REPUBLIC OF GUINEA COMPLETION REPORT PUBLIC …

AFRICAN DEVELOPMENT FUND

REPUBLIC OF GUINEA

COMPLETION REPORT

PUBLIC PHARMACEUTICAL SECTOR REHABILITATION PROJECT

COUNTRY DEPARTMENT OCTOBER 2001WEST REGION (OCDW)

TABLE OF CONTENTS

Page

CURRENCY EQUIVALENTS, WEIGHTS AND MEASURESACRONYMS AND ABBREVIATIONS, LIST OF ANNEXESSUMMARY, CONCLUSION AND RECOMMENDATIONSBASIC DATA AND PROJECT MATRIX i - xvi

1 INTRODUCTION 1

2 PROJECT OBJECTIVES AND FORMULATION 1

2.1 Project Objectives 12.2 Project Description 12.3 Project Formulation 2

3. PROJECT IMPLEMENTATION 2

3.1 Entry into Force and Start-up 23.2 Modifications 23.3 Implementation Schedule 33.4 Reporting and Auditing 33.5 Procurement of Goods and Services 43.6 Costs, Sources of Financing and Disbursement 4

4 PROJECT PERFORMANCE 5

4.1 Operational Performance 54.2 Institutional Performance 84.3 Performance of the Consultant 104.4 Performance of Contractors 104.5 Performance of Suppliers 10

5 SOCIAL IMPACT AND ENVIRONMENTAL EFFECTS 10

5.1 Impact social 105.2 Environmental Effects 11

6. SUSTAINABILITY 126.1 Infrastructure 126.2 Equipment and Maintenance 126.3 Financial Sustainability 126.4 Institution Building 12

7. PERFORMANCE OF THE BANK AND BORROWER 13

7.1 Performance of the Bank 137.2 Performance of the Borrower 13

8. OVERALL PERFORMANCE AND RATING 13

9. CONCLUSIONS, LESSONS AND RECOMMENDATIONS 13

9.1 Conclusions 13

9.2 Lessons 14

9.3 Recommendations 14

LIST OF ANNEXES

Number of Pages

1. Map of Country and Project Sites 12. Sources of information 13. Actual Expenditure by Category and Source of Financing 14. Provisional and Actual Expenditure Schedule on Loan and Grant 15. Performance of Project Implementation and Bank 16. Impact of Project on Development 17. Matrix of Recommendations and Follow-up Actions 18. Borrower Comments on PCR 19. List of Project Conditions 1

This report was prepared Mrs. B. BA (Health Expert) and a Consulting Architect, followingtheir project completion mission to the Republic of Guinea, from 15 September to 5 October1999. For further information please contact Mr. E. G. TAYLOR-LEWIS, Director, OCDW(Ext. 4041) and Mr. R. CRESSMAN, Division Chief, OCDW.5 (Extension 4112).

i

CURRENCY EQUIVALENTS

At Project Appraisal Upon Completion(1987) (PCR 1999)

UA 1 = GNF 636.89337 UA 1 = GNF 1649.89UA 1 = US$ 1.29039 UA 1 = US$ 1.36986

METRIC SYSTEM

FISCAL YEAR

January - December

ACRONYMS AND ABBREVIATIONS

PIU : Project Implementation UnitCNM : National Drug CommitteeDGS : General Health DirectorateDNPL : National Drugs DirectoratePCG : Pharmacie Centrale de Guinée [Central Pharmacy of Guinea]EPI : Extended Programme of ImmunisationPRISCO : Health Infrastructure Rehabilitation Project of ConakryPRSPP : Public Pharmaceutical Sector Rehabilitation ProjectPHC : Primary Health CareVRD : Site Development

ii

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

The Public Pharmaceutical Sector Rehabilitation Project (PRSPP), subject of thiscompletion report, is one of the first ADB Group operations in Guinea’s health sector. It cost atotal of UA 10.54 millions. The ADF provided UA 7.10 million, TAF UA 2.44 million and theGovernment UA 1 million. The project was approved on 23 February 1989 and its the loanagreement became effective on 18 April 1990.

Project Objectives and Formulation

Designed at the onset of Guinea’s second republic in 1984, after the national healthconference held in July 1984 to set the priorities for the entire country, the project is in keepingwith the emergency programme and aims specifically at facilitating access to essential drugs andbuilding the Government’s capacity to better manage the national pharmaceutical sector. Theproject’s objectives are: (i) strengthening the organisation and regulations of the pharmaceuticalsector; (ii) rehabilitating the public pharmaceutical sector; and (iii) assisting the projectimplementation unit.

Project Implementation

The project was approved on 23 February 1989 and its loan agreement andmemorandum of understanding became effective fourteen months later. The generalimplementation schedule could not be complied with not only because of the delay in theprocedure for approval and entry into force but also because of administrative sluggishness andsanctions levied on the country for non-payment of arrears owed to the Bank.

Nonetheless, the specific objectives were reached. The core and complementaryactivities have been completed. In 1995, after five postponements of the deadline for lastdisbursement, because of the delay in the implementation of activities, project activities ended.

Until 1995, at least between 1995 and 1999, the Borrower had sent project activityreports regularly. The only audit report for the period December 1990-June 1998 was sent to theBank at the beginning of September 1999. This completion report was prepared after a Bankmission to Guinea from 15 September to 5 October 1999.

Project Performance

From the social standpoint, the project contributed to addressing Guinea’s healthproblems by improving access of the majority to drugs, both in terms of geography andaffordability. Institutionally, the project has enhanced and built the Government’s capacity tobetter manage the entire pharmaceutical sector.

The project has enabled the renovation of the buildings of the Central Depot of Conakryand the country’s four secondary depots, the restructuring of the Central Pharmacy of Guinea(former Pharmaguinee), the training of about 105 officers and the revision of pharmaceuticallegislation. All furniture and equipment were purchased. Technical assistance services wereacquired and the National Drugs Commission put in place with considerable delay.

iii

Social Impact

Easier geographic access to generic drugs is the project’s main socio-economic impact.Indeed, the project has made it possible to procure drugs almost nationwide at affordable pricesand thereby contributed to better health. Thanks to the introduction of generic drugs in Guinea,the cost of drugs has fallen significantly. In 1995, a study on Guinea’s national pharmaceuticalpolicy carried out by WHO showed that it costs patients to treat some diseases (pneumonia forinstance) in the private sector (with mostly proprietary drugs) about six times more than in thepublic sector where mainly essential generic drugs are prescribed. In 1998, another studyconducted by the Ministry of Health illustrated that the average price of a prescription from adistrict hospital was GNF 1,200 (about UA 0.75), because of the generic drugs. On the whole,the population of Guinea, 40% of whom live below the poverty line have easier access to drugsboth from the standpoints of location and cost.

Sustainability

The infrastructure built is not only in good shape but is functional and well adapted tothe requirements of the people. In addition, the equipment is of good quality. The capacity ofthe administration to manage the entire pharmaceutical sector is stronger. These factors indicatethat there is potential for the system’s sustainability. Nevertheless, it must be pointed out thatdespite the multiple project possibilities and benefits, sustainability of these achievements willdepend on: (i) long term settlement of the cost to maintain the equipment and buildings; (ii)transparency in the management of the PCG; (iv) application of a sound drug price policy; (v)gradual integration of the EPI/PHC Unit into the PCG.

Performance of the Bank and Borrower

Technical supervision by the Bank was regular. In all, sixteen, including seventechnical, seven financial and two portfolio missions were fielded. Generally, the Bank’sperformance was acceptable. The Government for its part, spent considerable time fulfilling theconditions precedent to entry into force of the loan agreement and implementing supplementaryactivities; 99.66% of the counterpart funds were disbursed to the project well behind schedule.The performance of the Borrower was acceptable.

Conclusions

The Public Pharmaceutical Sector Rehabilitation Project is in keeping with the prioritiesof the Guinean Government’s health policy and is consistent with the Bank’s health guidelines.Despite difficult project implementation conditions, its impact has been positive. The projecthas made access to essential drugs easier and built the capacity of the Government to bettermanage the national pharmaceutical sector.

Lessons

. On the whole, the results of the Pharmaceutical Sector Rehabilitation Project arepositive. The initial period scheduled for the implementation of activities was reasonable. Inorder to avoid substantial balances from the amount allocated to supplementary activities, a goodproject fund estimate must be made. An in-depth analysis of the project’s beneficiary structuresmust be conducted and its institutional foundation well considered. The Government must

iv

honour its commitment as stipulated in the loan agreement (e.g. responsibility for recurrent costsand regular disbursement of counterpart funds) in order to ensure project sustainability.Furthermore, in relation to the status of the PCG, the Government’s financial withdrawal mustbe gradual until the Company can firmly hold the reins of administrative management, has had asignificant financial base and a good commercial service.

Recommendations

In order to ensure sustainability of this and similar future projects, the mission isrecommending that the Government:

For the Sustainability of Project Achievements

i) Take charge of recurrent project costs (renewing the stock of drugs, maintenance,etc.);

ii) Continue to support the pharmaceutical sector with the assistance of the donorcommunity and to study the practical terms for a gradual integration of theExtended Programme of Immunisation/Primary Health Care (EPI/PHC) Unit intothe PCG;

iii) Develop a PCG marketing service;iv) Take all steps to contact the drugs supplier Familia in order to recover FB 3 180

580 (in kind or cash) corresponding to the drugs supplied in packs of 100 insteadof 1000 tablets;

v) Establish a system for recycling gas, an incinerator in the drugs control laboratoryand complete the equipment and reagents in the laboratories;

In order to Draw Lessons for Future Projects

i) Adopt the “sectoral investment programme” approach, by taking intoaccount the Government’s budgetary capacity to efficiently carry throughprojects and defray the related recurrent costs;

ii) Analyse the impacts of the ministerial restructuring exercise on projectimplementation and institutional framework (e.g. dissolution of the GeneralHealth Directorate, change of the Bio-pharmacy Division into a NationalPharmacy and Laboratory Directorate);

iii) Organise periodic follow-up meetings between the Ministries of Planning,Finance, Health, Public Works and the Project Directorate;

iv) Shorten the period for signing of contracts; and

v) Conduct regular and thorough project audits.

The mission furthermore recommends that the Bank:

vi) Take the time necessary to prepare future projects better; and

vii) Take the necessary steps to ensure that accounts are audited annually.

v

BASIC DATA

1. Name of Project : Public Pharmaceutical Sector Rehabilitation

2. Number of loan : F/GUI/PHA/89/15

3. Number of grant : F/GUI/PHA/89/2

4. Borrower : Republic of Guinea

5. Guarantor : Republic of Guinea

6. Beneficiary : Ministry of Public Health

7. Executing Agency : Project Implementation Unit at the MSP

A. LOAN Estimate at Appraisal

1. Amount (UA million) : 7.10

2. Interest rate : NA

3. Service commission : 0.75 % a year

4. Repayment period : 40 years

5. Grace period : 10 years

6. Date loan negotiation : 15/02/89

7. Date of loan approval : 23/02/89

8. Date of signature of loan : 21/06/89

9. Date of entry into force : 18/04/90

B. GRANT Estimate at Appraisal

1. Amount (UA million) : 2.44

2. Interest rate : NA

3. Service commission : NA

4. Repayment period : NA

5. Grace period : NA

6. Date of loan negotiation : 15/02/89

vi

7. Date of loan approval : 23/02/89

8. Date of loan signature : 21/06/89

9. Date of entry into force : 18/04/90

C. PROJECT DATA

1. Project Cost (in UA million)

Sources of financing Amounts projected atappraisal

Actual expenditure

ADF 7.10 7.05TAF 2.44 2.41Government 1.00 0.95Total 10.54 10.41

2. Financing Plan at Appraisal (in UA million)

Sources F.E. % L.C. % Total %

ADF 6.32 74.17 0.78 38.61 7.10 67

TAF 2.20 25.83 0.24 11.88 2.44 23

Government - - 1.00 49.51 1.00 10

Total 8.52 100 2.02 100 10.54 100

% of total cost 80.84 19.16 100

3. Actual date of first disbursement : 25/05/90

4. Actual date of last disbursement : 14/10/99

5. Start-up of project activities : 1/07/90

6. Completion date of project activities : 30/09/99

D. PERFORMANCE INDICATORS

1. Balance % (loan) : 0.70%Balance % (grant) : 1.22%

2. Slippage on scheduleslippage against entry into force : 1 yearslippage against completion date : 6 yearsslippage against last disbursement : 5 yearsnumber of extensions of deadlinefor last disbursement : 6

3. implementation status : closed

vii

4. List of verifiable indicators : Percentage of realisation

A. Construction : 100%B. Furniture : 100%C. Equipment : 100%D. Technical assistance : 100%E. Training : 100%F. Operating : 100%G. Drugs : 100%

It is worth noting that the Bank will cancel the balances on the loan and grant.

5. Institutional performance:

Bank : AcceptableGovernment : Acceptable

6. Performance of Contractors:

C.D.E : SatisfactorySETRA and RWE : Rather good

7. Performance of suppliers:

INTERTROPICAL-COMFINA, PARAGRAPHIC, INTER-AGRARIA, ITS,JCA RENAULT, SOMATEM, MEDICAL GROUP, IDA and YATTASSAYE

: SatisfactoryFAMILIA : Acceptable

8. Performance of consultant :

CREDES, SCET-TUNISIE, VERITAS, IGG, andASSOCIATE AUDITORS : Satisfactory

E. MISSIONS

Number of persons Composition Year Number

Identification 6 SODETEC 1988 1Preparation - -Appraisal 4 ADF 1988 1Financial supervision 1 ADF 1991/92/93/94/95 7

96/97Technical supervision 2/3 ADF 1990/91/93/94/97/98 6PCR 2 ADF 1999 1

viii

LOAN DISBURSEMENT (in UA)

Total disbursed : UA 7 051 473.55Unused balance : UA 48 916.45Amount cancelled : UA 48 916.45

GRANTTotal disbursed : UA 2 414 980.46Unused balance : UA 25 807.54Amount cancelled : UA 25 807.54Annual disbursement of loan and grant (in UA)

Year Estimate appraisal Actual Percentage disbursed

ADF TAF ADF TAF ADF TAF

1989 278 157.70 291 052.43 0.00 0.00 0.00 0.00

1990 1 702 104.09 850 130.99 146 990.23 237 013.81 2.05 9.71

1991 4 757 233.58 737 762.65 118 446.83 597 113.79 1.66 24.46

1992 235 789.31 372 105.50 821 444.76 537 016.25 1.15 22.00

1993 128 026.23 188 815.66 1 819 347.22 464 608.14 25.62 6.53

1994 1 972 357.97 205 648.48 27.77 8.40

1995 128 217.14 115 723.71 1.80 4.71

1996 706 691.42 2 032.40 9.94 0.08

1997 594 305.03 128 901.28 8.36 5.24

1998 612 585.54 78 126.53 8.62 3.19

1999 131 087.40 48 796.04 1.85 1.96

Total 7 0101 310.91 2 439 867.23 7 051 473.54 2 414 980.43 99.29 98.77

F. CONTRACTORS/SUPPLIERS

LOAN

CONSTRUCTION

Name : Société d’Etudes et de Travaux(SETRA)

Type of contract : Construction works on the PIUpremises

Date of signature of contract : 11/09/91Duration of contract : 2.5 monthsDate of termination of contract : 5 February 1992Basic amount : GNF 97 017 479Financing : ADF and Guinean Government

ix

Name : Consortium d’EntreprisesType of contract : Construction works (PCG)Date of signature of contract : 19/11/91Duration of contract : 10 monthsDate of termination of contract : 28 March 1994Basic amount : GNF 2 387 328 093Amount amendment 1 signed on 9/12/93 : GNF 331 511 784Total contract amount : GNF 2 718 839 877Financing : ADF and Guinean GovernmentName : Bureau VéritasType of contract : Quality control (ten-year

guarantee)Date of signature of contract : 02/01/92Duration of contract : 10 monthsDate of termination of contract : 28 March 1994Contract amount : GNF 57 868 000Amount amendment 1 signed on 18/7/94 : GNF 5 092 380Total contract amount : GNF 62 960 380Financing : ADF and Guinean GovernmentName : Ingénierie Générale de Guinée

(IGG)Type of contract : Site supervisionDate of signature of contract : 26/03/92Duration of contract : 6 monthsContract amount : GNF 29 844 520Date of termination of contract : 14 February 1994Financing : ADF and Guinean Government

Name : Société d’Etudes et de Travaux(SETRA)

Type of contract : D.N.P.L construction worksDate of signature of contract : 18/02/93Duration of contract : 2.5 monthsContract amount : GNF 101 970 000Date of termination of contract : 18 January 1996Amount amendment 1 signed on 15/01/94 : GNF 34 875 440Total contract amount : GNF 136 846 440Financing : ADF and Guinean GovernmentName : Société Consortium d’Entreprise

(CDE)Type of contract : Construction site development of

the control laboratoryDate of signature of contract : 14/12/95Duration of contract : 6 monthsContract amount : GNF 514 452 600Date of termination of contract : 30 April 1998Financing : ADF and Guinean GovernmentName : RWE EnterpriseType of contract : Renovation Works on the Quality

Control Laboratory

x

Date of signature of contract : 20/06/97Duration of contract : 2 monthsContract amount : GNF 70 352 026Date of termination of contract : 1st February 1999

Amount amendment 1 signed on 27/08/98 : GNF 27 778 625Total contract amount : GNF 98 130 651Financing : ADF and Guinean Government

FURNITURE

Name : SOMATEMType of contract : Office furniture (PIU)Date of signature of contract : 10/12/91Date of termination of contract : March 1992Duration of contract : 1.5 monthsContract amount : GNF 28 458 606Financing : ADF

Name : SOMATEMType of contract : Office furniture PCG and DNPLDate of signature of contract : 29/09/93Date of termination of contract : March 1994Duration of contract : 3 monthsContract amount : FRF 809 823Financing : ADFName : Société Inter-AgrariaType of contract : Office furniture for the quality

control laboratoryDate of signature of contract : 07/09/98Date of termination of contract : 30 June 1999Duration of contract : 1.5 monthsContract amount : GNF 34 517 773Financing : ADF

EQUIPMENT

Name : Société Nissan Etoile Auto-Conakry

Type of contract : 7 vehicles (2 cross-country and 5light)

Date of signature of contract : 30/07/90Date of termination of contract : October 1990Duration of contract : 2 monthsContract amount : US$ 123 200Financing : ADFName : Société International Services

(ITS)Type of contract : 1 generator set for the PIU

xi

Date of signature of contract : 28/01/92Date of termination of contract : April 1992Duration of contract : 1.5 monthsContract amount : GNF 16 998 310Financing : ADFName : Société International Services

(ITS)Type of contract : Computer equipment, one

undulator, one fax and onephotocopier for the PIU

Date of signature of contract : 28/01/92Date of termination of contract : 15/05/93Duration of contract : 3 weeksContract amount : GNF 23 234 921Financing : ADF

Name : Imprimerie ParagraphicType of contract : 1.500 copies of the drug formDate of signature of contract : 17/09/92Date of termination of contract : 25/03/93Duration of contract : 2.5 monthsContract amount : FF 346 652Financing : ADF

Name : Intertropical-ConfinaType of contract : PCG Equipment (cold rooms,

generator sets, maintenanceequipment, etc.)

Date of signature of contract : 11/03/93Date of termination of contract : 10/03/94Duration of contract : 8 monthsContract amount : GNF 527 894 820Financing : ADF

Name : Société ITSType of contract : Computer equipment for DNPLDate of signature of contract : 22/07/94Date of termination of contract : 18/10/94Duration of contract : 1.5 monthsContract amount : FF 303 070Financing : ADF

Name : Société Yattassaye & FilsType of contract : Equipment for the Quality Control

LaboratoryDate of signature of contract : 07/09/98Date of termination of contract : 07/09/99Duration of contract : 3 monthsContract amount : GNF 175 800.264Financing : ADF

xii

Name : GICA RenaultType of contract : Vehicles for the PCGDate of signature of contract : 04/11/93Date of termination of contract : 10/05/93Duration of contract : 2 monthsContract amount : GNF 258 367 356Financing : ADF

Name : Inter-agrariaType of contract : Vehicles PCG/InspectionDate of signature of contract : 04/11/93Date of termination of contract : 10/05/94Duration of contract : 4 monthsContract amount : FF 1 255 080.65

Amount amendment 1 signed on4/11/97 : FF 819 894Total contract amount : FF 2 074 974.65Financing : ADF

DRUGS, CONSUMABLE AND CHEMICAL PRODUCTS

Name : Société Familia Guinée S.A.Type of contract : Drugs to the PCG.Date of signature of contract : 07/12/93Date of termination of contract : May 1996Duration of contract : 6 monthsContract amount : BF 53 811 197Financing : ADF

Name : Médical-Export GroupType of contract : Medical Consumables/PCGDate of signature of contract : 07/12/93Date of termination of contract : 27/07/94Duration of contract : 3 monthsContract amount : GNF 272 553 770Financing : ADF

Name : Société Intertropical-ConfinaType of contract : Chemical productsDate of signature of contract : 07/12/93Date of termination of contract : 27/09/94Duration of contract : 3 monthsContract amount : FB 2 766 819Financing : ADF

Name : International DispensaryFoundation (IDA)

Type of contract : Drugs

xiii

Date of signature of contract : 25/02/97Date of termination of contract : 12/11/97Duration of contract : 6 monthsContract amount : NLG 1 885 143.54Financing : ADF

G. CONSULTANTS/TRAINING

GRANT

Name : CREDESType of contract : Technical Assistance (DNPL and

PCG)Date of signature of contract : 14/02/90Date of termination of contract : 30/04/98Duration of contract : 48 monthsBasic amount : FF 11 715 970

Discount on basic contract : FF 219 089Amount amendment 1 signed on11/09/92 : FF 1 012 533Amount amendment 2 signed on 10/09/93 : FF 562 429Amount amendment 3 signed on 27/12/94 : FF 669 115Total contract amount : FF 14 179 136Financing : ADF

Name : SCET/TunisiaType of contract : Technical assistance (support

PCG/Commercial and accounts)Date of signature of contract : 10/02/97Date of termination of contract : June 1998Duration of contract : 12 monthsAmount : FF 1 440 000Financing : ADF

Name : Associated auditorsType of contract : Audit of accountsDate of signature of contract : 17/11/98Date of termination of contract : July 1999Duration of contract : 2 monthsAmount : 408 350 FRFFinancing : ADF

Name : National Management TrainingCentre

Type of contract : Training of P.C.G staffDate of signature of contract : 30/01/92Date of termination of contract : 25/09/92Duration of contract : 3 monthsAmount : GNF 16 335 000Financing : ADF

xiv

Name : Association for Health and SocialDevelopment

Type of contract : PCG management trainingDate of signature of contract : 02/12/92Date of termination of contract : June 1993Duration of contract : 9 monthsAmount : FF 225 000Financing : ADF

Name : Central Pharmacy of TunisiaType of contract : Training of officers for the

secondary depotsDate of signature of contract : 02/12/92Date of termination of contract : May 1993Duration of contract : 3 monthsAmount : FF 167 500Financing : ADF

Name : Institute of Training andCommunity Health Research ofParis

Type of contract : Training of members of theNational Drugs Commission(C.N.M)

Date of signature of contract : 8/09/93Date of termination of contract : July 1994Duration of contract : 10 monthsAmount : FF 125 000Financing : ADF

xv

REPUBLIC OF GUINEA

Retrospective Project MatrixName of Project: Public Pharmaceutical Sector Rehabilitation

Date of Completion: 30/09/99

Hierarchy of objectives Objectively verifiableindicators

Means of verification Assumptions

Sector goal

1. Facilitate access toessential drugs.

1.1.1 The percentage ofessential drugs inprescriptions of publichealth structures up from10% to 90% between1988 and 1999.

1.1.1 Statistics of Ministryof Health.

Project objectives1. Build the capacity ofthe state to better managethe entire nationalpharmaceutical sector.

1.1 Pharmacy staff trained,Management of thePharmacy and Laboratory(DNPL) assisted, formsfor drugs prepared, theNational DrugsCommission established.

1.1.1 Reports from theMinistry of Health andProject Office.

1.1.1.1 The countrymaintains its primaryhealth policy andcontinues to emphasize thepromotion of essentialdrugs.

2. Revive the publicpharmaceutical sector(former Pharmaguinée orCentral Pharmacy).

2.1 The Central Pharmacyis reorganised andregulated. The PCGturnover up by 250%between 1988 and 1994.the four regional depotsare built and operational.

2.1.1 records of themeeting of the PCGAdministrativeCommittee, reports of theregional depots andactivity reports from theProject Office.

2.1.1.1 IDEM.

Results

1.Pharmaceuticalregulations revised, thepharmaceuticalinspectorate strengthened,the national drugscommission set up, thedrugs lists drawn thenational form and druginventory prepared, 100pharmacists of the publicand private sector trainedat national level 8inspector-pharmacistsgiven a 12-month trainingabroad, the 2 secretaries ofCNM and CNEM trainedabroad for 9 and 5 monthsrespectively.

1.1 The Governmentdisseminates and uses thetools prepared; thepharmacy staff and peoplecomply withpharmaceuticalregulations.

1.1.1 Reports from theMSP and the ProjectOffice.

1.1.1.1 Statecommitment to regulatereorganise thepharmaceutical sector ismaintained.

2.1 PCG and 4 secondarydepots in Kankan,Faranah, Labé andN’Zérékoré,rehabilitated/built,equipped, furnished and

2.1. Physical state of thepremises.

2.1.1 Summary records ofthe delivery of buildings,furniture and equipmentsand supervision reports ofthe Bank and PIU. PIUtraining reports.

2.1.1.1 IDEM

xvi

stocked with drugs. Thestatus of the PCG changedfrom a public structureinto public institution ofan industrial andcommercial nature. 7pharmacists members ofthe staff of PCG andsecondary depots trainedfor 3 months abroad, 15PCG officers trainedlocally in pharmaceuticalmanagement.

5. Activities

1. Prepare biddingdocuments for thearchitectural, engineeringdesigns, procurement offurniture, equipment, anddrug formularies.2. Select consultants.3. Recruit enterprisesand suppliers.4. Sign agreements withTraining Institutes andsend officers on training5. Monitor sites.6. Prepare disbursementrequests.

Budget Resources

Sources:(in UA million)Projected ActualADF 7.10 7.05TAF 2.44 2.41Gvt. 1.00 0.92Total 10.54 10.38

1.1.1 Disbursement status,audit and Bank missionreports.

1.1.1.1. Government andADF resources providedfor the Project.

11 INTRODUCTION

1.1 Bank Group operations in the Republic of Guinea date back to 1974 when the ConakryWater Supply System Improvement and Extension Project I was financed. To date, Bankinvolvement covers several projects and studies including the Conakry Health InfrastructureRehabilitation (PRISCO) and the Pharmaceutical Sector Rehabilitation, approved on 23February 1989 and subject of this completion report.

1.2 During the Health Sector Round Table in July 1984, the Government defined the mainlines of the new health policy which aims at improving access of a majority of the people toindispensable pharmaceutical products. To that end, Pharmaguinée (now the Central Pharmacyof Guinea, PCG) is required to supply at the most reasonable prices, essential pharmaceuticals,basic medical equipment, reagents and other articles needed for the proper running of the publichealth services. This new policy prompted the Government to liberalise a number of state-owned companies including Pharmaguinée. In July 1985, an ADF grant of UA 2.05 millionmade it possible for the Government to carry out a general study of the health sector. Itsfindings enabled the Government and African Development Bank to identify and prepare thePublic Pharmaceutical Sector Rehabilitation Project which is a significant base for variousprimary health care projects the efficiency of which depend on the provision of drugs.

1.3 The project cost a total of UA 10.54 million. The ADF provided UA 7.10 million, TAFUA 2.44 million and the Government UA 1 million. The Bank’s Board of Directors approved iton 23 February 1989 and negotiations with the Government took place on 15 February 1989.During the loan agreement negotiations, there were no major changes to project activitiesalthough some loan conditions were reformulated. Started in April 1989, the project wascompleted six years later. Its implementation enabled the renovation of the offices of thePharmacie Centrale de Guinée (PCG) and Project Implementation Unit (PIU), construction ofpharmaceutical depots, procurement of equipment, furniture, training, and provision of drugs atleast cost almost nationwide. These activities were not only part of the core operations theimplementation of which lasted four (4) instead of three (3) years as planned, but also thesupplementary activities which spread over six (6) instead of two (2) years. All project facilitieswere operational upon completion of activities. Annex 1 is an administrative map of Guineashowing the project sites.

1.4 This completion report gives the status of project implementation and was written usingactivity and completion reports prepared by the Government. The list of documents given asAnnex 2 also served as sources of information.

2 PROJECT OBJECTIVES AND FORMULATION

2.1 Project Objectives

The project’s sector goal aims at facilitating access to essential drugs. More specifically,the purpose of the project is to build the capacity of the State to better manage the entire nationalpharmaceutical sector and revive the public pharmaceutical sector.

2.2 Project Description

2.2.1 The Pharmaceutical Sector Rehabilitation Project comprises three components coveringthe following expenditure categories: Construction /Renovation, Furniture, Equipment,Technical Assistance, Training, Operating Costs, Drugs. The activities of the variouscomponents can be summarised as follows:

2

Component I: Strengthening the Organisation and Regulations of the Pharmaceutical Sector- revision of the pharmaceutical regulations;- strengthening the pharmaceutical inspectorate;- setting up of the national drugs commission;- development of instruments (list of essential drugs);

national drug formulary, inventory).

Component II: Public Pharmaceutical Sector Rehabilitation- Renovation and reorganisation of Pharmaguinee’s main depot in Conakry- Construction and commissioning of four regional depots in:

Faranah, Kankan, Labé and N’Zérékoré.

Component III: Support to the Project Implementation Unit

2.3 Project Formulation.

In July 1984, the Government had decided during the national health conference, toadopt, especially in the context of the plan of priority actions, the essential drugs policy. Thelatter aims at ensuring the cover and quality of services, developing the network of healthcentres in order to make health staff more efficient, and improving access of the majority toindispensable pharmaceuticals. It is in that context that the Bank financed to begin with, a pre-project study conducted by the firm SODETEC, and subsequently, formulated with the Guineanauthorities this Pharmaceutical Sector Rehabilitation Project, designed and appraised by theGovernment and Bank in September 1988, negotiated in February 1989 and subject of thiscompletion report.

3. PROJECT IMPLEMENTATION

3.1 Entry Into Force and Start-up

The project was approved on 23/02/1989 and the loan agreement became effective on18/04/1990 following fulfilment of the precedent conditions by the Borrower. The precedentand other conditions are listed in Annex 9 of this report. The first two of the “Other Conditions”were fulfilled in toto and the last two in part. The pharmaceutical and chemical products, rawmaterials, laboratory reagents, surgical, scientific and technical equipment on the list drawn bythe Ministry of Health in line with the guidelines of the National Drugs Commission (CNM)were not taxed but the essential drugs were. Application of the recommendations made by thevarious PCG audits should enable inter alia, a better control of the prices of drugs and a bettermanagement of the PCG.

3.2 Modifications

The project as approved by the Bank did not undergo any major modification. However,in December 1994, with the balance left after completion of the core activities scheduled atappraisal, supplementary activities were funded at the proposal of the Government andfollowing Bank approval. Activities include: i) site development and fencing of the CentralPharmacy; ii) rehabilitation of the quality control laboratory and replacement of old equipment;iii) additional technical assistance in the field of commerce (12 months) and accounts (5months); and iv) ordering of the last package of drugs. In addition, for more practical reasons,the garage-workshop was made part of building 8 instead of building 7, although the surfacearea remained virtually the same. Similarly, the entrance to the Labe depot was designed as partof the neighbouring medical centre. Moreover, contrary to the basic programme, slightadjustments were made in connection with the requirements of the implementation unit under

3

the technical assistance component (7 man-months of health economics, company managementand computer technology).

3.3 Implementation Schedule

3.3.1 The table below summarises the provisional and actual schedule of basic activities.

Provisional and Actual Schedule of Activities

Activities Provisional Dates Actual Dates Differences

Loan approval February 1989 15 February1989

-

Establishment of the PIU February -April 1989 April 1989 -Recruitment of technical assistants April-July 1989 July 1990 15 monthsLaunching of bids for works and furniture,equipment and consumables for the PIU and capacitybuilding

August-October 1989 March 1990-November 1991

7 months

Analysis/award/approval by ADF January 1990-December 1991

January 1992-March 1994

2 years

Invitation to bid for furniture, equipment andconsumables

Oct.-December 1990 April 1990-February 1993

-

Analysis/award/approval by ADF January-February1991

Mai 1991-December 1993

2.5 years

Purchase and installation April-December 1991 March-June1994

3 years

Technical assistance August 1989-June1993

July 1990-December 1993

11 months

Training Oct.1989-Dec.1992 January 1992-December 1993

3 years

Additional activities January 1995 toSeptember 1999

4 years

3.3.2 The provisional project schedule was to span the period February 1989-December 1992,but could not be kept for the following reasons: i) delay in the effectiveness of the loanagreement; ii) administrative sluggishness on the part of the Government, PIU and Bank; andiii) implementation of additional rather important activities that were not scheduled at appraisal.Activities actually took off with the recruitment of technical assistants in 1990 or 15 monthslate and did not end until end September 1999.

3.3.3 Apart from the audit of accounts, activities as described in the appraisal report ended on31 December 1994 despite the delay at start-up. Moreover, the establishment of the NationalDrugs Commission in particular was delayed for lack of premises and state funds. For theirpart, additional activities were implemented between 1995 and 1999, although they wereinitially scheduled to last two years. The various project activity implementation delays aresummarised in paragraph 3.3.2.

3.4 Reporting and Auditing

Activity Reports

3.4.1 From 1990 to 1995, the Borrower submitted project activity reports regularly, at leastbetween 1995 and 1999, when additional activities were carried out well behind schedule. Atotal of 32 quarterly reports were submitted in the format specified by the Bank (or from 1990 to

4

1995 4 reports per annum; 1996: 3 reports; 1997 and 1998 2 reports a year; and 1999: just 1).

Audit

3.4.2 The only audit report dealing with the December 1990-June 1998 period, was sent to theBank early September 1999, although the auditor had finalised and submitted the report to theGovernment since May 1999. He pointed out the lack of an accounting system compatible withthe Guinean Accounting Plan. Therefore, the audit firm had to re-create the project’s resource-application situation for 1 July 1990 to 30 June 1998 using information available and concludedthe following: there was no justification for some expenditures, no explanation for the projectdebit of GNF 116 348 and over-payment of GNF 18 643 615 to a supplier. The Bankrecommended that the Government take the necessary steps to address the auditor’s concernsand commission an audit of project accounts from 1 July 1998 to 30 September 1999. At thetime this completion report was being finalised, the recommendations were yet to be applied bythe Government.

3.5 Procurement of Goods and Services

3.5.1 On the whole, apart from the delays and sluggishness in the award of some contracts,Bank rules of procedure for the procurement of goods and services were complied with. Themodes of procurement of project goods and services as provided for the in the loan agreementand memorandum of understanding were followed. Works on the National PharmacyDirectorate and Laboratories (DNPL) and furniture and equipment for these structures wereprocured through national competition. The enterprises responsible for renovation/construction,equipment, procurement of drugs and reorganisation of the main depot of the central pharmacyand four regional depots in Kankan, Faranah, Labé and N’Zérékoré, were selected throughinternational competition. Technical assistance services were procured through competitionbased on a short list (support to PCG).

3.5.2 At the end of this procedure, contracts were signed and the results contributed greatly tothe re-start of the pharmaceutical sector and the strengthening of achievements and skills.Institutions for training abroad were selected through limited shopping. Under complementaryactivities, works to rehabilitate the national quality control laboratory and site development,equipment and furniture were procured through international competition. The firm required toaudit project accounts was selected from a short list.

3.6 Costs, Sources of Financing and Disbursement

3.6.1 Total project cost, evaluated in 1989, was UA 10.54 million, including UA 8.51 millionin foreign exchange, and UA 2.03 million in local currency. The initial financing plan andamounts disbursed are summarised in the table below.

Costs, Sources of Financing and Disbursement in UA

Sources Estimate at Appraisal Actual Percentage disbursed

ADFTAFGOVT>

7 101 310.912 439 967.231 000 000.00

7 051 473.542 414 980.43953 000. 00

99.2998.7795.30

Total 10 541 278.14 10 419 453.97 98.84N.B.: the financial execution of the loan, grant and counterpart fund is summarised in Annex 3.

5

3.6.2 The first disbursement on the loan was made ten months (10) after signature of therelated agreement. Disbursement flow on the ADF resources was regular. However,disbursement flow on the counterpart funds was not only irregular but sometimes considerablydelayed. In addition, the counterpart funds disbursed differed slightly depending on the sourceof information quoted. It is GNF 1 008 000 000 (UA 953 000) according to the PIU and GNF 1098 300 000 (about UA 1 038 091) according to the Ministry of Finance. Service providers(suppliers, enterprises, consulting firms) were paid late because of slow dispatch of paymentrequests to the Bank and slow disbursement of the Government counterpart funds and Bankloan and grant resources. It took the Bank an average of between two to three weeks andsometimes three to four months, according to information from the Bank’s disbursementdepartment. Annex 4 of the report shows the provisional and actual annual expenditures on theloan, grant and Government’s counterpart fund.

4 PROJECT PERFORMANCE

4.1 Operational Performance

4.1.1 In relation to the objectives set initially, the project target to improve access to essentialdrugs was reached in so far as drugs have become more accessible through the four regionaldepots, and cheaper generic drugs are available. The core activities planned at appraisal tostrengthen the organisation and regulations of the pharmaceutical sector, the rehabilitation of thepublic pharmaceutical sector and support to the PIU were carried out satisfactorily. The qualityof the works on the central depot of Conakry and on the 4 secondary depots in the country’sinterior has been satisfactory and the premises are operational. The pharmaceutical legislationhas been revised and the National Drugs Commission is operational. All equipment, furnitureand drugs have been delivered and commissioned. Training activities have been completed andthe various technical assistance services carried out. In addition, complementary activitiesconcerning site development, fencing of the Central Pharmacy, rehabilitation of the qualitycontrol laboratory and complementary technical assistance in the field of commerce andaccounts as well the final order for drugs have been satisfactorily implemented. The operationalperformance of the project by component can be summarised as follows:

Component I: Strengthening the Organisation and Regulations of the PharmaceuticalSector

4.1.2 This component has been satisfactorily implemented since 1994 and concerns: i)revision of the pharmaceutical regulations under which the texts were revised and used by thehealth authorities; ii) strengthening the pharmaceutical inspectorate through which the staff wassatisfactorily trained and provided with means to work and step up productivity; iii)establishment of a National Drugs Commission that is still operational; iv) development of toolslike the list of essential drugs, the national drugs formulary and drugs inventory, satisfactorilyused as working instruments by the pharmaceutical staff; v) office furniture and equipmentneeded for the proper running of the National Pharmacy Directorate and Laboratory (DNPL),the Pharmaceutical Inspectorate and the National Drugs Commission (CNM). The premiseshousing the DNPL were renovated and equipped and are functional. Assistance, includingservices judged satisfactory by the Ministry of Health was provided and about a hundred peoplefrom the public and private sectors were trained in the pharmaceutical field (e.g. relatedregulations, drugs management, etc.).

Rehabilitation and Construction

4.1.3 The rehabilitation of the National Pharmacy and Laboratory Directorate (DNLP), knownas the Biopharmaceutical Division at the time of appraisal, was delayed because some of the

6

offices to be renovated were occupied and could not be vacated in time. This slow-down led tothe suspension of works which resumed following an amendment to the Company’s contract, asthe premises had deteriorated meanwhile. Such a delay suggests a flaw in the PIU’s capacity toproperly plan and coordinate rehabilitation of the premises. The DNPL, comprising five officesand two meeting rooms as well as toilettes, is to date operational and occupies a buildingdelivered in 1996.

Furniture/Equipment

4.1.4 Good quality office furniture was delivered and installed following internationalcompetition. Office equipment and vehicles were also provided. Three contracts were signedwith various suppliers for the equipment delivered and checked in 1994. Thus, the first contractwas for the supply of a roneo machine, four typewriters, two micro-computers and threephotocopiers. The second contract was for the provision of five cross-country and two lighttransport vehicles. The third package was for printing 1500 copies of drug formularies.Although these items are now old they are still in use and contribute to the running of thevarious departments.

Technical Assistance

4.1.5 In order to strengthen the organisation and regulatory framework of the pharmaceuticalsector, the following technical assistants were recruited between 1991 and 1993 for the project:an inspector-pharmacist (24 months); a pharmacist-legal officer (5 months); a medical intern (1month) and a pharmacologist-doctor (7 months) whose services were accomplished to thegeneral satisfaction of their Guinean counterparts.

Training

4.1.6 Training sessions judged rather useful by the beneficiaries were organised both at homeand abroad. In June 1993, four seminars were organised locally on regulations and legislation,each session lasting one week, for inspector-pharmacists in the country’s four natural regions.The trainers who gave the training courses locally were the eight inspector-pharmacists trainedin France for twelve (12) months in pharmaceutical management and pharmaceuticalregulations and legislation. The secretary of the National Drugs Commission was trained fornine months and the registrar for five months in France. In order to control the drain of theofficers trained, beneficiaries trained abroad had to pledge to work in the civil service for at leastfive years and these promises were kept. Local training activities covered four seminars in thecountries four natural regions for inspector-pharmacists in the fields of pharmaceuticalregulations and legislation.

Component II: Public Pharmaceutical Sector Rehabilitation

4.1.7 The following activities of component II were carried out: renovation/construction,equipment and reorganisation of the main depot of the central pharmacy and four regionaldepots in Kankan, Faranah, Labé and N’Zérékoré as well as drugs supply in and training ofpharmacists, dispensers and accountants for the management of the PCG.

Construction/Renovation

4.1.8 The renovation of the premises of the central pharmacy, which is functional and veryspacious, involves four two-storey buildings covering a total area of 2281.40 m2. The groundfloor of the first building (1229.10 m2) houses a canteen, a workshop that assembles kits andthe kit dispatch area, the first floor (1052.30 m2) houses the administrative departments of the

7

PCG. The ground floor of the second two-storey building (1471.20 m2) houses the store forliquids and massive solutes, stores for various liquids, an area for offloading orders platformsand the first floor (1,110.70m2) houses the store for dressings, stores for drugs and laboratoryreagents, cold rooms, cold rooms and offices (making a total of 2581 m2).

4.1.9 The third building, a new one-storey construction (of 212 m2) intended for the receipt,storage, preparation and dispatch of orders for inflammable products. The building planned forthe garage-workshop was slightly modified. The garage-workshop used by the vehicle andgeneral maintenance services was finally installed in another building (not provide for at thetime of appraisal) but there was no change to surface area (150 m2). The fourth building housesthe plumbing facilities. Two companies were responsible for quality control, monitoring andsupervision of works.

4.1.10 The regional depot buildings (new constructions) and the space required for work havebeen well defined. Each unit of the regional depot comprises two offices, cloakrooms, areas forreceiving, storing, preparing, and dispatching orders, premises for inflammable products (usedas a room for the watchman), a technical area comprising a small maintenance workshop, ashelter for mopeds, areas for spare parts, generator sets, boosters and a water reservoir, a wetcore and three-bedroom quarters for the head of the depot. All the depots are functional.

Furniture/Equipment

4.1.11 Furniture and equipment have been procured; the equipment is in working order andcomprises special equipment and vehicles for the transport of drugs (six 4x4 minibuses and 3trucks). The special equipment comprises cold rooms, generator sets and maintenance material.


4.1.12 The central pharmacy was provided with technical assistants whose services werejudged satisfactory by the Guineans. They contributed greatly to building the capacity of thePCG staff in the field of drug management. Technical assistants included an economist-pharmacist for the central pharmacy on three-year contract (1991-1994), a pharmacist (5months) and a chartered accountant (7 months).

Training

4.1.13 Three-month training courses were organised locally in the field of pharmaceuticalmanagement for the benefit of fifteen employees (pharmacists, dispensers and accountants) ofthe Central Pharmacy of Guinea. At the end of the training, the best trainees were given furthertraining in pharmaceuticals abroad. In addition, four professionals of the central pharmacy andfour employees of the secondary depots were sent to France and Tunisia respectively, for three-months training in depot management. One of the trainees sent on training was sent back homefor insubordination. On the whole, the contents and quality of the training courses were judgedacceptable by those trained. Moreover, these courses furthered the knowledge of thepharmaceutical personnel in drugs management.

Drugs

4.1.14 The drugs were procured in two tranches from different suppliers. The first tranche waslaunched in three bid packages: 1 for drugs, 1 for medical consumables and one for chemicalproducts. It must be pointed out however, that a poor estimate was made of requirements forthe first order of drugs; part of this order (the unsold stock expired subsequently) could not be

8

used thereby adversely affecting the Central Pharmacy (PCG)’s management of the drugs.

Component III: Support to the Project Implementation Unit

4.1.15 The Project Implementation Unit whose performance is on the whole acceptablecomprises a coordinator, an architect (three years) a managing accountant, five site supervisorsincluding four whose contracts have ended, two typists, two drivers, a watchman and a cleaninglady. The same management has monitored activities since project start-up. The PIU operatingcosts were defrayed under the project, and covered local staff salaries and allowances, officesupplies, fuel and vehicle maintenance. The PIU benefited from major technical assistance.

Construction

4.1.16 The PIU renovation/construction works have been completed, the building is functionaland will house the PIU of the new Health Project III. The building has been delivered sinceFebruary 1992.

Furniture/Equipment

4.1.17 The furniture and equipment required have all been procured, are functional and include:7 vehicles (5 light and 2 cross country), computer equipment, an inverter, a fax machine, aphotocopier and a generator set. They have been delivered, installed and officially accepted.


4.1.18 The PIU was provided with the following technical assistants whose services werejudged satisfactory: three engineers including one civil for a contract of thirty seven and a halfmonths, one electrical engineer and one sanitary engineer and for 6 months, one sitedevelopment engineer for 4 months and one economist for 2 months.

Complementary Activities

4.1.19 The site development works on and fencing of the Central Pharmacy as well as workson and equipment of the Quality Control Laboratory have been carried out since 1998. Theproject authorities officially handed over (end 1999) the keys of the laboratory to the Institute ofPublic Health which will be responsible for its management. The PCG was given technicalassistance in the field of commerce and accounting in 1998. Project accounts have beenaudited.

4.2 Institutional Performance

Management Efficiency and Organisation

4.2.1 On the whole project management and organisation were acceptable. During appraisal ithad been decided that project activities would be implemented by the PIU. In order to ensurecontinuity, the National Coordinator of the pre-investment study was appointed project manage.He was provided with technical assistance (36 man-months of a civil engineer, 6 man-monthsin electricity and sanitary plumbing and 2 man-months site development). Apart from thistechnical assistance, the PIU accounted for an architect, an accountant, 5 foremen, 2 secretaries,2 drivers, a messenger, a watchman and a cleaning lady. Such stable project management was agreat advantage for the continuity of activities. The PIU was under the supervision of theGeneral Health Directorate (DGS). Following the reorganisation of the Ministry of Health, theDGS was subdivided into technical directorates and project supervision was once again the

9

responsibility of the General Secretariat. Despite these new arrangements and thepharmaceutical specificity of the project, collaboration between the Bio-pharmacy Division(National Pharmacy and Laboratory Directorate), the PCG and PIU was not effective. Thisshortcoming and the management problems encountered by the PCG had a negative impact onthe quality of the first order. The PCG stated that it registered a lost estimated at 20% of thevolume or about GNF 360 million (UA 218 196,63) caused by poor sales and expiry of someproducts that were part of the first order.

4.2.2 Concerning the strengthening of the public pharmaceutical sector after the restructuringof the PCG, the number of staff was reduced from 150 to 50. From a purely public structure,the Central Pharmacy became a public commercial concern with a board of directors. Theorganisation put in place is in working order but can be improved. The PCG and its secondaryregional depots supply mainly hospitals and exceptionally health centres. It tenders also for theExpanded Programme on Immunisation/Primary Health Care (EPI/PHC). This programmewhich provides drugs at least cost to public health centres is highly subsidized by UNICEFwhose assistance will be phased out. With the disappearance of the EPI/PHC, the PCG shouldcover the demand from all public health centres currently estimated at GNF 17 billion. The PCGis responsible for the regular dispatch of drugs to the regional depots whereas the prefectoralhospitals (main clients) contact the depots directly for supplies.

4.2.3 Financial management is centralised in Conakry. In fact, based on a provisional budgetthe Central Pharmacy provides the regional depots with resources replenished half-yearly onpresentation of justifying documents. With a profit margin of 30% on drugs, the PCG is able todefray most of its recurrent costs. However, efforts are still to be made to maintain the buildingsand equipment and management has to be improved.

Recruitment, Training and Further Training

4.2.4 Only the Coordinator and secretary were seconded to the PIU and provided withallowances, as a result of a halt to civil service recruitment. The other members of the PIU teaminclude technical assistants and staff on contract whose services were acceptable.

4.2.5 In order to build the Government’s capacity to better manage the nationalpharmaceutical sector (one of the project’s objectives) sessions were organised both at homeand abroad for about one hundred (100) pharmacists of the public and private sectors. Withinthe framework of the project, eight (8) pharmacists-inspectors were given a twelve-monthtraining abroad in the field of pharmaceutical management. Similarly, the secretary of theNational Drugs Commission and the secretary of the National Drugs Registration Commissionwere trained for nine (9) and five (5) months respectively, in the field of pharmaceuticalregulation and legislation. The quality of this training was judged acceptable by thebeneficiaries met by the project completion mission.

4.2.6 Fifteen (15) employees of the Central Pharmacy were trained locally in pharmaceuticalmanagement for one month. At the end of this training, four (4) of the best trainees were trainedfor three (3) months in France in drugs management. Four (4) of the employees of thesecondary depots were sent to Tunisia for a three-month training on depot management. Thequality of these various courses were judged satisfactory by the beneficiaries who are stillemployed by the PCG or MSP

10

4.3 Performance of the Consultant

During project implementation, no external experts were approached for civil worksdesign and supervision which was carried out by the project civil engineer. For a propermonitoring of works a quality control firm was recruited. Indeed, although no mention of it wasmade in the appraisal report, the firms Véritas and the Engineering Firm were selected afterBank approval for quality control of works on the pharmaceutical depots. The services of theseconsultants have been judged satisfactory because the civil works were of very good quality. Inaddition, initial technical assistance by Credes made it possible to draw up an operational actionplan. However, planning the utilisation of technical assistants was not harmonised with thereturn of the pharmacists trained. The technical assistants available following the training of thepharmacists did not have the required skills and consequently the desired transfer of technologywas not possible. Nonetheless, skills enhancement, technical and strategic thinking were projectobjectives reached. Credes and Scet-Tunisie provided satisfactory technical assistance services.The firm Arthur Anderson audited project accounts using the documents available.

4.4 Performance of Contractors

4.4.1 The firm Setra commissioned to carry out renovation and construction works on theDNPL and PIU did not respect the implementation deadline and had to face a 45-day delaypenalty. The Bank’s completion mission visited the DNPL and PIU premises and judged thesetting functional and well adapted. On the whole, the performance of the firm has beensatisfactory and works of good quality.

4.4.2 Similarly, the firm Consortium d’Entreprises (CDE), selected to carry out civil works onthe depots including the offices of the PCG and quarters for the depot managers, carried out itsactivities satisfactorily with the exception of the false ceiling of the first floor south accessbalcony in the building housing the PCG offices in Conakry that is falling apart with pressurefrom the wind. Water is seeping through the roof of some of the quarters. The implementationdeadline was complied with. The buildings visited by the mission are in a rather good stateapart from some maintenance problems in the PCG building in Conakry.

4.5 Performance of Suppliers

4.5.1 The quality of the material supplied by Somatem, International Technical Services(ITS), Interagraria, l’Imprimerie Paragraphic, Intertropicale Comfina, Yattassaye & Fils, NissanEtoile Guinée, Gica Renault is satisfactory. The suppliers IDA and Familia Guinée, MédicalExport Group and Intertropical Comfina delivered the drugs. The products are of good qualityand delivery deadlines were respected.

4.5.2 However, IDA paid a penalty for delay and the PIU applied a 5% guarantee deductionon the amount on the contract with Familia which delivered packs of 100 instead of 1,000tablets. Consequently, there was a loss of BF 3 180 580, corresponding to a profit loss paid bythe project and undelivered (out of a total BF 53 811 197). The problem has been ongoing since1996 and despite the recommendations of the Bank supervision missions of 1997 and 1998, nosolution was found. The completion mission has once again formulated a recommendationaccordingly. Overall, the performance of the suppliers has been satisfactory.

5 SOCIAL IMPACT AND ENVIRONMENTAL EFFECTS

5.1 Social Impact

5.1.1 The project has had numerous positive effects. In fact, thanks to the initiatives of the

11

inspecting-pharmacists, quality control of drugs is stricter. Pending and unfulfilled orders at thelevel of the PCG suggest a patent access of the population to generic drugs. The positive andgradual trend of the orders of the regional depots and the requests from the health structuresillustrate well the potential for action and satisfying the national pharmaceutical sector. Inaddition, since generic drugs are much cheaper than proprietary drugs, the project has had apositive impact on poverty reduction in so far as the population in general and the poor inparticular who represent 40% of the total population, will spend less of their meagre incomes onprescriptions. The average cost of a prescription has fallen thanks to the project, taking intoaccount that a proprietary drug can sometimes cost five times less than a generic drug for thesame disease.

5.1.2 By opening depots in Conakry and in Guinea’s four natural regions (in Kankan,N’Zérékoré, Fananah and Labé), drugs have become more accessible and affordable to theentire Guinean population (7.2 million inhabitants). The quality of the services of the healthstructures has improved because drugs are easier to obtain. An increase in the number ofpatients to the health structures and the success of the strategy of the Bamako Initiative inGuinea are due in part to the availability of essential generic drugs at affordable prices.

5.1.3 By introducing generic drugs in Guinea, the cost of drugs has fallen considerably. Infact, in 1995, an assessment of the national pharmaceutical policy in Guinea, conducted byWHO revealed that the price of drugs in the private sector (which disposed particularly ofproprietary drugs) for the treatment of some diseases (e.g. pneumonia) was about six times lessthan in the public sector, which provides the population more with essential generic drugs.Furthermore, in 1998, another study carried out by the Ministry of Health revealed that theaverage price of a prescription in a prefectoral hospital was GNF 1 200 (about UA 0.75), thanksto the prescription of generic drugs. Since this project is the primary intervention to strengthenthe public pharmaceutical sector, it has contributed greatly to the affordability of drugs inGuinea. Consequently, it has contributed to a better well being of the population in general andmothers and children in particular who are the most vulnerable groups.

5.1.4 The project has contributed not only to the development of Guinea’s pharmaceuticalsystem, but facilitated access to drugs; however, the Central Pharmacy of Guinea (PCG) is farfrom being an efficient structure and encounters administrative and financial managementdifficulties that numerous audits have highlighted. The Government and Management of thePCG, assisted by the donor community will take the necessary steps to address the situation (cf.paragraph 6.3.2).

5.2 Environmental Effects

5.2.1. The project was approved in 1989, before the adoption of environmental classificationand environmental impact assessments. We are of the opinion nevertheless that theprogramme’s impact on the environment is rather limited. Indeed, technical provisions weretaken to avoid a deterioration of the environment and all depots are surrounded by areas plantedwith shrubs and flowers. In addition, shelters for storing inflammable products were built at areasonable distance from the main buildings. Project construction and rehabilitation works werecarried out in compliance with the relevant hygiene and sanitation measures, bearing in mind thephysical characteristics of the sites. For toxic gases, the laboratory was equipped with hoodsalthough, for budget reasons, it was not possible to install a recycling system for these gases. Itwould be advisable to provide an incinerator as soon as possible for solid waste.

12

6 SUSTAINABILITY

6.1 Infrastructure

In excellent state, the infrastructure is functional, adapted to requirements and wellmaintained. Following the recommendations of the Bank mission of December 1997, workswere carried out on the roof and running water system of the Faranah depot.

6.2 Equipment and Maintenance

The equipment is of good quality and maintained partly with PCG’s revenues from thesale of drugs. Consequently, additional efforts are being made by the Government to take fullcharge of project recurrent costs.

6.3 Financial Sustainability

6.3.1 The PCG started its activities only in April 1994 with a financial situation that revealedPharmaguinee’s net liquidation asset at around GNF 323 million, comprising mainly cashavailable in the Bank, and real estate. In addition, the PCG received from the project, aprovision of drugs estimated at GNF 2 958 million for which 2 tenders had been organised.

6.3.2 The findings of the audits financed by the project and European Union suggest arelatively positive trend of the PCG’s turnover from 1994 to 1998. The audit financed by theproject indicates also that the volume of sales rose from GNF 395 884 000 (UA 239 945) in1994 to GNF 1 012 299 000 (UA 613 555) in 1998. The PCG’s clientele is becomingdiversified (hospitals account for 37%, private structures 27% and health centres 9%). ThePCG can meet only 70% of the orders from clients because of frequent stock-outs.Furthermore, current assets are on a permanent decline and therefore PCG’s financial andaccounting situation must be given special attention. Accordingly, late 1999, the Ministry ofHealth conducted a study financed by the European Union on the supply and distributionsystems (including the PCG) followed by appropriate recommendations of which a betteradministrative and financial management, an increase in PCG’s drugs capital, more computerequipment, a revision of the PCG’s organisation chart, etc. Health development partnersincluding the Bank are providing the Government with assistance to address the issues raised inthe study. Thus, the Bank, through its new health project in Guinea (Health Project III) willcontribute to increasing PCG’s drugs capital and computer equipment. Furthermore, theGovernment has just made changes in the PCG Main Office with a view to improving itsmanagement.

6.4 Capacity Building

6.4.1 With the various training sessions, the capacity of the administration to manage thewhole pharmaceutical sector was strengthened. The technical assistants called upon under theproject worked well hand-in-hand with their Guinean counterparts enabling thus a transfer oftechnology. The formulas are used by health staff in all health structures. The National DrugsCommission continues to play a major role in the establishment and implementation of thenational drugs policy.

6.4.2 Nonetheless, it is important to stress that despite myriad possibilities and advantages, thesustainability of these achievements will depend on: (i) long-term settlement of maintenancecosts of equipment and buildings; (ii) transparency in the management of the PCG; (iii)improvement in the performance of the PCG; (iv) application of a good drug price policy; and

13

(v) progressive integration of the EPI/PHC into the PCG.

7 PERFORMANCE OF THE BANK AND BORROWER

7.1 Performance of the Bank

7.1.1 On the whole, the performance of the Bank was acceptable. Project costs seem to havebeen overestimated at appraisal, judging from the huge balance left upon completion of coreactivities in 1995. However, the savings made can also be explained by the effect of thedevaluation of the CFA Franc in 1994, and by a drop in the prices of inputs due to competitionbetween firms and suppliers. Besides, project objectives as formulated were somewhat vagueand no project matrix was prepared thereby making it difficult to assess project impact.Moreover, core activities like the implementation of the Control Laboratory and strengtheningof PCG’s management were minimised or even overlooked at project appraisal, butsubsequently, listed under additional project activities by the Borrower. As a result of theproject’s specific focus on the pharmaceutical sector, the Bio-pharmacy Division (DNPL) couldhave been more involved in the design and implementation of the project or even beencommissioned to supervise on the recommendation of the Bank. The PIU managed it single-handedly.

7.1.2 In addition, an institutional assessment of Pharmaguinée carried out at appraisal did notreveal any of the company’s difficulties. There was no close financial supervision and the Bankdid not resort to any coercive measure (e.g. suspension of disbursement, to demand annualaudits). Although pointed out by the Bank, some disbursement errors (e.g. bad deduction, etc.)were not or rectified with considerable delay. The closing of the Bank’s Office in Guineatowards end 1994 and the restructuring of the Bank in 1995/1996, also contributed to aslowdown of activities.

7.2 Performance of the Borrower

The performance of the Borrower was acceptable. Indeed, the conditions precedent toloan effectiveness were difficult and long to fulfil. In addition, although 99.66% of thecounterpart fund was disbursed it was made available well behind schedule. Guinea has in factfaced several sanctions for non-payment of arrears. Furthermore, additional activities financedwith the loan balance were delayed considerably.

8 OVERALL PROJECT PERFORMANCE

Both scheduled and additional activities were implemented. The quality of the works,equipment and furniture has been rather satisfactory. Technical assistance services, training, theestablishment of the various commissions and the efforts of the inspecting-pharmacists on thefield, all strengthen the institutional dimension and the operational capacity of thepharmaceutical sector. Despite the project’s delay its social impact is a major and positiveachievement.

9 CONCLUSIONS, LESSONS AND RECOMMENDATIONS

9.1 Conclusions

Based on the foregoing, the project’s impact is positive on Guinea’s pharmaceuticalsector. Consequently, the Guinean Government, with the assistance of its development partners,

14

must consolidate project achievements. The geographic accessibility and affordability of drugstranslated by an improvement in the capacity of the health administration to better manage thenational pharmaceutical sector must be improved with sustained and continuous action. Theproject replies to the needs of the Guinean people and is consistent with the Government’shealth policy.

9.2 Lessons

On the whole the results of the Pharmaceutical Sector Rehabilitation Project arepositive. The period set initially for the implementation of activities was reasonable. In order toavoid the substantial balances from additional activities, a good project financial estimate mustbe made. An in-depth institutional analysis of the project beneficiary structures must be madeand the project’s institutional framework well examined. The Government must honour itscommitments as laid out in the loan agreement (e.g. responsibility for recurrent costs and regulardisbursement of counterpart funds) with a view to ensuring project sustainability. Moreover, inrelation to the PCG’s status, state withdrawal should be phased until the company can boast of asolid administrative and financial management system and a good marketing service.

9.3 Recommendations

|In view of the sustainability of the achievements of the project and similar future projects themission is recommending that the Government:

In view of the Sustainability of Project Achievements

i) settle recurrent project costs (operating, restocking of drugs, maintenance, etc.);ii) continue to support the pharmaceutical sector, with the assistance of the donor

community and review practical terms for the gradual integration of theExtended Programme for Immunisation/Primary Health Care Unit (EPI/PHC)into the PCG;

iii) develop the PCG’s marketing service;iv) take the necessary steps to contact the drugs supplier Familia in order to retrieve

BF 3 180 580 (in cash or kind) as money for drugs delivered in packs of 100instead of 1000 tablets;

v) introduce a gas recycling system, an incinerator in the drug control laboratoryand complete the equipment and laboratory reagents;

In order to draw Lessons for Future Projects

vi) adopt the “sectoral investment programme” approach bearing in mind theGovernment’s budget capacity to efficiently implement projects and settle therelated recurrent costs;

vii) analyse the effects of the restructuring of the Ministries on projectimplementation and institutional framework (e.g. dissolution of the GeneralHealth Directorate, changing of the Bio-pharmacy Division into a NationalPharmacy and Laboratory Directorate);

viii) organise periodic follow-up meetings between the Ministries of Planning,Finance, Health, the Public Works and the Project Directorate;

15

ix) shorten the periods for the signature of contracts;

x) carry out regular and thorough project audits;

In addition, the mission is recommending that the Bank:

xi) take the time required to better prepare future projects;

xii) make provisions for the annual audit of accounts;

ANNEX 1REPUBLIC OF GUINEA


This map has been drawn by the African Development Bank exclusively for the use of readers of the report to which it isattached. The names used and the borders shown do not imply on the part of the Bank Group and its members anyjudgement concerning the legal status of a territory nor any approval or acceptance of these borders.



SOURCES OF INFORMATION

N° Doc

Documents Title Sources

1 Project Appraisal Report Bank

2 Technical Supervision Mission Reports Bank

3 ADF Loan Agreement and TAF Grant Memorandum of Understanding Bank

4 Health Statistics Ministry of Health

5 Activity Reports PCG and depots

6 Completion Report CECP

7 Project Completion Reports (Côte d’Ivoire – Hospital Infrastructure RehabilitationProject, Mali Health and Guinea - Education

Bank

8 Project Audit Reports for the Duration of the Project CECP

9 Results of the discussions with staff involved in project design and implementation. CECP, Ministry of Health, Ministryof Finances and Planning, PCG,regional pharmaceutical depots.

ANNEX 3

REPUBLIC OF GUINEAPUBLIC PHARMACEUTICAL SECTOR REHABILITATION PROJECT

Actual Expenditure by Category and Source of Financing(In UA)

Expenditure Category ADF % TAF % Gvt. % TOTAL

Construction/renovation 2 699 718.24 78 - - 746 000 22 3 445 718.24

Furniture 151 811.54 100 - - - - 151 811.54

Equipment 1 089 310.32 100 - - - - 1 089 310.32

Technical Assistance - - 2 092 728.19 100 2 092 728.19

Training - - 322 252.27 98 5 000 2 327 252.27

Operating Expenses 937 100.31 82 - 202 000 18 1 139 100.31

Drugs 2 180 964.13 100 - 2 180 964.13

TOTAL 7 058 904 .54 67 2 414 980.46 23 953 000 10 10 426 885

Borrower Commitments and Disbursements Status By Expenditure Category

(en GNF)

Categories Amount allocated Amount committed Amount disbursed % disbursed Balance to bedisbursed

Renov./ext. 806 000 000 806 000 000 806 000 000 100% None

Training 5 000 000 5 000 000 5 000 000 100% None

operating. 197 000 000 197 000 000 197 000 000 100% None

Total 1008 000 000 1008 000 000 1008 000 000

N.B. The annual exchange rate (from December of the previous year) between the UA and GNF has been utilised.

ANNEX 4


Provisional and Actual Expenditure Schedule on the ADF Loan

Year Estimate at Appraisal Actual Percentage disbursed

19891990199119921993199419951996199719981999

278 157.701 702 104.094 757 233.58

235 789.31128 026.23

0.00146 990.23118 446.83821 444.76

1 819 347.221 972 357.97

128 217.14706 691.42594 305.03612 585.54131 087.40

0.002.051.661.15

25.6227.771.809.948.368.621.85

Total 7 101 310.91 7 051 473.54 99.29

Provisional and Actual Expenditure Schedule on the ADF Grant

Year Estimate at Appraisal Actual Percentage disbursed

19891990199119921993199419951996199719981999

291 052.43850 130.99737 762.65372 105.50188 815.66

0.00237 013.81587 113.79537 016.25464 608.14205 648.48115 723.71

2 032.40128 901.2878 126.5348 796,04

0.009.71

24.4622.006.538.404.710.085.243.191.96

TOTAL 2 439 867.23 2 414 980.43 98.77

Comparison of actual expenditure ADF/ADB/TAF/GVT.

Financing Actual Expenditure in UA % Participation

ADF 7 051 473.54 68

TAF 2 414 980.43 23

GVT. 953 000 9

TOTAL 10 419 453.97 100


PUBLIC PHARMACEUTICAL SECTOR REHABILITATION PROJECTPerformance of Project Implementation

Evaluation Criteria Rating Comments

1. Compliance with implementationschedule.

2 The basic activities as described in the appraisal report were completed in 1994, i.e.a lag of one year from the 1992 completion date. However, additional activitiestook 5 years to implement making a total delay of 6 years.

2. Compliance with amountearmarked

2 Core and complementary activities were implemented without any cost overrun.However, we are of the opinion that the costs were over-estimated at appraisal sothat a rather substantial balance was used for supplementary activities.

3. Compliance with conditions. 1 Precedent conditions were met 10 months behind schedule. The Governmentundertook to defray the operating costs of the institutions strengthened (NationalDrugs Commission, National Pharmacy and Laboratory Directorate and thePharmaceutical Inspectorate) although the resources allocated to these structureswere inadequate. As to the other conditions, two out four were met and two werepartially met. In fact, all pharmaceutical products did not benefit from a privilegetax and custom system. Only essential drugs were exempted from all taxes andcustom duties. In addition, the new regulations did not enable the PCG to practiceprices that ensured its fiscal balance.

4. Relevance of supervision andaudits.

1 There was no regular financial supervision.

5. Satisfactory operations. 1.5 There is a pharmaceutical depot in each of Guinea’s main natural regions and drugshave become more accessible geographically and more affordable. PCG’s volumeof sales increased by 250% from 1994 to 1998.

Total 1.5 On the whole the project contributed to improving Guinea’s pharmaceutical sector.

Overall evaluation andimplementation performance

acceptable Project implementation was acceptable account taken of the delay in theimplementation of activities

Performance of the Bank During the Project Cycle

Evaluation criteria Rating Comments

1. At identification 2 A detailed study was carried out by a consulting firm on theBank’s financing.

2. At preparation 1 The findings of the studies mentioned above were used toprepare the project. Nonetheless, there was no formalpreparation.

3. At appraisal 1.5 The project was appraised but there was no project matrixand therefore no reference indicators.

4. At supervision 1.5 No supervision missions were fielded in 1992, 1995 and1996.

Evaluation of the overall performance ofimplementation.

1.5



Project Impact on Development

Evaluation Criteria Rating Comments

1. Relevance and attainment of objectives(i) Macroeconomic policy(ii) Sectoral policy(iii) Physical objectives (including production)(iv) Financial policy(v) Poverty reduction/social/gender(vi) Environment(vii) Private sector development(viii) Other

Sub-total

222

1.522

1.5None1.85

Project objectives were reached in so far as the project helped to facilitate access to essential drugs; moreover, it is consistentwith the Government’s pharmaceutical policy.The project contributed to an increase in PCG’s turnover even if the administrative and financial management of the structurecan be improved. In addition, the availability of essential generic drugs far cheaper than proprietary drugs will contribute toimproving health and well-being.

2. Institutional Development(i) Institutional framework including restructuring(ii) Financial and management information system (including audit

system)(iii) Transfer of technology(iv) Human resources (including turnover rate and counterpart staff)

Sub-total

21.5

22

1.87

From an institutional standpoint, under the project, 22 employees were trained in the field of pharmaceuticals; the NationalPharmacy and Laboratory Directorate strengthened and a National Drugs Commission established. In addition, staff of theProject Implementation Unit has a wide experience in project management. Therefore, the Project Manager was called upon tomanage another national health project involving one of the two national hospitals.

3. Sustainability(i) Continued commitment of Borrower(ii) Environmental policy(iii) Institutional framework(iv) Technical viability and staff supervision(v) Financial viability including systems of cost recovery(vi) Economic viability(vii) Environmental viability(viii) Operating and maintenance (availability of funds for recurrent

costs)Sub-total

22

1.52

1.522

1.5

1.81

The pharmaceutical depots are of very good quality and may last for a long time.The counterpart funds were made available and disbursed to the tune of 99%.

4. Internal rate of return SO

Overall evaluation of impact on development 1.84



Matrix of Recommendations and Follow-up Actions

Main Findings/Conclusions Recommendations Follow-up Actions Responsible Organ

Project Design/RationaleThe project’s design replies to needs determined atappraisal.

Continue to support the pharmaceutical sector withthe assistance of the donor community and examinethe practical terms for the gradual integration of theEPI/PHC Unit into the PCG. In addition, it isimportant to back the PCG with a view to improvingits administrative and financial management, increaseits drugs capital, make its marketing service moreefficient and strengthen its computer system.

In addition to a Bank-financed audit of the PCG, aEuropean Union-financed assessment of thepharmaceutical system made apt recommendationsfor the improvement of the essential drugs supply anddistribution systems in Guinea. The Governmentintends to organise a round table for discussing thefindings of the said assessment. .

Government, Bank and other development partners.

Project ImplementationThe Bank did not propose the cancellation of thebalance left over from the implementation ofactivities scheduled at appraisal and the Governmenttook time to carry out the additional activities.

Cancel balances or avoid using them for activitiesrequiring a long procurement process.

Ensure that the results are used rapidly orsystematically cancelled.

Bank/Government

Compliance with the Loan Agreement ConditionsConditions were not met within the prescribeddeadline.

Ensure that the conditions precedent to the entry intoforce of the loan agreement are met in time bypreparing the Government accordingly at appraisaland negotiation.

Sensitise the Government on the importance ofmeeting the conditions precedent to effectiveness ofloan agreements.

Bank

Performance EvaluationThe objectives set were reached because the projectcontributed to the geographic access to andaffordability of essential drugs. All scheduled andadditional activities have been implemented. Projectperformance has been satisfactory overall.

Maintain project achievements, ensure that recurrentcosts are settled, continue to assist the pharmaceuticalsector, gradually integrate the EPI/PHC Unit into thePCG, establish balanced drug prices, take the reviewof the public pharmaceutical sector a step furtherwith an in-depth review of private pharmaceuticalsector and the informal sector.

Send the findings of the studies carried out to theBank.

Government

SustainabilityThe buildings of the regional pharmaceutical depots(including quarters for the depot managers) and ofthe Central Pharmacy of Guinea have been built, wellequipped and are highly functional.

Ensure long-term settlement of the maintenance costsof the buildings.

Government



Borrower’s Comments on the PCR

(Not Available)

ANNEX 9


PRECEDENT AND OTHER PROJECT CONDITIONS

Precedent Conditions

i) undertake to earmark in its annual budget, funds to finance its share of the project costs incompliance with the financial plan;

ii) undertake to seek additional sources of finance in the event of an overrun on the estimated projectcost;

iii) undertake not to use the proceeds of the loan and grant to pay various duties and taxes attendanton the goods and services required to implement the project;

iv) undertake to defray the operating costs of the institutions strengthened (National DrugsCommission, Bio-pharmacy Division and Pharmaceutical Inspectorate;

v) undertake to authorise Pharmaguinée to practice prices that will enable its financial balance;

vi) provide evidence that Pharmaguinee’s regulations are duly approved by the Guinean authoritiesand are applied;

vii) provide evidence of the establishment of the Project Implementation Unit (PIU) and recruitmentof professional employees whose curricula vitae shall be submitted to the Fund for prior approval;

viii) provide evidence that the PIU has been provided with premises for its running;

ix) Provide evidence that the project has been granted the site allocated for the PIU premises and theBio-pharmacy Division;

x) Provide evidence that two accounts (foreign exchange and local currency) have been opened in abank in Conakry, into which the Fund’s loan resources will be paid for planned operatingexpenses. The PIU will be responsible for managing such resources;

Other Conditions

3.1.3 The other conditions are:

i) not later than 30 June 1989, conduct evaluation tests, take decisions to confirm and recruitprofessional and other employees for Pharmaguinée in compliance with the organic framework setout by the Ministry of Administrative Reform and Civil Service;

ii) submit to the Fund for approval, the list and curricula vitae of national employees to be trainedabroad;

iii) allow a privileged tax and customs system for essential drugs, pharmaceutical and chemical productsand raw materials, laboratory reagents, scientific and technical equipment on the list drawn by theMinistry of Public Health and Population based on the guidelines of the National Drugs Commission;

iv) submit to the Fund for comments, regulations that will make it possible for Pharmaguinée to practiceprices to enable its financial balance; the said regulations shall be adopted by the powers-that-be notlater than 31 December 1989.

REPUBLIC OF GUINEA COMPLETION REPORT PUBLIC …

Documents

Transcript of REPUBLIC OF GUINEA COMPLETION REPORT PUBLIC …