AFRICAN DEVELOPMENT FUND PROJECT COMPLETION REPORT HOSPITAL INFRASTRUCTURE REHABILITATION AND BASIC HEALTHCARE SUPPORT REPUBLIC OF COTE D’IVOIRE COUNTRY DEPARTMENT OCDW WEST REGION MARCH-APRIL 2000 SCCD : N.G. TABLE OF CONTENTS Page CURRENCY EQUIVALENTS, WEIGHTS AND MEASUREMENTS ACRONYMS AND ABBREVIATIONS, LIST OF ANNEXES, SUMMARY, CONCLUSION AND RECOMMENDATIONS BASIC DATA AND PROJECT MATRIX i to xii 1 INTRODUCTION 1 2 PROJECT OBJECTIVES AND DESIGN 1 2.1 Project Objectives 1 2.2 Project Description 2 2.3 Project Design 3 3. PROJECT IMPLEMENTATION 3 3.1 Entry into Force and Start-up 3 3.2 Modifications 3 3.3 Implementation Schedule 5 3.4 Quarterly Reports and Accounts Audit 5 3.5 Procurement of Goods and Services 5 3.6 Costs, Sources of Finance and Disbursements 6 4 PROJECT PERFORMANCE AND RESULTS 7 4.1 Operational Performance 7 4.2 Institutional Performance 9 4.3 Performance of Consultants, Contractors and Suppliers 10 5 SOCIAL AND ENVIRONMENTAL IMPACT 11 5.1 Social Impact 11 5.2 Environmental Impact 12 6. SUSTAINABILITY 12 6.1 Infrastructure 12 6.2 Equipment Maintenance 12 6.3 Cost Recovery 12 6.4 Health Staff 12 7. BANK’S AND BORROWER’S PERFORMANCE 13 7.1 Bank’s Performance 13 7.2 Borrower’s Performance 13 8. OVERALL PERFORMANCE AND RATING 13 9. CONCLUSIONS, LESSONS AND RECOMMENDATIONS 13 9.1 Conclusions 13 9.2 Lessons 14 9.3 Recommendations 14 Mrs. B. BA (Public Health Expert) and a Consulting Architect prepared this report following their project completion mission in the Republic of Cote d’Ivoire on March-April 2000. Questions should be referred to Mr. E.G.TAYLOR-LEWIS, Director, OCDW (Ext. 4041) and Mr. Russell CRESSMAN, Division Manager, OCDW.5 (Ext. 4112). i CURRENCY EQUIVALENTS At Appraisal At Completion (August 1990) (April 2000) UA 1 = FCFA 370.60665 UA 1 = FCFA 924.827 UA 1 = US $ 1.30082 UA 1 = US $ 1.38769 WEIGHTS AND MEASUREMENTS 1 metre (m) = 3.28 feet 1 square metre (m2) = 10.76 square feet 1 kilometre (km) = 0.62 mile FINANCIAL YEAR 1 January – 31 December ACRONYMS AND ABBREVIATIONS TBA : Traditional Birth Attendants BNETD : National Engineering and Development Studies Agency (Bureau National d’Etudes Techniques et de Développement) PICU : Project Implementation and Coordination Unit CHR : Regional Hospital (Centre Régional Hospitalier) CNTS : National Blood Transfusion Centre (Centre national de transfusion sanguine) CREMM : Regional Infrastructure and Equipment Maintenance Centre (Centre régional d’Equipement et de Maintenance du Matériel) DEMM : Directorate of Infrastructure and Equipment Maintenance (Direction de l’Equipement et de Maintenance du Matériel) MH : Ministry of Health PAMES : Macro-Economic and Structural Support Programme (Programme d’Appui Macroéconomique et Structurel) SME : Small and Medium-Scale Enterprises PHC : Primary Healthcare LIST OF ANNEXES Number of Pages 1. Location of Project Sites 1 2. Actual Expenditure by Expenditure Category and Source of Finance 1 3. Estimated and Actual Expenditure Schedule 1 4. Project Implementation and Bank Performance 1 5. Project Impact on Development 1 6. Matrix of Recommendations and Follow-up Action 3 7. Comparative Table of Activities Projected and Implemented 1 8. Sources of Information 1 9. Borrower’s Comments on the PCR 1 10. Performance of Contracting Firms 3 11. Performance of Suppliers 1 Status of Project Contracts Approved by the Bank Volume II ii REPUBLIC OF COTE D’IVOIRE HOSPITAL INFRASTRUCTURE REHABILITATION AND BASIC HEALTHCARE SUPPORT PROJECT Project Retrospective Matrix Project Name: Hospital Infrastructure Rehabilitation and Basic Healthcare Support Project Completion Date: 31/12/98 Hierarchy of Objectives Objectively Verifiable Means of Verification Assumptions Indicators Sectoral Objective 1. Improve the people’s 1.1.1 Maternal mortality 1.1.1 Statistics of the 1.1.1.1 Improved health by enhancing the reduced by 30% between Ministry of economic situation and efficiency of the system 1990 and the project Health. donors’ continuing and giving special completion (the 1990 rate 1.1.2 Health support to the Government attention to mothers’ and was 810 per 100 000). demographic children’s needs surveys (HDS) Project Objective 1. Help the country to 1.1 At least 80% of 1.1.1 Reports of the 1.1.1.1 The country improve the people’s surgical and gynaeco- Ministry of Health and guarantees the health condition by obstetrical operations the Project Bureau. running of health rehabilitating hospital conducted at the structures infrastructure, regional hospital level; 1.1.1.2 The people maintenance, primary the number of effectively healthcare revitalization, evacuations to Abidjan participate in health personnel and reduced by half developing matron training, and primary support for the AIDS 1.2 Matron service quality healthcare control programme. improved 1.3 The number of births assisted by qualified personnel increases by at least 50% 1.5 Increased life span of 1.5.1 Project reports and 1.5.1.1 Government buildings and health site visits ensures the running of infrastructure health structures 1.6 Fifteen bio-medical maintenance workers . operate at the peripheral level 1.7 Health staff make careful use of the equipment at their disposal 1.8 Secure blood used in 1.8.1 Reports of the 1.8.1.1 Government hospitals Daloa Regional Blood makes AIDS control a 3.2 Voluntary HIV/AIDS Transfusion Centre and priority test available in the of the Abidjan National project zone Blood Transfusion Centre Results iii 1. Fifteen (15) hospitals 1.1 Infrastructure exists 1.1.1 MH and project 1.1.1.1 Effective State rehabilitated and and is operational bureau reports commitment to improve equipped as well as the people’s health 2. Six CREMM built 1.2 Working conditions, building, and equipped health staff and matron furniture and 3. One (01) CRTS built skills improved equipment and equipped handing over 4. Fifteen (15) bio- minutes. medical maintenance workers trained and 1.1.2 MH and PIU assigned to the supervision CREMMs reports; 5. Forty-four (44) non- summary health medical workers surveys. trained and assigned to the CREMMs 6. 13 laboratory assistants and 13 radiologists trained and assigned to health structures 7. 1091 traditional birth attendants trained in 571 villages 5. Activities Budgetary Resources 1. Prepare bidding Sources: 1.1.1 Disbursement 1.1.1.1. Government and documents for (in UA million) status; account audit and ADF resources put at architectural and Est. Actual Bank mission reports, project disposal. engineering studies, ADF 7.36 7.36 Government completion procurement of ADB 4.05 4.05 report. furniture and delivery TAF 1.64 0.00 kits Govt. 1.46 11.08 2. Select the technical Total 14.51 22.49 assistance agency, recruit the contracting firms and suppliers 3. Send staff on training 4. Monitor sites. 5. Prepare dossiers iv SUMMARY AND CONCLUSIONS 1. Introduction The Hospital Infrastructure Rehabilitation and Basic Healthcare Support Project falls within the framework of Government health policies contained in the 1986-1991 five-year plan, and marks the ADB’s first health operation in Cote d’Ivoire’s health sector. The Bank appraised the project in August 1990. The total project cost amounted to UA 14.51 million, of which an ADB loan of UA 4.05 million (28% of the total), an ADF loan of UA 7.36 million (51%) and a TAF grant of UA 1.64 million (nearly FCFA 460 million in 1990) or 9% of the total project cost. Some changes were made to the initial design, including the cancellation of the TAF grant which was to fund the sectoral study and the preparation of a new project. Hence the total project cost fell to UA 12.89 million. The 1994 devaluation of the CFA Franc resulted in an increase in the prices of certain project inputs (civil engineering works and equipment). 2. Project Objectives and Design Owing to the difficult economic situation that Cote d’Ivoire faced in the ’nineties, health infrastructure and equipment deteriorated as a result of inadequate resources allocated to the sector. The aim of the Hospital Infrastructure Rehabilitation and Basic Healthcare Support Project was to assist the Government in improving the people’s health conditions through hospital infrastructure rehabilitation, revitalization of primary healthcare (PHC) and support for the national AIDS control programme. 3. Project Implementation The implementation schedule was extended for nearly five years mostly due to: (i) the delay in entry into force of the loan agreement; (ii) the topographic surveys which were to be conducted in the field prior to the architectural studies; (iii) problems related to management of the project implementation and coordination unit (PICU). In the wake of Government request, the Bank approved four postponements. The deadline for final disbursement was ultimately set at 31 December 1998. Additional activities funded with the counterpart contribution and the loan were also implemented. Furthermore, following the 1994 CFA Franc devaluation, the prices of certain project inputs increased and some contracts had to be revalued upwards. 4. Project Performance All project activities were implemented. The technical assistance bureau began its operations in 1993 and satisfactorily implemented them by April 1997. Apart from long-term technical assistance, four short-term consultants were recruited and adequately fulfilled their mission with the PICU. The auditing firm which audited the project accounts from 1991 to August 1998 could not certify the audit report in the absence of documents justifying certain expenditures. Building construction works assigned to selected SMEs under the civil engineering package was unsatisfactory. Bio-medical supplies and equipment as well as air- conditioning were of average quality. All basic training activities were implemented. Fifteen (15) national managers were trained in maintenance. Furthermore, training was also dispensed to 44 non bio-medical technicians, 13 laboratory assistants, 13 radiologists and 1091 traditional birth attendants.