Abdullah Asnawi, Stoelwinder Johannes
Department Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
World Health Popul. 2007 Dec;9(4):5-16. doi: 10.12927/whp.2007.19514.
Health resource allocation has been an issue of political debate in many health systems. However, the debate has tended to concentrate on vertical allocation from the national to regional level. Allocation within regions or institutions has been largely ignored. This study was conducted to contribute analysis to this gap. The objective was to investigate health resource allocation within District Health Offices (DHOs) and to compare the trends and patterns of several budget categories before and after decentralization. The study was conducted in three districts in the Province of Nanggroe Aceh Darussalam. Six fiscal year budgets, two before decentralization and four after, were studied. Data was collected from the Local Government Planning Office and DHOs. Results indicated that in the first year of implementing a decentralization policy, the local government budget rose sharply, particularly in the wealthiest district. In contrast, in relatively poor districts the budget was only boosted slightly. Increasing total local government budgets had a positive impact on increasing the health budget. The absolute amount of health budgets increased significantly, but by percentage did not change very much. Budgets for several projects and budget items increased significantly, but others, such as health promotion, monitoring and evaluation, and public-goods-related activities, decreased. This study concluded that decentralization in Indonesia had made a positive impact on district government fiscal capacity and had affected DHO budgets positively. However, an imbalanced budget allocation between projects and budget items was obvious, and this needs serious attention from policy makers. Otherwise, decentralization will not significantly improve the health system in Indonesia.
在许多卫生系统中，卫生资源分配一直是政治辩论的一个议题。然而，辩论往往集中在从国家到地区层面的纵向分配上。地区或机构内部的分配在很大程度上被忽视了。开展这项研究是为了填补这一分析空白。其目的是调查地区卫生办公室（DHO）内部的卫生资源分配情况，并比较权力下放前后几个预算类别的趋势和模式。该研究在亚齐特区省的三个地区进行。研究了六个财政年度预算，其中两个是权力下放前的，四个是权力下放后的。数据收集自地方政府规划办公室和地区卫生办公室。结果表明，在实施权力下放政策的第一年，地方政府预算大幅增加，尤其是在最富裕的地区。相比之下，在相对贫困的地区，预算仅略有增加。地方政府预算总额的增加对卫生预算的增加产生了积极影响。卫生预算的绝对金额显著增加，但按百分比计算变化不大。几个项目和预算项目的预算显著增加，但其他项目，如健康促进、监测和评价以及与公共物品相关的活动，预算则减少了。本研究得出结论，印度尼西亚的权力下放对地区政府财政能力产生了积极影响，并对地区卫生办公室的预算产生了积极影响。然而，项目和预算项目之间的预算分配不均衡是显而易见的，这需要政策制定者予以认真关注。否则，权力下放将不会显著改善印度尼西亚的卫生系统。
