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LESSONS:

Health and Population Project

sector: Health | country: Marshall Islands, Republic of the

As for all the projects in the social sector in the Pacific islands, a 5-year implementationperiod is too short, particularly for the achievement of performance targets. Anupfront implementation period of 6 to 8 years appears more realistic.

Due to the necessity of importing trainers for many of the skills required in the Pacific island developing member countries, outcomes depend to a large extent on the performance of the consultants. The selection of the consultants must be done carefully to ensure a project’s success. The experience with consulting firms was particularly unsatisfactory in the case of this project. Strong monitoring to allow for early detection of poor performance and termination of the contracts, if required, must be built into both the contracting procedures and the project’s management.

Experience from this project, as well as from other health projects in other countries,shows that external sources of aid are often in too much of a hurry to press governments toagree on policy positions consistent with their own views and priorities, allowing too little time forthe necessary political process. Also, pressures to expand the agenda to include all of thefunders’ favorite subjects can result in overly ambitious plans that do not necessarily reflect what islocally considered important to improve health outcomes.

In common with other small island states, the Marshall Islands suffers from a lack ofsuitably trained staff who can substitute for colleagues attending training courses or programs.The amount of training planned to take place during the life of the project was probablyunrealistically high. In addition, other trainings continued taking place during implementation,placing an unsustainable burden on staff. A simple way of reducing the disruptive effect oftraining would be to establish manageable blocks of time, for example two periods of 6 to 8weeks each year, during which training can take place.

The assistance provided to the Project Implementation Unit (PIU) for project implementation capacity proved of greatbenefit. However, it did not compensate for weaknesses in accounting. Where very limited accounting skills are available within the country, future projects must provide for additional capacities in this area.

The health education campaign has been less successful than anticipated because of the absence of a family health coordinator. The position has remained vacant in view of the inability to recruit a suitable candidate either locally or internationally. In general, as regards covenants requesting additional recruitments, they were in obvious conflict with the requirements of another ADB loan supporting the Public Sector Reform Program to decrease public service employment. Coherence has to be sought within ADB’s programs and projects.

The time budgeted for the consultants for the health financing and accountabilitysegment was obviously too short. Instead of one consultant for 8 person-months, twoconsultants for a total of 5 person-months were recruited. This did not allow enough time foreither of them to work along with local counterparts and implement any substantial change. Experience from other Pacific Developing Member Countries (PDMCs) has shown that a minimum of 1-2 years is required to obtainresults in this sector. However, most borrowers are reluctant to include long consultancies inprojects for economic reasons. Nevertheless, this concern must be balanced with the necessityof building long-term working relationships to obtain change and build capacity in smallcountries that lack skilled staff.

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