Summary Equitable Allocation of Health Resources

18 initiative. They will be able to produce more accurate data for workforce projections on an ongoing basis given various development scenarios. The unit within the MoH which is leading this is responsible for providing the Ministry of National Planning and Development and the Ministry of Finance with data on human resource needs for national budget allocations in the health sector. The same program is delivering an Executive Development Program EDP which aims to build capacity for senior managers to undertake strategic management of human resources. To date 40 people across the human resource department have taken part in the EDP program and another 40 are being trained in the workforce planning techniques and tools. Both are in the early stages of implementation so outcomes cannot be reported at this stage. The Health Policy Unit HPU was established in this reporting period led by a senior official who is the former head of the MoH Department for Research and Development. The intention is to provide senior advisers to the MoH with up to date information for emerging high priority policy issues which require an immediate response. AIPHSS senior management identified the HPU as a key mechanism to channel evidence and data produced from AIPHSS activities to assist policy formulation, and to lead on the policy dialogue series. The first policy dialogue was conducted in May 2015 on pharmaceutical policy in the era of JKN using data analysis and experts involved in the HSR to discuss the problem of the high cost of drugs, 14 and the impact on the JKN budget. It recommended seeking cross-sectoral partnership approaches involving the private sector. This recommendation will be followed through independently by the MoH partners. Intermediate Outcome: Providing appropriate, relevant and accurate information The revision of primary health care data is an ongoing activity which will be completed in the next reporting period. Currently Puskesmas are burdened with extensive data collection requirements making the information system dysfunctional, fragmented and poorly used for planning. The objective is to revise and reduce the amount of data and indicators that a Puskesmas is required to report on. It is expected that an improved dataset will contribute to better information at the Puskesmas level. Technical reviews conducted by the PTS on the revised SP2TP Puskesmas Integrated Recording and Reporting and SIKDA-NTT District Health Information System in NTT have revealed some weaknesses in the recommendations being made by the technical team as well a lack of appropriate assessment and coordination with the district level partners. In particular the revised SP2TP needs to be synchronized and combined with SIKDA NTT implemented by the AIPMNH program. The PTS has consulted Pusdatin Data Centre of MoH and NTT DHO and it is proposed to hold a specific meeting in NTT in September 2015 to discuss the integration. Strengthening the surveillance system for maternal mortality is another on-going activity. The intention is to develop a more integrated system for maternal mortality which engages relevant sectors at province-district and sub district level. The model is being trialled in AIPHSS districts and when finalised will be used to develop a national model. Data collection is now ongoing at the sub-district, district and provincial levels. The training of District Health Accounts teams in the AIPHSS districts has been completed and data is now being produced to advocate for the reallocation of health resources for primary care, public health and community outreach. DHA has been advocated extensively to local stakeholders, including local government officials and politicians. At this stage two local governments have promised to allocate additional health funding. From previous experience Prof. Ascobat Gani budget increases of only 10-15 can be expected. This is due to political and government pressures to use funds for the procurement of large capital equipment or structures.

3.4.1 Summary

Contributions to this EOPO are being achieved through all the building blocks and demonstrate how addressing equity and resource allocation is a cross cutting aspect of the AIPHSS program. The major 14 The cost of drugs in Indonesia is one of the highest in the S.E Asia region 19 activities reveal how achieving health systems strengthening outcomes requires integrated efforts across government systems and the involvement of multiple stakeholders at all levels of government. Adequacy of inputs: Careful monitoring of the effectiveness of the EDP will be required in the next reporting period as attendance by the participants has been variable. The activity was negotiated and agreed with MoH before commencement and intended to deliver competencies in strategic management of human resources that would be linked to the projections for workforce planning. The intentions of the inputs and quality of the advisers are adequate; the main risks are the competing work priorities limiting attendance and the application of knowledge skills. Compulsory assignment by the Head of BPPSDMK is needed. To address this, an internal letter has been issued to departmental management emphasising the need to commit to the program and to ensure attendance is compulsory unless there is an emergency. It is a significant investment and must have the commitment of all levels of management. The quality of TA being provided for the SP2TP has been reviewed by the PTS revealing weaknesses in their technical approach. The main problem is a lack of understanding about the needs of the Puskesmas by the technical team and poor coordination between the central level IU and DHOs. The PTS and TD have intervened and held several meetings with the IU and TA team and intend to closely monitor their progress. It should be noted that this is a difficult partner and they do not always respond to inputs and guidance from AIPHSS. Should these issues continue the TD will report the matter directly to the Secretary General. Progress against schedule: The EDP and TA for workforce planning are progressing on schedule. The HSR was completed in the last reporting period 15 exactly on schedule and the RJPMN was released in January 2014. The Puskesmas information systems is behind schedule by 1 month and the human resource information system development is behind by two months because of the time required for an open tender. All other activities are being implemented against schedule. Sustainability: The potential for sustainability is high as all activities are deeply rooted in national and local policy processes and systems with a strong sense of ownership by partners. The uptakes of the HSR and the RJPMN are highly sustainable inputs from AIPHSS, and have shaped national policy and partially influenced the MoH 5 year Strategic Plan. Next Steps:  Continue implementation of EDP but monitor for effective participation.  Continue implementation of workforce planning and the human resource information system  Monitor the outputs from the HPU. Gender, Social Inclusion and Disability: Contributions under this EOPO will support improved access to health resources for poor and disadvantaged, particularly when delivered in the AIPHSS districts as all these districts serve communities which are poor and minority groups. In terms of gender the contribution is from the improved surveillance systems for maternal mortality which is intended to provide improved information for planning maternal health services.

3.5 Governance and Supervision of the Health System