The World Bank Report No: ISR8987 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: 5 Status: ARCHIVED Archive Date: 08-Jan-2013 Country: Indonesia Approval FY: 2010 Product Line: IBRD/IDA Region: EAST ASIA AND PACIFIC Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 24-Sep-2009 Original Closing Date 31-Dec-2014 Planned Mid Term Review Date 29-Oct-2012 Last Archived ISR Date 28-Mar-2012 Effectiveness Date 09-Dec-2009 Revised Closing Date 31-Dec-2014 Actual Mid Term Review Date 29-Oct-2012 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 Moderately Unsatisfactory Overall Implementation Progress (IP) Satisfactory Moderately Satisfactory Overall Risk Rating Moderate Implementation Status Overview The Project's Mid Term Review Mission or the 6th Implementation Review Mission was conducted from October 29th to November 9th, 2012 and the wrap up meeting held on November 29th. The conclusion of the Mid Term review found that the establishment of the independent bodies for accreditation of health professional schools (LAM-PTKes) or for Page 1 of 7 The World Bank Report No: ISR8987 national competency testing (LPUK) are not yet operational. These are two key performance indicators for the project. The delay was due to initial delays in putting into effect the legal status for the establishment of LAM PTKes and LPUK, until quite recently. The establishment of LAM PTKes is dependent upon the finalization of the ministerial regulation (Peraturan Menteri) on accreditation, while the establishment of LPUK requires a joint Public Disclosure Copy ministerial regulation between MOEC and Ministry of Health (MOH). Although the draft regulations as well as other requirements to establish a new independent body were ready, the finalization was delayed due to internal legal assessment to be undertaken by the Ministry of Education and Culture (MOEC) . The establishment of the LAM-PTKes was particularly affected by the passing of the Higher Education Bill in July 2012. The Bill mandated the preparation of other regulations. before the existing draft LAM-PTKes regulation can be adjusted. These delays have hampered the achievement of the third project performance indicator which is to conduct the accreditation process of medicine, dentistry, nursing, and midwifery under the new system. For the development of the National Competency Testing, the delays in establishing LPUK has less of an as the LPUK continues its activities with the Indonesian Medical Council. The mission team found that various systems developed to support the national examination for medicine are comparable with International standards. For efficiency sake, the mission highly recommends that other health professionals follow those systems (with some adjustments) to meet the specific requirements for each profession. The disbursement of the Project fund is lower than expected, with about 50 percent the loan expected to be disbursed by the end of 2012. The mission discussed possible restructuring of the project with the Government during this Mid-Term Review. The proposed restructuring would cover the following: i) inclusion of quality assurance for the education of pharmacists, nutritionists, and public health specialists with no changes to the Project Development Objectives; ii) adjustments under component 3 to improve the quality of medical education in two of Eastern Indonesia medical schools, Cendrawasih University in Papua (UNCEN) and Nusa Cendana University in East Nusa Tenggara (UNDANA), and extension of the Financial Assistance Packages (FAPs) by six (6) months until the end of June 2014 (no change to the Project's current closing date), and iii) re-allocation of loan proceeds. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Establishment of the independent National Yes/No Value No No Yes Accreditation Agency (NAA) Date 09-Dec-2009 12-Dec-2012 31-Dec-2014 Comments The Joint Commission of See Component 1 for issues Charter of the NAA is Public Disclosure Copy National Accreditation Board established in 2013 for Higher Education (BAN- PT) and Indonesian Medical Council (KKI) Establishment of the National Agency for Yes/No Value No No Yes Competence Examination of Health Date 31-Dec-2009 31-Dec-2012 31-Dec-2014 Professionals (NACE HealthPro) Comments Consortium of College of See Component 2 for issues The Charter of NACE Indonesian Doctors (KDI) and Page 2 of 7 The World Bank Report No: ISR8987 Association of Medical HealthPro i/LPUK is Education Institutions (AIPKI) established in 2013 is the current engagement Health Professional Schools (medical, dental, Percentage Value 0.00 Public Disclosure Copy nursing, and midwifery) that have gone through Date 28-Sep-2012 31-Dec-2014 the accreditation process and publicize the Comments Accreditation using the new Medical 100%, Dental 100%, results instrument is not yet Nursing 48%, Midwifery 18%; materialized. The delays in Details below the establishment of the independent agency for accreditation has led to delays in the accreditation of health schools using the new instruments as required by the Project's key performance indicator Nursing schools that have gone through Percentage Value 0.00 48.00 accreditation process and publicize results Sub Type Supplemental Midwifery schools that have gone through Percentage Value 0.00 18.00 accreditation process and Sub Type Supplemental Medical Schools that have gone through Percentage Value 0.00 100.00 accreditation process and publicize the results Sub Type Supplemental Dental schools that have gone through Percentage Value 0.00 100.00 accreditation process and publicize the results Sub Type Date 31-Dec-2014 Breakdown Comments Graduates of health professional schools Percentage Value passing the national competency testing at first Public Disclosure Copy Date 31-Dec-2009 31-Oct-2012 31-Dec-2014 attempt Comments Medical 71.67%, Dental Medical 75.5%, Dental 81% 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 3 of 7 The World Bank Report No: ISR8987 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 Graduates of Nursing School passing the Percentage Value 0.00 65.00 national competency test at the first attempt Sub Type Supplemental Graduates of Midwifery Schools passing the Percentage Value national competency test at first attempt Sub Type Supplemental Trend of Mean Test Score of Graduates from Percentage Value 57.34 FAP Recipient Schools who take the National Date 03-Jan-2011 20-Feb-2012 31-Dec-2014 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 Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Responsibility for policies on prefessional Yes/No Value No No Yes accreditation, certification, and school licensure Date 31-Dec-2009 30-Apr-2013 31-Dec-2014 are clear and accepted by key stakeholders for Comments Medical and Dental : Under development. With the GoI has established a formal each of four health professions Indonesian Medical Council passing of the new Higher entity with responsibility for (KKI) established in 2006 Education Bill, the preceding oversight of accreditation Nursing and Midwifery : a regulations have to be review standards, competency-based formal entity with and adjusted to be in examination of each nursing responsibility for oversight of accordance with the new Bill. and midwifery profession accreditation standards, The regulations related to the Public Disclosure Copy competency-based establishment of LAM PTKes examination for each as the new independent profession, nursing and accreditation agency will have midwifery is not yet to be reviewed and adjusted established Education and competency standards are Yes/No Value No No Yes 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 and for Nurses and and Standards of Education and Standards of Education Midwives have been finalized for four professions are Page 4 of 7 The World Bank Report No: ISR8987 released by Indonesian and are waiting for validation agreed by all stakeholders Medical Council (KKI) in 2006 from the authorized bodies 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 The National Accreditation Agency (NAA) has Yes/No Value No No Yes independent and adequate budget to conduct Date 31-Dec-2009 31-Dec-2014 accreditation Comments A Joint Commission between Not yet established An independent NAA has the National Accreditation adequate budget to conduct Agency for Higher Education accreditation and Indonesian Medical Council is the current arrangement A charter supporting the establishment of the Yes/No Value No No Yes NACEHealth Pro (National Agency for Date 31-Dec-2009 31-Oct-2012 31-Dec-2014 Competency Examination of health Comments Current arrangement for The preparation documents The charter has been Professionals) including its tasks and responsibilitis, and working arrangements competency testing: for the establishment have established by the end of Consortium of College of been completed, minor 2011 Indonesian Doctors (KDI) and adjustments would be needed the Association of Medical to synchronize with the Joint Schools (AIPKI) Decree MOH-MOEC which becomes the basis for LPUK Number or percentage of medical schools Number Value 41.00 41.00 receiving finance support to strengthen the Date 30-Nov-2010 31-Dec-2014 program Comments 42 medical schools passed the proposal review and 41 of them have signed the contract to receive the grant. Two Public Disclosure Copy medical schools that from Eastern Indonesia are proposed to be included in the FAP scheme The National Accreditation Agency NAA has Number Value 0.00 80.00 300.00 access to adequate numbers of suitably trained Date 09-Nov-2012 31-Dec-2014 assessors Comments Numbers of trained assessors Numbers of trained assessors for each profession: Medical : for each profession: Medical : Page 5 of 7 The World Bank Report No: ISR8987 60 Dental : 20 Nursing : 0 60 Dental : 30 Nursing : 105 Midwifery : 0 Midwifery : 105 Public Disclosure Copy Data on Financial Performance (as of 13-Dec-2012) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P113341 IBRD-77370 Effective 24-Sep-2009 01-Oct-2009 09-Dec-2009 31-Dec-2014 31-Dec-2014 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P113341 IBRD-77370 Effective USD 77.82 77.82 0.00 38.44 39.38 49.00 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation Priority areas are the (i) finalization of the Ministerial Decree on Accreditation for Higher Education, (ii) legal status for LAMP PTKes and LPUK, and (iii) finalization of MOEC-MOH Joint Decree. Under the accreditation process, an MOU will need to be established by the end of January 2013 between the LAM PTKes and the BAN PT to clarify the roles and responsibility between the two bodies. The CPCU will prepare a manual that explains the contractual arrangement and fund management including fund transfer between MOEC and the independent bodies, LAM PTKes and LPUK. When these bodies are established, each of these bodies will develop a program implementation plan which along with the manual will be submitted to the Bank for review and approval. The dates for the submission will be decided mid January 2013. Restructuring History Page 6 of 7 The World Bank Report No: ISR8987 There has been no restructuring to date. Related Projects Public Disclosure Copy There are no related projects. Public Disclosure Copy Page 7 of 7