RFP_72049718R00014_-_USAID_HEALTH_FINANCING_(HF)_ACTIVITY.pdf

COVER LETTER

RFP Issuance Date: June 21, 2018

Questions Due Date: July 11, 2018, 14:00PM, Jakarta Time

Closing Time for Past Performance Submission: August 13, 2018, 14:00PM, Jakarta Time

Closing Date for Proposals Submission: August 20, 2018, 14:00PM, Jakarta Time

E-mail Submission to: proposals-indo@usaid.gov

NAICS Code: 541 -- Professional, Scientific, and

Technical Services/541990 -- All Other Professional, Scientific, and Technical Services

Authorized Geographic Code: 937

SUBJECT: Request for Proposal No. 72049718R00014

USAID Health Financing (HF) Activity

The United States Agency for International Development (USAID) Mission in Indonesia is seeking proposals from U.S Small Business organizations to provide the services described in the attached Request for Proposals (RFP). USAID anticipates awarding one Cost-Plus-Fixed- Fee (CPFF) Completion type contract, with a total estimated cost in the range of $13 to $15 million, covering a total estimated period of five (5) years.

This procurement will be conducted under full and open competition procedures, pursuant to Part 15 of the Federal Acquisition Regulation (FAR) (48 CFR Chapter I).

If your organization decides to submit a proposal in response to this solicitation, it must be submitted in accordance with the instructions provided Section L of this RFP. Offerors must also carefully review Section M - Evaluation Factors. Sections B through I of the solicitation will become a substantive part of the anticipated contract with blanks to be completed by the Contracting Officer upon award. Section K - Representations, Certifications and Acknowledgements must be filled out in full.

All questions, comments, and requests for clarifications must be sent in writing to proposals-indo@usaid.gov no later than the date and time indicated above.

Contractor Past Performance Information, Technical and Cost Proposals are to be submitted separately to USAID/Indonesia no later than the closing dates stated above. If the proposal is received after the closing date and time, or if it is incomplete, it will not be accepted nor considered unless authorized by the Contracting Officer pursuant to FAR 15.208.

This RFP in no way obligates USAID to award a contract nor does it commit USAID to pay any costs incurred in the preparation and submission of a proposal. Award of a contract under this mailto:proposals-indo@usaid.gov mailto:proposals-indo@usaid.gov mailto:proposals-indo@usaid.gov http://www.fbo.gov/

SOLICITATION, OFFER AND AWARD 1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 7900)

RATING PAGE OF PAGES

2. CONTRACT NUMBER 3. SOLICITATION NUMBER 4. TYPE OF SOLICITATION 5. DATE ISSUED 6. REQUISITION/PURCHASE NUMBER

CODE7. ISSUED BY 8. ADDRESS OFFER TO (If other than item 7)

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

SOLICITATION

9. Sealed offers in original and copies for furnishings the supplies or services in the Schedule will be received at the place specified in item 8, or if hand carried, in the depository located in until local time

CAUTION - LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

10. FOR

INFORMATION

CALL:

A. NAME B. TELEPHONE (NO COLLECT CALLS)

AREA CODE NUMBER EXT.

C. E-MAIL ADDRESS

11. TABLE OF CONTENTS

(X) SEC. DESCRIPTION PAGE(S) (X) SEC. PAGE(S)DESCRIPTION

A B C D E F G H

I

J

K

L

M EVALUATION FACTORS FOR AWARD

INSTRS., CONDS., AND NOTICES TO OFFERORS

REPRESENTATIONS, CERTIFICATIONS AND OTHER

STATEMENTS OF OFFERORS

PART IV - REPRESENTATIONS AND INSTRUCTIONS

LIST OF ATTACHMENTS

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

CONTRACT CLAUSESSOLICITATION/CONTRACT FORM

SUPPLIES OR SERVICES AND PRICES/COSTS

DESCRIPTION/SPECS./WORK STATEMENT

PACKAGING AND MARKING

INSPECTION AND ACCEPTANCE

DELIVERIES OR PERFORMANCE

CONTRACT ADMINISTRATION DATA

SPECIAL CONTRACT REQUIREMENTS

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

OFFER (Must be fully completed by offeror)

12. In compliance with the above, the undersigned agrees, if this offer is accepted within calendar days (60 calendar days unless a different period is inserted by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT

(See Section I, Clause No. 52.232-8)

14. ACKNOWLEDGMENT OF AMENDMENTS

(The offeror acknowledges receipt of amendments to the SOLICITATION for offerors and related documents numbered and dated):

10 CALENDAR DAYS (%) 20 CALENDAR DAYS (%) 30 CALENDAR DAYS (%) CALENDAR DAYS(%)

DATEAMENDMENT NO.AMENDMENT NO. DATE

15A. NAME AND

ADDRESS

OF OFFER-

OR

CODE FACILITY 16. NAME AND THE TITLE OF PERSON AUTHORIZED TO SIGN OFFER

(Type or print)

15B. TELEPHONE NUMBER

AREA CODE NUMBER EXT.

15C. CHECK IF REMITTANCE ADDRESS IS

DIFFERENT FROM ABOVE - ENTER SUCH

ADDRESS IN SCHEDULE.

17. SIGNATURE 18. OFFER DATE

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEMS 20. AMOUNT 21. ACCOUNTING AND APPROPRIATION

22. AUTHORITY FOR USING OTHER THAN FULL OPEN COMPETITION:

10 U.S.C. 2304 (c) 41 U.S.C. 253 (c)

24. ADMINISTERED BY (If other than Item 7)

26. NAME OF CONTRACTING OFFICER (Type or print)

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

(4 copies unless otherwise specified)

25. PAYMENT WILL BE MADE BY

27. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

28. AWARD DATE

CODE

ITEM

STANDARD FORM 33 (REV,. 9-97)

Prescribed by GSA - Far (48 CFR) 53.214 (c)

SEALED BID (IFB)

NEGOTIATED (RFP)

(Hour) (Date)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

3 162

REQ-497-18-000038

USAID/Indonesia, US Embassy Annex, Gedung Sarana Jaya, Jl. Budi Kemuliaan I/1, Jakarta, 10110 Indonesia

72049718R00014

N/A OAA, USAID/Indonesia 14:00

Yulian Christanti proposals-indo@usaid.gov

65 142

08/20/2018

6221 34359000

06/21/2018

RFP NO.72049718R00014

USAID HEALTH FINANCING (HF) ACTIVITY

Table of Contents

COVER LETTER

SECTION A – SOLICITATION, OFFER AND AWARD FORM

LIST OF ACRONYMS

PART I – THE SCHEDULE

SECTION B – SUPPLIES OR SERVICES AND COST/PRICES

B.1 PURPOSE

B.2 CONTRACT TYPE AND CONTRACT SERVICES

B.3 ESTIMATED COST, FIXED FEE, AND OBLIGATED AMOUNT

B.4 PRICE SCHEDULE

B.5 REIMBURSABLE COSTS

B.6 INDIRECT COST

B.7 ADVANCE UNDERSTANDING ON CEILING INDIRECT COST RATES AND FINAL

PERFORMANCE FOR INDIRECT COSTS

B.8 FIXED FEE - FAR 52.216-8 (JUN 2011)

B.9 MULTI-YEAR CONTRACT

SECTION C – DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

C.1 PURPOSE

C.2 BACKGROUND

C.3 CURRENT USAID STRATEGIC FRAMEWORK

C.4 TECHNICAL APPROACH

C.5 USAID HEALTH FINANCING CAPABILITIES

C.6 GEOGRAPHIC FOCUS

C.7 MONITORING AND EVALUATION/DATA

C.8 GENDER ANALYSIS

C.9 USAID MANAGEMENT

C.10 INITIAL ENVIRONMENTAL EXAMINATION

C.11 REFERENCES FOR USAID SUPPORT IN THE AREA OF HEALTH FINANCING 37

SECTION D – MARKING AND BRANDING

D.1 AIDAR 752.7009 MARKING (JAN 1993)

D.2 MARKING AND BRANDING STRATEGY

SECTION E – INSPECTION AND ACCEPTANCE

E.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

E.2 INSPECTION AND ACCEPTANCE

E.3 PERFORMANCE STANDARDS

SECTION F – DELIVERIES OR PERFORMANCE

F.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

F.2 PERIOD OF PERFORMANCE

F.3 PLACE OF PERFORMANCE

F.4 KEY PERSONNEL

SECTION G – CONTRACT ADMINISTRATION DATA

G.1 ADMINISTRATIVE CONTRACTING OFFICE

G.2 CONTRACTING OFFICER’S AUTHORITY

G.3 CONTRACTING OFFICER’S REPRESENTATIVE (COR)

G.4 CONTRACTOR’S PRIMARY POINT OF CONTACT

G.5 AIDAR 752.7003 DOCUMENTATION FOR PAYMENT (NOV 1998)

G.6 PAYING OFFICE

G.7 ACCOUNTING AND APPROPRIATION DATA

SECTION H – SPECIAL CONTRACT REQUIREMENTS

H.1 NOTICE LISTING CONTRACT CLAUSE INCORPORATED BY REFERENCE

H.2 AUTHORIZED GEOGRAPHIC CODE

H.3 LOGISTIC SUPPORT

H.4 LANGUAGE REQUIREMENTS

H.5 AIDAR 752.7007 PERSONNEL COMPENSATION (JULY 2007)

H.6 AUTHORIZED WORK WEEK

H.7 AIDAR 752.7004 EMERGENCY LOCATOR INFORMATION (JULY 1997)

H.8 GOVERNMENT FURNISHED FACILITIES OR PROPERTY

H.9 AIDAR 752.231-71 SALARY SUPPLEMENTS FOR HOST GOVERNMENT (HG)

EMPLOYEES (MAR 2015)

H.10 EXECUTIVE ORDER ON TERRORISM FINANCING (FEB 2002)

H.11 AIDAR 752.222-70 USAID DISABILITY POLICY – ACQUISITION (DECEMBER

2004)

H.12 AIDAR 752.245-71 TITLE TO AND CARE OR PROPERTY (APRIL 1984)

H.13 AIDAR 752.7032 - INTERNATIONAL TRAVEL APPROVAL AND NOTIFICATION

REQUIREMENTS (APRIL 2014)

H.14 AIDAR 752.229-71 REPORTING OF FOREIGN TAXES (JULY 2007)

H.15 AIDAR 752.222-71 NONDISCRIMINATION (JUNE 2012)

H.16 FOREIGN GOVERNMENT DELEGATION TO INTERNATIONAL CONFERENCES

(JAN 2002)

H.17 SUBCONTRACTOR CONSENT

H.18 BUSINESS CLASS TRAVEL

H.19 AIDAR 752.7036 USAID IMPLEMENTING PARTNER NOTICES (IPN) PORTAL

FOR ACQUISITION (JULY 2014)

H.20 AIDAR 752.228-3 WORKER’S COMPENSATION INSURANCE (DEFENSE BASE

ACT)

H.21 DEFENCE BASE ACT (DBA) INSURANCE FOR 2015 – 2020

H.22 ELECTRONIC PAYMENTS SYSTEM

H.23 VALUE ADDED TAX AND CUSTOMS DUTIES

H.24 CONFLICT OF INTEREST

H.25 DISCLOSURE OF INFORMATION

H.26 ENVIRONMENTAL COMPLIANCE

H.27 PUBLICATIONS, VIDEOS OR OTHER INFORMATION MEDIA PRODUCTS

H.28 USAID-FINANCED THIRD-PARTY WEB SITES (AUG 2013)

H.29 RESTRICTIONS AGAINST DISCLOSURE (MAY 2016)

H.30 SOFTWARE LICENSE ADDENDUM (MAY 2016)

H.31 ELECTRONIC AND INFORMATION TECHNOLOGY (MAY 2016)

H.32 USE OF INFORMATION TECHNOLOGY (MAY 2016) – (DEVIATION NO.M/OAA-

DEV-FAR-16-1c)

H.33 MEDIA AND INFORMATION HANDLING AND PROTECTION (MAY 2016)

H.34 PRIVACY AND SECURITY INFORMATION TECHNOLOGY SYSTEM INCIDENT

REPORTING (MAY 2016)

H.35 SKILLS AND CERTIFICATION REQUIREMENTS FOR PRIVACY AND SECURITY

STAFF (MAY 2016)

H.36 SECURITY REQUIREMENTS FOR UNCLASSIFIED INFORMATION

TECHNOLOGY RESOURCES (MAY 2016)

PART II – CONTRACT CLAUSES

SECTION I – CONTRACT CLAUSES

I.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

I.2 FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

I.3 FAR 52. 215-23 LIMITATIONS ON PASS-THROUGH CHARGES (OCT 2009)

I.4 FAR 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR

INFORMATION SYSTEMS (JUN 2016)

I.5 FAR 52.216-24 LIMITATIONS OF GOVERNMENT LIABILITY (APRIL 1984)

I.6 FAR 52.219-6 NOTICE OF TOTAL SMALL BUSINESS SET-ASIDE (NOV 2011) ... 103

I.7 FAR 52.219-14 LIMITATION ON SUBCONTRACTING (JAN 2017)

PART III – LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS

SECTION J – ATTACHMENTS

PART IV – REPRESENTATION AND INSTRUCTIONS

SECTION K – REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS OF

BIDDERS

K.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

K.2 FAR 52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS (JAN 2018) ..

K.3 FAR 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL

2013)

K.4 FAR 52.219-1 SMALL BUSINESS REPRESENTATIONS (OCT 2014)

K.5 INSURANCE - IMMUNITY FROM TORT LIABILITY

K.6 AGREEMENT ON, OR EXCEPTIONS TO, TERMS AND CONDITIONS

K.7 SIGNATURE

SECTION L – INSTRUCTIONS, CONDITIONS, AND NOTICES TO BIDDERS

L.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

L.2 FAR 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

(FEB 1998)

L.3 FAR 52.215-1 INSTRUCTION TO OFFEROR – COMPETITIVE ACQUISITION

(JAN 2017) & ALTERNATE I (OCT 1997)

L.4 FAR 52.215-22 LIMITATIONS ON PASS-THROUGH CHARGES –

IDENTIFICATION OF SUBCONTRACT EFFORT (OCT 2009)

L.5 FAR 52.215-23 LIMITATIONS ON PASS-THROUGH CHARGES (OCT 2009)

L.6 FAR 52.233-2 SERVICE OF PROTEST (SEP 2006)

L.7 FAR 52.216-1 TYPE OF CONTRACT (APR 1984)

L.8 QUESTIONS AND CLARIFICATION

L.9 PROPOSAL PREPARATION AND DELIVERY INSTRUCTIONS

L.10 GOVERNMENT OBLIGATION

L.11 UNNECESSARILY ELABORATE PROPOSAL

L.12 INSTRUCTIONS FOR THE PREPARATION OF THE TECHNICAL PROPOSAL 126

L.13 COMPONENTS OF TECHNICAL PROPOSAL

L.14 INSTRUCTIONS FOR THE PREPARATION OF THE COST PROPOSAL

L.15 INSTRUCTIONS FOR THE PREPARATION OF BRANDING IMPLEMENTATION

AND MARKING PLAN

L.16 FAR 52.222-56 CERTIFICATION REGARDING TRAFFICKING IN PERSONS

COMPLIANCE PLAN (MAR 2015)

SECTION M – EVALUATION FACTORS FOR AWARD

M.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

M.2 GENERAL INFORMATION

M.3 TECHNICAL EVALUATION FACTORS

M.4 COST EVALUATION FACTOR

M.5 DETERMINATION OF THE COMPETITIVE RANGE AND CONTRACT AWARD

M.6 BRANDING IMPLEMENTATION AND MARKING PLAN

ATTACHMENT 1 – SF LLL – DISCLOSURE OF LOBBYING ACTIVITIES

ATTACHMENT 2 – CONTRACTOR’S PAST PERFORMANCE INFORMATION

ATTACHMENT 3 – PAST PERFORMANCE REFERENCE FORM

ATTACHMENT 4 – INITIAL ENVIRONMENT EXAMINATION (IEE)

LIST OF ACRONYMS

AMELP - Activity Monitoring, Evaluation, and Learning Plan ADS - Automated Directive System ASEAN - Association of Southeast Asian Nations BCG - Boston Consulting Group BPJS-K - Badan Penyelenggara Jaminan Sosial – Kesehatan CDCS - Country Development Cooperation Strategy CHPM - Center for Health Policy and Management CHEPS - Center for Health Economics and Policy Studies CO - Contracting Officer COR - Contracting Officer’s Representative CTB - Challenge TB DDL - Development Data Library DEC - Development Experience Clearinghouse DJSN - Dewan Jaminan Sosial Nasional DKI Jakarta - Daerah Khusus Ibukota Jakarta DO - Development Objective DOC - Development Outreach and Communications EMMP - Environmental Mitigation and Monitoring Plan EQA - External Quality Assurance FOIA - Freedom of Information Act GIS - Geographic Information System GOI - Government of Indonesia HF - Health Financing HFG - Health Finance and Governance HIC - High Income Countrie(s) HFG - Health Finance and Governance KARS - Komisi Akreditasi Rumah Sakit (Commission for the Accreditation of

Hospitals) INA-CBG - Indonesian Case Based Groups INAHEA - Indonesia Health Economics Association INDOHUN - Indonesia One Health University Network IEE - Initial Environmental Examination IR - Intermediate Results JKN - Jaminan Kesehatan National M&E - Monitoring and Evaluation MIC - Middle Income Countrie(s) MOH - Ministry of Health MOF - Ministry of Finance OOP - Out-of-Pocket OECD - Organization for Economic Cooperation and Development PBI - Penerima Bantuan Iuran PMP - Performance Management Plan PPR - Performance Plan and Report RPJMN - Rencana Pembangunan Jangka Menengah Nasional SHI - Social Health Insurance SJSN - Sistem Jaminan Sosial Nasional TB - Tuberculosis TBPS - Tuberculosis Private Sector

THE - The Health Expenditure TNP2K - Tim Nasional Percepatan Penanggulangan Kemiskinan UHC - Universal Health Coverage

PART I – THE SCHEDULE

SECTION B – SUPPLIES OR SERVICES AND COST/PRICES

B.1 PURPOSE

The purpose of this Contract is to provide technical assistance and other services as described in detail in Section C - Statement of Work, to sustain and increase efficiency in financing for health to improve financial protection, equitable access to quality health services, and health outcomes in USAID priority areas of HIV, Tuberculosis (TB), and Maternal and Newborn Health

(MNH)

B.2 CONTRACT TYPE AND CONTRACT SERVICES

This is a Cost-Plus-Fixed-Fee (CPFF) completion type contract. For the consideration set forth below, the Contractor must accomplish the performance objectives and provide the results, deliverables and output as described in Section C and Section F, and in accordance with the performance standards specified therein.

B.3 ESTIMATED COST, FIXED FEE, AND OBLIGATED AMOUNT

B.3.1 The estimated cost for the performance of the work required hereunder, exclusive of fixed fee, if any, is $ [INSERTED AT AWARD]. The fixed fee, if any, is $ [INSERTED AT AWARD]. The total estimated cost plus fixed fee, if any, is $ [INSERTED AT AWARD].

B.3.2 Within the estimated cost plus fixed fee (if any) specified in paragraph B.3.1.(a) above, the amount currently obligated and available for reimbursement of allowable costs incurred by the Contractor (and payment of fee, if any) for performance hereunder is $ [INSERTED AT AWARD]. The Contractor must not exceed the aforesaid obligated amount nor will the Government be responsible for costs incurred should the Contractor do so.

B.3.3 Funds obligated hereunder are anticipated to be sufficient through [INSERTED AT

AWARD].

B.4 PRICE SCHEDULE

The Contractor is not allowed to exceed any Contract Line Item nor is authorized to shift funding between Contract Line Items without prior written approval of the Contracting Officer. The fee is fixed according to the Contract Summary Budget and the terms of this Contract.

[ PRICE SCHEDULE INSERTED AT AWARD]

B.5 REIMBURSABLE COSTS

The U.S. dollar costs reimbursable under this contract will be limited to those costs determined to be necessary allocable, allowable, and reasonable as determined in accordance with FAR 31 (Contract Cost Principles), 2 CFR 215 (Uniform Administrative Requirements for Grants and Agreements with Institutions of Higher Education, Hospitals, and Other Non-profit Organizations), 2 CFR 230 (Cost Principles for Non-Profit Organization), FAR 52.216-7, (Allowable Cost and Payment), and FAR 52.216-8, (Fixed Fee), if applicable, and AIDAR

752.7003 (Documentation for Payment).

B.6 INDIRECT COST

The Contractor is allowed to recover applicable indirect costs (i.e., overhead, G&A, etc.) on other direct costs (ODCs), if it is part of the Contractor’s usual accounting procedures, consistent with FAR Part 31, and an approved Negotiated Indirect Cost Rate Agreement

(NICRA).

Pending establishment of revised provisional or final indirect cost rates, for each of the Contractor’s accounting periods which apply to this Contract, allowable indirect costs must be reimbursed on the basis of the following negotiated provisional or predetermined rates applied to the bases which are set forth below:

Description Year 1 Year 2 Year 3 Year 4 Year 5 Type of Rate:

Base of Application:

Period:

[INDIRECT COST FOR PRIME CONTRACTOR AND

ANY MAJOR SUBCONTRACTORS INSERTED AT AWARD]

B.7 ADVANCE UNDERSTANDING ON CEILING INDIRECT COST RATES AND FINAL

PERFORMANCE FOR INDIRECT COSTS

B.7.1 Reimbursement for indirect costs will be at final negotiated rates, but not in excess of the following ceiling rates:

Description Year 1 Year 2 Year 3 Year 4 Year 5 Type of Rate:

Base of Application:

Period:

[CEILING RATES FOR PRIME CONTRACTOR AND

ANY MAJOR SUBCONTRACTORS INSERTED AT AWARD]

B.7.2 The U.S. Government will not be obligated to pay any additional amount should the final indirect cost rates exceed the negotiated ceiling rates. If the final indirect cost rates are less than the negotiated ceiling rates, the negotiated rates will be reduced to conform with the lower rates.

B.7.3 This understanding must not change any monetary ceiling, obligation, or specific cost allowance or disallowance. Any changes in classifying or allocating indirect costs require the prior written approval of the Contracting Officer.

B.8 FIXED FEE - FAR 52.216-8 (JUN 2011)

USAID paying office ordinarily pays the Contractor a percentage of a fixed fee that directly corresponds to the percentage of allowable costs being paid. Two exceptions to paying fixed fee in this manner apply:

(1) If the CO determines that this method results in paying a disproportionately higher ratio of fixed fee than the percentage of work that the Contractor has completed, then the CO may suspend further payment of any fixed fee until the Contractor has made sufficient progress to justify further payment, up to the agreed percentage.

(2) The clauses entitled "Allowable Cost and Payment" (FAR 52.216-7) and "Fixed Fee"

(FAR 52.216-8) are incorporated into this contract. The terms and conditions of these clauses apply after total payments of fixed fee reach eighty-five percent (85%) of the total fixed fee.

B.9 MULTI-YEAR CONTRACT

All contract CLINs under this award are considered non-severable and constitutes a multi-year contract as defined in FAR 17.103. Therefore, this contract is subject to the requirements of FAR 17.106. In the event that the Government cancels requirements for services in subsequent program years under this contract, the following conditions will apply:

[CANCELLATION DATES AND AMOUNTS INSERTED AT AWARD]

Cancellation Dates:

Contract Year 2: DATE TBD, 2019 Amount: $1 Contract Year 3: DATE TBD, 2020 Amount: $1 Contract Year 4: DATE TBD, 2021 Amount: $1 Contract Year 5: DATE TBD, 2022 Amount: $1

Cancellation Ceiling:

This is a CPFF completion type contract where the Contractor is authorized to be reimbursed for all costs which are allowable in accordance with FAR 52.216-7, “Allowable Costs and Payment

(June 2013).” Therefore, the Contractor will not incur any costs which would have been amortized over the life of the contract should the contract be cancelled in accordance with FAR 52.217-2, “Cancellation under Multi year Contracts (October 1997).” Therefore, the cancellation ceiling for each cancellation date is provided above.

[END OF SECTION B]

SECTION C – DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

C.1 PURPOSE

The purpose of this Activity is to support the Government of Indonesia (GOI) to sustain and increase efficiency in financing for health to improve financial protection, equitable access to quality health services, and health outcomes in USAID priority areas of HIV, Tuberculosis (TB), and Maternal and Newborn Health (MNH).

C.2 BACKGROUND

C.2.1 Health Financing Opportunities and Challenges in Indonesia

Significant progress has been made in implementing health financing reforms in Indonesia.

Against the backdrop of reforms begun in 1998, including the devolution of authority to the districts and provinces and the beginning of decentralization, the GOI began implementation in 2014 of a mandatory social health insurance program (Jaminan Kesehatan Nasional – JKN) to cover all Indonesians by 2019. As of May 1, 2018, over 196 million Indonesians have been registered under JKN.0F

1 Today, at the sub-national level, local governments have the authority to make locally-appropriate decisions on how to best allocate their resources to provide healthcare services to their constituents, including the licensing of private providers and facilities, while a central purchasing entity pools risk across the population and standardizes the purchasing of health care services from public and private providers. Despite recent progress, Indonesia faces the following challenges in financing its health system and ensuring financial protection for the poor and marginalized populations.

Low investment in health: Although, total health expenditure (THE) has increased over the years, the country has historically underspent on health, especially compared to its regional peers at the same income level, and is considered one of the lowest among the ASEAN countries. In 2015, Indonesia spent 3.6% of GDP on health ($121 per capita), an increase from 3.1% in 2012. Such low spending is a cause for concern as the country aims to reach universal health coverage (UHC). For the first time in 2016, GOI allocated 5% of its general government expenditure (central budget) to health.1F

Financial protection: In Indonesia, THE comes from four main sources: government (central and local government), social health insurance (SHI), voluntary/private insurance, and household out-of-pocket (OOP). External and donor financing only contributes a small share (less than 1%). In 2015, after JKN implementation, government spending on health was 22.2% of THE, SHI was 14.7% of THE, voluntary/private was 15.4% of THE and OOP was the largest at 47.6% of THE.2F

3 Although, OOP has decreased from 55.4% in 2012 (pre-JKN) to 47.6% in

1 https://bpjs-kesehatan.go.id/bpjs/index.php/jumlahPeserta 2 Prastuti Soewondo. National Health Accounts Indonesia - Achievements and Challenges. MoH World Health Day workshop on May 2, 2018 https://pdf.usaid.gov/pdf_docs/PA00T4JD.pdf 3 Prastuti Soewondo. National Health Accounts Indonesia - Achievements and Challenges. MoH World Health Day workshop on May 2, 2018 https://pdf.usaid.gov/pdf_docs/PA00T4JD.pdf https://bpjs-kesehatan.go.id/bpjs/index.php/jumlahPeserta https://pdf.usaid.gov/pdf_docs/PA00T4JD.pdf

2015 (post-JKN), the WHO recommended level is 30% or below. Thus, more work needs to be done as the 2015 level of OOP spending represents a high burden for households, particularly the 40% of the Indonesian population who lives on less than $2 per day.

Effective coverage: Ideally, Indonesia needs to significantly increase government spending on health, while simultaneously improving the quality of spending if it wanted to truly achieve UHC:

● Equity in access to health services - everyone who needs services should get them, not only those who can pay for them;

● The quality of health services should be good enough to improve the health of those receiving services; and

● People should be protected against financial-risk, ensuring that the cost of using services does not put people at risk of financial harm.

With about 69% of Indonesia’s population covered as of May 1, 2018, this is a representation of enrollment numbers and does not adequately reflect effective coverage or the actual financial protection of those who utilizes the health system. Although, GOI currently spends significant resources to fully subsidize the contributions of 92.2 million poor and near-poor (PBI - Penerima Bantuan Iuran) under JKN, this does not ensure equitable access to quality health services.

Inequities with regards to who benefits from JKN are evident across JKN membership groups as well as geographic inequities.3F

4 4F

Financial sustainability of JKN: Since the establishment of the BPKS-K insurance fund, total expenditures have exceeded total revenues on an annual basis.

The GOI covers the premiums of the PBI while the informal and formal sectors must contribute.

As in any contributory system, Indonesia faces a significant ‘missing middle’ issue, specifically among the informal sector population, leaving them vulnerable to catastrophic health expenditures, and hampering BPJS-K’s ability to pool funds for JKN.5F

6 Formal sector workers are hesitant to sign on to JKN as they do not want to give up their private insurance or do not want to use BPJS-K contracted providers and services. As JKN matures there, furthermore, needs to be a regulatory framework for a growing, vibrant private supplemental health insurance market, which is synchronous with the BPJS-K system.6F

There is pressure to increase the current premiums as the main source of new revenue.

However, as formal sector premiums increase they can distort economic growth taking the form of greater informality, loss of capital investment and loss of job formation. At the same time there is a need to identify a diverse and yet sustainable revenue base for future outlays under BPJS-K. This could include general revenues, earmarked taxes such as sin taxes or fuel subsidies, contribution through local government funds, or new innovative financing

4 Healthcare Utilization Trends Under Indonesia’s National Health Insurance Scheme: 2011–2016 https://pdf.usaid.gov/pdf_docs/PA00T4PN.pdf 5 A Benefit Incidence Analysis of JKN Hospital Expenditure https://pdf.usaid.gov/pdf_docs/PA00T4P6.pdf 6 The Financial Sustainability of Indonesia’s National Health Insurance Scheme: 2017–2021 https://pdf.usaid.gov/pdf_docs/PA00T4PB.pdf 7 Expanding Healthcare Access through the Private Sector https://pdf.usaid.gov/pdf_docs/PA00T4PJ.pdf https://pdf.usaid.gov/pdf_docs/PA00T4PN.pdf https://pdf.usaid.gov/pdf_docs/PA00T4P6.pdf https://pdf.usaid.gov/pdf_docs/PA00T4P6.pdf https://pdf.usaid.gov/pdf_docs/PA00T4PB.pdf https://pdf.usaid.gov/pdf_docs/PA00T4PB.pdf https://pdf.usaid.gov/pdf_docs/PA00T4PB.pdf https://pdf.usaid.gov/pdf_docs/PA00T4PJ.pdf mechanisms. As the economy grows and fiscal space increases, the Ministry of Finance (MOF) needs to work with the health sector to move this forward.7F

Collectability has been a challenge in terms of beneficiaries signing up, utilizing care and then dropping out of the system. New approaches are needed to maintain more reliable and predictable collection processes.

JKN offers a comprehensive, implicit benefit package and the Ministry of Health (MOH) only specifies a negative list of what is not covered without any cost-sharing in place. There are need to be more analysis on what should be the appropriate benefit package for the Indonesian population as well as an appropriate cost sharing mechanism that discourages unnecessary care while maintaining adequate financial protection.

Purchasing health services: At present, only about 15% of Indonesia’s THE comes from SHI and there remains substantial co-financing from supply-side budgetary expenditures at public facilities. As coverage expands under JKN, there is a significant increase in utilization, and expenditures are increasing more rapidly than revenues. Currently, BPJS-K purchases from both public and private providers a comprehensive benefit package of services with no cost share. The two main provider payment mechanisms include capitation at the primary care level and diagnostic related groups, termed Indonesian Case Based Groups (INA-CBG) at the secondary level. Improving the efficiency of JKN expenditures is necessary for making progress towards UHC, and there is an imperative to make better use of existing funds through strategic purchasing of JKN services.8F

However, for strategic purchasing to be effective in Indonesia, a holistic approach is needed that addresses all financing sources and services, including for USAID priority health programs, i.e., TB, MNH and HIV. Concerns remain about whether and how the MOH line-item budget, for centrally managed and funded programs like TB and HIV, should be integrated into JKN. Similar concerns lie at the sub national level where local governments are allocating resources from their budgets to the health sector. As the Indonesian economy matures and Indonesia transitions into being an upper middle income country, donor support for TB, HIV and MNH programs will further reduce. The most effective ways to pay for and sustain TB, MNH and HIV programs, in the JKN era, needs to be explored.9F

Given the fact that Indonesia faces a high burden of both communicable and noncommunicable diseases, the Indonesian health service delivery model will need to evolve to ensure cost per patient served is stabilized and contained, and quality care is consistently improved. Less cost-effective hospital-based care as a percentage of expenditures has increased under JKN, when JKN was intended to promote primary and outpatient care.10F

11 About two-thirds of JKN expenditure is on curative and rehabilitative care, with only a small proportion being spent on primary care, promotive and preventive care, indicating significant inefficiencies in the JKN

8 The Financial Sustainability of Indonesia’s National Health Insurance Scheme: 2017–2021

9 Overview of Strategic Purchasing Functions Under JKN https://pdf.usaid.gov/pdf_docs/PA00SVZR.pdf 10 Concept Note: Strategic Health Purchasing for UHC in Indonesia Phase 2 USAID/HFG and World Bank Collaboration: Strategic Purchasing for Priority Programs https://pdf.usaid.gov/pdf_docs/PA00SVZK.pdf 11 Purchasing of Referral Services Under JKN https://pdf.usaid.gov/pdf_docs/PA00SVZQ.pdf https://pdf.usaid.gov/pdf_docs/PA00T4PB.pdf https://pdf.usaid.gov/pdf_docs/PA00T4PB.pdf https://pdf.usaid.gov/pdf_docs/PA00T4PB.pdf https://pdf.usaid.gov/pdf_docs/PA00SVZR.pdf https://pdf.usaid.gov/pdf_docs/PA00SVZR.pdf https://pdf.usaid.gov/pdf_docs/PA00SVZK.pdf https://pdf.usaid.gov/pdf_docs/PA00SVZK.pdf https://pdf.usaid.gov/pdf_docs/PA00SVZQ.pdf https://pdf.usaid.gov/pdf_docs/PA00SVZQ.pdf gatekeeping / referral system and a high likelihood of escalating health care costs.11F

12 Financial incentives must align to prioritize primary and preventive services and ensure appropriate and high-quality diagnostic and curative services.12F

13 Increased coverage by national health insurance systems can be an opportunity to improve incentives for services in priority programs, but global experience shows that expansion of insurance programs, particularly with a curative care focus such as JKN, may crowd out resources for preventive and other priority services.

Finally, given that BPJS-K contracts with both public and private facilities, the JKN system needs to better understand and develop provider payment mechanisms that allocate equitable payments and are attractive to private providers, thus leading to improved access for all BPJS-K members and increased private investments in the health sector. Furthermore, local governments will need to allow a more competitive delivery of services across an integrated public and private mix of providers.13F

14 14F

Strategic purchasing has the potential to drive all three, service delivery system reform, including equitable access to the needed health care services across geographies and population groups, stabilization of cost per patient served and improved health outcomes.15F

Quality of Care: To ensure a satisfactory level of quality of hospital services, the GOI requires hospitals to undergo periodic accreditation. To that end, in 1996 a hospital accreditation body known as KARS (Komisi Akreditasi Rumah Sakit or Commission for the Accreditation of Hospitals) was established by the MOH. All hospitals are required to obtain accreditation through the KARS system every three years as mandated by the MOH and also as a requirement for participating in JKN. However, as of 2017, only 1,164 of the approximately 2,760 hospitals (42%) in the country had achieved accreditation. This has been attributed to low demand for accreditation as well as inadequate capacity in country to accredit facilities.

Currently BPJS-K does not enforce accreditation as a precondition for a JKN contract.16F

In addition to hospital accreditation, GOI has been working to develop an accreditation system for primary health services, including Puskesmas (public primary care facilities), private primary health centers, private doctors’ clinics, and dental offices. As of February 2018, about 50% or 4,200 Puskesmas were accredited as required by the law to function as a gatekeeper under the JKN system, i.e., to provide referrals for higher level care. Private primary care facility accreditation is yet to be introduced.

While the Indonesian MOH is the steward of health services, the country’s decentralized structure has assigned the delivery of healthcare services to the local government with the MOH issuing quality guidelines and policies to be implemented and monitored at the sub-national

12 The Financial Sustainability of Indonesia’s National Health Insurance Scheme: 2017–2021

13 Purchasing of Primary Health Care Under JKN https://pdf.usaid.gov/pdf_docs/PA00SVZP.pdf 14 RE-ENVISIONING MATERNAL AND NEWBORN HEALTH IN INDONESIA How the Private Sector and Civil Society Can Ignite Change https://pdf.usaid.gov/pdf_docs/PA00MCZ9.pdf 15 Indonesia’s Private Health Sector (2 briefs) http://www.healthpolicyplus.com/pubs.cfm?get=8224 16 Overview of Strategic Purchasing Functions Under JKN https://pdf.usaid.gov/pdf_docs/PA00SVZR.pdf 17 HAPIE Midline Report https://pdf.usaid.gov/pdf_docs/PA00M645.pdf https://pdf.usaid.gov/pdf_docs/PA00T4PB.pdf https://pdf.usaid.gov/pdf_docs/PA00T4PB.pdf https://pdf.usaid.gov/pdf_docs/PA00T4PB.pdf https://pdf.usaid.gov/pdf_docs/PA00SVZP.pdf https://pdf.usaid.gov/pdf_docs/PA00SVZP.pdf https://pdf.usaid.gov/pdf_docs/PA00MCZ9.pdf https://pdf.usaid.gov/pdf_docs/PA00MCZ9.pdf http://www.healthpolicyplus.com/pubs.cfm?get=8224 http://www.healthpolicyplus.com/pubs.cfm?get=8224 https://pdf.usaid.gov/pdf_docs/PA00SVZR.pdf https://pdf.usaid.gov/pdf_docs/PA00SVZR.pdf https://pdf.usaid.gov/pdf_docs/PA00M645.pdf https://pdf.usaid.gov/pdf_docs/PA00M645.pdf level.17F

18 This system contrasts sharply with the top-down administrative apparatus of BPJS-K, i.e., a highly centralized health care services purchasing agency. BPJS-K could use its power as a single purchaser to drive quality of care across all levels of the healthcare delivery system.18F

How BPJS-K reimburses health care providers has the potential to drive quality. Additionally, the tariff paid by BPJS-K could incentivize the over or under delivery of health care interventions as well as impact quality.

Currently, BPJS-K is implementing a performance-based capitation program to incentivize improvements in the quality of care at the primary care level. However, BPJS-K has not fully developed tools for greater accountability of performance. For example, it does not track key quality of care indicators like hospital readmissions or hospital acquired infections at the secondary level. To improve efficiency and better track quality, BPJS-K will soon pilot a hospital global budget project in two districts, Tanah Datar and Cilegon City.19F

20 This pilot could be a start to contain growing volumes of admissions and growing hospital costs, as well as one that should start tracking quality of care indicators.

BPJS-K Quality and Cost Control Teams at the national, provincial and local levels as well as in health facilities, are tasked to assess provider compliance with clinical guidelines and the consumption of health care commodities as part of the insurance claims review process. Some of their tasks include determining professional authority, utilization review and medical audit, compliance with ethical and disciplinary standards, and monitoring consumption of medicines and other commodities. This is a promising strategy to ensure facility compliance with established standards, fidelity to acceptable service delivery processes, and monitoring health outcomes. Results from this team are yet to be made publicly available.20F

Governance: As goes with any major sector reform, the health financing reform in Indonesia has a complex set of laws and regulations that guide its implementation. The SJSN Law 2004 established the National Social Security Program, under which the single purchaser system was established, with BPJS-K serving as the national health insurance agency reporting directly to the President of Indonesia. The MOH remains the steward of the health system while also retaining key strategic functions like premium setting, provider payment design, tariff setting (for capitation and INA-CBG), and updating of clinical standards. The MOH also maintains control of a significant portion of the health sector budget that includes special allocation funds earmarked for national health priorities and disbursed to local governments on an annual basis, vertical hospitals, national programs like TB, HIV and immunization, an operating budget that funds district capacity building activities, etc.21F

22 The National Social Security Council (DJSN) was created to act as an oversight and policy advisory body for the operationalization of the social

18 Australia–Indonesia Partnership for Health Systems Strengthening 2011–2016https://dfat.gov.au/about-us/publications/Documents/hss-design-doc-pd.pdf 19 HAPIE Midline Report https://pdf.usaid.gov/pdf_docs/PA00M645.pdf 20 BPJS-K/USAID Indonesia Hospital Global Budgeting Pilot Project https://pdf.usaid.gov/pdf_docs/PA00T4JC.pdf 21 Exploring Institutional Arrangements for Linking Health Financing to the Quality of Healthcare in the Asia Region:

Lessons from Indonesia, the Philippines, and Thailand, Concept note study https://www.hfgproject.org/exploring-institutional-arrangements-linking-health-financing-quality-care-lessons-indonesia-philippines-thailand/ 22 World Bank, 2017. Indonesia Health Financing System Assessment.

http://documents.worldbank.org/curated/en/453091479269158106/pdf/110298-REVISED-PUBLIC-HFSA-Nov17- LowRes.pdf https://dfat.gov.au/about-us/publications/Documents/hss-design-doc-pd.pdf https://dfat.gov.au/about-us/publications/Documents/hss-design-doc-pd.pdf https://pdf.usaid.gov/pdf_docs/PA00M645.pdf https://pdf.usaid.gov/pdf_docs/PA00M645.pdf https://pdf.usaid.gov/pdf_docs/PA00T4JC.pdf https://pdf.usaid.gov/pdf_docs/PA00T4JC.pdf https://www.hfgproject.org/exploring-institutional-arrangements-linking-health-financing-quality-care-lessons-indonesia-philippines-thailand/ https://www.hfgproject.org/exploring-institutional-arrangements-linking-health-financing-quality-care-lessons-indonesia-philippines-thailand/ http://documents.worldbank.org/curated/en/453091479269158106/pdf/110298-REVISED-PUBLIC-HFSA-Nov17-LowRes.pdf http://documents.worldbank.org/curated/en/453091479269158106/pdf/110298-REVISED-PUBLIC-HFSA-Nov17-LowRes.pdf security system (which includes both health insurance, and pensions and other labor-based issue areas), reporting directly to the President. The Ministry of Finance (MOF) plays an important role determining not only the final health sector budget, but also the contribution rate for the PBI segment. The Indonesian MOF is very engaged in the UHC discussion in country and expects a return on investment that is measured by improved quality of health sector spending, financial risk protection and health outcomes.22F

C.2.2 Health Financing Stakeholders in Indonesia

As in any country that undergoes significant system reform, Indonesia too has faced some challenges in implementing the changes it set out to make under the original SJSN Law 2004.

As the system evolves, actors accept, define and mature into their roles and responsibilities.

Currently, the following have been identified as the main system actors:

● National Planning and Monitoring: Coordinating Ministry of Human Development and Culture (PMK); National Development Planning Agency (BAPPENAS), and Ministry of Home Affairs.

● Public Financing:

○ Ministry of Finance (MOF)/Director General (DG) of Budget,

○ MOF/Fiscal Policy Agency (BKF),

○ Ministry of Health (MOH)/Center for Health Financing and Risk Protection

(PPJK): Health Financing division (NHA team, Costing team), Risk Protection Division (Casemix team, Tariff team), and Health Technology Review division

● Health Sector Programming and Monitoring:

○ MOH - DG Disease Control (P2)

■ MOH - Directorate for Direct Communicable Disease Control

■ MOH - National Tuberculosis Program (NTP)

■ MOH - Sub Directorate for HIV

○ MOH - DG Community Health (KesMas)

■ MOH - Directorate for Family Health (KesGa)

○ MOH - DG Health Services (Yankes)

■ MOH - Directorate for Primary Health Care (Yankes Primer)

■ MOH - Directorate for Referral Care (Yankes Rujukan)

○ MOH - Directorate for Quality and Accreditation (Yankes Mutu dan Akreditasi)

○ MOH - National Institute for Health Research and Development (NIHRD)

○ MOH - Body for Developing and Utilization of Health Manpower (BPPSDMK)

● Sub National Planning and Monitoring: Local Governments

● JKN Implementation and Oversight:

○ Body for Implementing Social Security in Health or National Health Insurance Agency (Badan Penyelenggara Jaminan Sosial-Kesehatan - BPJS-K): Research and Development, Management of Primary Care, Management of Referral Care, Actuarial team, Provider Payment team, etc.

23 Overview of Strategic Purchasing Functions Under JKN https://pdf.usaid.gov/pdf_docs/PA00SVZR.pdf https://pdf.usaid.gov/pdf_docs/PA00SVZR.pdf https://pdf.usaid.gov/pdf_docs/PA00SVZR.pdf

○ National Council for Social Security (Dewan Jaminan Sosial nasional - DJSN),

• Authority to Oversee Non-Bank Financial Institutions (Otoritas Jasa Keuangan - OJK)

● Health Provider Associations: PERSI (Private Hospital Association), ARSADA (Public

Hospital Association), and Local Health Office Association (Adinkes)

● Professional Organizations: Pulmonologist Association (PDP); Internist Association

(PAPD); OBGYN Association (POGI); Paediatrician Association (IDAI); Indonesia Medical Association (IDI); General Practitioners Association (PDU), Indonesia Midwives Association (IBI), Pharmacist Association (ISFI); Association of General Insurance (IAUI), Association of Indonesia Actuarist (PAI) etc.

● Centers of Excellence on Health Financing outside of GOI institutions: University of Indonesia (UI) Center for Health Financing (CHEPS); University of Gadjah Mada (UGM) Center for Policy and Health Management (CPHM) and the Indonesian Health Economics Association (INAHEA) housed at UI.

● Civil Society Organizations: BPJS-K Watch, Health Consumer Organization (Lembaga Konsumen Kesehatan).

● President's and Vice President’s Office, including the National Team for the Acceleration of Poverty Reduction (Tim Nasional Percepatan Penanggulangan Kemiskinan – TNP2K)

● The Indonesian House of Representatives (Dewan Perwakilan Rakyat – DPR)

C.2.3 USAID/Indonesia Investments in Health Financing

USAID partners with countries to provide sustained, equitable access to essential, high-quality health services responsive to people’s needs without financial hardship, thereby protecting poor and underserved people from illness, death and extreme poverty. This commitment is aligned with Sustainable Development Goal 3.8 to achieve UHC and the GOI’s Health Sector Program goals of developing a health system that will ensure that all Indonesians have access to the health care they need without fear of being pushed into or of remaining in poverty as a consequence of seeking health services.

USAID/Indonesia provides technical assistance to Indonesian institutions to manage clinical service delivery programs in districts and provinces, particularly in USAID/Indonesia Priority Health Areas of HIV23F

24, TB24F

25 25F

26and MNH26F

27. In addition to this, USAID also supports the GOI in a variety of health system strengthening areas with a focus on human resources for health27F

28, supply chain and drug quality and health financing28F

29. USAID activities are meant to be synergistic with each other as investments in the health system aim to leverage change at scale to improve health outcomes.

24 https://www.fhi360.org/countries/indonesia 25 http://www.challengetb.org/countries 26 https://govtribe.com/project/usaidindonesia-tuberculosis-private-sector-tbps-activity 27 https://www.dai.com/our-work/projects/indonesia-jalin 28 https://www.hrh2030program.org/hris-status-assessment/ 29 ARV and Commodity Pricing Analysis https://www.ghsupplychain.org/country-profile/indonesia https://www.ojk.go.id/en/default.aspx https://www.fhi360.org/countries/indonesia http://www.challengetb.org/countries https://govtribe.com/project/usaidindonesia-tuberculosis-private-sector-tbps-activity https://www.dai.com/our-work/projects/indonesia-jalin https://www.hrh2030program.org/hris-status-assessment/ https://www.ghsupplychain.org/country-profile/indonesia https://www.ghsupplychain.org/country-profile/indonesia

In the area of health financing, USAID has been actively supporting GOI agencies and Indonesian universities through its Health Policy Plus (HP+)29F

30 and Health Finance and Governance (HFG) projects30F

31. The central focus has been on studying the impact of the recent health financing reforms currently being implemented in country, as well as providing technical assistance to strengthen and better operationalize them. A more recent focus includes explicitly quantifying and defining the benefits as well as the unintended consequences of health financing reforms on USAID Priority Health Areas31F

32 of HIV, TB32F

33 and MNH. Output of the work thus far has included policy papers, journal publications, workshops, conference presentations, study tours and policy dialogue with mid-level and senior GOI representatives. Each interaction has been purposively designed to bring together GOI and other health system stakeholders to understand and tackle the issues in a coordinated manner. Specific areas where USAID has supported the GOI include: JKN comprehensive evaluation33F

34, institutionalization of health expenditure tracking34F

35; implementation research for UHC35F

36; and strategic health purchasing36F

37.

The USAID HFG project supported MOH/PPJK, in conjunction with the MOH/Planning and Budget Bureau (Roren); MOH/Finance Bureau; MOH/Research and Development Directorate General (NIHRD); BPJS-K, Statistics Indonesia (BPS - Badan Pusat Statistik) and University of Indonesia experts, in preparing the 2015 and 2016 national health accounts. USAID’s emphasis has been on supporting MOH/PPJK to institutionalize national health expenditure tracking systems, which includes building in house capacity to establish a transparent methodology and produce health accounts in a timely and accountable manner on an annual basis. Beginning in 2016, the MOH began to institutionalize within MOH/PPJK the production, interpretation, analysis, dissemination and use in policymaking health expenditure tracking data.37F

Strategic health purchasing (SHP), a powerful lever to improve efficiency, access and quality, has been a very important technical area for USAID. In partnership with the World Bank Indonesia, USAID, through the HFG project supported DJSN to convene a series of technical working group meetings to: 1) reach agreement on a SHP concept and vision for Indonesia; 2) identify the appropriate institutional roles and responsibilities to carry out SHP functions within JKN and at each level of government; 3) document current regulations, roles and responsibilities of all institutions that may play a role in the healthcare purchasing function; 4) develop a roadmap to make step by step changes to rationalize existing regulations, institutional roles and responsibilities, and operational processes to improve SHP across all sources of

30 Financial Sustainability: Indonesia’s National Health Insurance http://www.healthpolicyplus.com/pubs.cfm?get=8225 31 https://www.hfgproject.org/where-we-work/asia/indonesia/ 32 Influence of Indonesia’s National Health Insurance on Essential Health Services http://www.healthpolicyplus.com/pubs.cfm?get=8226 33 Engaging Private Providers to Improve TB Outcomes in Indonesia https://pdf.usaid.gov/pdf_docs/PA00SWQD.pdf 34 Equity Analyses: Indonesia’s National Health Insurance http://www.healthpolicyplus.com/pubs.cfm?get=8223 35 Health Accounts Institutionalization in Indonesia: Options for the Way Forward https://pdf.usaid.gov/pdf_docs/PA00T36Z.pdf 36 http://indonesia-implementationresearch-uhc.net/ 37 HFG Indonesia Strategic Health Purchasing https://www.hfgproject.org/hfg-indonesia-strategic-health-purchasing/ 38 Prastuti Soewondo.