social audit: a study of jamkesmas and jamkesda membership

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1A Study of Jamkesmas and Jamkesda Membership

SOCIAL AUDIT

A Study of Jamkesmas and Jamkesda Membership

Author

Ufi Ulfiah

Siti Khoiriah

Kamal Fuadi

Muhammad Maulana

Fitria Muslih

Hernindya Wisnu Adji

Hikmat Bijaksana

WulandariA.Warits

Mundiharno

Editor

Mundiharno (Bahasa Indonesia)

Debbie Budlender (Bahasa Inggris)

Layout

Meydhi Cahyono


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2 A Study of Jamkesmas and Jamkesda Membership

First Edition, May 2013

PP LAKPESDAM NU - IDEA PATTIRO INISIATIF - SekNas FITRA

International Budget Patnership

Published by :

PP LAKPESDAM NU

Jl. K.H. Ramli No.20A Menteng Dalem Tebet Jakarta 12870

Telp. (021) 8298855 Faks (021) 8354925

email: [email protected]

http://www.lakpesdam.org


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PREFACE

Indonesia is a country that cares about health and well-being. This can

be seen in the goal of the nation, that is to enhance public welfare.

Health care is a right of citizens that is protected by the 1945 Constitution. Asstipulated in the Constitution, government, through the government budget, is

required to allocate a specific budget for health care. This allocation is aimed at

supporting all health care programs, those implemented by the state as well as

those implemented by other parties.

Health care security should be a right of all citizens with no exception. However,

poor communities must be given special attention since their poverty is the

result of governments inablity to bring about the welfare of its citizens. Therefore,

the government develops various programs specifically targeting the poor.

During the New Order era, the Health Card and low tariff programs weredeveloped at community health centers and class-III public hospitals. In the

reform era, the government developed health care for the poor through the Social

Safety Net - Health Sector (Jaring Pengaman Sosial Bidang Kesehatan, JPS-BK)

program from 19982001, which was funded by the loan from the Asian

Development Bank.

Subsequently government changed the name of the program and the source of

funds, which were now taken from the reduction of unnecessary fuel subsidy.

The name of the program was changed into the Impact of Energy Subsidy Reduction

Program (Program Dampak Pengurangan Subsidi Energi, PDPSE) in 2001, and was

renamed again as Compensation of Fuel Subsidy Reduction Program (Program

Kompensasi Pengurangan Subsidi Bahan Bakar Minyak, PKPSBBM) in 20022004.

In 2005, at the beginning of SusiloBambangYudhoyonojs administration, the

program was named Health Insurance for the Poor (Askeskin) since, for the first

time, it was managed nationally. In 2008, the program was renamed again,

becoming Jamkesmas (National Health Insurance Program), its name up to now.

Indonesia has a law governing social security for its citizens in the Law No 40 of

2004 on the National Social Security System. In 2011, the government introduced


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another law strengthening the implementation of social security in Law No 24 of

2011 on Social Security Administration Agency (Badan Penyelenggara Jaminan

Sosial, BPJS). The government stated that January 1, 2014 would be the operational

date for the health care BPJS. At the end of 2012, the government, through The

National Social Security Council, issued a Road Map towards National Health

Security 2012-2019. Both the law and the Road Map streng thened the

governements commitment to implement social security programs for all

Indonesians.

According to Law No 40 of 2004, all citizens have the right to social security in

order to fulfill their basic needs of a decent and dignified life necessary for

achieving a secure, fair, and prosperous Indonesian society. This urges the

government to improve the quality of services provided to the citizens as a partof its role in protecting the citizens of the nation without discrimination.

Jamkesmas is social assistance in the form of health services for the poor paid for

by the government and implemented by the Ministry of Health. The Jamkesmas

policy is implemented to fulfill the basic right of all citizens, including the poor, to

receive health services. The policy provides access for members to all health care

facilities administering the Jamkesmas program. Also, it is expected to improve

the standard of health services, control the quality and costs, and manage

government finances in a transparent and accountable manner. This is a pro-poor

policy. Poverty and illness are interrelated and perpetuate each other unless an

intervention is made to address one or both of the problems.

In its implementation, the Jamkesmas program faces several problems, namely

membership, benefit packages, funding, health services, facilities, as well as

institutional problems. Much criticism and many complaints have been expressed

by the public, the government, and even by the government officials themselves.

The delegation of some parts of the policy to the local governments does not

solve the problems. The problems need to be studied/analyzed thoroughly in

order to find the solutions.

The Jamkesmas program launched by the government as the substitute for

Askeskin is still considered ineffective and as having many distortions. The issue

of ineffectiveness is a chronic problem expressed by many parties in respect ofthe management of the social assistance, especially on how to determine which

households can be categorized as poor and thus eligible as the recipients. That is

why, in the past, many regional governments did not want to distribute the list of

Askeskin/Jamkesmas members to PT Askes (the government-owned health

insurance company) since, in practice, it was not really clear which households

could be categorized as poor families. The differences between households


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seemed to be very small. When the identification process was inaccurate, then

targeting errors occurred.

Targeting errors exist when financially adequate households (not poor) receive

Jamkesmas cards or poor families (RTM) do not get cars. If the identification

process of poor households is inaccurate, then we have mistargetingof card

distribution.This study tries to analyze the so-called mistargeting that has already

occured so far. The local government seems to be helpless in preventing not-so-

poor households being classified as poor families. The inaccurate membership

data imposes costs on the government.

The data collection in respect of eligible persons for Jamkesmas membership is

still problematic. This process should involve the community at the neighborhood(RT) level or the Head of the Village, since they are the ones who know best the

condition of their community. The data should be updated in order to maintain its

accuracy. The persons who have already passed away should not be on the list of

the Jamkesmas members.

Besides the issue of inaccurate data collection, weak information dissemination

is also a cause of ineefficientJamkesmas. Many who haveJamkesmas cards do not

know what Jamkesmasis and its benefits. As a consequence, many of them do not

use the card when they have to obtain medical treatment in community health

centers or hospitals.

The aforementioned issues in the implementation of the Jamkesmas and Jamkesda

were empirically uncovered in the Social Audit of Jamkesmas and Jamkesda

membership. The audit was conducted in the Sumenep Regency, East Java Province

by PP Lakpesdam NU together with the other four Non Governmental

Organizations (NGOs)/Civil Society Organizations (CSOs) within the core team,

i.e. Fitra, Inisiatif, IDEA and Pattiro in cooperation with the International Budget

Partnership (IBP). In the period of 2008-2012, IBP had supported these organizations

to conduct various programs, such as budget advocacy movement, improving

community participation particularly in the budgeting process, conducting

studies, research and assistance for other NGOs/CSOs to carry out advocacy work,

as well as providing support for compilation of lessons learned and documentation.

The IBP Core Team in Indonesia has conducted various activities. Every year, one

big theme was agreed by the core team and IBP. The activites conducted at the

core team level included: The Study on the Social Security Scheme done by Inisiatif,

analysis on the Availability of the Health Care Budget, by Fitra, The Social Audit of

the Health Services by IDEA, and the Social Audit of BOS (School Operational Aid)

by Pattiro. This year, the big theme was health care issues, particularly the


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implementation of the health care security through the Social Audit of Jamkesmas

and Jamkesda conducted by PP Lakpesdam NU.

Considering the importance of Jamkesmas and Jamkesda, the civil society groups

played a role in monitoring the government program. The monitoring was aimed

at participating in driving the governments political good will in fulfilling the

basic rights of the citizens.

PP Lakpesdam NU, which is one of the deparments responsible forimplementing

the PBNU policies in the field of research and human resource development, felt

that it was important to contribute to health budget advocacy by publishing this

book on the social audit experience in Sumenep.

The book is expected to become a tool to improve the understanding of the social

audit process for NU cadres specifically, and the community in general. With this

understanding they are expected to be able to influence the stakeholders, both

at the executive and legislative levels, to make pro-poor laws and policies,

particularly on social security.

The book on the experience in conducting the social audit describes the

background of the cooperation between IBP and the NGOs/CSOs in Indonesia, a

brief history of the social audit, the methodology of the social audit, the social

audit on Jamkesmas and Jamkesda membership, the analysis of the health care

budget, the design of the social audit, the stages of the social audit, the results of

the social audit, and the stories on the transformation within the society and

follow-up actions after the social audit.

The book writing process was quite long since it involved not only the staff of PP

Lakpesdam NU, but also the IBP core team members from four other organizations.

In general, the steps in the process were: the initial discussion among the writing

team, the writing process, gathering inputs from the experts, and the finalization

of the book draft.

PP Lakpesdam NU would like to extend our deepest gratitude for the publication

of this book to all of the colleagues at Fitra, Inisiatif, IDEA, and Pattiro who have

collaborated very well to make the social audit of Jamkesmas and Jamkesdamembership possible. Our gratitude also goes to all of the colleagues at PP

Lakpesdam NU Sumenep who have spearheaded the struggle to realize a pro-

poor health care and social security policy. Also, thanks to PW Lakpesdam East

Java for their support in making the forums for the social audit research successful.

To all of the Lakpesdam team that supported the social audit program, we also

express our greatest gratitude.


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We also would like to thank Debbie Budlender and Ravi Duggal from the

International Budget Partnership and the Partnership as a whole for the support

that has been given. We also would like to thank Dr. Mundiharno for his

tremendous support for the social audit program that made it truly meaningful.

We wish that this book can be of benefit to budget advocacy and social and health

security advocacy activists in realizing a pro-poor health care budget and social

security policy

Yahya Mashum

Chairman of Board PP Lakpesdam NU


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TABLE OF CONTENT

PREFACE 3

CHAPTER I

BACKGROUND

A. Partnership with IBP 9

B. History of Social Audit 10

C. Variety of methodologies 11

D. Social Audit of Jamkesmas and Jamkesda Membership 12

CHAPTER IIANALYSIS OF HEALTH EXPENDITURES IN SUMENEP REGENCY

A. Local Expenditures Composition 15

B. Health Expenditures Analysis 16

CHAPTER III

SOCIAL AUDIT OF JAMKESMAS AND JAMKESDA MEMBERSHIP IN SUMENEP

A. SocialAudit Design 23

B. Phases and Best Practices 28

1. Recruiting Auditors 28

2. Building Multi-Party Relations 29

3. Collecting Data 31

4. Training Auditors 32

5. Developing Campaign Tools 38

6. Implementing SocialAudit 42

7. FGD 45

9. Public Hearing 62

C. SocialAudit Results 71

CHAPTER IV

STORIES FROM SOCIAL AUDIT IN SUMENEP

A. JamkesmasCards Distributed in the Evening Before the Implementation

of Social Audit 75

B. Community Awareness and Participation 77C. Follow-up Advocacy 79

CHAPTER V

CONCLUSION AND RECOMMENDATIONS

A. Conclusion 81

B. Recommendations 83


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A. Partnership with IBP

The International Budget Partneship (IBP) is an international organization

working in the field of budget advocacy. One of its roles is to provide assistance

to NGOs in developing countries that do work on budgetary issues and relatedadvocacy. One of those countries is Indonesia, where there are five NGOs

that are me mbers of the core team of IBP, i.e. Fitra, Lakpesdam NU, Inisiatif,

IDEA, and Pattiro. The five NGOs work on the same advocacy issue as IBP,

which is budget advocacy.

In the process of their partnership, IBP and the core team agreed to focus

their budget advocacy on the health sector budget, especially the alloocation

for the national health insurance program (Jamkesmas). The national health

insurance budget has been discussed since the beginning of the partnership

between IBP and its core team in Indonesia, which started with a budget

advocacy workshop in 2009 in Yogyakarta. IDEA was the the coordinator of the

core team at that time. Important issues related to the national health

insurance budget that were identified included membership, budget

availability and service mechanisms. These issues were always the hot topics

of all IBP annual workshops, including those coordinated by Pattiro (2010),

Perkumpulan Inisiatif (2011) and the last one in December 2012 coordinated

by PP Lakpesdam NU.

During the 2011 workshop coordinated by Perkumpulan Inisiatif, the core team

agreed that the membership issue was crucial and needed to be addressed in

order to push for a good health insurance scheme. The national health

insurance mechanism prevailing in Indonesia must be well-targeted and in

line with the conditions of the beneficiaries.

In the same year, IBP provided the opportunity for staff of all core team

organizations to learn about a social audit process that had been

institutionalized by visiting Hyderabad, India. The core team were invited to

learn about the process applied in social audit in the field.This inspired the

core team to use social audit as a method to push for well-targeted

membership of national health insurance, by implementing a social audit of

CHAPTER

IBACKGROUND


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national haealth insurance membership in two pilot villages located in two

sub-districts in Sumenep Regency. It was agreed that the social audit would

be led by PP Lakpesdam NU.

B. History and Concept of Social Audit

The term audit is generally understood as referring to an assessment and

evaluation of financial matters performed by competent, independent and

objective individuals known by the names accountants or auditors. However,

nowadays audits are not only related to collecting information on

organizational finances, but also consider the social aspects in a community

and the communitys perception of the benefits and achievements of programs

and policies executed by public or private institutions.

The concept or term social audit was first developed in 1960 by the Social

Economic Agency (Northem Ireland) when providing training to 10

organizations in order to train institutional auditors as well as external

consultants so that they can apply the method. The social audit movement

has developed in India and some other countries over the past seven to eight

years. In Indonesia, social audit has lately been used as a tool by non-

governmental organizations.

When the term social audit is used in budget research and advocacy work it

includes a key element that is also found in standard financial audits. This key

element is that the audit involves a comparison between what is written in

government administrative documents and what happens in reality. For

example, in a standard financial audit, the auditors check that the numbers

that are recorded in government documents as budget and expenditure match

what is recorded in procurement documents, invoices, payslips, and other

source documents. In a social audit, similarly, the auditors who are ordinary

community members check that what happens within the community or

society matches what is recorded on government administrative documents,

such as lists of people who benefit from various services and benefits.

A further important aspect that distinguishes the use of social audit in India is

that it involves an exercise that has strong participation by the community, soit is the community that does the main audit work. This reflects the fact that

the main voice that the social audit aims to hear is the voice of the

community, telling about their experience of using or trying to use a public

service. This strong focus on the voice of the community is not found in all

social audits. The focus on the voice of the community was, however, very

evident in the social audit in Sumenep. Since it is a tool, social audits can be

developed differently by each organization. In Indonesia, many organizations,


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such as Pattiro, IDEA, and Inisiatif, have used different tools. The tool that

was used in the exercise led by Lakpesdam NU and described in this book is

also different from the others.

Nonetheless, despite the different tools used by different organizations in

Indonesia, theapproaches used by the organizations have three main general

characteristics: they areperformed by communities, used to assess social

impact, and expected to be able to address social problems (transformative).

In many different ways, these approachess have been used to allow for the

voices of the poor, womens groups, and other marginalized groups to be

heard in assessment of the impacts of policies and development programs.

The approachesare also usually conducted with the wish to contribute to

change in the society by giving qualitative and quantitative data to government

institutions so that they can improve their performance and services.

Many advantages can be gained from social audits and other approaches

including, among others, encouraging the communitys involvement in

monitoring the development process, giving voice to the interests of

disadvantaged groups, developing human resources and social capital, as well

as improving participatory decision-making.

C. Variety of Methodologies

Social audit is a concept and practice that is still developing. The core of social

audit is, firstly, that it involves a comparison of what the community

experiences with what is recorded in government documents and, secondly,

that it isan assessment of the social relevance of a development program to

the needs of the beneficiaries, performed upon the initiative of the people.

Various forms and types of social audit have developed. Among the most

well-known are the social audits conducted by civil society groups in India,

united under MKSS, as the grassroot organization struggling for poor

communities to gain access to information. IBP (2008) had identified other

successful practices of monitoring os the budget execution stage in addition

to that performed by MKSS in India, including public expenditure tracking

survey (PETS) in Tanzania and Malawi for education and health sectors. For

the procurement process, IBP identifed, among others, the tender process

monitoring in the Philippines.

Many groups in Indonesia have started to initiate assessments of government

performance in public services. In relation to MDGs, the MDG network, for

example, uses score cards to evaluate MDGs achievements in an area. Another

instrument that has recently been developing is the customer survey method

in public services, such as the User Based Survey (UBS) or service users

satisfaction survey and Citizens Report Cards (CRC) which records peoples


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evaluation of public services using a survey method. This book focuses on the

social audit as a tool to assess government performance in delivering a

particular public service, namely social health insurance.

D. Social Audit of Health Insurance Program in Sumenep

The social audit of Jamkesmas and Jamkesda programs in Sumenep Regency,

East Java, focused on the membership aspect. There are other aspects of

Jamkesmas/jamkesda program that need to be assessed, including services,

regulation, finance, institution and administration.The main thing to look at

within the membership aspect of Jamkesmas/Jamkesdaduring the social audit

is the eligibility of target members.The Jamkesmas andJamkesda program in

Sumenep Regency is aimed at poor people, therefore the members need to

be verified as poor people.There are two questions regarding eligibility thatneed to be answered: (a) whether the members of Jamkesmas/Jamkesda are

actually poor (no inclusion error); and (b) whether there are poor people who

have yet to be covered by the program (no exclusion error).

To answer those questions, the same instrument as the one used by the

Jamkesmas program to determine poor households was utilized.The

instrument that has been used so far to make such determination is the one

used in Data Compilation for Social Security Programs (PPLS) of 2011. To come

up with the same results, the instrument used in the social audit was adapted

from that used in PPLS 2011. The fieldwork for the social audit took the form

of a household survey of all community members in two villages who were

listed on the local governments administrative list as being in poor

households. The questionnaire included questions that matched those used

in the PPLS. The questionnaire also included questions that asked about

membership of jamkesmas and use of health services. The data collected

were then further analyzed to see whether Jamkesmas/jamkesda members

fall in the category of poor people or not, and whether there are other poor

households that have not been covered by Jamkesmas/jamkesda.Next, the

results of the analysis were enriched by the results of focus group discussion

(FGD) and presented in public hearing.

There is another aspect that must be considered in addition to membership,

namely the level of members satisfaction with health services received. Inthis social audit, members satisfaction was briefly mentioned, but did not

become a main focus of analysis.


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CHAPTER

IIANALYSIS OF HEALTH BUDGET OFSUMENEP REGENCY

In health budget analysis there are several issues that need to be examined.

First, there is the question of whether the health budget provided by the

Government is sufficient. The issue of health budget sufficiency may be examined

from the perspective of standards stipulated by health laws or the prevailing

international ones, such as those of the World Health Organization. Second, thereis the question of whether the available budget has been allocated accurately. To

date, the health budget has been spent mainly on curative or rehabilitative

services while preventive and health promotion activities have not been given a

large portion of the budget. Third, there is the question of whether more health

budget is allocated for direct activities and operational expenditures or for indirect

activities and investment expenditures. Fourth, there is the question of whether

the health budget is well-targeted to citizens (pro-people) or, instead, more is

spent on the bureaucracy.

Composition of Local Revenue


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From the available data it can be understood that the revenue of Sumenep Regency

increased significantly over the period 2008-2012. In 2008, the revenue was only

Rp 758.6 billion, and it then increased to Rp 1.3 trillion in 2012. In other words,

there was a 68.8% budget growth within that period.

However, in terms of composition, the largest portion of the revenue, similar to

other regions, was from the fiscal balance fund (Graph 1). Local Own Revenue

(PAD) of Sumenep only contributed between 5% and 6% of the total annual

revenue, whereas the fiscal balance fund contributed up to 91% in 2008. Improving

trends are seen in the Other Legitimate Sources of Local Revenues (LDPS),

encompassing grants, adjustment and special autonomy funds, tax revenue

sharing with the province and other districts, financial assistance from the

province or other districts, as well as non-tax revenue sharing with the provinceand other districts. In 2008, Sumeneps LPDS accounted for only 4% of total

revenue in the Local Budget, while it was projected to reach 13% in 2012. It indicates

that Sumenep Government lacks the capability to maximize its local revenue

potential.

The sizeable portion of fiscal balance fund, particularly in the forms of General

Purpose Fund (DAU) and Special Purpose Fund (DAK), indicates that budget

management of Sumenep Regency highly depends on Central Governments

subsidies. Its budget dependency is also shown in the low proportion of Local

Own Revenue (PAD) in the Local Budget (APBD) structure of Sumenep Regency.

In terms of PAD sources, levies have always been the largest PAD source annually,

except for 2012 (Graph 2.). In the four years from 2008 to 2012, levies contributed

40%-56% of the total revenue. On average, 30% of the levies is from health service

fees, as in 2012 when local government estimated Rp 3.4 trillion health fees or

32% of estimated local levies, which amounted to Rp 10.7 trillion. The biggest

contribution from levies between 2008 and 2012 was in 2011, when it was 56% of


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total PAD. This shows how Sumenep local Government still takes advantage of

levies paid by citizens. In contrast, the Local Government does not optimize PAD

sources which are from local tax. It does not maximize revenue from separated

local asset management, although this component is financed by Local Budget.

The sizeable amount of revenue from health sector fees (particularly, from

community health centers) is a great concern. It means that Sumenep Regency

profits from the ill-health of its citizens. Revenue earned from health service

facilities, such as community health centers (puskesmas), hospitals or others,

should not be treated as local revenue, but instead can immediately be spent by

those facilities to promote their public services. Article 7 Paragraph 3 of the Law

on Hospitals stipulates that Hospitals established by Central and Local

Government as mentioned in Paragraph (2) must be in the form of a TechnicalImplementing Unit of an agency working in the field of health, or certain agency,

or Local Technical Agency with management of Public Service Agency, or Local

Public Service Agency in accordance with rules and regulations.

Based on the regulation, financial management of government hospitals, including

those of regencies, must follow the principles of a Public Service Agency. According

to such principles, the income of hospitals can be immediately used by hospitals

to render services to patients without first being collected in the Local Revenue

Office. If it is collected in the Local Revenue Office and treated as a local levy, it

may hinder the services provided to patients. The hindrance is particularly caused

by the delayed budget disbursement of a smaller amount of money allocated

than that submitted by the hospitals. If the amount of fees that hospitals and

puskesmas submit to Revenue Office is higher than that they receive, it is clear

that local government profits from the ill-health of its citizens. This is an irony

that must be ended.

Composition of Local Expenditures

Sumeneps Local Budget had a significant increasing trend with a 62% budget

growth in the period 2008-2011. In 2008, the total expenditure of Sumeneps

Local Budget was only Rp 808.6 billion, and it then rose to Rp 873.8 billion in 2009,

Rp 948 billion in 2010, Rp 1.1 trillion in 2011, to Rp 1.3 trillion in 2012. On average,

the annual growth in expenditure was 13%.

However, in terms of types of expenditure, much of the growth of local budget

expenditure was spent on employees salaries (Graph 3.). In 2008, employee

expenditure absorbed 55% of the total budget, and this rose to 58% and 63% in

2009 and 2010 respectively. Employee expenditure was projected to decline in

2011 and 2012, to 61% and 51% respectively. Along with the growth of employee

expenditure in the period 2008-2010, capital expenditure dropped significantly.


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It had allocations of 20% and 10% in 2008 and 2010 respectively, while goods and

services expenditures over this period had no significant change. This indicates

that the growth of employee expenditure reduces the capital expenditure for

development, such as for roads and bridges that benefit many people.

Health Expenditure Analysis

Law No. 36 of 2009 concerning Health categorizes health services into four, i.e.

promotional, preventive, curative and rehabilitative categories. The promotional

category is health services which prioritize activities concerning health promotion.

The preventive category prioritizes preventive activities while the curative one

is aimed at providing treatment, curing diseases, reducing the number of people

affected by diseases, disease control and disability control so that the quality of

life can be optimally maintained. The rehabilitative category is health services

that are focused on rehabilitation of former victims of disease so that they can

regain their functions as members of the society to the maximum possible extent

in line with their capabilities.

The sources of fund for all health service activities are the State and Local Budgets.

Furthermore, Law No. 36 of 2009 Article 171 firmly states that health budgets shall

be allocated a minimum of 5% of total expenditure of the State Budget and 10%

of total expenditure of the Local Budget. These percentages of budget allocation

are exclusive of salaries. Two-thirds of the health budget must be allocated tohealth services.

Based on the Human Health Development Index released by the Ministry of Health,

Sumenep is ranked 365th among all districts of Indonesia, with a score of 0.42. It

shows that Sumenep is a region with health development issues.


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Besides health development issues, Sumenep also has poverty issues. In 2010,

the number of poor people in Sumenep reached 256,419 individuals, or 24.6% of

the total population of 1,041,915. This figure indicates that the poverty rate in

Sumenep remains high. Furthermore, the poverty rate in Sumenep is higher than

that of East Java Province (15.3%), and the nation (13.3%). Therefore, the Ministry

of Health considers Sumenep as a region with poverty and health problems.

Health Expenditure Trends 2008-2011

Sumenep Local Government allocated health expenditure of Rp 19.6 billion in

2008, which was increased to Rp 21.8 billion in 2009. However, following an

increased local budget, health expenditure declined to Rp 20.1 billion and Rp 19.2

billion in 2010 and 2011, respectively.

As mandated by Law No. 36 of 2009 on Health, Local Budget must allocate 10% of

its total expenditure to health services exclusive of employee expenditure.

However, in the four years of budget under analysis, health expenditures has

never increased in either percentage, and seldom increased even in terms of the

amount. Health expenditure allocations have never exceeded 3% of total local

expenditure. In 2008, the health expenditure allocation was only 2.5%, and this

dropped to 2.3%, 2.2% and 1.8% in the subsequent years. In terms of amount,

there was an increase in budget from 2008 to 2009, but in terms of percentage, it

was actually a decline of 0.2 percentage points (Graph. 4.).

Despite a decline in health expenditure allocations in 2009-2011, employee

expenditure allocations were not affected. Annual employee expenditures have

increased by 9% to 22%. The allocation for Health employees was Rp 52.4 billion

in 2008 and increased to Rp 82.6 billion in 2011. In contrast, capital expenditure

did not increase along with the increase in employee expenditure. It had a

significant drop between 2009 until 2011. Health capital expenditure was Rp 10.7

billion in 2009, and fell to Rp 3.7 billion in 2011. Positive growth of capital


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expenditure only took place in the period of 2008-2009, when it increased by 6%

(Graph. 5).

Health Office Budget 2012

In 2012, the health office obtained a budget allocation of Rp 92.8 billion. The

budget allocation consisted of Rp 55.1 billion or 59% for indirect expenditure and

Rp 37.7 billion, or 41% for direct expenditure (Graph 6.). in terms of composition,

this indicates that more is allocated to local government apparatus than to citizens

because indirect expenditures have no direct benefits for the people. Indirect

expenditures consist of employee expenditure, interest, grants, social relief,

profit sharing with provinces/regencies/cities and villages, unexpected

expenditure and others. Direct expenditures, on the other hand, consist of

employee expenditure, goods and service expenditure as well as capital

expenditure.


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In 2012, Sumenep local government allocated a budget of Rp 37.7 billion for 17

programs implemented by the Health Office. When analyzed in terms of their

objectives, they can be categorized into six groups of objectives, namely curative,

promotional, preventive and rehabilitative health services, as well as allocation

for personnel and others.

Results of analysis show that the largest portions of the budget are allocated to

curative and promotional health services with Rp 28.4 billion and Rp 4.3 billion,

respectively. The third largest is dedicated to personnel, i.e. Rp 3 billion. The

peculiar part is that the budget for the preventive health services is smaller than

that for personnel, with only Rp 1.6 billion This reconfirms that the budget

allocation for public is less than that of the government apparatus.

The three programs with the largest budget allocations are:At a glance, these budget allocations show that local governments attention to

health services for poor citizens is high, as seen from the health service for the

poor that obtains the largest amount of budget. However, in terms of percentage,

the budget for health services for poor citizens is only 14% of the total expenditure

of the Health Office. While the expenditures for puskesmas facilities are 9% and

medicine and health supplies program gets 8%.

No ProgramBudget

Allocation (Rp)

% of Health

Office Budget

1 Health Care for the Poor

13.027.000.000

14%

2 Procurement, Upgrade, and Renovation of

Infrastructure and Facilities at Community

Health Centers (Puskesmas) / Auxiliary

Puskesmas and their network

8.270.343.260

9%

3 Medicine and supplies

7.073.641.149

8%

Source: Description o f APBD 2012


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If the budget allocation for health services for poor citizens was to be divided by

the number of poor citizens in Sumenep, which is 256,419 individuals, each

individual would then only receive health services of Rp 50,700 per year, or only

Rp 4,200 per month. This clearly is very low for providing health services for poor

citizens.

As for Procurement, Upgrade, and Renovation of Infrastructure and Facilities at

Community Health Centers (Puskesmas) / Auxiliary Puskesmas and their network,

the money is mostly allocated for renovation of buildings, which takes 69% or Rp

5.7 billion, while the budget for maintenance of buildings is only Rp 249 million.

With the existing 101 units of Puskesmas in Sumenep, consisting of 30 main

Puskesmas and 71 auxiliary Puskesmas, each unit will receive an average routine

maintenance budget of around Rp 2.5 million per annum.

From the above description, the following are the main findings:

Sumenep Regency has not optimally used its potential sources of local

revenue. This can be seen from the composition of its local revenue with

the highest contribution from fiscal balance funds. PAD, on the other hand,

only has a stagnant annual contribution of 5% - 6% from 2008 to 2012.

Levies have become the largest contributor to PAD for four subsequent

years from 2008 until 2011. On average, health fees contribute 30% of the

total local revenue from levies. The composition of expenditures of Sumenep Regency for five subsequent

years is dominated by employee allocations. Annually, employee

expenditure uses up more than 53% of local expenditures.

Health expenditures of Sumenep have declined between 2009 and 2012,

but health personnel expenditure has not. The latter has even seen

positive growth between 2008 to 2012.


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Sumenep local government has not fulfilled the mandate of the Health

Law, requiring a 5% allocation for health expenditures, exclusive of

salaries. From 2008 to 2012, the health expenditures only had a 2% portion

of the total local expenditures.

The budget of the health services for poor citizens is only Rp 50,700 per

individual per year, or Rp 4,200 per individual per month.

Based on these findings, it can be concluded that as a region with high poverty

and health issues, Sumenep Regency has no political will to promote its public

health and provide decent health services to its poor citizens. The local budget is

mainly used for employee expenditures with no direct benefit for the people.


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CHAPTER

IIISOCIAL AUDIT OF

JAMKESMAS AND JAMKESDAMEMBERSHIP IN SUMENEP

A. Social Audit Design

The International Budget Partnership (IBP) program in Indonesia, with the core

team consisting of PP Lakpesdam NU, FITRA, Pattiro, Inisiatif and IDEA, agreed to

appoint PP Lakpesdam NU as the core team leader for 2012. In general, the IBPprogram cycle for 2012 was as follows:

The IBP Program Cycle 2012


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The cycle went through five steps:

1. Program coordinating meeting

To start the program for 2012, PP Lakpesdam NU as the core leader

coordinated the core team by conducting a series of meetings. Those

meetings were aimed at designing a well-planned program, so that the

execution of all program activities could be successful.

2. Social Audit in Sumenep

Through several meetings coordinated by PP Lakpesdam NU, the core

team agreed to choose Sumenep Regency of East Java Province as the

location for the IBP social audit in 2012.

3. Writing Experiences of Social AuditThe core team experience in conducting social audit of Jamkesmas/

Jamkesda membership were written up in the form of a book. The book

aims to disseminate the experience of social audit to wider communities.

In addition, the book can be used as a guideline for those who are

interested in social audit and how to conduct a social audit. Besides the

book on the experience of the social audit, the core team agreed to write

another book on the stories of the auditors who were involved in the

audit as well as those of the respondents.

4. Annual Learning Workshop

The findings of the social audit were not only documented in a book. In

order to disseminate the findings of the program, IBP supported annual

learning workshops. The workshops involved stakeholders who were

interested in health policy in particular NGOs and CSOs working in budget

and health advocacy. In addition to becoming an event to disseminate the

social audit findings, annual learning workshops also became a learning

forum for NGOS and CSOs in budget and health advocacy.

5. Reporting to IBP

The last stage of the program was the reporting stage. PP Lakpesdam NU,

as the core leader, prepared a report on IBP-related activities in 2012 for

the IBP.

The steps of Social Audit

Social audit uses the activity scheme B. It consists of several activities, namely

training of auditors/volunteers, social audit field work, and public hearing. In

general, the steps of social audit activity and auditor training can be seen below


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Scheme B. 1

Auditor Training

Scheme B. 2

Social Audit Field Work, Data Entry, Meeting for Compilation of Findings, FGD

and Data Analysis

A scheme was designed for allocation tasks in the field to volunteers. 72 volunteers

were divided between three core tasks in the research. 50 volunteers were

assigned to the field as the surveyors (or auditors), 2 as sub-district coordinators,

and 20 as data entry staff. The compiled data were then brought to the village

stakeholders to be confirmed and clarified through focus group discussion (FGD).

The FGD was expected to strengthen the findings. In terms of time allocation, the

initial plan provided only 6 days for everything starting from the training to the

data compilation. In a later plan, the duration was extended to 10 days. This


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followed a realisation that more time was needed for data entry and data analysis,

which was very limited in the initial plan due to the compilation of findings data

not being divided into data entry and data analysis.

Scheme B.3 Public Hearing

The public hearing is a public discussion involving the community and the

government. The government was represented by The Sumenep Regent, and IBP

was represented by Debbie. The public hearing was used as a forum to disseminate

the findings from the social audit and as an advocacy forum on issues emerging

from the study. The flow of public hearing was as follows:


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An evaluation was held to assess the social audit implementation

comprehensively, starting from the implementation planning, analysis of findings,

to the dissemination of findings. The forum was expected to generate input,

criticism, and a follow-up plan for the next social audit activity. The forum was

attended by the core team, volunteers and an IBP representative. It was held on

Wednesday, May 30, 2012.


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B. Phases and Best Practices

1. Recruitment of Auditors

The social audit of Jamkesmas/Jamkesda membership required the

involvement of auditors. They were deployed to the field (Gedungan

village and Jadung Village) to interview the selected respondents. Prior

to visiting the villages, the auditors were equipped with knowledge of

social audit, Jamkesma/Jamkesda, as well as interview and questionnaire

guides through a 2-day training.

The auditors, data entry team, and coordinators were required to meet

particular qualifications and requirements (education, qualifications,

technical skills, personal skills, and time commitment). The requirements

were as follows:a. 20 35 years of age

b. Graduate of high school or higher

c. Availabe to join the auditors training, social audit, and reporting, with

the following details:

i Available for 2-day training

ii Available for field visit

iii) Available for reporting

d. Available to participate inpublic hearing

e. Specific for data entry team, able to operate Microsoft Office

(Word & Excel)

The requirements were set by the Lakpesdam team. PC Lakpesdam NU

Sumenep selected the auditors. The recruitment and selection were

conducted by using structural and social approaches. For the structural

approach, permission was asked of PC NU Sumenep to utilize NU networks

down to the village level. For the social approach, NU students in other

organizations which are culturally close to NU were contacted.

In the process of auditor recruitment, the conditions of the two villages

for social audit were taken into consideration. The auditors for Gedungan

Village, which is in the downtown area, were recruited from Indonesian

Moslem Students Movement (PMII), which is culturally very close to NU.

All of them were students, and none of them originally came fromGedungan Village.

In contrast, Jadung Village is a rural area having different social conditions

from Gedungan Village. For that reason, many of the auditors originally

came from the village itself. Using NU networks at village level, PC

LAKPESDAM NU Sumenep conducted Focus Group Discussion (FGD) with

the executives of NU Body at village level. The FGD involved the executives


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of NU womens organization (Fatayat), Muslimat NU, and Anshor Youth

Movement in Jadung Village. These focus group discussions were used to

identify auditors.

Based on the abovementioned requirements, the profile of auditors, data

entry team, and coordinators for the social audit of Jamkesmas/Jamkesda

membership in terms of their educational backgrounds was: 37 high school

graduates, 1 diploma holder, and 34 bachelors degree holders.

2. Building Multi-party Relationships

The paradigm shift on the relationship between the government and civil

society in the post-reform era continues to improve. It is marked by manycommunity group networks reporting their productive experiences in

collaborating with the government in the framework of budgeting and

planning advocacy. This situation shows the advantages of increasing

community participation in monitoring budget implementation.

Social audit and other forms of budget research and advocacy which have

been implemented in many regions in Indonesia has been successful

because of this paradigm shift. It needs a healthy and positive spirit of

good relations between the government and the community. It cannot be

claimed only as the domain of the civil society, but also as the governments

domain as the budget executors.

From the very beginning, a social audit must involve all parties in the

sector to be audited, including the beneficiaries, stakeholders in the area,

service providers, and the budget executors. The rationale of the social

audit should become common knowledge. Multi-party awareness is an

important basis in designing the intended social audit. This basis, at the

same time, builds a sense of belonging between the two parties for

sustaining the social audit activity in the future.

The multi-party collaboration in the context of developing the social audit

can be constructed through the following stages:

a. Communicating the social audit theme

As the point of entry, communicating the social audit theme, which

has been agreed by the community groups, to the budget executors is

a strategic point which should be managed well. To avoid

misunderstanding, it is crucial to explain the rationale behind the

theme while asking for responses and inputs from the budget

executors in order to make them comfortable. This opens up the


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possibility to create togetherness in achieving the social audit

objective, which is to improve the quality and accountability of public

services, and accountability of budget utilization. The success of

community groups in managing this strategic point would be the

starting point of success in designing the whole social audit activity.

b. Involving more parties in designing the social audit activity

The stages of training which provide comfortable spaces to all parties

to be engaged in designing the social audit consist of detailed sessions

such as understanding the map of the problems related to the theme

of the social audit, designing instruments for social audit, piloting the

instruments, reviewing and improving the instruments, designing

campaign materials, agreeing on steps and stages of social audit,analyzing social audit findings, and preparing the public hearing. The

details of the sessions must be built by all parties who participate in

the training. Agreement on the objective of the social audit must be

achieved by all participants.

c. Building collaboration in each stage of the social audit

The design of the social audit and all of its instruments that has been

developed during the training is managed with collaborative spirit

and understanding of different roles. Each party is expected to be

able to respect the rational choice of other parties in participating at

each stage of the activity. The representatives of executive and

legislative may possibly feel uncomfortable with collection of field

data, but they can be involved in the analysis and public hearing.

Other parties may feel similar when assigned certain roles in the

auditing process. The multi-party collaboration when going through

the stages of the social audit supports and maintains the spirit along

the way. It acts like a magnet which invites more people to be involved

in the initiation of the social audit. If more people are interested, the

objectives of the social audit can be easily achieved.

d. Managing public hearing recommendations together

The strategic stage in social audit is the public hearing. At this stage,

the social audit team will deliver a presentation on the stages of socialaudit, and the findings as well as the recommendations to stakeholders

and service providers being audited. The responses from public

services providers and policy makers are then used as the basis for

formulating public hearing recommendations. All parties participating

in the public hearing should agree on the public hearing

recommendations which in themselves affirm the roles of

stakeholders in monitoring the recommendations. The public hearing


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has two purposes: inviting the participants to finalize the campaign

themes and tools as well as presenting the social audit findings and

its recommendations. Productive management of the public hearing

can increase the interest and excitment of all parties in developing

the social audit and, for the budget executors, it is an opportunity to

hear and accept the communitys aspirations through the findings and

recommendations.

e. Maintaining the sustainability of social audit

As an innovative activity aimed at improving the quality of public

services, the social audit needs continued commitment from all parties

in taking it forward. Multi-stakeholder cooperation is the key to

success in building the future of social audit. Initiation of innovativecooperation in the form of a social audit usually starts from

volunteerism of communities and with the support from community

empowerment institutions, then in the process it can be developed

through recommendations from the public hearing, and then the

government can fund it for sustainability.

3. Collecting Data

Data has a crucial function in determining the success and validity of social

audit results. Data can be obtained from documents and persons. Hence,

it is important to develop a list of what data are needed in a social audit,

who has them, and how they can be obtained.

Desk review is a series of activities consisting of seeking, finding and

collecting data existing in documents. Desk review requires a clear

definition of relevant data. Copies of documents can be requested to the

owners of the documents.

In the context of social audit of Jamkesmas membership carried out in

Sumenep, June 2012, necessary data included membership data issued

by the Ministry of Health. In addition, the social audit team deemed it

necessary to ask for poor people data based on the list of poor recipients

of the rice subsidy, which could be obtained from the Office of Social

Welfare of Sumenep Regency. Both sets of data were obtained bysubmitting a formal request to the relevant government offices, clarifying

the purpose of using the data.

Apart from the data issued by the Health Office and Social Affairs Office

of Sumenep Regency, the social audit also required household-level data.

This was obtained by using in-depth interview technique with those listed


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as beneficiaries of Jamkesmas and rice for the poor and asking them about

membership of Jamkesmas.

The auditors who had received the social audit training were divided

according to the areas where Jamkesmas membership was going to be

audited. After that, the auditors visited the people listed in the

Jamkesmas and rice for the poor beneficiaries. Next, the auditors

interviewed these people by using a pre-designed social audit instrument.

In this case, the auditors verified with these people whether they are

true beneficiaries of Jamkesmas.

The interview process took place over three days. The auditors were given

targets of certain numbers of interviews to be accomplished in one day.This was done in order to achieve the desired target to complete data

collection in three days.

4. Training Auditors

Managing a social audit training requires a distinct kind of proactive spirit.

The distinctive spirit would later serve as the igniter of the combined

energy to participate in the social audit. As per its name social audit,

when the public hear the word audit being mentioned, almost all of

them have the same perception something shocking, specific findings,

some people to be blamed, and other perceptions. This situation, when

managed in a productive way, would become a very powerful in initiating

the community-led monitoring innovation.

The social audit training, by utilizing this situation, couldbecome the

foundation for future social audit designs. The diverse experience in

managing social audit training that is shared below can be used as a

reference for designing a social audit training.

a. Selecting the Social Audit Theme

This first stage covers in-depth review starting with mapping basic

community problems, considering the feasibility of a social audit, to

measuring the strength of community groups and network to initiating

the social audit. The mapping of basic community problems has

probably been performed relatively often, such as in respect of theproblems of School Operational Assistance (BOS) fund management,

poor services given to Jamkesmas patients, subsidized fertilizers

missing from the markets, etc. Any of these can be selected as the

theme of social audit. Some considerations in selecting the theme of

social audit include the feasibility of the activity using the available

alternative themes. Feasibility includes availability of all documents


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relevant to the theme, conducive communication with public services

administrators, readiness of the community network implementing

the social audit, including community media and mainstream media

network, etc. All of these considerations are reviewed before arriving

at the final selection of the social audit theme. The selected theme

will later be adopted as the name of the social audit training.

The social audit experience in Sumenep started with a series of

activities performed by the IBP core team in Indonesia. In 2011, the

IBP Core Team of Indonesia conducted esearch on Jamkesmas fund

management, and then the social audit of Jamkesmas membership

was initiated in 2012. Sumenep Regency was chosen as the location

for initiating the social audit following the feasibility study that lookedat Jamkesmas membership documents obtained from the Health

Office, the implementer of the activity which was PC Lakpesdam NU

Sumenep, selection of 2 villages, the stakeholder networks in 2 sub-

districts and the thousands of beneficiaries that could be covered in

the social audit.

b. Determining Participants of the Social Audit Training

What needs to be considered when determining participants of social

audit training is that the participants are limited to 25-30 people and

should involve more community groups. Ideally participation in

training would include representatives of all parties related to the

selected theme of the social audit. The correct composition of

participants has an impact on the implementation of the social audit.

The training could have, for example, 3 people from the Health Office,

2 people from the local parliament (DPRD), 3 people from the village

administration, and the rest from community groups and network.

Having a composition with more community representatives is advised

because these groups will be focused on becoming social auditors,

while other members are more comfortable being the parties who

participate in the design of the social audit. The diverse composition

of participants can also reflect the legitimacy of all parties to initiate

the social audit, and at the same time convey the message that the

social audit is in the interest of all parties. The audited public serviceproviders will gain feedback from the beneficiaries and the general

public, while the beneficiaries and the general public will get the

commitment of public service providers to improving the quality of

their services. DPRD will also benefit from the development of a social

audit design for strengthening their monitoring of public service

administration.


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In Sumeneps social audit experience, the training was dominated by

community groups and NU members, while the Office and DPRD were

not present. This less ideal condition can be understood from the fact

that initiation of social audit still requires some time in almost all

regions in Indonesia.

c. Social Audit Design Session

The session is the first in the series of activities in the training, and

aims to engage the participants from the very beginning in actively

participating in designing the social audit. The session is highly

strategic in packaging the social audit training which positions the

participants early on as individuals encouraged to actively determine

the phases and contents of the training. Such packaging that is distinctfrom other trainings is crucial for inviting more parties to be engaged

in developing social audit in Indonesia. The distinct packaging is

managed by inviting participants to see the best practices of social

audit in a number of places. Presentation of best practices through

photos and films creates positive psychological impacts on the

participants. In this foundation session for the social audit training,

the facilitator encourages the participants to replicate the flow of

social audit as seen in the presented photos and films. The

development of flow by the forum is also a participatory alternative

that can be taken with the facilitators moderation.

The following are flows of social audit developed in many places:

1) Selection of Social Audit Theme

2) Social Audit Training

3) Implementation of Social Audit

4) Analysis of Social Audit Data

5) Public Hearing on Social Audit Findings

6) Guiding the Recommendations from Public Hearing on Social Audit

The steps of the social audit should have been identified by the

participants in this session, as a sign that the social audit has become

a necessary activity for improving the quality of public services and

the accountability of budget management.

d. Presentation from Public Service ProvidersThis session, which is among the introductory sessions, is an

opportunity for the service providers to present a portrait of the

services. The portrait includes the legal basis for the public services

provided, number of beneficiaries, amount of fund managed,

performance and challenges encountered. The session is aimed at

giving a complete description of the public services selected as the

theme of the social audit. It also serves to push the public service


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provider to objectively position itself as party in need for feedback

regarding its performance in managing the public services.

In some experiences of social audit trainings, this session becomes

the trigger for training participants to explore the issues in public

services because these issues are related to the fulfillment of their

basic rights. Peoples experiences when accessing the services surely

become heated debate, which is the heart of the session.

Facilitators moderation can increase the sessions productivity by

codifying and guiding the participants into agreeing upon the problem

nearest to the beneficiaries. The process is of highest importance in

the session, whereby the domain of the social audit will be more

visible.

The Sumenep experience of social audit provided a variation of

describing public service issues in Jamkesmas membership, by

presenting indicators from the Central Bureau of Statistics (BPS)

assessment used in identifying poor households who were eligible

for jamkesmas services. These indicators became the domain of the

social audit by comparing them to the real conditions of the households

listed as Jamkesmas members. The session did not have presentation

from the Health Office because the domain of the social audit had

been reduced to jamkesmas membership and the need to cross-check

the facts in the field. It cannot be denied, however, that the presence

of the Health Office in the session were still needed in order to

respond to the experiences of beneficiaries and community members

related to Jamkesmas membership, as well as to reaffirm that the

social audit was very useful for them as key stakeholder in the health

sector.

e. Creating Instruments for the Social Audit

This session was the most interactive in a series of activities in the

training. After getting the complete picture or the public service in

the previous session, the participants were invited to create

instruments for the social audit. In the process of growing creativity,

the participants were reminded of the earlier session on bestpracticesin social audit. With the help of the facilitator, they were

asked to examine a number of social audit methods used in previous

experiences that became best practices. There are a number of

methods available: survey, polling, citizen report card (CRC), and

expenditure budget tracking. In this session, the participants were

encouraged to decide on the method most feasible to be

implemented.


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After the forum decided on the method to be used, the next step

would be creating the instrument. What the facilitator needs to do is

to make sure that participation has to be the soul of the session; to

encourage participants to create instruments that they were sure they

could implement by themselves. Growing sense of belonging towards

the whole design of the social audit, including the instrument, has to

be achieved in the training.

The instrument will highly determine the quality of the social audit

process. If a variety of instruments is needed, then they can be tailored

according to the needs. For example, questionnaire for students

parents was different from that for the school committee or school

management in the social audit conducted by Center for Budget Studies(PBA) of New Student Enrollment in Bantul Regency 2011. Or,

questionnaire for farmers who were recipients of subsidized fertilizers

was different from that for the distributors in a social audit of

subsidized fertilizers in Bantul Regency in 2011. Preparation of Score

Cards in the Citizens Report Card (CRC) method is also determined by

creativity of the participants of the social audit training. Despite having

its own level of difficulty and complication, the method of budget

expenditure tracking also requires instruments to help the social

auditors in the audit of APBS SMA 2 Wonosari, conducted by the

SRAWUNG network of Gunungkidul.

The social audit experience in Sumenep provided a simpler process

because it was focused more on poor households indicators issued by

BPS. Because of that, the instrument used was the one used by BPS in

determining the criteria of poor households. The session on

instrument creation in the social audit training in was geared more

towards guiding the participants to mastering the instrument. The

additional questions in the questionnaire were to give detailed

information on the Jamkesmas cards and how the beneficiaries use

them.

f. Social Audit Instruments Trial and Review

The instruments trial session is aimed at giving an opportunity for theparticipants to try and use the instruments in the field. The number of

instruments for trial can be determined by considering the usefulness

of the trial. This trial session is extremely useful for participants to be

familiar with the real condition of the field that will become the

location of social audit implementation, apart from improving their

skills in using the instruments.


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The social audit training experience showed some positive impact on

the participants after they went through the trial session. The process

of masterting the instruments was given the necessary space in the

session. The real condition when instruments were used by potential

social auditors with the targets could be felt by the participants. Trials

of 3 questionnaries given to 3 different audit targets were sufficient

for the participants to gain experience of using the instruments, and

they were able to make comments during the instrument review

discussion afterwards.

The instrument review discussion can be started by giving an

opportunity for a few participants to share their experience in trying

the instruments. Based on the experience, the facilitator then ask theforum to review the instruments in a detailed manner. When they are

considered to be adequate, the facilitator then ask the forum to finalize

the audit social instruments.

The social audit experience in Sumenep provided adequate space for

participants to conduct questionnaire trials. By interviewing 3

Jamkesmas members and recipients of rice for the poor, the

participants gained the experience in implementing the instruments,

were able to review the instruments and agreed on the final

instruments. The diverse background of participants turned out to

enrich their experience in trying the instruments.

g. Planning for the Implementation of Social Audit

The session is aimed at encouraging participants to manage a series

of productive field activities that can be easily replicated by other

groups. Consistent with the spirit of introducing social audit to many

parties, the simple pattern of social audit management will help many

parties to replicate and develop social audit in other sectors. The

session can be used as the trigger for designing social audit

implementation that will attract the interest of other parties to

develop social audit in different sectors.

The design of social audit implementation can be started by agreeingupon the area of the social audit that can be covered by the available

resources. The Social Audit of New Students Enrollment (PPDB) with 25

training participants was able to reach 800 parents in 2 schools within 5

working days, while the same number of auditors for the social audit of

PUAP in Gunungkidul were able to cover 600 beneficiaries of PUAP fund

in 6 villages in 2 sub-districts in Gunungkidul in 10 days. The agreed period


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based on the available resources will then be translated into a timetable

for the social audit implementation.

The facilitator of the session must also encourage the forum to map the

campaign instruments that will be used during the implementation. The

social audit campaign instruments will be applied in two opportunities,

i.e. during the implementation as a part of the dissemination of the social

audit, and during the public hearing. In their first function, the instruments

are used to disseminate information on the legal basis, procedures and

data on the public service, that will be displayed in public spaces in the

social audit location. The role of this campaign is to make people

understand the purpose and steps of the social audit. The campaign also

presents data from the public service documents. The data is very usefulfor the public because the information being presented has most likely

not been published. As for the function in the public hearing, the campaign

instruments are used to help the public understand the results of social

audit analysis and the recommendations presented during the public

hearing. Both functions of the social audit campaign instruments are

discussed in order to complete the session on the social audit

implementation. The development of the campaign instruments is

suggested to also consider the availability of resources and expect some

creativity of the participants.

In some social audit experiences, campaign instruments have not been

used a lot during implementation. This is due to limited availability of

resources. The social audit of Jamkesmas services in Bantul only placed

some xbanners in all community health centers (puskesmas) that were

the locations of the social audit. And then, during the public hearing, the

results of CRC analysis were accommodated on the xbanners displayed in

the public hearing location.

The social audit experience in Sumenep provides the more sufficient use

of campaign instruments. During the implementation, banners bearing

the names of Jamkesmas members and rice for the poor recipients were

diplayed in public spaces, and then during the public hearing, banners

having the social audit analysis results, recommendations and social auditdevelopment campaigns were displayed attractively in the location.

5. Development of campaign instruments

Encouraging the community to make the social audit process a joint

movement in participatory monitoring of public policy is a challenge. In

order to invite all elements of the community to take part in the social

audit, campaign instruments are required. These instruments reaffirm


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the position of social audit as an innovative activity aimed at improving

the quality of public services and accountability of budget management.

The campaign instruments are applied in two stages of the social audit

process, i.e. in the implementation and in the public hearing. The selection

and development of the instruments are conducted in the training process,

aimed at building participants involvement and sense of belonging

towards the whole social audit process. In the training, a variety of

campaign instruments can be introduced. However, in order to support

and optimize the social audit process, the campaign instruments used

were outdoor media.

The outdoor media were chosen because they could be placed in openspaces and easily accessible to all community members. The instruments

were placed in public spaces such as neighborhood watch posts, integrated

health posts, village hall and meeting hall. Different types of campaign

instruments chosen for the social audit included banners and flyers.

In addition to the print campaing instruments, the social audit also utilized

the community radio. It was done in order to optimize the information

transfer process to the people. The campaign instruments used on the

community radio included talkshows, public information commercials and

features.

In the implementation of social audits in Sumenep Regency, East Java

Province, and in Gunungkidul Regency, Yogyakarta Province, the campaign

instruments chosen were banners, talkshows and lists of beneficiaries.

Banners and talkshows were used in the social audit of rice for the poor

recipients in Gunungkidul, while list of Jamkesmas beneficiaries was used

in the social audit in Sumenep.

The instruments used in the process must include a number of important

aspects of the social audit, such as a key statement on the the Law on

Freedom of Public Information that guarantees the right of citizens to

access public documents, and relevant documents that are the directly

audited materials, such as the list of Jamkesmas card holders in the Social

Audit of Jamkesmas membership and the list of Rice for the PoorRecipients in the Social Audit of Rice of the Poor. In addition to the Law on

Freedom of Public Information, information on Law no. 20 of 2001 on

Eradication of Corruption and Government Regulation no. 71 of 2000 on

Community Participation in Corruption Eradication can also be

disseminated and used.


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The campaign instruments used during the implementation of the social

audit play a role in raising the awareness of the people of access to

information related to the theme of the social audit. Also, they encourage

people to ensure that the published data is in line with the purpose of the

program being audited. For example, whether the Jamkesmas card holders

were the appropriate beneficiaries, or whether the names on the list of

Rice for the Poor recipients deserve to receive it.

In the process, peoples critical mindset is bui lt so that they can participate

in monitoring the implementation of programs and reflect on the existing

poverty eradication programs. Do they deserve to receive the programs

or are they violating the rights of others? The process of building peoples

ability to be critical is the main target of developing social auditinstruments. It can be built by placing the campaign instruments in strategic

locations where people can have direct access to.

After peoples critical mindset has been built and the social audit has

been implemented, then the public hearing is conducted. It is aimed at

presenting the findings of the social audit. The process involves all

stakeholders starting from the executive, legislative, community to the

implementor of the program being audited, such as Jamkesmas

implementing team or Rice for the Poor implementing team, at all levels.


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Box 1Use of Banners: Social Audits of Jamkesmas Membership in Sumenep

and Rice for the Poor in Gunungkidul

The social audit of Jamkesmas membership in Sumenep Regency, East Java

Province agreed to use banners as the campaign instrument. The banners had

the list of Jamkesmas members from two pilot villages. The banners were

prepared at the time of the social audit implementation in the field, and then

placed in public facilities existing in the two villages; hamlet halls, early

childhood education facilities, by intersections, and other strategic locations.

When the banners were being placed, some community members lookedenthusiastic to examine the contents and stated that the information was

important, considering there had been no information provided on Jamkesmas

membership.

Banners were also used by social audit activists in Gunungkidul. Names of

target beneficiaries were written on the banners distributed to all hamlets of

the social audit and placed in strategic locations.

The lesson learned from the use of outdoor media placed in strategic locations is

that the critical space for people was made available through the public documentshaving the list of beneficiaries of JAMKESMAS or Rice for the Poor (RASKIN) written

on the banners. The critical space was created through the discussion on why

certain names were listed while the others were not, which then encouraged the

people to ask about these matters to the relevant parties. The creation of such

critical space also became the sign and the distinction from other audit processes.

Another interesting stage of the social audit, in which the campaign instruments

are used, is the public hearing. Campaign instruments are used to enrich the

presentation of social audit results. The recap of findings can be packaged in the

forms of attractive diagrams such as graphs, bar and pie charts that can be printed

on banners and displayed in the location of the public hearing. Participants of thepublic hearing will be assisted in getting the information on the process and

findings of the social audit by having the banners. At this point, campaign

instruments in the form of local arts can also be developed. Local arts can attract

public interest so that they are willing to be involved in the public hearing. The

types of arts to be selected should obviously be simple yet popular among the

people. They should be useful for the development of social audit and provide a

simple description of how important the process is. Musical instruments plus


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Box 2

The Use of Banners and Local Arts in the Public Hearing: Social Audits of

Jamkesmas Membership in Sumenep Regency and Subsidized Fertilizer

in Bantul Regency

lyrics or expressions sung in certain tones will help convey the messages of social

audit. Cooperation between the auditors team and arts team can develop a local

arts genre taking a theme of social criticisms which may enrich the public hearing

process.

The public hearing on the social audit of Jamkesmas membership in Sumenep

Regency utilized banners and local arts as instruments. The results of the

social audit analysis were packaged in attractive diagrams and displayed

around the venue. The placement of banners in the public hearing filled

some empty space and gap, which was useful for participants to get some

information and knowledge of the social audit while waiting for the event to

start. The same benefit was gained in the social audit of subsidized fertilizer

in Bantul Regency. The results of the social audit analysis and information on

the process displayed at the venue were very useful for the participants

especially in digesting the information on the social audit conducted.

The local art of Hadrohas a campaign instrument was used in the public

hearing of Jamkesmas membership in Sumenep. The faith-based local art

was believed to have been useful in raising peoples awareness of their

basic right in the health sector, which was the theme of the social audit.

6. Implementation of the Social Audit

Field exercise is a form of education through implementation/application

as a learning experience for participants ofSocial Audit Training. The field

exercise is a form of relevance between theory learned during the training

and the practice in the community. Not only is it conducted to improvethe observational, analytical and assessment skills necessary for making

comparisons between theory and practice, at the end of the day it will

also build the capacity of the community to observe the true and real

problems existing within their own environment.

The field exercise of social audit in Sumenep was one form of community

participation in observing and

social audit: a study of jamkesmas and jamkesda membership

Documents