The research result on access and utilization of health services for poor women in seven districts, has show that services and utilization for reproductive health, particularly maternal health for poor women still very poor, moreover the budget allocation for reproductive and maternal health services in the research areas in average not more than 2% out of the district health office budget. This research also shows that the policy on maternal and reproductive health in the research areas are not exists yet.
WRI currently had extensive data related to reproductive health services in seven districts that can be developed as data base on reproductive health services. The data may also be used as sources of several publications under the theme of Women’s Health Services that will be delved through the discussion with experts.
The workshops with the local multi stakeholders at the research sites in seven districts had made them show new attitude for applying gender budgeting and gender sensitive planning tools in identifying whether their health services already pro poor women.
During 2007, under different grant WRI also trained the multi stakeholders of the different 15 districts on budget and policy advocacy to reduce maternal and child mortality. The outputs of this program i.e. improved budget allocation to reduce maternal and child mortality, budget analysis regarding health services for mother and child in 15 districts, and advocacy module on policy and budget analysis to reduce maternal and child mortality. These tools or set of instruments produced to train the multi stakeholders in 15 districts, these set of instruments are also utilized to monitor and evaluate the policy and budget allocation in the seven districts of WRI’s research sites. At the end, these tools also may help WRI achieved its long term goals to improve the condition and position of women in Indonesia.
The research capacity of WRI’s researchers enhanced through intensive coaching with the research consultant in the designing stage of the research methodology in this project period. The capacity of WRI’s staff on gender budget analysis strengthened through intensive communication and exchanged information and tools with Debbie Budlender from International Budget Program, South Africa.
Activities/Issues Addressed Identified
Operations research in five districts: Mataram (Lombok), Surakarta (Central Java), Kupang (West Timor), Subang (East Java), and Jembrana (Bali) to examine:
- Whether WRI’s gender-sensitive budget allocation tools can produce changes in local policy makers’ attitudes and practices, which would result in concrete budget allocations that open access for women living in poverty to three basic rights: education, health care, and work opportunities (employment);
- Types of existing obstacles that limit women’s ability to emerge from poverty in relation to the three areas above (education, health, and employment);
- Types of supporting program plans, including technical assistance in monitoring gender-sensitive budget allocation, which can improve access to education, health, and employment by minimizing the obstacles mentioned above.
- Capacity building among internal WRI staff, especially in processing, tabulating, and analyzing quantitative and qualitative data from primary as well as secondary sources such as the Central Bureau of Statistics;
- Comparative study visits to India, Korea, and Brazil
As stated in the previous report, the research was implemented in more than five districts which are seven districts. In this reporting period the implementation of research activities in the seven districts is completed. Therefore, WRI had the data regarding access and utilization of health services for poor women in the seven districts.
The data including policy on reproductive health, particularly on maternal health, facts of reproductive health services for poor women plus facts of health providers, reproductive health services also facts of budget allocation for health services, particularly in relation to reproductive health, maternal and infant mortality in the seven districts. WRI had conducted FGD at the four districts in order to discuss the initial report of this research with the multi stakeholders (local policy makers & civil society), including the evaluation of the budget allocation and policy regarding maternal health services/reproductive health services. WRI also conducted Delphi panel with experts to discuss this initial research report.
The workshop with multi stakeholders in Jakarta (local policy makers and civil society) to present WRI’s initial research report is one way to gauge inputs from the stakeholders to enrich the initial analysis done by WRI. At the moment, data on budget allocation for health services in the seven districts showed only less than 9% or around 5.8 - 8.9% from the total annual budget district (APBD). The ideal health expenditure according to MDGs is Rp. 120,000,- per capita. Whilst, in reality the health expenditure is only Rp. 40,000,- per capita in most districts in Indonesia. Only Jembrana which had achieve the MDGs ideal, Rp. 151,000,- per capita. While, Indramayu with 281/100.000 of maternal mortality rate only Rp. 41,000,- per capita as its health expenditure. Yet, data on budget allocation for women’s health services in 2007 showed only less than 2% or ranging from 0 - 1.76%.
Data on type of existing obstacle that limit women with regards to reproductive health services in the seven districts among others are the little number of skilled health workers, particularly midwives and obstetric genealogists, poor infrastructure (bad transportation services and roads condition), limited tools to provide good health services, the expensive health services that the poor women should pay and unequal distribution of health insurance for the poor.
Data on types of supporting program plans from the seven districts showed that most of the subject of the research recommend technical assistance in monitoring gender-sensitive budget allocation, which can improve access to health by minimizing the obstacles mentioned
With regards to the capacity building among internal WRI staff, especially in processing, tabulating, and analyzing quantitative and qualitative data from primary as well as secondary sources such as the Central Bureau of Statistics, is an on going process. WRI’s researchers also discussed several times its research design and initial findings with Besral, statisticians and lecturer from the faculty of Public Health of the University of Indonesia since February up till June 2008. Lately, during the writing and analysis for the initial report WRI also discussed intensively the methodology and the Reproductive Health issues with dr Roy Tjiong (board member of IIPPF) and Prof. Dr. Gulardi Wignyosastro (POGI). In order to provide inputs for the data collection and preliminary findings of WRI’s research, the research division had hold four roundtable discussions at the WRI’s office and invited experts on gender and reproductive health issues as well as experts on social research & budget analysis, i.e. Yanti Muchtar, Ninuk Widyantoro, Myra Diarsi, Yuna Farhan, Dr. Alexander Irwan.
It was reported in the past report that the study visit had been changed from Brazil to Mexico and the visit to Korea it was cancelled to enable WRI send more people to visit India. The study visit conducted in order to learn participatory mechanism in engaging women in politics and their success in increasing budget for women’s empowerment in India. Whilst, the study visit to Fundar in Mexico City conducted to learn from their experiences in engaging the multi stake holders participation, particularly women in increasing women’s reproductive health in Mexico. The reports will be submitted separately.
Indicators of Success
In at least three out of the five districts, local stakeholders restructure their district budget allocation to meet women’s three basic rights to education, health care and equal work opportunity;
- In each of the districts, a set of instruments to monitor and evaluate the results of gender-sensitive budget allocation is available;
- Improved survey and qualitative data collection skills of the WRI staff, confirmed by a senior researcher from the University of Sydney who serves as their mentor;
- Publication and dissemination of research reports, trip reports, and working papers about gender-sensitive allocations through WRI’s website and journals.
Actual Results to Date
To date, the local stakeholders of the seven districts of WRI’s research sites had evaluate the districts budget allocation to meet women’s basic rights to health care. Four out of the seven districts had sit together to discuss the need to restructure the district budget allocation on women’s reproductive health services.
WRI has develop a set of instruments to monitor and evaluate the budget allocation using gender perspective and already being tried out in 15 districts in Indonesia. This set of instruments also being used to evaluate the budget allocation in the seven sites of WRI’s research. The set of instruments is composed in the form of Module on Budget and Policy to Reduce Maternal and Infant Mortality.
The WRI’s researchers have improved their survey and qualitative data collection skills which equip them to produce extensive data related to access and utilization of health services for poor women, in particular the data regarding reproductive health services, i.e. maternal health care.
On May 2008, WRI published a compilation of articles under the title of Bertahan Hidup di Desa atau Tahan Hidup di Kota. Balada Buruh Perempuan (Muddling through in the village or coping in the cities. The Story of Women Factory Workers). All of WRI’s publications and reports can be obtained at WRI’s website.
Goals Expected Goals to be Achieved
To develop a research agenda that focuses on the impact of decentralization policies on women’s political participation.
Goals Achieved to Date
During the reporting period, WRI to some extend has developed its research agenda that focuses on the impact of decentralization policies on women’s political participation. The data that being collected provided us with the picture of access and utilization of health services in the decentralization era, particularly reproductive health services for poor woman. The ability of women to bring forward their needs can be regards also as their attempt to participate politically, by expressing their concern on quality of health services and budget allocation. WRI has collected such data in the seven districts during this reporting period focusing on the issue of health services, in particular with regards to reproductive health services for poor women. ***
Women Research Institute
January - June 2008