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policy, influencing behavioural change through the development and implementation of regulation, and the use of information for evidence based decisions; 2 financing and equitable access and
distribution of resources; 3 improving the skills and distribution of the health workforce; and 4 providing quality health service delivery to obligatory minimum standards.
AIPHSS approach to health system strengthening. is guided by the GoI Ministry of Health MoH which has identified interventions that are designed to strengthen institutional, organisational and individual
performance, and address bottlenecks in health policy , system weaknesses in human resources, health financing , governance and health service delivery. Interventions are selected from an analysis of health
system gaps which have been identified in the Reform Agenda and the Health Sector Review HSR. This approach involves multiple stakeholders, including, ministries, departments and professionals to
identify gaps and to reach agreement on interventions and priorities.
AIPHSS has adopted a flexible and adaptive management approach. Some AIPHSS interventions are modified to adapt to changing circumstances or to the local provincial and district environment.
Interventions are also added at any time to the program when perceived gaps or needs are identified by partners. This responsive approach provides the MoH with rapid access to technical and financial
resources during shifts in policy which planning and budgeting GoI systems do not permit. This approach is a key factor in strengthening the partnership between the Government of Australia and
the Government of Indonesia.
The Implementing Service Provider ISP, Coffey International Development Coffey, sources technical expertise for the MoH and provides management support for the implementation of partner
selected interventions. These technical experts work in partnership with the MoH to identify and respond to key health policy and systems gaps. Interventions are selected by partners based on
partner experience of the health system weaknesses and the changes required alongside available evidence. These technical experts also assist with the development of evidence, advocacy and
implementation of policy and strategic plans.
The main MoH Departments supported by AIPHSS include: 1. Bureau of Planning and Budgeting Roren for governance;
2. The Pusat Pembiyaan dan Jaminan Kesehatan PPJK for health financing; 3. The Centre for Human Resource Development PPSDMK;
4. MoH Directorate for Development Standards BUKD; and 5. Bureau of Law and Organisation
AIPHSS is also supporting activities implemented through the Ministry of Planning and Development ’s
BAPPENAS Health and Nutrition Department. The program also collaborates with the other DFAT funded program such as the, Australian
Indonesian Partnership for Maternal Neonatal and Child Health AIPMNH, the Knowledge Sector Initiative KSI and the health team from the Poverty Reduction and Social Protection Program
TNP2K as well as the Governance Reform Partnership Reform the Reformers.
AIPHSS works with eight district level governments in two provinces which have a high poverty incidence as well areas that have been socially excluded due to ethnicity. These are: Situbondo,
Bondowoso, Sampang and Bangkalan in East Java Province; and Timor Tengah Utara TTU, Flores Timur Flotim, Ngada and Sumba Barat Daya SBD in East Nusa Tenggara Province NTT.
AIPHSS is scheduled to end on 30 June 2016.
1.2 The AIPHSS Reform Agenda for Health System Strengthening
The Reform Agenda acts as a guiding framework for the MoH partners in the selection and implementation of AIPHSS program activities. It provides a problem analysis and current challenges
faced by the national health system to respond to sectoral reforms to meet changing health care demands of communities. It was formulated based on consultations with MoH officials taking into
account the following:
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Key policy directions from the National Five Year Mid Term Development Plan RJPMN
Analysis conducted as part of the Health Sector Review HSR
Decentralisation legislation for health functions
Minimum Service Standards MSS for primary health care. The implementation of the Reform Agenda through the AIPHSS program aims to strengthen the
health system at the national and subnational levels while contributing to the implementation of RPJMN and the new five year MoH National Health Strategic Plan RENSTRA.
The Reform Agenda identified the following weakness in health policy related to the four AIPHSS focus areas:
Governance and Decentralisation
Decentralisation laws and regulations between the different tiers of government central, provincial and district require revision for the following reasons:
The current functional distribution is not consistent with the health system functions as stated in the Perpres-722012 on the National Health System SKN;
The functions do not meet the needs of all population segments;
The Minimum Services Standard, as listed in the Minister of Health Decree-741, does not provide comprehensively cover for essential health needs of communities;
In many districts the recruitment of the District Health Officer by the local government BupatiWalikota is not competency or merit based.
Human Resources
The human resource policy direction provided RPJMN 2015 –2019 and the MoH Strategic Plan 2015–
2019 is “improving the availability, distribution and quality of human resources for health”. The rationale for seeling significant improvement in this area is based on the following:
There is no strategic plan on the number, competencies and production of health workers, the quality and production of the health workforce is not in aligned with the changing demand for
services.
There is n o strategy on how to produce “primary health care physicians” as stated in the Law on
Medical Education UU Pendidikan Kedokteran Medical Education.
Mal-distribution of the health workforce, and insufficient availability, quality and low productivity of public health workers.
Lack of accessible and up-to-date information on human resources for health.
The quality of graduates in many cases does not meet the standard criteria, especially for midwives, and there is a general mismatch in the recruitment and placement of health workers.
There is no career development pattern for the health workforce.
Health Financing
The Health Sector Review identified a range of important policy and systems challenges in health financing which informed the RA. These include amongst others a severe underfunding of public
health services, which in the long term will have a negative impact on the National Health Insurance Scheme JKN financial burden by not addressing prevention and promotion services to address risk
behaviour. In addition, there is a need to find innovative and alternative sources of health financing to ensure public health programs are funded.
The RA highlighted other areas that need addressing:
JKN membership to include non-PBI
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participants, especially workers in the informal sector
Guidelines for a benefit packageclinical pathway and procedures of use
6 PBI is the subsidy for the poor which is administered by PPJK in the MoH
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Cost sharing by participants at service points
Development of cost control and quality control systems
Efficiency and effectiveness of payment of health services provider provider payment.
Defining the basic package of public health and clinical services and ensuring it is costed
Strengthening planning and performance-based budgeting
Strengthening MoH capacity in health financing policy analysis.
Primary Health Care
The RA follows the GoI definition of the main task of a Puskesmas which is improving area widesub-district health status through: 1 promoting community participation and empowerment; 2
implementing public health programs; 3 providing individual clinical health care services; and 4 encouraging health oriented development healthy public policy. Since 1 January 2014, the
Puskesmas has a new function as the primary health care provider for the national health insurance members and now must be equipped to respond to the treatment of 150 different categories of health
conditions which focus the Puskesmas on curative care. This requires Puskesmas reforms related to human resources, management, equipment, financing, information systems, accreditation, referral
and reporting systems. These all need to be tested at the district level requiring collaboration between government at the provincial and national levels.
1.3 Program Framework
