Equatorial Guinea - Health Improvement Project

Document of The World Bank FOR OFFICIAL USE ONLY MICROFICHE COPY Report No. 9421-EG Report No. 9421-EG Type: (SAR) BOYA, LOSO/ X34725 / J-8101/ AFIPH STAFF APPRAISAL REPORT REPUBLIC OF EQUATORIAL GUINEA HEALTH IMPROVEME1T PROJECT FEBRUARY 6, 1992 Population and Human Resources Division Occidental and Central Africa Department Africa Region This document has a restricted distribution and may be used by recipients only in the performance of their official dudes. Its contents may not otherwise be disclosed without World Bank aothorization.  CURRENCY EQUIVALENTS The rate of CPA francs 288 to the US dollar is used for cost projections as of January 1992. The CFA franc (C AF) is tied to the French franc (FF) in the ratio of FF 1 to CFAF 50. MASURES 1 m 1.09 yd. 1 m2 = 10.76 sq.ft. 1 k%o2 - 0.38 sq.mi. ABBREVIATIONS AND ACRONYKS AFDB African Development Bank ANU Administration and Finance Unit AIDS Acquired Immune Deficiency Syndrome BEAC Banque des Etats d'Afrique Centrale EPI Expanded Program of lmmnization EQG Equatorial Guinea FP Family Plannig Fy Fiscal Year ICB International Competitive Bidding lEC Information, Education and Communication MC Kanaging Committee HCHIFP Kother and Child Health and Family Planning NOR Ministry of Health NGO Non-Governmental Organization OCEAC Organisation de coordination pour la lutte contre les end4mies en Afrique Centrale PHC Primary Health Care PU Planning Unit SAR Staff Appraisal Report STD Sexually Transmitted Disease UNDP United Nations Development Program UNFPA United Nations Fund for Population Activities UNICEF United Nations Children's Fund MHO World Health Organization FISCAL YEAR January 1 - December 31  FOR OFFICIAL USE ONLY EQUATORLAL GUINEA HEALTH IMPROVEMENT PROJECT TABLE OF CONTENTS Page CREDIT AND PROJECT SUMMARY .................................... iii I. INTRODUCTION ............................................ 1 II. THE ECONOMY ............................................ 1 III. THE POPULATION, HEALTH AND NUTRITION SECTOR .... ......... 2 A. Population, Health and Nutrition Profile .... ......... 2 B. Performance and Constraints of the Health System ..... 6 C. Government Strategy for the Health Sector .... .......... 10 IV. THE PROJECT ....................... ........................ 13 A. Rationale for IDA Involvement .......................... 13 B. Project Objectives ..................................... 13 C. Project Description .................................... 14 1. Institutional Strengthening of the Ministry of Health 14 2. Health Strategy Development and Implementation ...... 17 3. Strengthening Priority Health Programs ............ .. 17 (a) Malaria Control ................................ 18 (b) Mother and Child Health and Family Planning .... 19 (c) Sexually Transmitted Diseases ..... ............. 20 (d) Pilot Program for Essential Drugs .... .......... 20 4. Human Resource Development . . 22 (a) Technical Assistance ......................... 22 (b) Hedium-Term Staff Training Program .... ......... 22 (c) Fellowships and Studies ......................... 23 V. PROJECT COSTS AND FINANCING ............................... 24 VI. PROJECT IMPLEMENTATION AND MANAGEMENT ..... ............... 26 A. Project Preparation ................. .................. 26 B. Project Implementation and Hanagement ........ ......... 27 C. Technical Assistance, Training, Fellowships and Studies .. 29 D. Civil Works ............ 30 E. Procurement ........................................... 30 F. Disbursements .................... ..................... 32 G. Project Accounts .................... 33 H. Accounting, Auditing and Reporting .......... .......... 33 I. Project Mid-Term Review .. 34 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.  it - VII. PROJECT BENEFITS AND RISKS .............................. 35 A. Benefits .................. 35 B. Risks ...... ....... 35 VIII. AGREEMNTS REACHED AND RECOMMENDATION . . 36 ANNEXES I. Basic Data II. Government Health Sector Strategy III. Organizational Structure of the Ministry of Health IV. Health Sector Budget and Investment V. Indicative List of Essential Drugs to be Procured VI. Project Implementation and Disbursement Schedule VII. Project Cost Estimates VIII. Disbursement Schedule IX. Operating Plan for Malabo Hospital X. Status of Bank Group Operations in Equatorial Guinea XI. Documents in the Project File MAP: IBRD 22929 This report is based on the findings of the Bank pre-appraisal and appraisal missions which visited Equatorial Guinea in January and October 1991, comprising Messrs/Mmes. Loso K. Boya, Projects Officer and Mission Leader; Eugenio Morice, M.D. Health Planner/Pharmacy Specialist; Karl Schiller, Hospital Kanagement Specialist and Marilou Bradley, Senior Program Assistant. Ms. Ishrat Z. Husain, Chief, AFTPN revieved the project design. Me. Marina Rovatti assisted with the typing of the report. Messrs. Michel Palein and Michael Gillette are the managing Division Chief and Department Director respectively for the operation.  - iii - REPUBLIC OF EQUATORIAL GUINEA HEALTH IMPROVEMENT PROJECT CREDIT AND PROJECT SUMMARY Borrower: Government of Equatorial buinea Beneficiary: Ministry of Health (MOH) IDA Credit Amount: SDR 3.9 million (US$5.5 million equivalent) Terms: Standard Project Description: The objective of the project is to strengthen the capacity of the Ministry of Health to plan, coordinate and monitor Equatorial Guinea's health sector activities by establishing a coherent sector policy and strategy; gradually building up a credible MOH management system and team, strengthening MOH's organization and staff capabilities, and promoting regular consultations with the donors active in health and the beneficiaries of health care. The project would also help the Government improve the quality of its field services and increase its capacity for service delivery in the critical areas of primary health care, mother and child health and family planning, major diseases control and essential drug supply to ensure continuity of vital health services. Specifically the project would: (a) institute at the central level a core management team (a Managing Committee, MC) of MOR Senior Managers, strengthen MOB's organization and decentralize functions; and improve sector management through training, provision of material support and technical assistance; (b) establish a management information system and a planning unit in MOB to carry out health investment screening, analysis and programming, and to support the implementation and subsequent annual revisions of the Government health strategy; (c) develop human resources for carrying out health activities through technical and management training of staff at all levels of the health system; and  - iv - (d) strengthen priority health programs targeted on vulnerable groups, includirng malaria control, mother and child health and family planning, and sexually transmitted diseases through rehabilitation of facilities and provision of medical equipment and essential drugs. Benefits and Risks: The project is expected to improve the effectiveness and sustainability of health sector investment and operations, and to strengthen the coordination of sectoral activities and donor aid to health; reinforcing HOH's institutional and management capabilities would lead to better planning and management of the sector as a whole; strengthening the capacity of HOH to deliver priority health programs would improve access to health care services for the poor and rural population, thereby reducing illnesses and premature deaths from preventable and curable diseases. Malaria control would directly protect 80,000 people living on Bioko Island from a major public health threat. The HCH/FP program would benefit an estimated 60,000 women and children, and contribute to the goal of halving maternal and infant death by the year 2000. Project risks include delays in implementation due to unfamiliarity of HOH in executing a project of this scope. Also, HOH's capacity to plan, manage and cooadinate health programs is weak, and the qualifications of local staff are inadequate. The risks were first addressed through the adoption of realistic objectives and a simplification of the original project design and would be further mitigated through technical assistance, training '40H staff at all levels. a strong supervisory role for