Argentina - Social Sector Management Technical Assistance Project

Document of The World Bank FOR OFFICLAL USE ONLY Report No. 14410 IMPLEMENTATION COMPLETION REPORT ARGENTINA SOCIAL SECTOR MANAGEMENT TECHNICAL ASSISTANCE PROJECT (LOAN 2984-AR) APRIL 28, 1995 Human Resources Operations Division Department I Latin America and the Caribbean Region This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization.  CURRENCY EOUIVALENTS Name of Currency Peso (P/) Appraisal Year US$1 = P/650 At 9/15/94 US$1 = P/1 WEIGHTS AND MEASURES 1 Square meter (m2) = 10.76 square feet (ft.2) 1 kilometer (km) = 0.62 miles GOVERNMENT OF ARGENTINA FISCAL YEAR January 1 - December 31 ABBREVIATIONS AND ACRONYMS ANMAT National Administration of Drugs, Foodstuffs and Medical Technology ANSSAL Social Security Health Care Financing Administration APH Autonomous public hospital IDB Inter-American Development Bank INAC Instituto Nacional de Acci6n Cooperativa INDEC National Institute of Statistics and Census MCHN Maternal and Child Health and Nutrition project MinEc Ministry of Economy and Public Work MinEd Ministry of Education MIS Management information system MSAS Ministry of Health and Social Action (Welfare) NPD National Project Director OS Social Security Health Care Funds (Obras Sociales) PAHO Pan American Health Organization PCU Project Coordinating Unit PRONATASS Programa Nacional de Asistencia T&enica a los Sectores Sociales SAIJ Computerized Legal Information System SSMTAL Social Sector Management Technical Assistance Loan (Project) UNDP United Nations Development Programme  FOR OFFICIAL USE ONLY IMPLEMENTATION COMPLETION REPORT ARGENTINA SOCIAL SECTOR MANAGEMENT TECHNICAL ASSISTANCE PROJECT (LOAN 2984-AR) Table of Contents Preface ................................................. iii Evaluation Summary ........................................ iv A. Project Objectives ................................... iv B. Implementation Experience and Results ...................... iv C. Findings and Lessons Learned ........................... vii PART I: PROJECT OBJECTIVES, IMPLEMENTATION, OUTCOME AND LESSONS LEARNED A. Project Objectives .................................. 1 B. Project Implementation ............................... 5 C. Assessment of Project Impact ........................... 12 D. Project Sustainability ................................ 15 E. Bank Performance .................................. 15 F. Borrower Performance ............................... 16 G. Summary of Lessons Learned ........................... 17 PART II: STATISTICAL TABLES Table IA: Assessments Through Time ...... .. ........... 18 Table IB: Consolidated Assessments ....... .. ........... 18 Table 2: Related Bank Loans ........... .............. 19 Table 3: Project Timetable ............ .............. 19 Table 4: Loan Disbursements: Cumulative Estimated and Actual . .. 19 Table 5: Key Indicators for Project Implementation .... ....... 20 Table 6: Key Indicators for Project Operations ...... ........ 21 Table 7: Studies Included in Project ........ .. ........... 21 Table 8A: Project Costs ............. ............... 22 Table 8B: Project Financing ........... .............. 22 Table 9: Economic Costs and Benefits ...... .. ........... 22 Table 10: Status of Legal Covenants ....... .. ........... 23 Table 11: Compliance with Operational Manual Statements .. .... 24 Table 12: Bank Resources: Staff Inputs (SW, Actual) .... ...... 24 Table 13: Bank Resources: Missions ....... .. ........... 25 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.  ii APPENDIXES 1. ICR Mission Aide Memoire pp. 26 - 28 2. The Borrower's Contribution to the ICR pp. 29 - 38 3. Original Project Objectives pp. 39 - 47 WORKING PAPERS (available in the Project files) A. Political, Macroeconomic and Social Sector Background B. Performance Addendum 1 - Financing Allocations Addendum 2 - Detailed Expenditures Addendum 3 - Fund Balances at the end of the Project Addendum 4 - Annual Distribution of Consultants Hired under the Project C. Organization and Management Addendum 1 - Implementation Strategy Addendum 2 - Implementation Issues Addendum 3 - Amendment to Loan Agreement D. The Bank's Role E. Internal and External Evaluation Reports of Individual Sub-projects F. List of Recipients of Project Documents G. Other Significant Information  IMPLEMENTATION COMPLETION REPORT ARGENTINA SOCIAL SECTOR MANAGEMENT TECHNICAL ASSISTANCE PROJECT (Loan 2984-AR) Preface 1. This is the Implementation Completion Report (ICR) of the Social Sector Management Technical Assistance Project, for which Loan 2984-AR in the amount of US$28 million was approved in July 1988 and became effective on May 23, 1989. On July 31, 1994 disbursements amounted to US$27.4 million, or 98% of loan proceeds. Closing date extensions from the original target date of June 30, 1992 first to December 31, 1993, and then to June 30, 1994, were justified on grounds of performance, benefits to be derived from operationalizing newly introduced policies, completing tasks underway, providing more focused analyses, and financing the preparation of two investment projects. The last disbursement took place on July 19,1994. 2. The ICR was prepared by Jose Andreu (consultant), and was reviewed by Evangeline Javier/Leain-Hong Ding (Task Managers, LAI HR), Alain Colliou (Chief, LA1HR), and Orville Grimes (Projects Adviser, LA1). The Borrower provided its own performance evaluation, which is contained in an Appendix 2. 3. Preparation of this ICR was begun on August 1, 1994. The ICR is based on materials in the Project file. The Borrower contributed to the preparation of the ICR mainly by arranging for the internal and external evaluations of sub-projects, and by commenting on this draft report. Before and during the ICR field mission of August 29- September 9, 1994, discussions were carried out with Government officials, UNDP, the PCU, Bank staff, and consultants who worked on the Project. 4. The Project was carried out in conjunction with a Japanese Grant which has financed activities in support of the Project's social sector goals. The Grant's closing date has been extended to close on June 30, 1995.   Evaluation Summary SOCIAL SECTOR MANAGEMENT TECHNICAL ASSISTANCE PROJECT (Loan 2984-AR) ARGENTINA A. Project Objectives 1. Project objectives encompassed a singularly wide variety of general and specific policy actions and institutional strengthening measures in twelve programmatic areas: health care, welfare for disadvantaged groups, health administration, education, social security, labor, justice, national and provincial statistics and censuses, management information, macroeconomic management and poverty alleviation. These included establishing new economic policy, manpower and control units; selecting criteria and drafting norms and regulations; introducing decentralized management and financing; management training programs and incentive schemes; targeting and socioeconomic models; and designing and starting off cost recovery, budgeting, management information, monitoring and expenditure review systems. 2. The Project's (SSMTAL) original ambitious goals and complex design reflected the urgency attached by both the Government and the Bank to avoiding an impending political, social and economic crisis by speedily bringing about major improvements in equity, efficiency and financial viability of the social sectors. The SSMTAL aimed at radical improvements through new laws and a leaner, more responsive bureaucracy. 3. In the course of implementation, and in response to serious political, administrative and technical constraints which made the Project unwieldy, objectives were consolidated, orders of priority established, the political will mustered to advance the key elements of the reform agenda, and follow-up action taken to design and operationalize key pieces of legislation and administrative regulations. B. Implementation Experience and Results 4. Original Flaws. The project scope was excessively ambitious. Originally, it consisted of more than 600 individual analytical tasks. Five ministries, twelve secretariats, and one semi-autonomous agency participated as executing agencies. The Ministry of Economy (MinEc) assumed passive (given its lack of power vis a vis the executing agencies) overall coordination. 5. From the beginning, SSMTAL implementation suffered from political instability, as well as design and administrative weaknesses. During the first year after effectiveness (in FY90), execution came to a standstill as a result of the collapse of the Alfonsin administration. Subsequently, the Menem administration could hardly be blamed for initially neglecting the Project. The present government had to take charge unexpectedly,  v a full six months ahead of the constitutionally mandated transfer of power and simultaneously improvise day-to-day in handling an economy and a public sector in crisis. Project design weaknesses included the lack of defined and agreed inter-sectoral and intra-sectorial priorities, unfocused and poorly coordinated work programs, and lack of transparency and accountability. Project administrative weaknesses included: (a) in the absence of a national social sector planning and coordinating agency, forcing these roles onto the Project Coordinating Unit (PCU), a weak, artificial creation facing difficult political conditions; (b) high turnover in all participating agencies, especially in the first three years of implementation, which included: six ministers of labor and social security, seven secretaries of labor and seven secretaries of social security; seven ministers and seven secretaries of justice; five ministers and six secretaries of education; nine ministers of health, nine secretaries of health and 11 secretaries of social action (welfare); three directors of the National Institute of Statistics and Census (INDEC); seven ministers of economy and 13 national project directors (NPD); (c) the excessive concentration of powers and responsibilities in the NPD (a high official with many more important duties) combined with a weak PCU; and (d) in 1989-1990, PCU's and executing agencies' lack of control of health and education consultants' selection, terms of reference, timing, quality and relevance of outputs. Canceling the loan would have been amply justified in those early stages. 6. Fortunately, the new Administration and the Bank continued to support the Project because of its potential importance. Economic stabilization and growth, the introduction of economic and public sector reforms at the macro level, stronger leadership at the MinEc and executing agencies, and a strengthened PCU substantially improved performance from early 1991 to Project Completion. 7. Results. The Project succeeded in its major policy and development objectives well beyond original expectations. More modest but still significant institutional goals in the health and education areas were met. Particularly important was the recovery experienced by the health sub-project in 1992-94. 8. The Project's substantial analytical. policy and legal framework. and institutional contributions include: (a) social security: i. providing the analytical basis for an already enacted and operational, radically new and financially self-sustaining national pension regime (with a potential coverage of 2.5 million or one half the total number of contributors), which creates a system based on individual retirement savings accounts to be managed by specialized private institutions; ii. a new dues collection system which helped increase annual pension contributions from US$4.8 billion to more than US$10.8 billion annually (in real terms) from 1991 to 1994; and iii. an improved benefits distribution system which made possible the identification of a US$11.8 billion debt to pensioners and its reduction by US$8.8 billion from 1991 to 1994, as well as the timely distribution of monthly pension checks; (b) labor: the analytical base for the already- enacted national labor law and complementary collective bargaining and productivity legislation in support of the modernization and privatization of the economy, which have improved the flexibility of hiring and firing workers, expanded partial and fixed term employment, and led to major increases in emergency employment and unemployment insurance; (c) social sector resource use: i. a national review of sources and uses of  vi public social expenditures; and ii. a new system for program budgeting for the social sectors (later extended to cover the economic sectors and five provinces) under MinEc sponsorship; (d) health care: i. legislation enabling public hospitals to gain greater management autonomy, compete for patients and collect revenues from the insured; ii. legislation establishing free production, marketing and pricing of drugs, and the production of generic drugs; iii. regulations introducing improved quality controls of foodstuffs and drugs; iv. the establishment of an agency in charge of implementing the above legislation; v. rules and agreements with faculties of medicine enhancing the role of family physicians and nurses, the pillars of basic health care; vi. analytical support for the Presidential Decree opening the door to competition among insurance schemes operated by labor unions; and vii. financing and overall review of preparation of the Bank-assisted Maternal and Child Health and Nutrition project (MCHN, Loan 3463-AR, the first national health care investment project in the country); (e) education: providing the analytical bases for strengthening and decentralizing to the provinces the secondary education system and financing the preparation of the first (for the country) education investment project in support of those policies; and (f) justice: the development of a computerized system for collecting, collating, disseminating and providing feedback of essential information in the areas of litigation, laws, decrees, and regulations affecting the administration of justice. 9. Also valuable are the National Institute of Statistics and Census (INDEC) sub- project's contributions in designing and introducing standardized provincial health and education statistics systems in seven of the 24 provinces, as well as incorporating welfare, health and education components in the periodic household survey in major population centers to better ascertain the extent and depth of poverty. 10. Impact and Sustainability. Under the impetus of major reforms being carried out by the present Administration, the SSMTAL's long-term impact should be substantial and long-lasting. The social security sub-project's impact is already large: it has helped eliminate current annual deficits running into the billions of dollars, and reduced debt to pensioners to one-fourth its original size. The new labor laws are permitting free labor negotiations: over 14,000 negotiation centers exist today (as opposed to the 400 existing in 1990), and are tying salaries to productivity. The review of social public expenditures provides the basis for major readjustments in social programs, while program budgeting has become an essential tool of fiscal discipline. Work on drug marketing and food/drug quality controls is beginning to have an impact on prices and enhanced health promotion throughout the country, while the MCHN project is strengthening basic health care and rationalizing services. Secondary schools have been decentralized with a sound budgetary and analytical basis, and will be supported by the already approved investment project. The justice informatics system should immeasurably improve efficiency and transparency in the legal area, which was so disorganized that it became an obstacle to the modernization of society. Much of the impact of individual sub-projects will be felt over the medium term and require assessment in three to five years. Sustainability is enhanced by several factors: i. the support of all political parties to the thrust of reforms; ii. the fact that many Project consultants became high Government officials in charge of implementing their own recommendations, as was the case for MinEc's vice- minister and secretary for economic planning, the social security secretary, the secretary  vii of labor, the undersecretary of education, and a large number of national and provincial officials at intermediate and working levels; and iii. enhanced awareness of the need for managing the social sectors more efficiently. 11. The Project's impact will be minimal in the area of social welfare, which suffered more than any other sub-project from a policy void and the high management and staff turnover. Lack of success in developing the health financing analytical base will delay overall sector reform efforts. The failure to develop standard inter-agency management information systems may create future problems. 12. The preparation of the Greater Buenos Aires health reform project was also unsuccessful and had to be stopped. The ambitious reform proposal was premature in view of the lack of support of the national health authorities, the major complicating factor of the transfer of national hospitals to the city of Buenos Aires, and the lack of coordination between city and provincial authorities. Weak Bank follow-up undercut its earlier recognition of the problems. However, the studies carried out for the city component are being used to target the poor, rationalize hospital use, integrate hospital and ambulatory services by geographic areas and set off important cost control initiatives. A project involving more modest reforms and a larger share of studies is now being prepared with PPF funds. 13. On balance, the SSMTAL's positive contributions far outweigh its few disappointments. In a way, the SSMTAL provided a reform-minded Administration with a ready-made instrument for defining priorities and providing the analytical base for major pieces of legislation and institutional change which are improving resource use in critical areas. The revenue increases and cost savings derived from implementing the SSMTAL sub-projects in the areas of social security, labor and program budgeting alone have already paid for the cost of the Project many times over. C. Findings and Lessons Learned 14. The Project was seriously flawed from its inception. It was excessively ambitious and complex, lacking priorities and well-defined, realistic actions and options. Additionally, an uncertain political commitment, the macroeconomic and social crisis, institutional weaknesses, and the experimental nature of the Project were not fully taken into account during Loan processing. Specially harmful was underestimation of the negative impact on the SSMTAL of the heavily politicized atmosphere of social sector agencies. 15. Unforeseeable circumstances further compromised the Project's initial viability. Paramount among these was the collapse of the Alfonsin administration in July 1989, two months after the Loan became effective. 16. In retrospect, a more focused approach in the three health and welfare sub- projects and in the education sub-project would have avoided waste and improved impact. Also, during the intial stage, should the Bank have better analyzed the implementation  viii capacity of the multitude of agencies involved, the implementation might have proceeded better. 17. However, a balanced analysis of performance would not ignore the historical conditions prevailing at the time the project objectives and scope were defined, and would help explain Government and Bank decisions. Under this perspective, it would be difficult to reject the main thrust underlying the SSMTAL: to promote, regardless of risks and in response to critical socioeconomic and political conditions and a very weak analytical base, the rapid introduction of tentative and mutually supporting broad sectoral and inter-sectoral reforms. 18. Viewed in this light, both the Government and the Bank were justified in being audacious. While the Govemment needed to respond quickly to long-neglected and rapidly worsening social needs, the Bank had a moral commitment to participate in a major way. The Alfonsin administration represented the first democratic regime in Argentina after many years of military rule. The Government had broad initial public support, a well-defined ideology, and a clear mandate for change: for the first time since the early 1950s, a government was elected with the participation of all political parties in the electoral process. The Government's agenda embodied widespread hopes for change after prolonged political instability, economic decline, and increased poverty. 19. Bank participation in a broad reform thrust was further justified on the basis of the Bank's own analyses (published in the late 1980s) indicating the large dimension of unmet social needs, and the need to take bold steps. The collapse of the Alfonsin administration could not have been foreseen. 20. Ironically, the original overambitious plans provided a framework ample enough for carrying out reforms under this Government. The sheer magnitude of the needs and required efforts identified at appraisal reinforced the new Administration's view that there were no alternatives to comprehensive reform. The restructured SSMTAL turned out to be the main Government policy vehicle for developing human resource priorities. 21. The two closing date extensions, the first one from mid-1992 to end-1993, and the second one to mid-1994 (shortened by six months from the originally planned extension), were amply justified and should have been expected given the Project's complexity and the unreasonably short, original three-year implementation plan when compared with the seven-year country implementation profile. By mid-1992, about US$15 million or 55% of Loan proceeds had been disbursed, an indication of adequate progress. Performance continuously improved from an initial "3" to an eventual "1" overall rank. The Project's restructuring beginning in mid-1992 led to the consolidation of tasks, and the reorientation of activities away from the weaker agencies (Ministry of Health and Social Action, MSAS, and Ministry of Education, MinEd) to the stronger ones (social security, labor, MinEc) in line with emerging priorities. 22. The extensions permitted the completion of important sub-projects, such as the national pension regime, Justice's informatics system, and program budgeting. The autonomous public hospital initiative got started. Two investment projects were prepared  ix in record time thanks to the ready availability of funds and the already established administrative machinery. These two projects are being followed by second stages which will extend reforms to the whole country in these two areas. On the negative side, the Project was not forthcoming in inducing reforms in the following areas: (i) health sector planning and development of a management information system; (ii) review of human resources development policy in the health sector; and (iii) development of targeted programs for disadvantaged groups such as street children and handicapped people.  IMPLEMENTATION COMPLETION REPORT ARGENTINA SOCIAL SECTOR MANAGEMENT TECHNICAL ASSISTANCE PROTECT (Loan 2984-AR) PART I: PROJECT OBJECTIVES, IMPLEMENTATION, OUTCOME AND LESSONS LEARNED A. Project Objectives Project Identity 1. Name Social Sector Management Technical Assistance Loan Loan Number 2984-AR RVP Unit Latin America and the Caribbean Region Country Department I Country Argentina Sectors Health, welfare, education, social security, labor, justice, statistics, management information, and public social expenditure Background 2. Sector Development Objectives. Social sector development objectives were very ambitious in response to critical political, social and macroeconomic conditions in the country and long neglected needs. At the time of the SSMTAL's inception, Argentina was in the midst of its most serious crisis in modem times, resulting from the compounded effect of negative growth rates; uncontrolled inflation; large and growing unemployment, public sector deficits and external debt service; and political instability . 3. At that time, the Government and the Bank agreed that the long-standing neglect of the poor was no longer acceptable. They also agreed on the urgency of introducing intra-sectoral priorities, and on improving the efficiency and financial self-sufficiency of programs that were costing Argentina billions of dollars a year, while showing little impact on the intended beneficiaries. 4. Inequity was particularly evident in the pension regime, education, housing and health care. In these areas, disproportionate shares of resources (in relation to needs and contributions) were being channelled to the better-off segments of the population. Pensions were being provided regardless of the number of years worked and the amount  2 of contributions, while privileged regimes favoring the politically powerful segments of society further increased inequity. Substantial expenditures on higher education benefitted the middle classes at the expense of primary and secondary public education, which were much more important to the poor. Subsidized housing was channelled also to people of some means, not the truly poor. Hospital-based care consumed most of the health sector resources and benefitted the insured and the urban uninsured to the detriment of the rural uninsured, the segment with the greatest absolute poverty. 5. Inefficiency plagued all sectors: oversized and leaderless bureaucracies; lack of standards against which to measure performance, and of incentives to improve it; assured life tenure of public servants regardless of merit; and poor control of productivity and quality led to waste and diminished the flow of resources actually reaching beneficiaries, most of whom were the poor, who disproportionately depended on those services. 6. Cost recovery and other means of self-financing represented a small share of social expenditures. Most of the financing had to be provided by general tax revenue allocations which, in turn, contributed to worsening public sector deficits. 7. Policy Context. The key policy issue of quickly developing the analytical base, policy recommendations and institutional capacity in the social sectors led the Government and the Bank to design the SSMTAL as a broad platform for getting reforms underway. The Government was extremely anxious to get a social agenda off the ground; while the Bank, reacting to Government's repeated urgings and based on its own 1987 social sectors, health and education analyses, was keen to use the SSMTAL as a vehicle for becoming involved in a major way. 8. The task was daunting. First, knowledge about coverage, degrees of inefficiency, quality and cost recovery was virtually nonexistent. This in turn limited the ability of policy makers to identify and orient tasks to the highest priorities. Second, institutions were weak, another factor hindering the prior selection of programmatic areas and agencies. Third, the option of proceeding with a more modest, better focused approach ran counter to the broad and critical political and social needs of the time. Fourth, a wider approach had the advantage of providing potential inter-sectoral linkages, and satisfied the need to rationalize public social expenditures on a large scale. 9. Linkages among Project. Sector, and Macro Policy Objectives. The linkages among SSMTAL sector and policy objectives could not have been stronger. The SSMTAL was designed and turned out to be the only vehicle for broad policy reform in the social sectors at the time of its initiation. Indications of the high priority that the Government gave the SSMTAL are: (a) the appointment of officials of the highest rank as national project directors: first, MinEc's Secretary of Economy, then MinEc's Secretary of Hacienda, and later the Secretary of the Presidency; (b) the large amount of external and local resources allocated to the Project; (c) the participation of the main social sector ministries; and (d) the establishment of executing units in those ministries and agencies directly reporting to ministers, secretaries and national directors.  3 Project Objectives 10. Overall Project Objectives. Original Project Objectives (Appendix 3) focused on a wide diversity of often very specific policy actions and institutional strengthening measures. These included establishing new economic policy, manpower management and control units; preparing criteria and norms; introducing decentralized management and financing, management training programs, incentive systems, targeting and socioeconomic models; and establishing cost recovery, budgeting systems, management information, monitoring and evaluation, and expenditure reviews. Sub-projects are analyzed below in order of their size. Detailed lists of individual budgets and actual expenditures by year, sub-project and task are available in the Working Papers, File B. 11. Individual Sub-projects' Objectives. The three sub-projects under the aegis of the Ministry of Health and Human Development (Ministerio de Salud y Accidn Social, MSAS) were initially allocated the largest share of resources (US$11.2 million, later reduced to US$7.4 million). They were: the health sub-project (US$5.9 million spent), with four components supporting hospital administration and accreditation, manpower development, management information systems, and health care financing. The health coordination sub-project (US$0.5 million spent) aimed at restructuring the Ministry's organization and management. The social action (welfare) sub-project (US$1.0 million spent) aimed at improving assistance to homeless minors, the old and the handicapped. 12. As an objective incorporated after the SSMTAL's restructuring, the health sub- project financed and oversaw the preparation of the first national investment project in the sector, the Maternal and Child Health and Nutrition project (MCHN, Loan 3643- AR). The project was prepared by a team (organized and under the supervision of UNICEF) in less than 12 months and, after initial mishaps, has considerably improved implementation, although disbursements are still behind original expectations. 13. The hospital administration component was enlarged to: (a) include drafting legislation (decrees 282/93 and 282/94) and initiating the execution of a plan to establish the autonomous public hospitals (APH), with an autarkic legal regime which enables them to set up their own boards, management and staffing, and charge fees for services to the insured; and (b) introduce indicative fee scales and accreditation of hospitals to enable them to compete for patients on standardized bases. By mid-1994 more than 50,000 beds, or half of the total number of public hospital beds, were incorporated under the APH regime. 14. As results of consolidation and re-orientation of sector strategy (Mid-term Evaluation and ongoing supervision), new objectives added during implementation, such as improving competition in the drug market and the quality control of foods and drugs, were amply reached. 15. After serious initial delays (by early 1992 less than 10% of the funds allocated had been spent) the manpower and MIS components took off in earnest. Under the manpower development component, proposals were drafted and agreements reached with the faculties of medicine of the universities of Buenos Aires and Tucuman to modify  4 curricula and introduce post- and pre-graduate programs in family medicine. An inventory of nursing resources was made, and training programs introduced to upgrade nursing auxiliaries and assistants to the level of registered nurses. Under the health promotion component (added subsequently) programs are being introduced to prevent work-related accidents, the most important cause of illness among young adults. The failed Greater Buenos Aires investment proposal produced a number of schemes of practical importance to improve population targeting, health care networks, accreditation and referral standards and cost controls. The health insurance component (US$0.3 million) was a failure due to lack of cooperation of the labor union-controlled health financing agencies. Likewise, the health coordination (US$0.6 million) and social action (allocated US$1.9 million, later reduced to US$1.0 million) sub-projects proved unsuccessful (the only contribution of the latter being the establishment of the Tribunal for Minors and supporting legislation), and were terminated in early 1994. 16. Of the education sub-project's original 14 components (US$5.1 million reduced to US$3.7 million), six (dealing with labor problems and inter-institutional relations, management information, technologies, research on educational reform, and development programming) costing US$650,000 were terminated early (in 1989 and 1990). Although some valuable analytical reports were produced, they lacked the necessary focus on practical results. Of the remaining eight components, five (a national inventory of physical infrastructure, restructuring the federal Ministry, manpower development, quality of secondary schooling and secondary schools' teacher training) were highly successful, and two (university management and coordination, and technical education) produced high quality results, with the former providing the basis for preparing a Bank- assisted investment project. The policy unit and budgeting and financial control components produced mixed results. Overall, these components were reoriented to better support the decentralization of secondary schools and the Decentralized Secondary Education Improvement project (Ln. 3794-AR), which was approved by the Board in September 1994. 17. Under the justice sub-project (US$3.3 million, increased to US$6.0 million), an initially modest proposal to develop pilot schemes was expanded to include upgrading the nationwide computerized legal system to permit the consolidation of legal information and its cross-referencing, as well as easy and standardized access to pending litigation for both the public and private sub-sectors. 18. The social security sub-project (with an initial budget of US$ 1.9 million later increased to US$2.3 million) had three components which strengthened revenue collection and the distribution of benefits, and also, developed an alternative pension model. The labor sub-project (US$0.3 million, increased to US$1.5 million) was originally geared to enhancing the role of the Labor Secretariat in expanding employment. It was later reoriented and expanded to help develop the national labor law promulgated in 1992, and complementary legislation promoting collective bargaining by individual enterprises, linking salaries to productivity. 19. The INDEC sub-project (the budget of which was increased from US$750,000 to US$1.2 million) was substantially expanded from a pilot statistical effort in three  5 provinces to include the development of health and welfare data modules which were incorporated into the census and the periodic household surveys of main population centers. This sub-project also designed and helped introduce standardized basic statistical systems for health and education in 17 of the 24 provinces. The social expenditure sub- project (US$215,000 spent) consisted originally of a national review of sources and uses of public funds. It was expanded (its allocation increased by US$1 million) to include the design of a system of program budgeting for the social sectors. 20. Broadly speaking, policymaking objectives, such as privatization, the reduction of the public debt, increasing efficiency and lowering local production costs to compete internationally (social security, labor, justice, health and social expenditure sub-projects), and service decentralization and rationalization (education, health and INDEC sub- projects) were reached and in most cases surpassed. 21. The objective of improving the delivery of services was reached for social security, labor, justice, INDEC and MinEc. Service delivery of primary health care and secondary education should improve under the respective investment projects prepared with SSMTAL financing. 22. Cost recovery and economic rationalization objectives were successfully reached or are being pursued. Social security registered the largest results. More equitable and higher levels of user charges have been introduced on a large scale under the social security pension regime. The autonomous public hospital legislation allows charging fees for services provided to insured patients. The Computerized Legal Information System (SAIU) was designed to sell its services to users once its usefulness is established. Improved targeting is being fulfilled by the social security sub-project (identification of taxpayers and beneficiaries, and charging fees linked to ability to pay); the labor sub- project (identification of the self employed and the unemployed); the justice sub-project (identification of potential SAIU users); and MinEc's social expenditure sub-project (identification of who pays, and who benefits from social expenditures). Monitoring and evaluation were strengthened in all of the above sub-projects, and should benefit from the implementation of the MCHN and the secondary education investment projects. B. Project Implementation Project Design and Organization 23. The Project was originally designed on the basis of independently developed agency proposals which were not properly vetted and consolidated by MinEc. After appraisal, MinEc and the Bank decided to emphasize action-oriented studies, and the implementation of their recommendations. In early 1991, the Loan documents were changed to permit financing of preparation of health, education and social security investment projects. 24. The National Project Director (NPD) and the Project Coordinating Unit (PCU) coordinated the work of the participating agencies, monitored their performance, and  6 coordinated with the Bank. Each participating agency operated through an executing unit directly reporting to the respective minister (in the case of ministries) or secretary (in the case of secretariats). Two interagency committees directly under the aegis of the PCU were set up to coordinate work on statistics and informatics carried out by the participating agencies. Critical Variables and Issues 25. The main gaps between planned and actual implementation are related to organization and management, scope and timing. A. Organization and Management 26. The most important factor bearing on management performance was that the PCU was forced to play the role of a national social sectors planning and coordinating body. In the absence of formal institutional arrangements for carrying out these tasks, the PCU had to carry this heavy burden in difficult political times and without a formal mandate or lines of command. In the circumstances it did a remarkably good job of helping set priorities, and enforcing the fulfillment of targets and programs. 27. Based on the lessons of experience which revealed the limits of the NPD Office's capabilities, and the potential for conflict at the NPD level, the NPD's role was limited to general performance overview and policy guidance. The PCU, under new and more forceful management from March 1990 through completion, was strengthened with specialists in charge of overall monitoring, individual sub-project coordination, and general administration (accounting, reporting and internal audits). The PCU's role was expanded to encompass all day-to-day management responsibilities, including approval of agency coordinators, consultants and purchase contracts, review of the bi-annual progress reports and action plans, preparation of disbursement requests, organization of audits, and liaison with the Bank. 28. Executing agency units suffered in the first three years from high management turnover at the highest levels of their respective ministries, particularly in the case of health and welfare, but to some extent also in justice and labor. The best performing units were those of MinEc, social security, labor and justice. A more active PCU supported executing units effectively in providing timely funding, reviewing performance and establishing action plans. 29. Participating external agencies were the United Nations Development Programme (UNDP) and the Pan American Health Organization (PAHO). UNDP performed a vital role, first in providing bridge financing to get the Project started, and later in processing consultant and purchasing equipment contracts which could not be handled by Argentineans because of potential litigation risks (which included the possibility of being accused even on flimsy evidence of misappropriation of public funds). PAHO performed a useful function in the initial stages: it hired health consultants, kept records and revised consultant reports for the PCU. International agencies, such as ILO/CIAT, PAHO, UNESCO and ILPES made mid-term and final external evaluations  7 of sub-projects in their respective areas. A UNICEF team prepared the MCHN investment project. 30. After a long teething period, Project accounting, reporting, field supervision, and overall monitoring eventually were carried out satisfactorily. Two computerized accounting and recordkeeping systems were introduced: one (database), to serve the internal needs of the PCU; the other (PARADOX), to transfer biannually relevant information to the Bank. Progress reports and action plans were prepared by the executing agencies, reviewed and approved by the PCU and sent to the Bank twice a year prior to the mid- and end-year supervision missions. Importantly, disbursements were authorized only on the basis of satisfactory progress reports and action plans. This strengthened compliance. 31. Auditing. Internal audits, by a private firm, were introduced in 1992 and helped improve PCU accounting and recordkeeping. The timing of external audits by the Tribunal de Cuentas de la Naci6n (TCN) improved through 1991: while the 1989 audit was not carried out until April 1991 with a one-year delay; and the 1990 audit was made in August 1991 with a four-month delay; the 1991 audit was completed on time by April 1992. However, the 1992 audit was delayed until September 1993 due to major changes in organization and management of public sector audits which included the elimination of the TCN and its replacement by a new entity, the Auditorfa General de la Naci6n (AGEN). The 1993 audit was delayed until August 1994 for similar reasons. AGEN has agreed to carry out the 1994 audit from November 1994 to March 1995. 32. All external audits were qualified: the auditors could not have access to UNDP or PAHO documentation with sufficient specificity to ascertain the sources and uses of funds. This matter, long discussed by the Bank and UNDP at the highest levels, was not satisfactorily resolved during implementation. B. Scope Project Mid-Term Restructuring 33. The Project was restructured as a result of close supervision in 1990/91 and the 1992 mid-term review, and focused on fewer, higher priority tasks. One important priority was to finish ongoing tasks of high potential impact. Developing enabling legislation for the labor and social security reforms are important examples. Others were completing justice's SAIJ; extending the introduction of INDEC's health and education basic statistics systems to 17 provinces; and operationalizing program budgeting. Tasks which were not related to practical results (mainly in education, partly in health) were terminated. The restructuring led to a transfer of several million dollars from health, education and social action to labor, justice, MinEc, social security, INDEC and the PCU. Within the health sub-project a major reorientation was carried out. It included funding tasks related to legislation freeing prices, and standardizing drug marketing, introducing the autonomous public hospital and supporting the enhancement of basic health-oriented manpower and management information. Two investment projects were prepared: the Maternal and Child Health and Nutrition (MCHN) project; and the  8 Decentralized Secondary Education Improvement project. Specific budget transfers among sub-projects and tasks, actual expenditures and balances are available in the Working Papers, Project file B on Performance, Addenda 1, 2 and 3. Total expenditures amounted to US$27.4 million or 98% of Loan funds. 34. Cutting down the size and scope of health sector activities was a major task. Originally, the health sub-project comprised 278 individual studies and activities under the responsibility of ill-prepared staff and management. Lack of clear prioritization and poor definition of tasks, together with focusing of attention on six-month work programs as opposed to final objectives, led to the indiscriminate hiring of consultants, procurement irregularities, poor coordination, and low quality of outputs during the first two years of implementation. Reference has been made to the education sub-project's major consolidation at the end of 1990, and its reorientation to support an investment operation. C. Timing The three-year implementation period calculated at appraisal was unrealistically short. It was out of line with the country's seven-year implementation profile, and under-estimated political, economic and institutional constraints prevailing at the time. Key aspects of the Project which required a longer implementation period are discussed below. Risks 35. Technical assistance operations are more difficult to carry out, monitor and evaluate than typical investment projects involving defined target populations, physical works and traditional (and unambiguous) monitoring and evaluation standards. Multi- purpose operations like the SSMTAL involve additional risks when compared to single- sector projects. Risks were increased by the experimental nature of the SSMTAL, which was the first comprehensive Government intervention (and the first project for the Bank) in the social sectors in Argentina. 36. Additionally, the SSMTAL faced serious obstacles which could not have been foreseen at the time of appraisal. The main unforeseen factors were: (a) the collapse of the Alfonsin administration six months before the end of its constitutional mandate, which disrupted execution and brought about a complete change in Government objectives and management; and (b) the high turnover of management staff, changes in agendas and overall lack of leadership, particularly in the NPD's office and in the MSAS. Project Documentation 37. Staff Appraisal Report and Working Papers. The staff appraisal report and related documentation, although somewhat imprecise in terms of operationalizing intended tasks, were generally adequate at the time they were written. However, much of it was quickly rendered obsolete by the macroeconomic and political changes which gripped Argentina during 1989.  9 38. Progress Reports, Action Plans and Supervision Reports. The timing and quality of progress reports were originally inadequate, but improved consistently. PCU recordkeeping also improved with the computerization of information. Supervision reports were timely, and in 1992 and 1993 accurately analyzed critical conditions and recommended remedial action. Bank budget constraints and the difficulty of sharing costs with other projects did not permit fielding the November 1993 supervision mission, but this did not affect implementation due to sustained review efforts. 39. Documentation Center. The PCU, with the help of documentation experts, established a documentation center containing approximately 3,000 substantive documents prepared by consultants for future reference. The documents are organized by secretariat, sub-project and topic. Abstracts were made of each document for easier reference. Lists of all these documents have been compiled, both in book form and in microfilm under the same classifications. By December 1994, one full set of written documents has been transferred to the Secretariat of the Presidency and another to MinEc's Secretariat of Economic Programming. At that time the recipient of the microfilm was determined. Project Relationships 40. Bank relations with MinEc's top management were very good. MinEc supported PCU and Bank efforts for improving objectives, scope and procedures. Relations with the Secretaria de la Presidencia were not good initially, but improved with the forced resignation of the official temporarily deputized by the NPD. 41. PCU relations with the executing agencies improved in spite of the latter's high management turnover and the difficulties associated with dealing with politically powerful line agency ministers. Good relations eventually enabled the SSMTAL to play a useful coordinating role for social sector agencies and MinEc. 42. The main credit for improving interagency relationships belonged to the PCU's coordinator and staff. They adroitly handled inherently difficult situations with executing agencies, including the NPD management crisis of 1991. 43. Importantly, the SSMTAL served as a catalyst to enlist the participation of national and international agencies involved with the social sectors. Argentinean private research groups carried out important analytical work, such as the di Tella Institute's original research on social sector expenditures. Reference has already been made (para 29) to the international agencies' participation. UNICEF's role was critical in organizing and managing the preparation (in record time and with a high quality product) of the MCHN investment project, which MSAS would have been unable to do at the time. Consulting Services 44. Role of Consultants. Consultants carried out practically all the substantive work. The regular staff of the executing agencies were not capable of providing the required expertise. Decades of continued deterioration in the quality of the civil service (due to  10 worsening recruitment standards, remuneration and other incentives, and virtually assured permanence in their jobs regardless of performance) precluded involving civil servants in a major executing role. An additional factor was that the few competent high level Administration appointees in the social sector agencies were overwhelmed by their normal workloads. The secretariats of social security, labor and finance (Hacienda) succeeded in involving line staff closely with consultants. The justice secretariat maintained its executing unit's staff in place in spite of changes of secretaries. This was a key factor in carrying out the SAU component. The numbers and distribution of consultants are available in the Working Papers, Project file B, Addendum 4. The Addendum reveals the large number of short-term consultancies (many on a monthly basis, the result of NPD's haphazard management practices) in 1989 and 1990, the slower pace of work while the Project was being restructured in 1991, and the pickup of activity in the final two and a half years of implementation. 45. Performance and Impact. The PCU was fully staffed by consultants. Its performance improved over time with a new, effective coordinator and the appointment of specialists and support staff. At its peak in 1993 the PCU had 6 full time sub-project coordinators and 8 administrative staff, as well as several part-time consultants. 46. Consultant performance and impact were uneven. The best performing consultants were those working on social security, labor, justice, MinEc and INDEC, which enjoyed strong leadership, clear objectives, and well defined work programs. Many of the worst performing consultants worked on health and welfare in 1989, 1990 and 1991. The education sub-project's consultant performance was mixed. High-quality consultants working on clearly defined tasks, such as those supporting secondary education, obtained good results. But much waste could have been avoided: poorly supervised, large numbers of consultants with vaguely defined terms of reference and action plans produced reports of dubious value which required canceling a number of components during the first two years of implementation. 47. Initial lack of standards, inadequacy of the original remuneration system, lack of compliance with the agreed new consultant remuneration system and high rates of inflation (accompanied by delayed fee adjustments) led to deteriorating consultant pay in real terms, low morale and lower quality of consultants in the first two years of implementation. 48. Consultant remuneration suffered while inflationary conditions continued unabated. The new remuneration system, designed in early 1990 by a UNDP consultant, was based on periodically updated market analyses of 14 key professional groupings and on equal shares of the Buenos Aires CPI and the US dollar exchange rate as measured by UNDP. However, the rules of the approved remuneration system were not respected by the NPD on several occasions: increases in the real value of fees resulting from exchange rate movements were countermanded, while the system's rules were applied when they led to lower real fees. The impact on quality of output in 1989, 1990 and 1991 cannot be measured, but may have been significant.  11 49. Other factors contributed to poor consultant performance. First, the massive contracting of individuals as opposed to consulting firms affected consistency, timing and quality of output. The problem was unavoidable in health and education due to the lack of reputable consulting firms. Individual consultants often worked on narrowly defined assignments and were not responsible for delivering complete products which could be better coordinated and assessed. Other negative factors were: during the first half of 1991, contracts were signed by the NPD for short (one to two months) time periods having no relationship with task requirements. This situation was resolved with the forced departure of the NPD; particularly during 1989 to 1991, hiring criteria were often unspecified; terms of reference (under the health and education sub-projects) often were not well defined; quality control was poor at the level of the executing agency (health, welfare and education) because the supervisors were not professionally equipped to provide adequate monitoring; consultants were not integrated with line staff in the health, social action, and education areas. 50. Lessons of Experience. The following actions strengthened the role of consultants in 1993 and 1994: (a) introducing criteria for elaborating terms of reference, hiring consultants and monitoring their work; (b) linking consultant payments to intermediate and final product quality, timing and acceptability; (c) having intermediate and final outputs reviewed by external consultants and agencies; (d) abiding by agreed pay scales related to cost of living indicators; and (e) in important cases, Bank review of consulting proposals and bids. The Japanese Grant 51. The Japanese Grant was approved on June 20, 1988 with the limited objectives of financing assistance to production cooperatives and self-help community centers. The Grant was inactive for almost three years due to the lack of the required Government signatures, difficult to obtain during the 1988/90 political crisis. At the request of the Bank, the Grant was amended on April 1, 1991 to better support the SSMTAL. It was finally approved by the Government in September 1991 and was signed the following December 19. The amended three-year Yen-denominated US$4.4 million grant (at August 1994 exchange rates) is providing support in critical areas which lacked alternative financing: (a) as an integral part of the SSMTAL, strengthening the decentralization of education (by financing the preparation of the secondary education investment project); and (b) promoting reforms for which Bank assistance was not readily available. These included, besides the original tasks of promoting the development of cooperatives in line with privatization efforts and self-help centers for minors, a review of litigation against the State and a training program for federal and provincial social agency managers. 52. Implementation began in earnest in April 1992. The closing date has been extended from December 31, 1994 to June 30, 1995. Disbursements quickly accelerated to US$2 million or one half of financing by mid-1993, US$3.2 million or 80% by the end of 1993 and to US$3.6 million by June 30, 1994. Expenditures have been made on consultancies (95%) and training.  12 C. Assessment of Project Impact 53. The SSMTAL's impact would be hard to exaggerate. It is likely to grow further in the medium term as newly designed policies and systems are implemented. A thorough performance evaluation in 3 to 5 years is essential to measure the full impact of the Project. A summary evaluation at the time of closing is given below. Reforms and institutional improvements undertaken were made possible because of the Government's positive political will to enact these new changes and reforms. Sub-projects Already Having Major Innpact 54. The social security sub-project has produced by far the largest impact. It provided the system (Law 4241/93, Decrees 1324/91 and 1831/93, and Resolutions 3 and 991/92 establishing a consolidated national administration, a single national labor registry, a registry of large and medium-size enterprises, an accounting system, a data bank of contributors and beneficiaries, and operational manuals) which resulted in increases in employers' pension contributions and family allowances, unemployment insurance and health insurance payments of almost 2.3 times, from US$4.8 billion to US$10.8 billion in real terms over the past three years. Analyses and administrative machinery set up under the SSMTAL permitted estimating (for the first time ever) the accumulated debt with pensioners and reducing the debt from US$11.8 billion to US$3 billion in three years, while enabling the system to make the right payments on time to pensioners and their beneficiaries. Most importantly, it designed and introduced a new pension regime which will comprise about one half of potential contributors (2.5 million out of 5.1 million) by the end of 1995 which provides for individual savings accounts, professional management of investments and self-liquidating results. This system replaces one which was producing annual operating deficits running into the billions of dollars. 55. The labor sub-project's impact is already exceeding expectations. The new labor law and supplementary legislation on collective bargaining and productivity are beginning to provide the bases for opening the labor markets, allowing competition, lowering production costs and introducing transparency and accountability in labor markets. The law introduces a system to measure unemployment, and enhances fixed-term and part- time employment, salary adjustments, uniform norms and procedures, and more flexible and less costly processes of hiring and firing employees. Under the law, 140,000 workers are benefiting from unemployment insurance, more than 100,000 benefit from intensive employment schemes, and thousands more are receiving short-duration, intensive training to qualify them for available jobs. More than 14,000 collective bargaining centers are replacing the 400-odd centralized and rigid salary-fixing centers which existed before the new legislation and which tended to increase salaries to the highest possible levels regardless of economic justification. 56. Similarly, the results of MinEc's social public expenditure sub-project are exceeding original expectations. The sub-project was initially conceived as a review of sources and uses of public funds for the social sectors. The review was the first  13 comprehensive analysis in Argentina of sources and uses of funds, and results in the social sectors, the first major effort at quantifying the distributional impact of public policies and programs, and the first attempt at measuring the equity and efficiency of programs and their budgetary aspects. The review's findings and recommendations were widely disseminated, and are already having an impact on public policy. More than 1,400 sets of reports were distributed to public and private agencies, and monthly seminars are still being conducted on these subjects by the consulting firm which carried out the studies. 57. MinEc's newly introduced program budgeting system is already showing major impact. The system, incorporated in the 1994 national budget, permits measuring input units and the production of goods and services, defining programs by objectives, identifying the executive unit responsible for each major task, establishes deadlines and performance indicators, and an economic classification of resources and expenditures. Program budgeting played a major role in helping decentralize national hospitals and secondary education in 1993. The system proved so successful for the social sectors that it has been extended to include the economic sectors, and the first five participating provinces. Sub-projects with Major Potential Impact 58. In the education sector, a good share of the analytical work carried out was incorporated as elements of the Decentralized Secondary Education Improvement project, which aims (together with a planned second stage) at strengthening decentralization, efficiency and quality of secondary schooling, all of which would have a major impact on the administration and financing of education services and, in the longer term, on the quality of the labor force. 59. Health Sector. The new system for liberalizing drug marketing, and controlling the quality of foods, drugs and medical equipment, is already having an impact in the marketplace, which should expand gradually in line with larger coverage. Resolution 47/93 introduced a new regime liberalizing drug prices, favoring the production of generic drugs and deregulating marketing. A new entity (the national administration of drugs, foodstuffs and medical technology, ANMAT) was established (Resolution 47/93), and now controls quality standards at 310 drug manufacturing plants. ANMAT is also beginning to control the quality of medical equipment and materials, such as fibrillators, respirators and contraceptives. Medical prescription practices are being reviewed, and food quality control schemes are being tried out in three provinces. 60. The impact of the promulgation of Decree 578 of April 1, 1993 introducing the autonomous public hospital (APH) will depend to a large extent on the degree of commitment of provincial health authorities. The impact will also depend on the adoption of legislation permitting hospitals to perform as autarkies, the most liberal legal regime for the organization, management and financing of entities with a public service purpose. In any event, this is likely to be a long process of changing not only legislation, but administrative structures and the attitude of participants. The expansion of programs for training family physicians and nurses could represent a major turning  14 point in orienting services towards health promotion and simple curative care, but again will depend on the speed with which present practices are modified, beginning with changed university curricula and funding practices. The MCHN project, and its already planned second phase, could serve as major instruments for enhancing equity and efficiency throughout the health sector. Analyses carried out as part of preparation of the first Greater Buenos Aires investment proposal are being used to improve targeting, develop health service networks, coordinate similar medical specialties and control costs in the city of Buenos Aires including the recently transferred national hospitals. 61. The justice sub-project developed a national, computerized legal information system which should standardize and consolidate the data base for litigation and legal administration. Its potential impact has been enhanced by the incorporation of the entire legal systems of the state (the Procuracion Nacional), representing 80 legal units and involving more than 1,800 lawyers. Further administrative support (perhaps transferring SAIJ administration to the Legislative Affairs Secretariat in the Ministry), and financial assistance to get started in a major way are necessary to produce the intended results nationwide. 62. INDEC's sub-project succeeded in introducing health and education performance indicators and questionnaires in the household surveys. It also designed and helped introduce basic statistical models for health and education in 17 of the 24 provinces. Its impact will depend entirely on the degree of commitment of provincial governments in carrying out the proposals and making use of them for policy and program administration. The impact will also depend on the degree of coordination reached among provincial health, and statistical services. Progress is likely to be uneven over the medium term until the new standards gain wide recognition. Sub-projects with Minimal Impact 63. The social action (welfare) sub-project was a failure. Several reorientations and changes in scope produced no important results because the Social Action Secretariat lacked a clear mandate and working program and also suffered from the highest management turnover of all executing agencies. The SSMTAL-based new National Council for Minors and the Family and analyses oriented to improving services for the aged have potential value, but they operate in a policy vacuum. The health coordination sub-project was superseded by measures which concentrated responsibilities in the Health Secretariat. 64. Inter-agency MIS efforts suffered from the lack of previous national standards, differing agency requirements and agenda and poor interagency cooperation. Improvement efforts never commanded the necessary priority. The interagency statistics and information committees did not work well. Impact in this area was minimal. These failed inter-agency efforts did not impact negatively on the separately developed MSAS and MinEd systems, which are meeting their goals.  15 Overall Impact 65. The Project's overall impact should be enhanced by: (a) the continuing increases in resources allocated to health, education and justice (the result of Government's national privatization and rationalization efforts); (b) the strengthening of inter-agency cooperation through seminars and discussions among project consultants, which established promising links; (c) the dissemination of published results and main products and their public discussion through seminars and workshops. Recipients of the above literature and participants in the discussions include the top layers of federal and provincial administrations, members of Congress, universities and research centers, and private firms (a list is in Working Papers, Project file F). These are helping increase awareness of key issues, both substantively and in the areas of transparency and accountability; and (d) the fact that many of the Project consultants are now in executive positions which enable them to execute plans and recommendations which they sponsored. 66. The Inter-American Development Bank (IDB) is planning to finance second stages of the SSMTAL-funded components dealing with employment in the northern (poorest) provinces, health promotion, labor and the administration of justice (estimated US$30 million allocated between two investments under processing). Financing is also being contemplated for follow-up implementation of the autonomous hospitals component. D. Project Sustainability 67. The continued reform thrust of the present Administration improves the likelihood of sustained actions in pursuit of the Project's goals. New laws, decrees, regulations and institutional arrangements are being used to reorient policies, enhance equity, increase financial solvency and improve resource use on a large scale and across a broad sectoral spectrum. Also, the SSMTAL is helping to raise awareness of the need for targeting, rationalization, transparency and accountability in the social sectors, a major improvement when compared with historical practices. Another long-term gain is the establishment of serious operational research as a permanent element of MinEc's contribution to social sector development. Implementing the health care and education investment projects will consolidate SSMTAL-originated policy and institutional reforms at the provincial and municipal levels. 68. The IDB will finance follow-up stages of the justice, health and labor sub-projects with an estimated US$30 million allocated under two projects which are being processed. E. Bank Performance 69. Major Strengths and Weaknesses. The Bank proved useful in helping turn general goals into specific programs and actions. The Bank's selective interventions were critical in defining the need, objectives and scope of the Project (Appendix 6, Addenda 1,  16 2 and 3); and subsequently, in improving project performance. Previous Bank social sector analyses (Social Sectors in Crisis ', and the Population, Health and Nutrition Review 2 in 1987) provided the initial analyses, and the justification, for the SSMTAL. 70. Bank supervision helped preserve the Project, and reorient and restructure individual sub-projects. During the second half of 1989, the Bank assumed operational responsibilities to get the Project started in spite of great political and legal uncertainties which weakened local managers' ability to function. At that time, the Bank helped preserve the health, social security and labor projects, which were going to be eliminated by the respective ministers. 71. The Bank helped focus the Project. Bank initiatives supported by the PCU helped introduce new components, as follows: labor (collective bargaining, and linking salaries to productivity); justice (a major expansion of the scope of the SAIJ sub-project); INDEC (introduction of statistical systems in the provinces); and public social expenditure (program budgeting). 72. The Bank also helped: (a) solve organization and management problems at the levels of the NPD and the PCU; (b) introduce investment project preparation as a legitimate project objective; and (c) establish adequate procedures (partly by helping identify and overcome irregularities in hiring consultants for the health sub-project). 73. The Bank's commitment to the Project included: (a) providing task management and supervision staff continuity beginning in 1990; and (b) allocating substantial implementation resources to help overcome major problems and to restructure the Project. The 38 sw allocated in FY90 were increased to 53 sw in FY91; and subsequently declined to a still substantial 36 sw in FY92 before falling to 16 sw in FY93 and 10 sw in FY94. Bank staff played a major role in restructuring the Japanese Grant and encouraging the Government to sign it. F. Borrower Performance 74. Borrower performance continuously improved under the present Administration with the appointment of strong top managers in all executing agencies. A strengthened PCU endowed with expanded powers was another important factor in improving performance. Coordination with the implementing agencies improved as a result of the appointment of capable executing agency staff with clear mandates. Better defined and enforced procedures also helped improve results. 1. Social Sectors in Crisis - Argentina, a World Bank (green cover) sector report, Report No. 6900, July 1987. 2. Population, health and nutrition sector review - Argentina, gray cover report, Report No. 6555, October 1987.  17 75. Major weaknesses were: (a) initially, at the macro level, an unstable, and inadequately staffed and motivated civil service; and (b) at the Project level, the difficulty of controlling the quality of a large number of outputs, and limited availability of the required expertise on a timely basis. G. Summary of Lessons Learned 76. By the Bank. In the future, the Bank should focus on a few, well-defined goals and tasks. This is particularly important for technical assistance, which is more difficult to control and evaluate. Government's needs and commitment, as well as macroeconomic and political constraints, should be assessed to determine the probability of success. A more gradual pace of reform might be advisable for the more radical reform proposals. Limiting the number of participating agencies is essential. The availability of experts should be ascertained before embarking on reforms of less traditional sectors, such as justice, labor, and management information. Ensuring closer monitoring of consultants by the PCU, tighter TORs, and so on would also be important. The mid-term evaluation was critical in restructuring the Project and in enhancing its impact. 77. By the Borrower. The needs are: simplifying objectives, activities and institutional arrangements; defining a critical path and closely monitoring its execution; ascertaining that conditions are favorable for providing greater continuity in leadership and administration; and ensuring that the required expertise will be available. 78. As mentioned above, lessons of experience should not detract from the merit of Govemment's and the Bank's decision-makers when the circumstances prevailing at the time of preparation and appraisal are taken into account. Those circumstances justified to a large extent the more ambitious original course of action for this project, and provided the framework for major reform under an Administration more favorably disposed to achieving its goals.   18 PART H: STATISTICAL TABLES 1. Summary of Assessments Table IA: Assessments Through Time Rating FY90 FY91 FY92 FY93 FY94 Overall Status 3 2 1 1 1 Project Objectives 3 2 1 1 1 Compliance with Covenants 2 1 1 1 1 Management Performance 3 2 2 1 1 Availability of Funds 3 2 1 1 1 Procurement Progress 3 2 1 1 1 Training Progress 3 2 2 1 1 T. A. Progress 2 2 1 1 1 Studies Progress 3 1 1 1 1 Table 1B: Consolidated Assessments A. Achievement of Objectives Macro policies substantial Sector policies substantial Financial objectives substantial Institutional development partial Physical objectives n.a. Poverty reduction n.a. Gender issues n.a. Other social objectives substantial Environmental objectives n.a. Public sector management substantial Private sector development : substantial B. Project Sustainability : likely C. Bank Performance Identification : satisfactory Preparation assistance : highly satisfactory Appraisal : satisfactory Supervision : highly satisfactory D. Borrower Performance Preparation : deficient Implementation : highly satisfactory after poor initially Covenant compliance : highly satisfactory Operations : highly satisfactory E. Assessment of outcome : highly satisfactory  19 Table 2: Related Bank Loans 79. The SSMTAL was the first Bank loan to the Argentinean social sectors. Other reform- oriented Bank loans approved since February 1991 are the: (a) Public Sector Management TAL (Loan 2712), completed; (b) Municipal Development (Loan 2920); (c) Provincial Development (Loan 3280); and (d) Public Sector Reform (Loans 3362 and 3394). These projects supported economic stabilization, public sector institutional reform, reduction of public sector deficits, privatization, improved public sector management, transfer of functions and financing to the provinces, and strengthened provincial and municipal administration. In FY94, the Maternal and Child Health and Nutrition project (Loan 3643-AR) became effective and started being implemented; and the Decentralized Secondary Education Improvement project was presented to the Board in September 1994. Table 3: Project Timetable Steps in Project Cycle Date Planned Actual Date Identification April 1987 April 1987 Preparation October 1987 October 1987 Appraisal April 1988 April 1988 Negotiations May 1988 May 1988 Board Presentation July 1988 July 1988 Signing August 1988 February 1989 Effectiveness September 1988 May 1989 Mid-term Review May 1992 Project Completion December 1991 May 1994 Loan Closing June 1992 June 1994 Table 4: Loan Disbursements: Cumulative Estimated and Actual (UJS$ million) FY 89 90 91 92 93 94 95 Appraisal Estimate 8.5 17.9 25.5 28.0 |_I_T_ Actual 2.9 5.5 12.5 15.0 22.0 26.9 27.4 Actual as % of estimate 34 31 49 1 54 1 79 96 98 Date of final disbursement: July 19, 1994.  20 Table 5: Key Indicators for Project Implementation Indicator Discussed Accomplished OVERALL MANAGEMENT Delegation of powers to PCU Sept. 88 Full delegation Oct. 91 Jul.-Dec. 90 l Nat. Proj. Dir. Jul.-Dec. 90 Single line command Jan. 91 PCU strengthening Jul. 89-Dec. 90 Continuous improvement Sept. 89 to completion CONSULTANTS Task-based hiring Jul. 90-june 91 Eventually carried out all sub-projects (health delays) Preference to firms/groups Jul.-Dec. 89 As above, also education delayed Fair Compensation April 89 UNDP system worked from early 91 July-Dec. 90 with Peso/US$ parity Integration with line staff Dec. 90 Espec. success. labor, soc. security, justice, MinEc. Follow Bank Procedures Dec. 90 MSAS irregularities fixed June 91 PROJECT SCOPE/PROCEDURES Project restructuring May 92 Consol. educ Sept. 90; health Dec. 90; MIS Dec. 91-General restruc. mid 92 Loan amendment providing financing of July 91 investment operations Japanese Grant April 89 Reformulation and signing in Dec. 91 Disbursements July-Dec. 90 NPD capricious cuts corrected Dec. 90 Accounting Jul. 89-Dec. 90 Database and Paradox operat. Jan. 91 Progress Reports/Action Plans Dec. 89 Formats agreed Dec. 89 Single report Bank/UNDP July 90 Audits Dec. 89 1989 audit by April 91 1990 audit by Aug. 91 1991 audit by April 92 1992 audit by Sept. 93 1993 audit by Aug. 94  21 Table 6: Key Indicators for Project Operations Indicator Estimated Actual 1. Health develop targeting, financing, Pres. Dec. (user choice ins) signed; auton. manpower, accreditation, hosp., drugs food qual. contr. legisl. enacted hosp. manag. and MIS plans and operational targeting and MIS failures 2. Coordination improve MSAS org., man. unsuccessful l _______________ develop 3. Human develop support systems for establ. of Tribunal for Minors and related Development minors, the aged legislat.; dev. support systems transferred under Japanese Grant 4. Education develop decentr. structure subst. contrib. through Second. Educ. inv. and operational standards project 5. Social increase revenues 22% increase April 91 to July 94 Security rationalize benefit adm. major improvement develop pension alternatives new nat. pension regime designed, approved, operational 6. Labor support employment new nat. empl. law; collective bargaining and creation productivity legal structures 7. Justice national legal info. system hardware/software purch. for operationalization 1994/95 8. INDEC develop health, educ. system developed at nat. level and introduced statistics in 17 provinces 9. Public study on sources and uses of study successfully completed Social funds Expenditure new program budgeting for social and economic sector development operationalized Note: Project restructuring in mid-1992 makes comparisons with original indicators less relevant Table 7: Studies Included in Project The Project consisted of studies and analytical pieces.  22 Table 8A: Project Costs Appraisal Estimate Actual (USS$ million) Local Foreign Total Local Foreign Total TOTAL 31.4 9.9 41.3 34.4 3.3 37.7 Table 8B: Project Financing Appraisal Estimate Actual (US$million) Local Foreign Total Local Foreign Total LBRD 18.1 9.9 28.0 24.1 3.3 27.4 Government 13.3 - 13.3 10.3 - 10.3 TOTAL 31.4 9.9 41.3 34.4 3.3 37.7 Note: Government's expected contribution of US$10 million equivalent in work provided by line staff and support services could not be quantified, but was substantial. Table 9: Economic Costs and Benefits n.a.  23 Table 10: Status of Legal Covenants Loan Condition Loan Document Compliance Date Signing - Presidential Decree authorizing Loan 7.01 February 1989 signing Effectiveness - Borrower shall enter into management 6.01, a) January 1989 service contracts - PCU established and staffed 6.01, b); 3.05, a) January 1989 - Action to permit procurement according 6.01, c) January 1989 to Bank guidelines - execution units established and staffed 3.07, a), b); 6.01, d) January 1989 - Establish roles and relations between 6.01, e) January 1989 PCU and executing agencies - Man. serv. contracts authorized 6.02, a) January 1989 - Separate accounting, reporting and 4.01, a), b), c) January/March 1989 auditing arrangements -PCU's functions, management 3.01, b), c) January 1989 -Arrangements with contracting and 3.02, a), b) February/ March 1989 procurement agent Other - Staffing and contracting conditions 3.09 b), c) March 1989 - Progress reporting arrangements 3.06 a), b) October 1989 - Annual action plans 3.03 October 1989 - Bank review of studies, TOR, final 3.04 a) March/April 1989 docs., implementation Schedule 1, Para. 4 December 1991 - Inter-sectoral committees establ.; their 3.08 September/October 1989 composition and functions agreed  24 Table 11: Compliance with Operational Manual Statements n.a. Table 12: Bank Resources: Staff Inputs (SW, Actual) Stage Total FY 87 88 89 90 91 92 93 94 95 Preparation 3.8 89.8 93.6 Appraisal 11.0 11.0 Negotiations 3.0 5.5 = = =_== =_ 8.5 Supervision 45.2 38.4 52.9 36.0 25.0 10.0 8.0 206.5 Midterm 12.0 12.0 Review TOTAL _ 331.9  25 Table 13: Bank Resources: Missions Stage of Project Month/ No. of Persons and S/W in Perf. Type of year Specialty * field * Rating problem Status ID/Preparation 5/87 2 (MS) 3 Preappraisal 11/87 14 35 Appraisal 4/88 7 (E,F.HS,E.M.O) 6 Post-Appraisal 5/88 4 (E,H,2 0) Subtotal 44 Supervisions I 9/88 8 (F,H,30,ES,L) 14 3 L II 4/89 4 (F,E,M,00 4 2 L III 6/89 7 (F,H,ES,M,2 0,W) 21 2 FMTLP IV 11/89 5 (F,H,ES,M, 10 0) 10 3 FMT V 6/90 7 (F,E,H,ES,M, 2 0) 21 3 FMT VI 10/90 2 (F,H) 6 3 FMTL VII 11/90 6 (F,E,H,ES, L,0) 18 3 FMTL VIII 7/91 5 (F,H,ES,M,0) 8 3 MT IX 12/91 4 (F,H,ES,M,0) 8 2 T X 6/92 4 (F,H,M,O) 4 1 XI 11/92 4 (F,H,M,O) 4 1 XII 6/93 3 (F,H,M) 3 1 Subtotal 121 (196 sw total) Midterm 2-3/92 6 Evaluation Total 127 Implementation * E= economist; P= planner; F= financial analyst; H= health specialist; W= welfare specialist; ES= education specialist; M= management specialist; O= operations; L= legal ** 1= problem-free or minor problems; 2 = moderate problems; 3= major problems *** 1= improving; 2= stationary; 3= deteriorating  APPENDIX 1 26 PROGRAMA NACIONAL DE ASISTENCIA TECNICA - PARA LA ADMINISTRACION DE LOS SERVICIOS SOCIALES EN LA ARGENTINA BIRF 2984 - AR PNUD ARG / 88 / 005 Tte. Gral. J. 0. PERON 315 - p. 1l Tel. 334 3864/ 3825 / 38S 1394 Buenos Aires - Argentina Fax 334- 3869 ARGENTINA PROGRAMA DE ASISTENCIA TECNICA A LOS SECTORES SOCIALES Pr6stamo 2984 - AR, PNUD 88/005 Misi6n de Supervisi6n - Evaluaci6n final-del 29 de agosto al 9 de Septiembre La mision del Sefior Jos6 Andreu cumpli6 a plena satisfacci6n sus trabajos y agradece la cooperaci6n prestada por la Unidad de Coordinaci6n y los sectores participantes. La misi6n sostuvo reuniones con los LMinistros, Secretarios de Estado, coordinadores y personal de las unidades de ejecuci6n de los subproyectos. Asimismo la mision se entrevist6 con representantes de la Auditoria General de la Naci6n, particip6 de la Reuni6n Tripartita -Cancilleria, PNUD y UCP-, y tuvo una reuni6n final con el Subsecretario General de la Presidencia en representaci6n del Secretario General y Director Nacional del PRONATASS. EJECUCION DESDE EL 1 DE JULIO DE 1993 HASTA EL 30 DE JUNIO DE 1 9 9 4 La misi6n constat6 la exitosa terminaci6n de los subproyectos de Salud, Seguridad Social, Educaci6n, Trabajo y Mlinisterio de Economia. Quedaron con tareas pendientes los subproyectos de INDEC Y SAIJ debido al corte prematuro del Prestamo, cuyos deseinbolsos se terminaron seis meses antes de lo previsto. No tuvieron los resultados esperados los proyectos de Acci6n Social y Coordinaci6n y Administraci6n del Mlinisterio de Salud. La MHisi6n constat6 que, afortunadamente, el seguimiento de varios de los componentes del subproyecto de Salud -Hospitales de autogesti6n, recursos humanos y sistemas de informaci6n- serA financiado con prestamos y donaciones del Banco Interamericano de Desarrollo.  27 PROGRAMA NACIONAL OE ASISTENCIA TECNICA PARA LA ADMINISTRACION DE LOS SERVICIOS SOCIALES EN LA ARGENTINA 6IRF 2984 - AR PNUO ARG / 88 / 005 Tte. Gral. J. 0. PERON 315 - p. t' Tel. 334 -3864/ 38E5 3868 1394 Buenos Aires - Argentina Fax 334 - 3869 EVALUACION DE SUBPROYECTOS La mision discuti6 en detalle los informes finales de evaluacion interna y externa de todos los subproyectos. Las evaluaciones externas fuero n realizadas por agencias especializadas del PNUD y por expertos internacionales individuales . ESTADOS FINANCIEROS DEL PROYECTO Del total de USS 28 inillones del Pr6stamo, qued6 Lin saldo no ejecutado de USS 570,000 que representa el 2%. Los estados financieros correspondientes apareceran en el Ap6ndice 5 del informe de evaluaci6n final del Banco. AUDITORIA Se recibi6 el informe de auditoria exterria de la Auditoria General de la Nacion correspondiente al anio 199.3, donde se constat6 la positiva aplicacion de procedimientos por parte de la UCP como en anos anteriores. La AGEN acord6 llevar a cabo la auditoria de 1994 en Noviembre/Diciembre de este aho. INFORmIE FINAL DE EVALUACION La misi6n se comprometi6 a terminar stu informe de evaluaci6n antes de fines de setiembre. El informe, previa disc.tsio6r en el Barico, sera enviado al Gobierno para SUS comentarios. El Gobierno a sti vez hara SU propia evaluaci6n final del proyecto a inas tardar a mediados de Octubre.  28 PROGRAMA NACIONAL OE ASISTENCIA TECNICA PARA LA ADMINISTRACION DE LOS SERVICIOS SOCIALES EN LA ARGENTINA BIFF 2984 - AS PNUO ARG / 88 I 005 Tte. Gral. J. 0. PERON 315 - p il Tel. 334 - 3864 / 3865 / 3868 1394 Buenos Aires - Argentina Fax 334 - 3869 CIERRE DE LA UCP La UCP transferira sut documentaci6n y equipamniento a la Secretaria General de la Presidencia de la Naci6n en Diciembre de este ano. El Banco 'Mundial aprueba para realizar las tareas contables de cierre, en mantener durante el mes de febrero de 1995 a la contadora del PRONATASS y a la asistente contable para poder concluir las tareas de auditoria y cierre final del pr-oyecto en el PNUD y la Subsecretaria de Admninistraci6n de la Secretaria General de la Presidencia. Ana Ja--Eiam.llo Jose' Andreu Coordina ora Jefe ,ie MHisi6n PRONATASS Banco Mundial Buenos Aires, 9 de Setiembre de 1994   29 Appendix 2 BORROWER'S REPORT (Translated from Spanish) 1. ORIGIN The PRONATASS has its origin in 1985, as a result of a World Bank mission headed by Kutlay Ebiri who hired three Argentinean consultants: Hector Dieguez, Atilio Elizagaray and Ana Jaramillo. The mission produced a diagnosis which was published in the Bank under the title, "Argentina: Social Sectors in Crisis". The results of the diagnosis basically deternined the inefficiency of the public social expenditure, the poor quality of the services, and the lack of equity in accessing them. 2. PROJECT DESIGN Work began in 1987 with a PPF to design an inter-sectoral project addressing the afore-mentioned problems brought out by the diagnosis. Said project was financed by a US$28 million Bank loan for five ministries and nine secretariats. Project coordination was headed by Atilio Elizagaray who carried out the design and the institutional organization of the early executing units, such as the agreements with UNDP and some specialized agencies. 3. THE LOAN The Loan was declared effective in 1989 a year and a half after it was designed and negotiated. It financed technical assistance, including training and equipment. The possibility of financing the design of investment projects for social areas was incorporated through amendments to the loan document in later years. 4. THE CONTEXT The political context was not the most beneficial for the project since, in the same year it was declared effective, there was a change of government due to President Alfonsin's resignation. As a consequence, this unexpected situation produced a period of political-institutional indecisions which prevented the prompt execution of the project. On March 1990, the Menem Govermnent proposed changes to the PRONATASS by placing Ana Jaramillo, who had participated in project preparation, in charge of coordination. Atilio Elizagaray was kept as sub-coordinator with the intention of maintaining as much as possible, continuity in project execution.  30 5. THE ECONOMIC AND SOCIAL REFORM In that first year, political measures were adopted aiming to produce a fundamental economic reform, such as the re-definitions and guidelines to make the Public Social Expenditure more effective. Among the most important political measures and guidelines that were defined are: the federalization of the public social expenditure, the administrative decentralization of the social sectors, the creation of systems of social benefits with participation from the private sector and the non-governmental organizations, the elimination of hidden subsidies to the higher income groups, the quantitative and qualitative restructuring of the social ministries in accordance with their new roles, the professional training of personnel and those in leading posts in the Government, and the prioritization of social investment reflected in the allocation of resources. Such measures aimed to resolve the problems of lack of equity, inefficiency, poor quality of social services, and the obsolescence of human, physical and administrative resources after decades of disinvestment. These guidelines in social policy, among other measures of structural adjustment such as deregulation, administrative decentralization, privatization, the elimination of fiscal deficit, the reduction of public expenditure and the Convertibility Plan, would complement a model of economic reforms that could free the country from its stagnation. 6. THE REFORMULATION OF PRONATASS The original design of PRONATASS was very ambitious not only with regard to the number of executing agencies (five ministries and nine secretariats) and the number of sub-projects, which reached 42, but also to finance the establishment of the administrative units needed to be able to implement the sub-projects. Since the assumption of the new coordinating unit and from 1991, the project were restructured in the important aspects of organization and management, including total delegation of its decision-making to the Project Coordinating Unit (PCU) in order to facilitate contracting and daily duties. It could be said that only from that moment on the project began to move rapidly. 7. THE COUNTERPART Another difficulty faced by the project was the absence in the country of a federal agency which could have had, among its assignments and functions, the coordination of social policy. Thus, the National Project Director never had among its duties or assignments, the specific task of PRONATASS. It started under the direction of the Secretary of Economy, later on the Secretary of Economic Coordination, followed by the Secretary of External Financing, then the Secretary of Finance, and finally, under the direction of the Secretary General of the Presidency. This situation reflected a lack of central support or interest at the central governmental level, with the sectoral ministries remaining as the real counterparts although fragmented by the interests of each of the sub-projects in their respective areas, thus reducing the inter-sectoral impact it could have had. Such absence was corrected only in part by the multisectoral team formed in the PCU consisted of all the coordinators proposed by the different Secretaries of the State.  31 8. PROGRAM COMPONENTS Finally, the following Ministries and Secretariats remained in the Program [Project], including those financed later on by a Japanese Grant: 1. Ministry of Economy, Public Works and Services 1.1 Secretariat of Economy 1.2 Secretariat of Finance 1.3 Secretariat of Programming (INDEC) 1.4 Secretariat of International Affairs (INAC) 2. Ministry of Justice 2.1 Secretariat of Justice 3. Ministry of Culture and Education 3.1 Secretariat of Education 4. Ministry of Labor and Social Security 4.1 Secretariat of Labor 4.2 Secretariat of Social Security 5. Ministry of Health and Social Action 5.1 Secretariat of Health 5.2 Secretariat of Social Action 5.3 Secretariat of Health Administration 5.4 Secretariat of Technical Cooperation 9. MANAGEMENT CRITERIA 1. Every six months, the Secretariats had to submit their plans of action, ratified by the Secretaries and approved by the PCU and the Bank, where the terms of reference, equipment contracting, trips and per diems were programmed. 2. Any expenditure or contract request had to be signed by the Secretary and approved by the PCU. 3. Contracting of head consultants and coordinators had to be approved by the Bank. 4. Payments were made against a final report approved by the Secretary and the PCU. 5. The Bank carried out supervision missions every six months. 6. The Comptroller's Office (Tribunal de Cuentas) audited the annual accounts as external auditor approved by the Bank. This is an essential procedure to initiate the disbursements.  32 7. Disbursements were made directly from the Bank to the UNDP. 8. The UNDP assumed the responsibility of signing contracts, paying purchase orders, trips and per diems. At the same time, it carried out the annual auditing through an independent auditor. 9. The Ministry of Foreign Affairs must request all contracts from the UNDP, since it is the latter's legal counterpart. 10. The PCU performs all administrative tasks and technical monitoring, such as: - Budget execution - Disbursements - Accounting - Dealing with audits - Payment of fees - Trips and per diems (requests and accountability) - Contracting (monitoring, approval and awarding) - Price comparisons - Public bids - Purchases - Publishing - Important technical monitoring of all program products and reports - Internal auditing 10. DIFFICULTIES Throughout the five years under the present coordination, there were several difficulties that were overcome and could serve as lessons for the future: 1. When documents were signed by the Secretary of Economy and the General Coordinator, the slowness in signing the contracts resulted in significant delay in administration and control, and it also created serious difficulties in terms of execution time. This was overcome by delegating the signing. 2. The UNDP, which administered a great number of projects, quite often experienced lengthy delays in administration, which were overcome to a certain degree, by establishing fast communication mechanisms and standard information systems. 3. Making disbursements directly to the UNDP prevented the Comptroller's Office from getting the original documents on the origin of the funds, resulting in the latter's abstention from making the audit report. This could be resolved by making the disbursements to a special account in the Banco Nacion or the Central Bank. It was difficult to use this mechanism during the initial period of PRONATASS, but it could be used now. Due  33 to this difficulty, the Comptroller's Office was performing essentially an operational auditing, abstaining to report on the origin of the funds. 4. The continuous changes of the political-institutional authorities throughout the Program complicated the normal development of the Program, and produced delays until the new authorities became acquainted with the Project. The political-institutional instability is shown by the fact that during that period, six Ministers, seven Labor Secretaries and seven Social Security Secretaries were changed. The Secretariat of Justice became a Ministry, and seven Secretaries/Ministers and seven Undersecretaries/Secretaries were changed. There were three Directors of INDEC, five Ministers and six Secretaries of Education, nine Ministers and nine Secretaries of Health and 11 Secretaries of Social Action. There were also seven Ministers of Economy. 5. However, the inter-sectoral feature of the Program, so rich and productive in the area of social policies, complicated its execution and administration. It required great flexibility on the part of coordination, as well as a clear technical and political authority in order to be able to maintain simultaneous and continuous relations with other authorities. 6. The delimitation of responsibilities and attributes were not clear at the beginning, which created management difficulties. It was possible to overcome such delimitation and criteria on attributes and organizational functiones. 7. The technical monitoring of such diverse objectives was very difficult without a team of high level generalist and sectoral specialists. Such team did not exist at the beginning, but it was established in 1990, thus making it possible to carry out sectoral and inter-sectoral coordination tasks. 8. The nonexistence of private consulting firms dedicated to social policies made it necessary to contract individual consultants in most of the sub- projects carried out by the Ministries. This situation resulted in very few bids being called for competitive bidding; but as a by-product, professional teams were formed during project execution and many of them became consulting firms. 9. The nonexistence of a political-institutional counterpart such as a Social Planning Secretariat or an Advisory Board on Social Policies made it difficult to transfer to the Government a PRONATASS acting as an inter- sectoral program with all its experiences in inter-sectoral social policies.  34 11. PRINCIPAL PRODUCTS BY SECRETARIAT AND PROJECTS SOCIAL ACTION: I) Children and family protection: restructuring of the institutional treatment system and training in new techniques; establishment of a demonstrative project of new rehabilitation policies; administrative restructuring of the CNPMF. II) Strengthening of youth groups: agreements with provinces to promote youth micro undertakings; organization of Training Workshops for young people involved in micro undertakings in the provinces. III) Social investment fund: preparation of a FIS project; survey of available financing sources for social promotion projects. IV) Executing Unit of the Federal Solidarity Program (PROSOL): creation of the Executing Unit; preparation of guidelines for the organization of projects, and training programs for the implementation of productive projects. EDUCATION: Participation in the evaluation of projects for the refonn of the Federal Education Law; studies to support the Federal Education Law; studies to support the redefinition of the structure and function of the Ministry; preparation of diagnosis and forecasts for the educational infrastructure; studies on Evaluation for the Improvement of the University Quality; preparation on improvement and evaluation of quality in education; work on improvement and updating of teaching; studies on modernization of technical education. FINANCE: Preparation of manuals on physical and financial budget methodology for Government agencies and National Universities; preparation of a manual on rules and procedures for the physical and financial programming of the budget execution process; design and methodology to complete the consolidated budget of the Non- financial Public Sector; training courses for Government officials on budget formulation and execution; participation in drafting laws and in the transfer of educational, hospital and social action services to the provinces and to the Municipality of Buenos Aires. SOCIAL SECURITY: System of nominative contributions, optimization of social security collection and updating of assets database; optimization of the Social Security Collection Databank; system to initialize and follow-up judicial trials, inspection of large companies and control and follow-up of collections; unification and generalization of the beneficiary grant system; diagnosis of the social security system in effect until 1993; comparative analysis of social security systems; design of a new social security system; draft of the social security law; design of the entity for the supervision of private companies incorporated into the new social security system. LABOR: Support and advice on the preparation of the national employment law and regulatory decrees; development of statistical information to define employment policies; proposal for the organization of the national temporary employment program; technical assistance for the identification and clearing process of non- registered employment; technical assistance for the definition and implementation of a new collective bargaining policy; advisory services in the preparation of legal norms and rules and regulations on collective bargaining; definition of a framework methodology to measure productivity and for the preparation of contracts linking productivity and salaries.  35 INDEC: Securing a roadmap on the supply and demand of statistical information by sector; preparation of a set of systemic proposals to establish firm bases for the installation of a Statistical System, federal in scope; formalization of rights and obligations through agreements entered into between INDEC, the national sector ministries and the provinces; innovation and transfer of techno-methodology resulting from the organization of a systematically integral "product" delivered to the provinces (procedures, data collection processes, standards, networks, documentation, application software, equipment, installation, training and legal framework). SAIJ: Updating of information technology: equipment and software were replaced, and complementary equipment was incorporated for the Direct Information Centers, equipment and software were acquired for the network of information suppliers; updating of documentary technology; expansion of services; internal restructuring; development of suppliers network. HEALTH: Technical assistance for the hospital decentralization process; preparation of a National Health Promotion and Protection Program; development of the Municipal Investment Project and identification of the Greater Buenos Aires Investment Project; institutional-functional design of the nation's Health Secretariat; design of alternative models for Management and Control System of the Health Secretariat; creation of the National Quality Guarantee Program on medical attention; information system organization for the technical area of the Health Secretariat; design and implementation of the National Administration of Drugs, Foodstuff and Medical Technology; creation of the National Pharmaceutical Monitoring System; strengthening of the management capacity of the Health Secretariat's Human Resources Directorate; technical assistance for the development of common actions with the Association of Medical Science Faculties of Argentina; design of the Maternal, Child Health and Nutrition project. 12. UNEXPECTED PRODUCTS The Program did not foresee many of the products it succeeded to achieve. Three of them which must be singled out, relate to technology transfer, which is nonexistent in the country in the inter-sectoral field of social policies. 1. The course on Training in Planning and Management of Social Policies financed by a Japanese Grant which supported the Program, where PRONATASS experience was useful. The first course relied on the participation of the Government and the University of Buenos Aires, and was attended by students from the provinces during one year, succeeding in training highly qualified human resources. This career was later established and incorporated into the Social Sciences Faculty of the University of Buenos Aires, which will produce more graduates. 2. The incorporation into PRONATASS of individual experts, added to the professionalization of the political posts as part of the government policy. Many former consultants are now Secretaries and National Directors in several government areas, as well as officials with very high political responsibilities.  36 In turn, the experts working as part of a team have become individual consultants or joined finns, which previously was non-existent in the social areas. 3. Another outcome is the establishment of the First Documentation Center with more than four thousand reports on all social policy subjects. Said Center is consulted by numerous institutional and individual users in the Government, academic institutions, universities, students, experts, consultants and by authorities from all the provinces. Said Center will be transferred to the Presidency of the Nation, and to the Documentation Center of the Ministry of Economy. 13. DIFFUSION Given the characteristics of the Technical Assistance Program for the policy on diffusion, the PCU defined the following criteria: 1. Carried out only institutional technical diffusion policy, leaving the political diffusion to the political-institutional authorities who executed the projects. 2. Produced two types of publications: a) Publication of reports with substantive content which the political authority considered important for its area. b) News bulletins on project progress. 3. Qualified diffusion: Due to the program characteristics, diffusion was not supposed to be massive, but available to qualified addressees [audience]. It was directed to all authorities in the Executive and Legislative branches with competence in the social areas, all universities in the country devoted to social sciences, church authorities, international organizations, non-profit organizations devoted to social policies, and periodical publications specialized in social subjects. 4. Creation of a Documentation Center. More than 4,000 reports submitted by consultants have been systematized and organized in the Documentation Center which is consulted by researchers, legislators and interested authorities. Said Center will be transferred to the Government at the closing of PRONATASS. The following is being enclosed: - List of publications - Three publications containing the list of reports - Bulletins with monthly news - Mailing to addressees  37 5. List of Publications: COORDINATION UNIT: - Social Planning. - Reports, Diagnosis, Proposals and Projects on Social Reform. Vol. I, II and III. - Age minority in Argentina. - Minors in Danger - Pilot Project. - Planning and Management of Social Policies. Postgraduate career. MINISTRY OF LABOR AND SOCIAL SECURITY SECRETARIAT OF SOCIAL SECURITY - Diagnosis of the Program on Family Allowances. - National System of Social Security: its Evolution and Situation at the End of the 80s. - Social Security System of Independent Workers. - Inequities in the existing National System of Social Security. - Distribution Mechanisms of ANSSAL. - Origin and Treatment of the SNPS Debts with the Beneficiaries: 1980/1993. - Social Security Coverage for Rural Workers. - Analysis of the Labor Market and its Future Projection. SECRETARIAT OF LABOR - Diagnosis of Unemployment and Seasonal Work in Argentina. - Recommendations on Employment Policies. - Structure of Unions and Collective Bargaining in Argentina. - Internal Differentiation of Wage Earners in Greater Buenos Aires. - Poverty: Social and Employment Policies. MINISTRY OF ECONOMY SECRETARIAT OF ECONOMY - The Public Social Expenditure: Vol. I and II. - Education Sector: Vol. III. - Education Sector (Annexes): Vol. III A. - Health Sector: Vol. IV. - Nutrition and Social Promotion Sector: Vol. V. - Housing Sector: Vol. VI. - The Practice of Cooperating. Manual for Labor Cooperatives. - Labor Cooperatives: Some Elements for their Analysis. SECRETARIAT OF FINANCE - Manual of Rules for Government Budget Formulation for 1993. NATIONAL INSTITUTE OF STATISTICS AND CENSUS (INDEC) - Education Statistics - Result Series No. 1. - General System for the Processing of Information from the Education Sector - Methodologies Series No. 1. - Synthesis of Education Statistics.  38 - Provincial Workshops for the Improvement of Vital Statistics and Registry Office. MINISTRY OF EDUCATION AND CULTURE SECRETARIAT OF EDUCATION - Quality of Education. - University Quality and Evaluation. - Evaluation for the Improvement of University Quality. MINISTRY OF HEALTH AND SOCIAL ACTION SECRETARIAT OF HEALTH - INDEC - Survey on Utilization and Expenditure in Health Services: Vol. I. - Methodological Aspects: Vol. II. - Expenditure in Home Health (1989) - Comparative Data: Vol. III. - Epidemiology Information System. EPIINFO 5.0 Program. Guide for the User. - Manual for the Student of the Introductory Course on Database IV. - System to Evaluate the Occupational Origin in Hospital Expenses. - Training in General Medicine. - Research on the Social Bases of Health Expenditure. - Survey on Utilization and Expenditure in Health Services: Vol. I and II. - Oral traumatisms. SECRETARIAT OF SOCIAL ACTION - Diagnosis on the Present Situation. Actions and Programs of the National Council of the Minor and the Family. - Training Manual in the Formulation and Evaluation of Investment Microprojects. MINISTRY OF JUSTICE SECRETARIAT OF JUSTICE - Juridical Document Information in Argentina. - The Argentinean Juridical System.  39 Apnendix 3 ORIGINAL PROJECT OBJECTIVES OBJETIVIO DE DESARROLLO DEL PROGRAMA Mejorar sustancialmente la prestaci6n y cobertura de los servicios soci.les, de acuerdo con las posibilidades presupuestarias y las prioridades establecidas por el Gobierno Nacional, con el objeto de asegurar crecientes niveles de bienestar a todos los habitantes del pais. Para lograr este objetivo se preve: i) fortalecer la capacidad de gesti6n del Estado en la prestaci6n de los servicios relacionados con los Sectores de Salud, Accion Social, Educaci6n. Justicia y Seguridad Social, ii) aumentar su eficiencia y iii) mejorar el acceso a esos servicios de los sectores mais necesitados de la poblaci6n. PROYECTO: SECRETARIA DE SALLTD SUBPROYECTO 1: Descentralizaci6n de hospitales Descentralizar los hospitales nacionales para adecuarlos a las necesidades y demandas de la poblaci6n. dotandolos de la capacidad gerencial suficiente e insertandolos en una red de servicios. USS 1.530.800 SUBPROYECTO 2: Sistema de Informaci6n de Salud Proveer productos informativos orientados al mejoramiento de la capacidad de gesti6n del sector salud, mediante la deeerminaci6n de necesidades emergentes de las politicas y objetivos establecidos. asi como el desarrollo, compatibilizaci6n e integraci6n de sistemas de informaci6n para satisfacer los requerimientos especificos de los distintos niveles del sector. USS 1.297.100 SUBPROYECTO 3: Relaci6n INOS-Secretaria de Salud Establecer un sistema que permita dar cobertura de atenci6n de salud equitativa y eficiente a toda la poblaci6p. A travis de: la mejora en la calidad de los servicios (acreditaci6n), la garantia de equidad de los servicios que prestan las Obras Sociales (prestaciones obligatorias). la normatizaci6n de las formas de contrataci6n (modalidades de contrataci6n) y la propuesra de mecanismos de ampliaci6n de cobertura a personas no cubiertas por la Seguridad Sqcial. US