Kenya - Rural Health Project III - Project Completion Report · 2019-06-29 · RURAL HEALTH PROJECT...

AFRICAN DEVELOPMENT FUND

KENYA

RURAL HEALTH PROJECT III

PROJECT COMPLETION REPORT (PCR)

OSHD/EARC

July 2013

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List of Abbreviations/Acronyms

CHEW- Community Health Extension Worker

CHW-Community Health Worker

CHC- Community Health Committee

DHMT- District Health Management Team

FBO- Faith Based Organisation

IEC- Information Education Communication

IMCI- Integrated Management of Childhood Illnesses IYCF- Infant and Young Child Feeding

MCH- Maternal and Child Health

MTEF- Medium Term Expenditure Framework PIU- Project Implementation Unit

PMU- Project Management Unit

VIP- Ventilated Improved Pit latrines

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PROJECT COMPLETION REPORT (PCR) A. PROJECT DATA AND KEY DATES

I. BASIC INFORMATION

Project Number: P-KE-IB0-001

Project Name: Rural Health Project III

Country: Kenya

Lending Instrument(s): ADF Loan and ADF Grant.

Sector: Social Environmental Classification: Category 2

Original Commitment Amount: (ADF Loan- UA 17.18 Million, ADF Grant -UA 6 Million and OPEC- USD 8 Million)

Amount Cancelled: N/A

Amount Disbursed: ADF Loan- UA 16.105.564, 57 and ADF Grant-UA 6 Million. This exclude Direct Payments under process at the Bank.

Percent Disbursed: ADF Loan -94% excluding direct payments under process at the Bank and ADF Grant-100%.

Beneficiary(borrower): Ministry of Finance

Executing Agency (ies) [List the main Ministries, Project Implementation Units, Agencies and civil society organizations responsible for implementing project activities.]: Ministry of Public Health and Sanitation. The Project was implemented by a Project Management Unit (PMU) comprising of; Project Manager, Project Quantity Surveyor, Project Procurement Specialist, Project Monitoring and Evaluation Specialist and Project Community Based Health Care Specialist. In addition, the Government seconded to the PMU a procurement assistant, an accounts assistant, two drivers and two support staff.

Co-financers and other External Partners [List all other sources and amounts of financing, technical assistance or other resources used in this project]: The project was Co-Financed by OPEC at USD 8 Million.

II. KEY DATES

Project Concept Note Cleared by OPSCOM: N/A

Appraisal Report Cleared by OPSCOM: N/A

Board Approval: July 7 2004

Restructuring(s): There was no major project restructuring in terms of project scope and objectives. The main changes were operational and entailed trainings approach and supervision of works. According to the Project Appraisal Report (PAR), all trainings were to be undertaken through consultancy. However, the Bank approved the Executing Agency's request to carry out the National Community Health Strategy Trainings by the Ministry at the district level through the District Health Management Teams (DHMTs) using the national training guidelines and curriculum. At the project's Mid Term Review, the Bank accepted to reallocate to works, some funds earmarked for disease specific trainings in communicable diseases such as HIV and Malaria since these was already being undertaken at a large scale through the Global Fund and USAID programs. The supervision of works could not be adequately carried out by the Ministry of Public Works as envisaged at appraisal due to its capacity constraints. Consequently, the project civil works design consultants were retained to supervise all the works under the project. Furthermore, the needs assessments for equipment and training was carried out by the PMU and Ministry Staff and not through consultancy as envisaged at appraisal to enable the project align to the current national/ministry priorities and standards. The project audit was carried out by the Kenya National Audit Office (KENAO) and not outsourced auditors as stated at appraisal. The radio communication equipment was not procured because the Ministry was using cellphones and funds for this activity were reallocated to medical equipment. The water source protection intervention to protect wells and springs was also dropped due to challenges on land ownership at the points the springs and wells are located and funds reallocated to works.

Original Date Actual Date Difference in months

[Actual-Original]

EFFECTIVENESS janv-05 21-avr-06

14 months

MID-TERM REVIEW mars-07 mai-09

13 months

CLOSING déc-10 30-août-12

20 months

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III. RATINGS SUMMARY All summary ratings are auto-generated by the computer from the relevant section in the PCR.

CRITERIA SUB-CRITERIA RATING

PROJECT OUTCOME

Achievement of Outputs 3

Achievement of Outcomes 3

Timeliness 3

OVERALL PROJECT OUTCOME 3

BANK PERFORMANCE

Design and Readiness 3

Supervision 4

OVERALL BANK PERFORMANCE 3

BORROWER PERFORMANCE

Design and Readiness 2

Implementation 3

OVERALL BORROWER PERFORMANCE 2

IV. RESPONSIBLE BANK STAFF

POSITIONS AT APPROVAL AT COMPLETION

Regional Director N/A Gabriel NEGATU

Sector Director Alice HAMER Agnes SOUCAT

Task Manager Walter MUCHEENJE Ruth KARIMI CHARO

PCR Team Leader Ruth KARIMI CHARO

PCR Team Members Walter ODERO and Ruth CHARO

B. PROJECT CONTEXT

Summarize the rationale for Bank assistance. State:

-what development challenge the project addresses, -the Borrower's overall strategy for addressing it -Bank activities in this country (ies) and sector over the past year and how they performed, and -ongoing Bank and other externally financed activities that complement, overlap with or relate to this project.

Please cite relevant sources. Comment on the strength and coherence of the rationale. [250 words maximum. Any additional narrative about the project's origins and history, if needed, must be placed in Annex 6: Project Narrative]

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The project was conceptualized in the context of ADF XI which for Kenya, directly supported Kenya’s Economic Recovery Strategy for Wealth and Employment Creation 2003-2007 as outlined in the appraisal. The National Health Sector Strategic Plan (NHSSP I) 1999-2004 targets included strengthening health systems, human resources development and management, and scaling up drugs and medical supplies. An important aspect of the Recovery Strategy was to ensure that the fundamental concerns of equity, access, affordability and quality in the provision of basic health services were addressed particularly for the rural and the poor. One of the measures spelt out was rehabilitation of existing health facilities. In addition, the agenda for reform in the then Kenya National Health Policy Framework 1994-2010 included upgrading of health infrastructure through rehabilitation and equipment to standards expected for effective and efficient provision of quality health care. This policy made specific reference to AFDB's required investments aid in this area. According to the 2003 Public Expenditure Review there were 95 planned and stalled projects (construction) in the health sector that required Ksh. 1.57billion to be implemented. The Ministry of Health outlined key priorities in the then Medium Term Expenditure Framework (MTEF) and among the key Government revenue budget was revitalizing health care services in the rural. The project objectives and activities set out to address some of these identified gaps by rehabilitating and upgrading existing rural health facilities (works, equipment and medical suppliers), strengthening management capacity of DHMTs and in-service training of Health Care Workers in the rural. The project outputs have also significantly contributed to achievement of NHSSP II (2008-2012) strategic thrust 1 on improving equitable access to public health and sanitation services. Performance of the country’s overall portfolio is satisfactory as per the Country's Portfolio Review for June 2011. The review noted critical areas needing improvement which include procurement, disbursement and weak M&E systems. The water and sanitation intervention in the slum area directly contribute to this project objectives in regard to reduction of diseases.

C. PROJECT OBJECTIVES AND LOGICAL FRAMEWORK

1. State the Project Development Objective(s) (as set out in the appraisal report)

To improve access of the population to quality health care.

2. Describe the major project components and indicate how each will contribute to achieving the Project Development Objective(s).

Component I: District Health System Strengthened. This component aimed at ensuring that the target districts are capable of providing quality basic (primary) healthcare services. Existing facilities were rehabilitated and equipped; supplied with essential medical outpatient and inpatient equipment; provided with desktop computers and printers to support the information system; and DHMT members were trained in management of health care services. Component II: Major Diseases Prevented and Controlled. This component aimed at reduction of disease burden through concerted effort to prevent and control major health problems prevalent in the seven districts. Essential drugs will be procured through a demand driven system to treat common ailments (outpatient care consultations); the project facilitated extensive sensitization and mobilization of target communities in health education and promotion; strengthening of the community coordinating structures through community health strategy trainings; development of communication materials; construction of VIP latrines and rainwater harvesting facilities in target health facilities and in 35 schools. Component III: Project Management strengthened. This component aimed at strengthening the capacity of the executing agency to implement this project. A dedicated Project Management Unit was established with core technical staff as outlined under 1 above and Government seconded to the PMU support staff and drivers.

3. Provide a brief assessment (up to two sentences) of the project objectives along the following 3 dimensions. Insert a working score, using the scoring scale provided in Appendix 1.

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PROJECT OBJECTIVES DIMENSIONS

ASSESSMENT WORKING SCORE

RELEVANT

a) Relevant to the country's development priorities

As outlined under B above, the objectives were relevant to Kenya's development priorities as outlined in the Economic Recovery Strategy for Wealth Creation 2003-2007, the National Health Sector Strategic Plan 1999-2004, Public Expenditure Review for 2003 and the agenda for reform in the then Kenya National Health Policy Framework 1994-2010. The strategies focused on quality health care services in the rural and among the poor as well as rehabilitation and upgrading of existing health facilities to improve quality.

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ACHIEVABLE

b) Objectives could in principle be achieved with the project inputs and in the expected timeframe

In principle, it was possible to achieve project objectives with the planned inputs and timeframes as set out at appraisal. However, the project start up/effectiveness was delayed by 2 years mainly due to administrative process by the Executing agency in recruiting the PMU and opening of the project's special accounts. The process to complete works designs and award works contracts took another 2 years. The list of the specific facilities was also not ready at by appraisal.

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CONSISTENT

c) Consistent with the Bank's country or regional strategy

The project was conceived within the ADF XI cycle priorities. For Kenya, this ADF directly supported investment in the then Economic Recovery Strategy for Wealth Creation 2003-2007 as indicated in the appraisal report. The recovery strategy included rehabilitation of existing health facilities as one of its key focus areas. In addition, the appraisal report refers to an assessment study conducted during the previous health project to assess the rehabilitation requirements of health facilities at district level-project formulation and priorities were also informed by the findings of this study.

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d) Consistent with the Bank's corporate priorities

The project was in line with the Bank's overall Strategic plan 2003-2007. In regard to health, the strategy placed emphasis on Primary Health Care as concerns accessibility, reliability and affordability particularly in rural and peri-urban areas. One of the strategy’s selectivity areas included strengthening of health infrastructure.

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4. Summarize the log. frame. If a log. frame does not exist, complete the table below, indicating the overall project development objective, the major components of the project, the major activities of each component and their expected outputs, outcomes, and indicators for measuring the achievement of outcomes. Add additional rows for components, activities, outputs or outcomes if needed.

COMPONENTS ACTIVITIES OUTPUTS EXPECTED OUTCOMES

INDICATORS TO BE

MEASURED

Component I: District Health Systems Strengthened

Rehabilitation of health facilities

52 health centers, 157 dispensaries rehabilitated, 17 dispensaries upgraded

Increase in utilization rate of primary health services

Utilization rate of primary health facilities increased from 60% to 90%

Number of women giving birth in health facilities increased

Number of persons enrolled for HIV care increased

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Equipping of health facilities 69 health centers provided with equipment and supplies to provide basic health care services


Immunization coverage increased from 60% to 90%

Provision of ambulance, a vaccine/drug delivery, mobile service vehicle, bicycles, motorcycles

7 districts provided with 1 ambulance, 1 vaccine/drug delivery vehicle, 1 mobile services vehicle, motorcycles and bicycles



Training of District Health Management Teams (DHMTs) on health service management aspects including planning & budgeting, supportive supervision, project management among others; Community Health Strategy Trainings mainly in disease prevention aspects and health education, health worker trainings in Infant and Young Child Feeding; and Integrated Management of Childhood Illnesses.

463 facility and district level health staff trained management of health services and select health interventions, 6,184 community level health staff trained on community health strategy

Percentage of health facilities receiving supervisory visits every 6 months; timely and adequate district level planning , budgeting and management.

Review and introduce computerized health information systems

57 computers provided in 57 health facilities. 32,100 assorted copies of Health Information System standard reporting tools to provide to Government and Faith Based health facilities countrywide

Annual Operational district health plans supported by data. DHMTs take decisions based on available data.

Carry out an assessment on the sustainability of the project

Project sustainability assessment done and report disseminated

Preventive Maintenance Institutionalized at central and lower levels.

Component II: Major Diseases Prevented and Controlled

Procurement of drugs 4,209 kits of essential medicines and medical supplies distributed to health facilities

Number of new cases for the three most prevalent diseases reduced by 50%

Construction of demonstration projects on rainwater harvesting and construction of VIP latrines in target schools

Demonstration projects constructed and operational in 35 schools


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Support outreach services by community health workers

6,184 health staff trained on Community Health Strategy, 32,100 assorted copies of Health Information System standard reporting tools reproduced, IEC, 157 bicycles, 77 motorcycles


Reproduction and distribution of IEC materials

IEC materials distributed to 431 health facilities and their catchment areas



Component III: Project Management

Establish a Project Management Unit

1 Project Manager, 1 Procurement Specialist, 1 Quantity Surveyor, 1 Accountant, 1 Community based Health Care Specialist, 1 Monitoring and Evaluation Specialist recruited, 3 drivers, 1 cleaner and 2 secretaries seconded and additional office equipment e.g. photocopier, desktop computers, printers and service contracts procured

Project managed and implemented as per appraisal report

Effective project management and supervision

Procure short-term consultancies

Short-term consultancies procured for development of M&E data base, Project Implementation Manual and project sustainability assessment

Project managed and implemented as per appraisal report

Effective project management and supervision

5. For each dimension of the log. frame, provide a brief assessment (up to two sentences) of the extent to which the log. frame achieved the following. Insert a working score, using the scoring scale provided in Appendix 1. If no log. frame exists, score this section as a 1 (one).

LOGICAL a) Presents a logical causal chain for achieving the project development objectives

At MTR and PCR, the teams had to establish linkages between activities, outputs and outcomes as this was not explicitly stated in the appraisal log frame although the project components descriptions outlined in detail the project activities. Similarly, there was an output indicator to measure number of patients on ARVs yet there was no activity or budget on ARVs and this indicator was dropped at the project MTR in June 2009. A few of the indicators above mainly under trainings and sustainability study were reformulated.

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MEASURABLE b) Expresses objectives and outcomes in a way that is measurable and quantifiable

Both the objectives and outcomes were expressed in quantitative and qualitative terms which enabled them to be measured and quantified during project implementation and at project completion.

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THOROUGH c) States the risks and key assumptions

The log frame takes into account relevant risks and assumptions particularly sustained government contribution to the project, adequacy of monitoring and supervision capacity of the PMU, and sustained community participation in healthcare development.

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D. OUTPUTS AND OUTCOMES

I. ACHIEVEMENT OF OUTPUTS

In the table below, assess the achievement of actual vs. expected outputs for each major activity. Import the expected outputs from the log. frame in Section C. Score the extent to which the expected outputs were achieved. Weight the scores by the activities' approximate share of project costs. Weighted scores are auto-calculated by the computer. The overall output score will be auto-calculated as the sum of the weighted scores. Override the auto-calculated score, if desired, and provide justification.

MAJOR ACTIVITIES Worki

ng Score

Share of Project Costs in percentage (as stated in

Appraisal Report)

Weighted Score (auto-

calculated)

Expected Outputs Actual Outputs

52 health centers, 157 dispensaries rehabilitated, 17 dispensaries upgraded, Demonstration projects constructed and operational

214 health facilities (57 health centers and 157 dispensaries) rehabilitated and fully operational. 35 schools supported with demonstration projects (rainwater harvesting facilities and VIPs).

3,00 39,7% 1,19

69 health centers equipped in accordance to MOH's standard list of equipment, An ambulance, a vaccine/drug delivery vehicle, a mobile service vehicle, motor cycles and bicycles provided for each district, Computerized health information system supported

58 Health Centers supplied with Outpatient, General Inpatient, Maternity, Laboratory, Kitchen and Laundry equipment. 154 Dispensaries supplied with Outpatient and maternity equipment. 2 utility cars for PMU, 7 ambulances, 7 double cabin vehicles, 7 vaccine/drug delivery vehicles, 77 motor cycles and 157 bicycles provided to the 7 districts 43 desktop computers, 2 laptop computers, 43 printers and 15 filing cabinets distributed to select facilities in the project districts, HIS reporting tools reproduced,

4,00 22,0% 0,88

120 DHMTs trained, key health staff trained and community strategy trainings undertaken

150 DHMT members trained in Health Service Management. In addition, the following health workers trained; 169 in Infant and Young Child Feeding, 144 in Integrated Management of Child Illness Case Management. Community Strategy trainings done; 467 Community Health Extension Workers s, 4600 Community Health Workers, 1,117 Community Health Committees members trained.

4,00 12,7% 0,51

Short-term consultancies Short-term consultancies procured and done for development of M&E database, Project Implementation Manual, Information Education and Communication strategy and project sustainability assessment.

4,00 10,4% 0,42

OVERALL OUTPUT SCORE [Score is calculated as the sum of weighted scores]

3,00

Check here to override the auto-calculated score

Provide justification for over-riding the auto-calculated score

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II. ACHIEVEMENT OF OUTCOMES

1. Using available monitoring data assess the achievement of expected outcomes. Import the expected outcomes from the log. frame in Section C. Score the extent to which the expected outcomes were achieved. The overall outcome score will be auto-calculated as an average of the working scores. Override the auto-calculated score, if desired, and provide justification.

OUTCOMES Working Score

Expected Actual

1. (Component 1)-Increase in utilization rate of primary health services (functional facilities)

The target was to increase the utilization rate from 60% to 90%. The performance is estimated at 86% based on the attached target district data. This is also inline with the overall sectors annual performance trends. The target for immunization coverage was to increase it from 59% to 90%. This takes into account coverage of four national antigens i.e. BCG, PENTA 3, OPV 3 and MEASLES. The coverage is as follows; BCG-60%, PENTA 3-81%, OPV 3- 85%, MEASLES- 84%.

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2. (Component 2)-Number of new cases of most prevalent diseases reduced

The target was to reduce the number of new cases of three most prevalent diseases by 50%. The performance is the difference in reported cases between the base year (2006) and 2011. The most prevalent diseases in the districts are Malaria, Other diseases of the respiratory system and diseases of the skin. New cases of clinical malaria reduced by 43%, new cases of Other diseases of respiratory system increased by 29% and new cases of skin diseases increased by 56%.

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OVERALL OUTCOME SCORE [Score is calculated as an average of the working scores]

OVERALL OUTCOME SCORE [Score is calculated as an average of the working scores]

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Check here to override the auto-calculated score

Provide justification for over-riding the auto-calculated score

Insert the new score or re-enter the autocalculated score

2. Additional outcomes. Comment on the project's additional outcomes not captured in the log. frame, including cross-cutting issues (e.g., gender).

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It can be concluded that the key determinant to additional outcomes were mainly due to engagement of beneficiaries at lower levels and ownership. (i) Rainwater harvesting facilities and latrine construction in target schools. These schools have now improved the learning environment beyond the intended project objective for this activity. For example, Gitwamba Primary School in Trans Nzoia District, reported the number of pupils who fell sick due to water related diseases had reduced from 10 to 2 per week which has also reduced school absentisim. Due the availability of water, the school now hires its grounds for community functions and the proceedings are used to finance the school's recurrent costs including additional water tanks. Also, the National Environmental Management Agency (NEMA), has supported the school to establish a tree nursery which is benefiting both the school and the surrounding community. At Chembulet Primary School in Uasin Gishu District, the number of children who fell sick due to water related diseases had reduced from 10-15 to 5 per week. The school has also been able to initiate and sustain the school feeding program. The neighboring school now uses the same water and is sourcing for funds to also install the rain water facilities. Furthermore, Kosachei Secondary School in Uasin Gishu District began a boarding facility for girls because of the availability of water. Heni Secondary School in Nyandarua District was buying water at Ksh. 10,000 per week from a source more than 40 Kms away. The school no longer buys water and this has reduced the financial burden on the parents and has also introduced a boarding facility for girls. (ii) Community Health Strategy Trainings. Some of the Community Health Units (CHUs) trained have realized a number of additional results. For example, Bikeke Community Unit in Trans Nzoia District has mobilized community members to establish 101 kitchen gardens and also successfully convinced pregnant mothers in the community to stop seeking health services from Traditional Birth Attendants and have delivered at the CHU link health facility in Bikeke. As a result, ante natal, skilled delivery and immunization coverage has gradually increased in the specific community as reported by the facility. (iii) Rehabilitation and Upgrading of health facilities. Most of the project target facilities classified as health centers are now offering 24 hours services especially maternity services-Government has deployed additional nurses after completion of works and equipping especially the maternity wings. In additional, the upgrading has facilitated some facilities for example Saboat, Remand Prison and Tulwet Health Centers to start operating HIV Comprehensive Care Centers using the additional rooms provided under the rehabilitation of these facilities. The patients form the communities are now not referred for these services to the districts hospitals.

3. Risks to sustained achievement of outcomes. State the factors that affect, or could affect, the long-run or sustained achievement of project outcomes. Indicate if any new activity or institutional change is recommended to help sustain outcomes. The analysis should draw upon the sensitivity analysis in Annex 3, where appropriate. The project appraisal identified "ownership" of project activities by the target communities as the key sustainability aspect of this project. A review of the project risks outlined at appraisal, revealed other macro level potential risks, mainly health sector budget allocation to the central and lower levels that could impact on sustainability of the project outcomes. However, during project implementation, a number of new policies and institutional reforms have been adopted which impact positively to sustainment of the project outputs and outcomes. For example, implementation of the decentralization of health services delivery system in line with the 2012 constitution has resulted in widening access and quality of health care services to the rural population through participation of Health Facility Management Committees (HFMCs) and Community Health Workers (CHWs). This has also enabled directly disbursement of operational funds to dispensary and heath centers through the Health Sector Service Fund (HSSF). The fund is flexible to the annual needs identified by the facility's HFMC and is used for operational costs including casual laborers, maintenance, electricity and water connections and restocking essential medicines. However, facilities reported that the HSSF fund is limited and could hamper effectiveness and sustainability of the optimal functioning of the target facilities. The project investments done on health physical infrastructure (buildings, ICT and medical equipment) will required adequate financial allocation for Operational and Maintenance to carry out routine preventive maintenance. The CHWs approach, has not only improved access to rapid health response at the point of need, but also enhanced community linkage with their health facilities management and ownership. However, drop-outs of trained CHWs has been witnessed in some communities. There is need to explore innovative approaches for CHWs retention, such as income generation activities (IGAs). The Government has been considering a stipend for CHWs for a while now; to date they offer voluntary community health services. It is envisaged that the Government commitment to macroeconomics reforms will lead to increased fiscal allocations for the health sector and secure budget provisions, leading to adequate and regular supply of drugs and equipment, as well as improved management and operation at health facilities, absorption of additional health workers, and remuneration of CHWs. The overall annual budgetary allocation for the Ministries of Health has continued to fall short of demand, hence, more innovative approaches for health care financing such as social health insurance and public private partnerships initiatives are being explored to enhance financial sustainability health care delivery systems. The Government has not taken up supply of drugs to the project target facilities since the FY 2012/2013 second quarter.

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E. PROJECT DESIGN AND READINESS FOR IMPLEMENTATION 1. State the extent to which the Bank and the Borrower ensured the project was commensurate with the Borrower’s capacity to implement by designing the project appropriately and by putting in place the necessary implementation arrangements. Consider all major design aspects, such as extent to which project design took into account lessons learned from previous PCRs in the sector or the country (please cite key PCRs); whether the project was informed by robust analytical work (please cite key documents); how well Bank and Borrower assessed the capacity of the implementing agencies and/or Project Implementation Unit; scope of consultations and partnerships; economic rationale of project; and provisions made for technical assistance. [200 words maximum. Any additional narrative about implementation should be included at Annex 6: Project Narrative]

According to the appraisal document and its annexes, the project design was informed by robust analytical work. A number of documents were used in the analysis which include the National Health Sector Strategic Plan (NHSSP) 1999-2004, Economic Recovery Strategy for Wealth and Employment Creation (ERSWEC) and its investment programme 2003-2007, an assessment of the rehabilitation needs of existing facilities in target districts, and the Public Expenditure Review 2003. The agenda and priorities in these documents were taken into account during the project design and prioritization of project activities. The appraisal made reference to Lessons learnt and issues emerging from the previous health project which are documented in the relevant aide memoires. Although the previous project (RHP II) PCR was conducted when the current project had already been formulated, the issues highlighted in the PCR are adequately reflected in this project's appraisals report and mainly relate to implementation capacity of the executing agency and project monitoring and supervision. This project provided for a dedicated PMU financed by the project and seconded support staff from the Ministry. Technical assistance through consultancies for works designs, trainings, creation of an M&E database, development of the project implementation manual, the IEC strategy and the sustainability program. Project vehicles were also provided to support field supervision by the PMU and DHMTs.

2. For each dimension of project design and readiness for implementation, provide a brief assessment (up to two sentences). Insert a working score, using the scoring scale provided in Appendix 1.

PROJECT DESIGN AND READINESS

FOR IMPLEMENTATION DIMENSIONS

ASSESSMENT WORKING SCORE

REALISM

a) Project complexity is matched with country capacity and political commitment.

As outlined in E. 1 above, the project implementation arrangements outlined at appraisal were to a great extent informed by implementation challenges experienced by the previous health project which related to executing agency capacities. A functional and full time PMU was established, Technical Assistance was provided for main project activities such as works design and a framework for PMU supervision and monitoring was defined. the project also acknowledged need for a strong M&E system not only to monitor project implementation but generate data to assess effectiveness of the intervention. The project was designed in line with key Government investment priorities as outlined in its then national strategies which resulted to satisfactory Government oversight on the project implementation and provision of the required counterpart funds although with delays in some FYs.

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RISK ASSESSMENT AND MITIGATION

b) Project design includes adequate risk analysis.

Adequate risk analysis was done and appropriate assumptions formulated based on the established Executing Agency capacity and lessons from the previous project. Some assumptions remained alive throughout the project period. For example, 'Government contribution is maintained and sustained' ; counterpart funds was problematic at times affecting contractors schedules and project operations such as timely distribution of equipment and drugs was disrupted by inadequate counterpart funds. However, at project completion, there were no pending bills on the Government counterpart funds.

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USE OF COUNTRY SYSTEMS

c) Project procurement, financial management, monitoring and/or other systems are based on those already in use by government and/or other partners.

Country systems were actively used including the ministerial tender committee for procurement reviews and award of contracts; the Kenya National Audit Office conducted annual project audits; fiduciary control measures for the special account included the Government's Authority to Incur Expenditure (AIE) procedures; DHMTs provided project oversight at the district level and trained CHWs; and the national health information system was utilized to collected and generate data on some of the project indicators. National training manuals and curriculum were used for the Community Health Trainings and the DHMT's Health Service Management Trainings. Project annual work plan was integrated into the Ministry's Annual Operational Plans and the Permanent Secretary's annual performance targets. The project's utilized the Government's accounting systems and procedures including processing of direct payments.

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For the following dimensions, provide separate working scores for Bank performance and Borrower performance:

WORKING SCORE

Bank Borrower

CLARITY

d) Responsibilities for project implementation were clearly defined.

The framework and institutional arrangements for the project were clearly spelt out on the appraisal report. The role of the executing agency and the purpose and number of the core PMU staff was indicated. Bank expectations from Government on supervision, reporting and audit were outlined. The executing agency was clear on its responsibilities based on the various mechanism it put in place for project implementation including recruitment of PMU staff, seconding of support staff and reporting procedures and oversight of the PMU.

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PROCUREMENT READINESS

e) Necessary implementation documents (e.g. specifications, design, procurement documents) were ready at appraisal.

This aspect led to significant delays (2 years after effectiveness) in actual project implementation. Although the target districts had been identified at appraisal, the specific target facilities had not been listed. Designs for works including scope of the work and bills of quantities were not ready at appraisal. The equipment list and specifications was also drawn during implementation. Overall, this dimension caused a 2 years delay in project implementation and take off after effectiveness.

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MONITORING READINESS

f) Monitoring indicators and monitoring plan were agreed upon before project launch.

The project outputs and outcomes are indicators are reflected in the Log frame. However there was no project monitoring and evaluation plan at appraisal a project data had not been updated since then. The M&E plan was formulated at the project's MTR in June 2009 and the project's data base established din 2010. A short term consultant was hired to assist PMU/Ministry with the "mini" database creation linking it to the Ministry's Health information System indicators.

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BASELINE DATA

h) Baseline data were available or are were collected during project design.

The log frame at appraisal had adequate baselines for each indicator for both the loan and the grant.

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F. IMPLEMENTATION

1. State the major characteristics of project implementation with reference to: adherence to schedules, quality of construction or other work, performance of consultants, effectiveness of Bank supervision, and effectiveness of Borrower oversight. Assess how well the Bank and the Borrower ensured compliance with safeguards. [200 words maximum. [Any additional narrative about implementation should be included at Annex 6: Project Narrative.]

There was significant time overruns on project milestones as set out at appraisal. The project became effective 14 months after board approval and its closing date was extended by 20 months from the original closing date. Also, the 2008/9 post-election violence affected project implementation by 8 months. Overall, the quality of construction is considered satisfactory and acceptable as evaluated by the supervising consultants, PMU and the Bank. Review and issuance of 'No Objections’ by the Bank took longer than expected for works and equipment which in total caused about a 5 months delay. The PMU carried out recommended a minimum amount for works payments to encourage contractor’s performance. Performance of consultants was also considered acceptable. However, consultants on works designs missed out on the patient work flow in the triage and maternity wards especially the labour and sluice rooms. The initial constructions had to be modified to correct this and all other facility designs corrected accordingly. Workflow in the maternity area is unique and the initial designs should have been verified by medics. The project MTR was adequately carried out to respond to emerging project issues. A detailed analysis of major issues affecting project implementation including the reshuffling of funds allocations and restructuring of the PMU was critical to the project satisfactory completion not forgetting the strong Government commitment in implementing the MTR recommendations. Effectiveness of borrower oversight was satisfactory. The project steering committee actively met with participation from MOF and DHMTs, and minuets were submitted to the Bank. The committee made critical decisions on emerging project issues for Bank consideration. The PMU staff signed annual performance contracts. The DHMTs were facilitated to supervise project activities at the district level and submitted reports to the PMU. The project manager was coopted to be a member of the Ministry's senior management meetings for Heads of Department to ensure project activities were aligned to Government priorities and also facilitate cooperation from the relevant departments. Concerning environmental safeguards, actions undertaken included construction of septic tanks and soak pits, incinerators for medical waste and training of CHWs on community based sanitation and safe waste management. The Bank provided adequate project. Ten (10) supervisions and two (2) internal project Bank audits were undertaken. In addition, the borrower submitted annual project audits and the Bank provided feedback on these as well as guidance, review and approval of procurement dossiers. Annual project work plans and procurement plans were formulated reviewed and approved by the Borrower and the Bank.

2. Comment on the role of other partners (e.g. donors, NGOs, contractors, etc.). Assess the effectiveness of co-financing arrangements and of donor coordination, if applicable.

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Co-financing (co-financing of the civil works). The project's works contracts were co-financed by OPEC ( 28.9% ) ,Government of Kenya (8.8%) and ADF (62.3%). Unfortunately, the co-financing arrangements for these contracts has not worked effectively and is a lesson learned. The delays in payments for the same certified payment varied significantly among the financiers with OPEC having the most delays for some payments up to four months. These demoralized the contractors and slowed down the progress of works. Towards project completion, 2012, the three financiers improved in payments processing; up to 8 months had already been lost in payment delays. The Government used this a some of the main justification for the project extension and consequently extension of works contracts. Concerning donor coordination, the Bank participated in the Health Donor's Working Group as a member. Within this framework, the Bank completed and submitted the required donor aid coordination tools including annual projects/programs budget projections and reporting tools for activities submitted in the sector. The project activities were also reflected in the sector's Annual Operational Plans (AOPs). The Bank was consulted by various donors formulating new projects or carrying out own project evaluations.

3. Harmonization. State whether the Bank made explicit efforts to harmonize instruments, systems and/or approaches with other partners.

The Bank supported the Ministry's annual operational planning (AOP) and MTEF processes where the project activities were annually captured alongside those of other donors in the health sector. Keys project documents for example the IEC strategy and sustainability assessment reports were disseminated to key stakeholders including donors to avoid duplication of efforts. As noted in 2 above, common annual planning and reporting tools are disseminated by the health donor’s secretariat for completion by all players in the health sector. The Bank completes and submits the tools.

4. For each dimension of project implementation, assess the extent to which the project achieved the following. Provide a brief assessment (up to two sentences) and insert a working score, using the scoring scale provided in Appendix 1.

PROJECT IMPLEMENTATION DIMENSIONS

ASSESSMENT WORKIN

G SCORE

TIMELINESS

a) Extent of project adherence to the original closing date. If the number on the right is: below 12, score 4 between 12.1 to 24, score 3 between 24.1 to 36, score 2 beyond 36.1, score 1

Difference in months between original closing date and actual closing date or date of 98% disb. rate.

3

20 months

BANK PERFORMANCE

b) Bank complied with:

Environmental Safeguards

To ensure compliance with environmental safeguards, a number of actions were undertaken as outlined in the appraisal report. These included construction of septic tanks, soak pits, incinerators for proper disposal of medical waste and, trainings of CHWs on the community health strategy whose curriculum included sanitation and safe waste management at the household level.

4

14

Fiduciary Requirements

Opening of a special account of the project was one of the loan conditions. The project was also required to hire a dedicated project accountant and submit annual project audits. These were done. Other measures undertaken included putting in place required financial management records in acceptable Bank formats i.e. cash books, vouchers system, contracts ledgers by category and assets registers. These were supervised during missions and status's as well areas for improvement noted in the aide memoires. Disbursement by each financier were also captured separately. Bank provided feedback to all project audit reports submitted. Two specific bank internal audit missions were carried out for the project in September 2008 and September 2009. The Bank followed up on the implementation of audit and financial management management recommendations. However, delays in processing disbursement requests led to contracts execution delays especially for works and overall project completion delays.

3

Project Covenants

The loan conditions by the Bank were relevant and were based on lessons learned from the previous health project. These included opening of project special accounts, establishment of a project steering committee and recruitment of core professional staff to the PMU.

4

c) Bank provided quality supervision in the form of skills mix and practicality of solutions

In total, the Bank carried out 12 supervision missions which included field visits. The skills mix was adequate as shown in the PCR annexes; the staff included health specialists, procurement and financial management experts. Mission recommendations addressed emerging issues under each component as outlined in the various aide memoires and management feedback to Government on mission's recommendations. The Bank followed up on the implementation of the mission's recommendations through quarterly reports and subsequent aide memoires.

4

d) Bank provided quality management oversight

As noted above, the Bank made effort to address emerging issues during supervision missions and review of project quarterly reports. The Bank provided training opportunities for the PMU in its procedures including procurement, financial management and M&E. There were initial significant delays in reviews and approval of project documents specifically works tender documents and bid evaluation reports.

3

15


e) Borrower complied with:

Environmental Safeguards

The borrower carried out environmental safeguards as outlined at appraisal. The project constructed in total 633 latrines in schools and health facilities, 3900 CHWs were trained on sanitation, safe water harvesting facilities and waste management facilities including septic tanks, placenta pits, incinerators were constructed in 211 facilities where these did not exist. In addition, existing IEC materials on environmental conservation were reproduced and distributed to facilities and CHWs in collaboration with the Health promotion department.

4

Fiduciary Requirements

Five Project audits were done from the period the project was declared effective i.e. Financial Years (FYs) 2006/07, 2007/08, 2008/09, 2009/10, 2010/11. The 2011/2012 audit report has commenced and will be submitted to the Bank by December 30 2012. The Borrower responded to issues raised by the auditors and the Bank as indicated in the relevant aide memoires. To date the Bank has accepted the project audit reports. Provision of Counterpart funds was delayed and inadequate in some FYs causing delays in contractor payments and project operational costs.

3

Project Covenants

The borrower fulfilled loan conditions (putting in place the PMU and opening of the special account) although 14 months after approval leading to project effectives delay and consequently overall project implementation delay. The Government has also followed up on 'other loan conditions’ notably continuous staffing, with additional nurses and laboratory technicians, for the completed facilities.

3

f) Borrower was responsive to Bank supervision findings and recommendations

To a great extent yes. The Ministry provided implementation status of mission’s recommendations as annex to the quarterly reports and in the mission project progress status reports.

4

g) Borrower collected and used monitoring information for decision making

The Ministry has developed a comprehensive project data base and carried out various needs assessments whose results have been used to inform project priorities for example equipment lists and specifications, drugs and medical supplies distribution, production of priority IEC materials and trainings.

4

G. COMPLETION

1. IS THE PCR DELIVERED ON A TIMELY BASIS, IN COMPLIANCE WITH BANK POLICY?

Date project reached 98% disb. Rate (or closing date if applicable)

Date PCR was sent to [email protected] WORKING SCORE (auto-calculated) if the difference is 6 months or less, a 4 is scored. If the difference is 6.1 or more, a 1 is scored

Closing date was August 30 2012 December 14 2012 5

2. Briefly describe the PCR Process. Describe the Borrower’s and co-financers' involvement in producing the document. Highlight any major differences of opinion concerning the assessments made in this PCR. Describe the team composition and confirm whether a site visit was undertaken. Mention any major collaboration from other development partners. State the extent of field office involvement in producing the report. Indicate whether comments from Peer Reviewers were received on time (provide names and positions of Peer Reviewers). [100 words maximum]

16

The PCR process was launched in July 2011 and followed up in November 2011 and June/July 2012 as indicated in these aide memoires. The PMU/Ministry's Health Information Team worked with the Bank to provide data for Section C and D. The Ministry has been documenting project outputs and outcomes and these data was also used. At the actual PCR mission in October 2012 a draft PCR formulated by the Bank and the Ministry was used to guide discussions at the district level. The Ministry has carried out a digital documentary on the project completion. The lessons learnt were mainly drawn from the borrower's experiences in project design and implementation challenges at central and district level. The PCR was field office led. The key issues raised were disbursement delays from Bank side and initial delays in procurement review and approvals. A Division Meeting was held on November 19 2012 to review the PCR. The names of reviewers and comments are indicated in the PCR annex.

H. LESSONS LEARNED Summarize key lessons for the Bank and the Borrower suggested by the project’s outcomes [250 words maximum. Any additional narrative about lessons learned, if needed, must be placed in Annex 6: Project Narrative]

The key determinant in the lessons relate to project design and readiness at appraisal. (i) Project readiness at appraisal and or loan/grant signature. Development of works designs and bills of quantities seem to take on average two years and therefore a project will encounter at least a two years implementation/disbursement delay from effectiveness if works designs are not ready at appraisal or by loan signature. This could be considered as a pre-condition for loan signature (ii) The scope and nature of works rehabilitation financed by the Bank needs to be critically considered to ensure value for money and desired outcomes. For example, rehabilitations that add value to the optimal functioning of a facility such as water and electricity connections and extensions of relevant rooms to facilitate work flow can be considered. However, rehabilitations arising from lack of preventive maintenance and inadequate routine maintenance may not need be financed under a project and lessons from such rehabilitations should inform other projects. (iii) The Government needs to standardize designs for each level of health care taking into account the unique work flows and functions of health care at each level, otherwise each donor will have own designs for facilities supported. Generally, local design consultants are not very familiar with the unique health care work flows which led to delays during actual construction. (iv) Health related projects should adopt a multisectoral approach to realizes desired health outcomes. Rain water harvesting in schools and latrine construction has contributed to reduction in diarrheas diseases in the targeted communities. (v) Delays in processing of disbursements requests needs to be addressed as this demoralizes contractors/suppliers and contributes to overall project implementation delays and creates alack of confidence from the service providers; some go slow until payments are assured.

I. PROJECT RATINGS SUMMARY

All working scores and ratings are auto-generated by the computer from the relevant section in the PCR.

CRITERIA SUB-CRITERIA WORKING

SCORE

PROJECT OUTCOME

Achievement of outputs 3

Achievement of outcomes 3

Timeliness 2

OVERALL PROJECT OUTCOME SCORE 3

BANK PERFORMANCE

Design and Readiness

Project Objectives were relevant to country development priorities. 4

Project Objectives could in principle be achieved with the project inputs and in the expected time frame.

2

Project Objectives were consistent with the Bank’s country or regional strategy 4

Project Objectives were consistent with the Bank’s corporate priorities 4

The log frame presents a logical causal chain for achieving the project development objectives. 2

The log frame expresses objectives and outcomes in a way that is measurable and quantifiable. 3

17

The log frame states the risks and key assumptions. 4

Project complexity was matched with country capacity and political commitment. 3

Project design includes adequate risk analysis. 4

Project procurement, financial management, monitoring and/or other systems were based on those already in use by government and/or other partners. 4

Responsibilities for project implementation were clearly defined. 4

Necessary implementation documents (e.g. specifications, design, procurement documents) were ready at appraisal. 1

Monitoring indicators and monitoring plan were agreed upon during design. 1

Baseline data were available or were collected during design. 3

PROJECT DESIGN AND READINESS SUB-SCORE 3

Supervision:

Bank complied with:

Environmental Safeguards 4

Fiduciary Requirements 3

Project Covenants 4

Bank provided quality supervision in the form of skills mix provided and practicality of solutions.

4

Bank provided quality management oversight. 3

PCR was delivered on a timely basis 4

SUPERVISION SUB-SCORE 4

OVERALL BANK PERFORMANCE SCORE 4


Design and Readiness

Responsibilities for project implementation are clearly defined. 4

Necessary implementation documents (e.g. specifications, design, procurement documents) are ready at appraisal.

1

Monitoring indicators and monitoring plan are agreed upon and baseline data are available or are being collected

2

PROJECT DESIGN AND READINESS SCORE 2

Implementation

Borrower complied with:

Environmental Safeguards 4

Fiduciary Requirements 2

Project Covenants 3

Borrower was responsive to Bank supervision findings and recommendations. 4

Borrower collected and used of monitoring information for decision-making. 4

IMPLEMENTATION SUB-SCORE 3

OVERALL BORROWER PERFORMANCE SCORE 3

J. PROCESSING

STEP SIGNATURE AND COMMENTS DATE

Sector Manager Clearance: Zhao Feng

Regional Director Clearance: Gabriel Negatu

Sector Director Approval: Agnes Soucat

I

APPENDIX 1 Scale for Working Scores and Ratings

SCORE EXPLANATION

4 Very Good- Fully achieved with no shortcomings

3 Good- Mostly achieved despite a few shortcomings

2 Fair- Partially achieved. Shorcomings and achievements are roughly balanced

1 Poor- Very limited achievement with extensive shortcomings

NA Non Applicable

II

LIST OF ANNEXES

Mandatory

1. Project Costs and Financing a. Project costs by component b. Financing by sources of funds

2. Bank Inputs. List the key team members, and their specialties, during preparation and supervision. Provide a consolidated list of Preparation, Supervision and Completion Missions in chronological order. Provide the date and ratings of the last supervision report.

3. Economic Analysis (ERR) and Financial Analysis, if appropriate Re-estimate the economic rates of return based on costs and benefits at completion, and compare with appraisal estimates. Break down by components as appropriate. Analyze the sensitivity of the ERR to key assumptions. Present a financial analysis for project beneficiary entities.

4. Procurement Plan. Please attached the most recent Procurement Plan

5. List of Supporting Documents

Optional

6. Project Narrative. Key factors not covered in the main template that affected the design and implementation of the project. Such factors, both positive and negative, could include: climate and weather, political changes, contractual or personnel matters, technical issues, procurement processes, and interactions with other partners. If any of these factors is significant enough to affect the evaluation ratings, it should be noted in the template with a reference to this annex.

Note: The formulas round up or down for decimal points. Only entire numbers are computed.

III

PROJECT COMPLETION REPORT Rural Health Project III

ANNEX A Project Costs by Component in UA millions at at Appraisal

UA (000)

Category F.E L.C Total %

Civil Works

Rehabilitation of Rhcs 2,32 2,43 4,75 15,09

Upgrading of Rhcs 1,32 1,40 2,72 8,65

Rehabilitation of Dispensaries 1,91 2,01 3,92 12,44

Demonstration Projects - 1,12 1,12 3,56

Sub-Total Civil Works 5,56 6,95 12,51 39,74

Services

Audit Services - 0,09 0,09 0,28

Consulting Services 2,11 - 2,11 6,71

Construction Supervision Services - 0,73 0,73 2,31

Service Contracts - 0,40 0,40 1,27

Training - 3,99 3,99 12,68

Sub-Total Services 2,11 5,21 7,32 23,24

Goods

Medical Equipment 1,62 - 1,62 5,13

Computers & Office Equipment - 0,67 0,67 2,12

Communication Equipment 0,30 - 0,30 0,94

IEC Materials - 0,53 0,53 1,69

Drugs (Including LLITNs) 6,00 0,68 6,68 21,24

Training Materials - 0,11 0,11 0,36

General Equipment - 0,07 0,07 0,22

Vehicles (including Motorcycles & Bicycles) 0,58 - 0,58 1,85

Sub-Total Goods 8,50 2,06 10,56 33,55

Operating Costs

Daily Subsistence Allowance 0,12 0,12 0,39

Salaries 0,78 0,78 2,49

General Operating Charges 0,18 0,18 0,58

Sub-Total Operating Costs - 1,09 1,09 3,46

Total Project Costs 16,17 15,31 31,48

Percentage Proportions 51,36% 48,64% 100%

Planned Financing by Source in UA Millions at Appraisal B

Source F.E %F.E L.C %L.C TOTAL % of TOTAL

ADF Loan 7,84 49% 9,54 62% 17,38 55%

ADF Grant 6,00 37% - 0% 6,00 19%

OPEC Loan 2,32 14% 2,43 16% 4,75 15%

Government - 0% 3,35 22% 3,35 11%

16,16 100% 15,32 100% 31,48 100%

IV

Actual Financing by Source in UA Millions at Completion C

UA (000)

Source F.E %F.E L.C %L.C Total % of Total

ADF Loan 13,45 576,68 1,39 30,00 14,85 53,07

ADF Grant 6,43 275,83 - - 6,43 23,00

OPEC Loan 3,44 147,49 - - 3,44 12,30

Government - - 3,26 70,00 3,26 11,64

23,32 1 000,00 4,65 100,00 27,97 100,00

Planned and Actual Financing by Category and Source in UA Millions at Appraisal and Completion

D

Categories Planned at Appraisal Revised at MTR 2008 Actual at Project Completion

ADF Loan

ADF Grant

OPEC Loan GOK Total

ADF Loan

ADF Grant

OPEC Loan GOK Total

ADF Loan

ADF Grant

OPEC Loan GOK Total

Civil works 0,01 0 0,00 0,00 0,01

6,03 - 5,42 1,38

12,83 9,27 -

4,13

1,37

14,76

Services 0,01 0 0 0,00 0,01

6,03 - - 1,17

7,20 1,99 - -

0,61

2,59

Goods 0,00 0,01 -

0,00 0,01

4,13 6,00 - 0,68

10,81 4,35 6,43 -

0,00

10,59

Operating Costs 0,00 - - 0,00 0,00

0,98 - - 0,31

1,29 0,90 - -

2,03

2,93

Total 17,17 6,00 5,42 3,54

32,13 16,50 6,43

4,13

4,01

30,87

ACTUAL DISBURSEMENTS BY SOURCE, YEAR AND CATEGORY OF EXPENDITURE IN UA MILLIONS AT COMPLETION

ADF Loan

E

Categories FY 2006/07 FY 2007/08 FY 2008/09 FY2009/10 FY 2010/11 FY 2011/12 TOTAL

Civil works - - 0,21 0,56 4,74 3,75 9,27

Services 0,01 0,22 0,58 0,21 0,09 0,87 1,99

Goods - 0,59 0,10 0,48 0,22 2,96 4,35

Operating Costs 0,12 0,10 0,09 0,19 0,20 0,20 0,90

Total - - - - - - 16,50

ADF Grant

F


Civil works - - - - - - -

Services - - - - - - -

Goods - 2,92 - - 3,32 0,20 6,43

Operating Costs - - - - - - -

Total - 2,92 - - 3,32 0,20 6,43

OPEC Loan

G


Civil works - - - 0,20 2,20 1,73 4,13

Services - - - - - - -

Goods - - - - - - -

Operating Costs - - - - - - -

Total - - - 0,20 2,20 1,73 4,13

V

GOK

H


Civil works - - - 0,09 0,88 0,40 1,37

Services - - 0,24 0,01 0,12 0,23 0,61

Goods - - - - - 0,00 0,00

Operating Costs 0,05 0,06 0,13 0,15 1,33 0,31 2,03

Total 0,05 0,06 0,38 0,25 2,33 0,94 4,01

TOTAL

I


Civil works - - 0,21 0,85 7,82 5,88 14,76

Services 0,01 0,22 0,83 0,22 0,21 1,10 2,59

Goods - 3,51 0,10 0,48 3,53 3,17 9,62

Operating Costs 0,17 0,65 0,23 0,82 1,52 0,51 3,90

Total 0,17 4,38 1,37 2,36 13,09 10,66 30,87

113,14

2 324,10 2 426,20

F 0,485933598 ADF OPEC

1 323,20 1 399,70 L 0,514066402

1 911,50 2 005,40

1

- 1 120,40

5 558,80 6 951,70

F 0,488026551

L 0,511973449

1

87,50

2 110,90

F 0,489243011

726,70 L 0,510735938

400,30

3 990,50

2 110,90 5 205,00

1 615,30

666,50

295,40

532,80

6 004,80 680,00

114,20

69,90

583,00

8 498,50 2 063,40

123,30

782,30

183,40

- 1 089,00

VI

ACTUAL DISBURSEMENTS BY YEAR AND CATEGORY OF EXPENDITURE IN '000 UAs AT COMPLETION

DISB CATEGORY

FIGURES IN '000,000 UAs


1 000,00 A Civil works - - 0,21 0,85 7,82 6,00 14,88

113,14 B Services 0,01 0,22 0,83 0,22 0,21 0,99 2,48

1 000 000 C Goods - 3,51 0,10 0,48 3,53 2,97 10,59

D Operatinng Costs 0,17 0,16 0,23 0,34 1,52 0,51 2,92

Total 0,17 3,90 1,37 1,88 13,09 10,46 30,87

ACTUAL DISBURSEMENTS BY YEAR AND SOURCE OF EXPENDITURE IN '000 UAs AT COMPLETION

FUNDING SOURCE


Donor FY 2006/07 FY 2007/08 FY 2008/09 FY2009/10 FY 2010/11 FY 2011/12 TOTAL

1 GOK 0,05 0,06 0,31

0,26

2,36

0,94

3,97

2 ADF Loan 0,12 0,91 1,06

1,42

5,22

7,59

16,33

3 ADF Grant - 2,92 -

-

3,32

0,20

6,43

4 OPEC Loan - - -

0,20

2,20

1,73

4,13

Total 0,17 3,90 1,37

1,88

13,09

10,46

30,87

ACTUAL DISBURSEMENTS BY SOURCE AND CATEGORY OF EXPENDITURE IN '000 UAs AT COMPLETION

FUNDING SOURCE


Donor Civil Works Services Goods Oper Costs TOTAL 1 GOK 1,48 0,65 0,17 2,03 4,32 2 ADF Loan 9,27 1,83 3,99 0,90 15,98 3 ADF Grant - - 6,43 - 6,43 4 OPEC Loan 4,13 - - - 4,13 Total 14,88 2,48 10,59 2,92 30,87

ACTUAL DISBURSEMENTS BY SOURCE AND CATEGORY OF EXPENDITURE IN '000 UAs AT COMPLETION

FUNDING SOURCE

FIGURES IN '000 Kshs

Donor Civil Works Services Goods Oper Costs TOTAL 1 GOK 167 739,51 73 311,76 18 842,93 229 263,09 489 157,29 2 ADF Loan 1 048 477,43 206 949,53 451 186,81 101 660,65 1 808 274,42 3 ADF Grant - - 727 907,03 - 727 907,03 4 OPEC Loan 466 793,16 - - - 466 793,16 Total 1 683 010,10 280 261,29 1 197 936,77 330 923,74 3 492 131,90

VII

BANK SUPERVISION MISSIONS Year Specific Mission dates Name of Bank staff Job Title

2006 28 July- 5 August Mrs. Bineta BA Health Analyst (Task Manager, Mission Leader)

Mr. Frank MVULA Architect

Mr. Dirk BRONSELAER Procurement Specialist

2007 10-24 June Mrs. Bineta BA Health Analyst (Task Manager, Mission Leader)

Mr. Frank MVULA Architect

2008 15-25 September Mr. Fabrice SERGENT Principal Health Analyst (Task Manager and Mission Leader)

Mr. Frank MVULA Senior Architect

Mr. Loxly EPIE Financial Management Specialist (ORPF.2 )

Mr. Abdullahi YAHIE Principal Social-Economist (KEFO)

Mrs. Ruth CHARO Social Development Specialist (KEFO)

2009 18-28 May Mr. Fabrice SERGENT Principal Health Analyst (Task Manager and Mission Leader)

Mrs. Ruth CHARO Social Development Specialist (KEFO)

Mr. Patrick OWUOR Procurement Specialist (KEFO)

Bank Internal audit (September 2009)

Ms. Mouhamed Ba Chief Internal Auditor

Ms. Riliwan Arowona Principal Internal Auditor

7-11 December Mrs. Ruth CHARO Social Development Specialist (KEFO)

Mr. Patrick OWUOR Procurement Assistant (KEFO)

2010 24 May- 4 June Mrs. Ruth CHARO Social Development Specialist (KEFO)


18-30 December Mrs. Ruth CHARO Social Development Specialist (KEFO)


Mr. Amilcar BILALE Senior Architect OSHD 3

2011 11-30 July Mrs. Ruth CHARO Social Development Specialist (KEFO)


28 Nov- 9 Dec Mrs. Ruth CHARO Social Development Specialist (KEFO)

Mr. Frank MVULA Regional Chief Procurement Specialist

Mr. Eric NGONDE Financial Management Specialist - Consultant (ORPF)

2012 14-25 May Mrs. Ruth CHARO Social Development Specialist/RHP III Task Manager-(OSHD/EARC)

Mr. David MUTUKU Financial Management Specialist (ORPF/EARC)

Mr. Patrick OWUOR Procurement Officer (ORPF/EARC)

2012 22-31 October Mrs. Ruth CHARO Social Development Specialist/RHP III Task Manager-(OSHD/EARC)

Mr. David MUTUKU Financial Management Specialist (ORPF/EARC)

Mr. Patrick OWUOR Procurement Officer (ORPF/EARC)

Mr. Walter ODERO Senior Macroeconomist (ORPF/EARC)

VIII

RATINGS

INDICATORS Precedings report

Last Mission

18.10.2010 11.07.2011 28.11.2011 14.05.2012 22.10.2012

A. PROJECT IMPLEMENTATION Compliance with loan conditions precedent to entry into force 2 2 2 2 2

Compliance with General Conditions 2 2 2 2 2 Compliance with Other Conditions

B. PROCUREMENT PERFORMANCE

Procuremet of Consultancy Services 3 3 3 3 3 Procurement of Goods and Works 3 3 3 3 3

C. FINANCIAL PERFORMANCE Availability of Foreign Exchange 3 3 3 3 3

Availability of Local Currency 3 3 3 2 3 Disbursement Flows 2 3 3 3 3 Cost Management 2 2 2 2 2 Performance of Co-Financiers 2 1 1 2 2

D. ACTIVITIES AND WORKS

Adherence to implementation schedule 3 3 2 2 2 Performance of Consultants or Technical Assistance 2 3 3 3 3 Performance of Contractors 2 2 2 2 2 Performance of Project Management 3 3 3 3 3

E. IMPACT ON DEVELOPMENT Likelihood of achieving development Objectives 3 3 3 3 3

Likelihood that benefits will be realized and sustained beyo 3 3 3 3 3 Likely contribution of the project towards an increase in 3 3 3 3 3 Current Rate of Return 0

F. OVERALL PROJECT ASSESMENT

Current Supervision Average 2,41 2,63 2,56 2,56 2,63 Current Trend over time

2,56

IX

STATUS-LAST MISSION 22.10.2012

Implementation Progress (IP) = 2.54

Development Objectives (DO) = 3.00

OVERALL STATUS : NON PROBLEMATIC PROJECT / NON POTENTIALY PROBLEMATIC PROJECT /

JUSTIFICATION OF RATINGS-22.10.2012

Generally project execution and realization of project outputs and outcomes is evaluated as satisfactory by the mission although the project experienced significant start up delays at the beginning. Various lessons have been learnt throughout the project implementation and during the Project Completion Report(PCR) consultations. The Ministry/PMU has executed the May 2012 mission’s recommendations. Notably, GOK provided adequate project counterpart funds which have enabled the project to clear works unpaid bills for the GOK counterpart and also facilitated project monitoring. The main issue for the Ministry/PCU at this mission is to ensure the 12 facilities lagging behind are completed and handed over before end of this year. The PMU will also ensure all the remaining equipment in the warehouse is distributed by November 20 2012 as per the target facilities list. The project will also take into account adequate project measures outlined in this aide memoire and prepare documentation for the final project audit. Concerning “other project conditions’ outlined at appraisal, Government has performed well in staffing the upgraded facilities. The PCR contains the details on additional staffing.

List of Supporting Documents

a) District Health Management Teams update reports.

b) Economic Recovery Strategy for Wealth and Employment Creation 2003-2007.

c) Kenya Health Policy Framework 1994 to 2012.

d) Ministries of Health-Annual Operational Plans and Annual Sector Reports.

e) Ministries of Health- Health Management Information Systems Reports.

f) National Health Sector Strategic Plan I and II.

g) Rural Health Project III Appraisal Report September 2003.

h) Rural Health Project III Mid Term Review Report May 2009.

i) Rural Health Project III M&E database Reports.

j) Rural Health Project III Supervision Missions Aide Memoires and Quarterly Reports.

k) Target Health Facilities Reports.

l)

Sustainability Assessment and Development of Sustainability Programme for the Rural Health Project III June 2012.

m) African Development Bank Strategic Plan 2003 to 2007.

Economic Analysis (ERR) and Financial Analysis.

“At appraisal no Economic Rate of Return (ERR) was calculated. As a result, there is no basis to re-estimate the ERR.”

X

ANNEX 1

RURAL HEALTH PROJECT III SUPERVISION AND PCR 22ND – 31ST OCTOBER, 2012 PERSONS CONSULTED DURING MISSION

PMU 1. David M. Waititu - Project Manager 2. Martin Wame - Project Quantity Surveyor 3. Mary M. Kariuki - Project Procurement Specialist 4. Elias Okoth - Project Accountant 5. Wycliffe Ondieki - Project Monitoring & Evaluation Specialist 6. David Rotich - Project Health Specialist

KAJIADO Ipolosat Dispensary 1. Dickson Sereka Kiranto - 0720215312 Emaroro Dispensary 1.Sylvia Sayianka – CHW - 0711152155 Mashuru H/C 1. Joe G. Kingori - Ogle Construction 2. Bernard Akhonya - Ogle Construction 3. Francis Ndicu - Ogle Construction

LOITOKITOK Kalesirua Primary School 1. James M. Mbova - D/H – 0723322355 Isinet Dispensary 1. Damaris Oketch - N/O Nursing Incharge – 0724327385 Loitokitok DHMT Meeting 1. P. N. Nyamumbo - DPHO 2. Nyotu D.M. - DDPHO 3. Moses M. Orundu - DDSC 4. Eric Lolgisoi - DMCC 5. Wilson Chesum - DPHN 6. Scholastica Makokha - KEPI Nurse 7. Richard K. Molel - DMLT 8. Kweheria Damaris - DHRIO 9. Leah Muthoni - DCHS Focal Person 10. Daniel Koech - DRH

Namelok H/C 1. Nancy Kariuki - N.O. I/c 2. Agnes Risie -R.C.O. I/c 3. Jim Odiyo Simwa - Mellech Engineering Olugulului Dispensary 1. Sylvester Kiio - N.O. I/c

NYANDARUA Kenton Gitwe Dispensary 1. Tom Waiharo - Apex Projects 2. Peter Mbugua - Apex Projects 3. Samuel Wainaina - I/c Kenton Dispensary 4. Grace Wambui - Clerk

Geta Bush H/C 1. Isaac Kiige - Kihara W. Construction 2. Ann Wambura - Nurse (KECHN) 3. Maryann Mbau - Nurse (KRCHN) 4. Damaris Muthee - Nutrinionist

Wanjohi H/C 1. Joseph M. Maina – R.C.O. I/c – 0721539555

XI

Silbwet H/C 1. George Ngure – Gesa Bldg. & Civil Eng. 2. Samuel Ngure - Gesa Bldg. & Civil Eng. 3. Cecilia Kibata – DPHN 4. John Wamae – N.O. I/c UASIN GISHU DHMT Meeting 1. Dr. Lubanga M. Billy – DMOH -Eldoret West 2. Gladys J. Koech – DHPO - Eldoret West 3. Samuel Kirui – DMCC/DDPHO - Wareng 4. Laban Kiprop – ADB/RHP III Coordinator – Uasin Gishu 5. Peninah J. Kipkosgei – DPHO – Eldoret Wast Disp. 6. Silas Kosgei – DHRIO - Eldoret Wast Disp. 7. Reuben Kimiei – DPHN - Eldoret East 8. James Ombati – DHAO - Eldoret Wast Disp. 9. John T. Kiprono – DPHN - Wareng 10. Mwasame Michael – DPHO - Wareng 11. Monicah A. Machini – DPHN - Eldoret West 12. Kipkemoi J. Viola – PHO Eldoret East Kaplelach Secondary School 1. Petronilla Mbakaya - D/Principal 2. James Tallam -Principal 3. Edward Sawe - Chairman BOG 4. Rev. Tengany - Sponsor 5. Mary Siruti - P.T.A. member 6. Pauline Joseph - P.T.A. member 7. John Tirop - P.T.A. Chairman 8. Batholomew – Tirop - P.T.A. member Tarakwa Dispensary 1. Lorna J. Bargerei - Nurse 2. Abdul Ali - N. CC 3. P.K. Macharia - C.O.W. 4. John Gisore -N.C.C. 5. Suleiman Adan Hassan - N.C.C. 6. Bashiri Abdrahman - N.C.C. Kipsigak H/C 1. Lily Koimet – KRCHN 2. Everline Jebet – Subordinate Staff Munyegwet Dispensary 1. Dorcas Lokai – KECHN 2. Sally Maiyo – KECHN 3. Scolata Ronoh – KRCHN 4. Anita Kaigogo – PHT 5. Daniel Okwara– Eldo Rotsa Construction Kaplelach H/C

1.Gachanja Thieri - Laton Engineering 2. Hannah Chepkemoi Murei - KRCHN 3. Miriam Chelimo Maiyo - KRHN 4. Evalyne Jerugut - Subordinate 5. Margaret Chemwol - Lab Tech. Uhuru Dispensary 1. Everline J. Kimitei - KRCHN 2. Pamela Omolo - KRCHN 3. John Sichei - KECHN 4. Salina Kwambai - Subordinate Elgeyo Border H/C 1. Rodah Buret - KRCHN 2. Sarafina Maiyo - Eldorosta TRANS MARA Nkararo H/C 1. Otieno Madero – Simori Enterprises.

XII

TRANS NZOIA Trans Nzoia West and Kwanza DHMTS 1. Dr. Mbithi P.M. -DMOH - Trans Nzoia West 2. Mr. Martin Khaemba - DHAO -Trans Nzoia West 3. Anata Faestus - DHAO -Trans Nzoia West 4. Angeline Otieno - DPHN - Trans Nzoia West 5. Ben N. Muyekho - DPHO - Kwanza 6. Agnes Imbosa - DCSFO - Kwanza 7. Vincent Maina – -DHRIO - Trans Nzoia West 8. Philip Bett - DMCC - Trans Nzoia West Bekeke and Machungwa Community Unit 1. 70 members Goseta Dispensary 1. Charity Akelemo – KRCHN Kaisagat Dispensary 1. Catherine Wafula – KRCHN Kwanza H/C 1. John Kibet - Kibet Gen. Contr 2. Moses Otwoma - Kibet Gen. Contr 3. Robert R. Kibii – - ADB projects cordinator 4. Gladys J. Yano - R.C.O. – MOHPS 5. Francis Opiro - PHO – MOHPHS

XIII

ANNEX 6 PROJECT NARRATIVE

1. Project Cost and Financing Sheet Reference Notes

i) The exchange rate used is 1UA=KSH. 113.14

ii) Table 1 A: The reference for this table is the Appraisal Report. We noted inconsistencies between the table on annex 8

and one on page 25 of the appraisal particularly on the rehabilitation of health centers (where the former had UA 4.75

while the latter had UA 5.42)-the respective expenditure categories in the two tables are therefore not the same. Table 8

in the appraisal annex 8 was adopted since it relates closely to the project cost information in the Bank system. However,

the table too had some inconsistencies on the summations. For instance, the total under services should read 7,315.9 and

not 7,238.9; the local cost under services should read 5,205 and not 5,203.2. The final project cost tables in the PCR

annexes are corrected and differ slightly from those in the appraisal and its annexes.

iii) Table B: The reference for this table was annex 8 of the appraisal report. However, the ratio between F.E and L.C varies from one line item to another. For consistency purposes, a ratio of F.E: L.C as 0.4859:0.5141

iv) Table C: (i) F.E= Grant AIA + ADB Loan AIA+OPEC Loan AIA

(ii) L.C= ADB Loan Revenue+ GOK Counterpart Funds

2. Additional Lessons Learnt for Project Planning and Execution

i) A signed memorandum of understanding or a contract agreement is critical when out-sourcing project services to existing

Government institutions or structures. Other Government systems were used for distribution of project procured goods.

However, given that the Bank and Government reporting and accountability requirements may not be necessarily the

same, there should be clear guidelines outlining expectations through an M.O.U or contract. For example, drugs batch 1

was distributed by the Kenya Medical Supplies Agency (KEMSA) and the distribution has to be audited since the

warehousing and quarterly distribution mechanisms and reporting expectations were not clearly defined from the onset.

ii) Geographical clustering of civil works contracts, as opposed to target district clustering facilitated effective contract

management and less cumbersome administrative procedures. However, there should be a moderation in the number of

facilities per contractors per cluster depending on facility locations. It was obvious that some of the contractors were

overwhelmed despite demonstrating capacity during tendering. This led to completion of works in some facilities way

behind schedules although other facilities in the same cluster had been completed and handed over.

iii) Procurement processes at appraisal where goods are envisaged to be received in a Warehouse for distribution should be

thought about beforehand, planned for and included in the project budget. The project entailed a lot of good procurement

some of which were distributed on a quarterly basis such as the drugs. Warehousing and distribution logistics were not

taken into account at appraisal and these costs had to be accommodated through ADF and counterpart funds during

project implementation. This caused some disruptions and delays in timely distribution of the goods.

3. Project Target Districts Indicators

Attached separately

XIV

4. Final Project Procurement Plan

Attached separately

PROCUREMENT PLAN General Country/Organisation: REPUBLIC OF KENYA

Project/Programme: RURAL HEALTH PROJECT III

Loan No: 2100150007894

Implementing Agency, Adress: MINISTRY OF PUBLIC HEALTH & SANITATION

Bank's Approval Date of Procurement Plan:

Date of General Procurement Notice: 16TH JUNE 2006

Period Covered by these Proc. Plans: 2008 - 2012

G O O D S Prior Review Threshold: Procurement decisions subject to Prior Review by the Bank as

stated in the Appraisal Report

Goods and Non-Consulting (see Note 1) Prior review

Procurement Method Threshold Comments (UAequiv.)

1. ICB All Drugs, Non-Pharms , LLITNs and Medical Equipment

2. NCB All Computers, Office Equipment, and IEC Materials

3. Shopping All Moyor Cycles, Motor Vehicles and Bicycles

3.

Procurement Packages with Methods and Time Schedule

BASIC DATA Bid Documents Bidding Period Bid Evaluation Contract Award Contract

Implementation

Description of Contract

Lot Number

Estimated Amount in

UA(000)

Procurement Method

Pre-or Post Qualification

Dom/Reg. Preference (Y/N)

Prior or Post

Review

Expected Date Issue of Bid Docs

Expected Bid closing Date

Plan vs. Actual

Transmission Bid Docs

Date

No-objection

Date

Bid Invitation

Date

Bid Closing-Opening

Bid Evaluation

Report

No-objection

Date

Contract Amount

in UA(000)

Contract Award Date

Contract Signature

Date Start Date End Date

Mosquito Bed Nets LLITNs 1 600,14 ICB Post Y-15% domestic Prior 30/07/07 15/09/07 Plan 13/07/07 23/07/07 30/07/07 15/09/09 30/08/07 15/09/07

600,14 01/10/07 22/10/07 29/10/07 10/12/07

1 520,00 ICB Post N/A Prior 16/06/07 16/08/07 Actual 16/06/07 16/06/07 16/06/07 16/08/07 21/09/07 26/10/07 520,00 10/12/08 07/02/08 21/02/08 30/04/08

Medical Equipment Batch 1 1, 2 & 3 530,30 ICB Post Y-15% domestic Prior 13/08/08 13/10/08 Plan 01/10/08 31/07/08 13/08/08 13/10/08 04/05/09 18/05/09

530,30 03/06/09 22/06/09 30/06/09 30/08/09

1, 2 & 3 208,20 ICB Post Y-15% domestic Prior 16/02/09 17/04/09 Actual 01/10/08 15/10/08 16/02/09 17/04/09 26/06/09 24/07/09 208,20 05/08/09 09/09/09 22/09/09 15/12/09

XV

Medical Equipment Batch 2

1,2,3,4,5,6,7 830,00 ICB Post Y-15% domestic Prior 07/01/11 18/02/11 Plan 15/12/10 29/12/10 07/01/11 18/02/11 04/03/11 18/03/11 830,00 01/04/11 14/07/11 21/07/11 13/10/11

1,2,3,4,5,D/1 1 830,40 ICB Post Y-15% domestic Prior 04/02/11 17/03/11 Actual 19/01/11

01/27/11 04/02/11 17/03/11 30/05/11

13/06/11 1 830,40 23/06/11

25/07/11

19/08/11

19/11/2011

Medical Equipment Batch 3

1,2,3 260,00 NCB Post N Prior 03/11/11 30/11/11 Plan 18/10/11 20/11/11

03/11/11 30/11/11 10/12/11 15/12/11 260,00 23/01/12 06/02/12 07/02/12 21/02/12

1,2,3 233,81 NCB Post N Prior

03/11/11 30/11/11 Actual

29/10/11

29/10/11

03/11/11

30/11/11 14/12/11 01/03/12 268,90 23/01/12 08/02/12 08/02/12 09/03/12

Computer and office equipment- Batch 1

1,2 88,39 NCB Post N Prior 26/09/06 19/10/06 Plan 18/09/06 02/10/06 26/09/06 19/10/06 02/11/06 10/11/06 88,39 24/11/06 30/12/06 31/12/06 30/07/07

1,2 77,89 NCB Post N Prior 15/08/06 31/10/06 Actual 10/08/06 25/08/06 15/08/06 31/10/06 17/01/07 06/02/07 77,89 20/02/07 14/04/07 15/04/07 30/06/07

Computer and office equipment- Batch 2 (HMIS)

1,2 578,00 NCB Post N Prior 27/05/09 24/06/09 Plan 06/05/09 20/05/09 27/05/09 24/06/09 08/07/09 22/07/09 578,00 29/07/09 19/08/09 26/08/09 25/10/09

1,2 83,58 NCB Post N Prior 16/06/09 14/07/09 Actual 03/06/09 08/06/09 16/06/09 14/07/09 18/08/09 07/09/09 83,58 09/09/09 30/09/09 07/10/09 30/12/09

Communication Equipment* 300,00 ICB Post Y-15% domestic Prior N/A N/A Plan N/A N/A N/A N/A N/A N/A 300,00 N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A N/A Actual N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

IEC Materials

1,2,3 110,00 NCB Post N Prior 26/10/10 09/11/10 Plan 28/08/10 11/09/10 26/10/10 09/11/10 23/11/10 07/12/10 110,00 21/12/10 04/01/11 11/01/11 01/02/11

1,2,3,4,5 110,59 Shopping Post N/A Prior 06/10/10 19/10/10 Actual 28/08/10 04/10/10 06/10/10 19/10/10 16/11/10 16/12/10 110,59 07/02/11 04/03/11 18/04/11 30/06/11

Drugs & Medical Supplies (Non Pharms) Batch 1

1,2,3,4,5 2 184,00 ICB Post Y Prior 28/06/07 12/07/07 Plan 28/06/07 12/07/07 16/07/07 17/09/07 17/10/07 13/10/07 2 184,00 15/11/07 21/12/07 02/02/08 30/04/08

2 449,17 ICB Post N/A Prior 16/07/07 17/09/08 Actual 28/06/07 12/07/07 16/07/07 17/09/08 04/12/07 07/12/08 2 449,17 27/02/08 29/02/08 01/04/08 30/06/08

Drugs & Medical Supplies (Non Pharms) Batch 2

1,2,3,4,5,6,7 3 765,60 ICB Post Y Prior 05/06/09 17/07/09 Plan 04/05/09 18/05/09 05/06/09 17/07/09 10/06/10 24/06/10 3 765,60 08/07/10 21/10/10 04/11/10 02/02/11

1,2,3,4,5,6,7 3 436,43 ICB Post Y-15% domestic Prior 08/02/10 24/03/10 Actual 22/12/09 04/02/10 08/02/10 24/03/10 17/07/10 02/09/10 3 436,43 22/09/10 11/11/10 25/11/10 30/06/10

Vehicles

1,2,3,4 397,74 Shopping Post N Prior 01/03/07 05/11/06 Plan 15/09/06 29/09/06 01/03/07 05/11/06 26/11/06 11/12/06 397,74 11/07/07 15/08/07 16/08/07 20/09/07

1,2,3,4 345,06 Shopping Post N Prior 01/03/07 05/11/06 Actual 15/09/06 30/09/06 01/03/07 05/11/06 26/11/06 11/12/06 345,06 12/07/07 21/08/07 15/09/07 28/02/08

Motorcycles Batch 1

1 123,74 Shopping Post N Prior 01/03/07 05/11/06 Plan 15/09/06 29/09/06 01/03/07 05/11/06 26/11/06 11/12/06 123,74 11/07/07 15/08/07 16/08/07 20/09/07

1 122,50 Shopping Post N Prior 01/03/07 05/11/06 Actual 15/09/06 30/09/06 01/03/07 05/11/06 26/11/06 11/12/06 122,50 12/07/07 21/08/07 15/09/07 28/02/08

Biycles Batch 1

1 8,84 Shopping Post N Prior 01/03/07 05/11/06 Plan 15/09/06 29/09/06 01/03/07 05/11/06 26/11/06 11/12/06 8,84 11/07/07 15/08/07 16/08/07 20/09/07

6,73 Shopping Post N Prior 01/03/07 05/11/06 Actual 15/09/06 30/09/06 01/03/07 05/11/06 26/11/06 11/12/06 6,73 12/07/07 21/08/07 15/09/07 28/02/08

Training Materials

1,2 141,40 Shopping Post N Prior 13/04/09 27/04/09 Plan 23/03/09 06/04/09 13/04/09 27/04/09 11/05/09 25/05/09 141,40 01/06/09 22/06/09 29/06/09 13/07/09

1,2, 97,51 Shopping Post N Prior 09/06/09 15/06/09 Actual 26/05/09 08/06/09 09/06/09 15/06/09 28/07/09 10/08/09 97,51 20/08/09 15/09/09 22/09/09 06/10/09

Reproduction of Community Strategy Training Materials

1,2,3,4 260,00 NCB Post N Prior 03/11/11 30/11/11 Plan 18/10/11 20/11/11

03/11/11 30/11/11 10/12/11 15/12/11 260,00 23/01/12 06/02/12 07/02/12 21/02/12

1,2,3,4 207,37 NCB Post N Prior

03/11/11 30/11/11 Actual

29/10/11

29/10/11

03/11/11

30/11/11 14/12/11 01/03/12 207,37 23/01/12 08/02/12 08/02/12 09/03/12

Acquisition of HMIS Materials

1,2,3 88,40 Shopping Post N Prior 13/04/09 27/04/09 Plan 23/03/09 06/04/09 13/04/09 27/04/09 11/05/09 25/05/09 88,40 01/06/09 22/06/09 29/06/09 13/07/09

1,2 64,42 Shopping Post N Prior 09/06/09 15/06/09 Actual 26/05/09 08/06/09 09/06/09 15/06/09 28/07/09 10/08/09 64,42 20/08/09 15/09/09 22/09/09 06/10/09

Total Cost 9 746,54 Plan 9 746,54

9 352,48 Actual 9 352,48

Budget appraisal

10 800,00

Budget revised 1 (date of Bank no objection)



Communication Equipment* The government polisy is changing and is likely that he initially envisaged radio Communication Equipment will notbe purchased hence the absence of data.

XVI

PROCUREMENT PLAN

General Fill gray cells only! Country/Organisation: REPUBLIC OF KENYA


Loan No: 2100150007894




Period Covered by these Proc. Plans: 2008- 2012

W O R K S

Prior Review Threshold: Procurement decisions subject to Prior Review by the Bank as stated in the Appraisal Report

Works (see Note 2) Prior review

Procurement Method Threshold Comments (UAequiv.)

1. ICB

2.

3. NCB no threshold Demonstration projects & dispensaries*

4. Estimates were done by Consultants**

5. Shopping

6.

3.


Basic Data

Bid Documents Bidding Period Bid Evaluation Contract Award Contract Implementation

Description of Contract

Lot Number

Estimated Amount in UA (000)

Procurement

Method

Pre-or Post Qualification

Dom/Reg. Preference

(Y/N)

Prior or Post

Review

Lumpsum or Bill of

Quantities

Expected Date Issue of Bid Docs

Expected Bid closing Date

Plan vs. Actual

Transmission Bid Docs Date

No-objection Date

Bid Invitation

Date

Bid Closing-Opening

Bid Evaluation Report

No-objection Date

Contract Amount in

UA(000)

Contract Award Date

Contract Signature

Date Start Date End Date

Civil Works - Tharaka

1 683,00 NCB Prior N Prior BQs 20/03/09 04/05/09 Plan 27/02/09 13/03/09 20/03/09 04/05/09 18/05/09 01/06/09 683,00 08/06/09 29/06/09 06/07/09 06/07/10

1 0,00 NCB Prior N Prior BQs 15/04/09 19/05/09 Actual 11/02/09 25/02/09 15/04/09 19/05/09 19/10/09 12/01/10 N/A N/A N/A N/A

Civil Works - Tharaka - Re-tender 1 676,15 NCB Prior N Prior BQs 20/03/09 04/05/09 Plan 14/01/10 28/01/10 02/03/10 30/03/10 10/06/10 24/06/10 676,15 08/07/10 22/10/10 29/10/10

30/04/12

1 693,85 NCB Prior N Prior BQs 22/03/10 20/04/10 Actual 14/01/10 22/02/10 22/03/10 20/04/10 17/07/10 02/09/10 693,85 22/09/10 11/11/10 29/11/10 30/08/12

Civil Works - Kirinyaga 1,2,3,4 2 286,00 NCB Prior N Prior BQs 23/04/09 08/06/09 Plan 01/04/09 15/04/09 23/04/09 08/06/09 22/06/09 06/07/09 2 286,00 13/07/09 03/08/09 10/05/10

30/04/12

1,2,3,4 2 588,28 NCB Prior N Prior BQs 22/04/09 22/05/09 Actual 07/04/09 17/04/07 22/04/09 22/05/09 19/10/09 12/01/10 2 588,28 03/02/10 13/04/10 10/05/10 30/06/12

Civil Works - Nyandarua 1,2,3,4 2 623,00 NCB Prior N Prior BQs 20/03/09 04/05/09 Plan 27/02/09 13/03/09 20/03/09 04/05/09 18/05/09 01/06/09 2 623,00 08/06/09 29/06/09 10/05/10

30/04/12


XVII

Civil Works - Uasin Gishu 1,2,3,4 3 810,00 NCB Prior N Prior BQs 23/04/09 08/06/09 Plan 01/04/09 15/04/09 23/04/09 08/06/09 22/06/09 06/07/09 3 810,00 13/07/09 03/08/09 10/05/10

30/04/12


Civil Works - Trans Nzoia (1 cluster to be re-tendered)

1,2,3 1 863,00 NCB Prior N Prior BQs 02/03/09 16/04/09 Plan 01/01/09 15/01/09 02/03/09 16/04/09 30/04/09 14/05/09 1 863,00 21/05/09 11/06/09 10/05/10 30/04/12

1&2 1 274,50 NCB Prior N Prior BQs 31/03/09 05/05/09 Actual 29/01/09 12/02/09 31/03/09 05/05/09 19/10/09 12/01/10 1 274,50 03/02/10 13/04/10 10/05/10 30/06/12

Civil Works - Trans Nzoia Re-tender 3 601,00 NCB Prior N Prior BQs 20/03/09 04/05/09 Plan 14/01/10 28/01/10 02/03/10 30/03/10 10/06/10 24/06/10 601,00 08/07/10 22/10/10 29/10/10

30/04/12


Civil Works - Trans Mara ( 1 cluster to be retendered)

1,2,3 1 453,00 NCB Prior N Prior BQs 20/03/09 04/05/09 Plan 27/02/09 13/03/09 20/03/09 04/05/09 18/05/09 01/06/09 1 453,00 08/06/09 29/06/09 10/05/10 30/04/12

1&3 1 077,69 NCB Prior N Prior BQs 15/04/09 19/05/09 Actual 11/02/09 25/02/09 15/04/09 19/05/09 19/10/09 12/01/10 1 077,69 03/02/10 13/04/10 10/05/10 30/10/12

Civil Works - Trans Mara Re-tender 2 548,44 NCB Prior N Prior BQs 20/03/09 04/05/09 Plan 14/01/10 28/01/10 02/03/10 30/03/10 10/06/10 24/06/10 548,44 08/07/10 22/10/10 29/10/10

30/04/12


Civil Works - Kajiado 1,2,3 3 447,00 NCB Prior N Prior BQs 20/03/09 04/05/09 Plan 27/02/09 13/03/09 20/03/09 04/05/09 18/05/09 01/06/09 3 447,00 08/06/09 29/06/09 10/05/10

30/04/12

1,2,3 3 427,39 NCB Prior N Prior BQs 15/04/09 19/05/09 Actual 27/02/09 13/03/09 15/04/09 19/05/09 19/10/09 12/01/10 3 427,39 03/02/10 13/04/10 10/05/10 30/10/12

Civil Works - Loitokitok 1 734,00 NCB Prior N Prior BQs 23/04/09 08/06/09 Plan 27/02/09 13/03/09 23/04/09 08/06/09 22/06/09 06/07/09 734,00 13/07/09 03/08/09 10/08/09

30/04/12

1 0,00 NCB Prior N Prior BQs 22/04/09 22/05/09 Actual 07/04/09 17/04/07 22/04/09 22/05/09 19/10/09 12/01/10 N/A N/A N/A N/A

Civil Works - Loitokitok Re-tender

1 976,67 NCB Prior N Prior BQs 20/03/09 04/05/09 Plan 14/01/10 28/01/10 02/03/10 30/03/10 10/06/10 24/06/10 976,67 08/07/10 22/10/10 29/10/10 28/11/11

1 1 007,60 NCB Prior N Prior BQs 22/03/10 20/04/10 Actual 14/01/10 22/02/10 22/03/10 20/04/10 17/07/10 02/09/10 1 007,60 22/09/10 11/11/10 29/11/10 30/10/12

Demonstration Project- Rainwater Harvesting - Phase 1

1, 2, 3, 6, 7 398,00 Prior N Prior BQs 07/10/07 27/11/07 Plan 16/09/07 30/09/07 07/10/07 27/11/07 11/12/07 25/12/07 398,00 01/01/08 22/01/08 29/01/08 25/03/08

334,77 NCB Prior N Prior BQs 14/05/08 30/06/08 Actual 21/03/08 04/04/08 14/05/08 30/06/08 16/08/08 20/08/08 334,77 13/11/08 17/12/08 19/01/09

10/10/09

Demonstration Project- Rainwater Harvesting- Phase 2 (Re-tender)

4, 5 177,00 NCB Prior N Prior BQs 15/01/09 03/01/09 Plan 01/01/09 15/01/09 15/01/09 03/01/09 30/09/07 14/10/07 177,00 21/10/07 11/11/07 18/11/07 13/01/08

168,80 NCB Prior N Prior BQs 13/01/09 27/03/09 Actual 10/12/09 24/12/09 13/01/09 27/03/09 16/03/09 22/04/09 168,80

15/06/09

17/06/09

01/07/09

30/04/10

Demonstration Project- VIPs- Batch 1

110,00 NCB Post N Prior Lumpsum N/A N/A Plan N/A N/A N/A N/A N/A N/A 110,00 N/A N/A 01/07/11 31/03/12

1-25 115,54 Shopping Post N Post BQs Actual 115,54 01/08/11 30/05/12

Demonstration Project- VIPs- Batch 2 -Retender Uasin Gishu and Transmara Districts

44,00 NCB Post N Prior Lumpsum N/A N/A Plan N/A N/A N/A N/A N/A N/A 44,00 N/A N/A 01/08/11 31/03/12

25-35 60,40 Shopping Post N Post BQs Actual 60,40 01/02/12 30/08/12

Total Cost 20 430,26 Plan 20 430,26

19 652,84 Actual 19 652,84

Budget appraisal




* Post review for dispensaries is not used because dispensaries are packaged together with facilities subject to prior review

**The costs of civil works as reflected in the plan derives from estimates compiled by consultants.

*** The contract implementation period includes 6 months Defects Liability Period

NB: The Civil Works includes the construction of additional staff houses as contained in the addenda issued for each of the clusters

XVIII

PROCUREMENT PLAN

1. General

Country/Organisation: REPUBLIC OF KENYA


Loan No: 2100150007894




Period Covered by these Proc. Plans: 2008 - 2012

C O N S U L T A N T S 2. Prior Review Threshold: Procurement decisions subject to Prior Review by the Bank as

stated in the Appraisal Report

Consultants (see Note 3)

Prior review

Procurement Method Threshold Comments

(UAequiv.)

1. QCBS (Firms) N/A Not specified in PAR

2. Single Source/Firms/Individual

3. Individual Consultants PMU Staff were recruted as individual consultants**

4. Consultant Qualification

5. Training All trainings subject to Post review*

6. Technical Assistance

3.


BASIC DATA Request for Expression of Interest Request for

Proposal & Short List Bid Proposals

Bid Evaluation Technical (T) & Financial (F)

Contract Award Contract Implementation

Description of Assignment

Estimated Amount

in UA (000)

Selection Method

Prior/Post Review

Lumpsum or Timed-Based

Expected EOI Date

Expected Proposals closing

Date

Plan vs. Actual

Submission Date

No-objection Date

Date Publishe

d

Submission Date

Plan vs. Actual

Submission Date

No-objection Date

Invitation Date

Submission/ Opening

Date

Submission Evaluation Report (T)

No-objection Evaluation Report (T)

Opening Financial Proposals

Submission Eval Report

(T) & (F)

Submission Negotiations

Report

No-objection Award &

Negotiations

Plan vs. Actual

Contract Amount

in UA (000)

Contract Award Date

Contract Signature Date

Start Date

End Date

TRAINING

DHMT/HMT in Management Round 1 (HSM) 123,00 QCBS Prior Lumpsum N/A N/A Plan N/A N/A N/A N/A Plan 15/09/07 30/09/07 01/10/07 14/11/07 N/A N/A N/A 28/11/07 N/A 14/12/07 Plan 123,00 26/01/08 08/02/08 18/02/08 18/04/08

21,93 QCBS Post Lumpsum N/A N/A Actual N/A N/A N/A N/A Actual 14/11/07 11/01/08 24/01/08 11/03/08 N/A N/A N/A 30/04/08 N/A 26/06/08 Actual 21,93 21/07/08 06/10/08 13/10/08 15/12/08

DHMT/HMT in Management Round 2

(HSM) 176,80 QCBS Prior Lumpsum 06/09/10 20/09/10 Plan 16/08/10 30/08/10 06/09/10 20/09/10 Plan 27/09/10 11/10/10 25/10/10 08/11/10 22/11/10 06/12/10 13/12/10 20/12/10 27/12/10 10/01/11 Plan 176,80 17/01/11 14/07/11 21/07/11 18/11/11

316.67 QCBS Post Lumpsum

11/06/10

03/08/10 Actual

11/06/10

30/06/10

20/07/10

03/08/10 Actual

14/09/10 13/10/10 15/10/10 12/11/10

29/03/11 15/04/11

19/04/11

N/A

27/05/11 Actual 316.67

23/06/11 27/07/11

31/10/11

17/02/12

IYCF Training

88,40 QCBS Prior Lumpsum N/A N/A Plan N/A N/A N/A N/A Plan 27/11/08 05/12/08 15/12/08 02/02/09 N/A N/A N/A 27/02/09 N/A 13/03/09 Plan 88,40 22/03/09 20/04/09 27/04/09 31/07/09

99,70 QCBS Post Lumpsum N/A N/A Actual N/A N/A N/A N/A Actual 27/11/08 15/12/08 02/02/09 N/A N/A 20/02/09 24/03/09 N/A 22/04/09 Actual 99,70

15/5/09

07/07/09

14/07/09

18/02/10

Community Strategy Trainings (In-house) Batch 1

200,00 QCBS Prior N/A N/A N/A Plan N/A N/A N/A N/A Plan N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Plan 200,00 N/A N/A 10/01/09 30/12/10

142,00 QCBS post N/A N/A N/A Actual N/A N/A N/A N/A Actual N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Actual 142,00 N/A N/A 10/01/09 30/06/11

Community Strategy Trainings (In-house) Batch 2

283,33 QCBS Prior N/A N/A N/A Plan N/A N/A N/A N/A Plan N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Plan 283,33 N/A N/A 01/07/11 30/12/11

QCBS post N/A N/A N/A Actual N/A N/A N/A N/A Actual N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Actual

PRE-CONTRACT CONS SCS

XIX

Tharaka

36,00 QCBS Prior Lumpsum 15/11/06 09/01/07 Plan 31/08/06 02/11/06 15/11/06 09/01/07 Plan 26/06/07 11/07/07 24/07/07 11/09/07 N/A N/A 03/10/07 15/10/07 N/A 25/10/07 Plan 36,00 24/11/07 14/12/07 15/12/07 15/03/08

44,30 QCBS Prior Lumpsum 15/11/06 09/01/07 Actual 31/08/06 02/11/06 15/11/06 09/01/07 Actual 26/06/07 11/07/07 24/07/07 11/09/07 N/A N/A 16/10/07 21/11/07 N/A 29/11/07 Actual 44,30 24/12/07 27/02/08 05/03/08 15/04/09

Kirinyaga



Nyandarua



UasinGishu



Trans Nzoia



Trans Mara



Kajiado



Loitokitok



Development of IEC Strategy Consultancy.

44,19 QCBS Prior Lumpsum N/A N/A Plan N/A N/A N/A N/A Plan 15/10/07 30/10/07 07/11/07 21/12/07 N/A N/A 20/02/08 15/01/08 N/A 30/01/08 Plan 44,19 28/02/08 14/03/08 28/03/08 27/02/09

38,85 QCBS Prior Lumpsum N/A N/A N/A N/A N/A N/A Actual 16/08/07 25/01/08 29/01/08 17/03/08 N/A N/A 01/04/08 30/04/08 N/A 21/05/08 Actual 38,85 29/05/08 08/07/08 15/09/08 30/03/09

Sustainability Consultancy

53,00 QCBS Prior Lumpsum N/A N/A Plan N/A N/A N/A N/A Plan 15/10/08 30/10/08 07/11/08 21/12/08 20/01/09 N/A 27/01/09 10/02/09 17/02/09 03/03/09 Actual 53,00 10/03/09 31/03/09 07/04/09 06/07/09

50,84 QCBS Prior Lumpsum N/A N/A N/A N/A N/A N/A Actual 22/01/09 23/01/09 03/02/09 20/03/09 16/04/09 N/A 05/12/09 Actual 50,84

22/12/09

10/02/10

17/02/10

25/06/10

Financial Management Systems

Development***

21,20 QCBS Prior Lumpsum 11/06/10 25/06/10 Plan 21/05/10 04/06/10 11/06/10 25/06/10 Plan 14/10/10 28/10/10 04/11/10 18/11/10 N/A N/A N/A N/A N/A N/A N/A 21,20 N/A N/A N/A N/A

QCBS Prior Lumpsum

11/06/10

30/06/10 Actual

11/06/10

30/06/10

23/09/10

07/10/10 Actual

11/06/10

30/06/10

23/09/10

07/10/10 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Project M&E Database devt

26,50 QCBS Prior Lumpsum 11/06/10 25/06/10 Plan 21/05/10 04/06/10 11/06/10 25/06/10 Plan 14/10/10 28/10/10 04/11/10 18/11/10 25/11/10 09/12/10 16/12/10 23/12/10 30/12/10 13/01/11 Plan 26,50 20/01/11 03/02/11 17/02/11 18/04/11

16,79 QCBS Prior Lumpsum 11/06/10

30/06/10 Actual

11/06/10

30/06/10

23/09/10

07/10/10 Actual

11/06/10

30/06/10

23/09/10

07/10/10

17/11/10

16/12/10

N/A

17/11/10

N/A

16/12/10 Actual 16,79

02/02/11

09/03/11

14/03/11

14/05/11

Project Implementation Manual

53,00 QCBS Prior Lumpsum N/A N/A Plan N/A N/A N/A N/A Plan 23/06/07 08/07/07 23/07/07 22/08/07 N/A N/A N/A 29/08/07 N/A 14/09/07 Plan 53,00 11/10/07 16/10/07 23/10/07 30/07/08

44,30 QCBS Prior Lumpsum N/A N/A Actual N/A N/A N/A N/A Actual 03/04/09 16/04/09 30/04/07 30/07/07 N/A N/A N/A 03/02/09 N/A 23/07/07 Actual 44,30 18/12/07 07/02/08 21/02/08 10/03/09

AUDITING SERVICES

90,00 QCBS Prior Lumpsum N/A N/A Plan Plan Plan 90,00

Actual Actual Actual

PMU STAFF FEES

individual consultants : PMU-Phase 1 ( PMU Staff during the 1st 3yr contract period))

782,30 Chapter V Prior Lumpsum N/A N/A Plan N/A N/A N/A N/A Plan N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Plan 782,30 N/A 01/02/06 01/02/06 28/02/09

327,98 Prior Lumpsum Actual Actual Actual 327,98 01/02/06 02/02/07

28/02/09

individual consultants : PMU-Phase

2 ( PMU Staff during the 2nd and last 2yr contract period))


365,66 N/A N/A Actual N/A N/A N/A N/A Actual N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Actual 365,66 N/A 01/03/09 01/03/09 01/03/11

individual consultants : PMU-Phase 3 ( PMU Staff during the envisaged contract extension period period))


156,80 Actual N/A N/A Actual N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Actual 156,80 01/03/11 01/03/11 31/12/12

Total Cost 3 435,19 Plan Plan 3 435,19

#VALEUR! Actual Actual

#VALEU

R!

Budget appraisal 7 790,00 Budget revised 1 (date of Bank no objection) Budget revised 2 (date of Bank no objection) Budget revised 3 (date of Bank no objection)

*Initially 7 PMU Technical Staff were recruited for a period of three years W.E.F from 01/02/06 * *The change of mode of procurement for training does not affect the entire package of UA 3.99 million, it only affects those that were tobe undertaken as under UA 200,000. * **There was no adequate response to the LOI and considering the length of the procurement process and the short time frame left to end the project, the PMU has decided not to procure this consultancy

Kenya - Rural Health Project III - Project Completion Report · 2019-06-29 · RURAL HEALTH PROJECT...

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