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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
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
Community facilitators must be qualified and committed, and enough time must be set aside for community empowerment activities, to ensure that community members are sufficiently involved in prioritizing their needs, developing investment proposals, and making decisions. [Main text, para. 65(ii)]

Project Number: 40247-013
Project Name: Rural Infrastructure Support to the PNPM Mandiri Project
Report Date:
Lesson
Involving the beneficiaries at all stages of planning and implementation of upgrading activities and promoting inclusive community empowerment are critical in ensuring pro-poor investments and sustainability.

Project Number: 40247-013
Project Name: Rural Infrastructure Support to the PNPM Mandiri Project
Report Date:
Lesson
Substantial evidence demonstrates that community-driven development (CDD) approaches are more effective than other approaches to basic infrastructure development. Evidence also indicates that CDD is likely to offer better cost recovery and maintenance of completed infrastructure facilities and services because of the strong sense of ownership of the community members. In addition, CDD leads to better accountability. Transparency in decision making and procurement and increased use of audits have demonstrably reduced corruption and leakage of public funds.

Project Number: 40247-013
Project Name: Rural Infrastructure Support to the PNPM Mandiri Project
Report Date:
Lesson
Lengthy administrative processes. Implementation delays were largely caused by lengthy procurement and financial control procedures at all levels. While the project management unit (PMU) and provincial project management unit (PPMU) capacity was also an issue, the government's administrative procedures were time consuming. ADB administration was considered relatively efficient.

Project Number: 30285-013
Project Name: Rural Health Project
Report Date:
Lesson
New or innovative projects should establish consistency of country definitions of dataand monitoring variables with international conventions during project preparation.This consistency is particularly important if such variables are to be used for projectperformance reporting and the determination of outcome and impact at project completion.

Project Number: 32143-013
Project Name: Community-Based Early Childhood Development Project
Report Date:
Lesson
Even if a project is aligned with regional strategies, designs need to incorporate sufficient national consultation and consider country absorptive and technical capacity and commitment.

Project Number: 38599-022
Project Name: HIV/AIDS Prevention and Capacity Development in the Pacific
Report Date:
Lesson
Establishing a project steering committee is challenging where separate development partner committees already exist to oversee arrangements for Pacific countries.

Project Number: 38599-022
Project Name: HIV/AIDS Prevention and Capacity Development in the Pacific
Report Date:
Lesson
Targeting. The project improved services for the poor and had a substantial focus on maternal care but provided less targeted support for ethnic minorities. Several of the interventions for ethnic minorities didn't materialize. The project evaluation study showed that the poor in general and ethnic minorities in particular benefited from the government support for commune health stations (CHSs) and health insurance, while ADB funding provided more general public support. More could have been achieved with better targeting for minorities, assuming MOH concurrence.

Project Number: 30285-013
Project Name: Rural Health Project
Report Date:
Lesson
The sequence of reforms in the policy matrix was such that all substantial results could be achieved only after the completion of second tranche actions. In addition, liberal assessment of compliance allowed the release of the first tranche without achieving much toward sustainable outputs. More result-oriented sequencing of policy actions for the first tranche could have achieved some sustainable improvements in social service delivery.

Project Number: 37218-013
Project Name: Balochistan Devolved Social Services Program
Report Date:
Lesson
Piloting reforms. While government ownership of project formulation was strong, proposed pilots were too ambitious given MOH constraints and the lack of detailed plans or technical support. On the other hand, the project flexibly responded to several policy changes and national developments by adjusting its scope, which counterparts appreciated. Demand-led programming improved project impact.

Project Number: 30285-013
Project Name: Rural Health Project
Report Date: