**PHN 1992 Sector Review**

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improve tuberculosis control in different settings in China. It will improve the disease surveillance system to adjust and target control activities appropriately and will improve monitoring and evaluation systems at all levels. In addition, this project will finance research into alternatives for improving surveillance and control of other key infectious diseases. Indicators will permit the tracking of project inputs, process steps, and epidemiological and output measures. Process indicators will clearly show whether and where project objectives are being achieved and will be sufficiently specific to highlight non-performing subregions, permitting quick intervention on the part of MOPH and IDA.

4.12 Indicators for the Romania project will provide for very extensive review of both process and output. An important objective of the India AIDS project is to monitor the development of the HIV/AIDS epidemic in the country. It will, in this regard, finance operational research and social/behavioral studies and epidemiological and intervention studies to fine-tune the program approach. It will also support the collection of baseline information for planning and programming, measuring changes in behavior and in process and outcome indicators, assessing mass awareness campaigns, and providing quality control. Process indicators have been established and agreed with the Government; impact indicators include World Health Organization (WHO) indicators for evaluating the AIDS strategy world-wide. Other impact indicators have been established to complement those of WHO and will be tracked through operational research supported under the project.

4.13 The India Safe Motherhood and Child Survival project is supporting the development of an enhanced management information system (MIS) designed to upgrade the monitoring and evaluation function. Key performance indicators have been discussed with the government and are process-oriented, focussing on quantity of services delivered and coverage level achieved. Impact heing more difficult to evaluate, studies and operational research will be undertaken to determine whether objectives are being achieved. The India Family Welfare project has compiled a set of indicators of progress and targets that will facilitate close tracking of that project. It itemizes by city: the objectives and components; indicators of project progress (number and proportion of couples effectively protected due to family planning methods; mortality figures in different age groups); and project targets and process indicators.

# B. **Quality of PHN Services**

4.14 Virtually all SARs for FY92 operations discuss the issue of low quality of services. Low quality is attributed to some combination of the following factors: state of disrepair of infrastructure and equipment; unreliable supply of essential drugs; poor performance of personnel, due to insufficient technical and outreach skills and low motivation; unresponsiveness of services to client demand; and inadequate financing of essential operating costs. Project efforts to address the issue of low service quality, consequently, aim to upgrade physical facilities and equipment; ensure an adequate and affordable supply of essential drugs; upgrade the skills and motivation of personnel; elicit and consider the demand of the client in service design and delivery; and ensure adequate recurrent financing through cost recovery, mobilization of more public funds for the social sectors, and/or reallocation of the public budget for social sectors in favor of basic services. All of these interventions are, without question, essential to improving the quality of services; and they are provided for in virtually all FY92-approved operations.

4.15 However, more can and should be done to improve the quality of services. While greater attention is being paid to demand, it is addressed in terms of the type and mix of services desired and not in terms of the compassion, care and