cameroon - sanitation project phase 1 (apl-1 ...€¦ · web view25.12.2017 · it is...

Document ofThe World Bank

Report No: ICR00004134

IMPLEMENTATION COMPLETION AND RESULTS REPORT(IDA-49840)

ON A

PROPOSED ADAPTABLE PROGRAM LOAN

IN THE AMOUNT OF SDR 18.6 MILLION (US$30 MILLION EQUIVALENT)

TO THE

REPUBLIC OF CAMEROOON

FOR A

CAMEROON SANITATION PROJECT PHASE 1 (APL-1)

IN SUPPORT OF THE CAMEROON SANITATION PROGRAM

December 22, 2017

Water Global PracticeAfrica Region

CURRENCY EQUIVALENTS

(Exchange Rate Effective 12/18/2017)

Currency Unit = FCFA 1.00 = US$0.0018US$ 1.00 = 555.54

FISCAL YEARJanuary 1 - December 31

ABBREVIATIONS AND ACRONYMS

AfDB African Development BankAPL Adaptable Program LoanBCP Business Continuity PlanCAS Country Assistance StrategyCBA Cost-benefit AnalysisCD Country DirectorCdP Project Steering Committee (Comité de Pilotage)CUD Urban Community of Douala (Communauté Urbaine de Douala)DALY Disability-adjusted Life YearEIRR Economic Internal Rate of ReturnERR Economic Rate of ReturnFM Financial ManagementGDP Gross Domestic ProductGoC Government of CameroonHDI Human Development IndexICR Implementation Completion and Results ReportIPF Investment Project FinancingIRI Intermediate Results IndicatorISR Implementation Status and Results ReportKPI Key Performance IndicatorM&E Monitoring and EvaluationMDG Millennium Development GoalMICS Multiple Indicators Cluster SurveyMINEE Ministry of Energy and Water (Ministère de l’Energie et de l’Eau)

MINEPDEDMinistry of Environment, Nature Protection and Sustainable Development (Ministère de l’Environment, de la Protection de la Nature et du Development Durable)

MINMAP Ministry of Public Procurement (Ministère des Marchés Publics)

MINEPAT Ministry of Economy, Planning, and Regional Development (Ministère de l’Economie, de la Planification et de l’Aménagement du Territoire)

NGO Nongovernmental OrganizationNPV Net Present ValueO&M Operation and Maintenance

PAD Project Appraisal DocumentPDO Project Development Objective

PDUEUrban and Water Development Support Project (Programme de Développement des Secteurs Urbain et de l’Approvisionnement en Eau)

PIM Project Implementation ManualPIU Project Implementation Unit

PNDP Community Development Program Support Project (Programme National de Développement Participatif)

SIL Sector Investment LoanTA Technical AssistanceTTL Task Team LeaderUEP Project Implementing Unit (Unité d’Exécution du Projet)UNICEF United Nations Children’s FundVIP Ventilated Improved PitWASH Water, Sanitation, and HygieneWSS Water Supply and SanitationWHO World Health Organization

Senior Global Practice Director: Guang Zhe ChenPractice Manager: Wambui G. Gichuri

Project Team Leader: Charles Delfieux / Pierre BoulengerICR Team Leader: Charles Delfieux / Pierre Boulenger

REPUBLIC OF CAMEROONSANITATION PROJECT PHASE 1 (APL-1)

CONTENTS

Data SheetA. Basic InformationB. Key DatesC. Ratings SummaryD. Sector and Theme CodesE. Bank StaffF. Results Framework AnalysisG. Ratings of Project Performance in ISRsH. Restructuring I. Disbursement Graph

1. Project Context, Development Objectives and Design................................................11.1 Context at Appraisal..............................................................................................11.2 Original Project Development Objectives (PDO) and Key Indicators..................51.3 Revised PDO (as approved by original approving authority) and Key Indicators, and reasons/justification..............................................................................................61.4 Main Beneficiaries.................................................................................................71.5 Original Components.............................................................................................71.6 Revised Components.............................................................................................81.7 Other significant changes......................................................................................9

2. Key Factors Affecting Implementation and Outcomes.............................................102.1 Project Preparation, Design and Quality at Entry................................................102.2 Implementation....................................................................................................112.3 Monitoring and Evaluation (M&E) Design, Implementation and Utilization.....122.4 Safeguard and Fiduciary Compliance..................................................................132.5 Post-completion Operation/Next Phase...............................................................14

3. Assessment of Outcomes...........................................................................................14

3.1 Relevance of Objectives, Design and Implementation........................................143.2 Achievement of Project Development Objectives...............................................153.3 Efficiency.............................................................................................................173.4 Justification of Overall Outcome Rating.............................................................183.5 Overarching Themes, Other Outcomes and Impacts...........................................193.6 Summary of Findings of Beneficiary Survey and/or Stakeholder Workshops....19

4. Assessment of Risk to Development Outcome.........................................................195. Assessment of Bank and Borrower Performance......................................................20

5.1 Bank Performance...............................................................................................205.2 Borrower Performance.........................................................................................21

6. Lessons Learned........................................................................................................227. Comments on Issues Raised by Borrower/Implementing Agencies/Partners...........23Annex 1. Project Costs and Financing...........................................................................25

Annex 2. Outputs by Component..............................................................................26Annex 3. Economic and Financial Analysis..............................................................30Annex 4. Bank Lending and Implementation Support/Supervision Processes.........53Annex 5. Summary of Borrower's ICR and Comments on Draft ICR......................55Annex 6. Comments of Cofinanciers and Other Partners/Stakeholders....................65Annex 7. List of Supporting Documents...................................................................66Annex 8. Description of the Components Revised at the First and Second Restructurings............................................................................................................67Annex 9.Map – IBRD 33382R..................................................................................70

A. Basic Information Country: Cameroon Project Name: CM-Sanitation ProjectProject ID: P117102 L/C/TF Number(s): IDA-49840ICR Date: 02/22/2017 ICR Type: Core ICR

Lending Instrument: APL Borrower:GOVERNMENT OF CAMEROON

Original Total Commitment:

XDR 18.60M Disbursed Amount: XDR 13.28M

Revised Amount: XDR 15.00MEnvironmental Category: BImplementing Agencies: Douala City Council (CUD); Ministry of Energy and Water (MINEE) Cofinanciers and Other External Partners:

B. Key Dates

Process Date Process Original Date Revised / Actual Date(s)

Concept Review: 02/10/2011 Effectiveness: 06/26/2011 06/26/2012

Appraisal: 05/05/2011 Restructuring(s):04/03/201511/16/201603/22/2017

Approval: 06/23/2011 Mid-term Review: 09/15/2014 12/02/2014 Closing: 08/31/2015 06/30/2017

C. Ratings Summary C.1 Performance Rating by ICR Outcomes: Unsatisfactory Risk to Development Outcome: Substantial Bank Performance: Moderately Unsatisfactory Borrower Performance: Moderately Unsatisfactory

C.2 Detailed Ratings of Bank and Borrower Performance (by ICR)Bank Ratings Borrower Ratings

Quality at Entry: Moderately Unsatisfactory Government: Moderately

Unsatisfactory

Quality of Supervision: Moderately Unsatisfactory

Implementing Agency/Agencies:

Moderately Unsatisfactory

Overall Bank Performance:


Overall Borrower Performance:


C.3 Quality at Entry and Implementation Performance IndicatorsImplementation

Performance Indicators QAG Assessments (if any) Rating

Potential Problem Project at any time (Yes/No):

YesQuality at Entry (QEA):

None

Problem Project at any time (Yes/No):

YesQuality of Supervision (QSA):

None

DO rating before Closing/Inactive status:


D. Sector and Theme Codes Original Actual

Major Sector/Sector Water, Sanitation and Waste Management Public Administration - Water, Sanitation and Waste Management

17 17

Sanitation 83 83

Major Theme/Theme/Sub Theme Private Sector Development Public Private Partnerships 10 10 Urban and Rural Development Rural Development 21 21 Rural Infrastructure and service delivery 21 21 Urban Development 40 40 Services and Housing for the Poor 40 40 Urban Infrastructure and Service Delivery 39 39

E. Bank Staff Positions At ICR At Approval

Vice President: Makhtar Diop Obiageli K. Ezekwesili Country Director: Elisabeth Huybens Mary A. Barton-Dock Practice Manager/Manager:

Wambui G. Gichuri Junaid Kamal Ahmad

Project Team Leader:Charles Delfieux / Pierre Boulenger

Meike van Ginneken

ICR Team Leader:Charles Delfieux / Pierre Boulenger

ICR Primary Author: Joseph W. B. Bredie

F. Results Framework Analysis

Project Development Objectives (from Project Appraisal Document)

The PDO for Phase I of the Program (APL-1) is to improve planning and management of the Recipient’s sanitation sector as well as to provide access to sanitation services through pilot approaches in selected areas.

At the (first) restructuring, approved on April 3, 2015, the Financing Instrument was changed from an Adaptable Program Loan (APL) in Phase 1, to a regular Investment Project Financing (IFP) to refocus on the original pilot activities without reference to a Program as initially requested by the Client. Following OPCS guidance, the PDO was edited to remove the (APL-1) mention. Project (APL-1) Development Objective: To improve planning and management of the Recipient’s sanitation sector as well as to provide access to sanitation services through pilot approaches in selected areas.

Revised Project Development Objectives (as approved by original approving authority)

The PDO was not revised.

Revised PDO indicators

Indicator Baseline Value

Latest Target Values (from

approval documents)

Formally Revised Target Values

Actual Value Achieved at Completion

Indicator 1: Direct project beneficiariesValue (quantitative or qualitative)

0 2,042,688 731,128 619,960

Date achieved 05/27/2011 04/03/2015 11/16/2016 06/30/2017Comments (incl. % achievement)

Mostly achieved (85%)

Of which female beneficiariesValue (quantitative or qualitative)

0 51 51 51

Date achieved 05/27/2011 04/03/2015 11/16/2016 06/30/2017

Comments (incl. % achievement)

Fully achieved (100%)

Indicator 2: People provided with access to “improved sanitation services”Value (quantitative or qualitative)

0 318,000 126,878 116,564


Mostly achieved (92%).

Indicator 2.1: People provided with access to “improved sanitation services” urbanValue (quantitative or qualitative)

0 175,000 12,830 1,411


Marginally achieved (11%).

Indicator 2.2: People provided with access to “improved sanitation services” - ruralValue (quantitative or qualitative)

0 143,000 114,048 115,153


Achieved (101%).

Indicator 3: People washing hands with soapValue (quantitative or qualitative)

20 60 33 33


Partially achieved (55%).

Indicator 4: Primary and secondary school children provided with access to improved and gender-separated sanitation at school under the project

Value (quantitative or qualitative)

0 120,000 121,900 150,650


Exceeded (124%).

Indicator 5: Number of local authorities that have developed a community sanitation plan acceptable to the regional sanitation committee


0 20 17 17

Date achieved 05/27/2011 04/03/2015 11/16/2016 06/30/2017Comments (incl. Achieved (100%)

% achievement)

Revised Intermediate indicators

Indicator Baseline Value

Latest Target Values (from

approval documents)

Formally Revised Target Values

Actual Value Achieved at

Completion or Target Years

Indicator 1: (dropped)

New condominial household connections that are resulting from the project intervention


0 2,000 2,000 N/A

Date achieved 05/27/2011 04/03/2015 11/16/2016Comments (incl. % achievement)

Dropped at the second restructuring following the decision of not financing this activity under the Project.

Indicator 2: Improved latrines constructed under the projectValue (quantitative or qualitative)

0 42,500 17,800 16,353


Mostly achieved (91.5%)

Indicator 2.1: Improved latrines constructed under the project – urban componentValue (quantitative or qualitative)

0 22,500 1,800 198


Marginally achieved (11%).

Indicator 2.2: Improved latrines constructed under the project – rural componentValue (quantitative or qualitative)

0 20,000 16,000 16,155


Achieved (101%).

Indicator 3: New public latrines resulting from project interventionValue (quantitative or qualitative)

0 3,000 2,120 2,617

Date achieved 05/27/2011 04/03/2015 11/16/2016 06/30/2017Comments (incl. Exceeded (123%).

% achievement)Indicator 3.1: New public latrines in school and health centers – rural componentValue (quantitative or qualitative)

0 1,000 720 1,054


Exceeded (146%).

Indicator 3.2: New public latrines in school and health centers – urban componentValue (quantitative or qualitative)

0 2,000 1,400 1,563


Exceeded (112%).


Capacity of new sludge treatment plants built (M3/day)


0 300 480 N/A




Volume of BOD pollution loads removed by treatment plants financed under the project (tons/year)


0 250 720 N/A



Indicator 6: (added)

Number of schools provided with access to water supply under the project


N/A N/A 236 195

Date achieved 11/16/2016 06/30/2017Comments (incl. % achievement)

Added to the first restructuring. Mostly achieved (83%).

Indicator 7: (added)

Number of school provided with access to water supply under the project urban component


N/A N/A 30 28


Added to the second restructuring. Mostly achieved (93%).

Indicator 8:(added)

Number of school provided with access to water supply under the project rural component


N/A N/A 206 167


Added to the first restructuring. Mostly achieved (81%)

Indicator 9: School teachers trained in hygiene educationValue (quantitative or qualitative)

0 2,400 1,700 1,399



Indicator 9.1: School teachers trained in hygiene education – urban componentValue (quantitative or qualitative)

0 1,600 1,400 719


Partially achieved (51%)

Indicator 9.2: School teachers trained in hygiene education – rural componentValue (quantitative or qualitative)

0 800 300 680


Exceeded (226%).

Indicator 10: Masons trained and equipped to build latrines and provide sanitation services


0 500 650 500



Indicator 10.1:(added)

Masons trained and equipped to build latrines and provide sanitation services - urban component

Value (quantitative or

N/A N/A 400 250

qualitative)Date achieved 11/16/2016 06/30/2017Comments (incl. % achievement)


Indicator 10.2: Masons trained and equipped to build latrines and provide sanitation services - rural component


0 500 250 250


Achieved (100%)

Indicator 11: People trained to improve hygiene behavior under project Value (quantitative or qualitative)

0 750,000 480,000 466,555



Indicator 11.1: People trained to improve hygiene behavior under project – urban component


0 350,000 80,000 1,411


Marginally achieved (2%)

Indicator 11.2: People trained to improve hygiene behavior under project – rural component


0 400,000 400,000 465,144


Exceeded (116%)

People trained to improve hygiene behavior under project – of which female


0 298,000 245,000 237,943


Achieved (97%)


City Sanitation master plans developed under the project


0 5 N/A N/A


Dropped at the first restructuring following the decision of not financing this activity under the Project funds.


Sanitation Information Management System set up


No Yes N/A N/A


Dropped at the first restructuring.

Indicator 14: Number of person-hours of training provided to staff of agencies responsible for sanitation


0 14,000 10,000 74,046


Exceeded (740%)

G. Ratings of Project Performance in ISRs

No. Date ISR Archived DO IP

Actual Disbursements(USD millions)

1 09/21/2011 Satisfactory Satisfactory 0.00 2 05/27/2012 Moderately Satisfactory Moderately Satisfactory 0.00 3 11/24/2012 Moderately Satisfactory Moderately Satisfactory 0.94 4 06/18/2013 Moderately Satisfactory Moderately Satisfactory 1.26

5 12/22/2013 Moderately Unsatisfactory

Moderately Unsatisfactory 1.86



7 12/17/2014 Moderately Satisfactory Moderately Satisfactory 3.01 8 06/16/2015 Moderately Satisfactory Moderately Satisfactory 3.72

9 12/23/2015 Moderately Satisfactory Moderately Unsatisfactory 5.58







H. Restructuring (if any)

Restructuring Date(s)

Board Approved

PDO Change

ISR Ratings at Restructuring

Amount Disbursed at

Restructuring in USD millions

Reason for Restructuring & Key Changes MadeDO IP

04/15/2015 MS MS 3.38

(i) Change of financing instrument from APL to IPF; (ii) Extension of closing date; (iii) Revision of KPIs to reflect a modified scope of activities in view of budget and time constraints, and security concerns.

11/16/2016 MU MU 8.49

(i) Reduction in scope with the cancellation of the condominial sewerage systems and of the two proposed sludge treatment plants for Douala because of increased costs, delays, technical and institutional issues. Accordingly, US$5.0 million was cancelled.(ii) Revision of KPIs to further reflect a modified scope of activities in view of budget, time constraints, and funds cancellation.

03/22/2017 MU MU 10.54

(i) Extension of closing date by 3 months to complete the uptake of activities under Component 2 in the Far North, Adamaoua, East and North Regions.

I. Disbursement Profile

1. Project Context, Development Objectives and Design

1.1 Context at Appraisal

A. Country Context

1. Cameroon is located in Central Africa and had a population of 19 million in 20101. It is characterized by strong geographic diversity between the Sahelian North and the tropical South. Per capita income in 2006 was US$630, slightly more than the average across Sub-Saharan Africa. However, poverty was widespread, with about 40 percent of the population living under the poverty threshold of about US$1 per day. Cameroon was urbanizing, with half of the population living in cities. It remains a centralized country, but in the late 1990s moved toward decentralization. The decentralizing strategy consisted of two complementary pillars: deconcentration of central government administrative units, and, strengthening decentralized local governments in service delivery. Cameroon lagged behind several other countries in Africa on social indicators. After a period of continuous progress from the 1960s until 1992, life expectancy dropped from 54.8 years in 1992 to 45.7 years in 2004. Ranked 144th out of 177 countries tracked in the Human Development Index (HDI), it is one of a group of 20 countries for which the HDI worsened between 1990 and 2006. Cameroon is off-track in meeting most of the Millennium Development Goals (MDGs), its performance is weaker than countries with lower per capita incomes with respect to access to water, sanitation, and health care.

B. Sectoral and Institutional Context

2. Access. Access to sanitation in Cameroon was low and access to sewerage virtually non-existent. According to a 2007 household survey (Multiple Indicators Cluster Survey 3 [MICS-3]), access to improved sanitation was 33 percent nationwide - 52 percent in urban areas and 15 percent2 in rural areas. The lowest access rates are in the Far North (12 percent) and the North (16 percent). Only 1.8 percent of the urban population was connected to sewerage. While the number of people with access to drinking water rose from 50 percent in 1990 to 74 percent in 2008, access to sanitation did not increase. Less than 47.1 percent of preschools and 44.1 percent of primary schools had latrines which not only pose public health risks, but also lowers school attendance rates for girls. 3. Fifty-seven percent of urban dwellers and 11 percent of rural households had access to an improved latrine. In rural areas, 20 percent of people did not have access to sanitation and defecated in the open. The precolonial sewerage system in Douala and two more recent small sewer systems were no longer functioning. The low levels of access to sanitation posed important health risks. The 2004 World Health Organization Burden of 1 According to the latest Recensement Général de la Population et de l’habitation census published in 2010. 2 The figures of the United Nations Children’s Fund (UNICEF)/World Health Organization (WHO) Joint Monitoring Program are a bit higher, estimating access to improved sanitation at 56 percent for the urban population and at 35 percent in rural areas. Access to improved sanitation is defined as the proportion of population using one of the following facilities: flush toilet, piped sewer system, septic tank, flush/pour flush to pit latrine, ventilated improved pit (VIP) latrine, pit latrine with slab or composting toilet. 1

Disease Report established that diarrheal diseases caused by lack of water, sanitation, and hygiene (WASH) led to 18,300 deaths per year, and accounted for 13.4 percent of the burden of disease.

4. Sector challenges. Challenges to develop sustainable sanitation services included complex legal ministerial frameworks and overlapping institutional responsibilities. The recent decentralization process led to inaction from the central government (which was no longer responsible) and local authorities (who lacked the resources and/or capacity). In addition, financing for both investment and operations in sanitation have been close to zero. The World Bank Africa Infrastructure Country Diagnostic study estimated public expenditure on sanitation at 0.2 percent of gross domestic product (GDP) against an average of 0.5 percent of GDP in Sub-Saharan Africa. Households have been investing in sanitation with support from non-governmental organizations (NGOs). In addition, donors have financed small pilot projects including: the condominial systems piloted by the NGO ENDA in Douala, Bertoua, and Edea, the UNICEF-financed Community-Led Total Sanitation campaign in rural areas3, and, the Peri-urban Water Supply and Sanitation Project financed by the African Development Bank (AfDB).

5. There is a lack of capacity in sanitation planning and implementation at the central and local levels. A small functioning private sector for construction of household facilities exists, but the small market limits competition and drives up prices. Households have invested in sanitation, but access rates remain low due to high unit costs and lack of demand. Approximately 70 sludge collectors (vidangeurs) operate in urban areas; however, no agency has responsibility for sludge treatment. No hygiene education to promote sanitation exists beyond the ad-hoc campaigns in the wake of cholera outbreaks. 6. National Sanitation Strategy. The Government of Cameroon (GoC) prepared the National Sanitation Strategy in 2010 through technical assistance (TA) from the World Bank. The letter of sector policy outlining the strategic direction of the sanitation sector was adopted by the Ministry of Energy and Water (Ministère de l’Energie et de l’Eau, MINEE) and signed by the Prime Minister on May 12, 2011. The objectives of the strategy are to increase access to improved sanitation in urban and rural areas; and, to ensure a viable sanitation sector which provides affordable and financially and environmentally sustainable services. It proposes a demand-driven approach with a focus on hygiene education and sanitation marketing. The strategy focuses on basic sanitation including the development of individual facilities (latrines and septic tanks) and semi-collective low-cost technologies (small diameter condominial systems) coupled with sludge collection systems and sludge treatment stations. The development of conventional sewerage systems was determined to be unaffordable.

7. The Strategy has eight pillars: (a) Improving public health by promoting hygiene and stimulating demand for sanitation facilities, (b) Stimulating access to improved sanitation through targeted subsidies to increase the access rate from 34 percent in 2010 3 A new AfDB-financed Rural Water Supply and Sanitation Project became effective in 2010 and includes some sanitation pilots in the West, South-West, North-West and South Regions.

2

to 57 percent in 2020, (c) Contributing to environmental protection through improved fecal sludge management and monitoring the quality of wastewater, (d) Guaranteeing the viability and efficiency of services by improving the design, construction, and operation of infrastructure and by ensuring construction standards and contractual obligations, (e) Supporting decentralization by reinforcing local authorities’ regulatory and contract management capacity, (f) Making the cost of services affordable via targeted subsidies and cost recovery, (g) Ensuring financial viability by stimulating competition between service providers and introducing cost recovery from users for recurrent and investment costs, and (h) Evaluating impact on public health and the environment, institutional arrangements, financing mechanisms, financial incentives, and quality of sanitation services.

8. Institutional framework. Overall policy development and coordination will be with MINEE. MINEE will clarify the institutional arrangements for the operation and maintenance (O&M) of sludge treatment plants and public infrastructure, and ensure financial flows for O&M. Other ministries with important roles in the sector include: Finance, Public Health, Environment, Urban Development, Education, and Internal Affairs. Municipalities are to take the leadership in sanitation. MINEE will back stop local governments in cities, while playing a more direct role in rural municipalities. Local governments will prepare municipal strategic sanitation plans as a basis for assistance and will administer subsidies to households for contractor build facilities.

9. Cost and financing. High unit costs were an obstacle to increasing access to sanitation. A VIP latrine cost approximately US$380 in urban areas, representing 0.8 months of average household expenditure and 2.7 months for poor households (11 percent of the urban population). In rural areas, the cost was US$230, equivalent to 0.5 months of average household expenditure and 1.2 months of expenditures for the rural poor (89 percent of rural population). Based on this analysis, the GoC proposed to subsidize the pit and slab of a VIP latrine in the amount of US$44 per person in urban areas and US$21 per person in rural areas, reducing the cost for a VIP latrine to 0.3 month of income for the average urban and a poor rural household. Sludge collection and treatment in the first five years will be subsidized to change household behavior to regularly empty their pit and for sludge collectors to use treatment stations instead of illegal dumping. 10. The Strategy would require major investments despite the focus on cheaper technology. Total investment costs over ten years would be approximately US$600 million. This was equivalent to 0.27 percent of GDP, still well below average investment in sanitation in Sub-Saharan Africa of 0.5 percent of GDP. Approximately 70 percent of investment costs would be financed by the state which was deemed realistic given the expected level of donor financing and economic development. Annual recurrent costs were estimated at US$1.5 million, mostly on fecal sludge management, which would be fully recovered from users.

3

11. The financing plan of the strategy comprised household investments (27 percent of investment costs), GoC internal resources (22 percent), and donor financing (51 percent). For recurrent costs, the plan comprised household financing for latrine maintenance and sludge collection (77 percent of recurrent costs); a surcharge on water consumption to finance subsidies for sludge management (14 percent); and, a sewerage tariff for those connected to a piped network (9 percent). The introduction of the surcharge on water was a sensitive political issue, but represented only a small fraction of the plan. The financing plan would require transparent arrangements for making financial resources available to local authorities.

C. Rationale for World Bank intervention

12. There was sound rationale for Bank intervention in the sector. First, the proposed project was aligned with the Government’s Growth and Employment Strategy Document (Document de Stratégie pour la Croissance et 1’Emploi, DSCE). The project would support actions aimed at developing basic infrastructure, improving the institutional framework, administrative management and governance, and decentralization. It would contribute to improved health, water supply, and sanitation, and to reaching the following urban development MDG targets: (a) reducing the under-five mortality rate (Target 4A), (b) improving access to water supply and sanitation (Target 7C), and (c) improving the lives of slum dwellers (Target 7D).

13. Second, the project was included in the World Bank’s Country Assistance Strategy (CAS) for Cameroon for 2010-2013 as an FY12 deliverable. It would contribute directly to Strategic Theme 2: Improving Services Delivery (Item 3: Greater access to basic infrastructure and social safety nets). While the CAS proposed a Sector Investment Loan (SIL), the Project Concept Note proposed an Adaptable Program Loan (APL). The APL approach aimed at providing phased support for a long-term development program of sustained changes in institutions, organizations, and behavior, and building consensus around the benefits of the reform. The project was within the second pillar of the 2011 World Bank Africa Strategy (vulnerability and resilience) and contributed to the foundation of the sanitation strategy (governance and public sector capacity). It sought innovative solutions and followed the reverse order of World Bank instruments - putting partnerships first, followed by knowledge, and then finance. 14. Third, the project was part of the World Bank’s support to decentralization and local development. It would be informed by the ongoing economic sector work on fiscal decentralization and complement other World Bank-financed projects including the Community Development Program Support Project (Programme National de Développement Participatif, PNDP) in rural areas, and the Urban and Water Development Support Project (Programme de Développement des Secteurs Urbain et de l’Approvisionnement en Eau, PDUE) in urban areas. The PNDP was an APL in its second phase, while the PDUE was a SIL which had received additional financing. Basic sanitation was a private good and the project did not include mechanisms to finance sanitation beyond communal facilities for schools and markets. Its focus on preventing

4

diarrheal diseases was complementary to curative activities financed by the Health Sector Support Investment Project.

1.2 Original Project Development Objectives (PDO) and Key Indicators

15. The project was structured as a two-phase APL comprising several stages of reform and institution building combined with behavioral change followed by investments. It comprised two overlapping phases, the first phase (APL-1) would extend from 2011 to 2015 for a credit amount of up to US$30 million. The second phase (APL-2), for an amount of US$50 million, was expected to begin in 2014 after achievement of the defined targets/triggers. Proposed PDO for Program Objectives (series of APLs)

16. The PDO was to increase the quality of and access to sanitation services for the targeted populations. Each phase of the APL would contribute to the APL objective through its specific PDO. APL-1 would support the national policy and institutional framework, pilot new approaches to urban and rural sanitation, and strengthen systems and capacities in the context of the proposed reform. APL-2 would complement the capacity development activities and would finance the roll-out of proven infrastructure interventions. Proposed PDO for APL-1

17. The PDO for APL-1 was to improve planning and management of the recipient’s sanitation sector as well as to provide access to sanitation services through pilot approaches in selected areas.

Key Results (including ‘Triggers’ for APL-2 Operation)

18. Results would be measured at three levels: program indicators that measure the progress of the combined results of the various phases of the APL, project indicators that measure the results of APL-1, and triggers based on which the decision to move from APL-1 to APL-2 would be made. Key Performance Indicators (KPIs) at the program level were: (a) direct project beneficiaries and the percentage of which are female, (b) people in urban areas provided with access to “improved sanitation”, (c) people in rural areas provided with access to “improved sanitation”, (d) percentage of people washing hands with soap, and (e) primary and secondary school children provided with access to improved and gender-separated sanitation at schools under the project.

19. The program KPIs would also be used as PDO indicators for APL-1. In addition, the following PDO indicator for APL-1 would be used in the area of planning and management of the sector: number of local authorities that have developed a community sanitation plan acceptable to the regional sanitation committee. Proposed triggers focused

5

on satisfactory implementation of planned sector reforms and planned studies. Table 1 below presents the triggers in each of these areas.

Table 1: Triggers for APL-2

Area Trigger Evidence of satisfactory implementation of planned sanitation reforms

• Sanitation surcharge on water consumption in place • A transparent arrangement for making financial

resources available to the local authorities is in place • Institutional arrangements for the O&M of sludge

treatment plants in Douala established

Evidence of satisfactory implementation of planned studies

• Advanced preliminary designs for selected sanitation works completed satisfactory to IDA

1.3 Revised PDO (as approved by original approving authority) and Key Indicators, and reasons/justification

20. The PDO was not revised, but it was edited in 2015 when as part of the first restructuring the program (APL-1) was changed to an Investment Project Financing (IPF) for the following reason “to refocus on the pilot activities specifically planned in the project, without the reference to a Program as initially requested by the Client 4”. Following Operation Policy and Country Services’ guidance, the PDO was to be edited to remove the mention of APL-1. The edited PDO was: “To improve planning and management of the Recipient’s sanitation sector as well as to provide access to sanitation services through pilot approaches in selected areas”.

21. Revised Key Indicators. The KPIs were revised in 2015 as part of the first restructuring and the end target dates were changed to reflect the extension of the closing date. All (seven) PDO indicators were revised by reducing the end-of-project target values to reflect a modified scope of activities in view of budget and time constraints and security concerns. Twelve of the fifteen Intermediate Results Indicators (IRIs) were revised for the same reasons, while five new IRIs were added and five IRIs were deleted. The five IRIs deleted under Component 3 related to activities that were included as the triggers (Table 1) for the next phase (APL-2).

22. The KPIs were revised for a second time in 2016 as part of the second restructuring of the project5. Two of the seven PDO indicators were revised to reflect the second extension of the closing date. All 15 IRIs were changed to reflect the revised end-of-project targets. Four new IRIs were added and three were deleted. 4 Taken from - Restructuring Paper on a Proposed Project Restructuring of Cameroon Sanitation Project Phase 1 (APL-1) Adaptable Program Loan IDA 49840 - Board Approval June 23, 2011 - to the Republic of Cameroon, April 3, 2015.5 Restructuring Paper on a Proposed Project Restructuring of CM-Sanitation Project – approved on June 23, 2011 – to the Republic of Cameroon (approved by the Country Director on November 16, 2016).

6

1.4 Main Beneficiaries

23. The program targeted 2 million project beneficiaries including 1.6 million people in four districts in Douala and 400,000 people in the Far North. Just over half (50.6 percent) of the beneficiaries would be women. All project beneficiaries would benefit from hygiene education and sanitation marketing, and 318,000 people would benefit from partial subsidies for household sanitation. A subset of project beneficiaries would also benefit from latrines in schools. Urban dwellers would benefit from improved sludge collection and management. MINEE and Urban Community of Douala (Communauté Urbaine de Douala, CUD) staff and staff from other ministries involved in sanitation, would benefit from TA, training, and study tours to raise their capacity to improve sector planning and management and, in addition, establish institutional arrangements for the O&M of sludge treatment plants in Douala. Municipalities would benefit from the capacity building provided to prepare municipal strategic sanitation plans as a basis for assistance and to administer subsidies to households.

1.5 Original Components

Component 1: Urban Sanitation

24. This component would target pilot activities in Douala, based on the large investment needs given the city’s high density, flood risk, and endemic cholera. Four districts were selected based on income levels, health statistics, access to services, and the technical feasibility of on-site sanitation based on groundwater tables and hydro-geological characteristics. The component would finance: (a) design and implementation of outreach and education activities for hygiene education, sanitation promotion and creation of demand for sanitation through mass media campaigns, (b) construction of household latrines in Douala districts III and V comprising the construction of the latrine pit and slab while the household would finance the superstructure, (c) construction of small diameter condominial sewerage systems, including the network and treatment infrastructure in districts II, III, or IV in Douala where latrines and septic tanks are not an option given population density, groundwater levels, and soil composition, (d) construction of public toilets in schools and markets, (e) construction of two to three sludge treatment plants and partial subsidy to plant O&M using a Build and Operate contract and training vidangeurs, and (f) provision of TA and training to strengthen the capacity of the CUD to manage sanitation through capacity building for sanitation-related units, and component management and coordination.

Component 2: Rural Sanitation

25. The component will support hygiene promotion, marketing of household latrines, and latrine construction in the Far North, a region with high poverty levels, low rates of access to sanitation, and grim health statistics including periodic occurrences of cholera. The component would finance: (a) TA to local authorities to develop a sanitation plan and train a local cadre of sanitation workers, (b) a hygiene promotion campaigns targeted

7

at households, mothers, and school children, including training of community outreach workers responsible for promoting hygiene practices and building awareness about access to latrines using small-scale awareness-building campaigns, (c) assisting 143,000 people to get household latrines through a subsidy for the pit and slab while households would pay a deposit, contractors would dig the pit and build the slab, and the household would build the superstructure (and get back their deposit) or have it built by a mason, and (d) construction of 800 latrines in schools and 200 latrines in health centers.

Component 3: Institutional Strengthening and Project Management

26. The component would provide TA to sanitation institutions and to establish sustainable sector financing mechanisms. The component would finance: (a) TA to establish a cost recovery mechanism for sanitation and develop an arrangement to make financial resources available to local authorities, (b) capacity building of urban municipalities to take charge of the O&M of sludge treatment plants and ensure sustainable financial flows, (c) TA for sanitation planning at the national and local levels, including the development of sanitation master plans for selected cities and technical studies for Phase 2 investments, including soil studies, (d) support to local governments to set up monitoring systems and mechanisms to collect and convey data from the municipality to the central level, and (e) the costs of the Project Implementation Unit (PIU) in MINEE.

Components APL-2

27. Phase 2 would incorporate infrastructure investments complementary to those of Phase 1, including: (a) hygiene education, sanitation marketing, and latrine programs, (b) scale up of sludge collection and treatment, (c) the investment program in condominial sewerage in Douala and one or two other cities, and (d) continuation of the institutional strengthening and project management component.

1.6 Revised Components

28. With the first restructuring in 2015, Component 2 was revised to include boreholes and school latrines in the Adamaoua, East, and North Regions transferred from the closed IDA-funded Education Development Capacity Building Project (P075964). The cost of Component 2 was increased to US$5.9 million, and end-of-project targets of three activities were revised. The activities the restructured Component 2 would finance, taken from the Project Restructuring Paper, April 3, 2015, are shown in Annex 8.

29. As part of the change from an APL to an IPF at the first restructuring in 2015, the activities of Component 3 that were the triggers for APL-2 were cancelled as were the activities of Components APL-2. The costs for Component 3 were reduced from US$5.3 million to US$2.7 million. The savings in component costs were transferred to Component 1 to cover the projected increase in costs for the sludge treatment plant (costs of Component 1 increased from US$19.4 million to US$21.4 million). In addition, the

8

end-of-project targets for 10 activities of Components 1 and 2 were revised to reflect the increased implementation time with the extension of the closing date. The description of the activities the restructured Component 3 would finance are shown in Annex 8.

30. With the second restructuring in November 2016, the financing of two major activities of Component 1, the condominial sewerage systems and the two to three sludge treatment plants was cancelled. The connection of schools to the water supply was added and the end-of-project targets of five activities were revised. The activities the restructured Component 1 would finance are shown in Annex 8.

1.7 Other significant changes

31. First project restructuring - changes in scope. To cope with the slow start and early significant set-backs (with staffing and procurement) in the first three years of implementation, the project was restructured in early 2015, reducing the scope by cancelling two activities of Component 3 related to the APL triggers. The financing instrument was changed from an APL to an IPF changing the project focus from a program of sustained changes in institutions and behavior to concentrating on implementing the pilot activities. The activities of the proposed APL-2 and proposed second phase financing of US$50 million were cancelled. The Restructuring Paper makes no mention of progress with institutional capacity building to manage sector planning and management at MINEE and the PIUs and the readiness of the PIUs to commence work on pilot sanitation facilities in Douala and the Far North. This omission may have hampered efforts to accelerate implementation which required a second restructuring.

32. Second restructuring – further changes in scope and funding. The 2015 restructuring was followed some 19 months (November 16, 2016) later with the second restructuring resulting in further reduction in scope with the cancellation of the condominial sewerage systems for Douala because of increased costs, delays, technical and institutional issues, and the cancellation of the two proposed sludge treatment plants (at Bois de Singes and Ngombe6). Moreover, as part of the second restructuring, US$5.0 million was cancelled, as these funds were not going to be spent, given the cancellation of the sewerage systems and sludge treatment plants.

33. Third restructuring. Four months later, on March 22, 2017, the third restructuring was approved to provide more time to complete the uptake of activities under Component 2 in the Far North, Adamaoua, East and North Regions. The closing date was extended by three months till June 30, 2017.

2. Key Factors Affecting Implementation and Outcomes

2.1 Project Preparation, Design and Quality at Entry6 The (CUD) government eventually informed the Bank of its intention to use the Bois des Singes site (which had been a sludge dumping site for years) to build high rise residences. The construction of the sludge treatment plant at Ngombe has been transferred to the proposed IDA financed Inclusive City Project approved in 2017 (P156210).

9

34. Responsiveness to government priorities. The Project was prepared to respond to the Government’s focus on developing basic infrastructure, improving the institutional framework, administrative management and governance, and decentralization. Preliminary studies of the constraints to urban and rural sanitation led to the choice of densely populated districts in Douala where different technical options were assessed. The Far North, a rural region with high poverty incidence and low access to sanitation was selected to pilot low-cost latrines. The project was also informed by the ongoing economic sector work on fiscal decentralization and complemented other Bank-financed projects. However, given that the sanitation strategy was relatively new, there was a lack of familiarity with the project approach in the Government, including the lead ministry MINEE and in the CUD.

35. Choice of APL. The project was initially structured as a two-phase APL comprising several stages of reform and institution building combined with behavioral change followed by investments. The choice of an APL recognized that, at preparation, the sanitation sector, lacking demand, capacity and funding, required capacity building first, followed by mass campaigns to create demand for sanitation and change of behavior. The APL approach aimed at providing phased support for a long-term development program of sustained changes in institutions, organizations, and behaviors, and building consensus around the benefits of the reform.

36. Implementation readiness. The project was prepared quickly in four months despite the fact that it was the first operation in the sanitation sector and no sanitation expertise or experience existed. However, the scope of the project in terms of complexity of components and projected results, as well as the short implementation period, was ambitious. The short preparation may have led to quick decisions about project scope based on inadequate analysis of demand and institutional capacity for sanitation.

37. Adequacy of government’s commitment. At appraisal, the government appeared to be committed to the project considering their support to the development of the new National Sanitation Strategy. The preparation benefited from a large mobilization of a wide variety of stakeholders, a process that was facilitated by the Government. Also, the Government agreed to commit counterpart funding to support the project realization. However, the initial positive momentum was not maintained during implementation as discussed in subsequent sections.

38. Four areas of risks were identified and corresponding mitigation measures built into the design. The risk of reluctance to the introduction of the new approach of the project would be addressed by raising awareness of the orientations of the new National Sanitation Strategy. The risk of unaffordability of sanitation for households would be offset by providing subsidies. The risk of inadequate capacity would be tackled through well-designed multi-pronged capacity building programs. Risks to project sustainability would be mitigated through an adequate cost recovery system for public facilities and a demand-driven approach for household facilities. Continued dialogue

10

between the central government and municipalities would hedge against sector risks. The overall project risk was not rated; neither were the individual areas of risk. Also, technical risks were not assessed or mitigated.

2.2 Implementation

39. Effectiveness delays. After early approval on June 23, 2011, the GoC missed two effectiveness deadlines. The project became effective with a delay of six months by June 26, 2012. Start-up was delayed by difficulties with recruiting staff to the PIUs (experienced staff recruited from the AfDB project left the PIU early) and because staff in the ministries or CUD responsible for sanitation had limited knowledge of the project.

40. Centralization of Procurement. A major obstacle to implementation occurred early on in June 2012 when the GoC announced the centralization of all public procurement under a new ministry (Ministere des Marches Public-MINMAP). Implementation came to a standstill while donors negotiated with the GoC about procedures, staffing, and authority of the new ministry. This process caused implementation delays estimated at 12 or more months despite efforts by the Bank to accelerate implementation. For example, the recruitment of the TA for the rural Component took 18 months.

41. Restructurings to accelerate implementation. The first few studies were started in June 2014 and a small number of contracts for latrines and technical studies were signed in late 2014, but new problems arose due to security concerns in the Far North. Given this lack of progress and in view of the August 2015 closing date, discussions to restructure, to accelerate implementation and extend the closing date were taken-up by both the GoC and the Bank. Through the first restructuring, the financing instrument was changed from an APL to an IPF, changing the project focus from a program of sustained changes in institutions and behavior to concentrating on implementing the pilot activities. The closing date was also extended by 19 months.

42. Slow uptake of latrines and design constraints. By the end of 2015, work on latrines had started. Bid preparations for the major works in Douala – the condominial sewerage and sludge treatment plants - were in an advanced state. However, given time and costs constraints and design issues with these works, a decision was taken to: (i) reduce the scope of the treatment plants; and, (ii) not to proceed with the condominial sewerage systems. Poor performance of the supervising contractor, slow uptake of latrines in Douala, and land issues around the site for the sludge treatment plants led to further delays. Calls for further restructuring to accelerate implementation by reducing project scope led to the approval of the second restructuring in November 2016. The financing for condominial sewerage systems and for the remaining sludge treatment plant at Ngombe was cancelled. Renewed efforts were made to construct both household and public latrines, and connect schools to the water supply, especially in the Far North, Adamaoua, East and North regions. In Douala, only as late as December 2016 did construction of latrines commence based on interest expressed by 800 households.

11

However, because most households preferred flush latrines (the project offered only dry ones), only 161 households made the required deposit. Similarly, water supply to schools in Douala experienced delays because of the preference for flush latrines. In the Far North, lack of capacity and security issues hampered implementation progress. However, flexible response from the MINEE-PIU and the World Bank team induced an uptake in demand for dry latrines in rural areas. To allow extra time to complete construction of latrines in the north, a third restructuring to extend the closing date to June 30, 2017 was approved late in March 2017.

2.3 Monitoring and Evaluation (M&E) Design, Implementation and Utilization

43. Design. The project included a Results Framework well aligned to the PDO. Key outcome and output indicators were clearly aligned with the project objective, except for specific indicators to measure the institutional capacity development (Component 3) which were missing. The Project Steering Committee (Comité de Pilotage) chaired by MINEE with representatives from the ministries of Housing and Urban Development, Economy, Planning, and Regional Development, and, of the Urban Government of Douala provided oversight, guidance and monitored implementation.

44. Implementation. In September 2012, the PIU in MINEE had acquired staff to implement the M&E system. Slow implementation during the first three years meant that there were only few activities to monitor. The ISRs were candid in reporting and included regular updates of the Framework indicators. These were taken from the reports prepared regularly by the MINEE-PIU’ M&E staff who visited construction sites and monitored works. The aide memoires mention only one meeting of the Steering Committee related to progress monitoring.

45. Utilization. The PIU-M&E staff did use their monitoring reports and photos to inform communities about the purpose and activities of the project. The M&E reports were used by the supervision missions to figure out the adjustments and revisions of the end-of-project targets of the Framework indicators at the three restructurings. The MINEE-PIU also designed a geo-referenced web-site with visuals of every sanitation work and borehole constructed to enable monitoring and evaluation paving the way for a digital M&E platform. M&E data provided relevant data to assess project outcomes and impact on beneficiaries during the preparation of the ICR.

2.4 Safeguard and Fiduciary Compliance

46. Relevant safeguard policies were identified at appraisal and no additional safeguard policy was triggered during implementation. The project triggered two safeguard policies including Environmental Assessment (OP 4.01) and Involuntary Resettlement (OP 4.12).

47. Environmental Assessment (OP 4.01). The project was designated Category B and Environmental and Social Management Framework (ESMF) was

12

prepared at appraisal. Increased access to sanitation and disposal of sludge were expected to have positive impact on health, quality of life, and reduced pollution. Adverse impacts during construction of the sludge treatment plants and public latrines were considered likely to be small, typical of Category B projects. The GoC had prepared the Environmental and Social Management Framework (ESMF) which had been disclosed in Cameroon and the Bank’s InfoShop in May 2011. However, environmental staff was appointed only in October 2013. In addition, World Bank supervision found that the construction contracts for sanitation facilities did not systematically include relevant environmental clauses and that PIU staff unevenly monitored environmental aspects during construction. For these reasons, environmental safeguards were rated MU at closing.

48. Involuntary Resettlement (OP/BP 4.12). The Resettlement Policy Framework (RPF) was prepared and disclosed in the country and at the Bank’s InfoShop in May, 2011. A Social specialist was appointed only in December 2014. The project did not establish a Grievance Redress Mechanism (GRM). Also, the reimbursement of households who made a deposit without receiving a latrine wat not completed at the time of the Project closing. This issue remains unresolved despite efforts by the Bank at closing to refund the deposits.

49. Financial management. Based on the Financial Management (FM) assessment, the FM responsibilities were shared between MINEE and the CUD. The overall FM risk rating was considered moderate considering mitigating measures which included the recruitment of a qualified financial specialist and accountant at the PIU-MINEE, updating of the existing Project Implementation Manual (PIM), upgrading the computerized information system, opening designated accounts, and, recruitment of an external auditor. Internal control issues raised by the 2016 audit were adequately addressed and the last two external audit reports contained unqualified opinions. The project complied with the Bank FM guidelines.

50. Procurement. Procurement risk was rated Moderate considering mitigation measures encompassing the appointment of a procurement specialist, preparation of an updated Procedures Manual, and satisfactory record keeping. Procurement was performed in compliance with Bank guidelines despite repeated delays in the submission of the relevant reporting documents. The World Bank carried out an assessment of the procurement capacity of the implementing agencies before project preparation and recommended capacity strengthening. The recommended training was delivered during implementation.

2.5 Post-completion Operation/Next Phase

51. At closing, the transfer of the financing of the Ngombe sludge treatment plant to the approved FY18 IDA-financed Inclusive Cities Project was confirmed7. This new project is addressing the lack of sludge treatment in Douala, a city of 2.5 million with

7 Report No: PAD1779

13

regular cholera outbreaks. In the Far North, Adamaoua, East and North regions where the project increased access, the satisfaction with the project sanitation facilities by authorities and households is high. But, these regions remain poor with very limited public or private funds to undertake sanitation works in the face of severe water scarcity and security threats. The MINEE and CUD are looking for ways to continuously improve access in the Far North and in the rest of the country, but had no concrete plans at closing.

52. The Bank is also exploring opportunities to support improved sanitation under upcoming environmental, education and social development projects, or through a dedicated project. The 2017 Cameroon Country Partnership Framework for the period FY17-FY21 focusses on: addressing the rural poverty gaps especially in northern regions, fostering infrastructure and private sector, and, improving governance. Addressing rural poverty would include increasing access to improved sanitation facilities and water supply possibly as part of a proposed FY18 Public Finance Management for Service Delivery Reform Project.

3. Assessment of Outcomes

3.1 Relevance of Objectives, Design and Implementation

Relevance of Objectives: Substantial (Pre- and Post-restructurings)

53. The objectives to improve planning and management of sanitation and provide access to sanitation services were relevant in 2011 at appraisal, considering low access to sanitation and high incidence of sanitation related diseases. The objectives remained relevant at closing in 2017. At appraisal, the objective was consistent with the FY10-FY138 Country Assistance Strategy (CAS) for Cameroon, specifically Strategic Theme Two: Improving Service Delivery which explicitly mentioned an Urban Sanitation Project9. The objective remained aligned with the FY17-FY21 Country Partnership Framework for Cameroon, specifically Focus Area 1: Addressing Multiple Poverty Traps in Rural Areas (with a focus on northern regions): Improved access to local infrastructure. The objective is also aligned with the current government National Sanitation Strategy with a ten-year horizon. The relevance of the objectives is substantial both pre-and post-restructuring since the PDO remained the same.

Relevance of Design and Implementation (Modest – Pre- and Post-restructurings)

54. Component 1: Urban Sanitation and Component 2: Rural Sanitation directly supported the PDO “access to sanitation services through pilot approaches” through the provision of sanitation facilities and the promotion of hygiene in both urban and rural areas. Component 3: Institutional strengthening and project management directly

8 This CAS was later extended until 2015.9

14

supported the PDO “Improve planning and management of Recipient’s sanitation sector” by providing technical assistance to establish sustainable financing mechanisms and support the development of sanitation master plans for selected cities and technical studies for Phase 2 investments, including soil studies to enable the choice between on-site sanitation and condominial sewerage.

55. The initial project design relied on a combination of key innovative approaches relevant to sanitation in Cameroon. Focus on capacity building, creating demand for sanitation, followed by the construction of sewerage and sludge treatment infrastructure in Douala and simple latrines in Douala and the Far North were addressing the most pressing needs for improved sanitation. The design was ambitious considering the novelty of the approach and the limited expertise and experience with sanitation in the country (Section 2.1). However, the focus on the poor, the targeting of densely populated districts of Doula, and the construction of sludge treatment plants were and remained relevant to the context. Similarly, choosing poor, dry and low density areas in the Far North for simple affordable latrines that could be built by the households themselves was also a well-adapted design at project appraisal and remained so at project closing. However, challenges associated with institutional weaknesses and lack of capacity were underestimated leading to successive restructurings (Section 2.2).

56. The Results Framework included a good mix of intermediate and project outcome indicators. Intermediate outcomes were well stated and a causal chain to objectives soundly established, as indicated in the PAD and in the restructuring papers.

57. Commencing with implementation capacity building in the original APL was relevant given the lack of prior implementation experience. But, progress with capacity building was hampered by delays in project effectiveness followed by a significant further slowdown from the Government’s decision to centralize procurement. It was further deterred by slow staff recruitment for the two PIUs, and delays with counterpart funding. Efforts by the Bank to accelerate implementation by reducing project scope (e.g. cancellation of the condominial sewerage systems for Douala, and of the two proposed sludge treatment plants (at Bois de Singes and Ngombe), changing the financing instrument and extending the closing date stimulated implementation only marginally (Section 2.2). Thus, the relevance of design and implementation is rated as modest both pre- and post-restructuring.

3.2 Achievement of Project Development Objectives

PDO#1: To improve planning and management of the Recipient’s sanitation sector – Modest (Pre- and Post-restructuring)

15

58. The project met its revised target of approval of seventeen local sanitation plans prepared by the Municipal Councils and approved by the regional sanitation councils. The objectives of the plan are to identify the location for the construction of the institutional latrines. In the Far North and adjacent region there is evidence of improved management and planning as also reflected in the successful implementation of the pilot latrines and the training of masons. However, even though small improvements in planning and managing sanitation have been achieved, implementation was hampered by lack of expertise. The study to institute a sustainable financing mechanism for the sector was not undertaken while only a small number (12) staff of MINEE and of the MINEE-PIU had been trained in sanitation planning and management. The experience with the design of sewerage, sludge treatment and latrine may provide information and models for future planning activities. However lack of experience with sludge management undermines long-term sanitation planning in Douala. Thus, even though the project substantially met the original target of 20 plans and achieved the revised target of 17 plans, given the mixed results in use of these plans for management, a rating of Modest is proposed pre-and post-restructurings.

PDO#2: To provide access to sanitation services through pilot approaches in selected areas (Pre-restructuring – Modest and Post-restructuring – Substantial)

59. The project helped provide 116,564 people with access to improved sanitation facilities including 1,411 people in urban areas and 115,153 in rural areas. Significant progress has been made with increasing access to sanitation in the Far North and adjacent regions through the construction of some 16,000 household and 1,000 public latrines plus almost 170 boreholes and pumps providing water to schools and their adjacent communities. The demand for access to sanitation and water increased substantially and the project succeeded in developing a model latrine that is affordable and can be locally constructed. Masons were trained to continue construction and expansion of access. In Douala, even though the output of household latrines (198 units) is negligible, almost 1,600 public latrines at schools had been constructed and 28 schools connected to the water supply at closing. The project substantially met the revised targets of 17,000 latrines and over 200 boreholes in the Far North, and 1,800 private and 1,400 public latrines and 32 schools with access to water in Douala.

60. The project also significantly contributed to promoting hygiene education. At project closing, around 466,555 people had received hygiene education nation-wide and it is estimated that one third of them now wash their hands with soap (after toilet use). This also included training of around 1,400 teachers to promote hygiene behavior such as handwashing. The hygiene education campaigns helped increase demand for access to sanitation, particularly in the rural areas of the Far North. In Douala, these campaigns have had only limited outcomes as there is still no significant increase in demand for sanitation.

16

61. Given that the project met 36 percent of the original target of people provided with access to sanitation and 92 percent of the revised target, a Modest rating pre-restructuring and Substantial rating post-restructuring are assigned.

3.3 EfficiencyRating: Modest (Pre- and Post-restructuring)62. At appraisal, the ex-ante economic analyses focused on the urban sanitation component of the project. The ex-post analysis includes all components and all project costs. This was done to capture the shift in benefits from the urban to the rural component as a result of the restructurings. Thus, the ex-post Cost Benefit Analyses (CBA) includes: (a) the urban sanitation subcomponent for households, (b) the urban sanitation subcomponent for schools, (c) the urban water supply subcomponent for schools, (d) the rural sanitation subproject for households, (e) the rural sanitation subproject for schools, and (f) the rural water subproject for schools (Annex 3).

63. Improved sanitation in Douala and in rural areas generated benefits including: (a) avoided health expenditures due to decrease in illness, (b) income gained due to decrease in illness-related absenteeism, (c) income gained due to decrease in child illness related absenteeism among caretakers, (d) opportunity cost of school absenteeism, (e) estimated value of loss-of-life avoided as a result of improvements in water and sanitation, and (f) estimated value of time savings resulting from improved of access to sanitation. In addition, improved access to water in schools in Douala and in rural areas generated benefits including: (a) health benefits associated with access to safe drinking water, and (b) benefits from time saving due to access to water.

64. While the ex-ante CBA of the project yields an Economic Internal Rate of Return (EIRR) of 18.6 percent and a NPV of US$19.4 million, the CBA of individual subcomponents revealed significant variations. The EIRR for the different subcomponents ranges from minus 6.5 percent for the urban sanitation of household subcomponent to 73 percent for the urban water supply for the schools subcomponent. Table 2 summarizes the results of the economic analysis.

Table 2: Summary of the Economic Analysis of the Project

Subproject or subcomponent

NPV (USD) at 5 percent discount

rate

EIRR (percent)ICR

ERR (percent)Appraisal

Urban sanitation subproject for households

-599,019 -6.5 19.78

Urban sanitation subproject for schools.

3,283,461 42.8 NA

Urban water supply subproject for schools

415,263 73.0 NA

Rural sanitation subproject for

11,544,443 33.7 NA

17

households.Rural sanitation subproject for schools

728,579 8.7 NA

Rural water subproject for schools

6,612,950 34.7 NA

Overall project 19,400,000 18.6 NA

65. In terms of administrative efficiency, the Project suffered significant delays due to effectiveness delays, Government’s decision to centralize procurement, delays in counterpart funding among other activities (Section 2.2). The Project was extended for a total of 22 months as a result of the delays.

66. Efficiency is rated as modest pre-and post-restructuring based on the mixed results in terms of EIRR among the activities of the three components that resulted in an overall EIRR of 18.6 percent for the project, as well as delays in implementation.

3.4 Justification of Overall Outcome Rating

Rating: Unsatisfactory67. Even though the PDO remained the same, a split evaluation has been done due to the significant change in targets for some key indicators. The team considered the November 2016 restructuring for the split evaluation where the targets were changed significantly. However, the overall outcome ratings remained ‘Unsatisfactory’ both pre-and post- restructuring as shown in the table below.

Table 3: Split evaluation

Against Original PDO targets

Against Revised PDO

targetsRelevance Relevance of Objectives Substantial SubstantialRelevance of Design & Implementation Modest ModestEfficacy PDO1: ‘Improve the planning and management of the Recipient’s sanitation sector

Modest Modest

PDO2: Provide access to sanitation through pilot approaches in select areas

Modest Substantial

Efficiency Modest ModestRating U URating value 2 2Weight (% disbursed before/after PDO change) 45% ($8.5/$18.7) 55%Weighted value 0.9+1.1Final rating 2 - Unsatisfactory

18

3.5 Overarching Themes, Other Outcomes and Impacts

(a) Poverty Impacts, Gender Aspects, and Social Development

68. Albeit on a small scale, the project resulted in providing poor people, a small number in Douala and a significant number in the Far North and adjacent regions, with sanitation facilities, thus positively affecting their poverty by freeing up time and improving their health and hygiene. In particular, women and school girls were affected positively thanks to gender separated latrines. Moreover, schoolgirls now have access to water for washing which reduces the incidence of water related diseases and school absenteeism. This is a significant outcome given that girls tend not to attend schools that have no sanitation facilities. Also, school children and families that have access to latrines and to water as a result of the project save the time previously spent on water fetching. Project activities in these areas had raised people’s demand for sanitation and their awareness for hygiene. (b) Institutional Change/Strengthening

69. MINEE and the communities where sanitation plans were developed experienced few institutional changes. MINEE now has a sub-directory for sanitation while CUD has a small sanitation unit. Several towns and villages now have staff trained in sanitation and hygiene, as well as masons trained in the construction of sanitation facilities. In addition, technical specifications and documents provide valuable tools and standards for planning further expansion of access based on affordable and locally built sanitation facilities.

(c) Other Unintended Outcomes and Impacts (positive or negative)

70. The construction of school latrines and boreholes in the northern and eastern regions generated positive unintended outcomes. In these conflict-affected regions, some orphans and displaced families now have access to latrines and to water. This represents a major benefit in these areas that face severe water scarcity and prolonged droughts in addition to serious security threats.

3.6 Summary of Findings of Beneficiary Survey and/or Stakeholder Workshops

No beneficiary survey was undertaken to prepare the ICR.

4. Assessment of Risk to Development Outcome Rating: Substantial

71. Risk to Government and stakeholder engagement. Although the project seemed to enjoy a high level of support from government at appraisal, the level of commitment declined through implementation (Section 2.1 and section 2.2). However, this is balanced by the high level of appropriation of the project results that project

19

beneficiaries continue to exhibit especially in rural areas. Engagement risks are rated Moderate.

72. Risk to sustainability of infrastructure. The main risk to the water and sanitation facilities especially in Douala is that of vandalism affecting water taps in schools, and pumps in the rural areas. These risks are rated Substantial.

73. Risk to O&M implementation. For the latrines, the simplicity of the design adopted reduces the O&M requirement most of which can be achieved by the beneficiaries or by the masons. The only other risks to the outcomes is shortage or lack of water at schools in the city to clean latrines and wash hands and more so in the rural areas during the dry season. In general though, the continued limited institutional capacity and funding pose an O&M risk for public sanitation facilities financed by the project. These risks are rated Substantial.

74. Based on the analysis above, the overall risk to development outcomes is rated Substantial.

5. Assessment of Bank and Borrower Performance

5.1 Bank Performance (a) Bank Performance in Ensuring Quality at Entry Rating: Moderately Unsatisfactory75. Design choices made at appraisal including the focus on the APL with the sequence of capacity building and behavior changes were sensible. Also, the selection of poor densely populated neighborhoods in Douala, the building of sewerage and sludge treatment plants in that city that lacked both, or simple (dry) latrines in areas with high water tables seemed appropriate. Similarly, proposing simple latrines that could be built by local masons was adequate (Section 3.2). However, the project was prepared hastily, as had the sanitation strategy and there was a lack of familiarity with and limited commitment to implement the project in the Government, including the lead ministry MINEE and in the CUD (Section 2.1). In hindsight, for a pioneer project in the sector, the technical complexity of the project appears to have been underestimated. Also, the 4-year implementation period was too ambitious given the limited capacity of the two PIUs.

(b) Quality of Supervision Rating: Moderately Unsatisfactory76. The Bank supervision mobilized an adequate mix of expertise including environment, procurement and sanitation specialists led by the TTL who had appraised the project. Early on, however, the TTL was replaced and the team encountered issues including the unavailability of counterpart funding and lack of capacity and familiarity with the project among the ministry and PIUs staff. The supervision teams actively tried to address these issues, but ran into obstacles with the GoC’s decision to centralize procurement under a new ministry.

20

77. Focus on development impact. While the Bank team reduced the scope and activities of the project to accelerate implementation and keep focus on development impact, these efforts were only partially effective. The impacts of a second and third restructuring helped maximize the project impacts in rural areas, but not in Douala (Section 3.3).

78. Adequacy of supervision inputs and processes. Despite the supervision missions, frequent video-conferences and meetings with Yaoundé-based staff, it was difficult for the team to overcome the many implementation challenges. Implementation issues especially around procurement accumulated due to delays with project staff appointments, cost increases of works, and further delays with counterpart funding (Section 2.2).

79. Supervision of fiduciary and safeguard aspects. The Bank team provided sufficient implementation support to address fiduciary and safeguard issues and ensured compliance (Section 2.4).

(c) Justification of Rating for Overall Bank PerformanceRating: Moderately Unsatisfactory72. Overall performance of the Bank is rated Moderately Unsatisfactory.

5.2 Borrower Performance(a) Government PerformanceRating: Moderately Unsatisfactory80. The Government demonstrated some commitment to the sanitation agenda through the preparation and approval of a new National Sanitation Strategy in 2011 that the project would help implement (Section 2.1). However, there were delays in meeting effectiveness conditions, appointing PIU staff and providing counterpart funding. Also, the establishment of a centralized Ministry in charge of procurement significantly complicated implementation of the project during the early years (Section 2.2).

(b) Implementing Agency or Agencies PerformanceRating: Moderately Unsatisfactory81. Despite shortcomings in dealing with the changes in national procurement procedures, ensuring timely availability of counterpart funding and improving capacity to plan and manage sanitation at the line ministry, the PIU responsible for the rural component in the northern regions managed to achieve almost 100 percent of the target value for household latrines, close to 150 percent for public latrines and 85 percent for boreholes. This achievement was possible notwithstanding recurrent terrorist attacks, dry spells and a highly-dispersed population. The CUD-PIU responsible for the large (initial costs US$28.5 Million) component in Douala that included sewerage, sludge treatment, household and private latrines was set-back by slow staffing, delays with procurement and counterpart funding. It was unable to address the underperformance of the supervising consultant which caused problems with studies, works, contracts, supervision and payment of contractors. The CUD was also not able to build adequate capacity to implement the project.

21

(c) Justification of Rating for Overall Borrower PerformanceRating: Moderately Unsatisfactory82. Overall Borrower performance is rated moderately unsatisfactory.

6. Lessons Learned

83. Designing sanitation projects that include access to water supply contributes to maximize impact on hygiene and sanitation (Section 3.2). The initial design of the project did not include provisions for water supply because the consensus at preparation was that dry latrines were the most suitable and affordable option for both urban and rural pilot areas. However, a lesson learned early in implementation was that access to water for cleaning and handwashing were paramount to improved hygiene and sanitation. During implementation, parents and staff voiced that associating access to water and access to latrines would be more conducive to improved hygiene and reduced hygiene-related diseases among students, especially girls. This led to a shift of focus, emphasizing water supply activities to enhance sanitation outcomes.

84. Designing a project for the first time in a sector demands a realistic timeframe, scope and expected outcomes (Section 2.1). The project was the first in the sanitation sector and its ambitious timeframe, scope and associated targets proved considerably challenging to implement. Counterpart staff unfamiliar with sanitation project implementation faced a steep learning curve. The resulting implementation bottlenecks hindered implementation progress. Substantial risks associated with pioneer projects demands that the timeframe, scope and associated Results Framework be realistic and flexible to address unanticipated implementation obstacles.

85. Complex sanitation projects with large numbers of installations require the use of modern technologies for monitoring from the start (Section 2.3). The project staff initially used computers to keep track of latrines and boreholes constructed under the project. Subsequently, the PIU designed a geo-referenced web-site with visuals of every sanitation activity and borehole constructed to track progress. This substantially facilitated monitoring of the project especially given the multiple small size facilities constructed in remote and dispersed areas. The use of the digital platform and integrated management information systems can provide an efficient and effective way to track project progress.

86. Sanitation projects must be designed to facilitate adaptability of design and construction of facilities (Section 3.2). Although the PDO mentioned that access to sanitation would be achieved through pilot approaches, implementation in both urban and rural pilot areas suggested that flexibility, adaptability and innovation with design and construction are essential to the success of the project. Particularly in rural areas, latrine and borehole designs had to remain affordable and be adapted to local conditions such as the presence of pests, constraints of low water-tables and specific conditions of the beneficiaries. Also in urban areas, frequent design adjustments were necessary to

22

account for the preferences of households or to enable accessibility for emptying services. Flexibility is fundamental to projects that involve a multitude of sites with different requirements.

87. The design of interventions tailored to the demand of beneficiaries is essential to achieve scaled-up impact (Section 3.2). The decision taken during preparation of the project to implement dry latrines in the urban areas did not reflect the actual demand of the population. A more proactive assessment of the actual demand would have avoided proposing dry latrines in Douala where the preference of the population was for flush latrines.

88. The impact of sanitation (and water supply) access is much greater in areas where poverty is most pervasive (Section 3.2). Initially, the pilot sanitation activities in the poor north were relatively modest compared to those in urban areas. However, it became apparent that the need for better sanitation are much greater and serious in areas with little or no sanitation, where communities and citizens lack the means to develop sanitation and where the consequences of poor sanitation on people’s health and on schooling are much more pronounced than in the cities. Moreover, illnesses from poor sanitation are much more costly and difficult to deal with in poor rural areas where access to adequate health care is much more challenging.

89. Land availability is one of the key binding factors in the design of sludge treatment plants (Section 2.2). Confirmation of the availability of land is critical and essential at the planning stage prior to commencing detailed design studies. The availability assessment needs to factor in environmental and social considerations. Failing to do so can lead to considerable delays.

7. Comments on Issues Raised by Borrower/Implementing Agencies/Partners (a) Borrower/implementing agencies90. The Borrower recruited a consultant to assist with the preparation of the government ICR for the project. The final report came out in June 2017. In the (English) summary attached as Annex 5, the report assesses the project relevance and effectiveness as satisfactory, efficiency as unsatisfactory and the project sustainability as likely. It points to low levels of involvement of key stakeholders in the preparation of the communal sanitation plans, the limited use of these plans, the lack of media involvement in the hygiene education campaign and limited role of the Steering Committee as the main reasons for the limited benefits of the project. It points to complex Bank procedures and weak M&E as the main implementation problems.

91. The Annex 5 also provides a summary of the comments of the Implementing Agencies on the draft World Bank’s ICR. The comments received from the Implementing Agencies generally further highlight the key factors having affected positively or negatively the implementation of the Project, such as the centralization of procurement that caused implementation delays, the inadequacy between the proposed design of latrines and the actual demand from the urban population in Douala, the

23

relevance of the Project’s restructuring that allowed to maximize the impacts of the Project through the transfer of funds from the urban to the rural component and through the extension of the Project’s closing date, as well as the lengthy technical review of the bidding document of the sludge treatment plant that led to consider its financing under a new Bank’s operation. The comments received from the Implementing Agencies also stressed out that the demand for latrines remains high in rural areas after the Project closing.

(b) CofinanciersNA

(c) Other partners and stakeholders (e.g. NGOs/private sector/civil society)NA

24

Annex 1. Project Costs and Financing

(a) Project Cost by Component (in US$ millions equivalent)

Components Appraisal Estimate (US$ millions)

Actual/Latest Estimate (US$

millions)

Percentage of Appraisal

Total Baseline Cost 37.30 32.30 92.30

Physical and Price Contingencies 3.10

0.00

7.70

Total Project Costs 40.40 32.30 100.00Front-end fee Project Preparation Fund 0.00 0.00 .00

Front-end fee IBRD 0.00 0.00 .00Total Financing Required 40.40 32.30 100.00

(b) Financing

Source of Funds Type of Cofinancing

Appraisal Estimate

(US$ millions)

Actual/Latest Estimate

(US$millions)

Percentage of Appraisal

Borrower 0.25 0.25 0.62 IDA 30.00 25.00 74.40 LOCAL: BENEFICIARIES 10.08 10.08 25.00

25

Annex 2. Outputs by Component Table 2.1. Outputs Produced up to First Restructuring (April 3, 2015)

Component Activities/Inputs OutputsComponent 1: Urban Sanitation (total project costs US$28.5 million, of which IDA US$19.4 million) Implementation of a program of activities to increase access to improved sanitation in Douala, consisting of1. Design and implementation of outreach and education activities for hygiene education and hygiene behavior change and creation of demand for sanitation services;2. Construction of household latrines consisting of (a) pits and slabs and (b) superstructure;3. Construction of several condominial sewerage systems;4. Construction of public toilets in schools, markets, and health centers;5. (a) Construction of several sludge treatment facilities and (b) promotion of specified assistance pertaining to the operation of the constructed facilities; and6. Strengthening of the CUD’s capacity to manage the sanitation subsector through (a) capacity-building activities for sanitation-related units within the CUD and (b) project management and coordination for this component.

1. The contract for the education activities has been submitted to World Bank for ‘no-objection’.2. Contract for household latrines signed. Bids for 1,600 household and 2,000 institutional latrines to World Bank for ‘no-objection’.3. Detailed studies for condominial sewerage system ongoing.4. Not started.5. Detailed studies for the sludge treatment facilities almost completed. CUD has acquired second site for sludge treatment plant at Ngombe.6. CUD staff benefitted from studies and plans but had not received any training in sanitation or project management.

Component 2: Rural Sanitation (total project costs US$6.6 million, of which IDA US$5.3 million) Implementation of a program of activities to increase access to improved sanitation, consisting of1. Design and implementation of outreach and education activities for hygiene education and hygiene behavior change and creation of demand for sanitation services;2. Construction of household latrines consisting of (a) pits and slabs and (b) superstructure; and3. Construction of public toilets in schools and health centers.

1. Hygiene education commenced in rural communities across the country coordinated with local governments2. Bids for 5 lots of 600 household latrines in Ada Maroua and East Province to World Bank for ‘no-objection’3. Not started

Component 3: Institutional Strengthening and Project Management (total project costs US$5.3 million, fully financed by IDA) Carrying out of an institutional strengthening program, consisting of1. Provision of capacity-building activities including training in sanitation planning and implementation to strengthen recipient’s related ministries and municipalities;2. Carrying out of a study of sanitation cost recovery mechanisms and revisions of related legislation and regulatory framework and dissemination of the recipient’s sanitation strategy;

1. Eleven communal sanitation plans have been prepared and eight have been approved by regional sanitation committees.2. Terms of reference for sector study approved by CdP.3. Not started.4. The M&E staff regularly updated the Results Framework.5. Problems with staffing, funding, and processing of procurement and services.

26

Component Activities/Inputs Outputs3. Carrying out of technical and environmental studies on sanitation with a view to develop investment plans for a subsequent phase of the program;4. Establishment of an M&E system; and5. Project coordination, management and monitoring, preparation of financial audits and periodic evaluations and the provision of goods, operating costs, and consulting services for the required purpose.

Table 2.2. Outputs Produced up to Second Restructuring (November 16, 2016)

Component Activities/Inputs OutputsComponent 1: Urban Sanitation (Revised at second restructuring from IDA US$21.4 million to IDA US$10 million) Implementation of a program of activities to increase access to improved sanitation in Douala, consisting of1. Design and implementation of outreach and education activities for hygiene education and hygiene behavior change and creation of demand for sanitation services;2. Construction of household latrines consisting of (a) pits and slabs and (b) superstructure;3. Construction of several condominial sewerage systems;4. Construction of public toilets in schools, markets, and health centers;5. (a) Construction of several sludge treatment facilities and (b) promotion of specified assistance pertaining to the operation of the constructed facilities; and6. Strengthening of the CUD’s capacity to manage the sanitation subsector through (a) capacity-building activities for sanitation-related units within the CUD and (b) project management and coordination for this component.

1. Training of households to improve hygiene behavior has commenced, reaching an estimated 400,000 individuals.2. Only 135 household latrines have been constructed and work on 57 of the projected 1,800 latrines is ongoing. However, these are only partially complete pits and slabs and not in use.3. In January 2016, it was decided to not finance the two proposed systems at Cite des Billes and Makepe-Missoke.4. Work started on 564 latrines; however, quality of work is poor and several latrines had to be redone. Also, schools want water toilet and missions suggest that the project finance connections to water supply.5. Technical studies for plants at Bois des Singes and Ngombe have been done, but decision has been taken not to finance these plants under the project.6. No change in CUD capacity.

Component 2: Rural Sanitation (Revised at second restructuring from IDA US$5.3 million to IDA US$12 million) Implementation of a program of activities to increase access to improved sanitation, consisting of1. Design and implementation of outreach and education activities for hygiene education and hygiene behavior change and creation of demand for sanitation services;2. Construction of household latrines consisting of (a) pits and slabs and (b) superstructure;4. Construction of 600 public toilets in schools and health centers;5. Construction of 182 boreholes (and hand pumps) at schools in the Far North, East, and

1. Completed.2. Of the projected 16,000 household latrines, 725 have been constructed (250 masons have been trained as well).4. A total of 262 public latrines constructed.5. Sixteen boreholes drilled and equipped.6. Seventeen communal sanitation plans have been prepared by municipal councils and approved by regional sanitation councils.

27

Component Activities/Inputs OutputsAdamaoua; and6. Development of communal sanitation plans.Component 3: Institutional Strengthening and Project Management (Revised at second restructuring from US$2.7 million to US$3 million)Carrying out of an institutional strengthening program, consisting of1. Provision of capacity-building activities including training in sanitation planning and implementation to strengthen recipient’s related ministries and municipalities;2. Carrying out of a study of sanitation cost recovery mechanisms and revisions of related legislation and regulatory framework and dissemination of the recipient’s sanitation strategy;3. Carrying out of technical and environmental studies on sanitation with a view to develop investment plans for a subsequent phase of the program;4. Establishment of an M&E system; and5. Project coordination, management and monitoring, preparation of financial audits and periodic evaluations, and the provision of goods, operating costs, and consulting services for the required purpose.

1. The training plans for MINEE and MINEPAT have been submitted to IDA for approval.2. A study concerning the feasibility of a sludge treatment plant for the city of Bafoussam has begun.3. Not started.4. Consultant has started to work on a website for completed works with photos and information on sanitation work that has been constructed under the project.5. Project management including M&E, audits, funding, and oversight of works and services ongoing.

Table 2.3. Outputs Produced up to Project Closing (June 30, 2017)

Component Activities/Inputs OutputsComponent 1: Urban Sanitation (total project costs US$28.5 million, of which IDA US$19.4 million) Implementation of a program of activities to increase access to improved sanitation in Douala, consisting of1. Design and implementation of outreach and education activities for hygiene education and hygiene behavior change and creation of demand for sanitation services;2. Construction of household latrines consisting of (a) pits and slabs and (b) superstructure;4. Construction of public toilets in schools, markets, and health centers; and5. Strengthening of the CUD’s capacity to manage the sanitation subsector through (a) capacity-building activities for sanitation-related units within the CUD and (b) project management and coordination for this component.

1. Training of households to improve hygiene behavior completed nation-wide and one-third of these now wash their hands with soap (after toilet use).2. About 198 household latrines have been constructed and are in use (about 11% of the targeted 1,800).4. About 1,563 latrines at schools have been constructed and commissioned and are in use (about 111% of the targeted 1,400). In addition, 28 schools have been connected to the water supply.5. No capacity building or management training conducted.

Component 2: Rural Sanitation (total project costs US$6.6 million, of which IDA US$5.3 million) Implementation of a program of activities to increase access to improved sanitation consisting of:1. Design and implementation of outreach and education activities for hygiene education and

1. About 466,555 people have received hygiene education nation-wide and one-third of these now wash their hands with soap (after toilet use).2. An estimated 16,155 household latrines will have been partly constructed (pit, slab, and vent pipe). About 250 trained masons are available to complete the work on the latrines and continue

28

Component Activities/Inputs Outputshygiene behavior change and creation of demand for sanitation services;2. Construction of household latrines consisting of (a) pits and slabs and (b) superstructure; and4. Construction of public toilets in schools and health centers.

with that after closing.4. An estimated 1,054 public gender-specific and handicapped-accessible latrines at schools will have been constructed at closing (exceeding the target of 720). In addition, about 167 boreholes equipped with hand pumps have been constructed and are providing water at the schools for students and the surrounding community (there is a great unmet demand for access to water in the North and local authorities are looking for ways to continue the construction of boreholes beyond the project).

Component 3: Institutional Strengthening and Project Management (total project costs US$5.3 million, fully financed by IDA)Carrying out of an institutional strengthening program, consisting of1. Provision of capacity-building activities including training in sanitation planning and implementation to strengthen recipient’s related ministries and municipalities;2. Carrying out of a study of sanitation cost recovery mechanisms and revisions of related legislation and regulatory framework and dissemination of the recipient’s sanitation strategy;3. Establishment of an M&E system; and4. Project coordination, management and monitoring, preparation of financial audits and periodic evaluations, and the provision of goods, operating costs, and consulting services for the required purpose.

1. Seventeen communal sanitation plans have been prepared and are now guiding these communities with their investment decision regarding access to sanitation (and to water in several instances).2. Not achieved.3. A website-based program is available that shows the location of the latrines and boreholes/hand pumps that have been constructed under the project. This enables the authorities to monitor operations and use.4. The MINEE PIU has conducted M&E for the project and managed audits and evaluated the provision of goods and services.

29

Annex 3. Economic and Financial Analysis Introduction

1. The economic analysis assesses the ex post economic performance of the project, specifically the following activities:

(a) Urban component. (i) Increase in the quality and access to sanitation services resulting from the construction of latrines, in households and in schools, and (ii) increase in water supply to schools resulting from the construction of connections to the public water supply system in schools in Douala

(b) Rural component. (i) Increase in the quality and access to sanitation services resulting from the construction of latrines, in households and in schools and health centers, and (ii) increase in water supply to schools resulting from the construction of boreholes in schools in the Adamaoua, East, and North Regions

2. A CBA is used to estimate the ex post economic performance of the project by calculating the NPV and the EIRR of the project using the stream of actualized benefits and costs. The analysis assesses each subcomponent and the project as a whole. Financial analysis is not applicable because the project does not generate revenues.

Cost-benefit Analysis Methodology

3. For sanitation activities in both urban and rural areas, the ICR CBA uses a similar approach as the appraisal CBA to ensure consistency and comparability. It uses the methodology developed by the WHO which includes the following categories of benefits for water and sanitation interventions: (a) avoided direct health expenditures due to decrease in illness, (b) income gained as a result of decrease in illness-related absenteeism in working age population, (c) income gained as a result of decrease in child illness related absenteeism among caretakers, (d) opportunity cost of school absenteeism of the school age population, (e) estimated value of loss-of-life avoided as a result of improvements in water and sanitation, and (f) estimated value of time savings resulting from improved access to sanitation. For water supply subprojects, the project benefit is assumed to mainly derive from time saving that results from improved access to drinking water through borehole and public connection.

4. At appraisal, the economic analysis focused only on the economic impact of improvements in sanitation access in Douala and evaluated the economic efficiency of three types of options: (a) construction of household latrines, (b) construction of small diameter community condominial sewerage system, and (c) construction of full sewerage system. Each option would target 2,000 connections representing about 19,000 people. The analysis used different cost estimates for each option but assumed that the estimated benefits of the three options are the same. It did not account for additional benefits from improved well-being. Option (c) was subsequently dropped because the economic

30

analysis did not demonstrate its economic feasibility. For the ICR, the economic analysis evaluated economic efficiency of option (a) (latrines) only. The ICR economic analysis has, however, a much broader scope as it covers subcomponents/subprojects, including rural sanitation (households and schools) and rural water supply.

5. For the sanitation subprojects, the ICR CBA is similar to the appraisal CBA. For water supply subprojects, the ICR uses a traditional methodology often used in WHO studies. The methodological details are presented in the corresponding sections. The economic analysis uses various data sources to estimate the costs and benefits. An effort was made to have local data for all assumptions used in the analysis whenever possible. Gaps are filled with regional or global data. Data sources include the following:

Hutton, G., and L. Haller. “Evaluation of the Costs and Benefits of Water and Sanitation Improvements at the Global Level.” WHO. 2004.

Institut National De La Statistique, République de Cameroun, Rapport Principal De L’ECAM3, Conditions De Vie Des Populations Et Profil De Pauvreté Au Cameroun En 2007.

Institut National De La Statistique, République de Cameroun, Rapport principal de L’Enquête par Grappes à Indicateurs Multiples 2006.

Rapport diagnostic sur les aspects institutionnels, financiers et techniques pour la stratégie nationale d’assainissement liquide au Cameroun, 2010.

WHO. 2005. Cameroon Country Profile of Environmental Burden of Disease. (A full list of assumptions including their sources is added as a table at the end of this annex.)

Hutton, G. 2012. “Global Costs and Benefits of Drinking-water Supply and Sanitation Interventions to Reach the MDG Target and Universal Coverage.”

PAD of AfDB. May 2010. Projet d’alimentation en eau potable et d’assainissement en milieu rural.

Cost-benefit Analysis Results at Appraisal

6. Table 3.1 presents the CBA results at appraisal.10

Table 3.1. Overview of the Project Benefits at Appraisal

Project Benefits Options 1: LatrinesOption 2:

Condominial Sewerage Network

Option 3: Conventional

Sewerage NetworkAt AppraisalNPV 730,560 111,783 (7,573,490)

10 For detailed analysis, the reader can refer to the PAD of the project, Report No: 60615-CM.

31

Economic Rate of Return (ERR) (%) 19.78% 12.63% 1.26%

Economic Analysis of the Different Subprojects

Urban Component: Increase Quality and Access to Urban Sanitation

7. Household latrines. The project was to finance construction of 1,800 household latrines in Douala. However, only 198 household latrines have been constructed due to challenges during implementation.

Estimated Subproject Costs

8. The costs of urban household latrines included (a) the costs of the slab and the pit financed by the project and the costs of the superstructure borne by the beneficiaries, (b) the costs of the supervision, and (c) the costs of maintenance. The life-span of the household latrines was estimated at 20 years. Table 3.2 shows the costs of the different components.

Table 3.2 Overview of the Costs of the Subproject

Subproject Costs Costs of Household Latrines (FCFA)

Costs of Household Latrines (US$)

IDA investments 684,339,377 1,206,948Annual O&M costs 1,600,913 2,823

Estimated Project Benefits

9. The project benefits were estimated based on the WHO methodology used at appraisal. The methodology and results for each of the benefits are as described in the following paragraphs.

10. Direct Health Expenditure Avoided. This benefit is calculated following the WHO’s guidance on burden of environmental diseases for Cameroon. Particularly, the calculation is based on the proportion of diseases that can be attributed to poor WASH. The analysis considered only diarrheal diseases. The burden of diseases attributable to diarrhea caused by lack of adequate WASH services (at 13 percent of the total diseases), combined with the estimated monthly health expenditures per household (private and public expenditure), results in about US$44 of annual health expenditure per household for all WASH-related diseases. The analysis assumes that about 30 percent of the total WASH-related disease incidents can be prevented because of the project interventions (based on estimates of other similar projects11 and global WHO estimates). Each household would therefore save about US$15 of annual health expenditures. Applied to the total number of households served by the project in urban areas, the total annual benefit from Direct Health Expenditure Avoided is US$2,670.

11. Income Gained due to Avoided Days Lost from Work. This benefit is calculated based on the estimated total incidence of sickness per person in the regions targeted by the project multiplied by the working age beneficiary population. The 11 PAD of AfDB, May 2010. Projet d’alimentation en eau potable et l’assainissement en milieu rural.

32

analysis estimates that 13 percent of the total number of sickness days are due to WASH-related diseases and that the project reduces these diseases by 30 percent. We consider an average of two days per incident following the WHO study, combined with the opportunity cost of time (minimum income in Cameroon) to estimate benefits from avoided days lost from work at US$207 annual benefit.

12. Days of School Absenteeism Avoided. The calculation of this benefit is based on the same assumptions as the previous benefit. Applying the number of absent days per incidence of sickness estimated at three days per incident for school-age population based on the WHO data, combined with the estimated opportunity cost of time of school-age target population, results in about US$156 total annual benefit. The opportunity cost of time for students is taken at 50 percent of that of active adults. Though most students are not active, school absenteeism would likely affect the ability of students to earn income in the future. It is therefore justified to assign economic value to these forgone future potential earnings in the ‘without project’ situation.

13. Income Gained due to Avoided Days Lost from Childcare. The calculation of this benefit is similar to the above two categories, as it is based on the total incidence of sickness in targeted population (children 0–59 months old). Incidence is estimated at 4.56 cases per child for all diseases and 0.59 cases per child for WASH-related illnesses. According to the WHO study, the duration of illness in this target population is estimated at five days, which is combined with the opportunity cost of time to calculate the benefit. Considering the likelihood that not all caretakers in the targeted population may be active, opportunity costs were estimated at 50 percent of the adult population’s opportunity cost of time (minimum wages), according to the WHO methodology. The result is about US$259 benefit per year for the entire targeted population.

14. Value of Loss-of-Life Avoided. The measurement of burden of WASH-related diseases relies on the concept of the disability-adjusted life year (DALY). The DALY is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability, or early death. The WHO estimates that 33 DALYs are lost per 1,000 members of the population per year because of the lack of water and sanitation services in Cameroon. When applied to the targeted project population and combined with the minimum income per year in Cameroon, this estimate results in about US$11,000 as the value of total avoided DALYs per year in the target population. In this calculation, the minimum wage, rather than median income, was used to be conservative. Also, this reflects better lower wages in rural areas.

15. Convenience Time Savings. The final benefit quantified for the CBA is the convenience time saving resulting from improved sanitation access. For instance, time savings occur from closer access to latrines and shorter waiting times at public latrines. Time saved can be used for productive activities or for leisure. The value of convenience time savings is estimated by assuming a daily time saving per individual for access to sanitation facilities and then multiplying this time saving by its opportunity cost estimated at the minimum wage. The 2004 WHO study estimates that average time saved per day because of closer access to sanitation facilities and reduced waiting time is about

33

30 minutes per person per day. A more conservative estimate of 15 minutes per day per person was used in this analysis. This estimate, combined with the total active project beneficiaries and multiplied by the minimum wage, leads to annual savings of about US$16,000.

Table 3.3. Overview of the Benefits of the Subproject

Project Benefits Annual Benefit Amount (FCFA)

Annual Benefit Amount (US$)

Avoided Health Expenditure 1,513,629 2,670Avoided Income Loss (Working Adult) 117,590 207Avoided School Absenteeism 88,193 156Avoided income Loss (Caretakers for Sick Child) 146,988 259

Avoided Loss of Life 6,083,013 10,728Convenience Time Saving 8,985,284 15,847Total 16,934,696 29,867

16. The relative weight of the various benefits is illustrated in figure 3.1.Figure 3.1. Relative Weight of Various Benefits

Note: Convenience time saving represents the largest share of the benefits, as in the WHO study.

Results of the Cost-benefit Analysis for Urban Household Latrines

17. Based on the assumptions and parameters discussed earlier, the estimated EIRRs of the project are presented in table 3.4.

Table 3.4. Overview of the Results of the CBA of the Subproject

Economic Indicators Discount Rate (12 percent) Discount Rate (5 percent)


Avoided Health Expenditure Avoided Income Loss (Working Adult)Avoided School Absenteeism Avoided income Loss (Caretakers for Sick Child)Avoided Loss of Life Convenience Time Saving

34

NPV in FCFA −250,814,417 −339,643,681NPV in US$ −442,353 −599,019EIRR (percent) −6.5

18. The economic analysis of the subproject results in an EIRR of −6.5 percent and an NPV of −US$599,019 for a 5 percent discount rate. This result reflects the low economic performance of this subproject. In fact, the unit cost of the construction of the household latrines were high (FCFA 3,456,259 per latrine) and this had a negative effect on the EIRR. Costs were estimated at FCFA 280,000 at appraisal.

Public/Institutional Latrines

19. In schools in Douala, the project financed the construction of 1,563 latrines serving 78,150 people. The economic analysis of this subproject includes the following benefits of public school latrines:12

20. Direct Health Expenditure Avoided. The methodology for the calculation of this benefit is the same as for household latrines. However, the amount of monthly expenditure per household has been adjusted to the average number of students per latrine. A proportionality rule has been used to estimate the health expenditure. The value obtained may be underestimated as children are more vulnerable to WASH-related diseases than adults. The total annual benefit from Direct Health Expenditure Avoided would be US$444,000 if students were to spend all their time at school. Since only a portion of time is spent at school, this figure is adjusted accordingly by assuming that students spend 7 hours a day at school, 5 days a week, and 8 months per year. The contribution of this benefit is estimated at US$92,000.

21. Days of School Absenteeism Avoided. The calculation of this follows the same methodology as for households. However, necessary adjustments are made as described under the benefit ‘Direct Health Expenditure Avoided’. The benefits from ‘Days of School Absenteeism Avoided’ are estimated at US$6.72,000.

22. Value of Loss-of-Life Avoided. For the calculation of the benefit of household latrines, the analysis sticks to the WHO value of 33 DALYs lost per 1,000 members of the population per year because of the lack of water and sanitation services in Cameroon. Applying this rate to the targeted student population of the project area and combining it with the minimum income per year in Cameroon yields US$593,000. When adjusted for time spent at school, the result is US$123,000.

23. Convenience Time Savings. For the calculation of the benefit of household latrines, the analysis uses the conservative value of 15 minutes per day per person for convenience time savings. The value is converted into an annual number of hours lost and multiplied by the opportunity cost of time. The opportunity cost of time is calculated as 50 percent of the minimum per hour wage to take into consideration that the student

12 It is assumed that children below 60 months of age do not go to school. Therefore, the benefits calculated do not include those related to Income Gained due to Avoided Days Lost from Work as a Result of Child Illness. Benefits related to Income Gained due to Avoided Days Lost from Work are not included because it is assumed that students do not work.

35

population are not yet active. After adjustment for time spent at school, the contribution of this category of benefits yields US$274,000.


Project Benefits Annual Benefit Amount (FCFA) Annual Benefit Amount (US$)

Avoided Health Expenditure 52,368,945 92,361Avoided School Absenteeism 3,810,012 6,720Avoided Loss of Life 70,153,887 123,728Convenience Time Saving 155,437,603 274,140Total 196,493,504 346,549

24. The relative weight of the various benefits is illustrated in figure 3.2.

Figure 3.2. Relative Weight of Various Benefits

Results of the Cost-benefit Analysis for Urban Schools Latrines

25. Based on the assumptions and parameters discussed above, the estimated EIRRs of the project are presented in table 3.6.


Economic Indicators Discount Rate (12 percent) Discount Rate (5 percent)NPV in FCFA 600,738,916 1,861,722,159NPV in US$ 1,059,504 3,283,461EIRR (percent) 42.8

26. At a discount rate of 5 percent, this subproject has an NPV of 3,283,461 and an ERR of 42.8 percent. This good economic performance was achieved because of lower latrines costs (FCFA 552,100 per latrine) and the high returns usually associated with this type of investment.


Avoided Health Expenditure Avoided School AbsenteeismAvoided Loss of Life Convenience Time Saving

36

Urban Component: Increase in Water Supply to Schools

27. The project provided access to water supply to 28 schools serving 8,400 people in Douala. The economic analysis of this subproject is presented as follows: Estimated project costs − Recurrent Costs. Recurrent costs mainly include O&M costs. They represent 0 to 10 percent of capital costs, according to the WHO. A 10 percent conservative value is adopted.

Table 3.7. Overview of the Costs of the Subproject

Project Costs Water Supply Systems in Urban Areas (FCFA)

At ICRInvestment Costs 37,778,095Annual Recurrent O&M costs 3,777,809Annual Water Price 22,320,480

Estimated Subproject Benefits

28. A 20-year time horizon is considered for the economic analysis of the subproject. The benefits are assessed using a well-known methodology based on the value of the time saved for collecting water.13 The project financed the construction of water supply connections for 28 schools benefitting students and staff. It is assumed that every user will need 20 liters of water per day.14 Without the project, the time to collect this water would be 20 minutes. The project is assumed to have halved this time to 10 minutes. The economic value of the time saved is calculated by multiplying the time saved by its opportunity costs.



Economic value of time saved 53,655,000 94,630Total 53,655,000 94,630

Results of the Cost-benefit Analysis for Water Supply Subproject for Urban Areas

29. Based on the assumptions and parameters discussed above, the estimated EIRR of the project are presented in table 3.9.

Table 3.9. Overview of the CBA of the Subproject

Economic Indicators Discount Rate (12 percent) Discount Rate (5 percent)NPV in FCFA 86,434,228 235,453,866NPV in US$ 152,441 415,263EIRR (percent) 73

30. The economic analysis shows that the subproject for access to water supply for schools and communities in rural areas generates an EIRR of 73 percent and an NPV of US$235,453,866 at a 5 percent discount rate. The project was therefore economically 13 Hutton, G. 2012. “Global Costs and Benefits of Drinking-water Supply and Sanitation Interventions to Reach the MDG Target and Universal Coverage.” p. 67.14 PAD of AfDB, May 2010. Projet d’alimentation en eau potable et d’assainissement en milieu rural.

37

justified with regard to the current World Bank recommendation of 5 percent rate as opportunity cost of capital.

Rural Component: Increase in the Quality and Access to Sanitation Services

31. Households. At project closing, the project achieved 13,249 latrines with installed concrete slabs and 3,759 with infrastructure. Therefore, at closing, the superstructure of 9,490 latrines was lacking. Given the time to construct the superstructure, it is assumed that the latrines will be in use a year after the project closing.


32. The costs of rural household latrines include (a) the costs of works including the costs of the stab and the pit financed by the project and the costs of the superstructure borne by the beneficiaries, (b) the costs of the supervision of works, and (c) the costs of maintenance. The life-span of the household latrines is estimated at 20 years. Table 3.10 shows the costs of the different components.


Subproject Costs Costs of Household Latrines (FCFA)

Costs of Household Latrines (US$)

IDA investments 1,403,599,060 2,520,892Beneficiaries investments 2,649,800,000 4,673,369Annual O&M costs 107,123,730 188,930Present value of all costs (12 percent) 2,090,875,337 3,687,611Present value of all costs (5 percent) 3,770,416,808 6,649,765


33. The project benefits were estimated based on the WHO methodology used at appraisal. The methodology and results for each of the benefits are as described in the following paragraphs.

34. Direct Health Expenditure Avoided. This benefit is calculated following the WHO’s guidance on burden of environmental diseases for Cameroon. Particularly, the calculation is based on the proportion of diseases that can be attributed to poor WASH. The analysis considered only diarrheal diseases because of data availability. The burden of diseases attributable to diarrhea caused by lack of adequate WASH services (at 13 percent of the total diseases) combined with the estimated monthly health expenditures per household (private and public parts of the expenditure), results in about US$42 of annual health expenditure per household for all WASH-related diseases. The analysis assumes that about 30 percent of the total WASH-related disease incidents can be prevented because of the project interventions15. Each household would therefore save about US$13 of annual health expenditures. Applied to the total number of households served by the project in rural areas, the total annual benefit from Direct Health Expenditure Avoided is US$165,362.

15 PAD of AfDB, May 2010. Projet d’alimentation en eau potable et d’assainissement en milieu rural.

38

35. Income Gained due to Avoided Days Lost from Work. This benefit is calculated based on the estimated total incidence of sickness per person in the regions targeted by the project multiplied by the working age beneficiary population. The analysis estimates that 13 percent of the total number of sickness days are due to WASH-related diseases and that the project reduces these diseases by 30 percent. We consider an average of two days per incident following the WHO study, combined with the opportunity cost of time (minimum income in Cameroon) to estimate benefits from avoided days lost from work at US$17,000 annual benefit.

36. Days of School Absenteeism Avoided. The calculation of this benefit is based on the same assumptions as the previous benefit. Applying the number of absent days per incidence of sickness estimated at three days per incident for school-aged population based on the WHO data, combined with the estimated opportunity cost of time of school-age target population, results in about US$13,000 total annual benefit. The opportunity cost of time for students is taken at 50 percent of that of active adults. Though most students are not active, school absenteeism would likely impact the ability of students to earn income in the future. It is therefore justified to assign economic value to these foregone future potential earnings in the ‘without project’ situation.

37. Income Gained due to Avoided Days Lost from Childcare. The calculation of this benefit is similar to the above two categories, as it is based on the total incidence of sickness in targeted population (children 0–59 months old). Incidence is estimated at 4.56 cases per child for all diseases and 0.59 cases per child for WASH-related illnesses. According to the WHO study, the duration of illness in this target population is estimated at five days, which is combined with the opportunity cost of time to calculate the benefit. Considering the likelihood that not all caretakers in the targeted population may be active, opportunity costs were estimated at 50 percent of the adult population’s opportunity cost of time (minimum wages), according to theWHO methodology. The result is about US$22,000 benefit per year for the entire targeted population.

38. Value of Loss-of-Life Avoided. The measurement of burden of WASH-related diseases relies on the concept of the DALY. The DALY is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability, or early death. WHO estimates that 33 DALYs are lost per 1,000 members of the population per year because of the lack of water and sanitation services in Cameroon. When applied to the targeted project population and combined with the minimum income per year in Cameroon, this estimate results in about US$718,000 as the value of total avoided DALYs per year in the target population. In this calculation, the minimum wage, rather than median income, was used to be conservative. Also, this reflects better lower wages in rural areas.

39. Convenience Time Savings. The final benefit quantified for the cost-benefit analysis is the convenience time saving resulting from improved sanitation access. For instance, time savings occur from closer access to latrines and shorter waiting times at public latrines. Time saved can be used for productive activities or for leisure. The value of convenience time savings is estimated by assuming a daily time saving per individual for access to sanitation facilities and then multiplying this time saving by its opportunity

39

cost estimated at the minimum wage. The 2004 WHO study estimates that average time saved per day thanks to closer access to sanitation facilities and reduced waiting time is about 30 minutes per person per day (minimum: 15 minutes and maximum: 60 minutes). A more conservative estimate of 15 minutes per day per person was used in this analysis. This estimate, combined with the total active project beneficiaries and multiplied by the minimum wage, leads to annual savings of about US$1,060,000.


Project Benefits Annual Benefit Amount (FCFA)


Avoided Health Expenditure 93,760,254 165,362Avoided Income Loss (Working Adult) 9,824,976 17,328Avoided School Absenteeism 7,368,732 12,996Avoided income Loss (Caretakers for Sick Child) 12,281,220 21,660

Avoided Loss of Life 407,039,661 717,883Convenience Time Saving 601,242,831 1,060,393Total 1,131,517,674 1,995,622


Note: Convenience time saving represents the largest share of the benefits as in the WHO study.

Results of the Cost-benefit Analysis for Rural Households Latrines

41. Based on the assumptions and parameters discussed above, the EIRR of the project are presented in table 3.12.


Economic Indicators Discount Rate (12 percent) Discount Rate (5 percent)NPV in FCFA 1,924,201,239 6,545,699,117NPV in US$ 3,393,653 11,544,443


Avoided Health Expenditure Avoided Income Loss (Working Adult)Avoided School Absenteeism Avoided income Loss (Caretakers for Sick Child)Avoided Loss of Life Convenience Time Saving

40

EIRR (percent) 33.7

42. The economic analysis shows that the subproject for access to sanitation for households in rural areas was economically justified with an EIRR of 33.7 percent and an NPV of US$11,544,443 for a 5 percent discount rate.

Schools and Health Centers

43. At project closing, the project had financed the construction of 1,160 latrines in public centers especially in schools. The economic analysis will focus on schools.


44. The costs of rural public latrines included (a) the costs of works including superstructure, (b) the costs of the supervision of works, and (c) the costs of annual maintenance. The life-span of the public latrines is estimated at 20 years. Table 3.13 shows the costs of the different components.


Subproject Costs Costs of School Latrines (FCFA)

Costs of School Latrines (US$)

IDA investments 1,861,655,000 3,280,554Beneficiaries investments n.a. n.a.Annual O&M costs 17,128,125 30,208Present value of all costs (12 percent) 941,429,982 1,660,370Present value of all costs (5 percent) 1,510,349,141 2,663,755


45. Categories of benefits considered in the analysis of the benefits of public school latrines include those discussed in the following paragraphs.16

46. Direct Health Expenditure Avoided. This methodology for the calculation of this benefit is the same as for household latrines. However, the amount of monthly expenditure per household has been adjusted to the average number of students per latrine. A proportionality rule has been used to estimate the health expenditure. The value obtained may be underestimated as children are more vulnerable to WASH-related diseases than adults. The total annual benefit from Direct Health Expenditure Avoided would be US$222,000 if students were to spend all their time at school. Since only a portion of time is spent at school, this figure is adjusted accordingly by assuming that students spend 7 hours a day at school, 5 days a week (considering weekends), and 8 months per year considering vacation time. The contribution of this benefit is estimated at US$46,000.

16 It is assumed that children below 60 months do not go to school. Therefore, the benefits calculated do not include those related to Income Gained due to Avoided Days Lost from Work as a Result of Child Illness. Benefits related to Income Gained due to Avoided Days Lost from Work are not included because it is assumed that students do not work.

41

47. Days of School Absenteeism Avoided. The calculation of this follows the same methodology as for households. However, necessary adjustments are made as described under the benefit ‘Direct Health Expenditure Avoided’. The benefits from Days of School Absenteeism Avoided are estimated at US$5 thousand.

48. Value of Loss-of-Life Avoided. For the calculation of the benefit of household latrines, the analysis sticks to the WHO value of 33 DALYs lost per 1,000 members of the population per year because of the lack of water and sanitation services in Cameroon. Applying this rate to the targeted student population of the project area and combining it with the minimum income per year in Cameroon yields US$441,000. When adjusted for time spent at school, the result gives US$92,000.

49. Convenience Time Savings. For the calculation of the benefit of household latrines, the analysis uses the conservative value of 15 minutes per day per person for convenience time savings. The value is converted into an annual number of hours lost and multiplied by the opportunity cost of time. The opportunity cost of time is calculated as the 50 percent of the minimum per hour wage to take into consideration that the student population are not yet active. After adjustment for time spent at school, the contribution of this category of benefits yields US$203,000.



Avoided Health Expenditure 26,240,310 46,279Avoided School Absenteeism 2,827,648 4,987Avoided Loss of Life 52,065,585 91,826Convenience Time Saving 115,359,961 203,457Total 196,493,504 346,549



Avoided Health Expenditure Avoided School AbsenteeismAvoided Loss of Life Convenience Time Saving

42

Results of the Cost-benefit Analysis for Rural Schools Latrines

51. Based on the assumptions and parameters discussed earlier, the estimated EIRR of the project are presented as in Table 3.15.


Economic Indicators Discount Rate (12 percent) Discount Rate (5 percent)NPV in FCFA −158,069,447 413,104,223NPV in US$ −278,782 728,579EIRR (percent) 8.7

52. The economic analysis shows that the subproject for access to sanitation for schools in rural areas generates an EIRR of 8.7 percent and an NPV of US$728,579 at a 5 percent discount rate. The project was therefore economically justified with regard to the current World Bank recommendation of 5 percent rate as opportunity cost of capital.

Rural Component: Increase in Water Supply to Schools Resulting from the Construction of Boreholes in Schools in the Far North, Adamaoua, East, and North Regions

53. The project contributed to increase water supply in schools and communities in several regions of Cameroon through the construction of 167 equipped boreholes.17

Estimated Project Costs

54. Recurrent costs. Recurrent costs mainly include O&M costs. They represent 0 to 10 percent of capital costs according to the WHO. A 10 percent conservative value is adopted.


Project Costs Water Supply Systems - Boreholes Constructed in Rural Areas (FCFA)

At ICRInvestment Costs 1,430,560,744Annual Recurrent O&M costs 143, 056, 074Present Value of all Costs (12 percent discount rate) 1,101,297,466Present Value of all Costs (5 percent discount rate) 3,175,809,279


55. A 20-year time horizon is considered for the economic analysis of the project. The benefits are assessed using a well-known methodology based on the value of the time saved for collecting water.18 The project financed the construction of 167 boreholes around schools. The school boreholes benefit not only to students and school staffs but also to the surrounding community members who may come and fetch water. The average hourly yield of a borehole is estimated at 1 m3 per hour. Assuming that the

17 Boreholes were developed around schools but serve all the surrounding community members.18 Hutton, G. 2012. “Global Costs and Benefits of Drinking-water Supply and Sanitation Interventions to Reach the MDG Target and Universal Coverage.” p. 67.

43

borehole will be used by the communities for about 6 hours a day and a daily water need of 20 liters per person per day, a borehole can provide sufficient water for 300 people.

56. In rural areas of Cameroon, local populations, mainly women, spend an average of 20 minutes to collect 20 liters of water in underserved areas.19 The project is assumed to have halved this time to 10 minutes. The economic value of the time saved is calculated by multiplying the time saved by its opportunity costs.



Economic value of time saved 640,027,500 1,128,796Total 640,027,500 1,128,796

Results of the Cost-benefit Analysis for Rural Equipped Boreholes

57. Based on the assumptions and parameters discussed above, the estimated EIRR of the project are presented as in Table 3.18.


Economic Indicators Discount Rate (12 percent) Discount Rate (5 percent)NPV in FCFA 1,212,678,602 3,749,542,780NPV in US$ 2,138,763 6,612,950EIRR (percent) 34.7

58. The economic analysis shows that the subproject for access to water supply for schools and communities in rural areas generates an EIRR of 34.7 percent and an NPV of US$3,749,542,780 at a 5 percent discount rate. The project was therefore economically justified with regard to the current World Bank recommendation of 5 percent rate as opportunity cost of capital.

Economic Analysis of the Overall Project

59. An overall ex post assessment of the project economic performance is made by considering all project costs and all project benefits. In addition to the costs of infrastructure the overall project assessment includes the costs of project management and coordination, costs for software activities including citizen awareness improvement, promotion of hygiene practices, and so on.

Estimated Project Costs

60. Table 3.19 summarizes the different project costs.

Table 3.19. Overview of the Costs of the Project

Project Costs Value (FCFA) Value (US$)At ICR

19 PAD of AfDB, May 2010. Projet d’alimentation en eau potable et d’assainissement en milieu rural.

44

Investment Cost - Water Supply - Urban 37,778,095 66, 628Investment Cost - Family Latrines - Urban 684,339,377 1,206,948Investment Cost - Institutional Latrines - Urban 862,933,053 1,521,928Investment Cost - Boreholes - Rural 1,430,560,744 2,520,892Investment Cost - Family Latrines - Rural (without beneficiaries investment) 1,403,599,060 2,473,381

Investment Cost - Family Latrines - Rural (with beneficiaries investment) 4,053,399,060 7,142,782

Investment Cost - Institutional Latrines - Rural 1,861,655,000 3,280,554Other project costs 1,412,681,993 2,491,503Total project cost (without beneficiaries investment) 7,693,547,323 13,557,345

Total project cost (with beneficiaries investment) 10,343,347,323 18,242,235


61. Table 3.20 summarizes the different project costs.

Table 3.20. Overview of the Benefits of the Project

Project Annual Benefits Value (FCFA) Value (US$)At ICRBenefits - Water Supply - Urban 53,655,000 94,630Benefits - Family Latrines - Urban 16,934,696 29,867Benefits - Institutional Latrines - Urban 563,540,894 993,899Benefits - Boreholes - Rural 640,027,500 1,128,796Benefits - Family Latrines - Rural 1,131,517,332 1,995,621Benefits - Institutional Latrines - Rural 196,493,504 346,549Total benefits 2,602,168,926 4,589,362

Results of the Cost-benefit Analysis for Rural Equipped Boreholes

Table 3.21. Overview of the CBA of the Project

Economic Indicators Discount Rate (12 percent) Discount Rate (5 percent)NPV in FCFA 1,999,993,481 8,952,514,980NPV in US$ 4,328,990 19,377,738EIRR (percent) 18.6

62. The economic analysis of the project as a whole yields an EIRR of 18.6 percent and an NPV of US$19.4 million. This result shows that the project exhibits a good economic performance with regard to the opportunity cost of the funds invested although the following important benefits could not be assessed due to the lack of reliable data.

63. Health benefits of improved water supply. Over recent decades, compelling evidence has been gathered that significant and beneficial health impacts are associated with improvements in access to safe drinking water (Hutton 2012). No monetary value could be attributed to this impact because of the limited availability of data in the area.

45

Economic Analysis Data and Assumptions

Table 3.22. Overview of Data/Assumptions Used in the CBA (Urban Household Latrines)

Description Value Unit SourceOverall assumptions

Discount rate 1 12 Percent World Bank recommendation at appraisal

Discount rate 2 5 Percent World Bank recommendation at ICR

Exchange rate FCFA/US$ 567 FCFA/US$Number of connections achieved 198

Number of people per household ECON3 Study

Number of households per plotNumber of people per connection 7.13 Project M&E

Total population covered 1,411 Project M&ENumber of people of working age per household 2.38 Team estimate

Number of children ages 0–59 months per household 2.38 Team estimate

Number of schoolchildren per household 2.38 Team estimate

Costs assumptionsInvestment costs - latrine 3,456,259 FCFA Project financial dataRecurrent costs - O&M, surveillance, and so on 2 US$/person/year WHO 2004, 13

Length of life of latrines 20 Years WHO 2004, 14Benefits assumptions

Incidence of sickness 1.85 Cases per person per year

15.2% in the past 30 days (MISC3, 216) - for Douala

% of sickness that is related to WASH risks (diarrheal only)

13.4 PercentWHO 2005 Burden ofEnvironmental DiseasesEstimates for Cameroon

Incidence of diarrhea (for children ages 0–59 months) 1.72 Cases 6.6 percent in the last 2 weeks

(MICS3, 139) - for DoualaReduction in incidence rates 30 Percent —Health expenditure per month 15,847 FCFA/household Calculation; public subsidy

represents 28 percentDays off work/episode (working age) 2 Days WHO 2004, 20

Duration of illness for babies and infants 5 Days WHO 2004, 20

Absent days/episode of diarrhea 3 Days WHO 2004, 18

Opportunity cost of time working adult 1680 FCFA/day Minimum wage

Opportunity cost of time caretaker 840 FCFA/day

Caretaker days gained for healthy infants are valued at 50% of wage rate

Opportunity cost of time schoolchildren 840 FCFA/day

46

Description Value Unit SourceProductive years lost due to lack of water supply and sanitation (WSS) services in DALYs

33 DALYs/1,000/yearWHO 2005 Burden of Environmental Diseases Estimates for Cameroon

Minimum income per year 435,240 FCFA Minimum wageSanitation access time saved per person per day 15 Minutes 15 minutes/day of WHO 2004

Table 3.23. Overview of Data/Assumptions Used in the CBA (Urban Public Latrines)


Discount rate 1 12 PercentWorld Bank recommendation at appraisal

Discount rate 2 5 PercentWorld Bank recommendation at ICR

Exchange rate FCFA/US$ 567 FCFA/US$ Average over project implementation

Number of latrines per school 6 Project M&E and calculations

Number of latrines achieved 1,563 Project M&ENumber of students per school 300

Number of students per latrine 50 UNICEF recommendationa

Total population covered 78,150 Team calculationCosts assumptions

Investment costs - latrine 552,100 FCFA Project financial dataRecurrent costs - O&M, surveillance, and so on 2 US$/person/year WHO 2004, 13



19% in the past 30 days (MISC3, 216) - for East

% of sickness that is related to WASH risks (diarrheal only) 13.4 Percent

WHO 2005 Burden ofEnvironmental DiseasesEstimates for Cameroon

Reduction in incidence rates 30 Percent

Public health expenditure per month 28 Percent

Cameroon Economic Update Towards a Greater Equity a Special Focus on Health, 20

Private health expenditure per month 7,703 FCFA/household MICS3, 223 - for

East region

Total health expenditure per month 10,699 FCFA/householdCalculation. Public subsidy represents 28 percent

Absent days/episode of diarrhea 3 Days WHO 2004, 18

47

Description Value Unit SourceOpportunity cost of time working adult 1680 FCFA/day




Productive years lost due to lack of WSS services in DALYs 33 DALYs/1,000/year

WHO 2005 Burden of Environmental Diseases Estimates for Cameroon

Minimum income per year 435,240 FCFA Minimum wageSanitation access time saved per person per day 15 Minutes 15 minutes/day of

WHO 2004 Source: a. UNICEF. 2014. Points d’eau, latrines, lave-mains, et kits d’hygiène en milieu scolaire. Normes, spécifications techniques, plans-types et photos pour les entreprises et les bureaux de contrôle.

Table 3.24. Overview of Data/Assumptions Used in the CBA (Urban School Water Supply)




Exchange rate FCFA/US$ 567 FCFA/US$ Team calculationNumber of schools 28Number of people per borehole in schools

Students Teachers Other school staff Communities

300 Team calculation

Total population, covered 8,400 Team calculationDaily quantity of water consumed per person per day (with project)

20 Liters Hutton 2012

Daily quantity of water consumed per person per day (without project)

20Liters Hutton 2012,

project team

Costs assumptions

Investment costs - connection 1,349,218 FCFA Project M&E

Recurrent costs - O&M, surveillance

10% of capital costs

WHO

Recurrent costs - water price 364 FCFA/m3

Length of life of the water Supply equipment 20 Years WHO

48

Description Value Unit SourceBenefits assumptions

Average time necessary to fetch 20 L of water per person (without project)

20 Minutes AfDB

Average time necessary to fetch 20 L of water per person (with project)

10 Minutes AfDB

Opportunity cost of time 210 FCFA/hour AfDB, minimum salary in Cameroon

Table 3.25. Overview of Data/Assumptions Used in the CBA (Rural Public Latrines)

No. Description Value Unit Source

Overall assumptions



Exchange rate FCFA/US$ 567 FCFA/US$Average over project implementation

Number of latrines per school 6 Project M&E and calculations

Number of latrines achieved 1,160 Project M&ENumber of students per school 300

Number of students per latrine 50 UNICEF recommendationa

Total population covered 58,000 Team calculationCosts assumptions

Investment costs - latrine 552,100 FCFA Project financial data

Recurrent costs - O&M, surveillance, and so on 2 US$/

person/yearWHO 2004, 13


Incidence of sickness 1.85Cases per person per year

15.2 % in the past 30 days (MISC3, 216) - for Douala


WHO 2005 Burden ofEnvironmental DiseasesEstimates for Cameroon

Reduction in incidence rates 30 Percent



49

No. Description Value Unit Source

Private health expenditure per month 12,381 FCFA/household

MICS3, 223 - for East Region

Total health expenditure per month 15,847 FCFA/household

Calculation; public subsidy represents 28 percent

Absent days/episode of diarrhea 3 days WHO 2004, 18Opportunity cost of time working adult 1,680 FCFA/day Minimum salary



Opportunity cost of time schoolchildren 840 FCFA/day Valued at 50% of wage rate

Productive years lost due to lack of WSS services in DALYs 33 DALYs/

1,000/year


Minimum income per year 435,240 FCFASanitation access time saved per person per day 15 Minutes 15 minutes/day of

WHO 2004 Source: UNICEF. 2014. Points d’eau, latrines, lave-mains, et kits d’hygiène en milieu scolaire. Normes, spécifications techniques, plans-types et photos pour les entreprises et les bureaux de contrôle.

Table 3.26. Overview of Data/Assumptions Used in the CBA (Rural Household Latrines)

No. Description Value Unit SourceOverall assumptions



Exchange rate FCFA/US$ 567 FCFA/US$ Average over project implementation

Number of latrines achieved 13,249 Project M&ENumber of people per household 7.13 Project M&E

Number of people per latrine 7.13 Project M&E and calculation

Total population covered 94,465 Team calculationNumber of people of working age per household 2.38 Team estimate

Number of children ages 0–59 months per household 2.38 Team estimate

Number of schoolchildren per household 2.38 Team estimate

Costs assumptionsInvestment costs - Latrine -subsidy for pit and slab 105,940 FCFA Project M&E

Investment costs - latrine - beneficiary contribution

200,000 FCFA Stratégie Nationale D’assainissement Liquide Au

50

No. Description Value Unit SourceCameroun



19% in the past 30 days (MISC3, 216) - for East


WHO 2005 burden ofEnvironmental diseasesEstimates for Cameroon

Incidence of diarrhea (for children ages 0–59 months) 4.56 Cases/child/year

17.5 percent in the last 2 weeks (MICS3, 139) - for East

Reduction in incidence rates 30 Percent Team estimate (see PAD)



Private health expenditure per month 7,703 FCFA/household MICS3, 223 - for

East RegionTotal health expenditure per month 10,699 FCFA/household Calculation

Days off work/episode (working age) 2 days WHO 2004, 20

Duration of illness for babies and infants 5 days WHO 2004, 20

Absent days/episode of diarrhea 3 days WHO 2004, 18

Opportunity cost of time working adult 1,680 FCFA/day

AfDB and based on 10 hours of work a day




Productive years lost due to lack of WSS services in DALYs

33 DALYs/1,000/year


Minimum income per year 435,240 FCFA/yearBased on a minimum salary of FCFA 36,270/month

Sanitation access time saved per person per day 15 Minutes

Team estimate is considerably more conservative than 30 minutes/day of WHO 2004.

51

Table 3.27. Overview of Data/Assumptions Used in the CBA (Rural Boreholes)

No. Description Value Unit SourceOverall assumptions



Exchange rate FCFA/US$ 567 FCFA/US$ Team calculationYield of the borehole 1 m3/hour

Number of hours of use of the borehole 6 Hours

PIU estimation; this is conservative as other sources including the WHO suggest 8 hours.

Number of people per borehole in schools Students Teachers Other school staff Communities

300 Number Team calculation

Total population covered Team calculationDaily quantity of water consumed per person per day (with project) 20 Liters Hutton 2012

Daily quantity of water consumed per person per day (without project) 20 Liters Hutton 2012,

project teamCosts assumptions

Investment costs - borehole 8,566,232 FCFA Project M&E

Recurrent costs - O&M, surveillance10% of capital costs

WHO

Length of life of the borehole equipment 20 Years WHOBenefits assumptions

Average time necessary to fetch 20 L of water per person (without project) 20 Minutes AfDB

Average time necessary to fetch 20 L of water per person (with project) 10 Minutes AfDB

Opportunity cost of time 210 FCFA/hourAfDB, minimum salary in Cameroon

Note: Based on a minimum salary of FCFA 36,270 per month retrieved from http://www.camer.be/51938/11:1/smig-le-cameroun-parmi-les-derniers-en-afrique-cameroon.html

52

http://www.camer.be/51938/11:1/smig-le-cameroun-parmi-les-derniers-en-afrique-cameroon.html

Annex 4. Bank Lending and Implementation Support/Supervision Processes

(a) Task Team members

Names Title Unit Responsibility/Specialty

LendingMeike van Ginneken Sector Leader and Task Team Leader AFTUW TTLJan Drozdz Senior Water and Sanitation Specialist AFTUW Sanitation SpecialistMadio Fall Senior Water and Sanitation Specialist AFTUW Sanitation SpecialistPatrice Rakotoniaina Municipal Engineer AFTUW Sanitation SpecialistBarbra Senkwe Water and Sanitation Specialist TWIAF Sanitation SpecialistNneoma Nwogu Counsel LEGAF LegalAissatou Diallo Senior Finance Office CTRFC DisbursementKouami Hounsinou Messan Senior Procurement Specialist AFTPC Procurement

Sekou Keita Financial Management Specialist AFTFM Financial Management

Africa Olojoba Senior Environmental Specialist AFTEN EnvironmentMaria C.J. Cruz Lead Social Development Specialist AFTCS Social DevelopmentDiego Garrido Martin M&E Specialist AFTDE M&ESerigne Omar Fye Safeguards (Consultant) AFTCS Social DevelopmentAbdoul Ganyi Bachabi Environmental Safeguards (Consultant) AFTUW EnvironmentGiorgi Kaviladze Economist (Consultant) AFTUW EconomistSerigne Seye Communications (Consultant) TWIAF CommunicationsOnur Ozlu Operations Officer AFTUW OperationsCommie Kok Sun Senior Program Assistant AFTUW ACSIrene Nnomo Ayinda-Mah Team Assistant AFCC1 ACSSupervision/ICRMiguel Vargas-Ramirez Senior Water and Sanitation Specialist GWA03 TTLCharles Delfieux Senior Water and Sanitation Specialist GWA07 TTLPierre Boulenger Senior Water and Sanitation Specialist GWA07 Co-TTLKouami Hounsinou Messan Senior Procurement Specialist GGO07 Procurement

Celestin Adjalou Niamien Sr Financial Management Specialist GGO26 Financial Management

Bertille Gerardine Ngameni Wepanjue Financial Management (Consultant) GGO13 Financial

ManagementAlbert Francis Atangana Ze Environmental Safeguards (Consultant) GENDR EnvironmentEmeran Serge Menang Senior Environmental Specialist GEN07 EnvironmentCharlotte Noudjieu Cheumani Social Safeguards (Consultant) GSU01 Social DevelopmentKristyna Bishop Senior Social Development Specialist GSU01 Social DevelopmentCedric Cubahiro Senior Finance Assistant WFALA DisbursementYoro Sidibe Young Professional GWA07 EconomistNneoma Nwogu Counsel LEGAF Legal

53

(b) Staff Time and Cost

Stage of Project Cycle

Staff Time and Cost (Bank Budget Only)

No. of Staff WeeksUS$ thousands (including

Travel and Consultant Costs)

Lending 34 284Supervision/ICR 108 592

54

Annex 5. Summary of Borrower's ICR and Comments on Draft ICR

(a) République du Cameroun - Rapport d’évaluation finale du projet d’assainissement liquide (SAN-CAM). Version definitive. Juin 2017

EXECUTIVE SUMMARY

Introduction

The promotion of access to sanitation is one of the main objectives of the National Liquid Sanitation Strategy developed by the GoC with World Bank funding. That is the reason why the GoC and the World Bank agreed to set up the Liquid Sewerage Project for which the related Credit Agreement was signed on October 28, 2011.

Description of the Intervention

Project activities were structured around three main components:

o Component 1: Urban Sanitation;

o Component 2: Rural Sanitation; and

o Component 3: Institutional Capacity Building and Project Management.

The original project was a two-phase APL, but because of difficulties encountered while implementing the project, it was restructured three times, the PLA was abolished, the project was transformed into a regular investment, and certain project activities have been cancelled. This led to a downward revision of the targets of the indicators in the Results Framework, with a 19-month extension of the duration of the project.

Summary of Main Findings

Relevance

The analysis of the information carried out by the evaluating team shows that the project is relevant, considering:

The national liquid sanitation strategy;

The national rural WSS policy;

The sectoral policy letter on urban water supply;

The strategy paper for growth and employment decentralization; and

55

The relevance of the project to the context, the problems, and the needs of the beneficiaries.

However, according to beneficiaries, the vulnerable population does not always benefit from household latrines because they do not have enough means to mobilize their input for the construction of household latrines. In the Eastern Region, MINEE was not involved in the choice of sites but rather in the reception of the works. The selection of the technological pallet, particularly for household and public latrines in the city of Douala, was done by the CAMSAN PIU and did not receive the favourable opinion of all households. Mass communication was not made due to the lack of available communication media and a logo for the project. The focus groups highlighted areas where there is room for manoeuvring to enhance relevance in future similar projects. They are

The low level of involvement of local key stakeholders in the process of developing business continuity plans (BCPs);

The low utilization of BCPs by the municipalities;

The lack of mass awareness through the media which should follow local outreach;

The low involvement of municipal and municipal councils despite their very high interests; and

The low awareness of the disability approach.

Overall, the relevance of the project can be judged to be satisfactory.

Effectiveness

In relation to the development indicators defined by the project, the situation, as of March 31, 2017, according to the Results Framework, is as follows:

The project directly benefitted 623,922 people for a target of 731,128, an achievement rate of 85 percent.

The number of inhabitants with access to improved sanitation due to the project is 47,472 for a target of 126,871, a realization rate of 37 percent.

The number of primary and secondary school children with access to improved and gender-sensitive school sanitation facilities is 95,200 for a target of 121,900, a 78 percent achievement rate.

The following problems were noted during the focus groups:

Poor performance of the companies responsible for the construction of boreholes and latrines

56

Delays in the provision of building materials

Weak involvement of the technical and territorial sectors only in the reception phase resulted in the resumption of certain aspects of the work (compliance with construction standards)

Limited presence of project managers in construction sites

Difficult access to certain localities

It was found that no target was achieved although they were revised downwards and the project was extended 19 months after various restructurings. However, a satisfactory performance of the project results from the Results Framework.

The effectiveness of the project is therefore satisfactory.

Efficiency

From the analysis carried out, general conclusions on the efficiency of the project to be noted are as follows:

In relation to the institutional arrangements and with regard to PIU-MINEE, the assessment shows that MINEE did not always approve the Annual Work Plan and Budget validated by COPIL as soon as possible. Moreover, it was noted in the 2015 audit report that MINEE/UEP employees have worked for more than a year without a contract, which should be signed by the Minister of Water and Energy.

The unavailability of key personnel such as the procurement specialist, who also holds the post of inspector general in the Douala Urban Community, did not allow the UEP/CUD to carry out its activities as quickly as possible and did not allow the UEP to ensure better monitoring of contracts.

With regard to the planning and M&E mechanism, the analysis carried out through the focus groups showed:

A very long period before the commencement of project activities;

Complexity of World Bank procedures and delays in the process of obtaining ‘no-objection’ from the World Bank;

Poor communication around latrines and drilling constructed;

Long delays in signing contracts between the project and NGOs;

Late payment of services by masons and RCAs in certain municipalities by NGOs;

M&E system to be improved; and

57

The absence of field relays responsible for monitoring, collection, and reporting of beneficiary information.

M&E system to be improved. This includes the following:

Compartmentalization of M&E information (including information on procurement, contracts, and deadlines for payment or ‘no-objection’) between the M&E officer and other stakeholders.

M&E information for the Douala UEP is not always available, most of which is absent from the MINEE UEP.

Project partners (mayor, departmental delegate MINEE, the MINEDUB, the MINESEC, the MINEPDED, and head of school) had no control over the project’s M&E system, as they were not involved in the follow-up of daily activities of the project.

Low capacity of CRAs for assimilation of awareness-raising techniques.

Based on these criteria, it can be concluded that the efficiency of the project is considered unsatisfactory.

Impact and Sustainability

The assessment of the impact and viability of the liquid sanitation project was limited by the lack of information from the continuous monitoring system. This lack of information was supplemented with fieldwork as a valuable source of verification to assess the qualitative aspects of the effects and impacts of the various activities undertaken by the project.

In general, and in connection with the conclusions of the previous evaluation criteria, it can be concluded that, it is at the social level that the effects/impacts of the project are most palpable. The project has contributed to improved sanitation services in underserved areas. SANCAM also contributed positively to the protection of nature and the environment. These impacts are the result of the project’s Environmental and Social Management Framework. Environmental screening preceded the choice of the beneficiary sites of the public and domestic latrines to ensure the protection of the water table. Promoting access to sanitation has generated direct health gains related to disease prevention and economic and social benefits.

In view of these responses, the impact of the project can be judged as satisfactory.

In terms of the viability of the project, the project enabled Mayo-Tsanaga, Mayo-Kani, and Mayo-Sava to designate focal points for liquid sanitation, responsible for monitoring all liquid sanitation activities within the Town Hall. The PCA is also a tool for educating elected officials on the need to consider aspects of hygiene and sanitation in creating adequate conditions for population well-being. The project also supported some schools in setting up the latrine, setting up drilling management committees, and training the

58

members of the management committee in the maintenance and maintenance of latrines and boreholes funded by the project within the schools. Capacity-building activities financed by SANCAM have enabled stakeholders to benefit from consultants’ experience transfers in the field of liquid sanitation and project monitoring and evaluations as well as data reporting. Municipalities have the potential to continue raising awareness. In addition, municipalities have enough opportunities to self-finance after the project with regard to local development issues. These elements contribute to improving the sustainability of the project.

It remains a matter of concern that committees have been constituted only in certain schools and not all. In addition, MINEE deconcentrated services did not participate in the pumping tests of certain boreholes, particularly in the Eastern Region. The limited presence of project managers on the sites does not guarantee accurately the durability of the drilling.

Overall, the sustainability of the project is likely.

Lessons Learned on the Liquid Sanitation Project

On the Relevance

NGOs’ or service providers’ involvement in the recruitment and training process of masons has made it possible to hire those who are professional and committed.

Local NGOs and CRAs (outreach agents) involvement in raising awareness has made it possible to get closer to the populations, especially in areas of insecurity.

The involvement of masons in the design of latrines has made it possible to better integrate the needs, costs, and sociocultural specificities of households.

Good awareness of household proximity increases the enthusiasm for adopting good hygienic practices (handwashing, cleaning of food, and acquisition and maintenance of latrines).

The development of municipal sanitation plans has provided a framework for the design and updating of a municipal sanitation plan.

The feasibility studies for the construction of the sludge treatment plants made it possible to obtain a more realistic financial estimate of the construction costs of this type of structure in Cameroon.

The realization of technical and socioenvironmental studies and the implementation of compensation mechanisms have shown that the construction of an STBV can take no less than five years.

59

The project has developed a graphic and sound chart that is not known to the general public.

On Effectiveness

Reducing the number of mutually dependent missions to be carried out by a single provider creates a risk of bottlenecks in the execution of activities.

The lack of continuous monitoring of the quality and effectiveness of services negatively affects the achievement of project targets and objectives.

Some activities such as socioenvironmental assessment, compensation, transfer of previous project activities, and so on, if not done at the preparatory stage, delay the execution of the project.

Experience has shown that building family latrines by craftsmen trained within the framework of the project makes it possible to move faster in the execution of activities than to have them built by the companies.

Procuring the public latrines in small batches makes it possible to move faster than making large batches.

On Efficiency

The obsession with searching for the lowest in market analysis boards has sometimes led to the selection of providers who are unable to perform contracts, which led to successive terminations, resulting in delays in project implementation.

The unavailability of counterpart funds sometimes created delays in the implementation of certain project activities not considered by IDA financing (operation of internal procurement commissions).

The low level of involvement of beneficiaries and sectoral stakeholders in monitoring is a determinant of the project ownership gap.

Harmonizing the understanding of procedures is a necessity. It avoids tensions and creates communication discomfort.

The coaching of the partners in the management of the procedures and the assembly of the payment files is essential. It builds capacity and contributes to the achievement of expected results.

Recommendations on the Liquid Sanitation Project

Following is a set of recommendations to include lessons learned during the implementation of future similar projects.

60

On the Relevance

Following the discussions on relevance, the following recommendations were made:

Continue the training of municipalities in the proper use of CACs and their annual updating.

Annually update BCPs through a participatory process and before the city council meeting.

Disseminate the image boxes produced by the project and intended to raise public awareness of good hygienic practices.

Disclose the graphic and sound charts elaborated to the general public.

Organize a national workshop for the return of project assets (liquid sanitation mark, construction plans and estimate of public latrines, CACs, geolocation of sanitation and water supply works, and so on); regional appropriation workshops.

Promote all improved latrine models developed by the project in line with the sanitation marketing approach provided for in the national liquid sanitation strategy (cost of models adapted to each household budget).

Continue training of users for use in improved latrine management and water reserves.

Mainstream the disability approach for all institutional latrines.

On Effectiveness

In view of the difficulties encountered in the implementation of SANCAM, the following recommendations were made:

Ensure that all contractual clauses are respected as far as possible.

Review the recruitment process of providers with an emphasis on the experience of providers.

Strengthen collaboration between the beneficiaries and the companies responsible for carrying out the work.

For future projects, the PIU must, from the outset, identify strategies for the delivery of construction equipment. A solution would be, for example, to offer a private contract to a well-known supplier who will be responsible for delivering the construction materials in the project areas.

Strengthen the system for monitoring benefits by associating decentralized services with sectorally competent local authorities.

61

Harmonize hygiene and sanitation approaches promoted by the sectoral sectors and develop a household awareness strategy for the construction of household latrines adapted to the urban environment.

Continue to strengthen local sectors or RTAs in means of locomotion with a view to monitoring the execution of latrines and boreholes.

On Efficiency

To ensure a rapid start of the activities of future projects, it would be ideal to have ready-to-sign contracts ready to be implemented immediately. The preparatory phase of the project should be used for both the detailed technical studies and the first contracts.

Reduce processing time for ‘no-objection’ applications.

Improve communication around the project (commissioning ceremony of the structure) as it allows to solve problems of use and maintenance.

To improve payment deadlines, it is recommended that future projects strengthen the capacity of all actors on the payment mechanism as well as all the documentation required for each actor.

Strengthen the M&E system, in particular with regard to the monitoring of the latrines and drilling constructed and the collection of data on them. The new system should integrate the focal points of the municipality as the basis for the feedback of information to feed the M&E system.

To improve the M&E system, it is suggested that a real M&E plan should be defined for future projects, describing in detail (a) the information to be reported to the M&E officer (CSR) by the various actors (SPM, RAF, accountant, experts, and so on); (b) reports and dashboards (monthly, quarterly, annual) to be produced by the CSR and; (c) the dissemination plan for the said reports. This system should be computerized.

Harmonize the hygiene and sanitation approaches promoted by the sectoral sectors and develop a strategy to sensitize households to the construction of household latrines adapted to the urban environment.

To Improve Partner Performance

To improve the performance of the World Bank, we recommend that the time frames for the issuance of the ‘no-objection’ opinions and, as the case may be, be governed by the World Bank's ability to issue ‘no-objection’ notices. The stability of the World Bank team that is responsible for monitoring a project throughout its implementation until the project closes should be maintained as much as possible.

62

To improve the performance of the MINMAP and CAA, it is necessary to specify the time frame for processing files at both the MINMAP and CAA levels and, above all, to set a maximum deadline for notification if a request. In addition, all actors involved in the procurement process should be made aware of and procedures for payment of the documentation to be provided by the providers should be made.

We also recommend that at the beginning of each project, the Minister of Public Procurement designate the ministry’s decentralized service managers as the representative of the MINMAP in the provisional acceptance commissions for the works carried out in its territory. It is important that the Minister of Public Procurement officially communicates the responsibility for the travel of MINMAP representatives during the provisional receptions.

About Sustainability

To ensure the sustainability of the achievements of the SANCAM project, the following recommendations were made:

Continue to strengthen the capacities of the health services responsible for sustaining SANCAM’s work in the field in the communes.

Encourage the Commons to use the BCPs and reserve a budget line for sanitation.

Continue to set up and train the management committees for all infrastructures carried out within the framework of SANCAM provided by MINEE.

Provide annual update of CACs followed.

(b) Comments on Draft ICR

The draft ICR was shared with the Borrower and with the implementing agencies of the project. The main non-editorial comments received are summarized below:

In order to illustrate how the procurement processes have been affected by the centralization of procurement, the Implementing Agency reminded that the recruitment of the TA for the rural Component took 18 months.

The geo-referenced web-site developed under the CAMSAN project also included the construction of the boreholes, in addition to the households.

The expansion of access to water and sanitation services to reduce poverty in rural areas will done through access to on-site sanitation (as opposed to sewerage) as well as access to improved water.

The restructuring of the Project actually did help substantially to achieve the project’s targets in rural areas.

63

The demand for new latrines remains high in the affected rural areas even after the project closing.

The project was successful in implementing cheap and locally constructed latrines.

The implementing agencies indicated that from, their own perspective, the appropriate environmental clauses were included in the bidding documents and that the supervision of the works by the works’ supervisors also encompassed the environmental supervision.

At project closing, a system was set-up by the CUD to proceed with the full reimbursement of the households having paid a deposit to benefit from a subsidized latrine.

The actual demand from beneficiaries in Douala was not sufficiently analyzed during the project preparation, this situation having led to offering an inappropriate type of latrines with regard to the actual demand.

The Implementing Agency in Douala also pointed out a lengthy technical revision of the bidding document for the sludge treatment plant in Douala that would have prevented to fund the plant under the CAMSAN eventually due to lack of time.

64

Annex 6. Comments of Cofinanciers and Other Partners/Stakeholders NA

65

Annex 7. List of Supporting Documents

Project Appraisal Document on a Proposed Adaptable Program Loan in the Amount SDR 18.6 Million (US$30 Million Equivalent) to the Republic of Cameroon for a Cameroon Sanitation Project Phase 1 (APL-1) in support of the Cameroon Sanitation Program. May 27, 2011. Urban and Water, Country Department AFCC1, Africa Region.

The World Bank. CM-Sanitation Project (P117102) - Implementation Status and Results Report. Sequence Number 1 to 11.

Republic du Cameroun, Projet d’assainissement liquide - Mission de suivi at d’appui technique - Aide Memoire 2011, 2012 (2), 2013 (2), 2014 (2), 2015, 2016 (2), and 2017.

The World Bank. Restructuring Paper on a Proposed Project Restructuring of Cameroon Sanitation Project Phase 1 (APL-1) Adaptable Program Loan IDA 49840. Board Approval June 23, 2011 to the Republic of Cameroon, April 3, 2015. Global Practice Water (GWADR), Africa Region (AFCC1).

The World Bank - CM-Sanitation Project (P117102). Restructuring Paper on a Proposed Project Restructuring of CM-Sanitation Project, Approved on June 23, 2011, to the Republic of Cameroon. Water. Africa. Report No: RES24703.

The World Bank - CM-Sanitation Project (P117102). Restructuring Paper on a Proposed Project Restructuring of CM-Sanitation Project, Approved on June 23, 2011, to the Republic of Cameroon. Water. Africa. Report No: RES27391.

International Bank for Reconstruction and Development, International Development Association, International Finance Corporation, and Multilateral Investment Guarantee Agency. Country Partnership Framework for the Republic of Cameroon for the period FY17–FY21, February 28, 2017. Africa Region, Central Africa Department 1. The International Finance Corporation. Multilateral Investment Guarantee Agency.

République du Cameroun - Rapport d’évaluation finale du projet d’assainissement liquide (SAN-CAM). Version definitive. Juin 2017.

66

Annex 8. Description of the Components Revised at the First and Second Restructurings.

1. With the first restructuring in 2015, Component 2 was revised to include bore holes and school latrines in the Adamaoua, East, and North Regions transferred from the closed IDA-funded Education Development Capacity Building Project (P075964). The cost of Component 2 was increased to US$5.9 million, and end-of-project targets of three activities were revised. The restructured Component 2 would finance the activities described in the following sections (taken from the Project Restructuring Paper, April 3, 2015).

Component 2: Rural Sanitation (total project costs US$6.6 million, of which IDA US$5.9 million)

Provide TA to local authorities to take leadership on sanitation, develop a sanitation plan, and appoint a focal point for the project. Training of a local cadre of sanitation workers will be a priority for them to play a key role and to support sustainability of the built infrastructure and hygiene behaviors.

Support a hygiene promotion campaign targeted at households, mothers, and school children. Community outreach workers (men and women) would be identified in the villages and trained and given the responsibility of promoting hygiene practices, providing information, and building awareness about access to latrines, using home visits, neighborhood meetings, and small-scale awareness-building campaigns. Activities would also aim to inform teachers and health care workers about hygiene and sanitation; 180 teachers will be trained, as will 250 local masons who would be building the toilets.

Assist 25,000 people to get household latrines through a subsidy for the pit and slab. Households would pay a deposit to qualify for a latrine. Contractors would dig the pit and build the slab, and the household would build the superstructure (and get back their deposit) or have it built by a mason.

Construct 590 latrines in public schools and in health centers to act as demonstrations and focal points for engaging the communities on hygiene practices.

Provide access to water in 206 rural schools through the construction of bore holes and hand pumps.

2. As part of the change from an APL to an IPF at the first restructuring in 2015, the activities of Component 3 that were the triggers for APL-2 were cancelled as were the activities of Components APL-2. The costs for Component 3 were reduced from US$5.3 million to US$2.7 million. The savings in component costs were transferred to Component 1 to cover the projected increase in costs for the sludge treatment plant (costs of Component 1 increased from US$19.4 to US$21.4). The restructured Component 3

68

would finance the activities described in the following paragraphs (taken from the Project Restructuring Paper, April 3, 2015).

Component 3: Institutional Strengthening and Project Management (total project costs US$2.7 million)

Build capacity of urban municipalities—with the help of private contractors—to take charge of the O&M of sludge treatment plants and ensure that they have sustainable financial flows to carry out their responsibilities.

Provide TA for sanitation planning at the national and local level, including the development of sanitation master plans for selected cities.

Support local governments to set up monitoring systems and establish a clear mechanism on how to collect and convey data from the municipality to the central level.

Finance the costs of the MINEE PIU and other project management costs.

3. In addition, the end-of-project targets for 10 activities of Components 1 and 2 were revised to reflect the increased implementation time with the extension of the closing date.

4. With the second restructuring in November 2016, the financing of two major activities of Component 1—the condominial sewerage systems—and the two/three sludge treatment plants20 were cancelled. The connection of schools to the water supply was added and the end-of-project targets of five activities were revised. The restructured component 1 would finance the following activities (taken from the Project Restructuring Paper, November 16, 2016):

Component 1: Urban Sanitation (total project costs US$28.5 million, of which IDA US$21.4 million)

Design and implementation of outreach and education activities for hygiene education, sanitation promotion, creation of demand for sanitation services, and behavioral change activities in the four selected municipal districts targeting 0.7 million people through mass media campaigns, 350,000 people through face-to-face hygiene education and sanitation marketing, and 1,700 primary and secondary school teachers.

Construct household latrines in Douala districts III and V. The component would finance the construction of the latrine pit and slab while the household would finance the superstructure.

20 The Restructuring Paper on a Proposed Project Restructuring of CM-Sanitation Project Approved on June 23, 2011, to Republic of Cameroon, (second restructuring approved by the CD on November 16, 2016). It should be noted that the second Restructuring Paper mentions only the cancellation of the proposed Ngombe Sludge Treatment Plant. The cancelling of the proposed Bois des Singes plant is mentioned only in the Aide Memoire of the October 31–November 4, 2016, supervision mission.

69

Construct public toilets in schools, markets, and other public places, fully subsidized by the component. In total, 1,800 public latrines would be constructed.

Provide TA and training to strengthen the capacity of the CUD to manage the sanitation subsector through (a) capacity-building activities for sanitation-related units within the CUD and (b) project management and coordination for this component.

Connect to the public water supply for 30 schools in Douala.

70

Annex 9.Map – IBRD 33382R

71