D_cument of The World Bank FOR oUTcL USE ONLY Repet No. P-4157-GH REPORT AND RECOMMENDATION OF THE PRESIDENT OF THE INTERNATIONAL DEVELOPMENTASSOCIATION TO THE EXECUTIVE DIRECTORS ON A PROPOSED CREDIT OF SDR 13.8 MILLION TO THF. REPUBLIC OF GHANA FOR A HEALTH AND EDUCATION REHABILITATION PROJECT December 24, 1985 :Tbkd dez ut b a nsutkdd didbuiu ma amy be .d by reipiens oly in the pofmumue d :~~br mml c-im ,w sO dwbe edd ko Ww Ban -mwbaf Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized
Transcript
D_cument of
The World Bank
FOR oUTcL USE ONLY
Repet No. P-4157-GH
REPORT AND RECOMMENDATION
OF THE
PRESIDENT OF THE
INTERNATIONAL DEVELOPMENT ASSOCIATION
TO THE
EXECUTIVE DIRECTORS
ON A PROPOSED CREDIT
OF SDR 13.8 MILLION
TO
THF. REPUBLIC OF GHANA
FOR A
HEALTH AND EDUCATION REHABILITATION PROJECT
December 24, 1985
:Tbkd dez ut b a nsutkdd didbuiu ma amy be .d by reipiens oly in the pofmumue d:~~br mml c-im ,w sO dwbe edd ko Ww Ban -mwbaf
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CURRENCY EQUIVALENTS
Currency Unit Calendar 1984 October 1985US$1 035.9 ¢60V.1 US$0.028 US$0.017
FISCAL YEAR
JANUARY 1 - DECEMBER 31
ABBREVIATIONS AND ACRONYMS
CIDA - Canadian International Development AgencyDHHT - District Health Management TeamEPI - Expanded Program of ImmanizationNDPI - Management Development and Productivity Institute'SFEP - Ministry of Finance and Economic PlanningMOE - Ministry of EducationMOR - Ministry of HealthPER - Public Expenditure ReviewPIL - Princess Marie Louise HospitalP14U - Project Management Unit'PNDC - Provisional National Defense CouncilUNFPA - United Nations Fund for Population ActivitiesUNICEF- United Nations Children's FundUSAID - United States Agency for International DevelopmentWHO - World Health Organization
FOR OMCIAL USE ONLY
GHAXA
HEALTH AND EDUCATION REHABILITATION
PRESIDENT'S REPORT
Table of Contents
Page
CREDIT AND PROJECT SUMMARY i
PART I THE ECONOMY 1
Basic Structural Characteristics . -. . . 1Past Economic Developments - The Inheritance . .2A Program of Reforms .3. . . . . 3Response of the Economy ... ....................... 4The Budget .. 4Money and Credit ... ... ... ... ... ... ... ... 5Prices .. 5Balance of Payments .. 5Development Program .. ... ... ... ... ... ... ... 6External Debt abd Creditworthiness. ... ... ... ... 6
Introduction .. 9Population,Health and Nutrition ... ... . 10Policies and Programs. .10Health Policy.. ... ... 11Population Policy ... .11Public Expenditure Program for
Population, Health and Nutrition . ... ... ... 12External Assistance to the Sector .. 13Policy Issues and Sectoral Needs (Health) . .. ... 14Bank Role .. ... ... ... ... ... ... ... ... ... 14Education .. 15Public Expenditure Program (1986-88) for Education . 16External Assistance .17Policy Issues and Sectoral Needs(Education) ... ... 17
This docamet has a restritd distribution and may be used by recipents only in the performance ofteir official duts Its ontents may not otherwise be dsclosed without World Bank authorization.
GHANA
HEALTH AND EDUCATION REHABILITATION
CREDIT AND PROJECT SUMABRY
Borrower: Government of Ghana
Beneficiaries: Ministry of Health (MOH)Ministry of Education (MOE)Managemen- Development and Productivity Institute (MDPI)
Amount: SDR 13.8 lillion (US$15 million equivalent)
Terms: Standard
Project The project represents the first secp in the long-termDescription: rehabilitation of the health and education sectors.
Designed to address the most urgent needs of the twosectors, the project would: (a) provide emergency assistanceto the health and education systems and to the MnagementDevelopment and Productivity Institute (MDPI); (b) re-habilitate service delivery at the peripheral level of thepublic health system; and (c) strengthen the manafgement andplanning capacity in the Ministries of Health and Education.The project would provide funding for essential equipmentand supplies, instructional materials, civil works, studies,technical assistance and training.
Project The project would yield the following benefits. TheBenefits deterioration in the quality of the health andand Risks: educational systems would be arrested through provision
of urgently-needed imported equipment, materials andsupplies. The delivery of primary health care would beimproved and expanded through strengthened communityoutreach activities, the principal beneficiaries being womeenand children. The institutional capacity for management andplanning in the MOH and MOE would be improved; and specialstudies in the health sector would contribute to thepreparation of a long-term sector plan. The project's mainrisk concerns the implementation capability of theministries. The MOH may experience difficulty incoordinating and implementing the many activities supportedby external assistance. To help mitigate this risk, theproject would provide 16 man-years of local and foreigntechnical assistance to help the MOR. In addition, the MOEmay be hard pressed to oversee the printing and distributionof a large textbook program envisaged under the project. Toalleviate this problem, about half of the textbook contractswould be awarded through ICB, and the project would financetraining programs for supervisors and textbook distributionand storage staff. The project would also support specialproject management units in both ministries.
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Estimated Cost: (net of taxes and duties from which the project wouldbe exempt).
REPORT AND RECOMMENDATION OF THE PRESIDENT OF THEINTERNATIONAL DEVELOPMENT ASSOCIATION
TO THE EXECUTIVE DIRECTORS ON APROPOSED CREDIT TO THE REPUBLIC OF GHANA FOR A
HEALTH AND EDUCATION REHABILITATION PROJECT
1. I submit the following report and recommendation on a proposeddevelopment credit to the Republic of Ghana for the equivalent ofSDR 13.8 million (US$15.0 million equivalent) on standard IDA terms to helpfinance a health and education rehabilitation project.
PART I - THE ECONOMY
2. An economic report entitled "Ghana: Towards Structural Adjust-ment" was distributed to the Executive Directors in October 1985. Asummary of the economic situation is presented in this section. Basiceconomic data and selected social indicators are summarized in Annex I.
3. Ghana once enjoyed a fairly high standard of living compared withmost other West African nations. However, a declining gross nationalincome has combined with high population growth (estimated at about 3 per-cent a year) to cause a substantial erosion in real per capita income. Theaverage per capita income in 1984 is estimated at US$350, which representsa substantial decline over what it was a decade ago. The rate of unemploy-ment is quite high and underemployment is widespread. Almost half thepopulation of about 12 million is now estimated to live in absolutepoverty. The country's basic needs indicators, once the best in Africa,are now no better than those of other Sub-Sab-.a African countries withcomparable per capita incomes. Modern health services are available toonly about a third of the people, and only 47 parcent have access to safewater. Although the education system is well established and primaryschooling has been free since 1962, 50 percent of adult men and 70 percentof adult women have had no formal education.
Basic S-ructural Characteristics
4. Ghana is comparatively well endowed with natural and humanresources. The country has valuable mineral deposits, particularly gold,but also diamonds, bauxite, manganese, and offshore oil. There is furtherpotential for hydro power generation. Ghana has a relatively good supplyof land suitable for growing tree crops, most importantly cocoa, but alsooil palm, rubber, and coconut; cereals and starchy staples; and possessesconsiderable fishing and forestry resources.
5. Agriculture is the largest sector of the economy, accounting forabout half of GDP. Approximately 11 percent of the land area iscultivated. Previously, cocoa had covered about half of the cultivatedland, but acreage has declined greatly in recent years. Nearly 70 percentof the population derive an income from agriculture or related activities.
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The staple foods are maize, rice, millet, yam, cassava, and plantain but,except for cassava, yields have stagnated in recent years. Per capita foodproduction in 1983 was only 61 percent of that in 1975. Prolonged droughtsin 1975-77 and 1982-83, inadequate support services, poor transport facili-ties, and lack of fertilizers and other inputs contributed to the decline.In recent years, Ghana has had to import 10 to 15 percent of its cerealconsumption (mainly rice and maize).
6. Ghana's economy is highly dependent on primary products forexports. Cocoa (of which Ghana is the world's third largest producer)contributes about two-thirds of total export earnings, although productionhas been declining. Mining, primarily gold, is Ghana's second largestforeign exchange earner, contributing 20 percent of the total, althoughproduction has fallen over the past two decades. Timber is also an impor-tant export. Efforts to diversify the export base have not made muchheadway.
7. Industrial production and services currently account for 9 per-cent and 40 percent of GDP, respecti-ely. Manufacturing-including tex-tiles, steel, tires, oil refining and simple consumer goods-contributed5 percent of GDP in 1984 down from 11 percent in 1970 and provided full- orpart-time employment to just over one-tenth of the labor force. Manufac-turing in Ghana remains heavily dependent on imported inputs.
8. Ghana used to import all of its petroleum, mostly in the form ofcrude oil, which is refined domestically and used chiefly as fuel fortransport. Recently, some oil deposits have been discovered and commercialexploitation has commt.. ced. Production of crude is now about 600 barrelsper day, satisfying only a minor share of the country's requirements.Hydroelectric power meets most of Ghana's non-transport commercial energyneeds. It was drastically affected by the drought during 1983-84, butproduction is now returning to more normal levels.
Past Economic Developments - The Inheritance
9. Throughout the 1970s, Ghana's economy was poorly managed. Largebudget deficits, necessitated partly to support a sprawling, inefficientpublic sector, led to a marked acceleration in domestic inflation. Giventhe reluctance to move the exchange rate, the fixed nominal rate becamegrossly overvalued, shifting relative incentives away from exports intoimport trade, and more specifically from cocoa, Ghana's main export, intosubsistence food production. The resulting deterioration in export perfor-mance, combined with a growing disenchantment on the part of aid donorswith Ghana's performance, caused a perpetual foreign exchange crisis thatpushed successive Governments into increasingly restrictive import regimes.What was once an economy with ample imports became one starved of the mainfuel for its growth. The erosion of the tax base due to declining exportsand imports, and the related drop in economic activity forced severecutbacks in Government operations and maintenance and capital expenditures.There was a marked deterioration in what was once a fairly well developedeconomic and social infrastructure. This, in turn, further reduced thecountry's productive capacity.
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10. A tendency to respond to shortages with controls and rationingworsened the problem by eroding the incentives to produce and save, dimin-ishing the capacity of public sector entities to maintain the level andquality of services, and creating a vast parallel black market with itsrelated corruption, smuggling and tax evasion. Declining real wages,political instability and reduced economic opportunities led talented andskilled Ghanaians to leave the country, depriving it of scarce managerial,administrative and technical resources.
11. To add to all its difficulties, Ghana was subjected in the early1980s to three other problems. First, a prolonged and severe droughtcreated the worst food shortages since Independence. Second, the externalterms of trade sharply deteriorated following the increase in petroleumprices, and a softening in prices of Ghana's major exports (cocoa andgold). Third, the sudden return of over one million Ghanaians from Nigeriaseverely strained the food and employment situation. The cumulative effectof the downward economic spiral and these most recent "shocks" to thesystem can be seen in the trends in key economic indicators between 1970and 1982: per capita real income declined by 30 percent; import volumesfell by a third; real export earnings fell 52 percent; domestic savings andinvestment declined from 12 and 14 percent of GDP, respectively, in 1970 toalmost insignificant levels; inflation ran at 44 percent per annum over theperiod.
A Program of Reforms
12. The Provisional National Defense Council (PNDC) came to powerunder the leadership of Flight Lieutenant Rawlings on December 31, 1981.An Economic Recovery Program was developed by the Government in closecoordination with the IMF and the World Bank. The program has been sup-ported by two IMF Standby Arrangements, totaling SDR 419 million, thelatter extending through December 1985; SDR 179 million in purchases fromthe Compensatory Financing Facility (CFF) on account of both a shortfall inmerchandise exports and an excess in the cost of cereal imports; and twoIDA Export Rehabilitation and two Import Reconstruction Credits, in alltotaling some SDR 187 million. Policy measures were aimed at a realignmentof relative prices in favor of production (particularly cocoa, timber, andminerals), an improvement in the Government's financial position, and theencouragement of private investment. The most important measure taken wasthe movement towards a more realistic exchange rate. The cedi depreciatedfrom ¢2.75 = US$1.00 in April 1983 to 050 = US$1.00 by December 1984.Further adjustments occurred during 1985, the most recent being a move to060 = US$1.00 in October 1985. Administered prices have been adjusted toreduce the distortions arising from the overvalued exchange rate, the mostcritical being a near doubling of the cocoa producer price announced in May1985. Petroleum prices have been raised steadily in line with changes inthe exchange rate. In addition, price controls are being dismantled. Only8 items are now subject to price and distribution controls compared to 23in April 1983. Interest rates have been adjusted in stages to the pointthat they are near-1y positive in real terms. The rate on 12-month timedeposits has doubled since October 1983 to the present level of 18 percent.The maximum lending rate is now 23 percent, up nine percentage points sinceOctober 1983. In the area of fiscal policy, the Government's efforts have
concentrated on eliminating subsidies; resource mobilization throughimproved tax collection and selective increases in consumption taxes andcharges; and more adequate provision for maintenance and capital expendi-tures. In addition, public sector salaries and wages, and statutoryminimum wages have been raised to offset partially the drastic erosion inreal income. Even after the adjustments, real wages in the public sectorare less than half their 1978 level.
13. Following che announcement of this program, the Bank, in consul-tation with the Govet.wtent, decided to reactivate the Ghana ConsulwaZiveGroup which had lain dormant for 13 years. There has been a good responseto this initiative. The Group met in Paris, first in November 1983, andthen again in December 1984 and November 1985, and has broadly supportedthe GovernmcLlt's program. Given the new aid commitments of about $478 mil-lion that materialized following the 1984 meeting and the existing pipe-line, disbursements during 1985 are estimated to be about US$300 million,helping to finance the increase in imports, thereby stimulating domesticproduction and exports.
Response of the Economy
14. The initial response of the economy to the policy reforms wastemporarily crippled by the severe drought in 1983 and a lag in aid in-flows. Nevertheless, the government continued and even broadened thereform program. After a real decline in output in 1983, economic perfor-mance sharply improved on several counts in 1984, benefitting to a largedegree from the return to normal rainfall, but also from better policies.The economy grew by nearly 8 percent. Agriculture led growth because of asharp expansion in foodcrops (output more than doubled for several crops),while cocoa production rose by only 8 percent from the historical low ofthe previous crop year. Wholesale and retail trade, and manufacturingoutput increased in line with overall growth, reflecting higher importlevels and the restoration of power supplies. Preliminary estimates for1985 indicate a grouth in GDP of about 5 percent, spurred primarily byhigher output in forestry, mining, and manufacturing. Given the higherbase, growth in agriculture is expected to be less, but cocoa output inlikely to rise to 200,000 tons in the 1985/86 season, an increase of16 percent over 1984/85.
The Budget
15. The Government's fiscal position improved markedly in 1984.Revenues as a share of GDP rose from 5 percent in 1983 to 8 percent in1984. The gain primarily reflected the impact of the depreciation of theexchange rate on the tax base and on the profits of export sectors.Although a lower than expected level of imports caused a shortfall inrevenue in several categories, this was more than made up by higher bankprofits (reflecting the deregulation of interest rates), major gains inincome tax collection, and a sharp increase in nontax revenue. Recurrentexpenditures rose modestly from 7 percent of GDP in 1983 to 8 percent in1984. Development expenditures and net lending increased to 1.7% of GDP,somewhat less than planned. As a result of these trends the overall budgetdeficit narrowed to 1.7 percent of GDP and reliance on bank financing was
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halved to only 0.6 percent of GDP. Although the overall budget deficit isexpected to increase to 2.3 percent of GDP in 1985, primarily because of amuch needed expansion in development expenditures, it is expected thatnearly two-thirds of it will be covered by foreign financing, enablingdomestic bank financing to be contained below the 1984 level.
Money and Credit
16. The massive exchange rate depreciation since April 1983, togetherwith the credit ceilings which are part of the government's program underthe DMF Standby Arrangement, resulted in a severe liquidity squeeze in thebanking system during 1984. While the demand for cedi credit to financeimports expanded sharply, the growth of broad money (M2) declined from49 percent in 1983 to 29 percent in 1984. Domestic credit rose by 32 per-cent in 1984, compared to 41 percent in 1983. The slowdown primarilyreflected lower growth in net credit to the government. Although privatesector credit more than doubled (from a very low base) in 1984, the in-crease was inadequate relative to needs.
Prices
17. Higher food supplies and the resulting sharp drop in prices was amajor reason for the deceleration in inflation in 1984, from an annualaverage increase of 123 percent in 1983 to 40 percent in 1984. This trendcontinued during the first half of 1985. The June 1985 point to point ratewas only 7 percent, despite an exchange rate depreciation of about50 percent in this period. This confirms that prices already werereflecting scarcity values and the tightness of current fiscal and monetarypolicies.
Balance of Payments
18. The current account of the balance of payments showed a deficitof 2.7 percent of GDP in 1984, close to the 1983 level. This outcome wasconsiderably lower than had been expected, almost entirely due to a largeimport shortfall because of the continued tight foreign exchange situationduring the first half of the year. Export earnings rose by about 30 per-cent, reflecting higher world prices for cocoa and an increase inelectricity sales. On the capital account, in spite of some initialdelays, aid disbursements rose sharply; net aid increased from 0.9 percentof GDP in 1983 to 3.4 percent in 1984. Allowing for other official andprivate capital movements, the overall deficit in 1984 amounted to$121 million. This was financed by net IMF purchases of $214 million. Thebalance of Fund resources was used to reduce arrears and to build upforeign exchange reserves. In 1985 both exports and imports are expectedto recover further and the current account deficit is projected to widen to5.5 percent of GDP. Higher capital inflows are forecast, enabling theoverall deficit to decline from the 1984 level. Expected IMF repurchaseswould be sufficient to cover the deficit and to clear more payment arrears.
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Development Program
19. In addition to achieving an appropriate incentive framework,public expenditure policy is an equally important component of the Govern-ment's development strategy. The neglected state of Ghana's economic andsocial infrastructure has become a critical bottleneck to the reform
v~ program's efforts to generate a strong supply response. Recognizing thisweakness, the Government's Economic Recovery Program for L984-86 initiatedrehabilitation programs in key sectors - cocoa, timber, gold mining, andtransport infrastructure. At the same time, the Government has begun toprepare a three-year rolling development program, beginning in 1986, basedon a review of public expenditures conducted jointly with the Bank in thespring of 1985. ihe highest priorities in the area of recurrent expendi-tures are to restore the viability and efficiency of public administrationand to expand significantly support to health and education. In addition,adequate allocations need to be provided for operations and maintenance.To meet these needs, the annual average recurrent expenditures during1986-88 would have to be about 20 percent higher in real terms than thelevels budgeted in 1985. The initial work on the capital side indicatessubstantial rehabilitation needs of the strategic economic sectors -agriculture, mining, and economic infrastructure. Consequently, there is alarge number of projects with high returns on incremental investments. Theonly area where significant new investments have been identified is oilexploration, which would be financed primarily by foreign investors.
External Debt and Creditworthiness
20. Ghana's medium- and long-term external public debt outstandingand disbursed at end-1984 amounted to $1.1 billion, about 20 percent ofG1DP. Bilateral creditors account for slightly less than half of the total,multilateral sources for about 40 percent (Bank loans and IDA creditscomprise 28 percent of total debt), and suppliers credits for only 10 per-cent. Despite the predominance of soft loans, Ghana's debt service burdenin the coming years is likely to be very heavy, for several reasons: first,amortization of previously rescheduled debt began in 1983; second, there isa relatively large amount of short-term debt, including $230 million ofpayment arrears at end-1984 which are to be cleared by 1988; and third, thereported debt excludes the use of Fund credit under the recent StandbyArrangements. The debt service ratio doubled from 14 percent in 1982 to29 percent in 1984. Including IMF charges and arrears payments, the sharewas 44 percent. In 1985-86 the debt service ratio is expected to be about44 percent, 60 percent including IMF charges and arrears payments.
21. In spite of the considerable gains which have been made, Ghana'seconomic situation remains difficult. That consideration plus the coun-try's dependence on, and hence vulnerability to, fluctuations in cocoaearnings, make it desirable that future debt service obligations be kept aslow as possible. In addition, Ghana's per capita income is relatively low($350). Consequently, Ghana will have to depend on IDA resources for BankGroup borrowing over the next few years. In order to help ensure anadequate flo-w of toreign exchange into Ghana and to supplement the coun-try's resource mobilization efforts, it also would be appropriate fordonors to finance a significant portion of local project costs.
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PART II - BANK GROUP OPERATIONS IN GHANA
Lending Strategy
22. The principal objectives which now guide the formulation of theBank's assistance program to Ghana are: (a) to support the adoption ofpolicies designed to adjust the structure and improve the efficiency of theeconomy and return it to a path of growth; (b) to help rehabilitate andimprove capacity utilization of the country's existing productive assets;(c) to stimulate agricultural and industrial production, particularly forexport promotion and efficient import substitution; and (d) to improve thecountry's essential infrastructure (transport, water, petroleum, power) andrelieve major bottlenecks to increased production. The Bank Group isundertaking a substantial program of economic and sector work to broadenand deepen understanding of the constraints which are likely to impede therecovery process and to provide direction to future lending and the designof project components. An economic memorandum (Report No. 5854-GH datedOctober 7, 1985) has been prepared and, in preparation for the SecondReconstruction Imports Credit, the Government budget and import program for1985 were reviewed in detail. A public expenditure review, an agriculturalsector review and an industrial sector study have been completed. Anenergy assessment is currently being carried out. In both lending andeconomic sector work, attention is being given to ways of strengthening theinstitutions responsible for economic management and development spending.The Bank's dialogue has been most effective, and the Government continuesto be both receptive and responsive to the Bank's advice.
23. In response to the Government's announcement of a major economicreform program in April 1983, the Bank Group reopened its lending to Ghanawhich had been put in abeyance for nearly two years due to political andeconomic uncertainties and lack of proper economic policies. The ExecutiveDirectors approved a US$40 million Reconstruction Import Credit (RIC) whichaim to meet emergency import requirements for the agricultural and trans-port sectors and is now approaching successful completion. A second RICfor US$60 million covering the agriculture, transport, mining and manufac-turing sectors was approved in March 1985 and supplemented with a SpecialAfrican Facility Credit of US$27 million in September 1985. Two creditswere also made for export rehabilitation and related technical assistance.To date, despite some expected initial problems, the performance onprojects approved after April 1983 has been satisfactory.
24. In the near term, IDA expects to support programs for rehabili-tation of Ghana's main ports as well as an agricultural rehabilitationproject emphasizing cash crops. Similarly, in industry, the rehabilitationand restructuring of key subsectors is envisaged. In brief, projects withmajor rehabilitation components are likely to absorb the bulk of IDAresources for the next few years as these are likely to show the highestbenefits and quickest returns. IDA is also maintaining a dialogue with theGovernment for a possible structural adjustment credit in the near future.The extent to which the Bank Group can provide financial and technicalassistance to support such a broad-based program will be conditioned uponthe performance of the Government in carrying through its economic recovery
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program. However, implementation of the recovery program and of therehabilitation-related projects also depends on improvement in the socialsectors. The proposed project is IDA's first attempt to rehabilitate thebadly deteriorated health and education sectors.
Past Operations
25. Since 1962, when the Bank Group financed its first operation inGhana, the Bank has mtade 10 loans totalling US$189.7 million and 30 creditstotalling US$595.2 million (including two Special African Facility Creditsfor US$37 million). In addition, Ghana is a beneficiary of a Bank-financedregional clinker project covering three countries (Togo, Ivory Coast andGhana). An IFC investment of US$55 million in Ashanti GoldfieldsCorporation in Ghana was approved in June 1984. Annex II contains asummary statement of Bank loans and IDA credits as of September 30, 1985.
26. Energy has been a major focus of Bank Group lending to Ghana(23.5 percent of commitments). Projects financed in this sector includethree hydro power generation projects and three power distributionprojects. A project aimed at strengthening Ghana's technical capacity toaccelerate petroleum exploration was approved in May 1983. A secondproject in the sector, approved in March 1984, provideg technical assis-tance and financing of immediate requirements for rehabilitation of Ghana'ssole refinery. The second most important sector in the Bank Group'sprogram in Ghana is transportation (18.2 percent of commitments) with fourroad projects and a railway rehabilitation project. The two ReconstructionImport Credits and the Export Rehabilitation Project are also providingpartial emergency assistance to the road transport and port subsectors.The Accra District Rehabilitation Project supports the transport subsectorin the Accra area as well as the strengthening of the administrative andfinancial basis of the Accra City Council and the improvement of a poorersection of the city. In agriculture (17.4 percent of commitments), themain thrust of the Bank Group's operations has been tc assist the countryin achieving self-sufficiency in agricultural production, particularly foodand raw materials for agro-industries, and rehabilitating the cocoasubsector. In the field of water supply, three projects (in 1969, 1974 and1983) have helped increase and improve water supply in the Accra/Temametropolitan area and adjacent rural areas, with the most recent onehelping to carry out emergency repairs and maintenance on main waterpipelines. In the manufacturing sector, two DFC operations (in 1975 and1979) have financed investment projects in manufacturing and agro-industryundertaken by small and medium enterprises.
Project Implementation Experience
27. The country's economic difficulties in recent years haveadversely affected a number of Bank Group-financed projects. DwindlingGovernment revenues have denied projects needed local financing, and thelack of foreign exchange has resulted in a severe shortage of importedmaterials and spare parts required for completed projects. The mass exodusof qualified Ghauaians to neighboring countries, and demoralization,absenteeism and low productivity among the remaining work force have alsoadversely affected project performance. The unusually adverse conditions
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surrounding Bank Group-financed projects and their generally poor perfor-mance have been described in greater detail in the Project PerformanceAudit Reports. Overall, the main conclusion of the reports was thatmacroeconomic and sectoral policy constraints were the major factorsresponsible for poor performance of the audited projects. Because ofdelays experienced in the implementation of a number of Bank Group-financedprojects in Ghana, disbursement performance is behind appraisal estimates.Annual gross disbursements over the four-year period FY81-84 have averagedabout 20 percent of outstanding loan/credit commitments and as ofSeptember 30, 1985, US$365.6 million remained undisbursed. The Bank Grouphas held periodic implementation reviews with the Government to identifysteps which could be taken by borrowers and the Bank Group to acceleratedisbursement on ongoing loans and credits.
IFC Operations
28. IFC approved an investment of US$55 million in the mining sector(Ashanti Goldfields Corporation Ltd. (AGC)) in June 1984. This is IFC'sfirst investment in Ghana. The loan will help finance a US$158 millionrehabilitation project designed to increase gold output from about255,000 oz. in 1984 to 400,000 oz. in 1989-90, a level of production AGClast achieved in the early 1970s before the deterioration in Ghana'sforeign exchange situation began to affect production at the mine.
PART III - THE HEALTH AND EDUCATION SECTOR
Introduction
29. The economic decline of the past decade in Ghana has had aparticularly serious impact on the social sectors. The health andeducation systems have severely deteriorated in urban as well as ruralareas. Macro-economic constraints have limited expenditures in bothsectors which, together with the Government wage policy, have contributedto manpower deficits, inadequate support services and ineffectiveadministrative capacity. Skewed resource allocations have resulted in moreemphasis on hospital and curative care rather than primary health andpreventive care and on university training rather than primary education.Since the constraints affecting Government expenditures in health andeducation are likely to continue, the health and education sectors mustimprove the use of existing human and financial resources and introducecost recovery measures to help meet part of the required operating costs.Further deterioration in the health and education systems should beprevented by a meaningful rehabilitation program, for which a significantincrease in external assistance is required.
30. The Bank has recently carried out a Public Expenditure Review(PER) on a broad spectrum of the Ghanaian economy. The results of thereview have been discussed with the Government. Based on the discussions,the priorities and target areas in the health and education sectors havebeen established. The project has been formulated on the basis of these
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priorities and addresses as well the emergency aspects of the health andeducation sectors.
POPULATION, HEALTH AND NUTRITION
Policies and Programs
31. Status. The economic difficulties of the past decade have led toa marked deterioration in health care services and general impairment ofhealth. Although the allocation for health expenditures has beenmaintained at 7 to 10 percent of the national budget, the per capitaexpenditure in the health sector has been reduced in nominal terms fromabout US$10 in 1974 to US$4 in 1984. In real terms the decline has beeneven greater. The budget is unbalanced with urban facilities receivingmore than 80 percent of the total budget allocation. Moreover, Governmentexpenditures in the health sector in recent years have been almostexclusively on wages, with limited support for critical non-wage items andvIrtually none for capital expenditures. Very low wages and poor workingconditions have contributed tc- the exodus of physicians and nurses as wellas to low morale. For example, between 1981 and 1984 the number ofphysicians in Ghana dropped by one half-from 1,665 to 817. Limitedexpenditures on budgeted non-wage items have resulted in inadequate support(logistics, supplies, communications). Lack of foreign exchange hasseverely limited imports of spare parts, equipment and drugs. Con-sequently, hospitals, health centers, training institutions and storagefacilities are in disrepair, and vehicles are poorly maintained. TheMinistry of Health's national radio communications network has broken down.In essence, the disruption in service delivery is the result of a generalbreakdown in the administrative and support systems. Nonetheless, many MORworkers, especially at the peripheral level in rural and urban areas and atthe specialized referral hospitals treating severe malnutrition cases, havepersevered in delivering some degree of health care under very tryingconditions.
32. Vital statistics have not been updated since the end of the1970's and do not reflect accurately the dramatic effect of the deteriora-tion. Recent reports indicate that mortality has increased, especially ininfants and children. Provision of health services has been disrupted bylack of supplies and manpower, thus reducing the utilization of suchservices in most facilities. The decreased production of food crops,drought conditions, declining purchasing power and dramatic increases infood prices in recent years have adversely affected nutritional status,particularly among pregnant and lactating mothers and pre-school children.Since the impact of these factors on food consumption is not welldocumented, there is need for better information on nutritional status andfor comparing basic indicators over time.
33. The MOE delivery system is orgunized into 10 health regions, eachwith 3 to 10 Government districts-a total of 68 districts nationwide. Twoteaching hospitals, 9 regional hospitals and some 50 district hospitalsserve as referral centers and provide tertiary and secondary care services.
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The MOH (1985) personnel staff includes about 460 doctors, 10,000 nursesand 27,000 other workers (principally non-health providers). The organiza-tion and delivery of health services is based on a three-tier system ineach of the districts. The district (Level C) is responsible for planning,monitoring, supervision, data collection, budgeting and finance and isheaded by a District Health Management Team (DEKT) consisting of a medicalofficer, public health nurse, health inspector, health administrator andmedical officer-in-charge of the district hospital. The health stations(Level B), which cover a population of 5,000 to 20,000 within a five-mileradius, are responsible for the first level of referral and supervision ofcommunity-level workers and are staffed by one or more community nursemidwives, environmental health workers and auxiliaries. The community(Level A) consists of community-based workers (community clinic attendant,traditional birth attendant and community environmental development worker)who are selected and compensated by the community and work with the Volun-teer Health Brigade overseen by the Local Health Committee. (An organiza-tion chart of the MOE is found in Annex VII.)
34. Health Policy. In 1978, Ghana formulated a primary health care(PEC) policy and strategy within the context of the WHO Alma-Ata Declara-tion. The goal was to provide PEC services to 80 percent of the populationby 1990 and to focus on common health problems that account for 80 percentof avoidable mortality and morbidity. Despite the policy statement andsubsequent endorsement of the PHC strategy in 1982 by the PNDC Government,initial efforts to promote PHC in 25 of the 68 districts failed due toinadequate training, lack of essential support systems (equipment, trans-port, supplies) and poor supervision. Nevertheless, in view of renewedGovernment interest in community outreach programs, including the PlCconcept, and the availability of external assistance, the MOH has outlineda sector strategy to:
a) restructure the delivery of health services with the healthstation (Level B) as the focal point;
b) promote community involvement in health services management; and
c) generate revenues to help meet operating costs through user feesand the sale of drugs.
In order to implement the strategy, the MOH has developed a short-term planfor 1986-88 (para. 36) and intends to develop a long-term plan on the basisof carefully-conducted sectoral studies.
35. Population Policy. In 1969, Ghana established the first officialpopulation policy in Sub-Saharan Africa. A population program was begun inthe early 1970's to help meet the country's demographic goal of apopulation growth rate of 1.8 percent by the year 2000. However,achievement has fallen far short of the goal. The population growth rateremains high; contraceptive practice is low (5 to 7 percent); and desiredfamily size is still large. In addition, the Government entity responsiblefor planning and coordinating population programs in the public and privatesectors is practically moribund. The Ghana National Family PlanningProgram (GNFPP) Secretariat tried, unfortunately, to become an operational
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rather than coordinating body, creating in the process a cadre of familyplanning nurses with special allowances. As a result, mny healthproviders in the Ministry of Health, especially nurses, consider familyplanning an "additional task" rather than an important element of maternaland child health services. Because of the limited public sector activity,non-governmental organizations, particularly the Planned ParenthoodAssociation of Ghana, have been the major, albeit limited, providers offamily planning information and services. The NOR now plans to takeresponsibility for the delivery of family planning services in the publicsector. The goal is to increase contraceptive usage through the MOH fromtwo to six percent by the end of 1987. 1/
Public Expenditure Program (1986-88) for Population, Health and Nutrition
36. During the Public Expenditure Review (PER), the mission and MOHofficials agreed to construct a three-year expenditure program based on theMinistry's needs, rehabilitation strategy and program priorities. Themajor focus would be on the infrastructure support required to rehabilitateexisting facilities in order to build a viable base for the PHC system,particularly in rural areas. The specific priority activities identifiedwere maternal and child health and family planning; expanded program ofimmunization (EPI); diarrheal disease control; health and nutrition educa-tion; malaria control and sanitation. To strengthen and improve theimplementation of these programs the MOHB's principal needs were determinedto be: (a) rehabilitation of rural health stations, urban health centersand selected hospitals; (b) in-service technical and managerial training atthe regional, district and health center levels; (c) improvement of thelogistical system, including the cold chain for vaccines and distributionof supplies, drugs and contraceptives; (d) development of a basic health/management information system; and (e) implementation of cost recoverymeasures. It was further agreed that preparation of a long-term healthsector plan should start as soon as possible to serve as the basis for thesecond phase of the MOB rehabilitation and health services improvementprogram.
37. The three-year (1986-88) expenditure program, which represents apreliminary estimate of the financial requirements for the first phase ofthe MOH's rehabilitation program, totals some US$390.0 million, of whichUS$ 304.0 million are for recurrent expenditures. The projections arebased on: (a) an approximately 50 percent increase in MOR salaries by 1988in constant 1985 prices to improve incentives for qualified staff; (b) amore than two-fold increase by 1988 in support of non-wage expenditures;(c) generation of revenues equivalent to 15 percent of total recurrentexpenditures in 1986 and remaining at that level euzrough 1988; and
1/ If the commercial sector, through some 3,000 commercial outlets andwith external assistance (USAID), goes fron virtually nothing atpresent to 7 percent, and the non-governmental organizations remain atabout 3 percent, the cortraceptive prevalence rate of the combinedprograms is expected to reach 16 percent by 1988.
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(d) continued subvention to church-run hospitals, more than doublingthrough 1988.
38. The Government is expected to finance about 60 percent(US$190.0 million equivalent) of total recurrent expenditures and cover anadditional 15 percent through cost recovery measures. If total recurrentexpenditures reach US$304.0 million, then the amount financed by Governmentand generated by cost recovery would be US$190.0 million andUS$42.0 million respectively. As for capital expenditures, it is assumedthat the Government could finance at best 15 percent (US$13.0 millionequivalent) of the total. Assuming a US$390.0 million program for1986-1988, the external financial requirements would be US$145.0 million.Of this amount, other donors are assisting the health sector with someUS$50.0 million, or about one-third of the financial gap. Agreement wasreached during negotiations that the Government would undertake a costrecovery program which would generate revenues equivalent to at least15 percent of total recurrent expenditures of MOR in 1986, 1987 and 1988.
External Assistance to the Sector
39. The external assistance of US450.0 million is based on known andanticipated support from a number of multilateral and bilateral donors. 1/(Details of the external assistance are provided in Annex IX.)
(a) UNICEF has approved a US$8.4 million five-year project to supportimmunization and diarrheal disease control nationvide, and health andnutrition activities in about 25 percent of the districts.
(b) UNFPA has funded a US$3.0 million four-year project, of which half isfor maternal and child health and family planning, and half is fordata collection and analysis of the 1984 census. Pendting approval bythe UNFPA is an additional project to assess the impact of thenational population policy and prepare a multisectoral plan forpopulation, human resources and development planning.
(c) USAID has approved a US$7.5 million three-year project to support thedistribution of contraceptives through the MOB infrastructure and theprivate commercial sector. USAID will also support In-servicetechnical and managerial training for health providers and improvementof the MOH logistics system.
1/ Not included in the US$50.0 million is the indirect support to thehealth sector from the Federal Republic of Germany which approved aDM 33.0 million (approximately US$10.0 million) three-vear loan inJanuary this year to expand the manufacturing capability of GIHOCPharmaceutical Company, which manufactures essential drugs for theMOH.
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(d) WHO, which provides US$1.2 million in biennial support to Ghana,recently funded missions to study the organization and management ofthe MOH and the system of drugs procurement, storage and distribution.
(e) CIDA approved in 1984 a US$2.5 million five-year project as part ofthe integrated development program in the Northern Region tostrengthen the MOH infrastructure and support PHC and immunizationprograms in rural areas.
(f) The Swiss Government provided a loan of US$1.0 million to purchase rawmaterials for local drug production.
(g) The Japanese Government recently extended its support to the NoguchiMemorial Institute for tropical disease research for anotherfive years at approximately US$0.5 million annually.
(h) The Saudi Fund for Development has offered a US$10.0 million loanwhich the MOH has requested be used to finance the rehabilitation ofteaching and regional hospitals, or alternatively, to constructmodified health stations at the "B" Level.
(i) The African Development Bank (ADB) has approved a study loan ofUS$1.7 million to conduct feasibility studies and prepare detailedspecifications for five district hospitals, the two-teaching hospitalsand a regional hospital. The ADB would carry over US$13.0 millioninto 1986 to fund rehabilitation of some of the hospitals.
Despite the amount of external assistance anticipated, it remains signifi-cantly short of the sectoral needs as projected in the public expenditureprogram.
Policy Issues and Sectoral Needs
40. To summarize, the major policy issues and program constraints inthe health sector relate to: (a) skewed allocation of resources favoringthe hospital sector over primary health care and urban over rural areas;(b) present limited non-wage expenditures and virtually no capital expendi-tures; (c) manpower constraints-shortages, maldistribution andover-specialization, lack of technical and managerial skills, overstaffingof non-technical health personnel; (d) limited cost recovery; (e) lack of along-term health sector plan; and (f) increasing need for closercoordination of government and foreign donor efforts. The prioritysectoral needs are to prevent further deterioration of, and thereby raisemorale in, the MOH health care system; provide badly-needed foreignexchange for the rehabilitation and re-eqeipping of facilities basic to thedelivery of PHC, particularly at the peripheral level in urban and ruralareas; and provide support for management, planning and sectoral analysis.
Bank Role
41. Beyond providing financial assistance to the investment program,the Bank can make a significant contribution to the health sector in Ghanaby: (a) assisting the Government in c3ordinating external assistance and
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targeting it to priority areas; the recent PER mission is an example;(b) supporting the development of long-term planning, including studiesleading to possible policy changes; in this the Bank has a comparativeadvantage, particularly on studies related to cost effectiveness and healthcare financing; and (c) seeking cofinancing for non-wage recurrent expendi-tures essential for operating the aystem. The disruption of the managementand support systems in the health sector precludes at this stage, ofcourse, the implementation of an ambitious development program. Thus, theproposed project is aimed mainly at the most urgently-needed aspects of thesector requirements, while establishing a firm basis for longer-termsupport for sector rehabilitation and development with assistance from theBank and other donors. In order to effectively assist the Government incoordinating external assistance, agreement of the MOE was obtained duringnegotiations to (i) review annually with IDA (a) the investments made bythe Government in the health sector during the 12 months immediatelypreceding the date of any such review, and (b) the investments proposed tobe made by the Government in the health sector during the 12 monthsimmediately following any such review; and (ii) provide data and otherinformation enabling the determination of the recurrent cost implicationsof the Government's investments in the health sector by the Government andIDA. The proposed project, coupled with consultations on the investmentprogram, is aimed at ensuring that the priority recurrent and capitalrequirements in the health expenditure program are met even in the eventthat the remaining financing gap is not fully covered by additionalexternal assistance (para. 38).
EDUCATION
Policies and Programs
42. Status. Ghana has neglected its educational system for over adecade. During the 1970's education expenditure as a proportion of GDPaveraged 3.4 percent which was below the average of 5.2 percent for--etherSub-Saharan Anglophone countries. This situation has worsened in the1980's. Expenditures on education were estimated at 1.0 percent of GDP in1983 and 1984, and are budgeted at 1.7 percent of GDP in 1985. (Recenteducation expenditures are found in Annex X.) While primary school enroll-ment ratios have been maintained at about 73 percent (77 percent for boysand 70 percent for girls) largely through the momentum of past efforts, theimpact of this reduced inflow of resources has manifested itself in variousways. First, there is a very high drop-out rate at both primary andsecondary levels, and the number of places available at the upper end ofthe first, the second and third (college and university) cycles arelimited. Thus, less than 7 percent of Ghanaian children gain admission tosecondary schools; only 1.1 percent get into sixth form and Q.8 percentinto university.- In addition, in the upper cycles, particularly in thesciences and technical courses, equipment has gone unrepaired andunreplaced, while chemicals and supplies are in extremely short supply. Atthe same time, teachers' incomes have eroded, leading to an exodus oftrained and experienced teachers from the educational system. The inevit-able result has been a deterioration of the quality of education in Ghanafrom that achieved in the 1960's and 1970's.
43. Financial allocation, particularly foreign exchange, for theprovision of instructional materials (e.g. textbooks, stationery, library
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books, journals, pens, pencils, laboratory supplies, etc.) has been ex-tremely restricted since 1980. For those imported supplies it is estimatedthat during 1980-1984 the Government was able to provide only about US$2.8million out of a requirement of US$20 million for primary and middleschools, and only US$3.6 million out of an estimated requirement of aboutUS$20 million for secondary schools. Allocations for post-secondaryinstitutions and universities were even smaller. In all educationalinstitutions, the impact of these low funding levels of non-wageexpenditures is pronounced. Many schools have no books at all, or at bestvery sparse stocks of old and out-of-date books. The problem appears to bebe more serious in rural than urban schools, where an expensive second-handmarket exists for those who can afford the inordinately high prices. Inrural areas even the second-hand option is often not available.
44. While the first priority is to increase the volume of resourcesgoing to education, even within the limited resources available, theGhanaian system of education finances is confronted with several seriousproblems. These include: (a) budgetary allocations have been heavilyskewed in favor of higher levels of education; (b) the unit costs of secondand third cycle education are high; (c) teacher salaries account for morethan 90 percent of recurrent expenditure at first cycle; (d) localauthorities have been unable to finance capital development of the firstcycle; and (e) there is a lack of cost recovery measures at all levels ofthe system, especially third and second cycles. Regarding the allocationof Government expenditures, about one-third of total education expendituresin 1984 was in primary schools where nearly two-thirds of the totalstudents are enrolled, while university education with less than one-halfof one percent enrollment accounted for over 17 percent. The high unitcosts associated with second and third cycle education are due in largepart to boarding costs and other government subsidies. Annual boardingsubsidies to second cycle institutiGus are estimated at US$7.2 million,more than actual non-wage expenditures on primary education in the recentpast. The relatively low student/teacher ratios in all types of second andthird cycle institutions also raise unit costs, even though these arerelatively low when compared to other anglophone African countries.
45. At present, cost recovery measures are negligible at all levelsof the educational system, and cost savings measures have not been intro-duced. While nominal fees are charged for books and supplies at first andsecond cycles, these amount to less than one percent of actual costs. Thegovernment fully subsidizes boarding and other services in the third cycle,charges no fees for tuition, and in some cases pays student allowances. Asa result of these increased financial costs and the general squeeze in thebudget, wages as a percentage of total expenditures in primary and middleschools have increased in the 1980's to over 90 percent, resulting inshortages of textbooks and materials at all levels. In addition, localauthorities have been unable to build new primary schools as well asmaintain existing schools. Under present fiscal arrangements, localauthorities do not have the tax base to carry out these functions. This isboth a short and longer term policy issue facing fi-st cycle education inparticular.
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Public Expenditure Program (1986-88) for Education
46. 'The Bank has recently been involved in reviewing the overallresource requirements of the education sector over the 1986-88 period inthe context of the Public Expenditure Review (PER) mission. The PERmission has recommended a total "core" program in the education sector ofUS$457 million over 1986-88. This would represent an increase of4.1 percent per annum over the 1984 allocation. This is only a modestincrease, considering that the education sector's allocation constitutedonly 1.0 percent of GDP in 1984. The findings of the PER mission will befurther refined during preparation of a medium-term sector projectcurrently underway.
External Assistance
47. The Canadian International Development Agency (CIDA), UK OverseasDevelopment Administration (ODA), various religious-based relieforganizations, British Council (which operates a modest textbook programprimarily for secondary schools and universities), and UNICEF provideassistance to Ghana for education.
Policy Issues and Sectoral Needs
48. The major policy issues with regard to education include:(a) the limited volume of resources directed to the sector, when consideredagainst the importance of human resources development to the Government'soverall rehabilitation and future development plans; (b) the lack ofinvestment strategy for recovery and eventual growth in the sector,including appropriate policies on cost recovery and criteria for allocatingresources among various subsectors within the system; and (c) the need toimprove sector management. Implicitly, through declining investment ineducation, the Government is pursuing a policy of divestment in humanresource development. This is quite possibly a consequence of the lack oflong term investment strategy for the sector and of an analysis of how theeducational system in its entirety and through specific subsectors isrelated to development. For example, the importance of linkingagricultural development to the educational system seems neglected, as doesthe importance of basic education. These gaps are reflected in skewedresource allocations as well as the declining resource pool for theeducational system.
49. The Ghanaian education system needs imediate rehabilitation toprevent further non-recuperable losses of both capital and human resources.The thrust of any future rehabilitation program should be to revitalizedeteriorating capital stock and to arrest the declining quality of inputsand outputs of the sector at all levels. The Government has developedstrategies for strengthening and reforming the educational system over themedium term, and is, through its education commission, still working ontheir elaboration. Most significant among these is the decision to changethe structure of the school system, and reduce the pre-university cyclefrom 17 years to 13 years. The Government also intends to embark on aprogram of curriculum reform (especially for the Grade 7-9 level of basiceducation) to ensure that education is more relevant and practically
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oriented to the local environment. Additionally, the Government plans toensure that all students have access to textbooks and other essentialsupplies, while taking appropriate steps to ensure that the studentseventually pay for these. Finally, the Government plans to ensure that, assoon as possible, students living in hostels will pay the full cost oftheir board and lodging. Certain policy issues, mostly pedagogical, stillremain under consideration. Included among these issues are: the degreeto which prevocational subjects should be taught; the methodologies used toteach prevocational subjects; the number of books that are required; theamount of time by which the school year and school day can be lengthened toaid in providing more effective teaching and learning; and the extent towhich the number of non-teaching staff can be reduced throughout theeducational system.
50. Ghana's large public sector has enormous needs for in-servicetraining and management improvement to increase its productivity. Civilservice training centers provide for the training of lower-level staff;higher levels are served by the Ghana Institute of Management and PublicAdministration (GIMPA) and by the Management Development and ProductivityInstitute (MDPI), as well as a small private sector capacity. MDPI'sobjectives are to improve management, efficiency and productivity in bothpublic and private sectors in industry, commerce and agriculture throughthe provision of management training, consultancy and research services;over the past two decades over 12,000 managers and supervisors have beentrbined, three-quarters from the private sector, and 150 consultancyassignments completed. Annex VIII sets out the objectives and functions ofMDPI.
51. MDPI has recently convened several high-level committees toevaluate its past activities and map out a strategy to enable it to playits intended role. The new strategy would consist of:
(a) transfer of MDPI to the responsibility of the PNDC CoordinatingSecretary, establishment of a policy-making and supervisoryboard, and increased autonomy for MDPI management;
(b) change in mix of activities to emphasize consultancy and trainingat the expense of research, and modernization of managementsystems at the expense of secondments and restructuringexercises;
(c) expansion of professional staff by 50 percent over 2-3 years,with a corresponding rundown in excessive administrative staff torestrain personnel costs;
(d) increased self-financing through consultancy and training feesfrom the present 10 percent, to reduce dependence on Governmentsubsidies;
(e) provision of emergency needs to enable MDPI to function properlyin the short-run; and of technical assistance to enable it toprepare its future plans; and
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(f) decisions on the completion of campus complex.
Bank Role
52. The Government is formulating policy guidelines and a medium andlong term recovery strategy, including (a) major policy guidelines for eachsubsector, and (b) investment priorities for 1986-88. Bank assistance toaddress medium-term needs is currently under discussion (para. 46). In themeantime, Bank-funded emergency assistance is essential to prevent furtherdeterioration of the school system and begin building the requiredinstitutional capacity to manage sector rehabilitation. The componentswhich have been identified for emergency support were selected on thefollowing criteria: (a) they address the most pressing needs of thesector; (b) they are designed to strengthen key institutions; (c) they aresimple in design and easy to implement; and td) they consist mainly ofimported equipment and materials in order to alleviate the scarcity offoreign exchange allocated to the sector.
PART IV - THE PROJECT
53. Following a Government request the project was identified by aBank mission in April 1984, prepared by the Government with the assistanceof the Bank, and appraised in May 1985. Negotiations were held inWashington from December 2 to 6, 1985; the Ghanaian delegation was headedby Mrs. V. Yeboah, PNDC Undersecretary for Education, and includedrepresentatives from the Ministries of Health, and Finance and EconomicPlaning, and MDPI. Supplementary data are presented in Annex III.
Project Objectives
54. The proposed project would be the first Bank Group operation in asocial sector in Gfana. It would address the most urgent rehabilitationneeds in health and education. Moreover, it would serve as a key elementin Bank support for Ghana's economic recovery program by helping to arrestthe rapid deterioration of the social sectors and by establishing the basisfor longer-term assistance from the Bank and other donors. The projectobjectives are threefold:
(a) to provide emergency assistance to the health and educationsystems and to MDPI;
(b) to rehabilitate service delivery at the peripheral level of thepublic health system, with special emphasis on immunization,family planning and nutrition; and
(c) to strengthen MOH and MOE management and planning capacity andsupport the development of planning and analysis functionsrequired in both ministries for further sectoral adjustment(financing, manpower, organizational).
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Project Description
55. To fulfill these objectives, the project would provide financingfor two main components:
Part A: Health
56. Strengthening Service Delivery. The project would strengthen themost immediate and cost-effective means to expand health, nutrition andfamily planning services. The project would re-equip and provide essentialsupplies to about 100 rural health stations (about 50 percent of the totalirmber in Ghana) and to 7 urban health centers in Greater Accra and 4 urbancenters in Kumasi. It would also provide for rehabilitation of two of theurban centers in Kumasi. By supporting these institutions, the projectwould provide much needed general support for primary health care deliveryand strengthen commnity outreach activities to the villages and to satel-lite "clinics" (held in schools, stores, garages, etc.) in the two majorcities (Accra and Kumasi). Moreover, since these institutions are thefirst level of referral and responsible for the supervision of community-level workers, support to them would expand the linkages between thecommunity and the NOE and thereby increase the number of referrals to alllevels of service delivery. Similar assistance would-go to about 50percent of the district health management teams (DE=T) which are;key-tosthetraining, support and supervision of health station personnel. The projectwould also complement UNICEF's support in rural areas for training, mitri-tion education, grinding mills for weaning food production at the communitylevel organized by local women's groups, and water and sanitation.
57. In addition to the general support for primary health care (PHC),the project would strengthen specific MKO priority programs, such asimminization, family planning and nutrition. The project would supportMOH's efforts to increase immnization coverage among children and comple-ment, as needed, UNICEF's contribution to the expanded program of immuniza-tion by improving the organi-zation, management and logistics of theexpanded program of immunization (EPI) through the provision of technicalassistance and cold storage facilities for vaccines.
58. To complement the support for training and the provision ofcontraceptives by USAID and UNEPA, the project would support the promotionof family planning as a health intervention. By increasing awareness andinvolvement of health providers in the delivery of family planningservices, one of the major obstacles to an effective fami1y planningprogram would be addressed, i.e., convincing health workers that familyplanning is an important element of maternal and child health services.The project would provide financing for workshops, a pilot study (to designand test a family planning classification of high-risk women and referralsystem), technical assistance and short-term observation training overseas.In addition to family planning, a population policy and program developmentscheme of MUFPA will be supported (para 39(b)) in the event the UNF-A doesnot have sufficient resources to fund it. This scheme would assess theimpact of the national population policy and provide for studies and
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workshops leading to a multisectoral plan for population, human resourcesand development planning. The Ministry of Finance and Economic Planningwould be the executing agency. An estimated US$500,000 required fortechnical assistance, local and overseas training, studies and workshopshas been allocated under the project.
59. The proposed project would assist nutrition-related activities inMOE health centers and stations (para. 56) and rehabilitate the referralhospitals specialized in the treatment of malnourished children, namely,the Princess Marie Louise (PML) Hospital in Accra and the Child WelfareCenter in Kumasi. These hospitals also offer nutrition education andfamily planning to mothers. In addition to civil works, each hospitalwould be provided with medical and technical equipment, furniture, suppliesand vehicles. Finally, the project would support, in collaboration withUNICEF, the improvement of nutrition surveillance and the establishment ofbenchmark indicators to aid in long-term monitoring of nutritional statusthrough surveys, workshops and technical assistance.
60. Strengthening the Ministry of Health. To improve the overallcapability of the NOR, the project would address training, staffrecruitment, technical assistance, transportation and communicationsrequirements. Funding would be provided for twelve ten-month fellowshipsin the fields of planning, management and economics, short-term observationtraining overseas for MOB personnel working in priority program areas, and16 man-years of local and foreign technical assistance. (The local andforeign consultants are listed in Annex V.) The project would rehabilitatethe national communications network between MOR headquarters, the medicalstores, the 10 regional officer, 2 teaching hospitals and the ruraltraining school by providing a new radio communications system. Theproject would also support operating costs of health services throughprovision of equipment, supplies, consumables, drugs, and raw materials.
61. Sectoral Adjustment and Policy Reform. The project would focuson critical studies for policy reforms and the preparation of a long-terminvestment plan. The studies would be conducted by NOR staff assisted bylocal and foreign consultants. Studies would cover health manpower(quantity, quality and training ), health care financing, (cost recoveryand insurance schemes), the drugs system (cost effectiveness of makinggreater use of local manufacturers for essential drug production and ofusing the private sector for procurement, storage and distribution), aninventory of health delivery, trainung and storage facilities and pro-totype design of urban and rural health centers. During negotiations,assurances were received that the Government would: (a) no later thanMarch 31, 1987, using the findings from ongoing studies, furnish to IDA apreliminary long-term investment plan for the health sector including costrecovery measures satisfactory to IDA, and (ii) no later than December 31,1987 complete the studies and the long-term investment plan for the healthsector.
62. Of the above sectoral studies, the most critical is health carefinancing. The MOH has just introduced a cost recovery program based onhospital user fees and the sale of drugs. Outpatient charges are graduatedto favor the rural population. Hospitals, health centers and health posts
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are to retain 50 percent of all revenues generated and to establish arevolving fund. The MOR is exploring ways to strengthen fee collection,financial control and monitoring of the cost recovery program and plans toidentify other measures with support from the project, such as insuranceschemes, to help finance health care.
Part B: Education
63. The project would also provide a fast injection of urgent-ly-needed instructional materials to the school system, and essentialback-up funding to support services, such as distribution, supervision andproject implementation. Technical assistance and additional inputs tostrengthen the MOE's capability to design and implement projects areplanned under the PPF for a follow-up project which is now under discus-sion. UNDP has also expressed interest to provide technical assistancestaff for this purpose. In particular, the proposed project would assistin the printing of primary and middle school textbooks that had beenprepared by the Ministry's Curriculum Research and Development Department(CRDD) but had not been printed due to lack of foreign exchange. The newtexts, which are pedagogically better prepared and more suitably -illus-trated for Ghana's schools than the older texts, would improve learningefficiency in primary and middle schools. Specifically, the project wouldfinance the following elements:
(a) Primary and Middle Schools. Printing and distribution of text-books and teachers' guides in three core subjects (English,mathematics and science) at the ratio of one textbook for twostudents for primary and middle schools. Manuscripts for allbooks (over 30 titles) were developed by CRDD and publishingarrangements have been completed in collaboration with localpublishers.
(b) Instructional supplies. Basic instructional materials (exercisebooks, pens and pencils) in sufficient quantity to cover theneeds of all primary and middle school pupils for two years.
(c) Secondary and University Books and Journals. Core books forGovernment secondary schools. The books would be selected fromthe standard Government-approved list of textbooks commonly usedin secondary level institutions in Ghana. Thirty textbooks wouldbe procured for each of the principal subjects in the secondaryschool curriculum for each of the approximately 300 secondarylevel institutions in the country. The project would alsofinance subscriptions to a core set of university journals andlimited number of library books for the three Universities.
(d) Education Planning and Project Implementation. Strengthening theMinistry of Education's capability for project preparation andimplementation. The project would provide basic equipment,supplies and local training to MOE's Division of Planning andStatistics which would serve as the focal point for the
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preparation of future projects; the Supplies Division would beheavily involved in the distribution of textbooks and schoolsupplies to be procured under the project.
(e) Management Development and Productivity Institute (MDPI).Meeting the emergency needs of MDPI to repair and refurbish itstemporary buildings, procure vehicles for essential transport andoffice equipment and supplies, to enable it to function properlyin the short run; and provide technical assistance to enable itto prepare its future plans. (MDPI is described in Annex VIII.)
Project Costs and Financing
64. The summary cost tables for the health (Part A) and education(Part B) components are presented separately in Annex XIV. Total projectcosts, are estimated at US$16.0 million equivalent, of whichUS$10.6 million are for health and US$5.4 million for education. Foreignexchange costs are estimated at US$11.4 million (about 73 percent). Basecoats are adjusted to October 1985 prices. Cost estimates for civil worksare based on recent contract awards for similar works in Accra and Klumasi.Medical equipment lists and costs are based on comparisons with standardlists and prices developed by UNICEF. The costs of technical assistanceand overseas training are based on Bank experience and judged appropriateand adequate. Contingency allowances have been applied as follows:(a) physical contingencies of 15 percent on the base costs of civil worksand 10 percent on all other non-construction goods and services; and(b) price contingencies on foreign costs at the rate of 7.0 percent in1986, 7.0 percent in 1987 and 7.5 percent in 1988; and on local costs atthe rate of 15 percent in 1986, 10 percent in 1987 and 10 percent in 1988.
65. Of the proposed US$15.0 million credit, US$10.0 million is forthe health component aa US$5.0 million for the education component. Ofthe total project costs of US$16.0 million, the proposed credit ofUS$15.0 million would finance all foreign exchange costs and 78 percent oflocal costs, representing about 94 percent of total project costs net oftaxes.
Procurement
66. Procurement arrangements for the health and education componentsare summarized in Annex XII.
Part A: Health
a) Civil Works. Since construction materials are in extremely shortsupply, the project would finance the importation of constructionmaterials not available in the country (estimated to costUS$650,000) following locally-advertised competitive biddingprocedures acceptable to the Association. The winning supplierwould be required to deliver materials to the four project sitesin accordance with the construction program. For the PML
- 24 -
Hospital, a labor and local materials contract (estimated valueUS$300,000) would be negotiated with the State ConstructionCorporation as this contractor is already employed on site. Forthe minor construction works at the three sites in Kumasi,contracts for labor and local materials (estimated valueUS$125,000) would be awarded following competitive bidding from aminimum of three contractors per contract.
b) Equipment, Furniture, Materials and Vehicles. Procurement ofthese items (estimated value US$5.6 million) would be awarded onthe basis of international competitive bidding (ICB) in accor-dance with IDA guidelines, except as follows: contracts costingless than US$10,000 equivalent (total aggregate limit US$200,000)would be procured through shopping procedures acceptable to theAssociation; and contracts costing less than US$75,000 equivalent(total aggregate limit US$800,000) would be awarded followinglocally-advertised competitive bidding procedures acceptable tothe Association.
c) Technical Assistance and Training. The MOR would contract forlocal and foreign consultants (estimated value US$1.2 million) inaccordance with IDA guidelines; the MOH would also select candi-dates for overseas training (estimated value US$0.2 million)-following procedures acceptable to the Association. The sameprocedures would be followed for population policy and programdevelopment component if IDA funds are utilized for it(para. 58).
d) Recurrent Costs. Of the total recurrent costs of US$1.3 millionfunded by the Association, US$0.6 million would be used forvehicle and equipment operation and maintenance and spare parts.Sundry costs of US$0.6 million, including local travel andsupplies would be disbursed from the project account incompliance with approved statement of expenditure procedures.
Part B: Education
a) Civil Works. Minor repairs to regional and district textbookdepots (estimated value US$100,000) and renovation of MDPIfacilities (estimated value US$140,000) would be undertakenthrough locally negotiated contracts.
b) Textbooks, School Supplies, etc. The manuscripts for over 30titles (textbooks) have been prepared by the Ninistry of Educa-tion in collaboration with six local publishers. Printingcontracts would be awarded through ICB, except those that arebelow $75,000 (totalling about US$1.1 million) which would beawarded to local printers through LCB procedures which will bereviewed by IDA to ensure that they conform to Bank guidelines.Instructional supplies (exercise books, pens, pencils, etc.) forprimary and middle schools (estimated value US$0.7 million) wouldbe procured from UNICEF. In order to expedite delivery of thesesupplies during the school year, a Project Preparation Facility
- 25 -
(PPF) advance has been authorized. Secondary school textbooksand university books and journals (estaimted valueUS$0.6 million) would be ordered directly from the publishers ortheir agents.
c) Equivment and Vehicles. Equipment and vehicles (estimated valueUS$200,000) would be procured through prudent shopping proceduresacceptable to the Association.
d) Training and Recurrent Costs. Short-term local training (esti-mated value US$332,000) and costs of office supplies and vehicleoperation and maintenance (estimated value US$155,000) would bepaid directly from the project account in compliance withapproved statement of expenditure procedures.
Disbursement
67. The estimated schedule of disbursement is found in Annex XIII.Funds from the IDA Credit of US$15.0 million would be disbursed per Table Ibelow. However, US$0.4 million of the Credit under the MDPI componentwould be disbursed only after MDPI has submitted a two year work plansatisfactory to IDA.
68. Two separate foreign exchange Special Accounts-one for thehealth component and one for the education component--will be set up in acommercial bank under terms acceptable to IDA. The initial amounts wouldbe US$1.0 million equivalent each for health and for education. Theaccounts will be operated by the respective project management units andfunds would be replenished on the basis of withdrawal applications to besubmitted quarterly. Claims for expenditures against contracts of lessthan US$10,000 equivalent and all local training activities would besubmitted under statements of expenditure, documents for which would beretained by the Borrower for inspection. All other clTAms would be fullydocumented.
Accounting and Reporting
69. The Ministries of Health and Education would establish andmaintain separate accounts for all project expenditures in accordance withsound accounting practices. Such project accounts, including documentationin support of statements of expenditure, would be audited annually byindependent auditors satisfactory to IDA, and annual audit reports would besubmitted to the Bank as soon as available but not later than nine monthsafter the end of the Government's fiscal year. Overall monitoring andreporting of the project would be the responsibility of the respectiveimplementing agencies which would prepare and submit semi-annual progressreports to the Bank. In addition, as part of its six-month report, the NORwould provide information on parallel activities in areas assisted byUNICEF. Six months after the closing date, the project manager in eachministry would submit a project completion report (PCR) to the Bank.
- 26 -
Amun of Crd±*-I ofAl3od MS bmiilaw. t
Part A. Himikh
1. CLVldl bdo 1,000 100 of fm2p --wbE ad75 of local _m-
dLbwm
2. Equ14mmt, Eztbwc, 5,600 I OE fontp -IftZa1.s, V*&I" 1mau adad ma1ia1 swum 95 iE bed aq
3. TacIomlca hiaLstam 2,200 100 oE totad T?mltm
) PM atoff, h-IUdN 100 90 GE totalmkraim
b) Otlur, .lo& 1,00 90 if total
sob-oal 9.900
Part : 1Atkn
5. C,wl 2 00 100 a E fer4p OL-
-5 loa
6. 1Tbdcs, Jmab asd 3,300 100 oE o -Libazy B1 pult ad
90 oE local _-
7. Fqmo ad Vddeles 1D0 100 of forup er-siditos ad
95 of 1la eupt-
8. lac l TM--I 230 M0 of tmotal
9. Opect1i F ta 230 90 of tot
9S.ib-tol 4,100
10. Reud f PHf 1,000*
70?L 15,000
* US$ OO5,000 for 1mlb ard 1 $875,000 fwr adst5n a .
- 27 -
Project Organization and Management
70. The MOB would be responsible for managing the health component ofthe proposed project. The Director of Medical Services would have overallresponsibility for project implementation. A Project Managesent Unit (PMU)would be formed in the MOH and attached to the Director's office. The PMUwould monitor project costs, keep project accounts, and authorize allproject expenditures. Key staff of the PHU would be the project manager, aprocurement officer, an accountant, an architect, a quantity surveyor, andthree secretaries. As a condition of effectiveness, the MOH will establishthe PMU, including provision of appropriate accommodations, and recruit andappoint a project manager, an architect and accountant with experience andqualifications satisfactory to IDA.
71. The project would provide 186 man-months of technical assistanceand 150 months for fellowships (120) and overseas observation training (30)for the health component. The MOH would enter into contractual arrange-ments with foreign and local consulta:ts in accordance with IDA guidelines.The selection of candidates for the fellowships would be made by asubcommittee chaired by the project director, with representatives from theMOH, universities and the Manpower Division of the MFEP. The overseasobservation training would be programmed and managed by the PMU.
72. As for the education component, the MOE has assigned a seniorofficial of the Ministry to serve as project manager. He will be assistedby an accountant and other support staff as needed. As a condition ofeffectiveness, the MOE will establish the PHU and would assign a projectmanager and project accountant with experience and qualificationssatisfactory to IDA. To assist the project manager in supervising thedistribution of instructional materials and generally to enhance theefficiency of project implementation, essential office equipment, vehiclesand supplies would be provided. The MDPI component would be implemented bythe director of the MDPI.
Status of Project Pr eparation
73. IDA has approved a Government request for a PPF advance totallingUS$1.0 million for health and education, of which US$125,000 is for thehealth component. The MOB has requested vehicles, equipment and suppliesunder the PPF and identified local consultants to be approved by the Bank.A Bank consultant has prepared the terms of reference and scope of work forthe MOR architect. The balance of the PPF, US$875,000, is for the educa-tion component. The funds are primarily for the purchase of instructionalmaterials, plus equipment and supplies for the MOE and MDPI. The MOE hasmade a detailed inventory of their stocks; procured new trucks to transportthe educational materials to be distributed; and made arrangements withprivate truckers to supplement the Government' s available transport. Allpreparations in both sectors should be completed in time for the scheduledstart-up in March 1986.
- 28 -
Project Benefits and Risks
74. The project would result in the following benefits to the healthand education sectors. In the health sector, the accessibility and cove-rage of health services would be expanded and the cost effectiveness ofservice delivery improved through the rehabilitation and re-equipping ofthe health centers in the two major cities and about 50 percent of thehealth stations in rural areas as well as the strengthening of about onehalf of the district health management teams. The improved communityoutreach activities of the expanded PHC program, including immunization,family planning and nutrition, should cover about one fourth to one thirdof the total population. The primary beneficiaries will be women andchildren. Mortality from malnutrition in urban areas would be decreasedthrough rehabilitation and upgrading of the two children's hospitalsspecialized in the treatment of severe malnutrition cases. A long-termsector investment plan would be prepared as a result of special sectoralstudies conducted by the MOH. In the education sector, the deteriorationin the quality of the school system would be arrested and the instructionin primary and secondary schools improved through the provision ofurgently needed instructional materials (e.g. books, supplies). Theinstitutional capacity in the MOE and MDPI for management and planningwould be improved and thereby the capability for project preparation andimplementation and the provision of Government management and consultancyservices.
75. The project's main risk concerns the implementation capability ofthe Ministries of Health and Education. The MOB may experience difficultyin coordinating and implementing the many activities supported by externalassistance. To help mitigate this risk, the project would provide 16man-years of local and foreign technical assistance to help the MOR. Inaddition, the MOE may be hard pressed to oversee the printing of therelatively large quantities of textbooks for nationwide distribution urderthe project. To alleviate this problem, only books costing less thanUS$75,000 would be printed locally; the rest (estimated at US$1.7 million)would be awarded throuch ICB. The project would also finance trainingprograms for supervisors and textbook distribution and storage staff.
PART V - RECOMMENDATION
76. I am satisfied that the proposed credit wculd comply with theArticles of Agreement of the Association and recommend that the ExecutiveDirectors approve the proposed credit.
A.W. ClausenPresident
AttachmentsWashingLon, D.C.December 24, 1985
- ANNEX I7age 1of 6
GHAMA - guCAL KinSITNA M) 1GHANA RE A 60w MWClxtowW A )
IDSI (Wt" UCO31 KSTUW%IE ^'W1 NT AFRICA 3A3 IS. UFi,%Ak MoLb1 go~3t,~sut" tw bA AF1CA U. Ur 111146
AMA (1361116 SQ. in)TOTAL 230.S MS 223.5ACRICILTURAL 62.3 41.4 62.2
/a The grup averqpa for each indicator are populatlan-vlghted aritlutic mans. tweragp of ccantriesaog the ntdicators depends on availability of data and is not ulfor_.
lb Uclss otbenise noted, "Data for 1960" refer to s*q year beween 1959 and 1961; "Data for 1970" betmveem1969 and 1971; and dta for "Mat Racet tlta_a" betwee 1981 and 1983.
Ic 1977; ld 1979; le 1980; /f 1962; Ia Public eodcation ly; A 1964; A 1978.
JUtE. 198s
31- ANNEX I
DEFINIMOrdS OF SOCIAL INDICATORS
Noun: Although the data are drawn rfom ourt generaly judgd the most authonative and reliable. t should also be noted that they may no be mntrnationmsllcomprable bemuse or the lack of stndardied ddiniions anAl conepts used by dillernc cutncs in collacung the data. The data are nonethels. useful todescibe orders of magnitude, medcate tres, and diaractenze crtatn major diffrnc betwem counties.The refence groups are IEl the sait country group of the subjeet country and (21 a country group with somewhat higher avenge income than the countrygrouW of te subject iountry (exocpt for -High Itncome Oil Expo,ters group where -Maddle Income North Africa and Middle East" is choen beause of stongersocio-cltural affinstiel. In the refene grup dat he averag are population weighted arithmeuc -mcns for ecch indicator and shown only when majorityof'the countmes in group hs data for 'hat tadcaor. Sinr the coverage ofcountries among the indicaton depends on the availability of data and is not unifonnr.caution must bczcinsedm relating a one indicator to another Ticw averas are only uscrul in comparing the value of one indicatorata timcaionglrte country ad refice group
AREA (thousand sq.km.n Crdr hinh Rore (pershmusaa)-Number of live births in the year
Teal-Total surface area comnprising land area and inland waters; per thousand of mid-year population; 1960. 1970. and 1983 data.1960. 1970 and 1983 dtal Cri Death Rate (per hrtaand)-Number of deaths in the yearArimeuruI-EstimIat of agriCUItu .rea used temporarily or per thousand of mid-ycar population; 1960, 1970. and 1983 data.permunently for crops. pastures, market and kitchen gardens or to Gram Reprodtio Raze-Average number of daughters a womanlie faDlow. 1960. 1970 and 1982 data. will bear in her normal reproductive period if she cxperiences
present age-specific ferility rates; usually fiSe-year averages caingGNP PER CAPITA (USS)-GNP per capita estimates at current in 1960. 1970. and 1983.market prices, calculated by sane conversion method as World F,aniy PLumuing-Acceprors. Amal (thanusds4 -Annual num-SBnk Ariar (1931-83 basis). 1983 data. ber of accptors of birth-control devices under auspices of national
ENERGY CONSUMPTION PER CAPITA-Annual apparent family planning progrm.consumption of commercial primary energy (coal and lignite. maly Pfimiiy-Lsr (percent ofm-ried ime-ea-The pee-petrolum. natural gas and hydro-. nuclear and geothermal dcec- tage of married wnmen of cbildaring age who are practicing ortricity) in kilogras of oil equivaknt per capita; 1960. 1970. and whose husbands are practicingany form ofcntraception. Women
y982 data. of child-bearing age are geneally women aged 15-49. although forsome countries contraceptive usage is measured for other agc
POPULATION AND VITAL STATlSTICS groups.
Tota Popurwim, Mid-Year (rhassastJ-As of July 1; 1960. 1970. FOOD AND NUTRIONand 1983 data.
Index ofFoodProdwct. Per G*Ci (1969-71 = 100)-Index of perMrp Populaio (perc en toael)-Ratio of urban to total capita annual production of all food commodities Production
population; different definitions of urban areas may affect compar- ecudes animal feed and seed for agrculture. Food commoditiesability or data among countries 1960. 1970. and 1983 data. incueimary comdie (e.g srgaricae ised cofmsugar
- - t~~~~~~~~~~~~~ncludc primary cofftnoditie (e.& sugace knsled of sugar),&2idt Prion which are edible and contain nutrients (eg. coffee and tea arePopulao nf in year 2000-The projection of population for 2000. cxdudedk they comprise cerals, root crops. pulses, oil seeds.made for each economy separately. Starting with information on vegetabls fruits. nuts, sugarcane and sugar beets. livestock, andtotal population by age and sex, fertility rates. morality rates, and lvestock p oducts. Aggregate production of each country is basedinternational migration in the base year 1980. these parameters on national average producer price weights; 1961-65. 1970. andwere projected at five-year intervals on dhe basis of genealized 1982 data.assumptions until the population became stationary. Per Capta SMWpy efCalri (percent ofrequareasem)-Comput-
Stationary popxdatior-ls one in which age- and sex-specific mor- ed from caloric equivalent of net food supplies available in countrytality rates have not changed over a long period. while age-specific per capita per day. Available supplies comprise domestic produc-fertility rates have simultaneously tknaired at replacement Lvel tion. iniports less exports. and changes in stock. Net supplies(net reproduction rate= I). In sucb a population, the birtb rate is exdude animal feed, seeds for use in agriculture. quantities used inconstant and equal to the death rate. the age strscture is also food processing. and losses in distribution. Requirements wereconstant. and the growth rate is zero. The stationary population estimated by FAO based on physiological needs for normal activitysize was estimated on thc basis of the projected characteistics of and health considcring environmental temperature, body weights.the population in the year 2000. and the rate of decline of fertility age and sex distribution of population. and alowing 10 percent forrate to replacement level, waste at household level: 1961. 1970 and 1982 data.PopudaIwIn Monramwn-Is the tendency for population growth to PFer Capa Spply of Proroh (grams per dar -Protein content of
continue beyond the time that replacement-level fertility has beet per capita net supply of food per day. Net supply of food is definedachieved. that is. even after the net reproduction rate has reached as above. Requirements for all countries established by USDAunity. The momnentum of a population in the year r is measured as provide for rminimum allowances of 60 grams of total protein pera ratio of the ultimate stationary population to the population in day and 20 grams of animal and pulse protein. of which 10 gramsthe year t. given the assumption that fcrtility renmains at replace- should be animal protein. These standards. are lower than those ofnent level from year t onward. 1985 data. 75 grams of total protein and 23 grams of animal protein as an
Papivlatiam Deusity average for the world. proposed by FAO in the Third World FoodPer sqkm.-Mid-year population per square kilometer (100 hec- Supply: 1961. 1970 and 1982 data.tares) of total area: 1960. 1970. and 1983 data. Per Capita PJoein Supply &om Animal and Pio-Protein supplyPer sqlm. agrcultural Iand-Compatted as above for agricultural of food derived from aaimals and pulses in grams per day: 1961-65.land only. 1960. 1970. and 1982 d-ata. 1970 and 1977 data.
Aopron Age Structure (percentj-Children (0-14 years). work- Cild (ages 1-4) Death Rate (perthoumsad)-Numberofideaths ofing age (15-64 years). and retired (65 years and over) as percentage children aged 1-4 years per thousand children in the samc ageof mid-year population; 1960. 1970. and 1483 data, group in a given year. For most developing countries data derivedPop.rl.rion Gremark Rate (percentr)-toral--Ananual growth rates of from life tables 1960. 1970 and 1983 data.total mid-year population for 1950-60. 1960-70. and 1970-83. HEALIH
Popultn Growth Rae (percent)-arban--Annual growth rates Me Expecrancy at Sink (pyewr)-Number of years a newbornof urban population for 1950-60. 1960-70. and 1970-83 data. infant would live if prevailing patterns of mortality for all people
-32- . ANNEX IPage 4 of 6
at the time of of its birth were to stay he same througbout its life; Pupi-teacher iatio primary. d secon&ar-Total students en-1960, 1970 and 1983 data. roled in primary and secondary levels divided by numbes oflfaw Matdy Rowe (pe *1.aaaudj-Number of infants who die teachers in the corrcsponding lIcelsbefore rching one year of age per thousand live births in a gvenyear. 1960. 1970 and 1983 deta. CONSUMPTIONAceCssi to So War (pff qc f pJpI dlts)-wih w_, aid Passag Cas (per thosad jvpua.J PhisienIer cars Com-rw&4-Number of people (totaL urba and runl) with rasonable prise motor cars seating ms than cight persons; excludes ambul-access to safe water supply (iludea ted surface water or arm. hans and military vhiclsuntreated but unntc minated water such as that from protected jAjo Re_dsm (per thad p*aui-All types of receivenboreolcs sprins and saitay well) percentages of their repec- for radio broadcau to general public per thousand of population;tive popuations In an urban am a pubbic fountain or standpost exclud un-licensed receivers in countries and in yea whenlocated not more than 200 meten fim a house may be oudered registration of radio sets was in efact; data for recent year mayas being within reasonble acoo of tht house. In rual area not be compasbc sio most couo bosisd licesisn.reaonable m would unply that the housenfe or menbers of thebehousdhold do not have to pnd a disproportionate pat of the day r'TV dv A (per cin nr for bradcastin fetching tbe filuLay s wau neeL to general public per thousad poputon excludes unlicnsed TVAeching to recEivers D f f 4fP4st)0 ul, iiin countries and in year when registrtion of TV et wsAccess to E.rut Dhpesu (jpmrat of irpusatodM)-4014atal,wham in effeCtL_d rmwl-Numbcr of people jtotal, urban and rural) served by
xcrta diposal as percntages of their respectivc populations. Newpar Cfrcumeu* (per shossioup.poIu.)-Shows the aver-Excra disposal may iiclude the collection and disposal. with or age ciculation of 'daily general intes newspapeyr. defined as awithout treatment, of human eacret. and wast-water by water- penodcl publication devoted primaily to recordinggeral news.borne systems or the use of pit privies and similar installations. It is conidered to be 'daily" if it appeas t least four imes a week.Rbpdhd. per Pji_dm-lopulation divided by number of pnc- Cime Asmua Atenduce per Capit pr Yw-Baned on thetising physicians qualified from a medical school at university level. number of tickets sold during the year, including admu ions toFbpuaou per Nwiag Ptn-Population divided by number of drive-in cinemas and mobile units.pracicing male and female graduate nurses, assistant nurscs.pracical nurses and nursing auxiliaries. LABOR FORCEPopuia. per Hospit-toeali whoa, mud rwal-Population Toal Labk Force (ruusands)-Econornically acive persons, in-(totaL urban, and rural) divided by their respective number of cluding armed forces and unemployed but excluding houewvives.hospital beds available in public and private, general andspestudents. etc.. covering population of all age Definitions inhospitals and rehabilitation center. Hospitals ate cstablishments vanous countnes are not comparable; 1960, 1970 and 1983 data.permanendy staffed by at last one physician. Establishments prov- Femak (peream)-Female labor force as pentape of total laboriding princpay custodial care are not induded. Rural hospitas. fotc.however. include bealth and medical centers not pemanently staffed Agneabwe (percent -Labor force in farminL forestry, huntingby a physician (but by a medicl asistant. nurs, mnidwife. etc.) and fishing as percentage of total labor force; 1960, 1970 and 1980whicb offer in-paticnt accommodation and provide a limited range data.of medical faclities. Igusuy (percent)-Labor force in minnin, construction. anun-Ad.dasios pgr Hos;al Bed-Total number of admissions to or facturing and electricity, water and gas as percentasg of total labordischarges from hospitals divided by the number of beds. force; 1960. 1970 and 1980 data.
Pwrdpaf Rae (perce ,)-otA mu, indL... rcpat oHOUSING or activity rates arc computed as total, male, and female br forceAverae Sie of Houehl (po- pw rea, a, as percentages of totaL male and female popuation of all agadAm el-A houseold consists ofa group ofindividuals who share respectively. 1960. 1970. and 1983 data.Teare bused on ILOsliving quarters and their main mcals. A boarder or lodger may or participation rates reflecting age-sex structure of the popubain, ndmay not be induded in the household for statistical purposes long inse trend. A few estimates are from na l souAverage Nmbegr of Paios pa' Reooa-ees4, arbanmd ural- Ecoinoic Dependey Ratio-Ratio of population under IS, andAverage number of perso per room in al urban. and rural 65 and over, to the working age population (those aged 15-64).occupied conventional dwelings. respectively. Dwellings excludenon-permanent structures and unoccupied parts. INCOME DISTRIBUTIONPeceag of Dwlin wmk Elctvicry-toral. amrb and rral- Percage .1 Toed Dispabek Iwme (bot in cms ed udm)-Conventional dwellings with electricity in living quarters as percen- Acruing to percentile groups of households ranked by total house-tage of total. urban. and rural dwellings -espectively. hold income.
EDUCATION POVERTY TARGET GROUPSA4jucd Enrolwa Rarios The following estimates are very approximate measures of povenyPrmary scsool - towal. male and female-Gross total, male and levels. and should be interpreted with considerable caution.female enrolhment of all ages at the primary levd as pertages of Esnat;ed Absoltae Prqt Income Level (USS per cet )-arbwrespective primary schoolage populations. While many countries and rral-Absolute povery income level is that income lvelconsider prinary school age to be 6-11 yea. others do not. The below which a minimal nutritionally adequate diet plus essentialdifferences in country practices in the ages and duration of school non-food requirements is not affordable.are reflected in the ratios given. For sme countries with unival Esrmwted Relatie Pov Income Leve (US per capia)-_arbameducation. gross enrollent may exceed 100 percent since some ,ad carat-Rural relative poverty income level is one-thira ofpupils art below or above the country's standard primary-school average per capita personal income of the country. Urban kvel isage. denved from the rural level with adjustment for higher cost ofSecondary school - total. mal and female-Computed as above living in urban areas.secondary education requires at least four years of approved pn- Esnnmated Pbpdaiou Bekw Absolte Poverty cme Leverd (per-mary instruction; provides general, vocationaL or teacher training centj-.an and rural- Percent of population (urban and ruralinstructions for pupils usually of 12 to 17 years of age. correspond- who are "absolute poor."ence courses are generally excluded.Vocatonal Exrolbnau (percent of secandar,v-Vocational institu- Comparative Analysis and Data Divisiontions include technical, industiaL or other programs which operate Economic Analysis and Projections Departmentindependendy or as depariments of secondary institutions. June 1985
- 33 -
ANNEX IPage 5 of 6
GNe PE aprE iN 1984: lS$350 1/
GM)ss NATIM& DIX IN M184 I/ A . PAME CE GMCZ cimtmt PdEeS)
Cedis MI1. 1979-84
GOP at Market Prim 287,507 100.0 -2.0Grow Dmeatic IzS estmen 21,068 7.3 -5.9Gross Na:t1 al Savig 13,267 4.6 -14.7Carrent Acot Balance 7,801 2.7 -Hqport of Goods, NES 21,356 7.4 -10.4lurt of Goods, NES 28,911 10.1 -8.7
1/ Provisioial est:hetes sbject to chney Tywixdes errors and ouLssions.
3I Tcnlinrg gold at national vahnticn.4/ As Z of eqxrts of goods and nm-factor services (wrcJdes short-tern debt).
October 1985
- 35 -AIMEX II
ME SIMS OF BA2IM Q PERAaIS 3N GIANA 1/
SMEN OF BAII LAS AM M, CEDITS (As of Sqece 30, 1985)
Iom or Amxmt IJSOf1Iim)2/Credit Fiscal Less CancelationNumber Year Borrower Puapose k M Urdisbsd 3/
Nine loamsand hrtee redxits fully disbcsed 166.7 107.41122{1- 1975 Post & TelecP1-
maiir-atiOt TePe 11mnxdcations 23.0 3.9901-1G 1979 Republic of (hana Secwd NIB 19.0 2.4
1009-al l980 Republic of Qana Volta Regi Ag.Dev. 29.5 22.11029-Q 1980 Republic of Quna Thrd Mimay 25.0 2.41170G- L981 Republic of iana Paiay 29.0 13.81327-al 1983 Republic of Qiana P C]WO 9.3 9.11342-a 1983 Republic of iana Water Supply 13.0 6.41373-al 1983 Republic of amna Energy Project U.0 8.11393-G 1983 Reublic of 1hana Ri port Cr. 40.0 6.81435-a 1984 RepUblic of Qiana T:port Realit n 40.1 33.2EJ09-Gl 1984 Rqxeblic of Qia Export R 1hailitation 35.9 34.11436-a 1984 Repblic of (ana Eqport abiln
and Techrncal Assistance 6.9 5.61498-al 1984 Republic of iana Second Oil Palm 25.0 22.8L564- 1985 Republic of aiana Accra District Rdbab. 22.0 23.61573-aH 1985 Republic of Chana Secd
iorts, Credit 60.0 54.7A003-QI 1985 Republic of aima SeconRc
lirports Credit 4/ 27.0 27.01601-GH 1985 Republic of Ghana Road hilatin and
IWjntenance 4/ 40.0 40.0AOLX-QG 1985 RBeglic of Qiana Road aehili n a
xaintenance 4/ 10.0 10.01628-GH 1986 Republic of Qana Power System
Reabilitation 4/ 28.0 28.0
Total 189.7 595.2 365.6of wbich has been paid 64.9 4.5
Total now outstanding 124.8 590.7
Amount sold 0.4of which has been repaid 0.4 0.0 0.0
Total now held by Bank & IDA 124.8 590.7
Total undisbirsed 3.9 361.7 365.6
1/ The status of the project listed in this part is described in a separate report on allBbkJIDM-financed projects mn execution, which is updated tisce yearly and circulated tothe Exeaitive Directors on April 30 and October 31.
2/ Prior to exchange adjustnents.3 Callated at the eKchanW rate applicable on September 30, 1985.4/ Not yet effective as at September 30, 1985.
- 36 -
ANNEX IIIPage 1 of 2
GHANA
HEALTH AND EDUCATION REHABILITATION PROJECT
SUPPLEMENTARY PROJECT DUTA SHEET
Section I: Timetable of Key Events
(a) Identification: A health reconnaissance mission in April, 1984 andidentification mission in June, 1984 initiated health sector discus-sions with the Goverment. The education component was identifiedin April, 1984 and project preparatiuon conducted in November-December 1984. In May, 1985 the Public Expenditure Review Missionassessed priorities and needs in the health and education sectors;and in May-June, 1985 a joint appraisal mission reached agreementwith the Government on the project components.
(b) Project prepared by: Ministry of Health: May-June 1984Ministry of Education: November-December 1984
(c) Date of appraisalmission: May 1985
(d) Date of completionof negotiations: December 1985
Ce) Planned date ofeffectiveness: March 1986
Section II: Special Bank Implementation Action
None
Section III: Special Conditions
(a) Conditions of effectiveness:
(i) In the health component, establishment of a Project Managementunit (PMU), includiag provision of appropriate accommodations,and appointment of a project manager, architect and accountantwith experience and qualifications satisfactory to IDA (para.70); and
(ii) In the education component, establishment of a PMU (para. 72)and appointment of a project manager and project accountantwith experience and qualifications satisfactory to IDA (para.72); and
- 37 -
ANNEX IIIPage 2 of 2
(b) Other Conditions:
(i) MOH to (a) no later than March 31, 1987 (using the findingsfrom ongoing studies) furnish to IDA a preliminary long-terminvestment plan for the health sector including cost recoverymeasures satisfactory to IDA, and (b) shall no later thanDecember 31, 1987 complete the studies and the long-terminvestment plan for the health sector (para. 61).
(ii) MOH to undertake a cost recovery program which win generaterevenues equivalent to at least 15% of total recurrentexpenditures of MOH in 1986, 1987 and 1988 (para. 38).
(iii) MOH to (a) review annually with IDA (i) the investments made bythe Government in the health sector during the 12 monthsimmediately preceding the date of any such review, and (ii) theinvestments proposed to be made by the Government in the healthsector during the 12 months immediately following such review;and (b) provide data and other information enablimg thedetermination of the recurrent cost implications of theGoverrment's investments in the health sector to be thoroughlyconsidered and determined by the Government and IDA(para. 41).
(iv) The IDA to disburse US$0.4 million of the Credit under the MDPIcomponent only after MDPI has submitted a two year work plansatisfactory of IDA (para. 67).
- 38 - ANNEX IVPage 1 of 3
GHANA
HEALTH AND EDUCATION REHABILITATION PROJECT
SELECTED DOCUMENTS AND DATA AVAILABLE IN THE PROJECT FILE
HEALTH COMPONENT
A. Reports and Studies Related to the Sector
A.1 A Primary Health Care Strategy for Ghana," Ministry of Health,Accra, August 1978 - Document #227 491
A.2 -The Health Policy of Ghana," Ministry of Health, Accra, April1982 - Document #227 492
A.3 Situation Analysis of Women and Children: Ghana, UNICEF,Accra, July 1984 - Available from Mr. B. Carlson
A.4 Ghana: Report of Mission on Needs Assessment on PopulationAssistance, UNFPA, Report No. 68, New York, July 1984Ref. Document D 00142
A.5 -Ghana: Public Expenditure Reviewr-Green Cover Report," TheWJorld Bank, Washington, D.C., August 1985 - Ghana B/R
B. Reports and Studies Related to the Report
B.1 -Plan of Operations: Services for Children and Women in Ghana(1986-90)," UNICEF, Accra, January 1985 - Document #227 493
B.3 -Ghana:, Support of a Population Programme," UNFPA,DP/FPA/PROJECTS/REC/16, New York, March 1985 - Document#227 494
B.4 "Review of Hospital Fees," Ministry of Health, Accra, 13 March1985 - Document #227 496
B.5 -Action Plans - 1985," Ministry of Health, Accra. December 1984Document #227 497
B.6 -Proposals for Areas of Immediate Term Cooperation between theMinistry of Health and the World Bank," Ministry of Health,Accra, May 1984 - Document #227 498
B.7 "Report on Cold Chain for Vaccines: Expanded Programme forImmunization E.P.I.,, UNICEF, Accra, May 1985 - Document227 499
B.8 "Ghana's Proposed PHC/EPI Service Delivery Strategy, Ministryof Health, Accra, April 1985 - Document #227 500
B.9 "Plans for Strengthening Health Care Delivery System(1986-1988), Ministry of Health, Accra, June 1985 - Document#227 551
5.11 'Ghana: Mission to Study System of Drugs Procurement, Storageand Distribution," WHO, Geneva, June 1985 - Document #227 503
C. Staff Working Papers
C.1 Archltect's Notes
C.2 Detailed Cost Estimates Available fromMr. B. Carlson,
C.3 Reconnaissance, Identification and PHND2Post-Appraisal Mission Reports, May andJuly 1984 and August 1985 respectively.
EDUCATION CO!PONENT
A. Reports and Studies Related to the Sector
A.1 Country Paper on Development of Education, 1981-83, Govermnentof Ghana, Prepared for the Thirty-Ninth Session of theInternational Conference on Education, October 1984Document #00143
A.2 Northern Ghana Literacy Project: An Internal Assessment,Summer Institute of Linguistics, Dallas, 1982 - Document#00144
A.3 Ghana: Education Sector Review and Proposed InvestmentStrategy, IBRD, 1985 - GH Ed Sector B/R August 9, 1985
A.4 Ghana: Technical and Vocational Education: Sub-sector Reporton Ghana, IBRD, 1985 - GH-Ed Sector B/R June 1C, 1985
A.5 Digest of Educational Statistics. Ministry of Education(1981 through 1984) - Document #227 504
A.6 Ghana: Public Expenditure Review, IBRD, August 1985(Green Cover Report) - GH-Sector B/R August 1985
A.7 Population Census of Ghana: Preliminary Report, Bureau ofStatistics, Accra, 1984 - Document #00145
A.8 Guidelines Towards a National Education Policy, Accra, 1982Document # 227 505
B. Reports and Studies Related to the Report
B.1 Textbook and School Stationery: An Assessment of Needs, BookDevelopment Council, London, Eagland, November 1985(Preparation Report) - Pop B/R November 1985
B.2 Survey of Textbook Warehouse and Storage Facilities, May 1985Pop B/R November 1985
- 40 - ANNEX IVPage 3 of 3
C. Staff Working Papers
C.1 Detailed Cost Estimates - Document #227 506
C.2 Architect's Report on MDPI - Document #227 507
C.3 Project Brief (filed February 11, 1985), Preparation Report onan Appraisal mission detailed Aide-Memoire and Post-appraisal(August 13, 1985) report on MDPI
- 41- ANNEX V
GHANA
HEALTH AND EDUCATION REHABILITATION
SUMMARY OF TECHNICAL ASSISTANCE AND CONSULTING SERVICES
HEALTH COMPONENT
(person months)
Yr Yr Yr TotalComponent Description 1 2 3
A. Expatriate Technical Assistance
Strengthening Ministry Specialist to assistof Health-Infrastructure in development of
national iimunizationprogram 12 12 24.0
Strengthening Ministryof Health-Planning
Specialist to assistin development ofplanning capability 12 12 24.0
Specialist to assistin analysis of healthpolicies 2 1 3.0
* Includes person-montbs prior to project start-up.
- 42- ANNEX VIPage 1 of 2
GHANA
HEALTH AND EDUCAIION REHABILITAIION PROJECT
IMPLEMENTATION SCHEDULE - HEALTH COMPONENT
Pre- Year Year YearProject j 1 2 3
Project Preparation/Coordination
- Establishment of PMU
- Establishment of Project Accounts
- Appointment of Consultants
Civil Works
Working Drawings, Tender Documents
- Bid Period and Contract Award I-H
- Construction
o PML Hospitalo Child Welfare Centero Health Center H
Urban Program
- Purchase of Equipment, Furnitureand Supplies
- Procurement of Vehicles
Rural Program
- Purchase of Drugs, DietarySapplements, Equipment I-]
- Training--Levels "A- and B' -- Village Surveys
- Procurement of Vehicles, Motor-cycles and Bicycles H-I
- Design and Testing of FPClassification/Referral System
-. 43 -ANNEX VIPage 2 of 2
Pre- Year Year YearProject 2 3
EPI
- Appointment of Consultant
- Purchase and Installation ofCold Chain equipment
Infrastructure
- Procurement and Installation ofRadio Coumunications System
- Procurement of Vehicles
- Purchase of Office Equipmentand Supplies
Preparation of Investment Plan
- Appointment of Consultants
- Analysis of Health Policies
- Studies on Health Manpower,Financing and Drug System
- Inventory of MOH Facilities
- Design of Prototype Health Centers H- Monitoring of Cost Recovery Program
Training
- Fellowships - l -l I-I
- Short-term Observation j -l
- 44 -
OWAZAN KaOF 7m maFm orB
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-3AaG N SIIDEPu3 MemQL UIZ
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PIM EiFLUrN Ia I WAdLLE _ I ;1-0 AI FUMIuEr 11na SIPE I . jrI
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- 45 - ~~ANNEX VIIIPage 1 of 2
Management Development and Productivity Institute (MDPI)
1. Ghana's large public sector has enormous needs for in-servicetraining and mangement improvement to increase its productivity. Civilservice training centers provide for the training of lower-level staff;higher levels are served by the Ghana Institute of Management and PublicAdministration (*GIMPA) and by MDPI, as well as a small private sectorcapacity. GIMPAts training and research activities are to be assisted byUNDP, while the Government has requested urgent IDA assistance foremergency needs of MDPI as well as assistance in enabling HDPI to play itsintended larger role.
2. MDPI was established in 1967 by the Government with theassistance of UNDP and ILO. Its objectives are to improve management,efficiency and productivity in both public and private sectors in industry,commerce and agriculture. Its professional staff of about 50 persons(excluding recent secondments to Ministries and other public agencies)provides management training, consultancy and research services; over thepast two decades over 12,000 managers and supervisors have been trained,three-quarters from the private sector, and 150 consultancy assignmentscompleted.
3. At the suggestion of IDA, MDPI has recently convened severalhigh-level committees to evaluate its past activities and map out astrategy to enable it to meet the high expectations Government has of itsfuture role. The elements of the new strategy are expected to be:
Ca) Transfer of MDPI to the responsibility of the PNDCCoordinating Secretary (equivalent in Ghana to PrimeMinister), establishment of a policy-making and supervisorboard, and increased autonomy for MDPI management;
(b) Change in mix of activities to emphasize consultancy andtraining at the expense of research, and modernization ofmanagement systems at the expense of secondments andrestructuring exercises;
(c) Expansion of professional staff by 50% over 2-3 years, witha corresponding rundown in excessive administrative staff torestrain personnel costs; housing and transport incentivesmay be necessary to achieve this expansion and improveconditions of existing staff;
(d) Increased self-financing through consultancy and trainingfees (the former well below private sector competitors) fromthe present 10%), to reduce dependence on Governmentsubsidies; projections show that well over half ofexpenditures could be met from MDPI's own earnings within2-3 years;
- 46 -
ANNEX VIIIPage 2 of 2
(e) Provision of emergency needs to repair and refurbish MDPI'stemporary buildings, procure vehicles for essentialtransport and office equipment and supplies, to enable MDPIto function properly in the short-run; and of technicalassistance to enable it to prepare its future plans; and
(f) Decisions on the completion of the core (classroom andadministrative) buildings on MDPI's new permanent campus,and on the subsequent completion of the whole campuscomplex, all presently held up for lack of funds.
4. The requirements under (e) are being met from some US$0.47million under the proposed project, including US$100,000 out of the ProjectPreparation Facility. This amount will be repaid out of the proposed IDAcredit.
5. With the stabilization aspect of Ghana's economic reform programbeing successfully transformed into a more growth-oriented medium-termeffort, the Government urgently needs an improvement in the managementcapability both in public and private sectors. Although MDPI has sufferedfrom shortages of foreign exchange and local currency allocations, it has acommendable record of producing highly trained professionals who now occupykey positions in the economy. If the improvement strategy as described inpara. 3 above is followed, MDPI's function as a key consultant institute toserve both public and private sectors will be restored in the near future.
- 47 -
ANNEX L't
DE riAL ASSIStANCE M 7u BEA SE=IN M BY ACr.tV FACtLY AND AGcr
(1985L-198)(US$ Million)
AM CMD EG FE AP. SADI ED SUISS UWPA lICEF USAM UD 1UT7ALkctivity
Rababdlitation of Hospitals x x x xHealth Omters
mc xDni Pro&ctLcn C xEPI x xEt: x xVAaxlari OmtIrol x x"I2P x x x x XNutrition x xPlazIMP Orgn !4Izr- x x x x
ReserchfStuies K xWater and Smitatin x x
Facility
civil Ibriw x x x xDnps, cwtraCaptives,
Rai Materials x x x x ftpet, ftafre
Vebicles,l teeial x x x x x x x x xTedmiacal Asaistane Training x x I X I X
Note: Figures in parentheses are the respective amounts to be financed bythe IDA credit.
a/ Costs include. physical and price contingencies.
b/ Other means of procurement include prudent shopping (off-the-shelfmaterials); Bank guidelines (technical assistance); fellowships;training overseas.
c/ Population policy and planning component cost of $0.5 million includes $0.3million in technical assistance and $0.2 million in training.
d/ Government contribution totals US$600,000 toward cost of civil worksand local wages.
- 51 -ANNEX XIIPage 2 of 2
GHANA
HEALTH AND EDUCATION REHABILITATION PROJECT
Procurement Arrangements (US$ Million)a/
Part B: Education Component
Procurement Method TotalProject Element ICB LCB Other"/ N/A Cost
A. Civil Works - - 0.3 - 0.3(-) C-) (0.2) (-) (0.2)
B. Texbooks, School 1.7 1.4 1.3 - 4.4Supplies, Library (1.7) (1.1) (1.3) (-) (4.1)Books and Journals
C. Equipment and - - 0.2 - 0.2Vehicles C-) C-) (0.2) () (0.2)
D. Local Training and - - - 0.5 0.5Recurrent Costs C-) C-) C-) (0.5) (0.5)
Note: Figures in parentheses are the respective amounts to be financed bythe IDA credit.
a! Costs include physical and price contingencies.
b1 Other means of procurement include prudent shopping (off-the-shelfmaterials); Bank guidelines (technical assistance); fellowships;training overseas, and procurement through UNICEF.
c/ Government constribution totals approximately US$400,000 toward cost ofcivil works and local printing.
