Lao People's Democratic Republic: Health System Development Project

Sovereign Project | 32313-022

Summary

The overall goal of the Project is to improve the health and nutrition status of the population, in particular the poor, women and children, and ethnic groups in the eight northern provinces of Lao PDR. It aims to improve health and nutrition behavior and demand for health services and make the provincial health system more effective, efficient and equitable in delivering Primary Health Care (PHC). The objectives of the Project are (i) to improve PHC delivery, in particular for vulnerable groups, in the eight northern provinces, and (ii) nation wide, to strengthen Ministry of Health capacity in health system development, including Human Resource Development, planning and budgeting, and coordination. The Project has two corresponding components and is based on a two phased PHC development concept covering 8 years, with the first phase of 4 years (2007 2011) to be supported by the Project.

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Project Name Health System Development Project
Project Number 32313-022
Country Lao People's Democratic Republic
Project Status Closed
Project Type / Modality of Assistance Grant
Source of Funding / Amount
Grant 0079-LAO: Health System Development Project
Asian Development Fund US$ 13.00 million
Strategic Agendas Inclusive economic growth
Drivers of Change
Sector / Subsector

Health - Health sector development and reform

Gender Equity and Mainstreaming
Description The overall goal of the Project is to improve the health and nutrition status of the population, in particular the poor, women and children, and ethnic groups in the eight northern provinces of Lao PDR. It aims to improve health and nutrition behavior and demand for health services and make the provincial health system more effective, efficient and equitable in delivering Primary Health Care (PHC). The objectives of the Project are (i) to improve PHC delivery, in particular for vulnerable groups, in the eight northern provinces, and (ii) nation wide, to strengthen Ministry of Health capacity in health system development, including Human Resource Development, planning and budgeting, and coordination. The Project has two corresponding components and is based on a two phased PHC development concept covering 8 years, with the first phase of 4 years (2007 2011) to be supported by the Project.
Project Rationale and Linkage to Country/Regional Strategy Lao PDR s key health indicators such as maternal and infant mortality rates are among the worst in Asia. To achieve the goal of health for all, the Government of Lao PDR has adopted the Millennium Development Goals and primary health care (PHC) strategy, in particular targeting rural poor, ethnic minorities, and women and children. With its ongoing project, ADB s Loan 1749 supports PHC expansion in 8 northern provinces and strengthening institutional capacity for PHC management nationwide. A network of health facilities has been put in place and volunteers have been trained to improve access. Paramedics and villagers are being trained, many of them from ethnic minorities. This expanded PHC system provides the basis for improving sector impact. However, the health system faces chronic underfunding, management constraints, lack of qualified staff for rural locations, and lack of public education.
Impact Improved health and nutrition in the eight northern provinces, particularly among the poor, women and children, and ethnic groups in rural and underserved areas
Project Outcome
Description of Outcome

1. Improved PHC delivery in the eight northern provinces--better-quality services, more accessible to vulnerable groups, affordable to the poor, and delivered efficiently, resulting in increased demand and coverage

2. Strengthened capacity for pro-poor health system development nationwide

Progress Toward Outcome The project was effective in achieving its desired outcome, which was to improve PHC delivery for vulnerable groups in the eight northern provinces and strengthen pro-poor health system development nationwide. Improvement to vulnerable groups was promoted through investments in upgrading staff competency, equipment, construction and renovation at the provincial, district and community level.
Implementation Progress
Description of Project Outputs

1.1. Improving PHC management and quality of care in eight northern provinces

1.2. Increased access to PHC for safe motherhood and remote populations

1.3. Increased PHC financing and affordability for the poor

2. 1. Strengthened MoH capacity for human resource development

2. 2. Strengthened planning and budgeting

2. 3. Integrating project administration and coordination

Status of Implementation Progress (Outputs, Activities, and Issues) Targeted outputs in capacity development were delayed and ultimately scaled back, while in-service training focused mainly on management and planning and less on clinical skills development, although it was widely acknowledged that these were rather limited . While educational barriers still exist among non-Lao ethnic groups, more appropriate bridging courses for health workers and more time could have helped to recruit staff from ethic groups in health centers. Overall health care utilization of the poor increased from 43% in 2006 to 46.7% in 2010. It is not evident whether targeting mechanisms were appropriate to reach the most vulnerable including non-Lao ethnic groups and if out-of pocket expenditures were reduced. Specific project outputs will be available in the Project Completion Report by Q3 2013.
Geographical Location 8 Northern provinces for PHC delivery Natonawide for capacity building and system development
Safeguard Categories
Environment C
Involuntary Resettlement C
Indigenous Peoples B
Summary of Environmental and Social Aspects
Environmental Aspects The Project's environmental impacts were reviewed through rapid environmental assessment; no significant adverse impacts were identified. The Project will support the construction of district hospitals and health centers based on MOH guidelines for the construction of health facilities developed under the PHCEP. Environmentally sound medical waste treatment will be included in the design of the new as well as upgraded health facilities. Site selection, design, construction, replacement work, and facility operation will conform to the relevant regulations and standards of the Government, international good practices, and ADB's Environment Policy (2002). No activities resulting from the Project will cause pollution, health hazards, or soil erosion. The Project is classified as Category C.
Involuntary Resettlement Replacement of 11 existing health centers and upgrading of three district hospitals under the Project will not require any new land. Construction of new provincial hospitals in Houaphan and Louang Namtha and 10 new health centers will, as a priority, be carried out on vacant and idle land owned by the Government that is free from all encumbrances, habitation, dispute, or controversy. Since the final site for each subproject has not been agreed yet, a resettlement framework has been prepared.
Indigenous Peoples The project design is built around the needs of ethnic groups and includes several strategies to ensure that ethnic groups benefit from the Project. The specific actions are included in the main text of this report and recommendation of the President.
Stakeholder Communication, Participation, and Consultation
During Project Design A stakeholder analysis as part of the project design dentified key stakeholders, to understand their related roles and interests, and to make a preliminary assessment of capacity for Project implementation. A variety of stakeholders were consulted including the relevant ministries, other national agencies, provincial and district health officials, managers and staff of hospitals and health centers, village health volunteers. Discussions were held with development partners (e.g., the World Bank) to ensure synergies and complementarities with their ongoing initiatives in the health sector, and with the private sector (Amanresorts International Private Limited) to seek out possible partnerships.
During Project Implementation A participation strategy is incorporated into the overall project design. The Project supports the MOH efforts to strengthen the decentralization of the health sector in the Lao PDR. It will also build MOH's capacity to coordinate among donors as the health sector gradually moves toward a program approach. It supports consultation and coordination activities among departments within MOH, between MOH and other line ministries, between the central and administrative levels, and in the districts and villages. The use of participatory approaches is critical for the design and introduction of HEFs. Villagers, especially women, will participate in the identification of candidates for PHC officer training. Health committees at different levels will perform various roles in the management of health facilities and of health programs, including the expansion of the village health program under the Project.
Business Opportunities
Consulting Services The Project will require five international consultants for a total of 47 person months, five national consultants for a total of 90 person months, and architect, engineering, and accounting services. The international PHC systems expert (21 person months), the international health policy and planning expert (6 person months) and the international health economist (8 person months) will be hired as individual consultants in accordance with ADB s Guidelines on the Use of Consultants (2007, as amended from time to time). The architect, engineering, and accounting services will be hired through separate firms according to ADB s Guidelines on the Use of Consultants, using the biodata technical proposal and consultant qualification selection or least cost selection method. Other consultants will be contracted through one firm according to ADB s Guidelines on the Use of Consultants, using the fixed budget selection method and biodata technical proposal. This package includes an international HRD expert (9 person months), and social development expert (3 person months) and a national health information expert (24 person months), health policy and planning expert (12 person months), HRD expert (24 person months), health care financing expert (24 person months), and social development expert (6 person months).
Procurement All ADB financed procurement will be in accordance with ADB Procurement Guidelines. Procurement of goods and services $100,000 and above and all civil works will follow national competitive bidding procedures. Vehicles will be procured through the United Nations system, which uses procurement procedures acceptable to ADB. Minor goods and services other than civil works and vehicles costing less than $100,000 may be procured by shopping.
Responsible ADB Officer Barbara Lochmann
Responsible ADB Department Southeast Asia Department
Responsible ADB Division Lao Resident Mission
Executing Agencies
Ministry of HealthDr. Prasongsidh Bouphaadb2laos@loxinfo.co.thVientiane, Lao PDR
Timetable
Concept Clearance 22 Feb 2011
Fact Finding 21 Aug 2006 to 22 Feb 2011
MRM 22 Feb 2011
Approval 29 Jun 2007
Last Review Mission -
PDS Creation Date 28 Feb 2006
Last PDS Update 22 Mar 2013

Grant 0079-LAO

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
29 Jun 2007 15 Aug 2007 01 Oct 2007 31 Mar 2012 30 Jun 2012 07 Mar 2013
Financing Plan Grant Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 15.00 Cumulative Contract Awards
ADB 13.00 29 Jun 2007 12.99 0.00 100%
Counterpart 2.00 Cumulative Disbursements
Cofinancing 0.00 29 Jun 2007 12.99 0.00 100%
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating Satisfactory - - - - Satisfactory
Title Document Type Document Date
Health System Development Project Project/Program Completion Reports Jul 2013
Grant Agreement for Health System Development Project between Lao People's Democratic Republic and Asian Development Bank dated 15 August 2007 Grant Agreement Jul 2007
Health System Development Project Procurement Plans Jun 2007
Health System Development Project Reports and Recommendations of the President Jun 2007
Health Sector Development Project Design and Monitoring Frameworks Jan 2007

Safeguard Documents

See also: Safeguards
Title Document Type Document Date
Health Sector Development Project Resettlement Planning Documents Jan 2007

Evaluation Documents

See also: Independent Evaluation

No documents found.


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