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Implementation Completion Memorandum Tajikistan

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Implementation Completion Memorandum Tajikistan Implementation Completion Memorandum Project Number: 46077-001 Grant Number: 9171 November 2018 Tajikistan: Improved Maternal and Child Health through Connectivity (Financed by the Japan Fund for Poverty Reduction) This document is being disclosed to the public in accordance with ADB's Public Communications Policy 2011. CONTENTS I. BASIC INFORMATION.................................................................................................................... 1 1 – 11 ................................................................................................................................................... 1 II. GRANT PERFORMANCE ASSESSMENT ..................................................................................... 2 12. Background and Description ......................................................................................................... 2 13. Grant Development Objectives.................................................................................................... 2 14. Key Performance Indicators: ....................................................................................................... 3 15. Evaluation of Inputs ...................................................................................................................... 4 A. Project Formulation and Terms of Reference ....................................................................... 4 B. Inputs and performance of the Recipient, EA, and IA .......................................................... 5 C. Inputs and Performance of the Contractor, Consultants, and Suppliers ............................. 5 D. Performance of ADB ................................................................................................................ 6 16. Evaluation of Outputs and Results .............................................................................................. 6 A. Actual Outputs and Quality ..................................................................................................... 6 B. Project Cost, Financing, and Grant Disbursement ............................................................... 7 A. Project Implementation Arrangement .................................................................................... 8 B. Implementation Schedule ........................................................................................................ 8 C. Initial Operation and Sustainability ......................................................................................... 9 D. Impact and Benefit Assessment ........................................................................................... 11 17. Overall Assessment and Rating (HS,S,PS,U) ........................................................................... 13 18. Major Lessons Learned ............................................................................................................... 13 19. Recommendations and Follow-up Actions ................................................................................ 14 20. Additional Remarks, Comments and Suggestions ................................................................... 14 III. PREPARATION AND APPROVAL .............................................................................................. 15 ANNEXES Annex 1. PROJECT FRAMEWORK ...................................................................................................... 16 Annex 2: PHOTOS OF MAJOR PROJECT OUTPUTS ....................................................................... 20 Annex 3: LIST OF MEDICAL EQUIPMENT PROCURED UNDER THE PROJECT ........................ 21 Annex 4. PROJECT COST AND FINANCING ..................................................................................... 23 Annex 5. GRANT DISBURSEMENT ..................................................................................................... 24 Annex 6. ORGANIZATION CHART FOR PROJECT IMPLEMENTATION ....................................... 25 Annex 7. CHRONOLOGY OF MAJOR EVENTS ................................................................................. 26 Annex 8. PROJECT MAP ....................................................................................................................... 29 1 JAPAN FUND FOR POVERTY REDUCTION (JFPR) IMPLEMENTATION COMPLETION MEMORANDUM (ICM) I. BASIC INFORMATION 1. JFPR Number and Name of Grant: Grant 9171-TAJ: Improved Maternal and Child Health through Connectivity 2. Country (DMC): 3. Approved JFPR Grant Amount: Republic of Tajikistan $2,500,000 4. Grant Type: 5-A. Undisbursed Amount 5-B. Utilized Amount ● Project / Capacity Building $8,119.33 $2,491,880.67 6. Contributions from other sources Source of Contribution: Committed Amount Actual Contributions: Remark - Notes: DMC Government $386,000 $350,000 for civil works of Component A Other Donors (please name) $ $ Private Sector $ $ Community/Beneficiaries $47,000 $0 In-kind contributions 7-A. GOJ Approval Date: 7-B. ADB Approval Date: 7-C. Date the LOA was signed (Grant Effectiveness Date): 12 December 2012 7 March 2013 9 April 2013 8-A. Original Grant Closing Date: 8-B. Actual Grant Closing Date: 8-C. Account Closing Date: 31 March 2016 30 September 2016 16 March 2017 9. Name and Number of Counterpart ADB (Loan) Project: Loan 2196-TAJ/Grant 0154-TAJ: Dushanbe–Kyrgyz Border Road Rehabilitation Project (Phase 2) Loan 2359-TAJ/Grant 0085-TAJ: CAREC Regional Road Corridor Improvement Project 10. The Grant Recipient(s): Ministry of Finance Mr. Qahhorzoda Faiziddin Academics Rajabov Street 3, Dushanbe Dushanbe, Tajikistan Tel: (992 37) 221-00-82, Fax: (992 37) 222 20 73 11. Executing and Implementing Agencies: Ministry of Transport Mr. Nurali Arabzoda, Executive Director, Project Implementation Unit Ayni 14, 73046 Dushanbe Tel: (992 37) 221 56 73, Fax: (992 37) 251 02 75 Email: [email protected] 2 II. GRANT PERFORMANCE ASSESSMENT 12. Background and Description The Government of Tajikistan identifies primary health care and Maternal and Child Health as top priorities in its comprehensive National Health Sector Strategy, 2010–2020. Poor child health outcomes in Tajikistan were caused by systemic health sector issues, including chronically limited financing and poor quality health services; poverty, particularly in rural areas; limited knowledge of health-promoting behavior; and poor access to clean water. The general population had insufficient access to health-related information and lacked awareness of the causes of ill health. The project area (Rasht district) is one of the most traditional and conservative areas in Tajikistan. Women from the area were less likely than women from other regions to participate in community activities or seek health services. Both the Infant Mortality Rate and Under-five Mortality Rate were 10%–15% higher in Rasht district compared with other regions. The district is one of the poorest in the country and had the highest rate of food insecurity (11%–18% of the population was classified as extremely food insecure and 74% as moderately food insecure). At appraisal, the project would support combined and interlinked health and transport interventions to improve the health of mothers and children. The bridge access and road improvement together with health interventions would have multiple synergetic social and economic effects: (i) improved transport services (e.g., availability, frequency, reliability, and costs); (ii) greater accessibility to health care resulting in improved health outcomes for women and children (due to an increased number of people seeking treatment for illness due to reduced travel times); (iii) better access to education opportunities; (iv) uninterrupted flow of agricultural goods and services (such as seed, fertilizer, and crops) across the river; and (v) growth in livestock raising through improved access to veterinary services and better access to market opportunities. The improved accessibility would increase economic opportunities of poor rural households, which in turn would contribute to increased income and, thus, improved health outcomes among women and children. The health information component of the project would increase demand for health services, and the project would support activities to match the demand by increasing the supply and quality of health services. The project would help ensure this supply by enhancing the mobility of health personnel and supplies by reestablishing the bridge and road connection and equipping the rural hospital in Navobod with a safe and operating ambulance. The Country Partnership Strategy for 2010–2014 emphasized ADB's continuing involvement in the transport sector through investments in domestic and regional road links, and includes gender mainstreaming as a core cross-cutting theme. The project would contribute to achieving MDG 4 (reduce child mortality) and MDG 5 (improve maternal health) in the project area. 13. Grant Development Objectives The primary objective of the project was to improve maternal and child health results for isolated rural communities of five jamoats in Rasht district,1 one of the poorest regions of the country with the highest rate of food insecurity. Health services were poor and knowledge of health-promoting behavior was limited. The situation had worsened since March 2009 when the only bridge connecting the communities to the district center was destroyed by flooding. Residents had to make a 17-kilometer detour to access the road to the district center. This had seriously constrained access
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