In the District of Pekalongan (Central Java), MADANI’s support to CSOs focuses on increasing the inclusivity of public health service delivery at community health centers (Puskesmas) for vulnerable groups, including for people with disabilities (PWDs). With MADANI’s support, two years collaborative advocacy and civic mobilization has led to a concrete achievement, improved accessibility and inclusivity at local community health centers.
PWDs often experience significant barriers to accessing health care services, including negative attitudes, insufficiently trained medical personnel, and structurally inaccessible health centers. In Pekalongan, this community, which includes almost 6,500 PWDs and 735 children with special needs, are reluctant to go to their local Puskesmas. While the district government has a bylaw (No. 2/2020) on the Protection and Fulfilment of the Rights of PWDs, the government has not issued the necessary executive order that would outline how the health service providers implement the bylaw at the frontline level.
With MADANI’s support, civil society organization (CSO) Muslimat NU Pekalongan – part of the women’s branch of Nahdlatul Ulama, Indonesia’s largest Islamic organization – took this issue on by engaging key stakeholders and approaching its members to take a more prominent role on the issue. Muslimat NU’s intervention worked to maximize community involvement and advocate for specific policy recommendations that would improve access to public services for PWD. In September 2020, they reached out to local CSOs, education institutions, and the media, and formed the multi- stakeholder Learning Forum Forum Serasi Madani. With 18 member organizations, the Forum Serasi Madani aims to strengthen advocacy on inclusive access to public health services, but it also serves as a space to learn and share knowledge among civil society members.
The results from a health services customer satisfaction survey conducted by the Forum Serasi Madani showed that the absence of adequate facilities for PWDs at frontline health service providers has been the main barrier to access. For example, Puskesmas do not have bathrooms or waiting areas that are friendly towards patients with disabilities. They also lack special wards for physical therapy or for children with intellectual disabilities. As part of its collaborative governance approach, Forum Serasi Madani approached the District Health Office (DHO) and the local branch of the state-owned Bank Rakyat Indonesia (BRI) to support the setting up of two disability- friendly health centers, which led to the to the signing of a tripartite memorandum of understanding. The private sector’s presence was greatly appreciated, as it demonstrated the spirit of the collaborative governance approach and how resources can be leveraged from new partners to solve a local development challenge.
“We hope that this collaboration can continue and improve in the future, as such cooperation are mutually beneficial to all of us,” said Anis Abdul Hakim, the Head of BRI in Pekalongan.
On 29 December 2021, the Forum Serasi Madani advocated for a draft executive order (Peraturan Bupati) on PWDs’ access to health services in a hearing with representatives from the local government and local parliament (DPRD). During the hearing, key points addressed included making Puskesmas more structurally accessible, issuing disability identification cards, developing a disability database, and supporting community-based caregivers.
The local government responded positively to the Learning Forum’s initiative, which includes the continued monitoring of how the quality of care has improved in the two disability-friendly health centers. Seeing the results at the current locations, in July 2022, the DHO and Learning Forum agreed to replicate the model to two more locations with local government funding, as part of the local government’s plan to expand disability-friendly Puskesmas. At the same time, Forum Serasi Madani continues to push for the enactment of the executive order.
“Improved access to public health services, especially for people with disabilities, is such a breakthrough,” said Setiawan Dwi Antoro, the Head of the District Health Office. “We hope to gradually replicate all the improvements to all Puskesmas throughout the district.”
This achievement in increasing social inclusion is the result of a multi-stakeholder effort, supported by MADANI, through which local CSO partners participated throughout –in public hearings, planning consultations, and drafting the proposed executive order. With a growing number of MADANI’s CSO partners assuming leadership roles in their districts, local governments and legislatures in MADANI’s districts – including in Pekalongan – are showing a greater willingness to not only acknowledge civil society’s recommendations, but also to value them enough to adopt them as policy.