Viet Nam: Health Care in the South Central Coast Region Project

Sovereign Project | 40019-013 Status: Approved

Summary

ADB is helping Viet Nam improve health care services in Da Nang City and seven provinces in the South Central Coast region. The project will target women, children, and ethnic minorities and give special focus on reproductive health care. It will build or upgrade health, water, and sanitation facilities, and strengthen provincial capacity for human resource development and provincial health systems.

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Project Name Health Care in the South Central Coast Region Project
Project Number 40019-013
Country Viet Nam
Project Status Approved
Project Type / Modality of Assistance Loan
Source of Funding / Amount
Loan 2468-VIE: Health Care in the South Central Coast Region Project
Asian Development Fund US$ 72.00 million
Strategic Agendas Environmentally sustainable growth
Drivers of Change Governance and capacity development
Sector / Subsector

Health - Health sector development and reform

Gender Equity and Mainstreaming Gender equity
Description The Project will improve the health status of the poor, women and children in eight provinces in the SCCR towards achieving the millennium development goals by 2015. The outcome is strengthened provincial health systems in the eight provinces with a focus on health care for the poor, women and children. This includes (i) upgraded hospital services providing expanded and better quality health services; (ii) improved provincial capacity for human resource development (HRD), better skilled staff and more staff from ethnic minorities; (iii) improved access to quality health care for the remote poor; and (iv) improved management of the provincial health system in terms of equity, efficiency, and effectiveness. The eight provinces are Da Nang, Quang Nam, Quang Ngai, Binh Dinh, Phu Yen, Khanh Hoa, Ninh Thuan, and Binh Thuan. The Project will support the Government's efforts to develop a comprehensive and well managed provincial health system.
Project Rationale and Linkage to Country/Regional Strategy
Impact The Project will improve the health status of the population in the South Central Coast Region (SCCR), in particular the poor, women and children, and ethnic groups
Project Outcome
Description of Outcome The outcome will be more comprehensive, well-managed, and better-used provincial health systems with a focus on health care for the poor, women and children, and ethnic minorities, including reproductive health care, in Da Nang City and Quang Nam, Quang Ngai, Binh Dinh, Phu Yen, Khanh Hoa, Ninh Thuan, and Binh Thuan provinces.
Progress Toward Outcome During the one year loan extension period until 30 June 2015, remaining deliverables for civil works, consulting services, and training programs were largely completed, except for some procurement packages, which are expected to be completed by end December 2014. Based on available project data during the review mission fielded in September 2014, it is likely that overall outputs would be achieved, except for a number of indicators which lag behind under outputs 1 (improved health facilities) and 3 (improved health care for the poor), respectively.
Implementation Progress
Description of Project Outputs

Output 1: Improved Health Facilities

1.1 New and upgraded health facilities and equipment

1.2 Improved water, sanitation, and waste management

Output 2: Strengthened Provincial HRD

2.1 Improved provincial human resource planning and management

2.2 Improved provincial training capacity

2.3 Improved quality and availability of staff

2.4 HRD provincial studies are used in policy formulation

Output 3: Improved Access to Health Care for the Poor

3.1 Better village health care in remote communes

3.2 Health and nutrition promoted in ethnic minority communes.

3.3 Reduced barriers to health care funds for the poor

Output 4: Strengthened Provincial Health Systems

4.1 Strengthened provincial health systems management

4.2 Strengthened hospital management

4.3 Better health management information systems

4.4 Effective project management support

Status of Implementation Progress (Outputs, Activities, and Issues)

All 25 health facilities meet MOH service standards.

Eight (8) new and 17 upgraded new facilities

The change in the number of district hospitals with capacity for EMOC in SCCR provinces from 2009 to 2013:

Da Nang =

Data not available

Quang Nam

2009 = 3 district hospitals

2014 = 4 district hospitals

Quang Ngai

2009 = 1 district hospitals

2014 = 4 district hospitals

Binh Dinh

2009 = 3 district hospitals

2014 = 8 district hospitals

Phu Yen

2009 = 2 district hospitals

2014 = 8 district hospitals

Khanh Hoa

2009 = 1 district hospitals

2014 = 6 district hospitals

Ninh Thuan

2009 = 0 district hospitals

2014 = 1 district hospitals

Binh Thuan

2009 = 2 district hospitals

2014 = 8 district hospitals

8 provinces developed by 2013 HRD plans. Of these:

5 provinces had their HRD plan approved by the PPC

6 provinces plans included targets for training of EM CHW and VHW

6 provinces plans included targets for training of female CHWs and VHWs.

The project trained:

739 master trainers in the Medical Pedagogy (47% female; 2% EM).

375 core trainers in TOT for various topics (54% female; 1% EM).

86% of master trainers apply skills based training techniques.

100% CHS have had at least trained female staff.

The number of female health care professionals participating in the Project s short term trainings was 19,074 (69% of total participants).

The number of EM health care professionals participating in the Project s short term trainings was 3,196 (12% of total participants).

7 studies conducted by MOH/Provinces, including 2 focusing on gender and ethnic minority issues.

In addition 2 HRD studies focusing on (i) staff retention; (ii) improving the competency of female and EM health staff.

18/18 (100%) of poor communes in endline survey had at least 1 female staff trained by the project.

83% of VHW apply 7 or more activities from the standard reproductive health care package (10 activities).

VHWs conducted health and nutrition campaigns to 302 ethnic minority communes.

By 2014:

81% of EM women and 79% of poor women accessed information on health care from VHWs.

44% of EM women received information on health care in EM language.

72% of both EM and poor women accessed information on HI from VHWs.

34% of EM women received information on health care in EM language.

By 2014:

provinces prepare annual provincial health plans and budgets.

provinces developed HRD plans (5 approved by the PPC).

8 provinces developed Gender Action Plans and Ethnic Minority Action Plans for the period 2015-2017.

The percentage of hospital managers in SCCR provinces that are female (and percentage of these who attended training):

Da Nang = 8% (23%)

Quang Nam = 17% (100%)

Quang Ngai = not available

Binh Dinh = 13% (75%)

Phu Yen = 22% (20%)

Khanh Hoa = 21% (79%)

Ninh Thuan = 45% (21%)

Binh Thuan = 21% (86%)

Under the Project s short course training program 405 managers participated in management training of which 23% were female.

The Project fielded 16 postgraduate candidates in Master of Hospital and Master of Public Management of which 75% were female.

The percentage of district hospitals in SCCR provinces applying MIS (at endline):

Da Nang = not available

Quang Nam = 7%

Quang Ngai = not available

Binh Dinh = 75%

Phu Yen = 57%

Khanh Hoa = 100%

Ninh Thuan = 50%

Binh Thuan = 25%

Project procurement and financial management met ADB s standards.

Geographical Location The eight provinces are Da Nang City and Quang Nam, Quang Ngai, Binh Dinh, Phu Yen, Khanh Hoa, Ninh Thuan, and Binh Thuan.
Safeguard Categories
Environment B
Involuntary Resettlement A
Indigenous Peoples A
Summary of Environmental and Social Aspects
Environmental Aspects

The Project will help safeguard the environment by upgrading or

constructing water, sanitation, and medical waste management

systems and training hospital staff in waste management theory

and practice, thereby significantly improving the handling and

disposal of medical wastes in these facilities and reducing

environmental threats to their surrounding communities. In

addition to disturbance and resettlement during construction, the

new and upgraded health facilities may pose future health

hazards due to poor maintenance, lack of supplies and other

reasons. The Project will support the development of

environmental plans and a waste management plan for each

hospital.

Involuntary Resettlement

The Project is expected to acquire 186,141 square meters of land, excluding the sites for

5 DPMCs, which will be identified during implementation. At the assessed sites, 112 households

(499 people) will be affected by the Project, 52 households will lose more than 10% of their

productive land, and 32 households will be required to relocate. A full resettlement plan has

been prepared for the subprojects where sites have been identified, and a resettlement

framework has been prepared to guide any resettlement or land acquisition that may occur for

the DPMCs and any other subprojects identified during implementation (Supplementary

Appendix D). The base cost of land acquisition and resettlement activities is estimated at $0.86

million. All households will be compensated for their losses at full replacement costs and current

market value. Residential and employment arrangements will be restored to pre-project

standards, if not better. As detailed designs of civil works are finalized and approved, MOH, with

the assistance of the PHBs, will be required to revise and update the resettlement plans for all

civil works. MOH will be responsible for approving the resettlement plans and supervising all

resettlement-related issues.

Indigenous Peoples

The Project falls into indigenous people impact category A. Specific activities directly

targeting ethnic groups as beneficiaries have been mainstreamed in the Project, which therefore

serves as the ethnic minority development plan. An ethnic minority strategy (Appendix 12) has

been developed to (i) ensure that ethnic minorities are consulted, participate, and benefit from

the project throughout project implementation; and (ii) guide the implementation of information,

education, and participation methodologies so that they are sustainable and appropriately

targeted to ethnic minority needs. The ethnic minority strategy is based on (i) consultations with

ethnic minorities, government officials, local organizations, and other key stakeholders; and

(ii) secondary sources and past ADB projects. The strategy is in accordance with current Viet

Nam regulations and complies with ADB's Policy on Indigenous Peoples (1998).

Stakeholder Communication, Participation, and Consultation
During Project Design Consultation undertaken with stakeholders
During Project Implementation Consultation undertaken with stakeholders
Business Opportunities
Consulting Services The Project required 9 international consultants for a total of 70 person-months, 12 national consultants for a total of 302 person-months, a nongovernment organization for 48 months, and short-term national consultants for a total of 12 person-months. MOH recruited as individual consultants one international engineering and environmental specialist; national experts in project management, resettlement, environmental and waste management, and HMIS; and the short-term consultants. All other consultants were hired through three firms in accordance with ADB's Guidelines on the Use of Consultants (2007, as amended from time to time), using a simplified technical proposal and quality and cost-based selection. Capacity building of counterparts was included in the assignment of consultants.
Procurement Each participating province prepared an annual procurement plan and submit it for the Ministry of Health's (MOH) approval before the start of the fiscal year. All ADB-financed procurement was undertaken in accordance with ADB's Procurement Guidelines (2007, as amended from time to time). Procurement of goods will use international competitive bidding procedures if over $1 million, national competitive bidding if $1 million or less, or shopping if less than $100,000. Civil works used international competitive bidding procedures if over $4 million, national competitive bidding if $4 million or less, or shopping if less than $100,000. Vehicles were procured through the United Nations, using procurement procedures acceptable to ADB.
Responsible ADB Officer Gerard Servais
Responsible ADB Department Southeast Asia Department
Responsible ADB Division Human and Social Development Division, SERD
Executing Agencies
Ministry of Health
Dr. Nguyen Doan Tu
Tudoanguyen@gmail.com
Ministry of Health, Viet Nam
Timetable
Concept Clearance 07 Sep 2006
Fact Finding 30 Jul 2007 to 10 Aug 2007
MRM 31 Oct 2007
Approval 07 Nov 2008
Last Review Mission -
PDS Creation Date 19 Feb 2008
Last PDS Update 22 Sep 2015

Loan 2468-VIE

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
07 Nov 2008 16 Dec 2008 20 Mar 2009 30 Jun 2014 30 Jun 2015 -
Financing Plan Loan Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 80.00 Cumulative Contract Awards
ADB 72.00 07 Nov 2008 66.71 0.00 94%
Counterpart 8.00 Cumulative Disbursements
Cofinancing 0.00 07 Nov 2008 69.12 0.00 97%
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating - - - - - Satisfactory

Safeguard Documents

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Safeguard documents provided at the time of project/facility approval may also be found in the list of linked documents provided with the Report and Recommendation of the President.

Evaluation Documents

See also: Independent Evaluation

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