I M P ROV I N G E F F E C T I V E N E S S A N D OUT C O M E S F O R T H E P OO R I N H E A LT H , N UT R IT I O N , A N D P O P U L AT I O N
Box 4.1: Quality-at-Entry for Multisectoral Projects Is Weak
Figure 4.5: Distribution of Multisectoral HNP Projects by the Number of Assigned and Demand-Driven Implementing Agencies
In 2008, the Bank’s Quality Assurance Group (QAG) issued an assessment of quality at entry of the lending portfolio approved in fiscal 2006–07, highlighting results for multisectoral projects. QAG’s conclusions were based on a review of a sample of 10 development policy operations and 10 investment projects Bank-wide. The report expressed the following concerns about the outcomes of multisectoral projects:
10 9
Number of projects
8 7 6 5 4 3 2 1 0 0
1
2
3
4
5
6
7
8
9
10
>10
Total number of assigned and demand-driven implementing agencies Multisectoral HIV
Other multisectoral HNP
Source: IEG portfolio review.
factory projects (both in nutrition).9 The Bank’s Quality Assurance Group (QAG) recently expressed concerns with respect to quality at entry for multisectoral projects Bank-wide, across all sectors (box 4.1). Evidence from IEG field assessments of multisectoral projects in Eritrea and Ghana contrasts a project design that encouraged intersectoral collaboration with the Ministry of Health with one that mobilized a large number of actors with less Ministry oversight and collaboration (box 4.2).
The lower performance of HIV/AIDS projects drove down the outcomes of multisectoral projects as a group.
Multisectoral projects had lower outcomes than did other HNP projects, but this is mainly because of the lower performance of HIV/ AIDS projects. Fewer than half of the multisectoral projects approved and completed during fiscal 1997–2006 had satisfactory outcomes, compared with about twothirds of single-sector projects (figure 4.6).10 Bank and borrower performance were also lower for multisectoral HNP projects, although the difference for borrower performance is not statisti-
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• Excessive complexity and overly ambitious objectives • Weak institutional capacity • Lack of readiness of the first year’s program for implementation • Task teams lacking adequate technical expertise and global experience • Fragmented managerial guidance because of the multisectoral nature of the projects. Source: World Bank 2008b.
cally significant. However, the performance of non-AIDS multisectoral projects was similar to that of single-sector HNP projects, while the multisectoral HIV/AIDS projects performed at a much lower level. Both types of multisectoral HNP projects had lower institutional development impact (IDI) than other HNP projects: only 43 percent of projects had substantial or high IDI, compared with 61 percent for single-sector HNP projects.11 In sum, multisectoral projects are inherently more demanding, and their share in the HNP portfolio has doubled, almost wholly due to the increase in HIV/AIDS project approvals. Multisectoral HNP projects with objectives other than HIV/AIDS perform at levels similar to projects in the rest of the HNP portfolio, but multisectoral HIV/AIDS projects do not. The large number of sectors involved, the lack of specificity in design documents about the roles and responsibilities of each participating sector, the relatively new institutions asked to manage the complex design, and the other factors that bring about lower performance in the Africa Region likely all contribute to lower outcomes for these projects.