RELATIONSHIPS AMONG PAPERS IN THIS VOLUME
Taufik Hanafi
 

Interventions to improve health status are an important policy instrument in the Indonesia's overall strategy in alleviating poverty and improving the welfare of the nation’s population. As in many developing countries governments intrude into many markets, but seldom as commonly or extensively as in health care. Growing awareness of the obstacles associated with this centralized structure has generated much interest and a number of government initiatives in decentralization. Decentralization of public services has been popular strategies in Eastern Europe countries and developing countries including Indonesia for remedying the problems of governance. Sixty-three of the 75 transitional and developing countries with population greater than 5 millions have transferred or in process of transferring authority from central to local governments (Dillinger 1994). The decentralization policy is advocated as a means to promote efficiency and responsiveness of the government programs and to strengthen community participation. My paper attempts to assess the extent of decentralization efforts in Indonesia and its impacts on sustainability of health care services at local levels.

Most societal issues including health, environmental, urban, economic, technological, and political problems can not be addressed adequately by a single discipline. A family of transitions paradigm suggested by Drake (1993), which has been hallmark of population-environmental dynamic approach, provides an useful framework how to sufficiently portray a complex societal problem, in which is characterized with the interconnectedness among sectors and across scales, and how to manageably deal with it. Having examined my colleague's papers with topics ranging from environmental (Angela, Natalie, Sujata, and Moria), economic (Lewis and Martha), urban (Zeynep and Chandra), poverty (Christina), population (Michael), and health (Mark), an interdisciplinary perspective is required to view complex relationships of such complex and dynamic setting. For example: demographic, economic, and epidemiological transitions contribute largely to the need of a higher degree of local autonomy in provision of public services in Indonesia. Demographic and economic transitions affect significantly to an increased demand for clean water and water resource preservation efforts in big cities and metropolitan areas in Argentina.

The transition periods in which are indicated by high rates of change and limited societal adaptive capacity are more likely to generate imbalanced struture. Economic transition as partly characterized by booming employment opportunities in many large cities has resulted a rapid urbanization rate and created urban crisis such as environmental pollution, limited availability of clean water, and increased demand for public services in Turkey. Similarly, the economic transition has contributed significantly to the spread of infectious disease such as AIDS/HIV, created high burden of health expenditure at both household and national level, and resulted high incidence rate of poverty in Uganda.

Given greatly varied issues discussed in the thirteen papers, emphasis of the policy implications proposed by my colleagues can be classified into individual, household, local, and national perspectives. For example, promoting changes in individual behavior towards more efficient use of clean water, promoting preservation of environmental resources at local and national level, promoting a greater access of women to financial resources, and strengthening local institutions for carrying more responsibilities in provision of public services.