Alternative fuels consist of renewable energy sources and thermal fuels, including clean coal options. Private sector support to the power sector is optimized with a comparative analysis of real fuel options.
Nameplate capacity needs to be considered in the context of a plant’s capacity factor. No power plant runs 100% of the time, and power plants, like that of AKL, that run on auto diesel fuel will need to shut down routinely for scheduled maintenance. Routine maintenance combined with unscheduled shutdowns lower actual net capacity. Hence, to mitigate the risk of providing support to nonviable private sector power generation projects, it is necessary that ADB include scheduled shutdowns and the possibility of unscheduled shutdowns when calculating initial economic and financial rates of return.
This is important when technical problems arise that cause major shutdown of operations, as was the case of AKL due to a 2004 fire. Private sector insurance enables unforeseen technical problems to be fixed along with compensation to the insured for revenue loss due to the incident. Foreign investors can leverage important insurance that is often difficult for sovereign entities to acquire.
In evaluating project ownership, attention must be given during appraisal not only to investment planning priorities but also to whether counterpart funding has been committed, key staff are in place, coordination mechanisms across and within different government levels are working effectively, and an institutional capacity exists to address social and environmental issues affecting the project’s long-term sustainability.
To achieve this goal, funding needs to be committed before loan approval to ensure that such issues will be addressed during implementation, and independent monitoring mechanisms put in place to measure the impact on local communities.
For Asian developing countries with a well developed local capacity in electric power or other infrastructure sectors, partnership with an international consulting firm in the implementation arrangements can be an effective mechanism to enable the transfer of state-of-the-art management and operational practices to national companies and agencies.
Delegation of implementation responsibility to the resident mission at an early stage of the project cycle is also good practice, provided locally recruited staff have sufficient familiarity with ADB operational and procurement procedures.
Unrealistic work schedules, poor procurement planning, insufficient implementation details, and loose monitoring targets prolonged implementation. A well-qualified and experienced project team leader and consultants’ familiarity with ADB processes are essential to implement an ADB-financed project.
ADB could have satisfied itself about project readiness in the key areas of detailed design, safeguards, procurement, and establishment of the project implementation unit.
A flexible approach could have been adopted with adequate supervision support for sector specialists in capacity development activities. Discussions at the technical level should have led to higherlevel discussion as the proposed reforms were far-reaching.
Indonesia still has a relatively high maternal mortality ratio. Capacity development in the areas of obstetric and neonatal care is still required, and the evaluation team came to know from the district health departments that they have limited finance to meet this capacity development requirement. According to key informants, basic emergency obstetric and neonatal care centers are often not used to assist with complications due to perceived lack of capability, and that not all districts have a functioning hospital with required emergency capability. Considerable further investment in infrastructure and human resource capacity will be required to meet the maternal mortality MDG target by 2015.
Inclusion of family planning advocacy in future programs could help reduce maternal mortality, as high fertility and maternal mortality are correlated. During key informant interviews, many expressed an opinion that more support for family planning is needed. It will require a coordinated and balanced joint approach from MOH and BKKBN, supported by appropriate resources.
Well-functioning provincial and district systems have proven to contribute to overall coordination and control of local health service delivery. During evaluation, health facility staff frequently cited the development of human resource capacity through longer-term fellowships as a key benefit of the project. Many of the project-supported fellows are now in key positions within the district and provincial health services. Many fellows thought that their careers would not have progressed so well without the project. The skills for networking, problem-solving, and data analysis and presentation that these fellowships help develop are still being used.
This was seen as a key positive feature of the project. Informants thought that by combining better planning and infrastructure and higher quality human resources, access to health services and their quality had improved. Many felt that without a comprehensive approach this might not have happened.
While the potential benefits of a comprehensive approach were noted during the evaluation team’s field visits, there is limited effort to quantify these benefits systematically. A survey of stakeholders was conducted at project exit and documented in a benefit-monitoring report. A range of customer satisfaction questions were posed and scored in the survey. Satisfaction indicators related to benefits associated with (i) training for midwives, (ii) utilization of skills by staff after training, (iii) availability and equipment to support MNCH, (iv) quality of civil works, (v) operations research, (vi) problem-solving ability of district health officers, (vii) staff motivation, (viii) political commitment, (ix) effectiveness of health reforms, (x) level of district funding (xi) health center utilization, (xii) safe delivery, and (xiii) patient satisfaction. However, no baseline survey was conducted with the satisfaction survey, so changes in with-and-without or before-and-after comparisons cannot be assessed. Similarly, no non-project facility appears to have been included in the survey. This would have helped in determining incremental benefits from project intervention compared with non-project situations.
To determine project impact, a focused survey of health status and client attitudes in project and non-project provinces should have been conducted at the start (to establish a baseline) and at project completion. Without this information it is not possible to attribute and quantify shorter-term project benefits.
A large number of staff in health service delivery received training or fellowships under the project. However, there has not been any attempt to document actual benefits stemming from this investment. A proper analysis will help the central, provincial, and district governments to determine skills gaps that can be targeted over the next couple of decades. Periodic evaluation of the value and impact of expenditure on capacity development should have been conducted. Although the number of physicians and the ratio of physicians to population have increased in all provinces and in rural areas, deployment practices and inequitable distribution remain serious concerns. M&E of current deployment and a skills audit are crucial to ascertain whether an effective long-term health workforce strategy is being implemented.
Problem analysis was undertaken to some degree during project preparations. Risks were outlined in the project framework (under Assumptions and Risks) but little detail was given in the main text of the report and recommendation of the President, or in the project design. Greater attention should have been placed on the political economy of decentralization, such as outlining key stakeholders, defining differential impacts of reforms, and identifying risks associated with possible future behavior of key stakeholders, along with capacity assessments across the broad geographic spread of the project. It would have been important to better assess the factors that help or hinder managerial and operational institutionalization of local health systems. The project did not do so. As a result, the standardized approach may not have worked in all districts. Decentralization is an evolving process and requires time to develop adequate capacity.