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GTZ SISKES & HRD in Nusa Tenggara, 2006 GTZ SISKES & HRD in Nusa Tenggara, 2006 - 2009 The lessons learnt working in the Indonesian Health Sector in the West and East Nusa Tenggara Provinces NGGARA NUSATE TIMUR B A A K D T A I H U S In loving memory of our dear friends and colleagues: Janette Margaret O'Neill (14 May 1955 - 16 November 2009) James Darmawan (9 June 1950 - 11 December 2009) © 2009 Deutsche Gesellschaft fuer Technische Zusammenarbeit (GTZ) GmbH Dag-Hammarskjöld-Weg 1-5 65760 Eschborn, Germany First Published December 2009 Published by Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH The Findings, interpretations and conclusions expressed herein do not necessarily reflect the view of the Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH, or the governments they represent. All Rights Reserved GTZ SISKES & HRD in Nusa Tenggara, 2006 - 2009: Lessons Learnt working in the Indonesian Health Sector in the West & East Nusa Tenggara Province, Indonesia. GTZ SISKES & HRD in Nusa Tenggara, 2006 - 2009 Lessons Learnt working in the Indonesian Health Sector in the West & East Nusa Tenggara Provinces, Indonesia Editor: James Carl Sonnemann Principal Advisor: Gertrud Schmidt-Ehry Layout & Design Karsten van der Oord NGGARA NUSATE TIMUR B A A K D T A I H U S Funded by: Table of contents Factsheet: SISKES..........................................................................................................................................1 Factsheet: HRD.............................................................................................................................................7 Linking IHPB & DTPS-MNCH........................................................................................................................11 Introducing District and Provincial Health Accounts in NTB Province: Public Expenditure Review ........................................................................................................................17 Health Sector Development in the Era of Decentralization: The “Think Tank” Approach......................................................................................................................29 Project flexibility can overcome differing or changing partner priorities..........................................................33 Reproductive Health Program coordination meetings: Where they useful ? ...................................................................................................................................37 Choosing the right introduction strategy: Scattered areas or full coverage of one area................................................................................................47 Different partners require different approaches: Introduction of Desa Siaga in NTB and NTT..................................................................................................51 NTB stakeholders pool resources to respond to local politics ........................................................................55 Making the referral system work: Guidelines for referral improve the handling of pregnancies with complication in West Lombok.....................59 Basic Emergency Obstetric and Neonatal care in NTB..................................................................................67 Empowerment from within: What moves communities to reduce maternal and neonatal deaths?.............................................................81 A community study to change behavior clean hands and cutting fingernails reduce infant diarrhoea: .......... ..95 SISKES partnership with VSO and its skilled volunteers led to greater achievements by the SISKES project.......101 The decentralized application of the WISN methodology ............................................................................105 SISKES SISKES Improvement of the District health System in East & West Nusa Tenggara Provinces The German Government has provided support An ongoing process of learning from experience to Indonesia's Health Sector in East Nusa was initiated in late 2008. Tenggara Province (NTT) since 1999 and in West Nusa Tenggara Province (NTB) since 2006. Three phases of the SISKES project Implemented by GTZ and partners, the SISKES Project addresses District Health System Phase Province Districts Period Funding improvement, focusing since 2006 also on Maternal and Neonatal Health with co-funding SISKES NTT East Sumba, Alor 1999 - 2.452.000 from the British Government (DFID). I 2002 Euro A central principle of the technical cooperation is SISKES NTT East Sumba, Alor, Belu, 2003- 2.345.000 II Kupang, Maumere, Timor 2005 Euro sustainable capacity building, working with Tengah Selatan (TTS), Indonesian Government partners to link all levels Rote Ndao, Ende and to focus strongly on improving the quality of SISKES NTT NTT: Health System 2006- 10.150.000 health systems management. Central level policy III & NTB Development: 16 districts 2009 Euro Making Pregnancy Safer (4.000.000 and guidelines combine with local priorities as a (MPS): 6 districts: Kota Euro BMZ Kupang, Kupang, Timor funding, basis for cooperation and harmonization between Tengah Utara (TTU), TTS, 4.200.000 stakeholders. Collaboration with professional Belu, Rote Ndao £ DFID associations, local NGOs, and others provides For more information about GTZ: additional opportunities for implementation. Primary Areas of Cooperation Organizing Project support through subsidies to be managed by local program officials wherever 1. Health System Management Strengthening possible establishes stronger, sustainable program ownership. Clear steering mechanisms have been Working within the Indonesian Government installed with MoH and at local level to cover three planning and budgeting cycle, the Project improves German-supported projects: Human Resources the health system by linking the various levels Development, SISKES, and Sector Program Health through planning based on local data and priorities addressing health facility equipment (through KfW). in conformity with national policies and standards. 1 Facts This process of Integrated Health Planning and Puskesmas involved demonstrated improved Budgeting (IHPB) is implemented through the performance and client satisfaction. In NTB, 31 of Provincial and District Health Offices (PHO, DHO). the 60 Puskesmas receiving the training also showed A monitoring and evaluation (Monev) toolkit better performance and client satisfaction. The provides integrated review before each new toolkit was later adapted to accommodate a new planning cycle. Sixteen districts in NTT and all ten Ministry of Health curriculum. in NTB are involved in IHPB, and all of their health centers (Puskesmas) (272 in NTT and 142 in NTB) are part of the process as a first step of IHPB. Analysis of district and province health account expenditures (DHA and PHA) has been introduced in all ten NTB districts as an important component of improved planning and budgeting and to promote public expenditure transparency. Local budgeting will sustain the DHA process beyond 2009. In collaboration with the GTZ Good Local Governance (GLG) and policy (PAF) projects, GTZ SISKES supports development of a health financing model in NTB for the poor who are not yet covered under the Ministry of Health's JAMKESMAS plan. In Beginning in 1999, hospitals in NTT received NTT, SISKES II supported expenditure analysis in significant support to improve their management East Sumba (2001-2003), and DHA is currently and infrastructure through GTZ and KfW/EPOS. supported by AusAID in nine districts. KfW provided 14 hospitals with equipment and related support for performance monitoring, SISKES has supported improvement of the Health procurement and maintenance of equipment and Management Information System (HMIS) through nursing management, GTZ supported business local HIS (SIKDA) teams within the PHO and DHOs planning during SISKES I and GTZ/Saniplan (SISKES in both provinces. A simplified manual HMIS II) supported seven hospitals (East Sumba, Alor, format and software version developed in Belu Belu, Ende, Kupang District, Maumere, and TTS) to District of NTT has been approved by the PHO for help them qualify for hospital management roll-out to all other districts of the province. In NTB, autonomy. All were oriented in quality management a computerized, semi-computerized and manual using the European Foundation for Quality system introduced and used in 98 selected Management model, and a pool of trainers was Puskesmas is scheduled for review and expansion at created. Four of the hospitals (East Sumba, Alor, the end of 2009. One NTB hospital has also Belu, Ende) also received intensive training in developed a computerized HMIS. accountancy and human resources management. Three were assisted to focus their quality Forums for coordination of donors at province improvement process in 2009 (SISKES III) on patient level, developed in both NTT and NTB, are fully safety (Kupang, Belu, TTS). Hospital management owned by Indonesian partners through the PHO in training in NTB has been introduced in all seven NTT and the Provincial Planning Board (BAPPEDA) hospitals in collaboration with Universitas Gajah in NTB. Mada/Yogyakarta (UGM), and the process of 2. Health Services Management continuous quality improvement has started. A comprehensive Puskesmas management After assessing referral systems in the five Making training toolkit was developed and used in both Pregnancy Safer program (MPS) focus districts, a provinces. In NTT, evaluation of 79 of the 103 guideline integrating
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