ICRR 10888 Report Number : ICRR10888 ICR Review Operations Evaluation Department 1. Project Data: Date Posted : 04/24/2001 PROJ ID : P000596 Appraisal Actual Project Name : Pop & Human Resource Project Costs 16 12.54 US$M ) (US$M) Country : Comoros Loan/ US$M ) 13.03 Loan /Credit (US$M) 12.071 Sector (s): Board: HE - Health (56%), Cofinancing Other social services US$M ) (US$M) (31%), Central government administration (13%) L/C Number : C2553 Board Approval 93 FY) (FY) Partners involved : Closing Date 06/30/1999 06/30/2000 Prepared by : Reviewed by : Group Manager : Group : Roy Jacobstein Timothy A. Johnston Alain A. Barbu OEDST 2. Project Objectives and Components a. Objectives The Project Objective was “to strengthen regional and community involvement in population and human resource development, through improving the delivery of basic health services and stimulating complementary community activities. b. Components The Project had two components: 1) Improving the delivery of basic health services, including family planning and AIDS prevention, through community participation, self-management and cost recovery; and, 2) Establishment of a Social Fund to support complementary community development initiatives, including the rehabilitation of basic infrastructure, income generating activities, the well-being of women, and training. c. Comments on Project Cost, Financing and Dates Total project costs at appraisal were estimated at $16M, to be funded by an IDA Credit of $13M and a GoC contribution of $3M. Actual/latest estimate of project costs were an IDA expenditure of $12.071M, GoC expenditure of $.094M, and beneficiaries’ contribution of $1,162M. The project was extended for one year beyond that planned at appraisal because of political instability and the Government's falling into arrears, which were only settled in 1999. 3. Achievement of Relevant Objectives: In general the Project was well designed, and it was successful from 1994-1996. But in 1997-1999 the political and economic situation deteriorated markedly, with several coup attempts made, frequent changes in government, and one of the country’s three islands attempting to secede from the other two. During that latter period Project activities virtually came to a halt. Nonetheless meaningful progress was made toward the Project’s overarching objective of strengthening regional and community involvement in health and family planning, and related areas, e.g., water, primary education and rural infrastructure development. 4. Significant Outcomes/Impacts: In the early stages of the Project, the MOH was successfully reorganized to promote greater decentralization, cost recovery, and institutional self-reliance. Community participation was widespread and robust, particularly in the development and implementation of community projects supported by the Social Fund. For example, with the support of the Fund, 215 classrooms in 90 schools were built, 40 water and sanitation projects were completed, 13 health posts and 10 women development centers were built. Microcredit support led to 42 income-generating subproject activities being funded, at an aggregate cost of only $200,000. Modern contraceptive prevalence had risen to 8% in 1996 from 3% in 1993, and FP is now part of the MOH’s basic health care package. Overall, according to the ICR, an estimated ¾ of the country’s population benefited directly or indirectly from Social Fund-supported projects. 5. Significant Shortcomings (including non-compliance with safeguard policies): The successive governments were not committed to the health sector reforms and the GoC only contributed $94,000 of its $3 million commitment. Health personnel salaries were frequently unpaid and morale was low. The various governments also interfered in the procurement process or the supervision of works. Health facilities that were upgraded did not receive funds for maintenance. Administrative costs of the Social Fund were much higher than expected, representing almost 1/3 of overall sub-project disbursements. Finally, the Project did not result in the anticipated improvement in overall health status, economic growth, or diminution of poverty. 6. Ratings : ICR OED Review Reason for Disagreement /Comments Outcome : Unsatisfactory Moderately The project made a number of Unsatisfactory contributions at the community level despite a negative external environment . Institutional Dev .: Substantial Substantial Sustainability : Unlikely Unlikely Bank Performance : Satisfactory Satisfactory Borrower Perf .: Unsatisfactory Unsatisfactory Quality of ICR : Satisfactory NOTE: NOTE ICR rating values flagged with ' * ' don't comply with OP/BP 13.55, but are listed for completeness. 7. Lessons of Broad Applicability: • Even in countries with weak governments and widespread political instability, meaningful development can proceed via strong support of community initiatives. • In such situations, beneficiary involvement can be encouraged and meaningful local financial support can be generated. • Testing different approaches for sub-project preparation, financing and supervision before committing large amounts of resources, as was apparently done with the Social Fund component before the Project was approved, is beneficial. • In these community-oriented project components relatively major investments in training are desired by the communities, and such investment in human resources is advisable in terms of lasting Bank contribution to development. • Conversely, investing in renovation of facilities when it is predictable that their operational maintenance is unlikely or on fragile footing is unwise. 8. Assessment Recommended? Yes No 9. Comments on Quality of ICR: The ICR is frank, fair, well-written, and concise. Principal performance ratings and ratings for achievement of objectives were convincingly supported in the text by quantitative data and other qualitative descriptions and findings.