Ratings for the Reproductive, Maternal and Child Health Services Improvement Project for Uganda were as follows: outcomes were satisfactory, the Bank performance was satisfactory, and the monitoring and evaluation quality was high. Some lessons learned included: strong political commitment and ownership at country level is critical to the achievement of the project' objectives. The project received strong political commitment and ownership at all levels of government that included the national parliament, Minister of Health, Permanent Secretary of MoH, Director General of the MoH, Ministry of Finance, Planning and Economic Development officials, district leaders and community stakeholders. This commitment contributed to the resolution of various challenges that the project encountered during project implementation, notably delays in procurements in the first two years. In any future projects of similar nature, efforts should be made to mobilize strong political commitment and ownership at all levels right from the project design stage. The successful nation-wide scale up of RBF required adequate preparatory work, including local expertise, routine analysis and sharing of program data with stakeholders. The investments in RBF were substantial to enable national-wide scale up of this innovation that had been implemented in Uganda as pilots since 2003 and some stakeholders were skeptical about whether this was the best use of the resources. The World Bank executed Trust Funds and Advisory Services and Analytics (ASA) are instrumental in providing technical assistance for the achievement of project objectives. The project benefitted from multiple World Bank executed Trust Funds which were used for, among others, technical assistance for the implementation of the project. These included the Swedish International Development Cooperation Agency (SIDA) supported RMNCAH operations research program, GFF grant which supported continuity of essential health services during the peak of the COVID-19 pandemic, and the Sustainable Health Financing ASA. Big civil work contracts, covering many regions of the country, are not suitable for contractors with limited capacity. The experience from the project was that some civil works contractors had significant challenges in implementing big contracts with up to fourteen sites spread across multiple regions of the country. While such big contracts were designed to attract experienced contractors with considerable experience, some contractors struggled to complete works within the stipulated time. In the future, each contractor should be given fewer sites, preferably in the same region, to minimize capacity and logistical challenges. This recommendation is already being implemented for the UCREPP.
Authors
- Disclosure Date
- 2024/06/04
- Disclosure Status
- Disclosed
- Doc Name
- Uganda - Reproductive, Maternal and Child Health Services Improvement Project
- Lending Instrument
- Investment Project Financing
- Product Line
- IBRD/IDA
- Published in
- United States of America
- Rel Proj ID
- UG-Uganda Reproductive, Maternal And Child Health Services Improve -- P155186
- Sector
- Public Administration - Health,Health-HG
- TF No/Name
- TF0A1287-UGANDA GFF PREPARATION BANK EXECUTED,TF0A2977-Uganda GFF-REPRODUCTIVE, MATERNAL AND CHILD HEALTH IMPROVEMENT PROJECT,TF0A3408-Uganda GFF Supervision,TF0A6636-BETF - SIDA Additional Financing for Uganda Reproductive Maternal and C,TF0A6713-RETF - SIDA Additional Financing Uganda Reproductive Health Maternal,TF0B3585-GFF Uganda COVID-19 TA
- Theme
- Health Systems and Policies,Human Development and Gender,Disease Control,Health Service Delivery,Health System Strengthening,Pandemic Response,Child Health,Adolescent Health
- Unit Owning
- HEALTH AFR E2 (HAEH2)
- Version Type
- Gray cover
- Volume No
- 1
Table of Contents
- A. CONTEXT AT APPRAISAL 11
- Context 11
- Sectoral and Institutional Context 12
- Rationale for World Bank’s Involvement 14
- Theory of Change (TOC) 14
- Project Development Objectives (PDOs) 17
- Key Expected Outcomes and Outcome Indicators 17
- Components 17
- B. SIGNIFICANT CHANGES DURING IMPLEMENTATION 19
- Revised PDOs and Outcome Targets 19
- Revised PDO Indicators 19
- Revised Components 20
- Other Changes 20
- Rationale for Changes and Their Implication on the Original Theory of Change 21
- Assessment of Relevance of PDOs and Rating 21
- B. ACHIEVEMENT OF PDOs (EFFICACY) 21
- Assessment of Achievement of Each Objective/Outcome 21
- Justification of Overall Efficacy Rating 27
- C. EFFICIENCY 27
- Assessment of Efficiency and Rating 27
- D. JUSTIFICATION OF OVERALL OUTCOME RATING 29
- E. OTHER OUTCOMES AND IMPACTS (IF ANY) 30
- Gender 30
- Institutional Strengthening 30
- Mobilizing Private Sector Financing 30
- Poverty Reduction and Shared Prosperity 31
- Other Unintended Outcomes and Impacts 31
- A. KEY FACTORS DURING PREPARATION 31
- B. KEY FACTORS DURING IMPLEMENTATION 32
- Factors Subject to the Control of Government and/or Implementing Entities 32
- Factors Subject to the Control of the World Bank 34
- Factors Outside the Control of Government and /or Implementing Entities 34
- A. QUALITY OF MONITORING AND EVALUATION (M&E) 35
- M&E Design 35
- M&E Implementation 35
- M&E Utilization 36
- Justification of Overall Rating of Quality of M&E 36
- B. ENVIRONMENTAL, SOCIAL, AND FIDUCIARY COMPLIANCE 36
- Environmental Compliance 36
- Social Compliance 37
- Financial Management Compliance 37
- Procurement Compliance 38
- C. BANK PERFORMANCE 38
- Quality at Entry 38
- Quality of Supervision 39
- Justification of Overall Rating of Bank Performance 39
- D. RISK TO DEVELOPMENT OUTCOME 39
