Document of The World Bank

FOR OFFICIAL USE ONLY

Report No: 36105

IMPLEMENTATION COMPLETION REPORT(SCL-43010)

ON A

LOAN

IN THE AMOUNT OF US$19.00 MILLION

TO THE

PHILIPPINES

FOR AN

EARLY CHILDHOOD DEVELOPMENT PROJECT

May 30, 2006

This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization.

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CURRENCY EQUIVALENTS

(Exchange Rate Effective May 1, 2006)

Currency Unit = Philippine Pesos Php 1.00 = US$ 0.194US$ 1.00 = PhP 51.51

FISCAL YEARJanuary 1 December 31

ABBREVIATIONS AND ACRONYMS

ADB Asian Development Bank CBC Communications for Behavior Change CAS Country Assistance Strategy CDW Child Development Worker CWC Council of Welfare of Children DepED Department of Education DHS Demographic Health Services DOH Department of Health DSWD Department of Social Welfare and Development ECD Early Childhood Development ECCD Early Child Care Development ECE Early Childhood Experience EPI Expended Program of Immunization FMS Financial Management Specialist GOP Government of Philippines IBRD International Bank for Reconstruction and Development ICB International Competitive Bidding IMCI Integrated Management of Childhood Illness LGU Local Government Units LGUFF Local Government Unit Financing Facility MTR Mid-Term Review NCB National Competitive Bidding PAD Project Appraisal Document PAGCOR Philippine Amusement and Games Corporation PEM Protein Energy Malnutrition ES Parent Effectiveness Service PSR Project Status Report QER Quality Enhancement Review RSCW Regional Sub-Committees Council of Welfare for Children WB World Bank

Vice President: Jeffrey GutmanCountry Director Xian ZhuSector Manager Fadia Saadah

Task Team Leader/Task Manager: Rekha Menon

PHILIPPINESEarly Childhood Development

CONTENTS

Page No.1. Project Data 12. Principal Performance Ratings 13. Assessment of Development Objective and Design, and of Quality at Entry 24. Achievement of Objective and Outputs 55. Major Factors Affecting Implementation and Outcome 156. Sustainability 167. Bank and Borrower Performance 178. Lessons Learned 189. Partner Comments 2010. Additional Information 22Annex 1. Key Performance Indicators/Log Frame Matrix 24Annex 2. Project Costs and Financing 25Annex 3. Economic Costs and Benefits 28Annex 4. Bank Inputs 29Annex 5. Ratings for Achievement of Objectives/Outputs of Components 34Annex 6. Ratings of Bank and Borrower Performance 35Annex 7. List of Supporting Documents 36Annex 8: Studies, Policies and Laws Implemented Under the Project 37

Project ID: P004566 Project Name: EARLY CHILDHOOD DEVELOPMENT

Team Leader: Rekha Menon TL Unit: EASHDICR Type: Core ICR Report Date: June 2, 2006

1. Project DataName: EARLY CHILDHOOD DEVELOPMENT L/C/TF Number: SCL-43010

Country/Department: PHILIPPINES Region: East Asia and Pacific Region

Sector/subsector: Health (90%); Pre-primary education (5%); Sub-national government administration (5%)Theme: Child health (P); Nutrition and food security (P); Participation and civic engagement (S);

Other communicable diseases (S)

KEY DATES Original Revised/ActualPCD: 04/18/1996 Effective: 07/07/1998 09/28/1998

Appraisal: 12/15/1997 MTR: 12/31/1999 11/14/2001Approval: 03/24/1998 Closing: 12/31/2004 11/30/2005

Borrower/Implementing Agency: Republic of Philippines/Department of Social Welfare and Development (DSWD)Other Partners: Center for the Welfare of Children (CWC), Department of Health (DOH),

Department of Education (DepED)

STAFF Current At AppraisalVice President: Jeffrey S. Gutman Jean-Michel SeverinoCountry Director: Joachim von Amsberg Vinay BhargavaSector Manager: Fadia M. Saadah Maureen LawTeam Leader at ICR: Rekha Menon Althea HillICR Primary Author: Claudia Rokx; Rekha Menon

2. Principal Performance Ratings

(HS=Highly Satisfactory, S=Satisfactory, U=Unsatisfactory, HL=Highly Likely, L=Likely, UN=Unlikely, HUN=Highly Unlikely, HU=Highly Unsatisfactory, H=High, SU=Substantial, M=Modest, N=Negligible)

Outcome: S

Sustainability: L

Institutional Development Impact: SU

Bank Performance: S

Borrower Performance: S

QAG (if available) ICRQuality at Entry: S

Project at Risk at Any Time: No

3. Assessment of Development Objective and Design, and of Quality at Entry

3.1 Original Objective:Despite an excellent start

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in addressing early childhood development issues, the situation of children in the Philippines in the 1990s was considerably worse off compared to other countries at the same level of economic development. Ill health, malnutrition, and poor psychosocial development among pre-schoolers were costing the country substantial amounts in terms of premature deaths, permanent disabilities, and lost future productivity and income.

The poor progress in child welfare was, in large part, due to the economic stagnation and under-investment in welfare programs during the Marcos period (1965-1986). Social indicators, infant mortality declined much slower in the Philippines than in other low and middle-income countries in Asia. For example, in the 1960s, Thailand and Philippines had similar infant mortality rates. By the 1990s (when this project was prepared), IMR in Thailand was at 30 per 1,000 live births while in the Philippines the rate was 57 per 1,000 live births. Although early childhood development programs and several programs were in place, these were grossly under-funded and poorly integrated across the various sectors. The situation worsened with devolution, which was slow to address inequalities in resources distribution. Despite strong political commitment at the national level, Local Government Units (LGUs), did not accord ECD-programs high budgetary priority: commitment remained largely in rhetoric.

In response to these concerns, the government set up a multi-agency Steering Committee to develop a 10-year National ECD Program and requested the World Bank and the Asian Development Bank to conduct studies to help program design.

The ECD project aimed to support the first six years of this 10-year National Early Childhood Development (ECD) Program in three regions (Region VI, VII and XII). The project’s objectives (which were the same as that of the National ECD Program) were to (i) contribute to the attainment of human development goals in these regions by providing services that ensure survival and promote physical and mental development of Filipino children, particularly those who are most vulnerable and disadvantaged and (ii) to establish an effective partnership between national and Local Governments Units (LGUs) in the provision of ECD services.

The achievement of the first objective would be measured by a reduction in under-five mortality by 30% of the baseline value; improvement in child malnutrition rates and reduction in the prevalence of micronutrient deficiencies with a 40% reduction in wasting among children under seven and a 30% reduction in iron-deficiency. The achievement of effective partnerships would be measured by the percentage of targeted municipalities that will have implemented the ECD packages by the end of the project and the increase in spending on ECD-activities at the municipal level.

The development objective was clear and in full accordance with the Government of Philippines’ 10-year ECD Program vision and strategy, as well as the development strategy of the World Bank Country Assistance Strategy (CAS-15362) for the Philippines. The two salient features of the project were: (i) it advocated a cross-sectoral and integrated approach to the delivery of ECD-services at the local level and (ii) it was among the first in the Bank to field a rigorous impact-evaluation study measuring impact of interventions in a program setting.

The project was a joint but parallel financed operation between the Asian Development Bank (ADB) and the World Bank. It became effective on September 28, 1998 and closed on November 30, 2005.

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3.2 Revised Objective:The original objectives were not revised.

3.3 Original Components:The project consisted of the following parts/components:

Component 1(A): The Early Childhood Development Services Delivery (US $4.6 million)

Implementation of programs to improve delivery of services for early childhood development in the three project Regions (VI, VII and XII) for five programs for a total cost of US$ 4.6 million

1. The Expanded Program of Immunization would supply inputs to the existing EPI-program including cold-chain equipment and replacement, training of cold-chain technicians in maintenance and repair and health care staff in basic EPI-skills; reproduction of IEC-EPI materials and monitoring charts.

2. The Integrated Management of Childhood Illness (IMCI) program, which aimed at improving the diagnosis, management and treatment of common childhood-illnesses, through the provision of in-service IMCI-training for health staff, supporting the integration of IMCI-curricula of medical, nursing and midwifery schools, and supplying delivery- and diet-kits to improve case-management of conditions affecting the new-born.

3. The Micronutrient Malnutrition Prevention and Control program aimed at preventing, managing and controlling micronutrient deficiencies through supplementation, fortification and deworming of children.

4. The Parent-Effectiveness Service program would upgrade the former PES-program with the introduction of a Mother and Child book in which permanent records of the child’s development and guidance were included. The book would be incorporated into the Teacher-Child-Parent program of the Department of Education as well as into the Department of Health (DOH)’s health education program.

5. The Grade I ECE/ECD program aimed at improving child readiness for elementary schools through the introduction of an 8-week module curriculum and teacher training and provision of materials. Grade I children would also receive iron-supplementation and deworming.

Programs 1, 2 and 3 were managed by the Department of Health (DOH), program 4 by the Department of Social Welfare and Development (DSWD) and program 5 by the Department of Education.

Component 1(B): Financing Facility (US$ 5.4 million)

In addition to the five programs, the first component included a Financing Facility. This facility was initially operated by the Municipal Development Fund and later transferred to DSWD. It provided matching financing on an income-related cost-sharing basis for investments in upgrading ECD-services at the LGU level. Eligible services included: the construction, upgrading and repair of facilities; and the provision of equipment, drugs, food supplements.

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Component 2: Support to Service Delivery (US$ 9.2 million)

This component aimed to support the LGUs in the areas of communications (US$1.3 million), planning, targeting and Management Information Systems (MIS) (US$3.7 million) and training (US$.4 million) at the central, regional, provincial and municipal levels. In particular, support was to be provided to the Council of Welfare for Children (CWC) which was to become the apex agency for the national ECD-program in the long-term. The component was managed by DSWD (US$3.8M).

Component 3: Research and Development (US$1.7 million)

This component was to finance R&D activities in support of effective ECD program implementation, including piloting interventions, testing new and innovative approaches, and monitoring and evaluating the effectiveness and impact of the project, including base and end-line surveys. This component would be managed by DSWD in coordination with CWC.

The objectives of these three components combined, were to contribute to (i) the attainment of human development goals of ensuring child survival and improving child physical and mental development and (ii) establishing an effective partnership between national and local governments.

The components were well related to achieving these objectives. The design benefited from extensive sector work and experiences in the social sectors from other projects in the Philippines as well as from international experience in ECD projects.

3.4 Revised Components:The original components were not revised.

3.5 Quality at Entry:The project pre-dates the introduction of the Quality Assurance Group (QAG) Reviews, so no official Quality as Entry assessment is available. However, the Quality at Entry of the project may be rated as moderately satisfactory.

The project covered the three regions which allowed for the evaluation of a sufficiently large pilot without being too ambitious. The project’s design was based on extensive sector work that had been carried out before project preparation in partnership between the two main financiers and the government. The sector work provided a detailed overview of the issues in ECD, the status of current interventions in the health and education sectors as well as the level of integration, and provided strategic recommendations. Both the sector work and project preparation benefited from stakeholder consultations and external experts.

The project’s implementation arrangements were adapted to the local circumstances. LGUs at the time of preparation of the ECD-project lacked necessary institutional capacity and commitment. The project, therefore, aimed at improving the quality of existing programs and interventions and only adding new services in areas already implementing ECD services.

An evaluation and research component was also built into the project design to ensure continued learning during project implementation and to help demonstrate and document key lessons learned to guide future developments of the Program.

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On the other hand, while a detailed Project Implementation Plan had been prepared to guide implementation, arrangements for implementation, such as establishment of project management teams, procurement bidding documents (due to delays in contracting of procurement functions to an international private procurement agency) and financial management arrangements had not been finalized by appraisal and delayed project effectiveness. As a result, the project took a long time to take off; actual implementation started effectively after the first 18 months.

Although the risks were appropriately identified at the design stage, the risk rating was under-estimated. The risk associated with the changes in leadership and commitment to program implementation was rated as low at the design stage. In hindsight, political considerations were not sufficiently taken into account in the design of institutional arrangements. Constant changes in leadership were at the root of problems encountered in the initial years of project implementation and responsible for long delays. Political commitment to the project however was very strong. The coordination of ECD activities was however divided between DSWD and CWC and leadership and management issues were not clearly defined early on. CWC had the mandate for national ECD Program while DSWD was the lead agency for the ECD Project.

On the whole, while the project concept, the rationale, the design and objectives all were appropriate since implementation arrangements were not finalized and did delay effectiveness, the quality at entry is rated as moderately satisfactory.

4. Achievement of Objective and Outputs

4.1 Outcome/achievement of objective:Achievement of the overall objective is rated satisfactory.

The results reported in this section are based on several sources: project’s monitoring data, the findings of a longitudinal impact evaluation study as well as the specific studies and assessments undertaken during project implementation. The key performance indicators of the project are monitored by comparing the baseline and endline survey results. In addition, results of the impact-evaluation study using longitudinal data over three rounds over three years ending late 2003 in randomly selected households in two treatment (Region VI and VII) and one control area (Region VII) are used to show impact of exposure to ECD programs on key indicators where appropriate.

The overall aim of the project of contributing to the attainment of human development goals of ensuring child survival and improving child physical and mental development was achieved. In addition, accessibility to services crucial to the survival of children and the promotion of physical and mental development increased as a result of the project. Measures of achievement of the program/project development objectives include (see Table below): a) Reduction in under five mortality rates in project areas - since the Demographic Health Survey 2003 was not representative at the regional level it was difficult to estimate the exact reduction - national level data however shows 16.7% reduction overall and there is evidence that in the project regions the reduction is even higher;b) 53 % decrease in the proportion of children under 6 years old with anemia; c) 59% reduction in malnutrition among under-seven children; d) increase in proportion of children 12-18 months old who are fully immunized to 92%; e) improved gross motor skills among children under 6 years old; andf) increased completion rate of Grade 1 to 89% of Grade 1 entrants.

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Key Performance Indicators Outcomes

Indicators Baseline

2001* End of Project Achievement Data source

1. Reduction by 30% of under-five mortality rate from the baseline

48/1000 (1998 )

40/ 1000 (2003)

16.7% reduction<30% target

National Level data (NDHS)

(No regional level data available to measure achievement)

2. Reduction by 30% of children under six with anemia from the baseline value 34.4 15.9

Achieved 53%reduction Baseline; Endline

3. Reduction by 40% in proportion under six with Grade 2 or 3 wasting from the baseline value (acute malnutrition) FNRI: 6.2 2.2 Achieved NCHS, FNRI; Endline

NCHS:5.4

59% (NCHS) 64% (FNRI)reduction

4. Increase to 90% in proportion of children aged 12-18 mos. fully immunized from baseline 80.1 91.6 Achieved 5. Improvement in a combined index of child development (motor and cognitive skills) among children

Proportion of children with below average gross motor development

Program area: 11.0

1 yr exposure in program area:4.6**

Gross motor: Significant impact Longitudinal Study

Control

area: 13.0 2 yrs

exposure:8.5**

Proportion of children with below average cognitive development

Program area:0.7

1 yr. exposure in program area: 1.0

Cognitive: No Significant impact

Control area:1.8

2 yrs. Exposure: -0.4

6. Increase in completion rate for Grade 1 to 70% 58 89 Achieved DepEd 2005 data

** Statistically significant improvement between program and control areas

The corollary goal of the project and the 10-year national ECD-plan of the GOP, the establishment of effective partnerships between national and local governments for the provision of ECD-services have

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been fully met. ECD-programs and services increased in the participating municipalities and there is indication that spending for such services also increased in a number of municipalities. Achievements in project outputs in targeted LGUs include:a) increase in the proportion of children aged 3-5 years old attending day care centers in target municipalities from 27.4% to 75%; b) establishment of functioning protein-energy malnutrition (PEM) programs in 59.1% for infant feeding and 86.4% for growth monitoring of the target municipalities/cities; c) establishment of active child development workers in 63% of target municipalities/cities; and, d) implementation of ECD sub-projects in 90% of targeted municipalities/cities.

Outputs: Targeted LGU Indicators 7. Increase to 75% in proportion of total children aged three to five in targeted municipalities attending day care centers.

<60% (27.4) 75% Achieved

2005 monitoring data

8. Establishment of functional PEM-programs in 50% of municipalities/cities. a. growth monitoring 86.4 Achieved Endline Survey b. Infant feeding 59.1 Achieved

9. Establishment of active CDW in 50% of municipalities/cities. 63% Achieved Endline Survey 10. Implementation of ECD subprojects in 90% of targeted municipalities. 90% Achieved

2005 monitoring data

In addition, as the project targeted poor and disadvantaged families and children and prioritized poorer provinces, municipalities and barangays. As such, access to ECD services improved for vulnerable groups. In particular, access to services for indigenous peoples in the project regions was specifically monitored and was found to have improved as a result of the project.

As shown above the project achieved almost all of its stated objectives. Thus, the achievement of the development objective is rated as satisfactory.

4.2 Outputs by components:Component I(A): Early Child Development Service Delivery– Moderately Satisfactory

The first component consisted of the implementation of 5 ECD-programs at the Barangay level. The Immunization (EPI) program (moderately satisfactory) aimed at enhancing the efficiency and effectiveness of EPI by infusing additional financial and technical resources at provincial, municipal and Barangay levels. In particular the project would replace old equipment, where needed, improve maintenance of existing cold-chain equipment and provide additional training to rural health midwives.

Inputs: In Region VI (the World Bank supported region) the proportion of LGUs with functional cold chain equipment increased from 65% in 2000 to 91% in 2004. Region VII showed no increase, while in region XII there was an increase from 63% to 84%. Cold-chain management improved and by 2004, 83% of the district health facilities had functional cold chain management. Training in EPI-Cold Chain management accompanied the replacement and improved maintenance activities; by 2004, 90% of

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health service providers were trained. However only 20 percent of rural midwives in Region VI (a key sub-group of health service providers for the project) and 50% of those in Region VII, interviewed in the longitudinal study, reported having received this training by 2004.

Results: By round three of the impact evaluation, 89 percent of children 1 to 2 years of age in Region VI and 88 percent in Region VII were fully immunized. Although this is not higher than in earlier rounds, it is 12 percentage-points higher than the immunization rate among this age-group in the control area. Endline survey results show that 92% of children in project areas were fully immunized compared with 80% at baseline thus achieving the project target.

Constraints and facilitating factors: Insufficient travel budget for regional and provincial health teams led to inadequate monitoring and supervision of frontline providers at the Barangay level raising service-quality concerns. Logistics for the delivery of vaccines were poorly managed. Despite sufficient supply, at the local level, vaccines arrived late and sometimes were near-expiration. These problems were particularly acute in remote and difficult to access areas. Serious delays in updating the information on the need for vaccine-carriers resulted in inadequate forecasting and poor supply chain management. In 2005, after consultations on these constraints, the government initiated the “Reaching Every Barangay” program which aims at improving the EPI-program by defining catchment areas for midwifes, clear performance goals and assuring better transport. Later in the project, these adjustments appear to show positive results.

The IMCI-program (moderately satisfactory) aimed at improving the diagnosis, management and treatment of common childhood conditions such as malaria, pneumonia, diarrhea, dengue and tuberculosis. In addition to the training for rural health workers, IMCI-booklets, recording forms, drugs and equipment were provided.

Inputs: In 2004, 65% of the 330 rural health units/city health offices, covered under the project, had at least 60% of staff trained in IMCI. Community based health and nutrition workers were also trained in IMCI but this training started late in the project which explains the low achievement to date, 16% of all local health and nutrition workers were trained, except in Region VI where 67% were trained. There was however strong support from local Barangay officials for this training and as a result a large number of Barangay Health and Nutrition Posts are currently functional.

Results: This program has had mixed results. The impact-evaluation study found positive trends in reduction in wasting and the proportion of children with worms among the younger age groups (children under three), but for the older-age groups the results were mixed. The study also showed a positive trend in the reduction in the proportion of children suffering from diarrhea among young children, but not in the older-age groups. The study also found significant differences in the quality of services delivered by providers between program and non-program areas. In program-areas providers were more likely to make referrals, counsel clients, monitor new cases and perform follow-up home visits.

Constraints and facilitating factors: Factors that negatively affected the implementation of this program are the long duration of the training courses provided. Training in IMCI takes on average three weeks and supervisors were found to be reluctant to allow staff to stay away from their jobs for such long periods. There was insufficient funding for these training programs and in Regions VII and XII the number of hospitals accredited to conduct such training was also limited. In addition, in some cases, doctors’ refusal of referrals from mid-wives trained in IMCI was perceived as a de-motivating factor. While non-availability of IMCI-protocol and inadequate supply of drugs remained a constraint, the

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construction of additional health centers and related increased availability of supplies contributed to an overall improvement in access and use.

The Nutrition programs (PEM, Micronutrient supplementation and Food fortification) (moderately satisfactory) aimed at reducing the rate of malnutrition, both under-nutrition and micronutrient malnutrition, among children under the age of four.

Inputs: While the supplementary feeding-programs aimed at reducing underweight, the growth-promotion activities aimed at preventing and reducing the risk of malnutrition by (i) monitoring children’s weight to enable early detection of growth faltering and (ii) counseling mothers and caretakers. Both feeding programs (wet feeding where the child is fed on-site in a center-based setting and dry feeding where a take-home ration is administered at home) were underutilized. Only 28 percent of underweight children benefited from the wet feeding and 10 percent from dry feeding by project closing. Participation in growth promotion program decreased slightly during project implementation (from 100% coverage in project LGUs to 86%),and there were serious quality concerns with regard to messages and materials provided, as well as the adequacy of time provided for counseling mothers and care-takers. Vitamin A supplementation of children between 11 and 59 months increased, but did so in both program and non-program areas - it is therefore difficult to attribute this gain to the program. The project monitoring data shows about 75% of children were provided Vitamin A supplementation, compared with 85% coverage necessary for effective reduction in child mortality rates. The percentage of mothers receiving vitamin A within a month after delivery too increased from 47.3% in 2002 to 73.6% by 2005, with the largest improvement in Region VI which increased coverage from 0.5% to 60.2% during this period. Vitamin A is provided to mothers after delivery to boost the infant’s Vitamin A intake through breast-milk. Iron-supplementation for children under four years of age increased more in the program areas than in the non-program areas between the first and last rounds of the surveys. In Region VI supplementation of this age-group increased from 15 to 22 percent, in Region VII it increased from 6 to 33 percent. Iron supplementation for pregnant women remained fairly stagnant at the initial 50% level in all three regions, with minor increases in region VI and VII. The food fortification program was aimed at improving the sustainability of the micronutrient deficiency programs. The DOH requires and provides food-producers with a “Sangkap Pinoy” seal for food that are fortified with iron, vitamin A and iodine. Although more vendors sold products with the seal in 2004, the consumption of these food products in the program areas did not vary significantly between the rounds of the longitudinal study. Some products were consumed more often, some less often; there are no clear trends to be detected that can be explained.

Results: Positive results were found for acute malnutrition (weight for height) but negative results were found for chronic malnutrition. Sustainability concerns arise with regards to feeding programs. While acute malnutrition, if related to acute food shortages or frequent bouts of diarrhea and infections, can be temporarily improved with extra feeding, chronic malnutrition requires behavior change in breastfeeding and weaning practices. The program significantly reduced the proportion of anemic children and those with low hemoglobin counts especially in poor municipalities. In these areas, anemia among children in progam areas declined from 26% to 8%. In poor non-program areas, the decline was less steep from 34 to 16%. Additionally, the adoption and subsequent application of the ASIN law (Republic Act No 8172 was passed in 1995 promoting salt iodization nationwide and DOH launched a major national campaign to implement the Law in 2002) has been successful. In 2004 85% of households used iodized salt. In Region VI, the increase has been most impressive, from 22% in 2000 to 89% in 2004. In this region, all LGUs complied with a local ordinance on iodized salt. All three regions also saw a substantial increase in vendors of salt that tested positive for iodine content, the availability reaching 91% in the three

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regions in 2004.

Constraints and facilitating factors: Awareness and training provided under the project contributed positively to the program. Barangay health and nutrition workers in program areas were more likely to conduct home-visits and dispense nutritional supplements according to the results of the impact-evaluation. The advocacy and strong communications program around iodized salt had a very positive influence in creating awareness. At Phase 3 of the longitudinal survey, it was found that a considerable number of households in project areas (a third in Region VII) that were using iodized salts were not even aware they were doing so, suggesting a very high level of vendor compliance. November 7 has been designated as the national food fortification day in Philippines. Delays in the development of the materials, pre-testing and training however reduced the impact of this component but it is likely to show benefits beyond the project period.

The ECD-programs (satisfactory), the child-minding program, child day-care program and the Grade-1 enrollment program were aimed at enhancing the cognitive and psycho-social development of children. Mothers and caretakers were encouraged to let their children participate in these programs.

Inputs: The child-day-care program was administered in day-care centers at the Barangay level for children ages 3 to 5. A total of 90 percent of the Barangays had a day-care center by the end of the project. According to the monitoring data, in Region VI, participation increased from 32% in 2000 to 52% in 2004, while there was hardly a minimal increase in Region VII (from 35% in 2000 to 38% in 2004). The Department of Education (DepEd) trained more Grade-1 teachers than projected (by 10%) on the 8th Week Curriculum. The Early Childhood Care and Development (ECCD)-checklist was developed in 2004. Almost half of the targeted providers were trained in the use of the checklist and in 2005, 23% of children were assessed. There is no data on the assessments themselves or how children rank. The Parent Effectiveness Service (PES) Program was aimed at improving parent’s active participation in ECD-programs. By the end of the project, almost 80% of the targeted providers (Municipal Social Welfare Development Officers, child development workers, Day-care workers) were trained in PES. More than 100,000 parents attended at least four of the 8 modules of PES, but only few of the fathers attended. There is no data on the total target group of parents or on how many parents dropped out after attending fewer than four modules.

Results: The findings from the impact-evaluation study suggest positive impact from the programs and an increase in impact (willingness to attend PES workshop) with increased duration of the program. Psycho-social, and gross motor development among children less than 4 years of age at the time of the survey improved significantly in program areas. Younger children exhibited faster improvement in psycho-social development than older children. Among two and three year olds that were exposed to the program, Z-scores were higher by one half to 1.8 standard deviations for motor and language development. The impact of the grade-1-enrollement program was also positive. According to the Department of Education, a base-line assessment found 50% of children were not ready for Grade I at the appropriate age for entry to school. After the 8-week school readiness curriculum, 80% of those children formerly not ready were found to be ready for Grade I.

Constraints and facilitating factors: The child-minding program and supervised neighborhood play catered to children under the age of 3 whose mothers work away from home. These services were uncommon before the project and for the child minding program, participation levels remained low during the project life. Unfamiliarity with the concept, having to pay fees for the service as well as the availability of the choice of leaving the child with family members were given as explanations for the lack of uptake in many areas. It did work well in one area Carmen, a very poor resettlement area where

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the neighborhood got organized around the children’s neighborhood play. The quality of the daycare improved with the revised day-care manual and upgrading of many of the facilities; some anecdotal information include parents’ satisfaction with the improved safety of day-care centers as they are now built further away from the main road. Grade I teachers reported very positive improvements in skills and competencies of Grade I pupils thanks to their (the teacher’s) better training as well as better and more educational materials. A large percentage of these children also had prior ECD-experience in the day-care, child-minding and preschools. A Save the Children Fund (USA) study found them better prepared for Grade I than those children that had not attended any ECD-setting before starting Grade I. Parents participating in the PES were mainly the mothers and commented that the time of the meetings interfered with their daily work.

Although the ECD-programs were satisfactorily implemented and show positive results, the basic health and nutrition programs were only moderately satisfactory. Combining these two ratings, the first component is rated moderately satisfactory.

Component I(B): Financing Facility for LGUs - Satisfactory

The financing facility for LGUs provided matching funds for LGUs wishing to invest in upgrading their ECD-services through a flexible cost-sharing scheme based on LGU income levels but with full funding (by LGUs) of major recurrent costs.

Inputs: By December 2004, 7941 Barangays in 320 LGUs with a total population of 12.5 million or 2.3 million households were covered under the program in the three regions (VI, VII and XII). Of the 320 LGUs, 132 received LGUFF grants in 2005, which accounts for 100% of what was projected based on income-levels and needs. LGUFF grants were provided on a progressive basis depending on LGU-income status. A total of 933 new day care centers were constructed and 924 repaired while 245 new Barangay Health posts were constructed and 498 rehabilitated. ECD-resources centers at the municipal level, part of the overall improved ECD-package were established in most municipalities. These resource centers provide materials to day care workers, showcase new materials and are used as centers for capacity building such as training of health and nutrition workers and other service providers as well as organizing seminars and other targeted information sessions for local politicians, mayors etc.. Results: There has been a substantial increase in ECD-services in program areas. Between 2002 and 2004, the proportion of municipalities implementing feeding-programs increased in the program areas from 32% to 70%, while in non-program areas it only increased form 28% to 39%. PES-programs were implemented in 100% of the municipalities in program-areas, up from 77% in 2002. There was no increase in the non-program areas, rather a decrease from 68 to 63%. Home-based day care increased from 16 to 44% in the program areas - despite earlier mentioned limited demand for this program. It is almost non-existent in non-program areas. The project has also been successful in improving the capacity of ECD-providers through regular training and provision of updated and new materials. The impact-evaluation study shows that by the third round of the survey, midwives and day-care providers in the program areas were substantially more likely than providers in non-program areas to have received training in parent education (PES-program), management of childhood illness (IMCI) and growth monitoring. Barangay health workers were also more likely to have received training, but only on ECD topics and not on health topics, in comparison to other health providers.

Constraints and facilitating factors: A wide-spread communication campaign advocated that the ‘sky was the limit”, and that there was no ceiling to the amount of matching funds available to LGUs under this cost sharing scheme. However, given budget limitations, soon after the campaign, a ceiling of PhP5

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million was introduced on the loan funds made available to each LGU. This dampened the enthusiasm but not to the extent that LGUs were no longer interested.

As mentioned earlier, not all ECD services introduced under the project were in demand and this is reflected in the investments made by LGUs. Few municipalities invested in the daycare-mother package, while almost all included the rural midwife package. While there was some demand for nutrition programs, it was not as much as that for the micronutrient packages. The ECD-resource centers while highly demanded by the users i.e., the day-care workers, they were less frequently utilized in remote areas as the fees charged for late-return of borrowed materials were high.

Component II: Institutional Development / Support to Service Delivery –Satisfactory

The advocacy activities which focused on raising awareness about the program and ensuring commitment from the local government to support the ECD-programs and improvement of the ECD-packages in their locality were very successful. Almost all LGUs responded positively to improving ECD-services and a large number increased spending on ECD programs. All LGUs took advantage of the capacity building efforts – they recruited day-care workers and enrolled rural health midwives and Barangay health and nutrition workers in the training programs offered.

The communications activities had mixed results. A new initiative “Bright Child” was developed as a unifying brand to promote and pursue the integrated delivery of ECCD-programs and services. The introduction of this package to local governments beyond the pilot areas to achieve national coverage was a strong and positive output of the component. The communications program also included many creative elements aimed at creating awareness and sustaining attention. Worth mentioning among these are: publications, web-pages with success-stories, ECD-Best practice workshops, and exhibits of the program at the Philippine Legislative Action Committee for Children, radio and television spots and guest talks on television.

Although the communications component of the nutrition package in component I, also included the development of materials as well as training on interpersonal counseling for the rural midwife and health and nutrition workers, the implementation was very weak. It thus contributed to the limited impact the program had on the nutrition and child physical growth outcomes. As discussed above, the training of providers’ however was satisfactory.

The institutional development of the CWC as an APEX agency was satisfactory. The agency was instrumental in the development and adoption of a series of laws and recommendations to the government that aimed at expanding ECD-services, enhancing quality and ensuring sustainability. The complete list of laws and recommendations adopted during the project is listed in Annex 8. In addition to central level advocacy and policy work, the agency was successful in creating awareness about early childhood issues, the potential negative consequences of failing to focus on early childhood development and in creating demand for ECD services at the local level. A series of workshops were conducted at LGU-level aimed at formulating the local development plans for children (LDPC) and the local investment plans for children (LIPC). A large percent of the local development plans of the LGUs include ECD-interventions and have identified ECD as a development priority.

Based on the individual ratings for these three sub-components, component II is rated satisfactory.

Component III: Research and Development - Satisfactory

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The pilots, studies and operational research component’s aim was to test the project interventions in various settings; develop new and innovative approaches to improve delivery and generate continuing data and information for improved planning, management and evaluation. In addition, a corollary objective of this component was to institutionalize the process of research utilization and information through a web-site. The Council for the Welfare of Children (CWC) undertook these activities. An impressive number of studies (13 in all) was undertaken to evaluate the project activities and the innovative approaches (complete list of studies included in Annex 8 of this ICR). Although the quality of the studies is varied, considerable effort was put into undertaking these studies and disseminating the results. As such, this component merits a satisfactory rating. The results of these studies were not only used for evaluation purposes, but helped guide improvement in ECD interventions (see Table 1 in section 10) and thus increased their effectiveness and helped build capacity for evidence-based policy making. For instance, a cost -effectiveness analysis showed that cost-savings could be incurred through investing in weekly iron supplementation without deworming to effectively prevent mild anemia. This finding formed the basis of the DOH policy, which subsequently introduced weekly iron supplementation into the regular DOH program, under the DOH Administrative Order No.119 series 2003.

It should also be noted that, the Philippines ECD-project was among the first in the World Bank to field a rigorous impact study measuring impact of ECD-activities in a program setting which has had positive externalities for ECD- programs in the region and worldwide.

The Monitoring &Evaluation component is rated moderately satisfactory. Although the monitoring system of the project was well designed, it focused too much on inputs monitoring and less on output monitoring and the implementation of the system was very poor until 18 months before project closing. For much of the duration of the project, monitoring data was not available on time and there was little analysis or follow up to guide supervision and improve service delivery quality. This sub-component is however rated moderately and not fully unsatisfactory because in the last 18 months of the project supervision, monitoring did improve and the evaluation part of the M&E system, as discussed above, was satisfactory. It has to be recognized, as mentioned earlier, that given this project was the first to include a rigorous impact evaluation, much of the attention was focused on the evaluation, which may have led to less attention being provided to monitoring of outputs.

On the whole, this component is rated satisfactory.

4.3 Net Present Value/Economic rate of return:During preparation, cost-effectiveness and cost-benefit analyses were carried out. The results of these studies indicated that the delivery of health, nutrition and early education inputs from this project would be highly cost-effective and combined in ways that strengthen the links between child health, education and economic returns. Investing in health and education of children increases a country’s overall standard of living by building human resources that generate higher economic returns, reduce social costs and increase efficiency of other investments. For health and nutrition interventions, the net present value of wage gains for children benefiting from the project was expected to increase from 9 billion pesos to 30 billion pesos. Early childhood development interventions were also to improve school attendance and performance and increase children’s prospects for higher productivity and future income. The economic rate of return calculated during preparation for this project’s ECD interventions was estimated at a minimum of 15%.

No overall ERR or net present value calculations were carried out at the end of the project but it can be argued that there will be economic gains from the ECD-investments and, despite late start and slow

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progress, to some extent from the health and nutrition investments.

More specific cost-effectiveness studies were carried out during the life of the project. One study was on the cost-effectiveness of combining deworming and weekly iron-supplementation in the reduction of anemia among pre-schoolers. Anemia among pre-schoolers reduces attention span and education attainment and would reduce effectiveness of investments in education. The null hypothesis was that the combined strategy of deworming (high worm loads cause and worsen anemia) and iron-supplementation would have a higher impact than solely supplementing with iron. The study however showed that the combined strategy did not have a higher impact on reducing anemia. The results were consistent with results reported elsewhere, as the low prevalence and intensity of soil-transmitted helminthiases, particularly hookworm infection, meant that the contribution to anemia among pre-schoolers was minimal. Deworming is not an effective intervention in reducing anemia, unless there is moderate to severe hookworm infection. Most importantly, however, the cost -effectiveness analysis showed that cost-savings could be incurred through investing in weekly iron supplementation without deworming to effectively prevent mild anemia. This finding formed the basis of the DOH policy, which subsequently introduced weekly iron supplementation into the regular DOH program, under the DOH Administrative Order No.119 series 2003.

In addition, an action research found that the iron-fortified product Pandesal did reduce mild anemia levels among children, but did not have additional benefits when fortified with both iron and vitamin A. Although the study recommended the use of the least costly iron-fortificant, the study could have been improved by using the estimated positive impact of fortification on measures of nutritional status and the costs associated with fortification in order to compute benefit-cost ratios for each type of fortification. The study did, however, mention apparent secondary outcomes of the trial, such as positive changes in school attendance rates.

4.4 Financial rate of return:Not estimated.

4.5 Institutional development impact:The project had a substantial impact on institutional development. After many years of building institutional changes, government officials finally agreed on the current institutional set up (whereby policy-making is a CWC responsibility and implementation of ECD a DSWD one). There are also other important signs that the program will continue to become more effective and efficient. The policy and program environment has been enhanced considerably during project implementation. For example the adoptions of “CHILD 21” - the national framework for the Development of Children - and its accompanying National Plan of Action for Children 2005-2010 are two important policy developments. Another major accomplishment is the effective integration of services for children in Child 21 – integrating health, education, nutrition and psycho-social development in one package with (now) clear leadership at high political levels. A number of Executive Orders give direction to National Government Agencies to actively support and implement ECD-programs. The capacity of the Council for Welfare of Children (CWC) was also strengthened over the life of the project.

Many gains in institutional development have been made at the local government levels in terms of planning and implementation capacity. Advocacy workshops and the continued involvement of three Regional Sub-Committees for the Welfare of Children contributed to awareness creation and the development of investment plans for ECD-interventions. Regional Sub-Committees for the Welfare of Children (RSCWC) and local ECCD Coordinating Committees were instituted at the decentralized levels. To date almost all LGUs have developed ECD-investment plans and some have already been

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adopted by the local councils.

The Commission on Higher Education has approved the inclusion of the 8-week ECE curriculum in its course offerings for Bachelor of Elementary Education major in Preschool Education. Also the parent effectiveness program and the micronutrient food-fortification program have been mainstreamed by the implementing agencies.

5. Major Factors Affecting Implementation and Outcome

5.1 Factors outside the control of government or implementing agency:There were no factors outside the control of government or implementing agency that affected the implementation and outcome of this project.

5.2 Factors generally subject to government control:

Ø Very strong political commitment had a positive effect on project activities. The highest levels of government were supportive of the program and project management had easy access to these high level officials which helped ensure sustainability and institutional development. Ø The government invested in a rigorous evaluation of the ECD program to help inform future program design and interventions.Ø During the last stage of project preparation, the newly elected government changed the lead agency from Department of Health (DOH) to Department Social Welfare and Development (DSWD). This decision was in hindsight good, given capacity, commitment and the importance of integration of services. However, implementation of this change was inadequate; little attention was given to resultant problems in the relationship between the two agencies, despite these being fairly clear right from the start. Ø The lack of clarity in institutional issues, leadership roles and management was at the root of many of the problems in first half of implementation. Only after the MTR, were these roles clearly defined, a new institutional set-up was established and effective implementation of project activities began. Firm action by government early on could have avoided this delay.

5.3 Factors generally subject to implementing agency control:Ø A very strong advocacy and communications program was successful in convincing almost all targeted LGUs (which in Philippines are autonomous government units with the mandate to implement social services) to increase their investments in ECD-programs. Ø During implementation, the project management unit was transformed from an independent unit to an organic unit within DSWD to improve collaboration and coordination between the implementing agencies. This ensured long term sustainability of project interventions.Ø During the first two years of implementation, the project management unit had little understanding of Bank procurement procedures and took time to educate its personnel on these. Ø Project monitoring was inadequately managed and there was very little effort to use regular monitoring data for program improvement.

5.4 Costs and financing:The total cost of this project was US$58.8 million and the credit financed US$19 million. The project was financed in parallel by the Asian Development Bank with a credit of US$ 21.7 million. During the life of the project there was one re-allocation of US$1.14 million on August 22, 2003. Ninety one percent of the credit was disbursed and the latest estimates of expenditures are provided in Annex 2. A total of US$1,683,930 was cancelled on April 3, 2006. A PHRD grant for US$ 830,000 was used to prepare the project. In addition, 97% of the 21.7 million ADB loan was disbursed.

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The PAD anticipated an implementation period of five and a half years and the project was completed in 6 years. The project became effective on September 28, 1998 and was closed, after an 11-month extension on November 30, 2005. At the Original Closing date of December 31, 2004, a total of US$ 14,808,454.74 was disbursed. The extension was granted on the grounds of: (a) slowing down of activities of the Local Government Units due to the upcoming election; (b) lack of appropriation cover to finance the planned activities due to insufficient allocation in the national budget for the increase in disbursement under the ECD-project; and, (c) the need for conducting the End-line Indicators Survey after all the interventions/inputs were fully implemented.

6. Sustainability

6.1 Rationale for sustainability rating:Institutional sustainability is likely. This rating is based on the institutional capacity that was built and the strong political support for project interventions to continue beyond the project period. In 2002, the government institutionalized the program by legislating the Early Child Care and Development (ECCD) Act, which established the governance structures and delivery systems for ECD interventions targeted to children between 0 and 6 years of age. The Council of Welfare of Children (CWC) was created as the highest policy making body. The DWSD remains the highest level implementing body. Although the government indicated it no longer wanted to borrow from the IBRD, it has allocated substantial resources to the continuation of the program through a Php2 billion funding from the Philippine Amusement and Games Corp. (PAGCOR) or Php400 million every year for the next five years.

Financial sustainability is likely. The setting aside of funds for ECD activities at the local government level and the fact that LGU have co-financed in large part the services add to the likelihood of continued financial sustainability of project-supported interventions. At the central level, financing continues to use off-budget resources making it less sustainable. CWC however, is well placed to provide strong advocacy for the program and has already been successful in securing funding for the program.

Operational sustainability is likely. A large number of LGUs continue to support the ECD-programs they have implemented and improved during the project period. The Department of Education has adopted the Grade 1 8-week curriculum nationwide. Advocacy and communications are well prepared and there is no indication that this would be discontinued after project closing. In fact, the closing of the project has boosted the enthusiasm of the implementing agencies to continue the activities and to take on more responsibility.

The ECD project’s prospect for sustainability is rated as likely based on the above three assessments of institutional, financial and operational sustainability.

6.2 Transition arrangement to regular operations:Although discussions had started with the World Bank to prepare a second ECD operation the Government of the Philippines did not request another loan. Instead provisions were made to continue financing the ECD activities using off-budget national funding from various sources, including, the proceeds of the gambling tax.

Although the likelihood that activities will continue without World Bank support is high, it is uncertain whether the much needed improvements in the quality of the services, particularly in the area of nutrition, will be achieved. Too little attention has been given to this problem and chronic malnutrition

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rates in the Philippines is increasing. Chronic malnutrition among young children has life-long negative consequences and will reduce any gains made from other ECD-interventions if more is not done to prevent and reduce this risk. Continued engagement with the Government of the Philippines on this issue is warranted.

7. Bank and Borrower Performance

Bank7.1 Lending:

The project requested by the Government of the Philippines was in line with the Philippines ECD strategy and the World Bank’s strategy as laid out in the 1998-CAS document. Sector work conducted before the project preparation was instrumental in guiding the national ECD-program design and ensured the alignment of GOP and Bank project design features and rationale for the project. The collaboration between the two financers, the Asian Development Bank and the World Bank, was satisfactory during preparation. The preparation was comprehensive, included teams with the appropriate skill mix, took into consideration the recommendations of the sector work. However, while the Project Implementation Plan was prepared, established of project management teams, financial management arrangements, procurement bidding documents and baseline survey design were not finalized delaying effectiveness. The political environment and the weak institutional capacity were recognized as problematic and addressed during preparation with additional missions and focused missions with specific goals, but were insufficiently recognized as risk during implementation. The Bank performance during preparation is rated moderately satisfactory

7.2 Supervision:The Bank supervision can be rated as moderately unsatisfactory in the early years of project implementation. An untimely death of the Task Team Leader (TTL), led to an interim arrangement in task management and this did affect the Bank’s ability to respond to the project’s needs on a timely basis for a short period. Once a regular TTL was assigned and effort was put into on improving the Bank’s human development portfolio, supervision improved. The Bank supervision in the following years can be rated as satisfactory.

Implementation reviews were, on average, undertaken at least every six months and occasionally more frequently. These were organized in close collaboration with the government. The Mid Term Review and several supervision missions were conducted jointly with the ADB. The skill mix of the Bank team for supervision was appropriate and included staff from DEC’s research group given the strong impact evaluation component. The teams also kept regular and close contact with the project implementers between supervisions. Management attention to the project was satisfactory during the life of the project and appropriate attention was given to follow up with government.

The write ups in PSRs and ISR, as well as in BTO were candid and clear. Given the candor the ratings may appear at times to be too positive. However, this may be more a reflection of the limited choices the task team has in ratings (either satisfactory or not, no rating for moderately satisfactory) than candor in ratings. Given this limitation, the ratings were appropriately reported.

7.3 Overall Bank performance:Overall Bank performance was moderately satisfactory.

Borrower7.4 Preparation:

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During preparation, Borrower’s performance was moderately satisfactory. The Department of Health, mandated with the preparation of the project, did not show sufficient leadership. Leadership was handed over to the Department for Welfare and Social Development only during the last stages of preparation. The latter decision was taken after a government change and only then was the speed of preparation picked up. In all, it took several years to prepare this investment operation.

7.5 Government implementation performance:The performance during implementation can be rated as unsatisfactory until late 2000 and satisfactory thereafter. At MTR progress was still weak, several activities had not started and coordination among the implementing entities was very weak. There were serious capacity problems in financial management and procurement and a lack of interest and counterpart funds. Only 21% of the funds were disbursed at the mid-term. At MTR, the government recognized these problems and took into account the MTR recommendations. It made significant changes to the institutional set-up of the management unit, and clarified the roles and responsibilities of the various ministries to improve coordination. Since then, counterpart funding was never flagged as a problem.

7.6 Implementing Agency:The implementing agency performance was unsatisfactory until late 2000 and satisfactory thereafter. The unit was weak to start with and lacked basic understanding of Bank procurement and financial management procedures. In hindsight, the fact that the ADB and the World Bank had different procedures added to the complexity. After MTR, the unit was placed within the organic administrative structure of DSWD and its capacity improved with the training in procurement and financial management procedures.

7.7 Overall Borrower performance:Overall borrower performance is rated moderately satisfactory.

8. Lessons Learned

In addition to more well-known lessons learned comparable operations such as the need for local level involvement, strategic communications development early in project and the importance of integrating services, this operation provides other interesting lessons such as:

Ø Focusing on nutrition within an ECD program. The project had a fairly large nutrition component and three of its key performance indicators were dependent on effective implementation of that component. The lead implementing agency DSWD however did not have improving nutrition in its own mandate. Was addressing nutrition through an ECD-project a good decision on hindsight?

o The answer is probably yes for selected interventions. While little impact was achieved on chronic nutrition indicators, acute malnutrition did improve and the micronutrient supplementation program and the food-fortification program performed well and showed positive results, except for iron-deficiency anemia.

o Nutrition programs that focus on behavior change and child growth promotion are best placed at the community-level. The ECD-program was implemented at the local level and strengthened local health provider’s knowledge on nutrition contributing to creating awareness and addressing the problem more effectively. To achieve effective reductions in chronic malnutrition require improving counseling for behavior change. With stronger coordination, this too could have been achieved.

Ø Value added of a strong evaluation of the ECD program in addition to regular

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monitoring. The strength of the project was the rigorous impact-evaluation conducted in a program setting as well as the various studies, pilots and operational research conducted under the project. The results of these studies helped guide improvement in ECD interventions, increased their effectiveness and helped build capacity for evidence-based policy making.

Ø Use of baseline surveys: The project had a baseline survey provide the baseline indicators for measuring project impact (through the longitudinal data study) as well as monitors changes in access to services with increased availability comparing baseline and endline survey results.

Ø Choice of lead agency in a multi-sectoral operation. Here the responsibility for the overall ECD program was with DSWD, despite the fact that about 80% of project activities fell under the implementation responsibility of DOH. This provides the following lessons:

o Need for strong collaboration between implementing agencies is key for the success of a cross-sectoral program. This decision to have DSWD as lead agency was right on hindsight but the execution of the decision and the resultant problems in collaboration could have been dealt with more effectively.

o In an institutional set-up requiring a high level of attention to coordination, strong capacity and leadership is crucial.

o An innovative program in an environment where there is no designated natural home (ECD in this case) can be successful, but building institutions and commitment takes time and sustained commitment.

Ø Scope of ECD services: LGUs at the time of preparation of the ECD-project lacked necessary institutional capacity and commitment. The project, therefore, aimed at improving the quality of existing programs and interventions and only adding new services in areas already implementing ECD services.

Ø Use of matching grants to encourage local government financing of ECD services was effective and provides a good example and the following lessons for other operations and countries:

o Strong community participation and support (financial and political) from local leaders determines success of any community-based program.

o Strong ownership built with advocacy around the matching grants component helped strengthen local commitment.

o Ceilings for matching grants need to be set up-front in order to avoid unsustainable financial needs or expectations.

Ø The combination of legislation and IEC was successful. The adoption of the Salt-I Law together with the strong IEC-campaign made an importance difference in producer compliance of salt-iodization and increased awareness and consumption at the household level.

Ø Embedding of the project management office within the organic structure of the lead implementing agency ensured institutionalization of project interventions and obliterated the need for transition arrangements to regular operations as is often required for investment projects.

Ø Value-added of joint but parallel financed operations with other development agencies: As a joint operation between ADB and the World Bank, the collaboration was effective and had value during preparation. The sector-work and technical discussions succeeded in convincing government of the need for and economic value of ECD services. However, during implementation

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there was little value added. Both agencies used different procurement guidelines, financial management and reporting mechanisms. The activities and regions were clearly divided and there was little effective collaboration. The financing arrangement added complexity and more work for project management. Harmonization of processes could have simplified project implementation.

9. Partner Comments

(a) Borrower/implementing agency:As a pilot project of the government from September 1998 to November 2005, the Early Childhood Development Project provided integrated services in health, nutrition, psychosocial intervention and early education for disadvantaged children from birth to six years old in Regions VI, VII and XII. About three (3) million children benefited from the service delivery packages of the Project since it started.

The project has successfully put in place human and physical resources that enabled 132 local government units to effectively and efficiently implement ECD programs and services at the community level. A total of 103,525 parents and caregivers and 9,355 service providers have been trained on parent effectiveness service, 8,658 service providers on integrated early childhood services and programs, 6,850 health workers on Integrated Management of Child Illnesses (IMCI), 4,032 health workers on family and community IMCI and 4,468 health workers on the Expanded Program on Immunization. Infrastructure-wise, 498 new barangay health stations (BHS) were constructed with additional 498 BHS upgraded and repaired. In addition, 933 new day care centers (DCC) were constructed and 974 DCC repaired and upgraded as well. Moreover, an ECD Resource Center has been set up in each of the 132 municipalities covered by the Project.

The Project yielded valuable lessons and insights from various studies and surveys that can now be used to improve ECD service delivery. A system for assessing a child’s development status from 0 month to 5 years and 11 months is now in place. It covers the seven domains: gross motor, fine motor, self-help, receptive language, expressive language, cognitive and socio-emotional. Likewise, measures to determine the school readiness of 6 years old children entering primary education have been operative beginning school year 2005-2006. Local development and investment plans for children are making headway in most of the local government units. At project end,13 provincial and 132 municipal LGUs in the three project regions have these plans in place.

To sustain and institutionalize the gains of the ECD Project and thereby ensuring the achievement of long-term impacts on the Filipino child, the Early Childhood Care and Development Law (Republic Act 8980) is now being implemented in all the 17 regions covering 73 (out of 79) provinces to date. President Gloria Macapagal Arroyo had also signed Executive Order No. 286 series of 2004 calling for a multi-sectoral and inter-agency action in support to the Bright Child Program, now serving as a unifying symbol of the holistic programs for children and Executive Order No. 349 series of 2005 incorporating pre-school in the education ladder as bridging program for five year olds thus, strengthen the early child education program of the Department of Education.

Evaluation of Bank's Performance. The mid-term review mission conducted last 2001, revealed that project accomplishments and disbursement during the first eighteen months was very minimal. That much of the shortfall in performance is attributable to the slow start-up of project activities. And one of the reasons is that PMO staff as well as the managers in DSWD lacked experience in implementation of foreign assisted projects, and did not get the management and technical support needed to facilitate project start-up from the funding agencies (ADB and World Bank). To compensate

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for the lost time, more intensive inputs from the funding agencies started to take place in year 2000. These include conduct of meetings, consultation dialogues and telephone calls which resulted to a speedy resolution of issues/problems affecting project implementation.

The project management as well as the implementing agencies had appreciated the strategy of the World Bank of fielding a team of experts during supervision missions. This strategy facilitated resolution of issues/problems on each of every technical and or operational aspects of the project that in turn resulted to an accelerated flow of activities to the intended beneficiaries.

The procurement guidelines of both World Bank and ADB are easy to understand and to implement. It also promotes economy, transparency and efficiency particularly in large-scale procurement activities. However, such guidelines or use of Request for Quotations (RFQ) should be flexible enough to accommodate the need in a relatively small-scale procurement, i.e. tomatoes, vegetables, meat and other perishable goods and small items for food supplementation. Training and provision of technical assistance by the banks’ representatives to the project management teams prior to the project implementation be conducted. This will clear the gray areas in the part of the project management teams in adhering to the banks guidelines.

The same with the procurement guidelines, the disbursement guidelines of both banks are easy to understand and to implement. Training of the project management teams on it prior to implementation should also be conducted for familiarization and appreciation. The imposition of the World Bank of a strict prohibition on the withdrawal of any advances out of special account, contributed to fund shortages thus resulted to the further delay in the implementation. The low bank financing by ADB on training and materials, which is 32% and 22% respectively, had tremendously contributed to the delay of project implementation. The implementing agencies as well as the LGUs have to look or wait for the 68% and 78% first before conducting trainings and or procuring materials that are vital in the attainment of the project objectives. Thus the effect on the overall project objectives of bank financing/cost sharing by category should have been taken into consideration.

(b) Cofinanciers:Asian Development Bank:

The assessments in this ICR are in line with the Asian Development Bank’s own assessments, based on our supervision of the ADB-financed portion of the Early Childhood Development Project in Regions VI and XII, and our participation in joint review missions with the World Bank over the life of the project. The overall rating of the achievement of the project’s development objective as satisfactory is a direct result marked improvements in implementation later on despite delay in project start-up and problems encountered in the earlier years. ADB notes in particular the problems with the M&E component, which focused too heavily on inputs and did not deliver timely monitoring data that could have resulted in program adjustments and improvements to service delivery.

As the ICR notes, however, there were marked improvements in overall project implementation later on. For this reason ADB also agrees with the assessment that the institutional development impact was substantial, and that sustainability is likely. Particularly commendable is the strong advocacy and communications program that encouraged most of the project LGUs to continue investments in ECD programs.

(c) Other partners (NGOs/private sector):

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10. Additional Information

Table 1. ECD Project-Supported Researches Completed, 1999-2004

Subcomponent/Research Title Use/Potential Use

a. Pilot-testing of Project Interventions (new PEM program, the upgraded PES program, and the new, improved ECD service delivery package)

Used for formulating policies and guidelines for full project implementation

b. Support to Program Innovation and Policy Development

1) Baseline study on nutritional status, psychosocial development and care of 0-6 year-old children in ECD provinces

Evaluation of project benefits and impact

Used to develop the ECCD checklist that was eventually adopted

Could be used for understanding the relationship among dimensions covered

2) Correlation analysis of children’s nutritional status, dietary intake and psychosocial development, and pregnant and lactating mother’s dietary intake in ECD and non-ECD Program areas

Policy formulation and program/project development for ECD packages or for single-sector interventions

3) School-readiness of 5½ to 6½ year-old children in various socio-economic environments

Used as basis for developing the School Readiness Assessment Tool which has been adopted in the public school system

Tool could help teacher in appropriate interventions to improve learning ability of grade school entrants.

Could also be used for formulating appropriate policies and programs for preschool and Grade 1 education

4) Methods of early detection and intervention of children with special needs

Policy formulation and program/project development for ECD packages

5) Perception and practice on parenting roles of Filipino fathers and mothers

Policy formulation and program/project development for ECD PES packages

6) Cost-effectiveness of deworming and weekly iron supplementation in the reduction of anemia among preschoolers: A field test

Used for formulating policies and programs on anemia prevention and control such as DOH Administrative Order 119 series 2003.

7) The efficacy of pan de sal baked from wheat flour fortified with iron and vitamin A in improving the iron status of anemic elementary school children

8) The effects of vitamin A-fortified pan de sal on the iron and anthropometric status of anemic school children

Provides evidence for wisdom behind mandatory fortification of wheat flour with iron and vitamin A; useful in advocating for compliance to mandatory fortification; and in deciding to maintain the mandatory fortification provided for by law

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9) The effects of iron-fortified pan de sal and weekly iron tablet supplementation on hemoglobin concentration and anthropometric status of anemic school children

Used for formulating policies and programs to prevent and control PEM and iron-deficiency anemia

10) Iron status of anemic school children in Compostela, Cebu before and after 7 months of weekly iron supplementation

Used for formulating policies and programs to prevent and control PEM and iron-deficiency anemia

11) The effects of iodized salt on the quality of selected processed food

Policy formulation, particularly on the scope of mandatory fortification

12) Household food consumption survey Policy formulation and program/project development along agriculture and nutrition

13) Evaluation of the continuum and best practices of project educational activities: case studies of selected sites

Policy formulation and program/project development of ECD packages

14) Cost-effectiveness study of ECD interventions and services of child development worker (CDW), rural health midwife (RHM), day care worker (DCW), day care mother (DCM) and the early childhood enrichment packages

Policy formulation and program/project development of ECD packages

15) Pre-testing of the Mother and Child Book Used as basis for refining and finalizing the MCB

c. Benefits monitoring and evaluation

1) Baseline indicators survey

2) Endline indicators survey

3) Indigenous People Survey

Used to validate project objectives and targets

Will establish the benefits obtained from the Project, which can be useful for advocating continued investments in the interventions and in the effort of integrated delivery of services and to vulnerable groups

Policy formulation and program/project design for ECD packages

Endnote

1

Public and privately run ECDs in Philippines (Center and home-based) date back over 16 years. Starting in 1978 with a presidential decree (No. 1567 "The Barangay Day Care Centre Law") mandating at least one day care center in every Barangay. In 1987, an amendment (Republic Act No. 6972, "The Barangay Level Total Development and Protection of Children Act) was adopted.

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Annex 1. Key Performance Indicators/Log Frame Matrix

Outcome / Impact Indicators:

Indicator/Matrix

Projected in last PSR1

Actual/Latest Estimate

Reduction by 30% of the under-five mortality rate from the baseline value (estimated at over 35 per thousand in PAD)

29.12 No project end-line data available, DHS 2003 - 40/1,000 at the national level

Reduction by 40% in the proportion of children under six with Grade 2 or 3 wasting from the baseline value (estimated at around 30% in PAD).

4.97 2.2%

Reduction by 30% in the proportion of children under six with anemia from the baseline value (estimated at around 50% among infants in PAD).

28% 15.9%

Increase to 90% in proportion of children aged 12-18 months fully immunized from the baseline value (estimated at under 85% in PAD).

90% 91.6%

Improvement in a combined index of child development (motor and cognitive skills) among children under six (indicator to be developed in baseline study).

Motor language development 0.5 -1.8 S.D. higher in children exposed to the program.

Proportion of children with below average gross motor skills

4.5 Two year program exposure: 8.5*One Year program exposure: 4.6*

Proportion of children with below average cognitive skills

1.0Two year program exposure:-0.4One year program exposure:1.0

6. Increase in completion rate for Grade 1 to 70% of Grade 1 entrants from the baseline value (currently estimated at 58%).

70% 89%

*Significant at p<0.05Output Indicators:

Indicator/Matrix

Projected in last PSR1

Actual/Latest Estimate

1. Establishment of functioning PEM programs in 50% of municipalities/cities by 2003.

50% of muncipalities 86.4 (growth monitoring) 59.1 (infant feeding)

Increase to 75% in proportion of total children aged three to five in targeted municipalities attending day-care centers (estimated at under 60% in PAD).

75% of muncipalities 75%

9. Establishment of active CDWs in 50% of municipalities/cities by 2003.

50% of muncipalities 63%

0. Implementation of ECD sub-projects in 90% of targeted municipalities by 2003

90% of targeted municipalities 90%

1 End of project

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Annex 2. Project Costs and Financing

Project Cost by Component (in US$ million equivalent)AppraisalEstimate

Actual/Latest Estimate

Percentage of Appraisal

Component US$ million US$ million1. ECD Service Delivery a. Program Support for Provincial LGUs 9.50 13.77 145 b. Financing Facility for Muncipality/City/LGU ECD Sub-Projects

25.40 16.75 66

2. Support to LGU Sub-Projects a. Communications Support 1.30 0.66 51 b. Planning, Targeting & MIS Support 3.70 1.47 40 c. Training Support 3.50 3.69 105 d. Institutional Development 3.80 9.10 2393. Research and Development a. Pilot Testing of Project Interventions 0.20 0.22 110 b. Program Innovation and Policy Development 1.90 0.97 51 c. Benefit Monitoring and Evaluation 1.50 0.80 53Taxes and Duties 1.70 2.12 125

Total Baseline Cost 52.50 49.55 Price Contingencies 6.30

Total Project Costs 58.80 49.55Total Financing Required 58.80 49.55

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Project Costs by Procurement Arrangements (Appraisal Estimate) (US$ million equivalent)

Expenditure Category ICBProcurement

NCB Method

1

Other2 N.B.F. Total Cost

1. Works 0.00 1.10 0.30 1.60 3.00(0.00) (1.10) (0.30) (0.00) (1.40)

2. Goods 4.20 2.20 2.00 11.90 20.30(4.20) (2.10) (1.90) (0.00) (8.20)

3. Services 0.00 0.00 8.30 26.10 34.40(0.00) (0.00) (8.30) (0.00) (8.30)

4. IEC 0.00 0.60 0.50 0.00 1.10(0.00) (0.60) (0.50) (0.00) (1.10)

Total 4.20 3.90 11.10 39.60 58.80(4.20) (3.80) (11.00) (0.00) (19.00)

Project Costs by Procurement Arrangements (Actual/Latest Estimate) (US$ million equivalent)

Expenditure Category ICBProcurement

NCB Method

1

Other2 N.B.F. Total Cost

1. Works 0.00 0.22 0.93 2.85 4.00(0.00) (0.22) (0.93) (0.00) (1.15)

2. Goods 2.63 5.15 0.38 17.06 25.22(2.63) (5.15) (0.38) (0.00) (8.16)

3. Services 0.00 0.00 7.53 11.67 19.20(0.00) (0.00) (7.53) (0.00) (7.53)

4. IEC 0.00 0.16 0.33 0.64 1.13(0.00) (0.16) (0.33) (0.00) (0.49)

Total 2.63 5.53 9.17 32.22 49.55(2.63) (5.53) (9.17) (0.00) (17.33)

1/ Figures in parenthesis are the amounts to be financed by the Bank Loan. All costs include contingencies.2/ Includes civil works and goods to be procured through national shopping, consulting services, services of contracted staff

of the project management office, training, technical assistance services, and incremental operating costs related to (i) managing the project, and (ii) re-lending project funds to local government units.

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Project Financing by Component (in US$ million equivalent)

Component Appraisal Estimate Actual/Latest EstimatePercentage of Appraisal

Bank Govt. CoF. Bank Govt. CoF. Bank Govt. CoF.1. ECD Service Delivery a. Program support for provincial LGUs

4.60 0.00 4.90 5.74 2.61 5.41 124.8 0.0 110.4

b. Financing Facility for Municipal/City/LGU ECD Sub-Projects

5.40 11.30 8.70 4.62 5.71 6.41 85.6 50.5 73.7

2. Support to LGU Sub-Projects a. Communications Support

1.30 0.00 0.63 0.03 0.00 48.5 0.0

b. Planning, Targeting & MIS Support

3.70 0.00 1.29 0.17 0.00 34.9 0.0

c. Training Support 0.40 3.10 3.47 0.21 0.00 867.5 6.8 d. Institutional Development

3.80 0.00 3.80 0.63 1.96 6.52 16.6 0.0 171.6

3. Research and Development a. Pilot Testing of Project Interventions

0.20 0.00 0.17 0.04 0.00 85.0 0.0

b. Program Innovation and Policy Development

1.90 1.90 0.00 0.39 0.58 0.0 30.5

c. Benefit Monitoring and Evaluation

1.50 0.76 0.76 0.04 50.7

Taxes and duties + price contingencies

8.00 2.90 2.40 0.00 0.00 0.0 0.0 0.0

Total Project Cost 19.00 18.10 21.70 17.31 11.60 21.04 91.1 64.1 97.0

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Annex 3. Economic Costs and Benefits

During preparation, cost-effectiveness and cost-benefit analyses were carried out. The results of these studies indicated that the delivery of health, nutrition and early education inputs from this project would be highly cost-effective and combined in ways that strengthen the links between child health, education and economic returns. Investing in health and education of children increases a country’s overall standard of living by building human resources that generate higher economic returns, reduce social costs and increase efficiency of other investments. For health and nutrition interventions, the net present value of wage gains for children benefiting from the project was expected to increase from 9 billion pesos to 30 billion pesos. Early childhood development interventions were also to improve school attendance and performance and increase children’s prospects for higher productivity and future income. The economic rate of return calculated during preparation for this project’s ECD interventions was estimated at a minimum of 15%.

No overall ERR or net present value calculations were carried out at the end of the project but it can be argued that there will be economic gains from the ECD-investments and, despite late start and slow progress, to some extent from the health and nutrition investments.

More specific cost-effectiveness studies were carried out during the life of the project. One study was on the cost-effectiveness of combining deworming and weekly iron-supplementation in the reduction of anemia among pre-schoolers. Anemia among pre-schoolers reduces attention span and education attainment and would reduce effectiveness of investments in education. The null hypothesis was that the combined strategy of deworming (high worm loads cause and worsen anemia) and iron-supplementation would have a higher impact than solely supplementing with iron. The study however showed that the combined strategy did not have a higher impact on reducing anemia. The results were consistent with results reported elsewhere, as the low prevalence and intensity of soil-transmitted helminthiases, particularly hookworm infection, meant that the contribution to anemia among pre-schoolers was minimal. Deworming is not an effective intervention in reducing anemia, unless there is moderate to severe hookworm infection. Most importantly, however, the cost -effectiveness analysis showed that cost-savings could be incurred through investing in weekly iron supplementation without deworming to effectively prevent mild anemia. This finding formed the basis of the DOH policy, which subsequently introduced weekly iron supplementation into the regular DOH program, under the DOH Administrative Order No.119 series 2003.

In addition, an action research found that the iron-fortified product Pandesal did reduce mild anemia levels among children, but did not have additional benefits when fortified with both iron and vitamin A. Although the study recommended the use of the least costly iron-fortificant, the study could have been improved by using the estimated positive impact of fortification on measures of nutritional status and the costs associated with fortification in order to compute benefit-cost ratios for each type of fortification. The study did, however, mention apparent secondary outcomes of the trial, such as positive changes in school attendance rates.

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Annex 4. Bank Inputs

(a) Missions:Stage of Project Cycle Performance Rating No. of Persons and Specialty

(e.g. 2 Economists, 1 FMS, etc.)Month/Year Count Specialty

ImplementationProgress

DevelopmentObjective

Identification/Preparation04/05/199307/05/199301/15/1994

03/07/1994

114

5

TASK MANAGER (1)TASK MANAGER (1)MISSION LEALDER AND MANAGEMENT SPECIALIST (1); PUBLID HEALTH AND NUTRITION SPECIALIST (1); PRE-SCHOOL EDUCATION SPECIALIST (1); COMMUNITY PARTICIPATION SPECIALIST (1)TASK MANAGER (1); PUBLIC HEALTH CONSULTANT (1); NUTRITION CONSULTANT (1); EDUCATION CONSULLTANT (1); COMMUNITY AND NGO PARTICIPATION CONSULTANT (1)

09/21/1994

11/22/1994

06/12/1995

12/05/1995

02/14/1996

1

3

4

2

4

MANAGEMENT SPECIALIST CONSULTANT (1)TASK MANAGER (1); MANAGEMENT AND NUTRITION CONSULTANT (1); ARCHITECT CONSULTANT (1)TASK MANAGER (1); PUBLIC HEALTH SPECIALIST (1); CONSULSTANT MANAGEMENT AND NUTRITION (1); CONSULTANT ARCHITECT (1)MANAGEMEN SPECIALIST (1); SOCIAL FUND SPECIALIST (1)TASK MANAGER (1); MANAGEMENT SPECIALIST (1); COMMUNICATIONS SPECIALITST (1); TRAINING SPECIALIST (1)

05/13/1996 9 TASK MANAGER (1); COMMUNITY PARTICIPATION SPECIALIST (1); COSTING SPECIALIST (1); CONSULTANT NUTRITION

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AND INSTITUTIONAL DEVELOPMENT (1); TRAINING CONSULTANT (1); IEC CONSULTANT (1); FINANCIAL ANALYST (1); PUBLIC HEALTH CONSULTANT (1); EARLY EDUCATION CONSULTANT (1)

07/12/1996 8 TASK MANAGER (1); MANAGEMENT CONSULTANT (1); CONSULTANT ARCHITECT (1); IEC CONSULTANT (1); TRAINING CONSULTANT (1);NUTRITION SPECIALIST (1); FINANCIAL ANALYST CONSULTANT (1); ECONOMIST (1)

08/08/1996 3 TASK MANAGER (1); IMPLEMENTATION SPECIALIST (1); CONTRACTOR PREPARATION OF ECD PROJECT PROPOSAL (1)

11/25/1996 3 TASK MANAGER (1); CONSULTANT OVERALL DESIGN OF COMPUTER PACKAGE (1); CONTRACTOR PREPARATION OF ECD PROJECT PROPOSAL (1)

01/27/1997 9 TASK MANAGER (1); ECONOMIST (1); NUTRITION SPECIALIST (1); EARLY EDUCATION SPECIALIST, UNICEF (1); SOCIAL MOBILISATION SPECIALIST, UNICEF (1); MANAGEMENT CONSULTANT (1); PUBLIC HEALTH CONSULTANT (1); TRAINING CONSULTANT (1); IEC CONSULTANT (1)

04/21/1997 7 TASK MANAGER (1); NUTRITION SPECIALIST (1); IMPLEMENTATION SPECIALIST (1); MANAGEMENT CONSULTANT (1); PLANNING AND MANAGEMENT CONSULTANT (1); CONSULTANTS (2)

05/21/1997 1 TASK MANAGER (1)

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07/15/1997 8 TASK MANAGER (1); NGO/COMMUNITY PARTICIPATION SPECIALIST (1); M&E SPECIALIST (1); IMPLEMENTATION SPECIALIST (1); ARCHITECT CONSULTANT (1); MANAGEMENT CONSULTANT (1); TRAINING CONSULTANT (1); IEC CONSULTANT (1)

09/09/1997 3 TASK MANAGER (1); IMPLEMENTATION SPECIALIST (1); FINANCIAL CONSULTANT (1)

Appraisal/Negotiation07/15/1997 7 TASK MANAGER (1);

NGO/COMMUNITY PARTICIPATION SPECIALIST (1); M& E SPECIALIST (1); FINANCIAL CONSULTANT (1); MANAGEMENT CONSULTANT (1); TRAINING CONSULTANT (1); IEC CONSULTANT (1)

01/26/1998 5 TASK MANAGER (1); LEGAL COUNSEL (1); IMPLEMENTATION SPECIALIST (1); FINANCIAL CONSULTANT (1); IEC AND MANAGEMENT CONSULTANT (1)

Supervision

11/27/1998 3 TASK MANAGER (1); OPERATIONS OFFICER (1); MANAGEMENT CONSULTANT (1)

S S

05/31/1999 3 TASK MANAGER (1); OPERATIONS OFFICER (1); PLANNING & MANAGEMENT (1)

S

05/31/1999 4 TASK TEAM LEADER (1); NUTRITION SPECIALIST (1); PROCUREMENT (1); FINANCIAL MANAGEMENT (1)

U S

04/30/2000 7 TASK TEAM LEADER (1); OPERATIONS ANALYST (1);

U S

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OPERATIONS OFFICER (2); PROCUREMENT OFFICER (1); FINANCIAL MGMT. SPEC. (1); IMCI SPECIALIST (1)

04/30/2000 8 TASK TEAM LEADER (1); PROCUREMENT SPECIALIST (1); OPERATIONS OFFICER (1); FIN MGT SPECIALIST (1); ADB TASK MANAGER (1); PROGRAM OFFICER (1); PROJECT ASSISTANT (1); IMCH CONSULTANT (1)

S S

04/06/2001 6 TASK MANAGER (1); PROCUREMENT OFFICER (1); OPERATIONS OFFICER (1); FM CONSULTANT (1); SENIOR PROJECT SPECIAL (1); TEAM ASSISTANT (1)

S S

05/29/2002 8 TASK TEAM LEADER (1); OPERATIONS OFFICER (1); PROCUREMENT SPECIALIST (1); FIN MGT SPECIALIST (1); NUTRITION SPECIALIST (1); PROGRAM OFFICER (2); PROGRAM ASSISTANT (1)

S S

11/28/2002 5 TASK TEAM LEADER (1); OPERATIONS OFFICER (1); PROCUREMENT OFFICER (1); NUTRITION SPECIALIST (1); EVALUATION SPECIALIST (1)

S S

05/27/2003 4 TASK TEAM LEADER (1); HUMAN DEV'T SPECIALIST (1); PROCUREMENT OFFICER (1); FM SPECIALIST (1)

S S

12/03/2003 4 TEAM LEADER (1); HD SPECIALIST (1); PROCURMENT OFFICER (1); FM SPECIALIST (1)

S S

05/05/2004 6 TASK TEAM LEADER (1); LEAD HEALTH SPECIALIST (1); HEALTH SPECIALIST (1); PROCUREMENT SPECIALIST (1); SR. FM SPECIALIST (1); COMMUNICATIONS (1)

S S

07/21/2004 6 SR. ECONOMIST AND TASK TEAM LEADER (1); LEAD HD SPECIALIST (1); PROCUREMENT SPECIALIST (1); HEALTH SPECIALIST (1); SR. FINANCIAL MANAGEMENT SPECIALIST (1); COMMUNICATIONS

S S

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SPECIALIST (1)02/07/2005 5 SR. ECONOMIST AND TASK

TEAM LEADER (1); LEAD ECONOMIST (1); PROCUREMENT SPECIALIST (1); HEALTH SPECIALIST (1); SR. FINANCIAL MANAGEMENT SPECIALIST (1)

S S

11/08/2005 5 SR. ECONOMIST AND TASK TEAM LEADER (1); SR. NUTRITIONIST (1); COMMUNICATIONS SPECIALIST (1); PROCUREMENT SPECIALIST (1); SR. FINANCIAL MANAGEMENT SPECIALIST (1)

S S

ICRConducted during last supervision mission

(b) Staff:

Stage of Project Cycle Actual/Latest EstimateNo. Staff weeks US$ ('000)

Identification/Preparation N.A. 1,564,800*Appraisal/NegotiationSupervision N.A. 543,800**ICRTotal N.A. 2,108,600

* total cost of project preparation.** Supervision costs including ICR preparation.

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Annex 5. Ratings for Achievement of Objectives/Outputs of Components(H=High, SU=Substantial, M=Modest, N=Negligible, NA=Not Applicable)

RatingMacro policies H SU M N NASector Policies H SU M N NAPhysical H SU M N NAFinancial H SU M N NAInstitutional Development H SU M N NAEnvironmental H SU M N NA

SocialPoverty Reduction H SU M N NAGender H SU M N NAOther (Please specify) H SU M N NA

Indigenous PeoplesPrivate sector development H SU M N NAPublic sector management H SU M N NAOther (Please specify) H SU M N NA

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Annex 6. Ratings of Bank and Borrower Performance

(HS=Highly Satisfactory, S=Satisfactory, U=Unsatisfactory, HU=Highly Unsatisfactory)

6.1 Bank performance Rating

Lending HS S U HUSupervision HS S U HUOverall HS S U HU

6.2 Borrower performance Rating

Preparation HS S U HUGovernment implementation performance HS S U HUImplementation agency performance HS S U HUOverall HS S U HU

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Annex 7. List of Supporting Documents

Aide Memoires, Back-to Office Reports, Project Status Reports and Implementation Status Reports 1995-2005;

Project Appraisal Document 17176-PH (1998)

Project Operations Manuals and Monitoring reports

Improving Early Childhood Development; An Integrated Program for the Philippines (1995) Heaver R. A. and J. M. Hunt Sector Report on ECD, Direction in Development World Bank

Early Childhood Development through Integrated Programs: Evidence from the Philippines Longitudinal Impact-study (2006) by Graeme Armecin, Jere Behrman, Paulita Duazo, Sharon Ghuman, Socorro Gultiano, Elizabeth King and Nanette Lee (publication forthcoming)

A Study of the Effects of Early Childhood Interventions on Children’s Physiological, Cognitive and Social Development; Results of the Longitudinal Evaluation Study (2005) Office of Population Studies, University of San Carlos, Cebu City, the Philippines

The Medium Term Philippine Plan of Action for Nutrition 2005-2010 – DRAFT

An Unfinished Agenda – Nutrition in the Philippines Mimeo by Rekha Menon (2005)

Effects of Iodized Salt on the Quality of Selected Processed Food Products (2005) Food and Nutrition Research Institute, Department of Science and Technology Philippines

Correlation Analysis of Children’s Nutritional Status, Dietary Intake and Psychosocial Development and Pregnant and Lactating Mothers Dietary Intake in ECD and Non-ECD program areas (2003) Food and Nutrition Research Institute, Department of Science and Technology, the Philippines

Cost-effectiveness of Deworming and Weekly Iron-supplementation in the Reduction of Anemia among Pre-schoolers: a Field Test (2003) Solon F. S., l. Fajutrao, J.A. Solon, J.N. Sarol, L. Wambangco and L. Fermin Nutrition Center of the Philippines

The Endline Indicators Survey "Effects of Early Childhood Interventions on Children's Physiological, Cognitive, and Social Development" Draft Final Report (April 2006) by Prudenciano Gordoncillo, Corazon Barba, Reza De Jesus, Marison Dy, Alelie Elizabeth Gana, Normahitta Gordoncillo, Merlyne Paunlagui, Emerito Solivas, Lilia Soliven, Ma. Theresa Talavera

Project Completion Report.

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Additional Annex 8. Studies, Policies and Laws implemented under the Project

Studies

1. Baseline survey and Data Generation on Nutritional Status, Psychosocial Development and Care of 0-6 Year Old Children in ECD Provinces - OPS

2. Cost Effectiveness of Deworming and Weekly Iron Supplementation in the Reduction of Anemia among Preschoolers: A Field Test - NCP

3. School readiness of 5 1/2 and 6 1/2 Children in Various Socio-Economic Environments - Save the Children

4. The Efficacy of Pandesal Baked from Wheat Flour Fortified with Iron and Vitamin A in Improving the Iron status of Anemic Elementary School Children - NCP

5. Correlation Analysis of Children's Nutritional Status, Dietary Intake and Psychosocial Development and Pregnant and Lactating Mother's Dietary intake in the ECD and Non-ECD Areas - FNRI

6. Effects of Iodized Salt on the Quality of selected Processed Food Products - FNRI7. Food Consumption Survey8. Baseline Indicators' Survey9. Baseline Survey of Indigenous Peoples' Access to and Utilization of ECD Services in Region

VI, VII and XII 10. Perception and Practice on Parenting Roles of Filipino Mothers and Fathers11. Cost Effectiveness of ECD Interventions/Services of CDW, RHM, DCW, DCM and the

Early Childhood Enrichment Packages12. Evaluation of the Continuum and Best Practices of Project Educational Activities13. Methods of Early Identification of Children with Special Needs14. The Endline Indicators Survey "Effects of Early Childhood Interventions on Children's

Physiological, Cognitive, and Social Development" Draft Final Report (April 2006) by Prudenciano Gordoncillo, Corazon Barba, Reza De Jesus, Marison Dy, Alelie Elizabeth Gana, Normahitta Gordoncillo, Merlyne Paunlagui, Emerito Solivas, Lilia Soliven, Ma. Theresa Talavera

Policies, executive and administrative orders and laws

1. Child 21, The National Framework for Plan Development for Children and its accompanying Plan of Action, the National Plan of Action for Children 2005-2010 that provide the impetus in addressing the holistic and diverse needs of Filipino children from birth to early childhood and throughout their life cycle.

2. Executive Order #286 Directing National Government Agencies and other concerned agencies to actively support and implement programs on the “Bright Child”

3. Executive Order #349 incorporating the pre-school in the education ladder to encourage early childhood development program of the Department of Education

4. DOH Administrative Order No.119 series 2003 on Weekly Iron Supplementation5. Department of Education adoption of the School Readiness Tool6. Adoption of the Revised ECCD Checklist as a developmental assessment tool for 0-6 year old

children through the Council for the Welfare of Children (CWC) Board Resolution No.5 series of 2004.

7. Revised Guidelines on Food Supplementation developed by the Inter-Agency Technical

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Working Group8. Development of a Resource Book on Establishing and Localizing the ECCD System building

on the experiences and lessons gained from the implementation of the Project.

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