PHN **1992** Sector Review 24 survey component of the Rwanda Food Security and Social Action project will strengthen government capacity to monitor the living standards of the population through socioeconomic surveys and studies, which will provide the foundation for the development of a long-term poverty alleviation strategy and for the development of a national food policy, both of which are important objectives of the project. The development of a National Household Welfare Monitoring and Evaluation System supported under the Kenya project will provide a better information base for the design of social policies.

3.36 Significant reform of _PHN_ policies and strategies are encouraged and supported through the great majority of PHN projects approved during the fiscal year. These reforms largely support a reorientation of priorities and refinement in strategies, the aim of which is to increase the quality, efficiency and equity of health care services and thus benefit the poor and vulnerable both directly and indirectly. New or reaffirmed priorities support, _inter alia,_ an increased emphasis on primary health care (prevention and health promotion, in particular) on selected diseases (e.g., malaria, schistosomiasis, tuberculosis, and AIDS) and health problems (e.g., high infant, child and maternal mortality), and on selected groups with acute needs (e.g. poor, underserved populations, women of childbearing age and children under five).

3.37 In order to address these priorities more effectively and efficiently, Ministries of Health with project support are testing and implementing institutional and financial reforms. While not always done exclusively for reasons of poverty alleviation, these reforms should facilitate achievement of that objective.

# 4.a _Institutional Reforns._

3.38 Institutional reforms supported by FY92 projects include efforts to embrace and use more rationally the potential of various actors in sector activity. Under these projects, decentralization policies will be implemented, the role and responsibilities of central ministries will be redefined and strengthened, private sector and NGO activity will be encouraged and supported, and community participation will be institutionalized. These reforms are likely to give the poor increased opportunity to participate in sector activity, and to have their concerns and problems addressed at the local level, where they would most likely be better understood. They could also improve the availability and affordability of basic social services. A number of community participation initiatives have already been described in section E. 2 above. The following paragraphs will describe selectively project support of decentralization and private sector development.

3.39 _Decentralization._ Virtually all FY92approved projects support decentralization of health sector activity. The Mauritania Health and Population Project supports the governments' strategy to decentralize service delivery. The government has already defined structural, administrative and staffing norms for regional services. The project will assist in strengthening regions' capacity to assume newly decentralized responsibilities by (1) developing training programs for regional personnel; (2) developing a maintenance system for vehicles, equipment and infrastructure; (3) strengthening financial management; and (4) strengthening health service delivery in three regions. The Chile Technical Assistance and Hospital Rehabilitation project will facilitate decentralization of decision-making and resource management, by delegating needs analysis and the design and implementation of hospital rehabilitation subprojects to Health Service Areas and hospital managers and staff. With assistance from the Equatorial Guinea project, decentralization of decision-makingwould be achieved though greater delegation of authority to the district level on use of approved budgets, personnel management, drug distribution, and management of revenues for drug supply and