The World Bank Report No: ISR5449 Implementation Status & Results Indonesia Health Professional Education Quality Project (P113341) Public Disclosure Copy Operation Name: Health Professional Education Quality Project (P113341) Project Stage: Implementation Seq.No: 4 Status: ARCHIVED Archive Date: 04-Jun-2011 Country: Indonesia Approval FY: 2010 Product Line: IBRD/IDA Region: EAST ASIA AND PACIFIC Lending Instrument: Specific Investment Loan Implementing Agency(ies): Ministry of National Education Key Dates Board Approval Date 24-Sep-2009 Original Closing Date 31-Dec-2014 Planned Mid Term Review Date Last Archived ISR Date 04-Jun-2011 Effectiveness Date 09-Dec-2009 Revised Closing Date 31-Dec-2014 Actual Mid Term Review Date Project Development Objectives Project Development Objective (from Project Appraisal Document) The specific Project Development Objectives are to strengthen quality assurance policies governing the education of health professionals in Indonesia. This will be achieved by: 1) rationalizing and assuring competency-focused accreditation of public and private health professional training institutions; 2) developing national competency standards and testing procedures for certification and licensing of health professionals; and 3) building institutional capacity to employ results-based grants for encouraging the use of accreditation and certification standards in the development of medical school quality. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Component 1 Strengthening Policies and Procedures for School Accreditation 7.18 Component 2 Certification of graduates using a national competency-based examination 12.90 Component 3 Results-based FAP for Medical Schools 61.40 Project Management 5.24 Public Disclosure Copy Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Implementation Status Overview The 4th Implementation Review Mission was conducted from October 24th to November 1st, 2011 and the wrap up meeting was conducted on November 21st. The mission found significant progress have been made in the three Project components especially in the completion of key activities to achieve this year's performance indicators for Component 1 and Page 1 of 6 The World Bank Report No: ISR5449 2. This year's indicators for both components are the establishment of two independent bodies for health professions education; one is for accreditation of health study programs (the Independent Accreditation Board for Health Professional Education Institution or LAM-PTKES) and the other one is for the competency testing (Board for Development of Competency Testing or LPUK). The delays in the establishment of both agencies are mainly due to longer time needed for the legal reviews and stakeholder consultations, and also the time to develop robust business plans to ensure the validity and sustainability of these new institutions. These activities are still ongoing and the establishment of the agencies is Public Disclosure Copy now projected to be achieved next year. Although the Project is not going to achieve those two indicators, two task forces have been established to exercise the functions of the two agencies. For instance, currently the task force for accreditation is conducting the LAM-PTKES functions such as preparing the accreditation of schools whose accreditations have expired, and the task force for competency testing LPUK is currently implementing activities to build the capacity of the National Health Professional Council (MTKI) in competency testing. In exercising these functions both task-forces are working in close collaboration with the major stakeholders. The disbursement of the Project fund is lower than expected, with projected only 18 percent of total Project value compare to the initial projection of 33 percent. The main reasons for the low disbursement are the Ministry of Education and Culture (MOEC)'s efficiency policy to cut the budget for transport, and also delays in this year's budget availability and delays in processing several procurement packages at the CPCU that have to be carried over to the next fiscal year. The first year implementation of the Financial Assistance Package (FAP) marked by delays in the budget availability which subsequently delayed the implementation of planned activities. This brings more difficulties to the partnership between leading medical schools under Scheme A and the weaker ones under Scheme C in implementing their joint plans, especially in re-scheduling activities. There were delays in completing procurement packages among grantees and several packages will have to be carried out in 2012. Despite of the delays the disbursement in the grant component is projected to be 76% of the total allocation for the grant component. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Mean Test Score of Graduates from FAP Percentage Value 57.34 Recipient Schools who take the National Date 03-Jan-2011 20-Feb-2012 Competency Testing Comments Average from 41 FAP Not yet available recipient Medical Schools, non-weighted. The baseline will be updated with the weighted average once it is available Graduates of health professional schools Percentage Value 73.75 Public Disclosure Copy passing the national competency testing at first Date 31-Dec-2009 03-Jan-2011 31-Dec-2014 attempt Comments Medical 71.67%, Dental Medical 84%, Dental 83%, 81.69% Nursing 65%, Midwifery 65% Graduates of Medical Schools passing the Percentage Value 71.67 73.75 84.00 national competency test at the first attempt Sub Type Supplemental Page 2 of 6 The World Bank Report No: ISR5449 Graduates of Dental Schools passing national Percentage Value 81.69 79.95 83.00 competency test at the first attempt Sub Type Supplemental Public Disclosure Copy Health Professional Schools (medical, dental, Percentage Value nursing, and midwifery) that have gone through Date 18-May-2011 31-Dec-2014 the accreditation process and publicize the Comments Accreditation instrument is Medical 100%, Dental 100%, results just being pilot-tested/tried out Nursing 48%, Midwifery 18% Establishment of the National Agency for Yes/No Value No No No Competence Examination of Health Date 31-Dec-2009 18-May-2011 31-Dec-2014 Professionals (NACE HealthPro) Comments Consortium of College of The name of the body is now The Charter of NACE Indonesian Doctors (KDI) and agreed to be called Lembaga HealthPro i/LPUK is Association of Medical Pengembangan Uji established in 2011 Education Institutions (AIPKI) Kompetensi or Board of is the current engagement Competency Testing Development (LPUK). The Business plan is being fimalized Establishment of the independent National Yes/No Value No No No Accreditation Agency (NAA) Date 09-Dec-2009 21-Nov-2011 31-Dec-2014 Comments The Joint Commission of Commitment building among Charter of the NAA is National Accreditation Board multi-stakeholders and the established in 2012 for Higher Education (BAN- legal review and academic PT) and Indonesian Medical papers are being finalized. A Council (KKI) task force has been established to exercise the function of the NAA especially to start accrediting schools whose accreditation is expired Intermediate Results Indicators Public Disclosure Copy Indicator Name Core Unit of Measure Baseline Current End Target Number or percentage of medical schools Number Value 41.00 receiving finance support to strengthen the Date 30-Nov-2010 program Comments 42 medical schools passed the proposal review and 41 of them have signed the contract to receive the grant Page 3 of 6 The World Bank Report No: ISR5449 A charter supporting the establishment of the Yes/No Value No No No NACEHealth Pro (National Agency for Date 31-Dec-2009 19-Oct-2010 31-Dec-2014 Competency Examination of health Comments Current arrangement for Under development The charter has been Professionals) including its tasks and Public Disclosure Copy responsibilitis, and working arrangements competency testing: established by the end of Consortium of College of 2011 Indonesian Doctors (KDI) and the Association of Medical Schools (AIPKI) The National Accreditation Agency NAA has Percentage Value access to adequate numbers of suitably trained Date 31-Dec-2014 assessors Comments Numbers of trained assessors for each profession: Medical : 60 Dental : 30 Nursing : 105 Midwifery : 105 The National Accreditation Agency (NAA) has Yes/No Value No No No independent and adequate budget to conduct Date 31-Dec-2009 31-Dec-2014 accreditation Comments A Joint Commission between An independent NAA has the National Accreditation adequate budget to cinduct Agency for Higher Education accreditation and Indonesian Medical Council is the current arrangement Education and competency standards are Yes/No Value No No No agreed by all stakeholders and published Date 31-Dec-2009 18-May-2011 31-Dec-2014 Comments Medical and Dental: Standards for Medical and Standards of Competencies Standards of Competencies Dental are being reviewed; for and Standards of Education and Standards of Education Nurses and Midwives have for four professions are released by Indonesian finalized drafts and waiting for agreed by all stakeholders Medical Council (KKI) in 2006 validation and published Nursing: Drafts of both standards are available Public Disclosure Copy Midwifery : Standards of Competencies released by MOH in 2007 and Draft standard of education available Responsibility for policies on prefessional Yes/No Value No No No accreditation, certification, and school licensure Date 31-Dec-2009 18-May-2011 31-Dec-2014 are clear and accepted by key stakeholders for Comments Medical and Dental : Under development GoI has established a formal each of four health professions Indonesian Medical Council entity with responsibility for (KKI) established in 2006 oversight of accreditation Page 4 of 6 The World Bank Report No: ISR5449 Nursing and Midwifery : a standards, competency-based formal entity with examination of each nursing responsibility for oversight of and midwifery profession accreditation standards, Public Disclosure Copy competency-based examination for each profession, nursing and midwifery is not yet established Data on Financial Performance (as of 07-Feb-2012) Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P113341 IBRD-77370 Effective 24-Sep-2009 01-Oct-2009 09-Dec-2009 31-Dec-2014 Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P113341 IBRD-77370 Effective USD 77.82 77.82 0.00 27.00 50.83 35.00 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation Page 5 of 6 The World Bank Report No: ISR5449 During the mission the mission team suggests to the CPCU to prioritize the recruitment of procurement management specialists and financial management specialists to support the Project implementation as already projected from the beginning that the workload will peak in the fiscal year 2012 and there will be additional workload from the carried over procurement packages and activities from FY 2011. The newly recruited procurement specialist has already been active in January 2012. Public Disclosure Copy The finalization of the accreditation framework still requires further consultation with the Indonesian Medical Association (KKI), particularly regarding the functions and authorities of the LAM-PTKES. It was agreed during the mission that the Directorate General of Higher Education will call a meeting in the near future involving the relevant parties to clarify the functions and authorities of the LAM-PTKES with the Indonesian Medical Council (KKI). A forum to discuss lessons learned and to intensify communication between the more advance medical schools (Scheme A) with the weaker ones (Scheme B) will be established to improve the partnership mechanism under the FAP grant component. The forum and also increasing the involvement of AIPKI (The Association of Medical Education Institutions) to improve the external review process is hoped to improve the implementation of the partnership. The forum will also bring up issues that require attention and interventions from higher authorities, i.e., the DG of Higher Education. The Fifth Implementation Review is scheduled to be conducted in May 2012 that includes initial review of some of the Project Component as a part of the Mid Term Review scheduled for the next year. The initial review in May 2012 will also focus on the disbursement and the measures that the CPCU has taken to overcome the lower that expected disbursement in 2011. The Mid Term Review will be conducted in October 2012. Restructuring History There has been no restructuring to date. Related Projects P122774-Additional Financing for Health Professional Education Quality Project Public Disclosure Copy Page 6 of 6