**PHN 1992 Sector Review**

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develop operational models for nation-wide replication.

# _2. Flexibility/Opportunitiesfor Learning and Fine-tuning_

_4.5_ As an extension of their strategic nature and long-term vision, FY92 projects for the most part demonstrate considerable flexibility to accommodate learningduringimplementation and consequent refinement of project activities and sector strategy. The Chile project will assist in the development, pilot testing and initiation of key reform measures through the undertaking of twelve policy/institutional reform studies and the pilot testing and start-up of recommendations for implementation. The project features built-in flexibility to adapt, as appropriate, recommendations of the reform studies: a $1.4 million fund under the project will finance their pilot testing. The Equatorial Guinea project will support the development and pilot-testing of efficient procedures for the procurement, distribution and management of essential drugs in public facilities. Under the Rwanda project, the component to develop micro-enterprise activity is experimental in nature. Operational research on this component will provide feedback and guidance to government and development agencies on ways off-farm employment can be developed in that country.

4.6 An essential drugs program pilot-tested under a first project in Sao Tome and Principe in FY90 introduced policy reform measures including: (a) preparation of a national essential drugs list; (b) preparation of guidelines for distribution and prescription; (c) improvements in drug procurement; and (d) introduction of cost recovery measures. The second (FY92-approved) project would help institutionalize and implement policy reforms initiated under the first project. The China project will research, deve!op and disseminate cost-effective methods and matcrials for further improving disease controi strategics and programs and sustaining progress made.

Operational research planned under the India AIDS project will assess and allow for adaptations in control interventions before replicating them in other areas. Under the India Family Welfare (Urban Slums) project, small-scale process and impact evaluation activities would be conducted to help adjust and shift the IEC program as needed. The findings of such research and feedback would be incorporated into program plans, which would be developed on an annual basis.

# _3. Project Management_

4.7 Project management arrangements for all FY92-approved projects are intended to strengthen the capacity of concerned ministries and institutions to manage sector activity over the medium- to long-term. In fact the great majority of projects are designed so that the implementation responsibility rests with appropriate, responsible units within government, both at the center and the periphery. Projects which work with a number of line ministries (e.g., Rwanda, Niger, and India AIDS) have placed project management responsibilities in Plan ministries and established inter-ministerial technical coordination committees. The two sector funds (Guyana and Honduras) are managed by agencies specially set up to handle these emergency operations. These agencies are largely autonomous, although they do coordinate with line ministries and are viewed as temporary institutions, whose purpose is to complement line ministries during a period of adjustment. The project management unit under the Rwanda operation was also set up to have as much operational autonomy as possible, separating program and financial management from technical management.

4.8 How the responsibilities of these more autonomous agencies will be gradually phased out and permanently integrated into concerned line ministries is not yet clearly set out, though this is a stated intention of those projects. A pattern of project management arrangements is detected in