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A.I.D. LOAN NO. 497 - U- 057
A.I.D. PROJECT NO. 497-0253

AMENDMENT NO . 1 TO

LOAN AGREEMENT

BETWEEN THE

REPUBLIC OF INDONESIA

AND THE

UNITED STATES OF AMERICA

FOR

AN EXPANDED PROGRAM IN IMMUNIZATION

DATED: September 21, 1984

()

Dated:

September 21, 1984

This AMENDMENT NO. 1, is entered into between the REPUBLIC OF
INDONESIA ("Borrower") and the UNITED STATES OF AMERICA, acting
through the AGENCY FOR INTERNATIONAL DEVELOPHENT ("A.I.D . "):
WHEREAS, the Borrower and A.I.D. entered into an Expanded
Program in Immunization Project Loan Agreement, designated as A.I.D.
Loan No. 497-U-057 on August 15, 1979 (nLoan Agreement"), whereby
A.I.D. agreed to lend to the Borrower up to Ten Million United
States ("U.S.") Dollars ($10,000,000)

("Loan");

WHEREAS, The Borrower and A. I.D. agree the objectives of the
Project may be accomplished with a reduction in the Loan of
$500,000, and wish to make certain other changes in the Loan

Agreement;
NOW THEREFORE, the Borrower and A.I.D. hereby agree as follows:
1.

The first sentence in the first paragraph of Section 3.1 is

revised to read as follows:
"Section 3.1.

The Loan.

To assist the Borrower to meet the

costs of carrying out the Project, A.I.D., pursuant to the Foreign
Assistance Act of 1961, as amended , agrees to lend the Borrower
under the terms of this Agreement not to exceed Nine Million Five
Hundred Thousand United States ("U.S.") Dollars ($9, 500 ,000)
("L oan ") .
2.

Section 3.2. (b).

Borrower Resources for the Project is

revised to read as follows:
"(b) The resources provided by Borrower for the total
Project (both Grant and Loan) will be not less than the equivalent
of U.S.$13,956,000, including costs borne

on an 'in-kind' basis."

- 2 3.

Sect ion 5. 3.

Disbursement for Training is hereby deleted

and a new Section 5.3 is substituted which read as follows:
"Section 5.3.

Disbursement for Vaccine Refrigerators.

Prior to

disbursement under the Loan, or to issuance by A.I.D. of
documentation pursuant to which disbursement will be made, for the
purpose of financing the procurement of vaccine refrigerators under
the Project extension, the Borrower will, except as A.I.D. may
otherwise agree in writing, furnish to A.I.D. in form and substance
satisfactory to A.I.D., by December 31, 1984:

(a) evidence that the

Government has provided all necessary clearances for the procurement
of Electrolux vaccine refrigerators from Luxembourg, and (b)
evidence that the Government will facilitate the entry of the
Electrolux vaccine refrigerators into Indonesia."
4.

In Article 6, Covenants, a new Section 6.6 is added which

reads as follows:
"The Borrower agrees that the funds provided pursuant to this
Loan Agreement may be used to finance the costs of in-country and
off-shore short-term training, or, training of less than 90 days
duration."
5.

A revised financial plan and revised amplified project

description are attached as Annex I and Annex II to this Amendment.
6.

Except as hereinabove expressly amended, the Loan Agreement

is ratified, confirmed and continued in full force and effect in
accordance with all of its terms.
IN WITNESS WHEREOF, the Borrower and the United States of
America, each acting through its respective duly authorized

-3representative, have caused this Amendment No. 1 to be signed in
their names and delivered as of the day and year first above written.

REPUBLIC OF INDONESIA
Signed

Atmono Suryo M.A.
Director General
for Foreign Economic Relations
Department of Foreign Affairs

UNITED STATES OF AMERICA
Signed

Robert K. Clark
Acting Director
USAID/Indonesia

ANNEX II
AMPLIFmD DESCRIPTION OF THE PROJECT

(same for Loan and Grant)

I.

Project Description

The Expanded Program in Immunization (EPI) of the Government of
Indonesia (GOI) is a nationwide preventive health program to reduce the
incidence of six diseases -- tuberculosis, diphtheria, pertussis, tetanus
measles and polio -- which contribute to the principal causes of infant
mortality in the Republic of Indonesia, as well as childhood and maternal
morbidity and mortality.
Through this project, the Ministry of Health's Directorate General
for Communicable Disease Control, Jakarta will contribute to further
expand the capabilities of the existing network of health centers
(Puskesmas) in order to provide, transport, store and administer vaccines
to the wi dely scattered, predominantly poor, rural population of
Indonesia. The EPI, which involves health staff from various sectors and
from all levels of the health structure, will also contribute to
developing the integration of health services through which Primary

Health care is delivered. The program will be directed towards three
major sub-populations: infants, school children and women of reproductive
age. Also, the project will assist P.u. Biofarma in strengthening its
vaccine production facilities.
Under the program
a. The plant facilities of the State Enterprise, P.U. Biofarma, in
Bandung, will be expanded and upgraded and the staff trained to enable
them to increase their production capacity of selected vaccines to the
levels required by the GOI for its long-range program.
b. The "Cold-Chain" -- the series of transportation and storage
links necessary for transporting vaccine from Biofarma to the remotest
Puskesmas -- will be upgraded with additional training, equipment and
vehicles.
c. Vaccinators and other health workers will be retrained to
administer the new vaccines and provided transportation to reach the
remoter areas of the country.
d. A program monitoring, surveillance and evaluation system will be
instituted to monitor critical disease incidence, vaccinator perfonnance,
and public awareness and acceptance of the program.
e. GOI personnel will be trained to adminster the technical,

logistical, maintenance, surveillance and managerial aspects of an
Expanded Program of Immunization carried out as an element of integrated
health services.

- 2 f. Studies and trials will be carried out to improve management and
technical approaches and to obtain active community support for and
participation in EPI as one of the Primary Health Care elements.
The program is a continuation and expansion of a vaccination program
already in existence in every province of Indonesia.
It will
progressively upgrade the quality and capability of selective kecamatans
each year to handle and administer vaccinations within their areas, and
increase the extent of their coverage:
It is estimated that by project completion, on a national basis, 57
percent of the children in the eligible population group (i.e. 73% x 78%)
and 56 percent of the pregnant women (i.e. 72% x 78%) will have been
reached by EPI, which should have a significant impact on mortality and
morbidity of the population.
Project Duration:

Until September 30, 1987

Administrative Arrangement and Management
The GOI Department of Health Directorate General of Communicable
Disease Control, Directorate of Immunization and surveillance, will have
overall responsibility for managing all central-level aspects of the
Project. This group will direct all technical assistance, participant
training and commodity inputs except those related to the Biofarma
vaccine production facility.
Sub-District Health Center Doctors (dokter-dokter Puskesmas) will
provide day-to-day supervision to vaccinators, nurses and mid-wives (who
also will vaccinate).
w.H.O. and UNICEF will continue their collaboration on this Project
through technical assistance, training and commodities complementary to
those provided through this Loan.
AID, through a PASA with CDC Atlanta, will provide long term
consultation, which will be a part of the EPI managerial team and as such
will coordinate with the staff of the Ministry of Health and other
consultants with whom they will exchange information and reports. These
staff members will deal with matters related to the program through their

government counterparts.
Implementation and Reimbursement
The technical assistance financed by AID shall be arranged with the
Centers for Disease Control, Atlanta, and other individual and
institutional sources in accordance with customary AID procedures.
Participant long-term training for people from the GOI as well as
short-tenn training shall take place in the u.s. and will be administered
by the AID/Indonesia Office of Training. The procurement of vaccine
production, cold chain and transportation equipment and other commodities
will take place in accordance with the provisions of AID Handbooks 11 and

15.

- 3 -

II.

Financial Plan
A. AID Contribution

AJD will provide both loan and grant funding in support of the
GOI program. A total of $12,700,000 shall be made available, of which
$9,500,000 shall be loan-funded and $3,200,000 grant-funded. Annex I
illustrates in greater detail the AlD and GOI contributions according to
various EPI inputs. Changes up to 30% may be made to line item amounts
shown in the budget without formal revision of this Agreement provided
that AID approves any such changes in writing, and that the total AlD
contribution is not increased or the Borrower's contribution for this
phase is not decreased below its agreed contribution. However, the funds
provided for the procurement of vaccine refrigerators under the project
extension, may not be transferred to any other line item. If the
condition precedent governing this procurement is not met in accordance
with the Project Loan Agreement, such funds may be deobligated at AID's
discretion.
lo Consultants
a. Two long-term consultants from the Centers for Disease
Control (CDC}, Atlanta and on personal services contract will work with
the Staff of the GOI Ministry of Health Directorate General for
Communicable Disease Control, Jakarta and other consultants from WHO,
UNICEF and other agencies or institutions. The teamwork generated will
aim at further developing the technical, training and managerial capacity
required to establish and operate a Cold Chain system, deal with other
logistical problems, surveillance, monitoring and evaluation.
b. Short-term consultants will be provided to help solve
specialized technical problems.
2. Participants
Long term participants in epidemiology, program management and
vaccine production and short term participants in more specialized
fields. Precise numbers of person and fields of training will be
included in a periodic training plans.
3. Commodities
Imported commodities including equipment useful for vaccine
production, administration, transportation and cold-chain will be
loan-funded.
4. Local Costs
a. Monitoring, surveillance, training, research, evaluation and
locally assembled vehicles (of u.s. source/orig.}
b. Promotion and special projects.

- 4 B.

GOI Contribution to the Project

The GOI contribution, as set forth in Annex I, shall amount to no
less than $13,956,000. These funds shall be used to fund various aspects of
production and purchase of vaccines, training, evaluation, research,
monitoring and technical assistance.

ANNEX I
EXPANDED PROORAM IN IMMJNIZATICN
SlM1ARY aJST ESI'IW\TE AND F:rNl\OCIAL PI.AN

(U.S. $000)

August 1984

NO.

I
II

I
I
II. I
I
III. I
I
I
I
I
I
I
I

I.

I
II
Tedmical Assistance
Vaccines
Commodities
a. Vaccine Production (Bio Fanna)
b. Transport
c. eo1a Cllain
d. :cata Processing F.quipnent
e. Vaccination F.quipnent
f. .Administration F.quipnent

IV. I Program lt>nitorin:;
I a. Evaluation
I b. Health Education, Operations
I
Research, Epidemiologic surveys
I c. Contingency

I

V. I Manpower ｾｶ･ｬｯｰｮｴ＠
I a. Participants
I b. Incountry Trainin:;

I
I
I
I
I
I
I
I
I
I
I

I
I

G 0 I

I
I

T 0 T A L

-

I

2,420

-

I
I
I

6,801

I

6,801

-

I

4,391. l

I

9,605.l

-

I
I

(2,668.4)
(773.1)

-

I
I

(265.6)
(684)

I
I

I

2,519.9
(2,496.4)
(23.5)

I

4,395.9

I

244

I

3,434

I
I

13,956

I
I

26,656

A.I .D.
LOAN

5,214
(l,467)
(l,560)
(2,167)
(20)

-

-TI - -

I
I
I
I
I
I
I
I
I
I
I

- - ---

2,420

I
I

I

1,546
(40)
(l,116)

I
I

I

(390)

I

(330)

I

450
(450)

I

2, 740
(920)
(l,820)

I
I

9,500

I
I

I

GRAN!'

I

330

-

I
I 'IUI'AL
I

)

I

ｾＭ

'

,r

I
I

3,200

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