The Indonesian National Family Planning Coordinating Board (BKKBN) has been a leader in developing and implementing innovative approaches to family planning. Yet precisely because of its leadership role in developing new models and strategies for wide-scale family planning program implementation, BKKBN faces what may be its most difficult challenge to date: the development of an ambitious program of self-sufficiency called "KB-Mandiri" to sustain growth of the family planning program over the long term. The goal of KB-Mandiri is to transfer the initiative for family planning away from the government and onto the people themselves.
KB-Mandiri, which means "family planning self-sufficiency," was launched in 1987. A joint partnership was developed between the private and public sectors and included the training of private doctors and midwives, who provide contraceptive services in their private practices, and the provision of contraceptive supplies to those providers. This was followed by the introduction of several commercial contraceptive products. Finally, community financing and commercial-based sales approaches to self-sufficiency have been tested in poorer urban localities and rural areas.
KB-Mandiri is not a new concept to BKKBN; most of the components of KB-Mandiri have been included in the family planning program from the beginning. The focus on community involvement and the use of volunteers have been a hallmark of the program from its early stages. The focus on the "small, happy, prosperous family" norm as the basis of self-reliance and sustainability has been instilled from the beginning. What is new is the specific goal of financial autonomy from the current mix of government and donor funding through the establishment of alternate revenue sources. This emphasis on the self-financing component has come as the result of the financial realities of projected decreases in both government and donor funding of family planning. However, BKKBN recognizes that sustainability will require more than just increases in revenues and strong financial management. Rather, it has recognized that sustainability will come from a long and gradual effort to shift the responsibility for contraception away from the government and on to the users.
This does not mean that all family planning acceptors will pay for services; rather it means that individuals will make family planning a high priority of their family life and will adopt behaviors and attitudes that ensure its effective use. Families who want only two children will do whatever is necessary to protect themselves against unwanted pregnancies. They will not require constant reminders from family planning fieldworkers, but will, on their own initiative, ensure they are adequately supplied and protected. The family planning program has the responsibility of providing clients with adequate access to services.
Through a variety of private sector initiatives, operations research, and pilot projects, BKKBN has developed considerable experience in the area of self-sufficiency. This experience includes:
While this general approach to KB-Mandiri has been well established, BKKBN felt that it needed more information on the best ways to implement this strategy in the field. In order to determine what types of financial and service delivery models would work best under realistic field conditions, BKKBN is using an operations research approach to test new models of program and financial sustainability in twenty-one provinces. To ensure proper evaluation of these projects, BKKBN is using a variety of sophisticated but inexpensive survey tools developed especially for this purpose.
The timing of this stage of the KB-Mandiri approach coincides with the need for the family planning program to expand and meet the needs of the growing number of family planning acceptors. In addition, extending the program to more remote and hard-to-reach populations will require additional commitment and resources from the local communities in order for the program to continue to grow and to reduce the fertility rate. Through the introduction of KB-Mandiri, BKKBN will gradually shift the responsibility for contraceptive use to the individual client and away from the government structure, with the result that existing resources can be redirected toward reaching new acceptors and the more difficult-to-serve populations. The long-term effect will be a more sustainable program based on wide-spread individual and community support and a simultaneous freeing of resources for use in new areas. This is the goal of KB-Mandiri.