Community health centers in Indonesia in the era of decentralization: The impact of structure, staff composition and management on health outcomes

This dissertation aimed to shed more light on the largely neglected organizational side of decentralization in health care systems: the role of Community Health Centers (CHCs). Point of departure for this project is the assumption that variation in the structure, composition and management of these front-line organizations strongly affects health outcomes in their respective service coverage areas. The dissertation comprised four empirical studies on Community Health Centres (CHCs) in Indonesia and their capacity to generate high performance in health outcomes in the context of decentralization. Its key question is if and how CHC discretion and autonomy in Indonesia’s decentralized era is related to their performance in terms of innovation, efficiency, efficacy, and co-production. Are performance differences between CHCs negligible, now that they have the discretion to tailor their operations to local circumstances, or do CHCs differ considerably in performance? If so, how can this be explained?. The findings suggest that variation in performance remained wide and the organizational dimensions of Community Health Centers matter. Scholars and policy makers may benefit from devoting more attention to this neglected dimension in their future attempts to improve the performance of the Indonesian health care sector.