The study reviews the strategy for aprospective health development, and the health benefitsassociated with decentralization, in a likely challengingnear to medium term period in Indonesia. It addresses themajor government reorganization, expected to take effect inJanuary 2001, which could well define the social processduring the next decade, consisting of decentralization ofspending authority, enhanced access to resources at localgovernment levels, and civil service reform. The potentialhealth system benefits, associated with decentralization,will enable citizens to become involved systematically indecisions regarding health policy, design, and financing, aswell as influencing service provision. The report describesthe health system performance, and costs in the country,namely an adaptation of health for all, aimed at a widecoverage, featuring integrated service provision at theprimary health level. However, mixed results proved greatimbalances, for low income families lagged behind otherquintiles in terms of infant mortality rates, prevalence ofspecific diseases, and nutrition problems, while householdsin the top expenditure distribution, proved high uses ofpublic facilities, compared to the bottom expendituredistribution. The pre-crisis policy is examined, i.e., theimpacts on the provider-client equation; and, policy optionsoffer opportunities through decentralization, reform relatedissues, and effective partnerships with non-governmentalorganizations, and donors.
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