 7.69 100
Second N 368 28 396
% 92.93 7.07 100
Middle N 442 16 458
% 96.51 3.49 100
Fourth N 494 20 514
% 96.11 3.89 100
Richest N 594 3 597
% 99.50 0.50 100
Total N 2186 91 2277
% 96.00 4.00 100
WealthIndex
Quintiles
UseHCforOutpatient
Chisquare:significantat0.01
Table 4.3 shows that about 8% of the poorest and 7% of the second poorest
households who have outpatients use health cards to get free services. Additionally,
can be seen there are some wealthier households, who dont have rights to use health
cards, use health cards for outpatient.
The mis-utilizations show that there is no good verification system on health
services providers, when the providers allow who have health card get the free
inpatient services even they are not the poor. Even if the program was designed very
well, the mis-targeting and mis-utilization will reduce the program effectiveness. The
impact of the program to the target beneficiaries will be very low or even not
significant without strong targeting.
To improve the effectiveness of the health card program, an appropriate
monitoring and evaluation system are very important. The system should be designed
well and supported with strong targeting process. It will be better to allocate more
budget and resources on targeting, monitoring and evaluation rather than implement
ineffective program with low impact.
Table 4.4 Tabulation between Health cards ownership
Total
0.No 1.Yes
0.No N 398 4 402
% 99.00 1.00 100.00
1.Yes N 71 16 87
% 81.61 18.39 100.00
Total N 469 20 489
% 95.91 4.09 100.00
Havehealthcard
UseHCforintpatient
From table 4.4 can be seen that only 18% from health card owner households,
those have family member who got in the last four week before survey, used health
cards for get free inpatient. It shows low utilization of health cards among the cards
owner. Additionally, there are some non health card owner households able to use
health card for inpatients. This is other kind of mis-utilization while someone who
borrow or take health cards from other households are successfully got inpatient
subsidy.

Table 4.5 Tabulation between health cards ownership
Total
0.No 1.Yes
0.No N 1839 23 1862
% 98.76 1.24 100.00
1.Yes N 347 68 415
% 83.61 16.39 100.00
Total N 2186 91 2277
% 96.00 4.00 100.00
Havehealthcard
UseHCforoutpatient
From table 4.5 can be seen that only 16% from health card owner households,
who had family member who had outpatient during the last twelve months before
survey, used health cards for outpatient. Additionally, there were some non health card
owner households able to use health card for outpatients. It might happen when
someone who borrowed health cards from other households were successfully got
inpatient subsidy because of low verification system.
Low utilization of the health cards is an interesting finding. Who had health
card, should be who had limited funding for access health services especially during
economic crisis. The health card owner did not use their health cards for accessing
health services because they might dont know how to use it, or might the health care
provider not allow him to use health card to get free access.
Demand side program without participation will be not effective. In this case,
health card only useful for who have and utilize them. Low utilization of the health
card means only small number of beneficiaries get benefit for the program. For future
intervention, social marketing and appropriate communication are very important to
improve the utilization and increase the programs effectiveness
4.2. Multivariate analysis

Difference in difference approach is one of effective way reducing selection
bias (Ravallion, 2001, 2008; Wooldridge, 2005). Wooldridge (2005), mention that the
calculation of difference in difference estimator requires panel data. Panel dataset
constructed from longitudinal dataset. According Yoddumnern-Attig et al (2009), the
longitudinal data is effective for investigate the impact of treatment effect, but
sometime an attrition bias can be occur if there is lost follow up cases or new entry.
To construct panel dataset and reduce the bias, the new entries is taken out
from 2000 data and take the drop out cases out from 1997 data and merging both
dataset to create panel dataset for the multivariate analysis. But, before dropped the
cases out, the diagnosis using logistic regression was conducted to test whether the
dropping case will change the characteristics of observation or not. The dependent
variable of logistic regression is category of matched household or not. The
independent variables are all variables that will be observed.
Table 4.6 shows the result of sampling selection bias test from each dataset.
Only five variables from twenty three variables of antenatal care dataset and only three
from twenty three variables of place delivery dataset those are statistically significant.
Additionally only eight from twenty three variables of contraceptives dataset those are
statistically significant. Because it is only small number of independent variables from
the dataset which are significant, dropping the cases are allowed for creates the panel
dataset.
Table 4.6 Sampling Selection Bias Test for Each Data Set
Antenatal Care
Dataset Coeficient
Place Delivery
Dataset Coeficient
Contraceptive
Dataset Coeficient
(Standard Error) (Standard Error) (Standard Error)
AntenatalCare -0.5150***
(0.1209)
Placedelivery 0.2205
(0.1954)
Contraceptives 0.1189*
(0.0564)
health card ownership 0.0112 0.0649 0.2214
(0.2555) (0.2846) (0.1579)
year dummy -0.3253* -0.3306 -0.7109***
(0.1472) (0.1615) (0.0740)
Interaction variable 0.3238 0.2597 -0.0982
(0.3183) (0.3527) (0.1814)
know where is public hospital. 0.2857* 0.2508 0.0221
(0.1370) (0.1517) (0.0720)
know where is private hospital -0.1562 -0.2466 0.0196
(0.1404) (0.1585) (0.0695)
know where is public/ auxiliary health center 0.0488 0.1745 0.2610*
(0.2362) (0.2682) (0.1105)
know where is private clinic -0.2489 -0.2313 -0.0173
(0.1915) (0.2258) (0.0811)
know where is private physician -0.0350 -0.0339 0.0467
(0.1321) (0.1470) (0.0664)
know where is midwife -0.0917 -0.2139 0.0940
(0.1400) (0.1549) (0.0680)
know where is nurse -0.1617 -0.1407 0.0118
(0.1235) (0.1366) (0.0607)
know where is traditional birth attendant 0.1604 0.2939 0.0359
(0.1399) (0.1606) (0.0664)
know where is traditional practicioner 0.0855 0.0209 0.0543
(0.1240) (0.1383) (0.0641)
know where is pharmacy -0.1055 -0.0912 -0.1442*
(0.1401) (0.1553) (0.0731)
know where is posyandu 0.1148 0.0341 0.1158
(0.1688) (0.1873) (0.0752)
household size 0.0759*** 0.1250*** -0.0027
(0.0212) (0.0235) (0.0120)
highest education hhh -0.0250 0.1029 -0.2620***
(-0.0250) (0.2058) (0.0817)
highest education shh 0.0830 -0.1028 -0.4488***
(0.2022) (0.2289) (0.0872)
house ownership -0.3867** -0.3513* 0.4389***
(0.1485) (0.1714) (0.0735)
using electricity -0.0393 -0.1802 -0.0781
(0.1776) (0.1690) (0.0994)
have television -0.1756 -0.3047* 0.2693***
(0.1347) (0.1476) (0.0690)
improve water source -0.0217 -0.2093 0.0198
(0.1249) (0.1384) (0.0629)
improve sanitation -0.1864 -0.3366 -0.0545
(0.1277) (0.1414) (0.0629)
constant -1.0409** -1.6505*** 0.9625***
(0.3442) (0.3821) (0.1697)
Log Likelihood -1005.1163 -832.83411 -4010.3015
N 2042 1869 8104
LR Chi2 62.46 76.78 432.93
Prob>Chi2 0.0000 0.0000 0.0000
Pseudo R2 0.0301 0.0441 0.0512

*=Significantat0.05;**=Significantat0.01;***=Significantat0.001
According Angrist and Pischke (2008), after we have panel dataset, we can
identify the impact of the health card program with the simple difference-in-difference
approach on equation (1).

I
xt
={E[DV|t=1,i=1]-E[DV|t=1,i=0]}-{E[DV|t=0,i=1]-E[DV|t=0,i=0]}(1)

Where:

I
xt
=Impact of the health card program on reproductive health services
DV =Dependent Variables
E[DV|t=1,i=1] =Access to reproductive health services (expected value of dependent
variables) of who got health cards (i=1) at time t=1(after project)
variables) of who did not get health cards (i=0) at time t=1 (after
project)
variables) of who will get health cards (i=1) at time t=0 (before
project)
variables) of who will not get health cards (i=0) at time t=0 (before
project)

The simple difference-in-difference in equation (10) is not able to address the
effect of independent variables. To include the effect of independent variable in
difference-in-difference estimation, we can use panel regression model as explained by
Angrist and Pischke (2008) on equation (2). Because the dependent variable is
dichotomous, we will use binary logistic regression for the model.

DV
xt
=+X
xt
+t
xt
+i
xt
+I
xt
(t*i)+e
0
.(2)

Where:
I
xt
=Impact of the health card program on reproductive health services
DV
xt
=Dependent variables
=Slope (Intercept)
=Coefficient of independent variables
X
xt
=control variables
=Coefficient of dummy time
t
xt
=dummy time
=Coefficient of dummy intervention
i
xt
=dummy intervention
t*i
xt
=Interaction variable

4.2.1. The Impact of health card ownership on antenatal care
Table 4.7 shows the descriptions of sample characteristics for each variable on
antenatal care dataset. The variables are classified as follow:
a. Dependent variables: antenatal care
b. Independent variables or control variables: health card ownership, year dummy
and interaction variable
c. Control variables (knowledge of health facilities): Know where is public
hospital, private hospital, public/ auxiliary health center, private clinic, private
physician, midwife, nurse, traditional birth attendant, traditional practitioner,
pharmacy and posyandu.
d. Control variables (economic): house ownership, using electricity, have
television, improve water sources and improve sanitation
e. Control variables (socio-demographic): household size, education of head of
household, education of spouse of head of household or eldest children (if head
of household are widowed).
The dataset is a panel dataset. Number of observation on the dataset is 440 that
consists two observation years of 210 women who were pregnant during 3 years of
observations (pregnant at 1995-1997 for 1997 and pregnant at 1998-2000 for 2000
data)

Table 4.7 Sample characteristics of antenatal care dataset

Variables N Mean Std. Dev. Min Max
1 Antenatal care 420 0.6190 0.4862 0 1
2 health card ownership 420 0.1786 0.3834 0 1
3 year dummy 420 0.5000 0.5006 0 1
4 Interaction variable 420 0.1238 0.3298 0 1
5 know where is public hospital. 420 0.6667 0.4720 0 1
6 know where is private hospital 420 0.3595 0.4804 0 1
7 know where is public/ auxiliary health center 420 0.9357 0.2456 0 1
8 know where is private clinic 420 0.1048 0.3066 0 1
9 know where is private physician 420 0.4143 0.4932 0 1
10 know where is midwife 420 0.7786 0.4157 0 1
11 know where is nurse 420 0.3357 0.4728 0 1
12 know where is traditional birth attendant 420 0.7119 0.4534 0 1
13 know where is traditional practicioner 420 0.3143 0.4648 0 1
14 know where is pharmacy 420 0.4881 0.5005 0 1
15 know where is posyandu 420 0.8524 0.3551 0 1
16 house ownership 420 0.8000 0.4005 0 1
17 using electricity 420 0.8405 0.3666 0 1
18 have television 420 0.5500 0.4981 0 1
19 improve water source 420 0.4524 0.4983 0 1
20 improve sanitation 420 0.4214 0.4944 0 1
21 household size 420 7.1167 2.5259 2 21
22 highest education hhh 420 0.2119 0.4091 0 1
23 highest education shh 420 0.1619 0.3688 0 1

To explore the impact of health card ownership on antenatal care, seven
models of multiple regressions are used. Each model has different purposes that can be
seen at the following explanation. Before started the logistic regression analysis, the
multicollinearity test is conducted to test whether there is correlation among
independent variables or not (Table 1 annex). With 0.5 as correlation cut off point, the
result shows that there is no multicollinearity among independent and control variables
that used in all models. The result of logistic regression of the following models can be
seen at table 4.8.
Model 1 is the simple regression that presents the real effect of having health
card on antennal care without controlling with knowledge of health facilities,
socio-demographic and economic context.
Model 2 is the multivariate regression that presents the combination effect of
having health card and program (before-after) periods on antennal care without
controlling with knowledge of health facilities, socio-demographic and
economic context.
having health card and program (before-after) periods on antennal care
controlling with knowledge of health facilities.
controlling with socio-demographic.
controlling with economic variables.
Model 6 is the full multivariate regression that presents the combination effect
of having health card and program (before-after) periods on antennal care
controlling with all knowledge of health facilities, socio-demographic and
economic variables.
Model 7 is selected multivariate regression model combination effect of having
health card and program (before-after) periods on antennal care controlling
with selected knowledge of health facilities, socio-demographic and economic
variables based on likelihood ratio test. Likelihood ratio test is conducted to
select control variables with highest explanatory power to the model. The
selected variables that pass likelihood ratio test were used on model 7 can be
seen on table 4 annex.

Table 4.8 regression coefficients and standard errors from multiple regression analysis
of The impact of health card ownership on antenatal care.
Model 1
Coeficient
Model 2
Coeficient
Model 3
Coeficient
Model 4
Coeficient
Model 5
Coeficient
Model 6
Coeficient
Model 7
Coeficient
(Standard
Error)
(Standard
Error)
(Standard
Error)
(Standard
Error)
(Standard
Error)
(Standard
Error)
(Standard
Error)
health card ownership -0.2324 -0.4496 -0.6261 -0.6010 -0.4128 -0.5927 -0.5497
(-0.2587) (0.4441) 0.4636 (0.4547) (0.4594) (0.4788) (0.4617)
year dummy -0.0190 -0.0992 -0.5205* -0.1990 -0.6494* -0.5157*
(0.2236) (0.2335) (0.2617) (0.2445) (0.2869) (0.2598)
Interaction variable 0.3214 0.4585 0.6937 0.3445 0.6180 0.6286
(0.5515) (0.5735) (0.5721) (0.5712) (0.5964) (0.5803)
know where is public hospital. 0.2895 0.1565
(0.2508) (0.2598)
know where is private hospital 0.3395 0.0443
(0.2669) (0.2758)
know where is public/ auxiliary health center -0.7587 -0.8675 -0.7374
(0.4712) (0.4817) (0.4666)
know where is private clinic -0.2258 -0.3486
(0.3621) (0.3812)
know where is private physician 0.0622 -0.0130
(0.2456) (0.2557)
know where is midwife 0.5431* 0.5888* 0.7458**
(0.2515) (0.2645) (0.2467)
know where is nurse 0.1100 0.0799
(0.2339) (0.2436)
know where is traditional birth attendant -0.0039 0.1634
(0.2537) (0.2683)
know where is traditional practicioner -0.1673 0.0519
(0.2356) (0.24889)
know where is pharmacy 0.4012 0.2594
(0.2555) (0.2687)
know where is posyandu 0.5494 0.4888
(0.3003) (0.3109)
household size 0.1328** 0.1429** 0.1404**
(0.0455) (0.0488) (0.0462)
highest education hhh 0.6896 0.4374 0.8667**
(0.3614) (0.3827) (0.2963)
highest education shh 0.2672 0.3801
(0.3991) (0.4259)
house ownership 0.2929 0.2207
0.2585 (0.2758)
using electricity 0.5194 0.3793
0.3034 (0.3294)
have television 0.2620 0.1177
0.2338 (0.2572)
improve water source 0.3223 0.2873
0.2208 (0.2427)
improve sanitation -0.2191 -0.1609
(0.2311) (0.2468)
constant 0.5279*** 0.5366*** 0.0497 -0.3383 -0.2385 -1.3268 -0.2671
0.1114 0.1515 0.5366 0.3222 0.3755 0.7053 0.5632
Log Likelihood -278.7017 -278.5184 -267.1242 -269.4201 -272.1993 -256.7999 -263.9404
N 420 420 420 420 420 420 420
LR Chi2 0.80 1.17 23.96 19.36 13.81 44.60 30.32
Prob>Chi2 0.3709 0.7609 0.0464 0.0036 0.0870 0.0030 0.0001
Pseudo R2 0.0014 0.0021 0.0429 0.0347 0.0247 0.0799 0.0543
Model 1 show that there is no direct effect of health card ownership on
antenatal care without controlling for other factors. The model is also not significant
that shown by prob>chi2 more than 0.05. No direct effect of health cards ownership to
antenatal care might be happen because low utilization of the health cards as discussed
on previous part in this chapter.
Model 2 show that there is no effect of health card ownership and dummy of
program interventions periods as well as there is no combination effect between health
card ownership and program duration on antenatal care without controlling for other
factors. The model is also not significant that shown by prob>chi2 more than 0.05.
card ownership and program duration on antenatal care controlling for knowledge of
health facilities. In this model, can be seen that knowledge of where is midwife have
significant effect on adequate antenatal care.
card ownership and program duration on antenatal care controlling for socio-
demographic variables. In this model can be seen household size have significant
factor of antenatal care.
card ownership and program duration on antenatal care controlling for economic
variables. Model 5 also shows that there is no effect of economic factor on antenatal
care.
Model 6 show that there is no effect of health card ownership as well as there
is no combination effect between health card ownership and program duration on
antenatal care controlling for all variables including knowledge of health facilities,
socio-demographic and economic variables. But there is significant effect of dummy
of program interventions periods (before and after). Consistent with model 3 and
model 4, there is positive effect of knowledge where is midwife and household size.
Model 7 show that there is no effect of health card ownership as well as there
is no combination effect between health card ownership and program duration on
antenatal care controlling for selected knowledge of health facilities variables, socio-
demographic variables and economic variables. Consistent with model 6, there is
significant effect of dummy of program interventions periods (before and after).
Consistent with model 3, model 4 and model 6, there is positive effect of knowledge
where is midwife and household size.
Result from all models show that there is no significant impact of health care
program on access to antenatal care. This result might came because low utilization of
utilization of health card for this purposes. Low utilization is one of key issues of this
study
The other possible answer is significant role of private provider like midwife
on providing antenatal care. This positive effect of knowledge where is midwife is
consistent with Pitoyo (2009) who found increase access for nurse, midwife and
paramedic during the crisis which might provide a cheaper cost or might provide better
services.
Midwife play significant role in Indonesian rural society especially since
implementation of Indonesian rural midwife program. Rule of midwife is not only on
providing health care services but also someone who is trusted by and has strong
position in communities. It also can be justified that midwife is one of major health
care provider for antenatal care.

4.2.2. Impact of health card ownership to place delivery
a. Dependent variables: place of delivery
consists two observation yeas of 165 women who deliver the baby during 3 years of
observations (deliver the baby at 1995-1997 for 1997 data and deliver the baby at
1998-2000 for 2000 data)

Table 4.9 Sample characteristics of place of delivery dataset
1 place delivery 330 0.1273 0.3338 0 1
3 year dummy 330 0.5000 0.5008 0 1
16 house ownership 330 0.8212 0.3838 0 1
18 have television 330 0.5152 0.5005 0 1
21 household size 330 7.5152 2.5291 2 21

To explore the impact of health card ownership on place of delivery, seven
seen at the following explanation. The result of logistic regression of the following
models can be seen at table 4.10.
card on place delivery without controlling with knowledge of health facilities,
socio-demographic and economic context.
having health card and program (before-after) periods on place of delivery
without controlling with knowledge of health facilities, socio-demographic and
economic context.
controlling with knowledge of health facilities.
controlling with socio-demographic.
controlling with economic variables.
of having health card and program (before-after) periods on place of delivery
controlling with all knowledge of health facilities, socio-demographic and
economic variables.
health card and program (before-after) periods on place of delivery controlling
with selected knowledge of health facilities, socio-demographic and economic
variables based on likelihood ratio test. Likelihood ratio test is conducted to
select control variables with highest explanatory power to the model. The
selected variables that pass likelihood ratio test were used on model 7.
Before started the logistic regression analysis, the multicollinearity test was
conducted to test whether there is correlation among independent variables or not
(Table 2 Annex). With 0.5 as cut off point, the result shows that there is no
multicollinearity among independent and control variables that used in all models
(Table 5 Annex).

Table 4.10 regression coefficients and standard errors from multiple regression
analysis of the impact of health card ownership on place delivery.
Model 1
Coeficient
Model 2
Coeficient
Model 3
Coeficient
Model 4
Coeficient
Model 5
Coeficient
Model 6
Coeficient
Model 7
Coeficient
(Standard
Error)
(Standard
Error)
(Standard
Error)
(Standard
Error)
(Standard
Error)
(Standard
Error)
(Standard
Error)
health card ownership 0.0424 0.0232 -0.8342 0.0440 -0.3945 0.7806 -0.6049
(0.4213) (0.7954) (0.8902) (0.8026) (0.8442) (0.9351) (0.8531)
year dummy 0.3486 0.3896 -0.0236 0.2484 0.3213 0.4831
(0.3678) (0.4173) (0.4267) (0.4345) (0.5734) (0.4451)
Interaction variable -0.0883 0.5042 0.0406 0.5282 0.3812 0.5562
(0.9442) (1.0641) (0.9716) (1.0082) (1.1445) (1.0491)
know where is public hospital. 2.2773** 2.1345** 2.3300**
(0.7720) (0.7944) (0.7537)
know where is private hospital 0.3339 0.3576
(0.4166) (0.4616)
know where is public/ auxiliary health center -0.1157 -0.2828
(0.7791) (0.8799)
know where is private clinic -0.5605 -1.0420
(0.6183) (0.6697)
know where is private physician -0.3669 -0.5995
(0.4087) (0.4509)
know where is midwife -0.4558 -0.2954
(0.4569) (0.5076)
know where is nurse -0.4844 -0.4415
(0.4528) (0.4738)
know where is traditional birth attendant -1.3987** -1.3506** -1.2259***
(0.4070) (0.4450) (0.3844)
know where is traditional practicioner 0.9254* 1.20741** 0.7666*
(0.4174) (0.4614) (0.3877)
know where is pharmacy 0.5207 0.2895
(0.4351) (0.4893)
know where is posyandu 1.1049 1.2418
(0.6522) (0.6988)
household size 0.0678 -0.0081
(0.0650) (0.0746)
highest education hhh -0.5524 -1.0147 -0.5232
(0.5611) (0.6286) (0.4913)
highest education shh 1.4414* 1.3266*
(0.5623) (0.6426)
house ownership 0.7112 1.0392
(0.5236) (0.5985)
using electricity 1.6348 1.0987
(1.0599) (1.1177)
have television 0.7474 0.7025 0.7400
(0.4117) (0.5035) (0.4171)
improve water source 0.8083* 0.5224
(0.3648) (0.4480)
improve sanitation 0.3706 0.2403
(0.4109) (0.5075)
constant -1.9332*** -2.1026*** -3.9553*** -2.6038*** -5.1959*** -6.4359*** -4.0059***
0.1835 0.2648 1.1710 0.5347 1.1707 1.7018 0.8412
Log Likelihood -125.7808 -125.2846 -99.3196 -121.3882 -112.9377 -90.9328 -99.6007
N 330 330 330 330 330 330 330
LR Chi2 0.01 1.00 52.93 8.80 25.70 69.71 52.37
Prob>Chi2 0.9202 0.8007 0.0000 0.1854 0.0012 0.0000 0.0000
Pseudo R2 0.0000 0.0040 0.2104 0.0350 0.1021 0.2771 0.2082
From table 4.10 can be seen that model 1 show that there is no direct effect of
health card ownership on place of delivery without controlling for other factors. The
model is also not significant that shown by prob>chi2 more than 0.05. No direct effect
of health cards ownership to delivery on public facilities might be happen because low
utilization of the health cards as discussed on 4.1.
card ownership and program duration on place of delivery without controlling for
other factors. The model is also not significant that shown by prob>chi2 more than
0.05.
card ownership and program duration on place of delivery controlling for knowledge
of health facilities. In this model, can be seen that knowledge of where is public
hospital have significant positive effect on delivery at public health facilities. In this
model also can be seen that knowledge of where traditional birth attendants are has
significant negative effect on delivery at public facilities. Interestingly, knowledge
where traditional practitioners are has significant effect to delivery at public health
facilities.
card ownership and program duration on place of delivery controlling for socio-
demographic variables. In this model can be seen that there is no socio-demographic
variables have significant effect to delivery in public facilities.
card ownership and program duration on place of delivery controlling for economic
variables. Model 5 also shows that there is no effect of economic factor on delivery in
public facilities.
card ownership and program duration on place of delivery controlling for all variables
including knowledge of health facilities, socio-demographic and economic variables.
Consistent with model 3, there is positive effect of knowledge of where is public
hospital and knowledge where traditional practitioners are as well as significant
negative effect of knowledge of where traditional birth attendant were on delivery in
public facility.
card ownership and program duration on place of delivery controlling for selected
knowledge of health facilities variables, socio-demographic variables and economic
variables. Consistent with model 3 and model 6, model 7 shows that there is positive
effect of knowledge of where is public hospital and knowledge where traditional
practitioners as well as knowledge of where traditional birth attendant were negatively
affected on delivery in public facility.
Result from all models show that there is no significant impact of health care
program on delivery at public health facilities. This result might come because low
utilization of health cards for delivery on public facilities. The other reason is health
card ownership was not a consideration for place delivery decision because the
delivery process itself is emergency activities.

4.2.3. Impact of health card ownership to utilization of modern contraceptive
a. Dependent variables: using modern contraceptive

consists 3175 married women for two observation year.

Table 4.11 Sample characteristics of place of contraceptive dataset
1 Modern contraceptive 6350 0.5394 0.4985 0 1
3 year dummy 6350 0.5000 0.5000 0 1
16 house ownership 6350 0.8534 0.3537 0 1
18 have television 6350 0.6443 0.4788 0 1
21 household size 6350 5.9425 2.1792 2 21

To explore the impact of health card ownership on place of delivery, seven
seen at the following explanation. The result of logistic regression of the following
models can be seen at table 4.12.
card on utilization of modern contraceptives without controlling with
knowledge of health facilities, socio-demographic and economic context.
having health card and program (before-after) periods on utilization of modern
contraceptives without controlling with knowledge of health facilities, socio-
demographic and economic context.
contraceptives controlling with knowledge of health facilities.
contraceptives controlling with socio-demographic.
contraceptives controlling with economic variables.
of having health card and program (before-after) periods on utilization of
modern contraceptives controlling with all knowledge of health facilities,
socio-demographic and economic variables.
health card and program (before-after) periods on utilization of modern
contraceptives controlling with selected knowledge of health facilities, socio-
demographic and economic variables based on likelihood ratio test.
The multicollinearity test was conducted before regression analysis to test
whether there is correlation among independent variables or not. With 0.5 as cut off
point, the result shows that there is no multicollinearity among independent and
control variables that used in all models (Table 3 Annex).
After multicollinearity test, likelihood ratio test was conducted to select control
variables with highest explanatory power to the model. On table 6 Annex, can be seen
the selected variables that pass likelihood ratio test were used on model 7.
Table 4.12 regression coefficients and standard errors from multiple regression
analysis of the impact of health card ownership on utilization of modern
contraceptive.
Model 1
Coeficient
Model 2
Coeficient
Model 3
Coeficient
Model 4
Coeficient
Model 5
Coeficient
Model 6
Coeficient
Model 7
Coeficient
(Standard
Error)
(Standard
Error)
(Standard
Error)
(Standard
Error)
(Standard
Error)
(Standard
Error)
(Standard
Error)
health card ownership 0.1947** 0.4325*** 0.3399** 0.4250*** 0.3461** 0.3128** 0.3174**
(0.0683) (0.1114) (0.1132) (0.1114) (0.1127) 0.1139 (0.1133)
year dummy -0.1042 -0.1756** -0.1697** -0.1538* -0.1793** -0.1907***
(0.0551) (0.0567) (0.0605) (0.0606) (0.0657) (0.0567)
Interaction variable -0.3530* -0.2798 -0.3246* -0.1961 -0.2068 -0.2036
(0.1420) (0.1441) (0.1426) (0.1440) (0.1453) (0.1447)
know where is public hospital. 0.1237* 0.0843
(0.0626) (0.0636)
know where is private hospital 0.0314 -0.0067
(0.0625) (0.0634)
know where is public/ auxiliary health center 0.1867 0.1850
(0.1098) (0.1105)
know where is private clinic 0.0266 -0.0139
(0.0780) (0.0794)
know where is private physician 0.0959 0.0534
(0.0597) (0.0608)
know where is midwife 0.1942** 0.1992** 0.2130***
(0.0625) (0.0629) (0.0620)
know where is nurse 0.0832 0.0755
(0.0551) (0.0554)
know where is traditional birth attendant -0.0866 -0.0133
(0.0595) (0.0617)
know where is traditional practicioner -0.2168*** -0.1956*** -0.1878***
(0.0570) (0.0574) (0.0566)
know where is pharmacy 0.0940 0.0241 0.0786
(0.0639) (0.0654) (0.0562)
know where is posyandu 0.4369*** 0.4366*** 0.4676***
(0.0710) (0.0714) (0.0683)
household size -0.0049 -0.0097
(0.0117) (0.0119)
highest education hhh 0.0938 -0.0669
(0.0795) (0.0832)
highest education shh 0.1404 0.0239
(0.0923) (0.0953)
house ownership -0.1263 -0.1159
(0.0734) (0.0758)
using electricity 0.0263 -0.0534
(0.0851) (0.0870)
have television 0.3906*** 0.3512*** 0.3531***
(0.0588) (0.0626) (0.0583)
improve water source 0.1410** 0.1406 0.1417**
(0.0548) (0.0575) (0.0549)
improve sanitation 0.0074 -0.0141
(0.0565) (0.0574)
constant 0.1258*** 0.1756*** -0.5620*** 0.1959** -0.0420 -0.5882*** -0.6045***
0.0275 0.0381 0.1202 0.0765 0.1086 0.1634 0.0825
Log Likelihood -4377.6903 -4369.7141 -4305.5943 -4365.5847 -4328.3262 -4282.4358 -4288.5722
N 6350 6350 6350 6350 6350 6350 6350
LR Chi2 8.18 24.13 152.37 32.39 106.91 198.69 186.41
Prob>Chi2 0.0042 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000
Pseudo R2 0.0009 0.0028 0.0174 0.0037 0.0122 0.0227 0.0213
Model 1 show direct effect of having health cards on using modern
contraceptives. People who have health card are more likely use modern contraceptive
without controlling for other factors.
Model 2 show that there is positive effect of health card ownership and
combination effect between health card ownership and program duration on utilization
of modern contraceptives without controlling for other factors. Consistent with model
1, household who have health cards are more likely have use modern contraceptive.
Model 3 show that there is positive effect of health card ownership and but
there is no combination effect between health card ownership and program duration on
utilization of modern contraceptives controlling for knowledge of health facilities.
Consistent with model 1 and 2, household who have health cards are more likely have
use modern contraceptive. But the periods variable show that household in 2000 are
less likely use modern contraceptive. The model also show positive effect of
knowledge of where is public hospital, midwife, traditional practitioners and posyandu
are on utilization modern contraceptives
Model 4 show that there is positive effect of health card ownership and there is
of modern contraceptives controlling for socio-demographic variables. Consistent with
model 1, 2, and 3 household who have health cards are more likely have use modern
contraceptive. Consistent with model 3, the year dummy show that household in 2000
are less likely use modern contraceptive. In this model also can be seen that there is no
socio-demographic variables have significant effect to delivery in utilization of
modern contraceptives.
Model 5 show that there is positive effect of health card ownership and dummy
of program intervention periods, but there is no combination effect between health
card ownership and program duration on utilization of modern contraceptives
controlling for economic variables. Consistent with model 1, 2, 3 and 4, household
who have health cards are more likely have use modern contraceptive. Consistent with
model 3 and 4, the year dummy shows households in 2000 are less likely use modern
contraceptive. The model also shows positive effect of having television and access to
improve water on utilization modern contraceptives.
Model 6 show that there is positive effect of health card ownership and dummy
of program intervention periods, but there is no combination effect between health
card ownership and program duration on utilization of modern contraceptives
controlling for all variables including knowledge of health facilities, socio-
demographic and economic variables. Consistent with model 3, the model also show
positive effect of knowledge of where is public hospital, midwife, traditional
practitioners and posyandu on utilization modern contraceptives. Consistent with
model 5, the model also shows positive effect of having television and access to
improve water on utilization modern contraceptives.
Model 7 show that there is effect of health card ownership and but there is no
of modern contraceptives controlling for selected knowledge of health facilities
variables, socio-demographic variables and economic variables.

Table 4.13 Adjusted Probability of having Health card
to utilization of modern contraceptive
Have health card
Number of
Observation
Adjusted
Probability
Standar
Error
No (0) 5299 0.5334 0.0279
Yes (1) 1051 0.5730 0.0634
LR Chi2 5.37
Prob>Chi2 0.0205

Adjusted probability result of health card ownership to modern contraceptive

use on table 4.13 show that 57% household that have health card will use modern
contraceptive, it is clearly confirm that having health card is one of factor affecting
the decision to use modern contraceptive during the crisis.
Table 4.14 Interaction effect between health cards

Ownership and year dummy
ie 6350 -0.0469 0.0036 -0.0517 -0.0410
se 6350 0.0339 0.0016 0.0311 0.0358
z 6350 -1.3788 0.0462 -1.5010 -1.3164

From table 4.12 model 7 can be seen that both health card ownership and year
dummy are highly statistically significant. However, the interaction variable is not
statistically significant. From model 7, could be concluded that there is no interaction.
However, in the logistic model, we can see that the magnitude and statistical
significance ranges widely. Despite the lack of statistical significance of the
coefficient on the interaction variable, the full interaction effect is large and
statistically significant for some observations

Figure4.1 Interaction Effect

From figure 4.1 can be seen the magnitude of interaction effect in wide range
and vary depend on level of each covariates. The mean of interaction effect is -0.046
(Table 4.14). At figure 4.1 can be seen that the interaction effect can be found widely
although none of them statistically significant according figure 4.2. It might be happen
because from 1997 to 2000 is crisis periods, therefore the time effect of program
intervention was neutralized by economic shock because of crisis.

Figure 4.2 Z-statistics
The other
possible answer why
the interaction effect
are not is significant
to contraceptive use
are stability of
contraceptive use in
Indonesia. This
argument is supported
by Strauss et al (2002) and Frankenberg et al (1999) who found that the economic
crisis did not affect a lot on the change of contraceptive uses. It means that neither
economic crisis nor health card program have significant effect to utilization modern
contraceptives.

Erlangga Agustino Landiyanto Conclusion and Recommendation/44

CHAPTER V
CONCLUSION AND RECOMMENDATION

Chapter V is the conclusion of this study. There are two topic of this chapter,
finding of the study and implication of this study

5.1. Conclusion
This paper not only found that the effectiveness of the program should be increase
but also can detect some part of the program that need to be improved. Some
important point for the analysis as follow:
Health card program have less performance on targeting and distribution.
There are some misallocation and inappropriate utilization.
Health card program did not affect to secure adequate antennal care of
pregnant women.
Knowledge where midwives is very important in securing access to adequate
antenatal care.
Health card program did not affect giving more access on delivery to public
health facilities
Knowledge of where is public hospital is very important to improve access on
delivery in public facility.
Health card program have positive effect on modern contraceptive use but the
interaction impact between health card ownership and year dummy is not
significantly improve utilization modern contraceptive.
Knowledge where public hospital, midwife, traditional practitioners and
Posyandu is very important to improve the utilization of modern contraceptive.
Interestingly, economic factors are not major constraint for reproductive health
access. It is need more study to answer why it is happened.

5.2. Recommendation
5.2.1 Recommendation for Further Social Safety Net Program

1. Improve the quality of targeting and distribution for further social safety net on
health program. Program implementer should have individual level data base
of targeted recipient of safety net and did not let local level official decided the
recipient freely without proper monitoring.
2. Improve the quality monitoring and evaluation for implementation of further
social safety net on health program.
3. Improve the verification system of health care providers to avoid misallocation
of the targeted subsidy.
4. Due of low utilization of health cards, Social marketing to support program
implementation are needed to ensure who have health card use it to access
health services.

5.2.2 Recommendation for Further Research
1. Conduct study with more sample size of pregnant women or who have
delivery, especially to investigate the impact social safety net on health to
antenatal care and place delivery.
2. Conduct further study on stable macroeconomic situation, to reduce the bias
because of the effect of business cycle fluctuation. It will be better if the further
study conducted with randomized evaluation methods to reduce selection bias
and neutralized external effect, especially when implementing pilot program
before scaling up. If the macroeconomic situation is not stable, the micro level
study (micro data analysis) can be combined with macro modeling to
accommodate macroeconomic dynamic into microanalysis.

Erlangga Agustino Landiyanto Bibliography/46

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Erlangga Agustino Landiyanto Annex/50

ANNEX

Table 4. LR test for each antenatal cares control variables
Table 5. LR test for each place deliverys control variables
Table 6. LR test for each contraceptive uses control variables

BIOGRAPHY

NAME Erlangga Agustino Landiyanto

DATE OF BIRTH August 24, 1980

PLACE OF BIRTH Surabaya, Indonesia

INSTITUTION ATTENDED Airlangga University, 2000-2005
Bachelor Degree (Economics)

Mahidol University, 2008-2009
Master of Art (Population and Reproductive
Health Research)

SCHOLARSHIP Measure Evaluation

HOME ADDRESS Keputran Pasar Kecil 1/ 57
Surabaya 60271, Indonesia

Evaluating The Impact of Health Card Program On Access To Reproductive Health Services: An Indonesian Experience

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Evaluating The Impact of Health Card Program On Access To Reproductive Health Services: An Indonesian Experience

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EVALUATING THE IMPACT OF HEALTH CARD PROGRAM

ON ACCESS TO REPRODUCTIVE HEALTH SERVICES:

EVALUATING THE IMPACT OF HEALTH CARD PROGRAM ON ACCESS TO

Fortunately, according the finding of Strauss et al (2002) and Frankenberg et al (1999),

According Saadah et al (2001) Strauss et al (2002) Sparrow (2006), the types

pregnancy, use traditional

Table 3.2 Intervention Variables

Table 3.3 Control Variables

Indonesian central bureau of

4.2. Multivariate analysis

Table 4.7 Sample characteristics of antenatal care dataset

e. Control variables (socio-demographic): household size, education of head of

Adjusted probability result of health card ownership to modern contraceptive

Table 4.14 Interaction effect between health cards

Erlangga Agustino Landiyanto Result and Discussion/42

Figure 4.2 Z-statistics

5.2.1 Recommendation for Further Social Safety Net Program

Development Network, Rio de J aneiro, Brazil, December 912, 2001, at

Erlangga Agustino Landiyanto Annex/50

Erlangga Agustino Landiyanto Annex/52

Table 4. LR test for each antenatal cares control variables

Erlangga Agustino Landiyanto Annex/54

Table 5. LR test for each place deliverys control variables

Table 6. LR test for each contraceptive uses control variables

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