Collaborative Governance in Improving Health Services in Bangka Tengah Regency

Abstract

This study examines collaborative governance to improve access and quality of health services in Central Bangka Regency, Bangka Belitung Islands. Despite constitutional guarantees and the JKN program, delivery remains uneven: several subdistricts lack hospitals, only one inpatient-capable puskesmas operates, health-worker ratios lag standards (e.g., 0.34 GPs per 1,000 vs 1.0), BPJS outpatient use fell from 40.99% (2023) to 26.45% (2024), and non-government participation is limited. These gaps and a research deficit on inter-actor dynamics motivate the study. The study applies Ansell and Gash’s (2008) Collaborative Governance framework (Starting Conditions, Collaborative Process, Facilitative Leadership, Institutional Design, and Outcomes) and refines it by elevating “shared mutual understanding” as an antecedent shaping direction. A qualitative design was used with purposive sampling of competent and authorized stakeholders. Data were collected through semi-structured interviews, non-participant observation, and document review. Analysis followed Miles and Huberman’s stages (collection, reduction, and verification). Credibility was strengthened through triangulation of sources and methods, cross-checks with partner agencies, and the researcher’s participation. Findings show a broad partnership ecosystem (local agencies, NGOs/CSOs, private sector, academia, communities/patients, and BPJS), yet collaboration remains suboptimal. Starting conditions feature resource asymmetries and a reactive stance; the process is constrained by reluctance to share data, low trust, and bilateral rather than multi-directional communication. Facilitative leadership and institutional design are underspecified, yielding output-oriented performance. Recommendations include secure IT-based data-sharing, multi-directional communication, periodic monitoring, evaluation, learning cycles, stronger leadership across the collaboration via liaison officers, and a standing coordination forum. The model adds “shared mutual understanding” and direct effects from leadership and institutional design to starting conditions and outcomes.