15 PHN 1991 Sector Review implementation would have had a positive<sup>impact on</sup> the success and sustainability of those<sup>projects. A</sup> review of institutional development<sup>in World Bank</sup> operations entitled, Institutional<sup>Development in</sup> World Bank Projects: A Cross-Sectoral<sup>ReviewVl,</sup> provides a useful matrix of analytical<sup>frameworks for</sup> institutional analysis, along with a critique<sup>of Bank's</sup> performance to date in undertaking<sup>such work,</sup>

# _b. Management Capacilyfor Policy_<sup>_Analysis and_</sup> _Implementation_

3.20 We have already noted the importance<sup>of a</sup> macroeconomic and multisectoral policy<sup>framework</sup> and transparency in the policymaking process<sup>to the</sup> capacity of countries to develop and<sup>refine their</sup> PHN policy and ensure its effective<sup>implementation.</sup> As imnportant are the quality and<sup>availability of</sup> _information;_ skills in _planning and_<sup>_programming and_</sup> _budgeting_ to ensure the translation of appropriate, well-articulated policy into implementable<sup>projects</sup> and programs; the availability, distribution,<sup>and man-</sup> agement of sector _resources;_ and<sup>sound</sup><sup>_project and_</sup> _program management._ _3.21 Infonmation._ Almost every PHN<sup>PCR pro-</sup> duced this year highlights the need for<sup>improving</sup> information, both for evaluating Bank-supported operations and for enabling governments<sup>to assess</sup> the needs of the PHN sector and to<sup>monitor and</sup> evaluate performance with a view to refining<sup>policy.</sup> The Indonesia Provincial Health PCR states<sup>that a</sup> simple monitoring system is more effective<sup>than a</sup> complex one collecting large amounts of<sup>data. The</sup> monitoring and evaluation system, envisaged<sup>under</sup> the Malawi Health project, was never put<sup>into place</sup> because it was accorded low priority<sup>by both the</sup> Bank and the government. The PCR on<sup>the Yemen</sup> First Health project, notes that lack of<sup>an evaluation</sup> plan and of any evaluation activities<sup>may have</sup> compromised the success of project activities.<sup>The</sup> Tunisian Government, as documented in the<sup>PCR on</sup> the Health and Population project, judged<sup>the MIS</sup> to be overambitious and problematic. The<sup>PCRs on</sup> 'Inisia and Indonesia both noted that research activities had been neglected.

3.22 The above and other experience reveals<sup>a need</sup> for increased attention to the quality and<sup>availability</sup> of information and countries' capacity<sup>to use it.</sup> Countries need to have at their disposal<sup>both quanti-</sup> tative and qualitative information on<sup>the population</sup> (PHN status, needs--both perceived<sup>and real-</sup> socioeconomic status, traditions, cultures)<sup>and on</sup> PHN services (coverage, performance,<sup>quantity,</sup> quality, efficiency, mix). Such information<sup>should be</sup> sufficiently disaggregated (e.g., by geographic<sup>region,</sup> socioeconomic group, gender, age<sup>group) to permit</sup> the development of differentiated information, education and communication (IEC)<sup>activities and</sup> strategies for their delivery. Information<sup>should be</sup> gathered by various agencies and through<sup>several</sup> channels, e.g., research, surveys, beneficiary<sup>assess-</sup> ments, and monitoring and evaluation.

3.23 Management information systems<sup>are often</sup> too complex and camberseme, in many<sup>cases because</sup> they were designed to meet the needs<sup>of various</sup> donor programs rather than to monitor<sup>and evaluate</sup> PHN policies and services countrywide. Operational research and evaluation activities<sup>are frequently</sup> underdeveloped and underutilized. Efforts<sup>to im-</sup> prove information collection and analysis<sup>must focus</sup> on the development of a streamlined MIS,<sup>designed</sup> to meet the carefully defined information<sup>needs of</sup> the country rather than those of donors. The<sup>capacity</sup> to undertake needs assessment, operational<sup>research,</sup> survey work, data processing, and<sup>monitoring and</sup> evdluation (including the encouragement<sup>and orches-</sup> tration of local input)--al of which<sup>have been ne-</sup> glected--must be developed.

3.24 _Plannng, Programming and Budgetig._<sup>Capac-</sup> ities must also be developed for using<sup>information</sup> appropriately to ensure that PHN seetors<sup>articulate</sup> and effectively re-pond to issues and<sup>needs. Skills</sup> need to be developed and methodologies<sup>identified</sup> for targeting, priority setting, policy<sup>formulation,</sup> testing and experimentation, implementation<sup>and</sup> evaluation. Policy statements need to<sup>be translated</sup> into implementable activities through<sup>the formula-</sup> tion of an operational strategy with<sup>medium-term</sup> targets and specific plans for priority<sup>programs, as</sup> well as an action plan with key indicators<sup>for success-</sup> ful and monitorable implementation.<sup>Skills in plan-</sup> ning, programming and budgeting need<sup>to be devel-</sup> oped, with a bottom-up emphasis on nlanning<sup>so that</sup> local government and community groups can<sup>become</sup> sufficiently involved in the process.