Second Health Sector Development Project
sector: Health | country: Mongolia
Policy reforms should not be too numerous and should be well integrated into an overall project. Highest priority should be given to policy reforms (and covenants) that are necessary for project implementation or sustainability. A stakeholder analysis should be conducted for all proposed policy reforms, and a strategy developed for moving systematically to the desired policy reform reflected in the project’s design and monitoring framework. Means of compensating the losers should be identified (e.g., by including project investments in institutions adversely affected by policy reforms). Progress toward achievement of policy reforms needs to be monitored carefully. The need to strictly adhere to the guidelines for the design and monitoring framework to ensure the participatory formulation of achievable objectives backed by relevant activities is a major lesson from this project.
Lessons from the irregularities with civil works in Zavhan aimag are the need to (i) provide external monitoring of civil works in addition to regular monitoring by MOH and various statutory inspection bodies (ADB has organized external monitoring for subsequent projects in the health sector), and (ii) strengthen the bid evaluation capacity of MOH (the weak capacity of some of the firms involved in irregularities could have been detected at an early stage).
The relationship between MOH and the PIU needed to be discussed from the beginning of the project. This would have avoided the PIU isolating itself from the Ministry of Health’s (MOH) decision-making process, as happened too often during the first 2 years of implementation. Decision-making procedures need to be clarified to involve MOH departments and higher authorities in decisions affecting bidding processes, consultant selection and outputs, policy matters, and resource allocation in the health sector. This requires setting up working groups within MOH and ensuring decisions are made by higher bodies and authorities of MOH.