Decentralization of Public Healthcare Services in the Province of Sumatera Utara, Indonesia

Februati Trimurni


The study examines the effectiveness of decentralization program on the healthcare sector at the provincial level in the context of political and administrative decentralization. The study adopts a qualitative approach and employs the technique of in-depth interview, observation and documentation. Informants consist of public servants, practitioners, community and relevant stakeholders. The study found the implementation of decentralization does not work that ideal for some reasons. Firstly, the devolution and the deconcentration programs are not conducted simultaneously, mutually support and complimentary. Secondly, the lack of local apparatus capabilities to understand  and carry out the principles and the practices of the programs in the field. Finally, the limitation of financial sources and support to conduct the programs. The study furthermore recommends the needs to synergies the “devoluted” programs and the deconcentrated programs in the field, enhancement of local capacities to undertake the healthcare programs as well as the need to reform and improve local fiscal..


Alfiyanti, R, “Evaluasi terhadap Akuntabilitas Dekonsentrasi pada Departemen Energi dan Sumber Daya Mineral” Jakarta:Universitas Indonesia, 2010.

Apreku, S. S, “Does decentralization improve public service delivery? Issues and policy implications for Uganda” Thesis (M.D.E), Dalhousie University, 2003.

Cheema, G. S. & Rondinelli, D. A, “Decentralization and Development: Policy Implementation in Developing Countries “ Beverly Hills, London, New Delhi: Sage Publications, 1983.

Creswell, J. W. & Poth, C. N, “Qualitative Inquiry and Research Design: Choosing Among Five Approaches: Sage Publications, 2017.

Detik, “Sri Mulyani: Ada 131 Daerah yang Setengah APBD Habis Buat Gaji PNS” Wednesday, 10 May 2017.

Exworthy, M., “Are NHS Foundation Trusts Able and Willing to Exercise Autonomy? ‘You Can Take a Horse to Water'’ Journal of health services research & policy 16:232-237, 2011.

Hartanti, E, “Alokasi Dana Dekonsentrasi Kementerian Pendidikan Nasional Kesesuaiannya dengan Peraturan Pemerintah No. 38 Tahun 2007” Jakarta: Universitas Indonesia, 2010.

Hoffman, B., & Kaiser, K. “The Making of the Big Bang and its Aftermath A Political Economy Perspective” A Conference Sponsored by the International Studies Program Andrew Young School of Policy Studies Georgia State University, 2002.

Kiriaghe, U. M, “The Impact of Decentralization on Health Service Delivery in Western Uganda” ProQuest Information and Learning Company Database, 2006.

Kobandaha, M, “Pelaksanaan Tugas Dekonsentrasi Oleh Gubernur Kajian Penyusunan Peraturan Daerah APBD di Kabupaten Bolaang Mongodow”, Jurnal Hukum Unsrat, 1:55-63, 2013.

Langran, I. V, “Decentralization, Democratization, and Health: The Philippine Experiment, Journal of Asian and African Studies, 46:361-374, 2011.

Ostwald, K.,, “Indonesia's Decentralization Experiment: Motivations, Successes And Unintended Consequences“ Southeast Asian Economies (JSEAE): 33:139-156, 2016.

Van der Geest, S., “Primary Health Care in a Multi-level Perspective: Towards a Research Agenda”, Social Science & Medicine 30:1025-1026, 1990.

Rajesh, K. & Thomas, M. B, “Decentralization and Interventions in the Health Sector “ Journal of Health Management, 14: 417-433, 2012.

Rondinelli, D. A., “Decentralization in Developing Countries. A Review of Recent Experience, World Bank 5-12, 1984.

Schmit, Leo, “Indonesia Law and Society ” in T. Lindsey (Ed.) “Decentralization and Legal Reform in Indonesia: The Pendulum Effect (The Second Edition)”, Australia: The Federation Press, 2008.

Sciortino, R, “Perawat Puskesmas di Antara Pengobatan dan Perawatan” Yogyakarta: Gadjah Mada University Press, 2007.

Smith, B. C, “Decentralization: The Territorial Dimension of the State” UK: George Allen and Unwin Ltd, 1985.

Sun, F., “An Exploratory Study of the Relationship Between Decentralization and Health System Performance” University of Alabama: Birmingham, 2003.

Usman, S., “Pelaksanaan Desentralisasi dan Otonomi Daerah, Kasus Tiga Kabupaten di Sulawesi Utara dan Gorontalo Jakarta: Lembaga Penelitian SMERU, 2001.

Widmalm, Sten, “Decentralization, Corruption and Social Capital: From India to the West New Delhi”, India: Sage Publications, 2008.

Widyanti, W., “The State of Local Governance and Public Services in Decentralized Indonesia in 2006: Findings From the Governance and Decentralization Survey 2 (GDS2)” Jakarta: SMERU Research Institute Jakarta, 2008.

Yin, R. K , “Case Study Research. Design and Methods“, California: Sage Publications, 2014.

Zarmaili, Desentralisasi dan Devolusi Kuasa: Kajian Kes di Daerah Jambi Negeri Jambi Indonesia, Jabatan Pengajian Pentadbiran dan Politik Fakulti Ekonomi dan Pentadbiran, Universiti Malaya, 2010.

Total views : 13 times


  • There are currently no refbacks.

International Journal of Public Health Science (IJPHS)
p-ISSN: 2252-8806, e-ISSN: 2620-4126

View IJPHS Stats

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.