The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) Indonesia - Supporting Primary Health Care Reform (P164277) EAST ASIA AND PACIFIC | Indonesia | Health, Nutrition & Population Global Practice | Requesting Unit: EACIF | Responsible Unit: HEAHN IBRD/IDA | Program-for-Results Financing | FY 2018 | Team Leader(s): Somil Nagpal, Jurgen Rene Blum Seq No: 6 | ARCHIVED on 15-Jan-2021 | ISR44138 | Created by: Yulia Nur Izati on 05-Nov-2020 | Modified by: Somil Nagpal on 13-Jan-2021 Program Development Objectives Program Development Objective (from Program Appraisal Document) Strengthening the performance of Indonesia’s primary health care system Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Implementation Status and Key Decisions This implementation status and results report provides update on the implementation progress of the Indonesia – Supporting Primary Health Care Reform (I-SPHERE) Program-for-Results (PforR) from July to December 2020. The Ministry of Health (MOH) has made rapid progress in adapting to the new PforR instrument and has put effective management arrangements for the program into place, including establishing a Secretariat. The Secretariat has worked well in providing support to the program implementation and coordination with related units within the MOH and with the World Bank. Regular meetings have been organized every quarter between the MOH, Ministry of Finance, Bappenas, and the World Bank to discuss disbursement-linked indicators (DLI) achievement progress and other management issues. In the current COVID-19 pandemic, the Secretariat is also closely monitoring the situation and the impact of the pandemic on the achievement of DLIs. Overall, the MOH has made commendable progress on most of the program DLIs. Many DLIs are progressing well, despite the current situation. The MOH has made remarkable progress specifically on design DLIs, including DLI 2, DLI 8, DLI 9 and DLI 10. The early disbursement- linked results (DLRs) for these DLIs are expected to be verified and disbursed soon. The World Bank team would in particular like to acknowledge the substantial progress made in developing a well-designed formula for the BOK Kinerja for DLI 9, through very elaborate analytical teamwork between the Planning Bureau and Litbangkes. Despite the slowdown in implementation in the context of COVID-19, several DLIs remained on track in 2020, because past performance levels had exceeded the respective 2019 targets (e.g. DLIs 3, 4 and 7). The MOH and the World Bank team also acknowledge that the emerging results stories for Indonesia are worth documenting for a wider audience. These results stories include primary care accreditation and the provision of special attention to remote areas through the deployment of health worker teams. The World Bank team also plans to continue providing technical assistance to support the DLIs’ achievement. The status of milestones agreed in the last implementation support mission (in September 2020) is satisfactory. The mid-term review mission is planned to be conducted in April 2021. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P164277 IBRD-88730 Effective USD 150.00 150.00 0.00 49.30 100.70 33% Key Dates (by loan) 1/15/2021 Page 1 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P164277 IBRD-88730 Effective 13-Jun-2018 17-Jul-2018 09-Oct-2018 30-Apr-2024 30-Apr-2024 DLI Disbursement Achievement Disbursed amount in Disbursement % for DLI ID DLI Type Description Coc DLI Amount Status Coc DLI Loan: IBRD88730-001 Performance dashboard 1.1 Regular USD 1,500,000.00 Not Achieved 0.00 designed & guideli 1.2 Regular Target: 90% USD 13,500,000.00 Not Achieved 0.00 mHealth impl plan PIS-PK 2.1 Regular USD 500,000.00 Not Achieved 0.00 completed mHealth for PIS-PK 2.2 Regular USD 1,000,000.00 Not Achieved 0.00 designed & field-test 2.3 Regular Target:1,500 Puskesmas USD 6,000,000.00 Not Achieved 0.00 1995 Puskemas received Partially 3 Regular USD 22,500,000.00 5,460,000.00 24 % higher levels of Achieved Target: 597Puskesmas Partially 4 Regular USD 7,500,000.00 4,387,500.00 59 % accredited in East Achieved Roadmap for independent 5.1 Regular USD 2,500,000.00 Not Achieved 0.00 commission is pr Costed business plan and 5.2 Regular USD 5,000,000.00 Not Achieved 0.00 by-laws submitt Decree issued establishing 5.3 Regular USD 2,000,000.00 Not Achieved 0.00 the independe 75% of KAFKTP staff 5.4 Regular USD 10,000,000.00 Not Achieved 0.00 appointed KAFKTP operating in 5.5 Regular USD 3,000,000.00 Not Achieved 0.00 accordance with byla Updated MOH guidelines 6.1 Regular USD 1,500,000.00 Not Achieved 0.00 and training modu Target:120 Lagging 6.2 Regular USD 6,000,000.00 Not Achieved 0.00 Districts Target: 1,039 special Partially 7 Regular USD 7,500,000.00 1,950,000.00 26 % health worker team Achieved Joint MOH and BPJS 8.1 Regular USD 6,000,000.00 Not Achieved 0.00 agreement on performa Target:60% of the number 8.2 Regular USD 18,000,000.00 Not Achieved 0.00 of primary heal Enhanced performance 9.1 Regular USD 1,000,000.00 Not Achieved 0.00 based DAK Non-fisik 1/15/2021 Page 2 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) Enhanced DAK Non-fisik 9.2 Regular USD 2,500,000.00 Not Achieved 0.00 baseline data col DAK Non-fisik allocated 9.3 Regular USD 2,500,000.00 Not Achieved 0.00 based on perform 9.4 Regular Target: 60% USD 24,000,000.00 Not Achieved 0.00 10.1 Regular IRIS designed USD 500,000.00 Not Achieved 0.00 Software application for 10.2 Regular USD 1,000,000.00 Not Achieved 0.00 IRIS completed IRIS implemented in 5 10.3 Regular USD 4,500,000.00 Not Achieved 0.00 provinces Program Action Plan MOH and MOF to allocate sufficient budget to allow KAFKTP to increase capacity and quality of facilitation and Action Description surveying Source DLI# Responsibility Timing Timing Value Status Other MOH and MOF Recurrent Yearly Not Yet Due Completion Measurement Budget documents show increase in budget Financial support for the accreditation has been allocated through APBN (in 2020: Rp1.4M) and DAK (in 2020: Comments Rp.610.4M). MOH’s Center for Data and Information (Pusdatin) to develop and roll out verification protocols to improve data Action Description quality Source DLI# Responsibility Timing Timing Value Status Other MOH Recurrent Continuous In Progress Completion Measurement Verification protocols developed and rolled out Pusdatin has developed, disseminated and trained on Technical Guidelines on Self-Assessment Routine Data Quality Monitoring (PMKDR) for 10 provincial/district/ health offices and Puskesmas. Pusdatin also plans to pilot the Comments implementation of PMKDR. Action Description BPJS, MOF and MOH to issue joint circular for data sharing between BPJS, MoF and MoH Source DLI# Responsibility Timing Timing Value Status BPJS, MOH, and Other Due Date 28-Jun-2019 Completed MOF Completion Measurement Joint circular for data sharing exists Presidential Regulation of 82/2018 on Health Security has been issued. Thus, the 3rd activity of PAP has been Comments achieved. 1/15/2021 Page 3 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) BPKP to monitor internal audit implementation in the Program and, with MOH, ensure achievement of level 3 of IA- Action Description CM of MOH by 2019 Source DLI# Responsibility Timing Timing Value Status Other BPKP and MOH Due Date 31-Dec-2019 Completed Completion Measurement MOH level 3 IA-CM accreditation issued by BPKP Comments Achieved MOH to include financial management training and fund utilization monitoring system as part of the Puskesmas Action Description management training Source DLI# Responsibility Timing Timing Value Status Other MOH Recurrent Continuous In Progress Completion Measurement Puskesmas management training reports The PHC Directorate has accommodated financial management and monitoring systems for the use of funds/budgets Comments in the PHC Management Training Module. The MOH has trained 1,643 Puskesmas in 2019; with total of 8.058 Puskesmas since 2016. MOH and LGs to strengthen DHO oversight and require primary care providers to report patient-care related Action Description complaints and feedback and publish them Source DLI# Responsibility Timing Timing Value Status Other MOH and LGs Recurrent Continuous In Progress Completion Measurement Data on complaints published Currently, Pusdatin is on process to prepare a system which allows data on patient-care related complaint to be Comments integrated in ASDK application. KAFKTP and MOH to strengthen facilitator and surveyor capacity in areas such as safe-handling of medical waste, Action Description emergency response, management of complaints and grievances, and patient consent processes and rights Source DLI# Responsibility Timing Timing Value Status Other KAFKTP and MOH Recurrent Continuous In Progress Completion Measurement Improved guidelines prepared, including specific SOPs or work Instructions The revised draft of the FKTP Accreditation Standard includes criteria and evaluation elements regarding the Comments appropriate management of medical waste in section 215. The revision of the standard is currently being finalized. 1/15/2021 Page 4 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) KAFKTP and MOH to develop necessary work instructions or standard operating protocols (SOP) to improve the Action Description existing guidelines for surveyors and for environmental sanitation officers on proper management of medical waste management. Source DLI# Responsibility Timing Timing Value Status Other KAFKTP and MOH Recurrent Continuous In Progress Training and workshops conducted Completion Measurement Surveyor’s performance evaluation Standards are still being verified and awaiting leadership approval. The training and workshops for all surveyors are Comments postponed due to COVID-19 pandemic. Workshop on waste management has been conducted. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Moderate Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Substantial Substantial Moderate Technical Design of Project or Program Substantial Substantial Moderate Institutional Capacity for Implementation and Substantial Substantial Moderate Sustainability Fiduciary Substantial Moderate Moderate Environment and Social Moderate Moderate Moderate Stakeholders Substantial Substantial Moderate Other -- -- -- Overall Substantial Substantial Moderate RiskComments Comments In line with the latest OPCS guidance, the team has reviewed the risk profile of the project and the following risks are proposed to be modified from the previous rating of substantial to moderate:  Institutional Capacity for Implementation and Sustainability: Given the established secretariat as well as the experience with implementing its first PforR over the last 2+ years, MOH has steadily built its capacity in implementing and monitoring implementation progress, improving the risk profile to moderate.  Political and Governance. Focus on the health sector in general and primary healthcare in particular is now prominent across the government and the new leadership at MOH. The risk profile is accordingly improved to moderate.  Sector Strategies and Policies. The sectoral strategy for the period 2020-2024 focuses on primary care, quality of services and improved information systems, and so is in line with the priorities of I-SPHERE. Further, it is expected that the pending policy decision on the primary accreditation system will be resolved soon. Accordingly, the risk is now perceived as moderate. 1/15/2021 Page 5 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277)  Technical Design of Project or Program. With implementation experience, the appropriateness of the technical design has now been established and the perceived risk is now moderate. Results PDO Indicators by Objectives / Outcomes Strengthening performance monitoring for increased local government and facility accountability IN00913939 ►Districts covered in MOH's published performance dashboard (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target The MOH has completed the dashboard design (based on ASDK/DHISII) and technical guidelines. Zero percent of districts The design comprises a met the 2019 target of Value 0.00 set of 50 “agreed” 90 % reporting 75% of 50 indicators, which will agreed indicators. serve as the basis for evaluating the number of districts covered in the dashboard. Date 29-Dec-2017 21-Feb-2020 31-Dec-2020 29-Dec-2023 According to BPKP’s preliminary verification findings (of December 2020), the 2018 target has been achieved. That is, the dashboard has been designed and the technical guideline has been published. BPKP’s findings indicate that the 2019 target has not yet been achieved. Accordingly, none of the districts Comments covered in the dashboard met the target of reporting 75% of 50 agreed indicators. MOH and the World Bank team are following up to improve future performance so that the overall PDO indicator achievement remains on track for 2023. Improving implementation of national standards for greater local government and facility performance IN00913940 ►Puskesmas that have received higher levels of accreditation (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 495.00 1,015.00 1,857.00 1,995.00 Date 29-Dec-2017 31-Dec-2019 31-Dec-2020 29-Dec-2023 Achievement is measured as the cumulative number of puskesmas receiving accreditation with Paripurna and Utama levels (the two highest accreditation levels) as certified by the primary care accreditation commission. This includes puskesmas receiving these levels of accreditation for the first time and Comments puskesmas receiving re-accreditation. According to BPKP’s preliminary verification findings (of December 2020), 1,014 Puskesmas were newly accredited or reaccredited at Paripurna and Utama levels during 2019. IN00914028 ►Pregnant women delivering at a health care facility (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 78.00 88.70 77.95 90.00 1/15/2021 Page 6 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) Date 29-Dec-2017 31-Dec-2019 30-Nov-2020 29-Dec-2023 Numerator : Number of births at either hospital or primary health care both private and public facility, Denominator: All births Comments Source of Data: Komdat Kesga at MOH, Quarter IV, 2020 up to November 2020. Enhancing performance orientation of health financing for better local service delivery IN00914026 ►Primary care providers that are implementing performance based JKN capitation (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target The MOH presented the MOH reported that as of recent revisions to the May 2020, 45% of current pay-for- FKTPs (out of 21,745 performance scheme, FKTPs) have Value 0.00 based on BPJS implemented the new 60 % Regulation - Peraturan PKBK. This BPJS (PerBPJS) number achievement surpasses 7/2019, effective the 2021 target of 40% November 1, 2019 of FKTPs. Date 29-Dec-2017 21-Feb-2020 30-Dec-2020 29-Dec-2023 Comments IN00914027 ►Districts showing an improvement on at least half of the performance indicators in the enhanced DAK non-fisik (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target MOH agreed to consider selection of indicators that show leverage to health status through Enhanced performance PBF formulation for DAK based DAK issued as a non-fisik allocation. A ministerial regulation for Value 0.00 webinar on indicators 60 % nationwide selection, measurement implementation in 2021. and monitoring with international experts has been done in MOH on February 27. Date 29-Dec-2017 06-Mar-2020 31-Dec-2020 29-Dec-2023 Minister of Health Regulation Law Number. HK.01.07/Menkes/2541/2020 Concerning Procedures for Calculating the Allocation of DAK Non-fisik in the Health Sector for the 2021 Fiscal Year issued on October Comments 7, 2020. Intermediate Results Indicators by Results Areas Strengthening performance monitoring for increased local government and facility accountability IN00914030 ►Puskesmas using electronic data reporting systems with complete and compliant data in accordance with MOH’s data dictionary (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 1/15/2021 Page 7 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) MoH has developed the MoH has developed the health data dictionary health data dictionary and also the website and also the website Value 0.00 80 % http://idn- http://idn- hdd.kemkes.go.id/it hdd.kemkes.go.id/it called “Kata Hat-I" called “Kata Hat-I" Date 29-Dec-2017 21-Feb-2020 31-Dec-2020 29-Dec-2023 Numerator: Number of puskesmas using electronic data reporting systems with complete information and in compliance with MoH’s data dictionary; Denominator: Total number of Puskesmas who use electronic data Comments reporting system. IN00914032 ►Puskesmas using mHealth application to support enhanced PIS-PK (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target The MOH has completed the mHealth implementation plan and A version of the has presented the initial mHealth application has design of the mHealth for been developed and PIS-PK application to the has undergone a first, Value 0.00 1,500.00 World Bank team, with a limited field-test in 30 strong focus on data Puskesmas in collection for the PIS-PK. November – December The WB team will provide 2020(2019 target). TA to improve the design. Date 29-Dec-2017 21-Feb-2020 31-Dec-2020 29-Dec-2023 According to BPKP’s preliminary verification findings (of December 2020), the 2018 target has been achieved. That is, the mHealth implementation plan has been completed. MoH also reported significant progress against the 2019 target: A version of the mHealth application has been developed and has Comments undergone a first, limited field-test in 30 Puskesmas. The field testing has provided valuable inputs for the function of the application for both community and health provider users. IN00914034 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,345,997.00 2,980,395.00 23,375,000.00 Date 13-Jun-2018 31-Dec-2019 30-Nov-2020 29-Dec-2023 Source of Data: Komdat Kesga at MOH, Quarter IV, 2020 up to November 2020. Comments IN00914036 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,345,997.00 2,980,395.00 23,375,000.00 Date 13-Jun-2018 31-Dec-2019 30-Nov-2020 29-Dec-2023 Improving implementation of national standards for greater local government and facility performance IN00914029 1/15/2021 Page 8 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) ►Puskesmas that have been accredited at any level in Eastern Indonesia (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 197.00 214.00 629.00 597.00 Date 29-Dec-2017 31-Dec-2019 31-Dec-2020 29-Dec-2023 Achievement is measured as cumulative number of puskesmas receiving accreditation at any level in the three provinces (Maluku, Papua and NTT) of Eastern Indonesia, as certified by the primary care accreditation commission. This includes puskesmas receiving accreditation for the first time and puskesmas Comments receiving re-accreditation. According to BPKP’s preliminary verification findings (of December 2020), 215 Puskesmas in Maluku, Papua, and NTT received accreditation at any level during the year 2019. IN00914031 ►Primary care accreditation body (KAFKTP) functioning as an independent commission (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target MOH is considering policy reforms to change (i) the organization of the primary health care accreditation body (ii) how accreditation The 2018 target has not assessments are yet been achieved. The Accreditation implemented. These policy decision on the commission operating Value No changes intend to: (a) reform of the primary in accordance with its reduce the costs of accreditation system is by-laws verification and (b) still pending. strengthen the role and ownership of regional health offices in the facilitation and processes of accreditation. Date 29-Dec-2017 06-Mar-2020 31-Dec-2020 29-Dec-2023 The envisaged reforms of the accreditation arrangements for Fasilitas Kesehatan Tingkat Primer - FKTP (Primary Health Care Facilities) have been a focus of the dialogue between the MOH and the World Bank Comments team since February 2020. These reforms can have far-reaching implications for the credibility of the accreditation system and for its effectiveness. A final policy decision is expected in the near future. IN00914033 ►Lagging districts that have produced improved annual plans and budgets (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target MoH has developed new training modules (2018 target). A first The preparation for the training based on the training has made good new modules has been progress but the training Value 0.00 conducted in the 3rd 120.00 is currently postponed quarter of 2020 with 35 due to the COVID-19 participating districts. situation. The case material for the trainings remains to be developed. Date 29-Dec-2017 21-Feb-2020 31-Dec-2020 29-Dec-2023 Comments 1/15/2021 Page 9 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) IN00914035 ►Special health worker teams deployed (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 439.00 768.00 801.00 1,039.00 Date 29-Dec-2017 31-Dec-2019 31-Dec-2020 29-Dec-2023 Achievement is measured by looking at number of Nusantara Sehat (or special team based deployment program) teams deployed in response to annual demand of DTPK (lagging, border, and islands) areas. According to BPKP’s preliminary verification findings (of December 2020), as of December 2019, 768 special health worker teams had been deployed (2019 target). As reported by MOH during a Monitoring and Comments Evaluation meeting in December 2020, as of December 3, 2020, this number had further increased to 801 teams. IN00914037 ►Provinces that are using an integrated referal information system (IRIS) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target The IRIS application currently is being piloted The IRIS application in 5 provinces (DKI has been designed and Value 0.00 5.00 Jakarta, West Java, field tested (2019 South Sulawesi, Central target). Java and East Java). Date 29-Dec-2017 21-Feb-2020 31-Dec-2020 29-Dec-2023 According to BPKP’s preliminary verification findings (of December 2020), the design and implementation plan of the IRIS application has been completed (2018 target). Accordingly, the IRIS application has also Comments been designed and field tested (2019 target). Disbursement Linked Indicators DLI_IND_TABLE ►DLI 1 Districts covered in MoH's published performance dashboard (Output, 15,000,000.00, 0%) End target (2022- Baseline Actual (Previous) Actual (Current) 2023) The MOH has completed the dashboard design (based on ASDK/DHISII) and technical guidelines. Zero percent of districts The design comprises a met the 2019 target of Value 0.00 set of 50 “agreed” 90 % reporting 75% of 50 indicators, which will agreed indicators serve as the basis for evaluating the number of districts covered in the dashboard. Date -- 21-Feb-2020 31-Dec-2020 -- According to BPKP’s preliminary verification findings (of December 2020), the 2018 target has been achieved. That is, the dashboard has been designed and the technical guideline has been published. BPKP’s findings indicate that the 2019 target has not yet been achieved. Accordingly, none of the districts covered in the Comments dashboard met the target of reporting 75% of 50 agreed indicators. MOH and the World Bank team are following up to improve future performance so that the overall PDO indicator achievement remains on track for 2023. 1/15/2021 Page 10 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) ►DLI 2 Puskesmas using mHealth application to support enhanced PIS-PK (Output, 7,500,000.00, 0%) End target (2022- Baseline Actual (Previous) Actual (Current) 2023) The MOH has completed the mHealth implementation plan and A version of the mHealth has presented the initial application has been design of the mHealth for developed and has Value 0.00 PIS-PK application to the undergone a first, limited 1,500.00 World Bank team, with a field-test in 30 Puskesmas strong focus on data in November – December collection for the PIS-PK. 2020(2019 target). The WB team will provide TA to improve the design Date -- 21-Feb-2020 31-Dec-2020 -- According to BPKP’s preliminary verification findings (of December 2020), the 2018 target has been achieved. That is, the mHealth implementation plan has been completed. MoH also reported significant progress against the 2019 target: A version of the mHealth application has been developed and has undergone a first, limited Comments field-test in 30 Puskesmas. The field testing has provided valuable inputs for the function of the application for both community and health provider users. ►DLI 3 Puskesmas that have received higher levels of accreditation, excluding Puskesmas in Eastern Indonesia (Output, 22,500,000.00, 0%) End target (2022- Baseline Actual (Previous) Actual (Current) 2023) Value 495.00 1,015.00 1,857.00 1,995.00 Date -- 31-Dec-2019 31-Dec-2020 -- Achievement is measured as the cumulative number of puskesmas receiving accreditation with Utama and Paripurna levels as certified by the primary care accreditation commission. This includes puskesmas receiving accreditation for the first time and puskesmas receiving re-accreditation. Comments According to BPKP’s preliminary verification findings (of December 2020), 1,014 Puskesmas were accredited or re-accredited during 2019 at Paripurna and Utama levels (as of December 2019). The total number of accredited Puskesmas is based on the database of the primary care accreditation commission. ►DLI 4 Puskesmas that have been accredited at any level in Eastern Indonesia (Output, 7,500,000.00, 0%) End target (2022- Baseline Actual (Previous) Actual (Current) 2023) Value 197.00 214.00 629.00 597.00 Date -- 31-Dec-2019 31-Dec-2020 -- Comments Achievement is measured as number of puskesmas receiving accreditation at any level in the three provinces (Maluku, Papua and NTT) of Eastern Indonesia, as certified by the primary care accreditation commission. This includes puskesmas receiving accreditation for the first time and puskesmas receiving re-accreditation. 1/15/2021 Page 11 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) According to BPKP’s preliminary verification findings (of December 2020), 215 Puskesmas in Maluku, Papua, and NTT received accreditation or re-accreditation during 2019 at any level as of December 2019. The total number of accredited Puskesmas is based on the database of the primary care accreditation commission. ►DLI 5 Primary care accreditation body (KAFKTP) functioning as an independent commission (Process, 22,500,000.00, 0%) End target (2022- Baseline Actual (Previous) Actual (Current) 2023) MOH is considering policy reforms to change (i) the organization of the primary health care accreditation body (ii) how accreditation The 2018 target has not assessments are yet been achieved. The KAFKTP operating implemented. These policy decision on the Value No in accordance with changes intend to: (a) reform of the primary its by-laws reduce the costs of accreditation system is still verification and (b) pending. strengthen the role and ownership of regional health offices in the facilitation and processes of accreditation. Date -- 21-Feb-2020 31-Dec-2020 -- The envisaged reforms of the accreditation arrangements for Fasilitas Kesehatan Tingkat Primer - FKTP (Primary Health Care Facilities) have been a focus of the dialogue between the MOH and the World Bank Comments team since February 2020. These reforms can have far-reaching implications for the credibility of the accreditation system and for its effectiveness. A final policy decision is expected shortly. ►DLI 6 Lagging districts that have produced improved annual plans and budgets. (Output, 7,500,000.00, 0%) End target (2022- Baseline Actual (Previous) Actual (Current) 2023) MoH has developed new training modules (2018 target). A first training based on the new modules has been Value 0.00 Training is postponed conducted in the 3rd 120.00 quarter of 2020 with 35 participating districts. The case material for the trainings remains to be developed. Date -- 21-Feb-2020 31-Dec-2020 -- Comments ►DLI 7 Special health worker teams deployed (Output, 7,500,000.00, 0%) End target (2022- Baseline Actual (Previous) Actual (Current) 2023) 1/15/2021 Page 12 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) Value 439.00 768.00 801.00 1,039.00 Date -- 31-Dec-2019 31-Dec-2020 -- Achievement is measured by looking at number of Nusantara Sehat (or special team based deployment program) teams deployed in response to annual demand of DTPK (lagging, border, and islands) areas. According to BPKP’s preliminary verification findings (of December 2020), as of December 2019, 768 special Comments health worker teams had been deployed (2019 target). As reported by MOH during a Monitoring and Evaluation meeting in December 2020, as of December 3, 2020 , this number had further increased to 801 teams. ►DLI 8 Primary care providers that are implementing performance based JKN capitation (Output, 24,000,000.00, 0%) End target (2022- Baseline Actual (Previous) Actual (Current) 2023) The MOH presented the recent revisions to the MOH reported that as of current pay-for- May 2020, 45% of FKTPs performance scheme, (out of 21,745 FKTPs) Value 0.00 based on Peraturan have implemented the 60 % BPJS (PerBPJS) number new PKBK surpassing the 7/2019 regulation, and it 2021 target of 40% of is being implemented by FKTPs. BPJS-K. Date -- 21-Feb-2020 31-Dec-2020 -- Based on the MOH Monitoring and Evaluation meeting in December 2020. Comments ►DLI 9 Districts showing an improvement on at least half of the performance indicators in the enhanced DAK non-fisik (Output, 30,000,000.00, 0%) End target (2022- Baseline Actual (Previous) Actual (Current) 2023) Building on previous dialogue, MOH has proposed a revised design for the enhanced Enhanced performance DAK non-fisik, focusing based DAK non-fisik on four coverage designed (2018 target), as indicators, namely: (i) regulated in Minister of institutional deliveries Health Regulation Law (PF); (ii) neonatal visits Number. Value 0.00 (KN1); (iii) complete HK.01.07/Menkes/2541/20 60 % immunization (IDL); and 20 Concerning (iv) the tuberculosis Procedures for Calculating success rate (SR). A the Allocation of DAK webinar on indicators Non-fisik in the Health selection, incentive Sector for the 2021 Fiscal design and verification Year. with international experts was conducted with MOH on February 28. Date -- 21-Feb-2020 31-Dec-2020 -- Based on the MOH’s Monitoring and Evaluation meeting in December 2020. Comments 1/15/2021 Page 13 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) ►DLI 10 Provinces that are using an integrated referal information system (IRIS) (Output, 6,000,000.00, 0%) End target (2022- Baseline Actual (Previous) Actual (Current) 2023) The IRIS application currently is being piloted The IRIS application has in 5 provinces (DKI Value 0.00 been designed and field 5 provinces Jakarta, West Java, tested (2019 target). South Sulawesi, Central Java and East Java). Date -- 21-Feb-2020 31-Dec-2020 -- According to BPKP’s preliminary verification findings (of December 2020), the design and implementation plan of the IRIS application has been completed (2018 target). Accordingly, the IRIS application has also been Comments designed and field tested (2019 target). 1/15/2021 Page 14 of 14