Sukri Palutturi1,2, Shannon Rutherford1, Peter Davey1, Cordia Chu1
1Centre for Environment and Population Health, Griffith University, Australia
2School of Public Health Hasanuddin University, Indonesia
Address: Centre for Environment and Population Health Griffith University, Australia
170 Kessels road, Griffith University, Nathan Campus, Brisbane, Australia, Post Code: 4111
Email: sukri_tanatoa@yahoo.com
ABSTRACT
Urban health problems are very complex and affected by many factors, ranging from social and economic to environment and living conditions. In the middle of the 1980s, WHO introduced a healthy city in Europe as a pilot project in response to a variety of urban problems including health. Then, in 1996 in Indonesia, the Ministry of Health and Home Affairs, began to develop healthy city programs including establishing a set of indicators to monitor improvements in urban health. However, in 1986, ten years before the notion of healthy city was known, the Indonesian State Ministry of Environment had recognised the Adipura – a clean cities program. Actually, the aims of both these programs are similar but have a different history and were established by different departments. They also bring with them different policies, indicators and implementation methods. Both the Healthy City and Adipura programs operate without any effort or coordination to assess their effectiveness. Thus, they seem to be overlapping, competing and causing confusion and also appear to cause inefficient resource use.
Based on an extensive literature review, in-depth interview, and document analysis, this paper compares and reviews the policies and existing indicators used by Healthy City and Adipura in order to facilitate a healthier environment. The analysis used to this study found that the programs have similar goals in addressing urban problems, but have different agendas and performance indicators and different stakeholders operating them. Therefore, building partnership and working together should be strengthened.
Keywords: Clean and healthy cities, indicators, Adipura, Indonesia
INTRODUCTION
Urban health problems are very complex and are affected by many factors, ranging from social and economic to environment and living conditions. Air pollution; traffic congestion; inadequate health services; inadequate water supply; slum areas up to social and economic problems such as street children and singers; homelessness; HIV/AIDS, narcotics use and urban poverty are a number of urban problems that occur in both developed countries and developing countries including in Indonesia (WHO, 2010). Urban problems are getting more complex because urban areas have already had own problems from their environment while urbanisation increasing from migration from the countryside to the cities also has brought its own problems with blending of culture, social structure, values, belief, habits and behaviour. As, a result, urban problems are becoming more and more difficult to address (Turan & Besirli, 2008).
In the middle of the 1980s, in response to a variety of urban problems including health, the World Health Organisation (WHO) introduced a Healthy City program in Europe as a pilot project. Since then the healthy cities movement has grown and now is worldwide, including Indonesia. In 1996, the Indonesian government through the Ministry of Health (MOH) and Ministry of Home Affairs (MOHA) began to develop a healthy city program including establishing a set of indicators to monitor improvements in urban health. Although, this WHO concept of healthy cities have been implemented since 1996, in Indonesia healthy city implementation effectively was carried out after issuing the regulation which is Joint Regulation between Ministry of Health and the Ministry of Home Affairs. However, around ten years before the formal notion of Healthy Cities was known, in 1986 the Indonesian State Ministry of Environment introduced the Adipura program – a clean city program (Dinamika Metropolis Tabloid, 2008b; N. Makarim, 2006; Nabiel Makarim, Adnan, & Roosita, 2010; N. Makarim & Butler; Supriyadi, Kriwoken, & Birley, 2000; Surjadi & Nukman, 2002), through which most of the clean and green cities programs were established particularly in the South-East Asian region.
Actually, the aims of both these programs are similar but they have a different history and were established by different departments. According to the Joint Regulation between the Ministry of Health and the Ministry of Environments No: 34/2005 and No: 1138/Menkes/ PB/ VIII/2005 the aim of the healthy city program in Indonesia is to achieve clean, comfortable, safe and healthy districts/cities to be occupied as a working place for its citizens by the implementation of various health programs with other sectors, in order to improve facilities and productivity and the community income (MOH and MOHA, 2005) whereas the aims of the Adipura program as mentioned in the Regulation of The State Ministry of Environment No. 01/2009 are to encourage districts/cities government and community in realizing clean and green cities through application of good governance principles in the field of environmental management (Dinamika Metropolis Tabloid, 2008a, 2008b; SMOE, 2009). Both the Healthy City program and Adipura have different policies, indicators and implementation methods and both programs tend to operate independently without any enough coordination to assess their program implementation and effectiveness. Thus, they seem to be overlapping, competing and causing confusion and they also appear to lead to inefficient use of resources.
This paper aims to compare and review the policies and existing indicators which are used by both the Healthy Cities and Adipura programs in Indonesia. Through this analysis recommendations will be made to increase the effectiveness and efficiency of resources used for the programs.
METHODS
For this study, seven dimensions will be reviewed in comparing Healthy City and Adipura in Indonesia: history, meaning of Swasti Saba and Adipura, policy documents and regulations, organizational structure, assessment, award system and budgeting. Information needed on these dimensions was obtained from the relevant sources; published research papers in particular from government documents and also an in-depth interview from the senior healthy city officer in the Ministry of Health. Information on Healthy City in Indonesia is available at the national guideline of healthy districts/cities implementation which is in the Joint Regulation between the Ministry of Health and the Ministry of Home Affairs No. 34/2005 and No. 1138/Menkes/ PB/ VIII/2005 (MOH and MOHA, 2005). This information was accessed from http://perpustakaan.depkes.go.id:8180/handle/123456789/908 in Indonesian language (bahasa). Information on Adipura can be found within the Regulation of the State Ministry of Environment No. 01/2009 on Adipura program (SMOE, 2009). It can be found at http://www.menlh.go.id/Peraturan/PERMEN/PermenLH01-2009/PermenLH01-2009+lamp1-2-3-5.pdf or http://www1.menlh.go.id/adipura/kontakkami.php. Both these sources of information were main issues. However, there are some local policies and regulations supporting them. The key words used to search data from Google and Google Scholar was “Peraturan Menteri Kesehatan Nomor 1138 tahun 2005” for healthy city and “Peraturan Menteri Lingkungan Hidup Nomor 01 tahun 2009” and “Adipura online” for Adipura. Data was presented in text and tables.
RESULTS
Each of the seven dimensions in both Healthy Cities and Adipura are analysed in this section.
History
Healthy city and Adipura have different histories. The Healthy City was developed by the Ministry of Health and the Ministry of Home Affairs following the WHO world health day theme “Healthy cities for better life” in 1996. This was the starting point for Indonesia in implementing healthy districts/cities. On 26 October 1998, in Jakarta, the Ministry of Home Affairs launched a Healthy Cities Pilot Project in 6 cities: Cianjur district, Balikpapan city, Bandar Lampung, Pekalongan, Malang, and East Jakarta. Subsequently it agreed to develop activities of healthy districts /cities especially in the field of tourism in 8 cities: Anyer Area in Serang District, Batu Raden Area in Banyumas District, Kotagede in Yogyakarta City, Brastagi Tourism Area in Karo District, Senggigi Beach Area in West Lombok District, Bunaken Beach and Coast in Manado City, Tana Toraja District and Nongsa & Marina Area in Batam (MOH and MOHA, 2005). Currently, Indonesia has developed healthy districts/cites in 216 districts/cities from 497 districts/cities in Indonesia (MOH, 2010).
However, ten years before the WHO notion of a Healthy City was conceptualised the Indonesian State Ministry of Environment recognised the Adipura Program or clean city program which focuses on improving quality of environment (N. Makarim, 2006; Nabiel Makarim, et al., 2010; Supriyadi, et al., 2000). It differs from the Healthy City where World Health Organisation has become an international umbrella in implementing such programs, while Adipura does not have any official relationship to WHO or other international agencies like WHO. Although, Adipura started to develop since 1986, Adipura ever stopped in 1998 due to Indonesian internal political crisis (reformation era). Adipura was re-launched in Bali on 5 June 2002 and continues to now. Since the time a further 59 cities have developed an Adipura program with total of 375 cities in Indonesia with an Adipura Award. That means there are 375 cities in Indonesia that have already developed Adipura program.
Meaning of Swasti Saba and Adipura
Swasti Saba is an award given to districts/cities which are successful in developing healthy districts/cities. The words “Swasti Saba” are from Sanskrit Language (Sansekerta). Swasti means healthy and prosperous and “Shaba” means city. Thus, “Swasti Saba” means healthy and prosperous city (KSB Government, 2011). There are three kinds of Swasti Saba: Swasti Saba Padapa (stabilization-basic), Swasti Saba Wiwerda (development-middle) and Swasti Saba Wistara (expansion-high). This Swasti Saba is a kind of award given by central government to districts/cities which are successful in developing healthy city. In contrast, Adipura also consists of two words: Adi and Pura. According to the Java Calender (Java is the largest island in Indonesia), Adi means having an edge in everything and a lot of new things (TetesingArt, 2011) while Pura was from Sanskrit language that has meaning as city, fortified city, towered city. According to the Indonesian Ministry of Education, officially Adipura means the most clean and beautiful cities. In bahasa it called kota yg terbersih dan terindah (MOE, 2008). Healthy City and Adipura Logo can be shown in Figure 1.
Policy Documents and Regulation
The Healthy City and Adipura have different program aims and their policy document and regulation. To achieve the healthy city aims as mentioned above there are 8 policies established by government:
1. Healthy district/city is implemented by application all health problems at district/city level gradually, began from prioritized community program at a number of sub districts at a number of villages or socially, economically and culturally business in certain areas.
2. Healthy district/city is implemented by placing community as main actors through forming or utilizing city forums or alias agreed by community and local government and getting facilities from related sectors by planned programs in the district/city.
3. Each district/city establishes potential areas as “an entry point”, is begun from simple activities, agreed community then developed in one area or wider aspect.
4. Healthy city/district implementation emphasises more process than output, runs continually, is begun from prioritised activities in one setting and achieved in a time based on community ability and all stakeholders support.
5. Agreement on selected healthy city/district settings and activities as well as types and magnitudes of its indicators are established by healthy district/city/ forums together with local government.
6. Local government facilitates selected community activities including community resources utilization needed.
7. Programs which have not become community choices are carried out regularly by each sector and gradually socialised to community and related sectors through meetings for healthy district/city forums.
8. Healthy district/city implementation is fully funded and implemented by concerned region and community with using the concept of community empowerment: from, by and for community.
While to achieve Adipura aims national government through the State Ministry of Environment establishes Adipura Program referring principles: Environmental conservation needs to obtain the strong political will; society needs to demand their right to obtain a good and healthy environment; need for effective democratic mechanisms that is sensitive to the demands of society and; governments, both at central and regional levels, need to have the ability to implement good governance in the field of environmental management or good environmental governance (Boyolali Environmental Board, 2011). The key words for healthy city are “clean, comfortable, safe and healthy districts/cities” while Adipura are clean and green districts/cities.
Although Healthy City initiatives were started in 1996 (MOH and MOHA, 2005), officially the Healthy City policy was only well documented in the guideline for the implementation of healthy districts/cities (Joint Regulation between the Ministry of Home Affairs (MOHA) and the Ministry of Health (MOH) No. 34/2005 and No. 1138/MOH/PB/VIII/2005, written in bahasa in 2005. The 2005 is even referred to as first Swasti Saba year since the guideline issued as following statement of the Healthy City Manager in the Ministry of Health:
“After issuing the Joint Regulation between the Ministry of Health and the Ministry of Home Affairs, 2005 was launched as first Swasti Saba year...”(SRHCNMOH)
Generally, the above guideline consisting of seven chapters, 19 articles and followed by two appendixes contains: general provision; healthy district/city application (community empowerment, healthy district/city forums, and the role of advisory team); healthy district/city classification and criteria; assessment; reward; development system; and budgeting. The main guideline only provides general dimensions of Healthy Districts/Cities while the Appendix provides in detail general explanation about Healthy Districts/Cities including a general description; aims and targets; policies and strategies; healthy district/city application; settings; classification and criteria; indicators; and more detail in evaluation and development system (supervising, advising, coordinating and developing capacities) and funding. Beside that, the Appendix also provide evaluation form for healthy districts/cities where this consists of three columns: evaluation variables; criteria; and scores (MOH and MOHA, 2005).
In relation to healthy district/city Act, at the national level there is no specific Act regarding healthy districts/cities. However, at a local level there is one city, Palopo City, located in South Sulawesi Province that has local Act (PERDA) on healthy city which is Palopo city. The Local Act was regulated in the regulation of Palopo Local Government No. 10/2008 (Department of Law, 2008). This city is the only city that has healthy city local Act in Indonesia (Healthy City Forum, 2009). This statement was supported in accordance with the results of an interview of one of the healthy cities program manager in the Ministry of Health, Indonesia as follows:
“I think we should follow the example of Palopo City in which Palopo City is the only city in Indonesia to date that has a local healthy city regulation (PERDA) (SRHCNMOH).
In contrast, the latest Adipura document was stipulated by the State Ministry of Environment No. 01/2009 on Adipura Program which was revision from the Regulation of The State Ministry of Environment No. 99/2006 and Regulation of The Ministry of Environment No. 14/2006. This generally covers general provision (terms definitions); Adipura application (including Adipura program officer, evaluation system, assessor team, cities classification); development system; sanction (ethical code for assessor team); funding; and final provision. Similar to Healthy Cities, there is no also specific national Act governing and managing Adipura. However, in many cities in Indonesia there is a local Act regarding city cleanness, hygiene and waste management such as Bontang Local Act No 4/2004 (Bontang Local Government, 2004); Balikpapan Local Act No. 10/2004 (Balikpapan Local Government, 2004); Sleman Local Act No. 10/2001 (Sleman Local Government, 2001) and other cities in Indonesia. A number of these regulations support much for achieving a healthy city (see Table 1).
Organizational Structure
The Healthy City Program has organisational structure at all governmental levels of Indonesia: national, provincial and districts/cities level. For example, at the national level, Healthy City is handled by two ministries: the Ministry of Home Affairs and the Ministry of Health. Healthy city in the Ministry of Home Affairs is organised by the Directorate General Regional Development while at the Ministry of Health is organised by the General Disease Control and Environmental Health. These two departments have different functions. The Ministry of Health implements and facilitates the Healthy City Program related to health while the Ministry of Home Affairs supports, encourages, commands other departments to contribute to healthy city achievement. Further, at the provincial and district/city level, healthy city is organised by the Regional Development Planning Board and the health office. The role of the Ministry of Home Affairs and Regional Development Planning Board at both a provincial and district/city level is crucial as identified by one of the informants:
“The role of the Ministry of Home Affairs is very…very….to synergize the relevant ministries in the implementation of healthy city program. If a letter from the Director General Diseases Control and Environmental Health it only worked in health department and did not work in other departments such as the Department of Public Works, Department of Environment and other departments. The healthy city has so many settings so that Regional Development in the Ministry of Home Affairs need to be involved (SRHCNMOH).
In contrast, according to the regulation of the State Ministry of Environment No. 01/2009 Adipura does not have any organisational structure at provincial and districts/cities level. The organisational structure of Adipura is only at the national level. However, to help with program implementation, the State Ministry of Environment has divided Indonesia into some regions according to the Environmental Management Centre: Regional office for Sumatera region in Pekanbaru, Riau; Regional office for Bali and Sout East Nusa in Denpasar, Bali; Regional office for Java region in Condong Catur, East Depok and Sleman, Jogjakarta; Regional office for Sulawesi, Maluku and Papua (SUMAPAPUA) in Makassar; and Regional office for Kalimantan in Balikpapan. A summary table can be seen in Table 2.
Evaluation
Evaluation is an important part in health management functions. Evaluation is a multipart process that aims to assess to what extent programs planned have been achieved or met. It includes to assess the level of achievements, the degree of success and to identify a variety of challenges influencing program achievements (Chu, 2009; Dwyer, Stanton, & Thiessen, 2004; Timmreck, 1995). In relation to Healthy City and Adipura, they have some differences in assessment or evaluation system. For instance they differ in the assessment period, choice of indicators, categories, and who assessor team will be. Healthy City evaluation is generally carried out in June, July or August every two years. There is no specific period of assessment like a month, a semester, or a year. This differs from the Adipura assessment system which is conducted from July in the running year up to June next year so that the assessment period runs for around one year.
There are three kinds of indicators evaluated in Healthy City: main indicators; general indicators and specific indicators. The main indicators include 9- year compulsory education, literacy rate, and domestic income per capita, Infant Mortality Rate (IMR) per 1000 live births. Furthermore, the general indicators include the availability of local government support, functioning of the district/city forums; village communication forums, and village working groups. Then, the specific indicators are based on the selected settings, for example city A selected setting “healthy settlement areas and public facilities”, it needs to meet the established indicators for instance clean water, clean river water, individual and public water supply, water disposal, waste management, housing and settlement, gardening and city forest, schools and market management. Also others settings such as traffic facilities areas and transportation services; healthy mining areas; healthy forestry areas and so forth have each indicators.
Unlike Healthy City program, Adipura divided cities into four types according to size of population or other natures as a city: metropolitan, large cities, medium cities and small cities (Siswanto, 2003). There are two aspects assessed in Adipura program: physical assessment and non-physical assessment. Physical assessment consists of two types: obligatory assessment and non-obligatory assessment. The obligatory assessment includes settlements areas, urban facilities such as market, school, office, hospital and park also sanitation facilities (waste management) while the non-obligatory assessment includes transportation facilities and tourist beach. Further, non physical assessment consists of three aspects: institution, management and responsiveness. Institution aspects assessed include the availability of law, policy products, budgets and facilities. Management aspects include planning, implementation and controlling, and responsiveness aspects include community participation. A number of indicators as mentioned above are also important indicators for Healthy City especially in the setting of “healthy settlement areas and public facilities”. This setting is handled by Department of Public Works and Regional Environmental Impact Control Board and not the State Department of Environment.
There is a difference in the evaluation step relating to who will assess the districts/cities. Healthy City is divided into two steps: provincial level and national level. For the provincial level, first step is provincial government selects and determines which districts/cities will be evaluated as healthy districts/cities. This assessment is conducted by provincial advisory team on behalf of Governor. This team consists of the provincial government and related institutions representatives such as Provincial Regional Development Planning Board, Health Office, Hasanuddin University. Results of the healthy districts/cities assessment by the provincial team will be submitted by Governor to the Ministry of Health and copy to the Ministry of Home Affairs to be further evaluated by national level. Central Assessor Team consists of representatives from the Ministry of Health and the Ministry of Home Affairs and related ministries.
Unlike Healthy City, Adipura evaluation system does not divide stages according to governmental level. Adipura directly evaluates those districts/cities whether metropolitan; large cities; medium cities; or small cities. The State Ministry of Environment representatives appointed by the State Ministry of Environment and provincial representatives appointed by the governor will evaluate those districts/cities. Provincial assessor team members consist of provincial environmental institutions, universities, mass media, NGOs, agencies or board representatives stipulated by Governor Decree. Adipura guideline explains more detail on assessor team while Healthy Cities assessor team only explain in general. Summary table comparing is shown in Table 3.
Award system
An award system for Healthy City is identified in detail in the Joint Regulation between the Ministry of Home Affairs and the Ministry of Health. It includes an award name, categories, year to give an award, by whom, moment, and type of an award. Name of a healthy city award is Swasti Saba. A Swasti Saba is an award given by central government to community through Regent(s)/City Mayor(s) who are successful in implementing healthy city. There are three levels of Swasti Saba: Swasti Saba Padapa (basic achievement); Swasti Saba Wiwerda (middle achievement), and Swasti Saba Wistara (high/good achievement). All cities/districts that meet indicators/requirements established as mentioned before and based on the results of joint decision between the Ministry of Health and the Ministry of Home Affairs would are invited by central government to receive an award (certificate) in November every two years in commemoration of National Health Day. The award is given by the Indonesian President, or can be Vice Precident or The Ministry of Health on behalf of central government. In contrast, Adipura also has a different award system in giving an award. There are three categories of Adipura award according to the level of city cleanliness: Anugerah Adipura (high); Piagam Adipura (middle) and Plakat Adipura (basic). These awards are given every year and usually by Indonesian President in commemoration of Environmental Day (Table 4 for summary).
Budgeting
Healthy City budgeting is based on the purposes, sources and types of activities. It is divided into three kinds of purposes: operational funding, general assistance and technical assistance. The operational funding is charged to the Revenue and Expenditure Budget of Districts/Cities (APBD) in accordance with the selected settings such as Healthy settlement areas and public facilities; traffic facilities areas and transportation services; healthy mining areas; healthy forestry areas; healthy industry and office areas; healthy tourism areas; food security and nutrition; healthy self-reliance community life; and healthy social life. Further, activities relating to the general guidance, the budget are charged to the State Revenue and Expenditure Budget of Department of Home Affairs, the Provincials and Districts/Cities Revenue and Expenditure Budge while technical assistance is charged to the State Revenue and Expenditure Budget of Department of Health, the Provincials and Districts/Cities Revenue and Expenditure Budget.
In contrast, the Adipura program focuses more on environmental, it does not explain implicitly and in detail regarding the purposes of the budget. Budgeting for Adipura is also from the State Revenue and Expenditure; the Provincial Revenue and Expenditure the Districts/Cities Revenue and Expenditure Budget or other sources accordance with stipulated constitutions. Therefore, both healthy districts/cities and Adipura budgeting are from the central government allocated in the State Revenue and Expenditure Budget (APBN) either by the Ministry of Health, the Ministry of Home Affairs, the State Ministry of Environment or other related ministries; the Provincial Revenue and Expenditure Budget (APBD); the Districts/Cities Revenue and Expenditure Budget (APBD) or other sources stipulated by constitutions or regulation (see Table 5 for summary).
DISCUSSION
Healthy City and Adipura are two national policies that have been developed in Indonesia by different ministries to achieve safe, comfortable and clean cities. The Healthy City is developed by the Ministry of Health and the Ministry of Home Affairs (MOH and MOHA, 2005). Joint regulation between these ministries provides the policy umbrella for healthy city to achieve a healthier environment whilst Adipura program is developed by the State Ministry of Environment. The Adipura program which focuses on environmental and hygiene aspects aims to achieve clean and green cities as a major component for achieving a healthy city. Both these programs are implemented across Indonesia. However, Adipura seems more awareness than Healthy City in particular at local government level. Almost every department and agency or group of people knows about Adipura while still many people and departments or agencies do not know about the Healthy City Program.
Even though Healthy City and Adipura have run well, as policies they still have weaknesses. Healthy city and Adipura concept need to complement each other because Healthy City concept may have strong points that are useful for Adipura program for example the existence of Joint Regulation between the Ministry of Health and the Ministry of Environment. Conversely, Adipura program may also have points that are useful for Healthy City for example evaluation system. Therefore regulation, assessment/evaluation systems between two these policies/programs need to be discussed further because these are important to achieve a better environment.
Regulation: Healthy City policy at the national level is regulated jointly between the Ministry of Health and the Ministry of Home Affairs. This is a strong point for healthy city implementation. Healthy city concept is developed based on settings: healthy settlement areas and general facilities; traffic facilities areas and transportation services; healthy mining areas; healthy forestry areas; healthy industry and office areas; healthy tourism areas; food and nutrition security; self-reliance healthy community life; and healthy social life (MOH and MOHA, 2005).
However, selected settings in local government are based on the local needs and specific conditions. Based on the regulation only one setting which is responsible of the Ministry of Health as a leading sector which is self-reliance healthy community life while others are handled by different departments or offices for example leading sector for healthy settlement areas and general facilities is Department of Public Works/Regional Environmental Impact Control Board; traffic facilities areas and transportation services is Department of Transportation/City Land Transportation Agency (DLLAJR); healthy mining areas is Department of Mining; healthy forestry areas is Department of Forestry; healthy industry and office areas is Department of Industry and Trade ; healthy tourism areas is Department of Tourism; food and nutrition security is Department of Agriculture; and healthy social life is Department of Social Affairs/People Welfare. All settings handled by departments and offices as mentioned above work under the Ministry of Home Affairs. Therefore, the roles of the Ministry of Home Affairs are crucial. The Ministry of Home Affairs has strong power to encourage and empower other department/ministries/offices.
In relation to Adipura program, the State Ministry of Environment does not include in the Healthy City Policy although many programs developed by those departments relate to Adipura achievements such as Department of Public Works and Regional Environmental Impact Control Board. The Adipura policy runs alone according to the State Ministry of Environment Regulation No. 01/2009. Even though the State Ministry of Environment Regulation does not explain implicitly the relationship between the Ministry of Home Affairs and the State Ministry of Environment and Adipura seems to run alone, the State Ministry of Environment still needs to build coordination with the Ministry of Home Affairs especially when giving reward/award for cities which qualify and meet the established requirements as clean cities. This is not regulated in this regulation. However, the State Ministry of Environment must cooperate with the Ministry of Home Affairs as a part of government system.
Assessment concept: Officially healthy city assessment does not divide cities based on the size of the city or population but settings selected according to local needs agreed by local government and community through healthy cities forums (MOH and MOHA, 2005). This differs from the Adipura program. The State Ministry of Environment developed Adipura program as a national ministry program according to the population scale of the cities: metropolitan; large city, middle city and small city. Metropolitan if > 1,000,000 population; large city if 500,000-1,000,000 population; middle city if 100,001-500,000 population and small city if 20,000-100,000 population (Dinamika Metropolis Tabloid, 2008b; SMOE, 2009). Such mechanism is useful for government and other decision makers especially local government because each city has different severity and magnitude level of the problems and also resources and political will support from local government. The metropolitan city is more complex and harder to be managed than small city that only has < 100,000 population. Such Adipura classification may be useful for Healthy City Policy in Indonesia. That means it needs to consider settings chosen and population and city size.
Furthermore, Adipura has more accurate assessment system to evaluate whether those cities are feasible to obtain an Adipura award or not because Adipura uses period of time of assessment which is from June in the running year up to June next year. Assessor team from the State Ministry of Environment and the provincial representatives will evaluate the physical and non physical achievement of the Adipura program. It differs from Healthy City concept, in that the evaluation is carried out only once and hence the assessor team does not know to what extent cities cleanliness before and after assessment. Cities can be dirty again after evaluation or assessment process that means cities cleanliness only exists when national assessor team is willing to evaluate the cities. Therefore, merge method can be useful for Healthy City assessment.
Regarding the assessor team, it is clearly and explicitly mentioned in the Adipura regulation that the assessor consists of the State Ministry of Environment representative appointed by the State Ministry of Environment and provincial representative appointed by governor. The assessor team representations from the provincial level includes environmental institutions, universities, mass media, NGOs, agencies or boards stipulated by the governor. Adipura assessor team as stipulated by the regulation is more representative and follow governance principles because the Adipura assessors come from different elements such as government representatives, universities representatives and NGOs. In contrast, healthy city assessment did not explain more details about healthy cities assessors. Article (8) chapter assessment mentioned “Assessment/evaluation of healthy districts/cities implementation referred to article (7) is carried out by central assessor team consisting of Department of Health representatives; Department of Home Affairs and relevant departments’ representatives”.
CONCLUSION
Healthy City and Adipura have similar goals in addressing urban problems especially environmental aspects, but they have different agendas and performance indicators and different stakeholders operating them. Healthy City indicators are very complicated and broad: main indicators, general indicators, and specific indicators by settings, but they really do not emphasise the essential problems of the urban environments such as hygiene and sanitation. By contrast, Adipura indicators are quite simple but they do not really cover social problems further and other determinants of health. Both programs have similarities in particular in the setting of Healthy Settlement Areas and Public Facilities. The existence of the Joint Regulation between the Ministry of Health and the Ministry of Environment and organisational structure at all levels of government system are to be strong point for Healthy City while assessment system carried by Adipura is to be a point for Adipura. However, Adipura is more awareness than Healthy City especially at local government level. Therefore, in order to create a healthier environment and to improve the effective and efficient use of resources, building partnership and working together among the Ministry of Health, the Ministry of Home Affairs and the State Ministry of Environment should be strengthened.
AKNOWLEDMENT
This paper work has been presented on the 4th Global Conference Alliance for Healthy Cities in Seoul South Korea on 26-29 October, 2010. Therefore, I would like to thank to the conference committee who has provided a great opportunity to present this paper as well as travelling grant. My thanks also go to the Ministry of Education, Indonesia who has given me a chance to undertake PhD Program at The Centre for Environment and Population Health, Griffith University, Australia.
REFERENCES
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KSB Government. (2011). West Sumbawa District (KSB) achieved an award in the field of health (KSB Raih Penghargaan di Bidang Kesehatan) Retrieved 16 August, 2011, from http://sumbawabaratkab.go.id/ksbfitrah/index.php?option=com_content&task=view&id=127
TetesingArt. (2011, 16 August). Java floods in 2011 (Jawa banjir di tahun 2011). Retrieved from http://tetesingart.yolasite.com/variousnews/kalender-jawa
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Table 1: Comparison of Healthy Cities and Adipura policy document and regulation in Indonesia
| Policy Document and Regulation | Healthy City | Adipura |
| · Title | Guidelines for the implementation of healthy districts/cities (joint regulation between the Ministry of Home Affairs (MOHA) and the Ministry of Health (MOH) No. 34/2005 and No. 1138/Menkes/ PB/ VIII/2005 | State Ministry of Environment No. 01/2009 on Adipura Program |
| · Year | 2005 | 2009 |
| · Corporate Author (s) | MOH and MOHA | State Ministry of Environment (SMOE) |
| · Language | Bahasa | Bahasa |
| · Publisher | MOH and MOHA | SOME |
| · Publisher place | Jakarta | Jakarta |
| · Physical description | 69 pages (2 pages for title and table of content; 8 main pages; 38 pages for Appendix I and 21 pages for Appendix II), A4 | 62 pages, 5 appendixes, A4 |
| · Status of document | Guideline | Guideline |
| Act | · There is no a national healthy district/city Act · Palopo City has a local Act (Perda) of healthy city | · There is no a national Adipura Act · Many cities have a local Act regarding cleanliness and waste management |
Table 2: Organizational structure comparison of Healthy Cities and Adipura in Indonesia
| Organizational Structure | Healthy City | Adipura |
| National level | · MOH: Directorate General Disease Control and Environmental Sanitation · MOHA: Directorate General Regional Development | State Ministry of Environment |
| Regional/provincial level | · Regional Development Planning Board · Provincial Health Office | Divided into five regions: Sumatera; Bali and South East Nusa; Java; Sumapapua and Kalimantan |
Table 3: Assessment system comparison of Healthy Cities and Adipura in Indonesia
| Assessment System | Healthy City | Adipura |
| Assessment period | There is no a specific period of time like a month, a semester, or a year | From July in the running year up to June next year (1 year) |
| Evaluated indicators | Three indicators: main indicators; general indicators and specific indicators | Physical assessment and non physical assessment |
| Categories | There is no a specific city classification | Metropolitan, large cities, medium cities, and small cities |
| By whom | Provincial level · Selection is conducted by provincial advisory team on behalf of Governor · Provincial advisory team consists of the provincial government and related institutions representatives National level · Assessment is conducted by Central Assessor Team that its members consist of representatives from the MOH, MOHA and related ministries | · State Ministry of Environment representatives pointed by the State Ministry of Environment and · Provincial representatives pointed by governor consisting of representation from provincial environmental institutions, universities, mass media, NGOs, agencies or boards stipulated by governor |
Table 4: An award system comparison of Healthy Cities and Adipura in Indonesia
| Award system | Healthy City | Adipura |
| An award name | Swasti Saba | Adipura |
| Categories | Padapa (basic), Wiwerda (middle) Wistara (good/best) | Anugerah Adipura, Piagam Adipura and Plakat Adipura |
| Giving an award | Every 2 years | Every year |
| By whom | Central government (can be a president, vice president and MOH on behalf of government) | President |
| When | November in commemoration of National Health Day | in commemoration of Environmental Day |
| Type of an award | a certificate | Gift, certificate, placard |
Table 5: Comparison of Healthy Cities and Adipura budgeting in Indonesia
| Budgeting | Healthy Cities | Adipura |
| Purposes | · Operational funding · General assistance · Technical assistance | There is no specific explanation |
| Source | · The Revenue and Expenditure Budget of Districts/Cities (APBD) for operational funding · The State Revenue and Expenditure Budget (APBN) of Department of Home Affairs, the Provincial and District/City Revenue and Expenditure Budget (APBD) for general guidance · APBN of the Department of Health, the Provincial and District/City Revenue and Expenditure Budget for technical assistance | · APBN; the Provincial District/City APBD · Other sources |
| Types of activities | Depends on the selected settings | There is no specific explanation |
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