Oman - Health Project

Document of The World Bank FOR OFFICIAL USE ONLY Report No. 15514 IMPLEMENTATION COMPLETION REPORT SULTANATE OF OMAN HEALTH PROJECT (LOAN 2807-OMA) APRIL 2, 1996 Human Resources Division Middle East Department Middle East & North Africa Region This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization.  CURRENCY EQUIVALENTS Currency Unit = Rial Omani (RO) April 1987: US$1 = RO 0.384 April 1995: US$1 = RO 0.384 WEIGHTS AND MEASURES The Sultanate of Oman uses the metric system of weights and measures ABBREVIATIONS BHCDS Basic Health Care Delivery System BRHO Batinah Regional Health Office FPMS Financial Planning and Management System HIS Health Information System HSMP Health Services and Manpower Planning MOFE Ministry of Finance and Economy MOH Ministry of Health ODA United Kingdom Overseas Development Agency PHC Primary Health Care RHO Regional Health Officer UNDP United Nations Development Program WHO World Health Organization FISCAL YEAR January 1 - December 31  FOR OFFICIAL USE ONLY IMPLEMENTATION COMPLETION REPORT SULTANATE OF OMAN HEALTH PROJECT (LOAN 2807-OMA) Table of Contents Preface ....................................................... i Evaluation Summary ....................................................... ii PART I. PROJECT IMPLEMENTATION ASSESSM]ENT A. Project Objectives ................................................. 1 B. Achievement of Objectives ................................................. 2 C. Implementation Records and Major Factors Affecting the Project .............. ................. 3 D. Project Sustainability ................................................. 4 E. Bank Performance ................................................. 5 F. Borrower Performance ................................................. 5 G. Assessment of Outcome ................................................. 6 H. Future Operation ................................................. 6 1. Key Lessons Learned ................................................. 6 PART II. STATISTICAL TABLES Table 1: Summary of Assessments. 9 Table 2: Related Bank Loans .10 Table 3: Project Timetable .10 Table 4: Loan Disbursements: Cumulative Estimated & Actual .11 Table 5: Key Indicators for Project Implementation .12 Table 6: Key Indicators for Project Operation .13 Table 7: Studies Included in Project .14 Table 8A: Project Costs by Expenditure (Category .15 Table 8B: Project Financing .15 Table 8C: Project Costs by Foreign & Local .15 Table 9: Economic Costs and Benefits .16 Table 10: Status of Legal Covenants .16 Table 11: Compliance with Operational Manual Statements .19 Table 12: Bank Resources: Staff Inputs .19 Table 13: Bank Resources: Missions .20 APPENDICES A: Estimated Number of Beneficiaries Covered by BHCDS: N. Batinah . 21 B: ICR Mission Aide Memiore .22 C: The Borrower's Contribution to the ICR .26 D: Map 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 wiLhout World Bank authorization.  I  IMPLEMENTATION COMPLETION REPORT SULTANATE OF OMAN HEALTH PROJECT (LOAN 2807-OMA) Preface 1. This is the Implementation Completion Report (ICR) for the Health Project in the Sultanate of Oman, for which Loan No. 2807-OMA in the amount of US$ 13.3 million equivalent was approved on May 5, 1987 and made effective on March 1, 1988. 2. The Loan was closed on May 31, 1994 corresponding to the original closing date. Final disbursement took place on October 13, 1994, and a balance of US$ 5,412,092.54 was canceled on December 20, 1994, the date on which cancellation was requested by the Borrower. 3 . The ICR was prepared by the Human Resources Division (MN2HR) of the Middle East and North Africa Region and was reviewed by Mr. Jacques Baudouy, Division Chief (MN2HR) and Ms. Tufan Kolan, Acting Project Advisor (MN2DR). 4 . Preparation of this ICR started during the completion mission in April 1995. It is based on material in the project file. The Borrower contributed to preparation of the ICR through its participation in the completion mission, and in preparing its own evaluation of the project's implementation phase.   - ii - IMPLEMENTATION COMPLETION REPORT SULTANATE OF OMAN HEALTH PROJECT (Loan 2807-OMA) EVALUATION SUMMARY Introduction 1. The project was designed during the Government's Second Five-Year Development Plan (1981- 85). Health indicators for Oman were considered poor in comparison to middle-income countries, and in some instances approximated indicators for Sub-Saharan Africa. Oman's health sector strategy concentrated on providing primary health care to meet the health needs of underserved areas, primarily rural populations and women and children, in order to address high maternal and infant mortality. Subsequent five-year development plans (third and fourth) continued this emphasis and all the components of the Health Project were incorporated into the Government's health sector strategy. There was no relevant prior Bank involvement in the health sector in Oman. Project Objectives 2. The project's objectives were to: (a) reduce mortality and morbidity, targeting the 300,000 inhabitants of the predominantly rural Batinah region; (b) strengthen Government's health planning and management capacity; and (c) strengthen the health care delivery system in support of the health sector strategy. 3. The project was to be implemented over five years and included components to: (a) develop health services by establishing a Basic Health Delivery System in Batinah Region as a model for the rest of the country, a Regional Training system, and by strengthening health promotion; and (b) strengthen the Ministry of Health's (MOH) existing Statistical Unit, establish a financial management section within the Directorate of Finance, and provide accounting, procurement and architectural assistance. Implementaion Experience and Results Achievement of Objectives and Project Sustainability 4. The project objectives were well conceived, specific and consistent with the Government's health sector strategy. The project achieved objectives (a) and (c), but objective (b) was only partially met. Under the first objective, the model health care delivery system was established in Batinah and by the end of the project, 81 percent of the population was receiving expanded and improved health care. Under the third objective, new health policies were introduced, enabling the MOH to integrate preventive and curative health care and to then decentralize the delivery system first to the regional level (1990) and subsequently to the district level (1992). The second objective - health planning and management strengthening - was partially met. For example, while the Financial Planning & Management Systems Unit (FPMS) was established and started operating, the numbers and skills of staff were inadequate (Table 5). In addition, only one of three planned studies was completed (Table 7).  - Hii - 5. The failure to achieve all the objectives, as well as the lengthy initial delays in implementation (civil works were delayed by three years) were due to the following problems: - a delay in deciding the type of facility designs by the MOH,1 thus postponing the commencement of civil works for three years; - problems in recruiting technical assistance resulting in slow placement of consultants for the institutional strengthening process; - recurring difficulties in obtaining counterpart funds from MOFE for annual work programs; - limited managerial capacity of MOH; - a slow start-up of the fellowship and training programs3; and - the government's evolving health policy which impacted on the project. 6. A change in project management staff (a new project director) in the last two years of the project sped up implementation and largely made up for past delays. Project sustainability is likely as the Government is providing adequate budgetary resources to the health sector and the MOH is firmly committed to its health sector strategy of which the project is an important component. To ensure continued sustainability the MOH must focus on improving its human resource capacities, particularly in planning and finance. It will also have to reassess its health sector financing policy in order to respond to population growth, and the increasing demand for and cost of health care. 7. Final project costs amounted to US$26.0 million compared with the appraisal estimate of US$30.6 million. US$5.4 million (41 percent) of the Bank loan was canceled. The shortfall in the use of the Bank loan was due to: (a) grant funds becoming available to the Government to finance technical assistance and training; (b) a reduction in equipment, vehicles and materials purchased following changes in facility design; and (c) disbursement problems (see paras. 16 and 17 of Part 1). Key Factors Affecting Outcome 8. The problems reviewed above (para. 5) clearly affected project outcome. Another related and compounding factor was the rapidly changing health environment in which the project was developed and implemented. The MOH continued to modify its strategy (e.g. the decision to change the health referral system by introducing polyclinics) in ways that affected project implementation. Specifically, two polyclinics, one hospital and three health centers were built instead of ten health centers which were planned. Key factors that contributed positively to project outcome are: (a) technical and advisory support from the MOFE and the Ministry of Development; and (b) progressive improvement in MOH leadership and an impressive learning curve on the part of the MOH managers and staff both with respect to the project as well as to health sector development in general. ' This was due to two main reasons: lack of consensus within MOH as to appropriate facility design and a national change in the health sector referral system (introduction of polyclinics). 2Mainly because counterpart funds provided by MOFE were released through the annual budget. 3 Strategy for nurses training took three years to be completed.  - Iv - Bank and Borrower Performance 9. While lank perfonnce was satisfactory with regard to project identification and supervision, preparation and particularly appraisal could have been better. Bank preparation missions should have ensured more complete MOH ownership of the project concept and design, and analyzed more fully the division of administrative responsibilities within the Government. The appraisal mission should have ensured complete agreement on architectural designs to minimize delays during project implementation. Borrower performance overall was satisfactory. Lack of project experience, difficulty in obtaining operating funds, and limited technical and managerial capacity at the start of project implementation caused delays. Project management subsequently improved. Legal covenants were complied with except for the studies covenant. Sunmnary of Findings, Future Operations, Key Lessons Learned 10. The project objectives were well conceived, specific and consistent with health sector strategy. While two objectives were met, the third was only partially met. Failure to assess accurately during project preparation the ability of the MOH to manage the project (para. 9) and to ensure complete agreement of architectural designs at appraisal resulted in implementation delays and also resulted in underutilization of the Bank loan on which the Government continued to pay commitment fees. uture Oqperations 11. The Sultanate of Oman has graduated from being a borrower. However the MOH has stated informally that it wants to develop a technical assistance relationship with the Bank for future health sector needs in the context of the Bank's Technical Cooperation Program. Key Lessons Learned 12. It is necessary to pay close attention to the roles of the relevant ministries, MOH and MOFE, in implementation. The existing institutional arrangements and structure and the absorptive capacity of the Borrower and sector ministry must be assessed in detail with regard to implementation mechanisms and project management arrangements. In particular, the division of responsibilities between the MOFE and MOH for project management and financing, the managerial capacity of the MOH as well as the Borrower's administrative, budgetary and procurement systems should have been fully assessed. The result of this assessment should have been fully reflected in the eventual implementation arrangements. 13. In hindsight it would also have been useful to do an explicit stakeholder analysis. The Bank might then have taken into account better the division of responsibility between the MOH and the MOFE in designing the managerial and administrative arrangements proposed for the project, and have ensured the full involvement of all the stakeholders in project design and preparation. 14. Architectural designs for the clinics should have been agreed during appraisal and confirmed during negotiations. 15. The Bank should have been more insistent that the baseline survey was carried out as this was central to the monitoring and evaluation system.  - v - 16. For the future the MOH should focus on continued strengthening of its human resources, and might consider carrying out a review of health costs and financing.  IMPLEMENTATION COMPLETION REPORT THE SULTANATE OF OMAN HEALTH PROJECT (LOAN 2807-OMA) PART I: PROJECT IMPLEMENTATION ASSESSMENT A. Project Objectives 1. The objectives of the Project were to: (a) reduce mortality and morbidity, targeting the 300,000 inhabitants of the predominantly rural Batinah region; (b) strengthen Government's institutional capacity to plan and manage the health sector; and (c) support the institution building processes necessary for the country-wide implementation of a more efficient and integrated health care delivery system. 2 . The project was to be implemented over five years and would provide funds for civil works, equipment, furniture, vehicles, materials, drugs and supplies, technical assistance, fellowships and training, and incremental operating costs. The project components included: Part A: Health Services Development (i) Establishing Basic Health Care Delivery System in Batinah Region (ii) Establishing Regional Training (iii) Strengthening Health Promotion Part B: Institutional Development (i) Upgrading the existing Statistical Unit of the Directorate of Statistics, Planning and Follow-up (DSPF) to a Health Information Section within the DSPF; (ii) Establishing a Financial and Management Section within the Directorate of Finance of the MOH; and (iii) Providing for accounting, procurement and architectural assistance to the Project Coordinator to ensure that Project activities are well coordinated. 3. In order to achieve the objectives: (a) appropriate infrastructure was to be developed to improve primary health care coverage to meet the needs of the regions where most of the rural population was underserved; (b) integration of preventive and curative care was to be developed within a program of basic health care services directed to the rural population. The basic health care delivery system in the Batinah Region was to serve as a model for different regions of the Sultanate; (c) capacity building was an integral component of the project to ensure appropriate manpower development through intensifying training and recruitment programs; and (d) the design included strengthening of institutional capability to enable MOH to plan and manage the health sector. This was supported by the Initiating Project Brief (September 30,1983, Oman Project File) which stated that 'the predicted pattern of mortality and morbidity in adults and children in Oman suggests that health status  - 2 - can be improved by the development of systematic basic health care and preventive activities at the local level". Evaluation of Project Objectives and Project Design 4. The project objectives were well conceived, specific and consistent with the planned sector goal to improve the health status of the target population. This was within the context of the "Oman: Population, Health and Nutrition Sector Memorandum" (Yellow Cover Report dated October 30, 1984, Oman Project Files). The importance of achieving these objectives were outlined in the Bank's Country Assistance Strategy (Country Programs, Departmental letter July 29, 1983-Oman Project File). MOH had recognized (a) that services were concentrated on the few urban areas; (b) the limited health benefits from greater focus and increasing expenditures on curative care; (c) the unmet health needs of the underserved rural populations (especially women and children); and (d) the cost-effective benefits that may accrue from improved preventive health care. 5. The project was developed in a rapidly changing health environment: (a) Oman was a high income oil-exporting economy which had been undergoing rapid modernization over the last 16 years; (b) the population was growing rapidly (growth rate in 1987 was estimated at 4.5%); and (c) the demand for health services was increasing. 6. Project appraisal identified high maternal and infant mortality' and rapid population growth as significant issues in the sector. However, preparation missions noted a high sensitivity to the population issue in Oman which was then strongly pro-natalist. Consequently, no direct mention of a family planning program was made in the appraised program of basic health care services. 7. Even though the risk of limited implementation capacity was recognized at implementation, it was underestimated. The project design failed to take sufficiently into account: (a) the limitation in MOH's absorptive capacity regarding rate of project inputs and processes (e.g., in operating project budget, processing procurement actions, etc.); (b) the system of clearances and review under which technical assistance and fellowships awards were administered; (c) the division of management, administrative, procurement and disbursement responsibilities between MOH and MOFE; and (d) the lack of experience of MOH senior managers and staff with respect to Bank procedures. B. Achievement of Objectives 8. The project achieved the objectives of reducing mortality and morbidity in the Batinah region (para. 9) and of strengthening the health care delivery system. But it only partly achieved the objective of strengthening Government's health planning and management capacity. 9. The model basic health care delivery system (BHCDS) was established in North Batinah with considerable success. The baseline study on health status (Table 7) was never carried out, which made it difficult to assess objectively mortality and morbidity reduction in the Batinah Region. However, as BHCDS was estimated to be providing improved health coverage to 81 % of the region's population and exceeded several appraisal targets (e.g. 94% of relevant population were fully immunized compared to a target of 90%), it is safely assured that health status improved. Under the third objective, new health policies were introduced, enabling the MOH to integrate preventive and curative care under a ' Infant mortality rate in 1986 was 103 infant deaths per 1000 live births. No estimates were available for maternal mortality.  - 3 - unified chain of command with full decentralization of health care delivery to each region (1990), and subsequent decentralization to the district (wilayat) level (1992). 10. The outcome under the second objective was mixed (Table 5). The Financial Planning & Management Systems (FPMS) Unit and the Statistical Unit of the MOH now provide relevant health management information and cost accounting information to the system. The project has also established cost accounting systems in four major hospitals and the MOH is gradually expanding this facility to other tertiary and major secondary hospitals. Auditors from the Diwan' of the Sultanate reviewed the establishment and work of the FPMS Unit and recommended strong governmental support for the institutionalization of such a system in other ministries. Though the FPMS Unit is functional, like the other divisions in the planning and management section of the MOH, it remains severely understaffed (actual staff recruitment was 30% of estimated requirements at appraisal). 11. Despite significant achievements, the institutional strengthening process could have been stronger. The major weakness was the inability to ensure adequate technical assistance and key MOH staff at critical times (mainly related to difficulties in obtaining operational funds - para. 14). Identified training objectives at the start of the project were only partly achieved (Table 5). This is partially explained by changes in government policy (pre-service training sub-objectives were not achieved as development of the main target cadre - assistant nurses - was discontinued) and by an inability to fulfill the designed fellowship program (25% of fellowships were not used). Conversely, targets for in- service training (except for management and finance) were exceeded (fourteen fold) as the MOH decided to make in-service training compulsory for all staff. The duration and curriculum of the training programs varied significantly from what had been identified at appraisal. Notably, the paucity of health planning and management courses is particularly significant as this could have long term implications on sustainability of the system (only a one-day course was offered in this area compared to five six-day courses which had been identified at appraisal, which in hindsight are themselves insufficient to achieve the degree of skills upgrading required). C. Implementation Record and Major Factors Affecting the Project 12. Implementing the project presented several challenges to the Government and MOH. The Staff Appraisal Report identified as a major risk MOH's capacity to meet the demands arising from the project in terms of management development, reorganization and expansion of the system to include new units/sections. 13. The appraisal team emphasized the need for MOH staff to participate fully in the preparation and appraisal of the project to minimize the above risk. Although an MOH Task Force was formed, the MOH decided to rely mainly on external technical assistance (UNDP, WHO, ODA-UK and Bank inputs ) for project preparation. 14. The appraisal of the project was too optimistic in terns of potential output achievable within the projected time horizon. After an extremely slow start, project implementation gained momentum in mid-1990 as a result of staff changes in project management (a project director replaced the project coordinator). The main reasons for the slow implementation initially were: - a delay in deciding the type of facility designs by the MOH thus postponing the commencement of civil works for three years; 'Council of Ministers. Highest authority under the authority of H.M. The Sultan.  - 4 - - problems in recruiting technical assistance resulting in slow placement of consultants for the institutional strengthening process; - recurring difficulties in obtaining counterpart funds from MOFE for annual work programs; - limited managerial capacity of MOE; - a slow start-up of the fellowship and training programs; and - the government's evolving health policy which impacted on the project. 15. The initial lag period of three years (1987-1990) was adequately redressed between 1990 to the end of implementation in 1994. This was primarily due to: (a) enhanced leadership and decision- making at the ministerial level including addressing constraints on TA, fellowship and training, and decisive action on civil works execution; (b) improved Government commitment; (c) better project management; and (d) strong motivation of health sector personnel. 16. Project Costs and Financing. The actual costs of the completed project were US$26.0 million compared with the appraisal estimate of US$30.6 million (see Table 8A). Civil works were higher than estimated (US$8.8 million disbursed vs. US$6.7 million appraised), mainly due to design changes (two polyclinics, one hospital and three health centers were built instead of ten health centers which were planned) and increases in construction costs. The higher costs were, however, mainly covered by additional Government funds. Less equipment, furniture, vehicles and materials were needed than had been identified at appraisal because fewer facilities were built (US$3.9 million disbursed vs. US$4.9 million appraised). Allocations for technical assistance and fellowships were also not fully utilized (US$3.1 million disbursed vs. US$4.9 million appraised) while virtually nothing was spent on local training and seminars (zero percent of loan allocation for this component was disbursed). 17. With regard to the Bank loan, less than sixty percent of the Bank loan was disbursed (Table 8a). In addition to previously identified implementation problems (para. 14), the shortfall in the use of the Bank loan was mainly due to: (a) reduction in equipment, vehicles and materials required (US$2.0 million disbursed vs. US$4.5 million appraised); and (b) problems with disbursement (MOH was unable to provide MOFE with critical information for certain withdrawal applications'). D. Project Sustainability 18. The project achieved its objectives of establishing a sustainable basic health care system in the regions, improving the health status of the target population and establishing planning and management institutions within MOH. The Sultanate's economic growth has been a potent factor in this context. 19. Oman is highly committed to the provision of quality health services. This is supported by the development strategy conceived by the Ministries of Development, Finance and Economy, and Health. All the elements of the Health Project are integral parts of the health program in the Fourth Five-Year Development Plan (1991-1995). The outline for the Fifth Five-Year Development strategy includes all ' For example, MOH was unable to disaggregate drug costs for project facilities from bulk government procurement or to provide required information on local training.  - 5 - the project elements and addresses four main areas: infrastructure development, health services, human resources planning and development, and research (Appendix B: Mission's Aide Memoire, paras. 6-8). 20. Limited human resource capacity (particularly in management and finance) which was a problem during implementation needs to be addressed in the medium to long term to ensure that health gains are sustained. While budgetary health allocations to MOH to date have been adequate to finance health services, it would be prudent to reassess health sector costs and financing in view of rising costs of care (one of the project studies not carried out), increasing patient demands for high-quality care, growing population and possible economic shocks in an oil-dependent economy. E. Bank Performance 21. The Bank participated in the design and preparation of the project. In spite of the existence of the MOH Task Force during project preparation, delay over facility design (para. 14) during implementation suggests that full participation was not achieved. This was responsible to a great extent for the three-year delay in commencement of civil works. The appraisal mission should have ensured complete agreement on architectural designs to minimize delays in project implementation. The appraisal mission identified but underestimnated the risk of limited capacity in the ministry. In retrospect, it was unrealistic to assume that the MOH would have been solely responsible for management (SAR, para. 5.06). Greater clarification between the role of MOH and MOFE should have been sought by preparation and appraisal missions (para. 23). Eleven supervision missions, including a disbursement mission, visited Oman between December 1988 and January 1994 to supervise the project (Table 13). These missions provided constructive advice (however, problems related to project funding between MOH and MOFE remained in spite of interventions by supervision missions and Bank management) and were responsive to issues arising during project execution. In conclusion, while identification and supervision of the project were satisfactory, preparation and particularly appraisal of the project were less than satisfactory. F. Borrower Performance 22. This was MOH's first experience with a Bank-assisted project. During the period under review, MOH's technical capability was mainly limited to the few staff at senior management level. Despite initial shortcomings (para. 14), MOH's overall perfornance was satisfactory. It received considerable support and direction from MOFE and the Development Council (now the Ministry of Development) in terms of government policies relating to Bank-Borrower relationships. The Borrower cooperated fully with the Bank and maintained regular communication throughout. 23. The proposed management of funds (SAR 5.06) was not in line with government policy. The project called for management of funds by the MOH, although MOFE had this mandate'. MOH staff were not trained in Bank procedures and experienced considerable difficulty providing MOFE required information (para. 17), particularly for preparing loan disbursements. The advice of a 1990 Bank disbursement mission that MOH staff be provided with the authority and training to prepare disbursement and procurement documents was not followed. Legal covenants were substantially complied with (except those related to the two studies that were not completed); accounts were audited annually; program budget, work plans and progress reports were regularly submitted annually to the Bank for review and were found to be of acceptable quality. ' In 1990, a disbursement mission noted that withdrawal applications for all five active World bank loans were prepared and submitted by MOFE.  - 6 - G. Assessment of Outcome 24. The Basic Health Services Delivery System is fully operational in North Batinah region and its replication has already begun in other regions. The major objectives of the project were achieved (paras. 9-11), to a large extent and are likely to be sustained. 25. The outcome for completion of civil works and infrastructure was satisfactory. The facilities built comprise three polyclinics, one district (wilayat) hospital and three health centers. The location is satisfactory and the physical attributes of the completed facilities are generally excellent. All facilities are fully operational in terms of staff, drugs, vehicles, equipment and services. Most appraisal service targets were met (SAR, para. 3.03)1. The project facilities provided 45% of health centers and 20% of secondary hospital coverage in the North Batinah region. Family planning services (birth spacing) is now being provided by the health centers. 26. The outcome in terms of institutional development and strengthening is mixed. A new Financial, Planning and Management Section (FPMS) was established while the Statistical Unit was upgraded to a Health Information Section (HIS). However staffmg levels of both sections are less than 50% of the estimated levels at appraisal. The lack of in-service training programs in planning and management can only worsen the outlook for continued development of these sections. H. Future Operation 27. The completion of the project coincides with the end of the Fourth Five-Year Development Plan, 1991-1995. The plan for the operational phase of the project components which are now integral parts of the MOH system are incorporated into the Fifth Five-Year Development Plan, 1996-2000. 28. The Sultanate of Oman has graduated from being a borrower. However, the MOH informally advised the ICR mission of its wish to develop a technical assistance relationship with the Bank. Areas that MOH may wish to explore include: (a) human resource planning and development (particularly in management and finance); (b) strengthening of the delivery system at the secondary and tertiary levels; (c) quality of services; and (d) a review of health costs and financing. I. Key Lessons Learned 29. It is necessary to pay close attention to the roles of the relevant ministries, in this case MOH and MOFE, in implementation. The existing institutional arrangements and structure and the absorptive capacity of the Borrower and sector ministry must be assessed in detail with regard to implementation mechanisms and project management arrangements. In particular, the division of responsibilities between the MOFE and MOH for project management and financing, the managerial capacity of the MOH as well as the Borrower's administrative, budgetary and procurement systems should have been fully assessed. The result of this assessment should have been reflected in the implementation arrangements. 30. In hindsight it would also have been useful to do an explicit stakeholder analysis. The Bank might then have taken into account better the division of responsibility between the MOH and the 'In addition to immunization (see para. 9), outreach and antenatal care targets were exceeded - 55% vs. 50%, 97% vs. 90% respectively.  - 7 - MOFE in designing the managerial and administrative arrangements proposed for the project. This would have ensured a better involvement of all the stakeholders in project design and preparation. 31. Architectural designs for the clinics should have been agreed during appraisal and confirmed during negotiations. 32. The Bank should have been more insistent that the baseline survey be carried out as this was central to the monitoring and evaluation system. 33. For the future the MOH should focus on continued strengthening of its human resources, and might consider carrying out a review of health costs and financing and deepen health systems analysis.  - 8 - THE SULTANATE OF OMAN HEALTH PROJECT (LOAN 2807-OMA) PART II: STATISTICAL TABLES Table 1: Summary of Assessments Table 2: Related Bank Loans Table 3: Project Timetable Table 4: Loan Disbursements: Cumulative Estimated and Actual Table 5: Key Indicators for Project Implementation Table 6: Key Indicators for Project Operation Table 7: Studies included in Project Table 8A: Project Costs by Expenditure Category Table 8B: Project Financing Table 8C: Project Costs by Foreign and Local Table 9: Economic Costs & Benefits Table 10: Status of Legal Covenants Table 11: Compliance with Operational Manual Statements Table 12: Bank Resources: Staff Inputs Table 13: Bank Resources: Missions  - 9 - Table 1: Summary of Assessments A ACHIEVEMENT OF SUSTANTlA PARTIA NEGLIGIBLE NOT APPLICABLE OBJECTIVES Sector Policies X Financial Objectives X Institutional Development X Physical Objectives X Poverty Reduction X Gender Issues X Environmental Objectives X Public Sector Management X Private Sector Development X B SUSTAINABILT.TY IJNKELY UNCERTAIN Project Sustainability X c BANK PERFORMANCE HIGHLY SATISFACTORY DEFICENT SATISFACTORY Identification X Preparation Assistance X Appraisal x Supervision X D BORROWER PERFORMANCE HIGHLY SATISFACTORY DEFICIENT SATISFACTORY Preparation X Implementation x Covenant Compliance X Operation E ASSESSMENT OF OUTCOME HIGHTLY SATISFACTORY UNSATISFACTORY HIGHLY SATISFACTORY UNSATISFACTORY |~~~ I X  - 10- Taljle 2': Related Bank Loans There are no related Bank loans. Table 3: Project Timetable STEPS IN PROJECT CYCLES DATE PLANNED ACTUAL DATE Identification 06/07-21/84 06/08-21/84 Preparation 03/21-28/84 03/21-28/84 05/09/-16/85 05/11-16/84 09/17/85 01/11-29/86 Appraisal 12/02/85 10/01-23/86 06/11/86 Negotiations 04/21/86 03/18/87 Board Presentation --- 05/05/87 Signing --- 07/17/87 Effectiveness 09/30/87 03/01/88 Mid-term Review 12/89 05/92 Project Completion 06/92 05/94 Loan Closing 05/31/94 04/30/95 - (extended)  - I I - Table 4: Loan Disbursements: Cumulative Estimated and Actual (US$ millions) FY88 FY89 FY90 FY91 FY92 FY93 FY94 Appraisal 1.6 3.6 6.0 8.2 10.4 | 12.2 13.3 Estimate Actual 0.7 1.4 1.8 3.0 5.1 7.5 7.9 Actual as % 44 39 30 37 49 61 59 of Estimate _ Date of Final Disbursement October 13, 1994 14 12 - 10- 4 42 ....----- : - / 2 FY88 FY89 FY90 FY91 FY92 FY93 FY94 Fbc Ywm Apprll Edah Actua  - 12 - Table 5: Key Indicators for Project Implementation KEY IMPLEMENTATION INDICATORS IN SARS ESTIMATED ACTUAL ESTABLISHMENT OF BHCDS 'IN BATINAH REGION INFRASTRUCTURE Health Centers Type A 3 new 2 polyclinics + 1 hospital Type B 4 new 0 Type C 3 upgrade 3 new Total new staff appointed for new facilities 200 343 Regional Health Office in Sohar (N. Batinah) upgraded upgraded ESTABLISHMENT OF REGIONAL TRAINING Regional Health Office (staff) 16 15 Tutors 2 3 Preservice Training (nurses) 120 2 Inservice Training 240 3,235 Workshops 1,900 1,506 Fellowships 25 18 STRENGTHENING HEALTH PROMOTION Health Education Section (staff) 15 10 PartB STRENGTHENING MOH'S PLANNING & MANAGEMENT CAPABILITY Health Services and Manpower Planning Section (staff) 9 3 Health Facilities Planning Unit (staff) 11 7 Trainee Counterparts (staff) 2 3 Health Information Section (staff) 5 3 Evaluation & Surveys Unit (staff) 11 7 Data Collection & Data Processing Unit (staff) 22 11 Financial Planning & Management Section (staff) 10 3 PROJECT MANAGEMENT (STAFF) 6 5 I BHCDS: Batinah Health Center Delivery System  - 13 - Table 6: Key Indicators for Project Implementation KEY OPERATING INDICATORS IN SAR ESTIMATED ACTUAL COMPLETION DATE COMPLETION DATE I. PROJECT MANAGEMENT - Staffing & equipping Project Coordinator's Office 1987 1987 - Establishment of Advisory Committee 1987 1987 - Annual work plans & budget 1992 1994 - Progress reports 1992 1994 - Mid-project evaluation - Implementation 1990 1992 - End of project evaluation 1992 1994 - Civil works 1989 1992 - Procurement of equipment & vehicles 1989 1993 - Procurement of technical assistance - Hiring 1992 1994 - Fellowship program - Operation 1991 1993 lII. HEALTH SERVICES DEVELOPMENT ESTABLISHMENT OF BHCDS1 IN BATINAH - Establishment & staffing of BRHO2 1988 1989 - Staffing of new facilities 1990 1993 - Commissioning of new facilities 1989 1993 - Establishing supervision, monitoring & reporting procedures 1988 1993 - Outreach program implementation (starting date) 1988 1989 onwards REGIONAL TRAINING - Inservice & induction training in Batinah 1987 1994 - Preservice training in Batinah 1988 1994 - Preservice training in other regions 1990 1992 - Workshops 1988 1994 HEALTH PROMOTION - Recruitment of incremental staff & consultants for health 1987 1990 education - Equipment, furniture & vehicles in place 1987 1992 - Survey 1988 1993 - Training in Health Education 1987 1989 m. INSTITUTIONAL STRENGTHENING: ESTABLISHING/UPGRADING: HEALTH INFORMATION, FINANCIAL PLANNING & MANAGEMENT, HEALTH SERVICES & MANPOWER PLANNING SECTIONS IN THE MOH - Recruitment of expatriates/technical assistance 1988 1994 - Equipment, furniture, vehicles in place 1987 1992 - Fellowship training of Omani staff 1987 1993 - Workshops 1992 1993 - Studies & Reports - Cost accounting reports 1989 1994 - Sector financing 1990 NA - Proposal for cost-containment 1989 NA - Proposal for nationwide implementation of the BHCDS 1988 1990 - Installing of the health information system (HIS) 1989 1993 - Installation of the financial information system: - Cost accounting system 1989 1994 - Financial data processing system 1992 1994 MOH annual plans & budgeting applications 1993 'BHCDS: Batinah Health Care Delivery System 2 BRHR: Batinah Regional Health Office 3Training in Health Education  - 14- Table 7: -Studies Included in Project STUDY PURPOSE AS DEFINED AT STATUS IMPACT OF STUDY APPRAISAL 1. Health attitudes survey To ensure the efficiency of Done The attitude of the in Batinah health promotion programs in Batinah population to the Batinah region illness was a major determinant in program strategy for the BHCDS' 2. Baseline survey of To provide baseline for Not done NA2 health status & coverage measurement of impact of in Batinah BHCDS program l 3. Health sector financing (a) To evaluate health TOR3 prepared & NA including alternative cost financing options. cost submitted to Bank recovery measures containment measures; (b) to copy of study not support the identification & provided implementation of opportunities for cost containment measures & assist in the design & implementation of an effective cost recovery system 1 BHCDS: Batinah Health Care Delivery System 2 NA: Not applicable 3TOR : Terms of Reference  - 15 - Table 8A: Project Costs * by Expenditure Category (US $ million) PROJECT COMPONENT PROJECT BANK PROJECT BANK PROJECT BANK APPRAISAL APPRAISAL ACTUAL ACTUAL DIFFERENCE DIFFERENCE A. INVESTMENT COSTS - TOTAL 18.4 13.3 15.8 7.9 -2.6 -4.4 1. Civil Works & Architectural Fees 6.7 4.0 8.8 4.2 +2.1 +0.2 2. Equipment, Vehicles, Materials 4.9 4.5 3.9 2.0 -1.0 -2.5 3. Technical Assistance & Fellowships 4.9 4.0 3.1 1.7 -1.8 -2.3 4. Local Training & Seminars 1.9 0.8 0.0 0.0 -1.9 -0.8 B. RECURRENT COSTS - TOTAL 12.2 0.0 10.2 0.0 -2.0 0.0 C. TOTAL PROJECT COSTS 30.6 13.3 26.0 7.9 -4.6 -4.4 * Project costs include contingencies Table 8B: Project Financing (US$ million) SOURCE OF FUNDS APPRAISAL ACTUAL DIFFERENCE BANK 13.3 7.9 -5.4 GOVERNMENT 17.3 18.1 +0.8 TOTAL X,Q6 26.0 4 6 Table 8C: Project Costs by Foreign and Local (US$ million) APPRAISAL ACTUAL DIFFERENCE FOREIGN 13.3 12.6 -0.7 LOCAL 17.3 13.4 -3.9 Table 9: Economic Costs and Benefits Not Calculated for This Operation  - 16- Table 10: Status of Legal Covenants Page 1 of 3 Agreement Loan/ Text Covenant Present Original Revised Description of Covenant Comments Credit Reference Class(es) status fulfillment fulfillment Number date date Loan 2807 Sch.5(1) 10 C -- The following personnel will be All specified positions appointed to execute their various have been filled functions as described: a Proj. satisfactorily. Coordinator; a Dep. Proj. Coordinator; a Regional Health Officer; a Manpower Dev. Officer; a Health Education Officer; a Health Information System Officer; an Administrator/ accountant; a purchasing officer and an architect. An advisory committee shall also be appointed. Sch.5(2) C -- Until completion of the Project, the Action completed. Borrower shall include in each However, $5,412,092.54 annual budget of the MOH, (59.3%/6) of loan amounts required to provide funds proceeds remained for the estimated yearly costs of the unspent and were project. canceled. Sch.5(3) 10 C -- The Borrower shall provide to the Regular submission in Bank for its review and comments October of each year by August 31 of each year until until FY93. completion of the project, an annual work plan for the Project, together with the proposed budgetary allocations for estimated project expenditures for the following year, and which shall include amounts required for creating positions for all incremental staff to be hired. Sch.5(4) 10 CD 11/30/87 10/87 The Borrower shall provide to the A report on these Bank for its review and comments sections, with a by November 30 1987, a report on proposed revised the implementation of the organization chart was establishment and staffing of the sent to the Bank in Health Services and Manpower October 1987. Planning Section, Health Information Section and Financial Planning and Management Section and upgrading of the Health Education Section. Sch.5.(5) 10 CD/CP (a) 4/30/88 (a) 6/91 The Borrower shall provide to the The attitudinal study (b)10/31/88 (b) 9/93 Bank for its review and comments design and schedule, as by April 30, 1988 TORs (a) for a well as the TORs for a survey in Batinah on health survey of health service attitudes, behaviors and beliefs, and coverage were submitted (b) a baseline study of health status to the Bank in June and of health service coverage in 1991. The study was Batinah and shall discuss with the completed and results Bank the results of the survey and forwarded to Bank study and the Borrower's September 1993. recommendations for follow-up actions by October 31, 1988. Status: C -Complied CD -Compliance after Delay CP -Complied with Partial  - 17 - Table 10 Page 2 of 3 Agreement Loan/ Text Covenant Present Original Revised Description of Covenant Comments Credit reference class(es) status fulfillment fulfillment Number date date Loan 2807 Sch.5(6) 10 C The Borrower shall provide to the Provided annually. Bank for its review and comments by January 31 ofeach year a plan for staff development, including the fellowships for the following academic year, and shall provide to the Bank for its review and comments future plans annually thereafter not later than January 31. Sch.5(7) 10 CD 5/31/88 * The Borrower shall provide to the Completed. Bank for its review and comments, by May 31, 1988, the design of programs to reach the population in Batinah which has limited access to health centers, and shall implement those programs according to a schedule satisfactory to the Bank. Sch.5(8) 10 C The Borrower shall provide to the These reports were Bank for its review and comments, shared with visiting by February 28 and August 31 of supervision missions, each year, semiannual reports semiannually. covering the periods ending December 31 and June 30. Sch.5.(9) 10 CD 7/31/88 10/93 The Borrower shall provide to the The report was submitted Bank for its review and comments, to the Bank in October, by 7/31/88, supervision, monitoring 1993. Procedures are and referral procedures for the basic fully implemented in N. health care delivery system in Batinah and in process of Batinah, and shall implement these replication in other 10/31/88 * procedures by 10/31/88. regions. Sch.5(10) 10 CP 12/31/88 * The Borrower shall complete, by MOH has decided to 12/31/88 the pre-service training train registered nurses programs for training of assistant instead of project- nurses and for training of registered specified assistant nurses, agreed between the Bank nurses. This training and the Borrower, and shall start continues with annual training by 09/30/89. intake of 35 - 40 students. Replicated in 7 other regions. Sch.5(1 1) 10 CP 6/30/88 12/92 The Borrower shall provide to the The study was not Bank for its review and comments submitted. A workplan by 06/30/88. TORs for a study on was submitted to the health sector financing, including Bank in December 1992. alternative cost recovery measures, and shall by 10/31/89 review with the Bank the findings and recommendations of such study and the measures proposed by the Borrower, to be taken by January 1990, on the basis of such recommendations. Specific fulfillment date not known atus: C - Complied with CD - Compliance after Delay CP - Complied with Partially  - 18- Table I0 Page 3 of 3 Agreement Loan! Text Covenant Preent Oriinal Revised Description of Covenant Comments Credit reference cla(es) status fulfillment flfillmnent Number date date Loan 2807 Sch.5(12) 10 C 6/30/89 * The Borrower shall imnplement The Health Information the health information and the System is in progress. cost-accounting systems in MOH The HIS has been fully by June 30, 1989. established and a network installed to district (Wilayat) level. i. " Sch.5(13) 10 C 12/31/89 5/92 The Borrower shall provide to A midtermn evaluation was the Bank for its review and completed in May 1992; comments by 12/31/89, TORs an action plan was for a mid-project evaluation, and reviewed by the Bank in shall discuss recommendations December 1992 with for an action plan with the Bank annual updates. by December 31, 1990. The Borrower shall implement the action plan according to a schedule satisfactory to the Bank. Sch.5(14) 10 C 3/31/90 * The Borrower shall complete by The BHCDS plan is in 03/31/90, a plan for the nation- operation and the wide implementation of the basic manpower development health care delivery system program has been during the next five-program implemented. and phased staffmg plan. Sch.5(15) 10 CD 3/31/90 * The Borrower shall complete, by (a) MOH has established 03/31/90, introduction of the an office of institutional structure in the Undersecretary for Health MOH which combines curative Affairs who is responsible and preventive care to manage for the integration of Dir. the basic health care delivery General preventive and system. curative care within its central organization (b) MOH reorganization provides integrated curative, preventive, promotive functions at the regional level where decentralized regional health administration has been established. Sec. I C -- -- The Borrower shall maintain or Completed. Continued 4.01(a) cause to be maintained records difficulty experienced in and accounts adequate to reflect extrapolating counterpart in accordance with sound expenditures. Also to accounting practices the some extent, difficulty in operations, resources and procurement/disbursement expenditures in respect of the procedures. project of the departments or agencies of the Borrower responsible for carrying out the project or any part thereof. Sec. 1 C 'Me Borrower shal have the Audit reports have been 4.01(b) records and accounts, including submitted regularly. those for the special account for each fiscal year audited, in accordance with appropriate auditing principles consistently applied, by independent auditors acceptable to the Bank. * Specific fulfillment date not known Status C -Complied with CD -Compliance after Delay CP -Complied with Partially  - 19- Table 11: Compliance with Operational Manual Statements There is no evidence of non-compliance Table 12: Bank Resources: Staff Inputs ($'000) STAGES OF PLANNED REVISED ACTUAL PROJECTS Weeks US$ Weeks US$ Weeks US$ Through 125.7 260.9 Appraisal Appraisal- 75.3 181.7 B oard _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ B3oard- 14.2 33.3 Effectiveness Supervision -- -- 88.8 239.4 Completion 8.0 4.0 6.7 2.1 Total -- 310.7 717.4  - 20 - Table 13: Bank Resources: Mission STAGE OF PROJECT MONTH/ NUMBER DAYS IN SPECIALIZED PERFORMANCE RATING2 TYPE OF3 CYCLE YEAR OF THE STAFF SKILLI PROBLEMS PERSONS FIELD REPRESENTED Implementation Development status objectives Through Appraisal 06/84 2 14 H, EC 03/85 2 8 EC IEC 05/85 2 6 EC, H 01/86 4 19 EC, H, IEC, OA 6 23 EC, H, IEFC, OA MS, A Appraisal through -- -- -- Board Approval Board approval through 08/87 3 16 EC, H, A Effectiveness 01/88 1 7 SIS Supervision 12/88 1 6 H 09/89 1 3 H 3 2 M 10/89 1 8 H 3 2 M 03/90 2 13 H, A 3 2 M 06/90 1 6 SOO 3 2 12/90 3 4 SOO, OA, A 3 2 P,TA 05/91 3 10 ES, A, H 2 2 TR,TA 01/92 1 16 H 2 2 09/92 1 14 H 2 2 05/93 1 10 H 2 2 01/94 2 6 H 2 2 Completion 04/95 1 10 H Footniotes Specialized Staff Skills Represented: A: Architect EC: Economist ES: Education Specialist H: Health Specialist IEC: Information/Education/Communication Specialist MS: Management Specialist OA: Operation Analyst SIS: Senior Implementation Specialist SOO: Senior Operations Officer 2 Performance Rating: I = Problem Free 2 = Moderate Problems 3 = Major Problems 3 Type of Problems: M = Managerial TA = Technical Assistance P = Procurement TR= Training  - 21 - APPENDIX A THE SULTANATE OF OMAN HEALTH PROJECT (LOAN 2807-OMA) Estimated Number of Beneficiaries Covered by BHCDS: N. Batinah 1. Base Population (Omani) (1993)1 Estirnated Total N. Batinah Population 285,100 Total N. Batinah Women Population 141,190 Total N. Batinah Children Population 154,532 II. Health Project Population Coverage in N. Batinah2 233,650 III. Beneficiaries~ Total Population Catchment Population- WCBY (15-45 yrs) 47,933 38,826 Children (0-14 yrs) 154,532 125,171 Total Beneficiaries 154,532 164,000 NOTE: Appraisal target (170,000) based on base population 300,000. First population census: December 1993. Mid-year population estimated from census results; Development Council, Sultanate of Oman. MOH: Directorate General of Health Services. North Batinah Region Annual Health Information Report: 1993. 2Six new health project facilities are located in 4 out of the 6 wilayats (districts) in North Batinah with a total catchment population of 233,650 or 81% of the total regional population. The following are the 4 wilayats: - Sohar 68,100 - Suwaiq 68,550 - Saham 61,350 - Shinas 35,650 Total 233,650 Beneficiaries are women of child bearing years (WCBY) aged 15-45 years and children 0-14 years. Mostly these form roughly 60-66% of total population in developing countries. In N. Batinah, the beneficiaries are around 58% of the population. The project facilities are located with a catchment population that is 81% of the total regional population. Thus potential project beneficiaries would be 81% of the total WCBY and children (0-14 years) population.  - 22 - APPENDIX B THE SULTANATE OF OMAN HEALTH PROJECT (LOAN 2807-OMA) Implementation Completion Mission (April 03-12, 1995! AideMemoire A. Introduction 1. A World Bank Mission from the Human Resources Division (MN2HR) of the Middle East & North Africa Region, consisting of Dr. Edward Pratt, visited the Sultanate of Oman from April 03 through April 12, 1995 to review and collate information for preparation of the implementation completion report (ICR) of the above-cited project. The loan was closed as of October 13, 1994 (the original closing date of the loan was May 31, 1994). At the request of the Ministry of Finance & Economy (MOFE)l Bank had approved the extension of the closing date by eleven months to enable the Ministry of Health (MOH) to complete remaining activities pertaining to fellowships, training and technical assistance. The MOH, however, had advised that it did not consider the extension warranted as all project components were reasonably established. MOFE requested cancellation of unspent funds and the loan was accordingly closed after the final disbursement on October 13, 1994. The undisbursed balance of the loan account, amounting to $ 5,412,092.54 (59.3%) was canceled as of December 20, 1994; this was the formal date of notice of cancellation to the Bank. A full refund of the unutilized balance of the Special Account was made on February 22, 1995. 2. The mission thanks the MOFE and MOH staff for the support, cooperation and courtesies extended to it during the pursuance of its work. The mission interviewed relevant officials of the MOFE and MOH, and reviewed, with relevant component areas, MOH's end of project evaluation report that had previously been submitted to the Bank. The mission's outcome was reviewed at a wrap- up meeting with the Project Director, MOH, as well as, with the Director of Loans, MOFE. A briefing meeting followed with H.E. The Undersecretary for Planning Affairs, Ministry of Health. PROJECT BACKGROUND APPROVED SIGNED EFFECTIVE CLOSED AMOUNT DISBURSED CANCELED 05/31/94 (original) 05/05/87 07/17/87 03/01/88 04/30/95 US$ 13.3 US$ 7.89 US$5.41 (revised) (to 10/31/94) (12/20/94) MOFE represents the Borrower (Government of the Sultanate of Oman): MOH is the executing agency for project implementation  - 23 - B. Project Components & Objectives Project Components A. Health Services Development: - Establishing Basic Health Care Delivery System (BHCDS) in North Batinah Region - Establishing Regional Training - Strengthening Health Promotion B. Strengthening Ministry of Health's (MOH) Planning and Management capability C. Project Management Project Objectives (i) To reduce mortality and morbidity, particularly in the predominantly rural Batinah region; (ii) To develop the MOH's institutional capability to plan and manage the health sector; (iii) To support the institution building processes necessary for the country-wide implementation of a more efficient and integrated health care delivery system. C. Project Status 3. With the closing date of the project having come into effect, all components of the project have been firmly established as follows: I. Health Services Development: Health services have been developed under the project in the North Batinah region in terms of an effective basic health care delivery system which is fully integrated, fully operational and proving effective in terms of improving the health status of the population; relevant vital and demographic supporting data will be provided in the ICR. It has served as a model that is being replicated in other regions of the Sultanate. A major achievement is the regional decentralization of the management, administration, planning and implementation of health services delivery. However, certain fundamental constraints to effective management are present involving quantitative and qualitative aspects of capacity building, as well as, a clear definition of management relationships between central MOH and its regional counterparts. This will be amplified in the ICR. II. Institutional Strengthening of the MQH: The various component areas in MOH requiring institutional strengthening have been established and are still engaged in the processes of improving all-around analytical, planning and management capability of the MOH. The key areas are: Health Information System, Financial Planning & Management, Health Services & Manpower (Human Resources) Planning, and Health Promotion. To a reasonable degree this has been achieved although consolidation of institutional inputs, particularly in the area of capacity building, requires further attention to ensure efficiency and quality assurance. There is therefore the need for the MOH to develop a plan for continued operationalizing of the programs evolving from the project; however, MOH considers it impractical to provide the mission with a  - 24 - matrix for an operational plan at this time (Para. 10 below refers). The phase of institutional development is at a dynamic stage whereby the expected goal of sector efficiency, effectiveness and financing is yet to be fully realized. The determinants for sustainability have been reviewed and will be elaborated upon in the ICR. D. Project Financing 4. There are no further disbursements from the proceeds of the loan and remaining funds that are unutilized have been duly canceled (para. 1 above, refers). This does not, in effect, discharge the Government of Oman from its obligations towards ensuring the viability and sustainability of programs, activities and elements of the project which now form an integral part of the health system. Disbursement Status of the Loan (as at December 1994) (US$) CATEGORY ORIGINAL PROPOSED DISBURSED UNDISBURSED ALLOCATION ALLOCATION 1. Civil Works 4,000,000 4,000,000 4,236,196.86 236,196.86- 2. Equipment, 3,800,000 4,800,000 1,943,553.00 2,856,447.00 furniture, vehicles, drugs 3. Tech. Assistance, 3,800,000 3,800,000 1,693,453.88 2,106,546.12 Training, Fellowships, Seminars 4. Local Training, 700,000 700,000 10,773.01 689,226.99 Seminars 5. Unallocated 1,000,000 -- -- Special Account - -- 3,930.71 3,930.71 Total 13,300,000 13,300,000 7,887,907.46 5,412,092.54 * Exchange loss on use of Special Account  - 25 - E. MOH End Of Project implementation Report 5. The mission undertook a review, with relevant project implementation officials, of the end of project implementation report submitted by MOH/MOFE to the Bank prior to the ICR mission. Performance indicators to monitor implementation were confirmed and the report provided a reasonable documentation of achievements of project objectives. Borrower's commitment to project objectives was reaffirmed at the executing and implementing levels. Under these terms, the report was precise. The report, however, did not carry analytical information relating to economic, financial, social and environmental conditions in which the project was implemented. The mission elicited some of this information during the review. MOFE considered the end of project report submitted incomplete as it did not include its assessment of project financing and Borrower-Bank performance; this will now be added by MOFE to that report. The mission further noted that key "lessons learned" form a significant part of implementation completion evaluation both for the Borrower and Bank; this was absent in the MOH report but the mission received some feedback in this area that will be reflected in the ICR. Operational Action Plan 6. The completion of the project coincides with the end of the Fourth FIVE-YEAR Development Plan (4FYDP), 1991-1995. The plan for the operational phase of the project components which are now integral parts of the MOH system will be dependent on the Fifth five Year Development Plan (5FYDP), 1996-2000, which is in the process of preparation. It will incorporate the components of the Health Project carried in the 4FYDP. The 5FYDP is being developed on the basis of monitoring and evaluation of the 4FYDP through a workshop to be held during April 1995; the Plan is expected to be ready sometime in 1996. 7. Four main areas will be addressed: health facilities (infrastructure development); health services/programs (in terms of improving efficiency, effectiveness and quality which may involve integration, consolidation, rationalization, and the continued strengthening of management information systems); manpower (human resources) planning and development involving basic and post-basic training and specialization, tailored to the assessed needs for sector development, for health, nursing and auxiliary cadres included will be improved curriculum for public health and health education; health systems and epidemiology research. 8. MOH assures the mission that the Plan will take into account the requirements for sustainability in terms of capacity building and health financing outlays (provision of capital and recurrent budgets). The mission feels that this particular element is partly dependent on the Government of Oman's resource mobilization and adjustments in the economy, and partly to MOH's planning efficiency. World Bank ICR Mission April 1995  - 26 - APPENDIX C IMPLEMENTATION COMPLETION REPORT THE SULTANATE OF OMAN HEALTH PROJECT (LOAN 2807-OMA) THE BORROWER'S REPORT  THE SULTANATE OF OMAN IBRD Supported Project Loan No 2807-OM Health ProJect Implementation Completion Report 1. Description of the project: The objective of the project are : (a) to reduce the mortality & mobility, particularly in the predominantly rural Batinah region; (b) to develop the MOH's institutional capability to plan and manage the health sector; and (c) to support the institution building process necessary for the country-wide implementation of a more efficient and integrated health care delivery system. 2. Effectiveness of the Loan Agreement: A very good progress has been made towards meeting the conditions of loan, effectively has developed Health Services ( i.e Basic Health Care Delivery System, Regional Training, and Strengthening of health promotion) and the improving management information system in health and finance ( financial planing 8& management ) and manpower. All activities of the project and the programs were conducted as planned. 3. Fellowships: The program of fellowship were implemented as per Annex 1 - Fellowship. 4. Basic Health care Delivery Services and Regional Training: All the six health facilities partly financed by the World Bank namely: Wadi Heibi Hospital, Suwaiq Polyclinic, Shinas polyclinic, Wadi Ahin Health Center, Wadi Al Jahawir Health Center 8z Wadi Bani Health Center are fully equipped and functioning very well. Annex 2(a) gives briefs on the establishment of Basic Health Care Delivery System (BHCDS) at North Batinah region. I  4.1. Local Training: The training program in North Batinah region started in December 1 989. It is zn on going process. (i) In-service Training Program: All the staff has to attend the training program in rotation. It is expected that the staff trained in this program will train the other staff in the health facilities. The topic of retraining cycle are usually: 1 - ANC. 2- Immunization. 3- Child Health. 4- CDD. 5- ARI. 6- School Health. 7- weaning & Nutrition. 8- Communicable disease. 9- Eye disease. 10- Health statistics and evaluations. Annex 2(b) indicates yearly in-services training taken place during the implementation period of this project. (ii) Pre-service Training (Regional Nurses Training) Pre-service Training is Basically for new staff to orient them regarding clinical and community health services. The MOH has built eight new regional training institutes for registered nurses; one nursing training school in Sohar, Batinah Region, and seven others in seven regions. The target is a total of 11 regional nursing training institutes by 1 996. Each school draws its intake from local candidates in its region. The Ministry decided to institute a 3-year registered nursing course in each region. The annual intake per school is 30-35. Annex 2(c) briefs on the BHCDS 5. Strengthening Health Education and Promotion: For the last few months, the Health Education &z Information Directorate Section has continued its active involvement in health education/promotion activities throughout the Sultanate. Workshops are conducted regularly. 2  There is a series of workshops conducted every year. Annex 3 shows the result of workshops and training taken place during the implementation period of this project. 6. Strengthening MOH's Health Sector Planning and Management Capab*i : The recruitment of Head of Financial Planning and Management Section has enable to set up a cost accounting system, which is a prelude to financial planning and management. The cost accounting system has already been installed in Royal, Khoula and Al-Nahdha Hospitals. Work Is in progress to install the same system in Rustaq and Buraimi Hospitals. 7. Health Information & Statistics Section: The National Health Information and Statistics section (HIS) has continued its work satisfactorily. The objectives of the HIS are: 1. To provide the information needed by decision-makers at all levels - local, regional and national to plan, monitor, evaluate and manage the health services for which they are responsible. 2. To develop and maintain a routine reporting and feedback system from each health unit to Regional Health Information Section and hence to the HIS. During 1992 a significant changes were made in the structure and operation of the Ministry's Health Information System. Under the directives of H.E. the Minister, Health Information Officers were appointed to each regional Directorate-General. These are now responsible for the information of their own region. Annex 4 gives the Regional Health Services Development Project Recruitment position. 8. Research and Studies The Oman Polio trial was conducted in North Batinah Region. Hospital and Public Health Unit covered 630 children for Inje Polio vaccine trial. 3  There were various other units in the Directorate undertaking and researches. They are as follows: 1. Base line survey 1990 2. KAP. of Mothers regarding diarrhea and ARI 3. Factors associated with Born Before Arrival cases 4. Access to health facilities in the region 5. Evaluation and cost of Mobile team 6. Trial on Family Health Record System 7. Effect of temperature and humidity on contraception 8. Pattern of physicians attendance's in the region 9. Cost of health center and Hospitals in the region 10. Survey about Lameness cases in school 1 1. Study of Anemia in Pregnancy in Sohar wilayat 12. Study of Cardiovascular diseases in the region 1 3. Study of congenital disease among new born in the region. Annex 5 gives the Yearly achievement of Health Care Program. 9. Loan Accounting 8a Monitoring Summarized below the summary of reimbursed expenditure :- Description Original Plan Revised Actual Plan Civil Works 4,000,000 4,000,000 4,236,196.86 Equipment, Furniture, 3,800,000 4,800,000 1,943,553.00 Vehicles, Materials, Drugs a Supplies Technic al Assistance & 3,800,000 3,800,000 1,693,453.88 Fellowships Local Training & 700,000 700,000 10,773.01 Seminars Unallocated 1,000,000 3,930.71 Total 13,300,000 13,300,000 7,887,907.46 4  Annex 6 gives monitoring details on the reimbursed expenditure for the project. The project as a whole has been successfully implemented with some changes in the Ministry of Health priorities. The undrawn balance was mainly contributed by saving achieved due to the bulk procurements and also by the changes of priorities in implementing the project. 10. Bank Mission The Bank missions have maintained high level of technical assistance throughout the period of the project in its impelemention. The missions close coordination and follow-up during the progress of the project assisted the concerned Ministries in the completion of the project as well as on the utilization of the loan funds. This close relation by the Bank missions & the Bank assistance as a whole will continue to be valued with appreciation. 5  Annex 1 LIST OF OMANI EMPLOYEES UNDERGONE TRAINING ABROAD I Pharm. Assistant 27 Months Pharm. Assistant Bahrain 3 Pharm. Assisunt 27 Months Pharm. Assistant |Bahrain | 4 Pharm. Assistant 27 Months Pharm. Assistant Bahrain 5 Dental Hygiene 30 Months Dental Hygiene Bahrain 6 Nurse 12 Months Comr. Nursing Bahrain 7 Nurse 12 Months Com. Nursing Bahrain 8 Head of Family and 1.5 Months Epidemiological Control USA Community Medlcine 9 Deputy Project Director 12 Months Hospital and Health Services U.K. Management 10 AsstL Stat. OMcer 12 Months Health Statistics U.K. 11 Secdon Head Manpower 3 Months Manpower Planning U.K. Planning 12 Nurse 1 Year Operating Theatre Course Ireland 13 Dlrector General of Planning 2 Months Health Economics and Planning for U.K. Developing Countries 14 Director of Research & 4 Months Operational u Social Research for U.K. Swdles Health Management & Planning 15 Section Head Financlal 1 Month Cost Accounting System U.S.A Planning u Control 16 Director OMce of H.E. the I Year Masters In Human Resource U.K. Minister Development 17 Statdstical Officer 1 Year Diploma in Health Statistics Egypt I 8 English Teacher 2 Years Masters course in ESP U.K. I19 Statistical Ofcer 2 Years Masters Course In Bio-Statistics U.S.A 6  Annex 2(a) ESTABLISHMENT OF BASIC HEALTH CARE DELIVERY SYSTEM (BHCDS) AT NORTH BATINAH The Ministry of Health had drawn up a plan for the integration of basic curative and preventive services In a regionalized, Basic Health Care Delivery System (BHCDS) In the North Batinah Region, as outlined In the Staff Appraisal Report (SAR). The following health facilities were planned during the project period. The Nursing school which was constructed from the MOH budget started functioning from September 1991 and at present there are 28 students in 3rd year, 38 in second year and 40 In 1 year batch. The health center Wadi JahawIr and Bani Omar were Inaugurated In December 1 991. These health centers cater preventive, promotive and curative services. While Shinas and Suweiq polycilnics have specIalists and Investigation facilities available. RENAL DIALYSIS SEPTEMBER 1991 CENTER FOR COMMUNICABLE DISEASE CONTROL SEPTEMBER 1991 NURSING SCHOOL SOHAR SEPTEMBER 1991 WADI JAHAWIR DECEMBER 1991 WADI BANI OMAR DECEMBER 1991 SHINAS POLYCLINIC DECEMBER 1992 SUWEIQ POLYCLINIC DECEMBER 1992 DIRECTORATE GENERAL OFFICE JULY 1993 WADI HEEBI HOSPITAL JULY 1993 WADI AHAIN HEALTH CENTER OCTOBER 1993 The new building of Directorate General of Health Services Office, which was constructed from MOH budget, started functioning from July 1 993. The strength of administrative Directors and section heads supported from the MOH budget. 7  Annex 2(b) IN- SERVICES TRAINING TOPIC t.NUMBER OF SESSIONS YEAR AND.NUMBER OF STAFF ATTENDED IN- SERVICES TRAINING 1989 1990 1991 1992 1993 1994 A.N.C (I WK) 24 36 23 42 34 12 C.D.D (2 DAYS) 65 55 58 0 0 372 A.R.I (2 DAYS) 75 104 95 0 0 379 E.P.I (3 DAYS) 0 85 92 0 0 0 SCHOOL HEALTH (1 DAY) 0 37 37 0 44 13 COMMUNICABLE DISEASE (1 DAY) 0 18 16 0 0 18 HEALTH INFORMATION U STAT. (I DAY) 0 0 32 33 36 35 EYE HEALTH CARE (2 DAYS) 29 81 27 89 30 18 CHILD HEALTH (I WK) 0 53 33 63 0 12 CARE ON NEONATES (1 DAY) 28 40 0 0 0 20 DENTAL HEALTH (2 SESSIONS) 0 62 0 0 0 0 COLD CHAIN AND P.E.M (1 DAY) 0 0 0 18 8 12 TRAINING OF MEDICAL ORDERLIES 0 0 0 0 52 25 C.S.S.D u INFECTION CONTROL (I DAY) 0 0 0 0 1 4 18 PRIMARY HEALTH CARE (2 WKS) 0 0 0 0 17 0 CDD\ARI WILAYAT TRAINERS 0 0 0 0 0 18 IFRI AND DEVELOPMENT 0 96 62 0 0 188 SCREENING AND WEANING BIRTH SPACING TRAINING 0 0 0 0 0 223 BABY FRIENDLY HOSPITAL 0 0 0 0 33 0 INITIATIVE (3 DAYS) 8  Annex 2c Sultanate of Oman IBRD Health Project Loan No 2807-OM THE BASIC HEALTH CARE DELIVERY SYSTEM (BHCDS) Overview: To reduce the high rate of morbidity and mortality that prevail among the population outside of the main urban clusters. The MOH has developed the BHCDS as a multilevel integrated regionalist system to effectively provide the population with an effective package of Basic Health Care Delivery Services. The BHCDS has improved the outreach &T referral programs and health. CURRENT SITUATION 1. The health care delivery services in Oman (region) is fairly widespread. The disease pattern do not show predominance of infectious disease. The distribution of disease follows the same pattern in different regions districts (Called wilayat in Oman). Recently Ministry of Health has integrated preventive and curative Directorate Generals to one called Health Affairs. The network under the Directorate General of Health Affairs consist of now both curative and preventive health services and in health facilities health activities occurs in which preventive and curative services are combined. The health care delivery system also include out-reach services which combines to curative and preventive services for far and remote areas. 2. Regionalization and integration of Basic Health Services: The health services were decentralized in 1 990 to regional and all health facilities in the region are under the Directorate General of Health Services. Further decentralization was done to district level. The regional Directorate General office provides unified management and supervision to all District Health Services. 3. The Basic Health Care Delivery includes: The region has been divided into six districts. The network of health services, staff and facilities are organized by the Superintendents of District Health Services. The District Health Superintendent is responsible for all preventive, curative and promotive health services other features 9  such as relationships to community and other inter-sectoral cooperation (water Electricity and Municipality Dept. in the district). 4. Directorate General of Health Service: The overall management of regional health services are managed by Directorate General of Health Services assisted by Director of Health Affairs, Director of Pharmacy and Medical Stores, Director of Administrative Affairs and Director of Finance Affairs. The Director of Health Affairs is directly responsible for regional health activities such as technical support and supervision of regional health network, who is assisted by staff to supervise various health care activities such as school health, maternal and child health, disease surveillance. 5. Service at regional level: All health centers \ hospital provides basic medial care, preventive and promotive services. Degree of sophistication improve at each level. 5a. Health Centers with no bed: Compromise of medical treatment, Expenditure Program of Immunization (EPI) oral dehydration therapy, MCH including school health, health education, environmental health & sanitation and child birth. (Health centers are AbuBaqra, Khatmat malaha, Wadi Safan and Mashaiq) 5b. Health Centers with no bed but with laboratory facility: In addition to services provided in the Health Centers ( para. 5a above), these centers provide laboratory services, school health services and pharmacy services. (They are Khaboura, Liwa and Wadi Bani Ahein). 5c. Health Centers with beds for delivery: Services are provided by the health centers mentioned in para 5b. These centers have two beds for maternity delivery services. (Wadi Jawahir & Wadi Bani Omar). 5d. Extended Health Centers: Extended health centers do not have at present in-patient facilities. These health centers provide ambulatory specialist services on ophthalmology, ENT, Surgical, Obst &t Gynaec., Internal medicine, Radiology and Laboratory investigations. (Suweiq and Shinas Extend. Health Center). 10  5e. Hospital with 12 to 1 8 beds: These hospital acts more or less like -primary health care center with in-patient facilities. These hospitals provide all health services which are mentioned in para 5c. Health center they have a laboratory services (These hospitals are Wadi Hawasna, Wadi Sarami, Wadi Heebi). 5f. The Hospital with specialist Services: The Heebi Hospital with 1 8 beds carries out in addition to services provided in hospital mentioned in para (5e), X-ray, pharmacy services and specialist services in Obstetrics &z Gynecology, pediatrics on ambulatory as well as inpatient basis. 5g. The hospital with more than 36 beds: The hospital in this category is Saham Hospital. It has specialists care in Internal Medicine, Obstetrics & Gynecology and Pediatrics with X-ray, and laboratory services. 5h. All facilities support services of communicable disease control, malaria and national programs such as EPI, ORT, TB and ARI. 6. Out-reach Programs: Out-reach program covers home visiting for defaulters tracing, health education, motivation and follow-up of EPI ORT and MCH cases. 7. Referral system: Regional hospital is the referral hospital for all the health facilities in the region referral hospital is equipped with selected specialist care, laboratory, radiological and maternal care. This hospital ensure the adequate support for cases referred from the health centers. The regional hospital provides support for referral at higher level. The referral is done through a referral form. To streghthen the referral system, the health centers mentioned in para 10, 11 would refer their patients to extended health centers or hospital Heebi or Saham. where the X-ray and specialist services are available and they will ensure the reference to regional hospital. 8. Staffing: Staffing norms for the BHCDs have been established by the Ministry of Health. These were based on perceived task for services to be delivered, patient's demand, utilization of services and response to the cultural factors that require sex separation of patients, 11  provision and accommodation for some services. As per these norms the staffing is as shown in the table below. Staffs recruited in Polyclinics, Health Centers & Hospital finance by World Bank Loan Suwelq Shinas Heb aawir ~Ahlen Bani Omar Staff Polycllnic PHospiul Healtke - t Heidi Center Total :__________________________ __-_-_____-Center Center __ m Doctor 17 14 3 1 1 1 37 Dental Surgeon 1 1 1 0 0 0 3 Medical Assistant 0 0 0 0 0 0 O Nurses 33 35 15 7 5 6 101 Midwives 0 1 0 0 0 0 1 School Health Visitor\PH 2 0 1 0 0 0 3 X-ray Technician 3 2 1 0 0 0 6 X-ray Assistant 0 0 0 0 0 0 0 Laboratory Technician 4 4 1 1 0 1 11 Laboratory Assistant 0 0 O 0 0 0 O Asstt. Pharnacist 3 3 1 0 0 1 8 Sanitary Inspector 1 2 0 1 0 1 5 Sanitary Assistant 0 1 1 1 1 0 4 Office Assistant 1 1 1 0 0 0 3 Clerks 9 8 4 2 1 2 26 Maintenance Techniclan 1 1 1 1 1 1 6 Medical Orderlies 6 7 8 3 3 3 30 Drivers 6 6 3 3 2 3 23 Ceaner\Farashes 3 1 5 2 2 2 1 5 Watchman 2 3 4 2 0 2 13 Sprayman 0 0 10 2 10 21 43 Refractonist 1 1 0 0 0 0 2 Helper 1 0 0 0 0 0 1 Cashier 1 1 0 0 0 0 2 Total 95 92 60 26 26 44 343 Health informatlon Office, DGHS,NBR 9. Drugs: A drugs formulatory has been designed by the Ministry of Health for authorized use of drugs at each level of services, it has explicit guidelines and information for all categories of clinical staff. 12  Drug supplies are regular and logistics is satisfactory In terms of storage, distribution and timely response to health facilities need. 10 Record and Reports: The records and reporting at regional level is a part of national health information system. The monthly statistical reports are complies by the nurses in health facilities. Records and registers are carefully maintained and regularly inspected by the responsible personnel from regional and central office of the Ministry of Health. The Regional Health Information office provides orientation and training to health center staff on use of reports and records, preparation of monthly reports, records keeping and computation through in-services training and technical guidance in conducting ad hoc surveys and studies in the region. The Health Information Systems Officer also provides the technical guidance and support to Statistical officers who are responsible for data collection, compilation and analysis at wilayat level. 11. Health center prepare the monthly statistical reports and submit to the statistics office at wilayat. All the data collected at wilayat level is further reviewed, analyzed and fed into the computer diskette. Further analysis of data is done at regional office and results are fed back to wilayat, health center and regional program managers. All the forms used for statistical reports, registration and records are reviewed, tested, approved and standardized by the health Information Section of the Ministry of Health. The regional heal information office to ensure that information collected and analyzed is initiate to program development and management. 12 Regional Training for BHCDS staff: In context to the implementation of the BHCDS the regional officer provide pre and in-service training opportunities, which meets the Objectives. To support the implementation of the BHCDS by providing health staff additional skill required by the integrated basic health care delivery system. 13  13 First Phase of the implementation of BHCDS: The Ministry of Health has implemented the BHCD program In six wilayats In the region as part of health project supported by a loan from the World Bank. The Implemented project appointed the followings: .1. Director General of Regional Health Services : The DGHS provides unified chain of command from head quarter to BRHO and consolidated communication from the head quarter to region. 2. Recruited Superintendent of Health Affairs - one professional and four support staff. 3. Recruited staff of various categories in new health centers/hospital and to bring up existing centers to staffing norm. 4. Provided in service training material equipments and supplies. 5. Construction of 7 building. These are (1) DGHS, Sohar (2) Two Extnd. Health Centers (one each in Shinas and Suwelq) (3) One hospital in Heebi and three health centers (one each in Wadi Ahein, Wadi Jahawir, and Wadi Bani Omar). 6. Provision of furniture, equipment and vehicle for health centers In BRHO. Nationwide implementation of BHCDS Programs support results in an increase of 35 percent In coverage mostly in unserved/underserved area. The experience obtained in Batinah region and enhancing training In health promotion 8& planning management capabilities of Ministry of Health has been extended to all over the country since 199 1. 14  Annex 3 WORKSHOPS AND TRAINING EYE HEALTH CARE 2 WKS 1990 35 PRIMARY HEALTH CARE 2 DAYS 1990 85 PRIMARY HEALTH CARE 3 DAYS 1991 37 PRIMARY HEALTH CARE 3 DAYS 1991 42 PRIMARY HEALTH CARE (WITH RUSTAQ) 3 DAYS 1991 15 SCHOOL HEALTH DAY 1991 47 SURGICAL SYMPOSIUM I DAY 1991 108 T.B. WORKSHOP I DAY 1991 31 DIABETIC WORKSHOP I DAY 1991 108 BREAST FEEDING & PNC I DAY 1991 35 BREAST FEEDING & PNC I DAY 1991 32 CHILD HEALTH CARE I DAY 1992 53 NURSING SEMINAR I DAY 1992 106 SCHOOL HEALTH 2 DAYS 1992 136 ARI WORKSHOP 2 DAYS 1992 56 MENTAL HEALTH I DAY 1992 23 ORTHOPEDIC & TRAUMA I DAY 1992 155 REHABILITATION _ "MALARIA WORKSHOP FOR LAB. TECH." 2 DAYS 1992 44 MALARIA WORKSHOP I DAY 1992 44 PEDIATRIC NURSING I DAY 1993 136 WORKSHOP FOR LAB TECHNICIANS (HOSPITAL & H.C.) 3 DAYS 1993 45 SYMPOSIUM ON ASTHMA I DAY 1993 23 AIDS WORKSHOP I DAY 1993 33 EYE HEALTH CARE PROGRAM 4 DAYS 1993 14 CHILD HEALTH CARD RECORDING I DAY 1993 19 SCHOOL HEALTH I DAY 1993 44 MALARIA ERADICATION WORKSHOP 3 DAYS 1994 40 WTPS TECHNIQUE 2 DAYS 1994 39 HEALTH EDUCATION ON MALARIA 1 DAY 1994 39 TRAINING ON NARCOTIC POLICY I DAY 1994 20 ORIENTAL ON MEDICAL RECORD SYSTEM 2 DAYS 1994 130 BIRTH SPACING WORKSHOP 17 SESSION 1994 209 MALARIA WORKSHOP I DAY 1994 30 EYE HEALTH CARE ORIENTATION PROGRAM I DAY 1994 26 MALARIA ERADICATION PROGRAM FOR PVT I DAY 1994 66 CLINICS LEPROSY & T.B TRAINING I DAY 1994 20 CDD\ARI MASTER TRAINER I DAY 1994 37 QUALITY ASSURANCE & ASSESSMENT I DAY 1994 81 LAB. TRAINING FOR BLOOD GROUPING I DAY 1994 32 WTPs WORKSHOP 9 DAYS 1994 34 is  Annex 4 REGIONAL HEALTH SERVICES DEVELOPMENT PROJECT STAFFING POSITION A. Project Management Administration Officer I B. Establishment of BHCDS in Batinah Regional Health Office Regional Health Offlcer I Technical Officer 1 Manpower Development Officer 1 Health Information System Officer 1 Clerk-typist 2 Driver 3 Secretary 1 C. Regional Training Tutor Assistant Nurses (Pre-services Courses) 2 Tutor Registered Nurses (Pre-services Courses) I D. Health Education Directorate Dlrectorate Head I Clerk 1 E. Strengthening Health Sector Planning Management H.S. U MP Unit Health Planner (Secdon Head) 1 Health Manpower Planner 1 F. Health Information Section (DSPF) Health Information Advisor (Expt.) 1 Section Head (Expt.) I Stadstical Officer (Omanis) 1 Statistical Officers (Expt.) 4 Evaluation and Survey Unit Statisticlans (Omani) 3 Stadstical Clerk 1 Clerk/Typist 1 Data Collecdon 8& Data Processing Unit NIL G. Financial Planning U Management (DGP) Section Head 1 Account Supervisor 1 16  Annex 5 SULTANATE OF OMAN ACHIEVEMENT OF HEALTH CARE PROGRAM OPV\DPT III 85% 939% 93% 91 % 93% 94% Percentage coverage MEASLES . 83% 95% 93% 97% .95% 96% Percentage coverage Number of visits ANC per 4.7 5.1 4.9 4.7 4.9 5.2 pregnancy Percent of severe Diarrhea . 0.8% 0.5% 1.0% 1.0% among all Diarrhea cases Percent of severe ARI among all I 1% 0.9% 0.9% ARI cases Deaths due to ARI among the . 20 22 3 4 Children (0-5) Polio cases 32 6 0 0 0 0 Malaria cases 913 2725 3155 2152 2548 5038 T.B. CASES 63 57 83 67 42 63 Health Informuadon Office, DGHS, NBR 17  Annex 6 Loan Accounting and Monitoring Details I.B.R.D Loan No 2807-OM - Health Project Applicn r4w PROJECT NAME CONTRACT Caigry AS PER APPLICATIONS W_ILemAco. #f I _______________|_____________ Amount Contractor 100% COST r| RIO Financed U.S.S (CBO) U.S.S USS Special Accourd with Cedral Dank ofOrun ( Iitial Dqosit ) FUND 600 000.00 603 625.90 55 Reovyered CAT (2 & 3) (5 842.64) (5 842.64) 56 Recovered CAT(1,2,3 &4) (94 230.23) (94 230.23) 57 Recovered CAT (2 & 3) (6 972.29) (6 972.29) 58 Recovercd CAT (2 & 3) (82 442.76) (82 442.76) 59 Recovered CAT( 1,2&3) (222 910.50) (222 910.50) 56-BIS Recovered CAT (2) (170 451.16) (170451.16) 60 Recovered CAT(3) (13 082.17) (13 082.17) 63 Recovered CAT(2&4) (1 140.66) (1140.66) 64 Rewvered CAT(2) _ (1 829.01) (I 829.01) Balancc of USS Special Account refunded Value February 22, 1995 (793.77) ___________________Currecy Exchange diffrence _ 3 930.71 2 01/87 Offices in M.O.H Contract 34 469.000 Ibn Ai Balad Onal Trd 1 33 049.525 60% 19 829.715 51 594.20 51 639.88 14 01/87 Oflices in M.O.H Approve 33 911.250 IbnAI BaladGwealTrd 1 861.725 60o 517.035 1 345.25 1 345.89 b Tau Ofzf1ces n MOII Fnancing 20 346.750 33 911.250 20 346.750 52 939.45 52 985.77 24 12/90 Shinas Polyclinic Contract 761 958.628 AlTurki Enterprie 1 72 626.421 60% 43 575.853 113 378.40 113 488.69 29 12/90 Shinas Polyclinic Approve 761 958.628 Al Turi Enteprises 1 44 421.196 60'/. 26 652.718 69 346.71 69 443.51 33 12/90 Shinas Polyclinic Financed 457 175.177 Al Turki Enterprises 1 31 694.510 60/ 19 016.706 49 478.86 49 495.30 36 12/90 Shinas Polyclinic Al Turb Enapriss 1 157 734.255 60% 94 640.553 246 241.75 246 241.75 39 12/90 Shinas Polyclinic Al Turki Eneprises I 145 073.803 60% 87 044.282 226 477.29 224 F52.88 50 12/90 Shinas Polyclinic Al Turki Etapria 96 206.900 60% 57 724.140 150 190.30 150 154.91 54 12/90 Shinas Polyclinic Al Tufki EaWpwris 1 77 722.753 60