|Project Name||Building Capacity for the Health Sector Program Approach|
|Country||Lao People's Democratic Republic|
|Project Type / Modality of Assistance||Technical Assistance
|Source of Funding / Amount||
|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|
|Project Rationale and Linkage to Country/Regional Strategy||
The Government has started preparing the draft 7th health sector development plan (HSDP) for 2011?2015. ADB considers supporting this Plan through a health sector development program (H-SDP) with a grant of $20 million in 2009. The Country Operations Business Plan also includes a capacity development TA of $500,000 to help develop the national capacity for the national sector approach.
Following the Vientiane Declaration on Aid Effectiveness in 2006, MOH is moving towards a national sector approach and aid harmonization with its partners led by the Government of Japan and WHO. A coordination framework has been agreed upon between MOH and partners. ADB and partners have supported MOH in developing several building blocks for a sector program approach. The next step is to develop the national sector approach and platform for partner support.
|Impact||Improved efficiency of the health sector in terms of financing and uses of funds.|
|Description of Outcome||Establishment of a national health sector program approach (NHSPA) by major partners by October 2011.|
|Progress Toward Outcome||The TA outcome of improving availability and allocation of funds for provincial health services was achieved in terms of having the capacity to better plan for and use of the program funding. With the additional funding provided under H-SDP non-wage recurrent budget for provincial health services received a boost. The actual percentage of non wage recurrent budget support increase as the outcome indicator and the increase in use of targeted services as the impact indicator can only be calculated once the final return of the 2010/2011 accounts are in and the Health Management Information System reports are compiled for 2011. The H-SDP team will continue to monitor both, to report on it in due course under the H-SDP program progress requirements.|
|Description of Project Outputs||
Strengthened MOH capacity in leading the NHSPA
1.1 Build capacity of the MOH secretariat for NHSPA
1.2 Prepare the roadmap for developing the NHSPA
1.3 Track building blocks for sector coordination and the NHSPA
1.4 Prepare and disseminate orientation packages for the NHSPA
Designed and agreed NHSPA and platform for external support
2.1 Obtain views from experts and stakeholders on the design of the NHSPA
2.2 Design and obtain approval for the NHSPA
2.3 Prepare detailed procedures for the NHSPA
2.4 Reach consensus on the design among ministries and partners
Improved provincial and district financial management capacity in the sector
3.1 Complete assessment of provincial and district financial management capacity initiated under the PPTA
3.2 Review and improve guidelines on the flow of funds
3.3 Prepare budget norms and tools for provincial plan formulation for program funding
3.4 Prepare provincial and district financial management guidelines
3.5 Provide financial management training for all provinces and districts
3.6 Evaluate provincial and district performance in financial management
|Status of Implementation Progress (Outputs, Activities, and Issues)||
The TA produced an inception report, a midterm review report, a manual on financial management and a manual on planning, monitoring and evaluation, and a final report. The final report is comprehensive and contains all the major outputs, including the discussions and presentation of the information sharing meeting with the development partners.
The TA produced the major outputs as planned. Under output 1, the CDTA team, together with the counterpart, (i) made an initial assessment of the financial management capacity of the provincial and district health offices, (ii) reviewed relevant laws, policies and guidelines of the Government regarding the flow of funds to provinces and districts, (iii) developed a design for the flow of funds including the approval process, eligibility criteria, and budget norms, (iv) sought support from stakeholders through consultations and a national workshop, and (v) facilitated MOF approval of the flow of funds mechanism in September 2010 (earlier than specified in the DMF), through a specific Memorandum of Understanding between MoF and MoH.
Under the second output, a manual on financial management (FM) was drafted by the CDTA staff to be applicable for ADB Program funds being disbursed from MOF to PHOs and downwards to the DHOs and HCs. This manual is based on the Government accounting procedures and can easily be used for other funding sources. The manual was discussed and tested with the PHOs in 3 pilot provinces and was used for the first tranche released in early 2011. The manual was approved, translated, and distributed by the Government to the PHOs country-wide. PHO batchesfrom the northern, central and southern regions were trained in the FM manual in Vientiane and follow-up visits were conducted by the team to provide additional training, especially to enable provincial accountants to train lower level accounts staff. 22 DHO participants from 11 districts in the pilot province (Xayaboury; selected as it is supported directly by the H-SDP) were trained in the manual by the PHO accountants with the support from the CDTA team. Subsequently 38 HC staff in one district (Hongsa) were trained. Direct coaching by the team to these staff proofed useful and led to improved performance in disbursement and accounting. In pre -and post test training on financial management concepts such as the documentation process for submitting financial statements, external audit, procurement, the objective of the Program (H-SDP) grant fund and its budget nomenclature, the tested staff performance improved by 53% (DMF required 50%)
For the third output, the CDTA team developed a Planning, Monitoring and Evaluation (PM&E) manual. The initial draft manual was tested in the 3 pilot provinces and after refinement through participatory workshops, a revised but simple manual that provides guidance on the process of planning, problem identification, prioritizing and reporting. It introduces monitoring concepts, and practical ways of conducting monitoring and evaluation. The manual contains a number of simple and practical tools which will be used in planning, monitoring and evaluation by with procedures for each level (HC/DHO/PHO). The ambition of the Department of Planning and Budgeting, MOH, is that the manual will be used country- and sector-wide for heath sector operations at all levels. The manual was translated into Lao language. Together with the budget norms (output 1) and the FM manual (output 2), H-SDP noticed an improvement in the planning of the program support by the provinces.
|Geographical Location||Lao PDR (nationwide)|
Summary of Environmental and Social Aspects
|Stakeholder Communication, Participation, and Consultation|
|During Project Design|
|During Project Implementation|
|Consulting Services||ADB will engage a total of 11 person-months of international consulting services and 40 person-months of national consulting services. International consultants include a health planning expert (6 person-months) and a financial management expert (5 person-months). National consultants include a public health expert (10 person-months), and 3 financial management experts (10 person-months each). The consultants will be engaged through a firm using the biodata technical proposal and fixed budget selection method in accordance with ADB's Guidelines on the Use of Consultants (2007, as amended from time to time).|
|Responsible ADB Officer||Postma, Sjoerd|
|Responsible ADB Department||Southeast Asia Department|
|Responsible ADB Division||Human and Social Development Division, SERD|
Ministry of Health
Dr. Prasongsidh Boupha
Ban That Khao Vientiane Lao, PDR
|Concept Clearance||24 Apr 2009|
|Fact Finding||27 Apr 2009 to 30 Apr 2009|
|Approval||14 Dec 2009|
|Last Review Mission||-|
|PDS Creation Date||17 Apr 2009|
|Last PDS Update||15 Dec 2011|
|Approval||Signing Date||Effectivity Date||Closing|
|14 Dec 2009||06 Jan 2010||06 Jan 2010||31 Dec 2010||31 Jul 2011||-|
|Financing Plan/TA Utilization||Cumulative Disbursements|
|500,000.00||0.00||20,000.00||0.00||0.00||0.00||520,000.00||14 Dec 2009||446,461.45|
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.
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|Title||Document Type||Document Date|
|Building Capacity for the Health Sector Program Approach||TA Completion Reports||Dec 2011|
|Building Capacity for the Health Sector Program Approach||Technical Assistance Reports||Dec 2009|
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.
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Evaluation Documents See also: Independent Evaluation
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