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TABLE OF CONTENTS
INTRODUCTION 1
TABLE OF CONTENTS 2
CHAPTER 1 EXECUTIVE SUMMARY 3
Kinerja’s Objectives and Achievements 3
Recommendations for Local Government Managers 6
Recommendations for Candidates of Implementing Organizations 6
Recommendations for Education and Training Institutions 7
CHAPTER 2 KINERJA ’S APPROACH
8
Kinerja’s General Approach 8
Principles of Health Governance 9
Elements and Stages in MSS Costing for Health 10
CHAPTER 3 KINERJA ’s EXPERIENCE IN MINIMUM SERVICE STANDARDS FOR
HEALTH 12
MSS Conditions in the Field 12
How Kinerja Began Working 13
Work Process 15
CHAPTER 4 ADDRESSING CHALLENGES AND ACHIEVING SUCCESS 18
Challenges 18
Program Success 19
CHAPTER 5 RECOMMENDATIONS FOR REPLICATION 22
Recommendations for Governments Interested in Replicating Kinerja’s
Approach 22
Recommendations for Consultants and Implementing Organisations 23
Recommendations for Training Providers 23
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CHAPTER 1 EXECUTIVE SUMMARY
Kinerja’s Objectives and Achievements
1. Objectives
Kinerja is a good governance program focusing on improving public service delivery in the sectors of basic education, maternal and children health, and business enabling environment.
The project is funded by USAID and implemented by a consortium consisting of RTI International as the lead firm, The Asia Foundation TAF, Kemitraan-Partnership, Social Impact SI, SMERU
Research Institute, and Gadjah Mada University UGM. The program implementation period is five years from September 30, 2010 until February 28, 2015.
Kinerja’s programs are carried out in 24 districts and cities in five provinces – Aceh, West Kalimantan, East Java, South Sulawesi, and Papua. KINERJA works with districtcity, provincial,
and central governments, and implements the program through civil society organisations CSOs to improve participation, transparency, and accountability. The program strengthens
local governments to become more responsive towards the public demand for better-managed public services.
Kinerja applies a double-sided approach, working with both service providers the ‘supply side’
and service users the ‘demand side’. The project encourages both sides to improve good
governance. On the supply side, Kinerja supports district technical offices eg, the health office, service units such as community health centers, local governments, and local parliaments to
implement effective and efficient management that leads to improved public services and the achievement of service standards. On the demand side, Kinerja facilitates activities aiming at
raising public awareness and increasing public participation and oversight of public service quality. The program supports multi-stakeholder forums MSFs, citizen journalists and
alternative media, and other community forums who share the same concerns. Working with the supply side, Kinerja builds capacity of service providers to adopt innovations in
service management and good practices of public service improvements in order to achieve minimum service standard MSS targets. MSS is a list of the types and qualities of basic
services that must be provided by district governments, and that each citizen should receive to a minimum level. Incorporating MSS into programs is mandated by the government regulations.
For example, MSS in health is stipulated by the Health Ministerial Decree No. 741MenkesPer VII2008 on Implementation of MSS in Health at the District Level. The standards are made up of
18 indicators, such as prenatal and ante-natal visits, coverage of births assisted by trained medical professionals, and basic health services for the poor.
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Kinerja’s objectives can be identified as follows:
1. Creating incentives for local governments to improve services
Incentives encourage district governments and service units to perform better, through improved accountability and stronger citizen participation, rewards or sanctions for
good or bad performance, and pride or shame when local government achievements are made public.
Kinerja’s technical assistance aims at creating strong incentive mechanisms. For example, Kinerja assists with training citizens to have a more effective
voice in advocating for public service delivery improvements, supporting local governments’ performance management systems, increasing competition through
benchmarking, and developing various award programs.
2. Encouraging local governments to adopt innovations in public services
Kinerja offers choices of targeted and well-designed technical interventions in three sectors; education, health, and business enabling environment. The program focuses on
a limited number of critical elements that will have positive impact, rather than implementing diverse activities.
3. Replicating improved public service management systems to other regions with
assistance from implementing organizations and consultants. Kinerja hopes that replication will help expand its impact nationwide.
4. Applying a rigorous impact evaluation scheme using carefully selected control
districts and in-depth studies. The evaluation measures the program results to reveal the most effective intervention, why, and how.
2. Kinerja’s Sites
Kinerja works in 24 districtscities in 5 provinces: 1. Aceh: Aceh Singkil, Aceh Tenggara, Bener Meriah, Simeulue, and Kota Banda Aceh
2. East Java: Bondowoso, Jember, Probolinggo Tulungagung, and Kota Probolinggo 3. South Sulawesi: Barru, Bulukumba, Luwu dan Luwu Utara, and Kota Makassar
4. West Kalimantan: Bengkayang, Melawi, Sambas, Sekadau and Kota Singkawang 5.
Papua: Jayapura, Mimika, Jayawijaya, and Kota Jayapura. Of the 24 districts, Kinerja assisted 13 districts in round one and 17 districts in round 2 on
MSS in health.
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3. Kinerja’s Achievements in MSS Planning and Budgeting for
Health
Kinerja’s non-MSS health programs at the district level focus on maternal and child health, with a focus on safe delivery and immediate exclusive breastfeeding.
In MSS for health, Kinerja’s assistance with planning and budgeting has resulted a number of key achievements along the length of the cycle:
Some examples of achievements at the drafting stage: a
More districts are able to complete MSS planning and budgeting after being supported for just six months. The planning and budgeting process includes
revamping data collection system for health MSS baseline calculation, analyzing MSS achievement gaps
and their causes, identifying and prioritizing programs, and calculating resources needed to achieve MSS targets MSS costing.
b Some district governments have successfully integrated MSS costing results into the regional planning and budgeting. This achievement means that the district administration
uses MSS to develop their plans and budgets. Some examples of achievements at the implementation stage:
a Some Kinerja-supported districts, such as Bener Meriah, Aceh Singkil, Jember, Singkawang and Bulukumba, have integrated MSS costing results into the district
planning and budgeting. Singkawang incorporated the MSS costing results into the strategic plan of the District
Health Office’s Regional Medium Term Development Plan RPJMD 2013-2018. Jember used the MSS costing results to allocate more than 79
billion Rupiah US5.7 million in the Public Financing Policies and Ceiling for Temporary Priority Funding KUA-PPAS 2014. The budget was used to finance health programs
that aimed to meet key MSS targets. b Makassar City issued a Mayoral Regulation on the Implementation of Minimum Service
Standards MSS for Health. The regulation includes sections on annual targets and program priorities which support the achievements of indicators and deadlines of health
MSS for 2015. The targets and programs were established by the district health office, MSF, and Kinerja through referring to the MSS costing results.
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Recommendations for Local Government Managers
Kinerja-supported MSS planning and budgeting programs have brought concrete results and changes to a number of districts throughout Indonesia.
Kinerja encourages district administration managers, particularly those from areas with limited budgets and big gaps in health care,
to learn from the project’s experiences. Kinerja hopes these leaders will learn about health MSS costing and integration of the MSS costing
results into planning and budgeting documents. Learning from the project’s experiences,
Kinerja would like to make the following recommendations: a Strong commitment from local government leaders district headmayor, district
parliament, district secretary, and head of district health office is essential for the implementation of MSS in health.
b Policies on public service provision should refer to MSS indicators in order for clear and easy measurement of achievements and outputs.
c Civil society organizationsCSOs and community multi-stakeholder forums MSFs must be involved in health governance programs.
d Existing staff, organizational structures, and local resources, such as Health Committees and universities should be empowered and used. It is not necessary to create new
working groups. e Coordination among the district technical offices such as the district health office and
other relevant local government agencies should be improved. f Performance indicators should be developed and program success should be measured.
g Local government agencies can adopt
Kinerja’s approaches and tools as supporting instruments to improve public services.
Recommendations for Implementing Organisations
Kinerja’s implementing organisations IOs and consultants are experienced in assisting district governments and community represenattives with MSS planning and budgeting for
health. They are invaluable local assets. With this in mind, the project makes the following recommendations for IOs and consultants who will continue working on MSS in health:
a To integrate good governance principles and involve the community in all activities and programs.
b To focus on achieving results, rather than fulfilling activity schedules and meeting the required number of participants.
c To provide stimulating advice and assistance, rather than acting as an employee. d
To use Kinerja’s modules to improve capacities of IOs, local governments, and the community.
e To increase capacity by working with other IOs and universities.
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Recommendations for Education and Training Institutions
Government owned-education and training institutions are strategically positioned to build the skills of government staff. They have significant influence on government staff
’s capacities because they provide them with regular trainings. Therefore, Kinerja recommends that training
intuitions to adopt the project’s approach and good practices in their curriculum and trainings.
Kinerja particularly recommends: a involving citizens in the implementation of good governance, as citizens are the users of
public services. b focusing more on improving skills rather than increasing knowledge.
c adopting the modules, innovations, and good practices developed by Kinerja, other donors, relevant technical ministries, and the Ministry of State for Administrative Reform.
d conducting regular trainings on public service provision, and exercising possibilities to work with other organizations IOs, consultants, and local government agencies that have been
innovative in public service improvements.
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CHAPTER 2 KINERJA
’s APPROACH
Kinerja’s Approach
Kinerja takes a two-pronged approach, working with both supply and demand sides, in its efforts to assist local governments in improving public services in health, basic education,
and business enabling environment. To achieve improvements, the project works through three types of intervention: incentives, greater innovation, and replication. Through this
intervention, local governments in Indonesia are expected to provide better quality services, and to be more responsive to the needs and requests of citizens.
One of the key aspects to Kinerja’s approaches is the participation of citizens, civil society
organizations CSOs, and local media, including alternative media and citizen journalists. These community members are encouraged to advocate for better public services. At the
same time, the project works with service provides to improve their capacity to meet the citizens’ demands.
With regards to MSS planning and budgeting, local parliamentarians play a strategic role since they are responsible for approving and overseeing the budget. In addition, the regional
planning and development agencies Bappeda have an important role as the regional planning coordinator. Most of
Kinerja’s activities are implemented by IOs and short-term consultants. Both receive training on governance and public service provision from the
project. Kinerja’s core strategies to improve local government and community capacity are:
1. Supporting the development of evidence and research-based policies, plans, and budgets, such as Regional Budget Analysis and MSS costing.
2. Establishing multi-stakeholder forums MSFs as part of an effort to stimulate participatory planning and budgeting. Through the forums, governments and citizens are
expected to create a strong partnership and work together. 3.
Involving citizens in public service oversight through implementing complaint-handling mechanisms, and developing service charters and technical recommendations.
4. Supporting public information officials to provide the public with access to information, as well as encouraging local media and citizens journalists to advocate for better public
service delivery. 5.
Establishing a team to draft MSS plans at the district level, whose membership consists of government staff and community members. The mixed background of this team leads
to better participatory planning and budgeting.
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Kinerja has three intervention focuses: 1. Improving capacity of service users
the ‘demand side’. 2. Promoting good practices and supporting local authorities to test and to adopt standard-
based health services. 3. Replicating good practices at the national level and supporting organizations in Indonesia to
disseminate good practices to local governments and assist with their implementation. Working with both service providers
the ‘supply side’ and service users the’demand side’, Kinerja is able to successfully promote the key good governance principles of transparency,
accountability, public participation, and responsiveness
Principles Governing the Health Sector
Kinerha’s health programs focus on safe delivery and immediate exclusive breastfeeding IEBF, which are implemented in Indonesia by referring to MSS targets. Kinerja uses the
following principles in providing technical assistance in the health sector:
• Encouraging coordination between health offices and other government bodies.
Maternal and child health MCH is not the sole responsibility of district health offices and community health centers puskesmas. It requires the support of a number of other local
government agencies, including district planning office Bappeda, organisational bureau, finance office, district labor office, sub-district governments, village governments, and the
district parliament. Therefore, cooperation among the local government agencies is crucial for good implementation of MCH programs
.
• Community participation. Community participation through groups such as multi-
stakeholder forums MSFs is important. It is important not only because citizens are legally obliged to assist with monitoring public services, but because public participation helps
service providers and district health offices to deliver programs in a more transparent and accountable manner. It also enables service providers to continuously improve their
services.
• Sustainability. MCH programs should obviously be sustainable. Sustainability can be
achieved when governments and communities monitor the program implementation together, and when the community members perceive that said programs benefit them.
• Meeting service standards. Service standards MSS, SOPs, Public Service Standards,
and ISO, when implemented properly, can be of great assistance in helping service providers to better measure their performances. Referring to standards also helps service
providers to compare the quality of their services to those of other districts and provinces, or even at the national level.
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Elements and Stages in MSS Costing for Health
Kinerja identifies the major elements of MSS planning and costing as: 1. Application of MSS andor other service standards will promote continuous and sustainable
improvement of public services. 2. Government regulations on MSS and other standards ensure that public services are not only of
better quality, bur are more equal and focused. 3. MSS costing is only useful if using valid and up-to-date data. Good data collection by district health
offices, community health centers, and hospitals is thus a major pre-requisite for MSS costing. 4. MSS costing is conducted based on government guidelines. It addresses the gaps between current
achievements and the targets set at the provincialnational level. In other words, the MSS costing is not decided by the head of health centers, community groups, or the head of districts.
5. Local governments are responsible for MSS costing. This task is carried out by an MSS team, whose membership consists of local government agencies, parliamentarians, and community members.
6. MSS indicators include achievements so that health budgets can be used for public service improvements, MSS compliance, and MCH quality improvements.
7. Local regulations such as Executive Decisions and District Regulations are essential to ensure that
MSS implementation is sustainable. 8. Regular monitoring and evaluation is important to ensure that MSS implementation meets identified
targets and to address any issues that emerge. 9.
Transparent complaint handling helps service providers to provide services that meet people’s needs and demands.
The process of MSS planning and costing at the district level is: 1. Making an agreement with the head of district, the head of puskesmas, and the head of Bappeda on
MSS costing activities. 2. Establishing the MSS team, which consists of divisions in the district health office, such as program
development, health services, and family health, puskesmas, socio-culture division in Bappeda, finance office, organization secretary, health commission of the local House of Representatives, sub-
district officials, and MSFs at sub-district and district level. Then, the head of district health office formalizes the team.
3. Assigning facilitatorstrainers to assist the MSS team in the planning and costing process. 4.
Organizing workshops to improv e stakeholders’ understanding of MSS. Local governments may
conduct a comparative study on how MSS is implemented in other districts, if necessary. 5.
After completing the previous steps, the MSS team is responsible for integrating MSS costing results into the district planning and budgeting documents, and monitoring the achievements.
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CHAPTER 3 KINERJA’S EXPERIENCE IN
