An Independent Review of World Bank Support to ... - DAG Ethiopia

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ProjectHEALTHFamilyHealthProjectCapacityBuildingCategoryOrganizational/HumanResourcesHumanResourcesObjectiveSupport the ID of the central MoHthrough strengthening its PPD and 5key units (after 1994 restructuring)Train personnel (partly funded by theWB)HSDP Institutional Implement Health Care FinancingStrategy to improve sector efficiencyand generate additional revenue fordirect financing of sectorInstitutionalInstitutionalInstitutionalHumanResourcesOrganizationalInstitutional/OrganizationalRestructure of the health services intoa four-tier system that is managed in adecentralized, participatory andefficient mannerSub-objectives included:*Devolve management authority andresponsibility to lower levels*Establish service standards for NGOand private sector health institutions*Improve skills in policy formulation,planning and budgeting, financialmanagement, and programimplementation, M&E for staff inMOH, regions and partially for lowerlevels*Revise 23 training curricula toinclude management subjectsStrengthen pharmaceutical sub-sectorregulation and management to ensureregular availability and rational use ofsafe and affordable drugs46Achievement of objectives(Based on JRM and PSR 2003 and interviews)Restructuring of the project substantially changed the scope and coverageof its capacity building goals, as primary emphasis was given to theconstruction of physical facilities (health stations, health centers).Imbalance between expanded facilities on the one hand and availability oftrained manpower and budgetary resources for operations on the otherhand, resulted in the continued shortage of personnel to run health servicesand funding to utilize the established training facilities.Did not formulate a cost sharing strategy and did not implement scheme.Draft legislation for a Health Fund was prepared but not approved. Asdecisions were not taken, the Heath Care Financing initiative stayed at theanalysis stage.The HSDP framework for planning and management has been used atfederal and regional level, but not at zonal, woreda and health facilitylevels. Target setting at the latter levels not linked to strategy, activity andresource planning. The four-tier system was not instituted as per plan.Health service management capacity has not improved as envisaged. ManyMOH posts have remained vacant for long periods, and four major regionsinstructed to transfer 40-60 percent of staff to lower levels. Noimprovement at all in emerging regions.Communities are represented in regional, zonal and woreda councils, butcommunity co-management of facilities appears to be a forgottenobjective. HSDP I did not formulate a strategy for participation of privatesector and NGOs in health service provision and did not take these nonpublicactors into account in service planning (other than including anNGO representative in the CJSC).Management training limited and has virtually ceased.Health service management not included in pre-service training curricula.Drugs Administration and Control Department reorganized intoautonomous agency under MOH. Pharmaceutical Administration andSupply Services reorganized out of involved MOH department. Itsprocurement capacity assessed in 2002 to be able to undertakeinternational procurement complying with acceptable standards.Development of standardized procurement and logistics procedures tosatisfy government and ALL donors’ requirements, not achieved, butpreparatory steps taken.
ProjectCapacityBuildingCategoryInstitutional/OrganizationalHumanResourcesObjective 22Strengthen health sector monitoringthrough improved collection anddocumentation of health informationDevelop an acceptable number andmix of health personnel who areproperly and appropriately trained,deployed, managed and retainedAchievement of Objectives(Based on HSDP I Final Evaluation 2003 23 )The HMIS system has made little progress due to lack of a national HMISstrategy, the existing being too ambitious and lack of staff resources forimplementation (only 1 of 5 positions in HMIS unit filled). However, thefew reports produced by HMIS are not being properly used for policy andplanning purposes.Training capacity expanded and strengthened:• 2 existing institutions started diploma/degree courses;• 4 new schools established;• 6 institutions rehabilitated and 2 expanded;• Training materials, teacher training and curricula revisions.Large numbers of staff trained. Staff remuneration is considered adequatedue to salary increases and incentive schemes. Exceptions are doctors andmanagement staff that leave remote locations. However, HR planning andmanagement remains critically weak, leading to over-production of somecadres, gross shortages of others, serious mal-distribution of staff betweenand within regions. Complex staff categories in nursing and mid-wiferynot resolved. Regional Training Centers were closed down due to staffdeployment and reorganization of RHBs.22Objectives as presented in the Government’s HSDP Program Action Plan October 1998 and the Bank’s HSDP support PAD September 1998.23 Report on the Final Evaluation of HSDP I, 3 rd March 200347
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An Independent Review of World Bank
Page 3 and 4: Annex D: Capacity Building Objectiv
Page 5 and 6: PEMPERPFPPIUPPDPRSPPRSCPSCAPPSMPSRR
Page 9 and 10: 1. IntroductionObjectives1.1 This s
Page 11 and 12: 2. Country ContextPolitical Develop
Page 13 and 14: complete state transformation (incl
Page 15 and 16: provide policy direction, coordinat
Page 17 and 18: 3. Bank Assistance Strategy and Cap
Page 19 and 20: 3.7 The program of lending operatio
Page 21 and 22: 4. Assessment of Bank Support to Ca
Page 23 and 24: organizational aspects of capacity.
Page 25 and 26: esource strong and flexible financi
Page 27 and 28: identification of capacity constrai
Page 29 and 30: government procurement systems unde
Page 31 and 32: Table 4.4: Service Improvements in
Page 33 and 34: Delivery of Support4.43 Value for M
Page 35 and 36: YearTable 4.5: Commitments for Capa
Page 37 and 38: instruments themselves. However, TA
Page 39 and 40: and its reluctance to accept TA inp
Page 41 and 42: 6. Conclusions6.1 The Bank’s cont
Page 43 and 44: late. TA staff can perform several
Page 45 and 46: Annex A: List of IntervieweesGovern
Page 47 and 48: Annex B: Documents and Projects Rev
Page 49 and 50: ProjectRSDP SupportProjectEconomicR
Page 51 and 52: ProjectEDUCATIONSeventhEducationPro
Page 53: ProjectESDP IICapacityBuildingCateg
Page 57 and 58: ProjectCapacityBuildingCategoryObje
Page 59 and 60: ProjectCapacity BuildingCategoryObj
Page 61 and 62: Project Details Timing Institutions
Page 63: Annex E: OED Ratings on Completed P
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