Lao People's Democratic Republic: Health Sector Development Program (Program Grant)

Sovereign Project | 41376-022 Status: Closed

Summary

ADB is helping the Lao People's Democratic Republic improve primary health care to achieve the Millennium Development Goals. The project will strengthen planning and financing; increase access to maternal, newborn, and child health care; and improve quality of human resources for health.

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Project Name Health Sector Development Program (Program Grant)
Project Number 41376-022
Country Lao People's Democratic Republic
Project Status Closed
Project Type / Modality of Assistance Grant
Source of Funding / Amount
Grant 0172-LAO: Health Sector Development Program (Program Grant)
Asian Development Fund US$ 10.00 million
Grant 0173-LAO: Health Sector Development Program (Project Grant)
Asian Development Fund US$ 10.00 million
Strategic Agendas Inclusive economic growth
Drivers of Change Governance and capacity development
Sector / Subsector

Health - Health sector development and reform

Gender Equity and Mainstreaming Gender equity
Description
Project Rationale and Linkage to Country/Regional Strategy
Impact

Project Outcome

Description of Outcome
Progress Toward Outcome

The project outcome indicators were assessed against findings from the projects endline survey. Final outcomes will be reported in the Project Completion Report.

According to H-SDP 2014 household survey.

The use of health services for each sub-group has increased from 9% to 47% and is a significant achievement.

Globally in 8 northern provinces, the percentage of deliveries attended by a skilled birth attendant during the year 2014 is 58%. The increase is more important among ethnic groups (other than Tai-kadai) and poorest quintiles.

Globally in 8 northern provinces, the percentage of persons ill in the past 4 weeks and seeking care with a village health volunteer is 6%.

In terms of coverage, HEF coverage increased significantly with the addition of five provinces which increased eligible beneficiaries from about 100,000 in the first year to more than 430,000 at the end of the third year of the assessment period.

HEF systems in the eight provinces are gender neutral, both for overall patient visits and for patient visits to each level of health care provider. Over the 3 year period (2012-2013) during which HEF has been active in 8 northern provinces, the total number of patient-visits has been 109,000 and the total number of female patient-visits has been 58,000 (53%). HEF Assessment Report, January 2015 . Table 6 page 35.

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

As of 30 June 2015, The project was physically closed. Overall project progress is satisfactory and the project performance rating in e-ops is on track.

Output1:

(i) All 17 provinces have developed result-based AOPs from 2010/2011 to 2014-2015. A total of 76 AOPs (17 AOP x 4 yrs + 8 AOP x 1 yr); In 2010-2011, the implementation of plan was 82%; in 2011-2012 and 2012-2013, it was 96% implemented; and in 2013-2014, it was 97%.

(ii) From 2010 to 2014, Government budget allocation for operations and maintenance of health facilities and equipment have been increased. For example, in FY2013-2014, about $2.03 million have been allocated to health facilities nationwide for non-wage recurrent costs.

(iii) Between 2011 and 2014, The number of OPD and IPD visits increased respectively by 89% and 52%. The number of deliveries in health facilities also increased by 50%. The number of surgery procedures by 23%, and the number of cesarean sections by 137%. (source HMIS)

(iv) Health equity fund for the poor was expanded covering 62 districts in 8 northern provinces. Since HEF has been operated in Oct 2011, the cumulative number of poor patient-visits is about 109,000.

Output 2:

(i) Procurement and distribution of medical equipment for hospitals to improve MNCH standard are completed.

(ii) Construction of one district hospital, 10 health centers and renovation of 2 district hospitals and 13 health centers are completed;

(iii) MNCH teams from 6 out of 12 type A district hospitals have been trained and an assessment of training needs for type B district hospitals was completed. 8 out of 13 type A district hospitals in eight provinces are able to provide surgery and cesarean sections.

(iv) The revised standards for district hospital and health center design approved by Minister of health in March 2014 include standards for privacy needs of women: separate toilet for women, delivery and post- delivery rooms.

(v) 5,254 villages declared as MHV as of 30 September 2014 in all provinces, including 2432 MHV in 8 northern provinces. About 1,000 MHV increased annually since 2010.

(vi) Globally in all facilities in 8 northern provinces, between 2011 and 2014, the number of ANC, deliveries, and cesareans increased respectively by 80%, 50%, and 137%.

Output 3:

- 153 health staff (92% are female and 28% are ethnic people) were trained as community midwives.

- 138 health center staff (62% are female and 51 are ethnic people) completed the 2 month SBA training and Training on SBA for another 30 HC staff is ongoing.

- 57 health staff (98% are female) completed the Emonc training, and training on BemONC for 30 district hospital staff is ongoing.

- 112 health staff (58% were female) completed village health workers training.

- 42 staff completed the 3-month management of obstetric and newborn emergencies.

- The Health Personnel Information database has been developed and made operational. Annual reports are produced to monitor implementation of the HPDS by 2020 and particularly indicators related to ethnic groups and females in the health workforce.

Geographical Location Vientiane and 17 Provinces of Laos, with focus on 8 Northern provinces

Safeguard Categories

Environment B
Involuntary Resettlement C
Indigenous Peoples C

Summary of Environmental and Social Aspects

Environmental Aspects The project environmental impacts were reviewed through rapid environmental assessment. The project will support the upgrading of four hospitals and upgrading or replacement of 20 health centers based on MOH guidelines for the construction of health facilities development under the Primary Health Care Expansion Project. No significant adverse impact were identified; the investment will have positive impacts on the environment. The main concern is medical waste management. Most health facilities separate waste but the subsequent handling is inadequate. The project will not cause any significant pollution, health hazards or soil erosion. No negative environmental impacts are anticipated.
Involuntary Resettlement The four hospitals and 20 health centers will be upgraded, renovated, or replaced on existing government land free of encumbrances. No resettlement issue has been identified or are expected. However, if any land acquisition or other action is required that effects private persons and/or users of the land, a land acquisition and resettlement framework has been prepared in according with ADB's Involuntary Settlement Policy (1995) to guide the preparation of a land acquisition and resettlement plan (Appendix 11 of RRP). In case of changes in scope, the new site will be also inspected for any possible resettlement issue.
Indigenous Peoples The project design is built around the needs of ethnic groups and includes several strategies to ensure that ethnic group benefit. Specific actions have been incorporated into project design. A gender and ethnic group action plan has been prepared to help ensure that health personnel and consumers from small ethnic groups benefit from policy reforms and related investment.
Stakeholder Communication, Participation, and Consultation
During Project Design Extensive consultations were held at national level (MOH departments, other ministries and partners; provincial level (governors, administrators); sub-provincial level (district officers and health staff); and potential beneficiaries (village health committees, volunteers, and clients). Several field studies have been conducted during the PPTA to appraise planning and budgeting, financial management, safe motherhood, quality of care, and civil works including public consultation on any resettlement or environmental issues.
During Project Implementation The MOH Steering Committee is to review program progress each quarter. The provincial health offices are being consulted weekly and all provinces are visited every quarter. The mechanism to incorporate feedback of beneficiaries is well developed under the model healthy villages but needs to be mainstreamed in general for the annual planning process and supervision.

Business Opportunities

Procurement The program grant proceeds will be used to finance the foreign exchange cost of items produced and procured in ADB member countries, excluding items included on a list of ineligible items and imports financed by other bilateral and multilateral sources. The grant recipient will certify that the volume of eligible imports exceeds the amount of ADB's projected disbursements under the program grant in a given period. ADB will have the right to audit the use of grant proceeds and to verify the accuracy of the recipient's certification.

Responsible Staff

Responsible ADB Officer Phoxay Xayyavong
Responsible ADB Department Southeast Asia Department
Responsible ADB Division Lao Resident Mission
Executing Agencies
Ministry of Health
Dr. Prasongsidh Boupha
hsdpadm10@gmail.com
Planning and Budgeting Department, Ministry of Health, Vientiane Lao PDR

Timetable

Concept Clearance 21 Jul 2009
Fact Finding 01 Jun 2009 to 12 Jun 2009
MRM 31 Jul 2009
Approval -
Last Review Mission -
PDS Creation Date 23 Jul 2009
Last PDS Update 29 Sep 2015

Grant 0172-LAO

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
10 Nov 2009 23 Nov 2009 17 Dec 2009 30 Jun 2012 - 31 Aug 2012
Financing Plan Grant Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 10.00 Cumulative Contract Awards
ADB 10.00 10 Nov 2009 10.00 0.00 100%
Counterpart 0.00 Cumulative Disbursements
Cofinancing 0.00 10 Nov 2009 10.00 0.00 100%
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating - - - - - Satisfactory

Grant 0173-LAO

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
10 Nov 2009 23 Nov 2009 17 Dec 2009 30 Jun 2014 30 Jun 2015 30 Oct 2015
Financing Plan Grant Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 10.80 Cumulative Contract Awards
ADB 10.00 10 Nov 2009 10.00 0.00 100%
Counterpart 0.80 Cumulative Disbursements
Cofinancing 0.00 10 Nov 2009 10.00 0.00 100%
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating - - - - - Satisfactory

Safeguard Documents See also: Safeguards

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.

Title Document Type Document Date
Health Sector Development Program Resettlement Frameworks Sep 2009
Health Sector Development Program Environmental Assessment and Measures Sep 2009

Evaluation Documents See also: Independent Evaluation

None currently available.

Related Publications

None currently available.


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