The paper aims to assess the impacts of decentralisation and privatisation reforms on access to and quality of health services in Indonesia. The research draws on qualitative and quantitative data from interviews, focus group discussions, and household surveys in four selected districts. The main conclusions are three-fold; the local administration of health care services is without transparency and accountability, health centres are turned into profit centres, and the increasing roles of private actors tend to reduce concerns over preventive health care and the conditions for poor people. Our policy recommendations include increased government spending to maintain public efforts in environmental and preventive health and in maintaining a minimum health service for the poor. © 2005 Elsevier Ireland Ltd. All rights reserved.