AFRICAN DEVELOPMENT FUND

BURKINA FASO

PROJECT COMPLETION REPORT

HEALTH SERVICES STRENGTHENING PROJECT

HUMAN DEVELOPMENT DEPARTMENT May 2009

 

 

TABLE OF CONTENTS CURRENCY EQUIVALENTS, WEIGHTS AND MEASURES, ACRONYMS AND ABBREVIATIONS, LIST OF ANNEXES, EXECUTIVE SUMMARY, CONCLUSION AND RECOMMENDATIONS, BASIC PROJECT DATA AND PROJECT LOGICAL FRAMEWORK MATRIX

Page

i to x

1. INTRODUCTION 1 2. PROJECT OBJECTIVES AND FORMULATION 1

2.1 PROJECT OBJECTIVES 1 2.2 PROJECT DESCRIPTION 1 2.3 PROJECT FORMULATION 3 2.4 IDENTIFICATION, PREPARATION AND APPRAISAL 3 2.5 NEGOCIATION AND APPROVAL 3

3. PROJECT IMPLEMENTATION 3 3.1 EFFECTIVENESS AND PROJECT START-UP 3.2 MODIFICATIONS

3 4

3.3 PROJECT IMPLEMENTATION SCHEDULE 5 3.4 REPORTS 6 3.5 PROCUREMENT OF GOODS AND SERVICES 6 3.6 COST, SOURCES OF FINANCING AND DISBURSEMENT 6

4. PROJECT PERFORMANCE AND OUTCOMES

7

4.1 OPERATIONAL PERFORMANCE 7 4.2 INSTITUTIONAL PERFORMANCE 8 4.3 PERFORMANCE OF CONSULTANTS, CONTRACTORS AND SUPPLIERS

8

5. SOCIAL AND ENVIRONMENTAL IMPACT

9

5.1 SECTOR IMPACT 9 5.2 SOCIO-ECONOMIC IMPACT 5.3 ENVIRONMENTAL IMPACT

10 10

6. PROJECT SUSTAINABILITY 10

7. PERFORMANCE OF THE BANK AND THE BORROWER 11

7.1 PERFORMANCE OF THE BANK 11 7.2 PERFORMANCE OF THE BORROWER

11

8. OVERALL PERFORMANCE AND RATING

12

9. LESSONS, CONCLUSIONS AND RECOMMENDATIONS 12 9.1 CONCLUSION 12 9.2 LESSONS 12 9.3 RECOMMENDATIONS 13

This report was prepared by a team of consultants comprising a Public Health Specialist and an Architectural Civil Engineer, with the support of Mrs. Salamata ILBOUDO, Social Development Specialist, BFFO, and under the supervision of Mrs. Maïmouna DIOP LY, Health Analyst, following the mission to Burkina Faso in February 2009. Questions on this document should be referred to Mr. Thomas HURLEY, Director OSHD (Ext. 2046) and Mr. Tshinko B. ILUNGA, Division Manager, OSHD.3 (Ext. 2117).

 

 

CURRENCY EQUIVALENTS

At Project Appraisal : At Project Completion April 1999 : December 2007 UA 1 = CFAF 829.162 : UA 1 = CFAF 706.649

WEIGHTS AND MEASURES Metric system

FISCAL YEAR 1 January to 31 December

ACRONYMS AND ABBREVIATIONS

ADB African Development Bank ADF African Development Fund AIDS Acquired Immune Deficiency Syndrome CHW Community Health Worker BCEAO Central Bank of West African States CADSS Health System Decentralization Support Unit CAM Procurement Commission CAMEG Generic Essential Drugs Purchasing Agency CHN National Hospital CHR Regional Hospital CHU University Teaching Hospital CIFRA International Research-Action Training Centre CM Medical Centre CMA Medical Centre with a Surgical Unit CNS National Health Council COGES Management Committee CPAM Provincial Procurement Commission PNC Pre-natal Consultation CSPS Health and Social Promotion Centre CSS Higher Health Council CT Technical Adviser DAF Directorate of Administration and Finance DEP Directorate of Studies and Planning DES Directorate of Health Infrastructure DFP Directorate of Vocational Training DGHSP General Directorate of Hospitals with Private Sub-sector Oversight DGIEM General Directorate of Infrastructure, Equipment and Maintenance DGPML General Directorate of Pharmacies, Medicine and Laboratories DGS General Directorate of Health DGSP General Directorate of Public Health DHPES Directorate of Public Health and Health Education DIS Health Infrastructure Directorate DL Laboratories Directorate DLM Disease Control Directorate

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DML Maintenance and Logistics Directorate DMPT Medicine and Traditional Pharmacopoeia Directorate DPM Directorate of Pharmacies and Drugs DRH Human Resources Directorate DRS Regional Health Directorate DS Health District DSF Family Health Directorate ECD District Supervisory Team FONALEP National Epidemic Control Fund HIV Human Immune-Deficiency Virus HT Health Training IB Bamako Initiative IEC Information, Education, Communication MEDEV Ministry of Economy and Development MEG Essential and Generic Drugs MFB Ministry of Finance and Budget SM Safe motherhood MH Ministry of Health NGO Non-Governmental Organization NR Not received NHDP National Health Development Plan OD Operationalization of Districts UNAIDS United Nation Organization for AIDS Control WHO World Health Organization PADS Health Development Support Programme PHA Promotion of Hygiene and Sanitation PMA Minimum Package of Activities PMU Project Management Unit UNDP United Nations Development Programme PRSS Health Services Strengthening Project PS Private Secretariat NHP National Health Policy PMCT Prevention of Mother-to-Child Transmission PLWHIV People Living With HIV/AIDS RH Reproductive Health SIEM Infrastructure, Equipment and Maintenance Department STD Sexually Transmitted Diseases STI Sexually Transmitted Infections UA Unit of Account UFR/SDS Health Services Training and Research Unit UNICEF United Nations International Children and Education Fund WFP World Food Programme

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LIST OF ANNEXES

Annexes Number of Pages 

Annex 1: Sources of Information........................................................................................... 1

Annex 2: Estimated and Actual Schedule ............................................................................. 1

Annex 3: Breakdown of Financing by Component and Expenditure Schedule at Appraisal 2

Annex 4: Project Implementation Outcome .......................................................................... 1

Annex 5: Bank Performance during the Project Cycle ......................................................... 1

Annex 6: Project Outcomes ................................................................................................... 1

Annex 7: Matrix of Recommendations and Follow-Up Measures ....................................... 2

Annex 8: List of Contracts signed under the PRSS ............................................................... 7

Annex 9: Map of Burkina Faso.............................................................................................. 1

Annex 10: Borrower’s Comments on the Bank’s PCR ........................................................ 1

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EXECUTIVE SUMMARY This project is the result of a study financed by the African Development Bank Group following a request by the Burkina Faso Government. In 1999, the health status of the Burkinabe population was characterized by high mortality rates and low availability of health services, especially in the three health regions in the country’s west. The project was to help improve the population’s health status. Its specific objectives were to: (i) improve access to and quality of health services in the project area: Bobo-Dioulasso, Dédougou and Gaoua; (ii) help reduce morbidity and mortality in that area; and (iii) build the institutional capacity of the Ministry of Health at national and regional level. The five components retained were: (i) strengthening the District health system; (ii) strengthening the second referral level; (iii) support for STI/AIDS control; (iv) institutional support at the central and regional levels; and (v) project implementation. Scheduled to be implemented over a five-year period (2000 to 2004), the project was estimated to cost UA 11.11 million at appraisal, comprising UA 10 million as ADF loan and UA 1.11 million as counterpart contribution. The project became effective on 7 December 2001, started up on 1 March 2002 and was completed on 31 December 2007. Many participants from the different levels of the Ministry of Health (MH) were involved. NGOs implemented the community mobilization and HIV control activities. The Project Coordinating Unit (PCU) handled the coordination. Overall, the project outcomes were satisfactory and activities carried out led to the attainment of its objectives. Furthermore, those in charge took the necessary precautions to ensure a degree of sustainability of project output. The project’s institutional performance is satisfactory, thanks to the involvement of the private and public sectors and civil society. The following lessons were learned following analysis of project output, (including analysis by the beneficiaries):

(i) Slowness in the Government’s fulfilment of the loan conditions led to slippage on the project implementation schedule;

(ii) Involvement of MH’s central and decentralized structures in project

implementation is vital for ownership and real institutional anchoring - drivers of project success and sustainability;

(iii) The adjustment of the project to the changing needs of the sector constituted an

additional factor of success; (iv) Supervision missions should be carried out by multi-disciplinary teams, including

sector specialists; (v) Whatever the project performance level, its rate of return and impact will be

limited by constraints from related sectors, especially the transport sector;

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(vi) Contract management requires a proper analysis of the many amendments requested by the project; and

(vii) Due to a cautious preventive and curative maintenance programme, biomedical

and other equipment can remain functional for about ten years. It will then be necessary to replace them.

(viii) During the implementation of a health project, the presence of sector experts

prevents donor/borrower dialogue from losing sight of the specific objectives of the operation and ensures implementation of necessary strategic refocusing; and

(ix) Funds that remain unjustified by project end may be difficult to retrieve.

In view of the above lessons, the following recommendations have been formulated to contribute to enhancing the design quality of the Bank’s future interventions in the sector in Burkina Faso: To the Bank:

i) Ensure compliance with the deadline for fulfilling loan and grant conditions;

ii) Limit the number of loan conditions;

iii) Show flexibility in ensuring the required contextual changes during project implementation with a view to facilitating the achievement of the expected outcomes, especially for training;

iv) Ensure quality supervision by using multi-disciplinary teams, including a sector specialist;

v) Apply more rigorously the Presidential Directive on processing amendments; and

vi) Ensure that the latest justifications of the revolving fund are transmitted to the Bank prior to preparation of the completion report.

To the Borrower:

(i) Ensure project institutional anchoring and the involvement of all the central and

decentralized structures immediately following project identification and effective implementation;

(ii) Systematically involve the local communities, including in project

implementation;

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(iii) In the envisaged investments, take into account national capacity to ensure not only the sustainability of procurements but also their renewal in the medium term by establishing a maintenance system; and

(iv) Include future national health-care development plans in a horizontal approach to

the multi-sector control of health issues, A. BASIC PROJECT DATA 01. Country: BURKINA FASO 02. Project: Health Service Strengthening Project 03. Project SAP number: P-BF-IBZ-001 03. Loan Number: 2100150000036 04. Borrower: Government of Burkina Faso 05. Guarantor: Government of Burkina Faso 06. Beneficiary: Ministry of Health 06. Management Organ: Project Coordinating Unit (PCU) 07. Loan Amount (in UA) : 10,000,000 08. Loan Approval Date: 06/10/1999 09. Repayment: 1 % between the 11th and 20th year and 3 % a year subsequently 10 Commitment Fee: 0.75 % 11 Repayment Period: 40 years 12 Grace Period: 10 years 13 Signature Date: 07/02/2000 14 Effectiveness Date: 07/12/2001 15 Start-up Date: 01/03/2002 16 ADF First Disbursement Date: 18/03/2002 17 ADF Last Disbursement Date: 08/04/2008 18 Project Activity Start-up Date: 01/03/2002 19 Project Activity Completion Date: 31/12/2007 B. PROJECT DATA 1. Project Cost at Appraisal and Actual Cost in UA

Sources of Financing Amounts at Appraisal Actual Amounts Disbursed as at 08/04/2008

Total (in % of the amounts at appraisal)

ADF 10 000 000 9 779 453.74 97.79 Government 1 110 000 1 241 468.96 103.61 Total 11 110 000 11 020 922.7 99.20 2. Initial Project Financing Plan (in UA million)

Source FE % Local Currency % Total % ADF 6.07 54.7 3.93 35.32 10.00 90.0 Government - - 1.11 9.98 1.11 10.0

Total 6.07 54.7 5.04 45.3 11.11 100.0 % of Total Cost 54.7 % 45.3 % 100.0 %

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3. Actual Project Financing by Source of Financing and Year (in UA) Year 2002 2003 2004 2005 2006 2007 2008 TOTAL

ADF 630 434.88 1 100 141.09 1 866 65.00 3 777 418,59 931 108.,25 1 003 093.86 470 692.07 9 779 453.74* Gov. 35,655.76 150,064.03 164,278.22 450,214.21 395,406.94 45,849.79 0 1,241,468.96

*: The Government’s annual disbursements in UA were obtained on the basis of CFAF amounts based on UA rates prevailing in December each year.

C. PROJECT PERFORMANCE INDICATORS Balance as at 08/04/2008 2.21 %

Time overrun /underrun

01. - Slippage on effectiveness 21 months 02. - Slippage on first disbursement NA 03. - Slippage on last disbursement 12 months 04. - Slippage on completion 16 months

Last disbursement deadline extensions

05. - Number of extensions 2

Level of financial implementation

06. - Unused loan balance (UA) 220,546. 26 07. - Unused loan balance (in % of total loan) 2.20 %

Level of physical implementation

08. - Construction completed (in % of estimates) 100 % 09. - Equipment procured (in % of estimates) 100 % 10. - Studies conducted (in % of estimates) 100 % 11. - Training conducted (in % of estimates) Not applicable Institutional performance 12. - Bank Group (overall rating) Satisfactory 13. - Borrower (overall rating) Satisfactory 14. - Consultants (overall rating) Highly Satisfactory 15. - Contractors (overall rating) Satisfactory 16. - Goods suppliers (overall rating Satisfactory 17. - Project Coordinating Unit (overall rating) Highly Satisfactory

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D. BANK MISSIONS Mission Number of

people Composition Date

Appraisal 3 A public health expert, a public health consulting expert and an architectural engineer

From 22/06 to 11/07/2001

Supervision 2 A public health expert and a disbursements officer From 24/02 to 03/03/2002 Supervision 2 A public health expert Public health expert and an architectural

engineer From 18/06 to 05/07/2002

Supervision NA NA From 06/12 – 07/12/2002 Supervision 1 A disbursements officer From 22/04 –30/04/2003 Supervision 2 An education expert and a consulting architectural engineer From 11/07 – 19/07/2003 Supervision 3 Division Manager, Social Development Division ; an education

expert and an architectural engineer From 25/01 –09/02/2004

Supervision 2 An education expert and an architectural engineer From 11/09 –03/10/2004 Supervision 2 Public health expert and an architectural engineer From 29/03 – 15/04/2005 Supervision 1 A Public health expert From 01/10 – 08/10/2005 Supervision 1 An education expert From 19/06 – 01/07/2005 Supervision 5 A Public health expert, an architectural engineer, a disbursement

officer, a social development specialist and a procurement officer From 15/11 –30/11/2006

Supervision 1 A public health expert From 15/06 – 30/06/2007 Supervision 5 A public health expert, an architectural engineer, disbursement

officer, a social development specialist and a procurement officer From 15/10 –31/10/2007

Mid-term Review 1 Undertaken by a public health expert recruited by the Project March 2005 Completion Report 2 Consulting public health expert and an architectural engineer From 20/01 – 04/02/2009

G. LOAN DISBURSEMENT Total disbursed as at 08/04/2008 : UA 9 779 453.74 Balance as at 08/04/2008 : UA 220 546.26 Loan balance : Unused and re-allocated to the food crisis Annual disbursements in UA million and in %

Year Estimate at Appraisal

Actual Disbursement Cumulative Disbursements

Annual Balance

% Disbursed

2000 0.64

2001 4.11

2002 3.77 0.63 0.63 9.37 6.30 %

2003 0.99 1.10 1.73 8.27 11.00 %

2004 0.40 1.87 3.60 6.40 18.67 %

2005 0.09 3.78 7.37 2.63 37.77 %

2006 0.93 8.31 1.69 9.31 %

2007 1.00 9.31 0.69 10.03 %

2008 0.47 9.78 0.22 4.71 %

Total 10.00 9.78 97.79 %

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Burkina-Faso: Matrix of the Health Services Strengthening Project

At Appraisal in 1999 and at Completion 2008 vis-à-vis the Means of Verification

OBJECTIVELY VERIFIABLE INDICATORS NARRATIVE DESCRIPTION At Appraisal At Completion

MEANS OF VERIFICATION

KEY ASSUMPTIONS

Project Objective

1. Improve access to and quality of health services in the Bobo-Dioulasso, Gaoua and Dédougou regions.

1.1 Increase in geographical accessibility to CSPS and CMA (additional 12 CSPS and 2 CMAs)

1 1.1 Periodic statistical reports at MH’s central, intermediate and peripheral level

Adequate high quality staffing

1.2 Increase in the frequency of supervision visits to 1 per month (1 per quarter in 1999)

1.2 100 % carried out. 1.2.1 Same as 1.1.1 2. Same as above

1.3 50 % increase in pre-natal consultation coverage (rate at Gaoua: 46 % in 1999)

1.3 Rate in project area: 46 % in 1999 and 58 % in 2006)

1.3.1 Same as 1.2.1 2. Same as above

1.4 50 % increase in assisted births (rate at Gaoua: 18 % in 1999).

1.4 Not implemented. Rate in project area 48 % in 2004 compared to below 20 % in 1999.

1.4.1 Same as 1.2.1 2. Same as above

 2. Contribute to the reduction of

morbidity and mortality in the area (AIDS and other STIs).

2.1 25 % increase in persons voluntarily undergoing HIV screening.

2.1 Data not available, but probable increase of over 25 % of the number of people undergoing voluntary HIV screening, considering the increase in the number of PLWHIV under ARVs which increased from 1,500 in 1999 to 12,342 in 2006.

2.1.1 Periodic statistical reports of the CMLS-health and CNLS sentinel sites

The State and the development partners continue performing their anti-AIDS activities

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2.2 All the pockets of transfused blood are tested

100 % of the pouches of transfused blood are tested

2.1.1 Periodic reports of CMA CHR and DRS

Same as above

2.3 Increase in vaccination coverage below the national standard of 85% (current rate in project area: about 50 %)

2.3 Increase in DTCP3 vaccination rate above the 85% national standard (current rate in the project area: 97 % in 2006)

2.3.1 Periodical statistical reports from the districts, DRS and EPI

The Government and UNICEF continue financing the PEV

3. Build MH’s institutional capacity 3.1 Quarterly supervision of ECD and professionals trained respectively by the DRS and DGSP/CADSS

3.1 100 % implemented 3.1.1 Annual reports of the DRS and MH

Smooth coordination of health activities exists at all levels and personnel available

Outcome and Activities

1. Construction and equipping of 12 CSPS and 2 CMA and standardization of 6 CSPS and 2 CHR

1.1 Existence of infrastructure 1.1 100 % implemented 1.1.1 Acceptance report; PIU reports

Sites available

2. Delivery of 4 ambulances;6 4x4 vehicles; 2 pick-up trucks;1 utility vehicle and 150 motorcycles

2.1 Existence of means of transport in the assigned structures

2.1 100 %implemented 2.1.1 Same as 1.1.1

3. Initial provision of MEG for 12 CSPS and 2 distribution depots; supplementary allocations for 253 CSPS, 13 distribution depots and 2 CHRs, and additional vaccines and GEDs for FONALEP.

Adequate allocations for the facilities

Existence of allocations in the CSPS, the distribution depots, the CHR of the project zone and FONALEP

3.1.1 Same as 1.1.1 No stock outages at CAMEG

4 Training of 24 Health Specialists and 2 maintenance technicians and the CHWs, members of Management Committees

Notification of award of 26 scholarships

Number of CHWs trained

26 scholarships awarded

100 % implemented 4.1.1 Training reports and

CHW activities

5. Community organization of care is improved

Number of assisted deliveries by village birth attendants

Not available (WHO and MH no longer consider village birth attendant-assisted deliveries as acceptable)

8.1.1 Supervision reports

 

 

1. INTRODUCTION 1.1 This project, entitled the “Health Services Strengthening Project (PRSS)” was the result of a study financed by the African Development Bank Group (the Bank) following a request from the Government of Burkina Faso. The request was submitted in August 1998 as part of effort to mobilize resources for the implementation of the 1998-2007 National Health Development Plan (NHDP). When the PRSS was appraised in 1999, Burkina Faso’s human development index ranked 170th out of 174. The health status of its population was unsatisfactory, characterized as it was by high mortality rates especially for mothers and children under five and a low health services utilization rate. That situation was mainly attributable to under-funding and the low performance of the national health sector which could not provide an acceptable level of access and use of quality health services. 1.2 This completion report was prepared following the Bank’s mission (via consultants) to Burkina Faso from 19 January to 4 February 2009. Among other things in the three regions of the project area, the mission visited eleven (11) new or rehabilitated health facilities, held discussions with top officials of the relevant ministries (Economy, Finance and Health) as well as with the technical staff at the central, intermediate and peripheral level. Information was gathered from different participants and representatives of project beneficiaries, including members of management committees (COGES). The report was mainly based on: (i) the appraisal report and project loan agreement; (ii) the Government’s provisional completion report; (iii) data available at the Project Coordinating Unit (PCU) and the Bank; (iv) activity and audit reports; and (v) ledgers and disbursement tables. Annex 1 presents the list of information sources. 2. PROJECT OBJECTIVES AND FORMULATION 2.1 Project Objectives 2.1.1 The PRSS was designed with a view to helping improve the health status of the Burkinabe population. The specific objectives were to: (i) improve access to and the quality of health services in the Bobo-Dioulasso, Dédougou and Gaoua zones; (ii) help reduce morbidity and mortality in the project area; and; (iii) build the institutional capacity of the Ministry of Health at the national and regional level.

2.2 Project Description The Health Services Strengthening Project scheduled for implementation over five years, comprised the following five components:

- I: Strengthening the District Health System: This component concerned the first and second levels of health care in the health district (CSPS and CMA) as well as the District Framework Team (ECD). It envisaged the reinforcement of the District Health system through support to the implementation of district plans in the project area, especially the construction of 12 CSPS and new two (2) Medical Centres with surgical units (CMA) the extension and rehabilitation of 6 CSPS, equipping and providing them with drugs, offering training and refresher courses for staff and health centre depot managers, community health workers equipped with health kits, management committee members, support to community health activities, advanced strategy and immunization activities, consultative activities in the district capitals, ECD supervision and monthly Management Committee meetings, provision of an

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ambulance and a pick-up truck for each CMA; essential generic drug kits, 110 motorcycles and 40 motorcycle ambulances; office equipment to the 15 District Supervisory Teams (ECD) and supply of essential generic drugs (GEDs) to the distribution depots of the fifteen districts in the area.

- II: Strengthening the second referral level: This component comprised the

extension, rehabilitation and equipment of the Dédougou Regional Hospital (CHR), the supply of additional equipment and furniture for the Dédougou and Gaoua CHRs with their supplies of essential generic drugs, and the continuous staff training and training of two maintenance technicians. The project was to organize administrative meetings, supply consumables and, in a degressive manner over four years as from the second year, fuel expenses and subsistence allowances of CHR management personnel.

- III: Support for Sexually Transmitted Diseases and AIDS Control: Through

this component, the project was to: (i) set up a sentinel site in the Dédougou CHR and furnish the Gaoua CHR; (ii) support NGOs, APRODEC/CADI and SAS Centre, in charge of information, education and communication (IEC) activities, HIV screening and disease monitoring; and (iii) support the implementation of multi-sector STD and AIDS control in the Gaoua district, and its extension to another district in the project area to be determined later. Specifically, the Project was to ensure the training of NGO personnel, provide them with medicines, audio-visual and IT equipment, documentation and the necessary facilities for health/advisory activities for the two sentinel sites (Gaoua and Dédougou), as well as means of transport (motorcycles).

- IV: Institutional Support at the Central and Regional Levels: At central level,

the project’s support mainly concerned the Vocational Training Directorate, the Permanent Secretariat of the National AIDS Control Committee, the Health System Decentralization Support Unit (CADSS) within the General Public Health Directorate (DGSP), the National Epidemic Control Fund (FONALEP) and the financing of studies, including urban health and alternative means of health care financing. At the regional level, it concerned the Regional Health Directorate (DRS). Regarding the DGSP/CADSS, the project was to provide the necessary equipment for carrying out the missions of training and monitoring of field training.

- V. Project Implementation: Under this component, the salaries of five officials

and eight support staff as well as the furniture and equipment necessary for smooth project management were to be financed by the ADF. The furniture and equipment comprised: two 4x4 vehicles, one liaison vehicle, one motorcycle, eight computers, five printers and software packages, one computerized management system, one photocopying machine, as well as office furniture for eight people. The operating costs of the Project Management Unit (PMU), including salaries and annual accounts audits, were to be financed by the project during its duration. The project activities were implemented by the health personnel, health committees, NGOs, the contractors and private consultancy firms.

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2.3 Project Formulation The PRSS was formulated using a participatory approach. Specifically, special emphasis was placed on local development, in conformity with the National Health Development Policy (NHDP) adopted for the 1998-2007 period. The development partners validated the different project components. The project was designed in a context where the decentralization policy was being implemented and communities were being urged to become seriously involved in managing the development of their towns and villages, including through already established management committees. Therefore, the project design process involved the population concerned, especially women whose health problems were among the project priorities. 2.4 Identification, Preparation and Appraisal The Bank appraised the project in January/February 1999. No formal identification mission was fielded or formal preparation undertaken. Nonetheless, discussions were conducted on the basis of the NHDP. The main issues discussed during the appraisal mission concerned project alignment with the priority areas defined in the 1998-2007 National Health Development Plan (NHDP), as well as the areas with inadequate partner support. The choice of the project area and activities envisaged complied with the needs identified in the 1998-2007 National Health Development Plan and complemented the commitments of the other partners involved in the sector. 2.5 Negotiations and Approval There were no special issues during the negotiations since the project design matched Government priorities. The project was approved on 6 October 1999. 3. PROJECT IMPLEMENTATION 3.1 Effectiveness and Project Start-Up 3.1.1 The project became effective on 7 December 2001, i.e. 21 months after approval. The following conditions precedent to first disbursement were fulfilled on 5 February 2002, i.e. 23 months after approval and two months after effectiveness. This was mainly because the project unit team had not yet been set up due to flaws in the procedures, thus delaying the process:

i) Provide ADF with evidence of the official decision to set up the Project Coordinating Unit at Bobo-Dioulasso under the authority of the General Secretariat of the Ministry of Health

ii) Provide ADF with evidence of selecting the supervisory staff of the Project

Coordinating Unit, i.e., one coordinator, an administrative manager, a public health doctor, one architect and one accountant. The CVs and the outcome of the related bid analysis were subject to prior ADF approval

iii) Provide ADF with evidence of allocating land for the construction of the

Medical Centres with surgical units in sectors 15 and 22 of Bobo-Dioulasso and the 12 new Health and Social Promotion Centres in the project regions.

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iv) Provide ADF with evidence of opening three accounts at Bobo-Dioulasso, for

project implementation: account opened at BCEAO where ADF funds would be deposited, an account opened at the Public Treasury to receive the counterpart funds and an account opened in a commercial bank to facilitate project management to be replenished with the account opened at the BCEAO.

3.1.2 Under “Other Conditions”, the Borrower was to:

i) Specify the Health District selected for the extension of the multi-sector plan no later than six months after project effectiveness.

ii) Provide to the Fund, three months prior to the completion of the CMA and

CSPS construction works, the price list for medical services and drugs in these newly built facilities.

iii) Provide the Fund, three months before the completion of the CMA and CSPS

construction activities with the nominative list of the necessary personnel to be assigned to these sectors, for the smooth operation of facilities.

iv) Submit to the Fund, no later than six months after the first loan disbursement,

a detailed training plan specifying the choice of establishments, selected candidates, schedule and duration of the training.

v) Ensure that health personnel to be offered long-term training under the project

undertake to serve in the public health structures for a minimum of 5 years after such training; and

vi) Submit to the Fund, no later than six months after the first loan disbursement,

a copy of the Memorandum of Understanding between the Government and the APRODEC/CADI NGO on the one hand, and between the Government and the SAS Centre on the other hand.

3.1.3 The loan conditions were relevant and helped facilitate project implementation. However, another condition on project sustainability (e.g. coverage of the cost of a biomedical technician by project region or the establishment of a regional fund to renew the biomedical equipment under the project) would have been opportune. 3.1.4 The loan agreement was signed on 07/02/2000 and became effective on 7 December 2001, i.e., with a 22-month time overrun due to the delay in setting up the PCU. 3.2 Modifications The modifications made during project implementation did not concern procurement methods or the consistency of the project at the mid-term review. They were mainly readjustments to ensure results that are more consistent. The most important modifications concerned the focusing of the third component and the architectural programmes. 3.2.1 Refocusing of the Third Component: The activities under the component were assigned to the MH AIDS control Ministerial Committee (Health CMLS) at a refocusing

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workshop in November 2002, where they were also reformulated. The Workshop retained: (i) consolidation of the blood banks as an essential means of ensuring safe blood transfusions; (ii) establishment of outpatient hospitals instead of Outpatient Treatment Centres (CTAs) in the Dédougou and the Gaoua CHR. The day hospital option would improve the treatment of people living with HIV, relations between caregivers, community-based associations and the families of patients, even as it would facilitate the introduction of ARVs, monitoring of their prescription and their distribution without hospitalization. A Memorandum of Understanding signed with the Nouna Health Research Centre (CRSN) led to the introduction of the Prevention of Mother-to-Child Transmission (PMCT) of HIV/AIDS in the district. 3.2.2 Change of Architectural Programmes: At the Dédougou CHR, the envisaged rehabilitation (hospitalization, ORL) were replaced by the refurbishment of the Paediatric Unit, CREN and the construction of latrines. In the CMA, the four planned staff accommodation units were replaced with one 18-bed ward per CMA. The construction of incinerators in all the facilities was decided for enhanced environmental protection. The cancellation of provision for accommodation did not affect the staff who already lived in town but was very useful since it made it possible to enhance the monitoring of patients who had been operated on. Some sites were changed because they were not suitable or already had facilities. These changes sometimes required contract amendments and were managed within the deadlines. 3.3 Project Implementation Schedule 3.3.1 It was not possible to adhere to the project implementation schedule. The project actually only started in March 2002 instead of March 2000. The delay was due to the Government’s slow fulfilment of the conditions precedent. The project was closed on 31 December 2007 following two (2) six-month extensions, each granted by the Bank to enable the Borrower to use the balance of UA 1,694,332.19 as at 31/12/2006. Following the recommendation of a Bank supervision mission and after three different proposals, the following actions were adopted: (i) finalize the delivery and installation of equipment in some health facilities; (ii) carry out external works; (iii) repair the poor workmanship noted at the Bobo-Dioulasso Sector 15 CMA; (iv) electrify maternity units; (v) build up CMA’s stock of medicines; (vi) replace the borehole pump column pipe; (vii) supervise the doctors trained in basic surgery; (viii) effect salary payments for project staff for six months. In fact, the extensions offered the opportunity of assembling the borehole pump column pipe and complete the installation of solar panels in the maternity wards, accommodation and drug sales depots. An amount equivalent to UA 295,936.02 was also deducted from the Loan Fund for the procurement of 936,000 doses of vaccines against meningitis and the unused balance (i.e. UA 220,546.26) was re-allocated to the food crisis at Government’s request. However, the second extension could have been prevented by following the Bank’s procedure for the use of balances. 3.3.2 In five years, the PRSS implemented all the activities envisaged in the appraisal report after revision of the list of goods and services. However, some goods and works had not yet been received by 31 December 2006. The table in Annex 2 demonstrates the difference between the estimated and actual project schedules.

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3.4 Reports 3.4.1 The PIU complied with the loan agreement provisions regarding the preparation and submission of periodic activity reports. Indeed, it forwarded on a timely basis 20 quarterly reports, 7 reports of the Steering Monitoring Committee (CDS), 6 public health study reports and 2 reports on mission to Bank headquarters. Moreover, at 30 June 2008, the Borrower submitted to the Bank the completion report that was expected at the end of project implementation. The completion report presents the general project situation fairly well but the there are few details on the project impact analysis. 3.4.2 Regarding project accounts, each of the five PRSS fiscal years was the subject of an audit conducted by an independent audit firm. All five reports were submitted to the Bank as scheduled in the loan agreement and the PIU implemented all the recommendations made to it. The main problems raised concerned some pre-financing and ineligible expenditure (for instance expenditure for laying the foundation stone for the construction of the two hospitals under Health Project III). All these expenditures were refunded by the Government. 3.5 Procurement of Goods and Services Under the PRSS framework, contracts for the procurement of goods, works or services were signed without much difficulty, in line with Bank Rules of Procedures and methods set out in the loan agreement. Ten amendments related to the construction of incinerators and additional equipment were made to the contracts and received Bank approval. Two amendments were made to the GED supply contract (a drop/increase) subsequent to the reduction in the costs of ARVs and the need to procure vaccines against meningitis. The two amendments were therefore unnecessary. 3.6 Costs, Sources of Financing and Disbursements 3.5.1 At appraisal, the total project cost, tax excluded, was estimated at UA 11.11 million, comprising UA 6.07 million (54.7 %) in foreign exchange and UA 5.04 million (45.3 %) in local currency. The ADF loan amount was UA 10.00 million and the counterpart contribution UA 1.11 million. At completion, the total project cost stood at UA 11.02 million, of which UA 9.78 million disbursed from the ADF loan as at 08/04/2008 and UA 1.24 million from the counterpart contribution. 3.5.2 Overall, disbursements by the two sources of financing were satisfactory. As at 31 December 2006, the counterpart contribution disbursed amounted to CFAF 934,952,999 compared to an initial estimate of CFAF 934,964,100. However, the extension of the project closure date twice succeeded in raising the contribution to a total CFAF 968,728,521, i.e. a disbursement rate of 103.61 % compared to the amount estimated in the loan agreement. 3.5.3 Disbursements on the ADF loan in April 2008 stood at UA 9.78 million, i.e. 97.79 % of the loan. However, it is worth noting that only UA 9.18 million was justified and broken down by expenditure category. The Government is yet to justify an amount equivalent to 8.15 % of the ADF loan. It is important that justification of the amount be transmitted to the Bank. Otherwise, the Government must refund the ineligible or unjustified expenditures. The project cost and the estimated and actual financing are summarized in Annex 3.

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4. PROJECT PERFORMANCE AND OUTCOMES 4.1 Operational Performance 4.1.1 Project results were satisfactory: the activities conducted under the PRSS led to the achievement of the project outcomes and specific objectives as indicated in the Table below and Annex 4.

Number of Units Activity Unit Estimated Actual

Component I Construct/standardize CSPS CSPS 18 18 Construct new CMA CMA 2 2 Provide the care centres with batches of standard equipment Centres 14 14 Train district employees in SSP techniques Staff 1,030 8242 Ensure supervision visits by the ECD Visits 720 3,234 Component II Ensure the extension and equipment of former CHR CHR 1 1 Provide the CHR with initial GEDs stock CHR 2 2 Component III Provide PNLS with ARVs for the treatment of PLWHIV Patient-year NA 400 Provide NGOs with equipment, consumables and other indispensable goods AIDS-control activities

NGO 2 2

Train workers in PLWHIV care methods Staff 2310 2312 Component IV Provide FONALEP with a stock of vaccines and MEGs for emergencies Stock 1 1 Provide the DRH with an efficient MH staff management software Software 1 1 Finance long duration training scholarships for senior MH officials Scholarships 26 26 Finance public health studies Studies 3 3 Component V Finance the operation of the PIU UA million 0.46 0.35 4.1.2 Project activities scheduled under Component I were conducted highly satisfactorily. Indeed, twelve new CSPS and two new CMAs were built and equipped in keeping with national standards, in addition to six CSPS which benefited from extension and rehabilitation. The fifteen distribution depots within the project zone received the initial supplies of GEDs. Over 8,000 district employees in this area were trained in various primary health care-related methods. Under support to Community Health Activities and “Advanced Strategy” activities, the project financed, among other things, 3,234 supervision visits by district managerial teams. 4.1.3 Project activities under Component II were carried out highly satisfactorily. Indeed, considerable civil engineering works were carried out at the Dédougou CHR. The works involved the rehabilitation of the Paediatric Service/Unit and the CREN, construction of latrines and extension of the Administrative Block, among other things. The project also financed the supply of equipment and additional furniture for the Dédougou and Gaoua CHRs, as well as their GED supplies and continuing staff training. For four years, the project bore the costs of fuel and subsistence allowance of management staff of the two CHRs. 4.1.4 Project activities under Component III were carried out highly satisfactorily. As planned, the project financed the procurement of the necessary materials for PLWHIV care,

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including ARVs, audio-visual and IT equipment, documentation and means of transport (motorcycles). Under this component, over 2000 district employees were trained in various PLWHIV care methods. Thanks to the project, a sentinel site was established at the Dédougou CHR and the one in the Gaoua CHR strengthened. As a result of PRSS support, APRODEC/CADI and the SAS Centre conducted intensive Information, Education and Communication (IEC) activities, performed hundreds of HIV screenings and correctly monitored scores of patients. 4.1.5 Project activities under Component IV were conducted highly satisfactorily. As envisaged, the project financed a study on urban health and healthcare finance alternatives. The DGSP/CADSS received the necessary equipment and resources to carry out its task of training and field monitoring. Twenty-six MH officials, including two DGIEM senior technicians and twenty-four doctors were awarded scholarships for training courses of two or more years overseas, while eighteen doctors received training in the country’s CHRs in basic surgery. FONALEP received a large stock of vaccines and MEG to meet possible emergencies. For its part, the DRH was provided with three person/months of technical assistance, with software called MISSYGRH as well as a human resource study which has since enabled it to obtain greater visibility and accurate knowledge of MH staff and their distribution throughout the country, as well as information on health staff career plan. 4.1.6 Project activities under Component V were carried out highly satisfactorily. The project financed the procurement of a set of necessary materials for PCU operation. They comprised two 4 x 4, vehicles, one liaison vehicle, furniture for the offices of eight management staff and one for a meeting room, a photocopier, printers, eight computers, a computerized management system and furniture, among other things. The project also ensured the regular financing of the PCU, including the salaries of PIU officials (6 in all) and support staff as well as expenses for renting premises occupied by the Unit in Bobo-Dioulasso from March 2002 to April 2008. 4.2 Institutional Performance 4.2.1 Institutional performance was highly satisfactory. Indeed, the PIU correctly performed its duties, namely: (i) coordination with the relevant departments of the ministries involved with project implementation; (ii) supervision and monitoring of project activities; (iii) preparation/monitoring of BD preparation for the procurement of goods and services; (iv) project administrative and financial management; (v) control of contract awards; (vi) liaison with the Bank; (vii) transmission of disbursement requests to the Bank through the DG-COOP; and (viii) preparation and submission of project activity reports to the Bank. The PCU played a key role in the arrangements for the acquisition of land on which many facilities were built under the project. Thanks to its efficiency, the PCU was entrusted with the management of the PADS-CEN Project, the successor of PRSS. Furthermore, activities by the Ministry of Health were well coordinated at all levels of the health care pyramid. The Steering Committee met regularly and contributed to this synergy, including the co-opting of civil society and private sector actors. 4.3 Performance of Consultants, Contractors and Suppliers 4.3.1 Performance of the Consultants: The performance of the consultants involved in project implementation (ARDI, GERCO, SESAP and CAMPC) was highly satisfactory. . ARDI, the civil engineering consulting firm, provided services with professionalism and rigour.

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CERCO, which was responsible for boreholes, demonstrated solid expertise in its field. Its intervention produced conclusive results. The NGO APRODECO-CADI and the SAS Centre performed their respective tasks within the framework of activities under Component III. 4.3.2 Performance of the Contractors: The performance of the contractors was rated satisfactory, considering the difficulties of access to some sites, the complexity of the conditions in which the works were carried out and the quality of the results. Among the six construction companies that were involved in works implementation, two performed very satisfactorily in the light of the quality of the infrastructure built, compliance with the deadline and contract management. The other four were quite responsive. Nonetheless, despite going beyond schedule, they fulfilled all the control requirements. One company had a very inadequate financial base, was poorly organized and lacked qualified supervisory staff, which impeded works implementation. Its contract was cancelled and the works reassigned to another company. However, all the companies involved in the boreholes executed their contracts competently and satisfactorily. 4.3.3 Performance of the Suppliers: The suppliers’ performance was satisfactory. They delivered good quality goods in accordance with the specifications. 5. SOCIAL AND ENVIRONMENTAL IMPACT 5.1 Sector Impact 5.1.1 That the PRSS has had an impact is unquestionable. The project significantly improved the availability of health services in the fifteen districts of the project zone. During the 2001-2006 period, the inhabitants/CSPS ratio of the project impact area attained and subsequently exceeded the national standard of 10,000 inhabitants per CSPS. The said ratio fell from 11,112 in 2001 to 9,806 in less than sixty months. In 2004, most of the population of the zone, (76 % in 2004 for the entire zone; 70 % in the Mohoun river loop HR; 74 % in the South-West HR and 83 % in the Hauts Bassins HR) already lived less than 10 kilometres away from a functional health service. Project efforts led to the consolidation of the second referral level. The construction and equipping of the CMA raised to 100 % the availability ratio of these medical/surgical structures in the health districts under the PRSS impact area without a CHR (13 in all). The number of caesarean operations conducted in the CMA of the PRSS zone increased from 485 in 2001 to 2,385 in 2006. However, the number of caesarean operations compared to all deliveries remains below the 1% bar, against the accepted values ranging from 4-6%. 5.1.2 The PRSS contributed significantly to HIV/AIDS control. It helped improve the quality and cover not only of screening but also of the care provided. The PRSS harmonized its support with that provided by the Government, the Global Fund and other development partners. The harmonization produced encouraging results. Thus by 31 December 2006, over 10,000 PLWHIV were under ARV treatment in the country, i.e. nearly 40 % of the PLWHIV in Burkina Faso. Furthermore, since 2002, all those receiving blood transfusion first go through the full array of tests required under national standards. This performance made it possible to save the lives of many patients with acute and severe anaemia and to contain the transmission of the viruses which cause AIDS, hepatitis and other serious diseases. Thanks to the efforts jointly made by PRSS and other development partners, the overall HIV prevalence fell from 5.4 % in 2000 to 2.7 % in 2006.

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5.1.3 The project also built acceptably institutional capacity at the central and regional level. In particular, it built the capacity of the Ministry of Health (MH) in planning, development and human resource management. This reinforcement was felt particularly in the two central directorates of the Ministry: the General Directorate of Infrastructure, Equipment and Maintenance (DIEM) and the Directorate of Human Resources (DRH). The DGIEM was closely involved in the PRSS with the preparation and implementation of bidding documents (BDs). This involvement enabled many officials of the Directorate to acquire skills in infrastructure/equipment norms and standards, from the design up to the reception of works and goods. Furthermore, the training and quarterly supervisions of employees financed by the PRSS for the Directorate and the Health System Decentralization Support Unit (CADSS) contributed to a significant increase in the availability of quality human resources in the MH. 5.2 Socio-economic Impact In February 2009, the social impact of the PRSS was still not perceptible. However, the project brought quality health services closer to the rural population. It significantly reduced the inequality between the urban and rural areas. Furthermore, the involvement of officials elected by the population in health services management, especially through Management Committees, initiated a process that promoted self-reliance and self-enhancement within the different local communities. The activities of the IEC (conducted by CHWs with the support of health professionals) will have a positive impact on knowledge, attitudes and behaviour of all the categories of the population, including women. In particular, the IEC activities broke taboos and led to improvement in social standards, especially those related to birth control. At the economic level, more efficient control which PRSS imparted on malaria, HIV infection and other major epidemics will raise the population’ productivity by reducing spending on health, thereby contributing to poverty reduction since these diseases constitute serious economic and social development problems. 5.3 Environmental Impact The PRSS did not have any significant negative impact on the environment, mainly because of all the measures the officials and stakeholders took in selecting the new infrastructure construction sites to prevent erosion problems, gullying and stagnation of rainwater, in compliance with the criteria for the treatment of wastewater, human, hospital and other wastes. Actually, the environmental assessment of the PRSS was positive. The incinerators, latrines, wells and solar panels which the project installed in many health establishments fostered attitudinal changes and created new comportments. These mechanisms helped improve the living environment in the rural environment. In a few health centres, individuals and some COGES planted fruit or decorative trees, created quickset hedge enclosures, or introduced cleaning days. The construction of the Daffa district CMA accelerated the urbanization of this peripheral area of Bobo-Dioulasso. 6. PROJECT SUSTAINABILITY 6.1 The infrastructure set up under the PRSS is guaranteed an acceptable level of sustainability. Precautions were taken to ensure that goods acquired under the Project were functional and adapted to Burkina’s needs and environment. Apart from a few problems of waterproofing in some of the roofing, right designs and materials were used. Maintenance

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contracts signed with private operators also enabled the health facilities to increase the lifespan of the equipment. Sustainability was also guaranteed by the mechanism put in place at the DGIEM to allow extensions to the premises and heavy maintenance of biomedical equipment. Through this mechanism, any establishment may include in its action plan items for the maintenance, repair of premises and equipment, and expect to obtain from the Ministry of Health the necessary financial resources to maintain these materials in or restore them to operational condition. The biomedical technicians trained at the central level to carry out specialized maintenance will also contribute to infrastructure sustainability. Although there is only one technician in Bobo-Dioulasso for the entire area, he tries to make up for the shortfall by closely involving users in the preventive maintenance of their respective work tools. Finally, the construction of additional infrastructure by the MH was undertaken by the Dafra CMA and the Dédougou CHR, which contributed to consolidating the existing ones and demonstrated the Government’s concern for the sustainability of the project outputs. The ongoing decentralized planning within the Ministry of Health will make it possible to ensure the maintenance of both infrastructure and equipment. 6.2 Training programmes and refresher courses were designed and carried out for members of the COGES to enable them conduct light maintenance and facilitate the population’s ownership of the facilities. The sustainability of the PRSS outputs was in particular ensured by building human capacity under the project through training and refresher courses. The people trained were given positions of responsibility where they are judiciously making the most of their acquired skills. Moreover, they participate in the training of their peers while simply carrying out their professional and administrative functions. 7. PERFORMANCE OF THE BANK AND THE BORROWER 7.1 Bank’s Performance The Bank performed satisfactorily. . Over the project implementation period, it fielded thirteen supervision missions (an average of one mission every six months), even though five of the missions did not include a health expert. The missions significantly helped to smoothen out any difficulties encountered and in anticipating possible problems. Nonetheless, the frequent change of supervisors and virtual absence of the disbursement department in the supervision teams slowed down decision-making and the utilization of financial justifying documents. The supervisions focused on examination of project physical and financial outputs. Scant attention was paid to sector strategic issues. For example, no mission raised the fact that the motorcycle ambulances delivered were not suited to the tracks in the project zone, especially during the rainy season. Similarly, the PRSS missions did not use the indicators adopted by the Ministry of Health in November 2003 to ensure monitoring of the NHDP, of which the PRSS constituted an element. 7.2 Borrower’s Performance The Borrower performed satisfactorily. The Government regularly paid its counterpart contribution towards the implementation of project activities on schedule, including during the extension of the last disbursement deadline. Therefore, its overall contribution exceeded the appraisal estimates. Lastly, the institutional anchoring of the

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project proved very effective for the smooth coordination and implementation of activities simultaneously involving many central and decentralized structures. However, it is worth pointing out that the Government did not strictly comply with the procedures for setting up the PCU team, even though such compliance was a prerequisite for the first loan disbursement. This held back project start-up. 8. OVERALL PERFORMANCE AND RATING Overall project performance was satisfactory. Although the PRSS started with a 21-month delay, 95 % or more of all activities envisaged in the loan agreement were implemented before 31 December 2006, the initial date for project closure. Infrastructure that was to be built new or “standardized” became the subject of final acceptance before 31 December 2006. Furniture, biomedical and other equipment were delivered and installed in the CSPS, the CMAs and elsewhere, where they were expected. The technical and support staff were trained and deployed as agreed. The project underwent several budget reallocations but was implemented without any overall cost overrun. The gains made mainly as a result of a reduction in the price of ARVs and the depreciation of the CFAF to the UA were used during the extensions to finance useful activities set out in the initial loan agreement. 9. CONCLUSIONS, LESSONS AND RECOMMENDATIONS 9.1 Conclusions As far as the Government, the direct beneficiaries and the communities are concerned, the project constituted a powerful instrument for national development. Not only did the health services supply increase and diversify, but also the quality of the training of health workers was enhanced through several courses run for trainers of trainers and other personnel, technical assistance and consolidation at the key directorates of the Ministry of Health (MH), etc. HIV screening and care for people living with HIV/AIDS in the project area have considerably improved in the project area and the training modules designed under the project are now used as a basis for all training courses on HIV infection management in the Ministry of Health. While the indicators have improved, they remain far below the levels which might be considered acceptable. Moreover, the sustainability of the PRSS outputs will also depend on Government’s determination to: (i) pursue its decentralization policy; (ii) continue to ensure the availability and stability of adequate staffing for intermediate and peripheral level facilities; and (iii) to step up its efforts to ensure the availability of adequate budget for the health and related sectors 9.2 Lessons On the basis of the analysis of the project outputs and their assessment (including by the beneficiaries), the following lessons should be brought to the attention of the parties involved:

(i) Slow Government fulfilment of the loan conditions led to slippage on the project implementation schedule;

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(ii) Involvement of the central and decentralized structures of the MH in project implementation is essential to ensure ownership and real institutional anchoring - the drivers of project success and sustainability;

(iii) Project adjustment to the changing needs of the sector constituted an additional

factor of success; (iv) Supervision missions should be conducted by multi-disciplinary teams,

including sector specialists; (v) No matter the performance level attained by the project, its profitability and

impact will be limited by constraints from the related sectors, especially the transport sector;

(vi) Contract management requires proper analysis of the many amendments

requested by the project; (vii) As a result of a prudent preventive and curative maintenance programme,

biomedical and other equipment can remain operational for about ten years. Thereafter, it becomes necessary to replace them.

(viii) During the implementation of a health project, the presence of sector experts

prevents donor/borrower dialogue from losing sight of the specific objectives of the operation and ensures implementation of necessary strategic re-orientation; and

(ix) Funds which remain unjustified by project end may well be difficult to

retrieve. 9.3 Recommendations In view of the above lessons, the following recommendations have been formulated to contribute to enhancing the design quality of the Bank’s future interventions in the sector in Burkina Faso: To the Bank:

(i) Ensure compliance with the deadline for fulfilling loan and grant conditions; (ii) Limit the number of loan conditions; (iii) Show flexibility in ensuring the required contextual changes during project

implementation with a view to facilitating the achievement of the expected outcomes, especially for training;

(iv) Ensure quality supervision by using multi-disciplinary teams including a sector

specialist; (v) Apply more rigorously the Presidential Directive on the processing of

amendments; and

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(vi) Ensure that the latest justifications of the revolving fund are transmitted to the

Bank prior to the preparation of the completion report. To the Borrower:

(i) Ensure project institutional anchoring and the involvement of all the central and decentralized structures immediately following project identification and effective implementation;

(ii) Systematically involve the local communities, including in project

implementation; (iii) When planning investments, take into account national capacity to ensure not

only the sustainability of procurements but also their renewal in the medium term by establishing a maintenance system; and

(iv) Include future national healthcare development plans in a horizontal approach

to the multi-sector control of health issues.

 

 

Annex 1 SOURCES OF INFORMATION

 

N° Title of Documents Sources Project Appraisal Report, November 1998 Bank Loan Agreement, April 1999 Bank Government Completion Report Government Disbursement Tables and Ledger Bank/GovernmentActivity Reports Government

Audit Reports Government Bank Aide-Memoire and Project Supervision Missions Reports Bank/Government

NHDP 1998 – 2007 Government

District Reports Government

DRS Reports Government

National Health Development Plan 1998-2007, Ministry of Health, 1997 Government

Harmonization of Tariffs for Medical Services, General Secretariat, Ministry of Health, 17 February 2003

Government

NHDP Monitoring Indicators and Information Guide, Ministry of Health, November 2003

Government

Study on the Organization of the Health System in Urban Areas, Ministry of Health, October 2004

Government

Study on the Training of Members of Management Teams and on the Establishment of a Support System at the Central and Intermediate Levels, PRSS, Ministry of Health, November 2004

Government

 

 

Annex 2 ESTIMATED AND ACTUAL SCHEDULE OF ACTIVITIES

Activities Initial Dates Actual dates Observations I. Approval and Publication Loan approval September 1999 06 Oct. 1999 1 months delay Signature of loan agreement December 1999 07 Feb. 2000 2 months delay General procurement notice January 2000 NA Loan effectiveness March 2000 07 Dec. 2001 21 months delay II. Project Implementation PCU personnel recruitment January-March 2000 12 Sept. 2001 21 months delay Provision of PCU premises January-March 2001 Sept. 2001 6 months delay Procurement of equipment and vehicles

March- August 2000 March-May 2002 21 months delay

Shortlist of consultancy firms/Selection

April- May 2000 March-June 2002 24 months delay

Mid-term review October 2002 March 2005 29 months delay Audits June 2000-March 2005 June 2003 – Jan. 2007 36 months delay Completion report June - August 2006 Jan.-Feb. 2007 6 months delay III. District Health System and Second Referral Level Study and preparation of civil engineering BDs

March-August 2000 June - August 03 36 months delay

Approval and launch of civil engineering BDs

August- Nov. 2000 September – November 2003

36 months delay

Approval and engineering procurement

Dec. 2000-Jan. 2001 Jan. - August 04 42 months delay

Civil engineering activities March 01-March 2002 Oct. 04-June 05 39 months delay Preparation of BDs furniture/equipment

June- Sept 2000 August – Sept. 04 48 months delay

Approval/launch of furniture/equipment bidding

Sept 2000-Jan. 2001 December 2004- August 2005

47 months delay

Approval/furniture/equipment procurement

June-July 2001 June – Oct. 2005 39 months delay

Delivery/installation furniture and equipment

April-May 2002 May – Dec. 05 42 months delay

Staff refresher courses Nov 2000-Feb. 2005 April 02 –Dec. 06 32 months delay CSPS and CMA staff support Jan. 2000-Dec.2004 April 02 –Dec. 06 24 months delay IV. AIDS/STD Control and Institutional Support Rehabilitation of building Oct.-Nov. 2000

PCU/NGO

Approval and launch of furniture/equipment TD

April-June 2001

PCU/ADF

Approval and procurement furniture/equipment

June-August 2001

PCU/ADF

Delivery/installation of furniture and equipment.

Dec. 2001-Jan. 2002

Suppliers

Training/refresher course; support to NGOs

Dec. 2000-Jan. 2005

CNLS/ MH

Training of 24 specialist doctors

Oct. 2000-Sept. 2004

MH

Training of 2 maintenance technicians

Oct. 2000-Sept. 2001

Selected establishment

NGO technical assistance April 2001-Feb. 2003

Consultants

Operation/supervision July 2001-June 2004

PCU/Government

Annex 3 Page 1/2 

 

DISTRIBUTION OF FINANCING BY COMPONENT AND CATEGORY AT APPRAISAL AND IMPLEMENTATION

3.1 Estimated Project Cost by Source of Financing and Component (in UA million)

Components ADF Govt. Total %

FE LC. Total LC. FE LC Total of total1. District health system 3.77 1.94 5.71 0.82 3.77 2.76 6.53 58.82. Second referral level 0.38 0.11 0.49 0.02 0.38 0.13 0.51 4.63. AIDS and STD control 0.41 0.93 1.34 - 0.41 0.93 1.34 12.14. Institutional support 1.04 0.67 1.71 0.27 1.04 0.94 1.98 17.75. Project implementation 0.47 0.28 0.75 - 0.47 0.28 0.75 6.8

Total 6.07 3.93 10.00 1.11 6.07 5.04 11.11 100.0Percentage 54.7 35.3 90.0 10.0 54.7 45.3 100.0

SOURCES Foreign Exchange Local currency Total % of totalADF 6.07 3.93 10.00 90.0Government - 1.11 1.11 10.0TOTAL 6.07 5.04 11.11 100.0Percentage 54.7 45.3 100.0

3.2 Estimated Project Cost by Source of Financing and Expenditure Category (in UA million)

Expenditure Categories ADF Govt. Total %

FE LC. Total LC FE LC Total of A. Studies and supervision 0.02 0.16 0.18 - 0.02 0.16 0.18 1.6B. Civil engineering 2.23 1.21 3.44 - 2.23 1.21 3.44 30.9C. Furniture 0.02 0.15 0.17 - 0.02 0.15 0.17 1.5D. Equipment 0.99 - 0.99 - 0.99 - 0.99 8.9E. Drugs 1.36 - 1.36 - 1.36 - 1.36 12.3F. Specialist services 0.36 0.09 0.45 - 0.36 0.09 0.45 4.0G. Training 0.58 1.75 2.33 0.60 0.58 2.35 2.93 26.4H. Operation 0.46 0.57 1.03 0.51 0.46 1.08 1.54 13.9I. Accounts audit 0.05 - 0.05 - 0.05 - 0.05 0.4

Total 6.07 3.93 10.00 1.11 6.07 5.04 11.11 100.0Percentage 54.7 35.03 90.0 10.0 54.7 45.3 100.0

3.3 Estimated and Actual Disbursement Schedule of ADF loan per Year (in UA million)

Year Estimate at Appraisal

Actual Disbursement

Cumulative Disbursement

Annual Balance % Disbursed

2000 0.64 2001 4.11 2002 3.77 0.63 0.63 9.37 6.30 % 2003 0.99 1.10 1.73 8.27 11.00 % 2004 0.40 1.87 3.60 6.40 18.67 % 2005 0.09 3.78 7.37 2.63 37.77 % 2006 0.93 8.31 1.69 9.31 % 2007 1.00 9.31 0.69 10.03 % 2008 0.47 9.78 0.22 4.71 % Total 10.00 9.78 97.79 %

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3.4 Actual Project Financing by ADF Funds by Category and Year

Year Disbursement of ADF Funds (in UA)

2002 630434.88 

2003 1100141.09 

2004 1866565.00 

2005 3777418.59 

2006 931108.25 

2007 1003093.86 

2008 470692.07 2002-2007 9,779,453.74

3.5 Estimated and Actual Expenditure by Loan Expenditure Category loan (in UA)

Expenditure Category

Amount Allocated

Amount Disbursed

Amount Committed

Undisbursed Amount

Uncommitted Amount

% of Loan Amount

Goods 3 117 605.62 2 902 130.6 2 768 168.36 215 475.02 349 437.26 3.49 Works 3 745 109.67 3 741 214.4 3 733 012.99 3 895.24 12 096.68 0.12 Services 2 682 284.71 1 924 450.6 2 334 340.4 757 834.16 347 944.31 3.48 Operation 455 000.00 349 644.19 349 644.19 105 355.81 105 355.81 1.05 Total 10 000 000.00 8 917 439.8 9 185 165.94 1 082 560.2 814 834.06 8.15

NB : According to this table, the actual undisbursed amounts stood at UA 1 082 560. After subtracting the actual disbursements from the ledger, a UA 8 million balance remains, accounting for about 8 % of the loan amount (i.e. 8 % of the disbursed and unvalidated loan). The Government must justify or reimburse that amount.

 

 

Annex 4 HEALTH SERVICE STRENGTHENING PROJECT

Result of Project execution

No Assessment criteria Rating (1 to 4) Observations

1 Compliance with schedule 2 There was a 16-month time overrun on the initial project completion date.

2 Compliance with costs 3

The initial activities were carried out without significant cost overrun. However, there were 9 contract amendments. ..

3 Compliance with loan conditions 3 The conditions were fulfilled albeit with delay.

4 Supervision and reports 2 Supervision was regular. Activity reports were produced.

5 Satisfactory operations (where applicable) 3 Implementation of the activities had an undoubted impact in terms of health indicators

TOTAL 13

Overall assessment of implementation performance

2.60 Satisfactory

 

 

Annex 5

PERFORMANCE OF THE BANK DURING THE PROJECT CYCLE  

No Assessment criteria

Rating (1 to 4)

Observations

1 At identification 2 - There was no formal identification.

2 At preparation 1 The project was based on the NHDP although there was no preparation.

3 At appraisal 3 The project was based on Government priorities

4 At supervision 3 Supervision missions were regular, but it must be pointed out that the composition of missions was not always adequate. Many missions were conducted by an education specialist without the presence of a health specialist

5 Satisfactory operations (where applicable)

3

TOTAL 12

Overall assessment of implementation performance

2.40

Satisfactory

 

 

 

Annex 6 PROJECT OUTCOMES

No Assessment criteria Rating (1 to 4)

Observations

1 Relevance and Achievement of Objectives 3.16 i) Macro-economic policy -- ii) Sector policy 4 The project related to the sector’s priorities iii) Physical Output 3 12 CSPS and 2 CMAs were built; 6 CSPS were

standardized, 1 CHR was rehabilitated and standardized.

iv) Financial component 3 All activities were carried out, leaving a balance of resources

v) Poverty reduction, social impact and gender 3 The project had an impact on women, granting them greater access to maternal health care

vi) Environment 3 There were no negative impacts, thanks to the adoption of proper measures. ..

vii) Private sector development 3 Several private companies obtained contracts under the project

viii) Others (specify) -- 2 Institutional development 3.00 i) Institutional framework 3 Managerial staff trained within the ministries

contributed to capacity building. ii) Financial and management information systems,

including audit systems 3 The different audits were conducted.

iii) Technology transfer -- Knowledge was transferred from the central to the peripheral level.

iv) Staffing by qualified persons (including turnover), training and counterpart staff

3 Training for health personnel, civil society of over 3 000 persons

3 Sustainability 3.00

i) Continued Borrower commitment 4 The Borrower honoured its commitments regarding the counterpart contribution and gave more than expected.

ii) Environmental policy 3 iii) Institutional framework 3 The institutional framework for the functioning of

the different structures exists. v) Technical viability and staffing 3 v) Financial viability, including cost recovery

systems 3 Recovery mechanisms exist but COGES should

operate better. vi) Economic viability -- vii) Environmental viability 3 viii) Operation and maintenance facilitation

(availability of recurrent funding, foreign exchange, spare parts, workshops, etc)

2 The maintenance system established was not well defined.

4 Economic rate of return -- TOTAL 49 Overall assessment of outcomes 3.06 Highly satisfactory

ANNEX 7 Page 1/2 

 

 

Matrix of Recommendations and Monitoring Measures

Principal Observations/Conclusions Lessons/Recommendations Monitoring Measures Responsibility Project design/Rationale: The project was a success in spite of the fact that it did not go through the formal identification stage. Its design was made in keeping with the participatory approach. Special emphasis was placed on consistency with the 1998-2007 NHDP, local level development, involvement of the population concerned and validation by the development partners.

Project design in keeping with a participatory approach enables problems to be properly identified and adequate solutions proposed.

Future projects should be designed in keeping using the participatory approach; they should lay special emphasis on consistency with national development plans drawn up with the assistance of development partners.

Bank/Government

Project Entry into Force The project started in March 2002 instead of March 2000. The delay in loan effectiveness led to a reduction in the envisaged number of facilities to be constructed, after the price rise observed at the time of project execution.

The Government’s inability to fulfil the loan conditions diligently constituted a factor of poor performance in a context characterized by runaway inflation.

A deadline should be set to oblige the Borrower to rapidly fulfil the loan and grant conditions

Bank

Project Implementation: The involvement of the central and decentralized structures of the Ministry of Health in project implementation and activities led to ownership and real institutional anchoring, which are drivers of project success and sustainability. The funds that were not justified before project end may well be difficult to retrieve.

It is essential to ensure the institutional anchoring of projects; local communities should be systematically involved to enable them better face problems of financing of maintenance and renewal of equipment. This will help guarantee the sustainability of project outputs. It must be ensured that the last justifications on the revolving fund are transmitted to the Bank prior to the preparation of the completion report

Ensure that project design gives adequate importance to the quality of institutional arrangements.

Bank/Government

Project Flexibility The project attained a number of its results thanks to its flexibility in decision-making during implementation. Thus, the fact that an exhaustive list of training sessions to be carried out under the project, was not drawn up, afforded the MH and PCU an opportunity to adapt training themes to the sector’s needs and priorities.

The capacity to adjust a project to the changing needs of the environment constitutes an additional factor of project success.

Ensure that the design of future projects allows some flexibility to enable adjustment to changes in the environment.

Bank/Government

ANNEX 7 Page 2/2 

 

 

 

Multisector Approach The project led to an improvement in the country’s health indicators, but they were far from attaining acceptable levels. Thus, in the specific case of the PRSS impact area, the risk of maternal mortality will remain high among women living over 10km away as long as the travel difficulties (access to health establishments) persist.

Whatever the performance level attained by a country’s health sector, its profitability and impact will be limited by constraints from the related sectors such as transport, agriculture, education and telecommunications.

Future NHDP should be included in a horizontal approach to multisector control of health problems, i.e. promote the setting up of multisector teams around local community leaders in the framework of decentralization, among other things

Government

Maintenance Limits The project enabled the MH to establish a preventive and curative maintenance programme which, if it continues to function, will enable biomedical and other equipment to remain functional for about ten years. Beyond that, it would be essential to replace them.

However efficient the maintenance system, the equipment should be replaced after a certain period.

In future investments, account should be taken of the national capacity to ensure not only the sustainability of procurements but also their renewal in the medium term

Bank/Government

Sustainability The facilities were well built and precautions taken to ensure the maintenance of equipment and presence of adequate staff. However, the sustainability of the PRSS outputs will also depend on the Government’s determination: (i) To pursue its decentralization policy; (ii) To continue ensuring the availability and

stability of adequate staff for the intermediate and peripheral level facilities; and

(iii) To consolidate efforts with a view to obtaining an adequate budget for health and the related sectors.

The sustainability of the facilities depends not only on the performance of the maintenance system, but also on the support of other central Government bodies and decentralized entities.

Maintain dialogue to ensure the Government’s determination: (i) To pursue its decentralization

policy; (ii) To continue ensuring the

availability and stability of adequate staff for the intermediate and peripheral level facilities and

(iii) To consolidate efforts with a view to obtaining an adequate budget for health and the related sectors.

Bank

ANNEX 8 Page 1/7 

 

 

LIST OF CONTRACTS SIGNED UNDER THE PRSS A - Goods (ADF share: 97.6 %) Contract reference : 2005-277/MFB/MH/SG /PRSS Name of Supplier : Groupement SMT-BBS Address : 01 BP 2258 Ouagadougou01; Tel.: (226) 50 39 3679 Type of contract : Supply and installation of hospital furniture Signature date : 6/10/2005 Amount : CFAF 78 548 752 TAX AND DUTY FREE Duration on submission : 5 months Start-up date/Completion date : 14/02/2006, Provisional reception: 22/09/2006 Actual date : 7 months and 08 days Difference : 2 months and 08 days Contract reference : 2005-278/MFB/MH/SG /PRSS Name : SYFF Distribution Address : 01 BP49484 Ouagadougou 01, Tel.: (226) 50 31 24 61 Type of contract : Supply, installation and commissioning of technical medical and surgical

equipment Signature date : 6/10/2005 Amount : CFAF 344 712 646 TAX AND DUTY FREE Duration at submission : 5 months Start-up date/Completion date : 16/02/2006, Provisional reception: 16/10/2006 Actual date : 8 months Difference : 3 months Contract reference : 2005-276/MFB/MH/SG /PRSS Name : ARCOA Address : France Type of contract : Supply, installation and commissioning of laboratory equipment Signature date : 6/10/2005 Amount : CFAF 141 513 566 TAX AND DUTY FREE Duration at submission : 5 months Contract reference : 2005-275/MFB/MH/SG /PRSS Name : Finance & Services Export (FSE) Address : 9, rue du Moniteur, 1000 Bruxelles, Belgium, Tel.: +32 2219 1103 Type of contract : Supply, installation and commissioning of technical medical equipment at the

CHR of Gaoua Signature date : 6/10/2005 Amount : CFAF 168 149 459 TAX AND DUTY FREE Duration at submission : 5 months Start-up date/Completion date : 16/02/2006 Provisional reception: 30/09/2006 Actual date : 7 months and 14 days Difference : 2 months and 14 days Contract reference : 2006-126/MFB/MH/SG/PRSS Name : Ets YTJ Address : BP 14 Koudougou, Tel.: (226) 5044 05 51 Type of contract : Supply, installation and commissioning of technical medical equipment at the

CHR of Dédougou Signature date : 08/05/2006 Amount : CFAF 51 999 960 TAX AND DUTY FREE Duration at submission : 5 months Start-up date/Completion date : 13/06/2006 Provisional reception: 15/12/2006 Actual date : 6 months Difference : 1 month Contract reference: 020/2003/MFB/MH/SG/PRSS Name : Alpha Diffusion Bureautique Address : 01 BP 6591 Ouagadougou 01, Tel.: (226) 50 31 36 12 Type of contract : Supply of IT and office automation equipment Signature date : 10/02/2003 Amount : CFAF 28 610 800 TAX AND DUTY FREE Duration at submission : 45 days

ANNEX 8 Page 2/7 

 

 

Contract reference : 006/2005/MFB/MH/SG/PRSS Name : Alpha Diffusion Bureautique Address : 01 BP6591 Ouagadougou 01, Tel.: (226) 50 31 36 12 Type of contract : Supply of office automation and sound equipment Signature date : 23/11/2005 Amount : CFAF 7 815 000 TAX AND DUTY FREE Duration at submission : 45 days Contract reference : LC 04/006 MH/SG/PRSS Name : PRESSIMEX SOMETA Address : 01 BP 253 Ouagadougou 01 Type of contract : Supply of furniture to CRSN Signature date : 11/10/2004 Amount : CFAF 2 720 000 TAX AND DUTY FREE Duration at submission : 45 days Contract reference : LC/2002/001 MH/SG/PRSS Name : MAAZAI Address : 01 BP 961 Bobo-Dioulasso, Burkina Faso 01 Tel.:50 61 50 14 Type of contract : Rehabilitation of NGO-CADI premises Signature date : 10/10/2002 Amount : CFAF 1 797 370 TAX AND DUTY FREE Duration at submission : 1 month Contract reference : 2005/209/MFB/MH/SG/PRSS Name : ESV Address : 02 BP 5274 Ouaga, Burkina Faso 02 Tel.: 50 31 77 67 Type of contract : Supply of biomedical equipment Signature date : 06/07/2005 Amount : CFAF 22 600 000 TAX AND DUTY FREE Duration at submission : 50 days Contract reference : LC 2005-03 Name : Général‐Eco Address : 01 BP 6768 Ouaga 01 Tel.: (226) 50 30 44 60 Type of contract : Supply of biomedical equipment Signature date : 06/07/2005 Amount : CFAF 14 518 600 TAX AND DUTY FREE Duration at submission : 90 days Contract reference : LC 2005-01 Name : AOF Address : 02 BP 2000 Bobo-Dioulasso, Burkina Faso; Tel.: (226) 20 97 47 69 Type of contract : Supply of biomedical equipment Signature date : 06/07/2005 Amount : CFAF 10 771 000 TAX AND DUTY FREE Duration at submission : 90 days Contract reference : LC/2002/003 Name : LIPTINFOR Address : 01 BP 4841 Ouagadougou o1 Tel.: (226) 50 31 1105 Type of contract : Supply of IT and office automation equipment Signature date : 21/11/2002 Amount : CFAF 6 852 000 TAX AND DUTY FREE Duration at submission : 45 days

ANNEX 8 Page 3/7 

 

 

Contract reference : LC/2002/002 MH/SG/PRSS Name : Le Mobilier Address : 01 BP 174 Ouagadougou 01, Tel.: (226) 50 30 74 40 Type of contract : Supply of office furniture Signature date : 04/12/2002 Amount : CFAF 12 503 500 TAX AND DUTY FREE Duration at submission : 21 days Contract reference : 019/2003/MFB/MH/SG/PRSS Name : DIACFA automobiles Address : Type of contract : Procurement of vehicles lot1 Signature date : 10/02/2003 Amount : CFAF 109 161 949 TAX AND DUTY FREE Duration at submission : 90 days Contract reference : LC /2003/000013 MH/SG/PRSS Name : ERIMETAL Address : 01 BP 1014 Ouagadougou 01 Tel. 226) 50 31 26 48 Type of contract : Supply of office furniture to 2 CHR Signature date : 10/10/2003 Amount : CFAF 13 507 460 TAX AND DUTY FREE Duration at submission : 30 days Contract reference : 2003-018/MH/SG/PRSS Name : CFAO-Burkina Address : 01 BP 23 Ouagadougou 01, Tel.: (226) 50 30 61 59 to 63 Type of contract : Supply of ambulances Signature date : 10/02/2003 Amount : CFAF 76 000 000 TAX AND DUTY FREE Duration at submission : 10 days Contract reference : 00014/MH/SG/PRSS Name : CFAO-Burkina Address : 01 BP 23 Ouagadougou 01, Tel.: (226) 50 30 61 59 to 63 Type of contract : Supply of one vehicle Signature date : 8/10/2003 Amount : CFAF 15 788 050 TAX AND DUTY FREE Duration at submission : 30 days Contract reference : 2004-273/MH/SG/PRSS Name : CFAO-Burkina Address : 01 BP 23 Ouagadougou 01, Tel.: (226) 50 30 61 59 to 63 Type of contract : Supply of motorcycle ambulances Signature date : 13/09/2004 Amount : CFAF 43 800 000 TAX AND DUTY FREE Duration at submission : 45 days Contract reference : 2005-208/MFB/MH/SG/PRSS Name : CFAO-Burkina Address : 01 BP 23 Ouagadougou 01, Tel.: (226) 50 30 61 59 - 63 Type of contract : Supply & installation of office furniture &biomedical equipment Signature date : 06/07/2005 Amount : CFAF 84 798 628 TAX AND DUTY FREE Duration at submission : 90 days Contract reference : 2004-274/MH/SG/PRSS Name : TOMODJEMA Address : BP 147 Fada, Tel.: (226) 40 77 08 77 Type of contract : 40 Ambulances for hitching to a moped Signature date : 14/09/2004 Amount : CFAF 19 800 000 TAX AND DUTY FREE

ANNEX 8 Page 4/7 

 

 

Contract reference : LC 04/007 MH/SG/PRSS Name : DIACFA Address : 01 BP 41 Ouagadougou 01, Tel.: (226) 50 30 62 92 93 Type of contract : Supply of audio-visual equipment to CRSN Signature date : 16/10/2003 Amount : CFAF 1 278 600 TAX AND DUTY FREE Duration at submission : 45 days SERVICES Contract reference : 2002/013/MFB/MH/SG/PRSS Name : ARDI, Architectes Conseils Address : 08 BP 11020 Ouagadougou 08, Tel.: (225) 50 34 21 53 Type of contract : Studies and supervision of civil engineering constructions Signature date : 27/01/2003 Amount : CFAF 69 072 000 TAX AND DUTY FREE Duration at submission : 15 months Amendment amount : CFAF 18 436 400 TAX AND DUTY FREE Duration at submission :  2 months  Contract reference :  085/2003 MH/SG/PRSS Name : CIECAM Address : 04 BP81 63 Ouagadougou 04, Tel.: (226) 50 31 62 52 Type of contract : Preparation of a manual of procedures and establishment of an accounts and

finance system Signature date : 08/0/2005 Amount : CFAF 18 150 000 TAX AND DUTY FREE Duration at submission : 3 months Contract reference : 03/2003 MH/SG/PRSS Name : CAFEC-KA Address : 10 BP 13675 Ouagadougou 10, Tel.: (226) 50 31 74 97 Type of contract : 2002 Audit Signature date : 18/02/2003 Amount : CFAF 3 375 000 TAX AND DUTY FREE Duration at submission : 1 month Contract reference : 04/2003 MH/SG/PRSS Name : CAFEC-KA Address : 10 BP 13675 Ouagadougou 10, Tel.: (226) 50 31 74 97 Type of contract : 2003 Audit Signature date : 18/02/2004 Amount : CFAF 3 375 000 TAX AND DUTY FREE Contract reference : 04/001 MH/SG/PRSS Name : SERSAP Address : 01 BP 3718 Ouagadougou 01, Tel.: (226) 50 33 13 65 Type of contract : Study on the central and intermediate level support system Signature date : 30/01/2004 Amount : CFAF 16 567 500 TAX AND DUTY FREE Duration at submission : 3 months Contract reference : 04/002 MH/SG/PRSS Name : SERSAP Address : 01 BP 3718 Ouagadougou 01, Tel.: (226) 50 33 13 65 Type of contract : Study on financing alternatives Signature date : 30/01/2004 Amount : CFAF 16 047 500 TAX AND DUTY FREE Duration at submission : 3 months

ANNEX 8 Page 5/7 

 

 

Contract reference : 04/004 MH/SG/PRSS Name : IRSS Address : 01 BP71 92 Ouagadougou 01, Tel.: (226) 50 36 32 15 Type of contract : Study on urban district health systems Signature date : 22/03/2004 Amount : CFAF 16 865 750 TAX AND DUTY FREE Duration at submission : 3 months Contract reference : 04 /005 MH/SG/PRSS Name : GERCO Address : 01 BP 41458 Ouagadougou 01 Tel.: (226) 50361250 Type of contract : Studies and control of borehole works; Signature date: 17/05/2004 Amount : CFAF 10 685 000 TAX AND DUTY FREE Duration at submission : 3.5 months Contract reference : 2004-029 MH/SG/PRSS Name : CAMPC Address : 08 BP 878 Abidjan 08, Tel.: (225) 40 77 08 77 Type of contract : Study on human resource development Signature date : 09/04/2004 Amount : CFAF 66 258 760 TAX AND DUTY FREE Duration at submission : 12 months Contract reference : 04/008 MH/SG/PRSS Name : ZAMPOU Téné Address : 10 BP36 55 Ouagadougou 10, Tel.: (226) 50 31 05 09 Type of contract : Evaluation of continued training Signature date : 06/10/2004 Amount : CFAF 9 055 000 TAX AND DUTY FREE Duration at submission : 21 days Contract reference : 2005/01 MH/SG/PRSS Name : ACECA INTERNATIONAL Address : 01 BP 4318 Ouagadougou 01, Tel.: (226) 50 3125 98 Type of contract : Audit of 2004 accounts Signature date : 7/03/2005 Amount : CFAF 7 317 000 TAX AND DUTY FREE Duration at submission : 1 month Contract reference : 2005/01 MH/SG/PRSS Name : ACECA INTERNATIONAL Address : 01 BP 4318 Ouagadougou 01, Tel.: (226) 50 3125 98 Type of contract : Audit of 2005 accounts Signature date : 7/03/2006 Amount : CFAF 7 317 000 TAX AND DUTY FREE Duration at submission : 1 month Contract reference : 02/MH/SG/PRSS Name : ACECA INTERNATIONAL Address : 01 BP 4318 Ouagadougou 01, Tel.: (226) 50 3125 98 Type of contract : Audit of 2006 accounts and closure of PRSS II Signature date : Amount : CFAF 16 670 000 TAX AND DUTY FREE Duration at submission : /Contract reference : LC 2005/01 MH/SG/PRSS Name : Dr SOME Mathias Address : 10 BP62 30 Ouagadougou 10, Tel.: (226) 50 34 33 09 Type of contract : Mid-term evaluation Signature date : 16/02/2005 Amount : CFAF 8 505 500 TAX AND DUTY FREE Duration at submission : 1 month

ANNEX 8 Page 6/7 

 

 

Contract reference : Protocol N° 2002-001/MH/SG/PRSS Name : CAMEG Address : Burkina Faso Type of contract : Supply of generic essential drugs and consumables Signature date : 12/08/2002 Amount : CFAF 1 128 000 000 TAX AND DUTY FREE Amendment 1 : Downward review of protocol amount Amount Amendment 1 : - 600 000 000 Amendment 2 : Upward review of protocol amount Amount Amendment 2 : - 670 000 000 Duration at submission : Project duration Contract reference : Protocol N° 2002-002/MH/SG/PRSS Name : Centre SAS Address : 01 BP 13 96 Bobo Dioulasso01, Tel.: (226) 20 97 14 21 Type of contract : Psycho- social activities of the treatment of persons affected by HIV Signature date : 29/07/2002 Amount : CFAF 38 770 000 TAX AND DUTY FREE Contract reference : Protocol N° 2002 - 0003/MH/SG/PRSS Name : APRODEC CADI Address : 02BP 1855 Bobo-Dioulasso 02 Tel.: (226) 20 97 08 55 Type of contract : IEC activities, screening and treatment of HIV/AIDS patients Signature date : 29/07/2002 Amount : CFAF 131 380 001 TAX AND DUTY FREE WORKS Contract reference : 2004-179/MFB/MH/SG/PRSS Name : ECOBAG Address : 01 BP 884 Ouagadougou, Tel.: (226) 50 31 25 15 Type of contract : Construction of a CSPS at Désso, Kouakoualé, Bassé, Rehabilitation off the CSPS

of Déguélin. Signature date : 17/08/2004 Amount : CFAF 255 150 583 TAX AND DUTY FREE Duration at submission : 6 months Start-up date/Completion date : 16/11/2004 Provisional Acceptance: 14/06/2005 Actual date : 7 months Difference : 1 month Contract reference : Contract 2004-180/MFB/MH/SG/PRSS Name : ECW Address : BP 170 Koudougou Tel.: 50 44 06 16 Type of contract : Construction of a CSPS at Gomgobili, Dimolo, Hélentira, Rehabilitation of the

CSPS Bouroum-Bouroum. Signature date : 17/08/2004 Amount : CFAF 266 310 183 TAX AND DUTY FREE Duration at submission : 6 months Amendment amount : CFAF 3 854 144 TAX AND DUTY FREE Amendment duration : 1 month Start-up date/Completion date : 16/11/2004 Provisional Acceptance: 22/06/2005 Actual date : 7 months Difference : 0 Contract reference : Contract 2004-181/MFB/MH/SG/PRSS Name : ECW Address : BP 170 Koudougou Tel.: 50 44 06 16 Type of contract : Construction of a CSPS at Fara and Guéna; Rehabilitation of the CSPS of Banzon. Signature date : 17/08/2004 Amount : CFAF 197 856 763 TAX AND DUTY FREE Duration at submission : 6 months Amendment amount : CFAF 2 890 608 TAX AND DUTY FREE Amendment duration : 1 month

ANNEX 8 Page 7/7 

 

 

Contract reference : 2004-177/MFB/MH/SG/PRSS Name : Enviro- Services Address : 01 BP 5986 Ouagadougou, Tel.: (226) 50 43 14 98 Type of contract : Construction of a CSPS at Dahoré, Langlé, Dolo, Rehabilitation of the CSPS

ofIolonioro Signature date : 17/08/2004 Amount : CFAF 275 955 963 TAX AND DUTY FREE Duration at submission : 6 months Amendment amount : CFAF 2 620 095 TAX AND DUTY FREE Amendment duration : 1 month Contract reference : 2003/300/MH/SG/PRSS Name : ETOF Address : 01 BP 8092 Ouagadougou 01, Tel.: (226) 50 34 19 47 Type of contract : Rehabilitation of the Dédougou CHR Signature date : 17/08/2004 Amount : CFAF 242 898 485 TAX AND DUTY FREE Duration at submission : 8 months Amendment amount : CFAF 3 938 660 TAX AND DUTY FREE Amendment duration : 2 months Contract reference : 2004-178/MFB/MH/SG/PRSS Name : ETOF Address : 01 BP 8092 Ouagadougou 01, Tel.: (226) 50 34 19 47 Type of contract : Construction of a CSPS at Dankana (District Sanitaire de Batié), Construction of a

CSPS at Timboura (District Sanitaire de Batié), Rehabilitation of the Djigoué CSPS (Batié Health District)

Signature date : 17/08/2004 Amount : CFAF 212 359 498 TAX AND DUTY FREE Duration at submission : 6 months Contract reference : 2004-175/MFB/MH/SG/PRSS Name : SANGA Address : BP 53 Bobo-Dioulasso Tel.: (226) 20 98 19 70 Type of contract : Construction of a CMA at sector 15 of Bobo-Dioulasso. Signature date : 17/08/2004 Amount : CFAF 591 617 965 TAX AND DUTY FREE; Duration at submission:8 months Start-up date/Completion date : 16/11/2004 Provisional acceptance: 29/12/2005 Amendment amount : CFAF 22 431 840 TAX AND DUTY FREE Amendment duration : 2 months Actual date : 13 months Difference : 3 months with amendment Contract reference : Contract 2004-174/MFB/MH/SG/PRSS Name : ECOBAA Address : 01 BP 4275 Ouagadougou, Tel.: (226) 5034 31 37 Type of contract : Construction of a CMA at sector 22 of Bobo-Dioulasso Signature date : 17/08/2004 Amount : CFAF 733 571 713 TAX AND DUTY FREE Duration at submission : 8 months Amendment amount : CFAF 29 688 930 TAX AND DUTY FREE Amendment duration : 2 months Start-up date/Completion date : 16/11/2004 / Provisional acceptance: 14/11/.2005 Actual date : 12months Difference : 2 months

 

 

Annex 9 MAP OF BURKINA FASO

 

Project  zone  

 

 

Annex 10

BORROWER’S COMMENTS ON THE BANK’S PCR

The Bank prepared this report in consultation with the Government. No additional comment has been made by the Government.