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cA AS5s t-A/+-)/A< Document of The World Bank FOR OFFICIAL USE ONLY Public Disclosure Authorized Report No. 12416-BUR STAFF APPRAISALREPORT BURKINAFASO Public Disclosure Authorized HEALTHAND NUTRITION PROJECT (PDSN) MARCH11, 1994 Public Disclosure Authorized MICROGRAPHICS Report No: 12416 BUR Type: SAR Population and Human Resources Operations Division Sabelian Department Public Disclosure Authorized Africa Region This documenthas a restldteddiskibu_on and may be used by rdpients only in the perormanoeof their officialduties. Its contentsmay no otherwisebe disclosedwtout World Bank autiorizlion. CURNCY OUIVLENT Curncy Unit = CFA Franc (CPAF)I US$1 = 270 CFAF (Rate prior to Janyary 12, 1994) Curmnt Rate = CFA FranclUSSI= 580 CFAF WEIGHTS AND MEASURES MetricSystem I m. = 1.O9yd. 1 sq.m. = 10.76sq. ft. FISCAL YEAR July 1 - June 30 -~~~~~~~~~~~~~~~~~~~~~ egg,, mu * a em m m d, ..e e . .. H.m. 01 ceescee. m e... * e m ...... me mm. i W Wr' Wt " r 111 "' .a.r 'tf1 StI tlirlliEI .WtE' r IE 1,1'I '['I MCH Mtderal and Child Haelth ME - MM6adwn endekaI Entia Drg MmFF Mnre d&l'EConoea Ja nFMa at dil I Minisr of FAMe NWPlanng MO - Min y of ealth MPR MA- uwi"proa4&qAue MSPSF - Mbslsalrahit swutM.Vle ll,c aciode sdc akde lakmd&I Mitry of Health,SoCW Developmet and th Famy MST - M ainduaszuuae awran I Sexaly Tauaitd Dsee NGO - Non-Pgove ntal Orgniatio OCCGB - Orgw ar d ceoniltnaon aetdscoeprusn pour la bc c L gmanduwand&a / Or1anizatodof Coordinato and Cooan forthe Fightapgnt Mjr Endeic Di_a OCP OnchoceciaadsContl Pogam OCS - Organtrclion ommunauatr d saw I communityHealt Orgaiaons OMS - Oryosak nondlal dc.toa a I WorldHealth Oaiza OR - Opeationa Reseah OSr - Ofca de sang ha auvai&ersI Bureauof Worker' Health PASE - Pogramme dppa a la su4WeillanCaipUdhmlgi q I EpidemiologicalSurveillaem Support ProjeAt PCU - Proect Coordinang Unit PDDS - Pkide &wlppain & dibct WaEI Dit Healh DevelopmentPlan PDSN - Proj.: devloppamaude saWn ade nurton I Hea and Nuti DevelopmentPoject PDSS - Projes 4dioppamaemes * ansfade sam / Health Serviea Deveowmen Project PEG - Prevuuona Lc conrak dhaand es goelsr a I Training Comm.con e Prvenon of Endmc Gown PEV - PrOgruMnsaEgi di ~-acccaonI Expanded Pognrame on Imn_iao PHC - Prmry HealthCare PMA Paqua ibm dactdvts I MInimumActvie Pacage PM - Proeion maaerne at bWfana I Mate:aal and Child Health PNUD - Pgrm des NadtonsUnapowrkd.Aoppmam I Unied Nat;onsDevelopment Progrmme PitA Pha-acs rgonala d'approvs omnem / RegiowalSupply P bamAci PSP - Pos. de sad pdmr I PrimaqHealth Care Post SA - Specal Accou SAFER - Soc#W ajHcbw d'icda a de Maksanom I Afica Firm for Stue sa Achievemnt SeP - Save the Childr Fund SPE - Sagqemm d'di I GovernmentCertified MiA SIDA - Syndv me d'lmw Jficcqids I AIDS SMI - Sawt mamelk aetinfundk / Mote and Chld Heath SOEs - State of Expends_ SONAPHARM - Soc-M nanalk d'aPPAvonMantph Iadque NationalPharmaceul SupplyCompany SOSUCO - SociEt acsQ,v de Ia ComoE I Como6 Companyof Sugar Manufetus 3SP - Soins de sanapfar / PrimaryHealth Care mSu - Seually Trnmited Disea TDCI - Troubes Du ear Carncas an de Iodine DeficiencyDiseses TRO - IhErapk de rfda"en par voe oral UCP - Unit d oorfinaton du projet 1 ProjectCoordini Unit UNDP - UnitedNations Development Programme UNFPA - Unitd NationsFund for Populatn Acvies UNICEF - UnitedNations lntemaonad Children's Fund USAID - UnitedSe Agecy for Inrnatinal Developm USC - UnW de souin des comosa VHW - Vllage HealthWorker VITAL - Viamin A Fidd SupportProject (JSAID) WHO - WodtdHealth O:anizaton WID - Womenin Dealoment BURKINAEAS ',ALTHAND NUTRITON PROJECT fPDSN) TABLE OF CONTENTS ClrET AND PROJCT SUMMARY........................... ,.i I. RODUCTION. .................... t . I1. SECTORALdCON EXT .................... 1 A. Health Status.................. I B. Sector Organizationand In stitu .................................................tio n s 3 C. Health Sector Financing and Staffing. ................................................. 5 D. SectorDevelopment Issues .......................... ... ... ......... "....I...6 1. Issueswith regard to HealthServices .................................................. 6 2. Issueswith regard to Nutritionand EndemicDisease Control .................... 8 E. Government'sStrategy ................................................ 9 F. TheBank Group's Role ................................................. 11 G. LessonsLearned ................................................. 13 m.IT BPOECT...................................................... 13 A. ProjectRationale ...................................................... 13 B. ProjectObjectives ...................................................... 14 C. ProjectSummary ...................................................... 14 D. ProjectScope ...................................................... 15 E. ProjectDescription..............16 B. Project Description~~~:.........I............................................. 1 1. ImproveQuality of HealthServices .................................................... 16 2. ReduceMicronutrient Deficiencies ............................................. 20 3. Achieveand MaintainControl of ParasiticDiseases ................. ..............22 4. StrengthenMSASF ............................................. 23 F. ProjectCosts and Financing ............................... 25 IV. PROJECT M...IEMENTAT.ON................................................ 26 A. Statusof ProjectPreparation and Readiness................................................... 26 B. ProjectCoordination and Management................................................... 26 C. Monitoringand Evaluation................................................... 27 D. Procurementand Disbursement....................... ............................ 27 E. Disbursements................................................... 30 F. Accomting, Auditing and Reporting................................... ................ 31 V. PROJECT BENEFMTSAND RISKS ........................................ 31 A. Benefits................................................... 31 B. RiskR ................................................... 33 VI. AfREEMENTS TO BE REACHED AND ........................... 33 Ts M p R s bo d ft fidingo paBank appranisa sim w h sedB Finau In un 19. cAbg mesma bm ,gmB Cras Mnage d =wiio dr). Saedd Be-Hahm (Opar Officer).Yva Gns (ulic Haft Spe,a . TOO Mar*l(Nute SpecW4. D1ai Bmm (I_ Specas, ad JenFhPire Uer (Publc Heat SPeia. 1Ma Badd 1. a _ B_Ute w peer iw. Pncips ppartoly docm-nt fr te t were pmpard by Caa M EMmGolde (&4ka Far. P*We EV wV R W : bh Sw W e S , a M. P Cli (a 1 Waiw S o U E S. u_ Heat NedIn &u9ia Pam'sRra C.uuada) folowingmrio to Ruh PIwoin 192 Ms Katede Mara ad Mr. Ptw Pr&mm we te Dqm Diror nd mgi Divion Chbe, rtlve*. TABLEOF CONrENIS (Cont'd) ANM-=EPaee No. 1.1 Socio - EconomicIndicators 36 2.1 Annual Bank Staff Reportto -the ExecutiveDirectors on the OCP 37 2.2 Organigrammedu Ministerede la Sante, de l 'ActionSociale et de la Famille 42 OrganizationChart of the Ministryof Health, Social Developmentand the Family 2.3 Backgroundon the MicronutrientComponent 43 2.4 Projetde Politique Ginmralepour le secteurde la santd 48 Draft Letter of Health Sector Policy 3.1 Organisationdu systemedes districts sanitaires 62 Organizationof the Health District System 3.2 Les Plans de DUveloppementdu district sanitaire 73 DevelopmentPlans for the Health District 3.3 Le systOmed'organisations commautaires partclpa a 1e'ffortde sante 76 CommunityOrganizations participating in the Health Movement 3.4 Formationdu personneldes districts sanitaires 80 Health DistrictPersonnel Training 3.5 Programmede reddplolementet de recrutementdu personnel de SanWPublque 92 Redeploymentand Ree.ruitmentProgramme of Public Health Personnel 3.6 Approvisionnementdu pays en m&Iicamentsessentiels : La CAMEG 94 Supplyingthe countrywith EssentialDrugs: the CAMEG 3.7 MicronutrientComponent: DetailedImplementation Plan and Objectives 99 3.8 Programmede lutte contre les dfflences en micron*rlents 101 MicronutrientDeficiency Control Program 3.9 Projet de note techniquesur la reorganisationde la directionde la mddecinepreventlve 104 Draft TechnicalNote on the Reorganizationof PreventiveMedicine Directorate 3.10 Projet dorganisation du service de maInenance 106 Draft Organizationof the MaintenanceService 3.11 Financementdes services de sante dans les districts sanitaires 108 Health ServicesFinancing in the Health Districts 4.1 Plan de supervision 120 SupervisionPlan 4.2 Termesde RNfUrencesde l'UCP 122 Terms of Referencefor the PCU 4.3 ProcurementPlan and Timetable 130 4.4 DisbursementProfile 131 4.5 Project Cost Tables 131 MAPS: IBRD 25394, 25476, and 25477 BURKINAFASO BALTH AND NUIRB N PROJECr (PDSN) CREDIT ANDPROJECT SUMMARY Govemment'f BuddnaFaso Beneficians:. Ministy of Public llealth and Social/FamilyAction Credit Amount: US$29.2 million (SDR21.2 million) Terms: Standard,with 40 yearsmaturity Description: The project would assist the Govemmentin its efforts to: (a) improve significantly the quality, coverage and utilization of basic health services for the Burkwnbe popuation, (b) enbance the nutritional status of the population, and (c) develop a national capacity for achieving sustainable control of endemicparasitic diseases. To achievethese bjectives,the projcct would support policy reformsand investmentsdesigned to: (1) improve galitX. coverage. and utilization of health semices by: (a) strengtheninhthe health system nymd through: (i) fimutionalupgading/cotuction of health facilities and increased uopervon of staff operations and refefls