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provision of resources for construction. While there has been a gradual shift over the years from a hardware orientation to more software-oriented activities, it remains an important, although occasionally overly dc inant, element of Bank projects.

Bank projects are tvpically larger and more complex than those of other donors, often encompassing a full range of national program activities. While this keeps the Baaik invol^- . in the central issues of the national program, coordinating all of thk. aments involved can be d:fficult and :'esult in delays and implementati i problems. Project completion is often delayed up to three years, due in ?art to the scale and co..vlexity of the -- projects and to the fact that full utilization of funds simply takes time possibly disbursement schedules are not realistic. Second generation projects often begin before the first project is complete, thus removing the opportunity to apply any lessons learned to developmqnt and implementation of follow-up projects.

'he review comments extensively on the Bank's heavy reliance on supervision missions to monitor project progress. It questions whether the mission approach -- which is often seen as disruptive to the ongoing work of the project and not able to provide adequate attention to all aspects of the project -- is preferable to the use of, for example, the resident specialist approach, which would provide constant monitoring and guidance to the project. * The review also suggests that the resident specialist approach might improve institutidn development efforts, an area which has received much mention in projects but where there has been limited success. The Bank's approach to institution development consists of structural reorganization, system design and skill development through formal training to develop strong institutions capable of designing and executing effective programs. The review concludes that the supervision mission approach generally does not provide sufficient technical assistance and monitoring to lead to effective institution building.

Bank projects typically approach population activities through the provision of primary health care. This often confines the Bank to working through ministries of health, which are often administratively and politically weak and whose traditional priority is to provide curative, clinic-based care, not to effect attitudinal and behavioral changes. The review also finds that the Bank has not been effective at tapping resources such as NGOs. Such collaboration could prove difficult as the Bank only lends to governments.

The quality and scope of sector work is seen as having improved over the years. The purpose of sector work is to provide a base for project identification and development, and for initiating policy dialogue with policy makers and program managers. Damographic and population analysis has been particularly strong in the sector reports; the reports have been less thorough in their analysis of program effectiveness issues.

The review presents a set of recommendations based on these findings. These inciude strengthening linkages with agencies other than ministries of health; increasing priority given to policy dialogue; increasing attention