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Nicaragua - Second Phase Health Services Extension and Modernization Project (Inglês)

Ratings for the Second Phase Health Services Extension and Modernization Project for Nicaragua were as follows: outcomes were moderately satisfactory; risk to development outcome was moderate; Bank performance was moderately satisfactory; borrower performance was also moderately satisfactory. Some lessons learned includes: the importance of surveillance and monitoring and evaluation should not be underestimated. Given the challenges associated with availability of data to monitor Project Development Objective (PDO) indicators and intermediate outcome indicators, the project could have had a stronger focus, including dedicated financial resources, to strengthen surveillance, monitoring and evaluation. The use of national outcome indicators as PDO indicators was problematic given that the project had a targeted approach. While the use of common national targets for all donors was helpful in terms of donor coordination and harmonization, it was not appropriate to measure the success of this project which featured interventions in targeted areas. Notwithstanding the issues in monitoring and evaluation, the project also demonstrated that the expansion of maternal homes (Casas Maternas) made a critical contribution to improving institutional deliveries. More generally, the project demonstrated that a primary health care model based on a basic package of services works in Nicaragua. Performance agreements became a very useful tool to establish a results-oriented culture. This was a powerful tool that had a positive impact for managing decentralized health programs. The project also proved that it is possible to move from a situation of many models and sources of financing to a coordinated sector approach. One final lesson, however, is that pooling funds is very difficult. The necessary conditions to allow for pooling of funds are challenging, and in hindsight it may have been overly optimistic given the country's capacity constraints and fiduciary systems to expect that this could have been possible from the start.


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    Conclusão da Implementação e Relatórios sobre Resultados

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    América Latina e Caribe,

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    Nicaragua - Second Phase Health Services Extension and Modernization Project

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    maternal and child health care;Demographic and Health Survey;provision of family planning services;provision of health service;infant mortality rate;access to health service;economic and financial analysis;Internal rate of return;primary health care delivery;monitoring and evaluation system;ip disbursements archived;population and reproductive health;Nutrition and Food Security;united nations population fund;delivery of health services;coverage of health insurance;marginal rate of return;primary health care services;Maternal and Child Mortality;cost of health care;monitoring and evaluation capacity;delivery of family planning;management of service delivery;health care service providers;basic package;health and nutrition;purchase of service;delivery of service;maternal mortality rate;public health providers;infant health care;pregnant woman;Health Service Delivery;private service provider;source of financing;public health expenditure;diagnosis and treatment;short of target;health care centers;outputs by components;process of decentralization;growth and development;per capita expenditure;live birth;management agreement;Public Health Emergency;number of beneficiaries;preventive health care;official development aid;care of adolescents;treatment of malaria;pool of fund;lack of availability;incentives for providers;health sector investment;Country Partnership Strategy;social security reform;awareness raising activity;human influenza virus;primarily due;availability of data;extremely poor family;Sexually Transmitted Disease;health insurance premium;improvement in technology;financial management staff;improvements in health;cost benefit analysis;lack of interest;international economic crisis;acute respiratory disease;distribution of contraceptives;infant health services;Education and Development;spacing between birth;cases of violence;inequality in health;waste management facilities;Indigenous People Plan;supply and installation;public health budget;Partners in Health;public health facility;provision of service;decentralization of management;quality of results;increase in mortality;improvements in access;concentration of poverty;health service contract;central government institution;national health system;integrated health care;Financial Management System;level of capacity;administrative datum;strategic objective;chronic malnutrition;donor support;Municipalities;development partner;institutional strengthening;Prenatal Care;hospital discharge;rural area;capitation payment;indigenous territory;budget transfer;performance agreement;early detection;beneficiary survey;public provider;medical equipment;indigenous community;indigenous communities;infant care;private provider;certification standard;maternal death;reproductive age;nutrition intervention;operational capacity;cost-benefit analysis;Health Promotion;primary care;counterpart fund;healthy diet;procurement staff;integrated care;investment cost;participating community;strategic framework;donor investment;infant death;Budget Management;present value;community health;pentavalent vaccine;vulnerable population;newborn infants;autonomous region;delivery model;waiting time;institutional change;health strategy;oral health;budgetary process;folic acid;donor coordination;managerial capacity;indigenous population;external funding;external financing;pap smear;ferrous sulfate;hospital waste;financial resource;secondary care;access gap;results framework;corrective action;utilization rate;social control;targeted population;management tool;efficiency improvement;program impact;staff attitude;nutrition status;borrower documents;main road;municipal boundaries;international boundary;increased income;Contracting Mechanism;increased demand;transmitted infection;sexual health;modest increase;private saving;medical supply;breast examination;generic medicine;annual budget;decentralized management;cost stream;investment level;recurrent budgets;pension contribution;Tax Reform;financial reporting



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