Document up-dated in May 2009 Country: Indonesia

TITLE OF PROPOSAL: HEALTH SYSTEM STRENGTHENING Time Period ISO Code HSS Prop. Nat. Health Plan Total Budget App. by Board: USD

Round

Approval Track First Submitted: 07.03.08 App. W conditions: n.a. Not approved: n.a. Resubmitted: n.a. First Approval: 26.06.08

Total Amt Disb-ed up to last date

Last Disbursement Date

IDN

20082009

20042009

24,827,500

7,961,000

20.03.09

SECTION I: HSS PROPOSALS AND NATIONAL HEALTH POLICIES: LINKAGES

National Health Policy Goals

Improved quality of health services through social mobilization and community empowerment for alert villages which can support health facilities providing basic services of preventive and promotive care, family planning, pregnancy and delivery care, nutrition, and management of health emergencies Improved surveillance of disease threats, and a revised health information system; Provision of a supportive legal and regulatory framework;

: Proposal Goals
The overall goal is to tackle those systemic obstacles to the improvement of the health of mothers, infants and children. Particular focus will be on the weaknesses in the community support for outreach services, and in the management of the outreach services by the public provider system. Communities (5) with low immunisation coverage will be targeted.

Proposal: Specific Health System Development Objectives: MCH & Immunisation focussed Health System Wide Community mobilization to enable an understanding of the fundamentals of healthy living; The provision of MCH outreach services; Support greater involvement of nongovernment Improvement of the management of MCH actors in partnerships to strengthen communities and services in the public provider system deliver effective services; and especially at district and health centre levels Conduct operational research on two of the more intractable problems facing the health system: viz, the motivation of the health workforce, and contracting of non-government providers.

Document up-dated in May 2009

SECTION II: IMPLEMENTATION ACTIVITIES, AND BUDGETARY ALLOCATIONS** Budgetary Allocation Unmet Needs, Bottlenecks& Barriers Identified:
Governance, Management, Organisational Unproductive separation between the public provider system and the CSOs serving the same catchment populations; Weaknesses in planning and supervision of services; Physical and geographic barriers to access in low population density areas (e.g. mountainous and remote island locations. Human Resource Development/Performance Management. Limited capacity of frontline health personnel to organize and deliver effective outreach services which depend on the linkage between the health providers and the communities they serve. Inadequate motivation of both community volunteers and salaried staff,

Proposed Tasks/Activities USD

Assessment and mapping of community activities in the selected provinces; Needs assessment by MoH/PHO/DHO staff of MCH management issues at district and puskesmas levels; Advocacy by MoH/PHO staff to district administration and political leaders for adequate budgetary support of MCH activities; Identification of partners, development of action plans, formulation of MOUs; Strengthening coordination, implementation of MOU, including regular consultations and joint monitoring and evaluation; Engaging private sector partners in MCH service delivery; orientation to government policies on MCH, and sensitisation of TBAs & private midwives; Selection of kaders (CHWs) in communities, village level training of kaders; Sensitisation of community and religious leaders to MCH issues, & the role of kaders; Devt. and distribution of management tools & guidelines, & training materials; Plan, design and conduct training of District Training Teams; Puskesmas team training in micro-planning, supervision, M&E, surveillance and managing community development; Pilot project on contracting health service provision for an under-served locality in Papua; Operational research on incentives for kaders and salaried staff of puskesmas. Devt., procurement and distribution of IEC materials and equipment; Assist with operational costs of community level collective action; Provide operational cost to support implementation of improved management in the topics of the team training. ------------------------------------------------------------------------------------Management of HSS 4,999,776

%
20.1

9,190,973

37.0

Drugs, Equipment, Supplies, Facilities ----------------------------------Monitoring and Evaluation Major weaknesses in the information system. Other: Inadequate popular demand and community support for preventive & MCH services. Overheads

8,935,384

36.0

----------1,701,117

---------6.9

TOTALS

24,827,250

100.00

** These figures are based on the Budgets provided by the country.

Health financing Gap: Not stated.

Document up-dated in May 2009

SECTION III - PERFORMANCE MONITORING, & EVALUATION ACTIVITIES Expected Source of Data/Information

Indicator Outcomes/Outputs: National DTP3 coverage (%); Number / % of districts achieving 80% DTP3 coverage; Under five mortality rate (per 1,000); Infant mortality rate (per 1,000); Attended delivery rate (%);

Baseline Values

Final Targets 2009 95% 85% 27 26 20%

Not stated Not stated 46 (2000) 35 (2000) Not stated

The following will provide the data:

Directorates of Child health % Maternal Health; District & Provincial Health Offices; EPI Division

% of community health workers (kaders) in target sub-districts trained in community mobilization; % of villages which received operational cost support; % of the target sub-districts with staff trained in management; % of the sub-districts regularly following good management practices after training; % of the target districts having joint regular meeting with CSOs (at least 3 p.a.)

Not known n. a Not known n.a. n.a."

80% 100% 100% 100% 100%

SECTION IV: PROPOSAL DEVELOPMENT, SUPPORT AND MANAGEMENT Country Management of Implementation: General management by HSCC & the Executing Agency, Directorate General of Communicable Disease Control and Environmental Health. Implementing agencies:= Directorates of Community Health, Maternal Health, Child Health; Health Promotion; and the Center for Planning and Management of Human Resources for Health. At Provincial & District levels the planning divisions. Channelling/Management of funds: Following existing GOI procedures funds will be received by the CDCMOH & overseen by the Ministry of Finance; Funds will be transferred into special accounts at provincial and district levels in accordance approved action plans. Fund managed by DHOs. Internal audit % an external audit will be conducted by the State Audit Authority (BPK) Strategies proposed for sustainability of activities: Govt commitment is demonstrated by a) the rapid expansion (avg. annual rate in excess of 15% since 2000) of public health expenditure especially at community level; b) the establishment of partnerships with CSOs, the networking developed between district authorities, health providers and communities, improved micro planning capacity, monitoring and evaluation of activities, the training and re-tooling of key personnel & the development of IEC and training materials. Collaboration with/ Involvement of other organisations in i) Proposal Design & Planning: Existing bilateral and multilateral agencies; Reps. from private and civil society organisations (not specified) ii) Proposal Management: None stated iii) Proposal Implementation: None stated Other Financial Support for HSS: Not stated

Document up-dated in May 2009