This project is a study of political process, both at the central and the local levels, in the evolution of the primary health care units from the Ministry of Public Health to the local administrative organizations. The result demonstrates irreconcilable visions on decentralization between the central and the local administrations. The central administration, in this case the Ministry of Public Health, proves reluctant to transfer its authority to the local administration, while the local administration grasps the new opportunities from the public health management. For the local administrative organizations, the health care management can be a valuable means to respond to the citizen’s needs which will significantly lead to secure the votes for the next elections. The health care service, thus, empowers the local administration although it apparently became an interest seeking for some local politicians.
In the process of public health evolution, obstruction and difficulties are found both at the central and the local levels. At the central administration, some difficulties are indicated as follows. (1) Although the decentralization process had been completed by the legal statement and organization structure, policies following the law were not implemented, thus, showing the failure of law enforcement even by the government agencies themselves. (2) The central administration emphasizes more on the expertise and profession than the decentralization doctrines do. The Ministry of Public Health has long been recognized for its capability to keep the professional standard, therefore, the officers do not see the necessity of decentralization. (3) The decentralization process that is engendered at the central administration gives rise to a deadlock. That is because it is fundamentally impossible for the power holders, particularly at the central administration, to relinquish their power to the others.
From the 5 case studies at the local administration, the difficulties are evinced as follows. (1) The local administrative organizations lacks of autonomy. (2) The local administrations are facing politicians’ corruption which in return had become liability for decentralization although there are only some cases of corruptions. (3) The local administrative officers and elected officers do not have skill and knowledge in the public health care.
However, this study discovers the distinguished dynamics at the local administration amid all those difficulties. Firstly, the way the local administrative organizations solve the particular issues at their localities is remarkable as this will lead to innovative governance. Secondly, the electoral politics makes accountability possible since the voters’ satisfaction became the focus of political power. Thirdly, despite some corruption cases, the local administrations are exposed to the challenge from the opponents and the civic groups alike. Eventually, all these dynamics will bring about better service providing by the local administrative organizations in the long term.