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 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)  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