Peru Basic Health & Nutrition Project (Loan 3701) and Mother & Child Insurance and Decentralization of Health Services, First Phase of Health Reform Project (Loan 4527) Project Performance Assessment Report
This Project Performance Assessment Report assesses the Basic Health and Nutrition Project (BNHP) and the Peru Health Reform Program (PARSALUD). During the review period (1994–2006) Peru had maternal mortality rates twice as high as the Region's average and stalled nutrition indicators. It... Full Description »
This Project Performance Assessment Report assesses the Basic Health and Nutrition Project (BNHP) and the Peru Health Reform Program (PARSALUD). During the review period (1994–2006) Peru had maternal mortality rates twice as high as the Region's average and stalled nutrition indicators. It also dealt with significant economic and political crises; at the beginning of the period the health system had nearly collapsed, so Peruvians basically paid for health care out of pocket. The objective of the BNHP was to improve maternal and child health and nutrition status. The project sought to improve access, use, and quality of services. It was restructured several times to increase its focus on service delivery. IEG rates the project's efficacy as modest and the relevance of its objectives and design as substantial. The project has an overall moderately satisfactory outcome rating and a moderate rating for risk to development outcomes. Both Bank and borrower performance are rated satisfactory. PARSALUD's objective was to improve maternal and child health and reduce morbidity from communicable diseases. The project sought to increase access of the poor to quality health programs and services. Despite significant political instability, the project's outcome rating is satisfactory based on its high relevance, substantial efficacy, and substantial efficiency. PARSALUD's risk to development outcome is moderate. IEG rates Bank performance as satisfactory and borrower performance as moderately satisfactory. The projects demonstrated some important lessons: An emphasis on pro-poor health policies can be sustained through use of multiple instruments, but failure to monitor design and implementation weakens programs' ability to assess impacts; creating new institutions can be less difficult than reforming existing ones; health reform projects need a realistic assessment of local risks; and donor coordination can be enhanced with joint management units.
The findings of this in-depth PPAR informed the IEG health, nutrition, and population evaluation.
Content Type : Reports , Doc Sub Category : Project Performance Assessment Report , Country : Peru
June 26, 2009