Bolivia - Integrated Child Development Project

Document of The World Bank FOR OFFICIAL USE ONLY Report No. 11905-BO STAFF APPRAISAL REPORT BOLIVIA INTEGRATED CHILD DEVELOPMENT PROJECT JUNE 7, 1993 Country Department III Human Resources Operations Division Latin America and the Caribbean Region This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization.  CURRENCY EQUIVALENTS Currency Unit = Boliviano (Bs) Bs 1.00 = US$0.25 US$1.00 = Bs 4.0 FISCAL YEAR January 1 - December 31  FOR OFFICIAL USE ONLY PRINCIPAL ABBREVIATIONS AND ACRONYMS USED CONAPSO Consejo Nacional de Politica Social (National Social Policy Council) DHS Demographic and Health Survey EC European Community EIH Encuesta Integrada de Hogares (Integrated Household Survey) EMSO Economic Management Strengthening Operation ESF Fondo de Emergencia Social (Emergency Social Fund) ETARE Equipo Tecnico de Apoyo a la Reforma Educativa (Technical Team for Education Reform) IHDP Integrated Health Development Project INE Instituto Nacional de Estadfsticas (National Institute of Statistics) JNSDS Junta Nacional de Solidaridad y Desarrollo Social (National Agency for Solidarity and Social Development) MEC Ministerio de Educaci6n y Cultura (Ministry of Education and Culture) MPC Ministerio de Planeamiento y Coordinaci6n (Ministry of Planning and Coordination) MPSSP Ministerio de Previsi6n Social y Salud Publica (Ministry of Social Assistance and Public Health) NGO Non-Governmental Organization ONAMFA Organismo Nacional del Menor, Mujer y Familia (National Organization of Minors, Women and Family) PIDI Proyecto Integral de Desarrollo Infantil (Integrated Child Development Project) SAFCO Sistema Integrado de Administraci6n Financiera y Control (National Law for an Integrated System of Financial Administration and Control) SIP Social Investment Fund SIG Sistema Informaci6n Gerencial (Management Information System) SSS Social Strategy Statement SVEN Sistema de Vigilancia Epidemiol6gica Nacional (National System of Epidemiological Surveillance) UDAPSO Unidad de Analisis de Polftica Social (Social Policy Analysis Unit) UNDP United Nations Development Programme UNICEF United Nations Children's Fund USAID United States Agency for International Development WFP World Food Programme This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization.   - DHi - BOLIVIA INTEGRATED CHILD DEVELOPMENT PROJECT STAFF APPRAISAL REPORT Table of Contents Page No. BASIC DATA SHEET ....... .................... vi CREDIT AND PROJECT SUMMARY .................x i 1. BACKGROUND ....... .................... 1 2. SECTORAL CONTEXT ............ 1 A. The Status of Women and Children in Social Development ....... .................... 1 B. Food Aid ......... .................... 3 C. The Institutional Setting ................... 3 3. SECTOR ISSUES AND GOVERNMENT STRATGY.... 6 A. Issues. 6 B. Govenment Sectoml Policy .10 4. ASSISTANCE STRATEGY FOR THE SECTOR ....... 11 A. Bank's Role and Strategy .................... 11 B. IDA Experience and Lessons Leamed .... ........ 12 5. THE PROJECT ............................ 15 A. Project Objectives and Concept ................ 15 B. Scope and Target Population .................. 16 C. Detailed Project Description .................. 18 This report is based on the findings of preparation missions which visited Bolivia in September and November 1992, and January 1993, led by Mr. Xavier Coil (LA4HR) and consisting of Messrs./Mmes. Jacques van der Giag, Nuria Homedes (LA3HR), Julie Van Domelen (LA4HR), Alan Berg (PHN), Jean Paul Faguet (Resident Mission), Angel Gonzalez- Malaxechovurrfa (LATPS) and Robert Myers (Consultant). An appraial mission visited Bolivia in May 1993, consisting of Messrs./Mmes. Xavier Coil (mission leader, LA4HR), Karen Lashman (LA3HR), Jean Paul Faguet (Resident Mission) and Robert Myers (Consultant). Support for report preparation was provided by Mmes. Maria Victoria Lister and Neily Vergara. The local preparation team, headed by Maria Gil de Liebers (Executive Director of ONAMFA) received valuable support in the preparation of the project proposl from Dr. Fernando Vfo, Mr. Santiapo Friedmann, Ms. Judith Evans, and a team from the Instituto Colombiano de Bienestar Familiar (ICBF) composed of Mmes. Ruth Patino, Teresa Medina, Raquel Diaz Ortiz and Francia Restrepo. Peor reviewers are Messrs. Alan D. Berg (PHN) and Laurence Wolff (MNIPH). Messrs. Jacques van der Gaag and Yoshiski Abe were, respectively, the managing Division Chief and Department Director.  - iv - Page No. 6. PROJECT COST AND FINANCING PLAN ... ....... 31 A. Project Costs . ......................... 31 B. Recurrent Costs and Project Sustainability .... ..... 32 C. Financing Plan ........ .................. 33 7. PROJECT IMPLEMENTATION ....... .......... 34 A. Project Management and Coordination .... ........ 34 B. Institutional Arrangements ..... .............. 36 C. Implementation Schedule ...... .............. 36 D. Procurement ......... .................. 37 E. Disbursements and Accounts ..... ............. 39 F. Financial Management, Accounting and Audits ... ... 40 G. Project Monitoring, Evaluation and Supervision ... ... 41 H. Environmental Impact ...... ................ 42 8. EXPECTED BENEFITS AND RISKS ..... ......... 42 A. Benefits .............................. 42 B. Risks ................................ 42 9. AGREEMENTS REACHED AND RECOMMENDATION .43 ANNEXES Annex 1: Organizational Structure of ONAMFA Annex 2: Project Coverage Objectives Annex 3: Sector Policy and Management Strengthening Component (Matrix of Objectives, Outputs and Costs and Timeline) Annex 4: The Bolivian Civil Service Reform Program and ONAMFA Positions to be Financed under the Credit Annex 5: Home Rehabilitation Component Annex 6: Management Information System and Impact Evaluation System  Annex 7: Detailed Project Cost Summary and Financing Plan by Year Annex 8: Supreme Decree No. 23415 (March 5, 1993) Annex 9: Organizational Stnrcture of the Integrated Child Development Project Annex 10: Studies to be Carried Out by ONAMFA Annex 11: Implementation Schedule Annex 12: Disbursement Forecast and Disbursement Allocations Annex 13: Supervision Schedule and Implementation Indicators Annex 14: Selected Documents and Data Available in the Project File MAP: IBRD No. 24922   - vu . BOLIA INTEGRATED CHILD DEVELOAMENT PROJECT Basi Dab S DATA YEAR SOURCE A. GENERAL COUNTRY DATA: 1. Total Area (Sq. Km.) 1,099 1992 WDR 2. Total Population (Millions) 7.2 Mid- WDR 1990 3. Urban Population as % of Totdal 51 1990 WDR 4. Pulation in Capital City a a % of Urban 34 1990 WDR as % of Total 17 1990 WDR S. Overall Incidonce of Urban Poverty (%) 55 1990 IHS 6. Women's Paricipation in the Labor Force, Primarily in thebnformal Sector (%) 44 1986 DHS of wbich Employmeat in Marginal Urban Ares 80 1986 DHS (%) 7. GNP per Capita (USS) 652 1991 UEM B. POPULATION DATA 1. Cnrde Birth Rate (Per 1000 Populaon) 36 1990 WDR 2. Cfude Deaih Rate (Per 1000 Populaon) 10 1990 WDR 3. Total Friy Rate (Births per Womn) 4.8 1990 WDR 4. Women of Chilbeaing Age " % of All 47 1990 WDR Women S. Coruacpve Pvalence (% of Women 15-49) 18 1988 WDR 6. Wome's Risk of Dying of Pregnancy Associated Cases (S) 10 1988 DHS 7. Averag Annual Population Growth 2.5 1990 WDR 1989-2000 (%) S. Population Age Strcturm (S of Total) 14 and under 42.5 1990 WDR 15-64 54.1 1990 WDR C. HEALTH DATA 1. Life Expecn at Birth (Yea) Overa 60 1990 WDR Female 62 1990 WDR Male S8 1990 WDR 2. Infant Mortality Rate (Per 1000 Live Birds) 96 1988 DHS 3. Maen Motlity Rate (per 100,000 Live Birbas) 480 1980 WDR 4. Under-S Motality Rate (per 1000 Live Births) Female 109 1990 WDR Male 127 1990 WDR  - viii - BOLIVIA INTEGRATED CHILD DEVELOPMENT PROJECT Basic Data Sheet DATA YEAR SOURCE 5. Population per Physician 1,530 1984 WDR 6. Population per Nurse 2,470 1984 WDR 7. Birth Attended by Health Staff (X) 36 1985 WDR 8. Babies with Low Birth Weight (%) 15 1985 WDR 9. Total Health Expenditures as Share of Total Public Expenditures (%) 2,3 1990 WDR D. NUTRITION DATA 1. Daily Calorie Supply (Per Capita) 1,916 1989 WDR 2. Children between 3 months and 3 years age group Underweight (%) 13 1988 DHS Stunted (%) 38 1988 DHS E. EDUCATION DATA 1. Total Adult Illitercy Rate (%) 23 1990 WDR of which Female 29 1990 WDR 2. Total Primary School Enrollment (%) 81 1989 WDR of which Female (%) 77 1989 WDR 3. Primry Pupil Teacher Ratio 25 1989 WDR 4. Total Secondary School Enrollment (%) 34 1989 WDR of which Female (%) 15 1989 WDR 5. Total Tertiary Education Enrollment (%) 23 1989 WDR 6. TotAl Education Expenditures as Share of Total Public Expenditurs (%) 18 1990 WDR SOURCES: World Development Report (WDR), World Bank, 1992; Integrated Household Survey (IHS), Bolivia, 1990; Demographic and Health Surveys (DHS), Bolivia, 1989; Updating Economnic Memorandum (UEM), World Bank, 1992.  - ix - BOLIVIA INTEGRATED CHILD DEVELOPMENT PROJECT STAFF APPRAISAL REPORT CREDIT AND PROJECT SUMMARY Borrower: The Republic of Bolivia Beneficiary: Organismo Nacional del Menor, Mujer y Familia (ONAMFA) Credit Amount: SDR 35.8 million, or US$50.7 million equivalent Terms: Standard IDA terms, with 40 years maturity Project Objectives: The proposed project supports the Social Strategy Statement (SSS) of the Government of Bolivia (GOB) and its Ten-Year Action Plan for Children and Women. It seeks to contribute toward poverty alleviation and human capital development objectives by supporting the initiation of the Proyecto Integral de Desarrollo Infantil (PIDI), thus expanding coverage and improving quality of child development programs in poor urban and peri-urban areas of the 34 largest cities. The specific objectives of the proposed project are to: (a) improve children's readiness to succeed in school and beyond by facilitating their physical, emotional, social and cognitive development; (b) enhance the status of women by increasing their employment opportunities, and expanding their knowledge of education, health and nutrition; and (c) increase community and private sector participation in the social development process. An associated objective of the project is to assist the GOB to strengthen its capacity to formulate and evaluate social policy. Project Description: The project comprises three main components: (1) The Sector Policy Development and Management Strengthening component (US$4.0 million equivalent) would enhance the public sector's capacity to formulate and evaluate social policy by supporting: (a) studies and technical assistance to permit the broadening of policy foundations in the areas of food security and nutrition, refinement of measures of child development, and extension of integrated child development services to rural areas, including financing for pilot projects; and (b) consolidation of ONAMFA's recent modernization efforts and its incorporation into the Civil Service Reform Program (CSRP). Funding would be provided for technical assistance; incremental salaries for 33 key ONAMFA positions to be brought under the CSRP (on a declining basis); and computer and office equipment, and training. (2) The Service Delivery Support component (US$133.6 million equivalent) would support the delivery of integrated child development services to poor children 6 months to 6 years of age by placing in operation over the project life some 8,600 non-formal, home-based day-care centers, each of which would provide integrated services to about 15 children by two to three caregivers  (depending on the age-mix of the children) who would be selected from the community. Caregivers would receive a monthly stipend for their services (roughly equivalent to a minimum salary) and beneficiaries would contribute a monthly user charge. Communities to participate in the project would be selected on the basis of poverty maps, and the children within them on the basis of distinct household socioeconomic criteria, with highest priority assigned to malnourished children. The component specifically would: (a) further develop and strengthen the project's operational structure at the central and regional levels; (b) refine mechanisms for targeting beneficiaries and selecting caregivers; (c) provide initial and in-service training to caregivers to respond to early education, nutrition and health service needs of the children; (d) promote the formation and build the capacity of parents' associations to assist in project administration; (e) finance, via a mixed grant-loan, the rehabilitation of those caregivers' homes which are to serve as day-care sites; (f) directly provide children with nutrition supplementation and a basic package of integrated early education services and, through cooperative agreements with local (public or private) referral health centers, ensure their access to key preventive and curative health services; and (g) for pregnant women who are caregivers or have children participating in the project, secure preferential user fees for services, thus increasing their access to appropriate maternity care, family planning education and services, and health and nutrition services. To these ends, the proposed project would finance furniture, equipment and supplies for the day-care centers; home rehabilitation; technical assistance; caregivers' stipends (on a declining basis), training and supervision; vehicles, equipment and supplies for project administration; a health fund (on a declining basis) to help finance diagnostic and treatment services for malnourished children from extremely poor families; food commodities (not IDA financed); and salaries of incremental positions for national and regional project teams (on a declining basis). (3) The Monitoring and Evaluation component (US$2.6 million equivalent) would support close project performance monitoring and impact evaluation by developing and implementing: (a) a management information system to monitor timeliness in achieving coverage targets and quality of services delivered; and the overall soundness of project administration and financing; and (b) an impact evaluation system, based on data generated from the Integrated Household Survey (EIH) and special modules on health, nutrition and child development status, and the conduct of special longitudinal studies and sociological surveys. The project would finance requisite technical assistance and computers and equipment for the operation of these systems. Project Benefits: By the end of the proposed project life, an installed capacity of some 8,600 day- care centers would exist to annually provide non-formal, home-based, integrated child development services to 130,000 of the country's poorest pre-school children, 6 months to 6 years of age; and cumulatively, by project end, given anticipated promotions of six year olds, more than 200,000 children are expected to have benefitted. Women also would be direct beneficiaries through project contributions to expanding employment opportunities (employing caregivers  - xi - and, via access to day-care, enabling mothers of participating children to work) and improving their knowledge of education, health and nutrition. Specifically, by its completion, the project would have trained and employed some 21,000 caregivers, most of whom are expected to be women. Approximately 8,600 of these caregivers also would benefit from access to credit to upgrade their homes and, via direct beneficiary contributions, assistance in the payment of basic utility bills to help offset the cost of using their homes for day-care centers. Significant improvements also are expected in the health and nutritional status of an estimated 16,000 pregnant women who either have children participating in the project, or are caregivers, as project-secured preferential user fees would increase utilization of pre- and post-natal care, safe deliveries, and family planning, and health and nutrition education and services. An additional benefit would be the GOB's strengthened ability to formulate and evaluate social policy, particularly in early childhood development, and food and nutrition. Project Risks: Principal risks relate to: (a) the possibility that the extensive project implementation demands might outstrip ONAMFA's managerial and administrative capacities; (b) uncertainties over the continuity of the GOB's initial commitment to absorb fully project-generated recurrent costs over the project life, crucial to its sustainability; and (c) the danger that desired improvements in children's nutritional status will not be achieved because of failure to maintain adequate dietary intake at the household level. With regard to (a), this risk should be minimized by: direct project support for ONAMFA's modernization initiative; ONAMFA's planned full incorporation into the CSRP, thus facilitating recruitment and retention of high quality staff; anticipated active assistance of NGOs and community groups in project implementation; project-supported contracting of external supervision staff to permit ONAMFA's close, continuous oversight of day-care activities; a very conservative implementation timetable, based on moderate increases in coverage objectives during the first half of the project, and annual and mid-term project reviews to assess implementation progress and adjust the pace and scope of implementation, as needed. With regard to (b), the GOB has committed itself to a solid financing plan and to gradually assuming recurrent costs on a clearly specified annual basis, including those generated by the CSRP. To help ensure continuing commitment to this plan, the GOB will review annually with IDA an updated financial plan for the successive three years of project implementation. In addition, the GOB will review with IDA at the project's Mid-Term Review its overall social sector investment plan to ensure that adequate provision is made for project financing. The issuance of the March 1993 Supreme Decree committing counterpart resources to the project also should minimize this risk. And with regard to (c), intensive health and nutrition education activities targeted toward parents of children participating in the project seek to minimize this risk.   BOLIVIA INTEGRATED CHILD DEVELOPNENT PROJECT 1. BACKGROUND 1.1 The economic policy, adopted by the Government of Bolivia in 1985, has been highly successful in stabilizing the economy and in reducing internal and external imbalances. As a result of the adjustment program, the public sector deficit was lowered and inflation was brought under control. For the first time in nearly a decade, the economy attained a positive Gross Domestic Product (GDP) growth rate of 2.6 percent in 1987, and continuous prudent macroeconomic management permitted the recovery to be sustained with steady annual GDP growth of 2.7 percent on average through 1990. During 1991 and 1992, the economic situation continued to improve, with GDP growth of 4.1 percent and 3.8 percent, respectively. 1.2 Despite good economic management in recent years, Bolivia aces a difficult set of development challenges. Per capita Gross National Product (GNP) of US$652 (1991) is among the lowest in Latin America, and the economic situation remains fragile. Moreover, the major macroeconomic adjustments of the last decade have not been accompanied by corresponding reductions in the levels of poverty or improvements in social indicators. Distribution of the economic and social benefits of growth remains highly skewed. While the 1976 census indicated that 80 percent of all households were poor, data from the 1990 Integrated Household Survey (EIH) revealed an overall incidence of urban poverty of approximately 55 percent, with an even worse situation in certain cities, such as El Alto and Potosf, where 70 percent of the households are deemed poor. Preliminary data from the 1992 census suggest that severe poverty remains pervasive. Key social indicators are among the worst in the Region, with about one-quarter of the adult population illiterate, and life expectancy at birth of only 60 years (1990), or below the average for lower middle-income economies. 2. SECTORAL CONTEXT A. The Status of Women and Children in Social Development 2.1 Women and young children are disproportionately represented among the poor and face especially difficult circumstances. Women are twice as likely to be illiterate as men, have limited access to child care, face discrimination in hiring practices and in wage determination, have virtually no access to credit from official or formal financial institutions, and are restricted by law from engaging in some productive activities. With  increased migration to cities, women's participation in the labor force rose from 27 percent in 1976 to 44 percent in 1989. This employment is primarily in the informal sector (representing over 80 percent of female jobs in marginal urban areas). While most women are forced to work to help support their families, social norms dictate that they remain the principal caretakers of their children. The difficulty of maintaining this dual role is exacerbated in urban areas where extended family arrangements typical of rural areas are not prevalent. Given limited access to day-care, many women must either leave their children alone at home or opt for relatively low paying jobs where their children can accompany them. As a result, both women and children suffer. 2.2 Maternal mortality rates are excessive. According to recent estimates, a woman's lifetime risk of dying of pregnancy-associated causes is 10 percent. Poor women rarely have access to health care and their utilization of services is low: 53 percent of women receive no prenatal or postnatal care, and only about 40 percent deliver in health facilities. High fertility is one of the principal contributing causes to poor health status of both women and infants. In 1990, the total fertility rate was estimated at 4.8 children. Modem contraceptive methods are used by only 18 percent of women of reproductive age, and abortion (induced or spontaneous) accounts for more than one-fourth of all maternal deaths. 2.3 Infants and young children are exceptionally vulnerable to illness and death. No reliable data on infant mortality exist. Recent estimates range from 96 per 1000 live births, based on a Demographic and Health Survey (DHS) carried out in 1988, to 102 per 1,000 live births according to data from the public health system--among the highest infant mortality rates in Latin America. Importantly, large differentials in health status persist across income groups. Health risks, already high because of the pathogenic environment in which much of the population live, are compounded by the limited coverage of preventive health services. For example, just 7 percent of infants have completed the full vaccination regimen by the end of the first year of life, and only 19 percent of children between 12 and 23 months of age are fully immunized. 2.4 Malnutrition is pervasive, contributing to excessive morbidity and mortality. According to the DHS, 13 percent of children in the 3 months to 3 years age group are underweight (i.e., low weight-for-age) and 38 percent are stunted (i.e., short height-for-age), reflecting chronic malnutrition. Data suggest that much of the nutritional deterioration occurs after the first 6 months of age, coinciding with the weaning period when breastfeeding should be supplemented by solid foods to meet nutritional needs. Both the extent of malnutrition and its distribution among different degrees remained fairly constant over the 1988-1991 period, despite substantial food aid and increases in commodity assistance. This strongly suggests that such aid has not been adequately targeted to the highest risk groups.  B. Food Aid 2.5 Food aid has become an integral part of Bolivia's social development programs. According to Government estimates, such external assistance slightly exceeds total national health expenditures and represents three times the Treasury's annual budgetary support to the Ministry of Social Assistance and Public Health (MPSSP). In 1992 alone, food aid was on the order of 300,000 metric tons, with a value of about US$116 million. The United States, the World Food Programme (WVFP), the European Community (EC), Canada, Spain, France, Holland and Argentina are the major sources of food assistance. U.S. food aid for Bolivia has increased strikingly over the past two years, from US$40.9 million in 1991 to US$97.9 million in 1992, currently representing 83 percent of all commodity aid. It is channeled by the U.S. Agency for International Development (USAID) via two main programs. Title U provides food and/or money (from the monetization of food) to some 1.6 million poor through NGO-administered programs including school feeding (48 percent), mothers' clubs (20 percent), food-for- work (17 percent), pre-school milk centers (12 percent), with the balance in clinic-based food supplementation programs and assorted other programs. The second conduit of U.S. food aid, the Title III program, supports broad food security objectives via use of policy conditionality and local currency programming, to finance food imports. 2.6 Administration of such substantial inflows of food aid presents numerous challenges, from its adequate transportation, storage and distribution, and local financing thereof, to prevention of spoilage, and diversion. To date, in depth evaluations of the effectiveness of targeting and overall impact of food aid have been generally lacking. The proposed project seeks to provide a coherent framework for targeting food aid to the neediest subgroups, through both the formulation of a national food and nutrition policy, and the rechannelling of a substantial share of existing food aid to children participating in child development activities. C. The Institutional Setting 2.7 In 1971, the Junta Naional de Desarrollo Social (JNSDS) was created as an autonomous agency to provide protection and social assistance to children and the elderly, particularly those from the most vulnerable socioeconomic groups. Presided over by the spouse of the President of the Republic, children's services provided by JNSDS (since March 1993, the Organismo Nacional del Menor, Mujer y Familia--ONAMFA) have included: health care, nutrition supplementation, provision of clothing and housing, legal advice, psychological counseling, training, and care for the disabled. Its family- and community-based programs have encompassed community kitchens, multi-purpose clinics, family legal assistance, training in productive  - 4 - activities, community greenhouses, provision of day care, shelter for abused women, and assistance programs for the elderly. The agency's service delivery network includes 109 children's homes, 20 homes for the elderly, 9 health clinics, 14 family legal centers, and 22 day-care centers. As part of its mandate, JNSDS/ONAMFA also has been overseeing the inplementation of laws pertaining to children, including adoptions, evaluations to determine custody of children, matters pertaining to social problems and abuse, and legal infractions committed by minors. 2.8 To carry out these programs, the agency employs a staff of approximately 1,200 distributed between its central and 9 regional and 74 sub-regional offices. Its organizational structure is highly decentralized. Less than 10 percent of its personnel are located in its central headquarters. Fifty-six percent of its staff are involved in direct service delivery, including doctors, nurses and educators assigned to health clinics, multi-purpose centers, and homes for children and the elderly. In the past, the ability of the institution to effectively manage its programs was limited by a lack of technical and administrative capacity, by an emphasis on charity over sustainable social programs, and by a dearth of leadership. This situation reduced its ability to attract internal and external resources and led to a deterioration in the quality of service provision. 2.9 The Restructuring of the JNSDS. In 1989, subsequent to a comprehensive institutional analysis, JNSDS initiated a major restructuring program designed to increase efficiency, attract external resources, and focus more effectively on the needs of vulnerable groups. The principal elements of this restructuring include: (a) modernization of its organizational structure, reducing the number of departments and divisions, and streamlining its personnel complement; (b) implementation of computerized financial and administrative control systems; (c) adoption of personnel policies to improve the quality and distribution of staff; (d) a programmatic shift to community-based preventive programs; and (e) increased cooperation with non-governmental organizations (NGOs) and community groups, and relatedly a reduced role in the direct management of facilities. 2.10 As part of its reorganization, with UNICEF support, JNSDS adopted a revised administrative and financial structure. Revisions were made in key systems including accounting, budgeting, inventory, warehouses, asset control, and personnel to comply with the new national law requiring an Integrated System of Financial Administration and Control (the SAFCO Law). Computerization of these systems at the central and regional levels has resulted in substantial gains in transparency and efficiency. Notably, budget execution increased from 73 percent in 1988 to 95 percent in 1991. In addition, JNSDS's improved image and financial control systems helped mobilize US$9 million in external resources over the 1990/1991 period. Improvements notwithstanding, administrative capacity remains weak, particularly in its smaller regional offices. Future efforts to consolidate ONAMFA's progress in strengthening its administrative systems must focus  - 5 - on the full implementation of these systems at the regional level, including recruitment and training of administrative and financial personnel. 2.11 During the restructuring process, JNSDS adopted policies to improve the quality and distribution of its staff. The number of personnel was reduced from 1,548 to 1,200 while, concomitantly, better trained technical staff were recruited at higher salaries. A cornerstone of its revised personnel policy is the agency's incorporation into the initial phase of the Civil Service Reform Program (CSRP). This program, executed through the Ministry of Finance, seeks to create a stable and high quality core of civil servants through staffing of key positions at competitive salary levels to be selected through a transparent, merit-based process. To qualify, a public agency must satisfy a number of prerequisites, including having comprehensive operational manuals, computerized administrative systems, and detailed job descriptions, including qualifications. JNSDS/ONAMFA was among the first agencies to meet these prerequisites (para. 3.4). 2.12 JNSDS/ONAMFA also reoriented its programmatic goals to place greater emphasis on community level preventive services. To this end, JNSDS has entered into management service contracts with local and international NGOs for the administration of its shelters for orphans, abandoned children and the elderly. By the end of 1992, over 80 percent of its homes for children and the aged had been delegated to NGO administration. This arrangement has leveraged additional resources from NGOs and improved the management of facilities. 2.13 The centerpiece of JNSDS' restructuring has been the drafting of the Minor's Law (C6digo del Menor), approved by Congress in December 1992. This law redefines the nature of the JNSDS and its operations under a new name, the Organismo Nacional del Menor, Mujer y Familia (National Agency for Minors, Women and the Family--ONAMFA). ONAMFA's new organizational structure at the central and regional levels is presented in Annex 1. The law sets overall policy on issues pertaining to children and the family (e.g., the rights of minors, judicial processes applicable to minors, adoption procedures, and conditions by which NGOs may provide social assistance services). ONAMFA remains an autonomous agency under the Presidency, but will not necessarily be managed by the First Lady. The law further stipulates that the President of ONAMFA will be appointed by the President of the Republic from a list of three candidates approved by a two- thirds majority of Congress. 2.14 ONAMFA will be managed by a Board of Directors comprised of nine members, including: (a) four representatives from government ministries; (b) one representative from the Bolivian Workers' Union (COB); (c) two representatives from NGOs; and (d) ONAMFA's President and Executive Director (the latter of whom has a voice but no voting power). The Board of Directors will set overall policies and strategies, review the annual work plan and budget, approve intemal regulations and appoint the  -6 - executive Director. ONAMFA's clout and capacity to guide social policy formulation has been strengthened by its recent incorporation into the National Social Policy Council (CONAPSO). 2.15 Following the adoption of the Minor's Law, a Decreto Reglamentario was approved in March 1993 which further defines ONAMFA's administrative and operational regulations as well as the intemal structure and functions of its central and regional levels. The approval of the Decreto Reglamentario constituted a condition of appraisal of the proposed project. 3. SECTOR ISSUES AND GOVERNMENT STRATEGY A. Issues 3.1 Institutional Capacity. Most public institutions in the social sectors face common institutional constraints to meeting poverty alleviation objectives, including: (a) structures characterized by highly centralized decision-making, weak planning and policy making capacity, over-staffing of administrative jobs, low salaries and inadequate personnel training; and (b) inadequate attention to demand-driven programs and, relatedly, beneficiary participation. 3.2 If national programs effectively are to target the most vulnerable groups, institutional capacity to formulate policy and coordinate its implementation is critical. In the past, this capacity has been weak due to several factors: (a) poor communication with and little planning input from regional and local levels; (b) absence of ability or power to coordinate the plethora of donor and NGO interventions; (c) a proliferation of self-contained project implementation units virtually independent from the coordinating ministry, yet carrying out line functions; and (d) a general dearth of sound policy units at the center. The result has been duplication of projects in certain areas and complete absence of intervention in others. Many ministries have become totally ineffective in fulfilling their intended normative role. Sub-national levels of government have little authority or resources to fill the service coverage gap. 3.3 In response to a recognized lack of leadership in formulation of social sector policies, the National Council on Social Policy (CONAPSO) was created in 1989. Chaired by the President of the Republic, it is comprised of the Minister of Planning and Coordination (MPC), and Ministers of Social Assistance and Public Health, Education and Culture, and Labor. In 1992, to provide technical support to CONAPSO, the Government created a Social Policy Analysis Unit (UDAPSO) within the MPC. CONAPSO and UDAPSO are steps in the right direction. Nevertheless, their technical capacity must be strengthened to consolidate policies, analyze information and design priority interventions in the areas of poverty alleviation, education, health  - 7 - and nutrition. Still in its nascent stage, UDAPSO has been well staffed and is beginning to play an influential role. The proposed project would support UDAPSO's objective to develop a comprehensive national food and nutrition policy as well as strengthen its project evaluation capacity. 3.4 Social programs cannot be successful if institutions responsible for delivering services are characterized by inefficiency and inadequate human resources. The public sector long has been a haven for surplus employment of poorly qualified technical staff who in tum receive low basic salaries. Compounding these difficulties are the distortions created by both Government and donor provision of salary supplements and non-salary bonuses. In 1988, in response to a persistent public sector management crisis, and with the assistance of United Nations Development Programme (UNDP) and IDA, the Government prepared a Public Sector Management Strengthening Program. This program aimed at rationalizing the uneven wage structure and creating conditions of stability within the civil service. Institution of the first phase of this program was financed by IDA through an Economic Management Strengthening Operation (EMSO) and resulted in the formulation of the Civil Service Reform Program (CSRP) under the overall management of the Ministry of Finance. Its second phase, delineated in Supreme Decree 2336 approved in November 1992, establishes CSRP's objectives and procedures and provides the framework for the selection into CSRP of govermment agencies and ministries. In January 1993, the Ministry of Finance approved ONAMFA's incorporation into the CSRP. 3.5 The failure of the public sector to carefully listen to social welfare needs, as defined by the communities, and to systematically seek direct participation of community organizations and NGOs, hampers successful implementation of targeted social service programs. Increased efforts must be made to ensure the capacity of local organizations be effectively combined with those of government and community groups. The proposed project actively promotes the creation and strengthening of local community groups, (e.g., parents' associations), and emphasizes their and/or NGOs direct involvement in integrated child development programs, through either assisting ONAMFA in the administration of project activities in a given geographic area, or their participation in discrete project components (e.g., training and supervision). 3.6 The new Minor's Law and the internal restructuring program specifically address the need to enhance ONAMFA's institutional capacity and operational focus, the lack of which have beleaguered its effectiveness in the past. New procedures for appointment of central and regional level managers, pursuant to its incorporation into the CSRP, are expected to help ONAMFA secure more highly qualified technical staff and continuity in key personnel. Nevertheless, ONAMFA's capacity, particularly at the regional level, to administer a large program is untested. Therefore, the project seeks to reinforce its central and regional offices through a management strengthening component.  -8 - 3.7 Service Delivery and Support. Inadequate coverage, low quality and pervasive inefficiencies in the operation of basic social services in many low- income areas can seriously undermine achievement of child development objectives. The paucity of potable water and sanitation services in most of the proposed project areas is a key underlying cause of poor overall health status, increasing the incidence of diarrheal diseases and, thus, contributing to malnutrition. At any given time, some 30 percent of children under the age of five suffer from diarrhea, mainly related to poor water quality. In addition, health outreach services in most poor urban and peri-urban areas are either absent or non-functional. Not only are preventive services limited in scope and coverage, but their impact is limited due to often ill-conceived cost recovery policies, poor definition and execution of priority interventions, and excessive dependence on bilateral assistance programs not necessarily coordinated or set within a national social development policy framework. 3.8 The proposed project aims to stimulate the demand for basic social services by: (a) promoting community initiatives to formulate and submit project proposals for water and sanitation services to institutions such as the Social Investment Fund (SIF); (b) establishing criteria for continued beneficiary participation in the project that include full immunization of all children within six months of program enrollment, and securing preferential fees to facilitate utilization of pre- and post-natal care and safe deliveries for all pregnant women with participating children; and (c) signing of formal inter-institutional agreements between ONAMFA and MPSSP (both at the national and the service delivery levels) or with private health institutions that guarantee provision of a basic package of health and related services to project beneficiaries. 3.9 Coverage and Quality of Public Health Services. Even in urban and peri-urban areas where a substantial network of public health facilities exists, service provision is minimal in terms of both quantity and quality. In rural areas, the paucity of access to care is critical. In fact, only about one- third of the total population receives adequate health care. This stems from inadequacies at all stages of programming, from health sector planning and financing to actual delivery and monitoring of services. The public health system also is characterized by inadequate organization, management and coordination. Excessive centralization of the MPSSP has precluded assumption of its intended normative, policy formulation and coordinative role. The lack of firm sector leadership contributes to a fragmentation of responsibilities between the MPSSP, the Bolivian Institute of Social Security and the private sector, including NGOs. 3.10 Given the importance of a well functioning local health system to the optimal operation of integrated child development programs, several steps have been taken to address sectoral weaknesses and, thus, support the proposed project. First, as a corollary to its direct project support, UNICEF has agreed to target its activities to upgrade matemnal/child health services within public health facilities in communities to be served by the project.  -9 - Such upgrading will include provision of essential equipment, pharmaceuticals and supplies (e.g., scales), and training of personnel in primary health care provision. Second, ONAMFA is actively promoting operational alliances with NGOs and community groups to assist and closely monitor operations of local health facilities. Third, where available and appropriate, private health facilities will be contracted by ONAMFA to provide core maternal/child health services to program beneficiaries, building on successful experiences during the project's pilot phase. 3.11 Nutrition Policy and Programs. Despite the extent and severity of malnutrition, Bolivia has neither a national nutrition nor food security policy. Nutrition interventions are generally untargeted and dispersed among a vast number of implementing agencies, have inconsistent and sometimes contradictory objectives, and fail to ensure continuity of services. The Government lacks a focal point to coordinate such programs and, in the absence of an ongoing evaluation system, has only fragmentary knowledge of projects under implementation. Though the amount of food aid is significant, the Government has little control over how this food is used. In addition, minimal attention has been given in the past to the issues of general food consumption and availability. Typically, social sector initiatives (e.g., nutrition surveillance, micronutrient supplementation) and agriculture production have been disconnected. The proposed project would support establishment and consolidation of the Government's capacity to formulate food and nutrition policy, and monitor its implementation. 3.12 Design of Early Child Development Programs. To be effective, design of early child development programs must pay careful attention to several issues. First, programs should precisely target communities and families within them whose children are at high risk of delayed or inadequate development. Attaining the desired impact is directly related to setting strict participation criteria. Second, early childhood development programs require a comprehensive and integrated strategy. Child development encompasses much more than solely cognitive development. It crosses disciplinary and sectomal lines, involving the equally important areas of physical, social and emotional development. Third, experience suggests that family and community participation increases the chances of program impact and sustainability as well as increases overall resources. Since mobilizing such participation requires time, it often conflicts with pressures to rapidly increase coverage. Hence, special attention must be given to securing real participation. Fourth, programs should aspire to deliver high quality interventions. The measure of quality transcends provision of adequate facilities and materials. Indeed, its most important determinant is the quality of field workers in terms of both their selection criteria as well as their day- to-day technical capacity, a product of initial and continuing training, the latter of which is intimately linked to supervision. Fifth, programs should be flexible and adjusted, as necessary, to local conditions and distinct cultural needs. Active participation of NGOs and community groups from the design stage through program implementation and evaluation is a crucial mechanism  - 10 - to guarantee cultural appropriateness and relevance. Sixth, programs should try to reach the largest possible number of children at risk, while taking into account actual implementation capacity and quality objectives. The design of the proposed project systematically has explored and incorporated features to respond to each of these areas. B. Government Sectoral Policy 3.13 The Government's sectoral policy is defined in its Social Strategy Statement (Estrategia Social Boliviana--SSS) of September 1991. Supreme Decree 22964 of November 1991 provides the policy's legal framework. SSS stresses the need to concentrate government action on human capital development by increasing social investment allocations, strengthening the informnation base for social policy decision-making, and increasing efficiency of resource use through sectoral reform, better targeting of policies and programs, and improved coordination with NGOs. The Privatization Law requires that net resources generated from privatization efforts be used for regional social and economic infrastructure projects; and the Government expects that these initiatives will increase substantially the availability of public funds for the social sectors. 3.14 The creation of CONAPSO and UDAPSO has enhanced government capacity to analyze and formulate social policy. UDAPSO is expected to conduct applied policy research in the following areas: health, education, food policy and nutrition, women in development, micro-enterprises, poverty, and social statistics. Based on 1992 Census data, and with technical support from the National Institute of Statistics (INE), UDAPSO now is elaborating a detailed poverty map. 3.15 A technical team attached to the MPC, the Equipo Tecnico de Apoyo a la Reforma Educanva (ETARE), was established in June 1991 to design an education reform proposal to improve the quality and overall efficiency of the education system. The reform directives, which call for a complete institutional re-structuring of the education system, received support in July 1991 of all political parties in the country. 3.16 Following guidelines set forth in the SSS, a Ten-Year Action Plan for Children and Women (Plan Decenal de Acci6n para la Ninez y la Mujer) was elaborated by an inter-ministerial and multidisciplinary team. This operationally-oriented Plan focuses on regional interventions primarily in the areas of health and nutrition, education, water and sanitation, children in difficult circumstances, and women. Among its key programmatic areas are: the National Program for Women, and the Proyecto Integral de Desarrollo Infanhil (Integrated Child Development Project--PIDI). The Government views the implementation of PIDI as a central strategy of the Plan Decenal's objective to enhance the welfare of young children and women.  - I1 - 4. ASSISTANCE STRATEGY FOR THE SECTOR A. Bank's Role and Strategy 4.1 IDA's country assistance strategy focuses on supporting the economic reform program, including the Government's efforts to: streamline the public sector and, concomitantly, strengthen its performance; promote private sector development; enhance aid coordination; and ameliorate poverty by improving the overall coverage and quality of social services. With regard to the latter, highest priority is assigned to building the institutional capacity of the social sectors, and relatedly to alleviating poverty, especially among the most vulnerable subgroups--infants, children and female heads of household--by assisting selective well-targeted interventions. 4.2 In 1990, IDA completed an assessment of the extent of poverty as well as government initiatives in poverty alleviation. The report (8643-BO) examines the macroeconomic policies and their effects on the poor, reviews institutional constraints to poverty alleviation, and assesses the present situation and initiatives in the areas of health, education, agriculture and transportation. Conclusions support the Government's medium- and long- term objectives of defining policies in the social sectors that improve efficiency and remove inequities in spending. In health, the report recommends that priority be given to implementing maternal health and child survival programs and shifting expenditures towards more cost-effective interventions such as immunizations, pre- and post-natal care and safe deliveries, family planning, and nutrition supplementation and education. Other recommendations include addressing institutional constraints through improvements in financial management and staffing. 4.3 IDA has previously extended support for an Emergency Social Fund (ESF), the Social Investment Fund (SIF), and a health project. Since 1990, it also has been supporting preparation of an Education Reform project. In 1986, the Government created the ESF as its primary mechanism for directly improving the condition of the poor and for addressing the deterioration in social conditions stemming from economic adjustment measures. ESF achieved great success by relying on a demand-driven approach and establishing a close cooperative relationship with NGOs and other private groups working at the local level. While some limitations existed in targeting resources to the neediest groups, the ESF proved to be highly successful in providing temporary employment to individuals displaced by the economic crisis and in strengthening the country's social infrastructure. IDA supported the ESF with two credits (1829-BO, of US$10 million equivalent, intended as a pilot project, and 1882-BO of US$27 million equivalent, intended as support for the main phase of ESF operations). ESF was closed in March 1991.  - 12 - 4.4 Drawing on the ESF experience, SIF (supported by Credit 2127-BO) was created in 1990 as an institution capable of attracting and effectively channeling external resources to help address the country's health and education development needs. Rather than adopting ESF's central goal of employment generation, SEF has focused on providing financing for sub- projects aimed at improving the health and education status of the poorest communities. A recent mid-term review of SIF is expected to guide future investments in this area. The Integrated Health Development Project (IHDP), supported by Credit 2092-BO which was approved in 1989, supports MPSSP's institutional development, improved training and distribution of human resources, and the implementation of a comprehensive health care model in the cities of Santa Cruz, Cochabamba, and La Paz/El Alto. It has suffered considerable implementation delays owing both to frequent project management turnover, and more generally to weaknesses in institutional, financial and procurement systems in the public health sector. These problems were addressed in a recent Country Implementation Review, and actions were agreed with Government to ensure recruitment and retention of high quality staff for key project management positions. 4.5 The proposed Education Reform Project would support the Government's objective to restructure and strengthen the education sector. It would provide financing for developing the MEC's capacity to establish policy guidelines; strengthening the qualifications of teachers at the primary and secondary level; preparing the basis for a curriculum reform; and laying the basis for improving access to education for the most disadvantaged groups (i.e., women and rural populations). 4.6 The proposed project is consistent with the IDA country strategy, supports one of the core programs of the Government's Social Strategy Statement, and complements ongoing and planned IDA-supported operations. B. IDA Experience and Lessons Learned 4.7 Overall, project design builds on, and has benefitted extensively from lessons learned in numerous social programs across a wide spectrum of countries in terms of levels of socioeconomic development, and institutional capacity, as captured in four principal sources of information: (a) review of research literature; (b) international context and experiences; (c) Bank-wide education and nutrition sector experience; and (d) early childhood development experiences in Bolivia. 4.8 Review of Research iUterature. In preparation for the recently approved Initial Education Project in Mexico (Loan 3518-ME), a research review was carried out, summarized in a Bank Green Cover Report (No. 10129-ME; February 1992)--The Initial Education Strategy. Early childhood development experiences are also reviewed in an LATBR document (A View  - 13 - from LATHR No.32--Early Childhood Development Programs in Latin America: Towards Definition of an Investment Strategy, August, 1992), and in Report No. EDT69, "The Eleven Who Survive: Toward a Re- Examination of Early Childhood Development Program Options and Costs' (March 1987). These documents underscore that both scientific evidence and previous project experience provide strong evidence for investing in integrated attention to care and development of young children. 4.9 International Experiences and Lessons Leared. In recent years, three intemational events have catalyzed renewed interest and commitments by the intemational donor community and governments to expand access and enhance the quality of early childhood education. First, the Convention on the Rights of the Child was adopted by the United Nations Assembly in November 1989. Second, the World Conference on Education for All, held in March, 1990 in Thailand under the sponsorship of the World Bank, UNDP, the United Nations Education, Scientific and Cultural Organization (UNESCO), placed special emphasis on the expansion of early childhood care and development through family involvement and community interventions, especially for poor and disadvantaged children. Third, the World Summit for Children, held at the United Nations in September 1990, promoted such initiatives. 4.10 Non-formal early childhood development interventions have been a major area of innovation worldwide, especially in Latin America. The most relevant experiences come from: (a) India, Integrated Child Development Services Project, with Bank support (Loan No.3253-IN); (b) Colombia Hogares de Bienestar Infantil, supported by the Bank-financed Community Child Care and Nutrition Project (Loan No.3201-CO); (c) Mexico, Initial Education Project, with Bank support (Loan No.3518-ME); (d) Kenya, Harambees--Let's pull together--movement); (e) Brazil (Creches Comunitarias, or Community Nurseries); (f) the United Kingdom (Playground Movement); and (g) Venezuela (Hogares de Cuidado Diario, or Day-Care Homes). Experience from integrated nutrition projects (e.g., the Tamil Nadu Nutrition Project--Loan No.2158-IN) is also relevant to the design of early childhood development projects. 4.11 Lessons learned from these international experiences include: (a) child development projects are cost-effective, with the costs of the early intervention more than offset by the savings resulting from the reduction in primary school repetition in the first and second grades; (b) non-formal child development approaches appear to focus more effectively on intended target groups, demonstrate a wider spectrum of long-lasting benefits, and are more cost-effective than formal modalities; (c) high supervision ratios are key to project quality and success; (d) sustainability of activities and benefits depends on effective community participation; and (e) effective child development requires the integration of education, health and nutrition services.  - 14 - 4.12 The Hogares de Bienestar Infantil project in Colombia is the closest in purpose and design to the proposed project and has demonstrated that it is feasible to mount an early childhood development project on a large scale (current enrollment figures suggest coverage of some 800,000 children between 2 and 7 years of age). An evaluation of the project was carried out in 1992 and concluded the following. First, the project appears to be reaching the target population. Second, positive effects on beneficiary children are found with respect to the development of gross and fine motor skills, language, social skills and general development, despite a lack of significant effect on nutritional status. Third, the project improved employment opportunities for women. The evaluation estimates that about 25 percent of women (i.e., caregivers and mothers of participating children) changed employment from (mainly) homemaking, domestic service and handicrafts to (mainly) employment as caregivers and work in "commercial" jobs. Finally, the utilization of health services by beneficiaries substantially increased. The lack of effect on nutritional status is associated with problems in ensuring the constant and timely availability of food, and the fact that children do not receive food supplements in the evenings and weekends. The evaluation points out that, if the project were to have achieved better nutritional effects, the psychosocial effects would have been even greater. Some of the evaluation's recommendations relevant to the proposed project are that: (a) food availability needs to be constant and timely, educators should be trained to identify malnourished children and supplement their food intake, and malnutrition-related infections have to be diagnosed and treated; and (b) it is insufficient solely to sign agreements with the health sector to guarantee that a minimum package of services is provided--monitoring and regular follow up is required at the local level to make those agreements operational. 4.13 Early Child Development Experiences in Bolivia. In the past, most early child development programs (with a varied mix of nutrition supplementation, health and early education activities) have been carried out through the MPSSP. The largest program, Asistencia Integral a MN'tos Pre- Escolares de Zonas Deprimidas de Bolivia, was initiated in 1987 with support from the WFP, the United Nations Fund for Children and Families (UNICEF) and the Pan American Health Organization (PAHO). The program's coverage objectives of 95,000 children were never attained; at the end of 1992, less than 20 percent of the target population was covered. 4.14 The program consisted of three service delivery modalities. The Chicolac Children's Centers began as a pilot project in 1985 and expanded between 1987 and 1990 to cover approximately 71,000 children. It focused on delivery of powdered milk and a piece of corn bread to groups of between 50 and 300 children. Parents took turns preparing and distributing food and were to receive training. In 1990, a total of 707 centers were operating in five peri-urban areas covering about 70,000 children. The program was suspended following an evaluation that pointed to a general lack of nutritional and developmental effects due to an insufficient production capacity and spotty delivery of food, and grave deficiencies in the implementation of child development and community participation activities.  - 15 - 4.15 The second modality is Integrated Child Care Centers--based on previous experiments with Guarderfas Infannles Populares (1982-84), and then Centros Infantiles Populares (1984-87). About 136 of these centers with a total enrollment of 6,305 children are in operation in urban marginal areas of five cities. Each center attends between 30 and 90 children who are 8 months to 6 years of age. The staff, which consists of one caretaker per ten children, receives payment in food (donated by WFP). An evaluation of the program has shown that family and community participation is relatively good and, despite problems in attendance, that cognitive development and nutritional status of children have improved. 4.16 The third modality of the program is the Home Child Care Centers, initiated in 1989. This modality involves use of a private home in which 10 or more children are cared for at least five hours daily by two mothers. As with the Integrated Child Care Centers, the caregivers are paid with donated food. These centers are managed through NGOs. In 1992, 1,350 children were being attended by about 230 caregivers in 82 child care homes dispersed across five cities. A 1992 evaluation indicated that attendance was high, but the hours were short, and the conditions and quality of care were minimal. 5. THE PROJECT A. Project Objectives and Concept 5.1 The proposed project supports the Government's Social Strategy Statement and the 10-Year Action Plan for Children and Women. It seeks to contribute toward poverty alleviation and human capital development objectives by supporting the initiation of the Proyecto Integral de Desarrollo Infantil (P11)I) in the 34 largest urban areas, and establishing a basis for development of long-term policies and programs to provide early childhood development services, including in rural areas. The specific objectives are to: (a) improve children's readiness to succeed in school and beyond by facilitating their physical, emotional, social and cognitive development; (b) enhance the status of women by increasing their employment opportunities, and expanding their knowledge of education, health and nutrition; and (c) increase community and private sector participation in the social development process. A secondary objective is to help the Government strengthen its capacity to formulate and evaluate social policy. 5.2 To achieve these objectives, the proposed project reflects a three- pronged strategy, inter alia: (a) support for development of national policies in the areas of early child development, food security and nutrition, while concurrently strengthening ONAMFA's management capacity to fulfil its intended role to help guide social policy formulation; (b) assistance for the delivery of integrated child development services in poor urban and peri- urban areas via a non-formal, home-based day-care center modality; and (c) establishment of an ongoing system for monitoring and evaluating project implementation performance.  - 16 - B. Scope and Target Population 5.3 The proposed project reflects the Government's goal to provide services to the most disadvantaged subgroups. As IDA's poverty assessment underscores, rural areas suffer the most extreme poverty. However, poverty is a pervasive and expanding problem in marginal urban areas. In the inter- censal period 1976 to 1992, the percentage of the population living in urban areas increased from 42 to 58 percent. Rapid growth in major and secondary cities has brought a series of new challenges for delivery of basic social services. For instance, only 35 percent of urban dwellers have sanitation services. It also is estimated that about 140,000 children are malnourished in the country's four major cities alone. Logistic and service delivery problems in the health, nutrition, education, and water and sanitation areas are exacerbated by cultural challenges, as rural and ethnic populations attempt to transfer traditional practices and beliefs to the city. For the most part, these new urban settlers face special problems because of the general loss of support systems, i.e., extended families, that helped care for their families in rural areas. 5.4 Strong financial and operational justifications also exist for concentrating proposed project activities, at least in this initial phase, in poor urban and peri-urban areas. Rural population is highly dispersed, presenting serious logistical problems for expanding access to basic social services, including day-care, early education, and health and nutrition care. The cost of delivering targeted, caregiver home-based child development services to these populations on a massive scale would be extremely high and arguably not culturally/technically appropriate. In contrast, the heavy concentration of the urban poor provides important economies of scale to service delivery. Nevertheless, the project will finance both an in depth analysis of the constraints and potential faced by existing program initiatives to expand such service coverage to rural areas; and based on this analysis, will identify and pilot test promising modalities for delivering integrated child development services in rural areas. 5.5 The proposed project specifically will target poor households in urban and peri-urban areas with populations over 10,000. According to preliminary results of the 1992 census, 34 cities, thus, would qualify for project participation, representing in aggregate 3.3 million persons or about 48 percent of the country's total population (Annex 2, Table 1). The project seeks, by the end of its sixth year, to have attained an installed capacity of 8,670 day-care centers to provide non-formal, home-based, integrated child development services to 130,050 children aged 6 months to 6 years annually, or about 16 percent of all children living in those urban areas. Cumulatively, taking into account expected promotions of six year olds, 203,547 children are expected to have benefitted over the project life (Annex 2, Table 2). Anticipated coverage levels, disaggregated by city, represent about 5, 18 and 47 percent of children at risk at the end of the second, fourth, and sixth years, respectively, of project implementation (Annex 2, Table 3).  - 17 - 5.6 In the selection of cities for phasing-in of the project, priority will be assigned to those with the highest prevalence of malnutrition. The relatively modest coverage targets over the first half of the project respond to the need to ensure the high quality of project content, systematically and thoroughly address evolving implementation issues, strengthen ONAMFA's institutional capacity at the national and regional levels, and refine logistical mechanisms, with special attention to the timely flow of critical program inputs, including food. Experiences from similar child development projects indicate that to ensure quality and the ultimate success of the project, expansion of coverage should occur slowly in the start-up phase, and then accelerate once administrative procedures have been tested and are fully operational. 5.7 Women also would be direct beneficiaries. The project would contribute to enhancement of women's status by increasing their employment opportunities through taining and participation of caregivers, and expanding access to day-care for mothers, and by improving their knowledge of education, health and nutrition. Further, by expanding substantially access to day-care, the project would free women's time to seek work or to improve their jobs. The overall health and nutritional status of women also is likely to improve for an estimated 16,057 pregnant women (based on present fertility rates) who either are caregivers or have children participating in day- care centers, as project-secured access to preferential user fees increases utilization of pre- and post-natal care, safe deliveries, and family planning and health and nutrition education and services (Annex 2, Table 4). By project completion, the proposed project would have trained and provided employment to an estimated 20,808 caregivers (most of whom are expected to be women) who would receive a monthly stipend equivalent to the minimum salary (Annex 2, Table 2). Approximately 8,600 of these caregivers also would benefit from other complementary project inputs, including access to credit to upgrade their homes and, via direct beneficiary contributions, assistance in the payment of basic utility bills, i.e., electricity and water, to help offset the costs associated with using their homes for day- care centers. 5.8 The planned inter-city distribution of day-care homes according to the extent of malnutrition provides only one, albeit important measure to ensure that project benefits are targeted to the most vulnerable groups. Complementary targeting mechanisms include: (a) a geographical selection of urban and peri-urban neighborhoods for program sites based on poverty mapping; and (b) and child-specific selection criteria for such neighborhoods (para. 5.18). 5.9 Given wide variations in poverty levels within urban centers, the project would disaggregate cities by poverty zones. During the first year of project execution, targeting would be based on SIF's "Urban Prioritization 1991" which defines four levels of poverty area based on service delivery indicators (i.e., coverage levels of water supply, sanitation and electricity), complemented with malnutrition prevalence data from the National System of Epidemiological Surveillance (SVEN). To refine the targeting of priority neighborhoods, utilizing 1992 census data, UDAPSO will develop updated  - 18 - poverty maps of all urban areas, disaggregated by census zones (comprising approximately 1,000-2,000 homes per zone). These poverty maps are expected to be finalized by the end of 1993. C. Detailed Project Description 5.10 The proposed project consists of the following components: (a) Sector Policy Development and Management Strengthening: enhance the public sector's capacity to formulate and evaluate social sector policy by supporting: (a) studies and technical assistance to permit the broadening of policy foundations in the areas of food security and nutrition, and refinement of measures of child development, and extension of integrated child development services to rural areas, including financing for pilot projects; and (b) consolidation of ONAMFA's recent restructuring efforts and its incorporation into the CSRP. (b) Service Delivery Support: support the delivery of integrated child development services in poor urban and peri-urban areas by implementing a non-formal early child development model in 34 cities, providing care through some 8,600 home-based day-care centers to about 15 children per center by two to three caregivers (depending on the age-mix of beneficiaries) selected from the local community. To this end, building on a successful pilot project experience, the project would: (a) further develop and strengthen the project's operational structure; (b) refine mechanisms for targeting of beneficiaries and selection of caregivers; (c) provide initial and in-service training to caregivers to enable them to respond to early education, nutrition, and health needs of the children; (d) promote the formation and build the capacity of parents' associations to assume select administrative functions within the program; (e) on a mixed loan-grant basis, finance the rehabilitation of the caregiver's home to serve as the actual day-care site; (f) directly provide children with nutrition supplementation and a basic package of integrated early education services, and through cooperative agreements with local health centers, ensure their access to key preventive and curative health services; and (g) for pregnant women who either are caregivers or have children participating in the project, secure preferential fees for service, thus, increasing their access to maternity care and family planning services, and health and nutrition education and services.  - 19 - (c) Monitoring and Evaluation: support close project performance monitoring and impact evaluation by developing and implementing: (a) a management information system to monitor timeliness in meeting programmed targets, and the overall technical quality, administration and financing of operations under the project; and (b) an impact evaluation system, to include addition of special modules to the Integrated Household Survey (EIH), and the conduct of special longitudinal studies and sociological surveys. Sector Policy Development and Management Strengthening Component (proposed outlay, US$4.0 million equivalent, including contingencies) 5.11 Sector Policy Development. The project would assist the Government in the formulation of sound policies and programs to enhance the welfare of disadvantaged children, women and their families. Specifically, the project would help broaden policy foundations in the areas of food security and nutrition, extend early child development services to rural areas, and refine measures to assess child development. To this effect, the project would finance studies supported by about 25 person-months of technical assistance, and select operating costs for conduct of pilot projects to test alternative delivery models, which activities would be concentrated in the first three years of the project. It is expected that, on the basis of the studies' recommendations, the Government would: (a) establish a focal point to coordinate food security and nutrition interventions, rationalize food aid and better integrate agriculture production and social sector programs; (b) develop and test a delivery model for the extension of early childhood development activities to rural areas; and (c) refine child development measures. 5.12 Management Strengthening. This sub-component focuses on two discrete but related activities. First, it would further efforts to modernize ONAMFA's administration and operations. Second, it would support ONAMFA's incorporation into the CSRP. 5.13 Since JNSDS/ONAMFA initiated its restructuring in 1989, significant strides have been made in improving the efficiency and transparency of its operations. Building on experience to date, the project would seek to consolidate the modernization process. The project would support the strengthening of ONAMFA's administrative and financial operations in the following areas: accounting, personnel management, budgeting, asset/inventory control, warehouse management and procurement.  - 20 - 5.14 To this end, the project would finance: (a) technical assistance (36 person-months concentrated in the first three years of the project) to support and oversee the modernization process. The consultant would work directly with ONAMFA's Executive Director and the chief administrative and financial officers at the central and regional levels; (b) the implementation of information systems, involving (i) the installation of computer equipment in each regional office and in the main administrative sections of the central office; (ii) training in systems operation for an estimated 170 staff; and (iii) technical assistance (4 person-months/year) to assist in the implementation of these systems and to introduce design modifications, as needed; (c) a mid-term technical and administrative evaluation of ONAMFA to assess progress in its modernization process and provide recommendations for further improvements (involving about 15 person-months of technical assistance); and (d) a mid-term evaluation of progress made in implementation of information systems that would include the design of a Five- year Information Systems Plan to guarantee ONAMFA's capacity to manage information beyond the life of the project (involving about 3 person-months of technical assistance). A matrix of objectives, outputs and timing of activities, and draft terms of reference of technical assistance related to this sub-component are provided in Annex 3. 5.15 Experience has shown that institutional strengthening measures which do not address the issues of capacity and continuity of staff are not sustainable. The success of ONAMFA's modernization process depends in great part on the ability to build a stable and weil qualified team of managerial and technical staff. To this end, ONAMFA has been accepted by the Ministry of Finance into the CSRP. Based on the overall agreement between the Ministry of Finance and ONAMFA signed in January 1993, the project would support the inclusion into CSRP of 33 key managerial and technical line positions. The incremental costs represented by the difference between current salaries and CSRP salaries would be financed by the project on a declining basis. Annex 4 provides an overview of the CSRP rationale, criteria for agency participation and personnel selection procedures, and implementation progress to date, as well as a list of positions to be financed under the proposed project and their financing levels. Additionally, the project would support the creation of a permanent division within ONAMPA to implement the project, and to support early child development programs (pam. 7.1). At negotiations, assurances were obtained from the Government  - 21 - that: (a) ONAMFA would maintain management with qualifications and experience satisfactory to IDA; and (b) the annual audit report would include a separate opinion as to whether CSRP criteria for selection of personnel have been observed in the choice of staff for project-financed CSRP positions. Service Delivery Support Component (proposed outlay, US$133.6 million equivalent, including contingencies) 5.16 Programmatic Model. The programmatic model to be adopted by the project includes provision of integrated early child development services (including education, nutrition and health) by two to three trained caregivers, depending on the age-mix of the beneficiaries. Typically, two caregivers will work in each day-care center. In centers with enrollment of three or more children under two years of age, a third caregiver will be employed. No center, however, will enroll more than five children under two. One of the caregivers also is the owner of a home within the given urban or peri-urban area in which the day-care center operates. Each such center will serve a group of 15 children between 6 months and 6 years of age, selected according to precise criteria (para. 5.18). The typical center will operate 8 hours per day, 5 days a week, and 12 months per year. The project offers access to funds on a mixed grant-loan basis to the owners of the house for basic rehabilitation to meet minimum acceptable standards of security, space and services for day-care activities. 5.17 Stipends to Caregivers and Beneficiary Charges. Each caregiver receives a monthly stipend, the costs of which would be financed under the project. The stipend is roughly equivalent to the minimum salary (calculated on the basis of US$4.5 equivalent per child per month). IDA would finance such costs on a declining basis. Costs associated with the day-to-day operation of the center would be covered by parents' payments equivalent to US$2.25 per month per child, declining to US$2 and US$1.75 equivalent for one and two additional siblings, respectively, attending the center. These beneficiary/user fees are expected to generate about US$8.8 million over the project life. 5.18 Targeting areas and potential beneficiaries. Subsequent to the selection of participating cities and neighborhoods based on the criteria defined above (paras. 5.5 and 5.9), a beneficiary selection process would be carried out. In principle, all children 6 months to 6 years living in the selected geographic area are eligible to participate in the project. However, priority would be given to those children who are, in order of importance: (a) malnourished; (b) under the care of only one person (e.g., children of single parents); (c) from families with parents employed and without child care and, thus, child at risk of abandonment; and (d) from high parity families (i.e., with five or more children).  - 22 - 5.19 Selecting caregivers among community women. Concurrent with the selection of children, ONAMFA staff will undertake project promotion efforts in the local community, including identification and elaboration of a list of potential caregivers. Priority would be given for pre-selection to those local residents who: (a) are between 18 and 50 years of age; (b) have writing, reading and basic mathematical skills (though not an exclusionary factor, as long as at least one of the two to three caregivers per center meets these requirements); (c) have obtained an initial certificate of good health, including results of three laboratory exams (blood test, urinalysis, and bacilloscopy) and have annual checkups thereafter; (d) have demonstrated full-time availability to work under the project; (e) are accepted by the community, as well as have obtained written consent from their spouse to participate in the project; and (f) have demonstrated a capacity to work well with children (though not necessarily having children of his/her own) 5.20 Training. Training is crucial to the quality and success of the project. Training activities would be directed at the following levels: (a) technicians at the national and regional level; (b) caregivers; (c) parents' associations; and (d) as local programs permit, health, nutrition and related promotion activities, including encouragement of breastfeeding, for women whose children attend the day-care centers. ONAMFA has prepared a comprehensive training plan including an implementation timetable. Draft terms of reference for technical assistance have been finalized. (a) Training of technicians would take place at the national level through: (a) technical assistance (approximately 10 person- months) to the team in the areas of health and nutrition, quality control of food and menu preparation, food distribution and use of the pre-school child development scale; and (b) attendance at workshops, courses and seminars (at the national and international level). In addition, the project would finance selectively study tours to other ongoing successful child development projects (e.g., visits to the Hogares de Bienestar Infantil program in Colombia). (b) At the regional level, training of the technical teams would involve: (a) an orientation session, involving a 2-day presentation in La Paz of the nature and scope of the project, its objectives and rationale and overall implementation arrangements; (b) a follow-up session at the regional level (two weeks after the initial orientation), where more specific project  - 23 - contents are presented, including: mechanisms for the selection of educators and children, implementation arrangements, training of educators, accounting and administrative procedures and monitoring and evaluation requirements; and (c) a supervision/training visit from the national team at least every two months. (c) Caregivers would receive an initial training session of 40 hours divided into the following modules: health, nutrition, early child education, fostering of community organization and participation through parents' associations, promotion of the role of women, and basic accounting and administration procedures. Each initial training sessions would include a maximum of 25 caregivers who would ultimately provide the base from which staff for 10 day-care centers would be selected, as well as potential back-ups should some of those initially chosen not prove able to carry out the job. (d) Training of parents' associations would involve the dissemination of information by the regional project teams on the objectives of the project and would include modules in accounting and administration procedures so that, where feasible, such associations could assist ONAMFA in local day- care centers' management functions. 5.21 Supervision. Prior to the initial training session for a potential group of caregivers, the regional team would select and contract an external supervisor (e.g., from a local NGO or university) who has completed, at a minimum, two years of secondary education. The external supervisor would provide support to the regional team during the sessions and would be acquainted with specific details and requirements for project supervision. 5.22 A detailed supervision plan has been developed. During the preparatory phase for opening a group of day-care centers, representing a period of approximately two months, a local architect would follow up house rehabilitation activities, while a regional technical officer would follow up the initial training of caregivers. During the subsequent four-month start-up phase, a member of the regional technical team would be assigned to each group of 10 centers. Together with an external supervisor, he/she would carry out regular bi-weekly training/supervision visits during the initial two months. For the next two months, the external supervisor would visit each center once a week. In the subsequent six-month follow-up phase, the external supervisor would visit each center twice a month, and the regional technician would visit each center at least once a month to oversee the work of the supervisor. In the subsequent consolidation phase, the regional technician would visit each center at least once every two months, and the external supervisor (responsible for a maximum of 20 centers) would carry out, at a minimum, one monthly visit to each center. To ensure adequate  - 24 - oversight, a member of the regional technical team would be responsible for no more than two external supervisors. 5.23 Home rehabilitation. The project would finance, on a mixed grant- loan basis, the costs of rehabilitation of the homes of those caregivers whose residences will serve as day-care sites. The objective of this sub-component is to: (a) ensure that all day-care sites meet minimum acceptable standards of security, space and services for conduct of their activities; (b) create a financial incentive for caregivers to remain in the project once rehabilitation is completed; (c) recover a portion of the private gains accruing to the caregivers from home rehabilitation; and (d) help develop a loan repayment discipline among participating caregivers. 5.24 This sub-component would operate as a revolving fund, with initial capital and replenishment paid by the project, from which funds would be drawn for individual rehabilitation activities, and into which repayments (i.e., partial cost recovery) would be made. The project would support this fund by contributing to it on an annual basis based on estimates of that given year's projected financing needs for rehabilitation, and the previous year's cost recovery amount. The balance remaining in this fund at the end of the project would revert to the Treasury. Contracting of construction materials and necessary labor would be the responsibility of the individual caregiver. ONAMFA's regional architects would be responsible for certifying that work has been completed in accordance with original designs and specifications. 5.25 The amount of the home rehabilitation grant-loan available to a given caregiver would be subject to a ceiling which is the equivalent of US$500. Repayments would be made over a maximum period of 24 months, and would be set by a scale according to the original rehabilitation grant-loan amount (Annex 5). This scale is designed to control the caregiver's monthly payments. A caregiver would repay approximately 50% of the original rehabilitation grant-loan amount in a period ranging from 6 to 24 months. Monthly payments are set so as to not exceed one-third of the caregiver's monthly stipend, and will be deducted directly from his/her monthly stipend to facilitate repayment. 5.26 The project would finance basic goods to equip each day-care center, including: furniture, kitchen stoves and equipment, toys, educational materials, refrigerators (one for each center in warm regions of Chaco and Oriente) and a first-aid kit. The initial investment for these goods has been estimated at US$2,100 per center. Pre-determined replacement rates and costs would be used to replace used or damaged furniture, equipment and materials. 5.27 Nutrition Services and Commodity Distribution. AU children attending the day-care centers who are either not malnourished or mildly malnourished would receive at least 70 percent of their daily age-adjusted nutritional requirements. The average amount of calories and proteins recommended to cover 70 percent of age-adjusted requirements are: children  - 25 - 6 months to 23 months of age: 931 calories and 19 grams of protein per day; and children 2 to 6 years of age: 1200 calories and 22.4 grams of protein per day. These supplements would be provided at the day-care center via three meals daily: breakfast, lunch, and an afternoon snack, providing 30 percent, 50 percent, and 20 percent, respectively, of the daily ration. To respond to distinct culturally-based dietary habits and, relatedly, the availability of fresh foods, seasonal and regional diets will be elaborated by the regional project team with technical assistance to be financed under the project. Nutritional value and costs of menus across regions will be standardized. Twenty-four hour recall studies of household food consumption and parents' nutrition education activities would be carried out to ensure that all participating children receive a complete diet and, hence, that appropriate levels of food intake occur within the home in the evenings and during weekends, so as to not compromise project beneficiaries' nutritional status. 5.28 Children with moderate and severe malnutrition will receive at the day-care center 100 percent of daily age-adjusted nutritional requirements via six meals per day. The caregiver, with support from ONAMFA's regional nutritionist, would be responsible for the special treatment of these children. The caretaker would be trained to supervise food intake by malnourished children, to ensure each is weighed by the local health referral center on a weekly basis to monitor his/her nutritional status progress, and to carry out home visits to assess environmental or socioeconomic conditions which may be underlying causes of the malnutrition. Children with mild malnutrition would also be monitored (i.e., recordation of their weight-for-age) by the referral health center on a weekly basis, but would only be provided 100 percent of daily caloric and protein requirements at the day-care center if they experienced no weight gain between monitoring visits. 5.29 In addition to confirming the malnutrition diagnosis and monitoring the child's progress in follow-up visits, the physician at the referral health center would carry out a complete check-up (including basic laboratory tests) of all malnourished children to identify any morbidity associated with their malnutrition. For those parents in extreme poverty who, thus, are unable to afford the costs of these laboratory exams and/or recommended treatment for malnutrition-associated morbidity in their children, financial assistance would be made available to them, via a project-financed health fund. However, financing from this fund would be limited to a monthly ceiling of US$5.00 equivalent per functioning day-care center. It is recognized that due to budgetary constraints, the proposed project can only provide seed money for this fund. To complement project-financed support to this health fund, the respective regional team will seek to mobilize additional resources from local parents' associations and/or patrons of the project (e.g., church groups, NGOs). The operation of the fund would be evaluated on a monthly basis via data from the project's management information system to ensure the equitable distribution of project-provided funds between regions.  - 26 - 5.30 Food (not IDA financed) would be made available to the project through two modalities: (a) distributed dry food commodities from food aid support, provided either in food, or via monetization, by local purchase; and (b) local purchase of perishable commodities. The first modality involves a quarterly assessment of food requirements by ONAMFA's regional offices, requests to donor agencies to guarantee availability of food for the following quarter, and the collection of food from warehouses by ONAMFA's regional office, NGOs, or where existent, local parents' associations. The second modality involves the direct transfer of funds to ONAMFA's regional office, NGOs providing support to ONAMFA in the administration of select day-care centers, or parents' associations, where existent, which would be responsible for purchase and overseeing distribution of fresh food. In this latter case, the responsible party would enter into six-month contracts with local suppliers, to be awarded on a competitive basis; the selected supplier would distribute such fresh food weekly to each day-care center. 5.31 Health Services. An agreement has been signed between ONAMFA and MPSSP specifying MPSSP's responsibilities in provision of a minimum acceptable package of services to project beneficiaries. These services will not be financed by IDA but rather via preferential user fees to be available to beneficiaries to obtain specific diagnostic, preventive and curative services. The national agreement would be supplemented by local agreements with each health referral center defining more detailed operational and logistical arrangements for the delivery of health and related services in support of project objectives. These local agreements should not be limited to the public sector and could involve private providers of health care services. The project also would finance training activities with the personnel of referral health centers to guarantee that agreed administrative procedures are followed, and that a minimum package of quality health and nutrition services is provided to project beneficiaries. 5.32 The basic package of preventive services includes, for all children enrolled in day-care centers, completion of their full immunization regimen within six months of their entry into the project. In addition, the following services would be provided to specific subgroups: (a) monthly check-ups for normal and mildly malnourished children, to include: nutrition assessment (including measurement and recordation of weight-for-age); and detection of diarrheal and respiratory diseases and of other common illnesses. (b) for all children with mild malnutrition who have not gained weight between control visits, and all children with moderate and severe malnutrition, weekly nutrition surveillance; medical check-ups for morbidity diagnosis (including laboratory tests); and treatment via bi-monthly medical visits with the doctor at the referral health center.  - 27 - (c) for pregnant women, including mothers of participating children and caregivers (for a preferential fee of US$2.5 equivalent), four prenatal control visits, including evaluation of obstetric risk, tetanus vaccine and iron supplementation; provision of a "clean packet" for home-based delivery, together with promotion of the use of hospital-based delivery services' (at a preferential fee of US$15-20); and at least one postnatal control visit, including breastfeeding promotion and family planning education. 5.33 The health referral system needs to be well defined and known by the caregivers at each day-care center to ensure that health centers provide the agreed minimum acceptable package of services to project beneficiaries. At negotiations, assurances were secured from the Government that, prior to opening any given group of day-care centers, an agreement would be finalized between ONAMFA and the respective public or private referral health center to ensure availability to project beneficiaries of a minimum acceptable package of health and nutrition services. 5.34 While parents of project participants are to continue to assume overall responsibility for referral and payment for curative services for their children, the caregiver would: (a) accept a sick child in the center in cases where an authorized physician has evaluated the child and allowed its attendance with clear directions for treatment; (b) take care of a child that has become sick while attending the center until the parents arrive; and (c) be responsible for referring the child to a health facility in emergency cases. For mild conditions, where beneficiary-provided resource pools exist, the caregiver would assume responsibility for payment of such treatment for children under his/her care. 5.35 Early Education. The project would support early education activities to promote the psychosocial development of participating children through the stimulation of their cognitive, social, emotional, motor and communication capacities. Education activities would be based on a diagnosis of the prevailing child rearing practices in the community. This diagnosis would serve to establish the abilities and needs of caregivers and help refine the plan of activities required for each day-care center and participating child. Building on this initial diagnosis, a program of education activities would be defined centered on play (free and directed play, and "working corners"). Each center would be equipped with play and educational equipment and materials, based on a standard list developed by ONAMFA's technical team. 1 Notably, hospital-based deliveries presently represent only about 40 percent of all annual births. Through project-supported education, and improved utilization of the health system, it is expected that this proportion will increase among women with children in the day-ca centers, and caregivers.  - 28 - 5.36 To assess the individual development of each child, a "Child Development Chart' would be applied by the caregivers. This chart has been developed and successfully tested and applied by a Bolivian NGO. Additionally, in order to monitor and evaluate the project's impact on child development, a Pre-School Development Scale would be administered by the technical supervisors within the first three months of the child's enrollment in the center, and thereafter: (a) every three months for children under one year of age; and (b) every six months for children in the 1 to 6 year age group. The pre-school development scale adopted would be that developed for a similar program in Colombia, and successfully used in this project's pilot phase. Project financing would be provided within the sector policy sub- component to further evaluate this development scale and refine it, as needed. Monitoring and Evaluation Component (proposed outlay, US$2.6 million equivalent, including contingencies) 5.37 The proposed project would finance the implementation of a monitoring and evaluation component consisting of a management information system (Sistema de Informaci6n Gerencial--SIG) and an impact evaluation system. The management information system would provide project management with a continuous flow of key indicators to measure project implementation performance, as measured by: (a) the actual pace at which key inputs are put in place vis-a-vis programmed coverage targets; (b) the extent of project compliance with established technical and operational norms and standards, essential to ensure constant delivery of high quality services to beneficiaries; and (c) overall trends which reveal whether the project is attaining desired intermediate objectives, without which the intended project impact is not likely to be achieved. 5.38 The impact evaluation system would document the effects of the project in three key areas: (a) how well it targets children, women and families at highest risk; (b) how participation affects the development and well-being of children, women and communities; and (c) the extent to which participation in this pre-school project improves the subsequent progress and performance of children in primary school. Concurrently, the impact evaluation will seek to ascertain whether and how the age of entry in day- care, length of participation, and/or differences in the relative efficiency and quality of day-care provided between centers, result in varying effects on participating children and their families; and whether synergistic effects exist between expected improvements in the status of women and communities as a result of the project, and the overall well-being of the children. A key measure of impact would be comparison, over time, of the developmental status of children enrolling in project-supported day-care centers from January-June 1994 with two matched control groups to be drawn from the Integrated Household Survey (EIH). Development progress of these three groups of children would be monitored via semi-annual EIH surveys, to  - 29 - include additional modules on health and nutritional status, and child development. In both the management information and impact evaluation systems, both quantitative and qualitative measures would be used. Annex 6 contains detailed information on the variables, indicators, and instruments to be used for data collection, the party responsible for data registration, and the frequency with which the indicators will be analyzed for the SIG; and the variables and methodological framework to be used for the impact evaluation. The project would finance the costs associated with the contracting of consultants from the National Institute of Statistics (INE) and other agencies selected to carry out the additional modules of the EIH, and the processing and analysis of project performance monitoring and evaluation data. Terms of reference for technical assistance needs have been finalized. At negotiations, assurances were obtained from Government that: (a) the agreed evaluation and monitoring systems would be under implementation no later than March 31, 1994; and (b) annual reports on progress and results of the monitoring and evaluation component would be prepared by ONAMFA and submitted for IDA review. 5.39 Monitoring. The management information system would provide indicators to monitor project implementation performance. The majority of these indicators would be generated for ONAMFA's SIG from regular reports of caregivers, project supervisors, and the Regional Technical Teams. Indicators for performance monitoring include: (a) existing levels of key project inputs, i.e., net number of functioning day-care centers, staff on regional technical teams, supervisors, caregivers, and children enrolled, as well as the extent and causes of turnover in such inputs, compared to programmed project coverage targets; (b) measures of the extent of compliance with technical and operational norms of the project, and the overall soundness of project administration and financing, including indicators on the adequacy of: (i) targeting and selection of communities, children and caregivers participating in the project; (ii) community promotion activities; (iii) initial training of potential caregivers; (iv) functioning of the day-care centers, including actual delivery of programmed health, nutrition and education interventions; (v) payment of user charges; (vi) administration of the project with regard to the operation and financial status of the Rehabilitation and Health Funds, and acquisition of requisite food, materiel and equipment for the day-care centers; (vii) functioning of parents' associations; (viii) inter-institutional coordination with NGOs, MPSSP, and the Ministry of Education and Culture; and (ix) actually received versus committed resources from food donor agencies and other project financiers; and  - 30 - (c) trends in attaining coverage of key interventions essential to achieve intended project impact, with a view toward ensuring that the project, over time, is resulting in: (i) an increase in the proportion of participating children with full immunization coverage within six months of enrolling, and who receive regular health care and nutrition surveillance; (ii) a reduction in the prevalence of child malnutrition, particularly of moderate and severe degree; (iii) a diminution in the proportion of children who score at the lower end of the Pre- school Development Scale; (iv) a decrease in the extent of non- attendance at day-care centers due to illness; (v) an increase in the proportion of project beneficiaries entering primary school upon reaching 6 years of age; and (vi) an augment in pregnant women's utilization of pre- and post-natal care and, relatedly, safe deliveries, and health and nutrition education and services. 5.40 In addition to regular monitoring activities, the project would finance special evaluations to better document the quality of the nutrition, health and child development interventions being delivered via the project. These evaluations include: child growth and monitoring activities, an evaluation of the use of the child development chart, child development activities, the amount and quality of food intake by children, and the treatment of children with nutritional problems. 5.41 Impact Evaluation. The project would finance the costs of ongoing evaluation of the impact of the project on the status of participating children, women and families. An ancillary objective is to evaluate changes in the quantity and quality of community development activities in participating neighborhoods. The key tool for evaluating impact would be analysis of data to be generated from periodic application of the EIH (a Living Standards Measurement/LSMS-type survey) to project beneficiaries and two carefully matched control groups. Commencing in January 1994, and semi-annually thereafter, the EIH's household interview-based survey, including new modules to be developed specifically under this proposed project to measure children's health, nutritional and child development status, would be applied to all families with children who enroll in project-supported day-care centers as well as the two matched control groups. 5.42 One control group would be selected from the overall EIH sample of households that have children under six years of age, and have comparable socioeconomic characteristics to families who are project participants. Another control group would be drawn from households located in neighborhoods where the project has been implemented but who have not enrolled their children in the day-care centers. A sub-sample of children identified in each of the three groups would be followed-up on a quarterly basis to document changes in the respective children's health and nutritional status and development.  - 31 - 5.43 To confirm results from the quarterly assessments of a sub-sample of children in the three control groups (and in view of anticipated high mobility of families within the control groups and, hence, difficulties in locating them over time), a follow-up EIH would be conducted in 1996 on the same households included in the initial 1994 survey. It is expected that the EIH- based impact evaluation system would continue to be carried out during the last three years of the project. The system, however, would be thoroughly reassessed at the time of the project's Mid-term Review, i.e., no later than November 30, 1996, to permit introduction of changes, as deemed desirable, to improve its methodological approach and statistical soundness. 5.44 In addition to the EIH-based impact evaluation system, the project would finance four special studies to assess: (a) the impact of the project on women, including caregivers; (b) the impact of the project on community development; (c) the cost-effectiveness of the project; and (d) the project impact on schooling and school performance. These studies would use a combination of methods including in-depth interviews, focus group discussions, analysis of data from the project SIG, and review of minutes from meetings of community groups. Draft terms of reference for these special studies have been finalized. 5.45 Project Preparation Facility (PPF). An advance of US$750,000 was approved by IDA on August 22, 1992 to finance project preparation activities and the implementation of pilot day-care centers in the cities of La Paz/El Alto, Tarija and Santa Cruz to test different delivery modalities and operational arrangements. The Government has submitted to IDA an evaluation of the pilot phase, including a detailed analysis of findings and recommendations for modifications to the program that have been incorporated into the final project design. 6. PROJECT COST AND FINANCING PLAN A. Project Costs 6.1 The total project cost is estimated at US$140.2 million equivalent, including taxes (US$5.7 million equivalent) and physical and price contingencies with a foreign exchange component of about US$16.9 million, or about 12 percent of total project cost. Project costs by component are summarized in Table 6.1. Detailed cost tables are provided in Annex 7.  - 32 - 6.2 Contingency Allowances. Total contingencies of US$8.3 million equivalent represent 6.3 percent of base costs and include physical contingencies of US$200,000 equivalent for equipment, furniture, vehicles and educational materials. Price contingencies (US$8.1 million equivalent), representing 6.2 percent of base costs assume: (a) a projected local inflation rate of 6.46 percent for 1994, 5.5 percent for 1995, 5.18 percent for 1996 and 1997, 5.11 percent for 1988, and 5.03 for 1999; and (b) a projected price increase for foreign costs estimated in US dollars at 3.1 percent. Cost calculations also assume a nominal exchange rate of 4.290 for 1994, 4.412 for 1995, 4.256 for 1996, 4.639 for 1997, 4.756 for 1998 and 4.875 for 1999. Table 6.1: Project Cost Summary By Component Local Foreign Total % Foreign % Total Exchange Base Costs ---------US$ million-------- A. Sector Polic Devpt. 3.2 0.7 3.9 18.5 3.0 Management Strengthening B. Service Delivery Support 112.2 13.4 125.6 10.7 95.3 C. Monitoring & Evaluation 1.4 0.9 2.3 39.6 1.7 Total Baseline Costs 116.4 15.0 131.3 11.4 100.0 Physical Contingencies 0.1 0.1 0.2 45.2 0.1 Price Contingencies 6.4 1.7 8.1 21.3 6.2 Total Project Costs 123.3 16.9 140.2 12.3 106.3 B. Recurrent Costs and Project Sustainability 6.3 Project incremental recurrent costs are generated by expenditures for administrative support, supervision and training activities, caregivers' stipends, equipment replacement, expenditures associated with the health fund, salary supplements for civil service positions, compensation of incremental personnel directly involved in project implementation at the national and regional level, and food commodities. Food-related costs totalling about US$52.0 million (representing 37 and 58 percent of total and recurrent costs, respectively) although recurrent, carry little financial burden for the government since most food needs are expected to be secured through current and anticipated food aid programs.  - 33 - 6.4 Incremental recurrent costs generated by the project at the end of year six would amount to US$33.2 million, distributed as follows: (a) food, 58 percent; (b) caregivers' stipends, 20 percent; (c) minor expenses associated with the operation of centers, 10 percent (financed by the beneficiaries); (d) administrative costs, 7 percent; (e) external supervision, 3 percent; (f) health fund, 1 percent; and (g) civil service-related expenditures, 1 percent. 6.5 The proposed project enjoys broad political support. Project sustainability rests principally on the Government's ability to find "fiscal space" for the proposed project's incremental recurrent costs. During the first three years of implementation (1994-96), given the conservative scale of proposed project operations, the net fiscal impact will not be significant. However, in the latter years (1997-99), in which coverage is programmed to increase rapidly, the incremental recurrent costs rise significantly, representing at the end of the project and annually thereafter US$33.2 million equivalent (about 1.5 percent of total projected public current expenditures, and about 0.5 percent of expected GDP). The actual fiscal burden should not be excessive, however, since the majority (i.e., 58 percent) of these recurrent costs are attributable to the project's food requirements, virtually all of which are expected to be met from external sources via food aid. The priority assigned by Government to the project is reflected in a Government agreement to allocate annually minimum amounts of domestic and external resources to the project (para. 6.6). This commitment is reinforced by the Government's Supreme Decree 23415 of March 5, 1993, already mandating the allocation of a significant share (i.e., US$48.2 million equivalent) of the food aid required by the proposed project (Annex 8). C. Financing Plan 6.6 The proposed loan of US$50.7 million equivalent would finance 36 percent of the total project cost. It would cover US$16.6 million equivalent or 96 percent of foreign exchange expenditures, and about US$34.1 million equivalent or 30 percent of the estimated local costs. The Government would finance US$21.0 million equivalent or about 15 percent of total costs. The World Food Programme (WFP) and the EC would finance about US$11.93 and US$1.86 million equivalent, respectively, in food donations. UNICEF would finance US$1.28 million equivalent, principally for training activities. Beneficiary contributions would represent US$8.8 million. USAID and the Social Investment Fund contributed, in aggregate, about US$0.6 million for project preparation activities and implementation of the pilot phase. A financing gap of about US$44.1 million to cover food requirements in the second half of the project is expected to be financed by food aid from bilateral agencies. During the appraisal mission, interest in financing food was expressed by USAID and Canada. Table 6.2 summarizes the project's financing plan. Annex 7 includes the detailed financing plan per project  - 34 - year. The Government has submitted to IDA projections of social sector investments for the 1994-99 period delineating all social sector projects to be financed both from domestic and external sources. These projections suggest sufficient "fiscal space' for the proposed project. At negotiations, assurances were obtained that the Government would allocate in its annual budget, for the years 1994 through 1999, and each year thereafter, the following minimum amounts (representing its direct budgetary contribution and the financing to be sought from donors) for the financing of project expenditures: (a) US$1.039 million for CY94; (b) US$2.287 million for CY95; (c) US$5.38 million for CY96; (d) US$10.58 million for CY97; (e) US$17.78 million for CY98; (f) US$27.73 million for CY99; and (g) US$33.2 million for each year thereafter. A condition of credit effectiveness would be that ONAMFA has received from the Treasury an amount equivalent to not less than US$340,000 for purposes of implementing the project during CY93. Table 6.2: Fmancing Plan US$(million) % Government 21.0 15 ]DA 50.7 36 World Food Programme 11.9 9 European Community 1.8 1 UNICEF 1.3 1 Beneficiaries 8.8 6 USAID/SIF 0.6 1 Other Cofinancing 44.1 31 TOTAL 140.2 100 7. PROJECT IMPLEMENTATION A. Project Management and Coordination 7.1 ONAMFA would be responsible for the overall implementation of the project. Since the project represents a new programmatic initiative, the technical and administrative structures necessary to implement the project have been added to the organization at the central and regional levels as a permanent program structure (i.e., Proyecto Integral de Desarrollo Irfandl- PIDI or Integrated Child Development Project). An organizational chart of the central and regional program offices and their integration within ONAMFA's structure is presented in Annex 9. At the national level, the program is headed by a national coordinator and complemented by seven technical staff in the areas of health and nutrition, education, project  - 35 - implementation, community outreach, administration, management information systems, and internal auditing. 7.2 ONAMFA would establish project teams in all eight of its regional offices. The teams would be fully integrated into ONAMFA's regional structure, with supervision by the regional Executive Director and support from the regional administrative systems. The regional teams include a regional coordinator, an education specialist, a health and nutrition specialist, a social worker, a management information systems operator, a procurement officer, an accountant and a secretary. Technical officers would be added to the regional teams for promotion and supervision of centers based on an estimated ratio of one technical officer per forty centers. Additional administrative support would be hired as necessary as the program expands. Architectural services would be contracted by the regional offices for the rehabilitation of caregivers' homes to be used as day-care sites, based on the volume of work. In addition, an accountant would be placed in those ONAMFA sub-regional offices where a NGO is assisting ONAMFA in the administration of a group of centers. 7.3 The project would finance the establishment and operation of the PIDI central and regional offices, including: (a) equipment, (i.e., computers, other office equipment and furniture); (b) vehicles (three four-wheel drive for the central level, one pick-up truck for each regional office, and one four- wheel drive for each five regional-level technicians); (c) salaries for incremental positions, and other operating expenses, on a declining basis; (d) training activities; and (e) technical assistance. The project would finance other operating expenditures, including materiel, transportation, maintenance and communication. 7.4 To support project implementation, the project would finance technical assistance in the areas of: (a) management information systems, (b) administrative and financial systems, and (c) adjustments necessary for the consolidation and expansion of the PIDI program as it scales up. Draft terms of reference for technical assistance have been finalized. In addition, technical assistance would finance the services of an external procurement agent (see para. 7.10) and an external auditor (see para. 7.20). 7.5 ONAMFA has prepared two basic documents to guide project implementation: an Administrative Manual (Manual Administradvo, June 1, 1993), and an Operations Manual (Manual de Normas y Procedimientos, June 1, 1993). The Administrative Manual includes: (a) organizational arrangements; (b) terms of reference for all project staff; (c) disbursement and procurement arrangements; and (d) internal and external audit TOR and scope. The Operations Manual incorporates all the technical contents of the project's components and sub-components, and financial and administrative implementation arrangements. Final versions of the manuals have been completed by Government and reviewed and approved by IDA.  - 36 - B. Institutional Arrangements 7.6 NGO Involvement. To ensure that coverage and quality objectives are reached and that the project is sustainable, ONAMFA would require broad involvement of and support from national and international NGOs with experience in the implementation of women and children projects. While coverage of most NGOs is limited and their institutional and operational capacity vary substantially, their knowledge of local conditions and community involvement is generally strong. ONAMFA has defined three broad modalities for NGO involvement: (a) support in the implementation of all project components in a given area; (b) support in the execution of specific project components nationwide (e.g., it is expected that an NGO would be involved in the nationwide training of the national and regional PIDI teams in women instruction methodologies); and (c) staffing for external supervision activities. 7.7 MPSSP Involvement. The proposed project is also encouraging interinstitutional arrangements with MPSSP and private providers of health services to ensure that project beneficiaries have access to a minimum package of quality preventive, diagnostic and curative health services (para. 5.32). C. Implementation Schedule 7.8 The project is planned to be implemented over a six-year period (i.e., the end of 1993 through the middle of 1999). Implementation of the Service Delivery Support component would be slow during the first half of the program and, as coverage expansion intensifies at the beginning of the fourth year, would rapidly accelerate in the second half of the project. The small coverage in the first half responds to a need to guarantee quality of contents, address implementation issues gradually, strengthen institutional capacity, and refine logistical mechanisms. Similar experiences from other child development projects demonstrate that, in order to ensure quality and not overextend institutional capacity, coverage expansion needs to be slowly phased-in during the start-up phase and accelerate once administrative procedures are tested and fully operational. 7.9 Studies to be carried out under the project's Sector Policy Development and Management Strengthening, and Monitoring and Evaluation components will be completed in accordance with the timetable outlined in Annex 10. During negotiations, assurances were secured that the Government would submit for IDA review the results of, and recommendations deriving from, studies to be carried out under the Sector Policy Development and Management Strengthening Component and the  - 37 - Monitoring and Evaluation Component, in accordance with an agreed timetable. D. Procurement 7.10 Arrangements for procurement and limits by type are summarized in Table 7.1. Annex 11 shows a procurement timetable (Project Implementation Schedule). Bolivia's procurement procedures require that, for contracts above Bs. 200,000 equivalent, public institutions use international procurement agents. The procurement of goods utilizing Local Competitive Bidding (LCB) and International Competitive Bidding (ICB) procedures would be carried out through one of these agents. The credit would finance the fee of the procurement agent to be retained using terms of reference and following procedures satisfactory to IDA. The Government has prepared a draft contract for the procurement agent, specifying timing requirements for procurement actions. The use of Bank Group standard bidding documents would be mandatory for the procurement of goods under ICB. Standard bidding documents already approved by IDA for the Social Investment Fund would be used for the procurement of goods under LCB. Bolivian manufacturers may be granted a margin of preference for bid evaluation purposes under ICB, in accordance with Bank Group guidelines. Goods 7.11 Contracts for vehicles, and office technology equipment are expected to total about US$1.7 million equivalent, would be combined in packages valued at not less than US$100,00 equivalent and would be awarded on the basis of ICB procedures. 7.12 Contracts for furniture and equipment for the home-based centers and ONAMFA's national and regional offices are expected to total about US$32.3 million equivalent. To the extent possible, contracts for goods (principally office equipment, furniture and kitchen stoves) would be combined in packages of US$100,000 equivalent or more, and contracts would be awarded on the basis of ICB. LCB would apply for contracts between US$25,000 and US$100,000 equivalent, up to an aggregate amount of US$10 million equivalent. Local shopping procedures could be used for contracts of US$25,000 equivalent or less up to an aggregate amount of US$4.5 million equivalent. Direct contracting procedures could be permitted for contracts of US$5,000 equivalent or less up to an aggregate amount of US$1.0 million equivalent for the purchase of small quantities of locally produced materials, and where shopping procedures are not practical.  - 38 - Table 7.1: Summary of Proposed Procurement Arrangements (US$ million equivalent) PROJECT ELEMENT ICB | LCB I Other NBF. Total Costs 1. Rehabilitation Fund 2.86 2.86 (2.86) (2.86) 2. Goods 2.1 Vehicles & Office Technology 1.74 1.74 (1.63) (1.63) 2.2 Furniture and Equipment 16.82 10.00 5.50 a/ 32.32 (13.50) (8.00) (4.36) (25.86) 2.3 Food Commodities 51.44 51.44 (0.00) (0.00) 3. Consultancies b/ 3.1 Studies & Technical Assistance 4.56 4.56 (3.65) (3.65) 3.2 External Supervision 2.79 2.79 (0.94) (0.94) 4. Salaries & Operating Expenditures 4.1 Civil Service Support 2.31 2.31 (1.10) (1.10) 4.2 Salaries 6.58 6.58 (2.37) (2.37) 4.3 Administrative Costs 3.42 3.42 (1.45) (1.45) 4.4 Stipends to the Caregivers 17.36 17.36 (7.32) (7.32) 4.5 Operating Costs of Centers 8.88 8.88 (0.00) (0.00) 4.6 Health Fund 1.29 1.29 (0.67) (0.67) 4.7 Training 2.66 2.66 (2.10) (2.10) 5. Miscellaneous 5.1 PPF Refinancing 2.19 2.19 (0.75) (0.75) TOTAL COSTS 18.56 10.00 51.52 60.12 140.20 (15.13) (8.00) (27.57) (0.00) (50.70) Note: Numbers in parenthlesis reflect IDA financing. a/ For goods: local shopping, of which direct contracting may be allowed up to an aggregate of US$1.0 million equivalent. b/ In accordance with Bank Group guidelines for the use of consultants.  - 39 - Consultants 7.13 Consultants required for the project would be hired in accordance with IDA's guidelines for the use of consultants. Except as IDA shall otherwise agree, time-based consultants should be employed under contracts using the standard form of contract for consultant services issued by the World Bank Group. IDA's Review 7.14 Prior review by IDA in accordance with IDA guidelines would be carried out for all contracts for goods to be procured under ICB, and for contracts for goods valued at US$75,000 equivalent and above under LCB. It is estimated that during the life of the project, about 80 contracts and award recommendations, representing about 52 percent of the total value of contracts, would require prior review by IDA. IDA would review ex-post, on a selected basis, contracts and bid evaluations for goods purchased under local shopping procedures and would carry out a selective review of a representative sample of contracts under direct contracting for goods. These review arrangements are considered appropriate in view of the nature of the goods to be procured, and the required use of standard bidding documents. 7.15 At negotiations, assurances were secured from Government that ONAMFA, through the procurement agent, would submit to IDA for prior review, bidding documents and award recommendations for all contracts for goods to be procured under ICB, and for contracts for goods valued at US$75,000 equivalent and above to be procured under LCB. E. Disbursements and Accounts 7.16 The proposed credit would be disbursed over a six-year period, typical for other IDA projects in the social sectors. The project completion date would be June 30, 1999 and the project closing date would be December 31, 1999. Annex 12, Table 1 contains the estimated disbursement forecast. 7.17 Annex 12, Table 2 contains the disbursement allocations. Disbursements would be made against the following categories of expenditures: (a) 100 percent of expenditures for the home rehabilitation fund; (b) 100 percent of foreign expenditures and 80 percent of local expenditures for goods; (c) 100 percent of expenditures for studies, technical assistance and training; (d) for recurrent expenditures associated with project implementation, according to decreasing percentages as defined in Annex 12, Table 2. Credit funds would not pay for food rations. Withdrawal applications for goods with a contract value of US$75,000 equivalent or more would be supported by full documentation. Contracts of less than US$75,000  - 40 - equivalent, disbursements against expenditures not undertaken by contract, and disbursements made under the home rehabilitation subcomponent, would be made on the basis of Statements of Expenditures (SOEs). Supporting documentation for these expenditures would be retained by ONAMFA and made available for periodic review by IDA staff. For home rehabilitation, this would include approved rehabilitation plans and detailed budget, certification of the completion of work, and a legalized copy of the contracts between ONAMFA and the caregivers. 7.18 Special Account. To facilitate timely project implementation, the Government would establish, maintain and operate, under terms and conditions satisfactory to IDA, a Special Account in US dollars at the Central Bank. IDA would make an initial deposit of US$2.5 million, equivalent to the average four-month project financing requirement. F. Financial Management, Accounting and Audits 7.19 A financial management evaluation of JNSDS/ONAMFA was carried out by IDA prior to the pre-appraisal mission. The evaluation included documentation and orientation in all aspects of accounting and financial systems, organizational structure, internal controls and audit. The evaluation concluded that from a general management, accounting and auditing perspective, the proposed project was "clean". 7.20 ONAMFA's accounts would be available for inspection by IDA. Annually audited accounts would be submitted to IDA no later than six months following the end of ONAMFA's fiscal year. The annual audit reports would include: (a) an audit of ONAMFA covering the financial position and results of operations focusing on its soundness and financial managerial capability under a "going concern" perspective; the scope of the audit is an examination of the external auditor of the basic financial statements and related supplementary financial information; (b) an audit of the project, including (i) a statement of sources and applications of funds; (ii) a statement of assets and liabilities; and (iii) supplementary financial information containing a matrix of project accumulated performance, a summary of significant bids processed and awarded, a list of main contractors and contracts, and a status of the financial execution of technical assistance; (c) an auditor's opinion on the eligibility of expenses submitted through Statement of Expenditures-SOE; (d) compliance opinions of the financial-managerial covenants in the Credit and of the most significant laws and regulations affecting ONAMFA's activities or the execution of the project; (e) an audit of the special account; (f) a management letter; and (g) a disclosure of the audit procedures utilized. The audit would be performed by a private firm of independent auditors acceptable to IDA. Terms of reference were reviewed and approved during IDA's financial management evaluation. At negotiations, assurances were secured from Government that the annually audited project accounts, in accordance with IDA guidelines,  - 41 - would be submitted to IDA no later than six months following the end of the Government's fiscal year. G. Project Monitoring, Evaluation and Supervision 7.21 The proposed project incorporates a comprehensive monitoring and evaluation component (paras. 5.37 and 5.38). Overall monitoring and evaluation of the project would be ONAMFA's responsibility. ONAMFA would contract institutions such as the National Institute of Statistics (INE) to collect EIH data and other public and/or private entities for the analysis of impact evaluation data. Specific tasks of ONAMFA include: (a) preparing quarterly reports on implementation progress; (b) preparing an annual implementation progress report, work plan for the upcoming year, and financial plan for the successive three years; and (c) preparing a Project Completion Report (PCR) that would be submitted to IDA no later than six months after the closing date of the Credit. At negotiations, assurances were obtained that ONAMFA would submit to IDA quarterly progress reports on March 31, June 30, September 30, and December 31 each year, and that the quarterly report of September 30 each year shall include: (a) an assessment of overall implementation progress over the past year, including implementation indicators; (b) a detailed work plan for the forthcoming year; and (c) an updated financial plan for the successive three years of project implementation. 7.22 The Government and IDA would hold Annual Reviews no later than November 30 each year. In addition, the Government and IDA would hold a Mid-Term Review no later than November 30, 1996 to evaluate, among other things: (a) the status of execution of the institutional strengthening of ONAMFA; (b) the status of preparation of the sector policy development studies; (c) the implementation progress in terms of coverage objectives, adequacy of targeting and beneficiary selection criteria and quality of services provided; (d) the impact of project implementation on the status of children, women and the community and the adequacy of the impact evaluation variables and methodology; (e) the adequacy of available and programmed project financing, including the sustainability of the project in the context of the Government's social sector investment plan; (f) the compliance with procurement and disbursement arrangements; and (g) the results of annual project audits. On this basis, the Mid-Term Review would determine whether adjustments in project arrangements and/or coverage targets should be made. At negotiations, assurances were secured from the Government that annual reviews with IDA would take place no later than November 30 each year; and that no later than November 30, 1996 a Mid-Term Review would be held to carry out a comprehensive assessment of: the implementation of the PIDI program and the project, including an assessment of performance against agreed implementation indicators; project financing; and the Government's social sector investment plan. Annex 13 provides an estimated Supervision Plan for the project and the implementation indicators  - 42 - to be examined during the annual and mid-term reviews. At negotiations, final agreements were reached with the Government on the implementation indicators and targets to be reviewed during the annual and mid-terrn reviews. H. Environmental Impact 7.23 The proposed project does not present environmental risks. It has been assigned a "C" environmental classification. 8. EXPECTED BENEFITS AND RISKS A. Benefits 8.1 By the end of the proposed project life, an installed capacity of some 8,600 day-care centers would exist to annually provide non-formal, home- based, integrated child development services to some 130,000 of the country's poorest pre-school children, 6 months to 6 years of age; and cumulatively, by project end, taking into account anticipated promotions of six year olds, more than 200,000 children are expected to have benefitted. Women also would be direct beneficiaries through project contributions to expanding employment opportunities (employing caregivers and, via access to day-care, enabling mothers of participating children to work) and improving their knowledge of education, health and nutrition. Specifically, by its completion, the project will have trained and employed some 21,000 caregivers, most of whom are expected to be women. Approximately 8,600 of these caregivers also would benefit from access to credit to upgrade their homes and, via direct beneficiary contributions, assistance in the payment of basic utility bills to help offset the costs of using their homes for day-care centers. Significant improvements also are expected in the health and nutritional status of an estimated 16,000 pregnant women who either have children participating in the project, or are caregivers, as project-secured preferential user fees would increase utilization of pre- and post-natal care, safe deliveries, and family planning, health and nutrition education and services. An additional benefit would be the Govermnent's strengthened ability to formulate and evaluate social policy, particularly in early child development, and food and nutrition. B. Risks 8.2 Principal risks relate to: (a) the possibility that the extensive project implementation demands might outstrip ONAMFA's managerial and administrative capacities; (b) uncertainties over the continuity of the GOB's initial commitment to absorb fully project-generated recurrent costs over the  - 43 - project life, crucial to its sustainability; and (c) the danger that desired improvements in children's nutritional status will not be achieved because of failure to maintain adequate dietary intake at the household level. With regard to (a), this risk should be minimized by: direct project support for ONAMFA's modernization initiative; ONAMFA's planned full incorporation into the CSRP, thus facilitating recruitment and retention of high quality staff; anticipated active assistance of NGOs and community groups in project implementation; project-supported contracting of external supervision staff to permit ONAMFA's close, continuous oversight of day-care activities; a very conservative implementation timetable, based on moderate increases in coverage objectives during the first half of the project, and annual and mid- term project reviews to assess implementation progress and adjust the pace and scope of implementation, as needed. With regard to (b), the GOB has committed itself to a solid financing plan and to gradually assuming recurrent costs on a clearly specified annual basis, including those generated by the CSRP. To help ensure continuing commitment to this plan, the GOB will review annually with IDA an updated financial plan for the successive three years of project implementation. In addition, the GOB will review with IDA at the project's Mid-Term Review its overall social sector investment plan to ensure that adequate provision is made for project financing. The issuance of the March 1993 Supreme Decree committing counterpart resources to the project also should minimize this risk. And with regard to (c), intensive health and nutrition education activities targeted toward parents of children participating in the project seek to minimize this risk. 9. AGREEMENTS REACHED AND RECOMMENDATION 9.1 During negotiations, the Government provided assurances that: (a) ONAMFA would maintain management with qualifications and experience satisfactory to IDA; and the annual audit report would include a separate opinion as to whether CSRP criteria for selection of personnel have been observed in the choice of staff for project-financed CSRP positions (para. 5.15); (b) prior to opening any given group of day-care centers, an agreement be finalized between ONAMFA and the respective public or private referral health center to ensure availability to project beneficiaries of a minimum acceptable package of health and nutrition services (para. 5.33); (c) the agreed evaluation and monitoring systems have been established and are under implementation no later than March 31, 1994; and that annual reports on progress and results of the monitoring and evaluation component would be prepared by ONAMFA and submitted for IDA review (para. 5.38);  -44 - (d) it would allocate in its annual budget, for the years 1994 through 1999, and each year thereafter, the following minimum amounts (representing its direct budgetary contribution and the financing to be sought from donors) for the financing of project expenditures: (a) US$1.039 million for CY94; (b) US$2.287 million for CY95; (c) US$5.38 million for CY96; (d) US$10.58 million for CY97; (e) US$17.78 million for CY98; (f) US$27.73 million for CY99; and (g) US$33.2 million for each year thereafter (para. 6.6); (e) it would submit for IDA review the results of, and recommendations deriving from, studies to be carried out under the Sector Policy Development and Management Strengthening Component and the Monitoring and Evaluation Component, in accordance with an agreed timetable (para. 7.9); (f) ONAMFA, through the procurement agent, would submit to IDA for prior review bidding documents and award recommendations for all contracts for goods to be procured under ICB, and for contracts for goods valued at US$75,000 equivalent and above to be procured under LCB (para. 7.15); (g) the annually audited project accounts, in accordance with IDA guidelines, would be submitted to IDA no later than six months following the end of the Government's fiscal year (para. 7.20); (h) ONAMFA would submit to IDA quarterly progress reports on March 31, June 30, September 30, and December 31 each year; and that the quarterly report of September 30 each year shall include: (i) an assessment of overall implementation progress over the past year, including implementation indicators; (ii) a detailed work plan for the forthcoming year; and (iii) an updated financial plan for the successive three years of project implementation (para. 7.21); and (i) annual reviews with IDA would take place no later than November 30 each year; and that no later than November 30, 1996 a Mid-Term Review would be held to carry out a comprehensive assessment of: the implementation of the PIDI program and the project, including an assessment of performance against agreed implementation indicators; project financing; and the Government's social sector investment plan (para. 7.22).  - 45 - 9.2 At negotiations, final agreements were reached with the Government on the implementation indicators and targets to be reviewed during the annual and mid-term reviews (para. 7.22). 9.3 A condition of credit effectiveness would be that ONAMPA has received from the Treasury an amount equivalent to not less than US$340,000 for purposes of implementing the project during CY93 (para. 6.6). 9.4 Recommendation. With the above agreements and assurances, the proposed project would constitute a suitable basis for an IDA credit of SDR 35,800,000 (US$50.7 million equivalent) to the Republic of Bolivia.  Annex 1 -46 - BOLIVIA iNTEGRATED CHLD DEVELOPMENT PROJECT ORGAN IZAT IONAL STRUCTURE ORGANISI4O RACIONAL DEL WENOR. MUJER Y FAMILIA "ONAMFA J (CEIITRAL OFFICE) r BOARD OF DIRECTORS PRESIDENT .............. PLANNIIIIOI |COMMITTEE EXECUTIVE DIRECTOR INSTITUTIONAL ANo SY T EMS |ACTlo N "LAN| EA FORTIONALE CHI D CMMUIYIOES FIVPS AOT ANO WOMEN OAFAGr OF OF R OANGER OF PROGR ----------------- ----------- AOMI NIST ATION -----------___-__ --- t " rGR HLDREN. 1------ -------_--------------- ACCOUNTIN SUDOET ASE MNATERAL RE. NATND E NL || M I or rlNANcc ADSINISTR^TION A l OEtT oErT | OCeT | | ocrT g } oIIT | N | I or I I or 11 or 1 l or 1 l or Tol'ol Dor ITI, | r R~~~~~~~~~~~~~~~~~~~~IE310OWAL I I ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~~~~C .. CO LTAT IVE I I g ~~~~~~~~~~~~~~~~COUNCILS | 8 | ~~~~~~~~~~~~~~~~REOIObAL | - ----------------------------------- -------------1 XCTV ----------- ---------- EEUIE---------------------------------- ' DIRECTORS  47 - Annex 1 BOLIVIA INTEGRATED CHILD DEVELOPMENT PROJECT [ ORGAN I ZAT I ONAL STRUCTURE 1 ORGANISMO NACIONAL DEL MENOR, MUJER Y FAMILIA "ONAMFA" (REGIONAL OFFICES) ; REGIONAL CONSULTATIVE COUNCIL REGIONAL EXECUTIVE DIRECTOR LEGAL ADVISOR [ MANAGERt OF |4MANAGER OF PROG. AO 1 INISTA AT[ON | FOR CHILDREN, AND F,INANCE lWOMEN AND FAMILY CHI LO C....NITY WOMENS PIvU. A:C'OVU'N:' ~ ~~~~~~~EVEL OUTREACH PROGRtAM CEER FU DEPT. DEPT. DEPT. DEPT. PIDI OF| MATERIALS  -48 - Annex 2 BOLIVIA INTEGRATED CHILD DEVELOPMENT PROJECT Table 1: POPULATION PROJECTIONS FOR THE 34 LARGEST CITIES cITE. POPULATtON I1 POPULATIN O UONTtS TO S nYAS 6 morths to Corwus Total' 6 yearstt 1993 1994 1995 1996 1997 1991 1999 I LaPaz 711,038 772,865 127,020 129,226 131,470 133,753 136.076 138,439 140,843 143.2s9 2 EtAlto 404,367 439,529 72,237 79,057 96,523 94,692 103,634 113,419 124,129 135.850 3 Vlachs 19,002 20,654 3.395 3,536 3,684 3,839 3,998 4,165 4,338 4,519 4 Sata Cruz 694,616 755,017 124,097 132,117 140,665 149,771 159,464 169,794 180.772 192,471 S MorAero 54,731 59,490 9,777 10,180 t0,599 11,036 11,491 11,964 12.457 12.971 6 Carnlrl 28,079 30,521 5,015 5,132 5,250 5,371 5,495 5,622 5,751 5,994 7 S.l.Valmsco 12,616 13,713 2,254 2,391 2,537 2,691 2,855 3,029 3,214 3,409 9 Mlnromg 11,114 12,080 1.995 2,058 2,132 2,210 2,290 2,373 2,459 2,549 9 Wernes 10,979 11,934 1,961 2,090 2,206 2,339 2,491 2,631 2,790 2.959 10 Robore 10,359 11,260 1,851 1,899 1,950 2,001 2,054 2,109 2.164 2,22t 11 PSuarez 10,240 11,130 1.929 1,933 2,042 2,157 2.279 2,407 2.543 2,687 12 Trlja 90,115 97,951 16,099 16,966 17,890 19,843 19,859 20,928 22,056 23,245 13 YaLiItle 31,049 33,749 5,547 5,925 6,330 6,762 7,224 7,717 9,244 9,eo7 14 4eemi o 21,313 23,166 3,807 3,959 4,114 4,277 4,446 4,622 4,904 4,994 tS V11morteu 11,009 11,965 1,966 2,043 2,122 2,205 2,290 2.379 2,471 2,567 :G^-:.-: -: .: :.i$,": :- : : 42;3s: :: : : 239 :: : 4; ... :::2,ei ... . 28;0 36 ,l :::X 16 8je 130,952 142,339 23.393 24,473 25,602 26,784 29,020 29,313 30,665 32,081 17 Colubanba 404,102 439,241 72,189 75,324 79,596 82,009 85.570 89,297 93,164 97,210 1S EleOullIollo 29,661 31,153 5,120 5,374 5.641 5,921 6,215 6,523 6,947 7,197 19 9 uQbIbLaolo 42,153 45,918 7,530 7,904 9,296 8,708 9,140 9,594 10,070 10,570 20 Pe Sacaba 21,830 23,728 3,900 4,155 4,427 4,717 5,026 5,355 5,705 6,079 21 Sacaba 15,318 16,650 2,736 2,916 3,106 3,310 3,526 3,757 4,003 4,265 22 Puruta 12,729 13,936 2,274 2,305 2,336 2,368 2,400 2,432 2,465 2,499 Q - -Q 3*29...ss,aX. -.,! ....... ......3........ 35 23 Oruro 193,194 199,124 32,726 33,530 34,355 35,199 36,084 36,951 37,959 38,790 24 Hi'urdn 14,313 15,558 2,557 2,527 2,498 2,469 2,440 2,412 2,394 2,368 :P.O1, ... . .. .......... .......... ....... : .......... 2 6j g :: ,14;4::::35. ; ........94::3.5. 25 Potosl 112,291 122,055 20,060 20,532 21,015 21,509 22,016 22,534 23,064 23,607 26 Vllbon 23,400 25,435 4,190 4,348 4,519 4,697 4,893 6,077 5,279 5,487 27 Ualmua 23,215 25,234 4,147 4,147 4,146 4,145 4,145 4,144 4,144 4,143 29 Tuplz 20,195 21,951 3,609 3,754 3,906 4,064 4,228 4,400 4,578 4,763 29 LMurd 11,301 12,294 2,019 2,049 2,078 2,109 2,139 2,171 2,202 2,235 30 Trta 56,919a 61,867 10,168 10,641 11,136 11,656 12,197 12,765 13,359 13,961 31 Rlbermlta 41,584 45,200 7,429 7,846 8,297 8,753 9,245 9,764 10,313 10,892 32 Guyarartn 26,779 29,107 4,784 5,016 5,261 5,517 5,7s5 6,067 6,382 6,671 33 S.A.Yaaurre 14,731 16,012 2,632 2,900 2,979 3,169 3,372 3,587 3,917 4,061 ............ ........... .:****.:.,~* ~: * * k'.... , P .:: ..::-::::;4::: ...4 : ::1; 2-::: e7: ........2s51::: I.... I :: ...I.... .. : ............ : 34 Cob&I 9,973 10,840 1,792 1,897 2,020 2,151 2,291 2,439 2,597 2,766 TOTAL 3,314,262 592,063 619,772 646,981 676,596 707,753 740,539 775,043 811,362 * Asmr ta Ms COneus cmMited OM 9% of dthe Popagon - *! ChMn I mcnVh b yews represert 16.43% of thI Popuaicn  BOLIVIA INTEGRATED CHILD DEVELOPMENT PROJECT Table 2: PROJECT TARGETS Total Day-Care Centers Opening Year 1994 1995 1996 1997 1998 1999 Period New Cumulative New Cumulative New Cumulative New Cumulative New Cumulative New Cumulative PPF 250 January - April 151 401 246 949 392 1,833 624 3,241 696 5,185 697 7,276 May - August 151 552 246 1,195 392 2,225 624 3,865 697 5.882 697 7,973 September - December 151 703 246 1,441 392 2,617 624 4,489 697 6,579 697 8,670 TOTAL 453 738 1,176 1,872 2,090 2.091 -~. - - - - -. - ' Total Beneficiary ChildrenNear 1994 1995 1996 1997 1998 1999 Period New Cumulative New Cumulative New Cumulative New Cumulative New Cumulative New Cumulative PPF 3.750 January - April 2.265 6.015 3,690 14.235 5.880 27,495 9.360 48.615 10,440 77,775 10,455 109,140 May - August 2,265 8,280 3,690 17,925 5,880 33,375 9,360 57,975 10.455 88.230 10,455 119.595 September - December 2.265 10,545 3.690 21,615 5,880 39,255 9,360 67,335 10,455 98,685 10,455 130,050 TOTAL 6.795 11,070 17,640 28,080 31,350 31,365 Annual Promotion 2,109 4,323 _ 7,851 13,467 1 19.737 26,010 Cumulative Promotion 2,109 _ 6,432 14.283 . 27,750 47,487 73,497 Total Coverage 12,654 28,04? 53,538 95,085 146,172 203,547 Total Caregivers/Year 1994 1995 1996 1997 1998 1999 NNew TCumulativ New |Cumulative Now |Cumulatives New ICumulativel New |Cumulative| New iCumulativel TOTAL 1,6871 1,887 1,7711 3,458 2,8221 8,280 4,4941 10,7741 6,0181 15,790 5,018| 20,808 TOTAL 3vdse~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~I  - 50 - ~~~~~~~~~Anex 2 BOLIVIA INTEGRATED CHILD DEVELOPMENT PROJECT Table 3: POPULATION AT RISK I Malnourished Children Ages Six Months to Six Years) M ALNOURISHED POPULATiON (S months tog years) Pr.valwmc of CITIES Malnutrition 1992 1993 1994 1995 1996 1997 1998 1999 .L P.. ..:.::::::: ,::::: ........ ..........:.:..: :: a 8381.:.83,26? :62. 6 .....9,56 s.9. ;as4:**.. 99,..7: 1 La Paz 48,636 49,481 50,340 51,214 52,104 53,008 53,929 54,865 2 El Alto 27,659 30,271 33,129 36,258 39,681 43,429 47,529 52,017 3 Viacha 1,300 1,354 1,411 1,469 1,531 1,595 1,661 1,731 iSANTA CRU 2g ::: ::9.q:18%: : .,s2t::.:..::44,6ss::::47,s7i:.::0,87. 54::3~9B.I.::.51,504< : Si 25:, s:65:.2;3: 4 Santa Cruz 34,968 37,231 39.640 42,206 44,937 47,845 50,942 54,239 5 Moraero 2,755 2,869 2,987 3,110 3,238 3.372 3,510 3,655 6 CanIri 1,414 1,446 1,479 1,514 1,548 1.584 1,621 1,659 7 S.I.Volasoo 635 674 715 75ii 805 854 906 961 a Minorco 559 580 601 623 645 669 693 718 9 Warnes 553 596 622 659 699 741 786 934 10 Robor? 521 535 549 564 579 594 610 626 II P.Suarez 515 545 575 609 642 678 717 7S7 A .iJA ::.... .. 30.58% 8,385 8,881. .. 3,406 ., 9,963. tO,553 . ill 7 :. 0t1,839.: 1259 12 Tarlis 4,923 s.188 5,469 5,762 6,073 6,400 6,745 7.109 13 Yaajiba 1,696 1,812 1,936 2,068 2,209 2,360 2,521 2,693 14 Beramjo 1,164 1,210 1,258 1,308 1,360 1,413 1,469 1,527 15 Vlllamrrones 601 625 649 674 700 727 756 79s Bf&JUlSACA:---::: :::33 sN:::9,0s23:::9.::439:.:.. sB7:: .10,30 :::: t097. 1? : :l:30oe :3:1:t.628 :.:12!7a:7 16 Sucre 9,023 9,439 9,875 10,330 1 0,807 11,306 11,928 12,373 suc..~ ~~~~~~~~~....... . ..2 . . . . .. . . . .. .... . . . ... . . . . . . . . . .. . . .. CQCF AAMBA.... 3s.3sr- : 3,178. :i::::a4: 3 6.saa: ~,58. :39a;22 .. 4a349.:~ 42,372 .: 44,486 :.::e7 17 Cochabamba 25,s48 26,657 27.815 29,023 30,283 31,s99 32,971 34,403 19 El. Oullaoollo 1,812 1.902 1,996 2,095 2.199 2,309 2,423 2,543 19 ouliltalIo 2,665 2.797 2,936 3,082 3,235 3,395 3,564 3,741 20 Ei Sacaba 1,380 1,470 1,567 1,669 1,779 1,895 2,019 2,151 21 Sacraba 968 1,032 1,099 1,171 1,249 1,330 1,417 1,509 22 Punats 805 816 827 838 849 861 872 984 ~RUR~. *::. .39.33%. :....:t3~77.: : 1:977..:: .138.. ..... ...77.... . .. .....:... .8. .. ... .... ...... ... 23 Oruro 12,671 13,188 13.512 13,644 14,184 14,533 14,890 15.256 24 Huanirn 1,006 994 9s2 971 960 949 937 927 F2 O:.::.::::::::4342 ' ':.:::e?s:::!,s:::sA3::abq::.627::l, t3:.::::: 0e:::::.is 25 PotosI 9,690 1,s94 9,104 9,319 9,s37 9,762 9,991 10,226 26 Villazon 1,811 1,883 1,957 2,035 2,115 2,199 2,286 2,377 27 Uallagua 1,797 1,796 1,796 1,796 1,796 1,795 1.795 1,795 29 Tupiza 1,563 1,626 1,692 1,760 1,632 1,906 1,983 2,063 29 Uyunr 875 e97 900 913 927 940 954 969 BE .::...::: ..::. .. : . .:.:.:: .....: ::: 7. 451.............. .. . .........: 3.::. : . :. .9809 .:. . . ..: 9848 ::!. ::: . ... . t 30 TrInIdad 3,029 3,170 3,318 3,472 3,634 3,803 3,980 4,165 31 Rberalia 2,213 2,337 2,469 2,607 2,754 2,909 3,072 3,245 32 Guayaramerin 1,425 1,494 1,567 1,643 1,723 1,907 1,9ss 1,987 33 S.A.Yacura 784 834 s87 944 1,004 1,069 1,137 1,210 ...... :::: ................. 09.......42...... ...7...5 6S.. ::::::qs..4::.:::.::.5.. 7... 34 Cobila 449 478 509 542 577 615 654 697 TOTAL 206,613 215,526 224,885 234,714 245,037 255.882 267,275 279,249  - 51 - Annex 2 Table 4: Beneficiary Pregnant Women 15 - 49 Age Group Potential Pregnant Women 15 - 49 Age Group CITIES 1992 1993 1994 1995 1996 1997 1998 1999 LA PAZ 7,417 7,751 8,113 8,501 8,919 9,370 9.857 10,381. 1. La Paz 4,649 4,729 4,811 4,895 4,980 5,067 5,155 5,244 2. El Alto 2,644 2,893 3,167 3,466 3,793 4,151 4,543 4,972 3. Viacha 124 129 135 140 146 152 159 165 SANTA CRUZ 3,106 3,295 3,496 3,707 3,936 4,174 4,429 .4,701 4. Santa Cruz 2,591 2,759 2,937 3,127 3,330 3,545 3,775 4,019 5. Montero 204 213 221 230 240 250 260 271 6. Camiri 105 107 110 112 115 117 120 123 7. S.1 Velasco 47 50 53 56 60 63 67 71 8. Mineros 41 43 45 46 48 50 51 53 9. Wames 41 43 46 49 52 55 58 62 10. Robor 39 40 41 42 43 44 45 46 11. P. Suarez 38 40 43 45 48 50 53 56 TARIJA 618 652 687 724 763 804 . .. 848 894 12. Tanla 363 383 403 425 448 472 498 524 13. Yacuibo 125 134 143 153 163 174 186 199 14. Bermejo 86 89 93 96 100 104 108 113 15. Villamontes 44 46 48 50 52 64 56 58 CHUQUISACA 712 745 779 815 853 892 933 .-976. 16. Sucre 712 745 779 815 853 892 933 976 COCHABAMBA 2,949 3,082 3,220 3,365 3,517 3.677 3,745 - -. 4.:4019 17. Cochabamba 2,270 2,369 2,472 2,579 2,691 2,808 2,930 3,057 18. Eie Qillacollo 161 169 177 186 195 205 215 226 19 Quillacolo- 237 249 261 274 287 302 217 332 20. Ee Sacaba 123 131 139 148 158 168 179 191 21. Sacaba 86 92 98 104 111 118 126 134 22. Punata 72 72 73 74 75 76 78 79 ORURO 1,279 . 1,307 1,336 1,364 - 1.395- 1,426 - -1,458:- 1.4911 23. Oruro 1,186 1,215 1.245 1,275 1,307 1,339 1,372 1,406 24. Huanuni 93 92 91 89 88 87 86 85 POTOSI 1,247 1,277 1,308.- 1,339 1.372: .. 1,406: 1441 1,476 25. Potosi 736 753 771 789 808 827 846 866 26. Villazon 163 159 168 172 179 186 194 201 27. Llallagua 152 152 152 152 152 152 152 162 28. Tupiza 132 138 143 149 155 161 168 176 29. Uyuni 74 75 76 77 78 80 81 82 BENI 625 657 690 727 764 805 ..:..846 889 30. Trinidad 254 266 278 291 305 319 334 349 31. Riberatta 186 196 207 219 231 244 258 272 32. Guyaramerin 119 125 131 138 144 152 159 167 33. S.A. Yacuma 66 70 74 79 84 90 95 101 PANDO 38 .40 43 45.. .48 ..2 -: 55 34. Cobrp.- 38 40 43 45 48 62 66 58 TOTAL' 17,991 18,806 19,672 20,587 21,667 22,606 23,612 24,886 TOTAL PROJECT BENEFICIARIESk(umJadvef' 67 347 1,081 2,375 4,528 7,695 11,609 16,057 COVERAGE(%)' 0.4 1.9 5.5 11.7 21.3 34.7 50.2 66.6  BOLIVIA INTEGRATED CHIILD DEVELOPNMENT PROJECT SECTOR POLICY AND MANAGEMENT STRENGTHENING COMPONENT Modernization of ONAMFA Matrix of Objectives, Outputs and Costs Timing Area ObjcAtives Activilies/Output (IProjcct Ycar) Costs (base cost) 1. Technical Assistaice to Supervise To provide continuity and technical Appointment of Advisor PY 1-3 36 months local consultant = USS72.000 Modemrizaticn Program supervisicn for modrenization activities, position to coordinate including civil service reform process restructuring activitics