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Indonesia
>> Regional Overview >> Indonesia Overview ACTIVITY DATA SHEET
PROGRAM: Indonesia
TITLE AND NUMBER: Health of Women and Children Improved,* 497-008
STATUS: Continuing
PLANNED FY 2001 OBLIGATION AND FUNDING SOURCE: $10,000,000 DA; $19,580,000 CSD
PROPOSED FY 2002 OBLIGATION AND FUNDING SOURCE: $10,000,000 DA; $21,280,000 CSD; $2,500,000 ESF
INITIAL OBLIGATION: FY 1999 ESTIMATED COMPLETION DATE: FY 2003Summary: Indonesia faces a health and health care crisis. The progress made in building a national health care system and improving health status has been undermined by several years of economic and political turmoil in Indonesia. In January 2001, Indonesia launched a massive decentralization program, placing additional pressure on the health care system as local governments assume planning and budgetary authorities. An estimated 80 million people (nearly 40% of the total population) continue to live below or near the poverty line and cannot meet basic needs, including a nutritious diet, transportation to health facilities, and payment of fees for health care, medicines, and contraceptives. Many Indonesians can no longer afford care from private providers and must increasingly rely on the public sector for maternal health care (i.e., safe pregnancy and delivery); prevention of neonatal mortality; prevention of micronutrient deficiencies; family planning; child health services; and treatment and control of infectious diseases. Indonesia also faces a rapidly increasing threat from HIV/AIDS and a resurgence of infectious diseases, such as tuberculosis (TB) and malaria.
This strategic objective will improve the health of women and children by strengthening local government commitment for reproductive and child health; improving access, quality and sustainability of health service systems; and empowering women, families and communities to take responsibility for improving health.
Key Results: At the strategic objective level, impact will be demonstrated by increases in the national contraceptive prevalence rate and the proportion of births attended by trained personnel. Achievement of this objective also relies on three key intermediate results: 1) policy environment for reproductive and child health improved; 2) health service systems strengthened to improve access, quality and sustainability; and 3) women, families and communities empowered to take responsibility for improving health.
Performance and Prospects: USAID intends to obligate a total of $29.58 million in FY 2001 ($10 million in DA and $19.58 million in CSD) to improve the health of women and children in Indonesia. This objective was refined in FY 2001 as USAID shifted from a "Crisis and Response Strategy (1998-2000)" to a "Transition to Democracy Strategy (2000-2004)." Activities under the crisis strategy will continue through FY 2001. These activities are designed to meet the needs of the urban poor and internally displaced persons. These activities will monitor family planning utilization, maternal health, and the nutritional status of mothers and children. In FYs 2001-2003, USAID activities will help local governments ensure that the delivery of health services does not decline in quality or scope under decentralization. USAID will also address the sharp increases in HIV/AIDS, TB and malaria.
USAID support allows the Government of Indonesia and nongovernmental organizations (NGOs) to play an active role in the collection, analysis and dissemination of data required by policy makers to determine resource allocations for health sector programs. USAID programs have played an important role in defining the policy agenda for the Ministry of Health and Social Welfare and assisting it to monitor the effects of the crisis on health service delivery and use. However, with decentralization, the centralized systems used in the past to implement national programs may not be the priority of local governments. Protection of the most vulnerable groups requires decision-makers at the local level to identify the effects of household and government expenditures on nutritional intake, disease outbreaks, and use of the health care system. This will allow local governments to prioritize limited resources for basic preventive health services, family planning, maternal/child health and nutrition, and prevention and control of HIV/AIDS, TB and malaria. Strengthening the Government of Indonesia capacity at all levels to monitor health, nutrition and disease and to prioritize resources for health will be important for the transition period and beyond.
Key primary health care services continue to be available to those most adversely affected by the political and economic crisis in Indonesia through the health Social Safety Net program, which is scheduled to be completed in 2001. However, the availability and use of high quality primary health care services remains low and consequently improvements in the health status of women and children have been marginal. Maternal mortality remains high because the providers used by poor women have not been trained properly. Use of basic child health services is static, which has led to increased child mortality. A lack of reliable contraceptive choices and appropriate counseling has resulted in increased unintended pregnancies and higher birthrates.
In FY 2001, USAID plans to provide $10 million in DA funds to improve the quality of reproductive and family planning services and increase acceptability, availability and effective use. Support would also be provided to a national demographic and population survey, communication strategies, and program management. USAID activities are also providing contraceptives to expand method choice and strengthening the provision of quality family planning and counseling services in selected districts.
Policies affecting the price and availability of rice, the staple food of the poor, have resulted in micronutrient deficiencies and poor nutritional status of women and children. Sexually transmitted infections and intravenous drug use have increased, which have contributed to the spread of HIV/AIDS. Shortages of diagnostics and drugs have impeded the ability of the health system to diagnose and treat infectious diseases.
In response, USAID activities are addressing high priority needs. Micronutrient supplementation (particularly vitamin A and iron) in selected areas has increased vitamin A coverage in children aged 12-59 months from 65% in 1999 to 70% in 2000, which has saved an estimated 47,000 lives. Child feeding programs, in collaboration with other donors, are assisting the urban and rural poor benefiting over 150,000 infants. USAID has responded quickly to meet health and nutrition needs in areas affected by conflict such as the Malukus and, most recently, the Madurese evacuated from Central Kalimantan. Over 320,000 internally displaced persons have benefited from this type of assistance.
In FY 2001, USAID plans to provide $14.8 million in CSD funds to improve the survival of vulnerable women and children through expanding vitamin A capsule distribution, conducting surveillance to identify micronutrient, health and nutritional status, reducing micronutrient deficiencies that contribute to maternal, neonatal and low birth weight, training midwives and doctors in essential life saving clinical skills, improving community and family level preparedness to address the most important causes of maternal and neonatal morbidity and mortality and improving the care of mothers and their newborns in the home during the first week of life. Support is also provided for surveillance and case detection for acute flaccid paralysis (AFP) for the National Polio Eradication Initiative and for vulnerable children in complex emergency situations.
With CSD funding, USAID activities support: introducing clinical principles of preventing and managing complications in pregnancy and childbirth in pre-service and in-service training of midwives and doctors; U.S. private voluntary organizations, indigenous NGOs and private sector entities that provide primary health care programs at the community level; and improving service delivery and education to prevent the transmission of STIs and HIV/AIDS and other infectious diseases, specifically TB and malaria.
In FY 2001, USAID plans to provide $3.88 million in CSD funds to support the STI/HIV/AIDS initiative that will increase the use of high-quality services and promote prevention behavior by high-risk groups. Activities will be focused on ten large urban port cities that represent the highest risk for transmission of HIV/AIDS.
Also in FY 2001, USAID plans to provide $900,000 in CSD funds to the Tuberculosis Coalition for Technical Assistance managed by USAID's Global Bureau. Specific activities in Indonesia will be managed by the Royal Netherlands Tuberculosis Association in association with the National Stop TB program to implement the Directly Observed Treatment Short Course strategy.
During a time of transition and decentralization of health services, effective communication is needed at all levels to advocate for sustained improvements in the health of women and children. USAID is working to empower women, families and communities in defining health needs and advocating for high quality, responsive family planning and maternal/neonatal health programs. Care-seeking behaviors for maternal and child survival are being mobilized. Knowledge and utilization of micronutrient rich foods and supplements to improve maternal and child nutrition will be increased. USAID has helped to establish a health coalition consisting of NGOs, local health boards and advocacy groups to develop a public information and media program in support of healthy life styles for a Healthy Indonesia 2010. Over time, the new paradigm will shift the health program from a highly centralized program focused on curative care to a decentralized one based on prevention. Families will also have comprehensive information about service availability in the private sector.
Possible Adjustments to Plans: Program emphasis has been on reproductive and child health (including family planning, maternal, and newborn health), nutrition, and HIV/AIDS. Additional support for infectious disease programs, particularly TB and malaria, may be needed over the next several years. Government of Indonesia and USAID monitoring efforts will determine necessary program adjustments.
Other Donor Programs: USAID works closely with several bilateral and multilateral donors active in the health sector. The Asian Development Bank and World Bank have significant investments in the health Social Safety Net program and are initiating block grants to allow selected provinces to test varying approaches to the decentralization of health services. Australia will support a Decentralization Unit in the Ministry of Health and Social Welfare and will continue its women's health program in eastern Indonesia. Canada is completing its donation of oral contraceptives. Japan will assist the Government of Indonesia in maintaining essential blood bank and transfusion services in Sulawesi and provide support for medicine and disposable medical supplies. The Netherlands will donate $4 million for control of TB. The United Nations Fund for Population Assistance will initiate a new country program on reproductive health with a special focus on adolescents. The United Nations Children's Fund will launch a new country program with a focus on growth monitoring, salt iodization, and rights of women and children. The World Health Organization will introduce a "Making Pregnancy Safer" initiative, and support planning for decentralized health systems and infectious diseases.
Principal Contractors, Grantees, or Agencies: Helen Keller International; Johns Hopkins University; Save the Children; Program for Appropriate Technology in Health; Family Health International; World Vision; Ministry of Health and Social Welfare; Ministry of Women's Empowerment; the National Family Planning Coordinating Board; the Midwives Association; and the Royal Netherlands TB Association.
* Previously reported as "Protecting the Health of the Most Vulnerable Women and Children."
FY 2002 Performance Table
Indonesia: 497-008
Performance Measures:
Indicator FY97 (Actual) FY98 (Actual) FY99 (Actual) FY00 (Actual) FY00 (Plan) FY01 (Plan) FY02 (Plan) Indicator 1: Contraceptive prevalence rate remains stable 57% NA NA NA NA NA 57% Indicator 2: Increased vitamin A capsule (VAC) coverage among children 6-11 months old NA NA 41% 61% 53% 64% 77% Indicator 3: Increased condom use in last commercial sex encounter NA 37% 48% 41% 65% TBD TBD Indicator 4: Proportion of births attended by a skilled provider 31% NA NA NA NA 32% 33% Indicator 5: Improved quality of care in family planning program NA NA NA NA NA NA 1.5 point increase over baseline Indicator 6: Increased proportion of pregnant women in program areas with a birth plan NA NA NA NA NA NA 41% Indicator Information:
Indicator Level (S) or (IR) Unit of Measure Source Indicator Description Indicator 1: S Percentage Indonesian Demographic and Health Survey CPR is the number currently married women age 15-49 using contraceptive methods divided by total number of currently married women age 15-49. Indicator 2: IR Weighted proportion. Intervention areas represent over 70% of population in 11 sites: 4 urban slum zones (Jakarta, Surabaya, Semarang & Makassar), and 7 rural zones (West, Central and East Java, South Sulawesi, Lombok, West Sumatera & Lampung) GOI/HKI Nutritional and Health Surveillance System Weighted proportion of children age 6-11 months old who reportedly received 100,000 IU dose of vitamin A during the most recent semi-annual campaign (February and August) Indicator 3: IR Percentage weighted aggregate average for all intervention sites Behavioral Surveillance Survey (special survey). The number of female commercial sex workers (FSWs) who report using a condom with their most recent client divided by number of commercial by the number of FSWs interviewed. Indicator 4: S Number of births attended by a skilled provider divided by number of total births a) Demographic and Health Survey (DHS); b) Nutrition and Health Surveillance System (NHSS) and special survey. Attended birth: skilled provider (midwives or physician) present at stages II, III, IV of labor/delivery. Indicator 5: IR Scale of 1 to 10 Quick Inventory of Quality (QIQ) survey Mean score among health centers surveyed on family planning quality index (QIQ) composite. Indicator 6: IR Women with birth plan divided by women with a live birth in past year Special Population-based survey program areas in W. Java Birth plan included a composite of behaviors including women seeing a trained provider for antenatal care, delivery, post-partum and postnatal care U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 62,774 DA 48,791 DA 13,983 DA 15,550 CSD 4,300 CSD 11,250 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Fiscal Year 2000 9,500 DA 1,697 DA 18,782 CSD 12,714 CSD 0 ESF 0 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 0 DFA Through September 30, 2000 72,274 DA 50,488 DA 21,786 DA 34,332 CSD 17,014 CSD 17,318 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Prior Year Unobligated Funds 0 DA 0 CSD 0 ESF 0 SEED 0 FSA 0 DFA Planned Fiscal Year 2001 NOA 10,000 DA 19,580 CSD 0 ESF 0 SEED 0 FSA 0 DFA Total Planned Fiscal Year 2001 10,000 DA 19,580 CSD 0 ESF 0 SEED 0 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 10,000 DA 16,000 DA 108,274 DA 21,280 CSD 35,495 CSD 110,687 CSD 2,500 ESF 0 ESF 2,500 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA
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Last Updated on: May 29, 2002 |
