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Ensuring Access to Health-ServicesFor example: Health Care in NTT and HIV-Prevention/Family PlanningImprovement of the Health Care Deliv-ery System in NTTThe health care system in Indonesia and especiallyin NTT does not offer satisfactorybasic hospital services to the population. Thedeficits are evident: poor hospital equipment,poor staff motivation and low quality of theservices.The government of Indonesia (GoI) requestedFinancial Cooperation (FC) to improve thehealth delivery system in Nusa TenggaraTimur (NTT), and the project “Improvementof the Health Care Delivery System in NTT”was initiated in 1999.Additionally, a project for Technical Cooperationwas initiated in the health sector in theNTT Province. Based on the result of a feasibilitystudy and proposals of the Indonesianpartners, the FC and TC project componentswere defined as a combined project involvingboth KfW, responsible for Financial Cooperation,and GTZ, responsible for TechnicalCooperation. The objective of this combinedproject is to improve the district healthsystem and the use of district health facilitiesby the population.Improvement of the district health system isplanned through: improvement of the infrastructure of 12district hospitals and one provincial hospital(construction and equipment andthe respective engineering services), improvement of the hospital maintenancesystem improvement of hospital management, support for health care planning authoritiesat provincial and district levels, and support for training institutions in thehealth sector.The project concept corresponds to the currentefforts of the GoI to decentralize healthservice delivery and to develop public hospitalsinto pro-active and autonomous healthservice units. Prior to the delivery of theequipment to the 13 hospitals, business planswill be elaborated for each hospital in participatoryworkshops. This approach is expectedto reflect the Indonesian prioritiesand to ensure the sustainability of the investment.The physical improvement, theprocurement procedures and the maintenanceconcept of the district hospitals shallbe based on these business plans. A supervisorybody consisting of representatives ofthe respective hospital management and thelocal government shall monitor the hospitalfunctions and its advisory activities.The Technical Cooperation project component(SISKES) concentrates on improving thedecentralized health system as a whole,8 Indonesian – German Development Cooperation
which includes the hospital care. SISKESworks in two districts of NTT, Alor and EastSumba, and follows a systems approach. Itprovides advice on appropriate policies forhealth sector reforms. SISKES focuses onre-orienting the services to the needs of thepopulation. Training of health staff in cooperationwith Bapelkes (provincial traininginstitution for health personnel) is also amajor component of this project. Moreover,the project aims at involving communities inthe health planning.HIV Prevention Measures and FamilyPlanning.High fertility, especially when it is unwanted,is a major cause of poverty. Family planning,as UNICEF notes, could “bring more benefitsto people at less cost than any other singletechnology now available to the human race”.The unmet need for family planning servicesis very high. It is estimated that a considerablepercentage of couples do not want achild, now or ever, yet modern contraceptivemethods are unavailable or inaccessible.Population programs must ensure access toquality family planning products and servicesfor everybody.Indonesia is still a low-prevalence countrywith regard to HIV infections. Recently, veryhigh infections rates have been detected insome small groups of the population (prostitutes,drug users, etc.), which is typical forthe development of the epidemic. If this remainsuncontrolled and if the country will beunprepared, the epidemic will spread to thepopulation at large. In this early stage improvementof the general attitude to protectionis essential.techniques are used as an appropriate instrumentto change attitudes and to give familyplanning and HIV prevention a better image.Using specific instruments and informationchannels, the programme can focus on thetarget groups (high-risk groups, poor strataof the population). Private-sector networksare used to ensure low cost delivery of familyplanning products. Subsidies make theproducts affordable for the poor. Given thehuge numbers of contraceptives provided andthe relatively cheap retailer system, the subsidiesare surprisingly low.The Indonesian Social Marketing Projectof the foundation DKT International began in1996 and was supported by a financial contributionfrom the German government underthe “HIV Prevention MeasuresProgramme”. In 2000 a new family planningand HIV prevention programme waslaunched and DKT Indonesia was chargedwith its implementation. Additional fundingof this project is envisaged.The programme delivers a range of contraceptives– condoms, oral contraceptives andinjectables. Condoms, still a key methodsunder the programme, are promoted bothfor disease prevention and for family planning.During 2000, the programme sold 27.6million condoms, nearly 1 million cycles oforal contraceptive and 936,000 injectables.Thus 5.7 million couples got protection, 1.4million unwanted births have been averted,114,000 maternal and infant deaths and also7,800 cases of HIV infection have been prevented.The family planning and HIV preventionprogramme financed by the German governmentthrough KfW aims to improve the accessof couples, especially low-income andhigh-risk groups, to reliable and affordablecontraceptives and HIV protection methods.A social marketing strategy was chosen toreach this goal. Contraceptives are usuallydistributed by the private sector at full costor by the public sector for free, which isoften inefficient. Social marketing combinesthe advantages of both channels: the efficiencyof market solutions with the support for thepoor through subsidies. Modern marketingIndonesian – German Development Cooperation 9
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Page 19 and 20: Friedrich- Naumann- StiftungThe Fri
Page 21 and 22: Katholische Zentralstelle fürEntwi
Page 23 and 24: Kedutaan Besar JermanJakartaKerja S
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Page 41 and 42: Yayasan Friedrich Nauman (FNS)Yayas
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