PATTIROs Experience in Health Program

Many hope that the decentralization in Indonesia, that has lasted for 16 years, will result in
improvements on the quality of public services and the use of public budget for the benefits
of society. Rooms of creativity will give regional government (Pemda) opportunities to
innovate the open public services. Sometimes it has to be started from societys response that
controls the management of public services. However, generally people need to be reminded
of their rights to receive these services.
Improvement on health services is one of many important issues that require peoples
awareness massively, especially in the level of communities from the second half of the first
decade of the 2000s. The two main objectives of the health programs are: (1) strengthening
societys awareness, whether it is in the level of communities, media and universities, to
understand more about their rights to health services and the responsibility of the government
as the administrator; (2) bolstering the enhancement of regional governments capacity to
develop mechanisms and service programs to be better in quality, and easier to access.
PATTIROs several important achievements are as follow:
1. Improving the civil societys knowledge and capacity in participating in the planning,
budgeting, administration, and monitoring of health programs. Civil society is able to
convey demands/suggestions/complaints to government and local district parliament
(DPRD) so that health policies may solve the existing imbalance. Enhancement is carried
out through training, health budget analysis workshops, surveys and joint researches with
society on health services, discussions on the enhancement of Integrated Services Post
(Posyandu), public hearings and audiences on policy and budget making, promotion of
rights for health services through mass media, the writing of a book about the
achievements of health quality, and many more.
2. More government administrators act accountably by publishing various policies to meet
societys needs and demands regarding the imbalance of health services. This effort is
executed through workshop of composing the Health Service Standards, giving
recommendations on health service system to the government (Puskesmas or community
health centers; Dinas Kesehatan or Local Health Agency; Bappeda or Regional
Development Agency; and local parliamentarians or DPRD), suggesting budget allocation
to improve health services and many more.
3. Increasing budget allocations and improvements on health service infrastructures. PATTIRO

ensures that the budget is sufficient for delivering the services through joint identification
the society, analyzing the APBD, public campaigns, dialogue with policy makers, and
advocacy to influence the process of budget policy making.

The Distribution of PATTIRO Networks Health Program Experiences

No.

Description of

Result

Region/

1.

2.

3.

Intervention
Health Budget Advocacy
Together with Members
of Posyandu
Communication Forum
(FKKP) advocating an
increase in budget
allocation for Posyandu.

Year
Budget allocation for Posyandu in APBD started to
increase since 2008. Before (2005-2007), only IDR
600.000 for each Posyandu. Since 2008 it became IDR
900.000; IDR 1,2 million (2009 - 2010); IDR 1,8
million (2011 - 2012); IDR 2 million (2013); and IDR
2,5 million (2014)

Surakarta
City,
2008 2014

Initiating and enhancing

Gender Awareness Forum
in Santri City (FPGKS),
in Pekalongan Regency.

This forum tracks the program suggested by the society

in the process of policy making.

Pekalong
an
Regency,
20092010

Advocacy to increase
budget allocation for
Social Health Insurance
in Semarang City

Budget allocation for Jamkesos (Social Security) in

Semarang City was increased, IDR 15 billion (2010),
IDR 25 billion (2011), IDR 40 billion (2012), IDR 45
billion (2013), and IDR 35 billion (2014). The decline
in 2014 was caused by the drop of trend in Jamkesmas
claim in 2013 as much as IDR 35 billion, and the
number was used as a standard in 2014.

Semarang
City,
2010 now

Advocation on Banda
Aceh City Health
Program Planning and
Budgeting

A program called Rumoh Ureng Tuha (House for

Older Peoples Physical and Mental Health Service) in
Lampuk Village, Ulee Kareng District, accommodated
by Banda Aceh Municipal Government

Banda
Aceh
City,
2014

PATTIRO encourages
policies about Health
Insurance in Pekalongan
City. The practices of
assisting society in
accessing health services
are suggested to be
sustainable through
policies.

Pekalongan Municipal Government formulated and

enacted Mayors Regulation No.1B/2011 on the
Administration of Health Insurance in Pekalongan.

Pekalong
an City,
2010

Advocacy on the policy

of the provision of health
insurance for Posyandu
members

As many as 10.000 Posyandu members enjoy the

benefit of inpatient services at a maximum of IDR 7,5
million per year. This policy was approved in 2013,
and enacted in 2014.

Surakarta
City,
20132014

Advocacy on the addition

of Class III rooms for
Jamkesmas services in
Regional Public Hospital
in 2010.

New building construction for Class III services for as

many as 180 bedrooms 2013 - 2014.

2010 2014

Allocation for Maternal and Neonatal Survival

Program were increased from IDR 75 million (in 2009)
to IDR 100 million (in 2010)

Health Policy Advocacy

Materials formulation, and discussions of this policy is

conducted collaboratively between PATTIRO together
with the society and Pekalongan Municipal
Government.

Societys Participation Enhancement

PATTIRO, together with

Nahdlatul Ulama Branch
Board of Executive
(PCNU) in Pekalongan
City, formed Nahdliyin
Centers (NC) in 8 subdistricts (initiative phase).

NC is active in assisting the poor, especially to whom

the health services are not accessible

Facilitating the
establishment initiation
of Members of Posyandu
Communication Forum
(FKKP) in Surakarta City
since 2008.

FKKP is capable of advocating the needs of

POSYANDU to give a proposal about supplementary
food program for the children under five years
old (PMT) budget.

PCNU in Pekalongan City develops this initiative into

an organizational policy. Now it has been formed in 21
out of 47 sub-districts.

Pekalong
an City,
2008 now

Surakarta,
2008

FKKP is able to administer learning practices among

Posyandus, especially about participations in program
recommendation and discussion on Posyandus
program planning, administration, and reporting.
Posyandu in the level of sub-village (Rukun Warga RW), 591 Posyandu for Children Under Five and 297
Posyandu for Older People.

Campaigning healthy life

behaviors through the
enactment of Regional
regulation No. 19/2012
about Areas Without
Cigarette.

Ten Community Centers in Pekalongan (Cabeah

Selatan, Al-Khoiriyah Women Network, Green Beans,
Female Fisherman Labor Committee, Pekalongan
People Forum, Formal Laborer, Green Student,
actively voice the campaign of not smoking in any
place, and use the provided spaces.

Pekalong
an City,
2012 now

Survey on the Society

Satisfaction Index
Toward the Services from
Jeneponto Regencys
Puskesmas.1

Recommendations based on the findings of this survey

are being followed up by the Government. The follow
ups are as follow:

Jeneponto
Regency,
2012

Survey on the Level of

Health Service in 18
Puskesmas2

1. Previously, Ambulances were often

monopolized by the Head of Puskesmas and
were not available when they were needed.
Now, ambulances are ready all the time with a
clear branding and completed with call center
(115);
2. Previously: 4 Puskesmas did not have any
doctors. Now, all Puskesmas have doctors that
serve the community
3. Previously: More than 10 out of 18 Puskesmas
did not have a transparent service flow and
SOP. Now, all Puskesmas display their service
flow.

1 Access

Phase II Jeneponto Regencys Dinas Kesehatan PATTIRO Jeka

2 Access

Phase II

Jeneponto
Regency,
2013

User Based Survey

(UBS) in Lebak Regency
(Puskesmas Cisalam
Rangkas Bitung and
Puskesmas Bojong
Manik) by assisted
society group.

1. Priority findings: the number of doctors was not

balanced yet, lack in the number of midwives,
Puskesmas were not being taken care of, no
queuing number, limited supply of medicine,
and service hours did not follow the rules.

Lebak
Regency,
2008

2. What Puskesmas did as a follow up for the

survey: the procurement of toilets for patients,
queuing number, information board, and a box
of complaints/suggestions in Puskesmas
Bojong Manik. One additional doctor in
Puskesmas Cisalam, improvement on the level
of hygiene with Jumat Bersih (Clean Friday)
movement.

User Based Survey

(UBS) on Services in
Puskesmas in Magelang
Regency (Puskesmas
Salam and Puskesmas
Tempuran)

The main problem in Puskesmas Tempuran (with rural

characteristics) was the need of building improvement.
On the other hand, the problem in Puskesmas Salam
(with urban characteristics and already possessed ISO
9000 certificate) was the services. The level of
societys satisfaction toward the services from
Puskesmas Salam was low.

Magelang
Regency,
2008

Citizen Report Card

(CRC) of Health Sector in
Lebak Regency

Findings: Services coverage of Village Midwives is

only 77 %; Up to 23% of the villages have not been
covered. The service rate of village midwives could
not be afforded by the society. The result is that the
rate of using the midwives service for giving births is
only 19%; meanwhile, 77% respondents choose paraji
(shaman) to help them, 4% choose both (shamans and
midwives).

Lebak
Regency,
2008

The rate of maternal and infant mortality (AKI and

AKB) is still high until 2014.3

Facilitating the
establishment of
Community Centers in 82
villages and the Tunatea
Crisis Center (LPM) in
Jeneponto Regency.

The society intensively performs monitoring and

participates in the improvements of health services.

Citizen Health Budget

Development with the

Comic books about an easy way to read health budget

were distributed widely to the community as well as

Tunatea CC functions as a medium for the society to

monitor public services, especially in the field of
health.

Jeneponto
regency,
2012 until
now.

NTB
Province,

Maternal immortality rate along 2013 in Banten Province was as much as 216 individuals per
100.000 births, or in other words in every 100.000 births there were at least 216 mothers died due
to complication and the process of giving birth (33 cases in Lebak Regency, 35 in Pandeglang
Regency, 57 in Serang Regency, 39 in Tangerang Regency, 12 in the Cilegon, 17 in the Serang, 9 in
Tangerang and 9 in South Tangerang (Tangsel). Around 60 percent from 35.000 babies that were
born in Lebak Regency, had their process of birth helped by Paraji, because there were not many
midwives in this area. Source: Harian Pelita edition 24 November 2014. Link:
http://www.pelita.or.id/baca.php?id=30105.

communities.

books about health budget in Dompu Regency, West

Lombok, North Lombok, and Bima

20122013

Women Report Card

Survey (WRC) of Health
Sector in the City of
Semarang

44,3% of the respondents stated that they people really

needed infrastructures; 22,7% respondents stated that
posyandu members needed incentives. Municipal
Government in Semarang followed up by increasing
the effectiveness of POSYANDUs Operational
Working Group and allocating IDR 250 million for the
procurement of infrastructure, which was worth of IDR
325 million incentives for Posyandu Members.

Semarang
City,
20102011

Facilitating Knowledge,
Attitude and Practice
(KAP) researches on
Surakarta Citys Public
Service User Society

As many as 86% of the people in Surakarta did not

know the regulations about public services. The
society did not know that they have the means to
convey their complaints regarding public services, and
because of that they did not know to whom they should
complain. They just cornered the service providers.

Surakarta
City,
2012

The Inspectorate of Surakarta Municipal Government

responded by making ULAS (Surakarta Complaint
Service Unit) through website, sms and social
networks.
Facilitating KLEM
Researches on Health
Protection Program for
the People of Surakarta

Societys complaints on health services were

identified, and were supported by facts through
observation on and verification toward service
providers

Surakarta
City,
2012

People had the needs of complaint channel services for

Surakrata Public Health Care Program (PKMS). This
finding was followed up by establishing PKMS Call
Center.
3. Technical Assistance Toward Government
Facilitating the Trainings
on Puskesmas
Management to Enhance
Service Quality
Facilitating the Trainings
on Puskesmas Service
Quality

4. All Heads of Puskesmas understand and practice

Puskesmas important roles as frontmen of
health services in ensuring societys rights to
receiving those services. Because the
Government of Jeneponto Regency replaced
17 out of 18 Heads of Puskesmas, the
replacements needed trainings on service
management.
5. Medical personnel understand their roles as a
key factor in the improvement of Puskesmas
services to serve professionally.

PATTIRO Facilitated
Trainings on Voluntary
Counseling and Testing
(VCT) Contagious Sexual
Infection (IMS) in
Jeneponto Regency.

18 Puskesmas in Jeneponto Regency had held health

services for patients suspected with HIV/AIDS.

Jeneponto
Regency,
2014
Activities
are
funded by
APBD

Facilitating the
Formulation of Minimum
Service Standards (SPM)
for Health Services.

Minimum Service Standards (SPM) in Surakarta City

was set and used as a standard in the planning,
budgeting, and development of health in Surakarta
City.

Surakarta
City,
2008

Technical Assistance for

the Formulation of
Standard Operating
Procedure (SOP) for the
Services from Local
Health Agency

The result was 5 SOPs that had already been approved.

Those 5 SOPs are as followed: Health Information
Service, Health Promotion Program Reporting;
General Government, General Administration, and
Study Task in Surakarta Local Health Agency.

Surakarta
City,
2013

Technical Assistance for

the Formulation of Unit
Cost on Health Minimum
Service Standards

The result was Unit Cost for services in relation to the

health of mother and child. It was then used in 2013 in
formulating APBD 2014 for Local Health Agency.

Surakarta
City,
2013

Reflection. Huge imbalance still exists between efforts performed by regional government
with the hopes/needs of the society regarding health services. One of the reasons is that the
policy of decentralization that shifted the responsibilities for health affairs from central
government to regional government was not followed by the balance of its budget
management.