Public Disclosure Authorized EAST ASIA AND PACIFIC Indonesia Health, Nutrition and Population Global Practice IBRD/IDA Specific Investment Loan FY 2010 Seq No: 9 ARCHIVED on 24-Dec-2014 ISR17306 Implementing Agencies: Directorate General of Higher Education Ministry of Education and Culture Public Disclosure Authorized Key Dates Key Project Dates Board Approval date:24-sep-2009 Planned Mid Term Review Date:29-Oct-2012 Original Closing Date:31-Dec-2014 Project Development Objectives Effectiveness Date:09-Dec-2009 Actual Mid-Term Review Date:29-Oct-2012 Revised Closing Date:31-Dec-2014 Public Disclosure Authorized Project Development Objective (from Project Appraisal Document) The specific Project Development Objectives are to strengthen quality assurance policies governing the education of health professionals in Indonesia. This will be achieved by: 1) rationalizing and assuring competency-focused accreditation of public and private health professional training institutions; 2) developing national competency standards and testing procedures for certification and licensing of health professionals; and 3) building institutional capacity to employ results-based grants for encouraging the use of accreditation and certification standards in the development of medical school quality. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Public Disclosure Authorized Name Component 1 Strengthening Policies and Procedures for School Accreditation:(Cost $7.18 M) Component 2 Certification of graduates using a national competency-based examination:(cost $12.90 M) Component 3 Results-based FAP for Medical Schools:(Cost $61.40 M) Project Management:(Cost $5.24 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory 12/24/2014 Page 1 of 11
Overall Risk Rating -- Moderate Implementation Status and Key Decisions The project, which closes on December 31, 2014, has broadly met the project development objectives as measured by the achievement of the project intermedicate indicators and key performance indicators. The Ministry of National Education and Culture Decree No 291/P/2014, dated October 17, 2014, acknowledged LAM-PTKES (Independent Accreditation Agency for Health Higher Education) as an independent entity authorized to conduct the accreditation of health higher education. At project closing, 168 schools completed the accreditation process using specifically designed instruments and accreditation process. LPUK-NAKES will continue to support professional associations and associations of higher education institutions. The Implementation Completion Report (ICR) mission for the project is planned for February 2015 12/24/2014 Page 2 of 11
Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- -- Moderate Macroeconomic -- -- Substantial Sector Strategies and Policies -- -- Moderate Technical Design of Project or Program -- -- Moderate Institutional Capacity for Implementation and Sustainability -- -- Moderate Fiduciary -- -- Moderate Environment and Social -- -- Moderate Stakeholders -- -- Moderate Other -- -- -- Overall -- -- Moderate Results Project Development Objective Indicators 12/24/2014 Page 3 of 11
The readiness of competency examination for pharmacy, nutrition and public health (Yes/No, Custom) Value N N Y Y Date 07-Mar-2013 30-Jun-2014 15-Dec-2014 31-Dec-2013 The status is yes for pharmacy and public health. Nutrition needs more time to clearly differentiate between the competencies of D3, D4 and S1 level graduates. Readiness means the availability of standards of competencies, examination blue print, examination items, and item bank. The implementation of a nationally standardized competency examination trial for pharmacy, nutrition and public health (Yes/No, Custom) Value N N Y Y Date 07-Mar-2013 30-Jun-2014 15-Dec-2014 31-Dec-2014 Pharmacy and public health have conducted the national competency examination trial. Nutrition will conduct the trial after the project closes as it still has to clarify the standards of competencies. Establishment of an accreditation system for pharmacy, nutrition, and public health study programs (Yes/No, Custom) Value N N Y Y Date 07-Mar-2013 30-Jun-2014 15-Dec-2014 31-Dec-2014 The three disciplines already have the accreditation instrument and trained assessors, and have completed the accreditation trial Mean Test Score of Graduates from FAP Recipient Schools who take the National Competency Testing (Percentage, Custom) 12/24/2014 Page 4 of 11
Value 60.88 64.25 64.38 -- Date 31-Dec-2010 30-Jun-2014 15-Dec-2014 31-Dec-2014 The mean test scores of non FAP recipients was 56.03 at baseline and 61.36 at project closing. It should be noted that FAP recipients include the weakest medical schools in the country. Graduates of health professional schools passing the national competency testing at first attempt (Percentage, Custom) Value 0.00 -- 0.00 0.00 Date 31-Dec-2009 30-Jun-2014 15-Dec-2014 31-Dec-2014 See the breakdown percentages for medicine, dentistry, nursing and midwifery. The percentage for medicine is below target, but the passing score has increased from 58% at baseline to the current 66%. The result does not reflect the final examination (November 2014) as the examination committee is still processing the data. The percentage for nursing is also below target, but the passing score for registered nurse (ners) has increased from 44% to 46.7% and for bechelor nurse from 37.47% to 42.16%. Graduates of Medical Schools passing the national competency test at the first attempt (Percentage, Custom Breakdown) Value 71.67 -- 72.47 84.00 Graduates of Dental Schools passing national competency test at the first attempt (Percentage, Custom Breakdown) Value 81.69 -- 92.31 90.00 12/24/2014 Page 5 of 11
Graduates of Nursing school (ners) passing the national competency test at the first attempt (Percentage, Custom Breakdown) Value 0.00 -- 57.81 65.00 Graduates of nursing schools (D3) passing the national competency test at the first attempt (Percentage, Custom Breakdown) Value 0.00 -- 47.81 65.00 Graduates of Midwifery Schools passing the national competency test at first attempt (Percentage, Custom Breakdown) Value 0.00 -- 64.65 65.00 Health Professional Schools (medical, dental, nursing, and midwifery) that have gone through the accreditation process and publicize the results (Number, Custom) Value 0.00 0.00 168.00 124.00 Date -- 30-Jun-2014 15-Dec-2014 31-Dec-2014 At midterm review, the target was reduced because of the delayed establishment of the LAM-PTKES. The new target is 42% from 69 schools of medicine (29 schools), 42% from 24 schools of dentistry (10 schools), 10% from 516 schools of nursing (52 schools), and 10% from 324 schools of midwifery (33 schools). The total target is 124 schools. When LAM-PTKES started implementing the new accreditation system in 2014, the DG of Higher Education proposed 290 candidates schools as priorities for going through the accreditation process. By the time of the writing of this final ISR, from the proposed 290 schools, 32 schools withdrew from the process, 24 schools were still in the facilitation process, 66 schools were about to have the field visitation, and 168 schools have completed the accreditation process (which is above the target of 124 schools) 12/24/2014 Page 6 of 11
Nursing schools that have gone through accreditation process and publicize results (Number, Custom Breakdown) Value 0.00 -- 82.00 52.00 Midwifery schools that have gone through accreditation process and publicize the results (Number, Custom Breakdown) Value 0.00 -- 56.00 33.00 Medical Schools that have gone through accreditation process and publicize the results (Number, Custom Breakdown) Value 0.00 -- 21.00 29.00 Dental schools that have gone through accreditation process and publicize the results (Number, Custom Breakdown) Value 0.00 -- 9.00 10.00 Establishment of the National Agency for Competence Examination of Health Professionals (NACE HealthPro/LPUK-NAKES) (Yes/No, Custom) 12/24/2014 Page 7 of 11
PHINDIRITBL Value N Y Y Y Date 31-Dec-2009 30-Jun-2014 15-Dec-2014 31-Dec-2014 Establishment of the independent National Accreditation Agency (NAA/LAM-PTKES) (Yes/No, Custom) Value N Y Y Y Date 09-Dec-2009 31-Dec-2013 15-Dec-2013 31-Dec-2014 On October 17, 2014, the Ministry of Education and Culture release decree no 291/P/2014 authorizing LAM-PTKES to conduct the accreditation of health higher education. Overall Intermediate Results Indicators The National Accreditation Agency NAA has access to adequate numbers of suitably trained assessors (Number, Custom) Value 0.00 128.00 439.00 300.00 Date -- 30-Jun-2014 15-Dec-2014 31-Dec-2014 The total number of trained assessors is 86 for medicine, 39 for dentistry, 168 for nursing and 146 for midwifery. 12/24/2014 Page 8 of 11
PHINDIRITBL PHINDIRITBL PHINDIRITBL PHINDIRITBL Number or percentage of medical schools receiving finance support to strengthen the program (Number, Custom) Value 0.00 43.00 43.00 43.00 Date -- 30-Jun-2014 15-Dec-2014 31-Dec-2014 A charter supporting the establishment of the NACEHealth Pro (National Agency for Competency Examination of health Professionals) including its tasks and responsibilitis, and working arrangements (Yes/No, Custom) Value N Y Y Y Date 31-Dec-2009 30-Jun-2014 15-Dec-2014 31-Dec-2014 The National Accreditation Agency (NAA) has independent and adequate budget to conduct accreditation (Yes/No, Custom) Value N Y Y Y Date 31-Dec-2009 31-Dec-2013 15-Dec-2014 31-Dec-2014 The schools pay for the accreditation process, the government still provides subsidy with the plan to gradually reduce the subsidy. LAM- PTKES is independently financing its operational costs. Education and competency standards are agreed by all stakeholders and published (Yes/No, Custom) Value N Y Y Y Date 31-Dec-2009 30-Jun-2014 15-Dec-2014 31-Dec-2014 The standards of education were agreed by the Association of Education of Institutions (of each of the 7 disciplines involved in the project), while the standards of competencies were agreed by the professional association (of each of the 7 professions involved in the project) 12/24/2014 Page 9 of 11
PHINDIRITBL Responsibility for policies on professional accreditation, certification, and school licensure are clear and accepted by key stakeholders for each of four health professions (Yes/No, Custom) Value N N Y Y Date 31-Dec-2009 30-Jun-2014 15-Dec-2014 31-Dec-2014 The higher education law (law 12/2012) and the medical practice law (law 20/2013), the health workforce law (Law 36/2014) and the nursing law (law 38/2014) are umbrella laws guiding the development of accreditation and certification policies. Three ministerial regulation from the Ministry of Education and Culture/MOEC (No 49/2014, No 50/2014, and No 67/2014) regulated the accreditation process. One ministerial regulation from MOEC (no 83/2013), and one joint Ministry of Health (MoH) and MOEC regulation supported the implementation of the national competency examination. Overall Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P113341 IBRD-77370 Effective USD 77.82 77.82 0.00 65.87 11.95 85% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P113341 IBRD-77370 Effective 24-Sep-2009 01-Oct-2009 09-Dec-2009 31-Dec-2014 31-Dec-2014 Cumulative Disbursements 12/24/2014 Page 10 of 11
Restructuring History Level Approved on 07-Mar-2013,Level 2 Approved on 16-Sep-2014 Related Project(s) There are no related projects. 12/24/2014 Page 11 of 11