BONDOWOSO Success Story: Improving Governance and Accountability through District Health Account (DHA)

DHA Bondowoso“When we review the calculation of DHA on health expenditures in Bondowoso, it appears that the allocation of funds for public health efforts (UKM) is smaller than for the individual health efforts (UKP)”.

“This suggests that the  health funding in the district so far is still directed to curative care rather than to promotional and preventive efforts, with the biggest beneficiaries from the productive age group”.

“The DHA results provides inputs for policy evaluation and   basis for the government of Bondowoso in improving the health financing system in the district”.

Dr. Moh. Imron, M.MKes, Acting Head of Bondowoso District Health Office.

Using good quality data in a timely manner to inform health sector  planning and allocative decisions as well as advocating for the health needs of the local community are core functions of a district health office and necessary skills which contribute to improving local governance and accountability.

Owing to the large, decentralized structure within Indonesia and a complex pattern of health care financing in the public sector, the compilation of reliable and comprehensive data on health expenditures has always been a challenge. However, in Bondowoso the institutionalization of District Health Accounts (DHA) as a tool for evidence based planning has resulted in finance data being used by local health offices to advocate for an increase in the district health budget.

Health Law in Indonesia states that 5% per cent of the national budget and 10% of district budgets must be allocated to health. The DHA analysis conducted by the Bondowoso District Health Office—with assistance from the Australian Government through Australia Indonesia Partnership for Health Systems Strengthening (AIPHSS) Program— indicated that the mandatory 10% contribution to health within the district health budget was not met. The analysis also demonstrated a shift in spending from primary health care to one more focused on curative services which could lead to the future escalation of unsustainable health care costs in the district.

District health financial data was then used by the district health team with local government to advocate for an increase in district health   funding to meet obligations under the health law. The prioritization of funding to one which better supported sustainable and efficient primary health care services and in particular for health programs which improved maternal and child health outcomes and to strengthening support for the national health insurance system (JKN) as a means by which to fund health   services.