DR.

DUMILAH AYUNINGTYAS, MARS

SITI KHODIJAH PARINDURI, SKM, MKM
FITRIA ARYANI SUSANTI, SKM, MKM
§ Public health is a very strategic affair and plays an important role in determining the
welfare of the Indonesian population.

§ The budget for health in the 2017 State Budget (APBN) is Rp 104 trillion, even up to
Rp 500 billion from the proposition in the 2017 State Proposed Budget (RAPBN).

§ The size of the budget in the health sector opens opportunities for misuse by related
agencies and individuals.

§ The values of leadership integrity become very important for the prevention of acts of
corruption.
General Purpose: This study aims to analyze the concept and implementation of
anticorruption leadership integrity in the health sector

Specific Purposes :
• Regulation related to integrity of leadership in health sector: to be part of basic
competence.
• Analysis of corruption cases in the health sector.
• The concept and criteria for anti-corruption in the health sector.
• Systemic efforts to prevent and eradicate corruption in the health sector.

The study was conducted with a qualitative
approach to explore the views of stakeholders
in the health sector and establish the thematic
phenomena from the content analysis of
interview results.
The analysis is sharpened with the utilization of
secondary data, literature review and news
analysis about corruption from various mass
media as well as triangulation in an effort to
maintain data validity.
Ethical Research
The entire research phase is done by taking into account
the ethical aspect in research and scientific writing.
Respect for the ethical aspect starts from the compilation
of the proposal with the inclusion of reference sources, the
preparation of permits in data collection, interviews and
surveys, also approval from the informed consent.
The process of ethical review has been done by presenting
the research proposal and has obtained the affirmation as
stated in the passing letter of ethical review number
74/UN2.F10/PPM.00.02/2017 .
No Research Informant
1 Administrative and health
policy experts , especially
hospitals.
2 Experts and Academics
3 Health economics experts
4 Health policy experts
5 Professors University of
Indonesia
6 Leaders of public health
faculty (FKM)
7 Head of PPSDM Agency of
the Ministry of Health
Reasons for Informants Selection
Professors of health policy, health service administration, healthcare financial
managers that are heavily involved in improving the quality of hospital
administrations in Indonesia, hospital advisory boards
Health experts in the regions that represent health projects owned by Department of
Health, WHO, USAID, World Bank, ADB, World Vision and AusAID. Health advocacy
expert, pioneer of Universal Health Coverage, National Social Security System (SJSN)
in Indonesia, and lecturers of anti-corruption education course.
Health policy and economic experts.
Health Policy Experts, academics in administration and health policy.
As experts and academics, the propulsion of MPKT courses (integrity education) at
the University of Indonesia, activist of plagiarism prevention in educational
institutions.
Stakeholders who are able to influence the direction of internalization policy of
anticorruption leadership integrityin the Faculty of Public Health (FKM)
One of the regulators of Human Resource Health in Indonesia.
The Information
Views on leadership in the health sector, corruption
and its prevention efforts in the health sector.
Views of corruption cases in the health sector, anti-
corruption leadership in the health sector.
Views of definition of corruption in the health sector,
driving factors of corruption in the health sector, and
anti-corruption leadership in the health sector.
Views of definition of corruption, Regulations and laws
anti-corruption integrity in the health sector.
Views of anti-corruption movements at higher
education institutions,
Prevention efforts and movements of anti-corruption.
Corruption-related views in the health sector, Faculty's
contribution to the anti-corruption movement.
Regulation-related views of anti-corruption movement
on health workers, recruitment criteria, and prevention
efforts of corruption in health human resources.
No Research Informant Reasons for Informants Selection The Information

8 Former Official of the 2004-
2009 period who was once
involved in corruption.
9 Head of district community
health centers (Puskesmas
Kecamatan)
10 Head of sub-district
community health centers
(Puskesmas Kelurahan)
11 Director of general hospital
12 Manager of regional general
hospital
13 Bureau of officialdom of the
Ministry of Health
Leaders in the health sector who have served their leadership that are able to
illustrate the peculiarities of the health sector and the view of corruption in the health
sector.
Leaders in district community health centers (Puskesmas) with regional public service
agency (BLUD) status.
Leader in health sector with functional position in sub-district community health
centers (Puskesmas Kelurahan).
Leaders in the hospital.
The one that in charge of management in the hospital.
The Chief of Officialdom Bureau who appoints and guarantees the process placement
and determination of position / rank in the Ministry of Health.
Views on leadership in the health sector,
characteristics of anti-corruption leadership and anti-
corruption movement efforts in the health sector.
Explores the values of leadership integrity in the health
sector.
Explores the values of leadership integrity in the health
sector.
Explores the values of leadership integrity in the health
sector.
Explores the values of leadership integrity in the health
sector.
Explores the rules / regulations relating to the
recruitment process and placement and positioning

In its implementation, this research has not succeeded in interviewing Head of PPSDM Agency of the Ministry of Health and Bureau of officialdom of the
Ministry of Health even though it has been formally requested, but no interview schedule is given.
Data Collection Techniques and Research Phases

Concept Design Interview (Expert

Quick Desk Definition Judgement)
Survey Studies Health Sector
Leadership (Criteria and
Characteristics) Research Phase 1

Public Test Quantitative

Advocacy Coalition (Policy Forum) Studies

Book Writing Research Phase 2

1. Regulations Relating to the Integrity of Leadership in the Health Sector

1. Reference rules for employee recruitment, appraisal and placement of health sector structural officials
have not explicitly stated the competence of anticorruption as part of the necessary requirements.
2. Regulations on recruitment of candidates for civil servants;
a. Rule No. 11 of 2017 on the Management of Civil Servants article 23. Prevention efforts have existed
as described in article 23 section 1, which is one of the requirements to apply for civil servant that is
never convicted.
b. In article 54 about the requirement to be appointed as a civil servant must have good integrity and
morality.
c. In article 58 about well-executed tasks with a sense of responsibility and integrity, no abuse of
authority, and avoidance of disgraceful acts.
3. The value of integrity becomes part of the basic competencies in Regulation of Health Minister
(Permenkes) No. 971 of 2019 on the establishment of structural positions.
2. Analysis of Corruption Cases in the Health Sector

Analysis of the various regulations relating to the placement and appointment for government officials shows
that the values of integrity and competence of anti-corruption leadership have existed as the basic values
implied. So it is not stated explicitly as a competency standard for health structural officials.

In addition to the Ministry of Health, health corruption also occurs in other health institutions such as Public
Health Office at Provincial /District /City level, General Hospitals and also Community Health Centers
(Puskesmas). Based on the monitoring of Indonesian Corruption Watch (ICW), there are 46 cases of corruption
occurred at Provincial / District / City Health Office, 55 cases in Hospital and 9 cases in Puskesmas throughout
Indonesia. The total state losses in these three health institutions reached Rp 210.1 billion (ICW, 2017)

The effectiveness of various regulations that include the integrity competence of anti-corruption leadership in
Indonesia can be reflected in various cases of corruption in the health sector as illustrated in table below:
Position Form of Corruption Amount of Loss
Central Region

2 Health Ministers 7 members of House of Representatives Procurement of Medical Devices Rp. 249,1 Billion
/Regional House of Representatives
(DPR/DPRD)
2 Director General of the 3 Head of Region Auction of Positions A total of 93 cases with a state
Ministry of Health loss of Rp. 512.9 Billion
2 Health Ministers 31 Head of Health Office Medicine at least Rp 6.8 Billion.

Former Secretary General 14 Director of Hospital Health Equipment Procurement for Extraordinary Case Rp. 6.2 Billion
(now Ministry of Health)
6 Directors and Employees 5 Head of Community Health Centers Construction / rehabilitation of laboratory development in hospitals and Rp. 2.67 Billion
BUMN / BUMD (Puskesmas) community health centers (Puskesmas)
1 Governor Health insurance More than Rp 500 million.

5 Head of Regional District (Bupati) Construction of inpatient and bridge building at Government General
Hospital (RSUP)
1 Mayor Space medical devices, where it should use overseas products but being
replaced by domestic products.
1 Vice Mayor Procurement of medical devices at Regional General Hospital.
3. The Concept and Criteria for Anti-
3.b Corruption is not always the motive of
Corruption Leadership in the Health Sector
personal interest and often occurs as a form of
negligence
3 a . Similar Conditions to Other Sectors in
Generic Patterns
“In health sector many doctors tend not to care
about the administration of frequent corruption due
“.. It can happen in various forms.. the victims
to mismanagement. Corruption happens not always
are human. This concern is important because
because of the desire to enrich themselves but could
health has a direct impact on humans. ”
also be due to fall.”
“The corruption system is already very board
“When there is corruption, it’s usually not from X as a
and common, for example like nepotism
doctor but from X as a management function,
corruption for promotion. It means this generics
(although there are also doctors who outsmart), but
also occur in the public sector as well as health
could also be because the system that is not rational”
sector. ”
3.c The Shifting and Changing of Moral Values
“Many history of civilization development in Indonesia was built by doctors. Initially it came up
with the concept of what my benefits to others. But now it’s becoming rare and shifting ...”

The Meaning Anti Corruption Leadership Integrity:

• Fear of God, Benevolence, Usefulness -PA
• Conscience, Think Out of the Box, Courage – High Official Ministry of Health 2004-2009

Corruption-inducing system:
“A fragile system to prevent corruption. There is a system that induces corruption. Because
governments are considered unfair, then it leads to the ways to survive”
 Should Anti-Corruption Leadership Integrity be Included into the Formal Competency Standards for
Structural Officials?

• All agree on the importance of the value of integrity of anti-corruption leadership.

• There are different views about whether or not to include it as formal competencies explicitly.

• There are considerations of how indicators, measurements and operationalization become inputs into the
formal competency standards.

• These quotations below are some excerpts:

“… how to measure it. Now it's fine, but later when it becomes a new official looks its original nature .. Not to
mention if the candidate is skillful to pretend...”

“… if there is a track record, it can help. But if there is only momentary measurement, it will be biased. Or peer
review that being asked to the people around them so that the process becomes indigenous...”
4.4. Systemic Efforts to Prevent and Eradicate Corruption in the Health Sector

• Efforts to prevent corruption should be instilled from an early age through continuous education in the family, the
planting of religious values.

• Based on the concept of Edward III, as the framework of policy implementation analysis there are four pillars of
bureaucratic structure, resources, communication and disposition to be everyone’s concern.

• Based on research by Hanevi Djasri (2016) stating that “discomfort in the health system causes various parties to
make a survival effort to survive during participation in the national health insurance program (JKN).”
¡ The research finds similar concerns about the incidence of
corruption in the health sector as well as other sectors.
Therefore, it becomes very relevant to prepare leaders with
the competence of anti-corruption leadership in the health
sector.

¡ Reference rules for the acceptance of civil servants, appraisals

and placement of health sector structural officials have not
explicitly stated the competence of anti-corruption as part of
the necessary requirements.
¡ The concept of anti-corruption leadership stems from the value of usefulness, the
willingness to help, the very strong character, the courage to act, willing to change and
accept the risks so they have the resilience against persuasion to do the corruption.

¡ These values and norms should be clearly stated in the competency instruments, although
these values should be planted early on and built from family values, religious education,
schools and peer-group environments.

¡ In particular, the appointment of someone to be a leader in the health sector should

consider comprehensive anti-corruption competencies. That are by utilizing the
assessment, starts from track records, assessment colleagues and superiors. The next
important thing is to operationalize the value of integrity and competence of anti-
corruption in order to be more measurable and applicable.