Turkey - Health Project

Document of The World Bank FOR OFFICIAL USE ONLY fi ZJ27 Lc Report No. 7433-TU STAFF APPRAISAL R2PORT REPUBLIC OF TURKEY HEALTH PROJECT APRIL 7, 1989 Population and Human Resources Division Country Department I Europe, Middle East and North Africa Region This document has a restricted distribution and may be used by recipients only In the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization.  REPUBLIC OF TURKEY STAFF APPRAISAL REPORT CURRgNCY EQUJIVALENTS Currency Unit = Turkish Lira (TLJ US$1.00 = TL1950 [March 1989] TL1,000 = US$0.51 [March 1989J FISCAL YEAR January 1 - Decenrber 31 PRINCIPAL ACR0NYMS USED BAG-KUR Social Insurarce Agency for Merchants, Artisans and Self Employed Professionals CTT Central Training Team FP Family Planning GERF Government Employees Retirement Fund GDMCHFP General Directorate for Maternal and Child Health and Family Planning GDPHC General Directorate for Primary Health Care MCH Maternal a'nd Child Health MOH Ministry of Health ORS Oral Rehydration Solution PCU Project Coordination Unit PHC Primary Health Care PTT Provincial Training Team RPCC Research, Planning and Coordination Council SIO Social Insurance Organization Y6K Higher Education Council  Document of The World Bank Report No. 7433-TU REPUBLIC OF TURKEY H E A L T H P R O J E C T JUNE 29, 1990 The attached note replaces pages (i), (ii), 17-35, and Annexes IV and V of the Staff Appraisal Report dated April 7, 1989. It reflects the change in the geographical coverage of the project and the updated cost of project-supported interventions. Population and Human Resources Division Country Department I Europe, Middle East and North Africa  REPUBLIC OF TURKEY HEALTH PROJECT -- STAFF APPRAISAL REPORT Project and Loan Summary Borrower: Republic of Turkey Amount: US$75.0 million Beneficiary: Ministry of Health (MOH) Terms: Seventeen years, including a five-year grace period, at the Bank's standard variable interest rate. Project Description: The project has three major objectives: (i) to improve the health status through access to basic health services of underprivileged populations in eight of the country's 67 provinces; (ii) to enhance efficiency in service delivery and improve financing prospects for the sector; and (iii) to strengthen the Ministry of Health's management capacity. The project has two components: (i) the reorganization and expansion of provincial health services in underserved areas of eight provinces, with a population of about 9 million; and (ii) institutional development of the Ministry of Health, focusing on training and curriculum development, management information systems, and applied studies. Specifically, the project would finance: (i) construction or expansion of provincial health facilities and training centers; (ii) furniture, equipment, and vehicles for the above facilities; (iii) technical assistance, overseas and local training, and applied research; and (iv) project monitoring and evaluation. Benefits and Risks: The project would reduce existing inequalities in health and fertility status by providing improved access to basic health care for about 9 million persons. Through its institutional development component, this project would also pave the way for achieving broader sectoral objectives under subsequent proiects. The long-term goal would be to establish a higher quality and partly self-supporting health care delivery system. The main risk faced by the project is the limited management capacity of MOH, and its lack of experience in implementing large projects; this risk is offset by the relatively simple design of the project, the decentralization of responsibilities for implementation, and the provision of technical assistance in key areas. The construction program includes a large number of small and scattered rural facilities; to ensure good quality standards, and reduce the risk of cost overrung and delays, the project will provide for additional supervision engineers. Finally, the implementation of the Management Information System may be held up owing to the shortage of specialized personnel; this risk will be minimized through the close collaboration with Universities, and the substantial training program included in the component.  ( ii) Project Cost Estimates (US$ Millions) Local Foreign Total Development of Provincial Health Services: 54.3 54.7 109.0 Institutional Development: Health Manpower Development 3.2 3.6 6.8 Management Information System 2.5 1.6 4.1 MOHSA Central Le:_. 0.8 1.4 2.2 TOTAL BASELINE COSTS 60.8 61.3 122.1 Physical Contingencies 5.5 5.7 11.2 Price Contingencies 4.3 9.1 13.4 TOTAL PROJECT COSTS 70.6 76.1 146.7 Financing Plan