Document of The World Bank Report No: ICR00001396 Public Disclosure Authorized IMPLEMENTATION COMPLETION AND RESULTS REPORT (IDA-H0210 and IDA-H2890) ON A GRANT IN THE AMOUNT OF SDR15.1 MILLION Public Disclosure Authorized (US$ 20.0 MILLION EQUIVALENT) AND ADDITIONAL FINANCING GRANT IN THE AMOUNT OF SDR 5.3 MILLION (US$8.0 MILLION EQUIVALENT) TO THE REPUBLIC OF SIERRA LEONE Public Disclosure Authorized FOR A HEALTH SECTOR RECONSTRUCTION AND DEVELOPMENT PROJECT May 28, 2010 Human Development Sector Health, Nutrition and Population (AFTHE) Country Department AFCW1 Public Disclosure Authorized Africa Region CURRENCY EQUIVALENTS Exchange Rate Effective March 2, 2010 Leones (Le) Le 3,790 = US$1.00 Le 1.00 = US$ 0.000264 FISCAL YEAR January 1 -- December 31 ABBREVIATIONS AND ACRONYMS AfDB African Development Bank APL Adaptable Program Lending CAS Country Assistance Strategy CDC Center for Disease Control and Prevention CMR Child Mortality Rate CPR Country Procurement Review CPAR Country Procurement Assessment Report CTB Central Tender Board DGA Development Grant Agreement DHS Demographic and Health Survey DOTS Direct Observed Treatment Short-course (TB) DPI Directorate of Planning and Information EIA Environmental Impact Assessment EMP Environmental Management Plan EU European Union FMR Financial Management Report GDP Gross Domestic Product GF Global Fund GIMPA Ghana Institute of Management and Public Administration GOSL Government of Sierra Leone GPN General Procurement Notice HNP Health, Nutrition and Population HRD Human Resources Development HSRDP Health Sector Reconstruction and Development Project IBRD International Bank for Reconstruction and Development IDA International Development Association IEC Information, Education and Communication IFC International Finance Corporation IHSIP Integrated Health Sector Investment Project KPI Key Performance Indicator MDG Millennium Development Goal M&E Monitoring and Evaluation MICS-2 Multiple Indicator Cluster Survey-2 Maternal Mortality Ratio MOHS Ministry of Health and Sanitation NGO Non-Government Organization NHAP National Health Action Plan PCD Project Concept Document PCU Project Coordination Unit PDO Project Development Objective PER Public Expenditure Review PHC Primary Health Care PHRD Policy and Human Resources Development PHU Primary Health Units PIU Project Implementation Unit PMR Project Monitoring Report RBM Roll Back Malaria SAPA Social Action and Poverty Alleviation SBCQ Selection Based on Consultants Qualification SIL Specific Investment Loan TSS Transitional Support Strategy TB Tuberculosis TTL Task Team Leader UN United Nations UNICEF United Nations Children's Fund UNFPA United Nations Fund for Population Activities WA Withdrawal Application WBI World Bank Institute WHO World Health Organization Vice President : Obiageli K. Ezekwesili Country Director : Ishac Diwan Sector Manager : Eva Jarawan ICR Team Leader : Jean-Jacques de St. Antoine ICR Primary Author : Willy De Geyndt SIERRA LEONE HEALTH SECTOR RECONSTRUCTION AND DEVELOPMENT PROJECT Table of Contents A. Basic Information ........................................................................................................ i B. Key Dates .................................................................................................................... i C. Ratings Summary ........................................................................................................ i D. Sector and Theme Codes ........................................................................................... ii E. Bank Staff ................................................................................................................... ii F. Results Framework Analysis ..................................................................................... iii G. Ratings of Project Performance in ISRs ................................................................. viii H. Restructuring ........................................................................................................... viii I. Disbursement Profile ................................................................................................. ix 1. Project Context, Development Objectives and Design ............................................... 1 2. Key Factors Affecting Implementation and Outcomes .............................................. 6 3. Assessment of Outcomes .......................................................................................... 14 4. Assessment of Risk to Development Outcome ......................................................... 19 5. Assessment of Bank and Borrower Performance ..................................................... 19 6. Lessons Learned ....................................................................................................... 22 7. Comments on Issues Raised by Borrower. ............................................................... 24 Annex 1. Project Costs and Financing .......................................................................... 25 Annex 2. Outputs by Component ................................................................................. 26 Annex 3. Economic and Financial Analysis ................................................................. 37 Annex 4. Bank Lending and Implementation Support/Supervision Processes ............ 38 Annex 5. Borrower's ICR ............................................................................................. 40 MAP A. Basic Information Health Sector Reconstruction Country: Sierra Leone Project Name: and Development Project Project ID: P074128 Grant Numbers: IDA-H0210; IDA-H2890 ICR Date: March 2, 2010 ICR Type: Core ICR GOVERNMENT OF SIERRA Lending Instrument: SIL Borrower: LEONE Original Total Disbursed SDR 15.1M SDR 18.8M Commitment: Amount: Revised Amount: SDR 20.4M Environmental Category: B Implementing Agencies: Ministry of Health and Sanitation Cofinanciers and Other External Partners: None. B. Key Dates Revised / Actual Process Date Process Original Date Dates Concept 10/03/2001 Effectiveness: 05/28/2003 05/28/2003 Review: Appraisal: 09/30/2002 Restructuring(s): 05/22/2007 Mid-term Approval: 02/25/2003 02/20/2006 02/06/2006 Review: Closing: 02/28/2008 12/31/2009 C. Ratings Summary C.1 Performance Rating by ICR Outcomes: Moderately Satisfactory Risk to Development Outcome: Moderate Bank Performance: Satisfactory Borrower Performance: Moderately Satisfactory C.2 Detailed Ratings of Bank and Borrower Performance (by ICR) Bank Ratings Borrower Ratings Moderately Quality at Entry: Satisfactory Government: Satisfactory Quality of Moderately Implementing Moderately Supervision: Satisfactory Agency/Agencies: Satisfactory Overall Bank Overall Borrower Moderately Satisfactory Performance: Performance: Satisfactory i C.3 Quality at Entry and Implementation Performance Indicators Implementation QAG Assessments Indicators Rating Performance (if any) Potential Problem Quality at Entry Project at any time Yes None (QEA): (Yes/No): Problem Project at any Quality of Yes None time (Yes/No): Supervision (QSA): DO rating before Satisfactory Closing/Inactive status: D. Sector and Theme Codes Sector Code (as % of total Bank financing) Percent Central government administration 20 Health 70 Solid waste management 2 Sub-national government administration 8 Theme Code (as % of total Bank financing) Conflict prevention and post-conflict reconstruction 24 Health system performance 25 Malaria 25 Other financial and private sector development 13 Participation and civic engagement 13 E. Bank Staff Positions At ICR At Approval Vice President: Obiageli K. Ezekwesili Callisto Madavo Country Director: Ishac Diwan Mats Karlsson Sector Manager: Eva Jarawan Alexandre Abrantes Project Team Leader: Evelyn Awittor Astrid Helgeland-Lawson ICR Team Leader: Jean J. de St. Antoine ICR Primary Author: Willy De Geyndt ii F. Results Framework Analysis Project Development Objectives (from Project Appraisal Document) The Health Sector Reconstruction and Development Project (HSRDP) is a SIL with some features of a sector-wide program. The project's overall development objective was to help restore the most essential functions of the health sector delivery system. The project would also help achieve the more specific objectives of: (i) increasing access to affordable essential health services by improving primary and first referral health facilities in four districts of the country; (ii) improving the performance of key technical programs responsible for coping with the country's major public health problems; (iii) strengthening health sector management capacity to improve efficiency and further decentralize decision-making to the districts; and (iv) supporting development of the private NGO health sector and involvement of the civil society in decision-making. Revised Project Development Objectives (as approved by original approving authority) The Board approved an additional financing grant of US$8 million equivalent on May 22, 2007 that did not change the original project development objective, the general project design or the implementation modalities. iii A. Original Grant Original Target Formally Actual Value Achieved Values (from Revised Indicator Baseline Value at Completion or approval Target Target Years documents) Values At least 50 health posts in the four priority districts are fully equipped as Indicator 1 specified in the Project Implementation Plan. Value (quantitative or 0 50 - 50 qualitative) December 18, 2009 Date achieved 2003 (Equipment