Senegal - Integrated Health Sector Development Project (Formerly listed as Population and Health Services Development)

Report No. PIC2775 Project Name Senegal-Integrated Health Sector... Development Project Region Africa Sector Health Project ID SNPA2369 Borrower Government of Senegal Implementing Agency Ministry of Health and Social Action Contact: Abdoul Aziz Diop Directeur de Cabinet, MHSA Palais du Gouvernement, Dakar Tel: 221-22-35-25 Fax: 221-22-26-09 Date Initial PID Prepared October 7, 1995 Date This PID Updated November 12, 1996 Projected Appraisal November 15, 1996 Projected Board Date May 20, 1997 Background 1. Country and Sector Background Demographically, Senegal+s population reached 8.4 million in 1994 and is expected to continue to grow at 2.69 p.a. through the 1990+s. Given the young age structure of the population, the early age at first marriage and the widespread practice of polygamy, prospects for a significant reduction in population growth in the near future are bleak if no major effort is undertaken to step up family planning activities and women and girl+s education. As for health statistics, they show that, although substantial improvements have been achieved since independence in 1964, Senegal+s human indicators of development are still well below those of other countries at comparable levels of development. In addition to preventable and treatable diseases, malnutrition and anemia remain a serious problem particularly among children and pregnant and lactating mothers. In addition, the prevalence of STDs and the spread of HIV infections as well as other opportunistic diseases such as tuberculosis are becoming an increasingly serious public health threat. 2. Project Objectives The project fully supports the Bank+s strategy for the health sector as described in the CAS. In health, the Bank+s goal is to help Government to a) achieve fertility decline and reduce the current high population growth rate; b) improve access of quality primary health care to the vast majority of the underserved and vulnerable population groups in urban and rural settings; and c) improve the management and financial viability of the public health system. The more comprehensive and synergetic approach to health services development under the proposed project would provide more efficient health care delivery. It would help alleviate the burden on limited public resources and reform some of  the programs that are part of the public health safety net. IDA involvement, would facilitate improvements in the management and delivery of secondary and tertiary level of health services to prevent further pressures and deterioration in the standards of hospitals and public health financing. Many components of the project would have financial requirements that are beyond the capacity of local resources or than can be mobilized through the international donor community. The IDA Credit sought by the Government would complement these resources. IDA current investments in the Human Development sector in Senegal include one planned and three ongoing operations which will directly or indirectly contribute to the objectives of the proposed project. They are the Endemic Disease Control Project (to be presented to the Board of Executive Directors during FY 97), the ongoing Human Resources Development Project in Education, the Higher Education Project, the Community Nutrition Project. Implementation of the Endemic Disease Control Project, which aims to strengthen the endemic diseases control program administration and establish a sector wide Management Information System (MIS), will be an integral part of the health sector investment program. In addition, the strong commitment of the Government for further reform in the field of population and health provides an excellent opportunity to improve both the efficiency of the health system and the quality and extent of reproductive health services including STD/AIDS prevention. 3. Project Description The proposed project will support the Government+s health plan and five year investment program for the period 1997-2001. Building on policy and institutional reforms initiated under the ongoing Human Resources Development Project (25-SE), the primary objectives of the proposed project are to: (a) expand access and use of health services; (b) increase the overall efficiency of the health care system in the mobilization and use of services; and (c) contribute to fertility reduction. The sector investment project preparation was initiated in September 1995, following the adoption by Government of a strategic framework for health sector development. Preparation of a ten year National health Development Plan (NHDP) and a first five year investment program to implement the framework is well underway with strong support from multilateral and bilateral donors. The health planning process is based on the preparation of district and regional health plans, the reform of state hospitals and the promotion of cost sharing through mandatory health protection plans as well as optional community-based health insurance schemes. The provision of an integrated package of Primary Health Care (PHC) and first level referral which are at the core of the district health plans, remains a major area of priority in the NHDP, along with measures to strengthen managerial capacity and increase service delivery efficiency at all level of the health system. PHC is defined as a minimum package of preventive and curative services including reproductive health ,family planning and STD/AIDS prevention. The project will finance investments in infrastructure and management of publicly-owned health facilities. Support will be provided to the districts+ health development plan and to regional and national hospitals, based on quality assurance and performance measures and upon satisfaction of eligibility criteria such as cost recovery and tariff policies, information and management system and appropriate legislation for increased administrative and financial autonomy. The project will - 2 -  support activities and technical assistance aimed at improving the managerial, planning and administrative capacity of basic health care facilities, first level referral district hospital and regional and state hospitals to strengthen their ability to generate resources and provide sustainable service deliveries. While it is expected that most public health facilities will be eligible for funding under the project, agreement was reached with the Government that a large share of resources under the investment program will be transferred to the lower levels of the health system with a priority for prevention and integrated primary health care. State Hospitals will apply for investment grants under the project and funds will be set aside under the Credit to that effect. Review and approval mechanisms of the district health plans and hospital investment plans will be developed and agreed upon with the Government prior to appraisal. All regions and districts are in the process of finalizing their development plans in cooperation with local authorities and other stakeholders. 4. Project Financing The project cost and the financing plan are not yet defined. Total IDA Credit is estimated at US$35 million with local counterpart funds representing 10%. The amount of funding from the other multi-lateral and bi-lateral institutions is still to be determined. 5. Project Implementation Health managers at district, regional, and national levels would have a lead responsibility for implementing the sector-wide investment program. Central technical divisions of the MHSA would be responsible for strategic planning and donor coordination. In addition, they would provide support and monitoring for peripheral activities. Credit financing would be made available to NGOs to promote health education and solidarity mechanisms within community health associations. 6. Project Benefits Major benefits are: A reduction of preventable infant and maternal death, expanded access to primary health care and referral services and increased prevalence of contraceptive use. These benefits will contribute to a reduction in the incidence of disease and disability among all population age groups, which in turn will impact positively on the alleviation of poverty. The decrease in the morbidity and mortality of women and children, one of the key determinants of fertility behavior, will impact positively on fertility decline as well as enable this large segment of the population to participate fully in the country