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WHO Operations
Areas of WHO Support
Current Comparative Advantages and Constraints
WHO Operations
Indonesia joined the World Health Organization on 23 May 1950, just months
after the country was liberated on 27 December 1949. WHO has established
a wide range of collaborative programmes with the Government of Indonesia,
and played an important role in national health development. The central
goal of the collaboration has been the attainment of the highest level
of health by the population. Over the years, as issues in the health sector
became more diverse, the scope of WHO collaborative activities expanded
to cover a large number of projects, many of them funding routine activities.
However, in the 1996-1997 biennium, WHO introduced 'umbrella' projects
aimed at making projects more coordinated, with effective linkages and
with measurable and accountable products.
In financial terms, the WHO Regular Budget provided US$ 10.4 million
in the 1996-1997 biennium with an extra budgetary component of US$ 1.31
million. For the 1998-1999 biennium, the allocation was US$ 10.7 million
for the regular budget, and US$ 2.4 million extra-budgetary.
For the biennium 2000-2001, planned staff costs, including duty travel,
will amount to about 45% of the country budget. Financial and technical
assistance from WHO has been prioritised and covers areas related to the
MoHSW's strategy to minimise the effects of the crisis on health. At the
same time expenditure on supplies and equipment has been drastically reduced
from 6.3% to 3.94% of the budget, and on fellowships from 3.5% to 0.56%.
The quality of products is constantly monitored and reprogramming carefully
reviewed.
Areas of WHO Support
WHO is strategically situated to provide key technical support as required,
and to undertake advocacy for key areas of health development in the country.
WHO'S past support has focused on the Ministry of Health (MoHSW) and
has consisted of technical assistance, training, fellowships, guidelines
and support for international standards. The main vehicles have been small
projects with limited scope but covering a large number of health areas,
especially communicable disease control. In general, although some staff
have been involved with the MoHSW's own projects and those of other development
partners, most staff and consultants were confined to WHO supported activities
and projects.
Until ten years ago, WHO sponsored international fellowships and trained
key MoHSW and university personnel. During the last decade, fellowships
have been for local degrees in public health for district health officers
in remote areas. WHO has also provided funds for MoHSW staff to attend
international meetings and conferences, as well as to procure key health
reference materials.
Current WHO support covers the following areas:
Technical support for key programmes
Technical support is provided for high priority areas, including STD
and HIV/AIDS, TB control and IMCI. In these areas, new programme guidelines
and protocols must be developed, tested and expanded. This requires extensive
technical inputs with minimal funds for operations.
Support for health sector policy and reform
Key areas of the health system where changes are essential include the
referral system, decentralised planning, health insurance and health financing
issues. Much of the WHO's effort concentrates on policy support, analysing
current data and providing papers on key policy issues. Where necessary,
limited field trials of innovations or training are undertaken.
Support for donor-assisted initiatives
to improve health
The substantial project funds provided by donors can have considerable
impact on the health sector in Indonesia. WHO provides technical support
to facilitate their work.
Advocacy and technical support for emerging priorities
in health
This involves support for health initiatives that are expected to grow
in importance in the coming years. Resources are currently being used
more for communicable diseases, as these are still widespread, but non-communicable
diseases are likely to become important in the next five years.
Limited technical support for all MoHSW
units and programmes
This range of activities for all units and programmes includes programme
evaluations, assessment to identify current needs, short-term technical
training and attending technical meetings. Some fellowships are supported.
Emergency response and preparedness
In emergency response WHO, in close collaboration with other UN agencies,
plays an active role in coordinating humanitarian action for displaced
populations and areas affected by social unrest and natural disaster.
Current Comparative Advantages and Constraints
The Indonesia WHO country office has demonstrable comparative advantages:
- the recognition of WHO as the primary agency in health not only by
the Government, but also by the donor community, the United Nations
Agencies and regional arrangements such as ASEAN
- the Ministry of Health and Social Welfare's judgment that WHO provides
sound and impartial technical advice. Since the funds directly available
from WHO are comparatively small, WHO is not seen as a major donor alongside
other agencies with large funds, who are sometimes perceived as prescriptive
- technical backup from SEARO and HO, providing expert advice and the
best technical practices, at short notice if necessary a large technical
staff working with direct counterparts in different units in the MoHSW.
This
facilitates access to decision- and policy-makers in the Ministry
- detailed involvement in supporting the MoHSW on work on health systems
and decentralisation. This has been a special strength of WHO work in
Indonesia over the last 5 years
- close involvement with NGOs. While there is no formal mechanism for
collaboration with NGOs, there is a good working relationship between
the WHO country office and NGOs working in the health sector
- good links with ministries outside health and institutions like the
Ministry of Women's Role, Ministry of Education, Ministry of Interior,
the Family Planning Board etc.
At the same time WHO faces some constraints:
- the general difficulty of securing support for implementing innovative
approaches in a bureaucratic system reluctant to make substantive change
- the perception that WHO staff and funds belong to specific programmes/MoHSW
units in an environment where inter-unit cooperation is weak. This somewhat
parochial attitude limits the
contribution of WHO staff across units and aggravates the difficulty
of supporting intersectoral issues such as health insurance or tobacco
and health
- the lack of a WHO presence at provincial/district level. This is especially
critical at the current time when widespread decentralisation is taking
place in a country as large as Indonesia.
These advantages and constraints have been taken into account in framing
WHO'S country cooperation strategy for the next five years.
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