Reducing Maternal and Neonatal Mortality in Indonesia Saving Lives, Saving the Future (2013) / Chapter Skim
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Chapter 6 Governance Issues
Chapter 6 Governance Issues
Pages 65-74
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From page 65... ...
However, the standards are outcome indicators for program evaluation without the meaningful measurements that would allow civil society and consumers of public health services and facilities to monitor and evaluate government responses to the needs and demands of its citizenry. Decentralization In 2001 Indonesia moved from a highly centralized government to a decentralized one; provinces, districts, and municipalities were extended the autonomy to choose and then plan their respective development paths.
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From page 66... ...
In this period, central government employees expanded by only 0.1 million, to 0.9 million civil servants, and those at the provincial level remained relatively stable, at 0.3 million. By contrast, the civil service at the district and municipality levels increased by almost 1 million, from 2.6 million to 3.4 million local bureaucrats.
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From page 67... ...
. TABLE 6-1 Percent Distribution of Place of Birth by Education of Mothers and Welfare Quintile: Indonesia, 2007 Health facility Education and Wealth Quintile Public Private Home Other Not specified Sum Education No schooling 5.9 9.5 81.4 1.4 1.8 100.0 Less than primary school 5.8 16.1 76.6 1.0 0.5 100.0 Primary school 7.1 23.8 67.2 0.9 0.9 100.0 Less than secondary school 9.6 39.1 50.2 0.5 0.7 100.0 Secondary school + 14.2 57.1 28.2 0.3 0.3 100.0 Wealth quintile Poorest Q 5.2 8.4 84.8 0.9 0.7 100.0 Q2 8.3 23.4 66.8 0.5 1.0 100.0 Q3 11.4 36.5 51.1 0.6 0.4 100.0 Q4 12.2 49.5 37.1 0.7 0.5 100.0 Wealthiest Q 12.3 71.0 15.5 0.6 0.6 100.0 Total 9.7 36.4 52.7 0.7 0.6 100.0 SOURCE: Badan Pusat Statistik and Macro International (2007: 138)
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From page 68... ...
For example, although the central government has a Ministry for Fishery, inland regions have no need for this service, or a municipality may consider forestry services unnecessary, 5 In most cases, program or project content is vertically defined, whereas local governments have the discretion to decide exactly where implementation will take place. 6 DAU has two major components: basic allocation and fiscal gap.
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From page 69... ...
Moreover, not just local governments but also local decision-making bodies are often uninformed of the commitments these bodies have to the needs of their citizens, including public social services, such as those related to maternal and neonatal health. Furthermore, the changing of the guard does not happen only once every five years when local heads are elected; rather, it happens far more frequently at the lower levels when those in power have to repay a favor.
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From page 70... ...
As shown in Table 6-3, this perception is reflected in the relatively low reliance on public health facilities, even among the poor. The causes of dissatisfaction are such things as administrative fees, slow or poor service delivery, ponderous bureaucratic procedures, and unskilled or,
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From page 71... ...
and include coverage of the following: visits by pregnant women to medical facilities, treatment of birth complications, birth attendance by trained personnel, postpartum services, and visits to medical facilities for infants from assisted births with neonatal complications. TABLE 6-3 Current District/Municipality Health Services Subjected to Minimum Service Standards in Ministry of Health Regulation No.
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From page 72... ...
Although the central government has introduced accountability measures to monitor service delivery, particularly through the introduction of minimum service standards, implementation has been inhibited by a lack of data and the inadequate human resource capacities of local governments. Outcome indicators produced under the MSS have little meaning to local government bureaucrats because no incentives are attached to any "achievements," and the indicators generally fail to deal with issues of service quality, which are at the core of customer dissatisfaction with public services.
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From page 73... ...
: 187 197. Direktorat Jenderal Otonomi Daerah, Kementerian Dalam Negeri (Directorate General of Regional Autonomy, Min istry of Home Affairs)
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