Document of

The World Bank FILE COPYFOR OFFICIAL USE ONLY

Report No. 2912-IND

INDONESIA

THIRD POPULATION PROJECT

STAFF APPRAISAL REPORT

May 19, 1980

Population, Health and Nutrition Department

This document has a restricted distribution and may be used by recipients only in the performance oftheir official duties. Its contents may not otherwise be disclosed without World Bank authorization.

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CURRENCY EQUIVALENT

US$1 Rupiah (Rp) 625Rp 100 US$0.16Rp 1,000,000 US$1,600

ABBREVIATIONS

ABRI = Armed Forces of the Republic of IndonesiaANM = Auxiliary Nurse MidwifeBAPPENAS = National Development and Planning AgencyGOI = Government of IndonesiaIPPA = Indonesian Planned Parenthood AssociationIUD = Intra Uterine DeviceIEC = Information, Education, and CommunicationMCH/FP = Maternal and Child Health/Family PlanningMOI = Ministry of InformationMOH = Ministry of HealthMOE = Ministry of Education and CultureNFPCB = National Family Planning Coordinating BoardPK = Perawat Kesehatan (Primary Health Nurse)PNPK = National Population Education Project (Ministry of

Education and Culture)PPFPC = Provincial Population and Family Planning CenterPTC = Provincial Training CenterREPELITA = Five-Year Development PlanSTC = Sub-provincial Training CenterTBA = Traditional Birth AttendantTFR = Total Fertility RateUNFPA = United Nations Fund for Population ActivitiesUNICEF = United Nations Children's FundUSAID = United States Agency for International DevelopmentVCDC = Village Contraceptive Distribution CenterWHO = World Health Organization

GLOSSARY

BUPATI = Chief Executive of a District (Kabupaten)CAMAT = Executive Head of a Sub-district (Kecamatan)KABUPATEN District of a ProvinceKECAMATAN = Administrative Sub-districtLURAH = Village HeadmanPROMOKESA = Primary Health WorkerPUSKESMAS = Kecamatan Health Center

Government of Indonesia Fiscal Year: April 1 to March 31

FOR OFFICIAL USE ONLY

DEFINITIONS

Crude Birth Rate Number of live births per year per 1,000 population.

Crude Death Rate Number of deaths per year per 1,000 population.

Rate of Natural Difference between crude birth rate and crude death

Increase rate; usually expressed as a percentage.

Rate of Population Rate of natural increase adjusted for (net) migration,

Growth and expressed as a percentage of the total population

in a given year.

Age-Specific Number of live births to women in a given age group

Fertility Rates per 1,000 women in the same age group, in a given

year. It is usually calculated for 5-year age groups.

Total Fertility The average number of children that would be born

Rate per woman if she were to live to the end of her

childbearing years, and bear children according to

a given set of age-specific fertility rates. The

Total Fertility Rate often serves as an estimate

of the average number of children per family.

Gross Reproduction This is the same as the Total Fertility Rate, but

Rate refers to the number of daughters a woman wouldhave under prevailing fertility patterns.

Net Reproduction The number of daughters a woman would have under

Rate prevailing fertility and mortality patterns, who

would survive to the mean age of childbearing.

Infant Mortality Annual number of deaths of infants under 1 year

Rate per 1,000 live births during-the same year.

Maternal Mortality Number of maternal deaths per 1,000 births attri-

Rate butable to pregnancy, childbirth, or puerperalcomplications (i.e., within six weeks following

childbirth).

Life Expectancy Average number of years expected to be lived by

children born in the same year if mortality

rates for each age/sex group remain the same in

the future.

Dependency Ratio Number of people 14 years and under plus people

65 years and over, divided by the populationaged 15 to 64 years.

This document has a restricted distribution and may be used by recipients only in the performanceof their official duties. Its contents may not otherwise be disclosed without World Bank authorization.

THIRD POPULATION PROJECT

BASIC DATA

Total Area ..... .............................................. 2,027,000 km2

Total Population. - Latest Census (1971) .............. . ..... 119.2 million2 - Latest Estimate (December 1979) 140.0 million

Density per km (1979) - Indonesia ........ 69- Java and Madura .... 631

Rate of Natural Increase (1979) ........ ........... 1.9%Crude Birth Rate (1979) ....... .... ....... ........ 35/1,000Crude Death Rate (1979) ). . ... ... ... . . .... .. . ... . .. *. 16/1,000Life Expectancy at Birth (1979) .................. ......... 48 years

Urban Population as Percent of Total Population (1979) .18%Adult Literacy Rate in Percent (1979) - Males ... 72%

- Females .............. 50%

- Total Adult Population 61%

Primary School Enrollment as Percentage (1979)of School Age Population (ages 7-12)- Males ................ 62%

- Females .. ...... ... oo 58%- Total .... o........... 60%

Age Structure in Percent (1976) - 0-14 years .42%- 15-64 years o......... 56%

- 65 and over .... ...... 2%

Married Women of Reproductive Age (15-44 years)...o ..... o.. 20.9 millionPopulation per Physician ('000s, 1979) ......... .... ........... 13.2Population per Nurse/Midwives ('000s, 1979) .................. 4.4Population per Auxiliary Health Personnel ('000s, 1979) ...... 4.0

Acceptors Recruited by the National FamilyPlanning Program - Cumulative through December 1979 ....... 15.0 million

Current Family Planning Users (March 1979)- Java and Bali ....... 5.0 million

- 10 Provinces in Other

Islands I ... o...o.... 0.6 million

- 11 Provinces in Other

Islands II ........ 0.1 millionCurrent Family Planning Users as Percentage of Married Women

aged 15-44 (March 1979) ..............ft..f.. . .f 27.0%GDP per capita (1979) ...... ....... US$370

INDONESIA

STAFF APPRAISAL REPORT OF A THIRD

POPULATION PROJECT

Table of Contents

Page No.

I. INTRODUCTION .................................................. 1

II. DEMOGRAPHIC PROFILE . .............................. .... 1

A. Current Status ................ .... ** .......... 1B. Regional Variations . ............................... 3C. Economic Development .................. ............ 4D. Future Trends ....... ......................... 5

III. POPULATION POLICY, ORGANIZATION, PROGRAM ANDACHIEVEMENTS ....... ................................. 5

A. Policy ......................................................... 5B. Organization ........... ........................... 6C. Program ........................................................ 7D. Financing of the Family Planning Program .... ....... 12E. Achievements of the Family Planning Program ........ 13F. Family Planning Program Needs .............. ........ 14

IV. FIRST AND SECOND POPULATION PROJECTS ................... 14

A. First Population Project .......................... 14B. Second Population Project ..... ..................... 15C. Experience with Implementation of the First and

Second Projects .............. . .16

D. Linkages Between the Earlier Projects and theProposed Project .......... .. .................. . 16

V. THE PROJECT ............................................ 17

A. Objectives ............................................ 17B. Project Composition ............... ................. 18C. Project Description . .............................. . 19

This report is based on the findings of the appraisal mission which visitedIndonesia in November 1979, followed by a post-appraisal mission in February1980. The post-appraisal mission consisted of the following Bank staff:Messrs. J.J. Kisa, D. Mills, A. Shaw, Dr. H.J. Park, Ms. S. Foster, andMr. T.S. Mehta (Consultant - Population Education).

Table of Contents (Continued)

Page No.

VI. PROJECT COST, FINANCING, DISBURSEMENT, ACCOUNTSAND PROCUREMENT .............. ....... ... ............ . 30

A. Project Cost ...... ................. ................ 30B. Project Financing ...... ............ ................ 32C. Disbursements and Accounts ..... .................... 32D. Procurement .............................................. 33

VII. PROJECT IMPLEMENTATION, MONITORING AND EVALUATION ..... 34

A. Overall Project Implementation ................... .. 34B. Implementation of Project Components ............ ... 34C. Project Monitoring and Evaluation ................ .. 35D. Implementation Schedule . . ........................... 36

VIII. BENEFITS AND RISKS ........................... 36

A. Benefits ......................................... .......... 36B. Risks .............................................. 37

IX. AGREEMENTS REACHED AND RECOMMENDATIONS ................ 37

ANNEXES

ANNEX 1 Tables

T-1 Socioeconomic Indicators in Selected Countries, 1979T-2 Population Age Structure in Indonesia, 1961-1976 (Selected Years)T-3 Total Population and Average Annual Growth Rates for Selected

Years, 1930-1976 and Population Density by Province, 1971-1976T-4 Knowledge and Practice of Family Planning Methods among Women

15-49 YearsT-5 Population Projections, 1980-2150T-6 Financing of Family Planning Program, 1969-1979T-7 NFPCB New Acceptor Targets and Achievements during

REPELITA I, II and Targets for REPELITA III,1969-1984T-8 Percentage of New Acceptors by Contraceptive Method Chosen,1969-1979T-9 Demographic and Program Data by Regions,December 1979T-10 Comparison of First and Second Population Projects and Proposed

Third Project ComponentsT-11 Expected Training Loads at Provincial Training Centers, 1980-1984T-12 Cost Estimates: Information, Education and Communication

Activities, 1980-1984T-13 Work Program for IEC Activities, 1980-1984

ANNEX 1 Tables (Continued)

T-14 Population Education Inputs for First and Second Projects andLinkages with Third Project

T-15 Cost Estimates: Population Education, 1980-1984T-16 Work Program for Population Education, 1980-1984T-17 Cost Estimates: Field Supervision, 1980-1984T-18 Cost Estimates: Training of Traditional Birth Attendants, 1980-1984T-19 Cost Estimates: Training of Nurses and Midwives, 1980-1984T-20 Staffing Pattern for Health Center with and without Ten-Bed

In-Patient AnnexT-21 Cost Estimates: Training of Doctors, Other Health Staff and

Community Leaders, 1980-1984T-22 Summary of Cost Estimates for Civil WorksT-23 Project Cost Estimates by Functional and Expenditure

Categories, 1980-1984T-24 Financing Plan by Expenditure and Functional CategoriesT-25 Estimated Expenditures by Year and by Expenditure CategoriesT-26 Estimated Schedule of Disbursements, 1981-1984T-27 Schedule of Key Project Actions To Meet the Disbursement ScheduleT-28 Quarterly Implementation Schedule for Non-Construction

Activities, 1980-1984T-29 Civil Works Implementation, Expenditure and Disbursement

Schedule, 1980-1984

ANNEX 2 Selected Documents and Data Available in the Project File

CHARTS

C-1 Organization of the National Family Planning CoordinatingBoard (NFPCB)

C-2 Organization of Training of Traditional Birth AttendantsC-3 Structure of the Ministry of Health

MAP

M-1 Indonesia: Administration and Population

INDONESIA

APPRAISAL OF A THIRD POPULATION PROJECT

I. INTRODUCTION

1.01 The Government of Indonesia (GOI) is continuing efforts to assure

its people an adequate minimum standard of living. The rapid growth of

population endangers the success of these efforts and thus is a matter of

serious concern to the GOI. Consequently, the GOI has incorporated in its

Third Five-Year Development Plan (REPELITA III, covering the period 1979/80-

1983/84) measures for accelerating the decline of fertility already achieved

by the national family planning program.

1.02 Despite the impressive success of the family planning program,especially in the islands of Java and Bali, the total fertility rate

(estimated to be 4.8 in 1979 corresponding to a crude birth rate of 35 per

1,000) is still high. The high death rate (16 per 1,000 in 1979) is likely to

decline rapidly in the near future, with the possible consequence of a sharp

increase in the rate of population growth if fertility remains unchanged.The fact that the population is predominantly young means that it will take

many years for a reduction in fertility to bring about an appreciable slowing

down in the rate of growth. Moreover, because the population of Indonesia is

so large (140 million in 1979), even a relatively low rate of growth means

large absolute annual increases.

1.03 The original objective of the national family planning program

was to reduce the 1971 total fertility rate by 50% over the period 1971-2000.

The date for achieving this goal was recently revised to 1990. This revised

target calls for intensified efforts to reduce the birth rate. The GOI is

therefore planning to reduce the total fertility rate from 4.8 in 1979 to

3.5 in 1984. The proposed project, the successor of the first project (Cr.

300-IND) financed jointly by the GOI, IDA and the United Nations Fund for

Population Activities (UNFPA), and the second project (Ln. 1472-IND) financed

by the GOI and the Bank, is designed to help the GOI to achieve this goal.

The proposed project, like its predecessors, will form part of the national

program, and will carry on and extend many of the activities begun under the

first and second projects.

II. DEMOGRAPHIC PROFILE

A. Current Status

2.01 The population of Indonesia -- the fifth most populous country

in the world - increased by about 21 million between the last census in

1971 and the end of 1979, when it was estimated to be 140 million. Because

immigration and emigration are negligible, the growth of the population is

determined by the difference between births and deaths, and the rate of growth

coincides with the rate of natural increase.

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2.02 Despite a substantial decline in the birth rate during the lasttwo decades -- the combined result of a highly successful family planningprogram and socio-economic development -- the rate of natural increase remainshigh in relation to the socio-economic development goals and the ratesachieved in some other Asian countries (Annex I, Table T-1). A decline in thebirth rate of about 26% during the period 1960-79 was masked by a decline inthe death rate of 30% during the same period. About two-thirds of the declinein the birth rate took place after the introduction of the family planningprogram. The table below shows the changes in key indicators over the period1960-79.

Expec-Crude Crude Rate of tation InfantBirth Death Natural Total of Life MortalityRate Rate Increase Fertility at Birth (per 1,000

(per 1,000) (per 1,000) (% per annum) Rate (in years) live births)

1960 47 23 2.4 6.0 41 1401970 43 17 2.6 5.5 44 1261977 37 16 2.1 4.9 48 1101979 1 35 16 1.9 4.8 48 100/2

/1 The 1979 figures are the estimates given by NFPCB; the other data are fromthe 1971 Census and the 1976 Intercensal Population Survey.

/2 The MOH gives 110 as the rate; Census Bureau estimates, however, indicatethat it ranges from 126 for females in Java to 176 for males in some ofthe other islands.

2.03 A built-in potential for further rapid growth of population isprovided by the universality of marriage, the young age structure of thepopulation and the likelihood that improvements in health services willbring about an appreciable reduction in mortality, which remains fairly highdespite a rapid decline in the 1960s. Thirty percent of women aged 15-19years, 80% of those aged 20-24, and 98% of those aged 30-34 are or have beenmarried. A high proportion of Indonesia's population (42%) is under 15 yearsof age. This high proportion not only adds to the dependency burden but intime will increase the proportion of women of reproductive age and thus createa momentum for population growth. (Age composition of the population is givenin Annex 1, T-2).

2.04 Although a reduction in mortality increases the rate of growth ofpopulation, a reduction in infant mortality, by enabling more children tosurvive to maturity, is likely to motivate couples to adopt family planning.High rates of infant mortality are commonly found together with high fertilityin low-income families. In the first place, mothers who cease breast feeding

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because of the death of an infant are biologically more likely to conceive

another. Moreover, parents who lose children are likely to try to replacethem; in addition, parents in communities with high mortality may also insurethemselves against future child loss by having more children than they wouldideally want. On the other hand, high fertility contributes to high infantand child mortality because close spacing of births and many births maydeplete the mother's physical resources and reduce the amount a family has tospend on each member of the family.

2.05 Infant mortality, which accounts for a large proportion of totaldeaths, was estimated at 100 per 1,000 live births in 1979. This rate com-pares unfavorably with those in Thailand (68), neighboring Malaysia (44) andKorea (38).

2.06 The chief cause of infant and child mortality is diarrheal diseaseswhich account for 60% of the deaths of children under five years of age.Other serious health problems affecting young children are acute respiratoryinfection, neonatal tetanus (often caused by traditional delivery practices),diphtheria, whooping cough, measles and protein-calorie malnutrition.

2.07 Maternal mortality, due principally to postpartum hemorrhage,infection and toxemia, is also high at 3 per 1,000 deliveries (1976). Sincethis figure is derived from data confined to mothers who deliver in hospitals,the actual rate may be much higher. Most deaths of the new-born and ofyoung children could be prevented by proper prenatal care, identification ofhigh-risk pregnancies and their delivery under competent supervision, andimmunization against tetanus and other childhood diseases. Only 10% ofpregnant mothers receive prenatal care, and only 15% of deliveries areattended by medical or paramedical personnel, or trained traditional birthattendants.

2.08 In time, a rise in the age at first marriage, a reduction in infantmortality and an older age structure may be expected to reduce the birthrate and the growth of population. Since changes in the age at marriageand the age structure of the population take place slowly, family planningand maternal and child health care will remain an important means of reducingthe birth rate and the rate of population growth.

B. Regional Variations

2.09 Indonesia's population is very unevenly distributed. Java and Baliaccount for 64% of the total population but less than 7% of the land area,while Kalimantan has 27% of the land area and only 4% of the population.The density of population is about 931 persons per km in Java -- higher thanin Bangladesh -- but only 26 per km in the rest of the country. Although the

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other islands account for only one-third of the total population at present,the proportion is growing because their population is growing faster thanthat of Java and Bali. (Comparative data are given in Annex 1, T-3).If the present difference in rates continues, the population of the otherislands will overtake that of Java within a few decades. The much lowerbirth rate in Java reflects the success of its family planning program.Infant mortality is lowest in Java and Bali, higher in Sumatra and Sulawesi,and highest in Kalimantan and Irian Jaya. Throughout the country, infantmortality is higher in rural than in urban areas, and higher among malesthan females. Differences in other demographic and socio-economic charac-teristics between Java and the other islands are also quite striking. Theother islands have a higher proportion of young children under five thanJava (16.1% compared with 14.5%) and a higher average number of childrenever born per ever-married woman (6.5 compared with 3.1). These figures areconsistent with the higher population growth rate and total fertility ratein the other islands.

2.10 There are also differences in the knowledge and practice of familyplanning between Java-Bali and the other islands (see Annex 1, T-4). Whereasroughly two-thirds of all women aged 15 to 49 in Java-Bali have heard of amethod of family planning, the proportions in the other islands are 58%in Sulawesi, 50% in Sumatra and Nusatenggara and only 30% of those inKalimantan. The differences in use of contraceptive methods are even morestriking. Of those women who have ever heard of a method, the proportion whoare currently using one in Java-Bali ranges from 47% in Bali to 20% in WestJava, while in the other islands, the proportion is never greater than 20%and is as low as 12% in Sulawesi and 13% in Sumatra. Of those currentlyusing a method, the proportion using a contraceptive method supplied by theprogram is substantially higher in Java-Bali, being as high as 97% in EastJava and 95% in Bali, while Jakarta has the lowest proportion at 77%. In theother islands, the proportion of those using a contraceptive method suppliedby the program ranges from 70% in Sulawesi to 40% in Nusatenggara. Thesedata indicate the need for expanding and intensifying the family planningprogram in the other islands.

C. Economic Development

2.11 In spite of the economic progress which Indonesia has made inthe past ten years, it is still a poor country. The per capita gross domesticproduct was estimated at $370 in 1979. About 28% of adults, and half of theadult women are illiterate; 20% of the children die before they attain fiveyears of age, and access to health services is poor. The annual additions toan already large population complicate the task of eliminating poverty towhich the GOI is committed. The high proportion of children aged 0-14 yearsand persons aged 65 and over is reflected in a high dependency ratio of 81(as compared with 56 in Singapore and 71 in Korea), with its serious impli-cations for the standard of living. Approximately 82% of the population livein rural areas, so that there is heavy pressure on agricultural land, especiallyin Java and Bali.

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D. Future Trends

2.12 Assuming that fertility declines so that a net reproductionrate of one is reached by 2020, Indonesia's population will increase from 140million in 1979 to 207 million by the year 2000 and will become stationary at357 million by 2145. 1/ Even with the assumed decline in fertility, therate of growth of population would still be about 1.5% by the end of thecentury, and would not fall below 1% until 2025-30 (Annex 1, T-5). Recentlythe GOI decided therefore to advance its target date for achieving a reductionof the total fertility rate as mentioned in para. 1.03. A reduction of thefertility rate from 4.8 to 3.5 is planned for the REPELITA III period.

III. POPULATION POLICY. ORGANIZATION, PROGRAM AND ACHIEVEMENTS

A. Policy

3.01 In the early years of independence under President Sukarno,Indonesia adopted a pronatalist policy. Family planning was viewed asunnecessary except to space births in order to preserve the health of themother. It was considered that, in the long-run, fertility would declinewith economic progress. Consequently, the GOI took no direct action toreduce fertility. With the accession to power of General Suharto in March1966, the G0I altered its policy toward the rapid growth of population. Itwas realized that the high rate of growth of over 2% per annum was retardingsocio-economic development by imposing excessive pressure on natural resourcesand contributing to unemployment. In addition, the high rate of growthtended to maintain the inequality of income distribution, limited savings andreduced the productivity of investment. The pronatalist population policywas therefore discarded in favor of explicit support for a national familyplanning program.

3.02 The first steps toward the adoption of a national family planningprogram were taken by community leaders and influential groups who saw aneed for such services for individuals, quite apart from the impact thatsuch services would have on population growth. From 1957 onwards theIndonesian Planned Parenthood Association (IPPA) provided services, mainlyfor the urban population. The IPPA continued to expand until the mid-1960s,when the political situation and the GOI's pronatalist policies forced it to

1/ World Bank, World Development Report, 1979.

Suspend its activities. With the advent of the new Government in 1966, theIPPA reopened its clinics, and over the next two years paved the way for theadoption of family planning as official policy.

3.03 With the signing of the Declaration of World Leaders on Populationby President Suharto in 1967, the IPPA expanded its activities significantly,and in 1968, the GOI formally adopted family planning as a national program,with the explicit purpose of reducing the rate of population growth. Follow-ing the report of a UN-WHO-IBRD mission in 1969, which recommended large scalegovernment action, the National Family Planning Coordinating Board (NFPCB)was established in 1970 to plan and coordinate the family planning program,at first restricted to Java/Bali, extended to ten provinces in the otherislands in 1974, and to the remaining eleven provinces of the country in1979. The geographical coverage and expansion of the program is shown inthe following table:

Java and Bali Provinces Other Islands I Provinces Other Islands II Provinces(Program started 1970) (Program started 1974) (Program started 1979)

1. Jakarta 1. Aceh 1. Riau2. West Java 2. North Sumatra 2. Jambi3. Central Java 3. West Sumatra 3. Bengkulu4. East Java 4. South Sumatra 4. Central Kalimantan5. Yogyakarta 5. Lampung 5. East Kalimantan6. Bali 6. West Kalimantan 6. Central Sulawesi

7. South Kalimantan 7. Southeast Sulawesi8. South Sulawesi 8. East Nusatenggara9. North Sulawesi 9. Timor Timur10. West Nusatenggara 10. Maluku

11. Irian Jaya

B. Organization

3.04 Part of the success of the Indonesian program is attributable tothe decentralization of program planning and management. The Chairmanof the NFPCB enunciates national policy in consultation with senior andmid-level officials of the national and provincial NFPCBs and implementingagencies. The provincial offices of the NFPCB, called Population and FamilyPlanning Centers (PPFPC), in collaboration with ministries, district NFPCBoffices and private organizations, then formulate provincial programs which,after approval by the Provincial Governors, are submitted to the centralNFPCB for approval. The national and provincial plans receive final approvalat an annual conference attended by provincial representatives and seniorofficials of the NFPCB and implementing agencies.

3.05 The NFPCB is a fully governmental body (unlike its predecessor,the semi-autonomous Family Planning Institute) with a chairman who reportsdirectly to the President who continues to give personal attention to theprogram, four deputy chairmen in charge of eleven functional bureaus, asecretariat and a Center for Education and Training. The structure of

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the NFPCB is shown in C-1. The execution of the program is carriedout by the NFPCB and various other government agencies. The NFPCB's authorityover these agencies is reinforced by the high priority assigned to theprogram and by its budgetary control over GOI family planning expenditures.These executing agencies include the Ministries of Health, Information,Education and Culture and Interior, as well as the armed forces (ABRI), andprivate organizations, including the IPPA, the Muslim Association, and theIndonesian Council of Churches.

3.06 At the provincial level, the execution of the national programis coordinated by provincial NFPCB Chairmen who are responsible to thenational NFPCB Chairman for administrative, financial and technical matters.Each provincial NFPCB office (PPFPC) has a secretary and three divisions forplanning, supervision, and research and evaluation respectively. ProvincialGovernors are responsible for the execution of the family planning program intheir respective provinces, and issue operational directives to provincialNFPCB Chairmen on behalf of the President.

3.07 As part of the policy of decentralization, the NFPCB has recentlyestablished offices at the district (kabupaten) level in Java and Bali, and isin the process of doing so in the other islands. At the district level, theNFPCB has a chairman, a supervisor for fieldworkers, and supporting staff.Here again, there are close links with the administrative head of the district(Bupati) and representatives of the service units. Although responsible tothe provincial NFPCB Chairman, the district Chairman receives directives andsupport on operational matters from the administrative head of the district.

3.08 At the sub-district (kecamatan) level, the administrative head(Camat) from the Ministry of Interior, the health center (puskesmas) physicianfrom the Ministry of Health (MOH) and the group leader of NFPCB's familyplanning fieldworkers, assisted by other officials, organize educational,informational and service activities. At the village level, the villageheadman (Lurah) from the Ministry of Interior, the NFPCB fieldworkers, andthe MOR midwife, assisted by the voluntary family planning worker, are respons-ible for recruiting acceptors and sustaining their practice of contraception.

C. Program

3.09 The services offered by the family planning program comprise informa-tion, education and communication (IEC), population education, maternal andchild health care, and family planning (MCH/FP). These services are supportedby the training of family planning and medical and paramedical personnel, andan effective monitoring and evaluation system.

Information, Education and Communication

3.10 The community education program, directed and supervised at thenational level by the Information and Motivation Bureau of the NFPCB which,

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through the Ministry of Information's Media Production Center, providesmaterials for fieldworkers, is planned and coordinated at the provinciallevel and implemented through family planning fieldworkers or through othergovernment workers.

3.11 The NFPCB has information bureaus at national, provincial anddistrict levels which use the mass media (radio, television and the press),mobile information units and personal contacts by fieldworkers to conveyfamily planning information to the public. The bureaus use the mass media tocreate a climate of opinion favorable to family planning, and then rely onfield activities to reinforce the message. Carefully designed audiovisualaids are of great importance in this field work. Now that people aregenerally aware of family planning, greater emphasis is being placed ondesigning messages addressed to specific groups.

3.12 The IPPA and the Ministries of Information and Religion also par-ticipate in IEC activities. The Ministry of Information has set up a familyplanning unit which works through information teams at provincial and districtlevels. These teams hold meetings to discuss population problems and therelationship between religion and family planning, and to provide informationon contraceptive methods. At these meetings, the IEC workers use audiovisualaids in the form of posters, flip charts, and sound slides, and willeventually use video systems, to drive home the "small family" message. Atpresent, however, there is a serious shortage of audiovisual aids and mostmeetings have to do without them.

3.13 Since 1974, the mobile information unit, a van with audiovisualequipment, has played an important role in the IEC program. The 115 mobileinformation units provided under the first project were used in Java and Balito draw large crowds, providing an occasion for community leaders and NFPCBstaff to talk to the villagers. Each van visited about 144 villages a year,and attracted roughly 288,000 people, so that the mobile information unitsreached 33 million people in Java and Bali over the six-year period. Themobile information units have therefore been of great importance, but somemomentum has been lost recently because of the shortage of up-to-datematerials. In addition, many of the mobile information unit vehiclesprovided under the first project in 1972 are due for replacement.

3.14 The GOI, with UNFPA support, will improve research into and theevaluation of IEC activities as well as in-service training. The UNFPA willsupport three studies to be carried out locally: (a) the evaluation ofIEC training; (b) an assessment of the family planning informational needsof eligible couples to be used in the design of visual aids; and (c) a studyto determine the training needs of mobile information units operators.

Population Education

3.15 In order to create a better understanding of population problemsand policy among the community and the younger generation, population educa-tion is being introduced into both formal and non-formal education. The

Ministry of Education and Culture has set up an effective unit to deal withthe program, and a small unit in the NFPCB is coordinating and monitoringthe population education activities of the various agencies.

3.16 In the early years of the program, workshops and seminars wereorganized to prepare a "critical mass" of teachers who could be used

in training, and in the supervision and implementation of the nationalprogram. Curricula have been prepared for all school levels and some in-struction materials have been produced. The program is gradually beingextended to the entire formal and non-formal education sectors and to pre-service and in-service teacher training institutions.

3.17 An evaluation of the population education program in 1979 identifiedthe needs as: (a) the expansion of the in-service training of teachersand the training of more instructors for the out-of-school program; (b)more textbooks for schools and non-formal education centers; (c) the trainingof school supervisors at district and sub-district levels to monitor theprogram and provide guidance for school and out-of-school activities; and (d)the training of specialists in population education. The population educationcomponent of the proposed project will help the GOI to meet these needs and toextend population education further into formal education, out-of-school

programs and teacher training institutions.

MCH/FP Services

3.18 Family planning and MCH services are delivered through 3,411clinics of the MOH, 319 ABRI clinics, 295 private clini:s, and 109 clinicsoperated by other government agencies, as well as through NFPCB fieldworkersand community level organizations.

3.19 Clinics. MCH/FP services are provided in rural areas as part ofhealth services in about 4,000 health centers. Each center serves about40,000 persons in Java and Bali, and 15,000-25,000 in the other islands. Afull complement of staff for a health center consists of one physician, onenurse, one midwife, three auxiliary nurse/midwives, one sanitarian, one dentalnurse shared by three health centers, and one clerk. Because of a shortage oftrained workers, many centers have not attained this level of staffing and areunable to provide the full range of services, which include basic medicalcare, maternal and child health care, family planning, communicable diseasecontrol, hygiene and sanitation, nutrition, and health education.

3.20 Cases which cannot be handled by the health centers, and patientsrequiring in-patient care, are referred to district hospitals. An importantgoal of REPELITA II was to upgrade district hospitals to serve as referralcenters, each with a surgeon, a gynecologist, an internist, and a pediatrician.Under REPELITA II, more than half of the Government hospitals (a total of 376hospitals in 19 provinces) were upgraded. This upgrading entailed not onlyincreased staffing but improved facilities, management, and record-keeping.Cases calling for treatment beyond the capacity of district hospitals arereferred to private or provincial hospitals. An important goal of REPELITA

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III is to continue the process of improving referral hospitals by providing

more staff, equipment and better management.

3.21 The static clinics are supplemented by about 2,000 mobile service

units operateA by MOH and ABRI which deliver family planning services in

remote villages. Each unit is staffed by a doctor, a midwife, and a nurse.

3.22 Fieldworkers. In addition to MOH clinics and staff, the NFPCB has

a corps of 7,000 family planning fieldworkers in Java and Bali who visit

homes, inform people about family planning, encourage them to practice con-

traception, and distribute contraceptives. They are usually local people

working in their own neighborhoods and are thus sensitive to the needs of

the people they serve.

3.23 Community Organization. Finding that it was nearing the limits

of the clinic-based approach, the NFPCB decided to transfer the primary

responsibility for motivating, recruiting and supplying family planning

acceptors from central government agencies to local authorities and to the

people themselves. Local community workers were enlisted to promote family

planning and distribute contraceptives. There are some 60,000 family planning

acceptors clubs and groups throughout the country which engage in economic

activities and promote the adoption and practice of contraception among

eligible couples.

3.24 Ir Bali, a hamlet bound together by kinship, social and economic

ties (banjax), has become the organizational unit for integrating family

planning. Household leads meet once a month to discuss community matters as

well as the family planning status of eligible women in their households.

Responsibility for family planning activities has been placed on the adminis-

tration of the hamlet. Under this system, each household head reports

publicly at the customary monthly meetings on the family planning and

pregnancy status of every married woman of reproductive age in his household.

Registers of all eligible couples are compiled, recording their addresses,

their use of contraceptive methods, and the supplies of contraceptives they

have received. A hamlet map identifies each household according to the method

of contraceptive use.

3.25 The NFPCB has established village contraceptive distribution centers

(VCDCs) staffed by villagers (usually satisfied acceptors) who are assisted by

fieldworkers from the provincial NFPCB. Distribution is through individual

contacts or collective meetings which provide opportunities for follow-up work

and motivational approaches to non-acceptors. The VCDCs (of which there are

now over 34,700) serve as community family planning posts which also enlist

local volunteers.

3.26 In the other islands, the NFPCB once again had to modify its

approach. Since it employs no fieldworkers in these provinces, the admin-

istrative head of a sub-district is used to train hamlet officials how to

manage the program in their areas.

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Training of Family Planning, Medical and Paramedical Personnel

3.27 The IPPA had set up regional training centers in the provinces.When the national program was introduced, the IPPA undertook to train thenecessary manpower in these centers on behalf of the NFPCB. Subsequently,the NFPCB decided to assume this responsibility itself in order to be able toexert better control over quality.

3.28 The Center for Education and Training of the NFPCB is responsiblefor training at the national level and for the coordination and supervision ofthe training provided by Provincial Training Centers (PTCs) in each of thesixteen provinces covered by the national program and by ten Sub-provincialTraining Centers (STCs) in West, Central and East Java. Similar PTCs are nowbeing established in the eleven provinces of Other Islands II.

3.29 The PTCs are responsible for training provincial family planningstaff, government officials and community leaders. The STCs are responsiblefor training other fieldworkers, sub-district and village level officialsand community leaders. Each PTC has a director, a deputy director, anadministrative coordinator and five trainers. The STCs are staffed by adirector, a field training coordinator and five trainers. The provincialNFPCB Chairman is in administrative control of the PTCs and STCs.

3.30 The majority of doctors who graduate from medical schools in Indo-nesia are assigned directly to health centers where the lack of in-patientfacilities limits the scope of practical application of their clinical train-ing. The GOI therefore proposes to organize six-months courses at provin-cial teaching hospitals to sharpen their clinical skills, specifically inminor surgery, obstetrics, gynecology, pediatrics and internal medicine. Inaddition, the GOI has plans for upgrading health centers by providing themwith adequate in-patient facilities.

3.31 At present there are several different categories of nurses andmidwives. In order to simplify the categories and to broaden the services,the MOH has decided to train primary health nurses (perawat kesehatan or PK)to provide basic nursing services, both in the villages and at health centers.The long-term goal is to train enough primary health nurses to provide six foreach health center, and one for each subcenter. The primary health nurse usesthe health center or subcenter as a base for work in the villages, and isassisted in some areas at the village level by five to seven primary healthworkers (promokesa) each of whom is responsible for 15-20 households. At thevillage level, traditional birth attendants perform the delivery of babies athome, provide information on family planning, nutrition and health, and referpatients who need professional attention to health centers. Thus they play animportant role in maternal and child health care at this level.

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Reporting and Evaluation

3.32 Targets are set as a guide for planning and as a stimulus to familyplanning workers. The NFPCB has estimated the number of new acceptors ofpills, IUDs, condoms, and other methods needed to reach the taiget of reducingfertility by 50% between 1971 and 1990, so that clinics and fieldworkershave a clear picture of the task they must accomplish. Each clinic isrequired to submit monthly service statistics of new acceptors, contraceptivesupplies, revisits, and contraceptive use to the NFPCB in Jakarta. Theinformation is used to measure and evaluate program performance. In addition,the NFPCB conducts knowledge, attitude and practice surveys in selected areasof the country and uses the findings to modify policy and service methods.The NFPCB also makes studies of contraceptive continuation rates andcontraceptive prevalence.

3.33 The Indonesian family planning program reporting system is one ofthe best in the world. The data are up-to-date, published regularly andfed back to program planners and managers. The advantages of the systemare that: (a) clinic reports can be checked against acceptor's record cardssent monthly to the central office, and (b) local administrators can comparetheir district's progress with that of other districts and thus have solidfacts to support requests for more funds and equipment. The data are alsoused to publish periodically new acceptor characteristics such as age, numberof children and education, which are used to monitor current trends in thetype of acceptors. The reporting and evaluation system therefore providesvital information to policy-makers and gives valuable guidance to localprogram administrators.

D. Financing of the Family Planning Program

3.34 The GOI has demonstrated its commitment to family planning throughits increasing financial support for the national program. Expenditures haverisen from $2.3 million in 1969/70 to over $26 million in 1978/79. The totalplanned allocation for the Third Five-Year Plan is $240 million. Annex 1,T-6 shows the growth of GOI expenditure and external funding for the familyplanning program during the period 1968/69-1978/79. External donors have alsoincreased their support, and by February 1980 had pledged well over $115 mil-lion for the Third Plan period. The largest donor continues to be the UnitedStates Agency for International Development, with a total of $77.8 millionpledged for the Third Plan period to be spent primarily on studies, training,equipment and vehicles, supply of contraceptives, local production of contra-ceptives, and village family planning services and maternal and child healthcare. Other bilateral aid, especially from the Netherlands, Japan andAustralia, has been and will continue to be an important source of contracep-tive supplies and other equipment. The UNFPA will provide about $33 millionfor the Third Plan period to support various aspects of the national program,including an evaluation of the IEC program (para. 3.14). The United Nations

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Children's Fund (UNICEF) has allocated $2.3 million for the family planning

and basic nutrition program. The external assistance is coordinated by the

NFPCB, and Bank assistance, which is directed primarily at the other islands,

will complement other donor assistance.

E. Achievements of the Family Planning Program

3.35 From its inception in 1969/70 to the end of December 1979, the

national family planning program had recruited nearly 15 million acceptors.

At present there are about six million eligible couples practicing contra-

ception. In each year since 1972/73, the program has achieved or exceeded

its targets (Annex 1, T-7). The proportion of married women of reproductive

age (15-44) practicing contraception in Indonesia as a whole in 1979 was

about 27%. The corresponding proportions for other countries were Korea 44%,

Malaysia 39%, Philippines 22%, and Singapore 77% (Annex 1, T-1). This

comparison shows that, although Indonesia has achieved significant results in

the nine years since it shifted from a pronatalist policy to national support

for family planning, there remains considerable scope for increasing the

proportion of acceptors.

3.36 Of the contraceptive methods in use in Indonesia, the oral pill

represents about 69% of acceptors and IUD 18%. Condoms are used by about

8% of acceptors, and other contraceptive methods, including the injectable,

account for about 5% of acceptors (Annex 1, T-8).

3.37 The overall achievements mask wide variations from one region

to another. As of March 1979, an estimated 37% of married women of

reproductive age were practicing contraception in Java and Bali. The

corresponding figures for Other Islands I and II (para. 3.03) are 10.3% and

2.3% respectively, indicating the need to intensify the family planning

program in these areas (Annex I, Table T-9).

3.38 Changes in fertility are attributable to changes in marital fer-

tility, age at marriage and/or proportions married, and the age composition

of the population. In Java and Bali, where the program has been in operation

since 1970, about 70% of the decline in fertility between 1971 and 1976 is

attributed to a reduction in marital fertility, most of the remainder (30%)

being explained by rising age at marriage.

3.39 The outstanding success of Indonesia's family planning program

is attributable to the total commitment of the country's leadership to the

program's success; the decentralized program management and monitoring; and

community participation and support.

3.40 The GOI made it clear from the outset that its objective was to

reduce the rate of population growth. From the President down to the village

headman, political leaders have consistently demonstrated their commitment to

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this objective. The decentralization of the NFPCB has served to enlistthe political power and enthusiasm of local leaders and officials in supportof the family planning effort. Operational decentralization has been extendedto the village level. Over the years, under the guidance of the NFPCB,the Indonesipn family planning program has become a unique blend of governmentinitiative and community participation. It has been successfully absorbedinto the fabric of local political and social institutions.

F. Family Planning Program Needs

3.41 In summary, the main needs of the MCH/FP service program arephysical facilities for further decentralization of program management andtraining, equipment and training for expansion of IEC activities, furthertraining for medical and paramedical personnel, and upgrading of healthfacilities to strengthen the referral system for MCH/FP services. Thefirst and second projects assisted the GOI to meet these needs in Java andBali and in other islands, and the proposed project will continue thisassistance and help to expand the program.

IV. FIRST AND SECOND POPULATION PROJECTS

A. First Population Project

4.01 The purpose of the first population project (Cr. 300-IND) was three-fold: (a) to strengthen NFPCB's capacity to coordinate the national program;(b) to improve family planning service delivery; and (c) to improve informationand motivation services. The project, whose components are shown in Annex 1,T-10, was confined to the islands of Java and Bali.

4.02 The estimated total project cost was $33.0 million, partly financedby an IDA credit of $13.2 million and a matching UNFPA grant of $13.2 million,and became effective in November 1972. As of March 1980, some $22.5 million(about 85% of the total IDA/UNFPA funds) had been disbursed. The project isexpected to be completed by December 1980.

4.03 The project has had a significant impact. The new provincialoffices and training centers have enabled NFPCB to supervise the program moreeffectively and have facilitated the training of MCH/FP personnel. Programmanagement and performance have improved. The MCH/FP pilot project inMojokerto has demonstrated the overwhelming advantages of integrating MCH withfamily planning services. Fifty percent of eligible women in the pilotproject area are now using modern contraceptive methods, compared with 37% inJava as a whole. Over 85% of the IUD acceptors and over 60% of the pillacceptors continue to use the methods after 12 months. A strong IEC programhas been established, and population education in schools has undergone its

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first trials. The NFPCB now has a well-established system of collecting,analyzing, and publishing service statistics. It has increased not only itsown research and evaluation capability, but also that of local demographicinstitutions, notably the Institute of Demography of the University ofIndonesia and the Population Institute at Gadjah Mada University.

B. Second Population Project

4.04 The objectives of the Second population project (Ln. 1472-IND) wereto assist the NFPCB to improve service delivery through the provision ofmobile service units, to expand and strengthen population education andmotivation activities with a view to promoting widespread acceptance of thesmall family norm and practice of contraception, to improve program managementand to provide training institutions. The project helped to achieve theseobjectives by providing transport for MCH/FP staff, providing instructionalmaterials for population education, improving NFPCB's management, andinvestigating the feasibility of providing raw materials for local productionof oral contraceptives from materials obtained from Indonesian plants. Theproject also included a pilot community incentive scheme study. The totalproject cost was $60.0 million, $24.5 million of which was financed by a Bankloan which became effective in August 1977 and the remainder by the GOI.(The components of the project are also shown in Annex 1, T-10.) The projectcovers ten provinces of Other Islands I, as well as parts of Java and Bali.

4.05 It is too early to assess the impact of the project, althoughphysical progress has been good. The construction of ten PTCs and NFPCBprovincial offices has been completed, and the National Family PLanningTraining Center is under construction in Jakarta, so that 100% of all civilworks are committed and 90% have actually been completed. The delivery ofvehicles has recently commenced and is expected to be completed within thenext two months. Population education is being extended and textbooks havebeen printed and teaching kits distributed. By the end of 1979, 30,000teachers had undergone training in population education. Equipment is beingprocured for the contraceptive raw materials study and the collection ofpromising samples of local raw materials is underway.

4.06 The project has made much greater progress than is suggested bythe current level of disbursements. Disbursements are lower than expectedfor the following reasons:

(a) All of the construction work is committed and 90% is com-pleted--yet only 50% of the funds allocated for constructionhas been disbursed. The difference is due partly todelays in the payments to contractors, and partly tothe customary withholding of part of the amount dueuntil the work is completed. GOI has agreed to expeditepayments and reimbursement applications.

(b) While most of the vehicles have been purchased and arebeing delivered, no reimbursement applications have yetbeen received. The Bank has been informed that the GOIis processing the applications.

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(c) The contraceptive raw materials study began in September1979--one year later than that originally forecast, andthe population education component was deferred for 12 monthspending the introduction of new curricula. Reorganizationwithin the MOE and a 6-month extension of the school ,ear duringwhich teachers were required to concentrate on school work alsocontributed to the delay.

(d) Because of the delays in starting the implementation of thetwo components in (c) above, the purchase of equipment andmaterials and the use of technical assistance for these activitieswere delayed. Procurement is now in progress and disbursementshould increase substantially when reimbursement applicationsare received.

(e) No disbursement has been made against the pilot communityincentive scheme due to protracted ongoing discussions betweenthe GOI and the Bank on the details and design of the study.

Despite these delays, it is expected that the project will be completed byOctober 1982, the original completion date.

C. Experience with Implementation of the First and Second Projects

4.07 Some problems encountered under the first two projects have provideduseful lessons for improving the proposed project. In the early stages of thefirst project, the lack of experience of the NFPCB with projects of that sizeled to considerable delays in the construction of civil works. This setbackwas due partly to inadequate briefing of the local architects, partly toNFPCB's unfamiliarity with GOI civil works procedure and documentation, andpartly to budgetary problems. As NFPCB gained experience, the civil worksunder the second project were handled very effectively. Construction underthe second project was greatly speeded up by the advance preparation ofbuilding plans.

4.08 Because the Ministry of Information pooled the mobile informationunits provided under the first project with its own mobile information units,some of the vehicles were used for non-project purposes. To ensure that thisdid not occur under the second project, all vehicles provided under theproject are to be owned and operated by the NFPCB and identified by color,markings and registration as NFPCB vehicles. A system and procedures formonitoring the operation and maintenance of the vehicles have been establishedand have been found satisfactory. They will be applied to vehicles providedunder the proposed project.

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D. Linkages between the Earlier Projects and the Proposed Project

4.09 The integrated MCH/FP pilot development project in Mojokerto(East Java) und_r the first project has demonstrated the effectiveness ofan approach designed to reach all pregnant or recently delivered women.The proposed project will extend this MCH/FP approach to the provinces ofCentral Java, West Java, North Sumatra, West Sumatra, South Sumatra, andSouth Sulawesi by adding an in-patient annex to selected health centers andby supporting the training of medical and paramedical personnel and traditionalbirth attendants to improve the delivery of MCH/FP services.

4.10 Under the first and second projects, population and family planningcenters were constructed in Java and Bali, as well as in ten provinces of theother islands. The extension of the program to the remaining eleven provincesduring REPELITA III calls for the construction of further centers underthe proposed project.

4.11 In earlier years, the information, education, and communicationprogram under the first two projects helped in recruiting a large number offamily planning acceptors in Java and Bali, but in 1978/79 the number of newacceptors appeared to reach a plateau. Greater motivation efforts are neededto recruit the more resistant potential acceptors. In the other islands,where program activities are only now getting underway and where the fertilityrate is above the national average, much greater efforts are needed. Theproposed project will also provide assistance in this important program area.Annex 1, T-10 compares the components of the first and s?cond populationprojects with those of the proposed project.

V. THE PROJECT

A. Objectives

5.01 The GOI has set for itself the goal of reducing the 1971 fertilityrate by 50% by 1990. This goal can best be achieved through a comprehensiveprogram which will have an impact on all factors affecting fertility, andthrough an intensified effort to reach all of the population of Indonesia.

5.02 The proposed project will, on the basis of the needs identifiedin paragraph 3.41, assist the GOI to achieve this goal in the followingways:

(a) Helping NFPCB to decentralize the management of the family planningprogram by providing office training and storage accommodation;

(b) Expanding the information, education, and communication activitiesbegun under the first two projects; and

(c) Strengthening maternal and child health services.

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B. Project Composition

5.03 The proposed project will provide for:

(a) Infrastructure development: Construction of, furnishing andequipping:

(i) Eleven provincial population and family planning centersin the Provincial Capitals of Riau, Jambi, Bengkulu,Central Kalimantan, East Kalimantan, Central Sulawesi,Southeast Sulawesi, East Nusatenggara, Timor Timur, Malukuand Irian Jaya; each such center to include an administra-tive headquarters, a training center, and a warehousefor storing contraceptives and information, educationand communication materials;

(ii) Warehouses for storing contraceptives and information,education and communication materials in the followingten provinces: Aceh, North Sumatra, West Sumatra, SouthSumatra, Lampung, West Kalimantan, South Kalimantan,South Sulawesi, North Sulawesi and West Nusatenggara;and

(iii) A district population and family planning multipurposecenter in each of the 107 districts in the ten Provincesset ou;. in (ii) above.

(b) Support for National Family Planning Program:

(i) Information, education and communication activities.Strengthening the information, education and communicationprogram by providing 50 specially equipped mobile infor-mation units (29 replacement units for Provinces in Java andBali and 21 units, one each for Provinces outside Javaand Bali), equipment, consultant's services, fellowships,and operating costs for the provincial media productioncenters, film production and training;

(ii) Population education. In-service training in populationeducation of teachers (about 50,000), school supervisorsat district and sub-district levels (about 4,200),sub-district level supervisors for non-formal education(about 1,600) and village workers for non-formal education(about 16,000), and provision of teaching equipment,instructional materials, fellowships and operatingcosts.

(iii) Strengthening of supervisory capacity. Provision of about1,500 motorcycles to supervisors and field coordinators inthe Provinces outside Java and Bali.

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(c) Maternal and Child Health and Family Planning SupportServices:

(i) Training of traditional birth attendants. Assistingin, and improving, the capabilities of TBAs by(a) providing operating costs for the training ofabout 20,000 and the retraining of about 47,000 TBAs,and (b) providing support for training materials andoperating costs for about 3,100 trainers.

(ii) Retraining of nurses and midwives. Assisting in theretraining of about 1,080 nurses and midwives to becomeprimary health nurses at nine existing nursing schoolsin the following locations: Banda Aceh, Medan, Padang,Palembang, Pontianak, Banjarmasin, Samarinda, UjungPandang and Ambon, by providing vehicles, specialequipment, fellowships and support for training expenses.

(iii) Training of teachers in nursing schools in communityhealth. Assisting in training in community health 960teachers in nursing schools at four existing nursetraining schools by providing vehicles, special equipment,fellowships and support for training expenses.

(iv) Maternal and child health and referral services. Con-struction, furnishing and equipping of 10-bed in-patientannexes at 50 existing health centers in the Provincesof North Sumatra, West Sumatra, South Sumatra, West Java,Central Java, and South Sulawesi.

(v) Training of health center doctors. Assisting in, andimproving, the training of 50 staff doctors to be assignedto the health centers referred to in (c)(iv) above byproviding support for fellowships.

(vi) Training of health center medical and paramedical personnel,local administrators and community leaders. Assisting inthe training of health center medical and paramedicalpersonnel, local administrators and community leaders, by.support for study tours and training sessions.

C. Project Description

Infrastructure Development

5.04 Provincial Population and Family Planning Centers (PPFPCs). ThePPFPCs, as the provincial headquarters of the NFPCB, are responsible forprogram management, supervision, training, IEC and some research and evalua-tion (para. 3.06). Each PPFPC thus includes: (a) provincial administrative

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offices, including a center for the production and distribution of IEC

materials; (b) the provincial training center; and (c) a contraceptive storage

and distribution center. (Details of training and storage facilities are

given in paras. 5.08, 5.12 - 5.13.)

5.05 The first project provided buildings for the PPFPCs in the six

provinces of Java and Bali to strengthen program management. These PPFPCs

have been in operation for three years. As noted in para. 3.39, decentralized

management and training at the provincial and district levels are largely

responsible for the success of Indonesia's family planning program. When the

GOI extended the program to Other Islands I in 1974, similar provincial

centers were included in the second project. The buildings have all been

completed and occupied. In 1979, the family planning program was further

extended to cover Other Islands II and the GOI now proposes to provide

similar PPFPC buildings in the 11 provinces of these islands. At present the

NFPCB has only inadequate borrowed or rented accommodation, which severely

restricts the efficiency of its work. The proposed project will provide for

the construction, equipment and furnishing of 11 PPFPCs in Other Islands

II.

5.06 The staff of a PPFPC should consist of a chairman, four section

heads and 32 supporting staff. Although the staff of the 11 PPFPCs in Other

Islands II is substantially in position, the present offices, some of which

are rented, are inadequate and overcrowded. Skilled manpower is scarce in

the other islands compared with Java and Bali, but the NFPCB has been able to

recruit staff fairly easily due to the high priority accorded to the family

planning program by the GOI.

5.07 Each PPFPC building will cover an area of 2,050 sq. m. Of this

space, 55% or 1,120 sq. m. will be for the PTC, 27% or 590 sq. m. for office

accommodation and 18% or 340 sq. m. for warehouses. The buildings are

expected to be completed within three years.

5.08 Contraceptive Warehouses and Distribution Centers. The expansion

of family planning activities in the other islands necessitates the

stocking of large supplies of contraceptives. When the NFPCB provincial

offices were built under the second population project, no provision was made

for warehouses, and these are now urgently required. With the very much

expanded family planning program, the procurement and storage of contracep-

tives is a major operation. The NFPCB policy is to hold a twelve months'

supply at provincial, six months' supply at district, and three months'

supply at health center levels. No storage space for these contraceptives

exists and consequently there is a danger that cartons of contraceptives

improperly stored or left out in the open will deteriorate. The proposed

project will therefore include the construction of warehouses as part of the

PPFPCS in the 21 provinces of the other islands.

5.09 District Population and Family Planning Center. In the interest

of efficiency, the NFPCB has started to decentralize its management still

further, down to the district level. The NFPCB spread its operations to

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district level in Other Islands I after establishing provincial offices inthese islands with the assistance of the second project. No provision wasmade at that time for district offices, which are now required. The NFPCBstaff is housed in unsatisfactory borrowed or rented offices, and in one casecrowded into a garage. In addition, training on the scale needed at districtlevel is impossible without suitable accommodation. The project thereforeincludes the construction, equipment and furnishing of NFPCB offices in eachof the 107 districts of Other Islands I.

5.10 The district centers perform the same functions as provincialcenters. The staff, consisting of a chairman, three section heads and 24supporting staff, is at present using other government offices.

5.11 Each district center building will cover an average floor area of245 sq.m. These centers will provide the nucleus for program management andsupervision, the basic training of local staff, the storage of contraceptives,and the production and distribution of IEC materials to meet local requirements.

5.12 Provincial Training Centers. The NFPCB is responsible for traininglocal staff and also the staff of other departments which take part in thefamily planning program. Because of ethnic, religious and cultural diversi-ties, the complexion of program operations in the provinces of the otherislands is different from that in Java and Bali. The problems of distance andcommunication between provinces requires each province of the other islands tobe as self-sufficient as possible. Remote areas have their own language ordialect. Training requirements therefore vary from one province to another,so that each province needs its own training center. The first and secondprojects therefore included the construction of provincial training centers aspart of the PPFPCs in Java and Bali and Other Islands I. The proposed projectincludes 11 PTCs, one in each province of Other Islands II.

5.13 The Center for Education and Training of the NFPCB will coordinateand supervise training at the provincial level as well as the training oftrainers and curriculum development. The staff of each PTC will consist of adirector, one deputy director, one administrative coordinator and five train-ers. The trainers will largely be drawn from the volunteer workers of theIPPA, which has been conducting training courses in Other Islands II. Eachcenter will conduct training courses for family planning staff and medical andparamedical staff from provincial, district and sub-district levels as well ascommunity leaders. The expected training load in each province (presentedin Annex 1, T-ll) justifies the construction of new training centers in eachof these provinces.

Support for National Family Planning Program

5.14 Information, Education and Communication. As mentioned in para.3.11, the use of the mass media has been found to be effective in Indonesia.The mobile information units provided under the first project have reachedlarge audiences in Java and Bali. The proposed project will further expandIEC activities in Java and Bali and the other islands. The project willprovide: (a) 29 new mobile information units with audiovisual equipment to

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replace the 29 in Java and Bali which have become unserviceable; (b) 21 newmobile information units with audiovisual equipment, one for each of the 21provinces in the other islands; (c) videotape and cameras to enable the mobileinformation units to produce programs using the villagers themselves asparticipants; (d) public address systems for the 5,500 village family plan-ning acceptors' clubs in Java and Bali; and (e) two video duplicating machinesto enable the national television network to duplicate centrally-producedprograms for regional use, and of locally-produced programs for use by mobileinformation units. The project will also establish and equip provincialmedia production centers in the PPFPCs in the 21 provinces of the otherislands to produce sound slides, posters, cassettes, leaflets, brochures, andphotographs. The UNFPA is funding the six media production centers for Javaand Bali. The staff of all provincial media production centers will betrained at the central Media Production Center in Jakarta. The idea ofprovincial media production centers is new, and is the result of two UNFPA-funded studies which found that centrally-produced materials did not havesufficient impact on the different social groups in Indonesia. Two productiontechnicians for each of the 21 provincial media production centers will betrained.

5.15 The proposed project will also enable NFPCB to produce 15 newhalf-hour films to inform and motivate people. All films will be pretested,tested, and evaluated in the areas for which they have been designed, and 100copies of each film will be made. A previous exercise of this kind hasalready led to improvements in the scenarios of the films. When the film isalmost completed, it : s tested in the villages, or shown to representativegroups in Jakarta. Tle film is then completed and evaluated after a numberof public showings. The results of the evaluation influence film productionand communication strategy in general. Ideally, each mobile information unitoperator should have a complete set of films. But, given the high cost ofcopies, it is expected that 100 copies of each film will be enough to permitthe IEC program to cover the whole country.

5.16 The 29 mobile information unit operators from Java and Bali who arealready working with the units need in-service training. The operators havenot made good use of aids such as slides and public address systems, sincefilms are easier to use. A UNDP-assisted training course will help trainthem to make use of a wider range of audiovisual aids. None of them has beentrained in video production or the use of video equipment, and since theywill all be provided with this innovative equipment, training is essential.The proposed project will therefore provide technical assistance for threemonths to train 29 video operators from Java and Bali and the 21 operatorsfrom the other islands in video techniques and maintenance at the CentralMedia Production Center in Jakarta. In addition, the project will providefunds for study tours for three people to study rural video production.(Cost estimates are given in Annex 1, T-12).

5.17 The development of the capacity to produce audiovisual aids aimedat target groups will take some time, during which the UNFPA will finance

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research to identify such groups within the population (para. 3.14). Bothshould be completed at the same time so that production can be geared to theresults of the research. The Bureau of Information and Motivation will drawup a research and evaluation plan for the IEC program.

5.18 It is important that the NFPCB prepare an overall plan for theproduction of IEC materials. Assurances have been obtained that such a planwill be prepared by the NFPCB and submitted to the Bank for review not laterthan December 31, 1980. (The tentative IEC work program is given in Annex 1,T-13).

5.19 Population Education. The first project initiated the introductionof population education into school curricula by means of pilot activities in30 schools and 30 non-formal education centers. The second project helped toextend these activities by supporting the training of trainers (master teach-ers), the preparation of prototype teaching kits and their distribution, thepreparation of a population education curriculum for vocational schools andthe provision of textbooks. In addition, the GOI trained 30,000 primary andsecondary school teachers from a total of approximately 130,000 (one teacherfrom each primary school and two from each secondary school).

5.20 The project will help to meet the needs identified in a mid-termevaluation (para. 3.17) and to complete the process of integration ofpopulation education throughout the educational system. It will cover thein-school program, the out-of-school program, and teacher education. Popula-tion education activities included in the first two projects and those to beincluded in the proposed project are shown in Annex 1, T-14.

5.21 For the in-school program, the proposed project provides supportfor: (a) the operating cost of training 50,000 teachers in population education;the printing and production of additional textbooks and teachers' handbooks,and 4,000 teachers' kits; and (b) 16,000 cassettes (48 for each district) forradio programs. For the out-of-school program, the project provides supportfor: (a) the operating cost of training 17,760 instructors (160 from learningcenters, 1,600 sub-district workers and 16,000 village workers) for districtand sub-district learning centers and the production of training materials;and (b) 160 slide projectors for district learning centers (one for eachexisting learning center). For teachers' education the project includessupport for: (a) the operating costs of training 120 teachers from teachertraining institutes (six from each of the remaining teacher education insti-tutes not covered in the second project) and the production of teachingmaterials; and (b) 80 man-months of fellowships, study tours and stipends (36man-months for three teacher education institutes lecturers and 44 man-monthsfor short-term study tours for provincial and district education officers).

5.22 The in-school program in the proposed project includes the trainingof an additional 50,000 teachers, comprising 25,000 from primary schools,15,000 from junior high schools and 10,000 from senior high schools. Whenthis additional training has been completed, each junior high school, senior

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high school and primary teacher training school will have two trained teachers--one in social studies and the other in science--the two chief subjects to beused as vehicles for population education. Furthermore, about half of theprimary schools (all large schools) will have one trained teacher by the endof the project period. The rest will be trained by the GOI in :he course oftime from its own funds. (Cost estimates are given in Annex 1, T-15). Sincethe GOI has adopted a decentralized system of training, this will enable itto handle the training of large numbers of teachers during the projectperiod.

5.23 The training of primary school teachers will be held at sub-district

level, that of junior high school teachers at district level, and that ofsenior high school teachers at provincial level, and will be organized by thelocal offices of the Ministry of Education and Culture. Master teachers(trainers) and education supervisors already trained under the second projectwill take part in this training. The Population Education Unit of theMinistry of Education and Culture will be in charge of the program.

5.24 In the long run, pre-service and in-service training in populationeducation will form part of regular teacher training which the Governmentintends to establish with Bank assistance under a proposed education project.At the present stage, however, it is necessary to continue to organize aseparate in-service training program in population education because: (a)population education is new and did not form part of the pre-service trainingof the teachers already in service; (b) if included in the regular in-servicetraining program, the training might take much longer to reach a large numberof teachers, and might be diluted in the process; and (c) the special trainingprogram will attract attention, as is desirable in the early stages. Therewill be periodic evaluations of the teacher training program during theproject period to improve its effectiveness.

5.25 The teaching of population education will be further strengthened

by the provision of about 4,000 teaching kits (one for each sub-district anddistrict offices of education) to be used by district and sub-districteducation offices for the in-service training of teachers. The proposedproject will provide four additional sets of textbooks for all primaryschools, 10 additional sets for all junior high schools and 15 additionalsets for all senior high schools, as well as guides for teachers on alltextbooks. Both textbooks and the teachers' guides will be reviewed in termsof format, presentation, and content by the GOI before printing and distri-bution.

5.26 All of the 160 non-formal learning centers will be provided withteaching kits, slide projectors and textbooks with a view to bringing popula-tion education to an estimated 200,000 young men and women during the projectperiod. Three hundred non-formal education supervisors (one from eachdistrict) will receive a ten-day course in population education. All theexisting 1,600 subdistrict-level instructors will attend one-week trainingsessions and 16,000 village workers will undergo a two-day orientation. Onehundred and fifty officials from the other islands will be sent on one-weekstudy tours of Java and Bali to observe the non-formal population educationprogram.

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5.27 To improve the pre-service training of primary school teachers,about 1,000 teacher trainers from primary Teacher Training Institutes (two

from each institution) will undergo in-service training under the proposedproject. An advanced course (Education Specialist) will be introduced at theTeacher Training Institute in Jakarta. The project will support the preparationof curricula, teaching materials, and the training of lecturers. The proposedproject will provide funds to cover training costs, and the cost of books forlibraries in 10 Teacher Training Institutes where population education istaught as a compulsory subject at the undergraduate level.

5.28 Radio programs will be used to supplement population education inschools, non-formal education and teacher training. The project will providefunds for cassettes for distribution to the district radio stations for theirbi-monthly population broadcasts. They will be prepared at the GovernmentCenter for Out-of-School Communication Technology.

5.29 The proposed project also provides 80 staff-months of fellowshipsfor short-term study tours of Asian countries to review population educationand for attending specialized courses abroad, particularly to strengthenthe advanced level of teacher education programs.

5.30 An evaluation of curricula, teaching methodology, training program,instructional materials and the performance of students, teachers and super-visors will be conducted. In the evaluation particular attention will bepaid to the effectiveness of the training program and the efficiency of theinstructional materials. Assurances have been obtained that the MOE willprepare not later than June 30, 1981, a plan satisfactory to the Bank forevaluating the population education aspects of the proposed project. Theproject provides for the operating costs of the evaluation. (The popu-lation education work program is shown in Annex 1, T-16).

5.31 Field Supervision of Family Planning. The project will provideNFPCB supervisors and field coordinators with 1,500 motorcycles to increasetheir mobility; 1,150 motorcycles will be distributed in Other Islands I and350 in Other Islands II (Annex 1, T-17). Since the other islands do nothave NFPCB fieldworkers as do Java and Bali, it is essential that the super-visors and coordinators should have maximum mobility. Assurances have beenobtained that the NFPCB will monitor, in a manner satisfactory to the Bank,the operation and maintenance of all vehicles required for the proposedproject until its completion.

Support for Maternal and Child Health Program

5.32 Training of Traditional Birth Attendants. About 80% of alldeliveries are conducted by TBAs in rural areas. It is essential thereforeto improve the skills and knowledge of the TBAs if primary health care is tobe strengthened and the health coverage of the rural population broadened.The GOI has embarked upon a program to train TBAs in simple hygienic birthpractices and to provide them with skills for identifying high-risk pregnanciesfor referral to health centers or hospitals.

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5.33 Of the total 79,000 registered TBAs in Indonesia as a whole,47,000 have already received basic training. The GOI target during REPELITAIII is to provide refresher training for the 47,000 TBAs and basic trainingfor a further 20,000. The basic training course requires 30 days of non-consecutive attendance spread over a period of 6-12 months . The traineesvisit health centers once every week or two weeks for training and returnhome at the end of the day. The training takes place at about 3,000 healthcenters at sub-district level. Such decentralized training makes it possibleto train about 4,000 to 5,000 a year. The TBAs are trained by one ofthe three nurse/midwives posted at each health center and the health centerdoctor, who in turn, are trained at district health offices by trainerswho would have been trained at provincial health offices for about 28 days.(See Chart 2 for the organization of training and the workload.)

5.34 The GOI has now decided that: (a) the trainers should receiverefresher training; and (b) the TBAs already trained should be retrained toimprove their knowledge and skills. The GOI also proposes that there shouldbe a continuous program for retraining TBAs in order to improve their skillsgradually, keep them in regular contact with health centers so as to improvethe referral system as well as to keep health center staff informed of thehealth problems they encounter, and replenish the delivery kits. The programwill upgrade the skills of TBAs and improve their performance and role in thecommunity health system.

5.35 The proposed project will assist in improving the capabilities ofTBAs by: (a) providing operating costs for training of about 20,000 andretraining of about 47,000 TBAs, and (b) providing support for trainingmaterials and operating costs for about 3,100 TBA trainers.

5.36 The refresher training of trainers at the district level and pro-vincial levels will last seven days in a year, while the retraining of TBAswill take six days a year and will be conducted at sub-district level. Thecost estimates are given in Annex 1, T-18.

5.37 Two seven-day national training sessions will be held--one in 1981and the other in 1983--to discuss the methods, content, and effect of TBAtraining. The proposed project will provide funds for these sessions.UNICEF will continue to support the basic training by providing TBA kitsand training materials. The MOH National Center for Education and Trainingwill give technical assistance to the Directorate-General of Community Healthfor TBA training. The World Health Organization has assigned a nurse to theMOH to provide technical assistance for the MCH and TBA training program.The provision of kits should give TBAs an incentive to enroll for training.

5.38 Assurances have been obtained that the MOH will review the trainingprogram and curriculum for the trainers of TBAs and furnish a copy of suchreview to the Bank by December 31, 1980, for comment.

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5.39 Training of Primary Health Nurses. As mentioned in para 3.31, inorder to simplify the training of nurses and midwives in Indonesia, the GOIplans that in the future there should be only a single category of nurses,namely, primary health nurses or PKs. It has established 58 schools for theregular three-year basic training of these nurses, but has still to retrainthe existing nurses and midwives to become primary health nurses. Suchretraining will not only simplify the training of nurses and midwives butalso broaden the range of services that will be provided at the healthcenters. Each health center has two to three nurses and midwives who needsuch retraining. The total number to be retrained is 11,350.

5.40 Because of the limited number of trainers, the GOI has decided tostart the retraining program on a small scale. The training will be conductedin nine schools, each in a different province, selected from the 58 schoolsfor the regular basic training of primary health nurses. The nine schools arein Banda Aceh (Aceh), Medan (North Sumatra), Padang (West Sumatra) Palembang(South Sumatra), Pontianak (West Kalimantan), Banjarmasin (South Kalimantan),Samarinda (East Kalimantan), Ujung Pandang (South Sulawesi) and Ambon (Maluku).The selection of schools is based on the GOI's assessment of the physical andstaff capacities of these schools to undertake the additional training load.The additional three trainers needed to supplement the existing staff at theseschools will be selected by the MOH from existing hospital and health centerstaffs. Each of the nine schools will retrain about 30 trainees a year forthree months, or a total of 270 nurses and midwives a year, so that about1,080 nurses and midwives will be retrained during the project period. Theproject will support the retraining of nurses and midwives by providing ninemini-buses (one for each school) for field training; 27 motorcycles (threefor each school) for supervision by the additional three nurses; 9 projectors(one for each school) for audiovisual support for training; teaching equipment;18 fellowships for short training visits to local institutions, and incrementaloperating cost (per diem and travel) for the students. (Cost estimates aregiven in Annex 1, T-19.).

5.41 Training of Teachers in Nursing Schools in Community Health. Inaddition to the retraining described above, the GOI also proposes to give theteachers at the 400 nurse training schools instruction in community healthcare as an aid to their teaching. The instruction will be given at the fourexisting nurse-teacher training schools. The National Center for Educationand Training will direct, coordinate, monitor and evaluate the teacher train-ing program. Each of the four schools will give two courses a year, eachlasting one month, for about 30 persons, so that about 960 teachers willreceive instruction during the project period. The proposed project willprovide vehicles, training equipment, instructional materials, fellowships,and travel and per diem for the trainees.

5.42 The MOH National Center for Education and Training, which is respon-sible for the retraining program, will appoint a committee to advise on theprogram and to coordinate the training activities. Assurances have been

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obtained that the MOH will prepare comprehensive programs for: (a) retrainingnurses and midwives to become primary health nurses and (b) training teachersin nursing schools in community health and send a draft of these programs tothe Bank by December 31, 1980 for review.

5.43 Program of Health Center Upgrading. The GOI proposes to addin-patient annexes to health centers in areas where there are no hospitalfacilities. The GOI also intends to make a survey of the health centers todetermine the health centers which need these additional facilities. Mean-while, it has identified 50 health centers which need annexes immediately.The proposed project will include the construction, furnishing and equippingof 10-bed annexes at 50 selected health centers in the following six provinces:North Sumatra, West Sumatra, South Sumatra, West Java, Central Java, andSouth Sulawesi. Four of the six provinces are in the other islands and werechosen on the basis of the size of their population; two of the more denselypopulated provinces of Java were also included because of their low MCHcoverage. Each of the health centers is in a separate district. The centerswere selected according to the following criteria:

(a) the center should be remote from the district hospitalor other referral hospital, but accessible to thesurrounding health centers and subcenters;

(b) the center should be headed by a doctor, and have afull complement of staff, or be likely to have a fullcomplement in the near future;

(c) there should be not less then 620 m of land availablefor construction of a 246 m building;

(d) the district or the provincial government should bewilling to meet the recurring costs of the 10-bedunit;

(e) the center and the adjoining health centers shouldhave a target population of at least 20,000; and

(f) the center building should be a permanent structure.

5.44 Each in-patient annex will consist of a 246 m2 building comprisinga 10-bed ward, a small operating room, a recovery room, a nurses' station, adelivery room, and a storeroom. The equipment to be provided will include 10beds with accessories, and nursing and surgical equipment. The expandedhealth centers will be able to care for high-risk pregnancies and deliveries,emergency cases, IUD insertion, the treatment of complications, and otherfamily planning services. Eight annexes will be constructed in GOI fiscalyear 1980/81, a further 17 in 1981/82, and the remaining 25 in 1982/83.

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5.45 Each 10-bed annex will require additional staff comprising onemidwife, two primary health nurses, one clerk and one night watchman. Thetotal staff of an expanded health center will then comprise: one doctor,three nurses, two midwives, one sanitarian, three auxiliary nurses/midwives, adental nurse shared among three health centers, two clerks, and one nightwatchman. (The staffing pattern is given in Annex 1, T-20.) Assurances havebeen obtained that a full complement of staff will be assigned to each of the50 health centers with annexes as and when the annexes are completed.

5.46 Training of Health Center Staff. As mentioned in para 3.30, themajority of newly qualified doctors are assigned directly to health centersfor at least three years of service. The doctors at the 50 health centerswhere in-patient annexes are to be provided will receive practical clinicaltraining as proposed by the GOI. They will already have had one year'sexperience at health centers and on completion of the training they shouldhave at least one and a half years of service at health centers. Thistraining will consist of a six-month course at provincial teaching hospitalscovering practice in minor emergency surgery, obstetrics and gynecology,internal medicine, pediatrics, IUD insertion and the treatment of complica-tions. The estimated costs of this training are given in Annex 1, T-21.

5.47 In the past the MOH has organized study tours to neighboring Asiancountries for health personnel which led to improved performance. Theproject will provide funds for additional study tours for health centerstaff selected on merit. Each year of the project period two groups, eachconsisting of a doctor, two nurses, two midwives, and a sanitarian willvisit Malaysia, Thailand, and the Philippines to observe rural health programsin these countries, so that a total of 48 staff members will benefit fromthis experience. The tours will also serve as an incentive to improve theperformance of health center staff. The estimated cost of this training isshown in Annex 1, T-21.

5.48 The proposed project will also provide funds for training sessionsfor health center staff, local administrators, and community leaders to beheld within Indonesia. Local leaders from villages with successful communityhealth programs would visit other areas to discuss their experiences andlearn about the problems of others. These visits, besides widening experience,will serve as an incentive, and participants will be selected for theiroutstanding performance. A total of 480 people will participate in thesefive to eight-day sessions over the project period.

5.49 The construction of ten-bed annexes is part of a general programof health center upgrading designed to improve health care and referralservices. The practical clinical training of the doctors to be assignedto these health centers is an important element in the program. It is,however, necessary to assess the impact of the program. During loan negotia-tions, it was agreed that a detailed and comprehensive study should be under-taken to assess, inter alia, the total impact that the expanded health center(including staffing) has had on health care family planning services andactivities.

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VI. PROJECT COST, FINANCING, DISBURSEMENT, ACCOUNTS, AND PROCUREMENT

A. Project Cost

6.01 The total estimated project cost, including allowaoces for contin-gencies, is US$72.6 million equivalent. The tax element in t'.e proposedproject is insignificant. Project costs are summarized below' and detailsare given in Annex 1, T-22 and T-23.

ESTIMATED PROJECT COSTS BY EXPENDITURE CATEGORY

Rupiah in Millions US$ in Millions % of % ofCategory Local Foreign Total Local Foreign Total FEC Base Cost

A. Civil Works:Construction 8,000.0 2,500.0 10,500.0 12.8 4.0 16.8 24 32Professional Fees 1,125.0 125.0 1,250.0 1.8 0.2 2.0 10. 4Furniture 1,625.0 312.5 1,937.5 2.6 0.5 3.1 16 6Equipment 250.0 1,500.0 1,750.0 0.4 2.4 2.8 86 5Site Development 5,625.0 - 5,625.0 9.0 - 9.0 - 17

Subtotal (A) 16,625.0 4,437.5 21,062.5 26.6 7.1 33.7 21 64

B. Other Project Components:Vehicles 187.5 1,500.0 1,687.5 0.3 2.4 2.7 89 5Special Equipment 2,812.5 2,812.5 4.5 4.5 100 9Advisory Assistance and Fellowships 125.0 187.5 312.5 0.2 0.3 0.5 60 1Operating Costs:Training, Workshops and Seminars 4,000.0 - 4,000.0 6.4 - 6.4 - 12Preparation and Production of

Training and IEC Materials 2,687.5 - 2,687.5 4.3 - 4.3 - 8Maintenance and Operation of MIUs 125.0 - 125.0 0.2 - 0.2 - 1

Subtotal (B) 7,125.0 4,500.0 11,625.0 11.4 7.2 18.6 39 36

Total 23,750.0 8,937.5 32,687.5 38.0 14.3 52.3 27 100

C. Contingencies:Physical on Civil Works 1,687.5 437.5 2,125.0 2.7 0.7 3.4 21 7Price 8,562.5 2,000.0 10,562.5 13.7 3.2 16.9 19 32

Subtotal (C) 10,250.0 2,437.5 12,687.5 16.4 - 3.9 ZRy 19 39

Total Project Cost 34,000.0 11.375.0 45,375.0 54.4 18.2 72.6 25 139

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6.02 Cost estimates for civil works are based on current BAPPENAS guide-lines for construction costs which have been reviewed by the Bank and found

reasonable. Building space allowances conform to GOI requirements.Estimates for special equipment and materials are based on equipment listswhich are reasonable in scale and cost. The costs of seminars, workshops andtraining courses are based on prevailing GOI local travel and per diemallowances. The cost of a foreign consultant ($15,000 for video training) isbased on $5,000 per man-month (including fees, housing and travel). Localconsultant fees (including detailed supervision costs) are calculated at theprevailing rate for such services in Indonesia. The contingency allowance of$20.3 million includes: (a) physical contingencies estimated at 10% of basecivil works costs; and (b) price contingencies averaging 30% of base costsplus physical contingencies, assuming an annual inflation rate of 15% in 1980and 1981, and 10% thereafter for local components; and 10.5% in 1980, 9% in1981, 8% in 1982 and 7% thereafter for foreign components. Price contingenciesare based on the expected sequence of commitments. The foreign exchangecomponent of the project is estimated at $18.2 million, or 25%. Cost estimatesby functional categories are summarized in the table below:

ESTIMATED PROJECT COSTS BY FUNCTIONAL CATEGORY

Rupiah (in millions) US$ (in millions) Z Z ofComponents Loca'l Foreign Total Local Foreign Total FEC Total

A. Population & Family Planning Management1. Provincial centers 2.500 0 750.0 3,250.0 4.0 1.2 5.2 23 72. District Offices 10;250:8 2437.5 12.687.5 16.4 3.9 20.3 19 28

Subtotal 1Z 750U-0 3,187.5 15,937.5 20.4 5.1 25.5 20 35

B. TrainInE3. Provincial Training Centers 5,437.5 1,312.5 6,750.0 8.7 2.1 l0.R 20 156. Iraditional Birth Attendantc 2,062.5 - 2,062.5 3.3 - 3.3 0 55. Nurses and midwives 1.437 .5 250.0 1,687.5 2.3 0.4 2,7 S6. Health Ccnter Staff 312.5 62.5 375.0 0.5 0.1 0.6 17 1

Subtotal g,250.0 1,625.0 10,875.0 14.8 2.6 17.4 15 24

C. MCH/FP Service Delivery7. Upgrading of 50 Health Centers 13,250.0 812.5 4,062.5 5.2 -1.3 6.5 20 98. Field Supervision 125.0 1,187.5 1,312.5 0.Z 1.9 2.1 90 39. Contraceptive Warehouses 2.625.0 625.0 3,250.0 4.2 1.0 5.2 19 7

Subtotal 6,000. 0 2,625.0 8.625.0 9.6 4.2 13.8 30 19

D. IEC Activittes 1,937.5 3,812.5 5,750.0 3.1 6.1 9.2 66 13

E. Population FducationIn-School Program 3,000.0 - 3,000.0 4.8 - 4.8 0 6Out-of-School Program 812.5 - 812.5 1.3 - 1.3 0 2Teacher Education 250.0 125.0 375.0 0.4 0.2 0.6 33 1Subtotal 4,062.5 125.0 4,187.5 6.5 0.2 6.7 3 9

Total Project Cost 34,000.0 11,375.0 45,375.0 54.4 18.2 72.6 25 100

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B. Project Financing

6.03 The proposed project will be financed by a Bank loan of $35.0million, or about 50% of total project cost less the cost of vehicles (amount-ing to $3.2 million, including price contingencies), on which the GOI hasimposed a total import ban and which the GOI will finance and purchase throughlocal procurement. The loan will cover the total foreign exchange cost ($15.4million equivalent) except the foreign exchange component of the cost of thevehicles provided by the GOI and $19.6 million of local costs. The balanceof $37.6 million will be financed by the GOI. The financing plan is given

in Annex 1, T-24.

6.04 In order to ensure the prompt implementation of the project,evidence was provided during negotiations that budgetary allocations forproject expenditures in 1980/81 have already been made. Assurances have beenobtained that the GOI will make adequate budgetary provisions in a timely mannerfor all project expenditures for each forthcoming fiscal year. (The estimatedyearly expenditures are given in Annex 1, T-25.)

C. Disbursement and Accounts

6.05 The loan will be disbursed against the categories shown in thefollowing table:

Amount of % ofLoan Allocated Expenditures

Category (US$ Million Equivalent) to be Financed

Civil Works 16.8 100%

Equipment 6.4

a. directly imported 100% of foreign expendituresb. locally manufactured 95% of local expenditures

(ex-factory)c. imported procured locally 65% of local expenditures

Consultants services 2.0 100%

Fellowships; training of nurse- 6.8 100%trainers, nurses and midwives,trainers of traditional birthattendants; and in-schoolpopulation education and teachereducation programs

Unallocated 3.0

TOTAL 35.0

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6.06 Disbursements for equipment, consultants services, and civil workswill be made against full documentation. With respect to training, disburse-ments will be made against statements of expenditure certified by the imple-menting agencies. The supporting documentation will be retained by the NFPCBbut available for inspection by the Bank, as submission of the originals willbe impracticable and too expensive to reproduce. The estimated disbursementschedule is given in Annex 1, T-26, and the key actions necessary to meetthis schedule are given in Annex 1, T-27.

6.07 Separate project accounts will be established and maintained byexecuting agencies for all project expenditures. Assurances have been obtainedthat the NFPCB will have the project accounts for each fiscal year audited byindependent auditors acceptable to the Bank and furnish to the Bank not laterthan six months after the end of each GOI fiscal year copies of the auditedaccounts.

D. Procurement 1/

Civil Works

6.08 Construction, totalling $16.8 million equivalent will be spread over23 provinces and 178 sites. Because of the scattered nature of the sites,packaging is impracticable and uneconomical; consequently 178 contracts will beawarded. None of these contracts is likely to exceed tke equivalent of $1.0million, and international contractors are unlikely to le interested intendering. Construction contracts will therefore be awarded after compe-titive bidding advertised locally under procedures acceptable to the Bank.The GOI's regulations require civil works contractors to be prequalified.Foreign contractors will not be excluded from bidding. Contracts of $300,000equivalent and over will be awarded after Bank review.

Equipment

6.09 The cost of equipment (medical kits, office, audiovisual and train-ing equipment and materials) amounts to $7.3 million equivalent. Most of theequipment is diverse and specialized and will be required for facilitiesspread throughout Indonesia. Since it cannot be packaged in lots suitable forinternational competitive bidding, it will be procured through competitivebidding advertised locally under procedures acceptable to the Bank. Foreignsuppliers, who will not be excluded from bidding, are well represented inIndonesia and there are sufficient suppliers to ensure adequate competition.Small off-the-shelf packages costing less than $30,000 and limited to a totalof $300,000 will be procured locally through prudent shopping after solicitingat least three price quotations. Contracts for equipment and materialsestimated to cost $100,000 equivalent or more will be submitted to the Bankfor review before award. Bid evaluation and contract documents not subject toprior Bank review will be made available to the Bank for random ex-post review.

1/ All estimates exclude contingencies.

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However, before bids are invited, the GOI will furnish to the Bank for comments

the text of the invitations to bid and the specifications and other biddingdocuments together with a description of the advertising procedures to befollowed for the bidding and will make such modifications in the documents orprocedures as the Bank may reasonably request.

6.10 Consultant services will be procured in accordance with Bank Groupguidelines. Furniture and vehicles (costing $3.1 million and $2.7 millionrespectively), which are being financed entirely from GOI funds,will be procuredaccording to GOI procedure. During negotiations agreement was reached thatthe vehicles will be procured in a timely manner, be suitable for the tasksinvolved, and the numbers will be consistent with those set out in thisReport.

VII. PROJECT IMPLEMENTATION, MONITORING AND EVALUATION

A. Overall Project Implementation

7.01 The NFPCB, the MOH, the MOI and the MOE will be responsible forthe execution of the proposed project, and the GOI will establish a SteeringGroup consisting of representatives of these agencies for coordinating theimplementation of the project. The Group will be presided over by the NFPCBDeputy Chairman for Administration and Management, who will be designatedProject Coordinator. Assurances have been obtained that the Steering Groupwill be established bv December 31, 1980.

7.02 Within the MOH, the Director-General for Community Health and theDirector of the National Center for Education and Training will be responsiblefor the health components (see Chart 3). The management of health services,including MCH/FP, progresses from the MOH in Jakarta through the HealthDepartment in each province down to district, subdistrict and village levels(Organization Chart 2).

7.03 The NFPCB has had experience with the implementation of Bank-assistedpopulation projects since 1972. Despite early management problems, the NFPCBhas developed into an effective organization and the impressive success of thefamily planning program is attributable in large measure to its efficientmanagement. The MOH's experience with Bank-financed projects is limited,but with support from the NFPCB, the MOH should gain experience in implement-ing Bank-assisted projects.

B. Implementation of Project Components

Civil Works

7.04 The implementation of the NFPCB civil works component will bethe responsibility of the Deputy Chairman, Administration and Management,whose office incorporates the engineering unit which was responsible for

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the civil works of both the first and second projects. As with these earlierprojects, local architectural consultants will be engaged for design andsupervision. Arrangements have already been made by the GOI with the con-sultants who were engaged for the second project and preliminary plans forthe buildings have been prepared. The MOH civil wocks component is com-paratively small ($2.6 million equivalent base cost, spread over 50 locations).The basic designs will be prepared by the Ministry's Directorate of HealthFacilities, and contracts for construction will be awarded at provinciallevel through tender committees convened by the provincial project officersin accordance with normal GOI procedure. Both NFPCB and MOH implementationwill be monitored by the Project Secretariat in the NFPCB.

7.05 About 178 sites will be required for project buildings, of which 29will be needed for buildings scheduled to be constructed during the first yearof project implementation. During negotiations evidence was produced showingthat considerable progress had been made toward the acquisition of thesesites and the 29 sites for the first year construction program will all beacquired by September 30, 1980. Assurances were obtained that sites for allthe project buildings will be acquired in accordance with a timetable satis-factory to the Bank.

IEC

7.06 The IEC activities will be managed at the national level by NFPCB'sBureau of Information and Motivation, and in the field by provincial anddistrict NFPCB offices. The maintenance of audiovisual equipment will bethe responsibility of the NFPCB whose staff will be trained in the maintenanceof the equipment by the staff of the Central Media Production Center inJakarta.

Population Education

7.07 As in the case of the population education components of the firstand second population projects, the proposed project population educationcomponent will be implemented by the National Population Education Project(PNPK) in the Ministry of Education and Culture. The PNPK will maintainclose liaison with the Center for Education and Training in the NFPCB sothat adequate coordination is assured, especially with respect to theprovision of funds in the NFPCB budget for population education activities andthe timely release of such funds. As the proposed project phases out, theprogram and its expenses will be incorporated into the work of the Ministryof Education and Culture.

C. Project Monitoring and Evaluation

7.08 Project monitoring and evaluation will be carried out by the NFPCBDeputy Chairman for Supervision and Control, the Bureau of Reporting andEvaluation under the Deputy Chairman for Administration and Management, andby the Bureau of Planning of the Ministry of Health. The NFPCB Secretariatwill prepare quarterly progress reports on the project for forwarding to theBank not more than eight weeks after the end of each quarter.

- 36 -

D. Implementation Schedule

7.12 The proposed project is scheduled for completion within four years.

The implementation schedule for construction and non-construction activities

during the project period is given in Annex 1, T-28 and T-29.

VIII. BENEFITS AND RISKS

A. Benefits

8.01 While it is difficult to calculate precisely the direct contribution

the project is likely to make toward the reduction of the fertility rate or

of maternal, infant and child mortality and morbidity, it can be stated that

the project will assist the GOI in reducing the fertility rate from 4.8 in

1979 to 3.5 by the end of REPELITA III in 1983/84. This will be a big step

toward the GOI's target of halving the 1971 fertility rate by 1990. Achieve-

ment of these targets would enable Indonesia to reduce its rate of populationgrowth substantially and would improve the prospects of rapid socioeconomic

development.

8.02 It is also difficult to estimate accurately the number of people

who will benefit from the project, but some 25 million people in the other

islands will have better access to family planning services as a result of the

intensification of family planning activities under the proposed project. The

IEC program will reach nearly all Indonesians, and the population education

compoment will have reached all 30 million students and their teachers by the

end of the project period. The strengthening of maternal and child health

services will directly benefit an estimated 20 million mothers and their

children.

8.03 The project will promote: (a) better management of the family

planning program through improved working and training facilities; (b)

effective delivery of maternal and child health and family planning services;

(c) improved logistics for the storage and distribution of contraceptives,and (d) closer supervision of family planning services, and expanded informa-

tion, education and communication activities, and population education. The

evaluation component built into the various components of the project will

enable the GOI to make general improvements in these important areas. All

these factors, which are the focus of the proposed project, will contribute

to the reduction in fertility and the rate of population growth. By improving

the health of mothers and children, the project will help to raise their

current and future productivity. The smaller families resulting from contra-

ceptive use will reduce the dependency burden, help to increase income per

capita, and improve the quality of life.

- 37 -

B. Risks

8.04 The main risks foreseen for the project are: (a) that the 50 health

centers with 10-bed annexes will not be fully staffed on time; and (b) delays

in site acquisition may cause construction to fall behind schedule.

IX. AGREEMENTS REACHED AND RECOMMENDATIONS

9.01 During negotiations, assurances were obtained from the GOI that:

(a) The NFPCB will prepare an overall plan for the production ofinformation, education and communication materials and submitthe plan to the Bank by December 31, 1980, for review (para 5.18);

(b) The Ministry of Education and Culture will prepare a plansatisfactory to the Bank not later than June 30, 1981 forevaluating the population education aspects of the project(para. 5.30);

(c) The NFPCB will monitor in a manner satisfactory to the Bank, theoperation and maintenance of all vehicles required for theproject until the completion of the project (para. 5.31);

(d) The MOH will review the programs and curriculum of the trainersof TBAs and furnish a copy of the review to the Bank byDecember 31, 1980 for comment (para. 5.38);

(e) The MOH will prepare comprehensive training programs forretraining nurses and midwives to become primary health nursesand for training teachers of nursing schools in communityhealth and submit a draft of these programs to the Bank byDecember 31, 1980 for review (para. 5.42);

(f) The MOH will ensure that a full complement of staff is assignedto each of the 50 health centers and annex as and when theannex is completed (para. 5.45);

(g) Adequate budgetary provisions for all project expenditures foreach forthcoming GOI fiscal year will be made in a timely manner(para. 6.04);

(h) Separate project accounts will be established and maintainedby executing agencies for all project expenditures, and theNFPCB will have the accounts for each GOI fiscal year auditedby independent auditors acceptable to the Bank and submitcopies of the audited accounts to the Bank no later than sixmonths after the end of each GOI fiscal year for review (para.6.07);

- 38 -

(i) The NFPCB will establish a Steering Group by December 31, 1980consisting of representatives of the NFPCB, MOH, MOI and MOEpresided over by the NFPCB Deputy Chairman for Administrationand Management to coordinate the implementation of the project(para. 7.01);

(j) All land and rights in respect of land for the construction andoperation of the facilities included in the project will beacquired according to a timetable satisfactory to the Bankand evidence satisfactory to the Bank will be furnishedpromptly after acquisition (para. 7.05).

9.02 With the above assurances, the project would be suitable for a Bankloan of US$35.0 million, with a 20-year maturity, including a grace period of5 years. The borrower would be the Republic of Indonesia.

INDONESIA: THIRD POPULATION PROJECT

SOCIOECONOMIC INDICATORS IN SELECTED COUNTRIES, 1979

Indonesia Korea /4 Malaysia Philippines Singapore

Total Population (mln. est.) 1 140.0 37.6 13.3 46.2 2.4

Population Density per sq. km. 69 377 70 144 3,784

Percent Population Urban /1 18 48 27 32 100

Crude Birth Rate /1 35 24 31 34 17

Crude Death Rate T 16 7 6 10 5

Rate of Natural Increase (Percent)/l 1.9 1.7 2.5 2.4 1.1

Infant Mortality Rate /1 100 38 44 80 12

Per Capita Income (US$) 370 820 930 450 2,880 1

Percent GDP Derived from Agriculture, 1977 /2 31 27 26 29 2 w

Male Literacy /3 72 94 90 77 87

Female Literacy /3 50 84 62 76 67

Dependency Ratio; 1976 /3 81 71 84 86 56

Female Aged 15-44 Married (mln.), 1977 /3 20.9 4.5 1.5 5.3 .28

Number of FP Users (mln.), 1977 /3 5.7 /5 1.1 0.6 1.2 .2

Users as Percent of MWRA 27.1 44.2 39.4 22 77.1

Annual Per Capita Family Planning Budget in(US$), 1976 /3 16 52 /6 28.5 5.8 41

FP Budget as Percent of Total National Budget,1976 /3 .20 .18 /6 .11 .40 0.1

/1 Source: Population Reference Bureau, 1979 World Population Data Sheet. Data xe for mid-1979.

/2 Source: World Development Report, 1979. Data are for 1977, except for Indonesia (1978).

/3 Source: Nortman and Hoffstatter, Population and Family Planning Programs, a Population Council

Fact Book, Fifth Ed'tion.Z Source: IBRD, Staff Appraisal of a Population Project in the Republic of Korea, November 16, 1979.

/5 1979T6 1978 F

INDONESIA: THIRD POPULATION PROJECT

POPULATION AGE STRUCTURE OF INDONESIA, 1961-1976 (Selected Years)(In percentages)

1961 Census 1971 Census 1976 Survey Age Group Males Females Total Males Females Total Males Females Total

0 - 4 17.8 17.6 17.7 16.5 15.8 16.1 15.0 14.2 14.6

5 - 9 16.2 15.6 15.9 16.3 15.5 15.9 15.3 14.5 14.9

10 - 14 9.1 7.9 8.5 12.6 11.4 12.0 13.3 12.0 12.6

15 - 19 8.1 7.9 8.0 9.6 9.6 9.6 10.6 10.8 10.7

20 - 24 7.3 8.9 8.1 6.2 7.4 6.8 7.4 8.3 7.8 g

25 - 34 15.4 17.5 16.5 13.1 15.3 14.2 12.0 13.7 12.9

35 - 44 12.0 11.0 11.5 12.0 11.8 11.9 11.7 11.9 11.8

45 - 54 7.5 7.1 7.3 7.4 7.0 7.2 7.9 7.4 7.7

55 - 64 4.0 3.8 3.9 3.8 3.9 3.9 4.2 4.2 4.2

65+ 2.5 2.5 2.5 2.5 2.5 2.5 2.5 2.9 2.7

Not Stated 0.1 0.0 0.0 0.0 0.0 0.0 0.1 0.1 0.1

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

/1 Excludes population of East Nusatenggara, Maluku and Irian Jaya.

Source: Central Bureau of Statistics.

INDONESIA: THIRD POPULATION PROJECT

TOTAL POPULATION AND AVERAGE ANNUAL GROWTH RATES FOR SELECTED YEARS, 1930-1976, AND POPULATION DENSITY BY PROVINCE, 1971-1976

Population Density

Census s Census/ Surve Growth Rate (E) (Persons/Sq Km)1930 1961 1971 1976 1930/61 1961/71 1971/76 1971 1976

I. Java and Bali 42,819 64,776 78,223 84,400 1.3 2.1 1.7 'AA NA

D"..I.Jakarta 811 2,907 4,576 5,367 4.2 4.6 3.8 7,756 9,097West Java 10,586 17,615 21,633 23,454 1.7 2.1 1.8 467 507Central Java 13,706 18,407 21,877 23,558 1.0 1.7 1.7 640 689East Java 15,056 21,823 25,527 27,103 1.2 1.1 1.4 533 566D.I. Jogjakarta 1,559 2,241 2,490 2,625 1.2 1.6 1.2 786 828Bali 1,101 1,783 2,120 2,293 1.6 1.8 1.8 381 412

II. Other Islands I 13.251 24,084 30.474 34,105 2.6 2.7 2.4 46 52

Aceh 1,003 1,629 2,009 2,226 1.6 2.1 2.3 36 40West Kalimantan 802 1,581 2,020 2,281 2.2 2.5 2.7 14 16South Kalimantan 835 1,473 1,699 1,846 1.8 1.4 1.9 45 49Lampung 361 1,668 2,777 3,439 5.1 5.2 4.9 83 103West Nusatenggara 1,016 1,808 2,202 2,401 1.9 2.0 1.9 109 119South Sumatra 1,378 2,773 3,444 3,871 2.3 2.2 2.7 33 37West Sumatra 1,910 2,319 2,793 2,994 0.6 1.9 1.6 56 60North Sumatra 2,541 4,965 6,623 7,467 2.2 2.9 2.7 56 60North Sulawesi 748 1,351 1,718 1,899 1.9 2.8 2.3 94 105South Sulawesi 2,657 4,517 5,189 5,681 1.7 1.4 2.1 71 78

III. Other Islands II 4.523 8.159 10.536 11,779 2.6 2.9 2.4 NA NA

Bengkulu 323 406 519 567 0.7 2.5 2.0 25 27Jambi 245 744 1,106 1,103 3.6 3.5 2.1 22 25Riau 493 1,642 1,642 1,843 3.0 3.1 2.6 17 19Central Kalimantan 203 497 700 812 2.9 3.5 3.3 5 5East Kalimantan 329 551 734 927 1.7 2.9 5.4 4 5Central Sulawesi 390 652 914 1,014 1.7 2.8 2.4 13 15South East Sulawesi 436 559 714 785 0.8 2.5 2.1 26 28East Nusatenggara 1,343 1,967 2,295 2,462 1.2 1.6 1.6 48 51Maluku 579 790 1,089 1,258 1.0 2.5 3.3 15 17West Irian 179 758 923 1,008 4.8 2.0 2.0 2 2Timur-Timor NA 'NA NA NA I NA _NA,

TOTAL 60,593 97,019 119,233 130,284 1.5 2.1 2.0 63 68

NA - Not avaftrde. -

/1 Includes adjustment for the exclusion of Rural Irian Jaya./2 Includes adjustment for the exclusion of Rural Irian Jaya, Maluku and East Nusa Tenggara. l

Sources: Population Census Reports for 1961 and 1971; 1976 Intercensal Population Survey; and 1975 Statistical Year Book.

-42- ANNEX 1

T-4

INDONESIA: THIRD POPULATION PROJECT

KNOWLEDGE AND PRACTICE OF FAMILY PLANNING METRODS

AMONG WOMEN 15-49

Percentage of Women 15-49

Have Been Using Have Been UsingProvince or Have Heard (of those who a Program MethodRegion of a Method have heard) (of those using)

Java/Bali:DKI Jakarta 65 32 77West Java 69 20 83Central Java NA NA NAYogyakarta NA NA NAEast Java 64 44 97Bali 65 47 95

Other Islanc,s:Sumatra 51 13 66Sulawesi 58 12 70Kalimantan 30 20 54Nusatenggara 52 18 40

Source: Government of Indonesia.

INDONESIA: THIRD POPULATION PROJECT

/1POPULATION PROJECTIONS, 1980-2150--

(In millions)

1980 1985 1990 1995 2000 2025 2050 2075 2100 2125 2150

Population (in millions) 142.5 157.8 173.9 190.4 206.9 277.9 325.7 346.4 353.3 356.1 356.8

Population Below Age 5 39.0 42.6 45.3 47.1 48.1 46.0 46.5 46.6 46.6 46.6 46.6

Women in Reproductive Age(15-49) 29.5 33.7 38.0 45.4 50.4 70.3 77.5 78.4 78.5 78.6 78.6

Working Age Population(15-64) 66.4 77.4 87.7 101.4 113.0 174.8 208.9 209.5 219.7 220.7 221.2

(per thousand)

1975-80 1980-85 1985-90 1990-95 1995-2000 2025-30 2050-55 2075-80 2100-05 2125-30

Total Fertility Rate(per woman) 4.850 4.445 3.998 3.636 3.306 2.196 2.118 2.093 2.084 2.0682

Expectation of life at BirthFemales 49.55 52.03 54.76 57.50 60.00 69.34 74.18 76.40 77.28 77.50

Males 46.65 49.10 51.61 54.14 56.47 65.39 70.32 72.71 73.66 73.90

Birth Rate 36.7 35.0 32.5 29.8 27.1 17.4 14.5 13.6 13.3 13_2

Death Rate 16.2 14.6 13.1 11.6 10.5 8.9 10.7 12.6 12.9 13.1

Natural Rate of Increase(M) 2.05 2.04 1.94 1.82 1.66 0.85 0.38 0.10 0.05 0.01

/1 Prepared in connection with the Second World Development Report.

Assumes NRR of 1 by year 2020.

Ul

- 44 -ANNEX 1T-6

INDONESIA: THIRD POPULATION PROJECT

FINANCING OF FAMILY PLANNING PROGRAM, 1969-1979

Fiscal Year Government Outside Sources Total(in US$'000)

REPELITA I1969-70 289.1 2,041.0 2,330.11970-71 1,200.0 2,246.0 3,446.01971-72 3,614.5 3,795.4 7,409.91972-73 5,662.6 10,037.1 15,699.71973-74 6,024.1 5,890.4 11,914.5

REPELITA II1974-75 9,161.4 13,190.3 23,071.71975-76 13,436.1 12,208.3 25,644.41976-77 16,014.4 17,131.7 33,146.11977-78 20,722.9 23,882.7 44,605.61978-79 17,600.0 /1 8,687.2 26,287.2

/1 Reflects the effect of the Nov. 15, 1978 devaluation; the actualrupiah amount showed an increase.

Source: National Family Planning Coordinating Board.

INDONESIA: THIRD POPULATION PROJECT

NFPCB NEW ACCEPTOR TARGETS AND ACRIEVEDIETS DURING REPELITA

I, II AND TARGETS FOR REPELITA III (1969-1984)

Percentage ofYear Target Achievement Target Achieved

REPELITA I:

1969-70 100,000 53,103 53.1

1970-71 125,000 181,059 144.8

1971-72 55U,000 519,330 94.4

1972-73 1,OOU,000 1,078,889 107.9

1973-74 L,252,nn 1,369,07:7 109.5

TOTAL REPELITA I: 3,025,000 3,201,458 105.8

REPELITA II:

1974-75 1,450,000 1,592,891 109.9

1975-76 1,600,000 1,966,565 122.9

1976-77 1,775,000 2,212,790 124.7

1977-78 1,975,000 2,248,468 113.0

1978-79 2,200,000 2,215,884 100.7

TOTAL REPELITA II 9,000,000 10,236,618 113.7

REPELITA III:

1979-80 2,524,000

1980-81 2,588,000

1981-82 2,751,000

1982-83 2,804,000

1983-84 2,841,000

TOTAL REPELITA III: 13,511,000

Source: National Family Planning Coordinating Board.

INDONESIA: THIRD POPULATION PROJECT

PERCENTAGE OF NEW ACCEPTORS BY CONTRACEPTIVE METHOD CHOSEN, 1969-1979

Method Chosen (%)Year Pill IUD Condom Other

1969-70 27.5 54.7 17.8

1970-71 44.0 42.2 13.8

1971-72 54.3 40.9 3.1 1.7

1972-73 56.3 35.2 7.2 1.3

1973-74 62.6 21.4 15.4 0.6

1974-75 68.3 11.7 18.9 1.1

1975-76 67.6 12.8 18.1 1.4

1976-77 66.9 18.1 12.6 2.4

1977-78 70.9 16.3 8.9 3.9

1978-79 68.8 18.3 8.0 4.9

Source: National Family Planning Coordination Board.

INDONESIA: THIRD POPULATION PROJECT

DEMOGRAPHIC AND PROGRAM DATA BY REGIONS, MARCH 1979

Married No. of .. % of Users by Method Total Fer- Total Fer-

Women of . Current Y. of % of Users by Method lity Rate lity Rate

Province 'Repr. Age (MWRA) FP Users MWRA IUD Pill Condom Others 1967-70 1978-79

I. JAVA/BALI

Jakarta 935,895 185,022 19MR 44.3 37.7 3.9 13.9 5.1 4.30

West Java 3,766,796 870,096 23.1 17.0 79.2 0.6 2.9 5.9 4.74

Central Java 3,791,175 1,387,464 36.6 22.7 64.3 10.3 2.4 5.3 3.99

Yogyakarta 415,998 153,252 36.8 30.8 34.1 26.3 8.5 4.7 3.77

East Java 4,305,570 2,286,215 53.1 34.6 61.4 2.3 1.5 4.7 3.08

Bali 362.682 173,914 47.9 82.7 8.6 3.2 5.3 5.8 3.78

TOTAL 13,578,116 5,055,963 37.2 30.2 61,8 5.0 2.8

IIo OUTER ISLANDS I

Aceh 360,509 23,730 6.6 13.9 74.4 5.1 6.4 6.2 5.89

North Sumatra 1,221,202 103,402 8.5 22.2 49.3 12.8 15.5 7.0 6.47

West Sumatra 468,595 65,451 13.9 46.1 40.1 6.5 7.2 6.0 5.57

South Sumatra 637,096 46,788 7.3 15.2 69.9 7.8 6.9 6.3 5.9

Lampung 598,617 89,829 15.0 12.3 80.1 6.0 1.4 6.3 5.67

West Nusa Tenggara 382,412 39,763 10.4 27.0 67.3 2.3 3.2 6.5 6.05

West Kalimantan 375,452 21,712 5.8 29.3 63.9 3.6 3.0 6.1 5.8

South Kalimantan 294,402 43,131 14.6 7.1 88.3 1.9 2.5 6.4 5.66

North Sulawesi 305,290 70,852 23.2 46.3 42.6 0.9 9.9 6.7 5.53

South Sulawesi 915,798 68,074 7.4 13.3 74.6 4.4 7.5 5.6 5.26

5,559,373 572,732 10.3 23.8 62.7 5.9 7.3

III. OUTER ISLANDS II

Riau 300,063 4,213 1.4 1.4 77.b 9.4 4.1 NA NA

Jambi 182,835 4,724 2.6 2.6 77.2 7.6 6.3 NA NA

Bengkulu 108,931 7,884 7.2 3.4 87.4 7.4 1.6 NA NA

East Nusa Tenggara 389,531 2,457 0.6 24.9 57.5 9.6 7.8 NA NA

Central Kalimantan 135,680 4,522 3.3 2.6 86.7 7.6 2.9 NA NA

East Kalimantan 143,929 7,729 5.4 6.7 79.6 5.7 7.8 NA NA

Central Sulawesi 159,020 3,035 1.9 25.7 62.8 3.8 7.6 NA NA

Southeast Sulawesi 125,417 2,613 2.1 2.6 82.8 10.8 3.6 NA NA H >

Maluku 196,139 2,268 1.2 15.8 59.9 4.3 19.8 NA NA

Irian Jaya 27 345 1,586 5.8 25.4 59.7 11.7 3.0 NA NA

1,768,960 41,031 2.3 9.5 77.2 7.4 5.7

Source: National Farily Planning Coordinating Board: Bureau of Reporting and Evaluatlon as of December 1979.

- 48 -ANNEX 1T-10

INDONESIA: THIRD POPULATION PROJECT

COMPARISON OF FIRST AND SECOND POPULATION PROJECTS AND PROPOSED THIRD PROJECT COMPONENTS

First Project Componentsl/ Second Proect_Components Third Project Components

1. MCH/FP Service Delivery

Construction of 95 MCH/FP Provision of mobile service units Construction of in-patientCenters in East Java and equipped with TUD and public annexes at 50 existing healthBali and support for health nurse kits, centers in West and Certralhospital and field post- Java; North, West and Southpartum program. Sumatra; and South Sulawesi.

Provision of transport for Construction, furnishing andMCH/FP staff. equipping of 21 provincial

warehouses in the Other Islandsanid 107 district warehouises ini

Other Islands I for storage and

distribution of contraceptivesand other supplies.

Salary support for 7,000family planning fieldworkersand supervisory staff.

2. Management

Construction, furnishing and Construction, furnishing and Construction, furnishing and

equipping NFPCB headquarters equipping of 10 NFPCB provincial equipping of 11 NFPCB provincialin Jakarta and 6 provincial offices in Other Islands I. offices in Other Islands II and

offices in Java and Bali. 107 district offices in OtherIslands I.

Technical assistance and Provision of motorcycles forFellowship support for field coordinators and supervisorsprogram management and to improve the supervision of theimplementation. family planning program.

3. Training

Construction, furnishing and Construction, furnishing and Construction, furnishing and

equipping of 6 NFPCB provincial equipping of NFFCB National Family equipping of 11 NFPCB provincialtraining centers and 10 sub- Planning Training Center and 10 training centers.provincial training centers. provincial training centers in Other Islands II.

Other Islands I.Construction, furnishing and Training of health center doctors,equipping of 9 auxiliary nurses and midwives.nurse/mi dwife training schools.

Training of traditional birthattendants.

Provision of minibuses andmotorcycles for nurse trainingschools.

4. Information, Education andCommunication (IEC)

Provision of 115 Mobile Provision of 50 Mobile

Information Units, technical Information Units.assistance, fellowships andstudies for IEC activities.

Support for production ofTIEC materials.

5. Population Education

Support for pilot population Support for introduction of Support for expansion and complete

education components. population education through integration of population educationpreparation of textbook materials, into the entire educational system,for curriculum development, and including non-formal education,training of 30,000 teachers out through the training of 50,000of the total 130,000. teachers and 4,200 supervisors,

and provision of additionaltextbooks.

6. Research and Evaluation

Technical assistance, Technical assistance, fellowships andfellowships, studies and equipment for a study of the feasibi-seminars for research and lity of providing and raw materials forevaluation. local production of oral contraceptives

trom indigenous Indonesian plants.

Support for implementation of a pilotcommunity incentive scheme.

1/ Reflects revision of project cmponeuts of First Project (Cr. 300-IND).

INDONESIA: THIRD POPULATION PROJECT

EXPECTED TRAINING LOADS AT PROVINCLAI, TRAINING CENTERS IN OTHER ISLANDS lI, 1980-1984

Ftaa Nag.- Central East Central S,E. Irian Timor.Riau Jambi Bengkulu t.nggara Kalimantan Kalinnantan Sulaweni Slra.esi M.alaku JDy Timur Total

1 1980-61

Hospital FP Program/Staff 57 52 - 54 36 54 54 - 42 54 54

(Regency Level) LI

FP Clinic Personnel /2 120 95 120 160 160 473 145 72 110 - 100

NFPCB Administrative Staff 289 164 126 460 3501 269 131 137 156 427 254

and Fieldworkers /3

Local Authorities and Staff /4 409 256 168 577 430 400 337 215 262 777 464

SUBTOTAL 875 567 414 1,251 976 1,196 667 424 570 1,258 872 9,070

II. 1981-82

Hospital FP Program Staff - - - 72 36 - - - 42 - -

(Regency Level) /1

FP Clinic Personnel /2 120 95 120 160 160 468 145 75 110 100 100

NFPCB Administrative Staff 575 518 480 1,074 579 612 510 428 850 809 513

and Fieldworkers /3

Local Authorities and Staff /4 390 266 505 636 374 428 332 328 337 760 499

SUBTOTAL 1,085 879 1,105 2,753 1,149 1,508 987 831 1,339 1,669 1,112 14,417

III. i982-83 a

Hospltal FP Ptogram Staff 57 52 - 54 16 54 54 - 42 54 54

(Regency level) /1

FP Clinic Per-onnel 12 120 95 120 160 160 473 145 72 110 - 100

NFPCB Ad.lnistrative Staff 586 614 428 1,060 744 577 581 357 753 775 489

and Fieldworkers /3

Local Authorities and Staff /4 329 256 203 577 430 400 337 215 262 777 464

SUBTOTAL 1,092 1,017 751 1,851 1,370 1,504 1,117 644 1,167 1,606 1,107 13,226

IV. 1983-84

Hospital FP Program Staff - - - 72 36 78 - - 42 - -

(Regency level) /1

FP Clinic Personnel /2 120 95 120 160 160 468 145 75 110 100 100

NFPCB Administrative Staff 540 754 554 994 779 768 726 461 743 801 403and Fieldworkers /3

Local Authorities and Staff /4 390 342 235 657 382 428 332 328 337 773 512

SUBTOTAL 1,050 1,191 909 1,883 1,357 1,742 1,203 864 1,232 1,674 1,015 14,120

TOTAL 1980-84 4,102 3,654 3,179 7,738 4,852 5,950 3,974 2,763 4,308 6,207 4,106 50,883

/1 Includes doctors, paramedical personnel, and clerks.

12 Includes doctors, midwives, auxiliary midwives, and reporting and recording persn-el.

73 Includes provincial, regional, and subdistrlct information officers, provincIal and re-ional logistIcs officers, s,obdistrlct FP coordinators, rearch

and evaluation officers, provincial and regional reporting and recording staff, SFPCB adninistrators, and village contraceptive distrlbution center oftic-als.

/4 T

n-iude- BSoatis, Supati staff, Conats, Canat staff, implenenting unit staff, ann kev oersonne.

Source National Familv Planning Coordinating Board.

INDONESIA: THIRD POPULATION PROJECT

COST ESTIMATES: INFORMATION, EDUCATION AND COMMUNICATION ACTIVITIES, 1980-1984(US$'000)

1980/81 1981/82 1982/83 1983/84 Local Foreign Total

A. Mobile Information Unit1. Vehicles (50) /1 302.0 417.1 71.9 647.2 719.12. Audiovisual Equipment 574.9 973.8 1,548.7 1,548.73. Maintenance 10.1 24.1 24.1 58.3 - 58.34. Operating Cost 33.6 80.0 80.0 193.6 193.6

B. Public Address for VillageAcceptors Club 1,906.9 1,906.9 1,906.9

C. 1. Video Duplicator System 150.0 150.0 150.02. Video Cassette 7.7 7.7 7.7 7.7 30.8 30.8

0D. Video Tape Recorder forOther Islands1. Video Monitor 165.7 165.7 165.72. Video Player 98.4 98.4 98.4

E. Provincial Media Production Center 610.2 100.5 100.5 100.5 402.0 /2 509.7 911.7

F. Film Production 251.4 355.2 355.2 355.2 1,317.0 - 1,317.0

G. Training/ 3_ 147.0 117.0 30.0 147.0Subtotal 3,190.3 1,531.0 1,958.4 567.5 2,159.8 5,087.4 7,247.2

Contingencies 346.7 499.0 827.6 339.5 931.2 1,081.6 2,012.8 ij

TOTAL 3,537.0 2,030.0 2,786.0 907.0 3,091.0 6,169.0 9,260.0

/1 29 replacements for Java and Bali and 21 new vehicles for other Islands, or a total of 50./2 Local cost for production.

/3 $15.0 of which is for fellowships; $15.0 for advisory assistance and the remainder for operating cost.Source: Government estimates.

INDONESIA: Third Population Project

WORK PROGRAM FOR IEC ACTIVITIES, 1980-1984

Serial Approx. Size andNo. Program Activities Time Number Remarks

1. Mobjle IrtformatiQn Units <HIUs) - Training Unit Mid 1981 1 Training at Jakarta

MIUsl- Exhibition 1981-1982 49 Work in villages

MIUs Sets of AVA Equip. 1981-1982 50

2. Public Address Systems Use in villages 1981 5,500 Mothers Clubs & Communities

3. Regional Media Production Production equipment 1980 6 For use by field workersCenters (RMPCs) for visual aids desig-

ned for local needs

4. Video Production Duplicating taped 1981 2 Installed in regional TV stationsprograms

Video Exibition -1 Cassette players/ 1982 46 Use at Kabupatan levelrecorders

Video Exhibition Monitor/players 1982 27 Use at Kabupatan level & in MIUs

5. Training Video technicians use 1981 50 Operators from the MIUsand maintenance ofequipment

RMPC staff - 2 1981 12 Production of AVA materials andper center use of video equipment

Specialist to design and 1981 1 Three monthscarry out video train-ing courses

Stuldy tours for use of 1981 3 Philippinesvideo in rural situations

6. Film Production Locally produced 1/2 hr. 1981-84 15 For use in MIUsdramatic films in color

/1 Provided by GOI.

- 52 -

INDONESIA: THIRD POPULATION PROJECT ANNEX 1T-14

POPULATION EDUCATION INPUTS FOR FIRST AND SECOND PROJECTS AND LINKAGES WITH THIRD PROJECT/

School Programs I & II Projects III Project

Number of Schools Inovolved 92P00 Primary School (SD) l2QO0O SD8SWO Junior Secondary (SMP) 10,000 SMP ! All Schools under3,600 Senior Secondary (SMA) 4000 gMAJ the MOE

Number of Teachers Trained/ 20p00 SD 25pO0 SDto be Trained 6,000 SMW 15DOO SMP

1,500 SMA lO,OO SMA

Number of Supervisors Trained/ 6003 SMP 3,500 SD Levelto be Trained J SMA 550 SHP Level

180 SMA Level

Number of Textbook Supplied/ 4 Per School (SD) 4 Per School (SD)to be Supplied 12 Per School (SMP) 30 Per School (SMP)

12 Per School (SMA) 40 Per School (SMA)

Number of Teachers Handbooks 1 Per School (SD) 1 Per School (SD)Supplied/to be Supplied 3 Per School (SMP) 5 Per School (SMP)

3 Per School (SMA) 10 Per School (SMA)

Teaching Kits 2000 to Kabupaten Provincesand 4pOO to Kachamaten,SPGEducation Offices'

Supply of Projectors 500 to Kabupaten and IKIPS ___

Cassettes for Radio Program ----- 16,OOD(48 for each Kabupaten)

Out-of-School-Program

Training of Instructors 6,750 PENMAS 160 Learning Centers (SKB)PENILIN 1600 PENILIK

16,00 Village Workers(Learning Groups)

Textbooks 4,200(30 to each Training Center) 200,000 Learning Center (SKB)and Learning Group PArticipant. (SB)

Teachers Guides 700 (5 to *a6 Traalagi Cemter) 2 0

,000tO all Pemilika _d

Supplementary Reading Material ---- 200,000 Learning Ceter Particamt

Intra-Cotmtry Visit by Officials ---- 150 Persons fro Otbr Islanda

Cassettes for Radio Program ---- 14,000(48 for each district)

Slide Projectors ---- 160 for all gRTeacher Education

Teacher Education ~~~~~~~~~~~120 Lect. from IKIPSTraining of Teacher Educators 240 Lecturers from IKIP 1200 Lect, from SPG (included

900 Lecturers from SPG in SMA Training)

Advance Level Courses at IKIP ---- 20 Students at Ed. S. Level

Library Strengthening ---- 10 IKIPS

Fellowships 90 Person-months 80 Pers6n-months

(IKIP and Other Edu. Officials) (Short-term, Long-term) (Short-term, Long-term)

Abbreviations

IKIP…----Teacher Training Institute SKB---Learning CentersMOE-----Xinistry of Education SMA---Senior SecondaryPENILTK-Non-vormal Education nfficial SMP--Junior SecondaryPENMAS_-Community Education SPG--Teacher Training SchoolSD--- ---Primary School

/1 Work undertaken in Projects I and II and projected for Project III.

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P w a P w. P° °°° w o'PHHPooo o Xoooo o ooo

- 54 -

ANNEX 1T-16

INDONESIA: THIRD POPULATION PROJECT Page 1 of 2

WORK PROGRAM FOR POPUTATION EDUCATION, 1980-1984

ApproximateSerial No. Program Activities time Size & Number Remarks

1. In school program Training of teachers Training to be held at:

f'rimary school 1984 25,000 (SD) Kecamaran levelJunior secondary 15,000 (SMP) Kabupaten levelSenior secondary 10,000 (SMA) Provincial levelSPG (SPG)

Printing and productionof textbooks 1980-82 SD 400,000 4 per school

SMP 240,000 30 per schoolSMA 120,000SPG 40 per school

Printing and productionof teachers handbook 1980-82 SD 120,000 One per school

SMP 40,000 5 per schoolSMA 27,000 10 per school

Production of kits 198U-82 SD to be distributedSMP _ 4000 to Kecamatan, Kabupaten

SMA, and provincial officesfor training of teachers

Training of supervisors 1980-84 SD 3500 4 daysSMP 550SMA 180 one week

Radio program 1980-84 Training of 10 daysscript writersone workshop

Purcdiase of cassettes Cassettes A set of 40 cassettes16,000 to be given to each

Wsbunaten fcr bi-monthlybroadcast

'ut of School Training ot instructors 1980-84 SKB 160 regional level(Non-Formal) Penilik 1,600 Kabupaten lex'ei

ciR l,cnan vecar.atar level

Printing and production 1980-82 200,000 for participantsof textbooks copies in non-formal program

Printing of teachers 1980-82 20,000 for all Peniliks, SBguides and SKB staff

Preparation of supplemen- 1980-81 one workshop 10 days at nationaltary material 40 persons

Production of supplemen- 1981-82 200,000 copies for participantstary material

Production of kits 1981-83 6000 to be distributed toSKB and Kecamatanoffice of non-formaleducation

Purchase of slide 1982 160 to all SKBsprojectors

Purchase of slides 1981-83 10 sets of 25 to all SKBsand production slides

Intra-country study 1981-84 150 persons 150 persons trom 10tour Other Island 7 days

duration

Training of supervisors 1981-84 300 one from each provincial leveldistrict 5 days

Radio program 1981-84 14 days trainingof script writers

Purchase of cassettes 1981-84 16,000 a set ot 48 to bedistributed to eachdistrict

- 55 -

ANNEX 1T-16

INDONESIA: THIRD POPULATION PROJECT P.;. 2 of 2

WORK PROGRAM FOR POPULATION EDUCATION, 1980-1984

ApproximateSerial No. Program Activities time Size & Number Remarks

3. Teacher Education

Special course atIKIP level (Sl.Sarjana)

Preparation of 190-81 30 participants National level workshopcurriculum 10 days 10 days

Preparation of textbook 1980-81 working group to be farmed out toand teaching package 6 persons IKIP and University

Honorarium and teachersmeeting forreviewing

Training of IKIP 1Y80-84 120 persons 10 days' duration

Lecturers and educa. 10 days'durationfaculty we1rbers- -

Strengthening libraries 1981-82 10 IKIPsat 10 IKIPs

Developing Pasca Sarjana 1981-84 working group a study group will prepare(Ed.S.) Course at IKIP, honorarium, meetings andJakarta administrative support

to be provided to this group

Developing course contact 1981-84 (bidang study)and trainingpackage, etc.

Special library for 1980-83 - for Pasca Sarjana CourseJakarta,IKIP (Education specialist in

Population Education)

Honorarium to specialist 1982-84 specialist will be invitedto teach: approximately

Stipend to 20 students 1982-84 24 months @ e80 per month to 2080 oer month candidates for 24 months

4. Fellowships Short-term study tours 1981-83 80.person/month 3 candidates for IKIP tofor school and out-of- be sent for specializationschool for specializa4 36 person months, 44 mantion in Pop. Ed. for months for short-termIKIP Program study tours

5. Evaluation and Evaluation at provincial 1981-84 2 provincial Evaluation will include

Research level and national level level 1 national school,out-of-school andlevel Teacher Ed. programs-Money

for supervision will beobtained from GOI (rupiahbudget).

Research projects con- 1980-84 Projects to be IKIPs and Universitycerned with program farmed at natio-

nal & provinciallevels

6. Distrioution of Distribution to provin- 1981-84 Textbook & teach- to be distributed at Kabu-ces,Kabupaten and ing kits paten & Kecamatan levelsKecamatan

Abbreviations: IKIP--Senior Teacher Institutes, SB--Learning Group, SD--Primary School, SPG--Primary Training School,SMA--Senior High School, SMP--Junior High School, SPG--Primary Training School.

- 56 - ANNEX 1

T-1 7

INDONESIA: THIRD POPULATION PROJECT

COST ESTIMATES: FIELD SUPERVISION, 1980-1984(US$000)

1980/81 1981/82 1982/83 1983/84 Local Foreign Total

Vehicleo(1,500 Motorcycles) 580.0 580.0 580.0 - 174.0 1,566.0 1,740.0

Contingencies 63.0 125.0 183.0 _ 53.1 317.9 371.0

Total 643.0 705.0 763.0 - 227.1 1,883.9 2,111.0

Source: Mission estimate.

INDONESIA: ThiRD POPULATION PROJECT

COST ESTIMATES: TRAINING OF IRALITIONAL BIRTH ATTENDANTS, 1980-1984

1980/81 1981/82 1982/83 1983/84 Local Foreign 1oo1l

operating Costs

1. National LevelSeminar Provincial MCH Doctors 5.4 5.4 - 10.8 - 10.8Provincial MCH Midwives 17.9 - _ 17.9 - 17.9MCI Medical Doctors and Midwives Participants consist of 6 doctors 7.7 - 7.7 - 15.4 - 15.4

and 6 ,,idwives 2Jand 11 Ministry of Health staff:

Transport Cost - S3.8Per Diem - $8.3Training Cost - $3.3

Total $15.4

2. Provincial LevelMCN Evaluation 32.0 32.0 32.0 32.0 128.0 - 128.0Regency MCR Midwives Participants: 121 midwives

2/ 66.2 17.4 17.4 17.4 118.4 - 118.4

Duration: 1st year: 28 days2nd,3rd & 4th years: 7 days

Cost for Training:Ist year:

Training Cost: 121 midwivesx 28 days x Rpl2,000 -Rp4O,6 56,000

Transport Cost: Rp700,000

2nd, 3rd & 4th years:Training Cost: 121 midwives

x 7 days x Rpl2,000 -RplO,164,000

Transport Cost: Rp700,0003. Regency Level

NC/MCH Midwives (604, Java & Bali) - 55.6 55.6 55.6 166.8 - 166.8MCN Midwives (2,371) Participants: MCH midwives 221.6 221.6 221.6 221.6 886.4 - 886.4from Health Centers!2

Duration: 7 days every yearTransport Cost: Rp5,729,000Training Cost: 2,371 midwives

x 7 days x Rp8,000Rpl32,776,000

4. Subdistrict LevelNew TBAs (5,000/year) 154.5 157.2 157.2 154.5 623.4 - 623.4Retraining TSAs (47,OuJ) Rp500 x 6 days x No. of TEAs 62.4 91.2 120.0 148.8 422.4 - 422.4

retrainee annually, plngother training expenses

Subtotal 567.7 575.0 616.9 629.9 2,389.5 - 2,389.5

Price Contingencies 85.3 185.0 280.1 378.1 928.5 _ 928.5

TOTAL 653.0 760.0 897.0 1,008.0 3.318.089.0 1OO0 331 0 - 3,318.0

Source: Government estimates.

1/ Includes training, transport costs and per diem.

2/ From 6 provinces (2 in Java and 4 in Other Islands 1)

INDONESIA: THIRD POPULATION PROJECT

COST ESTIMATES: TRAINING OF NURSES AND MIDWIVES, 1980-1984(US$000)

1980/81 1981/82 1982/83 1983/84 Local Foreign Total

A. Retraining Nurses and MidwivesVehicles /1 1 mini-bus and 3 motorcycles

for each of 9 provinces 155.8 - - 15.6 140.2 155,8Special Equipment

Projectors I for each of 9 provinces 1.0 - - - - 1.0 1.0Teaching Equipment 21 for each of 9 provinces 8.9 - _ _ _ 8.9 8.9Books $3,000 for each of 9 provinces 27.0 - L3.5 13.5 27.0

Fellowships 18 persons @ $432 each - 7.8 - - 7.8 - 7.8Operating Costs

Training Costs 1,080 nurses and midwives 152.5 152.5 152.5 152.5 610.0 - 610.0Workshops and Seminars 32.5 32.5 32.5 32.6 130.1 - 130.1

Subtotal 221.9 348.6 185.0 185.1 777.0 163.6 940.6

B. Teacher ReorientationVehicles /1 1 for each of 4 schools 55.4 - - 57 49.7 55.4 CSpecial Ecujipment

Projectors I for each of 4 schools 0.4 - - - - 0.4 0.4Books $3,000 for each of 4 schools 12.0 - - - 6.0 6.0 12.0

Fellowships 7 persons @ $432 each - 3.0 - - 3.0 - 3.0Operating Costs

Training Costs 960 teachers 168.4 168.4 168.4 168.3 673.5 _ 673.5Workshop and Seminar 19.0 19.0 19.0 19.0 76.0 - 76.0

Subtotal 199.8 245.8 187.4 187.3 764.2 56.1 820.3

Total A & B 421.7 594.4 372.4 372.4 1,541.2 219.7 1,760.9

Price Contingencies 224.3 271.6 169.6 223.6 743.8 145.3 889.1

TOTAL 646.0 866.0 542.0 596.0 2,285.0 365.0 2,650.0

/1 To be financed by the GOI, others by IBRD.

Source: Government estimates.

- 5 9 - ANEEX 1T-20

INDONESIA: THIRD POPULATION PROJECT

STAFFING PATTERN FOR HEALTH CENTER WITH ANDWITHOUT TEN-BED IN-PATIENT ANNEX

Number of StaffExisting With 10-Bed

Staff Health Center In-Patient Annex

Medical Doctor 1 1Nurse 1 3Midwife 1 2Sanitarian 1 1Dental Nurse /1 1 1Auxiliary Nurse/Midwife 3 3Clerk 1 2Night Watchman 0 1

Total 9 14

/1 Shared between three health centers.

Source: Ministry of Health.

INDONESIA: THIRD POPUIATION PROJECT

COST ESTIMATES: TRAINING OF DOCTORS, OTHER HEALTH STAFF AND COMMUNITY LEADERS, 1980-1984(US$000)

1982/81 1981/82 1982/83 1983/84 Local Foreign Total

A. FellowshipsStudy Tours in Asian Groups of 5 Paramedical Staff and one 29.0 29.0 29.1 29.1 - 116.2 116.2Countries for 48 Staff Health Center (HC) Doctor, twice a year

Per Diem: 6 participants X 2 times X 28 daysX 4 years X $40= $53,760

Transport: 6 participants X 2 times X 4 yearsx $1,300 = $62,400

Clinical Training of 50 Doctors X $3,600; 15 Doctors for 1st and 54.0 54.0 72.0 - 180.0 - 180.050 HC Doctors 2nd years; 20 Doctors in 3rd year _ _ _

Subtotal 83.0 83.0 101.1 29.1 180.0 116.2 296.2 C

B. Operating CostSeminars for Health Per Diem: 30 participants X 8 days X 4 years 15.3 15.3 15.3 15.2 61.1 - 61.1Center Staff X $33.6

Transport: 30 participants X 4 years X $240.0

Administrators, Kecamatan Same as above 15.3 15.3 15.3 15.2 61.1 - 61.1and Kabupaten Level

Village Community Leaders Per Diem: 60 participants X 5 days X 4 years 9.1 9.1 9.1 9.1 36.4 - 36.4x $27.2

Transport: 60 participants X 4 years X $16

Subtotal 39.7 39.7 39.7 39.5 158.6 - 158.6

TOTAL A & B 122.7 122.7 140.8 68.6 338.6 116.2 454.8

Contingencies 16.7 35.3 58.3 37,9 118.4 29.8 148.2 '

TOTAL 139.4 158.0 199.1 106.5 457.0 L46A0 603.0

Source: Government estimates.

IN0OSESIA: THtRD POPULATION PROJECT

SUMtlARY OF COST ESTIMATES FOR CIVIL WORK3

BANK GOT TOTAL CIVIL WORKS COSTS

Number RNpiaha (Millions) US$OOO Dollars Ripha_s (Millions) us$55 Dollars US$OOO DollasT

Ministry of Unit. Local Foreign Total Local Foreign Total mi1 i Foreign Total LocoI Foreign Total Local Foreign Total

M CONSTRUCTION

a) Populaion Center. (O.1.II) NFPCB 11 3,533.4 1,116.0 4,649.4 5,653.4 1,705.6 7,439.0 1,408.3 - 1,488.3 2,381.3 - 2,381.3 8,034.7 1,785.6 9,820.3

b) Provincisl Warehouse. (0.1.I) NFPCB 10 429.0 135 5 564.5 686,4 216.8 903.2 186.9 - 166.9 299.0 - 299.0 985.4 216.8 1,202.2

c) District Officca (O.l.I) NFPCB 107 2,777.8 877.2 3,655.0 4,444.5 1,403.5 5,848.0 3,239.2 - 3,239.2 5,182.7 - 5,182.7 9,627.2 1,403.5 11,030.7

d) NC In-Patient Facilities MON 50 1L228.5 3BB.o 1.616.5 1,965.6 620.8 2,586.4 689.2 - 689.2 11_02,7 1.102.7 3,068.3 620.8 3,689.1

Total 7,968.7 2,516.7 10 485.4 12,749.9 4,026.7 16,776.6 5,603 6 - 5,603.6 8,965.7 - 8,965.7 21,715.6 4,026.7 25,742.3

Physical Contingencies at 10M 796.9 251.6 1,048.5 1,275.0 402.7 1,677.7 560.4 _ 560.4 896.6 - 896.6 2,171.6 402.7 2,574.3

Total Construction Basa Coat 8.765.6 2.768.3 11L5339 14,02949 4,429.4 I1,454.3 6.164.0 - 6, 164.0 9,862.3 -- 9,862.3 23.B7.2 4,429.4 28,316.6

2. PROFESSIONAL FEES AND SUPERVISION

a) Papolation Cnnters (0.1.1I) NFPCB 11 518.0 70.6 588.6 828.8 113.0 941.8 - - - - 828.8 113.0 941.8

b) Provincial Warshoses (0.1.1) NFPCB 10 - - - - -

c) District Offices (0.1.1) NFPCB 107 450.3 61.4 511.7 720 5 96.2 818.7 - - - - - - 720.5 98.2 816.7

d) RC In-Patient Facilities OHO 50 145.5 19.8 165.3 232.8 31.7 264.5 - _ 232.8 31.7 264.5

Total 1,113.8 151.8 1,265.6 1,782.1 242.9 7,025.0 -_ - 1,782.1 242.9 2,025.0

Physical Contingencies at 107. 111 4 15.2 126.6 178.2 24.3 202.5 - - - - - - 178.2 24.3 202.5

Total Profesoionel PFes andSopervision Sase Cost 1.225.2 167,0 1.392.2 1,960.3 267.2 22 - -_ 1,960.3 267.2 2.22 7.5

3. FURNITURE

a) Popolstion Centers (O.l.II) NFPCB 11 - -_ - 942.0 179.5 1,121.5 1,507.2 287.1 1,794.3 1,507.2 287.1 1,794.3

b) Provinciai W-rehon..a (8.1.1) NFPCB 10 --- -

c) DiaLrict Offices (0.1.1) NFPCB 107 5 - - _ - 598.2 114.0 712.2 957.0 182.3 1,139.3 957.0 182.3 1,139.3

d) itC In-Patient Facilities MON 50 - 101.8 19.4 121.2 162,9 31.1 194.0 162.9 31.1 194.0

Total - - ---- 1,642,0 312,9 1,954,9 2,627.1 300.5 3,127,6 2,627.1 500.5 ~3,127.6Physical ContingencIes at 107. - - - 164.2 31,3 195.5 262,7 50.1 312.6 262,7 50.1 312.6

Total Furniture B.sa Cent - - - - - - 1,806.2 344.2 2,150.4 2.889,8 550.6 3.440.4 2,889,8 5S0.6 3,440.4

4. EQUIPMENT

a) Population Centara (0.1.l) NFPCB 11 - 544.1 544.1 - 870.6 878.6 242.9 - 242.9 388.7 388.7 368.7 670.6 1,259.3

b) Provincial Warehomoes (0.1.1) NFPCB 10 - -

:) District Offices (0.1.I) NFPCB 107 - 558.9 558.9 894.2 894.2 249.4 - 249 399.1 399 1 894 2 1,293.3

d) RC Is-Patient Facilities MOhI 50 105.7 105.7 1 88. .0 0 51.6 _ 5. B5.27

Total 1,208.7 1,208.7 1,952.8 1,952,8 543.9 543.9 870.3 870.3 870.3 1,952.8 2,623.1

Physiral aontingenciro 0t 107% 120.9 120.9 195.3 195.3 54.4 5 34.4 87.0 67.0 87,0 195.3 282.3

Total Equipment Base Cost - 1,3296 1,529.6 - 2,146.1 2,148.1 598.3 - 598.3 957.3 957,3 __9573 2,148.1 3,105.4

NFPCB AND MOE COMBINED

1. CNnFtPCction NFPCB/MOE 178 7,968.7 2,516.7 10,485.4 12,749.9 4,026.7 16,776.6 5,603.6 - 5,603.6 8,965.7 - 8,965.7 21,715.6 4,026.7 25,742.3

2. Profeaional Faee nod Supervision NFPCB/MC8 1,113.8 151.8 1,265.6 1,782.1 242.9 2,025.0 - - - - - - 1,782,1 242.9 2,025.0

3, Furnitura MFPCB/MOE . 1,642.0 312.,9 1.954.9 2,627.1 120.5 3,127.6 2,627.1 500.5 3,127.6

4. Equipment NFPCB/MOH - 1,208.7 L208.7 - 1j.95 1,952.8 543 9 - 543.9 8703 37 - - 0 3 - 2,823.1 2, 823.1

Physical C9ntingnci2 at 10 9,082. 3,877,2 12,909.7 14,532.0 6,222,4 20,754,4 7,789,5 312.9 8,102.4 12,463.1 500.5 12,963.6 26,124.6 7,593,2 33,718. 9

Phy i.-I Cl.ti~ge-i.. at 10% 906.3 387.7 1,296.0 1,453.2 672.2 2,075,4 778.9 91.3 610,2 1,746.3 10.1 1,596,4 2~,612.5 719.4 3,371.9

Total Cost of Civil Works 9.990,8 4 2

64.9 14,255.7 15985. 2 6.B44.6 22,829.8 8.568.4 344.2 8,912.6 13.709.4 550.6 14.260.0 26.737.3 8,352.6 37.089.9

NOTE No. 1: The Popolation Casters in this table include - (a) NFPCB Provincial Offices; NOTE No. -2: The clement shown as COl Financed Costs

(b) Provincial Traicing Centers: sd (t) Provincial Warebo.ses for storage in this table appeors in other tables as

of cotr.aceptives. "Site Develop-ent."

INDONESIA, THIRD POPULATION PROJECT

PROJECT COST ESTIMATES BY FUNCTIONAL AND EXPENDITURE CATEGORIES, 198001984

(in US$000)

Specia1 Advisory Operating Physical Prtce TotalCiFil Works Equipsent Vehicles Assistance Fellowships Costs Subtotal Contingencies Conting.nci.i Contingenciea Local Foreign Total

A. Popolati.n and Family PI-nning HMnageentI. ii provincial casters ~~~~3,730.2 - - - 3,730.2 373.0 1.146,8 1.519.8 4,028.9 1,221.1 5.250.02. 107 Ditrncit OffCnte 3, 2 8 2 14 282.0 1G428. 4,532.8 5,961.0 16,385.1 3.85 20;243.10

Subtotal 18,012.2 - _ _ _ 18,012.2 1,801.2 5,679.6 7,480.8 20,414.0 5,079.0 25,493.0B. T-aiSti

3. IlProvi.moia1 Training Centers 7,598.7 - - _ _ 7,598.7 759.9 2,441.4 3,201.3 8,748.0 2,052.0 10,800.04. Training of Medic-l and Pata.sedEtal 8taff: (a)Tr Ni.i.g f dEivaa.dP-di. S.f - 49.3 211.2 -10.8 1,489.8 1,760.9 889.1 889.1 2,285.0 385.0 0,650.0 ~(b) Tradition I Birth Attendants - - 2 - - 2,389.5 2,389.5 - 928.5 928.5 3,318.0 - 3,318.10Hc)Nelth Canter OStaff- - 298.2 158.6 454.8 -148.2 148.2 457.0 E46.0 603.0

Subtotai 7,598.1 49.3 211.2 - 307.0 4,037.7 12,203.9 759.9 4,407.2 5,167.1 14,808.0 2,563.0 17,371.0C. MCH/FP Service Dellvery

5. Upgrading of 50 NHalth Centers 4,418. - - - - - 4,418.1 441.8 1,639.1 2,080.9 5,215.0 1,284.0 6.499.06. Field npervtsio. _ _ 1,740.0 - _ _ 1,740.0 - 371.0 371.0 227.1 1,883.9 2,111.07. 21 Contrneptive Wrh . 3,689. _ - _ - 9. 368.9 1112.1 1481.9 4,137.0 1,033.0 5,170.0subtotal 8,107.1 - 1,740.0 - - - 9,847.1 810.7 3,122.2 3,932.9 9,579.1 4,200.9 13,780.0

D. IEC Activtties - 4,410.3 719.1 15.0 15.0 2,087.8 7,247.2 - 2,012.8 2,012.8 3,091.0 6,169.0 9,260.0E. Popletio.. Ed i...tt - 32.8 - 120.0 4,814.9 4,967.7 - 1,728.3 1,728.3 6,506.0 190.0 6,696.0

TOTAL PROJECT COST 33,718.0 4,492.4 2,670.3 15.0 442.0 10,940.4 52,278.1 3,371.8 16,950.1 20,321.9 54.398.1 i8.201.9 72,600.4

ANNEX 1- 63- T-24

Page 1 of 2

INDONESIA: THIRD POPULATION PROJECT

FIlWICING PLAN BY EXPIDITUIX AND FUNCTIONAL CATEGORIES

(in US$000)

Functional and Expenditure Category IBRD GOI Total

A. FP/Population Management

1. Provincial Centersa. Construction 2,008.4 - 2,008.4b. Professional Fees and Supervision 254.3 - 254.3c. Equipment 235.1 104.9 340.0d. Furniture - 484.5 484.5e. Site Development - 643.0 643.0

Subtotal 2,497.8 1,232.4 3,730.2Physical Contingencies 249.8 .123.2 373.0Price Contingencies - 1,146.8 1,146.8

Total 2,747.6 2,502.4 5,250.0

2. District Officesa. Construction 5,848.0 - 5,848.0b. Professional Fees and Supervision 818.7 - 818.7c. Equipment 894.2 399.1 1,293.3d. Furniture - 1,139.3 1,139.3e. Site Development - 5,182.7 5,182.7

Subtotal 7,560.9 6,721.1 14,282.0Physical Contingencies 756.1 672.1 1,428.2Price Contingencies 312.0 4,220.8 4,532.#

Total 8,629.0 11,614.0 20,243.0

B. Training

3. Population Training Centera. Construction 4,091.5 - 4,091.5b. Professional Foam asd Suprvision 51S.0 - 516.0c. Equipment 478.8 213.8 692.6d. Furniture - 966.9 966.9e. Site Development - 1,309.7 1,309.7

Subtotal 5,088.3 2,510.4 7,598.7Physical Contingencies 508.8 251.1 759.9Price Contingencies - 2,441.4 2,441.4

Total 5,597.1 5,202.9 10,800.0

4. Training of Nurses and Midwives _ 211.2 211.2a. Vehicles212212b. Special Equipment 32.3 17.0 49.3c. Fellowship 10.8 - 10.8d. Operating Cost

Nurses/Midwives 740.1 740.1Teacher Reorientation 749.5 749.5

Subtotal 1,532.7 228.2 1,760.9Price Contingencies 604.7 284.4 889. 1

Total 2,137.4 512.6 2,650.0

5. Training of TBAsa. Operating Cost:

Seminar at the National Level 44.1 44.1Training of 121 MCH Midwives at

Provincial Level 118.4 - 118.4MCH Evaluation - 128.0 128.0Training of 2371 MCH Midwives at

Regency Level 886.4 - 886.4Training of 604 MCH Midwives

(Java/Bali) at Regency Level - 166.8 166.8Training of new TBAs (5,000/Year) - 623.4 623.4Retraining of TBAs - 422.4 422.4

Subtotal 1,004.8 1,384.7 2,389.5Price Contingencies - 928.5 928.5

Total 1,004.8 2,313.2 3,318.0

ANN4EX 1

64- T-Z

INDONESIA: THIRD POPULATION PROJECT

FrlIAPC UNB PLA 81u De TURn AND FuCTrnAL CAUGMIES(in MOW00

Functional and Extenditure Category IBRD GOI Total

6. Health Center StaffA. Fellowship 296.2 - 296.2b. Operating Cost - 158.6 158.6

Subtotal 296.2 158.6 454.8Price Contingencies - 148.2 148.2

Total 296.2 306.8 603.0

C. MCH/FP Services Delivery

7. Upgrading of 50 Health Centersa. Construction 2,586.4 - 2,586.4b. Profesaioual Fees and Supervision 264.5 - 264.5c. Equipment 188.0 82.5 270.5d. Furniture - 194.0 194.0a. Site Development - 1,102.7 1,102.7

Subtotal 3,038.9 1,379.2 4,418.1Physical Contingencies 303.9 137.9 441.8Price Contingencies - 1,639.1 1,639.1

Total 3,342.8 3,156.2 6,499.0

8. Field Supervisiona. Vehicles - 1,740.0 1,740.0

Price Contingencies - 371.0 371.0

Total - 2,111.0 2,111.0

9. Contraceptive Warehouses (21)a. ConatrtotiOl 2,242.3 - 2,242.3b. Profassoal lees and Superflioe 169.3 - 169.5c. Equipment 156.7 70.0 226.7d. Furniture - 322.9 322.9e. Site Development - 727.6 721.6

Subtotal 2,568.5 1,120.5 3,689.0Physical Contingencies 256.8 112.1 368.9Price Contingencies - 1,112.1 1,112.1

Total 2,825.3 2.344. 7 5,170.0

D. 10. IEC Activitiesa. Vehicles - 719.1 719.1b. Equipment 4,410.2 - 4,410.2c. Fellowship 15.0 - 15.0d. Advisory Services 15.0 - 15.0e. Operating Cost:

Film Production - 1,317.0 1,317.0Media Production Center 402.0 402.0Others - 368.9 368.9

Subtotal 4,440.2 2,807.0 7,247.2Price Contingencies - 2,012.8 2,012.8Total 64A40L2 4,SRl9R 9 260.0

E. 11. Population Educationa. Equipment 21.3 11.5 32.8b. Fellowship 120.0 - 120.0c- Operating Cost

In-School Program 3,559.0 - 3,559.0Out-of-School Program - 976.6 976.6Teacher Education 279.3 279.3

Subtotal 3,979.6 988.1 4,967.7Price Contingencies - 1,728.3 1,728.3

Total 3,9796 2,716.4 6,696.0

Totals

Construction 16,776.6 - 16,776.6Equipment 0,416.7 898.8 7,315,5Profeasional FOas, Advisory Services

and Fellowships 2,482.0 - 2,482.0Furniture - 3,127.6 3,127.6Site Development - 8,965.7 8,965.7Vehicles - 2,670.3 2,670.3Operating Cost 6,332.1 4,607 8 10,940.4

Subtotal 32,007.9 20,270.2 52,278.1Contingencies 2,992 1 17,329.8 20,321.9

Total 35 0000 37,600.0

ANN. IL

INDONESIA: THIRD POpULATION PROJECT

ESTIMATED CMKITMENTS OR EXPENDITURES BY YEAR AND EXPENDITURE CATEGORIES(in US$000)

1980/81 1981/82 1982/83 1983/84 TOTAL

Support for Family Planning/Population Program/I

1. Civil Works /2 7,979.0 16,109.9 4,940.5 270.5 29,299.92. Vehicles 580.0 580.0 580.0 - 1,740.03. Contingencies 2,119.4 7,059.6 3,148.5 205.6 12,533.1

Subtotal 10,678.4 23,749.5 8,669.0 476.1 43,573.0

Support for Maternal and Child Health Program /3

1. Civil Works /2 1,010.0 1,270.0 1,590.0 548.1 4,418.12. Special Equipment 49.3 - - - 49.33. Vehicles - 211.2 - - 211.24. Fellowships 83.0 93.8 101.1 20.1 307.05. Operating Costs 979.8 987.1 1,029.0 1,041.8 4,037.76. Contingencies 563.9 1,069.4 1,466.3 948.1 4,047.7

Subtota3 2,686.0 3,631.5 4,186.4 2,567.1 13,071.0

Support for IEC

1. Special Equipment 2,838.4 582.7 981.5 7.7 4,410.32. Vehicles - 302.0 417.1 719.13. Advisory Assistance and Fellowships - 30.0 - - 30.04. Operating Costs 351.9 616.3 559.8 559.8 2,087.85. Contingencies 346.7 499.0 827.6 339.5 2,012.8

Subtotal 3,537.0 2,030.0 2,786.0 907.0 9,260.0

Support for Population Education Program

1. Special Equiplent - 32.8 - - 32.82. Fellowships - 40.0 40.0 40.0 120.03. Operating Costs 713.3 2,819.1 654.1 628.4 4,814.94. Contingencies 107.0 921.8 308.4 391.1 1,728.3

Subtotal 820.3 3,813.7 1,002.5 1,059.5 6,696.0

TOTAL 17,721.7 33,224.7 16,643.9 5,009.7 72.600.0

/1 Includes the following components: 11 Population Centers, 11 PTCs, 107 District Offices, 21 Warehouses andmotorcycles for field supervision.

/2 Includes construction, furniture, equipment, professional fees and site development./3 Includes the following components: Upgrading of 50 Health Center and training of nurses, midwives,

TBA trainers, TBAs, Health Center medical and paramedical staff, local administrators and community leaders.

- 66 - ANNEX 1T-26

INDONESIA: THIRD POPULATION PROJECT

ESTIMATED SCHEDULE OF DISBURSEMENTS, 1981-1984/1

IBRD Fiscal Year Amount (In US$ millions) Cumulative X ofand Quarter End of Quarter Cumulative Total Loan Amount

FY81March 1981 1.00 1.00 3June 1981 1.00 2.00 6

FY82September 1981 1.20 3.20 9December 1981 1.21 4.41 13March 1982 1.97 6.38 18June 1982 2.42 8.80 25

FY83September 1982 3.46 12.26 35December 1982 3.56 15.82 45March 1983 3.72 19.54 56June 1983 3.56 23.10 66

FY84September 1983 2.92 26.02 74December 1983 2.48 28.50 81March 1984 2.12 30.62 87June 1984 2.12 32.74 94

FY85September 1984 1.68 34.42 98December 1984 .58 35.00 lOQ

/1 Based on schedule of key project actions shown in Annex 1, T-24

ANNEX 1T-27Pooe I of 3

INDONESIA: THIRD POPULATION PROJECT

SCHEDULE OF KEY PROJECT ACTIONS TO_MEET THEDISBURSEMENT SCHEDULE/1

Actions Latest Dates to AgencyComplete Action Responsible

A. Training

1. Drawing up of specifications, tendering February 1981 MOHand awarding of contracts for the purchaseof medical equipment and training aidsfor nurse midwives training programs

2. Delivery of medical equipment and teaching September 1981 MORaids referred to above

3. Reorientation of 960 teachers in fournurse training schools in groups of 120(a) first group December 1980 MOH(b) second group June 1981(c) third group December 1981(d) fourth group June 1982(e) fifth group December1982(f) sixth group June 1983(g) seventh group December 1983(h) eighth group June 1984

4. Completion of local fellowship programfor nurse and midwives conversion training October 1981 MOH

5. Fellowship for nursing school teachers June 1981 MORreorientation

6. Training of doctors and midwives as trainersin six provinces for TBA training program MOR(a) first seminar, national level June 1981(b) second seminar, national level June 1983

7. Training of district MCIH midwives (121)as trainers for TBA training program MOR(a) basic training November 1980(b) refresher training Novemberl981(c) second refresher training November 1982(d) third refresher training November 1983

/1 This schedule is the basis for estimating the disbursement schedule shown inAnnex 1, T-2 7.

-68 -

ANNEX 1T-27'Page 2 of 3

INDONESIA: THIRD POPULATION PROJECT

SCHEDULE OF KEY PROJECT ACTIONS TO MEET THEDISBURSEMENT SCHEDULE /1

Latest Dates to AgencyActions Complete Action Responsible

8. Training of health center MCH midwives September 1984 MOH(2,371 in 121 kabupatens)

9. Clinical training of 50 health center doctors MOH(a) first group of 15 June 1981(b) second group of 15 June 1982(c) third group of 20 June 1983

10. Study tours for health center staff, in MOHgroups of 12(a) first group June 1981(b) second group June 1982(c) third group June 1983(d) fourth group June 1984

B. Information, Education and Communication Activities NFPCB

11. Drawing up of specifications, tendering and September 1980awarding of contracts for the purchase ofaudiovisual equipment

12. Delivery of audiovisual equipment Nov. 1981 - Nov. 1982

13. Study tour for video technicians June 1981

14. Hiring of consultant for video training Aug. 1981

C. Population Education (In-School Program) NFPCB and MOE

15. Printing and production of textbooks,teachers/handbooks and training kits June 1982

16. Training of teachers(a) primary school level September 1984(b) junior secondary school level September 1984(c) senior secondary school level September 1984

17. Tendering and awarding of contracts for May 1981slide projectors (160)

18. Delivery of slide projectors December 1981

19. Fellowships for population education(3 persons for 1 year each)(a) 1st and 2nd fellows September 1982(b) 3rd fellow September 1983

20. Study tour December 1980

ANNEX 1-6 9- T-27

Page 3 of 3

INDONESIA: 'rIRD POPULATION PROJECT

SCHEDULE OF KEY PROJECT ACTIONS TO MEET THEDISBURSEMENT SCIEDULF

D. Civil Works

AwardNumber Acquisition of Procurement Procurementof of Construction of of

Facility Facilities Sites Contracts Furniture Equipment

NFPCB Provincial Population 8 9/15/80 6/30/81 12/31/81 12/31/81Centers (11) 3 6/30/81 6/30/82 5/31/82 5131/82

NFPCB Provincial 6 9/15/80 6/30/81 - -Warehouses (10) 4 6/30/81 6130/82 - -

NFPCB District Offices(104) 40 9/15/80 6/30/81 12/31/81 12/31/8140 6/30/81 6/30/82 12/31/82 12/31/8227 6/30I82 3/31/83 6/30/83 6/30/83

MOH In-Patient Annexes (50) 8 9/15/80 6/30/81 9/30/81 9/30/8i17 6/30/81 6/30/82 9/30182 9/30/8125 6/30/82 3/31/83 9/30/83 9/30/81

-70- ANNEX 1

Pap 1 If

INDONESIA: THIRD POPULATION PROJECT

QUARTERLY IMPLEMENTATION SCHEDULE OF NON-CONSTRUCTION ACTIVITIES, 1980-1984

1980 1981 1982 1983 1984

Activity 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3

A. Training of:1. Nurses and Midwives

a. Establishment of CoordinatingCommittee X X

b. Procurement of Medical Equipment,Teaching Aids and Vehicles X X X X X

c. Re-training of 1,080 Nurses X X X X X X X X X X X X X Xd. Re-orientation of 960 Teachers X X X X X K XX X X X X X X Xe. National Workshops/Seminars

(i) For Nurses X X X X X X X X(ii) For Teachers X X X X

2. Traditional Birth Attendants (TBAs)a. National Seminar X Xb. Provincial Level (121 Regency MCH

Midwives) X X X Xc. Regency Level (2,371 MOH Midwives) X X X X K X X X K X X X X Xd. Kecamatan Level (retraining 30,000

TBAs) X X X XKX X K X X X

3. Doctors, Other Health Center Staff, LocalAdministrators snd Community Teachersa. Clinical Training of Doctors X X X X K XX X Xb. Study Tours for Health Center Staff X X X Xc. Seminars for:

(i) Health Center Staff X X X X(ii) Administrators, Kabupaten

and Kecamatan Levels X X X X(iii) Village Community Leaders X X X

B. MCH/FP Service Delivery1. Health Center In-Patient Facilities

a. Recruitment of Staff X X X

2. Field Supervisiona. Procurement of Motorcycles X X Xb. Distribution of Motorcycles to

Fieldworkers X X X

C. IEC Activities1. Mobile Information Unit

a. Procurement of Vehicles and AVA X X X X X Xb. Operation of MIU X xxx x

2. Public Address System for VillageAcceptors Cluba. Procurement XX X Xb. Distribution X X X X

3. Video Duplicator System and Cassettesa. Procurement Xb. Operation X X

4. Provincial Media Production Centera. Procurement Xb. Operation K

5. Video Monitor/Playersa. Procurement Xb. Operation X

6. Study Tour X

7. Film Productiona. Pre-test X X Xb. Production X X Xc. Copy X K X X X

8. Training of Video Technicians

- 71 - AONe I

Page 2 of 2

INDONESIA: THIRD POPULATI(% .

QUARTERLY DHPLEMENTATION SCHEDULE OF NON-CONSTRUCTION ACTIVITIES, 1980-1984

1980 1981 1982 1983 1984

Activity 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3

D. Population Education1. In-School Program

a. Training of Teachers(i) Primary School X X X X X X X X X X X X X XXX(ii) Junior Secondary School X X X X X X X X X X X X X XX(iii) Senior Secondary School X X X X X X XX X X X X X X X X

b. Printing and Production of Text-books X X X X X X X X -

c. Printing and Production ofTeachers' Handbooks X X X X X X X X X

d. Production of Kits X X XXX X X X X X X X X XXe. Training of Supervisors X X X X X X X X X X X X X X X Xf. Radio Program X X X X X X X X X X X X X X X X

2. Out-of-School Programa. Training of Instructors X X X X X X X X X X X X X X Xb. Printing and Production X X X X X X X X Xc. Printing of Teachers' Guides X X X X X X X X Xd. Preparation of Supplementary

Materials X X X X Xe. Production of Supplementary

Materials X X X Xf. Production of Kits X X X X X X X X X X X Xg. Purchase of Slide Projectors Xh. Slides Purchase and Productions X X K X X X X X X X X Xi. Intra-country Study Tour X X X X X X X X X X X X X X XJ. Training of Supervisors X X X X X X XX X X X X X X Xk. Radio Program XX X X X X X X X X X X X

3. Teachers Educationa. Special Course at IKIP Level

(51 - Sarjana) X XX X X X X X X X X X X X XXb. Preparation of Curriculum X X X X Xc. Preparation of Textbook and

Teaching Package X X X X Xd. Training of IKIP's Teacher -

Educators and Education FacultyMambers X X X X X X XX X X X X X X X X

e. Strengthening Libraries at 10IKIPs X X X X X X X X

f. Developing Pasca Sarjana (Ed.S,Course at IKIP Jakarta X X X X X X XX X XX X X X X

g. Developing course oontent andtraining inckage X X X X

h. Special Lilrary for IKIP Jakarta X X X X X X X X X Xi. Fellowship X X X X X X X X X X

(i) Study Tours for school andout-of-school X X X X X X X X

(ii) Specialization in Pop. Edu.IKIP Program X X X X

J. Evaluation Activities in Provin-cial and National Level X X XX X X X X X X X X X XX

k. Research Projects X X X X X X XX X X X X X X X1. Distribution of Textbooks X X X X X X X X

- 79 -

INDUONSIA: THIR0 POPULATION PROJECT

CIVIL WORKS INPIEHNEIATION, EXPENDITUBE AND DISBURSEHENT SCHEDULE, 1980-1984

1980 1981 18S2 1983 _9b4

Sep ...- J. Mar.. J n.. . S.p . Dc J..a.. r... J.nn.... S W . D-ec J. _- Mar... Jun .... Se. . e. D a, Mar.. Jn ... ... SE. Dle

Land Acq. IIl1111111

PROVINCIAL Soil Inn. ...... a.a....uaa.a. aa..a.aaPOPU,.AfON 11 D-.In dddddddddCENTEUS ikg. Dtg- dvevn,deddewdedwdwdvdvd

Tender. tentttttittitttS

Innate Coat nUSS.439.DooEUpndlture 0.4 0.6 011 1. 2 1.2 1.2 0I 8 07 0.239

Db- -tur eIaen1 1. 3 1.2. 2 2 0 8 0 7 0 234

Prof I..Fe I-'l pfpfpfpfpfpftfpfpfpfpfp fpfpfpfpfp fpfpfpfpfpfpfpfp fPfpfpfPfpfpfPfpfpf PfpfPfpfpfpfPfpfPfrf.fD ffrf,fpft fpfp fDfDfpffo fDS59414,800 D0b. 0 05 0.05 0.05 0.05 0. 0 0.05 0.1 0.1 0.1 0.1 0. I 0 I O 041

F_rniture Proc. ffffffffffffffffUS1. 794.300 Dieb. 0.5 0.5 0.5 0.2953

E-uip-ent Proc. ........ ......

USSI.085.600 Diab. 0 5 0.5 o 0856

Land Acq. IllPYOVINCIAL Soil Inn. ....

WAREHOUSES 10 Deeign dddWrk.D.vs . odvddTendera ttttt

Cunntc Coot US$903, 200

E,perditruD 0.1 0.2 0.2 0.2 0.1 0.1 0 0032-iaurecent 0.3 0.4 0 1 0.1032

Land Acq. 11111111111IIIl1101ilillIlIIDISTRICT Soil Inv. eaaaaa .a ......ae a .....eaa a ....

OFFICES 107 Deaign ddddddtdkg. Oe. Id.adan.doeodeeoOnadaTender- ttttttrttttt itnrttt ettntt

Cnott. Coat U5$5.848.000

Epndituce 0.3 0.5 0.5 0,5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.548

Diabturonnt 0.3 0.5 0.5 0.5 0.5 0.5 0.5 0,5 1.5 0.548

Frof .PFeon IFpI. pfpfpfpfpfpfpfpfpfpfpfpfpfpfpfpfpfpfpfpfpfpfppfpfpf rpfpfpfptpfpfpfpfpfpfpfpfpfpfpfpfpfpfpEpfpfpfpfpfpfpfpfpfpfpfpfpfpfpfpfpfpfpfpfpfpfpfpfpfPfpf008S18,700 Disb. 0.05 0.1 0.1 0.05 0.05 C.05 0.05 0.05 0.05 0.00 0.05 0.1 0.0687

FPintin.r Proi. jffffffffffff ffffffffffffuS$I,139.3UO Hi.a. i 0.1 0.1 0.2 0.2 0.2 0.1 0.1 0.1 0.0393

Eqnip.nat Proc. .e.....e.e.ee... ...........USS1,114.900 DIeb. 0.2 0.3 0.1 0.2 0.3 0.d149

Land Alql 1111111111.119 1 1110111 .11

HC Soil lnn aoeaaeeaaaeooaeaaaaaaaaoasaeIN-PATIENT 50 Deeigt dddFACILITIES wklgg. .. 4dwqvdwdvdvdvdeodwdwdwdvdddvd

landera ttnneert t ttetc tiuctutt vttt

Coootr.Ctmt US02.586.400

.xpanditore 0.05 0.1 0.2 0.2 [ 0.2 O.2 0.2 0.2 0.2 0.2 0.3 0.3 0.2364

Di.b.rte.i-- 0.15 0.2 0.2 0.0 0.2 0.2 0.2 0.2 0.2 0.3 0.3 0.2364

Prof .F... I.pl. pfpfpfpfp fpfpfpfpf pfpfpfpfpfp fpf pfpfpfpfpf pfpfpfpfp fpfpf pfpfpfpfpfpfpfpfpf pf pfpffpf pfpfpfp Epfpfpfpfpfpfpfp*fpfpfpfpfpfpEpfpfpfpkpfpUS1264,500 Diab. 0.05 0.02 0.02 0.02 0.02 0.02 D.02 0.02 0.02 0.02i 0.02 0.0145

Prnitre Pr fffffffff fffffffff fffffffffUS$194,0O0 Diab. 0.03 D.07 0.094

Fqtip-t3t Proc. aeeeeoeo00S5230,000 DfOa. 0.1 0.1 0.03

SUIlSf OF ANICIPIITBD DOSOUBIHRSMNS F00 CIV.L LfODBd j

C-n.trucrLon US16,776.6 - - - 0.15 1.2 1.8 2.4 2.0 1.9 1.6032 1.4 0.934 0.8 1.8 0.7844

Ptof.Fee US$ 2,025.0 0.05 0.1 0.2 0.17 0.12 0.12 0.17 0.17 2.17 0.17 0.07 0.17 0.1610 0.0832

Pornittre US0 3,127.6 - - - - . 0.03 - 0.0 0.6 0.77 0.7 0.4943 0.1 0.194 0.1 0.0393

oqoipuone US$ 2,430.5 - - - - - 0.1 0.3 0.33 D.5 0.5 0.1856 0.2 0.3 0.0148

TOtAL US$24,359.7 0.05 0.1 0.2 0.321 1.35 2.02 2.97 3.1 3.34 2.9732 2.2499 1.4D 1.4558 1.9981 0.8237

8ep ..... Ja.. MHo .. Jon. .S ep . D.. Jan... . ..... Sap .... . Sp ... D.c . Jan. Mar . Jo. n. S.p . Hc Tao.J. M. ........... iJn. Sep .. D .. a

1980 1981 l 1982 1983 1984 -

- 73 - ANNEX 2

INDONESIA

Q-L")CZ3D LUiIENT;S MID DATA AVAILABLE IN THE PROJECT FILE

A. General Reports

Central Bureau of Statistics, "Population and Manpower Statistics," 1978.

Economic and Social Commission for Asia and the Pacific, "Asian PopulationProgramme News," Volume 6, No. 1, 1977.

Government of Indonesia and UNICEF, "Master Plan of Operations for aProgramme of Basic Services for Children in the Republic ofIndonesia, 1979-1984".

House Select Committee on Population, "Remarks of Haryono Suyono, Ph.DDeputy Chairman III, National Family Planning Coordinating Board,Jakarta, Indonesia", April 27, 1978.

National Family Planning Coordinating Board, "Ten Year Review of theNational Family Planning Program", 1980.

National Family Planning Coordinating Board, "The Integrated MCH FamilyPlanning Development Project in Mlojokerto, East Java, 1973-1979",1979.

Planned Parenthood Federation of America, "International Family PlanningPerspectives", June 1979.

Population Reference Bureau, "Indonesia's Family Planning Story: Successand Challenge," Population Bulletin, November 1977.

Presidential Decree, "Organization of the National Family PlanningCoordinating Board" 1978.

UNFPA, "Indonesia: Report of Mission on Needs Assessment for PopulationAssistance", August 1979.

UNFPA, "Five Year Program 1980-1984".

WHO, "Collaborative Study on Perinatal Mortality and Morbidity," 1979.

WHO, "Strengthening of Maternal and Child Health Services, Indonesia,"August 1979.

World Bank, "Appraisal Report of a Joint IDA-UNFPA Population ProjectIndonesia," Report PP-8a, February 1972.

World Bank, "Employment and Income Distribution in Indonesia," Report2378 - IND, February 1979.

World Bank, "Indonesia Appraisal of a Second Population Project", Report1534b - IND, May 1977.

74 ANNEX 2Page 2

INDONESIA

SELECTED DOCUMENTS AND DATA AVAILABLE IN THE PROJECT FILE (Cont.)

World Bank, "Indonesia: Long-Run Development and Short-Run Adjustment",February 20, 1980.

World Bank, "Regional Aspects of Family Planning and Fertility Behaviorin Indonesia," Report 2922 - IND, March 1980.

World Fertility Survey, "The Indonesia Fertility Survey, 1976: ASummary of Findings", October 1978.

B. Papers Related to the Project

Architect's Working Papers, "Indonesia III: Third Population Project:Civil Works", March 1980.

Department of Health Indonesia, "Health Centre Reference Manual Volume II,"April 1976.

Government of Indonesia, "Indonesia Project Proposal (Third PopulationProject), iovember 1979.

Ministry of Health, "Health Centre Services Development", February 1980.

- 75 - C-1

INDONESIA: THIRD POPULATION PROJECTORGANIZATION CHART OF NATIONAL FAMILY

PLANNING COORDINATING LCARD (NFPCP5

PRESIOENT OF INOONESIA

CHA1RMA. - - - _ CONSU LTATIVE TEAM FOR PROGRAM

VICE CHAIRMAN EXECUTtON

EDUCATION AND TRAINING … -CENTER _ _ _ _ _ _ _ _ _ _

IMAPLEMENTING UNITSECRETARiAT ~~CENTRAL LEVEL

OEPUTY FOR SUPERtVISION AND OEPUTY FOR ADMINISTRATION DEPUTY FOR FAMILY DEPUTY FOR POPULATIONI^ca FROL n ANO MANAGEMENT _F 7 PLNN NG AFFAIRS

. F 1 _ SUReAUffPUNNING _ W~~~~BREAU OF INFORMATION WUREAUOP POPULATION BUREAU OP PLANNING AND MOTIVATION DUR AU TA

BUREAU OPFPROGRAM EVALU-

INPECTORATE OF MNSPECTORATE INSPECTOtATEAMANPOWER AND OP FINANCIAL OF MATERIALSPROGRAM AFAIRSUREAU O SUPPLY BUREAU OP FIELD BUREAU OF PROGRAM

AND LOGISTICS . OPERATIONAL CONTRtOL COOHO INATION _

PROVINCIALGOVERNOR

DtSTIICT WEAO/CITY MAYOR PRtOVINCIALNFPCt

|OISTRICTIKABUPATEN NFPCB OFFICE TVINCtALLEVEL

L--------------------_

CT IbPLEbENTING UNIT

Worl 4Bk - 21490

INDONESIA: THIRD POPULATION PROJECT

SYSTEM OF TRAINING OF TRADITIONAL BIRTH ATTENDANTS

National Seminar on MCH Organizer: Directorate General of Community Health, MOHNational Level for Trainers: Staff of the MCH Sub-directorate and staffDoctors, Midwives responsible of the National Center for Education and Training

for MCH and TBA Training Program Objectives: To discuss--(I) Overall MCH policy(2) Role of TBAs(3) Training of TBAs

(curriculum, method of training, supervision,referral, etc.)

Procedure: To be held in Jakarta, once every two years.

Provincial Level Training of Kabupaten Organizer: Provincial health officeMidwives* Trainers: Provincial doctors

Provincial midwivesObjectives: To provide knowledge about--

(1) Overall policy(2) Role and function of TBAs(3) How to organize training program for TBAs(4) Technical support, supervision, follow-up, etc.

Procedure: To be held at Provincial health offices once a year.Each province to train 20 midwives on the average.

Kabupaten Level Training of Health Center Organizer: Kabupaten health office(District) Midwives* Trainers: Kabupaten doctor 0

Kabupaten midwivesObjectives: Same as for training program for Kabupaten midwivesProcedure: To be held at Kabupaten health offices once a year.

Each office to train 20 - 25 midwives on the average.

Kecamatan Level Training of TBAs Organizer: Health center(Subdistrict) Basic Training (20,000) Trainers: Health center doctor

(5,000 per year) Health center midwifeRetraining (47,000) Objectives: To impart knowledge about--

(about 12,000 per year) (1) Normal delivery(2) How to examine pregnant women(3) Care of high-risk pregnant women(4) Care of eye, mouth, nose, etc,(5) Family planning(6) Other health problems

Procedure: To be held at 3,000 health centers over a period of4 years. Each center to train 15 - 20 TrAs.

Village Level Services by TBAs

(67,000)

* Bank financing covers training of 121 Kabupaten and 2,371 Health Center Midwives. The rest is covered by the Government.

C-3- 77 -

INDONESIA: THIRD POPULATION PROJECTTHE STRUCTURE OF THE MINISTRY OF HEALTH

Minister of Health

I nspector Secretary General

Director General Director General Director General Director General ofof Medical Care of Community Health of Communicable Drug and Food Control

Dim.s Control

ational Intitute of National Center forResearch & Developmen Education and Training

Head ofProvincial Health Office

Head ofDistrict/Kabupaten Health Office

| ~~~~Head of | Community Health Center (PUSKESMAS)

World Bank - 21489

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