A Study of Selected Factors Influencing the Development of Primary Health Care in Rural Indonesia : The Banjarnegara Experience

Suwandono, Agus (1986) A Study of Selected Factors Influencing the Development of Primary Health Care in Rural Indonesia : The Banjarnegara Experience. Doctoral thesis, University of Hawai.

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Abstract

Primary Health Care (PHC) was formally adopted as a National Health Strategy for Indonesia after the Alma Ata conference in 1978. Prior to that time, small scale efforts utilizing variations of classical PHC approaches were launched spontaneous1y in various sections of the country. One of these efforts began in Banjarnegara Regency in Central Java Province in ear1y 1970. A group of dedicated physicians and public servants, responding to the 1ocal conditions and community needs, established a unique approach to PHC and community development. This approach combined the resources and political commitment of local government with the flexibility and innovation of the private sector into a quasi non-Government organization (NGO) called "Yayasan Pembangunan Pengembangan Sosial Ekonomi" (YPPSE). The result was a relatively successful and socially acceptable health and development program. It has served as a model for the Government of Indonesia's national strategy for replicating its PHC program throughout the country. Particular attention in the YPPSE approach is focused upon two components, training and "POLITICALIZATION." The latter is a term used in this research study to epitomize the process of developing political commitment and its inculcation in the providers of PHC and community members. The research reported here was designed to examine the Banjarnegara experience in an effort to determine if the approach used resulted in an identifiable impact upon selected health and socio-economic indicators. The findings indicated that these two processes, training and “POLITICALIZATION, “working through a series of intervening and interrelated variables, are related to significant increases in nutritional environmental indicators in the Banjarnegara communities. POLITICALIZATION" was found to be a process which, in turn, was related to leadership provided by key policy makers and health managers. Also substantiated as a crucial mechanism for eliciting community involvement was the innovation introduced by YPPSE and known as the “KRING” system. The "KRING" was a planned, systematic process through which community groups participated in planning, implementation and budgeting of the PHC and community development program. The research supports a recommendation that culturally adapted variations of the YPPSE approach should be tested in different Indonesian settings to determine its suitability for replication.

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