Indonesia: Modernization of the Health System

OBJECTIVE

Through closing the medical equipment gaps across the country, the Project will attain higher operational functionality and efficiency of the healthcare service, with the aim to modernize Indonesia’s primary healthcare, referral, and laboratory systems and to improve the accessibility, equity, and quality of healthcare.

DESCRIPTION

The Project comprises three components to close the medical equipment gaps nationwide: (i) a primary care component at the three levels of primary care facilities in Indonesia; (ii) a referral network component at the three levels of hospital care in Indonesia; and (iii) a public health laboratory component in Indonesia.

ENVIRONMENTAL AND SOCIAL INFORMATION

The proposed loan will be co-financed with the World Bank (WB) and the Project’s environmental and social (E&S) risks and impacts will be assessed in accordance with WB’s Environmental and Social Framework (ESF). To ensure a harmonized approach to addressing E&S aspects of the Project, and as permitted by AIIB’s Environmental and Social Policy (ESP), WB’s ESF will apply to the Project in lieu of AIIB’s ESP. AIIB has reviewed WB’s ESF and is satisfied with (i) WB’s ESF is consistent with AIIB’s Articles of Agreement and materially consistent with the provisions of AIIB’s ESP including the Environmental and Social Exclusion List and the relevant E&S Standards, and (ii) the monitoring procedures in place are appropriate for the Project. WB has categorized the Project’s E&S risk rating as ‘moderate’, which is similar to Category B if AIIB’s ESP were applicable.

The key environmental impacts include the anticipated increase in the volume of medical and other types of waste, energy consumption, quantities of chemical and hazardous substances to be managed, and occupational health and safety risks, such as chemical exposure, noise, electrical safety, and infection control. Further assessment of the Ministry of Health (MoH)’s capacity to manage the E&S impacts will be done by appraisal and a capacity-building plan will be included in the Environmental and Social Management Framework (ESMF) and Environmental and Social Commitment Plan (ESCP).

Social risks are insignificant and may involve health and safety risks to primary supply workers during the distribution, installations, and maintenance of the equipment that will be conducted nationwide, and to Project beneficiaries (e.g., health worker and patient) due to potential operation failure of the new medical equipment. Risks of social exclusion issues are not envisaged, as the Project design and its goal focus on expanding access to essential health services, including to underserved areas. In addition, no groups or communities qualifying as Indigenous Peoples under the ESF will be adversely affected by the Project, as the Project activities focus on provisions of new medical equipment.

A draft Stakeholder Engagement Plan (SEP) is being prepared by the MoH. The SEP will outline general principles, information on previous engagement activities with relevant stakeholders during the project identification and preparation, stakeholder identification including vulnerable communities, and a collaborative strategy as well as the engagement process. In addition, detailed E&S monitoring and reporting arrangements will be determined during the appraisal. The SEP and other E&S instruments including ESMF and ESCP both in English and local language will be disclosed on the MoH website and consulted with key stakeholders as early as possible during the project preparation process. AIIB will provide links to those E&S instruments on its website.

A Grievance Redress Mechanism (GRM), as part of the SEP, will be established by the Project as a project-level GRM to let stakeholders lodge grievances or feedback for the Project that will be proportionate to the potential risks and impacts of the Project and will be accessible and inclusive. GRM specific to contracted workers involved directly or indirectly in Project activities will be provided to address grievances related to labor use and working condition and requirements to the borrower to the relevant primary suppliers to introduce procedures and mitigation measures to address safety issues on distribution, installation, operation, and maintenance of the new medical equipment. The information of the established GRM and the WB’s independent accountability mechanism (IAM) in the local language will be disclosed in an appropriate and timely manner.