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Completion Report

Project Numbers: 41505-012, 41507-013, and 41508-014 Loan Number: 2699 Grant Numbers: 0231 and 0232 Grant Numbers (Additional Financing): 0448, 0449, and 0450 June 2019

Second Greater Mekong Subregion Regional Communicable Diseases Control Project This document is being disclosed to the public in accordance with ADB's Access to Information Policy.

CURRENCY EQUIVALENTS

CAMBODIA

Currency unit – riel/s (KR) At Appraisal At Project Completion

28 October 2010 31 December 2017 KR1.00 = $0.000237 $0.000248

$1.00 = KR4,226 KR4,037

LA LAO PDR

Currency unit – kip (KN) At Appraisal At Project Completion 28 October 2010 31 December 2017

KN1.00 = $0.000124 $0.000121 $1.00 = KN8,035 KN8,296

VIET NAM Currency unit – dong (D)

At Appraisal At Project Completion 28 October 2010 31 December 2017

D1.00 = $0.000051 $0.000044 $1.00 = D19,495 D22,709

ABBREVIATIONS

ADB – Asian Development Bank AOP – annual operational plan APSED – Asia Pacific Strategy for Emerging Diseases CDC – communicable disease control CLV – Cambodia, Lao PDR, and Viet Nam DMF – design and monitoring framework EGP – ethnic group plan GAP – gender action plan GMS – Greater Mekong Subregion IEC – information, education, and communication IHR – International Health Regulations Lao PDR – Lao People’s Democratic Republic MDA – mass drug administration MHV – model healthy village MOF – Ministry of Finance MOH – Ministry of Health NFP – national focal point NTD – neglected tropical disease PIU – project implementation unit

PMU – project management unit PPMU – provincial project management unit RCU – regional coordination unit RMTF – Regional Malaria and Other Communicable Disease Threats Trust

Fund S&R – surveillance and response TMT – training management team U5M – under-5 mortality VHW – village health worker WHO – World Health Organization WRA – woman of reproductive age

GLOSSARY Model healthy village

– An innovative approach designed to empower remote border villages to improve their own community’s health and living standards to help address communicable diseases through basic disease control and prevention practices, safe hygiene, and environmental cleanliness.

Malaria – A communicable disease caused by a parasite that commonly infects a type of mosquito that feeds on humans between sunset and sunrise. Malaria can be fatal but can be prevented through early diagnosis and strict adherence to treatment.

Dengue – A communicable disease widespread in tropical and subtropical countries caused by a mosquito vector that feeds on humans between early morning and evening before sunset. Community participation for sustained vector mosquito control is the best method for dengue prevention and control.

Neglected tropical diseases

– A group of communicable diseases, which include dengue, lymphatic filariasis, schistosomiasis, soil-transmitted helminthiases that exist in tropical and subtropical countries. Populations most affected are those living in poverty, with limited sanitation and water sources. Women and children suffer the most. Schistosomiasis, soil-transmitted helminthiases, and lymphatic filariasis can be controlled through mass drug administration, and improvement of water, sanitation, and hygiene.

NOTE

In this report, “$” refers to United States dollars.

Vice-President Ahmed M. Saeed, Operations 2

Director General Ramesh Subramaniam, Southeast Asia Department (SERD) Director Ayako Inagaki, Director, Human and Social Development Division, SERD Team leader Ye Xu, Health Specialist, SERD Team members Rosemary Atabug, Associate Social Development Officer (Gender and

Development), Sustainable Development and Climate Change Department Chandy Chea, Senior Social Development Officer (Gender), SERD Ralie Dusseldorf Flores, Project Analyst, SERD Luvette Miclat, Senior Project Assistant, SERD Rangina Nazrieva, Safeguard Specialist (Resettlement), SERD Theonakhet Saphakdy, Senior Social Development Officer (Gender), SERD Azusa Sato, Health Specialist, SERD Indah Setyawati, Senior Safeguards Specialist (Resettlement), SERD

Shekinah Wenceslao, Senior Operations Assistant, SERD Phoxay Xayyavong, Senior Social Sector Officer (Health), SERD

In preparing any country program or strategy, financing any project, or by making any designation of or reference to a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area.

CONTENTS

Page

BASIC DATA i

I. PROJECT DESCRIPTION 1

II. DESIGN AND IMPLEMENTATION 1

A. Project Design and Formulation 1 B. Project Outputs 2 C. Project Costs and Financing 5 D. Disbursements 6 E. Project Schedule 6 F. Implementation Arrangements 7 G. Technical Assistance 7 H. Consultant Recruitment and Procurement 8 I. Gender Equity 8 J. Safeguards 9 K. Monitoring and Reporting 9

III. EVALUATION OF PERFORMANCE 10

A. Relevance 10 B. Effectiveness 10 C. Efficiency 11 D. Sustainability 11 E. Development Impact 12 F. Performance of the Borrower and the Executing Agency 12 G. Performance of the Asian Development Bank 13 H. Overall Assessment 13

IV. ISSUES, LESSONS, AND RECOMMENDATIONS 13

A. Issues and Lessons 13 B. Recommendations 14

APPENDIXES

1. Design and Monitoring Framework 16

2. Provisional Operation Guidelines on Communicable Diseases Information Sharing between Cluster Provinces 29

3. Project Cost at Appraisal and Actual 34

4. Project Cost by Financier 39

5. Disbursement of ADB Loan and Grant Proceeds 51

6. List of Consulting Services 57

7. List of Procurement Packages 61

8. Summary of Gender Equality Results and Achievements 70

9. Summary of Ethnic Group Plan Results and Achievements 117

10. Status of Compliance with Loan and Grant Covenants 135

11. Economic and Financial Analysis 160

12. Contract Awards of ADB Loan and Grant Proceeds 163

13. Chronology of Main Events 169

BASIC DATA (Cambodia)

A. Grant Identification

1. Country Cambodia 2. Grant number and financing source 0231-CAM (SF) and 0448-CAM (RMTF) 3. Project title Second Greater Mekong Subregion Regional

Communicable Diseases Control Project 4. Borrower Kingdom of Cambodia 5. Executing agency Ministry of Health 6. Grant amounts $10 million and $4 million 7. Financing modality Project grants

B. Grant Data

1. Appraisal – Date started – Date completed

6 April 2010 and 29 July 2014 9 April 2010 and 31 July 2014

2. Grant negotiations – Date started – Date completed

11 October 2010 and 18 August 2015 12 October 2010 and 18 August 2015

3. Date of Board approval

22 November 2010 and 26 October 2015

4. Date of grant agreement

27 January 2011 and 10 November 2015

5. Date of grant effectiveness – In grant agreement – Actual – Number of extensions

27 April 2011 and 8 February 2016 22 March 2011 and 4 January 2016 1 (G0231)

6. Project completion date – Appraisal – Actual

31 December 2016 and 30 June 2017 30 June 2017

7. Grant closing date – In grant agreement – Actual – Number of extensions

30 June 2016 and 31 December 2017 31 December 2017 1 (G0231)

8. Financial closing date – Actual

28 February 2018

– Grace period (number of years) – Second-step borrower

9. Disbursements

a. Dates

a1. G0231

Initial Disbursement 6 May 2011

Final Disbursement 25 August 2016

Time Interval 64.60 months

Effective Date 22 March 2011

Actual Closing Date 31 December 2017


ii

a2. G0448

b. Amount ($ million)

b1. G0231

Category

Original Allocation

(1)

Reallocation during

Implementation (2)

Last Revised

Allocation (3=1+2)

Amount Disbursed

(4)

Undisbursed Balancea

(5 = 3–4) 1 Laboratory and Office

Equipment 2.240 (1.254) 0.986 0.901 0.085

2 Vehicles 0.380 0.055 0.435 0.515 (0.080) 3 System Development 0.460 1.221 1.681 1.611 0.070 4 Training, Workshop,

Fellowships 1.600 0.473 2.073 2.136 (0.063)

5 Community Mobilization in Cash

0.420 0.286 0.706 0.748 (0.042)

6 Consulting Services 0.920 0.126 1.046 1.025 0.021 7 Project Management 0.930 (0.064) 0.866 0.884 (0.018) 8 Recurrent Costs 1.500 0.168 1.668 1.712 (0.044) 9 Pooled Funds 0.480 0 0.480 0.380 0.100 10 Incremental CDC

Program Cost 0 0.058 0.058

0.058 0.000

11 Unallocated 1.070 -1.070 0.000 0.000 0.000 Total 10.000 0.000 10.000 9.970 0.030

( ) = negative, CDC = communicable disease control. Note: Totals may not sum precisely because of rounding. a $30,486.29 was cancelled at grant closing (28 February 2018).

b2. G0448

Category

Original Allocation

(1)

Amount Disbursed

(2)


(3 = 1–2) 1 Laboratory and Office Equipment 0.260 0.352 (0.092) 2 Vehicles 0.143 0.380 (0.238) 3 System Development 1.348 0.403 0.945 4 Training, Workshop, Fellowships 0.446 0.928 (0.482) 5 Community Mobilization in Cash 0.083 0.322 (0.238) 6 Consulting Services 0.479 0.647 (0.168) 7 Regional & Cross-Border Activities 0.417 0.250 0.167 8a Recurrent Costs – Project Management 0.285 0.136 0.150 8b Recurrent Costs – Supplies 0.291 0.316 (0.250) 9 Unallocated 0.247 0.000 0.247

Total 4.000 3.733 0.267 ( ) = negative. Note: Totals may not sum precisely because of rounding. a $266,934.74 was cancelled at grant closing (28 February 2018).

Initial Disbursement 3 March 2016

Final Disbursement 1 December 2017


Effective Date 4 January 2016



iii

C. Project Data

1. Project cost ($ million)

1.1 G0231

Appraisal Estimate Actual 11.00 10.76

1.2 G0448


2. Financing plan ($ million)

2.1 G0231

Cost Appraisal Estimate Actual Implementation cost Borrower financed 1.00 0.79 ADB financed 10.00 9.97 Other external financing 0.00 0.00 Total implementation cost 11.00 10.76

ADB = Asian Development Bank.

2.2 G0448



3. Cost breakdown by project component ($ million)

3.1 G0231

Component Appraisal Estimate Actual 1. Strengthening regional CDC systems 4.90 4.56 2. Improved CDC 2.80 4.01 3. Integrated project management 2.20 2.14

Contingencies 1.10 0.05 Total 11.00 10.76

CDC = communicable disease control.

3.2 0448




iv

4. Project schedule

4.1 G0231

Item Appraisal Estimate Actual Date of contract with consultants First contract (individual) Q1 2011 1 April 2011 Last contract (individual) Q3 2012 27 October 2017 First contract (firm) Q1 2011 11 September 2012 Last contract (firm) - 4 September 2014 Goods (equipment and vehicles) First procurement Q1 2011 12 August 2011 Last procurement Q3 2012 23 August 2017 Other milestones First extension of grant closing date - 16 September 2015

4.2 G0448

Item Appraisal Estimate Actual Date of contract with consultants First contract (individual) Q4 2015 1 January 2016 Last contract (individual) Q4 2015 16 March 2017 First contract (firm) Q4 2015 17 February 2017 Last contract (firm) - 3 July 2017 Goods (equipment and vehicles) First procurement Q4 2015 23 May 2016 Last procurement Q4 2015 5 December 2017

5. Project performance report ratings

5.1 G0231

Implementation Period Single Project Rating From 22 March 2011 to 31 December 2011 On track From 1 January 2012 to 31 December 2012 On track From 1 January 2013 to 31 December 2013 On track From 1 January 2014 to 31 December 2014 On track From 1 January 2015 to 31 December 2015 On track From 1 January 2016 to 31 December 2016 On track From 1 January 2017 to 31 December 2017 On track

5.2 G0448

Implementation Period Single Project Rating From 4 January 2016 to 31 December 2016 On track From 1 January 2017 to 31 December 2017 On track

D. Data on Asian Development Bank Missions

1. G0231

Name of Missiona Date No. of

Persons No. of

Person-Days Specialization of Membersb

Fact-finding mission 6–9 April 2010 2 4 a, b Inception mission 27–29 June 2011 2 3 a, c Review mission 1 5–7 December 2011 2 3 a, d Special project administration mission 23–27 July 2012 2 5 a, c Review mission 2 30 November–4

December 2012 4 3 a, c, d, e

Consultation mission 14–15 January 2013 2 2 a, d Midterm review mission 2–7 May 2013 5 4 a, c, d, f, g, h Consultation mission 26–28 September 2013 3 3 a, f, g, i Review mission 3 10–14 March 2014 4 5 c, f, g, j

v


Persons No. of


Review mission 4 13–14 October 2014 4 2 c, f, g, j Review mission 5 2–6 November 2015 3 5 f, k, l Review mission 6 18–24 August 2016 5 5 c, f, m Review mission 7 17–23 May 2017 6 5 c, g, m, n, o Project completion reviewc 22–26 October 2018 6 5 c, d, p, q, r, s, t, u

a Some missions were fielded concurrently with other missions. b a = project officer/lead health specialist, b = consultant/regional coordinator, c = associate project analyst/project

analyst, d = senior social development officer (gender), e = consultant/laboratory management expert, f = project officer/senior health specialist, g = consultant/regional coordinator, h = senior social sector specialist; i = social sector specialist, j = consultant/public health specialist, k = consultant/health specialist; l = alternate executive director; m = project officer/health specialist, n = consultant/knowledge management specialist, o = consultant/monitoring and evaluation specialist, p = project officer/young professional (health), q = safeguards specialist (resettlement), r = consultant/gender specialist, s = consultant/project completion report (project evaluation specialist), t = associate social development officer (gender and development), u = consultant/safeguards specialist.

c The project completion review mission comprised Y. Xu, Health Specialist, Human and Social Development Division (SEHS); R. Nazrieva, Safeguards Specialist (Resettlement); C. Chea, Senior Social Development Officer (Gender), Cambodia Resident Mission (CARM); R. Atabug, Associate Social Development Officer (Gender and Development); R.D. Flores, Project Analyst, SEHS; L. Tabora, Project Evaluation Specialist (consultant); P. Chea, Gender Specialist (consultant); and T. Sareivouth, Safeguard Specialist (consultant).

2. G0448


Persons No. of

Person-Days Specialization of

Membersb Fact-finding mission 29–31 July 2014 8 3 a, b, c, d, e, f, g, h Inception mission 18–24 August 2016 3 5 a, i, j Review mission 1 17–23 May 2017 2 5 i, j, k, l, m Project completion reviewc 22–26 October 2018 6 5 j, n, o, p, q, r, s, t

a Some missions were fielded concurrently with other missions. b a = project officer/senior health specialist, b = lead health specialist, c = senior social sector officer, d =

consultant/public health specialist, e = consultant/technical advisor, f = consultant/program coordinator, g = consultant/project administrator, h = consultant/project administration and support consultant, i = project officer/health specialist, j = associate project analyst/project analyst, k = consultant/regional coordinator, l = consultant/knowledge management specialist, m = consultant/monitoring and evaluation specialist, n = young professional (health specialist), o = senior social development officer (gender), p = safeguards specialist (resettlement), q = consultant/gender specialist, r = consultant/project completion report (project evaluation specialist), s = associate social development officer (gender and development), t = consultant/safeguards specialist.

c The project completion review mission comprised of Y. Xu, Health Specialist, Human and Social Development Division (SEHS); R. Nazrieva, Safeguards Specialist (Resettlement); C. Chea, Senior Social Development Officer (Gender), Cambodia Resident Mission (CARM); R. Atabug, Associate Social Development Officer (Gender and Development); R.D. Flores, Project Analyst, SEHS; L. Tabora, Project Evaluation Specialist (consultant); P. Chea, Gender Specialist (consultant); and T. Sareivouth, Safeguard Specialist (consultant).

vi

BASIC DATA (Lao PDR)

A. Grant Identification

1. Country Lao PDR 2. Grant number and financing source 0232-LAO (SF) and 0449-LAO (RMTF) 3. Project title Second Greater Mekong Subregion Regional

Communicable Diseases Control Project 4. Borrower Lao People’s Democratic Republic 5. Executing agency Ministry of Health 6. Grant amounts $12 million and $3 million 7. Financing modality Project grants

B. Grant Data



2. Grant negotiations – Date started – Date completed




4. Date of grant agreement

8 December 2010 and 17 November 2015

5. Date of grant effectiveness – In grant agreement – Actual – Number of extensions

8 March 2011 and 15 February 2016 22 March 2011 and 4 January 2016 1 (G0232)



7. Grant closing date – In grant agreement – Actual – Number of extensions

30 June 2016 and 31 December 2017 31 December 2017 1 (G0232)


29 August 2018

– Grace period (number of years) – Second-step borrower

9. Disbursements

a. Dates

a1. G0232

Initial Disbursement 27 April 2011

Final Disbursement 28 April 2017


Effective Date 22 March 2011



vii

a2. G0449


b1. G0232

Category

Original Allocation

(1)

Reallocation during

Implementation (2)

Last Revised

Allocation (3=1+2)

Amount Disbursed

(4)



Equipment 2.360 0.281 2.641 2.799 (0.158)

2 Vehicles 0.600 0.018 0.618 0.618 0.000 3 System Development 0.500 (0.189) 0.311 0.328 (0.017) 4 Training, Workshop,

Fellowships 2.100 0.061 2.161 2.171 (0.010)


0.650 0.649 1.299 1.282 0.017

6 Consulting Services 1.100 0.000 1.100 0.927 0.173 7 Project Management 1.220 (0.074) 1.378 1.244 0.135 8 Recurrent Costs 1.770 0.056 1.696 1.840 (0.144) 9 Pooled Funds 0.740 (0.960) 0.796 0.786 0.010 10 Unallocated 0.960 0.000 0.000 0.000 0.000

Total 12.000 0.000 12.000 11.995 0.005 ( ) = negative. Note: Totals may not sum precisely because of rounding. a $5,289.95 was cancelled at grant closing (29 August 2018).

b2. G0449

Category

Original Allocation

(1)

Amount Disbursed

(2)


(3 = 1–2) 1 Laboratory and Office Equipment 0.257 0.343 (0.086) 2 Vehicles 0.053 0.000 0.053 3 System Development 0.381 0.181 0.201 4 Training, Workshop, Fellowships 0.530 0.326 0.204 5 Community Mobilization in Cash 0.325 0.386 (0.061) 6 Consulting Services 0.430 0.517 (0.087) 7 Regional & Cross-Border Activities 0.217 0.365 (0.149) 8a Recurrent Cost- Project Management 0.579 0.767 (0.187) 8b Recurrent Costs - Supplies 0.106 0.047 0.059 9 Unallocated 0.121 0.000 0.121

Total 3.000 2.933 0.067 ( ) = negative. Note: Totals may not sum precisely because of rounding. a $66,783.97 was cancelled at grant closing (29 August 2018).

C. Project Data


1.1 G0232


Initial Disbursement 28 March 2016

Final Disbursement 14 September 2017


Effective Date 4 January 2016



viii

1.2 G0449



2.1 G0232


2.1 G0449




3.1 G0232




3.2 G0449




4. Project schedule

4.1 G0232

Item Appraisal Estimate Actual Date of contract with consultants First contract (individual) Q1 2011 1 December 2010 Last contract (individual) Q3 2012 2 September 2013 First contract (firm) Q1 2011 1 February 2011 Last contract (firm) Q3 2012 - Goods (equipment and vehicles) First procurement Q1 2011 30 September 2011 Last procurement Q3 2012 23 February 2016 Other milestones First extension of grant closing date - 16 September 2015

ix

4.2 G0449

Item Appraisal Estimate Actual Date of contract with consultants First contract (individual) Q4 2015 4 January 2016 Last contract (individual) Q4 2015 1 May 2016 First contract (firm) Q4 2015 1 August 2016 Last contract (firm) - - Goods (equipment and vehicles) First procurement Q4 2015 10 May 2016 Last procurement Q1 2016 13 December 2017


5.1 G0232

Implementation Period Single Project Rating From 22 March 2011 to 31 December 2011 On track From 1 January 2012 to 31 December 2012 On-track From 1 January 2013 to 31 December 2013 On track From 1 January 2014 to 31 December 2014 On track From 1 January 2015 to 31 December 2015 On track From 1 January 2016 to 31 December 2016 On track From 1 January 2017 to 31 December 2017 On track

5.2 G0449

Implementation Period Single Project Rating From 4 January 2016 to 31 December 2016 On track From 1 January 2017 to 31 December 2017 On track


1. G0232


Persons No. of


Fact-finding mission 19–23 April 2010 4 5 a, b, c, d Inception mission 7–10 June 2011 2 4 a Review mission 1 28 November–2

December 2011 4 5 a, e, f, g

Special project administration mission 2–6 July 2012 3 5 a, f, g Review mission 2 15–20 November 2012 4 4 a, f, h, i Consultation mission 9–11 January 2013 2 3 a, j Midterm review mission 8–15 May 2013 5 6 a, b, h, i, k Consultation mission 1–2 October 2013 3 2 a, b, k, Review mission 3 13–19 December 2013 2 5 b, i Review mission 4 17–22 September 2014 1 4 b Review mission 5 26–30 January 2015 4 5 b, f, g, i Review mission 6 16–20 November 2015 1 5 l Review mission 7 22–27 July 2016 2 4 i, m Review mission 8 26 April–2 May 2017 7 5 e, f, i, k, m, n, o Project completion reviewc 26–30 November 2018 6 5 e, f, i, p, q, r

a Some missions were fielded concurrently with other missions. b a = project officer/lead health specialist, b = project officer/senior health specialist, c = social development specialist

(gender and development), d = counsel, e = senior social development officer (gender), f = senior social sector officer (health), g = associate project analyst (resident mission), h = senior social sector specialist, i = associate project analyst/project analyst, j = social sector economist, k = consultant/regional coordinator, l = consultant/health specialist, m = project officer/health specialist, n = consultant/knowledge management specialist, o = consultant/monitoring and evaluation specialist, p = project officer/young professional (health), q = consultant/safeguards, r = consultant/project completion report (project evaluation specialist).

x

c The project completion review mission comprised of Y. Xu, Health Specialist, Human and Social Development Division (SEHS); P. Xayyavong, Senior Social Sector Officer (Health), Lao Resident Mission (LRM); T. Saphakdy, Senior Social Development Officer (Gender), LRM; R.D. Flores, Project Analyst, SEHS; L. Tabora, Project Evaluation Specialist (consultant); C. Insouvanh, Safeguards consultant.

2. G0449


Persons No. of


Membersb Fact-finding mission 29–31 July 2014 8 3 a, b, c, d, e, f, g, h Inception mission 22–27 July 2016 2 4 i, j Review mission 1 26 April–2 May 2017 7 5 c, i, j, k, l, m, n Project completion reviewc 26–30 November 2018 6 5 c, j, n, o, p, q

a Some missions were fielded concurrently with other missions. b a = project officer/senior health specialist, b = lead health specialist, c = senior social sector officer (health), d =

consultant/public health specialist, e = consultant/technical advisor, f = consultant/program coordinator, g = consultant/project administrator, h = consultant/project administration and support consultant, i = project officer/health specialist, j = associate project analyst/project analyst, k = consultant/regional coordinator, l = consultant/knowledge management specialist, m = consultant/monitoring and evaluation specialist, n = senior social development officer (gender), o = project officer/young professional (health), p = consultant/safeguards, q = consultant/project completion report (project evaluation specialist),

c The project completion review mission comprised of Y. Xu, Health Specialist, Human and Social Development Division (SEHS); P. Xayyavong, Senior Social Sector Officer (Health), Lao Resident Mission (LRM); T. Saphakdy, Senior Social Development Officer (Gender), LRM; R.D. Flores, Project Analyst, SEHS; L. Tabora, Project Evaluation Specialist (consultant); C. Insouvanh, safeguards consultant.

xi

BASIC DATA (Viet Nam)

A. Loan and Grant Identification

1. Country Viet Nam 2. Loan and Grant numbers and financing

source Loan 2699-VIE (SF) and Grant 0450-VIE (RMTF)

3. Project title Second Greater Mekong Subregion Regional Communicable Diseases Control Project

4. Borrower Socialist Republic of Viet Nam 5. Executing agency Ministry of Health 6. Amounts of loan and grant

SDR17,263,000 ($27million equivalent) and $2.5 million

7. Financing modality Project loan and project grant B. Loan and Grant Data



2. Loan and Grant negotiations – Date started – Date completed




4. Date of loan and grant agreement

23 February 2011 and 19 February 2016

5. Date of loan and grant effectiveness – In loan and grant agreement – Actual – Number of extensions

24 May 2011 and 19 May 2016 20 May 2011 and 19 May 2016



7. Loan and Grant closing date – In loan and grant agreement – Actual – Number of extensions

30 June 2016 and 31 December 2017 31 December 2017 1 (L2699)


13 July 2018

9. Terms of loan – Interest rate – Maturity (number of years) – Grace period (number of years)

1% per annum during the grace period 1.5% per annum after the grace period 32 years 8 years

xii

10. Disbursements

a. Dates

a1. L2699

Initial Disbursement 4 August 2011

Final Disbursement 9 January 2017


Effective Date 20 May 2011



a2. G0450

Initial Disbursement 13 July 2016

Final Disbursement 3 May 2017


Effective Date 19 May 2016




b.1 L2699 ($ million)

Category

Original

Allocation (1)

Reallocation during

Implementation

(2)

Last Revised Allocationa

(3=1+2) Amount

Disbursed (4)

Undisbursed Balanceb

(5=3–4) 1 Laboratory and Office

Equipment 10.810 2.146 12.956 12.620 0.336

2 Vehicles 2.490 0.455 2.945 2.814 0.132 3 System Development 1.350 0.284 1.634 1.436 0.198 4 Training, Workshop,

Fellowships 3.170 (0.240) 2.929 2.919 0.010


1.100 (0.018) 1.082 0.998 0.084

6 Consulting Services 1.300 (0.168) 1.132 1.074 0.059 7 Project Management 1.020 (0.003) 1.017 0.892 0.125 8 Recurrent Costs 2.070 0.440 2.510 2.292 0.218 9 Interest Charge 0.790 0.003 0.793 0.725 0.068 10 Unallocated 2.900 (2.900) 0.000 0.000 0.000

Total 27.000 0.000 27.000 25.770 1.230 Notes: Total may not sum up due to rounding off. ( ) = negative. a Actual $ equivalent may differ because of SDR forex fluctuation. Used forex at appraisal for uniformity. b $ equivalent of SDR125,137.81 was cancelled at loan closing (13 July 2018).

b.2 L2699 (SDR million)

Category

Original Allocation

(1)

Reallocation during

Implementation (2)

Last Revised Allocation

(3=1+2) Amount

Disbursed (4)



Equipment 6.913 1.371 8.284 8.391 (0.107)

2 Vehicles 1.590 0.293 1.883 1.883 0.093 3 System Development 0.864 0.181 0.952 0.952 (0.030) 4 Training, Workshop,

Fellowships 2.026 (0.153) 1,903 1.903 0.034


0.864 (0.014) 0.658 0.658 0.006

6 Consulting Services 0.831 (0.107) 0.719 0.719 0.060 7 Project Management 0.650 0.000 0.650 0.590 0.070 8 Recurrent Costs 1.323 0.282 1.605 1.535 0.070

9 Interest Charge 0.507 0.000 0.507 0.507 0.000

xiii

Category

Original Allocation

(1)

Reallocation during

Implementation (2)


(3=1+2) Amount

Disbursed (4)


(5 = 3–4) 10 Unallocated 1.853 (1.853) 0 0 0

Total 17.263 0.000 17.263 17.138 0.125 ( ) = negative. Note: Totals may not sum precisely because of rounding. a SDR125,137.81 was cancelled at loan closing (13 July 2018).

b.3 G0450 ($ million)

Category

Original Allocation

(1)

Cancelled during

Implementation (2)


(3=1-2) Amount

Disbursed (4)



Equipment 0.156 0.000

0.156 0.149 0.007

2 System Development 1,065 (0.104) 0.961 0.965 (0.004) 3 Training, Workshop,

Fellowships 0.352 0.00

0.352 0.318 0.035

4 Community Mobilization 0.150 0.00 0.150 0.171 (0.021) 5 Consulting Services 0.145 (0.118) 0.027 0.007 0.020 6 Regional & Cross-

Border Activities 0.264 (0.100)

0.164 0.182 (0.018

7 Project Management 0.211 0.000 0.211 0.229 (0.018) 8 Unallocated 0.157 (0.157) 0.000 0.000 0.00

Total 2.500 (0.478) 2.022 2.021 0.111

( ) = negative. Note: Totals may not sum precisely because of rounding. a First partial cancellation of $174,600 was approved on 1 September 2017; second partial cancellation of $303,894.26 was approved on 21 December 2017. b $110.88 was cancelled at grant closing date (12 July 2018).

C. Project Data


1.1 L2699


1.2 G0450



2.1 L2699



xiv

2.1 G0450


ADB = Asian Development Bank


3.1 L2699


Contingencies 3.40 0.00 Financing Charges During Implementation 0.80 0.73 Total 30.00 28.40


3.2 G0450




4. Project schedule

4.1 L2699

Item Appraisal Estimate Actual Date of contract with consultants First contract (individual) Q1 2011 1 February 2012 Last contract (individual) Q3 2012 1 April 2016 First contract (firm) Q3 2012 25 December 2012 Last contract (firm) Q3 2012 14 April 2017 Goods (equipment and vehicles) First procurement Q2 2011 7 May 2012 Last procurement Q3 2012 27 October 2016 Other milestones First extension of grant closing date - 16 September 2015

4.2 G0450

Item Appraisal Estimate Actual Date of contract with consultants First contract (individual) - - Last contract (individual) - - First contract (firm) Q4 2015 2 July 2017 Last contract (firm) - -- Goods (equipment and vehicles) First procurement Q4 2015 6 February 2017 Last procurement Q4 2015 9 March 2017

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5.1 L2699

Implementation Period Single Project Rating From 20 May 2011 to 31 December 2011 Potential problem From 1 January 2012 to 31 December 2012 On track From 1 January 2013 to 31 December 2013 On track From 1 January 2014 to 31 December 2014 On track From 1 January 2015 to 31 December 2015 On track From 1 January 2016 to 31 December 2016 On track From 1 January 2017 to 31 December 2017 On track

5.2 G0450

Implementation Period Single Project Rating From 19 May 2016 to 31 December 2016 On track From 1 January 2017 to 31 December 2017 On track


1. L2699


Persons No. of


Membersb Fact-finding mission 12–16 April 2010 4 5 a, b, c, d Inception mission 30 May–3 June 2011 1 5 a Review mission 1 8–9 December 2011 2 2 a, e Special project administration mission 30 July–9 August 2012 3 5 a, e, f Review mission 2 22–28 November 2012 2 5 a, e Midterm review mission 16–21 May 2013 5 4 a, b, e, f, g Consultation mission 5–6 September 2013 3 2 a, e, g Review mission 3 31 March–4 April 2014 10 5 b, e, f, g, h, i, j, k, l Review mission 4 27–31 October 2014 4 3 b, e, g, i Review mission 5 5–8 October 2015 3 4 b, f, m Review mission 6 4–8 July 2016 2 5 f, n Review mission 7 25–31 May 2017 5 5 f, g, n, o, p Project completion reviewc 19–23 November 2018 7 5 f, q, r, s, t, u, v

a Some missions were fielded concurrently with other missions. b a = project officer/lead health specialist, b = project officer/senior health specialist, c = social development specialist

(gender and development), d = counsel; e = senior social sector officer, f = associate project analyst/project analyst, g = consultant/regional coordinator, h = senior social development officer (gender), i = consultant/program team leader, j = consultant/program coordinator, k = consultant/chief technical advisor, l = consultant/national project coordinator, m = staff consultant/health specialist, n = project officer/health specialist, o = consultant/knowledge management specialist, p = consultant/monitoring and evaluation specialist, q = project officer/young professional (health), r = senior safeguards specialist (resettlement), s = consultant/gender specialist, t = consultant/international project completion report (project evaluation specialist), u = consultant/national project completion report, v = consultant/gender.

c The project completion review mission comprised Y. Xu, Health Specialist, Human and Social Development Division (SEHS); I. Setyawani, Senior Safeguards Specialist (Resettlement), Viet Nam Resident Mission; R.D. Flores, Project Analyst, SEHS; L. Tabora, Project Evaluation Specialist (consultant); D.T. Hang, national project completion report consultant; and T.H. Tran, gender consultant.

2. G0450


Persons No. of


Membersb Fact-finding mission 29–31 July 2014 8 3 a, b, c, d, e, f, g, h Inception mission 4–8 July 2016 2 5 i, j Review mission 1 25–31 May 2017 5 5 i, j, k, l, m Project completion reviewc 19–23 November 2018 7 5 j, n, o, p, q, r, s

a Some missions were fielded concurrently with other missions.

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b a = project officer/senior health specialist, b = lead health specialist, c = senior social sector officer, d = consultant/public health specialist, e = consultant/technical advisor, f = consultant/program coordinator, g = consultant/project administrator, h = consultant/project administration and support consultant, i = project officer/health specialist, j = associate project analyst/project analyst, k = consultant/regional coordinator, l = consultant/knowledge management specialist, m = consultant/monitoring and evaluation specialist, n = project officer/young professional (health), o = senior safeguards specialist (resettlement), p = consultant/gender specialist, q = consultant/international project completion report (project evaluation specialist), r = consultant/national project completion report, s = consultant/gender.

c The project completion review mission comprised Y. Xu, Health Specialist, Human and Social Development Division (SEHS); I. Setyawani, Senior Safeguards Specialist (Resettlement), Viet Nam Resident Mission; R.D. Flores, Project Analyst, SEHS; L. Tabora, Project Evaluation Specialist (consultant); D.T. Hang, national project completion report consultant; and T.H. Tran, gender consultant.

I. PROJECT DESCRIPTION 1. The Greater Mekong Subregion (GMS) countries are vulnerable to communicable and neglected tropical diseases because of a conducive climate and environment, the weak foundation of health systems, and a lack of sustainable financing to scale up interventions. Emerging infectious diseases, mostly of animal origin, pose a constant threat. Neglected tropical diseases (NTDs) such as dengue, and diseases with outbreak potential, such as measles, cholera, typhoid, and Japanese encephalitis, continue to spread. Better connectivity of goods and services and increased mobility of the GMS population further raise the risks of cross-border transmission. Communicable disease outbreaks are associated with significant direct and indirect economic and social costs; the governments of the GMS countries have therefore given high priority to communicable disease control (CDC). 2. Successful CDC not only depends on strong national surveillance and preventive efforts but also on the collective actions of neighboring countries to coordinate monitoring and response. The Second GMS Regional Communicable Diseases Control Project was the second project of the Asian Development Bank (ADB) in the GMS in support of stronger national CDC systems and regional cooperation for CDC, with the participation of Cambodia, the Lao People’s Democratic Republic (Lao PDR), and Viet Nam (together, the CLV countries).1 It built on the successful experiences from the first project2 to further enhance regional collaboration systems (Output 1), improve CDC along borders and economic corridors (Output 2), and implement integrated project management (Output 3). The expected project outcome was the timely and adequate control of communicable diseases of regional relevance. The outcome and outputs contributed to the impact of improved health of the GMS population. The project was approved on 22 November 2010 and was financed by $49 million in grants and a loan, all from ADB, and $5 million in counterpart funds from the CLV governments.3 Additional financing of $9.5 million was approved on 26 October 2015, extending support to malaria elimination.4 The revised design and monitoring framework (DMF) and the assessment of achievements are in Appendix 1.

II. DESIGN AND IMPLEMENTATION A. Project Design and Formulation 3. The CLV governments are highly committed to collaboratively controlling and preventing communicable diseases and ensuring regional health security. 5 An agreed common strategy is to collectively seek compliance with the International Health Regulations (IHR) 2005 core capacities, and to jointly implement the Asia Pacific Strategy for Emerging Diseases (APSED)6

1 ADB. Second Greater Mekong Subregion Regional Communicable Diseases Control Project. 2 ADB. Greater Mekong Subregion Regional Communicable Diseases Control Project. 3 Cambodia received a grant of $10 million, the Lao PDR received a grant of $12 million, and Viet Nam received a

loan of $27 million. Counterpart funds contributed by the governments were $1 million each from Cambodia and the Lao PDR, and $3 million from Viet Nam.

4 Additional financing to fight malaria is financed through the Regional Malaria and Other Communicable Disease Threats Trust Fund (RMTF). Financing partners: the governments of Australia, Canada, and the United Kingdom.

5 Their commitments were voiced at high-level political events such as the GMS Summit of Leaders; and the November 2018 meeting of Association of Southeast Asian Nations representatives in Bali: ASEAN Health Ministers renew commitment to fight communicable and emerging infectious diseases.

6 The IHR 2005, a global framework endorsed by the 58th World Health Assembly, provide a legal instrument intended to identify core minimum capacities that need to be implemented nationally; World Health Organization (WHO). Asia-Pacific strategy for emerging diseases (APSED).

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and the World Health Organization (WHO) malaria elimination strategy for the GMS.7 Each country adopted health sector strategies and action plans with CDC as a priority (i.e., Cambodia’s Second Health Strategic Plan 2008–2015; the Lao PDR’s National Strategy on Emerging Infectious Diseases 2006–2010; and Viet Nam’s Law on Prevention and Control of Infectious Diseases enacted in 2008). The design of the project was aligned with these international commitments and national strategies and policies. 4. The project design also aligned with ADB’s long-term strategic frameworks,8 its Regional Cooperation and Integration Strategy,9 and the Health Sector Operations Plan (2015–2020), which emphasize ADB’s important role in supporting regional health security as a regional public goods. It was also consistent with ADB’s country partnership strategies and country operations business plans for the CLV countries. 5. The project was designed to achieve better targeting of vulnerable populations by focusing on border districts and remote communities, establishing stronger provincial training systems and adopting community-based CDC, and further strengthening the cross-border cooperation mechanisms. While the project has an integrated regional approach with common objectives, each country component was adapted to the country needs. 6. The project received a grant of $9.5 million in additional financing to contain artemisinin-resistant malaria after it was found in 2008 along the Thai–Cambodian border. With the additional financing, the scope of the project was expanded to include malaria-related activities and performance indicators in the DMF. The project closing date was extended from 30 June 2016 to 31 December 2017. The additional financing enhanced the relevance of the project design since it addressed the unique challenge of drug-resistant malaria in the GMS and provided timely support to limit the potential spread of drug-resistant malaria from the GMS to other regions. B. Project Outputs 7. Output 1: Enhanced regional CDC systems. The first output supported regional and national disease surveillance and control, and aimed to (i) improve the capacity for regional cooperation in CDC, (ii) expand surveillance and response (S&R) systems, and (iii) target support for emerging infectious diseases and NTDs. Most planned activities were successfully conducted, and output targets were fully or substantially achieved. 8. Improved capacity for regional cooperation. Under the project, IHR–APSED national focal points (NFPs) were assigned in the CLV countries to serve as the key CDC contacts and facilitators of regional collaboration. The NFPs monitored progress in building IHR core capacities and coordinated CDC efforts among S&R units, public health facilities, other government offices, and development partners. The NFPs led the regional dialogue, information exchange, knowledge sharing, and joint policy making. They were instrumental in the adoption of the standard protocol for cross-border communicable disease information sharing (Appendix 2). 9. The CLV countries jointly implemented the WHO Regional CDC strategy (i.e., APSED) as a guiding tool for strengthening CDC systems to achieve the IHR (2005) core capacities. Joint implementation workshops on IHR–APSED were conducted annually, and cross-border action

7 WHO. Strategy for Malaria Elimination in the Greater Mekong Subregion (2015–2030). 8 ADB. 2008. Strategy 2020: Working for an Asia and Pacific Free of Poverty. Manila; and ADB. 2018. Strategy 2030

Achieving a Prosperous, Inclusive, Resilient, and Sustainable Asia and the Pacific. Manila. 9 ADB. 2006. Regional Cooperation and Integration Strategy. Manila.

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plans that included malaria control activities were developed among neighboring cluster provinces. Numerous regional workshops and technical forums (including five focusing on malaria elimination) discussed specific aspects of IHR–APSED, such as laboratory services, the control of zoonoses, hospital infection prevention and control, and emergency management systems. In all, 45 cross-border information meetings and one joint simulation exercise took place since 2016. Cambodia and Viet Nam are already reporting significant outbreaks across the border within 24 hours. All countries conducted joint external evaluations of IHR compliance with WHO (Cambodia: 2016; Lao PDR: 2017; Viet Nam: 2016). 10 The evaluation results showed a meaningful improvement in overall compliance with IHR (2005) in the CLV countries, noting particular strengths in the areas of coordination, communication and advocacy, and surveillance, to which this project contributed substantially.

10. Knowledge management was strengthened and sustained under the project. In particular, the project supported the CLV countries in updating their knowledge management plans and developing knowledge materials, such as CDC good practices in communities and effective use of information communication technology to support the CDC surveillance system. A regional CDC website and country-specific project sites were maintained and regularly updated with information on project-related initiatives, outbreak situations, news releases, monthly bulletins, and knowledge products such as MOH strategies; guidelines and policy documents; project reports and maps; survey reports; and information, education, and communication (IEC) materials. The project also promoted the inclusion of gender contents in CDC training curricula, human resource plans, and cross-border activities. 11. Expanded surveillance and response systems. The project contributed to substantially improved national S&R systems11 through its support to outbreak investigation, rapid reporting and response, and laboratory services. Villages and districts routinely reported event-based outbreak information. Increased reporting of disease outbreaks had already been noted as the project progressed. Rapid response capacity improved thanks to functioning emergency response centers and response teams at all levels. The project provided equipment and vehicles to facilitate outbreak response, especially in remote villages. Health staff and volunteers received training on immediate investigation and response. Small funding was made available for initial investigation of and response to incidents so as to prevent more serious disease outbreaks. Joint outbreak investigation and response in border villages was also promoted. Essential laboratory equipment and consumables for stronger diagnostic capacity were procured and provided to targeted provincial and district laboratories. Laboratory staff received competency-based training aimed to improve the reliability and safety of diagnostic services. Though additional financing, the project helped update the vector surveillance and control guidelines as well as training manuals, procured vector control equipment, and trained staff on malaria diagnosis, use of diagnostic equipment, administration of anti-malarial drugs, and reporting malaria cases through the district health information systems. 12. Targeted support for emerging and neglected diseases. Numerous control measures for dengue and NTDs were taken. The project supported Cambodia’s schistosomiasis and filariasis prevalence study in 2014, as well as the finalization of the National Dengue Control Strategy 2013–2020. Dengue control interventions (e.g., rapid testing) and clinical case management training were implemented in the CLV project provinces that had a high burden of

10 WHO. 2017. Joint external evaluation of IHR core capacities of the Kingdom of Cambodia. Geneva; WHO. 2017.

Joint External Evaluation of IHR Core Capacities of the Lao People’s Democratic Republic. Geneva; WHO. 2017. Joint External Evaluation of IHR Core Capacities of Viet Nam. Geneva.

11 The Cambodia Early Warning System; Early Warning, Alert, and Response Network of the Lao PDR; and Viet Nam’s electronic communicable disease surveillance software

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the disease. In Viet Nam, the project supported additional preventive care, such as tetanus vaccination for women of reproductive age (WRAs), and vaccination against Japanese encephalitis and diphtheria for ethnic minority groups in remote and border areas. 13. Output 2: Improved CDC along borders and economic corridors. This output sought to improve community-based CDC by developing model healthy villages (MHVs) in isolated and poor border areas. It also aimed to improve provincial staff’s capacity for CDC through a sustainable training system. 14. Improved community-based CDC. The project established 699 MHVs in poor and remote communities. The MHV concept is consistent with the principles of primary health care and implements community-based prevention and control of communicable diseases. Project strategies and activities included health education, community mobilization, behavioral change communication on hygiene, and CDC. Mass drug administration (MDAs) for NTDs were conducted. Some villages received latrine materials to improve sanitation. Volunteer village health workers (VHWs) were mobilized and trained to promote CDC practices and a healthy lifestyle. Viet Nam reduced the number of MHVs supported by the project12 but included additional features such as the provision of first-aid packages to VHWs; and “clean-born” delivery packages for safe delivery at home, targeting ethnic minority women in isolated communes. 15. The project promoted joint cross-border activities among border districts. This included weekly cross-border CDC information exchange at checkpoints and border districts, simulation exercises, and joint workshops and training. Despite good efforts, the target of two or more cross-border activities per year was only substantially achieved given the complexities of organizing joint activities in border districts. Through additional financing, Cambodia and Viet Nam were able to reach targets on cross-border activities focusing on malaria, including malaria management among the mobile population in border areas. In the Lao PDR, only half of the project border districts participated in joint activities. 16. Improved staff capacity for CDC. The project established a provincial training management system in the CLV countries. This comprised a core training management team (TMT) in each province, responsible for conducting training needs assessments, and identifying and engaging trainers across a range of technical and competency areas, including clinical skills, technical areas, management, public health, and finance. The project developed training materials for TMTs to guide their operations. The TMTs then coordinated the training in each province, developed training budgets, implemented the training, and evaluated training results. In all 38 project provinces, the provincial training system was well established and functional, and their respective training plans integrated into provincial annual operation plans (AOPs). In the Lao PDR, the training system was even adopted by other provinces not targeted under the project. 17. About 1,500 training workshops were conducted on a wide range of topics targeted at more than 60% of all CDC staff and all the VHWs. While the target of training CDC staff was achieved in all three countries, Viet Nam was only able to train 52% of all VHWs, reporting difficulties in reaching those in remote communities. VHWs received training on IEC delivery and community mobilization, practical methods of vector control, and disease symptoms. Trained VHWs in targeted districts substantially achieved the required basic competencies, but they would need refresher training on more difficult technical subjects such as malaria prevention and control. CDC staff received training on surveillance, outbreak investigation and response, laboratory

12 Other donors, such as the United Nations Children Fund (UNICEF), also supported the MHVs, so the reduction was

to avoid overlapping efforts.

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diagnosis, and data management and analysis. Post-training assessments concluded that trained CDC staff showed 80% basic competencies on defined CDC skills in the Lao PDR and Viet Nam. Lower competency levels were registered in Cambodia because of more stringent performance indicators. In addition to in-service training, the project provided scholarships for field epidemiology and for members of ethnic groups to be trained as health staff. These activities contributed to an increase in health and CDC human resources at all levels.

18. Output 3: Integrated project management. The third output supported effective and sustainable project management through project management units (PMUs) and project implementation units (PIUs). The PMUs provided administrative and financial management and helped coordinate with the PIUs, the regional coordination unit (RCU), and ADB. They also took the lead in sustaining project activities, ensuring compliance with social safeguard and loan covenants, and executing monitoring and evaluation. The PMUs supervised the implementation and reporting on the gender action and ethnic group plans. Provincial expenditures and accounts were closely monitored to ensure suitable investments and the topping-up of provincial subaccounts. Through training and practice, provincial staff improved their competency in results-based planning. PIUs staff also received training and district staff received orientation on results-based planning. In addition, PIUs were trained on integrating CDC in AOPs, including training plans, cross-border activities, and malaria incidence targets. Guidance manuals on procurement and disbursement were made available, and project staff received related orientation. Results-based planning was observed in the preparation of the 5-year implementation plan for the project and the AOPs for each country. All provincial AOPs included CDC targets with special attention to cross-border activities, in-service training, gender and ethnic group-oriented activities, as well as malaria incidence targets under additional financing. C. Project Costs and Financing 19. At appraisal, the project cost was estimated at $22.0 million in grant financing and $2.0 million in government funding; at completion, the project cost was $23.75 million, or 98.95% of the appraisal because of grant savings and less counterpart funding. For the loan fund, the project cost at appraisal was $30 million, including ADB loan financing of $27 million and government counterpart funding of $3 million; at completion, the project cost was $28.40 million, or 94.67% of the appraisal because of the appreciation of the special drawing right, loan savings, and less counterpart funding. For the additional financing, the project cost at appraisal was estimated at $10.1 million, including grant financing of $9.5 million from the Regional Malaria and Other Communicable Disease Threats Trust Fund (RMTF) under the Health Financing Partnership Facility,13 and government counterpart funding of $0.6 million. At completion, the project cost was $9.02 million, or 94.94% of the appraisal because of partial cancellations, grant savings, and less counterpart funding. The project fully utilized ADB funds to support all components except taxes and duties for laboratory and office equipment and vehicles, which were borne by the CLV governments. Reallocations were done to increase allocations for training, community mobilization, and consulting services during implementation. The partial cancellations resulted from unused funds in G0450 (VIE); the implementation of additional financing was shorter in Viet Nam (13 months only) due to start-up delay. The project costs and financing plans at appraisal and completion are detailed in Appendices 3 and 4.

13 Financing partners: the governments of Australia, Canada, and the United Kingdom.

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D. Disbursements 20. In Cambodia, payments for eligible expenses were made through direct payment and advance fund procedures. Grant funds were disbursed from ADB’s account to an advance account jointly managed by MOH and the Ministry of Economy and Finance. Project funds flowed from ADB through the advance account to provincial health departments and national institutes using sub-accounts. Each PIU opened a sub-account and disbursed grant funds from it based on the AOP. The PIUs submitted fund transfer requests for the liquidation and replenishment of their sub-accounts. At project completion, disbursements totaled $9.97 million under the project and $3.73 million under additional financing. 21. In the Lao PDR, the grant funds were disbursed from ADB’s account to an advance account in the Ministry of Finance (MOF). The PMU, for the executing agency, opened the national sub-accounts and 12 PIU sub-accounts in a commercial bank acceptable to ADB and MOF. The expenditures of the national institutions as implementing agencies were managed by the PMU. MOH provided an initial advance from the national sub-accounts to each provincial sub-accounts, or alternatively, requested MOF to provide funds directly from the advance account. The PIUs submitted fund transfer requests for the replenishment of their project accounts. At project completion, disbursements totaled $11.99 million under the project and $2.93 million under additional financing. 22. In Viet Nam, payments for eligible expenses were made through direct payment and advance fund procedures. The government authorized 20 project provincial governments and five institutions to open a dong account as second-generation advance account in a commercial bank, and a dong current account for bank charges and interest earned. Funds were allowed to be transferred from the first-generation advance account to these accounts based on the AOPs prepared by the PIU and acceptable to the PMU. At project completion, disbursements totaled $25.77 million under the project and $2.02 million under additional financing.

23. About 5% of the grant funds (in Cambodia and the Lao PDR) was allocated as pooled funds to facilitate the conduct of regional activities. This was administered by ADB through the RCU and covered expenditures for the regional steering committee, technical forums, international consulting services, regional studies, cross-border activities, and RCU operations. 24. Disbursement procedures followed ADB’s Loan Disbursement Handbook (as amended from time to time). The project’s extensive use of the advance account contributed to the efficiency in project implementation. To simplify documentation requirements for liquidation and replenishment, the statement-of-expenditure procedure was used. The original disbursement projections were realistic—annual disbursements were largely comparable to the appraisal estimates. Discrepancies were noted between the final audited project financial statements and the loan and grant financial information system for L2699, G0231, and G0448. Reconciliation was done and the discrepancies were found to result from interest charges, pooled funds, and refunded amounts. No expenditure was charged to the project after the closing date. Although retroactive financing was allowed, it was not used. The disbursement details are in Appendix 5. E. Project Schedule 25. The project started smoothly with no major delays. The project completion date was extended by 18 months to complete activities related to malaria elimination funded by the

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additional financing. The project closed on 31 December 2017. The financial closing of the Lao PDR grants was delayed to address some minor audit findings.14 F. Implementation Arrangements 26. In Cambodia, the executing agency was represented by the Health Sector Support Program secretariat in MOH with the secretary of state as project director. The Communicable Disease Control Department served as the coordinating implementing agency, with its director as project manager. The director of the Department of Planning and Health Information was appointed as project coordinator. The PMU continued to manage the day-to-day implementation, and was responsible for administration, finance, procurement, planning, and monitoring. The National Center for Parasitology, Entomology and Malaria Control as well as 11 provincial health departments served as implementing agencies.

27. In the Lao PDR, the executing agency was represented by the Department of Planning and Cooperation, whose deputy director general served as the project director. The department also implemented the project, in close collaboration with the Department of Hygiene and Prevention. The PMU continued to provide administrative support, which included financial management, procurement, monitoring, reporting, and coordination with the project implementing agencies to ensure consistency of plans and activities. The National Center for Laboratory and Entomology, the National Center for Laboratory and Epidemiology, and 12 provincial health departments also served as implementing agencies. 28. In Viet Nam, the executing agency was represented by the General Department of Preventive Medicine, whose director general served as the project director. The general department has a PMU based in the Hanoi Provincial Preventive Medicine Center. The 25 PIUs included 20 provincial PMUs (PPMUs) and 5 PMUs in five institutions: (i) National Institute of Hygiene and Epidemiology, (ii) Pasteur Institute of Nha Trang, (iii) Institute of Hygiene and Epidemiology of the Highlands, (iv) Pasteur Institute of Ho Chi Minh City, and (v) National Institute of Malaria, Parasitology, and Entomology, together with its regional centers in Quy Nhon and Ho Chi Minh City, which provided technical assistance under the additional financing. 29. The project benefited significantly from the existing project management structures inherited from the first project (footnote 2). Functions continued and/or improved, and key staff were retained. All three countries reported a high level of personal commitment, technical competence, professionalism, and structured communications with provincial implementing agencies as factors contributing to the success of the project. G. Technical Assistance 30. In 2009, ADB provided technical assistance of $0.5 million for the design of the project.15 This was conducted in close consultation with WHO, government counterparts in the respective MOHs, and major country stakeholder groups. WHO contributed $0.03 million, and the governments of Cambodia, Lao PDR, and Viet Nam provided a total of $0.02 million in in-kind contributions. The technical assistance generated a mutually agreed project proposal for Cambodia, Lao PDR, and Viet Nam, which included the preliminary project design and necessary due diligence.

14 Driver’s contract missing and use of funds to maintain vehicles not purchased under the project. A copy of the contract

and justification were provided. 15 ADB. Regional: Second Greater Mekong Subregion Regional Communicable Diseases Control Project.

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H. Consultant Recruitment and Procurement 31. All consultant recruitment followed ADB’s Guidelines on the Use of Consultants (as amended from time to time). All procurement activities were undertaken according to ADB’s Procurement Guidelines (as amended from time to time), and consistent with approved procurement plans. Cambodia’s executing agency recruited 16 individual consultants (5 international and 11 national), and 4 consulting firms (two through single source selection and two through consultants’ qualification selection). Three packages of goods were procured through international competitive bidding, eight through national competitive bidding, 45 through shopping, and two through direct purchases. All procurement contracts were awarded, although some were delayed. The Lao PDR’s executing agency recruited 10 individual consultants (2 international and 8 national), and one firm (through consultants’ qualification selection). Three packages of goods were procured through national competitive bidding, 67 through shopping, and two through direct contracting. All procurement contracts were awarded, although some were delayed. Viet Nam’s executing agency recruited 20 individual consultants (3 international and 17 national), and 5 firms (through least-cost selection). One package of goods was procured through international and 31 packages through national competitive bidding, and 10 through shopping. All procurement contracts were awarded, although some were delayed. Under the additional financing, the eligibility requirements waiver was applied to procurement. However, no procurement package needed to apply the waiver. Four international consultants were recruited under the pooled funds, managed by the RCU. The consultants provided expertise to the CLV countries on knowledge management, laboratory quality, regional coordination, and safeguards. 32. Overall, the consultants’ and suppliers’ performance was satisfactory. The original contract award projections proved to be realistic—the actual contract awards were comparable to the appraisal estimates. The list of consulting services is in Appendix 6 and that of the procurement packages is in Appendix 7. I. Gender Equity 33. The project was categorized effective gender mainstreaming. The gender action plan (GAP) design resulted in significant gender benefits and contributed to the overall success of the project. The GAP implementation, at project completion, is rated satisfactory in all three countries—Cambodia completed 100% of all six actions and achieved 87% of targets (13 of 15); the Lao PDR completed 100% of 19 activities and achieved 87.5% of targets (14 of 16); and Viet Nam implemented 88.9% of activities (8 of 9) and achieved 91.7% of targets (11 of 12); the other was partly achieved. 34. The project provided both strategic and practical benefits to the poor, women, children, ethnic groups, and other vulnerable groups in remote areas. It promoted gender balance among CDC staff and VHWs, and paid special attention to building the capacity of female health workers through various technical training units. The target of 60% of trained staff to be women was not achieved, mainly because of the small share of female staff in the Cambodian and Vietnamese CDC systems; instead, substantial efforts were made to extend training to 92% of all female CDC staff in Cambodia and 82% of all female CDC staff in Viet Nam. In the Lao PDR, 65% of trained staff were women. Complementary efforts were also made to promote the recruitment of female CDC staff and VHWs, especially women from ethnic groups. The project made sure that at least 50% of newly selected VHWs were women. The project also contributed to ensuring that sex-disaggregated data are integrated into national CDC data systems as well as community-based assessments or demographic assessments. The project also directly supported MDAs targeting

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WRAs and children under 5 years old. Finally, the project strengthened the understanding of and capacity for gender-sensitive planning approaches among project staff, including placing gender contents in CDC training curricula and human resource development plans, and inserting related indicators in provincial AOPs. Details of the GAP achievements are in Appendix 8. The gender-related performance indicators are also reported in the DMF in Appendix 1. J. Safeguards 35. The project was classified category C for environment and involuntary resettlement, and category B for indigenous people. An ethnic group plan (EGP) was developed. In Cambodia and the Lao PDR, the EGP implementation was satisfactory. Both countries engaged a national gender and safeguard consultant to design and monitor the implementation of the GAP and EGP. In Cambodia, an ethnic group sensitivity and awareness training was carried out to impart how best to work with ethnic minorities and ensure their access to health services. The EGP indicators were clearly defined and disseminated to provincial implementers, who then included budget for ethnic group training and activities in their AOPs. In the Lao PDR, achievements were particularly high in terms of training CDC staff with ethnic group backgrounds (85% of ethnic group staff in provinces and districts were trained) and recruiting new staff from ethnic groups (63% newly recruited staff are from an ethnic group), but also in terms of consistent data reporting disaggregated by ethnic groups; integrating ethnic group issues, activities, and budget in provincial AOPs; and prioritizing ethnic group villages for MHV support. The Lao PMU conducted a study of project impacts in 2017 and found that positive project impacts were benefiting the ethnic groups to the same extent as the general population. The main issues in health services for indigenous people centered on reduced access because of remoteness and cultural practices. 36. In Viet Nam, a national gender and safeguard consultant was engaged to develop the project EGP from February 2012 to July 2013. Some EGP activities were implemented by the PPMUs in 16 border provinces with high density of ethnic minority people (e.g., translating IEC materials in Khmer language for ethnic groups in Tay Ninh Province). Training sessions for the health staff and VHWs from ethnic group backgrounds were the main benefits of the projects. However, the central PMU was not able to provide data to confirm achievements on certain activities and targets—most importantly, the inclusion of ethnic group issues in project planning and management meetings, and the implementation of ethnic disaggregated data for S&R in all forms and reporting documents. With 8 indicators achieved, 4 indicators partly achieved, and 5 with unknown results because of unavailable data, it was concluded that the EGP implementation in Viet Nam was less than satisfactory. More strategic planning and close monitoring is required for future projects in which ethnic groups are targeted as project beneficiaries. EGP achievements are detailed in Appendix 9. K. Monitoring and Reporting 37. Quarterly project monitoring reports were submitted by each country to ADB as required. ADB recorded findings from all missions in memorandum-of-understanding and back-to-office reports. A limited-scope project procurement-related review for the Lao PDR was conducted in 2013 and concluded that project funds were being used for the intended purposes and beneficiaries. The financial management capacity assessment at the design stage proved reasonable since it was based on experiences and lessons from the first project (footnote 2). The audited loan and grant and financial statement reports were submitted yearly, i.e., 9 months (G0231, G0232, L2699, and G0449) and 6 months (G0448 and G0450) after each fiscal year. Except for one covenant on ethnic groups in Viet Nam (para. 36), all loan covenants were fully

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complied with, and no loan covenants were modified, suspended, or waived. The status of grant and loan covenants is in Appendix 10.

III. EVALUATION OF PERFORMANCE

A. Relevance 38. The project was rated highly relevant at appraisal and remained so throughout the implementation and at completion. The project and the additional financing aligned with the CLV governments’ strategic health sector priority of preventing and controlling communicable diseases and with their mutual agreements to implement APSED and achieve IHR (2005) core capacities to sustain regional health security. The additional financing aligned with the commitment made by GMS political leaders at the 2014 East Asian Summit, i.e., to eliminate malaria in the GMS by 2030. The project aligned with ADB’s Strategy 2020 (footnote 8), Regional Cooperation Strategy (footnote 9), the GMS Health Cooperation Program, and ADB’s country partnership strategies for Cambodia, the Lao PDR, and Viet Nam. The project design was formulated based on previous experience and extensive consultations, and proved to be appropriate for achieving the intended results. The project was implemented as planned, without major changes in scope. The design and monitoring framework was ambitious, but most indicators were relevant and clearly defined. At its completion, the project remained relevant to the CLV governments’ joint implementation of APSED III16 and ADB’s Strategy 2030 (footnote 8). It has also led to a third ADB project on regional health security which the CLV countries (and Myanmar) have been jointly implementing since 2017.17 B. Effectiveness 39. The project is rated effective in achieving its outcome. All outcome indicators were either achieved or substantially achieved. The Lao PDR has not yet implemented cross-border outbreak reporting with Cambodia and Viet Nam within 24 hours but is committed to initiate this from 2019. Output indicators are mostly achieved or likely to be achieved. 40. The project has contributed to substantial improvements in the national and provincial S&R systems. As a result, nearly 100% of all disease outbreaks were reported to the respective MOH and the RCU within 24 hours, and investigated and responded to within 48 hours (i.e., Cambodia and Viet Nam achieved this in 100% of cases, while the Lao PDR did so in 84% of cases). The efficiency and reliability of the outbreak reporting system is a critical cornerstone of effective CDC. It relies on the technical judgment of frontline health workers to identify potentially important outbreaks, and to follow a standardized protocol to report and respond. Technical training for CDC staff; investment in capacity development, including formulation of guidelines, standards, and protocols; and the provision of necessary tools such as internet and phone call credits enabled this achievement. The project further mobilized support and institutionalized regional cooperation mechanisms for CDC such that various forms of cross-border activities were regularly planned and organized. The CLV countries shared the responsibility of organizing cross-border information exchange and other joint activities, and actively participated in such activities regularly. The frontline defense against communicable diseases was strengthened through improved hygiene and better prevention in the villages, as demonstrated in the MHVs. Lastly, the malaria incidence in all targeted provinces declined dramatically as a result of delivering targeted interventions supported by the additional financing and other development partners.

16 APSED was updated in 2017 to include public health emergency preparedness (WHO. 2017. APSED III). 17 ADB. Regional: Greater Mekong Subregion Health Security Project.

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41. Most output targets were achieved or substantially achieved; however, achievements on three of them were low across CLV countries: (i) provincial-level full compliance with IHR–APSED, (ii) all WRAs and under-5 children receive micronutrients and deworming drugs, and (iii) joint cross-border activities per district per year increased to 2 or more per district per year. While the project made earnest efforts to support the strengthening of provincial S&R systems, an assessment of full compliance with IHR–APSED at national level is being conducted only now. A joint external evaluation with WHO revealed that national compliance had improved substantially in the CLV countries, although progress varied, and to reach full compliance, the countries need to further strengthen their human resource capacity, intersectoral collaboration and coordination, and formalization and documentation of procedures. More investment and time would be needed before the provinces achieve IHR compliance. As for the mass administration of micronutrients and deworming drugs, these programs were already supported by other development partners such as WHO and the United Nations Children Fund (UNICEF), and the governments had regular funding for these programs. The less than 100% achievements on this indicator, particularly in the Lao PDR, suggest that more investment is indeed needed. Joint cross-border activities were conducted satisfactorily under the project. However, the agreement to conduct cross-border activities by cluster provinces18 for efficiency may have limited the opportunities for districts to fully participate. In addition, joint cross-border simulation exercises require substantial resources and coordination to organize. It is clear that cross-border activities were conducted mainly in the form of information-sharing meetings, while only one joint simulation exercise between Cambodia and Lao PDR border provinces in the central cluster was carried out. However, it is concluded that partial achievements of these output targets do not affect the overall effectiveness of the project. C. Efficiency 42. The project is rated efficient because the intended outputs and outcome were achieved within the loan and grant budget, and on time. At completion, the discounted total benefits of the project over 6 years in three countries are estimated at about $95.9 million (in 2010 $). With a total cost of $74 million over 5 years, the project’s economic net present value is estimated at about $21.8 million (high for Viet Nam, and negative for both Cambodia and the Lao PDR), lower than appraised ($27 million), while the economic internal rate of return is estimated at 21%, against 28% at appraisal.19 This is a conservative estimate of the total economic benefits from the project because it excludes possible sustained benefits years after the end of the project and only considers the direct benefits from fewer disease outbreaks and more productivity benefits. Other potential benefits include a reduction in the cost of health services, improvements in learning and cognitive performance, better maternal outcomes as a result of deworming, and the impact on the population of interrupted disease transmission. An estimation of these benefits would require more substantive data collection and modeling. An updated economic and financial analysis is in Appendix 11. D. Sustainability 43. The project is rated likely sustainable. In Cambodia, core capacities for detecting, preventing, and responding to diseases and public health emergencies will continue to be developed under the Cambodian National Work Plan 2016–2020 for Emerging Diseases and Public Health Emergencies to Achieve IHR. The Lao PDR’s new Law on Communicable Disease

18 The cluster arrangement and the provinces in each cluster are shown in Appendix 2. 19 The computation included the cost of capital for Cambodia and the Lao PDR, both funded by ADB grants.

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Control was approved by the National Assembly in 2017, providing additional stimulus for government funding to CDC. Viet Nam’s Law on Prevention and Control of Infectious Diseases has been effective since 2008 and was updated in 2019. It will continue to serve as a foundation for effective CDC work at all levels. 44. During implementation, project funding complemented national programs that receive regular government funding and funding from other partners. Interventions at provincial and district levels were integrated into their operational plans with regular funding. Recurrent costs were estimated to be a small share of total health sector budget (Appendix 11). The project strengthened health system management functions in project provinces, including planning, budgeting, and strengthening primary health care through the MHVs and community health networks, which will benefit health programs and projects in the long term. The ongoing ADB-financed GMS Health Security Project (footnote 17) also continues to support IHR capacity development, particularly as regards laboratory capacities, cross-border collaboration, and IHR core capacities. GMS countries (including the People’s Republic of China and Thailand) endorsed in December 2018 the GMS Health Cooperation Strategy 2019–2023, consolidating long-term CDC experience in the subregion and aiming for a more inclusive approach to ensuring greater health security in the future. This development is another opportunity to sustain a regional cooperation platform for CDC. E. Development Impact 45. Achieving the outcomes contributed to the intended development impact of improved health of the GMS population. No major outbreaks of communicable diseases of international concern occurred since 2011, with only scattered cases of cholera, Japanese encephalitis, and avian influenza. By 2017, the burden of communicable diseases had decreased significantly. Cambodia declared the elimination of malaria, filariasis, and trachoma as a public health problem before the end of the project. The prevalence of schistosomiasis had been reduced from 4% in 2010 to 0.2% in 2017. The dengue incidence decreased from 5,063 cases in 2010 to 1,751 in 2017. The population’s health in general continues to improve, and under-5 mortality (U5M) fell from 44.4 deaths per 1,000 live births (44.4/1,000) in 2010 to 29.2/1,000 in 2017. In the Lao PDR, U5M slowed from the 2010 baseline of 80.4/1,000 to 63.4/1,000 in 2017. The immunization coverage for DPT320 and measles increased from 32% in 2000 to 88% (and 89% for measles) in 2015. During the project period, dengue cases decreased by about 20%; the schistosomiasis prevalence fell from 3% in 2012 to 0.12% in 2015 in targeted populations. In Viet Nam, by 2015, the dengue mortality rate had declined by 42.8% and morbidity by 40%. The national U5M rate fell from 22.9/1,000 in 2010 to 20.9/1,000 in 2017.21 The project contributed to the significant decrease in malaria cases in the pilot sites in Cambodia and the Lao PDR, and prevented an increase of malaria cases in pilot sites in Viet Nam. The development impact is rated satisfactory. F. Performance of the Borrower and the Executing Agency 46. Overall, the performance of the borrowers and the executing agencies is rated satisfactory. The executing agencies provided counterpart staff as required. They, as well as the implementing agencies, PMUs, and provincial implementing partners, performed well in delivering their responsibilities. In each country, a high-level official from MOH was appointed to the project management, which contributed to successful project implementation. The PMUs also effectively

20 DPT3 vaccines is a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis

(whooping cough), and tetanus. 21 Data source: MOHs of Cambodia, Lao PDR, and Viet Nam.

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used the experience and knowledge of senior personnel who had been involved in previous ADB health projects. The PPMUs showed strong leadership in carrying out activities in their respective provinces, including active participation in cross-border activities. Cambodia’s PMU also benefited from the standard operating procedures in project implementation developed by the Ministry of Economy and Finance. The project structure facilitated the integration of CDC into the preventive health program of MOH in each country. The project procurement-related review in the Lao PDR found the use of project funds for the intended purposes to be satisfactory (para. 37). G. Performance of the Asian Development Bank 47. ADB’s performance during project design and implementation was satisfactory. ADB provided regular guidance and timely support to the project during its implementation. In the 7-year implementation period, including the additional financing, ADB fielded (i) 18 project administration missions to Cambodia totaling 72 staff person-days, (ii) 19 project administration missions to the Lao PDR totaling 79 staff person-days, and (iii) 17 project administration missions to Viet Nam totaling 73 staff person-days. On average, about 32 staff person-days per year were allocated to the project, which appeared efficient for supervision and achievement of results. ADB resident mission staff (in Cambodia, Lao PDR, and Viet Nam) participated proactively in the review missions, providing orientation on project administration, gender, and safeguard issues as necessary. In addition, the ADB project team sought synergies from other ADB projects as well as knowledge support oriented at CDC, and ensured coordination with development partners. H. Overall Assessment 48. Overall, the project is rated successful based on the four key criteria shown in the table below. The design of the project was sound and relevant throughout the project period. Project outcome and outputs were substantially achieved. The project was implemented as originally planned, without changes in scope or significant delays. It is clear that the CLV countries are carrying forward the coordinated CDC efforts and their commitments to regional health security, therefore the project is likely sustainable. The project strengthened each country’s national and provincial CDC systems, further solidified the regional collaboration platform, and helped advance regional integration. It also improved the health of the GMS population, particularly of women, ethnic groups, and other vulnerable people.

Overall Ratings Criteria Rating Relevance Highly relevant Effectiveness Effective Efficiency Efficient Sustainability Likely sustainable Overall Assessment Successful Development impact Satisfactory Borrower and executing agency Satisfactory Performance of Asian Development Bank Satisfactory Source: Asian Development Bank.

IV. ISSUES, LESSONS, AND RECOMMENDATIONS

A. Issues and Lessons 49. Investment in regional essential for health security. The ability of communicable diseases to cross international boundaries and affect large number of people demands a

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sustained and coordinated response among neighboring countries. The continued cooperation between the CLV countries provided a good practice for a coordinated response mechanism against this threat. The regional design enabled the sharing of knowledge, experiences, and resources and supported better data capture and timely information exchange, which are essential to CDC. Initially supported by grant resources from ADB, the regional platform was nurtured by the established NFPs and the regional steering committee, who advocated continued investment from national resources for regional activities. The RCU was instrumental in organizing regional activities and helped the CLV countries initiate coordination mechanisms. 50. Effective communicable disease control starts in the communities. Community preparedness to detect and respond to communicable disease outbreaks is crucial to effective CDC. The MHV model was a learning experience for public health and local leaders in this project. Through community participation, the local stakeholders who are most directly affected were empowered, which in turn encourages ownership and sustainability of the MHV concept. 51. Strong laboratory capacity and field epidemiology vital for rapid response. The project has appropriately targeted the strengthening of laboratory capacity and field epidemiology as essential for accurate early detection of disease outbreaks. These investments boosted the level of diagnostic preparedness, and the CLV countries rightly requested continued support in improving laboratory quality and building capacity in field epidemiology. The ongoing GMS Health Security Project (footnote 17) continues to support these areas as well as hospital infection prevention and control. 52. Experienced and dedicated teams contribute to implementation success. The project largely inherited the oversight and management teams from ADB’s first GMS CDC project (footnote 2). Continuity of staff and consistency of support from ADB contributed significantly to the success of the project in achieving most of its outcome and outputs. The appointment of high-ranked officials as project directors ensured effective coordination and implementation of project activities. 53. ADB and country project teams also noted a few areas for improvement. First, the project DMF was found to be complex, overly detailed, and challenging to tackle because a few indicators were not easily identifiable nor conducive to routine data collection. The DMF could have been updated after the midterm review, which found a few indicators to be inappropriate, and inconsistencies between DMF and GAP indicators could have been identified by then. Second, executing and implementing agencies should put more emphasis on GAP and EGP activities. Finally, when it comes to MDA programs, greater attention should be given to prophylaxis—especially in the Lao PDR with its high prevalence of helminth infection in rural areas. For remote and hard-to-reach areas, the best possible delivery mechanism for helminth prevention is yet to be identified. B. Recommendations

1. Project-Specific 54. Model healthy villages. The MHV concept implemented under the project was generally successful. It is recommended that in addition to the capacity-building activities, future interventions should consider including more support for necessary civil works, latrines, and water supply. Village health volunteers could be given token compensation, non-monetary recognition, additional training, and leadership opportunities as ways to motivate and retain them.

15

55. Knowledge management. As the CLV countries continue to share CDC knowledge and information on country and regional platforms, they should consider extending support to original research in epidemiology and social practice to help foster a better understanding of the impacts of communicable diseases, enable the formulation of well-informed policies and guidelines, and provide input to guide community-based CDC interventions. 56. Training. The governments should allocate regular budget support to maintain the provincial training system. The system should strengthen post-training evaluations and provide regular refresher training. Stronger pedagogy should be considered to improve training outcomes in difficult technical subjects. Turnover among VHWs—and volunteers, in particular—tends to be high, and it was recommended that appropriate human resource policies be introduced to solve this issue.

2. General

57. Regional cooperation can be further enriched and deepened. The CLV countries have taken ownership of the regional cooperation platform and noted the value of the RCU in planning regional events. In addition to information sharing and knowledge exchange, regional cooperation could be further enhanced through a formal agreement on joint simulation exercises; harmonized treatment protocols (e.g., for malaria, tuberculosis, and HIV/AIDS); and collaboration on tracking the mobile population, particularly those at high risk of communicable diseases. Eventually, members of the GMS or the Association of Southeast Asian Nations may aspire to a regional S&R system similar to the European CDC. ADB facilitated the adoption of the GMS Health Cooperation Strategy in 2019. As a next project, ADB has been requested to support migrant health in GMS countries. 58. Technological innovation could further boost surveillance and response. The CLV countries may consider conducting studies on the technology readiness of districts and communities for event-reporting and other CDC functions, and identify the most cost-effective and sustainable technology to digitize CDC information at these levels and integrate it into the national S&R system. This may significantly improve the reliability of information and the effectiveness of CDC within the communities. Cambodia is piloting this with ADB support.22 59. Access to treatment can be improved. While the additional financing under the project contributed to stronger prevention of and response to communicable disease outbreaks, future investments may need to consider clinical and treatment support to further reduce mortality and morbidity. This is particularly important for malaria and dengue.

22 Small funding was supported by the High-Level Technology Fund.

16 Appendix 1

DESIGN AND MONITORING FRAMEWORK Design Summary Performance Indicators and

Targets Project Achievements

Impact Improved health of the population in the GMS Outcome Timely and adequate control of communicable diseases of regional relevance

Proportion of disease outbreaks reported within 24 hours increased from 50% to 80%

Achieved. Timely reporting of disease outbreaks has been accomplished. Cambodia (Achieved) 276 disease outbreaks occurred during the project periods (2011–2017) have all been reported within 24 hours in 12 project provinces (100%), exceeding the target. Lao PDR (Achieved) 152 out of 185 (82%) disease outbreaks in the 12 project provinces were reported within 24 hours, on par with the national average (84%) during the project periods. Viet Nam (Achieved) Viet Nam government defined 20 type of Category A diseases to be monitored and reported within 24 hours (e.g., polio, avian influenza, Ebola, West Nile virus, yellow fever, cholera etc.). 55 such outbreaks in the 20 project provinces during the project period have all been reported within 24 hours (100%).

Proportion of border outbreaks reported across borders within 24 hours increased from 20% to 50%

The SOP (Provisional Operation Guidelines on Communicable Diseases Information Sharing) for Joint Investigation of Outbreaks and Public health Emergencies, agreed among Cambodia, Lao DPR and Viet Nam in December 2015 stipulates the agreed reporting of border outbreaks. Cambodia (Achieved) 2 border outbreaks in 2016–2017 have been reported within 24 hours cross border to Viet Nam (100%). Lao PDR (Ongoing/Partly Achieved) Setting up the cross-border information exchange in Lao was delayed due to lower management and human capacity. It is expected to start in 2019. Viet Nam (Achieved) Two outbreaks of Influenza A (H5N1) occurred in the border districts located in Long An and Bin Phuoc provinces since 2011. Both were reported within 24 hours across border to Cambodia (100%).

Appendix 1 17

Design Summary Performance Indicators and Targets

Project Achievements

Proportion of populations in targeted villages that conduct proper CDC prevention and care increased from 40% to 60%.

Each country defined a list of behaviors for hygiene/sanitation and CDC prevention to be observed in households, villages and/or communities. These lists were distributed to villages with relevant training and education. Cambodia (Achieved) Post evaluation survey showed 70% of population in targeted villages in project provinces are practicing CDC prevention and care. Lao PDR (Achieved) Post-project survey indicated 61.2% of populations in targeted villages practice appropriate CDC prevention activities. Viet Nam (Achieved) Post-project survey indicated 81.6% of populations in targeted villages practice CDC prevention and care.

In targeted areas: reduction of annual parasite index of Plasmodium falciparum (confirmed PF malaria cases/1,000 inhabitants): (i) Cambodia: Preah Vihear 20.2 in 2013 down to 17.2 in 2018; (ii) Lao PDR: Champasack 10.0 in 2013 down to 8.5 in 2018; Attapeu 26.5 in 2013 down to 22.5 in 2018 (iii) Viet Nam: Dak Nong 0.34 in 2013 down to 0.24 in 2018, Binh Phuoc 0.97 in 2013 down to 0.87 in 2018.

Cambodia (Achieved) This indicator was reduced from 20.2 in 2013 to 4.4 in 2017. Lao PDR (Achieved) This indicator was greatly reduced to 0.87 and 2.88 in Champasack and Attapeu, respectively, in 2017. Viet Nam (Achieved) This indicator was reduced from 0.34 (2013) to 0.15 (2017) in Dak Nong, and 0.97 (2013) to 0.60 (2017) in Binh Phuoc.

Outputs: Output 1 Enhanced regional CDC systems

Functional MOH focal points and capacity for regional cooperation in CDC

Cambodia (Achieved) National focal point from MOH, with alternates are in place and responsible for coordination and regular communication within the country, with border countries and other GMS countries concerning CDC and regional health security. Lao PDR (Achieved) A senior official from MOH (DG of CDCD) was designated as focal person for regional cooperation in CDC. Responsibilities include regional coordination and participating in regional meetings and workshops. Provincial focal persons are also designated, usually S&R staff at provincial health offices.

18 Appendix 1



Viet Nam (Achieved) MOH’s focal point for regional cooperation in CDC is GDPM’s Deputy Director General, who has been appointed since 2011. The focal person is responsible for (i) timely sharing of information on disease situation, especially for emerging diseases; (ii) quarterly, online meetings with Lao PDR and Cambodia on disease situation and preventive action, capacity building for preventive health workers; (iii) regular technical exchanges with the WHO Office in Viet Nam on emerging diseases: influenza type A H7N9, H5N1, hand foot and mouth disease, MERS-CoV, dengue fever; rabies; etc.; and (iv) organizing group meetings with the participation of general department of veterinary, WHO, FAO, USCDC and other partners on disease prevention measures.

Joint implementation of regional strategies for emerging diseases and NTDs including specific measures to address gender and ethnic group issues

Achieved Cambodia, Lao PDR, and Viet Nam are jointly implementing IHR 2015 and the APSED-III. Joint implementation workshops on IHR/APSED were conducted each year, as well as regional technical forums on IHR/APSED implementation (in May 2013, March 2014), One Health (September 2014), and APSED III Implementation (November 2016). All countries share CDC information with WHO as per IHR/APSED and have conducted JEE of IHR compliance with WHO (Cambodia: 2016; Lao PDR: 2017; Viet Nam: 2016) APSED III ensures gender-specific surveillance data. CDC data with sex-disaggregation was presented in joint workshops. Gender and ethnic group issues were discussed on specific topics (e.g., schistosomiasis prevention and control) and strategies were developed jointly. In Viet Nam, online conferences on emerging communicable diseases and status of prevention activities also paid special attention to gender and ethnic group issues, for example: (i) the elimination of tetanus for newborn by vaccination for women of childbearing age; (ii) vaccination for Japanese Encephalitis in high risk areas in mountainous areas targeting ethnic minority groups; and (iii) vaccination for Diphtheria targeting ethnic groups in the districts of K’Bang in Gia Lai province and Tay Giang in Quang Nam province.

MOH makes at least quarterly contributions to knowledge management for CDC

Cambodia (Achieved) Knowledge management plan has been updated and knowledge materials have been developed, such as (i) effective use of ICT to support CDC surveillance system in Cambodia; (ii) CDC through better hygiene and sanitation; (iii) a case study on

Appendix 1 19



CDC good practices at community level, and (iv) lessons learned on malaria elimination in Preah Vihear provinces. The project website has become an information hub for the public. It has been integrated into the newly upgraded MOH website and contain information of CDC2-related initiatives and knowledge products, including project reports and maps, survey reports, news releases, monthly bulletins, IEC materials, and reports from the Cambodia Early Warning System. Regular and frequent updating is undertaken to provide data and information on CDC. Lao PDR (Achieved) Lao PDR organized five regional technical workshops, a knowledge management forum, and two regional annual workshops. Technical reports, guidelines, survey results, and other knowledge and learning materials are available in the CDC website. Viet Nam (Achieved) MOH maintained CDC website with up-to-date information, including on technical articles, CDC guidelines and disease outbreaks and other CDC relevant documents. Project provinces provide CDC reports weekly, monthly and annually. CPMU developed knowledge management materials (e.g., leaflets, posters, IEC material, research and study reports) for CDC and distributed to all project provinces. All project activities are posted on the project website, which is linked to the GDPM website. Viet Nam’s experience is also shared in regional workshops, e.g., malaria control.

MOH exchange information on disease outbreaks as per IHR, including gender-disaggregated data

Achieved MOH of the three countries exchanged disease outbreaks information consistent with IHR/APSED and agreed SOP to exchange information regularly (weekly by district health centers and border checkpoints and monthly between provincial health authorities). The data shared is sex-disaggregated. SOP (2015) also include a list of 12 IHR notifiable diseases and conditions to be reported within 24 hours. IHR focal persons also report the IHR notifiable diseases to the Emergency Information System of WHO.

Targeted provinces in full compliance with IHR and APSED

Partly Achieved This indicator is considered inappropriate. In the ongoing Health Security Project, an indicator related to national IHR compliance only set a 70% compliance target.

20 Appendix 1



Under CDC2/AF, all project provinces in the three countries implemented plans and activities related to and consistent with IHR and APSED. However, as per JEE results, the countries have not achieved full compliance with IHR and APSED at the national level, despite slow and steady improvements over time. Provincial level capacities are more variant and are still developing. Provinces have not yet started reporting individually on IHR compliance. Cambodia, Viet Nam and Lao PDR are the first three countries to voluntarily conduct a JEE of IHR (2005) in the Western Pacific Region. Cambodia’s strengths were identified in areas of “IHR coordination, communication and advocacy, event-based surveillance and immunization”; Viet Nam’s strengths were apparent in “IHR coordination, communication and advocacy, zoonotic diseases, real-time surveillance, and immunization”; Lao PDR demonstrated high capacity in “IHR coordination, coordination and advocacy, surveillance, national laboratory capacity, and multi-sectoral outbreak response”. All three countries still face challenges in sustainable financing, human resource capacity, intersectoral collaboration and outbreak coordination, and formalization and documentation of procedures, and the application of monitoring and evaluation mechanisms to inform improvements in systems and processes.

Countries and provinces exchange information weekly on communicable diseases

Achieved Cambodia, Lao DPR and Viet Nam are following the Regional SOP (2015) to exchange information on communicable diseases at district health centers and checkpoints on a weekly basis, and by provincial health authorities on a monthly basis, using standard reporting templates.

Gender content reflected in CDC training curriculum, HRD plans, and cross-border activities

Cambodia (Achieved) CDC training curriculum, HRD plans and cross-border activities included gender mainstreaming in health sector and sex-disaggregated CDC data. Health Workforce Development Plan 2016-–2020 endorsed by MOH in March 2016 has include gender-related content. The Gender Mainstreaming Strategy and Action Plan for MOH 2014–2018 for strengthening communicable and noncommunicable disease services has advocated the inclusion of gender dimension.

Appendix 1 21



Lao PDR (Achieved) CDC training particularly targeted at women and ethnic groups. GAP training provided to 230 CPMU and PPMU staff in 2016. HRD plans have targets regarding the female composition of CDC staff and newly recruited staff. Female representation ensured in regional information exchange activities. Cross-border meetings featured gender-related topics such as women’s participation, setting up quotas for women participation during capacity development trainings, discussion on women’s issue and why sex-disaggregated data is a necessary component in project implementation, monitoring and reporting. Viet Nam (Achieved) All 16 border provinces had integrated GAP and EMP contents into project planning (AOPs) with budget. Gender contents are reflected in training, workshops, information and communication materials, HRD plans and cross-border activities. CPMU and PPMUs have one project officer responsible for monitoring and reporting results. 14,665 surveillance and response staff including 6,811 female staff (46.4%) were trained in CDC and 1,750 laboratory staff including 801 female staff were trained in utilization and operation of testing equipment. All CPMU and PPMU staff (100% of 313) including 92 female staff (29.4%) were trained in gender sensitivity and GAP. CPMU and PPMUs each had one project officer responsible for monitoring and reporting results.

At least three annual cross-border action plans focusing on malaria developed by neighboring provinces (2015 baseline: 0)

Achieved Neighboring cluster provinces meet every year to exchange information about annual action plans, which covers joint simulation, training, referrals, joint outbreak investigation, RRT and disease reporting. Malaria is included as a priority communicable disease in these plans. All provincial AOPs include malaria targets and activities. Cambodia (Achieved) In 2016, a cross-border action plan was developed for Kampot province (bordering with An Giang province, Viet Nam). In 2017, cross border action plans were developed for Ratanakiri (bordering with Attapeu province, Lao PDR), Svay Rieng (bordering with Tay Ninh province, Viet Nam) and Preah Vihear provinces. 1 cross-border event on malaria control and elimination in 2016, and 3 in 2017 were conducted. Lao PDR (Achieved)

22 Appendix 1



Agreements on joint activities and interventions were made between between Lao provinces (Phongsaly, Luangprabang, Huaphan, Xiengkhuang) with Viet Nam provinces (Dien Bien, Son La, Thanh Hoa, and Nghe An) in 2016; and between Bolikhamxay, Khammouane (Lao PDR) and Nakhon Phanom, Nong khai and Bueng kan (Thailand) in 2017. Viet Nam (Achieved) In 2016, cross-border action plans were developed for Son La and Thanh Hoa provinces bordering with Houaphanh province in Lao. In 2016 and 2017, cross-border action plans were developed for An Giang province bordering with Kampot province in Cambodia and Tay Ninh province in Viet Nam bordering with Svay Rieng province in Cambodia.

At least one regional technical forum on malaria organized annually (2015 baseline: 0)

Achieved Cambodia hosted a regional technical forum on malaria control and elimination in 2016. Lao PDR hosted again in 2017. Viet Nam organized 3 regional technical forums on malaria control for migrants in 2017 (in Dalat, Long An, and Dien Bien). Participants were from CLV countries, as well as Myanmar, Thailand and Malaysia.

Output 2: Improved CDC along borders and economic corridors

By 2017: Two new healthy villages per district per year are supported in border districts

Substantially achieved Overall, the number of healthy villages supported in border districts fell short of the target of two per district per year (2011–2015). Cambodia (Achieved) A total of 180 villages from 18 border districts, all located at border communes have been selected in 2012–2013 to participate in community-based CDC, including malaria prevention and care. Lao PDR (Substantially achieved) A total of 304 healthy villages in border areas were established, slightly short of the original target of 350. Viet Nam (Substantially achieved) A total of 215 healthy villages were supported in border areas in 16 provinces to participate in community-based CDC. Strong IEC was implemented creating health literacy particularly on hygiene and health, and communicable disease prevention. First-aid packages were provided to VHWs, and “clean-born” delivery packages were provided to ethnic minority women who may deliver at home. Originally targeting at 550 villages, MOH and ADB agreed on reducing the number of model healthy

Appendix 1 23



villages to ensure more depth and quality of activities. Other development partners (i.e. UNICEF) also provided support to model healthy villages.

By 2017: Trained village health workers in targeted districts achieve 80% of basic competencies

Basic competencies for VHWs were defined by each country and in general cover a range of knowledge and skills areas including personal hygiene, environmental cleanliness and health, prevention of water-borne and vector-borne diseases, identifying the symptoms of common infectious diseases and initial response/treatment. Cambodia (Substantially Achieved) Trained VHWs in targeted districts has achieved 80% of basic competencies from 2011–2016. However, the first training of village malaria workers in Preah Vihear achieved 44% of basic competencies due to difficulty of technical contents. Refresher training is planned to be conducted in subsequent years. Lao PDR (Achieved) Project competency survey indicated 80.7% of trained VHWs self-assessed as capable and competent in a number of specific skills areas. Viet Nam (Achieved) Based on post training assessment, 100% of trained VHWs from 2012–2015 has achieved 80% of basic competencies.

By 2017: All women of reproductive age and children aged 1–5 years receive micronutrients and deworming

Substantially achieved The project supported MDA in CLV between 2011–2014. Cambodia (Substantially achieved) Project supported provision of micronutrients and deworming from 2011–2014. By 2014, 77% of women of reproductive age and 95% of children under-5 were covered. MOH sustained this intervention through government funding and, in 2017, the coverage for women of reproductive age was 81% and for children under-5 was 87% (PHD data). Activity was de-prioritized to maintain the budget for outbreak responses in 2014. Lao PDR (Partly achieved) A household survey in 2016 indicated 44.6% of women of reproductive age and 51.8% of children under-5 received deworming in the past year. 78.3% of women of reproductive age received iron supplementation and 73.1% of under-5 children received Vitamin A supplementation (micronutrient supplementation was supported by UNICEF).

24 Appendix 1



Viet Nam (Substantially achieved) Between 2012–2015, 86.6% of women of reproductive age and 94.4% of children under-5 received deworming for common helminthiasis. Certain population remains hard to reach in remote and isolated areas. No data was provided on micronutrients.

By 2017: Joint cross-border activities per district per year increased from below 1 to 2 or more per district per year

Substantially Achieved Joint cross-border activities included information exchange and planning workshops, trainings and workshops, technical forums, and joint simulation etc. CLV countries agreed to conduct joint cross-border activities by cluster provinces as defined by PMU of each country since 2015. A total of 45 cross-border information meetings have been conducted; in addition, the project supported one joint simulation exercise between Cambodia and Lao PDR border provinces in Central Cluster. The mechanism for joint cross-border activities has been formalized through the cluster provinces, guided by the RSC and facilitated by the RCU. As a result, the frequency and strength of cross-border cooperation have both been enhanced under the project. Appendix 2 listed all the cross-border activities from 2011–2017. However, the records of district-level participation in these cross-border activities were incomplete and the activities are mostly led by provincial health authorities, making it difficult to assess the achievement against the specific indicator. Not all project provinces are included in the 4 Clusters, and it was not clear how they participated in the cross-border activities. Cambodia reported 11 operating districts (since 2016) had participated in at least 2 joint cross-border activities in 2017. Lao PDR reported 53 cross-border activities being conducted between 2013–2016. Viet Nam reported a total of 336 times of joint cross-border activities in the 55 border districts of 16 border provinces.

By 2017: At least 50% of newly selected village health workers are female

Cambodia (Achieved) 721 women (56.4%) village health workers are recruited from 2012–2017 are female. In Preah Vihear, 169 out of 332 malaria (51%) village workers recruited were female. Lao PDR (Achieved) 50% of the newly selected VHWs are female (453 female out of 916 new VHWs).

Appendix 1 25



Viet Nam (Achieved) Of the newly selected VHWs, female accounted for 60% (357 out of 599).

By 2017: All village health workers in border districts are trained in the last 5 years

Cambodia (Achieved) In 2014 all village health workers in border districts have been trained and all have received refresher course in 2016. Lao PDR (Achieved) 100% of VHWs in border districts received training from 2012–2016, some more than once.

Viet Nam (Partly achieved) Of the 7,269 VHWs, 3,779 (52%) have undergone training on CDC from 2012–2015.

By 2017: At least 60% of CDC staff is trained

Cambodia (Achieved) Overall, 88% of the total targeted CDC staff have been trained in all core capacity areas of IHR, including rapid response staff from project provinces, laboratory staff from provincial hospitals and 27 health centers in Preah Vihear. Lao PDR (Achieved) 76% of CDC staff (2,135 out of 2,796) received technical trainings on laboratory diagnosis, microscope, surveillance and response, malaria case management, vector control, field epidemiology etc. Viet Nam (Achieved) 91% of targeted CDC staff has received training on disease prevention, epidemic surveillance and response.

By 2017: At least 60% of trained staff is female

Cambodia (Substantially achieved) The indicator was inappropriate because only 30% of CDC staff are female (412 of 1373 trained staff). However, 412 of 448 (92%) female CDC staff were trained under the project.

Lao PDR (Achieved) 65% of trained staff (1,395 out of 2,135) are women (all types of training). Viet Nam (Substantially achieved) 48.1% of the trained staff were female, which accounts for 81.6% of all female CDC staff at all levels. Target is unrealistic because although majority of the CDC staff were trained, only 46.5% of all CDC staff is female.

By 2017: Trained CDC staff in provinces achieve 80% of basic competencies

Cambodia (Substantially achieved) This indicator was achieved for trained CDC staff from 2012–2016. In 2017, trained CDC staff

26 Appendix 1



achieved 56% basic competencies. Overall, 78.6% of all trained CDC staff in provinces achieved 80% of basic competencies. Lao PDR (Achieved) 87% of trained CDC staff in project provinces attained 80% competency, based on self-assessment.

Viet Nam (Achieved) All trained CDC staff attained 80% of basic competencies (100%).

In 2017, 80% of the project border districts conduct at least one cross-border activity focusing on malaria. (2015 baseline: 0)

Cambodia (Achieved) The additional financing focused on Preah Vihear, where 100% of the border operational districts have participated on cross-border activities in 2017. This includes meetings on information and knowledge sharing information, coordination, planning, and joint simulation exercise. Lao PDR (Partly achieved) Only 50% of project border districts (16 out of 35) are involved in cross-border activities, such as joint surveillance and response. Cross-border activities were focused not only on malaria but other CDs as well. Viet Nam (Achieved) 7 out of 8 project border districts (88%) participated in regional workshop on malaria prevention and control. All border districts hold regularly meetings to share information on malaria prevention and control and enhancement of malaria management among the mobile population.

By 2017, at least five village health workers per project border districts trained in malaria control and treatment, at least 50% of participants to the training are women (2015 baseline: 0)

Cambodia (Achieved) The AF focused on Preah Vihear province, where training in malaria control and treatment training was conducted among almost all village malaria workers (331 out of 332), among which 51% are female (169 out of 331). Lao PDR (Substantially achieved) The minimum target of 175 VHWs exceeded with total of 322 VHWs from 35 districts trained in malaria control and treatment. 113 out of 322 (35%) were women. Viet Nam (Achieved) There were 8 project border districts in Dak Nong and Binh Phuoc. In total, 134 village health workers (out of 467) in Dak Nong and 102 VHWs (out of 293) in Binh Phuoc were trained in malaria control and treatment, exceeding the target. 111 trainees in Dak Nong and 80 trainees in Binh Phuoc were women.

Appendix 1 27



Output 3 Integrated project management

By 2017: Provincial staff competent in results-based planning

Cambodia (Achieved) Provincial staff have been trained on results-based planning. Provincial project AOPs developed are aligned to the MOH national annual operational plan. Lao PDR (Achieved) Trainings in procurement, financial management, and results-based planning were conducted for relevant provincial staff. Annual operational plans with clear outcomes were developed during the project period. Viet Nam (Achieved) Provincial staff were given trainings on results-based planning. All targeted provinces develop and implement an AOP according to project targeted results.

By 2017: Baseline and outcome surveys conducted as planned

Cambodia (Achieved) Baseline survey on model healthy village completed in 2014 and malaria indicator survey in Preah Vihear was completed in 2017. The results provided sufficient baseline information on indicators. End of project evaluation survey was completed in third quarter 2017. Lao PDR (Achieved) Baseline survey was conducted in 2014 and post project survey was completed in September 2016. Viet Nam (Achieved) Baseline survey was conducted in 2013 and post project evaluation was completed in June 2017.

By 2017: Provincial AOPs include CDC targets with special attention to border villages, cross-border collaboration, gender and ethnic groups, and in-service training

Cambodia (Achieved) Eleven project provinces integrated into provincial AOPs the requirement for cross-border activities, training and capacity building for health staff, community CDC/malaria activities targeting mostly women and indigenous communities at border villages. All AOPs included gender actions and targets with the allocation of gender budget. Lao PDR (Achieved) Provincial AOPs developed annually. AOPs reflect gender and ethnic groups issues. Viet Nam (Achieved) The AOPs of 20 project provinces include specific targets regarding cross-border activities and continued CDC in-service training for staff. Gender actions and ethnic groups issues are integrated into CDC training, human resource planning and cross-border activities.

28 Appendix 1



By 2017: GAP and EGP fully implemented and reported on

Cambodia (Achieved) Updated Gender and Ethnic group plan were implemented. Tool for data collection is finalized and used to measure progress. GAP/EGP Review workshop conducted in Q2 2017 provided disaggregated data as required in GAP and EGP. Lao PDR (Achieved) The project implemented GAP and EGP and monitored progress regularly in quarterly reports. A gender and safeguard consultant was recruited (18 months) to provide guidance to GAP and EGP implementation and monitor progress. Viet Nam (Achieved) PPMUs integrate gender and ethnic groups plan into human resource development and training activities, workshops, information and communication. These were fully implemented and reported.

By 2017: 80% of all provincial AOPs include malaria incidence targets (2015 baseline: 0)

Cambodia (Achieved) 100% of the 5 provinces (Preah Vihear, Kraties, Stung Treng, Mondulkiri and Ratanakiri) affected by malaria included malaria incidence targets. Lao PDR (Achieved) All project provinces include malaria target and activities in their provincial annual operational plans. Viet Nam (Achieved) The two project provinces (Dak Nong and Binh Phuoc) included malaria incidence targets in their provincial annual operational plans.

AOP = annual operational plan; APSED III = Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies; CDC = communicable disease control; CDC2/AF = Second GMS Regional Communicable Diseases Control Project additional financing; CDCD = Communicable Disease Control Department; CLV = Cambodia, Lao, Viet Nam; CPMU = central project management unit; EGP = ethnic groups plan; EMP = Environmental Management Plan; FAO = Food and Agriculture Organization of the United Nations; GAP = gender action plan; GDPM = General Department of Preventive Medicine GMS = Greater Mekong Subregion; HRD = Human Resource Department; IEC = information, education, communication; IHR = International Health Regulations; JEE = joint external evaluation; Lao PDR = Lao People’s Democratic Republic; MDA = mass drug administration; MOH = Ministry of Health; NTD = neglected tropical disease; PMU = project management unit; PPMU = provincial PMU; RRT = rapid response team; SOP = Standard Operational Procedures; S&R = surveillance and response; VHW = village health worker; WHO = World Health Organization

Appendix 2 29

PROVISIONAL OPERATION GUIDELINES ON COMMUNICABLE DISEASES INFORMATION SHARING BETWEEN CLUSTER PROVINCES 1

1. The cross-border information exchange was piloted between the selected cluster provinces (see list below) in Cambodia, Lao People’s Democratic Republic (PDR), and Viet Nam. Four clusters (North, Center-1 and Center-2, and South) were determined by the project management unit (PMUs) in Cambodia, Lao PDR, and Viet Nam. The Regional Steering Committee agreed (November 2014) about the regular information exchange at checkpoints (weekly) and between provincial health authorities (monthly) under the supervision of the national International Health Regulations (IHR) focal points. Myanmar’s Ministry of Health will join the information exchange from 2016.

Table A2.1: Cluster Provinces

Cambodia Lao PDR Viet Nam

Northern Cluster Louang Phabang Dien Bien

Houaphanh Nghe An Phongsali Son La Xiengkhouang Thanh Hoa

Central-1 Cluster

(North-Centre)

Bolikhamxay Ha Tinh

Khammouane Quang Binh

Central-2 Cluster

(South-Centre)

Ratanakiri Attapeu [Kon Tum]

Stung Treng Champasack

Southern Cluster Kampot An Giang

Kandal Long An Svay Rieng Tay Ninh Takeo [Dak Lak]

Tbong Khmum [Dak Nong]

Note: The General Department of Preventive Medicine Viet Nam will define the procedure for joining Kon Tum Province (beyond the second project and the health authorities of Dak Lak and Dak Nong provinces, selected for implementing malaria-elimination activities.

2. The cross-border information exchange was piloted under the guidance of the national IHR focal points and authorized local health authorities nominated by the executing agency (Ministry of Health, Communicable Disease Control Department/General Department of Preventive Medicine. The procedures of the information collection and sharing were tailored to existing national health/quarantine regulations and norms. In CDC project priority was given to testing the regular information exchange: at checkpoints and between bordering districts health authorities on weekly basis, and bordering cluster provinces on monthly basis. 3. The cross-border information exchange was implemented in addition to existing procedures determined by the IHR (2005/2010), the quarantine agreements and other bilateral and multilateral agreements referred to the health information exchange, including the bilateral provincial agreements. 4. The information were collected on weekly/monthly/quarterly basis at local levels (checkpoints and district health services) and provincial health services. The information exchange procedure across the borders were agreed by the provincial health authorities in

1 Agreed by CLV countries on the second regional communicable diseases control project annual regional workshop

2015 5th regional steering committee meeting, 10-12 December 2015, Nha Trang, Viet Nam.

30 Appendix 2

consultation with the PMUs and National IHR Focal Points. The forms were unified for all participating provinces and levels (See Annexes 1, 2); moving forward, each responding health service unit will fill the available data for those diseases for the given reporting periods.

Scheme 1. Reporting formats and time periods

5. The Checkpoint and the District Health Authority (nominated by the PHD) will submit to the PHD/PPMU the Form 1 on weekly basis. 6. The Provincial Health Authority (nominated by the PHD in consultation with the IHR National Focal Point) will exchange with the bordering Provincial Health Authority with the consolidated Form 1 (with indication of the emerging diseases) on weekly basis, and Form 2 on monthly basis. The list of the authorized PHD officers and their full contact details is attached in Annex 3. The copy of Form 2 will be submitted to MOH/PMU. 7. For monitoring purpose PHD will forward to the RCU on monthly basis the copy of Form 2 and attached copies of the weekly reports of the Forms 1, submitted by checkpoints and districts within the reporting month.

Scheme 2. Reporting procedure

8. The National IHR Focal Points establish and/or renew information exchange bilateral mechanisms between bordering project participation countries. The project will test the use of IT for the needs of information exchange including the limited-access web page for IHR Focal Points at GMS Health Security Project Web Portal.

Appendix 2 31

9. The MOH/PMU in each project participating country nominates the national center or relevant health authority to submit the data to the National IHR Focal Points on malaria, dengue fever and HIV/AIDS cases in disaggregation by provinces on quarterly basis. The PMU ensures that the copy of these quarterly data reports is e-mailed to RCU for monitoring purposes. 10. The RCU monitors the regular reports and reflects the information flow in its regular reports to EAs/PMUs/National IHR Focal Points. The RCU displays the information on project related GMS and local maps and other means of infographics. These maps and other computer graphic products are designed for project management purpose only and will be reviewed by the concerned EAs/PMUs prior to use. The EAs/PMUs and countries' project teams can widely use the disclosed infographic product for project presentations, publications, trainings and information workshops.

Scheme 3. Communication and use of data

Annexes: 1. Form 1 (Checkpoint/District weekly reporting) 2. Form 2 (Provincial Health Authority monthly reporting)

32 Appendix 2

Annex 1: Form 1 (Checkpoint/District weekly reporting)

Appendix 2 33

Annex 2: Form 2 (Provincial Health Authority monthly reporting)

34 Appendix 3

PROJECT COST AT APPRAISAL AND ACTUAL ($'000)

Table A3.1: G0231-CAM Project Cost by Outputs/Components

Item Appraisal Estimate Actual A. Base Cost

1.Strengthening regional CDC systems

4.90 4.57

2. Improved CDC along borders and corridors

2.80 4.00

3.Integrated project management

2.20 2.14

Subtotal (A) 9.90 10.71 B. Contingencies 1.10 0.05 Total (A+B) 11.00 10.76 Notes: Total may not sum up due to rounding. CDC = communicable disease control. Source: Asian Development Bank estimates.

Table A3.2: G0448-CAM Project Cost by Outputs/Components Item Appraisal Estimate Actual A. Base Cost 1. Strengthening regional CDC

systems 2.10 0.72


1.30 1.27

3. Integrated project management 0.50 1.79 Subtotal (A) 3.90 3.78 B. Contingencies 0.30 0.00 Total (A+B) 4.20 3.78 Notes: Total may not sum up due to rounding. CDC = communicable disease control Source: Asian Development Bank estimates.

Table A3.3: G0232-LAO Project Cost by Outputs/Components Item Appraisal Estimate Actual A. Base Cost 1. Strengthening regional CDC

systems 5.90 6.02


3.50 3.84

3. Integrated project management 2.50 2.45 Subtotal (A) 11.90 12.31 B. Contingencies 1.10 0.68 Total (A+B) 13.00 12.99 Notes: Total may not sum up due to rounding. Source: Asian Development Bank estimates.

Table A3.4: G0449-LAO Project Cost by Outputs/Components Item Appraisal Estimate Actual A. Base Cost 1. Strengthening regional CDC

systems 2.00 2.35


0.40 0.61

3. Integrated project management 0.70 0.07

Appendix 3 35

Item Appraisal Estimate Actual Subtotal (A) 3.10 3.03 B. Contingencies 0.05 0.05 Total (A+B) 3.15 3.08 Notes: Total may not sum up due to rounding. CDC = communicable disease control Source: Asian Development Bank estimates.

Table A3.5: L2699-VIE Project Cost by Outputs/Components Item Appraisal Estimate Actual A. Base Cost 1.Strengthening regional CDC

systems 15.10

17.62


6.70

6.47

3.Integrated project management 4.00 3.58 Subtotal (A) 25.80 27.67 B. Contingencies 3.40 0.00 C. Financing Charges During Implementation

0.80 0.73

Total (A+B+C) 30.00 28.40

Notes: Total may not sum up due to rounding. CDC = communicable disease control Source: Asian Development Bank estimates.

Table A3.6: G0450-VIE Project Cost by Outputs/Components Item Appraisal Estimate Actual A. Base Cost 1.Strengthening regional CDC

systems 1.20 1.18


0.85 0.59

3.Integrated project management 0.44 0.39 Subtotal (A) 2.50 2.16 B. Contingencies 0.25 0.00 Total (A+B) 2.75 2.16 Notes: Total may not sum up due to rounding. CDC = communicable disease control Source: Asian Development Bank estimates.

Table A3.7: G0231-CAM Project Cost by Expenditure Category Appraisal Estimate Actual Item Total Cost Total Cost A. Base Cost 1. Laboratory and Office

Equipment 2.57 0.94

2. Vehicles 0.46 0.52 3. System Development 0.46 1.61 4. Training, Workshop, Fellowship 1.60 2.14 5a Community Mobilization in cash 0.42 0.75 5b Community Mobilization in kind 0.59 0.00 6. Consulting Services 0.92 1.02 7. Project Management 0.63 1.63 8 Pooled Funds 0.48 0.38 Subtotal (A) 8.42 8.99 B. Recurrent Costs 1.Supplies 1.09 1.28

36 Appendix 3

Appraisal Estimate Actual Item Total Cost Total Cost 2.Vehicle operations and maintenance

0.12 0.15

3.Laboratory operations and maintenance

0.29 0.28

Subtotal (B) 1.50 1.71 C. Contingencies 1.Physical Contingencies 0.36 0.06 2.Price Contingencies 0.72 0.00 Subtotal (C) 1.07 0.06 Total (A+B+C) 11.00 10.76 Notes: Total may not sum up due to rounding. Source: Asian Development Bank estimates.

Table A3.8: G0448-CAM Project Cost by Expenditure Category Item Appraisal Estimate Actual A. Base Cost 1.Laboratory and Office Equipment 0.34 0.40 2.Vehicles 0.21 0.38 3.System Development 1.35 0.40 4.Training, Workshop, Fellowship 0.45 0.93 5.Community Mobilization in cash 0.08 0.32 6.Consulting Services 0.48 0.65 7.Regional and Cross-Border

Activities 0.42 0.25

Subtotal (A) 3.33 3.33 B. Recurrent Costs 1.Project Management 0.33 0.14 2.Supplies 0.29 0.32 Subtotal (B) 0.62 0.45 C. Contingencies 1.Physical Contingencies 0.11 0.00 2.Price Contingencies 0.14 0.00 Subtotal (C) 0.25 0.00 Total (A+B+C) 4.20 3.78 Notes: Total may not sum up due to rounding. Source: Asian Development Bank estimates.

Table A3.9: G0232-LAO Project Cost by Expenditure Category Item Appraisal Estimate Actual A. Base Cost 1.Laboratory and Office Equipment 2.67 2.83 2.Vehicles 0.72 0.80 3.System Development 0.50 0.33 4.Training, Workshop, Fellowship 2.10 2.17 5a.Community Mobilization in cash 0.65 1.28 5b.Community Mobilization in kind 0.52 0.00 6.Consulting Services 1.10 0.93 7.Project Management 1.22 1.35 8.Pooled Funds 0.74 0.79 Subtotal (A) 10.22 10.48 B. Recurrent Costs 1.Supplies 1.46 1.71 2.Vehicle operations and

maintenance 0.07

0.07

Appendix 3 37

Item Appraisal Estimate Actual 3.Laboratory operations and

maintenance 0.24

0.06

Subtotal (B) 1.77 1.84 C. Contingencies 1.Physical Contingencies 0.29 0.00 2.Price Contingencies 0.71 0.68 Subtotal (C) 1.01 0.68 Total (A+B+C) 13.00 12.99

Notes: Total may not sum up due to rounding. Source: Asian Development Bank estimates.

Table A3.10: G0449-LAO Project Cost by Expenditure Category Item Appraisal Estimate Actual A. Base Cost 1. Laboratory and Office Equipment 0.34 0.42 2. Vehicles 0.08 0.00 3. System Development 0.38 0.18 4. Training, Workshop, Fellowship 0.53 0.32 5. Community Mobilization in cash 0.32 0.39 6. Consulting Services 0.43 0.52 7. Regional and Cross-Border Activities

0.22 0.37

Subtotal (A) 2.29 2.20 B. Recurrent Costs 1.Project Management 0.62 0.79 2.Supplies 0.11 0.04 Subtotal (B) 0.73 0.83 C. Contingencies 1.Physical Contingencies 0.03 0.00 2.Price Contingencies 0.09 0.05 Subtotal (C) 0.13 0.05 Total (A+B+C) 3.15 3.08 Notes: Total may not sum up due to rounding. Source: Asian Development Bank estimates.

Table A3.11: L2699-VIE Project Cost by Expenditure Category Item Appraisal Estimate Actual A. Base Cost 1.Laboratory and Office Equipment 10.81 12.62 2.Vehicles 2.49 2.82 3.System Development 1.35 1.44 4.Training, Workshop, Fellowship 3.17 2.92 5.Community Mobilization 1.10 0.99 6.Consulting Services 1.30 1.08 7.Project Management 2.67 3.04 Subtotal (A) 22.90 24.91 B. Recurrent Costs 1.Supplies 2.52 2.36 2.Vehicle operations and maintenance

0.11 0.07

3.Laboratory operations and maintenance

0.30 0.33

Subtotal (B) 2.94 2.76

C. Contingencies 1.Physical Contingencies 0.97 0.00

38 Appendix 3

Item Appraisal Estimate Actual 2.Price Contingencies 2.40 0.00 Subtotal (C) 3.37 0.00 D. Interests 0.79 0.00 0.79 0.73 0.00 0.73 Total (A+B+C+D) 27.00 2.98 30.00 1.11 27.29 28.40 Notes: Total may not sum up due to rounding. Source: Asian Development Bank estimates.

Table A3.12: G0450-VIE Project Cost by Expenditure Category

Item Appraisal Estimate Actual A. Base Cost 1. Laboratory and Office Equipment 0.16 0.15 2. System Development 1.06 0.96 3. Training, Workshop, Fellowship 0.35 0.32 4. Community Mobilization in cash 0.15 0.17 5. Consulting Services 0.14 0.01 6. Regional and Cross-Border Activities

0.26 0.18

Subtotal (A) 2.13 1.79 B. Recurrent Costs 1.Project Management 0.44 0.37 Subtotal (B) 0.44 0.37 C. Contingencies 1.Physical Contingencies 0.08 0.00 2.Price Contingencies 0.10 0.00 Subtotal (C) 0.18 0.00 Total (A+B+C) 2.75 2.16 Notes: Total may not sum up due to rounding. Source: Asian Development Bank estimates.

Appendix 4 39

PROJECT COST BY FINANCIER

Table A4.1: G0231-CAM Project Cost at Appraisal by Financier Item ADB Government of Cambodia Total $

million % of Cost Category $ million

% of Cost Category $ million

% of Total Base Costs

A. Base Costs 1 Laboratory and Office Equipment 2.24 87% 0.33 13% 2.57 25.91% 2 Vehicles 0.38 83% 0.08 17% 0.46 4.64% 3 System Development 0.46 100% 0.00 0% 0.46 4.64% 4 Training, workshop, fellowships 1.60 100% 0.00 0% 1.60 16.13% 5a Community Mobilization in cash 0.42 100% 0.00 0% 0.42 4.23% 5b Community Mobilization in kind 0.00 0% 0.59 100% 0.59 5.95% 6 Consulting services 0.92 100% 0.00 0% 0.92 9.27% 7 Project Management 0.93 100% 0.00 0% 0.93 9.38% 8 Pooled Fund 0.48 100% 0.00 0% 0.48 4.84% Subtotal (A) 7.43 88% 0.99 12% 8.42 84.88% B. Recurrent costs 1 Supplies 1.09 100% 0.00 0% 1.09 10.99% 2 Vehicle operations and maintenance 0.12 100% 0.00 0% 0.12 1.21%

3. Lab Equipment Operation and maintenance 0.29 100% 0.00 0% 0.29

2.92%

Subtotal (B) 1.50 100% 0.00 0% 1.50 15.12% Total Base Cost (A+B) 8.93 100% 0.00 0% 9.92 100.00% C. Contingencies 1. Physical Contingencies 0.36 100% 0.00 0% 0.36 3.63% 2. Price Contingencies 0.72 100% 0.06 0% 0.72 7.26% Subtotal (C) 1.07 100% 0.00 0% 1.07 10.79% Total Cost (A+B+C) 10.00 91% 1.00 9% 11.00 110.89%


40 Appendix 4

Table A4.2: G0231-CAM Project Cost at Completion by Financier Item ADB Government of Cambodia Total

$ million % of Cost Category $ million



A. Base Costs 1 Laboratory and Office Equipment 0.90 96% 0.04 4% 0.94 8.78% 2 Vehicles 0.52 100% 0.00 0% 0.52 4.86% 3 System Development 1.61 100% 0.00 0% 1.61 15.03% 4 Training, workshop, fellowships 2.14 100% 0.00 0% 2.14 19.98% 5a Community Mobilization in cash 0.75 100% 0.00 0% 0.75 7.00% 5b Community Mobilization in kind 0.00 0% 0.00 0% 0.00 0.00% 6 Consulting services 1.03 100% 0.00 0% 1.02 9.62% 7 Project Management 0.88 54% 0.76 46% 1.63 15.31% 8 Pooled Fund 0.38 100% 0.00 0% 0.38 3.55% Subtotal (A) 8.20 91% 0.79 9% 8.99 84.03% B. Recurrent costs 1 Supplies 1.29 100% 0.00 0% 1.29 12.04% 2 Vehicle operations and maintenance 0.15 100% 0.00 0% 0.15 1.40%

3. Lab Equipment Operation and maintenance

0.28 100% 0.00 0% 0.28 2.61%

Subtotal (B) 1.71 100% 0.00 0% 1.71 15.97% C. Contingencies 1. Physical Contingencies 0.06 100% 0.00 0% 0.06 0.56% 2. Price Contingencies 0.00 0% 0.00 0% - 0.00% Subtotal (C) 0.06 100% 0.00 0% 0.06 0.56% Total Cost (A+B+C) 9.97 93% 0.79 7% 10.76 100.56%


Appendix 4 41

Table A4.3: G0448-CAM Project Cost at Appraisal by Financier

Regional Malaria and Other Communicable Disease Threats Trust

Fund under the Health Financing Partnership Facilitya Government of Cambodiab Total Costs

Amount % of Cost Amount

Taxes and

Duties Total

Amount % of Cost Total Costs % of Total

$ million Category $ million $ million $ million Category $ million Base Costs A. Base Costs 1 Laboratory and Office

Equipment 0.260 76.9% 0.000 0.078 0.078 23.1% 0.338 8.6% 2 Vehicles 0.143 66.7% 0.000 0.071 0.071 33.3% 0.214 5.4% 3 System Development 1.348 100.0% 0.000 0.000 0.000 0.0% 1.348 34.1% 4 Training, Workshop,

Fellowships 0.446 100.0%

0.000 0.000

0.000 0.0% 0.446 11.3% 5 Community Mobilization in

Cash 0.083 100.0% 0.000

0.000 0.000

0.0% 0.083 2.1% 6 Consulting Services 0.479 100.0% 0.000 0.000 0.000 0.0% 0.479 12.1% 7 Regional and Cross-border

Activitiesc 0.418 100.0%

0.000 0.000

0.000 0.0% 0.418 10.6% Subtotal (A) 3.176 95.5% 0.000 0.149 0.149 4.5% 3.326 84.2%

B. Recurrent Costsd 1 Project Managemente 0.285 86.1% 0.040 0.006 0.046 13.9% 0.331 8.4% 2 Supplies 0.291 100.0% 0.000 0.000 0.000 0.0% 0.291 7.4% Subtotal (B) 0.576 92.6% 0.040 0.006 0.046 7.4% 0.622 15.8% Total Base Costs (A+B) 3.752 95.1% 0.040 0.155 0.195 4.9% 3.948 100.0%

C. Contingencies 1 Physical Contingencies 0.108 98.2% 0.002 0.000 0.002 1.8% 0.110 2.8% 2 Price Contingencies 0.140 98.3% 0.002 0.000 0.002 1.7% 0.142 3.6%

Subtotal (C) 0.248 98.2% 0.004 0.000 0.004 1.8% 0.252 6.4% Total Cost (A+B+C) 4.000 95.2% 0.044 0.155 0.200* 4.8% 4.200* 106.4%

Notes: Total may not sum up due to rounding. a Financing partners: the governments of Australia and the United Kingdom. Administered by the Asian Development Bank b The Government contributions are staff salaries of the PMUs and PIUs staff office space (in kind), and taxes and duties on equipment and vehicles. c Regional cross-border activities include regional workshops, joint investigation of malaria epidemics, referral of cases and meetings between neighboring

provinces. d ADB and the Government will finance recurrent costs in parallel. e ADB will finance project management costs such as audit costs estimated at $14,000, bank charges, and operational costs of the PMUs and PIUs including but

not limited to staff salaries of incremental contracted staff, office utilities, and communication expenses. Source: Asian Development Bank estimates.

42 Appendix 4

Table A3.4: G0448-CAM Project Cost at Completion by Financier


Fund under the Health Financing Partnership Facilitya Government of Cambodiab Total Costs

Amount % of Cost Amount

Taxes and

Duties Total



Equipment 0.35 87% 0.00 0.05 0.05 13% 0.40 10.58%

2 Vehicles 0.38 100% 0.00 0.00 0.00 0% 0.38 10.05% 3 System Development 0.40 100% 0.00 0.00 0.00 0% 0.40 10.58% 4 Training, Workshop,

Fellowships 0.93 100% 0.00 0.00 0.00 0% 0.93 24.60%


0.32 100% 0.00 0.00 0.00 0% 0.32 8.47%

6 Consulting Services 0.65 100% 0.00 0.00 0.00 0% 0.65 17.20% 7 Regional and Cross-border

Activitiesc 0.25 100% 0.00 0.00 0.00 0% 0.25 6.61%

Subtotal (A) 3.28 98% 0.00 0.05 0.05 2% 3.33 88.10%

B. Recurrent Costsd 1 Project Managemente 0.14 100% 0.00 0.00 0.00 0% 0.14 3.70% 2 Supplies 0.32 100% 0.00 0.00 0.00 0% 0.32 8.47% Subtotal (B) 0.45 100% 0.00 0.00 0.00 0% 0.45 11.90% Total Base Costs (A+B) 3.73 99% 0.00 0.05 0.05 1% 3.78 100.00%

C. Contingencies 1 Physical Contingencies 0.00 0% 0.00 0.00 0.00 0% 0.00 0% 2 Price Contingencies 0.00 0% 0.00 0.00 0.00 0% 0.00 0%

Subtotal (C) 0.00 0% 0.00 0.00 0.00 0% 0.00 0% Total Cost (A+B+C) 3.73 99% 0.00 0.05 0.05 1% 3.78 100%

Notes: Total may not sum up due to rounding. a Financing partners: the governments of Australia and the United Kingdom. Administered by the Asian Development Bank b The Government contributions are staff salaries of the PMUs and PIUs staff office space (in kind), and taxes and duties on equipment and vehicles. c Regional cross-border activities include regional workshops, joint investigation of malaria epidemics, referral of cases and meetings between neighboring provinces. d ADB and the Government financed recurrent costs in parallel. e ADB financed project management costs such as audit costs estimated at $14,000, bank charges, and operational costs of the PMUs and PIUs including but not limited to staff salaries of incremental contracted staff, office utilities, and communication expenses. Source: Asian Development Bank estimates.

Appendix 4 43

Table A4.5: G0232-LAO Project Cost at Appraisal by Financier Item ADB Government of Lao PDR Total




A. Base Costs 1

Laboratory and Office Equipment 2.36 88%

0.31 12% 2.67

22.27% 2 Vehicles 0.60 83% 0.12 17% 0.72 6.01% 3 System Development 0.50 100% 0.00 0% 0.50 4.17% 4 Training, workshop, fellowships 2.10 100% 0.00 0% 2.10 17.51% 5a Community Mobilization in cash 0.65 55% 0.00 0% 0.65 5.42% 5b Community Mobilization in kind 0.00 0% 0.52 100% 0.52 4.34% 6 Consulting services 1.10 100% 0.00 0% 1.10 9.17% 7 Project Management 1.22 100% 0.00 0% 1.22 10.18% 8 Pooled Fund 0.74 91% 0.00 0% 0.74 6.17% Subtotal (A) 9.26 91% 0.96 9% 10.22 85.24% B. Recurrent costs 1 Supplies 1.46 100% 0.00 0% 1.46 12.18% 2 Vehicle operations and maintenance 0.07 100% 0.00 0% 0.07 0.58%

3. Lab Equipment Operation and maintenance 0.24 100% 0.00 0% 0.24

2.00%

Subtotal (B) 1.77 100% 0.00 0% 1.77 14.76% Total Base Cost (A+B) 11.03 92% 0.96 8% 11.99 100.00% C. Contingencies 1. Physical Contingencies 0.29 100% 0.00 0% 0.29 2.42% 2. Price Contingencies 0.67 94% 0.04 6% 0.71 5.92% Subtotal (C) 0.97 96% 0.04 4% 1.01 8.42% Total Cost (A+B+C) 12.00 92% 1.00 8% 13.00 108.4%


44 Appendix 4

Table A4.6: G0232-LAO Project Cost at Completion by Financier Item ADB Government of Lao PDR Total




A. Base Costs 1 Laboratory and Office Equipment 2.80 98.94% 0.03 1.06% 2.83 22.97% 2 Vehicles 0.62 77.50% 0.18 22.50% 0.80 6.49% 3 System Development 0.33 100.00% 0.00 0.00% 0.33 2.68% 4 Training, workshop, fellowships 2.17 100.00% 0.00 0.00% 2.17 17.61% 5a Community Mobilization in cash 1.28 100.00% 0.00 0.00% 1.28 10.39% 5b Community Mobilization in kind 0.00 0.00% 0.00 0.00% 0.00 0.00% 6 Consulting services 0.93 100.00% 0.00 0.00% 0.93 7.55% 7 Project Management 1.24 91.85% 0.11 8.15% 1.35 10.96% 8 Pooled Fund 0.79 100.00% 0.00 0.00% 0.79 6.41% Subtotal (A) 10.16 96.95% 0.32 3.05% 10.48 85.06% B. Recurrent costs 1 Supplies 1.71 100.00% 0.00 0.00% 1.71 13.88% 2 Vehicle operations and maintenance 0.07 100.00% 0.00 0.00% 0.07 0.57%

3. Lab Equipment Operation and maintenance 0.06 100.00% 0.00 0.00% 0.06

0.49%

Subtotal (B) 1.84 100.00% 0.00 0.00% 1.84 14.94% C. Contingencies 1. Physical Contingencies 0.00 0.00% 0.00 0.00% 0.00 0.00% 2. Price Contingencies 0.00 0.00% 0.68 100.00% 0.68 5.52% Subtotal (C) 0.00 0.00% 0.68 100.00% 0.68 5.52% Total Cost (A+B+C) 11.99 92.30% 1.00 7.70% 12.99 105.44%


Appendix 4 45

Table A4.7: G0449-LAO Project Cost at Appraisal by Financier

Regional Malaria and Other Communicable Disease Threats

Trust Fund under the Health Financing Partnership Facilitya Government of Lao PDRb Total Costs

Amount % of Cost Amount Taxes and

Duties Total



Equipment 0.257 76.9% 0.000 0.077 0.077 23.1% 0.335 11.1%

2 Vehicles 0.053 66.7% 0.000 0.026 0.026 33.3% 0.079 2.6% 3 System Development 0.381 100.0% 0.000 0.000 0.000 0.0% 0.381 12.6% 4 Training, Workshop,

Fellowships 0.530 100.0% 0.000 0.000 0.000 0.0% 0.530 17.5%


0.325 100.0% 0.000 0.000 0.000 0.0% 0.325 10.8%

6 Consulting Services 0.430 100.0% 0.000 0.000 0.000 0.0% 0.430 14.2% 7 Regional and Cross-

border Activitiesc 0.217 100.0% 0.000 0.000 0.000 0.0% 0.217 7.2%

Subtotal (A) 2.193 95.5% 0.000 0.103 0.103 4.5% 2.297 75.9%


C. Contingencies

1 Physical Contingencies 0.033 97.0% 0.001 0.000 0.001 3.0% 0.034 1.1% 2 Price Contingencies 0.089 96.7% 0.003 0.000 0.003 3.3% 0.092 3.0%

Subtotal (C) 0.122 96.8% 0.004 0.000 0.004 3.2% 0.126 4.2%

Total Cost (A+B+C) 3.000 95.2% 0.042 0.108 0.150 4.8% 3.150* 104.% Notes: Total may not sum up due to rounding. a Financing partners: the governments of Australia and the United Kingdom. Administered by the Asian Development Bank b The Government contributions are staff salaries of the PMUs and PIUs staff, office space (in kind) and taxes and duties on equipment and vehicles. c Regional cross-border activities include regional workshops, joint investigation of malaria epidemics, referral of cases and meetings between neighboring provinces. d ADB and the Government will finance recurrent costs in parallel. e ADB will finance project management costs such as audit costs estimated at $8,000, bank charges, and operational costs of the PMUs and PIUs including but not limited to staff salaries of incremental contracted staff, office utilities, and communication expenses.

46 Appendix 4

Table A4.8: G0449-LAO Project Cost at Completion by Financier

Regional Malaria and Other Communicable Disease Threats

Trust Fund under the Health Financing Partnership Facilitya Government of Lao PDRb Total Costs

Amount % of Cost Amount Taxes and

Duties Total


$ million Category $ million $ million $

million Category $ million Base Costs A. Base Costs 1 Laboratory and Office

Equipment 0.34 80.95% 0.08 0.00 0.08 19.05% 0.42 13.86%

2 Vehicles 0.00 0.00% 0.00 0.00 0.00 0.00% 0.00 0.00% 3 System Development 0.18 100.00% 0.00 0.00 0.00 0.00% 0.18 5.94% 4 Training, Workshop,

Fellowships 0.32 100.00% 0.00 0.00 0.00 0.00% 0.32 10.56%


0.39 100.00% 0.00 0.00 0.00 0.00% 0.39 12.87%

6 Consulting Services 0.52 100.00% 0.00 0.00 0.00 0.00% 0.52 17.16% 7 Regional and Cross-border

Activitiesc 0.37 100.00% 0.00 0.00 0.00 0.00% 0.37 12.21%

Subtotal (A) 2.12 96.36% 0.08 0.00 0.08 3.64% 2.20 72.61%


C. Contingencies

1 Physical Contingencies 0.00 0.00% 0.00 0.00 0.00 0.00% 0.00 0.00% 2 Price Contingencies 0.00 0.00% 0.05 0.00 0.05 100.00% 0.05 1.65%

Subtotal (C) 0.00 0.00% 0.05 0.00 0.05 100.00% 0.05 1.65%

Total Cost (A+B+C) 2.93 95.13% 0.15 0.00 0.15 4.87% 3.08 101.65% Notes: Total may not sum up due to rounding. a Financing partners: the governments of Australia and the United Kingdom. Administered by the Asian Development Bank b The Government contributions are staff salaries of the PMUs and PIUs staff, office space (in kind) and taxes and duties on equipment and vehicles. c Regional cross-border activities include regional workshops, joint investigation of malaria epidemics, referral of cases and meetings between neighboring provinces. d ADB and the Government financed recurrent costs in parallel. e ADB financed project management costs such as audit costs estimated at $8,000, bank charges, and operational costs of the PMUs and PIUs including but not limited to staff salaries of incremental contracted staff, office utilities, and communication expenses.

Appendix 4 47

Table A4.9: L2699-VIE Project Cost at Appraisal by Financier Item ADB Government of Viet Nam Total




A. Base Costs 1 Laboratory and Office Equipment 10.81 100% 0.00 0% 10.81 41.83% 2 Vehicles 2.49 100% 0.00 0% 2.49 9.64% 3 System Development 1.35 100% 0.00 0% 1.35 5.22% 4 Training, workshop, fellowships 3.17 100% 0.00 0% 3.17 12.27% 5 Community Mobilization in cash 1.10 100% .0.00 0% 1.10 4.26% 6 Consulting services 1.30 100% 0.00 0% 1.30 5.03% 7 Project Management 1.02 38% 1.66 62% 2.67 10.33% Subtotal (A) 21.24 93% 1.66 7% 22.90 88.62% B. Recurrent costs 1 Supplies 1.78 70% 0.75 30% 2.52 9.75% 2 Vehicle operations and maintenance 0.08 70% 0.03 30% 0.11 0.43%


0.21 70% 0.09 30% 0.30 1.16%

Subtotal (B) 2.07 70% 0.87 30% 2.94 11.38% Total Base Cost (A+B) 23.31 90% 2.53 10% 25.84 100.00% C. Contingencies 1. Physical Contingencies 0.79 82% 0.18 18% 0.97 3.75% 2. Price Contingencies 2.11 94% 0.29 12% 2.40 9.29% Subtotal (C) 2.90 96% 0.47 13% 3.37 13.04% D. Interests 0.79 100% 0.00 0% 0.79 3.06% Total Cost (A+B+C+D) 27.00 90% 3.00 10% 30.00 116.10%


48 Appendix 4

Table A4.10: L2699-VIE Project Cost at Completion by Financier Item ADB Government of Viet Nam Total




A. Base Costs 1 Laboratory and Office Equipment 12.62 100.00% 0.00 0.00% 12.62 45.64% 2 Vehicles 2.81 100.00% 0.00 0.00% 2.81 10.16% 3 System Development 1.44 100.00% 0.00 0.00% 1.44 5.21% 4 Training, workshop, fellowships 2.92 100.00% 0.00 0.00% 2.92 10.56% 5 Community Mobilization in cash 0.99 100.00% 0.00 0.00% 0.99 3.58% 6 Consulting services 1.07 100.00% 0.00 0.00% 1.07 3.87% 7 Project Management 0.89 29.28% 2.15 70.72% 3.04 10.99% Subtotal (A) 22.74 91.36% 2.15 8.64% 24.89 90.02% B. Recurrent costs 1 Supplies 1.96 83.05% 0.40 16.95% 2.36 8.54% 2 Vehicle operations and maintenance 0.06 85.71% 0.01 14.29% 0.07 0.25%


0.27 81.82% 0.06 18.18% 0.33 1.19%

Subtotal (B) 2.29 82.97% 0.47 17.03% 2.76 9.98% Total Base Cost (A+B) 25.04 90.50% 2.63 9.50% 27.67 100.00% C. Contingencies 1. Physical Contingencies 0.00 0.00% 0.00 0.00% 0.00 0.00% 2. Price Contingencies 0.00 0.00% 0.00 0.00% 0.00 0.00% Subtotal (C) 0.00 0.00% 0.00 0.00% 0.00 0.00% D. Interests 0.73 100.00% 0.00 0.00% 0.73 2.64% Total Cost (A+B+C+D) 25.77 90.74% 2.63 9.26% 28.40 102.71


Appendix 4 49

Table A4.11: G0450-VIE Project Cost at Appraisal by Financier


Fund under the Health Financing Partnership Facilitya Government of Viet Nam Total Costs

Total % of Cost Total % of Cost Total Costs % of Total

$ million Category $ million Category $ million Base Costs A. Base Costs

1 Laboratory and Office Equipment 0.156 100.0% 0.000 0.0% 0.156 6.1%

2 System Development 1.065 100.0% 0.000 0.0% 1.065 41.3%

3 Training, Workshop, Fellowships 0.352 100.0% 0.000 0.0% 0.352 13.7%

4 Community Mobilization 0.150 100.0% 0.000 0.0% 0.150 5.8% 5 Consulting Services 0.145 100.0% 0.000 0.0% 0.145 5.6%

6 Regional and Cross-border Activitiesc 0.264 100.0% 0.000 0.0% 0.264 10.2% Subtotal (A) 2.132 100.0% 0.000 0.0% 2.132 82.7%

B. Recurrent Costsd 1 Project Managemente 0.211 47.4% 0.234 52.6% 0.445 17.3% Subtotal (B) 2.211 47.4% 0.234 52.6% 0.445 17.3% Total Base Costs (A+B) 2.343 90.9% 0.234 91.1% 2.577 100%

C. Contingencies 1 Physical Contingencies 0.067 90.9% 0.007 9.1% 0.074 2.9% 2 Price Contingencies 0.089 90.9% 0.009 9.1% 0.098 3.8%

Subtotal (C) 0.157 90.9% 0.016 9.1% 0.172 6.7% Total Cost (A+B+C) 2.500 90.9% 0.250 9.1% 2.750 106.7%

a Financing partners: the governments of Australia and the United Kingdom, administered by the Asian Development Bank. b The Government contributions in kind are staff salaries of the PMUs and PIUs staff. c Regional cross-border activities include regional workshops, joint investigation of malaria epidemics, referral of cases and meetings between neighboring

provinces. d ADB and the Government will finance recurrent costs in parallel. e ADB will finance project management costs such as audit costs estimated at $25,000, bank charges, and operational costs of the PMUs and PIUs including but

not limited to staff salaries of incremental contracted staff, office utilities, communication expenses, and office space.

50 Appendix 4

Table A4.12: G0450-VIE Project Cost at Completion by Financier


Fund under the Health Financing Partnership Facilitya Government of Viet Nam Total Costs

Total % of Cost Total % of Cost Total Costs % of Total

$ million Category $ million Category $ million Base Costs A. Base Costs

1 Laboratory and Office Equipment 0.149 100.00% 0.000 0.00% 0.149 6.90%

2 System Development 0.964 100.00% 0.000 0.00% 0.964 44.63%

3 Training, Workshop, Fellowships 0.318 100.00% 0.000 0.00% 0.318 14.72%

4 Community Mobilization 0.171 100.00% 0.000 0.00% 0.171 7.92% 5 Consulting Services 0.007 100.00% 0.000 0.00% 0.007 0.32%

6 Regional and Cross-border Activitiesc 0.182 1000.0% 0.000 0.00% 0.182

8.43%

Subtotal (A) 1.791 100.00% 0.000 0.00% 1.791 82.92% B. Recurrent Costsd 1 Project Managemente 0.229 62.06% 0.140 37.94% 0.369 17.08% Subtotal (B) 0.229 62.06% 0.140 37.94% 0.369 17.08% Total Base Costs (A+B) 2.020 93.52% 0.140 6.48% 2.160 100.00%

C. Contingencies 1 Physical Contingencies 0.000 0.00% 0.000 0.00% 0.000 0.00% 2 Price Contingencies 0.000 0.00% 0.000 0.00% 0.000 0.00%

Subtotal (C) 0.000 0.00% 0.000 0.00% 0.000 0.00% Total Cost (A+B+C) 2.020 93.52% 0.140 6.48% 2.160 100.00%

a Financing partners: the governments of Australia and the United Kingdom, administered by the Asian Development Bank. b The Government contributions in kind are staff salaries of the PMUs and PIUs staff. c Regional cross-border activities include regional workshops, joint investigation of malaria epidemics, referral of cases and meetings between neighboring

provinces. d ADB and the Government financed recurrent costs in parallel. e ADB financed project management costs such as audit costs estimated at $25,000, bank charges, and operational costs of the PMUs and PIUs including but not

limited to staff salaries of incremental contracted staff, office utilities, communication expenses

Appendix 5 51

DISBURSEMENT OF ADB LOAN AND GRANT PROCEEDS

Table A5.1: G0231-CAM Annual and Cumulative Disbursement of ADB Grant Proceedsa ($ million)

Annual Disbursement Cumulative Disbursement

Year Amount

($ million) % of Total Amount

($ million) % of Total 2011 1.19 11.91 1.19 11.91 2012 1.77 17.80 2.96 29.71 2013 3.11 31.18 6.07 60.89 2014 2.02 20.30 8.09 81.19 2015 1.29 12.99 9.39 94.18 2016 0.58 5.82 9.97 100.00 2017 0.00 0.00 9.97 100.00 2018 0.00 0.00 9.97 100.00

Total 9.97 100.0% ADB = Asian Development Bank. a Includes disbursements to advance accounts. Source: Asian Development Bank.

Figure A5.1: G0231-CAM Projection and Cumulative Disbursement of ADB Grant Proceeds

($ million)

Year 2011 2012 2013 2014 2015 2016 2017 2018

Projected 1.00 2.50 4.50 7.00 10.00 10.00 10.00 10.00

Actual 1.19 2.96 6.07 8.09 9.39 9.97 9.97 9.97

The project administration manual does not have projections. Baseline projection version 1 (project effectiveness) from eOperations was used. Projections in eOperations were actualized annually. Any excess or shortage from previous year were carried

over by adjusting the projection of the 1st quarter of the following year. On 16 September 2015, the grant closing date was extended by 1.5 years to 31 December 2017, projections

were revised based on actualized figures.

0.00

2.00

4.00

6.00

8.00

10.00

12.00

2011 2012 2013 2014 2015 2016 2017 2018

Projected Actual

52 Appendix 5

Table A5.2: G0448-CAM Annual and Cumulative Disbursement of ADB Grant Proceedsa ($ million)


Year Amount


($ million) % of Total 2016 1.90 50.81 1.90 50.81 2017 1.84 49.19 3.73 100.00


Figure A5.2: G0448-CAM Projection and Cumulative Disbursement of ADB Grant Proceeds

($ million)

Year 2016 2017 2018

Projected 1.60 4.00 4.00

Actual 1.90 3.73 3.73


over by adjusting the projection of the 1st quarter of the following year.

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

1 2 3

Projected Actual

Appendix 5 53

Table A5.3: G0232-LAO Annual and Cumulative Disbursement of ADB Grant Proceedsa ($ million)


Year Amount


($ million) % of Total 2011 1.84 15.36 1.84 15.36 2012 1.96 16.32 3.80 31.69 2013 2.46 20.50 6.26 52.18 2014 3.24 26.99 9.49 79.17 2015 2.09 17.43 11.58 96.60 2016 0.19 1.61 11.77 98.21 2017 0.22 1.88 11.99 100.00 2018 0.00 0.00 11.99 100.00

Total 11.99 100.00 ADB = Asian Development Bank. a Includes disbursements to advance accounts. Source: Asian Development Bank.

Figure A5.3: G0232-LAO Projection and Cumulative Disbursement of ADB Grant Proceeds

($ million)

Year 2011 2012 2013 2014 2015 2016 2017 2018

Projected 1.50 3.00 5.50 9.40 12.00 12.00 12.00 12.00

Actual 1.84 3.80 6.26 9.49 11.58 11.77 11.99 11.99




0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

2011 2012 2013 2014 2015 2016 2017 2018

Projected Actual

54 Appendix 5

Table A5.4: G0449-LAO Annual and Cumulative Disbursement of ADB Grant Proceedsa ($ million)


Year Amount


($ million) % of Total 2016 2.20 50.81 2.20 74.92 2017 0.74 49.19 2.93 100.00 2018 0.00 0.00 2.93 100.00


Figure A5.4: G0449-LAO Projection and Cumulative Disbursement of ADB Grant Proceeds

($ million)

Year 2016 2017 2018

Projected 1.20 3.00 3.00

Actual 2.20 2.93 2.93



0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

1 2 3

Projected Actual

Appendix 5 55

Table A5.5: L2699-VIE Annual and Cumulative Disbursement of ADB Loan Proceedsa ($ million)


Year Amount


($ million) % of Total 2011 2.32 9.02 2.32 9.02 2012 4.18 16.24 6.51 25.25 2013 5.40 20.94 11.91 46.20 2014 9.08 35.22 20.98 81.42 2015 3.76 14.59 24.74 96.01 2016 0.67 2.58 25.41 98.59 2017 0.36 1.41 25.77 100.00 2018 0.00 0.00 25.77 100.00


Figure A5.5: L2699-VIE Projection and Cumulative Disbursement of ADB Loan Proceeds

($ million)

Year 2011 2012 2013 2014 2015 2016 2017 2018

Projected 2.70 5.20 9.70 15.70 26.40 26.40 26.40 26.40

Actual 2.32 6.51 11.91 20.98 24.74 25.41 25.77 25.77




0.00

5.00

10.00

15.00

20.00

25.00

30.00

2011 2012 2013 2014 2015 2016 2017 2018

Projected Actual

56 Appendix 5

Table A5.6: G0450-VIE Annual and Cumulative Disbursement of ADB Grant Proceedsa ($ million)


Year Amount


($ million) % of Total 2016 1.72 85.23 1.72 85.23 2017 0.30 14.77 2.02 100.00 2018 0.00 0.00 2.02 100.00


Figure A5.6: G0450-VIE Projection and Cumulative Disbursement of ADB Grant Proceeds

($ million)

Year 2016 2017 2018

Projected 1.00 2.50 2.50

Actual 1.72 2.02 2.02


over by adjusting the projection of the 1st quarter of the following year. First partial cancellation of $174,600 was approved on 1 September 2017; Second partial cancellation of $303,894.26 was approved on 21 December 2017.

0.00

0.50

1.00

1.50

2.00

2.50

3.00

1 2 3

Projected Actual

Appendix 6 57

LIST OF CONSULTING SERVICES G0231/G0448-CAM

Consultant Name Position Contract Duration Inputs (Person-months)

Start End

National 1 Dr. Mat Bunthan Assistant Project Manager 1 April 2011 31 December 2017 81 2 Ms. Ton Chhavivann Monitoring and Evaluation

Expert 1 April 2011 31 December 2017 81

3 Mr. Lak Sunthy Procurement Officer 1 April 2011 16 September 2012 18

Procurement Expert 1 October 2016 31 December 2017 15

4 Mr. Mom Vortana IT/Database/GIS Expert 9 April 2012 30 July 2017 64 5 Dr. Somchum Daka Community Health Specialist 1 August 2013 31 December 2017 53 6 Mr. Thuy Sovanna Project Accountant 1 April 2011 31 December 2017 81 7 Ms. Ouk Leakhena Accounting Assistant 1 April 2011 31 December 2017 81 8 Ms. Kung Bora Administrative Assistant 1 April 2011 31 December 2017 81 9 Dr. So Phat Training Consultant 1 April 2012 30 June 2013 15 10 Mr. Luy Tech Chheng Gender & Indigenous

Population Expert, Social Development Specialist

1 January 2012

1 December 2016

30 June 2014

30 June 2017

30

7 11 Mr. Krang Sunlorn Project Completion Consultant

30 October 2017 15 December 2017 30 person-

days International 12 Mr. Peter John Miller Chief Technical Advisor 1 January 2012

31 December 2013 24

13 Md. Hedayetul Islam Malaria Elimination Expert 3 June 2015 31 December 2017 18 14 Mr. Anthony Thomas

Bott Social Development Specialist 1 December 2016 30 June 2017 30 person-

days 15 Dr. Jutta Marfurt QA/QC Consultant 22 February 2017 5 May 2017 40 person-

days 16 Dr. Charles

Delacollette Malaria Elimination Expert

3 Jun 2105 15 December 2017 10

Firms 15 Institut de Pasteur du

Cambodge Seroprevalence Survey for HFMD and Dengue

September 2014 August 2015

16 SBK Research and Development Co., Ltd

Impact monitoring (baseline and endline)

August 2014 June 2017

17 SBK Research and Development Co., Ltd

Malaria Indicator Survey (baseline and endline)

July 2017 December 2017

18 Various (MEF bundling package)

External Audits

GIS=geographic information system, MEF=Ministry of Economy and Finance, QA/QC=Quality Assurance/Quality Control.

G0232/G0449-LAO

Package Number

General Description

Estimated Value

Awarded Contract Value

Recruitment Method

Date of Contract

Date of Completion

Comments

2F1.4 IT/Database/GIS Consultant

48,000.00 3,022.26 ICS 2 September 2013

12 December 2013

G0232

1F1.5 Chief Technical Adviser (48)

648,000.00 505,320.07 ICS 1 February 2011

31 December 2015

G0232

2F1.2 Gender and IP Expert (18)

18,000.00 19,000.00 ICS 19 November 2012

31 December 2015

G0232

1F1.4 NTD/Dengue Expert (48)

48,000.00 58,082.13 ICS 1 July 2011

31 December 2015

G0232

58 Appendix 6

Package Number

General Description

Estimated Value


Recruitment Method

Date of Contract

Date of Completion

Comments

1F1.3 Procurement Specialist

21,600.00 69,697.68 ICS 1 July 2011

31 October 2015

G0232

2F1.1 Surveillance and Response Expert (48)

48,000.00 35,189.96 ICS 1 July 2011

31 December 2015

G0232

2F1.1.1 Training Consultant (15)

15,000.00 44,334.40 ICS 2 May 2012

31 December 2015

G0232

2F1.5 Accounting Firm 150,000.00 174,600.00 CQS 19 February

2012

31 July 2016 contract extension

under G0232 until 31 July

2013 1AD1.1 International

Consultant for Malaria Control

78,000.00 78,169.00 ICS 19 Septembe

r 2016

30 November 2016

G0449 (AF) Prof. Ananda

Rajitha Wikremasinghe

; duration: 1 May 2016-30

Nov 2016 intermittent

2F1.3 National Project Procurement Expert

8,160.00 16,072.44 ICS 11 February

2016

31 December 2016

G0449 (AF); contract

extension (duration: 4 Jan

2016-31 Dec 2016)

2F1.2 (extension)

National Gender Consultant

6,300.00 12,256.90 ICS 1 June 2016

31 December 2016



2016-31 Dec 2016)

2F1 (extension)

National Training Consultant

6,420.00 12,624.70 ICS 2 February 2016

31 December 2016



2016-31 Dec 2016)

1F1.2 Monitoring and Evaluation (60)

60,000.00 78,003.00 ICS 1 July 2011

31 May 2017 contract extension

under G0232 until 31 May

2017 1F1.1 Project Manager

(60) 99,600.00 116,549.42 ICS 1 January

2017 30 September

2017 contract

extension under G0232 until 30 April

2017 (116,784.14);

contract extension from 1 May-30 Sep 2017 charged

to G0449 ($8,355.80)

1F1.5 (AF) Chief Technical Advisor

270,000.00 375,552.37 ICS 1 December

2015

30 September 2017



2016-31 Sep 2017)

Appendix 6 59

Package Number

General Description

Estimated Value


Recruitment Method

Date of Contract

Date of Completion

Comments

1F1.4 (extension)

National Dengue/NTD Expert

21,060.00 25,503.94 ICS 1 January 2016

31 October 2017

G0449 (AF) extension of

contract, duration: 4 Jan

2016-31 October 2017)

2F1.1 (extension)

Surveillance and Response Expert

16,560.00 19,808.80 ICS 1 January 2016

31 October 2017



2016-31 October 2017)

GIS=geographic information system, ICS=individual consultant selection, IP=indigenous people, NTD=neglected tropical diseases. L2699/G0450-VIE

Package Number

General Description

Estimated Value

Awarded Contract

Value Recruitment

Method Date of

contract Date of

Completion Comments

185 Gender and Ethnic Group Specialist

45,000.00 33,500.00 ICS 1 June 2012

5 October 2012

So Rothavy

Gender and IP Expert

18,000.00 18,000.00 ICS 1 February 2012

31 July 2013 Pham Quynh Huong

13 Baseline Project Assessment

110,000.00 109,476.00 LCS 25 December

2012

6 August 2013

Research Center for Rutal

Population & Health

12 Audit (FY 2011 & 2012)

20,000.00 12,500.00 LCS 12 April 2013

24 December 2013

Au Lac Auditing Company Limited

144 Chief Technical Advisor/training systems

360,000.00 331,525.00 ICS 7 May 2012 6 May 2014 Tarek Mahmud Hussain

319 Laboratory Expert 24,000.00 24,000.00 ICS 30 November

2012

1 August 2014

Nguyen Hoang Tung

268 Laboratory Management Specialist

30,000.00 22,000.00 ICS 11 August 2014

31 October 2014

John Gregory Askov

73-3. Project Coordinator 19,800.00 19,800.00 ICS 1 April 2013 3 September 2015

Nguyen Thi Hong Chuyen

50 Surveillance and Response

48,000.00 23,000.00 ICS 1 February 2012

30 September

2015

Nguyen The Hung

43 Behavior Change Communication expert

48,000.00 47,000.00 ICS 1 February 2012

31 December 2015

Dang Xuan Ket

238 Dengue/NTD Expert 48,000.00 41,000.00 ICS 1 August 2012

31 December 2015

Nguyen Van Bien

45 IT/Database/GIS Expert

48,000.00 47,000.00 ICS 1 February 2012

31 December 2015

Nguyen Quoc Trinh

46 Monitoring and Evaluation

54,000.00 47,000.00 ICS 1 February 2012

31 December 2015

Le Thi Xuan Mai


48,000.00 28,200.00 ICS 1 February 2012

31 December 2015

Nguyen Lam


48,000.00 47,000.00 ICS 1 February 2012

31 December 2015

Phung Xuan Ty


48,000.00 47,000.00 ICS 1 February 2012

31 December 2015

Hoang Anh Vuong

47 Training Consultant 48,000.00 45,000.00 ICS 1 February 2012

31 December 2015

Bui Vu Binh

73-2 Accountant 88,000.00 36,900.00 ICS 17,100.00 31 July 31 December Do Thi Thu Mai

60 Appendix 6

Package Number

General Description

Estimated Value

Awarded Contract

Value Recruitment

Method Date of

contract Date of

Completion Comments

2013 2015 (Contract No. 240/VIE2699)

19,800.00 1 April 2013 31 December 2015

Nguyen Thi Minh Phuong

(Contract No. 73/VIE2699)

201 Computer Specialist 36,000.00 30,000.00 ICS 4 July 2013 31 December 2015

Nguyen Manh Hung

73-1 Procurement Specialist

36,000.00 19,800.00 ICS 1 April 2013 31 December 2015

Nguyen Thi Luong

377 Regional Focal Coordinator on Communicable Disease Control

43,200.00 13,000.00 ICS 1 December 2014

31 December 2015

Le Thi Song Huong

36 Auditing Service FY 2013-2015

60,000.00 33,960.00 LCS 25 May 2015

9 September 2016

AASC Auditing Firm Limited

ICS/2015 Senior Program Manager

27,000.00 13,500.00 ICS 1 April 2013 30 December 2016

Vuong Thuy Lan

3/2015 Project Closing Assessment

110,000.00 108,961.00 LCS 14 April 2017

28 September

2017

Joint venture between center for environment

and health studies and center for

community health

development C-1 Auditing Firm for FY

2016-2017 25,000.00 6,749.22 LCS 2 June

2017 25 December

2017 VND

153,295,120 FY=fiscal year, ICS=individual consultant selection, IP=indigenous people, LCS=least cost selection.

Appendix 7 61

LIST OF PROCUREMENT PACKAGES G0231/G0448-CAM

Package Number Description of

Goods Date of Contract

Contract Amount

($) Supplier

Plan Year 2011 1 ADB-GMS-CDC2-G-Shopping-

11-001 Refrigerators (7 units)

12 August 2011 3,339.00 OMC Co., Ltd

2 ADB-GMS-CDC2-G-Shopping-11-002

USB Modem for mobile internet (32 units)

2 August 2011 928.00 Kim Heng Computer

3 ADB-GMS=CDC2-G-Shopping-11-003

GPS Device (3 units) 2 August 2011 1,740.00 ICE Computer


Mobile Generator (10 units)

14 September 2011 6,900.00 Envisioning Co., Ltd


Office Furniture: Office Desk (11 units), Stainless steel Chair (90 units), Swivel Arm Chair (29 unit), Cupboard (11 units), Book Shelves (4 units) & Filling Cabinet (24 units)

14 September 2011 3,340.00 Leeco Shop Modern Office Furniture

4,987.00 Leang Hong Import Export Co., Ltd

1,485.00 V.S.V Trading Co., Ltd


Infrared Scan units (30 units) Thermometer

9 December 2011 1,168.80 Medicom Co., Ltd


Timer Stand Fan (10 units) & Portable Loudspeaker (25 units)

19 October 2011 7,475.00 Cheang Sim Shop

8 ADB-GMS-CDC2-G-NCB-11-001

Motorcycle (capacity 125cc) 32 sets

2 February 2012 38,080.00 Yamahar Motor Cambodia Co., Ltd


Bicycle (1,132 units) 16 March 2012 62,882.60 V.S.V Trading Co., Ltd


Office Equipment: 1-Lot-1 (1-Desk top 20 units & 2- Desktop for Server 1 unit), Lot-2 (Laptop 25 units), Lot-3 (LCD Projector 17 units), Lot-4 (Color Printer 16 units, Fax/Phone 7 units & Scanner 17 units), Lot-5 (Photocopy Machine 2 units) & Lot-6 (External Hard Disk 24 units & USB Flash 15 units)

5 March 2012 21,278.40 Envisioning Co., Ltd

19,220.00 Envisioning Co., Ltd

9,125.00 Narita Distribution Cambodia Co., Ltd

38,056.29 Neeka Limited 9,444.60 Neeka Limited 2,880.90 PTC Computer

Co., Ltd


Video Conference Equipment

3 July 2012 61,795.00 Daun Penh Hi-Tech Screening Technology & LTE Co., Ltd

12 ADB-GMS-CDC2-G-ICB-11-001 Vehicles 4WD (15 sets)

2 March 2012 343,500.00 RMA (Cambodia) Co., Ltd

62 Appendix 7



Contract Amount

($) Supplier

Plan Year 2011 & 2012 1 ADB-GMS-CDC2-Direct-12-G-

01 Virology Testing for CNM

20 August 2012 9,999.24 Institut Paster Du Cambodge

2 ADB-GMS-CDC2-Shopping-12-G-01

Office Furniture: Office Desk (5 units), Steel Cupboard (6 units), Swivel Arm Chair (5 unit), Book Shelves (6 units)

11 February 2013 3,454.00 V.S.V Trading Co., Ltd


Spraying Machine (2 units) for CDC

11 February 2013 2,342.64 Medicom Co., Ltd


Sphymomanometers (30 units) for CDC

8 February 2013 880.20 Medicom Co., Ltd


GPS Device (24 units)

8 February 2013 14,400.00 Kim Heng Center


Computer Server with UPS

15 March 2013 4,072.20 PTC Computer Co., Ltd


USB Modem for Internet

8 February 2013 3,800.00 Kim Heng Center


Computers' Software (QuickBooks, Mricrosoft Office Professional & Home Business and Arc GIS)

10 April 2013 9,174.00 Neeka Limited

9 ADB-GMS-CDC2-G-ICB-11-002 Laboratory Equipment and Materials for 10 Provincial Hospitals

11 January 2013 232,452.10 Envisioning Co., Ltd

28 January 2013 21,794.25 CFP Group A/S

10 ADB-GMS-CDC2-ICB-12-G-01 Medical Equipment for NIPH and for TSMC

5 March 2013 339,142.29 Envisioning Co., Ltd

Plan Year 2013 1 ADB-GMS-CDC2-NS-13-G-01 Fiber Optic for

Internet & Monthly Fee

14 August 2013 18,865.00 Telcotech

2 HSSP2/ADB-GMS/2013/Printing/Shopping/01

Printing Document 12 June 2013 990.00 IPML Services Co., Ltd

3 HSSP2/ADB-GMS/2013/Printing/Shopping/02

Printing & T-shirt 31 July 2013 7,929.90 IPML Services Co., Ltd

31 July 2013 5,049.00 Makud Pech Printing House

4 ADB-GMS-CDC2-NS-Translate-13-03

Translation Document

30 September 2013 1,060.00 Sunshine Translation Services

5 ADB-GMS-CDC2-NS-MS-13-02 Medical Supply 5 August 2013 7,134.86 Medicom Co., Ltd

6 ADB-GMS-CDC2-NS-G-13-03 Office Equipment 10 January 2014 95,341.81 Neeka Limited Plan Year 2014 - 2015

1 HSSP2/GMS2/14/NCB/G/01 Material for Latrine Construction

Lot 1 Lot 3

30 November 2015 362,882.85 MTA Construction Co., Ltd

30 November 2015 383,805.60 Golden Hall Services Co., Ltd

Appendix 7 63



Contract Amount

($) Supplier

2 HSSP2/GMS2/14/NCB/G/01 Laboratory Rapid Test

8 September 2015 98,225.10 MediGroup Asia Ltd

3 HSSP2/GMS2/14/NS/G/01 Laboratory Consumable

16 February 2015 65,875.37 Medicom Co., Ltd

4 HSSP2/GMS2/14/NS/G/02 Equipment for Laboratory Improvement

16 February 2015 26,630.70 Universal Healthcare Ltd

5 HSSP2/GMS2/14/NS/G/03 Billboard 10 February 2015 63,000.00 Pidana Co., Ltd 6 HSSP2/GMS2/14/NS/G/04 Reagents for Existing

Laboratory Equipment

20 April 2015 55,275.30 Envisioning Co., Ltd

7 HSSP2/GMS2/14/NS/G/05 Laboratory Training Material

30 January 2015 3,571.65 Medicom Co., Ltd

8 HSSP2/GMS2/14/NS/G/06 Medical Consumable Supply

HSSP2/GMS2/14/NS/G/06-Re-Bid

10 June 2015 39,814.50 Medicom Co., Ltd

9 HSSP2/GMS2/14/NS/G/07 IEC Material 22 October 2015 3,942.40 IPML Services Co., Ltd

10 HSSP2/GMS2/14/NS/G/09 Medical Consumable Supply for HQ

10 June 2015 3,504.49 Envisioning CO., Ltd

Year 2016 for Additional Financing 1 HSSP2/GMS2-AF/NCB-16-G-

01 LAMP test for 20,000 cases with 2 machines

29 July 2016 160,855.06 Medicom Co., Ltd

2 HSSP2/GMS2-AF/Shopping-16-G-01

Billboards, IEC materials, posters and leaflets ($5,000)

8 May 2017 24,332.00 Sefeta (Cambodia) Co., Ltd (for Lot-1)

8 May 2017 12,320.00 IPML Services Co., Ltd (for Lot-2)


DDD for Preah Vihear province (300 units)

23 May 2016 28,710.00 Mongkul Bee Co., Ltd


Purchase software for DDD

11 November 2016 4,862.00 Mongkul Bee Co., Ltd


36 laptops & 3 desktops (30 high specs laptops for CNM ($55,620) +6 laptops & 3 desktops for PCU ($16,686), One Laser Printer Color jet (A3&A4) for PCU) ($6,000), One multi-function printer for CNM ($1,694)

23 May 2016 63,919.90 Neeka Limited


Purchase 3 cars (One car for Preah Vihear PHD, one car for CNM, and one car for central monitoring team-DPHI)

26 July 2016 77,997.00 K (Cambodia) Co., Ltd


Purchase 24 Motorbikes for Preah Vihear

23 May 2016 42,900.00 Mongkul Bee Co., Ltd

64 Appendix 7



Contract Amount

($) Supplier


Personal Protection Package targeting cross-border malaria positive people (hammock with net and repellent) 5,600 units

22 February 2017 30,240.00 Sefeta (Cambodia) Co., Ltd


Microscope mounted camera and USB link to desktop computer for internet connectivity (20 sets)

4 January 2017 75,900.00 Envisioning Co., Ltd

10 HSSP2/GMS2-AF/Direct Contracting-16-Broadcast-01

Broadcasting of TV & Radio Spot for Malaria

Budget of Preah Vihear (work done by Preah Vihear Province)

11 GMS-CDC2-Shopping-16-G-09 Purchase 1 car (for PMU)

13 December 2016 25,800.00 RMA (Cambodia) Co., Ltd

Plan Year 2017 for Additional Financing 1 GMS-CDC2-Shopping-16-G-10 Purchase of 1 station

wagon vehicle 25 September 2017 31,000.00 RMA

(Cambodia) Co., Ltd

2 GMS-CDC2-Shopping-16-G-11 Purchase 40 sets of motorcycles

3 May 2017 67,892.00 OMC Co., Ltd

3 GMS-CDC2-Shopping-16-G-12 Purchase 20 sets of microscopes

20 July 2017 74,140.00 Medicom Co., Ltd

4 GMS-CDC2-Shopping-16-G-13 Purchase 2 Pick Up Vehicles

14 September 2017 54,000.00 RMA (Cambodia) Co., Ltd

5 GMS-CDC2-Shopping-16-G-14 Purchase 3 sets of microscopes

25 September 2017 10,978.65 Medicom Co., Ltd

6 GMS-CDC2-Shopping-16-G-15 Purchase 1 Air-conditioner

5 December 2017 1,265.00 Mongkul Bee Co., Ltd

7 GMS-CDC2-Shopping-16-G-16 Purchase Office Equipment (1 Laptop, 1 Photocopy, 1 Printer, 1 Scanner & 2 LCD)

15 September 2017 12,350.00 Mongkul Bee Co., Ltd

8 GMS-CDC2-Shopping-16-G-17 Consumable for LAMP

6 October 2017 26,042.74 Medicom Co., Ltd

9 GMS-CDC2-NCB-17-G-01 Purchase 104 sets of motorcycles

27 November 2017 170,768.00 OMC Co., Ltd

AF=additional financing; CDC= communicable diseased control; CNM=National Center for Parasitology, Entomology, and Malaria Control, DPHI=Department of Planning and Health Information; GIS=geographic information system; DDD=digital data device; GMS=Greater Mekong Subregion; HQ=headquarters; HSSP=health sector support program, ICB=international competitive bidding; IEC=information, education and communication; LAMP= Loop mediated Isothermal Amplification; NCB=national competitive bidding; NIPH=National Institute of Public Health; PCU=project coordination unit; TSMC=Technical School for Medical Care.

G0232/G0449-LAO

Package Number

General Description Estimated

Value

Awarded Contract

Value

Procurement Method

Date of Contract

Date of Completion

1K1 Printing for Surveillance and Respond program

2,000.00 2,520.00 SHOPPING 13 August 2011

30 September 2011

1K2 Printing for Dengue and Parasite Control Program

37,000.00 38,000.00 SHOPPING 29 September 2011

31 October 2011

Appendix 7 65

Package Number


Value

Awarded Contract

Value

Procurement Method

Date of Contract

Date of Completion

2A1.1 Office equipment for PMU 5,000.00 4,500.00 SHOPPING 10 December 2011

31 December 2011

1D8 Personal Protection Suit for sprayers for project targeted provinces

6,000.00 5,650.00 SHOPPING 15 November 2011

31 January 2012

1B1 Vehicles (14 Pickup) 445,000.00 444,164.00 DC 23 August 2011

31 January 2012

1B2 Vehicles (4x4 Jeep) 96,000.00 95,123.55 DC 23 August 2011

31 January 2012

1A1 Office equipment for PMU, NIAs and PIAs


29 February 2012

1D2 Dengue rapid test, Larvicide, Deltacide, Larvae Survey Kits and Stool Kits

70,000.00 70,090.00 SHOPPING 20 February 2012

31 March 2012

1D2.1 Larvicide and Deltacide 65,000.00 68,850.00 SHOPPING 11 January 2012

31 March 2012

1D1 Spray machine 32,000.00 31,460.00 SHOPPING 2 January 2012

31 March 2012

2K1.3 Health Education T-shirt for Dengue Control program

18,000.00 17,500.00 SHOPPING 5 January 2012

30 April 2012

2K1.1 Printing S&R Program 10,000.00 9,600.00 SHOPPING 15 March 2012

31 May 2012

2K1.2 Printing dengue patient care manual for nurses

5,500.00 5,000.00 SHOPPING 15 March 2012

31 May 2012

2K1.4 Printing for Training program (including training management and teaching methods manuals)

3,000.00 3,000.00 SHOPPING 15 March 2012

31 May 2012

2C1.1 Laboratory supplies 80,000.00 61,090.00 SHOPPING 31 July 2012 2B2 Motorbikes (75) 97,500.00 78,750.00 SHOPPING 4 May 2012 31 October

2012 2K1.13 Print SOP and RRT employment 2,000.00 2,000.00 SHOPPING 2 October

2012 30 November

2012 2K1.6 Print SOP on MDA for OV, LF and

Shisto 2,500.00 2,500.00 SHOPPING 2 October

2012 30 November

2012 2K1.12 Print revised Outbreak Manual 2,000.00 2,000.00 SHOPPING 2 October

2012 30 November

2012 2K1.10 Printing IEC tools (poster, flipchart,

brochure) on dengue control and prevention

39,000.00 42,000.00 SHOPPING 30 April 2013 30 November 2013

2K1.5 Printing for Village Development Program (MHV guidelines)

6,800.00 6,034.37 SHOPPING 15 October 2012

30 November 2012

2K1.11 Printing posters for OV control and prevention


30 November 2012

2A1.2 Metallic furniture for PPMUs 10,000.00 7,500.00 SHOPPING 5 December 2012

31 December 20142

2A3 Video Conference system 50,000.00 48,187.00 SHOPPING 9 November 2012

31 December 2012

2K1.7 Print 1000 copies of the revised implementation guidelines and 10,000 copies of STH prevention

15,000.00 14,800.00 SHOPPING 10 December 2012

31 January 2013

2C2.1 Reagents 61,000.00 88,430.00 SHOPPING 9 November 2012

28 February 2013

2B1 Dengue Rapid test 24,000.00 24,650.00 SHOPPING 11 January 2013

30 June 2013

1D9 Support Equipment for MHVs 70,000.00 68,000.00 SHOPPING 5 March 2013 30 September 2013

1D9.1 Support Equipment for MHVs 70,000.00 70,000.00 SHOPPING 10 May 2013 30 September 2013

EA2.2.1 Procure training equipment for provincial training

36,000.00 35,230.00 SHOPPING 30 April 2013 14 October 2013

2K1.9 Print EBS posters 2,000.00 1,975.92 SHOPPING 5 September 2013

31 October 2013

2K1.8 Print SOP on IBS & EBS 2,000.00 3,262.43 SHOPPING 5 September 2013

31 October 2013

EA1.2.13 Procure RRT kits (PPE, Lab, medical kit) 1/pro


30 November 2013

66 Appendix 7

Package Number


Value

Awarded Contract

Value

Procurement Method

Date of Contract

Date of Completion

TBD-03 Procure scale for MDA 2,400.00 2,400.00 SHOPPING 11 October 2013

30 November 2013

EA2.1.10 Procure speakers for targeted healthy villages


30 November 2013

2C1.2 Laboratory equipment 350,000.00 489,000.00 NCB 3-Feb-14 31 December 2014

2C1.3 Laboratory equipment 350,000.00 452,000.00 NCB 3 March 2014 31 December 2014

4C1.3 Abate (1% SG) for targeted project provinces

80,000.00 80,000.00 SHOPPING 3 March 2014 31 January 2015

2.1.3.5 Basic equipment for underground water supply and sanitation

70,000.00 70,000.00 SHOPPING 28 July 2014 31 January 2015

4C1.1 Dengue rapid test (Dengue RDT) for Epidemiology Unit at provincial and district levels

31,350.00 31,350.00 SHOPPING 15 May 2014 31 January 2015

4A1.1 Desktop computer for 24 targeted districts (2 districts/province)


4C1.4 Insecticide (Deltamethrine 0.5 %) for targeted project provinces (Adulticide)

87,500.00 87,500.00 SHOPPING 5 August 2014 31 January 2015

4A1.2 PPE for sprayers (Mask for chemical protective, glasses, rubber, trouser and shirt with long sleeve)


1.3.2.17 Printing IEC tools (poster, flipchart, brochure) for dengue control and prevention


31 January 2015

1.2.2.1 Printing communicable diseases control and dengue control policy & strategy of disease surveillance.


31 January 2015

2.2.3.13 Printing gender/IP training guidelines related to communicable diseases


31 January 2015

2.2.3.7 Printing manual on training management and education methodology.


31 January 2015

2.2.3.14 Printing the second edition of five -years national strategy to promote the NSAW 2011-2015


31 January 2015

2.1.3.9 Speakers and health education tools for targeted healthy villages in targeted districts


31 January 2015

4C1.2 Spray machines 35,568.00 35,568.00 SHOPPING 15 May 2014 31 January 2015

4D1 T- shirt with print dengue vector control messages for villages health committee


31 January 2014

Tshirts T-Shirts 8,720.00 8,720.00 SHOPPING 10 February 2015

31 March 2015

Stool Stool survey kits 15,000.00 15,000.00 SHOPPING 8 April 2015 30 May 2015 Ins/1.3.2.

15 Dengue Test kits 28,160.00 26,752.00 SHOPPING 8 July 2015 21 August

2015 LV 2015 Abate (1% SG) for targeted project

provinces (Larvicide) 87,150.00 88,800.00 SHOPPING 24 March

2015 30 June 2015

OE.DT/12.1.10

Office Equipment for surveillance in 35 targeted districts

40,000.00 47,000.00 SHOPPING 5 May 2015 15 September 2015

Prazi2015

Paraziquentel 88,000.00 97,000.00 SHOPPING 24-Mar-15 15 October 2015

AD 2015 Insecticides (Deltamethrine 0.5 %) for targeted project provinces (Adulticide)

42,240.00 92,850.00 SHOPPING 23 July 2015 31 December 2015

ADB-LAVII 2015

Larvicide 99,000.00 99,200.00 SHOPPING 10 December 2015

29 February 2016

ADB1.3.1 IEC Materials (poster) related to Dengue and Malaria Control

25,200.00 24,588.51 SHOPPING 12 March 2016

25 May 2016

Supplies Laboratory consumables and supply 80,000.00 92,850.00 SHOPPING 25 March 30 June 2016

Appendix 7 67

Package Number


Value

Awarded Contract

Value

Procurement Method

Date of Contract

Date of Completion

2015 for some provincial hospitals and NCLE labs.

2016

Reagent 2015

Reagents for some provincial hospitals and NCLE labs.

80,000.00 96,790.00 SHOPPING 23 July 2015 30 June 2016

ADC2 Spray Machines for selected district 98,600.00 98,020.00 SHOPPING 3 June 2016 31 August 2016

ADA165 Computers and printers for PMs and selected district health office.

97,500.00 97,175.00 SHOPPING 8 June 2016 1 September 2016

ADC1 Hemoglobinometers for 37 district in 5 provinces in southern part of Lao (KM, SLV, CPS, SK and ATP)

70,300.00 69,967.00 SHOPPING 29 June 2016 20 September 2016

ADA2 Replacement of some office equipment (laptop, desktop) at executing agency


10 October 2016

ADA3 Replacement of some office equipment (laptop, desktop) at CMPE, NCLE and provinces


20 December 2016

ADB-Lao/CDCII/Ins/LV2

016

Abate (12,000 kg) 96,000.00 44,800.00 SHOPPING 25 April 2017 31 December 2017

ADB-LAO/CDCII/ADC1

(2)

Haemoglobinometers 50,000.00 47,875.00 SHOPPING 18-Sep-17 31 December 2017

Office 2017

Office Equipment (1 laptop and 2 color laser printers)


31 December 2017

Website Website 10,000.00 3,685.00 SHOPPING 9 May 2017 31 December 2017

5C1 Laboratory Equipment 300,000.00 253,492.00 NCB 23 February 2016

ATP=Attapeu, CMPE=Center of Malariology, Parasitology, and Entomology, CPS=Champasack, EBS=event-based surveilance, IBS=indicator-based surveillance, IEC=information, education and communication, IP=indigenous people, KM=Khammuane, LF= Lymphatic filariasis, MDA=mass drug administration, MHV=model healthy villages, NCB=national competitive bidding, NCLE=Center of Malariology, Parasitology, and Entomology, NIA=national implementing agency, NSAW=National Committee Advancement of Women, OV= onchocerciasis; , PMU=project management unit, PPE=personal protective equipment, PPMU=provincial project management unit, RDT=rapid diagnostic test, RRT=rapid response team, SG=, SK=Sekong ,SLV=Salavan, SOP=standard operating procedure, STH=soil-transmitted helminthiasis, STP=simplified technical proposal, S&R=surveillance and response.

L2699/G0450-VIE

Package Number General Description Estimated

Value Awarded Contract

Value Procurement

Method Date of

contract Date of

Completion 10 Refrigerated centrifuges (10

units) and hematology centrifuges (147 units)

2,528,000.00 521,334.00 NCB 2 June 2012 20 December 2012

5 Urine Analyzers (14 units) 42,000.00 38,220.00 NCB 15 June 2012 21 December 2012

6 ELISA system 112,000.00 110,880.00 NCB 9 May 2012 25 December 2012

1 Other equipment (training and communication)

357,000.00 355,993.00 NCB 7 May 2012 25 December 2012

4 Automated Hematology Analyzers

396,000.00 385,182.00 NCB 9 May 2012 28 December 2012

3 Automated biochemistry analyzers (16 units)

400,000.00 397,575.80 NCB 9 May 2012 28 December 2012

7 Class II biological safety cabinets

98,000.00 94,486.00 NCB 9 May 2012 28 December 2012

9 Equipment for microbiology rapid test in water and food

760.500,00 752,895.00 NCB 1 June 2012 28 December 2012

8 Equipment for rapid testing of pesticide

175,000.00 147,224.00 NCB 31 May 2012 28 December 2012

2 Single water-distillers (126 693,000.00 432,432.00 NCB 2 July 2012 28 December

68 Appendix 7



Value Procurement

Method Date of

contract Date of

Completion sets) 2012

20 Accounting Software 40,000.00 39,274.05 SHOPPING 4 May 2013 29 July 2013 17 Insecticides 60,000.00 55,214.13 SHOPPING 14 May 2013 6 August 2013 18 Printing and distribution of

IEC materials 12,000.00 11,166.89 SHOPPING 3 May 2013 28 August

2013 19 Office Computer and IT

equipment for PMU and PIU 11,000.00 909,678.00 NCB 14 May 2013 30 August

2013 25 Freezer (-20C) 192,500.00 190,575.00 NCB 6 August 2013 5 December

2013 24 pH meters 655,000.00 599,368.00 NCB 6 August 2013 5 December

2013 4 Communication and office

equipment for IHR 470,240.00 468,888.64 NCB 30 September

2013 9 December

2013 28 Water bath and Oil bath 465,000.00 442,002.00 NCB 6 August 2013 9 December

2013 23 Microscope binoculars 204,000.00 195,228.00 NCB 6 August 2013 11 December

2013 31 Sample blenders 150,000.00 147,488.00 NCB 30 September

2013 11 December

2013 22 Motorbikes for districts 78,000.00 77,792.00 NCB 6 August 2013 17 December

2013 32 UV-Vis Spectrophotometers 292,000.00 286,000.00 NCB 7 October

2013 17 December

2013 26 Incubators and Dryers 497,400.00 429,792.00 NCB 30 September

2013 31 December

2013 11 Logistics for Equipment 142,000.00 141,350.00 NCB 31 December

2013 27 Autoclave 960,000.00 598,617.25 NCB 30 September

2013 16 January

2014 30 Shaker and magnetic stirrers 738,600.00 656,865.00 NCB 30 September

2013 25 February

2014 33 ULV Sprayers 434,300.00 362,186.00 NCB 30 September

2013 31 March

2014 16 Upgrading of

videoconference equipment 95,000.00 94,879.49 SHOPPING 7 May 2013 21 April 2014

14 Vehicles 2,755,000.00 2,736,000.00 ICB 31 March 2014 20 October 2014

29 Double water distillers 768,800.00 399,302.86 NCB 30 September 2013

28 November 2014

38 test kits for Ecoli and Coliform detection and test kits for pesticide detection

55.000 50,161.00 SHOPPING 11 August 2014

8 December 2014

1.060.920.000 VND

35 Logistic Services for motorbikes and equipment

216,000.00 215,963.00 NCB 11 October 2013

31 December 2014

15 Logistics for vehicles 100,000.00 99,000.00 NCB 12 August 2014

31 December 2014

39 Printing and distribution of IEC materials

12,000.00 10,171.23 SHOPPING 12 May 2015 10 August 2015

21 Automated hematology analyzer and automated biochemistry analyzer

505,333.00 498,771.00 NCB 28 May 2015 23 September 2015

5/2015 Laboratory Equipment 771,880.00 752,229.25 NCB 27 October 2016

12 December 2016

4/2015 Office Equipment 706,410.00 689,974.85 NCB 27 October 2016

12 December 2016

1/2015 Upgrading of infectious diseases surveillance software server

60,000.00 55,534.45 SHOPPING 17 March 2016 12 December 2016

2/2015 Printing and distributing leaflet and poster on CDC

19,000.00 11,229.92 SHOPPING 22 March 2016 30 December 2016

G-3 Mobile Communication equipment

91,000.00 87,478.45 SHOPPING 6 February 2017

22 May 2017

Appendix 7 69



Value Procurement

Method Date of

contract Date of

Completion G-2 Testing Kits 36,400.00 34,017.95

SHOPPING 28 February 2017

30 May 2017

G-1 Microscope 120,000.00 114,547.05 NCB 9 March 2017 13 June 2017 CDC= communicable disease control, ELISA= Enzyme-linked immuno-sorbent Assay, ICB=international competitive bidding, IEC=information, education and communication, IHR=international health regulations, NCB=national competitive bidding, PIU=project implementing unit, PMU=project management unit, ULV=ultra low volume

70 Appendix 8

SUMMARY OF GENDER EQUALITY RESULTS AND ACHIEVEMENTS (CAMBODIA)

I. PROJECT DESCRIPTION

1. The Greater Mekong Subregion Regional Communicable Disease Control Project was designed to develop the capacity to contain emerging diseases and reduce the burden of common neglected diseases in Cambodia, the Lao People’s Democratic Republic (Lao PDR), and Viet Nam (the CLV countries). The project builds on the achievements and lessons learned of the first Greater Mekong Subregion (GMS) Regional Communicable Diseases Control Project (CDC1),

which played a major role in the GMS to contain the spread of emerging diseases, improve provincial health systems and communicable diseases control (CDC) in vulnerable groups, and strengthen regional cooperation. The project will further (i) enhance regional CDC systems including improved regional cooperation capacity, expanded surveillance and response systems, and targeted support for the control of dengue and neglected tropical diseases; and (ii) improve provincial capacity for CDC including staff training and community-based CDC in border districts. The project will particularly benefit the poor and ethnic groups in border districts, especially women and children. 2. The project became effective on 22 March 2011 and project completion was on 31 December 2017. The project was implemented in 12 target provinces: Kampot, Takeo, Kandal, Prey Veng, Svay Rieng, Kampong Cham, Tboung Khmum, Kratie, Stung Treng, Ratanakiri, Mondulkiri, and Preah Vihear. The project was categorized as effective gender mainstreaming (EGM). A gender action plan (GAP) was developed as part of the social assessment and proposed several actions to mainstream gender issues in project activities. Under the additional financing, one action and one target were added to the original GAP. The detailed implementation results are in Table A8.1: GAP Monitoring Table (Cambodia).

II. GENDER ANALYSIS AND PROJECT DESIGN FEATURES

A. Gender Issues and Gender Action Plan Features 3. Gender is a significant variable in understanding the spread of communicable diseases, as well as designing and delivering appropriate communicable disease prevention, control and response. Women and girls have specific health needs distinct from men and boys, as is well understood in the context of sexual and reproductive health. Additionally, men and women also have different vulnerabilities to infectious diseases depending on how they are exposed through their different social and gender roles in households and productive activities; and/or they may have different levels of access to—or understanding—of information about disease prevention and treatment. Certain communicable diseases can have serious consequences for pregnant women and their fetuses, particularly for those living in rural provinces. Pregnancy can also make women more susceptible to certain diseases and pregnant women’s specific risks to infectious diseases should be considered when planning a response to emerging infectious disease threats. Gender norms still place the responsibility on women to be the custodians for the prevention, detection and care of infectious diseases among family members. According to Cambodia Demographic and Health Survey (CDHS) 2014,1 maternal death account for 9% of all deaths to women age 15-49, infant mortality was 28 deaths per 1,000 live births, Neonatal and post-neonatal mortality rates was 10 deaths per 1,000 live births and the perinatal mortality rate is 20 deaths per 1,000 pregnancies. More than half (56%) of currently married women were using a method of contraception, with most women using a modern method (39%), more than 9 in 10

1 National Institute of Statistic, 2014. Cambodia Demographic and Health Survey 2014.

Appendix 8 71

(95%) mothers received antenatal care from a skilled provider, 9 in 10 (89%) births were assisted by a skilled provider, and 83% of births were delivered in a health facility. Challenges that women aged 15-49 faced in accessing to and utilize health care include (i) not having money for treatment; (ii) do not wanting to go to the facility alone; (iii) distance to the health facility; and (iv) getting permission from family to go to a facility. 4. Although the majority of health sector staff are oftentimes women, they are more concentrated in lower level service delivery than in decision-making or technical roles. Over 19,000 people are employed in the health sector in Cambodia. Women make up most of the health workforce, and yet rarely hold senior roles, and have fewer opportunities that women to re-train for new position. Only one in five leadership positions in the Ministry of Health are held by women. Just 16% of senior health workers (such as doctors) are female, compared to 100% of midwives.2 Increasing gender equity in all levels and functions of the health sector staffing can improve communicable disease control and wider health outcomes for communities, because the level of trust and confidence that patient may have in being treated by a person of the same sex. 5. The GAP included a number of measures to ensure women’s access to project benefits, including participation and empowerment through various project activities. These included ensuring:

i. the increased training of women in CDC surveillance and response with all female surveillance and response staff trained at all levels and at least 70% of female laboratory staff trained;

ii. specific collection of sex-disaggregated data in all surveillance forms and reporting documentation;

iii. gender specific content reflected in CDC training curriculum, HRD plans cross-border activities and all training activities include gender issues;

iv. encouraging and monitoring the hiring of new female staff with annual proportional increase of newly hired female staff;

v. proactively training women as village health volunteers, targeting at least 60% of women in urban and 40% in rural areas;

vi. increasing the number of female participants in community-based CDC activities and campaign to 40% of all participants;

vii. at least 80% of women of reproductive age receive annual preventive anthelmintic treatment; and

viii. at least 80% of preschool and school-aged girls and boys receive annual preventive anthelmintic treatment.

B. Overall Assessment of Gender-Related Results/Achievements 6. The project was categorized as EGM, per Asian Development Bank (ADB) policy on gender and development. The project includes a GAP to maximize benefits to women, poor, ethnic groups and vulnerable people in the project areas. By project completion, GAP implementation was rated successful with 6 of the actions (100%) implemented and completed, and 13 of the 15 targets (87%) achieved, with 2 targets not achieved. The implementation results are in Table A8.1. GAP actions and targets were integrated throughout the project outputs and

2 Hyde S. and Hawkins K. (2017) “Promoting women’s leadership in the post-conflict health system in Cambodia”,

Building Back Better/Research in gender and ethics: Building stronger health systems (RinGs)

72 Appendix 8

17 gender focal points were assigned at national and provincial levels to overall implement and monitor the GAP with technical support from a gender specialist. The project also engaged MOH’s Gender Mainstreaming Action Group (GMAG) to design and deliver “Gender Mainstreaming into Health Sector.” In terms of project design, it is also noted that two actions and two targets in the design and monitoring framework (DMF) were not found in the GAP and one gender numerical target set in DMF is not consistent as set in the GAP. 7. The project provided both practical and strategic benefits to the poor, women, children, ethnic groups and other vulnerable groups in remote areas. The project built the capacity of 1,373 rapid response team (RRT)/malaria staff including 412 female staff on surveillance, outbreak response, data management and malaria. The project improved capacity of diagnosis on communicable diseases at provincial and district referral hospital laboratories by providing laboratory equipment and capacity building training to 75 female laboratory staff (all female laboratory staff in both laboratory competencies and management). The provincial hospital laboratories could detect and diagnose different types of communicable diseases, allowing quick responding actions. At the village level, 2,925 women (or 42%) of the 6,971 village health workers trained on malaria clinical diagnostic and treatment. The project contributed to ensuring that sex-disaggregated data are integrated into the national communicable surveillance system including severe acute respiratory infection, influenza like illness, and malaria and community-based assessment or demographic assessment. 8. The project contributed to improving women and children’s access to effective, efficient, and quality primary health care services in project areas. For instance, 1,600,163 (81% of 1,980,606) women of reproductive age; 3,484,469 (87% of 3,993,304) preschool-aged children; and 7,344,641 (95% of 7,767,992) school-aged children in all targeted provinces received annual preventive anthelmintic treatment. The project re-established the functions of 331 village malaria workers including 169 women (or 51%) to provide services in malaria diagnostic and treatment at the village level in Preah Vihear province. To ensure better and timely control of epidemics, community-based CDC activities/campaigns were conducted and attended by 2,926 women (44%) of 6,713 participants. The community reporting system has been established using call hotline 115, which communities can call for free to report malaria cases or outbreaks. Hotline 115 remains functioning until project completion. 9. The project also contributed to promoting gender balance among newly recruited CDC/malaria staff at national and provincial levels and village health volunteer/workers. Increasing gender balance in all levels of health sector staffing has contributed to an effective outreach to women and improving communicable disease control. Between 2012 and 2016, the annual proportion of newly hired female CDC/malaria workers increased from 44% to 54% with total recruitment of 150 women (46%) of 327 newly recruited staff. Over the project period, 699 women (or 58%) of 1,208 people were recruited as village health workers in all target provinces. At project implementation level, the project employed 228 female staff (or 40%) of the total 565 project staff at PMU/PIU, provincial health department, operational districts, referral hospitals, and health centers. C. Gender Equality Results

1. Practical benefits from the project

10. The project delivered the following results:

Appendix 8 73

(i) Output 1: Enhance the opportunities and contribution of female staff in CDC systems and malaria: The annual proportion of newly hired female CDC/malaria workers increased from 44% in 2012 to 54% in 2016 with total recruitment of 150 women out of 327 newly hired staff over the project period. All the 412 female RRT and malaria staff attended the training sessions on surveillance, outbreak response data management and malaria. The sessions were conducted every year between 2012 and 2017. The project improved capacity of diagnosis of communicable diseases at the provincial and district referral hospital laboratories through the provision of laboratory equipment and training to all 75 female laboratory staff or 100% of the total female staff on both laboratory competencies and management.

(ii) Age and sex-disaggregated data are integrated into all of national Communicable Surveillance System including Severe Acute Respiratory Infection, Influenza Like Illness and malaria and community-based assessment or demographic assessment. For details, please visit the website: http://www.cdcMOH.gov.kh.

(iii) The project customized training of trainers’ curriculum on “Gender Mainstreaming into Health Sector” developed by GMAG which is subsequently integrated into all of the CDC/malaria training sessions of the project. Checklist was also developed to ensure gender inclusive content was reflected in project workshops and training sessions. The cross-border activities discussed the inclusion of sex-disaggregated data of CDC surveillance and gender-based constraints in accessing to basic health care services.

(iv) (v) Output 2: Improved CDC along borders and economic corridors: At village

level, 2,925 women (or 42%) of the 6,971 village health workers were trained on malaria clinical diagnostic and treatment. The project recruited and trained 721 women (or 56%) of 1,278 people as village health workers in all the target provinces. To improve access to quality primary care services, the project provided annual preventive anthelmintic treatment to 1,600,163 women or 81% of reproductive-aged women, 3,484,469 (87%) preschool-aged children and 344,641 (95%) school-aged children in all targeted provinces. To ensure better and timely control of epidemics, community-based CDC activities were conducted and attended by 2,926 women (44%) of 6,713 participants. The community activities included outreach and village meetings on CDC control and prevention, antenatal care, birth deliveries at the health center, as well as early detection of signs and symptoms of illness, home care of sick children, vaccination, and hygiene and sanitation. The project also established the community reporting system using hotline call 115, so anyone can call for free to inquire detailed information on CDC, report outbreaks and make other inquiries.

74 Appendix 8

Case Study 1: Mrs Ben Heng (Volunteer Health Worker), aged 59 years old, lives with her son, daughter in law and grandchildren in Kampong Kol village, Sam Pao Poun commune, Kok Thom district, Kandal province. At home, she prepares food, takes care of grandchild and raises backyard chickens. Apart from her daily work, she has volunteered as a village health worker since 1998. Although the work is voluntary, she enjoys taking on her responsibilities because she gained knowledge and contributed in keeping her family and villagers healthy. Since the project started in 2012, Heng attended health trainings on CDC prevention and control, hygiene and sanitation, preventive anthelmintic treatment and vaccination at least once or twice a year. She then disseminated information and health messages, reported diseases through informal meetings or helped gather villagers to attend health education sessions at the health center. In the past, her village was littered with garbage and plastic waste and without proper sanitation. There

was dirty stagnant water behind the houses especially during and right after the rainy season. Open

defecation among children was often practiced. Due to poverty, absence of proper sanitation facilities

and lack of health education, many families focused mostly on their subsistence livelihoods and were

unaware of health and hygiene in cleaning their houses and household compounds.

Heng recognizes the many villagers have significantly changed as they are willing to attend village health education sessions and discuss about health. They used toilet, cleaned their house and surroundings, sent family members for vaccinations, and sought doctor consultations at the health center when they are sick. “Now, 100% of pregnant women go for regular health check-ups before and after giving birth and all of them deliver at health center. Almost all of the children in my village have received vaccinations,” said Heng.

Mrs. Ben Heng, volunteer health workers Telegram of written case notification

(vi) Output 3: Integrated Project Management: The project employed 228 women (or 40%)

of the 565-project staff at national and subnational levels. The GAP, developed and approved by MOH, was implemented at all levels. To ensure effective implementation, GAP actions and targets were integrated into all AOPs and adequate budget was allocated. PMU assigned and trained 17 gender focal points at national and province level to implement, monitor and report GAP achievement. Among the 17 gender focal points, 7 (or 41%) were women. The national social development and gender specialist have been recruited to build capacity of gender focal points and support the GAP implementation. The project provided GAP orientation and gender sensitively training to 565 project staff including 228 women. Additionally, 198 RRT/malaria and health center staff including 104 female staff (53%) trained on gender mainstreaming into health sector.

Appendix 8 75

2. Strategic benefits

11. Women’s voice and gender equality in decision-making. Women have received strategic benefits under the project and GAP design features through institutional and community-level action groups and health and planning governance bodies leading to gender-responsive health sector plans and improved community health governance. Giving women a voice in various working groups, has ensured that all plans, including cross-border action plans, have taken gender mainstreaming and women’s needs in the communicable disease control program of the health sector into consideration. Under the Malaria Elimination Action Framework 2016–2020, for example, specific interventions for women, such as provision of bed nets for women with children under 5 years old, were identified; and through the GMAG, the CDC and malaria training curricula and health workforce development plan now include gender-related content (analysis, strategy, approaches). A checklist was also developed to ensure that gender concerns were addressed in all project workshops and technical training sessions.

Case study 2: Dul Sotheara (Midwife at health center in Sam Pao Poun commune, Kok Thom district, Kandal province), aged 34 years old, is a member of the Rapid Response Team at the health center. She has attended trainings on the prevention of communicable diseases and learned various topics such as prevention of diarrhea, malaria, respiratory infection, pneumonia, rabies, avian flu, swine flu, cholera, H1N1 virus. With her increased her knowledge and skills as a midwife, she is qualified to perform higher level functions like administering immunization and diagnosing diseases. Her main responsibilities included data entry of recorded cases, patient consultations, vaccinations, deliveries, and communicable diseases outbreaks into the Health Information System. She explained the two kinds of reporting in the system that include the seven types of infection reported on a weekly basis, and other types on a monthly basis. Ms. Sotheara hopes to continue upgrading her skills to be more confident in treating patients and assisting the medical doctors during child delivery operations.

L-R: Hotline 115 has helped improved services at the health center; Ms. Sotheara with Dr. Daka Somchum of the PMU. Ms. Sotheara dedication in her work and expertise also reflects in other aspects of her life. Her husband works as a pharmacist the same health center and together they raise their 4-year old son, she mentors community volunteers whom she regularly meets every month, sharing knowledge on how to keep healthy. She happily recognizes that she has contributed improved awareness and understanding of how to identify and prevent diseases among her fellow villagers.

12. Use and analysis of sex-disaggregated data for community-based assessment and planning. A key feature of the GAP was empowering health workers, both staff and volunteers,

76 Appendix 8

and using evidence-based data to influence the design and planning of the gender responsiveness of the government’s CDC program in targeted districts and provinces. For instance, baseline and post evaluation surveys and demographic assessments with age and sex-disaggregated data helped shape communicable disease surveillance and response systems and contributed to developing model healthy villages (MHVs).

Case study 3: Kao Tho Kayeng (CDC Staff in Preak Srey, Kok Thom district, Kandal province). At 58 years old, Ms. Kayeng has experienced first-hand how health services have evolved having worked in the hospital since 1980. She attended and graduated from the midwifery course, delivered births, and performed office work in the hospital. One of the positive changes is the proper reporting of incidences of communicable diseases. She used to do this work manually and it was time-consuming. Since the new improvements has been made, she regularly updates the data in the system using the computer and her mobile phone. Her job of administering vaccines and distributing medicines have been complemented with trainings on various health topics like preventive care for children, diagnosing diseases, reporting CDC cases using the smart phone. After attending the trainings, she has a much better understanding and appreciation of the proper recording of data, with relevant disaggregation by sex and age. She fully understands that data is used for assessment, planning, programming, and setting-up surveillance and response systems, and protocols for life and death situations.

“Technology has helped make work more manageable,” says Ms. Kayeng. The modern improvements have now made data recording easier and efficient. This helped Ms. Kayeng save time and gain confidence in her job, allowing her to do more productive tasks at work and at home. She is able to fulfill her multiple roles as a health worker/midwife, mother, and grandmother.

13. Community involvement and participation. Community participation is vital for efficient health service planning, organization, and improvement of health service quality. Women’s participation reached 44% (2,926 women out of 6,713), exceeding the target of 40%, in community outreach and village meetings on communicable disease control and prevention, antenatal care, health-center-based births, recognizing signs and symptoms of illnesses, caring for sick children at home, vaccination, and hygiene and sanitation. The community reporting system (Hotline 115), established under the project, was widely utilized and proved effective in providing detailed information on CDC, reporting outbreaks, and other health-related inquiries, free of charge.

Case study 4: Sreng Tor (Community member in Kampong Kol village, Sam Pao Poun commune, Kok Thom district, Kandal province) is 51 years old and an active member of the community. Together with her sister, she has attended health education training sessions on hygiene and sanitation and other topics. One of her key takeaways is knowing how to prevent infection. Some of the ways she learned is by properly preparing food and keeping the house and surroundings clean of litter and waste. Married with three daughters, a typical morning for Ms. Tor is spent cleaning the house, going to the market which is a 4-kilometer bicycle ride, cooking, and washing. In the afternoon on some days, she attends socials,

Appendix 8 77

ceremonies, and blessings where she is able to share her acquired knowledge from community meetings and training sessions with friends and neighbors.

She witnessed the positive impact of the project in their community. It was common for children and adults getting sick with diarrhea, dengue, and flu. Lack of proper toilet facilities as one of the causes and those days are gone now, she says. There have been less diseases, less infection, and no need to spend so much money on medicines. She uses her savings for necessary repairs in the house and to provide preventive health care and better education for her children.

14. Mobilizing resources for gender-specific needs and planning. The targets and actions in the GAP were implemented and achieved as planned with the help of adequate resources. The budget of $342,691 allocated for GAP implementation set the ground for integrating gender across the three outputs to mainstream gender into the consciousness of MOH officials and staff, through the various orientation and training workshops on gender sensitivity, and by integrating gender issues. Use of sex-disaggregated data has become standard practice at the community, provincial, and national levels as demonstrated in the national communicable surveillance system including severe acute respiratory infection, influenza like illness, and malaria and community-based assessment or demographic assessment.

Case study 5: Teng Srey (Medical doctor, Gender focal point, CDC 2, Ministry of Health). She served as the project’s gender focal point when it started in 2012. In the early phase of implementation, she was tasked to organize the model healthy village groups composed of 5-6 members, including 1-2 village health workers at the health center, district, and provincial levels. At the onset, expectations were made clear on the use of sex-disaggregated data and the meaningful representation of women. Recalling her experience in other projects, she cites CDC 2 as groundbreaking in terms of the importance placed on gender mainstreaming and backed up by resources to implement the gender action plan. Apart from training health staff and volunteers on CDC prevention, capacity building was also provided to media on a nationwide scale on TV, radio, social media, and other online platforms. It was memorable for Dr. Srey to be part of implementation since it was under the project that she had gender training for the first time. For Dr. Srey and many colleagues in MOH in Phnom Penh, gender mainstreaming is newly acquired knowledge which they are able to apply to their work and enabled them to perform their tasks well to deliver expected results. She has seen improvements on mainstreaming gender in CDC while acknowledging that initiatives should be continued to sustain and build on the gains made in CDC2. Some of these notable changes are to improve prevention of outbreaks, quickly available information through the hotline and press releases, early detection, proper surveillance and assessment systems.

Ms Seng Tor with her nephews; “Preventive care and practices are important to keeping healthy,” she says.

78 Appendix 8

Dr. Teng Srey advocates for gender equality in the health sector through various ways and means. One of the challenges she has encountered, and continues to face, is the unconscious bias against women in the health sector. While it has greatly improved, some people still think that women’s work should be limited to office, clerical and administrative work. As a result, women are seldom sent for trainings to improve and learn new skills. Dr. Srey still finds herself telling colleagues that women are just as capable as men because even women like her, with of higher positions in the workplace, occasionally experience discrimination and was treated differently or even looked down upon compared with men holding similar high positions. She believes that changing behavior and mindsets should be a continuous and multi-stakeholder effort. CDC 2 has paved the way for her and others to continue the advocacy for gender equality and women’s empowerment.

3. Contribution of gender equality results to overall loan outcomes and

effectiveness

15. The second project has contributed to national achievements of (i) reducing of under-five mortality rate by about 10% (Per 1,000 live births), (ii) reducing annual dengue cases by 20%, (iii) decreasing prevalence of NTD by 30%. Proportion of disease outbreaks reported within 24 hours increased from 50% to 80%. Proportion of border outbreaks reported across border within 24 hours increased from 20% to 50%. Proportion of populations in targeted villages that conduct proper CDC prevention and care increased from 40% to 60%. Overall, the project contributed to reducing burden of illness, mortality rate through better CDC and timely control of epidemics. Local people have benefited from gaining productivity and cost savings from health impacts of emerging diseases like avian influenza and severe acute respiratory syndrome (SARS). 16. Gender designs were incorporated across all the project’s outputs to ensure inclusive access of the poor, women, vulnerable groups and people living in remote areas to quality, efficient and effective basic health care services. The gender-specific interventions also promote gender balance of health care service providers and improve women’s capacity for effectively offering the health care services as well as their career development. Therefore, gender equality results contributed to overall grant outcome and effectiveness, ensuring universal access to basic health care.

III. LESSONS AND RECOMMENDATIONS

17. Several factors were critical to the success and achievements of GAP targets and actions:

Appendix 8 79

(i) The project GAP was prepared to provide equitable opportunities for all. This aligns with the MOH that considers gender equality as important in building the capacity of its staff and has been integrated in its strategy and departmental plans. This reflects in the policy of participation in capacity building opportunities organized by MOH provided to not only those who already possess high knowledge and skills on CDC, but also for those from remote areas for both women and men.

(ii) Gender mainstreaming was consistently integrated in the training sessions/workshops organized by MOH and PHDs and contributed to gaining more support to promote gender equality in health sector.

(iii) The project engaged MOH’s GMAG in early stage of project implementation to design and deliver the training on gender mainstreaming in the health sector to all project staff and minimized inputs and supported by the national gender specialist. GMAG extended the training to the entire ministry’s structure, both national and subnational levels. This modality is carried on in current ADB financed-project, GMS Health Security Project.

(iv) The project allocated human and financial resources for GAP implementation. The project assigned 17 gender focal points at all project levels and all the target provinces to responsible for implementing GAP. After the project completed, all the gender focal points have become members of provincial GMAG at provincial department of health.

18. Sustainability: The Project is likely sustainable because of the following reasons (i) GAP was well supported in the ministry’s Gender Mainstreaming Into Health Sector Strategic Plan that considers gender equality and capacity gender building of its staff as priority actions, (ii) all project gender focal points have become members of GMAG both at national and provincial and continued to support the ministry in mainstreaming gender into health sector and promoting gender balance in sectoral ministries, (iii) some female staff who engaged in project activities and newly recruited female staff during project period have advanced their career and hold decision-making positions at the ministry and provincial departments, (iv) at village level, model health village workers composed of both male and female, extending the health care services to specific needs of both women and men and reaching the wider population, especially the poor and ethnic groups in the community.

19. Recommendations: (i) The GAP should have an explanation of technical key terms and GAP orientation

shall be conducted by ADB to the project team at the early start of the project implementation to ensure that they fully understand the benefits of the GAP implementation, monitoring and reporting.

(ii) The gender specialist should be mobilized to start at project commencement. (iii) Consistency of the numeric target set in the DMF and the GAP. The numerical

gender targets set in DMF should be consistent with the GAP to ensure they are achievable. For instance, the GAP said “at least 80% of women reproductive age receive annual preventive anthelmintic treatment and (ii) at least 80% of preschool and school age girls and boys receive annual preventive anthelmintic treatment, but the DMF said “all women (100%) of reproductive age and children received micronutrient”.

(iv) Gender related features in DMF should be included in the GAP to ensure that they are implemented. This DMF gender indicator could not find in the GAP “at least 60% of trained staff is female”.

(v) Baseline data should be collected to set gender targets in DMF and GAP. This is to ensure they are practical and achievable.

80 Appendix 8

20. Setting a target of 100% of women’s participation from organization or community in the training or project activities is very challenging to achieve due to individuals’ availability and commitment. A more realistic target is between 80%-90% of women’s participation.

Appendix 8 81

Table A8.1: ACHIEVEMENT ON GENDER ACTION PLAN IMPLEMENTATION

Date of Update: November 2018 Project Title: Second Greater Mekong Subregion Regional Communicable Diseases Control Project +AF Country: Cambodia Project No.: 41505-012 Type of Project (Loan/Grant/TA): Grant Approval and Timeline: 22 Nov 2010 Gender Category: Effective Gender Mainstreaming Mission Leader: Ms. Ye Xu Project Impact: Improved regional health security of the population in the Greater Mekong Subregion (GMS). Project Outcome: Timely and adequate control of communicable diseases likely to have a major impact on the region's public

health and economy.

Gender Action Plan (GAP Activities, Indicators and

Targets, Timeframe and Responsibility)

Progress by project completion (This should include information on period of actual implementation, sex-disaggregated

quantitative updates (e.g., number of participating women, women beneficiaries of services, etc.), and qualitative information. However, some would be on-going - so

explain what has happened so far towards meeting the target.

Issues and Challenges (Please include reasons why an activity was not fully implemented, or if

targets fall short, or reasons for delay, etc.,

and provide recommendations on

ways to address issues and challenges)

Output 1: Enhanced Regional Communicable Diseases Control Systems

1.1 To enhance the opportunities and contribution of female staff in CDC systems and malaria systems

Target 1: All female surveillance and response staff trained at all levels Achieved

- 412 women (92%) of 448 female RRT and malaria staff attended the training sessions on surveillance and outbreak response data management and malaria. Women participation in training increased from 74% to 92% of the total female RRT between 2012-2017. Other 36 women who could not attend the training due to availability and pregnancy, (Table 1)

Table1: Female RRT and Malaria Staff trained in CDC/Malaria surveillance and Response

Year Total

RRT/CDC Female Staffs trained

Female staff traine

d

Percentage of female

2012 1004 238 578 175 74%

2013 1031 253 797 211 83%

2014 1164 344 978 318 92%

Invitations were sent to all female surveillance and response staff, yet some of them were not available to attend due to their schedule and pregnancy. Setting target for 100% of all female staff attending the training is very challenging to achieve due to individual’s availability. 90% of female staff

82 Appendix 8










2015 1328 383 978 318 83%

2016 1486 423 1,242 381 90% Q3, 2017 1569 448 1,373 412 92%

attending the training is more achievable, giving that individual has different commitments.

Target 2: At least 70% of female laboratory staff trained Achieved

- All 75 female staff or 100% of female laboratory staff from 12 provinces trained on microscopy and clinical management

- A refresher training on microscopy and clinical management was conducted in selected provinces.

1.2 To improve gender analysis in regional CDC system

Target 3: 100% of surveillance and response data is sex-disaggregated, as appropriate Achieved

- All data of CD surveillance system includes Severe Acute Respiratory Infection (SRI), Influenza Like Illness (ILI) and malaria is sex-disaggregated. The outbreak data, malaria supervision checklist, Training/workshop, HH survey and Village demographic assessment is also sex-disaggregated.

For the details: http://www.cdcmoh.gov.kh

Action 1: Gender content reflected in CDC training curriculum, HRD plans cross-border activities Achieved

- MOH’s Gender Mainstreaming Action Group (GMAG) developed Training of the trainers’ curriculum on “Gender Mainstreaming into Health Sector 2012”. The project cooperated with GMAG to customize the available training materials and included gender mainstreaming in all 7 project’s CDC/malaria training curricula. The gender contents in training conducted covered (i) gender vs sex, gender equality and equity (ii) why does gender matter in health sector, (iii) gender analysis in health sector, (iv) gender and right based approach in claiming for basic health care.

- The project developed a checklist to ensure that gender is reflected in all workshops and technical training sessions of the project.

- Gender-related content has been included in the Health Workforce Development Plan 2016-2020 endorsed by MOH on 01 March 2016 included gender-related content.

- Sex-disaggregated data of CD surveillance were reported during cross-border meetings. Gender-based constraints in accessing to basic health care services were also discussed. The project ensured women participation in cross-border meeting. In first quarter of 2017, 12 women (25%) out of 48 participants attended cross-border meeting in Preah Vihear, Stung Treng and Ratanakiri provinces.

Appendix 8 83










Action 2: Annual proportional increase of newly hired female staff Achieved

- The annual proportion of newly hired female CDC/malaria increased from 44% to 54% between 2012 and 2016. There were 150 women (46%) out of 327 newly recruited staff to be assigned as CDC/malaria staff.

Table 1: Annual proportional increase of newly female CDC/malaria staff between 2012 and 2016.

Table 2: Number of newly recruited staff between 2012-2017

Year Total newly

recruited Total Female newly

recruited Percentage

2012 9 4 44%

2013 38 18 47%

2014 148 71 48%

2015 104 50 48%

There was no new recruitment in 2017.

84 Appendix 8










2016 13 7 54%

2017 0 0 NA

Action 3: Specific intervention for women are part of new national malaria policies and strategies CDC 2-Additional financing Achieved

- Cambodia Malaria Elimination Action Framework (MEAF) 2016-2020 was signed in 2016. Under the MEAF, specific interventions for women included (i) pregnant women residing in the endemic areas are given priority for malaria screening during the first antenatal visits, (ii) women are provided with antenatal malaria screening, (iii) women received training on the use of long-lasting insecticidal nets (LLIN), (iv) provision of bed nets to women with children under 5 year old, (v) collecting age and sex disaggregated data of malaria cases and (vi) women are targeted in community mobilization/sanitization to increase uptake malaria interventions. Community sensitizations are organized in cooperation with ODs/HCs involving important community actors including community healthcare workers, women volunteers under Ministry of Women’s Affairs and other stakeholders to strengthen the linkages between the key actors and quality malaria service providers.


2.1 To improve responsiveness of CDC to gender issues in targeted districts/provinces

Target 4: All community-based assessments and plans use and analyze sex-disaggregated data

Achieved

- Demographic assessments between 2013 and 2014 for 180 MHVs used and analyzed sex and age disaggregated data.

- In 2014, MHV baseline survey collected sex disaggregated data and the project post evaluation survey conducted in third quarter 2017 included data with age and sex-disaggregation.

- Specific gender and IP data collection forms are developed and trained to all PIAs for completion. Some sex and age disaggregated data included (i) sex-disaggregated data of population (ii) proportion of women delivery attended by an MOH mid-wife, (iii) proportion of village pregnant women with 2 or more ANC consultation with skilled health personnel, (iv) percentage of mothers reported currently using the contraception, (v) percentage of village women of child bearing age (age 15 – 44 years) who have received mebendazole, (vi) De-worming treatment among children and women, (vii) percentage of mothers reported having vaccinated by TT before and during last pregnancy and (viii) children under 5 years

Appendix 8 85










disaggregated by sex reported having diarrhea/ARI within past 2 weeks and treatment.

2.2 To increase participation and awareness of women in CDC and integrated with malaria disease

Target 5: At least 60% of female urban (and 40%of female rural) village health volunteers/workers1 trained

Achieved

- 2,925 women (or 42%) of the 6,971 village health workers in all the target provinces trained on malaria clinical diagnostic and treatment. Refresher training sessions were also provided to them in selected provinces. The project was implemented in provinces which are rural areas. According to the ministry’s data collection system, there is no define between urban and rural areas in the province. Table 3: Female Village Health Workers Trained in CDC/Malaria

Year Total village health workers

Female village health workers

Village health workers trained in CDC/malaria (cumulative)

Female village health workers

%

2012 13,826 6,285 2,532 1,226 20%

2013 14,190 6,467 5,017 1,870 29%

2014 14,686 6,792 6,378 2,535 37%

2015 14,708 6,804 6,378 2,535 37%

2016 14,708 6,804 6,923 2,739 40%

2017 15,052 6,979 6,971 2,925 42%

MOH has no criteria to define urban and rural areas and MOH system does not define urban and rural areas. In Cambodia, the term “village” refers to rural areas. By 2017, the total number of village health workers is 15,052 including 6,979 women (46%) (see table 3). Appropriate target is 40%, giving that all targets areas were in rural areas and women make up of only 46% of total health village workers.

Target 6: At least half of newly selected village health

- 721 women (or 56%) of the 1278 of health workers were newly recruited to be village health workers between 2012 and 2017

Table 4: Newly female village health worker selected between 2012 and 2017

1 Specific numerical targets may have to be adjusted for national contexts depending on baselines; similarly, different urban and rural targets may not be relevant

for all countries, e.g., Lao PDR.

86 Appendix 8










volunteers/workers in districts are female

Achieved

Year

Total village health

workers

Female village health

workers

Total newly

Female village health

workers

%

2012 13,826 6,285 52 27 51.9%

2013 14,190 6,467 364 182 50.0%

2014 14,686 6,792 496 325 65.5%

2015 14,708 6,804 22 12 54.5%

2016 14,708 6,804 0 0 Data not complete

2017 14,982 6,957 344 175 55.8%

Total 1,278 721 56.4%

Target 7: Number of female participants in community-based CDC activities and campaigns increases 40% Achieved

- 2,926 women (44%) of 6,713 people participated in community-based CDC activities including community outreach and village meeting on CDC control and prevention, antenatal care, deliveries at the health centre, as well as recognizing signs and symptoms of illness, home care of sick children, vaccination and hygiene and sanitation.

- The project also established community reporting system using hotline call 115, so community can call free of charge to inquire detailed information on CDC, report outbreak and other inquiries.

- Project re-established functions of 331 village malaria workers including 169 women (or 51%) to provide services in malaria diagnostic and treatment at village level in Preah Vihear province for additional financing.

Target 8: At least 80% of women of reproductive age receive annual preventive anthelmintic treatment Achieved

- 1,600,163 (81%) women of 1,980,606 reproductive-aged women (15-49-year-old) received annual preventive anthelmintic treatment between 2012-2014.

Table 5: Women of childbearing age received preventive anthelmintic treatment

Women of Children Age (WCBA) treated

Year WCAB targeted WCBA treated Coverage (%)

2012 660,202 498,683 75.53

2013 660,202 593,113 89.84

2014 660,202 508,367 77.00

This activity completed in 2015. Target in DMF is 100%. GAP and DMF shall be consistent to ensure it is achievable.

Appendix 8 87










Total 1,980,606 1,600,163 80.79

Target 9: At least 80% of preschool and school age girls and boys receive annual preventive antihelmentic treatment

Achieved

- 3,484,469 (87%) children of total 3,993,304 preschool children from the targeted provinces received annual preventive antihelmentic treatment between 2012 and 2014,

- 7,344,641 (95%) children of the total 7,767,992 school aged children from the target provinces got annual preventive antihelmentic treatment between 2012-2014.

Table 6: De-worming in CDC2 from 2012-2014

Target Group Targeted Treated Percent

Pre-school children 3,993,304 3,484,469 87.26

School-aged children 7,767,992 7,344,641 94.55

These activities were completed in 2015. Target in DMF is 100%. GAP and DMF shall be consistent to ensure it is achievable

Target 10: All training activities include gender issues Achieved

- All training sessions included gender issues. For instance, gender issues were included in 29 sessions of training sessions and workshops for RRT and malaria supervisors, 21 training sessions and 10 meetings for VMG in community CDC/Malaria. Additionally, the project conducted 4 separated training sessions on gender equality, IP and CDC in the target provinces.

- Some gender issues raised during the training were as follows: ● Busy with many housework and looks after the children ● Domestic violence often appears in the family ● Women’s illiteracy in remote areas ● Long distance and difficult roads to access health service ● Ashamed to report for some health problems, such as sexual health and

reproductive health

Target 11: Recommendation to address at least 5 gender issues identified in the joint actions plan for malaria prevention and response in the border provinces CDC 2-Additional financing

- Joint action plan has not yet been developed. Yet, AOP allocated budget for cross-border meeting. Gender issues pertaining to joint action plan not yet been identified.

- The project organized a number of cross-border meeting, where sex-disaggregated data in CDC were discussed.

This activity is under additional financing commencing in 2016. There was very little time to implement it.

88 Appendix 8










Not achieved

Output 3: Integrated Project Management

3.1 To enhance the gender-awareness and responsiveness of CDC/malaria project management

Action 4: National/provincial GAPs developed and implemented

Achieved

- Gender action plan was developed and approved by MOH and effective on 4 January 2013. It was developed in close collaboration with all members of GMS PCU, ADB-gender specialist and HOM’s GMAG. Provincial gender focal points and relevant project staff were responsible for implementing GAP at both national and provincial levels supported by a gender consultant.

Target 12: All AOPs include gender-related activities and budget allocations

Achieved

- All AOPs included actions and targets in GAP. PMU also allocated 342,691 US Dollar in total to AOPs to disseminate and implement the GAP at both provincial and national level. Some gender-related activities covered in the training sessions/workshops integrated gender issues, GAP orientation, gender sensitivity training, training on sex-disaggregated data collection, conducting sex-disaggregated community assessment, community-based CDC activities with inclusion of women participation.

Table 7: Budget allocation to implement gender activities

Year Budget ($)

2012 58,952

2013 61,666

2014 78,284

2015 29,050

2016 35,884

2017 78,855

Total 342,691

Action 5: Gender representatives in PMU/PIU/SC gender report on gender/GAP Achieved

- PMU assigned and trained 17 gender focal points at national (PMU) and provincial levels (PIU-11 provinces) to implement, monitor and report on GAP achievement. Out of 17 GFPs, 7 (41%) were women. The gender focal points are technically supported by project gender consultants. GAP progress reports were prepared and submitted to ADB.

Appendix 8 89










Action 6: Social development specialist employed Achieved

- PUM recruited a social development expert and a national social development specialist to support and build capacity of gender focal points and relevant project staff to implement the GAP.

Target 13: 100% of project staff receive gender sensitivity and GAP training Achieved

- 565 project staff including 228 female staff representing 100% of project staff received GAP orientation and training on gender in health conducted in collaboration between gender focal points and MOH’s GMAG and supported by project gender consultant. PMU also organized GAP refresher and sex-disaggregated data collection trainings.

- 198 RRT/Malaria and health centre staff (including 104 female staff or 53%) from the target’s provinces were trained on gender and health.

- The content of gender and health training covered (i) gender vs sex, gender equality and equity (ii) why does gender matter in health sector, (iii) gender analysis in health sector, (iv) gender and right based approach for basic health care.

Target 14: Gender issues included in all workshops Achieved

- Gender in health sectors and GAP orientation/refresher included in all 12-project planning/management workshops. The project organized two project planning/management workshops annually.

- A Checklist to ensure Gender issues in Workshops and Technical Training has been developed and presented during training for PIU/PMU.

- This checklist seeks to ensure that Gender and ethnic minority group issues are mainstreamed into the Project. Workshop and Training content discussed and addressed gender issues. Gender is a central and integral part of the project as women form the bulk of intended beneficiaries.

- The annual workshop included the gender content and sex-disaggregated data. - The speeches of project director in opening the workshop emphasized the

importance of implementing GAP and addressing gender issues in health sector.

Target 15: At least 30% of PMU/PIU Achieved

- 228 women (40%) of 565 PMU/PIU and counterparts at provincial health department, operational district, referral hospital and health centers staff employed in 12 provincial project offices, CNM and CDC department.

90 Appendix 8

SUMMARY OF GENDER EQUALITY RESULTS AND ACHIEVEMENTS (LAO PDR)

I. PROJECT DESCRIPTION

1. The Asian Development Bank (ADB) approved the Second Greater Mekong Subregion (GMS) Regional Communicable Diseases Control Project on 22 November 2010. The Project, building on the achievements and lessons learned from the first GMS Communicable Diseases Control project (CDC1), is a regional health sector partnership between the governments of Cambodia, Lao People’s Democratic Republic (PDR), and Viet Nam. The project impact was improved health of the population in the GMS. The expected project outcome was timely and adequate control of communicable diseases of regional relevance. The project was implemented through three outputs: output 1: enhanced regional CDC Systems; output 2: improved CDC along borders and economic corridors and output 3: integrated project management. 2. CDC2 became effective for Lao PDR on 22 March 2011. An additional financing was approved on 26 October 2015 and made effective on 4 January 2016 extending support to malaria elimination in the GMS. The project closed on 31 December 2017. The Ministry of Health (MOH) was the project executing agency, and implementation was conducted through the Department of Planning and Cooperation. The project beneficiaries were the poor in the selected 12 provinces,1 particularly ethnic communities, women and children. The project was categorized as effective gender mainstreaming (EGM).


A. Gender Issues and Gender Action Plan Features

3. Gender is a significant variable for understanding the spread of communicable diseases, as well as designing and delivering appropriate communicable diseases prevention, control, and response. Women and girls have specific health needs compared with men and boys, as is well understood in the context of sexual and reproductive health. However, men and women may also have different vulnerabilities to infectious diseases depending on how they are exposed through their different gender roles in households and productive activities. Despite efforts made, gender specific issues are not well integrated into sectoral and local development plans. Women and girls still have to face challenges of stereotypical attitudes on traditional gender roles, unplanned child births, heavy workload, and restricted opportunity for better education, especially in rural areas. Furthermore, language barriers amongst ethnic groups living in remote areas, together with inequality in schooling, nutrition, employment, cultural and social norms have made gender an important social determinant of health in the Lao PDR and/or they may have different levels of access to, or understanding of, information about disease prevention and treatment. Pregnancy can also make women more susceptible to certain diseases and pregnant women’s specific risks to infectious diseases should be considered when planning a response to emerging infectious disease threats. Gender norms still place the responsibility on women to be the custodians for the prevention, detection and care of infectious diseases among family members. The majority of health workers are women. Their usual tasks and responsibilities are more concentrated in lower-level service delivery rather than in decision-making or technical roles in the health sector. Increasing gender equity in the health sector and paying attention to the women’s needs and gender sensitivity will help improve CDC activities and wider health outcomes for communities.

1 The targeted provinces were Bokeo, Luang Namtha, Phongsaly, Oudomxay, Huaphane, Xieng Kuang, Bolikhamsay,

Khammouane, Saravane, Sekong, Attapeu and Champasack.

Appendix 8 91

4. A Gender Action Plan (GAP) was prepared under Grant 0232/0449 to maximize benefits to women, poor, ethnic groups and vulnerable people in the project areas. The GAP included the following key gender actions and targets:

(i) Promote the increased training of women in CDC surveillance and response with all female surveillance and response staff trained at all levels and at least 70% of female laboratory staff trained

(ii) Specific collection of sex-disaggregated data in all surveillance forms and reporting documentation

(iii. Gender content reflected in CDC training curriculum, human resource development plans cross-border activities and all training activities include gender issues

(iv) Encourage and monitor the hiring of new female staff with annual proportional increase of newly hired female staffs

(v) Proactively train women as village health volunteers, targeting at least 60% of women in urban and 40% in rural areas

(vi) Number of female participants in community-based CDC activities and campaign increases to 40%

(vii) At least 80% of women of reproductive age receive annual preventive anthelmintic treatment (viii) At least 80% of preschool and school age girls and boys receive annual preventive

anthelmintic treatment.

B. Overall Assessment of Gender-Related Results/Achievements 5. By project completion, GAP implementation was rated successful with 19 of actions (100%) implemented and completed, and 14 of the 16 targets (87.5%) achieved. The implementation results are detailed in Table A8.2. GAP actions and targets were integrated throughout the project outputs and the GAP contributed to overall project achievement. The GAP targets and actions been completed were the following: (i) the project promoted the increased training of women in CDC surveillance and response and other areas of CDC by ensuring that female staff were invited to all the project trainings. 1,395 out of 2,796 CDC staff trained in CDC

surveillance and response were women; (ii) 147 (90.7%) out of 162 laboratory staff trained were women; (iii) 100% of surveillance and response data was sex disaggregated; and (iv) there was increase in the number of women CDC staff from 45% in 2014 to 69.5% in 2017. Based on project achievements, the gender targets contributed to the empowerment of women and enhancing women’s capacities and opportunities in the health sector.

C. Gender Equality Results

1. Participation, access to project resources and practical benefits.

6. The project promoted effective participation and practical benefits for women. The project encouraged women participation in project activities as much as possible. The practical benefits for women include: (i) 147 women (90.7%) out of 162 laboratory staff trained on the biosafety in the laboratory and lab quality service including malaria and other communicable diseases diagnosis. After the trainings, the women participants report gaining confidence in performing job related tasks. (ii) All workshops included discussions on the key gender issues (such as women’s participation, setting up quotas for women participation during capacity development trainings, discussion on women’s issues and why sex-disaggregated data is a necessary component in project implementation, monitoring and reporting). Traditionally, it was mostly only men participating in the trainings and workshops. This could be attributed to culture and traditional

92 Appendix 8

practices on limiting women’s mobility and voice. This project met the target on gender quota for women’s attendance in the trainings to ensure that equitable opportunities were provided to women. The project facilitated women’s participation and created opportunities for women for improving their status in their workplaces and in their communities. Sex-disaggregated data helped identify women’s and men’s needs and constraints. These supported the promotion of gender equality by identifying strategic and practical needs (iii) 110 (100%) women surveillance and response (S&R) staff trained; 87% of them were highly competent. The project helped to strengthen capacity of S&R women by including them in the training, and women gained more confidence in performing their duties in their jobs. (vi) 84% of the village health volunteers have been trained (2,493 out of 2977) were women. Village health volunteers play a significant role to help the community in improving the early detection capacity of communicable epidemic response surveillance. The close proximity of the village health volunteers to the people in community, their knowledge of the cultural practices and their ability to speak the local language were significant factors in effectively implementing communication campaigns on disease prevention and control in the villages. The project supported trainings for village health volunteers and workers on disease protection, hygiene and awareness of treatment procedures to improve the health status of the community. The story below shows how people in the community have benefited from the initiatives included in the project GAP.

Box: 1: Improving status of women in the community in in Tay Oy district Saravan

province.

2. Strategic changes in gender relations

7. Institutional changes included the improved capacity of health staff in gender-sensitive planning and budgeting. Gender mainstreaming was integrated into planning and budgeting at provincial and district levels. The MOH’s Human Resource Development Strategy by 2020 sets clear targets and a timeline for the recruitment of female staff at each level of the health system. For example, the representation of women and ethnic groups among health leaders and managers was targeted to increase by 35% for women and 20% for ethnic groups by 2015, and by 50% and 35%, respectively, by 2020. The data on health service coverage indicators was disaggregated by sex and ethnicity. 8. The project promoted strategic changes in gender relations and women’s empowerment in many aspects including: (i) targeted actions for reaching women by setting up quota for women participation in project activities. The gender quota was included in the GMS annual joint review of national malaria policies and strategies; (ii) gender content have been integrated in CDC

Professional educational opportunities for females Dr. Vanida Bounnhoseng 47 year – old - woman from the

Epidemiology Section in Champasack Provincial Health Department was one of four Lao health staff (two male and two female) selected for the Master of Public Health (Epidemiology) course at Khon Kaen University in Thailand, funded under the project. During the full-time two-year course, Dr Vanida increased her quantitative and technical skills in outbreak investigation, disease transmission and disease prevention. She was able to apply these skills to her daily work on return to her role in province. She was also able to pass on these skills to other workmates, thus increasing capacity more broadly in her organization. Out of her work she also teaching student in health college in Champasak province.Dr. Vanida, told that after completed her education, she is very confident to deliver presentations and writing report disease signs.

Appendix 8 93

training curricula at institutional, MHV, and community levels; (iii) human resource development plans are gender responsive; (iv) the project facilitated and consistently monitored the hiring of new female staff through the setting up of quotas for new recruitment of female CDC staff . The narrative below illustrates how the career opportunities of women were improved through the project:

3. Contribution of gender equality results to overall loan outcomes and effectiveness

9. CDC 2 project has contributed to the reduction of infectious illnesses and decreased mortality rate through improved detection of CDC and timely control of epidemics. Local people have benefited from gaining productivity and cost savings from health impacts of emerging diseases like avian influenza and severe acute respiratory syndrome (SARS). The gender features were designed across all project’s outputs to ensure inclusive access of the poor, women, vulnerable groups and people living in remote areas to quality, efficient and effective basic health care services. The gender-specific interventions promoted the gender balance of health care service providers (e.g., 453 (50%) out of 916 village health workers were women) and the strengthening of women’s capacity to effectively provide appropriate health care services (e.g., 2,493 women village health workers (84%) out of total 2,977 VHWs have been trained). Women staff who attended the capacity development activities have reported better opportunities in career development. Therefore, gender equality results contributed to overall project outcome and effectiveness, ensuring universal access to basic health care.

10. The GAP implementation enhanced the contributions of women staff in CDC systems. There was an increase in women’s knowledge and participation in CDC prevention in project locations. The gender-awareness and responsiveness of CDC project management has been

Box 2: Professional educational opportunities for females Ms Lap, a 25-year- old woman from Kaole village, Tay Oy district in Saravanh was one of 152 new women village health volunteer workers in the Saravan province (since 2012: 75% of total of 225 VHWs in the province are women). Ms Lap shared that before the project, she did not have any skills and experiences related to health. People in her village faced difficulty in accessing health services and information on health and sanitation. This is particularly true for women who stay at home with their children and have limited opportunities to access health information. When project began, Ms Lap decided to be a village health volunteer/worker. She said: “I want to help my village people and my relatives to take care of their health. We live far from city and it will be helpful if I can be a contact person in my village to communicate with health staff in the district hospital”. She, along with other village health volunteers/workers, received trainings funded by the project. This includes prevention, early detection, and care of family members with infected diseases, recognizing disease signs, reporting suspected outbreaks or events, community health education and vector control. Becoming a village health worker increased Ms Lap’s self-confidence and raised her status in the village. Her work was respected and her contributions to the community were valued. Ms. Lap is actively consulted by both men and women villagers, reflecting the increased in her skills and capacity. She has contributed to the overall improvement of community health as prioritized in the project. Villagers were comfortable to communicate with Ms. Lap as she is community person, living with them and helping them.

94 Appendix 8

strengthened. The key contributions of gender mainstreaming to achieve the DMF outputs were as follows:

a. Output 1: Enhanced Regional Communicable Diseases Control Systems

11. The project paid attention on facilitating women’s participation through in the key performance indicators of the gender action plan. Actions implemented to enhance CDC systems include: (i) promoted the increased training of women in CDC surveillance and response and other areas of CDC by inviting women staff to all the project trainings 1,395 women out of 2,796 CDC staff have been trained; (ii) trained 147 women (90.7%) out of 162 laboratory staff trained were female; (iii) collected sex disaggregated data for all surveillance forms and reporting documentation; (iv) 100% of surveillance and response data is sex disaggregated; and (v) gender content reflected in CDC training curricula at institutional, MHV, and community levels. HRD plans are gender responsive.

b. Output 2: Improved CDC along Borders and Economic Corridors 12. Village health workers (VHW) are the key focal persons with greater awareness of the community health status. The project emphasized on providing capacity development training to the village health workers. Achievements are as follows: (i) the project proactively invited and trained women as VHW; 2,493 (84%) out of 2977 VHWs were women; (ii) the project has set up a criteria that each village must have one male and one female VHW. As a result, 50% (453) of the total 916 newly recruited VHW were women; and (iii) the number of women participants in community-based CDC activities and campaigns increased from 39.8% in 2014 to 63,3% in 2017. c. Output 3: Integrated Project Management: 13. The project gender action plan and ethnic group plan were fully implemented and reported on. All AOPs in each project target province included gender activities and budget allocation. Gender training provided at provincial district, health center and MHV levels. 161 (72 women) project staff received gender sensitivity and GAP training and all workshops included gender issue (set up quota for female participants, discussed on women’s issues and sex-disaggregated data).

III. LESSONS AND RECOMMENDATIONS

14. Several factors were critical to the success and achievements of GAP targets and actions:

(i) The project GAP was prepared to provide equitable opportunities for all. The project GAP is aligned with Lao National Gender Strategy. The Ministry of Health considers that promotion of gender equality and gender equity is important to support women empowerment and contribute in the implementation of the Lao National Gender Strategy.

(ii) Collaboration between project implementation team and ADB project team was one of the key factors in the success of the GAP implementation. The project collaborated with the ADB gender specialist and has introduced the GAP in the earliest stage to the executing agency and implementing agency. The project team ensured that the PCU and PIU understood the project gender requirement.

(iii) GAP implementation was generally successful. Two performance targets were not achieved but positive progress have been documented in the two GAP target indicators: the number of women of reproductive age who have received annual preventive anthelmintic treatment has increased from 35.5% in 2014 to 44.5% in

Appendix 8 95

2016 (GAP target: 80%). Efforts have been made to achieve the 80% target. However, the difficult road accessibility posed as a major challenge in reaching women living in the remote areas. There are some villages that could not be accessed during the rainy seasons. Although the number of preschool and school age girls and boys who have received annual preventive anthelmintic treatment increased from 45.9% in 2014 to 51.8% in 2016 (GAP target: 80%) access to children in remote provinces was difficult for the project implementation team.

(iv) The project was designed before MOH’s Women Advancement Unit established (June 2011). Therefore, coordination was impossible.

15. Recommendations. The following recommendations will enhance long-lasting impacts on women in future projects:

(i) To ensure that all GAP targets are achieved, at the design stage the project should collect baseline data, and target selection should be informed by baseline data collected through the gender assessment.

(ii) GAP requirements and gender targets should be clearly communicated at all levels of project implementation, and as early during implementation as possible;

(iii) Project managers should coordinate more closely with the MOH’s Division of the Advancement of Women (DAW) when formulating and implementing the GAP to strengthen coordination mechanism between DAW and the project, and gradually build the division's capacity to co-lead GAP implementation and monitoring, as well as to sustain the gender gains achieved beyond the life of the project.

96 Appendix 8

TABLE A8.2: ACHIEVEMENT ON GENDER ACTION PLAN IMPLEMENTATION (LAO PDR)

Updated: 29 November 2018 Project Title: Second GMS Communicable Diseases Control Project and additional financing project Country: Lao PDR Project (Loan/Grant/TA): G0232/0449 Approval and Timeline: Nov 2010 – Dec 2017 Gender Category: Effective Gender Mainstreaming Mission Leader: Ms. Ye Xu Project Impact: Improved health of the population in the GMS Project Outcome: Timely and adequate control of communicable diseases

Gender Action Plan (GAP Activities, Indicators and Targets,

Timeframe and Responsibility)

Progress to Date (This should include information on period of actual implementation, sex-disaggregated

qualitative and quantitative updates (e.g. number of participating women, women beneficiaries of services, etc.). However, some would be in process - so explain what has

happened towards meeting this target. Activity 1: Promote the increased training of women in CDC surveillance and response

Achieved Project promoted the increased training of women in CDC surveillance and response and other areas of CDC by inviting female staff to all the project trainings. Of the 2,796 CDC staff trained, 1,395 are women.

Target 1: 100% female surveillance and response staff trained at all levels

Achieved 110 (100%) women surveillance and response (S&R) staff attended training sessions on surveillance and outbreak response data management and malaria. Source: The 2017 Competency Report estimated 87% of S&R staff at all levels were highly competent.

Activity 2: Proactively target female laboratory staff for training

Achieved The project proactively targeted female laboratory staff for training by setting up quotas for women to participate in the trainings. The trainings conducted were based on the training needs and concerns raised by women laboratory staff such as training on stool culture to detect the causative agents of acute diarrhea; operational maintenance cost for biosafety cabinet, autoclave and incubators.

Target 2: At least 70% of female laboratory staff trained

Achieved 147 women (90.7%) out of 162 laboratory staff trained on the biosafety in the laboratory and lab quality service including malaria and other communicable diseases diagnosis. Source: Provincial Training and Gender Survey 2017.

Appendix 8 97

Activity 3: Specific collection of sex disaggregated data in all surveillance forms and reporting documentation

Achieved Project collected specific sex disaggregated data in all surveillance forms and reporting documentation. In 2015, CLV agreed to use a standard template for reporting on 13 diseases and emphasized on the collection of sex disaggregated data. .

Target 3: 100% of surveillance and response data is sex disaggregated, as appropriate

Achieved 100% of surveillance and response data is sex disaggregated. Source: Monthly reports on outbreaks and notifiable disease cases

Activity 4: Targeted actions for reaching women included in the GMS annual joint review of national malaria policies and strategies

Achieved During the GMS annual joint review of national malaria policies and strategies 2016-2020, the targeted action for reaching women have been discussed and incorporated. The targeted action includes setting up quota for women participation. Village Health Workers have to work closely with Lao Women Union and target women group for dissemination of malaria prevention.). Source: Trainings and workshop reports; National Malaria Policies and Strategies M/Y

Activity 5: Specific interventions for women are part of new national malaria policies and strategies

Achieved The National Strategy for Malaria Control and Elimination assesses risk and identifies targets and strategies. Young male forest workers are overwhelmingly the most at-risk group, although the report identifies mobile and migrant population (MMPs) including women and ethnic groups conducting slash and burn farming as potential at risk groups. Women are recognized as important in family welfare and for ensuring use of Long- lasting insecticidal nets (LLINs). The strategy is therefore to continue to emphasize and market bed nets to households, particularly through women and wives. Women are perceived as the family members mainly responsible for malaria prevention. This perception is stems from traditionally assigned roles to women as primary caregivers of children as well as other family members. Taking this cultural aspect into account, the project worked closely with village Lao Women’s Union to ensure support on malaria prevention (e.g., provision of bed nets to all family members).

Activity 6: Gender content reflected in CDC training curriculum, HRD plans cross-border activities.

Achieved Gender content reflected in CDC training curricula at institutional, MHV, and community levels. HRD plans are gender responsive. Source: Provincial reports, workshop reports and plans.

98 Appendix 8

Activity 7: Encourage and monitor the hiring of new female staff

Achieved Project encourages and monitors the hiring of new female staff through set up quota for female. Example, Health Personnel Development Strategy by 2020 (page 9 English version) mentioned targets of increasing female staff from to 35% by 2015 and 50% by 2020. Page 17 of the Health Personnel Development Strategy by 2020 mentioned equity and equality of opportunity. The MOH implements, analyzes, and monitors the proportion, recruitment, supervision and retention of health personnel especially women health staff. MOH also works on improving the work environment for better performance of staff. The MOH ensures safe work environment and avoid sexual violence and discrimination of ethnic, religion, economic status, and others. Additionally, MOH implements appropriate work shift and work leave such as pregnancy delivery or post-delivery.

Target 4: Annual proportional increase and % of newly hired female staff

Achieved There was an increase in the number of newly recruited women CDC staff from 45% in 2014 to 69,5% in 2017. Details are as follows:

Year Total newly recruited Total Female newly recruited Percentage

2014

578 261 45% 412 (District) 188 (Province) 45.6%

155 (District) 69 (Province) 44.5%

2016

622 384 61.7%



2016-2017 23 16 69.5% Source: Provincial Training and Gender Surveys 2014 and 2017.

Activity 8: Collect, use and analyze sex-disaggregated data in community-based CDC assessments and plans

Achieved The project collected, used and analyzed sex-disaggregated data on maternal health, family planning, child immunization, childhood illness, prevention of communicable disease, de-worming, latrines and clean water, food practice, medicine, source of education in community-based CDC assessments and plans. Source: Based line and Endline surveys

Target 5: 100% community-based assessments and plans use analyze sex-disaggregated data

Achieved All project plans and assessments use sex-disaggregated data: e.g. project run focus groups for IP research; Household Surveys; training reports; and outbreak and surveillance data.

Appendix 8 99

Source: Training and Gender Surveys, Household Surveys, regular reporting on training and workshops.

Activity 9: Proactively train women as village health volunteers/Workers

Achieved Project proactively trained women as village health volunteers/Workers by invited women VHW to participate in trainings.

Target 6: At least 60% of female urban (and 40% of female rural) village health volunteers/workers trained

Achieved 2,493 (84%) out of 2,977 village health workers trained were women. (The training did not separate urban and rural VHW). All village health volunteers/workers were based on rural areas. There were no VHW in the urban because urban areas have adequate health facilities. Source: Provincial Training and Gender Survey 2017.

Target 7: At least half of newly selected village health volunteers/workers in districts are female.

Achieved New VHW female 453 (50%) out of 916 VHW were female (The project set up criteria that each village must have VHW 1 male and 1 female). Source: Competency Survey 2017.

Activity 10: Proactively outreach and target women in community-based CDC activities and campaigns using gender-sensitive IEC methods and materials.

Achieved The project targets women in community-based CDC activities and campaigns using gender-sensitive IEC methods and materials by inviting women to participate in CDC activities and campaigns and using gender-sensitive (easy for women to understand such as using posters or pictures) IEC methods and materials.

Target 8: Number of female participants in community-based CDC activities and campaigns increases 40%

Achieved The number of women participants in community-based CDC activities increased from 63.3% in 2017 (baseline data in 2010 was 0). Source: Provincial Training and Gender Surveys 2017.

Activity 11: Where included in the community package, expand implementation of community-based deworming programs for women of reproductive age and preschool children

Achieved The project continues to expand implementation of community-based deworming programs for women of reproductive age and preschool children. CDC2 project provide funding to CMPE to carry out the monitoring during the distribution drug to school children, stool survey for evaluation the impact of deworming programs and carry out health education to communities on three hygiene’s at school and communities, conducted by district health staff.

Target 9: At least 80% of women of reproductive age receive annual preventive anthelmintic treatment

Not achieved Women of reproductive age receive annual preventive anthelmintic treatment 2014 – 531 (35.5%) out of 1497 2016 – 667 (44.6%) out of 1497

100 Appendix 8

Number of women of reproductive age accessed to health services was low. It was challenging for the project implementation team to achieve the 80% target due to difficult road accessibility to reach women living in the remote areas. There are some villages that could not be accessed during the rainy seasons Source: Project Household Surveys – 2014 and 2016 (sample size 1497)

Target 10: At least 80% of preschool and school age girls and boys receive annual preventive anthelmintic treatment

Not achieved Under-5 children received deworming in the last 12 months 2014 – 687 (45.9%) out of 1497 were girls 2016 – 776 (51.8%) out of 1497 were girls Deworming programs for school children are jointly implemented between MOE and MOH (Main player are DCDC and CMPE). WHO support the anthelmintic drug and operational cost. Source: Project Household Surveys – 2014 and 2016 (sample size 1497)

Activity 12: Systematically include gender specific issues into the training activities implemented by the Project

Achieved Training conducted under the project from 2011-2017 incorporated gender and women concerns in the planning and discussions. Gender concerns were opportunities for women staff to participate short term training on CDC/S&R; Laboratory service training; community mobilization and orientation; (health worker and volunteer and (training on strengthen management system. All are systematically included gender specific issues into the training activities.

Target 11: 100% training activities include gender issues.

Achieved All training activities are gender mainstreamed and participation sex disaggregated. Trainings and MHV training curricula include gender. Source: Training reports.

Activity 13: Integrate gender issues and targeted actions for women in joint action plans for malaria prevention and response in the border provinces

Achieved The project integrated gender issues and targeted actions for women in joint action plans for malaria prevention and response in the border provinces. For example, the following have been undertaken in collaboration with the Lao Women’s Union at the village level. The project collaborated with village Lao Women’s Union to disseminated information on malaria prevention and response. Women village members participate in health education on malaria control and prevention. They received practical prevention and control methods, such as on the use of bed nets. Women villagers helped health volunteer workers to report and monitor malaria symptoms or cases happening in their villages.

Appendix 8 101

Target 12: Recommendations to address at least 5 gender issues identified in the joint actions plan for malaria prevention and response in the border provinces

Achieved Recommendations to address gender issues identified in the joint actions plan for malaria prevention and response in the border provinces: - provided health information and knowledge about specific diseases (causes,

transmission, prevention and control by emphasizing on women to take care of their family members).

- developed an easy and appropriate materials (posters, radio spot) to malaria control for local people (make women easy understanding as much as possible).

- suggested villagers (both men and women) sleeping under mosquito net. - provided guidance to the community to conduct the cleaning campaign at the village

level. - supported VHWs on primary health care activities implementation then monitoring and

evaluation by health center staff. Activity 14: Tailor the GAP to national/provincial contexts

Achieved The project team leader discussed with ADB mission team to tailor GAP and combined GAP monitoring table between CDC 2 and additional financing during the ADB mission 26 April-5 May 2017.

Activity 15: National/provincial GAPs developed and implemented.

Achieved The project developed GAP and apply it to both national and provincial for implementation (The GAP had been developed and combined for CDC2 and additional financing projects during the mission on 26 April – 5 May 2017). Source: Gender actions and activities reported in provincial AOPs

Activity 16: Integrate gender-related activities and budget allocation in AOPs

Achieved AOPs include gender activities and budget allocations. Gender training continue to be carried out at provincial district, health center and MHV levels. Source: AOPs submitted to the project

Target 13: 100% AOPs include gender-related activities and budget allocations.

Achieved All AOPs in each project target province include gender activities and budget allocation. Gender training ongoing at provincial district, health center and MHV levels. Source: AOPs submitted to the project

Activity 17: Appoint gender representatives in PMU/PIU/SC.

Achieved The project appointed gender representatives in PMU/PIU

Activity 18: Gender representatives in PMU/PIU/SC gender report on gender/GAP

Achieved Quarterly reports included GAP and IP updates. Related data (e.g. outbreaks and training) are sex disaggregated. Source: Quarterly Reports have a standard gender and IP section

102 Appendix 8

Activity 19: Recruit a social development specialist to cover gender issues/GAP implementation.

Achieved International gender and IP specialist mobilized January 2012 for 06 person/months. Local gender and IP specialist engaged instead and mobilized November 2012 for 18 person/months. Source: Research and reports completed under the CDC2

Target 14: Gender sensitive/GAP training for project staff.

Achieved 161 (72 women) project staff received gender sensitivity and GAP training.

Target 15: Gender issues included in all workshops

Achieved All workshops included gender issue (set up quota for female participants, discussed on women’s issues and sex-disaggregated data). Source: Workshop reports

Target 16: At least 30% of PMU/PIU officers are women

Achieved 2014 % 2017 %

PMU staff 51/98 52% 41/85 48.2% Source: Provincial Training and Gender Survey 2017

Comments/Remarks: 19 Activities: Achieved 19 (100%) activities; achieved 14 (87.5%) out of 16 targets. Accomplished by: Sommay Mounsourisak, Project gender consultant and Michael O’Rouke, project team leader Reviewed by: Theonakhet Saphakdy, ADB LRM Social Development Officer (Gender)

Appendix 8 103

SUMMARY OF GENDER EQUALITY RESULTS AND ACHIEVEMENTS (VIET NAM)

I. PROJECT DESCRIPTION 1. The Second Greater Mekong Subregion (GMS) Regional Communicable Diseases Control Project (CDC2) for Cambodia, the Lao People’s Democratic Republic (PDR) and Viet Nam was approved by ADB on 22 November 2010, became effective on 20 May 2011 and CDC2 – Additional Financing (AF) was approved on 26 October 2015 and effective on 19 May 2016. The project covers 20 provinces1 in Viet Nam benefiting about 1.7 million people. The main objectives of project were to: (i) strengthen GMS cooperation in CDC and national capacity for surveillance and response; (ii) improve capacity of CDC staff in particular at district and commune levels and awareness of CDC among vulnerable and underserved populations with a high disease burden and at risk of major communicable diseases; and (iii) improve the quality of diagnosis and treatment to enhance the effectiveness of treatment for malaria patients and malaria parasite carriers. The project impact was “improved health of the population in the GMS, in particular for the poor, ethnic groups, and women and children in border districts”. The project outcome is “timely and adequate control of communicable diseases of regional relevance that are likely to have a major impact on the region’s public health and economy”. The project outputs are: (i) enhanced regional CDC systems, (ii) improved CDC along borders and economic corridors, and (iii) integrated project management. 2. The project started in 20 May 2011 and completed on 31 December 2017. The project gender classification was effective gender mainstreaming (EGM). A gender action plan (GAP) was developed at the project design and it was revised at the additional financing processing. The results of the GAP implementation are presented in Table A8.3.


A. Gender Issues and Gender Action Plan Features

3. The project area is located in the remote border districts, in which the population face the risk of being infected with many communicable diseases which are associated with poverty and poor environmental sanitation and poor health services. Women with lower levels of education tend to carry a higher burden of communicable diseases than men. More often than not, there are very few mechanisms to adequately address sex differences and gender disparities in the prevention of communicable diseases. Women’s access to healthcare remains limited, only 59% of rural residents throughout the country have access to health centres and this situation has a large impact on the healthcare of mothers and infants and 60% of ethnic minority women never receive pregnancy check-ups,2 and only 59.2% of ethnic minority mothers have neonatal tetanus vaccination.3 Women were also limited in accessing information on health care, only 49.6% of women know HIV can be transmitted from mother to child.4 Certain communicable diseases can have serious consequences for pregnant women and their fetuses, particularly those living in rural provinces. Pregnancy can also make women more susceptible to certain diseases and pregnant women’s specific risks to infectious diseases should be considered when planning a response to

1 20 provinces in Viet Nam (Lao Cai, Dien Bien, Son La, Thanh Hoa, Nghe An, Ha Tinh, Quang Binh, Quang Tri, Dak

Lak, Dak Nong, Binh Phuoc, Tay Ninh, Long An, Dong Thap, An Giang, Kien Giang; Hanoi, Can Tho, Ben Tre, and Tra Vinh). Only Binh Phuoc and Dak Nong were involved in Additional Financing.

2 Country Gender Profile: Viet Nam, 2011 (JICA) 3 Investigation of Objectives Evaluation -Children and Women 2011 (UNICEP, UNFPA, GSO-Viet Nam) 4 Investigation of Objectives Evaluation -Children and Women 2011 (UNICEP, UNFPA, GSO-Viet Nam)

104 Appendix 8

emerging infectious disease threats. Gender norms still place the responsibility on women to be the custodians for the prevention, detection, and care of family members with infected diseases. 4. The majority of health workers are women. However, their jobs are concentrated in lower-level service delivery rather than in decision-making or technical roles’ levels. Increasing gender equity in the health sector and paying attention to the women’s needs and gender sensitivity will help improve CDC activities and wider health outcomes for communities.

5. A gender action plan was prepared under Loan 2699 and two GAP indicators under a separate Grant 0450-VIE were merged in the GAP of Loan 2699-VIE to ensure gender equality in the distribution of project benefits and to enable active engagement of women in subproject design and implementation. The revised GAP includes the following features:

(i) to enhance the opportunities and contribution of female staff in CDC systems including all female surveillance and response staff trained at all levels;

(ii) to improve gender analysis in regional CDC systems; (iii) to improve responsiveness of CDC to gender issues in targeted districts/province; (iv) to increase the participation and awareness of women in CDC prevention in project

locations including (a) At least 60% of female urban and 40% of female rural village health volunteers/workers trained and number of female participants in community-based CDC activities and campaigns increases 40%, and (b) At least 80% of women of reproductive age and preschool and school age girls and boys receive annual preventive anthelmintic treatment;

(v) to integrate gender issues and targeted actions for women in joint action plans for malaria prevention and response in the border provinces; and

(vi) to enhance the gender awareness and responsiveness of CDC project management including 100% of project staff receive gender sensitivity and GAP training and all annual operation plans include gender related activities and budget allocations.

B. Overall Assessment of Gender-Related Results and Achievements

6. The GAP implementation is rated satisfactory. The revised GAP consisted of 8 activities and 13 targets. As of completion, 87.5% (7 out of 8) activities have been completed; and 92.3% (12 out of 13) targets have been achieved, with the remaining activity and target have been partially achieved. The DMF included nine gender-related output indicators, of which seven indicators (77.8%) have been achieved, and two targets have been partially achieved, due to: (i) one target in the design and monitoring framework (DMF) was inconsistence with project GAP;5 and (ii) one target was not realistic6 (more details are given in Table A8.3). 7. The key achievements under the GAP include: (i) 100% of 4,553 female surveillance and response staff in 20 provinces trained on communicable diseases control (target: 100%); (ii) 100% of 573 women laboratory staff trained on utilization and operation of testing equipment (target: 70%); (iii) 357 (59.6%) out of 599 newly-recruited VHWs were women (target: 50%); (iv) 431 (53.8%) out of 801 participants trained on CDC communication were women (target: 40%); and (v) 100% of 313 CPMU and PPMUs staff trained gender sensitivity and GAP (target: 100%).

5 Target c of output 2 in revised DMF “All women of reproductive age and children aged 1–5 years receive micronutrients and

deworming” and targets 7 and 8 in GAP “80% of women of reproductive age and children aged 1–5 years receive micronutrients and deworming”. The implementation result in GAP was achieved but in DMF was not achieved. (see para. 7)

6 Target h of output 2 in revised DMF: “At least 60% of trained staff is female”, this target was not realistic because the proportion of women in CDC system was only 50%, which led to the related training target not being achieved.

Appendix 8 105

8. The project developed sex-disaggregated monitoring and evaluation database for all project activities. The GAP monitoring results were regularly updated and attached to project quarterly progress reports.

C. Gender Equality Results

1. Participation, access to project resources and practical benefits

9. The project promoted effective participation and practical benefits of project resources for women. The practical benefits for women include:

(i) 6,811 (46.4%) women out of 14,665 surveillance and response staff at all levels received training on monitoring, analysis and reporting of infectious diseases and malaria surveillance. All 4,553 (100%) female surveillance and response staff at all levels in the 20 project provinces were trained, each female staff participated in at least one course during project implementation (target: 100%);

(ii) 801 (45.8%) women out of 1,750 laboratory staff received training on laboratory techniques and the use of microscopes, which contributed to improving the early detection capacity of communicable epidemic response surveillance. All 573 female laboratory staff (100%) in 20 project provinces received at least one training course during project implementation (target: 70%);

(iii) 2,847 women (65.5%) out of 4,343 VHWs received training on CDC and malaria surveillance, which has contributed to improving community-based communicable disease control;

(iv) the project focused on enhancing communication to change community behavior and improve skills for VHWs, WUs and volunteers of CDC with 431 (58.1%) women out of 801 participants participated in 31 courses (target: 40%). The project conducted the community communication activities on CDC with 141,585 (60.7%) women out of 239,799 local participants in communication campaigns (target: 40%);

(v) 852,326 (86.6%) women out of 984,211 women in reproductive age and 392,509 (94.4%) out of 415,793 preschool children received annual preventive anthelmintic treatment (target: 80%); and

(vi) all 313 project CPMU and PPMUs staff including 92 women trained on gender sensitivity and GAP orientation.

Box 1: Practical gender benefit: female CDC staff access to training

Le Thi Mai (49 years old), Laboratory of Truong Xuan District Healthcare Center, Thanh Hoa Province The project has provided the Truong Xuan District Healthcare Center with medical and laboratory equipment such as drying cabinets for preservation of specimens, microscopes, medicine sprayers, medical kits, among others. The appropriate training for laboratory staff on O&M procedures of laboratory equipment have also been provided. All members of the laboratory faculty in the Truong Xuan District Healthcare Center have participated in this training course (i.e., faculty has 3 staff and all are female staff). After the course, Ms. Mai and other staff of the laboratory have understood the how some equipment in the laboratory functions and been trained how to operate this equipment, which have enabled them to effectively operate, use, and maintain the equipment to ensure biosafety for the testing. Thanks to the support of the project on equipment and training provision, the Truong Xuan District

106 Appendix 8

Healthcare Center has promptly detected infectious diseases occurring in the district and then worked out appropriate measures to timely abate the epidemic, particularly petechial fever, measles, and hand-foot-mouth diseases. Ms. Mai is one of 573 female laboratory staff in 20 project provinces received training under project.

2. Strategic changes in gender relations

10. The project promoted strategic changes in gender relations and women’s empowerment in many aspects:

(i) 391 (43.1%) women out of 908 participants participated in conferences and information-sharing sessions on CDC to support the development, promulgation, introduction and dissemination of legal texts and documents as well as technical guidelines. Examples of these legal documents are (a) Development of circulars guiding the implementation of some articles of the Government's Decree on vaccination activities; (b) Updating of the circular on the practice of ensuring biosafety in laboratories; and (c) Contribution to the development of Circular No. 54/2015/TT-BYT guiding the regime of information, reporting and declaration of infectious diseases and epidemic, etc. The participation in these activities has created a sense of empowerment for those women involved.

(ii) Annual proportion increase of newly hired female staff from 2011 to 2017 in CDC system with 819 (49.4%) women out of 1,658 newly hired staff and 357 (59.6%) women out of 599 newly hired VHWs. This has increased gender equity in all levels and functions of health sector staff in a way that they can improve communicable disease control and wider health outcomes for communities, because female health workers are often better placed to understand the specific health needs of women and to effectively outreach to women in the communities.

(iii) The project has encouraged 4,553 female staff in CDC systems at all levels and 2,847 female VHWs to participate in the training courses on CDC surveillance and response and 174 female staff at all levels have been provided with scholarship support (long-term and short-term) for their participation in CDC trainings. These activities have enabled women to improve their roles and importance in CDC response capacity and increase their capacity and confidence to take on leadership roles in the management of CDC systems.

Box 3: Strategic gender benefits for women: improved women’s voice in policy formulation process Ms. Ha Thi Cam Van (34 years old), Project coordinator, Deputy Manager of Vaccine Management and Testing - Department of Preventive Medicine During the implementation of the project from 2011 to 2017, Ms Van had participated in the training courses organized by the project on gender, annual planning formulation and especially professional training on CDC. Through the trainings organized by the project, she gained more professional knowledge and planning skills, which helped her in fulfilling functions assigned by the project. In 2014, she was promoted to take on the role of deputy manager.

She shared that thanks to project she had opportunities participated in the CDC review meetings and in the formulation of the CDC guidelines developed by the project. The CDC guidelines became the basis

Appendix 8 107

of the Ministry of Health in reviewing and amending the the Law on Prevention and Control of Infectious Diseases and the Circular 48/2010/TT-BYT guiding the declaration, information and reporting of communicable disease. Ms Van’s effective contribution to the policy review, specific collection of sex disaggregated data is incorporated in the new Circular No. 54/2015/TT-BYT on guiding for reporting and declaration of infectious disease. This was not included in the previous Circular No. 48. Ms. Van’s participation in project activities helped her improve her work functions and enhanced her voice in the policy formulation progress. Ms. Van is one of 4,553 female staff participated in the trainings conducted by project.

Box 3: Strategic benefits for Women: Increased women’s voice in community leadership Ms. Nong Thi Quyet (54 years old) of Tay ethnicity and Ms. Tran Thi Lan Phuong (55 years old), village health workers in Dak Wil Commune, Cu Jut District, Dak Nong Province. Ms. Quyet and Ms. Phuong have participated in VHW training courses organized by the project at Cu Jut District Healthcare Center and at the commune healthcare station from 2012 to 2017. The commune has 17 villages with 17 VHWs. All VHWs are women and have attended CDC training courses organized by the project. The training design covered the CDC transmitted through soil, foot-hand-mouth disease, measles, malaria, and (provide specific examples). After the training, Ms. Quyet and Ms. Phuong disseminated information on how to detect and prevent diseases through Women Union’s or village leaders’ meetings and public meetings. With good understanding about the knowledge of disease prevention and control, they collaborated with commune healthcare staff in conducting village communication events and methods for timely reporting of disease situations in the village to related agencies. The communication campaigns on disease prevention and control organized by Ms. Quyet and Ms. Phuong in their communities have contributed to the behavior-change among villagers in terms of disease prevention and treatment. At present, public health has improved; previously, local people in the community self-treated sick children at home, which could result in complications. Now, parents allow their children to receive vaccinations, regular check-up visits to the commune healthcare station for timely examination and treatment, resulting in less disease outbreaks in the village and commune. By actively participating in the project activities, village health workers Ms. Quyet and Ms. Phuong are more confident in taking part in the social activities of the village and gained trust and support of the villagers.

3. Contribution of gender equality results to overall loan outcomes and

effectiveness

11. Relevance. The project, in general, has adequately addressed gender issues in project design through the inclusion of gender targets in DMF’s outputs. The DMF included nine gender-related output indicators, of which seven indicators have been achieved. In addition, the GAP (consisting of 21 performance indicators, including 13 quantitative targets) aligns with DMF and includes relevant gender actions and targets. 12. Effectiveness. These gender equality results certainly contribute to achieving project DMF’s outputs. The GAP implementation has contributed to enhancing the opportunities and contribution of women staff in CDC systems, increasing the participation and awareness of women in CDC prevention in project locations, and strengthening the gender-awareness and responsiveness of CDC project management. Specifically, the contributions of gender mainstreaming to achieve the DMF outputs are as follows:

a. Output 1: Enhanced Regional Communicable Disease Control Systems. (i) Joint implementation of regional strategies for emerging diseases and neglected

tropical diseases (NTDs) including specific measures to address gender and ethnic group issues; Achieved: The project has conducted workshops to contribute to the improvement of the legal framework for CDC in Viet Nam and share information on communicable disease prevention through regional collaboration activities. The project has supported the implementation of (i) the action plan for tetanus

108 Appendix 8

elimination for newborn by providing vaccinations to women of childbearing age or organizing vaccination campaign, such as Japanese Encephalitis for high-risk areas with ethnic minority groups in mountainous provinces; and (ii) supporting the organization of vaccination campaign for Diphtheria for ethnic minority groups in K’Bang, Gia Lai province in 2016–2017, and in Tay Giang district, Quang Nam province in 2016;

(ii) MOH exchanges information on disease outbreaks as per International Health Regulations (IHR), including sex-disaggregated data; Achieved: MOH exchanged disease outbreaks information with Cambodia and Lao PDR consistent with IHR/APSED. The data shared is sex-disaggregated.

(iii) Gender content reflected in CDC training curriculum, HRD plans cross-border activities: Achieved. In CDC training curriculum included the contents on the GAP and ethnic minority development plan (EMDP) implementation. 20 provinces had integrated GAP and EMP contents into project planning (AOPs) with budget. GAP are reflected in training, workshops, information and communication materials, HRD plans and cross-border activities. CPMU and PPMUs have one project officer responsible for monitoring and reporting results.

b. Output 2: Improved CDC along Borders and Economic Corridors (i) At least half of newly selected village health volunteers/workers in districts are

female; Achieved: 357 female VHWs among 599 VHWs (59.6%) recruited in project districts.

(ii) By 2017, at least five village health workers per project border district trained in malaria control and treatment, at least 50% of training participants are women: Achieved: 191 (80.9%) women out of 236 VHWs in Dak Nong and Dak Lak provinces participated in training courses on prevention and control of malaria.

(iii) The project created opportunities for women VHWs in the recruitment and trainings. These helped women VHWs to access CDC activities and improve the knowledge on the proliferation of communicable diseases as well as controlled efficiency in case detection and treatment management in village.

c. Output 3: Integrated project management (i) Provincial AOPs include CDC targets with special attention to border villages,

cross-border collaboration, gender and ethnic groups, and in-service training; Achieved: 100% PPMUs developed plans and implemented project activities following PMU’s instruction to meet project targets. Contents on GAP were included in CDC training programs and HRD plans included in AOPs.

(ii) Gender action plan and ethnic groups plan are fully implemented and reported; Achieved: 100% of PPMUs developed and implemented the gender and ethnic minority action plans integrated into project activities such as training, workshop, communication and human resources. All data on training, workshop, communication and human resources of the project were analyzed by gender and ethnicity, and reported to the CPMU and ADB on a quarterly basis.

III. LESSONS LEARNT AND RECOMMENDATIONS

A. Factors Contributing to the Success of GAP Implementation

13. The revised GAP indicators to be relevant and integrated into project activities, most of which directly benefited women and were easy for women to participate in, such as in training,

Appendix 8 109

women of reproductive age received micronutrients and deworming, and communication program (such as: T1, T2, T8 and T9 in table 1). 14. CPMU and each PPMU assigned gender focal points who were responsible for GAP implementation, monitoring and reporting. 15. CPMU developed and maintained a sex-disaggregated monitoring and evaluation database of all project activities, which helped the CPMU to monitor and report on GAP implementation more effectively. B. Constraints During GAP Implementation

16. The government’s guideline (Circular No.48/2010/TT-BYT) on reporting CDC cases and death did not require data to be sex-disaggregated, therefore, the gender data collection was not integrated in the reporting system. Only until 2015, the Circular No. 54/2015/TT-BYT replacing Circular No. 48/2010/TTBYT would provide that the declaration, information and reporting of communicable disease require sex-disaggregated data; 17. The guidelines on gender integration were developed in 2013 (two years after project start-up) and the consulting time of the international gender expert was too short to provide a more thorough assessment on equipping project staff at various levels with the appropriate skills and knowledge to undertake meaningful gender work under CDC2. 18. The target for female CDC staff participation in training on CDC (60%) was not realistic because the proportion of female staff in CDC system was only 50%, which led to the related training target not being achieved. C. Sustainability 19. Total of 16,415 staff including 7,612 women surveillance and response staff and laboratory staff at all levels received training and participated in the implementation of supervision and response, testing and operation of equipment etc. and continued to implement CDC in their provinces beyond the project. In addition, 512 health staff including 174 women staff at all levels received scholarships by project, which has helped to improve professional qualifications in CDC system. 20. The project has contributed to reducing poverty by improving the health of the local people in the project area through communication to significantly increase the percentage of households with modified CDC behavior7 and to contribute significantly in decreasing the communicable diseases morbidity for the community in the project provinces, and support for women of reproductive age and children aged 1-5 years received micronutrients and, deworming. The project’s contribution is particularly significant for women in border areas where infectious diseases is closely inter-related with poverty and poor environmental sanitation and inadequate medical services. The morbidity and mortality rates of infectious diseases have reduced, thereby improving health, increasing work capacity and production of the target population groups.

7 The proportion of households with CDC behavior increased properly from 69.8% in 2013 to 81.6% in 2017 (page 9, PCR prepared

by Government)

110 Appendix 8

D. Recommendations

21. Improvement of GAP design: For future projects, GAP performance targets should be set realistically with adequate gender analysis in project sites and aligned with proposed actions (target h of output 2 in DMF for example). The target in GAP should be consistent with gender related target in DMF (the targets T7 and T8 in GAP were inconsistent with target c in revised DMF). 22. Improvement of GAP implementation: (i) The project should ensure that gender mainstreaming trainings are provided to EA/IAs staff as soon as project start up and in more practical manner (i.e., relating to roles of stakeholders in GAP implementation) in order to gain their understanding, support, and monitoring of the gender activities and results effectively; (ii) The gender specialist should be recruited and mobilized from the beginning of the project to guide PMUs in the integration of sex-disaggregated data into the project management and monitoring system. This would help the PMUs to monitor GAP and adjust planning to achieve the gender actions and targets. 23. The projects in the future should take active steps to recruit health workers from minority background and support scholarship for female and ethnic minority health workers to encourage their participation in the trainings on CDC. This would help improve CDC activities as well as wider health outcomes for communities.

Appendix 8 111

Table A8.3: Achievement on Gender Action Plan Implementation (VIET NAM)

(As 20 November 2018)

1 Source: interview Mr. Cam Ba Thang- Director of Thuong Xuan District Health Centre, Thanh Hoa province; Mr. Tran Kim Long - Vice manager of communicable diseases control,

Vaccine and biological, Buon Don district health centre; Ms. Hoang Thi Hien - Staff, Dak Wil commune health center, Cu Jut district, Dak Nong province, Mr. Phan Thanh Tinh - Director of the Cu Jut district health center

Project outputs/ Gender specific

Objective

Gender design features /Activities

Performance Targets/Indicators

Results Issues/challenges

Output 1: Enhanced control of regional communicable diseases 1.1. To enhance the opportunities and contribution of female staff in CDC systems 1.2. To improve gender/ethnic analysis in regional CDC systems

Promote the increased training of women in CDC surveillance and response

T1: All female surveillance and response staff trained at all levels

Achieved: During 2011-2017, the project conducted training courses on control of communicable diseases and reporting of infectious diseases for 14,665 staff at all levels including 6,811 female staff (46.4%). Total of female surveillance and response staff was 4,553 (50% of 9,104 CDC staff at all levels) in 20 provinces and 100% female surveillance and response staff trained, each female staff participated in at least one course during the project implementation1. Support for scholarships also given priority for female staff with 174 (33.4%) female staff out of 512 health staff at all levels.

Proactively target female laboratory staff for training

T2: At least 70% of female laboratory staff trained

Achieved: The project conducted 84 training courses on utilization and operation of testing equipment for 1,750 laboratory staff including 801 female staff (45.8%). All 573 female laboratory staff (100%) in 20 project provinces received at least one training course during the project implementation.

Specific collection of sex-disaggregated data in all surveillance forms and reporting documentation

T3. 100% of surveillance and response data is sex-disaggregated, as appropriate

Achieved: The information on the status of national communicable diseases was shared to the provincial health quarantine units/preventive medicine units. Data on cases/death from 2011-2015 was not classified into genders according to Circular No. 48/2010/TTBYT guiding the declaration, information and reporting of communicable disease. By the end 2015, Circular No. 54/2015/TT-BYT dated 28/12/2015 replaced Circular No. 48/2010/TTBYT guiding the

112 Appendix 8

2 Circular No. 54/2015/TT-BYT: Annex 1: report on the case of disease; Annex 3: Monthly infectious disease report (for the health care stations) and annex 7: Report on outbreak

detection

declaration, information and reporting of communicable disease with sex-disaggregated data2. 391 (43.1%) women out of 908 participants participated in conferences and information-sharing sessions on CDC to support the development, promulgation, introduction and dissemination of legal texts and documents as well as technical guidelines.

Incorporate gender and ethnic-related content into curriculum training modules, human resource development plans and cross-border activities

A1. Gender content reflected in CDC training curriculum, HRD plans, cross-border activities

Achieved: In CDC training curriculum included the contents on the GAP and ethnic minority development plan (EMDP) implementation. 20 provinces had integrated GAP and EMP contents into project planning (AOPs) with budget. GAP are reflected in training, workshops, information and communication materials, HRD plans and cross-border activities. CPMU and PPMUs have one project officer responsible for monitoring and reporting results.

Encourage and monitor the hiring of new female staff

A2. Annual proportional increase of newly hired female staff

Achieved: The total of staff recruited from 2011-2017 in CDC system was 1,658 staff including 819 female staff (49.4%). Proportion of female staff increased every year from 2011-2015, but decreased between 2016- 2017, details as below:

Year Total of newly hired staff

In which newly female staff

% of newly female staff

2011 343 165 48.1

2012 400 194 48.5 2013 385 192 49.9 2014 311 154 49.5 2015 216 113 52.3 2016 0 0 0.0 2017 3 1 33.3 Total 1,658 819 49.4

During 2016-2017, the project only conducted in Dak Nong and Binh Phuoc provinces. In 2017, Dak Nong province recruited one female staff out of 3 staff for communication campaigns on malaria prevention and prophylactic treatment.

Appendix 8 113

3 GAP indicator under Grant 0450-VIE: Second Greater Mekong Sub-region Regional Communicable Diseases Control Project Regional Malaria and Other Communicable Disease Threats Trust Fund under the Health Financing Partnership Facility 4 Part 4.4 Communication on malaria prevention; Part 5. Specific tasks are performed in stages (Decision 4717/2014/QD-BYT on The National malaria control program 2015–2020) 5 Source: Annex table 21: General information of interviewers, Annex table 32: Characteristic of children to be test feces; and Annex table 35: Percentage of STH infection among

the children by gender (Loan 2699 PCR prepared by Government) 6 Source: Annex table 13: Percentage of health village workers was trained in 5 years and reports of Binh Duong and Dak Nong PPMUs in 2016 and 2017 7 Interview: Mr. Tran Kim Long - Vice manager of communicable diseases control, Vaccine and biological, Buon Don district health centre; Ms. Hoang Thi Hien - Staff, Dak Wil

commune health center, Cu Jut district, Dak Nong province, Mr. Phan Thanh Tinh - Director of the Cu Jut district health center, Ms. Nong Thi Hong Phuong, VHW, hamlet 6, Tan Hoa commune, Buon Don district, Dak Lak province and Ms. Nong Thi Tuyet and Tran Thi Lan Phuong- VHWs, Dak Wil commune health center, Cu Jut district, Dak Nong province

Targeted actions for reaching women included in the GMS annual joint review of national malaria policies and strategies

A3. Specific interventions for women are part of new national malaria policies and strategies3

Achieved: The National malaria control program (2015-2020) addressed the participation of Women Union in communication campaigns on malaria prevention and prophylactic treatment for pregnant women4.

Output 2: Improved CDC along Borders and Economic Corridors 2.1 To improve responsiveness of CDC to gender/ethnic issues in targeted districts/provinces

Collect, use and analyze sex-disaggregated data in community-based CDC assessments and plans

T4. All community-based assessments and plans use and analyze sex-disaggregated data

Achieved: Community based assessments have used and analyzed sex-disaggregated data such as baseline and end-line survey on result of interview on knowledge of communicable diseases and the children to be tested fences or STH infection financed by project5

Proactively train women as village health volunteers/ Workers

T5. At least 60% of female urban (and 40% of female rural) village health volunteers/workers trained.

Achieved: The project collected sex-disaggregated data on trained VHWs only, it did not disaggregate data on urban and rural sets. From 2011-2017, the project delivered training courses on CDC to 4,343 VHWs including 2,847 women (65.5%)6. All the female VHWs participated in the training courses on CDC7. 191 (80.9%) women out of 236 VHWs in Dak Nong and Dak Lak provinces participated in training courses on prevention and control of malaria.

Proactively outreach and target women in community-based CDC activities and campaigns using gender-sensitive IEC methods and materials

T6. At least half of newly selected village health volunteers/workers in districts are female

Achieved: The number of newly-recruited VHWs in the project districts was 599 VHWs including 357 female VHWs (59.6%).

114 Appendix 8

2.2. To increase the participation and awareness of women in CDC prevention in project locations

Where included in the community package, expand implementation of community-based deworming programs for women of reproductive age and preschool children

T7. Number of female participants in community-based CDC activities and campaigns increases 40%.

Achieved: The project supported the provinces to organize 31 courses on CDC communication for VHWs, WUs and volunteers in BBC of CDC with 801 participants including 431 women (53.8%). The project conducted 6,992 times of community’s awareness raising communication for local people to actively in CDC with 239,799 local people in the community including 141,585 women (60.7%).

Systematically include gender-specific issues into the training activities implemented by the Project

T8. At least 80% of women of reproductive age receive annual preventive anthelmintic treatment

Achieved: 852,326 (86.6%) out of 984,211 women of reproductive age in project districts received annual anthelmintic treatment

T9. At least 80% of preschool and school age girls and boys receive annual preventive anthelmintic treatment

Achieved: 392,509 (94.4%) out of 415,793 children of preschool (24-60 month of age) received annual preventive anthelmintic treatment

T10. All training activities include gender issues

Achieved: Under CPMU’s instructions, PPMUs integrated gender issues into training and workshop. Project conducted specific gender training courses (process and implementation of local HRD plans, gender awareness and GAP implementation) Gender issues integrated in some aspects of CDC training with priority given to women of reproductive age in the target population. For example: vaccination (measles, rubella, tetanus, etc.), promotion of public communication on worm infection in the community, periodic deworming, etc.

Appendix 8 115

8 GAP indicator under Grant 0450-VIE: Second Greater Mekong Subregion Regional Communicable Diseases Control Project Regional Malaria and Other Communicable Disease Threats Trust Fund under the Health Financing Partnership Facility

Integrate gender issues and targeted actions for women in joint action plans for malaria prevention and response in the border provinces.

A4. Recommendations to address at least 5 gender issues identified in the joint actions plan for malaria prevention and response in the border provinces.8

Achieved: PMUs identified actions plan for malaria prevention and response and acted upon 5 gender issues such as: (i) the proportion of women targeted for malaria prevention interventions, (ii) proportion of women especially pregnant women for early detection and prompt treatment, (iii) proportion of women given health education on malaria prevention, (iv) better access to healthcare services by improving health seeking behaviors, and (v) encouraging women adherence of malaria campaign for using interventions such as treatment and use of bed net.

Output 3: Integrated Project Management 3.1 To enhance the gender-awareness and responsiveness of CDC project

Tailor the GAP to national/provincial contexts

A5. National/provincial GAPs developed and implemented

Achieved: GAP were prepared and introduced to PPMUs. All CPMU and PPMUs implemented GAP related to their part.

Integrate gender-related activities and budget allocation in AOPs

T11. All AOPs include gender-related activities and budget allocations

Achieved: 100% PPMUs developed plans with budget allocations and implemented project activities following PMU’s instruction to meet project targets. Contents on GAP were included in CDC training programs and HRD plans included in AOPs.

Appoint gender representatives at PMU/PIU/SC

A6. Gender representatives at PMU/PIU/SC gender report on gender sensitive/GAP

Achieved: Each PPMU and CPMU assigned one gender focal point staff to monitor and report project GAP implementation progress.

Recruit a social development specialist to cover gender issues/GAP implementation

A7. Social development specialist employed

Achieved: Two gender consultants were recruited (01 international expert and 01 national expert). These experts developed gender and ethnic minority plan and guided project provinces in implementation

Gender sensitive/GAP training for project staff

T12. 100% of project staff receive gender sensitivity and GAP training

Achieved: From 2012 to 2015, the project conducted gender sensitivity and GAP training for all CPMU and PPMU staff (313 (100%) project staff including 92 women (29.4%).

Inclusion of gender issues in project

A8. Gender issues included in all Workshops

Achieved: PMU updated GAP annually in workshop on AOP and summary of implemented results. All GAP

116 Appendix 8

planning/management workshops.

activities were collected sex-disaggregated data and reported quarterly.

Promote women's participation in project management

T13. At least 30% of PMU/PIU officers are women

Achieved: Total of CPMU and PPMUs staff was 313 including 92 women (29.4%).

The project area located in the almost border provinces with the remote border districts, so few female staff who worked in the CDC in these provinces.

Appendix 9 117

SUMMARY OF ETHNIC GROUP PLAN RESULTS AND ACHIEVEMENTS

ETHNIC GROUP PLAN (EGP) MONITORING TABLE

Date of Update: 26 October 2018

Project Title: Second Greater Mekong Subregion Regional Communicable Diseases Control Project+AF Country: Cambodia Project No.: 41505-012 Type of Project (Loan/Grant/TA): Grant Approval and Timeline: 22 Nov 2010 Indigenous Category: B Mission Leader: Ms. Ye Xu Project Impact: Improved regional health security of the population in the Greater Mekong Subregion (GMS). Project Outcome: Timely and adequate control of communicable diseases likely to have a major impact on the region's public

health and economy. EGP focuses on 4 northeast provinces (Mondulkiri, Ratanakiri, Steung Treng, Kratie) and Preah Vihear province as part of additional

financing.

Ethnic Group Plan

(EGP Activities, Indicators and Targets, Timeframe and Responsibility)

Progress to date (as of December 2017)

(This should include information on period of actual implementation, ethnicity-disaggregated quantitative updates (e.g., number of participating minority group,

minority beneficiaries of services, etc.), and qualitative information. However, some would be on-going - so explain what has happened so far towards meeting the target.

Issues and Challenges

(Please include reasons why an activity was not fully implemented, or if




Output 1: Enhanced Regional Communicable Diseases Control Systems

1.1. To enhance the opportunities and contribution of ethnic groups in CDC systems

Activity Indicators Target

A1. Promote the increased involvement and training of ethnic

80% of ethnic groups surveillance and response staff trained at all levels

80% Achieved.

Cumulatively, up to Q4, 2017 there were 45 (100%) of total 45 ethnic groups CDC/malaria staff trained in CDC/malaria surveillance and response.

Preah Vihear province was included in 2016.

118 Appendix 9

Ethnic Group Plan










groups in CDC surveillance and response

Overall, 100% of ethnic groups CDC/Malaria staff have been trained by 2017.

Increased proportion of ethnic groups in newly recruited staff

Increased annually

Partially Achieved.

Overall, the annual proportion of newly ethnic group staff has increased over the project period. The total newly recruited staff in 4 northeast provinces and Preah Vihear between 2012 and 2016 was 45 and amongst those 4 were ethnic group staff (8%).

A2. Specific collection of data disaggregated by ethnicity in all surveillance forms and reporting document, as appropriate

All surveillance and response data is disaggregated by ethnicity, as appropriate

Partially Achieved. The outbreak investigation and response data forms are disaggregated by ethnicity. However, web-based CD surveillance system (Severe Acute Respiratory Infection (SRI), Influenza Like Illness (ILI) and malaria) only disaggregates data by sex.

The Cambodia Early Warning (EWARN) application developed for the mobile phone reporting does not allow disaggregating data as it assumes urgent communication/action on the outbreak investigation and response. The data, however, is further disaggregated later after RRT conducts investigation and response, including in the regular reporting system.

1.2 To improve attention to ethnic group issues in regional CDC systems


Appendix 9 119

Ethnic Group Plan










A3. Incorporate ethnic group-related issues into curriculum training modules, human resource development plans and cross-border activities

Ethnic groups issues reflected in CDC training curriculum, HRD plan, and cross-border activities

Yes Achieved.

A checklist to ensure EG content in workshop and technical training is developed and introduced to IAs in Q1 2017, and they are using it when appropriate.

The ethnic group issues have been discussed during the 3 cross border collaboration activities held in Preah Vihear, Rattanakiri, Stung Treng provinces with the prevalent IP and EG population.

HRD plans include the actions aimed at enhancing communications skills and capacity building of the ethnic group staff to ensure increase in number of EG staff at higher levels.

A4. Include discussion on ethnic groups in regional malaria technical and regional workshops

Achieved.

The Regional Malaria Technical Forum in 2016 covered discussion on mobile population, ethnicity and other vulnerability factors.

Output 2: Improve CDC along Borders and Economic Corridors

2.1 To improve assessment and analysis of CDC for ethnic groups in targeted provinces


A5. Collect and analyze data disaggregated by ethnicity in community-based CDC assessments and plans

All community-based assessments and plans include data disaggregated by ethnicity

100% Achieved. The Project reached the target. 100% of the community-based assessments and plans collect data disaggregated by sex, ethnicity, and gender. Specific gender and IP data collection forms developed and introduced to all PIAs for completion. Demographic assessments between 2013 and 2014 for 180 MHVs used and analyzed sex and ethnicity disaggregated data. In 2014, MHV based line survey collected with sex and ethnicity disaggregation data.

120 Appendix 9

Ethnic Group Plan










The project post evaluation survey conducted in Q3-2017 includes ethnicity-disaggregated data.

A6. Proactive increase the participation and train of ethnic groups people as village health volunteers/workers

At least 30% of village health volunteers/workers are from ethnic groups, where appropriate.

30% Achieved. The total 2,062 village health workers (1,730 in 4 NE and 332 in Preah Vihear) in all the Project target provinces (4 NE Provinces and Preah Vihear), 927 (45%) were from ethnic groups. Hence, the Project exceeds its targets for this indicator

Ethnic Group Village Health Workers in Ratanakiri, Kratie, Stung Treng, Mondulkiri and Preah Vihear

Year (1) Total

(2) Ethnic Group

(3) Percentage (3= 2 x 100/3)

2012 1,406 752 53%

2013 1,598 871 55%

2014 1,708 884 52%

2015 1,730 913 53%

2016 1,730 913 53%

2017 2,062 927 45%

Source: Project Data Collection Form of each project province 2011- 2017

2.2 To increase participation and awareness of ethnic groups people in CDC prevention in project locations


A7. Proactively outreach and target underserved ethnic groups people in

At least 50% of ethnic groups people participate in

50% Achieved.

Appendix 9 121

Ethnic Group Plan










community-based CDC activities and campaigns using culturally appropriate IEC methods and materials

community based-CDC activities and campaigns

In the selected villages for the community-based CDC activities within the Project target provinces 100% of village management group members were from ethnic groups. In 2017, 83 IP village management group members and villagers participated in the outreach and health education of village health workers on community-based CDC and malaria conducted in Ratanakiri and Mondulkiri. This made 75% of the total number of participants – 110. In 2016, 277 persons participated in community based-CDC activities in northeast provinces and among those 135 (49%) were from ethnic groups.

A8. Expand implementation of community-based deworming programs for women of reproductive age and preschool children

At least 50% of ethnic groups women of reproductive age receive preventive antihelmentic treatment every year

50% Information Not Available. The deworming program support has covered 2012-2014 therefore the indicator is measure and reported last in 2014: (i) Praziquantel distribution covered 86.87% of the population in Kratie and 88.10% population in Stung Treng provinces in the Schistosomiasis endemic areas (ii) Mebendazole distribution in the same provinces covered 77% child-bearing age women (only one round has been conducted)

The Helminth Control Program has been implemented by the National Malaria Center (CNM) but its Mass Drug Administration (MDA) data is not disaggregated by ethnicity.

At least 70% of preschool and school ethnic group girls and boys receive preventive antihelmentic treatment every year.

70% Information Not Available. In 2014 in project provinces, Pre-school: 95.3%, School-aged: 96.0% (M:47.3%, F:52.7%). Data source: Health Management Information System of DPHI Project stop supporting since Q4 – 2014. No disaggregation of report by ethnicity in health information system. However, the coverage of mass drug administration is high at IP populated provinces.

122 Appendix 9

Ethnic Group Plan










A9. Ethnic community health workers and volunteers trained in malaria prevention and treatment

At least 2 volunteers/health workers from ethnic groups are trained on malaria prevention and treatment in every ethnic village covered by the project

Yes Partially Achieved. The malaria prevention and treatment activity has been included as part of Additional Financing and started in 2016 focusing on 1 province – Preah Vihear. Training in malaria treatment and prevention started in 2017. 14 Village Malaria Worker (VMW) from ethnic group in 27 villages received training on malaria treatment and prevention in Preah Vihear Province.

Output 3: Integrated Project Management

3.1 To enhance the awareness and responsiveness of CDC project management to ethnic group issues


A10. Tailor of EGP to national/provincial contexts, as appropriate.

National/provincial EGPs developed and implemented

Yes Achieved. EGP 2012-2015 is developed and approved by MOH on 4 January 2013 and implemented. Project updated EGP and its indicators are clearly defined. The updated EGP covered 2016-2017 covering additional Project scope. There is no provincial EGP, however, provincial AOPs incorporate all the activities related to EG.

A11. Integration of ethnic group-related activities and budget allocation in AOPs

All AOPs include ethnic group-related activities and budget allocations

100% Achieved.

2012: only PCU had budget for Gender and IP

2013: PCU, CDCD, 3 provinces (Mondulkiri, Ratanakiri Stung Treng)

2014: PCU, CDCD, and all 4 provinces.

2016: Only PVH

2017: PCU, 5 provinces.

Appendix 9 123

Ethnic Group Plan










The project has ensured the project provinces allocate budget for gender and ethnic group activities. In 2017 AOP, 5 targeted provinces (Preah Vihear, Rattanakiri, Mondulkiri, Stung Treng, Kratie) allocated budget for gender and ethnic group activities, and PCU also allocated budget for its AOP to disseminate the updated Ethnic Groups Plan (EGP) and Gender Action Plan (GAP) to all provincial and national project implementing agencies. In addition, the AOPs for each of the 5 provinces have been reviewed and where an activity showed cooperation with another agency such as the PCU, CDCD or CNM, the corresponding AOP for each institution was reviewed to ensure that the activity and the intended cooperation was included in both the host and the cooperating agent’s AOP.

A12. Appointment of representatives for ethnic group issues in PMU/PIU and on Steering Committee

PMU/PIU/SC representatives report on ethnic group issues and EGP

Yes Achieved. Provincial and National IP/Gender focal points have been appointed and trained in all 12 project provinces. Currently, the project has 17 Gender and IP focal point and amongst those 7 are women. Ethnic group issues and EGP implementation progress has been reported by IP/Gender focal points through quarterly reports, workshops, RSC meetings and supervision checklists.

Further capacity building and mentoring is needed to improve quality of reports and enhance understanding of focal points roles.

A13. Recruitment of a project social development specialist to cover ethnic group issues and oversee EGP implementation.

Social development specialist employed

Yes Achieved. In 2016, one social development expert and one national social development specialist were recruited. They are on board in 2017, finished contract by June 2017.

A14. Train project staff on the implementation of EGP

100% of project staff receive EGP training

100%

Achieved. In 2012 81 persons (100% project staff) have been trained on EGP. All the project staff has also been trained on EGP during the annual workshop in January 2017 as part of the additional scope for the Project. A workshop on EGP/GAP was conducted on 21 December 2012 by PCU with 81 participants (15F) from CDCD, CNM, PCU, PIAs, and GMAG for the first EGP/GAP workshop of the GMS-CDC2 Project in Cambodia. EGP’s activities and indicators were well received by project staff. In Q4, 2013, CDCD have organize a workshop to disseminate the EGP and GAP and its monitoring tools to project staff with 59

124 Appendix 9

Ethnic Group Plan










participants and among those 18 are women. In 2017 a new training module for EG awareness and sensitivity has been prepared and be rolled out in May 2017. The EG awareness and sensitivity training is integrated in Gender training to Gender and EG Focal points in early June 2017. Cumulatively, 100% of project staff 139/139 (32F) trained on EGP.

A15. Inclusion of ethnic group issues in project planning and management workshops and meeting

ethnic group issues included in all workshops

Yes Achieved. Before 2017, Gender and EG issues included in most of the workshops For Q1, Q2 and Q3, 2017: EGP is integrated in annual workshop which organized by PCU to disseminate the contents, aims, objectives, outputs and activities under the updated EGP, and M&E data needs for updating the EGP progress against its indicators. The IP issues are raised in the workshops to ensure that critical challenges are addressed and lessons learnt to improve EG focused activities in future. These issues include longer time requirement to collect IP disaggregated data, language barrier to be considered for IEC and training/workshops preparation, sensitivity (belief, culture etc.) to be factored in when health service is provided to the EG/IP communities; remoteness of IP prevalent areas from health facilities. IP issues raised in the speech of Project Director in the Regional project review workshop 2016 and 6th Regional Steering Committee meeting, December 2016. In 2017 PCU also carried out field coaching to support IP and gender focal points in 5 provinces (Preah Vihear, Stung Treng, Kratie, Ratanakiri, and Mondulkiri), it instructed provincial staff to allocate budget for gender and ethnic group (EP) activities or issues in their future AOPs, and management workshops or meetings. Consultative workshop in October 2017 on lesson learnt from malaria elimination has discussed IP contribution towards achieving targets.

A16. Promote ethnic group participation in project management

At least 1 staff member per PIU is from an ethnic group, where appropriate

Yes Partially Achieved. There are 4 PIUs under the project. To date number of IP/EG PIU staff made only 2 PIU has 2 EG member (They are working at hospital in Ratanakiri and Mondul Kiri).

Appendix 9 125

ACHIEVEMENT ON ETHNIC GROUP PLAN IMPLEMENTATION (LAO PDR)

Ethnic Groups Plan (EGP) Activities,

Indicators and Targets

Achievements

Remarks

1. Output 1: Enhanced regional CDC systems

1.1 EGP Specific objective: To enhance the opportunities and contribution of ethnic groups in CDC systems

1.1.1 80% of ethnic group surveillance and response staff are trained at all levels

Staff Total EG % EG % EG trained Staff

trained

CDC 2796 645 23.1% 479 74.2% Prov Lab 40 7 17.5% 7 100% Dist Lab 180 24 13.3% 19 63.6% Dengue 78 10 12.8% 9 90% NTD 84 11 13.1% 7 78% S&R Prov 51 9 17.6% 7 78% S&R Dist 189 59 31.2% 51 86.4% Total S&R 240 68 28.3% 58 85% HC 2174 525 24.1% 379 72% VHW 6408 3564 55.6% 1481 41.5%

Source: Provincial Training and Gender Survey 2017

Achieved Overall, high levels of EG staff are trained in project areas. Targets for S&R staff achieved – 85% trained at provincial and district levels (58/68)

1.1.2 Increased proportion of ethnic groups in newly recruited staff.

2014 2016

No EG % No EG %

Lab Prov 13/69 19% 7/40 17.5% Dist 25/148 17% 24/180 13.3% Dengue 20/80 25% 10/78 12.8% S&R Prov 12/59 20% 9/51 17.6% Dist 39/182 21.3% 59/189 31.2% NTD 14/29 48% 11/84 13.1% HC 273/846 32.3% 525/2174 24.1% VHW 667/2199 30.4% 3564/6408 46.5%

Staff Total EG % EG trained % Prov 253 37 14.6% 30 81.8% Dist 369 83 22.5% 70 84% Total 622 120 19.3% 100 83.3%

Achieved Excluding VHWs: 396 EGs in 2014 645 EGs in 2016 Estimate of new EGs in 2016: (645-396) =252 252/396*100=63% 63% relative increase in the number of newly recruited indigenous CDC staff. (Note: this number is based on the project’s Provincial Training and Gender Survey 2017 and is higher than overall government statistics on

126 Appendix 9



Achievements

Remarks


health staff recruitment 2014 and 2016, which is much lower: 41% in 2014 and only 19% in 2016 due to budget in cut in new staff recruitment) EG trained staff numbers are high in provincial and district staff

1.2 EGDP Specific objective: To improve attention to indigenous people issues in regional CDC system

1.2.1 All surveillance and response data is disaggregated by ethnicity, as appropriate.

100% of S&R data is disaggregated by gender and also by ethnicity.

Source: Monthly reports on outbreaks and notifiable disease cases

Achieved EG and ethnic status reported

1.2.2 EG issues reflected in CDC training curriculum, HRD plans, and cross-border activities

EG issues addressed in CDC and MHV training curriculum and cross-border activities. Where ethnic group language was identified as an issue, ethnic groups interpreters, mostly ethnic groups health staff, were used as a communication tool. Source: AOPs submitted to the project

Achieved EG issues emphasized in provincial plans and activities


2.1 EGDP Specific objective: To improve the assessments and analysis of CDC for EG in targeted provinces

2.1.1 All community based CDC assessments and plans include data disaggregated by ethnicity

Household surveys assessed EG needs separately and data were reported back to provinces for specific actions. Regular surveillance (outbreaks) data includes ethnicity Source: Project Household Surveys and EG Research Study.

Achieved See EG research report

2.1.2 At least 30% of VHWs from ethnic groups

Project targets remote and ethnic populations, so most district and villages have significant ethnic populations. Culture/ethnic sensitivity has been incorporated in the project planning and implementation Visualized CDC communication material and verbal ethnic groups languages were used as a mean of communication and training

Total EG VHWs 3564/Total VHWs 6408. 55.6% of VHWs are EG


Achieved

In 35 districts, there are 350 target villages. 158 are 100% EG (and 35 more are >70% ethnic). Names of villages in each district, with EG status, as xiii in dossier

Appendix 9 127



Achievements

Remarks

2.2 EGDP Specific objective: To increase the participation and awareness of EG people in CDC prevention in project locations

2.2.1. At least 50% of EG people participate in targeted community-based CDC activities and campaigns.

2014 EG

% 2017 EG %

Community Events

113/646 17.6% 3156/4550 69.4%

VMG Events 124/342 36.3% 1087/3341 32.5%

Community event, health campaigns were conducted by the provinces and districts. Source: Provincial Training and Gender Surveys 2014/17

Achieved Significant increases in EG numbers at community-based events. For community-based events in the survey combined (7891 participants), 4243 were EG – 53.7%

2.2.2 At least 50% of EG women of reproductive age get preventive antihelmentic treatment every year.

EG women dewormed in previous 12 months 2014 – 35.5% 2016 – 44.6% Source: Household Surveys - 2014 and 2016

Although increases in deworming in EG women, there are still significant gaps in anti-helminth treatments

2.2.3 At least 70% of pre-school and school EG girls and boys get annual preventive antihelmentic treatment

EG children under 5 dewormed in previous 12 months 2014 – 45.9% 2016 – 51.8% Source: Household Surveys - 2014 and 2016

Mass community deworming, including deworming in schools, is done annually by provincial malaria stations and supported by the CDC2 project. Although deworming increased since 2014, there are still gaps in treatment and provision of MDA

2.2.4 At least 2 VHWs from EGs trained on malaria prevention and treatment in every EG village covered by the project

843 EG VHWs in 198 villages were trained in malaria. Not possible to identify numbers at the village level, but the high prevalence provinces of Saravanh, Attapeu and Sekong all achieved the target. 7/11 provinces achieved the VHW malaria training targets Source: Project research on VHWs (x and xii in dossier refers)

Partially achieved

Three provinces (Phongsali, Champasack, Khammoune) did not achieve the target. 396 malaria trained VHWs was the target and 843 VHWs were trained. 165/198 villages have malaria trained VHWs – xiv in dossier refers

Output 3: Integrated project management

3.1 EGDP Specific objective: To enhance the awareness and responsiveness of CDC project management indigenous people’s issues

128 Appendix 9



Achievements

Remarks

3.1.1 National/ provincial Ethnic Groups Plan (EGP) developed and implemented.

Project EG research reached a number of conclusions about improving access and service provision to EG communities and suggested potential measures that could be incorporated in a future national plan

National EG Action Plan requires consent and support of Lao PDR government and cannot be undertaken solely by the CDC II project.

Refer to EG assessment for more information

3.1.2 All AOPs include EG related activities, corresponding budget allocations

AOPs include EG activities.

Source: AOPs submitted to the project

Achieved

EG issues emphasized in provincial plans and activities

3.1.3 PMU /PIU/SC representatives report on EG issues and EGP

EG research data disseminated and regular updates on EGAP are addressed in quarterly reports

Source: Project quarterly reports

Achieved 2016 household survey

results and competency report with EG issues and EG-disaggregated data shared with provincial health departments. Used to inform PHDs to address gaps, access issues, concerns and service provision.

3.1.4 Gender/EG focal point persons in national and provincial implementing agencies officially appointed and functioning

EG focal points established in all provinces (at provincial and district levels).

Source: Reports from provinces

Achieved. Of the 130 EG focal

points, 44% are female and 28% are EG

3.1.5 Social development specialist employed

Specialist engaged intermittently since November 2012. Achieved.

Gender specialist covers social development and EG issues.

3.1.6 100% of project staff

28,000 staff in 12 provinces and centrally received training under the project and much of the training covered EGP issues, but not all project staff had specific training on EGP or EG concerns

Partially achieved

Prov Total Female Ethnic

PSL 13 7 13 LNT 9 4 6 BK 9 3 3 ODX 11 2 4 HP 9 7 4 XK 9 5 3 BLK 8 5 0 KM 12 0 0 CPS 11 7 0 SRV 15 4 0 SK 14 7 3 ATT 10 6 0 Total 130 57 36

Appendix 9 129



Achievements

Remarks

rece7ives EGP training

3.1.7 EGP orientation on implementation conducted to PCU/NIAs/PIAs

EGP orientation provided to PMU managers and provincial trainers April 2013. EG training conducted for central staff in March 2014 (40/43 female)

EG training conducted in all 12 provinces from March-August 2014 (223/301 female and 64 ethnic staff)

EG training for Health Centre staff conducted in all 12 provinces from June-Dec 2016 (135/230 female and 83 ethnic staff)

Source: Training reports and reports from provinces

Partially achieved Note: These training

have lower number of EG due to the fact that most of the government staff belong to the main Lao ethnic and therefore, although the number of the ethnic groups is low, but the percentage is high. For instance, at the central level, because there is only one staff belong to an ethnic group, the percentage of EG joined the training is 100%.

3.1.8 ethnic groups’ issues included in all workshops

EG issues reviewed in management workshops, meetings

Source: Workshop reports

Achieved

EG issues emphasized in provincial training activities

3.1.9 At least 1 staff member per PIU is from an ethnic group

All PPMUs have EG representation. EGs represent 26% (22/85) of total PMU staff in provinces.


Achieved

130 Appendix 9

RESULTS ON ETHNIC GROUPS PLAN IMPLEMENTATION 2011– 2017 (VIET NAM) (based on 16 border provinces with high density of minority ethnic groups)

Project Outputs/ Gender and Ethnic-specific Objective

Gender and Ethnic Design Features/Activities


Implementation status Data source

Output 1: Enhanced Regional communicable Diseases Control Systems 1.1. To enhance the opportunities and contribution of ethnic groups staff in CDC systems 1.2 To improve ethnic groups analysis in regional CDC systems

Promote the increased training of ethnic groups in CDC surveillance and response

Specific collection of data-disaggregated by ethnicity in all surveillance forms and reporting Documentation

Incorporate ethnic group-related content into curriculum training modules, human resource

80% of ethnic groups surveillance and response staff trained at all levels

Increase proportion of ethnic groups in newly recruited staff

All surveillance

and response data is disaggregated by ethnicity, as appropriate

Total EG staff Trained

EG staff Note

2011 6,369 985 155 16 border provinces

2012 6,405 952 239

2013 6,466 920 300

2014 6,600 1,053 217

2015 7,189 945 238

2016 185 18 9 PPMU Dak Nong

6/2017 185 26 19

2016 284 24 9 PPMU Binh Phuoc

6/2017 284 24 2

Partly achieved

Priority is given to ethnic minorities and females, but the selection also depends on the selection criteria in terms of staff expertise. - In 2011, 60 ethnic groups people in 289 newly recruited

staff (20.8%). - In 2012, 60 ethnic groups people in 337 newly recruited




staff (26.0%) - In 2016 -6/2017:

+ Dak Nong: 2016: 0

Provincial report Provincial report

Appendix 9 131





development plans and cross-border activities

Ethnic group issues reflected in CDC training curriculum, HRD plans cross-border activities

In June 2017: All three newly recruited staff were ethnic groups people (100.0%)

+ Binh Phuoc: 2016: 0 In June 2017: 0

Achieved. Data disaggregated by ethnicity on infected cases/death is not

classified according to Circular No. 48/2010/TT-BYT guiding the declaration, information and reporting of communicable disease (valid until 30 June 2016). Circular 54/2015/TT-BYT (effective since 1 July 2016), data reported on infectious disease must be ethnic - disaggregated (applied for both Report of case and Report of outbreak) The provinces have started to report data disaggregated by ethnicity based on Circular 54.

Partially achieved: 100% PPMUs developed ethnic minority

plan integrating with major activities such as training, workshop, communication, etc. However, ethnicity contents are not especially reflected in CDC training curriculum, HRD plans cross-border activities

Provincial report CDs surveillance and management system Provincial report

Output 2: Improved CDC along Borders and Economic Corridors 2.1 To improve responsiveness of CDC to ethnic groups issues in targeted districts/provinces 2.2. To increase the participation and awareness of ethnic groups in CDC prevention in project locations

Collect, and analyze disaggregated by ethnicity in community based CDC assessments and plans

Proactively increase the participation and training of ethnic groups people as village

health volunteers/ Workers Proactively outreach and target ethnic groups in community-based CDC activities and campaigns, using culturally appropriate IEC methods and materials

All community based CDC assessments and plans include data disaggregated by ethnicity

Partly achieved: Some main community-based CDC assessments have used and analyzed ethnic-disaggregated data such as project baseline surveys and researches on CDC financed by project. However, used data just show primary results, it would be analyzed more. These surveys data included ethnic-disaggregated data. In 2014: survey and communication to prevent helminths among populations in Quang Binh, Quang Tri, Dak Lak, Dak Nong, Thanh Hoa, Lao Cai, Tay Ninh, Long An, Hau Giang, Soc Trang In 2015, survey and communication to prevent Fascioliasis and worm infection in population of 08 provinces of Quang Binh, Quang Tri, Quang Nam, Quang Ngai, Phu Yen, Khanh Hoa, Dak Lak, Dak Nong

PMU report Survey results

Provincial report

132 Appendix 9





Expand implementation of

community-based deworming programs for women of reproductive age and preschool children

At least 30% of village health volunteers /workers are from ethnic groups, where appropriate1

At least 50% of

ethnic groups people participate in community-based CDC activities and campaigns

At least 50% of ethnic groups women of reproductive age receive preventive antihelmentic treatment every year

At least 70% of

preschool and

Total VHW

EG staff % Note

2011 13,228 2,746 20.8 16 border provinces

2012 13,390 2,834 21.1

2013 13,247 2,751 20.8

2014 13,358 2,792 20.9

2015 13,457 3,493 26.0

2016 760 149 19.6 08 districts of Binh Phuoc and Dak Nong 2017 760 149 19.6

Data for this indicator is not available: Many communication

campaigns at provincial, district and commune levels conducted under CDC2 project funding, but it is unable to disaggregate data by ethnicity

Data for this indicator is not available: From 2011 to 2015,

16/16 PPMUs have over 90% of women of reproductive age reached with MDA for common helminthiasis (2,363,163 women of reproductive age). However, PMU were not able to collect ethnicity-disaggregated data.

Data for this indicator is not available: From 2011 to 2015, 7/16 PPMUs got over 90% of pre-school children in targeted districts reached with MDA for common helminthiasis (Son La, Quang Tri, Quang Binh, Dac Lac, Long An, Dong Thap, An

Provincial report

Provincial report

Provincial report

1 Specific numerical targets may have to be adjusted for national contexts depending on baselines.

Appendix 9 133





Ethic community health workers and volunteers are trained in malaria prevention and treatment

school ethnic group girls and boys receive preventive anthelmintic treatment every year

At least 2 volunteers/health workers from ethnic groups are trained on malaria prevention and treatment in every ethic village covered by the project

Giang). There were 572,919 children dewormed. However, PMU were not able to collect ethnicity-disaggregated data

Total VHWs trained

EG

2016 Binh Phuoc 102 15

Dak Nong 134 21

6/2017 Binh Phuoc 96 21

Dak Nong 132 25

Output 3: Integrated Project Management 3.1 To enhance the ethnic groups -awareness and responsiveness of CDC project management

Tailoring of EGP to national/provincial contexts as appropriate Integration of ethnic group related activities and budget allocation in AOPs Appointment of representatives for ethnic group issues in PMU/PIU and on Steering Committee Recruitment of a project social development specialist to cover ethnic issues and oversee EGP implementation

National/provincial EGPs developed and implemented All AOPs include ethnic group -related activities and corresponding budget allocations PMU/PIU/SC representatives report on ethnic group issues and EGP Social development specialist employed.

Achieved. EGP was introduced to PPMUs (oriented) and implemented in PMU and PPMUs. Achieved. Organized annual meetings on HRD plan for Ethnic groups in 20 PPMUs (19.200 USD) to emphasize the importance of integrating G&E with all project activities. PMU provides instructions to PPMUs to include EM target in AOPs. Achieved. Assigned staff at PMU/PPMUs acting as focal point for gender and minority ethnic groups. PPMUs’ focal points submit reports to PMU. Achieved: Two gender consultants (int’l and national) were recruited. The consultants developed a gender and ethnic minority group plan. Partially Achieved

PMU/PPMUs report PMU/PPMUs report PMU/PPMUs report PMU report PMU report

134 Appendix 9





Train project staff on the implementation of EGP Inclusion of ethnic group issues in project planning and management workshops and meetings Promote ethnic group participation in project management

100% of project staff receive EGP training Ethnic group issues included in all workshops At least have one person of PMU/PIU officers are EM

Training of trainers on EGP in June 2012 for 16 people. These trainers and a national specialist then cascaded training to 130 of 320 staff from PMU, 20 PPMUs, 4 IHEs, 3 IMPEs. In 2015, PMU in collaboration with VRM to train on gender, minority/gender action plan for 30 out of 277 project staff from PMU and 20 PPMUs (including focal points for gender and EG issues in 20 PPMUs). The focal point then organized training sessions for 210 staff at the local level. PMU provided guidelines on the implementation of activities for the development of ethnic minority plan in July 2015. Achieved. There aren’t EGP specific workshops, however there are specific workshop on combined gender and ethnic groups (GEGAP) Achieved: - 2011 – 2015: 6 EM staff out of 266 project staff - 2016 – 2017: 1 EM staff out of 52 project staff

PMU/PPMUs report PMU/PPMUs report

Appendix 10 135

STATUS OF COMPLIANCE WITH LOAN AND GRANT COVENANTS

G0231/G0448-CAM Grant Agreements

Covenant Reference in

the Grant Agreement

Status of Compliance

G0231-CAM Grant Agreement: 1. Implementation Arrangements The Recipient, through MOH, shall ensure that the Project is implemented in accordance with the detailed arrangements set forth in the PAM. Any subsequent change to the PAM shall become effective only after approval of such change by the MOH and ADB. In the event of any discrepancy between the PAM and this Grant Agreement, the provisions of this Grant Agreement shall prevail.

Schedule 4, para. 1

Complied The Communicable Diseases Control Department (CDCD) in MOH is the coordinating Implementing Agency (IA). The existing CDC2 Project Management Unit (PMU) is the coordinating IA and will continue the day-to-day project implementation. The National Center for Parasitology, Entomology, and Malaria Control (CNM) and 12 provincial health departments will continue to serve as IAs. The project revised organization structure incorporating additional financing implementation arrangement. It has been approved by MOH on 24 June 2016 and disseminated to ADB and to all project IAs of national and provincial level. The EA proposed to submit quarterly progress report on 15th of May, Aug, Nov of the year, and 15th of Feb of the following year, respectively for Q1, Q2, Q3 and Q4 progress reports. The Q4 progress report is incorporated in the Annual Project Report. This will permit sufficient time for full financial acquittal, endorsement of project accounts and financial reports across 11 sub-accounts for CNM and 10 provinces under grant 0231. While under G0448 additional financing there are 13 sub-accounts for CNM and 12 provinces. Project technical reports continues to improve the quality with a revised Project Performance Monitoring Evaluation System (PPMES). The EA discussed during ADB grant review mission/ midterm review, to align frequency of project progress report submission with MOH reporting frequency and timing.

2. National Focal Point for CDC Within 1 year of the Effective Date, the Recipient, through MOH, shall strengthen, on a sustainable basis within the premises of MOH, a regional focal point for CDC. Such regional focal point shall (i) comprise at least 1 full-time officer assigned by MOH, and (ii) be responsible for coordinating (a) regional disease reporting and coordination of outbreak control; (b) regional knowledge management, workshops, and training activities; and (c) regional epidemiological investigation.

Schedule 4, para. 2

Complied The MOH confirmed the CDCD directorate as National Focal Point (FP) for Regional Cooperation in CDC, within one year of Grant effectiveness, including with Terms of Reference. The MOH re-nominated National International Health Regulation (IHR) Focal Points on 19 June 2014 with new contact detail. That National IHR Focal Point is represented by Dr. Ly Sovann, CDCD Director and 2 alternates, Dr. Bun Sreng, Deputy-Director, CDCD and Dr. Teng Srey, Deputy-Director, CDCD. The CDCD Directorate also functions as the National IHR Focal Point under the IHR Secretariat of the World Health Organization. In addition to the National IHR FP above mentioned, on 13 October 2016,10 (ten) provincial Focal Points for Public Health Events information sharing were appointed by respective Provincial Health Department

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following nominative list as stated in the final version of Regional SOPs for Joint Outbreak Investigation and Response. Focal Points for Cross-border Cooperation and for Knowledge Management were appointed by MOH on 01 July 2013. Two Expert Information Sharing Group were nominated on 8 November 2016.

3. Regional Cooperation in CDC The Recipient, through MOH, shall realign and implement its own strategies for disease control and cooperation/coordination with neighbouring countries based on WHO regional disease control strategies for emerging and neglected diseases. The Recipient, through MOH, shall further ensure that any information regarding CDC will be exchanged with neighbouring countries in a smooth and timely manner through MOH’s regional focal point.

Schedule 4, para. 3

Complied The MOH strategies for disease control and cooperation and coordination with neighbouring countries are firmly based on the Asia Pacific Strategy for Emerging Diseases (APSED, 2010) and aligned with WHO regional control strategies for NTDs, and the International Health Regulations (IHR, 2005). MOH has made progress in regional cooperation in terms of having a focal point for regional coordination of outbreak reporting and response, an EOC (Emergency Operating Centre) room with training facilities and video conferencing facilities, technical exchanges, information exchanges on outbreaks with neighboring country’s focal points, and support for incidental outbreak investigation. MOH committed to conduct more regular information exchanges with other focal points and conduct and participate in simulation exercises for surveillance and response to communicable diseases among countries in GMS. MOH agreed to accelerate rolling out IHR/APSED, and examine ways for improving dengue control, NTDs control, and laboratory services based on WHO strategic frameworks and advised of experts. As of 30 June 2017: Regional workshops: CAM organized 12 workshops (5 in 2016 and 2 in 2017 including CLV Expert meeting) and participated in 25 workshops organized by Viet Nam, Lao PDR and ADB; In 2017, Cambodia organized (i) One Health Approach Regional Workshop on 30–31 March 2017 at Siem Reap and (ii) on Joint simulation exercise TOT on 4-5 December 2017 and Siem Reap. Cambodia participated in (i) Regional Workshop on Malaria control on MMP at border areas on 2–3 March 2017 in Dalat, (ii) Regional Joint Cross-border Table Top Exercise on Surveillance and response to Avian Influenza between border provinces of Cambodia, Lao PDR and Viet Nam on 10–11 May 2017 at Hue city, Viet Nam, (iii) Regional workshop on Malaria Orienting Health System towards effective control and elimination of malaria in the GMS on 28–30 June 2017 in Vientiane, Lao PDR, (iv) on GMS Workshop launching of Health Security Project organized by the

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Asian Development Bank on July 4–7, 2017 in Bangkok, Thailand. Cross-border collaboration activities: - CAM organized 5 meetings (1 in 2014, 1 in 2016

and 3 in 2017);

- CAM participated in 8 cross-border meetings (4 in

2014, 2 in 2016 and 2 in 2017) organized by Viet

Nam and Lao PDR.

SOP for Joint Cross-Border Outbreak Investigation and Response was endorsed. Communicable diseases data information sharing of cluster provinces had been regularly shared by respective cluster provinces to neighboring border provinces of Lao PDR and Viet Nam, and informed the Regional Coordination Unit.

4. Mainstreaming the Project in the Provincial Annual Operational Plan and Budget The Provincial Health Department of each Project province shall submit to MOH the provincial annual operational plans and budgets for the health sector, including the annual provincial work plans for the Project as part of the overall provincial annual operational plan and budget, all based on a format agreed to by the concerned parties, as a basis for allocating funds and monitoring performance, and MOH shall inform to ADB the approval of such annual plans. In particular, the provincial annual operational plans for the health sector shall include plans and budgets for in-service training activities for CDC, cross-border cooperation, reaching remote communities with CDC, and implementation of gender and ethnic group plans under the Project

Schedule 4, para. 4

Complied The CDC2 and CDC2 AF AOP 2016 and 2017 showed more priority for increasing benefits for peripheral staff and the poor, gender and indigenous people, including roll out and monitoring of model healthy villages. The project AOP 2016 and 2017 has been prepared in accordance to MOH’s planning cycle and guideline, project priority activities, and endorsed by Health Sector Steering Committee. The CDC2 and CDC2 AF AOP has to be consistent in terms of budget and planned activities reflected in the MOH sector AOP. The project has ensured the project provinces allocate budget for gender and indigenous population (IP) activities. In 2017 AOP, there were 5 targeted provinces (Preah Vihear, Ratanakiri, Mondulkiri, Stung Treng, Kratie) allocated budget for gender and IP activities, and PCU also allocated budget into its AOP to disseminate the updated the Gender Action Plan (GAP) and Ethnic Groups Plan (EGP) to all provincial and national project implementing agencies. AOP budget reflected in both hosted and participated agencies.

5. Environment The Recipient shall ensure that health facility waste management in health facilities supported under the Project is carried out as per health care waste management guidelines developed by WHO, and that adequate budget, training, and supplies are provided under the Project to do so.

Schedule 4, para. 5

Not applicable

The project is category C for environmental safeguard. The project did not directly support building, renovation, or solid waste management systems in commune health stations or district hospitals. It has supported lab equipment and materials in provincial hospitals and latrine materials in the model villages. Therefore, in multiple review missions, ADB team and government counterpart concluded this provision is not applicable. In each country, however, all health facilities must comply with regulations of the Ministry of Health on medical waste management.

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6. Involuntary Resettlement The Recipient shall ensure that any of the Project activities do not involve any involuntary resettlement. In the event, however, that any involuntary resettlement impacts are unavoidable, the Recipient, through MOH, shall (i) prepare a resettlement plan for such activity in accordance with the agreed land acquisition and resettlement framework under the Project and ADB’s Safeguard Policy Statement (2009); (ii) ensure that such resettlement plans are prepared on the basis of the detailed technical design, disclosed to affected persons, and submitted to ADB for review and approval; and (iii) ensure that all compensation and rehabilitation assistance is paid before dispossession of assets.

Schedule 4, para. 6

Not applicable No resettlement issues arose.

7. Gender and Development The Recipient through, through MOH, shall ensure that the Gender Action Plan agreed for the Project is fully implemented and in accordance with ADB’s Gender and Development Policy (1998). In particular, MOH shall (a) use training and outcome targets for women in project-supported activities; (b) cause the Project provinces to include specific gender-related activities in the respective provincial annual operation plans and budgets; (c) recruit a social development specialist with terms of reference that include responsibility for integrating gender issues across project activities; (d) include provisions for addressing gender issues in all guidelines, terms of reference, strategies and plans developed under the Project; and (e) Disaggregate all monitoring and evaluation data by sex.

Schedule 4, para. 7

Complied. (a) Training on “Gender mainstreaming into health

sectors” conducted for CDC staffs and all targets for women project staff and participation were integrated into project activities. Gender road map was developed to guide the implementation.

(b) All AOPs included gender actions and targets in GAP. A total amount of $342,691 was allocated for gender activities.

(c) Gender specialist was intermittently mobilized between 2013 and 2017 to implement GAP.

(d) Cambodia Malaria Elimination Action Framework

(MEAF) 2016-2020 developed under project support included special provisions for women and children.

(e) All data on M&E and in the CDC database are age

and sex-disaggregated. 8. Ethnic Groups The Recipient through, through MOH, shall ensure that the Ethnic Group Plan agreed for the Project is fully implemented and that all Project activities are mainstreamed in the

Schedule 4, para. 8

Complied.

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annual operation plans for the Project, and designed and implemented in accordance with the ADB’s Safeguard Policy Statement. In particular, MOH shall

(a) use training and outcome targets for ethnic groups in Project activities, with a particular focus on ethnic women;

(b) cause the Project provinces to include specific ethnic group-related activities in annual operation plans and budgets;

(c) recruit a social development specialist with terms of reference that include responsibility for integrating ethnic group development across project activities;

(d) include provisions for addressing ethnic minority issues in all guidelines, terms of reference, strategies and plans developed under the Project; and

(e) Disaggregate all monitoring and evaluation data by ethnicity.

(a). Ethnic Group Sensitivity and Awareness Training developed. The objective of the training is to understand and develop an appreciation of how to work with ethnic minorities to ensure they benefit from an improved health service. EGs traditionally inhabit remote upland forested areas which have been identified as malaria hot spot areas, so it is critical that CDC2 AF training reaches and is understood by EG members. It is important then that CDC2 staff know what issues for consideration are when planning work in an EG community, and what special measures might be needed to ensure the training will be effective Indicators of Project EGP are clearly defined, and those have been disseminated during annual workshop in January 2017 to all project implementers about the contents, aims, objectives, outputs and activities under the EGP, and M&E data needs for updating the EGP progress against indicators. In addition, the updated Road Map has been prepared to assist in guiding implementation the EGP for the CDC2 Additional Financing (b). The AOP 2017 of 5 targeted provinces (Ratanakiri, Mondukiri, Kratie, Stung Treng, Preah Vihear) included budget for Gender and IP training. AOP 2016 and 2017 have been revised to incorporate IP activities for malaria elimination in Preah Vihear and refresher training of other 11 project provinces. This IP activities confirmed by IP communities and resulted in higher level of awareness on CDC prevention and care among the target IP communities, particularly women. (c). The Social Development Expert (International) and Social Development Specialist (National) were on board. The national consultant provided training on gender and IP in 2016 in Preah Vihear province. In 2017, Gender sensitive/ GAP training is integrated in annual workshop which was organized by PCU to disseminate the contents, aims, objectives, outputs and activities under the updated GAP and EGP, and M&E data needs for updating the GAP and EGP progress against indicators. (d). All guidelines, strategies and plans include activities addressing IP issues. TOR for consulting firms have also incorporate IP issues. Project will ensure TOR for individual consultants have provisions for addressing IP issues. e). All M&E data are disaggregated by IP at provincial level.

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9. Targeting border Districts and Communities Unless otherwise agreed by ADB, the Recipient shall select and implement activities under Output 2 in isolated communities in the border districts of the Recipient. The Recipient, through MOH, shall ensure that the Project provinces are allowed to use innovative measures to reach and assist such districts and communities to improve local CDC, provided that these measures are relatively cost-effective and assessed in terms of outcome. The Recipient, through MOH, shall ensure that baseline and end-of-project surveys are conducted to assess the impact of this Output in the targeted border districts.

Schedule 4, para. 9

Complied. Reaching remote communities with CDC. Since 2013, 180 villages in border area are selected for MHV implementation; orientation, assessment of community vulnerability conducted. Consultation was also undertaken with provincial, district and commune council officials to validate data of shortlisted villages within communes to approach to participate in the MHV initiative. In 2014–2015, 50% of selected MHV villages had been conducted village demographic assessment and currently rolling out community health education and sanitation. The activities mostly focus to the indigenous groups residing along borders. In 2016, the refresher trainings to MHV community volunteers carried out and strongly enrol community health education. 4737 sets of latrine materials are also provided to poor, IP, female headed households in 90 border villages. Project also focus on upgrading capacity of village malaria workers in border district in Preah Vihear province through training and supervision. In 2017, project trained 331 village malaria workers (169 are female) on electronic reporting and malaria diagnostic and treatment. They are currently serving malaria services at remoted and hard to access communities. The baseline survey for Model Healthy Village had been conducted in October–November 2014, but the endline survey is expanded to End-project evaluation survey which include also border districts.

10. Integrated Project Management MOH shall ensure that Project activities, to the extent possible, are integrated in MOH in such areas as joint reviews, and sharing of information, know-how and staff among different Outputs, and shall cause each Project province to ensure that all Project activities implemented in the relevant Project province are mainstreamed and sustained.

Schedule 4, para. 10

Complied. The project’s approved AOP is part of MOH Provincial AOPs and MOH Sector AOP. A central technical task group comprising members from each of the central national implementing agencies is to jointly plan based on result, to review progress by outputs, sub-outputs, indicators and collaborate in field activities. On project monitoring and evaluation, some key indicators come from the national Health Information System (HIS). It was noted that the M&E framework is logical, follows donor DMF that was updated by December, 2013 for CDC2 and 28 April 2016 for CDC Additional Financing. The project report is made on quarterly basis, sent to ADB within defined time. The report in English and in a format consistent with the agreed project performance monitoring and evaluation system (PPMES). The consolidated report include progress as measured through the indicator's performance targets,

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key implementation issues and solutions, updated procurement status, financial progress report, status of action agreed with ADB and GAP and EGP monitoring update table reported in the new templates quarterly report of GAP and EGP about the progresses and issues or challenges.

11. Governance and Anticorruption The Recipient shall ensure that (i) periodic inspections of the Project contractor’s activities related to fund withdrawals and settlements are carried out; (ii) relevant provisions of ADB’s Anticorruption Policy (1998, as amended to date), are included in all bidding documents for the Project; and (iii) contracts, financed under the Project, include provisions specifying the right of ADB to audit and examine the records and accounts of MOH and Project provinces, contractors, suppliers, consultants, and other service providers as they relate to the Project.


Complied The MOH adheres to all provisions of the Cambodian Government Civil Service Statute (1994); The Royal Government of Cambodia - Updated Standard Procedures [Procurement] for Implementing all Externally Financed Projects/ Programs (May 2012); The MOH Good Governance Framework as well as strictly adheres to ADB’s Anti-corruption Policy in all respects related to procurement of goods and services, financial management practices and internal, as well as external financial audits

12. Disclosure The Recipient shall disclose, through the existing CDC website, accessible by the general public, information about various matters concerning the Project, including general Project information, procurement, Project progress, and contact details in the English and Khmer languages. The website shall also provide a link to ADB's Integrity Unit (http://www.adb.org/Integrity/complaint.asp) for reporting to ADB any grievances or allegations of corrupt practices arising out of the Project and Project activities. With regard to procurement, the website shall include information on the list of participating bidders, name of the winning bidder, basic details on bidding procedures adopted, amount of contract awarded, and the list of Goods, Works and Consulting Services procured.


Complied The MOH is committed to full and transparent disclosure of project information, project progress and procurement procedures. The MOH publishes project procurement information and job announcement on the MOH-CDC website. http://cdcmoh.gov.kh/cdc2-project/procurement Since 2014, the MOH commits to publish quarterly and annual project reports and in English on the MOH-CDC website. The links to ADB’s Office of Anticorruption and Integrity are: https://www.adb.org/site/integrity/main https://www.adb.org/site/integrity/how-to-report-fraud

G0231-CAM Grant Agreement (Particular Covenants): 4.01 In the carrying out of the Project and operation of the Project facilities, the Recipient shall perform, or cause to be performed, all obligations set forth in Schedule 4 to this Grant Agreement.

Article IV. Section 4.01

Complied During the Review Mission and in Quarterly Progress Reports.

4.02 (a) The Recipient shall

Article IV. Section 4.02 (a)

Complied

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(i) maintain, or cause to be maintained, separate accounts for the Project; (ii) have such accounts and related financial statements audited annually, in accordance with appropriate auditing standards consistently applied, by independent auditors whose qualifications, experience and terms of reference are acceptable to ADB; (iii) furnish to ADB, as soon as available but in any event not later than 9 months after the end of each related fiscal year, certified copies of such audited accounts and financial statements and the report of the auditors relating thereto (including the auditors' opinion on the use of the Grant proceeds and compliance with the financial covenants of this Grant Agreement as well as on the use of the procedures for imprest account/statement of expenditures), all in the English language; (iv) furnish to ADB such other information concerning such accounts and financial statements and the audit thereof as ADB shall from time to time reasonably request.

(i). Grant 0231 (SF) and Grant 0448 (EF) has been managed separately. (ii). The account has been reported and audited annually. (iii). Audited financial report 2011 was submitted to ADB on 16 October 2012. Audited financial report 2012 was submitted to ADB on 19 November 2013. Audited financial report 2013 was submitted to ADB on 8 December 2014. Audited financial report 2014 was submitted to ADB on 4 August 2015. Audited financial report 2015 was submitted to ADB on 27 June 2016. Audited financial report 2016 was submitted to ADB on 16 June 2017. Audited financial report for 2017 was submitted 14 June 2018. The EA complied with the provision of the Grant Agreement for APFS submission. (iv) There was no other information requested.

(b) The Recipient shall enable ADB, upon ADB's request, to discuss the Recipient’s financial statements for the Project and its financial affairs related to the Project from time to time with the auditors appointed by the Recipient pursuant to Section 4.02(a) hereabove, and shall authorize and require any representative of such auditors to participate in any such discussions requested by ADB, provided that any such discussion shall be conducted only in the presence of an authorized officer of the Recipient unless the Recipient shall otherwise agree.

Article IV. Section 4.02 (b)

Complied. MOH did not receive request from ADB.

4.03 The Recipient shall enable ADB’s representatives to inspect the Project, the Goods and Works financed out of the proceeds of the Grant, and any relevant records and documents.


Complied. Allowed ADB representative to conduct inspection.

G0448-CAM Grant Agreement (Particular Covenants): 4.01 In the carrying out of the Project and operation of the Project facilities, the Recipient shall perform, or cause to


Complied.

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be performed, all obligations set forth in Schedule 4 to this Grant Agreement. 4.02 (a) The Recipient shall (i) maintain separate accounts and records for the Project; (ii) prepare annual financial statements for the Project in accordance with accounting principles acceptable to ADB; (iii) have such financial statements audited annually by independent auditors whose qualifications, experience and terms of reference are acceptable to ADB, in accordance with international standards for auditing or the national equivalent acceptable to ADB; (iv) as part of each such audit, have the auditors prepare a report (which includes the auditors’ opinion on the financial statements, use of the Grant proceeds and compliance with the financial covenants of this Grant Agreement as well as on the use of the procedures for imprest fund and statement of expenditures) and a management letter (which sets out the deficiencies in the internal control of the Project that were identified in the course of the audit, if any); and (v) furnish to ADB, no later than 6 months after the end of each related fiscal year, copies of such audited financial statements, audit report and management letter, all in the English language, and such other information concerning these documents and the audit thereof as ADB shall from time to time reasonably request.


Complied. (i). Grant 0231 (SF) and Grant 0448 (EF) has been managed separately. (ii). G0448 first annual financial statements (FY 2016) submitted to ADB on 16 June 2017. APFS for FY 2017 submitted to ADB on 14 June 2018. (iii) G0448 2016 and 2017 financial statements were audited by independent auditors whose qualifications, experience and terms of reference are acceptable to ADB, in accordance with international standards for auditing or the national equivalent acceptable to ADB; (iv) Complied. (iv) Complied. The EA complied with the provision of the Grant Agreement for APFS submission.

(b) ADB shall disclose the annual audited financial statements for the Project and the opinion of the auditors on the financial statements within 30 days of the date of their receipt by posting them on ADB’s website. (c) The Recipient shall enable ADB, upon ADB's request, to discuss the financial statements for the Project and the Recipient's financial affairs where they relate to the Project with the


Article IV. Section 4.02 (c)

(b) Complied. APFS disclosed in ADB website.

(c) No request has been received from ADB.

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auditors appointed pursuant to subsection (a)(iii) hereinabove and shall authorize and require any representative of such auditors to participate in any such discussions requested by ADB. This is provided that such discussions shall be conducted only in the presence of an authorized officer of the Recipient, unless the Recipient shall otherwise agree.

4.03 The Recipient shall enable ADB's representatives to inspect the Project, the Goods and Works, and any relevant records and documents.


Complied. ADB representatives inspected the Project during review missions.

4.04 The Recipient acknowledges and agrees that this Grant Agreement is entered into by ADB, not in its individual capacity, but as grant administrator for the Regional Malaria and Other Communicable Disease Threats Trust Fund. Accordingly, the Recipient agrees that (i) it may only withdraw Grant proceeds to the extent that ADB has received proceeds for the Grant from the Regional Malaria and Other Communicable Disease Threats Trust Fund, and (ii) that ADB does not assume any obligations or responsibilities of the Regional Malaria and Other Communicable Disease Threats Trust Fund in respect of the Project or the Grant other than those set out in this Grant Agreement.


Complied. Grant proceeds used for intended purposes.

ADB= Asian Development Bank; CDC = communicable disease control; CDC2 = Second GMS Communicable Disease Control; CDC2 AF = CDC2 additional financing; CDCD =Communicable Diseases Control Department; CLV = Cambodia, Lao PDR, and Viet Nam; Lao PDR = Lao People’s Democratic Republic

G0232/G0449-LAO Grant Agreements


the Grant Agreement


G0232-LAO Grant Agreement: 1. Implementation Arrangements The Recipient, through MOH, shall ensure that the Project is implemented in accordance with the detailed arrangements set forth in the PAM. Any subsequent change to the PAM shall become effective only after approval of such change by the MOH and ADB. In the event of any discrepancy between the PAM and this Grant Agreement, the provisions of this Grant Agreement shall prevail.

Schedule 4, para. 1

Complied Project was implemented in accordance with the detailed arrangements in the PAM. PAM was updated when necessary.

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2. National Focal Point for CDC Within 1 year of the Effective Date, the Recipient, through MOH, shall strengthen, on a sustainable basis within the premises of MOH, a regional focal point for CDC. Such regional focal point shall (i) comprise at least 1 full-time officer assigned by MOH, and (ii) be responsible for coordinating (a) regional disease reporting and coordination of outbreak control; (b) regional knowledge management, workshops, and training activities; and (c) regional epidemiological investigation.

Schedule 4, para. 2

Complied A focal point for CDC established with senior officer assigned and start functioning from Q4 2012

3. Regional Cooperation in CDC The Recipient, through MOH, shall realign and implement its own strategies for disease control and cooperation/coordination with neighbouring countries based on WHO regional disease control strategies for emerging and neglected diseases. The Recipient, through MOH, shall further ensure that any information regarding CDC will be exchanged with neighbouring countries in a smooth and timely manner through MOH’s regional focal point.

Schedule 4, para. 3

Complied MOH strategies based on WHO strategies as per IHR/APSED and information exchanged on a regular basis.

4. Mainstreaming the Project in the Provincial Annual Operational Plan and Budget The Provincial Health Department of each Project province shall submit to MOH the provincial annual operational plans and budgets for the health sector, including the annual provincial work plans for the Project as part of the overall provincial annual operational plan and budget, all based on a format agreed to by the concerned parties, as a basis for allocating funds and monitoring performance, and MOH shall inform to ADB the approval of such annual plans. In particular, the provincial annual operational plans for the health sector shall include plans and budgets for in-service training activities for CDC, cross-border cooperation, reaching remote communities with CDC, and implementation of gender and ethnic group plans under the Project

Schedule 4, para. 4

Complied All project activities were coordinated with provincial health departments and integrated into provincial AOPs. Alignment with overall project AOP is assured. MOH submits the overall AOPs to ADB for approval. AOPs included plans and budgets for in-service training in CDC, cross border cooperation, reaching remote communities with CDC, and implementation of gender and ethnic group plans as per covenant.

5. Environment The Recipient shall ensure that health facility waste management in health facilities supported under the Project is carried out as per health care waste

Schedule 4, para. 5

Not applicable

The project is category C for environmental safeguard. The project did not directly support building, renovation, or solid waste management systems in commune health stations or district

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management guidelines developed by WHO, and that adequate budget, training, and supplies are provided under the Project to do so.

hospitals. It has supported lab equipment and materials in provincial hospitals and latrine materials in the model villages. Therefore, in multiple review missions, ADB team and government counterpart concluded this provision is not applicable. In each country, however, all health facilities must comply with regulations of the Ministry of Health on medical waste management.

6. Involuntary Resettlement The Recipient shall ensure that any of the Project activities do not involve any involuntary resettlement. In the event, however, that any involuntary resettlement impacts are unavoidable, the Recipient, through MOH, shall (a) prepare a resettlement plan for such activity in accordance with the agreed land acquisition and resettlement framework under the Project and ADB’s Safeguard Policy Statement (2009); (b) ensure that such resettlement plans are prepared on the basis of the detailed technical design, disclosed to affected persons, and submitted to ADB for review and approval; and (c) ensure that all compensation and rehabilitation assistance is paid before dispossession of assets.

Schedule 4, para. 6

Not applicable No resettlement issues arose.

7. Gender and Development The Recipient, through MOH, shall ensure that the Gender Action Plan agreed for the Project is fully implemented and in accordance with ADB’s Gender and Development Policy (1998). In particular, MOH shall (a) use training and outcome targets for women in project-supported activities; (b) cause the Project provinces to include specific gender-related activities in the respective provincial annual operation plans and budgets; (c) recruit a social development specialist with terms of reference that include responsibility for integrating gender issues across project activities; (d) include provisions for addressing gender issues in all guidelines, terms of reference, strategies and plans developed under the Project; and

Schedule 4, para. 7

Complied (a) GAP was considered in project implementation. Targets for women participation has been integrated into project activities. (b) Overall project AOP and the provincial AOPs included gender actions and targets in GAP. (c) An international and a national gender and IP specialists were engaged for 6 months and 18 months, respectively in 2012. Both reviewed AOPs to ensure integration of gender issues in the implementation of project activities. National gender specialist supported training and other activities. (d) All CDC trainings and AOPs included gender issues. The updated vector surveillance and control guidelines assesses risk and identifies targets and appropriate strategies.

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(e) Disaggregate all monitoring and evaluation data by sex.

(e) The project collected and analysed sex-disaggregated data, such as in household survey, IP research, surveillance and disease outbreaks data. All project

8. Ethnic Groups The Recipient through, through MOH, shall ensure that the Ethnic Group Plan agreed for the Project is fully implemented and that all Project activities are mainstreamed in the annual operation plans for the Project, and designed and implemented in accordance with the ADB’s Safeguard Policy Statement. In particular, MOH shall

(a) use training and outcome targets for ethnic groups in Project activities, with a particular focus on ethnic women;

(b) cause the Project provinces to include specific ethnic group-related activities in annual operation plans and budgets;

(c) recruit a social development specialist with terms of reference that include responsibility for integrating ethnic group development across project activities;

(d) include provisions for addressing ethnic minority issues in all guidelines, terms of reference, strategies and plans developed under the Project; and

(e) Disaggregate all monitoring and evaluation data by ethnicity.

Schedule 4, para. 8

Complied EGP developed and implemented for the project. (a) Training and outcome targets for ethnic groups, particularly for ethnic women were used and met in the project. (b) Ethnic groups health issues were addressed, and relevant activities were included in AOPs with budget. (c) The project recruited a gender and safeguard consultant to guide and monitor the implementation of EG-related activities. (d) EG issues addressed in project guidelines, TOR, strategies and plans developed under the project. Specifically, on human resource, training, participation of cross-border activities, selection of model healthy villages, and M&E with disaggregated data on EGP. (e) All monitoring and evaluation data were disaggregated by ethnicity.

9. Targeting border Districts and Communities Unless otherwise agreed by ADB, the Recipient shall select and implement activities under Output 2 in isolated communities in the border districts of the Recipient. The Recipient, through MOH, shall ensure that the Project provinces are allowed to use innovative measures to reach and assist such districts and communities to improve local CDC, provided that these measures are relatively cost-effective and assessed in terms of outcome. The Recipient, through MOH, shall ensure that baseline

Schedule 4, para. 9

Complied. Isolated communities in border districts were selected to implement Output 2 activities particularly the model healthy village. Project baseline survey identified a range of issues for border areas and isolated communities. Issues were presented to provinces for targeted action to improve local situation(s). Baseline survey conducted in March 2014 and end-line survey conducted in April 2016.

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and end-of-project surveys are conducted to assess the impact of this Output in the targeted border districts. 10. Integrated Project Management MOH shall ensure that Project activities, to the extent possible, are integrated in MOH in such areas as joint reviews, and sharing of information, know-how and staff among different Outputs, and shall cause each Project province to ensure that all Project activities implemented in the relevant Project province are mainstreamed and sustained.


Complied

Project activities are aligned with various national strategies for major communicable diseases such as dengue, malaria, NTDs, national laboratory and epidemiology, and mainstreamed within MOH and in provincial plans.

11. Governance and Anticorruption The Recipient shall ensure that (i) periodic inspections of the Project contractor’s activities related to fund withdrawals and settlements are carried out; (ii) relevant provisions of ADB’s Anticorruption Policy (1998, as amended to date), are included in all bidding documents for the Project; and (iii) contracts, financed under the Project, include provisions specifying the right of ADB to audit and examine the records and accounts of MOH and Project provinces, contractors, suppliers, consultants, and other service providers as they relate to the Project.


Complied All Lao Government and ADB anti-corruption laws and polices enforced. Project had 5 audits – all assessed satisfactory.

In 2013 ADB’s OAI conducted a project procurement related review (PPRR) of Grant 0232-LAO(SF). The PPRR report is available at: https://www.adb.org/sites/default/files/project-document/79796/41507-012-lao-pprr.pdf”.

12. Disclosure The Recipient shall disclose, through the existing CDC website, accessible by the general public, information about various matters concerning the Project, including general Project information, procurement, Project progress, and contact details in the English and Khmer languages. The website shall also provide a link to ADB's Integrity Unit (http://www.adb.org/Integrity/complaint.asp) for reporting to ADB any grievances or allegations of corrupt practices arising out of the Project and Project activities. With regard to procurement, the website shall include information on the list of participating bidders, name of the winning bidder, basic details on bidding procedures adopted, amount of contract awarded, and the list of Goods, Works and Consulting Services procured.


Complied Website with links to Integrity Unit and project information, including procurement, operational since April 2017. www.laohealthplanning.org The links to ADB’s Office of Anticorruption and Integrity are: https://www.adb.org/site/integrity/main https://www.adb.org/site/integrity/how-to-report-fraud

G0232-LAO Grant Agreement (Particular Covenants): 4.01 In the carrying out of the Project and operation of the Project facilities,


Complied

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the Recipient shall perform, or cause to be performed, all obligations set forth in Schedule 4 to this Grant Agreement.

4.02 (a) The Recipient shall (i) maintain, or cause to be maintained, separate accounts for the Project; (ii) have such accounts and related financial statements audited annually, in accordance with appropriate auditing standards consistently applied, by independent auditors whose qualifications, experience and terms of reference are acceptable to ADB; (iii) furnish to ADB, as soon as available but in any event not later than 9 months after the end of each related fiscal year, certified copies of such audited accounts and financial statements and the report of the auditors relating thereto (including the auditors' opinion on the use of the Grant proceeds and compliance with the financial covenants of this Grant Agreement as well as on the use of the procedures for imprest account/statement of expenditures), all in the English language; (iv) furnish to ADB such other information concerning such accounts and financial statements and the audit thereof as ADB shall from time to time reasonably request.


Complied Complied Complied Audits conducted annually and submitted to ADB Complied Complied ADB requested for a copy of the driver’s contract to clear audit findings in APFS covering Oct 2015-Dec 2016 (covers 15 months due to change in LAO fiscal year).

(b) The Recipient shall enable ADB, upon ADB's request, to discuss the Recipient’s financial statements for the Project and its financial affairs related to the Project from time to time with the auditors appointed by the Recipient pursuant to Section 4.02(a) hereabove, and shall authorize and require any representative of such auditors to participate in any such discussions requested by ADB, provided that any such discussion shall be conducted only in the presence of an authorized officer of the Recipient unless the Recipient shall otherwise agree.


Complied Financial statements and project financial document available to ADB if requested. No special request from ADB was received.



Complied Inspections allowed if requested.

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the Grant Agreement


G0449-LAO Grant Agreement (Particular Covenants): 4.01 In the carrying out of the Project and operation of the Project facilities, the Recipient shall perform, or cause to be performed, all obligations set forth in Schedule 4 to this Grant Agreement.


Complied All obligations in Schedule 4 met

4.02 (a) The Recipient shall (i) maintain separate accounts and records for the Project; (ii) prepare annual financial statements for the Project in accordance with accounting principles acceptable to ADB; (iii) have such financial statements audited annually by independent auditors whose qualifications, experience and terms of reference are acceptable to ADB, in accordance with international standards for auditing or the national equivalent acceptable to ADB; (iv) as part of each such audit, have the auditors prepare a report (which includes the auditors’ opinion on the financial statements, use of the Grant proceeds and compliance with the financial covenants of this Grant Agreement as well as on the use of the procedures for imprest fund and statement of expenditures) and a management letter (which sets out the deficiencies in the internal control of the Project that were identified in the course of the audit, if any); and (v) furnish to ADB, no later than 6 months after the end of each related fiscal year, copies of such audited financial statements, audit report and management letter, all in the English language, and such other information concerning these documents and the audit thereof as ADB shall from time to time reasonably request.


Complied Separate accounts maintained for G0449 and reported separately.

(b) ADB shall disclose the annual audited financial statements for the Project and the opinion of the auditors on the financial statements within 30 days of the date of their receipt by posting them on ADB’s website.


Complied

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(c) The Recipient shall enable ADB, upon ADB's request, to discuss the financial statements for the Project and the Recipient's financial affairs where they relate to the Project with the auditors appointed pursuant to subsection (a)(iii) hereinabove, and shall authorize and require any representative of such auditors to participate in any such discussions requested by ADB. This is provided that such discussions shall be conducted only in the presence of an authorized officer of the Recipient, unless the Recipient shall otherwise agree.


Complied Financial statements and project financial document available to ADB if requested


Section 4.03 Complied Inspections allowed if required.

4.04 The Recipient acknowledges and agrees that this Grant Agreement is entered into by ADB, not in its individual capacity, but as grant administrator for the Regional Malaria and Other Communicable Disease Threats Trust Fund. Accordingly, the Recipient agrees that (i) it may only withdraw Grant proceeds to the extent that ADS has received proceeds for the Grant from the Regional Malaria and Other Communicable Disease Threats Trust Fund, and (ii) that ADB does not assume any obligations or responsibilities of the Regional Malaria and Other Communicable Disease Threats Trust Fund in respect of the Project or the Grant other than those set out in this Grant Agreement.

Section 4.04 Complied Grant proceeds withdrawn as per Covenant 4.04

ADB = Asian Development Bank, APSED = Asia Pacific Strategy for Emerging Diseases, AOP = annual operational plan, CDC = communicable disease control, GEGAP = gender and ethnic groups’ action plan, IHR = International Health Regulations, IP = indigenous persons, IST = in service training, M&E = monitoring and evaluation, MOH = Ministry of Health, OAI = Office of Anticorruption and Integrity, PMU = project management unit, WHO = World Health Organization

L2699/G0450-VIE Loan and Grant Agreements

Clause Reference in the

Loan/Grant Agreement


L2699-VIE Loan Agreement: 1. Implementation Arrangements The Borrower, through MOH, shall ensure that the Project is implemented in accordance with the detailed arrangements set forth in the PAM. Any subsequent change to the PAM shall become effective only after approval of

Schedule 5 Para.1

Complied. The project has been implemented in accordance with the detailed agreement in the Project Administration Manual.

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such change by the MOH and ADB. In the event of any discrepancy between the PAM and this Loan Agreement, the provisions of this Loan Agreement shall prevail. 2. National focal point for CDC Within 1 year of the Effective Date, the Borrower, through MOH, shall strengthen, on a sustainable basis within the premises of MOH, a regional focal point in MOH for CDC. Such focal point shall (i) comprise at least 1 full-time officer assigned by MOH, and (ii) be responsible for coordinating (a) regional disease reporting and coordination of outbreak control, (b) regional knowledge management, workshops, and training activities, and (c) regional epidemiological investigation.

Schedule 5 Para.2

Complied. - National focal point on regional cooperation for CDC: Dr. Vu Ngoc Long, Vice chief of Division of Communicable Disease Control, General Department of Preventive Medicine is assigned to be NFP for CDC in the region. Decision No. 3230/QD –BYT dated 7 September 2012. The decision was issued within 1 year from the effective date of Loan agreement – 20 May 2011. - Recruited national consultant on regional focal coordinator for CDC: Dr. Le Thi Song Huong to: + Support MOH focal point of IHR on CDC matters, update the outbreak situation in Viet Nam and related countries + Support MOH focal point of IHR on collecting and analyzing information on WHO/APSED strategies and information sharing with regional GMS CDC

3. Regional cooperation in CDC The Borrower, through MOH, shall realign and implement its own strategies for disease control and cooperation/coordination with neighboring countries based on WHO regional disease control strategies for emerging and neglected diseases. The Borrower, through MOH, shall further ensure that any information regarding CDC will be exchanged with neighboring countries in a smooth and timely manner through MOH's regional focal point.

Schedule 5 Para.3

Complied. - Established Office for Emergency outbreak response pursuant to Decision No. 1424/QD-BYT dated 02 May 2013, GDPM is the permanent unit to collect and share information on disease situation, advice and coordinate with other resources for CDC. - Division of CDC, GDPM is the focal point in charge of major activities: (i) Timely sharing of information on disease situation especially information on new emerging diseases (ii) Video conference with Laos and Cambodia on disease situation was conducted, (iii) Frequently working with technical consultant in WHO representative office in Viet Nam (with expertise in emerging diseases: Influenza type A H7N9, HFMD, MERS-CoV, dengue, rabies) (iv) Expert group working meetings on prevention and control measures were organized with the participation.

4. Mainstreaming the Project in the Provincial Annual Operational Plan and Budget The Provincial Health Department of each Project province shall submit to MOH the provincial annual operational plans and budgets for the health sector, including the annual provincial work plans for the Project as part of the provincial annual operational plan and budget, all based on a format agreed to by the concerned parties, as a basis for allocating funds and monitoring performance, and MOH shall inform to

Schedule 5 Para.4

Complied. - Annual Operation Plan was made in accordance with the procedure and regulations. - PPMUs developed provincial operation plans integrated with provincial CDC plan. PMU compiled and built the AOP for the whole project then submitted it to ADB, GDPM and relevant departments for approval. - Based on the approved AOP, PPMU worked on a detailed budget. After the responsibility contract was signed between PMU and PPMU, provincial funds were allocated in accordance with regulations to implement project activities during the year.

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ADB the approval of such annual plans. In particular, the provincial annual operational plans for the health sector shall include plans and budgets for in-service training activities for CDC, cross-border cooperation, reaching remote communities with CDC, and implementation of gender and ethnic group plans under the Project. 5. Environment The Borrower shall ensure that health facility waste management in health facilities supported under the Project is carried out as per health care waste management guidelines developed by WHO, and that adequate budget, training, and supplies are provided under the Project to do so.

Schedule 5 Para.5

Not applicable.

The project is category C for environmental safeguard. The project did not directly support building, renovation, or solid waste management systems in commune health stations or district hospitals. It has supported lab equipment and materials in provincial hospitals and latrine materials in the model villages. Therefore, in multiple review missions, ADB team and government counterpart concluded this provision is not applicable. All health facilities in Viet Nam must comply with regulations described at Decision No. 43/2007/QD-BYT of the MOH on medical waste management and National Technical Regulation 28:2010/BTNMT on health waste management.

6. Involuntary Resettlement The Borrower shall ensure that any of the Project activities do not involve any involuntary resettlement. In the event, however, that any involuntary resettlement impacts are unavoidable, the Borrower, through MOH, shall (a) prepare a resettlement plan for such activity in accordance with the agreed land acquisition and resettlement framework under the Project and ADB's Safeguard Policy Statement (2009); (b) ensure that such resettlement plans are prepared on the basis of the detailed technical design, disclosed to affected persons, and submitted to ADB for review and approval; and (c) ensure that all compensation and rehabilitation assistance is paid before dispossession of assets.

Schedule 5 Para.6

Not applicable.

No resettlement issues arose.

7. Gender and Development The Borrower, through MOH, shall ensure that the Gender Action Plan agreed for the Project is fully implemented and in accordance with ADB's Gender and Development Policy (1998). In particular, MOH shall (a) use training and outcome targets for women in project-supported activities; (b) cause the Project provinces to include specific

Schedule 5 Para.7

Complied. (a) the project used relevant gender-related training and outcome targets in planning project activities as per DMF and GAP, e.g., number of female trainees in training activities, proportion of female staff among newly recruited staff; scholarships offered to female candidates etc. (b) specific gender-related activities were included in provincial annual operation plans and budgets, for

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gender-related activities in the respective provincial annual operation plans and budgets; (c) recruit a social development specialist with terms of reference that include responsibility for integrating gender issues across project activities; (d) include provisions for addressing gender issues in all guidelines, terms of reference, strategies and plans developed under the Project; and (e) disaggregate all monitoring and evaluation data by sex.

example, female surveillance and response staff training; female laboratory staff training, female VHWs training. (c) an international consultant and a national gender consultant were recruited in 2012, whose responsibilities are integrating gender issues across project activities. (d) all guidelines, terms of reference, strategies and plans developed under the project include provisions for addressing gender issues, including reporting sex-disaggregated data, monitoring of activities in GAP, and include gender activities in provincial AOPs. - PMU issued Decision No.75/QD-VIE2699 dated 28 July 2014 guiding the implementation of activities for EMG/ GAP development and Dispatch No. 252/VIE2699 requesting PPMUs to nominate focal points for EMG/ GAP and to perform reporting regime as stipulated. PMU has compiled the list of 20 focal points on gender and ethnic and 20/20 report of provinces and send to VRM by mail on 3/2015. (e) The project developed a tool for monitoring gender issues. All data from training, workshops, conferences and study tours were sex –disaggregated. The project also organized 01 workshop on gender, minority/gender action plan, the nation for gender focal points of the 20 provinces/cities in Hanoi from 14-15 December 2015.

8. Ethnic Groups The Borrower, through MOH, shall ensure that the Ethnic Group Plan agreed for the Project is fully implemented and that all Project activities are mainstreamed in the annual operation plans for the Project, and designed and implemented in accordance with ADB's Safeguard Policy Statement. In particular, MOH shall (a) use training and outcome targets for ethnic groups in Project activities, with a particular focus on ethnic women; (b) cause the Project provinces to include specific ethnic group-related activities in annual operation plans and budgets; (c) recruit a social development specialist with terms of reference that include responsibility for integrating ethnic group development across project activities; (d) include provisions for addressing ethnic group issues in all guidelines, terms of reference, strategies and plans developed under the Project; and (e) disaggregate all monitoring and evaluation data by ethnicity.

Schedule 5 Para.8

Partially Complied (as of 22 November 2018). (a) Applied training and outcome targets for ethnic groups in Project activities, with a particular focus on ethnic women. A total of 1149 EMG S&R staff out of 13,969 S&R staff trained (8.2%). A total of 68 EMG laboratory staff trained out of 1774 (3.8%). A total of 4,238 EMG village health workers (VHW) out of 17,916 trained (23.65%). A total of 39 EMG out of 538 newly VHW recruited (7.2%). One (1) EMG staff was offered scholarship for postgraduate training out of 34 scholarship recipients (2%). (b) No figures were provided by the EA on the number of trainings conducted with EGP activities. (c) Recruited a social development specialist with terms of reference that included responsibility for integrating ethnic group development across project activities - Recruited national and international specialist on gender and EMG. (d) Included provisions for addressing ethnic group issues in all guidelines, terms of reference, strategies and plans developed under the Project

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PMU issued Decision No.75/QD-VIE2699 dated 28 July 2014 guiding the implementation of activities for EMG/ GAP development and Dispatch No. 252/VIE2699 requesting PPMUs to nominate focal points for EMG/GAP and to perform reporting regime as stipulated. (e) Disaggregated all monitoring and evaluation data by ethnicity.

9. Targeting border Districts and Communities Unless otherwise agreed by ADB, the Borrower shall select and implement activities under Output 2 in isolated communities in the border districts of the Borrower. The Borrower, through MOH, shall ensure that the Project provinces are allowed to use innovative measures to reach and assist such districts and communities to improve local CDC, provided that these measures are relatively cost-effective and assessed in terms of outcome. The Borrower, through MOH, shall ensure that baseline and end-of project surveys are conducted to assess the impact of this Output in the targeted border districts.

Schedule 5 Para.9

Complied. (i) Criteria for selecting isolated communes in border areas to conduct Output 2 activities were developed in 2011. (ii) in line with Output 2 activities, the model healthy village model was piloted in 104 villages of 52 border districts and scaled up to 215 by 2015. Mobile clinics with vaccines were sent to these remote and isolated communities to conduct vaccination. (ii) Baseline and endline project survey included assessment of project impact in targeted border districts, focusing on Output 2.

10. Integrated Project Management MOH must ensure that Project activities, to the extent possible, are integrated in MOH in such areas as joint reviews, and sharing of information, method and staff among different outputs, and require each Project province to ensure that all Project activities implemented in the relevant Project province are mainstreamed and sustained.

Schedule 5 Para.10

Complied. The project’s management activities were implemented effectively and integrated with provincial CDC plan, including following content: support to CDC activities, non-CDC and CDC activities, and border health quarantine, community for health, gender and ethnic minorities, etc. PPMUs implemented all activities according to regulations and report to MOH and donor.

11. Counterpart funds The Borrower have to ensure that the Project’s provinces receive funds necessary to implement the Project in a timely manner.

Schedule 5 Para.11

Complied. 20 PPMUs received adequate and timely counterpart fund during project implementation. Accumulative 2011-2015, counterpart fund received totaled US$1.7 million from central funding and $ 1.83 million from local funds.

12. Governance and Anticorruption The Borrower must ensure that (i) periodic inspections of the Project contractor's activities related to fund withdrawals and settlements are carried out; (ii) relevant provisions of ADB's Anticorruption Policy (1998, as amended to date), are included in all bidding documents for the Project; and (iii) contracts was financed from the Project also include provisions specifying that ADB has the right to audit and inspect

Schedule 5 Para.12

Complied. (i) Periodic inspections of the Project contractor's activities related to fund withdrawals and settlements are carried out by CPMU at least 1-2 times a year; (ii) relevant provisions of ADB's Anticorruption Policy (1998, as amended to date), are included in all project’s bidding documents (iii) Contracts was financed from the Project also include provisions specifying that ADB has the right to audit and inspect profiles, records and accounts of the Ministry of Health as well as of the project provinces,

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profiles, records and accounts of the Ministry of Health as well as of the project provinces, contractors, suppliers, consultants and other service providers related to the project.

contractors, suppliers, consultants and other service providers related to the project. CPMU has assisted ADB missions in field visits that involved inspection of procured equipment under the project.

The Borrower must disclose, through the existing CDC website, accessible by the general public, information about various matters concerning the Project, including general Project information, procurement, Project progress, and contact details in the English and Vietnamese languages. The website shall also provide a link to ADB's Integrity Unit (http://www.adb.org/Integrity/complaint.asp) for reporting to ADB any grievances or allegations of corrupt practices arising out of the Project and Project activities. With regard to procurement, the website shall include information on the list of participating bidders, name of the winning bidder, basic details on bidding procedures adopted, amount of contract awarded, and the list of Goods, Works and Consulting Services procured.

Schedule 5 Para.13

Complied. The project website has been merged with the mew regional health security project and updated web address is https://gms-healthsecurity.vn/. In this website, the project has published information related to project consists of general information of the project, bidding, project progress, details of the contract in English and Vietnamese. This webpage contains weblinks to ADB’s Office of Anticorruption and Integrity to report allegations of fraud and corruption occurred in the projects and activities of the project.

L2699-VIE Loan Agreement (Particular Covenants): 4.01 In the carrying out of the Project and operation of the Project facilities, the Recipient shall perform, or cause to be performed, all obligations set forth in Schedule 4 to this Grant Agreement.


Complied.

4.02 The Borrower must (i) maintain, or cause to be maintained, separate accounts for the Project; (ii) have such accounts and related financial statements audited annually, in accordance with appropriate auditing standards consistently applied, by independent auditors whose qualifications, experience and terms of reference are acceptable to ADB; (iii) furnish to ADB, as soon as available but in any event not later than 9 months after the end of each related fiscal year, certified copies of such audited accounts and financial statements and the report of the auditors relating thereto (including the auditors' opinion on the use of the Loan proceeds and compliance with the financial covenants of this Loan Agreement as well as on the use of the procedures for imprest account and statement of expenditures), all in the

Article IV Para.4.02 (a)

Complied. (i)-(iii) PMU has maintained separate accounts for the Project. The Borrower has audited annually for accounts and related financial statements, in accordance with appropriate auditing standards consistently applied. All audit reports (FY 2011-2017) have been submitted to ADB already. The borrower has sent to ADB a notarized copy of the audited accounts and financial reports as well as reports of the relevant auditing company, all in English. (iv) There was no other information requested.

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English language; and (iv) furnish to ADB such other information concerning such accounts and financial statements and the audit thereof as ADB shall from time to time reasonably request. 4.02 (b) The Borrower shall enable ADB, Upon ADB's request, to discuss the Borrower's financial statements for the Project and its financial affairs related to the Project from time to time with the auditors appointed by the Borrower pursuant to subparagraph (a) hereabove, and shall authorize and require any representative of such auditors to participate in any such discussions requested by ADB, provided that any such discussion shall be conducted only in the presence of an authorized officer of the Borrower unless the Borrower shall otherwise agree.

Article IV Para.4.02 (b)

Complied. Complied to ADB’s request. CPMU has assisted ADB missions in field visits that involved inspection of procured equipment under the project. Discussions on financial statements and audits reports were conducted with ADB missions and through emails.


Article IV Section 4.03

Complied.

G0450-VIE Grant Agreement (Particular Covenants):

4.01 In the carrying out of the Project and operation of the Project facilities, the Recipient shall perform, or cause to be performed, all obligations set forth in Schedule 4 to this Grant Agreement.


Complied.

Follow PAM to implement project activities in accordance with regulations.

4.02 (a) The Recipient shall (i) maintain separate accounts and records for the Project; (ii) prepare annual financial statements for the Project in accordance with accounting principles acceptable to ADB; (iii) have such financial statements audited annually by independent auditors whose qualifications, experience and terms of reference are acceptable to ADB, in accordance with international standards for auditing or the national equivalent acceptable to ADB; (iv) as part of each such audit, have the auditors prepare a report (which includes the auditors’ opinion on the financial statements, use of the Grant proceeds and compliance with the financial covenants of this


Complied.

(i) PMU maintained separate accounts and records for the Project. (ii) PMU prepared annual financial statements in accordance with accounting principles acceptable to ADB (iii) Project account and related financial statements were audited annually. (iv) The auditor for FY 2016-2017 is Grant Thorton (Viet Nam) Ltd, accepted by ADB. (NOL letter in 23 May 2017)

158 Appendix 10

Grant Agreement as well as on the use of the procedures for imprest fund and statement of expenditures) and a management letter (which sets out the deficiencies in the internal control of the Project that were identified in the course of the audit, if any); and (v) furnish to ADB, no later than 6 months after the end of each related fiscal year, copies of such audited financial statements, audit report and management letter, all in the English language, and such other information concerning these documents and the audit thereof as ADB shall from time to time reasonably request.

(v) As listed in the TOR for auditors, the audit report includes the auditor’s opinion on the financial statements, use of the Grant process and compliance with the financial covenant of this Grant Agreement as well as on the use of procedure for imprest fund and statement of expenditures, and management letter. The audit report of FY 2016 shall be submitted to ADB before 30 June 2017, all reports are prepared in English language

(b) ADB shall disclose the annual audited financial statements for the Project and the opinion of the auditors on the financial statements within 30 days of the date of their receipt by posting them on ADB’s website. (c) The Recipient shall enable ADB, upon ADB's request, to discuss the financial statements for the Project and the Recipient's financial affairs where they relate to the Project with the auditors appointed pursuant to subsection (a)(iii) hereinabove, and shall authorize and require any representative of such auditors to participate in any such discussions requested by ADB. This is provided that such discussions shall be conducted only in the presence of an authorized officer of the Recipient, unless the Recipient shall otherwise agree.


Article IV. Section 4.02 (c)

ADB disclosed financial statements and opinion of the auditors on the financial statements on the ADB’s website.

(c) There was no other information requested.


Section 4.03 Complied. PMU ensured that all procurement records and documents are available to be inspected by ADB’s representatives at any time. The rapid assessment is conducted at the PMU. The mission found the PMU and PPMU’s capacity to manage SOE procedure satisfactory

4.04 The Recipient acknowledges and agrees that this Grant Agreement is entered into by ADB, not in its individual capacity, but as grant administrator for the Regional Malaria and Other Communicable Disease Threats Trust Fund. Accordingly, the Recipient agrees that (i) it may only withdraw Grant proceeds to the extent that ADS has received proceeds for the Grant from the Regional Malaria and Other Communicable Disease Threats Trust Fund, and (ii) that ADB does not

Section 4.04 Complied. The Recipient agreed that (i) it may only withdraw Grant proceeds to the extent that ADB has received proceeds for the Grant from the Regional Malaria and Other Communicable Disease Threats Trust Fund, and (ii) that ADB does not assume any obligations or responsibilities of the Regional Malaria and Other Communicable Disease Threats Trust Fund in respect of the Project or the Grant other than those set out in this Grant Agreement.

Appendix 10 159

assume any obligations or responsibilities of the Regional Malaria and Other Communicable Disease Threats Trust Fund in respect of the Project or the Grant other than those set out in this Grant Agreement.

ADB = Asian Development Bank, APSED = Asia Pacific Strategy for Emerging Diseases, AOP = annual operational plan, CDC = communicable disease control, GEGAP = gender and ethnic groups’ action plan, IHR = International Health Regulations, IP = indigenous persons, IST = in service training, M&E = monitoring and evaluation, MOH = Ministry of Health, OAI = Office of Anticorruption and Integrity, PMU = project management unit, WHO = World Health Organization

160 Appendix 11

ECONOMIC AND FINANCIAL ANALYSIS Second Greater Mekong Subregion Regional Communicable Diseases Control Project

1. Background. The Second Greater Mekong Subregion (GMS) Regional Communicable Disease Control Project (comprising Cambodia, Lao PDR and Viet Nam) aimed to improve the health of the population in the GMS, particularly, the poor, ethnic groups and women and children through control of communicable diseases. The project objectives were to enhance regional coordination and cooperation in Communicable Diseases Control (CDC) and improve disease control systems along border areas. The rationale for the project was that emerging and neglected diseases pose a major public concern in the region. The project aimed to build on the achievements of the first project which focused on strengthening surveillance and outbreak response capacity. The project was implemented through three components: Component 1: Enhanced regional CDC Systems, Component 2: Improved Communicable Diseases Control along borders and economic corridors and Component 3: Integrated Project Management. The project beneficiaries were the poor in 12 selected provinces, particularly ethnic groups, women and children. 2. Beneficiaries. The project provided both practical and strategic benefits to the poor, women, children, ethnic groups and other vulnerable groups in remote areas. The project improved CDC in 116 border districts with 7.2 million people in 44 provinces. In output 2, the population of 699 remote communities benefitted from the development of these communities into model health villages designed to ensure strong community engagement in CDC. Around 7,570 community members from border areas have received training as village health workers, supporting their respective villages on community-based CDC interventions. In Cambodia, an estimated 1.6 million women of reproductive age and 3.5 million of under-5 children received annual preventive anthelmintic treatment. 3. Benefits. Project benefits include (i) gains in productivity, due to a reduced burden of illness; (ii) gains in learning, particularly relevant for the control of diarrheal diseases and helminthiasis; (iii) savings on health care costs in the family; and (iv) indirect benefits relating to the control of epidemics. By strengthening surveillance and response, including cross-border cooperation on surveillance and response systems these contributes to the reduction of costs associated with disease outbreaks. CDC interventions at provincial, district and community levels improve the capacity of stakeholders to address risks and better prepare for possible epidemics. A. Re-evaluation of Economic Internal Rate of Return

4. Cost-benefit analysis. Following the methods described in the Economic and Financial Analysis at appraisal,1 the project’s cost and benefit were recalculated to reflect additional costs, and expansion in project coverage, as well as update baseline assumptions based on recently available data. However, in addition to serious methodological constraints for analyzing the economic benefits of a regional project focusing on public goods, the absence of a specific epidemiological data limits the estimation of project benefits. The estimation relies on the available information to support its assumptions and provide conservative estimates of project benefits and economic internal rate of return (EIRR). Table A11.1 summarizes the key assumptions used in this report, and reflects any departure made from the initial assumptions at project appraisal.

1 The Economic and Financial Analysis at appraisal follows ADB’s Guidelines for the Economic Analysis of Projects,

ADB’s Handbook for the Economic Analysis of Health Sector Projects, Jeffry Hammer’s Economic Analysis of Health Projects, and other publications.

Appendix 11 161

Table A11.1: Assumptions for the Re-estimation of Project Cost-effectiveness Assumption at appraisal Revised assumption Total project cost $ 54 million $ 63.5 million Population and provinces covered

CAM: 6.5 million in 9 provinces LAO: 3.1 million in 11 provinces VIE: 22.3 million in 21 provinces

CAM: 6.5 million in 12 provinces LAO: 3.1 million in 12 provinces VIE: 22.3 million in 20 provinces

Expected reduction in burden of disease

by 20% for dengue fever, by 90% for intestinal worm infection

by 10% for dengue fever, by 10% for intestinal worm infection

Probability of occurrence of major epidemic

5% 5% (same as at appraisal)

Benefit of epidemic control (as % of the GDP)

0.2% 0.2% (same as at appraisal)

Discount factor 12% 12% SCF 0.988

5. Productivity benefits. At the end of the project, the economic benefits of the project in terms of productivity gains is estimated at around $43.6 million (in 2010 $), lower than the $85.2 million estimated at appraisal. At the appraisal, the project was expected to reduce the disease burden of dengue fever by 20% and by 90% for intestinal worm over the operational life of the project. Given that the baseline disability-adjusted life years (DALYs) for both diseases were actually higher than initially projected based on 2004 WHO data, the expected percentage reductions in disease burden were adjusted to a more conservative value for both diseases (10%). But as in the appraisal, the productivity benefits throughout the project implementation were quantified at project completion in terms of the value of the expected reductions disease burden across project areas. It is estimated by multiplying the average income or cost of labor by the gains in disability-adjusted life years (DALYs) per disease among the working-age population across project areas.2 The DALY disease burden comprises mortality, captured through years of life lost, and years lived with disability.

6. Benefit of epidemics control. The project is expected to improve the local surveillance and response system in the project areas. Surveillance entails tracking of the disease and programmatic responses, and taking action based on the data received. Improved surveillance is estimated to reduce the negative cost impact of the serious epidemics on the GDP by around $99.6 million (in 2010 $) or higher than at appraisal.3 Based on estimates of past epidemics, the model assumes that a good surveillance and response system on average avoids the cost of a major epidemic in the project area (0.2% of GDP), which has a 5% chance of occurrence.

7. Net present value of benefits and EIRR. At completion, the discounted total benefits of the project over 6 years in the three countries are estimated at around, $95.9 million (in 2010 $). This excludes possible sustained benefits years after the end of the project. As at appraisal, a 12% discount rate was used in line with the first project analysis. With a total cost of $74 million over 5 years, the project’s economic net present value is estimated at around $21 million (high for Viet Nam, and negative for both Cambodia and the Lao PDR) and EIRR at 21%, both lower than at appraisal ($27 million and 28%).4 These underestimate the total economic benefits from the project. Apart from disease outbreaks, other factors not considered are reduced cost of health

2 The World Bank’s WDI Online provides data on average annual GDP per capita for the 3 countries, while WHO (2018)

provides national estimates for the disability-adjusted life years per disease for population aged 15-29, 30-49, and 50-59 for 2010. At appraisal, benefits were estimated using projected income and population-projected DALYs based on 2004 WHO data. In addition to using recent data, unlike at appraisal, DALYs in the project sites are assumed to be lower than national estimates by around 10%.

3 At appraisal, annual GDP is estimated assuming a 5% GDP growth across the 3 countries. At project completion, data on average annual GDP per capita for the 3 countries from the World Bank’s WDI Online were used.

4 The computation has included the cost of the capital for Cambodia and the Lao PDR as the project for those two countries is funded by an ADB grant.

162 Appendix 11

services, such as for Dengue prevention, improvements in learning and cognitive performance and maternal outcomes as a result of deworming, and population impact of interruption of disease transmission. Estimation of these benefits would require more substantive data collection and modeling. B. Financial Sustainability Analysis

8. The project’s recurrent costs include costs of service delivery, procurement of medical supplies, and ongoing institutional strengthening, which together account for about $1.35 million per year during implementation. These are not expected to decline following project completion as these services are to be maintained by the national governments and provinces. Government expenditures for recurrent costs are increasing, indicating future sustainability of the project. Recurrent cost implications for the targeted provinces are estimated at 1% of recurrent spending for Cambodia and Viet Nam, and about 10% for the Lao PDR. National governments are expected to continue subsidizing preventive services.

Table A11.2: Health Expenditures for Cambodia, Lao PDR, and Viet Nam

Indicator Cambodia Lao PDR Viet Nam

Population, total—WDI-2009 14,446,056 5,859,891 85,154,900

Population growth (annual %)—WDI-2009 1.74 1.73 1.2

GDP growth (annual %)—WDI-2009 10.2 7.86 8.48

GDP per capita (constant 2000 US$)—WDI-2009 494.69 467.67 617.25

Total expenditure on health as % of GDP—WHO 6* 3.6 6.6* Per capita total expenditure on health at average exchange rate (US$)—WHO 30* 22* 46* Per capita total expenditure on health sector at international dollar rate—WHO 167* 85* 264* Private expenditure on health sector as % of total expenditure on health sector—WHO 73.9* 79.2 67.6* Public (government) spending on health sector as % of total expenditure on health sector—WHO 26.1* 20.8 32.4* Government (domestic) expenditure on health sector as % of total expenditure on health sector--WHO 10.7* 4.1* 6.8* Out-of-pocket expenditure on health sector as % of total expenditure on health sector—WHO 62.37* 74.05* 60.5* External assistance on health as % of total health spending—WHO 22.3* 14.1* 2.2* GDP = gross domestic product, Lao PDR = Lao People’s Democratic Republic, WHO = World Health Organization. Source: WHO and WDI, 2007 (*: 2006).

Table A11.3: Project Recurrent Cost Financing

Indicator Cambodia Lao PDR Viet Nam Total national health spending ($ million) 433 129 3,917 Total government health spending ($ million) 46.3 5.3 266.4 Total project cost per year ($ million) 2.0 2.4 6.0 Average recurrent Project cost per year ($ million) 0.3 0.3 0.8 Project recurrent cost to Government (domestic) spending on health

0.6 5.6 0.3

Lao PDR = Lao People’s Democratic Republic.

Appendix 12 163

CONTRACT AWARDS OF ADB LOAN AND GRANT PROCEEDS

Table A12.1: G0231-CAM Annual and Cumulative Contract Awards of ADB Grant Proceeds ($ million)

Annual Contract Awards Cumulative Contract Awards

Year Amount


($ million) % of Total 2011 0.18 1.82 1.18 1.82 2012 2.16 21.63 2.34 23.45 2013 3.12 31.25 5.45 54.70 2014 2.14 21.42 7.59 76.12 2015 1.19 11.97 8.78 94.18 2016 1.03 10.29 9.81 100.00 2017 1.16 1.62 9.97 100.00 2018 0.00 0.00 9.97 100.00

Total 9.97 100.0% ADB = Asian Development Bank. Source: Asian Development Bank.

Figure A12.1: G0231-CAM Projection and Cumulative Contract Awards of ADB Grant Proceeds ($ million)

Year 2011 2012 2013 2014 2015 2016 2017 2018

Projected 1.00 3.00 5.50 8.00 9.70 10.00 10.00 10.00

Actual 0.18 2.34 5.45 7.59 8.78 9.81 9.97 9.97




0.00

2.00

4.00

6.00

8.00

10.00

12.00

2011 2012 2013 2014 2015 2016 2017 2018

Projected Actual

164 Appendix 12

Table A12.2: G0448-CAM Annual and Cumulative Contract Awards of ADB Grant Proceeds ($ million)


Year Amount


($ million) % of Total 2016 1.08 28.91 1.08 28.91 2017 2.42 64.91 3.50 93.82 2018 0.23 6.18 3.73 100.00

Total 3.73 100.0% ADB = Asian Development Bank. Source: Asian Development Bank.

Figure A12.2: G0448-CAM Projection and Cumulative Contract Awards of ADB Grant Proceeds ($ million)

Year 2016 2017 2018

Projected 2.00 2.00 4.00

Actual 1.08 3.50 3.73



0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

1 2 3

Chart Title

Projected Actual

Appendix 12 165

Table A12.3: G0232-LAO Annual and Cumulative Contract Awards of ADB Grant Proceeds ($ million)


Year Amount


($ million) % of Total 2011 1.75 14.59 1.75 14.59 2012 2.15 17.90 3.90 32.49 2013 2.21 18.40 6.10 50.89 2014 2.72 22.66 8.82 73.56 2015 2.29 19.12 11.11 92.68 2016 0.35 2.94 11.46 95.62 2017 0.46 3.87 11.93 99.49 2018 0.07 0.59 11.99 100.00 Total 11.99 100.00

ADB = Asian Development Bank. Source: Asian Development Bank.

Figure A12.3: G0232-LAO Projection and Cumulative Contract Awards of ADB Grant Proceeds ($ million)

Year 2011 2012 2013 2014 2015 2016 2017 2018

Projected 1.00 3.50 6.50 10.00 11.70 12.00 12.00 12.00

Actual 1.75 3.90 6.10 8.82 11.11 11.46 11.93 11.99




0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

2011 2012 2013 2014 2015 2016 2017 2018

Projected Actual

166 Appendix 12

Table A12.4: G0449-LAO Annual and Cumulative Contract Awards of ADB Grant Proceeds ($ million)


Year Amount


($ million) % of Total 2016 1.26 43.06 1.26 43.06 2017 0.63 21.33 1.89 64.36 2018 1.04 35.61 2.93 100.00 Total 2.93 100.00


Figure A12.4: G0449-LAO Projection and Cumulative Contract Awards of ADB Grant Proceeds ($ million)

Year 2016 2017 2018

Projected 1.50 3.00 3.00

Actual 1.26 1.89 2.93



0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

1 2 3

Projected Actual

Appendix 12 167

Table A12.5: L2699-VIE Annual and Cumulative Contract Awards of ADB Loan Proceeds

($ million) Annual Contract Awards Cumulative Contract Awards

Year Amount


($ million) % of Total 2011 0.01 0.05 0.01 0.05 2012 5.05 20.18 5.07 20.23 2013 8.50 33.95 13.57 54.18 2014 5.29 21.12 18.86 75.30 2015 3.17 12.64 22.02 87.94 2016 2.68 10.69 24.70 98.63 2017 0.31 1.22 25.01 99.85 2018 0.04 0.15 25.04 Total 25.04 100.0%


Figure A12.5: L2699-VIE Projection and Cumulative Contract Awards of ADB Loan Proceeds ($ million)

Year 2011 2012 2013 2014 2015 2016 2017 2018

Projected 1.00 4.00 9.50 17.00 25.60 25.60 25.60 25.60

Actual 0.01 5.07 13.57 18.86 22.02 24.70 25.01 25.04




0.00

5.00

10.00

15.00

20.00

25.00

30.00

2011 2012 2013 2014 2015 2016 2017 2018

Projected Actual

168 Appendix 12

Table A12.6: G0450-VIE Annual and Cumulative Contract Awards of ADB Grant Proceeds ($ million)


Year Amount


($ million) % of Total 2016 0.14 6.83 0.14 6.83 2017 1.16 57.48 1.30 64.31 2018 0.72 35.69 2.02 100.00 Total 2.02 100.0%


Figure A12.6: G0450-VIE Projection and Cumulative Contract Awards of ADB Grant Proceeds ($ million)

Year 2016 2017 2018

Projected 1.25 2.50 2.50

Actual 0.14 1.30 2.02


over by adjusting the projection of the 1st quarter of the following year. First partial cancellation of $174,600 was approved on 1 September 2017; Second partial cancellation of

$303,894.26 was approved on $303,894.26 was approved on 21 December.

0.00

0.50

1.00

1.50

2.00

2.50

3.00

1 2 3

Projected Actual

Appendix 13 169

CHRONOLOGY OF MAIN EVENTS G0231-CAM Date Event 22 November 2010 Board Approval 11–12 October 2010 Grant negotiations 27 January 2011 Grant signing 22 March 2011 Grant effectiveness 27–29 June 2011 Inception mission 31 January 2012 Minor change memo: Change in scope of reallocation of grants proceeds 22 October 2012 Minor change memo: Consulting services and use of single source selection 1 March 2013 Minor change memo: Change in consulting services recruitment and

procurement packages 11 September 2013 Minor change memo: Reallocation of grant proceeds 15 July 2014 Minor change memo: Change in consulting services recruitment and

procurement packages 16 September 2015 Minor change memo: Extension of closing date, reallocation of grant proceeds

and revision of contract awards and disbursement projections 28 February 2018 Financial Closing Source: Asian Development Bank.

G0448-CAM Date Event 26 October 2015 Board Approval 18 August 2015 Grant negotiations 10 November 2015 Grant signing 4 January 2016 Grant effectiveness 18–24 August 2016 Inception mission 28 February 2018 Financial closing date Source: Asian Development Bank

G0232-LAO Date Event 22 November 2010 Board Approval 11–12 October 2010 Grant negotiations 8 December 2010 Grant signing 22 March 2011 Grant effectiveness 7–10 June 2011 Inception mission 15 December 2014 Minor change memo: Change in procurement plan 16 September 2015 Minor change memo: Extension of closing date and revision of contract

awards and disbursement projections 19 April 2018 Change in Disbursement Arrangements: Extension of Winding-up Period 29 August 2018 Financial Closing Source: Asian Development Bank.

G0449-LAO Date Event 26 October 2015 Board Approval 18 August 2015 Grant Negotiations 17 November 2015 Grant signing 4 January 2016 Grant effectiveness 22–27 July 2016 Inception mission 19 April 2018 Change in Disbursement Arrangements: Extension of Winding-up Period 29 August 2018 Financial closing date Source: Asian Development Bank.

170 Appendix 13

L2699-VIE Date Event 22 November 2010 Board Approval 1112 October 2010 Loan negotiations 23 February 2011 Loan signing 20 May 2011 Loan effectiveness 30 May–3 June 2011 Inception mission 15 May 2015 Minor change memo: Change in Procurement Plan 16 September 2015 Minor change memo: Extension of closing date and revision of contract

awards and disbursement projections 13 July 2018 Financial Closing Source: Asian Development Bank.

G0450-VIE Date Event 26 October 2015 Board Approval 18 August 2015 Grant Negotiations 19 February 2016 Grant signing 19 May 2016 Grant effectiveness 4–8 July 2016 Inception mission 1 September 2017 Memo: Partial Cancellation ($174,600) 21 December 2017 Memo: Partial Cancellation ($303,894.26) 13 July 2018 Financial Closing Source: Asian Development Bank.

draft pcr cdc2 final 21 june - asian development …...completion report project numbers: 41505-012,...

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