Decentralization in the health sector?<\/p>\n
By Rita A. Widiadana<\/p>\n
JAKARTA (JP): Decentralization is a hot topic in the health
\nsector. It is relieving for many but others welcome it rather
\npessimistically.<\/p>\n
In the national congress on epidemiology, organized jointly by
\nthe National Epidemiology Network (JEN) and Atmajaya Catholic
\nUniversity, held here from Nov. 7 through Nov. 9, the topic of
\ndiscussion centered on the readiness of people in the health
\nsector to properly implement the policy which is to be effective
\nfrom May next year.<\/p>\n
JEN's chairman Dr.Satoto was optimistic, saying it is high
\ntime for health managers and workers in regional and provincial
\nlevels to get up and set up their own programs.<\/p>\n
\"We've been spoiled by the central government (in this case
\nthe Ministry of Health) for more than 30 years. Everything has
\nbeen created and decided by the central government, while
\nregional officers only act as 'caretakers',\" said Satoto, a
\nprofessor of epidemiology.<\/p>\n
Health policies made by the central government often do not
\nsuit every area. \"In this reform era, such a top-down approach is
\nno longer appropriate.<\/p>\n
Dr. Tonny Sadjimin, professor of epidemiology at Gajah Mada
\nUniversity in Yogyakarta, cited a good example of the failure of
\ncentral government in dealing with various epidemic illnesses.<\/p>\n
In dealing with disease outbreaks such as malaria, diarrhea or
\nother infectious diseases, the central government usually resort
\nto their standardized policies and guidelines.<\/p>\n
\"In some areas, the standardized guidelines may be appropriate
\nbut in other areas they do not work at all,\" Dr. Tonny asserted.<\/p>\n
Each place has its own territorial characteristic, as well as
\na different social, economic and cultural background. The
\navailability of health facilities and human resources also play
\nsignificant roles in the implementation of each program or
\npolicy.<\/p>\n
\"The management of malaria outbreak in Kalimantan should be
\ndifferent from that in Java or Sumatra,\" he said.<\/p>\n
Dr. Philip Stokoe, resident advisor at the Asian Development
\nBank, shared a similar view. \"Decentralization in the health
\nsector is a must. It is not a fiction or a future. It is a
\nreality that we have to face, like it or not,\" commented Stokoe.<\/p>\n
He acknowledged that many people at regional levels have
\nlittle or no knowledge of how the policy will be implemented next
\nMay.<\/p>\n
\"During my visit to several provinces and regencies, the
\nmajority of people have not yet read about Law 22 and 25 about
\ndecentralization, especially in the health sector,\" Stokoe
\nexplained.<\/p>\n
Laws 22 and 25 on decentralization includes devolution,
\nderegulation, delegation, privatization and accountability.<\/p>\n
\"The question in everybody's mind is the districts' ability,
\ncapacity and commitment to the policy of decentralization,\" he
\nsaid.<\/p>\n
He added that the current view is that some of the districts
\nare ready to implement decentralization, while there are others
\nthat can implement it if given technical assistance, however the
\nrest would heavily rely on the provinces and the central
\ngovernment.<\/p>\n
Dr. Budi Utomo, a medical professor at the University of
\nIndonesia's School of Medicine, explained that decentralization
\nin the health sector will determine whether reformation in the
\nsector will work.<\/p>\n
\"Decentralization requires changes in mindsets and mentalities
\nof those involved in the health sector, especially health
\nofficials in regional levels,\" said the professor who is also
\ndirector of the Population Council.<\/p>\n
The roles of community health centers would become very
\ncrucial in the era of decentralization.<\/p>\n
Provincial and regional government must be ready and must be
\nable to accept new responsibilities.<\/p>\n
Firstly, they have to be able to identify and prioritize the
\nhealth problems in their respective areas.<\/p>\n
Secondly, they must plan, implement and monitor each health
\nprogram in regional and provincial levels.<\/p>\n
The responsibility of the central government would be limited
\nto only setting health standards, regulations and guidelines, and
\ncontrolling and monitoring various national-scale programs.<\/p>\n
\"Compared to the central government, health workers in
\nprovincial and regional areas are actually more capable of
\nidentifying and managing their specific health problems,\" said
\nthe professor.<\/p>\n
The professor, however, reminded that there must be consensus
\nbetween every interest group in the society and it should be
\nsupported by appropriate information and data.<\/p>\n
Andi Malarangeng, assistant to the minister of home affairs
\nand regional autonomy, warned decentralization poses both a
\nnightmare in implementation and a challenge for the future.<\/p>\n
\"Successful implementation will depend on true delegation of
\nmanagerial decisions to the provinces and districts, the
\npreparedness of the districts, and the commitment of senior
\nmanagement staff, health officials and related personnel,\" Andi
\nsaid.<\/p>\n
In connection with fund allocation, Andi said the central
\ngovernment will no longer allocate funds for regional levels.<\/p>\n
\"It is you, health workers, who should fight for funds from
\nthe regional government,\" he said.<\/p>\n
Not all regional governments pay enough attention to the
\ndevelopment of basic issues like health and education.<\/p>\n
\"There are some governors and regents who still regard health
\na minor issue and a money-consuming program. Therefore, you have
\nto strongly convince them that health is a long-term and
\nintangible investment for the nation,\" Andi said.<\/p>\n
He suggested doctors, academicians and health-related
\npersonnel collectively push regional governments to provide
\nadequate funds for the development of health facilities and to
\nimprove human resources in the health field.<\/p>\n
Currently Indonesia spends a meager 1.8 percent of the GNP on
\nhealth.<\/p>\n
Dr. Satoto concluded the session by saying that
\ndecentralization in the health sector is urgent.<\/p>\n
\"Compared to other (sectors), our health sector is more well-
\nprepared. We have thousands of community health centers and other
\nhealth services across the country which could be fully
\nempowered,\" he maintained.<\/p>\n
The private sector and communities have been very active in
\nvarious health programs.<\/p>\n
The problem is whether the central government would release
\nits powerful hands in controlling health programs-- which for
\nmany high-ranking officials are profitable mines.<\/p>",
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