8 PHN 1991 Sector Review TIbchnical Cooperation Unit of the Europe, Middle East and North Africa Country Department m (EM3), which reviewed the organization and functoning of the Ministry of Health of Saudi Arabia. About half the reports treat PHN in the context of broader human resource, poverty alleviation, and social sector issues or, particularly in Africa, in relation to women in development issues.

2.14 The reviews, which focused exclusively on the PHN sector (or subsectors), were undertaken most often in countries where the Bank is at an early stage of involvement (e.g., the PHN sector report in Lao PDR), or where it has had to adapt to changing govermnent policy (e.g., the *New Directions in Family Planningf report in the Philippines). In health, several reports dealt in some detail with the technical issues of health financing and health planning, questions of growing concern. In nutrition, an increasing number of reports assessed needs and interventions in the broader context of food secuity concerns. IWo important areas of population sector work were (a) policy development and the institutional framework necessary for program implementation, and (b) the use of alternative channels for bmily planning services-- NGOs and, to some extent, the commercial sector. Secor work will remain at much the same level of activity in FY92 and FY93.

# C Supelion and Project Evaluatlon

2.15 The PHR divisions are currently responsible for a heavy supervision workload (Annex 1, Figure 1). Ninety-seven projects, representing commitments of nearly $4.5 billion, are being implemented. Nearly half these projects are in the Africa Region. (The implications of this workload are discussed in more detail in Chapter IV.) 2.16 Seven project completion and audit reports were produced during FY91 (Annex 1, Ihble 7). Several of them--the ibmil Nadu Integrated Nutrition Project, in particular-distill the lessons of experience in ways that have wide applicability. These completion reports were used by the Operations Evaluations Department (OED) in its 1990 _Reiew of Project Performance Results: Human Rsources Pojets._ Although the unsatisfactory rating for achievement of original objectives for three of the five projects reviewed in this exerc aises con cern, four of thowe projects were considered to be sustainable. The projects were among the first health and nutrition operations of the Bank; and the process of their review and evaluation has indicated that a review of criteria for rating success of PHR projects may be in order.

2.17 One OED report issued in FY90 with important implications for Operations was the review of the Bankes work to date on population, based on eight country case studies. The report found justification for the Banks greater focus (since its reorganization) on coherent macroeconomic and multisectoral strategies at the country level and for the poverty focus of its worL Although several of the famly planning programs studied were able to raise contraceptive prevalence levels even under unfavorable socioeconomic conditions, the report stresses the limits to such an approach. It argues that project impact would have been greater had family planning programs been developed in combination with reinforcing social programs that produce conditions favoring the emergence of preferences for smaller family size. The report cites the ase of Indonesia, where parallel investments in education helped to create the condidons for fertility decline and the increased demand for family planning services. Another important conclusion of the OED report Is that greater financial resources from the Bank would not necessarily have Improved the programs' impact; rather, non-financial assistance in the form of more sector work, more focus on software than hardware, a more pro-active role in some countries, and more collaboration and coordination with other donors, would have been useful oDmplements. Operations is already moving in the dections, and the report confirms the soundness of these approaches.

# D. PopulatIon, Health and Nutrulton Content of Projec

2.18 The increasing integration of PHN into country strategies, which was noted in the FY90 sector review, has continued, and the Staff Appraisal Reports (SARs) document increasing coordination with other donors as welL A growing number of projects address PHN and other components together, and sector work is preparing the ground for