Djibouti-PCR- Health Services Improvement · ARI Acute Respiratory Infection CNTS National Blood...

Language: English Original: French

AFRICAN DEVELOPMENT FUND

BASIC HEALTH SERVICES IMPROVEMENT PROJECT

COUNTRY: REPUBLIC OF DJIBOUTI PROJECT COMPLETION REPORT Date: April 2012

Project Team

Team Leader: H. MRABET, Architect, OSHD.3 Team Members: H. MRABET and 2 Consultants (N. Y. Coulibaly, Health Expert, and M. Cissé, Architect) Sector Division Manager: F. ZHAO OSHD.3 Sector Director : A. SOUCAT, OSHD Regional Director: K. MLAMBO, OREB

Peer Reviewers

Mmes: B. Ba Diagne, Health Economist, OSHD.3 L. Lannes, Health Economist, OSHD.3 C. Jehu – Appiah, Health Economist, OSHD.3 M. Diop Ly, Health Analyst, OSHD.3 Messrs.: F. Sergent, Health Analyst, OSHD.3

A. El Maghraby, H. R. S for Health Services OSHD.3 I. Sanogo, Health Analyst, OSHD.3

K. P. Agyeman, Consulting Architect, OSHD.3

TABLE OF CONTENTS

A. PROJECT DATA AND KEY DATES I. Basic Information 1 II. Key Dates 1 III. Ratings Summary 1 IV. Responsible Bank Staff 2

B. PROJECT CONTEXT 2

C. PROJECT OBJECTIVES AND LOGICAL FRAMEWORK 3

D. OUTPUTS AND OUTCOMES 7 I. Achievement of Outputs 7 II. Achievement of Outcomes 9

E. PROJECT DESIGN AND READINESS FOR IMPLEMENTATION 10

F. IMPLEMENTATION 12

G. COMPLETION 15

H. LESSONS LEARNED 15

I. PROJECT RATINGS SUMMARY 16

J. PROCESSING 18

ANNEXES

I. Project Presentation, Description and Implementation I II. Project Financial Implementation IV III. Procurement Plan – 2010 V IV. Missions undertaken by ADB Experts XII V. Ratings of the last supervision mission (December 2010) XIII VI. Sources of information XIV

LIST OF ABBREVIATIONS AND ACRONYMS ACRONYM MEANING ADB African Development Bank ADF African Development Fund AIDS Acquired Immunodeficiency Syndrome ARI Acute Respiratory Infection CNTS National Blood Transfusion Centre DEH Dar El Hanane Maternity DSSB Department of Basic Health Care EMD Djibouti Medical School FDJ Djibouti Franc HIV Human Immunodeficiency Virus IMF International Monetary Fund LW Labour Ward MOH Ministry of Health MTR Mid-Term Review OFID OPEC International Development Fund PMU Project Management Unit RAC Air Communication Network RD Republic of Djibouti RH Reproductive Health SEPS Health Education Service SIS Health Information System Service UA Unit of Account UNICEF United Nations Children’s Fund USD United States Dollar UTS Blood Transfusion Unit

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A. PROJECT DATA AND KEY DATES I. BASIC INFORMATION

Project Number: P-DJ-IBE-001

Project Name: Basic Health Services Improvement Project (Health Project I)

Country: Republic of Djibouti

ID Number of all Lending Instrument(s): Loan No. 2100150006927 and Grant No. 2100155001836

Sector: Health Environmental Classification: II

Original Commitment Amount: - Loan: UA 3 million - Grant: UA 1 million

Amount Cancelled: UA 447 766.63 on the Loan

Amount Disbursed: Loan: UA 2 552 233.37 Grant: UA 1 000 000

% Disbursed: Loan: 85.07% and Grant 100%

Borrower: Republic of Djibouti

Executing Agency: Projects Management Unit within the Ministry of Health Co-financiers and other External Partners: OPEC : UA 2.01 million

II. KEY DATES Project Concept Note Cleared by Ops. Com.: N. A.

Appraisal Report Cleared by Ops. Com.: N. A.

Board Approval: 17 July 2002

Restructuring(s): N. A

Original Date Actual Date Difference in months

[actual date - original date]

EFFECTIVENESS Dec-02 27-May-04 17

MID-TERM REVIEW Oct-05 May-08 1

CLOSING 31-Dec-08 30-June-11 30

III. RATINGS SUMMARY

CRITERIA SUB-CRITERIA RATING

PROJECT OUTCOME

Achievement of Outputs 1

Achievement of Outcomes 2

Timeliness 0

OVERALL PROJECT OUTCOME 2

BANK PERFORMANCE

Design and Readiness 3

Supervision 1

2

OVERALL BANK PERFORMANCE 2

BORROWER PERFORMANCE

Design and Readiness 2

Implementation 2

OVERALL BORROWER PERFORMANCE 2

IV. RESPONSIBLE BANK STAFF

POSITIONS AT APPROVAL AT COMPLETION

Regional Director K. MLAMBO (OREB)

Sector Director A. HAMER A. SOUCAT

Task Manager M. COULIBALY M. M. CHAKROUN

PCR Team Leader H. MRABET

PCR Team Members

H. MRABET and 2 consultants (N.Y. Coulibaly, Health Expert and M. Cissé, Architect)

B. PROJECT CONTEXT Summarize the rationale for Bank assistance. State: - what development challenge the project addresses, - the Borrower's overall strategy for addressing it, - Bank activities in this country (ies) and sector over the past year and how they performed, and - ongoing Bank and other externally financed activities that complement, overlap with or relate to this project. Please cite relevant sources. Comment on the strength and coherence of the rationale. [250 words maximum. Any additional narrative about the project's origins and history, if needed, must be placed in Annex 6: Project Narrative] At appraisal (2002), 10% of sedentary households in Djibouti lived below the extreme poverty line and almost 50% of the sedentary population was affected by relative poverty. This state of poverty allows for the persistence of certain endemic, infectious and parasitic diseases such as tuberculosis, malaria, and diseases caused by fecal pollution. Hence, the health sector has been recognized as a priority for the Government of Djibouti. In 1995-1996, the Government, with the support of IDA, conducted a health sector study. It made proposals for the reform of the health system, and prepared strategies for improvement of the organization, management, and efficiency of Djibouti’s health services. In May 2001, the Japanese Government awarded a grant to Djibouti’s Government to update health sector data. In September 2001, the study report was discussed, amended by the Government, and validated through workshops. In October 2001,

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the general policy document for sector reform, resulting from the workshop deliberations, was submitted to a group of experts (World Bank, Government and Consultant) for finalization prior to distribution for the Donor Round Table Meeting. Under implementation of this reform, the Government of Djibouti submitted a request to ADF for the funding of a Basic Health Services Improvement Project. The Bank mobilized technical assistance funds provided by the Netherlands, which it used to cover the preparation and appraisal of this project. The Bank preparation mission team visited the site in February 2001, and the project appraisal mission was fielded in Djibouti in June 2001 and the re-appraisal mission in March 2002. To date, the Bank has funded four operations in the social sector: Education Projects I and II, the Social Development Fund Project, and the Women’s Advancement Support Project, which are still ongoing. Recently, the overall performance of the Bank Group’s portfolio in Djibouti has been unsatisfactory, given that in 2000, it comprised 43% projects at risk. Generally speaking, such poor performance of the portfolio has been blamed on the late fulfillment of loan conditions, inadequate acquaintance with the Bank's rules for procurement of goods and services, low loan repayments (especially since 1993), and red tape in the disbursement of counterpart funds. This project is the Bank Group’s pioneer operation in the health sector in Djibouti. It falls within one of the key sectors of the Bank's vision, and is consistent with its health sector policy and the CSP (1999-2001). The project supports activities funded by other donors: WHO, UNICEF, AFD, Global Fund, UNFPA, and the World Bank. The strategy adopted by the project to address the identified problems is based on promoting Mother and Child Health, strengthening surveillance and control of communicable diseases, and supporting health sector reforms. The activities of the “Mother and Child Health/Reproductive Health (MCH/RH) component” as well as those of the “surveillance and control of infectious communicable diseases” cover the entire territory. The training and sensitization” activities for health staff as well as the population concern the entire country. This project involves the entire Djibouti population without distinction, including immigrant and refugee populations. C. PROJECT OBJECTIVES AND LOGICAL FRAMEWORK 1. State the Project Development Objective(s) (as set out in the appraisal report) Sector Objective: Contribute to strengthening the government’s efforts under its poverty reduction policy by improving the health status and living conditions of the population. Specific objectives: Improve: (i) the quality of mother and child and reproductive health services; (ii) the quality of surveillance and control of communicable diseases and (iii) reduce the risk of contamination by infectious or parasitic communicable diseases and HIV infection in particular. 2. Describe the major project components and indicate how each will contribute to achieving the Project Development Objective(s). The project comprises 4 components: Component I: Promotion of Mother and Child Health: extension, building, equipping and provision of essential drugs for the Dar El Hanan Maternity and 3 labour wards, and programme support for the integrated management of childhood illnesses; the fight against diarrheal and respiratory diseases and the nutrition programme to promote better mother/child care. Component II: Reinforcement of surveillance and control of communicable diseases: the establishment of a monitoring and control system and enhancing blood transfusion safety by strengthening the National Blood Transfusion Centre (CNTS) and 3 blood transfusion units and building the capacity of the Ministry of Health to reduce the spread of communicable diseases. Component III: Support for health sector reform: institution building of the newly created departments under implementation of health sector reform, and studies on health insurance and school health will contribute to better coordination of mother and child health. Component IV: Project Management: the capacity of the Health Project Management Unit is established and strengthened. 3. Provide a brief assessment (up to two sentences) of the project objectives along the following 3 dimensions. Insert a working score, using the scoring scale provided in Appendix 1.

PROJECT OBJECTIVES DIMENSIONS ASSESSMENT WORKING

SCORE

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RELEVANT a) Relevant to the country's development priorities

Given the national poverty reduction priorities, particularly the reduction of infant and maternal mortality and control of communicable diseases, the project objectives are relevant.

3

ACHIEVABLE b) Objectives could, in principle, be achieved with the project inputs and in the expected timeframe

Given that the objectives are not measurable, it is difficult to assess achievements. Although eight infrastructures were built, only two are operational. The lack of statistical data on health facilities makes it difficult to estimate the number of people likely to use the various facilities.

2

CONSISTENT c) Consistent with the Bank's country or regional strategy

The project is consistent with the Bank's country strategy and meets the Government's concerns regarding the implementation of the health sector reform and the living conditions of the population.

4

d) Consistent with the Bank's corporate priorities

The project is consistent with the Bank's strategy and relevant sector policies (health sector policy and operational guidelines for AIDS control). 4

4. Lay out the logical framework. If a logical framework does not exist, complete the table below, indicating the overall project development objective, the major components of the project, the major activities of each component and their expected outputs, outcomes, and indicators for measuring the achievement of outcomes. Add more rows for components, activities, outputs or outcomes, if needed.

THE LOGICAL FRAMEWORK WAS RECONSTITUTED WITH ELEMENTS TAKEN FROM THE PROJECT MATRIX

COMPONENTS ACTIVITIES OUTPUTS EXPECTED OUTCOMES

INDICATORS TO BE MEASURED

Component I: Promotion of Mother and Child Health

Activity 1: Extension/building /equipping/ supply of essential drugs/ pharmaceutical consumables / Dar El Hanan maternity, 4 labour wards and 1 Health Centre

Output 1: Higher rate of utilization of pre-natal and postnatal services by over 50% by 2008

Outcome 1: Improved geographical access to health centres for pre-natal and postnatal services

* Number of operational maternities * Number of Blood Transfusion Units

Activity 2: Support for national nutrition programmes, programmes to control diarrheal and acute respiratory diseases, and the Expanded Programme of Immunization.

Output 2: Reduction of pre-natal and maternal morbidity by at least 25% by 2008.

Outcome 2: Better mother and child care

* Infant-child and maternal mortality rate * Rate of utilization of pre-natal and postnatal services

Activity 3: extensive continuing training programme (training at local level and abroad) for various health staff (midwives, nurses,

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auxiliaries, traditional midwives and community health staff).

Activity 4: Sensitization: National IEC campaigns in reproductive health, action against female genital mutilation, control of childhood diseases and safe motherhood.

Component II : Reinforcement of surveillance and

control of communicable

diseases

Activity 1: Establishment and equipping of a network of 5 units for epidemiological surveillance of communicable diseases

Output 1: The Health Information System (SIS) is strengthened.

Outcome 1: Improvement in the surveillance of communicable diseases

* Number of operational units * Early warning and appropriate rapid response to epidemics

Activity2: Extensive continuing training programme (local training and abroad) of various health staff (physicians, nurses, laboratory technicians, and paramedical staff)

Output 2: 100% of the blood transfused is of good quality

Outcome 2: Safe blood transfusion is improved

* Quantity of safe blood bags delivered; * Incidence of communicable diseases and HIV/AIDS in vulnerable groups

Activity 3: Extension, equipping and supply of kits, and pharmaceutical and laboratory consumables to the CNTS and its network of 4 UTS in CMHs.

Activity 4: Continuing training of nurses of the CNTS and UTS.

Activity 5: Technical assistance (36 P/M) for safe blood transfusion

Component III : Support for health sector reform

Activity 1: Support for the Secretariat General, DSSB, SEPS

Output 1: The Secretariat General, DSSB and SEPS are strengthened and are operational

Outcome 1: Better coordination of the activities of basic health services

* Timely implementation of activities * Number of progress reports prepared and

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Output 2: SEPS is strengthened.

number of supervision missions fielded.

Activity 2: IEC training abroad for SEPS staff.

Activity 3: Technical assistance in IEC (44 S/M).

Component IV : Project management

Activity 1: Equipping the PMU (vehicles, IT equipment, and furniture)

Output 1: The PMU is strengthened and operational

Outcome 1: Better coordination of PMU activities.

* Timely implementation of activities * Number of progress reports prepared and number of supervision missions fielded

Activity 2: Support for PMU by a Technical Assistance service (70 S/M).

Activity 3: Recruitment of a consulting firm

Output 2: Establishment of a financial management system

Outcome 2: Better accounting

Number of available audit reports certified and approved by the Bank

5. For each dimension of the logical framework, provide a brief assessment (up to two sentences) of the extent to which the logical framework achieved the following. Insert a working score, using the scoring scale provided in Appendix 1. If no logical framework exists, score this section as a 1 (one).

LOGICAL FRAMEWORK DIMENSIONS ASSESSMENT WORKING SCORE

LOGICAL a) Presents a logical causal chain for achieving the project development objectives

The specific objectives contribute to achieving the sector goal of the project.

2

MEASURABLE b) Expresses objectives and outcomes in a way that is measurable and quantifiable

The objectives are not measurable and quantifiable. However, planned activities are measurable and observable, which allows for assessment of outcomes.

1

THOROUGH c) States the risks and key assumptions

Risks and key assumptions are clearly stated. 4

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D. OUTPUTS AND OUTCOMES

I. ACHIEVEMENT OF OUTPUTS In the table below, assess the achievement of actual vs. expected outputs for each major activity. Import the expected outputs from the logical framework in Section C. Score the extent to which the expected outputs were achieved. Weight the scores by the activities' approximate share of project costs. Weighted scores are auto-calculated by the computer. The overall output score must be calculated as the sum of the weighted scores. Override the calculated score, if desired, and provide justification.

MAJOR ACTIVITIES Working Score

Share of Project Costs in

percentage (as stated in Appraisal

Report)

Weighted Score

(automatically

generated)

Expected Outputs Actual Outputs

1. Increase the rate of utilization of pre-natal and postnatal services by over 50% by 2008

2. Reduction of pre-natal and maternal morbidity by at least 25% by 2008

1. Of the three labour wards received, two are operational (Doraleh and Dermajog). The Dar El Hanan Maternity and Wéa labour ward are not yet operational: the former is not up to standard and the latter must be rehabilitated and supplied with water and electricity for it to become operational. The PK 12 CS has been equipped, as well as the Balbala labour ward, whose financing had been eliminated from the project. The lack of data makes it difficult to compare actual outputs to expected outputs at appraisal. 2. The national nutrition programmes, programmes to control diarrheal and acute respiratory diseases and EPI, were not supported by the project as planned. The support was provided by other donors. Local training was organized, whereas training abroad was abandoned. The MOH (Ministry of Health) then wanted to train nurses instead of senior MOH staff. Lastly, resources were allocated to strengthen the medical school of Djibouti. The lack of data makes it difficult to compare actual outputs with expected outputs at appraisal.

2 39.67 0.79

3. SIS is strengthened 4. 100% of the

3. The 5 sentinel sites were not established as planned in the project. Local training for SIS staff was organized as provided for in the project. 4. Technical assistance for safe blood transfusion was not provided. According to the national authorities, technical assistance is no longer

2 36.38 0.73

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blood transfused is of good quality

justified because since the project appraisal in 2001, the MOH has acquired the necessary skills. The CNTS and UTS received a supply of essential drugs, pharmaceutical products and consumables, laboratory reagents and kits, some of which have already expired. The new CNTS ward and UTS lack essential equipment and are not operational.

5. The General Secretariat, DSSB and SEPS are reinforced, and are operational.

5. Delivery of a vehicle to the Department of Basic Health Services. The computer equipment and furniture provided for were delivered.

3 8.23 .25

6. The PMU is strengthened and operational.

6. Technical assistance was not provided. The accounting system is operational, and the accounting software has been updated with the latest version of "SUCCESS". The project was audited annually. A liaison vehicle for the PMU was purchased. The supervision of works was unsatisfactory.

2 15.72 0.31

OVERALL OUTPUT SCORE [Score is calculated as the sum of weighted scores] 2

X Check here to override the calculated

score Provide justification for over-riding the calculated score The Dar El Hanan Maternity, a referral structure for mother and child health, is not operational. Of the three labour wards, only the construction of the Damerjog ward is satisfactory. Works on the other two wards are very unsatisfactory (the Wéa ward should already be rehabilitated in order for it to be operational). Regarding blood safety, neither the National Blood Transfusion Centre (CNTS) nor any of the (regional) Blood Transfusion Units (UTS) that were built and equipped under the project is operational, for want of necessary equipment. Apart from the problem of equipment, there is significant rainwater infiltration at the Obock UTS that will impede its commissioning and lastly, the Dikhil and Tadjourah UTS are not supplied with electricity which will also thwart their commissioning. Despite the poor quality of the works, all buildings were received provisionally without any reservations.

Insert the new score or re-enter the calculated score 1

I. ACHIEVEMENT OF OUTCOMES 1. Using available monitoring data, assess the achievement of expected outcomes. Import the

expected outcomes from the logical framework in Section C. Score the extent to which the expected outcomes were achieved. The overall outcome score must be calculated as an average of the working scores. Override the calculated score, if desired, and provide justification.

OUTCOMES Working

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Score

Expected Actual

1. Outcome 1: Improved geographical access to health centres for pre-natal and postnatal services.

While it true that geographical accessibility to health centres has certainly improved with the commissioning of the Damerjog and Dolareh labour wards, it should be noted that it still falls below expectations, given that the Wéa labour ward is not operational, and the extension of the Dar El Hanan Maternity (referral facility) is below standard.

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2. Outcome 2: Better mother and child care.

A few local training courses have been organized on the management of high risk pregnancies. However, it should be noted that while mother and child care has improved, it still falls short of expectations because midwives and other staff were not trained abroad.

2

3. Outcome 3: Better coordination of mother and child health activities.

A Department of Mother and Child Health was established. The General Secretariat, kingpin of the Ministry, is reinforced and equipped. A Health Promotion Department was established in lieu of the Health Promotion and Education Service.

3

4. Outcome 4: Improvement in the surveillance of communicable diseases.

None of the five branches for the epidemiological surveillance of communicable diseases has been established. The training abroad of SIS workers did not take place. Epidemiological surveillance has not improved.

1

5. Outcome 5: Safe blood transfusion is improved.

The removal of essential equipment from the BD (Bidding Documents) (Elisa chains; portable machines; automatic haematology analyzer; visual spectrophotometer and coagulation equipment/ haemostasis) and from batches supplied to CNTS and UTS simply does not allow them to be operational. According to the authorities of the Ministry of Health, these pieces of equipment were supposedly provided by other partners but were not delivered to the relevant facilities.

1

6. Outcome 6: Better coordination of PMU activities.

The PMU was expected to be strengthened through technical assistance (60 S/M for a Project Manager and 10 S/M worth of consultation on a case-by-case basis) but it was not provided. Instead, a manager/assistant, an accountant and a secretary were recruited. This led to extra work, which caused red tape and inefficiency.

1

OVERALL OUTCOME SCORE[Score is calculated as an average of the working scores] 2

Check here to override the calculated score

Provide justification for over-riding the calculated score

Insert the new score or re-enter the calculated score 2

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2. Additional outcomes. Comment on the project's additional outcomes not captured in the logical framework, including cross-cutting issues (e.g., gender).

The mid-term review mission was informed that the technical assistance, provided for at appraisal, was no longer valid because the MOS had the necessary human resources and skills, and had received support from other partners. Consequently, the grant resources were used (with the consent of the Bank) primarily to support the Djibouti School of Medicine (EMD). In this regard, an agreement was signed between the Djibouti School of Medicine and some Tunisian medical schools, such as the Tunis Faculty of Medicine and the Sousse Faculty of Medicine for education support. Between 2008 and 2009, over 40 teaching assignments were performed at EMD (biochemistry, anatomy, microbiology, physiology, histology, semiotics, public health, etc.). With respect to gender, pride of place was given to women’s issues in the project under the mother and child component. In addition, women attended training courses offered locally with project resources. The prevention of mother-to-child HIV transmission, which is relatively inexpensive and reduces the risk of foetus-maternal transmission, was included in the project. As regards environmental protection, activities planned in the appraisal report (tree planting, green areas, erosion control measures on project sites) were not implemented: they were not included in the BDs for works. Similarly, the training of health personnel in "environmental management" was not carried out. 3. Risks to sustained achievement of outcomes. State the factors that affect, or could affect, the long-

run or sustained achievement of project outcomes. Indicate if any new activity or institutional change is recommended to help sustain outcomes. The analysis should draw upon the sensitivity analysis in Annex 3, where appropriate.

Upon closure, the project’s sustainability depends on the Government’s willingness to mobilize sufficient resources to upgrade buildings and equipment, as well as ensure water / electricity supply to project facilities, so as to make them fully operational and consolidate their sustainability.

E. PROJECT DESIGN AND READINESS FOR IMPLEMENTATION

1. State the extent to which the Bank and the Borrower ensured the project was commensurate with the Borrower’s capacity to implement by designing the project appropriately and by putting in place the necessary implementation arrangements. Consider all major design aspects, such as extent to which project design took into account lessons learned from previous PCRs in the sector or the country (please cite key PCRs); whether the project was informed by robust analytical work (please cite key documents); how well Bank and Borrower assessed the capacity of the implementing agencies and/or Project Implementation Unit; scope of consultations and partnerships; economic rationale of project; and provisions made for technical assistance.

[250 words maximum. Any additional narrative about implementation should be included at Annex 6:

Project Narrative] The sector study conducted in 1995-96 that led to the PNDS (1996-1999) proposed health system reforms and strategies to be implemented with a view to improving the organization, management and efficiency of health services. Hence, the Djibouti Government submitted to ADF a request for the financing of the Basic Health Services Improvement Project, which, consistent with the CSP (1999-2001), is one of the key sectors of the Bank's vision and is the outcome of cooperation among several donors: the Dutch Technical Assistance Fund was mobilized to finance the preparation and appraisal missions. In May 2001, Japan awarded a grant to the Government to update health information; in September, the study report was discussed, amended and approved; in October, experts finalized the policy document. In February 2002, the sector analysis, the Strategic Plan 2002-2011 and PNDS 2002-2006 were finalized during the Donor

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Round Table meeting in which the Bank Group participated actively. Based on the health sector study conducted, project activities lay special emphasis on human resources development, reducing the spread of communicable diseases, mother and child health and institution building which should help strengthen Government's efforts in its policy to improve the health status and living conditions of the population. At appraisal, there was no completed Bank-financed project from which lessons could be drawn. The PMU human resources were considered inadequate to manage the project. Hence, to strengthen them, an administrator and short-term consultants were provided for.2. For each dimension of project design and readiness for implementation, provide a brief assessment

(up to two sentences). Insert a working score, using the scoring scale provided in Appendix 1.

PROJECT DESIGN AND READINESS FOR IMPLEMENTATION DIMENSIONS ASSESSMENT WORKING SCORE

REALISM (a) Project complexity is matched with country capacity and political commitment.

The implementation of structural reforms, strict compliance with Bank rules of procedure, the strengthening of the Project Management Unit and the availability of counterpart resources had been retained as guarantee for the timely and satisfactory completion of the project.

4

RISK ASSESSMENT AND MITIGATION

(b) Project design includes adequate risk analysis

Risks that could be detrimental to the project were identified, but no mitigation measures were recommended.

2

USE OF COUNTRY SYSTEMS

(c) Project procurement, financial management, monitoring and/or other systems are based on those already in use by government and/or other partners.

Since the shortage of national staff and the drastic reduction in technical assistance affected the country's institutional capacity, the Bank's procurement and management systems were adopted.

2

For the following dimensions, provide separate working scores for Bank performance and Borrower performance:

WORKING SCORE

Bank Borrower CLARITY

(d) Responsibilities for project implementation were clearly defined.

The respective responsibilities of the Bank and the Borrower (in the appraisal report) were clearly defined.

4 4

PROCUREMENT READINESS

(e) Necessary implementation documents (e.g. specifications, design, procurement documents) were ready at appraisal.

Neither the Administrative, Financial and Accounting Procedures Manual, nor the implementation manual, was available at appraisal. 1 1

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MONITORING READINESS

f) Monitoring indicators and monitoring plan were agreed upon before project launch.

Project monitoring and evaluation are organized in accordance with item 5.6 1 of the appraisal report. The reinforced PMU should be responsible for monitoring the implementation of programme components in accordance with the implementation schedule agreed upon with the Borrower and the standard ADF supervision plan. It should be assisted in its work by architectural firms, and consulting firms, recruited by the project for the supervision of civil works.

Unfortunately, the indicators in the appraisal report matrix do not allow for proper project monitoring.

1 1

BASELINE DATA h) Baseline data were available or are collected during project design.

Since the objectives are not measurable, the collection of baseline data will not allow for proper evaluation so as to fairly assess project outcomes and impacts.

1 1

F. IMPLEMENTATION

1. State the major characteristics of project implementation with reference to: adherence to schedules, quality of construction or other work, performance of consultants, effectiveness of Bank supervision, and effectiveness of Borrower oversight. Assess how well the Bank and the Borrower ensured compliance with safeguards.

[300 words maximum. [Any additional narrative about implementation should be included at Annex 6:

Project Narrative.] The project was finally completed after 7.5 years, instead of 5 years as initially planned. Given its simplicity, it could have been implemented within the stipulated timeframe, had its implementation not been stalled by red tape in the procurement and disbursement processes. With respect to the works, the quality of construction is unsatisfactory, due to failure to implement the recommendations of supervision missions: The Dar El Hanan Maternity requires upgrading works before it can be operational. The works concern: (i) two operating theatres and (ii) neo-natal and intensive care services. Other facilities considered complete are not operational, and could be operational after substantial rehabilitation works (case of Wéa labour ward and Obock UTS). In addition, it should be noted that for lack of electricity supply, some project facilities (CNTS, Dikhil and Tadjourah UTS, Wéa labour ward) are not operational. As regards equipment, there are only two oxygen outlets, while each of the 5 neonatal beds at Dar El Hanan should be provided. As for the CNTS and three UTS, they lack the necessary biomedical equipment that would enable them to become operational. These unsatisfactory results ensue primarily from: (i) inadequacies of the document review and approval process; (ii) inadequate capacity of the PMU; (iii) laxity of the consulting firm and weak capacity of the companies selected; and (iv) lack of vigilance by the Bank. Inadequacies of the document review and approval process: The preliminary design of the Dar El Hanan

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Maternity should have been submitted and approved by users, before proceeding to the subsequent phases (detailed design and BD), which would have avoided having a maternity with critical services below standards, are not suitable. Inadequate capacity of the PMU: The presence of a biomedical engineer in the PMU would have helped to establish the list and specifications of biomedical equipment and materials tailored to the needs of beneficiary structures and to avoid the current situation, i.e. a National Blood Transfusion Centre and decentralized Blood Transfusion Units that do not have the indispensable equipment for operation. The performance of the PMU is unsatisfactory. It did not take the necessary steps to ensure smooth implementation of activities and enforce compliance with the contract terms and conditions: (i) approval of unsatisfactory architectural designs; (ii) acceptance of works performed with too many defects; (iii) failure to monitor procurement documents and tailor equipment to the needs of CNTS and UTS; and (iv) environmental safeguards for work sites were not provided. Laxity of the consulting firm and weak capacity of companies: In addition to the shortcoming of the architectural designs (see Dar El Hanan Maternity), the consulting firm countersigned the provisional acceptance of all buildings without reservations, despite the numerous obvious defects identified on each site. Furthermore, the weak capacity of companies led to poor quality work and significantly longer timeframe. The performances of the consulting firm and companies are unsatisfactory. Ineffective oversight by the Borrower: The Borrower failed to disburse its counterpart contribution to the project and ensure the satisfactory conduct of project activities in accordance with the arrangements of the Appraisal Report and Loan Agreement. Borrower performance is unsatisfactory. Lack of vigilance by the Bank: Upon submission of the APD and BD to the Bank for approval, the Bank should have ensured that the design was consistent with medical standards and that the flaws reported by supervision missions were corrected. The project’s mid-term review should have been an opportunity to refocus project activities. The project's (initial) logical framework was not updated during the review. The PMU was committed to the review and to seeking information and indicators from the health information service, as well as to amending the matrix in consultation with the Bank. This was not done and the recommendations of the review were limited to reduction of technical assistance and removal of training abroad. In light of the foregoing, Bank performance is unsatisfactory. The only satisfactory performances recorded are those of UNICF, suppliers of goods and Tunisian medical schools which met their obligations with respect to deadlines and contract terms and conditions. 2. Comment on the role of other partners (e.g. donors, NGOs, contractors, etc.). Assess the

effectiveness of co-financing arrangements and donor coordination, if applicable. The project is co-financed by OPEC. The various procurements with OPEC resources were made in accordance with ADB rules and procedures. Unlike the preparation phase, cooperation with other partners was not pursued until implementation. As a result of red tape in the Bank's review and approval procedures, some activities, planned under the project, were funded by other partners without any duplication, e.g.: (i) antimalarial products by the Global Fund; (ii) support for the fight against tuberculosis by AFD and the Global Fund; and (iii) sensitization activities by the World Bank, UNICEF and WHO. The IDB and AFESD funded the construction of health infrastructure not planned under the Project. 3. Harmonization. State whether the Bank made explicit efforts to harmonize instruments, systems

and/or approaches with other partners. Unlike the preparation phase, at implementation, the Bank failed to harmonize the relevant instruments, systems and/or approaches with the other partners. This role was devolved to the PMU, which ensures the day-to-day management of all health projects, and which, in principle and in conjunction with the DEPCI, ought to ensure coordination among donors involved in the health sector. The PMU did not fulfil this role.

PROJECT IMPLEMENTATION DIMENSIONS ASSESSMENT Working

Score TIMELINESS a) Extent of project

adherence to the original closing date. If

Difference in months between original closing date and actual closing

This required 2 extensions of the last

2

14

the number on the right is: below 12, "4" is scored between 12.1 to 24, "3" is scored between 24.1 to 36, "2" is scored beyond 36.1, "1" is scored 1

date or date of 98% disbursement rate.

disbursement timeframe.

30

BANK PERFORMANCE

b) Bank complied with :

Environmental Safeguards

The project is classified under Environmental Category II. Besides the installation of incinerators for solid waste disposal, no other planned environmental activity was carried out.

2

Fiduciary Requirements

No fiduciary supervision mission was undertaken for the project (disbursement and procurement).

1

Project Covenants The Bank fulfilled most of its commitments. However, it did not provide support for the health sector reform and the establishment of a database of health indicators. Furthermore, it did not monitor the financial management of the project.

2

c) Bank provided quality supervision in the form of skills mix and practicality of solutions.

During its implementation, the Bank supervised the project once a year and not twice as planned. The project has always been supervised by a health expert and an architect. The mid-term review was conducted by a health expert. Given the problems that were looming, the review team should have been multidisciplinary. Furthermore, the Bank should have been more specific in its recommendations and more responsive regarding the monitoring of its recommendations.

1

d) Bank provided quality management oversight

No fiduciary supervision mission was fielded, and the Bank did not take account of the recommendations of the supervision missions.

1


e) Borrower complied with: Environmental Safeguards

With respect to construction, including the aesthetic impact of new constructions (tree planting, green areas, and erosion control measures) in the training of health personnel in "environmental management" should enable such staff to monitor the environmental component. None of these activities was carried out.

1

Fiduciary Requirements

With the exception of Fiscal Year 2011, subject to the approval of the use of the balance available to PMU, with TAF resources, the project was audited for all fiscal years.

3

Project Covenants The Government did not meet its 2

15

commitments as regards payment of counterpart contributions (10.31% of disbursements only), and other procurement terms and requirements of the loan agreement.

f) Borrower was responsive to Bank supervision findings and recommendations

Generally speaking, Borrower was not responsive to Bank supervision findings and recommendations in respect of the project. 1

g) Borrower collected and used monitoring information for decision making

Since monitoring indicators were not identified in the appraisal report, it was not possible to measure them. Decisions taken by the Borrower could not be retrieved from the monitoring process (which is absent).

1

G. COMPLETION

1. IS THE PCR DELIVERED ON A TIMELY BASIS, IN COMPLIANCE WITH BANK POLICY? Date project reached 98% disbursement Rate (or closing date if applicable)

Date PCR was sent to [email protected]

Difference in months

WORKING SCORE If the difference is 6 months or less, a 4 is scored. If the difference is 6.1 or more, a 1 is scored

30-Jun-11 Apr-12 4 6

Briefly describe the PCR Process. Describe the Borrower’s and co-financers' involvement in producing the document. Highlight any major differences of opinion concerning the assessments made in this PCR. Describe the team composition and confirm whether a site visit was undertaken. Mention any major collaboration from other development partners. State the extent of field office involvement in producing the report. Indicate whether comments from Peer Reviewers were received on time (provide names and positions of Peer Reviewers). [150 words maximum] This completion report was prepared jointly by the Government and ADB. The team comprised an ADB architect, two consultants (an architect and a public health physician), and the manager/assistant and MU procurement officer. Neither OPEC, co-financier of the project, nor any other partner contributed to the preparation of the Project Completion Report. On the ground, the joint PMU/ADB mission visited all project sites. The mission met with country officials of structures established by, and/or receiving support from, the project. H. LESSONS LEARNED

Summarize key lessons for the Bank and the Borrower suggested by the project’s outcomes [300 words maximum. Any additional narrative about lessons learned, if needed, must be placed in Annex 6: Project Narrative] * To allow for better implementation of future projects, there should be proper identification of objectives and indicators (processes and outputs) while avoiding the formulation of objectives with terms as vague as

16

"improving", "strengthening";

* At preparation, an administrative, financial and accounting procedures manual should be prepared prior to project start-up, and a management system and operational manual established;

* The Bank should be more vigilant in monitoring project implementation: fiduciary (procurement and disbursement) oversight is needed to improve project performance and support the PMU, which must include all the skills mix necessary to conduct planned activities and ensure close monitoring of the Project’s financial management (accounting, internal control, budgeting, etc.);

* For risk projects, it is necessary to be proactive in risk management and problem solving. There is need to increase the pace of supervision, incorporate the relevant expertise and enhance communication between the Bank and Project Implementation Units, with a view to speeding up project implementation;

* The Mid-Term Review Mission should be a multi-disciplinary team comprising expertise required for the analysis and reorientation of project activities;

* The shift in focus is necessary to adapt to the situation, given the long period between the appraisal report and project implementation;

* Provide a mechanism for sanctions against suppliers of goods, works and services whose performances are obviously poor;

* Promote South/South cooperation for the implementation of project activities;

* On its own, health infrastructure coverage does not improve the: (i) use of services by the population concerned; and (ii) efficiency of the infrastructure. Support measures (staff in sufficient quality and quantity. availability of equipment, drugs and consumables, maintenance, etc.) are needed to make them operational and have a real impact on the health and standard of living of the population;

* The Borrower should enhance coordination between the PMU and other partners so as to avoid duplication, increase the financial resource absorptive capacity and allow for better implementation of activities; and

* The Borrower should ensure that activities financed with counterpart contributions do not constitute a hindrance to project completion, and it must honour its commitments as stipulated in the Loan Agreement and/or as a result of updates in order to ensure the achievement of objectives.

I. PROJECT RATINGS SUMMARY

All working scores and ratings are found in the relevant section in the PCR

CRITERIA SUB-CRITERIA WORKING SCORE

PROJECT OUTCOME

Achievement of outputs 1 Achievement of outcomes 2 Timeliness 2

OVERALL PROJECT OUTCOME SCORE 2

BANK PERFORMANCE

Design and Readiness Project Objectives were relevant to country development priorities. 3 Project Objectives could in principle be achieved with the project inputs and in the expected time frame. 2

17

Project Objectives were consistent with the Bank’s country or regional strategy. 4

Project Objectives were consistent with the Bank’s corporate priorities. 4 The log frame presents a logical causal chain for achieving the project development objectives. 2 The log frame expresses objectives and outcomes in a way that is measurable and quantifiable. 1 The log frame states the risks and key assumptions. 4 Project complexity was matched with country capacity and political commitment. 4 Project design includes adequate risk analysis. 2 Project procurement, financial management, monitoring and/or other systems were based on those already in use by government and/or other partners. 2 Responsibilities for project implementation were clearly defined. 4 Necessary implementation documents (e.g. specifications, design, procurement documents) were ready at appraisal.

1 Monitoring indicators and monitoring plan were agreed upon during design. 1 Baseline data was available or were collected during design. 1

PROJECT DESIGN AND READINESS SUB-SCORE 3 Supervision: Bank complied with: Environmental Safeguards 2 Fiduciary Requirements 1 Project Covenants 2

Bank provided quality supervision in the form of skills mix provided and practicality of solutions. 1

Bank provided quality management oversight. 1 PCR was delivered on a timely basis. 6

SUPERVISION SUB-SCORE 1 OVERALL BANK PERFORMANCE SCORE 2


Design and Readiness Responsibilities for project implementation are clearly defined. 4

Necessary implementation documents (e.g. specifications, design, procurement documents) are ready at appraisal. 1

Monitoring indicators and monitoring plan are agreed upon and baseline data are available or are being collected. 1

PROJECT DESIGN AND READINESS SCORE 2 Implementation Borrower complied with: Environmental Safeguards 1 Fiduciary Requirements 3 Project Covenants 2 Borrower was responsive to Bank supervision findings and recommendations. 1

18

Borrower collected and used of monitoring information for decision-making. 1

IMPLEMENTATION SUB-SCORE 2

OVERALL BORROWER PERFORMANCE SCORE 2

J. PROCESSING

STEP

Sector Manager Clearance: Mr. F. ZHAO

Regional Director Clearance: Mr. K. MLAMBO

Sector Director Approval: Mrs. A. SOUCAT

19

APPENDIX 1 Scale for Working Scores and Ratings

SCORE EXPLANATION

4 Very Good- Fully achieved with no shortcomings

3 Good- Mostly achieved despite a few shortcomings

2 Fair- Partially achieved. Shortcomings and achievements are roughly balanced

1 Poor- Very limited achievement with extensive shortcomings

NA Non Applicable

Note: The formulas are rounded up or down for decimal points. Only whole numbers are computed.

I

LIST OF ANNEXES

Mandatory

1. Project Costs and Financing

a. Project costs by component b. Resources by sources of financing

2. Bank Inputs. List the key team members, and their specialties, during preparation and supervision.

Provide a consolidated list of Preparation, Supervision and Completion Missions in chronological order. Provide the date and ratings of the last supervision report.

3. Economic Analysis (ERR) and Financial Analysis, if appropriate. Re-estimate the economic rates of return

based on costs and benefits at completion, and compare with appraisal estimates. Break down by components as appropriate. Analyze the sensitivity of the ERR to key assumptions. Present a financial analysis for project beneficiary entities.

4. Procurement Plan. Please attach the most recent Procurement Plan.

5. List of Supporting Documents.

Optional 6. Project Narrative. Key factors not covered in the main template that affected the design and implementation of the project. Such factors, both positive and negative, could include: climate and weather, political changes, contractual or personnel matters, technical issues, procurement processes, and interactions with other partners. If any of these factors is significant enough to affect the evaluation ratings, it should be noted in the template with a reference to this Annex.

II

ANNEX 1

PROJECT PRESENTATION, DESCRIPTION AND IMPLEMENTATION

Origin and Background The health sector has been recognized as a priority by the Government of Djibouti, which conducted a health sector study in 1995-1996, and formulated proposals for the reform of the health system and strategies to be implemented to improve the organization, management, and efficiency of Djibouti’s health services, with the support of National Health Development Plan for the 1996-1999 period. The project was adopted as part of the implementation of this reform. Project activities covered the following areas: (i) mother and child health and reproductive health; (ii) surveillance and control of communicable diseases; and (iii) institution building and support for health sector reform.

Objectives

The project will contribute to strengthening the Government’s efforts under its poverty reduction policy by improving the population’s health status and living conditions. The specific objectives of the project are to: (i) improve the quality of mother and child health services; (ii) improve the quality of the surveillance and control of communicable diseases; and (iii) reduce the risk of contamination from these communicable diseases, and HIV infection, in particular.

Description The project comprises four components, namely: (i) Promotion of Mother and Child Health; (ii) Strengthening of Communicable Disease Surveillance and Control; (iii) Support to Health Sector Reform; and (iv) Project Management.

The total project cost (excluding tax and duty) is estimated at UA 6.68 million, i.e. FDJ 1 474.84 million (UA 1= FDJ 224,737 at March 2002 rates). The cost comprises UA 5.29 million in foreign exchange (79.20%) and UA 1.39 million in local currency (20.80%). Average provisions of 5.90% for risks and physical contingencies and 3.80% for price escalation over a 5-year period, have been incorporated in the project cost.

Implementation level The fulfilment of loan conditions recorded a 17-month delay between the original and actual dates, given the high number (6) and nature of the conditions (establishment of the PMU and recruitment of its staff; prior signing of the Loan Agreement by OFID) as well as red tape. The project, which is not complex, could have been implemented in a timely manner as specified at appraisal, but was not completed until 30 June 2011, i.e., 30 months behind schedule. Its implementation was slowed down by procurement and disbursement delays. Construction and infrastructure expansion works were executed and biomedical equipment and furniture delivered to project facilities. Furthermore, computer, communications and office equipment, vehicles and essential drugs were procured. Regarding training, only six of the twenty local training courses provided for were organized, and none of the 12 training courses planned abroad was organized. With respect to technical assistance services, none of those proposed was provided, and the resources allocated for this purpose were used to provide support to the Medical School of Djibouti (training and technical assistance).

III

At the quality level, activities were affected by the poor quality of architectural and engineering designs and the lack of follow up on the recommendations of successive Bank supervision missions. Hence, all construction and extension works were handed over (provisional acceptance) without correcting the flaws noted by the supervision missions. Only two labour wards are operational (Doraleh and Dermajog). The Dar El Hanan Maternity requires upgrading works before it can become operational. In addition, some facilities, considered complete, are not operational and could become operational only after substantial rehabilitation works (Wéa labour ward and Obock UTS). It should also be noted that for lack of electricity supply, some project facilities are not operational (CNTS, Dikhil and Tadjourah UTS). In addition, the CNTS and three UTS of the project did not receive the necessary biomedical equipment (removed from the list found in the Bidding Document for the procurement of biomedical equipment) that would have allowed them to become operational. The PK 12 CS was equipped, as well as the Balbala labour ward and UTS, whose financing had been eliminated from the project. IEC campaigns were not organized. National programmes on nutrition, control of acute respiratory diseases, diarrheal diseases and EPI were not supported by the project as planned. Nevertheless, other donors provided this support. Local training took place, whereas training abroad was abandoned and resources were allocated for the institution building of the Medical School of Djibouti (EMD). To this end, an agreement was reached with certain Tunisian medical schools for teaching support. Hence, two senior staff of the medical school of Djibouti were trained abroad and over 40 teaching assignments were performed at EMD (biochemistry, anatomy, microbiology, physiology, histology, semiology, public health, etc.). The five sentinel sites were not created as planned in the project to reinforce the Health Information System (SIS). Similarly, technical assistance for the safety of blood transfusion was not provided.

Activities to be finalized Considering the observations and data gathered on the ground, it must be acknowledged that the project is not successful. To remedy this situation, the Government should endeavour to mobilize adequate resources to upgrade infrastructure, in order to make them fully operational and ensure their sustainability: buildings, equipment and power supply. Furthermore, the 2011 and closing accounts should be audited.

IV

ANNEX 2 PROJECT FINANCIAL IMPLEMENTATION

The financial implementation rate stands at 100% for the grant and 85.07% for the loan, and the remaining UA 447 766.63 has been cancelled. Disbursement levels stand at 8.96% for counterpart contributions and 72.14% for OPEC respectively.

PROJECT RESOURCES BY SOURCE OF FINANCE

Sources of Financing At Appraisal ompletion on 30/06/2011

UA Million % UA Million %

ADF Loan 3.00 44.91 2.55 85.07

ADF Grant 1.00 14.97 1.00 100.00

OPEC 2.01 30.09 1.45 72.14

Government 0.67 10.03 0.06 08.96 TOTAL FINANCEMENT 6.68 100 5.06 75.74

PROJECT COST BY EXPENDITURE CATEGORY The breakdown of project resources, at appraisal, is summarized in the table below:

Expenditure Category ADF LOAN ADF GRANT OPEC LOAN GOVT TOTAL %

TRAVAUX 0.62 0.00 1.69 0.11 2.42 36.230.94 0.00 0.32 0.05 1.31 19.611.39 1.00 0.00 0.35 2.74 41.02

OPERATING COSTS 0.05 0.00 0.00 0.16 0.21 3.14TOTAL 3.00 1.00 2.01 0.67 6.68 100.00

The breakdown of project resources, at completion on 30 June 2011, is summarized in the table below:

Expenditure Category ADF LOAN ADF GRANT OPEC LOAN GOVT TOTAL TRAVAUX 0.75 0 1.10 0.00 1.85 36.56

1.45 0 0.35 0.00 1.80 35.57

0.18 1.00 0 0.00 1.18 23.32

OPERATING COSTS 0.17 0 0 0.06 0.23 4.55

TOTAL 2.55 1.00 1.45 0.06 5.06 100.00 PROJECT COST BY COMPONENT

Components Appraisal Completion on 30/06/2011 UA Million UA Million %

1. Promotion of mother and child health 2.65 39.67 3.02 59.68

2. Reinforcement of surveillance and control of communicable diseases 2.43 36.32 1.76 34.78

3. Support for health sector reform 0.55 08.23 0.03 00.60

4. Project management 1.05 15.72 0.25 04.94

TOTAL 6.68 100.00 5.06 10000

Audits and account management Project accounts were audited annually. Five project accounts audits were completed and all reports, prepared after the audits, were approved by the Bank. The 2011 and closing accounts should be audited.

V

Annex 3 Procurement Plan -2010

1. General

Country/Organization : REPUBLIC OF DJIBOUTI

Project/Programme Description

The project will contribute to strengthening the Government’s efforts under its poverty reduction policy by improving the population’s health status and living conditions. The specific objectives of the project are to: (i) improve the quality of mother and child health services; (ii) improve the quality of the surveillance and control of communicable diseases; and (iii) reduce the risk of contamination from these communicable diseases, and HIV infection in particular.

Project/Programme SAP Identification No. P-DJ-IBE-001

Loan No./Grant No.: Loan No.2100150007241 - Grant No. 2100155001836

Executing Agency: PROJECT MANAGEMENT UNIT (MINISTRY OF HEALTH)

Procurement Plan(PP) Approval Date : December 2010

General Procurement Notice(GPN) Date:

Early Procurement Action

Period Covered by this PP: June 2010 - June 2011

VI

1. GOODS Various lots with procurement methods and Schedule

Baseline Data

Description* Number of Lots

SPN */ PQN *

Acceptance Date

Date of No-Objection to SPN/PQN

(UNDB) SPN/PQN Publication

Date

Currency Amount

Estimate in UA (000)

Procurement Method

Pre- or Post-Qualification

Nation./Reg. Preference

(Y/N)

Ex-ante or Ex-post

Consideration

Estimated Bid

Submission Date

Procurement of IT equipment for the 4 Blood Transfusion Units (UTS)

1 LOT NO 7 351.70 NCB N EX-ANTE

Procurement of office furniture for the Dar El Hanan Maternity (MDEH) and the National Blood Transfusion Centre (CNTS)


Procurement of medical equipment for the Dar El Hanan Maternity (MDEH) and the National Blood Transfusion Centre (CNTS)

2 LOTS 08/07/2010 1 555 086.00 ICB N EX-ANTE

Procurement of office furniture for the 4 UTS and 4 labour wards


Total Cost of Goods 1 603

763.70

VII

Bidding Documents (BD) Pre-Qualification (PQ) Pre-Qualification (PQ) Bidding Period Bids Assessment

Revised/ Current/

Plan

Date of Receipt BD

Date of No-objection

Date of publication

PQ

Date of Submission candidacies

Date of Receipt

Appraisal Report

Date of No-

objection

Date of issue of Competitive

Bidding

Date of Bid Submission-

Opening

Date of Receipt Bid Evaluation

Report


Current 01 /11/2009 25/11/2009 13/06/2010 09/06/2011

Current 05/10/2010 14/10/2010 18/10/2010 18/10/2010 27/11/2010 19/12/2010 29/12/2010

Current 09/07/2010 14/07/2010 14/07/2010 25/08/2010 25/09/2010

Current 27/12/2009 26/01/2010 10/02/2010 09/06/2010

Current

VIII

Draft Contract Contract Award Contract Execution

Date of Receipt Draft Contract Date of No-Objection

Contract Amount in UA (000)

Date of Contract Award

Date of Signature of Contract Start Date Completion Date

4 277.13 14/08/2010 14/08/2010 06/09/2010

29/12/2010 25/01/2011 18 990.95 25/01/2011 29/12/2011 30/01/2011 24/02/2011 date 10/01/2011 1 446 876.60 04/11/2010 18/12/2010 17/03/2011

13/06/2010 14 706.68 14/02/2010 13/06/2010 13/06/2010 05/09/2010 1 484 851.36

IX

Various lots with Procurement Methods and Schedule

Baseline Data

Description* Number of Lots

SPN*/PQN* Acceptance

Date

Date of No-Objection to SPN/PQN

(UNDB) SPN/PQN Publication

Date

Currency Amount

Estimate in UA (000)

Fixed Rate or

Unit Price

Procurement Method

Pre- or Post-

Qualification

Nation./Reg.

Preference (Y/N)

Ex-ante or Ex-post

Consideration

Estimated Bid

Submission Date

Works Completion at UTS, OBOCK

1 LOT 18 000.00 CFN N EX-ANTE

Total Cost Works 18 000.00

Bidding Documents (BD) Pre-Qualification (PQ) Pre-Qualification (PQ) Bidding Period

Revised/ Current/ Plan

Date of Receipt BD


Date publication PQ

Date of Submission

Bids

Date of Receipt

Assessment Report


Date of Issue of Competitive Bidding

Date of Bid Submission-

Opening

Current 02/03/2011 23/12/2010 23/01/2011

Current

2. WORKS

X

3. CONSULTANTS

Various Services provided with Selection Method and Schedule Baseline Data

Description* Date of Reception EOI


Selection Method

Fixed Rate or Time Based

Currency Amount Estimate in UA

(000)

Ex-ante or Ex-post

Consideration

Estimated Bid

Submission Date

Audit of Basic Health Services Improvement Project for FY 2010 "CECA"

ND 13 000.00 EX-ANTE

Total Cost Services 13 000.00

Bid Evaluation Draft Contract Contract Award Contract Execution

Date of Receipt Bid Assessment

Report


Date of Receipt Draft

Contract


Contract Amount in UA

(000)


Date of Signature of

Contract Start Date Completion

Date

24/01/2011 27/01/2011 17 669,098 05/02/2011 26/01/2011 06/03/2011

17 669,098

XI

Expression of

Interest (EOI)

Terms of Reference (ToR) Short List Request for

Proposals (RFP)Proposals

Submission Period

Technical (T) & Financial (F) Assessment

Revised/ Current/

Plan

Date of Publicatio

n

Submission Date

Date of Receip

t

Date of No-

objection

Date of

Receipt

Date of No-

objection

Date of

Receipt

Date of No-

objection

Date Invitation

Date of Bid

Submission-

Opening

Date of

Submission Assessment Report

(T)

No-objection Assessm

ent Report

(T)

Date Openin

g Financi

al Proposa

ls

Date Submission (T) & (F) & Neg

Ass. Report

No-objection

(T) & (F) & Neg Ass. Report

Current 31/01/201

1

Current

Draft Contract Contract Award Contract Execution

Date of Receipt Draft Contract

Date of No-Objection

Contract Amount in UA (000)


Date of Signature of Contract Start Date Completion Date

28/01/2011 12 022.40 03/02/2011 03/02/2011 03/02/2011 30/06/2011 12 022.40

SPN: Specific Procurement Notice PQN: Pre-Qualification Notice

XII

ANNEX 4

MISSIONS FIELDED BY ADB EXPERTS

No. Missions Date No. of days

No. of pers. Composition

1 Preparation February 2001 ND ND ND 2 Appraisal June 2001 ND ND ND 3 Re-appraisal Mars 2002 ND ND ND

4 Launch 27/11 - 6/12/2004 10 02 Health Expert and Architect (consultant)

5 Desk supervision 14 - 16/2/2006 3 01 Health Expert 6 Supervision 18/11 - 4/12/2006 10 01 Health Expert 7 Supervision 7 - 16/12/2007 10 01 Health Expert 8 Mid-Term Review 23/5 - 1/6/2008 10 01 Health Expert 9 Supervision 20 - 27/12/2008 8 01 Architect 10 Supervision 23/10 - 2/11/2009 11 01 Health Expert 11 Supervision 14 - 21/11/2009 8 01 Architect 12 Supervision 13 - 24/12/2010 12 02 Health Expert and Architect

13 Preparation of Completion Report 17 - 31/12/2011 15 03 Architect and 2 consultants (Architect

and Health Expert)

XIII

ANNEX 5

PREVIOUS SUPERVISION MISSION RATINGS (December 2010)

Project Performance Indicators SCORE A. Project Implementation 1. Fulfilment of conditions precedent to loan effectiveness 1 2. Compliance with general conditions 1 3. Compliance with “other” conditions 1 B. Procurement Performance 1. Procurement of consultancy services 3 2. Procurement of goods and services 2 C. Financial Performance 1. Foreign exchange availability 3 2. Local currency availability 1 3. Cash flows 3 4. Cost management/recovery 3 5. Performance of co-financiers (if any) 3 D. Activities and works 1. Timely implementation 3 2. Performance of consultants and technical assistants 3 3. Performance of contractors 1 4. Project Management Performance 2 E. Impact on development 1. Likelihood of achieving project objectives 2 2. Likelihood of preserving benefits beyond the investment phase of

the project 2

3. Project’s likely contribution to institutional capacity building 2 4. Expected Rate of Return F. Overall Assessment 1. Currently 2.12 2. Progression over time 1.95

STATUS Implementation Progress (IP) = 2.14 Development Objectives (DO) = 2.00

XIV

ANNEX 6

SOURCES OF INFORMATION AFRICAN DEVELOPMENT BANK:

1- CSP 1999-2001 2- Appraisal Report of the Basic Health Services Improvement Project (Health Project I) of the Republic

of Djibouti (April 2002) 3- Mid-term Review Report of the Basic Health Services Improvement Project (June 2008) 4- Aide-mémoire of the mid-term review mission of the Basic Health Services Improvement Project (24-

31 May 2008) 5- Aide-mémoire of the supervision mission of the Basic Health Services Improvement Project (20 - 27

December 2008) 6- Aide-mémoire of the supervision mission of the Basic Health Services Improvement Project (23 – 31

October 2009) 7- Aide-mémoire of the supervision mission of the Basic Health Services Improvement Project (23 – 31

October and 14 – 21 November 2009) 8- Aide-mémoire of the supervision mission of the Basic Health Services Improvement Project (14 - 25

December 2010) PMU 9- Training Report on the Screening and Care for pre-eclampsia and "Toxaemia of Pregnancy" (Mother

and Child Health Directorate (ADB - May 2008) 10- ADF – Summary Statement of Expenditure, (28/05/2008- 08/09/2008- 12/06/2010) 11- Progress reports on the status of the Basic Health Care Improvement Project Financing - African

Development Fund /OPEC : Quarterly Report No.12 (October – December 2011) and Half yearly Report No. 13 (January - June 2011)

12- Acceptance reports for works and delivery of equipment and furniture

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