By Kate Hawkins

Growing hope – building sustainable futures in Indonesia will take place on the 5-6th November 2016 in Yogyakarta. It brings together Flinders alumni and staff to share approaches to effecting positive change in Indonesia. REACHOUT will be represented by Ralalicia Limato and Patricia Junio Veronica Tumbelaka, members of our Indonesia team.

Licia will be presenting a paper on, "Power and politics at the decentralised level: Lessons from Cianjur district, Indonesia on how local governance effects the provision of maternal health services."

Good governance is one of the determinants of a well-functioning health system and effective health service delivery. Under the decentralised government in Indonesia, health system management shifted from national to district level in 2001. It was believed that decentralisation would make the provision of health services responsive to the needs of the community. However, reports from national and district level have indicated continued failure to deliver services that satisfy community expectations.

This study explored the impact of decentralisation on maternal health service delivery. Data were collected using semi-structured interviews, focus group discussions and field notes in four villages in Cianjur district, West Java province, Indonesia. Forty-six informants included health stakeholders, village heads, community leaders, maternal health service providers and community members. All interviews were recorded, transcribed, translated into English, coded and analysed using NVivo10.

The findings show that the decentralisation to district-led governance impeded maternal health service delivery in four ways: 1) delayed disbursements of staff entitlements (delivery fees) decreased the motivation; 2) greater focus on tax and revenue generation compared with maternal health programmes; 3) prioritisation of the incumbent political party agenda over the community health needs which led health officials to support politic interests for fear of transfer to less attractive postings; 4) inappropriate use of earmarked health funds for political lobbying.

Our study provides lessons on governance in decentralised systems which resonate with other settings where this process is underway. Under the decentralised system, the political agenda took precedence over serving the health needs of the community. This affected staff motivation, funding for services and the quality of health services. Potential strategies to mitigate this include stronger oversight by the central government and/or by independent bodies to monitor the local government actions.

We hope to see you at the Symposium and learn more about your work.

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