Direct Local Elections Must Stand, They Improve Public Health Services

By Saidiman Ahmad, Program Manager at Saiful Mujani Research and Consulting (SMRC).

The public desire to maintain the system of direct local executive elections remains incredibly strong. The majority of Indonesians want to exercise their sovereignty by choosing their own regents, mayors and governors. This attitude has remained consistent over the years, as confirmed by public opinion surveys conducted by credible polling institutions.

An SMRC survey in May 2023 found that 86 percent of citizens rejected the idea of electing local leaders through regional legislatures (DPRD). A survey by Indikator Politik Indonesia in August 2025 showed that 94.2 percent of citizens wanted regents and mayors to be elected directly by the people. Similarly, a Litbang Kompas survey in December 2025 found that 77.3 percent of citizens supported direct local elections.

Public support for direct local elections is almost unanimous. This implies that the push to change the election system does not reflect the aspirations of the people, but rather those of political elites who lack popular roots. Indonesians do not want their right to determine regional heads to be usurped.

Amid widespread public resistance, the House of Representatives and the government backed down on Monday from the plan to reinstate indirect local elections, stating there was no plan to revise the Regional Elections Law this year.

The near-universal desire of citizens to directly choose their leaders is highly rational. Public expectations in electing local leaders are tied to the hope that their needs will be fulfilled. The people themselves best understand their own needs; therefore, their demand to directly evaluate their leaders is natural.

Moreover, direct local elections, implemented since 2005, have provided valuable experience for society. The continued public support indicates that this system has done more good than harm, contrary to the claims of elites who advocate for its abolition.

Critics frequently argue that indirect elections produce leaders who better serve the public, claiming that regional development has stagnated and that direct elections breed corruption. In fact, more than 400 regional leaders have been implicated in corruption, including the regent of Pati in Central Java and the mayor of Madiun in East Java who were arrested by the Corruption Eradication Commission (KPK) last week. However, we must recognize that entrusting sovereignty to the people is valuable in and of itself. It is not merely an instrument to achieve other goals.

Even if elected leaders fail to meet expectations, that is no reason to revoke the people’s mandate. If we were to consider welfare or development outcomes as the sole metrics of democracy, the logical consequence would be to abolish democracy whenever those goals are missed.

Although popular sovereignty is an end in itself, in practice, this system has also brought significant improvements in public policy. Claims that direct elections have caused governance chaos lack evidence.

One of the most significant outcomes of direct elections concerns public health. A study by political scientist Diego Fossati, titled “Is Indonesian Local Government Accountable to the Poor? Evidence from Health Policy Implementation” (Journal of East Asian Studies, 2016), offers compelling evidence.

Fossati’s study examined whether local governments in Indonesia were responsive to the needs of the poor, focusing on the implementation of Jamkesmas (Community Health Security), the free health insurance program for the poor implemented from 2008 to 2013. Fossati traced national and local policy processes related to health services.

He found that while public health policies had existed since the 1970s, they were highly elitist and generally not aimed at the poor. Before the implementation of direct local elections in 2005, local leaders rarely prioritized health issues, preferring to focus on security and infrastructure.

Direct local elections created political incentives for candidates to address public health. For example, the Regional Health Insurance program (Jamkesda) expanded dramatically after the introduction of direct elections. This development paved the way for the National Health Insurance (JKN) program administered by BPJS Kesehatan, which began in 2014.

Using data from around 400 districts and the 2013 National Socioeconomic Survey (Susenas), Fossati measured local government accountability by examining how well health coverage reached the poor. He found that in districts with high poverty rates, public demand for free health services was greater, making it a salient political issue.

Crucially, the relationship between poverty levels and the quality of health implementation was much stronger when local politics were competitive. In competitive districts with high poverty levels (20 percent), Jamkesmas coverage increased by 8.5 percentage points during election years. In contrast, in non-competitive districts with similarly high poverty levels, the increase was only 1.9 percent.

In districts where power is contested rather than dominated by a single elite group or political dynasty, health service implementation tends to be superior. Districts holding elections also show stronger service delivery compared with those that do not.

In short, public participation in local executive elections compels local governments to implement policies that reflect public priorities. Competition makes elites responsive. The revolution in public health services currently taking place in Indonesia is a positive outcome of elite competition driven by direct local elections.

Without direct local elections, what political incentives would local leaders have to care about public health at all?

*Dimuat di Harian The Jakarta Post pada 23 Januari 2026 halaman 2

https://www.thejakartapost.com/opinion/2026/01/23/direct-local-elections-must-stand-they-improve-public-health-services.html

Sumber foto: RSUD Bangil

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