Epistemic layers in development planning: A case study of the health sector in the Gunungkidul District, Indonesia

Abstract

The paper analyses how knowledge systems and epistemic cultures contribute to development planning through conduct of a microqualitative sociological case study of the health sector in Indonesia. The data were attained from 37 in-depth interviews and a stakeholder engagement workshop conducted in Gunungkidul, Yogyakarta, complemented with documentary media analysis. Our findings show that centralisation continues to exist in the development planning practice within the decentralisation era. This is shown through dependence on budget prescriptions and indicators from the centre in Jakarta. Further, this study demonstrates how the integration of indicators in the development planning process is hampered by myopic practices of government officials at the district level where there is evidence of an absence of verified knowledge in the Health Bureau of the District of Gunungkidul. Furthermore, there is dependence on data and information from volunteers in the Health Integrated Service Post (Posyandu) at the local village level. This study reveals, therefore, that development planning operates at three levels, yet with different knowledge systems and epistemic cultures at each level: central, district, and village.

The impact of decentralisation on health systems in fragile and post-conflict countries: a narrative synthesis of six case studies in the Indo-Pacific

“…The reforms addressed these traditional norms and practices poorly and may have weakened their effectiveness. One study suggests that knowledge systems and epistemic culture support the maintenance of central decision-making in development planning, explained by dependence on top-down budget prescriptions [ 61 ]. Realising the potential efficiency dividends of decentralisation may therefore require understanding and, where appropriate, accommodating existing socio-cultural norms.…”

“…Directing fiscal allocations to local government alone has not been shown to improve child immunisation rates [60]. It is argued that the capacity and capability of local government is important for achieving efficiency close to the ground [40,[60][61][62][63]. Zaida et al [45] noted that despite increased provincial health allocations, a lack of coordination between provincial and central level in Pakistan impeded effective implementation.…”

The Right to Health in Evidence-based Policymaking

“…It increases the capacity and the quality of the interventions and programmes to achieve its intended aims; namely, reducing the numbers of cases of malnutrition and at the same time improving the nutritional status. By taking evidence as scientific knowledge, our earlier study explored the barriers to incorporating scientific knowledge for policymaking in governance structures, and topographical-health related and communication factors (McDonald et al 2009, Purwaningrum andShort 2018). These barriers are the relatively centralised governance structures, broad coverage of karst land in Gunungkidul, which makes access to water difficult, and lack of communication amongst health officials.…”

“…In Gunungkidul, it will be difficult to sustain the current habit of nutritional volunteers (kader gizi) recommending the use of local resources for food, due to the lack of knowledge-base with regard to the local food alternatives available, as well as a lack of interaction among stakeholders through planning (Musrenbang/Musyawarah Perencanaan Pembangunan) or decision-making processes (Purwaningrum and Short 2018). Nevertheless, it is essential to note that the Gunungkidul District government focuses on health issues, especially nutrition, although funds are still limited.…”