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Lesson
Unforeseeable changes in the regulatory framework introduced after project approval can result in changes in project design and scope. In this case, it prompted lengthy discussions that ended up with the cancellation of one output. The experience needs to be considered for projects that plan to address complex issues with multisectoral involvement in countries like Mongolia that are still transitioning and frequently introduce changes in the existing regulations.

Project Number: 45009-002
Project Name: Fifth Health Sector Development Project
Report Date:
Lesson
High turnover of staff in project implementing and other relevant agencies affects institutional memory. It requires additional time and effort to introduce to new staff while ensuring close involvement and ownership in project implementation.

Project Number: 45009-002
Project Name: Fifth Health Sector Development Project
Report Date:
Lesson
High staff turnover worsens capacity constraints. In this project, it aggravated lack of capacity to undertake procurement using ADB's Procurement Guidelines and the increased risk of misconduct and delays during implementation. Additional procurement capacity building for executing agency staff during implementation is therefore necessary even if procurement capacity risk is considered minimal at project appraisal.

Project Number: 48226-003
Project Name: Fifth Health Sector Development Project
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: