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Lesson
Ensuring close coordination between relevant agencies and capacity building are essential for land acquisition and resettlement activities are carried out in a timely and satisfactory manner. For this project, close coordination was forged between the implementing unit and the Land Agency.

Project Number: 41243-012
Project Name: Fourth Health Sector Development Project
Report Date:
Lesson
High turnover of government project staff affects institutional memory and implies additional time and effort to introduce the project’s concepts to a new team to ensure the government is involved and owns the project implementation.

Project Number: 41243-012
Project Name: Fourth Health Sector Development Project
Report Date:
Lesson
Unforeseen events outside the control of the executing agency, such as amendments to laws and regulations and changes in decisions, require additional effort, time, and resources—and accordingly, flexibility in the project. This is especially relevant in the context of a country such as Mongolia, which is still transitioning to a market-based economy and rapidly developing, and therefore, frequently introduces new changes to the existing legislation.

Project Number: 41243-012
Project Name: Fourth Health Sector Development Project
Report Date:
Lesson
Projects that plan to introduce systemic reforms require more time for advocating new concepts, building consensus, and overcoming the institutional interests of stakeholders. This was the case with the establishment of the Medicines Regulatory Authority, for which thegovernment spent nearly 10 years.

Project Number: 41243-012
Project Name: Fourth Health Sector Development Project
Report Date:
Lesson
Understanding and addressing the needs of all those involved in the sector. The health system requires two types of personnel: (i) health services providers; and (ii) administrative personnel responsible for planning, budgeting, resource allocation, and monitoring. Both need to be involved.

Project Number: 47137-003, 47137-006
Project Name: Health Sector Governance Program (Subprograms 1 and 2)
Report Date:
Lesson
The implementation arrangements ensured that the provincial health offices, as implementing agencies, were stakeholders of the reforms. Rather than simply following instructions from the center, the provinces were involved in the program, better understood the reform objectives, and supported the implementation of the HSRS.

Project Number: 47137-003, 47137-006
Project Name: Health Sector Governance Program (Subprograms 1 and 2)
Report Date:
Lesson
Intersector coordination. ADB involvement in the financial sector facilitated dialogue with and support from the MOF and ensured better harmonization of the financial systems from different sectors. This support from one key sector, for instance, reinforced effectiveness of the reforms and is likely to enhance the sustainability of the program.

Project Number: 47137-003, 47137-006
Project Name: Health Sector Governance Program (Subprograms 1 and 2)
Report Date:
Lesson
Better data and information. A better use of more accurate data for planning and budgeting by newly trained personnel at the central, provincial, and district levels could have significantly improved allocative efficiency in the health sector, enabling better targeted policies and activities in operational and development plans.

Project Number: 47137-003, 47137-006
Project Name: Health Sector Governance Program (Subprograms 1 and 2)
Report Date:
Lesson
Implementation of government’s priorities. Involving the provincial and district levels and strengthening their capacity to identify and address the local needs reflected the government’s Sam Sang initiative, giving provinces and the districts more responsibilities and authorities. The reforms offered an opportunity to effectively apply the new policy, resulting in a strong government support for HSGP. ADB’s capacity-building activities at the provincial level in previous health projects provided useful experience to better target technical support at all levels.

Project Number: 47137-003, 47137-006
Project Name: Health Sector Governance Program (Subprograms 1 and 2)
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
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
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: