Fifth Population (Family Planning)
Report No: ; Type: Report/Evaluation Memorandum ; Country: Indonesia; Region: East Asia And Pacific; Sector: Targeted Health; Major Sector: Health
                                                  Nutrition & Population; ProjectID: P003924


Indonesia—Fifth Population Project (Loan 3298-IND)

       The Fifth Population Project (Family Planning and Safe Motherhood), supported by Loan 3298
for US$104 million, was approved in FY91. It closed on schedule in FY97. A total of US$4.1 million was
canceled. The Implementation Completion Report was prepared by the East Asia Regional Office. The
borrower’s comments are included as an appendix.

        The project’s main objective was to support the strategies of the Government of Indonesia in
expanding access to family planning and maternal health services, particularly among the urban poor and
hard-to-reach communities of the coastal and transmigration areas. The project had two main components.
The specific objectives for Part A (implemented by BKKBN) were the promotion of family planning
services through improved service accessibility and community outreach and institutional development
through staff development and improved evaluation and research capacity. The specific objectives of Part
B (implemented by MOH) were the strengthening of the policy framework for the training and
deployment of village midwife services; improving training capacity through training of trainers, teaching
materials, and equipment; and improving the effectiveness of about 16,000 village midwives (BDDs),
including establishing accreditation standards for midwifery training schools, the establishment of a
Midwifery Board, and certification procedures for BDDs.

         The project’s objectives were substantially achieved. Part A achieved or exceeded i ts appraisal
targets with family planning services and IEC provided to employees in over 7,000 businesses; 15,000
doctors, midwives, and field workers trained in clinical skills and counseling; 4,000 government staff
undertaking degree courses; and over 44 research activities conducted. Implementation of family planning
activities in the hard-to-reach communities of the coastal and transmigration areas was completed,
although an accurate estimate of the increase in contraceptive use is not available. Part B was successful in
supporting the legitimization of the role of the midwife as a (private) health provider in Indonesian
society, developing an accreditation system for midwifery schools, and funding the training of 16,000
community midwives. However, the establishment and implementation of midwifery standards are still in
the early stages, and the establishment of a Midwifery Board did not materialize. As for the deployment of
community midwives, a Midwife Coordinator located at the district and subdistrict level was created to
assist in their deployment, but the role and effectiveness of these coordinators still requires evaluation,
especially since community midwives receive little supervision and support. Because of the difficulty of
capturing benefits quantitatively and of isolating the influence of the project on the overall program’s
impact, no cost-benefit analysis was undertaken either at appraisal or completion. National indicators for
modern contraceptive use and family planning services nevertheless showed a positive trend over the
period. The professional and economic viability of the new village midwife cadre is yet to be fully
demonstrated, and further evaluation will be required. Overall, the greatest impact was achieved in the
more accessible target groups—the organized sector and the more accessible islands. Continued effort is
needed to effectively reach communities in remote coastal and transmigration areas and the unorganized
urban sector.

       OED agrees with the ICR’s performance ratings. Outcome is rated as satisfactory, institutional
development as substantial, sustainability as likely, and Bank performance as satisfactory.
        The project’s key lessons are as follows. First, investment project’s have an advantage when they
adopt a flexible annual planning process that allows them to respond to issues that emerge during
implementation. However, the benefits of such an approach are likely to be limited when government
procedures lack the same degree of flexibility. Second, addressing the needs of hard-to-reach groups can
require different modalities for community mobilization and service delivery than for the general
population. Finally, successful project implementation does not guarantee development effectiveness; this
requires continuous monitoring of performance, during and after project completion, to ensure that results
are being achieved on the ground.

        The ICR is satisfactory and includes borrower comments on both Part A and Part B of the project.

         No audit is planned, but the project will be assessed in the context of a planned sector impact
study in Indonesia.