HEALTH POLICY DEVELOPMENT
Country Issues and Challenges :
In the beginning of 2001, the Government of Indonesia began a major process of decentralization,
the various aspects of which are delineated in Law No. 22/1999 on Regional Government (UU PD) and
Law No. 25/1999 on the Fiscal Balance between the Central Government and the Regions (UU PKPD).
These laws effectively transfer authority and responsibility for governmental expenditures from
national to the local government. The decentralization policies present new opportunities for
revitalizing the health sector, although the challenges and complexities should not be underestimated.
Before the recent moves towards decentralization, the public health system was highly centralized,
technical programmes vertically managed along traditional health service delivery models, and overall
public spending in the health sector extremely low at 1% of GDP in FY1999/2000, due in part to the
economic crisis. While the government has expanded access to basic interventions, it has placed
relatively less emphasis until recently on high quality comprehensive care, skilled providers,
and responsive health systems. Certain health indicators in Indonesia remain at alarming levels.
The maternal mortality ratio, for example, is estimated at 470 maternal deaths per 100,000 live births.
Systematic monitoring of the processes and outcomes is needed, particularly given that the health
indicators and system performance prior to decentralization were not optimal.
There is a particular need to develop greater flexibility within the national level MoH to
coordinate a response to issues that arise in policy implementation at the provincial and district
levels. The MoH has stated the need to support further guidelines for capacity development among
the district health service managers because of their new roles and responsibilities. Given that
the relationships between the central, provincial and district levels are based on technical expertise
rather than funding and hierarchy, input must be provided in such a way as to support skills development
and experience-sharing among the district managers enabling them to carry out their roles and functions
effectively. At the provincial level, a need has been identified to evaluate the role of the provincial
health authorities in monitoring and supporting district health service development.
Expected Contribution :
- Strengthened capacity for using evidence in decision-making via enhanced central
stewardship and policy-setting role and provincial responsibilities under a decentralized setting.
- Increased awareness and involvement of international issues directly related
to the WHO Country Cooperation Strategy.
HEALTH MANPOWER DEVELOPMENT
Country Issues and Challenges :
Decentralization policies transferred operational planning, management, and budgeting
to the district, and an information system is needed to support this process. Data accuracy
is important and it is recognized that the quality of the data is critically dependent on its
use at all levels within the system. Previous assessments have indicated that the use of
information in facilities is poor in support to care provision and use of information is poor
on district management level in support to the system.
Expected Contribution :
- Develop improved capacity, performance and governance frameworks, especially of nurses
and midwives and to improve their training with special attention to Maternal/Neonatal health care.
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