INTEGRATION OF DATA SYSTEMS FOR SOCIAL ASSISTANCE PROGRAMS; WHY AND HOW? Executive Summary A number of Social Assistance (SA) programs are currently implemented in Indonesia to reduce poverty. While these are good and necessary programs, the lack of integration in terms of data systems, targeting, modules and implementation leads to a high degree of inefficiency. We reviewed the current situation of the Family Hope Program (PKH), in relation to other programs and identified bottle necks to successful implementation and management. Based on the results of the assessment, new integrated android-based applications were developed to support PKH’s data collection and management system, and strengthen the counseling function of its facilitators. In addition, the aggregated results from these application can be used by local governments to inform their decision making related to planning and budget allocations. This paper provides recommendation for future improvements of the data systems used by PKH and the integration of data systems and implementation across programs.   Introduction poor in a phased manner so that it Now a middle-income country, becomes a more nutrition-focused Indonesia still faces serious program; and (c) structure temporary problems. More than 28 million SA at the central and local level by Indonesians still live below the improving the coordination and poverty line and approximately 40% sharing of authority between of the entire population (~250 million) ministries/institutions that implement remain vulnerable of falling into temporary SA. Moreover, this inter- poverty, as their income hovers sectoral cooperation will also benefit marginally above the national poverty other programs. line. [1] While overall, the impact of SA Since the phasing out of the fuel programs in Indonesia on poverty subsidies in 2005, the Government of and inequality reduction is still limited Indonesia (GoI) has created a number [3], the CCT PKH Program is the of targeted social assistance (SA) most effective in terms of poverty and programs (see box) to support its inequality reduction impact per IDR overarching goal to reduce poverty. spent, but the lowest budget allocation [3]. Robust impact Moreover, GoI prioritizes the evaluations have already shown establishment of a comprehensive positive impacts of PKH in increasing social protection system for all food expenditures, health-seeking citizens and improve targeting behavior, and education for poor accuracy of the SA programs for the families and their communities [4,5] poor [2]. Its policy direction also These include increases in discusses the need to (a) integrate participation in elementary and several family-based SA schemes for secondary school, transition from poor and vulnerable families that primary to junior secondary school, have children, disabled, and elderly, prenatal visits, and complete in the form of Conditional Cash immunization for children. Moreover, Transfers (CCT) and/or through in- CCTs have been proven to not kind assistance to support nutrition; increase recipients’ purchasing of (b) transform the rice subsidy for the Current Social Assistance and related used in PKH in particular and how programs these relate to common problems such as targeting, assessment of Family Hope Program (Program Keluarga Harapan/PKH): Conditional Cash Transfer program effectiveness, program (CCT) and Family Development Sessions (FDS) efficiency and coordination between focusing on health and education the existing programs. According to Smart Indonesia Program (Program World Bank calculations [3], IDR 31 Indonesia Pintar/PIP): CCT scholarship trillion are spent yearly on these targeting children aged 6-21 years from poor programs to reduce poverty and it is families, including PKH beneficiaries. therefore of the utmost importance Healthy Indonesia Program (PIS): aims to that the funds are allocated in a way improve the national health and nutrition status that benefits the most people. through community empowerment supported by financial protection and equitable health services. Approaches and Results Rice for Family Welfare (Beras We reviewed the data systems of Sejahtera/Rastra): subsidized rice for poor PKH and related programs, and families (15 kg/family/month) conducted in-depth interviews with Smart and Healthy Generation (Generasi 49 PKH implementers as well as Sehat Cerdas/GSC), aims to empower focus group discussions (FGD) with communities through capacity building to increase the quality of basic services, 45 stakeholders in six locations in particularly on health and education. North Sumatra, West Java and North Sulawesi. Family Welfare Movement (Program Kesejahteraan Keluarga/PKK) is a national PKH currently serves approximately movement with units down to the sub-village 10 million households, recently level, aiming at community empowerment to increase family welfare. upscaled from 6 million. To support this scale-up, a new data system was Posyandu (Integrated Service Post) is a designed for the 4 million new Community-based effort to provide basic health services and improve the nutritional households, called e-PKH, which has status of the community. an android component for data Building Families with Underfives Program validation and verification by the (Bina Keluarga Balita/BKB) aims to increase Facilitators and a web-based knowledge and skills of parents related to component for the Data Operators. growth and development of children under five. Unfortunately, these two components Integrated Holistic Early Childhood are not compatible and data-sharing Education and Development (Pendidikan requires an external device or a data Anak Usia Dini-Holistik Integratif/PAUD-HI) cable. In addition, the e-PKH is an early childhood development program platform, is not yet accessible for the aiming to fulfill the essential needs of children aged 0-6 years in a simultaneous, systematic, Data Operators. Instead, the data are and integrated way, combining pre-school sent directly to the Ministry of Social (PAUD) with Posyandu and BKB. Affairs (MoSA) at the central level for Community-led Total Sanitation (Sanitasi processing. In addition, the initial Total Berbasis Masyarakat/STBM)  focuses system (Sistem Informasi on behavior change related to sanitation. Management-PKH/SIM-PKH), which Communities are facilitated to conduct their uses paper-based forms to collect own appraisal and analysis of open defecation (OD) and take their own action to become ODF data on the existing 6 million (open defecation free). households, and the newer e-PKH are not compatible. alcohol or cigarettes or to discourage work [6]. In some areas, insufficient numbers of computers with inadequate Still, a number of challenges remain. technical specifications to support This paper describes the current the management of large amounts of situation related to the data systems data combined with slow and In some of the areas, insufficient unreliable internet connections to numbers of computers with complicate the work at the district inadequate technical specifications to level. In addition, there are no proper support the management of large standard operational procedures amounts of data combined with slow (SOP) related to data security, and unreliable internet connections to backup and recovery systems within complicate the work at the district the PKH program. Backups are level. important to safeguard the data in The monthly verification of health data case of technical problems and some only captures Posyandu attendance of Data Operators have taken the the PKH beneficiaries, while no data initiative to make backups on external on nutritional and health status are devices. In addition, sharing of recorded. As a result, it is difficult for usernames and password between the PKH program to claim an impact Facilitators who need assistance and on these indicators, and is limited to those who assist them forms a reporting increasing Posyandu serious breach of data security. attendance rates of pregnant women Human resources are limited in skills and children under the age of five [3]. to support their tasks. In particular we found a lack of computer-related and The different SA programs fall under facilitation skills among PKH different ministries, use different data Facilitators. In some cases this was sources and approaches to target exacerbated by advanced age (>50 their beneficiaries, which leads to years) and limited educational levels. targeting issues. In turn, the over- On the other hand, the shift in job targeting of some families causes description from data entry staff to aid-dependency, while other families data manager caused by the new e- remain untouched. PKH system, leads to miss-matching Currently there are no mechanisms of the rather large number of data for cross-program coordination and operators with limited skills in view of data sharing. the increased technical aspects of their work. Figure  1  Current  and  Future  Information  Flow  Model  for  PKH The development of integrated android-based e-PKH application To address the issues related to health and nutrition data availability and the PKH database system, and to lay the ground work for integration of data across programs, an integrated android-based e-PKH application was developed, consisting of four sub-applications: nutrition, immunization, early childhood education and WASH (Figure  2). Figure  3  Example  of  Detailed  risks  and  suitable  key   messages  maternal  form   The same principle is used in all sub- applications. The applications were tested by six facililators in Bolaang Mongondow district in North Sulawesi. Their feedback showed that the applications were easy to use and quicker to complete than the paper- based forms. In addition, the data can be stored locally on the cellphone and uploaded once there is Figure  2  Maternal  and  Child  Nutrition  Status   internet connection. The applications Monitoring  Information  System  Tools   provide summary data as well, but these are limited to process The Maternal and Child Nutrition indicators such as Posyandu Status Monitoring Information  System attendance rates. Unfortunately the Tools are designed to integrate the technical specifications of the PKH data collection system on the cellphones used by facilitators do not health and nutrition (and education) support the generation of aggregated status of PKH beneficiaries. Entering data. This however can be done by the data in the application will trigger the Data Operator and fed back to risk flags such as ‘anemic pregnant the Facilitators (see Table 1 for woman’, ‘does not consume iron example). These results will be useful supplementation’, which in turn will to support village leaders for planning generate appropriate key messages to and budgeting purposes. The be used in counseling (Figure  3). usefulness of the applications for counseling was not part of the field test and needs to be piloted at the to (a) Use standard data definitions next stage. and formats (International or National), (b) Define quality standards Table 1 Summary of Selected Data Field Test and apply appropriate validation Integrated Application processes for each dataset, (c) Adopt formal Query and Change Underfive H&N (n=87)1 n % Management procedures, and (d) Birth Weight >2500 grams (n=42) 42 100% Underweight (n=45) 5 11% Ensure that data are quality assured Normal 40 89% prior to use or release. In addition, an Stunting (n=14) 4 29% interface system should be built-in to Normal 10 71% integrate and synchronize the data Exclusive Breastfeeding 68 78% between the cellphone application Received age-appropriate Vitamin A 9 10% and web-based application of e-PKH. Complementary Feeding 1 1% Intestinal parasites 4 5% The lack of computers with sufficient ECE (PAUD) (n=73) technical specifications and poor PAUD available 11 15% internet connections are major Child registered at PAUD 3 4% restricting factors for the District Data Routine attendance 2 3% Operators, while some Facilitators Communication PAUD-Parents 1 1% still use cellphones with only 1GB WASH (n=94) RAM, which causes their phone to Place for waste disposal 28 30% repeatedly crash. Access to clean water 90 96% Own Latrine 45 48% Currently, the H&N data collected by Handwashing with Soap 87 93% the PKH Facilitators are limited to Vector control 47 50% attendance of Posyandu, rather than Consumption Vegetables and Fruit 48 51% the actual nutrition status of Physical activity of mother (10- beneficiaries. In addition, other data 30’/day) 26 28% platforms available like data on Protection against Cigarette Smoke 42 45% WASH (‘SMART STBM’), immunization and ECE are not yet Conclusions integrated in one data platform. This A Data Management System (DMS) is a missed opportunity to provide an embraces the whole range of integral picture of the beneficiary activities involved in the handling of households. However, database data from the entry point up to the integration is not entirely server and use of data [7-9]. straightforward, as these databases There are problems related to the only contain aggregated data at the data integration and synchronization sub-district level. between the android e-PKH The large variation in skills, application used by the PKH knowledge and performance of PKH Facilitators and the e-PKH web- program personnel causes disparities based application used by the District in program implementation Data Operators. Moreover the nationwide, which in turn will existence of two separate systems negatively impact the potential (SIM-PKH and e-PKH) does not impact of the program as a whole. support successful program implementation. The different modules of the FDS sessions of the PKH program, of In order to be effective the data which we assessed H&N and management system should consider Education, and even the topics within                                                                                                                 these modules are not integrated in 1  Not  all  children  had  complete  data  and  it  is  likely   terms of messages and visuals, as that  among  those  without  data  suboptimal   nutritional  status  was  more  common.   well as in terms of the data collected. Looking beyond the boundaries of a should be adequate to support single program, there are two major the program. ways in which PKH can support the 3. A coordination forum at the integration of existing Basic Social national level between MoSA and Service (BSS) programs: by other stakeholders should be strengthening the existing roles and established to discuss the activities at the Village/Sub-district integration of the data and the level and through sharing and program implementation at the integration of the data system. community level. Such a forum PAUD-HI and BKB programs include will enable regular data sharing parent education sessions quite and feedback between similar to the FDS sessions of PKH, stakeholders, prevent duplication which forms an opportunity for of data collection and ensure one integration. The modules developed integrated database, as well as for PKH are well-thought through and streamline the grass-root level could be used in different programs implementation. without the need to re-invent the 4. The newly developed applications wheel. In addition, these modules can present the possibility to provide be used by health staff, such as summary data on the status of midwives and nutritionists, in their the beneficiaries for planning and education sessions such as the budget allocation purposes at the regular Nutrition and Pregnancy village level. Classes. This will reduce some of the workload of the PKH Faciliators while 5. Prior to implementation, the newly ensuring the topics are explained by developed applications should be professionals. piloted among a large sample of Facilitators and beneficiaries, The data that will be collected representative of different areas in through the new application can Indonesia. This pilot should support not only PKH, but can also include an assessment of the be used by other programs, the MoH extent to which the applications as well as the village level planning are useful to support the forum as a basis for their  decision   facilitators’ counseling tasks, and making.   data integration and synchronization with the e-PKH application. Recommendations 6. While previously the role of the Information Management Sysem District Data Operators (DDOs) focused on data entry, the 1. The SIM PKH should be integrated introduction of an android-based with the e-PKH into one large system requires fewer staff with database management system more advanced data to streamline program management skills. In addition, implementation, improve data to support the migration from quality and reduce workload. SIM-PKH to e-PKH, the SOPs to address issues related to recruitment of technical experts backup, data security and recovery such as data analysts and system should be put in place. programmers should be considered. 2. The technical specifications of computers and mobile phones, as well as the internet connection, Program Integration building and institutionalization could be addressed by GSC. 7. Strong political will is needed to 10. The use of a central database is integrate the social assistance crucial to to streamline existing and BSS programs in line with the SA and BSS programs. The RPMJN 2015-2019. An TNP2K integrated database can overarching policy, preferably a be used as a basis to build this Presidential Instruction, database to facilitate data sharing describing the roles and across programs. responsibilities of all relevant ministries and institutions, 11. The integration of the programs appointing a leading sector and will also eliminate the need for a detailing coordination multitude of membership cards. mechanisms, can form the basis The Family Welfare Card (KKS) for this integration. can be adapted to access the different types of BSS programs. 8. The establishment of All eligible households (e.g., 40% coordination forums at the poorest in the population) should district and sub district levels, have access to Rastra, PIS and including program staff, local FDS (subsidized rice and government and community healthcare, and education for leaders for program coordination families). Among these and integration, data sharing, and households, those with pregnant problem solving is essential for women and/or children under-five program convergence. would be eligible for PKH (CCT 9. PAUD-HI could be considered as focused on nutrition) and those the implementation point for SA with school-age children for PIP programs such as PKH, (CCT). 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