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: 5 | ARCHIVED on 15-Jul-2020 | ISR42064 | Created by: Somil Nagpal on 29-May-2020 | Modified by: Somil Nagpal on 14-Jul-2020 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 I-SPHERE is a program-for-results, which is a new instrument for Indonesia and for the Ministry of Health (MOH). The MOH has made rapid progress in adapting to the new instrument and has put effective management arrangements for the program into place, including 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, MOF, Bappenas, and the World Bank to discuss DLI achievement progress and other management issues. In the current COVID-19 pandemic, the Secretariat is also closely monitoring the situation and the impact on the achievement of DLIs. A minor amendment for better consistency/clarity of DLI wording has been completed in May 2020. A disbursement amounting to US$ 11.8 million has been completed in June 2020, reflecting year 1 achievements under DLIs 3, 4 and 7. The status of milestones agreed in the last implementation support mission (in February 2020) is satisfactory. 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) 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 7/15/2020 Page 1 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) 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 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 7/15/2020 Page 2 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) 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 Allocation for KAFKTP and accreditation operational budget for FY2020 decreased from IDR 2.3 billion (FY2019) to IDR 1.8 billion. Comments Allocation for DAK Non-Fisik for FY2020 decreased from IDR 769 million (FY2019) to IDR 610 million. 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 Comments Monitoring (PMKDR) for 10 provincial/district/ health offices and Puskesmas. Pusdatin also plans to pilot the 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 In Perpres No. 82 of 2018, the data sharing between BPJS K, MOF and MOH is provided under Article 83, Paragraph Comments 1 and Paragraph 2. 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 7/15/2020 Page 3 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) 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 The MOH is planning to include the complaints and feedback as one entry field in the ASDK application and publish it Comments in the Performance Dashboard. 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. 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 7/15/2020 Page 4 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) 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. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Substantial Substantial Substantial Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary Substantial Substantial Moderate Environment and Social Moderate Moderate Moderate Stakeholders Substantial Substantial Substantial Other -- -- -- Overall Substantial Substantial Substantial RiskComments Comments The Fiduciary and Safeguards risk ratings have improved, based on the revisions done by the sector specialists. The I-SPHERE secretariat has been established with adequate staffing, and working well now, and the implementing units in MOH have also understood their roles towards achieving the results areas better. This partially mitigates the risk foreseen at design stage, but the risk rating for institutional capacity has not been modified in this ISR (retained as Substantial) as there are new risks created by the COVID-19 situation that may create unexpected delays in field visits or temporarily affect the ability of health sector to focus on this PforR. The team is monitoring the impact of the COVID-19 situation on Sector Strategies and Policies. Though the sector is under pressure to address the emergency situation, there is also heightened interest in sectoral policy reforms, which may help mitigate the risks seen at the design stage and in the earlier phase of implementation. However, at this stage, the risk is conservatively retained at Substantial in view of the uncertainties created by this situation. Results PDO Indicators by Objectives / Outcomes 7/15/2020 Page 5 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) Strengthening performance monitoring for increased local government and facility accountability IN00851260 ►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 Design and guidance or ASDK/DHISII) and manual of dashboard has technical guidelines. Value 0.00 been produced and The design comprises a 90 % signed by the Secretary set of 50 “agreed” General of MOH. indicators, which will serve as the basis for evaluating the number of districts covered in the dashboard. Date 29-Dec-2017 12-Dec-2019 21-Feb-2020 29-Dec-2023 Achievement is measured by looking at development of a “performance dashboard” using the District Health Information System – 2 (DHIS2), or any other suitable system, that pulls together agreed performance indicators from various information systems already in place. This will help benchmark performance across districts, make the results public and therefore help improve performance orientation of districts. At the time of the mission, baseline information on the level of completeness of each of the 50 indicators, from different available sources, was still missing. An excel template to request the relevant information was Comments previously shared with Pusdatin in October 2019. This information will be necessary (i) to help choose the most reliable and useful source of data for each indicator and (ii) to inform disbursements for years 1 and 2. The World Bank team has provided assistances in filling the template and discussed it with the MOH, especially information on the available level of aggregation and completeness from each source. Further discussion will be held to finalize the excel template Improving implementation of national standards for greater local government and facility performance IN00851261 ►Puskesmas that have received higher levels of accreditation (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 495.00 877.00 1,015.00 1,995.00 Date 29-Dec-2017 17-Jul-2019 31-Dec-2019 29-Dec-2023 Achievement is measured as number of puskesmas receiving accreditation with Utama and Paripurna levels Comments as certified by the existing primary care accreditation commission. This includes puskesmas receiving accreditation for the first time and puskesmas receiving re-accreditation. IN00851264 ►Pregnant women delivering at a health care facility (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 78.00 86.20 88.70 90.00 Date 29-Dec-2017 31-Dec-2018 31-Dec-2019 29-Dec-2023 Numerator : Number of births at either hospital or primary health care both private and public facility, Comments Denominator: All births Enhancing performance orientation of health financing for better local service delivery IN00851262 7/15/2020 Page 6 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) ►Primary care providers that are implementing performance based JKN capitation (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target The MOH presented the recent revisions to the current pay-for- Design for performance performance scheme, based JKN capitation based on BPJS Value 0.00 60 % being finalized by P2JK Regulation - Peraturan and BPJS K. BPJS (PerBPJS) number 7/2019, effective November 1, 2019 Date 29-Dec-2017 31-Oct-2019 21-Feb-2020 29-Dec-2023 The World Bank team signalled its expectation that the performance-based JKN capitation will need to be designed more ambitiously, in particular including additional performance indicators and increasing the Comments financial penalty, if it is to effectively incentivize better primary care delivery. IN00851263 ►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 Design on enhanced consider selection of DAK non-fisik has been indicators that show compiled; however leverage to health further discussion are still status through PBF needed to finalize the formulation for DAK formula of incentive non-fisik allocation. A Value 0.00 60 % calculation for webinar on indicators distritct/cities in line with selection, measurement the national priority and monitoring with program indicators international experts achievement. has been done in MOH on February 27. Date 29-Dec-2017 12-Dec-2019 06-Mar-2020 29-Dec-2023 Building on previous dialogue, the proposed revised design focuses on four coverage indicators, namely: (i) institutional deliveries (PF); (ii) neonatal visits (KN1); (iii) complete immunization (IDL); and (iv) the tuberculosis success rate (SR). On each indicator, districts would receive a score of 1 to 4 points, based on whether they met national targets and on whether they improved relative to the previous fiscal year. The Comments World Bank team has advised on further strengthening this design, in particular by (a) focusing on rewarding performance improvements rather than the level of performance; (b) by piloting the use of quality of care metrics; (c) by establishing credible verification arrangements Intermediate Results Indicators by Results Areas Strengthening performance monitoring for increased local government and facility accountability IN00851266 ►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 MoH has developed the Enhanced data dictionary Value 0.00 health data dictionary 80 % published. and also the website 7/15/2020 Page 7 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) http://idn- hdd.kemkes.go.id/it called “Kata Hat-I" Date 29-Dec-2017 30-Aug-2019 21-Feb-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. IN00851268 ►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 has presented the Design of the mHealth initial design of the system has been mHealth for PIS-PK finalized and expected to Value 0.00 application to the World 1,500.00 be launched shortly, and Bank team, with a will be piloted in 5 strong focus on data provinces. collection for the PIS- PK. The WB team will provide TA to improve the design. Date 29-Dec-2017 12-Dec-2019 21-Feb-2020 29-Dec-2023 Achievement is measured as development and use of mHealth as an innovation to support PIS-PK - with plans to develop healthy family indices based on twelve indicators as well as to add specific service Comments delivery interventions. IN00851270 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,420,954.00 4,345,997.00 23,375,000.00 Date 13-Jun-2018 31-Dec-2018 31-Dec-2019 29-Dec-2023 Comments IN00851272 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,420,954.00 4,345,997.00 23,375,000.00 Date 13-Jun-2018 31-Dec-2018 31-Dec-2019 29-Dec-2023 Improving implementation of national standards for greater local government and facility performance IN00851265 ►Puskesmas that have been accredited at any level in Eastern Indonesia (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 7/15/2020 Page 8 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) Value 197.00 421.00 214.00 597.00 Date 29-Dec-2017 17-Jul-2019 31-Dec-2019 29-Dec-2023 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 Comments commission. This includes puskesmas receiving accreditation for the first time and puskesmas receiving re- accreditation.. IN00851267 ►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 Roadmap has been accreditation body (ii) drafted and included in how accreditation the 2018-2022 strategic assessments are Accreditation plan of KAFKTP. implemented. These commission operating Value No Meetings on changes intend to: (a) in accordance with its development of business reduce the costs of by-laws plan were conducted in verification and (b) November-December strengthen the role and 2018. ownership of regional health offices in the facilitation and processes of accreditation. Date 29-Dec-2017 14-Jun-2019 06-Mar-2020 29-Dec-2023 In 2015, MOH established an Accreditation Commission for Primary Health Care Facilities (Komisi Akreditasi Fasilitas Kesehatan Tingkat Primer – KAFKTP) under a Minister of Health decree. There is a planned expansion of the national capacity of the primary care accreditation commission in terms of surveyors and planned expansion of local government capacity to have district level facilitators to assist with the accreditation process. KAFKTP is currently financially dependent on MOH. Comments There are ongoing policy discussions on accreditation modalities for primary healthcare. The team has organized technical inputs for MOH from a consultant, who is an expert with the ISQua, regarding the potential and possibility of the proposed accreditation modality to be ISQua certified. Further technical assistance will be provided to help make progress towards the target of international recognition for the independent accreditation body. IN00851269 ►Lagging districts that have produced improved annual plans and budgets (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target The preparation for the training has made good Training of districts is not progress but the training Value 0.00 yet started, planned to be 120.00 is currently postponed conducted in 2020 due to the COVID-19 situation. Date 29-Dec-2017 12-Dec-2019 21-Feb-2020 29-Dec-2023 Comments Ministry of Health will upgrade the training modules and re-design the pedagogical methods in order to strengthen local government capacity in developing improved annual plans and budgets. Ministry of Health will define number of lagging district based on the absorption of special allocation funds, and other relevant health system indicators. Achievement will be defined as the number of lagging districts (low absorption capacity) as defined by Ministry of Health that have conducted workshops on integrated planning and 7/15/2020 Page 9 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) budgeting and have produced an improved annual plan and budget in accordance with MOH guidelines.The refined modules are currently under review by the national agency for training and curriculum of health human resources (HHR Training Center). The World Bank team has reiterated the importance of including case study materials from other districts in the training modules and of adopting a hands-on, applied training approach. To obtain case study materials, the WB suggested that MOH could draw on the experiences of returned mentors who were deployed to districts in late 2019. The WB team agreed to recruit a consultant to provide TA on improving the training materials. The selected 10 Districts for the 2019 target of mentoring activities have received support by the mentoring teams from 8 Universities in Indonesia. IN00851271 ►Special health worker teams deployed (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 439.00 595.00 768.00 1,039.00 Date 29-Dec-2017 17-Jul-2019 31-Dec-2019 29-Dec-2023 Achievement is measured by looking at number of Nusantara Sehat (or special team based deployment Comments program) teams deployed in response to annual demand of DTPK (lagging, border, and islands) areas. IN00851273 ►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 designed IRIS is in 5 provinces (DKI Value 0.00 being piloted in 5 5.00 Jakarta, West Java, provinces. South Sulawesi, Central Java and East Java). Date 29-Dec-2017 12-Dec-2019 21-Feb-2020 29-Dec-2023 Achievement is measured as development and use of an integrated referral information system that connects puskesmas and hospitals to enable timely and appropriate referrals as well as integrated patient care. The IRIS application currently is being piloted in 5 provinces (DKI Jakarta, West Java, South Sulawesi, Central Java and East Java).[RH1] However, some adjustments to SISRUTE will be required to align referral protocols with the new PMK n.3/2020. The team visited Wahidin Sudirohusodo Hospital (where Comments SISRUTE began) in Makassar to view the system in action. The team found several challenges with the current design that ought to be addressed: 1) the system needs to ensure automatic approval of referrals; 2) system needs additional resources and support to ensure interoperability with SISRUTE system; 3) it is important to reduce dependence on parallel communication by analyzing the information (i.e. missing information, unresponsive facilities) shared to other means than the system (WhatsApp) to help improve the current SISRUTE system. 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) Design and guidance or The MOH has completed Value 0.00 manual of dashboard has the dashboard design 90 % been produced and (based on ASDK/DHISII) 7/15/2020 Page 10 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) signed by the Secretary and technical guidelines. General of MOH. The design comprises a set of 50 “agreed” indicators, which will serve as the basis for evaluating the number of districts covered in the dashboard. Date -- 12-Dec-2019 21-Feb-2020 -- However, baseline information on the level of completeness of each of the 50 indicators, from different available sources, was still missing. An excel template of the requested information was previously shared with Pusdatin in October 2019. This information will be necessary (i) to help choose the most reliable and useful source of data for each indicator and (ii) to inform disbursements for years 1 and 2. The World Bank team has Comments provided assistances in filling the template and discussed it with the MOH, especially information on the available level of aggregation and completeness from each source. Further discussion will be made to finalize the excel template. ►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 Design of the mHealth has presented the initial system has been design of the mHealth for finalized and expected to Value 0.00 PIS-PK application to the 1,500.00 be launched shortly, and World Bank team, with a will be piloted in 5 strong focus on data provinces. collection for the PIS-PK. The WB team will provide TA to improve the design Date -- 12-Dec-2019 21-Feb-2020 -- Key next steps include: (a) the MOH team to provide the World Bank team with access to the current version of the mHealth app, so that the World Bank team can provide TA on the design improvement; (b) MOH and Comments World Bank to jointly review the feedback received during the pilots conducted so far; and (c) a technical meeting with the eHDW team to be conducted, to ensure synergies between both apps. ►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 495.00 877.00 1,015.00 1,995.00 Date -- 17-Jul-2019 31-Dec-2019 -- The figure is as reported by the MOH to BPKP for verification in their letter dated on February 28th, 2020. Comments ►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) 7/15/2020 Page 11 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) Value 197.00 421.00 214.00 597.00 Date -- 31-Dec-2018 31-Dec-2019 -- The figure is as reported by the MOH to BPKP for verification in their letter dated on February 28th, 2020. Comments ►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 Roadmap has been health care accreditation drafted and included in body (ii) how accreditation the 2018-2022 strategic assessments are plan of KAFKTP. implemented. These KAFKTP operating Value No Meetings on changes intend to: (a) in accordance with development of business reduce the costs of its by-laws plan were conducted in verification and (b) November-December strengthen the role and 2018. ownership of regional health offices in the facilitation and processes of accreditation. Date -- 14-Jun-2019 21-Feb-2020 -- Amidst the policy changes on accreditation modalities, the team has managed to provide technical assistance from a consultant, who is an expert with the ISQua, regarding the potential and possibility of the proposed Comments accreditation system within MOH to be ISQua certified. Further technical assistance will be provided to support the international recognition of the independent body of accreditation. ►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) Training of districts is not Value 0.00 yet started, planned to be Training is postponed 120.00 conducted in 2020 Date -- 12-Dec-2019 21-Feb-2020 -- Based on the joint workshop with MOH in February 2020. Comments ►DLI 7 Special health worker teams deployed (Output, 7,500,000.00, 0%) End target (2022- Baseline Actual (Previous) Actual (Current) 2023) Value 439.00 595.00 768.00 1,039.00 Date -- 17-Jul-2019 31-Dec-2019 -- The figure is as reported by the MOH to BPKP for verification in their letter dated on February 28th, 2020 Comments 7/15/2020 Page 12 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) ►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 Design for perfomance current pay-for- based JKN capitation performance scheme, Value 0.00 60 % being finalized by P2JK based on Peraturan BPJS and BPJS K. (PerBPJS) number 7/2019 regulation, and it is being implemented by BPJS-K. Date -- 31-Oct-2019 21-Feb-2020 -- Based on the joint workshop with MOH in February 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 DAK Design on enhanced non-fisik, focusing on four DAK non-fisik has been coverage indicators, compiled; however namely: (i) institutional further discussion are still deliveries (PF); (ii) needed to finalize the neonatal visits (KN1); (iii) Value 0.00 formula of incentive complete immunization 60 % calculation for (IDL); and (iv) the distritct/cities in line with tuberculosis success rate the national priority (SR). A webinar on program indicators indicators selection, achievement. incentive design and verification with international experts was conducted with MOH on February 28. Date -- 12-Dec-2019 21-Feb-2020 -- Based on the joint workshop with MOH in February 2020. The World Bank team has advised on further strengthening this design, in particular by (a) focusing on Comments rewarding performance improvements rather than the level of performance; (b) by piloting the use of quality of care metrics; (c) by establishing credible verification arrangements. ►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) Value 0.00 The designed IRIS is The IRIS application 5 provinces being piloted in 5 currently is being piloted in provinces. 5 provinces (DKI Jakarta, West Java, South 7/15/2020 Page 13 of 14 The World Bank Implementation Status & Results Report Indonesia - Supporting Primary Health Care Reform (P164277) Sulawesi, Central Java and East Java). Date -- 12-Dec-2019 21-Feb-2020 -- The IRIS application currently is being piloted in 5 provinces (DKI Jakarta, West Java, South Sulawesi, Central Java and East Java). However, some adjustments to SISRUTE will be required to align referral protocols with the new PMK n.3/2020. The team visited Wahidin Sudirohusodo Hospital (where SISRUTE began) in Makassar to view the system in action. The team found several challenges with the current design that ought to be addressed: 1) system need to ensure automatic approval of referrals; 2) system needs additional Comments resources and support to ensure interoperability with SISRUTE system; 3) reduce dependence on parallel communication by analyzing the information (i.e. missing information, unresponsive facilities) shared to other means than the system (WhatsApp) to help improve the current SISRUTE system 7/15/2020 Page 14 of 14