Document of

The World Bank

FOR OFFICIAL USE ONLY

Report No. 12588-PAK

STAFF APPRAISAL REPORT

ISLAMIC REPUBLIC OF PAKISTAN

SOCIAL ACTION PROGRAM PROJECT

MARCH 8, 1994

MICROGRAPHICS

Report No: 12588 PAKType: SAR

Country Department IIIPopulation and Human Resources DivisionSouth Asia Region

This document has a restricted distribution and may be used by redpients only in the perfonnance oftheir official duties. Its contents m.y not otherwise be disclosed without World Bank authorization.

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CURRENCY EQUIVALENTS

Currency Units = Rupees (Rs)US$1.00 = Rs 30.5 (January, 1994)

FISCAL YEAR (FY)

July I - June 30

PRINCIPAL ACRONYM%S USED

ADP = Annual Development ProgramAJK Azad Jammu and KashmirASDEO Assistant Sub-Divisional Education OfficerBHU Basic Health UnitCBR Cruie Death RateCHW Community Healt'i WorkerCMC Coordination and Monitoring Committee for SAPDDAC District Development Advisory CommitteeDHO District Health OfficerDHS Director General (or Direc or) of Health ServicesDLGRD Department of Local Government and Rural DevelopmentDOH Department of HealthEAD Economic Affairs DivisionEFYP Eighth Five Year PlanEPI Extended Program for ImmunizationFANA Federally Administered Northern AreasFATA Federally Administered Tribal AreasGPR Gross Participation RateICT Islamabad Capital TerritoryIEC Information, Education and CommunicationIMR = Infant Mortality RateMCH = Mother and Child HealthMNA Member National AssemblyMOE Ministry of EducationMOH Ministry of HealthMPA Member Provincial AssemblyMPW Ministry of Population WelfareMSU = Multi-Donor Support Unit for the SAPNAC National Advisory Committee for the SAPNEMIS National Education Management Information SystemNFC National Finance CommissionNGOCC NGO Coordinating CouncilNRSP = National Rural Support ProgramPHED Public Health Engineering DepartmentPWD = Public Works DepartmentRHC = Rural Health CenterRWSS = Rural Water Supply and SanitationSAPCC - SAP Coordinating CommitteeSSR Standard Schedule of RatesTBA Traditional Birth AttendantTFR = Total Fertility RateVFPW Village based Family Planning Worker

FOR OMCIAL USE ONLY

ISLAMIC REPUBLIC OF PAKISTAN

SOCIAL ACTION PROGRAM PROJECT

Table of Contents

Page No.

Program and Credit Summary ..................................... i

1. BACKGROUND AND STRATEGY .............. 1................ A. Low Social Indicators ................................... IB. Weaknesses in Basic Social Services .......................... 3C. The SAP Initiative ..................................... 5D. Project Strategy: An 'Umbrella" Approach ..................... 6E. Lessons from IDA Experience ............................. 8

H. THE PROJECT .......................................... 12Objectives ........................................ 12Summary of Project Description ............. ............ 13

A. The SAP Framework ................................... 13The Structure . . .................................... 13Annual Agreements ....... ........................... 14Coordination and Monitoring Mechanisms .... 16Participatory Development . . . . 18

B. The Annual Agreement for 1993/94 . . . 191993/94 Agreements on Reforms .... 20Improvements Already Accomplished ....................... 22

a. Improvements in Level of Effort and Implementation ... .... 23b. Improvements in Program Design ................... 23c. Stronger Political Commitment .................... 25

HI. COSTS, FINANCING, AND SUSTAINABELITY ..................... 26A. Social Action Program Costs ............. .... 26B. Sources of Funding for the Project - the First Three Years .... ........ 28C. Project Financing ..................................... 30D. Retroactive Financing ................................... 33E. Disbursement ........................................ 34F. Procurement ........................................ 37G. Accounts, Audit and Reporting ............................. 38

IV. IMPLEMENTATION AND MONITORING ........ .. .............. 39A. Implementation Arrangements .............................. 39

Overall Responsibility ................................ 39

This document has a restricted distribution and may be used by recipients only in the perfonnanceof their official duties. Its contents may not otherwise be disclosed without World Bank authorkation.

Implementation Agreements between GOP and the ImplementingAgencies .................................... 39

The Planning, Approval, Implementation and Monitoring Cycle ... .... 40Supervision by IDA ................................... 41The Role of the Multi-Donor Support Unit (MSU) ............... 42The Implementation Plan of Reforms ....................... 43

B. Monitoring and Evaluation (M&E) ........................... 43Monitoring of SAP Inputs .............................. 44Monitoring of SAP Impacts ............................. 45Monitoring Institutions ..... .......................... 47Funding Monitoring and Management .. ...................... 48

C. The Participatory Development Program (PDP) ................... 48

V. RISKS AND BENErPITS ...... ........... .................... 50A. Risks ................. ........................... 50B. Benefits .......................... 51

Primary Education ........................ 52Primary Health Care ........................ 54Population .......................... 55RWSS: ........................ 55

VI. AGREEMENTS AND CONDIMONS ............................ 57Key Elements of the Policy Commitnents .57

ANNEX I ..... 60Implementation Plan ................... 60

ANNEX .. 161Supervision Plan .161

ANNEX III .162List of Documents Consulted .162

This report is based on the findings of Appraisal missions in September and November 1993. Missionmembers were: John W. Wall (Task Manager); Salem Gafsi (Senior Operations Officer), Mae Chu Chang(General Educator), Christopher Walker (Senior PHN Specialist), (SA3PH); Lea Donaldson (SeniorProject Engineer, SA3EI); Hanid Mukhtar (Economist, RMP); K. Minnatullah (Chief, RWSG-SA); RajaRehman Arshad (Project Advisor, RMP); Bashir Parvez (Project Advisor, RMP); Bashir ul Haq (ProjectAdvisor, RMP); Siraj ul Haq (Consultant, RMP); Syed Ahmed (Legal Counsel); Graeme Lee (FinancialAnalyst, SA3EI) and Deepa Narayan (ENVSP). Ann Duncan (Senior Economist, former Head, MSU)and Tahseen Sayeed (Senior Program Officer, MSU) contributed during the preparation of the Projectthrough the MSU. Peer Reviewers were Nancy Birdsall (former Director, DEC); M. Karcher (Chief,(SAIPH); A. Verspoor (ESP); and Helena Ribe (AF6PH). The processing of the project was supervisedby Barbara Herz, Chief, SA3PH and Paul Isenman, Director, SA3.

ISLAMIC REPUBLIC OF PAKISTANSOCIAL ACTION PROGRAM PROJECT

Program and Credit Summary

Borrower: Islamic Republic of Pakistan

Beneficiaries: Four Provinces, Azad Jammu Kashmir, and federallyadministered are& and territories of Pakistan; and the FederalMinistries of Education; Finance and Economic Affairs;Health; Planning and Development; and Population Welfare.

Amount: SDR 145.2 million (US$ 200.0 million equivalent)

Terms: Standard, with 35 years maturity

Program Description

The proposed Project would provide a multi-sector investment and maintenance credit tostrengthen implementation of Pakistan's Social Action Program (SAP). SAP is the name givento Pakistan's overall effort to irprove basic social services over the five year period 1993/94-1997/98. The Project would reinforce existing social sector programs and projects, whether ornot aid-financed, by focusing on a few core problems that impede implementation throughoutthe social sectors. It would help finance the first three years (1993/94-1995/96) of the Program.For planning and monitoring, the SAP is divided into constituent sub-programs. The main onesinclude twelve that cover three basic social services -- primary education, primary health care,and rural water supply and sanitation (RWSS) -- in each of Pakistan's four provinces, plus thenational population program. Others cover selected federally managed health and educationprograms and basic services in areas directly administered by the federal Government. TheProject would also provide US$ 6 million to improve monitoring and evaluation. It intends toprovide US$10 million to help promote community involvement and innovation in basic servicedelivery with an initial allocation of $5 million and, if performance warrants, a second allocationof $5 million.

The Government's Social Action Program, and the proposed SAP Project which would supportit, address Pakistan's relative weakness in basic social services, which the Government considersa major shortcoming in, and constraint on, Pakistan's development. Pakistan's GDP growth hasbeen vigorous -- almost 6% per year in recent years. However, very rapid population growth(about 3% annually) meanis that per capita income growth has been only half as fast. Pakistan'shealth indicators and educational attainments fall far below expected values for its income levels.Pakistan has therefore asked IDA and other donors to join now in a broad-based effort toimprove the most basic social services. Investments in basic social services will boost economicproductivity, reduce poverty, and promote smaller, healthier, and better educated families. Socialreturns to investments that reach women will - especially high.

The proposed Project would take a broad-based "umbrella" approach to complement existing

programs and more narrowly focused projects because Pakistan's problems in the social servicesare mainly not sector-specific but endemic, common across services and areas of the country.These problems fall into three categories: i) implementation of social services has beendeficient; ii) design of social services has been flawed; and iii) levels of effort in social serviceshave been low. Underlying all three sets of problems are political considerations and insufficientfocus on the social sectors. Until now, sector- and province-specific government programs anddonor projects have addressed these core problems piecemeal, often with disappointing results.This Project would instead simplify by cutting across sectors and provinces to identify a fewcore problems that impede the social sectors as a whole. It would then concentrate attention,resources, and political will on these core problems, thereby improving the "implementationclimate" for all programs and projects. The Project would thus complement and undergird otherIDA or donor projects -- present or future -- that focus more narrowly but in greater depth onone sector in one or two provinces.

Improving Implementation. Existing basic social services tend to operate inefficiently. Inparticular, they suffer from poor planning and budgeting techniques, delays in release andexpenditure of allocated funds, recruitment bans and excessive staff turnover, overcentralizedmanagement of dispersed front-line services, and insufficient beneficiary participation. As aresult, sector-specific, province-specific projects often disburse more slowly and achieve lessthan planned. The SAP Project would complement other projects by addressing implementationproblems common to all the basic social services or particularly important to one or two.Solutions to many of these problems involve not just the sectoral ministries, but also the fmanceand planning ministries. The SAP Project has already led to actions thfat help relieveimplementation problems, thereby strengthening existing projects. For instance, in contrast tohistory, the Government is now protecting social-sector budgets in its new fiscal retrenchmentprogram and has instituted mechanisms to release social-sector funds on time to line agencies.It has hired thousands more teachers and health workers despite overall bans on recmitment.

Improving Program Design. Social services in Pakistan ought to focus more intensively andconsistently on basic or primary levels of social services, and the basic services ought to focusmore on quality and on access, especially for women and girls. The Social Action Program willshift the focus to basic services. The SAP Project would lay particular emphasis on quality andaccess, by increasing attention to inputs like books and medicines and by encouraging Pakistanto adopt approaches that have worked in other countries. Some progress has already occurred,for instance in designing basic services to involve beneficiaries more and to include more femaleproviders to serve other women and girls. The SAP Project can also highlight sector-specificdesign issues, such as including more family planning in health services. It thus reinforcessector-specific projects.

Increasing Level of Effort. As implementation capacity expands and design improves,Government expenditure on basic social services should rise. The SAP Project builds visibilityfor the social services as a whole and focuses attention on this key level-of-effort issue. TheProject has already helped Government develop plans that are a "reach", but realistic. Totalexpenditures on the basic social services will rise from 1.7% of GDP in 1991/92 to 2.6% in

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1997/98. The Government's share of incremental costs will rise from about 46% in 1993/94 to59% in 1995/96 and about 69% in 1997198. Budgets for 1993/94 show increases; for instance,the population budget is over 40% higher than the previous year's.

Political Will. By supporting the Government's SAP, the SAP Project is reinforcing politialcommitment to the social sector, by its very scope and by its reliance on annual assessments todetermine funding. Pakistan's Government gives high priority to the SAP and has already takenimportant steps to fund and implement it.

Operation of the Project. The SAP Project emphasizes a continuing policy dialogue, phasedfunding, and competition for resources among provinces and sectors based on performance. TheProject is based on appraisal of the first three years of the Social Action Program. Butdisbursements can be made to any sub-program only after the Bank and the Government reachagreement, through annual assessments, with those responsible for each year's more detailedoperational plans, including budgets and "implementation plans". In effect, sub-programscompete for funds. The annual budgets cover both development (investment) budgets andrecurrent budgets. The implementation plans cover policies -- identifying problems andspecifying prior actions and measurable targets for progress that year. The assessment thereforeamounts to an expenditure and policy review. It addresses performance of programs and of aidprojects, policies, and proposed expenditure programs and draws on IDA's and other donors'knowledge and experience from other social-sector projects that treat specific sectors in moredetail. Once agreement is reached, IDA expects to reimburse a specific share of expendituresfor that year, subject to the normal understanding that perfonnance will be adequate. Ifperfonnance of a sub-program proves deficient during the year, disbursements will be reducedby slow spending. The next year's agreement will reflect performance on programs and onprojects financed by donors as well as new plans (with prior actions and targets). Proceeding"bottom up", IDA will help Government determine the reasons impeding implementation ofsocial programs and focus on them. The feasibility of the annual-agreement process wasdemonstrated during appraisal, when Government and IDA agreed on the 1993/94 program,including actions on policy and budgets that have been taken. Because the experience was goodand the fiscal year is more than half over, retroactive financing of 20% is proposed.

Project Costs, FInancing, and Sustainabilit

The first three years of the five-year SAP would cost about $4 billion (development andrecurrent costs), including increments totaling about $1.5 billion over comparable earlierexpenditures. The Government expects to contribute about $3 billion of the total (about 76%)and to use $552 million more in existing or expected future donor assistance. It seeks fundingfor the remaining gap of $418 million. IDA has reached agreement with the Government on theframework of this three-year program, and tute SAP Project would provide $200 million, 5 % ofthe total cost and about 48% of the gap. The three-year program should be seen, however, inthe context of the five-year SAP. The full program will cost $7.7 billion, including incrementsof about $3.2 billion over comparable earlier expenditures. The Government expects tocontribute $5.9 billion and to use $1.1 billion more in existing or expected donor assistance. It

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seeks funding for a total gap of about $700 million for the five-year period. The Governmenthas undertaken to increase its share of increm.;%al cost fiancing from 46% in 1993/94 to 59%in 1995/96 and 69% in 1997/98, which IDA jutiges to be well within feasible limits even undera stringent fiscal policy. Extraordinary aid, of the type mobilized under this project, will fallfrom 27% of incremental costs in 1993/94 to 12% in 1997/98. The remainder of project costswill be provided by regular project aid that is expected to continue throughout the period. Overtime, the emphasis on community participation will encourage cost recovery and build politicalsupport that will help sustain Government commitment.

Risks

The main risk is that so large and comprehensive a Project could over-strain the managementcapacities of the Government and the supervisory resources of IDA. The Project addresses thisrisk in five ways. First, it focuses on a few core issues to improve performance of basic serviceprograms and projects. Second, it exploits "joint products" through its structure: work done forthe Project will reinforce work done on province- and sector-specific activities and vice versa.For IDA, this will permit dual-purpose supervisory missions. Third, it is helping to build theGovernment's capacity to plan, budget, and implement. Fourth, a Multi-donor Support Unit(MSU) has been established to help the Government with the SAP and to improve monitoringand donor coordination. Finally, the Project has a carefully designed and agreed implementationplan.

A second risk is that the intended reforms will not be achieved or will be seriously delayed. Thisrisk is addressed by unusually intensive monitoring through the MSU as part of technicalassistance to GOP; and by the phased annual release of funds based on annual agreementsreflecting performance and emphasizing prior actions and monitorable targets. Moreover, theProject draws on lessons learned from past and existing sector-specific projects supported byIDA and other donors, who were closely involved in Project preparations.

A third risk is that the SAP Project will undermine existing donor- and IDA-supported projectsby providing a softer option with weaker conditionality than those projects require. This risk isaddressed by treating existing aid -- or future aid, when it comes -- as "above the line" whendefining the annual funding gap that the SAP Project would help fill, thus removing thetemptation to substitute Project funds for other aid. Moreover, the Project considers performanceunder other aid projects in the annual assessments of programs to determine their eligibility forSAP Project finance. The MSU also promotes donor coordination to help prevent such problems.

A fourth risk is that Government commitment will weaken. This risk too is addressed by thephased funding and annual agreements. It is also addressed by the broad scope and multi-ministerial team-building emphasis of the Project. And it is addressed by giving importantoversight responsibilities to coordinating committees that include the highest levels of federal andprovincial government.

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A fifth risk is that the SAP, and patticularly its recurrent costs, will be difficult to sustainbecause it depends heavily on donors, The Project finances recurrent as well as developmnentcosts because recurrent costs are the main costs of basic social services. These costs areinvestments in human capital, in any event. Moreover, the Government will assume a usingshare of total as well as recurring costs as the SAP proceeds. Although SAP expenditures willrise to 2.6% of GDP by 1997/98, this level is wel' below levels of effort for basic socialservices in comparable low-income countries and should be sustainable by the Government,even under stringent fiscal policy. The Project will also emphasize the need for more beneficiarycontributions and cost recovery, especially in RWSS. Over time, donor financing (from bothregular projects and extraordinary aid) of incremental SAP costs will fall, from 53% in 1993 to41 % in 1995/96 to 30% in 1997/98. If this Project does well, there could be a subsequent onewith a further decline in the share financed by donors. This is only slightly higher than theshare of costs for basic services that donors covered before the SAP began.

Consistency with Country Assistance Strategy and IDA Rationale

To reduce poverty and promote development progress in Pakistan, IDA believes the two highestpriority tasks are to secure a sound economic policy framework and to establish basic socialservices. Despite the country's rapid economic growth, poverty remains widespread and rapidpopulation growth persists. As the World Development Report on Poverty has emphasized,reduction of poverty requires a combination of economic incentives that promce efficient growthand investments in "human capital" that enable people to respond as new opportunities emerge.Pakistan has recently made a major effort to improve its economic policies. Although thecountry's performance in the social sectors has been very weak compared to other countries, theGovernment is now determined to move much more energetically, through the Social ActionProgram to improve access and quality of basic social services to the poor. The proposed SAPProject -- along with efforts to sustain the economic policy improvements -- therefore take thehighest priority in IDA's work on Pakistan today and fully support World Bank policy on useof IDA funds. The SAP Project therefore fits into the Country Assistance Strategy.

Poverty Category: Program of Targeted Interventions

The Project is designed explicitly to reduce poverty and misery by attacking core problems inimplementation, design, and level of effort that now impede or prevent access to social services,particularly for the rural poor. The poor are now disproportionately disadvantaged; the Projectwould disproportionately benefit them by providing greater access to the most basic services.The Project would especially help women and girls.

Benefits

The SAP Project would help Pakistan's Social Action Piogram redress the generic weaknessesof basic social services by addressing core problems of implementation, design, and level ofeffort that now impede the performance of those services. It would thus help expand Pakistan'scapacity to carry out social service programs. It would pave the way -- if successful -- for

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increased IDA and donor involvement as time passes, through either traditional projects focusingon key needs in a sector or through operations providing "program support" but addressing thesector in more depth than the SAP Project would. Th. "AP Project would thus help improve thequality of basic social services and increase access, particularly for the poor and specificallyincluding women. It would therebv promote productivity, reduce poverty, and encouragesmaller, healthier, better educated families. It would also h'r, to slow Pakistan's exceptionallyrapid population growth. Preparations for the SAP Project have already produced demonstrableimprovements in planning and budgeting, in policy and procedures, and i-n program performancein all four sectors and provinces.

The emphasis on greater community participation in basic services would mean that serviceswould be better used, better managed, and better maintained. Communities would feel a greatersense of "ownership" and would be more likely to contribute to their costs. In addition, popularpolitical support for Government programs would be more likely to grow, thus enhancingGovernment commitment to investments in social services.

The SAP Project would promote gains in social services that are mutually reinforcing. Healthy,well ntourished children are better able to learn. The most effective way t.o improve children'shealth is to educate their mothers, while providing better health care. Satisfactory rural watersupply and sanitation reduce the high risk of diarrheal and other water-borne diseases, and thuscomplement basic health services. Demand for, and use of, family planning services rises whenwomen and girls are better educated and when children receive health care that increases theirchances of survival. Finally, gains in health and learning promote economic productivity.

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Costs of the Social Action Program(Current US$ million and Rs million)

In Current US Dollars (Milion) In CUrrent Rupees (Million)Three- Five- Three- Five-

Starting Year Year Starting Year YearYear Program Program Year Program Program

(1993i94) (FY94-96) (FY94-98) (1993/94) (FY94-96) (FY94-98)

PUNJAh) LH789 3,457 16.184 57.242 112.832Education 362 1,259 2,434 11,023 40,276 79,455Health 79 260 532 2,412 8,314 17,353RWSS 90 270 491 2,750 8,652 16,024

SINDH 237 782 1 471 7.204 25,031 47,998Education 175 578 1,096 5,335 18,497 35,760Health 36 105 190 1,096 3,345 6,204RWSS 25 100 185 773 3,189 6,034

NWFP 157 594 1,156 4.790 19.002 37.729Education 99 378 736 3,024 12,088 24,016Health 19 99 182 579 3,156 5,956RWSS 39 117 238 1,188 3,758 7,757

BALOCHISTAN 116 364 689 3.517 11659 22.503Education 57 168 315 1,736 5,375 10,280Health 23 107 218 694 3,436 7,123RWSS 36 89 156 1,087 2,849 5,100

PROVINCIAL SUB-TOTAL 1.)041 3.529 6.773 31.695 112.934 221,063Education 694 2,382 4,581 21,117 76,236 149,512Health 157 570 1,122 4,781 18,250 36,636RWSS 190 576 1,070 5,798 18,447 34,915

AZAD JAMMU & KASHMIR 28 104 207 837 3,319 6,772Education 17 65 130 524 2,076 4,236Health 5 20 41 164 652 1,330RWSS 5 18 37 149 591 1,207

FEDERAL SUB-TOTAL 88 387 751 2.667 12,377 1Other Federal Areas 36 137 275 1,108 4,393 8,964

Education 19 79 166 563 2,522 5,408Healdt 7 26 49 201 845 1,608RWSS 11 32 60 341 1,027 1,947

Population 35 173 350 1,054 5,533 11,425Commumiable Disease Control 16 66 116 475 2,099 3,773Participatory Development Program 0 5 5 0 160 163SAP Monitonng & Evaluation 1 6 6 30 192 196

NATIONAL TOTAL 1.156 4.020 7 731 35.200 128 252.35

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Sources of Funding for the SAP in FY93/94-95196(Current US$ million)

Total %

Government's internal resources 3.050 75.9Existing/expected aid 552 13.7Program Assistance 313IDA (SAP Project) 200 5.0ADB 100 - 2.5Government of the Netherlands 13 0.3Additional Assistance to be Mobilized 105 2.6

Total 4,020 100.0

Disbursements

Estimated Disbursement Schedule

(USS Million)

1993/94 1994/95 1995/96Annual Disbursements 50 80 70Cumulative Disbursements 50 130 200

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SOCIAL ACTION PROGRAM PROJECT (FY94-96)

I. BACKGROUND AND STRATEGY

1.1 Pakistanhas achieved vigorous GDPgrowth, averaging 5.7% over 1982/83-1992/93.This growth reflects strong performance in agriculture (growing at 4% annually), inmanufacturing (growing at 7%), and in energy. But the population is increasing at 3% annually-- faster than in any other large country in Asia. Thus annual per capita income (now about$400) has grown only half as fast as GDP, and poverty is widespread. Most families are large,poorly educated, undernourished, and unhealthy. Although health indicators and educationalattainments have improved over the past twenty years, they generally remain below the expectedlevels for countries of comparable income, especially for women and girls. Sustaining the recentpace of progress, much less accelerating it, will be difficult. Pakistan will have to adhere to itsrecent fiscal reforms to achieve greater discipline, with more effective and broad-based taxation.It will have to pursue broader economic reforms that encourage international competition. It willneed to expand its infrastructure. And it will need to develop an educated, healthy populace andreduce its rapid population growth. The proposed multi-donor SAP Project would address thislast set of objectives.

A. Low Social Indicators

1 2 In education, the differences between Pakistan and other low-income countries arestriking. The female literacy rate in Pakistan is among the lowest in the world. Estimates ofGross Enrollment Rates (GERs) suggest that in Pakistan, roughly half of all school-age childrenand about two-fifths of the girls are enrolled in primary school. Yet the South Asia region asa whole has made substantial progress: comparable figures for neighboring India are 97% forall children and 83% for girls; in Bangladesh, 73% for all children and 68% for girls. Forchildren in low-income countries as a whole, the GER is about 100% for all children and 96%for girls. 1

1.3 Nationwide data mask differences among and within provinces. Estimates ofprimary level GERs in 1992/93 (including kindergartners) ranged from about 62% in Punjab to31% in Sindh and Balochistan. For girls, the GERs ranged from 55% in Punjab to 14% inBalochistan. Yet AJK -- a mountainous and remote area -- has a GER of 58% for girls, higherthan that of Punjab, which suggests that much can be accomplished with stronger effort.Available information suggests that in rural areas, the primary GER for boys averaged about71 % and 40% for girls; in urban areas the GER for boys averaged about 81% for boys and 73 %for girls. Table 1.1 presents the picture in greater detail.

1 Gross Enrollment Rates at the primary level are defied to be the number of childrenof all ages enrolled in primary school divided by the population of children of primary-schoolage. For some countries the GER may exceed 100% because some pupils are younger orolder than the country's standard primary age.

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Table 1.1 Gross Enrollment Rates in Primary School(Including Kindergarten) 1992-93

(Percent)

Total Girls Boys

Punjab 62 55 69Sindh 44 30 56NWFP 45 29 60Balochistan 31 14 46Azad Jammu & Kashmir 64 58 71Northern Areas 42 25 58Tribal Areas 36 9 62

Overal! 53 41 63

Source: 1992 National Educational Management System

1.4 In health, a similar picture emerges. Despite progress, particularly in urban areas,health indicators remain poor throughout most of the country. The crude death rate fell by 40%over the past twenty-five years but remains at 12 per 1000, above the low-income countryaverage of 10. Infectious and communicable diseases are still widespread, and about half ofPakistani children are malnourished. At present health problems are concentrated among youngchildren and their mothers, as reflected in high child and maternal mortality rates. The under-five mortality rate for girls in 1991 in Pakistan was 139 and for boys 137 -- compared withaverages of 96 and 104, respectively, for all low-income countries, and 125 and 123 inneighboring India. Although male life expectancy in Pakistan is about 59 years as compared with58 for all low income countries, female life expectancy, at 59 years, is below the low-incomecountry average of 61, and the female proportion of Pakistan's population is among the lowestin the world.

1.5 Not surprisingly, fertility is high. Pakistan's total fertility rate (TFR) is 5.7compared with 3.8 for low-income countries as a whole, 4.4 for Bangladesh, and 3.9 for India.Universal marriage and low contraceptive use contribute to maintaining high fertility rates.Unlike most of its neighbors, Pakistan has not yet begun to show a sustained decline in fertility.As a result, its population includes a relatively high proportion of dependent children, whoseneeds - if met -- would absorb substantial resources. Thus, for example, Pakistan needs toincrease its expenditures on education by 3 percent annually just to maintain its current lowprimary enrollment rate.

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B. Weaknesses in Basic Social Services

1.6 Limited educational attainment, poor health status, and high fertility in Pakistanreflect widespread and long-standing weaknesses in social services, and especially in the basics:primary education, primary health care, family planming, and rural water supply and sanitation.These basic services are the main source of service for the poor majority of Pakistan'spopulation. The provinces are responsible for primary education, primary health care, and ruralwater supply and sanitation. The Federal Government provides policy guidance, coordination,and much of the provinces' development (investment) budgets. The provinces cover theirrecurrent budgets, including most salaries and inputs like books and medicines needed tomaintain service quality. Pakistan's population program is financed by the federal governmentand run jointly by the federal and provincial governments.

1.7 In all provinces, government primary education programs suffer similar problems.Solutions need to be tailored to fit local circumstances, of course, but the similarities areevident. For instance, planning has long been weak, so that objectives are unrealistic, resourcerequirements are inaccurately projected, and critical paths and monitorable indicators areunclear. Plans also have paid too little attention to quality: education budgets typically spend lessthan 1 % of resources on non-salary inputs like books. Nor do plans adequately address thecultural requirements that must be met for girls to attend school (e.g., schools close to home,female teachers, and private lavatories). Implementation of the plans is, in turn, hampered bydelays in the release of the development budgets to departments, by misplaced politicalinfluences (especially on the location of local schools), and by irregularities in construction.Primary education systems in all provinces also suffer from recruitment bans, high absenteeism,and excessive or improper transfers of staff. Some 2,000 rural schools stand idle because theirteachers arranged transfers to urban areas while continuing officially to occupy the rural posts.All have overly bureaucratic and duplicative administrations - separate ones for girls and forboys. Finally, primary education systems do not involve parents or communities enough; noris private competition much encouraged. As a result, primary education is often inefficient, ofpoor quality, and insensitive to local views on what should be taught and how.

1.8 The better schools - or at least the schools with regularly attending teachers -- tendto be overcrowded. But many others are underused: 3,000 rural schools have fewer than 10students, in addition to the 2,000 with none. Many parents keep children at home because it doesnot seem worthwhile to incur the costs (direct and opportunity) of poor-quality schooling. Manyparents have been particularly reluctant to educate girls because others (e.g. in-laws, society ingeneral) will reap most of whatever rewards exist after the girls grow up and "marry out".Recent experience suggests, however, that parents will send their children - including girls --to school if the school offers decent-quality, culturally sensitive education. Moreover, the"decent quality" standard that parents seek is rarely unattainable. It is well within the limits ofwhat is practical and affordable. In fact, it can also be cost-effective because more childrenwould attend regularly and they would learn more.

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1.9 The weaknesses of primary health care resemble those of primary education. Themost pressing need is to improve maternal and child health. Accomplishing this will require, asa start, greatly improved functioning of the existing network of small local facilities. Simpletechnologies to deliver basic health, nutrition and family planning services can make anenormous difference if they are made available effectively. In recent years, health services havebeen expanded. Over 90% of local Union Council Areas now have a Basic Health Unit or otherhealth facility, but they seldom wvork efficiently. Most deliver poor quality basic care and failto reach out into communities. Many are not furnished regularly with key medicines,contraceptives, or immunization supplies: expenditures on non-salary inputs are far too low. Inaddition, Basic Health Units are often not staffed reliably. Moreover, they tend to lack trainedfemale health workers, even though women cannot easily seek health care for themselves or theirchildren from men. As communities are too little involved in the design or delivery of suchservices, their preferences are not adequately considered. Thus, many local health facilities areunderused or abandoned, because they fail to meet users' needs.

1.10 Moreover, the primary health care system is inefficient. The sector has evolved intohard-to-manage, complex structures -- duplicative and too centralized -- with weak backup andsupervision for the smaller facilities, The key district management level is overstretched andlacks authority to act on its own. First-line district level referral services vary greatly in quality.Throughout the system, planning and budgeting, personnel policies and practices, and logisticsfor essential supplies are all inadequate. Delays in release of funds, bans on new recruitment,and excessive staff turnover have exacerbated these problems.

1.11 Family planning services are extremely weak, even though surveys report that some40% of Pakistani women want to avoid pregnancy. Family planning is supposed to be offeredregularly by all health facilities but seldom is. To give greater emphasis to faxrry planning, theGovernment established a separate population program in 1981, managed federally by theMinistry for Population Welfare (MPW). It is supposed to concentrate on making familyplanning more readily available, especially at the local level. In principle, the services of theMPW can complement and promote better use of primary health care, as they do in othercountries. But the services offered through the MPW share many of the problems of primaryhealth care (in planning, funding, staffing, and logistics), with even more centralizedmanagement.

1.12 The private health sector, ranging from modern physicians and nurses to traditionalbirth attendants and pharmacies, provides considerable health care and is beginning to offer somepreventive services, including family planning. Several social marketing efforts have been quitesuccessful. More than half of all expenditures on health now are for private services. The qualityof private care varies a great deal, posing some risk. But its potential needs to be explored,particularly in the better-off urban areas where most modem private services are concentrated.It may be possible to focus private services more on higher-level curative care with more costrecovery, and so allow public resources to concentrate more on providing better quality but

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affordable care for the vast rural areas and for the poor whether rural or urban, with anemphasis on preventive and basic curative services.

1.13 Rural domestic water supply services also fail to reach more than half the ruralpopulation, and quality often falls below minimum standards in the areas that are served.Sanitation coverage is far less than that for water supply. Many existing water supply systemsinvolve capital-intensive and costly technology that is difficult to use or nmaintain and have falleninto disrepair, accomplishing little. Government policies in RWSS have been inconsistent, andplanning and management in government agencies responsible for RWSS has been weak.Government-sponsored RWSS programs have depended too heavily on the federal governmentand on donors for direction and assistance. RWSS systems would be more effective and moreaffordable if they involved community-based approaches using simpler and less costly technologythat could be operated and maintained at the local level, with communities covering the costs ofoperation and maintenance. In tovvns, users should also contribute to cost recovery. Butcommunities and users have been too little involved in the design, operation, and managementof RWSS systems, with the result that they feel little ownership and so contribute little.

C. The SAP Initiative

1.14 Pakistan has now committed itself to a broad-based effort to improve the most basicsocial services, for which it seeks help from the donor community. The Government deploresPakistan's weak performance in the social sectors and believes greater investment in basic socialservices would accelerate gains in productivity, reduce poverty, and promote smaller, healthier,better-educated families. A consensus is emerging that female education has particularly highprivate economic and social returns in Pakistan. Education not only increases women's economicproductivity but also improves their children's health and learning and lowers fertility. (Maleeducation also has high private economic returns but has less impact on fertility or children'shealth.) Similarly, it is evident that health and family planning services that reach womenaccomplish much more than those that do not. Moreover, returns to social sector investmentsin Pakistan today -- particularly those reaching women -- would exceed those from investmentsin many other sectors. The Governnent therefore, supported by many donors, has embarked ona Social Action Program (SAP) to improve primary education, primary health care, population,and rural water supply and sanitation services throughout the country. The SAP comprises allprograms and projects, whether or not aid-financed, in the SAP sectors. The proposed SAPProject -- with financing from IDA, the Asian Development Bank, the Netherlands, andpotentially other donors -- would provide overall support to the SAP. It would complement othersector-specific and province-specific projects, whether on-going or future, by strengthening the"implementation climate" for all projects and programs in basic social services.

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D. Project Strategy: An "Umbrella" Approach

1.15 The proposed Project would take a broad-based, "umbrella" approach to improvebasic social services in Pakistan because the main problems are not sector-specific but endemic -- common across all services and areas of the country. A variety of sector- and province-specificprograms and projects have tried to deal with these problems piecemeal, but often withdisappointing results. It would be simpler and more efficient to deal with these problems as awhole rather than continuing to deal with them piecemeal. The proposed Project's "umbrellaapproach' would address them as a whole. It would look across sectors and provinces to identifya few core problems that impede performance in the social sectors, exploit similarities insolutions to them, and -- through its very scope -- help marshall the political commitment andresources to deal with them. These problems fall into three categories: (i) implementation ofsocial services has been deficient, (ii) design of social services has been flawed, and (iii) levelsof effort in social services have been insufficient. Underlying all three sets of problems arepolitical considerations and insufficient focus on the social sectors. Reflecting past politicalneglect, social sector institutions are generally weak. The SAP Project will help concentratepolitical attention, commitnent, and resources on these issues.

1.16 Improving Implementation. Pakistan's social services tend to operate inefficiently.f expansion is to occur, it must rest on a stronger base in all four SAP sectors. All four suffer

from:

o Poor planning and budgeting.

o Bureaucratic delays in the release of budgeted funds to line departments andexecuting agencies.

o Lack of trained staff to meet rapidly expanding needs, made worse byrecruitment bans imposed by the Government on all programs to promotefiscal discipline, without exemptions for priority needs.

O Absenteeism and excessive or improper transfers of staff -- managers as wellas front-line workers, including teachers and health workers.

O Inadequate and unreliable supplies of key inputs (including books, medicines,and contraceptives) needed to maintain service quality.

o Locating schools and health units within communities with too little attentionto the location of most potential users.

o Faulty construction.

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o Excessively centralized management of dispersed front-line services, whichcould be more effectively run through decentralized systems with flatter"organizational pyramids".

O Weak monitoring and bureaucratic obstacles to mid-course correction(particularly in the rigid application of the government's procedures formodifying projects).

1.17 As a result, sector-specific and province-specific Government programs and aidprojects often disburse more slowly and achieve much less than planned.

1.18 By jointly addressing implementation problems common to all the basic socialservices, the SAP Project can strengthen the performance of basic social services even over therelatively short period of three years and thereby increase implementation capacity. It can thuscomplement the efforts of other on-going projects with a narrower focus while paving the wayfor future projects that could begin during this three-year period or later on. These projectscould include traditional operations focusing on key issues in one sector or "program" operationsthat support entire sectoral programs but in more depth and detail than the SAP Project. TheSAP Project would also promote effective sharing of ideas and experience and encourageimprovements in one sector -- say, primary health care -- that bolster improvements in another -- say, family planning. Moreover, solutions to many implementation problems involve not justthe sectoral ministries and departments but the finance and planning ministries whoseresponsibilities allow them to focus on common cross-sectoral issues at once. Of course, the SAPProject would also help concentrate attention on important sector-specific problems that arise,such as the special management requirements of the national population program, which wouldalso complement other projects. If the Project succeeds in helping the Government increase itsimplementation capacity, it will enable greater Government level-of-effort and, in step with that,greater involvement of IDA and other donors in the future.

1.19 Improving Program Design. Social services in Pakistan need to give greater priorityto basic, as opposed to higher-level, services, and the basic services need to focus moreconsistently on improving quality and on expanding access for the poor majority in far flungrural as well as urban areas. Special effort will be required to provide services that are ofdecent quality but still affordable in many of Pakistan's rural areas where population densitiesare low and most people are poor. Special effort will also be required to design services toreach women and girls more effectively. The Social Action Program does shift focus to thebasics, and the SAP Project would emphasize quality and access. The Project would encouragereforms across the SAP sectors that have worked in other countries, including ways to reachmore poor women and girls. These involve bringing basic services closer to users throughnetworks of small outlets, which tend to perform more efficiently for all users. Other approachesto reach women include recruiting, posting and retaining more female teachers and healthworkers, especially in rural areas, and offering more flexible hours for services. The SAP

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Project would also highlight sector-specific design issues, such as the introduction of coeducationwhere acceptable, or the inclusion of more family planning in basic health care, or the operationand maintenance of rural water systems by communities. In its effects on program design, theSAP Project would reinforce other social-sector projects financed by IDA and other donors.

1.20 Increasing Levels of Effort. As implementation capacity increases and designimproves, Govermnent expenditure on basic services should increase. The SAP Project wouldhelp build visibility for the social services as a whole and would focus attention on the level-of-effort issue. It is designed to increase coordination and cooperation among the federal ministriesand provincial departnents involved, including finance and planning. It has already helped theGovernment develop plans that are a "reach" but realistic. Under the SAP, total expenditureson the basic social services are projected to rise from less than $1 billion in 1991/92 to morethan $1.5 billion by 1995/96. Both Government and the donor community will have to increasetheir financing to meet these targets, but the Government has committed itself to reducingdependence on donors for social sector financing. Its own contribution will rise from $0.8 billionin 1991/92 to $1.2 billion by 1995/96. It will cover an increasing share of incrementalexpenditures in these sectors, from 46% in 1993/94 to 59% in 1995/96 and 69% in 1997/98.If the SAP and the proposed Project succeed in increasing implementation capacity, levels ofeffort could be fuither increased.

1.21 Political Will. If the SAP is to succeed, political will must be sustained from thefederal and provincial levels through to the local levels. The very fact that the Government hasdeveloped, and stands behind, the SAP gives hope that this goal is achievable. The SAP Projectunderlines the interest of IDA and other donors in this outcome.

E. Lessons from IDA Experience

1.22 The proposed SAP Project is innovative, but its design reflects the experience gainedfrom an extensive portfolio of projects financed by IDA and other donors. Currently, IDA hasprimary education projects in three provinces; a fourth in preparation; and a middle schoolingproject which includes primary; two primary health projects, each covering two provinces; aRWSS project focussed in two provinces and Azad Janunu Kashmir; and a national populationproject in preparation. (See Table 1.2 for IDA-supported projects from FY75 through FY93.)Two education projects (Primary Education and Education III) have been audited and have hadproject completion reports prepared by the Operations Evaluation Department (OED). OED hasprepared a project completion report on the Population, Health and Nutrition Project as well.

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Table 1.2 IDA Social Sector Projects (FY75-FY93)

CreditName of Project Y Amount

EducationBalochistan Primary Education 93 106.0Punjab Middle Schooling 92 115.0Sindh Primary Education 90 112.5Primary Education III (Punjab) 87 145.0Primary Education II 85 52.5Primary Education 79 10.0Educa:ion III 77 15.0

Sub Total 556.0

Health and PopulationFamily Health II 93 48.0Faamily Hea!th 91 45.0Population 83 18.0

Sub Total 111.0

Rural Water SupplyRural Water 91 136.7Water Supply 83 25.0

Sub Total 161.7

TOTAL 828.7

Non-SAP

Second Vocational Training 86 40.2Vocational Training 81 25.0

NON-SAP TOTAL 65.2

1.23 The fist, and perhaps most important, lesson from experience is that most of theseprojects focused on key needs in a given sector but were often hampered by the broaderimplementation problems described earlier. Recent sector-level operations have therefore tendedto move away from partial approaches toward strengthening programs at the provincial level as

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a whole, and these projects have worked better. The SAP Project takes the program approacha step further. It supports programs in all four basic services, province by province, and aimsat improving the overall implementation environment as well as addressing important sector-levelissues. It provides a comprehensive framework for reaching consensus within Government andamong donors on key reforms affecting the whole program as well as its individual components.Once carried out, the reform measures under the SAP Project should increase the Government'simplementation capacity in the social sectors, enabling it to comply more readily with legalcovenants under IDA projects and speeding implementation of all projects in the social sectors.

1.24 Second, projects have run into difficulty when they were too complex. The SAPProject appears complex because it supports all four sectors in the different provinces and areas.It simplifies policy reform, however, by providing one framework for the annual assessmentsand by focusing annually on key reforms that are timely and feasible and adjusting to promoteother reforms as the SAP proceeds. It manages the remaining complexity by subdividing thework into more tractable sub-programs that are sector-specific and province-specific. It alsostrengthens the monitoring and implementation capacity of the federal and provincialgovernments. Still, complexity in the SAP Project remains a concern and may be the price ofaddressing the core issues that impair social services throughout the country.

1.25 Third, other projects have had difficulty because of a lack of Government follow-through on commitments to carry out agreed reforms. The SAP Project is designed to requireand strengthen such follow-through, particularly by phased funding and by insistence on annualagreements on programs, including verification of prior actions and specification of monitorabletargets.

1.26 Fourth, other projects have sometimes had disappointing results because they didnot focus sufficiently on basic services. The SAP Project is deliberately designed to focus on thebasics.

Rationale for IDA Involvement

1.27 This project helps fulfill a priority objective of the Bank's assistance strategy inPakistan-to expand the reach and enhance the performance of the basic social sectors. Aconsensus for reforms that can make substantial progress under current circumstances hasemerged. IDA's involvement helps the GOP seize this opportunity by strengthening the handsof those who want to make progress. Other donors have worked closely with the Bank and areencouraged by the Bank's focus on the social sectors and leadership. The Bank is exercisingleadership by helping the federal and provincial governments formulate operational plans fortheir programs that meet the standards of the Bank and other donors for possible financing. Ithas also established and is heading a Multi-Donor Support Unit (MSU) for the SAP to assist theGovernment in formulation, implementation, and monitoring of the SAP.

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Country Assistance Strategy

1.28 The Bank Group Country Assistance Strategy for Pakistan was last discussed withthe Board on !uly 2, 1992; and it will be discussed along with this project. The last PovertyAssessment was completed in August, 1990 and currently is being updated. This work has beena key building block in the formulation of the Country Assistance Strategy. The Bank and IDAassistance strategy for Pakistan supports the Government's main medium-term developmentgoals, namely to promote economic growth, alleviate poverty, improve social sectorperformance, and strengthen macro economic management. More specifically, the strategyconcentrates on four priorities: strengthening social sector perfomiance; improving the enablingenvironment for the private sector; improving management of Pakistan's natural resources andthe entvironment; and improving public expenditure performance as a key part of strengtheningmacro-economic performance and carrying out structnual adjustment.

1.29 Progress in all four areas will be essential to achieve the Bank's overridingobjectives of sustained growth and poverty reduction. High priority is being given to investmentin social services, especially basic services, not only to improve social welfare but to increaseproductivity and earning capacity, especially of the poor. The 1990 World Development Reporton Poverty has emphasized that reduction of poverty requires a combination of economicincentives that promote efficient growth and investments in "human capital" that enable peopleto respond as new opportnities emerge. Investments in basic social services are therefore anessential part of the Bank's poverty reduction strategy. Similarly, strong private sectordevelopment remains key to sustained growth, which is clearly essential for expandingemployment opportunities for the poor. The increased focus on enviroDmental concerns is alsodirectly linked to poverty reduction goals. Improving water supply and sanitation, reducing urbanpollution, and slowing and repairing degradation of natural resources are needed both forsustainable growth and for improving the quality of life and the earning potential of the poor.Better management of public expenditures, with emphasis on helping ensure increased fundingfor social and physical infrastructure, also contributes directly to meeting poverty reductionobjectives. A Poverty Assessment, currently being prepared, will assess poverty reduction effortsto date and develop a more comprehensive strategy for future action, including the possibledevelopment of more targeted interventions to improve productivity and raise incomes of thepoor. It will emphasize the particular importance of human capital investments, including theSAP, in Pakistan today. The SAP Project thus fits well into the Country Assistance Strategy.

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H. THE PROJECT

Objectives

2.1 The SAP project supports the overall implementation of the Government's SocialAction Program, which aims to reverse Pakistan's historic under-investment in social welfare,and thus to increase educational attainment, improve health status, and slow population growth.It calls for improvement and expansion of all four of the country's basic social services --primary education, primary health care, population, and rural water supply and sanitation(RWSS) -- at a total cost of US$7.7 billion over the Eighth Five-Year Plan (1993/94-1997/98)or about $3.4 billion more than the Government spent on these services in the previous five-yearplan. The bulk of the financing for the program as a whole (about $5.9 billion), and for itsincremental costs, will come from the Govertnent. An additional $1.1 billion or so will comefrom on-going and anticipated donor-aided projects. To fill the remaining gap, the oovernmenthas requested $0.7 billion of program fiancing from various donors, including IDA. The SAPProject would help finance the first three years of the SAP, 1993/94-1995/96. IDA has agreedwith the Government on the broad outlines of the five-year program, a more specific frameworkfor the three-year program, and detailed operational plans for the first year, 1993/94.

2.2 The previous chapter focussed on the four cross-sectoral issues essential to thesuccess of the SAP which require improvement in:

- implementation by strengthening planning, budgeting and operationalefficiency;

- service design with a focus on quality and access, especially women and girls;

- levels of effort, including Government funding and community responsibility;and

- political will.

2.3 This chapter focuses first on the framework for reaching these objectives.2 Thisframework has been worked out over the past two years through dialogue among theGovernment of Pakistan, IDA, and other donors. It is intended to provide impetus, direction andcoordination for activity under the SAP; to allow the SAP to exploit and promote similarities andsynergies among the four sectors; and to focus attention on the all-important cross-sectoral

2 Arrangements for financing and implementation are described in detail inChapters Im and IV.

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issues. The framework approach is already having a positive impact, as will be evident fromthe discussion of the 1993/94 Agreement in the second part of this chapter.

Summary of Project Description

2.4 A mo-e detailed project description is contained in the "Implementation Plan"annexed to this report. The project supports the Pakistan's entire program of primary education,primary health care, population and rural water supply and sanitation, in the four provinces, AJKand the federal areas of Pakistan. The bulk of project funds (over 90%) will be allocated to thedelivery of these basic services. A small amount will be allocateWi for the ParticipatoryDevelopment Program to encourage the non-government sector to heip provide these services.Finally, another small amount will be allocated to deepen and strengthen the monitoring of thedelivery of these services, as well as a household survey monitoring the receipt of these servicesby the intended beneficiaries.

A. The SAP Framework

2.5 The major elements of the framework are:

- A decentralized structure, to clarify responsibilities for implementation ofprograms in each of the four social services, province by province;

- Performance-based annual agreements, with detailed operational plans andmeasurable targets, to determine funding;

- Mechanisms for continuing policy dialogue, coordination and monitoring whichreach from front-line ministries and departments through to the highest levels ofGovernment; and

- A Participatory Development Program to encourage community participation andexperimentation through non-governmental organizations (NGOs) and related privateinstitutions.

The Structure

2.6 The SAP is clearly a program of substantial scope. Without some system forsubdividing the work, program planning, management and monitoring would be extremelydifficult. Thcl overall program is sub-divided naturally into sub-programs. Most of these aresector- and province-specific; others will cover the national population program, some nationallyrun education and health programs (e.g., the Expanded Program of Immunization), and basicservices in the federally administered areas and territories. Many sub-programs match upconveniently with current IDA or other donor projects: for example, IDA has primary education

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projects in supervision or preparation in all four provinces. Thus the structure facilitates "jointproducts" -- work that simultaneously serves the SAP itself, the SAP Project, and a sector- andarea-specific project. The structure therefore makes the work for the SAP and for the proposedProject more practical and feasible. IDA proposes to finance two additional programs -- aParticipatory Development Program to promote community participation and innovation throughNGOs and a program to strengthen monitoring and evaluation capability. While the SAP is anationwide program, covering all provinces and areas, a substantial porticn of expenditure willbe directed at the most important programs. The most important sub-programs can be depictedin a grid:

Table 2.1: SAP Sub-Programs

PrimaryEducation PHC RWSS Population Other

PROVINCIAL PROGRAMBalochistan x x xNWFP x x xPunjab x x xSindh x x x

FEDERAL PROGRAMMinistry of Population Welfare xOther federal ministries x xFederal areas/territories x x xParticipatory Development Program xMonitoring & Evaluation x

Annual Agreements

2.7 The SAP Project will be implemented through a series of annual agreements -- basedon assessments of past performance, underpinned by continuing policy dialogue, and supportedby the previously described Multidonor Support Unit (MSU). This procedure will permit theGovernment, IDA, and other donors to adjust to changing conditions aud thereby make morerealistic plans year-by-year. There will be three such annual agreements, each covering onefiscal year during 1993/94-1995/96 and each summarizing the detailed individual agreements forindividual sub-programs (such as the primary education program in the Punjab or the nationalpopulation program). Agreements on each sub-program will be sought each spring, before thefiscal year begins on July 1. Each will present Operational Plans that describe in detail aprogram of specific size and content. The Operational Plans will comprise plans for capital andrecurrent expenditures as well as "implementation plans" specifying prior actions (policy reformsand changes in practices) with monitorable targets for achievement during that fiscal year. The

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assessments thus amount to a kind of expenditure review and cover past performance as well aspolicies and proposed expenditure programs. They draw on Government and donor experiencein other programs and projects that focus in greater depth on one sector in one or two provinces.Agreements will generally be reached on each sub-program before the fiscal year begins and willbe confi-med just after the start of the fiscal year that they cover. Once agreement is reached,the sub-program will be eligible for IDA funding for that fiscal year. In some sub-programs,however, it may not be possible to reach agreement; those sub-programs will then be ineligiblefor SAP Project funding that fiscal year, until agreement is reached.

2.8 The amount of SAP Project funding for each sub-program will be determined at thesame time as the Operational Plans are agreed by all parties, including IDA. Disbursements foreach sub-program will be made only against actual expenditures which conform to the agreedoperational plans or as subsequently modified by mutual agreement. Once agreement is reached,IDA expects to reimburse the agreed share of expenditures for that year, subject to the usualunderstanding between IDA and Government that performance will be adequate. If performancein a sub-program proves to be seriously deficient, then spending may fall short of planned levelsand disbursements will decline. Recommendations for improving performance will be offered.Subsequent expenditures and hence funding will be based on past performance, which will beclosely monitored, as well as on operational plans for the new year.

2.9 This system of annual assessments and agreements is designed to create plans forimproving and expanding basic social services in Pakistan that are a "reach", but realistic --more feasible and practical than past plans have proven to be. First, the system requiresassessments of each sub-program from which cross-cutting or "core" issues emerge. These coreissues become the focus of attention for the SAP policy dialogue and the highlights of thesummary agreement for that year. Second, the system encourages governments to compete forfunds based on their past performance in programs and in all aid projects and their proposedplans and budgets. More funds (from Government or donors) will be allocated to sub-programsthat perform well because they will have larger programs approved. Third, the system will helpsub-programs with weaker performance to improve their implementation capacity by involvingsenior officials in frequent reviews, by requiring annual approval of implementation plans, andby offering assistance where necessary. Fourth, the annual process allows for flexibility andadjustment as circumstances change. For instance, if implementation capacity expands anddonors design new projects for some sectors and provinces, then the "gap" requiring funds fromthe SAP Project will fall. If performance in a particular sector in one province improvesmarkedly but declines elsewhere, resources can be shifted to support the strong performer whileefforts are undertaken to improve the weaker performer. Or if new "core problems" emerge,they can be focused upon. The SAP Project will provide the incentive of resources, includingtechnical advice (coordinated through the MSU). It creates powerful incentives for both frontlineofficials (who want to see their programs succeed) and finance and planning officials (who wantto ensure full disbursement of the IDA credit). The result should be stronger performance notonly of the basic social services but also of other donor-funded projects in these sectors. The

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MSU provides a forum for improved dialogue on implementation problems between donors andgovernment, as well as within the donor community; if sufficiently serious, the SAP Project canhelp address implementation problems in other donor-funded projects (if those problems cannotbe satisfactorily addressed in the context of that project).

Coordination and Monitoring Mechanisms

2.10 Basic capacity to monitor the SAP exists now but will be improved under theProject. Performance in each cell is already being monitored by existing line departments in eachsector and by units in the planning and finance departments. The proposed Project willstrengthen monitoring in some line departments, particularly in education, according to plans thathave been agreed. The Government has also taken steps to improve coordination of monitoringacross sectors and givc a clearer overall picture of how the SAP is functioning. It has set upsmall monitoring cells at the federal level and in the four provinces to augment the existingmonitoring capacity in the line departments. The new cells are in place and staffed. Moreover,the Government has established new, high-level coordination and monitoring committees whichare the institutional expression of the Government's determination to see the SAP succeed. Atthe federal level, a SAP National Steering Committee will be chaired by the Deputy Chairman,Planning Commission, and assisted by the Federal SAP Secretariat, located in the PlanningDivision. A comparable committee in each province will be chaired by the Chairman/AdditionalChief Secretary, P&D; it will be assisted by new provincial SAP Cells and the existingmonitoring units in the sectoral departments. Continuing policy dialogue will take place throughall of these mechanisms, including the MSU.

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2.11 Figure 2.1 represents the reporting structure of the monitoring system indiagrammatic form. It is described in detail in Chapter 4.

Figure 2.1 SAP Monitoring System

SAP NATIONAL STEERING COMMITTEEMONITORING NATIONAL SAP

FEDERAL SAP SECRETARIAT

F~~~~~~~~~PROVINCIAL SAP CO-ORDINATION COMMITTEE

(For each Province, AJK, and Federal Programs/Areas)MONITORING PROVINCIAL SAP

PROVINCIAL FINANCE PROVINCIAL P&D DEPTSDEPARTMENT MONITORING IMPLEMENTATION

MONITORING FINANCIAL OF ALL POLICIES ANDFLOWS PROGRAMS INCLUDING

AGGREGATING INFORMATIONOF LINE DEPARTMENTS AND

SPOT-CHECKING IT

LINE DEPARTMENTSHEALTH, EDUCATION, POPULATION,

RURAL WATER SUPPLY & SANITATION(PHED & LGRDD)

MONITORING EACH PROGRAMINDIVIDUALLY, ATOPERATIONAL LEVEL

2.12 The Multi-Donor Support Unit (MSU). In addition, the Government can draw onthe recently established Multi-Donor Support Unit (MSU), sponsored by several bilateral andinternational donors for assistance in monitoring and coordinating the SAP (para 4.17, 4.18).The donors have established a Trust Fund (currently funded at $2.5 million, with possiblefurther contributions up to $4-5 million, depending on need). The Trust Fund is executed byIDA, and provides support for design, monitoring and coordination of the SAP. The MSU hasalready taken the lead in coordinating the donors' policy dialogue with the Government on

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various aspects of SAP planning, and has provided assistance to the governments for the designof the SAP. It organized task forces for each of the four sectors, which identified criticalimplementation bottlenecks and reached consensus between donors and government agencies onneeded reforms: the resulting "guidelines" were discussed in detail with each provincialdepartment/agency and formed the basis for each implementation plan of reforms, as discussedmore fully below in the section on imp2ementation.

2.13 Support for Monitoring and Evaluation. Finally, the SAP Project includes support(complementary to that provided under other projects) to strengthen national and provincialmonitoring and management systems, which are essential to more effective management. TheProject will provide advice and resources to support studies, help the provincial and federal SAPUnits develop better performance standards for social services, and monitor implementationagainst those standards. The Project will help sectoral ministries in cases where resources arenot available from sector-specific projects. It will also finance independent consultants to helpmonitor key aspects of SAP performance (for instance, achievement of agreed targets such ashiring teachers or adherence to agreed procedures for procurement) and to assess managementperformance and needs.

2.14 The support for monitoring and evaluation will also finance studies, data collection,and analysis of program impact to complement the monitoring of program inputs and processmeasures. The core of this effort will be surveys building on the earlier donor-supportedPakistan Integrated Household Survey (PIHS) and implemented by the Federal Bureau ofStatistics. The resulting information will be critical to assessing the effectiveness of various SAPprogram initiatives and determining whether pilot schemes should be replicated or scaled up.

Participatory Development

2.15 The Government of Pakistan seeks to increase community participation in andresponsibility for the delivery of basic social services, whether or not fimanced by Government.This will encourage local contributions and cost recovery and help planners to design servicesthat better meet local needs; it will also increase the chances that services will be properlymaintained and operated. Non-government organizations (NGOs) and other private efforts inmany countries have pioneered approaches that have later been taken up by the Government.particularly in family planning and health care. Through its operations in all four of the SAPsectors, IDA is already supporting Government efforts to develop participatory approaches,particularly in RWSS and in primary education. Plans are also underway for community-basedfamily planning and health care. The SAP Project will expand such efforts by promoting andhelping finance programs, including on-going ones in primary education and rural water supply,that specifically promote participatory approaches. The Project will also support the newcommunity-based family planning outreach program and a sharp expansion in community healthworkers. The SAP Project will help to track the progress of such efforts, including mid-coursecorrections, thus providing guidance for possible expansion and replication.

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2.16 In order to provide for trying new and innovative participatory approaches, the SAPintends to provide $10 million, with a proposed initial allocation of $5 million, from FY95 fora "participatory development program" (PDP). An additional $5 million can be made availablefrom unallocated project funds as warranted by the progress of this component. The PDP wouldhelp community organizations, NGOs, private institutions, foundations, academic and researchinstitutions, and Government agencies to expand their efforts to involve communities and usersmore closely in basic service delivery, as well as to promote more effective cooperation betweencommunities and the government departments providing basic social services. Several suchpromising programs in Pakistan today reach more than 2 million people, in both rural and urbanareas. In addition, some 10,000 NGOs are operating on a relatively small scale in the foursectors. These private efforts have developed mainly in areas where Government services areweak, but some involve partnerships with Goverrnent agencies. They offer potential forimproving the effectiveness and efficiency of public resources by increasing communityresponsibility and participation. Issues of replication and affordability arise with these efforts,but some include ideas and experience that may prove seminal for future basic social servicedevelopment, whether publicly or privately financed.

2.17 To receive funding, organizations will have to meet appraisal criteria, including:demonstrated effectiveness in organizing and delivering community-based services on asubstantial scale with participatory approaches involving both men and women; with practicalplans for replication and expansion; demonstrated need for additional funds; ability to work withgovernmental social sector institutions; and willingness to test different innovations.

2.18 IDA will work with the Government and other donors to see if it would be possiblefor the PDP to assist some of the smaller groups. Issues to be analyzed include adequacy ofavailable funding and accountability. No new institution will be cieated to manage the PDP.Rather, funds will be advanced to the selected agencies that form an agreed part of each annmialprogram, through the Economic Affairs Division in the federal government, to be reimbursedby IDA.

B. The Annual Agreement for 1993/94

2.19 IDA's appraisal process established that annual assessments of each sub-program area feasible way to reach agreement on each year's programs. IDA carried out that process anddid reach agreement with Government on programs for 1993/94. The assessments were madeeasier because the Government, IDA, and other donors could all draw on their considerableexperience and knowledge gained from current or past projects that treat specific sectors in moredepth. During appraisal, IDA agreed with the Government on the framework of the five-yearSocial Action Program, with a focus on the first three years, including specific, monitorableobjectives for achievement. IDA appraised in detail and agreed with Governent on the morespecific annual operational plans only for 1993/94, because operational plans are prepared yearby year. For the three-year framework and the 1993/94 plans, IDA concentrated on ensuring that

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program targets would be ambitious but feasible and realistic given Pakistan's implementationcapacity and financial circumstances. The final agreements for the three-year framework and the1993/94 operational plans scaled back the Goverrnent's original proposals, in some casesconsiderably, but provide for considerable increases in effort and substantial policy reform.

2.20 For 1993194, IDA reached agreement with Government on Operational Plans formost of the sub-programs discussed earlier. These include primary education and primary healthcare in every province and in the federally administered territories. Agreement was also reachedon the national population program and on RWSS in four provinces, AJK, and two of the federalareas. Dialogue on the RWSS sub-programs in FATA is continuing. As outlined above, eachagreement embodies three key elements known collectively as the "Operational Plan" -- an"Implementation Plan of Reforms" with prior actions and monitorable targets for progress oncritical problems; a development (investment) budget fnanced largely by the federal governmentand other donors; and a recurrent budget financed largely by the province. These plans areincluded in the Annual Agreement for 1993/94, along with plans for the monitoring andevaluation program and the PDP described above. The agreed Operational Plans specify prioractions and realistic targets, as well as key reforms to be implemented by the front-lineministries and departments. They were developed by the ministries and departnents concernedthrough consultation with IDA and other donors through the mechanisms outlined earlier. Foreach, IDA conducted an assessment comprising a public expenditure review and policy analysis.After amalgamating the findings from these assessments, IDA and the Government agreed onthe 'core" cross-cutting and sector-specific reforms to be carried out in 1993/94. Many of thesehave already been accomplished. The Government conveyed these fully revised OperationalPlans to IDA at Negotiations under an official letter.

2.21 The costs to IDA and the Govermment of the appraisal and the 1993/94 assessmentwere lower than they would otherwise have been because the appraisal and assessment coulddraw on IDA's work for sector-specific projects in supervision or in preparation. Fortunately,those projects now cover all four SAP sectors in most provinces. Other donors' analysis andproject experience was also utilized. In this way, the appraisal could also ensure that theproposed Project would indeed complement other projects and programs. The cost to IDA andthe Government was reduced further because the MSU and other donors contributed to theappraisal and the 1993/94 assessment.

1993/94 Agreements on Reforms

2.22 For 1993/94, the Government has committed itself to undertake the followingreforms, with specific variations for each sector and province (see Annex on Implementation):

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(a) Prinary Education programs will:

0 improve the functioning and utilization of existing schools through such measures asfilling vacant teacher posts, reducing absenteeism and sharply restricting staff transfers;establishing a separate management structure for primary education; strengtheningmanagement information systems; and, through PDP and other efforts, promotingcommunity and parental involvement.

* improve the quality of education, by expanding teacher training and increasingexpenditure on non-salary recurrent costs from its present low base to supply more itemslike books;

* improve access to education, particularly in rural areas, by building more schools andsiting them according to need based on population criteria;

* increase girls' enrollments (and particularly their retention rates) by recruiting andtraining more female teachers and either instituting co-education or providing more girls'schools;

* expand primary education systems as fast as is practical, increase Governmentsupport, and encourage greater community participation in education.

(b) Primary Health care programs will:

* improve the efficiency and utilization of basic health care by strengtheningmanagement units and planning capability, by rationalizing the structure of different levelsof health care, and by linking programs now run vertically, such as those forcommunicable disease control, more effectively with basic services;

c improve program design by paying more attention to "quality" inputs such asmedicines (improving logistics and increasing expenditures); by giving more priority tocommunicable disease control including immunizations; and by including more familyplanning in basic health care;

* increase access to health care by constructing more basic facilities in those areas stilllacking them (particularly in the more remote areas) and by consulting users more in thedesign and delivery of services;

* increase women's access to health care by recruiting and training more female medicalstaff at various levels of service;

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* increase Government expenditure on and promote community participation in healthcare.

(c) Population programs will:

* improve the operation and utilization of existing services through better planning,management, and logistics and through decentralization of more activities to the provinces;

* sharply expand access to family planning and improve quality of services, particularlyby instituting government-sponsored, community-based outreach programs in rural areasand by helping train health workers in the health departments in clinical as well as non-clinical methods of contraception;

* encourage interest in family planning through information and education programs toincrease public understanding of contraception and its links to maternal and child health;

* increase government expenditures as fast as practical and encourage communityparticipation (for both men and women).

(d) RWSS programs will:

* improve performance and utilization of local RWSS systems and ease financialdependence on the Government and on donors by: improving planning and managementof Government agencies; by encouraging the involvement of communities; and bypromoting community responsibility, particularly for operation and maintenance;

* improve quality and expand access, especially for women, through greater reliance oncommunity-based approaches.

* improve rural sanitation by increasing the share of RWSS budgets devoted tosanitation and promoting community-based approaches, using appropriate, maiaitainableand affordable technology.

Improvements Already Accomplished

2.23 The policy dialogue during the preparation of the proposed SAP Project, togetherwith the dialogue for other projects including the Public Sector Adjustment Loan, produced morethan agreements on reform. Important steps in several difficult areas have already been takenby various levels of Government which are beginning to improve the implementation climate inthe social sectors. Those steps include:

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a. Improvements in Level of Effort and Implementation

* In every province, far better annual operational plans have been developed forprimary education, health, and RWSS, with higher levels of effort and greaterrealism. The national population program plans for providing services at the locallevel are also more solid and practical.

* Total budgets for basic social services are up sharply. There was a large jumpin overall allocation to SAP target services from 1.7% of GDP in 1991/92 to 2.2%of GDP in 1993/94. There was also a significant jump in the proportion of totalgovermnent expenditures devoted to SAP services - from 7% in 1991/92 to over9% in 1993/94. Within that total, the 1993/94 population budget in rupees is over40% higher than the previous year's. Expenditures are also increasing for non-salaryrecurrent costs for key "quality" inputs, including essential medicines, vaccines andbooks. In the health sector, expenditures on non-salary inputs have risen by at least15% and by considerably more in some provinces.

* All governments have agreed to refrain from imposing any ban on recruitmentof field level staff involved in the delivery of SAP services.

* The Government has moved to resolve the long-standing problem of fundingdelays; it has instituted at the federal and provincial levels new mechanisms toprotect SAP funds and ensure timely release to the provinces.

* Steps have been taken to reduce political inte ference in the siting of schoolsand improve the supervision of construction. All provinces have agreed that sitesfor new schools will be selected according to objective criteria based on the locationof the population, and three have already submitted lists of sites selected this way.All provinces have also agreed to hire private fmns to supervise school constructionbetter; two have done so.

* Monitoring and evaluation have been strengthened, particularly in primaryeducation. All provinces have established MIS systems in education with plans forexpansion and upgrading at the district level.

b. Improvements in Program Design

* To improve female access, basic service programs are being designed to recruit,train and post more women teachers and health care providers in rural areas. Thus,for instance, Balochistan has relaxed age and quaificaion requirements for femaleteachers and health workers and will provide an incentive payment of Rs 500 permonth for women working in rural areas; it is also allowing women to fill more

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senior posts in education and health services. NWFP is instituting similar measuresand will increase the number of women teachers from 9,691 in June, 1991 to11,700 by June, 1994. Punjab and Sindh have also adopted policies to expand theirfemale health staffs and to allow women to occupy more senior posts. Both of thoseprovinces are also considering incentives for rural teachers and health workers.Punjab is filling all its posts for female teachers, and all new schools will havefemale/male teachers in the ratio 70/30.

0 The SAP Project has particularly emphasized the need for steps to increasegirls' enrollment in school. Historically girls' and boys' schools have been separate,and often girls had no school. Some parents allow their daughters informally toattend boys' schools (with male teachers), but many do not. Now all provinces areshifting towards co-education. Punjab and NWFP have announced that all schoolswill accept both boys and girls. Where resistance to co-education remains, priorityhas been given to construction of girls' schools, which often become "co-educationalgirls' schools" that boys are also allowed to attend. In Balochistan, for instance,most new schools built in the next three years will be of this type.

* Efforts are also under way to increase the involvement of communities -- andparticularly parents -- in schools and in rural water supply programs. In Balochistan,for instance, parents' committees have been formed to help oversee governmentschools, and this year some 100 communities without schools have already builttheir own and found women teachers who will be paid by Government. Allprovinces and areas are preparing policies and modifying Government agencies tohelp shift responsibility for RWSS to communities, and most are engaged in pilotefforts to do so. Community-level organizations, such as "users' committees", arebeing established and are working with both NGOs and government agencies todevelop more participatory approaches and greater community responsibility. Forinstance, Sindh has adopted a policy requiring community participation in new waterprograms, and NWFP is taking similar steps. In Balochistan, under a new policy,any new RWSS program will involve village organizations and township waterassociations from the design stage onward; communities will cover operation andmaintenance costs of simple rural schemes, with some subsidy to poor communities,and user charges will be established for rural schemes that are more complex andfor towns. Punjab and Sindh have also revised their policies to increase user chargesand are instituting procedures to implement them.

* Greater effort is being made to increase access to family planning servicesthrough the health departments as well as through the national population program.In all provinces, the Government has agreed that basic health workers should betrained in family planning. The training, provided mainly by the Ministry ofPopulation Welfare, is already under way. In Punjab, over 800 health facilities can

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now provide family planning, and the numbers are increasing elsewhere. Tocomplement these efforts and build demand for family planning, the Ministry forPopulation Welfare is instituting and rapidly expanding a community-based outreachprogram meant to provide at least one village-level worker for each of Pakistan's12,000 villages by mid-1997. Recruitment for the first 3,000 villages is to becompleted by July 1994. The MPW is also strengthening its family planning serviceprograms and its information efforts. It is understood that the MPW has decided todecentralize management to the provincial level in a step that will substantiallypromote efficiency as the national population program expands.

c. Stronger Political Commitment

* The SAP has attracted far more political commitment and public attention tosocial services. Pakistan's three recent Governments all gave, and continue to give,high priority to the SAP and have taken steps to promote its implementation. ThePrime Minister of Pakistan, the Prime Minister of A1K and the Chief Ministers havecommunicated to IDA their commitment to the SAP. The Secretary of Planningwill carry the main responsibility for implementing the SAP -- and the SAP Project-- at the federal level. The Chairman, Planning and Development (P&D) Board, orAdditional Chief Secretaries, P&D will be similarly responsible at the provinciallevel. Such commitment must be sustained for the next several years to fulfill thepotential of the SAP. The Project has begun to help in this regard, through itspolicy dialogue and 1993/94 agreements.

X The SAP Project appears to have influence beyond the scale of financing forseveral reasons. First, its support for the basic social services as a whole hassubstantially raised the political ante and encouraged greater attention andwillingness to act from the Government at the provincial as well as the federal level,not least from the financing and planning authorities. Second, its emphasis onannual agreement on operational plans promotes a close and continuing policydialogue and inter-cell competition; advice on perfornance is highly sought. Third,it involves linkages to other IDA projects and to other donors. The SAP dialoguehas also improved the performance of several continuing IDA projects.

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m. COSTS, FINANCING, AND SUSTAINABIFITY

A. Social Action Program Costs

3.1 IDA proposes to support the first three years (1993/94-1995/96) of Pakistan's five-year Social Action Program at this time. The total projected cost of those first three years isequivalent to US$4 billion in current prices, out of a projected total of US$7.7 billion for theentire five-year period. These sums will cover the total cost of delivering expanded socialservices (primary education, primary health, population and mral water supply and sanitation)ntationwide for the period in question, including both recurrent and capital costs.3

3.2 Cost breakdowns by province and sector for the initial year, the first three years,and the full five-year program, as appraised, are summarized in Table 3.1 in both current USdollars and current rupees. Costs were estimated in 1992/93 prices and translated into currentprices, using IDA projections of local inflation and US dollar/rupee exchange rates. No separateprovisions were made for price contingencies.

3 Cost estimates used in this report are taken from the Eighth Five-Year Plan as updatedin the "Social Action Programme: Report to the Pakistan Consortium 1994-95": Febrary,1994. They were discussed with the Government during appraisal and negotiations anddeemed to be adequate, although, in keeping with the framework's emphasis on annualagreements, IDA appraised only the first year's program in detail.

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Table 3.1: Costs of the Social Action Program(Current US$ million and Rs million)

In Current US Dollars (Million) In Current Rupees (Million)Three- Five- Three- Five-

Starting Year Year Starting Year YearYear Program Program Year Program Program

(1993/94) (FY94-96) (FY94-98) (1993/94) (PY94-96) (FY94-98)

PUNJAB 532 1.789 3.457 16.184 57.242 112.832Education 362 1,259 2,434 11,023 40,276 79,455Health 79 260 532 2,412 8,314 17,353RWSS 90 270 491 2,750 8,652 16,024

SINDH 237 782 1.471 7.204 25,031 47,998Education 175 578 1,096 5,335 18,497 35,760Health 36 105 190 1,096 3,345 6,204RWSS 25 100 185 773 3,189 6,034

NWFP 157 L%4 1.156 4.790 19.002 37.729Education 99 378 736 3,024 12,088 24,016Health 19 99 182 579 3,156 5,956RWSS 39 117 238 1,188 3,758 7,757

BALOCHISTAN 116 364 689 3.517 11.659 22.503Education 57 168 315 1,736 5,375 10,280Health 2? 107 218 694 3,436 7,123RWSS 3. 89 156 1,087 2,849 5,100

PROVINCIAL SUB-TOTAL L04i 3.29 6.773 31.695 112.934 221.063Education 694 2,382 4,581 21,117 76,236 149,512Health 157 570 1,122 4,781 18,250 36,636RWSS 190 576 1,070 5,798 18,447 34,915

AZAD JAMMU & KASHMIR 28 104 207 837 3,319 6,772Education 17 65 130 524 2,076 4,236Health 5 20 41 164 652 1,330RWSS 5 18 37 149 591 1,207

FEDERAL SUB-TOTAL 88 387 751 2.667 12.377 24.521Other Federal Areas 36 137 275 1,108 4,393 8,964

Education 19 75 166 563 2,522 5,408Health 7 26 49 201 845 1,608RWSS 11 32 60 341 1,027 1,947

Population 35 173 350 1,054 5,533 11,425Communicable Disease Control 16 66 116 475 2,099 3,773Participatory Development Program 0 5 5 0 160 163SAP Monitoring & Evaluation 1 6 6 30 192 196

NATIONAL TOTAL 1156 4.020 7.731 35.200 128.630 22.356

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B. Sources of Funding for the Project - the First Three Years

3.3 Government. Table 3.2 outlines the funding plan for the first three years of theSAP. Of the total of US$4 billion required, the Government will provide US$3.05 billion. Ithas been agreed that the proportion of incremental costs provided by the Government will riseeach year, from 46% in 1993/94 to 59% by 1995/96 (and 69% by 1997/98).

3.4 On-going aid projects. In addition, the Govermnent will use $552 million fromexisting and expected aid, leaving a projected three-year gap of $418 million.

3.5 The SAP Project and Associated Donors. IDA has worked in unusually closecooperation with other donors to help Pakistan cover the fnancing gap arising from the agreedprogram. The MSU has helped provide continuous coordination for donors working inpartnership. For this part, as shown in Table 3.2, IDA proposes to fill a part of this gap witha multi-sector investment and maintenance credit of US$200 million -- on the understanding thatagreements must be reached, in each sub-program each fiscal year before funds can bedisbursed. Other donors -- in close coordination with IDA as well as the Government ofPakistan -- will participate under the same arrangements. Thus, the Asian Development Bankhas pledged US$100 million and the Government of the Netherlands, $13 million, to support theSAP program.

Table 3.2: Sources of Funding for the SAP in FY93/94-95/96(Current US$ million)

Total %

Government's internal resources 3,050 75.9Existing/expected aid 552 13.7Program Assistance 313

IDA (SAP Project) 200 5.0ADB 100 2.5Government of the Netherlands 13 0.3

Additional Assistance to be mobilizedPossible Sources

Other Sources, including IDA/ADB1Netherlands 105 2.6

Total 4,020 100.0

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3.6 Pakistan is negotiating with other donors to raise the additional $105 million neededto implement the total program as agreed. The detailed expenditure will be agreed year-by-yearand may differ somewhat from the indicated amount. The first two years of the project periodare fully funded. IDA will work with other donors, including ADB and the Netherlands, andthe Govermnent to close the remaining gap for the third year, as warranted.

3.7 Sustainability of funding. Table 3.3 presents ratios of SAP expenditures to GDPand to total Government expenditures; aiid ratios of Govermnent expenditures on the SAP toGDP and to total Government expenditures. As agreed under this project, SAP expenditures,and the Government's contributions to SAP expenditures, rise steadily as a percent of GDP.4

SAP expenditures also take a rising share of total Government expenditures, showing theintended rise in level of effort on these crucial and basic social services; this proportion risesfrom less than 9% in 1993/94 to over 12% by 1997/98. The Government's own contributionto total SAP expenditures rises over time, from three-quarters initially to 79% of the total by1997/98. Finally the share of incremental costs contributed by increases in the Governmenteffort rises quite rapidly, from 46%in 1993/94 to 69% by the end of the period. While donorshave contributed a substantial share of the increased costs at the outset of the SAP, this sharerapidly falls and is modest by the end of the five year period. The ending level of expenditureson SAP services is still lower than the levels routinely spent on these services in otherdeveloping countries of comparable income level; this level of effort should be within thecapacity of the Government to sustain and indeed increase in the future.

Table 3.3 SAP Expenditures as a Percent of other Variables. FY93/94-FY97/98

1993/94 1994/95 1995/96 1996/97 1997/98

SAP Total Expenditure --% of GDP 2.2 2.4 2.4 2.5 2.6

SAP Government Expenditure --% of GDP 1.6 1.7 1.8 1.8 1.9

SAP Total Expenditure --% of Government Expenditure 9.1 10.1 10.8 11.5 12.3

SAP Government Expenditure% of SAP Expenditure 76 75 76 76 79

Change in Government SAP Expenditureas a % change in Total 46 50 59 60 69

4 As a fail-safe, as expressed in the legal documents, the Government has agreed in no casewill the SAP expenditures fall below 2.05% of GDP in 1993/94, 2.15%in 1994/95 and 2.3%in 1995/96. The higher targets discussed above are those adopted by the Government as itstargets to achieve.

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C. Project Financing

3.8 The SAP Project will help support:

(a) Provincial grograms covering primary education, primary health care, and RWSSin each of the four provinces: Total cost $3,529 milli-n (88%), of which IDA $118million; and

(b) Federal programs covering:

(i) Basic services in AJK and the federally administered areas and territories(including the Capital Territory of Islamabad). Total cost $241 million (6%),of which IDA $31 million;

(ii) The national population program: Total cost $175 million (4%), of which IDA$31 million;

(iii) The Communicable Disease Control Program: total Cost $66 million (2%)ofwhich IDA $13 million;

(iv) A Participatory Development Program (PDP) to promote communityparticipation and innovation through NGOs: Total initial cost $5 million,fnanced two-thirds by IDA and one-third by ADB;

(v) A sub-program to strengthen Government capacity to undertake monitoringand evaluation: Total cost $6 million, financed two-thirds by IDA and one-third by ADB.

3.9 Overall, the Project will cover 5% of total expenditures under the SAP for the firstthree years, or about 48% of the gap between projected costs and the total available fromGovernment and on-going aid projects. Table 3.4 provides an illustrative breakdown by provinceand sector, although actual IDA funding on any given sub-program each year will be determinedby a formula based on the size of approved operational plans and on the availability of otherresources.

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Table 3.4 Illustrative SAP Funding for 1993/94-1995/96(Current US$ Million)

Three- Disburse SAP Expend. IDAYear ment from Net of Government Funding Funding

Program Regular Regular Contribu- Gap (US$)(FY94-96) Projects Projects tions

PUNJAB 1,789 177 1,612 1,494 118 50Education 1,259 140 1,119 1,056 63 27Health 260 37 223 202 21 9RWSS 270 0 270 236 34 14

SINDH 782 93 689 631 58 25Education 577 66 511 490 21 9Health 105 15 90 72 18 8RWSS 100 12 88 69 19 8

NWFP 594 94 500 432 68 29Education 378 61 317 272 45 19Health 99 21 78 55 23 10RWSS 117 12 105 105 0 0

BALOCHISTAN 364 140 224 189 35 15Education 168 63 105 90 15 6Health 107 14 93 74 19 8RWSS 89 63 26 26 0 0

PROVINCIAL SUB-TOTAL 3,529 504 3025 2,747 278 118Education 2,382 330 2,052 1,908 144 61Health 571 87 484 403 81 34RWSS 576 87 489 436 53 22

AZAD JAMMU & KASHMIR 104 10 94 85 9 9Education 65 1 64 59 6 6Health 20 0 20 18 2 2RWSS 19 9 10 8 2 2

FEDERAL SUB-TOTAL 387 38 349 219 130 73Other Federal Areas 137 0 137 115 22 22

Education 79 0 79 65 14 14Health 26 0 25 18 8 8RWSS 32 0 32 32 0 0

Population 173 19 154 85 69 31Communicable DiseaseControl 66 19 47 18 29 13Participatory Develop-ment Program 5 0 5 0 5 3

SAP Monitoring & Evaluation 6 0 6 0 6 4

NATIONAL TOTAL 4,020 552 3,468 3,050 418 200

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3.10 Assuming good performance and agreement on operational plans, IDA funding foreach sector in any given province will be calculated as follows:

(a) Total cost of agreed one-year program,

(b) Less disbursements from on-going or expected projects, equals

(c) The amount to be financed by Government and SAP donors,

(d) Less the agreed Government contribution (which rises annually as a proportion ofincremental funds), equals

(e) Net funding gap, or "SAP gap,' to be filled by IDA's proposed SAP project andother donors.

3.11 The total cost of the agreed one-year program will reflect performance in currentprojects. If performance is seriously deficient, the agreed program will be more modest or -- ifperformance is very poor -- no agreement will be reached. If new donor aid is receivedunexpectedly, the "SAP gap" wiil be that much smaller, because project funds take precedence:the SAP gap funding is meant to be funding of last resort and not a softer option than projectfunds would provide. The proportion of each province's SAP program to be filled by IDA anddonors is item (e), the SAP gap, divided by item (c), which is the total cost net of donorcontributions from on-going projects. (These contributions are subtracted in order to avoidbasing donor contributions to the SAP gap in part on other donor contributions.) IDA's shareis equivalent to its proportion of total donor contributions to the SAP gap. IDA's percentageshare would be the same for all sectors within a given province, but would vary amongprovinces, depending on the amount of other resources available.5

3.12 Eligibility to claim IDA funds will be determined annually, on the basis ofperformance in the previous year and the agreed program for the coming year. During the firstyear, the 1993/94 Operational Plans of expenditures and policy reform were reviewed and the

5 An illustrative numerical example may help clarify this. Using the estimates inTable 3.4, and taking Punjab as an example, the total costs are estimated at $1,789 millionfor three years; disbursements for on-going (and anticipated) projects are expected to be $177million, leaving a funding need of $1,612 million. Of this the Govermnent of Punjab istargeted to provide $1,494 million leaving $118 million to be funded by donors. IDA'sshare of this would be $50 million, or 3.1% of the $1,612 million needed. So, IDA woulddisburse 3.1 % of total expenditures (net of those already financed by other projects) on eacheligible sub-program in the Punjab's SAP. The percentage would vary each year, dependingon other donors and the year-by-year program.

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up front actions assessed in each sector and province. Sub-programs whose actions and planswarranted support were determined eligible and IDA funds are allocated to reimburse the agreedportion of the agreed expenditures of these sub-programs. These reimbursements will continuethroughout the year. Slippages would be monitored and discussed during the monitoring andsupervision of the project and remedial measures agreed upon.

3.13 In the next annual review of the first year's performance and of the next year'sprogram (1994195), any problems in implementation would be assessed and rectified, dependingon their nature. Slow implementation of the agreed program would lead to lower estimates ofimplementation capacity, hence lower programs for the next year and a correspondingly lowergap for donor funding (given the fixed nature of the agreed government contribution). Policyslippages would need to be examined for the cause. If the problem were that the targets wereelusive despite good-faith effort, perhaps because the measures agreed turned out to beineffective, new solutions would need to be identified to make progress toward the sameobjective.

3.14 If it were not possible to reach agreement on the scope of the expenditure program,or the policy measures to be introduced, or if compliance were not credible, the sub-programwould not become eligible for reimbursement for the coming year. Therefore there would beno IDA funds allocated for the ineligible sub-programs.

3.15 The funding mechanism works to use IDA funds only to reimburse expenditures foreligible sub-programs and not to fund ineligible programs. When IDA funds are exhausted, theSAP project will close. This sets up incentives for each sub-program to become eligible,maintain that eligibility, and implement that sub-program as agreed. Slow implementation, orpolicy slippage leading to ineligibility, reduce or withhold donor funds for that sub-program andmake these funds available for eligible sub-programs.

D. Retroactive Financing

3.16 The Government has proposed disbursement of up to $40 million (20% of the creditamount) to reimburse expenditures under the Project incurred after July, 1993 and up to creditsigning, which is expected in April, 1994, at the earliest. It was recommended that this proposalbe accepted, for a number of reasons:

(a) IDA has been deeply involved in the design of the SAP since 1991 onward, andreached tentative agreement on the 1993/94 SAP during the pre-appraisal missionin March/April, 1993. Agreement was also reached on almost all sub-programsunder the SAP Project. Overall levels of expenditures were appraised on the basisof a financing plan that included expected funding from IDA and other donors.

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(b) IDA delayed the appraisal of the project during the period of an interim government(April to October, 1993) to ensure the new federal and provincial governments werethoroughly committed to the SAP.

(c) The agreed program started in July 1993, which means that at least nine months ofthe first year's fiscal year will have passed by the time of signing. Furthermore,up-front actions for the first year were undertaken by the Government even earlier,in accordance with the agreements reached with IDA. Since the SAP includes theGovernment's entire program of primary education, primary health, population, andrural water supply and sanitation, expenditures under the program could not bepostponed until approval by IDA's Board.

(d) Under the 1993/94 agreement, the Government will be entitled to seekreimbursement for a portion of expenditures in eligible sub-programs -- i.e., thosewhere agreement on Operational Plans has been reached. The expenditures eligiblefor reimbursements under the SAP Project would be the same as those for the SAPoverall-- recurrent costs for delivering the social services as well as capital costs forincreasing capacity over the longer run. By the time of signing, it is estimated thatexpenditures for eligible sub-programs would suffice to claim over $40 million.

(e) Expenditures eligible for retroactive financing will be subject to the sameprocurement, disbursement, and monitoring procedures as for the SAP Projectgenerally.

(f) To maintain the momentum achieved through the greater levels of spending onsocial services, it is important that the IDA portion of the financing plan beavailable for the entire period, including the three-quarters of the first year whichwill have occurred before credit signing.

E. Disbursement

3.17 To ensure that Government commitment is translated into increased allocation,timely release, and subsequent spending of funds in the social sectors, the project wouldreimburse only against actual expenditures and on the basis of actions already taken. Simpleprocedures have been agreed with govermnent Accounting General Offices, finance departmentsand line departments which would allow the identification and reporting of all SAP expenditureson a monthly basis to allow disbursement requests to be submitted promptly. (See Annex onImplementation).

3.18 In practice, the project would reimburse a proportion of development and non-development expenditures incurred in the sectors of primary education, primary health,population welfare, and rural water supply and sanitation, excluding those already funded under

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on-going externally funded projects.

3.19 Expenditures eligible for reimbursement would be identified in detail by federal andprovincial governments and agreed with IDA. These will include all expenses incurred fordelivering the basic services, including salaries, operating expenses, supplies, goods, civil worksand maintenance expenses. Expenditures fuianced under other donor-aided projects will bereported separately and will not be part of expenditures reported as eligible for reimbursementunder this project. A functional and object classification for budgeting and accounting purposesis being introduced to distinguish the fiancial reporting of SAP-related expenditures, from thatof non-SAP expenditures. This would be done by reference to (i) the existing non-developmentfunctional and object classification of sector expenditures; and (ii) the individual developmentschemes comprising the SAP. Financial reports would be derived from the monthly CivilAccounts, Abstract of Accounts, and detail of expenditures on ADP schemes, prepared by theAccountant General.

3.20 Reimbursement would be claimed at intervals determined by the capacity of theGovernment to generate the claims. Claims would be made separately for each SAP sector, ineach province or federal territory, in the form of a Statement of Expenditure (SOE) specifyingcategories (civil works, goods, operating costs, etc.) and total eligible expenditure. Each SOEwould be supported by a financial statement, retained by the borrower, separating recurrent anddevelopment expenditure by function and object, together with the respective civil accounts andsummary of ADP-scheme expenditure. The financial statement would specify the categoriesof expenditures eligible for donor financing - such as civil works, goods, and operating costs -- and would not be applied to ineligible items, such as land acquisition and taxes. For theParticipatory Development Program, funds will be disbursed through a special account to beopened by the federal Govermment with an anticipated allocation of $500,000.

3.21 The claim for reimbursement would be submitted to the Federal SAP Secretariat,under the authority of the Additional Chief Secrtary, P&D. This Secretariat would certify thatthe sector met the eligibility crieria before forw'arding the SOE to IDA for reimbursement. Inthe case of the monitoring and evaluation component, disbursements would be made againstexpenditures incurred after July 1, 1993 on eligible consulting services and operating costs,forwarded to the Federal SAP Secretariat and approved by IDA. The consulting services wiUbe used for prcurement monitoring and other assistance needed for monitoring and evaluation.Operating costs will include the costs incurred to strengthen the SAP Secretariat and the SAPmonitoring cells in the provinces, AJK and the federl areas; audits; and the costs of carryingout the household survey. These costs will include equipment and training needed instrengthening the Secretariat and monitoring cells; and the salaries subsistence, transport andother related costs of incremental staff needed to carry out the survey; and other additionalequipment required for the survey.

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J.22 The credit is expected to disburse over a period of three years in conformity withthe schedule in table 3.5. These allocations are based only on expected actual disbursements toreimburse expenditures in the first year of the Project. The $140 million listed as "unallocated'would be disbursed on expenditure incurred in the second and third years. These allocationswould be made upon agreement regarding each subsequent year's implementation plan andfinancing requirements for the various sub-programs.

Table 3.5: Allocatior. of IDA Funds(US$ Million)

Category Amount

PROVINCIAL PROGRAM 46.1Punjab 23.9Sindh 9.6NWFP 5.1Balochistan 7.5

FEDERAL PROGRAM (including Federal Areas) 13.9Federal Ministries and Areas 9.0Population 4.2SAP Monitoring & Evaluation 0.7

UNALLOCATED (to be allocated in FY94-95) 140.0

NATIONAL TOTAL 200.0

3.23 It should be noted that these allocations are, on the one hand, "front loaded, " in thesense that IDA (along with the ADB and the Government of the Netherlands) would finance agreater proportion of the expenditure gap in the first year because it is the first donor to makeits funds available; the proportion supplied by fincing from other donors would be higher inlater years. On the other hand, the disbursements are adjusted downward tc allow for theprobability of a slow start during the first year and the chance that some sub-programs will beineligible for reimbursement for part of the period. The net effect is that disbursement toreimburse a part of eligible expenditures made in the first year are estimated at $60 million ofIDA resources.

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F. Procurement

3.24 In a program of this nature it is extremely difficult to forecast the total amount ofprocurement at the outset and to categorize it into civil works, goods, and services. Mostprocurement including all civil works is expected to involve small contracts over widelydispersed geographical areas suitable only for local competitive bidding and prudent shopping.Some procurement, however, will be suitable for international competitive bidding which willbe based on the Bank's Standard Bidding Documents. This will include vehicles, chemicals,contraceptives, some pharmaceutical products and consulting contracts. The Government mayrequest UNICEF and UNFPA to carry out some of this procurement for it, under arrangementssatisfactory to IDA.

3.25 During appraisal, IDA reviewed the Government's local competitive biddingprocedures, already in use in ongoing IDA funded projects, and found them to be in compliancewith IDA guidelines. There have been some minor shortcomings identified in their applicationof the rules/procedures. This is partly due to frequent staff rotation, lack of training inprocurement procedures, and inadequate monitoring. The Project, therefore, makes specialprovision for training of staff involved in procurement and monitoring procurement practices.The minor shortcomings are detailed in the annex on Implementation and implementing agencieshave been advised to ensure that their staff follow agreed procedures.

3.26 To confirm that procurement is carried out in an efficient and economical manner,the Government has agreed to engage consultants to oversee and monitor the procurementprocess. All consultants will be selected in accordance with IDA guidelines to include prior IDAreview of the selection process of all contracts costing the equivalent of $100,000 or more.

3.27 To assist the implementing agencies in performing their procurement function inaccordance with agreed procedures, the consultants will carry out a review of the first fivecontracts prior to award, and the prior review of all contracts above $50,000. In addition, theconsultants will also perforrrm ex-post review of the remaining procurement documents on asample basis. IDA will petform a prior review of all procurement requirements which will beconducted using ICB procedures as well as all procurement documents for contracts costing theequivalent of $200,000 or more.

3.28 All civil works and goods, vaccines, pesticides and equipment to be financed out ofproceeds of the project estimated to cost the equivalent of $300,000 or less per contract, up toan aggregate amount not to exceed $5 million for vaccines, medicines, supplies and pesticidesand $1 million for equipment, may be procured under contracts awarded on the basis ofcompetitive bidding advertised locally in accordance with procedures satisfactory to theAssociation. Goods, vaccines, medicines, supplies, pesticides and equipment to be financed outof proceeds of the project estimated to cost $25,000 or less per contract, up to an aggregateamount not to exceed the equivalent of $500,000 per agency may be procured on the basis of

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prudent shopping.

G. Accounts, Audit and Reporting

3.29 Accounts will be maintained by the line departnents in accordance with sound andlocally recognized accounting principles and practices satisfactory to IDA. The AccountantGenerals will collate the SOEs and certify their eligibility for funding under the progrdm. Theaccounts, SOEs, and documentation relative to procurement will be audited at the end of eachyear by independent auditor acceptable to IDA. The audit reports will be submitted to IDA nolater than nine months following the end of year the audits refer to. The reports will includean assessment of the adequacy of the accounting system and internal financial control, thereliability of the SOEs as a basis for credit disbursements, and compliance with agreed financialarrangements.

3.30 The Federal SAP Secretariat will prepare and submit quarterly reports to IDA onprogress in program implementation. The report will include an assessment of the performanceof each sector/province in implementing the agreed program and the reform agenda. It will alsoinclude an assessment of the flow and use of funds.

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IV. IMPLEMENTATION AND MONITORING

A. Implementation Arrangements

Overall Responsibility

4.1 The Government of Pakistan (GOP), and its political sub-units, are the implementingagencies of the Social Action Program, with GOP's federal level Planning Division acting as thesponsoring and coordinating agency. The Secretary of Planning has overall responsibility forthe national SAP and for the SAP Project. He is assisted by the Federal SAP Secretariat, a unitin the Planning Division. In addition to these coordinating and sponsoring roles, the PlanningDivision has direct responsibility for implementing two project components; the ParticipatoryDevelopment Program (PDP) and the monitoring and evaluation program (see below). A SAPNational Steering Committee and four Provincial SAP Coordinating Committees, will meetquarterly -- or more often if required -- to provide impetus and direction and assess progress.

4.2 Provincial/Territory Sub-Programs. The provincial/territory (and AJK) govermmentsare responsible for implementing primary education, primary health care, population and ruralwater supply and sanitation -- 94% of the SAP -- through their established sectoral linedepartments. Their departments of Finance and of Planning and Development (P&D) haveresponsibilities for financial control and coordination. These sub-programs are supported byOperational Plans that include expenditure and implementation plans.

4.3 Federal Sub-Programs and National Program. The Ministry of Population Welfarehas overall responsibility for the population program nationwide, along with responsibility forproviding guidance to provincial-level population welfare and health departments. Thepopulation sub-program is also supported by an operational plan. The federal ministries ofHealth and Education also are responsible for implementing some national programs, such asthe Ministry of Health's communicable disease control program and the Ministry of Education'sNational Education Management Information System.

Inplementation Agreements between GOP and the Implementing Agencies

4.4 Before the SAP started, the GOP asked the agencies responsible for deliveringPakistan's basic social services in the provincial and territory governments to formulate aprogram to improve the quality of, and enhance the capacity to deliver, these services over theperiod of the Eighth Plan, 1993/94-1997/98. The GOP also asked IDA and other donors to helpformulate these programs. After many drafts and reviews, programs were elaborated for thefive-year period as a whole and will be detailed in annual SAP Operational Plans. The first, for1993/94, has been completed.

4.5 The annual Operational Plans consist of three elements: (i) an "implementation planof reforms", which details the steps (prior actions) taken before the outset of the period and thefollow-up steps to be taken to overcome identified constraints and improve delivery of services;

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(ii) a non-development budget (mainly the budget for recurrent costs) sufficient to improve thequality of the services delivered; and (iii) a development budget (mainly the capital costs ofphysical expansion but also important non-capital costs, such as training).

4.6 The Operational Plans for 1993/94 prepared by the implementing agencies wereapproved by the Government as a basis for funding, while the five-year programs werereviewed and agreed at the administrative level. Although the Eighth Plan as a whole has yetto be approved at the political level due to the transition in governments during 1993, the SocialAction Program, because of its priority, was approved in total and for the first year by theNational Economic Council (NEC), the competent body. The first year's Government financingfor the SAP was protected from diversion to other uses by making it non-fungible with non-SAPresources.

The Planning, Approval, Implementation and Monitoring Cycle

4.7 Implementation of the SAP occurs on a fixed annual cycle, geared to the annualbudgeting and planning processes of the Govermnent and the implementing agencies. Provincialassemblies approve the annual budget and annual development plan during June of each year,before the beginning of the Government's fiscal year on July 1. To prepare for this, theimplementing agencies involved, with assistance from the Multi-Donor Support Unit (see below),begin formulating their Operational Plans for each sub-program by December of the previousyear; they work on them through the Spring before submitting them for approval by theirgovernments.

4.8 In March-April of each year, before the Operational Plans are formally approved,they will be absessed by IDA and associated donors. An IDA/donor mission will visit, reviewthe plans, and leave behind its written recommendations for consideration of the governmentsinvolved. These recommendations will cover the non-development recurrent budget, thedevelopment capital budget, and the next steps to be taken on the implementation reformsunderway in each target sector.

4.9 The provincial and federal governments will then finalize their Operational Plans(including budgets and implementation plans for reforms) and set in motion the reforms toprepare for the coming fiscal year. The plans (budget and reforms) will be approved by theadministration, government and assemblies of elected representatives before July 1. In parallelwith these preparations, the Government, in early Spring each year, will communicate the broadoutlines of the SAP to the implementing agencies, and indicate the level of Governmentdevelopment loans that would be available to help carry it out. Once the plans, budgets, andup-front reform measures are approved by the Goverrnent and the provincial/territoryassemblies, IDA and the other donors supporting the SAP will check to make sure they stillapprove them. At the same time, eligibility for IDA/donor support of each sub-program willbe assessed. Sub-programs whose Operational Plans were agreed, and where the required up-front measures were in place, would be eligible for donor reimbursement of a part of programexpenditures. Sub-programs that were not in agreement, or which had not complied sufficiently

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with the requirements for prior action, would be the focus of corrective efforts, looking towardeventual agreement, if possible. Eligible sub-programs would be allocated funds forreimbursement; those not yet eligible would be allocated funds only when they became eligible.

4.10 The implementing agencies will carry out the programs as agreed. The federalGovernment will provide its share of the SAP financing in advance, each quarter, to theprovincial and territory finance departmnents, which would in turn release the funds forexpenditure in a timely way so that the agreed programs proceed smoothly. New procedureshave been established to ensure timely release of funds. The governments will prepare the basisfor donor reimbursement for the eligible sectors (Statements of Expenditure, or SOEs) andforward them to the donors, who will check for eligibility and reimburse the agreed percentageof eligible expenditures.

4.11 From the outset of the fiscal year, the SAP monitoring arrangements described insection B, below, would be in operation. The first quarterly meeting of SAP monitoringcommittees (at both provincial/territory and federal levels) would take place in early October,with subsequent meetings around the end of December, March and June. Discussion would bebased on brief SAP monitoring reports prepared, respectively, by the P&D departments in theprovinces and by the Planning Division at the federal level. The reports would also beforwarded to donors for review, along with minutes of the meetings.

4.12 After the government monitoring committees report their findings, they would beconsidered at quarterly SAP meetings organized by the MSU to inform interested donors. Thepurposes of these meetings are: (i) to review progress under the SAP and disseminateinformation of any kind related to the program, including progress/problems with other donor-aided projects in the target sectors; (ii) to provide a formal mechanism for donors (whetherparticipating in the funding of the SAP or not) to raise issues of concern; and (iii) to provide aforum for advice from the larger donor community on the future implementation of the SAPitself.

Supervision by IDA

4.13 The SAP Project will require intensive supervision by IDA. Fortunately, the netincrease in the resources required for this task is less than it would otherwise be, because relatedIDA-supported operations already exist in virtually every sub-program of the SAP -- primaryeducation and primary health in all four provinces; rural water supply and sanitation in twoprovinces and the AJK; and, prospectively, the population program. This permits supervisionefforts to be combined for greater effectiveness. A similar situation exists for the AsianDevelopment Bank, the second largest SAP donor.

4.14 As noted earlier, IDA would need to start its supervision cycle with a March/Aprilmission to review the draft Operational Plans being prepared for the coming fiscal year. Thiswould be the major supervision mission of the annual cycle and would involve a review of eachgovernment's and each sector's budgets, and implementation reform proposals, as well as a

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review of monitoring over the previous three quarters (i.e., since the beginning of the fiscalyear). Required reviews of on-going IDA-supported investment projects would be includedunder the umbrella of this SAP mission, since the mission member would possibly include thesame people who would review the sector-specific projects.

4.15 A second supervision mission would be a brief review of the Operational Plans(budgets and reform measures). It would take place early in the fiscal year (i.e., early July).This mission would determine eligibility of individual sub-programs for IDA funding and wouldleave a record of recommendations on what it would take to make deficient programs eligible.The second mission would also review the governments' monitoring of progress and the resultsof the quarterly SAP monitoring committees.

4.16 The third and final supervision mission of the annual cycle would probably takeplace in. December or January, to review mid-year progress and contribute IDA's views onissues to be addressed in preparation for the coming year's Operational Plans. This missionwould also check on the governments' monitoring progress.

The Role of the Multi-Donor Support Unit (MSU)

4.17 The MSU has an important role to play throughout the implementation process.Early on, in preparation for the first year, it organized technical task forces -- one for each ofthe target social sectors - to identify issues relating to policy reform measures, budgets andplanning which, in the view of the various donors, should be addressed. The MSU conveyedthese issues ("Guidelines") to the provincial and territorial governments, for their informationand use in preparing the Operational Plans. The MSU will continue this process in future years,forwarding its recommendations in December and January. It will also coordinate -- and, as alast resort, provide -- assistance to help the implementing agencies prepare their OperationalPlans.

4.18 In addition, the MSU will give selective assistance to governments to help themimprove their own monitoring and implementation. It would ensure that issues identified bydonors for the coming year's SAP are understood by the implementing agencies; thatgovernments receive any technical assistance needed to prepare the draft Operational Plans intime for the March/April review mission; and that the information needed from the actualbudgets and plans, as approved by the assemblies, is presented in simplified formats for theJune/July mission. The MSU would also keep in touch on a continuous basis with themonitoring and evaluation undertaken by governmnents and assist them as needed to improve thNoperation of that system. It would ensure that the monitoring reports and minutes of thequarterly monitoring committee meetings reach the concerned donors, including IDA, and itwould stand ready to help governments to organize any training needed for operating theprocurement and disbursement systems for IDA and the other donors involved.

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The hnplementation Plan of Reforms

4.19 As part of their Operational Plans, all provincial and territorial sub-programs, andthe national population program, have agreed implem-entation plans with reforms and priordetails. These plans are prepared annually for the coming fiscal year, and are agreed with IDAstaff and approved by the governments involved. For simplicity and ease of updating, they arepresented in a matrix form which includes:

(a) identification of the policy issues;

(b) notation of up-front actions (to be) taken;

(c) identification of follow-up actions to be taken during the fiscal year in question;

(d) notification of the agency responsible for taking the needed action;

(e) (quantitative) indicators of the concrete steps/reforms to be taken during the fiscalyear;

(f) (quantitative and time-bound) indicators of outputs or achievements; and

(g) specification of the assumptions and/or riLks underlying the actions (to be) taken.

4.20 The Operational Plans are prepared in detail for each sub-program and are too bulkyto append to this report. They formally will be conveyed to IDA under cover of an officialletter; and they will form part of the SAP project file. This has already happened for the firstyear, 1993/94. Summaries of key reforms for 1993/94, distinguishing between up-front andfollow-up actions, are presented in the Annex on Implementation.

B. Monitoring and Evaluation (M&E)

4.21 Given the comprehensive nature of the SAP and past weaknesses in implementation,transparent and implementation-oriented monitoring systems are crucial to the success of theSAP and of the proposed SAP Project. An effective monitoring and evaluation system is requiredto: (i) assess progress in implementation of the annual work programs under the SAP; (ii)verify the adoption and implementation of the agreed policy and institutional measures in supportof the SAP; and (iii) evaluate the impact of the SAP on the quality of social services and theextent of their accessibility to the population at large. Such a monitoring system, to be managedby the provincial planning departments and coordinated by the Federal SAP Secretariat is inplace. Funding to help ensure that the governments have the capacity to implement this systemis an important element of the Project. IDA appraised these arrangements and found themsatisfactory. (See Monitoring and Evaluation below).

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Monitoring of SAP Inputs

4.22 The existing M&E system needs to be organizationally streamlined and its capacityenhanced to meet the need for systematic feedback on SAP performance. A strengthened systemwould provide the basis for tracking progress in SAP implementation and for identifying andremoving constraints to the achievement of SAP goals at various levels of decision making(including the local level) as follows:

(a) At the level of the line departments, the monitoring system would: (i) provideinformation on performance against targets in terms of financial expenditures,physical implementation, and perfonnance indicators (e.g., key inputs such as thenumber of vacancies filled, particularly for female teachers of the agreed workprogram, and (ii) pinpoint bottlenecks and provide the information for selecting thenecessary corrective actions. The information generated by the line departmentswould form the basis for quarterly reports for use by managers/decisionmnakers inthe line departments and would provide an input for more aggregated monitoring bythe P&D and Finance departments. In some sectors such as education, welldeveloped provincial Education Management Information Systems already exist andwill be strengthened under SAP.

(b) At the level of the P&D and Finance departments, the monitoring system wouldenable these departments to provide effective and timely support to the linedepartmnents by providing the basis for: (i) addressing any constraints that cannot beaddressed within the sphere of responsibility and authority of the line departments;and (ii) assisting the line departments in initiating the necessary actions in caseswhere program performance lags behind program targets.

(c) At the level of the provincial apex of the government, the monitoring system wouldprovide the basis for: (i) coordinating cross-sector interventions and facilitatingcross-sector flows of experience; (ii) assessing the effectiveness of the SAP inhelping to meet provincial social objectives; and (iii) adjusting the provincial policyinstruments or resource allocation, as needed, to facilitate effective implementationof the SAP.

(d) At the federal level, the monitoring system would keep the national authoritiesinformed about the effectiveness and adequacy of SAP-related interventions bothwithin and across provinces and would provide the basis for any decisions/actionsin support of the national program. Moreover it would provide an aggregatednational picture of progress under the SAP. The Government will participate withIDA and other donors in quarterly review of the SAP.

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Monitoring of SAP Impacts

4.23 In order to complement assistance for monitoring program inputs and processmeasures, the SAP Project will also finance or strengthen an existing system of data collectionand analysis for monitoring outcomes (such as girls' enrollment rates) in relation to inputs (suchas recruitment of female teachers) in SAP sectors and evaluating the effectiveness of variousSAP program initiatives. Various studies will be supported. At the core of the effort are flexible,broad-based surveys at household, community, and facility (e.g., schools, health centers) levelswhich will be implemented under the aegis of the Federal Bureau of Statistics during the EighthPlan. Capacity for monitoring and evaluation will be developed under the Federal SAPSecretariat, with support from the MSU and IDA. The overall cost of the household surveys andanalysis over three years is estimated to be US$3 million.

4.24 The system will also help pinpoint the actual beneficiaries under the SAP anddetermine how they benefit. For example, it is important to know whether the SAP leads toimprovements in access to basic services for the poor and other disadvantaged socio-economicgioups, whether consumption of services increases, and whether increased access and use isreflected in improvements in outcomes indicators (e.g., higher primary school enrollments,better nutrition. higher immunization rates). Given the well-known gaps in social indicators formales and females in Pakistan, it is also important to see how SAP initiatives affect females. Inaddition, careful monitoring is important for developing the necessary base of information fordeLermining whether pilot schemes developed under the SAP are worthy of replication orscaling-up.

4.25 Examples of the kinds of questions that will be addressed include:

- In primary education. What measures work most effectively to increase schoolenrollments for girls? How important are other factors affecting demand forservices, such as parental education, family size, income levels, and culturalfactors?

- In population. What structure of family planning services will most increase useof contraceptives in rural areas? What kinds of contraceptives do most peopleprefer'? How does education affect contraceptive use or family size?

- Regarding cost recovery. What will households and communities pay for variousservices? What happens to use patterns when user fees are introduced?

- Regarding non-governmental activity . How can NGOs and communityorganizations help provide basic social services?

4.26 The system of data collection. Much of the necessary information will be collectedby the Federal Bureau of Statistics under an extension of the Pakistan Integrated HouseholdSurvey (PIHS) project, which was begun in 1988 and supported by IDA, UNDP, and USAID.

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The first round of the PIHS project, completed in 1991, covered 4,800 households in 300 urbanand rural communities. A comprehensive questionnaire was developed for the first year of fieldwork, including core modules on the demographic structure of households, consumptionexpenditures, and detailed income accounting, as well as special modules measuring labor-forceparticipation, unemployment, women's time use, infrastructure, public services, dwelling-unitcharacteristics, education and training, health status and health care utilization, infant-feedingpractices, nutrition outcomes, household energy use, transfers and remittances, migration andcredit. Community, school, health-facility, and price surveys were also administered in the 300sample communities. Thus, the first round of the PIHS provides a solid baseline of informationon the social and economic status of households and communities throughout Pakistan.

4.27 For the present Project, it is proposed to increase the sample size of the corehousehold survey to about 11,000 households residing in 900 urban and rural communities, andto administer the survey on an annual basis. Urban and rural population shares as well asprovincial shares would be roughly representative of the population as a whole. To respond toconcerns regarding the distribution of benefits from SAP initiatives, it is proposed to expand thesample of the core survey in five of Pakistan's more backward districts to include a continuouspanel of 500-600 additional households in each district.

4.28 A set of core questions (derived from the 1991 core modules) will be administeredthroughout PIHS data collection -- likely covering household composition, consumptionexpenditures, housing and access to social services. Additions, deletions, and modifications willbe made to the questionnaire in each round (i.e., annually), although core information will beretained throughout. Thus, modules on timely topics of specific interest to Government, theMSU or donors could be included or discussed in any round of the survey. For instance, theeducation module will be expanded to provide more extensive information on school attendance,costs of enrollment, failure rates and repetition, and informal education and training. Thequestion of which modules to retain and which to modify, add or drop would be decided on anannual basis, and would reflect the emerging agenda and experience with the design andimplementation of the SAP.

4.29 Community, facility and price surveys will be administered throughout the survey.Given the focus of the SAP, the community-level questionnaire will be developed to detail thetypes of basic services offered, so that program planners can know with more precision whatencourages people to send their children to school, seek health care, and so on. Such analysis,though difficult, is important to determine what the provision of basic services can accomplishand for whom--and at what cost.

4.30 The PIHS and associated community survey will be conducted by the governmentthrough the main statistical office with the participation of the Pakistan Institute for DevelopmentEconomics and other private organizations, supported by the MSU and by IDA supervision.

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Monitoring Institutions

4.31 Institutionally, the monitoring system would make use of the monitoring capacityin the line departments and in the P&D and Finance departments at the provincial level. AProvincial SAP Coordination Committee would be created and would meet regularly to assessprogress and provide support for continued smooth implementation. At the federal level, thesystem would be supported by the Federal SAP Secretariat in the Planning Division and anational Social Sector Coordinating Committee. In ascending order monitoring and evaluationinstitutions would include the following:

(a) Monitoring cells in line departments: These cells are already in existence althoughnot necessarily referred to by this name. They would be strengthened so as toenable them to produce information on each scheme within standardized formats,indicating targets, performance, and critical constraints with respect to both financialexpenditures and physical implementation. The agreed indicators include: physicalprogress of the project; the project budgetary and financial position; progress inintroducing agreed reforms; and impact or outcome indicators to measure progresstoward SAP objectives.

(b) Monitoring cells in the P&D and Finance Departments: These cells already exist.Their responsibilities vis-a-vis the SAP may have to be more focussed, and theircapacity to monitor the program strengthened. Specifically, the P&D and Financemonitoring cells would need to develop the capacity to aggregate and analyze thescheme-level information provided by the line departments into sectoral- andprogram-level formats, respectively, indicating sectoral and program performanceat each stage of implementation and specifying the critical bottlenecks requiringintervention. These departments should also have the capacity to spot check theinformation generated by the line departments, which would enhance the utility ofthe system of quarterly review meetings described earlier and would provide thebasis for closer cooperation between the P&D and the Finance Departments.

(c) SAP Provincial Co-ordination Committee (SAPCC): This Committee would bechaired by the Chairman/Additional Chief Secretary, P&D. The Additional ChiefSecretary, Planning and Development (P&D), who would also serve as membersecretary for the Committee and, as such, would be responsible for following up onthe implementation of the Committee's decisions. Membership would also includethe Provincial SAP Coordinator, and the Secretaries of Finance, Education, Health,Population, Welfare, Rural Water Supply and Sanitation, (Public Health EngineeringDepartment, PHED and Local Government and Rural Development, LG&RD). TheCommittee would meet quarterly (or more often as required) to assess progress inSAP implementation, using as a resource a brief monitoring report prepared by theP&D Department in cooperation with the Finance Department. The SAPCC wouldaddress any sectoral, cross-sectoral or inter-departmental issues which may beholding up implementation of the SAP and which may be amenable to solution

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within the scope and authority of the Provincial Government. The Committeewould also meet at the request of any of its members to address urgent issues orinter-departmental differences of view. It should be empowered to make decisionsbinding on all departments and subject to immediate implementation. The purposeof the SAPCC is not to appropriate the SAP responsibilities of the P&D or anyother department. Rather, its purpose is to support the P&D and FinanceDepartments in coordinating the implementation process by providing a forum forquick decisions on sectoral inter-departmental and other policy issues which theP&D and Finance may be unable to resolve.

(d) Social Sector Coordination Committee (SSCC): This Committee wvould be chairedby the Deputy Chairman, Planning Commission. It would meet on a regular basisto discuss issues in the social sectors and, in particular, to assess progress in theimplementation of SAP and to address issues that are beyond the scope of authorityof the Provinces. The Committee would also consider inter-provincial policy issues.It would base its discussions on analytical work and a monitoring report on the SAPprepared by the Federal SAP Secretariat based on its continuous interaction withprovincial P&D, Finance and line departments.

Funding Monitoring and Management

4.32 The SAP Project will help finance the strengthening of the provincial and federalunits outlined above and help them develop performance standards in the delivery of socialservices. This could include funds to hire private firms and institutions to conduct analyses,assist with monitoring, and otherwise help the Government expand its implementation capacity.The MSU will assist the federal and provincial governments in developing proposals and inselecting the required technical assistance to carry them out. Funds will be allocated on thebasis of documented needs approved by the Federal SAP Secretariat.

C. The Participatory Development Program (PDP)

4.33 As noted in Chapter 2, the SAP Project will include a program to explore newapproaches for involving communities, test innovative ways to deliver social services at thecommunity level, and foster stronger linkages between communities, NGOs. and Governmentservices in the SAP sectors. Funds will be available to support analysis and studies of policiesand programs, workshops, and dissemination of best practice. In 1994/95, the PDP willconcentrate on helping larger, well-established NGOs. universities or apex organizations whichhave already helped to establish effective partnerships among Government. NGOs, andcommunities.

4.34 To make use of funds in the PDP, NGOs, universities, or other private institutionswill submit proposals for grants of at least $100,000 for programs typically covering more thanone year and fitting criteria to be agreed between IDA and Government. after consultations withother donors. Priority would be given to NGOs acting as apex organizations with a proven track

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record and able to "retail" small grants among the 10,000 smaller NGOs that presently operatein Pakistan, which are often the source of important new approaches. Funds would also supportthe work of these apex organizations in fostering further cooperation and collaboration betweenGovernment and NGOs (e.g. seminars, workshops, study tours, analysis and dissemination offield experience and analysis of the "enabling environment" within which NGOs operate inPakistan). NGOs working in particularly sensitive or challenging fields, such as population,would also receive priority.

4.35 No new institution will be created to manage the PDP. Instead, proposals will besubmitted to the Federal SAP Coordinating Unit, reviewed by the Planning Division with theassistance of the MSU, and selected and submitted to IDA for approval. Money will beadvanced upon authorization from the Economic Affairs Division (EAD) of the federalgovernment directly to the selected NGOs on a periodic basis through a special account, to bereimbursed by IDA. The participating NGOs will submit quarterly and annual progress reportsdocumenting performance according to specified indicators and financial statements; financialreporting and audits will be conducted in accordance with EAD procedures for NGOs, whichare acceptable to IDA. In addition to undertaking regular monitoring visits, the PlanningDivision with the support of the MSU will monitor the selected NGOs regularly and, togetherwith IDA, will organize and manage the final evaluation of the Participatory DevelopmentProgram itself.

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V. RISKS AND BENEFTS

A. Risks

5.1 The main risk is that so large and complex a Project could over-strain themanagement capacities of the Government and the supervisory resources of IDA. The SAP andthe Project address this risk in five ways. First, it focuses on a addressing a few criticalproblems that impede basic service delivery. Second, the sub-program structure means that workdone through the SAP and the project will reinforce GOP and donor work on province- andsector-specific activities and vice versa. In the case of IDA, this will permit "joint products" inthe form of dual-purpose supervisory missions, avoiding undue strain on staff resources. Third,the SAP effort is building the Government's capacity to plan, budget, and implement. Fourtha Multi-donor Support Unit has been established to assist the Government with the SAP and topromote coordination and monitoring. Fifth, the Project also has a detailed and carefullydesigned implementation plan.

5.2 A second risk is that the intended reforms will not be achieved or will be seriouslydelayed. This risk is addressed by the phased annual release of funds based on prior performanceand annual agreements identifying prior actions and monitorable targets. Second, the design ofthe Project draws on lessons learned from sector-specific projects supported by IDA and otherdonors, who were closely involved in Project preparations. The MSU's unusually intensivemonitoring will permit early identification of problems and provision of assistance.

5.3 A third risk is that the SAP Project will undermine existing donor- and IDA-supported projects by providing a softer option with weaker conditionality than those projectsrequire. This risk is addressed by treating existing and expected aid as "above the line" whendefining the funding gap that the SAP Project will help fill, thus removing any temptation tosubstitute Project funds for other aid. If additional aid projects are received they too will betreated as "above the line". The risk is also addressed by including performance under other aidprojects in anmual assessments of prior performance.

5.4 A fourth risk is that Government commitment will weaken or fail. This risk too isaddressed by the phased funding and annual agreements. It is also addressed by the broad scopeand multi-ministerial team-building emphasis of the Project. And it is addressed by givingimportant oversight responsibilities to coordinating committees that include the highest levels offederal and provincial government.

5.5 A fifth risk is that the SAP, and particularly its recurrent costs, will be financiallyunsustainable because it depends too heavily on donors. The Project finances recurrent as wellas development costs because recurrent costs are the main costs of basic social services. Thesecosts are investments in human capital, in any event. Moreover, the Government has agreed toassume a rising share of total as well as recurring costs as the SAP proceeds. Govermnentexpenditures will rise to 2.6% of GDP by the end of the Eighth Plan in 1997/98. This level iswell below levels of effort for basic social services in comparable low-income countries and

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should be sustainable by the GOP, even as part of Pakistan's current stringent fiscal policy.Nonetheless, Government resources will be very limited, even for priority fields like basic socialservices. The Project would also emphasize the need for more cost recovery, especially inRWSS. Over time, donor financing of incremental SAP costs will fall, from 53% in 1993 to41 % in 1995/96. It will continue to fall, so that this share would be 30% by 1997/98. This isonly slightly higher than the share of costs for basic services that donors covered before the SAPbegan. If this Project does well, there could be a subsequent one with a further decline in theshare financed by donors.

B. Benefits

5.6 The SAP Project would contribute over 1993/94 to 1995/96 to the Government'sSocial Action Program, which aims to redress the generic weaknesses of basic social servicesin Pakistan. It would increase the Government's implementation capacity and so complement andfacilitate additional IDA and donor projects, whether traditional narrowly-focused ones or onesthat support entire sectoral programs. It would particularly help the poor because the poor arenow disproportionately disadvantaged by the core problems that the SAP Project would address;it would concentrate on improving and increasing access to the most basic services. The Projectwould thus promote produictivity, reduce poverty, and encourage smaller, healthier, bettereducated families. It would also help to slow Pakistan's exceptionally rapid population growth.

5.7 Although the Project would finance only 5 percent of the total costs of the SAP forthe period 1993/94-1995-96, it would, through its policy dialogue, focus attention and resourcesto address a few "core" problems that now impede the provision of social services. Thoseproblems fall in three categories: implementation, design (to improve quality and access), andlevel of expenditure. The Project would work through annual agreements on programs tostrengthen Government planning, policies, and budgeting and so help expand basic serviceprograms in practical ways. Its specific and immediate benefits would thus include changes inplans, policies, and expenditure programs. But the Project would thereby contribute to the SAP'saccomplishments more broadly, improving the implementation and quality of basic services andincreasing access, particularly for women and the poor. The emphasis on basic services andgreater community participation in their design and implementation would mean that fewerservices will be unwanted, underused or poorly maintained. Communities would feel a greatersense of "ownership" and be more likely to contribute to their costs. In addition, popularpolitical support for Government programs would be likely to grow, thus enhancing Governmentcommitment to investments in social services.

5.8 Gains in the four basic social services would be mutually reinforcing. For instance,healthy, well nourished children will be better able to learn. The most effective way to improvechildren's health is to educate their mothers while providing better health care. Satisfactoryrural water supply and sanitation reduce the high risk of diarrheal and other water-bornediseases, and those both complement basic health services. As is well known, demand for, anduse of, family planning services to limit fertility rises when women and girls are better educatedand when children receive health care that increases their chances uf survival to adulthood.

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Finally, improvements in health and learning will all promote greater economic productivity, forboth men and women.

5.9 Sector-specific Project benefits cannot be separated out from those of on-going donoractivities, since the Project supports the entire Government program for improving socialservices. The SAP Project will, however, reinforce sector-specific IDA- and donor-supportedprojects through its emphasis on Government commitment to social services in general,strengthening overall implementation capabilities, and better monitoring of both inputs andoutputs in the social service sector. Preparations for the Project have already produceddemonstrable improvements in both policy and programming in several sectors and provinces(see Chapter 2). Thus the SAP Project would contribute to the following objectives of the SocialAction Program as agreed with. IDA:

Primary Education

5.10 In primary education, the SAP Project will help raise enrollment rates, especiallyfor girls, by improving the performance of existing schools and building new schools whereneeded. Extensive efforts will be undertaken to improve management of primary education, toensure that schools have trained teachers who attend regularly, and to increase the supply ofbooks and other inputs needed to improve the quality of education.

o Punjab: Some 30,000 primary school teachers (21,000 women and 9,000 men)will be recruited and trained to fill new posts and erase the backlog of vacancies, bringing thetotal supply of teachers to 130,000 women and 150,000 men. As expenditures on non-salaryitems rise from less than 1% to ov- r 10% of recurrent cost budgets, the supply of books andother learning materials will improve. Institution-building will continue, including strengtheningof provincial and district-level management and improvements in the MIS, which will improveimplementation of primary education services. During the three years, some 15,000 primaryschools will be constructed, bringing the total to about 90,000. About 70% of the new schoolswill be for girls, bringing that total to 40,500. Some 5,000 existing schools will be renovatedor rebuilt. Over the three years, the Gross Enrollment Rate (GER) for girls is expected to risefrom 55% to 76% and, for boys from 69% to 85%.

o Sindh: 7,500 male and 13,300 female teachers will be recruited to fill new postsand long-standing vacancies, bringing the total number to 73,000 men and 30,000 women, whowill be trained through expanded in-service and pre-service training programs. Ongoing workto improve provincial and local management of the primary education system will continue,including the expansion of EMIS to district level and better school supervision. Some 5,660girls' schools and 3,770 boys' schools will be built during the three-year period and about 2,100schools will be renovated or rebuilt. Over the three years, the GER for girls should rise from30% to 48% and the GER for boys from 56% to 74%.

o NWFP: All schools will allow cross-registration of boys and girls. Several newGovermnent Colleges of Elementary Teacher Training will be constructed to meet the growing

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need for primary school teachers, especially women, to staff the new schools. In-service teachertraining will be expanded, and mobile teacher training will be provided for women teaching inremote areas. At the provincial level, planning and management capability will be improved aswill district offices. School supervision will be strengthened through training, improvements intransport for learning coordinators, and greater community involvement in schools. Some 5,160schools will be constructed, including 3,000 girls' schools and 300 coeducational; and about2,400 will be renovated or rebuilt during the three-year period. The total number of schools willthus rise to 24,000 including 7,000 girls' schools. It is expected that the GER for girls will risefrom 29% to 44% and for boys from 60% to 79%.

o Balochistan: Pre- and in-service teacher training programs, as well as mobileteacher training for women in rural areas, will be expanded and provided for 13,000 men and2,000 women. Some 2,000 men and 2,000 women teachers will be recruited, bringing the totalto 15,000 men and 4,000 women, and long-standing vacancies will be filled. The managementand implementation capacity of the Directorate of Primary Education will be improved andEMIS units will be expanded to the district level. School supervision will be improved throughbetter transport of supervisors and learning coordinators and by encouraging communityinvolvement. Through an innovative program, some 200 rural communities which have neverhad a school will organize each year to build their own school and find a literate woman fromthe community to teach the children; these women will then be trained and paid by thegovernment. Participating parents will agree to send their own girls to the school. (During1993/94, some 120 community schools have been built; enrollment and attendance rates forstudents in these schools are very high.) Some 1,400 coeducational girls' schools will beconstructed and about 400 will be renovated or rebuilt during the three years. The GER for girlsis expected to rise from 15% to 29% and for boys from 49% to 72%.

o AJK and Federal Areas:

-- AJK: Some 500 men and 1,000 women teachers will be hired and trained.A directorate of Primary Education will be established and a permanent NEMIS cell will belocated at each Directorate. About 250 new girls' schools will be built during the three yearprogram bringing the total to 4,200. The GER for girls is expected to rise from 89% to 95%and for boys will remain at 100%.

-- FATA: In these most remote areas of Pakistan, some 540 girls' schoolsand 240 boys' schools will be built during the three-year period, bringing the totals to 1,000 forgirls and 1,900 for boys. Buildings will be provided from 180 shelterless schools (mainly forgirls) and 300 schools will receive more classrooms. The GER for girls is expected to rise from9% to 38% and for boys from 61% to 81%.

-- FANA: In the mountainous North of Pakistan, some 420 schools will bebuilt during the three years, bringing the total to 330 for girls and 460 for boys. Some 750community schools will also be opened, and communities will also help reform curriculum, trainteachers, and supervise the schools. A permanent NEMIS unit will be established. The GER for

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girls is expected to rise from 25% to 36% and for boys from 58% to 65%.

-- Islamabad Capital Territory: This area has achieved universal primaryenrollment; hence only 30 schools and 120 more classrooms will be provided. 180 teachers willbe recruited, and the planning and management capacity of the Federal Directorate of Educationwill be improved, particularly through the addition of a NEMIS unit.

Primary Health Care

5.11 The Eighth Plan sets a range of ambitious targets including increasing lifeexpectancy by two years and reducing infant mortality by nearly 25%. To this end, the SAPProject will help provide better quality and more available primary health care, particularly inrural areas. This would improve the health and lower the fertility of the population generally,but would especially benefit high-risk and underprivileged sections of the community. Womenwould benefit particularly, through improved maternal health services, especially ante- and post-natal care, and through increased availability of family planning services. The SAP will alsogive more attention to preventive services (including immunization, malaria, respiratory diseases,and, potentially, an AIDS program).

5.12 The SAP and the Projects will support critical quality improvements in the primaryhealth care system, starting with management reforms at all levels to improve implementation.In addition, non-salary recurrent budgets, which have suffered badly in recent years, willincrease by 5% a year (in real terms) for each year of the Eighth Plan. Additional femaleparamedical staff will be recruited and trained, together with extra staff for the communicabledisease program, so that after five years there should be one paramedical for 1,165 people.Health education programs will be strengthened and essential drug lists introduced.

o Punjab: The province has the essential basic elements for service provision inplace; there is one health facility for every 10,000-12,000 people. Therefore, the focus of theprogram and the reform measures is on making the system work better through, for example,ensuring female staff are actually available in rural facilities (and a further 160 will be recruitedin 1993/94), introducing community health workers (in the first district in 1993/94), establishingand enforcing referral systems, strergthened and decentralized management, and markedly betteravailability of supplies through a substantially increased (22% in 1993/94) recurrent budget,including a significant shift from 24% to 33% of the total allocated for non-salary expenditure.

o NWFP: This is the other province in which there will be virtually noconstruction of new facilities, since the province has also reached one facility for every 10,000-12,000 people. The emphasis is on quality improvements including up-grading existing facilities(currently over 600, or some two-thirds of the total, in the five years but under review),expanding recruitment of female paramedical workers by improving training and offering "hardareas" allowances, maintaining coverage of the immunization program at over 85%, and sharplyincreasing the distribution of oral rehydration salts.

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o Sindh The construction program after being reviewed was reduced, with thesavings (Rs 40 million in 1993/94) allocated to priority communicable disease control programs.Through the SAP dialogue, the non-salary recurrent budget for 1993/94 has been sharplyincreased (by almost or 15% over 1992/93), which will partly restore badly eroded medicine,maintenance and utility budgets in primary facilities.

o Balochistan: Since lack of female staff is a chronic problem, intensiverecruitment schemes and substantially improved service conditions and allowances are a centralpart of the program. As in Sindh, the non-salary recurrent budget was badly eroded and hasbeen substantially increased for 1993/94 (again by some 15% compared with 1992/93). Theposition of this province is rather different. The five-year program proposes about 200 newrural facilities to meet the needs of the widely dispersed population, although this proposalremains under review.

Population

5.13 The SAP -- and the SAP Project -- will support major expansion in family planningservices to begin to increase Pakistan's very low contraceptive prevalence rate (12%) and startto reduce the very high rates of fertility (5.7) and population growth (3%). Ambitious targetshave been set for the five-year period of the SAP, including increasing the coverage of theprogram to 100% in urban areas and 70% in rural areas (defined as family planning servicesbeing available within 5 kms.), a near doubling of contraceptive use, and a 10% fall in theoverall population growth rate. Important aspects of the Government's five-year programinclude: a crucial new village outreach program (increasing village workers from a few hundredto 12,000, such that every village of 2,000 or more people has one worker); increased servicedelivery points (including an extra 200 Family Welfare Centers and a doubling to 251 of theMobile Service Units); enlarged staff pre- and in-service technical training (over 4,000 traineesduring the five years); management enhancements (for example, management training up bysome 25%); and strengthened population information activities (including a 10% per annumincrease in mass media activities). Moreover, by the end of the Plan, over 6,500 health facilitiesshould offer family planning services, and social marketing will expand. Population educationin schools will also be sharply increased, and NGO activities are projected to double over thefive years.

RWSS:

5.14 In RWSS, a major shift in policy has occurred that will increase rural water supplyand sanitation coverage through more sustainable approaches with greater communityinvolvement and accountability. Under the Eighth Five Year Plan, an additional 18.3 millionpeople will obtain rural water supply services and 22 million more will have improvedsanitation. To reverse the past trend toward deterioration of existing services and promotesustainability, a major effort will be made to include community and user groups in the designand operation of RWSS programs and to increase cost recovery. In particular, responsibility foroperation and maintenance of RWSS programs will be shifted to communities, while reducing

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operation and maintenance costs through shifts to more appropriate technologies and moreefficient local management. Some user charges will be instituted, particularly in towns.Government agencies responsible for RWSS will be strengthened through training, and NGOswill be encouraged to play a greater role in the provision of RWSS in cooperation withcommunities.

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VI. AGREEMENTS AND CONDITIONS

6.1 As discussed earlier, the SAP Project is based on a framework of annual agreementson Operational Plans (budgets and reform measures), leading to government commitment andaction. Each year, in March/April, the governments will discuss with the Bank their intentionsfor funding the recurrent and investment needs of the total program fer delivering the targetservices, as well as the coming year's program of implementation reforms. The Bank willconfirm that the budgets, development plans and the reforms are agreed and therefore may besupported with program funding via the SAPP.

6.2 The first annual agreement for 1993/94, is complete. During a preparation periodbetween December 1992 and June 1993 Bank staff and the MSU were in close contact with thegovermnents and discussed in detail their budgets, development plans and implementation reformplans for the 1993/94 fiscal year. These discussions led to Operational Plans (including currentbudgets, development plans and implementation plans or reforms) for 1993/94, which wereexamined by IDA. Annexed to this report is a matrix of the implementation plans or reformsagreed with the four provincial governments, AJK and the federal areas (Annex onImplementation). The matrices summarize the government submissions and reflect in theirlanguage the steps they have committed themselves to take. The key issues and proposals arefurther summarized below.

Key Elements of the Policy Commitments

t In public expenditures, the governments concerned will reach agreementannually with the Bank on public expenditure programs in the SAP sectors,both recurrent and development;they will provide a balance in terms of sizeand composition between consolidation of past efforts and feasible cypansionof new capacity based on actual achievement in the past year; and these willensure that all existing and new facilities are adequately staffed andmaintenance and non-salary inpttzi are adequately provided. Agreement ona public expenditure program is a prior action.

o In primary education, the governments will undertake to: (a) enhance girls'enrollment in primary education and improve the efficiency of the systemthrough the introduction of co-education, steps to increase the recruitment offemale teachers, and acceleration of the opening of schools with female staffand administration; and (b) strengthen primary education's institutions andprocedures by increasing the administrative focus on primary education,through establishing or strengthening directorawes of primary education, ortheir equivalent; follow uniform, merit-based site selection criteria for thelocation of primary schools; revise and enforce posting and transfer policiesto reduce turnover and undue political interference; increase the provision ofnon-salary items like books to improve quality; and improve the database bystrengthening and using the educational management information systems now

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being formed in each of the provinces and at the federal level.

o In primary health, the governments will commit themselves to: (a) establishand use strategic planning mechanisms; (b) re-organize primary health careservices and finances to strengthen front line services, involving re-allocationof available recurrent budgets to improve the availability of non-salary inputsand strengthenin: district health offices; (c) decentralize administrative andfinancial powers, focusing on the district level, to improve effectiveness; (d)improve the gender balance in staffing by increasing the recruitment andretention of female health staff; and (e) establish and follow rules of businessto expand the health departnent's participation in the population program.

o In population, in addition to improving the outreach program, thegovernments will commit themselves to (i) assure and protect adequatefunding for the population program in the Eighth Five Year Plan andannually, starting with Rs 1.1 billion in 1993/94; and ensure timely releasesto the provinces; (ii) improve program management; (iii) increase theparticipation and ownership of the provincial governments in the populationprogram by decentralizing more activities to the provinces, providing familyplanning services through health department outlets, and including populationeducation in the formal school system; (iv) improve human resources withinthe population program; (v) increase private sector participation, includingNGOs, in the delivery of family planning services; and (vi) ensure anadequate supply of contraceptives.

o In rural water supply and sanrtation, the govermnents will committhemselves to: (a) adopt a uniform policy for establishing and financingRWSS, to avoid the almost complete subsidization that occurs now; (b)introduce community management and participation in the design andoperation of RWSS; and (c) introduce effective cost recovery mechanisms.

6.3 The Federal and Provincial Governments, as the case may be, have provided thefollowing assurances:

(a) that the GOP's overall level of spending on the SAP will rise to the levels agreedwith IDA within the framework of the SAP (Tables 3.1, 3.2 and 3.3); in no casewill these levels be allowed to fall below 2.05% of GDP in 1993/94, 2.15% in1994/95 and 2.3% in 1995/96 (para. 3.7);

(b) within that total expenditure, that the Governrment of Pakistan's own contributionwill rise to agreed target levels (Tables 3.2 and 3.3); 1.6% of GDP in 1993/94,1.7% of GDP in 1994/95 and 1.8% of GDP in 1995/96 (par. 3.7);

(c) that the priority of the service delivery in the SAP sectors will be protecteJ by

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refraining from bans on recruitment of basic staff to deliver these services by theGovernment of Pakistan, AJK, and the governments of the provinces and territories(para. 2.23);

(d) that the governments participating in the SAP will prepare annual operational planssetting forth inter alia proposed sub-programs to be carried out in each successiveyear and agree with IDA each year on their expenditure and reform content (paras.4.7, 4.8, 4.9);

(e) that the governments participating in the SAP will implement their agreedoperational plans (which would include public expenditure on SAP services, aprogram of implementation reform and a financing plan) for the SAP, to thesatisfaction of IDA (para. 4.10);

(f) that the governments will carry out quarterly reviews of implementation of the SAPand furnish IDA with progress reports; and will participate with IDA and otherdonors in an annual review of each past year's performance as part of the processof reaching agreement in each successive year's SAP (para. 4.22);

(g) that grants for the Participatory Development Program will be made in accordancewith procedure and on terms and conditions satisfactory to IDA (paras. 4.34, 4.35).

6.4 On the basis of the Project's benefits, and having obtained the above confirmationsand reached the above agreements with the Government of Pakistan, AJK, Punjab, Sindh,Balochistan, NWFP and FATA, the proposed project constitutes a suitable basis for an IDAcredit of SDR 145.2 million ($200 million equivalent) on standard terms with 35 years maturity.The borrower would be the Islamic Republic of Pakistan.

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ANNEX I

SOCIAL ACTION PROGRAM PROJECT

Implementation Plan'

I. The Project

A. Project Summary

1. The Social Action Program Project provides a multi-sector investment andmaintenance credit to strengthen implementation of Pakistan's Social Action Program (SAP).SAP is the name given to Pakistan's overall efforts to improve basic social services over the fiveyear period 1993/94-1997/98. The Project would help finance the first three years (1993/94-1995/96) of the Program. The SAP covers both cross-sectoral and sector-specific programs andissues. For planning and monitoring purposes, the SAP is divided into sub-programs. Thesecover one of three basic social services -- primary education, primary health care, or rural watersupply and sanitation (RWSS) -- in one of Pakistan's four provinces, AJK and federal areas.Others cover the national population program, and the federally administered CommunityDisease Control Program. The Project also supports NGOs to promote community involvementin the design and delivery of basic services; and it strengthens monitoring and evaluation. TheProject will complement existing social sector programs and projects, whether or not aid-financed.

2. The Government's Social Action Program, and the proposed SAP Project whichwould support it, address Pakistan's relative weakness in basic social services, which hasbecome a major shortcoming in, and constraint on, Pakistan's development accomplishments.Pakistan's GDP growth has been vigorous -- almost 6% per year in recent years. However, veryrapid population growth (about 3% annually) means that per capita income growth has been onlyhalf as fast as GDP growth. Pakistan's health indicators and educational attainments fall farbelow expected values for its income levels. Pakistan has agreed with the IDA and other donorsthat a broad-based effort to improve the most basic social services is now needed. Effectiveinvestments in basic social services will boost economic productivity, reduce poverty, andpromote smaller, healthier, and better educated families. Returns to investments that reachwomen will be especially high for the economy and the society as a whole.

3. A broad-based, "umbrella" approach is needed to complement existing programs andprojects because many of Pakistan's main problems in the social services are not sector-specific

I This annex is designed to present in one place key information needed toimplement the project. It is meant to be separate from the Staff Appraisal Report (SAR).As such, it repeats some of the content of the SAR.

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but endemic, common across all services and areas of the country. These problems fall into threegeneral categories: (i) implementation of social services has been deficient; (ii) design of socialservices has been flawed; and (iii) levels of effort in social services have been too low.Underlying all three sets of problems are political considerations -- insufficient politicalcommitment at provincial and national levels and inappropriate political interference, particularlyat local levels. Weak institutions in the social sectors reflect past neglect. The SAP Project willhelp to concentrate attention, resources, and political will on the basic social services.

4. Improving Implementation. Existing basic social services tend to operateinefficiently. In particular, they suffer from poor planning and budgeting techniques,bureaucratic delays in release and expenditure of allocated funds, recruitment bans and excessivestaff turnover, over centmlized management of dispersed front-line services, and insufficientbeneficiary participation. As a result, sector-specific, province-specific projects often disbursemore slowly and achieve less than planned. The SAP Froject will complement such projects byaddressing implementation problems common to all the basic social services. Solutions to manyof the implementation problems involve not just the sectoral ministries, but also the cross-sectoral finance and planning ministries The SAP Project has already led to up-front actions thatrelieve implementation problems, thereby strengthening existing projects. For instance, the SAPProject dialogue has produced new mechanisms to protect and release social sector funds.Recruitment bans have also been lifted for the social sectors. And efforts to encouragebeneficiaries to participate in and take more responsibility for their own social services havebeen expanded, particularly in water supply and in education. The SAP Project will also addresssector-specific implementation problems, in ways that complement other projects in thosesectors.

5. Improving Program Design. Social services in Pakistan ought to focus more onbasic or primary levels of social services, and the basic services ought to focus more on qualityand on access, especially for women and girls. The Social Action Program will shift the focusto basic services. The SAP Project is laying particular emphasis on quality and access, by gettingagreement on minimum expenditures and by encouraging Pakistan to adopt approaches that haveworked in other countries. Some progress has already occurred, for instance in designing basicservices to involve beneficiaries and to include more female providers to serve other women andgirls. The SAP Project will also highlight sector-specific design issues, such as including morefamily planning in health services. It thus reinforces sector-specific projects.

6. Increasing Level of Effort. As implementation capacity expands and designimproves, Govenmment expenditure on basic social services should increase. The SAP Projectbuilds visibility for the social services as a whole and focuses attention on this central level-of-effort issue. Total expenditures on the basic social services will rise from less than 1.7% of GDPin 1991/92 to over 2.6% in 1997/98. The Government's share of incremental costs will risefrom about 46% in 1993/94 to 59% in 1995/96 and about 69% in 1997/98.

7. Building Political Will. One important underlying cause of all the weaknesses inPakistan's basic social services has been a history of a lack of political will to change. The SAP

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Project has helped to build political commitment, by its very scope and by its reliance on annualassessments to determine funding. Pakistan's three recent Governments all gave or give highpriority to the SAP and have taken important steps to fund and implement it.

8. Operation of the Project. The SAP Project emphasizes a continuing policy dialogue,phased funding, and competition for resources among provinces and sectors based onperformance. The Project is based on appraisal of the first three years of the Social ActionProgram. But disbursements can be made only after the Bank and the Government reachagreement with those responsible for each year's more detailed operational plans (includingbudgets and implementation plans) through annual assessments. In effect, sub-programs competefor funds. The annual budgets cover both development (investment) budgets and recurrentbudgets. The implementation plans specify prior actions and measurable targets for progress ineach year. The Project reimburses a share of the expenditures on the agreed programs. Ifperformance of a sub-program is weak, the current year's disbursements will be reduced byfailure to spend, or disbursements can be suspended entirely. The next year's agreement willreflect past performance as well as new plans (again with prior actions and targets). The firstannual assessment, for 1993/94, was completed during appraisal; retroactive financing up to20% is proposed. The SAP also includes US$6 million to strengthen the Government'smonitoring and management capacity and US$5 million to help non-government organizations(NGOs) promote community involvemeuL in basic service delivery and improve cost-effectiveness (with another $5 million to be allocated if this component proceeds well).

Project Costs and Financing

9. The first three years of the five-year SAP will cost about $4 billion (developmentand recurrent costs), including increments totaling about $1.5 billion over comparable earlierexpenditures. The Government expects to contribute about $3 billion of the total (about 76%)and to use $552 million more in existing or expected donor assistance. It seeks funding for theremaining gap of $418 million. IDA has reached agreement with the Government on theframework of this three-year program, and the SAP Project would provide $200 million, 5 % ofthe total cost and about 48% of the gap. The three-year program should be seen, however, inthe context of the five-year SAP. The full program will cost $7.7 billion, including incrementsof about $3.2 billion over comparable earlier expenditures. The Government expects tocontribute $5.9 billion and to use $1.1 billion more in existing or expected donor assistance. Itseeks funding for a total gap of $0.7 billion for the five-year period. The Government hasundertaken to increase its share of incremental cost financing from 46% in 1993/94 to 59% in1995/96 and 69% in 1997/98, which should be well within feasible limits.

Risks:

10. The main risk is that so large and comprehensive a Project could over-strain themanagement capacities of the Government and the supervisory resources of IDA. The Projectaddresses this risk in five ways. First, it focuses on a few core issues to improve performanceof basic service programs and projects. Second, it exploits "joint products" through its structure:

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work done for the Project will reinforce work done on province- and sector-specific activitiesand vice versa. For IDA, this will permit dual-purpose supervisory missions. Third, it is helpingto build the Government's capacity to plan, budget, and implement. Fourth, a Multi-donorSupport Unit (MSU) has been established to help Government with the SAP and to improvemonitoring and donor coordination. Finally, the Project has a carefully designed and agreedimplementation plan.

11. A second risk is that the intended reforms will not be achieved or will be seriouslydelayed. This risk is addressed by unusually intensive monitoring through the MSU as part oftechnical assistance to GOP; and by the phased annual release of funds based on annualagreements reflecting performance and identifying prior actions and monitorable targets.Moreover, the design of the Project draws on lessons learned from past and existing sector-specific projects supported by IDA and other donors, who were closely involved in Projectpreparations.

12. A third risk is that the SAP Project will undermine existing donor- and IDA-supported projects by providing a softer option with weaker conditionality than those projectsrequire. This risk is addressed by treating existing and expected aid as "above the line" whendefining the funding gap that the SAP Project will help fill, thus removing the temptation tosubstitute Project funds for other aid. The risk is also addressed by including performance underother aid projects in annual assessments of programs. The MSU also provides a channel forcommunications between donors to help prevent such problems.

13. A fourth risk is that Government commitment will weaken or fail. This risk too isaddressed by the phased funding and annual agreements. It is also addressed by the broad scope2-id multi-ministerial team-building emphasis of the Project. And it is addressed by givingimnportant oversight responsibilities to coordinating committees that include the highest politicallevels of federal and provincial government -- the Prime Minister and the provincial ChiefMinisters -- as well as Cabinet Ministers and federal and provincial Secretaries.

14. A fifth risk is that the SAP, and particularly its recurrent costs, will be financiallyunsustainable because it depends too heavily on donors. The Project finances recurrent as wellas development costs because recurrent costs are the main costs of basic social services. Thesecosts are investments in human capital, in any event. Moreover, the Government will assumea rising share of total as well as recurring costs as the SAP proceeds. Although SAPexpenditures will rise to 2.6% of GDP by the end of the Eighth Plan in 1997/98, this level iswell below levels of effort for basic social services in comparable low-income countries andshould be sustainable by the GOP, even as part of a stringent fiscal policy. The Project will alsoemphasize the need for more beneficiary contributions and cost recovery, especially in RWSS.Over time, donor financing of incremental SAP costs will fall, from 55% in 1993/94 to 41%in 1995/96 and 30% by 1997/98. This is only slightly higher than the share of costs for basicservices that donors covered before the SAP began. If this Project does well, there could be asubsequent one with a further decline in the share financed by donors.

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Benefits:

15. The SAP Project will contribute over 1993194 to 1995/96 to the Government'sSocial Action Program to redress the generic weaknesses of basic social services in Pakistan.The Project will help improve the quality of basic services and increase access, particularly forwomen and the poor, thus promoting productivity, reducing poverty, and encouraging smaller,healthier, better educated families. It will also help to slow Pakistan's exceptionally rapidpopulation growth.

16. Gains in the four basic social services will be mutually reinforcing. For instance,healthy, well nourished children are better able to learn. The most effective way to improvechildren's health is to educate their mothers, while providing better health care. Satisfactoryrural water supply and sanitation reduce the high risk of diarrheal and other water-bornediseases, and thus complement basic health services. As is well known, demand for, and use of,family planning services rises when women and girls are better educated and when childrenreceive health care that increases their chances of survival to adulthood. Finally, improvementsin health and learning all promote greater economic productivity, for both men and women.

17. The emphasis on basic services and greater community participation in their designand implementation will mean that fewer services will be unwanted, under-used or poorlymaintained. Communities will feel a greater sense of "ownership" and will be more likely tocontribute to their costs. In addition, popular political support for Government programs is likelyto grow, thus enhancing Government commitment to investments in social services.

18. Sector-specific Project benefits are difficult to separate from those of on-going donoractivities, since the Project supports the entire Government program for improving socialservices. The SAP Project will, however, reinforce sector-specific IDA- and donor-supportedprojects by increasing overall implementation capabilities, improving program design,strengthening Government commitment, and supporting better monitoring of both inputs andoutputs in the social service sector. Preparations for the Project have already produceddemonstrable improvements in both policy and program performance in several sectors andprovinces.

B. Detailed Project Description

1. Primary Education

19. Status: Pakistan's literacy and the gross enrollment rates (GER)2 are notcommensurate with the country's economic achievements. The present GER for primaryeducation of 58% and literacy rate of 30% are far below the corresponding averages for 'other'

2/ The gross enrolment ratio (GER) is defined as the gross enrollment in primary level classes (pre-school througi5th grade) as a percentage of school age children. This ratio can exceed 100% due to enrollment of over- and under-agechildren.

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low income countries of 75% and 49%. Furthermore, the enrollment ratio for girls and femaleliteracy ratios are among the lowest in the world at 40% and 20%. Low enrollment partlyreflect moderate quality of education services offered: fewer than 1 in 5 pupils complete fiveyears of education. Nationwide data on performance of the education system mask significantdifferences between and within provinces, and between rural and urban areas and males andfemales. Primary-level GERs (including the pre-school or kachi class) ranged from about 65 %in Punjab to 34% in Balochistan.

20. Organization: The delivery of education is the responsibility of provincial governments.and the federal govermment has a coordinating and policy-making role. In the past, primaryeducation has received too little priority when it was under the control of the provincialDirectorates of Schools, which favored secondary schools. Recently GOP has moved towardsestablishing a Directorate of Primary Education, separate from a Directorate of SecondaryEducation. Such "bifurcated" directorates currently exist in both Balochistan and NWFP; andat district level and below in Sindh, while Punjab is in the process of setting up a Directorateof Elementary Education. In addition, from district level down to schools, the administrationis duplicative and segregated by gender. In practice, the past neglect of girls' education meantthat the "female administration" is much smaller and weaker than the male administration andthe number of girls' schools is about one-third that of boys' schools.

21. Issues: The education system does not use its resources efficiently and effectively;hence the achievement of its stated goal of universal primary education is unlikely under presentinstitutional arrangements, even with increased financial resources. The officially segregateddual administrative system is not only costly to operate, but the policy of segregated boys' andgirls' schools cause significant inefficiencies in locations where all school-age children of bothsexes could be accommodated by one school. Over 3000 schools in rural areas have less than10 students. The segregated schools also lead to disadvantage for girls: once a boys' school isopened the number of children is too small to justify opening a second school for girls in thesame village. The political process governing the hiring and transferring of teachers andselection of school sites for school construction is another major source of inefficiency resultingin over 2000 "schools" without students. Less desirable rural schools sometimes lose theirteachers who transfer to urban schools with surplus teachers. The rural school cannot replacethe absentee teacher because the post has been occupied. Weak planning processes failing toexamine the total program lead to fragmentation of inputs and duplication of effort. Past Five-Year Plans have not been sufficiently realistic and have over-emphasized physical expansion,with too little attention to quality. Plans have not provided for trained teachers and instructionalmaterials for every school building constructed and the Government's recurrent cost budgetshave traditionally devoted less than 1% to non-salary "quality' inputs such as books. Under-utilization of existing facilities indicate that services have been inadequately designed and thatthey are unresponsive to the needs of intended beneficiaries. In some areas, the Governmenthas not made use of the private sector in areas in which it has a comparative advantage, suchas publication of quality textbooks, and construction management. Better use of private sectorresources could reduce the recurrent cost burden of the Government considerably.

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22. The SAP Project: The SAP introduces a series of policy reforms in primaryeducation to address the systemic problems described above. Each provincial government hascarried out a series of up front actions prior to negotiations. These reform measures include:1) increasing efficiency through officially allowing for cross-registration of girls in boys schoolsand vice versa, and establishing new co-educational schools; 2) alleviating the problem of ruralschools without teachers due to frequent transfers by "localization" of teacher posts to preventtransfer of a teacher originally appointed in a rural area to a vacancy in an urban area, or toother jurisdictions; 3) increasing the number of female teachers in rural areas by relaxing entry-age and qualification requirements; 4) enforcing needs-based site selection by using thecomputerized Education Management Information System database; 5) strengtheningmanagement's focus on primary education by delegating financial and administrative powers toDirectorates of Primary Education; 6) encouraging beneficiary participation by supportingcommunity schools; 7) supporting private sector participation through Education Foundations,and contracting out construction management and establish evaluation criteria and proceduresfor textbook publishing to include non-Govermment publishers.

23. To improve planning and better integrate all ongoing and future government anddonor activities, the SAP aims to examine the province's primary education sector programs intheir totality, covering all activities in primary education regardless of funding sources, anddevelopment and recurrent expenditures together. The program approach consists of anintegrative framework, strategies, criteria and planning procedures for the sector. The specificsize and composition of each year's plan are flexible and are agreed upon at annual reviewsfollowing a logical planning process including assessment of needs and judgements on thefeasibility of the proposed program. Feasibility will be judged on the basis of actualachievements in the past year and on the backlog of work begun in the past year, to becompleted in the next year. The program approach will help ensure a proper balance betweenconstruction and quality inputs, development and recurrent expenditures, and salary and non-salary expenditures. Recurrent costs will be calculated on the basis of the number of all existingand new classrooms in each province.

24. The SAPP will support implementation of the Government's total program inprimary education in the four provinces and in the federal areas for 3 years between FY94 andFY96. This includes support for implementation of policy reforms, and for expansion andqualitative improvements of the system. Several components are similar in all provinces,including support for institution building at the provincial, district and sub-district levels,improved planning and data-driven management through, inter alia, expansion of the provincialEMIS cells, and improvement of both the quantity and quality of educational inputs. The privatesector will be encouraged to expand its role in the provision of primary education throughsupport from provincial Education Foundations. Private sector involvement will also be soughtin the areas of construction management and supervision, and textbook development andproduction. The size of civil works programs, teacher training and recruitment efforts andexpected increases in enrollments vary by province/area. Schools to be built will includeboundary walls, provision of toilets, water, and electricity particularly in girls' schools. Therespective programs and expected enrollment increases are detailed below.

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25. Punjab: Male and female primary school teachers will be trained and recruited asrequired to fill new posts and make up for the existing backlog of vacancies. Institutionbuilding, including gradual strengthening of district level management capabilities and of thePunjab EMIS will continue. Over the three years an estimated 15000 schools will beconstructed, of which 70% will be for girls. Abou: 5000 existing schools will be reconstructedor renovated. It is expected that the GERs for girls will rise from 55% to 76% and for boysfrom 69% to 85%, respectively.

26. Sindh: Male and female primary school teachers will be trained through expandedpre- and in-service programs, and recrited as required to fll new posts and make up for theexisting backlog of vacancies. On-going work to improve provincial and local management ofthe primary education system will continue, including establishment of district level EMIS cells,and improved school supervision. An estimated 5660 girls schools and 3774 boys schools willbe constructed, and about 2166 schools will be reconstructed or renovated, during the three yearperiod. It is expected that the GERs for girls will increase from 30% to 48% and for boys from56% to 74%, respectively.

27. NWFP: At the provincial level, the planning and management capability of theDeparanent of Primary Education will be strengthened and its implementation capacityimproved. District offices will receive additional resources and responsibilities for planning andmanaging primary education activities. School supervision will be strengthened through trainingand improving the mobility of learning coordinators, and, importantly, by stimulating increasedcommunity involvement. An estimated 5162 mainly girls and "genderless" schools will beconstructed, and aoout 2400 will be reconstructed or renovated during the three years. Severalnew Government Colleges of Elementary Training will be constructed to meet the growing needfor female primary school teachers resulting from the construction program. The in-serviceteacher training program will also be expanded, and mobile teacher training will be madeavailable to females in remote areas. It is expected that the GERs for girls will increase from29% to 44% and for boys from 60% to 79%, respectively.

28. Balochistan: Male and female primary school teachers will be recmited as requiredto fill new posts and make up for the existing bacldog of vacancies. The management andimplementation capacity of the Directorate of Primary Education will be strengthened. EMIScells will be established at the district level, and school supervision will be improved throughincreased mobility of ASDEOs and learning coordinators, and through fostering communityinvolvement. An estimated 1400 schools without gender designation will be constuucted, andabout 400 will be reconstructed/renovated during the three years. Pre- and in-service teachertraining programs, as well as mobile teacher training for females in nrual areas, will beexpanded. It is expected that the GERs for girls will increase from 14% to 24% and for boysfrom 46% and 60%.

29. Federal Areas:

(a) AJK: A Directorate of Elementary Education will be established and a permanent

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NEMIS cell will be located at the Directorate. An estimated 250 schools will beconstructed during the three year program period, and teachers will be trained andrecruited as required. It is expected that the GERs for girls and boys will increaseto 95% and 100%, respectively.

(b) FATA: Teacher training facilities will be expanded and improved, particularly forfemales through added hostel space. 180 existing schools will be provided withresidential quarters for female teachers. Policies aimed at increasing enrollments,including free textbooks, improved learning environment and milk distributionprograms, will be initiated. An estimated 540 girls' schools and 240 boys' schoolswill be constructed during the three year period. Buildings will be provided for 180shelterless schools and 300 schools will receive additional classrooms. It isexpected that the GERs for girls and boys will increase to 38% and 81%,respectively.

(c) FANA: The primary education curriculum will be reformed, pre-and in-serviceteacher training will be strengthened and supervision improved with the aid ofcommunities. A permanent EMIS cell will be established. An estimated 420schools will be constructed during the three years, and 750 village schools will beopened with the support of local communities. It is expected that the GERs for girlsand boys will increase to 36% and 65%, respectively.

(d) ICT: The planning and management capacity of the Federal Directorate ofEducation will be improved, particularly through the addition a NEMIS cell. TheICT has already achieved universal primary enrolment; hence only a limitedconstruction program of an estimated 30 schools and 120 additional classrooms isrequired. Teachers will be recruited as required.

30. Links to Other IDA/Donor Projects: Every province has five to seven donorprojects under the primary education component of SAP, and about 80% of current donorfinancing comes from IDA. These donor projects represent about 70% of the developmentbudget for education, with recurrent costs to be borne by the Government. However, theGovernment has been unable to fully finance the recurrent costs of expanding primary education,leaving schools without enough teachers, and teachers without enough instructional materials.The SAPP support would remedy these deficiencies through budgetary support for recurrent anddevelopment costs, where gaps exist. The SAPP supports the implementation of these ongoingand planned projects and program by reinforcing the key policy measures introduced andproviding an integrated framework to facilitate implementation.

2. Primary Health Care

31. Status: general health indicators are improving slowly but remain poor (the under-five mortality rate for girls was 139 and for boys 137, compared with averages of 96 and 104

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respectively for all low-income countries). The Eighth Plan sets a range of ambitious targetsincluding increasing life expectancy by two years and reducing infant mortality by nearly 25%.Although the establishment of a primary health care program (PHC) has been a governmentobjective for over a decade, nowhere in Pakistan has a strong, large-scale PHC program yetbeen successfully organized. National PHC policy is generally sound, especially in its emphasison MCH, but implementation has been weak, especially in remote rural areas. Yet Pakistan hasrecorded a major achievement in the construction of an extensive network of basic healthfacilities throughout the country; over 95% of Union Council areas now have a facility. Thenext step will be to improve the functioning of these facilities while gradually expanding to theareas that remain under-served.

32. Organization: the federal government establishes health policy, including that forPHC, while the provincial governments are responsible for its execution. In practice, thieprovincial Departments of Health implement all PHC programs (although the federal governmentprovides supplies for e.g. the immunization and malaria programs). PHC programs run mainlythrough the Departmental line hierarchy (provincial, district, sub-district and individual facility)although many of the communicable disease programs have partly parallel supervisory systems.The overall result is a complex organization structure.

33. Issues: a wide range of issues need to be solved before reasonable quality PHCservices will be available to most people in Pakistan. Financing of the sector generally isinadequate (typically less than 3% of public expenditure) and that for PHC particularlyinadequate. PHC services are of poor quality for a number of reasons. Despite the generalavailability of small health facilities, they are often inadequately staffed, and attendance by staffis erratic. Small health facilities are especially short of female paramedical staff (there are onlysome 3,000-3,500 qualified female paramedical staff in the rural public health system). Keysupplies--medicines, contraceptives and equipment--are very poor. The supply of medical andparamedical staff is severely unbalanced; for example, there may be as many as 6,000unemployed doctors. Most doctors are untrained in PHC work. And in-service PHC trainingfor all staff needs to be organized. Funding for key non-salary items, such as medicines andpetrol, is seriously deficient (around 25-30% of the total PHC recurrent budget in mostprovinces) and tending to decline. Very few family planning services are provided through thePHC system; health education is in its infancy; anI preventive and control programs have lowpriority. Management capabilities throughout the PHC system are very limited, and thedifficulties are compounded by the complexity of the system and inadequate decentralization.Hence, supervision of PHC services is weak. The critical referral connections between theprimary and the first and second referral levels are very poor. How to provide cost-effectiveservices to scattered populations, especially in Balochistan, has yet to be solved. On the otherhand, especially in urban areas the extensive private commercial sector (modem and traditional)and its potential for a start to involvement in PHC should be encouraged. NGOs aresubstantially involved in PHC, but the number and range of their activities is limited (there areonly about 10-15 large NGOs working in PHC) and need to be expanded. The overallconsequence of this set of inter-related issues is that PHC services are of inadequate quality,have little outreach and are severely under-used, particularly by women.

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34. The SAP Project: The SAP Project will strengthen the PHC system in theforthcoming PHC investment and recurrent programs. Particular attention will be given toachieving sufficient non-salary recurrent budgets, including increases in tde present year tomaintain the real value (particularly in Balochistan and Sindh), and subsequently real annualincreases of at least 5% for each of the three years of the SAP. The agreements will also ensurethat a full range of PHC services will be provided and that promotive and preventive servicesare properly resourced (especially the malaria and immunization programs). Service content willalso be strengthened by providing more family planning services (to some 6,500 health facilitiesby the end of the Plan) by expanding health education and by introducing essential drugs lists.More specifically, programs of new facility construction will be examined and, if necessary, cut-back to essential and modest levels. Additional female paramedical staff will be recruited andtrained, together with extra staff for the communicable disease control programs (the five yeartarget is that there should be one paramedical for 1165 people). Management and planningsystems will be strengthened, especially through improved delegation, staff training, and betterresourced health planning units.

35. The overall PHC programs are similar between provinces, but the provincialemphasis varies. The PHC system is most developed in Punijab, with the essential basicelements for service provision in place; there is one health facility for every 10-12,000 people.Therefore, the focus of the program and the reform measures is on making the system workbetter through, for example, ensuring female staff are actually available in rural facilities,introducing community health workers (in the first district in 1993/94), establishing andenforcing referral systems, strengthening and decentralizing management, and ensuring markedlybetter availability of supplies through a substantially increased (22% in 1993/94) recurrentbudget (including a significant shift from 24% to 33% of the total allocated for non-salaryexpenditure). NWFP is the other province in which there is virtually no construction of newfacilities because they have also reached the level of one facility for every 10-12,000 people.The emphasis is therefore on quality improvements including up-grading existing facilities(currently over 600, or some two-thirds of the total, in the five years), expanding recruitmentof female paramedical workers, training, increasing introduction of "hard areas" allowances forwomen, maintaining coverage of the immunization program. at over 85%, and sharply increasingthe distribution of oral rehydration salts. Sindh is unusual in having a large unfinished ruralfacility construction program of some 300 rual facilities carried over from tiie last Plan togetherwith plans for additional construction. This is being reduced, with the savings (Rs 40 millionin 1993/94) allocated to priority communicable disease control programs. Through the SAPdialogue the non-salary recrurrent budget for 1993/94 has been sharply increased (15% over1992/93) which will partly restore badly eroded budgets for medicine, maintenance and utilityin primary facilities. The position of Balochistan is rather different. The five year SAPprogram proposes 210 new rural facilities to meet the needs of the widely dispersed population;the cost-effectiveness of this approach is under review. The lack of female staff is a chronicproblem; intensive recruitment schemes and substantially improved service conditions andallowances are a central part of the program. As in Sindh, the non-salary recurrent budget wasbadly eroded and has been substantially increased for 1993/94 (by some 15% compared with1992/93). Overall, as in the population and education sectors, progress has already been made

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this year through the SAP dialogue, for example, in recruiting for female paramedical staff andin improving their conditions of service, on staff training for family planning, and on delegationof authority to districts.

36. Links to other IDA/donor projects: IDA has two Family Health projects, coveringthe four provinces, being implemented. They focus on PHC service development, with anemphasis on MCH. The other sizeable PHC projects include two financed by ADB, one inNWFP and Balochistan focusing on facility development, and the other concentrating onparamedical staff development. UNICEF and WHO are active in a wide variety of PHCtechnical areas; a few bilateral donors (for example ODA, CIDA) also contribute. Previouslarge-scale USAID assistance for PHC has virtually ceased. The design of the SAP Projectreflects much of the implementation experience of these other projects. It will complement themby reinforcing their messages, for example by emphasizing the critical need for training andhiring more female staff, improving service quality and management, and giving proper attentionto preventive and promotive services.

3. Population Welfare

37. Status: Pakistan's population continues to grow very rapidly at 3% annually, its totalfertility rate is 5.7, and the prevalence rate for contraception only 12%. Despite over thirtyyears of Government-sponsored family planning programs, the national population program stilldoes not function effectively, and availability of family planning services remains very limited.Recent policy has improved, but implementation--as in primary health--has been poor. Toaddress these problems, the Government is seeking to revitalize the population programparticularly through a major increase in service availability. Very ambitious targets have beenset including increasing the coverage of the program to 100% in urban areas and 70% in ruralareas (defined as family planning services being available within 5 kms.), a near doubling ofcontraceptive use, a four point reduction in the crude birth rate, a 10% fall in the overall growthrate.

38. Organization: unusually for a field program in Pakistan, the population program isentirely federally financed but jointly implemented by the federal and provincial governments.In practice, federal control remains substantial through the central Ministry of PopulationWelfare (MPW); provincial Departnents of Population Welfare (DPWs) focus on day-to-dayimplementation. The provincial Departments are currently being substantially expanded withthe addition of new organizational levels at the division and sub-district levels, putting them ona similar footing to other provincial line departments. At present, the government populationprogram includes 1290 clinics, 79 main contraceptive surgery centers, 130 mobile service units,and some 3,000 health facilities of other agencies offering family planning. A new crucialvillage level initiative is beginning.

39. Issues: the program needs to solve a wide range of problems before it will becomegenuinely effective. Unmet demand for services seems to be significant (about 40% of women

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wart to avoid another pregnancy), suggesting that good-quality services would be welcome.Earlier government initiatives have suffered from limited political support and prematurerevisions. Total program financing has always been modest, but under the SAP the 1993/94budget of Rs 1,100 million represents a 43% increase over the previous year. New initiativesare being introduced and have already been strongly endorsed by the Governments. Theseinitiatives appropriately focus on improving service quality (including contraceptive methodchoice, sound counselling, and readily available relevant information), combined with muchmore active village-level outreach. Work on operationalizing these initiatives is well in-hand,but needs strengthening (including the critical field supervision). Links with the independentgovernment PHC services also need strengthening. Population and PHC services are potentiallymutually reinforcing, with MPW/DPWs focusing on motivation and community outreach inaddition to routine family planning service provision, while primary health facilities focus moreon referral especially for clinical contraceptive methods, and on general MCH requirements,including the benefits of birth-spacing. Similarly, although the program is designed to be multi-sectoral, links with other key agencies (particularly education) need strengthening for this to beeffective. Management of the program remains centralized. The provincial level and belowneed strengthening to permit responsibilities and accountability to be delegated, to handle theexpanding program, and to improve supervision. NGOs already provide a substantial part ofall family planning services, cost-effectively. They net . o be further supported to expand, andto experiment with innovations. Other private sector in;uatives such as social marketing haveproved successful and should be expanded. The potential of the large number of private sectorhealth providers should also be encouraged.

40. The SAP Project: would address many of the above issues. Unlike the other threesectors included in the SAP, a fully detailed program for the coming five years for populationhas been prepared by the Government. The SAP project would support and supplement thisprogram. Important aspects include sharply expanded village outreach (increasing villageworkers from a few hundred to 12,000, such that every village of 2,000 or more people wouldhave one worker), increased service delivery points (including an extra 200 Family WelfareCenters and a doubling to 251 of the Mobile Service Units), enlarged staff pre- and in-servicetechnical training (over 4,000 trainees during the five years), management enhancements (forexample, management training up by some 25%), and strengthened population informationactivities (including a 10% per annum increase in mass media activities). Additionaldevelopments incorporated in the SAP include: measures to protect program funding and toensure that funds are available on time throughout the administrative hierarchy; for the firsttime, that population is reflected in provincial budgeting, accounting and reporting systems;strengthening of planning, operational research, and monitoring systems; steps begun todecentralize the program to the provinces and to delegate more powers to the district level:strengthening links to provincial Health Departments including through changed job descriptionsand the introduction of family planning in pre-service curricula (by the end of the Plan, over6,500 health facilities should offer family planning services); sharply speeding-up theestablishment of population education in schools; reviewing and improving the contraceptivesupply system; protecting and if possible expanding NGO projects including strengthening NGOfunding chamels (NGO activities are projected to double during the five years); and continuing

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the social marketing of contraceptives. With the number of initiatives being taken, adjustmentswill be essential to the approved five year program and an annual mechanism for this has beenagreed. Such changes otherwise would have been very difficult to make. Through the SAPdialogue, significant overall progress has already been made although difficult issues remain.

41. Links to other IDA/Donor Projects: donor support for the sector is currently limited.iDA, in addition to the SAP population work, is preparing a new population project--its first forover five years--which would support the national program. It is expected to start in 1995. TheADB has just approved its first population project focussing mainly on community outreach andstaff development. UNFPA is active in a wide variety of technical areas; a few bilateral donors(for example ODA) also contribute to key components of the government program. USAID wasby-far the largest single population donor, but all their assistance has now stopped. The lesignof the SAP Project population component draws heavily on the experience of earlier lonorprojects with all of the few donors involved in the sector having contributed directly to thepreparation of the SAP Project. Several donors are likely to reinforce key elements of theirexisting and planned projects through establishing specific links to the SAP dialogue, especiallyin areas such as institution building, decentralization, improved contraceptive logistics, andstrengthened ties with government health facilities.

4. Rural Water Supply and Sanitation

42. Status. Pakistan has set ambitious goals for extending the coverage of rural watersupply and sanitation services to its inhabitants for this decade. It is estimated that 80% of allcases of sickness and disease in the country are due to inadequate supply of safe drinking waterand sanitation. Despite the high priority accorded by the Government, only about half of thetotal population have access to safe drinking water. While about 85% of urban population iscovered, the coverage for the rural areas is less than 45%, with varying service levels acrossprovinces. Azad Jamtnu and Kashmir, Balochistan and Sindh are the worst provided, with 1991coverage of 41%, 22% and 46% respectively. Despite the low coverage, repeated surveys findthe quality of water provided through the rural water schemes has been below the acceptablestandards. Of the rural population deemed to have an adequate supply of drinking water, morethan half is served by hand pumps (mostly concentrated in the sweet water areas of Punjab andSindh). These hand pumps are not sealed, permitting infiltration of contaminated surface waterrendering the water unsafe. Due to high cost and inappropriately designed latrines, lack ofperceived need, and limited government promotion of health benefits associated with hygiene,only 12 % of the rural population have means to safe sanitation (compared to 55 % for the urbanpopulation).

43. One additional factor that will influence the future development of the sector ispopulation growth, and the spatial distribution pattern in rural areas which results in high unitcosts of basic water and sanitation services, endangering their affordability to the rumral poor.The need thus exists to concentrate on low-cost technologies and staged approaches to theprovision of these services in order to permit the implementation of sustainable schemes.

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44. Organization. Under the Constitution of Pakistan, the provincial and stategovernments have responsibility for water, sanitation, and local government affairs.Nevertheless, as in most of the other social sectors, the Federal Government has considerableinfluence over the planning process and program funding. The Physical Planning and HousingSection of the Planning Commission is responsible for processing water supply and sanitationinvestments as the part of the Annual Development Plan (ADP). At the provincial/state level,sector activities are coordinated by the Planning and Development (P&D) Departments whichare also responsible for planning and coordinating development activities in the province/state,including the ADP's foreign aid components. The Public Health Engineering Departments(PHEDs) are the main sector implementing agencies at the provincial level. These were initiallyset up to provide services to the urban areas, but because of the growing need, have recentlybeen involved in the rural areas as well with a primary focus on medium and larger settlements.The Departments for Local Government and Rural Development (DLGRD) are community-oriented and are responsible for supervision and coordination of the functions of District andUnion Councils, including basic services such as water supply, community health, drainage andeducation. The District Councils, on the other hand, have the responsibility for disbursementof ADP grants and their own resources for specific schemes. Union Councils are the lowestlevel in the local govenmment with each council covering some 10-18 villages. Theirresponsibilities include, among other functions, water supply, sanitation and disposal of solidwaste.

45. The multiplicity of institutions has led to overlapping responsibilities, contradictorypolicies, management deficiencies, and unqualified staff. Donors introduce technologies whichrequire a level of maintenance not available in Pakistan into the projects they fund. In addition,the intended beneficiaries did not change behavior or attitudes that are critical to the projectsuccess because they were not participants of the decision-making process of the new schemes.The failure to mobilize the will of the people is one of the major reasons why many schemes fellinto disrepair.

46. Issues. To improve water and sanitation services, and to achieve the national sectorgoals, the financial arrangements of the sector have to be improved to foster increasedinvestment productivity, higher user cost recovery, and better utilization of the existing facilities.The major fnancial constraints in the sector are:

(a) Over-dependence on federal or provincial grants and the donor community. Ananalysis of the investments made from 1989 to 1992 indicates that over 98% of theinvestment resources came from federal or provincial grants and from the donorcommunity. The availability of these moneys allows designs and construction to takeplace outside the realities of cost considerations and provides little incentives for theeffective operation and maintenance of the schemes. In addition, the limitedresources do not allow an adequate increase in coverage.

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(b) Lack of consistency of the policy framework. These different sources of financialassistance to the sector result in an arbitrary allocation of funds and hidden subsidiesand system inefficiencies.

(c) Weakl" enforced policies of communitv provision of O&M resources. The weakenforcement of community provision of O&M resources often has resulted ininadequate arrangements to pay for operation and maintenance costs; neither thecommunity, the local council nor the provincial govermments have providedadequate funds resulting in deterioration of the systems and unpaid electricity bills.

(d) Low cost recovery. High capital cost, lack of consumer affordability, poor watersupply services, and the notion that water supply is a "free public good" have beenused to explain political resistance to enforced cost recovery. As a consequence, theobjective of sustainability is largely defeated. A scheme-specific pricing policy forrural water supply is a more effective method for sustainability, as evidenced byworld experience in community-managed schemes. Most community-managedschemes collect recurrent funds on an ad hoc basis, often maintaining a small fundfor use as required.

(e) Deficient investment plnning and analysis. Too often, the rural water supply andsanitation systems in Pakistan are over-designed or do not take into account properphasing and least cost analysis. There is a tendency to build new schemes, andalternative solutions such as more efficient use of the existing facilities are often notconsidered.

47. SAP Project. The governments commit themselves to:

(a) adopt a uniform policy for establishing and financing RWSS, to avoid the almostcomplete subsidization that occurs now;

(b) introduce community management and participation in the design and operation ofRWSS;

(c) the full operation and maintenance costs for existing schemes until transferred to thecommunity;

(d) formulate a strategy and take steps toward implementing that strategy to introducecommunity participation in existing schemes in the long-run; and

(e) introduce effective cost recovery mechanisms.

48. A major shift in the policy environment of the rural water supply and sanitationsector has already taken place; however, an important concern is that a large part of the ruralpopulation in Pakistan still lacks access to safe and sufficient water for domestic purposes. This

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concern is much greater in sanitation. Furthermore as a large portion of the existing systemsare not functional, the actual coverage level is even lower than what is shown in statistics. Theproposed project aims to support GOP's sector strategy to reverse this deterioration, and wouldfinance agreed investments in the first three years of the Eighth Five-Year Plan.

49. The Five-Year Plan (FY94-99 . The Eighth Five-Year Plan prepared by the GOPintends to increase rural water supply and sanitation coverage, build sustainable schemes, anddevelop a system which encourage community participation. The Appraisal mission reviewedthe Plan and found that it is sound in concept. The Eighth Five-Year Plan is expected to provideservices on a sustainable basis for an additional 18.3 million people with water supply and 22.0million people with adequate sanitation. It was agreed that the following sectoral issues whichact as impediments for implementing the government strategy, need to be addressed duringproject implementation.

The Reform Agenda

(a) Sustainability. Experience in Pakistan shows that water supply and sanitationservices which are provided by public bodies are not properly maintained. Thisresults in a generalized lack of sustainability of the initial benefit and a waste of theoriginal investment. Many of these facilities are technologically inappropriate,incorrectly located, socially unacceptable, environmentally unsound, not very userfriendly, or suffer from a combination of some or all of these limitations. Often,recipient communities do not perceive such facilities as belonging to them and,hence, take no responsibility for maintenance or continuing operation of theschemes. In addition, the public bodies are not well equipped to handle the task,especially given the widely scattered and often remote locations which have to beserved. Lack of financial resources, the high cost of capital replacement and thelack of trained personnel and staff motivation contribute to the problem ofsustainability. Unlike government bodies, most rural communities have both thecapability and willingness to maintain water supply and sanitation schemes, if theytake on responsibility for the initial construction and if they feel that the systems aretheir own property.

(b) Full Commitments for Community Management. Although the general agreementto transfer the management of schemes to communities calls for the future reductionof the O&M expenses, the non-development budgets of all the provinces and federalareas do not indicate this trend. A progressive decrease in the O&M expenses ofschemes should therefore be reflected in the five year plan. Furthennore, thepercentage of salary expenses also show an increasing trend, which should graduallyslow down. It was agreed that the year's non-development budget will reflect theabove recommendations.

(c) Implementation Capacity. The mission accepted the proposed development budgetswith the understanding that the implementation capacity of the line departments will

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be enhanced with the involvement of the NGOs. The governments recognize thatboth the PHED and LGRDD are severely under-equipped, especially in the requisitecommunity mobilization and training skills, for the major tasks ahead. It wasagreed that each line department will prepare the procedures to be adopted topromote and involve NGOs in the implementation of the SAPP by Appraisal.

(d) PHED O&M Staff. One of the major constraints for transferring the managementof the schemes to the communities is the PHED O&M staff. As schemes aretransferred to the communities the PHED, O&M staff will be rendered surplus. Toavoid/reduce this constraint, it was agreed that each PHED will prepare (i) a planfor retraining or helping O&M staff to move into the private sector, and (ii) aproposal of a program of retrenchment of others by offering them a goldenhandshake. Several provinces are considering the possibilities of assisting staff tocreate their own O&M/construction companies for which a special fund would berequired.

(e) Sanitation. In spite of an extremely low sanitation coverage, most of thedevelopment plans are stidi heavily biased towards water supply schemes only. Itwas agreed that preparation of the 1994/95 development budgets will take in.oaccount the lack of sanitation in the communities. This low sanitation coveragehampers the achievement of better health indicators.

50. The 1993/96 Plan. The proposed project is addressing the financial gap of the three-year Plan. The Plan is going to be reviewed every year to take into account the real investmentsmade the previous year and the actual capacity building achieved. As proposed, the FY94-96Plan will increase the services coverage of water supply and sanitation.

51. The 1993/94 Plan. The 1993/94 Plan has been appraised in detail and an agreementhas been reached in Punjab, NWFP, Sindh, Balochistan and the Federal Areas. The exceptionis FATA. The UNDP/World Bank Regional Water and Sanitation Group (RWSG-SA) inIslamabad is assisting the FATA, to revise its 1993/94 Plan, and develop a strategy coherentwith the SAP Donors Guidelines.

52. Links to other IDA/Donor Projects: The major donor-aiided project in the RWSSsector is the IDA funded Rural Water Supply and Sanitation Project, which covers Sindh,Balochistan and AJK. There are a variety of donor-aided interventions in search of community-based solutions, including a program by UNICEF and the Government of German's KFW andGTZ programs in several provinces. The SAP has maintained an integrated approach tocomplement the on-going efforts in RWSS, both in terms of financing and program design.

5. Monitoring and Evaluation (M&E)

53. The Monitoring and Evaluation program is comprehensively presented in the SAPProject Staff Appraisal Report itself (Chapter IV). The key implementation tool for the

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monitoring committees mentioned in the SAR are the monitoring indicators. These have beenagreed between the provincial and federal governments and the donors, including IDA. Theformat of these indicators are attached to this annex as Attachment One.

6. The Participatory Development Program (PDP)

54. As noted in Chapter 2, the SAP Project will include a program to explore newapproaches for involving communities, testing innovative ways to deliver social services at thecommunity level, and fostering stronger linkages between communities, NGOs, and Governmentservices in the SAP sectors. The Participatory Development Program (PDP) will provide fundsto NGOs and others to innovate, demonstrate and institutionalize new working partnershipsbetween communities and government agencies to rehabilitate and deliver SAP target services.It is intended that $10 million will be provided for the PDP, with $5 million to be allocatedbeginning in 1994/95. An additional $5 million will be allocated if the program provessuccessful.

55. The SAP's effectiveness can be enhanced by creating and supporting strongcommunity organizations which government line agencies can use to: a) deliver social servicesthat communities -want, are willing to pay for and will use; and b) establish communitywillingness to manage, monitor or take care of services provided. Community organizationsneed to be strengthened and new community based delivery approaches demonstrated on a largescale. However, successful institution building at the community level through participatorydecision making is by definition demand- based, time-intensive and location-specific. It precedestechnical inputs from line agencies and requires the presence of intermediary support groups thatcan respond to cross sectoral community needs. Field based NGOs are best placed to undertakethis community organizational work and act as intermediaries, facilitating linkages betweencommunities and various govermnent agencies.

56. It is estimated that there are approximately 10,000 NGOs in Pakistan, most of whichare small and have not worked in direct collaboration with government line agencies in the socialsectors. The NGO sector in Pakistan is not as developed as in other countries in South Asia.There are many policy and procedural obstacles to successful NGO operation on any scale inPakistan. These include: taxation policies, govermnent procedures regulating NGOs andcomplicated procedures to access funds; inherent difficulty in channelling assistance andassessing the performance of thousands of small and scattered NGOs; lack of interest andexperience among line agencies in working with NGOs. However, the new governmentrecognizes NGOs as important development partners in improving the Human Developmentindicators in Pakistan.

57. Despite the obstacles, and inspired by the successes of community based programssuch as AKRSP (Aga Khan Rural Support Program) and OPP (Orangi Pilot Project), severallarge scale Rural Support Programs and apex NGO organizations have become operational inthe last few years. These organizations support and create a network of well functioningconmmunity based organizations in limited geographic areas, either directly or by financing

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smaller NGOs. They have been financed by the GOP and international agencies.

58. Hence, there is need for NGOs to support new community, NGO and governmentpartnerships in (i) implementation of SAP sector activities where community organization workhas already been undertaken; (ii) direct support to community based social sector activities wheredemand is high; (iii) pilot projects to demonstrate community managed approaches wherenecessary; and (iv) policy refinement to remove existing bottlenecks (including fundingmechanisms) to effective community, NGO and government partnerships.

59. No new institutions will be created. The PDP will operate through existinginstitutions and mechanisms to ensure strengthening of existing organizatiorns and timely accessto funds by NGOs. The PDP will consist of grants directly to NGOs with a proven track recordand field presence. These NGOs or other community outreach organizations will be requestedto submit detailed project proposals to the Federal SAP coordinating unit. The proposals willbe reviewed by the P&D and submitted to the Bank for approval. While the proposal and workprograms will be for longer periods, funds will be approved on a yearly basis based on previousperformance. No proposal below $100,000 will be considered.

60. Grant money will be transferred upon authorization by EAD direc.ly to the pre-qualified NGOs on a six monthly basis. IDA will provide credit funds to the GOP for thispurpose through a Special Account opened for the purpose. All the NGOs will submit quarterlyprogress reports documenting progress on agreed indicators and financial statements; financialreporting and audits will be conducted in accordance with EAD procedures for NGOs on behalfof the Bank. In addition to undertaking quarterly monitoring visits, P&D will organize yearlyevaluations of the NGOs and together with the Bank organize and manage the final evaluationof the component.

61. The monitoring and evaluation of this component will be integrated into the overallM&E framework for the SAP. The M&E framework will incorporate capacity buildingindicators and participatory methods including beneficiary assessment procedures. The UNDP-World Bank Water and Sanitation Program will provide technical expertise and monitoringsupport to the rural water sector activities financed under the PDP.

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C. Project CostsCosts of the Social Action Program

(Current USS million and Rs million)

In Current US Dollars (Million) In Current Rupees (Million)Three- Five- Thrce- Five-

Starting Year Year Starting Year YearYear Program Program Year Program Program

(1993/94) (FY94-96) (FY94-98) (19S3/94) (FY94-96) (FY94-98)

PUNJAB 532 1.789 3.457 16,184 57.242 112.832Education 362 1,259 2,434 11,023 40,276 79,455Health 79 260 532 2,412 8,314 17,353RWSS 90 270 491 2,750 8,652 16,024

SINDH 237 782 1,471 7.204 25,031 47,998Education 175 578 1,096 5,335 18,497 35,760Health 36 105 190 1,096 3,345 6,204RWSS 25 100 185 773 3,189 6,034

NWFP 157 594 1.156 4,790 19.002 37.729Education 99 378 736 3,024 12,088 24,016Health 19 99 182 579 3,156 5,956RWSS 39 117 238 1,188 3,758 7,757

BALOCHISTAN 116 364 689 3,517 11.659 22.50Education 57 168 315 1,736 5,375 10,280Health 23 107 218 694 3,436 7,123RWSS 36 89 156 1,087 2,849 5,100

PROVINCIAL SUB-TOTAL 1 041 3.529 6.773 31.695 112.934 221,063Education 694 2,382 4,581 21,117 76,236 149,512Health 157 570 1,122 4,781 18,250 36,636RWSS 190 576 1,070 5,798 18,447 34,915

AZAD JAMMU & KASHMIR 28 104 207 837 3,319 6,772Education 17 65 130 524 2,076 4,236Health 5 20 41 164 652 1,330RWSS 5 18 37 149 591 1,207

FEDERAL SUB-TOTAL 88 387 751 2,667 12.377 24.521Other Federal Areas 36 137 275 1,108 4,393 8,964

Education 19 79 166 563 2,522 5,408Health 7 26 49 201 845 1,608RWSS 11 32 60 341 1,027 1,947

Population 35 173 350 1,054 5,533 11,425Communicable Disease Control 16 66 116 475 2,099 3,773Participatory Development Program 0 5 5 0 160 163SAP Monitoring & Evaluation 1 6 6 30 192 196

NATIONAL TOTAL 1.156 4.020 7.731 35.2 0 252.356

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D. FinancinR Plan

Sources of Funding for the SAP in FY93/94-95/96(Current US$ million)

Total %

Government's internal resources 3.050 75.9Existing/expected aid 5 13.7Program Assistance 313

IDA (SAP Project) 200 5.0ADB 100 2.5Government of the Netherlands 13 0.3

Additional Assistance to be MobilizedPossible Sources

Other Sources, Including IDA/ADB/Netherlands 105 2.6

Total 4,020 100.0

Disbursements

Estimated Disbursement Schedule

(US$ Million)

1993/94 1994/95 1995/96Annual Disbursements 50 80 70Cumulative Disbursements 50 130 200

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II. Inplementation Arrangements

A. Overal responsibility

62. The Government of Pakistan (GOP), and its political sub-units, are the implementingagencies of the Social Action Program, with GOP's Planiing Division acting as the sponsoringand coordinating agency. The Secretary of Planning has overall responsibility for the nationalSAP and for the SAP Project. He is assisted by the Federal SAP Secretariat, a unit in thePlanning Division. In addition to these coordinating and sponsoring roles, the Planning Divisionhas direct responsibility for implementing two project components -- the ParticipatoryDevelopment Program (PDP) and the monitoring and evaluation program (see below).

63. A national SAP Steering Committee, chaired by the Deputy Chairman of thePlanning Commission and a Provincial SAP Coordinating Committee, will meet quarterly ormore often if required -- to provide impetus and direction and assess progress.

64. Provincial/Territory Sub-Programs. The provincial/territory (and AJK) governnnentsare responsible for implementing the sub-programs in primary education, primary health care,population and rural water supply and sanitation -- 94% of the SAP -- through their establishedsectoral line departments. Their departments of Finance and of Planning and Development(P&D) have responsibilities for financial control and coordination. These sub-programs aresupported by Operational Plans but include expenditure and Implementation Plans.

65. Federal Sub-Progam and National Program. The Ministry of Population Welfarehas overall responsibility for the population program nationwide, along with responsibility forproviding guidance to provincial level population welfare and health departnents. Thepopulation sub-program is also supported by an Operational Plan. The ministries of Health andEducation are responsible for implementing national programs, such as the Ministry of Health'scommunicable disease control program and the Ministry of Education's National EducationManagement Information System.

B. Inplementation Agreements between GOP and the Implementing Agencies

66. Before the SAP started, the GOP asked the agencies responsible for deliveringPakistan's basic social services -- the provincial and territory governments -- to formulate aprogram to improve the quality of, and enhance the capacity to deliver, these services over theperiod of the Eighth Plan, 1993/94-1997/98. The GOP also asked IDA and other donors to helpthe implementing agencies to formulate these programs. After many drafts and reviews,programs were elaborated for the five-year period as a whole and will be detailed in annual SAPOperational Plans. The first, for 1993/94 has been completed.

67. The annual Qperational Plans consist of three elements: (i) an implementation planof reforms, which details the steps (prior actions) taken before the outset of the period and thefollow-up steps to be taken in order to overcome identified constraints to enhanced delivery of

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services; (ii) a non-development budget (mainly the budget for recurrent costs) sufficient toimprove the quality of the services delivered; and (iii) a development budget (mainly tbe capitalcosts of physical expansion but also important non-capital costs, such as training).

68. The Operational Plans prepared by the implementing agencies were approved by theGOP as a basis for funding, while the five-year programs were reviewed and agreed at theadministrative level. Although the Eighth Plan as a whole has yet to be approved at the politicallevel due to the transition in governments during 1993, the Social Action Program, because ofits priority, was approved in total and for the first year by the National Economic Committee(NEC), the competent body. The first year's GOP financing for the SAP was protected fromdiversion to other uses by making it non-fungible with non-SAP resources.

C. The Planning, Approval, Implementation and Monitoring Cycle

69. Implementation of the SAP occurs on a fixed annual cycle, geared to the annualbudgeting and planning processes of the Govermment and the implementing agencies. Provincialassemblies approve the annual budget and annual development plan during June of each year,before the beginning of the Government fiscal year on July 1. To prepare for this, theimplementing agencies involved, with assistace from the Multi-Donor Support Unit (see below),begin formulating their Operational Plans for each sub-program by December of the previousyear; they work on them through the Spring before submitting them for approval by theirgovernments.

70. In March-April of each year, before the Operational Plans are formally approved,they will be assessed by IDA and associated donors. An IDA/donor mission will visit, reviewthe plans, and leave behind its written recommendations for the consideration of the governmentsinvolved. These recommendations will cover the level of non-development recurrent budget,the development capital budget, and the next steps to be taken on the implemnentation refomnsunderway in each target sector.

71. The provincial and federal governments will then finalize their Operational Plans(including budgets and plans for reforms) and set in motion the implementation reforms toprepare for the coming fiscal year. The plans (budget and reforms) will be approved by theadministration, government and assemblies of elected representatives before July 1. In parallelwith these preparations, the Government, in early Spring each year, will communicate the broadoutlines of the SAP to the implementing agencies, and indicate the level of Governmentdevelopment loans that will be available to help carry it out. Once the plans, budgets, and up-front reform measures are approved by the Government (NEC) and the provincial/territoryassemblies, IDA and the other donors supporting the SAP will check to make sure they stillapprove them. At the same time, eligibility for IDA/donor support of each sub-program willbe assessed. Sub-programs whose Operational Plans are approved, and where tt it required up-front measures are in place, will be eligible for donor reimbursement of a p.rt of programexpenditures. Sub-programs that are not in agreement, or which have not comp .ied sufficientlywith the requirements for prior action, will be the focus of corrective efforts, looking toward

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eventual agreement, if possible. Eligible sub-programs will be allocated funds forreimbursement; those not yet eligible will be allocated funds only when they become eligible.

72. The implementing agencies will carry out the programs as agreed. The federalGovernment will provide its share of the SAP financing in advance, each quarter, to theprovincial and territory finance departments, which will in turn release the funds for expenditurein a timely way so that the agreed programs proceed smoothly. The governments will preparethe basis for donor reimbursement for the eligible sectors (Statements of Expenditure, or SOEs)and forward them to the donors, who will check for eligibility and reimburse the agreedpercentage of eligible expenditures.

73. From the outset of the fiscal year, the SAP monitoring arrangements describedbelow will be in operation. The first quarterly meeting of SAP monitoring committees (at bothprovincial/territory and federal levels) will take place in early October, with subseq-uent meetingsaround the end of December, March and June. Discussion will be based on brief SAPmonitoring reports prepared, respectively, by the P&D departments in the provinces and by thePlanning Division at the federal level. The reports will also be forwarded to donors for review,along with minutes of the meetings.

74. After the government monitoring committees report their findings, they will beconsidered at quarterly SAP meetings organized by the MSU for interested donors, governmentagencies and NGOs. The purposes of these meetings are: (i) to review progress under the SAPand disseminate information of any kind related to the program, including progress/problemswith other donor-aided projects in the target sectors; (ii) to provide a formal mechanism fordonors (whether participating in the funding of the SAP or not) to raise issues of concern; and(iii) to provide a forum for advice from the larger donor community on the futureimplementation of the SAP itself.

D. Supervision by IDA

75. The SAP Project will require intensive supervision by IDA. Fortunately, the netincrease in the resources required for this task is less than it would otherwise be, because relatedIDA-supported operations already exist in virtually every sub-program of the SAP -- primaryeducation and primary health in all four provinces; rural water supply and sanitation in twoprovinces and the AJK; and, prospectively, the population program. This will permitsupervision efforts to be combined for greater effectiveness. A similar situation exists for theAsian Development Bank, the second largest SAP donor.

76. As noted earlier, IDA would need to start its supervision cycle with a March/Aprilmission to review the draft Operational Plans being prepared for the coming fiscal year. Thiswould be the major supervision mission of the annual cycle and would involve a review of eachgovernment's and each sector's budget, plan and implementation reform proposals, as well asa review of monitoring over the previous three quarters (i.e., since the beginning of the fiscalyear). Required reviews of on-going IDA-supported investment projects would be included

85

under the umbrella of this SAP mission, since the mission member would possibly include thesame people who would review the sector-specific projects.

77. A second supervision mission would be a brief review of the Operational Plans(budgets and reform measures) as formally passed by the assemblies. It would take place earlyin the fiscal year (i.e., late June/early July). This inission would determine eligibility ofindividual su')-programs for IDA funding and would leave a record of recommendations on whatit would take to make deficient programs eligible. The second mission would also review thegovernments' monitoring of progress and the results of the quarterly SAP monitoringcommittees.

78. The third and final supervision mission of the annual cycle would probably takeplace in December or January, to review mid-year progress and contribute IDA's views onissues to be addressed in preparation for the coming year's Operational Plans. This missionwould also check on the goverrments' monitoring progress.

E. The Role of the Multi-Donor Support Unit (MSU)

79. The MSU has an important role to play throughout the implementation process.Early on, in preparation for the first year, it organized technical task forces -- one for each ofthe target social sectors -- to identify issues relating to policy reform measures, budgets andplanning which, in the view of the various donors, should be addressed. The MSU conveyedthese issues ("Guidelines") to the provincial and territory governments, for their information anduse in preparing the Operational Plans. The MSU will continue this process in future years,forwarding its recommendations in December and January. It will also coordinate -- and, as alast resort, provide -- technical assistance to help the implementing agencies prepare theirOperational Plans.

80. In addition, the MSU will give selective assistance to governments to help themmonitor and coordinate these programs. It will ensure that issues identified by donors for thecoming year's SAP are understood by the implementing agencies; that governments receive anytechnical assistance needed to prepare the draft Operational Plans in time for the March/Aprilreview mission; and that the information needed from the actual budgets and plans, as approvedby the assemblies, is presented in simplified formats for the June/July mission. The MSU willalso keep in touch on a continuous basis with the monitoring and evaluation undertaken bygovernments and assist them as needed to improve the operation of that system. It will ensurethat the monitoring reports and minutes of the quarterly monitoring committee meetings reachthr concerned donors, including IDA, and it will stand ready to help governments to organizeany training needed for operating the procurement and disbursement systems for IDA and theother donors involved.

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III. Implementation Plan

A. Detailed Implementation Plans

81. Each provincial and territorial sub-program, and the national and provincial populationprograms have agreed implementation plans. These plans are prepared annually for the comingfiscal year, are agreed upon with the World Bank staff and approved by the goverunentsinvolved. They are in presented in a matrix form for simplicity and ease of updating. Theirformat includes;

(a) identification of the policy issue(b) notation of up front actions (to be) taken(c) identification of follow up actions to be taken during the fiscal year in question;(d) notification of the agency responsible for taldng the needed action;(e) (quantitative) indicators of the concrete steps or reforms to be taken during the fiscal

year;(f) (quantitative and time-bound) indicators of outputs or achievements; and(g) specification of the assumptions and/or risks underlying the actions (to be) taken.

82. These implementation plans for each sub-program mentioned above form part of theagreed Operational Plarns. These plans are to bulky too append to this report. They areavailable with the implementing agencies, the Government and form part of the SAP project file.Summaries of the key reforms for 1993/94, distinguishing between up front actions and followup actions are presented in Attachment Four ("Pakistan: Social Action Programme (SAP)Implementation Plans: Summary of Key Reforms, September 1993, Planning and DevelopmentDivision, Government of Pakistan").

B. Disbursement Arrangements

83. The disbursement arrangements under the SAP Project are covered in Chapter Imof the SAR. That discussion mentions the Statements of Expenditures (SOEs) that are expectedto handle the vast bulk of disbursement claims. Attachment Two of this annex contains theformat of the SOEs agreed with the various governments, IDA and other donors.

C. Procurement Arrangements

84. The procurements are also covered in Chapter III of the SAR. That discussionmentions the use of consultants by the Government to monitor procurement under the SAP.Draft terms of reference for these consultants are attached (Attachment Three).

85. Goods, services and civil works will be procured according to Governmentprocedures, which have been found by other IDA-supported projects to be in conformity withIDA's procurement guidelines. At IDA's request, the Government has agreed to correct someminor shortcomings identified during appraisal. To that end, the govermments concerned agreed

87

to issue written instructions to their line departments to adjust their practices to conform withthe written Government procurement procedures. These instructions will specify that:

(a) Calls to bid will be advertised in local newspapers;

(b) Bidders will have at least 30 days to obtain bidding documents and submit theirbids;

(c) Bid evaluation criteria will be set out in the bidding documents;

(d) If pre-qualification is required, then the pre-qualification list should be reopenedperiodicall} to allow consideration of additional firms, contractors, suppliers andindividual consultants; and

(e) Use of the standard schedule of rates (SSR) should be used for estimation purposesonly; contracts should be awarded on the basis of market prices (not a percentageof the SSR) submitted by contractors; and no post-bid negotiations on competitivelybid contracts should be allowed.

86. Most procurement is expected to involve small contracts suitable only for localcompetitive bidding and prudent .hopping. Some items, however, will be suitable forinternational competitive bidding. These include vehicles, chemicals and some pharmaceuticalproducts, and large consulting services contracts. Procurement of these items will conform toIDA guidelines.

87. Shortcomings in the application of procurement rules are often due to theunfamiliarity of Government officials with IDA guidelines and the Government's ownprocedures. This is partly the result of frequent staff rotation, lack of training in procurementprocedures (GOP's and donors'), and inadequate monitoring. The Project, therefore, makesspecial provision for monitoring and procurement practices and training staff involved inprocurement matters.

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ATTACHMENT 1

MONLTORING INDICATORS PROFORMALEADING GOALS

1. Improve social indicators, especially for females; increase female staffing ofservices.

2. Reverse past neglect of social sectors by increased funding and better delivery; clearbottlenecks to implementation, and improve quantity and quality of services.

3. Increase community/NGO/private sector participation in delivery and financing of socialservices.

4. Protect social sectors from aus;erity cuts.

5. Improve quality and cost effectiveness of services.

6. Make the provision of social services needs-based and demand-oriented.

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EDUCATION PROVINCE/ AGENCY

INDICATORS BASELINE TARGET ACHIEVEMENT1992/93 1993/94 1993-94

A. OUTPUT INDICATORS

1. Total and X enrolled (K-5) Boys/Girls

2. Total and X enrolted in Class-5 Boys/Girls

3. Number of Government Primary Schools without students

4. Number of Rural Government Primary Schools withPupil/Teacher ratio below 10. -

B. POLICY REFORM PROGRAM INPUTS

1. Minimum X Increase in the Number of Schools with MixedEnrol lient under Female Administration

2. Minimua X Decrease in the Number of Rural Female TeachingVacancies

3. Number and X of Untrained Female Teachers Trained throughCondensed pre-service and in-service Training Program

4. Number of Village Education Committees

5. Percent of teachers hired from the same districts as theschool (Male/Female)

6. Percent of total teachers transferred during school year(Male/Female)

7. Percent of sites selected on need-based criteria accordingto EMIS data (based on agreed criteria)

8. Percent of Female Schools provided with:

a) Latrineb) Waterc) Boundary Walls

C. FINANCING INDICATORS

1. RaMease

a) Development Budgetb) Recurrent Budget (Salary/Non-salary) - Non-salary as X

of total recurrent budget

2. Ex.enditure

a) Development Budgetb) Recurrent Budget (Salary/Non-salary) - Non-Salary as X

of total recurrent budget

hX = Annual Reviewi/ = Semi-Annual Reviewii/ = Quarterly Review

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RURAL WATER SUPPLY & SANITATION PROVINCEt AGENCY

INDICATORS BASELINE TARGET ACHIEVENENT1992/93 1993194 1993-94

A. OUTPUT INDICATORS

1. Percent of Vitiages with access to water

2. Number of Households with access to sanitation /

3. Percent of villages managing and running schemes (of totaLwith schemes)

B. POLICY REFORM PROGRAM INPUTS

1. Nwuer and percent of new schemes with Memorandum ofUnderstanding by Community organization to undertake 0&"

2. Number and % Existing Schemes handed over to comunmity tomanage and run

3. Number of villages with VO s and TVUAs - as X

4. For PHED-run schemes, X villages seeking Cost RecoveryObJectives

S. Percent of staff trained in community organization(male/female)

6. Percent of new schemes designed and planned with commmnityinvolvement (men, men and women)

C. FINANCING INDICATORS

1. Release

a) Development Budget

b) Recurrent Budget (Salary/Non-salary)

2. Excenditure

a) DeveLoptent Budget

i) water supplyii) sanitation

b) Recurrent Budget (Salary/Non-salary) - CUE as X oftotal recurrent budget

/ = Annual Reviewjj - Semi-Annual Reviewi_ Quarterly Review

HEALTHI PROVINCE/ AGENCY

INDICATORS BASELINE TARGET ACHIEVEMENT1992/93 1993/94 1993-94

A. OUTPUT INDICATORS

1. EPI Coverage _/

2. Introduction of EDL

S. POLICY REFORM PROGRAM IN?UTS

1. Number of contraceptive acceptors at DON Outlets forBHUs/RHCs MedicaL Centers i/i (Male/Female)

2. Number of LHV/Female Pare/Medical Vacancies hi is %

3. Number TBAs/Number of BHUs and RHCs

4. Number of Community Health Workers (Female), Number of8HUs and RHCs

5. % of BHUs & RHCs with residential quarters

6. Number of Health Outlets out of stock of at least one typeof contraceptives for more than 4 weeks ii(

7. Admission to LHV/FHT Schools

8. Introduction of PHC component in Curricula of Doctors (onetime activity)

C. FINANCING INDICATORS

1. Release

a) Development Budget

b) Recurrent Budget (Salary/Non-salary) - Non-salary as Xof total recurrent budget (rate of growth)

2. ExDenditure

a) Development Budgetb) Recurrent Budget (Salary/Non-salary) - Non-Salary as %

of total recurrent budget (rate of growth)

A/ = Annual Reviewi/ = Semi-Annual Reviewii/ = Quarterly Review

92

POPULATION PROVINCE/ AGENCY

INDICATORS BASELINE TARGET ACHIEVEMENT____ ____ ____ ______ 1992/93 1993/94 1993-94

A. OUTPUT INDICATORS

1. Percent in Mumber of Continuous Users ilj (Male/Female)

2. Number of Users Served Through Private Sector (NGOs, SMC,Private Maternity Service

8. POLICY REFORM PROGRAM INPUTS

1. Number of VFPWs (Trained/Working in Conumunities) iil

2. Number of FwCs that in anv month did nct have a futlsupply of Contraceptive ii/- % of Districts with 6 months supply

3. Number of doctors given practical training in familyplanning methods

4. Number of Vacant Posts if/ (Male/Female)

5. Number of districts with contraceptive supply system andreporting system functional (MPW & OCH)

C. FINANCING INDICATORS

1. ReLease: level- received more than I month late in the Province

2. Expenditure

a) Development Budgetb) Number of VFPUs receiving honorarium more than 7 weeks

Latec) Number of staff receiving salary more than 1 month late

A/ = Annual Review-/ = Semi-Annual Reviewii/ = Cuarterly Review

SOCIAL ACTION PROGRAMME IDA PORm IC-iDRAFT STATEMENT OF EXPENDITURE ADB FORM XYYYY

Z For all civil works contracts less that $200,000 equivalentDate . ..

EXPENDITURES OF ............................... SECTOR Credit No.: .

FINANCIAL YEAR 199 /9 Application No.: .

Reporting Period: ........... to ................... Summary Sheet No.:

Fd 1. EXPEND1TURES (Expressed in Pak Rupees)

IS/LI (1) (2) 1 (3) (4) (5) [ (6) (7)

II i _ _ _ ._ _ _ _ _ _ _ I _ _ __-~ _i _ _ _ _ I _ _ _ _ _ i _ _ _ _ _ I _ _ _ _ I _ _ _ _ _ _ II I lExpenditures from I Expenditures | Expendituree to I Expenditures I Expenditures I

I I I July 1l 199 ... I during | end of I Previously lbeing Reportedi Remarks

I I Description of Expenditures I to beginning of I reporting Ireporting period Reported I for this

I I I reporting period I period I (Columns 2+3) I | Period

I I I I I {(columns 4-5) I

I 1 ITOTAL CIVIL WORKS FOR SECTOR I

Note: Amounts to agree with Sector Summary Sheet

2. FISANCING

IS/LI (1) (2) I (3)

I I h j Amount for

I ISources of Finance Percentage this Period(Column 6 above)

Cl) I From:

, I IDA (inc. ......0

Z I Asian Dev. Bank3 etc.

4 etc . |

I Govt. of . .

_ TOTAL tequal8 Sec. l SIL l,col(6) above) I 100%! _ _ _ _ _ _ _ _ _ _ _ I _ _ _ _ _ I I__ _ _

Thtis is to certify that the expenditures described above have been paid for proper execution of project activities within the terms and conditions under

the Credit Agreement. The relevant supporting documentation is retained by .... ............... and available for Bank supervision missions.

(name of agency)Islamic Republic of Pakistan

by: ....Authorised Representative

SOCIAL ACTION PROGRAMMB IDA FORM IC-2

DRAFT STATBMENT OF EXPENDITURE ADS FORH XXXXX

For all contracts lses that $200.000 equivalentand excluding civil works, consultancy and technical assistance Daa...

EXPENDITURES OF ............... S ECTOR Credit No.: .

FINANCIAL YEAR 199 /9 Application No. :

Reporting Period: ........... to ................... Summary Sheet No.:

1. EXPENDITURES (Expressed in Pak Rupees)

ISILl 1 ) (2) -4) 1 (S) 6(7)

_Expenditures from IExpenditures | Expenditures to Expenditures | Expenditures

Ii Desc|iption of Expe:.ditures July 1, 199 ... during end of Previously |being Reportedl Remarks

| Description of Expeuditures | to beginning of reporting reporting period Reported for this

reporting period period | Wolumns 2+3) Period l

I I (Columns 4-5)

1 ITOTAL SECTOR | _ , _ _ __

I IWIORAnDt5 (See Note) ( iirotal Comprising of:

2 lsstablishment Charges - {operating Costs)3 IPurchase of Durable Goods- (Goods)

| 4 (Repairs and Maintenance - (operating Costs)s ICommodities and Services - (operatingC Costs')| _i_

j6 TOTAL SECTORI_ _ _ ___ . -_I__ I _ _ I _i

s W. e. Amounts to agree with Sector Summary Sheet

2. PINANCING

;S/LI (1) | (3) l

I I | _ .__ | Amount forISources of Finance I Percentage this Period l

I (Column 6 above) |

I || 1 IDA {inc. )

2 Asia Dev. Bank I

1 3 1 etc.j4 etc.5 1 etc.6l7 Govt. of .....

8 (TOrAL (equals Sec. 1. S/L 1, col(6i above) 1 l00% JI 1 -.~.... I__ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ I

This is to certify that the expenditures described above have been paid for proper execution of project activities within the terms and conditions under

the Credit Agreement. The relevant supporting documentation is retained by .and available for Bank supervision missions.(name of agency)

Islamic Republic of Pakistanby:.

Authorised Representative

SOCIAL ACTION PROGRAMME Pak Rupees

FINANCIAL YZAR 199 /9

SBCTOR FINANCIAL STATEMENT

Sector: .... (See Note Below) Expenditure to end: .............. 199

ISILI (Expenditure in Year to Start of Period i Expenditure in Period 8xpenditure in Year to End of Period

I I I . I I

I I Object Classification |Non-Development Development I Total Non-Development |Development Total Non-Development |Development Total

I I (1) 4 (2) (3) ( 5) I (6) (7) i (8 9) ' (10)

1 1 (Establishment Charges , I II2 (Purchase of Durable Goods t |1 3 lPrre-invest. Project Analysisj 4 IConstruction and works || (Repairs and Maintenance ) || 6 IC-amnodities and Services | I17 (Transfer Payments I I I i

a8 (Investment| 9 |Loans and Repayments(10 )Miscellaneous I t

I1I (Total (per Civil A/cs) | I I I | -

(12 ivorks (from schemes summary) I I I I 1

as I- I ~ ~ ~ ~ ~ ~ ~ ~ ~~~~~~~I I I . .113 (Land Acquisition ( -------- JI_____ ______ _____ ______ _____I_____

NoteList the subsectors and functional codes being summarized above

Sub-Sector Functional Code......... ......................... .................

~~~~~~~~.................. ..................... .. ...

.................. ...................................

.................. ...................................

.................. ...................................

SOCIAL ACTION PROGRMME Pak Rupees

FINANCIAL YEAR 199 19DF.TAILED FINANC1A STATEMENT

Sector: .. ................. .... ...... Sub-Sector. .. . ........... Functional Classification: . ........................... Expenditure to end: .............. 19......19

IS/LI |Expenditure in Year to Start of Period I Expenditure in Period I Expenditure in Year to End of Period |

I I I I - 1 Ii | Object Classification |Non-DeveLopmnent |Development I Total |lRon-xDevelopment |Development I Total |Non-Development |Development I Total

I ( 1 2) ( 3} (4) 5 (6) ( 7) (g3) I (9) I (10)

J Establishment Charges 2 IPurchase of Durable Goods

1 3 |Pre-invest. Project Analysis

i 4 IConstruction and Works |I S fRepairs and Mbintenance t16 |Commodities and Services i||||;

i 7 ITransfer Payments| i

I 8 linvestment tI

t 9 (Loans and Repayments|||10 siscellaneous||i

ilt rotal (per X-;A/co) gg|

112 lWotks (from sonemes summary)

113 iLand Acquisition ( --------)I

I I_ I I I!II_114 i, TOTIl

97

ATFACHMENT 3Terms of Reference for

Procurement Monitoring

Background

1. The Social Action Program Project (SAPP) aims to help relieve poverty, improve the wellbeing of families, and slow population growth in Pakistan by supporting that country's entireSocial Action Program (SAP). The SAP comprises all of Govermnent's efforts to strengthenbasic social services--primary education, primary health care, family planning, and rural watersupply and sanitation--during the Eighth Five-Year Plan (1993/94-1997/98). As it now stands,Pakistan's weak social services are undermining the country's development efforts. Educationalattainments and health indicators, especially for women, fall well short of those for countries ofsimilar income levels. At 3 percent per year, popu:ation growth consumes half the gains inGDP. With the support of the SAP Project, Pakistan's central Social Action Program now seeksto increase school enrollment in general (and female enrollment in particular) and to bring basiceducation up to minimum quality standards. It will strengthen the primary health care system(especially in rural areas) and sharply expand family planning services particularly at thecommunity level. Finally, the SAP will increase the area served by rural water supply programsand at the same time shift responsibility for maintenance to communities. The SAP Projectproposes to help finance the first three years (1993/94-1995/96) of the SAP with a credit thatwill complement existing social sector programs and projects, whether or not aid-financed.

2. To strengthen Pakistan's Social Action Program, the SAP Project will provide amultisectoral investment-and-maintenance credit. The Project will therefore support a varietyof cross-sectoral and sector-specific programs and issues amalgamated into one i oherentframework by Pakistan's SAP. For purposes of program planning and monitoriug, the SAP isdivided into constituent sub-programs covering basic social services-primary education, primaryhealth care, or rural water supply and sanitation (RWSS)-in one of Pakistan's four provinces.Other sub-programs cover the national population program, a federally administered healthprogram, and basic social services in areas administered by the federal Govermnent. The SAPProject will fimance a time-slice of annual programs as agreed each year by the Government, theWorld Bank, and other donors. The Project will also finance efforts to promote communityinvolvement through NGOs as well as improvements in monitoring and management of socialservices.

3. The SAP Project is designed to emphasize implementation of the SAP as a whole throughcontinuing policy dialogue, agreements on funding that are reviewed each year, and competitionfor resources among provinces and sectors. Disbursements will be made only after annualassessments and agreement by the Bank, other donors, and govermnent authorities responsiblefor that year's operational plans. The operational plans include development (investment)budgets and current budgets as well as implementation plans that specify both prior actions andmeasurable targets for progress in each year. The Project reimburses a share of the expenditures

98

for agreed programs. Each subsequent year's agreement will reflect past performance as wellas new plans (again with prior actions and targets). The first annual assessment, for FY93/94,was completed as part of the appraisal for the SAP Project.

4. Development and recurrent costs for the SAPP will total about $4.1 billion, including $1billion increase over comparable earlier expenditures. The Govermnent expects to contributeabout 76% of this total, about $3 billion, and use $552 million more from existing or expecteddonor assistance. For the remnaining gap of $572 million it seeks funding. IDA would provide$ I3 million or 5% of the total cost-about 48% of the gap.

Consultant's Terms of Reference.

5. The consultant will assist the GOP/Planning Division/SAP Secretariat in theaccomplishment of their procurement activities by providing review and advice. They willmonitor SAP's procurement activity to confirm that it is performed in accordance withcompetitive bidding procedures acceptable to IDA.

6. More specifically, the consultant will provide 81 consultant months (that is, the equivalentof 3 full time staff for 27 months each of qualified/experienced experts in building and civilworks procurement) to conduct a continuous, random review of all procurement under the SAP.In performing the reviews, the consultant will adhere to the following guidelines:

a. conduct a prior review of the first five (5) procurement requirements initiated, subsequentto consultant appointment, by each of the GOP implementing agencies;

b. conduct a prior review the procurement documents for all requirements with an expectedcontract value of US$50,000 equivalent, or more;

c. conduct an ex-post review of the procurement documents for all other procurement usingacceptable sampling techniques. The ex-post review will include a sample of allprocurement accomplished prior to the signing of the Project Agreement which will beeligible for retroactive financing.

7. The consultant will include all bidding documents and contracts within the scope of theirreviews and carry out field visits as appropriate. The reviews will assess the adherence of theprocurement activity to the IDA Guidelines for Procurement and agreed standard biddingdocuments.

8. The consultants will provide quarterly reports which describe the documents reviewed,identify the agency responsible for the procurement, and highlight the findings of the reviewwith appropriate recommendations for follow up reviews by GOP. The consultants will alsoprepare an annual report which will summarize the review activity and provide recommendationsfor procedural revisions to improve the GOP procurement process.

ATTACHMENT 4

99

PAKISTAN

SOCIAL ACTION PROGRAMME (SAP)

IMPLEMENTATION PLANS

SUMMARY OF KEY REFORMS

September 1993

PLANNING AND DEVELOPMENT DIVISIONGOVERNMENT OF PAKISTAN

100

SOCIAL ACTION PROGRAMME

PROVINCIAL IMPLEMENTATION PLANS

SUMMARY OF KEY REFORMS

101

EDUCATION

1. Enhance Girls Primary Education

a. Introduce Co-Education at the Primary Level

b. Increase Female Teachers

2. Strengthen Primary Education Institutions & Procedure

a. Increase Focus on Primary Educationb. Streamline Site Selectionc. Revise and Enforce Posting and Transfer Policies

d. Strengthen data base for Managing Primary Education

3. Foster Private, NGO and Community Participation

a. Use Private Engineering firm for construction management and

supervisionb. Education Foundationc. Community Participation

EDUCAtl9N1 Enhance Girls Primary Education

a) Introduce Co-Education at the Primary Level

SALOCHI STAN NWFP PUNJAB SIID11

Action Prior to Action to be taken Action Prior to Action to be taken | Action Prior to Action to be taken Action Priot to Action to be takenSept. IS, 1993 During 1993/94 Sept. IS, 1993 During 1993/94 | Sept. 15 1993 During 1993/94 Sept. 1 1993 j During 1993/94

- COO has aqreed - GONlFP has 100 new schools - GOPun,ab-Secy. GOPun)ab will No traditional 0O$ to formulateall new prif ary issued a circular will be opened of education carry out these bar for girls to and announceschools will be that girls can without gender tstued instructions and attend boys policy ofCo-Educational attend girls' or designation, where instructions develop criteria schools unification.open to both boys' schools communities do not that all schools for new schoolsgenders ob3ect. 492 will accept and for converting

genderless schools children of both mosque schoolsplanned to be genders and that

- 22 Community - A list of opened by 199S all new _chools COS to in*tiate Some genderlessSchools of mixed communities which (and converted study of schools will begender opened do not object to n,osque schools) utsitying primary opened in willIng

Co-education A feasibility will have educatiotn and to c >mmunit iesschools hbs been study on female:nale identifyagreed upon antegrating teacher ratior conwcrunities open

primary school of 70:30 to mixed schools- GOB decided in Amend rules so - A district-wise administrationprinciple to that new openings list has been will be conductedintegrate Primary above Grade 19 can prepared to set 0Education be filled by up 100 genderlessAdministration either gender schools underabove Grade 19 female district

administrationwith femaleteachers

EDflUCATION

1. Enhance Girls Primary EducAtionb) Increase real. Teachers

BALOCHISSAN IN"F PUNJAB StINW~~I _. , ,, ,, - . .. .. - ., , . . i l. Xx. . C

Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be takenSept. IS 1993 During 1993/94 sept. 1S, 1993 During 1993/94 Sept. IS, 1993 During 1993/94 Sept. IS, 1993 During 1993/94

- Age and Intensity training - Proposal (or Cabinet to approve - GOPunjab has The Education - GOS has GOS is preparing aqualificatich to upgrade skills, relaxation of age and issue lifted its Dept. will relaxed age package ofrules relaxed for and qualification notification recruitment ban identity under limit and incentives forfemale teachers Performance of rules for female and is served areas and qualification approval and

such recruits to teacher and to Recruit enough recruiting take steps to introduction- 00C has be monitored provide Rs500 female teachers to female teachers ensure GOs will examinesanctioned per month have 11,700 female to fill all availability of incentives forRsSOO/p.m. Establish Khuadar incentive for primary teachers posts. female teachers female ruralincentive payment teacher training female teachers by June 1994 (vs. teachersfor female college submitted to 9691 in 1991/92) - GOPunjab hasteachers working GONWFP Cabinet raised the entryin rural areas Remove domicile Revise service age for female

restriction for Preparations made rules to allow teachers to 52- crash training female teachers for mobile hiring of local yearsprogram started teacher training girls to be

Allow re-entry of for females in trained by mobile - Studyretired teachers, remote areas in 3 units commissioned on 0-especially female districts, with teacher 0

reduced entry incentives as aqualification basis for action

?4

EDUCRTION2. Strenothen Primary Education Institutions and Procedure

a. Increase Focua on Primary Education

BALOCHISTAN NWFP PUNJAB Sl#DH

Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken

Sept. 15, 1993 During 1993/94 Sept. IS, 1993 During 1993/94 Sept. 15, 1993 During 1993/94 Sept. 15S 1993 During 1993/94

- Directorate of Achieve full - Directorate of Strengthen role of - Directorate of - GOS has GOS will consider

Primary Ed4cation operatipn, Primary Education directorate Elementary established an appointing a

established as an implement reform established Education Additional director of

attached and achieve established Director for Primary Education

department. New targeta for Primary at the Divisional

directorate to Primary Education Education at the level

assume full for 1993/94 Divisional level

administrative andfinancial control Delegate - Separate

administrative and district

financial powers education

to director offkcersestablished

l~ ~~~~~~~~I

a

EDUCATION2. Strengthen Primary Education Institutions and Procedure

b. Streamline Site Selection

9ALOCHISTAN tlWFP PUNJAB SIMDH

Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be takenSept. 15, 1993 During 1993/94 Sept. 15, 1993 During 1993/94 Sept. 1. 1993 During 1993/94 Sept. 1 1993 During 1993/94

- COi h.a 4ecided No new school will - COtWFP has Only on cites that - Agreed COPunjab to issue - GoS has COS will updatesites of all new be constructed circulated meet criteria will criteria used notification that established ItS inventory ofSchools will meet unless they are objective construction be for donor-aided all schools to oblective schools andobjective approved on the criteria for site allowed schools meet agreed criteria for naitiate schoolcriteria, based on basis of selection criteria site selection, mapping.a school mapping establiehed carry out schooldata (BENISI criteria - Criteria for mapping at - COS has All sites are to

establishment of district level establishied be selected on the- All sites for All new locations schools notified District basis ofschool to be selected on All sites for Deveicpment establishedconstruction the basis of - Categorization 1994195 schools committee to hid crtteriavalidatedduring 1993/94 to established of districts on selected using in site by databe approved. on criteria and EMIS needo basis for criteria and be seIect ioubasis of criteria data allocation of completed by July

schools for 1993- 15 1994.Po new school 94 completedconstruction underHPA program; such - Notificationfunds to be used stating that 50%

Qfor existing of schools wouldshelterless be based on needsschools, only. within districts

- The rationalefor use ofcriteria and e8t9sto be explainedto MPls and theirsupport sought

EDUCATIO2. Strenathen Primary Edgcation Institutions and Procedures

c. Rkevoie and tnfore. Postina and Transfer Policies

BALOCHISTAN HUPP PtWJA8 SIND"

Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to te takenSept IS, 1993 During 1993/94 Sept. IS, 1993 During 1993/94 Sept. IS, 1993 During 1993/94 Sept. IS. 1993 During 1993/94

- GOB has decided GOB to develop a - PrOposals on The Dept. of - GOPunjab has The Education - Draft outline The Cabinet andprimary scho4l policy on posting delinking Education and decided to Department will of revised Chief Minister lifteachers will form and transfer; postings and GONIFP will carry restrict implement the departmental required) willa district cadre' appointment letter transfers from out new transfers of policy to the policy on approve a revisedand not liable for to include area of political instructions and primary teacher effect of reducing restricting postings andtransfer out of posting and to consideration and entorce existing within the unneeded transfers teacher transfer transfer policy,their home restrict transfers a ban on transfer ones to reduce markar )sub- and localization and GOS willdistrict during the unneeded transfers district) in Monitoring of teacher initiate a

No teacher will be academic year which they are procedures for posting prepared monitoring system- Community transferred from submitted to the The Cabinet is to appointed spot checks andSchools Program post after start Chief Minister issue instructions regular reporting All new;ill include of academic year. and Cabinet relating to - The eligible of learning appcintments wiII

restrictions on postings and area of trantsfer coordinator and irclude a bondtransfers Policies to be transfers based on for new teachers AEOs will be thiat new appointe*

developed and educational need is turttier establistied will serve innotified reduced, to the tirst posting to:

Female teachers Union Council; ttiree years.appointment to be (where no suchlocalized teachers are Policy to be

available, approved andrecruitment at notifiedthe markazlevel).

2. strenathen Primary Education Institutions and Procedurpsd. Strengthen data base for manaoinQ Primary Education

BALOCHISTAN "wFP PUNJAS SIND"

Action Prior to Action to be taken Action Prior to Actlon to be taken Action Prior to Action to be taken Action Prior to Action to be takenSept. IS, 1993 During 1993/94 Sept. 15, 1993 During 1993/94 Sept. IS, 1993 During 1993/94 Sept. IS, 1993 During 1993/94

- 8alochisfan Coverage will be - NWP Education EMIS to be - Punjab Educ. - EHIS to carry - Sindh GOS to strengthenEducation expanded, to Management upgraded and Hgnt. Info. out 1993-94 survey Education SEHIS, un4er theManagement include finance Information installed in 17 System and make use of Management planning data baseInformation System and construction System has been districts in NWFP, established in data for Information and monitor use ofestablished and is management. set-up in 9 and used to 12 districts, management System SEMISproducing MIS Senior management districts and has support decision with budget, establashed anreports- to be trained in completed the making staff and - School mapptng 18 districts.

use of data for final physical initial prep. to be carried out and the two- A two year planning and census for a physical physicalschedule for monitoring survey - Allocate budget censuses ha eexpansion under - Coordination and hire operators been completedAmplementation with the national - E£IS ard ltCMIS

EMIS worked Out im1tegr.t.d

- Additional EMIS Consultantsstaff provided appointed for

data entry on1992-93 survey

3. Poster Private. NCW and Communitv Particinationa. Use Private tnaine rina firm tor construction manaoement and suggrvision

BALOCHISTAN NWFP PUNJAD SINDH

Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be takenSept.15, 1993 During 1993/94 Sept. IS, 1993 During 1993194 Sept. 15, 1993 During 1993/94 Sept. IS. 193 During 1993/94

- A privatA Use of engineering - A nuculeas The GONWFP will - GOPunjab Supervision - COS has GOS will selectengineerinl firm firms tg be cell for the contract with already uses contract to be decided to hire consultant andengaged-to design extended to all Construction of private private firms extended to all a consultant for sign a contractand supervise primary schools Advisory Unit engineering firms for supervision schools top supervision for topconstruction/maint after evaluation (CAU) established to supervise and of construction of construction supervision toenance of schools of performance oversee the of schools on start by October

construction of aided projects - GOS prepared 1993primary schools TOR for this

consultant; listThe CAU will pre- of consultantsqualify list of ready forprivate firms prequalatication

00

3. Foster Private. OGO and Community ParticiPationb. 6ducation Poundat ion

WALOCHISTAN NVFP PUNJAB SINDH

Action Prior to Action to be taker Action Prior to Action to be taken Action Prior to | Action to be taken Action Prior to Actioh tO be LakenSept. 1S 1993 During 1993/94 Sept. IS, 1993 During 1993/94 Sept. 15, 1993 During 1993/94 Sept. A5S 1993 During 1993/94

- Balochistan Foundation's rules - Frontier GONF? to obtain - Punjab GOPunjab will - The Sindh The regulatoryEducation and operational Education funds from GOP. Education review the role of Education framework is underFoundation set up. framework will be Foundation set up Foundation is the Education Foundation has preparation and

developed and Dept. of Education established and Foundation and been will be approvednotified - CGOWFP released is to draw a functioning revise the established.

funds and bridge regulatory criteria for The Educationfinance of Ps.1SO framework and - GOPun3ab assistance, Foundation willmillion incentive package appointed including that for developguidel&nes

for greater consultants to the private sector for use of thisparticipation of conduct a study support andprivate sector in of regulation GOPunjab will prepare andprimary education over private review policies .pprove an

sector's and regulation and incentive packageactxvity in incentLves for for the privateeducation private sector's sector.

role in educationby June 1994 Government of

Silidh to beprovided tundinqby GOP

I-

3. Pogter Private. 4CO and CoWsntv ParticiRAtionc. Community Participation

SALOCHISTAN NlFP PUNJA9 SImI

Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be takensept. IS, 1993 During 1993194 Sept. IS, 1993 During 1993/94 Sept. IS, 1993 During 1993/94 Sept. 15. 1993 During 1993194- Village Expansion of - GOUPP has GONWFP to - GOPunjab is cOPunjab will - Some community COS to considerEducation comunity approach constituted establish village exploring prepare a pilot schools already strengthening tileCommittees into new areas District education proposals for project, devise exist tAga Khon role of parent-established to set Education Boards, committees to community mechanisms and Education Teachercoxritteesup schools Create -community/ under the Deputy organize village involvement in provide budgets Services) and to explore"GO Development Commissioner with schools school for these other approaches- 95 community cell within P&D power to approve construction, esperiments - Gos has Assued toward coamunatyschools set up; Department new schools i0 experiaental maintenance and a notification schools112 teachers starting in community schools provision of a Consultant to constitutingappointed A total of 120 new 1993/94 to be opened in 3 teacher and a revxse report on Parent-Teacher- 10O0 established posts to be districts teaching kit to the basis of committeesto assist sanctioned - Divisional comimunities that comments receivedcommunity Departmental otherwiseparticipatioi Committees organize a

empowered to schoolsanction primaryeducation - Consultantpro3ects upto study completedRJ.7.5 million

- GONWFP issued anotification tocreate villageeducationcomittees as of OMar. 23. 1993

1. Establish Strategic Planning Mechanism

2. Re-organize PIIC Services and Financing

3. Decentralize Administrative and Financial rowers

4. Improve Gender Staffing Imbalances

5. DON Expanded Participation in ..)pulation Programme

HEALTH

2. Establish Strateoic Planning Mechanism

BALOCHISTAN NWFP PUNJAB SlZFPH

Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to | Action to be taken | Action Prior to Action to be takenSept. 15, 1993 During 1993194 Sept. 15, 1993 During 1993/94 Sept. 1S, 1993 During 1993/94 Sept. lS 1993 During 1993/94

- Planning office - By Aug. 93, - Planning cells - Establishment of Planning cell Preparation of - Planning, - capacityestablished in the provide recurrent exist in the planning cell at exists in the policy statement Monitoring and building of pHEC 6Health Dept. budget for Secretariat; the Health office of the for health sector Evaluation Cell Planning sectionsSecretariat; planning cell, and Directorate, June Secretary Dec. 93 (PMEC) at Directorate,

sanction posts by - Distt. Health 94 established in Divisional- Four June 94 Boards (DMHs) - Planning cell - SAP program the Health Directors Cprofessionals established - Strengthening of in D.G. Health's indicators - Dec. Secretariat District Startedappointed - By Dec. 93, planning cell at office, headed 93

complete situation - Consultancy to Secretariat, June by Director - Planning -District Health- 5 year health analysis; develop revised 94 - commence Officer Mar.agement teamssector development planning - Outline of 5 preparation of ADP appointed in the aesignatedrFian prepared - By April 94, procedures and - District Health year plan 94/95 - Jan. 94 offices of D.G.

prepare draft guidelines, TORs Boards ~n all the prepared Health, - Current planningrolling plan approved Districts - Mid-year review Divisional procedures

functioning by of ADP 93/94 - Director of documented, June- Commence - Consultancy for April 94 Feb. 94 Health & 94preparation of part of eight teachinghiealth sector health studies - iHMIS expanded to - Rolling plan hospitals - Situationpolicy by Oct. 93 approved other Divisions, prepared - April analysis completed

June 94 94 - A Deputy June 94- SAP Program - 2 planning Director of PMECindicators, & SAP offirers, a - Study of - Strengthening of assigned toPlan prepared by vehicle and database started strategic planning monitor surDec. 93 ancillary mechanism implementation 6

facilities - Study on support SAP- Strengthening of provided at the location, ExecutingStrategic Planning Secretariat level condition and agenciesMechanism by June under ODA performance of1994 assistance of 3rd health facilities

Health Project

HEALTH

i. Establish StrateQic PlanninQ Mechanism (Continued)

bALOCIIISTAN I4FP PUNJAB sIzDm

Action Prior to Action to be taken Action Prior to Ac5ion to be taken Action Prior to Action to be tAken Action Prior to Action to be takesSept. 15, 1993 During 1993/94 Sept. 15, 1993 During 1993/94 Sept. IS, 1993 During 1993/94 Sept. i5s 1993 During 1993/94

- SAP Monitoring - HMIS started in - Preration of - Workshop ofsystem developed Pechawar and Rolling plani April Planning Ofticerby Harch 94 Nalakand Division 94 conducted

- NIP prepared, - Situat ionFeb. 94 analysis

initiated- Planningprocedures andguidelinesrevised, Dec. 93

- Implementationof revisedPlanningguidelines/procedures Apr. 94

- Establish PHfCSAP focus inHealth Directorate

HEALTH

2. Re-organize PHC Services and Financina

8ALOCHISTAN VWFP PUNJAB SINDH

Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be takenSept. 15, 1993 During 1993/94 Sept. 15, 1993 During 1993/94 Sept. 15, 1993 During 1993/94 | Sept. 1S, 1993 During 1993/94

Drug schedules for - Integration of - Essential drugs - Increase & - Formula for Improve staff - Budget for - Anaiyzing non-RHCs & BHUs exist vertical programs list for functional allocation of availability 6 medicines has salary budget &

at Directorate & different levels redistribution of non-salary fill vacant been revised. identifyingprimary level; of PHC facilities non-salary budget budget revised positions now an average changes that are- hnalysis & xndicating of PHC services with approval of according to RHC will receive necessary for itscorrection of quantities for April 1994 Finance Deptt., availability of Rs.165,000, a betterutilizationbudgetary one year notified which lead to trained BHU Rs.E0,000 - Oct. 93imbalances in PHC - Field doubling the staff by June 94 and a Dispensaryservices by March - One Divisional preparation of non-salary Rs.249.000 for Projects prepared94 coordination referral support budget of PHC a) lon-salarv medicines for modifying the- Improve staff Committee on CDC to PHC - June 94 facxlities budoet: allocat.ionswithinavailatility L notified - Assess provLsion - ;dditional the non-salarylill :acant - Reorganize - Running budget of r.on-salary budgets for budgets of the PHCpositioll of all preventive allocation o.r budget for 94!95 druos and urits by Dec. 1993staff categorxes programmes into 93/94 made on as par new medicines alsoaccording to broad based CDC the basis of new formula, strict provided through - Job descriptionavailability of programme formula compliance with malaria 6 TB of technical stafftrained staff by procedures and the yard stick by Control Program of PHC unitsJune 94 processes studied Effort made to Dec. 93 revised by April- Establish expert improve staff - Drugs 94committee to - Job enrichment availability by b) Referrals formulary anddevelop essential for health major - Referral system drug Scheduledrug list (EDL) personnel of PHC recruitment procedures develo- introducedFeb. 94, & notify notified March 94 efforts ped and introducedEDL & commence by Mar. 94.implementation by - Start CHWs - StrengtheningApril 94 training programme CDC by merging

with appropriate vertical programs,linkages with PHC staff training i

logisticspracedures

HEALTH

2. pe-organize PHC Servic-6 And rinancing (Continued)

BALOCHISTAN NWIP PUNJAB SIIIDH

Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be takenSept. 1S, 1993 During 1993/94 Sept. IS. 1993 During 1993/94 Sept. ls 1993 During 1993/94 Sept. IS, 1993 During 1993/94

- Prepare 6 notify - Link T As with developed and - Communit - DHCs functionsdrug schedule by PHC outlets for approved by June Involvement: and links withlevel of facility supervision, 94 Districtas per EDL - April training and - Beefing up In every management94 logistic support services at first district, health Coninittees

procedures referral level; comaittees have established by- Planning steps prepared - June 94 preparing been formed for Dec. 93.to start CHWs inventory by all AHCs, SItUs,pilot project - Link 8HlUs to services required and DispensarAes - Drug fortnularycompleted by June RHCs and Civil 6 identifying as first step and drug schedules94 Hospitals - June deficiencies by for involviug revised on tbe

94 Feb. 94 local basis of EDL by- Referral systems communities Feb. 93.procedures study c) M.Lzinitiated June 94 - By Dec. 93 - Preventive

esLabliSh *xpert services madenmre- Review of commsit tee to broad basedvertical develop Essentialprogra_ves of CDC Drugs List /EDL) - Referralfor integration - Notify EDL a procedurescotttpleted by June ccaxtc nence developed - June94 implementation by 94

March 94- Performance of - finalize drughealth personnel schedule by levelas team reviewed of facility as perApril 94 EOL by March 94

CoaFunitv dl I££Involvemaent: Cmunit

Involvement- Pilot project Coemened andot PHC formation of VHC(including CIMlI by Dec. 93in Sheikhupura

2. georoanize PHC Services and FLnancina (Continued)

BALOCHISTAN NWPP PUNJAB SINDN

Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be takenSept. IS, 1993 During 1993/94 Sept. 15, 1993 During 1993/94 Sept. 15, 1993 During 1993/94 Sept. 15, 1993 During 1993/94

district - Constituteapproved Committee of

experts for- curricula of developingtraining of CHWs training curriculareviewed for CHWs/TBAs -

Nov. 93- Selection - Identificationcriteria of CHWs of male & femaleprepared health centres, 6

village TBAs by- All PHC Jan 94facilities - Pilotingdesignated linkages of

CHWs/TBAs withSHUs inSheikhupuraDistrict by May 94- Developprocedure andmechanism ofmonitoringlinkages betweencHWs and ThAs byApril 94- Establish amonitoring systemof CHWs primarilyby VHCS & LJtVS Of

PHC facilities byoct. 93

ft

HEALSHT

3. Decentralize Administrative and Financial Powers

BALOCHISTAN NWFP PUNJAB SINDH

(Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken

Sept. 15, 1993 During 1993/94 Sept. 15, 1993 During 1993/94 Sept. 1S, 1993 During 1993/94 Sept. IS, 1993 During 1993/94

Proposal to - Set up Task- - DHO recruits - DHO to recruit - Constitution 1. Approval of a) Recruiting, - Incharge of one

restore delegated force regarding personnel in BPS personnel in BPS of working procedure for hiring & firxng RHC in each Div.administrative delegation of 1-5 6-9 groups for purchase of authority declared as Cat.powers under powers to DHO/DHS preparing medicines under delegated to Ill officer underexamination by the by June 30, 94 - DHO Category - ADHO (BPS-18) to proposals on rate contract by DHOs (BPS 1-11), the Finance rulesGovernment III Officers to recruit personnel rate contract DOH by March 94. & Div. Directors on experimental

- Restoring exercise in BPS 1-S for supply of 2. Approval of (BPS 1-15) basis - Dec. 93delegated financial power medicines direct procedure for - Selectionadministrative - ADHO {BPS-18) to to RtSCs, local local purchase of Committeesauthorities Dec. - DHO exercise be declared purchase of medicines by SMo constituted for93. powers to category IV medicines, by Nov. 93. reclultment of

transfer officers for delegation of 3. Approve staff at Distt.- Development of personnel upto financial power powrrs to, delegation of D iiv. levels;management n.odules BPS-16 MOS/S5:0s for follow2no pooers - r,c-harge ofJune 93 - M.Os at BHUs to posting of and issue every PHC

initiate staff; nctification by notified unit as- Set up Task disciplinary - TOR, prepared Fet- 94:. initiatingForce to study action if for engagement a) SMOs of RHCs officer for ACRspersonnel & required, and of consultants with Admn: of paramedicfinancial sanction casual for health authority to hire staff, S DOO asmanagement of PHC leave upto one manual. and fire st4ff Cousiter-sioningas well as week, and to upto BPS-S. offi.erprocurement 6 undertake b) 5140 to act assupply of drugs & performance DDO for BHUs.budgetary evaluation of c) SMO to haveallocations of facility staff financial powersRHCs & BHUs study of category IVcompleted by June - Mos of RHC/BHU officers for94 have reasonable making purchases.

imprest forcontingencies/emergencies

:4

3. Decentralize Administrative and finAncial Powers fContinued)

BALOCHISTAN NWFP PUNJAS SIHDH

Action Prior to Action to be taken Action Prior to Action to be taken 1 Action Prior to Action to be taken Action Prior to Action to be takenSept. 15, 1993 During 2993/94 Sept. IS, 1993 During 3993/94 | Sept. 15, 1993 During 1993/94 Sept. 1iS 1993 During 1993/94

- Drugs and dl $HO to be - Authority, formedicines procured empowered to selectingon rate control as purchase medicines candidates forper EDL and locally upto 10% enrollment insupplied to of budget. paramedicsBHU/RHC, bills e) to give powers trainingpaid by ADHos to 4.O. of BHU to institutions has

initiate been- Standardize disciplinary decentralizedequipment for PHC action against thefacilities and staff of the BHU. - Fin, powers offollow purchase of t) To give 34O. of oHos enhanced todrugs and SHU financial Cat.11medicines, powers to operateprocedures and iLprest accountprocesses for contingencies.finalized, Jan. 94 4. To commence

posting Stios xnSHtO t/C RHCs to be tiPS-lB in fHHCs byadministrative Dec: 1993.head of RHC and S. Approve TOR anddesignated 8SHUs appoint

consultants toprepare Hanual Istdraft June 94

3. Decentrali2o Adainiatrative and Financial Powers (ContinuedI

BALOCHISTAN NWFP PUNJAB Su",N

Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be takenSept. 1S, 1993 During 1993/94 Sept. IS, 1993 During 1993/94 Sept. 1S, 1993 During 1993/94 Sept. 1S, 1993 During 1993/94

- formulatetraining progr _.for managing theoperations/activities of SNOBby February 1994.

6. Cormencetraining of SnOsin exercising therevisedadministrative andfinancial powersby April, 1994.

4. Imorove Gender Stafflno Imbalances

BALOCIIISTAN NW.'P PUNJAB SINDH

Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken | Action Prior to Action to be takenSept. 15, 1993 During 1993/94 Sept. 15, 1993 During 1993/94 Sept. IS, 1993 During 1993/94 Sept. 15, 1993 During 1993/94

- Decision to - Relaxation of - Study conducted - Review issues of Working group 1. Preparation arid - Career pattern - Identificationallow Rs.400 per age & entry of by CIDA recruitment, constituted. for approval of job developed for of hard areas,month to temale qualifications for training, preparing description and LHVs by creating hard areasmedical staff female trainees - h list of retention and service rules/ service rules of supervisory allowance 6 caseserving outside Dec. 93 incentives/ promotion of career structure LHV Cadres by posts at Distt/ for financialmunicipal limits reforms female staff Dec. for LHVs and tor June, 1994. Div. & incentives taken- Paymeot of identified and 93 identification 2. Change LH.V Provincial up with thestipend to school approved by of hardship cadre from levels Governmentgirls entering Technical - Finalize areas Divisional to - For admin.health profession Committee headed recommendations district Cadre. positions, no - By June 94: -tagreements & by D.C. Health and approved by Issue notification gender

budget allocations provincial * by June 1994. discrimination a) approve hardmade) for 94/95 government Harch 3. Selection, and - Gender task- areas alloiance;budget 94 promotion of LHVs force appointed

to Senior LHVs by in Nov. 92 b) create- Publicity 6 - Decisions June, 1994. - Number of supervisory postsEducation campaign notified & 4. The Health admissions seats for LHVs atto increase implementation Department to for training of Oistt., Div. 6recruitment- started by April identify the LIVN & FHTs Prov. levelscomplete all 94 underserved/ raised from lS0arrangements by hardship areas and to 300 each; c\ Correct theDec. 94 - Budget devise - Posts for anomal) of pay

allocation for methodologies which only women scale of LHVs d-8-Free 94/95 made by May lwhich may include are eligible 6 8-9 betweenaccommodation to 94/95 monetary have been Sindh 6 otherfemale health incentives) for upqraded (e.g. Provincesworkers in rural improving Principal ofareas by Dec. 93

Public Health

Schools,

Director MCHI

Services p

4. Improve Gender Staffing Imbalances (Continued)

BALOCNISTAN NWFP PUNJAB SINDH

Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be takenSept. IS, 1993 During 1993/94 Sept. 1S, 1993 During 1993/94 Sept. I5S 1993 During 1993/94 Sept. 15, 1993 Durlng 1993194

- Initiate work on availability of - Womenauxiliary training health staff in candidatesschools 6 after these areas by eligible for all

! training schools December, 1993. paramedicfor females June progranmes -94 S. Changing TA notification

rules from fixed issued June 93- Identify to open TA basedhardship/ under on journeys - 16 other postsserved areas 6 performed for LiVs for womendeviae Notification by doctors upgradedmethodologies for Dec. 1993. from 8-18. 8-19;improving female women arehealth staff in 6. Selection at eligible forsuch areas Dec. 93 Markaz level of promotion- Budgetary girls for against 165provision for hard admission in LIIV other upgradedship areas April schools by Dec. posts94 1993.- Creation of - ComparableSenior LHV promot ionpositions in 94/9S opportunities tobudget by April 94 higher posts

exists for bothfemale and malestaff

HEALTH

5. DOHj Ixeanded Partilioation in Pogulation Proara_

sALOCHrSTAN NWFP PUNJhB SItOH

Action Prior to Action to be taken Action Prior to Action to be taken | Action Prior to Action to be taken Action Prior to Action to be takensept. 15. 1993 During 1993/94 Sept. 15, 1993 During 1993/94 | Sept. 1S, 1993 During 1993/94 Sept. 15, 1993 During 1993/94

- Training plan to 420 health - Training plans - Curricula for - lot training - Revision of job - Training plan - By Dec. 93, jobtrain health facilities for personnel of training revised plan under description of under descriptions ofpersonnel in FP providing FP Health Department and implemented - implementation health workers has implementation health workersunder services - June 94 fin consultation April 94 (210 WMOs & 241 started with a No. of health revisedto includeimplementation with PWDO being LHVs already view to include FP personnel Family Planning

- DTCs functioning implemented - District trained): by Dec. 93 trained up to- 81 female Technical June 93: - establishdoctors trained G - Revision of - contraceptive committees are - 811 health - Revision of in- - Male Drs.: 917 contraceptive177 LHVs/FHT health workers' services being, functional in all outlets have service curriculum - WH40s: 459 distribution

job description to provided in 552 the districts potentiaL to by DON C its - LNVs: 238 system through FWA- 159 health include FP as a health outlets April 94 provide piloting by Dec. - FHTst 88 of PWD by Apr. 94facilities normal function - contraceptive 93 - NMTs. 69providing June 94 - DOH staff Duties of health Services - By March 94,contraceptive trained in FP: staff will be - DTCs functioning - 134 health DTCs functional inservices - Establish 135 Wtos; 539 enriched to - 29 District facilities all Distts; and

contraceptive LHVs; 171 FHTs; include family Technical - establish provide establish- DTCs established distribution Managers (21); planning component Committees contraceptive contraceptive monitoring systemin 13 program system to provide Male doctors June 94 established distribution services; through DTCs (HIS)districts (for contraceptives to (517); Male system through PWA by March 94,entire province) 6 upgraded RHCs & M4edical - Health of PWD at 50% of - pTcsmeeting sHUs where trained Technician (517), facilities health facilities functioning in - By June 94:periodically staff is posted - mid-wives/Dais provided IUD by June 94, 6 100% 15 out of 18

June 94 (610) also insertion kits by Dec. 94; districts 1. 70% femaletrained by PWD paramedic staff

- Identify pre and - establish - Revised in- trained in IUDin-service - District - 289 RHCs monitoring system service training insertion;training needs to Technical provided with a to be implemented curricula hasprovide FP committees (DTC) male motivator by DTCs by June 94 been revised andservices Dec. 93 established in (by PWD) is ready

all Districts responsible forcontraceptivesupplies to BHUs

N

5. DOB Expanded Participation in Population Pronramme (Continued)

BALOCH41STAN NWFP PUNJAB SINDH

Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be takenSept. 1S, 1993 Otiring 1993194 Sept. 1S, 1993 During 1993/94 |Sept. 1S, 1993 During 11993194 Sept. 1S, 1993 Duringj 1993/94

- Preparation of - Funds allocated - Pre-service - By June 94, 2. 70% healthpre-services & by MPW to curriculum for provide IUD facilities withrevision of in- Regional Training medical students equipment in female F workersservice training Institute for & LHVs prepared facilities where providing FPcurricula - June training of Wtos & sent to fen.ale staff are 3. IUD kit in94 6 paramedicals Federal working place in 70% of

Government health facilities- Continue - Funds allocated

training of health to District Pop.personnel in FP Uelfare Officertechniques (DPwo) for

training 6 malemedicaltechnicians

tN

124

1. Assurance of adequate funding for 8th 5-Year Plan and protection of ADPallocations

2. Improved program management

3. Increased participation of provincial governments

4. Human resource development

s. Increased private sector participation, including NGOs

6. Ensure adequate supply of contraceptives

POPULATION

FEDERAL PUNJAB SINDH

Policy Issues Actions taken by Steps to be taken Action taken by Steps to be taken Action taken by Steps to beSeptember 15.1993 during 1993-94 September 15. 1993 during 1993-94 September 15. taken during

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ L _ _ _ _ _ _ _ _ _ _ _ _ _ I L I _ _ _ _ _ _ _ _ _ _ _ _ _ L 1993 1 993-94

1. financial Issues - Rs 9.1 billion - ECNEC Approval PCI cleared by Approved PCI by PCI cleared by ECNEC approvalDevelopment Budget: Program part of of PCIs - CDWP: Aug 1993 ECNEC - Dec 1993 CDVP on Aug 29, of PCI by Dec

draft 8th Plan Dec 1993 1993 1993- 8th Plan Allocation - 8th Plan - Approval of 8th

Program PCIs Five Year Plan -awaiting ECHEC June 1994approval

- ADP Allocation - Rs 1.1 billion - Review ADP Rs 408.620 millton - Provincial Rs 164.220 - Recasting ofallocated for 1993-94 in the for 1993-94 Program for 1994- million for 1993- annual plan1993-94 light of 95 prepared - Dec 94 based on

expenditure for 1993 approve ADP -first 3 months - - NIS Revision and Oct 1993Oct 93 allocation to be - Preparation- ADP 1994-95 made for PWP & not of plan forprepred Jan'94 12 different Sub- 1994-95 - Dec- Allocations for projects 19931994-95 approved Release ofJune 1994 funds in Oct

1993. Jan andT Timely Releases - Timely payment - Timely releases Releases for Ist April, 1994

of salary in Oct 1993. Jan quarter receivedcomponent already & April 1994resolved for MatchBalochistan recurrent

expenditureRecent expenditures Proposals needs to

prepared revisedoperational

I___________ I_____ plan.

POPUIATION

FEDERAL PNJAB SIWDR

Policy Issues Actions taken by Steps to be taken Action taken by Steps to be taken Action taken by Steps to beSeptember 151993 during 1993-94 September 15. 1993 during 1993-94 September IS. taken during

_ __ _ _ _ _ _ _ _ _ _ ._ _ _ _ _ _ _ _ _ I _ _ _ _ _ _ _ _ _ _ I _ _ _ _ _ _ _ _ _ _ L 1993 1993-94

2. Program Management - Planning Units Strengthen Strategic planning - Further StrengthenIssues exist in Ministry Strategic and Operational Strengthening of strategic

- Strategic Planning and Provinces Planning Units - Capacity Strategic and planningcontinuous Strengthening - Operational capacity atprocess June 1994 planning capacity provincial

at all levels level June- Ilmpeont 1994Planning capacityPlan- Rolling planprepared everyyear

- Operational Plann?ng - Reasonable Strengthening Limited Operational Draft Plans StrengthenCapacity exists Operational Operational Planning Capacity prepared operationalIn Ministry and Planning at Planning Capacity Plan prepared at planningProvinces Ministry leve. - exists at Divisional. cap4city at

June 1994 Provincial and Dfstrict Tehsil provincfal.District Levels Levels - June 1994 divisional

district andtebsil levels- June 1994

- Supervision Develop agenderspecificsupervisionplan

Policy onsupervisionand planpromu gated byJune. 1994

POPULATION

FlDERAL PUNJAB SINDIIH

Policy Issues Actions taken by Steps to be taken 1 Action taken by Steps to be taken Action taken by Steps to beSeptember 15.1993 durlng 1993-94 September 15. 1993 during 1993-94 September 15. taken during________________________ _ I ___________________ _____ I ___ 11993 1993-94

_____ 1 _ .___ ____ . __ _ .I . ._ _ _

- Monitoring I Monitoring b Review Monitoring H&E Units exist at - Revfew Completed ProvideEvaluation Evaluation Units and Evaluation Divisional and at MSE System - availability

exist in Ministry System - June Oistrict offices June 1994 to technicaland Provinces 1994 directorate

for fieldmonitor tnq.Weeklytechnicalfieldmonitorinvisit bytechnnicalDirectorate to

- Operational Research - Review - Research Agenda be introducedCoepleted Prepared - June by March 1994Research - Dec 19941993- ReviewCommissionedResearch - Dec1993- Prepare anAgenda forOperationalResearch - May1994- Plan forImproved CapacityDave I!Fmet

POPULATION

FEDERAL PUNJAB SINDH

Policy Issues Actions taken by Steps to be taken Action taken by Steps to be taken Action taken by Steps to beSeptember 15. 1993 during 1993-94 September 15. 1993 during 1993-94 September 15. taken during

- __ _ __ '_ .= -_-_ _ , : : 7 - . - - = : = =---.-._ _ ~1993 1993-94

- Strengthen senior - Fill vacantmanagement capacity of postsPWO. Sindh December. 1993

- Sanction andfill new postsfor 1993-94

- Review Funding Initiate step3. Increased Servise Delivery - Review Funding arrangements - Feb to transferparticipation of already with the arrangements 1994 accounts toProvincial Governments Provinces between - Financial Powers provincial

Functional Provincial and to be delegated to A G officeDecentralization Federal Program Officers

Governments - Feb of Punjab - June c1994 1994- PSDP allocation - Personalto be made under recruitment Powersone head and not to beunder 12 decentralized -different June 1994canponents - Dec - Supervision1993 delegated to field- Federal PSDP staff andrelease to organizationsProvincial revised - JuneGovernments to be 1994made on quarter ;ybasis - Jan&April. 1994- Federalfunctionsredefined; Planfinalized June

.___________________ 1994

POPUIATION

FEDERAL PUNJAB SINDU

Policy Issues Actions taken by Steps to be taken Action taken by Steps to be taken Action taken by Steps to beSeptember 15.1993 during 1993-94 September 15. 1993 during 1993-94 September 15. taken during

1993 1993-94

- Family Planning - Health Staff - Continue - 210 WHO and 441 To provide - Training plan - Districtservices through health Trained in FP current LHVs Trained technical under Technicaloutlets of Line methods. Male arrangements of - 811 Health assistance to plan implementation CamitteesDepartment: Doctors: 1444 - training and Clinics Provide FP activities - April - No. of health functional In

- Health Deptartment Female Doctors: contraceptive services 1994 personnel already all districts-885 - 1anagers:21 supply to health - 22 DTCs - Existing trained upto March 1994- Kale outlets - June established arrangements to June. 1993 - Jobparamedies:586 - 1994. train staff and - Male description ofFemale - Review current provision of doctors:917 health workersparamedics:1454 - arrangements in Contraceptives to - UMOs:459 revised toOutlets providing the light of continue - June - LHVs:238 include familyfP services:2256 family health 1994 - FHTs:88 planning - Dec

projects and MHTs:69 1993performance of - EstablishHealth Dept - - District contraceptiveMarch 1994 Technical distribution- Introduce Committees system throughfamily planning created in 15 FWA (Male) ofmethods In all districts out of PMID. Sindh -pre-service 18 April 1994training programs - Establishof health monitoringpersonal - June system (HIS)1994 thorugh OTCs -- Jobs of health March 1994personnel revised - 0% FemAleto include nP parmedicservice and staff trainednotified - June in IUD1994 insertion

- ?O0X healthfacilitieswith femaleworkersprovidecontraceptiveservices- UD

POPULATION

FEDERAL PUNJAB SINDH

Policy Issues Actions taken by Steps to be taken Action taken by Steps to be taken Actfon taken by Steps to beSeptember 15.1993 during 1993-94 September 15. 1993 during 1993-94 September 15. taken during

1993_ 1993-94

place in 70Xof healthfacilitieswith femalestaff- Quarterlymeetings ofWHll PIED.Sindh, Tils.PHSs, filSchools

- Education: - Population - Continue - Pre-servicePopulation education Education Cell In training of training of al) 0in formal school Curriculum Wing secondary school trainee, teacherssystem of WOE teachers lnlcude Population

established 1983 - Developed- Revision and curriculum ofdevelopment of populationcurriculum and education formaterials on primary schools -population for June 1994secondary - Materialseducation schools developed of* Textbooks for primary schools -classes VI-X in June 1994the subject of - Curriculumlanguages, social revised forStudies. Pakistan middle andStudies. General secondaWr schoolsScience & Home - June 1994Economics include Development ofmaterial of training packagePopulation for resourcefducation persons - June1MO00 Teachers 1994

fainedDistrict

POPUIATION

FEDERAL PUNJAB SI9DH

Policy Issues Actions taken by Steps to be taken Action taken by Steps to be taken Action taken by Steps to be

September 15,1993 during 1993-94 September 15. 1993 during 1993-94 September 15, taken during

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ I _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 _ _ _ _ _ _ _ _ _ _ _ 1993 11993-94

EducationOfficers 8Managers trained- PTC/CI and B.Edcurricularevised, learning

l _______________________ materials revised

i __ . _ _ _ _.._ __ I ____

_ __ j . _ _ _ -I _ _ _ , _ _ _ _ __ I __ iI____ I- I- I - I__- :

POPULATION

N V F P BALOCHISTAN AK FANA

Policy Action Taken by Steps to be Action taken by Steps to be Action taken by Steps to be Action taken by Steps to be

1993-94 1993-94 1993-94 1993-94

*. vNgol MINSIB

Developmaent PC-1 cleared by -Approved PC-1 PC-I cleared byBudget CDWP- Aug. 1991 by SItCN - Dec. CatP on Aug.8tb Plan 1993 29, 1993.allocation

APP allocation Re. 115.910 -Provincial Re. 52.950 Timelymillion for Program for million for quarterly1993-94 1994-95 1993-94. releases Oct.

prepared - Dec. 1993. Jan.1993 1994. April

1994.

Expenditure Purtherdevelopment of(rapid)financialmonitoring

2. _m 6 ruAw IBSUpB

-Strategic Planning r'nit -Strategic and Planning Unit |- orkahop onPlanning available Operational available strategic

Capacity planningStrengthening - concepts - Mar.June 1994 1994.

- Situationanalysis June1994.

-Operational Limited Operational Limited Month-vise work Limited Month-wise Work Limited Month-wise WorkPlanning Operational Planning operational plans for each capacity at Plan by eacb | capacity at Plan for each

Planning capacity planning district by mAos. district tWigs. districtCapacity exists created at capacity exists Nov. 93. prepared by end prepared by endat Provincial Divisional & at provincial Dec. 1993. Dec. 1993.and District Federal levels and districtLevel. - June 1994. level.

In-servicetraining andrecruitment ofnew staff.

POPULATION

N V F P BALOCHISTAN AJK PANA

Policy Action Taken by Steps to be Action taken by | Steps to be Action taken by Steps to be Action taken by Steps to beissues Sept. 15, 1993 taken during Sept. 15, 1993 taken during Sept. 15, 1993 taken during Sept 15, 19s3 takesi dur3ng

1993-94 1991-94 1993-94 1993-94 l

-M4onitoring M&E Units exist -Review M&E Units exist -Strengthening Basic nucleus -Establish Basic nucleus -Establishmentand Evaluation at Divisional Completed of at provincial of provincial exists. Population exists. of Pop. Yelfare

and District M&E System - level. monitoring unit Unit. cell at FANAOffices. June 1994. and creation at - Establish 110s.

divisional and system of flow -Design ofdistrict logistic & system for flowlevels. information of informatioll- Review of MaE system. asystem contraceptives.completed, toinclude input,process, andoutputindicatorsresponsible tosystem'sperformance byJune 1994.

3. INCRASR PARTICIPATIfm OF PROVIC1UAL U.VT.a

Provincial Chief Minister -Review Funding -Review Fundinggoverniments invited to open Arrangements Arrangements

inter-depart'l between Federal between Federalworkshop on and Provinces - MPW andpromotion of Feb. 1994. Provinces -population -Regular Dec. 1993.planning in meetings -Reflection ofline Provincial provincialdepartments. Population. populationProvincial Welfare budget inPopulation Council, of provincial ADPCouncil Population for FY94-95.meeting. Welfare

Steeringrommi t tee.-PaD andFinanice teviewsof PPIWDactivitiesst retngt iened-

POPULATION

N V F P EALCHISTAM AJK FA

Policy Action Taken by Steps to be J Action taken by Steps to be Action taken by Steps to be f Action taken by Steps to be

Issues Sept. IS, 1993 taken during Sept. 29, 1993 taken during Sept. 13, 1943 taken durinq Sept. IS, 1993 taken durinS

I =Sues 1Sp.1,19 ta993e 94 d 1993-94 1993-94 1993-94

Line -135 100 and -To provide Involved 159 To involve 420Departments 539 tJVa. 171 technical health outlets; new outlets,-Health rTs, 21 assistance to trained 81 train 130 4oa,-Labour managers, 519 plan activities LNOsj 177 32 WMOs, 68-Education male doctors - April 1994. UIVs/FWTs. paramedics.-Social trained. -existing Involved a Involve S moreWelfarq -522 Health arrangements to health outlets health outlets-Local Govt. Outlets provide train staff and of local govt. of LOD.

PP services. provision of Involved 10 Involve 11 more-DTCs contraceptives health outlets outlets of LWD.established in to continue - of Labour Involve 1all districts. June 1994. Welfare. health outlet-Joint meetings -Implement DONs No SUD outlet of SWD.with DOm to decision to as yet. Involve 2agree concrete involve all DOM Involved 13 health outletssteps for facilities, to health outlets of IGPC.improved develop further of IGPC. -

cooperation. and implement-Pre-service plan fortraining of all training DoN0trainee staff, toteachers ensure regularinzclude reporting of FPPopulation activities byEducation. DOH facilities

Iwithconsolidationsprovided byPPID to DO1R,withcoordinationbetween DOH andPPWD personnel,to ensureregularmeetings ofDistrictTechnicalCommittees, todecIate large

POPULATION

N V F P BALOCHISTAN AK FANA

policy Action Taken by Steps to be Action taken by Steps to be Action taken by Stepe to be Action taken by Steps to be

Isues Sept. 159 1993 taken during Sept. 159 3993 taken during Sept. 99 1993 taken during Sept. i, 1993 taken durin

1993-94 1993-94 1993-d4 d193-94

healthfacilities asfocal pointsfor PPactivities,interdepart' lworkshops formanagers.Continuetraining forall graduateDOm staff.

4. tRESS REZXJU:CS DEVRlONIT

-Requirement -Let out study -PC-l cleared -Consultant 4 specialists, -Meeting with -In-service -Meeting with F.

-Training.: to develop a by CWDP. hired to 10 each IM0s M"P for training given MPM to finalize w

.In-service Human Resource -Re. 500 a prepare a study and ULVs 6 150 clearance of to 10 WMs, 4 staff 6.

.Pre-service Development month rural on human paramedics Pop. Cell posts HUVs. 20 Moo 6 resources

-Deployment: Plan - June allowance for resource trained, and training 200 paramedics availability

.Policy 1994. female workers. development by facility. done. Nov. 1993.

.Recruitment June 1994. -Training plan -Training plan

of staff -Staff ready by D0H by designed by

.Staff recruitment Dec. 1993. Dec. 1993.

Transfers under approved -Staff -Staff

-Staff PC-1 by Nov. recruitment by recruitment by

Remuneration 1993 and May April 1994. April 1994.

-Staff 1994.

Retention

S. 1nOMB PAUCPAYl OP PPIVAU RSCSOR, Iamn m0 & CClB_.as

-NGOs -Establish 131 RHPs . Train 319 more Nil -Train a Nil -Involve

- SMC links with involved. RMPs. involve 100 village

- Private local NGOs, Train and hakeems and communities

Hospitals local SMC involve 150 homeopaths. 23 PHC outlets.

- Cofmunity outlets. hakeems. -Tratn 23 LUVs,

-Assess and -9 outlets of Train and |50 TAs, 100

enlist private NGOg involved. involve S0 Qws, S00

hospitals for homeopaths. community

contrac<:ptive organizers.

surgery as RIIS8 centers.

POPULATION

N W F P BALOCHISTAN AJK FANA

Policy Action Taken by Steps to be Action taken by Steps to be Action taken by Steps to be Action tak,-n by Steps to beIssu es Sept. 15, 1993 taketi durintg Sept. is, 1993 taken during Sept. IS, 1993 taken duriJn9 St-pt 19, 1'993 t4ken durtng

1993-94 1993-94 1993-94 1993-94

6. ADBOUIIIT Review the Continued Supply andSUWPPE OP arrangements. activity. reportingco#IRACRPT1Ves system in place

for eachdistrict beforeMarch 1994.13 districts,10 tehails havedisplayedcharts ofsupply system,functional byMarch 1994.

7. "DIRSI1IP Ensure PPCO I4IllENU content in all

curricula/subject matterfor briefingsof new andexistingpoliticians andother leaders.Develop planforestablishingsystem ofdeveloping andfostering

leadershipcommitment.

December 9, 1993

m:\pak\sapp\populatn.tab

137

Rural Water SuoDl1 alld Sanitation

A. Policy Unification

S. Community Management and Participation

C. Cost Recovery

I~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Policy Unification

SALOCMISTAN NWFP PUNJAB SIND"

Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be takenSept. 15. 1993 During 1993/94 Sept. IS, 1993 During 1993/94 Sept. IS, 1993 During 1993/94 Sept. IS, 1993 During 1993/94

- G08 has No new schemes to - GONWFP has The Cabinet will - GOPunjab has GOPunjab will - Unified policy Procedural systemsformulated a be undertaken initiated the approve a RYSS decided on a enforce tSis Siew on subsidy, cost being workedunified policy on without )4OU signed formulation of strategy, based on unified policy tariff policy recovery and out/draftedcommunity by genuine unified policy by the committees of tariff uniformally, and handing over ofparticipation, village/community constituting a recommendations collection monitor its schemes to Devisesubsidy, cost organization to Speaker's (Re.20 for water implementation community has implementationrecovery and O0M undertake 06M of Committee which The Provincial supply house been formulated, strategy tocf schemes. schemes. has recommended Aasembl-y will connection and and approved by operationalizeand

institutional and endorse the P.s.8 for the Government enforce the- An At least 20% of financial Cabinet decision drainage) unified policy."Implementation existing schemes policies for and issue aComaittee" headed will be handed RtiSS. notification in Undertaket- Additional ov.er to ccmmun;ty - A task force 1993!54. The Task publicity campaionChief Secretary lirreversibly) to has been formed Force will to inform and(Dev.), formed. manage, run and and its TOR continue to work increase public

maintain. prepared to to implement awareness on theimplement this decision. The P6D unified policy.committee's Department willdesign for the seek to unify cost Familiarizationgradual transfer recovery and user visits by publicof RWSS to users. participation reps. to- The task force policies of all successf-lhas its report agencies/programs communityand its promoting RWSS participation RWSSrecommendation projects.underconsideration bythe Sub-Committeeof the SpeakerCommittee

R.W.S.S.

2. Community Manaoement and Particioation

BALOCt4rSTAN OW?P PUNJAB sitlol

Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be takensept. 15. 1993 During 1993/94 Sept. IS, 1993 During 1993/94 Sept. IS, 1993 During 1993/94 Sept. 15, 1993 Ouring 199'!94- S.x Community Formation of - Speakers Cmte. - CONWFP will by - PHED and P&D PHED will evaluate - Supportive 6-12 addicionalDevelopment teams Village recommended Decu 1993 Departments have performance of policy P'Ts to be formedset up in PliED Organization gVosi transfer of RWSS strengthen PHiED to started pilot these 30 schemes environment laid and trained toand Township Water schemes to local support village project to hand down for undertake- .'en vila?e UJsers Association councils. organizations to over 06M of RUSS ccmmunity ccmmunit ycrganLzations se: 47.wUU). - PHED developed manage 06M. to 30 user involvement in mctiva:ton inup a step-wise GONWFP will communities in future rwss about 1000Strengthening PHED approach to strengthen the one district. projects under villages.to ensure community Local Govt. and the unified

community participation; Rural Dev. Dept. PHEO will select poALCy 000 :1:Jages toParticipation as has started one and foster inter- communities for deciaraticn. te orgar.i:ed toczncev:ed in iDA- unit for field agency the pilot and tac.e c .r and?.:SS prc)ect work and has collaboration. invclve electel - Six Pr-ect manace T=pJetedsanctioned five - The Task Force representation 1:*6.ee,;:-n rr-.ees.more; and has will continue to in community Tear-$ IPTs)

- For any new started training seek technical motivation by formed b- 1HED PITs to consultscheme communities of staff. assistance and Sept. 1993 to introduce 200 communitieslvillage - Task force set collaborationlcoor communit y And asscciate themorganxzations and up for this dination with development (cr preptratxon c'Township Water purpose and has existing donor on work, and are new schemes 6users Association) submitted its the field IGT2, undergoing obtatninnwill be involved interim report UNICEF & RWSG-SA) training. undertaking fromfrom design stage for gradual hand - A coordinated them for 0SM.to contracting over of existing structure between

& new schemes to the line- Inconsistency user communities: departments andwith unified recommendations the communitypolicy due to are under development unitrecruitment of tax consideration of at the districtcollectors to be the sub-committee level will bereviewed and final - Diset. Dev. defined in linedecision to be Boards for RWSS with Task Forcereached. notified recowmendations.

4

3. Cautl ovar

sALOCII srtA MVP PUNJAB SIMON

Action Prior to Action to be taken Action Prior to Action to be taken hction Prior to Action to be taken | Action Prior to Action tobe takenSept. IS. 19S3 During 1993/94 sept. is, 199' Oi Cring 1993/94 Sept. IS, 1993 During 1993/94 | Sept. IS, 1993 During 1993J94- 3 types of cost for schemes - The Speakers' GONWFP will apply - Chief Minister COPunjab will - Cost recovery evise strategy torecovery strategy jmanaged by PHt5D Committee has and collect the has approved a enforce this new polcy including implement newuggested in the routine review and recommended enhanced rates. revised water tariff. PHEP will COS subsidy for schees an theunxfted policy2 revisSon of increased RWSS PHED will start tariff tRs.20 hire consultants electricity and bassi of counjtytariffs to meet charges 1R9.30 impro0vd billing per month for a to designn install recovery through demand through1p Ssmple rurap recurrent costs. p.M., per house system over the house (Water and operate the indirect explicitschemes - 06H connection. extended area. supply) required billing taxation has undertaking byrespOnSibLlLty of Revenue generated Rs.200 for connection; Rs.$ system, and train been formulated coemunsty tovillage frcm one township initial Computerized per month for its staff in under the asintain theorqanizaCion will not be connecc&onI billing system to drainage . operating this -unified schetes.21 Rural schems - 1ierted to other - GO"#FP has be extended so as system. Policy.Foor comm nities - tcwns for cross- reviewed the to "eet target of - The Board of WOO coamuntcAmssons subsidy subs.oy. administration oS 50% by 1996. Revenue has The Board of - Steps taken to ttarget) wti be3) txceptionally cost recovery and agreed to Revenue will deteilI targeted forcamplex schemes CO has found it can The Cabinet will collect the collect tariffs procedures and motivation 6 totownships - 'Impiementation be improved; approve enhanced tariff through for PNED. increase GOS assume Ottmanaged by PHED Committee to caoputerized rates Nambagdar on revenue to responsibtittseswith flat rate devise and billing has been behalf of PHED. financeusers charges pprLodicaily started in 100 recurrent About SOO(tR.30 per review the subsidy ROSS schemes, charges for completed schemeshousehold, Rs.2S0 structure for poor with the result electricity will beper coemrcial comunities and that recovery has being worked rehabil&tatedconnection.) the indirect doubled over out, before therecovery strategy previous year in commnity takesfrom special tax, target areas. over.ceos or levy.

Sufficientprovision to oemade in AMP/Dudgetfor recurrent costas per new policy.

I~~~~~

3. Cost Recovery (COntinuedl

SALOCHISTAN mWAP PUNJAD SIND"

Aetion Prior to Action to be taken Action Prior to Action to be taken Action Prior to (Action to be taken Action Prior to Action to be taken

Sept. Is, 1991 During 1993/94 Sept. Is. 1993 During 1993/94 Sept. 15i 1993 During 1993/94 Sept. 15. 1993 During 1993/94

-CFfP has - Steps taken to - Proceures fortaken steps t* increase community based

extend improved (increasing case 06M will bebilling charges on land. approved and- Protoma cotton, sugar s enforced by thebalance sheet paddy) government.developed for governrentconeulting with revenue to Metcosunities on part of 06t costthe nature C cost (about 2/3rd)of new schems. Apilot projectbeing impleamentedin 4 villages of4 districts.

. . , , .~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~3

3-

142

PAKISTAN

SOCIAL ACTION PROGRAMME

...

AJKE FATA, ICT, and Northern Areas

IMPLEMENTATION PLANS

SUMMARY OF KEY REFORMS

143

AJK: Azad Jammu and ICashmir

FATA: Federally Administered Tribal Areas

ICT: Islamabad Capital Territory

NA: Northern Areas

I

1449iU-CATXQN

1. Enhance Girls Primary Education

a. Introduce Co-Education at the Primary Levelb. Increase Female Teachers

2. Strengthen Primary Education Institutions 6 Procedure

a. Increase Focus on Primary Educationb. Streamline Site SelectionC. Revise and Enforce Posting and Transfer Policiesd. Strengthen data base for Managing Primary Education

EDUCATIONA. Enhgnce Cirls Primary Education

a) Introduce Co-Education at the Primar, Level

AJK FATA IcT tlorthern AreasAction Prior to Action to be taken Action Prior to | Action to be taken Action Prior to Action to bW tacen Action Prior to Action to be takenSept. 15, 1993 During 1993/94 Sept. IS, 1993 During 1993/94 Sept. 15, 1993 j During 1993/94 Sept. 1S. 1993 During 1993/94constru:tion of 20 schools to be Combined Efforts to Already |A11 the .7 Decision by Chief:SO gir s primary constructed and administrative convince parents Islamabad proposed new Commissionerschools &ncluded staf fed system already in to allow girl Capital schools -dill be tiorthern Areas.in 8th Plan place; students to attend Territory has single system. and Kashmir

Directorate of boys schools. substantively a Affairs andEducation, FASA single system Niorthern Areashas notified that out of total of Itinistry that: a)there is no bar 218 primary all new schoolson co-education schools all of will be girlsupto primary the 60 urban schools which boyslevel. schools and Sot can also attend,

rural schools and b) that- directive are on single existing schoolsissued to appoint system will become co-aged male educational

teachers in girlsprimary schools.

- decisions to benotified by Chief- in some areas Commissioner/ttin.-

like Kurram stry

Agency, girlsalready attendingboys school but

tndue to socio-culturalcondition thesystem cannot befully implemented

, . .... . ............ s_ ,, ,, ' ,~~~~~~~~~~~~~~~~~~~~~~~~~~

£ODICAtION1. Enhance Girls Primary Educatkon

b) Increase Female Teachers

AJK FATA ICT Northern AreasAction Prior to Actxon to be taken Action Prior to iction to be taken Action, Prior to Action tO be taken |Action Prior to Actton to be takenSept. I5S 1993 During 1993/94 sept. 1S, 1993 During 1993/94 Sept. IS. 1993 During 1993/94 [Sept. 15, 1993 During 1993/94GoAJX nas relaxed Inter-deparmeneal Governor has age relaxation for Out o' total of f All 477 new school examine relaxationage rules ito 3' Task F:rce to be directed that in female teachers; 2779 teachers, teachers to be of age and qualifyyears) for ten.3.e established to future every girl 65% are women. hired will be rules for femaleteachers determine other primary school - lowering women, teachers; andmeasures like pay would include educational - transport issuelevels and residenttal qaulification from facility - initiate notification;I:,cen.lVes guarters y.atric to Middle provided for proposal to

for female PTC rural female increase transport - provisicn of.eachers; teachers through facility for rural :ncentive packagea buses. female teachers for female- recruitment of

teachers in rezoteaddxtional 459 - initiate areasfemale teachers in proposal to giveBPS 1-7 sub)ect to salary incentivesbudget allocation to rural femaleby Federal teachersGo:ernment;

- fret in-servicetraining andstipends forfemale teachers;

__

- appoint retired 0male teachers

EDUCATION2. stg.hen Prisiarv Education Institutions & Procedurge

a) In¢rease FOCUs on Primary Education

AJK FATA ICt Northern AreasActicn Prior to ActLon to be taken Action Prior to [Action to be taken Action Prior to Action to be taken Action Prior to Action to be takenSept. IS. 1993 - 6Durino 1993194 Sept. IS, 1993 During 1993/94 Sept. 15, 1993 During 1993/94 Sept. IS, 1993 During 1993/94Z07 primary 48 prisary schools Plan proposed Plan to give:Orhools buildings buildings will be submitted for S rural schoolsare at different coopleted

SAP new building;stages of addition ofcompletion - furniture and classroom in 200tecahing material rural schoolswill be provided therby having Sto 50 primary classrooms in eachschools scnools; -allsconstructed in 40GOAJK will rurals girlsestablish a schools andDirectorate of toilets providedElemen:ry in 25 rural girlsEducatson schools; prov{sionof water in 120a study required rural schools andto develop electricLty in 50training strategy rural schools. Pand implementat ion

plan for theDirectorate

do

2. Str ntth Primarv Educatign Institutione A Prtaedurebi Streamline Site Selection

AJX FATA ICT Northern Areas_et _ 5 19_ _uin 93I jSt. 15 199 Duin -39 Sp. 1, 199 D,in 93/Sp. .S 19, Duin _ -,IActicn PrAor to ACtion to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action tO be takenSept. It. 993 >4rzn9 1993/94 Sept. Is 1993 During 1993194 Sept. IS, 1993 During 1993/94 Sept. IS, 1993 During 1993/94For 93/94 Criteria% Site selection Proposed to all sites are Undertake tbeir TADirectorate of - primary schools is based on 2 improve surveying provided by the financing, aEducation, fATA to be opened where principles: procedures for community free school mappinghas received from catchment is site selection of of cost exerciseall the Agency atleast 100 - taking schools schoolsEducation to remote and - sife selection - formation ofOfficers, a list - a middle/primary cut off areas - ongoing scheme carried out by committes tocf :ojsztle Rates school shall not of 25 03 class District Site reccnnendlocatiorlh,ch il be exist within the - FDE survey room) Schools; 3 Selection of rew schoolsconsidered as and radius of IS km of determines under ccnstruction Committeeswhen ADP/SAP is proposed site minimum of 30 and 10 on line composed of - decisions takenfinalized children from during 93/94 Deputy Director that all new sites- land is provided locality unable Education and a will befree of cost by to attend school commnity topographically

c6mmunity/local because of lack representative appropriate and sM4alik of access with .,lose- location of proxim.ty to- site is selected schools decided village

by the Political in consultation settlementsAgent in with nA councilconsultation with msmbersEducationDepartment - location of

village schoolsdecided by Vos.

. == r i _ _ . .~~~~~~~~~~~~~~~~~

EDUCATION2. Screngtnen Primary Education Institutions & Procedure

c) Revise and Inforce Posting and Transfer Policies

FATA ICT Northern Areash' '.i',r, -t .'r t . fs- *.1. I. '> n*w^ 2 aS It.J s, *rt.s.r to | Anct to hu takur, Action Prior to Action to be taken n Action Prior to Action tO be b.IQfnSept..:9S: jr:nj 19'-/'4 I 1 !uring 1553/94 Seot. 15, 1993 |-Outing 1993/94 Sept. 15. 1993 | During 1993/94

,~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~!ic~~ulr(; 19.9 set IS 1993

Primary scr._ols 17" an-, Cabinet New transfer Implememtation Formation ofteachers frornm srou:. decide to policy approved continues on the working group toGrade cannot ce exclu_2e any in 3ovemsber 92 new transfer frame merit-basedtransfered outsi-e inter!erence in by MOE; and policy postings andthe District pcst:n-s .nd being

transfers policy:.-se-s ±rr.plem:ented

- notification of- period of. ,ork;.ng grouprural and urban

stay fixed

- rural urban

inter-transfer

ensured after

fixed days

- remotness oflocation traded

off withdirection

- Nlon ICTAteachers sent to

rural areas

4~~~~~~~~~~~~~.

tDUCATION2. Strengthen Primary Education Institutions & Proceduredi Stgengthen data base for Managino Primarv Educatton

IAJK PATA ICT _ Northern AreasAction Prior to Action to be taken Action Prior to Action to be taken Action Prnor to Action to be taken Action Prior to Action tobe takenSept. 15. 1993 During 1993/94 Sept. IS, 1993 During 1993194 Sept. 15 1993 During 1993/94 Sept. 15. 1993 During 1993/94fJEM1S functioning Decision required iNEf4S is already Under the GIS - Computer has All data to be put MENIS working in Strengthentn AJl and is to e*tend NEfIS housed in the prolect. the bench been installed on line nA statistscs dept.compiling activity to Scnool Directorate ot mtark will be in Federal for compilingprovincial mapping Education, FATA. further Directorate of educationalstatist ics on Updated facts and improved/authenti- Education statisticseducation figures available cated.

on educacion in - More accurate - preparation ofFATA - establisnment of data Is consolidatedGIS cell and availatle protect forremote sensing institutionalCeoll trengthening

- Seminar on GtS - extensin ofbeing organized by .nEWIS to NAP6D Dept.

J. . , v .. . ._

151

HEALTH

1. Establish Strategic Planning Mechanism

2. Re-organize PHC Services and Financing

3. Decentralize Administrative and Financial rowers

4. Improve Gender Staffing Imbalances

5. DOH Expanded Participation in Population Programme

NEALTH

1. Establish Strategic Planning .%1echanism

AJK FATA ICr Northern AreasAction Prior to I Action to be taken Action Prior to Actxon to be taken Action Prior to ActLon to be taken Action Prior to Action to be takenSec. iS, 1993 Duringq 193/94 Sept. 15, 2993 During 1993/94 Sept. 15, 1995 | During 1993/94 [Sept. 15, 1993 During 1993/94Pianning Unxt Prepare plans for Establish a Two proposals to Establishplanningesrabliihed in building planning planning unit at initiate cell at1lealth D:r.ctcrate :apacity at the Directorate institutional Directorate levelDistrict level - strengtheninr by expanding.Jure 1994 - Preparation of instead of Health and

rclling plans - eutatlishment cf populationApril 1594 new facil ttes; planning mechanism

SAP and 2nd - June 1994- Preparation of Fam .i-: HedIIhArnual Plans - prtjectAprii !-94

-2%id Famil:.Health Projectappro7ed b4y£CIIEC dated11.2.!593

- .he matter hasbeen d:scussedtu:ih iiealth Division of Dev.Wing ICT andagreed foropening ofimprest acccunt

HEALTH2. Ae-oraanize PHC Services and Financxnn

AJK FATA ICT Ijorthern AreasActLon Prior to | Action to be taken Action Prior to Action to be taken Action PrLor to Action to be taken Action Prior to Action to be takenSept. 15S 1993 Durxng 1993/94 _ Sept. 1, 1993 Ouring 1993/54 Sept. IS, 1993 During 1993/94 Sept. 15, 1993 During 19S3/94meeting held staff to be Improvement/Up- One BHU to be Plan incentive for Training Working groupbetween Planning provided to these gradation of new upgraded to RHC botter performance programs for formed to studyand Development centres/units. Basic Health and two of CH'ds health auxallary reorgarization,and Fir.ance tF-iits, Rural dispensaries to be staff underway. prepareDepartments to - Increase in dev. dealth Centres upgraded to BHUs.

reccmmendatiorns -meet r.ecessary and non-salary and providing Preventive health - Immunization :May l9C4sta'fing needs in recurring budget * residential facilities to be and 1CH servicesthe constructed April 1'54. quarters with xncreased. being expanded. - nctl!y uwcrklngBasic Health Units - CDC program ;c Basic Health Construction of S crcur

ar.i Rural Health be broad based - Units (included new SH'Js to start.Cc-r.t:es. c.lans and in SA.?P. - ccns:rut;:.n .

rccesses prepared 5 res:dences for.-une 954. - Pre service Basic Health Unit

- ::otirational training program M:edxcal Officerscampaign for for para medics icat III).female trainees included in SAP - "nrrease non-planAed and salary bucdget byapproved - April current vear1994. before- Management negotiations andtraining to FtfC next year by Junemacagers - details l1S4prepared and - Strengthen CDCapproved - June program1994. - Link health- Strengthen facilitiesreferral system - Referral systemplans approved - & suppQrt to PHCJune 1594. - Stari traininq

of PHC managers Lnmanagement

HEALTH3. Decentra3ize Administrative and Financial Powers

AJx PATA IC? N4orthern AreasAction Prior to Action to be taken Action Prior to Action to be taken Actiro Prior to fAction to be taken Action Prior co Action to be takenSept. IS, 1993 During 2993;94 Sept. IS 1993 - During 1993/94 Sept. I5. 1993 During 1993/94 Sept. 15, 1993 During 1993/94CFO recruiting Establish a Task Setup Task Force - Propctal for - Implementation Formation ofauthorxt? for BPS Force to review to study recrs:u.ent feasitle oeacuse workin9 group to1-7 existing system, decentralizing poI:-, with solution :nternal prepareMay 1994 authority from Federal GCvt. ta ICTA recomrmendation- DHO categoty 11 Federation to Area alread'officer for - Report ready tn:t;ated - Personnel andfinancial ;urpose April 1994 financial

authcrities- Establish Task delegated by KAIRAForce to Study tc areaadministrati e~ authoritiessetup for FATA; ndnot part of - notifLcatxon ofprovincial setup - wor)king groupReport of TasxForce ready byApril 1994

- Study groupconstituted torevxewdecentralizationof powers toAgency Surgeons -June 1994

k~~~~~~~~~~~~~~~~ ~ ~~~~ ~ ~~ .. .. .. .. . .

HEALTH4. Improve Gender StaffinQ rmbalances

AJK PATA ICT r)orthern AreasAct:on Pricr to AC:ion to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior tGo Action to Oa takenSept. IS, 99uring 1993/94 Sept. IS, 1993 During 1993/94 Sept. IS, l9S9 During 1993/94 Sept. 1S. 1993 During 19t3194'nder current For fucure Distt. Health Dev. At BHU level 2 Working group toins em. 'emale raOanc;es female Centres fDHDC) in incharge S.MOS; ail drawa" if ataff ' wi.ll citLes bordering female CHWs tc ne recommer.dationaiid.:a..atiel :s =.:ntinue to be the agencies will appointed. pian of acticn -sre!erred for C preference train. bHV/nurses/

Dec. 19;3recruitment para medic staff - use SAP to- Prepare plans (under Family inrtiate hir:r.g of - Prepare plan for-Onl cne school for the Health Project). CH1Ns, and ISAs requiree.ent of..|rrer.tl trains requ:rement of (subject to :emale health!,:sa,e heal:h - appointment of Federal Gov.t. Laramedizo; i : r;mes::. doct:rs at SHUs recruitment 1 a an:z..C---w:tn a - 8DHCs to start and availabl.i:t. p:antraLnin,; plan - traninon; cf funds)i 'une '?94 - proposed Rs.1500 - not ifcation o'

p.m. Rural working group

CompensatoryAllowance forfemale r.O cotmparedwith Rs.1200 p.m.for male Po

Ln- sp*cial projectunser SAP fortratning paramedic staffincluding nurseswith stipendar

- Develop a planfor Human ResourceDe%. training

plan - June 1994

HEALTHs. DC" Expanded ParticipatLon in Poyulation Programme

AJK FATA ICT tlorthern Areasj Action Prior to Action to be taken Action Prior to ActLon to be taken Action Prior to Action to be taken Action Prior to Action to he takenSept. 15. 1953 Dur_ng 1993/94 Sept. 15. 1993 During 1993/94' Sept. 1'. 1993 During 1993/94 | Sept, 15. 1993 Durirn 199l /94Collabaration Expansion of FP Extension of CHWs 'till initiate Joxnt sneetings ofalready exist services in PHC contraceptive community level Populationbetw,een H9.alth and i^:l.z:es supply to selected population Ministry and VIAPopulation Wi:&re 1J0 SHUs, 5 RHCs, programme HealthDepartments 6 MCHs (free of

Directoratescost under Family

finalize- Population Health Pro)ect) modalitles - Juneprogram part cf 1994?fC in a !ir.tee - 3 day trainino

r.umber c' :ef _H'..s at BHUs - M?a: arc Health9 fa:;l::ies !::rectra:e tc- S3 June c4, 1':. issue necessaryusage of famLly directxves to

planning is their Off'ces inexpected to be flortherr. Areas toach:aved implemer.t theprogramme.

- Agree on

procedures ofprovxding servicesat all health carefacilities - Dec.1993

4-.

a,Start providing

family planningser-vices inselected healttlfacilities - June1994. _ . ,. . . . _ _ _ .j

157

Rural Water Supply and Sanitation

1. Policy Unification

2. Community Management and Participation

3. Cost Recovery

R.W.S.S.

1. Policy UnificationAJK FATA ICT porthern Areas

| Actic'n Prior to ActLJn to be taken Actxon Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to te takense . IS. !993 Durina 1993/94 Sept. IS, 1993 During 1993/94 Sept. 1S 1993 During 1993/94 Sept. lIS 1993 During 1993/94l urniorm Approval of the PHEO's Task Force Recommendations of - Draft Implementation of Prepare workingc:s-edure ,or RtXS uniform policy tor has given interim Task Force resolution of pro)ect sub)ect to paper showingPr_ e ;v3.* as been Xater Suppl- report to reviewed and rural area capital cost existing schemesr.::ated ::r :'rogram implement appropriate Coordination funding of 11 under various

Speakers decisior taken by Comsittee on schemes pr-gram,mes andCommittee's Dec. 93. water charoes makedecision for levied by Union recommendationsgradual transfer Uniform policies Councxils passed for implementationof P.1S schemes to in place by Dec. cf unifors. polcy.user cornrnunit es a4.

r*artcpatn on i

a.rura.s rcnerdte

_ :mplementuniform poticy !trPWS sector wh.chtransters O&MresponsibiL~ty t-crmmunities andincreasescommnunity lpartiOLpAtion inscheme preparat &tr.and~mplementat ion.

R.W.S.S.

2. Community Management and Participation

_ AJK FATA ICT Northern Areas

i A:tLon Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be takerSe;t. 15, 1,13 During 1993/94 Sept. 15. 1993 During 1993/94 Sept. 15. 1993 During 1993/94 Sept. 15. 1993 During 1993/94

[' ,A and DtICEF In-service Strengthen PHED to Water User's Limited NGO L&RD is Preparation of a.asststel ,WsS training of PHED support VDOs to Committees presence, however preparing donor new schemes usir-prsects h staff started undertake & manage organized in concerned village assisted community ±edcomiuniti schemes most villages Committees will projects in approach.part.cipaticn - Directive participate in collaborationaireay jinzer.)av issued to - Approval of PCI implementation 6 with AYRSP with Tra ning of sta:

establish of Pak-German O&M stage a community led on commurittycommunity based Promotion of PHED a-proach partic:pat:n ;norganizations IPhase II), AY.RSP-HPDI.

includingincreased training

- Revitalizationof multi partysteering committee

. .~~~~~~~~~~~~~~~~~~~~~~~~~~%

3. Cost RecoveryAJK FATA ICT Northern Areas

Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be taken Action Prior to Action to be takenSept. IS, 1993 During 1993/94 sept. IS, 1993 During 1993/94 Sept. IS, 1993 During 1993/94 Sept. 15, 1993 During 199 /94In the rural

As in I above As in I abovedesveloFpentsector. PISSs1beres ar- runand mainr.ta±r..A tvconur.. t iesthroug' their,water ::fr.7.:tees.Gra:ity sche5es61.0c pur:ring .;nltSha,e *. f!senttal.ftr. I.1e.. Lrthr. p.. r.?cop6-c;t:. c' tr.ecemmun.ties.- soff.e cr,ounitiesha.e r.a nta:nedOts: ccst reco:erysyster cut at d-esnc: ccnzrituteto--arcs thefinances of GOA.'r..

0.

161

ANNEX IIISLAMIC REPUBLIC OF PAKISTAN

Social Action Program Project

Supervision Plan

The annual cycle of supervision was described in the "Implementation Chapter" of the StaffAppraisal Report and again in the "Implementation Plan" annex to this report. This annexpresents a budget for this supervision, along with a few comments on the magnitude of therequirements.

While the SAPP is a single project, it deals with four sectors in four provinces and fourfederal territories along with several other components. This means the supervision of thisproject inevitably will be more costly than a normal investment project. And, because of thedecentralized approach to policy formulation and monitoring, it also will be more costly tosupervise than an adjustment operation. Much of the supervision cost can be borne jointly withthat of on-going projects in the SAP sectors. The following budget presents the supervision costfor both the on-going projects and the marginal costs of the SAP project supervision.

Basic Social Services: Cost of IDA Supervision in Staffweeks

Province/ Education Education Heatth Health RUSS RUSS TOTALSArea Project SAP Project SAP Project SAP

Sindh 16 2 8 2 5 2 35

Punjab 32 2 8 2 - o - 2 46

Salochistan 16 2 8 2 5 2 35

NWFP Appraisal 2 8 2 -a - 2 14

FederalTerritory - o - 1 -o - 1 2 1 5

FederalMinistry - o - I - 0 - 1 -a- -0- 2

Sub Total 64 10 32 10 12 9 137

In addition to these provincial/territory supervision requirements are thefollowing:

Population 6 swsProcurement/disbursement 2 swsParticipatory Development Fund/Monitoring and Evaluation/

overall task supervision 12 swssub-total 20 Sws

From table for SAP 29 swsTotal--Additional for SAP Supervision 4

162

ANNEX III

SOCIAL ACTION PROGRAM PROJECT

List of Documents Consulted

1. Towards a Social Action Program for Pakistan: Impediments to Progress andOptions for Reform - World Bank Interim Report (EMENA), October 1991

2. Progress Report on Provincial Plans - Operationalizing the Social Action Program; Ms.Shahnaz Wazir Ali, August 1992

3. Social Action Program: Task Force Guidelines, December 1992 for:(a) Education Sector(b) Health Sector(c) Population Sector(d) Rural Water Supply & Sanitation Sector

4. Inventory of Foreign Project Assistance in SAP Sectors, Consultants' Report, January1993

5. Social Action Program: Internal Concept Paper, January 1993

6. SAP: Summary of Sectoral Policy Issues for the Islamabad Capital TerritoryAdministration (ICTA) - Dr. Moazam Mahmood, April 1993

7. SAP Project: World Bank Project Preparation Mission National and ProvincialAide-Memoires, March/April, 1993

8. SAP Project: Government of Pakistan; Federal & Provincial Operational/ImplementationPlans, March/April, and September/October, 1993

9. SAP Project: Government of Azad Jammu & Kashmir; Operational/ImplementationPlans, March/April, and September/October, 1993

10. SAP Project: FATA, FANA and ICT's Operational/Implementation Plans, March/April,and September/October, 1993

11. SAP Project: Government of Pakistan, Operational/Implementation Plans for Population,March/April, and September/October, 1993

12. SAP Project: World Bank Pre-Appraisal Mission Aide-Memoire, September, 1993

163

13. SAP Project: World Bank Appraisal Completion Mission Aide-Memoire, November, 1993

14. SAP: Summary of Key Reforms; Federal & Provincial Governments, P&D Division, andP&D Departments, May and September, 1993

15. SAP: Summary of Key Reforms; GOAJK, GONWFP for FATA, GOPakistan for ICT,and Northern Areas Administration for FANA, May & September, 1993

16. SAP: Federal & Provincial Eighth Five-Year Plans (1993-1998); P&D Division,GOPakistan, and P&D Departments, GOProvinces, 1993

17. SAP: Eighth Five-Year Plan (1993-1998) for Azad Jammu & Kashmir; GOAJK, February1993

18. SAP: Eighth Five-Year Plan (1993-1998) for Population; Ministry of Population Welfare,GOPakistan, March 1993

19. SAP: Memorandum for the Pakistan Consortium, 1993-94; Planning Commission,Government of Pakistan, April 1993

20. SAP: Report to the Donors Meeting; Planning Conunission, Government of Pakistan,September 1993

21. Assessment of SAP Allocations in the Federal & Provincial Budgets, FY93-94: ShahidKardar, August 1993

22. Federal & Provincial Budget Documents; Budget 1993-94, Government of Pakistan,Provincial Governments, and Govt. of AJK

23. Social Action Program: Two-Year Plan, 1993-1995; Government of Pakistan, 1993

24. Federal Annual Plan, 1993-94 (Blue Book); Government of Pakistan, June 1993

25. Review of Loan Disbursement and Withdrawal Procedures under SAP; World BankConsultants Report (A. F. Fergusons & Co.), October 1993

26. SAP Project: Review of Local Procurement Procedures; World Bank Consultant'sReport (Navaid A. Nasri), October 1993

27. SAP Project: Monitoring System in the Provinces; World Bank Consultant's Report (Dr.Syed Akmal Hussain), October 1993

28. Pakistan: Population Welfare Program Project - World Bank Project Preparation MissionAide-Memoire, May 1993

164

29. Pakistan: World Bank SAP Project (Population) and Population Program Project MissionAide-Memoire, (Volumes I-Ill), November 1993

30. Population Welfare Program (Federal Activity), 1993-1998; Ministry of PopulationWelfare, Government of Pakistan, 1993

31. Report of the Committee on Social Action Program; Government of Pakistan, undated.

32. National Rural Support Program (NRSP); Briefing Notes, August 1993

33. Improving the Efficiency & Effectiveness of Spending in the Social Sectors, andIncreasing Mobilization in the Provinces: A Study of the Canadian High Commission,October 1993

34. Prime Minister's Program for Family Planning & Primary Health Care: Paper by theHealth Division, GOPakistan, November 1993

35. World Bank's Health Sector Study: Key Concerns and Solutions, June 25, 1993

36. Pakistan: Progress Under Economic Adjustment; World Bank Country EconomicMemorandum, March 1993

37. Balanced Development: A Prescription for Social Action in Pakistan, UNDP Study,September 1991

38. Japanese International Cooperation Agency (JICA) Reports on:(a) Pakistan: Population Welfare Program, April 1992(b) Pakistan: Women in Development, April 1992(c) Pakistan: Primary Health Care, April 1992(d) Pakistan: Primary Education, April 1992

39. Balochistan Primary Education; World Bank Staff Appraisal Report, March 1993

40. Pakistan: Second Family Health Project; World Bank Staff Appraisal Report, September1992

41. Pakistan: Guidelines for Policy Agenda in Health Sector; World Bank Staff AppraisalReport, August 1993

42. Pakistan: Primary Health Care Project; World Bank Staff Appraisal Report, March 1993

43. Operational Plans for 1993/94 dated February, 1994 for the following:Punjab, Sindh, NWFP, Balochistan. AJK, FATA, FANA, ICT and Population Welfare

MAP SECTION

IBRD 23805R

JS3 Oi 44 ZBEKISTAN TAJIKISTAN'q TAJIKISTAN 4%

CHINATURKMENISTAN

AFGHANISTAN f Co.*oI134' 34*

Pes JAMMU A.SLAMABAD KASHMI

32~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~r/ l h~~~~ ~ ~ ~ ~ ~~~~Queffo @ 0

ISLAMICREP OF 2 PAKISTAN

IRAN= ~ ~ ~ ~~~ ^ ,_f { ~~~~~~~~~~~~~~~~ ~Rivers

- ti D~~~~~~~~~~~~~~~~~~~~~~~~~ Province Copitol,_Jw + $ @~~~~~~~~~~~~~~~~~~~~~~~~ National Capital

26' Province Boundaries 264t -~~~~~~~~~~~~. \ I~~~~~~~~~~~~ntemnolonrzl Boundaries

- _ - - _. Hyderabd

Arabian Sea

24. 0 20 40 60 W 10 2t

Kr ~~~~~~~~~~~~~~~~~~Y

42- . *' qr - < 7,2- 7,4 76

JULY 1993