PHN 1991 Sector Review 52 parenthesis): TFR at 7.2 (85); modern contraceptive prevalence rate (CPR) at 20.0 (9.0); and 276,000 FP users (100,000).

# _Senel - Population and Health_

The objectives of the proposed project are to support Government's efforts to: (i) control fertility and reduce the rate of population growth, through the implementation of a National Population Program; and (ii) restructure the health sector to enable It to provide basic health services of improved quality and wider accessibility, through the Implementation of its National Health Policy. lb achieve these objectives, the project would finance investments for (a) population to: (i) strengthen the National Rimily Planning Program; (ii) promote the status of women; (iii) sensitize youth on family welfare issues; and (iv) strengthen institutional capacity to promote the national population program; and (b) health to: (i) develop the district health system, including the promotion of community healt rganizations; (ii) promote the use and availability of essential drugs; and (iii) strengthen institutio.1<sup>il capacity in the health</sup> sector, with emphasis on manpower development, and budgeting and financial planning.

While the project is a specific investment operation, it will involve the adoption and implumentation of key policy measures in both the population and health sectors including: (i) liberalization of regulations on contraceptive distribution and use; (ii) adoption of organizational norms for the district health system, ensuring sufficient budgetary allocations, personnel re-deployment, and adoption of organizational and procedural guidelines for community health associations; and (iii) promotion of essential drugs.

## - _Tbgo  Population and Health Sector Adjusm Operation_

The credit would support the implementation of a comprehensive package of sector policy reforms ia the area of population and health aimed at assuring a satisfactory level of primary health care and family planning services to the population, especially in rural areas. It would address in the short to medium term, pervasive morbidity and mortality resulting from inadequate treatment and prevention of tropical communicable and parasitic diseases and would increase current use of family planning services among couples. The Credit weald help the Government achieve these results by providing balance of payment support; the resulting counterpart funds will be used over four years for: (a) instituting better sector planning; (b) reforming institutional deficiencies within MSP and at regional levels; (c) improving personnel and financial management in the sector, and (d) instituting cost recovery and improving beneficiary participation in management of services.

Specifically, reforms incorporated in the operation would effect a transformation of the Health Sector and the Government's population activities through policy measures geared to address prevailing key sector systemic constraints. It would: (i) launch the Government's new population policy by expanding family planning services, supporting NGO activities in family planning and creating greater awareness of availability and use of services; and (ii) reverse the deterioration in the quality of basic health care services and gradually increase their accessibility to the general population particularly in rural areas and for the most deprived groups. Specifically, the Program would: (a) integrate family planning into expanded primary health care activities; (b) strengthen institutional capabilities in: (,) planning and programming. (ii) budgeting, financial management and cost recovery, and (iii) sector coordination; (c) rehabilitate, reequip and provide adequate operating expenses for operating existing facilities, and (d) redeploy, train, and improve the productivity and efficiency of technical and management staff.