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Lesson
The central project management unit and provincial project management units have monitored financial flows and activity progress as part of routine quarterly reporting. Limited attention was paid to project outcomes in the project framework; outcomes were not changed during the project. Similarly, measurement of the outcomes of the training programs appears to have been limited. Given ADB's results-based approach to Project Management, both the Ministry of Health and ADB should have given a greater focus to monitoring and evaluation.

Project Number: 37115-013
Project Name: Health Care in the Central Highlands Project
Report Date:
Lesson
Investment in civil works and equipment has recurrent budget implications. Monitoring of whether provinces are allocating greater resources to recurrent budgets is difficult as financial tracking is complicated in a devolved financial management system. User fees may help support the ongoing expenditure support for buildings and equipment in the curative sector, but the preventive system has limited capacity to mobilize resources outside of the state budget.

Project Number: 37115-013
Project Name: Health Care in the Central Highlands Project
Report Date:
Lesson
The considerable delays in implementation were due to complicated procurement regulations of both ADB and the government. These delays and price inflation resulted in the quality of civil works being compromised in some locations and some facilities deviating from the design. Delays in equipment procurement led to the purchase of inappropriate and out-dated equipment. Limited district administrative capacity resulted in delays in imprest accounts being replenished, which constrained progress.

Project Number: 37115-013
Project Name: Health Care in the Central Highlands Project
Report Date:
Lesson
The Joint Annual Health Review, 2010 notes that a shortage of human resources continues in several fields, including preventive medicine, public health, pediatrics, infectious diseases, mental illness, forensics, pathology, tuberculosis and leprosy, food safety and hygiene inspection, medical technology, engineers specialized in medical equipment, health statistics, and hospital management. The provincial health departments identified postgraduate training in health specializations as a major project benefit, leading to more available district staff and specializations.

Project Number: 37115-013
Project Name: Health Care in the Central Highlands Project
Report Date:
Lesson
The selection of adjoining provinces in the Central Highlands had several benefits. First, these provinces have a large number of poor ethnic minorities and other residents with low health status and limited access to health services. As such, these areas align with both the government's policy of supporting disadvantaged groups and ADB's overarching objectives of tackling poverty. Ethnic minorities needed continuous targeting as their health status and sociocultural adverse health behaviour warranted project interventions.

Project Number: 37115-013
Project Name: Health Care in the Central Highlands Project
Report Date:
Lesson
Self-supply groundwater wells have not been closed completely as envisaged at appraisal and still exist in Qingfeng and Puyang counties. As a result, the actual operational capacity of three water supply plant (WSP) subprojects is lower than designed. The self-supply groundwater wells also caused difficulties in collecting the wastewater tariff.

Project Number: 34473-013
Project Name: Henan Wastewater Management and Water Supply Sector Project
Report Date:
Lesson
At the beginning of project implementation, three local governments tried to adopt build-operate-transfer (BOT) modality and contracted private companies to construct the wastewater treatment plants (WWTPs). However, the local governments had inadequate capacity to conduct due diligence, and the contracted companies could not provide adequate counterpart financing. The unsuccessful introduction of BOT modality also showed that the capacity of individual WWTPs was too limited to ensure commercial viability.

Project Number: 34473-013
Project Name: Henan Wastewater Management and Water Supply Sector Project
Report Date:
Lesson
Inclusion of an innovative process monitoring system enabled the correction of processes during implementation. This was especially important given the volatile and uncertain security conditions. Process monitoring helped in assessing the work of nongovernment organizations and modifying village planning, livelihood enterprise development services, and microfinance processes. [Main text, para. 68]

Project Number: 33249-013
Project Name: North East Coastal Community Development Project
Report Date:
Lesson
Channeling credit through community organizations rather than individuals could reduce defaults through peer group pressure and lower administration costs. Credit lending terms should be consistent with the prevailing local microfinance conditions. [Main text, para. 67]

Project Number: 33249-013
Project Name: North East Coastal Community Development Project
Report Date:
Lesson
No legal precedents for the special area management planning safeguards existed and no single agency was empowered to handle legal aspects of coastal resource planning. Implementation of coastal planning needed better interagency coordination and the Coast Conservation Department should have been included in the design as the implementing agency for component C to give a greater sense of ownership. [Main text, para. 66]

Project Number: 33249-013
Project Name: North East Coastal Community Development Project
Report Date:
Lesson
Providing initial training for the government field staff, which had been weakened by the civil conflict, would have helped implementation. The capacities of the implementing partner nongovernment organizations were overestimated at the design stage and the project management unit spent a lot of time on guidance and training. [Main text, para. 65]

Project Number: 33249-013
Project Name: North East Coastal Community Development Project
Report Date:
Lesson
The Gender Action Plan (GAP) provided a framework for gender-balanced activities but a project management unit gender specialist should have been included in the project design to manage the plan. Implementing the GAP separately through the rural development societies and the women's rural development societies gave women space for involvement but reduced opportunities for fully gender-balanced operations. [Main text, para. 64]

Project Number: 33249-013
Project Name: North East Coastal Community Development Project
Report Date:
Lesson
A strong project management unit with qualified staff under a competent project director who remained throughout the project enabled implementation despite disruption from a tsunami and renewed conflict. [Main text, para. 63]

Project Number: 33249-013
Project Name: North East Coastal Community Development Project
Report Date:
Lesson
The establishment of the Integrated Water Resources Management Unit (IWRMU) in 2003 to monitor completed subprojects further enhanced the commitment of Local Government Engineering Department to the sustainable management of small-scale water resources subprojects. The current frequency of staff transfers and re-posting at the IWRMU, on the other hand, diminishes initiative and commitment to work. [Main text, para. 60(vi)]

Project Number: 30209-013
Project Name: Second Small-Scale Water Resources Development Sector Project
Report Date:
Lesson
The Local Government Engineering Department should have submitted withdrawal applications on time and ADB disbursements against the applications also had to be timely, to sustain the flow of funds. [Main text, para. 60(v)]

Project Number: 30209-013
Project Name: Second Small-Scale Water Resources Development Sector Project
Report Date: