Geographic Selection

As discussed in section 4.1.5 Geographical focus above, the three provinces of NTT, NTB and East Java have been selected in consultation with GoI based on four principles. Papua and East Papua were considered for inclusion given their low health outcomes and weak health systems but have not been included given DFAT’s plan to develop a separate health and development program for the Papuas.

Table 2 Selected Provinces for PERMATA Support

Rationale for selection Comment Other DFAT programs

Planned No. of districts NTT Highest prevalence of

stunting and high neonatal mortality. Second highest incidence of malaria in the country. Follow-on and

consolidation of support under AIPMNH.

Natural fit with AIPHSS. Quick wins to be gained

While maternal mortality rates have improved with DFAT program support over many years, newborn mortality remains high and over 50% of children under 5 are stunted. Previous investments have not addressed stunting or family planning.

NTT has high poverty levels and a largely rural population with large geographical barriers to accessing health services. Approaches that

AIPD; PNPM Generasi; PKH; Access; PAMSIMAS; previously AIPHSS 10

60 Rationale for selection Comment Other DFAT

programs Planned No. of districts through dissemination of successful MNH approaches developed under AIPMNH.

work in NTT are likely to be relevant to NTB, underperforming areas of Sulawesi, and the Papuas.

NTB High neonatal and infant mortality rates, and high levels of stunting. Natural fit as extension of NTT interventions. Other DFAT programs are active here.

One of the highest neonatal and infant mortality rates in the country.

Originally planned as an extension province in AIPMNH.

High poverty levels.

AIPD; PNPM Generasi; PKH; Access; PAMSIMAS 5 East Java Large population. Significant inequity. Large absolute numbers of very poor.

DFAT programs active.

While overall provincial maternal and neonatal health indicators are fair, there is considerable and significant inequity within the East Java population and across districts. Given the very large population (particularly compared to some eastern Provinces) this results in a VERY LARGE number of very poor and disadvantaged people. Opportunity to test models and approaches in a better resourced more populated region with a view to helping GoI scale up nationwide. Successful approaches in East Java are likely to be relevant to more urban and densely populated areas of the country.

East Java’s high political profile will facilitate translation of cost- effective models into national policy. AIPHSS; PNPM Generasi; PKH; Access; PAMSIMAS; MAMPU; previously AIPHSS 10 4.7.1 DISTRICT SELECTION

A set of criteria was developed for selecting the focal districts in NTT (see Annex 07). After extensive consultation with the Provincial Government, including the Governor, Bappeda and the Health Departments, and District Administrations, 10 districts were selected. It is not anticipated that the program will have activities in all sub-districts of each of these districts. PERMATA will follow the model

61 established in AIPMNH of agreeing a work plan with the district authorities in advance of any activities. This work plan will identify the activities and sub-districts where PERMATA activities will be implemented. In NTB selection of districts will be undertaken during the inception phase in consultation with the Government. Selection criteria used for NTT may be modified for NTB but will include colocation with other DFAT frontline health impacting programs such as the decentralisation program, village support program and social protection programs. Given that the decentralisation program has established relationships in four districts of North Lombok, West Lombok, Bima and Dompu it is likely, with national and local government agreement, that PERMATA will collocate in these districts and hence only one additional district will be chosen.

In East Java an initial analysis of districts and preliminary selection has been started. Five of the ten districts have been identified, but these will need to be agreed and the process completed with Government during inception.

Table 3 District Selected

Province NTT (total 10 districts) NTB (total 5 districts) East Java (total 10 districts) District selection Selected and agreed with

Provincial Government: 1. Flores Timur

2. TTU 3. Ngada

4. Sumba Barat Daya 5. Manggarai Barat 6. Manggarai 7. Lembata 8. TTS 9. Sumba Timur 10. Sumba Barat To be undertaken in inception year

Selection process begun but needs to be agreed and completed with Provincial Government: 1. Malang 2. Situbondo 3. Bondowoso 4. Sampang 5. Bangkalan

As a general rule PERMATA will seek to work in the same districts and sub-districts where other DFAT frontline programs are located to benefit from synergies, even if additional districts and/or sub-districts are supported by PERMATA. As discussed earlier, PERMATA will facilitate replication of successful models across sub-districts, districts and provinces, and technical assistance may well be used to support GoI with replication at all levels. A small budget for non-supported districts in the three provinces has been allocated to facilitate their involvement in learning activities, such as workshops, seminars and domestic study tours.

4.7.2 DISTRICT GRADUATION

Districts will be gradually introduced into PERMATA. In the inception year this will include 10 districts in NTT and five districts in East Java. A model for graduating districts will be developed during the inception year by the managing contractor in consultation with DFAT and GoI. This will include clear criteria for graduation and the likely pace of graduation given current levels of performance and evidence. The rationale behind graduation is for sustainability and as a measure of the GoI’s commitment to taking carriage over the objectives of the program. Graduation of districts will be complex where there is cross- district and/or phased implementation of key interventions and to allow sufficient time for evaluation. A

62 tentative trajectory of graduation has been built into the proposed budget and is presented below; this is based on 10 districts graduating out of the program before completion. That said, PERMATA will need to be flexible about graduation, given the potential delays in getting the demonstrations up and running and the long timeframes required to see outcomes. PERMATA will also explore the possibility of taking on new districts to replace graduated ones, pending resources.

Table 4 Assumed District Expansion

Assumed District Expansion

Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8

NTT 10 10 10 10 10 10 5 5

NTB 0 5 5 5 5 5 5 5

Jawa Timur 5 7 10 10 10 10 7 5

Total 15 22 25 25 25 25 17 15