Evaluation of the comprehensive health improvement program - province specific, October 1987

Evaluation covers the period 1981-10/87. Progress has been made in improving provincial health staffs" capabilities in problem identification and epidemiology, and this process is being institutionalized by providing complementary training for staff at the district and health center levels. More needs to be done in the areas of non-disease specific problem analysis, planning, and monitoring, however. Some progress towards decentralization has been made in Aceh and West Sumatra provinces, but the district-level has not yet been involved; the Government of Indonesia (GOI) needs to allow greater financial flexibility if decentralization is to proceed. Other findings include: (1) project activities have supported GOI health objectives; (2) the project has had an impact on community health and has worked closely with community groups; (3) institutionalization has progressed fastest in the area of personnel skills, followed by the generation of local financial resources; the least progress has been made with "system" changes; and (4) the three provinces involved in the project have been preparing to meet national objectives in decentralization, use of national resources, child survival, and quality of life under the GOI"s next five-year plan. Despite this progress, however, the gains made to date remain fragile. Over 30 specific recommendations were made by the evaluation team, which suggested that priority should be placed on consolidating the gains made by extending them more widely throughout each province and finding ways to sustain the new practices financially and institutionally. The GOI should make appropriate changes in financing and accounting, encourage provincial initiatives by measuring success in terms of outputs (not inputs), strengthen the managerial capabilities of provincial health staffs, and examine the cost-effectiveness of project activities. (Author abstract, modified)