## _cr0718

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---

### Executive summary and scope
- APR period covered: June 2005 through June 2006.
- SL-PRS key elements analyzed: (i) macroeconomic performance; (ii) good governance, peace, and security; (iii) pro-poor sustainable growth for food security and job creation; and (iv) human resource development.
- APR links to the Results Framework Matrix presented during the 2005 Consultative Group meetings.
- APR evidence: adequate PRSP implementation and progress on two issues from the previous Joint Staff Advisory Note (JSAN) related to monitoring and protection of poverty-reducing expenditures.
- Timing note: APR timing, if maintained, would allow inclusion of findings into annual budget preparation.

### Enhancing macroeconomic and fiscal management
- Economic performance
  - Economic growth: "remained strong in 2005 and continued to be robust in 2006," reflecting buoyant agriculture, mining, construction, and service sectors.
  - Inflation: end-period inflation declined from 13 percent (year-on-year) in December 2005 to 9 percent in June 2006.
  - Causes cited for lower inflation: improved supply situation for basic commodities, slow growth in money supply, and a relatively stable exchange rate.
- Fiscal policy and revenues
  - Fiscal performance: weaker in 2005, improved in 2006.
  - Revenue and wage outcomes: slippages in meeting targets for revenue collection and government wage bill expenditures in 2005; corrective measures in late 2005 led to higher-than-programmed domestic revenues in H1 2006.
  - Wage bill: overruns continued through end-June 2006; some wage growth consistent with PRS objectives (hiring more teachers and police).
  - Revenue projections: revenue collections in 2005, and projections for 2006 as a whole, are lower than anticipated in the SL-PRS.
  - VAT delay: APR does not explain delays in the introduction of the value-added tax originally scheduled for 2007.
  - Staff recommendation: continue to increase the current revenue-to-GDP ratio by implementing non-regressive measures for revenue mobilization to reduce dependence on foreign aid without increasing poverty.
- Poverty-reducing and pro-poor spending
  - Nominal doubling: government doubled pro-poor spending in nominal terms in 2005 under the HIPC Initiative relative to pre-HIPC level in 2001.
  - Poverty-reducing expenditures: Le 267.4 billion in 2005 compared to Le 126.5 billion in 2001.
  - HIPC Interim Relief: fell from US$35 million in 2004 to US$21 million in 2005.
  - MDG integration: government has integrated the Millennium Development Goals (MDGs) into the SL-PRS; monitoring capacity remains low.
  - Effectiveness concerns: need to assess whether spending is truly "pro-poor" (example: high pupil-teacher ratios in poor, rural areas).
- Protection mechanisms and budget execution
  - Fiscal priority framework: implemented to specify well-identified resources and ensure coverage of priority expenditures in event of shortfalls.
  - Result: reduced variation between planned spending and actual expenditure, especially for health and education in 2005.
  - H1 2006: poverty-related spending was below program targets; APR did not explain shortfalls. Preliminary Q3 2006 data indicate planned poverty expenditures for that quarter were protected.

### Good governance
- Governance initiatives
  - Improved Governance and Accountability Pact (IGAP): communiqué committing government to reforms in ten governance and accountability areas during 2006–07.
  - IGAP areas include: Anti-corruption; Auditor General and Public Accounts Committee Reports; Procurement Reform; Civil Service Reform; Improving Service Delivery; Extractive Industries Transparency Initiative; Decentralization; Non-State Actors; Anti-Money Laundering; and Elections.
- Anti-corruption
  - NACS: National Anti-Corruption Strategy published February 2005 with an implementation plan proposed.
  - ACC capacity: intelligence and investigative capacity improved via recruitment and intensive training.
  - Case outcomes: 50 corruption cases investigated in 2005; 22 referred to court; 7 convictions.
  - Constraints: few high-profile civil servant cases resolved; conflict of roles between ACC and Attorney General’s Department hampers effectiveness.
  - Staff recommendation: amend the Anti-Corruption Act to improve effectiveness.
- Public financial management (PFM) reforms
  - Progress: substantial strides in the Common Action Plan for PFM reforms; staffs commend progress and encourage full implementation of IGAP and PFM actions.
  - Selected PFM measures:
    - Budgeting and Accountability Act (2005) eliminates discretionary powers and sets roles/standards to promote transparency and accountability.
    - Procurement reforms: replacement of central tenders board with decentralized procurement committees and units; establishment of a regulatory procurement authority; establishment of an independent review panel; initiation of procurement planning in key ministries.
    - Accountant-General's Department strengthened through recruitment and upgraded financial management computer software.
    - Internal audit units set up in key ministries; Office of the Auditor-General reducing backlog of audit reports.
    - Public expenditure tracking surveys conducted annually.
    - Improved record-keeping in the Accountant-General's Department completed in 2005; personnel file improvements underway in the Establishment Secretary's Office (ESO) and key ministries.
- Transparency in extractive industries
  - Anti-money laundering legislation enacted; participation in the Kimberly Process.
  - Cadastral-based system introduced in July 2006 for administering mining rights.
  - Government declared in October 2006 it will implement Extractive Industries Transparency Initiative (EITI) principles and meet all EITI criteria.
  - Progress measurement: through the Public Expenditure and Financial Accountability (PEFA) framework.
- Decentralization
  - As of early 2006: six ministries devolved some functions (agricultural crops, livestock, education, health, water supply, sanitation, gender, youth and sports) to local councils.
  - Principle: local councils to receive grants sufficient to finance at least same coverage and quality of services as before devolution.
  - Capacity building: all local councils developing procurement and accounting capacity under intensive mentoring; financial statements and tender documents to be posted on public notice boards.

### Growth, food security, and job creation
- Private sector and trade
  - Regulatory changes promoted private sector development and international trade.
  - Diagnostic studies (including DTIS) are only now starting to translate into concrete policies, programs, and projects.
  - APR omissions: does not discuss impact of common external tariff adopted in 2005 (ECOWAS context) nor DTIS recommendations.
  - Staff advice: start implementing action plans from previous studies; strengthen Ministry of Trade and Industry capacity to define and pursue trade policy objectives.
- Youth development and labor market
  - Many programs reached only a few thousand beneficiaries or far less.
  - 2003/04 Integrated Household Survey: 45 percent of young men between ages 20 and 24 do not participate in the labor force (note: may overstate problem due to older youth returning to school).
  - Government budget speech for 2007: refers to a new initiative aiming to create jobs for 20,000 youths.
  - Doing Business observations: Sierra Leone’s labor laws consistently reported among the most onerous in the world.
  - Staff recommendation: reconsider youth strategy—empower private sector to create jobs through minimal but appropriate regulation and provision of adequate infrastructure; strengthen role in improving quality of labor supply via health and education policies.
- Agriculture and food security
  - Government support: services and machinery to farming families; livestock restocking program; fish smoking houses; training programs for business development skills.
  - Targeting and impact: decisions to expand/reduce programs should be evidence-based; 2003/04 household survey shows rice farmers among the poorest of the poor.
  - APR production data: asserts substantial progress in food production in 2005, in excess of most SL-PRS targets; staffs judge these as preliminary estimates and recommend citations/supporting surveys.
  - Extension services: 2006 Service Delivery Perception Survey (SDPS) — only 12 percent of farm households reported any use of government extension services; 71 percent of agricultural households reported no visit in the last year.
  - Staff recommendation: improve access to markets via better roads and road maintenance; better coordination between government and non-government extension providers.
- Mining and extractive sector
  - Mining restart: re-start of rutile and bauxite mines in 2006 directly created an estimated 1,400 new jobs in mining areas.
  - Mining law review: underway to increase international competitiveness.
  - Cadastre: phased implementation initiated July 2006.
  - Commitments: IGAP commitment to full implementation of EITI; reaffirmed at October 2006 EITI Conference in Oslo, Norway.
  - Capacity needs: strengthen Ministry of Mineral Resources capacity to provide competitive legal framework, establish robust geological database, and provide administrative, geological, and engineering services.
- Infrastructure
  - Roads: share of feeder roads in good condition increased to 36 percent in 2005 from 30 percent in 2004 (SL-PRS target: 40 percent); 781 kilometers of trunk roads constructed by mid-2006, up from 581 kilometers in 2004. (No PRS target set for 2006; target for 2007 is 996 km.)
  - Power: national power generating capacity increased, but majority of population has no access to public power; actual delivery fell due to poor maintenance and tariffs inadequate relative to fuel costs.
  - Water: 2005 IRCBP baseline service delivery survey found 61 percent of the population lived within 15 minutes of a safe drinking water source; World Bank estimate: only 57 percent have access to potable water, compared to an average of 75 percent for all low income countries.
  - Ports: preparation of port sector reforms advancing, including private provision of port operations.

### Human resource development
- Education
  - Primary enrollment: total primary school enrollment increased in 2004/05 to 1,280,853 from 1,134,815.
  - Gross enrollment rate (MEST estimate): increased to 160 percent from 146 percent in 2003/04.
  - NPSE passes: increased to 55,000 in 2004/05 from 43,400 in 2003/04.
  - Infrastructure: government built 200 primary schools, 30 junior secondary schools and 30 technical-vocational institutes in 2005.
  - Teacher and quality issues: pupil/teacher ratio increased to 67:1 in 2005; many teachers not qualified; classroom crowding noted.
  - Gender: no substantial progress in reducing ratio of boys to girls (1:1.2); 2006 World Bank Country Status Report notes gap in pass rates between boys and girls worsened in 2004/05 relative to 2000/01.
  - Geographic bias and access: SDPS found bias in service quality favoring Freetown and the Western Peninsula; some respondents reported paying fees or for books despite government policy of free primary tuition and books; access to textbooks generally limited.
  - Data note: no data available for 2005/06 school year at time of report; 2003/04 household survey estimates lower gross enrollment ratios (125 percent for boys and 121 percent for girls).
- Health and other human capital
  - Staffs encourage government to strengthen role in improving quality of labor supply through health and education policies (linked to youth and employment strategy).

### Health sector outcomes and data credibility
- Overall assessment: government provided a variety of health services but much more will be needed to bring health sector indicators up to acceptable standards.
- Data credibility: APR indicates substantial progress was made in reducing mortality rates between 2004 and 2005, although the outcomes for 2005 are labeled as estimates; staffs suggest citation of available survey data would have made the report more credible.
- Specific mortality data cited:
  - Under-5 mortality rate quoted as 202/1000.
  - Recent UNICEF MICS survey conducted in 2005 estimates Under-5 mortality at 286/1000.
- HIV/AIDS and STDs
  - National HIV/AIDS policy put into place in 2005.
  - As of mid-2006, 15 ministries were implementing the policy.
  - By mid-2006, over 700 staff were trained in preventative measures.
  - By mid-2006, 600 people living with HIV/AIDS received anti-retroviral medicines (840 by September 2006).
  - 900,000 condoms were distributed nationwide.
- Service delivery challenges and access
  - Only 44 percent of those surveyed believed the quality of service was improving; rural respondents were less satisfied than urban respondents.
  - 87 percent of respondents had no knowledge of the essential drugs and other resources supposed to be delivered to their health units.
  - Many vulnerable groups (children, the elderly, pregnant and nursing women) were being asked to pay for services meant to be free.
  - Mission hospitals and NGOs have recently reduced activities due to increased security.
  - Free drug policy in some facilities has put stress on private providers.
- Human resources and infrastructure constraints
  - In 2004, there were 0.45 medical personnel per 1,000 people, well below the World Health Organization standard of 2.5 per 1,000.

### Building implementation capacity (civil service)
- Civil service composition and capacity gaps
  - A recent study for the Ministry of Finance found the majority of the civil service (roughly 14,000 out of 16,000) was in the lowest grades, constituting a workforce of clerks and messengers.
  - Skilled professionals such as accountants, agronomists, chemists, doctors, geologists, and lawyers are in very short supply.
- Outstanding policy decisions and needed actions
  - Key decisions not yet made include policies on remuneration, training policy, and the draft civil service law.
  - Need to assess skill gaps and devise recruitment policies to fill them.
  - Authorities encouraged to implement recommendations of management and functional reviews for key ministries to strengthen capacity for public service delivery.
- Fiscal and social considerations
  - Hiring more professional staff would have implications for the wage bill unless some low skill workers were released.
  - The potential poverty impact of any retrenchment in lower grade staff would need to be studied.

### Monitoring and evaluation (M&E)
- Current state of the M&E framework
  - Staffs judge that the Monitoring and Evaluation framework for the SL-PRS needs strengthening.
  - APR documents progress in the design of a results framework and a reporting structure comprising all key sectors and all levels of government, including progress in reporting modes and standardized reporting formats.
- Data gaps and recommended use of existing surveys
  - Line ministries, local governments, and other implementing units generally lack capacity to provide primary data required by the M&E framework; this is evident in the APR’s reporting quality.
  - Authorities could make better use of existing reports and surveys, including:
    - the 2003/04 household survey,
    - the 2005 baseline survey conducted by the IRCBP,
    - the 2006 Service Delivery Perceptions Survey,
    - the upcoming Core Welfare Indicators Questionnaire.
  - To determine SL-PRS impact on poverty relative to the 2003/04 survey, timely completion of the 2008 integrated household survey is viewed as a key priority.

### Conclusions, priorities, and staff recommendations
- Assessment of the APR
  - APR provides an adequate assessment of SL-PRS implementation through June 2006, summarizing progress and highlighting areas for improvement.
  - Noteworthy achievements cited: protection of poverty-reducing expenditures, PFM reforms, decentralization of public services, and primary school enrollment.
  - Key areas needing improvement: weak institutional capacity and weak capacity for monitoring progress toward SL-PRS goals.
- Four critical areas to pursue SL-PRS objectives better:
  1. The government needs to pursue a larger revenue mobilization effort to expand priority poverty-reducing programs.
  2. The reform of the civil service needs to be accelerated to improve its composition and enhance its ability to design and implement government policies and programs.
  3. Key infrastructural services such as power, water, sanitation, and road maintenance must be revitalized.
  4. The capacity to monitor and evaluate progress must be enhanced by all entities that use public resources.
- Additional recommendations
  - The population needs to be better informed of the nature of the SL-PRS objectives, what has been achieved, and the impact of SL-PRS achievements to reduce the gap between expectations and feasibility.
  - Authorities are encouraged to integrate their external debt management strategies into future PRSPs to prevent excessive debt accumulation in the post-debt-relief era.
  - The next Annual Progress Report should make full use of existing resources when reporting results and actions, include more participation from SL-PRS Pillar Working Groups, and report fully on all priority SL-PRS objectives with equal attention to progress realized and progress constrained.

*Source: The first Annual Progress Report (APR), dated September 2006, review of Sierra Leone’s Poverty Reduction Strategy (SL-PRS) (June 2005–June 2006).*

### 1.      The first Annual Progress Report (APR), dated September 2006 reviews the

### The first Annual Progress Report (APR), dated September 2006 reviews the implementation of Sierra Leone’s Poverty Reduction Strategy (SL-PRS) from June 2005 through June 2006

### Executive summary and scope
- APR period covered: June 2005 through June 2006.
- SL-PRS key elements analyzed: (i) macroeconomic performance; (ii) good governance, peace, and security; (iii) pro-poor sustainable growth for food security and job creation; and (iv) human resource development.
- APR links to the Results Framework Matrix presented during the 2005 Consultative Group meetings.
- APR evidence: adequate PRSP implementation and progress on two issues from the previous Joint Staff Advisory Note (JSAN) related to monitoring and protection of poverty-reducing expenditures.
- Timing note: APR timing, if maintained, would allow inclusion of findings into annual budget preparation.

### Enhancing macroeconomic and fiscal management
- Economic performance
  - Economic growth: "remained strong in 2005 and continued to be robust in 2006," reflecting buoyant agriculture, mining, construction, and service sectors.
  - Inflation: end-period inflation declined from 13 percent (year-on-year) in December 2005 to 9 percent in June 2006.
  - Causes cited for lower inflation: improved supply situation for basic commodities, slow growth in money supply, and a relatively stable exchange rate.
- Fiscal policy and revenues
  - Fiscal performance: weaker in 2005, improved in 2006.
  - Revenue and wage outcomes: slippages in meeting targets for revenue collection and government wage bill expenditures in 2005; corrective measures in late 2005 led to higher-than-programmed domestic revenues in H1 2006.
  - Wage bill: overruns continued through end-June 2006; some wage growth consistent with PRS objectives (hiring more teachers and police).
  - Revenue projections: revenue collections in 2005, and projections for 2006 as a whole, are lower than anticipated in the SL-PRS.
  - VAT delay: APR does not explain delays in the introduction of the value-added tax originally scheduled for 2007.
  - Staff recommendation: continue to increase the current revenue-to-GDP ratio by implementing non-regressive measures for revenue mobilization to reduce dependence on foreign aid without increasing poverty.
- Poverty-reducing and pro-poor spending
  - Nominal doubling: government doubled pro-poor spending in nominal terms in 2005 under the HIPC Initiative relative to pre-HIPC level in 2001.
  - Poverty-reducing expenditures: Le 267.4 billion in 2005 compared to Le 126.5 billion in 2001.
  - HIPC Interim Relief: fell from US$35 million in 2004 to US$21 million in 2005.
  - MDG integration: government has integrated the Millennium Development Goals (MDGs) into the SL-PRS; monitoring capacity remains low.
  - Effectiveness concerns: need to assess whether spending is truly "pro-poor" (example: high pupil-teacher ratios in poor, rural areas).
- Protection mechanisms and budget execution
  - Fiscal priority framework: implemented to specify well-identified resources and ensure coverage of priority expenditures in event of shortfalls.
  - Result: reduced variation between planned spending and actual expenditure, especially for health and education in 2005.
  - H1 2006: poverty-related spending was below program targets; APR did not explain shortfalls. Preliminary Q3 2006 data indicate planned poverty expenditures for that quarter were protected.

### Good governance
- Governance initiatives
  - Improved Governance and Accountability Pact (IGAP): communiqué committing government to reforms in ten governance and accountability areas during 2006–07.
  - IGAP areas include: Anti-corruption; Auditor General and Public Accounts Committee Reports; Procurement Reform; Civil Service Reform; Improving Service Delivery; Extractive Industries Transparency Initiative; Decentralization; Non-State Actors; Anti-Money Laundering; and Elections.
- Anti-corruption
  - NACS: National Anti-Corruption Strategy published February 2005 with an implementation plan proposed.
  - ACC capacity: intelligence and investigative capacity improved via recruitment and intensive training.
  - Case outcomes: 50 corruption cases investigated in 2005; 22 referred to court; 7 convictions (from Box 1).
  - Constraints: few high-profile civil servant cases resolved; conflict of roles between ACC and Attorney General’s Department hampers effectiveness.
  - Staff recommendation: amend the Anti-Corruption Act to improve effectiveness.
- Public financial management (PFM) reforms
  - Progress: substantial strides in the Common Action Plan for PFM reforms; staffs commend progress and encourage full implementation of IGAP and PFM actions.
  - Box 1 PFM measures (selected):
    - Budgeting and Accountability Act (2005) eliminates discretionary powers and sets roles/standards to promote transparency and accountability.
    - Procurement reforms: replacement of central tenders board with decentralized procurement committees and units; establishment of a regulatory procurement authority; establishment of an independent review panel; initiation of procurement planning in key ministries.
    - Accountant-General's Department strengthened through recruitment and upgraded financial management computer software.
    - Internal audit units set up in key ministries; Office of the Auditor-General reducing backlog of audit reports.
    - Public expenditure tracking surveys conducted annually.
    - Improved record-keeping in the Accountant-General's Department completed in 2005; personnel file improvements underway in the Establishment Secretary's Office (ESO) and key ministries.
- Transparency in extractive industries
  - Anti-money laundering legislation enacted; participation in the Kimberly Process.
  - Cadastral-based system introduced in July 2006 for administering mining rights.
  - Government declared in October 2006 it will implement Extractive Industries Transparency Initiative (EITI) principles and meet all EITI criteria.
  - Progress measurement: through the Public Expenditure and Financial Accountability (PEFA) framework.
- Decentralization
  - As of early 2006: six ministries devolved some functions (agricultural crops, livestock, education, health, water supply, sanitation, gender, youth and sports) to local councils.
  - Principle: local councils to receive grants sufficient to finance at least same coverage and quality of services as before devolution.
  - Capacity building: all local councils developing procurement and accounting capacity under intensive mentoring; financial statements and tender documents to be posted on public notice boards.

### Growth, food security, and job creation
- Private sector and trade
  - Regulatory changes promoted private sector development and international trade.
  - Diagnostic studies (including DTIS) are only now starting to translate into concrete policies, programs, and projects.
  - APR omissions: does not discuss impact of common external tariff adopted in 2005 (ECOWAS context) nor DTIS recommendations.
  - Staff advice: start implementing action plans from previous studies; strengthen Ministry of Trade and Industry capacity to define and pursue trade policy objectives.
- Youth development and labor market
  - APR documents government efforts to create jobs and training for youth, but many programs have reached only a few thousand beneficiaries or far less.
  - 2003/04 Integrated Household Survey: 45 percent of young men between ages 20 and 24 do not participate in the labor force (note: may overstate problem due to older youth returning to school).
  - Government budget speech for 2007: refers to a new initiative aiming to create jobs for 20,000 youths.
  - Doing Business observations: Sierra Leone’s labor laws consistently reported among the most onerous in the world.
  - Staff recommendation: reconsider youth strategy—empower private sector to create jobs through minimal but appropriate regulation and provision of adequate infrastructure; strengthen role in improving quality of labor supply via health and education policies.
- Agriculture and food security
  - Government support: services and machinery to farming families; livestock restocking program; fish smoking houses; training programs for business development skills.
  - Targeting and impact: decisions to expand/reduce programs should be evidence-based; 2003/04 household survey shows rice farmers among the poorest of the poor.
  - APR production data: asserts substantial progress in food production in 2005, in excess of most SL-PRS targets; staffs judge these as preliminary estimates and recommend citations/supporting surveys.
  - Extension services: 2006 Service Delivery Perception Survey (SDPS) — only 12 percent of farm households reported any use of government extension services; 71 percent of agricultural households reported no visit in the last year.
  - Staff recommendation: improve access to markets via better roads and road maintenance; better coordination between government and non-government extension providers.
- Mining and extractive sector
  - Mining restart: re-start of rutile and bauxite mines in 2006 directly created an estimated 1,400 new jobs in mining areas.
  - Mining law review: underway to increase international competitiveness.
  - Cadastre: phased implementation initiated July 2006.
  - Commitments: IGAP commitment to full implementation of EITI; reaffirmed at October 2006 EITI Conference in Oslo, Norway.
  - Capacity needs: strengthen Ministry of Mineral Resources capacity to provide competitive legal framework, establish robust geological database, and provide administrative, geological, and engineering services.
- Infrastructure
  - Roads: share of feeder roads in good condition increased to 36 percent in 2005 from 30 percent in 2004 (SL-PRS target: 40 percent); 781 kilometers of trunk roads constructed by mid-2006, up from 581 kilometers in 2004. (No PRS target set for 2006; target for 2007 is 996 km.)
  - Power: national power generating capacity increased, but majority of population has no access to public power; actual delivery fell due to poor maintenance and tariffs inadequate relative to fuel costs.
  - Water: 2005 IRCBP baseline service delivery survey found 61 percent of the population lived within 15 minutes of a safe drinking water source; World Bank estimate: only 57 percent have access to potable water, compared to an average of 75 percent for all low income countries.
  - Ports: preparation of port sector reforms advancing, including private provision of port operations.

### Human resource development
- Education
  - Primary enrollment: total primary school enrollment increased in 2004/05 to 1,280,853 from 1,134,815.
  - Gross enrollment rate (MEST estimate): increased to 160 percent from 146 percent in 2003/04.
  - NPSE passes: increased to 55,000 in 2004/05 from 43,400 in 2003/04.
  - Infrastructure: government built 200 primary schools, 30 junior secondary schools and 30 technical-vocational institutes in 2005.
  - Teacher and quality issues: pupil/teacher ratio increased to 67:1 in 2005; many teachers not qualified; classroom crowding noted.
  - Gender: no substantial progress in reducing ratio of boys to girls (1:1.2); 2006 World Bank Country Status Report notes gap in pass rates between boys and girls worsened in 2004/05 relative to 2000/01.
  - Geographic bias and access: SDPS found bias in service quality favoring Freetown and the Western Peninsula; some respondents reported paying fees or for books despite government policy of free primary tuition and books; access to textbooks generally limited.
  - Data note: no data available for 2005/06 school year at time of report; 2003/04 household survey estimates lower gross enrollment ratios (125 percent for boys and 121 percent for girls).
- Health and other human capital
  - Staffs encourage government to strengthen role in improving quality of labor supply through health and education policies (linked to youth and employment strategy).

*Source: The first Annual Progress Report (APR), dated September 2006, review of Sierra Leone’s Poverty Reduction Strategy (SL-PRS) (June 2005–June 2006).*

### 20.      The government provided a variety of health services but much more will be

### _cr0718 - 20.      The government provided a variety of health services but much more will be

### Health sector outcomes and data credibility
- The government provided a variety of health services but much more will be needed to bring health sector indicators up to acceptable standards.
- The APR indicates substantial progress was made in reducing mortality rates between 2004 and 2005, although the outcomes for 2005 are labeled as estimates.
- The staffs suggest that citation of available survey data would have made the report more credible.
- Specific mortality data cited in the APR:
  - Under-5 mortality rate quoted as 202/1000.
  - Recent UNICEF MICS survey conducted in 2005 estimates Under-5 mortality at 286/1000.

### HIV/AIDS and sexually transmitted diseases
- Progress reported in addressing HIV/AIDS and other sexually transmitted diseases:
  - A national HIV/AIDS policy was put into place in 2005.
  - As of mid-2006, 15 ministries were implementing the policy.
  - By mid-2006, over 700 staff were trained in preventative measures.
  - By mid-2006, 600 people living with HIV/AIDS received anti-retro-viral medicines (840 by September 2006).
  - 900,000 condoms were distributed nationwide.

### Service delivery challenges and access
- Public perceptions and service delivery findings:
  - Only 44 percent of those surveyed believed the quality of service was improving; rural respondents were less satisfied than urban respondents.
  - 87 percent of respondents had no knowledge of the essential drugs and other resources supposed to be delivered to their health units.
  - Many vulnerable groups (children, the elderly, pregnant and nursing women) were being asked to pay for services meant to be free.
- Systemic and provider-level pressures:
  - Many mission hospitals and NGOs that served during and just after the war have recently reduced activities due to increased security.
  - The free drug policy introduced by the government in some facilities and by some large international NGOs has put stress on private providers.
- Human resources and infrastructure constraints:
  - Weak national infrastructure and inadequate staffing exacerbate challenges.
  - In 2004, there were 0.45 medical personnel per 1,000 people, well below the World Health Organization standard of 2.5 per 1,000.

### Building implementation capacity (civil service)
- Civil service composition and capacity gaps:
  - A recent study for the Ministry of Finance found the majority of the civil service (roughly 14,000 out of 16,000) was in the lowest grades, constituting a workforce of clerks and messengers.
  - Skilled professionals such as accountants, agronomists, chemists, doctors, geologists, and lawyers are in very short supply.
- Outstanding policy decisions and needed actions:
  - Key decisions not yet made include policies on remuneration, training policy, and the draft civil service law.
  - There is a need to assess skill gaps and devise recruitment policies to fill them.
  - Authorities are encouraged to implement recommendations of management and functional reviews conducted for key ministries to strengthen capacity for public service delivery.
- Fiscal and social considerations:
  - Hiring more professional staff would have implications for the wage bill unless some low skill workers were released.
  - The potential poverty impact of any retrenchment in lower grade staff would need to be studied.

### Monitoring and evaluation (M&E)
- Current state of the M&E framework:
  - The staffs judge that the Monitoring and Evaluation framework for the SL-PRS needs strengthening.
  - The APR documents progress in the design of a results framework and a reporting structure comprising all key sectors and all levels of government, including progress in reporting modes and standardized reporting formats.
- Data gaps and recommended use of existing surveys:
  - Line ministries, local governments, and other implementing units generally lack capacity to provide primary data required by the M&E framework; this is evident in the APR’s reporting quality.
  - The authorities could make better use of existing reports and surveys, including:
    - the 2003/04 household survey,
    - the 2005 baseline survey conducted by the IRCBP,
    - the 2006 Service Delivery Perceptions Survey,
    - the upcoming Core Welfare Indicators Questionnaire.
  - To determine SL-PRS impact on poverty relative to the 2003/04 survey, timely completion of the 2008 integrated household survey is viewed as a key priority.

### Conclusions, priorities, and staff recommendations
- Assessment of the APR:
  - The staffs believe the APR provides an adequate assessment of SL-PRS implementation through June 2006, summarizing progress and highlighting areas for improvement.
  - Noteworthy achievements cited: protection of poverty-reducing expenditures, PFM reforms, decentralization of public services, and primary school enrollment.
  - Key areas needing improvement: weak institutional capacity and weak capacity for monitoring progress toward SL-PRS goals.
- Four critical areas to pursue SL-PRS objectives better:
  1. The government needs to pursue a larger revenue mobilization effort to expand priority poverty-reducing programs.
  2. The reform of the civil service needs to be accelerated to improve its composition and enhance its ability to design and implement government policies and programs.
  3. Key infrastructural services such as power, water, sanitation, and road maintenance must be revitalized.
  4. The capacity to monitor and evaluate progress must be enhanced by all entities that use public resources.
- Additional recommendations:
  - The population needs to be better informed of the nature of the SL-PRS objectives, what has been achieved, and the impact of SL-PRS achievements to reduce the gap between expectations and feasibility.
  - Authorities are encouraged to integrate their external debt management strategies into future PRSPs to prevent excessive debt accumulation in the post-debt-relief era.
  - The next Annual Progress Report should make full use of existing resources when reporting results and actions, include more participation from SL-PRS Pillar Working Groups, and report fully on all priority SL-PRS objectives with equal attention to progress realized and progress constrained.

*Source: IMF staff assessment and APR content through June 2006 provided in the supplied document.*

---


_Source: https://www.imf.org/-/media/websites/imf/imported-full-text-pdf/external/pubs/ft/scr/2007/_cr0718.pdf_