HEALTH PLANNING AND BUDGETING: ECONOMIC PROCESS OR POLITICAL PROCESS ? ECONOMIC PROCESS OR POLITICAL PROCESS ? (Case Study in Three Districts in East Java)
Ernawaty Department of Health Administration and Policy, Faculty of Public Health ‐ l f bl l h Airlangga University l Surabaya Indonesia
Introduction • Indonesia’s decentralization policy has been d i ’ d li i li h b operative since 2001. • According to Government Ordinance No. 38 Year 2007 and Act No. 23 Year 2014, it is mandatory for districts to regulate their own health affairs. • Although was made on a good premise that local government best understands about its own issues and therefore devises the best solution, the decentralization policy was reported not to achieved its normative goals.
• Many research in Indonesia showed that the hi d i h d h h decentralization have not achieve the goals. • Maharani et al (2014) • Heywood and Choi (2010) y ( ) • Heywood and Harahap (2009) • Simatupang (2009) Simatupang (2009) There is euphoria of autonomy in decentralization era h i h i f i d li i which tend to disserve the health sector (Hartono et al, 2007) t l 2007)
There are some of decentralization problems p , which implicated to health sector, i.e. 1. There are many districts which are still unable to execute the mandate of Health act unable to execute the mandate of Health act in 10% allocation of APBD for health 2. Fat bureaucracy, because autonomy right is influenced by political interest (Sukarrno, influenced by political interest (Sukarrno, 2013). 3 The performance of manpower which is still 3. Th f f hi h i ill not optimal (PKDOD‐LAN, 2011)
Objectives • The study aims to analyze the process of p g g g health planning and health budgeting in 3(three) districts in East Java, i.e. Mojokerto, Sidoarjo and Trenggalek Sidoarjo and Trenggalek.
Methodology • The research method is qualitative p phenomenology. gy • In 4(four) months, the data is self‐gathered through in depth interview through in‐depth interview • 17(seventeen) informants were chosen through snowball method.
Result • The result showed that budgeting process always involve various actors who having different purposes g p p • “... egosektoral muncul, padahal kita harus mengacu pada visi misi bupati Jadi kita harus menggiring mensinkronkan kearah itu ” bupati. Jadi kita harus menggiring...mensinkronkan kearah itu..” • (“...sectoral ego arosen, in other hand we must refer to mayor’s vision‐mission. So we need to herd ... syncronize to those direction...”) • “kalau kalau dari dewan biasanya ee...punya kepentingan yang dari dewan biasanya ee punya kepentingan yang jelas......jadi yang seperti sekarang ini, karena biar dipilih lagi.... “ • (“while from parliament mostly ...having clear interest...so it just b become right now, due to their intention to be elected once i h d h i i i b l d again...”)
• The result demonstrates an existing political p process throughout the process of health g p planning and health budgeting, from the devising of the work plan (Renja) to the devising of the work plan to the establishment of the law draft (RAPERDA).
Result • Di District’s mayor t i t’ ma or influenced highly on setting up priorities over i fl d hi hl tti i iti different development goals “...(selalu) masih ada ruang khusus (untuk mengubah rancangan) bagi kepala daerah...” (B5) “...there is (always) still special space (to revise the budget) for ( y) p p ( g ) district’s mayor...”) “...beliau punya kegiatan atau program super prioritas .. beliau punya kegiatan atau program super prioritas ” (B5) (B5) “....he/she still have activity or program which claimed as super priority ....”)
• Th There were political bargains over the form of the government liti l b i th f f th t program and its budget . • Disputes over a program’s target location were also detected. “.... waktu hearing ya deal‐deal‐an... tak ke’i sak mene..alah wes sak karepe sampeyan..........misale saya minta tambah .....ya saya bantu t b ht i h h h h tambah tapi..hahahaha..........” (KM5) ” (KM5) “...in hearing time (with parliament) we do compromize....ok this portion is for you well up to you So if i want more no problem I portion is for you...well up to you... So if i want more...no problem I will give you more, but .....hahahahah.....”
• While legislators often conducted a program in such a way that it benefitted their constituencies. “ “...titipan b biasanya di kegiatan, misal kita dapat alokasi hanya bisa d k lk d l k h b memperbaiki 10 pustu, mereka menghendaki 15 pustu atau 10 yang ini ga setuju tapi maunya 10 yang lain. Itu yang biasa dinegokan ..tapi kita sudah punya dasar yaitu usulan resmi dari puskesmas ..” (KT7) d h d it l id i k ” (KT7) “ ....parliament’s order are commonly formed as activities, such as we have allocation that enough only to renovate 10 sub pimary health center (sub PHC) , they ask 15 sub PHC or another 10 sub PHC (to t ( b PHC) th k 15 b PHC th 10 b PHC (t renovate. This kind of matter which always we negotiate...but we already have PHC’ proposal as evidence, ...so we can’t...” “..ada pernah nambah sampai 500 juta karena keinginan mereka... Ya...karena konstituennya ... kita siap asalkan itu tetap menunjang program kita.....” (KT7) ki ”( ) “...there was ever we got additional 500 million rupiah due to their interest...because of their contituent...we are always ready...as long as those interest support our programs...”
• All of the above activities influenced the p g attainment of the health planning and health budgeting and, thus, also influenced the overall success of the health sector overall success of the health sector.
Conclusion • In conclusion, the process of health planning g g y and health budgeting is not a merely economical process; it contains within a powerful political process powerful political process
maturnuwun
H t Haturnuhun h A i tō Arigatō Terimakasih 고맙습니다 谢谢 trimong trimong gunaseh tr imong imong gunaseh gunaseh gracias i dankjewel
ध यवाद ໍຂຂອບໃຈທ ່ ານ
