The application of good governance within governance prerequisite that cannot be left out is the participation of the community in public policy. The main prerequisites were when the Government implemented the autonomous region with the principle of decentralization, community participation. It involves all aspects of the implementation of the development in areas starting from planning to supervision. Participatory governance is governance putting citizens or non-government as an individual or organization as a viable social stakeholder in making public policy that has just dominated the Government. Model of participatory governance policy in the primary health services is eligible to be developed by optimizing and strengthening cooperation intersectional, increasing the motivation of health workers as well as eliminating social and cultural barriers in the community.
Background: In this era of decentralization , access and provision of drugs for people in the local area is the responsi- bility of local governments. Because the limitations of the local budget, the central government is obliged to guarantee the availability of drugs in the area. Financing sources of drugs from central and local government have not reached the stan- dard of WHO i.e. 2 dollars per capita. To cover demand of financing drug, a Specific Allocation Fund (DAK) proposed state budget that funds given to certain areas to fund special activities that are regional affairs and in accordance with na- tional priorities. General criteria to consider certain areas (re- gional fiscal capacity), specific criteria (regional characteris- tics) and technical criteria (policy formulation from Ministry of Health). Since drug financing is allocated in DAK in 2010, there is a need to evaluate the drug financing at the local level. The purpose : to evaluate the amount of DAK for Pharma- ceutical services in 2011 and 2012. Methods : The study used secondary data from 2010 and 2011 consist of 6 (six) factors: fiscal capacity, character of the area, population number, proportion of poverty , local bud- get for drugs and prediction for the remaining stock of the drug. The analysis statistics uses chi-square and multiple regression. Qualitative interviews is conducted with manag- ers of pharmacy in 2 districts with high financial capability. Results : Result from multiple regression test of the 6 factors used in the allocation of SAF 2011 and 2012 shows only 3 factors that really affects the allocation which are the number of population, the poor and the prediction of the remaining stock of the drug . However, the highest factor is the popula- tion. Result for qualitative with 2 respondents shows that since they got DAK they reduced local budget for drugs, because the drug financing is sufficient from DAK. Conclusion : local sense of ownership towards the health budget in the area is low resulting in reliance on the central health budget. The effeciency of the central budget causes reduction of health budget both in central and local level. Latar belakang : Dalam era desentralisasi ini, akses dan penyediaan obat bagi masyarakat di daerah menjadi tanggung jawab pemerintah daerah. Namun keterbatasan anggaran daerah maka pemerintah pusat berkewajiban menjamin ketersediaan obat di daerah. Sumber pembiayaan obat di daerah melalui APBN dan APBD belum mencapai standar WHO, 2 dol- lar per kapita. Untuk menutupi kekurangan pembiayaan obat, diusulkan DAK yaitu dana APBN yang diberikan kepada daerah tertentu untuk mendanai kegiatan khusus yang merupakan urusan daerah dan sesuai dengan prioritas nasional. Daerah tertentu mempertimbangkan kriteria umum (kemampuan fiskal daerah), kriteria khusus (karakteristik daerah) dan kriteria teknis (rumusan kebijakan Kementerian Kesehatan). Sejak kebijakan obat melalui DAK pada tahun 2010, perlu dilakukan evaluasi besaran DAK Bidang Kesehatan untuk Kefarmasian tahun 2011 dan 2012. Tujuan : tujuan penelitian ini adalah melakukan evaluasi besaran DAK Bidang Kesehatan untuk Kefarmasian 2011 dan 2012. Metode : Penelitian menggunakan data sekunder 2010 dan 2011 yang terdiri 6 faktor yaitu; kemampuan fiskal, karakter wilayah, jumlah penduduk, penduduk miskin, anggaran obat dalam APBD dan prediksi sisa stok obat untuk pengalokasian DAK 2011 dan 2012. Uji analisis menggunakan chi square dan multipel regresi. Kualitatif dengan wawancara pengelola farmasi di 2 kabupaten dengan kemampuan keuangan tinggi. Hasil: Dari uji multiple regresi terhadap 6 faktor yang digunakan dalam pengalokasian DAK 2011 dan 2012 hanya 3 yang mempengaruhi alokasi yaitu jumlah penduduk, penduduk miskin dan prediksi sisa stok obat. Namun yang paling tinggi adalah jumah penduduk. Untuk kualitatif pada 2 responden, sejak mendapat DAK terjadi pengurangan anggaran obat di APBD, karena pembiayaan obat cukup dengan DAK. Kesimpulan: daerah belum memahami ownership anggaran kesehatan di daerah sehingga masih mengandalkan anggaran dari pusat, dimana ketidakstabilan anggaran pusat dengan ef isiensi menyebabkan pemotongan merata anggaran kesehatan di pusat dan daerah.
Background: Accessibility to essential drugs is a public right, therefore it's the government responsibility to make them available.Previously before the era of regional autonomy, public drug management in all districts/cities was performed by the so-called District Pharmaceutical Warehouses (GFK).However, nowadays the situation has changed because of the difference in vision and perception of each regional government on the former warehouses.Some public drug management units in certain districts/cities are not functioning optimally.Inefficient drug procurement regarding the number and kind of drugs as well as timeliness results in gap between drug need and procurement.Furthermore, loosening in drug supply procedure makes essential drugs more unavailable to public.On the other hand, decentralization policy in drug management also undeniably brings advantages to the districts, for example capacity building in drug procurement, increasing capability in budget management and negotiation with district decision makers as well as enhancing regional economic activity.In revitalizing district pharmaceutical warehouses so as to attain minimal health care standards in districts/cities, baseline data in drug management and financing in several districts/cities should make a valuable contribution.Methods: A cross sectional descriptive study had been carried out during July-December 2006 in 26 districts/cities out of 11 provinces.Samples were 26 district health offices (Dinas Kesehatan Kabupaten/Kota) and 26 District Pharmaceutical Warehouses (GFK) where as respondents were head of drug section and head of warehousing respectively.Data were collected by means of structured questionnaires and in-depth interviews as well as the collection of secondary data of drug logistics.Qualitative and quantitative analysis was performed. Results:The study shows that: 1) although health budget in general had risen, the average percentage of drug budget allocation from 21 district health authorities was only 12.06%, reflecting the low drug priority in district health policy because drug expenditures may amount up to 40% of the total health budget.2) Public drug management was mostly performed by the so-called regional technical provider unit (UPTD) with some limitations concerning human resources and material in achieving an effective and efficient drug management, and 3) there was still lack of pharmacist assistants to manage drugs in primary health care (Puskesmas) up to 20% and even more piteously the lack of pharmacist in district drug management unit (GF/UPOP Kabupaten/Kota, 12,5%).Conclusions: Apart from the achievement of predetermined indicators stated in minimal health care standards in districts/ cities, especially regarding essential and generic drugs, drug management in general has been well performed concerning planning and drug availability.More support and commitment from the district government is a must considering that regional development can not be separated from the health development of the subject themselves.
Background: Health financing provided by the government greatly helps the implementation of health system in the decentralized era. General Allocation Fund and Local Revenue and Expenditure Budget are apparently inadequate to finance health service. Some efforts have been made to finance health service such as Community Health Insurance (Jamkesmas), Childbirth Insurance (Jampersal), and Health Operational Fund (Bantuan Operasional Kesehatan/BOK). These are meant to achieve Millennium Development Goals in 2015. The practice of coordination from planning to implementation and stakeholders’ commitment can affect the process of maternal and child health service. Coordination is definitely needed to run the program policy and prevent the overlapping financing in order that the objective of the program can be achieved. Objective: To evaluate coordination of planning, implementation and stakeholders’ commitment in relation to maternal and child health (MCH) service in Lombok Tengah District. Method: This was a descriptive-analytical study with a qualitative approach and a case-study design. Samples were taken purposively. The data were obtained through in-depth interview, observation and documentation analysis. Result: The planning coordination of MCH health financing had not been optimal, even despite the involvement of cross sector and program. However, the organizations of health professionals were not involved in program planning. The coordination of health financing implementation had not been optimal as well. Even though there was no overlapping financing from some different sources, in the policy implementation there was cost sharing for referral and drugs. Private sectors were not involved in the implementation of Jampersal. Stakeholders’ commitment was relatively optimum as reflected from the policy and action in health development acceleration particularly MCH. The process of MCH service at both primary and secondary level could run well. Conclusion: Coordination of MCH financing implementation in Lombok Tengah District through BOK, Jampersal, Jamkesmas, Community Empowerment National Program of Healthy and Smart Generation and Local Revenue and Expenditure Budget had not been optimal; therefore, it needed to be improved to eliminate cost sharing. Professional organizations and private health providers were not yet involved in the program planning and implementation. Keywords: coordination, stakeholders’ commitment, health financing, maternal and child health, program evaluation
Background: The degree of Maternal and Child Health (MCH) is still a major problem in health development in Indonesia. One factor that may be an obstacle in solving this problem is the limited cost. In this context, planning and cost utilization are essential to improve so that they can produce a great impact for the improvement of MCH. Therefore, in-depth information about the MCH financing situation in regions as an input to develop efficient activities in improving MCH status is needed. Objective: To analyze health financing situation of MCH program in 2010 which sourced from government and to make policy recommendations related to the program in Sabu Raijua District, East Nusa Tenggara Province. The situation in question is availability, budget planning process, expenditure accuracy, and fund flow rate. Method: This was a descriptive research with a case study strategy. Result: The total cost of MCH program was IDR 450,787,500. It was not sufficient to provide basic health services for pregnant women from early pregnancy until postpartum period. The budget proportion from the central, provincial, and district governments amounted to 79.63%, 3.56%, and 16.78%, respectively. Cost allocation of the district budget was 0.80%. Planning activities of MCH program was from the district budget through the development planning meeting (Musrenbang). Proposed activities in Musrenbang were dominated by physical activities. The cost of MCH program was spent more on direct activities and operational cost in villages and sub districts. The implementation of the activities was not supported by facilities and adequate human resources. The MCH fund disbursement from the central government was conducted in October- November while from the provincial and district governments were in July to August. Conclusion: The government’s commitment was still low in financing MCH program as a priority program due to budget decentralization. Musrenbang activities had not demonstrated significant impacts on quality activities improvement and budget allocations from the district budget. Availability of personnel and health facilities greatly affected the performance of MCH program. Delays in funds disbursement disrupted the implementation of activities and provided opportunities for corruption. Therefore, the supervision function must be improved both internal and external. Keywords: financing, maternal and child health program, health account, budget, government.
Contracting out is the practice of public sector or private firms of employing and financing an outside agent to perform some specific task rather than managing it themselves.The rationale for contracting is that public providers lack the incentive to use resources efficiently, and that private (or autonomous) providers are more efficient than public providers.Contracting out clearly separates the roles of purchaser and provider, and tightly links payment to performance of the provider.According to classical economic theory, contracting stimulates competition among providers in managed markets, induces cost awareness among providers and purchasers, and enhances transparency in negotiations.Providers are forced to minimize production cost and adjust the prices to meet the demand and requirements of purchasers.All these factors contribute to efficiency.In addition, contracting would promote decentralization managerial responsibility, a shift that would translate in efficiency gains in contrast to the old highly-centralized, bureaucratic structure, considered insensitive of the cost implications of allocative decisions.As is the case with any model, contracting out approach is not a panacea to all health problems.But in light of the limited absorptive capacity of the public sector, it is an alternative strategy worth considering for increasing the coverage and the quality of services in developing countries such as Indonesia.Monitoring and evaluation is an indispensible instrument for contracting out to exhibit its relative advantages.
Implementation of decentralized drug policy brings an impact in the form of finance mechanism changes. Before decentralization, drug budget was calculated by the amount of resident and indigent resident percentage. After decentralization, the budget is specified by each regional government according to needs and existing health problems. This change leads to problems of allocation and distribution especially in some areas where Original Earnings of Area (PAD) is relatively small. The allocation is strongly influenced by the amount of Common Allocation Fund (DAU) and the drug manager ability in the area to manage the fund of drugs as efficient and effective as possible to assure the availability and sustainability of health service. The aim of the study was to calculate the adequacy rate of drug cost before and after decentralization and to determine the influence of decentralization itself toward the adequacy of drug cost in the area.\nA case study was conducted using quantitative data and the result was analyzed with regard to drug cost adequacy. The study began with calculating indicator of drug management and drug cost requirement on the therapy of top 10 diseases using morbidity method during 1999-2002. The result was analyzed with ABC analysis and compared to realization of drug cost on the same periode and interpreted to assess the drug cost adequacy before and after decentralization.\nThe result showed that the average of ability on the drugs cost procurement based on comsumtion method to fullfill drug cost requirement based on morbidity method before decentralization was 31,33%, after decentralization increased to 78,51%. And then the average of ability on the drugs cost based on comsumtion method to fullfill drug cost requirement based on morbidity method before decentralization was 15,14%, after decentralization increased to 60,67%. Nevertheless, the increase of fund adequacy and drug cost rate was not significant (p>0,05) between before and after decentralization. It was concluded that although the adequacy rate of drugs cost and fund has increased significantly after decentralization, it was not able to fulfill the requirement up to 100%. In other words, decentralization has not influenced the cost adequacy rate of primary health care drugs in the area.\n\nKeywords: availability –adequacy –decentralization –cost of drugs.
Background: Health account is one method to acquire information about financial situation in the district or the state. Based on the information, the analysis on the policy can be made, such as priority setting and equity. The information is also used for policy decision and financial planning. Complete health finance data can be acquired in condition when there is a district health account.\nObjective: To describe health financial before and after the decentralization was implemented (1998 to 2002) in Sinjai District.\nMethod: This research is a quasi experiment research with before and after design. Method of health account development, is adopted from National Health Account.\nResult: This research showed that there was an increase of health funding since 1998 to 2002 in Sinjai District obtained from the government. Before decentralization central government role in health finance was high (11,6% to 60%), but after decentralization, the role of central government decreased and district government role increased (24% to 83%). From finance intermediary site the role of hospital as finance intermediary increased since 1999 to 2002 (11% to 40%). District Health Official still! took prominent finance intermediary point in Sinjai District. From health provider site, health expenditure allocation at community health center showed a trend to decrease. Health care administration and investment function showed escalation trend. Public health action constantly decreased since 1998 to 20002.\nConclusions: Sinjai District Health Finance increased since 1998 to 2002. Due to the increase of hospital health financial allodation, hospital finance intermediary also increased. On the other hand, the financial allocation in public health programs decreased. This pattern of health finance should be reserved for a pro-poor resource allocation.\n\nKeywords: health finance, District Health Account