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1 Introduction
This report is the fifth Six Monthly Report for the Australian Indonesia Partnership for Health System Strengthening AIPHSS. It covers the period from the beginning of January 2015 until the end of
June 2015.
The structure of reporting has changed during this period to provide a focus on End of Program Outcomes EOPOs
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and contributing intermediate outcomes. A revised program logic model was developed by key stakeholders in February 2015 and five revised end-of-program outcomes were
agreed with the Department of Foreign Affairs and Trade DFAT Health team. This led to a revision of the interim Monitoring and Evaluation Plan April, 2015 and changes to the performance
framework. The program reporting now reports progress against these revised end-of-program outcomes which is discussed in Section 3.
This period also reflects the implementation of the new “Reform Agenda for Health System Strengthening” finalised during the last reporting period and emanating from the Independent
Progress Review IPR conducted in the first quarter of 2014. This process adopts a systemic approach to health systems reform focussing on four components or “health system building blocks”:
1 Leadership and Governance; 2 Health Financing; 3 Human Resources for Health; and 4 Service Delivery. Work plans implemented by Implementing Units IUs for this period use this
building block structure for reporting on activities and outputs.
Given these recent changes, the introduction section of this report provides an updated summary on the background to AIPHSS, the Reform Agenda RA, and the current Program Framework. This
illustrates how the implementation framework, which is based on the Reform Agenda and health system building blocks, is used to deliver the end-of-program outcomes in support of the broader
program goals see program conceptual framework p.6 below.
Section 2 provides a more detailed analysis of the relevance of the program in relation to the current Australian government aid policy. It explores the political economy, key contextual factors and the
expected benefits of the investment.
Section 3 provides a summary of progress towards end-of-program outcomes. This is a synthesis of the program’s contribution to each of the outcomes through an analysis of major activities and outputs
facilitated by AIPHSS.
Section 4 describes current implementation processes, challenges and emerging risks, as well as progress against the Annual Implementation Plan including planned versus actual expenditure.
Section 5 provides an evaluative summary of the program against the Aid Quality Criteria, including cross cutting issues such as gender and social inclusion.
Section 6 outlines priorities for the next period and recommended improvements to program implementation.
1.1 Background to AIPHSS
AIPHSS commenced in December 2012 and is jointly undertaken by the Governments of Indonesia GoI and Australia GoA to support the development and implementation of health sector reforms
and health systems strengthening.
The ultima te goal of the program is “to improve the health status of poor and disadvantaged people of
Indonesia”. The program focuses on improving access to better quality health care services, including public health. It does this by reducing financial barriers to accessing quality health care and
strengthening governance and systems that facilitate improved local health service delivery. Across the health system it focuses on four areas: 1 governance, with a specific focus on improving health
5 Previous reports focused on Health Systems Building Blocks and the five program objectives.
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policy, influencing behavioural change through the development and implementation of regulation, and the use of information for evidence based decisions; 2 financing and equitable access and
distribution of resources; 3 improving the skills and distribution of the health workforce; and 4 providing quality health service delivery to obligatory minimum standards.
AIPHSS approach to health system strengthening. is guided by the GoI Ministry of Health MoH which has identified interventions that are designed to strengthen institutional, organisational and individual
performance, and address bottlenecks in health policy , system weaknesses in human resources, health financing , governance and health service delivery. Interventions are selected from an analysis of health
system gaps which have been identified in the Reform Agenda and the Health Sector Review HSR. This approach involves multiple stakeholders, including, ministries, departments and professionals to
identify gaps and to reach agreement on interventions and priorities.
AIPHSS has adopted a flexible and adaptive management approach. Some AIPHSS interventions are modified to adapt to changing circumstances or to the local provincial and district environment.
Interventions are also added at any time to the program when perceived gaps or needs are identified by partners. This responsive approach provides the MoH with rapid access to technical and financial
resources during shifts in policy which planning and budgeting GoI systems do not permit. This approach is a key factor in strengthening the partnership between the Government of Australia and
the Government of Indonesia.
The Implementing Service Provider ISP, Coffey International Development Coffey, sources technical expertise for the MoH and provides management support for the implementation of partner
selected interventions. These technical experts work in partnership with the MoH to identify and respond to key health policy and systems gaps. Interventions are selected by partners based on
partner experience of the health system weaknesses and the changes required alongside available evidence. These technical experts also assist with the development of evidence, advocacy and
implementation of policy and strategic plans.
The main MoH Departments supported by AIPHSS include: 1. Bureau of Planning and Budgeting Roren for governance;
2. The Pusat Pembiyaan dan Jaminan Kesehatan PPJK for health financing; 3. The Centre for Human Resource Development PPSDMK;
4. MoH Directorate for Development Standards BUKD; and 5. Bureau of Law and Organisation
AIPHSS is also supporting activities implemented through the Ministry of Planning and Development ’s
BAPPENAS Health and Nutrition Department. The program also collaborates with the other DFAT funded program such as the, Australian
Indonesian Partnership for Maternal Neonatal and Child Health AIPMNH, the Knowledge Sector Initiative KSI and the health team from the Poverty Reduction and Social Protection Program
TNP2K as well as the Governance Reform Partnership Reform the Reformers.
AIPHSS works with eight district level governments in two provinces which have a high poverty incidence as well areas that have been socially excluded due to ethnicity. These are: Situbondo,
Bondowoso, Sampang and Bangkalan in East Java Province; and Timor Tengah Utara TTU, Flores Timur Flotim, Ngada and Sumba Barat Daya SBD in East Nusa Tenggara Province NTT.
AIPHSS is scheduled to end on 30 June 2016.
1.2 The AIPHSS Reform Agenda for Health System Strengthening
