Financing Agreement, C4442-KH Conformed
Levesque,Roch
Rating for the Health Sector Reform Project for Kyrgyz Republic are as follows: outcome was moderately unsatisfactory; risk to the development outcome was moderate; and the performance of the Bank and the Borrower was highly satisfactory. Ratings for the Second Health Sector Reform Project are as follows: outcome was satisfactory; risk to the development outcome was negligible low; and the performance of the Bank and the Borrower was satisfactory. Lessons learned from the projects included: 1) the political economy of health sector reform inevitably creates both winners and losers. Early and comprehensive anticipation of stakeholder interests, institutional analysis to facilitate understanding of those interests, and the generation of a coherent plan to build support for reform and to persuade and/or co-opt potential opponents is essential; 2) the Bank should not, however, underestimate the potential leverage wielded by its financing and expertise; 3) one effective mechanism for countering political resistance to reform is strong and consistent Monitoring and Evaluation (M&E), where analytic results can be generated and disseminated rapidly and effectively, building support for project activities in a politically contentious environment; 4) another important tool for overcoming political resistance to reform is the engagement with civil society organizations that give health professionals and users of the health care system a voice in the decision process and a clear sense of affiliation and identity; and 5) tradeoffs between efficiency, equity/access, and quality of care will not be addressed in the absence of explicit and consistent attention to the balance between them and interventions to correct imbalances.
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