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Venezuela - Health Service Reform Project (English)

The project outcome was unsatisfactory, with an unlikely sustainability, though with modest institutional development impacts, and, similarly, both performances by the Bank, and Borrower are deemed unsatisfactory. Through the many lessons drawn from the project, it is primarily specified that, given the country's weak capacity to design, and implement a complex health reform, it would have been preferable to proceed with simplified, phased reforms, complemented by management, and infrastructure improvements, rather than preconditioning other components, on the successful implementation of the policy analysis, and pilot experimentation component. This could have reduced the risk of costly delays, and, permitted the phased construction of a policy framework to foster further institutional development. Moreover, key indicators - increased coverage, quality and efficiency - to measure basic outcomes, should have been agreed at appraisal time, not as it turned out, during implementation, when the focus is on the project progress in the short-term, and not intended for the long-term implementation efficiency, and impact evaluation. Similarly, other lessons offer suggestions as for the preparation (and careful supervision) of policy studies; for project restructuring, provided changes in government policy, and priorities so require to ensure relevance, and impact; for the design of training programs, to include an evaluation scheme, integral to the overall training program; and, for the appropriate use of the Mid Term Review, in a planned, strategic manner for efficient implementation, impact evaluation, and if so needed, for restructuring the scope, and content of the project.




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Venezuela - Health Service Reform Project (English). Washington, D.C. : World Bank Group.