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Lesson
Support cannot be directed to the most vulnerable in a crisis in the absence of a social protection system that can be utilized or adapted for this purpose—which provides an additional reason for working with developing member countries to establish and strengthen such systems.

Project Number: 54346-001
Project Name: COVID-19 Rapid Response Program
Report Date:
Lesson
When functions and responsibilities are decentralized, policy dialogue with the concerned local authorities during project processing is just as important as dialogue at the central level.Although ULBs in Bangladesh depend on LGD, they enjoy some autonomy. The ULBs rapidly realized the benefit of better governance and financial management and these components were timely implemented. However, it took longer for the ULBs to appreciate the benefits of investments in sanitation and food safety funded by the project loan.

Project Number: 39305-013
Project Name: Urban Public and Environmental Health Sector Development Program
Report Date:
Lesson
In a project involving several ministries, the choice of the executing agency (or agencies) and the role of each ministry must be carefully assessed and discussed with the government and all concerned ministries.

Project Number: 39305-013
Project Name: Urban Public and Environmental Health Sector Development Program
Report Date:
Lesson
Project preparation should have included better articulation of the need or logic for integrating a program loan and a project loan in a sector development program (SDP). Policy dialogue, which is essential to clearly establish an understanding among the executing agencies that policy reforms and project loan financed investments are interlinked, should have been undertaken; however, this was missing in this SDP. Two separate loans delivered in sequence may have been preferable and more manageable.

Project Number: 39305-013
Project Name: Urban Public and Environmental Health Sector Development Program
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
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
Focusing on existing social protection programs and systems and making in-depth policy discussions on reforming them contribute to avoiding the creation of ad hoc programs and arrangements or introducing reforms without having in place a solid institutional setup for its implementation. Alignment with the relevant national strategies ensures the government's strong ownership of prior actions and outcomes. Consideration of these two key lessons will strengthen the design and implementation of future similar programs.

Project Number: 55041-001, 55041-003
Project Name: Strengthening Social Resilience Program (Subprograms 1 and 2)
Report Date:
Lesson
Strong leadership by high-level authorities is required to carry out in-depth and timely policy discussions across a range of government and other development agencies and stakeholders involved in social protection. To meet the country's significant financial needs in a timely manner, the program needed to be prepared under time pressure. Therefore, strong leadership by high-level government authorities in the government was imperative.

Project Number: 55041-001, 55041-003
Project Name: Strengthening Social Resilience Program (Subprograms 1 and 2)
Report Date:
Lesson
Coordination across several government agencies require strong leadership and persistence; given the regular transfer of government officials to other positions and ministries, it is important to set up a scheme for maintaining institutional memory within the executing and implementing agencies throughout program implementation.

Project Number: 55041-001, 55041-003
Project Name: Strengthening Social Resilience Program (Subprograms 1 and 2)
Report Date:
Lesson
A social protection system needs to evolve in line with changes in the socioeconomic conditions of a country. This program supported social protection system reform, requiring the government's continued commitment for sustainable implementation. A key lesson highlighted by this project is for social protection systems to continue transforming in the face of demographic changes and urbanization and to be shock-responsive.

Project Number: 55041-001, 55041-003
Project Name: Strengthening Social Resilience Program (Subprograms 1 and 2)
Report Date:
Lesson
Close consultation with stakeholders during project design and implementation is especially needed to address the difficulties commonly arising from finding appropriate sites for solid waste and medical waste management facilities in urban projects. Due to lack of land and higher costs of construction than estimated at appraisal, it was not possible to construct the integrated waste treatment facilities, slaughterhouses, and medical waste management facilities planned under this program. These components were eventually dropped.

Project Number: 39305-013
Project Name: Urban Public and Environmental Health Sector Development Program 
Report Date:
Lesson
Overall project success depends to a large extent on the successful implementation of risk mitigation measures carefully identified at appraisal. Weak institutional arrangements and lack of ownership saddled the implementation of this program. A lack of capacity and coordination among different agencies compounded the difficulties. The difficulties could have been minimized or avoided through the timely implementation of risk mitigation measures drawn at appraisal. The measures should be based on a thorough assessment of all potential risks throughout the project period.

Project Number: 39305-013
Project Name: Urban Public and Environmental Health Sector Development Program 
Report Date:
Lesson
The project demonstrated that vertical programs such as HIV/AIDS can be efficiently integrated into PHC services. While specific technical support and management will remain necessary at the central level to guarantee quality and effectiveness of the program interventions, implementation at the local level would yield better results when integrated into PHC, whenever possible.

Project Number: 39033-022
Project Name: HIV/AIDS Prevention and Control in Rural Development Enclaves
Report Date: