INTER-AGENCY NETWORKS AND COORDINATION IN PUBLIC HEALTH SERVICE DELIVERY: A CASE STUDY OF JENEPONTO REGENCY, INDONESIA

Abstract

Inter-agency networks represent critical infrastructure for delivering integrated, responsive healthcare services, yet their effectiveness in resource-constrained settings remains poorly understood. This study examines network coordination mechanisms, access expansion strategies, and innovation capacity within a district healthcare system experiencing declining service quality. Through qualitative case study methodology involving in-depth interviews with seven key informants representing health administration, hospital management, and primary care leadership, supplemented by community satisfaction data and policy document analysis, this research investigates how inter-organizational relationships influence healthcare delivery outcomes. Findings reveal significant gaps between formal coordination structures and operational effectiveness across three network dimensions. First, despite extensive coordination frameworks including quarterly cross-sectoral meetings and monthly facility-level forums, coordination functions predominantly as formalistic reporting rather than substantive problem-solving, resulting in fragmented service delivery and information system incompatibilities. Second, although geographic coverage spans 12 community health centers, 45 sub-centers, and 195 integrated health posts, access remains inequitable due to transportation barriers, financial constraints, and cultural exclusion disproportionately affecting remote and vulnerable populations. Third, innovation initiatives remain localized pilots lacking systematic knowledge exchange mechanisms, evaluation frameworks, and scaling pathways that would enable collective learning and adaptive improvement. The documented 4.13-point decline in community satisfaction from 2023 to 2024, with particularly sharp deteriorations in service time and complaint handling, substantiates inadequate translation of coordination efforts into service quality improvements. Strengthening healthcare networks requires fundamental transformation prioritizing relational quality, inclusive engagement mechanisms, collaborative capacity development, and systematic learning infrastructures rather than merely establishing formal coordination structures. These findings contribute empirical evidence on network governance implementation challenges in decentralized health systems, offering insights for policy-makers seeking to enhance inter-organizational collaboration effectiveness.