Third Health Sector Development Project: Completion Report
sector: Health | country: Mongolia
Very high turnover of MOH (Ministry of Health) staff slowed policy reforms that required legislative approval and government commitment. Although government changes cannot be predicted, a longer-term assessment of overall political stability would be valuable, so as to prioritize project policy goals that are necessary for project implementation and sustainability. A key lesson is that reform ambitions need to match the actual capacity of government agencies and factor in turnovers. Also, high staff turnover has an eroding effect on the institutional capacity of MOH, particularly in areas of policy analysis, continuity of policy reforms, and institutional memory. Therefore, future health projects should instigate skills development, training on policy analysis, and regular briefings and information sharing for MOH staff to improve counterpart competence, both individual and organizational. The government should enforce the implementation of current legal acts, such as the Civil Service Law, to make professional staff appointments independent from political changes in government. Strengthening legal enforcement is a more sustainable approach, but would require consolidated efforts by all political parties.
The working relationship between MOH (Ministry of Health) and the project team was to be assisted by working groups whereby MOH staff would work in tandem with project staff and consultants. This arrangement was meant to co-opt MOH in project implementation. Often however, the ministry officials’ understanding of their role was limited to reviewing and commenting on project outputs, and that project staff and consultants would be responsible for project outputs. This view is shared widely across all government institutions, not just MOH. The working relationship between MOH and a project team could be improved with clearer cooperation arrangements and agreed schedules. An expanded management board version, where project-related stakeholders are invited to the formal management board meeting as observers with the right to vote, could be an
option to be explored in the future. In the longer term, ADB should consider not to establish a parallel PIU (project implementation unit) and instead engage ministry staff in project administration. Although this approach could possibly result in slower project implementation because of staff overload and unfamiliarity with ADB regulations and procedures, overall government ownership and commitment could increase significantly.
This validation agrees with the lessons enumerated in the project completion report (PCR), especially on (i) the need to match reform ambitions with actual capacity of government agencies, and factoring in staff turnovers; and (ii) the need to minimize the eroding impact of high staff turnover and leadership changes in the executing agency by improving counterpart competence, both individual and organizational, through training or skills in development in policy analysis and through regular briefing, dialogues, and information sharing with Ministry of Health (MOH) staff. In addition, there should be continuing advocacy and social marketing of the reform ideals, given frequent changes in leadership. Hence, it is important to keep the rhetoric up and alive to create and maintain the groundswell of support from everyone.
This validation supports the longer-term recommendation of the PCR for ADB to consider engaging the ministry staff in project administration, instead of establishing a parallel project implementation unit (PIU). This can be supported, but not led, by an external consulting service. While this may have challenges due to staff capacity, it is ideal from the standpoint of ownership and may perhaps discourage the high staff turnover experienced in the past. Staff accountability can be strengthened through closer monitoring of its performance and the provision of staff development inputs based on needs.