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 It may not be published, quoted or cited without Bank Group authorization.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-struc- ture 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 mid- wifery 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 visit- ing 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 con- struction contracts. Group II Equipment = Depreciable equipment of five years' life or more, not normally purchased through con- struction 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 in- cludes 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 avail- able 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.