18 PHN **1992** Sector Review decentralized and demand-driven manner, and includes: credits to small business/entrepreneurs, provision of basic social services (food aid, primary health care, day care centers), and income generation opportunities/temporary employment on public works activities to develop social and economic infrastructure at the local level. Medium-term components of these projects include efforts to increase national capacity to monitor living standards and basic needs of populations and to reform policies and develop and implement strategies (both inter- and intrasectoral) to climinate poverty.

3.13 _Category 2: Provision of Basic Social Services to the Poor as Primary Objective._ As an important complement to broadly-based economic growth to generate income earning opportunities for the poor, the WDR 1990 emphasized the direct improvement of the welfare of the poor through the provision of basic social services. This category of projects, of which there are six (or about 35 percent of the FY92 portfolio) focuses on that aspect of the Bank's poverty reduction strategy as the primary objective. These projects target poor populations, and within those populations, particularly disadvantaged and vulnerable groups (mostly mothers and children). All of these projects include both short-term assistance, aimed at improving the quality and accessibility of basic social services, and medium/long-term assistance aimed at developing national commitment and capacity to reform, implement and monitor sector policy with a view to improving the social welfare of poor and vulnerable groups. Of the six projects included in this category, four are in the Africa region (Equatorial Guinea Health Improvement, Mauritania Health and Population, Niger Population, and Sao Tome and Principe Health and Educaton), and two are in India (Child Survival and Safe Motherhood, and Family Welfare [Urban Slums]).

3.14 _Category 3. PHN Interventions Whose Benefits to PoorAre Important But Not the Primary Objective._ Projects in this third category (totaling seven, or about 45 percent of the FY92 protfolio) do not set poverty alleviation as their primary objective, but support strategic sectoral interventions, which will in fact benefit poor and vulnerable groups both directly and indirectly. Four of these projects (Kenya Health Rehabilitation, Poland Health Services Development, Romania Health Rehabilitation, and Chile Technical Assistance and Hospital Rehabilitation) are supporting policy, institutional and operational reforms from which the poor should derive significant benefits. Such reforms include: (a) increased attention and resources for prevention and promotional activities (vs. curative); (b) increased financial and managerial autonomy for higher levels of health care and greater private sector involvement, both of which should liberate public funds for basic services; (c) regulation of drug production, procurement, distribution and prescription for better quality and greater affordability of health services; (d) development and expansion of the institutional framework for health (private sector involvement, decentralization of authority and responsibility, community involvement), which should provide the poor with "exit" and 'voice" options; and (e) mobilization of resources through cost recovery with a social safety net for the poor.

_3.15_ In addition to medium-term interventions focussed on sector reforms, these projects also include components which are more clearly and directly focussed on poverty issues -- both short- and medium-term. The Chile project will improve health service provision to a majority of the poor population of metropolitan Santiago by upgrading the dilapidated capital stock of seventeen hospitals that cater to the ambulatory and tertiary care needs of the city's semi-rural and marginal peri-urban areas. The Kenya Health Rehabilitation project will support the establishment of a National Household Welfare Monitoring and Evaluation System to monitor trends in poverty and evaluate impact of policies on household welfare. The Poland and Romania projects provide for more effective targeting of poor and vulnerable populations.