University of Groningen
Community health centers in Indonesia in the era of decentralization Miharti, Suwatin
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Publication date: 2018
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Miharti, S. (2018). Community health centers in Indonesia in the era of decentralization: The impact of structure, staff composition and management on health outcomes. University of Groningen.
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Propositions
Community Health Centers in Indonesia in the Era of Decentralization:
The impact of Structure, Staff Composition and Management on Health Outcomesby Suwatin Miharti
1. Limited decision space (authority) of Community Health Centers in Indonesia, combined with strong accountability (control) mechanisms, facilitates Community Health Centers to innovate services for responsive health care. (Chapter 2)
2. Indonesian Community Health Centers that operate in poor areas are generally less successful in achieving efficiency, but the way these centers design their organizations can reduce the negative effect of poverty on efficiency. (Chapter 3)
3. Contrary to what is often assumed, a high variety in types of staff employed in the Community Health Centers in our sample did not relate to an increase in efficiency of health services. (Chapter 3)
4. Whereas it is often assumed that midwives and nurses can substitute the work of physicians, the research in this dissertation suggests that these professions complement each other’s work and that other specialists (such as dentists and pharmacists) may contribute to particular tasks of the Community Health Centers. (Chapter 4)
5. In the Community Health Centers in our sample, pathways to high efficacy in four different health care domains were characterized by five or six different types of health staff, and not eight as is the government standard. Hence, less can be more in this context, although to a certain threshold. (Chapter 4)
6. Although the Community Health Centers that work in remote areas are in a disadvantaged position compared to their colleagues in non-remote areas while attempting to provide health care services, the way these centers organize themselves may partly mitigate the negative effect of remoteness on these centers’ performance. (Chapter 3 and 5)
7. Given that only few health service coverage areas of Community Health Centers in Indonesia have organizationally strong Posyandu (community-based organizations), the surprising positive effect of Posyandu of medium and weak organizational strength on the number of weighed infants in such areas is encouraging: Posyandu do not need to be strong in order to be effective (Chapter 5).
