african development fund project completion report …

AFRICAN DEVELOPMENT FUND

PROJECT COMPLETION REPORT

PROJECT OF THE CONSTRUCTION AND EQUIPMENT OF THE OUIDAH REGIONAL PUBLIC HEALTH INSTITUTE

REPUBLIC OF BENIN

HUMAN DEVELOPMENT DEPARTMENT OSHD NOVEMBER 2006

TABLE OF CONTENTS Page CURRENCY EQUIVALENTS, WEIGHTS AND MEASURES, ACRONYMS AND (i-xvi) ABBREVIATIONS, LIST OF ANNEXES, SUMMARY CONCLUSION AND RECOMMENDATIONS, BASIC DATA AND PROJECT MATRIX 1. INTRODUCTION 1 2. PROJECT OBJECTIVES AND FORMULATION 2 2.1 Project objectives 2 2.2 Project description 2 2.3 Project formulation 3 2.4 Identification, preparation and appraisal 3 2.5 Negotiation and approval 3 3. PROJECT IMPLEMENTATION 3 3.1 Effectiveness and start-up 3 3.2 Modifications 4 3.3 Implementation schedule 5 3.4 Reports and Audit 6 3.5 Procurement of goods and services 6 3.6 Costs and financing sources and disbursements 6 4. PROJECT PERFORMANCE 7 4.1 Overall performance 7 4.2 Operational performance 7 4.3 Institutional performance 9 4.4 Performance of consultants, contractors, suppliers 9 5. SOCIAL AND ENVIRONMENTAL IMPACTS 10 5.1 Social impact 10 5.2 Impact on women 10 5.3 Environmental impacts 11 6. SUSTAINABILITY 11 7. PERFORMANCE OF THE BANK AND THE BORROWER 11 7.1 Bank’s Performance 11 7.2 Borrower’s Performance 11 8. OVERALL PERFORMANCE AND RATING 12 9. CONCLUSIONS, LESSONS LEARNT AND RECOMMENDATIONS 12 9.1 Conclusions 12 9.2 Lessons Learnt 12 9.3 Recommendations 13 This report was written by a health consultant, following a mission undertaken in May 2006. Mrs A. DAO SOW, Education Analyst, contributed to the drafting of the report. For further information, please contact Mrs A. HAMER, Director, OSHD (Extension 2046) and Mr. J. E. PORGO, Acting Division Manager, OSHD.1 (Extension 21 73).

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CURRENCY EQUIVALENTS UA 1= CFA.F 350.2925 (January 1991) / UA 1 = US$ 1.21041 (January 1991) UA 1 = CFA.F 769.687 (May 2006) / UA 1 = US$ 4 1.47106 (May 2006)

BUDGET YEAR

From 1 January to 31 December

LIST OF ANNEXES 1. Map of the Republic of Benin and Project Area 2. Estimated and Real Costs of the Project and Financing Plan 3. Proposed and Real Loan Disbursement Schedule and Proposed and Real National Contribution Disbursement Schedule 4. Project Implementation Performance 5. Performance of the Bank during the Project Cycle 6. Impact on Development: Project Results 7. Matrix of Recommendations and Follow-up Actions 8. Sources of Information 9. Government’s Comments on the Bank’s Completion Report

UNITS OF MEASURES 1 metre : 3.28 feet 1 square metre (m²) : 10.76 square feet 1 kilometre : 0.62 mile 1 square kilometre (km²) : 0.38 square mile 1 hectare (ha) : 2.47 acres

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ACRONYMS AND ABBREVIATIONS ICB : International competitive bidding NCB : National competitive bidding VHW : Village health worker ADB : African Development Bank PIU : Project Implementation Unit AAF : Autonomous amortization fund PCC : Project Coordination Committee CCS : Complexe Communal de Santé / Communal Health Complex CHP : Centre Hospitalier Provincial /Provincial Hospital Centre CNHU : Centre National Hospitalier Universitaire / National University Hospital

Centre DHC : District Health Centre DEP : Direction des Etudes et de la Planification/ Analysis and Planning

Department DPS : Direction Provinciale de la Santé / Provincial Health Department ADF : African Development Fund FSS : Faculté des Sciences de la Santé / Health Science Faculty ISP : Institut de Santé Publique/ Public Health Institute MEN : Ministry of National Education MET : Ministry of Infrastructure and Transport MSP : Ministry of Public Health STD : Sexually Transmissible Diseases WHO : World Health Organisation EPI : Expanded Programme on Immunization MCP : Maternal and Child Protection RB : Republic of Benin AIDS : Acquired Immunodeficiency Syndrome PHC : Primary Health Care UA : Unit of Account UNB : Université Nationale du Benin / National University of Benin UNICEF : United Nations Children’s Fund

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EXECUTIVE SUMMARY 1. Introduction The project for the construction and equipment of the Regional Public Health Institute (IRSP) in Ouidah, Benin, was estimated and implemented in the bid to meet the crucial needs in human resources specialised in the health sector. At the ALMA ATA Conference in 1978, it was agreed that primary health care was the best means of achieving the health for all objective by 2000. However, it was observed that the human resources existing in this area were not sufficiently qualified and motivated to meet the health needs of communities, particularly in Sub-Saharan Africa. After identifying the needs in medical specialists in the epidemiology/public health sector and observing the non existence of an institution capable of training such specialists, the World Health Organisation’s (WHO) Regional Office for Africa came up with a proposal to the Government of the Republic of Benin, for the creation of a Public Health Institute (PHI) in its country. However, since its advent, the Public Health Institute, which later became the Regional Public Health Institute (IRSP) has not been provided with suitable and functional premises. The need to establish it in its own permanent structures was thus considered as a priority by the Beninese authorities, who financed the technical feasibility studies. These studies gave rise to the design of an architectural project for the construction of the Regional Public Health Institute (IRSP) which was submitted to the African Development Fund for financing. This report gives an account of the state of completion of the project as assessed by the Bank in 1990. The said project was executed by a Project Implementation Unit, under the supervision of the Ministry of Higher Education and Scientific Research. Despite a thirty-three month delay, it contributed to the development in Africa of human resources specialised in the health area, and to regional integration. The project’s objectives are in line with the strategy of the WHO Africa Region, aimed at strengthening human resources for the development of health systems. 2. Objectives and Formulation The project was formulated in response to the concerns of African countries relative to the shortage of health personnel to provide the required services to the populations, particularly the rural and most disadvantaged. It also meets the concern of the WHO Regional Office for Africa to train doctors specialised in epidemiology/public health in the appropriate environment. The Governments concerned and WHO thus realised the need to associate curative medicine and preventive medicine and provide the kind of training required in an appropriate framework. 3. Project Implementation Approved in March 1991, the loan agreement for the project estimated at UA 10.25 million, was signed on 9 May 1991 and became effective on 15 February 1994. The loan relative to this project was estimated at UA 9.21 million. The implementation schedule was not complied with for several reasons. One of the main causes of the setback is the thirty-three (33) month delay registered in the effectiveness of the loan agreement. Approved in March 1991, the loan became effective only on 15 February 1994. The second reason was due to the fact that the site on which the Institute should have been built was changed several times. At the beginning, the activity reports had not been prepared and transmitted to the Bank, in accordance with the provisions of the loan agreement. However, since 1996, following the preparation of a

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single report covering the period between 1993 and 1996, i.e. eleven (11) reports, the Project Implementation Unit regularly provided the Project’s status reports, while the audits were regularly prepared and transmitted to the Bank. 4. Project Performance The activities planned by the project have been satisfactorily carried out. Despite the delay in the architectural and technical studies, the construction work that was initially planned kicked-off in November 1998 and was fully implemented. The buildings have been operational since July 2002. All the acquired material is functional and the various training sessions have been carried out. The project results thus provided Benin and the rest of sub-Saharan Africa with an appropriate system, that would enable them to address the challenge relative to the development of human resources in the health sector. The project performance is satisfactory 5. Social and Environmental Impact Africa’s current economic and social development challenges particularly require health personnel with specialized training, as offered by the IRSP. This institution provides the countries concerned with professionals capable of applying a more appropriate design and a better management of health programmes, by using new technologies and targeting priority health problems (Malaria, HIV/AIDS, Tuberculosis, reproductive health…), in the bid to meet the needs of the most vulnerable population groups (women and children), within the specific context of poverty reduction strategies. To-date, over 900 public health specialists from more than 25 countries of the region have been trained at the IRSP. Most of them hold top positions in the Health Ministry structures or technical departments in their countries. 6. Environmental Impact The project materialized through the construction of solid infrastructure, in compliance with modern standards set for structures of the same type, with the appropriate water supply system and septic tanks. Besides, the external works made it possible to institute a system for rainwater collection and drainage, to facilitate its channelling into Ouidah city’s general sewage system. 7. Sustainability Due to the quality of infrastructure built within the framework of the project, the prospects for its sustainability are good, since the required maintenance is guaranteed. Actually, the project resulted in the installation and training of maintenance technicians. The financial sustainability of the IRSP is also ensured, particularly within the framework of the partnership between the Republic of Benin and the Regional Office of the World Health Organisation (WHO) which signed an agreement during the creation of IRSP, whereby the WHO undertook to financially cater for a Director and an Administrator, as well as pay for other support posts (driver, secretaries), and partially contribute to the operating costs.

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8. Performance of the Bank and of the Borrower Bank’s Performance he Bank’s performance was satisfactory, particularly because of the technical support provided for the implementation of the activities of a project which encountered difficulties during its start-up phase. Thanks to the Bank’s supervision, appropriate and practical responses were provided to problems encountered in the field, to the modifications relative to the civil works, and to the termination of the architect’s contract for failing in his obligations. The Bank’s performance during the project cycle is in annex 4. Borrowers’ Performance espite the 33 month delay registered at the start of the project’s activities, the Borrower’s performance was by and large satisfactory. In fact, the latter met its commitments by regularly disbursing the counterpart funds, but also by paying additional funds to cater for expenditures related to some contracts (contract amendments). The activity and audit reports were regularly prepared (except at the start-up) and transmitted to the Bank. 9. Lessons and Recommendations Lessons 9.1 The following key lessons were learnt from the different components of the project :

i) non availability of land during the implementation of projects leads to delays, with possible consequences on project costs; it is thus essential to ensure, through the appropriate documents, that the land is available and verify that the said land is not being disputed, in any way, by the Beneficiaries, in the event it is not State-owned;

ii) the long period observed in meeting the conditions precedent to the

effectiveness and first disbursement of loans and/or grants resulted in delays in the implementation of projects.

iii) the partnership (Government of Benin, WHO and ADB Group) for the

implementation of development projects, attests to its efficiency, to ensure the sustainability of the project results by catering for recurrent costs.

Recommendations The key recommendations of the report are as follows: The Government should:

i) step up income-generating activities at the level of IRSP, to enable it to

cover the expenditure related to its operation;

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ii) take the appropriate measures to fulfil, within the required time-frame, the conditions precedent to its effectiveness and to the first loan/and or grant disbursement.

The Bank should:

i) ensure that Borrowers provide proof that the plots of land effectively exist before the initial loan/grant disbursement, if the activities relative to the construction works are scheduled within the framework of the projects concerned;

ii) Encourage the establishment of sub-regional training structures within the

framework of a partnership; iii) Ensure that the results and the lessons drawn from the IRSP construction

and equipment project, particularly those relative to the partnership, are widely disseminated.

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PROJECT BASIC DATA 1. Loan number 2100150000107 (Loan Nº F/BEN/ SAN/91/24) 2. Borrower Government of Benin 3. Beneficiary Regional Public Health Institute of Ouidah 4. Executing Agency Project Implementation Unit (CEP)/Ministry of Higher Education and Scientific

Research. A. LOAN DATA Estimated Actual 1 09.21 million UA (at appraisal)

UA 8.64 million

2 Repayment of the principal at the rate of 1% per annum from the 11th to the 20th year, and 3% per annum thereafter

3 Repayment period 50 years Grace period 10 years Date of negotiations March 1991 Date of approval 02 May 1991 Date of signature 09 May 1991 Effectiveness date 15 February 1994 B. PROJECT DATA 1. Total start-up cost : UA 9.87 million 2. Project cost after restructuring : UA 9.21 million 2. Financing plan

In millions of UA

Estimated cost (at appraisal) Estimated cost (after restructuring) Real cost

Foreign Exchange

LC Total Foreign Exchange


LC Total

6.091 5.039 11.13 5.61 4.64 10.25 6.24 3.63 9. 87

Estimated and Actual Financing Plan

After restructuring (in millions of UA) At completion (in millions of UA)

Sources Foreign exchange

LC Total Foreign exchange

LC Total

ADF 5.61 3.60 9.21 6.24 2.40 8.64 Government 0.00 1.04 1.04 0.00 1.23 1.23 Total 5.61 4.64 10.25 6.24 3.63 9.87 % 54.7 45.3 100 63.2 36.8 100

3. Estimated date for first disbursement May 1991 4. Effective date of the first disbursement 20/05/1994 5. Deadline for the last disbursement 31/12/1993 6. Revised deadline for the last disbursement 31/12/2003 7. Start-up of project activities 15/10/1993 8. Date of completion of project activities 30/06/2002

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C. PERFORMANCE INDICATORS

1. Total Disbursed 8.64 million UA Cancelled amount 0.56 million UA Undisbursed balance 0.56 million UA 2. Time Overrun/ underrun

Slippage on effectiveness 33 months Slippage on completion 96 months Slippage on last disbursement 120 months Number of deadline extensions 2

3. State of project implementation Completed (100%) 4. Verifiable indicators in relation to expenditure category allocations

A. Architectural Studies and Supervision Completed (100%) B. Rehabilitation/Construction Fully Implemented C. Equipment and furniture Delivered 100% D. Technical Assistance Fully Implemented E. Training Completed (100%) F. Operations Fully Implemented

5. Institutions’ Performance (Unsatisfactory/Fair/Satisfactory/Highly Satisfactory)

The Bank Group Satisfactory The Government Satisfactory

6. Performance of Construction Firms Satisfactory 7. Consultants’ Performance Satisfactory (with the

exception of the Mehou Loko Firm)

8. Suppliers’ Performance Satisfactory C. MISSIONS

Type of mission Number of persons Composition Persons/day Identification - Preparation - - - Appraisal 02 Education Expert and architect 28 Supervision 1994 1995 1996 1998 1999 2001 2002

1 1 2

02 02 02

Health Expert Education Expert Education Expert and architect Education Expert and architect Education Expert and architect Education Expert and architect

14 14 24 24 24 20

PCR 2 Education expert and health expert 28

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E. DISBURSEMENTS (in millions of UA)

Estimated and Actual Loan Disbursement Schedule (in millions of UA)

Year

Estimate at appraisal (in UA)

Real disbursements (in millions of UA % disbursed

Approved amount 9.21

Cancelled amount 0.56

1991 2.27 0.0 1992 6.49 0.0 1993 1.24 0.0 1994 0.17 1.91 1995 0.06 0.63 1996 1.31 14.22 1997 0.13 1.43 1998 1.31 14.19 1999 1.36 14.73 2000 2.25 24.45 2001 1.05 11.38 2002 0.57 6.25 2003 0.43 4.71 Total 10.009000 8.64 93.89

Estimated and Actual National contribution disbursement schedule (in million of UA)

Year


Real disbursements (in millions of UA) % disbursed

1991 0.335 0.00 1992 0.700 0.00 1993 0.071 0.00 1994 0.186 17.88 1995 0.00 0.00 1996 0.00 0.00 1997 0.057 5.48 1998 0.151 14.52 1999 0.151 14;52 2000 0.375 36.05 2001 0.306 29.42 2002 0.00 0.00 2003 0.00 0.00 Total 1.04 1.226 117.87

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F. WORKS 1. Nature of the contract : Execution of construction works

Contract amount : 4.607.539.460 F (4.209.448.051 ADF and 98.091.409 BENIN

Participation : Government of Benin / ADF Contract N° : 3617/MENRS/MEHU/MF/CAB Date of signature : 22 July 1998 Corporate name : The Arab Contractors Nationality : Egyptian Head Office : Batch B5 Les cocotiers – 04 BP 0274 Cotonou Approved procurement method : International competitive bidding Current procurement method International competitive bidding

G. BIENS

2. Nature of the contract : Supply and delivery of equipment on site

ADF : 57.787.806Contract amount : 65.982.880 CFA F BENIN : 8.195.074

Contract N° : BENIN – ADF Date of signature : 949/MENRS/MEHU/MF/CAB Corporate name : 15 February 2000 Nationality : CAPALIA IDF Head Office : Beninese Approved procurement method : 03 BP 515 – Tél. / Fax: 30.35.71 – Cotonou Current procurement method : International competitive bidding Contract N° : International competitive bidding

3. Nature of the contract : Supply and delivery of furniture on site Contract amount : 97.705.571 CFA F (ADF 85.570.539 et BENIN 12.135.032)Participation : BENIN – ADF Contract N° : 948/MENRS/MEHU/MF/CAB Date of signature : 15 February 2000 Corporate name : CAPALIA IDF Nationality : Beninese Head Office : 03 BP 515 – Tél. / Fax: 30.35.71 – Cotonou Approved procurement method : International competitive bidding Current procurement method : International competitive bidding

4. Nature of the contract : Supply and delivery of furniture on site Contract amount : 98.138.040 CFA F (ADF: 85.949.295 ; BENIN: 12.188.745) Participation : BENIN – ADF Contract N° : 1331/MENRS/MEHU/MF/CAB Date of signature : 25 February 2000 Corporate name : ADFOUL TECHNIBOIS Nationality : Beninese Head Office : 01 BP 2042 Tél. : 33.73.06 Cotonou BENIN Approved procurement method : International competitive bidding Current procurement method : International competitive bidding

H. SERVICES

1. Nature of the contract : Architectural studies Contract amount : 262.398.240 CFA F Participation : African Development Fund Contract N° : 4696/MEN/MEHU/MF/CAB Date of signature : 12 October 1994 Corporate name : Architecture and urban planning firm MEHOU-LOKO Nationality : Beninese Head Office : BP 445 Cotonou Approved procurement method : Mutual agreement Current procurement method : Limited competitive bidding Reasons for the change (where relevant)

: Contract termination

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2. Nature of the contract : Supervision of construction works Contract amount : 67.504.733 CFA F Participation : African Development Fund Contract N° : 3534/MENRS/MEHU/MF/CAB Date of signature : 05 May 1999 Corporate name : HUEZIZE ARCHITECTURE Nationality : Beninese Head Office : Batch 26 Haie vive – 01 BP 2424 – Cotonou Percentage of participation of each company : None Approved procurement method : Limited competitive bidding Current procurement method : Limited competitive bidding Contract amendment To facilitate the supervision of additional works, Contract

amendment N° 8538 of 12/12/2000 was signed in favour of the HUEZIZE ARCHITECTURE firm, for an amount of 29.349.466 CFA F ( excluding duties and taxes)

3.

Nature of the contract : Technical assistance in civil engineering Contract amount : 101.450.000 CFA F Participation : African Development Fund Contract N° : 4856/MEN/MEHU/MF/CAB Date of signature : 15 September 1995 Corporate name : SONED-AFRICA Nationality : Senegalese Head Office : 7 bis, rue Wagane Diouf – BP 2084 Dakar Percentage of participation of each company : None Approved procurement method : Selection on the basis of a limited list Current procurement method : Selection on the basis of a limited list Contract amendment : N° 2122 of 28 March 2000 amounting to 35.707.980 CFA

F (excluding duties and taxes).

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4. Nature of the contract : Assistance for engineering control Contract amount : 65.000.000 CFA F Participation : African Development Fund Contract N° : 5812/MENRS/MEHU/MF/CAB Date of signature : 17 November 1997 Corporate name : Bureau SOCOTEC-BENIN Nationality : Beninese Head Office : BP 06-1915 – Cotonou Percentage of participation of each company : None Approved procurement method : Selection on the basis of a limited list Current procurement method : Selection on the basis of a limited list

5. Nature of the contract : Maintenance expertise Contract amount : Can $ 220, 000 Participation : African Development Fund Contract N° : 5967/MENRS/MEHU/MFE/CAB Date of signature : 30 August 2000 Corporate name : International Consortium for Development in Education Nationality : Canadian Head Office : 2075, rue University, suite 810, Montréal – Québec –

CANADA H3A 2L1 – Tél. : 286 7004 – Fax : 286 7513 Approved procurement method : Selection on the basis of a limited list Current procurement method : Selection on the basis of a limited list 6. STOP

Nature of the contract : Studies and supervision Contract amount : 58.966.400 CFA F (excluding duties and taxes) Participation : African Development Fund Contract N° : 6069/MESRS/MEHU/MFE Date of signature : 04 December 2001 Corporate name : Société Tunisienne d’ingénierie (studi) Nationality : Tunisian Head Office : 2, rue des métiers – zone industrielle – 1080 Tunis –

Carthage cedex - Tunisia Percentage of participation of each company : None Approved procurement method : International competitive bidding Current procurement method : International competitive bidding 7. Nature of the contract : Assistance for engineering control Contract amount : 15.372.500 CFA F (excluding duties and taxes) Participation : African Development Fund Contract N° : 6070/MESRS/MEHU/MFE Date of signature : 04 December 2001 Corporate name : SOCOTEC – BENIN Nationality : Beninese Head Office : BP 06 – 1915 Cotonou Approved procurement method : International competitive bidding Current procurement method : International competitive bidding

8. Nature of the contract : Financial auditing of the project Contract amount : 9.200.000 CFA F Participation : African Development Fund Contract N° : 5043/MEN/MEHU/MF/CAB Date of signature : 25 September 1995 Corporate name : Cabinet AFRICA-ETUDES Nationality : Beninese Head Office : BP 2577 – Cotonou Approved procurement method : International competitive bidding Current procurement method : An amendment to contrat 5043/MEN/MEHU/ MF/CAB of

25/09/95 relative to the annual audit of accounts covering a 4-year period, which was not provided for in the evaluation report, was signed. This contract amendment of a total amount of 16.000.000 CFA F is entirely catered for by the

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Beninese counterparty Reasons for the change (where relevant) : Supplementary service since the initial contract did not take

into account the project’s financial auditing. Amount after review : None 9.

Nature of the contract : Financial auditing of the project Contract amount : 11.300.000 CFA F (excluding duties and taxes) Participation : African Development Fund Contract N° : 5964/MESRS/MEHU/MFE Date of signature : 23 November 2001 Corporate name : Cabinet Africa-Etudes Nationality : Beninese Head Office : BP 2577 Tél. 31 24 14 – fax 31 47 12 Cotonou BENIN Approved procurement method : International competitive bidding Current procurement method International competitive bidding

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REPUBLIC OF BENIN PROJECT FOR THE CONSTRUCTION OF THE REGIONAL PUBLIC HEALTH INSTITUTE

RECONSTITUTED LOGICAL FRAMEWORK MATRIX

OBJECTIVES OBJECTIVELY VERIFIABLE INDICATORS AT APPRAISAL

OBJECTIVELY VERIFIABLE INDICATORS AT PROJECT

COMPLETION

MEANS OF VERIFICATION IMPORTANT ASSUMPTIONS

A. Sector goal (Regional objectives)

1. Contribute to attaining

health for all by 2000 through the promotion of physical, mental and social well-being and the provision of better trained human resources:

1.1 In 2000, the 46 countries of

the Africa region would have acquired maximum capacity for the implementation of their human resource development policy in the field of health.

1.1.1.1 About 900 officials from

African countries are trained by IRSP in Benin in the field of public health: besides, several seminars, symposia, workshops and meetings of Beninese Ministries, NGOs and development partners were organised between 2002 and 2007.

1.1.1. Annual Report of the Health Ministry

and WHO

1.1.1.1 Public health continues to be the

priority of WHO and African countries

B. Project objective 1. Contribute to improving

the framework and environment for the training of health personnel in the various public health disciplines, on the one hand, and ensure an on-going maintenance of the equipment infrastructure, on the other hand.

1.1 In 1993, IRSP conducted: i)

the training of post-graduate level specialists in the fields of public health, health service management, health economy and sanitary engineering; ii) the continuous training of administrative, management and technical staff, in charge of health development programmes through seminars and conferences

1.2 In 1993, IRSP would have

become a research centre performing services for the

1.1.1 About 900 public health

specialists from over 25 African countries were trained (public health, epidemiology and health services management). Most of the trained staff occupy top positions in Health Ministry structures or technical departments in their various countries

1.2.1 IRSP is also engaged in

research activities focussed on the health

1.1.1. IRSP Activity Reports and Report of the

Public Health Ministry 1.2.1.1 IRSP Activity Reports and Report of

the Public Health Ministry and WHO

1.1.1.1 WHO continues to provide its

financial support to IRSP 1.2.1.1.1 Idem

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COMPLETION


different public and private institutions active in the promotion of health in countries of the region and serving as an African regional centre for documentation, information and reference in the field of community health.

1.3 In 1993, IRSP ensured the

continuous maintenance of the infrastructure and equipment.

system and performs services in the various health development sectors.1

1.3.1 Four technicians trained

within the framework of this project carry out the maintenance of the IRSP buildings and equipment

1.3.1.1 Activity Reports of the IRSP

maintenance unit

1.3.1.1.1 Idem

Infrastructure building and site layout 1. Construction/site layout :

Administrative buildings; accommodations; site layout (external works; water tank; games areas).

1.1. In 1993, IRSP had

administrative, educational buildings as well as accommodation for trainees

1.1.1 Since 2002, IRSP has an

administrative and educational block comprising 9 classrooms, 2 of which are reserved for teaching multimedia computing, 1 amphitheatre with a capacity of 280 seats, a documentation centre, a reprographics centre; residences for trainees with a total capacity of 90 rooms and 30 studio apartments ; 5 villas and 5 residence pavilions for the IRSP management staff; kitchens, a restaurant with an 80 seats capacity and a cafeteria ; sports grounds

1.1.1. Report of the Project Implementation

Unit and mission for the preparation of the project’s completion report; and acceptance statements.

1.1.1.1 Implementing the contract of the

architect in charge of the architectural studies and supervision.

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COMPLETION


2. Equipment / Furniture

(copying equipment ; communication equipment ; various office equipment and others).

3. Creation of a unit for the

maintenance of infrastructure

Construction/ fit-up and equipment of a maintenance unit.

2.1 In 1993, IRSP was provided

with the teaching and administrative equipment required for its operation.

3.1 In 1993, IRSP would be

capable of effecting the maintenance of buildings and equipment which would be provided.

(handball, volleyball, basketball, tennis), and a gymnasium ; workshops and warehouses; a laundry room and dryers; offices for the support staff; parking spaces and green areas

2.1.1 Since 2002, all the

equipment and furniture were installed and are in full used by the Beneficiaries.

3.1.1 Four technicians trained

within the framework of this project carry out the regular maintenance of the buildings and the delivered equipment.

2.1.1.1 Report of the Project Implementation

Unit and mission for the preparation of the project’s completion report; and acceptance statements.

3.1.1.1.1 Activity Report of the Project

Implementation Unit, Report of IRSP and of the Ministry of Public health.

2.1.1.1 Public health continues to be the

priority of WHO and African countries

Activities 1. Architectural studies and

supervision. 2. Construction works 3. Equipment/ furniture. 4. Technical assistance 5. Training 6. Operation..

Resources in millions of UA ADF : 9.21 Govt : 1.04 Total : 10.25

Resources in millions of UA Estimated Actual ADF 9.21 8.64 Govt 1.04 1.23 Total 10.25 9.87

Status of disbursements. The national contribution is available .

1 INTRODUCTION 1.1. The project for the construction and equipment of the Regional Public Health Institute (IRSP) in Ouidah, Benin, was appraised and implemented in response to the crucial needs in human resources specialised in the health sector. Actually, the health situation in most African countries, particularly in West Africa, was essentially characterized by the prevalence of endemo-epidemic diseases, infectious and parasitic diseases (malaria), insalubrity and a high under-5 mortality rate. The main constraints confronting the health personnel essentially relate to lack of coordination in programming and staff use, and the training gaps with respect to the management of human, material and financial resources. At the ALMA ATA Conference in 1978, it was agreed that primary health care was the best means of achieving the health for all objective by 2000. This approach very quickly brought up the issue of sufficiently qualified and motivated human resources to meet the health needs of communities, particularly in Sub-Saharan Africa. After identifying the needs in medical specialists in the epidemiology/public health sector and observing the non existence of an institution capable of training such specialists, the World Health Organisation’s (WHO) Regional Office for Africa proposed to the Government of the Republic of Benin, the creation of a Public Health Institute (ISP/PHI) in Benin. 1.2. However, since its establishment, the Public Health Institute, which later became the Regional Public Health Institute (IRSP) has not been provided with suitable and functional premises to conduct the required quality of training. The need to establish it in its own permanent structures was thus quickly perceived as a priority not only by the WHO, which agreed to provide the future Institute’s entire recurrent operating costs, but by the Beninese authorities, who financed the technical feasibility studies. These studies gave rise to the design of an architectural project for the construction of the Regional Public Health Institute (IRSP) which was submitted to the African Development Fund for financing. 1.3. The African Development Bank group thus fielded several missions to Benin and even to the headquarters of the WHO Regional Office for Africa in Brazzaville, to discuss the terms and conditions for its implementation. Following these various contacts, an ADF appraisal mission, comprising a public health expert and two architects, visited Benin from 21 November 1990 to 5 December 1990 to appraise the project. The loan was approved on 2 May 1991 and signed on 9 May 1991. This document reports on the status of the project as appraised by the Bank in 1990. The said project was implemented within the limits of the budget that was initially allocated under the loan, despite the 1994 devaluation. The Project Implementation Unit (PIU) was responsible for carrying out all the activities, under the supervision of the Ministry of Higher Education and Scientific Research. This unit coordinated the implementation of the project activities, which registered a 33-month delay. Despite this situation, the project contributed to the development in Africa of human resources in the health sector, by providing the institute with quality infrastructure and equipment, likely to develop its public health training capacities. The project objectives are in line with the strategy of the WHO Africa Region, to strengthen human resources for the development of health systems.

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2 PROJECT OBJECTIVES AND FORMULATION 2.1 Project objective 2.1.1 The general objective of the project was to improve the framework and environment for the training of health personnel in the various public health disciplines, on the one hand, and ensure an on-going maintenance of the equipment and infrastructure, on the other hand. The specific objective was to develop training that is adapted to the environment of the African region and based on the multi-sectoral community health approach. 2.1.2. To achieve these objectives, the specific missions of the Regional Public Health Institute were defined as follows: i) train post-graduate level specialists in the fields of public health, health service management, health economy and sanitary engineering; ii) ensure the continuous training of administrative, management and technical staff, in charge of health development programmes through seminars and conferences; iii) become a research centre performing services for the different public and private institutions active in the promotion of health in countries of the region; and iv) serve as an African regional centre for documentation, information and reference in the field of community health. 2.2 Project description 2.2.1 The project comprised the following components:

I. Construction of infrastructure and site layout

A. Supplementary architectural studies and supervision ; B. Construction / Lay-out; C. Equipment and furniture.

II. Creation of an infrastructure maintenance centre

A Supplementary architectural studies and supervision; B. Construction /Lay-out; C. Equipment and furniture; E. Training.

III. Project Implementation Unit

C. Equipment (vehicles); D. Technical assistance; F. Operation.

2.2.2 The Regional Public Health Institute (IRSP) which covers an area of eight hectares, comprises several blocks, including an administrative and educational block; residences for trainees with a total capacity of 90 rooms and 30 studio apartments ; 5 villas and 5 residences for staff members. IRSP is a real university campus in which education spaces and recreation and leisure zones lie side by side, to liven up the training period. The modernity and operationality of the design of this complex are meant to promote the institution’s mission and open new perspectives for public health training, research and development in countries of the region.

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2.3 Project Formulation 2.3.1 The project was formulated in response to the concerns of African countries relative to the shortage of health personnel to provide the required services to the populations, particularly the rural and most disadvantaged. It also meets the concern of the WHO Regional Office for Africa to train doctors specialised in epidemiology/public health in the appropriate environment. The Governments concerned and WHO thus realised the need to associate curative medicine and preventive medicine and provide the kind of training required in an appropriate framework. Thus, the Government of the Republic of Benin agreed to create a Public Health Institute (ISP) in Benin. At the beginning, the courses were held in rented premises located in the city of Cotonou, which made it difficult for IRSP to provide the required training quality. There was thus need to establish IRSP in its own structures and, in this regard, the Government of Benin pre-financed the architectural and technical feasibility studies which were submitted to the African Development Fund for financing. 2.3.2 The African Development Bank Group then undertook various missions to Benin and the headquarters of the WHO Regional Office for Africa in Brazzaville, to discuss the terms and conditions for the implementation of the project. In this context, the project was designed with the following three components: 2.4 Identification, Preparation, Appraisal and Approval 2.4.1 In response to the Beninese Government’s request, the African Development Bank Group expressed its interest in the project by sending several missions to Cotonou and to the headquarters of the WHO Regional Office for Africa in Brazzaville. Following these various contacts, ADF undertook an appraisal mission to Benin from 21 November to 5 December 1990. It did not deem it necessary to prepare specific reports, since the technical documents submitted to ADF contained sufficient information for the project’s appraisal. 2.5 Negotiation and Approval Following the appraisal mission, negotiations were held in May 1991 between the Republic of Benin and the African Development Fund with view to awarding a loan of UA 9.21 million. The loan was approved on 2 May 1991. The loan agreement was signed on 9 May 1991 and became effective on 15 February 1994.

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3. PROJECT IMPLEMENTATION 3.1 Effectiveness and Start-up 3.1.1 Prior to loan effectiveness, the following conditions were to be fulfilled:

Conditions precedent to loan effectiveness Fulfilment dateA. Conditions precedent 1. Provide evidence of the creation of the Project Implementation Unit (CEP) within

the Ministry of Higher Education and Scientific Research and the posting of the national support staff required for the implementation of the project.

15 October 1993

2. Provide evidence that a bank account has been opened for the operation of the Project Implementation Unit (CEP) by the Sinking Fund (CAA) at the B.C.E.A.O.

August 1991

3. Provide evidence that the Project Implementation Unit (CEP) has been provided with the appropriate premises.

15 November 1993

4. Provide evidence of an undertaking by the WHO to cover the operating costs of the Regional Public Health Institute.

09 December 1991

5. Provide evidence that a plot big enough to build the Regional Public Health Institute has been provided.

04 January 1991

B. Other conditions 1. Take the appropriate measures to ensure that the training starts twelve (12)

months after the project start-up, at the most. 1997

2. Consult the Fund before the appointment of a new Director. - 3.1.2 Conditions precedent n° (2), (4) and (5) were fulfilled without difficulty. However, those relative to the creation of the Project Implementation Unit (PIU) within the Ministry of Higher Education and Scientific Research ; posting national support staff required for the implementation of the project and providing the PIU with suitable premises, raised problems and their fulfilment was delayed. This situation was due to the country’s administrative red tape. In practice, condition n° (3) concerning the use of the land big enough for the construction of the Regional Public Health Institute was particularly difficult to meet because the targeted plots were changed several times. The first three plots of land which were allocated to IRSP were later withdrawn, either because they were not functional, or because their owners did not give their consent. The Institute was thus built on the fourth plot provided in Ouidah. Besides, as a result of the administrative red tape, the loan agreement, approved in March 1991 and signed on 9 May 1991, did not become effective until 15 February 1994, i.e. thirty-three months after its approval by the Bank’s Board of Directors. Actually, the delay registered in the effectiveness of the loan agreement was linked to the tardy ratification of the loan agreement by the Beninese National Assembly, which did so only on 22 March 1993. With the fulfilment of the precedent conditions, the legal opinion was finally issued on 15 June 1993, and the loan agreement was declared effective. 3.2 Modifications 3.2.1 The project underwent changes relative to the increase in the areas (90.04%) of the administrative and educational blocks, to make them more functional. These changes concerned both the ground floor and the storey. The block for the accommodation of the management staff was also enlarged in terms of surface area (an additional 1,077.10 m²) in order to further meet the needs. The “maintenance unit” block, which initially covered an area of 83.62m² was extended to 589.18 m², i.e. an increase of 505.56m². Other changes were also made at the ‘trainees’ block, where, instead of the 4 residences of 3 508 m2 initially planned, 5 residences were built to house 120 trainees, and three (3) of these were reserved for bachelors (R+3) while two (2) were earmarked for married trainees (R+3). Moreover, the health care unit which should

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have been built on an area of 50 m2 was finally integrated in the administrative and educational unit covering an area of 120 m2. Parking areas covering a total area of 296.00 m2 were also built. 3.2.3 The overall built-up surface area of the Regional Public Health Institute was finally expanded from 6,643.62 m² to 12,968.72 m², i.e. an increase of 6,325.10 m² equivalent to 95.21% of additional areas, built without increasing the initial budget. The different changes effected contributed to improving the working conditions of the administrative staff and ensured that trainees did not live in cramped conditions, by providing them with games areas to make their working environment pleasant to be in. The secondary infrastructure that were built also contributed to improving the atmosphere and living environment. All these modifications were carried out with ADF’s concurrence. 3.3 Implementation schedule 3.3.1 The project’s activity schedule, initially set to last thirty-six months (from March 1991 to March 1994) was not complied with. There were many reasons for the lag between the initially scheduled completion date and the effective completion date. The slippage on effectiveness of the loan agreement was due to the Government’s delay (33 months) in fulfilling the conditions precedent to the loan. Besides, the fact that the plot of land on which the institute should have been built was changed several times, also held-up the launching of the project’s activities. In fact, through an Order dated 4 January 1991, the Government allocated a land of eight (08) hectares for the construction of the institute on the Abomey-Calavi campus. Unfortunately, the site was located on the basin of the Beninese Electricity and Water Company. A second site, also situated within the confines of the Abomey-Calavi campus, was assigned to the project. Since it did not meet the required conditions, it was also abandoned for another one opposite the inter-State road, but whose owners refused to sell it. Thus, a fourth site, allocated under title deed 120 of Ouidah, was finally agreed on. 3.3.2 The poor performance of the Architect’s Firm, initially entrusted with conducting architectural and technical studies also contributed to the delay observed in the implementation of the Project activities. The firm had registered a delay of about twenty-four (24) months in the preparation of the tender documents for the IRSP construction works. After lengthy negotiations, the Bank requested that the contract be terminated, and things started to move again. The table below shows the lag between the proposed schedule and the real project implementation schedule:

Estimated and Actual Schedule for the Implementation of Project Activities

Activities Proposed schedule Real schedule Delay in terms of months

Loan approval March 1991 March 1991 0

Recruitment of consultants (technical assistance) March – July 1991 September 1995 ; August 2000

49 49

109

Launching competitive bidding for the construction December 1991 – January 1992 May 1997 64

Processing, award and approval February – March 1992 August 1997 ; July 1998 76 Construction works April 1992 – January 1994 August 1998 ; June 2001 90 Launching competitive bidding for equipment and furniture January – February 1993 February 1999 72

Processing, award and approval March – April 1993 April 1999 ; February 2000 82

Acquisition and installation May–September 1993 September 2000 ; March 2002 107

Training April 1992 – Mars 1994 ⎯ 96

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3.4 Reports and Audit At the start of the project, the activity reports were not transmitted to the Bank, in accordance with the provisions of the loan agreement. To address this situation, the Project Implementation Unit (CEP) undertook, in 1996, to prepare a single report covering the period between 1993 to 1996 (corresponding to eleven (11) quarterly reports). With effect from this date, it regularly provided the required activity reports. Thus, on the whole, from the date the loan agreement became effective until the mission for the preparation of the completion report was undertaken, thirty-three (33) quarterly activity reports were transmitted to the Bank. With respect to financial auditing, the Government submitted eight annual audit reports prepared by the Afrique Etudes Firm (1994-2001 period). The project’s management was generally based on the administrative and financial procedures in force. However, a few weaknesses were observed as regards internal auditing. The observations emanating from the annual audits were taken into account by the project management unit team. The Borrower also prepared and transmitted the required completion report to the Bank. This report presents the overall situation of the project fairly well. 3.5 Procurement of goods and services Goods, services and works were generally acquired in accordance with the Bank’s procedures. With the exception of the construction works for which the Bank requested that the bid processing be reviewed because of non compliance with the provisions of the bidding documents, the Borrower had no difficulty with the acquisitions. Not many local procurements were made. These were for equipment (vehicles, reproduction equipment, communication and office equipment). The international competitive bidding enabled the Government to : i) select a technically qualified and financially capable company to carry out the IRSP construction works ; and ii) chose the best suppliers to deliver the equipment. All in all, twelve (12) basic contracts were concluded. Five (5) of the twelve (12) contracts were awarded on the basis of international competitive bidding, while five (05) were concluded following consultations based on a limited list, and two were awarded by mutual consent, with the Bank’s concurrence. The additional works carried out during the implementation, were the object of a contract amendment, with the Bank’s non-objection notice. 3.6 Costs, Financing Sources and Disbursements 3.6.1 At appraisal, the total cost of the project, excluding duties and taxes, was estimated at 11.13 million UA, including ADF contribution of 10 million UA (i.e. 90% of the overall project costs) and that of the Beninese Government estimated at 1.13 million UA (i.e. 10% of the overall project cost). The loan amount should cover the entire costs in foreign exchange and 78% in local currency. In 1994, with the review of Benin’s portfolio, conducted after the devaluation of the CFA franc, the overall project cost, excluding duties and taxes, was estimated at 10.25 million UA, of which 9.21 million UA come from the ADF loan and 1.04 million UA represent the Beninese Government’s contribution. After completion, the overall project costs, excluding duties and taxes, were estimated at 9.87 million UA, including 6.24 million UA (63.2%) in foreign exchange and 3.63 million UA (36.8%) in local currency. The following table presents the financing plan during the evaluation and after the restructuring of the portfolio :

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In millions of UA

Estimated cost (at appraisal) Estimated cost (after restructuring) Real cost

Foreign Exchange



LC Total

6.091 5.039 11.13 5.61 4.64 10.25 6.24 3.63 9.87


After the restructuring (in millions of UA) At completion (in millions of UA)

Sources Foreign Exchange


LC Total


3.6.2 It was only in May 1994, that the loan disbursements started, marking a 36-month delay in relation to the date on which the loan agreement was signed. The said disbursements were pursued until 2002. The total disbursed loan amount is estimated at 8.64 million UA (i.e. 93.89% of the total loan amount). A balance of 0.56 million UA was thus cancelled because the amount used for the construction, supervision, equipment and furniture components below the estimated budget. 3.6.3 The Beninese Government’s contribution had to be increased by 0.186 million UA (i.e. 17.87%), primarily to cover some contract amendments. The details of the project cost and the proposed and real financing plan are summarized in annex 2. 4 PROJECT PERFORMANCE 4.1 Global Performance On the whole, the activities scheduled by the project were satisfactorily delivered. Apart from delays in the architectural and technical studies, the construction works that were initially planned kicked-off in November 1998 and were fully implemented. The works were provisionally accepted on 3 July 2001 while the formal acceptance of buildings that were already operational, took place in June 2002. With the exception of the power-operated screen, all the equipment and furniture were installed and used; the various training courses were carried out. The project results thus provided the country with an appropriate system to address the challenges relative to the development of human resources in the health sector in sub-Saharan Africa. The project’s operational performance is satisfactory. 4.2 Operational performance 4.2.1 The operational performance is analysed through the conduct of activities relative to the following 3 components of the project:

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(i) Building the infrastructure and site layout : 4.2.2 The architectural and technical studies were entirely carried out, with some delay (this situation led to the termination of the contract of the architect’s firm in charge). The basic construction works were carried out according to schedule (August 1998 – July 2001). These include an administrative and educational block comprising 9 classrooms, 2 of which are reserved for teaching multimedia computing, 1 amphitheatre with a capacity of 280 seats, a documentation centre, a reprographics centre; residences for trainees with a total capacity of 90 rooms and 30 studio apartments ; 5 villas and 5 residences for the IRSP management staff; kitchens, a restaurant with an 80 seats capacity and a cafeteria ; sports grounds (handball, volleyball, basketball, tennis), and a gymnasium ; workshops and warehouses; a laundry room and dryers; offices for the support staff; parking spaces and green areas. The project’s civil engineering consultant confirmed that the works comply with the building plans. The technical supervision of the IRSP construction work was carried out according to schedule. Additional works had to be undertaken due to the option shift concerning the improvement of the site, the modifications of the implementation plans, electrical appliances, air-conditioners, needs for solidity, security and operationality. The works also involved the carcass, the waterproofing, plumbing, fire protection, electricity, air conditioning and joinery work. All the equipment as well as the furniture provided for in the project were also delivered and installed. 4.2.3 IRSP moved to its permanent structure in Ouidah in 2002 and changed its name to IRSP - Dr. Alfred Comlan QUENUM. It is placed under the double tutorship of the WHO Regional Office/AFRO and the Government of Benin through the Ministry in charge of Higher Education and the University of Abomey-Calavi. The institute currently develops training programmes in public health, epidemiology and health service management, for health personnel of several African countries (IRSP also trains the personnel of some projects financed by the Bank).

(ii) Creation of an infrastructure maintenance unit: 4.2.4 The infrastructure and equipment maintenance unit was established in 2001, with the recruitment of a maintenance expert, entrusted with the conduct of activities until the technicians provided for within the framework of the project are recruited. With effect from July 2002, a team of technicians took over the maintenance of the IRSP infrastructure and equipment following their training. The unit is functional.

(iii) Project management support: 4.2.5 The project was managed by the Project Implementation Unit (PIU), established in May 1991, and mandated to coordinate, as well as administer, supervise and monitor all project activities. This structure was composed of administrative (director, deputy director, head of the administrative service), technical (accountant and deputy accountant, head of the technical service) and support (secretaries, receptionists, drivers, maintenance officers and watchmen) staff. The implementation of the team’s activities benefited from operating costs, equipment and furniture, provided for within the framework of the project. The Project Implementation Unit (PIU) succeeded in solving the problems relative to the plot of land required for the construction works and carrying out all the other activities, in particular the procurement of goods and the scheduled training.

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4.3 Institutional performance Efficiency in terms of management and organisation 4.3.1 The Project Implementation Unit (PIU), under the control of the Ministry of Higher Education and Scientific Research, coordinated the implementation of the project activities, which kicked off with a 33-month delay. Despite this situation, the PIU’s performance is considered satisfactory as far as the project’s implementation is concerned. In fact, all the components of the project were fully implemented, despite extensive changes, approved by the Bank to meet users’ needs and which did not affect the estimated budget. 4.3.2 Factors attesting to this good performance include the dialogue approach for the resolution of problems. Thus, as regards the delay in the architectural and technical studies, a crisis committee, chaired by the Project Implementation Unit (PIU) and comprising the architect himself and the consulting engineer, was set up. The work of this committee resulted in the preparation of the bidding documents (with some difficulty), which were finally published in February 1997. After processing the bids, the contract was awarded to the ‘ THE ARAB CONTRACTORS’ firm and the architect’s contract was terminated. There was thus need to recruit another architectural firm to supervise the works which were about to start. While the process for the recruitment of an architectural firm was afoot, the Project Implementation Unit (PIU) succeeded in obtaining the Bank’s authorisation to find an architect from the Ministry of environment, Housing and Town Planning (MEHU) to provisionally (during a 6 month period) supervise the works. Thus, an architect from MEHU was temporarily posted to the project to supervise the works from 17 August 1998 to the end of March 1999, when the HUEZIZE ARCHITECTURE firm, recruited by the project, commenced its activities. 4.3.3 The Project Implementation Unit (PIU) monitored the project activities satisfactorily, thanks to the periodic and regular meetings (weekly and technical meetings, monthly meetings). Weekly and technical meetings were held on the building site to take stock of the state of progress of the works, visit the site to identify what did not comply with the plans or good practices. These meetings were attended by representatives of the supervision firm, the department of housing and construction, the technical assistant to the project and CEP technicians. The problems raised during the meetings were provided with practical and urgent solutions. The monthly meetings attended by the heads of the various structures, accompanied by their technicians, served as an opportunity to organise discussion sessions, file reviews, approve different implementation documents as well as share the Bank’s observations on the Implementation Unit’s (PIU) activity reports. 4.4 Performance of Consultants, Contractors and Suppliers. Performance of Consultants

4.4.1 The selected firms were SONED-AFRICA (civil works) ; CIDE (maintenance) ; HUEZIZE ARCHITECTURE (construction works supervision) ; SOCOTEC – BENIN (engineering control) and AFRICAS – ETUDES (financial auditing). Under the control of the Project Implementation Unit (PIU), all these firms carried out good quality work. The consultants’ availability and the regular visits to the work site made it possible to settle the problems as they surfaced. They had good relations with the various partners and no conflictual situation was reported. With the exception of the MEHOU L. MARCEL architectural firm (because of the delay in the delivery of the project), the consultants’ performance is considered satisfactory.

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Performance of Contractors 4.4.2 ‘ THE ARAB CONTRACTORS OSMAN AHMED OSMAN & Co’ satisfactorily carried out good quality construction works, within the set timeframe, with all the required changes costing 0.038 million UA less than the budget estimated in the project. The performance of the construction firm ‘THE ARAB CONTRACTORS’ is considered satisfactory. Performance of Suppliers 4.4.3 All the required equipment and furniture were supplied and installed, thus facilitating the smooth functioning of IRSP. The suppliers’ performance is deemed satisfactory. 5 SOCIAL AND ENVIRONMENTAL IMPACTS 5.1 Social impact 5.1.1 The current economic and social development challenges in Africa cannot be effective without the existence of health personnel with specialised training, of the type provided by IRSP. This institution provides the concerned countries with management staff capable of applying a more appropriate design and a better management of health programmes, by using new technologies and targeting priority health problems (Malaria, HIV/AIDS, Tuberculosis, reproductive health…), in order to specifically meet the need of the most vulnerable populations (women and children), within the specific context of poverty reduction strategies. 5.1.2 To date, more than 900 public health specialists from over 25 countries of the region have been trained at the IRSP. Most of them hold top positions in Health Ministry structures or technical departments in their countries. IRSP is also engaged in research activities focused on the health system and performs services in the various health development sectors.2 It also serves as a framework for seminars, symposiums, workshops and meetings of Beninese Ministries, NGOs and development partners. Moreover, the project has a positive impact on regional integration because it receives management staff from different African countries. 5.2 Impact on women Women are among the key Beneficiaries of the project results, since the IRSP management has always given priority to women candidatures not only because of their current role in the implementation of the health programmes in Africa, but also because of their capacity to mobilise target groups. Between 2002 and 2007, about 25% of the Beneficiaries of the training are women. Their participation in the training sessions thus enables them to play a leading role in the development of health care, in general, and of human resources, in particular. Every year, about 2000 people transit through IRSP within the framework of the above-mentioned workshops and seminars.

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5.3 Environmental impacts The project had a positive impact on the environment. It was actually materialized through the construction of solid infrastructure, in compliance with modern standards set for such structures, with the appropriate water supply system and septic tanks. Besides, the external works made it possible to institute a system for rainwater collection and drainage, to facilitate its channelling into Ouidah city’s general sewage system. 6. SUSTAINABILITY

6.1. Due to the quality of infrastructure built within the framework of the project, the prospects for their sustainability are good, since the required maintenance is guaranteed. Actually, the project provided for the training of maintenance technicians with a view to guaranteeing the durability of the infrastructure and equipment used at the IRSP. 6.2. The financial sustainability of IRSP is also ensured, particularly within the framework of the partnership between the Republic of Benin and the Regional Office of the World Health Organisation (WHO) which signed an agreement during the creation of IRSP, whereby the WHO undertook to provide the Institute with operating costs (staff salaries, logistics…). 6.3. Besides, in addition to the grants given by the Beninese Government to IRSP, the latter generates its own resources through its training and research activities and various other services performed, thanks to the broad partnership it has established, in the bid to implement some training programmes, including the public health course for humanitarian assistance (with Red Cross support), training in reproductive health (with the assistance of the University of Montreal and UNFPA), and regional sensitization seminars on human resources for health in the African Region (WHO). The project’s sustainability also resides in the fact that the demand in training exists and the States are committed to employ those who have already been trained. 7. PERFORMANCE OF THE BANK AND THE BORROWER 7.1 Bank’s Performance The Bank performed satisfactorily, particularly judging from the technical support provided for the implementation of the project activities which encountered difficulties during its start-up phase. Thus, ten supervision missions were undertaken by the Bank’s experts during the project’s lifespan, between its effective date and its completion. Thanks to these supervisions, appropriate and practical solutions were found for the problems encountered (land, project re-appraisal following the devaluation of the CFA franc, changes concerning civil works, termination of the architect’s contract because of the latter’s failure to meet his commitments and the regular payment of the national contribution). The Bank’s performance during the project cycle is satisfactory as indicated in annex 4.

7.2 Borrower’s Performance Despite the 33 month delay registered at the start of the project’s activities, the Borrower’s performance was, by and large, satisfactory. In fact, the Beninese Government met its commitments by regularly disbursing the counterpart funds, but also by paying additional funds to cover expenditure related to some contracts. The activities and audit reports were regularly prepared (except at the start-up) and transmitted to the Bank.

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8. OVERLL PERFORMANCE AND RATING The objectives of the IRSP construction and equipment project in Ouidah (BENIN) were pertinent. All the activities were fully and satisfactorily accomplished, on the basis of the goods, services and works acquisition procedures and methods stipulated in the provisions of the loan agreement. The changes in the civil engineering component which were deemed necessary and proposed by the Borrower, were effected, with the Bank’s approval, without over-budgeting. The expected results were reached. The project’s global performance is considered satisfactory. The rating of the project’s impact on development is mentioned in annex 5. 9. CONCLUSIONS, LESSONS LEARNT AND RECOMMENDATIONS 9.1 Conclusions 9.1.1 The IRSP construction and equipment project in Ouidah (BENIN) essentially contributed to the development in Africa of human resources specialised in the health sector and to regional integration, by providing the institute with quality infrastructure and equipment, to develop its training capacities in the field of public health. The objectives set by the project are in line with the strategy of the WHO Africa Region to strengthen human resources for the development of health systems. 9.1.2 The project’s implementation was marked by delays in fulfilling the loan conditions which essentially resulted in the extension of the project implementation period. However, all the architectural studies, construction works and technical supervision were completed. The equipment and furniture were delivered and installed, the maintenance unit was established and maintenance training was conducted. 9.1.3 To date, IRSP trained more than 900 public health specialists from over 25 countries of the region and provided space for the organisation of numerous seminars and various symposiums. The project materialized through the construction of solid infrastructure, in compliance with modern standards set for such structures, with the capacity to prevent negative environmental impacts. 9.2 Lessons Learnt The following key lessons were learnt from the different project components:

i) Non-availability of land during the implementation of projects leads to delays with possible consequences on project costs; it is thus essential to ensure, through the appropriate documents, that the land is available and verify that the said land is not being disputed, in any way, by the Beneficiaries, in the event it is not State-owned;

ii) the long period observed in meeting the conditions precedent to the

effectiveness and first disbursement of loans and/or grants resulted in delays in the implementation of projects:

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ii) the partnership (Government of Benin, WHO and ADB Group) for the implementation of development projects, attests to its efficiency to ensure the sustainability of the project results by catering for recurrent costs

9.3 Recommendations

The key recommendations of the report are as follows: The Government should:

i) step up the income-generating activities at the level of IRSP, to enable it to

cover the expenditures related to its operation; ii) take the appropriate measures to fulfil, within the required time-frame, the

conditions precedent to its effectiveness and to the first loan/and or grant disbursement.

The Bank should:

i) Ensure that Borrowers provide proof that the plots of land effectively exist

before the initial loan/grant disbursement, if the activities relative to the construction works are scheduled within the framework of the projects concerned;

ii) Encourage the establishment of sub-regional training structures within the

framework of a partnership; iii) Ensure that the results and the lessons drawn from the IRSP construction

and equipment project, particularly those relative to the partnership, are widely disseminated.

Annex 1

MAP OF THE REPUBLIC OF BENIN AND PROJECT AREA

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

Project site: OUIDAH. Source : WorldAtlas.com

Annex 2

ESTIMATED AND ACTUAL COSTS AND FINANCING PLAN

Overall project cost

In millions of UA Estimated cost (at appraisal) Estimated cost

(after restructuring) Real cost

Foreign Exchange



LC Total

6.091 5.039 11.13 5.61 4.64 10.25 6.24 3.63 9.87


After restructuring (in millions of UA) At completion (in millions of UA)

Sources Foreign Exchange


LC Total


Annex 3

Estimated and Actual Loan Disbursement Schedule (in UA)

Year


Actual disbursements (in

millions of UA)

% disbursed

1991 2.27 0.0 1992 6.49 0.0 1993 1.24 0.0 1994 0.17 1.91 1995 0.06 0.63 1996 1.31 14.22 1997 0.13 1.43 1998 1.31 14.19 1999 1.36 14.73 2000 2.25 24.45 2001 1.05 11.38 2002 0.57 6.25 2003 0.43 4.71 Total 10.009000 8.64 93.89

Estimated and Actual Disbursement Schedule of National Contribution (in UA)

Year

Estimate at Appraisal (in UA)

Actual disbursements (in

millions of UA)

% disbursed

1991 0.335 0.00 1992 0.700 0.00 1993 0.071 0.00 1994 0.186 17.88 1995 0.00 0.00 1996 0.00 0.00 1997 0.057 5.48 1998 0.151 14.52 1999 0.151 14.52 2000 0.375 36.05 2001 0.306 29.42 2002 0.00 0.00 2003 0.00 0.00 Total 1.04 1.226 117.87

Annex 4 PROJECT IMPLEMENTATION PERFORMANCE

Evaluation criteria Rating Observations

1. Adherence to implementation schedule

1 The project should have been implemented within 3 years. There was a time-lag of 96 months between the initial completion date and the effective completion date.

2. dherence to cost schedule 3 The costs of the constructions, supervision, equipment and furniture were mostly less than the budget projected by the project. Only the categories of expenditure relative to operations and technical assistance registered slight overspending due to the extension of the project duration.

3. Compliance with covenants and conditions.

4 However, the clauses and conditions of the loan were complied with, but with a 36-month delay in relation to the project approval date, for the precedent conditions.

4. Adequacy of supervision 3 Technical supervisions were effected at an average rate of 1 supervision per year, during the project lifespan. The quarterly activity reports were prepared and sent to the Bank.

5. Satisfactory operations 3 This project basically contributed to the development in Africa of human resources specialised in health, by providing the institute with quality infrastructure and equipment, to develop its public health training capacities.

Total 2,4 On the whole, the project implementation was satisfactory

Overall implementation evaluation

Satisfactory The social impact of the project is essentially connected with the improvement of the populations’ health in the African region, which requires health personnel with specialised training, like the type provided by IRSP.

Annex 5

BANK’S PERFORMANCE DURING THE PROJECT CYCLE

Component indicators Rating Observations 1. At identification 3 The project was not identified by the Bank; it is among the national priorities and is in line with the WHO Africa strategy for the

development of human resources in the health sector. 2. During preparation

3 The project was not prepared as such since the information contained in the documents submitted to ADF in 1989 were sufficient for its appraisal. However missions were fielded to Benin and the WHO regional office in Brazzaville to establish contacts; and to Benin to discuss the matter.

3 At appraisal

3 After receiving the documents submitted by the Government of Benin, the Bank fielded an appraisal mission to Benin from November to December 1990

4. During supervision

3 The technical supervisions were satisfactory (1 per year from 1994 to 2002). These supervisions made it possible to resolve, on time, the problems encountered on the ground, whose solution was necessary for the implementation of the Institute’s construction works.

Overall evaluation of the Bank’s performance

3 The performance is satisfactory.

ANNEX 6 Page 1 of 2

IMPACT ON DEVELOPMENT: PROJECT OUTCOME

No. Indicators and components Rating Observations 1 Relevance and achievement of

objectives

(i) Macroeconomic policy NA (ii) Sectoral policy NA The project is fully consistent with the declaration made at the ALMA ATA. Conference in 1978. Actually, it

was agreed that primary health care was the best means of achieving the health for all objective by 2000. With this approach, the issue of human resources sufficiently qualified and motivated to meet the health needs of communities, particularly in Sub-Saharan Africa came up. After identifying the needs in medical specialists in the epidemiology/public health sector and observing the non existence of an institution capable of training such specialists, the World Health Organisation’s (WHO) Regional Office for Africa proposed to the Government of the Republic of Benin the creation of a Public Health Institute (ISP) in Benin. The project is also in line with the Bank’s strategy in the field of health.

(iii) Physical outputs 4 The project objectives are pertinent and were fully achieved. In fact, the basic construction works were carried out according to schedule. These include an administrative and educational block comprising 9 classrooms, 2 of which are reserved for teaching multimedia computing, 1 amphitheatre with a capacity of 280 seats, a documentation centre, a reprographics centre; residences for trainees with a total capacity of 90 rooms and 30 studio apartments ; 5 villas and 5 residences for the IRSP management staff; kitchens, a restaurant with an 80 seats capacity and a cafeteria ; sports grounds (handball, volleyball, basketball, tennis), and a gymnasium ; workshops and warehouses; a laundry room and dryers; offices for the support staff; parking spaces and green areas. Additional works were also carried out. These involved the carcass, the waterproofing, plumbing, fire protection, electricity, air conditioning and joinery work. Besides, the infrastructure and equipment maintenance unit was created in 2001. A team of 4 technicians has been entrusted with the maintenance of the IRSP infrastructure and equipment since July. The unit is operational.

(iv) Financial policy NA (v) Poverty Reduction NA (vi) Environment 3 The project built solid infrastructure, in compliance with modern standards set for structures of the same type,

with the appropriate water supply system and septic tanks. It is also worth noting that the external works initially scheduled, created technical problems, particularly with respect to the operationality of the retention basin and of its geographical position. It was thus considered necessary to redo the external works studies, which finally resulted in the institution of a new system for rainwater collection and drainage, to facilitate its channelling into Ouidah city’s general sewage system.

(vii) Private sector promotion NA (viii) Others (specify) NA Sub- total 4 2 Institutional building (i) Institutional framework NA

ANNEX 6 Page 2 of 2

No. Indicators and components Rating Observations (ii) Financial information and

management systems NA

(iii) Transfer of technology NA (iv) Human resources (including turnover

rate, training and counterpart staff) 3 The project trained four infrastructure and equipment maintenance technicians and about 900 African

management personnel (Angola, Benin, Burkina Faso, Burundi, Cameroon, Chad, Comoros, Congo Brazzaville, Côte d’Ivoire, Guinea Bissau, Gabon, Guinea, Madagascar, Mali, Niger, Mauritania, Nigeria, Democratic Republic of Congo, Central African Republic, Sao Tome and Principe, Senegal, Togo, Rwanda, Cape Verde, ) have been trained since 2002. Other training seminars were also held every year.

Sub-total 3 Sustainability 4 (i) Borrower’s continuous commitment 4 The development of human resources in the health sector is still a priority of the Government of Benin and

other Governments of the Africa region within the poverty reduction context. (ii) Environmental policy NA (iii) Institutional framework 4 IRSP benefits from the partnership established between the Government of Benin and the WHO Regional

Office which provides technical and financial support to IRSP. Besides, trainees generally receive grants for their maintenance (accommodation, food) and the required training cost. Cost recovery is thus guaranteed. Moreover, Statutes are about to be adopted by the two sides (WHO and Government of Benin) to transform IRSP into an International Training and Research Institute and endow it with financial autonomy.

Iv Technical visibility and staff supervision

4 IRSP has a team of competent lecturers and appropriate teaching aids for the training provided.

(v) Financial viability and cost recovery mechanisms

4 IRSP moved to its new premises in March 2002. It designs training programmes in public health, epidemiology and health service management, for health personnel from several African countries (IRSP also trains the personnel of some projects financed by the Bank).

(vi) Economic viability NA (vii) Environmental viability NA (viii) Operation and maintenance

(availability of funds to cover recurrent costs)

4 WHO caters for the operating costs, with the exception of recurrent ones (water and electricity). In addition to the grants which IRSP receives from the Beninese Government, the Institute generates its own resources through its training and research activities and various other services performed, thanks to the broad partnership its has established, in the bid to implement some training programmes, including the public health course for humanitarian assistance (with Red Cross support), training in reproductive health (with the assistance of the University of Montreal and UNFPA), and regional sensitization seminars on human resources for health in the African Region (WHO)..

Sub-total 4 4 Rate of return NA Overall evaluation of the impact on

development 4 Satisfactory.

Annex 7

MATRIX OF RECOMMENDATIONS AND FOLLOW-UP ACTIONS

Key observations/Conclusions Recommendations Follow-up actions Responsibility Formulation/rationale The project design meets the needs defined by the appraisal mission.

Ensure a wide dissemination of project results and lessons learnt.

Prepare a plan for the dissemination of project results and lessons learnt

Bank Group

Project implementation Despite the delays registered, all the scheduled activities were satisfactorily implemented and the expected results were attained. The changes proposed by the Borrower concerning the civil works component were carried out, following the Bank’s approval.

NA NA

Compliance with loan agreement conditions The conditions were met but with some delay (Loan agreement, signed on 2 May 1991, was not ratified until 1st April 1993).

Take the necessary measures to reduce the deadline for the ratification of loan/grant agreements

Government

Performance evaluation The achievement of the project objectives contributed to the development of human resources in the health sector in Africa, by providing the quality infrastructure and equipment, likely to develop its public health training capacities

NA

NA NA

Sustainability

Improve the upkeep and maintenance of the infrastructure and equipment. Carry out activities likely to generate additional resources, for the upkeep and maintenance of the infrastructure and equipment.

Establish a maintenance plan with the required resources. Ensure the close supervision of the team responsible for IRSP maintenance. Establish a plan for the marketing of IRSP income-generating activities.

Government

Annex 8

SOURCES OF INFORMATION

a. African Development Bank Group. Operations Manuel, June 1999. b. African Development Fund. Project Evaluation Report. 15 February 1991. c. Quarterly Project Activity Reports (1996 – 2002). d. Supervision Reports (1999 à 2005). e. Audit Reports (1997 – 2001). f. Borrower’s Completion Report, June 2002. g. Bessaoud K. (IRSP Director). Une nouvelle façon de parler de la santé :

Comment focaliser sur les déterminants sociaux ? WHO – AFRO Brazzaville, 27 – 29 Juillet 2005.

h. Statistics of the IRSP Management. 2007 i. IRSP Web Site www.irsp.bj.refer.org

Annex 9

PROJECT IMPLEMENTATION COMPLETION REPORT

OBSERVATIONS BY THE GOVERNMENT/EXECUTING AGENCY

ON THE BANK’S REPORT IRSP made observations on the following points:

i) The surface area of the plot of land which is eight hectares;

ii) WHO’s commitment which materialized through the posting of a Director and an Administrator, the financing of other support posts (driver, secretary), and its partial contribution to the operating costs, with the exception of recurrent charges (electricity, water, upkeep and maintenance) which fall under the responsibility of the Beninese Government (see operation plan) ;

iii) A few cracks observed on the office walls ; and

iv) Statutes about to be adopted by the two Parties (WHO and Government of Benin) transforming IRSP into an International Training and Research Institute and endowing it with financial autonomy.

african development fund project completion report …

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