Abstract
Ministry of Public Health (MOPH) has continuously driven Health Area Development. However, in practice, there were many obstacles and barriers that prevented expected health area development, that is the health area development issue has become one of important agendas that the MOPH and other related authorities have paid attentions to. This issue was continuously a part of the strategic plans of the MOPH and health reform plan of the Health Reform Commission. In an attempt to define and propose solutions that could lead to health area development, this research chose the 6th Health Area of the MOPH as the pilot area to in depth collect data, analysis, and design system and mechanism to drive health area development in the 6th Health Area. The researchers collected secondary information and data including National Health Reform Plan, Heath Area Development Proposals, health area development evaluation report, health area strategic/ action plans in the National Health Reform Plan, foreign experiences regarding health system management and health area development, regulatory sandbox’s concept and experiences, and MOPH and the 6th Health Area’s works regarding health system management, and health area development. Moreover, opinions of those responsible for the 6th Health Area development were also collected during the data collecting process. This was aimed to reflect expectations, problems and obstacles in the previous development attempts, as well as suggestions of conditions solutions to achieve goals in health area development. Conceptual idea in health area development and progress evaluation referred to WHO Health System Framework with 6 Building Blocks which led to identify health area development strategies that would achieve health developments of population in health area. The strategies are comprised of (1) human resource management, (2) Information system or database that could support works and health services, (3) enhancing of productions and usage of qualified and accessible technology, (4) financial management that could enhance sustainability and support health services in the health area, and (5) work mechanism that could enhance direction, policies, strategies setting for the whole health area. Moreover, the 6th Health Area is a location of the Eastern Economic Corridor that there were plenty of investment demand in service improvement and leverage. These led to conclusions that measures to drive health area development should cover (1) Health Area and Health Area Office Management, (2) Human Resource Management, (3) Health Area Management Authorization, and (4) Efficiency Improvement and Financial Sustainability. To lead concrete action the researchers propose to make proposals for system and mechanism to drive health area development in the 6th Health Area in a manner to operate in the form of a Regulatory Sandbox by conducting experiments to improve regulatory constraints that impede the action of driving the work of health area. Which has clear terms and conditions for the trial operation and evaluate the results of the experiments conducted to support the implementation of the regulation and set concrete action guidelines in the overview. Regulatory Sandbox for experiments to drive the work of the health area, consisting of 3 field test operations, which are 1) Regulatory Sandbox 1 for restructuring of work / personnel structure of the health area and the health district office, 2) Regulatory Sandbox 2 for improvements in procurement conditions and investment to increase work efficiency and create a fiscal sustainability of health area, 3) Regulatory Sandbox 3 for collaboration in health area. In the implementation in health area, found that some parts of Regulatory Sandbox 1 and Regulatory Sandbox 2 had been performed through various mechanisms that can finalize the implementation and monitor the progress of the operation to lead the proposals for action in the next phase. Finally, all of the proposals have been put forward for trials in pilot health areas under the supervision of the National Health Reform Commission.
