Indonesia: Decentralized Health Services Project

Date: December 2013
Type: Evaluation Reports
Evaluation; Governance and public sector management; Health
Series: Project Performance Evaluation Reports
Project Number: 34007-012; 34007-013


This performance evaluation report provides a set of lessons from a sector-wide, reform-based health program in Indonesia going through a process of decentralizing government services since 1999. The findings from the evaluation will feed into higher-level evaluations, including validation of the country partnership strategy final review planned for 2014.

The project aimed to improve the health status of the population in the project areas. It had twin objectives of improving health and family planning services, and guaranteeing access of the poor to essential health and family planning services. ADB provided for a loan of $65 million. The project was originally designed to cover 50 districts and 12 cities in seven provinces but, as decentralization evolved, the coverage expanded to 73 districts in eight provinces.

The evaluation concludes that project performance was successful overall. Primary, district, and provincial health services have developed to improve access for a greater number of people, including those in remote and rural areas, because of project support. Locally, however, health service delivery has been constrained by limited funding that focuses on administrative expenditure and involves significant transaction costs. Insufficient recurrent expenditure, limited hospital beds and specialists, and high staff turnover are often inadequately dealt with. Nevertheless, the central government is responding to some of these concerns with the introduction and subsequent scaling up of health insurance schemes such as those initiated under the project.

The evaluation recommends a number of measures, among them, that ADB should promote that local, district, provincial, and central governments work on and adhere to a clear funding framework for stronger health and family planning services at all levels. Health service facilities need reliability and less complexity in funding for infrastructure development, procurement of equipment and drugs, and retention of qualified health workers.


  • Basic data
  • Executive summary
  • Introduction
  • Design and implementation
  • Performance assessment
  • Other assessments
  • Issues, lessons and follow-up actions
  • Appendixes