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LESSONS:

Health System Development Project

sector: Health | country: Lao, People’s Democratic Republic

1. Project design should include detailed implementation plans for the first year. If project implementation is not carefully planned, delays are inevitable. Simply listing outputs and fixing a timetable does not constitute effective planning, as illustrated by substantial delays of the training activities in this project.

2. Consider carefully the implications of any major reallocation of project resources. When there are substantial unit-cost increases in a particular cost category (e.g., equipment or civil works), consider the project’s overall objectives and priorities carefully before deciding to reallocate funds from other inputs. The alternative of reducing the quantities of those inputs having inflated costs will usually be an option.

3. A health equity fund (HEF) is mainly funded through donor support and should have a larger government contribution to ensure ownership and commitment. Launch of comprehensive social health protection mechanisms such as HEF should be accompanied by an independent evaluation to assess cost-effectiveness, financial sustainability, and appropriate mechanisms to expand nationwide. Comprehensive communication interventions would have been beneficial to ensure a common understanding about beneficiaries’ entitlements and providers’ obligations.

4. Despite the financial implications, health equity fund administration should have been continued by a third party to not unnecessarily burden the limited administrative and financial management capacities of the provincial health offices. Identifying mechanisms to enhance transparency would have increased the funds’ efficiency.

5. There was no verification undertaken as to whether the target mechanism used was appropriate to reach all eligible beneficiaries, nor was there an explicit targeting system to support ethnic groups. The targeting mechanism of health equity fund (HEF) should have been evaluated prior to scaling up the scheme. Careful consideration should be given also to adding a post-identification procedure to avoid denying HEF benefits to the poor who for some reason are not on the Ministry of PIanning and Investment lists.

6. Data were regularly collected through the monitoring system. Nevertheless, data quality at entry remains poor and incomplete because it is not complemented by data from national routine reporting systems. Provinces and districts would benefit from capacity building on monitoring and evaluation to be able to use project data for results-based management. It is particularly important to monitor implementation of recommendations made during a midterm review and to evaluate and report on training outcomes.

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