Report No. PID6521

Project Name Albania-Health System Recovery and Development Project

Region Europe and Central Asia

Sector Other Population Health and Nutrition

Project ID ALPE45312 Public Disclosure Authorized Borrower Government of Albania/Ministry of Finance

Implementing Agency Ministry of Health/PIU Deshmoret e Kombit Boulevard Tirana, Albania Tel: 355-42-27938 Fax: 355-42-27942

Environment Category C

Date This PID Prepared 2/3/98

Projected Appraisal Date 2/15/97 - 2/2/97 Public Disclosure Authorized Projected Board Date April 23, 1998

Country and Sector Background

1. Objectives. The proposed Project is consistent with and guided by the Sector Recovery and Development Strategy of the Government. It is designed to support the health sector in addressing the pre- crisis priorities, which remain valid, and to alleviate the needs resulting from the disturbances, through targeted provision of pharmaceuticals and supplies The Project would help develop institutions and national capacity for an effective and sustainable health care system. Its specific objectives are to: (i) Public Disclosure Authorized establish/strengthen sound institutional and human resource capacities to ensure viability and efficiency of the health sector; and (ii) support government efforts to reduce avoidable illnesses and deaths by improving the accessibility, effectiveness and efficiency of essential health services.

Description

2. The Project would include the following four components:

a. National Capacity Building. This component would develop and strengthen institutions and competencies required to implement the sector development strategy. The strategy was developed over the past three years by Albanians with international donor collaboration, and endorsed by the MOH in letters to the Bank, in Public Disclosure Authorized December 1997. The target institutions are the MOH and the Health Insurance Institute (HII).

b. Governance and Management of Health System in Tirana Region. This component would support the establishment and functions of institutions to undertake the decentralization of planning and management to the regional level in Tirana, through assistance to two entities: the Regional Health Management Team (RHMT) and its Management Board.

c. Upgrading of Tirana Health Care Delivery System. This component would support civil works, medical equipment, and supplies for a network of one hospital, three polyclinics, 37 health centers; technical assistance to improve the functional relationships among the health services and facilities; technical assistance for the adaptation and use of standard clinical protocols; and technical assistance in support of selected public health interventions of potentially high impact on health status. d. Project Management. This component would provide support to overall management of the Project, in the form of additional office equipment, technical assistance and staff training for the existing Project Coordination Unit (PCU) in the MOH.

Financing

3. The estimated total cost of the Project is US$28.0 million equivalent, including physical contingencies of 10 percent on civil works and goods, and 5 percent on technical assistance and training. Investment costs (US$26.6 million) covering civil works, medical equipment, vehicles, technical assistance and training, constitute 95 percent of the total Project costs. Incremental recurrent costs (US$1.5 million), including medical supplies, operation and maintenance of equipment and vehicles, as well as other operating costs, constitute 5 percent of the total Project cost. The proposed US$17.0 million IDA Credit would finance about 60 percent of the total project costs.

Implementation

4. The Project would be implemented over a four year period by the Ministry of Health in close coordination and collaboration with related health authorities at the central and local levels. Overall responsibility for implementation of the Project would rest with the MOH, while the planned project activities would be managed and implemented by the various national and regional institutions concerned, including the proposed Tirana Health Authority, the Health Insurance Institute (HII), Medical Faculty of University of Tirana, municipalities, NGOs and other donor agencies.

Sustainability

The Project will build upon and expand the scope of successful activities carried out under the on-going project. The Project focuses primarily on the restructuring and improvement of existing institutions and, as such, is not expected to lead to increased recurrent budgetary outlays, besides the need to support operations induced by the recent crisis. If anything, the consolidation of institutions, related re-deployment of staff, and efficiency gains resulting from better management would lead to a neutral budgetary impact -compared to the pre-crisis situation- while improving the relevance and effectiveness of services rendered to the population.

- 2 - The Project will establish a basis for medium- to long-term sustainability by supporting a rational approach to sector planning and by professionalizing sector management in a decentralized structure

Lessons learned from past operations in the country/sector

5. Experience gained and lessons learned from the first Bank- financed investment in the health sector demonstrate the critical importance of context-specific and efficient implementation arrangements, as well as the need for full Government commitment. Project implementation and management capacities are given particular importance in this Project, as shown by the emphasis placed on staff training and support to management for all activities, and the fact that the PCU would be entirely funded out of the IDA Credit. Based on experience with the on-going project, an important lesson learned is the need for intense and sustained support to the PCU in the early stages of implementation. The PCU would be supported by high quality technical assistance and by the Bank's health sector team for Albania, based in Tirana, Budapest and Washington.

Poverty Category

6. Program of targeted interventions.

Environmental Aspects

7. This is a Category C Project: "No appreciable environmental impact." Upgrading of unsanitary hospital buildings would contribute to improved environmental safety, as would the replacement of old equipment -- radiology and laboratory -- that present health risks. Sanitary procedures would be introduced for dealing with waste management.

Program Objective Categories

8. The project falls into the Program Objective Category: Poverty Reduction and Human Resources Development (100%).

Contact Point Olusoji Adeyi, Task Manager The World Bank 1818 H Street N.W. Washington, DC 20433 Telephone No.: (202) 458-5835 Fax No.: (202) 477-1996

Note: This is information on an evolving project. Certain components may not necessarily be included in the final project.

Processed by the InfoShop week ending February 6, 1998.

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