ポスターセッション１

[5OlXCzC1-10] Perspective on Governance Barriers to Effective Health Infrastructure Financing at the National and Subnational Levels in Indonesia

*Cynthia Febrina Febrina¹, Stanley Saputra² (1. Hiroshima University (Japan), 2. Ministry of Health (Indonesia))

キーワード：

Governance、Health、Infrastructure、Indonesia、Qualitative

The Indonesia Health Systems Strengthening (IHSS) Project is a health system transformation initiative led by the Government of Indonesia (GoI) under the Ministry of Health. It is financed through a loan agreement between the GoI and several Multilateral Development Banks (MDBs), including the World Bank, ADB, AIIB, and IsDB. The project aims to address challenges in Indonesia’s public health and laboratory systems by procuring essential medical equipment for primary and referral healthcare facilities nationwide, including those in remote areas. Before receiving equipment through the project, healthcare facilities must meet specific readiness criteria. These include adequate infrastructure (such as sufficient electrical capacity and clean water supply), functional waste management systems, and the availability of trained healthcare personnel capable of operating the equipment. To support fulfillment of these criteria, several funding mechanisms are available, including the Physical Special Allocation Fund (DAK Fisik), through which the GoI transfers funds to subnational governments. These funds can be used to certain infrastructure needs, including to renovate facilities, upgrade electrical systems, and improve waste management system. However, challenges persist in both planning and fund absorption at national and subnational levels. Thus, this study conducted in-depth interviews and focus group discussions with representatives from relevant ministries and subnational governments to identify barriers to effective fund utilization. Findings indicate key barriers, including frequent regulatory changes, misalignment between central and subnational planning processes, and limited technical capacity due to staff turnover. Strengthening funding governance through more systematic reforms is essential to ensure healthcare facilities are fully prepared and able to deliver improved and equal healthcare services to the population.