ICRR 10182 Report Number : ICRR10182 ICR Review Operations Evaluation Department 1. Project Data : OEDID : OEDID: L3099 Project ID : P004518 Project Name : Health Development Country : Philippines Sector : Basic Health L/C Number : L3099 Partners involved : Prepared by : Charles Derek Poate, OEDST Reviewed by : Susan A. Stout Group Manager : Roger H. Slade Date Posted : 08/17/1998 2. Project Objectives, Financing, Costs and Components : Objectives : The project sought to: (i) improve the control of major communicable diseases; (ii) develop maternal and child health; (iii) enhance equity, by targeting services to under-served areas and high risk groups; (iv) establish partnerships among government, NGOs and communities; (v) strengthen the institutional capacity of DOH; and, (vi) build up DOH capacity for health policy development. Components : (i) programs to reduce the incidence of malaria, schistosomiasis and tuberculosis and to improve MCH; (ii) delivery of field health services through midwives and community health development; and, (iii) institutional capacity building through improvements in health planning, the improvement of communication within DOH, strengthening the central laboratory and the provision of training. Costs and financing : The total project costs were US$ 102.78 million (US$ 108.4 million at appraisal) of which the Bank financed US$ 68.21 million (US$ 70.1 million at appraisal). The project was co-financed with US$ 3.97 million from Japan (US$ 4.3 million at appraisal) and US $8.1 million from Italy. The Bank loan was approved on June 22, 1989, was made effective on January 10, 1990, and was closed on December 31, 1997, one year after the original closing date. Final disbursement took place on May 11, 1998. 3. Achievement of Relevant Objectives : Overall, the project outcome was satisfactory. Disease control objectives were partially achieved, although there was greater success in the control of schistosomiasis than for TB and field service delivery objectives were substantially achieved. However, institutional strengthening objectives were only partially achieved. The achievements of training, the establishment of a central laboratory and the development of health policy were negligible. 4. Significant Achievements : (i) The achievement of schistosomiasis control was substantial - with a 50% reduction in the prevalence rate, the component exceeded its output targets; (ii) The excellent national survey carried out by the project will be useful for the planning of TB control in the next five years. Project support for field health services (provision of midwives) was very successful, although it is not yet clear whether local government authorities (LGAs) will be willing to absorb the recurrent costs of these programs -- to date only 20% of the midwives generated through the project have been absorbed into long term positions. 5. Significant Shortcomings : The achievement of the institutional development objectives negligible because they were not specifically defined nor carefully monitored; a government wide devolution process, which took place after the project was designed might have been better anticipated, was made worse by the lack of contingency plans or sufficient flexibility to adapt the project design to a new political and administrative environment; the project experienced severe cash flow problems in 1991 causing serious delays and discontinuities and the size, duration and scope of the project severely taxed the management capacity of the DOH. 6. Ratings : ICR OED Review Reason for Disagreement /Comments Outcome : Satisfactory Marginally Satisfactory Although the disease control objectives were substantially achieved, there were significant shortcomings in the achievement of other components and the long run sustainability of the most successful elements of the project is uncertain.. Institutional Dev .: Negligible Negligible Sustainability : Uncertain Uncertain Bank Performance : Satisfactory Satisfactory Supervision intensity and quality declined following the first 4 years of implementation, at least in part as a consequence of multi-tasking missions with significant additional responsibilities for preparation of several new projects in the sector. Borrower Perf .: Satisfactory Satisfactory The Borrower's completion report is exemplary. Quality of ICR : Satisfactory 7. Lessons of Broad Applicability : (i) There should be strong linkages among the various components of projects to facilitate coordination and encourage complementarities. (ii) Streamlining of drug and equipment procurement should be assured before any major public health commitment is made by a project. (iii) Successful NGO and community participation requires a change in the bureaucratic processes and approaches of government; (iv) there is a need for project design teams to be aware of the political miliew, including . monitoring of possible legislative actions while planning and implementing projects 8. Audit Recommended? Yes No 9. Comments on Quality of ICR : The quality of the ICR is satisfactory with most major issues being addressed succinctly yet comprehensively. The inclusion of a cost:benefit ratio for a health project was an excellent innovation. The Borrower's ICR is especially complete and thoughtful.