Family Planning in Asia and the Pacific - International Council on ...

than <strong>in</strong> ensur<strong>in</strong>g a grow<strong>in</strong>g role for public accountability.O<strong>the</strong>r recent developments <strong>in</strong> familyplann<strong>in</strong>g <strong>and</strong> population policyThere have been a number of o<strong>the</strong>r recent developments <strong>in</strong>FP <strong>and</strong> population policy <strong>in</strong> Indonesia which are importantfor underst<strong>and</strong><strong>in</strong>g <strong>the</strong> current situation.Hull <strong>and</strong> Mosley reviewThere have been a number of reviews of <strong>the</strong> current statusof FP <strong>in</strong> Indonesia <strong>in</strong> recent years (e.g., Hayes, Lewis<strong>and</strong> Vogel, 2003; Hayes, 2006). The most importantreview was that undertaken by Hull <strong>and</strong> Mosley (2009),entitled Revitalization of <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> <strong>in</strong> Indonesia.They discussed many of <strong>the</strong> same issues described <strong>in</strong> <strong>the</strong>present report. Their recommendations are reproduced <strong>in</strong>Table 7, toge<strong>the</strong>r with snippets from <strong>the</strong>ir accompany<strong>in</strong>gjustification <strong>and</strong> clarification, <strong>and</strong> some additional briefcomments of our own.Their review was followed by ano<strong>the</strong>r which suggestedoperational strategies for implement<strong>in</strong>g <strong>the</strong> Hull <strong>and</strong>Mosley recommendations (Lewis <strong>and</strong> Haripurnomo,2009). Eight strategies were outl<strong>in</strong>ed:Strategy to support <strong>the</strong> role of <strong>the</strong> private sector <strong>in</strong> RE/FPStrategy for technical support for decentralizationNational communications strategyCapacity-build<strong>in</strong>g strategy to address decentralization<strong>and</strong> priorities <strong>in</strong> RH/FPStrategy to improve <strong>the</strong> quality of RH/FPSupport strategy for ensur<strong>in</strong>g equity <strong>in</strong> access <strong>and</strong> useof RH/FP servicesStrategy for prevent<strong>in</strong>g high-risk pregnanciesStrategy for balanc<strong>in</strong>g <strong>the</strong> contraceptive method mix.BKKBN has adopted some of <strong>the</strong>se recommendations,although not necessarily <strong>in</strong> ways that o<strong>the</strong>rs would regardas engender<strong>in</strong>g a “revitalization” of <strong>the</strong> FP programme.For example, BKKBN has begun to address <strong>the</strong> issue ofmethod mix, but <strong>the</strong> lynchp<strong>in</strong> of its strategy is to provideall contraceptive methods free of charge: that is, a strategywhich secures a large procurement budget for <strong>the</strong> agencywithout requir<strong>in</strong>g any significant organizational reform.It is not clear how this strategy adds value to “work<strong>in</strong>gclosely” with <strong>the</strong> M<strong>in</strong>istry of Health (<strong>the</strong> phrase oftenused <strong>in</strong> public statements) or adds value to implement<strong>in</strong>geffective decentralization; no premium appears to havebeen placed on provid<strong>in</strong>g contraceptive methods <strong>in</strong> a costeffectiveway. The fact that BKKBN can comm<strong>and</strong> sucha large procurement budget demonstrates that <strong>the</strong> agencystill has a lot of political capital, but it is be<strong>in</strong>g spent mostlyto ma<strong>in</strong>ta<strong>in</strong> bus<strong>in</strong>ess as usual, not to <strong>in</strong>troduce <strong>in</strong>novativereform.The Hull <strong>and</strong> Mosley recommendations are em<strong>in</strong>entlysensible <strong>and</strong> well thought out. However, <strong>the</strong>se qualitiesare rarely sufficient <strong>in</strong> any democracy to ensure that <strong>the</strong>government will adopt <strong>the</strong>m. In Indonesia governmentagencies are still largely neo-patrimonial bureaucracies;promotion <strong>in</strong> <strong>the</strong> civil service is still not clearly determ<strong>in</strong>edby performance, although this situation is slowly chang<strong>in</strong>g.Key political decisions are often determ<strong>in</strong>ed by websof patronage <strong>and</strong> <strong>the</strong> capacity to capture <strong>and</strong> comm<strong>and</strong>resources. Under <strong>the</strong>se circumstances it is difficult forany agency to adopt changes on <strong>the</strong> grounds that <strong>the</strong>ywill result <strong>in</strong> everyone do<strong>in</strong>g a better job at serv<strong>in</strong>g <strong>the</strong>needs <strong>and</strong> aspirations of <strong>the</strong> public. It is difficult to<strong>in</strong>troduce evidence-based reforms designed to improve anagency’s performance without fur<strong>the</strong>r civil service reform(Synnerstrom, 2007).RecommendationsOur recommendations, which were presented as discussionquestions for <strong>the</strong> Consultation <strong>in</strong> Bangkok, 8-10 December2010, are as follows:Recommendation 1Can Indonesia’s national FPprogramme be given a central focusto meet all rema<strong>in</strong><strong>in</strong>g unmet need forservices by 2015?The FP programme does not currently have a clear focus.Its core bus<strong>in</strong>ess should be reduc<strong>in</strong>g unmet need, butlittle progress has been made on this dur<strong>in</strong>g <strong>the</strong> last 15years. Unmet need is primarily a health <strong>and</strong> reproductiverights issue <strong>and</strong> it needs to be addressed urgently for anumber of reasons. Unmet dem<strong>and</strong> for FP services meansthat millions of women <strong>in</strong> Indonesia today are at risk ofunwanted pregnancy. This is a serious health <strong>and</strong> genderissue.Focus<strong>in</strong>g <strong>the</strong> FP programme on reduc<strong>in</strong>g unmet need forFP services is <strong>the</strong> k<strong>in</strong>d of challenge which could revitalize<strong>the</strong> programme. It is a goal which has major health benefits<strong>and</strong> which promises to empower more women (<strong>and</strong>couples), toge<strong>the</strong>r with all <strong>the</strong> flow-on benefits this entails.It is also a goal which enjoys almost universal support, both236