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Lesson
The scope and implementation coverage of projects should be manageable. For significant impact, project investment should not be spread too thinly nor be so ambitious in scope as to hamper implementation. The project interventions, while generating some positive outcomes locally, did not show much impact at the provincial level because they were too small to produce a broader impact. Concentrating investment in a few provinces would have been more effective. Strategic investment choices based on poverty and health needs should have been made when deciding geographical coverage.

Project Number: 34007-012, 34007-015
Project Name: Decentralized Health Services Project
Report Date:
Lesson
A good M&E system can help develop a better understanding of what works and what does not. While the potential benefits of a comprehensive approach were noted during the evaluation team’s field visits, there is limited effort to quantify these benefits systematically. A survey of stakeholders was conducted at project exit and documented in a benefit-monitoring report. A range of customer satisfaction questions were posed and scored in the survey.

Project Number: 34007-012, 34007-020
Project Name: Decentralized Health Services Project
Report Date:
Lesson
Results from successful pilot initiatives should be disseminated in time and used in scaling up such initiatives to maximize the impact. The health insurance scheme piloted in the Jembrana district of Bali has been recognized as one of the successful initiatives and is now being rolled out across the entire province. A number of lessons have emerged for ADB and the World Bank from piloting of this reform.

Project Number: 34007-012, 34007-014
Project Name: Decentralized Health Services Project
Report Date:
Lesson
ADB has helped improve infrastructure and promote reforms in a comprehensive manner. This was seen as a key positive feature of the project. Informants thought that by combining better planning and infrastructure and higher quality human resources, access to health services and their quality had improved. Many felt that without a comprehensive approach this might not have happened.

Project Number: 34007-012, 34007-019
Project Name: Decentralized Health Services Project
Report Date:
Lesson
Proper problem analysis is needed based on risk and mitigation analysis before rolling out a program under decentralization. Problem analysis was undertaken to some degree during project preparations. Risks were outlined in the project framework (under Assumptions and Risks) but little detail was given in the main text of the report and recommendation of the President, or in the project design.

Project Number: 34007-012, 34007-013
Project Name: Decentralized Health Services Project
Report Date:
Lesson
A comprehensive approach is needed for a well-functioning health system. Well-functioning provincial and district systems have proven to contribute to overall coordination and control of local health service delivery. During evaluation, health facility staff frequently cited the development of human resource capacity through longer-term fellowships as a key benefit of the project. Many of the project-supported fellows are now in key positions within the district and provincial health services. Many fellows thought that their careers would not have progressed so well without the project.

Project Number: 34007-012, 34007-018
Project Name: Decentralized Health Services Project
Report Date:
Lesson
Greater synergy is required between family planning and health-care services. Inclusion of family planning advocacy in future programs could help reduce maternal mortality, as high fertility and maternal mortality are correlated. During key informant interviews, many expressed an opinion that more support for family planning is needed. It will require a coordinated and balanced joint approach from MOH and BKKBN, supported by appropriate resources.

Project Number: 34007-012, 34007-017
Project Name: Decentralized Health Services Project
Report Date:
Lesson
Proper evaluation of capacity development would help assess the utility of current investment and justify further investment in human resource development. A large number of staff in health service delivery received training or fellowships under the project. However, there has not been any attempt to document actual benefits stemming from this investment. A proper analysis will help the central, provincial, and district governments to determine skills gaps that can be targeted over the next couple of decades.

Project Number: 34007-012, 34007-022
Project Name: Decentralized Health Services Project
Report Date:
Lesson
Capacity development requires continued commitment. Indonesia still has a relatively high maternal mortality ratio. Capacity development in the areas of obstetric and neonatal care is still required, and the evaluation team came to know from the district health departments that they have limited finance to meet this capacity development requirement.

Project Number: 34007-012, 34007-016
Project Name: Decentralized Health Services Project
Report Date:
Lesson
Generally accepted health systems strengthening indicators, such as those outlined in the World Health Organization's handbook should be included in a national and project-related M&E system. To determine project impact, a focused survey of health status and client attitudes in project and non-project provinces should have been conducted at the start (to establish a baseline) and at project completion. Without this information it is not possible to attribute and quantify shorter-term project benefits.

Project Number: 34007-012, 34007-021
Project Name: Decentralized Health Services Project
Report Date: