Download role of development assistance in supporting health system policy

ROLES OF DEVELOPMENT ASSISTANCE
IN SUPPORTING HEALTH SYSTEMS
POLICY FORMULATION AND REFORM
IN INDONESIA*
Soewarta Kosen
Health Economics and Policy Analysis Unit,
Center for Community Empowerment, Health Policy and Humanities,
National Institute of Health Research & Development
Ministry of Health Republic of Indonesia
*Presented at the 4th Technical Review and
Planning Meeting for the Health Policy and
Health Finance Knowledge Hub,
Melbourne 10-11 October 2011
THE HEALTH SECTOR IN INDONESIA IS
CHANGING
 The mix of diseases (double burden) is changing due to the
epidemiological and demographic transition:
 The private sector has played an important role in meeting the
demand for health services
 These changes with different pace of area development will continue
in the future
 Overall health spending (both private and public) is low by
international standards, and much of current public sector health
spending is devoted to curative care
 Decentralization of the health sector and democratic environment,
human rights issue (compulsory assignment of health man-power,
hospital autonomy, health equity, poverty alleviation) change the
climate
 Growing number of middle income population and better educated
civil society demand better quality of health care (GDP per capita in
2010: US $ 3,300.00)
HEALTH SECTOR REFORMS
• Main strategies and health programs
Influenced by world environment and agenda
of international agencies, among others:
• Child survival (Unicef, USAID)
• Safe Motherhood/Making pregnancy Safer (WHO,
UNICEF, UNFPA, USAID, AusAID)
• Fighting ATM (Global Fund, WHO, AusAID)
• Malaria control program (USAID, WHO)
• Managed Care (USAID)
• Social health insurance (GIZ)
• Decentralization of health sector (WHO, World Bank, ADB,
European Union)
• Investment in Health (World Bank)
• MDGs, NCD (UN, World Bank, WHO, etc.)
• Health Systems Strengthening (WHO, AusAID, World
Bank, Global Fund)
How?
• By exposing policy makers to international initiatives
thru international, regional & national conferences/
workshops/meetings
• Organizing in-country policy workshops /seminars (WB
organizing several policy workshops for decision
makers on Investment in Health, Health Transition &
NCD, Decentralization, Human Resources for Health;
WHO-TFI: on tobacco tax)
• Thru development assistance (Grants, Loans)
– USAID: managed care project, health sector financing
project, Hospital Autonomy, Family Planning, HIV/AIDS
– WB and ADB: Decentralization of health sector
– WB, GIZ: Health Management Information System
– JICA: MCH Handbook
– AusAID: NHA, Making Pregnancy Safer
– Global Fund, AusAID: Health Systems Strengthening
DIRECT DEVELOPMENT ASSISTANCE
FOR POLICY
• USAID supported the the formation of Health
Economics and Policy Analysis Unit of the Bureau
of Planning, MoH (1988) and policy research
activities
• GIZ supported development of the Center for
Health Policy & Development, MoH and
development of Social Health Insurance (2004)
• The MoH maintains independency in policy
formulation
CURRENT HEALTH SYSTEMS POLICY
FORMULATION
• Growing number of national & local health
experts in various fields (educated in country and
overseas)
• Better capacity in implementing policy research,
policy analysis and engaging in politics of health
• Increased national and local health budgets
• Increased roles of national and local parliament
in health planning and budgetting
• Increased transparancy and roles of civil society
What are still needed?
• Operations research/health systems research
and policy research
• Pilot projects
• Technical assistance with specific tasks
• Equal cooperation in conducting research and
training
• Advocacy Seminars/Workshops on specific
topics
• Capacity development in specific area: equity
analysis