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Lesson
The success of nongovernment organization (NGO) contracting of health services under the project provided the foundation for Ministry of Health's (MOH) introduction of new contracting arrangements (internal contracting) based on the government's Policy on Public Service Delivery (2006) and adoption of MOH's procedures and guidelines on contracting arrangements.

Project Number: 32430-013
Project Name: Health Sector Support Project
Report Date:
Lesson
Policy reforms should not be too numerous and should be well integrated into an overall project. Highest priority should be given to policy reforms (and covenants) that are necessary for project implementation or sustainability. A stakeholder analysis should be conducted for all proposed policy reforms, and a strategy developed for moving systematically to the desired policy reform reflected in the project's design and monitoring framework.

Project Number: 31242-013
Project Name: Second Health Sector Development Project
Report Date:
Lesson
Rationalization of PHC institutions and provision of adequate health financing should go 'hand in hand'. Thus, the restructuring of health institutions should be accompanied by trained primary health care (PHC) staff, sufficient coverage of PHC facilities, adequate supplies of essential drugs and medical commodities, and health reform;

Project Number: 33036-013
Project Name: Health Sector Reform Project
Report Date:
Lesson
The focus of the EA and PSU was on implementation of the policy matrix. Considerably less importance was given to the loan covenants. The PSU indicated that it would have recruited local support groups if it had been a condition in the policy matrix; however, since it was not a tranche condition, the PSU did not feel compelled to comply. This was also the case with covenants related to social sector expenditures and conditional grants, which were key covenants for ensuring improved social sector performance.

Project Number: 32264-013
Project Name: Punjab Devolved Social Services Program
Report Date:
Lesson
Monitoring and evaluation framework. The overall success of the EAPCR could have been greater had the DMF been better designed. The impact statement could have been closer to the outcome, and assumptions about investor and consumer confidence should have been more realistic. The impact statement could have focused on maintaining sustainable and inclusive public sector spending rather than to restore the Georgian economy to the pre-war trajectory of growth and social development.

Project Number: 42477-013
Project Name: Emergency Assistance for Post-Conflict Recovery
Report Date:
Lesson
The implementation efficiency of the program was constrained by the late recruitment of the Technical Assistance Management Agency (TAMA), and the lack of recruitment of local support groups. The TAMA was meant to mobilize about 4,000 person-months of consulting services. The local support groups were expected to be mobilized in each district for 3 years to enhance capacity. For the majority of program implementation, these tasks became the responsibility of ADB and the program support unit (PSU), albeit with insufficient resources, which negatively affected implementation efficiency.

Project Number: 32264-013
Project Name: Punjab Devolved Social Services Program
Report Date:
Lesson
Lending Modality: Having an appropriate modality is critical. ADB's Disaster and Emergency Assistance Policy together with Achieving Development Effectiveness in Weakly Performing Countries provided a ready framework for Emergency Assistance for Post-Conflict Recovery (EAPCR).

Project Number: 42477-013
Project Name: Emergency Assistance for Post-Conflict Recovery
Report Date:
Lesson
The risk assessment of political resistance to devolution was not sufficiently robust, and mitigating measures were not realistic. The design should have been revised to address political resistance to implementation of the Punjab Local Government Ordinance 2001 (PLGO). Failure to do so undermined program implementation. Another significant design flaw was the multi-sector and ambitious scope of the program. This observation was also raised by the executing agency (EA) during the program completion review mission.

Project Number: 32264-013
Project Name: Punjab Devolved Social Services Program
Report Date:
Lesson
Intensive information campaigns ensure a high degree of community participation in PHC management, sourcing of financing, co-sharing, contributions in kind, and other expressions of support that help to sustain health reform projects.

Project Number: 33036-013
Project Name: Health Sector Reform Project
Report Date:
Lesson
In support of MOH's sectorwide management strategy, ADB's participation in the sectorwide management approach along with other partners in a jointly administered project proved the benefits of close collaboration among health partners. While the Health Sector Support Project (HSSP) was cofinanced by different donors and implemented through an integrated project implementation arrangement under the sectorwide management approach, the project was administered by each donor agency with different implementation schedules.

Project Number: 32430-013
Project Name: Health Sector Support Project
Report Date:
Lesson
The relationship between MOH and the PIU needed to be discussed from the beginning of the project. This would have avoided the PIU isolating itself from the Ministry of Health's (MOH) decision-making process, as happened too often during the first 2 years of implementation. Decision-making procedures need to be clarified to involve MOH departments and higher authorities in decisions affecting bidding processes, consultant selection and outputs, policy matters, and resource allocation in the health sector.

Project Number: 31242-013
Project Name: Second Health Sector Development Project
Report Date:
Lesson
The need for advance recruitment of consultants to assist with planning and review, pre-implementation preparations, and legal support to ensure that project implementation is not delayed.

Project Number: 33036-013
Project Name: Health Sector Reform Project
Report Date:
Lesson
Building on lessons from the Basic Health Services Project, the project gave greater emphasis to close monitoring and supervision by MOH to ensure that civil works were closely coordinated with the supply of equipment and drugs under minimum package of activities (MPA) and complementary package of activities (CPA) guidelines. However, efficient planning, a well-executed plan, and close oversight by MOH would have allowed timely completion of civil works and avoided cost overruns.

Project Number: 32430-013
Project Name: Health Sector Support Project
Report Date:
Lesson
It is essential to include maintenance components for new systems and facility renovations to ensure the sustainability of project outputs. The project initiated several new monitoring systems and supported renovation of health and education facilities. Since it often takes time for staff to understand the usage of new systems and facilities, 6 to 12 months of maintenance services are required to support the gradual shift of maintenance responsibility to the national and state governments.

Project Number: 33312-013
Project Name: Basic Social Services Project
Report Date:
Lesson
Adequate consultation and participation at the state and community level during project design and scope change are essential for understanding the institutional capacity, and for identifying appropriate implementation arrangements and required technical assistance. Although most of the project activities were at state level, the project was designed to be managed at the national level. Consultations with all stakeholders at state or lower level during the design and preparation of scope changes would have been helpful to identify most appropriate activities and arrangements.

Project Number: 33312-013
Project Name: Basic Social Services Project
Report Date: