Innovative Practices Case Study International Resource Cities Program
Innovative Practices Case Study:
Public Health Improvement and
Public Service Management Training
Kabupaten Kutai Kartanegara, Indonesia,
and
Washington County, Oregon, USA
Background
Located in the Indonesian Province of East Kalimantan on the Island of Borneo,
Kabupaten Kutai (County of Kutai) is rich in natural resources, particularly
forestland, gold and coal deposits, and palm oil plantations. The revenues from
these resources, however, are unevenly distributed between the central
government, the Indonesian elite and overseas investors. Very little of the profits
are filtered down to the citizens of Kutai, who struggle to get by. Opportunities to
access jobs created by these large companies are low, as very few of the
workers in the Kutai have the proper skills. Years of misuse and neglect have
left public facilities, such as the hospital, in disrepair.
The recent enactment of laws on fiscal and administrative decentralization has
put more autonomy in the hands of the local governments. Now Kutai has an
opportunity to take more control over its own destiny and improve the quality of
life for its citizens.
Washington County was chosen as a partner for Kutai because of its location in
the Portland Metropolitan area — home to numerous community colleges and
universities. The County Administrator, Charlie Cameron, has also been
recognized for his commitment to training for staff development. Washington
County also has excellent public services, including hospitals.
Problem Statement
The law on regional autonomy in 2001 assigns to central government only key
national functions such as defense, judiciary, foreign relations and the monetary
and fiscal system, while devolving most authorities directly to local governments
(city and district) providing public services at the local level. The law gives local
government great autonomy over most of the functions that affect people most
directly, including urban services, primary and secondary education, public and
basic health services, environmental management, planning and local economic
development. It also wholly reverses the previous practice of central control of
most decisions, creating new opportunities for democratic control of local affairs.
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New laws and regulations create a basic framework for local self-government. At
the same time, the local government of Kutai Kartanegara has little experience
with the new model of participatory self-rule. Like other local governments in
Indonesia it needs assistance to create adequate mechanisms for effective public
service management, transparency and accountability. They also have limited
technical capacity, particularly to perform functions that used to be provided by
central agencies. Kutai needs support to demonstrate to citizens that autonomy
does lead to improvements in services.
Hospital management prior to regional autonomy was structured hierarchically.
Classes of service were allocated to hospitals, from the national service level in
Jakarta to the province and district levels. Administration and funding were
arranged by the central government Department of Health. Under local
autonomy, health services are administered by the Kabupaten and are in
transition, since most regulations and administrative procedures still follow the
old templates. It is a challenge for the Kabupaten to reorganize and restructure
the whole process while maintaining or improving the current level of services to
the public.
Kutai Kartanegara faced several impediments to implementing standard health
services:
• Outdated, sub-standard medical equipment in the hospital.
• An ineffective bureaucratic model of hospital management.
• A shortage of trained medical staff and specialists to meet the required
standards.
• A plan to build a new, modern international hospital constrained by lack of
paramedic staff with international accreditation.
• Public health delivery through local clinics at the sub-districts is in need of
improvement and should be integrated with the district health system.
Emergency medical procedures are not properly documented nor are they widely
distributed.
The 94-bed hospital (the only hospital serving the 450,000 residents of Kutai)
suffers from a lack of uniform in-service training for its nursing staff.
Inasmuch as regional autonomy is in its early stages, the professional staff has
not had sufficient access to public administration skill building and organizational
culture training.
Project Description
Kutai Kartanegara has received the largest national general allocation fund for its
annual budget since the new laws on autonomy were implemented. There have
been many new developments in Kutai since regional autonomy began. Most
projects are on basic transportation infrastructure, such as finishing a new
suspension bridge, building new connecting roads from/to Samarinda, and the
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development of a tourism/ amusement park at the Kumala Island. However, key
services are still not being addressed.
Provided the opportunity by the Resource Cities Partnership program, Kutai has
determined to use its partner's support to address certain critical issues. As
Oregon neighbors and collaborating service providers in the United States,
Washington County has come together with the City of Tigard, Oregon to provide
examples of how local governments work closely and exchange their services.
The two US local governments wanted to help create this sort of collaboration
between Kutai and Tigard's partner, Samarinda. In February 2002, the four local
governments signed an MOU demonstrating their commitment to work together
to implement joint programs.
The work plan is focused on the following:
Improving hospital nursing staff training, emergency medical care protocols and
medical equipment.
Developing a core in-house public administration training program for
supervisors, managers and executives.
Developing methods of forest product inventory control.
Training staff on double-entry accounting systems.
Refine existing revenue structures and to identify new revenue opportunities.
The last-two topics on finance were designed to be conducted together with
Samarinda-Tigard. While the widely-known major forestry policy issues in Kutai
and East Kalimantan in general would be addressed more specifically through
implementing an inventory technique.
To-date, the partners have completed four exchanges. The focus of these
exchanges has been primarily on the health and training component of the work
plan. During this time, the partners have made great strides in taking the right
direction for the improvement of public health management and public service
training of Kutai Kartanegara.
Future exchanges will focus more heavily on the real delivery of training and an
internship program for managerial skill improvement where progress has been
made, but work still needs to be done.
Implementation Timeline
Trip #1: February 2002 to Kutai
The purpose of the exchange was to make an initial assessment of Kutai's
challenges and potential and to develop the work plan. More specific
observations were made regarding health service provision and the status of
Parikesit Hospital of Kutai. An additional assessment was made regarding the
capacities of local officials and their needs for skill training in public service
management.
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During this visit, a joint workshop between Kutai and Samarinda was organized.
Both local water companies sat together to share their experience and exchange
ideas with Tigard and Washington County. The occasion was deliberately
designed to start building better communication with the neighboring city and
kabupaten while addressing common concerns about drinking water for the
people of both countries.
Trip #2: June 2002 to Washington County
A joint delegation from Samarinda and Kutai traveled to Oregon for the second
exchange in June 2002. The Kutai officials visited Tualatin hospital, a fire and
emergency station, Oregon State University's extension service, Portland
Community College nursing schools, vocational training classes at two
campuses, and Portland State University School of Government. As well,
numerous other discussions and meetings were held partner officials and the
County Council.
Trip #3: September-October 2002 to Kutai
For third exchange in September-October 2002, Washington County and Tigard
traveled to East Kalimantan together. Washington County's public health
manager made a further assessment of specific areas for technical support and
capacity building.
Trip #4: November 2002 to Washington County
The Bupati of Kutai — at his own expense - traveled with two senior staff to meet
extensively with senior experts from Washington County. They visited Tualatin
hospital at Forest Grove, with the specific purpose to launch the "cooperative
action plan" to:
• Increase hospital capacity through nursing staff training, the adoption of
an emergency medical reference guide, and the donation of medical
equipment and textbooks.
• Provide technical assistance in the areas of human resource development
and capacity building.
• Prepare a "Public Service Training Program" that will lead to the
implementation of higher education opportunities in Kutai through
cooperation between Portland Community College, Portland State
University and Kutai Kartanegara University, facilitated by the county-
kabupaten partnership.
• Establish the "task force," by both partners, that will accelerate
communication between expert staff to come up with realistic, attainable
programs and sustainable cooperation beyond the current partnership.
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Exchanges have not taken place in recent months due to the unstable global
political climate and busy schedules of the local governments. In the meantime,
Kutai has established a task force to work on technical matters regarding the
commitment made in the MOU. Washington County has formed a similar task
force. Together, these groups are working with two education and training
consultants to come up with specific action plans and steps toward the
establishment of training centers for paramedics and public service managers.
Solutions Overview and Specific Results
■ Kutai Kartanegara received a donation of three heart monitors from
Tualatin Hospital.
■ A formal task force has been established by each partner. The purpose of
the task force is to coordinate on issues pertaining to the work plan and to
move the partnership agenda along in a timely manner. Both task forces
have been endorsed by the leadership of the Washington County and
Kutai Kartanegara. The task forces are communicating with one another
via e-mail.
• The Washington County Task Force has designed training modules on
public service management, which will be delivered at a train-the-trainers
program during the next exchange.
Benefits
• The Bupati and other local officials understand the need to improve the
skills of paramedics to improve the health care for the kabupaten as a
whole.
• Kutai Kartanegara now has more contacts with higher education
institutions in the Portland metropolitan area. This has increased the
likelihood that Kutai will establish a training center using Portland
Community College as a model.
• The Task Force that has been established in Kutai is a useful mechanism
for coordinating new offers from other institutions (such as Pertamina) and
donor agencies / foreign grants (such as from French and British
government). Kutai now has a better framework for putting together
development options.
• When public service management training is delivered and transferred to
the local trainers, there is a good chance that such training can be
replicated through the Association of Indonesian Regencies, or APKASI. A
similar possibility applies to the paramedic and hospital management
training. Kutai could be the center for such training programs.
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Conclusion — Sustainability and Transfer
Sustainability: Using a systematic approach, Kutai Kartanegara has made critical
steps to ensure that professional staff (e.g., paramedic and hospital managers) is
properly trained. Initial training in public service management has opened an
opportunity for Kutai to become a center for local government training. The
existing Task Force will develop a plan to make this happen and sustain the
momentum necessary to tackle such an ambitious plan. The leadership and
support of the Bupati of Kutai will be critical to the success of the project.
Transfer: Public health and hospital management issues are typical of the
general problem of public service management of local governments. This has
opened the discussion about whether public service management training (in
general) is needed among local officials in Kutai, as well as in other local
governments. Coincidentally, the current Bupati of Kutai Kartanegara is also the
Board Chairman of APKASI (the Indonesian Associations of District
Governments). As a result, what Kutai has been doing in this area could be
transferred or replicated more easily to other district governments.
Development of a public administration/leadership training program could be
modeled in other local governments with similar needs. Similarly, Kutai could
become a center for public administration in the region where local governments
could send their civil servants to improve their skills.
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