Selanjutnya
MEMORANDUM OF UNDERSTANDING
BETWEEN
THE MINISTRY OF HEALTH OF THE REPUBLIC OF INDONESIA
AND
PROGRAM FOR APPROPRIATE TECHNOLOGY IN HEALTH
CONCERNING
COOPERATION TO IMPROVE HEALTH IN INDONESIA
The Ministry of Health of the Republic of Indonesia, hereinafter referred to as "MOH" and Program
for Appropriate Technology in Health, hereinafter referred to as " PATH", a non governmental
organization. non-sectarian, non political and non-profit organization, both of them hereinafter
ref erred to as the "Parties":
CONSIDERING their common interest in the improving health in lndonesi.a through better health
technology, i0.proved health delivery systems, and more active participation of the population in
improving health; and
PURSUANT to the prevailing laws and regulations in Indonesia, as well as the procedures and
policies of the Government of the Republic of Indonesia concerning international technical
cooperation:
HAVE AGREED AS FOLLOWS:
ARTICLE 1
OBJECTIVES OF COOPERATION
General Objective: To improve health in Indonesia, especially the health of women and children.
Specific Objectives:
1. To assist the Government of Indonesia in improving its immunization program by introducing,
testing. and implementing improved technology, and by assisting in the design and
impiementation of activities to improve immunization coverage, safety and efficiency.
2. To design, implement and evaluate activities to improve the health knowledge, attitudes and
behaviors of health providers, communities, and individuals in order to achieve better health in
Indonesia.
3. To assist in strengthening Indonesia's capacity to meet its health challenges through technical
training, training in management, widespread sharing of technical health information,
supporting health networks, and other appropriate activities.
4. To implement other projects and activities in support of health in Indonesia, within PATH's
capabilities.
5. To maintain and strengthen _partnerships and collaborative relationships with the Government
of Indonesia, with national and international health Non Government Organizations, and with
the private sector to improve health in Indonesia.
ARTICLE 2
AREA OF COOPERATION
MOH and PATH shall cooperate to carry out health programs in Indonesia with emphasis on
improving health technology, enabling health behavior change, and strengthening Indonesia's
capacity to meet health challenges.
ARTICLE 3
PROGRAM DIRECTION AND PLAN OF OPERATION
1. A detailed mechanism of this cooperation is defined in the Program Direction, which is set out
in the Annex and constitutes an integral part of this Memorandum of Understanding. This
includss a statement of PATH's basic interests in Indonesia, a description of current activities,
and a plan for activities for 2003-2008.
2. The Program Direction and The Plan of Operation shall be drawn up and agreed upon by both
Parties, and approved by the State Secretariat of the Republic of Indonesia.
ARTICLE 4
RESPONSIBILITIES
On the implementation of this cooperation,
A. MOH shall:
1. Provide direction in the planning, implementation and evaluation of the programs in health
through strengthening governmental, non-governmental, and community capacities. The
implementation of cooperation will be coordinated by the Secretary General of the Ministry of
Health in consultation with the Director General, Community Health and the Director General,
Control of Communicable Diseases and Environmental Health; and National Institute for Health
Research and Development.
2. Assist in coordinating the implementation of the program with Provincial and District Health
Offices;
3. Provide the health personnel and facilities as required for the implementation of cooperation;
4. Assist in arranging the required permits to enter and leave the country whenever necessary, as
well as working and stay permits and other relevant documents as needed for expatriate staff
and experts assigned by PATH and mutually agreed upon by MOH to assist in the
implementation of the Program, and for their family members;
5. Assist in arranging the exemption of taxes on. income for approved PATH expatriate staff and
expe0s, exemplion of import duties on personal household effects, and exemption from
taxation when they leave Indonesia;
6. Assist in arranging the exemption from Value Added Tax (VAT), as well as duty-free import of
equipment. medical material, supplies and locally purchased vehicles for official purposes of
PATH or the MOH as mutually agreed upon by PATH and the MOH.
2
B. PATH shall:
1. Cooperate with MOH in the planning, implementation, evaluation and monitoring of its health
programs;
2. Plan, organize, implement, and evaluate, in cooperation with MOH, projects mutually agreed
between the Parties;
3. Provide funds and necessary equipment as well as technical assistance for program
implementation as agreed between the Parties;
4. Assign qualified staff and experts, in consultation with MOH, to assist in the implementation of
the activities under this cooperation;
5. Assist in analysis, publication and dissemination of study and program results, as well as in the
preparation of reports, article for professional journals, papers for relevant cont erences, and
publications and manuals as needed;
6. Assist in coordinating activities and resources with other international and local agencies
involved with the programs described in the Memorandum of Understanding.
ARTICLE 5
RESEARCH AND SURVEY
MOH and PATH shall conduct any research or surveys necessary for the implementation of this
IV1emoran1jum of Understanding together, with the involvement of other relevant institutions. Any
intellectual property rights resulting from research and survey activities conducted under this
Memorandum of Understanding shall be arranged as stated in Article 6.
ARTICLE 6
INTELLECTUAL PROPERTY RIGHT, RESULTS AND PUBLICATIONS
1. Any Intellectual Property Right brought by one of the Parties for the implementation of the
cooperative activities under ·this Memorandum of Understanding shall remain the property of
that Party. However, that Party shall indemnify that the intellectual property right is not the
result of the infringement of any third party's legitimate rights. Further, that Party shall be liable
for any claim made by any third party on the ownership and legality of the use of the
intellectual property right which is brought in by the aforementioned Party for the
implementation of the cooperative activities under this Memorandum of Understanding;
2. Any Intellectual Property Right, data and information resulting from research and survey
activities conducted under tbis Memorandum of Understanding shall-be jointly owned by both
Parties, and both Parties shall be allowed to use such property for non-commercial purposes
free of royalty.
3
Should the intellectual property right, data and information resulted from the cooperative
activities under this Memorandum of Understanding be used for commercial purposes by one
Party, the other Party shall be entitled to the royalties obtained from the exploitation of such
property on the basis of the principle of equitable contribution. In such case, the object of the
research activities conducted under this Memorandum of Understanding shall constitute a part
of the contribution of the Party from which the object derives. The Value of the object as part of
contribution will be measured by taking into account the fallowing factors:
•
the scarcity of object (the rarer the objects is, the higher its value will be);
•
the commercial values of the result of the research or survey (the higher its commercial
values are, the higher the value of the object as part of the contribution will be);
3. If either Party i,visbes to disclose confidential data and/or information resu!ting from the
cooperative activities under this Memorandum of Understanding to any third party, the
disclosing party must obtain prior written consent from the other Party before any disclosure
can be made;
4. Whenever either Party requires the cooperation of another party outside Indonesia for any
commercial undertaking resulting from intellectual property covered by this Memorandum of
Understanding, this Party will give first preference for the cooperation to the other Party under
this Memorandum of Understanding, which will be waived, if the other Party is unable to
participate in a mutually beneficial manner;
5. Termination of this Memorandum of Understanding shall not affect rights and/or obligations
under this Article during the first ten (10) years after such termination.
ARTICLE 7
LIMITATION OF PERSONNEL ACTIVITIES
PATH ensures that its personnel engaged in the programs under this Memorandum of
Understanding shall not engage in political affairs and any commercial ventures or activities in
Indonesia outside the program of cooperation under this Memorandum of Understanding, without
the prior approval of the Government of the Republic of Indonesia through the State Secretariat of
the Republic of Indonesia.
ARTICLE 8
SETILEMENT OF DIFFERENCES
Any differences arising out of the interpretation or implementation of this Memorandum of
Understanding shall be settled amicably through mutual consultation or negotiation between the
Parties.
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ARTICLE 9
AMENDMENT
This Memorandum of Understanding can be reviewed or amended at any time by mutual written
consent by the Parties. Such revision or amendment shall enter into force on such date as will be
determined by the Parties, and it shall be formed an integral part of this Memorandum of
Understanding.
ARTICLE 10
FINAL PROVISIONS
1. This Memorandum of Understanding shall enter into force from the date of its signing;
2. This Memorandum of Understanding shall remain .in force for a period of 5 years, with the
possibility of further extension as agreed by both parties.
3. This Memorandum of Understanding may be prolonged or terminated by either Party with
written notice to the other Party at least 3 (three) months in advance or by mutual consent of
the Parties. In case the Memorandum of Understanding ceases to be in effect on account of
termination thereof, _the provisions of the Plan of Operation and Annual Program Plan shall
continue to apply to the extent necessary to secure the completion of existing activities as
agreed upon in the Plan of Operation and Annual Program Plan.
IN WITNESS WHEREOF, the undersigned, have signed this Memorandum of Understanding.
DONE in Jakarta on 25 March 2004 in two originals in English language, both of the text being
equally authentic.
··
1"
FOR
THE MINISTRY OF HEALTH OF
THE REPUBLIC OF INDONESIA
Dr. Dadi S. Argadiredja. MPH
Secretary Gerieral
ｾ＠
FOR
PROGRAM FOR APPROPRIATE
TECHNOLOGY IN HEALTH
ｾ｣Ｍｦｬ＠
｣ｾ＠
Christopher J. Elias. M.D., M.P.H.
President
5
-·
'
ｾＭ
'
.. ｾ＠
""',,,...:·,r"
ANNEX:
PROGRAM DIRECTION
I. General Objective
The worldwide mission of the Program for Appropriate Technology in Health {PATH) is to
improve health of people around the world by advancing technologies, strengthening
systems, and encouraging healthy behaviors. Founded in 1977 and maintaining a
presence in lnrjonesla since 1981, PATH identifies, develops, and applies appropriate and
innovative solutions to public health problems, particularly in low-resource settings. PATH
shares knowledge, skills, and technologies with governmental and non-governmental
partners and with groups in need.
Core Themes:
1. lmprovina immunization technology and svstems
For many years, PATH has worked in partnership with the Government of Indonesia
{GOI) to make appropriate vaccines and immunizations available to all infants and
children. For example, since 1987, PATH has worked successfully with GOI to make
Hepatitis B vaccine an essential part of its immunization system (Indonesia thereby
becoming the first country to do so), and to make a birth dose available to block
vertical transmission from mother to child. PATH has also helped P.T. Bio Farma
become the first pharmaceutical company to produce immunizations in Uniject™, a
PATH-developed syringe technology, both for domestic use and for export.
Now, through its Children's Vaccine Program (CVP) and its linkage with the Global
Alliance for Vaccines and Immunizations (GAVI), PATH is able to provide broad,
sustained support for Indonesia's 5 Year Plan for Immunization Services for 2002·
2006. PATH has a small technical support unit for immunization in Jakarta,
supplemented by a unique high-level technical capability at its headquarters and other
offices.
2. Enabling Behavior Change
Behavior change is an inescapable component of technology introduction, as well as
being an integral part of the overall public health agenda. PATH has extensive
experience in utilizing mass media, social mobilization techniques, interpersonal
communication, and other techniques to convince people to adopt healthier behavior.
At present, PATH is involved in behavioral change in three projects in Indonesia:
• In Lombok, behavior change techniques have helped convince parents of
pneumonia-sick babies to seek appropriate medical care.
• Within the Maternal and Neonatal Health project, PATH is seconding 9 staff
members to support the social mobilization component.
• To improve Maternal Child Health (MCH) care through behavior change at multiple
levels, PATH is implementing the ASUH (Healthy Start for a Healthy Life) project
in West Java and East Java. A key part of this project involves ensuring that birth
visits by Bidan di Desa take place, in part to allow for the birth dose of Hepatitis B
vaccine.
6
To implement these activities, PATH supports a staff of several mid- to senior-level
Indonesian specialists. This expertise is supplemented by a substantial body of
international expertise, both in its US offices and in other developing countries.
3. Strengthening Indonesia's Caoacitv to Meet Health Challenaes
PATH has been involved in capacity strengthening in Indonesia throughout its
presence here, although for the most part it has been more in the form of project
components than of independent projects or activities. During the period of this plan,
PATH intends to focus on capacity building as a core theme. In addition to focusing on
the capacity building aspects of targeted health projects, PATH will seek to mobilize
additional funds especially dedicated to capacity building in Indonesia.
Three particular issues in capacity building will occupy priority attention for PATH:
• Sharing up-to-date health information within the professional health community.
• Supporting district-level capabilities in health management, leadership, and
utilization of information for decision making.
• Strengthening the leadership capabilities of health professionals.
These three core themes will be implemented through a variety of types of health
projects, as indicated below. To carry out these projects, PATH intends to maintain its
main office in Jakarta and at least two field offices elsewhere in Indonesia throughout
the period of this plan. It will maintain a size and configuration of staff appropriate to its
project portfolio, concentrating on the enhancement of high-quality capabilities among
its Indonesian staff.
II. Mechanism of Cooperation
2.1. Major Current Activities
At present, PATH has three major ongoing projects in Indonesia, and one additional
area of activity that is expected to take on project configuration in 2003. Its main office
is in Jakarta, with local offices in Lombok, Bandung, Surabaya, and 8 districts in West
Java and East Java. The total PATH staff as of June 2003 was 75, of whom 72 are
Indonesian and 3 are expatriates.
Immunization support
PATH continues to assist the MOH in implementing its immunization program. Through
its CVP (Children's Vaccine Program, funded by the Bill and Melinda Gates
Foundation), PATH is a key member of GAVI (Global Alliance for Vaccines and
Immunizations, also substantially funded by Gates), which has allocated US$40 million
in support of Indonesia's immunization program from 2002-2006. With financial and
technical support from CVP and use of its own staff, PATH Indonesia has been working
in close partnership with the Immunization Department of MOH and WHO to access the
GAVI funding and to use that funding to implement its programs. In particular, in recent
months PATH:
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•
•
•
Has assisted GOi in preparing its 5 Year Plan for Immunization Services for
2002·2006.
Has assisted GOI in submitting (successfully) its application for GAVI support for
the birth dose of Hepatitis B vaccine.
Is assisting GOI in preparing its application for GAVI support for immunization
safety.
PATH is particularly focused on supporting the birth dose of Hepatitis B in Uniject™
syringes, and on improving management of the cold chain, and is currently completing
studies on these topics.
Haemophilus lnfluenzae Type b Study
PATH is working with the National Institute for Health Research and Development and
the Provincial Health Service NTB, with Sadan Pengawas Obat dan Makanan, with
Association Pour l'Aide a la Medicine Preventive, and with other partners to implement
a major study of Haemophilus influenzae type b bacteria as a cause of infant
pneumonia and meningitis on Lombok island. This study is primarily funded by the
Gates Foundation through CVP and by Aventis Pasteur. The study, which began in
September 1998, is mainly intended to determine the proportion of severe childhood
pneumonia cases that are caused by Haemoph1lus influenzae type b, in order to better
judge the priority to be assigned to introduction of Haemophilus influenzae type b
vaccine into the routine immunization program of Indonesia in the future. Fieldwork for
the study is currently expected to be completed at the end gf 2002, and the basic
results known in 2003.
Awai Sehat-untuk Hidup Sehat
In partnership with the Directorate of Family Health, MOH and appropriate local Health
Departments, PATH is implementing the ASUH (Awai Sehat untuk Hidup Sehat)
project in eight districts of West Java and East Java provinces. This project, building on
previous PATH work in NTB and Bali provinces which introduced the early postpartum
home (KN1) visit by the Bidan di Desa and the birth dose of Hepatitis B vaccine, is
intended to improve maternal and child health in West and East Java in the context of
decentralization. Utilizing a variety of approaches to behavior change, the project aims
to improve the capacity of the health system, the communities, and families to work
together to improve health. A particular focus is to strengthen the Bidan di Desa's
willingness to make the KN1 visit and improve the content of the visit, and thereby to
increase the proportion of newborns immunized with Hepatitis B vaccine.
This project is funded by USAID's Indonesia mission under a cooperative agreement.
· · Funding began in 2000 and is assured through September 2003, with a possibility for
an additional two years of support.
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Support for Social Mobilization in the Maternal and Neonatal Health Project
Through a sub agreement with the Johns Hopkins Program for Information and
Education in Gynecology and Obstetrics (JHPIEGO), PATH is providing technical
assistance and other support for the social mobilization component of the MNH
{Maternal and Neonatal Health) Project. For this purpose, PATH seconds staff to the
MNH project, and provides funding support for social mobilization activities. This
support has two main components: first, the establishment of the 55 Desa Siaga
activity in three districts of West Java province to make communities and families
aware of the need to be prepared for emergencies during pregnancy and childbirth;
and second, to establish and support an Alliansi Pita Putih of organizations within the
civil society of Indonesia to support safe ·motherhood.
Ti·ie overall MNH project is a centrc.!ly funded USA!D Project. PATH's support, which
began in 1999, will continue in the field until September 2003, with some additional
closure activities until March 2004.
2.2. Future Activities, 2003-2007
PATH fully expects to remain active in support of health in Indonesia in the coming 5
years, as it has been over !he past 20 years. It expects continued funding from its two
major current donors, the BBi and tvielinda Gates Foundation, and USAID. At the same
time, PATH will seek funding from other donors for a broadened portfolio of activities.
PATH is capable of supporting a range of health interventions in Indonesia through its
expertise at headquarters and in its 19 offices in 11 countries around the world. This
international expertise is grouped in nine strategic program areas:
•
•
•
•
•
•
•
•
•
Technology Solutions
MCH/Nutrition
Reproductive Health·
HIV and AIDS
Adolescent Health
Gender, Violence, and Rights
Children's Vaccine Program
Malaria Vaccine Initiative
Meningitis Vaccine Program
The first six of these incorporate a variety of individual projects, some of which can and
do provide financial and/or technical support for activities in Indonesia. Over the period
of this plan, most new project activities are expected to come from these areas.
The latter three strategic programs are large individual projects. Of these, the
Children's Vaccine Program, which supports PATH's immunization work, is expected
to remain the most important for Indonesia during this plan period.
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Core Themes:
1. lmprovin_g immunization technology and systems
PATH will continue to build on its history of supporting the availability and utilization of
improved technology in vaccines and immunizations in Indonesia. Utilizing funds from
its Children's Vaccine Program (CVP} and other sources, PATH will support selected
aspects of the Government's 5-year immunization plan.
It is anticipated that starting in 2003 for at least two years, the CVP will provide major
project support for immunization, including a full-time resident advisor, appropriate
supporting staff, and funds for implementing selected activities not supported by GAVI.
Primary focus for this support is expected to include:
Improving immunization technology:
• Testing and introduction of new immunization technologies.
o Completing the introduction of Hepatitis B (in Uniject™) into the routine
immunization system.
o Evaluating the suitability of introducing Haemophilus influenzae type b vaccine
into the routine immunization system.
o Testing and introducing new immunizations when available (e.g.,
pneumococcus, rotavirus).
• Improving the safety of immunizations.
o Supporting increased use of auto-disable syringes in routine immunization.
o Improving the disposal of sharps.
• Improving cold chain management.
• Reducing wastage of vaccines and biological products.
Improving immunization delivery systems:
• Increasing the proportion of visits by trained providers in .the first week after birth
(and therefore increasing first-week immunizations).
• Strengthening the posyandu system as a basis for routine immunization.
• Strengthening the monitoring of coverage and quality.
• Developing and distributing training and information materials for providers.
It is expected that over the period of this plan PATH, through its Technology Solutions
strategic program, will develop new technologies in immunization and other health
areas. As this occurs, PATH will work closely with MOH to evaluate the suitability of
these technologies for Indonesia, and where appropriate to assist in their introduction
to Indonesia. For example, making oxytocin available in Uniject™ can help Indonesia
implement its policy of using oxytocin for management of third stage labor in cases
where the Bidan di Desa attends home deliveries. PATH has conducted a trial
indicating the suitability of lhis approach; it now intends to work with MOH to find ways
to reduce the cost involved in making this technology available.
10
2. Enabling Behavior Change
As its current projects come to an end, PATH intends to apply its expertise in behavior
change in new activities to improve health in Indonesia. As illustrative examples from
current thinking, PATH will seek to develop or support projects in the following areas:
•
•
•
•
•
•
•
•
For immunization, behavior change among providers will be particularly needed to
strengthen immunization safety, to improve management of the cold chain and
reduce wastage, and to improve coverage.
The reluctance off amilies to seek modern health care for sick children needs to be
addressed. In particular, the successes of the Lombok Haemophilus influenzae
type b study in improving health seeking behavior for pneumonia sick children
need to be more widely applied.
More positive interaction among health care providers, communities, and clients is
needed, ｰ｡ｲｴｩ｣ｵｾｬｹ＠
at the district and local levels. PATH will look to build on the
work currently underway in ｾｨ･＠
ASUH project, to continue to improve these
approaches and to implement them throughout Indonesia.
New mechanisms are needed to strengthen community involvement in health. The
community empowerment approaches of the ASUH and MNH projects need to be
integrated, refined, and replicated. New mechanisms need to be found to revitalize
the posyandu system.
The resurgence of tuberculosis and malaria indicate the need for increased
resources and attention. Improved public education and health seeking behavior
will be needed as part of a coordinated approach to dealing with these diseases.
If and when Postinor-2™ (an emergency contraceptive pill) is approved by POM,
PATH is interested in assisting with public education and motivation efforts.
The growing problems of commercial sex and drug addiction in Indonesia is
creating a subculture of persons who pose severe health risks to themselves and
their communities, particularly from HIV/AIDS. A substantial and challenging
behavior change effort is needed to change the risk behaviors of these women
and men, to protect their health and the health of other in contact with them, and
to improve their human rights situation.
Protecting the health of adolescents will require improved approaches to health
education and motivation for behavior change. PATH would like to build on
important previous work accomplished in this area.
3. Strengthening Indonesia's Caoacitv to Meet Health Challenges
PATH's approach will be one of gradual development. PATH will initialize utilize
funding available from existing projects and small amounts of PATH funds to build
expertise and portfolio in this area, so that over time it will be able to attract
substantial, targeted funds for capacity building.
Capacity strengthening activities may include professional training, institutional
capacity strengthening, and strengthening the cohesion of the professional health
community. Two issues for special attention will be leadership development and
information sharing. Key elements of this strategy will include:
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Development of PA TH Indonesia capabilities in c.apacity strengthening. PATH will
initially assign a staff member to coordinate this theme. This p.erson will develop
and maintain information databases, e.g., mailing lists, tra)ring opportunities, ｾｴ｣ＮＬ＠
and do a needs assessment. Existing PATH personnel will increase their attention
to capacity building activities within their spheres. Capacity building within projS?pts
will be focused and rationalized. As funds become available, capacity building
specialists will be hired or reassigned.
• Indonesian language information for health professionals. PATH will initiate a
pro!Jram of preparing (or translating) brief, up-to-date infor.mation for health
professionals, and distributing this to appropriate MOH, NGO and priva.te Ｌｳｾ｣ｴＮｯｲ＠
health professionals.
• Leadership development. .PATH will review leadership development Ｎｲ･ｳｯｾＨ｣＠
and activities in Indonesia, and establish liaison with lea.dership doriQrs
internationally. Selected PATH staff will be sent for international leadersbfp
·training, with the intention of providing in-country leadership training opportunities
in Indonesia.
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• Funding. Once the basic elements are in place and PATH has developed some
track {ecord in lower-cost efforts, we will make a focused ftffort to find substantial,
medium- to long-term funding for an integrated program. of capacity. building for
Indonesia.
•
·111.
Reporting
-PATH shall submit annual reports to MOH, State Secretariat, Ministry of Fpreign Affairs
and relevant authorities covering:
1. Completed and ongoing programs;
2. 'Difficulties and I or problems faced during implementation;
3. Recommendation.
IV.
Evaluation
'Evaluation of Programs shall be carried out as set forth ｢･ｬｯｾＺ＠
1. Program and progress results will be ･ｶ｡ｬｵｴﾫｩ＿､｟ｒＮｳ［ｲｮｾ＠
ann.ually to the MOH,
State Secretariat and Ministry of Foreign Affairs;
2. The MOH can make an additional evaluation of the PA"i.:H programs as it sees fit.
12
BETWEEN
THE MINISTRY OF HEALTH OF THE REPUBLIC OF INDONESIA
AND
PROGRAM FOR APPROPRIATE TECHNOLOGY IN HEALTH
CONCERNING
COOPERATION TO IMPROVE HEALTH IN INDONESIA
The Ministry of Health of the Republic of Indonesia, hereinafter referred to as "MOH" and Program
for Appropriate Technology in Health, hereinafter referred to as " PATH", a non governmental
organization. non-sectarian, non political and non-profit organization, both of them hereinafter
ref erred to as the "Parties":
CONSIDERING their common interest in the improving health in lndonesi.a through better health
technology, i0.proved health delivery systems, and more active participation of the population in
improving health; and
PURSUANT to the prevailing laws and regulations in Indonesia, as well as the procedures and
policies of the Government of the Republic of Indonesia concerning international technical
cooperation:
HAVE AGREED AS FOLLOWS:
ARTICLE 1
OBJECTIVES OF COOPERATION
General Objective: To improve health in Indonesia, especially the health of women and children.
Specific Objectives:
1. To assist the Government of Indonesia in improving its immunization program by introducing,
testing. and implementing improved technology, and by assisting in the design and
impiementation of activities to improve immunization coverage, safety and efficiency.
2. To design, implement and evaluate activities to improve the health knowledge, attitudes and
behaviors of health providers, communities, and individuals in order to achieve better health in
Indonesia.
3. To assist in strengthening Indonesia's capacity to meet its health challenges through technical
training, training in management, widespread sharing of technical health information,
supporting health networks, and other appropriate activities.
4. To implement other projects and activities in support of health in Indonesia, within PATH's
capabilities.
5. To maintain and strengthen _partnerships and collaborative relationships with the Government
of Indonesia, with national and international health Non Government Organizations, and with
the private sector to improve health in Indonesia.
ARTICLE 2
AREA OF COOPERATION
MOH and PATH shall cooperate to carry out health programs in Indonesia with emphasis on
improving health technology, enabling health behavior change, and strengthening Indonesia's
capacity to meet health challenges.
ARTICLE 3
PROGRAM DIRECTION AND PLAN OF OPERATION
1. A detailed mechanism of this cooperation is defined in the Program Direction, which is set out
in the Annex and constitutes an integral part of this Memorandum of Understanding. This
includss a statement of PATH's basic interests in Indonesia, a description of current activities,
and a plan for activities for 2003-2008.
2. The Program Direction and The Plan of Operation shall be drawn up and agreed upon by both
Parties, and approved by the State Secretariat of the Republic of Indonesia.
ARTICLE 4
RESPONSIBILITIES
On the implementation of this cooperation,
A. MOH shall:
1. Provide direction in the planning, implementation and evaluation of the programs in health
through strengthening governmental, non-governmental, and community capacities. The
implementation of cooperation will be coordinated by the Secretary General of the Ministry of
Health in consultation with the Director General, Community Health and the Director General,
Control of Communicable Diseases and Environmental Health; and National Institute for Health
Research and Development.
2. Assist in coordinating the implementation of the program with Provincial and District Health
Offices;
3. Provide the health personnel and facilities as required for the implementation of cooperation;
4. Assist in arranging the required permits to enter and leave the country whenever necessary, as
well as working and stay permits and other relevant documents as needed for expatriate staff
and experts assigned by PATH and mutually agreed upon by MOH to assist in the
implementation of the Program, and for their family members;
5. Assist in arranging the exemption of taxes on. income for approved PATH expatriate staff and
expe0s, exemplion of import duties on personal household effects, and exemption from
taxation when they leave Indonesia;
6. Assist in arranging the exemption from Value Added Tax (VAT), as well as duty-free import of
equipment. medical material, supplies and locally purchased vehicles for official purposes of
PATH or the MOH as mutually agreed upon by PATH and the MOH.
2
B. PATH shall:
1. Cooperate with MOH in the planning, implementation, evaluation and monitoring of its health
programs;
2. Plan, organize, implement, and evaluate, in cooperation with MOH, projects mutually agreed
between the Parties;
3. Provide funds and necessary equipment as well as technical assistance for program
implementation as agreed between the Parties;
4. Assign qualified staff and experts, in consultation with MOH, to assist in the implementation of
the activities under this cooperation;
5. Assist in analysis, publication and dissemination of study and program results, as well as in the
preparation of reports, article for professional journals, papers for relevant cont erences, and
publications and manuals as needed;
6. Assist in coordinating activities and resources with other international and local agencies
involved with the programs described in the Memorandum of Understanding.
ARTICLE 5
RESEARCH AND SURVEY
MOH and PATH shall conduct any research or surveys necessary for the implementation of this
IV1emoran1jum of Understanding together, with the involvement of other relevant institutions. Any
intellectual property rights resulting from research and survey activities conducted under this
Memorandum of Understanding shall be arranged as stated in Article 6.
ARTICLE 6
INTELLECTUAL PROPERTY RIGHT, RESULTS AND PUBLICATIONS
1. Any Intellectual Property Right brought by one of the Parties for the implementation of the
cooperative activities under ·this Memorandum of Understanding shall remain the property of
that Party. However, that Party shall indemnify that the intellectual property right is not the
result of the infringement of any third party's legitimate rights. Further, that Party shall be liable
for any claim made by any third party on the ownership and legality of the use of the
intellectual property right which is brought in by the aforementioned Party for the
implementation of the cooperative activities under this Memorandum of Understanding;
2. Any Intellectual Property Right, data and information resulting from research and survey
activities conducted under tbis Memorandum of Understanding shall-be jointly owned by both
Parties, and both Parties shall be allowed to use such property for non-commercial purposes
free of royalty.
3
Should the intellectual property right, data and information resulted from the cooperative
activities under this Memorandum of Understanding be used for commercial purposes by one
Party, the other Party shall be entitled to the royalties obtained from the exploitation of such
property on the basis of the principle of equitable contribution. In such case, the object of the
research activities conducted under this Memorandum of Understanding shall constitute a part
of the contribution of the Party from which the object derives. The Value of the object as part of
contribution will be measured by taking into account the fallowing factors:
•
the scarcity of object (the rarer the objects is, the higher its value will be);
•
the commercial values of the result of the research or survey (the higher its commercial
values are, the higher the value of the object as part of the contribution will be);
3. If either Party i,visbes to disclose confidential data and/or information resu!ting from the
cooperative activities under this Memorandum of Understanding to any third party, the
disclosing party must obtain prior written consent from the other Party before any disclosure
can be made;
4. Whenever either Party requires the cooperation of another party outside Indonesia for any
commercial undertaking resulting from intellectual property covered by this Memorandum of
Understanding, this Party will give first preference for the cooperation to the other Party under
this Memorandum of Understanding, which will be waived, if the other Party is unable to
participate in a mutually beneficial manner;
5. Termination of this Memorandum of Understanding shall not affect rights and/or obligations
under this Article during the first ten (10) years after such termination.
ARTICLE 7
LIMITATION OF PERSONNEL ACTIVITIES
PATH ensures that its personnel engaged in the programs under this Memorandum of
Understanding shall not engage in political affairs and any commercial ventures or activities in
Indonesia outside the program of cooperation under this Memorandum of Understanding, without
the prior approval of the Government of the Republic of Indonesia through the State Secretariat of
the Republic of Indonesia.
ARTICLE 8
SETILEMENT OF DIFFERENCES
Any differences arising out of the interpretation or implementation of this Memorandum of
Understanding shall be settled amicably through mutual consultation or negotiation between the
Parties.
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ARTICLE 9
AMENDMENT
This Memorandum of Understanding can be reviewed or amended at any time by mutual written
consent by the Parties. Such revision or amendment shall enter into force on such date as will be
determined by the Parties, and it shall be formed an integral part of this Memorandum of
Understanding.
ARTICLE 10
FINAL PROVISIONS
1. This Memorandum of Understanding shall enter into force from the date of its signing;
2. This Memorandum of Understanding shall remain .in force for a period of 5 years, with the
possibility of further extension as agreed by both parties.
3. This Memorandum of Understanding may be prolonged or terminated by either Party with
written notice to the other Party at least 3 (three) months in advance or by mutual consent of
the Parties. In case the Memorandum of Understanding ceases to be in effect on account of
termination thereof, _the provisions of the Plan of Operation and Annual Program Plan shall
continue to apply to the extent necessary to secure the completion of existing activities as
agreed upon in the Plan of Operation and Annual Program Plan.
IN WITNESS WHEREOF, the undersigned, have signed this Memorandum of Understanding.
DONE in Jakarta on 25 March 2004 in two originals in English language, both of the text being
equally authentic.
··
1"
FOR
THE MINISTRY OF HEALTH OF
THE REPUBLIC OF INDONESIA
Dr. Dadi S. Argadiredja. MPH
Secretary Gerieral
ｾ＠
FOR
PROGRAM FOR APPROPRIATE
TECHNOLOGY IN HEALTH
ｾ｣Ｍｦｬ＠
｣ｾ＠
Christopher J. Elias. M.D., M.P.H.
President
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-·
'
ｾＭ
'
.. ｾ＠
""',,,...:·,r"
ANNEX:
PROGRAM DIRECTION
I. General Objective
The worldwide mission of the Program for Appropriate Technology in Health {PATH) is to
improve health of people around the world by advancing technologies, strengthening
systems, and encouraging healthy behaviors. Founded in 1977 and maintaining a
presence in lnrjonesla since 1981, PATH identifies, develops, and applies appropriate and
innovative solutions to public health problems, particularly in low-resource settings. PATH
shares knowledge, skills, and technologies with governmental and non-governmental
partners and with groups in need.
Core Themes:
1. lmprovina immunization technology and svstems
For many years, PATH has worked in partnership with the Government of Indonesia
{GOI) to make appropriate vaccines and immunizations available to all infants and
children. For example, since 1987, PATH has worked successfully with GOI to make
Hepatitis B vaccine an essential part of its immunization system (Indonesia thereby
becoming the first country to do so), and to make a birth dose available to block
vertical transmission from mother to child. PATH has also helped P.T. Bio Farma
become the first pharmaceutical company to produce immunizations in Uniject™, a
PATH-developed syringe technology, both for domestic use and for export.
Now, through its Children's Vaccine Program (CVP) and its linkage with the Global
Alliance for Vaccines and Immunizations (GAVI), PATH is able to provide broad,
sustained support for Indonesia's 5 Year Plan for Immunization Services for 2002·
2006. PATH has a small technical support unit for immunization in Jakarta,
supplemented by a unique high-level technical capability at its headquarters and other
offices.
2. Enabling Behavior Change
Behavior change is an inescapable component of technology introduction, as well as
being an integral part of the overall public health agenda. PATH has extensive
experience in utilizing mass media, social mobilization techniques, interpersonal
communication, and other techniques to convince people to adopt healthier behavior.
At present, PATH is involved in behavioral change in three projects in Indonesia:
• In Lombok, behavior change techniques have helped convince parents of
pneumonia-sick babies to seek appropriate medical care.
• Within the Maternal and Neonatal Health project, PATH is seconding 9 staff
members to support the social mobilization component.
• To improve Maternal Child Health (MCH) care through behavior change at multiple
levels, PATH is implementing the ASUH (Healthy Start for a Healthy Life) project
in West Java and East Java. A key part of this project involves ensuring that birth
visits by Bidan di Desa take place, in part to allow for the birth dose of Hepatitis B
vaccine.
6
To implement these activities, PATH supports a staff of several mid- to senior-level
Indonesian specialists. This expertise is supplemented by a substantial body of
international expertise, both in its US offices and in other developing countries.
3. Strengthening Indonesia's Caoacitv to Meet Health Challenaes
PATH has been involved in capacity strengthening in Indonesia throughout its
presence here, although for the most part it has been more in the form of project
components than of independent projects or activities. During the period of this plan,
PATH intends to focus on capacity building as a core theme. In addition to focusing on
the capacity building aspects of targeted health projects, PATH will seek to mobilize
additional funds especially dedicated to capacity building in Indonesia.
Three particular issues in capacity building will occupy priority attention for PATH:
• Sharing up-to-date health information within the professional health community.
• Supporting district-level capabilities in health management, leadership, and
utilization of information for decision making.
• Strengthening the leadership capabilities of health professionals.
These three core themes will be implemented through a variety of types of health
projects, as indicated below. To carry out these projects, PATH intends to maintain its
main office in Jakarta and at least two field offices elsewhere in Indonesia throughout
the period of this plan. It will maintain a size and configuration of staff appropriate to its
project portfolio, concentrating on the enhancement of high-quality capabilities among
its Indonesian staff.
II. Mechanism of Cooperation
2.1. Major Current Activities
At present, PATH has three major ongoing projects in Indonesia, and one additional
area of activity that is expected to take on project configuration in 2003. Its main office
is in Jakarta, with local offices in Lombok, Bandung, Surabaya, and 8 districts in West
Java and East Java. The total PATH staff as of June 2003 was 75, of whom 72 are
Indonesian and 3 are expatriates.
Immunization support
PATH continues to assist the MOH in implementing its immunization program. Through
its CVP (Children's Vaccine Program, funded by the Bill and Melinda Gates
Foundation), PATH is a key member of GAVI (Global Alliance for Vaccines and
Immunizations, also substantially funded by Gates), which has allocated US$40 million
in support of Indonesia's immunization program from 2002-2006. With financial and
technical support from CVP and use of its own staff, PATH Indonesia has been working
in close partnership with the Immunization Department of MOH and WHO to access the
GAVI funding and to use that funding to implement its programs. In particular, in recent
months PATH:
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•
•
•
Has assisted GOi in preparing its 5 Year Plan for Immunization Services for
2002·2006.
Has assisted GOI in submitting (successfully) its application for GAVI support for
the birth dose of Hepatitis B vaccine.
Is assisting GOI in preparing its application for GAVI support for immunization
safety.
PATH is particularly focused on supporting the birth dose of Hepatitis B in Uniject™
syringes, and on improving management of the cold chain, and is currently completing
studies on these topics.
Haemophilus lnfluenzae Type b Study
PATH is working with the National Institute for Health Research and Development and
the Provincial Health Service NTB, with Sadan Pengawas Obat dan Makanan, with
Association Pour l'Aide a la Medicine Preventive, and with other partners to implement
a major study of Haemophilus influenzae type b bacteria as a cause of infant
pneumonia and meningitis on Lombok island. This study is primarily funded by the
Gates Foundation through CVP and by Aventis Pasteur. The study, which began in
September 1998, is mainly intended to determine the proportion of severe childhood
pneumonia cases that are caused by Haemoph1lus influenzae type b, in order to better
judge the priority to be assigned to introduction of Haemophilus influenzae type b
vaccine into the routine immunization program of Indonesia in the future. Fieldwork for
the study is currently expected to be completed at the end gf 2002, and the basic
results known in 2003.
Awai Sehat-untuk Hidup Sehat
In partnership with the Directorate of Family Health, MOH and appropriate local Health
Departments, PATH is implementing the ASUH (Awai Sehat untuk Hidup Sehat)
project in eight districts of West Java and East Java provinces. This project, building on
previous PATH work in NTB and Bali provinces which introduced the early postpartum
home (KN1) visit by the Bidan di Desa and the birth dose of Hepatitis B vaccine, is
intended to improve maternal and child health in West and East Java in the context of
decentralization. Utilizing a variety of approaches to behavior change, the project aims
to improve the capacity of the health system, the communities, and families to work
together to improve health. A particular focus is to strengthen the Bidan di Desa's
willingness to make the KN1 visit and improve the content of the visit, and thereby to
increase the proportion of newborns immunized with Hepatitis B vaccine.
This project is funded by USAID's Indonesia mission under a cooperative agreement.
· · Funding began in 2000 and is assured through September 2003, with a possibility for
an additional two years of support.
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Support for Social Mobilization in the Maternal and Neonatal Health Project
Through a sub agreement with the Johns Hopkins Program for Information and
Education in Gynecology and Obstetrics (JHPIEGO), PATH is providing technical
assistance and other support for the social mobilization component of the MNH
{Maternal and Neonatal Health) Project. For this purpose, PATH seconds staff to the
MNH project, and provides funding support for social mobilization activities. This
support has two main components: first, the establishment of the 55 Desa Siaga
activity in three districts of West Java province to make communities and families
aware of the need to be prepared for emergencies during pregnancy and childbirth;
and second, to establish and support an Alliansi Pita Putih of organizations within the
civil society of Indonesia to support safe ·motherhood.
Ti·ie overall MNH project is a centrc.!ly funded USA!D Project. PATH's support, which
began in 1999, will continue in the field until September 2003, with some additional
closure activities until March 2004.
2.2. Future Activities, 2003-2007
PATH fully expects to remain active in support of health in Indonesia in the coming 5
years, as it has been over !he past 20 years. It expects continued funding from its two
major current donors, the BBi and tvielinda Gates Foundation, and USAID. At the same
time, PATH will seek funding from other donors for a broadened portfolio of activities.
PATH is capable of supporting a range of health interventions in Indonesia through its
expertise at headquarters and in its 19 offices in 11 countries around the world. This
international expertise is grouped in nine strategic program areas:
•
•
•
•
•
•
•
•
•
Technology Solutions
MCH/Nutrition
Reproductive Health·
HIV and AIDS
Adolescent Health
Gender, Violence, and Rights
Children's Vaccine Program
Malaria Vaccine Initiative
Meningitis Vaccine Program
The first six of these incorporate a variety of individual projects, some of which can and
do provide financial and/or technical support for activities in Indonesia. Over the period
of this plan, most new project activities are expected to come from these areas.
The latter three strategic programs are large individual projects. Of these, the
Children's Vaccine Program, which supports PATH's immunization work, is expected
to remain the most important for Indonesia during this plan period.
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Core Themes:
1. lmprovin_g immunization technology and systems
PATH will continue to build on its history of supporting the availability and utilization of
improved technology in vaccines and immunizations in Indonesia. Utilizing funds from
its Children's Vaccine Program (CVP} and other sources, PATH will support selected
aspects of the Government's 5-year immunization plan.
It is anticipated that starting in 2003 for at least two years, the CVP will provide major
project support for immunization, including a full-time resident advisor, appropriate
supporting staff, and funds for implementing selected activities not supported by GAVI.
Primary focus for this support is expected to include:
Improving immunization technology:
• Testing and introduction of new immunization technologies.
o Completing the introduction of Hepatitis B (in Uniject™) into the routine
immunization system.
o Evaluating the suitability of introducing Haemophilus influenzae type b vaccine
into the routine immunization system.
o Testing and introducing new immunizations when available (e.g.,
pneumococcus, rotavirus).
• Improving the safety of immunizations.
o Supporting increased use of auto-disable syringes in routine immunization.
o Improving the disposal of sharps.
• Improving cold chain management.
• Reducing wastage of vaccines and biological products.
Improving immunization delivery systems:
• Increasing the proportion of visits by trained providers in .the first week after birth
(and therefore increasing first-week immunizations).
• Strengthening the posyandu system as a basis for routine immunization.
• Strengthening the monitoring of coverage and quality.
• Developing and distributing training and information materials for providers.
It is expected that over the period of this plan PATH, through its Technology Solutions
strategic program, will develop new technologies in immunization and other health
areas. As this occurs, PATH will work closely with MOH to evaluate the suitability of
these technologies for Indonesia, and where appropriate to assist in their introduction
to Indonesia. For example, making oxytocin available in Uniject™ can help Indonesia
implement its policy of using oxytocin for management of third stage labor in cases
where the Bidan di Desa attends home deliveries. PATH has conducted a trial
indicating the suitability of lhis approach; it now intends to work with MOH to find ways
to reduce the cost involved in making this technology available.
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2. Enabling Behavior Change
As its current projects come to an end, PATH intends to apply its expertise in behavior
change in new activities to improve health in Indonesia. As illustrative examples from
current thinking, PATH will seek to develop or support projects in the following areas:
•
•
•
•
•
•
•
•
For immunization, behavior change among providers will be particularly needed to
strengthen immunization safety, to improve management of the cold chain and
reduce wastage, and to improve coverage.
The reluctance off amilies to seek modern health care for sick children needs to be
addressed. In particular, the successes of the Lombok Haemophilus influenzae
type b study in improving health seeking behavior for pneumonia sick children
need to be more widely applied.
More positive interaction among health care providers, communities, and clients is
needed, ｰ｡ｲｴｩ｣ｵｾｬｹ＠
at the district and local levels. PATH will look to build on the
work currently underway in ｾｨ･＠
ASUH project, to continue to improve these
approaches and to implement them throughout Indonesia.
New mechanisms are needed to strengthen community involvement in health. The
community empowerment approaches of the ASUH and MNH projects need to be
integrated, refined, and replicated. New mechanisms need to be found to revitalize
the posyandu system.
The resurgence of tuberculosis and malaria indicate the need for increased
resources and attention. Improved public education and health seeking behavior
will be needed as part of a coordinated approach to dealing with these diseases.
If and when Postinor-2™ (an emergency contraceptive pill) is approved by POM,
PATH is interested in assisting with public education and motivation efforts.
The growing problems of commercial sex and drug addiction in Indonesia is
creating a subculture of persons who pose severe health risks to themselves and
their communities, particularly from HIV/AIDS. A substantial and challenging
behavior change effort is needed to change the risk behaviors of these women
and men, to protect their health and the health of other in contact with them, and
to improve their human rights situation.
Protecting the health of adolescents will require improved approaches to health
education and motivation for behavior change. PATH would like to build on
important previous work accomplished in this area.
3. Strengthening Indonesia's Caoacitv to Meet Health Challenges
PATH's approach will be one of gradual development. PATH will initialize utilize
funding available from existing projects and small amounts of PATH funds to build
expertise and portfolio in this area, so that over time it will be able to attract
substantial, targeted funds for capacity building.
Capacity strengthening activities may include professional training, institutional
capacity strengthening, and strengthening the cohesion of the professional health
community. Two issues for special attention will be leadership development and
information sharing. Key elements of this strategy will include:
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Development of PA TH Indonesia capabilities in c.apacity strengthening. PATH will
initially assign a staff member to coordinate this theme. This p.erson will develop
and maintain information databases, e.g., mailing lists, tra)ring opportunities, ｾｴ｣ＮＬ＠
and do a needs assessment. Existing PATH personnel will increase their attention
to capacity building activities within their spheres. Capacity building within projS?pts
will be focused and rationalized. As funds become available, capacity building
specialists will be hired or reassigned.
• Indonesian language information for health professionals. PATH will initiate a
pro!Jram of preparing (or translating) brief, up-to-date infor.mation for health
professionals, and distributing this to appropriate MOH, NGO and priva.te Ｌｳｾ｣ｴＮｯｲ＠
health professionals.
• Leadership development. .PATH will review leadership development Ｎｲ･ｳｯｾＨ｣＠
and activities in Indonesia, and establish liaison with lea.dership doriQrs
internationally. Selected PATH staff will be sent for international leadersbfp
·training, with the intention of providing in-country leadership training opportunities
in Indonesia.
'
·
• Funding. Once the basic elements are in place and PATH has developed some
track {ecord in lower-cost efforts, we will make a focused ftffort to find substantial,
medium- to long-term funding for an integrated program. of capacity. building for
Indonesia.
•
·111.
Reporting
-PATH shall submit annual reports to MOH, State Secretariat, Ministry of Fpreign Affairs
and relevant authorities covering:
1. Completed and ongoing programs;
2. 'Difficulties and I or problems faced during implementation;
3. Recommendation.
IV.
Evaluation
'Evaluation of Programs shall be carried out as set forth ｢･ｬｯｾＺ＠
1. Program and progress results will be ･ｶ｡ｬｵｴﾫｩ＿､｟ｒＮｳ［ｲｮｾ＠
ann.ually to the MOH,
State Secretariat and Ministry of Foreign Affairs;
2. The MOH can make an additional evaluation of the PA"i.:H programs as it sees fit.
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