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A.I.D. LOAN NO. 497 - U- 057

A.I.D. PROJECT NO. 497-0253

AMENDMENT NO . 1 TO

LOAN AGREEMENT

BETWEEN THE

REPUBLIC OF INDONESIA

AND THE

UNITED STATES OF AMERICA

FOR

AN EXPANDED PROGRAM IN IMMUNIZATION

Dated: September

21, 1984

This AMENDMENT NO. 1, is entered into between the REPUBLIC OF

INDONESIA ("Borrower") and the UNITED STATES OF AMERICA, acting

through the AGENCY FOR INTERNATIONAL DEVELOPHENT ("A.I.D . "):

WHEREAS, the Borrower and A.I.D. entered into an Expanded

Program in Immunization Project Loan Agreement, designated as A.I.D.

Loan No. 497-U-057 on August 15, 1979 (nLoan Agreement"), whereby

A.I.D. agreed to lend to the Borrower up to Ten Million United

States ("U.S.") Dollars ($10,000,000) ("Loan");

WHEREAS, The Borrower and A. I.D. agree the objectives of the

Project may be accomplished with a reduction in the Loan of

$500,000, and wish to make certain other changes in the Loan

Agreement;

NOW THEREFORE, the Borrower and A.I.D. hereby agree as follows:

1.

The first sentence in the first paragraph of Section 3.1 is

revised to read as follows:

"Section 3.1.

The Loan.

To assist the Borrower to meet the

costs of carrying out the Project, A.I.D., pursuant to the Foreign

Assistance Act of 1961, as amended , agrees to lend the Borrower

under the terms of this Agreement not to exceed Nine Million Five

Hundred Thousand United States ("U.S.") Dollars ($9, 500 ,000)

("L oan ") .

2.

Section 3.2. (b).

Borrower Resources for the Project is

revised to read as follows:

"(b) The resources provided by Borrower for the total

2

-3.

Sect ion 5. 3.

Disbursement for Training is hereby deleted

and a new Section 5.3 is substituted which read as follows:

"Section 5.3.

Disbursement for Vaccine Refrigerators.

Prior to

disbursement under the Loan, or to issuance by A.I.D. of

documentation pursuant to which disbursement will be made, for the

purpose of financing the procurement of vaccine refrigerators under

the Project extension, the Borrower will, except as A.I.D. may

otherwise agree in writing, furnish to A.I.D. in form and substance

satisfactory to A.I.D., by December 31, 1984: (a) evidence that the

Government has provided all necessary clearances for the procurement

of Electrolux vaccine refrigerators from Luxembourg, and (b)

evidence that the Government will facilitate the entry of the

Electrolux vaccine refrigerators into Indonesia."

4.

In Article 6, Covenants, a new Section 6.6 is added which

reads as follows:

"The Borrower agrees that the funds provided pursuant to this

Loan Agreement may be used to finance the costs of in-country and

off-shore short-term training, or, training of less than 90 days

duration."

5.

A revised financial plan and revised amplified project

description are attached as Annex I and Annex II to this Amendment.

6.

Except as hereinabove expressly amended, the Loan Agreement

is ratified, confirmed and continued in full force and effect in

accordance with all of its terms.

-3-representative, have caused this Amendment No. 1 to be signed in

their names and delivered as of the day and year first above written.

REPUBLIC OF INDONESIA

Signed

Atmono Suryo M.A.

Director General

for Foreign Economic Relations

Department of Foreign Affairs

UNITED STATES OF AMERICA

Signed

ANNEX II

AMPLIFmD DESCRIPTION OF THE PROJECT (same for Loan and Grant)

I. Project Description

The Expanded Program in Immunization (EPI) of the Government of Indonesia (GOI) is a nationwide preventive health program to reduce the incidence of six diseases -- tuberculosis, diphtheria, pertussis, tetanus measles and polio -- which contribute to the principal causes of infant mortality in the Republic of Indonesia, as well as childhood and maternal morbidity and mortality.

Through this project, the Ministry of Health's Directorate General for Communicable Disease Control, Jakarta will contribute to further expand the capabilities of the existing network of health centers

(Puskesmas) in order to provide, transport, store and administer vaccines to the wi dely scattered, predominantly poor, rural population of

Indonesia. The EPI, which involves health staff from various sectors and from all levels of the health structure, will also contribute to

developing the integration of health services through which Primary Health care is delivered. The program will be directed towards three major sub-populations: infants, school children and women of reproductive age. Also, the project will assist P.u. Biofarma in strengthening its vaccine production facilities.

Under the program

a. The plant facilities of the State Enterprise, P.U. Biofarma, in Bandung, will be expanded and upgraded and the staff trained to enable them to increase their production capacity of selected vaccines to the levels required by the GOI for its long-range program.

b. The "Cold-Chain" -- the series of transportation and storage links necessary for transporting vaccine from Biofarma to the remotest Puskesmas -- will be upgraded with additional training, equipment and vehicles.

c. Vaccinators and other health workers will be retrained to administer the new vaccines and provided transportation to reach the remoter areas of the country.

d. A program monitoring, surveillance and evaluation system will be instituted to monitor critical disease incidence, vaccinator perfonnance, and public awareness and acceptance of the program.

e. GOI personnel will be trained to adminster the technical, logistical, maintenance, surveillance and managerial aspects of an

2

-f. Studies and trials will be carried out to improve management and technical approaches and to obtain active community support for and

participation in EPI as one of the Primary Health Care elements.

The program is a continuation and expansion of a vaccination program already in existence in every province of Indonesia. It will

progressively upgrade the quality and capability of selective kecamatans each year to handle and administer vaccinations within their areas, and increase the extent of their coverage:

It is estimated that by project completion, on a national basis, 57 percent of the children in the eligible population group (i.e. 73% x 78%) and 56 percent of the pregnant women (i.e. 72% x 78%) will have been

reached by EPI, which should have a significant impact on mortality and morbidity of the population.

Project Duration: Until September 30, 1987

Administrative Arrangement and Management

The GOI Department of Health Directorate General of Communicable Disease Control, Directorate of Immunization and surveillance, will have overall responsibility for managing all central-level aspects of the Project. This group will direct all technical assistance, participant training and commodity inputs except those related to the Biofarma vaccine production facility.

Sub-District Health Center Doctors (dokter-dokter Puskesmas) will provide day-to-day supervision to vaccinators, nurses and mid-wives (who also will vaccinate).

w.H.O. and UNICEF will continue their collaboration on this Project through technical assistance, training and commodities complementary to those provided through this Loan.

AID, through a PASA with CDC Atlanta, will provide long term

consultation, which will be a part of the EPI managerial team and as such will coordinate with the staff of the Ministry of Health and other

consultants with whom they will exchange information and reports. These staff members will deal with matters related to the program through their government counterparts.

Implementation and Reimbursement

The technical assistance financed by AID shall be arranged with the Centers for Disease Control, Atlanta, and other individual and

institutional sources in accordance with customary AID procedures. Participant long-term training for people from the GOI as well as

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-II. Financial Plan

A. AID Contribution

AJD will provide both loan and grant funding in support of the GOI program. A total of $12,700,000 shall be made available, of which $9,500,000 shall be loan-funded and $3,200,000 grant-funded. Annex I illustrates in greater detail the AlD and GOI contributions according to various EPI inputs. Changes up to 30% may be made to line item amounts shown in the budget without formal revision of this Agreement provided that AID approves any such changes in writing, and that the total AlD contribution is not increased or the Borrower's contribution for this phase is not decreased below its agreed contribution. However, the funds provided for the procurement of vaccine refrigerators under the project extension, may not be transferred to any other line item. I f the

condition precedent governing this procurement is not met in accordance with the Project Loan Agreement, such funds may be deobligated at AID's discretion.

lo Consultants

a. Two long-term consultants from the Centers for Disease Control (CDC}, Atlanta and on personal services contract will work with the Staff of the GOI Ministry of Health Directorate General for

Communicable Disease Control, Jakarta and other consultants from WHO, UNICEF and other agencies or institutions. The teamwork generated will aim at further developing the technical, training and managerial capacity required to establish and operate a Cold Chain system, deal with other logistical problems, surveillance, monitoring and evaluation.

b. Short-term consultants will be provided to help solve specialized technical problems.

2. Participants

Long term participants in epidemiology, program management and vaccine production and short term participants in more specialized fields. Precise numbers of person and fields of training will be included in a periodic training plans.

3. Commodities

Imported commodities including equipment useful for vaccine production, administration, transportation and cold-chain will be loan-funded.

4. Local Costs

a. Monitoring, surveillance, training, research, evaluation and locally assembled vehicles (of

u.s.

source/orig.}

4

-B. GOI Contribution to the Project

The GOI contribution, as set forth in Annex I, shall amount to no less than $13,956,000. These funds shall be used to fund various aspects of production and purchase of vaccines, training, evaluation, research,

EXPANDED PROORAM IN IMMJNIZATICN SlM1ARY aJST ESI'IW\TE AND F:rNl\OCIAL PI.AN

(U.S. $000)

ANNEX I

August 1984

NO.

I

I

A.I .D.

I

G 0 I

I

T 0 T A L

I

I

LOAN

I

GRAN!'

I

I

I

I

-T - -

- -

---I .

I

Tedmical Assistance

I

-

I

2,420

I

-

I

2,420

I

I

I

I

II.

I

Vaccines

I

-

I

-

I

6,801

I

6,801

I

I

I

III.

I

Commodities

I

5,214

I

-

I

4,391. l

I

9,605.l

I

a. Vaccine Production (Bio Fanna)

I

(l,467)

I

I

b. Transport

I

(l,560)

I

-

I

(2,668.4)

I

c. eo1a Cllain

I

(2,167)

I

-

I

(773.1)

I

d.

:cata

Processing F.quipnent

I

(20)

I

I

e. Vaccination F.quipnent

I

-

I

-

I

(265.6)

I

f.

.Administration F.quipnent

I

-

I

-

I

(

684)

I

IV.

I

Program lt>nitorin:;

I

1,546

I

330

I

2,519.9

I

4,395.9

I

a. Evaluation

I

(40)

I

-

I

(2,496.4)

I

b. Health Education, Operations

I

(l,116)

I

-

I

(23.5)

I

Research, Epidemiologic surveys

I

c. Contingency

I

(390)

I

(330)

I

V.

I

Manpower ｾｶ･ｬｯｰｮ･ｮｴ＠

I

2, 740

I

450

I

244

I

3,434

I

a. Participants

I

(920)

I

(450)

I

b. Incountry Trainin:;

I

(l,820)

I

I

'IUI'AL

I

9,500

I

3,200

I

13,956

I

26,656

I

I

I

I

I

)

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