Decentralisation in Indonesia: The Impact on Local Health Programs

Muhammad Syamsu Hidayat, Afzal Mahmood, John Moss


Background: After more than a decade of implementation, the outcomes of decentralisation in Indonesia, particularly for the health sector are still obscure. Government health expenditure in a number of districts has increased considerably, but despite this health system performance to a large extent seems unaffected, calling into question how health stakeholders actually interpret local needs and how this interpretation can influence the consequent process for developing health programs. The main objective is to reveal the impact of decentralisation on health programs. Methods: In order to explore the complexity of the process, thirty-six stakeholders from eight different districts were interviewed, individually. These stakeholders consisted of representatives of the executive and legislative bodies, and the head of the district health office. Using purposive sampling, districts as the unit of analysis were selected on the basis of different degrees of fiscal strength and of urbanisation. The data were explored using framework approach. Results: One feature of decentralisation was the transfer of central government-that includes the discretion to develop and financing local initiative health programs to the local governments. However, the extent of health programs in each local government depends on factors such as local fiscal capacity, regulations, and the political process. In the case of Jamkesda, local fiscal capacity will determine the coverage and benefit of the health scheme that usually was supported by local regulations. However, the amount of local budget allocated for Jamkesda, relied greatly on the political process. The role of Jamkesda as a vote-getter for local politicians is significance, both in term of local commitment (budget allocation and regulation) and the sustainability of the program. Conclusion: Decentralisation has changed the development of local health program, nevertheless, the scope of local initiative health programs is determined by local fiscal capacity and the political process.


decentralisation; fiscal capacity; jamkesda

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Manor J. The Political Economy of Democratic Decentralization. Washington: World Bank; 1999. 145 p.

Regmi K, Naidoo J, Greer A, Pilkington P. Understanding the Effect of Decentralisation on Health Services: The Nepalese Experience. J Health Organ Manag. 2010;24(4):361–82.

Simatupang R. Evaluation of Decentralization Outcomes in Indonesia: Analysis of Health and Education Sectors [Dissertation]. Georgia State University; 2009.

Heywood P, Choi Y. Health System Performance at the District Level in Indonesia After Decentralization. BMC Int Health Hum Rights. 2010 Mar 5;10(3).

Kristiansen S, Santoso P. Surviving Decentralisation?: Impacts of Regional Autonomy on Health Service Provision in Indonesia. Health Policy. 2006 Aug;77(3):247–59.

Kruse I. 2009. Available from:

Lanjouw PP Menno Saadah, Fadia Sayed, Haneed Sparrow, Robert. Poverty, Education, and Health in Indonesia: Who Benefits from Public Spending? The World Bank; 2001. 68 p. (Policy Research Working Papers).

Despite Poverty Reduction in Indonesia. Gap between Rich and Poor Widens. 2014.

Kruse I, Pradhan M, Sparrow R. Health Spending and Decentralization in Indonesia. Verein für Socialpolitik, Research Committee Development Economics; 2009. (Proceedings of the German Development Economics Conference, Frankfurt a.M. 2009). Report No.: 33.

Smith J, Firth J. Qualitative Data Analysis: The Framework Approach. Nurse Res. 2011;18(2):52–62.

Ritchie J, Lewis J. Qualitative research practice: a guide for social science students and researchers. London: Sage Publications; 2003.

Srivastava A, Thomson SB. Framework Analysis: A Qualitative Methodology for Applied Policy Research. Rochester, NY: Social Science Research Network; 2009 Jan. Report No.: ID 2760705.

NatCen Learning. The Framework Approach to Qualitative Data Analysis. 2012.

Ahmad MS, Talib NBA. Empowering local communities: decentralization, empowerment and community driven development. Qual Quant. 2015 Mar 1;49(2):827–38.

Snyder KA, Ludi E, Cullen B, Tucker J, Zeleke AB, Duncan AJ. Participation and Performance: Decentralised Planning Andimplementation in Ethiopia. Public Adm Develoment. 2014 Apr 16;34(2):83–95.

Bennis W, Nanus B. Leaders: The Strategies for Taking Charge. New York: Harper and Row; 1985.

Kanter RM. Power Failure in Management Circuits. Harv Bus Rev. 1979 Aug;57(4):65–75.

Conger JA, Kanungo RN. The Empowerment Process: Integrating Theory and Practice. Acad Manage Rev. 1988;13(3):471–82.

BAPPENAS. Standar Kapasitas Institusi Perencanaan Pusat dan Daerah dalam Menunjang Pelaksanaan Jabatan Fungsional Perencana. Jakarta;

Tim Nasional Percepatan Penanggulangan Kemiskinan. Komitmen Pemerintah Daerah Turut Mendukung Kesuksesan Program Raskin. 2014.

Tim Direktorat Fasilitasi Perencanaan Peraturan Daerah. Panduan Praktis Memahami Perancangan Peraturan Daerah. Jakarta; 2011.

Zhang X. Fiscal Decentralization and Political Centralization in China: Implications for Growth and Inequality. J Comp Econ. 2006 Dec 1;34(4):713–26.

Uchimura H, Jütting JP. Fiscal Decentralization, Chinese Style: Good for Health Outcomes? World Dev. 2009 Dec 1;37(12):1926–34.

Lewis BD. Indonesian Local Government Spending, Taxing and Saving: An Explanation of Pre- and Post-decentralization Fiscal Outcomes*. Asian Econ J. 2005 Sep 1;19(3):291–317.

Pembatasan Gaji Anggota DPRD. 2007.

Torgerson DJ. Cost-Effectiveness Analysis and Health Policy. Nestle Nutr Workshop Ser Clin Perform Programme. 2009;12:95–104.

Walt G, Gilson L. Reforming the Health Sector in Developing Countries: The Central Role of Policy Analysis. Health Policy Plan. 1994 Dec;9(4):353–70.

Brewer G, DeLeon P. The Foundation of Policy Analysis. Monterey: Brooks/Cole; 1983.

Brown KM. Decentralization & Ethnic Regionalism in Indonesia: The Case of Minahas [Thesis]. University of Hawaii at Manoa; 2002.

Azra A. Pemekaran dan Garis Agama-Etnis. 2009.

Seitte FA. Pemekaran Wilayah dan Politik Identitas Studi Kasus di Waisarisa, Kabupaten Seram Bagian Barat, Maluku [Thesis]. Universty of Sanata Darma Yogyakarta; 2009.

Hasanudin AH, Erawan IKP. Konflik etnisitas dalam pemekaran wilayah :: Studi tentang konflik etnisitas dalam pembentukan Kabupaten Mamasa [Thesis]. Universitas Gadjah Mada; 2005.

Duncan CR. Reconciliation and Revitalization: The Resurgence of Tradition in Postconflict Tobelo, North Maluku, Eastern Indonesia. J Asian Stud. 2009 Nov;68(4):1077–104.

Buehler M. The Rising Importance of Personal Networks in Indonesian Local Politics: An Analysis of District Government Head Elections in South Sulawesi in 2005. In 2009. p. 101–24.

Aspinall E. Democratization and Ethnic Politics in Indonesia: Nine Theses. J East Asian Stud. 2011;11(2):289–319.

Moniruzzaman M. Deepening Democracy in Indonesia? Direct Elections for Local Leaders (Pilkada). By Maribeth Erb and Priyambudi Sulistiyanto (eds.). Intellect Discourse. 2009 Sep 12;17.

Sejarah Singkat Jamkesda DKI. 2012.

Fatmawati AM, Turtiantoro, Harsato P. Realisasi Janji Kampanye Program Kesehatan Bupati Semarang Periode 2010-2015. J Ilmu Pemerintah Undip. 2014;3(2):86–95.

Kementerian Kesehatan Republik Indonesia. Profil Data Kesehatan Indonesia. Jakarta: Kementerian Kesehatan Republik Indonesia; 2012.

Aspinall E. Health Care and Democratization in Indonesia. Democratization. 2014 Jul 29;21(5):803–23.



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Kes Mas: Jurnal Fakultas Kesehatan Masyarakat 
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