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Health Sector Reform Project Completion Report Project Number: 33036 Loan Number: 2054-TAJ(SF) December 2010 Tajikistan: Health Sector Reform Project CURRENCY EQUIVALENTS Currency Unit – somoni (TJS) At Appraisal At Project Completion (15 November 2003) (30 September 2009) TJS1.00 = $0.3274 $0.2282 $1.00 = TJS3.0544 TJS4.3822 ABBREVIATIONS ADB – Asian Development Bank CDH – central district hospital DHD – district health department DHIS2 – Development Health Information System–2 DSG – district supervisory group ESRP – Education Sector Reform Project FGP – family group practice HMIS – health management information system HSRP – Health Sector Reform Project JFPR – Japan Fund for Poverty Reduction MOF – Ministry of Finance MOH – Ministry of Health NGO – nongovernment organization NMPC – National Medicine and Medical Commodities Procurement Centre NSC – national steering committee PAU – project administration unit PHC – primary health care PIU – project implementation unit PMU – project management unit PSFCI – Pharmaciens Sans Frontières Comité International RCDE – Research Center for Drug Expertise SDR – special drawing rights TA – technical assistance TSMU – Tajikistan State Medical University NOTES (i) The fiscal year (FY) of the government and its agencies ends on 31 December. (ii) In this report, "$" refers to US dollars. Vice-President X. Zhao, Operations 1 Director General J. Miranda, Central and West Asia Department (CWRD) Country Director & J. Tokeshi, Tajikistan Resident Mission (TJRM), CWRD Team Leader Sector Director D. Kertzman, Financial Sector, Public Management and Trade Division, CWRD Team member N. Kvanchiany, Assistant Project Analyst, TJRM, CWRD In preparing any country program or strategy, financing any project, or by making any designation of or reference to a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area. CONTENTS Page BASIC DATA i MAP v I. PROJECT DESCRIPTION 1 II. EVALUATION OF DESIGN AND IMPLEMENTATION 1 A. Relevance of Design and Formulation 1 B. Project Outputs 2 C. Project Costs 8 D. Disbursements 9 E. Project Schedule 9 F. Implementation Arrangements 9 G. Conditions and Covenants 10 H. Related Technical Assistance 10 I. Consultant Recruitment and Procurement 11 J. Performance of Consultants, Contractors, and Suppliers 12 K. Performance of the Borrower and the Executing Agency 12 L. Performance of the Asian Development Bank 12 III. EVALUATION OF PERFORMANCE 12 A. Relevance 12 B. Effectiveness in Achieving Outcome 13 C. Efficiency in Achieving Outcome and Outputs 13 D. Preliminary Assessment of Sustainability 13 E. Impact 14 IV. OVERALL ASSESSMENT AND RECOMMENDATIONS 14 A. Overall Assessment 14 B. Lessons 15 C. Recommendations 15 APPENDIXES 1. Project Framework 16 2. Basic Social, Economic, and Health Data on Tajikistan 25 3. Strengthening of Planning and Management Capacity in the Health Sector 30 4. Human Resource Development of Health Sector 34 5. Capacity Building for Family Group Practice 38 6. Strengthening Drug Quality Control and Drug Procurement 40 7. Delivery of Pro-Poor Health Services 42 8. Information on Civil Works Contracts 45 9. Project Cost and Financing Plan (Appraised and Actual) 47 10. Project Implementation Schedule 50 11. Project Organizational Diagram 52 12. Status of Compliance with Loan Covenants 53 13. Overall Assessment of the Health Sector Reform Project 62 BASIC DATA A. Loan Identification 1. Country Republic of Tajikistan 2. Loan number 2054-TAJ(SF) 3. Project title Health Sector Reform Project 4. Borrower Republic of Tajikistan 5. Executing agency Office of the President 6. Amount of loan SDR5,238,000 7. Project Completion Report Number PCR: TAJ 1202 B. Loan Data 1. Appraisal – Date started 9 June 2003 – Date completed 20 June 2003 2. Loan negotiations – Date started 13 November 2003 – Date completed 15 November 2003 3. Date of Board approval 17 December 2003 4. Date of loan agreement 15 April 2004 5. Date of loan effectiveness – In loan agreement 14 July 2004 – Actual 15 July 2004 – Number of extensions 0 6. Closing date – In loan agreement 30 June 2009 – Actual 23 November 2009 – Number of extensions 0 7. Terms of loan – Interest rate 1% per annum during the grace period and 1.5% per annum thereafter – Maturity (number of years) 32 years – Grace period (number of years) 8 years 8. Disbursements a. Dates Initial Disbursement Final Disbursement Time Interval 26 August 2004 30 October 2009 63 months Effective Date Original Closing Date Time Interval 15 July 2004 30 June 2009 59.5 months ii b. Amount (SDR million) Original Last Revised Amount Undisbursed Category Allocation Allocation Disbursed Balance Civil works 640,000 1,574,472 1,507,325 67,147 Equipment and furniture 1,240,000 1,613,460 1,681,657 (68,197) Overseas training 105,000 114,631 110,862 3,769 In-country training 283,000 418,038 384,705 33,333 International consultants 430,000 270,292 252,646 17,646 National consultants 37,000 124,493 116,814 7,679 Surveys and studies 71,000 24,340 11,493 12,847 Public information campaign 127,000 12,713 0 12,713 Materials and consumables 624,000 263,051 235,314 27,737 Project management 409,000 610,771 568,629 42,142 Procurement center/PSFCI 405,000 0 0 0 Family group practice seed capital 239,000 78,590 67,233 11,357 Recurrent cost 58,000 23,623 23,092 531 Interest charge 138,000 68,175 68,175 0 Unallocated 432,000 41,351 0 41,351 Total 5,238,000 5,238,000 5,027,945 210,055 PSFCI = Pharmaciens Sans Frontières Comité International. ( ) = negative. 9. Local costs (financed) - Amount ($ million) 2.869 - Percent of local costs 92.56 - Percent of total cost 37.17 C. Project Data 1. Project cost ($ million) Cost Appraisal Estimate Actual Foreign exchange cost 5.340 4.851 Local currency cost 4.035 4.611 Total 9.375 9.462 2. Financing plan ($ million) Cost Appraisal Estimate Actual Implementation costs Borrower financed 1.875 1.742 ADB financed 7.302 7.616 Other external financing 0.000 0.000 Total 9.177 9.358 IDC costs Borrower financed 0.000 0.000 ADB financed 0.198 0.104 Other external financing 0.000 0.000 Total 0.198 0.104 ADB = Asian Development Bank, IDC = interest during construction. iii 3. Cost breakdown by project component ($ million) Component Appraisal Estimate Actual A. Base cost 1. Institutional development 2.022 2.058 2. Drug supply and quality control 1.254 0.910 3. Pro-poor health package 4.227 5.412 4. Project management 0.586 0.978 B. Contingencies 1.089 0.000 C. Interest charge 0.197 0.104 Total cost 9.375 9.462 4. Project schedule Item Appraisal Actual Estimate Date of contract with consultants International (National) Project management adviser Aug 2004 13 Nov 2004 Laboratory and drug quality control Jan 2005 20 Feb 2005 (22 Feb 2005) Human resource development Jan 2005 22 Feb 2005 (22 Feb 2005) Health personnel licensing and accreditation May 2005 17 Jun 2005 (22 Feb 2005) Family group practice May 2005 9 Aug 2005 (22 Feb 2005) Capitation payment specialist Jan 2006 10 Aug 2005 (22 Feb 2006) Clinical pharmaceutical specialist Feb 2006 3 Apr 2006 (14 Sep 2005) Drug marketing specialist Nov 2005 (1 Feb 2006) Health management information system Oct 2006 12 Nov 2007 (20 Dec 2006) Health planning and rationalization Mar 2007 29 Jun 2007 (22 Feb 2005) Monitoring and evaluation specialist Jun 2007 10 Jun 2008 (10 Oct 2007) Mapping of health facilities Apr 2006 Aug 2006 Civil works contract Date of award Jan 2007 4 Apr 2004 Completion of work Jun 2009 15 Sep 2009 Equipment and supplies First procurement Nov 2004 15 Oct 2004 Last procurement Nov 2008 23 Apr 2009 Essential drugs supply Sep 2005 Aug 2006 Trainings Overseas training Nov 2004 Dec 2004 In-country training Jun 2005 Sep 2005 Community awareness and participation (JFPR 9043a) May 2006 May 2007 JFPR = Japan Fund for Poverty Reduction. a ADB. 2004. Proposed Grant Assistance to the Republic of Tajikistan for Community Participation and Public Information Campaign for Health Improvement. Manila 5. Project Performance Report Ratings Ratings Implementation Period Development Implementation Objectives Progress From 30 Dec 2003 to 29 Jun 2005 Satisfactory Satisfactory From 30 Jul 2005 to 30 May 2006 Satisfactory Highly satisfactory From 29 June 2006 to 30 Aug 2008 Satisfactory Satisfactory From 29 Sep 2008 to 30 June 2009 Satisfactory Highly satisfactory iv D. Data on Asian Development Bank Missions No. of No. of Specialization Name of Mission Date Persons Person-Days of Members Pre-loan inception mission 1 2–8 Feb 2004 2 10 a, c Pre-loan inception mission 2 5–9 Apr 2004 2 10 a, d Inception mission 13–17 Sep 2004 1 5 a Review mission 1 28 Jan–10 Feb 2005 2 28 a, c Review mission 2 22–30 Jul 2005 2 18 a, b Review mission 3 6–10 Feb 2006 2 10 a Review, reconnaissance, and 15–29 Jun 2006 4 60 a, d, e, f inception mission Midterm review mission 23 Oct–3 Nov 2006 5 60 a, c, e, g, h Review mission 4 11–23 Jun 2007 2 26 a, g Review mission 5 1–10 Dec 2007 3 30 a, e, g SOE review mission 17–20 Mar 2008 1 4 i Review mission 6 16–21 Oct 2008 2 12 g, j Review mission 7 18–25 May 2009 2 16 e, j Project completion review 1 Sep–5 Oct 2009 3 29 e, h, c a = senior health specialist/health specialist, b = senior project specialist/project specialist, c = project assistant/analyst, d = project implementation specialist, e = principal portfolio management specialist, f = transport specialist, g = social sector specialist, h = staff consultant, i = financial control specialist, SOE = statement of expenditures.
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