Document of The World Bank Public Disclosure Authorized FOR OFFICIALUSE ONLY Report No: 21320-KM IMPLEMENTATIONCOMPLETION REPORT Public Disclosure Authorized (2553) ONA CREDIT IN THE AMOUNTOF SDRs9.2 MILLION(US$ 13.0 MILLIONEQUIVALENT) TO THEREPUBLIC OF COMOROS FOR A POPULATIONAND HUMANRESOURCES PROJECT Public Disclosure Authorized December 21, 2000 HumanDevelopment 4 AfricaRegion Public Disclosure Authorized This documenthas a restricteddistribution and may be used by recipientsonly in the performanceof their official duties. Its contents may not otherwise be disclosed without World Bank authorization. CURRENCYEQUIVALENTS (ExchangeRate Effective1993) CurrencyUnit = ComorianFranc (CF) CF 1 = US$ 0.003663 US$ = 273'CF FISCALYEAR January l-December31 ABBREVIATIONSAND ACRONYMS AIDS AcquiredImmuno Deficiency Syndrome CDSF CommunityDevelopment Support Fund EPI ExpandedProgram of Immunization FADC Fonds D'Appuiau DeveloppementCommunautaire GDP Gross DomesticProduct IDA InternationalDevelopment Association IEC Information,Education, and Communication ILO InternationalLabor Organization (of the UN) MERCAP MacroeconomicReform and CapacityBuilding Project MOH Ministryof Health NGO Non-governmentalOrganization OAU Organizationof AfricanUnity PNAC NationalAutonomous Pharmacy of Comoros PPF Project PreparationFacility SAR Staff AppraisalReport UNDP UnitedNations Development Program Vice President: CallistoE. Madavo CountryManager/Director: HafezM. H. Ghanem SectorManager/Director: ArvilVan Adams Task Team Leader/TaskManager: MalongaMiatudila FOR OFFICIAL USE ONLY IMPLEMENTATION COMPLETION REPORT COMOROS: POPULATION & HUMAN RESOURCES PROJECT CR. 2553 CONTENTS Page No. 1. ProjectData 1 2. PrincipalPerfornance Ratings 1 3. Assessmentof DevelopmentObjective and Design,and of Qualityat Entry 1 4. Achievementof Objectiveand Outputs 4 5.Major FactorsAffecting Implementation and Outcome 7 6. Sustainability I1 7. Bank and BorrowerPerformance 10 8. LessonsLearned 12 9. PartnerComments 14 10.Additional Information 14 Annex 1. Key PerformanceIndicators/Log Frame Matrix 15 Annex 2. ProjectCosts and Financing 19 Annex3. EconomicCosts and Benefits 21 Annex4. BankInputs 22 Annex5. Ratingsfor Achievementof Objectives/Outputsof Components 24 Annex6. Ratingsof Bankand BorrowerPerformance 25 Annex7. List of SupportingDocuments 26 Annex 8. BeneficiarySurvey 27 Annex9. Borrower'sContribution 31 Map # IBRD 26074 This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not be otherwise disclosed without World Bank authorization. ProjectID: P000596 ProjectName: POP & HUMAN RESOURCE Team Leader: Eileen Murray TL Unit.'AFMMG ICR Type: Core ICR Report Date: December 21, 2000 1. Project Data Name: POP & HUMAN RESOURCE LIC/TFNumber: 2553 Country/Department: COMOROS Region: Afiica Regional Office Sector/subsector: HT - Targeted Health; SA - Social Funds & Social Assistance KEY DATES Original Revised/Actual PCD: 10/21/1990 Effective: 06/29/1994 06/29/1994 Appraisal: 03/01/1993 MTR: 06/01/1996 11/01/1996 Approval: 12/14/1993 Closing: 06/30/1999 06/30/2000 Borrower/Implementing Agency: GOVT./M1N.OF HEALTH/EDUCATION Other Partners: STAFF Current At Appraisal Vice President: Callisto E. Madavo Edward K. Jaycox Country Manager: Hafez Ghanem Francisco Aguirre-Sacasa Sector Manager: Arvil Van Adams David Berk Team Leader at ICR: Eileen Murray, Malonga Amolo Ng'weno, Daniel Viens Miatudila ICR Primary Author: Jdr6me Chevallier 2. Principal Performance Ratings (HS=HighlySatisfactory, S=Satisfactofy, U=Unsatisfactory, HL=Highly Likely, L=Likely, UN=Unlikely, HUN=Highly Unlikely,HU=Highly Unsatisfactory, H=High, SU=Substantial, M=Modest, N=Negligible) Outcome: U Sustainability: UN Institutional Development Impact: SU Bank Performance: S Borrower Performance: U QAG (if available) ICR Quality at Entry: S S Project at Risk at Any Time: Yes 3. Assessment of Development Objective and Design, and of Quality at Entry 3.1 Original Objective: The broad objective of the project was to strengthen regional and community involvement in population and human resource development, through improving the delivery of basic health services, and stimulating complementary community development activities. The project was designed to: (i) help establish efficient health regions and other supportive services capable of providing comprehensiveand cost-effective health care, includingfamily planning services and AIDS prevention,through community participation, self-management,and cost recovery; and (ii) support complementiuyinitiatives in communitydevelopment to develop social infrastructureand grassroots participation in small-scaleproductive activities. In addition to its social development objectives,the project was also expectedto stimulate economic growth. The objective was clear, and a detailed set of performance indicatorswas defined for monitoring the outputs and outcomes of the project at appraisal, mid-course (1996) and completion (1999). The objective was realistic,the project sought to build upon a strong tradition of self-help and community participationto improve the health condition of the Comorian population. The project was important for the Comoros in view of a high incidenceof preventable illnessesand a strong populationgrowth rate (3.1 percent per annum) in a highly densely populated country,with a high level of unemployment. The project was consistent with the country assistance strategy (CAS) discussed with the Board in December 1993. The CAS focused on economic reform, human capital development,and protecting the Comoros' fragile eco-system. The project was one of three projects included in the five-year lending program, together with an Education project and an EnvironmentProtection project. A credit to support economic reform and capacity building (MERCAP) had been approved in December 1992. The reform program emphasized resource mobilization,the streamliningof an over-extended civil service, the restructuringof public enterprises, and the implementationof a new accounting system for both public and private enterprises. The project review was consistent with the reform program through its focus on enhancingthe efficiency of the civil serviceand relying on local communities to improve the delivery of basic services. 3.2 RevisedObjective: The objective of the project has not been revised. 3.3 OriginalComponents: The project included two components, namely:(a) the improvementof health services, and (b) the establishmentof a Social Fund. The first component included: (i) strengtheningand developing program planning and monitoring capacities at the regional level, and stimulatingcommunity participationin health and populationactivities; (ii) conducting a series of training activities to increase the productivity of regional health workers; (iii) strengtheningthe capacity of MSPP to provide adequate technical and operational support to regional staff in the implementationof health activities; (iv) partially rehabilitating a number of health care facilities; (v) designing multi-media,well-targeted Inforrnation, Education and Communication (IEC) strategies and formulating other population and DIV/AIDSactivities; (vi) equipping about 20 laboratories to improve their diagnostic capabilitiesfor purposes of fertility and HIV/AIDS control services; and (vii) ensuring regular supply required to carry out fertility and HIV/AIDS control activities, as well as monitoring the impact of such activities. The second component was designed to support: the rehabilitation of basic infrastructure,including rural roads and bridges, primary schools, water supply and health care facilities; (ii) income generating activities;(iii) activities which promote the well-beingand developmentof women; and (iv) training of communitiesand groups in appropriatetechnologies, and in resource and project development and management. -2 - The two componentsof the project were highly complementary. The development of the health services componentrequired a strong involvementof local communities. By supportingthe developmentactivities initiatedby local communities through the social fund, the project was expected to empower local groups and improve the conditions for the deliveryof health servicesto the population. The two componentswere designed to achieve the project's objectives. Both componentswere designed taking into account past experience.The Social Fund component was developedtaking into account the lessons from experience in other African countries and elsewhere in the world. The Social Fund was designedto finance projects submittedby local communities,especially for the rehabilitation of social facilities and other key infrastructure. A manual of procedures setting up the criteria for project financing was agreed upon during negotiations. The contribution of local communities to the cost of sub-projectswas expectedto be no less than 20 percent. Non governmentalorganizations (NGOs), local and international,were closely associated in the design of the Social Fund. A first batch of projects, of which 20 for the rehabilitationof primary schools and 12 for improving water supply, was prepared for fnancing during the first year of project implementationunder funds made available through the on-going Second Education Project at the time. The Social Fund was also expected to finance income-generatingactivities in close association with an ongoing program supportedby the UNDP and ILO. Finally the Social Fund was to focus on training for