| Project Detail |
Project Name Primary Healthcare and Public Health Laboratories Upgrading and Strengthening Project
Project Number 54224-002
Country / Economy Indonesia
Project Status Approved
Project Type / Modality of Assistance Loan
The Primary Healthcare and Public Health Laboratories Upgrading and Strengthening Project will assist the Ministry of Health in strengthening primary care services and public health laboratories. Along with three multilateral development banks, ADB will cofinance the provision of equipment to upgrade and enhance the capacity of primary care facilities and public health laboratories throughout the country. It will also help address the adverse health impact of climate change and improve the preparedness and resilience of the health system to handle future public health threats. The outcome of project will be equitable access to primary care and public health laboratory services for the prevention, detection, and treatment of communicable and noncommunicable diseases, and other health conditions, expanded.
Project Rationale and Linkage to Country/Regional Strategy
Primary care transformation. In Indonesia, government primary care providers account for about 60% of all primary care providers and include (i) about 10,321 community health centers or puskesmas, and about 48,000 auxiliary puskesmas or pustus, staffed by health professionals; and (ii) around 300,000 posyandus operated by around 1.5 million community health workers (kaders), as volunteers, who provide public health services to households, with a focus on maternal and child health services. The strengthening of these primary care providers and tier 1 public health laboratories (labkesmas) is pivotal for achieving universal health coverage (UHC) and other Sustainable Development Goals (SDGs) in health. Up to 90% of the essential UHC interventions are primary care interventions, and up to 75% of the projected health gains from the SDG health targets could be achieved through strengthened primary care. , MOH will implement reforms in governance and policymaking capacity, standardization of the life cycle-based primary care service delivery model, digital transformation of primary care, and enhancement of skills and capacities of primary care providers including kaders in posyandus.
The life cycle-based primary care approach will provide continuous, age-appropriate promotive and preventive services to expedite further reductions in maternal and neonatal mortality, stunting, and major communicable and NCDs. It will also address the emerging health needs of older people and adolescents, including mental health. The strengthening of the pustus will extend primary care professionals to villages to provide primary care, particularly maternal and child health care, and the prevention of gender-based violence. A revitalized tier-1 labkesmas located in puskesmas will support early detection and surveillance of common communicable diseases and NCDs. These reforms are supplemented by the promotion of the use of digital tools in primary care and tier-1 labkesmas, and the improvement of the quality and competitiveness of health human resources, including their increased awareness of climate change, and the adoption of mitigation and adaptation measures against climate change.
Capacity gaps in puskesmas, pustus, and posyandus. Primary care facilities face a pressing need to address the gaps in equipment to enhance service capacity and implement the life cycle-based primary care model. As of 2022, less than a quarter of the puskesmas including tier-1 labkesmas meet the minimum requirement and only 13% of the pustus meet the minimum requirement for equipment to be able to provide health services as required by the government. As a result, only about 75% of puskesmas are considered capable of handling a standard set of 144 diagnoses that are expected to be managed at the primary care level, and only 77% can provide the full services needed for antenatal, delivery, and postnatal care. Around 65.4% of the posyandus are not fully active partly due to the lack of needed equipment. There is also a need for primary care facilities to help the population respond to the heightened risks of communicable diseases, NCDs, and nutritional problems due to climate change, and reduce carbon emissions by the health sector.
Public health laboratories (labkesmas). The public health laboratory or labkesmas system currently comprises 10,011 tier-1 laboratories located in puskesmas, 231 tier-2 laboratories in districts or cities, 29 provincial tier-3 laboratories, 12 regional tier-4 laboratories, and two tier-5 national laboratories. Each tier of the labkesmas has different functions. The tiers 1 to 3 labkesmas are managed by puskesmas, districts or cities, and provinces, while the tiers 4 and 5 are managed by the MOH. As part of the HSTA, the MOH is upgrading the lakesmas system by expanding the number of public health laboratories and ensuring that current and additional public health laboratories are fully equipped to fulfill their expected functions.
Capacity gaps in labkesmas. The importance of public health laboratories in the provision of health services, including primary care and maternal and child health services, and the conduct of epidemiological surveillance and outbreak response were highlighted during the COVID-19 pandemic. The pandemic response showed how rapid investments in molecular laboratories and polymerase chain reactions (PCR) machines, and laboratory staff who can do the PCR test for coronavirus can quickly build up needed capacity for tracking and eventually controlling the pandemic. The upgrading of all tiers of public health laboratories needs a similar rapid augmentation of necessary equipment and health human resource capacity to enable the different labkesmas tiers provide the comprehensive and standardized laboratory services assigned to them. Similar to primary care facilities, there is also a need for the public health laboratories to both help the population respond to the heightened risks of communicable diseases and NCDs and nutritional problems induced by climate change, and contribute to the reduction of carbon emissions by the health sector.
Government response. The MOH developed three investment projects to address the equipment gaps in primary care facilities, labkesmas, and secondary care facilities that would strengthen their service capacities. Two projects are essential for the primary care transformation pillar. These are: (i) Strengthening of Primary Healthcare in Indonesia Project (SOPHI), which will procure and distribute equipment to primary care facilities and help them meet the MOH minimum standards for equipment, and (ii) IndonesiaPublic Laboratory System Strengthening Project (InPULS), which will procure and distribute equipment for tiers 2 to 5 labkesmas to enhance public health surveillance capacity. Both SOPHI and InPULS include capacity building for the operation and maintenance (O&M) of the equipment as part of the equipment procurement packages. ADB will be co-financing both SOPHI and InPULS as ADB has shown the expertise in supporting primary care reforms. In addition to technical assistance supporting primary care, ADBs proposed Supporting Essential Health Actions and Transformation (SEHAT) results-based lending (RBL) program and the Boosting Productivity through Human Capital Development (HCD) Program policy-based lending (Subprogram 2) will support institutional reforms and financing policies, digital health and other interventions which are part of primary care transformation pillar (para. 6). The proposed equipment procurement and capacity building in equipment operation and maintenance in puskesmas, pustus, and posyandus will address these constraints and will supplement the SEHAT and HCD programs. The third project is the Strengthening Indonesias Healthcare Referral Network (SIHREN) Project, which will provide equipment for government referral hospitals to enhance service capacity for cancer, neurological, cardiovascular, and kidney diseases.
Multilateral development banks support. Four multi-lateral development banks (MDBs): ADB, the Asian Infrastructure Investment Bank (AIIB), the Islamic Development Bank (IsDB), and the World Bank were requested to support SOPHI, InPULS and SIRHEN. With World Bank designated as the coordinating agency, it will co-finance all three projects with AIIB joining WBs co-financing of SOPHI and SIRHEN. ADB was requested to cofinance SOPHI and InPULS (para 12). IsDB will cofinance SIHREN with AIIB and the World Bank, reflecting ISDBs experience in upgrading MOH hospitals. The proposed cofinancing arrangement between ADB, AIIB, and the World Bank is in Table 1. ADB is expected to finance 50% of the total cost of InPULS and 22% of SOPHI.
Impact
Maternal and child mortality reduced and disease control and nutrition status improved |
