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Lesson
The successful implementation of HSDP is the result of ADB’s long-term commitment to the health sector in the Lao PDR. Long-term commitment and policy dialogue built on trust and confidence between ADB and MOH, and the government, in general. The SDP modality was proposed by ADB in 2007 for the Health System Development Project but MOH was not yet confident enough about the support of MOF. Policy dialogue continued and in 2009, MOH and MOF were ready for an SDP approach.

Project Number: 41376-022
Project Name: Lao People’s Democratic Republic: Health Sector Development Program
Report Date:
Lesson
Need to better identify barriers to access and use of primary health care services by the intended beneficiaries. HSDP addressed supply-side issues, but demand for services needs to be increased and oriented through better information and communication, and social marketing addressed to the beneficiaries. The health sector needs to mobilize other sectors to achieve health for all. Some barriers cannot be reduced by the health sector alone.

Project Number: 41376-022
Project Name: Lao People’s Democratic Republic: Health Sector Development Program
Report Date:
Lesson
Project design should be thorough, realistic in cost and time estimation, and in the delivery of target outputs.

Project Number: 35377-013, 35377-023
Project Name: Regional Road Development Project
Report Date:
Lesson
An SDP approach increases the transaction costs compared with a programmatic approach. It is, however, a useful transition in supporting the development of a sector, and in establishing collaboration between MOF and line ministries (such as MOH or others). A CDTA grant or loan attached to an SDP or a program increases the chances of successful development of the sector.

Project Number: 41376-022
Project Name: Lao People’s Democratic Republic: Health Sector Development Program
Report Date:
Lesson
Output and outcome performance monitoring was generally limited to the baseline, midterm and end of program survey. Key core performance data should be collected, analyzed and reported on a quarterly basis, in alignment with standard government indicators. This provides provinces and the national level with an up-to-date status of program performance and comparative data across provinces. These data should inform the annual planning process and identify where additional support is needed.

Project Number: 41376-022
Project Name: Health Sector Development Program
Report Date:
Lesson
Funding is necessary, but is not sufficient for building capacity in the provinces and districts as they move to decentralized governance. Strengthening regulatory arrangements and institutional capacity is dependent on good management and financial procedures. A number of the provinces have increased management and technical competency and can play a valuable role through mentoring and/or twinning programs to help expand successful initiatives to others provinces.

Project Number: 41376-022
Project Name: Health Sector Development Program
Report Date:
Lesson
The coverage for the health equity fund (HEF) scheme supported by the program increased from three pilot provinces to cover all eight target provinces. This resulted in a higher number of eligible beneficiaries and health service utilization by the poor. Despite this, a large percentage of the eligible beneficiaries were not accessing the free HEF-funded services.

Project Number: 41376-022
Project Name: Health Sector Development Program
Report Date:
Lesson
The program tested a new fund flow mechanism for the health sector. Based on the successful trial the government has increased funding for health at the provincial level, resulting in expanded health services coverage, particularly for maternal, newborn, and child health care (MNCH) services and the provision of free health care for the poor.

Project Number: 41376-022
Project Name: Health Sector Development Program
Report Date:
Lesson
The need to take immediate action to scale down project costs, and/or cancel part of the corresponding loan, when it becomes apparent that the government is unable or unwilling to put up the necessary counterpart funds. While it is important to correctly and objectively assess implementation constraints and implementation capacity, countries with serious development needs and weak institutional capacity should be assisted with building up this capacity as part of project design.

Project Number: 30210-013
Project Name: Reproductive Health Project [Loan 1900(SF)-PAK]
Report Date:
Lesson
The need for more frequent review missions, probably with an appropriate consultant/advisor on board, in the early years of implementation and for as long as project implementation is deemed off track; and

Project Number: 30210-013
Project Name: Reproductive Health Project [Loan 1900(SF)-PAK]
Report Date:
Lesson
The need for start-up TA to set the stage for effective project implementation as part of the loan covenant, establish the PCUs and/or PIUs, and ensure that a realistic implementation arrangement is put in place, even if it means revising the project implementation design, drafting a management operation manual, assisting in the opening of imprest accounts, training project staff on ADB procurement and disbursement procedures and reporting requirements, and initiating the preparation of procurement and disbursement documents;

Project Number: 30210-013
Project Name: Reproductive Health Project [Loan 1900(SF)-PAK]
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
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
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
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: