Ex-post Evaluation

1. Outline of the Project

Country:

Indonesia

Project title:

The Project for Strengthening District Health Services in Sulawesi

Issue/Sector:

Health and medicine

Cooperation Scheme:

Grant Aid

Division in Charge:

Grant Aid Management Department

Total Cost:

1,209 million yen

Period of Cooperation

FY 1995

Partner Country’s Implementing Organization:

Ministry of Health’s District Health Offices, Health Center Development Office

Supporting Organization in Japan:

Related Cooperation:

1-1 Background of the Project

In Indonesia, facilities such as health centers, midwife clinics, centers for small-scale examinations and educational activities using private residences, and pharmacies were located in each districts and villages. These facilities provided residents with basic health and medical services in areas without hospitals. However, despite the steady economic growth, the mountainous region of eastern Sulawesi still lagged behind in development. Medical facilities in Sulawesi like those described above lacked diagnostic and therapeutic equipment and did not have enough cars for medical staff to make medical check tours. Therefore, the standards of the medical services were extremely low, and it was a crucial issue that diseases which could be prevented and treated in other regions could be fatal in this particular area.

In these conditions, the government of Indonesia requested the Japanese government for cooperation in their plan to provide the equipment needed to improve basic medical services across the Sulawesi island and to strengthen the maternal health program.

1-2 Project Overview

The employment of equipment to improve basic medical services and the development of the maternal health program is procured for Sulawesi’s regional health and medical facilities in order to contribute to the improvement of medical standards in local areas of Sulawesi.

(1) Overall Goal
To improve medical standards in Sulawesi.

(2) Project Purpose
An environment that provides appropriate medical services is developed in Sulawesi’s regional health and medical facilities.

(3) Outputs
1) Equipment that strengthens educational activities for local residents and regional health care is provided.
2) Equipment to strengthen the function of maternal health programs is procured.
3) Equipment that strengthens the supervisory and instruction capacity in the state and province are provided.

(4) Inputs

Japanese Side: 1,209 million yen

2. Evaluation Team

Members of Evaluation Team

Thomas WIDODO
PT. Mitrapacific Consulindo International (MCI)

Period of Evaluation

January 29, 2003 – February 21, 2003

Type of Evaluation:

Ex-post Evaluation by Overseas Office

3. Results of Evaluation

3-1 Summary of Evaluation Results

(1) Impact
This project targeted 8,084 facilities, covering health facilities as the smallest unit, in all four provinces in Sulawesi and providing 106,000 pieces of equipment and material. As a result, the medical services in the regions improved overall, training activities for disease prevention and diagnosis improved, the maternal death rate declined, and the technique of medical personnel improved.

Providing cars, boats and medical education kits needed for traveling medical services enabled educational activities, lowered the maternal and infant mortality rate and led to improvements in maternal/infant health and health awareness. School programs using the equipment provided for local health and hygiene education activated their health programs.

(2) Sustainability
Most of the equipment provided in the project was basic and not difficult to operate, and had been already used in all health centers. Operating manuals in Indonesia are provided with the equipment as necessary. Although the measure of ensuring consumable supplies for the future is vital, most of the equipment operates in good condition. However, there is some equipment which is not used constantly due to the shortage of funds. This results in the insufficiency in consumable supplies. There is also some other equipment which can not be maintained in health centers and requires support from district level health centers. Regarding the new oxygen tanks introduced, sometimes the oxygen supply takes time it is supplied from the district health centers.

With the decentralization in 2000, the health centers were put under the jurisdiction of the health department of the local government by command of the central government. They were responsible for planning and implementing all health service in the local communities, and mandated to provide medical services that would meet the needs of the communities. However, since health centers formerly implemented projects following the instruction by the central government, technical support by the central government is still needed at the time of evaluation.

Before the decentralization, the health centers implemented activities with a budget for each program from the central government, but currently the budget from the prefectural health department is the main source, and sometimes it is insufficient. The health centers needs to find another source of revenue to activate their programs fully, but the profit from patients is not stable and their activities are sometimes restricted. In addition, supply of commodity sometimes takes time due to the shortage of budget.

3-2 Factors that promoted realization of effects

Most of the equipment was basic and most of which had already been used in the health center level. The provision of operation manuals written in Indonesian enabled medical personnel even in isolated areas to operate the equipment without major problems.

3-3 Factors that Impeded Realization of Effects

N/A

3-4 Conclusion

Almost all of the equipment procured to targeted facilities in the project including the smallest health centers in the four provinces in Sulawesi was operated in good condition. The project contributes to improve health awareness, patient care, diagnosis and treatment in local areas in Sulawesi where development is slow due to the mountains. With the decentralization in 2000, the position of the health center was changed, and was put under the jurisdiction of the prefectural health department by command of the central government. Although the activity at the health center is supported largely with the budget from the prefectural health department, it is sometimes insufficient. In addition, income from other resources is not stable. As a result, the activities are sometimes restricted and it sometimes takes time to supply consumables for the equipment.

3-5 Recommendations

The local government needs to consider an increase in budget in order to enable the health centers to activate their programs fully and supply consumables for the equipment regularly.