PENGARUH DESENTRALISASI FISKAL TERHADAP PELAYANAN PUBLIK SEKTOR KESEHATAN DI INDONESIA

• Main Author: Nurrahmawati, Nina
• Format: Final Project
• Language: Indonesia
• Subjects: Perencanaan wilayah
• Online Access: https://digilib.itb.ac.id/gdl/view/32008
• Institution: Institut Teknologi Bandung

Decentralization has lasted for one and a half decade in Indonesia. Decentralized governance itself is a form to improve basic public services provision which tends to decline if it runs by centralized governance. Regional development based on local capacity is important to be implemented because it plays an important role to support the region in the era of decentralization. In addition, delegating responsibility to the local level is expected to improve both technical and allocative efficiency. Decentralization is also expected to achieve Millennium Development Goals (MDGs) achievements by local government through the provision of public services. Since the health sector is one of the main goals of MDGs, this study aims to determine the impact of fiscal decentralization on public services of health sector in Indonesia. There are three objectives in this study; the first is the identification of conditions and patterns of fiscal decentralization component dynamics related to the health sector in Indonesia; second is the identification of the condition of outputs and outcomes of health services and patterns of its development in Indonesia; and third is the identification of the relationship between components of the fiscal decentralization and public health services. This study uses the quantitative approach. Data collected through survey of secondary data. The data used fiscal decentralization components data and indicators of public health services in 476 regencies/municipalities in Indonesia during 2010-2013. The data is analyzed by using statistical descriptive analysis, spatial analysis, R-Pearson correlation analysis and econometric analysis of panel data. The results shows the development of a special allocation fund of health (DAK Kesehatan) and health spending—as a fiscal decentralization component—fluctuates every year. However, the progress on outputs and outcomes of public health services tends to increase each year. Meanwhile, the influence of regional disparities are not distinguishable in the development of health component of fiscal decentralization. While in health indicators, it appears that the gap between regions affect the achievement of health indicators, which at KBI, Java-Bali and municipalities are likely to achieve better health indicators than KTI, non Java-Bali and regencies. The relationship between special allocation fund of health with an output of health facilities—such as Puskesmas—tends to be very weak-moderate, while the relationship between health spending and Puskesmas ratio to population is moderate-strong. The regression analysis of panel data shows that components of fiscal decentralization have a positive impact on health services outputs and health outcomes. Therefore, it can be concluded that fiscal decentralization affects public health services. However, from the fiscal decentralization components of health, only health spending has positive and significant impact to the public health service indicators. Meanwhile, the fiscal balance transfer from the central government—which is given as special allocation fund of health—is not giving a significant effect to the public health services.