Morocco: Review of The Bank’s Assistance to the Health Sector, 1994-2004

Evaluation Team

This report was prepared by Mr. Albert-Eneas Gakusi, Principal Evaluation Officer, Operations Evaluation Department (OPEV) and Mr. Mathias Sanou, Socio-economic Consultant.

Objective

The evaluation of the Bank’s health policy in Morocco aims at examining the Institutions health policy and strategies as well as the performance of its assistance relating to the lending and non-lending activities in the sector. The evaluation makes it possible to learn lessons with a view to strengthening the Bank’s policy and strategies and improving the quality of future operations 

Main Lessons

• The participation of the different stakeholders – including medical personnel and beneficiary populations – in the design of health project ensures that the technical and cultural aspects are taken into due account in the architectural plans, and fosters an enhanced utilization and ownership of the constructions.

Main Recommendations

Recommendation(s) to the Beneficiary:

• To ensure a smooth functioning and improved viability of health facilities, the Government should: a) take measures to assign medical personnel to the health facilities that have been shut-down, and to the local hospitals whose laboratories as well as X-ray and admissions units are not functioning; b) ensure the maintenance of the health infrastructure and bio-medical equipment; and c) set up a system for the treatment of solid wastes in all the health facilities

• The Government should adopt a human-resource management policy more conducive to the operation of health facilities in rural areas. In so doing, the authorities could put in place a system of staff rotation within and between the provinces and equally provide for more incentives, including premiums and allowances for personnel working in rural areas

• Considering the increasingly-important role played by the beneficiary populations and medical personnel regarding the operation and upkeep of the basic health care establishments, the Government must ensure that all stakeholders are actually involved in the design of health projects, including the architectural plans, with a view to better integrating the technical and cultural parameters into the design. This would foster improved operation and utilization of the health facilities

• The Government should ensure that all the activities provided for in the loan agreements are carried out so as to maximize the impact of the Bank’s assistance. In that regard, it is important not to introduce changes likely to hamper the attainment of objectives

Recommendation(s) to the Bank:

• To improve the competitiveness of the Bank, a strategy for non-lending assistance must be devised to enable the Bank to ensure greater added value within the framework of its fundings. To do so, the Bank must take further initiatives to propose non-lending activities that better respond to the country’s concerns, including technical assistance and sector studies. The initiative: Strengthening the Bank’s Support to Middle-Income Countriesresponds to this concern

• The Bank’s sector strategy and its application to the social sector, and in particular the health sector, should be more explicit in the CSP. Hence, it should be based on the analysis of the principal evolutions, challenges and constraints in the sector so as to clearly map out sector strategy guidelines

• The Bank’s health sector projects with a component on the construction of health care establishments, should adopt an integrated approach by taking due account of the different aspects such as rendering the constructions serviceable, securing the human resources necessary for their operation, and ensuring that there is an adequate system for the treatment of bio-medical waste

• In case of a change in the sector policy at project start-up, the Bank should carry out a timely evaluation of the impact of the change on project objectives and cycle, with a view to taking the appropriate measures

• In order to guarantee a better quality at completion and greater sustainability for the health infrastructure constructed with the Bank’s funding, it is necessary to promote the involvement of all stakeholders, including civil society and the medical personnel. In that regard, the Bank’s assistance could also anticipate measures for building the capacities of thebeneficiaries, including training

• To improve its performance in emergency aid operations, the Bank should expeditiously put the funds earmarked for financing emergency aid operations at the disposal of the institution it would have identified for managing such funds