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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
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
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:
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
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
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
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
Learning from and drawing on the achievements of past interventions is critical to the success of comprehensive policy reforms supported by the programmatic approach to policy-based lending (PBL).

Project Number: 51199-001
Project Name: Ulaanbaatar Air Quality Improvement Program
Report Date: