Clinics 3999 Existing Health Facilities 3760 Physical Project Facilities 3732 Intensive Input Dexfbnstrationarea

CIRCULATINGCOPY TOBE RETURNED TOREPORTS DESK

DOCUMENTOF INTERNATIONALBANK FOR RECONSTRUCTIONAND DEVELOPMENT INTERNATIONALDEVELOPMENT ASSOCIATION Public Disclosure Authorized Not ForPublic Use

Report No. PP-12a Public Disclosure Authorized

APPRAISALOF

A POPULATIONPROJECT

MALAYSIA Public Disclosure Authorized

December 21, 1972 Public Disclosure Authorized

Populationand NutritionProjects Department

This report was prepared for official use only by the Bank Group. It may not be published, quoted or cited without Bank Group authorization. The Bank Group does not accept responsibility for the accuracy or completeness of the report.

CURRENCYEQUIVAIENT

US$1.00 M$2.82 M$1.00 Us$0.3545 Nl million - US$355,000

A. ABBREVIATIDNS

FFPA Federation of Family Planning Association FP Family Planning GFR General Fertility Rate GOM Government of Malaysia IUD - Intrauterine Device MCH = Maternal and Child Health MCQ = Midwifery clinic-cum-quarters NHC = Main Health Center NOE = Ministry of Education M)H = Ministry of Health NFPB = National Family Planning Board PHI = Public Health Institute RHTC = Rural Health Training Center SHC = Sub Health Center SIDA Swedish International Development Authority TAN = Trained Assistant Nurse UNFPA = United Nations Fund for Population Activities WHO World Health Organization

B. DEFINITIONS

Birth Pate * Births per thousand of population per year. Death Rate = Deaths per thousand of population per year. General Fertility Rate = Number of annual births per thousand women 15-44years. It is a more refined index of fertility than the 'crude birth rate" as it ex- cludes the effect of changes in the age-structure of the population. Infant Mortality Rate Annual deaths of infants aged less than one year per thousand of live births. Midwifery clinic-cum-quarters = Serves as a station for domiciliary midwifery services in rural areas. Usually four MCQs are under one SHC. Main Health Center = Located in a rural area with a full-time doctor. Usually there is one NEC in a health district. Midwife = Trained for two years in midwifery after six years of general schooling. Sub Health Center = Located in a rural area with a doctor visiting on certain days from MHC. Usually four SHCs are under one MNC. Trained Assistant Nurse = Trained in nursing for two years after nine years of general schooling. Group I Equipment = Built-in ecuipment usually inc'uded in construction contracts. Group II Equipment = Depreciable equipment of five years' life or more, not normally purchased through construction contracts. This group is comprised of large items of furniture and equipment having a reasonably fixed location in the building but capable of being moved. Group III Equipment Nondepreciableequipment of less than five years' life, normally purchased through other than constructioncontracts. This group includes small items of low unit cost which are suited to store-room control.

Fiscal Year January 1 - December 31 MALAYSIA: APPRAISAL REPORTOF A POPULATJDNPROJECT

BASIC DATA

WEST MALAYSIA

1957 1969 1970 1971

Area (in sq mi) ...... 50.840 50,84050,840 50,840 Density per sq mil...... 126 180 183 188 Population(000) ...... 6.o405,4 9,128 9,300 92534 Birth Rate per 1,000.. 64.2 33.0 32.2 32.4 DeathRate per 1,000...... 12.4 7.2 7.2 7.2 Infant Mortality Rate per 1,000 ...... 75. 43 - - Rate of NaturalIncrease per 1,000 ...... 33.7 25.8 25.0 25.2 Net Migration (000) ...... - 2.4 0.3 - General Fertility Rate per 1,000 .22 229 163 175 158 Women 15-44 years Total(000) 1,262...... 1 827 1,872 1,943 ProportionMarried ...... 72.4 63.7 FamilyPlanning Acceptors Total(000)...... - 71 56 55 As Percentageof the targets ....- 77 48 46 As Percentageof eligibleWomen .- 16 21 26 Age Structure(%) Under 15Years .. .. 43.8 43.3 - 42.3 15-59 Years .. 51.6 50.6 - 51.9 60 Years and Over . ... 4.6 6.1 - 5.8 Populationby EthnicGroup (%) Malays ...... 49.8 50.6 53.2 - Chinese.37.1 36.3 35.4 - Indians and Others. 13.1 13.1 11.4 - Percentageof RuralPopulation .... 68 - 70 - Adult LiteracyRate 2/. 76.8 3/ - LaborForce (in millons).. - 3.1 - UnemploymentRate ..- 8% - Gross NationalProduct (at marketprices) 2/ US$ Total (in millions).- - - 4,120 Per Capita .- - - 380 Rate of Growth ...... - - - 3 Population per Physician 2/ ...... - 4,100 - Population per Nurse 2/... - - 1,900 - Population per Hospital Bed 2/.- - 330 -

1/ Estimates. 2/ Malaysia. 3/ 1967.

MALAYSIA: APPRAISAL REPORT OF A POPULATION PROJECT

TABLE OF CONTENTS

SUMARY AND CONCLUSIONS ......

I. INTRODUCTION ......

II. POPULATION PROBLEMS ......

III. FAMILY PLANNING PROGRAM ...... 3

A. Organization ...... 3 B. Existing Facilities ...... 4 C. Program Achievements ...... 6 D. Future Targets and Constraints ...... 7

IV. TIIE PROJECT ...... 8

A. Administration ...... 10 B. Services ...... 11 C. Training ...... 13 D. Information, Education, and Communications 13 E. Evaluation and Research ...... 14 F. Intensive Input Demonstration Area ...... 14

V. COSTS, FINANCING, IMPLEMENTATION AND DISBURSEMENTS... 14

A. Costs ...... 14 B. Proposed Financing ...... 16 C. Implementation ...... 17 D. Disbursements ...... 18

VI. SOCIO-ECONOMIC ANALYSIS ...... 19

VII. AGREEMENTS REACHED AND RECOMMENDATIONS ...... 19

This report is based on the findings of the appraisal mission that visited Malaysia from February 21 to March 21, 1972 and the subsequent meetings at the headquarters between the UNFPA and the Bank. The appraisal mission consisted of Miss I.Z. Husain, Dr. T. I. Kim, and Mr. Burfield from the Bank, Dr. L. Corsa (Medical-WHO), Miss M. Verderese (Nqursing-W%HO),and Messrs. R. Colle (Communications), J.Y. Takeshita (Evaluation), and M. Milo (Architecture). This report was prepared by Miss I.Z. Iiusain and Dr. T.I. Kim with the cooperation of Mr. Burfield in particular sections. -2-

ANNEXES

1. Comparative Population Program Indicators in Selected Countries

2. Population Growth and Economic Development

Table 1 - Population Size and Growth Rate, 1911-71 Table 2 - Fertility and Mortality Rates, 1957-71 Table 3 - Population Projections with Constant Fertility, 1975-1999

3. Rural Health Centers for MCH/FP Clinic Construction

4. Hospitals for Family Planning Clinic Construction

5. Intensive Input Demonstration

Table 1 - Intensive Input DemonstrationAreas Table 2 - Location of MCQs for Additional Construction

6. Project Cost by Functional Categories

7. Detailed Cost Estimate of Physical Project Facilities

8. The IBRD-AssistedComponents of the Project

9. The UNFPA-FinancedComponents of the Project

10. IncrementalOperational Costs

11. Implementationand ExpenditureSchedule

12. Project Implementationand Administration

13. Draft Terms of References for Advisers

14. Estimated Schedule of Disbursements

15. Demographic Impact of the Project

Table 1 - Age and Sex Structure of Population - With the Project Table 2 - Age and Sex Structure of Population - Without the Project Table 3 - Births to be Averted to Achieve Targets of Reduction in Fertility Table 4 - Required Woman-Years of Protection for Target Decline in Fertility Table 5 - The Age-specific Continuation Rates Table 6 - Required Number of Users for Target Reduction in Fertility Table 7 - Required Number of Acceptors for the Target Decline in Fertility

16. Economic and Social Impact of the Project -3-

Charts

6482 National Family Planning Board Organization Structure 6507 Ministry of Health OrganizationalStructure 7220 State Level OrganizationsMinistry of Health and National Family Planning Board 7044 Family Planning and Population Information System 7035 Birth Rate, Death Rate, Death and Natural Increase Rate of Population, 1970-85

Maps

3731 Government Family Planning Clinics 3999 Existing Health Facilities 3760 Physical Project Facilities 3732 Intensive Input DexfbnstrationArea.

MALAYSIA: APPRAISAL REPORTOF A POPULATIONPROJECT

SUMTMARYAND CONCLUSIONS

I. This report appraises a population project in West Malaysia for which a Bank loan of US$5.0 million is proposed. The project consists of items to be financed by the Bank, the United Nations Fund for Population Activities (UNFPA) and the Governmentof Malaysia, (GOM). The UNFPA and the Bank would finance separate identifiableproject components.

ii. Although well-endowedwith natural resources and currentlyin a favorable financial position, Malaysia is facing economic and social pres- sure resulting from a high rate of population growth. On the one hand, the high rate of population growth has been rapidly adding to the labor force and, on the other hand, it has made fewer of the country'sresources available to raise living standards%andto create employment. Consequently,the country suffers from large unemploymentand underemployment. Furthermore, the relativelyhigh fertility of the poorer sections of the society has made the equalizationof economic opportunitiesmore difficult.

iii. The national program that helped to reduce the birth rate from 46 in 1957 to 33 in 1969 is facing difficultiesin further reducing the birth rate. The number of new acceptors has been continuously declining since 1969. One of the main constraints in reducing the general fertility rate is the inadequacy of resources to reach 70% of the population living in rural areas. Without a sharp decline in fertility the birth rate 1/ is expected to increase because of a larger number of persons entering the reproductive ages as a consequenceof the post-WorldWar II baby boom.

iv. The proposed project is designed to strengthen the national family planning program. In functional terms the project will help to: (a) improve administration and management of the family planning program, (b) extend family planning services to rural areas, (c) expedite training of paramedical personnel in family planning, (d) introduce population education in schools, (e) improve family planning,nutrition and health education programs particularlyfor the rural population, (f) establish population research units, and (g) demonstrate the effect of various intensive inputs in an area as a basis for developing long-term policies.

1/ The birth rate is births per 1,000 total population; the general fertility rate is births per women aged 15-44. Birth rates can change with changes in the age-distributionwhich is often variable, but which does not reflect a change in reproductive behavior. Thus, birth rates are usually easier to calculatethan fertility rates, but are less significant as an indicator of changing reproductivebehavior. - ii - v. The project would consist of:

(a) construction,equipment and furniture for maternal and child health and family planning (MCH/FP) administrativecenters in each state, MCH/FP clinics in rural health centers, family planning clinics in Governmenthospitals, a new rural health training center (RHTC) and additions to an existing RHTC and to existing midwifery clinic-cum-quarters;

(b) equipment for evaluation and research, sterilization operations, IUD insertions,pap smear tests, nutrition education, and for production of educationaland training materials and audiovisualsupport for group talks;

(d) advisory services for MCH/FP administration and management, for introduction of population education, population and communications research, production of educationalmaterial and training in health education;

(e) funds for training teachers in population education and training of paramedicalstaff and traditionalmidwives in family planning;

(f) preparationand printing of material for populationeducation and for information,education and communications program;

(g) supplies of contraceptives,books and films; and

(h) establishmentof a Project ConstructionUnit and an external review of the program mid-way through the project. vi. Total project cost is estimated at US$14.5 million. It will be financedby a UNFPAgrant of US$4.3 million, a Bank loan of US$5.0 million, and a GOM contributionof US$5.2 million. The Bank loan finances the total foreign exchange cost estimated at 49% of the Bank-assistedcomponent of the project, including interest and other charges. vii. Items to be financed by the UNFPA consist primarily of contraceptive supplies,vehicles, training stipends, medical instrumentsand various advisory services. The Bank loan will finance construction, certain vehicles, computing and audiovisualequipment, research advisers and a managementstudy. viii. For the implementationof the project, the GOMwould form a Project Implementation Committee that would be chaired by the representativeof the Economic Planning Unit and would consist of representatives of all agencies responsible for the project. The proposed Deputy Director of the NFPB would - iii - act as Project Administrator and be responsible for the whole project. A Project Construction Unit would be established in the Ministry of Health to implement the construction component of the project. ix. Contracts for equipment, furniture and vehicles would be awarded on the basis of internationalcompetitive bidding in accordancewith Bank guidelines. The contracts for civil works would be subject to Malaysia's procurementprocedures. x. The project is intended to help the national family planning program achieve faster fertilitydecline than possible otherwise. It is expected that by 1985 the project should help to reduce the birth rate to 21 as compared to 26 evisaged without it. Consequently,in 1985, the natural rate of population growth will be reduced to 1.5% instead of about 2.0%. As a result of lower population growth, it is estimatedthat by 1985 the per capita income with the project would be higher by about 5%. In addition, with a sharper reduction in fertility, the labor force should be smaller by about 237,000 by the end of the century; in 1970 the labor force was 2.9 million, of which 250,000were unemployed.

APPRAISAL REPORTOF A POPULATIONPROJECT MALAYSIA

I. INTRODUCTION

1.01 Followinga reconnaissancemission to Malaysia from June 27 - July 1, 1971 a preappraisalmission visited Malaysia from November 1 -26, 1971 at the request of the Governmentof Malaysia (GON). The main findings of the mission and a proposed project were transmittedto the GOM in December, 1971. As a result of the GOM's positive reaction, an appraisal mission visited Malaysia from February 21 to March 21, 1972.

1.02 At the same time as a project suitable for Bank financingwas being developed, the GOM was preparing several requests for UNFPAfinancing for some components of the national family planning program. Consequently, the UNFPA and the Bank agreed to coordinate their efforts on a comprehensive project to be financed on a parallel basis. A UNFPA mission, which visited Malaysia in June 1972 to discuss the requests with the GOM was joined by a Bank staff member. As a result of this visit and subsequent meetings at Bank headquartersbetween the Bank and the UNFPA and between the GOM and the Bank, a project suitable for parallel financing by the UNFPAand the Bank was finalized. During negotiations of the Bank-financed components in Washington, a representative of the UNFPAwas present; and the Bank sent a representative to attend negotiations of the UNFPAagreement in New York.

II. POPULATIONPROBLEN5

2.01 Malaysia today is a country of about 11 million people. It is relativelywell-endowed with natural resources and the per capita income is fairly high. The demographic fact that gives importance to the national policy of slowing population growth is the average annual rate of natural increase of about 3% for the sixties, which has been one of the highest in Asia (Annex 1). As a result, the country has serious unemploymentand un- deremploymentproblems. The high rate of population growth has not only rapidly added to the labor force but also reduced the ability to create a sufficiently large number of jobs. Further, the high fertility of low income groups has made the task of equalizing economic opportunitiesmore difficult. While it is well-recognizedthat the task of improving living standards is a complex one, lower fertility is one significant means of equalizing economic opportunities, raising per capita income, and, particularly in the long run, of reducing unemployment.

2.02 During the First MalaysianPlan period (1966-70),the pace of new job creation could not keep up with the large increase in the labor supply. As a result, unemployment increased from about 180,000 or 6.5% of the labor force in 1965, to 250,000 or about 8% in 1970. Unemployment in West Malaysia - 2 - is largely a youth problem partly because of the post-war baby boom; in 1969, about 75% of the total unemployed were in the 15-25 age group. Serious unemployment occurs in urban areas where the rate is around 10%. The Second Malaysia Plan (1971-75) stresses the importance of job creation to reduce unemployment. The labor force is expected to grow at 3.2% per annum during this period. Therefore, despite the creation of 596,000 jobs over the Plan period, the rate of unemployment is expected to remain constant at 8% in 1975. In addition to open unemployment, a large number of workers are in low productivity jobs or they are underemployed, particularly in rural areas (Annex 2).

2.03 In Malaysia, the per capita gross national product at market prices (US$380) is much higher than that of many other developing countries. But its rate of growth has been slow in recent years because of deteriorating terms of trade in its major export crops on the one hand and a high rate of population growth on the other hand. For example, the increase in gross national income which averaged more than 7% per annum in 1961-65, declined to 4.8% in 1965-70 and to 3.0% in 1970-71. These increases w~'ere largely offset by the high rate of population growth. Consequent' , the growth in per capita income declined from 4% per annum in 1961-65 to 1.4% in 1965-70 and 0.3% in 1970-71.

2.04 Reliable data on income distribution are not available. Yet, on the basis of available information and observation, income disparities among various ethnic groups and regions appear to be large. These disparities are reinforced by relatively larger sized families among the disadvantaged groups and thereby limited opportunities for better education, nutrition and health among the most needy section of the population.

2.05 The first census in 1911 reported the population of West Malaysia at 2.3 million and according to the 1957 census the population had reached 6.3 million. Although the results of the 1970 census are not yet final, the population is estimated at 9.3 million. Between 1957 and 1964, the natural rate of population growth averaged more than 3%, and declined to 2.5% by 1970. This decline resulted from a decrease in the birth rate from more than 46 in 1957 to 32 in 1970, and despite a simultaneous decrease in the death rate from 12.4 per thousand to 7.2. This decline in crude birth rate repre- sents a genuine decline in fertility and not simply a change in the age structure of population as the general fertility rate also declined from 229 in 1957 to 157 in 1970.

2.06 Recently, the country has been facing considerable difficulty in reducing the general fertility rate because of inadequate facilities for extending the program to rural areas. Between 1969 and 1970, the general fertility rate declined only from 163 to 157 and the birth rate from 33 to 32. The task of reducing the birth rate is likely to become all the more difficult for the next several years because of the entry of an even larger number of persons in the reproductive ages resulting from the postwar baby boom. Thus, the birth rate is estimated to have increased to 30. 4 in 1971 - 3 - and may go as high as 35.3 in 1975 and to 37.6 in 1980, if current fertility rates remain unchanged and consequently,the rate of population growth may increase to about 2.8% in 1975 and to more than 3% in 1980. Even largely increasedGOM efforts in family planning can, therefore,only reduce the birth rate moderately,due to those transitory,but unfavorable,effect of the age distribution. If fertilityremains constant,however, it is estimated that the populationmay reach 23 million by the end of the century.

III. FAMILY PLANNING PROGRAM

A. Organization

3.01 Recognizing the problems posed by rapid pcpulation growth, the Family Planning Association,a voluntary organization,first began family planning activitiesin Selangor State in July 1953. By July 1962, Family Planning Associationshad been establishedin all eleven states of West Malaysia. At present they are responsible for implementationof the family planning program at state level, while a council incorporatingthe eleven FPA representativescalled the Federationof Family Planning Association (FFPA) is responsiblefor overall planning and policy.

3.02 The Governmentadopted family planning as a national policy in 1964. To implement the program, the National Family Planning Board (NFPB) was establishedin 1966 as an interministerialorganization under the Prime Minister'sDepartment; it was given statutory powers and a certain degree of autonomy under the Family Planning Act. The Board is comprised of a Chair- man, at present the Minister of Commerce and Industry, a Director and twenty members--ten representing different ministries and ten representing various public groups. At present, the NFPB is comprised of six technical divisions with acting heads and other full-time staff which numbered 456 in 1971. The head of the Administrative, Finance and Supply Division is the Secretary of the Board. (Chart 6482) At the state level, the NFPB has medical officers and information officers, as well as other staff to implement its activities. The official family planning program is so far confined to West Malaysia where 85% of the country'spopulation resides and where the population density is 183 per square mile. In East Malaysia,which has a density of 22 miles2 and is comprisedof the two states of Sabah and Sarawak, voluntary organizationshave initiated the program.

3.03 Recently the NFPB decided to extend family planning services to rural areas by integratingfamily planning with the maternal and child health (MCH) services of the Ministry of Health (MOH). Integration,in this case, means extension of services to rural areas by utilizing the health personnel and facilitiesunder the responsibilityof the MOH. (Chart 6507) The Director of the NFPB, however, is still responsiblefor planning,directing, and coordinating family planning services in the country and exercises the same power in the integrated areas as in the others. Coordination Committees, - 4 - comprisedof representativesof the NFPB and the MOH, have been formed at central and state levels for coordinationof activities. The State Medical and ilealthOfficer (SMHO), the highest officer of the 4I0Hat the state level, is the Chairman of the State CoordinatingCommittee and is responsiblefor executing and supervising the integratedprogram.

B. Existing Facilities

Family Planning Clinics

3.04 The NFPB delivers family planning services largely in urban areas through 77 clinics providingdaily services and through 413 mobile teams providing periodic services. Most of the clinics are located either in Govern- ment hospitals or maternal and child health clinics. While the NFPB was quite successfulin establishingits clinics in urban areas it failed to meet the schedule in the rural areas mainly due to a shortage of health personnel. Having recognizedthis difficulty, the NFPB agrred that family planning services should be functionallyintegrated with the rural health services of the MOTI. By 1971, the MOH integrationprogram had covered a population of a little less than 1 million in 8 health districts in 7 states out of 47 health districts in 11 states. (Map 3731) Therefore, out of 44 main health centers (MHCs) and 180 subhealth centers (SHCs) in West Malaysia, family planning services are only available in 11 MHCs and 42 SHCs. (Map 3999) The MOHis planning to extend integration to six more districts by 1973 and to the remaining districts in phases during 1974-76depending on the completionof staff training in these states. In addition to the NFPB and the MOH clinics, the FFPA delivered services through 164 clinics in 1970. Since the NFPB is gradually taking over the m A clinics, the FFPA recognizes that, as a voluntary organization,it can play a more importantrole in future information and education efforts.

Training

3.05 Most of the staff employed by the NFPB for the delivery of services is medical or paramedical. The doctors are trained at the Faculty of Medicine, Universityof Malaya which has an annual intake of 100-120 students. The paramedical staff consists of nurses, trained assistantnurses (TANs), and midwives. The basic training of nurses takes place in three schools of nursing, assistantnurses are trained in 17 schools at Governmenthospitals and midwives are trained in thirteen of these hospitals. The annual student intake is: 450 for nurses, 280 for assistantnurses, and 150 for midwives. Although family planning is not included in the basic student curricula for any of these staff categories,in-service training in public health (includingfamily planning) is provided at the Public Health Institute (PHI) to doctors and staff nurses and, at its subsidiaries,the two rural health training centers (RHTCs), to other paramedicalstaff. The annual intake for the PHI is about 500 and for the RHTCs about 144. Family planning courses are included in in-service training at the PHI and the RHTCs. The short-term in-service training in family planning of medical and paramedicalstaff in integration areas is the responsibilityof the NFPB and the MOH. The NFPB is responsible for training of doctors and staff nurses and the MGH for assistantnurses and midwives at state level. The trainingprogram proceeds gradually state by state.

Information,Education, and Communications

3.06 The InformationDivision of the NFPB with its ten regional offices is responsiblefor information,education, and communicationaspects of the family planning program. Each regional office has an informationofficer and a field assistant. All regional offices have radios, tape recorders and slide projectors to reinforce informationtalks. These regional information offices carry out group education in collaborationwith other ministries wherever possible. The headquartersunit supervisesand coordinatesthe work of the regional units and develops and produces material for group sessions. The MOH is planning to include family planning in its health education programs to emphasize the health aspects of the program.

Evaluationand Research

3.07 The evaluationof the program is undertakenexclusively by the EvaluationDivision of the NFPB with technicalsupport by the Government Departmentof Statistics. The Division is comprisedof the head of the unit, a research assistant,coders and punchers, and has access to computer facilitiesat the Departmentof Statisticswhenever computer time is available. Research capabilitiesof the Division are limited and so far most of the research on populationhas been undertakenby the Universityof Michigan.

Family Planning Budget

3.08 The GOM is the main source of funds for institutionsproviding family planning services and is complementedby foreign assistance. In 1971, while the NFPB estimated the expendituresat M$2,313,000 (US$820,000),only M$2,000,000(US$709,000) was available due to the budget cut. However, the provision of an additional grant was being consideredby the COM. In 1972, for the first time, the MOH had a budgetary provision of M$70,415 (US$24,974) for family planning.

Foreign Assistance

3.09 In addition to the GOM grant of US$709,000, the NFPB received US$275,000in 1971 from the Swedish InternationalDevelopment Authority (SIDA) in the form of contraceptivepills and equipmentand about US$82,000 from UNICEF for the training of midwives. In 1966, the Ford Foundationap- proved an initial grant of US$189,000 for the Universityof Michigan to provide advisory assistanceand material to the Governmentof Malaysia. An additionalgrant of US$124,000was approved to cover assistanceuntil 1970. -6-

C. Program Achievements

Acceptors

3.10 The targets of new acceptors for 1967-70 were based on the somewhat arbitrary goal of reaching one quarter of the married women; these targets were not related to a desired reduction in the birth rate and were not too ambitious compared to the targets in other countries such as Korea. However, the national program during this period recruited about 21% of the married women as new acceptors against the target of 26%. The largest number of new acceptors was reached in 1968 at 75,000; since then the number has declined to less than 56,000 in 1970 and 55,000 in 1971. The trend for this year is also not very encouraging as only about 19,000 new acceptors were reported by April 1972. By the end of the year, the performance may not be better than in 1971. While the achievement exceeded the target in 1968 and 1969, it was only 48% of the target in 1970 and less than 46% in 1971. Between 1967-72, the NFPB recruited 63% of the acceptors; the FFPA, 28%, and the MOH 1.5%; the rest were recruited by other organizations, s nch as rubber estates, Federal Land Development Authority, etc. Accordaipg to the NFPB annual report, the program so far seems to have concentrated on the less- educated and on high fertility groups. About three-fourths of the acceptors were reported to have had no schooling or only a primary school education, and more than half of them were less than 30 years of age.

Methods and Continuation Rates

3.11 The pill constitutes the basic method of contraception; 87% of the new acceptors used this method in 1971. However, sterilization is gaining in popularity. In 1971, sterilization (mainly female) accounted for 7.2% of all methods used as compared to 3.8% in 1969. According to the acceptor follow-up survey of 1969, 54% of the acceptors continued to use contraception after one year of acceptance and about 42% after 18 months, representing relatively high continuation rates.

Knowledge, Attitude, and Practice

3.12 Results of knowledge, attitude, and practice surveys of family planning for 1966-67 (before the program started) and for 1970, are available. During this period, eligible respondents with knowledge of family planning increased from 44% to 84%; those disapproving of family planning declined from 21% to 13%, those who ever used a method increased from 14% to 27% and current users increased from 9% to 18% in the country as a whole. These results suggest an increasing awareness and hopefully an increasing demand for family planning services. -7-

D. Future Targets and Program Constraints

Targets

3.13 The existiligprogram aims at a reduction in birth rate to 32 in 1975 and to 26 in 1985. Accordingly,the target is to recruit 600,000 new acceptors in 1971-75. From this total, 420,000 are estimated to be recruited from rural areas and 180,000 from urban areas. With existing facilities, the MOH estimates that it could reach only about 217,000 of the rural acceptors, while the NFPB estimates that it could recruit about 150,000urban acceptors, or nearly 40% of the targets. Although a small proportionof these targets may be reached by the FPAs and other agencies, there would still be a considerable short£fall in achievementsas compared to the targets of acceptors. This would imply a rate of population growth possibly exceeding 2.5% in 1975. Even in 1985, with the existing aim of decline in birth rate to 26, the growth rate of populationwould still be around 2%. The program, therefore,needs improvementnot only to achieve the existing targetsbut to set more reasonable goals to reduce the birth rate to at least 21 and thereby, the rate of populationgrowth to 1.5% by 1985.

Program Constraints

3.14 InadequatePolitical Commitment: Although the program was quite successfulin the initial years, increasinglyit is experiencingdifficul- ties partly as a result of the political situation. The subject of family planning is politicallysensitive in Malaysia today, a situationwhich pre- vents the Government from addressingitself to demographicproblems as openly and directly as some proponentsof fertilitycontrol would like.

3.15 InsufficientAdministrative Personnel: There is no Deputy Director of the NFPB to fill the gap in the administrativehierarchy between the Di- rector and the Division Heads. In the absence of the Director, the program is handled by the heads of various divisions but they lack authority to make major decisions. At the MOH as well, despite the fact that three-fourthsof the staff at the rural health centers are employed to assist in the provision of MCH services, no one officer at the state level is fully responsible for such services.

3.16 Inadequate InteragencyCoordination: Although the MOM is expected to play an important role in the national program, its activities are not fully coordinatedwith the NFPB. The CoordinatingCommittees formed by the NFPB and the MOH are not effective as they lack proper recognitionand power. Consequently,in the integratedareas at state level, there is very little cooperationbetween the NFPB and the MOH staff, a situationwhich adversely affects the implementationof the program. Also, the program has a heavy medical orientationand until now there has not been much involvementof the Ministriesof Education,National and Rural Development,and Information, etc. These Ministrieshave important extension education programs in rural areas which can be fruitfully utilized for family planning education in cooperation with the NFPB. - 8 -

3.17 Delay in Extension of Family Planning Services. The pace of extending family planning services to the rural populationhas been too slow. Even the present plan to complete the coverage of rural areas by 1976 is inadequate for achieving the targets. The main bottleneck in the extension of the family planning services to rural areas is stated to be an insufficient number of paramedicalpersonnel trained in family planning. The RHTCs responsible for in-service training in family planning do not have sufficient space and facilities to accommodate the existing backlog. The short-term in-service training program of the NFPB and the MCH is inadequate largely because of a shortage of funds and the lack of initiative by state-level MH officers to make the necessary arrangements.

3.18 Heavy Reliance on Pills: Until the present time, the family planning program has relied heavily on oral contraceptives. However, since about half of the acceptors reportedly are under 30 years of age, remaining on pills for 10-15 years would not ensure high continuationratps in the long run. The MOH has not as yet decided to provide sterilizationservices, although it in- tends to provide IUD services. The NFPB does perform sterilizations, but only in its urban clinics.

3.19 Restrictionon InforNtion, Education and CommunicationsProgram: At present, informationefforts are confined to infrequent talks within a region by the NFPB. The face-to-face motivation program is also inadequate since the hospital postpartum program is not well-developed and a NFPB policy for home visiting has not been established. In addition,political problems have caused restrictionof mass media usage as well as the organizationof NFPB group talks in some regions.

3.20 Limited Program Evaluati_o and Research. The Evaluation Division of the NFPB is largely engaged in the computation of service statistics. No detailed evaluation is made of program inputs to analyze their impact. So far, no institute in Malaysia is involved in studies and research on population problems. Until now all research on population has been conducted by outside investigatorswith token collaborationby local researchers, resulting in the developmentof limited capabilitywithin the country.

3.21 Indefinite Plan of Action: Although the NFPB determines the targets for the country's five-year plan, so far no comprehensive family planning plan relating program activities to target has been approved by the Board and adopted by the Government.

IV. THE PROJECT

4.01 The project has been developed in the light of foregoing constraints and other program requirements. It covers only West Malaysia where the Gov- ernments efforts have been so far confined. The project aims at the extension of services to the rural population and intensificationof such efforts in urban areas. Since the success of the program depends on the demand for - 9 -

these services, the project incorporates facilities to effectively approach the couples in the reproductive ages and to introduce population education in the school system for the younger generation. The long-termdevelopment of the program under the project would be based on the results of a management study, the experiencegained by evaluating the effectivenessof intensive inputs in the demonstrationareas, and operationalresearch to be undertaken by the NFPB. Locations for the physical project facilitiesare indicatedon Map 3760 and a summary descriptionof the project by functionalcategories follows:

i. Administration: (a) construction,equipment and furnishingof MCH/FP administrativecenters in all eleven states, (b) a management systems study by a consultingfirm, and advisory services for MCE/FP integration (24 man-months)and (c) 22 vehicles for supervisionof family planning services.

ii. Services: (a) construction,equipment, and furnishingof family planning clinics in 162 rural health centers and 31 Government hospitals, (b) contraceptivesupplies for a three-yearperiod following terminationof SIDA supplies in 1974, (c) equipment for IUD insertions,pap smear tests, sterilizationsand nutrition education, (d) 26 mobile health teams for MCH/FP services, and (e) fellowshipsfor training abroad for central and state MOH and NFPB staffs concernedwith family planning.

iii. Family Planning Training: (a) construction,equipment, and furnishingof a new RHTC and extension of an existing school, (b) equipment for production of trainingmaterials and audiovisual equipment for all training centers, (c) advisory services for training material productionat the PHI (12 man-months),for introductionof training in health education/familyplanning and use of media at the PHI (60 man-months),(d) short-term fellowships for the PHI and the FFPA staff members involved in family planning training, (e) six buses for RHTCs and four for regional auxiliary staff training centers and for FFPA trainees,and (f) training of auxiliary staff and traditionalmidwives in family planning services and seminars on various aspects of the family planning program.

iv. Information, Education and Communications Program: (a) equipment for educational material production at the NFPB and the MOHand audiovisual equipment for rural health centers and state MCH/FP administrative centers, (b) advisory services for media production at the NFPB (24 man-months),communications research at the NFPB (21 man-months),and introductionof population education at the Ministry of Education (MOE) (30 man-months),(c) fellowships for the NFPB, the MOH, and the FFPA informationand health education officers, (d) supplies of films on family planning for the NFPB and the FFPA, (e) eleven mobile vans for state MCH/FP centers with audiovisualequipment, 2 exhibitionvans - 10 -

and 1 landrover,and (f) curriculum developmentand teachers training for population education,as well as information material production at the NFPB and inservice training in health education.

v. Evaluation and Research: (a) a mini computer including sorters and punchers for the NFPB, desk calculatorsfor the NFPB and the University of Malaya (UN), (b) advisory service for population research at the NFPB (60 man-months) and for the population studies and research center at the UM (72 man-months) and for medical records (6 man-months),(c) fellowshipsfor UM staff in demographyand for FFPA staff in evaluation, (d) one vehicle each for the NFPB and the UM, (f) research and seminars at the UM, and (g) library books for the NFPB and the UM.

vi. Intensive Input Demonstration: (a) construction,equipment, and furnishing of 365 midwifery clinic-cum-quarters (MCQs) in the 14 demonstrationdistricts, (b) 102 buses and 200 motorized bicycles for supervisorynurses, and (c) local training of midwives, production of informationmaterial, s- 'cial evaluation, baseline surveys and applied nutrition program.

vii. External Review: A team of internationalconsultants to be appointedby the Government to review the program midway through the project.

viii. Project ImplementationCommittee: The formation of the Project Implementation Committee responsible for the administration of the whole project and establishmentof a unit for implementing the constructioncomponent of the project.

A. Administration

4.02 The physical facilities of the project will provide MCHIFP centers in 11 states with offices for both MCH/FP staff of the MOHand the NFPB regional staff, along with accommodationsfor training,seminars and a library. At present there is no center for family planning administration at the state level. Administrative processes therefore are carried out separately and on ad-hoc basis by the NFPB and the MOH. (Chart 7220) These would provide a locus for family planning administration at state level to coordinate the workings of the NFPB and the MOHby bringing them under one roof and under the single monitoring of the State Medical and Health Officers, without causing the NFPB to lose its identity. For effective supervisionof family planning services throughout the state, vehicles have been provided for the NFPB and the rPrA staff in each state, as well as one for the head of the MCH unit at the MOH.

4.03 Institutional and administrative improvements and additional personnel are extremely importantat this stage of program developmentin West - 11 -

Malaysia. The project, therefore, provides for a management study of the family planning program by a professional firm. An MCH/FP adviser is also provided in the project to assist with the technical aspects of integrating family planning with MCHservices. The MOHintends to create posts for officers in each state responsible exclusively for MCH/FP services. The NFPB needs a Deputy Director, preferably a social scientist or an administrator, to assist the Director. To give the program a broader base and to provide improved coordination of activities, the membership of the Coordina- tion Committees at the central and state levels should include representatives from the Ministries of Information and Broadcasting, National and Rural Development, and Education. The terms of reference for these Committees should be clearly defined and a mechanism should be established to give effect to their recommendations. For better organization of the program a comprehensive five-year family planning plan for 1976-80 should be prepared by the NFPB and adopted by the Government. It would then become a commitment to all ministries and agencies involved in the program. For the interim period, 1973-75, a plan of action should be prepared covering all aspects of the program and including extension of services to 90% of the rural population as early as possible, but nct later than 1975.

4.04 Agreement has been reached during negotiations on all the points mentioned in para. 4.03 specifically: (a) appointment of a firm to undertake a management study midway throuh the project, (b) the appointment of a MCH/FP adviser by June 30, 1973, (c) appointment of MCH/FP officers in all the eleven states by December 31, 1973, (d) appointment of a Deputy Director of the NFPB by April 30, 1973, (e) establishment of a mechanism for implementing recommendations of the Central and State Coordination Committees by June 30, 1973, and review of the membership of these Committees and definitions of their terms of reference and (f) preparation of the five-year family planning plan for 1976-80 in consultation with the Bank by January 31, 1974 and a plan of action for 1973-75 ensuring the coverage of 90% of the population by 1975.

B. Services

4.05 Rural Services: To improve the coverage of the rural population, the project will expand significantly the space and equipment in most of the rural health centers, as well as the number of mobile clinics. Many rural health centers are so crowded that, at present, the NFPB or health center staff must carry out family planning activities in a eorner of the hall or even on the porch. There is no privacy during the clinic session nor are there rooms for private consultations, sterilization operations, or IUD services. Not only is the existing space at the health centers inadequate, but also additional space will be required for the applied nutrition program and group talks on health and family planning which are planned to be an important part of MCHservices. The nutrition program would help,reduce the toddler mortality rate and also attract eligible mothers to the clinics, thus providing opportunities for more ready acceptance of family planning. In all, 162 of the 245 existing health centers, - 12 - with averagedaily outpatientattendances of 20 or more during the last three years, have been selected for additional clinic space. (Annex 3)

4.06 At present, the existing health center staff is servicing 234 remote villages through subsidiaryclinics. To improve the coverage of population, the GOM is planning to constructadditional health centers. Meanwhile, about 26 mobile MCH/FP service units, provided by the project, would cover the remote population. These mobile units would service 26 of the 47 health districtswith populationsexceeding 150,000. As a part of the project, audiovisualequipment to be used with group talks and family planning films will be provided for all health centers. The project also includes equipment for IUD insertionsat main health centers in rural areas, for pap smear tests at urban hospital clinics, and for nutrition education at all rural health units. At present, some of the staff members of the MCH unit at the MOH are nottrained in public health, therefore,three one-year fellowshipsfor the masters degree program in public health are provided for the MOHX,in addition to fellowshipsfor short-term training for all state medical officers and for MOH staff members at the central level.

4.07 Urban Services: The project provides for the re- acement of existing inadequateaccommodations in the Governmenthospital clinics. Family planning clinics in Governmenthospitals are the best strategic points to (a) provide contraceptiveservices, such as sterilizationsand IUD insertions,and (b) approach maternity patients for face-to-facemotivation. Most hospitals are already suffering from lack of space and their operating theaters are too busy for the scheduling of sterilization cases within a reasonable period of time. At present, in some cases, the NFPB utilizes hospital corridorsor garages for its clinics; in other cases, no space at all is availablewithin the hospital premises. From the 44 clinics in these hospitals, the 31 selected for replacementare those (a) with substandardfacilities or locatedoutside the hospital premises;or (b) with a large number of deliveries;and or (c) located too far away from the nearest health center. (Annex 4) Fellowshipsfor short-termstudy tours for NFPB nurses are included in the project to help them to get a broader perspective of the program.

C. Training

4.08 The project will greatly expand the existing capacity for in-service training of paramedicalpersonnel and will assist in the establishmentof a center for the production of training materials. Because of the limited training capacitiesat the two existing RHTCs (at Jitra on the West Coast and Rembau in the South), only 40% of the existing assistant nurses and 15% of the midwives have completed in-service training. It is estimated that with the existing trainingcapacity, it will take about 17 years to cover the backlog as about 2,500 assistantnurses and midwives are to be trained during 1972-75. Since family planning services will be a part of health services, it is proposed that the training of staff for rural health services (which include family planning) be expedited. One new RHTC, with a capacity of 60 - 13 - students, is proposed for constructionat Marang in the State of Trengganu on the East Coast. In addition, the existing RITC at Rembau would be expanded to increase the intake by 36 students. The new school and the extensionof the existing one would increase the capacitiesof RHTCs by 288 annually over the present total of 144. For effective teaching of courses in family planning, the project includes equipment for production of trainingmaterial and audiovisualequipment for the PHI, the RHTCs and for the schools of basic nurses training. Vehicles are also provided for each of the three RHTCs for field training of trainees.

4.09 To expedite the integrationof family planning with MCH services, the MOH is planning to organize four regional centers for short-term training of paramedicalstaff. About 9 courses--eachwith a three-weekduration and accommodating25 students--wouldbe organized at each of the four centers annually to prepare 900 students per year out of the total of 2,500. The project includes the total cost of establishing these centers including stipends, vehicles, salary support and other expenses, with the exception of building rent. With the existing schedule, it will still take more than two years to complete the training. Agreement has been reached during negotiations that a schedule for completion of the short-term training of paramedical staff will be prepared and sent to the Bank by June 1973.

D. Information,Education, and Communications

4.10 The project will strengthenand expand the information,education, and communicationsactivities of the NFPB, the MOH, the MOE, and the FFPA . Each agency will reach different types of audiencesby group talks supported by films and slides, the distributionof printed material, posters and by the introductionof populationeducation in schools. The roles of the organizationsand other ministries are shown in Chart 7044. Equipment is provided for establishingunits at the NFPB and the MOH for productionof material such as posters, booklets, slides, and photos. While the NFPB will concentrateon family planning material alone, the MOH will produce material on health educationand will obtain assistance from the NFPB concerning family planning content. Two advisers are provided at the NFPB not only to assist in the production of material but to test its response and conduct research in communications. The project will also give salary support to additional local personnelneeded for the purpose. All MCH/FP clinics (245 existing and 99 to be added during the next five years) will have audiovisualequipment to support group talks. To reach more of the rural population,an additional mobile van with equipment for each state is included in the project to support present NFPB efforts. Audiovisualequipment is also provided for use at the MFPAseminars and group talks for opinion leaders. The project includes all componentsneeded for the introductionof population education in the school system, such as advisory services for curricula development,training of teachers and printing of material. Agreement has been reached during negotiations that population educationwill be introducedin the school system not later than December 31, 1976. - 14 -

E. Evaluationand Research

4.11 The project will establish two new and somewhat differentpopula- tion research units to develop the capabilityfor training and research in populationproblems in the country. One unit within the EvaluationDivision of the NFPB will concentrateon onerationalresearch relevant to program evaluation,the other, at the Universitvof Malaya will deal with national demographicproblems and training. Both units will be furnishedwith compu- tationalequipment, library materials,and advisers. In addition, the NFPB will be provided with a computer and the U.4with fellowshipsfcr the training of Malaysians. The managementconsulting firm, forming part of the project, will also review the system of evaluation to suggest suitable modification. During negotiations,agreement has been reached that research advisers at the NFPB will be appointed and a PopulationStudies and Research Unit will be establishedat the TUniversityof Malaya by June 30, 1973.

F. Intensive Input DewonstrationArea

4.12 The project will provide additionalfacilities,in 14 districts where the family planning services are already integratedwith health services or where the decision to integrate shortly has been made. These additional facilitieswill help to demonstrate the effect of intensityof various inputs on the acceptanceof family planning and thereforewill facilitatethe development of long-termpolicies for the country as a whole. In all 14 districts special family planning training will be given to midwives and trained assistant nurses and vehie]es will be provided to health center staff to permit closer supervisionof activitiesat the peripheral units, i.e., the midwifery clinic-cum-quarters(MCOs), and to permit more home visiting by midwives. Also, all MCQs will be enlarged by building separate quarters for the resident midwives; the existing quarters will then be used for the provision of broadened health services, including family planning. (YAP 3732) Detailed evaluationof this demonstrationis an important part of the project. (Annex 5)

V. OST S FINCANING7,IMPLEMENTATION AND DISBURSEMENTS

A. Costs

5.01 The total project cost including contingencies is estimated at US$14.5 million. The project cost by the ftnctionalcategories is stum- marized in the following table, while the details are given in Annex 6. - 15 -

M$ . thousands ...... US$ Local Foreign Total Local foreign Total %

I. Administration 1,740 1,562 3,302 617 554 1,171 10.3 II. Services 5,425 5,165 10,590 1,924 1,832 3,756 33.0 III. Training 2,058 1,272 3,330 730 451 1,181 10.4 IV. Info., Ed., Comm. 3,397 2,896 6,293 1,205 1,027 2,23219.6 V. Evaluation & Research 107 1,765 1,872 38 626 664 5.8 VI. IntensiveInput Demonstration 4,258 2,473 6,731 1,510 877 2,387 20.9 Total 16,985 15,133 32,118 6,024 5,367 11,391 100.0 VII. Project Construction Unit 296 - 296 105 - 105 - VIII. External review 70 - 70 25 - 25 - IX. Contingencies 2,836 2,529 5,365 1,006 897 1,903 Interest and other charges - 3,090 3,090 - 1,096 1,096 Total 20,187 20,752 40,939 7,160 7,360 14,520

5.02 Construction(including equipment and furniture) accounts for 44% of the project costs. Of the remaining costs, less than one-tenthrepresents technicalassistance and more than one-sixth local cost of printing and training, in which the major items are the preparation of population education material and the training of teachers and paramedical staff. The cost estimatesby disbursementcategories are summarized in the following table:

__ __ thousand. u $ Local foreign Total Local Foreign Total % 1. Construction, equipment and furniture 10d677 6,013 16,690 3,786 2,13 3 5,919 44.1 2. Special equipment 1,866 1,866 662 662 4.9 3. Contraceptives 1,1B i,13 - 3°3 393 2.9 4. Books and films 202 202 71 71 0.5 5. Vehicles 2,510 2,5 10 890 890 6.6 6. Technical assistance 3,,434 3,14341 1,218 1,218 9.1 7. Printing and training 5,898 5,898 2,092 2,092 15.6 S. Salary support 410 410 146 146 1.1 9. Project Construction Ujnit 296 296 105 - 105 0.8 10. Externalreview 70 70 25 - 25 0.2 11. Contingencies 2, 36 2,529 5,365 10n6 897 1,903 14.2 Total 20,167 17,662 37,849 7,160 6,264 13,424 lo0.0 12. Interest and other charges 3,090 3,090 1,096 1,096 TOTAL 20,187 20,752 40,939 7,160 7,360 14,520 - 16 -

5.03 The cost estimates for buildings are based on the assessment of 1971-72area unit prices from current examples of building contracts recently executed. They have been subsequently adjusted to reflect more economical building standards. The proposed method of project implementation which would provide strict technical control over standards may fturther reduce costs. The cost of construction is expected to vary between US$4 to US$7 per sq. ft. depending on the type and location of building. Furniture and equipment cost estimates were reviewed for all the institutions in the project. Reasonable bulk costs for these categories of goods have been included in the costs for each clinic, training school and administrationbuilding and include Group I and Group 2 equipment. Group 3 equipment (small items supplied and put in position by building users) is specificallyexcluded from these estimates. Cost of imported items are net of duties from which the project will be exempted. Also the cost of site surveys and building permit fees have been excluded. The detailed cost estimates of physical project facilities are given in Annex 7.

5.04 The estimates of the Bank-assistedcomponents include an allowance for contingencies,10% per annum for physical and 4% per annum for price escalation over the five-yearperiod of the project. The estimated foreign exchange component for buildings (30%) includes direct materials, the estimated foreign exchange component of locally-produced materials, and the depreciationof contractors'imported plant during the constructionperiod. Interest and related charges on the loan during the implementationperiod through December 1978 have been included.

B. Proposed Financing

5.05 The project would be financed by a UNFPA grant of US$4.3 million, a Bank loan of US$5.0 million, and a Government contributionof US$5.2 million. The external financing is arranged in parallel,with each donor financing separate and identifiable project components. Items to be financed by the UNFPAconsist primarily of contraceptive supplies, training stipends, the production of informationmaterial, certain vehicles, medical instruments and various advisory services. The Bank loan will finance construction, certain vehicles, audiovisualand computing equipment, and some advisory services. Details of the items to be financed by each donor are set out in Annexes 8 and 9.

5.06 The Bank loan will cover the foreign exchange component of the Bank-assisted items in the project including interest and other charges. It amounts to US$5.0 million, or 49% of the total cost of the Bank-assistedpart of the project. The total external contributionwill cover the foreign exchange cost of the project of US$7.4 million, plus local costs amounting to about US$2.0 million. The following table summarizes the financing arrangements: - 17 -

M$ . millions ...... US$ Local Foreign Total Local Foren Total %

Bank loan - 14.10 14.10 - 5.00 5.00 34.44 UNFPA 5.h4 6.65 12.09 1.93 2.36 4.29 29.54 cGO 14.75 - 14.75 5.23 - 5.23 36.02 Total 20.19 20.75 40.94 7.16 7.36 14.52 100.00

The GON will contribute US$5.2 million in capital costs. In addition, an estimatedUS$1.4 million for incrementalcurrent costs resulting from the project (Annex 10) will be borne by the GOM. The total GOM involve- ment averages outtat just over US$1.0 million per year for the five-year project period. These additional budgetary requirements should be well within the financial ability of the MOH.

C. Implementation

Project Imnlementation Committee

5.07 The proposed project will be implemented during 1973-78. (Annex 11) The NFPB will be mainly responsiblefor the administrationof the project, in particular the non-constructionpart. Since the project involves im- plementationthrough a number of organizationsand ministries the Govern- ment will appoint a Project ImplementationCommittee to ensure effective executionand implementationof the project. The Project Implementation Conmitteewill consist of a representativeof the Economic Planning Unit, the Director-Generaland the proposed Deputy Director of the NFPB, the Director of Health Services, and representatives from the Planning and DevelopmentDivision of the MOH, the Ministry of Education, the University of atlayaand the Treasury. The representativeof the Economic Planning Unit will be the chairman of the committee.The Deputy Director of the NFPB will be Executive Secretary of the Project Implementation Committee and the Project Administrator. (Annex 12) The formation of the Project Implementa- tion Committee is a condition of loan effectiveness.

Project Construction Unit

5.08 A Project Construction Unit will be established in the Ministry of Health for the implementationof the constructioncomponent of the project. An architectwill be in charge of the Project ConstructionUnit; he will be provided with an adequate number of technicalpersonnel and facilities necessary for efficientoperation of the unit. Agreementhas been reached during negotiationsthat the Project ConstructionUnit will be established by April 30, 1973.

ProfessionalServices

5.09 The need to evaluate and establisheconomical building standards for the project and closely supervisethe implementationrequires the - 18 - emplovment of professional manpower beyond the existing resources within the Government. Therefore, agreement has been reached during negotiations that the Government shall employ an architectural consultant not later than April 30, 1973. Ilewill have recognized expertise in health delivery and family planning facilities and will be acceptable to the Bank and appointed upon terms and conditions satisfactory to the Bank.

Advisorv Services

5.10 The Government has agreed during negotiations to consult both the Bank and the IJNFPAon appointments of MCH/FP advisers and the management consulting firm and has further agreed that these advisers shall lhave qualifications and experience satisfactory to the Banl. In the case of technical advisers, to be provided through the TWUOand the UNESCO or appointed directly by the Government, aoreement was reached during negotiations between the GOM, the UNFPA and the Bank on their qualifications and terms of reference, and no further consultations will be necessary. The agreed terms of reference for these advisers are given in Annex 13.

Procurement

5.11 Contracts for furniture, equipment and vehicles require' for the project and financed from the proceeds of the loan would be awarded on the basis of international competitive bidding in accordance with the Bank's guidelines. Contracts for civil works w'ould be subject to local bidding procedures. According to Malaysian procedures for public work contracts, foreign contractors will be allowed to bid. However, civil works consist mainly of the construction of small buildings. It is spread over a 3-year period in eleven states and grouping would be pcssible only in packages of say 20 to 30 units. With unit costs varying from US$3,000 to US$10,000, such contracts are unlikely to attract foreign contractors. The annual workload of this project will only represent a small proportion of the local construction industries' annual capacity.

5.12 Local manufacturers of furniture, equipment and vehicles competing for the supply of these items will be allowed a margin of preference of 15% over the CIF landed costs of competing imports or the existing rates of import duties, whichever is lower. The lists and estimates of furniture and equipment prepared by the consultant would be approved by the Bank before procurement. All procurement will be based on contract documents and bid packages prepared by the consultants and approved by the Government and the Bank. The consultants will also advise on and review tendering procedures, adjudication of bids received and comment on contract awards. The details of their duties with respect to procurement and supervision are given in Annex 12.

D. Disbursements

5.13 The loan would be disbursed agalnst: (a) 100%/ of the CIF price for directly imported and against the exfactory price of locally manufactured - 19 - special equipment,vehicles and furniture; (b) 70% of total cost for locally procured but previouslyimported equipment,vehicles and furniture;(c) 90% of foreign exchange expendituresfor technicalassistance; and (d) 30% of the total cost for civil works and professional services. The disbursement schedule is given in Annex 14.

VI. SOCIO-ECONONICANALYSIS

6.01 The project will help the Government to achieve higher targets of fertility decline than could be achievedwithout it. A faster reductionin the rate of population growth will result in more rapid increases in per capita income. In the long run, the project will assist in slowing the growth of the labor force and in reducing unemployment. By extending family planning services in poor (mainlyrural) sections of the societv, the project will help to equalize economic opportunities. Through its health and nutrition components,the project will improve the mental and physical capabilitiesof children and reduce maternal and child mortality and morbidity.

6.02 Quantitative projections of these benefits with any degree of precision is difficult; yet other things being equal, it is expected that by 1985 the project should help to reduce the birth rate to 21 instead of to 26 as envisaged under the existing targets without the project. (Chart 7035) Consequently, the rate of natural increase of population may decline to around 1.5% instead of 2% by 1985. These demographiceffects of the project would lead to further reductionsin the birth rate after 1985 (Annex 15) and in 1990, the birth rate may correspondto a net reproduction rate of 1 and result in achieving zero population growth sometime in the next century.

6.03 ks a result of the realizationof these demographic targets through the project, average per capita income in 1985 would be about 5% higher than otherwise,a benefit that would continue to grow thereafter. To secure a comparableincrease in per capita income through alternative investmentswould, in most cases, require an investment that exceeds the total cost of the project several times over. In addition, the estimated reduction in the growth of the labor force of around 240,000 by the end of the centurywould help reduce unemployment(currently estimated at around 250,000) and improve productivity. (Annex 16)

VII. AGREEMENTSREACIIED AND RECOMMENDATIONS

7.01 During loan negotiations, agreement was reached on the following principal points:

(a) The appointment of all additional officers, technical advisers and consultingfirms required for the project (para. 4.04, 4.11, 5.10 and 5.11); - 20 -

(b) the preparationof a five-yearfamily planning plan (1976-80)9 a plan of action (1973-75)and a schedule of short-term training of paramedicalstaff (paras. 4.04 and 4.09);

(c) the establishmentof a mechanism for implementingthe recommendations of the Central and State CoordinationCommittees (para. 4.04);

(d) the introductionof population educationin the school svstem (para 4.10); and

(e) the establishmentof the Project ConstructionUnit; (para 5.03).

7.02 Conditions of loan effectivenessare the establishmentof a Project ImplementationCommittee (para 5.07) and the conclusionof arrangements of UNFPA financialassistance to the project.

7.03 Subject to the assurancesand fulfillmentof conditionsdescribed above, the proposed project is suitable for a Bank loan of US$ 5.0 million for a term of 25 years includinga ten-year grace period. West Malaysia ANNEX 1

Copa..ative Pop.l.tion Program Indicators in Selected Coutrie- Page 1 of 1 (1970 or Latest Available Year) 2/

Sources: Chi"a Arab Rep. of Korea Kenya Yn,. of) Malay.ia Singapore Thailand T-nisia Turkey (Rep. of) Egypt Gh... India Indonesia Icao Japan 3 6 2 102 11.7(est)ef 32.06 of 9.3 of 2.1 of . (.st)ef 5.2 ef35.5 o I/ Unless otherwise indi- I Populatios(n a.illi-s) 14.7 33.3 of 9.3 of 547.4 e 121 .f 28.7 13o 328f70f3.9f 46 f taken Population Density per 390 hf 33 hI 38 hf 182 ef 81 hsf 1-,h/ 2801hf 20 of 326ef cated, data war / 32e 7e 1946 / frm D. Nortmoan, cq. lkt. -18 3fl.32 32.2 e/ 22.4 41 38 o 40 'yopuletiossand Family Cruds Birth Rate 27.2 35.6 p/ 50 38 ef48 e/ 48 18.8 10 5/ ~f Pf-amig Prograsua: A (Per 1000) 7.2 ef 5.2 e/ il 13 of 15 Pact Sooak", Reports on Crude oath Rate 4.9 15.0 ef 20 17 of 22 ef 16 6.9 17 Of9-11 Ppopl.tio./Family Plan- (Per 1000) 2.0-2.2 2.5 of 1.7 of3.0 7.5 of2.5 niuR, The Pop.lation Rots of Natural 1ncrease 2.2 2.1 of 3.0 2.1 ~f 2.6 3.2 1.2 3. 3s 93 157(1970)ef 98.5 ef212 of Council, N.Y. Sept. 1972. Geea etlt ae 14 182 203-224 1f95(1961-65)ef 207 cf 139 . ~f 26.2 of 115 ef119 hf Infant Mortality Rats 18 1/ 119 (1969) If 122 bf 139 of 125 of - 13 bf 132 rf 49 of/ 43.2 ef 20.8 ~f 46 42 43.3 of/ 38.8 e/ 44 of 41 42 hI/ Population Reference Percep.to1 Population 40 40.3 of 46 42 ef 42.1 of 46 24 Bureau. In..., 1972 world under 15 years 6.8 1.9 0.47 2.5 of 1.1 of 7.5 Population Date Sheet. Nubner of F-nle. 15-44 3.3 7 of 2 115 29 5.5 26.3 2.5 of years (Millions) 29 a70 ef ofOECD. Population Somey Perent Of Birth. at H-om u 75 df a o0 71 43 29 100 15 035 (Prese.nted at the fourth Percent of Population in 63 42.1 of 29 Sf 20 14 41 68 10 A.-Ia Population Confer- Urban Ar... 150 8 24 19 once) Oct. 1971. Literacy date Percent of Population 35 31 14 10 12 23 5 7 38 12 for Egypt, Ghana, Japan and Residing in Cities of Thailand are f-r 1960; 100.000 + Iran and Tuni.ia fot 1966; Percnot Literate 8 2 9376.8 70 89.671o-. 321_710.. 80 7i5sA Malaysia for 1967; Singapore Male ..7. 35r:-4 d 21 725+ 29.4_71st 55 32.8 715+ 99.8 55-1 10+ 7861.17 52- for 1968; Turkey for 1969; Fo1male15+12 d 7 12.2- 99.9 42 25 cj 9.6 of 12 cf 27 df Indonessia Kenya eandKorea Percent of Married Women 44c 1-2 of 11.2 of 1.3 I/ 9.3 cf 3 d/ of26 for 1970; and India for 15-44 protected by 1971. PaJly Planning Continnatims Rates for dIPop.latIon Counc il. Dee Year 66.7 gf 38 d/ Pi lSSUsero 32 r/ 60. a54 d/ 37 df 58 56 c/ 57 d1 69 of76.0 a./ 67- ef Latest available IBBD data. IUDh 67 of77 £'86 ~/ 63 !41 Mealth Ministry Budget 0.97 7.3 8 3.3 4*7 ff U.N1. Population and Inter- &o% Of Total Central 3,4 14 2.1 1L4 13.4 6.9 national Statistics July Govar-e.ot Budget 1971. Per Capita E,psnditurea by Family Planning custs) 6.9 11 14.6 624 24 4.8 6.9 18 7.7 14 16.8 4.6 sfFamilyPlanning in Thai- Pragrassa (U.S. 4.50 df 10. 60 EL/ 39 39 df/ land. 1965-70, Ministry Coat Per Ac-pto- (U7.S.) 4 df of Health, Thailand. 1971. Population Par Health Worker (500) 10 2 4 1.6 11 6 2 U.N. D-ographic Yearbook, Doctor 4 2 13 5 28 3 0.9 hI 5 4 1.0 11 25 3 1970. Midwife 7 2.2 11 21 19 14 3.4 5 9 1.7 3 8 8 4 0.4 2 2 2 0.5 5 2 2 'N,rse (IC5) 2190 ('65) 2860 ('65) Calorie Intake Per Capita - 2940 (68~) - 2110('60) 1980 ('60) I8.7065) 2460 (-60) 2120 ('60) 2390 ('65) 2400 ('60) 2400 ('60) 2140 Per Day (goons) 310 Estimated P-r Capita 390 210 310 110 80 380, 1920 150 250 380 920 200 250 Income (1970)

ANNEX2 Page 1 of 7

West Malaysia

Population Growth and Economic Development

1. This annex attempts to (a) summarizethe long-term demographic trends in West Malaysia and (b) relate the recent trends in population growth with growth in per capita income, unemploymentand underemployment in the country as a whole. The purpose of such an analysis is to illustrate the implications of a high rate of population growth for long-term economic development and reduction of unemployment. It is, of course, well-recognized that social and economic implications of population growth are far more extensive and basic than can be revealed in one or two simple variables for which data are available. The social implications of relatively higher fertility of lower income groups leading to perpetuation of inequality in income distribution through inadequate nutrition, health and education, is one example which cannot be demonstrated quantitatively because not enough data are usually available for such analysis.

Population Size and Growth Rate

2. The first census in 1911 reported the population of West Malaysia at 2.3 million and according to the 1957 census the population had reached 6.3 million. Although the results of the 1970 census are not yet final, the population is estimated at 9.3 million. Between 1957 and 1964, the natural rate of population growth averaged more than 3%, and declined to 2.5% by 1970. (Table 1) This decline resulted from a decrease in the birth rate from more than 46 in 1957 to 32 in 1970 and despite a simultaneous decrease in the death rate from 12.4 per thousand to 7.2. This decline in birth rate representsa genuine decline in fertility and not simply a change in the age structure of population as the general fertility rate also declined from 229 in 1957 to 157 in 1970. (Table 2)

3. Recently, the country has been facing considerable difficulty in reducing the general fertility rate because of inadecuatefacilities to extend the program to rural areas. Between 1969 and 1970, the general fertility rate declined only from 163 to 157 and the birth rate from 33 to 32. The task of reducing the birth rate is likely to become all the more difficult for the next several years because of the entry of an even larger number of persons in the reproductiveages resulting from the postwar baby boom. The birth rate is estimatedto have increased to 32.4 in 1971 and may go as high as 35.3 in 1975 and to 37.6 in 1980 if current fertility rates remain unchanged. Consequently,the rate of population growth may increase to about 2.8% in 1975 and to more than 3% in 1980. Even largely increasedefforts in family planning can, therefore, only reduce the birth rate moderately, due to the transitorybut unfavorableeffects of the age distribution. Without an effectivefamily planning program, however, it is estimatedthat the population may reach 23 million by the year 2000. (Table 3) ANNEX2 Page 2 of 7

Per Capita Income

4. The impact of population growth on the growth rate of national and per capita incomes during the last decade for Malaysia as a whole is shown in the following table:

Average Annual Growth Rate 1961 1965 1970 1971 1961-65 1965-70 1970-71 Real Cross National Income (US$ million) 2,150 2,808 3,487 3,594 7.7 4.8 3.] Population (000i) 8,368 9,421 10,945 11,241 2.8 3.2 2.7 Per Capita Income 257 298 319 3201/ I 0 1.4 0.3 (US$)

1/ The difference between the basic data figure of per capita GNP at US$380 and that given in this table is due to the change in exchange rate, revision of figures, and differences in prices and concepts. The income is at 1965 prices.

Source: IBRD, Current Economic Position and Prospects of Malaysia, 1972, Table 2.1.

5. The wide fluctuationsin the economy emanate from the structure of the economy that relied heavily on the primary sector, mining and services. About half of the income is generated from agriculture, forest-y and only 13% from the manufacturingsector of the economy. The recent slow down in Malaysia's economy is reported to be due to "decline in exports caused by a recession in foreign markets for tropical timbers, exceptiur.aliylow prices for rubber, exhaustion of iron ore mines and a reductior. in tin out- put.'t The domestic market, of course, is reported to have reco-ared significantly from the depressed portion of 1969 and increased by sometlhinglike 12% both in 1970 and 1971. This shows that a self-sustained stable rate of economic growth that depends on the capacity to save and invest in the economy would reouire a rapid industrialization and diversification of the domestic economy. Thus, insofar as the high rate of population growth inhibits rapid increases in savings and investment, there is an incompati- bility between achieving these development objectives and the high population growth rate.

Unemployment

6. The official figures indicate an unemployment of 8% of the labor force mainly concentrated in West Malaysia. The Second Five-Year Plarn (1971-75) observes that "the pace of new job creation could not keep up with the strong spurt in labor supply during the First Malaysian Plan Period (1965-70)." As a result, unemploymentrose from about 6.5% of the ANNEX 2 Page 3 of 7 labor force at the start to about 8% at its close. In spite of 596,000 additional jobs to be created in the Second Plan, or 3.2% per annum, about 324,000persons are estimated to be unemployed in 1975. In other words, the employment situation would not improve over the next five years in spite of a large effort on the part of the Government. Any short fall in the targets of the Second Plan would, of course, cause further deterioration. Data are given in the table below.

Comparison of First and Second Five-Year Plans (1965-70 and 1971-75) (in thousands)

Average Average Annual Annual 1970 Increase Growth 1975 Increase Growth 1965 (Est) 1966-70 Bate (g) Tarfet 1971-75 Rate (%)

Malaysia Labor Force 3,246 3,768 522 3.0 4,413 645 3.2 Employment 3,048 3,493 445 2.8 4,089 596 3.2 Unemployment 198 275 77 6.8 324 49 3.3 Unemploymentas 6.1 7.3 - - 7.3 - - percent of Labor Force

West Malaysia Labor Force 2,730 3,150 420 2.9 3,690 540 3.? Employment 2,550 2,900 350 2.6 3,395 495 3.2 Unemployment 180 250 70 6.8 295 45 3.3 Unemploymentas 6.5 8.0 - - 8.0 - - Percent of Labor Force

Source: Governmentof Malaysia,Second Five-Year Plan.

7. The fact that existing unemployment is largely due to the high rate of population growth in the past is bbvious from the fact that it is largely concentratedamong the new entrants in the labor force. over 64% of the total unemployedwere in the 15-25 age group in 1962; by 1967 this had risen sharply to exceed 75%. About 65% of the unemployed in 1967 were first-time job seekers, up from 47% in 1962. In locational terms, serious unemploymentoccurs in the urban areas where the rate is around 10%. Here again, youth unemployment rates are very high. 1/ This phenomenon is

1/ Government of Malaysia, Second Malaysia Plan 1971-75, p. 99-101. ANNEX 2 Page 4 of 7 largely because of the migration of unemployed and underemployed young persons from the rural areas, delays in development project implementation, and the postwar baby boom. Similarly, about one-half of the labor force is in the agricultural sector and more than one-third in services. Thus, about 85% of the labor force is in occupations with heavy underemployment. 8. The problem of underemployment is ecqually serious in West Malaysia. The Second Plan again observes that in addition to overt and measured unemployment there remains large numbers of workers in low productivity jobs who are underemployed,in the sense of both low intensity of work as well as low earning and income. In 1967, about 11% of the workers classi4tied as employed were reported to be working less than 25 hours per week. Be- sides the underemployed, there remain those not classified within the labor force because they are not actively seeking jobs but would accept one if offered. Some portion of 63,000 persons so identified in 1967 would be likely to move into the active job market if labor demand grew brisk. ANNEX2 Page 5 of 7

Table 1

Population Size and Growth Rate, 1911-71

Annual hate Annual Rate Population of' Natural of Groizth of Yc r (thouand ) IilcrsCoC P'onleatdior,

1911 2339 1 21 2907 2.b 1.931 3788 - 3.0 15)47 4908 - 1.8

1957 6279 33.7 2.8 1'531 6I495 32.33. 1$y59 ,6B9P 32.3 3.1 196,0 69o9 31 .1, 3.2 1961 t 17 32.7 3.3 1962 7377 31.0 3.4 1''63 7611 3..4 3.2 196b 7Ui1i 361.0 2.7 i6c5 803>,! 28.8*.9 1966 829 2S.7 3.2

1967 828 27.8 2.9 1965Q 8789, 27.6 ,.9 9019 25 2.6 1/70 930u 25.0 1971 9534 25.2

Sources: Department of Statistics, Vital Statistics, April and October 1971, p. 3. Government of Malaysia, Second Malaysia Plan 1971-75D, p.90. Data for 1971 are mission estimates. ANNEX2 Page 6 of 7

Table 2

Fertility and Mortality Rates, 1957-71

General Infant Birth Total Fertility Death Mortality Toddler Year Rate Fertility Rate Rate Rate Mortality

1957 46.2 6.7 229 12.4 76 11 1958 43.3 6.1 - 11.0 80 9 1959 42.2 6.1 - 9.7 66 8 1960 40.9 6.1 - 9.5 69 8 1961 41.9 6.2 - 9.2 60 8 1962 40.4 5.9 - 9.4 60 8 1963 39.4 5.9 - 9.0 57 7 1964 39.1 6.o - 8.1 48 6 1965 36.7 5.5 - 7.9 50 6 1966 37.3 5.2 - 7.6 48 5 1967 35.3 5.2 - 7.5 45 5 1968 35.2 - - 7.6 42 5 1969 33.0 4.8 163 7.2 43 5 1970 32.2 - 157 7.2 1971 32.4 158 7.2

Sources: Department of Statistics, Vital Statistics,West Malaysia, 1969. General Fertility Rates, NFPB estimates. Data for 1971 are mission estimates. ,NNEX 2 Table 3 Page 7 of 7

Population Projectionswith ConstantbFertility, 1975-1999 (inthousands

Birth Death Natural Rate Tntal MJIal.e~.. Female Rate Rate of Increase

1975 10,899 5,558 5,341 35.3 6.7 28.6 1980 12,708 6,468 6,240 37.6 6.3 31.3 1985 14,871 7,56o 7,312 37.1 5.8 31.3 1990 17,330 8,804 8,527 35.2 5.3 29.9 1995 20,075 10,194 9,880- 34.0 4.9 29.1 1999 22,563 11,458 11,105 34.0 4.6 29.5

Assumptions:

1. Age-specificfertility rates for 1970 estimated as follows remain constant until 1999.

Ages 15-19 20-24 25-29 30-34 35-39 40-44 Rate 60 230 300 195 128 45

2. The expectation of life increases from about 65 years in 1970 to 73 years in 1999.

Source: Mission estimates.

ANNEX 3 Page 1 of 6

West Malaysia

Rural Health Centers for MCH/FP Clinic Construction

OutpatientClinic Atten- State and Location dances, Daily Average

Johor: Main Health Center 1969 1970 1971

1. Renggit, Batu Pahat 34 76 148 2. Parit Jaw&, Muar 70 46 66 3. Parit Raja, Batu Pahat 38 39 43 4. Ayer Baloi, Pontian 32 24 44

Sub-Health Center

1. Parit Yusoff Laut, Muar 44 47 37 2. Parit SuLong, Batu Pahat 34 27 28 3. Sri Menanti, Muar 33 37 30 4. Bukit Bakri, Muar 40 35 46 5. Bukit Gambir, Muar 47 33 29 6. Simpang Rengamn,Kluang 38 22 49 7. Pekan Nanas, Pontian 21 7 32 8. Parit Bakar, Muar 35 29 30 9. Masai, Johor Bahru 31 27 29 10. Yong Peng, Batu Pahat 26 24 34 11. Chalah, Segamat 39 24 21 12. Bagan, Batu Pahat 26 25 14 13. Pagoh, Muar 43 39 37 14. Endau, Mersing 25 27 41 15. Klai, Johor Bahru 39 47 63 16. Sungei Mati, Muar 45 35 15 17. Labis, Segamat 45 36 39 18. Paloh, Kluang 30 33 36

Kedah: Main Health Center

1. Jitra, Kubang Pasu 154 156 190 2. Pokok Sena, Kota Star 82 79 101 3. Serdang, Bandar Bahru 42 35 38

Sub-Health Center

1. Kodiang, Kubang Pasu 48 61 66 2. Tunjang, Kubang Pasu 33 34 33 3. Mahang, Kulim 21 21 22 4. Guar Chempadak, Yen 45 37 35 5. Kuala Nerang, Padang Terap 60 66 61 6. Padang Serai, Kulim 82 78 42 7. Sungei Tiang (FLDA), Kota Star 47 39 39 ANNEX3 Pa-ge2of 6

Outpatient Clinic Atten- State and Location dances, Daily Average

1969 1970 1971 Kedah: 8. Ayer Itam, Kubang Pasu 49 49 49 9. Kubor Panjang, Kota Star 31 29 36 10. Sik, Sik 59 69 79 11. Lubok Buntar, Bandar Bahru 32 24 19 12. Jeniang, Sik 22 29 44 13. Merbok, Kuala Muda 43 46 53 14. Yen Besar,Yen 60 56 48

Kelantan: Main Health Center

1. Machang, Machang 109 108 111 2. Kota Bharu, Kota Bharu 24 25 29 (Wakaf Che Yeh) 3. Pasir Puteh, Pasir Puteh 95 110 163 4. Dabong, Ulu Kelantan 15 27 24 5. Pasir Mas, Pasir Mas 228 252 270

Sub-Health Center

1. Tanah Merah, Tanah Merah 76 77 72 2. RantauPanjang, Pasir Mas 24 23 25 3. Kubang Kerian, Kota Bharu 35 31 34 4. Ayer Lanan (FLDA), Tanah Merah 46 42 34 5. Bachok, Bachok 73 59 66 6. Seliseng, Pasir Puteh 83 46 56 7. Ketereh, Kota Bharu 69 65 58 8. Tumpat, Tumpat 66 66 88 9. Cherang Ruku, Pasir Puteh 19 39 47 10. Kangkong, Pasir Mas - 23 38 11. Gunong, Bachok 48 63 46 12. Gua Musang, Ulu Kelantan 23 21 27 13. Pulai Chondong, Machang - 24 32

Malacca: Main Health Center

1. Alor Gajah, Northern Malacca 82 142 125 2. Jasin, Southern Malacca 96 96 93

Sub-Health Center

1. Ramuan China Kechil (Lobok China), Alor Gajah 36 30 31 2. Padang Sebang, Alor Gajah 20 27 27 3. Bukit Rambai, Alor Gajah 31 28 27 ANNEX 3 Page 3 of 6

Outpatient Clinic Atten- State and Location dances, Daily Average

1969 1970 1971

Malacca: 4. Kuala Sungei Bharu, Alor Gahah 50 48 44 5. Simpang Bekok, Jasin 25 26 26 6. Durian Tunggai, Alor Gajah 33 39 41 7. Sungei Rambai, Jasin 35 32 27 8. Ayer Molek, Melaka Tengah 15 46 59 9. Simpang Empat, Alor Gajah - 27 28

Negri Sembilan: Main Health Center

1. Rembau, Bembau 63 57 2. Bahau, Kuala Pilah 67 61 -

Sub-Health Center

1. Gemencheh, Tampin 76 72 - 2. Astanah Raja, Rembau 19 21 - 3. Nilai, Seremban 30 34 - 4. Simpang Durian, Jelebu 31 28 - 5. Linggi, Port Dickson 22 33 - 6. Rantau, Seremban 29 39 - 7. Gemas, Tampin 78 68 - 8. Pekan Juasseh, Kuala Pilah 101 94 - 9. Terachi, Kuala Pilah 40 34 - 10. Johol, Kuala Pilah 40 37 - 11. Titi, Jelebu 42 43 - 12. Lenggeng, Seremban 23 31 -

Pahang: Main Health Center

1. Temer Loh, Temerloh 88 91 - 2. Kuala Rompin, Pekan 30 21 - 3. Karak, Bentong 31 34 - 4. Dong, Raub 35 25 - 5. Jerantut, Jerantut 115 119 -

Sub-Health Center

1. Maran, Pekan 17 24 - 2. Triang, Temer Loh 28 30 - 3. Chenoh, Raub 22 25 - 4. Bukit Betong, Kuala Lipis 22 18 -

Penang: Main Health Center

1. Kubang Semang, Central P. W. 125 77 80 2. Bayan Lepas 83 109 86 ANNEX 3 Page 4 of 6

Outpatient Clinic Atten- State and Location dances, Daily Average

1969 1970 1971

Penang, 3. Kepala Batas, P. W. North 121 114 117

Sub-Health Center

1. Tassek Glugor, P. W. North 52 53 58 2. Penaga, P. W. North 58 54 64 3. Sungei Dua, N. E. Penang 30 45 48 4. Prai, * P. W. Central 88 79 84 5. Simpang Ampat*, P. W. South 60 49 54 6. Nibong Tebal*, P. W. South 125 85 85 7. Ayer Itam*, Penang Island 484 221 242 * M.C.H.C. up-graded to Subcenters

Perak: Main Health Center

1. Parit, Kuala Kangsar 61 128 107 2. Bagan Datoh, Lower Perak 22 21 51 3. Bidor, Batang Padang 27 30 28 4. Bagan Serai, Krian 93 80 91 5. Tg. TuaIlang,Kinta 15 34 46 6. Changkat Jering, Matang 20 27 24 7. Lenggong, Upper Perak 91 100 78 8. Slim River, Batang Padang 31 39 42 9. Sungei Sumun, Lower Perak 67 46 29

Sub-Health Center

1. Sitiawan,Dindings 91 92 208 2. Sungei Siput, Kinta 31 49 46 3. Selama, Selama 41 42 46 4. Bota Kiri, Kuala Kangsar 28 33 30 5. Pangkor Island, Dindings 43 43 61 6. Batu Kurau, Larut dan Matang 33 41 43 7. Padang Rengas, Kuala Kangsar 33 41 34 8. Bruas, Dindings 32 46 43 9. Sungkai, Batang Padang 31 22 20 10. Hutang Melintang, Lower Perak 15 21 22 11. Pantai Remis, Dindings 129 149 136 12. Langkap, Lower Perak 21 21 23 13. Kroh, Upper Perak 36 35 29 14. Kuala Kurau, Krian 45 34 34

Perlis: Main Health Center

1. Simpang Ampat 51 58 84 ANNEX 3 Page 5 of 6

OutpatientClinic Atten- State and Location dances, Daily Average

1969 1970 1971

Perlis: Sub-Health Center

1. Beseri 39 53 58 2. Kaki Bukit 39 37 31 3. Padang Besar 23 20 22

Selangor: Main Health Center

1. Sungei Pelek, Kuala Langat - 34 - 2. Rawang, Ulu Selangor - 46 - 3. Sungei Besar, Sabak Bernam - 70 - 4. Telok Datoh, Kuala Langat - 25 - 5. Semenyih,Ula Langat - 53 -

Sub-HealthCenter

1. Sabah Bernam, Sabak Bernam - 73 - 2. Kapar, Llang - 24 - 3. Sungei Ayer Tawar, Sabak Bernam - 32 - 4. Parit Bharu, Sabak Bernam - 35 - 5. Sekinchan,Kuala Selangor - 48 - 6. Jeram, Kuala Lumpur - 29 - 7. Sungei Selisek,Ulu Selangor - 23 - 8. Rasa T.B., Ulu Selangor - 35 - 9. Ulu Yam Bharu, Ulu Selangor - 37 - 10. Kuala Selangor, Kuala Selangor - 54 - 11. Ulu Langat T.B., Ulu Langat - 26 - 12. Pulau Ketam, Klang - 63 - 13. Kuang, Ulu Selangor - 39 - 14. Dengkil, Ulu Langat - 22 15. Kampong Ijok, Kuala Selangor - 39 - 16. Tanjong Sepat, Kuala Langat - 49 -

Trengganu: Main Health Center

1. Kuala Blang Ulu Trengganu 53 57 - 2. Kemaman (Chukai),Kemaman 70 39 - 3. Tepoh (Bk. Tunggal), Kuala Trengganu 58 78 - 4. Jerteh,Besut 103 104 -

Sub-Health Center

1. Batu Rakit, Kuala Trengganu 45 45 - 2. Chalok (FLDA),Besut 40 25 - 3. Batu 20 Ajil, Ulu Trengganu 35 36 - 4. Marang, Marang 13 21 - 5. Jeranggau (FLDA),Dungun 31 24 - ANNEX 3 Page 6 of 6

Outpatient Clinic Atten- State and Location dances, Daily Average

1969 1970 1971

Trengganu: 6. Pasir Akar, Besut 34 47 - 7. Kampong Manir, Kuala Trengganu 24 23 - 8. Kuala Besut, Besut - 21 - 9. Kemasek, Kemaman 154 142 _

Remarks: 1. 1969 report on outpatient clinic attendances for Selangor State was not available.

2. 1971 report on outpatient clinic attendances for Selangor, Negri Sembilan, Pahang, and Trengganu were not available.

SUMMARY

mHC SHC Total Johor rX 18 22 Kedah 3 14 17 Kelantan 5 13 18 Malacca 2 9 11 N. Sembilan 2 12 14 Pahang 5 4 9 Penang 3 7 10 Perak 9 14 23 Perlis 1 3 4 Selangor 5 16 21 Trengganu 4 9 13 Total 4 11i9 16F Annex 4 Page I of 2 West Malaysia

HosPitalsfor Family PlannirnClinic Construction Informationon Exist- Number of Name of Teaching Obstetrics Deliveries New Acceptors ing Family Planning State Construction Hospital Activity Beds Beds 1969 1970 1971 Clinics

Perlis 1 Kangar G.H. 60 787 314 339 421 240 square feet. No space for vaginal examination. Kedah 3 Alor Star G.H. MN & H 65 2,976 - - - 520 square feet. Utilizinga part of main health office located outside of the hospital complex. Sg. Patani AN 31 1,970 356 215 311 300 square feet. An old dilapidatedbuild- ing outside the hospital limits. Kulim 22 1,132 304 209 117 300 square feet. The building is condemned for orthopedics and could be taken over by the hospital soon. Penang 3 Penang G.H. N 129 7,336 755 1,023 790 600 square feet. Clinic is located far away from the maternity wing. Butterworth 20 1,818 910 767 595 225 square feet. Exist- ing facility is com- parable to a counter. Bukit Hertajam 48 2,773 650 604 705 700 square feet. Rent- ed private premise and locationis not conducive to FP service Perak 7 IpohG.H. AN 107 5,482 1,270 808 824 1,600 square feet. Not adjacent to the maternitywing and lack of space for clinical examination. Taiping AN & M 94 3,547 997 619 567 640 square feet. Inadequatespace in all aspects. Kuala Kangsar 42 1,502 397 240 171 500 squarefeet. Space is not adequate. Batu Gajah AN & M 34 1,817 349 376 299 200 square feet. dlinic situated outside the limits of maternity section. Place is not adequate for the service. Kampar 16 819 198 127 125 200 square feet. Space is not adequate. Tg. Malim 18 819 242 120 105 No independent space. Telok Anson 48 2,312 700 572 502 300 square feet. Space is not adequate. Selangor 2 Klang AN & M 53 3,695 79.0 666 606 500 square feet. Space is inadequate in all aspects. No space for vaginal examination. No space for vasectomies. [Jang 42 2,010 475 281 242 100 square feet. The present space is so small that not more than one patient couild be seen. Negri Sembilan 2 Seremban G.H. AN & M 91 4,276 414 368 408 1,000 square feet. Rented private premises, inconvenientto con- tact patient in the hospital. Tampin 16 878 145 112 213 No independent space. Absolutelyno space availablefor any activity. Malacca 1 Malacca O.H. AN & N 134 6,084 736 552 488 150 square feet. The place is too small to house even the clerks/ receptionist. 5 Johor Bharu G.H. N 104 4,952 _ - 500 square feet. Clinic is situated on the second floor of the main health office and difficult to con- tact hosDital oatients. Annex 4 Page 2 of 2

Information on Exist- Number of Name of Teaching Obstetrics Deliveries New Acceptors ing Family Planning Sta&te Construction Hospital Activity Beds Beds 1969 1970 1971 Clinics

Muar AN & M 59 2,885 894 470 442 150 square feet. Vasectomy and IUD insertions cannot be done because of inadequate space. Kluang M 55 2,452 267 143 175 120 square feet. Vasectomy and IUD insertions cannot be done because of inadequate space. Batu Pahat 44 1,907 1,125 748 675 300 square feet, Vasectomy and IUD insertions cannot be done because of inadequate space. Segamat 34 1,961 811 359 292 200 square feet. Vasectomy and IUD insertions cannot be done because of inadequate space. Pahang 4 Kuantan G. H. AN & M 34 1,104 - - - 400 square feet. Inadequate space facilities in all aspects. Kuala Lipis AN 59 600 170 2 125- 150 square feet. Inadequate space facilities in all aspects. Raub 13 950 - 9 181 No independent space. Absolutely inadequate in all aspects. Mentakab -4 1,050 246 318 212 100 square feet. Absolutely inadequate in all aspects. Bentong M 16 963 420 288 252 Inadequate snace Trengganu 1 Trengganu G.H. AN & M 40 592 - - - Rented private premise, no space in the general hospital. Xelantan 1 Kota Baharn G.H. AN & M 60 1,204 - - - Rented private premise, no space in the general hospital.

(Total 31 hospitals)

N Nurse AN ' Assistant Nurse M - Midwife GH = General Hospital ANNEX 5 Page 1 of 10

West Malaysia

Intensive Input Demonstration

Objective

1. In West Malaysia, family planning services are being integrated with maternal and child health services for extension to the rural areas. At this stage of program development,therefore, it is highly desirable that the pattern and intensityof delivering family planning services and new techniquesof stimulatingdemand be tested and evaluated in limited geographicareas. This type of demonstrationwould help in the development of long-termpolicies along sound lines.

Method

2. The facilitiesprovided in these areas, in addition to those provided for West Malaysia as a whole, are called intensiveinputs. These inputs would allow the following specific activitiesto be carried out and would be continouslyevaluated for their impact on the number of acceptors and ultimately on the births prevented in a given area:

a. developmentof improvedmanagement procedures for the family planning program;

b. assessmentof the adequacy and effectivenessof additional physical facilitiesand manpower in the delivery system;

c. determinationof the extent and nature of the training required for midwives;

d. provision of a model set up for practical training of health center staff from non-projectareas;

e. study of the integrationof the family planning serviceswith the Governmenthospital functions;

f. evaluationof new techniquesof informationand education;and

g. streamliningof the evaluation system and developmentof the system of generating data useful for program management.

Area

3. To compare performance"before and after" and with and without providing the additional inputs, 14 districtshave been selected for the provision of intensiveinputs. The districtsselected are those where the Governmenthas already integrated family planningwith MCH services or will be doing so shortly. The health centers involved in such demon- strations are given in Table 1 while the areas are shown on Map 37321R. ANNEX 5 Page 2 of 10

Inputs

4. In addition to the project's other components provided for in the country as a whole, the demonstration component would include the following special inputs:

IBRD

a. Additional clinic space in existing midwifery clinic-cum-quarters (MCQs) to provide minor health services, as well as to increase the attendance and coverage of population. Detailed locations are given in Table 2.

b. Special management and research studies and surveys by the research advisers and a management consulting firm.

UNFPA

c. Special training for existing midwives and trained assistant nurses (TANs) in family planning and other aspects of health.

d. Vehicles for health center staff to supervise the activities at MCQs and for midwives at MCQs to make home visits.

GOM

e. Operating expenses for introducing applied nutrition education (at the experimental stage in one district at present).

f. Special information and education materials to be prepared by the NFPB for response test.

g. Continual evaluation of the performance and impact of the program units by additional staff to strengthen the Evaluation Unit.

h. Filling all the vacant posts and creating posts for one TAN at all 82 MHCs and SHCs and for clerks at 19 MHCs.

Administration

5. The demonstation program would be administered jointly by the MOH and the NFPB. The Project Administrator will be mainly responsible for the whole program and specifically for the special information, evaluation and research part of the program. In working out the details of the demonstration program, the MOH and the NFPB would be helped by: (a) the Project Implementation Committee, (b) the advisers for management, research and communications, and MCH/FP integration. ANNEX 5 Page 3 of 10

Cost

6. The cost estimatesof the intensive input demonstrationare given in the cost tables for the project.

Timing

7. The demonstrationproject would cover a period of five years starting around March 1973 when the loan will likely become effective. ANNEX 5 Page 4 of 10

Table 1

IntensiveInput DemonstrationAreas

Maternal and Main Midwifery Child Health Health Sub Health Clinic-cum- State Centers Centers Centers Quarters Total

Johor 1. Muar 1 1 9 52 63

Kedah 2. Kubang Pasu 0 2 4 20 26 3. Kota Star/Pdg.Terap/ Yen 2 1 7 38 48

Kelantan 4. Pasir Mas/Tumpat 0 1 5 15 21

Malacca 5. lor Gajah (Uttara) 2 2 4 20 28

Negri Sembilan 6. Reibau/Tampin 0 1 4 20 25 7. Kuala Pilah 1 1 5 19 26 rPahang T8.Kuantan/Pekan 0 2 6 42 50

Penang 9. P. Wellesley Central/ South (TengahSelantan) 1 1 4 25 31

Perak fTO7 Batang Padang 0 1 3 19 23

Perlis 11. Perlis 1 1 6 28 36

Selangor 12. Kala Langat 1 1 4 17 23 13. Kuala Selanpor 0 2 8 26 36

Trengganu 14. Kuala Trengganu/ Ulu Trengganu/Marang 1 2 4 24 31

Total 10 19 73 365 467 ANNEX5 Page 5 of 10

Table 2

Location of MCQs for AdditionalConstruction

Johor

1. Muar Health District.

Pt. Haji Zain Ayer Itam Bt. 15 Bakri Bt. 5 Jeram Tepi Kereta Rembu Pt. Raja Gersik Bkt. SerampangUtara Kundang Ulu Durian Chondong Bkt. Kepong Iorak Kg. Tui Lenga 31 Panchor Lenga Batu 28 Liang Batu Lenga 27 M.S. (FLDA) Kg. Raja Pagoh Paya Redan Kg. Sagil Kg. Sialang Bekok Belading Sagil Kesang Pt. Samsu Darat Bkt. Mor Pt. 9amsu Ulu Pt. Keroma Pt. Pinang Seribu Pt. Bakar Darat Temiang Telok Rimba Rawang Bkt. Kangkar Serom I Serom II Serom III Sg. Balang Darat Pt. Haji Latiff Pt. Yusof Darat Serang Buaya Pt. Bulat Lintang Sg. Gersik Pt. Ulu Jamil Sg. Mudo Simpang Lima Sg. Bilah SengKang Bt. 20 Sawah Ring Tanjong Selabu Bkt. Serampang (FLDA) Sid Mahmoor

Kedah

2. Kubang Pasu Health District. Telok Malek Kg. Sanglang Kg. Malau Lana Bulu Napore Jerlun Kepala Batas Sg. Korok Kg. Binjal Kg. Feeder II Kg. Darat Padang Perahu Batn Lapon Megat Dewa Bkt. Derang Pulau Tuba Changloon Batu Kg. Kuah Batu 4 Sanglang Ulu Melaka ANNEX 5 Page 6 of 10

3. Kota Star/Pdg. Terap/YenHealth District.

Tandop Kubang Rotan Cherok Kudang Bukit Jambol Sebrang Kuala Kedah Gunong Tauah Merah Sg. Limau DPlam Yen Kechil Simpang Tiga/Sg. Limau Yen Bukit Pinang Tit Haji Idris Hutan Kampong Kg. Lepai Bukit Besar Tokai Permtg Buloh Kuala Kangkong Kg. Bukit/BukitLada Bukit Tembaga (FLDA) Naka Tuallang Kg. Jabi Nami Bukit Payong Pokok Assam Tandop Besar Padang Sanai Kg. Nusa (Pedu) Pandang Nyior Kubong Lintah Padang Durian Lubok Merban Padang Pusing Alor Janggus Seberang Kota Anak Bukit Tajar (Pendang) Kelantan

4. Pasir Mas/Tumpat Health District. Repek Lobok Stol Gelang Mas Gual Perick Pohon Buloh Chabang 4 Bunut Susu Geting Banggol Chicha Kg. Laut Meranti Bunut Sarong, Burong Tok Uban Kubang Tendong

Malacca

5. Alor Gajah (Uttara) Health District. Lendu Hutan Percha Ayer Pa'Abas Solok Menggong Rembia Pulau Sobang Pegoh Godek Sg. Petai Sg. Buloh Sg. Siput Melekeh Ramuan China Besar Taboh Naning Brisu Durian Daun Kuala Linggi Tg. Bidara Kuala Pulau Pengkalan Balak ANNEX 5 Page 7 of 10

Negri Sembilan

6. Rembau/Tampin Health District. Pedas Tebong Bongek Bkt. Rokan Sepri Sg. Jerneh Selama Ulu Rokan Pelin Gedok Kundor(Kundor Balai Pasar Besar Sawah Raja Bangka Ulu Lubok China Ayer Kuning Kota Sg. Kelammah Keru

7. Kuala Pilah Health District.

Ampang Tinggi Serting Ulu Senaling Ayer Hitam Sg. Dua Sg. Lui Tanjong Ipoh Kuala Jempol Talang Rompin Sri Menanti Pelangai Ulu Pilah Ulu Juasseh Inas Batu Kikir Dangi Tengkeh Ayer Mawang Padang Lebar Dispensari

Pahang

8. Kuantan/Pekan Health District.

Paya Bungor Permtg. Bodek Batu 8 3/4, Iln. Tanjong Pulai Sg. Ular Cherating Sg. Karang Lubok Paku Ulu Luit Sg. Kertam (FLDA) Tanjong Lumpur Kempadang Gheroh Paloh Panching Kg. Ubai Batu Sawah .Alor Batu Johor Narasi Kerchoug Kg. Pianggu Merchong Kg. Tetok P. Timoman Leban Chondong Tg. Genmk Pontian Temai Salong Paleh Hinai Mambang Pelak Belimbing Tg. Selangor Pahang Tua Pulau Jawa ANNEX5 Page 8 of 10

PulanRuh a Pasir Panjang Ganheong Tg. Batu Tg. Medong Kuala Pahang Kg. Langgar Tg. Pulai

Penang 9. P. Wellesley Central/South (Tengah Selantan) Health District. Bkt. Indra Muda Kg. Nanas Kubang Ulu Permtg. To'Mahat Padang Ibu Sg. Bakau Permatang Ara Tg. Berembang Bukit Tengah/Spg.Ampat ,Sg.Acheh Kg. Sekolah Juru Sg. Duri Kg. Pertama Wellesley Permtg. Rawa GhangkatVillage Alma Tasek Machang Bubok Bkt. Tambuh Berapit Vald'Or Juru Village Permtg. Tinggi Sg. Lembu

Perak

10. Batang Padang Health District.

Sungei Behrang (ELDA) Pehrang Station Kg. Kelawar Slim Village Kf. Pasir Behrang Ulu Kampong Bekam Kampong Cuntong Cht, Sulaim Sg. Klah (FLDA) Jeram Mangkuang Kg. Poh Kg. Jambai Kg. Temoh Station Kg. Tapoh Road Kg. Chenderiang Sg. Losong Ayer Kuning Kg. Banir

Perlis

11. Perlis Health District.

Kuala Sg. Bharu Abi Long Boh Padang Mal8u Tambun Tualang Arau 3g. Padang Jejawi Seberang Ramai Guar Nangka Behor Lateh Mata Ayer ANNEX 5 Page 9 of 10

Surau Utan Aji Padang Siding To'Kaya Pekan Puah Paya Kepala Batas Panggas Kg. Serdang Padang Malangit Padang Kiria Santan Padang Besar Titi Tinggi Bintang Tasoh Seraib

Selangor

12. Kuala Langat Health District.

Kg. Kelanang Batu Laut Telok Benut Giching Hilir Kg. Sg. Lang Sijankang Telok Pulai Bandar Kg. Telok Batu Sg. Buaya Bukit Changgang Kg. Morib Kg. Labohan Dagang Bukit Bangkong Bukit Cheeding Kg. Endah Jengarom Sepang

13. Kuala Selangor Health District.

Sawah Sempadan Sg. Burong Tiram Burok Ulu Bukit Bedong Kg. Ulu Tiram Burok Jeya Stia Pasir Pemambang. Ijok N. V. Kg. Kuantan Batu 38 Assam Jawa Kg. Baru Bukit Cheraka Parit 9 Sg. Sembilang Parit 12 Bukit Kerayong Sekendi Bukit Kuching Parit 6 Pasir Panjang Simpang Lima Kg. Sg. Sireh Hj. Durani Parit 4 B. Berjuntai

Trengganu

14. Kuala Trengganu/Ulu Trengganu/Marang Health District.

Kg. Tajin Kg. Pauh Kg. Tengkawang Jeneris Kg. Buloh, U. T. Kg. Dusun Bukit Gemuroh Pasir Tinggi ANNEX 5 Page 10 of 10

Bukit Banding (FLDA) Kg. Menerong Belara (FLDA) Seberang Takir Langkap Sg. Tong Merang Pantai Batu Rakit Pulan Babi Kg. Kesou Banggol Peradong Bukit Diman Eukit Guntong Seberang Takir Kg. Tanggol Wakaf Mesira ANNEX 6, Page I of 1.

West Malaysia

Project Cost B Functional Categories

UNFPA - Financed Components IBRD - Financed Components TOTAL of the Project of the Project Foreign Total Local Foreign Total Local Foreign Total Local ADMINISTRATION 616,175 353,788 969,963 616,175 353,788 969,96 3 a) Construction, Furniture and Equipment _ _ _ b) icchnical Assistance 60,000 - 90,000 90,0o0 - 150,000 1J.0(Io ()'j Advi'osoy Services - 60,000 - - - so0,ts 10.180 c, lhi lIs - 50,180 50,180 - - ,0 - 600 - - - 600 d; Operating CostS 600 616,775 1,1,hR 1,170,743 Subtotal 600 110,180 110,780 616,175 443,788 1 ,05963

1,102,904 3,027 ,01I I,)24,9oQ 1,102,904 3.n27.013 a Cn-,lrruct lor,Furniture and Equipment _- - 1,924,109 - )-3l000 311,000 bh Contraceptive Supplies - 393,000 393,000 - 124,800 124,800 124,811o t) Special Equip.ent - 124,800 - - - 103,100 1113 10(1 d;' Vehicleb - 103,500 103,500 ------cI Technical Assistance - 101,200 0o, 200 (El Filowsh-ips - 108,200 108,200 ______P1 J.ucaiCost______1,924,109 1,832,404 3,716,13 f)Subtotal I.o. Cost - 729,500, 500 500 1.924.109 1,102,904 3,027,013

111. TKAININC 160,660 450,203 289,540 160.61,) 450,201 .) C-.tr-ction, Furniture and Equipment _ . - 289,540 : 54,584 54,284 b) Special Equipment _ 54,584 54,584 - - 23.000 23.000 - 40,500 40,500 c) veeinles - 17,500 17,500 _ _ d) Technical Assistance _ _ _ - - - 180,000 180,000 (1) Advisory Services _ 180,000 180,000 - - - - - 15,200 15.200 (2) Fellowshipa _ 15,200 15,200 - 440,269 - 440 26-)- e) Local Coat _ 440 269, - 44 26 Subtotal 2672 707,55374,6 289,540 183,660 473,200 729,809 450,944 1,780,713

IV. INFORMATION, EDUCATION AND CaMUNICATION - 222,000 222,000 - 367,579 367,5,79 a) Special Equipment _ 145,579 145,579 b) Technical Assistance 17,500 _ 187,300 187,300 - - - - 187,500 (2) Advisory Services - 113,800 113s800 - 113,800 113,800 - - - (2) Fellowships 327.600 _ 52,600 52,600 275,000 275,000 - 327,600 c) Vehicles - 30,134 30,134 _ 30,134 30,134 - - , d) S,pplies 1,093,863 - ,091,3 e) Local Cost 1,093,863 - 1,093,863 - - - 111,030 - 1,0930 f) Operating Cost 111 030. _ 111,030 1,204,893 1,026,613 2,231,1.06 Subtotal 1 529,613 1,734,506 - 497,000 497,000

V. EVALUATIONAND RESEARCH 80,000 80,000 - 114,700 114,700 a) Special Equipment _ 34,700 34,700 b) Technical Assistance 380,000 _ 195,000 195,000 - 185,000 185,000 - 380,000 (2) Advicory Services 83,100 83,1001 _ 83,100 83,100 -- (2) Fellowships 7,000 7,000 c) Vehicles _ 7,000 7,000 - - 41,500 41,501 d) - 41,500 41,500 - - Supplies 38,000 - 38,no 38,000 00 - 00- e) Local Cost 626,300 664,300 Subtotal 38,000 361,300 399,300 - 265,000 265,000 38,000

INTENSIVE IMPUT DEMONSTRATION Vl, 956,774 515,297 1,472,071 and Equipment _- - 956,774 515,297 1,472,071 a) Construction, Furniture - - 361,600 361,60( - 361,600 361,600 - - b) Vehicles - 519,596 207,596 - 207,596 312,000 - 312,000 519,596 c) Local Cost 3 - 34.200 34 200 - 34.200 - - d) Operating Cost 1,784,071 1,510,570 876,897 2,387,467 Subtotal 241'796 361,600 603,396 1,268,774 515,297

- 105,000 105,000 - 105,000 VII. PROJECT CONSTRUCTIONUNIT - - 105,000 25.000 - 25.000 25,000 - 25,000 VTtII, EXTERNAL REVIEW - 7,236,247 6,154,156 5,367,126 11,521,282 Total 1,925,558 2,359,477 4,285,035 4,228,598 3,007,649

- 1,006.197 896.751 1,902,948 1,006.197 896,751 1 902.948 IX. CONTINGENCIES - 9,139,195 7,160,353 6,263,877 13,424,230 Total 1,925,558 2,359,477 4,285,035 5,234,795 3,904,400

- 1095.600 1.095.600 - 1.095,600 10_95.6,0 X. INTEREST AND OTHER CHARGES - 5,234,795 5,000,000 10,234,795 7,160,353 7,359,477 14,519,830 TOTAL .;1,925,558 2,359,477 4,285,035

Annex 7 Page 1 of 1

West Malaysia

Detailed Cost Estimate of Physical Project Facilities

M$ US$ Local Foreign Total Local Foreign Total

(1) State MCH/FP Administrative Blocks (11)

Site preparation 363,158 155,639 518,797 128,800 55,200 184,000 Construction 1,142,693 489,722 1,632,415 405,275 173,688 578,963 Professional fees 11 90,790 38,910 129,700 32,200 13,800 46,000 Furniture and equipment 132,801 309,869 442,670 47,100 109,900 157,000 Fees for furniture and equipment 7,895 3,383 11,278 2,800 1,200 4,000 Subtotal 1,737,337 997,523 2,734,860 616,175 353,788 969,963

(2) Rural MCH/FP Clinics (162)

Site preparation 921,711 395,019 1,316,730 326,900 140,100 467,000 Construction 3,173,685 1,360,151 4,533,836 1,125,600 482,400 1,608,000 Professional fees 2/ 197,368 84,586 281,954 70,000 30,000 100,000 Furniture and equipment 411,936 961,185 1,373,121 146,100 340,900 487,000 Fees for furniture and equipment 19,737 8.459 28,196 7,000 3,000 10.000 Subtotal 4,724,437 2,809,400 7,533,837 1,675,600 .996,400 2,672,000

(3) FP Clinics in Hospitals (31)

Site preparation 80,377 34,447 114,824 28,507 12,217 40,724 Construction 514,594 220,540 735,134 182,509 78,218 260,727 Professional fees 2/ 29,749 12,749 42,498 10,551 4,522 15,073 Furniture and equipment 72,348 31,006 103,354 25.659 10.997 36,656 Fees for furniture and equipment 3,617 1,551 5,168 1,283 550 1,833 Subtotal 700,685 300,293 1,000,978 248,509 106,504 355,013

(4) Rural Health Training School - Trengganu

Site preparation 102,632 43,985 146,617 36,400 15,600 52,000 Construction 353,290 151,410 504,700 125,300 53,700 179,000 Professional fees I/ 55,263 23,684 78,947 19,600 8,400 28,000 Fuiniture and equipment 36,372 84,868 121,240 12,900 30,100 43,000 Fees for furniture and equipment 4,342 1,861 6,203 1,540 660 2,200 Subtotal 551,899 305,808 857,707 195,740 108,460 304,200

(5) RHTS-Extension - Rembau

Site preparation 49,342 21,147 70,489 17,500 7,500 25,000 Construction 169,737 72,744 242,481 60,200 25,800 86,000 Professional fees 1/ 25,658 10,996 36,654 9,100 3,900 13,000 Furniture and equipment 17,763 41,447 59,210 6,300 14,700 21,000 Fees for furniture and equipment 1,974 846 2,820 700 300 1,000 Subtotal 264,474 147,180 411,654 93,800 52,200 146,000

(6) Midwife Clinic-Cum-Quarters (365)

Site preparation 367,920 157,681 525,601 130,489 55,924 186,413 Construction 2,117,003 907,286 3,024,289 750,830 321,784 1,072,614 Professional fees 3/ 48,180 20,648 68,828 17,088 7,323 24,411 Furniture and equipment 155,806 363,539 519,345 55,259 128,935 184,194 Fees for furniture and equipment 8,763 3,753 12.516 3.108 1 331 4,439 Subtotal 2,697,672 1,452,907 4,150,579 956,774 515,297 1,472,071

TOTALS

Site preparation 1,885,140 807,918 2,693,058 668,596 286,541 955,137 53° Construction 7,471,002 3,201,853 10,672,855 2,649,715 1,135,590 3,785,305 3C2 Professional Fees 447,008 191,573 638,581 158,539 67,945 226,48430% 'Furniture and equipment 827,026 1,791,914 2,618,940 293,318 635,532 928,850 &9e Fees for furniture and equipment 46.328 19-,853 66,181 16,430 7,041 23,471 Total 10,676,504 6,013,111 16,689,615 3,786,598 2,132,649 5,919,247

1/ Calculated at 12.5% of construction cost. 2/ Calculated at 5% of construction cost. 3/ Calculated at 2% of construction cost (supervision only).

ANNEX 8 Page 1 of 3 West Malaysia

The IBRD-Assisted Components of the Project (US$)

LOCAL FOREIGN IOTAL I. ADMINISTRATION

a. Construction, Equipment and Furnidshing of State MCH/FP Administration Centers (11) 616,175 353,788 969,963

b. Advisory Services of

i) Management Study Firm 90,000 90,000

Subtotal 616,175 44 3,788 1,059,963

II. SERVICES

a. Construction, Equipment and Furnishing of

i) 11CH/FPClinics in Rural Health Centers (162) 1,675,600 996,400 2,672,000

ii) FP Clinics in Urban Govt. Hospitals (31) 248,509 106,504 355,013

Subtotal 1,924,109 1,102,904 3,027,013

III. TRAINING

a. Construction, Equipment and Farnishing of

i) Rural Health Training Center at Trengganu 195,740 108,460 304,200

ii) Extension of RHTC at Rembau 93,800 52,200 146,000 b. Vehicles

i) Micro Bases (6) for Field Training for RHTC (2 each) 23,000 23,000

Subtotal 289,540 183,660 473,200

IV. INFORMATION, EDUCATION & COMMUNICATION NFPB a. Equipment for J) Audiovisual Equipment for 66 MHCs and 247 SHCs 222,000 222,000 ANNi;X 8 Page 2 of 3

LOCAL FOREIGN TOTAL b. Vehicles

i) Mobile Vans with Audiovisual Equip- ment (11) (State Centers) 275,ooo 275,000

Subtotal 497,000 497,000

V. EVALUATIONAND RESEARCH a. Equipmaent

i) Mini Computer for NFPB 80,000 80,000 b. Technical Assistance

1) Advisory Services

i) NFPB Population Research (Senior) (1 x 36) 135,000 135,000

ii) NFPB Population Research (Junior) (1 x 24) 50,000 50,000 Subtotal 265,ooo 265,ooo

VI. INTENSIVE INPUT DEMON- STRATION (14 DISTRICTS) a. Construction, Equipment and Furnishing of 365 Midwifery Clinic-cum- Quarters 956,774 515,297 i,472,071 b. Local Cost Special Training of

i) 200 Assistant Nurses and Midwives 150,000 150,000

ii) Applied Nutrition Program 12,000 12,000

iii) Special Educational Material Production 60,000 60,000

iv) Additional Staff at NFPB Evaluation Div. 40,000 40,000

v) Basic Line Surveys 50,000 50,000

Subtotal 1,268,774 515,297 1,784,071 ANNEX8 Page 3 of 3

LOCAL FOREIGN TOTAL

VII. PROJECT CONSTRUCTION UNIT 105,000 105,OOO

VIII. EXTIRALREVIEW 253000 25,000

IU. CONTINGENCIES .1,006,197 896,751 1,902,9X8

Subtotal 5,234,795 3,904,*400 9,139,195

X. INTEREST AND OTHiER CHARGES - 1,095,600 1,095,600

TOTAL 5,234,795 5,000,000 10,234,795

ANNEX 9 Page 1 of 8-

West Malaysia

The UNFPA-FinancedComponents of the Project (US$)

1973 1974 1975 1976 1977 Total

I. ArP4ThISTRATION

a. Advrisory Services of

i, iMsCH/FPAdviser for MjDH(lx24) 30,000 30,000 _ _ _ 60,000

b. Vehicles

i; Carsi for NFPB for State MCH/FP Units (10) 9,490 9,490 - _ - 18,980

ii) Station Wagon for Central MCH/FP Unit at the MOH (1) 3,700 - - - - 3,700

iii) Station Wagons for the FFPA (11) 10,000 10,000 7,500 - - 27,500

c. Operating Cost Driver for MCH Unit Station Wagon 600 - - - - 600

Subtotal 53,790 49,490 7,500 - - 110,780 II. SERVICES

a. Gontraceptive Supplies 10,000 15,000 368,ooo - - 393,000 b. Equipment

i) IUD Insertionand Pap Smear Test in 66 Main Rural Health Centers 6,650 7,000 9,450 - - 23,100

ii) Nutrition Education for 1968 Health Units 18,225 18,225 12,750 - _ 49,200 iii) Culdoscopic Sets (14) for NFPB Clinics 11,000 13,750 13,750 - - 38,500 iv) Vasectomy Sets for NFPB Clinics (40) 1,500 1,000 1,500 _ _ 4,000

Note: Figures in the brackets indicates the number of units. In case of advisory services, the first figure in the bracket shows the number of advisers and the second figure,the man-months. ANNEX 9 Page 2 of 8

1973 1974 1975 1976 1977 Total v) Pap Smear Test for NFPB 5,000 5,000 _- _ 10,000 c. Vehicles

i) Mobile MCH/FP Team with Eauipment (26) 45,000 52,500 - - 97,500 ii) Delivery Vans for NFPB (2) 3,000 3,000 - - 6,ooo d. Fellowships

i) MPH Course for Central W)H Staff (3x12) 6,400 6,400 6,400 - - 19,200 ii) Study Tour for Central MXHStaff (3x3) 2,500 2,500 2,500 - - 7,500 iii) Study Tour for State Medical Officers (11x6) 4,200 4,200 3,100 - - 11,500

iv) Study Tour for NFPB Staff Nurses (120x0.5) 30,000 20,000 20,000 - - 70,000

Subtotal 143,475 148,575 437,450 - - 729,500 III. TRAINING

a. Ecuipment for

i) Training Material Pro- duction Center at PHI 20,000 - - - - 20,000

ii) Audiovisual (A/V) Equip- ment for 3 RHTCs 6,000 4,000 - - - 10,000

iii) A/V Equipment for PHI 5,064 - - - - 5,o64

iv) A/V Equipment for 4 Auxiliary Training Centers 3,520 - - - - 3,520

v) A/V Equipment for 4 Basic Nursing Train- ing Schools 10,000 - - - - 10,000

vi) Video Tape Machine for FYPA Training Program 1,500 - - - - 1,500 ANNEX9 Page 3 of 8

1973 1974 1975 1976 1977 Total

vii) Office Equipment for FFPA 3,180 160 160 - - 3,500 viii) Duplicating machine 1,000 - - - 1,000 b. Vehicles

i) Vans for 4 Auxiliary Training Centers (4) 13,200 - - - - 13,200

ii) Minibus for FFPA 4,300 - - - - 4,300 c. Technical Assistance

(1) Advisory Services for

i) Production of Training Material (lx12) 15,000 15,000 - - - 30,000

ii) Assisting in Health Education, family planning and Media Pro- duction at PHI (5x30) - 90,000 60,000 - - 150,000

(2) Fellowships for

i) Medical Officer from Training Areas -PHI (3x1.5) 1,200 1,200 1,200 - 3,600

ii) Sister Tutor from PHI (4x3) 6,000 - - 6,000

iii) Programmed Instruction for FFPA (1x2) - 5,600o o - 5,600 d. Local Expenses for

(1) Auxiliary Training

i) Stipend for 2700 Nurses 81,C00 81,000 81,000 - - 243,000

ii) Guest Lecturer's honorarium 17,455 8,728 8,727 _ - 34,910

iii) Cost of Supervision 4,485 2,243 2,242 - _ 8,970

iv) Salaries for Drivers (4x36) 2,400 - - _ - 2,400 ANNEX9 Page 4 of 8

1973 1974 1975 1976 1977 Total

v) Salaries for 2 Clerks 2,400 - - - - 2,400

(2) Printing of Programmed Instructionsby FFPA 1,000 1,500 1,000 - - 3,500

(3) TraditionalMidwives Trg.

i) Cost of Training (3 years) 35,000 35,000 35,000 - - 105,000

ii) Midwifery Kits (1500) 3,000 6,000 6,000 - - 15,000 (4) Seminars

i) Management Planning for Family Planning - 4,700 - _ - 4,700

ii) MCH/FP Seminar 9,800 - 4,700 - - 14,500

iii) FP Seminars for Hospital Specialists 1,963 1,963 1,963 - - 5,889

Subtotal 248,467 257,094 201,992 - - 707,553

IV. INFORMATION,EDUCATION AND 0MMUNICATJDNS,NPB

a. Equipment NFPB i) Printing Educational Material 100,000 - - - - 100,000

ii) Photo Lab and Graphics 8,000 - - - - 8,000

iii) Auto Stack Projectors (15) (State Centers) 760 380 285 - - 1,425

MDH i) Health Education Material Production 23,964 - - - - 23,964

ii) Tape Recorders for 66 MHCs 2,640 - - - 2,640

iii) Equipment for school health for 102 health centers in demonstration areas 3,375 4,275 _ - - 7,650

FFPA i) Slide Projectors (10) 500 500 500 - - 1,500

ii) 2 Overhead Projectors 400 - - - 400 ANNEX9 Page 5-of 8

1973 1974 1975 1976 1977 Total b. Vehicles

i) Landrover (1) 4,000 - - - - 4,ooo

ii) Roving Exhibition Truck 25,000 - - - - 25,ooo

iii) Outboard Motor Unit 20,000 - - - - 20,000

iv) Station Wagon for FPA (1) 3,600 - - - - 3,600

c. Technical Assistance

(1) Advisory Services for

i) Media Production (lx24) of NFPB 30,000 30,000 - - - 60,000

ii) Commmication Research at NFPB (1x21) 30,000 15,000 7,500 - - 52,500

iii) Population Education at NDE (lx30) 30,000 30,000 15,000 - - 75,000

(2) Fellowship for

i) Information for Unit Staff of NFPB (5x3) 15,000 - - - - 15,000

ii) 1MDHin Health Educa- tion (10x18) 32,000 48,ooo 16,000 - - 96,000

iii) FFPA Family Life Edu- cation Program 2,800 - - - - 2,800 d. Supplies

i) FP Films for NFPM 4,000 - - - - 4,000

ii) FP Films for FFPA 9,417 9,192 525 - - 19,134

iii) FP Films for NFPB 3,500 1,750 1,750 - - 7,000 e. Local Expenses for

i) Printing News Letters, Teachers Resources, Guide Books, Teacher and Pupils Kits and Supple- mentary Text Materials 62,943 80,876 21,172 - - 164,991 AMEX 9 Page 6 of 8

1973 1974 1975 1976 1977 Total ii) Teachers Orientation Courses for MDE 172,651 396,607 225,000 - - 794,258 iii) Library for Population Education 10,714 - - - - 10,714 iv) Evaluation of the Population Education Program for MOE - 1,786 12,500 - - 14,2d6

v) Inservice Training in Health Education for MH 5,400 5,400 5,400 - - 16,200

iv) FFPA Workshops 3,000 6,667 6,667 - - 16,334 v) MDH Seminars in Health Education 7,080 - - - - 7,080

iv) Integrationof School Health FP? 70,000 -- - - 70,000

f. Operating Cost (NFPB)

i) Artist, Layout and Graphics (2x21) 6,500 3,250 1,625 - - 11,375

ii) Photographer(1x36) 2,350 2,350 1,175 - - 5,875

iii) Writer (2x36) 5,650 5,650 2,825 - - 14,125

iv) Printing Operatives (2x36) 4,450 4,45o 2,225 - - 11,125 v) Mass Media Survey Contract (3 years) 5,000 5,000 5,000 - - 15,000

vi) Field Testers (5x36) 5,500 5,500 5,500 - - 16,500 vii) Assignment Contracts for Art, Work, Film, Radio and TV 10,750 11,250 6,750 - - 28,750

viii) One Secretary/Typist 2,760 2,760 2,760 - - 8,280

Subtotal 723,704 670,643 340,159 - -1,734,506

V. EVALJUATION AND RESEARCH

a. Equipment

i) IBM Card Sorter for 11,100 NFPB 11,100 ---- 1,0 ANNEX9 Page 7 of 8

1973 1974 1975 1976 1977 Total

ii) Electric Desk Computers for NFPB and UM (2) 3,100 - - - - 3,100

iii) Electric Calculators(46) for UM (26) and NFPB (20) 9,000 - - - - 9,000

iv) Calculating Machine for Health Centers of MDH (160) 10,000 - - - - 10,000

v) Library Equipmentfor NFPB 1,500 - - - - 1,500 b. Vehicles

i) Minibus for UM 3,000 - - - - 3,000

ii) Landroverfor NFPB 4,000 - - - - 4,000 c. TechnicalAssistance

(l)AdvisoryServices for

i) UM-Demographers(2x36) 45,000 60,000 60,000 15,000 - 180,000

ii) )MDHin Medical Records (1x6) 15,000 - - - - 15,000

(2) Fellowshipsfor

i) UM in Demography(5) 4,300 24,200 25,600 21,400 1,100 76,600

ii) NDH in Medical Record (lx6) 3,700 - - - - 3,700

iii) FFPA Evaluation Work - - 2,800 - - 2,800 d. Supplies

i) Library Books for NFPB 5,500 7,500 6,000 - - 19,000

ii) Library Books for UM 11,250 5,625 5,625 - - 22,500 e. Local Expenses for

i) Seminars and Confe- rences at UM 4,000 4,000 - 8,000

ii) Research Support at UM 10,000 10,000 10,000 - - 30,000

Subtotal 136,450 111,325 110,025 40,400 1,100 399,300 ANNEX 9 Page of 8

1973 1974 1975 1976 1977 Total

VI. INTENSIVEINPUT DEMNSTRATION (14 DISTRICTS)

a. Vehicles

i) Motorized Bicycles for 200 Midwives 12,500 12,500 - - - 25,000

ii) Buses (102 Health Centers) 188,100 148,500 - - - 336,600

b. Operating Cost Driver for 102 Buses for one year 34,200 - - - - 34,200

c. Local Expenses for Special Training of

i) Family Planning Courses for Supervisory Personnel 51,509 47,961 48,126 - - 147,596

ii) Developmentof Case Cards 30,000 30,000 - - - 60,000

Subtotal 316,309 238,961 48,126 - - 603,396

Total 1,622,1951,476,088 1,145,252 40,400 1,100 4,265 035

Summary of UNFPA Financing by Agencies

MS US$ I. National Family Planning Board 3,650,672 1,294,771 (includingFamily Planning Association)

II. Ministry of Health 4,523,728 1,604,415

III. Ministry of Education 2,986,606 1,059,249

TV. University of Malaya 920.865 326,600

Total 12,081,871 4,285,035 ANNEX 10 Page 1 of 1

West Malaysia

Incremental Operational Costs

Annual Salary and Allowances To Cover Total Categories Per Person Years Cost (US$>

1. JCH Officerin the A!900 1973-77 1,369,500 (485,716) 11 State MCH/FP Adm. (5 yrs) Blocks

2. AdditionalTrained 4,500 1973-77 2,025,000(718,200) AssistantNurse in the (5 yrs) 90 Rural Health Centers in the Demonstration Districts

3. AdditionalClerk in the 4,o80 1973-77 367,200(130,243) 18 Main HealthCenters in (5 yrs) the DemonstrationDistricts

4. Driver/Operator(A/V 4,600 1974-77 202,400 ( 71,785) equipment) for 11 Kobile (4 yrs) Vans

TOz A 1 3 .33C,964,3` 4 9

Remarks: Basis of unit costs

1. M$24,900: Salary, M$1,800 X 12m 21,600 Travel allowance, I4Z12.50 X 120 days 1,500 Mileage, N$150X 12m 1,800

2. M$ 4,500: Salary, M$300 X 12m = 3,600 Travel allowance, F$25 X 12m = 300 Overtime, M$50 X 12m 600

3. M$ 4,080: Salary, M$290 X 12m 3,480 Mileage, M$50 X 12m 600

4. M$ 4,600: Salary, M$200 X 12m - 2,400 Travel expense, M$10 X 120 days = 1,200 Overtime, M$100 X 12m = 1,000

1/ For Bank-assisted items only.

West Malaysia Annex 11 Page I of I Implementation and Expendituri Schedule (in thousands)

Year 4 Year 5 Year 1 Year 2 Year 3

4 1 1 2 3 4 1 2 13 14 11 2 . 3 Tota Toa 1 12 3 14 1 21 13 14

x x x x x x x x x x x x x x x x x x x x x x x x x x x State FFMCIiAdami. Centers (11) 3,555.5 1,261.0 sas * ** * a = X It (+) X It x X It I + (4+ + = X It t X It X (4) Xt X It Xt X X M1C/FP Clinics (162) 9,794.0 3,473.6 sas * x t It I I It t It It X X xX ( + RRT Treogganu (1) 1,080.5 383.2 eas '

= t I It It I It It (--+ RH'TCExtension - Rambau (1) 501.9 178.0 as * *== I I t It(-- -4 FP Clainis in hospitals (31) 1,201.1 426.0 = I It It It It It I It (+) + X X XXXX XXX XX XX P53Qs f365) 4,974.9 1,764.4 sa: **x

204 99 87.4 70 59 464 314 314 314 244 244 244 244 204 204 204 Physical Facilities 4,740 13,365 104 348 348 417 18, 66 216 17 327 84.8 Equipment & furn. 929 2,618 28 172 21 32 31 13 12 11.5 10.3 Fees 1 227 638 32 3Z 32 3442.6 3.4 Fees 2 23 66 10 59.8 26 32 42 15 121 91 81 110 123 67 65 73 143 56 53 Continigencies 1,664 4~,747 175 173 176 23 20 21 22 Project (bustruation Unit 105 296 19 15 16 16 16 15 20 11 11 11 15 Teclimical Assistance 275 775 47 82 52 31 2 6 18 Special Equipment and Vehicles 600 1,691 107 24 360 8 8 8 8 8 9 9 9 9 9 9 9 8 8 8 8 Local Cost of intensive Input 312 879 84 84 9 Dowis8Tation 25 External Review 25 70

Contingencies on Non-Con- 2 3 3 3 3 78 4 4 4 5 12 9 19 5 6 2 struction Items 219 617 33 15 9 371.5 211 154.8 141 85 738 466 424 553.4 635 390 338 394 720 318.5 267 Sub-Total 9.139A~ 25.768 290 664 101 1,277 264.3 OA 0.3 0.1 283 5 5 5 168 3 3 3 217 1 1 1 interest antd other Charges 1.-i 3,089 9.3 9 8 109.2 635.8 211A 155.1 141.1 368 743 471 429 721.4 638 393 3.41 611 721 319.5 268 Total 10,235 26,858 299.3 673 789 1,386.2

Miarch 31, 1973 NOTE: IWplstat.ioul starts at date of effectiveness nf L.oan Agreement, tentatively

oh selection and appoLtoteut of consultant survey of sites and design ** Construction document phase - TesdLosg of bids I Constructtion phaae (4-) Defects liability (bsuildings) + Defects liability (equipment)

ANNEX 12 Page 1 of 5

West Malaysia

Project Implementation and Administration

1. The Project Implementation Committee will consist of the representative of the Economic Planning Unit, the Director-General of the NFPB, the Deputy Director of the NFPB, the Director of Health Services, and representatives of the Planning and Development Division of the Ministry of Health, Ministry of Education, the University of Malaya and the Treasury. The representative of the Economic Planning Unit will act as Chairman and the Deputy Director of the NFPB as Project Administrator.

Functions

2. The responsibilities of the Project Implementation Committee shall include ensuring:

a. the appointment of advisers under the project and coordination and follow-up of their work;

b. implementation of the training program under the project;

c. implementation of the intensive input demonstration and its evaluation and follow-up;

d. provision of necessary operating costs and maintenance of components provided under the project;

e. submission to the Bank of periodic reports on the progress of the project; and

f. the establishment of the Project Construction Unit.

Project Administrator

3. The NFPB's Deputy Director will act as the Project Administrator and Executive Secretary of the Project Implementation Committee and shall be responsible for:

a. the general administration of the project;

b. liaison with the Project Construction Unit;

c. coordination of (i) arrangements for procurement of items of special equipment and vehicles under the project and (ii) arrangements relating to the provision of advisory and/or technical services under the project;

d. administration of fellowships and study tours pertaining to family planning in cooperation with the appropriate technical agencies; and ANNEX12 Page 2 of 5

e. disbursement of expenditure with respect to special equipment, vehicles and advisory services for Bank-assisted components of the project.

Secretariat

4. The NFPB shall serve as the secretariat of the Committee and Project Administrator.

Project Construction Unit

5. The GDM will establish within its Ministry of Health a Project Construction tnit for implementation of the construction component of the project. It will be under the charge of a Project Architect who will be provided with an adequate muberof technical personnel and facilities necessary for thle efficient functioning of the Unit. The Project Architect will be assisted by the architectural consultants whose duties and responsibilities are detailed in a later section. functions

6. The Project Construction Unit under the Project Architect shall intBr alia have responsibility for:

a. liaison with the Project Administrator;

b. preparation of a comprehensive implementation chart showing the planned timetable of coordinated activities and responsibilities on the basis of which the civil works component of the Project will be carried out;

C. all matters (jointly with the architectural consultants) concerning the establishment of standards, user requirements, equipment listsj space schedules and preparation of schematic and final designs for oonstruction components and their cost estimates;

d. agreeing with the architectural consultants and the appropriate agencies of the Government including any firms of private architects appointed by the Government on the production of tender documents, contract documents and supervision of execution of the works;

e. arrangements for the review and approval by the appropriate authorities of architectural and engineering reports, plans, specification8 and other submitted material; and

f. such other matters as the Government and the Bank may determine. ANNEX 12 page 3 of 5

Functions and Responsibilities of the Project Construction Unit Architect

7. The Project Construction Unit Architect will have execution responsibility for the following matters: ___ a,- preparation of a comprehensive implementation chart showing the planned timetable of coordinated activities and responsibilities, on the basis of which all aspects of the civil works will be carried out, and which will be prepared as the first step in implementing the project; and the planned timetable shall not be put into effect without the Bank being first given reasonable opportunity to comment on it;

b. jointly with the Consultant Architects, for all matters concerning the establishment of standards, user requirements, equipment lists, space schedules and the preparatiom of schematic and final designs for construction components and their cost estimates; c. agreeing with the Consultant Architect and the appropriate agencies of the Government and, firms of private architects, for the production of tender documents, contract documents and supervision of the execution of the works;

d. arrangements for the review and approval by appropriate authorities of architectural and engineering reports, plans, specifications, and other submitted material.

8Q. He will ensure continuity in the project by the following: a. arranging for the assembly of all information relating to site and site conditions of the project institutions;

b. maintaining liaison with the Ministry of Health, the NFPB, as well as the otheruser agenciesinvolved in the project,and representativesof the ultimatebuilding users and obtaining background data with regard to detail environmental requirements;

c. reviewing architectural drawings in detail to ensure that space provisions and specifications have been interpreted so as to minimize changes and alterations both during final design phase and construction, and to ensure the satisfactory interpretation of user requirements into proposals; d. liaising with the Consultant Architect and the user agency in all matters of adaptation and implementation of materials and detailing which may requirethe prodactionof rapid alternative detaildesigns; ANNEX 12 Page 4 of 5

e. preparing tendering and bidding procedures, and obtaining and checking the lists of equipment and furniture for the project buildings, advise on packaging and grouping of bid components;

f. advising on and observing the adjudication procedure performed by the Consultant Architect and making final recommendations on the award of contracts to the Project Implementation Com- mittee;

g. taking all steps required to ensure that furniture and equipment are designed and installed according to specifications, as well as insuring timely procurementfor use according to schedule;

h. issuing and/or processingand expeditingall private firms of architects' certificates for payment of contractorssub- mitted, and forwarding to the accountant of the project unit when advised for payment, and to observe and implement the Bank's procurementprocedure;

i. evaluating progress, receiving the weekly progress reports and submitting a monthly progress report to the Project Implementation Committee and the trimestrial report to the Committee and IBRD.

Functions, and Responsibilities of the Consultant Architect

9. The Contract with the Architectural Consultants to provide professional services to the Ministry of Health should include:

a. The terms and conditionsof employment. The terms of reference should include a draft plan of operations, with time schedules and set-out remuneration and reimbursable expenses. As far as practicable, fees and expenses should be firm figures;

b. The Consultants shall prepare guidelines for the participation of the various central and regional government bodies, outlining the project and its implementation, together with guidelines on timing and financial control;

c. The Consultantswould prepare a Design Guide, with recommendations based on experience gained and new conditions foreseen. Where practicable, the Design Guide may be modified to give specific requirements and should give special regard to developing economics during the production of the project components;

d. Standard architectural engineering plans and specifications and standard bills of quantitiesshould be prepared for all buildings in the project oy the Consultants,with the guidance and col- laborationof the Project Architect. 'TheProject ConstructionUnit will incorporate these standard documents in the design and supervision of the project's civil works; ANNEX 12 Page 5 of e. The Consultants will advise on the examination, adjudication, and provision of comments and recommendations to the Government and the Bank Group on draft contracts between the Government and firms of contractors and suppliers, and research institutions and organizations, as well as any executive architects or engineers whose services may be retained. Each contract should incorporate a plan of operation, time schedule, estimates of fees, and reimbursable expenses; f. Ihe Consultants' responsibilities would include: visiting and recommending approval of the project sites in liaison with the Project Architect and a representative of the Government town planner; recommending any adjustments or modification to the schedule of accommodation due to local circumstances; assisting with furniture and equipment lists and estimates; establishing detailed cost plans for each project building; advising on the size of bid packages; and reviewing documents for bidding and contract; g. The Consultants would assist in regularprogress reporting to the Chairman of the Project Implementation Committee and the Bank, and in the preparation and up-dating of PERT (Program Evaluation and Review-Techniquo or CPM(Critical Path Method) charts, and withdrawal certificates. They would also assist the Project Architect in the overall supervision of the project; h. The Consultants would assist in the establishment of a project accounting system which would have the approval of the Bank.

ANNEX13 Page 1 of 5

West Malaysia

Draft Terms of Referencesfor Advisers

A. Management Consultant

Functions

To review the management of the population program and suggest any changes in the system that would help make it more responsive to the administrative needs of the national family planning program by providing a rapid feedback of relevant information necessary for rational decision- making on the program.

Duties and Responsibilities

1. To review the present organization and management and information system of the populationprogram.

2. To identify and plan the key points at which informationmust be gathered and analyzed for use by program administratorsin improving program management.

3. To help review the present service statisticssystem to meet the objectives under (2) above.

4. To help identifynew evaluationactivities and assist in implementingthem.

5. To plan and assist in implementingthe translationof evaluation data into a regular system of analysis to assist program administratorsin decision-making.

Qualifications

1. Specializationin management systems analysis and program evaluation.

2. Experience in applicationof above to on-going family planning programs.

B. MCH/FP Adviser

Functions

To advise the Ministry of Health on the delivery of MCH services as an integrated program so that family planning services form part of the total health package for better family health. ANNEX13 Page 2 of 5

Duties and Responsibilities

1. Assess existing technicaland administrativeprocedures for MCH and family planning services in the Ministry of Health.

2. Assist in developingthe state and local MCH/FP activities.

3. Assist in staff preparationfor integrationof family planning with maternal and child health services.

4. Review the program for the integration of FP with the Rural Health Services with a view toward accelerating the speed of effective integration.

5. Review the MCH/FP program periodically and prepare monthly and quarterly reports.

Qualifications

Physician, Master or Diploma of Public Health holder with broad experience in public health and MCH services and, preferably,with a minimum of five years' experience in the management of family planning and MCH services.

C. Senior Research Adviser to the NFPB

Function

To establish a Research Unit at the Evaluation Division of the NFPB and put it in operation on sound lines.

Duties and Responsibilities

1. Draw a research plan for five years that would help in the development of population policy in the country.

2. Follow-up the base line survey already undertaken in the country.

3. Develop methodology for assessing the impact of various input on the family planning program.

4. Assisting the Head of the EvaluationDivision in analysis of service statistics.

Qualifications

Ph.D. in Economics/Sociology/Statistics,training in Demography and extensive experience in research on population problems and field research techniques. ANNEX 13 Page 3 of 5

D. Junior Research Adviser

Function

To assist the senior-level adviser to the NFPB.

Duties and Responsibilities

1. To assist the senior-level adviser in the performance of duties and responsibilities as defined by his terms of reference.

2. Within the framework as defined above, to identify projects within his own subarea of specialization.

3. To undertake jointly or singly some projects with bearing on subareas of specialization for the purpose of demonstrating how they are identified,designed, implemented,and utilized.

Qualifications

1. Ph.D. or near Ph.D. (Some advanced graduate studies beyond the Masters level), with specializationin one of the following subareas.

a. Demography (preferablyEconomic Demography);

b. Fertility Studies and Survey Research; and

c. Program Evaluation.

2. Some experience in research in the area of specialization.

E. Communications Research Advisers

Functions

To advise the Ministry of Health and National Family Planning Board in establishing a communications research and evaluation program to provide information on the best types of media and message content to achieve communication targets and in developing curriculum for training information officers, health educators and family planning field workers in motivational techniques.

Duties and Responsibilities

1. Assess communications research, evaluation and training needs.

2. Draft plan to carry out research and training program.

3. Review and revise plan in collaborationwith officers in the Ministry of Health and the NFPB. ANNEX13 Page 4 of 5

4. Assist in field implementationof research and training plans.

Qualifications

High academic cualifications (preferably Ph.D. in Psychology or any behavioral science) with experience in communicationsresearch and training programs.

F. Population Educations Adviser

Functions

To advise the Ministry of Education on development population education as an essential component of education in schools.

Duties and Responsibilities

1. Advise senior officials in the Ministry of Education on the broad spectrum of population education.

2. Assist in developing staff and committee mechanisms for continu- Iingactivity: coordinating and planning group, subject work groups, and ad hoc groups on special topics.

3. Advise professionalsin education on determining specific emphasis,age and grade levels for the several areas of content comprising educationor population problems.

4. Assist curriculum committeesfor various school levels in preparing syllabus material, reading and referencelists, tape recordings and related instructional aids.

5. Consult with officials of the several teacher training institutions on building population education components into the basic teacher education curricula.

Qualifications

High academic oualifications (preferably Master's degree in education behavioral sciences) with experience in educational planning, curriculum development and in managing population education or related programs.

G. Health Education/FP Training Advisers

Functions

To advise and assist the Director, Public Health Institute in developing a program for health education including family planning training, and development and use of media for training in rural health including family planning. ANNEX 13 Page 5 of 5

Duties and Responsibilities

1. To assist the PHI faculty in planning curricula for such a training program.

2. To act as faculty member as program is establishedand evaluating initial training program.

3. To conduct feasibility study to determine need for profession- ally trained faculty planning - health education/FP specialists.

4. To assist in the development and use of media for the PHI training program.

Qualifications

High academic aualifications(preferably at doctoral level in health educationwith some background in faculty planning), teaching experience at graduate and postgraduatelevel in the same field; and experience in planning and curriculum development and development of media.

H. External Review

Functions

The external review mission would examine the total program to suggest suitable modifications to the Government of Malaysia. They would pay particular attention to:

a. assessment of the impact of the composition,use of methods and continuationrates of acceptors on fertility,

b. the review of targets of fertility reduction,

c. the cost effectivenessof the program,

d. the adecuacy of informationand communications,support of the management as well as the disseminationaspects of the program,

e. implementation of population education,

f. the studies in evaluation undertaken and the plan of relevant information, and

g. the review of research studies program and its relevance to the program.

Qualifications

Experts of international standing covering all aspects of the FP program.

ANNEX 14 Page 1 of 1

West Malaysia

Estimated Schedule of Disbursements

IBRD Fiscal Year Cumulative Disbursement and Quarter at end of Quarter (US$ 000)

1972/73

March 31, 1973 176 June, 1973 416

1973/74

September,1973 670 December,1973 1,559 March, 1974 1,874 June, 1974 2,039 1974/75

September 30, 1974 2,193 December, 1974 2,576 March,1975 2,874 June, 1975 3,013

1975/76

September 30, 1975 3,135 December,1975 3,506 March, 1976 3,870 June, 1976 3,999 1976/77

September 30, 1976 4,087 December, 1976 4,4 March, 1977 4,545 June, 1977 4,593

1977/78

September 30, 1977 4U,692 December, 1977 5,000

ANNEX 15 Page 1 of 11

West Malaysia

Demographic Impact of the Project

1. It is difficultto measure the demographicimpact of the project over a long period with any degree of certaintyas many variables influenc- ing the size of the family cannot be held constant. Further, the process of change of family size norm is too complexand the project facilities in- fluence only a part of it. At the same time, setting up some sort of targets for fertility decline which should accompany the project is significant for policy makers. On the one hand, it illustrates the efforts required for achieving the targets and, on the other, shows the implications of the various demographic targets.

2. This annex attempts to estimate (a) the targets of fertility decline with the project facilities, (b) the relative demographicimpact of the existing and the proposed targets, (c) the additional number of births to be prevented and woman-years of protection required and (d) the current users and annual acceptors required for preventing these births with the existing and proposed targets.

A. Targets of Fertility Decline

3. With the improvementsin the program through the project, it should be possible to reduce the birth rate to 30.6 by 1975 and to 21 by 1985 that would imply a reduction in fertilityto half of the 1970 level by 1985. The existing targets are to reduce the birth rate to 32.6 by 1975 and to 26 by 1985. According to demographic indicators, it is unlikely that without the project the GOM would be able to achieve the existing target by 1985. It is more probable that the existing targets could only be achieved with additional facilities provided in the project. Under these circumstances,the demographic impact of the project as estimated here would be the minimum.

4. By 1990 the project assumes a decline in the crude birth rate to less than 20. This would correspond to a net reproduction rate of 1. While no targets of fertility decline beyond 1985 presently exists, it is assumed, however, that by 1999 the GOM may be able to achieve a birth rate of 20 or a net reproductionrate of 1.

B. Demographic Impact

Population Size, Growth Rate, and Fertility Rates

5. Estimated demographicparameters with and without the project are summarized through 1999 in the following table: ANNEX 15 Page 2 of 11

Total Population Fertility (millions) Birth Rate Death Rate Growth Rate Rate

I II I II I II I II I II

1970 9.3 9.3 32.2 32.2 7.2 7.2 25.1 25.1 4.8 4.8 1975 10.3 10.3 32.6 30.6 7.1 7.0 25.5 23.5 4.5 4.2 1980 11.7 11.5 29.5 26.5 6.6 6.5 22.9 20.0 3.8 3.3 1985 13.2 12.6 26.1 21.3 6.1 6.1 20.0 15.2 3.1 2.5 1990 14.5 13.5 23.4 19.5 5.8 5.9 17.7 13.6 2.8 2.2 1995 15.8 14.5 21.8 19.1 5.5 5.7 16.3 13.4 2.6 2.2 1999 16.7 15.3 20.3 18.4 5.3 5.7 15.0 12.7 2.4 2.2

I Without the project. II With the project.

6. In 1970, the birth rate was estimatedat 32.2 correspondingto a total fertility of 4.8. It is estimated that without the project the birth rate would increase slightly to 32.6 in 1975 from 32.2 in 1970 despite a decline of 8% in total fertility because of a larger proportion of persons entering the reproductive ages due to the postwar baby boom. With the project, however, total fertility is expected to decline by 13% thus reducing the birth rate slightly to 30.6 by 1975. The existing target of reducing the birth rate to 26 by 1985 would still give a growth rate of 2% per annum. The birth rate if reduced to 21.3 by 1985 would result in a rate of population growth of 1.5%. With the project, it is expected that total fertility may be reduced to 2.2 by 1990, thus bringing the fertility close to a net reproduction rate of 1 which would help stabilize the population in the next century. Without the project, a NRR of 1 may not be achieved even by the end of the century.

7. As a result of the assumed declines in fertility,the population would be smaller by 0.6 million or by about 5% in 1985 and by 1.h million or by 8% in 1999 with the project than without it.

Age Structure

8. As a result of a sharper decline in fertility, the age structure of population would improve further with the project than without it. Tables 1 and 2 (at the end of the annex) project the population by age and sex through 1999. The results indicate that by 1985 only 34% of the population would be under 14 years of age with the project as against 37% without it. By the end of the century; only about one-fourth of the population would be under 14 years of age with the project as against around 30% without it. ANNEX15 Page 3 of 11

C. Efforts Required

9. An attempt is made to illustrate the efforts required to reduce fertilitywith and without the project in terms of (a) births to be prevented, (b) the recrairedwoman-years of protection, (c) the total users of family planning methods needed for the required woman-years of protection, and (d) the number of acceptors to be recruited each year to give the needed users and their distributionby region and clinic.

a. Births to be prevented The births to be prevented to achieve the reduction in fertilitywith and without the project are given in Table 3. It shows the (i) births needed to be prevented to reduce fertilitywith and without the project and (ii) the births to be prevented as a proportion of births with constant fertility. A little less than one-third of the total births with constant fertility will need to be prevented in 1975 with the project instead of 27% without it. By 1985 less than 60% of the births with constant fertility will have to be averted with che project instead of more than 40% without it. The corresponding propor- tions may go up to 64% and 58% by the end of the century.

b. Current users The number of woman-years of protection against pregnancy that should be contributed by women practicing family planning to prevent the required number of births is summarized in Table 4. It constitutesmore or less the same proportion of women in the reproductive ages as the proportion of births to be prevented. However, because of the discontinuationof practice, the number of current users in a year must be larger than the woman-years of protection in order to achieve the required woman- years of protection. The number of current users needed has been worked out assuming that (i) continuationrates reported for the pill remain constant (Table 5), (ii) the pill will continue to be the main method used, and (iii) compositionof acceptors by method and by continuationrate is the same for acceptors registered at clinics as for those practicing on their own. On these assumptions, the estimates indicated that without the project in 1973, about 28% of women in the reproductive ages should be using family planning methods in the country as a whole. With the project, the proportion should increase to about 32%. By 1985, about 60% of the woman should be using the methods for reducing fertility according to targets with the project and 47% for the targets without the project. (Table 6)

C. Acceptors The currentusers in a particular year consist of (i) new acceptors, (ii) those who resume the practice after dis- continuing,and (iii) those who continue. The required number of acceptors (categories (i) and (ii)) for the country as a whole are given in Table 7. For some time to come the majority of the acceptors may be new, as the number already practicing family planning is quite small. An attempt is made to estimate the required total number of acceptors in rural areas in each plan ANEX 15 Page 4 of 11

period up to 1985 on the assumption that (i) the number of acceptors in rural areas would be the same proportion as the rural population (70%), (ii) the percentage of rural population would decline from 70 at present to 65 in 1976-80 and to 60 in 1981-85. The data are given below:

Acceptors Acceptors With the Project Without the Project (thousands) (thousands) Total Rural Urban Total Rural Urban

1971-75 1,328 930 398 1,142 799 343 1976-80 2,148 1,396 752 1,707 1,110 597 1981-85 3,127 1,876 1,251 2,395, 1,437 958

10. Only a certain proportion of the total acceptors listed above wbuld be using clinic facilities. It is estimated that about 29% of the births were averted by the program in 1970 when it was mainly confined to urban areas. Assuming that 80% of the raral acceptors and 30% of the urban atceptors would use clinic facilities, the total acceptors required to be registered at the clinics are given below.

Acceptors Acceptors With the Project Without the Project

Total Rural Urban Total Rural Urban

1971-75 863 744 119 742 639 103 1976-80 1,343 1,117 226 1,067 888 179 1981-85 1,886 1,511 375 1,204 1,150 54

11. The above table shows that without the project about 742,000 acceptorsare to be reached during 1971-75; that is close to the target of 600,000 already set by the NFP]B. With the project, however, the attempt should be to reach at least 863,000 during the period, or about an additional 40%.

12. Usually the agencies responsible for program execution keep records of the new cases registered at the clinics. For effective monitoring of the progralm the agencies should keep records of the total current users and acceptors (both new and old) in the clinics and check their number in the country through a periodic survey. Annex 15 Page S offl

Table I

Age And Sex Structure Of Population (With The Proiect)

1975 1980 1985 1990 1995 1999 % % Female 7. Ases Male h Female % Male % Female % MKle Female % Male Z Female Z Male 7. Female Male 646,781 699,363 668,600 _ 4 743,882 713,288 771,108 738,877 726,664 695,688 668,274 639,433 676,299 636,307 668,289 639,578 5 - 9 700,873 674,202 736,146 706,175 764,564 733,225 721,690 691,419 664,568 28% 690,029 27% 668.162 26% 640,220 26% 10 - 14 669,427 40X 650,985 407. 697,970 387 671,805 37% 733,482 35% 704,086 34% 762,190 31% 731,412 31% 719,797 729,518 731,226 701,831 15 - 19 602,881 582,886 665,725 647,989 694,551 669,245 730,369- 701,859 759,401 699,099 755,490 727,275 20 - 24 514,496 498,697 597,502 578,822 660,459 644,151 689,728 666,038 725,988 662,626 711,224 686,187 25 - 29 381,643 363,403 509,097 494,269 591,978 574,401 655,136 640,149 684,948 636,125 676,933 656,988 30 - 34 313,417 305,224 377,437 359,614 504,151 489,797 586,989 570,074 650,416 565.484 635,109 621,327 35 - 39 254,228 264,866 309,278 301,362 373,043 355,646 499,034 485,166 581,874 479,836 560,457 544,583 40 - 44 208,929 229,765 249,730 260,618 304,367 297,029 367,860 351,169 492.987 463,268 451,590 45 - 49 172,442 186,284 203,482 224,777 243,781 255,149 297,822 291,642 360,871 345,527 284,507 331,027 318,297 50 - 54 158,531 162,729 165,578 180,517 195,944 218,257 235,507 248,574 288,588 239,439 65% 266,315 67% 269,120 65% 55 - 59 140,434 53% 132,302 53% 148,773 557 155,381 567 155,978 587 172,844 59X 185,324 62% 209,566 62% 223,669 657 197,671 197,930 220,238 60 - 64 134,954 123,604 127,231 123,332 135,381 145,318 142,730 162,337 170,492 147,446 144,938 174,726 65 - 69 103,932 84,796 115,752 110,365 109,846 110,717 117,642 131,113 124,986 111,101 99,132 121,372 70 - 74 69,155 54,852 81,926 70,486 91,744 91,989 87,906 93,097 94,968 8% 7z 139,965 gY 75 + 57.640 7Z 55.668 7h 72.020 7% 65.874 7% 88.126 72 82.751 7% 103.149 7% 106.567 7% 109,899 7% 121.915 117.714 7,726,575 7,581,896 Tq¢al 5,226,861 5,083,552 5,828,754 5,690,263 6,374,061 6,240,561 6,851,352 6,719,615 7,329,752 7,193,410

Ass mtions

1. Fertility declines to .51 of 1970 level by 1985 and .42 by 2000. 2. Expectation of life at birth increases by 0.25 years per year from the present level of 63.4 years for males and 66.1 years for females. Annex 15 Page b of 11

Tal 2

Age And Sex Structure Of Population .4 thopt The Pro ect) l

1975 1980 1985 1990 1995 1999 Ages Male % Female 7 Male Z Female 2 Male % Female % Male % Female % Male 7, emaAe 2 Male 70 Female %

0 - 4 767,069 735,518 843,318 808,058 879,056 841,571 877,583 839,661 854,157 816,884 815,030 779,185 5 - 9 700,873 674,202 759,048 728,141 836,085 801,808 872,949 836,324 872,667 835,556 857,448 820,617 10 - 14 669,427 41% 650,985 40% 697,970 39% 671,805 38% 756,299 37% 725,985 37% 833,485 35% 799,822 35% 870,653 33% 834,639 32% 872,025 307 S35,555 29 15 - 19 602,881 582,886 665,725 647,989 694,551 669,245 753,095 723,693 830,449 797,758 863,969 829,219 20 - 24 514,496 498,697 597,502 578,822 660,459 644,151 689,728 666,038 748,584 720,850 813,774 783,372 25 - 29 381,643 363,403 509,097 494,269 591,978 574,401 655,136 640,149 684,948 662,626 726,419 700,841 30 - 34 313,417 305,224 377,437 359,614 504,151 489,797 586,989 570,074 650,415 636,125 676,933 656,988 35 - 39 254,228 264,866 309,278 301,362 373,043 355,646 499,034 485,166 581,874 565,484 635,109 621,327 40 - 44 208,929 229,765 249,730 260,618 304,367 297,029 367,860 351.169 492,987 479,836 560,457 544,583 45 - 49 172,442 186,284 203,482 224,777 243,781 255,419 297,822 291,642 360,871 345,527 463,268 451,590 50 - 54 158,531 162,729 165,578 180,517 195,944 218,257 235,507 248,574 288,588 284,507 331,027 318,297 55 - 59 140,434 52% 132,303 53% 148,773 54% 155,381 55% 155,978 56% 172,844 57% 185,324 58% 209,566 59% 223,669 61% 239,439 61% 266,315 61% 269,120 63' 60 - 64 134,954 123,604 127,231 123,332 135,381 145,318 142,730 162,337 170,492 197,671 197,930 220,238 65 - 69 103,932 84,796 115,752 110,365 109,846 110,717 117,642 131,113 124,986 147,446 144,938 174,726 70 - 74 69,155 54,852 81,926 70,486 91,744 91,989 87,906 93,097 94,968 111,101 99,132 121,372 75 + 57.640 8% 55,668 77, 72.020 7% 65,874 7% 88,126 7% 82,751 67. 103,149 7% 106,567 6% 109,899 6%7 121,915 7% 117,714 9% 139,965 8'

lbtal 5,250,049 5,105,782 5,923,866 5,781,410 6,620,791 6,476,927 7,305.891 7,154,992 7,960,208 7,797,363 8,441,487 8.266,995

Assumptions

1. Fertility declines to only .67 of 1970 level by 1985 and .43 by 2000. 2. Expectation of life at birth increases by 0.25 ye rs per year from the present level of 63.4 years for males and 66.1 years for females. ANNEX 15 Table 3 Page 7 of 11

Births to be Averted to Achieve Targets of Reduction in Fertility

Percentage of Births with Constant Fertility ______

Without the With the Without the With the Project 1/ Project 2/ Proiect Pro.ject

1973 109,334 121,584 25 28 1974 117,109 132,500 26 30 1975 126,842 145,620 27 31 1976 138,884 162,677 29 34 1977 150,923 180,106 30 36 1978 163,963 198,906 32 39 1979 177,122 218,203 33 41 1980 191,147 238,745 35 44 1981 205,873 260,352 37 46 1982 221,137 282,839 38 49 1983 236,764 305,998 4o 51 1984 253,508 330,538 41 54 1985 271,144 356,186 43 57 1990 360,680 439,666 51 62 1995 466,879 501,537 58 64

1/ Births to be prevented to achieve the existing program targets. -/ Births to be prevented to achieve the targets with program improvement.

Note: Births to be prevented to achieve the desired reduction in fertility reDresent the difference between the births with constant fertility (age-specific marital fertility of 1957), assuming the 1967 proportion married in the reproductive ages remains constant. ANNEX15 Table 4 Page 8 of 11

Required Woman-Years of Protection for Target Decline in Fertility (thousands)

As Percent of Married Women

Without the With the Without the With the Project Project Project Project

1973 375 424 27.4 30.1 1974 406 466 28.6 32.9 1975 444 521 30.2 35.4 1976 483 576 31.7 37.8 1977 525 636 33.4 40.4 1978 567 698 3h.9 42.9 1979 612 764 36.5 45.5 1980 659 833 38.1 48.1 1981 708 905 39.7 50.7 1982 758 979 41.3 53.3 1983 811 1.058 43.0 56.1 1984 868 1,140 44.8 58.9 1985 917 1,189 46.6 60.0 1990 1,222 1,451 54.3 64.9 1995 1,560 1,634 61.7 66.1

Assumption 1. Estimates are based on the assumption that 3.2 woman-years of protection would avert one birth after a lag of one year. ANNEXi5 Page 9 of 11

Table 5

The Age-specificContinuation Rates

First Segmnt All Segments Ages SampleSize 12!month lt-month 12-month 18-month

15-19 91 41.6 20.4 52.5 27.2 20-24 495 46.o 30.7 57.4 44.4 25-29 699 54.1 44.6 68.2 58.8 30-34 549 59.3 46.6 71.7 39.9 35-39 308 57.2 47.6 67.9 66.1 40-44 121 57.9 52.2 67.9 61.2 45 and over 10 (79.3) -/ (79.3) 2/ (79.3) 2/ (79.3) 2/

All ages 2,275 1/ 53.8 41.7 66.0 55.5

1/ Rounded figure of a weighted sample. 2/ Unreliabledue to small samplesize. Source: TakeshitaJ. and Tan Boo Ann, Acceptors Survey 1969, NFPB. ANNEX15 Table 6 Page 10 of 11

Required Number of Users for Target Reduction in Fertility ( thoupanda )

As a Proportion of Married Women

Without the With the Without the With the Project Fr3ject Proct Project

1973 384 432 28.1 31.5 1974 424 493 29.9 34.8 1975 460 544 31.3 37.0 1976 501 602 32.9 39.6 1977 544 663 34.6 42.1 1978 586 726 36.0 44.6 l979 633 795 37.7 47.4 1980 680 863 39.3 49.9 1981 730 939 40.9 52.6 1982 781 1,011 42.5 55.1 1983 835 1,095 44.3 58.1 1984 894 1,177 46.2 60.8 1985 936 1,199 47.2 60.4 1990 1,255 1,468 55.8 65.7 1995 1,589 1,647 62,8 66.7

The formula used for estimation is:

Un=Pn-y -Anay -~~y- Un is users at time n, Pn is woman-years of protection at time n, An is acceptors at n period. z=e-r _1-e X=er i+r r7_~~ ~ ~~r The dropout function is assumed to be hAe-rt. The value of 'R' on the basis of 12 monthscontinuation rate data is taken as 0.66 and of la! as 0.9.

Sources; Unpublishe, papers, The @ itioz of FuturQ Caseloads in Family plamni3g Pr4rma by R. Cuca, IBRD 172. ANNEX 15 Table 7 Page 11 of 11

Required Number of Acceptors for the Target Decline in Fertility ( thousands

As Proportion of Married Women Without the With the Without the With the Project Project Project Project

1971 195 218 14.2 15.6 1972 211 241 15.0 16.5 1973 222 258 15.4 17.6 1974 244 285 15.7 18.2 1975 271 326 16.6 19.4 1976 292 356 17.8 21.4 1977 317 393 18.6 22.6 1978 339 428 19.5 24.2 1979 366 466 20.2 25.5 1980 393 505 21.1 26.9 1981 421 546 22.0 28.3 1982 448 588 22.9 29.7 1983 480 634 23.8 31.2 1984 513 681 24.8 32.7 1985 533 678 25.8 34.3 1990 713 815 30.7 36.0 1995 892 900 33.8 35.9

Pn-(Pn-l)e-r The formula used for calculating the number of acceptors is An - a (1-e-r)

W^hereAn is the number of acceptors Pn- Woman-years of protection. The dropout function is assumed to be R=ae-rt. The value of 'R' on the basis of 12 months'continuationrate data is taken as 0.66 and of la' 0.9.

Sources: Unpublishedpapers, The Estimation of Future Caseloads in Family Planning Programs by P. Cuca, IBRD '72.

ANNEX16 aTgeI of 2 West Malaysia

Economic and Social Impact of the Project

1. This annex presents a simple order-of-ma gitude analysis of the impact of the project in terms of (a) the increase in per capita income up to 1985, (b) the slowing in the growth of the labor force to 1995 and 2000, and (c) further reductions in child mortality and morbidity. Per Capita Income

2. The project would permit per capita income to rise more rapidly than otherwise; this conclusion assumes, as we believe justified, that the slowing of population growth induced by the project would have no effect on the growth of national income. The following table shows the growth of per capita income with and without the project, using the long-term growth in national income assumed in the Government's perspective plan. 1/

Percent Population GDP GDPUS$ Increase Required Increase (thousands) (US$ millions) Per Capita GDPWP (US$ millions) WOP WP WOP WP GDP Investment

1975 10,355 10,310 4,099 396 398 - 20.7 62 1980 11,705 11,518 5,743 490 498 1.6 94.0 281 1985 13,198 12,614 8,368 634 663 4.6 383.0 1,148:

3. Therefore,as a resultof the project,per capitaincome would be around 1.6% higher in 1980 than without the project, and around 5% higher by 1985. To produce increases in per capita income of this magni- tude would require increases in investment several times larger than the totalcost of the presentproject. A populationproject is thus a far cheaperway of generatingincreases in per capitaincome than by investment in productionfacilities alone up to a certainextent. Labor Force 4. The effecton the laborforce of slowingdown populationgrowth beginsto be felt only about15 yearslater. The followingtable showsthe estimateddifference in the size of the laborforce in 1995 and 2000with and withoutthe project. (thousands) WithoutProject With Project Difference M F T M F T 1995 4,256 1,971 6_,27 4,228 1,935 6,13- 94 2000 4,809 2,191 7,000 4,655 2,108 6,763 237

1/ Governmentof Malaysia, An OutlinePerspective Plan for 1965-1985. The figures for 1975 do not exactly correspond to those given in the Second Five-Year Plan (p. 52) for GNP at 1964 prices. ANNEX16 Page 2 of 2

The most striking point is the very rapid slow-down realized between 1995 and 200C; this reflects the rapid build-up of births averted in the late 1970s and early 1980s. By 2000 the labor force is estimated to be about 3% smaller than it otherwise would be. The most important effect of slowing the growth of the labor force will be a slowing in the growth of unemployment, now estimated at about 250,000, or 8% of the total labor force. With a labor force of about 7 million in 2000, unemployment would run about 560,000 if the present rate should continue. Since the project is estimated to reduce the total labor force by nearly 240,000 by 2000, unemployment would be only about one-half what it might be in the absence of the project.

Mortality, Morbidity, and Nutrition

5. West Malaysia has made good progress in reducing infant and child mortality in recent years, although the rates are still fairly high, especially in rural areas. The following table shows the trends in toddler mortality rate,i.e.,numbers of deaths of children 1-4 years per thousand of children of that age among major ethnic groups. (The Malay ethnic groups are pre- dominantly rural and the Chinesepredominantly urban.)

Ratio of Year Malav Chinese 2 to 3 T1Y Mr) _T3) 1957 141 66 2.1:1 1960 109 44 2.4:1 1968 72 26 2.8:1

Source: Ministry of Health, Government of Malaysia.

The project facilitiesand services will have a rural bias, which should help to prevent any further worsening of the relationshipbetween rural and urban child mortality.

7. The project contains a small nutrition component, limited to nutrition education. The relationshipbetween malnutritionand infection as well as mental development is now well-established. The combinationQf strengthenedMCH services, nutrition and health education, and family planning which the project will provide will help improve not only the chainces of survival of children, but also their mental and physical health, and hopefully their school performance. It is,of course,true that the health components of the project will have demographic effects directly opposite to those which constitutethe project's principal objective, i.e.,a slowing in the rate of population growth. Better health services and nutritionwill keep more people alive (especiallychildren), although the strength of this effect is difficult to estimate. The negative demographic effects of keeping more people alive is certainlyno reason against doing so; they do, however, add urgency to the need to bring fertility under better control. WEST MALAYSIA NATIONAL FAMILY PLANNING BOARD ORGANIZATION STRUCTURE

CAEi N ET

CABINET SUB COMMITTEE l Family Planning The Treasury Ministry of Health Ministry of Information PRIME MINISTER S NATIONAL FAMILY PLANNING BOARD Ministry of National & Rural Development DEPARTMENT _ Ministry of Education Ministry of Agriculture & Cooperative Ministry of Local Government & Housing Ministry of Welfare Services CHAIRMAN Ministry of Labor and public representatives from the fields of commerce, labor, education, social services and professions.

EXECUTIVE COMMITTEE

DIRECTOR GENERAL

Tehia an Administrative, Fin. | valtuation | Training, Education || Service inomtonDvso Plnnn Div. and Supply Division || Division ||& ResearchDivision || Division lfrainDvso

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NOTE: The total number of staff for all Divisions in 1971 was456.

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State Director oi Medical and Health Services

StateMatron

Director of Deputy Senior Medical Dental Services Director Officer of Health

Chief Public elhSaeHealth HHealth ealtho C StateiI Education Inspection MtoMCOfie ]Officer 1

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formation Supervisor

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