Acta Tropica, 57(1994)211 227 211

ACTROP 00393

Institutional constraints to building social science capability in public health research: a case study

from Indonesia

Terence H. Hul l*

Pusat Penelitian Kesehatan (Health Research Center) and School of Public Health, Research Institute, University of lndonesia, Depok Campus, Depok, Jabar, 16424, Indonesia

The promotion of social sciences capabilities in public health research in universities frequently encounters unexpected barriers. This paper argues that, in Indonesia, historic factors and institutional structures of public health research have created constraints to success in public health research and international technical assistance. Donors are often frustrated by apparent inconsistencies between agreed intentions and the subsequent behaviour of recipient colleagues, thus resulting in poor relations and failure of collaborative links. For social sciences to be integrated into public health research, assistance is needed in graduate education, library development, computerisation, and research methodology. Contributions in these areas may be ineffectual if they are not preceded or accompanied by efforts by recipients to reform or circumvent existing institutional weaknesses. Some important barriers to the development of research capabilities in Indonesia are beyond the control of individual faculties of public health, or even universities, and are affected by regulations and budgeting procedures of the National Department of Education and Culture, or the civil service administration. There are, however, changes that can be made at faculty or university level to encourage a more productive 'research culture' and promote linkages between the social and health sciences.

Key words: Health social science; Indonesia; Medical education; Technical assistance

Introduction

Indonesia has a long history of health related research, both in the clinical setting and in the community. Under Dutch colonial rule, medical schools were established in Batavia (now Jakarta) and Surabaya, and major research institutes related to pharmacology and nutrition were built in Bandung and East Java. Staff were oriented to both the potential to contribute to international scientific literature, and the need to address issues of relevance to the health problems of both the colonising and native populations. The Netherlands East Indies was the location for the discovery of vitamins, development of an effective live plague vaccine, and successful hygiene education projects. Dutch and Indonesian researchers achieved international recogni- tion in work on malaria, tuberculosis and filariasis. Persistent campaigns for indige- nous public health workers at village level, recorded in a series of publications in the 1930s and 1940s by Dr John Hydrick of the Rockefeller Foundation, were

*Corresponding author. Tel.: 62-21-727-0154. Fax: 62-21-727-0153. Home Tel.: 62~1-769-1576.

SSDI 0001-706X(94)00028-Y

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inspirations for the Chinese 'barefoot doctors'. These initiatives ultimately resulted in the development of the World Health Organisation model of Primary Health Care.

The high level of institutional quality earlier this century is reflected in comments by Dr Victor Heiser of the Rockefeller Foundation in 1915 that the Batavia medical school 'contains all the laboratory facilities required by Class A colleges in the United States. The laboratories appear unusually well equipped with modern appara- tus'. The low level of institutional quantity, however, resulted in remarks by interna- tional visitors who saw the two medical schools and a handful of laboratories as being inadequate to address the health needs of millions of Indonesians inhabiting the huge and varied archipelago.

Heiser and Hydrick challenged the Dutch to do more to educate Indonesian people in healthy habits, while De Haas and other radical socialist Dutch doctors called for thoroughgoing political and social reforms. Both streams of thought encouraged young Indonesian doctors to be concerned with and work for the common Indonesian people, as was recorded by Indonesian novelist Pramoedya Ananta Toer in 'Jejak Langkah' (Footsteps) (1985).

The Dutch medical research establishment was aware of the need to understand cultural factors in disease prevention and cure, although this awareness often led individual researchers to opposite conclusions. Indonesian people were sometimes seen as the ignorant 'vectors' of illness who needed to be controlled and contained by a strong authoritarian health system. Arguments were also developing about the need to understand disease from the patient's viewpoint, so that a health system could develop interventions which educated people into more healthy lifestyles. Both of these approaches viewed culture as the basis of poor health, but one system sought to control while the other sought to change that base.

Tensions between authoritarian and educative approaches to health care were a part of medical education and research agendas of successive generations of Indonesian doctors and their foreign advisers. These different approaches to health care shaped campaigns such as the fight against plague in the period 1910-1939, and efforts to reduce fertility in the family planning program begun in 1968 (see Hull, 1987, 1989). This historical setting produced a medical establishment with a high sense of social duty, and a perception that cultural and social factors are important determinants of disease and health and warrant special attention. This is important for people seeking to promote social sciences in public health research today. These characteristics are documented in doctors' autobiographies and in histories of medicine written by Indonesians who lived through the evolution of health care from the colonial times to Independence. The first generations of Indonesian doctors carried these values with them into the classroom and the field. Indonesian universities have seen medicine as closely linked to political and social imperatives, and have thus been responsive to suggestions that clinical initia- tives need to be placed in an appropriate social perspective.

The growth of the role of government in health care in Indonesia over the last century paralleled that of the industrialised countries of Europe. Rosen characterised the development of the European welfare state approach to health services as 'the continuous and progressive replacement of smaller units by larger ones' in the quest for greater efficiency, and in the process 'developments have necessarily led to the widespread acceptance of the need for a strong central authority entrusted with large powers to promote social well-being' (1968). Whether an authoritarian or

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educative approach to health care, the responsibility was in the hands of an increas- ingly centralized government administration.

In Indonesia under the Dutch and the Japanese the central government served colonial goals. Even with independence, imperatives of national unity continued to promote a strong central form of governance to promote health, education, and economic development. To Rosen, such changes in the rationalisation and bureau- cratisation of health services 'explains in part why in our time the social sciences have become an increasingly important element in public health' (1968). Another view is that the social sciences are tools to obtain compliance to centrally determined behavioural changes in contradiction to popular desires. A more radical critique might see the social sciences as providing a forum for democratic and liberating reports of the people's demands. However interpreted, these perspectives provided widely accepted justification for the inclusion of social science (and sometimes the participation of social scientists) in health research and program development. The emphasis on community health outreach in the community health centre system (PUSKESMAS) and neighbourhood integrated service posts (POSYANDU) are evidence of the commitment of medical leaders to social development of health care.

Attempts to integrate the social sciences into medical and public health education, and efforts to promote research capabilities in these fields, have encountered institu- tional constraints. This paper explores these issues and argues that the problems faced by researchers attempting to integrate social and health sciences lie less with problems of inappropriate 'research paradigms' than with structural barriers to research in general in the Indonesian university system. Problems identified in this paper primarily exist in state universities, and tend to be more intractable in larger, older institutions. Generalisations are based examining two institutions: the University of Indonesia and Gadjah Mada University. Both universities have attempted to promote social science perspectives in public health teaching and research, and both have produced valuable public health research. Both also have talented individuals who conduct international research activities. The argument presented in this paper is not that good research is impossible, or that talent doesn't succeed in the Indonesian university system. This paper identifies some basic con- straints which inhibit the university system from producing good research and nurturing successful researchers on a larger scale. Suggestions are made for reform of the university system to help construct a more productive and internationally oriented research culture, integrate the social and health sciences, and promote full range of scientific research in universities.

The institutional dimensions of public health research in Indonesian universities

Public health research activities are found in many positions within university structures resulting in a wide variety of research potential and experience. There are four major structures in which public health is established as a discipline: 1. Faculties of Public Health are established and routinely funded in five state

universities. 2. Faculties of Public Health or Medicine have the potential to establish research

units or programs within their structures. 3. All state universities have Research Institutes (Lembaga Penelitian) administered

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by the Rector (head) of the university, and capable of maintaining a number of centrally defined Research Centres.

4. Faculties of Medicine in state universities maintain departments (jurusan) of public health, or include public health courses in departments of community medicine or epidemiology. Each of these structural settings has a different potential for establishing sustain-

able research activities. Faculties have large professional and administrative staff structures, which provide

undergraduate and graduate training. All universities share a commitment to teach- ing, research and community service as part of their government established mandate (the Tridharma Perguruan Tinggi), and have regular programs of action research and community development, containing some form of health-related activity, organ- ised through Faculties of Public Health or Medicine. While unlikely to be sophisti- cated, such activities are broadly regarded as public health action research. Faculties also routinely receive development budget funds from the Department of Education and Culture, and are eligible for regular research funds managed by the university. Staff members of faculties can therefore be attached to research projects either through their departments (jurusan), through a research unit or program, or through an ad hoc group set up to carry out a contract research or action research project within the faculty or in public health units in other faculties.

Special research units set up within faculties generally have only limited access to routine funding and virtually no access to government development budget funds. They are sustainable only to the extent that they can generate outside funding for activities, or utilize faculty facilities such as rooms, electricity, telephones and staff services on the decision of the dean. At the School of Public Health of the University of Indonesia (UI) the Center for Child Survival was established in this way, though in structural terms it is also linked to the Research Institute. It is sustained through contracts for managing longitudinal field research, undertaking data entry or analysis, and through occasional short courses for fee or on contract.

Units attached to university level research institutes are theoretically eligible to receive routine funding for staff, but are required to seek additional funding for field research activities. At UI the Research Institute consists of five interdisciplinary research centres, including a Center for Health Research with staff from a variety of fields including anthropology, law, medicine, and sociology. The Center is primar- ily a public health research facility. None of the five centres at UI receive routine budgets for staff, though they are provided with rooms and ancillary utilities. Staff maintain their activities through contract research projects, running routine short courses (e.g. on computer software), and through other contract activities with government departments or foreign donors.

Public health research activities in smaller state universities tend to depend on the interest and commitment of individuals in a Faculty of Medicine. By and large field activities in these institutions tend to be organised through the university Community Development Institute, and consist of surveys of poor communities, and the organisa- tion of health services such as vaccination or family planning (carried out by senior medical students). Data may be collected during such outreach activities, but are seldom of sufficient scope, quality or interest to justify publication. Research papers are sometimes printed in a local journal to satisfy the need to demonstrate 'research' capabilities.

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Private universities are unlikely to have Faculties of Medicine or departments of public health. Those with medical schools, like their government counterparts, take community health issues and activities seriously. With a few notable exceptions (such as Jakarta's Atma Jaya, Taruma Negara and Trisakti Universities or the Sultan Agung University in Semarang), funding of staff and public health research in private universities is minimal.

Public and private Indonesian universities share some common structural charac- teristics. They tend to be organised with strong faculties and weak central administra- tions. In the largest and oldest universities the power of faculties has been compared to feudal baronies. The University of Indonesia was founded by combining a number of independent faculties, in the course of which faculty autonomy was codified in both the constitution and the working procedures of the institution. As other state universities were formed, graduates and staff from UI and UGM were relied upon to fill positions. In this way the general pattern of strong faculties was repeated throughout the national system.

The University Senate is a powerful institution where senior staff of faculties reinforce their status quo positions through consistent actions by alliances and lobbies to control the central administration. Irrespective of desires to consolidate libraries, establish better interdisciplinary links or eliminate duplication of programs, projects or staffing, the faculties through the senate has sufficient power to inhibit changes.

The central administration has important powers as a 'gatekeeper', linking faculties to the Department of Education and Culture, so it has some power to rein in the most obvious excesses of faculties. However, it tends to lack the power and budget to build central academic institutions such as libraries, computer centres and commu- nal facilities like restaurants, bookstores or student unions. In administering of scholarships, research funds, and other budgetary decisions, the central administra- tion must balance the demands of large, influential faculties against those of smaller faculties yearning to become large. Both practical politics and community ethical perceptions call for central administrators to be 'fair' in their decision-making, but this is a matter for interpretation.

Library resources for social sciences and health

Foreign visitors are immediately struck by a number of consequences of the balancing of central and faculty powers. At UI a glaring example of the lack of central university facilities is the four storey central library which has rows and rows of bookshelves but no books. People joke about it as a 'haunted' library which most staff and students have never visited, much less used. Budgets for book acquisitions and journal subscriptions are held by faculties, each of which sets aside some space in their building for a small collection and a reading room. Sometimes smaller units like departments or research centres also maintain small collections obtained through gifts, exchanges, and purchases when the opportunity arises.

It seems the UI library system lets everybody down. The central library staff devote their time to piecemeal journal acquisitions under project funding, and thinking about the possibility of an on-line 'union' catalogue of the university's scattered collection. In describing this plan some of the more enthusiastic Deans

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talk of the central library as a hive of computer terminals, linked by landline to the faculty collections. Users could scan the entire university collection, and perhaps other national or international collections, to locate important monographs or journals. Technology would enable users to see if a volume was available or not; the volume could be sent over to the central library building, where any authorised user could either read it, copy the abstract or borrow the volume. The irony is that these dreams of easy access are unlikely to be realised through the installation of a computer network since barriers to using the material now are not technological, but bureaucratic and psychological. The plan is also based on the assumption that funds would be available to move large numbers of volumes around the campuses, but doesn't raise the question of the time and labour required for such a service. The central library currently is moribund, with only minor developments of a small general reading collection, a few shelves of reference books and selected journals, and the 'legal documentation' and 'sino-japanese' collections to attract users.

Faculty librarians may have a large collection of books and journals, but they are not happy with the situation. They face the space constraints, and the lack of budget security, resulting in lapses on journal subscriptions and chronic inability to keep up with a broad program of acquisitions requested by academic staff. Students find the 'closed stacks' of the faculties difficult to use, and are frustrated when the books they need are 'gone but not out' because stacks are depleted by staff members who fail to return overdue volumes and librarians lack the power to enforce library rules. In considering the need for either public health students to read social science literature, or social scientists to have access to medical journals and monographs, the fragmented library system has tended to encourage a number of faculty collec- tions to duplicate holdings and subscriptions even though their very limited budgets result in a collective failure to obtain a broad collection of important research materials.

Public health research at UI faces other difficulties related to library resources. While the Faculty of Public Health library claims 387 journal titles and 17,000 monographs, the holdings are incomplete. Some journals have only a few issues, and others are missing volumes due to lapsed subscriptions. Many monographs are of little relevance to the faculty teaching and research priorities, while important titles have not been purchased due to lack of funds or uncertainty as to how to place an order. Teaching programs are in Bahasa Indonesia and the bulk of the collection is in English, while many Bahasa Indonesia titles of historical interest have not been acquired.

These comments, based on specific examination of the public health content of the collection, are of relevance when considering the development of a social science research collection for students of the Faculty of Public Health. Journals such as Social Science and Medicine, Journal of Biosocial Science and Population Studies are found in the new acquisitions rack and are regularly skimmed by library users. Journals of cognate fields of anthropology, sociology, political science, economics, demography, and statistics are beyond the grasp of the students. It is too expensive for the Faculty of Public Health to purchase the full range of relevant social science journals. Journals with key articles on issues related to social science and health will be held in other faculty collections on the Depok campus of UI or in libraries in the old city campus. Teachers wanting senior undergraduate or graduate students to immerse themselves in the anthropology of health, issues of demographic

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transition, or new perspectives on community diagnosis, will either need to provide photocopies, or send students to faculty and centre libraries.

UI students, conforming to the culture of their faculties, are clannish, and are seldom prepared to walk fifteen or twenty minutes to another faculty, or thirty minutes by train to the city, to use a library. Those who do, face a closed shelf system, and the bureaucracy of becoming a visiting member of the library of the other faculty. To give an example of what this can entail, a Public Health student wishing to use the Faculty of Economics library must present a letter from the Dean of Public Health, a copy of their current semester course listing (kartu rencana studi semester), a passport photo, a Rp 1000 tax stamp and pay Rp 5000 per semester as a membership fee.

Faculty library administrations are open only from 8 am till noon, and from 1 to 3 pm, which is coincidentally also the time when most undergraduate and graduate classes are held. In some cases the reading rooms stay open until the early evening hours, but this, as with all policies related to the running of the libraries, depends on the decisions of the Dean and the budget available from the Faculty. Rules and practices vary widely across the eleven libraries in the University. One highly moti- vated ex-student commented recently that in her trips to other libraries looking for material for her dissertation she always 'felt like an alien visiting another planet'. For the health researcher seeking social science materials this means a visit to a number of 'planets': Economics, Medicine, Demography, Sociology and Political Science, Psychology, and Arts. Most students and staff lack the motivation to make such visits.

Despite their academic qualificatons, graduates hired by faculties and research units are therefore rarely familiar with literature on the topics of the unit's research projects. They have never 'browsed the stacks' or tracked down a chain of citations behind a key theoretical article. Lecturers present students with facts and opinions, but do not require them to write essays requiring critical analysis of theoretical debates or the historical development of ideas. Graduates, although intellectually capable, have not been exposed to the range of ideas, controversies, methodologies and theories which are needed in social science research. They crave detailed directions from supervisors in pursuing their research endeavours. When these graduates become teachers for the next cohort of students, they follow the specific ideas and notes of their teachers as the library remains unfamiliar territory for them. Thus the cycle is continued.

The UI currently suffers from a major split in campuses which has serious problems for social sciences and public health. The Faculty of Medicine, the Graduate School and the Demographic Institute are on the old city campus, while the Faculties of Public Health, Economics, Sociology and Politics, Psychology, Law, and Arts and the Research Institute have moved one hours' drive away to the new campus in Depok, West Java. This means that even if faculty library holdings in health and social sciences were immediately centralised in a large research library, there would be a dilemma in the placement of the collection, with both the Research Institute on the new campus and the Graduate School on the old campus claiming to be the natural centre for a research library. A number of other universities in Indonesia face similar difficulties as their campuses are moved out of large cities to rural settings.

Those who have studied overseas, and used library collections on American,

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Australian and European campuses, reminisce on the time they spent in libraries, reading newspapers, journals, and monographs, learning to use on-line databases and various indexes of social science abstracts and citations. That, they report, was the time of greatest concentrated learning, more so than their time in classrooms or seminars. But when asked whether they think such environments can be recreated in their own campuses they just shake their heads, and detail the problems outlined above. On a personal level they keep up with the international literature through the networks they built up while overseas, relying on international colleagues to provide them with materials which are not available through Indonesian university libraries.

The central administration of UI is aware of all these problems, but is unable to rationalise either current library holdings or to centralise library budgets to support a more accessible and efficient central facility. This is due to the collections being the property of faculties, and budgets largely under the control of deans. In the words of one administrator, UI can be seen as a federation. Faculties not only believe they have the right of ownership of resources, but there is also an ego involvement, preventing them from cooperating to build central collections or pool- ing resources to achieve efficiencies of scale. The national institution which has ambitions of being Indonesia's first true 'research university' is therefore handicapped by its split and decentralised administration structure as it attempts to build workable research facilities. The 'university', states one professor, is actually a 'diversity' of interests.

Computerisation and management dilemmas

While the situation of university libraries demonstrates the way decentralised and piecemeal funding inhibits the development of research capabilities, UI experience with microcomputers is somewhat different. At first glance many problems appear similar - the need for large capital budgets, the challenge of using manuals and software in English, and the requirement for complementary investments in space, supplies, and ancillary equipment. With computers, the Faculty of Public Health, and most other UI Faculties, made substantial early progress in applying the new technology to their research activities. The Center for Child Survival and the Health Research Center acquired computers and software at the cutting edge of develop- ment, and quickly established groups of operators familiar with data and word processing technologies, who could respond quickly to the needs of field researchers. The Department of Biostatistics and Population Studies established a computer laboratory with thirty machines purchased under various grants, and ran courses to train students in the use of standard epidemiology and data base programs. This made an important contribution to the Faculty's teaching and research capacity.

Some institutional practices and budgetary constraints of the Faculty gave rise to problems for the sustained management of computer facilities. In common with faculties across Indonesia, when initial purchases are made by development assistance agencies, it is common to seek a budget for 'overheads' which can in part cover the maintenance of computers. Such budgets are bound by the limitations of the duration of a particular project, which may be only a year, or, in rare instances, may be three to five years. Computers purchased through grants or the government budget are

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maintained under the routine Faculty budget, which is always under pressure from competing demands.

With the working life of computers averaging three years, there is a need to plan for replacement or upgrades of machines to keep up with technological advances. Machines acquired from donors generally need to be replaced under the government budget, if a Faculty is to maintain its facilities. These issues of maintenance and depreciation go to the heart of the government budgeting process - yet this is an area where donors fear to tread, and recipients prefer to hope for the best. It is thus not surprising when computer labs on campuses have a third to half of their equipment out of service, due to lack of funds for maintenance or replacement.

A search for the root causes of these problems leads to a variety of possibilities. There is a lack of funds caused by budget constraints of a poor nation in the process of development. Yet it is easy to identify ways in which both the national budget and faculty budgets could be restructured to achieve greater efficiencies, if there was a recognition and a will to restructure institutional priorities.

Another possibility is the question of whether management and planning staff in universities have the skill to deal with complex interrelated issues of depreciation, inventories, maintenance schedules, training and equipment renewal. Deans, depart- ment heads and central administrators come from medical or social science back- grounds, and often lack management skills. Clerical staff who might have some interest or aptitude in this direction suffer from a lack of status in the university hierarchy, and are unwilling to contradict their boss, or make a fuss if they see a need for equipment to be replaced. This is not simply a university problem, since similar patterns can be found in many government departments, and in the private sector. Bookstores are filled with volumes on 'total quality management' and other self improvement texts, but even if individuals are interested in reform, they are often quickly reminded of their position as small cogs in very large systems.

Finally, there is the nature of the donor-recipient relationship. Donors often invest large amounts of capital funding, but not funds for recurrent maintenance costs. Even if recipients are aware of the economic implications of receiving the gift, they would be embarrassed and possibly criticised if they refused it. In such situations it often seems better to hope for the best. After all, individuals involved in the negotiations will probably not be in the same job when it comes time to replace the machine in three or five years time and their replacements will prove their mettle by obtaining new grants to buy replacement machines.

Formation of a research staff

If problems of establishing capital for research capabilities seem daunting, these are at least recognised and acknowledged more than issues surrounding human resources for research activities. The comment about lack of awareness of literature among junior staff needs to be explained in the context of the procedures by which staff are recruited to academic jobs.

State universities hire academic staff into positions within the framework of the national civil service. It is assumed that the post will be for the duration of a person's working life, although it is also assumed that it will be not an exclusive commitment. In contrast to systems in some other ASEAN countries, university posts are not

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advertised. There is very little employment mobility among state universities, although there is a great deal of overlap in hiring between state and private univer- sities. Persons looking for a job rely on friends or the grapevine to tell them of opportunities. Frequently, they are offered a post by a department or centre head, and the bureaucratic 'paperwork' of hiring is something to be cleared up at a later time. A selection committee drawn from department members is rarely asked to review an application for employment, and job descriptions or lists of required qualifications are not made public. In short, hiring is non-competitive and arbitrary. There is no participation by 'experts' from outside a unit to judge scholarly creden- tials of candidates. This would not be an issue if faculties hired staff from within their own disciplines. Unfortunately, faculties strive for 'interdisciplinary' strength through the recruitment of specialists from a broad range of fields. It is not unusual for a Faculty of Medicine to hire an anthropologist, sociologist or psychologist to teach one or two courses, rather than sending their students to take courses in the faculties specialising in these fields. As a result, faculties often hire specialists through a selection procedure without peer review. These specialists then find themselves in an environment which isolates them from colleagues in their discipline.

It is assumed that universities should hire young talented people who can be trained on the job, and later by degree and short courses. In practice people do not like to talk about what to do with staff who fail to respond to training, who fail to produce high quality research, or who prove unwilling or incapable of doing the jobs assigned to them. It seems that the lack of a system containing competition, independent selection committees, and the potential for job mobility forces state universities to rely on systems of individual incentives to ensure conscientious com- mitment to all forms of work, including research.

The institutional setting of incentives for research

University staff in state institutions have security of tenure, being public servants, but suffer from the insecurity of low salaries, and from pressures to build a work portfolio to qualify for advancement. This compensation system is a cause of justified complaint, limiting the ability of academic staff to commit themselves full time to research endeavours. Low salaries are supplemented by regular allowances (tunjan- gan) paid only on the continued demonstration of contributions to university teaching programs.

In addition, a de facto 'piecework' system is applied to ensure participation in various faculty and university activities, with 'envelopes' containing a small amount of money given when a staff member has signed an attendance book. In a classic 'involutional' pattern, similar forms of incentive are built into academic participation in government department meetings, seminars and conferences, development pro- jects, and service activities. Many state university staff also teach in private universi- ties as a way of supplementing their incomes, and doctors and dentists often have private practices in the afternoon or evening hours. This pattern of 'compensational involution' results in major impacts on research capabilities: 1. No academic staff member can devote their time, even outside core teaching

responsibilities, to research activities without an immediate loss of income. 2. Staff members who choose to devote a large portion of their time to research risk

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the loss of future supplementary income opportunities as their names are dropped from the invitation lists of potential 'employers'.

3. 'Monetary incentives' given in envelopes at seminars and conferences organised by government departments encourage attendance but do not guarantee interest or active participation among the audience members. Another aspect to this system is the leverage that employers have in influencing

the content of academic discourse by controlling grants and budgets. This then determines individual participation in seminars and research activities. Academics on the 'outside' of this system feel their exclusion both through their isolation and their pockets.

Accounting for promotion

Portfolios compiled by academic staff for promotion in state universities must demonstrate contributions to the university's teaching, research and community service missions as a reflection of individual accomplishment of the institutional Tridharma goals. The measurement of different forms of accomplishment is made in terms of credits which are popularly referred to as kum, or cumulative points. Credits are needed to advance each step on a nine level scale of academic promotion from 100 credits for the base level of assistant, through a series of 100 or 150 credit steps to the top level of 1000 for a full professor. In each category of advancement a minimum of 25 percent of credits must come from teaching, 25 percent research, and a maximum of 15 percent for community service activities. Eligibility for research credits includes participation in a project or the publication of results, but advance- ment cannot be guaranteed by research alone. Staff are under constant pressure to demonstrate their teaching and community service (including attending seminars and conferences), and to serve in administrative roles in their faculties. Staff in a Faculty of Public Health or Social Science are not disadvantaged by this system if they wish to expand their work to a more interdisciplinary scope. Like all researchers, however, they are bound by detailed procedures and implied incentives which can inhibit attempts to strike out into new areas of research.

In describing her attempts to work through the processes of advancement one staff member likened the calculation of kum to mastering a set of tax laws. Rules, formulae and examples fill a 14 page handbook and a series of accompanying decrees, explanatory memoranda and forms. While the whole process of applying for promotion absorbs large amounts of time and emotional energy that might otherwise be used for research, the detailed working of the system also embodies a series of incentives which shape decisions staff members make about the type of research they will carry out, and the form in which they publish their results.

Contributions in all three areas of Tridharma obligation have implications for research activities. For instance, the largest single amount of credits under the heading of teaching and education is awarded for successful completion of a Ph.D. program (called $3 in Indonesia), providing 150 units. Completion of an MA ($2) program attracts 100 credits. Teachers who prepare a classroom handout or a tutorial guide of at least 50 pages in length are eligible for up to 50 credits. The determination of precisely how many credits are to be given to a particular piece of

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work depends on the Faculty and University Senate Committee appraisal of the content, scope and importance of the material.

By contrast, specific research contributions attract the following maximum number of credits for each individual product presented for evaluation:

1. Results of a research project: Book, published and distributed nationally 25 Article, in a scientific journal (recognised by Ministry of Education) 15

2. A published scientific work Book, published and distributed nationally 20 Article, in a scientific journal (recognised by Ministry of Education) 10

3. An unpublished research or scientific work Book of at least 40 pages in length 10 A manuscript article 5

In evaluating these materials the review committees apply standard formulae to the division of credits among members of a research collaboration. The senior author receives 60 percent of the credits, and all junior authors (to a maximum of 5) divide the remaining 40 percent equally.

Community service consists largely of outreach activities directed at developing the Indonesian nation and serving the people, and most activities in this category are worth one or two credits. Writing an approved school text book can add 5 credits to a portfolio. Credits are also given for service to professional organisations, and leadership in organising or participating in scientific meetings. Officers of interna- tional scientific groups obtain two credits, while officers of national organisations earn one and a half credits. Heading or being a member of an organising committee of a scientific meeting attracts three or two credits respectively, whether the meeting is at an international, regional or national level.

Details of the credit and promotion system have not been presented to illustrate details of an academic administration system, but rather to give a sense of staff perceptions of incentives surrounding research activities. A system which offers a maximum of 50 points for the production of classnotes, but only 25 points for a nationally distributed research monograph, and 20 points for a theoretical mono- graph, obviously indicates to junior staff how to spend their working hours.

In contrast to Australia, where 'international literature' is the primary, and some- times sole target of academic writers, credits in the Indonesian system are given for nationally distributed books and articles in journals recognised by the Department of Education and Culture, with no attempt to encourage publication internationally. Finally, the formulae for dividing credits for joint research is extraordinarily rigid, and discourages collaboration where two or three authors work equally hard and determine the order of names on the title page by alphabet or by lot. This system is invidious since local etiquette demands that seniority would determine the listing of authors, irrespective of the relative contribution of each to the formulation, analysis or writing of the research.

Participants in this system would be quick to point out that the incentives do not necessarily work in the form indicated above. Specifications of maximum credits for various activities are no guarantee that these would be the amounts granted, since the university level committees have the power to partially or fully reject claims. This might work to reshape the incentive structure in favour of more important

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research products, although it has the side-effect of introducing a degree of arbitrari- ness into an already rigid structure. Committee members are unlikely to be experts in the particular fields of research under consideration, and may not understand the potential significance of different pieces of work.

Staff members need Faculty approval of applications for promotion Senate Committee reviews. In recent years there has been a tendency for faculty reviewers to return applications for minor revisions. A few staff regard the process as a massive 'bean-count' rather than an evaluation of the quality of their work. This attitude clouds their thinking about pursuing imaginative, but risky, research ideas, and focuses their energies on narrow, generally nationally oriented, publication plans. A staff member seeing that an unpublished paper or book could attract half the credits as the same material published by a reputable international outlet with a strong peer review system could be forgiven for yielding to the temptation of avoiding demands for revision, polishing and proofreading, by taking the option of a few easy credits, using the time thus gained for other 'credit-rich' pursuits. The phrase used by staff members to describe this is 'kepuasan murah' or 'cheap satisfactions'.

Other elements of a research culture

In this environment, state universities fail to promote a strong commitment to research activities, or the perception of research as a global endeavour with high and attainable standards of scientific research. For many committed young research- ers who have been exposed to overseas training and professional practices, the culture of the state university seems confining and enervating. Sabbatical or study leave is not available to encourage them to work on projects they find interesting. Staff members can, however, obtain permission to undertake training courses, degree study, or short-term trips abroad for conferences or collaborative research if they are invited by a foreign sponsor.

The hectic pace of teaching, meetings, fieldwork, conferences, visitors and admin- istration for staff offer multiple stimuli that can suggest innovative research topics and exciting field proposals. Yet the atmosphere which stimulates also limits the ability to develop ideas beyond the first imaginative step. Words like 'contemplation', 'reflection' and 'muse', which stereotype academic pursuits in the West and give rise to complaints about 'ivory towers', are not easily attached to Indonesian concepts of academic or intellectual activities. This is a product, in part, of the state university structures and the centralised bureaucratic controls, which shape the research environment.

To some degree researchers are given incentives to produce outstanding work by the operation of various competitions for 'best' work at the university and the national level. Such competitions invite research results to be presented in Bahasa Indonesia, and are often geared to encourage young researchers, or promote research on particular topics. Sheer academic excellence is seldom regarded as the main focus of the competitions. Panels of reviewers rarely include internationally recognised experts on the topic of a particular project.

An example of a competition designed to encourage research is one run by the Director of Higher Education. Participation in the competition is limited to research projects fully funded by Ministry of Education and Culture research grants, with a

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limit of two million rupiah (around US$ 1000). Although advertised as a means of promoting high quality research, few senior researchers are attracted to the competi- tion, and few participants extend their research to a scholarly publication either domestically or internationally. It is questionable that research competitions are of much use in providing incentives for scholarly research when the sense of 'literature' is so weak and when the research environment is limiting. By contrast, research competitions in the UI system are increasingly oriented to outside publication as a major objective.

Individual researchers face a major problem with language. Even when the subject is Indonesian, they need command of foreign languages to gain access to theoretical and methodological literature providing the 'cutting edge' of scientific endeavour in any discipline. A 'translator', such as a course instructor, may give researchers a general notion of a technique, and a limited vocabulary for discussion. This cannot substitute, however, for the ability to read a variety of articles and texts, or critically evaluate a theory or method.

In teaching activities of the university, students seldom come in contact with recent research results, and they often fail to seek out the most recent and relevant articles in the preparation of essays or theses. While a few journals publish literature review articles, the notion of the 'literature' is vague and often beyond the reach of even very talented researchers due to limited library facilities, and a hesitance to write to foreign or Indonesian colleagues to request reprints. Essays written by students at the Faculty of Public Health of the University of Indonesia are notable by their lack of citation of major international journals. This is not because the students lack an understanding of the need for citations. In fact, they frequently cite working papers or reports produced by government departments. Rather, they have little sense of the scope of established local or international public health journals.

Negotiating terms of development

There is an old English saying: 'in for a penny, in for a pound'. This notion of commitment has international parallels, but differences in understanding of what the term commitment even means makes the application of the principle difficult. An example of this is that the publishers of Acta Tropica state quite clearly 'the metric system is to be used throughout' , but it would be an insensitive editor who would quote the English saying as 'in for a penny, in for a dollar'. It would represent a spurious application of a standard, in a context where science does not demand it and culture would find it abhorrent.

In the same way, the development of social science research capabilities requires sensitivity to separate the essential elements of social science method from the baggage of cultural, political and economic content of social research as represented in the international literature. Too often students are so intent on applying the lessons of Western research results to Indonesian problems, that they forget to apply the scientific principles of analysis and logic to define their problems in a broad Indonesian context and design a system of analysis which is relevant. Western public health experts are often of little help in guiding their thinking on such issues, especially if they lack an understanding of the Indonesian historical and cultural context of the problems, but even more so when they define the practical applications

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of the desired knowledge in terms of Western or international political agendas, rather than, say, the realities of Jakarta health and family planning activities.

The cultural chasms separating Indonesian researchers and their international colleagues are not soluble with reference to a 'key program' of collaboration or a 'magic bulletin' of agenda setting, but rather through an open, two-way process of negotiation. As in all negotiations, there must be a willingness on each side to compromise some of their position. In this sense international colleagues must be 'in for a pound'.

To integrate social sciences into the public health curricula of the University of Indonesia, the a priori assumption of 'outsiders' might be that the Indonesian side would need to modify a 'medical model' of defining health problems, and accept a 'social and cultural model' to analyse disease and its prevention. In contrast they might feel that foreigners should be prepared to compromise on the scope of literature students should study, focusing instead on specific techniques, taught in Indonesian, with perhaps a recent manual translated for the students. Both sides might agree that Indonesia needs books, computers, scholarships, and research funds to ensure that a program of assistance can be established.

This paper argues that such assumptions are inappropriate. In the first place, the Indonesian public health establishment has an appreciation of the need for social sciences, but lacks understanding of what this means for curricula, intellectual paradigms or research agendas. Investment by foreign donors in methodology- related short courses, or promotion of specific techniques like 'rapid assessment', is unlikely to provoke the kind of institutional changes needed in faculties. Training may supplement, but it can never adequately substitute for, education.

Moreover, these assumptions fail to acknowledge the structural difficulties under- lying problems with libraries, computer facilities, and individual staff commitments to research. Without structural reform, common assistance efforts are worthless. It is not appropriate, nor possible, for foreigners to dictate structural reform prior to giving assistance. A process of constructive dialogue can be promoted, to draw Indonesian public health and social science professionals more effectively into the international academic community, reinforcing their efforts to build research capabil- ities at home.

The potential for major substantive reform is indicated in the commitment of the leadership of UI to make the institution Indonesia's first and foremost 'research university'. Rector Tadjudin (1994) has called on all faculties and the Research Institute to work together in pursuing this goal. As part of the strategy to promote high quality research the Tridharma obligations of the university, which have pro- vided the foundation for the current institutional situation, are being reinterpreted. Staff will be encouraged to make research the central focus of their activities, with the slogans 'teach through research, service through research, and development of research'.

Teachers will be expected to enrich their lectures by exposing students to research results of national institutions, including UI. Community service will no longer be seen as simple 'mini-development projects', but will be based on solid research findings and geared to the application of innovative technologies and methodologies. The leadership of UI acknowledges that the process of research must be enhanced in both quantitative and qualitative dimensions. On the quantitative side it is necessary for the institution to compete for and win more competitive grants, as a

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means of improving facilities and developing staff capabilities. On the qualitative side research should contribute both to the expansion of knowledge, and to solving the practical problems of national development. The slogan chosen to reflect this aspect of the research agenda is 'UI, The Pillar of Sustainable Development'. Measures have been proposed to deal with the structural problems which to date have inhibited the development of libraries and prevented staff from realising their potential as researchers in a range of disciplines.

UI is interested in promoting interdisciplinary research, and encouraging inter- faculty collaboration. It will be difficult for this large institution to achieve these goals, but the commitment to do so has been clearly articulated at senior leadership levels. The hope is that 'outsiders' - whether bureaucrats, donors, research con- tractors, professional associations, or individual colleagues - will recognise and reinforce the moves being made in the direction of a first rate research-oriented campus. In terms of the theme of this paper, these plans would encourage the specific objective of integrating health and social sciences in a more fruitful partnership.

Conclusion

Universities in Indonesia are national or provincial institutions with ambitions to participate in international intellectual advancement. The dilemmas facing academics attempting to build research capabilities linking the health and social sciences are rooted in university structures and procedures which inhibit broad bi-lingual gradu- ate education and drain energy from individual attempts to contribute to the interna- tional literature. Public health researchers face problems in gaining strong educational foundations, access to important literature, encouragement to carry out valuable research, and security of livelihood consistent with incentives for quality research. Solutions for these problems may take many years to implement but in the meantime public health specialists and donors alike should recognise that the agenda to integrate social sciences into health research in Indonesian universities is one requiring a broad awareness of the structural constraints to good research entrenched in current educational systems. Foreigners collaborating with Indonesian institutions need to develop workable collaborative arrangements with Indonesian colleagues. Experience demonstrates that joint research can be achieved in this environment, which realistically may require a high degree of mutual understanding and flexibility to succeed.

Acknowledgments

Some of the material presented in the introduction was obtained from the Rockefeller Archives in Tarrytown, NY. I am grateful to the Rockefeller Foundation staff for giving me access to the collection. People who have provided me with important insights and critical comments include Prof Yaumil C. Agoes Achir, Prof Umar Fahmi Achmadi, Dr Sri Haryati Hatmaji, Dr Meiwita Iskandar, Ms Umi Pudjihastuti, Dr Rosalia Sciortino, Ms Yetty Sunaryo, Prof M.K. Tadjudin, Dr Budi Utomo, Dr Adik Wibowo, and Dr Mary Zurbuchen. I thank them unreservedly

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for their inputs and absolve them absolutely from responsibility for any misinter- pretations on my part.

References

Hull, T.H. (1987) Plague in Java. In: Norman G. Owen (Ed.) Death and Disease in Southeast Asia: Explorations in Social, Medical and Demographic History. Singapore: Oxford University Press, pp. 210-234.

Hull, T.H. (1989) The hygiene program in the Netherlands East Indies: roots of primary health care in Indonesia. In: P. Cohen and J. Purcal (Eds.) The Political Economy of Primary Health Care in Southeast Asia. Canberra: Australian Development Studies Network, pp. 140-148.

Pramoedya Ananta Toer. 1985 (1990) Jejak Langkah (Footsteps). Jakarta: Hasta Mitra. (Trans. by Max Lane, Harmoudsworth and Ringwood: Penguin).

Rosen, G. (1968) Public Health. International Encyclopaedia of the Social Sciences, pp. 167 170. Tadjudin, M.K. (1994) Pemantapan Keterpaduan dan Otonomi Universitas Indonesia Menuju

Universitas Penelitian dan Pusat Unggulan Ilmiah (Integrating Activities and Protecting Autonomy in the University of Indonesia to Develop a Research University and Centre for Scientific Excellence). Unpublished speech on the Occasion of the Forty-Fourth Anniversary of the University of Indonesia.