Using soft-system management technique for transforming Yogyakarta city health office for more stewardship and enforcement function

One important issue in health care decentralization in Indonesia, is the strengthening of District Health Office as stewardship and enforcement agency to improve health status. This function is a new thing for most of Indonesian District/City Health Office (around 400 districts). Traditionally, the organizational culture of this organisation is more as a health provider. To develop the new fuction, academia from Graduate Program in Public Health Gadjah Mada University have a multi-years partnership program with Yogyakarta City Health Office since 2004. In this collaboration, the academia at Gadjah Mada University act as facilitator for the strengthening program using Soft-System-Management technique. This technique provides a conceptual framework as the following: real-life situation and problems is brought into modeling in the campus using various scientific frameworks.  The frameworks come from WHO guidance, academic journals, and books. These frameworks were adapted to real situation condition in the City of Yogyakarta. The conceptual model  then used for a systematic change in the real life. In 2008, after 5 year  of implementation, the organizational culture of City Health Office have changed. More activities in stewardship and enforcement were carried on by City Health Office.  The activities such as: re-licensing hospital and other health fasilities, re-licensing health workers include medical specialists, quality control on public and private hospitals. Local government regulation as the legal basis for the new fuction had been enacted. The City Health officers gain more confidents in implementing supervision and field monitoring to public and private health facilities and workers. As the conclusion, academia can have partnership with District Health Officers and act as facilitator of cultural change in the District Health Office City of Yogyakarta from provider of services to more stewardship and enforcement functions.