Design Update

DFAT thanks all those who responded to the request for comments on the investment concept note for the new maternal and newborn health and nutrition program, and reports that even those comments received after the closing date were considered.

Some aspects of the concept have changed over the course of the design process as a result of the change of Australian Government and in response to the Indonesian context.

The following information is caveated by the fact that the scale, scope and focus of the proposed program may change at any time and is subject to formal approval by the Australian and Indonesian Governments before a tender process will commence.

Key issues to be aware of in the design of the next maternal and newborn health and nutrition program are outlined below:

1. The proposed time frame is eight years from 2015, covering up to 30 districts in three provinces. The program will no longer focus on Papua or West Papua.
2. Subject to approval, the estimated budget will be up to $150 million.
3. It is proposed that this program will have an integrated modular structure across two integrated pillars.
   • Pillar 1 – Primary health care system strengthening: - At its core the program will focus on strengthening primary health care services in Indonesia, starting at the community health centre (Puskesmas). It will ensure that primary care delivers community based health prevention, promotion and surveillance, early detection and appropriate management of important health issues. It will equip Puskesmas to appropriately manage health problems as appropriate at health centre level as well as their efficient referral to higher levels when needed. This health systems approach to improving the continuum of care with a focus on primary care will not only improve maternal and newborn health outcomes but also improve the health systems responsiveness to and outcomes in other key communicable diseases (such as TB and malaria) and non-communicable diseases.
   • Pillar 2 – A maternal and newborn health specific focus: - complementing the health systems focus will be a program component that will deliver technical assistance, demonstration projects and information, education and communication interventions in areas specific to the improvement of maternal and newborn health outcomes. This is likely to include previously described activities in family planning, maternal nutrition and strengthening of maternal death audit processes and use of information.
4. It is important to note that there will be no vertical focus on any issue other than maternal and newborn health and nutrition. Any gains in other communicable and non-communicable disease outcomes would be seen and achieved through the improvement of primary care systems under pillar 1 alone.
5. Operational research and rigorous monitoring and evaluation, with a clear strategy for lesson learning, continuous improvement and ongoing dissemination, will be used to ensure realistic but effective models have the best chance to influence policy and implementation at a larger scale than the program districts.
6. In addition, an overarching monitoring and evaluation framework across the whole of DFAT's health portfolio in Indonesia may be developed and separately contracted to allow cohesive links and integration between programs. This will include selected analytics, independent impact evaluations and activities to support lesson sharing.
7. Considering the additional level of complexity that the program will have and taking into account comments received, including those from government counterparts and peer reviewers, it is proposed to reduce the number of focus provinces in the program to three. The program will focus on areas with the greatest need. The proposed provinces are:
   
   
   

   Provinces	Proposed final number of districts to be supported
   Jawa Timur	10-15
   Nusa Tenggara Timur	10
   Nusa Tenggara Barat	5
   Total Districts	25-30

8. Jawa Timur is densely populated with large numbers of poor, while the other two provinces are consistently in the bottom five Human Development Index rankings for Indonesian provinces.
9. Discussions are ongoing with central and provincial governments and other stakeholders. Focus districts in NTT will be identified during the design phase so that there can be a smooth hand-over and continuation of the present support provided through the Australia Indonesia Partnership for Maternal and Neonatal Health (AIPMNH). Districts in the other provinces will be selected in consultation with stakeholders during the inception period and support will be phased in over the first two years of the program.
10. Wherever feasible, Australian supported programs (such as programs on decentralisation and on water and sanitation) will be co-located in the same provinces and districts to achieve synergies and reduce government transaction costs.
11. The program design anticipates the support of a central management facility in Jakarta. Each province will also have a support and administration facility co-located within Bappeda or the Provincial Health Office and district coordinators based in each supported district. The remaining districts in each province will have access to a small budget that would enable them to participate in learning activities, a key factor in encouraging replication of successful demonstration activities.
12. It is anticipated that DFAT will go to market to identify a managing contractor to lead the implementation of the program in June 2014. Given the size and reach of the program a consortium of organisations will likely be needed to meet the scope of services.
13. Contacts: Danielle Sever at danielle.sever@dfat.gov.au +62 812 1240852

Related information

• Concept note for the Maternal and Newborn Health and Nutrition Program, Indonesia