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World Bank Document Document of The World Bank FOR OFFICIAL USE ONLY Public Disclosure Authorized Report No. 5440-MOR Public Disclosure Authorized STAFF APPRAISAL REPORT KINGDOMOF MOROCCO HEALTHDEVELOPMENT PROJECT Public Disclosure Authorized May 15, 1985 Public Disclosure Authorized Population, Health and Nutrition Department This document has a restricted distribution and may be used by recipients only in the performance of their oflicial duties. Its contents may not otherwise be disclosed without World Bank authorization. CURRENCYEQUIVALENTS US$1.00 = Dirham (DH) 9.47 DR 1.00 = US$0.106 FISCAL YEAR January 1 - December 31 MOROCCO FORIOMFCIAL USE ONLY HEALTH PROJECT Table of Contents Page No. Table of Contents .............................. i Loan and Project Summary *.............................- iv Basic Data Sheet ........... ..... ...... ....... ........ vi Definitions ........... ...... 0...................... vii Abbreviations ......... .........................*..* ** ix I. THE SECTOR . ............................. 1 Background ........................................... 1 A. Population .............................. 1 Population Profile ........... ................... 1 Population Policy ............................ 0.... 2 * Family Planning Program ............................. 3 B. Nutrition ...................................... 4 Nutritional Status .............................. 4 Causesof Malnutrition .............................. 5 Government Nutrition Policies rnd Programs .......... 6 C. Health .................................................. 6 Health Status .............................................6 Environment............................ ............. 8 Bealth Services and Programs ........................ 9 GovernmentHealth Policy ............................ 10 Public Health Services . ..................... ........ 11 D. Sectoral Resources ............... ...................... 12 PhysicalResources ....................... ................ 12 Human Resources .....................................13 FinancialResources .. ...............................14 E. Sectoral Issues ........................................15 HealthCare Delivery System ......................... 15 Management........................................... 16 Supply of Basic Drugs ............. ....................... 16 F. Summarv Assessment of the Sector ....................... 18 G. Government's Objectives and Bank Role .................. 19 This report is based on the findings of an appraisal mission vhich visited Morocco in September/October1984. The mission consisted of Messrs. Jean Pillet (Mission Leader), Louis G. Vassiliou, Richard Skolaik, Bernard Hubert, and Ms. Taraneh Tavana, World Bank staff, and Messrs. Hank Schut and Jean Lecoute, World Bank consultants. This document has a restricted distribution and may be ued by recipients ooiy in the performance of their offcl duties Its contents may not otherwise be disdosed without World lank authorization. - ii - II. THE PROJECT .. **................................. .. 20 A. Proiect Concept and Obiectives .............. ............ 20 B. Project Composition ..................................... 20 C. Proiect Description ... .................................... 21 * Primary Health Services Component ..... ...............21 ManagementComponent ....... .......................... 23 * Training and IEC Component ...........................25 . Supply of Basic Drugs ...... ....................... 27 III. PROJECT COSTS AND FINANCING .......................... 30 * Cost of the Project ......... ..... ....30 . Project Financing ... ....... ..........................32 IV. PROJECT ORGANIZATION AND IMPLEMENTATION ............... 33 Organization .. .......................... 33 . Procurement ..................... ......................34 = Disbursement......................................... 35 * Accountsand Audits .................................. 36 . Monitoring ................. ............ ....... 37 . Reporting and Evaluation ............. ............... 38 V. PROJECT JUSTIFICATION AND RISKS ..........................39 Justification........................................ 39 . Risks .... ............................................. 40 VI. AGREEMENTS AND RECOMMENDATIONS .................. ..... 41 = Condition of Board Presentation .......... .. ..........42 . Conditions of Disbursement ........... ................42 ANNEXES ANNEX A - Morocco Health Sector Basic Data Tables A.1 Contraceptive Prevalence .. ................44 A.2 Nutrition ........... ...................45 A.3 Causes of Mortality .. .....................46 A.4 Profile of Demand for PHC .. ...............47 A.5 Manpower Resources .a ................... ... 48 A.6 Manpower Education .................... .... 49 A.7 Health Care Facilities ... .................51 A.8 Capacity and Utilization of Hospitals ..... 52 A.9 MOPE Operating and Capital Budget .. .......53 A.10 Foreign Assistance in Population and Health Activities ....... ..................54 - iii- ANNEX B - Proiect Area Description ................ 55 Tables B.1 Socio-demographic Characteristics ......... 58 B.2 Population Distribution ................... 59 B.3 Contraceptive Prevalence by Method ........ 60 B.4 Family Planning Acceptors ....... .......... 61 B.5 MCH Consultations . ........ .... ........... 62 B.6 Existing Manpower . ............ * *. * * * * * * * .. 63 B.7 Additional Manpower ....................... 64 ANNEX C - PHC Core Proprams ................... ........ ... 65 ANNEX D - PHC Strategies ............................ 71 ANNEX E - Organization of the Health Delivery System ........ 74 ANNEX F - Plannina and Studies Structure and Rer.ponsibilities of the DICP ....... 75 ANNEX G - Druft Supply System Options for the supply of basic drugs ............. 79 Tables G.1 Requirements and Supply of Basic Drugs .... 82 G.2 Sequence of Operations of the Drug SupplySystem . ........... ......... ...... 83 ANNEX H - Proiect Implementation Tables H.1 MOPH Organizational Chart ................84 H.2 Project Implementation Organizational Chart ..................................... 85 H.3 Project Implementation Timetable .......... 86 1.4 Technical Assistance ............ ..........87 ANNEX I - Disbursement & Cost Tables ................. ..... 88-96 ANNEX J - IBRD Allocation ...... ...........................97 ANNEX K - Selected Documents and Data Available in the Project File ................................... 98-99 Maps IBRD 18651, 18652, 18653 ............................ 100-102 - IV - KINGDOM OF MOROCCO HEALTH DEVELOPMENT PROJECT Loan and Proiect Summary Borrower The Kingdom uf Morocco Beneficiary The Ministry of Public Health (MOPH) Amount US$28.4 million equivalent Terms Payable in 20 years, including five years of grace at the Bank's standard variable interest rate. The Borrower would bear the foreign exchange and interest rate risks. The loan would include the refinancing of the PPF of about US$.08 million equivalent. Project Description The project would assist the Ministry of Public Health in strengthening and accelerating the ongoing shift from an urban-based hospital-oriented health system to a more cost-effective system of lrimary care including family planning. The project would include: (a) the strengtheningof primary care in three provinces by upgrading and expanding the physical infrastructure,provision of equipment, training of health staff and improving logistics; (b) the improvementof MOPE management; (c) the strengthening of training and IEC programs, and (d) the improvementof the supply of basic drugs. The main benefits of this first project in the health sector are to provide the Government with a cost-effectivemodel for primary care including family planning, while raising the capacity of the central MOPE to improve the logistics and yet control the costs of the health care delivery system. The main risk of the project relates to the stringency of MOPH recurrent budget. This risk is being addressed by minimizing incrementaloperating costs while reducing unit costs of the services. Project Costs Estimates: (US$ million) Local* Foreizn Total A. Development of Basic Health Services 12.5 10.7 23.2 B. Strengthening of NOPH Management 0.8 0.9 1.7 C. Strengthening of Trainiug and IEC Capacity 0.5 1.1 1.6 D. Improvement of Drug Supply System 2.4 4.4 6.8 Total Baseline Costs 16.2 17.1 33.3 Physical Contingencies 1.2 1.5 2.7 Price Contingencies 4.9 4.6 9.5 Provision for imple- mentation delays 1.0 1.1 2.1 Total Project Costs 23.3 24.3 47.6 (USS million)** Financing Plan: Local Foreian Total IBRD 4.1 24.3 28.4 Government 19.2* - 19.2 Total 23.3 24.3 47.6 Estimated Disbursements: Bank Fiscal Year 1986 1987 19°8 1989 1990 1991 1992 Annual 1.3 3.7 5.4 6.0 6.0 4.5 1.5 Cumulative 1.3 5.0 10.4 16.4 22.4 26.9 28.4 * Includes US$7.1 million equivalent in taxes. ** This includes US$2.1 million provision for implementation delays. - vi - MOROCCO HEALTH DEVELOPMENTPROJECT Basic Data Sheet A. General Country Data: 1. Area (km2) 447,000 1983 2. Total Population (Million) 21.4 1983 3. Population Projections (Million) 31.0 2000 4. GNP per Capita (US$) 870 1983 5. Urban Population as Percentage of Total 42 1983 B. PoDulation Data: 1. Rate of Population Growth (Z) 2.6 1970-82 2. Rate of Natural Increase (Z) 2.9 1970-82 3. Total Fertility Rate 5.8 1983 4. Total Fertility Rate: - Among Women with No Schooling 6.4 1980 - With Seven Years of Schooling or More 4.1 1980 5. Crude Birth Rate (per 1,000) 46.0 1982 6. Crude Death Rate (per 1,000) 13.5 1982 7. Infant Mortality
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