Healthcare reform in the post-Soeharto era and Its effect on the performance of (local) health institutions in West-Kalimantan, Indonesia

Abstract

Decentralization is a core public sector reform in Indonesia, as well as across the globe. Its central principle is the transfer of more authority (power), responsibility (tasks), and (financial) resources to numerous actors at different levels of government, from the central to regional governments (province, district/municipality), or from local government (district, municipality) to its agencies - allowing for the satisfactory delivery of services.

Decentralization in Indonesia has initiated after Soeharto’s resignation in 1998 as a result of several (political) events that degraded the public trust in government. Since then, a vast number of guidelines and norms have been issued by the central government to ensure every level of government performs better. However, decentralization is highly contextual: its effectiveness depends on where and when decentralization processes and systems are applied. It also involves numerous actors across sectors with different levels of autonomy, functions, and tasks. Therefore, the outcomes of decentralization still vary widely across regions in Indonesia. This dissertation proposes a new approach to examining the effects of decentralization, specifically in the healthcare sector, by taking into consideration plausible reasons behind the differing results of decentralization at the level of local government.

This book also offers a framework of a multilevel governance (MLG) system for the analysis of healthcare decentralization. MLG systems emphasize mutual connection and cooperation between numerous actors at central and regional governments, including civil servants, the local people, or corporates, to address or solve healthcare inequity.