The fate of decentralization by the health sector in Indonesia

By : Zukhrofi Muzar

By implementing decentralization of the health sector in Indonesia, it will give a larger authority for province authorities to handle health problems faced in each provnce by itself. Of course it will narrow “the area” of departement of health in implementing health policies in Indonesia. The centralization pattern of the previous government has become attached in government practice, thus It can lead to conflict of bureaucracy when facing to decentralistic system with its bottom-up model like happens today.

It’s a natural that a system will sustain its inertia if changing happens, likewise with this reformation from centralization to decentralization. But if the government does not hustle to take a stance of this chance effectively, in other words lack of province authoritries responses, it will affect to implementation of decentralization partially, where the central government remain its stranglehold as a main role that actually ought to be at the province government use.

The existence of decentralization policy will bring about a broad implication to province government and community. It can be positive impacts and negative impact too. The positives are : 1) Realization of health development democratically based on people aspiration, 2) Equality of health development and services, 3) Optimalization of potency of health development in province and rural areas that is not cultivated so far, 4) To urge the initiatives and creative attitudes of province government apparatus that is only refer to boss instruction before, 5) To develop a pattern of independency in health services (Including the health financing) without overlooking other sectors role. The negatives come up from government duty of health which ues of the policy comes out from the central government, to be required to make their own programs and policy. If the province government doesn’t have reliable resources to analyze needs, to evaluate programs, the programs that will be made will be pointless and a waste of funding. On that note, the control of funds must be noticed to avoid corruption.

Current decentralization requires more cutting-edge of bureaucracy in government apparatus. This becomes a hurdle since this change needs longer time and commitment from government apparatus.

Law 32/2004 has explained how genuine of reformation from centralization to decentralization is. But in the decentralization of health sectors, there is inequality remaining between vision of province and central government. Implementation of health decentralization is ideal as an attempt to realize Indonesia’s vision in 2010, to be realized soon, since it took long time to make the law. So, there must exist a synergy between the commitment of central government to run the health decentralization integrally and to accelerate and boost province authorities resources in the struggle for health decentralization and at the same time to be responsible for the guarantee quality of implementation health programs in province and rural areas.