NGADA Success Story: Improving Governance and Accountability Through District Health Account (DHA)

DHA Ngada“For Ngada district, the results of DHA studies are very important as inputs for policy evaluation and as a basis for the district government in improving the health financing system”. 

“Ngada district health office, with the support of AIPHSS program, has implemented a local tobacco tax to fund the provision of essential and sustainable health care to the most vulnerable communities in the district.”

“The policy of implementing the tobacco tax to fund health expenditures in Ngada district may be one of the most effective methods and can be replicated in other areas in Indonesia to reduce premature death and disability, especially among the poor.”

Yak Yoseph Mawo, S.Sos, Acting Head of Ngada 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 Ngada 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 Ngada 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 as a means by which to fund health   services.

Ngada District Health Office, with the support of a policy process, has implemented a local tobacco tax to fund the provision of sustainable  essential heatlh services to those most vulnerable.  Implementing a tobacco tax may also be one of the most effective methods to  reduce premature death and disability especially amongst the poor in Indonesia.