Health Strategy in a Post-Crisis, Decentralized Indonesia
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World Bank, Washington, DC
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The study reviews the strategy for a
prospective health development, and the health benefits
associated with decentralization, in a likely challenging
near to medium term period in Indonesia. It addresses the
major government reorganization, expected to take effect in
January 2001, which could well define the social process
during the next decade, consisting of decentralization of
spending authority, enhanced access to resources at local
government levels, and civil service reform. The potential
health system benefits, associated with decentralization,
will enable citizens to become involved systematically in
decisions regarding health policy, design, and financing, as
well as influencing service provision. The report describes
the health system performance, and costs in the country,
namely an adaptation of health for all, aimed at a wide
coverage, featuring integrated service provision at the
primary health level. However, mixed results proved great
imbalances, for low income families lagged behind other
quintiles in terms of infant mortality rates, prevalence of
specific diseases, and nutrition problems, while households
in the top expenditure distribution, proved high uses of
public facilities, compared to the bottom expenditure
distribution. The pre-crisis policy is examined, i.e., the
impacts on the provider-client equation; and, policy options
offer opportunities through decentralization, reform related
issues, and effective partnerships with non-governmental
organizations, and donors.
Palabras clave
BASIC HEALTH SERVICES, COMMUNICABLE DISEASES, COMMUNITY HEALTH, DEATHS, DECENTRALIZATION, DECISION MAKING, DEVELOPMENT GOALS, DISEASE CONTROL, DISTRICTS, DOCTORS, EMPLOYMENT, EXPENDITURES, EXTERNALITIES, EXTERNALITY, FAMILIES, FAMILY PLANNING, HEALTH CARE, HEALTH CENTERS, HEALTH EDUCATION, HEALTH EXPENDITURE, HEALTH FACILITIES, HEALTH FINANCE, HEALTH FINANCING, HEALTH FOR ALL, HEALTH INDICATORS, HEALTH INTERVENTIONS, HEALTH INVESTMENTS, HEALTH OUTCOMES, HEALTH POLICY, HEALTH PROGRAMS, HEALTH PROMOTION, HEALTH REFORM, HEALTH SECTOR, HEALTH SERVICES, HEALTH STATUS, HEALTH SYSTEM, HEALTH SYSTEM PERFORMANCE, HMO, HOSPITALS, HOUSEHOLDS, IMMUNIZATION, INFANT MORTALITY, INFANT MORTALITY RATE, LABORATORIES, LAWS, LOCAL GOVERNMENTS, LOW INCOME, MALNUTRITION, MEDIA, MEDICAL CARE, MORBIDITY, MORTALITY, MOTIVATION, NGOS, NURSES, NURSING, NUTRITION, OCCUPANCY, OCCUPANCY RATES, OUTPATIENT CARE, PARTNERSHIP, PATIENTS, PERSONALITY, PRIMARY CARE, PRIMARY HEALTH CARE, PRIVATE SECTOR, PROFESSIONAL ORGANIZATIONS, PROVIDER INCENTIVES, PUBLIC HEALTH, PUBLIC HOSPITALS, PUBLIC SECTOR, PUBLIC SERVICES, RESIDENCES, SAFETY, SCHOOLS, SUPERVISION, SUSTAINABILITY, SUSTAINABLE FINANCING, UNIVERSITIES, WORKERS HEALTH SYSTEMS DEVELOPMENT & REFORM, GOVERNANCE, HEALTH ECONOMICS HEALTH CARE ADMINISTRATION, HEALTH CARE DELIVERY, HEALTH CARE COST CONTROL, HEALTH CARE REFORM, DECENTRALIZATION, GOVERNMENT POLICY CHANGES, GOVERNMENT DEREGULATION, LOCAL GOVERNMENT PARTICIPATION, RESOURCE AVAILABILITY, CIVIL SERVICE REFORMS, HEALTH CARE FINANCING, HEALTH CARE DELIVERY, COST ESTIMATES, HEALTH INDICATORS, PRIMARY HEALTH CARE, INTEGRATED HEALTH CARE, INEQUITY, POLICY REFORM, NONGOVERNMENTAL ORGANIZATIONS, DONOR PARTICIPATION