New Book: States Without Citizens?

2012-01-26T15:29:00.001+07:00

Dear reader, when the book comes to the reader, this book is not just the result of analysis conducted on a pile of documents and policies, a series of notes on the interview or also a review of the news media. This book is also not the result of scientific analysis process within and dry from the social and political struggles, or simply laid down as part of efforts to pursue academic goals and the pulpit alone.

Of course a series of scientific methodology - through triangulation, excavation and use of accurate data - be part of the research that produced this book, however, this book is more than that. This book is part and simultaneously record the process of strengthening and advocacy to promote the welfare and fulfillment of the rights of marginalized groups in policy at the local level.

This process is strung since early 2011, when the conversation about welfare and the role of the state initiated by a script in the District of Semarang with some local migrant worker community-term that we use to describe those who migrate between regions on a variety of reasons including economic reasons. Spontaneous dialogues, a mixture of unhappiness or a colorful protest, and apathy are also strong coloring process in the initial phases. Chat that we have built as part of an effort to bring the discourse of citizenship (citizenship) in the daily lives of workers in the initial phase is not an easy process. Engraved in the absence of state position, life is more about workers' discourse is dominated by corporate citizens making the country almost no role and is not unimaginable.

Is a challenge for Literacy to develop approaches, methods, tools and tactical choices that others in situations like the one above. Convinced that it is crucial to seat the concept of citizenship as the basis for urgent fulfillment of rights (claiming rights), alternative methods ranging from strengthening the organization of citizenship, critical educational, establishing a dialogue with key political officials to use media like comics and movies are part of coloring petajalan strengthening local rights of migrant workers that we are doing this. Notes to the processes is recorded in the book of this action research.

What is also interesting, the process of finishing this book in conjunction with the success of the labor movement that succeeded in pushing its passage BPJS which will mark a new phase of social security for workers in Indonesia. In the same spirit, we hope this book contributes to the ideas and efforts to strengthen and fulfill the rights of workers everywhere.

Of course, we owe it to my friends in District Bawen community (Society of Workers Terminal Bawen), District Pringapus (Community of the Rainbow) and District Bregas (Community Twins), which became a major learning friend in this process. And therefore, unto them we dedicate this book. Literacy also expressed appreciation and thanks to friends who become a team of writers of this book: Hasrul Hanif, Sutrisno Budiharto and Dati Fatima. Do not forget, this process will not be possible without the hard work as Program Manager Aminatun Zubaedah who mated series dikomunitas processes, research activities and campaigns as well as well as advocacy and lobbying undertaken. Nor would this story may be assembled without the stained Wakid and Susilo Budhi S which accompany the process of learning communities with Ari and Rima in Semarang. Without them, it's hard to imagine this book will present to the future readers.

Yogyakarta, October 30, 2011

Dati Fatimah

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Portrait of Reproductive Health Before and After the Regional Autonomy

2012-01-25T22:41:00.009+07:00

REPRODUCTIVE HEALTH is one of important issues in human development. Moreover, Indonesia has ratified the International Conference on Population and Development (ICPD) on 1994 as a global agreement. The ICPD (Cairo Documents, 1994) stipulates the multi aspects of Reproductive Health; be it physical, metal and social aspect.
The implementation of reproductive health administration policy in Indonesia changes related to the implementation of Regional Autonomy (decentrali-za¬tion) following the enactment of Law No. 22 of 1999 (later revised Law No.32 of 2004 on Regional Government). The authority of health affairs which was central government affairs devolved to local government as the result of the regional autonomy policy, either in the planning, implementation and evaluation of the programme.
So, what kind of reproductive health services in post-Autonomous Region? This Fact Sheet will unravel how the portrait of post-reproductive health Autonomous Region in Klaten regency, Central Java Province.

REPRODUCTIVE HEALTH IN KLATEN
We will look at reproductive health conditions from several indicators such as maternal mortality rate, infant mortality rate, data of family planning participants, health facilities, and gender issues in reproductive health.

A.MATERNAL MORTALITY RATE
Maternal mortality rate in Klaten between 2005-2009 fluctuated as shown in the table below.
There were 19 cases of maternal deaths in 2009, two of which occurred in the pregnancy, four during labor, and 13 others during childbirth.

B. INFANT MORTALITY RATE
The infant mortality rate in Klaten fluctuated in 2005-2009. The highest number occurred in 2006 and the lowest occurred in 2008. The figures are calculated per 1,000 live births.

C. FAMILY PLANNING DATA
Woman participatory is higher than man in the family planning. There were 38.121 woman participants and 1.880 man participants (467 who use Men Surgery Mode-MOP and 1.413 who use condom) in 2010. The data shown that woman still burden the responsibility in the family planning affairs.

D. REPRODUCTIVE HEALTH FACILITIES
There are eight hospitals, 34 community health centre, 86 health units, 260 maternity care units, and 34 mobile health care units in Klaten. While in the availability of midwives is sufficient enough with 426 midwives which means that there is one midwives in each village on average. Those numbers are not included with private midwives which number is more than state midwives.

The table shown that there are enough physicians but it is not for the public health personnel.
On the other hand, the implementation of Regional Autonomy in Klaten contributes in a reduction of family planning extension workers with reducing the socialization of family planning as the impact. There were 162.468 (78.7%) active family planning participants in 2009 and getting reduce in 2010 with 152,762 (75.7%).
Autonomy emphasizes the efficiency and reducing many aspects. The public health personnel worked more effective, there were 8 instructors in each sub-districts before autonomy. But now there are less than 4 instructors and ending with one instructor in each sub-district. It causes the reduction of family planning participants.
[NS, Famili Planning instructor in Klaten

E. GENDER ISSUE IN REPRODUCTIVE HEALTH

The issue of reproductive health remains a discourse for certain people such as medical officers. While there are still many people have less understanding about reproductive health although it is an innate thing.
Definition of reproductive health was limited to maternal and infant nutrition. While among adolescents is only found in junior high and high school, and even then only in biology classes. Sex education and body authority lesson is still considered taboo for there is a dilemma that giving sex education similar with promulgating free sex.
Since there is considered as taboo, the community do not have any open forum for adolescent to talk about sexuality. Instead of giving the sexuality knowledge to mothers only with the expectation that they are able to share the knowledge to their children.
There are inequalities that participants of family are mostly women. It is important to involve men in family planning programme so that there is a sharing responsibility for a quality family planning.

REPRODUCTIVE HEALTH INSTITUTION AND ACCESS
Reproductive health affairs become the responsibility of several institutions which are Public Health Service and Office of Women’s Empowerment and Family Planning, among others, at local level and National Demographic and Family Planning Agency (BKKBN) at the central level. The working relationship between the institutions originally based on a centralized coordination line, but now turned into a partnership. For example in the service of contraceptive installation, Public Health Service served as an acceptor provider and medical officers, while Office of Women’s Empowerment and Family Planning (Kantor PPKB) as the organizer and the BKKBN as a provider of contraceptive. The problem is that the coordination among the institutions is weak.

FINANCING OF PUBLIC HEALTH AFFAIRS
Financing of Health Affairs has been set in Law No. 36/2009 on Health. It is stated in Article 171 (2) of Law no. 36/2009 that local government health budgets of the provincial, regency/city are allocated a minimum of 10% of the Regional Budget (APBD) not included salaries. But in reality, the budget of Health Affairs allocation in Klaten has not met the provisions of article 171 (2) of Law no. 36/2009. For example in 2008, the expenditure of health affairs was Rp 65,829,765,000, or 6.37% of total expenditures (Rp1.032.951.973.000). While in 2009 the expenditure slightly increased to Rp73.606.052.000 or 7.11% of total expenditures.

The allocation of health affairs for reproductive health expenditure is much lower comparing with total local budget (approximately Rp 1,2 trillion). We can see the allocation for contraceptive installation services in the Standardization Programme of Health Service in the table below:

Ironically the budget for reproductive health services explicitly allocated in the Empowerment of Women Affairs, Child Protection, Family Planning, and Family Welfare programme which is coordinated by the Office of Women’s Empowerment and Family Planning, as shown in the table below:

Budget allocation of reproductive health services in the six programs above spelled out relatively small compared with the total expenditure of local budget that now reaches more than 1.2 trillion. Moreover, there is one program that eliminated from the budget; i.e. Contraception Services Program which had budget Rp.44.000.000 (2008) and Rp.80.000.000 (2009).

STRATEGIC ISSUES AND RECOMMENDATION
We can conclude some points from the description above as follows:

The lack of public knowledge and awareness about reproductive health led to the assumption that it is a woman’s matter solely and limited as matter of pregnancy and childbirth issues. It is more complicated when talking about sex is taboo in their culture. Therefore, advocacy and socialization on the importance of reproductive health is essential to do in order to increasing the equal awareness between men and women.
The reduced of family planning instructors cause the declining of active family planning participants during the implementation of regional autonomy requires special attention from the related institutions. an important and essential thing to do is strengthening the synergy among the implementing agencies – the Health Department, BKKBN and PPKB Office – to formulate more integrative program planning and implementation.
The lack of a budget constraint of Reproductive Health services. While the allocation of budget funds for civil servants is substantial concerning with the large number of civil servants who reach 16,200 people and spending Rp 962 billion (70%) of total budget in 2011. In fact, Klaten is one of 124 regencies/cities in Indonesia are threatened with bankruptcy because more than 60% of budget allocated to civil servants and staffs expenditure (research results Indonesian Forum for Budget Transparency/Fitra). Therefore, there should be a more serious effort in the application of principles of effectiveness and efficiency in the implementation of regional autonomy in order that the budget of public services, including reproductive health, can be improved.(*)

Published by: AKSARA supported by IPPF

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New Book: States Without Citizens?

Portrait of Reproductive Health Before and After the Regional Autonomy