Burkina Faso - Health Services Development Project

 Health Services Development Project Report No: ; Type: Report/Evaluation Memorandum ; Country: Burkina Faso; Region: Africa; Sector: Basic Health; Major Sector: Health Nutrition & Population; ProjectID: P000271 Burkina Faso: Health Services Development Project (Credit 1607-BUR) The Burkina Faso Health Services Development project, supported by Credit 1607-BUR for US$26.6 million equivalent, was approved in FY85. The original closing date, January 31, 1991, was extended four times to December 31, 1994. Final disbursement took place on April 30, 1995, and an amount of US$0.6 million was canceled. The Implementation Completion Report (ICR) was prepared by the West Central Africa Regional Office, and borrower comments are included. The project objectives were to: strengthen basic health and family planning services through immunization and malaria programs, in-service training, and construction and upgrading of health facilities; further formulate national health and population policies and promote their application with a focus on cost recovery, drug distribution, village health and nutrition systems, and the establishment of a population program; and strengthen the Ministry of Public Health's (MOPH) institutional capability in planning, evaluation, project implementation and monitoring through the establishment of eight Provincial Directorates of Public Health and provision of two mobile epidemiological surveillance units. The project ultimately achieved all its major objectives. Initially, however, success was uneven due to the absence of an implementation plan, lack of strong government commitment, and inadequate Bank supervision. Following an intensified dialogue between the Government, Bank and other donors, the Government decided in 1990 to decentralize the health system at the district level. The project was restructured accordingly and project performance improved considerably. The institutional development component was reduced substantially due to the availability of grant funding. At closing the project appeared to have had substantial impact on the development of the health sector in the country, particularly in the areas of decentralization and pharmaceutical policy. However, due to the lack of a monitoring system and monitorable indictors, project impact is difficult to assess empirically. The dialogue on policy reforms continues in the context of the follow-on Health and Nutrition project (Credit 2592- BUR) and Population and AIDS project (Credit 2619-BUR). The ICR and the Operations Evaluation Department rate the project's outcome as satisfactory, sustainability as likely, institutional development as modest and Bank performance as satisfactory. Important lessons of the project, which are identified in the ICR, are that: a detailed implementation plan, which also incorporates a monitoring system and appropriate monitorable indicators, is essential to keep track of project progress; and it is crucial to expand public education programs on health and population issues in order to increase acceptance rates. The ICR is satisfactory as it provides a comprehensive evaluation of project achievements and weaknesses. However, it does not give a description of the project's restructuring which was key in helping the project achieve its objectives; moreover, the section dealing with the future lacks specificity regarding the operation of services supported under the project and only provides a general outlook for the sector as a whole. An audit is planned.