Guinea - Health Services Development Project

. 4~ 11 _9 ' . ., Document of - ThecWorld Ban,A YOR OFFICIAL SE ONLY Report No. 6679-GU STAFP APPRAISAL lRT GVUA LTS I SERVICES DEVELOPIN PROJECT Hay 29, 1987 'A -~ ~~~~~~- Population, Health and Nutrition Depatmtent This doeal as a regukte diuributiou and may be wed by repits odly in the performance of their Ockia du i its teps may sot odmwis b diseleW withot WAd Bank abutoriation.  : .-l Cmrrency Unit = Guiea, Franc (Gt) 05$1.00 GUOt 410 a" 1 = 0US.00244 off 1 Million U 0S 2,439 Metric Syste January 1 - Decemer 31 AiD3 Africa Developmt Bank MI Association Guindeo de Bie.tre Feailiel (Guins" Asociation for Fmdly Velib1ng) CV? Centre de Fomtion Fdinine (W omeIs Training Center) co CaCitd de Geation (Health Nan_gnt'Coitt*e) C7V C.itd Technique de Coordination (Technical Coordinating Comittee) DAT Division de l'Administration et ds Finas (Division of Administrtion and F1in e) -P Division d'Etudew de Pleification et Fonation (Division of iamins, Trainig and Studies) DS Direction de la SSatd (Directorate of _eltb) USC Helth Mhnagant Comittee IDA rnternatioual Develquat Association lee Imforation, Education ad Ccanication IMW tnternational Mobetary Fund iWV International Planned Panthood Ftedation IRAS Inspection Rdgionale de Ia SatE et des Atfairm Sociales (Regional Inapectorate of Health and Social Affairs) MCI/VP Meternal and Child Health/tFinly Planning HIS a n t Info mation Syates i ; fUAS Minist6re de la Santo et db Affaires Soci ales (Ministry of Health and Social Affairs) NWO No4ovenmnuental Organization PPF Project Proparation facility mR Rsdio-Tdldvision Ouindenne SEaS Secretariat d'Etat aux Affairms Sociales (Secretariat of State for Social Affairs) WlP U.itd de Gestion du Projet (Project M1mt Unit) UWPA United Nations Fund for Population Actiities UIIICEF United Nations Children's fund UFIIDO United Nations Industrial Developent Organization USAID United States Agency for International Developmt WHO World Health Organizatioo  FOR OffiILAL UR ONLY - C"Ts ADWU = nrr : Republic of guinea wLisi.s : tMinitry of Isalth nd Social Affairs (fB) t :SR 15.1 ;,i1lion (US$19.7 million oquivalent) - : 8Staudrd fte11 t roThe project will suppattgovrznt's efforts to (i) JAi ,1Qdevelop planins and _mnagement capabilities within the MM and introdce policy nd administrative reform to improve the qulity and efficiency of basic bohlth / s_vicw, taludig tomitly plmtng; A(i) improve - helth care in the ragion of Middle Ogiiea; (iii) strengthn finacial and operational g t o tie region of Mddle auinea; and (iv) develop and evaluate cost recovry activities. ltitgtj : The project will help the Government to establiah a permanent capability for improved health sector planing, policy imlementation and coordintion of external asistne. The project will als improve the quality and accessibility of helth and ocial -service for about 1.3 million people in Middle Guinea. TSe establishment of regular program of in-srvice training ad suprvision of medical and pd pernel will upgrade their skills and imrove the overall quality of services. Strengtbhing of MCO, nutrition and helth education pgrm, including the prmotion and extension of family plaming sorvices, should reduce morbidity and mortality amg women and children. This document has a estced distribution'and may be used by recipients only in the performan of their offlcia duties Its contents may not otherwis be diclosed without World Bank authoriaton.  - ii - Nuim : lecaueo this will be the tfit k-ftianced operation ia the helth sector In Guine, there i the risk of dela. in ipl_tation. aoermet's comitment cod the ca_petence of the umit set up to coordinate Iwlinmntatiou have almbly been effectively dmstrated by the suaceful and timely completion of project pnaratioa. Techical mistan and training will help minimize the risk of delay ed unatisfactory ixplwnmtation. This risk will be further mitigated by the direct participation of locl authorities and comimittlie in projact mmngmt and implmntation. Anoher risk in that the cost recvry progr desi to mbilise additioal r _sorcs for non-lried VperatIng Costs ay not succeed. To minidmi this risk, cost revery is limited to curative services including the cost of drut, for which the populion bh dm-ntrated a willinss to pWy ad the _mtgemt of esursm Is being decantrmlised to develop locl cotrol ud improve manag_nt within each facility. annul evalustion of coat recovey activities shold asble _nagmet comittee and halth authorities to tak timely, corrective action.  Ia1t.aJLua JoL1 For Toa Malmet2d agAm ontat FWO~US* mLli TOW A. ntiNttIal t t m 1. Strengtheig of mom Suppot fiti. 0.1 - 1.1 1.2 2. Str of MM techical ftntiams 0.3, 0.8 1.2 subtotal A. 0.5 1.9 2.4 B. Develo,amt of 1mith Sector erMtIm in Middlie 1. Strenenn of Ibnal kith 0.3 0.6 0.9 2. Strghing of Baic Neulth Services 4.8 6.6 10.4 3. Upgrading Shill. of Oegional Ilth 0.0 0.1 0.1 Personnel 4. Improving finacial t d Cost 0.0 0.0 0.1 Rovery subtotal 3. 8.2 6.3 11.5 C. Project _uasgenunt ed Administration 0.6 1.5 2.1 D. Project Prertion Advanc 0.2 0.7 0.9 Total BDmline Costs 6.4 10.5 16.9 phical Contingecie. 0.6 0.9 1.l Price Contingenies. 3.7 0.4 4.1 TOTAL PJECT 005 10.8 11.8 22.5 Note: Total. my not add up due to roedint. kttimted project coot re net of taxes and duties frc, which the project would be expt.  i iiv n ~ ~~~~~~~~~48 tOWi Te DA 7.9 11.8 19.7 Gov.tint- 2.0 - 2.0 Imficiari.. 0.8 - o.a Total 10.8 11.8 22.5 Notisted Didbur"_ ms m nso nml FM rm 94 midll a - Anual 2.2k' 3.1 5.0 4.3 2.9 1.8 0.4 - wGlattv 2.2 5.3 10.3 14.6 17.0 19.3 19.7 Ibt ofg Ibh: D. a. ProJect -let io Date: Jm 30, 1993 ~: MI=D 20128 and 201 1/ includes repaymet of I advanm o Of us0.9 milion.  Table gfCotet Credit md Projeat Smrwy . . . ..*. .**... . . * I Definitios . . . ..... X1 0* 90009909t 9 0 S 4 , 9 * * 1 II. TEPPUlN ELHAND UUU $207MR**.. 2 A. Populations Nslthad Nutrition Status . . . . . . 2 S. me thyst .......... 3 1. Orguiizatiom 9 4 9 9 9 0 0 9 0 9 * 9 9 n.. 9 S 3 2. Lavel .and Typ.f5ervicm o f. .S.. .. .' 3 3. .fwu 4 4. Drug Pfr cue't md Distribution ....'.. . 6 C. elthtihimaod t . ........... ... . . . a 1. cDrtr t .eaditures . . . . . . . . . . . .... 6 3. bxt.wul Assistance ..... .. 8 D. Halith Syatan PewOX *inuaoe- and Constraints . . . 9 1. P.rforumnc. 9 . 9 * 9 9 0 * 9 * * 0 3 2. Constraints . ... ....... . . . . . -. 9 This report is based on the findigs of an IDA ubiouaiohich visited gauIDe in Decombr 1966. lbs aissin um composed of M. Anefor (Mission a ) B. Sederlof (_in.o_al Analyst), D. Vaillancourt (Operatio_s nalyst), D. Jolly (Constant, Public Nmith .asginut Specialist), C. sywr (Caosultant, Health Edation and Cmmications Specialist)* C. Suftan (Conltsnt, Public Nalth Specialist) and J. Wechter (Consulta Architect).  i~~~-v 'I~ ~ ~ ~~~V S. SectorPUc a 8trte ... .......... 10 2t * . trtio . . . . . . . . . . . . . . . . .. . ; 12 2. Nlutrition .2 3. Population .*. . . . *.99 @940. , . 13 F. DA's Role 13 Irl. P ID * 913 A. Project Objectives ..... . , - 13 Z. Sumwy Project Desoiptio ......... 14 C. Detailed ProjectDincription . 1 1. Institutionsl Delogmt of MM ...... 15 a. Stregthening of Mm Suport mtio . . 16 b. Strengthesing of 8M Techical mctic. . 17 2. Dee1oi.t of ealth Sector Oprattie ic Middle uia 20 a. Strengthning of RIgioaol Health Ne_amt . 20 b. Str thing of ami ilth Svice . . . 21 C. Vprading Skills of Regional Helth d. lmprovIg fiacial _ t and coat Recovery . . . . .4 IV.P3JUOTCOT NDFinm .. ........... . 26 - . -. P... ... 29 VI. Pl m IT 1 34. VII*P.J? IENEITOD ANO AND A0I*SI 36 I BasicData . . . . . . . . . . . . . . . . . ' 39 2-1 Orgnizational Chart of the Ministry of Hblth and Social Affairs 40  - Vii - 2-2 Orsgizatiomal Cart of the Secetariat of state mm A In Chwr of 8ial Affairs ....... 41 2-3 Helth XnvestssIt Budget, is--7" 42 3-1 Vital staffing for central MBAs ubits To BID tr.t_me undr the Project 43 3-2 Tecdoaul Training Progrm for medical and Perutdic'L Pe1ersoupex in Middle Gue . . . . . 46 3-3 e f ees tor Helth Center Services o Be Tested Utr the Project . . .... . 47 3-4 lutited Nate of humuption by Ienficiwiss of elth Ceter rug Costs and Comsequet Pr_opo IDA Flnacig of Drugs ......... 48 4-1 ySr Account by Project Componet . . . . . . . . 49 4-2 Project C _oSn by Yer . ............ *50 4-3 B reekdo of umry hAounts .... . . . . 81 4-4 for lstiamtl Project costs . . . . . . . . 82 4-6 Dotils of Inar_metal Rncurret Costs fw Yew Six of the Project . . . . . . . . . . 83 5-1 Projct Orgaixstion Scheme .W....87 8-2 Sumwyof Tecbiclh Aistanc . . . . . . 88 5-3 s7ry of FlO hips 89 8-4 ImpleatationSchedules .60 -6. Disburant. Plan . . . . . . . . . . . . . . 63 8-6 Esid th:timated ofDibarnits . . . . . . - . 64 Selected Documents aud D%ta Availuale to the Project file . . 66 MAPS: IID 20128 and 20129 .  Adult Literacy-Rate :,,,The percentage of persons age 15 and over who. can read and write. Chil,d Death Rate;, a Tenmber oif deaths among children 1-4 years'- of age per '1,000 Tchildren in the seams g grouw in a given yearo Crude Birth Rate : The 'numbr of live birth. per year per ljOOO- population in a given year. Crude Death Rate : The numher of deiftbo per year per -1,000 population' in a given year.- Infant MortalitylBate : Tae number of death. of infants under I yewr - ~~of age in agiven yewrper 1,00O live births during the saeasyear. Life Expetotacy at Birth: N erof years a newborn child would live if- subject to the mortality risks prevailing for the crass-section of population at time of birth. Maternal Mortality Rate ume of deaths to wamenWm whode -due, to pregnancy and cbiIltserS.ngcoqplicat ions in a given year per 1,000 birth. in that year. Morbidity : ~The frequency of diseaem and -i llness in -a population. Rate of Natural Increase : Rate at which a population is increasing (or deceasng)in a given year due to a surplus (or a deficit) of births over deaths. rhe rate of natural increase equals, the crude birth rate u$puu the crude death rate. Total fertility Rate : The average number of children that would be born alive to a wooma during her lifetius if ehe were to conform,, duEtiog ber reproductive life, to age-specific fertility rates of a given year. *~~~~~~~~~~~~~~~~~~~~~~~~~~~~~l  l, - '1: ,~~~~~~ - * ~ s' ,. '- . 1.01 Althogb G.in. Is Well e sd With IWV+A=t grultural, mineral and enegrg resources, economic growth ilm ince indepneire has beem limited. Poor ecoomic pwor c be In lo pert to In-rpate onomic policies ad'to weak t of thw econay. Eonomic dl t'ha ao been cosmtraine by the rapid ate of' populatin wth which coutinue to outstrip the rate of wth o the ,on__w ad of food production. 1102 As a copoooeof the abov factors, uinea ramaiwc one of the lea1t deelXod Wt African couotries. Social indicat#rs ae low eves by African stendard: life expectanc at birth is under 40 year; the 6dult litercy rate Is 20 percent; the priawy school eoroll_mt rate is 26 percet; accs to sae ttr ts limited to les thl 20 peret of the po lation; and (M per cwita in only US$230 (x 1). 1.03 With DW ad IDA _sistane, the nn t in'l iebxd en en eXtensve progrm to rebabilitate the eo6ny end to stimlate development. so pro ' a'tour 'an deloent poritie awe (i) monetary , includin improvemetst in the bankig otm and xchgs rt adtetmet; (ii) tatio f pvat setor el ent; (ii) strenghi qf the Capacity and Pe oe' f t or, water supply and social -ectors; end (iv) the increae ad divenafication of exports through _UpenteI dmetic production.' lie onoin economic atuastment. progr will. introduc policy r