Journal of Accounting and Investment Vol. 23 No. 2, May 2022 Article Type: Research Paper The Service Quality of Community Health Centers During the COVID-19 Pandemic: Do Governance Practices Benefit? Suryo Pratolo*, Arifin Hamsyah Mukti, and Hafiez Sofyani Abstract: Research aims: This study aims to examine the role of internal control on the service quality of community health centers in handling the COVID-19 pandemic with transparency and accountability budget management as intervening variables. Design/Methodology/Approach: The population of this study was all community health centers located in the Special Region of Yogyakarta Province. The cluster sampling technique was used in determining the samples. Eighty-two community health centers participated in this study. Data were collected by distributing questionnaires. Partial Least Square (PLS) was employed to test the hypotheses. Research findings: The results revealed that, during the COVID-19 pandemic, internal control implementation was not associated directly with the service quality of the community health center. Instead, the association was mediated by transparency, not accountability. Additionally, transparency independently was associated with service quality. Theoretical contribution/Originality: This study extends the literature by examining the role of good governance mechanisms and principles in the community health center context by positioning transparency and accountability as intervening. In addition, this research was conducted in the context of the COVID-19 pandemic, where the service quality of community health centers has a crucial role in dealing with people exposed to COVID-19. Practitioner/Policy implication: The results of this study can be used as input for the relevant regulator to improve the service quality of community health centers through good governance practices. Research limitation/Implication: This research only involved community health centers in the Special Region of Yogyakarta Province as samples. Keywords: Service Quality; Internal Control; Transparency; Accountability Introduction Good quality health services that agree with related standards are a concern for developing countries to enhance their living quality (Moucheraud & McBride, 2020). As an element of public service, a community health center must always strive to improve its services on an ongoing basis (Simangunsong & Rahayu, 2021). It is in line with the Regulation of Indonesian Minister of Health Number 43 of 2019, where health service institutions must provide quality services through a quality control mechanism (Ministry of Health of the Republic of Indonesia, 2019). AFFILIATION: Department of Accounting, Faculty of Economics and Business, Universitas Muhammadiyah Yogyakarta, Special Region of Yogyakarta, Indonesia *CORRESPONDENCE: suryo@umy.ac.id DOI: 10.18196/jai.v23i2.14324 CITATION: Pratolo, S., Mukti, A. H., & Sofyani, H. (2022). The Service Quality of Community Health Centers During the COVID-19 Pandemic: Do Governance Practices Benefit? Journal of Accounting and Investment, 23(2), 360-378. ARTICLE HISTORY Received: 25 Mar 2022 Revised: 20 Apr 2022 11 Jun 2022 Accepted: 14 Jun 2022 This work is licensed under a Creative Commons Attribution-NonCommercial- NoDerivatives 4.0 International License JAI Website: https://www.scopus.com/authid/detail.uri?authorId=57195473385 https://www.scopus.com/authid/detail.uri?authorId=57203309417 https://accounting-feb.umy.ac.id/ https://accounting-feb.umy.ac.id/ https://accounting-feb.umy.ac.id/ https://accounting-feb.umy.ac.id/ https://accounting-feb.umy.ac.id/ mailto:suryo@umy.ac.id https://journal.umy.ac.id/index.php/ai/article/view/14324 https://journal.umy.ac.id/index.php/ai/article/view/14324 https://crossmark.crossref.org/dialog/?doi=10.18196/jai.v23i2.14324&domain=pdf Pratolo, Mukti, & Sofyani The Service Quality of Community Health Centers During the COVID-19 Pandemic: … Journal of Accounting and Investment, 2022 | 361 However, Menap et al. (2021) contended a decline in the quality of services at some community health centers during the COVID-19 pandemic. It can be seen from the unpreparedness of the community health center to providing health facilities when facing the spread of COVID-19, impacting the uncertainty of service patterns. On the other hand, one method used to assess the quality of community health center service is an accreditation system (Yogyakarta Health Office, 2019). The Ministry of Health reported that in 2020 out of 9,153 accredited community health centers, only 241 had plenary status (3%), 1,664 had parent status (18%) and still dominated with medium status with 5,072 (55%) and basic status with 2,176 (24%) (Ministry of Health of the Republic of Indonesia, 2020). These data illustrate that improving the quality of community health centers, especially in terms of services, still needs to be encouraged. A service quality improvement of community health centers during the COVID-19 pandemic is a form of government responsibility to the community (Ulumiyah, 2018). To do so, several supporting factors are needed. Gordon and Kalenzi (2019) revealed that internal control's role is crucial in realizing good service quality. Internal control is an integral process by management designed to address risks and assure that in pursuing the mission, the organization must carry out operations orderly, fulfill accountability obligations, comply with the law, and safeguard existing resources (Long & Kanthor, 2013). In addition, some scholars (Lauma et al., 2019; Rohman et al., 2019) argued that the principles of good governance, including transparency and accountability, contribute to improving the quality of public services. Several previous studies discussing service quality and internal control have yet to find consistent results. Gordon and Kalenzi (2019) found that internal control in the community health sector in Uganda could enhance the quality of health services. Syukryati and Solikin (2018) revealed that by implementing internal control, the quality of services from public institutions would also improve. It contrasts with Wardayati et al., (2019), who revealed that internal control activities could not improve the performance quality of the community health center in Jember. On the other hand, Andriono and Nurkholis (2018) uncovered that the internal control system improved the service performance of the state treasury office in Bali. Meanwhile, Amole et al. (2015) explained that the internal control system could improve Nigeria's quality of health services. However, Dewi et al. (2021) stated that the internal control applied could not make hospitals in Garut improve the quality of their services. Seeing these conditions, one of the focuses needed to improve the quality of community health center services is to corroborate good governance through the practice of transparency and accountability in budget management (Lauma et al., 2019). Properly carried out transparency and accountability of budget management will reduce suspicion of acts of corruption and improve the implementation of public services (Darlena et al., 2021). It is because budget management accountability represents the obligations of the management of public organizations in managing entrusted resources related to public finances (PIC Working Group, 2017). Meanwhile, budget management transparency can create mutual trust between public institutions and the public through easy access to accurate and adequate financial information (Prokomsetda, 2017). These two principles Pratolo, Mukti, & Sofyani The Service Quality of Community Health Centers During the COVID-19 Pandemic: … Journal of Accounting and Investment, 2022 | 362 of good governance can pressure to achieve organizational performance targets, including health centers. Furthermore, they will mobilize quality services as an indication of performance. However, as related research presenting empirical evidence is difficult to find, it is crucial to investigate the role of transparency and accountability in budget management as the intervening variables. In addition, today, research on the role of internal control on the service quality in the health sector is limited to the context of normal conditions or before the COVID-19 pandemic (Amole et al., 2015; Gordon and Kalenzi, 2019; Wardayati et al., 2019). On the other hand, until now, studies on the application of internal control in the field of community health have been found in the context of a direct relationship to service quality. To cover highlighted gaps, this study is intended to examine the role of internal control on the quality of services in the health sector during the COVID-19 pandemic, raising two intervening variables in the form of transparency and accountability in budget management. Theoretically, this study contributes to knowledge by expanding the literature on internal control and its relationship with the good governance practices carried out by public sector organizations and their role in service quality during the COVID-19 pandemic. Practically, this study recommends that the relevant regulator improve the quality of health center services to the community during the COVID-19 pandemic or perhaps in other disaster conditions. Literature Review and Hypotheses Development Theoretical Framework This study is underpinned by using stewardship theory. Stewardship theory is characterized by the idea of serving others rather than self-interest (Block, 1993). Stewardship theory puts forward the view that individuals, in this case, leaders, are often motivated by considerations of fairness, justice, and concern for other interests (Buchanan, 1996). It emphasizes cooperation and collaboration (Sundaramuthy & Lewis, 2003). Exploring this theory, Podrug (2011) stated that leaders act in various ways to maximize the organization's interests. It aims to realize an ethically responsible service. Therefore, there is a link between stewardship theory and service quality; whereby prioritizing the principle of serving others, the organization will seek to improve the quality of its services to meet the community's satisfaction, needs, and expectations (Block, 1993; Firmansyah et al., 2022). With the assistance of the implementation of internal control and the practice of accountability and transparency in managing the COVID-19 budget, it is hoped that the quality of community health center services will be better. Pratolo, Mukti, & Sofyani The Service Quality of Community Health Centers During the COVID-19 Pandemic: … Journal of Accounting and Investment, 2022 | 363 Internal Control and Community Health Center Service Quality Internal control is a process carried out by the board of directors and management to ensure that organizational objectives related to asset protection, compliance with applicable regulations, reliability and transparency of financial reporting, and operating efficiency and effectiveness can be achieved (Romney & Steinbart, 2014). From the objectives mentioned above, operation and applicable regulation associated with service quality is a concern (Ntongo, 2012; Gordon & Kalenzi, 2019; Oppong et al., 2016). Internal control promotes efficiency in utilizing organizational resources, such as work performed according to standards, service personnel always working all the time, and fair allocation of resources, resulting in timely delivery of quality services (Gordon & Kalenzi, 2019). In addition, the internal control component in the form of supervision can encourage the implementation of quality services. Monitoring provides important feedback on the extent of service delivery and whether service delivery makes a difference for clients and organizations and provides useful insights for detecting changes in performance and understanding trends over time (Rossi et al., 2004). From the aspect of information and communication, the right, timely, up-to-date, and precise information will encourage the organization's ability to achieve the desired performance results. In control activities and risk management, the risks can be handled in a timely, effective, and efficient manner, further improving the service quality. In other words, in the context of public sector organizations, internal control is closely related to the quality of services to the public (Block, 1993; ACT Health, 2018; Long & Kanthor, 2013; Mwazo et al., 2017). Based on this explanation, the proposed hypothesis is as follows: H1: Internal control implementation is positively associated with the service quality of community health centers. Community Health Center Transparency and Its Service Quality Transparency is one of the conditions needed to improve service quality and reduce the scope of corruption and impunity (Bauhr & Grimes, 2014; Bauhr & Nasiritousi, 2012; Islam, 2006; Kosack & Fung, 2014; World Bank, 2002). There is empirical support regarding the role of transparency in improving government performance (see: Alt et al., 2002; Besley & Burgess, 2022; Brunetti & Weder, 2003; Reinikka & Svensson, 2005; Winters & Weitz, 2013). Block (1993) argued that by prioritizing the interests of others, the principle of transparency would be implemented in managing the organization so that the services provided will be maximized. Therefore, with good transparency, organizations will be encouraged to improve the quality of their services to the community (Nguyen et al., 2017). Several studies have also supported the role of transparency in other public organizations, such as education and other health entities (Bjorkman & Svensson, 2009; Keefer & Khemani, 2005; Lieberman et al., 2014). Based on the preceding discussions, the proposed hypothesis is as follows: H2: Community health center transparency is positively associated with service quality. Pratolo, Mukti, & Sofyani The Service Quality of Community Health Centers During the COVID-19 Pandemic: … Journal of Accounting and Investment, 2022 | 364 Community Health Center Accountability and Its Service Quality Accountability is one measure to show how big the conformity level of the performance of service providers with external measures in the community and are owned by stakeholders, such as values and norms that develop in society (Melinda et al., 2019). Related to that, public services in the health sector provided by the government are not only to meet the community's needs but also to meet accountability (Putra, 2015). Through accountability, the organization will prioritize the public interest by providing maximum service to the public (Block, 1993). Mokoagow et al. (2013) revealed that accountability could improve service quality at PT Pos Indonesia (Persero) Manado. Based on the above discussions, the proposed hypothesis is as follows: H3: Community health center accountability is positively associated with service quality. Intervening Role of Transparency In achieving public service quality performance, internal control implementation in government activities is crucial (Yuliani, 2017). Using stewardship theory, it is suggested that internal control implementation will make community health centers prioritize the interests of the public by maximizing services through fulfilling information transparency to the public during the COVID-19 pandemic condition (Block, 1993). Internal control is also an effort made by community health center managers to create efficiency and effectiveness in organizational activities through management transparency. From the arguments above, internal control appears to create transparency, leading to efforts to pursue service quality performance in community health centers. In other words, transparency will mediate the relationship between internal control and service quality performance. Based on this explanation, the proposed hypothesis is as follows: H4: The relationship between internal control and service quality is mediated by transparency. Intervening Role of Accountability One of the good management entities is accountable or clear management. This accountable management will make the effectiveness and efficiency of the organization, including in terms of public services (Azlina & Amelia, 2014; Syukriyati & Solikin, 2018). Using stewardship theory as a basis, internal control is believed to encourage increased accountability practices over the budget, triggering service quality improvement (Block, 1993). The higher management accountability will form personnel with good qualifications in providing services (Mokoagow et al., 2013). Thus, accountability also has an intermediary role in the relationship between internal control and service quality performance (Istikhomah & Asrori, 2019; Purwantini & Khikmah, 2014; Saraswati & Larasati, 2021). Based on this explanation, the proposed hypothesis is as follows: Pratolo, Mukti, & Sofyani The Service Quality of Community Health Centers During the COVID-19 Pandemic: … Journal of Accounting and Investment, 2022 | 365 H5: The relationship between internal control and service quality is mediated by accountability. Based on the hypotheses developed above, the research model was formulated, as depicted in Figure 1. Figure 1 Research Model Research Method Population, Sample, and Data Collection Techniques The population in this study was all community health centers in the Special Region of Yogyakarta Province, namely 121 units in total. The sampling technique used was cluster sampling with the selection based on locations: Yogyakarta City, Sleman, Bantul, Kulon Progo, and Gunung Kidul Regencies. The inclusion criteria in the sample were community health centers that had treated patients exposed to COVID-19. Furthermore, 82 community health centers participated as the samples of this study (Table 1). Table 1 Number of Community Health Center Samples by City/Regency No Location Number of community health centers 1 Yogyakarta City 10 2 Sleman Regency 20 3 Bantul Regency 12 4 Kulon Progo Regency 10 5 Gunung Kidul Regency 30 The data collection technique was done by distributing survey questionnaires to respondents. Before using it for data collection, the questionnaire had previously been tested for validity and reliability. Respondents in this study consisted of two groups Transparency Internal Control Service Quality H2+ H3+ H1+ H4+ H5+ Accountability H4+ H5+ Pratolo, Mukti, & Sofyani The Service Quality of Community Health Centers During the COVID-19 Pandemic: … Journal of Accounting and Investment, 2022 | 366 divided based on the character of the variables with consideration of the relevance of the person filling in the questionnaire. The questionnaire containing the internal control, transparency, and accountability variables of community health centers’ budget management was completed by the community health center’s leadership because they had a thorough knowledge of community health center governance. On the other hand, the second questionnaire regarding the service quality of community health centers was filled in by community health center patients because it was the patients who directly felt the facilities available. This kind of separation of data sources is also useful for mitigating common method bias (Richardson et al., 2009). Operational Definition and Measurement of Variables The endogenous variable of this study was the service quality provided by the community health centers. Service quality is an effort to meet customers' or consumers' needs and desires. This variable was measured by five indicators: (1) tangible evidence, (2) reliability, (3) responsiveness, (4) assurance, and (5) empathy (Fikri et al., 2016). Moreover, the independent variable in this study was an internal control. Internal control is a continuous integration process carried out by the leadership to provide adequate confidence in achieving organizational goals (Long, & Kanthor, 2013). This variable was assessed using five dimensions of the internal control system for Indonesian government institutions, including (1) control environment, (2) risk assessment, (3) control activities, (4) information and communication, and (5) internal control monitoring (Government of the Republic of Indonesia, 2008). Related regulation is the community health center as a government institution. Furthermore, the intervening variables used in this study consisted of transparency and accountability of the community health center's budget management. Both variables are two elements of good government governance principles. Both variables were measured by the questionnaire developed by Krina (2003). Accountability measures covered making accurate and complete decisions from the information. Meanwhile, the transparency variable was determined following the information disclosure related to planning, budgeting, and program monitoring and evaluation, which was easily accessible by the public. In addition, a five-point Likert scale was used to measure the variables for all questions, with responses ranging from 1 = “Strongly Disagree”; 2 = “Disagree”; 3 = “Neutral”; 4 = “Agree”; 5 = “Strongly Agree” (Pratolo et al., 2021). Data Analysis Technique Partial Least Square-Structural Equation Modeling (PLS-SEM) was used to analyze the data and test the proposed hypotheses. This method can test the measurement model simultaneously with structural model testing (Chin et al., 2003; Hair et al., 2014). The selection of Partial Least Square was motivated by the existence of a Likert scale, which is non-parametric in nature and avoided multicollinearity. Akbar et al. (2012) and Sofyani (2016) stated that PLS was considered suitable for this study because it allows minimal data assumptions and requires a relatively small sample size (Chin et al., 2003). Using a Pratolo, Mukti, & Sofyani The Service Quality of Community Health Centers During the COVID-19 Pandemic: … Journal of Accounting and Investment, 2022 | 367 less strong theoretical basis is also more profitable using PLS than Covariance-Based Structural Equation Modeling (CB-SEM) (Chin et al., 2003). Furthermore, in using PLS, the researchers needed to follow a multistage process consisting of (1) model specification, (2) evaluation of the outer model, and (3) evaluation of the inner model. The model specification stage was concerned with setting the inner and outer models. The outer model is better known as a measurement model, namely the validity and reliability test. Meanwhile, the inner model, or the structural model, shows the relationship between the exogenous and endogenous variables evaluated (Hair et al., 2014). Result and Discussion This study utilized SPSS to analyze descriptive statistics. The measurement results can be seen in Table 2. Generally, each variable's average (mean) was moderate. It implies that the aspects being researched still need improvement. Table 2 Descriptive Statistics Criteria Accountability Service Quality Internal Control Transparency Min 1.6 2.0 1.6 1.6 Max 5.0 4.7 4.9 5.0 Mean 3.5 3.7 3.6 3.6 SD 0.8 0.7 0.8 0.8 Furthermore, the validity and reliability tests were carried out before testing the hypotheses. The test results are presented in the next paragraph. Validity Test Validity testing was conducted by using convergent and discriminant tests. Table 3 shows that the convergent validity was met, as indicated by loading and AVE values higher than 0.5 (Hair et al., 2014). On the other hand, Tables 4 and 5 reveal the discriminant validity test results, which were also valid. It can be seen from the scores of cross-loading and Fornell-Larcker, where the AVE root value of each construct was greater rather than the construct squared correlation with other constructs (Barclay et al., 1995; Fornell & Larcker, 1981). Pratolo, Mukti, & Sofyani The Service Quality of Community Health Centers During the COVID-19 Pandemic: … Journal of Accounting and Investment, 2022 | 368 Table 3 Loading and AVE Scores Construct Indicator Code Loading AVE Accountability COVID-19 budget management report to stakeholders AK1 0.869 0.721 Preparing COVID-19 budget realization and related financial report AK2 0.842 Valid recording AK3 0.889 Vaccination report AK4 0.772 Communicative reports (easy to understand) AK5 0.868 Service Quality of COVID-19 handling Health protocols in waiting rooms, the examination rooms, and health tools and equipment used KP1 0.818 0.635 Examination of COVID-19 patients according to the queue KP2 0.793 Responsive service during the pandemic KP3 0.726 Adequate personal protective equipment (standardized) for doctors and medical service employees KP4 0.788 Caution in carrying out every maintenance action KP5 0.720 Medical service employees or community health center employees pay attention to patient complaints. KP6 0.873 Accuracy of COVID-19 detection tools for patients KP7 0.823 Screening every patient who comes to find out whether the prospective patient indicates being exposed to the COVID-19 virus KP8 0.788 Service friendliness KP9 0.794 Understanding of medical service employees on health protocols in preventing the transmission of the COVID-19 virus KP10 0.787 Professional service, without discrimination against general patients and COVID-19-positive patients KP11 0.801 The services provided are under the applicable SOPs. KP12 0.843 Internal Control Community health centers set rules regarding employee ethical standards. PI1 0.781 0.670 The community health center has a clear organizational structure. PI2 0.801 Performance appraisal of medical service employees PI3 0.874 Delegation of authority to appropriate employees and following their level of position to achieve goals PI4 0.824 Inspection of equipment for personal protective equipment for medical service employees is sufficient and per applicable protocols. PI5 0.870 Service risk control PI6 0.860 Pratolo, Mukti, & Sofyani The Service Quality of Community Health Centers During the COVID-19 Pandemic: … Journal of Accounting and Investment, 2022 | 369 Table 3 Loading and AVE Scores (cont’) Construct Indicator Code Loading AVE Internal Control Comprehensive risk analysis of the possible risk of spreading the COVID-19 virus among medical service employees PI7 0.848 Evaluation of risks and actions to minimize them PI8 0.760 Segregation of duties according to responsibilities PI9 0.797 Socialization of the internal control system to all medical service officers/employees PI10 0.755 Internal control information is delivered on time, so there is quick correlative action. PI11 0.812 Supervision to assess the quality of internal control carried out regularly PI12 0.826 Regular monitoring of inputs or complaints filed by the community or patients PI13 0.819 Transparency The openness of the community health center's annual activity plan to be implemented TR1 0.666 0.704 The openness of competence for community health center managers TR2 0.873 Availability of access to information on planning related to handling COVID-19 TR3 0.846 Availability of access to funding plan information TR4 0.879 Availability of access to information on budget work plans TR5 0.886 Availability of access to the preparation of budget work plans TR6 0.862 AVE: Average Variance Extracted Table 4 Cross Loading Code Accountability Service Quality Internal Control Transparency AK1 0.869 0.536 0.734 0.703 AK2 0.842 0.375 0.733 0.660 AK3 0.889 0.376 0.738 0.662 AK4 0.772 0.376 0.600 0.528 AK5 0.868 0.504 0.719 0.714 KP1 0.482 0.818 0.413 0.459 KP10 0.274 0.787 0.316 0.447 KP11 0.313 0.801 0.363 0.470 KP12 0.397 0.843 0.392 0.473 KP2 0.429 0.793 0.388 0.443 KP3 0.427 0.726 0.334 0.395 KP4 0.453 0.788 0.396 0.480 KP5 0.241 0.720 0.189 0.326 KP6 0.493 0.873 0.453 0.516 KP7 0.461 0.823 0.399 0.464 KP8 0.447 0.788 0.375 0.362 KP9 0.411 0.794 0.379 0.396 PI1 0.619 0.237 0.781 0.575 PI10 0.622 0.501 0.755 0.582 PI11 0.752 0.377 0.812 0.643 Pratolo, Mukti, & Sofyani The Service Quality of Community Health Centers During the COVID-19 Pandemic: … Journal of Accounting and Investment, 2022 | 370 Table 4 Cross Loading (cont’) Code Accountability Service Quality Internal Control Transparency PI12 0.724 0.343 0.826 0.612 PI13 0.717 0.293 0.819 0.566 PI2 0.627 0.309 0.801 0.567 PI3 0.668 0.402 0.874 0.614 PI4 0.668 0.313 0.824 0.618 PI5 0.719 0.347 0.870 0.663 PI6 0.705 0.428 0.860 0.689 PI7 0.709 0.460 0.848 0.698 PI8 0.611 0.417 0.760 0.625 PI9 0.690 0.516 0.797 0.640 TR1 0.639 0.336 0.593 0.666 TR2 0.746 0.478 0.709 0.873 TR3 0.587 0.463 0.671 0.846 TR4 0.592 0.458 0.658 0.879 TR5 0.669 0.480 0.558 0.886 TR6 0.663 0.540 0.638 0.862 *Values in bold indicate loadings for items above the recommended value of 0.5. Table 5 Discriminant Validity (Fornell–Larcker) Construct Accountability Service Quality Internal Control Transparency Accountability 0.849 Service Quality 0.515 0.797 Internal Control 0.832 0.469 0.818 Transparency 0.774 0.552 0.763 0.839 Diagonals (in italic bold) represent the root of the AVE, while the other entries represent the squared correlations. Reliability Test Reliability testing was conducted to determine the instrument's consistency, accuracy, and precision in measuring a construct. In doing so, Cronbach's Alpha score was used to measure the lower limit of the reliability value, while composite reliability was employed to estimate the internal consistency of a construct (Achjari, 2004). From Table 6, it can be concluded that the items in this study met the rule-of-thumb requirements. It can be seen through Cronbach's Alpha values greater than 0.6 (Chin et al., 2003). On the other hand, Fornell and Larcker (1981) explained that a composite reliability value of 0.5 or greater is considered acceptable. Table 6 Reliability Test Construct Loading Range Cronbach’s Alpha Composite Reliability Accountability 0.772-0.889 0.903 0.928 Service Quality 0.720-0.873 0.948 0.954 Internal Control 0.755-0.874 0.959 0.963 Transparency 0.666-0.886 0.914 0.934 Pratolo, Mukti, & Sofyani The Service Quality of Community Health Centers During the COVID-19 Pandemic: … Journal of Accounting and Investment, 2022 | 371 Hypothesis Test Table 7 shows the hypothesis testing results, where Panel A provides test results for direct effects while Panel B shows results for indirect effects (mediation). A hypothesis is supported if the p-value is less than 0.05 or the t-statistic value is higher than 1.64 for the one-tailed hypothesis test, as this study did (Ikhsania, 2015). Based on the test, two hypotheses were found to be supported. Table 7 Hypothesis Testing Results Summary Construct Relationship Code Coef. P-Values Supported? Panel A. Direct Relationship Internal Control →Transparency - 0.763 0.000* Not hypothesized Internal Control →Accountability - 0.832 0.000* Not hypothesized Internal Control → Service Quality H1+ -0.020 0.456 No Transparency → Service Quality H2+ 0.392 0.002* Yes Accountability → Service Quality H3+ 0.226 0.119 No Panel B. Indirect Relationship Internal Control → Transparency → Service Quality H4+ 0.300 0.004* Yes Internal Control → Accountability → Service Quality H5+ 0.188 0.121 No *p< 0.01 (highly significant) Discussion Although it was not hypothesized as the primary focus of this research, the results showed that internal control was positively associated with transparency and accountability in the management of community health centers. This result aligns with Purnamadewi et al. (2021); Sari et al. (2020), who stated that the implementation of internal control could improve the practice of transparency. In addition, this study also supports Cuomo (2005) and Widyaningsih (2015), stating that internal control could improve accountability. According to some literature, internal control aims to create operational efficiency and effectiveness, financial reporting constraints, and compliance with regulations (COSO, 2013; Sofyani et al., 2022). Thus, the high internal control triggers high transparency and accountability in the management of community health centers. However, internal control and budget management accounting practices were not associated with the quality of community health center services during the COVID-19 pandemic. These results are not in line with research conducted by ACT Health (2018) and Mwazo et al. (2017). Instead, the service quality of community health centers during the COVID-19 pandemic was only positively associated with transparency in budget management. It is consistent with Bjorkman and Svensson (2009) and Lieberman et al. (2014), which uncovered that the quality of service would increase with good transparency practices. It denotes that the transparency of budget management will create a good monitoring system. Furthermore, with this supervision, the organization can improve the quality of its services to the community. Pratolo, Mukti, & Sofyani The Service Quality of Community Health Centers During the COVID-19 Pandemic: … Journal of Accounting and Investment, 2022 | 372 Furthermore, the indirect effect test results found that the internal control implementation would be positively associated with the service quality of handling COVID-19 only if the practice of transparency followed it. Considering the previous finding that internal control was not directly associated with service quality, the mediation type found in this study is pure. This finding indicates that budget management transparency during the COVID-19 pandemic is crucial and a prerequisite to promoting service quality in handling COVID-19 as it is a form of government responsibility to the community by providing adequate health services. These results support the research by Istikhomah and Asrori (2019) and Saraswati and Larasati (2021) that transparency can be an intervening variable. However, it was found that budget management accountability could not mediate the relationship between internal control and the quality of services for handling COVID-19. These results reinforce the research findings by Christiana and Ardila (2020) that good governance, including accountability, could not be an intervention variable. Drawing from this study's findings, it can be concluded that the COVID-19 pandemic is an extraordinary condition, so handling it requires public calm (Dai, 2020). In this case, transparency will create mutual trust between the government and the community by providing accurate and adequate information because the information is an important need in society to participate in services. On the other hand, in line with the theory of stewardship, the organization must prioritize the interests of the public and all its stakeholders. Implementing an internal control system coupled with transparency will make leaders and employees work together to serve the community's interests and produce good service quality (Block, 1993). Moreover, it is undeniable, even acknowledged by the government, that during this pandemic, the government is faced with a trade-off between service speed and accuracy versus a limited service budget (Ministry of Finance, 2020). Both accuracy and budget constraints require internal control. Good internal control will encourage high accountability and transparency, resulting in accuracy and tight budget usage. However, in extraordinary conditions where service speed is needed, the implementation of internal control sometimes becomes an obstacle (Saravistha et al., 2021). It can be seen that internal control was not directly associated with service quality in this study. Considering the purely mediating role of transparency in influencing the relationship between internal control and service quality, during a pandemic, transparency must be enforced to mitigate internal control practices that are not associated with the service quality of handling COVID-19. Conclusion This study examined the role of internal control system implementation on the service quality of community health centers through transparency and accountability as intervening variables. The study results revealed that internal control was not associated with service quality unless transparency was a prerequisite. Furthermore, while transparency was associated with service quality independently, accountability was not. Drawing from these findings, practical and theoretical contributions were proposed. Pratolo, Mukti, & Sofyani The Service Quality of Community Health Centers During the COVID-19 Pandemic: … Journal of Accounting and Investment, 2022 | 373 Theoretically, this study expands the discussion of stewardship theory related to internal control, governance, and service quality. Explicitly, this study found that the transparency of community health centers’ budget management became a full intervention in the relationship between internal control and service quality. Practically speaking, this study suggests that the quality of service from community health centers will be created if the principle of transparency in managing COVID-19 funds can be implemented properly. This study has several limitations. First, this research was only conducted in the scope of community health centers in the Special Region of Yogyakarta Province. Therefore, the readers should be careful when they want to generalize the results of this study in a wider context. To extend this study, the researchers suggest conducting similar studies in various regions, especially Indonesia. Furthermore, this study used only a survey design. As such, deeper exploration could not be presented in this research. Further research is highly recommended from these limitations to explore similar issues with a qualitative research approach. References Achjari, D. (2004). Partial Least Squares: Another Method of Structural Equation Modeling Analysis. 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Retrieved from https://www.unisbank.ac.id/ojs/index.php/fe3/article/view/5558 https://doi.org/10.20885/jca.vol1.iss2.art4 https://www.iiste.org/Journals/index.php/RJFA/article/view/27843 https://doi.org/10.5129/001041513x13815259182857 https://www.dinkes.jogjaprov.go.id/berita/detail/akreditasi-puskesmas--mutu-pelayanan--akreditasi-puskesmas-apakah-menjamin-peningkatan-mutu-pelayanan- https://www.dinkes.jogjaprov.go.id/berita/detail/akreditasi-puskesmas--mutu-pelayanan--akreditasi-puskesmas-apakah-menjamin-peningkatan-mutu-pelayanan- https://www.unisbank.ac.id/ojs/index.php/fe3/article/view/5558