Papua New Guinea - Population and Family Planning Project

Document of The World Bank FOR OFFICIAL USE ONLY Report No. 11264-PNG STAFF APPRAISAL REPORT PAPUA NEW GUINEA POPULATION AND FAMILY PLANNING PROJECT MARCH 12, 1993 Country Department III East Asia Regional Office 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 - Kiiia (PGK) US$1.00 = PGK 0.95 I Kina = US$1.045 (December 1992) FISCAL YEAR January 1 - December 31 ABBREVIATIONS ADB - Asian Development Bank AIDAB - Australian International Development Assistance Bureau AMS - Area Medical Store ASH - Assistant Secretary of Health CR - Civil Registration DFP - Department of Finance and Planning DRHAY - Department of Religion, Home Affairs and Youth DPM - Department of Personnel Management FAS - First Assistant Secretary FP - Family Planning HCMU - Health Curriculum and Media Unit IMR - Infant Mortality Rate IPPF - International Planned Parenthood Federation KBO - Keyboard Operator MCH - Maternal and Child Health MMR - Maternal Mortality Rate NACPP - National Advisory Committee on Population Policy NCD - National Capital District NDOH - National Department of Health NEC - National Executive Council NGO - Non-Government Organization NPC - National Population Council NSO - National Statistical Office PDOH - Provincial Division of Health PDF - Provincial Division of Finance PDS - Provincial Data System PEC - Post Enumeration Check PIP - Public Investment Program PIU - Project Implementation Unit PNG - Papua New Guinea PNGFPA - Papua New Guinea Family Planning Association PNGIMR - Papua New Guinea Institute of Medical Research PPU - Population Planning Unit PSC - Project Steering Committee PSS - Pharmaceutical Services Section SEATS - Service Expansion and Technical Support Project STD - Sexually Transmitted Disease TFR - Total Fertility Rate UNDP - United Nations Development Program UNFPA - United Nations Population Fund UPNG - University of Papua New Guinea USAID - United States Agency for International Development WHO - World Health Organization  FOR OFFICIAL USE ONLY DEFINITIONS Child Mortality Rate Number of deaths of children under five years of age per 1,000 live births in a given year. Contraceptive Prevalence Proportion of married women of reproductive age (1544) estimated to be using contraceptives. Crude Birth Rate Number of live births per year per 1,000. Crude Death Rate Number of deaths per year per 1,000. Rate of Natural Increase Difference between crude birth and crude death rates; usually expressed as a percentage. Rate of Population Growth Rate of natural increase adjusted for (net) migration, expressed as a percentage of the total population in a given year. Total Fertility Rate The average number of live children that would be born per women if she were to live to the end of childbearing years and bear children according to a given set of age-specific fertility rates. The Total Fertility Rate serves as an estimate of the average number of children per family. Net Reproduction rate The number of live born daughters a cohort of females would bear under a given fertility schedule and a given set of survival probabilities, from birth to the end of childbearing years. Infant Mortality Rate Annual number of deaths of infants under one year per 1,000 live births during the same year. Maternal Mortality Rate Number of maternal deaths in a given period divided by the number of live births during the same period. The maternal mortality rate is usually expressed per 1,000,000 live births. 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.  I I  PAPUA NEW GUINEA POPULATION AND FAMILY PLANNING PROJECT LOAN AND PRoJECr SuMMARY Borrower: Independent State of Papua New Guinea Amount: US$6.9 million equivalent Terms: Repayable in 20 years including 5 years of grace at the Bank's standard variable interest rate. Project Desciption: The principal objectives of the project are to create the capacity to bring the rate of population growth into balance with the potential for better human resource development and to improve the health of mothers and children through greater use of family planning and related maternal services. The project will support the implementation of the Government's population policy announced in March 1991. A program approach has been adopted which will (i) develop the institutional capcity to foster and manage a comprehensive population program; (ii) deliver effective family planning services; (iii) generate an increased demand for family planning; and (iv) mobilize public awareness and support for the program through government and non-government channels. The project will significantly contribute to improvements in female reproductive health, thus female health in general. The legitimacy of family planning will be strongly enhanced leading to overall improvement in the social welfare of the current generation and ultimately to macro-economic and environmental benefits from moderated population growth. While Government policy aims to provide better family planning services nationwide, in the initial phases program strategy will direct efforts to areas of highest population density. Improved family planning services will be fostered through (i) provision of improved facilities for family planning delivery and counselling, including appropriately equipping the facilities; (ii) operational support for management and supervision; (iii) staff training in clinical and communication skills; and (iv) incremental staffing. The provision of family planning services and the overall  - ii - population program will be supported through (i) improved logistics and contraceptive supplies; (ii) enhancement of non- government organizations capabilities in this sector; (iii) development of a health promotion center; (iv) population and family planning research; (v) improved collection of demographic data including a demographic health survey in 1995; and (vi) management and program monitoring and evaluation activities. Benefits: The Government will be assisted in providing effective family planning services, improving the reproductive health of women and, in the longer term, leading to a moderation in population growth. This is expected to contribute towards enhanced socio- economic development and amelioration of social problems related to high fertility levels. Environmental management may expect to benefit from a moderated rate of population growth. Risks: There is broad support within the community for a population program. However, expectations of any rapid decrease in fertility have to be tempered by experience from other countries and particularly by recognition of the low educational attainment and restricted access to information characteristic of PNG. A long term and sustained effort will be required which may test political resolve and which emphasizes the need to deeply involve community based organizations. In the short term, institutional issues are a concern for management capabilities within the responsible agencies remain weak. Project Costs: Local Foreign Total --------------------- US$ million--------------------- Provincial Family Planning 7.4 4.8 12.2 Service Delivery Program Support 5.8 9.5 15.3 Baseline Cost 13.2 1. 27.5 Contingencies: Physical 0.6 0.7 1.3 Price Increase 2.3 1.6 3.9 Subtotal 2.9 2.3 512 Total Proiect Cost 16 1 27 L/ Includes local taxes estimated at US$150,000 equivalent.  - iii - Fmnancing Plan: Local Foreign Total - -------------- US$ million --------------------- Government 5.4 3.6 9.0 IBRD 2.8 4.1 6.9 ADB 2.9 3.9 6.8 AIDAB 5.0 5.0 10.0 Tota 161 32.7 Estimated Disbursements: Bank FY 1994 1995 1996 1997 1998 1999 ------------------------------- US$ million - --------------------------- Annual 0.7 1.0 1.4 2.0 1.2 0.6 Cumulative 0.7 1.7 3.1 5.1 6.3 6.9 Economic rate of Return: Not applicable   - iv - CONTENTS Page No. 1 POPULATION AND HEALTH POLICIES, STRATEGIES AND PROGRAMS .......................... 1 A. Population Characteristics and Trends ....................... 1 B. Population Policy ................................... 2 C. Health Status and Policies .............................. 3 D. Public Expenditure on Population, Health and Family Planning Activities ............................. 4 E. Administrative Structure for Population and Family Planning Policy Implementation ..................... 5 F. Family Planning Service Delivery ......................... 6 G. Non-Government Sector ............................... 8 H. Family Planning Program Issues .......................... 10 I. External Assistance.11 J. Bank's Role and Strategy ............................... 11 K. Environmental Considerations ............................ 12 2 THE PROJECT ...................................... 13 A. Origin of the Project ................................. 13 B. Project Objectives and Scope ............................ 13 C. Project Description .................................. 14 D. Monitoring & Evaluation, Management & Implementation .... ...... 21 This report is based on the findings of an appraisal mission that visited Papua New Guinea in April/May 1992 comprising Dr. M. Porter (mission leader); Ms. M. Masuda (operations assistant); Dr. J. Hohnen (public health specialist - AIDAB); Ms. C. McMurray (demographer - AIDAB); Mr. R. Hoffman (project economist - ADB); Mr. Mark Turner (consultant - management specialist); Mr. Ved Kumar (consultant - pharmaceutical specialist); Ms. Cecilia Verzoza (consultant - health promotion); Ms. Marjorie Andrew (consultant - PNG project preparation coordinator); and Dr. Mellie Samson (on assignment from the National Department of Health). Peer reviewers were Ms. A. Hill (SA2PH) and Mr. C. Walker (SA3PH). The project was endorsed by Mr. Clifford Gilpin, Chief, EA3PH, and Ms. Marianne Haug, Director, EA3.  Page No. 3 PROJECT COSTS, FINANCING, PROCUREMENT AND DISBURSEMENT 25 A. Cost Estimates ..................................... 25 B. Financing .......... .............................. 28 C. Procurement ...................................... 29 D. Disbursements ..................................... 31 E Accounts, Audits and Reports ............................ 32 4 BENEFITS AND RISKS ................................. 33 A. Benefits ......................................... 33 B. Risks ........... ................................ 33 5 AGREEMENTS REACHED AND RECOMMENDATION ..... ...... 34 TABLES IN TEXT 1.1 Percentage of Methods Adopted by New Acceptors By Year. 7 3.1 Summary of Project Costs by Component .25 3.2 Summary of project Costs by Category of Expenditure .26 3.3 Financing Plan .29 3.4 Procurement Arrangements .30 ANNEXES 1. Family Planning Service Delivery - Detailed Description .35 2. New Staff Positions .49 3. Detailed Schedule of Training Activities .51 4. Technical Assistance - Terms of Reference .55 5. Organogram of Health Promotion Center .70 6. Organogram of Program Management .71 7. Project Management - Detailed Description .72 8. Implementation Schedule .81 9. Monitoring and Evaluation Program .84 10. Supervision Plan .87 11. Detailed Cost Tables .89 12. Summary of Technical Assistance Program ................... 92 13. Year and Source of Funding for Technical Assistance .94 14. Schedule of Disbursements .95 15. Selected Documents Available in the Project File .96 MAP: IBRD Map No. 24125  POPULATION AND HEALTH POLICIES, STRATEGIES AND PROGRAMS A. POPULATION CHARACTERISTICS AND TRENDS 1.1 Population Size and Growth. The first complete enumeration of the population of Papua New Guinea (PNG) was undertaken in 1980, recording a total of 3,010,727 persons, 99 percent of whom were citizens of the country. The population was characterized by its youth (over 43 percent were under 15 years of age), its rurality (some 87 percent lived in rural areas) and its low life expectancy (49.6 years for both sexes). Of the four political regions, that of the Highlands carried 37 percent of the total population with a relatively dense (45 persons per sq km) but scattered settlement pattern. Internal migration was found to be substantial, with the National Capital District (NCD) and the island provinces being poles of attraction due to better employment opportunities. More recently, migration has been towards the plantation economy of the Eastern and Western Highlands Provinces, the oil palm resettlement areas in West New Britain and Northern Province, and the mineral industry. 1.2 The 1990 census excluded North Solomons Province, but a preliminary hand count of the 19 provinces where the census was carried out yielded a total of 3.6 million. Of these, 3,511,700 are presumed to be citizens, compared with 2,881,933 citizens in the 19 provinces in 1980. This suggests an average growth rate of just under 2.27 percent, which is the figure currently used in official releases. However, it is widely agreed by researchers that both censuses undercounted the population; the 1980 census by about 8 percent and the 1990 census by more, so they cannot be compared without adjustment. 1.3 A post enumeration check (PEC) found that the 1990 census was completed in only 12,730 census units of a total of 13,937, excluding North Solomons Province. Up to 65 percent of households in the PEC yielded different results from the census. From this it was estimated that the total population could be between 3.9 and 4.6 million, depending on the assumptions made about the level of accuracy in census units that were not checked. A conservative assumption of 10 percent under-enumeration in 1990 yields a growth rate of 2.5 percent in the intercensal period, but the most recent estimates place the growth rate closer to 3.0 percent. I/ The official result of the 1990 census is expected in April 1993. 1.4 Population Projections. As estimates of fertility and mortality for the 1980-1990 intercensal period are unavailable, population projections can only be speculative. A rough 1/ The estimated annual growth rate for PNG compares with neighboring Melanesian countries. The average annual growth rate for Solomon Islands 1976-1986 was 3.5 percent, and that for Vanuatu 1979-1989 3.1 percent.  - 2 - guide is that a total population of 4 million in 1990 growing at an average rate of 2.5 percent per annum would exceed 6.5 million by 2010. If the average growth rate is about 3.0 percent the population size in 2010 would be around 7.3 million. If, as is likely, the PNG population actually exceeded 4 million in 1990, the corresponding figures would be larger. 1.5 Fertility. The national total fertility rate is still officially estimated at around 5.3 children per woman, the figure derived from the 1980 census. That corresponds with a Crude Birth Rate (CBR) of 35 per thousand. There was, and continues to be, considerable variation between provinces, from below 5 children per woman in the Highlands to 6.8 in West New Britain. At present there are no new data available to assess trends, but since most areas of Papua New Guinea had traditionally controlled the number and spacing of children through periodic abstinence (facilitated by polygamy), it is possible that the TFR has increased as modernization erodes these practices. In addition, expected improvements in health care are also likely to result in further increases in fertility, especially in the Highlands, where high levels of sexually transmitted disease contribute to lower fertility levels. 1.6 Mortality. Improvements in nutrition, living conditions and health care have resulted in a rapid decline in the crude death rate, now estimated to be in the order of 13 per thousand. The infant mortality rate (IMR) declined by 50 percent between 1971 and 1980, to about 72 per thousand live births and the child mortality rate to 42 per thousand. These rates are still relatively high and considerable improvement is possible in the coming years. Together with other improvements in age-specific mortality, the average life expectancy of the population at large is expected to improve from its low level of 50 years in 1980. Estimates of maternal mortality rate (MMR), varying from 2 per thousand in urban areas to 5 per thousand in accessible rural areas and up to 12 per thousand in remote parts of the country, lead to an informed guess of about 7 maternal deaths per thousand live births (among the highest in the world) for the country as a whole. 1.7 Vital Events. Despite a Civil Registration Act, there is no effective registration of vital events in PNG. A system of birth registration was introduced into the Southern Highlands in 1987 and, in 1989, into Milne Bay to provide estimates of fertility and infant and child mortality. The system has been described as incomplete. Civil registration activities come under three pieces of legislation, the Civil Registration Act, the Marriage Act and the Printers and Newspaper Act; responsibility for this legislation rests with the Registrar General at the Department of Religion, Home Affairs and Youth (DRHAY). With a staff of 10, the Registrar General had no operating budget for 1992 due to administrative changes carried out in January 1992. The Government has indicated that the registration of births, marriages and deaths should be enforced. This would prove difficult in practice and it is not expected that a vital registration system will be an effective tool for monitoring vital events in the foreseeable future. B. POPULATION POLICY 1.8 Antecedents. Moves toward a population policy were made at the time of Independence in 1975 leading to a submission to National Executive Council (NEC) to adopt a population policy in 1978. The NEC did not endorse the proposed policy on the grounds that it had not been generated endogenously, that there were adequate land resources and that large families were required for security reasons. There were also internal organizational disputes over responsibility for jurisdiction. In 1980, a Family Planning and Population Coordination Committee was formed to develop a demographic research program but this initiative was  - 3 - quickly abandoned. In 1987, the NEC directed that a National Advisory Committee on Population Policy (NACPP) and a population policy unit be established within the Department of Finance and Planning (DFP). In May 1988, the "Guidelines Towards a National Population Policy" were submitted to the NACPP, but no further action was taken by that body. 1.9 Policy endorsement. In 1990, a Population Planning Unit (originally called the Population Planning and Coordination Unit) was established within the Social Affairs Division (now the Social Planning Division) of DFP and a document titled "An Integrated National Population Policy for Progress and Development" prepared and submitted to the NEC for consideration. On March 1, 1991, the NEC endorsed the policy expressed in the paper, approved the establishment of a National Population Council (NPC) by legislation, directed the National Department of Health (NDOH) to be actively involved in implementing a national family planning program, endorsed the involvement of the provincial governments, and directed that the membership of the NACPP be reduced to a manageable number. Since the NEC meeting, the Government has accepted the recommendation contained in the Bank's sector report 2/ which proposed that the NACPP should not be resurrected and that only one central body be retained, the NPC. 1.10 Policy directions. The population policy is anchored in the view that it is necessary to view population in the context of the country's broader development concerns and that the current rate of population growth inhibits the achievement of social and economic development. Particular concerns to the Government are that: (i) the maternal mortality is high compared to other countries at the same level of development; (ii) the dependency ratio is projected to double between 1980 and 2015, from 0.8 to 1.6 dependent for each working age adult; (iii) the economy has to generate employment for ever larger cohorts of labor entrants which are insufficiently trained for non-agricultural jobs; and, (iv) the challenges involved in generating human capital in a situation of competition for investments with the quantitative increases in the school age populations. Consequently, a program to implement the population policy would aim to improve family welfare, by providing accurate and timely information and services to support individual couple's fertility decisions, as well as to reduce fertility and maternal and infant mortality. Ultimately, these health and welfare measures would also reduce the rate of population growth. C. HEALTH STATUS AND POLIcEES 1.11 Mortality and Morbidity. Although health statistics are unreliable, small scale studies and hospital and health center data indicate that infectious diseases continue to be the leading cause of death. The proportion of deaths due to pneumonia has seen an upward trend and was the leading cause of institutional deaths at 21.9 percent in 1988 followed by malaria at 9.2 percent. Tuberculosis also shows an upward trend and contributed 5.5 percent of institutional deaths while perinatal mortality contributed about 8.5 percent. Few reliable data are available on morbidity patterns. One indicator is that 30 percent of hospital and health center admissions were for infectious diseases. Only about 35 percent of deliveries are supervised by trained health care providers making estimates of maternal mortality and morbidity somewhat of an educated guess. The three most prevalent reported causes of maternal mortality are 2/ Papua New Guinea. Management, Manpower, Money: A Select Review of Health and Population in Papua New Guinea. February 25, 1991.  - 4 - puerperal sepsis (25 percent), postpartum hemorrhage (22 percent) and associated medical/surgical conditions (20 percent). 1.12 Sexually Transmitted Diseases (STD). Because of their impact on fertility and maternal and child health, mention must be made of the high endemicity of STDs in PNG, in particular gonorrhea and syphilis. Other increasingly recognized STDs are chlamydia and genital herpes. Hospital statistics show a strong relationship between STDs, stillbirths and infertility among specific population groups, the highland region being the most affected. The first case of AIDS in PNG was reported in 1987 and reported cases of HIV cases have nearly doubled in each succeeding year. The predominant pattern of HIV transmission is through heterosexual contacts. D. PUBLIC EXPENDnTURES ON POPULATION, HEALTH AND FAMILY PLANNING AcnVTvEs 1.13 Recurrent Budget. In 1990, public expenditure on health accounted for 10.3 percent of total government expenditure and 3.3 percent of GDP. Between 1985 and 1990 real public expenditure on health increased by 2.5 percent annum between 1985 and 1990 but expenditure decreased over this period in per capita terms. Approximately 88 percent of total recurrent expenditure on health is currently financed by public tax revenues. The fluctuations of the macroeconomy and the country's high population growth rate both indicate the need for PNG to enhance the equity and efficiency of resources allocated for health programs. 1.14 Efforts to monitor general expenditure trends for the health sector or to break out the relative share of sectoral expenditures devoted to specific programs, such as family planning, in PNG are complicated by (i) the sharing of financing and expenditure responsibilities between the NDOH and the provincial Divisions of Health (PDOH); and (ii) the budgeting procedures. After decentralization in 1983, NDOH retained control of recurrent budget only for planning and policy formulation, training, pharmaceutical supply and distribution, programs designed to monitor health sector performance and a limited number of facilities. Control of the recurrent budget for almost all other programs, including rural and family health programs passed to the PDOHs. At present, it is not possible to isolate expenditures on family planning programs by the PDOHs which, under the non-uniform budgetary practices now in use, may incorporate expenditures for such activities under various aggregated budgetary categories including extension services, rural health and church health services. A 1988 survey of expenditures and work patterns at health centers and sub-centers bears out the relative lack of attention paid to family planning services at present. It was estimated that family planning services accounted for less than 2 percent of recurrent expenditures at both the health center and sub-center level. 1.15 Investment Budget. Health sector investments included in the 1989 Public Investment Program (PIP) for 1990 amounted to 10.1 percent of total government investment. Closure of the Bougainville Copper Ltd. mine and its impact on government revenue and fiscal balance led to severe cuts in the PIP. The provisions made for the health sector declined to 3.9 percent of total government investment for 1990, and a further downward adjustment of the budget was made during 1990 which in particular affected the rural health services. The allocation of projected investment resources for health during the 1993-1997 period are expected to rise to about 5.6 percent annually.  -5 - 1.16 Foreign Assistance. Foreign assistance for the health sector is about twice the level of government investments (PGK 8.7 and PGK 4.3 million respectively for 1990). About half of these investments are for urban health services and a further 28 percent for rural services. The rest is mainly for specific disease control activities such as AIDS and Expanded Program of Immunization (EPI) with only limited support for population and family planning activities (see also paras.1.42-1.44). E. ADMINIsTRATivE STRUCTURE FOR POPULATION AND FAMILY PLANNING POLICY IPLEMENTATION 1.17 The National Population Council. The mandate of the National Population Council (NPC), as perceived by the NEC, will be to guide and monitor the implementation of the population policy and to ensure the incorporation of demographic factors into social and economic planning. The NPC will coordinate population activities between national and provincial levels of government. The composition of the NPC is given in Annex 7. Representation of the provinces on the NPC will be decided annually at the Provincial Premiers' Conference. Broader community representation on the NPC will be assured through inclusion of members drawn from interested organizations, such as the churches. 1.18 The Population Planning Unit (PPU) at the Department of Finance and Planning (DFP) will act as a secretariat for the NPC, organizing support from different constituencies, monitoring the progress of policy objectives, overviewing data collection and analysis and identifying and contracting policy research. Thus DFP, and expressly the PPU, will play a pivotal role in overseeing the implementation of the population policy and ensuring coordination between the NPC, the government departments responsible for implementation and those community based organizations interested in participating in activities related to the policy. Enabling provincial governments to include demographic considerations into the planning of economic and social development effectively is also a function of the PPU. 1.19 Under the population policy, the main intervention will be the provision of family planning services in the context of improvement of maternal and child health. The locus of responsibility for family planning is the NDOH and within NDOH, the Maternal and Child Health and Family Planning (MCHIFP) Unit of the Family Health Section of NDOH's Primary Health Services's Division. The Unit is staffed by four senior nurses and is responsible for a variety of functions provided in an integrated program of family health including policy direction, monitoring of FP activities, participation in training through contributing to curricula, and conducting some in-service training activities for both national and provincial levels and provide support for provincial in-service family planning training activities. There is no designated staff at the national level for family planning only. 1.20 The National Health Plan 1991-1995, a document prepared by NDOH with provincial assistance, provides the directions for provinces to pursue national health objectives including family planning. There is no direct control by NDOH over provincial divisions of health (PDOH). The Minister and Secretary of Health can only exercise influence and leadership in orchestrating a consensus and effective collaboration between the national and provincial governments in the implementation of the health and family planning policies. 1.21 Provincial Divisions of Health (PDOH). Responsibility for health and family planning service delivery is firmly located within the PDOH's which are responsible to the  - 6 - provincial governments. NDOH has little authority or influence on the allocation of health resources between provinces and between different health programs within provinces. The pattern of the organization and management of health services differs between provinces. Some provinces experimented with decentralization of authority to district level but have reasserted provincial control with the exception of Western Highlands Province. However, the locus of responsibility for family planning services between provinces is very similar. Generally, a MCHIFP Coordinator or Community Nursing Coordinator is responsible through the Provincial Nursing Supervisor to the Assistant Secretary of Health (ASH) for the operation of MCH/FP services. Thus, whatever the designation, there is a senior nurse in each province with specific responsibility for family planning. The provincial In-service Training Officer and Health Education Officer also contribute to family planning activities. F. FAMILY PLANNING SERVICE DELIVERY 1.22 Antecedents. The country's first family planning clinic was established in Port Moresby in 1963 by the Papua New Guinea Family Planning Association (PNGFPA), a member of the International Planned Parenthood Federation (IPPF). In 1967, the Public Health Department followed this initiative by providing limited family planning services through its facilities. After Independence, approval was given to establish a Family Planning Division within NDOH and a more systematic program began in 1978. Although marked by a serious effort to persuade politicians and community leaders of the need for family planning, it lost momentum with budget cuts and with decentralization of administrative responsibility for health services to the provinces in 1983. The number of new acceptors dropped from an average of 17,000 per annum between 1979 and 1983 to some 15,000 in 1984. With decentralization, NDOH's Family Planning Division was abolished and responsibility for providing family planning services was transferred to PDOH's. Many provinces chose to exercise their new authority by defining their own priorities and family planning was a major casualty of this exercise. The contraceptive prevalence rate in PNG is presently estimated to be less than 10 percent of married women of reproductive age, which is very low. 1.23 Service Delivery Outlets. The bulk of family planning services are delivered through the government network of health centers, health sub-centers and, to a small extent, aid posts. Those public services are complemented by a similar network run by various churches. The Government funds and manages about 72 percent of the health centers and 37 percent of the sub-centers, the balance are run by the churches with financial support from the Government through grants. Responsibility for the operation of the system and for liaison with the church network rests with the provincial governments. 1.24 Staff perceptions of the benefits of family planning for maternal and child health are limited and services are generally only provided following requests by clients. Thus, a proactive approach to prevention of reproductive risks is lacking. Previously, women were only allowed to accept family planning with the consent of their husbands but an advisory notice was issued in March 1990 which dispensed with the need for this consent. This notice aroused concern among staff who feel that the consent of the husband is needed to protect them from the possibility of compensation claims and even assault. Despite the advisory notice, use of consent forms remains widespread. This procedure is undoubtedly restrictive, since time and impetus are lost seeking spousal consent, but it could be turned to advantage in the development of an outreach system which does not exist at present. There is no follow-up of drop-outs for a number a reasons among which lack of transport and the law- and-order situation rank  -7 - prominently. Officially, unmarried people cannot obtain contraceptive supplies through the public system. 1.25 Demand for Family Planning Services. Improved transportation has increased access to towns, while improved education and general modernization are additional factors which have generated increased demand for family planning services in the major urban centers. Larger towns now offer family planning in their urban health clinics. While the frequency of family planning sessions is limited, the trend is towards the extension of hours and making family planning available on an every opportunity basis. Reports from health center staff indicate that demand for family planning services consistently exceeds supply of contraceptives and that method-switch is often used in response to shortages of specific types of contraceptives. This indicates that contraceptive use could increase significantly by meeting the unmet demand for family planning. Knowledge of family planning methods and outlets is still low however and large segments of the population need to be reached with information on family planning before informed choice can be exercised. 1.26 Contraceptive Logistics and Supplies. Shortages and interruptions in supplies and frequent changes in source of contraceptives, especially the oral pills, are common problems. Generally, supplies of contraceptives are more secure at urban clinic than at rural facilities. All health centers indent to a regional supply center for contraceptives and there is no overall control at district or provincial level. Contraceptive indenting depends on the person in charge and there are lapses in routine indenting procedures. Furthermore, requirements tend to be grossly overestimated by health center staff who have learned that only a proportion of the indent will be met. It is therefore difficult to quantify the real level of shortages. Private chemists in the urban centers provide some back-up in the event of a supply failure at the clinic although to what extent this source is used under these circumstances is unknown. 1.27 Contraceptive Mix. The policy is to make a variety of contraceptive methods available at both government and church service outlets, except that only information on the ovulation method is officially available at centers run by the Catholic Church. Among catholic and protestant acceptors of contraceptives, oral pills and condoms are used at about the same level. Based on government statistics, which are by no means accurate, Table 1.1 gives the percentage of methods adopted by new acceptors for the past five years, showing that the most commonly accepted method is the oral contraceptive, followed by Depo Provera injectable contraceptives and tubal ligation; comparable figures for earlier years are not available. Table 1.1: PERCENTAGE OF METHODS ADOPrED BY NEW ACCEPTORS BY YEAR Year IUD Pills Injection Condom Ovulation Tubal ligation Vasectomy 1987 2.2 55.5 26.6 2.6 5.3 7.4 0.4 1988 1.4 44.3 25.4 16.7 4.0 7.5 0.7 1989 1.5 54.6 26.0 3.7 6.2 7.9 0.1 1990 1.0 54.6 30.9 2.8 4.0 6.4 0.3 1991 1.0 43.6 33.1 4.3 7.2 10.1 0.7  - 8 - 1.28 Until July 1989, the use of Depo Provera was restricted to women who had more than four children because it was believed to be associated with higher levels of infertility compared with oral contraceptives. There is no scientific base for this belief. Although a revised policy instruction on this matter was issued by the Secretary for Health, its message has not percolated widely. A combination of indifference to the importance of family planning and strongly held personal views among service staff limits method choice by clients and thereby the efficacy of the program. Male and female sterilization services are available at hospitals but are usually offered only to clients who have at least four children and high risk mothers. Female sterilization far exceeds vasectomies. However, some mission hospitals report ready acceptance of vasectomy in selected areas. It is not known whether this indicates the potential acceptability of vasectomy in general or by specific cultural or religious sub-groups only. 1.29 Communications. Being a passive program, little attempt is made to inform and educate couples about family planning. Health Education as a specific program was largely abandoned on decentralization in 1983, although effort is now being made to re-introduce trained professionals. Articles on the benefits of modern contraception appear in the national newspapers (counterbalanced by the spread and publication of incorrect rumors), but clinics rarely display posters or notices. A series of family planning guides was produced by NDOH including one oh contraceptive methods and another on counselling for family planning. NDOH also produced four volumes on family planning methods intended for in-service training programs and distance learning. The extent to which these publications are currently used is limited. Recently, a Family Planning Guide was published with the assistance of USAID which was used for Training of Trainers. G. NON-GOVERNMENT SECTOR 1.30 Churches and Church Health Services. Churches and church organizations play an important role in the fabric of PNG society with, collectively, activities which reach into every corner of the country. The PNG National Council of Churches 2f has endorsed, in principle, the Government's new population policy with an emphasis on family welfare which encompasses the health of mothers and children. Interpretation of the means to achieve the policy's goals varies with each group but there is general advocacy for programs which improve the welfare of families and with most church groups this includes family planning to facilitate spacing of births in monogamous nuclear families. 1.31 Mission health facilities, located almost exclusively in rural areas, continue to play a critical role in providing health care and family planning services. Among the health centers, some serve as small district hospitals and are able to perform sterilizations. There is wide variation in the range of services offered, a function in part of the denomination which controls the facility. Many training centers for health workers are also run by the churches in conjunction with their clinical facilities. Church-run services are subsidized by government, but, despite this, many find it increasingly difficult to operate to an acceptable standard and a few have closed. The level of subsidy for individual facilities varies from year to year and decisions about allocation of subsidies made by the provincial authorities appear arbitrary. The level of 3/ The National Council of Churches has seven groups; the major ones are the Lutherans, United Church, Catholic Church, and Anglicans. The only major church group which is not a member is the Seventh Day Adventist Church.  -9 - support from outside PNG is diminishing and it has become more difficult to recruit expatriate staff on which many of the mission centers have relied in the past. Missions are recruiting more local staff now although they do not share the same benefits or opportunities for advancement as their government counterparts. 1.32 The Family Planning Association. The Papua New Guinea Family Planning Association (PNGFPA) was established in 1974 and is a member of the IPPF which is the source of about 60 percent of its funds. The Association has recently gone through a difficult period caused primarily by inexperienced staff and a lack of administrative routines. There are 16 full- time staff. The PNGFPA has a volunteer membership of some 60 persons with a head office in Port Moresby and branches in Morobe and East Sepik provinces. In 1988, the last year for which information is available, the PNGFPA ran 126 family planning sessions in rural areas and four in urban areas; only two of the urban clinics and none of the rural clinics function in premises owned by the Association. They provided services to just over 5,000 acceptors of which 49 percent use Depo Provera injections and 47 percent oral pills. 1.33 The PNGFPA runs an innovative mail order service for condoms which attracted 131 persons in 1988, despite a charge of 70 toya for a packet of 15. The Association also charges for oral contraceptives (50 toya per cycle) at the behest of the IPPF and is anxious to persuade the government to provide them with free supplies which might enlarge the clientele. It provides a range of information activities such as presentations at gatherings, translation of promotional literature from English into Pidgin and Motu, and promotion of an advertising spot on national TV. A small scale community based distribution scheme, funded by UNFPA, covers the recruitment, training and support of community distributors of contraceptives in East Sepik province. In 1988, there were 42 trained women who covered 61 villages and provided oral contraceptive services to some 1,600 acceptors. 1.34 Women's Organizations. Earlier this year, the NEC endorsed a National Women's Policy developed by DRHAY in collaboration with the non-governmental National Council of Women. The document says nothing specific about family planning, but the networking potential of the National Council of Women could provide a national family planning program with considerable support and promotional potential. In addition, the Women's Division of the DRHAY has recruited women to act as facilitators at the village level for various social programs on payment of an honorarium. The program is still weakly focused and under- supported but is a potential conduit for information and promotion of family planning and maternal and child health interventions in the community. 1.35 The Private Health Sector. From small beginnings, private health care provision by PNG nationals is steadily growing and has considerable potential for further growth. In 1989, there were 61 private medical practitioners (not all nationals), about 25 percent of all medical practitioners in PNG. Higher incomes, demand for quality curative care and facilities and growing insurance coverage by the population drive this development combined with the Government's consistent focus on primary health care. In addition, some mining companies and agro-businesses offer a full range of health care to their employees and their dependents. The Government intends to facilitate private provision of health care as it allows scarce public resources to be directed to the poor and to those who have not yet entered the cash economy. Private practitioners are not yet significantly involved in family planning service provision.  - 10 - 1.36 Traditional Health Care. In many areas, people still rely on traditional health care which is based on herbal medicines and spells. In those areas where access to modern health care is an option, a fair proportion seek out the help of traditional healers first and only turn to modem medicine when the complaints become more serious or persistent. Little research has been done on the active ingredients of traditional herbal remedies and traditional healers operate outside the modern system. Use of Traditional Birth Attendants is not widespread in PNG. H. FAMILY PLANNING PROGRAM ISSUES 1.37 Leadership and Management. Strengthening the national family planning program implies addressing the serious management, administrative and financial constraints affecting the delivery of health services in general and of FP/MCH in particular. It particularly requires influential leadership at the national level and a clear locus of responsibility at NDOH. On that basis, the national and provincial governments could develop a consensus on policy directions and agreement on effective administrative procedures, taking into account the relative advantages of central and decentralized responsibilities for aspects of staff development and service delivery. The complexities inherent in the decentralized structure of the health sector could then be turned to advantage and become a facilitating feature in involving communities in the design and implementation of programs. 1.38 Community Participation. Organizations rooted in the community and representing a broad cross-section of the population may be used in the dissemination of family planning knowledge, legitimizing its use and facilitating adaptation of services to the needs of widely diverse cultural groups in PNG. Central management cannot be expected to be sufficiently attuned to the specificities of local values and norms affecting family life throughout the country. In addition, ways must be found to communicate with and involve over 700 different language groups, which again points to the need for decentralized responsibilities. Health care staff and volunteers from church and other community based groups may be best placed to establish rapport with clients and meet their expectations. As family planning is still an innovation to the large majority of the population, feedback on program performance is especially important to learn from experience and identify best practices and failures expeditiously. 1.39 Outreach. Major efforts must be made to reach couples with information, advise and services on family planning. Given the distribution of the population and its rurality, that is a major challenge to be faced. Problems of staffing and communications, exacerbated by the stringencies of financial shortages and the prevailing law-and-order problems, militate against a successful outreach program. In such conditions, a successful outreach program will depend on active support from local leaders for family planning services. In the present situation, clinic staff only respond to the enquiries of interested groups and individuals for information and talks. In developing a more active strategy, staff should be encouraged and rewarded for involving community groups actively in the promotion of family planning. This work will, at first, make heavy demands on staff time, but the objective should be to switch the onus of motivation to the community groups themselves. The NDOH could lead this effort by establishing closer and more formal linkages with the PNGFPA, the Women's Council, church groups and others. Community involvement is critical in changing attitudes which can often be done better by voluntary organizations rather than government staff.  - 11 - 1.40 Innovations. In addition, the program must support local innovations to spread knowledge and motivation. In several provinces, such as Western and Eastern Highlands, plantation agriculture is well developed and plantation management could be encouraged to be involved in motivational work if not in providing services. Small stores are dotted throughout the country; their potential as supply agents for condoms and pills is being tested through a USAID supported Social Marketing project. 1.41 Another opportunity would be to link up with the initiatives to increase the number of supervised deliveries. Women, and men, are most receptive to advice on spacing (and stopping) of births in the postpartum period. Given PNG's strong traditions of long birth intervals and periods of breastfeeding, development of a postpartum family planning effort seems to have major potential. In addition, maternity waiting houses which serve remote populations should be utilized for health education and family planning information with due regard for meeting re-supply requirements. I. ExTERNAL AssLSANciE 1.42 United Nations Population Fund (UNFPA). External assistance for family planning commenced with UNFPA's support for training and contraceptives in 1974 which was followed later by an MCH/FP project (PNG/84/PO1) in three provinces. Implemented by WHO, this three year project was designed to increase the number of service outlets, provide refresher training for staff, and introduce a new system of recording and reporting. As described in official reports, major problems resulted from the lack of involvement of national and provincial staff in the formulation stage, particularly those of the three selected provinces who were apparently not consulted. During implementation, shortages of staff, intermittent contraceptive supplies, as well as delays in the release of project funds were reported as being serious implementation problems. Although some improvements were claimed with the MCH interventions, there was no measured improvement in contraceptive acceptance. The government has requested UNFPA to focus its future country assistance on some of the components of the national program. UNFPA is planning to increase their commitment to family planning and population activities though the 1992-96 program cycle and will address population education needs and provide contraceptives. 1.43 USAID currently supports two programs in select regions of PNG. Working in six provinces, the Service Expansion and Technical Support (SEATS) Project is engaged in a range of activities aimed at strengthening family planning services. The project's training of trainers activities are conducted in conjunction with the John Hopkins Program for International Education in Reproductive Health and their training center at Manila. The SEATS project also collaborates with a program which supports the social marketing of contraceptives. 1.44 The Asian Development Bank (ADB) assisted Third Rural Health Project, which became effective in July 1992, seeks to strengthen rural health services and to redress the decline in the quality and coverage of health services, particularly as it relates to MCH and primary health care programs. J. THE BANK's ROLE AND STRATEGY 1.45 The Bank has recognized human resource development as a key area for assistance to PNG. The Bank has been substantially involved in assisting the education sector and the  - 12 - recently - approved Education Sector Project includes support for expanding the participation of girls in Secondary Schooling. Hitherto, the Bank has not been involved in the population and health sector and the government has relied on ADB and other donors for sectoral assistance. In November 1989, the Bank was requested to assist with the preparation of the National Health Plan for 1991-1995 by undertaking an analysis of selected population and health issues and a Bank sector mission visited PNG in March/April 1990 for this purpose The ensuing report's recommendations dealing with population were largely adopted by government and were reflected in the population policy (para. 1.9) which was announced shortly after completion of this work. Subsequently, the Bank was requested by the government to take the lead in mobilizing assistance to develop a program to implement the new population policy. 1.46 The long term strategy is to create an indigenous capacity, through institutional and human resources development, to analyze and guide PNG through the demographic transition with due emphasis on improving the health and status of women and ensuring their full and free participation in the development and implementation of the Population and Family Planning Program. The project seeks to adopt a program approach in support of the Government's population policy. The project, envisaged as the first phase of a medium-term assistance strategy, will initially concentrate on regions of highest population density to ensure the largest possible number of beneficiaries in areas under population pressure. Within those areas, the project will initially focus on strengthening or creating the institutional capacity to deliver credible family planning services as part of the extension services to the largely rural population of PNG. In addition, MCH/FP units in selected rural facilities will be upgraded to facilitate access to clinical methods of family planning and as points of referral for extension services. 1.47 The key rationale for the project is to reduce the rate of population growth to enhance better human resource development and to ensure improvements in female health in general and reproductive health in particular. In addition, the project aims to legitimize the practice of family planning through public education to enhance understanding of the benefits of safe motherhood for the overall welfare of the current generation of citizens and the eventual macro-benefits of moderated population growth. By ensuring a strong leadership role for women in the implementation of the project, the project intends to demonstrate the vital contribution women can make to national development and welfare. K. ENviRoNMENTAL CONSIDERATIONS 1.48 In the longer term, moderation of the population growth rate may be expected to have a beneficial environmental impact.  - 13 - 2 THE PROJECT A. ORIGIN OF THE PROJECT 2.1 Following the Bank's sector report and the request made by government for Bank assistance, the Bank mobilized a consortium of agencies to assist with the formulation and financing of a consolidated Population and Family Planning Program. The Asian Development Bank (ADB) and Australian International Development Assistance Bureau (AIDAB) joined with the Bank to assist the Government prepare and finance the project. UNFPA and USAID were also involved at various stages of the preparation process and were kept fully informed of progress. Identification of the project was undertaken in May 1991 and preparation commenced in October 1991. The project was pre-appraised in February 1992 and appraised in April/May 1992. A post-appraisal mission visited PNG in September 1992. B. PROJEcr OBJEcTivEs AND SCOPE 2.2 The key objective is to help the Government implement its population policy announced in March 1991. To achieve this goal the project would create the capacity to bring the rate of population growth into balance with the country's potential for socio-economic development and, in particular, human resources development, and to improve the health of mothers and children through greater use of family planning. The more specific objectives are to: (i) develop the institutional capacity to foster and manage a comprehensive population program; (ii) deliver effective family planning services; (iii) generate a greater demand for family planning; and (iv) mobilize public awareness and support for the program through government and non-government channels. 2.3 The project seeks to adopt a program approach in supporting implementation of the Government's population policy. Thus the project will address a range of activities which will contribute to the overall attainment of Government objectives related to the population issue. A major element of this program is the delivery of effective family planning services, currently provided in the context of maternal and child health activities which dominate the agenda. The strategy adopted to achieve this will initially concentrate on areas of high population density in the provinces of East New Britain; Eastern Highlands; Morobe; Southern Highlands; Western Highlands and the National Capital District (NCD). The project is designed to address the needs of the rural majority, as well as key urban areas, for information, supplies, facilities and service delivery activities through government and non-government organization (NGO) channels. The Government's program is national in scope and it is anticipated that more intensive program activities will be extended to other areas of the country in a phased manner, thus eventually reaching all potential beneficiaries. To this end, provision has been made to allow extension of activities during the project to other provinces once the systems necessary for an effective  - 14 - program are firmly in place. It is expected that decisions about the pace of extension and choice of population centers to be covered will be guided by the National Population Council (NPC). C. PRoJEcT DEsCRIPTION 2.4 The project has two elements. The first is support for family planning service delivery including: (a) upgrading of selected health facilities to provide effective family planning services; (b) operational support for fixed facility and outreach services including supervision and monitoring; (c) training in clinical and communication skills both in-country and externally; and (d) incremental staffing to enhance program management and supervision capacity. The second group of activities will build long-term capacity for the population program and will include (a) supply and distribution of contraceptives and related drugs; (b) training, technical assistance and financial support for NGOs; (c) development of a health and family planning promotion unit; (d) a sample national demographic survey and piloting of a provincial data system; (e) operational and behavioral research and research training; and (f) program management. 1. Provincial Family Planning Service Delivery (estimated cost US$12.2 million, excluding contingencies) 2.5 The intent of the service delivery component is to increase the quality and coverage of family planning (FP) services, in order to increase acceptance and continued use of effective FP methods. Newer contraceptive technologies, such as Norplant will be introduced into the program on a trial basis, with the approval and guidance of the appropriate Government authorities. Although in some larger centers FP services may be provided separately for reasons of efficiency or teaching, in the majority of locations FP will be available as part of an integrated Maternal and Child Health (MCH) service. While emphasis is placed on fertility control, the problem of infertility mainly a result of STD's will receive attention. The project will benefit from policy and technical guidance and monitoring from NDOH. Specific activities and interventions designed for each province, on the basis of detailed observations and discussions with local personnel, are set out in Annex 1. An overview of the range of interventions common to the group is provided below. Civil Works 2.6 A limited program of renovation, extension and construction of MCH/FP clinics, almost exclusively at existing facilities, will be carried out at key facilities; this will help to ensure privacy to clients for examination and counselling and to allow FP services to be offered on a continuous basis. In some provinces extra space will be created for the office of FP Coordinator, and, in Morobe and Southern Highlands provinces, to enhance the facilities for in- service training. Equipment 2.7 Equipment kits will be provided for health facilities as needed and appropriate for the range of FP methods to be offered: this will include instruments for surgical contraception in hospitals. Some training equipment and office equipment will also be allocated where its use will enhance the program. Provision will be made to ensure that the equipment is distributed, used, maintained and stored appropriately, and that inventories are maintained. Vehicles will  - 15 - be provided to undertake outreach programs for MCH/FP and to ensure that transportation is available for the program managers and supervisors to perform their tasks and assist the training programs. Planning, Management and Supervision of FP Services 2.8 Fourteen new positions will be created within the selected provinces and NCD to ensure that each has a FP Coordinator and sufficient staff to supervise and administer the program. The additional positions will be based at the provincial centers except for some supervisory positions at secondary population centers in the highlands provinces. The details of the additional posts are listed in Annex 2 and clearance from DPM for creation of these posts has been obtained. During negotiations, the Government agreed to recruit and post these staff prior to loan effectiveness (para. 5. 1). 2.9 A program of management development will be introduced, to upgrade the skills of the FP Coordinators and others with program responsibilities, to establish routines of planning, supervision, monitoring and review. A reference manual of management procedures will be prepared and the management information system for MCH/FP will be reviewed and revised, compatible with the current health information system. Resources will be provided for supervisory visits from national to the provincial level and from provincial level to the field level for hands-on supervision. Training 2.10 The project will support a wide range of capacity building activities at national and provincial levels to improve the competence of managers, service staff and administrative personnel. A major element of this program will be to improve and expand existing in-service training capacity for health workers at all service provider levels and in private or commercial settings, emphasizing counselling and communication as well as technical skills in family planning. Training and refresher courses for trainers will be undertaken, to develop a cadre of resource persons, initially for the selected provinces but ultimately for the country. Where appropriate, currently funded training initiatives will be revised and continued. 2.11 Supplementary teaching and learning materials will be developed for doctors, health extension officers, nursing and community health workers undertaking pre-service training and also for the teachers of FP subjects in the training schools. An annual program of seminars particularly for doctors (private and public sector) and senior nurses in the provinces will be conducted by appropriate experts in the field of family planning from overseas and PNG. A short certificate course in FP for doctors will be introduced later in the project, to give a recognized practical qualification in this field. The feasibility of a distance learning program will be investigated and trials of such a program introduced in some provinces. The current draft of the National Family Planning Guidelines will be revised and reprinted and a pocket handbook on FP for health workers will be produced. A limited number of short-term overseas training opportunities in clinical and management aspects of FP will be provided. Annex 3 contains a detailed schedule of training activities.  - 16 - Technical Assistance 2.12 Technical support will be required to support specific aspects of service delivery as well as other aspects of the project. Where possible national personnel with requisite competence will be employed, but for more technical activities it will be necessary to recruit externally. Two long term advisers will be based at NDOH supported by short term consultants to carry out specific technical functions. Of the two long-term advisors, one will have a management function while the other will be responsible for all training programs. The technical assistance for service delivery will (i) provide support for program managers in the provinces and NCD, assisting with program orientation, start-up activities and overall management; (ii) establish supervision and monitoring procedures and assist with problem solving in the early stages; (iii) revise the MCH/FP component of the health information system, with software development and training of the users of the system; (iv) review curricula in some pre-service courses; (v) revise training of trainers (TOT) courses and support course delivery and follow-up; and (vi) develop teaching/learning materials for both pre-service and in-service courses and for distance education modules. Where external assistance is used, an appropriate national counterpart will be identified, and there will be a responsibility to assist with skill transfer in a coaching or mentor relationship. The terms of reference of the key technical assistance required are included in Annex 4. Short lists of sources of technical assistance were reviewed during appraisal and draft contracts were reviewed and agreed upon at loan negotiations. II. Program Support (estimated cost US$15.3 million, excluding contingencies) Contraceptive/Pharmaceutical Logistic System 2.13 To date, much of the contraceptive supply has been donor funded, with some purchased by the Government, partly because of infrequent and delayed supplies by donors. These purchases have been insufficient to maintain an adequate supply. Contraceptives are bought through the pharmaceutical supplies budget but no specific allocation is made, unlike STD drugs for which a specific amount is reserved (K 100,000 in 1992). The project will assist the Government to purchase its contraceptive needs through the period of the project. The level of purchase using government resources will be adjusted relative to the proposed assistance from UNFPA for contraceptive supply, indicated to be about US$500,000 for 1993-96. The budget for contraceptives encompasses an estimate of the total country's requirements during the project thus simplifying the monitoring of contraceptive purchases. 2.14 The present pharmaceutical supply system is not adequately equipped for regular delivery of supplies to health facilities; this results in frequent interruptions of contraceptive and drug availability. The system will be under further strain to handle an expected fivefold increase in contraceptive supplies under the expanded family planning program. There is a shortage of material handling equipment, budget for transporting of goods and trained manpower. The project will finance equipment for storage and handling of drugs and contraceptives, renovation of the area medical store (AMS) at Rabaul and renovation and expansion of the AMS at Mt Hagen and Lae to overcome some storage constraints. 2.15 The Pharmaceutical Services Section (PSS) which manages the system has been given the additional responsibility for procurement of drugs and contraceptives as a part of Department of Personnel Management's (DPM) structural review of NDOH, without provision  - 17 - of adequate staff support. In addition to three positions already sanctioned for procurement officer, systems analyst and key board operator, the section will need an additional pharmacist and a procurement officer for preparation of technical specifications, drug quantification, bid evaluation, delivery scheduling and quality control. These positions will be created as part of the project's staff strengthening of NDOH. 2.16 The institutional capacity of the PSS will be further reinforced by 18 man-months of technical assistance from a contraceptive and logistic specialist. This consultant will assist the PSS to (i) prepare standard technical specifications; (ii) determine drug quantities based on morbidity data; (iii) prepare standard international bidding documents; (iv) procure supplies using economies of scale; (v) coordinate donor inputs; (vi) develop a protocol for testing of drugs on order; (vii) maintain a record of supplier performance and minimum stock levels; and (viii) develop a buffer stocking system and a two-way information flow system to monitor the movement and shelf life of drugs and contraceptives in the system. The project will also support in-service training of 36 dispensers at the College of Allied Health Sciences over three years and fund external training and fellowships for four senior managers in drug management and procurement. 2.17 PSS has recently installed a computerized inventory control system at headquarters and area medical stores but it is not linked to any peripheral information flow system to monitor and compute stock holding and stock movement at health facilities. In addition, although a system is being operated, very few staff are computer literate to input and interpret data. The project will finance a six month consultancy for a computer specialist to train staff at PSS and AMS in computer skills and software use to help develop an information system to ensure reliable supplies of contraceptives at health facilities. It is proposed in the initial stages to supply pre-packaged contraceptive kits scaled to needs of different levels of health facilities and supplied at a regular frequency without indents from the facilities. Finance will be given during the life of the project for pre-packaging, transportation from AMS to health facilities and for supervision and monitoring of supply, distribution and usage of stocks at the health facilities. 2.18 In summary, the scope of this component will include: (i) supplies of contraceptives and selected STD drugs to supplement government purchases and commodity aid from external sources; (ii) improved storage capacity at the AMS's and provincial storage facilities for contraceptives and medicines and supplies required for effective MCH and STD programs, including extensions of some existing storage facilities and upgrading of some furnishings and equipment; and (iii) strengthening of supplies management at the PSS of NDOH and at AMS', including staff training, technical assistance and provision of support for transport and distribution of supplies. Support for Non-Government Organizations 2.19 NGOs and their networks reach throughout the community and provide alternative and supplementary avenues to address population issues at the community level. Discussions with the main NGOs who have an interest in family welfare has established a broad level of interest at all levels of church and women's groups in increasing their involvement with population issues, although how that might be expressed depends on the values and beliefs of each organization. The main activities which the NGOs are expected to undertake are increasing awareness, advocacy and some provision of services. Training of male and female communicators in FP will be organized through these NGOs in each province at the community  - 18 - level, whether in urban or rural areas. Community based distribution of contraceptives will be introduced in a phased manner in suitable areas and expanded as experience grows. Assistance is being extended to the Council of Women in Western Highlands to build a new facility from which to conduct their activities. 2.20 Despite extensive contacts and discussions, it has not been possible to discuss the program with all NGOs which may have an interest in participating. Thus, a twofold approach has been adopted. First, funds have been allocated for suitable proposals already received and, second, funds have been set aside to support future proposals from NGOs. It is planned that NGOs will submit proposals to the Non-Government Organization Division of the DRHAY which has the capacity and a budget mechanism for working with NGOs. From there the proposals will be submitted to the Project Steering Committee (PSC) for review and approval. A format for submissions and guidelines for preparing and evaluating the proposals will be developed at the beginning of the Project. Accounting procedures which are acceptable to the Government and funding agencies will be identified at the same time. 2.21 Technical assistance will be provided for the first two years of the project so that the potential contribution of the NGOs to the Government program can be harnessed (see Annex 4). The adviser will assist the NGOs to identify and implement activities, and train NGO staff in project management, accounting and report preparation. The adviser will also assist in monitoring and evaluation of NGO initiatives. 2.22 The Women's Division, DRHAY, is the structure through which the National Women's Training Policy and programs are being developed to empower women in Papua New Guinea. A consultant will assess project related women in development issues. Training support will be provided to strengthen the ability of the Women's Division, DRHAY, to help with women's programs and to educate trainers within the Training Section, Provincial Women's Officers and Community Women's Organizers about family planning. This support will be closely coordinated with the technical assistance provided by ADB and other agencies to strengthen the institutional capacity of the Women's Division. Promotion of Health and Family Planning 2.23 The NDOH needs a comprehensive health promotion program to support, inter alia, the delivery of family planning services to the nation. Health promotion has been constrained since the abolition of health educator positions during the 1982 budget cuts. Recently, the ADB assisted Third Rural Health Services Project has provided for health educator positions in 11 provinces and the NCD. This project proposes to build capacity in health promotion by creating a new organization to be called the Health Promotion Center (HPC) within the NDOH. This center will provide overall management and direction to the nation's health and family planning promotion programs. 2.24 An HPC, responsible to the First Assistant Secretary, Primary Health Services, and headed by an Assistant Secretary, will be constructed and staffed. The HPC will be built as an extension of the existing Health Curriculum and Media Unit which houses the NDOH's printing capacity. The HPC will (i) manage the health and family planning promotion program for the Department of Health; (ii) develop a national health and family planning promotion plan, in collaboration with the provincial health educators and monitor its implementation; (iii) train provincial health educators in all phases of communication work; (iv) provide policy guidelines  - 19 - on message content and behavior change goals; and (v) standardize technical content of messages. 2.25 Currently, there are five staff reporting to the Assistant Secretary, Primary Health Coordinator/Health Educator in the Primary Health Services Branch of NDOH who will be transferred to the HPC. These are (i) Health Information Editor; (ii) Health Information Officer; (iii) Health Educator; (iv) Visual Layout Artist; and (v) Keyboard Operator (KBO). The project will create four new technical positions and one administrative position for the center. These are (i) Communication Research Officer; (ii) Multimedia materials production officer; (iii) FP/MCH Communications Officer; (iv) Information retrieval/dissemination Officer; and (v) KBO (Annex 2). The proposed new organizational structure is presented in Annex 5. Three staff units in the HPC will provide technical assistance to the subject matter specialists. These units are: (i) a communication research unit, responsible for directing research activities, (ii) a multimedia materials production unit; and (iii) a clearinghouse for population/family planning materials. The head of the HPC will have the following responsibilities: (i) manage the day-to- day operations of the HPC; (ii) direct all activities aimed at developing a national behavior change strategy and communication plan; (iii) implement this strategy to promote family planning; (iv) subcontract individuals and agencies to undertake specific project activities; and (v) direct all related staff training. 2.26 The HPC will be developed with a technical assistance package for capacity- building using the family planning program as an opportunity for the center staff and the provincial health educators to "learn by doing" while conducting a comprehensive information and promotion campaign. The key objective is institutionalization and capacity-building. External technical assistance will focus on training and skills transfer with counterpart staff from NDOH and the provinces. A full-service organization, with a broad base of health communication experience in developing countries will be contracted to provide one full-time resident advisor and intensive short-term technical assistance will also be provided for the center. 2.27 The technical assistance, in concert with a core group of staff from the HPC and the provincial health educators and their partner agencies, will (i) conduct training workshops in communication planning, research, materials production and program management; (ii) develop, manage and evaluate a family planning campaign; (iii) implement and evaluate a family planning promotion program in the six initial areas and prepare a plan for national implementation; (iv) firmly establish a new organizational unit within NDOH with responsibility for managing the national health and family planning promotion program; and (v) catalogue and store at the central HPC and make available to provinces, NGOs, and the commercial sector for use and adaptation to other sites, multimedia materials (print, radio, video, TV, computer-based instructional materials and communication research reports) for use in the family planning promotion program. 2.28 At provincial level the health educator will be the communication program manager. The key task is to develop a behavior change strategy that supports the public health and family planning goals of the province and to recruit partner agencies from the government and the private sector in developing a communication plan and implementing health and family planning promotion activities. The health educator may tap local and national experts in the various aspects of health promotion work including: communication research, materials development and pretesting, training in counselling skills, and implementation of an intensive health promotion program.  - 20 - 2.29 The first 2-3 years of the project will demonstrate how communication programs are developed, managed and evaluated. On-the-job training will be complemented with formal training workshops organized by NDOH. The feasibility of providing continuing education units for participants at these workshops will be explored. The goal is to develop the profession of health promoters and develop a career path for those who choose to undertake this line of work. From the third year, short-term technical assistance will be provided on a declining basis. Population and Family Planning Research 2.30 Research is needed to evaluate progress and to provide assurance that the activities of the project are appropriate. The information collected will be used to modify old practices and design new practices as required. 2.31 Several PNG institutions have some capability to carry out this research, but their capacity is restricted by a shortage of trained research staff. Implementation of the population policy will generate a demand for statisticians and health personnel with training in demography and population studies. The Population Studies Program in the Department of Geography, University of Papua New Guinea (UPNG) offers courses in demography, and there is some dernographic training in the Department of Community Medicine. 2.32 The Project will increase research and training capacity by providing (i) a social scientist and a counterpart at the PNG Institute of Medical Research (PNGIMR); (ii) at the Department of Community Medicine, UPNG (a) one population and family health specialist for six months to review the curriculum and to develop appropriate programs to address population policy issues; (b) two national teaching fellows, with on-campus housing and provision for overseas study at masters' level; (c) two computers, one printer, one uninterrupted power supply and one overhead computer display screen; and (d) support for student research projects related to family planning; and (iii) in the Population Studies Program, UPNG funding for (a) one national Teaching Fellow for three years; (b) two fellowships for overseas training at masters' level; (c) training students in field research; (d) population library resources; and (e) three 486 computers, three printers, one plotter, software and computer room establishment costs. 2.33 Specific research studies will be identified during the life of the project. Research proposals will be submitted to the Project Steering Committee (PSC) for review and approval. The average cost of such studies is expected to be K 25,000. A budget allocation of K 75,000 per year, commencing in the second year of the project, will be made available through the Population Planning Unit (PPU) to fund this research. During the first year an allocation will be made for a study of changing fertility patterns among workers in the forest industry, as part of a wider study being undertaken by the PNGIMR. Demographic Data Collection and Utilization 2.34 Demographic data are essential for social and economic planning at the national and provincial level and also to monitor the progress of the population project. In the past, the main source of such data has been the census held at ten year intervals with some supplemental data collection. However, the difficulty of collecting reliable census data in the PNG physical environment and the long intervals between collection have limited the availability and accuracy of population data. There is therefore a pressing need to gather demographic data more frequently and to develop alternative methods of collecting reliable data.  - 21 - 2.35 The project will support a demographic and health sample survey (DHS) in 1995 to provide demographic, health and family planning data in the intercensal period and until a Provincial Data System (PDS) and Civil Registration (CR) program is established nationwide. The DHS will comprise a 5 percent sample survey of households in all provinces and will be carried out by the National Statistical Office (NSO). The detailed content of the survey will be determined jointly by NSO and PPU, and will include questions to aid the formulation of strategies for family planning service delivery. The project will support technical assistance to advise on questionnaire design and training, preparation and collection costs. 2.36 The project will also support a program of training for NSO and provincial statistical staff to improve collection and analysis of survey, census and PDS data: (i) graduate diploma and masters level training in demographic analysis, statistical methods and administration; (ii) diploma level training in management of information systems and sampling; (iii) short course training in sampling and census evaluation; and (iv) workshop training in survey research methods for NSO and provincial statistical staff. 2.37 The Provincial Data System, which operated in the early 1980s, will be re-activated and will be used not only to monitor the project by providing much of the data formerly collected in censuses and surveys, but also to facilitate the expansion of CR and to provide data for economic and social planning. The project will support a pilot PDS/CR with a view to attracting funding from other sources to re-establish the system nationwide. The pilot will be established in East New Britain, administered by the NSO in Port Moresby. East New Britain was selected because it is one of the project provinces and some recent PDS data have been collected by the Provincial Statistician although not yet computerized. The objective of the pilot will be to develop a process for (i) computerizing and managing data; and (ii) delivering results in an easily understood form by means of self-explanatory, interactive computer software. Interested parties, including line departments and community governments, will be able to extract information from the database with little or no special training. PDS data will be updated biennially by provincial statistical officers and CR will be carried out continually by the Office of the Registrar General. 2.38 The project will support (i) technical assistance to review progress in CR to date and to explore the legal requirements for a CR system to be run in conjunction with a PDS; (ii) technical assistance to determine the structure and components of the PDS/CR database; purchase of customized software to manage the database and interface with users; (iii) digitization of Census Unit boundaries; (iv) purchase of two computers and two printers to run the pilot system in East New Britain and a copy at the NSO in Port Moresby; (v) installation and training; and (vi) position of a data entry clerk. D. MON1TORING AND EVALUATION, MANAGEMENT AND IMPLEMENTATION Monitoring and Evaluation 2.39 Careful monitoring of the project will be a critical task for project management at both NDOH and PPU. The most critical long-term benchmark will be created by the 1995 DHS. The baseline information obtained from this survey will be a measure of key demographic trends, and its satisfactory completion will be a major contribution of this project.  - 22 - 2.40 It is intended to monitor the progress of this project through a series of process indicators, determining whether planned activities have been carried out. Through careful surveillance of project inputs, the performance of government departments and other institutions in implementing project activities will be followed. Annex 9 contains a detailed description of the project monitoring and evaluation program. 2.41 The issue of monitoring progress will be one of the subjects to be discussed at the launch workshop, to be held once the project receives approval. Personnel of the provincial Divisions of Health, with some NDOH staff, will meet to make workplans for implementation of the activities agreed upon for their provinces. At this time a practical list of process and outcome indicators will be further defined, referring to those already in use in the information system, with additions relevant to the project objectives. Indicators of service quality will be included. The method, frequency and source of collection for each will be defined. This set of indicators will form the basis of the regular reporting and review activities of the provincial managers and also for overall monitoring of this component of the project. The outcome of these decisions will provide the source of information to be considered by the PSC along with a concomitant exercise by the PPU to finalize the indicators to be used for other project components. 2.42 The three funding agencies will conduct at least two joint supervision missions a year to supervise the project. One of these missions, timed to coincide with the beginning of the budget cycle in PNG, will undertake an annual project review and project planning exercise, during which progress will be assessed and major decisions made about future activities. A mid- term assessment of project progress and achievements will be conducted towards the end of 1995 or early 1996. A detailed supervision plan is contained in Annex 10. Management 2.43 The project embraces a wide range of activities such as civil works, contraceptive supply, education and research. These diverse activities will be mainly implemented by three national government departments and by provincial governments. There will also be NGO involvement. The project is geographically dispersed with much of the family planning activity taking place in five selected provinces and National Capital District (NCD). The essential management requirements for a project of this nature are: (i) co-ordination of the project activities of all participating organizations; (ii) monitoring of all project activities with an accompanying capacity for rapid response to the findings of the monitoring system; (iii) a central organizational unit to oversee all the project activities and to provide a focus for project management; and (iv) flexibility to adjust management forms and practices in line with changing demands and circumstances. 2.44 In summary, the general management responsibilities will be as follows: (a) National Population Council (NPC): The NPC will be responsible for policy advice and overseeing implementation of all population and family planning activities in PNG. The NPC will be chaired by the Deputy Prime Minister. The NPC has been established. (b) Project Steering Committee (PSC): The PSC will have the overall responsibility for guiding the project, making decisions and resolving issues which may arise.  - 23 - The PSC will coordinate the preparation of annual implementation plans which will be developed in concert with the Government's annual budget cycle and will be reviewed by the funding agencies each September. The PSC, chaired by the Project Manager who will be the First Assistant Secretary, Social Planning Division, DFP, will comprise permanent representatives from the three major, national government departments involved (DFP, NDOH, DRHAY). The Project Steering Committee will be the central management unit with authority over the day-to-day management of the project. The PSC has been established. (c) Department of Finance and Planning: The Population Planning Unit, located within the Social Planning Division of DFP, will have the overall responsibility of ensuring the implementation of PSC decisions, coordinating project activities particularly those undertaken through DRHAY and the research institutions, liaising with the donors and preparing project related reports. In general, the PPU will be responsible for non-service delivery components and the NDOH for service activities. The PPU of the DFP will act as Secretariat to both the PSC and the NPC. It will have direct responsibility for research institutions and the NSO. It will also have linkages to the two other major participating departments in the project - NDOH and DRHAY; (d) National Department of Health: NDOH will be answerable for the conduct of those activities for which it is directly responsible, including training, health and family planning promotion and the supply and distribution of contraceptives and related drugs and will closely coordinate with the provincial divisions of health about implementation of all provincial activities. The Project Implementation Unit (PIU) of the NDOH will be linked directly to the PSC and to the PPU and will have responsibility for monitoring and assisting implementation by the provincial departments and units within the NDOH; and (e) Divisions of Women's Affairs and Non-Government Organizations, Department of Religion, Home Affairs and Youth: DRHAY will have responsibility for women's and NGO activities and will be linked directly to the PSC and to the PPU through the PSC. 2.45 The organizational relationships of the project management are expressed diagrammatically in Annex 6. A detailed description of the management structure and functions is given in Annex 7. Office equipment, training and technical assistance, consisting of an overall project adviser, project administrator and a technical adviser at NDOH will be provided to strengthen management capabilities; the terms of reference are included in Annex 4. The terms of reference for the senior project adviser, health promotion specialist, NGO program facilitator and pharmaceutical supply system specialist have been approved by the Department of Personnel Management (DPM), and the senior project adviser, health promotion specialist and NGO program facilitator will be recruited prior to loan effectiveness (para.5. 1). Implementation 2.46 The project will be implemented over a five year period through existing government structures, mainly the PPU at DFP and the PIU at NDOH, whose capacities will be enhanced through increased staff and technical assistance to cope with the expected additional  - 24 - work burden. As a recent structure, the PPU has had no experience in implementing projects. In contrast, the PIU located within the Policy, Planning and Evaluation Unit of the Administration Division of NDOH has had approximately 10 years experience in coordinating health projects funded by the Asian Development Bank. This experience will be built upon and the PIU developed and expanded so that it also performs coordinating functions for this project and for other projects that may be externally funded. 2.47 The implementation schedule is presented in Annex 8. The project completion date will be June 30, 1998 and the loan closing date June 30, 1999. Status of Project Preparation 2.48 The duty statements for the additional staff positions to be created under the project have been agreed and the creation of these positions has been approved by DPM. The terms of reference for the identified technical assistance (para.2. 12) have been approved by DPM. No site acquisition is required for the civil works, for almost all civil works is at existing sites owned by the various health departments. Preliminary discussions have been held with the Department of Works about the design and construction of additions to existing buildings and the new facilities. A general design for extensions to health centers to accommodate the MCH/FP clinics has been prepared but will require modification on a case-by-case basis prior to construction. Detailed lists of medical equipment have been drawn up and costs estimated. Discussions have been held with UNICEF as potential suppliers of some medical equipment.  - 25 - 3 PROJECT COSTS, FINANCING, PROCUREMENT AND DISBURSEMENTS A. CosT EsnsATES 3.1 Summary of Project Costs. Project costs are estimated at K 31.2 million or US$32.7 million equivalent including identifiable taxes and duties. Tables 3.1 and 3.2 summarize the estimated costs by project component and by category of expenditure, respectively. Detailed costs are provided in Annex 11. Table 3.1: SUMMARY OF PROJECT COSTS BY COMPONENT Foreign Kina million USS million as % of Component Local Foreign Total Local Foreign Total Total Family Planning Service Delivery: East New Britain 1.0 0.5 1.5 1.0 0.5 1.5 36 Eastem Highlands 0.9 0.5 1.4 0.9 0.6 1.5 36 Morobe 0.8 0.5 1.3 0.9 0.5 1.4 35 Nat'l Capital District 0.9 0.5 1.4 1.0 0.5 1.5 36 Southern Highlands 0.9 0.5 1.4 1.0 0.5 1.5 36 Westem Highlands 0.9 0.5 1.4 0.9 0.5 1.4 36 Other Provinces 0.4 0.1 0.5 0.4 0.1 0.5 20 Nat'l Dept. of Health 1.2 1.5 2.7 1.3 1.6 2.9 55 Subtotal 7.0 4.6 11.6 7.4 4.8 12.2 40 Program Support: Contraceptive/Pharmaceutical Logistic System 1.5 4.3 5.8 1.6 4.5 6.1 74 Support for NGOs 0.8 0.2 1.0 0.8 0.3 1.1 25 Promotion of Health & Family Planning 1.1 1.6 2.7 1.2 1.6 2.8 58 Pop & F/P Research 0.4 0.5 0.9 0.4 0.5 0.9 60 Demographic Data 0.8 0.6 1.4 0.8 0.7 1.5 43 Project Management 1.0 1.8 2.8 1.0 1.9 2.9 64 Subtotal 5.6 9.0 14.6 5.8 9.5 15.3 62 Baseline Cost 12.6 13.6 26.2 13.2 14.3 27.5 L Contingencies: Physical 0.6 0.6 1.2 0.6 0.7 1.3 54 Price Increase 2.2 1.6 3.8 2.3 1.6 3.9 42 Subtotal 2.8 2.2 5.0 2.9 2.3 5.2 44 Total Proiect Cost /a 15.4 15.8 31.2 16.1 16.6 32.7 Li /a Includes identifiable local taxes estimated at US$150,000 equivalent. Contraceptives, drugs ad equipment items imported under the project would be exempt from duties and taxes.  - 26 - Table 3.2: SUMMARY OF PROJECT COSTS BY CATEGORY OF EXPENDITURE Foreign Kina million USS million as % of Category Local Foreign Total Local Foreign Total Total Civil works 2.4 1.3 3.7 2.5 1.4 3.9 35 Equipment, furniture and vehicles 0.5 1.0 1.5 0.5 1.1 1.6 67 Contraceptives and drugs 0.2 3.2 3.4 0.2 3.4 3.6 95 IEC and media production 1.2 0.7 1.9 1.2 0.8 2.0 40 Training: Training of trainers 0.1 0.1 0.2 0.1 0.1 0.2 30 Domestic training 2.2 0.6 2.8 2.4 0.6 3.0 21 Overseas training 0.1 1.0 1.1 0.1 1.0 1.1 95 Technical assistance: Project support 0.6 1.5 2.1 0.6 1.6 2.2 73 Capacity building 0.8 2.6 3.4 0.8 2.7 3.5 75 Policy support 0.1 0.3 0.4 0.1 0.3 0.4 90 Studies 0.2 0.2 0.4 0.2 0.2 0.4 48 Demographic survey 0.7 0.3 1.0 0.8 0.3 1.1 30 NGO field activities 0.5 0.2 0.7 0.5 0.2 0.7 20 Related operating costs: Incremental salaries 1.5 0.0 1.5 1.6 0.0 1.6 0 Operations and maintenance 1.5 0.6 2.1 1.6 0.6 2.2 29 Baseline cost 12. 13.6 26.2 13.2 14.3 27.5 52 Contingencies: Physical 0.6 0.6 1.2 0.6 0.7 1.3 54 Price Increase 2.2 1.6 3.8 2.3 1.6 3.9 42 Subtotal 2 50 2-2 2 3 5 2 44 Total Project Cost /a 15.4 15.8 3 16.1 16.6 32.7 5 1 /a Includes identifiable local taxes estimated at US$150,000 equivalent. Contraceptives, drugs and equipment items imported under the project would be exempt from duties and taxes.  - 27 - 3.2 Basis of Cost Estimates. Base costs are expressed in December 1992 prices. Civil works costs are based on standard cost estimates from the Department of Works. Equipment, furniture and vehicle costs are based on agreed lists of items and on prices currently being paid for similar items. Contraceptive and STD-related antibiotics estimates are also based on current prices being paid for similar items and on the projected demands. Contraceptives/STD-related antibiotics and equipment imported under the project, would be exempt from import duties. Duties on imported construction materials are estimated to average about 9 percent. Cost estimates for training of trainers are based on costs being incurred for similar training being undertaken under other projects in PNG. Domestic training costs vary widely depending on the type of training being given and its location, and range from K 300 per one-day workshop for 20 community leaders to K 6,400 per one-week training course for 24 senior nurses and sisters-in-charge. Overseas training costs are estimated in the range of K 20- 25,000 per study-year for degree programs and at an average of K 6,000 per participant for short-term study visits. The estimated costs of specialist services are based on unit costs of similar services and activities in programs currently being implemented in Papua New Guinea. Costs of consultants includes housing, relocation costs, salaries, subsistence, fees, overheads and internal travel. The technical assistance program, including costs, is detailed in Annex 12, while Annex 13 provides the year and source of funding for technical assistance. Salaries of additional staff are based on the government salary scale and related operating costs on standard allowances and travel costs. 3.3 Contingency Allowances. Project costs include a contingency allowance for unforeseen physical conditions and for estimated price increases. Physical contingencies are estimated at 5 percent for all project items except for the support for non-government organizations where no physical contingencies are provided. Price contingencies are estimated on the basis of the implementation schedule (Annex 8) and on expected annual average price increase of 5.5 percent for local costs and 3.7 percent for foreign costs throughout the project period. Accordingly, total contingencies represent about 19 percent of baseline costs, of which 14 percent is the aggregated price contingencies of the baseline costs plus physical contingencies and 5 percent is the physical contingencies. 3.4 Foreign Exchange Costs. Direct and indirect foreign exchange costs are estimated at about K 15.8 million (US$16.6 million equivalent) including contingencies, which represent about 51 percent of the total project cost. The foreign exchange percentages for the major categories of expenditures are estimated as follows: (a) civil works and furniture - 35 percent; (b) equipment, vehicles, contraceptives and STD-related antibiotics--95 percent; (c) IEC and media production - 40 percent; (d) domestic training and in-country consultants - 20 percent; (e) overseas training - 95 percent; (f) international consultants - 90 percent; (g) demographic survey - 30 percent; (h) incremental salaries - 0 percent; and (i) related operations and maintenance - 30 percent. 3.5 Recurrent Costs and Sustainability. Under the proposed project additional recurrent costs would be generated mainly by: (a) the recruitment of additional staff required for implementation of the population program and for strengthening of health promotion activities in NDOH; and (b) needs for additional supervision and training budgets to sustain the proposed improvement in the delivery of family planning services. The annual incremental recurrent cost generated upon completion of the project is estimated to be about K 0.85 million which represents about 1.5 percent of the NDOH and five provincial health recurrent budgets in 1991. The proposed project is the first stage towards achieving government population objectives and  - 28 - the program will need to extend over several decades. To sustain the population program in the longer term it will be necessary to maintain the supply of contraceptives and promotion activities. Although it is difficult to estimate the expected rise in demand for contraceptives, it is probable that an annual 5 percent increase in supply will be needed at the end of the project, amounting to an annual increase of about US$40,000. Experience with family planning programs in other countries indicates that there is a case for maintaining support for contraceptive supplies. It is also difficult to estimate future family planning promotion costs, which vary enormously depending on the approaches taken. However, direct program costs are likely to prove insignificant compared with potential savings in health, education and child-raising costs as birth rates decline. Over the long-term, the environmental and economic costs of significant continued population growth would outweigh the investments required to moderate fertility levels. To ease the long-term financial burden of these investments on the Government, the project also aims to maximize the capacity of the private sector and non- governmental organizations to deliver family planning services. B. FINANCING 3.6 The proposed IBRD loan of US$6.9 million equivalent would finance about 21 percent of the total estimated project costs, net of estimated duties and taxes (about US$150,000 equivalent). The Asian Development Bank would co-finance US$6.8 million, on a parallel basis using Asian Development Fund resources, which represents about 73 percent of costs of the three components - the contraceptive/pharmaceutical logistic system; the health and family planning promotion; and the support for non-government organizations. The ADB financing would represent about 21 percent of total estimated costs, net of duties and taxes. The Government of Australia (AIDAB) would co-finance, with a grant of US$10.0 million on a parallel basis, the domestic and overseas family planning service delivery training, the data collection activities and the project management. AIDAB financing would represent about 31 percent of total estimated project costs, net of duties and taxes. Together, the three external agencies would provide US$23.7 million representing 73 percent of total estimated project costs, net of duties and taxes. The Government of PNG would be responsible for the remaining US$9.0 million (27 percent of total estimated project costs), including duties and taxes. Project financing would be in accordance with Table 3.3. Prior to loan effectiveness all conditions precedent to the ADB loan agreement and the Memorandum of Understanding of AIDAB will have been complied with (para. 5.1). 3.7 Theflow offunds to project implementing agencies would be in conformity with the current GOPNG budgeting system and procedures for financing foreign assisted development projects. Based on the approved annual budget, PPU/DFP, PIU/NDOH, DWA/DRHAY and the Provincial Divisions of Finance (PDFs) in the five project provinces and NCD would, at the commencement of project implementation, (a) prepare and submit quarterly cash flow statements for respective planned project activities to the Office of International Development Assistance (OIDA) of the DFP, and send copies to the Project Accountant in PPU/DFP; (b) on the basis of these statements, OIDA would determine project financing requirements for the first quarter and would authorize the Treasury to release to the project implementing agencies the required funds for the first quarter; (c) PPU, PIU, DRHAY and PDFs would submit to OIDA, on a monthly basis, revised cash flow statements and statements of actual expenditures incurred and paid for, with copies to the Project Accountant of PPU; (d) OIDA would then authorize the Treasury to withdraw from the Special Account, the Bank's share of actual expenditures incurred, and reimburse GOPNG (para. 3.15); (e) on the basis of (c) and (d) above, withdrawal  - 29 - applications would be submitted by OIDA to the Bank for replenishment of the Special Account, or for reimbursement in the case of payments above US$200,000; and (f) funds reimbursed to GOPNG from the Special Account could then be used to prefinance expenditures for subsequent quarters. Funds to NGOs would be channelled through the DRHAY (para.2.20). To monitor the flow of funds for family planning service delivery activities, a separate line item in the appropriate budgets will be established to identify budget allocations for MCH/FP (para. 5.1). 3.8 Financial support for NGO activities is provided by ADB. The Government is seeking grant financing through AIDAB for these activities. In the event that such financing is secured and agreement is reached that the NGO activities identified under the project would be so financed, then that portion of the ADB loan would be either cancelled or directed to other project activities. Table 3.3: FINANCING PLAN Estimated share of GOPNG ADB AIDAB IBRD Total IBRD Category of Expenditure ----------------------- US$ million ---- ----------- financing Civil works 0.4 0.7 - 3.4 4.5 76 Equipment, furniture and vehicles 0.1 0.8 0.1 0.8 1.8 44 Contraceptives and STD drugs 3.1 - - 1.1 4.2 26 IEC and media production 0.5 1.9 - - 2.4 0 Training and studies - 0.3 4.7 0.6 5.6 11 Consultant services - 2.3 3.9 1.0 7.2 14 Demographic survey - - 1.3 - 1.3 0 NGO field activities 0.2 0.8 - - 1.0 0 Incremental recurrent costs 4.7 - - - 4.7 0 Total 9.0 6.8 10.0 6.9 32.7 21 C. PROCUREMENT 3.9 Procurement arrangements are summarized in Table 3.4 below. 3.10 Civil works (estimated value US$4.5 million equivalent, of which US$0.7 million to be financed by ADB) would comprise renovation and/or extension of: (i) 63 district health/FP centers in five provinces and NCD; (ii) two area medical stores in two provinces; (iii) construction of a health promotion center at NDOH; (iv) eight staff houses in three provinces and NCD; and (v) a new facility for the Council of Women in Western Highlands. Individual contracts for specific locations, which are expected to average US$100,000 equivalent each, are not expected to attract foreign bidders due to (i) their small contract amounts and (ii) the scattered location of the sites. Contracts for civil works would thus be awarded on the basis of local competitive bidding (LCB) procedures acceptable to the Bank, totalling to an aggregate  - 30 - Table 3.4: PROCUREMENT ARRANGEMENTS (US$ million) Procurement Total cost procedures including ICB LCB Others La N.B.F. contingencies Civil works 2.3 1.5 0.7 4.5 (2.0) (1.4) (3.4) Equipment, furniture and 0.6 0.3 0.9 1.8 vehicles (0.6) (0.2) (0.8) Contraceptives and STD drugs 4.2 4.2 (1 .1) (1 .1) IEC & media production 2.4 2.4 Training and studies 0.6 5.0 5.6 (0.6) (0.6) Consultant services 1.0 6.2 7.2 (1.0) (1.0) Demographic survey 1.3 1.3 NGO field activities 1.0 1.0 Incremental recurrent costs 4.7 4.7 Lotal 4.2 L2 2 22L2 327 (1. 1) (2.6) (3.2) (0-0) (6.9) Note: Figures in parentheses are the respective amounts financed by the Bank. N.B.F.: Not Bank-Financed including parallel financing from ADB and AIDAB. La Includes local prudent shopping, purchase through UNICEF, force account for civil works construction in remote areas, and selection of consultants following Bank Guidelines. value of US$2.3 million equivalent. Contracts below US$50,000 may be awarded to qualified contractors after comparing at least three quotations to an aggregate value of US$1.0 million equivalent. In remote areas, in particular in the highlands provinces where local contractors do not operate or are not available, renovation and extension works (averaging US$40,000 each) at district health/FP centers may be carried out by Department of Works force account through hiring local day labor for the period necessary to complete the work, up to an aggregate total value of US$0.5 million. Contracts for three area medical stores and the health promotion center (estimated total value US$0.7 million equivalent), which will be financed by the ADB, would be awarded in accordance with ADB procurement procedures.  - 31 - 3.11 Equipment items (estimated value US$1.4 million equivalent, of which US$0.8 million to be financed by the ADB and US$0.1 million by AIDAB) include small medical equipment and health kits for MCH/FP centers/clinics and hospitals, computers, office and training equipment and materials, and vehicles. To the extent practicable contraceptives and S7D-related antibiotics (estimated value USS4.2 million equivalent) would be grouped into bid packages costing US$100,000 or more and would be bid through International Competitive Bidding (ICB) procedures in accordance with Bank guidelines. Because of the low value and limited quantity of each item, all other goods can not be appropriately grouped into packages suitable for ICB. Small medical equipment and health kits for health centers and hospitals (estimated value US$0.3 million equivalent) would be procured through a UN agency (UNICEF/UNFPA) following the agency's procedures, which is acceptable to the Bank. Other equipment items including computers, copying machines and vehicles (estimated value US$0.2 million equivalent) would be procured on the basis of LCB acceptable to the Bank. Foreign suppliers of computers and vehicles are well represented in PNG and would assure competitive prices. Miscellaneous items not exceeding US$50,000 in value could be procured through prudent shopping on the basis of price quotations from at least three suppliers, eligible under Bank guidelines, while computer software and books may be procured through direct purchase after negotiations with the publishers or their authorized distributors, subject to an aggregate total of US$0.1 million equivalent. Equipment for the two ADB-financed components (estimated total value US$0.8 million equivalent) would be procured in accordance with ADB procurement procedures and those to be financed by AIDAB (estimated value US$0.1 million) would be purchased following AIDAB procedures. Furniture (estimated total value US$0.3 million equivalent) would be procured through LCB procedures acceptable to the Bank. For IEC and media production under the promotion of health and family planning component to be financed by the ADB (estimated value US$2.4 million equivalent), ADB procedures would be followed. 3.12 Consultants for the senior project adviser, clinical training and curriculum development and population and family planning research activities, to be financed by the IBRD loan (estimated value US$ 1.0 million), would be selected in accordance with bank guidelines for Use of Consultants. Other consultants required under the project to be financed by (i) ADB for the contraceptive/pharmaceutical logistic system, promotion of health and family planning and support for NGO's (estimated total value US$2.3 million), and (ii) AIDAB for provincial family planning service delivery training, provincial database system, women in development and project management (estimated total value US$3.9 million) would be selected in accordance with their respective procedures. 3.13 Prior review by the Bank would be required for: (a) ICB documents for the procurement of contraceptives and STD drugs; (b) the initial sets of bidding documents for procurement of works and goods through LCB, which would subsequently be used as standard master documents for the project; and (c) award recommendations for award of contracts above US$100,000 equivalent for works and goods. It is estimated that about 26 percent of the total value under the proposed project, would be subject to prior review by the Bank. Other contracts would be subject to selective post-review or required review by cofinanciers D. DISBURSEMENtS 3.14 The proposed loan of US$6.9 million equivalent would be disbursed over a period of about six years (Annex 14). The disbursement schedule is based on the implementation schedule (Annex 8), which is shorter than the standard disbursement profile of seven-and-a-half  - 32 - years for all Bank-assisted projects in Papua New Guinea. Disbursements are expected to be completed by the June 30, 1999, closing date, and would be made against the following categories of expenditure: (a) civil works--90 percent of expenditures; (b) equipment, furniture and vehicles--100 percent of foreign expenditures for directly imported equipment and vehicles or 100 percent of local expenditures (ex-factory cost) for locally manufactured items, and 70 percent of expenditures for locally procured equipment items and furniture; (c) contraceptives and STD drugs--26 percent of expenditures; and (d) specialist services, training and studies-- 100 percent of expenditures. Full documentation would be required by the Bank to support withdrawal applications for all specialist services, overseas training, studies, and for all other contracts above US$100,000 equivalent. Disbursements for civil works, equipment, furniture and vehicles contracts below US$100,000 equivalent and for in-country training would be made on the basis of itemized statements of expenditure (SOEs). The documentation for SOE expenditures would be retained by the PPU/DFP, the PIU/NDOH and the DRHAY, and made available for review as requested by visiting Bank missions. 3.15 To facilitate disbursement, a Special Account would be established and maintained in Kina at the Bank of Papua New Guinea. The initial deposit would be in the amount of US$0.5 million, the estimated average of four months' expenditures, and would be used to make payments in all categories of less than US$100,000 equivalent for both foreign and local expenditures. All other expenditures above this amount could be submitted directly to the Bank for payment. Replenishment of the Special Account would be made monthly or whenever the available balance in the account drops below 50 percent of the authorized initial deposit, whichever occurs first. Withdrawal applications for direct payment and special commitment would be a minimum of US$100,000 per application and supported by appropriate documentation. E. ACcOuNTS, AUDITS AND REPORTs 3.16 Separate project accounts would be established and maintained by each of the implementing agencies (DFP, NDOH, DRHAY and PDFs) for their respective expenditures in accordance with sound accounting practices. Project accounts and separate accounts of statements of expenditure would be prepared annually by each of the implementing agencies and submitted to the PPU/DFP which would prepare consolidated project accounts for audits. The consolidated project accounts including the Special Account (para. 3.15) would be audited in accordance with Bank guidelines. Within nine months of the end of the Government's fiscal year, the Bank would be provided with an audit report of such scope and detail as the Bank may reasonably request, including a separate opinion by the auditor on disbursements against certified SOE. During negotiations, assurance was obtained that the Government would provide the required reports. The PPU would also monitor progress in project implementation and submit semi-annual progress reports to the Bank, ADB and AIDAB in March and September each year.  - 33 - 4 BENEFITS AND RISKS A. BENEF1TS 4.1 The project will assist the Government to develop systematic and effective family planning services and referral for a broader range of female health services which will contribute to female and child health. In the medium term, greater use of family planning will result in lower fertility and lead to a moderation of population growth. Better access to family planning may be expected to contribute towards an amelioration of social tensions arising, in part, from a breakdown of traditional family patterns and values. Eventually, lower birth rates will lead to enhanced prospects for human resource development and improved and more sustainable social and economic development. Availability of reliable demographic information will strengthen government's ability to monitor social development and to improve the basis for making informed decisions about future development strategies. In the longer term, environmental management may expect to benefit from a moderated rate of population growth. B. RISKS 4.2 There is broad support within the community for a population program. However, expectations of any rapid decrease in fertility have to be tempered by experience from other countries and particularly by recognition of the low educational attainment and restricted access to information characteristic of PNG. A long term and sustained effort will be required which may test political resolve and which emphasizes the need to deeply involve community based organizations. In the short term, institutional issues are a concern for management capabilities within the responsible agencies remain weak. A project steering committee has been established to oversee project implementation and technical assistance will be provided to assist project management.  - 34 - 5 AGREEMENTS AND RECOMMENDATION 5.1 The following conditions of loan effectiveness were agreed during loan negotiation; (a) key staffing positions will have been recruited and posted (para. 2.8); (b) the long-term adviser positions (including the senior project adviser, health promotion specialist and NGO program facilitator) will have been recruited (para. 2.45); (c) all conditions precedent to the ADB loan agreement and the Memorandum of Understanding of AIDAB have been complied with by the borrower (para.3.6); and (d) approvals necessary for establishment of a separate budget line item for MCH/FP activities conducted under the National Department of Health, East New Britain, Eastern Highlands, Morobe, Southern Highlands and Western Highlands will have been granted (para 3.7). 5.2 The following subjects are covered by specific covenants in the Loan Agreement: (a) for those staff positions which will not necessarily be filled under the terms of loan effectiveness, the dates of their posting; (b) the appointment for the Director, Family Planning at the Department of Clinical Science by September 30, 1993; and (c) the timing of the mid-term review, which is expected to be conducted in 1995 depending on project progress. Recommendation 5.3 Subject to the above conditions, the project would constitute a suitable basis for a Bank loan of US$6.9 million equivalent to the Independent State of Papua New Guinea for a term of 20 years, including a grace period of five years, at the Bank's standard variable interest rate.  -35 - ANNEX 1 PAPUA NEW GUINEA POPULATON AND FAMILY PLANNING PROJECT FAMILY PLANNiNG SERVICE DELIVERY - DETAn LD PRoJEcT DEsCRIMrON The strategies which will be followed to implement and strengthen family planning service delivery capacity in the regions targeted under this project include: (a) support family planning services in existing service delivery centers through improved training, management, supervision, supplies, equipment and clinic facilities; (b) increase understanding and involvement of men and women in population/FP issues, and acceptance of family planning, through communication and community initiatives; and (c) support development of provincial population policy and its integration into provincial level planning. The detailed description of activities to be pursued in each of the targeted areas is given below. A. EAST NEW BRITAIN PROVINCE Project Activities Meetings of key officials in the Division of Health with their counterparts in other project provinces will be arranged annually for briefing on the overall scope and objectives of the project, and for preparation of yearly action plans which will be submitted to the Provincial Government and to PIU, to serve as guide for project implementation. Training of FP trainers (TOT) in Port Moresby will be arranged for 3 selected nursing staff in the first year of the project, and an additional one in the third year. A refresher course will be given in alternate years. A comprehensive training program, involving up to 450 people will be conducted in the province, building on the present in-service activities in FP/MCH, with elements suitable for service delivery, supervision and management, and community education. Within the health service there will be orientation programs for health administrators and section heads, planning and supervision workshops for Officers and Sisters in Charge of health centers and in-service courses for community health and hospital staff of all categories. The program will include training for male health workers to counsel men on family planning matters, and annual two day seminars in Rabaul for doctors and senior nurses, led by visiting authorities from PNG and overseas.  - 36 - ANNEX 1 Provision will also be made for selected nursing staff to take clinical FP training overseas. Supervision of FP/MCH services will be strengthened through the provision of a vehicle to the MCH/FP section for health center visits. Some funds for air and boat travel and for overnight stays will be included. Supervision principles and procedures will be developed duiing training programs for the officers involved. Civ;l Works. New clinic space suitable for FP counselling and service with a training room, office and store is proposed for the Rabaul Town Clinic. Extensions will also be built at selected health centers with high MCH/FP workload. Appropriate furniture and equipment will be provided. Two staff houses will be built to accommodate those occupying the proposed new positions (see below). Equipment to be provided will comprise kits for health centers offering clinical FP services, some training equipment and office equipment including a photocopier and computer for word processing and data management. Training will be organized and procedures established for correct use, maintenance and storage of the equipment, and for regular inventory reviews. East New Britain, along with other project provinces, will participate in review and updating of the management information system for MCH/FP. This will remain compatible with the current health information system, but incorporate some additional data for use by managers at provincial level. Stationery, software and training for this will be provided for in the project. Program Management The Assistant Secretary Health will be the project coordinator in the province, reporting plans and progress to the Provincial Development Team (PDT), chaired by the Provincial Secretary, on a quarterly basis. After approval or amendment by the PDT, the report will be forwarded through the Provincial Executive Committee to the Provincial Assembly, with a copy to the Project Implementation Unit in Port Moresby. To improve the management of FP services the position of Family Planning Coordinator will be established, with a channel of communication to the Matron of Community Health Nursing Services. A second new position will be provided for FP Counsellor with special responsibility for counselling and educating men. The logistics and clerical duties associated with the project will be carried out by existing staff in the Division. Financial administration of project funds will the responsibility of the Provincial Division of Finance, with delegation to the Assistant Secretary Health, following procedures currently used for ADB operational funds. Funds for civil works under the project will also go to the province for use by the Provincial Works Division.  -37 - ANNEX I Project Initiation An appropriately designed orientation program will be organized for government officials, politicians and community leaders, following which a working group will be convened to draft a provincial population policy. Orientation visits to a neighboring country with an active FP program will be arranged for two selected Health Division Officers in each of the first two years of the program. Health Promotion for Family Planning The Provincial Health Educator will be trained and assisted to carry out the role of manager of health promotion for the Division of Health. A technical assistance package for health promotion in the province will include: (i) training workshops on communication planning, research and implementation for a core group of government and non-government personnel, including the health educator, NBC staff, Social Action Committee and Provincial Communications Division; (ii) supervision and technical support from the NDOH Health Promotion Center during planning and implementation of a FP communication intervention; (iii) policy guidelines on the health promotion program goals and objectives; (iv) nationally produced communication materials in print, video and audio-cassette format for use in health promotion and in-service training. Translation and adaptation for local use will be possible, provided the technical content remains consistent with national standards. Funds will be provided for development, adaptation and pretesting of local promotional materials (print, radio, video) as well as for the conduct of both quantitative and qualitative research in support of design and evaluation of the health promotion program. Local resources will be tapped to produce multimedia materials for use in FP health promotion efforts. The Provincial Council of Women will be assisted to train selected members from each community women's association to deliver the women's health and family planning components of the national women's training package, and to organize community based distribution of contraceptive supplies in selected areas, in liaison with the Division of Health. Technical Assistance from national or external sources will be provided for specific aspects of project implementation. An external adviser will support the project provinces in the first two years to assist with orientation and start-up activities, the establishment of supervision and monitoring procedures and with problem solving in the early stages. A national training manager, based in Port Moresby, will support the training of trainers and make follow-up visits to the provinces to help the local personnel from time to time. Technical assistance in health promotion and in continued development of the management information system for MCH/FP will also be provided. A facilitator for NGO initiatives will also cover the five project provinces and NCD.  - 38 - ANNEX 1 B. EASTERN HIGHLANDS PROVINCE Project Activities The project will build on the existing work in FP training and service activities, particularly the foundation laid by the SEATS project. Meetings of key officials in the Division of Health with their counterparts in other project provinces will be arranged annually for briefing on the overall scope, objectives and progress of the project and for preparation of yearly action plans which will be submitted to the Provincial Government and to the Project Implementation Unit, to serve as a guide for project implementation. Training and refresher course of FP Trainers (TOT) will be arranged for selected nursing staff, including those involved in the SEATS training courses. A comprehensive training program in FP and MCH, involving up to 400 health workers, and 200 community and church leaders, will be conducted, with elements suitable for service delivery, supervision and management, and community education. Within the Health Division there will be orientation programs for health administrators and section heads. planning and supervision workshops for Officers and Sisters in Charge of health centers and sub-centers and in-service courses for community health and hospital health staff of all categories, both mission and government. There will be an annual one-day seminar for church leaders and their invitees in Goroka. One-day information and education courses for local community leaders will also be organized by the senior staff (OIC, SIC) of health centers and sub-centers. Two days of training and seminars will be conducted annually by visiting FP experts, consisting of one day for doctors in government, mission, private practice and at the Institute of Medical Research, and one day for senior nursing staff. One of the experts will be from overseas and one from within PNG, on a tour covering all project provinces. Short overseas courses in clinical and management aspects of FP will be arranged in a suitable nearby country. Supervision of FP/MCH services will be strengthened by two new posts (see below) supported by a vehicle to be allocated to the Community Health Nursing supervisor for training and supervision. Some funds for air travel and for overnight stays will be included. Supervision principles and procedures will be developed during training programs for the officers involved. Civil Works. It is proposed that additional space for FP counselling and service be included in the second urban clinic for Goroka, to be constructed soon. The MCH clinic building at Goroka Hospital will be renovated and the space used for children converted for maternal care and FP, if funds for a new children's clinic are made available. There will be an extension to the Health Division's administrative block in the hospital grounds to accommodate the Community Health Nursing section, including the FP Coordinator. Selected health centers and sub-centers will be extended to provide more space and privacy for mothers attending clinic or outpatients. In some health centers, waiting houses for pregnant mothers will be constructed from local materials, to encourage supervised delivery.  - 39 - ANNEX 1 Equipment to be provided will comprise kits for health centers offering clinical FP services, selected training equipment, and items for the FP Coordinator's officer, including a computer for word processing and data management. Eastern Highlands, along with other project provinces, will participate in review and updating of the collection and processing of information related to the management of the MCH/FP program. This will be supplementary to but remain compatible with the current health information system. Stationery, software and training for this will be provided for in the project. Program Management The Assistant Secretary Health will be the Project Coordinator for the province, reporting plans and progress to the Provincial Management Team, chaired by the Provincial Secretary, on a quarterly basis and also to the Project Implementation Unit in National Department of Health. The position of Provincial FP Coordinator, proposed in the new provincial structure will be supported by the project, as will an additional position for MCH/FP Supervisor based in Kainantu, and additional accounts clerk position in the Health Division office in Goroka. Project Initiation An orientation program will be organized for government officials, politicians and community leaders, following which a working group will be convened to draft a provincial population policy. Orientation visits to a neighboring country with an active FP program will be arranged for selected Health personnel in the early part of the project. Promotion of Family Planning The project will provide technical assistance in training a core group of potential implementors of FP promotion activities in communications planning, project implementation and communication research. It will also provide funds for local production of print, video and radio materials. Technical assistance will be in the following specific areas: (i) training workshops on communication planning, research and management, aimed at developing and implementing a behavior change strategy to increase use of family planning; (ii) materials production, pretesting and distribution; (iii) supervision and technical support from the NDOH Health Promotion Center during planning and implementation of a FP promotion campaign; (iv) policy guidelines on FP promotion goals and the medical content of FP messages; and (v) nationally produced communications materials in print, video and radio formats for use in promotion activities and health worker training. Translation and adaptation for local use will be possible, provided that the medical content of the messages conforms to national guidelines. In Eastern Highlands the following core group of health promotion implementors will be trained: the provincial health educator, Health Studies staff of the Goroka Teachers College, Department of Culture and Tourism, (the Raun Raun local theater group and a film production unit called Skul Bilong Wokim Piksa) and the Communication Institute which provides certificate courses for video production, journalism and script-writing.  -40- ANNEX 1 Non-government Organizations. Assistance will be given to enable the Provincial Women's Officer to increase her supervision visits to district level for community awareness activities, and to backstop the planned support from the PNGFPA to the Provincial Council of Women to develop a community based awareness and distribution program. Technical assistance from national and external sources will be provided for specific aspects of project implementation. An external adviser will support the project provinces in the first two years to assist with orientation and start-up activities, the establishment of supervision and monitoring procedures and with problem solving in the early stages. A national training manager, based in Port Moresby, will support the training of trainers and make follow-up visits to the provinces. Technical assistance in FP promotion, as described above, and in continued development and use of the management information system for MCH/FP will also be provided. A facilitator for NGO initiatives will also cover the project provinces. C. MOROBE PROVINCE Project Activities Meetings of key officials in the Division of Health with their counterparts in other project provinces will be arranged annually for briefing on the overall scope and objectives of the project, and for preparation of yearly action plans which will be submitted to the provincial government and to PIU, to serve as a guide for project implementation. Refresher training will be arranged for those officers already trained as FP trainers under the SEATS program, and provision made for an additional person to receive this TOT during the project. A comprehensive training program, involving up to 500 people, will be conducted in the province, building on the foundation of the SEATS funded activities, with elements suitable for service delivery, supervision and management, and community education. Within the health service there will be orientation programs for health administrators and section heads, planning and supervision workshops for Officers and Sisters in Charge of health centers and in- service courses for government, mission, NGO and privately employed health workers. The program will include training for male health workers to counsel men on family planning matters. Seminars for community leaders at district level will be organized by health center officers on an annual basis, as will two day seminars in Lae for doctors and senior nurses, led by visiting authorities from PNG and overseas. Provision will be made for selected nursing staff to take clinical FP training overseas. Improved supervision of FP services will be supported through the strengthened MCH/FP unit at provincial level and the provision of a vehicle to the unit for travelling on supervision and training visits. Funds for air and boat travel and for overnight stays will be included. Supervision principles and procedures will be developed during training programs for the officers involved. Support will also be provided for doctors from Angau Hospital to visit district health centers on a regular basis for clinical supervision of MCH/FP services and, if appropriate conditions are met, to perform surgical contraception.  - 41- ANNEX 1 Civil Works. A building at the Lae School of Nursing will be renovated as an in- service classroom and office, with priority for FP/MCH oriented programs. Extensions will be built on to each of the 6 urban clinics in Lae for improved maternal care and FP services, and provision will be made for renovation of the Lae Town Clinic in the Angau hospital complex, with space for the MCH/FP unit office. Appropriate furniture will be provided. Two staff houses will be built to accommodate those occupying the new positions in the FP unit (see below). Equipment to be provided will comprise kits for health centers and hospitals offering clinical FP services, training equipment for the in-service classroom and office equipment, including a photocopier and a computer for word processing and data management. Training will be organized and procedures established for correct use, maintenance and storage of the equipment. Morobe, along with other project provinces, will participate in a review and revision of the collection and processing of information related to management of the MCH/FP program. This will remain compatible with the current health information system but incorporate additional data for use by managers at provincial level. Stationery, software and training for this will be provided for in the project. Program Management The Assistant Secretary Health will be project coordinator in the province, reporting plans and progress to the Provincial Management Team, chaired by the Provincial Secretary, and to the Project Implementation Unit (PIU) in Port Moresby on a quarterly basis. To improve the management of FP services the position of FP Coordinator will be created, responsible through the Community Health Matron and Director of Community Services to the Assistant Secretary Health. A second position of FP Logistics Officer, responsible to the Community Health Matron, will also be provided, to handle a wide range of duties in support of the FP/MCH program. Financial administration of project funds will be the responsibility of the Provincial Division of Finance, with financial delegation to the Division of Health, following the procedures currently used for ADB funds coming to the province. Project Initiation Orientation programs will be organized for government officials, politicians and community leaders, following which a working group will be convened to draft a provincial population policy. Visits to a neighboring country with an active FP program will be arranged for two selected Health Division officers in each of the first two years of the project. Promotion of Family Planning Morobe has a group of potential partners in FP health promotion. These include: Kristen Media Productions with 25 years experience in print and broadcast production, including  - 42 - ANNEX 1 support of the UNICEF immunization program; the NBC which broadcasts weekly Radio Dokta programs and has conducted a radio listeners survey in collaboration with Radio Australia, the Morobe branch of the Family Planning Association which has extension workers giving talks in the villages, the local Dua Dua theater group which has presented dramas on nutrition and immunization; and the Provincial Council of Women who conduct population/FP awareness programs and produce a women's magazine. The project will provide impetus for an integrated FP promotion campaign through: (i) training workshops on communication planning, research and management, aimed at developing and implementing a behavior change strategy to increase use of family planning; (ii) materials production, pretesting and distribution; (iii) supervision and technical support from the NDOH Health Promotion Center during planning and implementation of a FP promotion program; (iv) provision of policy guidelines on FP promotion goals and the medical content of FP messages; (v) provision of nationally-produced communications material (print, video and radio) for use in promotions activities and health worker training. Translation and adaptation for local use will be possible, provided that the medical content of the messages conforms to national standards. In addition, funds will be available to the province for production, pretesting and adaptation of media materials as well as for conducting qualitative and quantitative research. Non-government Organizations Support for the Provincial Council of Women, through the Provincial Women's Officer (PWO), will comprise funding for a provincial level workshop in 1994 for district representatives on implementation of the women's health/FP component of the National Women's Training package, and for one workshop at district level in each succeeding year of the project. The PWO would have participated in a TOT program for this purpose in 1993 (a centrally funded project initiative). A fund will be created at national level to support suitable proposals from non- government organizations as they arise during the project. Technical Assistance from national or external sources will be provided for specific aspects of project implementation. An external adviser will support the project provinces in the first two years to assist with the orientation and start up activities, the establishment of supervision and monitoring procedures and with problem solving in the early stages. A national training manager, based in Port Moresby, will support the training of trainers and make follow- up visits to the provinces to help the local personnel from time to time. Technical assistance in FP promotion, as described above, and in continued development of the management information system for MCH/FP will also be provided. A facilitator for the program to support new NGO initiatives will also cover the project provinces. D. NATIONAL CAPiTAL Dig cT Project Activities The project will build on the existing work and plans for FP services, stressing improved management, improved availability and quality of service and community awareness.  - 43 - ANNEX 1 A meeting of key health personnel with their counterparts in the project provinces will be arranged annually for briefing on the scope, progress and objectives of the project and for preparation of yearly action plans which will be submitted to NDOH to serve as a guide for project implementation. Refresher training will be arranged for the FP trainers of health staff, who have completed a TOT program in 1992. A comprehensive training program involving up to 400 people annually will be conducted in the District, building on the present in-service activities, with elements suitable for service delivery, supervision and management, and community education. There will be orientation programs for health administrators and section heads, supervision workshops for the sisters in charge of urban clinics, and in-service courses for clinic and outreach staff. The program will include training for male health workers to counsel men on FP matters. Health staff of government bodies and the private sector will be included. Annual one day FP information days will be conducted for leaders of local community organizations, settlement communities, church groups etc., associated with each on the nine urban clinics, and organized by the clinic staff. lTree days of seminars will be conducted annually by experts in FP, consisting of two one-day programs for doctors, especially those in private practice, and one day for senior nursing staff. One of the experts will be invited from overseas and one from within PNG, on a tour covering NCD and the project provinces. Overseas clinical training will be organized for a small number of nursing staff. A program for community volunteers in MCH/FP will be developed, with training of the volunteers and their supervisors, and involvement of community leaders in monitoring and supporting the people selected. The volunteers would assist in the urban clinics and form a link between the service providers and clients. Supervision of the urban clinics and outreach program will be strengthened by the provision of an additional vehicle. Extensions will be provided to six of the urban clinics, to allow space for private counselling and for FP services along with necessary equipment and furnishings. NCD participate in review and updating of the management information system for MCH/FP. This will remain compatible with the current health information system, but incorporate some additional data for use by the District managers. Program Managerment The Assistant Secretary Health will be the project coordinator for the district, reporting plans and progress to his superior in NDOH and to the Project Implementation Unit.  - 44 - ANNEX 1 An additional nursing officer position will be provided for a FP Coordinator, responsible to the Assistant Secretary Health through the Community Health Matron. Funds for an additional Accounts Clerk position will also be provided. Project Initiation At the commencement of the project an orientation program will be organized for government officials, politicians and community leaders, following which a working group will be convened to draft a population policy for the District. Orientation visits to a neighboring country with an active FP program will be arranged for selected senior health personnel. Promotion of Family Planning A number of government and non-government agencies based in NCD can be tapped to assist in designing and implementing a family planning promotion program. A core group of implementors will be trained in communication planning, research and management so that an effective FP promotion effort can be launched in NCD. This core group will also provide technical assistance in the project provinces. The project will provide the following: (i) training workshops on communication planning, research and management, aimed at developing and implementing a behavior change strategy to increase use of family planning; (ii) materials production, pretesting and distribution; (iii) supervision and technical assistance from the NDOH Health Promotion Center during planning and implementation of a FP promotion program; (iv) policy guidelines on FP promotion goals and the medical content of FP messages; and (v) funds and international technical assistance in the development, pretesting and production of FP promotional materials (print, video and radio) for use in the NCD's promotion activities and health worker training. Non-government Organizations NCD will be the location of a number of national initiatives involving NGOs in FP promotion activities. The PNGFPA will also be supported in particular aspects of its program. A fund will be established at national level to support suitable proposals from NGOs as they arise during the project. Technical Assistance from national and external sources will be provided for specific aspects of project implementation. An external adviser will support NCD and the project provinces in the first two years to assist with orientation and start-up activities, the establishment of supervision and monitoring procedures and with problem solving in the early stages. A national training manager, based in Port Moresby, will support the FP trainers in NCD and the provinces. Technical assistance in Health Promotion, as described above, and in updating of the management information system for MCH/FP will also be provided. A facilitator for NGO initiatives will also cover the NCD and project provinces.  -45 - ANNEX 1 E. WEsrERN HiGHLANDS PROVINCE Project Activities Activities will comprise: (i) participation by key Health Division officials in annual planning workshops, with plans to be submitted to the Provincial Government and PIU, as a guide to project implementation; (ii) training of selected staff to become trainers in FP, with refresher training also arranged; (iii) overseas clinical FP training for selected nursing staff; (iv) a comprehensive provincial training program for up to 400 people including hospital and community health staff, both government and mission, community leaders at district level, and health workers in private or statutory organizations; (v) seminars for doctors and senior nurses will be included. The Provincial Council of Women will organize training for their members and the Community Women's Organizers, using Health Division and other personnel as resource people; (vi) construction of a new FP/MCH clinic within the grounds of Mt. Hagen Hospital, along with one staff house, and extensions to a number of rural health centers and sub-centers and to Kudjip hospital; (vii) equipment for clinical contraception at centers and sub-centers, and for surgical contraception at Mt. Hagen and Kudjip hospitals; (viii) a computer with word- processing and data packages for the FP Supervisors office, to assist with correspondence, preparation of reports, guidelines, training materials and the monitoring of project activities. All project provinces will be involved in the review and modification of the information system for management of the MCH/FP program. This will remain compatible with the current health information system, but incorporate additional data for use by managers at provincial level. Program Management The Provincial Health Adviser will be the project coordinator in the province, reporting progress and plans to the Provincial Management Team through the Coordinator of Social Services, and to the Project Implementation Unit (PIU) in the Department of Health on a quarterly basis. The FP Coordinator will be responsible for day to day implementation and monitoring of the project in the Health Division, reporting to the Health Adviser through the Community Health Matron. Financial administration of project funds will be the responsibility of the Provincial Division of Finance, with financial delegation to the Health Adviser, following procedures currently used for ADB funds coming to the province. Project Initiation An orientation program for politicians, government officials and community leaders will be organized, following which a working group will be convened to draft a provincial population policy. Visits to a neighboring country with an active FP program will be arranged for selected Health personnel to observe the FP program.  - 46 - ANNEX 1 Promotion of Family Planning The project recognizes the need for technical support in communication planning, research and management for a core group of potential partners in FP promotion. The group includes the provincial health educator, the media unit of the provincial government, the NBC and various groups involved in media materials production and public health. The project will provide the following: (i) training workshops on communication, planning research and management, aimed at developing and implementing a behavior change strategy to increase use of family planning; (ii) materials production, pretesting and distribution; (iii) supervision and technical assistance from the NDOH Health Promotion Center during the planning and implementation of a FP promotion program; (iv) policy guidelines on FP promotion goals and the medical content of FP messages; and (v) provision of nationally produced communication material (print, video and radio) for use in promotion activities and health worker training. Translation and adaptation for local use will be possible provided that the medical content of the messages conforms to national standards. In addition funds will be available for the production, pretesting and adaptation of media materials, as well as for the conduct of qualitative and quantitative research. Non-government Organizations A fund will be created at national level to support suitable proposals from non- government agencies as they arise during the project. From this fund a contribution will be made to the Provincial Council of Women for construction of a women's resource center in Mt. Hagen and for conducting training programs for members. Technical Assistance National or external sources will be used to provide for specific aspects of project implementation. An external adviser will support the project provinces in the first two years to assist with orientation and start-up activities, the establishment of supervision and monitoring procedures, and with problem solving in the early stages. A national training manager, based in Port Moresby, will support the training of FP trainers and make follow-up visits to the provinces. Technical assistance in FP promotion, as described above, and in continued development of the management information system for MCH/FP will also be provided. A facilitator for the program to support NGO initiatives will also cover the project provinces. F. SoUTEIN HIGHLANDS PROVINCE Project Activities Meetings of key officials in the Division of Health with their counterparts in other project provinces will be arranged for orientation and preparation of yearly action plans, to be submitted to the Provincial Government and PIU and to serve as a guide for project implementation. Training will be arranged for three selected nursing staff to become trainers of other health staff in FP. This TOT will be carried out in the first year of the project and refresher provided in alternate years thereafter.  - 47 - ANNEX 1 A comprehensive training program with elements suitable for service delivery, supervision and management, and community education will be provided for up to 700 people comprising health workers of government and church organizations, leaders of women's organizations and women's organizers of the Social Affairs Division. It will include training for male health workers to counsel men on family planning matters. Seminars for community leaders at the district level will be organized by Health center officers on an annual basis, as will two day seminars for doctors HEOs and senior nurses, led by visiting authorities from PNG and overseas. Supervision of FP services will be supported through of an additional vehicle for MCH/FP supervision. Funds for air travel and for overnight stays will be included. Agreement will be reached for the Provincial Women's Officer to accompany MCH staff from time to time, to support the Community Women's Organizers in the districts in their FP activities. Extension or renovation work will be carried out at the Mendi town clinic and in selected major district health centers to ensure appropriate rooms are available for family planning and related services. An extension to the in-service dormitory and classroom will be constructed. Equipment provided under the project will include kits for health centers and hospitals offering clinical FP services; some office equipment including a photocopier will be supplied. All project provinces will be covered by an initiative to review and update the collection and processing of information related to management of the MCH/FP program, to remain compatible with the health information system but incorporating additional data for use by managers at provincial level. Stationery and software for this will be provided for in the project. Program Management The Project Coordinator in the province will be the Assistant Secretary Health, reporting progress to the Provincial Management Team, chaired by the Provincial Secretary, and to the Project Implementation Unit (PIU) on a quarterly basis. New positions for a Provincial Family Planning Coordinator in Mendi and for MCH/FP supervisors in Tari and Ialibu will ensure effective use of project inputs. The FP Coordinator will report to the Assistant Secretary Health through the Provincial Nursing Officer, in close coordination with the Community Health Matron. An additional accounts clerk position will support the administrative functions for the project. Financial administration of project funds will be the responsibility of the Provincial Division of Finance, with financial delegation to the Division of Health, following the procedures currently used for ADB funds coming to the province.  - 48 - ANNEX 1 Project Initiation Orientation programs will be organized for government officials from provincial and district level, politicians, and community leaders. Following these a working group will be convened to draft a provincial population policy. Visits for selected provincial staff to a neighboring country with an active FP program will also be arranged. Promotion of Family Planning The provincial health educator has access to some agencies with resources for health promotion work. These include the NBC which airs a weekly Radio Doctor program; the media unit of the provincial government which has both print and video equipment; and journalists with the Times and Wantok. UNICEF has recently worked with a local puppet theater group for their health project. The project proposes to provide the following: (i) training workshops on communication planning, research and management, aimed at developing and implementing a behavior change strategy to increase use of family planning; (ii) materials production, pretesting and distribution; (iii) supervision and technical support from the NDOH Health Promotion Center during planning and implementation of a FP promotion program; (iv) policy guidelines on health promotion goals and objectives and the medical content of FP messages; and (v) nationally produced communications materials in print, video and radio format for use in promotion and in health worker training. Translation and adaptation for local use will be possible, provided that the technical content remains consistent with national standards. Funds will be provided for development, adaptation and pretesting of local promotional materials (print, radio and video) as well as for quantitative and qualitative research. Non-government Organizations A fund will be created at national level to support suitable proposals from non- government agencies as they arise during the project. Technical Assistance Technical assistance will be provided for specific aspects of project implementation. One external adviser will support the project provinces in the first two years to help establish new procedures in supervision and monitoring and in the orientation of personnel to the purpose and scope of the project, and their duties and tasks, and to facilitate problem solving in the early stages. A national training manager, based in Port Moresby, will support the training of trainers and make follow-up visits to the provinces to help local personnel establish the training program. Visits of specialists in obstetrics and gynecology to the province, covering FP as well as other aspects of reproductive health will be supported. Technical assistance in health promotion, as described above, and in continued development and use of management information for MCH/FP will also be provided.  - 49 - ANNEX 2 PAPUA NEW GUINEA POPULATION AND FAMILY PLANNING PROJECT NEW STAFF POSITIONS This project has been prepared to assist the Government implement its population program. This is a new program which has been designed to use the existing institutional base and staff resources to the extent possible. In preparing the project to implement this new Government program, the need for some new staff positions has been identified. These new positions are mainly for the management and supervision of this program and the number of new positions has been kept at a level consistent with what is estimated to be essential if there is going to be an effective population program. Only in one subject area is a new organizational structure proposed. The establishment of a Center for Health Promotion at the National Department of Health will significantly strengthen the Department's ability to carry out one of its mandates - to provide the public with information and promote better health practices which includes promotion of family planning on health and other grounds. The establishment of this center will clearly signify recognition of the need for a more active program in this area. The center will be established under the First Assistant Secretary, Primary Health Care. The staff will comprise some existing staff whose jobs include health education activities and some additional posts to create a viable unit. The job descriptions for both transferred staff and new posts will require definition. List of Proposed New Positions National Department of Health (a) Project Implementation Unit. A post of Senior Project Coordinator. (b) Training. A post of national coordinator of MCH/FP training. (c) Center for Health/FP Promotion. The project proposes the creation of four new technical positions and one administrative position, namely (i) Communication Research Officer (CC 10); (ii) Multimedia materials production officer (CC 10); (iii) FP/MCH Communications Officer (CC 8); (iv) Information retrieval/ dissemination Officer (CC 8); and (v) Computer keyboard operator (CC 3). (d) Pharmaceutical Services. The posts of one pharmacist and one procurement officer (CC 10). Department of Finance and Planning - Social Planning Division To assist project management, two additional posts will be created: (i) project accountant (CC 9): and (ii) keyboard operator.  - 50 - ANNEX 2 East New Britain - Division of Health To supervise and manage the program three additional posts are needed: (i) provincial family planning co-ordinator; (ii) family planning counsellor; and (iii) data entry clerk. Eastern Highlands - Division of Health To supervise and manage the program two posts have been identified: (i) family planning co-ordinator; and (ii) accounts clerk. Morobe - Division of Health To supervise and manage the program two posts have been identified: (i) family planning co-ordinator; and (ii) logistics officer. National Capital District - Division of Health Two family planning supervisor positions (nursing officer 4, CC 6) will be required, the first in 1994 and the second in 1996. Southern Highlands - Division of Health Two additional posts have been identified for 1993; (i) family planning co-ordinator; and (ii) logistics clerk. Two additional posts for MCH/FP supervisors have been identified, one for Tari in 1995 and one for lalibu in 1997. Western Highlands - Division of Health A position for a family planning supervisor has been tentatively identified, but this proposal requires further discussion. A total of 22 posts are indicated in the initial stages of the project for effective management of the program, with 3 additional posts during the life of the project (5 years) to continue strengthening program management as it expands. There is also an additional post for the UPNG Population Program and two for the Institute of Medical Research.  - 51 - ANNEX3 Page 1 of 4 PAPUA NEW GUINEA POPULATION AND FAMILY PLANNING PROJECr TRAINING PROGRAM A. Training of Trainers (TOT) Program Training of FP Trainers courses consisting of 2 phases to total 7 weekswil take place in Pt Moresby, I week refri courses will follow alternative years thereafter. Number of Participants TOTAL Subcomponent 1993 1994 1995 1996 1997 Partiipants No. of weed East New Britain Province TOT courses 3 - 1 - - 4 28 Refresher courses - - 3 - 1 4 4 Eastern Highlands Province /a TOT courses 2 - - - - 2 14 Refresher courses - 2 2 2 2 8 8 Morobe Province /b TOT courses 1 - - - - 1 7 Refresher courses - 3 1 3 1 8 8 National Capital District /b TOT courses - - - 0 0 Refresher courses - 3 - 3 - 6 6 Southern Highlands Province TOT courses 3 - - - - 3 21 Refresher courses - - 3 - 3 6 6 Western Highlands Province /c TlOT courses 3 - - - - 3 21 Refresher courses - 1 3 1 3 8 8 Other provinces /d TOT courses - - 10 - - 10 70 Refresher courses - - - 10 10 10 TOTAL: TOT courses 12 0 11 0 0 23 161 Refresher courses 0 9 12 9 20 50 50 /a Two persons have been trained as trainens under the SEATS progrm. Two additional peona will be provided with a TOT program All four trainers will bc provided with refresher coures alternative years thereafter. /b Three persons trained as trainers under the SEATS program will be provided with refresher courses In Years 2 and 4. /c One has been trained to bc a trainer under the SEATS program. Three additional persons will be prvided with a TOT program in Y with refresher courses alternative years thereafter. /d To be determined.  - 52 - ANNEX 3 Page 2 of 4 PAPUA NEW GUINEA POPULATION AND FAMILY PLANNING PROJECT TRAINING PROGRAM B. Domestic Short-term Training Program No. of persons to Number of Participants T O TA L Component/Type of Training be trained 1993 1994 1995 1996 1997 1998 Participts No. of s/mo.. FAMILY PLANNING SERVICE DELIVERY East New Britain Province: one-wk courses for OlCs/SICs - 30 30 30 30 30 150 35 one-wk courses for nurses & CHWs - 200 200 200 200 60 860 198 one-wk courses for hospital and 0 nursing school staff - 80 80 80 80 - 320 74 - one-day courses for section heads 30 - 30 - 30 - 90 4 - one-day sessions for medical 0 doctors & senior nurses - - 35 35 35 - 105 5 Subtotal 450 30 310 375 345 375 90 1,525 316 Eastern Highlands Province -one-wk courses for OlCs/SICs 24 24 24 24 24 24 144 33 - one-wk courses for nurses & CHWs 80 240 240 240 240 80 1,120 258 one-wk courses for hospital and nursing school staff - 20 20 20 20 - 80 18 - two-day trng for p.health staff 20 20 20 20 20 20 120 11 - one-day sessions for medical doctors & senior nurses - - 55 55 55 - 165 8 - one-day sessions for community leaders - 280 280 280 120 960 44 - one-day session for church leaders - 60 60 60 60 - 240 11 Subtotal 600 124 364 699 699 699 244 2,829 384 Morobe Provincc - one-wk courses for HEOs/SICs 20 40 40 40 40 20 200 46 - one-wk courses for d.health staff 80 360 360 360 360 80 1,600 369 - two-day trng for section heads 20 - 20 - 20 - 60 6 - one-day sessions for medical dloctors & senior nurses - - 55 55 55 - 165 8 - one-day sessions for community leaders - - 240 240 240 120 840 39 Subtotal 500 120 400 715 695 715 220 2,865 467 National Capital District: - one-wk courses for clinic staff 60 140 140 140 140 80 700 162 - one-wk courses for staff of clinics rmn by govt statutory bodies & private - 60 60 60 60 20 260 60 - or:e-wk courses for comm.volunteers 40 40 - - - - 80 18 - two-day trng for supervisors and admin staff - 40 - 40 - 40 120 11 - one-day sessions for medical doctors & senior nurses - - 55 55 55 - 165 8 - one-day sessions for community leaders - - 180 180 180 80 620 29 Subtotal 400 100 280 435 475 435 220 1945 287  - 53 - ANNEX 3 Page 3 of 4 Domestic Short-term Training Program (continued) No. of penons to Number of Participants T O TA L Component/Type of Training be trained 1993 1994 1995 1996 1997 1998 Participts No. of u/mos. Southern Highlands Province: - one-wk courses for HEOs & SICs - 40 40 40 40 20 180 42 - one-wk courses for APOs,CHWs - 200 200 200 200 100 900 208 - one-wk courses for women organizers - 16 16 16 16 16 80 18 - two-day FP trng for prov.hstaff 20 20 20 20 20 20 120 11 - one-day sessions for medical doctors & senior nurses - - 35 35 35 - 105 5 - one-day sessions for community leaders - - 280 280 280 140 980 45 - orientation courses for leaden 20 20 20 20 20 - 100 5 Subtotal 700 40 296 611 611 611 296 2465 333 Western Highlands Province: - one-wk courses for HEOs & SICs - 30 30 30 30 30 150 35 - one-wk courses for CHWs, nurses - 300 300 300 300 160 1,360 314 - one-wk courses for hospital staff (public and private) - 80 80 80 80 20 340 78 - two-day trng for section heads 20 - 20 - 20 - 60 6 - one-day sessions for distr.managers 20 20 20 20 20 - 100 5 - one-day sessions for medical doctors & senior nurses - - 36 36 36 - 108 5 - one-day sessions for community leaden - - 280 280 280 60 900 42 Subtotal 400 40 430 766 746 766 270 3018 484 National level training: /a 2-day workshop for CHWs 16 - - - - - 16 1 - one-wk w/s for teachers 14 - - - - - 14 3 -one-wk courses for CHW trainen - 16 16 16 16 - 64 15 -one-wk courses for FP trainem 9 18 18 18 18 9 90 21 Subtotal 64 39 34 34 34 34 9 184 40 Total - FP Service Delivery _ 3.114 493 2.114 3.635 3,605 3.635 1,349 14,831 2,312 PROGRAM SUPPORT/b Contraceptive/Pharmaceutical Logistic System: - one-mo.in-service for dispensers 36 12 12 12 - - - 36 36 Dcmographic Data Collection and Utilization: - three-wk workshop in survey methodology 60 - 20 40 - - - 60 42 - two-wk management training for provincial officers (for the Demographic Health Survey) 19 - - 19 - - - 19 9 Total - Program Support 115 12 32 71 0 0 0 115 86 TOTAL 3,229 505 2,146 3,706 3,605 3,635 1,349 14,946 2,398 /a Included also re: (i) workshops for national supervisors and PP coordinators on provincial mmengement development; and (il) short certificate courses for medical doctors. lb Included also In the proposed project re: (i) two teaching fellowsip (one-year) for Department of Community Medicine, UPNG; (ii) one two-year diploma In cartography; and (iii) provisions of training for diploma In cartography; and (iiI) provisions of training for staff of PPU and PIV. (limos denotes staff-months.)  - 54 - ANNEX 3 Page 4 of 4 PAPUA NEW GUINEA POPULATION AND FAMILY PLANNING PROJECT TRAINING PROGRAM C. Overseas Training Number of Participants T O T A L Type of Training/Component 1993 1994 1995 1996 1997 1998 Participants No. of mo Sbort Clinical A Maatcemcet Traimiag: (3-weeks) East New Britain Province - 3 3 3 3 3 15 10 Eastern Highlands Province - 4 2 4 2 - 12 8 Morobe Province - 4 2 4 2 1 13 9 National Capital District - 4 - 3 - - 7 5 Southern Highlands Province - 4 - 4 - - 8 6 Western Highlands Province - 4 - 4 - - 8 6 Clinical Training for Doctors - 2 2 2 2 2 10 7 Subtotal 0 25 9 24 9 6 73 51 Demograpbic data sampling and census - 1 1 - - - 2 8 evaluation: (4-ionths) Overseas visits In FP Management: (I-mo) Project Management - PPU - 2 2 2 2 2 10 10 Project Management- PIU - 2 2 2 2 2 10 10 Subtotal 0 4 4 4 4 4 20 20 Detree/DiRlomm Programs: Contraceptive/Pharmaceutical Logistic System: - 1-yr in drug management - 1 1 1 1 - 4 48 -1-yr in pharmacy - - I - - - 1 12 -1-yr in supply & procurement mngt - I - - - - 1 12 - 1-yr in pharmaceutical management - - I - - - 1 12 and qualitycontrol Population/FP Research: - MA program (2-yrs) (DCM-UPNG) - - I I 2 48 - MA program (2-yrs) (PP-UPNG) - - 1 1 2 48 Demographic Data Collection & Utilization: - Diploma in administration (1-yr) - I 1 12 - MA in demogranalysis (2-yrs) - I I 2 48 - Sampling method (1-yr) - I - - - - 1 12 - Mngt of Information system (1-yr) - - I - - - 1 12 Subtotal 0 5 7 3 1 0 16 264 TOTAL 0 35 21 31 14 10 111 343  - 55 - ANNEX 4 PAPUA NEW GUINEA POPULATION AND FAMILY PLANNING PROJECT TECENiCAL ASSISTANCE The following provides the terms of reference for the long term advisers required for project implementation. In addition, a number of short term consultants will be required for specific technical tasks. The terms of reference for the short term consultants are also provided where the tasks have been adequately identified. Provision has also been made in the budget to recruit additional consultants to meet unforeseen requirements. A. LONG TERM TECHNICAL ASSISTANCE (ONE YEAR OR MORE) - TERMS OF REFERENCE I1. Senior Project Adviser - Terms of Reference Location: Social Planning Division, Department of Finance and Planning (DFP). Term: Intermittent, with visits of about one month duration three times a year for a total of no more than three months each calendar year over the life of the project. Counterpart: First Assistant Secretary, Social Planning Division, DFP. Terms of Reference: The advisor will render assistance to the project by: (i) counselling and advising about the further development and implementation of population policy; (ii) providing technical guidance to senior management including the National Population Council about population issues; (iii) assisting with resolution of management issues and problems which may arise; (iv) assisting with resolution of issues related to procurement of goods and services; (v) providing senior project staff with the opportunity to interact with an experienced person and facilitating the on-the-job learning process of those staff; (vi) assisting and brokering issues which relate to agency-Government interfacing; and (vii) assisting with identification of appropriate consulting services, if required; (viii) assist with determination of the appropriateness of additional consulting services which may be required under the project; and  - 56 - ANNEX 4 (ix) provide guidance, if required, about the evaluation of project studies and research proposals and results. Qualifications: The person would be an external consultant. The adviser should be a senior person with broad experience with implementation of population programs in developing countries and academic qualifications in the field of population and/or public health. Preferably, the adviser should possess a knowledge of Papua New Guinea and a good working knowledge of the agencies involved in this project. Superior inter-personal and political skills would be highly desirable. 2. Project Administrator - Management Location: Social Planning Division, Department of Finance and Planning (DFP). Term: Five years, with an initial period of three years with the option of extending for a fuirther two years subject to satisfactory performance od duties and approval of the Project Steering Committee (PSC). Starting date - May 1, 1992. Counterpart: Assistant Secretary, Health and Population, Social Planning Division, DFP. Terms of Reference: The advisor will assist the following activities: (i) prepare and maintain detailed plans and schedules of project activities; (ii) establish a detailed, time-phased financial plan, ensuring that each project component is included in the annual budget estimates submitted by the agencies involved; (iii) supervise the project staff in DFP (accounts clerk and KBO); (iv) monitor and coordinate project activities in all participating agencies where appropriate; (v) coordinate with the aid donors and the project adviser; (vi) prepare quarterly reports for the Government and semi-annual reports for the donors concerning project performance, and assist with the mid-term evaluation of the project; (vii) liaise with OIDA, Public Accounts and Auditor General staff about maintaining acceptable project accounts, procedures for disbursing loan funds, audits and financial reporting; (viii) be responsible for administration of project records, files and correspondence, reports, contracts and updating the project procedures manual; (ix) assist with preparation of consultant short lists, preparation and issuance of invitation documents for consultant proposals and contract negotiations where appropriate;  -57- ANNEX 4 (x) coordinate the work of the project consultants where appropriate; (xi) assist the agencies with preparation of contracts for goods and services, tender documents, tender invitations, evaluation of bids and negotiating contracts; and (xii) assist and advise the Population Program Unit (PPU), as and when requested, with the following: - National Population Council - public relations - departmental and ministerial briefs - monitoring and further development of Population Policy Project Steering Committee, including agenda setting and monitoring PSC's decisions. Qualifications: The post would be an external consultant (AIDAB supported). The main qualification would be demonstrated broad experience in administration and management and a master's level of academic achievement, preferably in the area of public administration. Experience within Papua New Guinea would be an advantage. The candidate would also have proven communication skills, both oral and written, an ability to maintain good inter-personal relations and an aptitude for negotiation are also sought. While a background in population and health would be preferable, this is not essential. 3. Project Adviser - Technical Location: National Department of Health Term: Five years, with an initial contract period of three years with an option to extend for a further two years provided that performance is satisfactory and with the approval of the PSC. Starting date - May 1, 1993. Counterpart: First Assistant Secretary, MCH/FP Terms of Reference: The adviser will assist with the following activities: (i) maintenance of effective implementation and co-ordination of project activities under the direction of the National Department of Health and provincial Divisions of Health; (ii) making available current technical knowledge relating to all aspects of family planning; (iii) introduction and trials of community based distribution of contraceptives; (iv) organization of overseas training activities for family planning staff;  - 58 - ANNEX 4 (v) as necessary, assist with the organization and conduct of training programs under the project; (vi) in close collaboration with the management advisor based at Social Planning, DFP, assist preparations for meetings of the PSC and with any required follow-up actions (the technical advisor should be an ex-officio member of the PSC); and (vii) preparation of reports relating to the project and assist with the mid-term review. Qualifications: The post would be an external consultant (AIDAB supported). The consultant should have professional qualifications, at least at master's level, in the field of maternal and child health and family planning, preferably with the emphasis on the latter. The consultant should have extensive experience in managing and administering major programs in this field. The consultant should have good communication and negotiating skills and also demonstrated ability to maintain good inter-personal relations. A good knowledge of Papua New Guinea is preferred. 4. Provincial Program Adviser Location: National Department of Health (based at Goroka) Term: The appointment would be for a period of two years. Starting date - September 1, 1993. Counterpart: First Assistant Secretary MCH/FP, NDOH Terms of Reference: The consultant will provide assistance to the five provinces in the following general areas: (i) preparation of project work plans; (ii) introduction of record systems for family planning; (iii) organization of training activities in conjunction with training staff; (iv) liaison with NGO activities and act as additional resource person for NGO programs; (v) organization of meetings for senior provincial leaders; (vi) provincial information source for the program and public relations activities; (vii) monitoring and evaluation activities; and (viii) provision of responses to other project related issues which may be identified by the provincial authorities. Qualifications: The post would be an external consultant (AIDAB supported). The person should have professional qualifications in the health/population field (i.e.senior nurse or  - 59 - ANNEX 4 MPH qualifications) and broad experience in project related work in developing countries. Past experience in Papua New Guinea would be an advantage. The candidate should possess good communication and inter-personal skills. The person will be expected to undertake extensive traveling, sometimes under difficult circumstances. 5. Training Consultants The project will provide a package of training assistance incorporating the use of long term and short term expertise from outside and from within PNG. It is intended that this package be organized, coordinated and monitored by a single institution or organization under contract to the Government of PNG in conformity with guidelines and conditions acceptable to the funding agency. This technical support for training will be provided in three distinct but interlinked functional areas: the in-service training of health workers, the pre-service training of health workers, and the training of medical students and doctors. One long term external adviser will be provided in each of the first two areas. For medical training it is expected that a national member of the UPNG teaching staff will be seconded to do the work, and that his position will be taken by an overseas contract officer, funded by the project. To assist with the workload two national long term consultants will be recruited. Senior Training Adviser MCH/FP Location: Family Health Services, NDOH (Port Moresby) Term: Five years, commencing June 1993. Counterpart: Coordinator, MCH/FP Training, NDOH Terms of Reference: Assist with technical support, coordination and monitoring of all the health training interventions of the project. Duties: (i) Support NDOH and project staff in planning, conduct and follow up of the training program for provincial FP trainers (TOT), ensuring documentation to produce course guidelines. (ii) Facilitate training interventions, workshops etc at national level for the FP coordinators and other key Health Division staff in the project provinces. (iii) Support and monitor the in-service training programs in the project provinces, and participate in annual reviews of these. (iv) Maintain liaison with Training Division, the Chief Nursing Officer and Primary and Secondary Health Services in NDOH, and with UPNG, CAHS and other health training institutions. (v) Ensure procurement and distribution of training materials and equipment to the project provinces. Liaise with the Health Curriculum and Media Unit and the Health Promotion Center in the local production of training materials.  - 60 - ANNEX 4 (vi) Supervise the work of project training and training support staff and the administration of the project's training section. Provide PIU with progress reports. Qualifications: Graduate in medicine, nursing, social science or education; post-basic qualification in public health,education, or manpower development; experience in health training and in administration of training programs in developing countries. Training Specialists (two) Location: Family Health Services, NDOH (Port Moresby) Term: Four years, commencing April 1994 Counterpart: Coordinator, MCH/FP Training, NDOH Terms of Reference: Assist the Senior Training Adviser with the overall training program. Duties: to assist with (i) organization and conduct of MCH/FP training activities conducted under the project, including course planning and design, preparation of course materials, selection of participants and reporting on training performance; (ii) design of curriculum materials; (iii) monitoring and evaluating provincial training activities; (iv) further development of Family Planning Guidelines and other written materials; and (v) act as a resource person for other service providers on matters related to family planning training. Qualifications: The two training specialists should be senior national nurses, preferably with a master's degree in nursing and with extensive experience in the organization and conduct of training activities and development of training materials. They should have superior communication skills. Director, Family Planning Location: Department of Clinical Science, Faculty of Medicine UPNG (Port Moresby) Counterpart: Professor and Head of Department of Obstetrics and Gynecology Term: Long term, with funding from the project for two years, commencing in September 1993. Terms of Reference: (i) Develop all aspects of the university's program of clinical training in family planning.  -61- ANNEX 4 (ii) Supervise establishment of a model family planning clinic at Port Moresby General Hospital. (iii) Assist NDOH to develop and implement a plan to improve family planning in secondary health services, beginning in the project provinces. (iv) Provide authoritative comment and guidance on family planning issues to health policy makers, public officials and the general community, using appropriate channels, including mass media. (v) Provide advice to the Project Steering Committee, Population Policy Unit and NDOH on medical and clinical aspects of population/FP policy and strategy. (vi) Assist in providing guidelines for correct medical content of communication materials on family planning for the general public. (vii) Coordinate the University's program of research into the clinical aspects of family planning. Qualifications: Medical degree with specialist qualification in Obstetrics and Gynecology; additional training in family planning; experience, interest and skill in teaching clinical aspects of family planning to health workers; competence in public speaking and in presenting family planning information to the public through newspapers, radio and television; skill in writing and editing reports, guidelines and teaching materials. The project will provide short term external consultancies in a number of specialized areas of expertise, including training design, materials development and distance education. 6. Health Promotion Consultants To implement the health promotions component of the Family Planning and Population project in PNG, a full-service organization will need to be contracted with expertise in health promotion and an ability to provide both a long-term (3-5 years) communication advisor, as well as short-term consultants. This agency should have the capacity to undertake all phases of communication work. The consulting agency will station a Resident Advisor in Port Moresby for a five year period. Short-term consultancy assignments will involve travel around the country particularly the five pilot provinces and the National Capital District. Location: National Department of Health Term: The consultancy agreement will be for five years. Starting ate April 1, 1993. Counterpart: Assistant Secretary, Health Promotion Center at NDOH. At the provincial level the counterparts will be the Provincial health educators. Terms of Reference: The consulting agency will provide technical assistance in all phases of health promotions work namely:  - 62 - ANNEX 4 (i) communication planning and strategy development; (ii) message design and materials development/pretesting; (iii) communication research both formative and summative; (iv) research and development activities aimed at developing innovative training materials and teaching methods to respond to PNG-specific problems hindering effective health promotions, such as high levels of illiteracy among the target population, the use of several hundred languages, poor reading skills. The agency must be able to subcontract local agencies in PNG for specific communication outputs. It must be able to institute a viable technology transfer and mentoring system over the period of the project. The Resident Advisor will provide both formal and informal , on-the-job training to the members of the counterpart units, both NDOH and the five pilot provinces and the National Capital District in all phases of health promotion work, particularly communication planning and behavior change strategy development; message design and materials development/pretesting; and, communication research. Qualifications of Resident Advisor: Educational background in the social sciences, with 5 - 10 year's experience in the use of communications for development. A graduate degree is an asset. Work experience in public health desirable. 7. Consultant for NGO Activities Location: Department of Religion, Home and Youth Affairs (DRHAY) - Non- Government Organization and Womens' Divisions. Term: The appointment would be for a period of two years. Starting date - September 1, 1993. Counterparts: Assistant Secretaries, Non-Government Organization and Womens' Divisions, DRHAY. Terms of Reference: The consultant will undertake the following activities: (i) assist the development of procedures for NGO submissions and help NGO's prepare submissions to the PSC for funding approval. Provide the PSC with an assessment of the proposals; (ii) identification of NGO projects eligible for assistance; (iii) act as a resource person for the NGO's providing technical guidance to the NGO's during implementation of their programs; (iv) assist the NGO's in meeting required accountability standards;  -63 - ANNEX 4 (v) prepare a report of activities on a six-monthly basis for submission to the PSC; and (vi) assist the Non-Government Organization Division and DWA in developing satisfactory procedures for implementing and monitoring the program of support for NGO's. Qualifications: The position would be open to either a PNG national or external consultant. The candidate should have had broad experience in working in the population field with non-government organizations. The candidate should have a masters level qualification in the population or social studies disciplines but other educational achievements would be considered in conjunction with an appropriate work experience. The candidate should have superior communication skills, especially oral and preference would be given to a candidate with competency in pidgin English. Alternately, the candidate would be expected to make every effort to develop such a language competency. 8. Contraceptive/Pharmaceutical Supply Systens Specialist Location: Department of Pharmaceutical Services/NDOH Term: 18 months, starting about September 1, 1993. Counterpart: Chief of Pharmaceutical Services Terms of Reference: The consultant will assist the pharmaceutical section to: (i) standardize procurement procedures for international procurement, prepare standard bidding documents, technical specifications, evaluation criteria and delivery scheduling; (ii) devise norms for various procurement options such as local competitive bidding, direct shopping, limited international bidding and international competitive bidding; (iii) establish procurement schedules to obtain best prices through economies of scale; (iv) review the current procedures for demand forecasting and develop a quantification procedure based on national morbidity data and consumption patterns; (v) based on realistic demand estimates obtained through morbidity data and contraceptive prevalence rates, evaluate the adequacy of current budgetary allocation for drugs and contraceptives and suggest revised budgetary inputs to ensure uninterrupted supply of contraceptives and drugs; (vi) help develop norms for minimum stock levels at various distribution points, automatic re-ordering procedures and the buffer stocks required to overcome any interruptions in supply; (vii) estimate the lead time involved in international procurement to design a rolling procurement cycle;  - 64 - ANNEX 4 (viii) develop a two-way information flow system to monitor stock holding, movement and shelf-life of drugs and contraceptives and devise a system for tracking and inter-facility transfers of excess and limited shelf-life stocks to avoid losses; (ix) design pre-shipment inspection supplies including random testing of drugs before shipment and develop testing protocols for drugs on order and drugs in the system; (x) develop criteria for maintaining track records of suppliers to eliminate unreliable suppliers; (xi) suggest options for better coordination of donor inputs for drugs and contraceptive supplies to avoid double ordering; (xii) train store staff to monitor shelf-life, special storage requirements for certain drugs and physical inspection of drugs for signs of deterioration and degradation; (xiii) strengthen the current inventory control system, design a procedure for periodic physical inventorization of stocks and procedures for disposal of expired and obsolete stocks; (xiv) design a supervision system for periodic monitoring of stocks at various health delivery levels and training of staff in drug management. Qualifications: The consultant should be a pharmacist with at least ten years experience in procurement management, tender processing, finance, warehousing and storage of drugs, inventory control and distribution and monitoring or medical supplies and contraceptives. They should also be familiar with development and operation of computer-based inventory management, demand forecasting and bid comparison programs to monitor stocks and process procurement. B. SHORT TERM CONSULTANTS (LESS TEAN ONE YEAR) - TERMS OF REFERENCE 1. Consultant - Population Data Location: National Statistical Office (NSO) Term: Three weeks, approximately June 1994 Counterpart: Assistant Statistician Terms of Reference: The consultant will perform the following activities: (i) liaise with NSO, East New Britain Provincial Statistical Office and the Civil Registration group in the Department of Home Affairs and Youth, to select variables to be included in the pilot Provincial Data System/Civil Registration (PDS/CR);  - 65 - ANNEX 4 (ii) liaise with NSO, East New Britain Provincial Statistical Officer, Civil Registration group and other potential users to determine report formats to be used in the pilot PDS/CR; (iii) review existing computerized Papua New Guinea databases, including PNGRIS and National Mapping Bureau data and determine the extent of pilot PDS/CR compatibility with other databases; (iv) prepare specifications for the pilot PDS/CR database and the preparation of customized software to extract data. Qualifications: The consultant should have an extensive knowledge of demographic data in Papua New Guinea, and of the type of data required to monitor population change and to plan for economic and social development at the national and provincial level. The consultant must also be experienced in the use of computerized database systems and in the analysis and presentation of population data. 2. Consultant - Civil Registration Location: Department of Religion, Home Affairs and Youth Term: Five weeks, approximately June-July 1994 Counterpart: Deputy Registrar General Terms of Reference: The consultant will perform the following activities: (i) review, evaluate and report on progress with Civil Registration in PNG to date; (ii) evaluate the existing legislation relating to registration of births and deaths and advise on any changes, new acts, bills or other legal steps necessary to enable the system to become mandatory and enforceable; (iii) review mechanisms for implementing registration of births and deaths and evaluate existing documentation for birth registrations and recommend any necessary revisions; (iv) advise on staffing, computer hardware and software requirements to carry out registration and advise on appropriate data storage systems for retaining records at the National Archives in Port Moresby; (v) determine any legal steps are necessary to enable the PDS to be used to identify cases for registration; (vi) liaise with the NSO and East New Britain Provincial Government to determine a mechanism for using the pilot PDS to identify cases for registration;  - 66 - ANNEX 4 (vii) prepare a timetable for the phasing in of universal registration, including dates at which registration will become mandatory, at first with a period of grace for defaulters and later with enforcement; (viii) advise on an appropriate fee structure for the issue of certificates. Qualirications: The consultant will possess a law degree and have an extensive knowledge of the legal requirements for Civil Registration. They should also be experienced in designing mechanisms for implementing bureaucratic procedures. 3. Consultant - Computer Specialist for Pharmaceutical Supply Services Location: Pharmaceutical Supply Services, NDOH (Port Moresby) Term: Six months (possibly two three month periods), approximately at the end of 1993. Counterpart: Chief of Pharmaceutical Services Terms of Reference: The consultant will undertake the following activities: (i) evaluate PSS and AMS staff computer competency; (ii) design and conduct a training program for PSS and AMS staff; (iii) assist with development of an information flow system and other systems consistent with ensuring the availability of contraceptives at all health facilities; and (iv) advise on the further purchases of software and hardware for PSS and AMS. Qualifications: The consultant will have had extensive experience with computer software and hardware as applied to the supply and distribution of pharmaceuticals and wIll also have had experience with the organization and conduct of computer training at all levels of competency. 4. Consultant - MIS Specialist Location: Family Health Services, NDOH (Port Moresby) Term: 8 weeks in the first year and 4 weeks in the second year. Counterpart: Coordinator, MCH/FP Training, NDOH Terms of Reference: The consultant will undertake to: (i) design, test, revise and introduce written and computer software package for MIS for family planning, supplementing and compatible with the existing health information system;  -67 - ANNEX4 (ii) assist provincial and national authorities to refine appropriate management, service and performance indicators for the family planning program, based on review of currently used indicators and new program plans; (iii) assist with revision of recording and reporting forms to incorporate the agreed indicators, for testing in the project provinces; (iv) assist with the training of provincial family planning coordinators and health information officers, and regional and national level supervisors in the operation and use of the MIS; (v) prepare written guidelines about the use of the system to be incorporated eventually into a management manual for provincial family planning coordinators; (vi) orient the responsible officer in NDOH to the process of MIS development and handover the work at the conclusion of the first consultancy period; and (vii) follow-up in the following year to assess performance of the system, and reinforce skills of users at each level of the system. Qualifications: Experience in design and training of the use of HIS/MIS software applications in developing countries. 5. Consultant - Distance Learning Specialist Location: Family Health Services, NDOH (Port Moresby) Term: Three months during each year commencing in the second year. Counterpart: Coordinator, MCHIFP Training, NDOH Terms of Reference: The consultant will design and assist with the implementation of a distance learning program for community health and other staff in FP/MCH which will entail the following activities: (i) conduct of a review of past experience and current initiatives in distance learning in PNG, and a feasibility study for a new program in distance learning in FP/MCH, considering technological and training innovations likely to be effective in the setting of PNG; (ii) presentation and discussion of the findings and the study with officers of NDOH, health training institutions and other involved organizations; (iii) preparation of a detailed plan for a distance learning program for the project provinces, to be commenced in year 3 of the project; and (iv) assisting staff with the implementation of the plan, regular review, monitoring and evaluation.  - 68 - ANNEX 4 Qualifications: The consultant will have qualifications and experience in distance learning programs and approaches, preferably with experience of applying these in the health field in developing countries. 6. Consultant - Senior Level Curriculum Specialist Location: Department of Community Medicine, University of Papua New Guinea Term: Six months (possibly in two periods) Counterpart: Head, Department of Community Medicine Terms of Reference: The consultant will revise the curricula for undergraduates and diploma students in the Department of Community Medicine, to ensure that appropriate attention is given to social, policy, planning, communication (EC) and service delivery aspects of population issues, family planning and women's health. The specific activities include: (i) Familiarization with the background and present status of Papua New Guinea's population policy and national plans and priorities for reproductive health and family planning; (ii) Reviewing the relevant portions of the existing curriculum and exploring the experience of both teachers and students with this curriculum; (iii) the desired attitudes and competencies of medical practitioners and other graduates to contribute to leadership and support in the further development and implementation of programs in population, reproductive health and family planning; (iv) Developing learning objectives for the curriculum to achieve these competencies; (v) Preparation of outlines of course units with schedules of learning experiences, supplementary activities, teaching specifications and requirements for instructional material to achieve the agreed learning objectives; (vi) Identifying likely sources of instructional materials as well as supervision of local production of materials where necessary; (vii) Identifying appropriate assessment methods and tools for the course units; (viii) Documentation of all aspects of the revised curriculum to meet the requirements for submission to the official UPNG approving body; and (ix) Participation in the orientation of staff to the new curriculum, when it has been approved for introduction. The consultant will work in a counterpart or mentor relationship with a designated faculty member, under the direction of the Head of the Department of Community Medicine,  - 69 - ANNEX 4 reporting to a steering committee made up of some faculty members with other local expertise if available. The work will as far a possible be a participative process, involving consultation with government and university officials, teaching staff and medical practitioners in various types of service, a series of workshops with faculty members, and circulation of drafts and examples as the work develops. Qualifications: Graduate in Medicine or Social Science, with higher qualification in public or community health and teaching. Extensive experience of designing and teaching courses in the social, policy and health service aspects of population, reproductive health and family planning to undergraduate and postgraduate university students in similar country situations. Willingness to work in a consultative and collegial manner with senior officials and university staff.  PAPUA NEW GUINEA POPULATION AND FAMILY PLANNING PROJECT HEALTH PROMOTION CENTER Asat. Sec Health Promotion Population Admin Clearing House Support ReerI: m ulti Media Prod E Pr | FP/MCH STDAID Comm. Spec ~~~~~~~~~~~~~~~~~Comm. Spec  PAPUA NEW GUINEA POPULATION AND FAMILY PLANNING PROJECT ORGANIZATION OF POPULATION PROGRAM MANAGEMENT | NEC National ~~~~~Project Director Population Secretary DFP Council I Project Manager FAS Social Planning PSC Chairman - | Project Steering | |NGO and Women's Pouato Project Implementation| Divisions (DRHAY) Planning Unit (NDOH) Unit (DFP)l <~~~~Ntoa Reeac Depts. | |Center Phra MC/F NGOs Statistic. Institutions of the for Health ceutical Unit Office Province Prmt (NDOH) Services (NDOH)  - 72 - ANNEX 7 PAPUA NEW GUINEA POPULATION AND FAMILY PLANNING PROJECT DETAILED PROJECT MANAGEMENT The management components and their relationships are given in detail below. A. NATIONAL POPULATION COUNCIL (NPC) The NPC will have the responsibility for overseeing and coordinating the implementation of the Government's population policy and program. Membership of the NPC is: (i) Deputy Prime Minister as Chairperson (ii) Five departmental secretaries (DFP, NDOH, DRHAY, National Department of Education (NDOE), and the Department of the Prime Minister (DPMin) (iii) Four regional representatives chosen by the provincial premiers (iv) Three non-government representatives (PNG Council of Churches, PNG Family Planning Association, and a community leader) The composition of the NPC aims to combine political authority at the highest level (the Deputy Prime Minister) with leading public servants, regional representatives and relevant NGOs. Drawing these persons together will help to fulfil NEC objectives of making the NPC a policy advisory, implementation and monitoring body of the highest authority and representative of a wide range of interests and expertise. The NPC should meet at least twice each year and publish an annual report for wide circulation. At least during its formative stages it appears advantageous to establish the NPC under the authority of the NEC rather than through legislation. This would enable changes to be made more readily in its constitution and in the range of its responsibilities as the NPC evolves . The main functions of the NPC are: (i) Determine how population policy is to be effected; (ii) Control the receipt and disbursement of funds from both internal and external sources needed to achieve population policy goals and objectives; (iii) Approve annually the development programs relating to population activities of departments and organizations required to implement the National Population Policy;  - 73 - ANNEX 7 (iv) Coordinate the activities of line departments and organizations in carrying out programs needed to develop the National Population Policy; (v) Ensure the adequacy of information needed to monitor and evaluate population policy and programs, and to assess requests for external assistance; (vi) Ensure continuing visible national and local commitment to population policy, and facilitate wide publicity and discussion of such policy and programs; and (vii) Provide advice and proposals on future population policy to the NEC. The NPC will be directly linked to the NEC. It will also be linked to the Project Coordinator and PSC. The Project Coordinator is a member of the NPC. Membership of the NPC will ensure close and direct contact with the Secretaries of major government departments, provincial departments and NGOs concerned with population policy and its implementation. Secretariat functions for the NPC will be performed by the PPU. B. SENIOR PROJECT MANAGEMENT The principal persons with senior management responsibility for the project are as follows: Project Director The Project Director will be the Secretary of the DFP. It is necessary to have a senior person as Project Director to emphasize the importance of the project and of the National Population Policy, to be able to call high-level meetings, and to exercise authority over all project participants. The Secretary of the DFP will be a member of the NPC. Although carrying the title of Project Director, the Secretary of the DFP will not be involved in the day-to-day management of the project. The Director will, however, carry the highest authority over all matters relating to the project's implementation. Project Manager The Project Manager will be the FAS of the Social Planning Division of the DFP. Drawing both Project Coordinator and Project Manager from the highest levels of DFP emphasizes that responsibility for project management is being placed firmly within the existing bureaucratic structure rather than creating a special organization for this purpose. The Project Manager will hold responsibility for the operational control, coordination and monitoring of project activities. In order to facilitate this, the Project Manager will be the Chairperson of the PSC. The Project Manager is by virtue of the position as FAS of the Social Planning Division responsible for the DFP's PPU which has vital secretariat functions for the NPC and the PSC. The Project Manager will report to both the NPC and the Project Director on behalf of the PSC, which is the most important body dealing with day-to-day project coordination, control and monitoring.  - 74 - ANNEX 7 C. PRojEcr STEERNG COMmrTrEE (PSC) The PSC will have operational control over project implementation and will be serve as the integrating body. The PSC will take a global view of the project by monitoring all project components. It will be invested with the authority to make decisions about the project in line with the project objectives and plans, in consultation with the Project Director. The PSC will comprise the principal national government persons responsible for project implementation. Restricting the permanent membership of the PSC to six persons should facilitate close working relations between the committee members and promote effectiveness and rapid response in dealing with project implementation. The permanent members are proposed as follows: (i) FAS of the Social Planning Division of the DFP as Chairperson. This person is also the Project Manager; (ii) Assistant Secretary (AS) for the Health, Population and Social Services Branch of the DFP. This person is also directly responsible for the PPU; (iii) FAS for Maternal Child Health/Family Planning (MCH/FP) of the NDOH (a proposed new position); (iv) Coordinator of the Project Implementation Unit (PIU) of the NDOH; (v) AS of the Division of Women's Affairs in the DRHAY; (vi) AS of the Non-Government Organization Division of DRHAY. Other members will be co-opted for particular meetings as is appropriate to deal with such matters as technical advice, national-provincial relations and NGO activities. The authority to co-opt will enable the PSC to respond in a flexible and informed way to all aspects of project implementation. Co-opted members will attend meetings and give advice according to instructions from the permanent PSC members. The two project advisers (management and technical) would attend meetings of the PSC on an observer basis. The functions of the PSC are as follows: (i) Act as the focal point for the coordination of all project implementation activities and have operational authority over these activities; (ii) Be accountable to the NEC and external donors about all matters relating to project implementation; (iii) Have the authority to resolve problems which may emerge in the implementation of the project; (iv) Monitor regularly the progress of all project activities including work undertaken, outputs and outcomes;  -75 - ANNEX 7 (v) Monitor regularly the allocation and expenditure of all project funds; (vi) Make decisions relating to project implementation covering all agencies engaged in these tasks; (vii) Have the authority to co-opt personnel to provide technical advice on any matter relating to project implementation; (viii) Issue instructions to all implementing agencies on actions to be taken to ensure that project goals are followed and achieved. This may include the modification of project implementation activities to cope with changing circumstances and implementation experience; (ix) Make submissions and report to the NPC on matters relating to the project, and on population/family planning in general if required by the NPC; (x) Ensure that the Project Coordinator is kept fully informed of PSC actions and decisions, and if necessary seek the authority of the Project Coordinator for these actions and decisions; (xi) Decide on the appropriate allocation of funds to NGOs and Research Institutions according to submissions and advice received and requested; (xii) Utilize the services of the PPU as a Secretariat. All administrative matters will be dealt with by the PPU Secretariat as required by the PSC. Requirements will be worked out in consultation with the DFP; (xiii) Encourage communication between agencies participating in the project; and (xiv) Publicize the progress of the project to a wide constituency. It should be noted that as the project evolves and circumstances change, the functions of the PSC should be reviewed to reflect these changes. In this way, the PSC should be able to maintain the necessary flexibility and rapidity of response for a project of this nature. To fulfil its role as focus for the day-to-day running of the project the PSC will need to meet regularly. The intervals between meetings will be determined by the PSC and the Project Director according to the demands of the project but it is anticipated that such meetings will be at least monthly. This will enable members with responsibilities for different project components to maintain a comprehensive knowledge of the status of other components and of the project as a whole. The PSC will be closely linked to all major organizations and bodies concerned with project implementation and with general population policy. These organizational linkages are laid out as follows: (i) The PSC will keep the NPC informed of project progress and will supply information as required by the NPC;  - 76 - ANNEX 7 (ii) The PSC will report to and consult with the Project Director concerning project progress and decisions made about the project. It is not anticipated that the PSC will refer all matters to the Project Director as this may overload that person with business which can be satisfactorily resolved by the PSC. The PSC should wield considerable delegated authority on project implementation matters; (iii) The PSC will receive reports from and request information from the PPU as required. The PSC will issue advice and instructions regarding implementation to the PPU. Such advice instructions will only cover project activities which fall under PPU control. The Head of the PPU (AS for the Health and Population Branch of the Social Planning Division of the DFP) will be a member of the PSC. The PPU will provide Secretariat services to the PSC; (iv) The PSC will receive reports from and request information from the Project Implementation Unit (PIU) of the NDOH. The PSC will issue advice and instructions regarding implementation to the PIU. Such advice and instructions will only cover project activities which fall under PIU control. The head of the PIU will be a member of the PSC; and (v) The PSC will receive reports from and request information from the Non- Government Organization and Women's Affairs Divisions of the DRHAY. The PSC will issue advice and instructions regarding implementation to these divisions. Such advice and instructions will only cover project activities which fall under the Divisions control. The AS's who head the two divisions will each be a member of the PSC. D. POPULATION PLANNING UNIT (PPU) The PPU is a section of the Health and Population branch of the Social Planning Division of the DFP. This is according to the proposed restructure of the DFP which the DPM is currently considering. The PPU is the successor to the Population Planning and Coordination Unit (PPCU) which appeared in earlier project planning documents. The PPCU was never formally established and the PPU represents a slight reformulation of the composition and functions of the PPCU as originally formulated. According to the DFP proposal the PPU has the following staff: (i) principal Program Coordinator (Level 1); (ii) population data analyst (CC 9); (iii) one CC 7; and (iv) one CC 5. Due to the volume and nature of work which the PPU will be expected to perform, an increase in staffing is desirable at least for the duration of the project. In the current formulation there does not appear to be a person to deal with accounting and budgeting matters. If, as seems likely, the functions of the PPU include such financial activities, then it is vital to add somebody to deal with them. The volume of paperwork passing through the PPU should be considerable, especially as it will be providing Secretariat services to both the NPC and the PSC. A Keyboard Operator should be included in the PPU to address this matter. The additional positions should be as follows: (i) project accountant (CC 9); and (ii) Keyboard Operator (KBO 5).  - 77 - ANNEX 7 The DFP has expressed a strong interest in receiving technical assistance to set up the varied operations of the PPU. There will be much new activity associated with the PPU such as the Secretariat functions. Coordination of the PPU activities and the building of effective and efficient links to other agencies involved in the project and in population and family planning in general are essential. There is a requirement for a consultant who can assist in the creation of these organizational processes and in training PPU staff in managerial matters. The person would not be concerned with technical matters such as demography and family planning but would focus on management with the objective of producing an effective and efficient organization. The primary function of the PPU is the coordination of activities, data-gathering and organizations which are related to population and family planning in PNG. The idea is not to control other organizations but to provide a central point where relevant information can be gathered, stored and analyzed; where population indicators useful for planning can be developed; where population policy proposals can be assessed; where the feasibility of planning proposals can be assessed; where project and program implementation can be monitored and evaluated; where assistance can be given to other agencies regarding population and family planning matters; where the activities of all other agencies engaged in population and family planning is monitored and evaluated; where publicity and information for population and family planning matters will be prepared and distributed; where advocacy for population and family planning will be organized for a range of national and provincial agencies. From the point of view of the project, the PPU performs vital coordinating functions. Among the most important are the Secretariat services which the PPU will undertake for both the NPC and the PSC. These are likely to absorb considerable amounts of PPU time and effort. It is not a concern at this stage to establish specific operational procedure for the PPU's Secretariat duties. These can be set up by the PPU, NPC and PSC when these organizations are actually formally constituted and starting work. It should be recognized that many of the other routine functions of the PPU will contribute information which will be used in fulfilling Secretariat functions for the NPC and PSC . The PPU will directly supervise and coordinate various project activities being implemented by other organizations. These organizations include: (i) research institutions; and (ii) National Statistical Office. The PPU will maintain communication with the other two national government departments engaged in the implementation of the project. Data and advice are expected to flow both ways although the PPU will be the recipient of most information given its coordination functions and its Secretariat role. It will be the official conduit for decisions made by the NPC and PSC. The major organizational links of the PPU will be: (i) secretariat for the NPC; (ii) Secretariat for the PSC; (iii) official communication of NPC and PSC decisions and requirements to other project organizations; (iv) regular communication with the PIU (representing the NDOH) and the Division of Women's Affairs (representing the DHAY) on any matters relating to the project, and to population/family planning matters in general; and (v) supervision and coordination of the Research Institutions and National Statistical Office participation in the project.  - 78 - ANNEX 7 The AS for Population, Health and Social Services is the direct supervisor of the PPU and will be expected to take an active and leading role in PPU affairs. The AS's role as member of the PSC will help to emphasize this responsibility. E. PROJECT IMPLEMENTATION UNIT (PIU) Located in the Policy, Planning and Evaluation Unit (PP&E) of the Administration Division of the National Department of Health (NDOH), the PIU has 10 years experience in coordinating health projects funded by the Asian Development Bank (ADB). According to the recent restructuring of the NDOH, a new division has been created based on the old components of the PP&E. It maintains its old name, merely substituting division for unit. The PIU should either remain in this division or be made directly responsible to the Secretary in order that it will be able to perform its functions which involve dealing with units in all divisions of the NDOH. When fully staffed the PIU has an establishment of four officers and one Keyboard Operator. However, it is currently operating at well below its establishment level. Two of the four positions are specifically related to the new ADB-funded health project. On advice from the NDOH it appears that it is necessary to create only one new position for the coordination of this project. There are scales of economies to be gained from utilizing the existing personnel. The creation of a new unit to deal exclusively with this project is avoided as it could lead to unnecessary duplication, inappropriate use of human resources, confusion, and additional costs. The calculations about PIU capacity to cope with the workload with only one extra person (Senior Project Officer - World Bank Project) are based on the assumption that the full establishment, as currently prescribed, is in place. The suggested staffing of the PIU is as follows: (i) Project Coordinator (Level 1); (ii) Project Accountant (CC 10); (iii) Procurement Officer (CC 7); (iv) Senior Project Officer (ADB Project) (CC 9); (v) Senior Project Officer (World Bank Project) (CC 9); and (vi) Keyboard Officer (KBO 5). For the World Bank project the PIU would utilize the procedures already used for the ADB projects. They could be modified according to needs and requirements and new procedures could be instituted where necessary. The basic principle is to build on what is already known, institutionalized and works. It is unwise to build entirely new structures and procedures in situations where administrative capacity is limited. Given the limited administrative capacity in parts of the NDOH and the current restricted knowledge of PIU procedures it appears desirable to appoint a Technical Advisor (TA) to the NDOH who would, inter alia, assist the PIU in the review of existing procedures, the modification where agreed of these procedures, the creation of new procedures to cope with project activities which are new to the PIU, and the training of PIU and other NDOH personnel involved in the project. The TA would also assist in establishing management procedures and monitoring and communications systems for the proposed MCH/FP Division of the NDOH. The PIU will assume responsibility for a range of project monitoring, advisory and coordination tunctions involving the following organizational linkages: (i) The PIU will monitor, advise and provide other services as required to the departments of the Province involved in this project;  -79 - ANNEX 7 (ii) The PIU will advise and provide services as required to the (a) Center for Health Promotion; (b) units providing educational and training services in the field of population and family planning; (c) Pharmaceutical Services (this unit is responsible for ordering and dispatching contraceptives and necessary medical supplies required in the implementation of the family planning program in the provinces and National Capital District); and (d) proposed MCH/FP division of the NDOH. (iii) The PIU will liaise with any unit of the NDOH as required by the demands of the project and as requested by the PSC and the NPC; (iv) The PIU will maintain communication concerning project progress, problems and other matters with the other implementing units of the major national departments involved in the project - the PPU of the DFP and the DWA of the DRHAY; and (v) The PIU will report to the PSC on project progress and will ensure implementation of PSC decisions in the units for which the PIU is responsible. The official channel to the PSC will be via the PPU which acts as the Secretariat to the PSC. However, as the Head of the PIU will be a member of the PSC direct communication between the two bodies will be facilitated by this link. F. TmE NON-GOVERNmENT ORGANIZATION AND WOMEN'S AFAIRS (DWA) DIVISIONS The two divisions are the units of the DRHAY involved in the implementation of the project. The divisions will be responsible for the administration of grants provided for NGOs. The NGOs involved in the first instance are listed below but others may well be added as the project progresses: (i) PNG Family Planning Association; (ii) PNG Council of Churches; (iii) PNG National Council of Women. T he grants for the NGOs will be made through normal budget mechanisms. This is the preference of the national government. There are established procedures for such a relationship between government and NGOs. A single line transfer of funds will be made to a DRHAY activity and this will then be used to fund the work of the NGO. The allocation of the funds to the NGO will be based on submissions made to the relevant division by the NGOs. The submissions will be reviewed and approved by the PSC. The NGO to which the funds are given will account for expenditures and report on work done and outcomes to the DRHAY, and through the relevant division to the PSC. The organizational links will be as follows: (i) The relevant division will be responsible for the administration of the project funds allocated to NGOs. The NGOs will be accountable for the expenditure of these funds and for the work undertaken to the relevant division, and through it to the PSC. (ii) The divisions will maintain communication concerning project progress, problems and other matters with the other implementing units of the major national departments involved in the project - the PPU of the DFP and the PIU of the NDOH.  - 80 - ANNEX 7 (iii) The divisions will report to the PSC on project progress and will ensure implementation of PSC decisions concerning matters relating to the NGOs. The official channel to the PSC will be via the PPU which acts as the Secretariat to the PSC. However, as the Heads of the Non-Government Organization Division and DWA will be members of the PSC direct communication between the two bodies will be facilitated by this link.  - 81 - ANNEX O Pago 1 3 PAPUA NEW GUINEA POPULATION AND FAMILY PLANNING PROJECT Implemonntion Schedule Bank FY 1994 199 i | 199i 1997 199t 1990 = Calondar/PNO Fiscal Year 1993 1994 190 10996 1907 199t 0990 (07/93) <-Est matadEffective ea Compledon oeate- t (00/00) Loan 4losing Date.-. 4/99) 1. PROVINCIAL FAMILY PLANNING SERVICE DELIVERY Civil Works: Renov.1extenslon df health eonters: Tender does.preparaton and _ _ iN approval by GOPNG & IBRO /a Tender & contract award _ _ _ _ Construction Furnishing Equipment: Tender doce.preparadon and it approval by GOPNC & I3RD /a Tender & contract award _ _ DiiveryAlnstallaon Clinical kitlb b Technical assistance: MCHlFP training adviser NOOH -_ Training specialists (N) Director family planning UPNO ._ Oesign/support/doca for TOT ._ _ _ _ _ _ Teaching materials pecialists Training: Training of Tralenra Courses TOT refresher courses _ _ _ _ Domeslc traiing Overseas training (3-weeks) Planning. Management & Supervision of FP Rehviw and revision of the MiS for MCH/FP I. PROGRAM SUPPORT UDoradina ContraceDoUe/Pharmaceudcal Loaislc System: Clvil works: (extenslon/renov.od AMSs) Work schedules prepared SpecilicaBons prepared Construction Equipment: (moving equipment, racking systems) Area Medical Stores submit formal requesbt DoNvery/instaIliaon ContracepUvee & STD related drugs: Procurement processing _ _ _ Delivery Technical assistance: Contraceptivs/pharmaceutcail loghsdc specialist Computer speciallst Training: Inservice training for dspensers _ _ Preservice tralning for dipensers Domslic training for new pharmacists Overseas feilowehips /a Tender documxntb upon approval by GOPNO and IBRD will be used as standard documents under the project. /b Clinical kits for health conters and hospitals will be procured through a UN agency.  - 82 - ANUiX O pag 2 of 3 PAPUA NEW GUINEA POPULATION AND FAMILY PLANNING PROJECT Imprnienltaon Schedul* (condnued) Bank FY 1904 10095 111 | 117 L ,1L * Calendar/PNO Fiscal Year 1903 1904 log0o 100 1ItT7 16 101,1 (07M03) <-Elt ated Effeoole *se Compleon a - (o100) Uporading of Family Planning Promotion Capacift: Loan C ooing Odei- Civil Works: (construction of Health Promotion Center): SpecIfcation prepared Contract award Construction Technical assistance: Resident adviser (communication apeclait) Short-term consultants (as required) IEC Development: (general sequence): Situation analysis (field vielt/KAP survey) Finalization of communications strategy Development of IEC messegee - _ _ _ Fil1d pre-testing of IEC messages Production of IEC messages Dlsermination of IEC messages Monitoring of IEC mesesges Increasing Population a FP Reesarch Capacity: Civil Works: (staff houses) Tender & contract award Construction Equipment: Tender & contract award DOiiveryAlnstaIlation Technical assistance: Social scientist Teaching fellow _____ Pop/FP health specialist Overseas training Student field research Demogireohic Data Collecton Utilkzafon: Equlp ment: Tender a contract award Deliveryllnstailstion Technical assistance: Pop data analyst & ciil r.giatr specil t Tralning: Domestic training Overseas training Health & demographic survey  - 83 - ANNEX I Flages3 s01 PAPUA NEW GUINEA POPULATION AND FAMILY PLANNING PROJECT Impiementsglon Schedule (continued) BSank FY 1994 100695 1 190 . 191117 1J190 149 Calendar/PNG Fiscal Year 19g3 1994 1990 1e" 1097 101m le (07p/93 <-Es tated Efecfvoe sea Cormppion a-(Oe/Op In. PROJECT MANACEMENT & IMPLEMENTATION Loa Closing DaOo >(O00) National Population Council established and mainta maintIned Proelct SterIng Committee establshed and maintained Popubtaon Planning Unit In DFP established and maintained Project Implementatlon Unit In NDOH established and maintaIned Equipment: Vehicl*s Office equlpmentjfurniture _ Technical Assistance: Sr. project advisor _ Project administrator. PPU/DFP Project technIcal sdvIsor, PIU/NDOH Provincial program advisor . Training: DomesIec Overseas short-tbrm vIsitb_ Project launch worckshop Joint project supervislon and evaluatlon Mid-term review Reporting requirements: Semi-annual progress reports Anual audit reports  - 84 - ANNEX 9 PAPUA NEW GUINEA POPULATION AND FAMILY PLANNING PROJECT MoNITORING AND EVALUATION SYSnEM Introduction 1. In accordance with GOPNG's Population and Health policies, the project has three operational aims to be achieved during the project period i.e. - expansion and improvement in family planning services, including IEC; - institutional development and capacity raising; - demographic data collection and utilization. 2. Together those inputs would (i) realize the human right of couples to plan their family size through better access to and use of family planning; (ii) lower maternal and child mortality and morbidity as a result of appropriate birth spacing; and (iii) achieve a reduction in the rate of population growth through the prevention of unwanted births. In addition, demographic data collection would enable the government to integrate demographic data into development planning and resource allocation, at the national as well as the provincial levels. Monitoring and Evaluation of Project Activities and Family Planning Services 3. In the initial years of the project, emphasis will be placed on monitoring of inputs into the process of improving services through the implementation of planned activities by the government departments and other institutions responsible for distinct activities. Performance indicators are: - timeliness of completion of activities as compared to deadlines; - quality and appropriateness of those activities e.g., design of demand generation materials in accordance with user-needs i.e., providers and clients; - reporting reliability and completeness. 4. Starting from the second project year onward, progress on service quantity and quality should become measurable in terms of continuity of contraceptive supplies, effective choice of methods by clients and satisfaction with services received and growing awareness of population issues in PNG among policy makers and the public at large. These intermediate project objectives would be evaluated through: - analysis of service statistics from all types of health facilities and support services and focussed feedback to the data providers;  - 85 - ANNEX 9 - focus group research; - supervision visits and reports; and - clinic exit interviews. Impact Evaluation 5. Impact evaluations i.e., improvements in contraceptive prevalence, fertility and mortality levels and population-development planning effectiveness will only be possible on the basis of appropriate benchmark data. Those data are not available at the initiation of the project specific to the project provinces nor reliable for the country as a whole. 6. Project inputs will aim to develop those benchmark data i.e., for awareness on FP/MCH and population issues, for utilization of services and for the status of demographic data collection and utilization through a high quality Demographic and Health Survey in 1995 i.e., about the mid-point of the project period. That survey will provide the benchmark data for impact evaluations by the end of the 5-year project period and beyond that period. Participatory Formative Evaluation Style 7. The monitoring and evaluation system to be used under the project will aim to detect in a timely manner situations where implementation capacity does not match the expectations implicit in the implementation schedule. This will enable project management to identify problems and direct assistance, in a timely and relevant manner, to upgrading staff capacity and removing administrative barriers to performance. 8. It is the intention that the first year implementation schedule be discussed and reviewed at the Project Launch Workshop, to be held once the Project receives approval, with the involvement of representatives of all implementing parties. The final implementation schedule will provide the basis for assessment of performance as specified above. Evaluation Scores and Feedback 9. A scale of 1 to 5 will be used to score performance on meeting quantitative as well as qualitative objectives, as follows: I = excellent 2 = good 3 = fair 4 = weak 5 = no performance Scores between 3 and 5 would indicate that formative action has to be taken by project management matching the degree of seriousness of the problem identified. Persistent problems would be referred to the Project Steering Committee for support in resolving structural problems and barriers to performance exceeding the capacity of day to day project management to resolve.  - 86 - ANNEX 9 Key areas for monitoring 10. Training. As a key input to staff development for capacity building, training activities in all substantive technical areas will receive special attention through evaluations of capacity pre- and post training attendance. In addition, the selection and deployment of trainees will be systematically reviewed to ensure that those that are selected will be in a position to utilize the training received in their assigned posts. Feedback on training activities will be given to the departments of origin of the trainees. 11. Supply of contraceptives. Whatever other progress is made on project activities, a reliable supply of contraceptives is key to achievement of the ultimate project objectives. Special attention will be paid to monitoring the flow and availability of contraceptives and the identification of bottlenecks and barriers in the case of supply failures. Prompt and appropriate corrective action by project management will be a key indicator of project performance. 12. Health Promotion. To ensure free and informed choice by couples of reproductive age, technically and culturally appropriate health promotion materials and campaigns to the public is a pre-condition. From the second project year onwards, small scale research and evaluations will be carried out, through contractual services by the University and research institutions, to assess the dissemination of materials and the impact of health messages on knowledge and comprehension by different cultural and language groups. 13. Ethics and Quality. Quality of service, free and informed choice and full information will be the principle governing service delivery. Courtesy, patience and respect for clients must at all times be exercised. Project management will carry out quality control on that basis and follow-up on all legitimate complaints being voiced by clients and community organizations such as the churches, women's groups and other community based organizations. Satisfied clients are a prerequisite for progress and for achieving significant improvement in women's health. Responsibility for Evaluation 14. Evaluation is a shared responsibility by all involved parties, including the funding agencies, as an integral part of ensuring project success. Thus, first line responsibility rests with those whose task it is to carry out specific activities. The draft Implementation and Administration Manuals, to be developed before the project launch workshop, will assign primary responsibility for all first year project activities as well as contributory responsibility if inputs from several departments and agencies is necessary for satisfactory completion of a specific activity. Those manuals will be discussed at the launch workshop in Lae and agreement sought on the final distribution of responsibilities. 15. Monitoring of deadlines will be carried out by project management i.e., the PPU (DFP) and the PIU (NDOH) on a monthly basis. Compilation of these monitoring reports indicating actions taken on identified delays will form the basis for twice-yearly reports to the Project Steering Committee and the funding agencies. Those reports will be discussed during consortium supervision missions and the Project Review and Project Planning exercise to be carried out yearly with involvement of the NPC and the Project Review and Project Planning exercise.  -87 - ANNEX 10 PAPUA NEW GUINEA POPULATION AND FAMILY PLANNING PROJECT SUPERVIWSON PLAN 1. General Considerations In view of the following factors the project will require intensive supervision: (a) The project represents a major new initiative for the PNG Government, involving several relatively inexperienced implementing agencies; (b) The project is complex, covering a number of sectors with scattered foci of implementation (at national level and in five provinces); (c) There is possible phased expansion to other provinces at appropriate stages during the life of this project; (d) Substantial time is required for travel in-country; (e) Coordination with the two other project funding agencies (ADB and AIDAB) creates additional staff effort; (f) Continued dialogue will also be required with all agencies providing development assistance in the population sector (including UNDP/UNFPA, USAID and others), and with higher government officials; and (g) The absence of a resident mission in PNG imposes a higher workload on members of visiting supervision teams. The three funding agencies will conduct at least two joint supervision missions each year, beginning with the project launch workshop in August 1993. September is an appropriate point in the budget cycle of the PNG government for annual project review and planning activities. It is agreed that ADB and AIDAB will provide representatives with project expertise on these missions, as well as appropriately timed technical supervision of those project components for which they have particular responsibility, including IEC, logistics, NGO support, training, research and the demographic and health survey. The table below gives estimated World Bank staff input for supervision for FY94-96. The requirement would be reviewed before each mission according to the current circumstances.  - 88 - ANNEX 10 2. Bank Supervision Input FY93-96 Approx. Skill Staff Weeks Date Activity Requirements Field HQ Total 8/93 Launch workshop TM (public health) 4 2 6 Start up briefings Senior Project Off.(VP) 3 - 3 Review special acct. Procure/Disb. Officer 3 1 4 & audit requirement Population Specialist 3 1 4 Total 13 4 17 11/93 Project Supervision Health/pop tech review TM (public health) 3 1 4 Finance/procurement Procure/Disb. Officer 3 1 4 review Total 6 2 8 4/94 Project Supervision TM 4 1 5 Annual project review Population Specialist 4 1 5 Govt./donor sector rev. Procure/Disb. Officer 4 1 5 Field visits Total 12 3 15 FY'94 Total 40 9/94 Project Supervision TM 3 1 4 Budget Review Procure/Disb.Officer 2 2 4 Total 5 3 8 4i95 Project Supervision Annual project review TM 4 1 5 Govt/donor sector rev. Population Specialist 4 1 5 Field visits Procure/Disb. Officer 2 2 4 Planning for mid-term review Total 10 4 14 FY'95 Total 22 9/95 Project Supervision TM 3 1 4 Analysis of mid-term Population Specialist 3 1 4 review Institutional Specialist 2 - 2 Budget review Procure/Disb. Officer 2 2 4 Total 10 4 14 4/96 Project Supervision TM 3 1 4 Annual project review Population Specialist 3 1 4 Govt/donor sector rev. Procure/Disb. Officer 3 2 5 Field visits Total 9 4 13 FY'96 Total 27 TM = Task Manager  PAPUA NEW GUINEA POPULATION AND FAMILY PLANNING PROJECT Summary Accounts by Year Totals Including Contingencies Totals Including Contingencies Kina USS 1993 1994 1995 1996 1997 1998 Total 1993 1994 1995 1996 1997 1998 Total 1. INVESTMENT COSTS A. Civil Works 51 1115 1780 956 516 0 4418 54 1170 1868 1003 542 0 4636 B. Equipment & Furniture 14 648 926 114 65 0 1768 15 680 972 120 69 0 1855 C. Contraceptives & drugs 241 562 710 877 1060 588 4038 253 589 746 920 1112 617 4237 D. IEC & Media Production 154 616 734 391 332 51 2277 161 646 770 410 349 53 2390 E. Training 1. Training of Trainers 33 51 45 56 26 0 211 34 53 47 59 27 0 221 2. Domestic Training 185 585 746 844 829 283 3471 194 614 783 885 870 296 3642 3. Overseas Training 0 353 317 325 147 46 1188 0 371 333 341 154 49 1247 Sub-Total 217 989 1108 1225 1002 329 4870 228 1038 1163 1286 1051 345 5111 F. Technical Assistance 1. Project Support 240 732 586 371 374 177 2480 252 768 615 389 393 186 2603 2. Capacity Building 376 1155 935 672 628 247 4012 394 1211 981 705 659 259 4210 oo 3. Policy Support 35 73 88 79 95 43 413 37 77 92 83 99 45 434 %D Sub-Total 651 1960 1609 1122 1097 467 6905 683 2056 1688 1177 1151 490 7246 G. Studies 21 84 88 130 96 34 454 23 88 93 136 101 35 476 H. Demographic Survey 0 0 1235 0 0 0 1235 0 0 1296 0 0 0 1296 1. Field Activities (NGO) 26 159 190 199 197 0 770 27 167 199 209 207 0 808 Total INVESTMENT COSTS 1376 6132 8380 5014 4366 1469 26737 1444 6434 8793 5261 4581 1541 28055 II. RECURRENT COSTS A. Incremental Salaries 129 348 388 409 431 225 1930 136 365 407 430 453 236 2025 B. Operations & Maintenance 213 459 453 490 538 366 2519 223 482 475 514 564 384 2643 Total RECURRENT COSTS 342 807 840 900 969 591 4449 359 847 882 944 1017 620 4668 Total PROJECT COSTS 1718 6939 9220 5914 5335 2059 31186 1803 7281 9675 6205 5598 2161 32724 ======================================= ============= ============