**PHN 1992 Sector Review**

sustainability of PHN operations is ensured through sector reform and project conditionality aimed at mobilization of increased resources for the sector and at their more efficient allocation.

# _Sector Work_

8. 'Iwenty-five sector reports were completed in the PHN sector during FY92, a decline from the 33 reports produced in FY91. Five country-specific health sector reports, which reached grey cover in FY92, were reviewed to assess their usefulness for devising policies and programs to address poverty alleviation and the quality of PHN services. Collectively the reports cover the essential aspects of these issues: identification of poor and vulnerable groups, allocation of resources for health; mobilization of additional resources through increased public resources and/or greater role for private sector; decentralization of sector activity; and assessment of the demand for services. However, not all reports adequately covered all of these aspects. While financing issues were generally well addressed, the identification of poor groups and assessment of their demand and needs were not always carried out in sufficient depth. The review stresses that this element of sector work is necessary to influence and inform the design and targeting of Bank investments in the sector and makes suggestions for improved performance in these important areas.

# _Supervision_

9. During FY92, the PHN sector had 107 projects under supervision, representing commitments of $5.3 billion. Nineteen percent of PHN operations under supervision this year were categorized as problem projects. While this represents an increase in the proportion of problem projects over the FY91 level for PHN (13 percent), it approximates the overall FY92 Bank average of 18 percent, indicating that the overall "health" of PHN projects under supervision is in line with the Bank average. The average supervision coefficient for PHN in FY92 was 17.0, exceeding the overall Bank average of 13 by 30 percent. At 20.9, the PHN supervision coefficient including local staff input exceeds the Bank average of 14.1 by almost half, but does reflect a greater use of local staff for supervision than the Bank average. This divergence from the Bank average is probably a reflection of the relative newness of the health sector and the consequent inexperience of weak health ministries in managing Bank projects, and also of the increasing attention to software components in PHN projects, which, while appropriate, tends to add to the complexity of operations.

10. Given the paucity of project completion reports (PCRs) completed during the year and the growing importance and interest attached to the lessons of implementation experience, this review provides: a brief overview of lessons learned from various sources; examples of good practices in Staff Appraisal Reports (SARs) for analyzing lessons and incorporating them into new project designs; a summary of PCR findings, and a compilation of lessons derived from the Seventeenth Annual Review of Implementation and Supervision (ARIS).

# _Policy, Pesearch and Dissemination_

11. The PHN Department l maintains a diverse work portfolio that includes: the carrying out of policy and program-relevant research; the dissemination of research findings drawing from work undertaken both inside and outside of the Bank; and the provision of direct support to operations. Specific operationally relevant research ongoing or completed in FY92 include: a Best Practices paper on Micronutrient Deficiency Disorders, a Best Practices paper on Women's Health and Nutrition; a paper on Effective Family Planning Programs, Guidelines on Safe Motherhood, and a study of the Economic Impact of Adult Mortality in Africa, focusing specifically on how households cope with illness and death of victims of Acquired Immunodeficiency Syndrome (AIDS).

12. Dissemination activities include the organization of 19 seminars attended by 363 Bank staff, on a variety of PHN topics; the publication of 19 Working Papers and a series of two-page "PHN Notes"; and the publication of three technical papers. PHRHN and the technical