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World Bank Document Documentof The World Bank FOR OFFICIAL USE ONLY Public Disclosure Authorized ReportNo. 11788-COM STAFF APPRAISAL REPORT FEDERAL ISLAMIC REPUBLIC OF COMOROS Public Disclosure Authorized POPULATION AND HUMAN RESOURCESPROJECT NOVEMBER19, 1993 Public Disclosure Authorized Population and Human Resources Division OperationsDepartment III Public Disclosure Authorized Africa Region This document has a restricted distribution and may be used by recipients only in the perfornance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization. CURRENCY EQUIVALENTS Currency unit = Comorian Franc (CF) 1990 US$1 = CF 272 1991 US$1 = CF 282 1993 US$1 = CF 273 MEASUREMENTS 1 meter = 3.28 feet 1 kilometer = 0.62 mile 1 square kilometer = 0.39 square mile 1 hectare = 2.47 acres FISCAL YEAR January 1 - December 31 This report is basedon the findingsof an appraisal missionwhich visited Comorosin March 1993. The missionmembers were DanielViens (MissionLeader), AmoloNg'weno, MicheleLioy, Pierre Mersier, MalongaMiatudila, Cung Tran-Luu(AF3PH), and Paul Geli (consultant). The report was preparedby Lynne Sherbume-Benzand Amolo Ng'weno. The report was processedby Val6rie Vincent, RoselyneLeroy and Hilda Emeruwa. Willy De Geyndt is lead advisor and Messrs. Steen Jorgensenand AlexandreMarc were the peer reviewers. Francisco Aguirre-Sacasaand David Berk are the DepartmentDirector and ManagingDivision Chief respectivelyfor the operation. FOR OFFICIAL USE ONLY ABBREVIATIONSAND ACRONYMS AfDB African Development Bank AIDS Acquired Immuno Deficiency Syndrome ASI French NGO (Association Sante International) CARE International Development NGO CARITAS International NGO of the Catholic Church CCC Central Coordination Committee CDSF Community Development Support Fund CECI Canadian NGO (Centre Canadien d'Etudes et de Cooperation Internationale) CIR Country Implementation Review CPR Contraceptive prevalence rate CTARIAP Technical Commission on Adjustment and Strengthening of the Public Administration CYP Couple-years of protection DHE Directorate of Health Education DPI Directorate of Pharmaceutical Inspection ENS National Public Health School EPI Expanded Program of Immunization FAC Aid agency of the French Government (Fonds d'Aide a la Cooperation) FIRC Federal Islamic Republic of Comoros FP Family planning GDP Gross domestic product GNP Gross national product HIV Human Immunodeficiency Virus IDA International Development Association IEC Information, Education and Communication ILO International Labor Organization (of the UN) IMF International Monetary Fund MCH Maternal and Child Health MEN Ministry of Education MERCAP Macroeconomic Reform and Capacity Building Project MIS Management Information System MOH Ministry of Health NES National Executive Secretariat NGO Non-governmental organization PC Pilot Committees PHC Primary Health Care PEP Public Expenditure Program PNAC National Autonomous Pharmacy of Comoros RC Regional Committee RES Regional Executive Secretariat RHT Regional Health Team RMO Regional Medical Officer SSA Sub-Saharan Africa STD Sexually Transmitted Disease TB Tuberculosis UNDP United Nations Development Program UNFPA United Nations Fund for Population Activities UNICEF United Nations Children's Fund WHO World Health Organization This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization. TABLE OF CONTENTS Basic Data .................................... i Credit and Project Summary .................................... ii I. BACKGROUND ........................................... 1 A. Recent Economic Developments ............. ............................. 1 B. Conditions in the Social Sectors .......................................... 2 C. IDA's Assistance Strategy and Lessons Learned ......................................... 5 II. HUMAN RESOURCES SECTOR ISSUES .......................................... 6 A. Health Sector .......................................... 6 B. Education Sector .......................................... 9 C. Community Development .......................................... 10 III. THE PROJECT .......................................... 11 A. Project Objectives and Approach .......................................... 11 B. Project Description .......................................... 12 IV. PROJECT COSTS AND FINANCING ................... ....................... 23 V. PROJECT IMPLEMENTATION .......................................... 26 A. Project Preparation .......................................... 26 B. Project Management .......................................... 27 C. Implementation Schedule.......................................... 31 D. Project Monitoring and Reporting .......................................... 33 E. Implementation Issues in Comoros .......................................... 34 F. Procurement .......................................... 36 G. Disbursement .......................................... 38 VI. BENEFITS AND RISKS .......................................... 39 VII. CONDITIONS AND RECOMMENDATION ..................................... ..... 40 -2- (continued) Tables in Main Text Table 4.1 SummaryProject Costs by Component Table 4.2 SummaryProject Costs by Category of Expenditures Table 4.3 Allocationof IDA Credit by DisbursementCategory Table 5.1 ImplementationSchedule Table 5.2 : ProcurementArrangements Table 5.3 : DisbursementCategories Annexes Annex I : CommunityDevelopment Support Fund (list of sub-projects) Annex II Information,Education and Communication Annex III Technical Assistanceand Training Annex IV SummaryProject Costs and Financing Annex V : EstimatedSchedule of Disbursements Annex VI PerformanceIndicators Annex VII : SupervisionPlan Annex VIII SelectedDocuments in the ProjectFile Annex IX The Pilot Experienceat MitsoudjdHealth Center Annex X : Health Component:Activity ImplementationSchedule Annex XI : ComorosDemography and Health Resources, 1991 - i - BASICDATA (1990 or most recent estimate) Comoros Sub-Saharan Africa Total Area (kmi): 1,862 23,066,000 Grande Comore 1,147 Anjouan 424 Moheli 290 Total Population(millions) 0.48 495 Populationgrowth rate (annual %) 3.1 3.0 Populationper km: Grande Comore 243 Anjouan 429 Moheli 109 Crude birth rate (per thous. pop.) 44.7 45.9 Crude death rate (per thous. pop.) 13.6 15.6 Life expectancyat birth (years): Overall 54.5 50.6 Female 55.9 52.4 Male 53.0 Infant mortality rate (per thous. live births) 114.5 107.3 Under 5 mortality rate (per thous. live births) 131.2 166.8 Total fertility rate (births per woman) 6.60 6.46 Primary school enrollment(% of school-age-group) 62.4 68.8 Populationper physician 8,816 Populationper nursing person 621 Populationper hospital bed 363 Access to health care (% of pop.) 83%g Percentageof pregnant women receivingprenatal care: 1982 24 1989 70 Per capita GNP (US$) 510 340 Daily calorie supply (calorieper person) 1,960 2,120 ContraceptivePrevalence Rate (1991) 4% - 11 - CREDIT AND PROJECT SUMMARY Borrower: Federal Islamic Republicof the Comoros ExecutingAgencies: Ministry of Health and CommunityDevelopment Support Fund (CDSF) CreditAmount: SDR 9.2 million (US$13.0million equivalent) Terms: StandardIDA terms, with 40 years maturity ProjectObjectives: The overall objectiveof the project is to strengthenthe developmentof human resources in the Comorosby: (i) increasingthe efficiencyand effectivenessof basic health services, through the establishmentof efficienthealth regions and other supportive services, which will be capable of providing comprehensivegood quality and cost effectivehealth care, includingfamily planning services and Acquired ImmunodeficiencySyndrome (AIDS) prevention,and will involve community participation, self-managementand cost recovery; and (ii) by promoting complementarycommunity development initiatives to develop social infrastructure and grassroots participationin small-scaleproductive activities, through a Community DevelopmentSupport Fund (CDSF). Project Components: The project has two components: populationand health, and communitydevelopment. The populationand health componentwill build upon existingsuccessful pilot programs for self-managementand cost recovery to establishservices capable of ensuring cost-effectiveand sustainableprovision of comprehensiveand good quality health care, includingFamily Planning (FP) and AIDS control services. To that end, the componentwill: (i) strengthenthe capacitiesof the three health regions to plan, implement,administer, and supervisehealth care services, in part through improving and expandingthe training of district health personnel; (ii) equip and rehabilitate two regionalhospitals and a number of health centers; and (iii) promotefamily planning and AIDS control services. In the second componentof the project, complementary communitydevelopment activities as well as activitiesto encouragesustainable economicdevelopment would be supportedthrough a CommunityDevelopment SupportFund (CDSF). While demand driven, the CDSF would focus primarily on: training of communitiesand groups in micro-projectdevelopment, management, and implementation;rehabilitation of social infrastructure(especially primary schools, water supply, and health posts); activitiesto promotethe well-beingand development of women; and incomegenerating activities. - iii - Benefits and Risks: The project is expectedto enhancethe developmentof human resourcesby improving the health, education,and income status
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