DECENTRALI Z ATION OF FAMILY PLANNING PROGRAM IN INDONESIA

1. DECENTRALIZATION OF FAMILY PLANNING PROGRAM IN INDONESIA By Dr. AbidinsyahSiregar , DHSM, M.Kes Deputy National Population and Family Planning Board

2. Indonesia used to be known as a country with very successful family planning program. In the period between late 1970s and the early 2000s, the contraceptive prevalence rate (CPR) increased dramatically and FP almost became a social norm. However, that success story has begun to decline thereafter. (Indonesia has 17.504 islands)

3. For more than a decade later the condition has changed drastically. Indonesia’s modern CPR (mCPR) has declined and is stagnating at 57.4%. Albeit of strong supply of contraceptives and its supporting materials, unmet need for FP is estimated only at 9 %. The total fertility rate is 2.6 but with significant disparities geographically. Source : IDHS 1991-2007

4. Family Planning in the Beginning of Decentralization The radical change was taking place during the transition from centralization to decentralization of the Indonesian government system. The decentralization system was rolled out in the 2000s and District Governments are the emphasis of the decentralization system. National Population and Family Planning Board (BKKBN) started to be decentralized in 2004.

5. FP in the Beginning of Decentralization (1) • Decentralization has changed the functions of the government organizations involved in FP Program Devolve of authority; human resources, office facilities and budget to Local Governments • No point of return of decentralization process • All authorities of services to public including FP are decentralized (except security and defense, foreign affairs, fiscal and monetary, justice, religious affairs) • Swing from heavy centralized to people oriented system • A delicate political arrangements Source: Lewis & Haripurnomo, 2009

6. FP in the Beginning of Decentralization (2) • Local governments determines critical aspects of FP management • Weak coordination between central and local governments • Not all district government positioned FP issues as a top priority development program • District Governments fully financed and managed family planning program at their respective district • Declining quality of care of public as well as private providers Lack of adequate district budget to support all aspects of FP program (including demand generation) due to low priority status determined by District Governments. Source: Lewis & Haripurnomo, 2009

7. FP in the Beginning of Decentralization (3) • Disappearance of the former FP office (Missing or Merger) • Number of district/municipality has increased from 341 district in 1999 to 524 in 2015 Yet only less than 10 percents of 524 localgovernments had dedicated FP offices in 2015 • Significantly decreasing number of FP field workers from more than 33 thousand in 1990s to only around 20 thousand in 2007. With 82.000 villages across Indonesia, the number of field workers is undoubtedly inadequate. Source: Lewis & Haripurnomo, 2009

8. The Revitalization of Family Planning Program The critical problems mentioned above and the deteriorating of FP performance coupled with decentralization government system have instilled BKKBN Central to introduce a breakthrough strategy to influence government structure at all levels to revitalize FP program.

9. Policy Responses President Instruction to Revitalize Family Planning, 2007 National Family Day 2007, Ambon

10. Policy Responses (cont’d) 2. The new law No. 52/2009 on Population Dynamic and Family Development to strengthen the legal basis for: • Establishing the new institution of local Population and Family Planning Offices at provincial as well as districts and municipalities. • Expanding program to include activities beyond family planning program, i.e Family Resilient Program • Restructuring the National Coordination Family Planning Board into the National Population and Family Planning Board

11. Policy Responses (cont’d) 4. Developing National and District Grand Design of Population and Development 5. Increasing national and local budget to support the population and family planning program 6. To fill the budget’s gap in local level then the central government provides assistance through Special Allocation Funds (DAK) 7. Improving central government roles in the process of building core analytical and technical competencies related to FP at all levels of government and in both the public and private sphere

12. Policy Responses (cont’d) 8. Improving capacity of provincial FP officers to provide assistance, identify problems and needs for technical assistance and to coordinate assistance for efficiency 9. Initiate leadership capacity building for reproductive health and FP in the districts/municipalities 10. Strengthen the role and functions of the new district level office/boards of FP and women empowerment

13. Policy Responses (cont’d) • Engaging the private sector with training, technical assistance and incentives to ensure that all women can choose the contraceptive method best for their life stages • Developing and promoting national communication strategies focus on the issue of unmet need and unreached groups • Promoting initiatives nationally and locally to increase the availability and accessibility of long acting contraceptives-IUD, implants and sterilization to all couples • Monitoring & Evaluation

14. Policy Responses (cont’d) 15. Filling the Gap of FP Field Workers : • Recruitment of FP Field Workers by Local Government • Maximizing the role of village midwives as FP Field Workers • Skill training to improve capacity of FP Field Workers • Increasing the incentives for FP Field Workers • Establishing new offices at sub district levels

15. Current Situation of Family Planning Programin Decentralization Era In this perspective BKKBN Central has applied an operational policy to carry out advocacy activity as a critical strategy to influence policy makers to revive FP program. Simultaneously BKKBN Central has also attempted to strengthen the capability of Districts BKKBN staff to develop comprehensive work plan for FP program and to construct district population data as the basis for developing the work plan.

16. CURRENT CHALLENGES RELATED TO DECENTRALIZATION AND REGIONAL AUTONOMY STAGNANT UNMET NEED TFR CPR ASFR 15-19 Source : IDHS 1991-2012

17. Strengthened Government Regulations • Current Government Regulations mandate local government to support family planning using local budgets • Government Regulation No.38/2007 on division of responsibilities between national and sub-national governments stipulating population and FP are among 31 obligatory functions at Central/Provincial and District/Municipal levels • Government Regulation No.41/2007 in 2007 requiring organization of FP to be grouped with women’s empowerment at the Board (Badan) or Office (Kantor) level  CURRENT SITUATION (1)

18. Local governments have begun to accept family planning as local initiative • Budget allocated by local government is recorded increasing • Institutionsbegun to emerge at local level • Currently only 5 percent of total 524 districts/municipalities have no family planning offices CURRENT SITUATION (2)

19. CURRENT SITUATION (3) • Total number of field workers increased from only 20 thousands in 2007 to 22,4 thousands in 2014 • Allocation and coverage of DAK is steadily rose to 462 million rupiah for 442 districts/municipalities Source : IDHS 1991, 1994, 1997, 2002/2003 and 2007

20. Increasing Trends of Total National Budget and DAK Allocation 2006-2014 (in thousand IDR) Rate US $ 1 = IDR 13.300 Source : IDHS 1991, 1994, 1997, 2002/2003 and 2007 Source: Planning Bureau, BKKBN

21. Lesson Learnt : • Reformulating rules and regulations that fitwell to both central and local governments is important foundation for transferring authority(ies) from central to local government • Continued technical assistance should be provided by central government • BKKBN obliges to advocate local leaders with guidances and program implementation strategies as well as to share best practices

22. Terimakasih Thank you