financing department of the organisation

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Appendix 1

Results from first interview with Dr. Nyoman Sutedja

Monday 11 juni 2001, 9:30-10:30u, Office Provincial Health Department

In order to collect data for my research I went to the office of the provincial Health

department. After a few days, allowing my permission letter to be processed, I went back.

My goal was to make a appointment with the head of the department, but I got a better deal: an interview with Dr. Nyoman Sutedja, who works as head of the planning &

financing department of the organisation. This interview was very fruitful, because Dr.

Sutedja had much knowledge about the decentralisation process, his department and (very important) about the relationship between the provincial department and that of the regions (kabupaten). Besides that, his English was very good and that made

communicating much more easier. For this interview I used the list of questions that I had prepared for the head of the department. The interview could be characterised as semi- structured, the prepared questions were only used as a basis, when I discovered interesting topics additional questions were asked. The used questions are listed at the end of this piece, the information extracted from the interview is written down below.

General:

Dr. Nyoman Sutedja is working since 5 years at his present function. The job of his department is plan how the health resources are divided over the diverse health institutions. Dr. Sutedja is already working 17 years as a civil servant, before this function he worked at the Kabupaten level, for some years in a HRM-function. Dr.

Sutedja is 45 years old and born in Bali. He has attained a doctor degree in Medicine, and did a part of his study in Bangkok, Thailand.

Decentralisation:

While talking we already start discussing my research topic, the decentralisation process and the consequences for the internal labour market of the health department.

He explained that before the new UUD 22/1999 the following actual power structure existed¹:

Jakarta

Provincial Level (deconcentrated) Kabupaten

In this situation the central government in Jakarta gave the orders and the funds. After that, the provincial level made the planning and divided the money among the diverse Kabupatens. These Kabupatens than executed the tasks and in the process spend the resources given to them.

1 I use the term of actual power structure, because before the new law there were many formal structures that were never really used. On paper there already existed a deconcentrated health institution, for example.

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The new situation, after the implementation of law 22/1999 is the following:

Jakarta

Provincial Level Kabupaten

In this new situation, the diverse Kabupaten have the same status and decision power as the department at provincial level, that formerly operated as their instructor. These situations (old and new) reassemble the situation in Central Kalimantan. Also, the same problems with the implementation process are found.

Dr. Sutedja has found many indications that the civil servants at the Kabupaten are not ready for their new tasks yet. He experiences this in his day-to-day work, almost every day he gets calls from officials of the Kabupatens that state that their funds are already used and that they need more money. But, as they should know, the provincial level has loosed the authority and funds to do so.

The Kabupatens seem to have great difficulties planning their operations and allocating their funds to the right places. Dr. Sutedja feels that there are a few reasons for this problem:

1. The civil servants at the Kabupaten level formerly only executed orders, did the operational work. That is also what they like to do, and all the new paperwork is seen as trouble. The fact that they now have their own budget is seen as a great

improvement, but the duties connected to this responsibility seem to be ignored.

2. The civil servants at the Kabupatens have no experience on the topics: planning, budgeting and human resources.

3. The Kabupatens now directly receive funds from Jakarta, but only one amount of money for their whole budget. Its up to them to divide these funds to the diverse areas (as Education, Health, Public works, etc.). It seems that Health is on the end of the list of priorities.

4. The money that is allocated to the Health function is not used effectively and

efficiently. As example Dr. Sutedja told me that the Kabupatens spend way too much money on the construction of buildings. It is his opinion that this behaviour is caused because the civil servants don’t know how to spend the money right. They then choose something concrete, a decision that is inspirited by many years of operational work experience, they like to see concrete results of their work.

5. The general level of education is too low. Left alone a few exemptions, the level of education is SLTA (Senior High School), 35% of this group also followed a SMA- education (Polytechnic).

Dr. Sutedja assured me that he supported the idea behind the decentralisation process, but he thinks the process of change goes to fast. He think within 3 years the problem caused by this transition will surface, and that it than will take at least 5 years to grow into a better situation.

With him I discussed how the problems could be solved without harming the

implementation of the new constitutional law. The idea that I proposed to him where the provincial department functions as an expert and educator for the Kabupatens appealed

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very much to him. In the next interview I’m planning to ask him his vision about the ideal internal labour market, considering the new circumstances.

Another curious aspect that I found was that although the deconcentrated and the decentralised health departments at provincial level officially have merged (as imposed by law), they are still operating independently. Both chiefs of the departments still manage their own organisation, there seems to be some sort of co-operation but it reassembles in nothing the complete merge that is demanded by law.

Structure

Before explaining the organisation of the Health service in Bali, the general governmental structure has to be explained further. One Kabupaten (=Kotamodya) consists of the following levels:

Kabupaten (region)

Kacamatan (district)

Desa (village)

Banyar (part of village)

The organisation of the Health service is than as follows:

• 8 general hospitals:

every Kabupaten has one general hospital (except the Kabupaten Badung)

• 1 central hospital:

RSUP in Denpasar, still funded by the central Jakarta and therefore still not participating in the decentralisation process

• 112 health centres:

every Kacamatan has one or two Health Centres

• 585 sub-health centres:

every village had a sub-health centre for emergency cases

E/E:

For the Kabupaten level, this topic is already discussed.

For the provincial level: Dr. Sutedja thinks his department was working more effectively in the old situation. In that time, his department made the general planning and that was executed by the Kabupaten. In the new situation his department still tries to coordinate a bit, but the organisation has no formal power to do so. doing now. He thinks his

department could also be working more efficiently, identifying the low-education level as the main cause for this problem.

Personnel: Job qualifications and requirements:

The provincial Health department deploys currently around 325 persons. This number can be devided in 175 working at the old deconcentrated Kanwil department and 150 working at the old decentralised Dinas Tingkat I office. Officily these employees now are

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collegues, all working for the Health department of the province of Bali (‘departement Kesehatan propinsi Bali’).

The level of education within this department is generally speaking SLTA combined with a SMA education. About 25% of the employees went to university after their SLTA and earned a degree of the lowest level (serjana 1), while only 12 persons within the

department made it until the next level, serjana 2.

In the old situation the employees of this department made the planning of the health resources of the island, made regulations for the health institutions and controlled whether the lower levels were performing their tasks properly.

During this interview I didn’t got a clear view about the kind of tasks the employees are now performing. This will be a point in the following interview, but it can already be said that this was one of the problems I noted just by reading the constitutional laws. When the Kabupatens get all the responsibilities, what tasks are left for the provincial

department?

Other information that I received was that the provincial department does have a HRM- function, and that it does not have direct contact with the habitants of Bali.

The changes of promotion, an important point when analysing the ILM are almost zero.

Dr. Sutedja agrees that this is a major problem, it makes it really hard to motivate people for conducting the right kind of behaviour. Many times he finds situations were he sees a younger, more capable employees being ordered by their boss, who only has his age for him to count. He thinks it will take serious effort and a time span of at least 5 years to change this situation.

I will receive information about the organisation structure and job levels latter on. I already arranged a second interview. In that interview I’m planning to ask Dr. Sutedja the questions that stand still open and I will try to let him elaborate further on his views of the internal labour market.

Interview-questions prepared for the head of the Health Department (departement kesehatan), but used for the interview with Dr. Sutedja.

My name is Eelco Rusman. I’m a student at the University Groningen in the Netherlands.

My study is Management & Organisation, with a specialisation in Human Resource Management (SDM).

Here in Bali I’m researching the topic of ‘otonomy daerah’ for the province of Bali. I will try to find out what the consequences of the new constitutional laws UUD 22 & 25 will be for the civil servants working at the governmental departments of Bali. Because I couldn’t research all departments, I had to choose one. I choose the Health department because it has my interest and because I think health is maybe the most important service that habitants of a country should receive from their government.

I got the permission of the governor (show letter!!!!) to do research at this department.

Furthermore the co-ordinator at the office of BAPPEDA Tingkat I also proposes this research. I would like to ask you if you could help me with this research. I think it could be useful for this department and maybe in the end for all the people of Bali.

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I would be very grateful if you would help me. You know so much more about the topic than I do, so with your help my research will be of much better quality. Without your help it would almost be impossible to conduct the research properly. With your help and knowledge I hope I can get a clear picture of the consequences of the decentralisation process for the civil service in Bali.

General:

• How long have you already been working at this department? At the same position?

-What did you do before?

-How long do you work at a governmental institution?

-Do you originally come from Bali?

-May I ask what your age and education level is?

E/E:

• Do you think this department is working effectively? Could it be more effective?

• Do you think this department is working efficiently? Could it be more efficient?

Personnel: Job qualifications and requirements

• How many people work at this department?

• Can you explain the organisation structure to me?

• Can you explain what task precisely your department fulfil? What do the people working here?

(for example: make decisions about what hospitals can spend)

• How many job levels are there?

• Are there many changes to get a promotion within this department?

• What is the mean level of education in this department?

• Does this organisation also has direct contact with habitants of Bali (the customers)?

• Does your organisation has a personnel affairs department/function (SDM)?

Results from second interview with Dr. Nyoman Sutedja

Wednesday 13 juni 2001, 9:30-11:55u, Office Provincial Health Department

Two days after the first interview I interviewed Dr. Nyoman Sutedja for the second time.

This second interview was better structured because I already had gained a better insight in the situation and because the relationship with Dr. Sutedja was already very good, so I didn’t had to spend much time on that aspect this time. Also, I first explained what topics I wanted to discuss during the interview. From his secretary I also received the new organisational structure for the provincial Health department.

Personnel:Recruitment and selection

1. Yes, this rule is from before the decentralisation process, but most departments still use it. The province of Bali, and so their departments can now make their own rules, so it is not some sort of law that prohibits growth, but here in Bali we try to stick to it.

We do this because we have already one of the best service ratio’s of whole

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Indonesia. Here there is one doctor for every 2000 people, in some areas in Indonesia that is 10000. Another reason to stick to the rule is that many people from outside Bali try to come to Bali to work here. This is seen as a major problem, because this originally Hindu island has now many many Muslims. Many people are afraid there will be the same clashes as in Kalimantan and Timor (today there is a meeting in Jakarta about this problem).

Bali basically has enough employees to make the health service work. But one problem exists: to many doctors stay in Denpasar. They work in the hospitals here or in private clinic and this causes a shortage of qualified doctors in the rural areas.

At the same time the non-firing policy is also still active, although once again every department and kabupaten can decide for its own. But untill now people only leave the organisation because of illness, death or pension.

2. This department hasn’t hired people from outside the governmental system for years.

Every year 5 til 10 person start working here, they come from other departments but mostly from one of the Kabupatens.

3. When a job is vacant a selection committee is formed. This committee consists normally of five persons. The head of the department and Dr. Sudetja himself and then three other relevant employees. Candidates are screened and than selected by job interviews. The final decision to hire someone is made by the head of the department.

Before 1999 even these decisions were made in Jakarta, sometimes candidates just had to travel to Jakarta to take a job interview.

Decentralisation process:

1. Already discussed 2. Combined with 3.

3. The most important implication is that there are no more standards that every

institution has to follow. In the old situation Jakarta made the regulations, most of the time these regulations were translated into standards which every health service had to fulfill as a minimum requirement. In the new situation every Kabupaten can decide about these levels of performance for their own. Example: immunisation. In the old situation Jakarta decided which injections were required for the population of whole the country. Nowadays this can differ between all the Kabupatens. The island of Bali has now made a standard on their own to secure that every habitant gets the injection he needs, but formerly this is a task for each individual Kabupaten. They get the funds and along with it comes a target to aim at, but its their own decision to try to attain that target or to spend the money otherwise.

4. Positively, but without proper HRM management it will fail! The general idea behind it is good, but the implementation is hard and causes big problems

5. Process started in 2001, but the official organisation structure you received for after the merge still only exist on paper. Dr. Sudetja doesn’t even know yet wether he can stay on his current job. The 20^th of June the fusion/merge should be completed, but right now the two heads of the old departments are still in charge.

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6. There are no real changes yet, and that is seen by Dr. Sudetja as a big problem. The people working in his department are not really willing to change. They still keep doing the same job, or do nothing at all. He expect that with the current workforce no big changes will happen.

7. This is especially true for the relationship between the department and the Kabupatens. Now there is a struggle between these two levels. The provincial departments still wants to play a co-ordinating role, the Kabupatens say no against any agreement that could harm their new gained autonomy. Dr. Sudetja think this attitude will maybe change after one year, when the Kabupaten discover the problems of non co-operation, then they will cooperage.

8. Some parts will work better, but not all parts. Some parts were already working quite effectively and efficiently and it will take time and effort to get the same results in the new situation.

Stakeholders

1. Identified stakeholders:

The Kabupatens Provincial department NGO’s

The health services

University Udayana (now makes the regulations) Habitants of Bali

Mayor of Kabupaten DPR Bali

Governor

2. Yes, see above

3. Kabupatens against provincial department about the regulations and standards and wether the PD still can play a coordinating role

Universitas Udayana now makes regulations for the Kabupatens. For me it is still unclear wether this is just a target or wether these regulations have to be followed by the Kabupatens

4. The central government, the DPR of Bali and the provincial departments (like the Health department), see also point 8.

5. Expecially the Kabupatens, they get much more decision power and their own budgets to spend

6. Dr. Sudetja identifies the older employees working at the departments and the Kabupatens as the main resistors of the change process. They are not willing to change the way they work, they have already been working like this for decades (see also the remarks from Dr. Sudetja about this topic at the end of this interview)

7. The central government has for some time supplied resources for the change process.

The departments also received books that explained the consequences of the

decentralisation laws 22/1999 and 25/1999 and instructed how the changes should be implemented.

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8. The DPR of Bali (parlement) and the governer of bali both feel unsatisfied with the consequences of the decentralisation process. They feel that to much power is delegated to the Kabupaten level, this makes it almost impossible to govern the province. As an example, one of the most important revenues, the tourist tax is now collected by the Kabupatens and no longer by the province. This makes results in big income differences between the diverse Kabupatens. Those situated in the touristic southern part of the island are becoming really wealthy while the western and eastern parts of the country get poorer and poorer. This causes also a migration process towards the southern part of the island.

Based on this kind of arising problems the governer, backed by a majority of the parliament wants to install a special form of decentralisation, ‘decentralisasi khusus’.

This sort of autonomy is already used for the region of Atceh and city of Yogjakarta, which is in some way a province on its own. The governor and parliament like the idea of autonomy for the island but argue that the lower levels of government now how to much power, which makes it impossible to govern the island well. Dr. Sudetja expects the government of Bali will try to get a special status, making it possible to transfer transition power from the Kabupaten level to the provincial level.

New ILM:

1. Not only the supply side should change, but also the demand side. The work that has to be done should be better organised and devided between employees. Furthermore the education of the employees should be raised, not only the general education, but employees should also follow specific courses that correlate more with the skills required in the job. In the future, candidates for vacant job positions should posses higher qualifications, at least sarjana 1 or 2.

Also, high-educated people from the provincial department should be transferred to the Kabupaten-level in order to close the big knowledge gap. At the provincial level are now too many servants, because of the merge between the Dinas Tingkat I and the Kanwil department almost every function is covered double. The problem here is that at this moment the Kabupatens ‘don’t like’ the provincial department and their employees, thet want to work independently. Maybe after one year they will change their mind, if they find out what kind of knowledge they miss.

2. See 1.

3. For the provincial departments the regulations about what tasks now belong to the provincial level should be made.

For the Kabupatens the demand side should constitute the need for education, regulations and sound budgeting in their organisational structure. Also new tasks descriptions should be made for this level.

4. See 3.

5. Dr. Sutedja really feels positively about a sort of expert-role for his department, we already discussed that idea in the first interview. He thinks his department should be able to transfer the needed knowledge to the Kabupaten. But after that the provincial department still should be a co-ordinating rol also. Topics only concerning one Kabupaten can be dealt by the Kabupaten, but topics concerning more Kabupatens

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will still need some co-ordination. He thinks the main quality of the Kabupatens is still performing the operational tasks and that stretching their responsibilities is asking for trouble.

6. There will be much co-ordination needed. When the Kabupatens are willing to let the provincial department play a coordinating role again, Dr. Sutedja would like to install a Management Information System. By using such a system the provincial level could collect the needed data from the Kabupaten, compare them, make standards, and communicate the results back to the Kabupaten.

7. In the end, the Kabupaten would accept the new role for the provincial department.

They already know they don’t have enough knowledge, experience and skills to make the right decisions. They know they need our department, right now they just not ready to admit that.

Change process:

1. First there should be a meeting in which should be decided that all parties commit to the change, that the provincial department will play a role as co-ordinator of health issues that cover more than one Kabupaten. After that there should be weekly or monthly reports from the Kabupatens to the provincial department about their situation, as a source of data collection for the department. Also their should be montly meeting in which the departments explains what is done with the collected data and which actions the Kabupaten should take. Ideally a MIS should be installed.

Dr. Sutedja thinks this new structure is possible within the UUD 22, the Kabupaten still have autonomy, but just make the agreement to cooperate with the provincial level.

To achieve this situation he thinks it would be the best to let the Kabupatens first work alone for a few months. Through the problems and mistakes that will arise the Kabupatens will realise that they need to co-operate.

2. A project team consisting of Kabupatens members and provincial employees should work together to make new regulations. The provincial department has enough accomendation for both the meetings and the project group.

3. At the most one year for the Kabupaten to discover the need to co-operate, and then another year to get used to the new co-operation.

4. Yes

After this the interview seemed to be ending, but Dr. Sutedja spontaneously started to talk about ways to make the proposed changes work. He stated that he sees sending older employees of for an early pension as a requirement to make the decentralisation process work. The older people are not willing to change and their education level is poorly, most of the time only elemtary or high school (SMA). I want to stress that Dr. Sutedja started about these solutions himself, because it happened to be the same measures I had in mind. He would be in favour of offering the older employees bonus of 20-months salary or the opportunity to transfer to the Kabupaten (if the Kabupaten want to accept them). In this way the less capable employees can be removed and vacant positions can be filled by younger and better educated people.

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Second interview with Dr. Sutedja Wednesday 13 juni 2001, 9:30-

Personnel: Recruitment and selection

1. I heard there is a general zero-growth policy for governmental organisations. Does that rule also count for your organisation?

2. Do you now still hire people? How many a year (by proximity)?

3. How does your organisation recruit new employees?

-Is there a selection procedure?

-Are there job interviews? Is there a selection committee?

-Are there any selection criteria for the candidates: how is the decision to hire someone made?

-Require some job/functions a minimum level of education or proven skills?

-Who makes the final decision in the selection process?

-Are you personally also involved when an employee is hired?

1. Do you know the new constitutional laws UUD 22 and 25? Could you tell me the contents of it?

2. What do you think that the consequences will be for the province of Bali?

3. What do you think that the consequences will be for your health department?

4. Do you look at this decentralisation process in a positive or negative way?

•

5. Has the change process in your organisation already started? How far is it?

6. What are the effects of these changes?

7. Normally an organisation in transition can have some problems working effectively and efficiently, because much energy is used for the change process. Does your organisation that kind of difficulties?

8. Do you think that after the transformation the health service will work better? (more effectively and efficiently)

•

Stakeholders:

1. Which parties are involved in this decentralisation process?

2. Do you see the habitans of Bali as a stakeholder? And your employees?

3. What are the interest of these various parties in this decentralisation process: what do they expect from it?

4. Are there parties which gonna loose power and resources because of this decentralisation process? Which parties are that?

5. Which parties are really looking positively at these changes? And which parties view these changes in a negative way?

6. Are there parties who really resist the changes? Can you give examples of the kind of resistance?

7. What is the role of the central government?

8. And the government of Bali?

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New ILM:

1. If you make the assumption that the decentralisation process can’t be reversed, how should than the new internal labour market look like ?(ILM= supply and demand of labour, so workforce and the work do be done, to say it simple)

2. What changes are needed at the supply side, how should the workforce change?

• for the provincial department level?

• for the kabupaten level?

3. What changes are needed at the demand side, should the organisation of the work also change?

4. Are there differences between the needed changes at the two levels, and why?

5. How do you see the relationship between the provincial department and the kabupatens in the future?

6. Will there be much communication? Do you think the provincial department will still play a coordinating role? If not, what is gonna be the new task of your department?

7. In the last interview we discussed the idea of a role as educator, expert role for the provincial department. The employees of the Kabupatens could than learn the planning, budgeting and HRM skills by trainings from this department. In that way the knowledge and skills from this department could also be obtained by the regional departments.

What do you think of that idea? Would it work in the new situation?

Change process:

1. Can you descibe how the needed changes you described above could be implementated?

2. How should this transition process be managed?

3. How long would it take?

4. Do you think it is possible to achieve the desired situation?

Personnel: Recruitment and selection

• I heard there is a general zero-growth policy for governmental organisations. Does that rule also count for your organisation?

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• Do you now still hire people? How many a year (by proximity)?

• How does your organisation recruit new employees?

• Do you know the new constitutional laws UUD 22 and 25? Could you tell me the contents of it?

• What do you think that the consequences will be for the province of Bali?

• What do you think that the consequences will be for your health department?

• Do you look at this decentralisation process in a positive or negative way?

• • Has the change process in your organisation already started? How far is it?

• What are the effects of these changes?

• Normally an organisation in transition can have some problems working effectively and efficiently, because much energy is used for the change process. Does your organisation that kind of difficulties?

• Do you think that after the transformation the health service will work better? (more effectively and efficiently)

•

Stakeholders:

• Which parties are involved in this decentralisation process?

• Do you see the habitans of Bali as a stakeholder? And your employees?

• What are the interest of these various parties in this decentralisation process: what do they expect from it?

• Are there parties which gonna loose power and resources because of this decentralisation process? Which parties are that?

• Which parties are really looking positively at these changes? And which parties view these changes in a negative way?

• Are there parties who really resist the changes? Can you give examples of the kind of resistance?

• What is the role of the central government?

• And the government of Bali?

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Appendix 2 Interview met Dr. Budiana, director Hospital Gianyar

General:

1. Dr. Budiana works already 6 years as director of the Gianyar hospital. Before that he worked also in the health sector. He has worked at diverse Health centre’s

(puskasmas) before getting promoted to the Kabupaten Gianyar, in the old structure Dinas Tingkat II. After 4 years there he became director of the hospital.

2. See 1

3. In total 22 years

4. Dr. Budiana is born in Gianyar

5. Dr Budiana has a university degree in medicine and attained a post-graduate in Hospital Management

Relationship with Kabupaten and provincial department:

1. The director of the hospital is responsible to the major, who leads the Kabupaten.

Furthermore the Kabupaten is the owner of the hospital and provides a big part of the budget of the hospital. Until recently the Kabupaten also managed the HRM function of the hospital. The hosptial told what kind of personnel was needed, and the

Kabupaten than searched for candidates. Recently the hospital selects its personnel itself, because the management of the hospital has more knowledge about the topic.

The director explained to me that he has obtained a high degree of autonomy on almost al subjects. He has made the agreement with the Kabupaten that all revenues obtained by treatment of patients can be hold by the hospital. In that way the hospital has it own revenues. Those revenues should cover the operational costs, the costs of investments are than covered by money provided by the Kabupaten. The Kabupaten Gianyar has stated clearly that the people working in the hospital have much more knowledge about how to perform their tasks well and looks at the results only. In the 6 years time that Dr. Budiana works at the hospital the number of beds have risen with 58 (now 175), the hospital has now a C-status (which indicates the hospital has several specialists) and poor people are still served well (there is a class system in beds, VIPS, first, second and third class, the first three classed pay extra for the poor people who are served third class). The Kabupaten finds these results satisfying and holds on to the policy of autonomy.

2. The hospital has in the new structure only contact with the provincial on three topics:

promotion, prevention and communicable diseases.

E/E:

1. Almost immediately after the decentralisation law became effective the management department of the hospital got a new organisation structure. The old functional structure is now changed in a line structure. In this new structure people know better what to do, there is more clarity of tasks. Dr Budiana thinks this structure really improved the general effectiveness and efficiency of the hospital.

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2. The efficiency could be higher because there are still too many people working at the hospital. These employees/work ratios should be improved.

3. The Kabupaten has helped by giving the hospital autonomy. Dr. Budiana thinks the provincial department couldn’t be of help in the new structure.

Personnel: Job qualifications and requirements:

1. 337 2. director

vice-director

installati (every installati is responsible for a part of the hospital)

3. at the management level three (see above), at operational level two times two (specialist, dokter) (nurse, midwife)

Questions for interview with Dr. Budiana, director Hospital Gianyar, Thursday 21 juni, 8:00 Gianyar

General:

1. How long have you already been working at this department? At the same position?

2. What did you do before?

3. How long do you work at a governmental institution?

4. Do you originally come from Bali?

5. May I ask what your age and education level is?

Relationship with Kabupaten and provincial health department:

1. Can you explain to me the relationship between this hospital and the Kabupaten Gianyar? What do they exactly for this hospital?

2. Can you explain to me the relationship between this hospital and the provincial department? What do they exactly for this hospital?

E/E:

1. Do you think this hospital is working effectively? Could it be more effective?

2. Do you think this hospital is working efficiently? Could it be more efficient?

3. Could the Kabupaten or the provincial department be of help with improving the performance of this hospital?

Personnel: Job qualifications and requirements 1. How many people work at this department?

2. Can you explain the organisation structure to me?

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3. How many job levels are there?

4. Are there many changes to get a promotion within this department?

5. What is the mean level of education in this department?

6. Does your organisation has a personnel affairs department/function (SDM)?

Personnel: Recruitment and selection

1. I heard there is a general zero-growth policy for governmental organisations. Does that rule also count for your organisation?

2. Do you now still hire people? How many a year (by proximity)?

3. How does your organisation recruit new employees?

1. Do you know the new constitutional laws UUD 22 and 25? Could you tell me the contents of it?

2. What do you think that the consequences will be for the province of Bali?

3. What do you think that the consequences will be for the health service in general?

4. What do you think that the consequences will be for your hospital?

5. Do you look at this decentralisation process in a positive or negative way?

6. Do you think the performance of this hospital will improve because of the decentralisation process?

7. Has the change process in your organisation already started? How far is it?

8. What are the effects of these changes?

9. Normally an organisation in transition can have some problems working effectively and efficiently, because much energy is used for the change process. Does your organisation that kind of difficulties?

Stakeholders:

1. Which parties are involved in this decentralisation process?

2. Do you see the habitants of Bali as a stakeholder? And your employees?

3. What are the interests of these various parties in this decentralisation process: what do they expect from it?

4. Are there parties which gonna loose power and resources because of this decentralisation process? Which parties are those?

5. Which parties are really looking positively at these changes? And which parties view these changes in a negative way?

6. Are there parties who really resist the changes? Can you give examples of the kind of resistance?

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7. What is the role of the central government?

8. And the government of Bali?

New ILM:

2. What changes are needed at the supply side, how should the workforce change?

• for the hospital?

•

4. Are there differences between the needed changes at the three levels, and why?

5. How do you see the relationship between the provincial department and the

kabupatens in the future? And how will that effect the performance of this hospital?

6. Will there be much communication? Do you think the provincial department will still play a coordinating role? Do you wish such an role for the provincial department?

7. In the interview with Dr. Sudetja of the provincial department we discussed the idea 8. of a role as educator, expert role for the provincial department. The employees of the

Kabupatens could than learn the planning, budgeting and HRM skills by training from this department. In that way the knowledge and skills from this department could also be obtained by the regional departments.

Change process:

1. Can you descibe how the needed changes you described above could be implementated?

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Appendix 3

Interview with Kepala Dinas Kesehatan Kabupaten Badung, Dr. Sudetja, Jl Kamboja, tel 224276

General:

• How long have you already been working at this department? At the same position?

-What did you do before?

-How long do you work at a governmental institution?

-Do you originally come from Bali?

-May I ask what your age and education level is?

Dr. Sudetja has been working as director of the health service of the region Badung for nine months at the same position. Before that he work as a director of the health service Karang Asem.

He has been working for governmental institution for thirteen years. Dr. Sudetja

originates from Bali, is 40 years old and attained a doctor degree at University Udayana after seven years of study.

E/E:

• Do you think this department is working effectively? Could it be more effective?

• Do you think this department is working efficiently? Could it be more efficient?

Yes, it is already working effectively and efficiently following standard procedures. It could also become more efficient and effective after that the changes because of the decentralisation are finished completely.

• How many people work at this department?

At the health department of the kabupaten Badung are working 101 employees, but indirectly the director manages another 401 people, who work at the Puskesmas (Pusat Kesehatan Masyarakat), the health centre’s for the society.

• Can you explain the organisation structure to me?

See copy of Organisational structure in Appendix. The positions are already defined, but it is not yet clear which people will fulfil those positions in the new structure. This new structure can be seen as a direct result of the decentralisation process.

• Can you explain what task precisely your department fulfil? What do the people working here?

The health department makes regulations and instructions and planning tables for the Puskesmas. Furthermore the civil servants of this department also inspect the Puskesmas to make sure the quality of the delivered services is sufficient. The health service of the kabupaten makes promotion about how to prevent diseases and how to live a healthy life, this is done in cooperation with the provincial department.

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• How many job levels are there?

See organisation structure

• Are there many changes to get a promotion within this department?

Yes (Dr. Sudetja didn’t elaborated on this issue.)

• What is the mean level of education in this department?

The majority of the employees only followed one year of college after their high school (SMU). This then results in a ‘Diploma’. Only a few went to University.

• Does this organisation also have direct contact with habitants of Bali (the customers)?

Yes, sometimes (critical) letters come in from people of the society asking the health department to help solve an urgent health problem in the region. The department than seeks direct contact with those people to help them.

Furthermore the health department sometimes also helps out when one of the Puskesmas is short in staff. These employees have then direct contact with the people.

Also, the department tries to install contact persons, to know exactly what the wishes are of the people they serve.

• Does your organisation have a personnel affairs department/function (SDM)?

Yes

Personnel: Recruitment and selection

• I heard there is a general zero-growth policy for governmental organisations. Does that rule also count for your organisation?

No, that rule doesn’t count for our organisation no more, we can decide for our own whether or not to hire people.

• Do you now still hire people? How many a year (by proximity)?

Yes, how much I don’t really know

• How does your organisation recruit new employees?

The recruitment and selection process is not a task of the health department. If health department needs people they are gone file a request to the head of the general Kabupaten (bupati), the actual HRM activities is then done by the SDM department of the general Kabupaten office.

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• Do you know the new constitutional laws UUD 22 and 25? Could you tell me the contents of it?

The UUD 22 is about the decentralisation process. After this law came in effect the provinces of Indonesia had the right to decide on most topics of government as: general works, health, education, habitants, industry, labour, cooperation, trade, etc.

The central government only has the right to decide on the following five issues:

monetary, fiscal, religion, jurisdiction and military.

The UUD 25 is about the budgetting of the Kabupaten. After the decentralisation every Kabupaten has its own budget. They also have the right to control their own resources. Of this revenues some percentage should be contributed to the central government (tax).

• What do you think that the consequences will be for the province of Bali?

For Bali the consequences will be positive, Bali get much money out of its tourist business. In the old situation this money disappeared to Jakarta, now it will stay on the island.

• What do you think that the consequences will be for your health department?

This department will be able to work more effective and efficient because it is now able to make its own decisions. In the old situation many orders from Jakarta which were useless for this region were still followed. Although the decentralisation process will make the work at the department more difficult, the director still thinks his department will perform better.

• Do you look at this decentralisation process in a positive or negative way?

Positive, see above.

• Has the change process in your organisation already started? How far is it?

It officially must completely done from first January 2001, but still isn’t. Dr. Suteja thinks the process is now almost done and will be finished within this year.

• What are the effects of these changes?

More effective and efficient work by this department. The clarity of the tasks has also risen and for many tasks there is now a timetable, so people know when they should have finished their jobs.

• Normally an organisation in transition can have some problems working effectively and efficiently, because much energy is used for the change process. Does your organisation that kind of difficulties?

Dr. Sudetja doesn’t expect that kind of problems, he thinks that by communicating really well when problems arise these problems can be solved without difficulties.

• Do you think that after the transformation the health service will work better? (more effectively and efficiently)

Absolutely!

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• What is the relationship with the provincial health department after this

decentralisation process? Do you still have contact? Do they still co-ordinate some matters?

The provincial department isn’t able to give orders anymore, but sometimes still play a coordinating role in subjects as promotion and prevention.

Stakeholders:

• Which parties are involved in this decentralisation process?

All the people (I think Dr. Sudetja didn’t really understand the question, but on the other hand: he has a point. As my friend and translater Joe said: I’m also involved, I am from Java and now have to get a new identification card because of the new laws.)

• Do you see the habitants of Bali as a stakeholder? And your employees?

Yes.

• What are the interests of these various parties in this decentralisation process: what do they expect from it?

The people hope that the government will be more responsible and take better care of their people. The provinces will also use each other as examples to perform better.

• Are there parties which gonna loose power and resources because of this decentralisation process? Which parties are those?

Yes, before the decentralisation process the Kabupaten had 22 department, afterwards only 19. These tree departments have disapeared and naturally the employees of this department don’t like this situation. One of these department is the Information

department. Dr. Sudetja was a bit afraid to talk about this subject but after some trying finally told this.

Furthermore the provincial department has lost influence and decision power and Dr.

Suteja thinks many employees there also are not happy with this situation.

• Which parties are really looking positively at these changes? And which parties view these changes in a negative way?

The Kabupaten generally look positive on the changes because they get more decision power.

New ILM:

It depends on the situation. (He didn’t really understood the question, I think) 2. What changes are needed at the supply side, how should the workforce change?

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The employees working at the health department should be forced to continue their education to higher their knowledge and skills. Furthermore they should co-operate more with each other and with the provincial department. Dr. Suteja thinks these changes should be taken slowly, step by step.

3. Are there any skills that this department is missing and should posses to perform the new tasks?

No, the performance could be improved by higher education, but the general skills are already here.

People should be assigned to jobs that fit them better. Their education should be more in line with their job.

5. How do you see the relationship between the provincial department and the kabupatens in the future?

There should still be communication, but the working relation is getting worse. The jobs of the people working at the provincial department have become less important and sometimes they are a bit frustrated by that. Before they could give orders and now they are at the same level as the Kabupaten employees.

6. Will there be much communication? Do you think the provincial department will still play a coordinating role? If not, what is gonna be the new task of that department?

The provincial should play a coordinating role, but the communication should be at the same level, as equal partners.

7. In the interview with Dr. Sutedja I discussed the idea of a role as educator, expert role for the provincial department. The employees of the Kabupatens could than learn the planning, budgeting and HRM skills by trainings from this department. In that way the knowledge and skills from this department could also be obtained by the regional departments.

Dr. Sudetja would welcome such a situation because he thinks both parties would benefit from this. He believes his employees could learn a lot from the employees of the

provincial department, and in this way the provincial department still has an important task.

Change process:

1. Can you describe how the needed changes you described above could be implemented?

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By forcing the employees to enhance their educational level we can make a solid basis to perform our new task. I think education is the key element in this decentralisation

process, without good education of our employees it will never work.

Dr. Sudetja will make a speech for his employees in which he will announce a new policy. People will switch to jobs that better fit to them and will also have to follow better education. Also new procedures will be presented to perform the new tasks.

It depends on my employees, it should officially already been working since January first 2001. But I will try to finish the general change process this year. Of course, the re- education process will take much longer.

Yes.

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Appendix 4

Interview with Dr. Ketut Sanjana, director Tabanan Hospital, Saturday 19 August

General:

1. How long have you already been working at this department? At the same position?

2. What did you do before?

3. How long do you work at a governmental institution?

4. Do you originally come from Bali?

5. May I ask what your current age and education level is?

6. Are you following additional education at the moment?

Dr. Ketut Sanjana is 44 years old and has attained a master degree in Hospital

Management at the University of Yogyakarta. He is now 3 years director of the hospital Rumah Sakit Tabanan and has started at the same position. At this moment he is

following a consultant training course.

Relationship with Kabupaten and provincial health department:

1 Can you explain to me the relationship between this hospital and your Kabupaten?

What do they exactly for this hospital?

The hospital is nowadays owned by the local government. The Kabupaten makes all the decisions about budgets, revenues, people and equipment.

2 Can you explain to me the relationship between this hospital and the provincial department? What do they exactly for this hospital?

In the old situation budget for the purchase of big equipment came from the provincial department. Dr. Sanjana doesn’t know yet what the relation with the provincial

department will be in the future. He hopes this will become clear in the next year. He hopes that the provincial department can play intermediate in the relationship with the Kabupaten. Dr. Sanjana is also scared that the budget of the Kabupaten will leave no room for the purchase of big equipment so that the hospital can’t buy the things it needs.

3 Has the relationship with the Kabupaten and/or the provincial department changed since the decentralisation process started?

See above. Furthermore Dr. Sanjana wishes that the provincial level will become a regulator and in that function gives standards and procedures that the Kabupaten should follow.

E/E:

1. Do you think this hospital is working effectively? Could it be more effective?

Not yet. With the current workforce we should be able to serve the patients much better.

As example: We have 4 doctors for 144 pregnant women a month. This should be enough, but because they don’t work hard enough we only have 15 caesarean deliveries.

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That means that some women don’t get that treatment although they need it. This is very dangerous for the women and their babies.

2. Do you think this hospital is working efficiently? Could it be more efficient?

No, we should work more efficient. Therefore I started a budget monitoring program, so that we can look how much we spend on a patient and how much every function spends. I hope this will make the employees more conscious of the costs involved in the treatment of patients.

But there are still many problems to be solved and the key solution is autonomy.

3. Could the Kabupaten or the provincial department be of help with improving the performance of this hospital? How?

Kabupaten: by giving autonomy to this hospital. We need autonomy in Human Resources, budgeting and purchasing. We have much more knowledge about how to manage this hospital than the people working at the Kabupaten.

Provincial: by supplying the human resources we need. I think the provincial department should become for one part a educational institution, providing training for doctors and nurses. Furthermore the provincial department should set the standards for the

Kabupatens.

1. How many people work at this hospital?

390

2. Can you explain the organisation structure to me?

See organogram

3. How many job levels are there?

3 levels

4. Are there many changes to get a promotion within this department?

At first the changes look small, but within every profession like doctor or nurse are several levels. When a employee performs very well he or she will be promoted to a higher level. This brings along more responsibility, salary and status.

5. What is the mean level of education in this department?

This is very hard to estimate. The doctors of course all have a university degree in medicine. The nurses all have at least senior high school. The level of education for the structural employees (like administrative and planning) is to low. Only two people have a university degree, including Dr. Sanaja himself.

6. Does your organisation have a personnel affairs department/function (SDM)?

Yes, this function helps to determine who gets promotion and keeps the data of our employees. Furthermore they play a role in the contracting of the employees who we contract for two years. This is something we may do without authorisation from the Kabupaten.