Indonesia: Second Decentralized Health Services

Sovereign Project | 34149-013 Status: Closed

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Project Name Second Decentralized Health Services
Project Number 34149-013
Country Indonesia
Project Status Closed
Project Type / Modality of Assistance Loan
Source of Funding / Amount
Loan 2074-INO: Second Decentralized Health Services
Ordinary capital resources US$ 64.80 million
Loan 2075-INO: Second Decentralized Health Services
Asian Development Fund US$ 35.20 million
Strategic Agendas Inclusive economic growth
Drivers of Change Governance and capacity development
Sector / Subsector

Health - Health system development

Gender Equity and Mainstreaming Gender equity
Description The goal of the Project is to improve the health status of the people by enhancing service coverage, quality, and utilization of health facilities. The objective of the proposed project is to assist local governments, health professionals and communities in identifying health needs and priorities, developing locally appropriate solutions and improving health services quality. The project will comprise capacity building and training activities, physical investments to improve service quality, and support for locally adapted health sector reforms.
Project Rationale and Linkage to Country/Regional Strategy
Impact Improved health status of the population, especially of poor and vulnerable groups.

Project Outcome

Description of Outcome Improved health services in 9 provinces and 90 districts and cities.
Progress Toward Outcome

The Project's impact and outcome indicators baseline refers to the 2003 Indonesian Demographic Health Survey (SDKI). SDKI surveys have been performed in 2003 and 2007. The results of the 2012 SDKI survey are expected by end of 3rd quarter 2013.

MOH yearly reports show a positive trend in maternal mortality rates (All provinces have reached or exceeded the 220 maternal deaths per 100,000 living births target). By contrast, only one province (West Sulawesi) reaches the infant mortality rate target. However, the indicators will be compared and analyzed when 2012 SDKI report will be published.

Measles immunization coverage increases from 78.4% in 2003 to 85% in 2012. MOH communicable diseases control (P2M) 2011 data show that 8 provinces among 9 have reached or exceeded project's target. East Nusa Tenggara province has not reached yet the target. However, indicator results have to be confirmed using SDKI data.

By the end of 2012, contraceptive prevalence rate increases by 10% from benchmark 2003 in every province. Based on the BKKBN annual mini surveys results, contraceptive prevalence rates (CPR) increased in 7 provinces from 2005 to 2011. Only South Sulawesi and Gorontalo provinces show a decrease in CPR. However, only NTT province has achieved the project's target (10% increase from baseline 2005).

Unmet needs for family planning services decreases from 10.5% (2003) to 8% (2012). Four provinces (South Sumatera, Bangka Belitung, Central Kalimantan, South Kalimantan) have reached and exceeded the 8% target. Three provinces (NTT, NTB and West Sulawesi) have reduced unmet needs, but do not reach the project's target yet. In two provinces (South Sulawesi and Gorontalo), unmet needs for family planning have increased compared to the 2003 baseline.

Births attended by skilled medical staff increases from 53.4% (2005) to 80% in (2012). All provinces except 2 (Central Kalimantan and East Nusa Tenggara) have reached the project's target.

Implementation Progress
Description of Project Outputs

Strengthened maternal and child health (MCH) services

Enhanced community participation in improving maternal and child health (block grants for desa siaga)

Revitalized family planning services.

Improved district capacity in managing decentralization

Strengthened government capacity to support decentralized health service

Status of Implementation Progress (Outputs, Activities, and Issues) The Project has satisfactory completed all activities in the 9 original project provinces by end of 2012. Target indicators have been met and executive agency (EA) is closing the provincial financial accounts. Civil works in West Sumatera have stalled because carried over 2012 national budget (DIPA) was not released until end-July and so contractors did not receive timely payment and stopped work for some time. Civil works are expected to be completed by 30 November 2013. The Project's closing date is confirmed on 31 December 2013.
Geographical Location Bangka Belitung, Central and South Kalimantan, East and West Nusa Tenggara, Gorontalo, South and West Sulawesi, South Sumatra, West Sumatra

Safeguard Categories

Environment B
Involuntary Resettlement
Indigenous Peoples

Summary of Environmental and Social Aspects

Environmental Aspects

The Borrower will ensure that an initial environmental evaluation/

environmental impact assessment is prepared for each candidate subproject. Subprojects with a

value of $300,000 or less will be submitted to the relevant regional environment office for

approval prior to subproject approval; subprojects with a value of more than $300,000 will be

submitted for ADB approval prior to subproject approval. The Borrower will ensure that all

actions taken as a result of the DHS2 are in accordance with the ADB's Environmental

Assessment Guidelines 2003 and all applicable Indonesian environmental laws and regulations.

The Borrower will ensure that MOH and BKKBN strictly apply an environmental review

procedure, as agreed upon by the Borrower and ADB, when reviewing subprojects for approval.

The Borrower will cause MOH and BKKBN to ensure that all works are carried out in

accordance with the approved initial environment evaluation and environmental management

and monitoring plan.

Involuntary Resettlement

The Borrower will ensure that, within 1 year of the

loan effective date, all land acquisition and resettlement activities will have been completed in

accordance with the resettlement framework agreed upon by the Borrower and ADB; the

Borrower's laws, regulations, and procedures; and ADB's requirements as defined in ADB's

Policy on Involuntary Resettlement and the Handbook on Resettlement. No civil works will

commence in any geographic area prior to completion of resettlement and income restoration

activities in that geographic area.

Indigenous Peoples

The Borrower will ensure that measures are undertaken to

promote full participation of indigenous peoples in project activities, including developing

mechanisms to include indigenous peoples in capacity building and training under the DHS2.

The PPMS developed under the DHS2 will include performance indicators that facilitate the

monitoring of participation of indigenous peoples in project activities. The Borrower will ensure

that project activities are carried out in accordance with ADB's Policy on Indigenous Peoples

and in accordance with the Action Plan for Indigenous Peoples and the Specific Action Plan for

Indigenous Peoples, as agreed upon by the Borrower and ADB.

Stakeholder Communication, Participation, and Consultation
During Project Design
During Project Implementation

Business Opportunities

Consulting Services To be determined.
Procurement To be determined.

Responsible Staff

Responsible ADB Officer Barbara Lochmann
Responsible ADB Department Southeast Asia Department
Responsible ADB Division Human and Social Development Division, SERD
Executing Agencies
Ministry of Health
Dr. Budihardja, Director General for Public Health
dhs2 project
MOH Building, Block C, Floor IX, Rasuna Said, Jakarta


Concept Clearance 08 Mar 2002
Fact Finding 07 Jul 2003 to 18 Jul 2003
MRM 10 Oct 2003
Approval 19 Dec 2003
Last Review Mission -
PDS Creation Date 01 Dec 2006
Last PDS Update 27 Sep 2013

Loan 2074-INO

Approval Signing Date Effectivity Date Closing
Original Revised Actual
19 Dec 2003 16 Dec 2004 29 Mar 2005 31 Dec 2010 31 Dec 2013 08 Aug 2014
Financing Plan Loan Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 64.80 Cumulative Contract Awards
ADB 64.80 19 Dec 2003 42.42 0.00 91%
Counterpart 0.00 Cumulative Disbursements
Cofinancing 0.00 19 Dec 2003 46.37 0.00 100%

Loan 2075-INO

Approval Signing Date Effectivity Date Closing
Original Revised Actual
19 Dec 2003 16 Dec 2004 29 Mar 2005 31 Dec 2010 31 Dec 2013 08 Aug 2014
Financing Plan Loan Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 35.20 Cumulative Contract Awards
ADB 35.20 19 Dec 2003 37.26 0.00 98%
Counterpart 0.00 Cumulative Disbursements
Cofinancing 0.00 19 Dec 2003 37.95 0.00 100%
Title Document Type Document Date
Second Decentralized Health Services: Project Completion Report Project/Program Completion Reports Sep 2014
Second Decentralized Health Services Project: Summary Poverty and Social Assessment Initial Poverty and Social Analysis May 2004
Second Decentralized Health Services Reports and Recommendations of the President Nov 2003

Safeguard Documents See also: Safeguards

Safeguard documents provided at the time of project/facility approval may also be found in the list of linked documents provided with the Report and Recommendation of the President.

Evaluation Documents See also: Independent Evaluation

None currently available.

Related Publications

None currently available.

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