Indonesia Health Systems Strengthening Project

active

Prospective

Spanning 5,100 km from west to east and with a population of over 273 million people, Indonesia is the largest archipelagic nation in the world. It is also a vastly diverse nation, with nearly 1,300 ethnic groups spread across 17,500 islands, speaking about 700 different languages. Against this backdrop, it has been difficult for the Government of Indonesia (GoI) to achieve economic growth equitably across the nation. Indonesia has achieved significant gains in health outcomes but continues to lag behind regional and economic peers. However, there are regional disparities in healthcare access and quality leading to widely varied health outcomes across the nation. Insufficient access to referral-level health services also exists across Indonesia, contributing to low health outcomes and high healthcare costs. There is widespread lack of access to referral-level hospital services, especially in remote and rural areas of Indonesia. Currently, the facilities with the capability to deliver standardized services for critical non-communicable diseases are still concentrated on the island of Java. Further, the COVID-19 pandemic exposed and exacerbated significant shortcomings and spatial and socioeconomic inequities in Indonesia’s public health system, which need to be urgently, comprehensively, and concertedly addressed. These shortcomings emerged both in terms of the capacity of primary and referral-level care to provide high-quality and equitable health services to all Indonesians, especially when confronted with public health shocks and peak demand, as well as in the coverage and surveillance capacity of its public laboratory system to detect, monitor, and report on known and newly emerging public health threats. MoH, based on the mandate of President Joko Widodo, has initiated a Health Transformation Agenda (2021 to 2024) in the wake of the COVID-19 pandemic. This comprehensive transformation of the country’s health system comes in response to the pressing gaps in the Indonesian public health and surveillance system that, although previously in existence, were highlighted by the pandemic. Given the pressing equipment needs of Indonesian public health facilities, the proposed Project seeks to contribute to the provision of equipment to all public health facilities across Indonesia to ensure the filling the critical service delivery gaps identified through the MoH gap assessment, aligned with both the Indonesian Health System Transformation Agenda led by MoH and the directions and policies of the health development strategy in the GOI’s National Medium Term Development Plan (RPJMN) for 2020-2024. The gap assessment demonstrated that the total public health system facility equipment needs total US$3.979 billion. Of this, the primary care facility needs total US$1.59 billion, the hospital care facility needs total US$1.80 billion, and the laboratory facility needs total US$590 million. Under the leadership of MoH, Bappenas, and MoF, the decision was made to close the equipment gaps through a single-phased, comprehensive investment, without phasing over time or geographic slicing, with all procurement to be completed by the end of the first project year at the end of 2024. MoH has opted for a partnership of four MDBs to deliver on this project with the World Bank as coordinator. The partnership of MDBs includes the World Bank (WB), Asian Infrastructure Investment Bank (AIIB), Asian Development Bank (ADB), and Islamic Development Bank (IsDB), will jointly support the Government to deliver on this transformative operation. MoH and the MDBs have agreed on (i) a joint co-financing between WB, AIIB, and ADB for the primary care component, (ii) a joint co-financing between WB and ADB for the laboratory component, and (iii) a joint co-financing between WB and AIIB, as well as parallel co-financing from IsDB, for the referral hospital component. As guided by MoH, all MDBs that form part of the joint co-financing arrangement have agreed to use World Bank procurement regulations. The financing share of the World Bank is at US$1.485 billion equivalent. The proposed Project is also closely aligned with the World Bank Group’s Indonesia Country Partnership Framework (CPF) for Fiscal Year (FY) 2021-2025. Its development objective, which seeks to strengthen health and laboratory facilities’ service readiness and improve access of all Indonesians to integrated, quality health services in the country, resonates strongly with the CPF Objective 3.2 on strengthening the quality and equity in nutrition and health. This is part of Engagement Area 3, ‘Nurture Human Capital’. The Project sets out to contribute to addressing the critical health sector challenges identified in the CPF. The proposed Project will have the following key components and activities: (a) Component 1: Procurement, installation, operation, and maintenance of equipment to primary care facilities across Indonesia “Strengthening of Primary Healthcare in Indonesia’ or SOPHI component. This component seeks to contribute to the procurement of equipment for all Posyandu, Pustu, and Puskesmas, as well as Tier 1 public health laboratories across Indonesia. The types and numbers of equipment, as well as the facility location where these pieces of equipment will be delivered will be based on the updated gap assessment from MoH, supported by the World Bank, during project preparation. (b) Component 2: Procurement, installation, operation, and maintenance of equipment to referral hospital facilities across Indonesia “Strengthening Indonesia’s Healthcare Referral Network” or SIHREN component. This component seeks to contribute to the procurement of equipment for all Madya, Utama, and Paripurna-level hospitals across Indonesia. (c) Component 3: Procurement, installation, operation, and maintenance of equipment to tier 2, 3, 4, and 5 public health laboratory facilities across Indonesia “Indonesia – Public Laboratory System Strengthening” or InPULS component. This component seeks to contribute to the procurement of equipment for all tier 2, 3, 4, and 5 public health laboratories across Indonesia.(d) Component 4: Project Management, Digitization and Training across the SOPHI, SIHREN, and InPULS components. The centralized, single-phased procurement at the central Government level and economies of scale also allow to tackle challenges around the maintenance and operation of the equipment, which traditionally poses barriers to sustained health service delivery due to equipment downtime because of faulty equipment or incorrect operation. The large volumes of procured equipment, packaged, and bundled into lots whereby a single equipment type and lot is sourced from a single vendor, allows to commit vendors to its maintenance while ensuring the transfer of operational skills training to health workers. The cost of maintenance and operational skills transfer by the vendor to health workers upon installation of the equipment at the facility will be enclosed in the bidding documents and be part and parcel of the contract.

FY17 - Health

World Bank Group

Project

Hospital, Government