ICRR 10007
                                                                                              Report Number : ICRR10007
                    ICR Review
                    Operations Evaluation Department




1. Project Data :
             OEDID :
             OEDID:     L3034
         Project ID :   P002091
      Project Name :    Imo Health and Population
            Country :   Nigeria
             Sector :   Basic Health
       L/C Number :     L3034
  Partners involved :
       Prepared by :    Timothy A. Johnston, OEDST
      Reviewed by : L. Landau
    Group Manager : Roger H. Slade
       Date Posted : 03/31/1998

2. Project Objectives, Financing, Costs and Components :
Objectives :
1. Imo State: a) strengthen State capacity; b ) improve HNP services.
2. Federal MOH: a) support HNP policy development; b ) strengthen capacity

Revised objectives : deliver a minimum basic service package in Imo and Abia States through : a) PHC training; b)
essential drugs; and c) upgrading health facilities.

Project cost : IBRD loan of $27.6 million; $11.7 million cancelled.


3. Achievement of Relevant Objectives :
The project met few of the original State -level objectives, and none of the national objectives . The Objectives were
substantially reduced after a mid -term review in 1994. Of the reduced revised objectives, the project met some of its
output targets by closing, but the impact on services is still uncertain . The project renovated 119 clinics and 36 local
government drug stores; trained 838 village health workers and traditional birth attendants; established essential
drug programs in both states; set up drug revolving funds at state and facility level; and provided equipment and
drugs to some local facilities. The minimum basic package of health services was introduced to 12 local government
areas in Imo and Abia, although implementation varies considerably . The project did help bring together community
representations and providers to assess health problems and plan strategies .

4. Significant Achievements :
The project achieved modest success in meeting the reduced objectives, including introducing the minimum basic
health care package (MBHP) to some local governments. The training, facilities, and equipment provided may
continue to be useful, although the impact on services in uncertain given the weak economic and institutional
context. Stronger government commitment and project management in Abia State contributed to progress in
implementing the MBHP.

5. Significant Shortcomings :
The project met none of the national objectives, and few of the original State objectives . Despite some
achievements in Abia State after the mid -term review, the impact is uncertain and sustainability unlikely . Project
design was overly complex, and did not consider the weak institutional environment . The national government met
less than 3 % of its counterpart funding obligations . No project indicators were specified during design .


6. Ratings :             ICR                        OED Review               Reason for Disagreement /Comments
               Outcome : Unsatisfactory             Unsatisfactory
     Institutional Dev .: Negligible                Negligible
         Sustainability : Uncertain                 Unlikely                 Despite recent progress in Abia State, the
                                                                           commitment to the project depends on a
                                                                           few individuals, and the overall economic
                                                                           and institutional environment remains
                                                                           negative.
   Bank Performance : Deficient                   Unsatisfactory           .
      Borrower Perf .: Deficient                  Unsatisfactory           .
       Quality of ICR :                           Satisfactory


7. Lessons of Broad Applicability :
   Project design should be more adaptable
   Projects in weak administrative environments should minimize components
   Project Coordinated Units established separately from the Ministry can undermine ownership
   Community involvement is important for successful PHC
   Mid-term reviews, and restructuring if necessary, can be beneficial and should be conducted earlier in the project
   turnover of Bank task managers undermined supervision effectiveness
   Procurement agents do not solve all procurement problems

8. Audit Recommended?        Yes      No

9. Comments on Quality of ICR :
The ICR provides a candid review of project experience . Although monitoring indicators were collected only in the
project's final years, these should have been summarized in the ICR . The full text of the Borrower's comments
should have been included, rather than a summary . The ICR might also have addressed :
1. Why did the Bank allow the project to languish five years?
2. To what extent did corruption influence project implementation, and were the Borrower's complaints regarding
ICB justified?