Improving Quality of Public Services (BOJ0005)

Issues to be addressed: Public service is yet to be delivered optimally especially in the health sector. Primary objective: The commitment seeks to improve public service standards through an effective periodical evaluation and increased public participation in the public service delivery schemes/ public service policy making process. Commitment Description: We are committed to improve the quality of public service through the implementation of Service Standard Evaluation and a public service standard that is jointly developed and agreed both by the government and local society in two community health centers. OGP Challenge: Strengthening public service delivery and government accountability Relevance: Improved public service standards formulation process through collaborative approach, aims to improve public trust and satisfaction towards the government Ambition: Stronger collaboration between the 4 (four) stakeholders with transparent and accountable manner that can foster public participation and better public service delivery

5. Improving Quality of Public Services

Commitment text

Objective: The commitment seeks to improve public services standards through an effective periodical evaluation and increased public participation in the public service delivery schemes/public service policymaking process.

Description: We are committed to improve the quality of public service through the implementation of Service Standard Evaluation and a public service standard that is jointly developed and agreed both by the government and local society in two community health centers.

Ambition: Stronger collaboration between the 4 (four) stakeholders with transparent and accountable manner that can foster public participation and better public service delivery

Milestones

Year 2016:

1. Implementation of Public Service Standard Evaluation (SPP)

2. Development of public service standard as jointly agreed by local government administration and by the public in 2 (two) community health centers (Puskesmas)

Year 2017:

3. Implementation of Public Service Standard that involves active participation from local citizens

4. Implementation of Public Service Standards that have been jointly agreed by local government administration and by the public in 2 (two) community health centers (Puskesmas)

Commitment Overview

Commitment Aim

Overall Objective & Relevance

This commitment aims to fulfill one of OGP Grand Challenges, i.e., “Improving Public Services.” In collaboration with the Institute Development of Society (IDFoS), the Government of Bojonegoro is committed to improve the quality of public service delivery through the co-creation of public service standards between the government and citizens. The ‘public service standards’ are an innovative way to consult with citizens about their satisfaction with public services being delivered to the community. They are meant to be written by citizens with government members to diagnose current practices in specific public institutions (like health centers or public schools) and outline which needs are not being covered. These documents would result in the ‘service standards’, responding to community needs. The government identified the health sector as an initial area to tackle first. Targeting two pilot public health centers (puskesmas) of Pungpungan and Gayam, the commitment seeks to provide effective periodical evaluation of public health facilities by changing the method of civil society-government collaboration through the stimulation of public participation. If the implementation of this commitment proves successful, the intention is to carry out this framework in other areas of government.

Improving the delivery of public health services is one midterm goal of the Government of Indonesia. To achieve this, the national government has committed to implement a Public Service Law (No. 25/2009), improve innovation in public service delivery, and increase public participation in service delivery by developing their capacity and involving them in public service monitoring and evaluation. The quality of health service is a major issue in Indonesia, especially following the establishment of the new, integrated system of national health security (JKN). This transition has caused many technical problems in delivering services in state-owned health facilities, especially at the primary level or puskemas.

To include civil society members in the process of developing public services standards, the Government of Bojonegoro, in alliance with IDFoS, aimed to facilitate civil society-government collaboration in two pilot puskesmas. According to the commitment text, the standards were to be jointly agreed by the public officials and local communities living in the service areas of the targeted puskesmas, and these standards would be specific to the puskesmas in question. In so doing, the government would have more accurate knowledge on community needs and there could be an improvement in public trust and satisfaction towards public services performed by the local government.

Specificity and Potential Impact

The specificity of the commitment is considered medium. The commitment’s language is clear, but the deliverables are not specific enough to measure and could be open to interpretation from the reader. For instance, it is not clear what the difference is between milestone 3 and 4 and to what extent their implementation would contribute to the objective of the commitment. Nevertheless, if implemented, it could have a significant impact. This commitment proposes a major step forward in the evaluation of public service delivery, considering the innovative method of co-developing and co-implementing public service standards with citizens. The commitment offers an alternative approach of civic participation that, if successful, would serve as a model to be replicated in other sectors and other regions of the country. Although, as planned, this commitment will first be applied in the health sector, it identifies multiple other co-implementing institutions (such as the Public Works, Education and Communication Offices), that could carry this pilot forward.

Completion
Substantial

This commitment was substantially completed. Two milestones were carried out with delays, but within the timeframe, while other two saw limited progress.

Milestone 1 was completed in time, albeit the changes that transcribed during the implementation process. The Government of Bojonegoro contracted the private consultancy PT KOKEK ^{Government of Bojonegoro registry of contracts in 2016, ‘Procurement of Community Satisfaction Survey Services to the Licensing Agency PT KOKEK’, services procured in November of 2016, Line 5820/LS-BJ/2016: http://www.bpkkdbojonegoro.com/sp2d/view/179/01-11-2016} to design and conduct a community satisfaction survey in two community health facilities (puskesmas) with the aim of understanding how services were being delivered. These surveys were conducted in November 2016 and followed the national legislation requirements and guidelines stipulated by the Ministry of Administrative and Bureaucratic Reform. ^{Description of PT KOKEK services regarding the Community Satisfaction Services: http://www.kokek.com/services/survei-kepuasan-masyarakat/} PT KOKEK carried out the survey in puskesmas located in Kedungadem and Malo, nevertheless, the implementation of milestones 2 and 4 took place in the facilities of Gayam and Pungpungan. According to the IDFOS representative, the lack of sufficient financial support forced the changes. ^{Joko Hadi Purnomo, IDFOS, in focus discussion with IDFOS (October 26, 2017).} These two sub districts were later chosen to take advantage of Exxon Mobile’s social responsibility plans, which were to be focused in these two communities.

The efforts to secure resources caused significant delays in the completion of milestone 2. The development of the public service standards should have been completed by December 2016. Instead, the milestone was completed in August 2017. To gather input from different stakeholders in Gayam and Pungpungan, IDFOS organized a series of events in Gayam and Pungungan throughout 2017 as part of the Mama Asih program, financed by Exon Mobile to improve public health services. The Mama Asih program (a contraction of Maklumat Bersama Pelayanan Bersih, Joint Declaration for Clean Service) was built upon an existing forum that Bojonegoro’s Health Office used to disseminate findings to health cadres in the region. The IDSoF changed the format and introduced monthly meetings in puskesmas to spur iterative dialogue between citizens and the government. ^{Joko Hadi Purnomo, IDFOS, in focus discussion with IDFOS (October 26, 2017).} In those meetings, puskesmas’ beneficiaries could join and express their opinions, interests, hopes, and solutions in regards to increase the quality of health delivery service in the puskesmas. ^{Separate interviews with Syaifuddin, members of Gayam’s Mama Asih forum, (October 27, 2017) and Bakri, members of Pungpungan’s Mama Asih forum (October 27, 2017).} These meetings served as awareness raising events ^{‘Pungpungan-IDFoS health center coordination of service announcement’, IDFoS website, (9 January 2017), https://www.idfos.or.id/puskesmas-pungpungan-gelar-fgd-maklumat-pelayanan/} and focus groups with service providers and users. ^{Pungpungan health center holds focus group discussions on service announcement’, IDFoS website, (22 June 2017), https://www.idfos.or.id/puskesmas-pungpungan-gelar-fgd-maklumat-pelayanan/} Together with the managers of particular puskesmas, citizens co-created public service delivery standards according to geographical, social and cultural contexts of the region.

The final two public service standards created for the puskesmas in Gayam and Pungpungan were signed on 30 August 2017 by four representatives of the different stakeholder groups: the community leader from the Pungpungan Forum of the Mama Asih Program, the head of the Pungpungan puskesma, the head of the Health Service Department and the ombudsman of East Java. They include minimum standards of operation (defining service hours, complaint mechanisms, sanctions, and other issues). ^{https://drive.google.com/file/d/1UV0hxRGY7YdesNyUy1W4Zdwwmp0ugTmB/view?usp=sharing and https://drive.google.com/file/d/0By7NDz0CM7jzR3djR2dIaHhhZlU/view?usp=sharing}

In October 2017, the standards were made effective in both puskesmas, within the action plan development period, although with delays. On 25 October 2017, with high level representation from the Regency of Bojonegoro and from the sub districts and Exon Mobile representatives, IDFoS led the ‘Transparent and Participatory Health Service Training’, a two-day training for capacity building on the new standards. Ten members of the two health centers and 12 representatives of community forums in Gayam and Pungpungan attended to learn about openness, participatory mechanisms, handling complaints, the creation of public service standards and other useful information, such as health insurance policies. ^{‘Important transparency for health services’, IDFoS, (25 October 2017), https://www.idfos.or.id/transparansi-penting-untuk-pelayanan-kesehatan/} These efforts were considered as part of the implementation of the agreed upon standard, therefore, milestone 4 is considered complete.

As to milestone 3, it remains unclear how it differs from milestone 4 and no evidence was provided to assess its completion.

Early results: did it open government?

Access to information: No change
Civic Participation: Major
Public Accountability: Marginal

The commitment targets one OGP Grand Challenge (Improving Public Service) by increasing civic participation and public participation in health service delivery. There was significant civic participation in the course of developing public service standards in two locations: Pungpungan and Gayam. In so doing, more people acquired knowledge in how the health facilities and systems have been working so that they could contribute in improving the system itself.

In the area of civic participation, there was a new opportunity for the public to influence decisions in local health service delivery through a new-established forum of “Mama Asih” (a contraction of Maklumat Bersama Pelayanan Bersih, Joint Declaration for Clean Service) in the subdistricts of Pungpungan and Gayam. The forum was an optimization of a monthly meeting in puskesmas initiated by IDFoS. Before that, the meetings were a one-direction communication of health information dissemination from representatives of the Office of Health to health cadres in the region, according to a member of the forum in Pungpungan. With a full funding from Exxon Mobile Cepu Ltd (EMCL), IDFoS facilitates the transformation of the meetings into dialogue between citizens and the government. ^{Joko Hadi Purnomo, IDFOS, in focus discussion with IDFOS (October 26, 2017).} In those meetings, puskesmas’ beneficiaries could join and express their opinions, interests, hopes, and solutions in regards to increase the quality of health delivery service in the puskesmas. ^{Separate interviews with Syaifuddin, members of Gayam’s Mama Asih forum, (October 27, 2017) and Bakri, members of Pungpungan’s Mama Asih forum (October 27, 2017).} Together with the managers of particular puskesmas, citizens co-created public service delivery standards according to geographical, social and cultural contexts of the region. The standards created for each facility is tailored made, considering regional differences, community needs among other factors. Therefore, the two public service standards created differ from each other due to the inclusive nature of the mechanism. The forum has also been functioning as a medium for public officials to explain their responsibilities and limitations, which is an important step towards public accountability in Bojonegoro. In that sense, there have been a series of productive monthly dialogues between citizens and public officials in finding solutions and alternatives to improve public health service delivery in particular health facilities. The results are then set forth in joint declaration in two puskemas of Pungpungan and Gayam. ^{https://drive.google.com/file/d/1UV0hxRGY7YdesNyUy1W4Zdwwmp0ugTmB/view?usp=sharing and https://drive.google.com/file/d/0By7NDz0CM7jzR3djR2dIaHhhZlU/view?usp=sharing}

There has been an effort to establish a similar forum at the regency level in order to control and monitor public health delivery service in Bojonegoro, especially in the public hospitals. However, there is a strong dependence on private sector funding to carry out the practice of producing collaborative public service standard evaluations. This presents itself as a limitation to the scalability of the program and its reach to other centers, new communities and sectors beyond health.

In their November clarification, the government claimed its routine programs, such as LAPOR, Friday Dialogue, or radio talk show as the result of Milestone 5.3. ^{Email communication with Alit Purnayoga, OGP team’s secretary (November 23, 2017).} This differs from the information collected in the course of a visit from the IRM researcher in August, where the government promised to employ similar technique of co-developing public service standards (5.2) to other public service sectors, i.e. education affairs and civil registration offices. ^{Eliza Zuraida Zen, Division of Organization and Governance, in focus discussion with OGP team’s members (August 10, 2017).} However, there has been not enough evidence of any effort to initiate the co-creation of the standard in those sectors from both the government and CSO sides.

Recommendations

The IRM researcher recommends the government to continue their work on the Public Service Standard Evaluation as a method to collaborate with citizens in the improvement of public services. Although it has proven to be a useful method, there are still questions of the sustainability of the program. The government could:

1. Focus on deepening civic participation and sustaining the co-developed standards in the two heath centers they are currently engaged with.

2. Develop a strategy for sustainability of the program and its possible expansion to other sectors and communities; increase government ownership of the activity and provide funding of spaces for dialogue.