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 Name||Health System Development Project|
|Country||Lao People's Democratic Republic
|Project Type / Modality of Assistance||Grant
|Source of Funding / Amount||
|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|
|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.|
|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||Nation-wide, Houaphan, Khoueng Bokeo, Khoueng Oudomxai, Khoueng Phongsali, Louangnamtha, Luang Prabang Province, Xaignabouli, Xiangkhouang|
|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.|
|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 $100,000 may be procured by shopping.|
|Responsible ADB Officer||Lochmann, Barbara|
|Responsible ADB Department||Southeast Asia Department|
|Responsible ADB Division||Lao Resident Mission|
Ministry of Health
Dr. Prasongsidh Boupha
Vientiane, Lao PDR
|Concept Clearance||22 Feb 2011|
|Fact Finding||21 Aug 2006 to 22 Feb 2011|
|MRM||22 Feb 2011|
|Approval||29 Jun 2007|
|Last Review Mission||-|
|PDS Creation Date||28 Feb 2006|
|Last PDS Update||22 Mar 2013|
|Approval||Signing Date||Effectivity Date||Closing|
|29 Jun 2007||15 Aug 2007||01 Oct 2007||31 Mar 2012||30 Jun 2012||07 Mar 2013|
|Financing Plan||Grant Utilization|
|Total (Amount in US$ million)||Date||ADB||Others||Net Percentage|
|Project Cost||15.00||Cumulative Contract Awards|
|ADB||13.00||29 Jun 2007||12.99||0.00||100%|
|Cofinancing||0.00||29 Jun 2007||12.99||0.00||100%|
|Status of Covenants|
Project Data Sheets (PDS) contain summary information on the project or program. Because the PDS is a work in progress, some information may not be included in its initial version but will be added as it becomes available. Information about proposed projects is tentative and indicative.
The Public Communications Policy (PCP) recognizes that transparency and accountability are essential to development effectiveness. It establishes the disclosure requirements for documents and information ADB produces or requires to be produced.
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In preparing any country program or strategy, financing any project, or by making any designation of, or reference to, a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area.
|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
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
None currently available.
None currently available.
The Public Communications Policy (PCP) establishes the disclosure requirements for documents and information ADB produces or requires to be produced in its operations to facilitate stakeholder participation in ADB's decision-making. For more information, refer to the Safeguard Policy Statement, Operations Manual F1, and Operations Manual L3.
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