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World Bank Document Document of The World Bank FOR OFFICIAL USE ONLY Public Disclosure Authorized Report No. 5589 PROJECT PERFORMANCE AUDIT REPORT JAMAICA SECOND POPULATION PROJECT (LOAN 1284-JM) Public Disclosure Authorized April 9, 1985 Public Disclosure Authorized Public Disclosure Authorized Operations Evaluation Department This document has a restricted distribution and may be used by recipients only in the perfonance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization. CURRENCY EQUIVALENTS Currency Unit Jamaican Dollar (J$) Appraisal Year Average: US$1.00 = J$0.91 Intervening Years: 1978 US$1.00 = J$1.70 1979-82 US$1.00 = J$1.78 1983 US$1.00 = J$3.28 GOVERNMENT FISCAL YEAR April 1 to March 31 ABBREVIATIONS CCRA Cornwall County Health Administration CHA Community Health Aide CHW Community Health Workers FP Family Planning GDP Gross Domestic Product GFR General Fertility Rate GOJ Government of Jamaica ICB International Competitive Bidding IEC Information, Education and Communication JPP Jamaica Population Project LCB Local Competitive Bidding MCH Maternal and Child Health MOHEC Ministry of Health and Environmental Control NDA National Development Agency NFPB National Family Planning Board PAHO Pan-American Health Organization PEU Planning and Evaluation Unit UNDP United Nations Development Agency USAID United States Agency for International Development WRAG Women of Reproductive Age Group FOR OMCIAL USE ONLY POPULATIONIHEALTHINUTRITON STATUS AND TREND/a 1960 1982 Total Population (million) 1.6 2.4 Birth Rate (per thousand) 42 27 Death Rate (per thousand) 9 6 Rate of Natural Increase (Z) 3.3 2.1 Infant Mortality Rate (per thousand) 52 10 Total Fertility Rate 6.7 3.4 Z Population under 14 39 38 Z Population over 65 4 6 % Urban 34 48 Life Expectancy (Male/Female) 61/71 65/75 GNP Per Capita (US$dollars) 1,330 Population per physician 2,590 2,830 Population per nursing staff 420 630 Contraceptive Prevalence (%) 55 Daily Calorie Supply (Total) 2,643 as % of requirement 119 /a For definitions see next page. Sources: World Development Report 1984. Population Reference Bureau, data sheet 1984. 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. DEFINITIONS Age-Specific Fertility Rate : Number of registered births per thousand women of a specific age group during the year. Contraceptive Prevalence : Percentage of married women of reproductive age (15-49) using some method of contraception at a given time. Crude Birth Rate (CBR) : Number of registered births per thousand at mid-year. Crude Death Rate (CDR) : Number of registered deaths per thousand at mid-year. Discontinuation (Attrition Rate) : Annual rate of suspended use by a cohort of acceptors. Specific for each method of coatraception. General Fertility Rate : Number of registered births per thousand women between 15-44 years of age. Gomez Scale : Grade 1 - 75-89Z of standard weight for age. Grade 2 - 60-74% of standard weight for age. Grade 3 - 59% of standard weight. Gross Reproduction Rate : Computed similarly to the total fertility rate (see below) but based on family births only. Infant Mortality Rate : Number of infant death (between 0-1 year of age) per thousand live births. Maternal Mortality Rate (MMR) : Number of mother's deaths per thousand live births, as a result of complications of pregnancy, childbirth and the following ten-day period (puerperium). Net Reproduction Rate (NRR) The total number of female births experienced by a woman from 15-44 years of age but taking into account their age-specific death rates. The net reproduction rate is significant in relation to a stable population. Rate of Natural Increase (RNI) : Crude birth rate minus crude death rate, usually expressed as a percentage. Total Fertility Rate (TFR) : The average number of children that would be born per woman if she were to live to the end of her child- bearing years, and bear children according to a given set of age- specific fertility rates. The Total Fertility Rate often serves as an estimate of the average num- ber of children per family. PROJECT PERFORMANCE AUDIT REPORT JAMAICA SECOND POPULATION PROJECT (LOAN 1284-JM) TABLE OF CONTENTS Page No. Preface ............................................................ i Basic Data Sheet .................................................... ii Highlights .......................................................... iii PROJECT PERFORMANCE AUDIT MEMORANDUM I. BACKGROUND AND SETTING .................... ...... 1 National Context .......................................... 1 Jamaican Economy ....................................... 2 Sector Context ........................................... 3 Bank's Involvement ...................................... 5 II. PROJECT SUMMARY ......................................... 6 Project Formulation ....................................... 6 Project Implementation ................................... 7 Project Impact ......................................... .. 8 III. PROJECT ISSUES ........................................... 9 A. Project Design ........................................ 9 B. Project Environment ................................... 12 C. Bank Lending Policy and Supervision .................. 13 D. Institutional Development and Technical Assistance ... 14 IV. FOLLOW-ON AND SUSTAINABILITY ............................. 15 Table 1 Net Recurrent and Capital Expenditure for the Ministry of Health ............................................... 17 ANNEXES: 1. Project Summary of First Population Project .................. 19 2. Clinics in Cornwall County ................................... 23 3. Technical Assistance in Population Projects -............... 27 TABLE OF CONTENTS (cont'd) Page No. PROJECT COMPLETION REPORT I. Introduction ............................................. 31 II. Project Implementation ....................... 38 III. Project Cost and Financing ............................... 50 IV. Outcome and Impact of the Project ........................ 51 V. Bank Performance ........................................ 55 VI. Conclusions .............................................. 57 ANNEXES: 1 - 12 Map: IBRD 11939 Location of Health Facilities PROJECT PERFORMANCE AUDIT REPORT JAMAICA SECOND POPULATION PROJECT (LOAN 1284-JM) PREFACE This is a performance audit of the Second Population Project in Jamaica, for which a loan of US$6.8 million was approved in June 1976. The original loan closing date of December 31, 1980 was extended twice to December 31, 1982. The final disbursement was made in September 1983 and the remaining balance (US$0.77 million) was cancelled. The audit report consists of an audit memorandum prepared by the Operations Evaluation Department (OED) and a Project Completion Report (PCR) prepared by the Population, Health and Nutrition (PHN) Department. The PCR was prepared following a mission to Jamaica in June 1983 and is based upon a completion report prepared by the Ministry of Health and Environmental Con- trol (MOHEC), available in OED. The audit memorandum is based on a review of the Appraisal Report (1040b-JM) dated May 27, 1976, the President's Report (P-1859-JM) dated May 27, 1976, the Loan Agreement dated June 17, 1976, and the PCR. Correspondence with the Borrower and internal Bank memoranda on project issues as contained in Bank files have been reviewed, and Bank staff associated with the project have been interviewed. The Project Performance Audit Report (PPAR) of the Jamaica First Population Project (Loan 690-JM), DED Report No. 2580 dated June 29, 1979 has also been consulted. An OED mission visited Jamaica in September 1984 for the audit of this project. Discussions were held with officials in the MOREC, the Minis- try of Finance, the Planning Institute of Jamaica, the University of the West Indies, the regional Cornwall County Administration the National Development Agency (NDA) and the United States Agency for International Development (USAID). A field trip to Cornwall County to visit project clinics was under- taken. The information gathered during the mission was used to test the validity of the PCR's conclusions. The audit finds that although the PCR covers the project's salient features it insufficiently highlights the main lessons learned and the real achievements made by the project. In addition to summprizing the objectives and results of the project, the audit memorandum expands upon certain issues because their importance to this as well as to other population projects - particularly the effects of project design on project performance. environmental effects, the Bank's lending style in population, institutional development and technical assistance. - ii - The draft report was sent to the Borrower for comments on December 20, 1984; however, none have been received. The valuable assistance provided during the preparation of this report by officials of the Government of Jamaica and executing agencies is gratefully acknowledged. PROJECT MERIORMANCK AUDIT RORT BASIC DATA BURT JAMAECA SECDND 10PULAIN PROJECT (LOAN 123 4-JM) KEY PAJCT DATA Appraisal Actual or Actual as Z of Item Expectation Current Estimate Agerateal Etizate Total Project Cost (US$ million) 14.14 12.16 86 Loan/Credit Amount (US$ million) 6.80 6.03 89 Date Board Approval - 061176 Date Signing - 06/17/76 Date Effectiveness 09/15/76 B/30/76 83/a Date Physical Component Completed/b 06/30/80 12/31/81 1377 Proportion then
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