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Lesson
Establishing a comprehensive coordination unit for rural health transformation is a gargantuan and complex task requiring dedicated programming and targeted resources. A feature of the intended design, where the project support unit would be integrated into the Department of Health (DOH) to establish a comprehensive coordination unit for rural health transformation, was not realized. The ambition was relevant, and the government’s capability to manage projects to improve primary health care and coordinate partner programs should be strengthened.

Project Number: 41509-013
Project Name: Rural Primary Health Services Delivery Project
Report Date:
Lesson
Determining and improving the effectiveness of large and complex projects are far more complicated than measuring progress against the indicators in the design and monitoring framewrok (DMF). The emphasis on quantitative measures, even if well considered, could result in displacing goals and/or inaccurately representing project success or failure. In the context of the COVID-19 pandemic and the Implementation timelines, some DMF targets were unrealistic. The project provided for formative evaluations but they were not closely coordinated with the DMF.

Project Number: 41509-013
Project Name: Rural Primary Health Services Delivery Project
Report Date:
Lesson
Specificity of intended outcome is essential to enable programming, innovation, and cycles of project improvement. The project’s outcomes were broadly defined and lacked clear pathways detailing how the outputs would interact with each other and achieve the outcomes. The vagueness is likely part of the reason that the design had significant gaps and flawed assumptions on how the activities would lead to the intended outcomes.

Project Number: 41509-013
Project Name: Rural Primary Health Services Delivery Project
Report Date:
Lesson
Use of data and planning to target delivery strategies improve performance. Staffing and access to medical supplies were common challenges and well recognized during project design and documented during the project, including through the formative evaluations, the DFAT-funded independent evaluation, and the project midterm review. The chief executive officers (CEOs) of the provincial health authorities in high-performing provinces identified the use of data and planning to target delivery strategies as a factor in improved performance.

Project Number: 41509-013
Project Name: Rural Primary Health Services Delivery Project
Report Date:
Lesson
The private sector can be a viable partner in health services delivery.

Project Number: 39033-022
Project Name: HIV/AIDS Prevention and Control in Rural Development Enclaves
Report Date:
Lesson
Multisector collaboration is most beneficial for HIV/AIDS prevention.

Project Number: 39033-022
Project Name: HIV/AIDS Prevention and Control in Rural Development Enclaves
Report Date:
Lesson
Context−specific behavior change programs are crucial to HIV/AIDS prevention.

Project Number: 39033-022
Project Name: HIV/AIDS Prevention and Control in Rural Development Enclaves
Report Date:
Lesson
The project supported the One Health concept, which emphasizes the links between animal health and human health and emerging animal and human diseases. One Health provided a platform for unprecedented integration of animal, human and ecosystem health issues to fight the threat of avian influenza. The systematic collaboration of technical agencies across disciplines, such as FAO (veterinarians) and WHO (medical doctors) and civil society organizations (community health workers) supported by the project has promoted this concept since the beginning of the project.

Project Number: 39662-012
Project Name: Prevention and Control of Avian Influenza in Asia and the Pacific
Report Date:
Lesson
ADB's high-level steering committee demonstrated ADB's institutional support, which enhanced coordination between development partners. The committee, comprising the heads of all regional departments and the Strategy and Policy Department and chaired by the director general of RSDD, provided prompt policy guidance and expedited decisions and actions. It also ensured that the needs of the countries were ascertained and that they had adequate access to project resources.

Project Number: 39662-012
Project Name: Prevention and Control of Avian Influenza in Asia and the Pacific
Report Date:
Lesson
ADB was able to use its convening power effectively because it had the necessary in-house technical expertise. Public health experts on ADB's staff with knowledge of emerging infectious diseases were involved in designing and implementing the project. This in-house expertise made the dialogue with the technical and regional agencies to strengthen regional collaboration within and across the animal health and human health sectors possible.

Project Number: 39662-012
Project Name: Prevention and Control of Avian Influenza in Asia and the Pacific
Report Date:
Lesson
Each new outbreak of disease confronts projects such as this one, as well as the implementing partners and global community, with a fresh challenge, because its early spread outpaces the gathering of scientific evidence needed to formulate containment policies. Each successive outbreak is followed by an initial opaque period characterized by a frustrating lack of scientific evidence on which to base policies and technical guidance.

Project Number: 39662-012
Project Name: Prevention and Control of Avian Influenza in Asia and the Pacific
Report Date:
Lesson
The rapid launch and accelerated implementation of the project made necessary by the threat that avian influenza would become a pandemic made it difficult to define verifiable indicators for a number of the outputs under the regional capacity building and regional coordination components. A mid-term review of the project would have facilitated a review and updating of the design and monitoring framework.

Project Number: 39662-012
Project Name: Prevention and Control of Avian Influenza in Asia and the Pacific
Report Date:
Lesson
National M&E remains a challenge due to lack of capacity and minimal regional support to assist participating DMCs. While regional evaluations of some activities have taken place, they need to focus on impact or outcome indicators rather than on the process of implementation.

Project Number: 38599-022
Project Name: HIV/AIDS Prevention and Capacity Development in the Pacific
Report Date:
Lesson
Establishing a project steering committee is challenging where separate development partner committees already exist to oversee arrangements for Pacific countries.

Project Number: 38599-022
Project Name: HIV/AIDS Prevention and Capacity Development in the Pacific
Report Date:
Lesson
An executing agency's ability to implement project activities within set timeframes is diluted where there is limited PMU capacity, a lack of experience with ADB procedures, and inadequate executive oversight.

Project Number: 38599-022
Project Name: HIV/AIDS Prevention and Capacity Development in the Pacific
Report Date: