Peru Second Phase of Health Reform Program Implementation Completion and Results Report

Annex 11: Loan Amount Allocation

Loan Amount Allocation (in millions of US$)
	Approved	Revised	Actual
(1) Goods, works, consultant’s services and Training under Part 1 of the Project	2.99	1.49	0.52
(2) Goods, works, consultant’s services and Training under Part 2 of the Project	9.16	11.96	10.32
(3) Goods, works, consultant’s services and Training under Part 3 of the Project	2.59	1.30	0.88
(4) Goods, consultant’s services including audit and Operating Costs	0.25	0.25	0.25

Annex 12: Organization of PARSALUD II Project Implementation Unit (PIU)

Source: http://www.parsalud.gob.pe/organizacion

General Coordinator: Dr Walter Vigo Valdez

Technical Coordinator: Dr Rosa Ines Bejar Caceres

Financial Administration Coordinator: Mr Fernando Masumura Tanaka

MAP

1^ A summary of triggers is reported in the PAD, pp 10-11. The trigger that was not achieved was the separation of financing and service provision within the Social Security Fund (ESSALUD). Changes in the regulatory framework granted more autonomy to ESSALUD and reduced the ability of MINSA to influence its institutional processes. Eventually, ESSALUD started piloting a separation of functions, but this was decided independently from the PARSALUD trigger.

2^ Due to difficulties in monitoring MMR, institutional delivery was used as a proxy for maternal mortality by PARSALUD.

3^ The IADB project and the Bank project in support of PARSALUD II were aligned in terms of development objective, timeline and resources committed (US$15 million each). The results frameworks of the two projects slightly differed on some of the KPIs and IOIs. While the Mid-Term Review was conducted jointly and communications between the two teams was maintained throughout the life of the projects, supervision missions were largely carried out separately by the two co-founders.

4^ Segunda fase del Programa de Apoyo a la Reforma del Sector Salud - PARSALUD II. ESTUDIO DE FACTIBILIDAD. Nov 2008

5^ More precisely, one health center underwent two types of renovations and received two sets of equipment; hence although technically the number of health centers renovated and equipped was 68 and 103 respectively, the number of renovation works done and sets of equipment delivered was 69 and 104 respectively.

6^ Black R, Levin C, Walker N, Chou D, Liu L, and others. 2016. "Reproductive, Maternal, Newborn, and Child Health: Key Messages from Disease Control Priorities, 3rd Edition." The Lancet. Published online 9 April 2016

7^ World Health Organization the case for Asia and the Pacific, Investing in Maternal Newborn and Child Health, Geneva, Switzerland.

8^ Bill and Melinda Gates Foundation, Maternal, Newborn and Child Health Strategy Overview, www.gatesfoundation.org.

9^ Black R, Laxminarayan R, Temmerman M, and Walker N. editors. 2016. “Reproductive, Maternal, Newborn, and Child Health. Disease Control Priorities, third edition, volume 2”. Washington, DC: World Bank. doi:10.1596/978-1-4648-0348-2. License: Creative Commons Attribution CC BY 3.0 IGO

10^ Until three months before the project closing date, the PARSALUD team assured that the project would disburse 100% of the loan. However, this did not materialize due to legal problems with regard to a big consultancy contract and delays in civil works, which are being funded by domestic resources.

11^In 2005 a rural sick child affiliated to SIS had a 2.9 higher likelihood to demand health services than a sick rural child with no SIS affiliation (http://www.parsalud.gob.pe/factibilidad-del-programa, Estudio de Factibilidad: Modulo III: Formulacion, pag 434).

12^ In 2004 (INEI, 2006) malnutrition was almost four times higher among children living in the rural areas (39 percent) than for those living in urban areas (10 percent). The regions of Huancavelica, Huánuco and Ayacucho, among the poorest in Peru, have more than 40 percent stunting levels.

13^ Fan, Shenggen, Infrastructure and Pro-poor Growth, Paper prepared for the OECD DACT POVNET Agriculture and Pro-poor Growth, Helsibki Workshop, 17-18 June 2004.

14^ Many of the health complications women face during childbirth could be prevented with better access to skilled health care professionals during labor (World Health Organization).

15^ Black R, Levin C, Walker N, Chou D, Liu L, and others. 2016. "Reproductive, Maternal, Newborn, and Child Health: Key Messages from Disease Control Priorities, 3rd Edition." The Lancet. Published online 9 April 2016

16^ World Health Organization the case for Asia and the Pacific, Investing in Maternal Newborn and Child Health, Geneva, Switzerland.

17^ Bill and Melinda Gates Foundation, Maternal, Newborn and Child Health Strategy Overview, www.gatesfoundation.org.

18^ Black R, Laxminarayan R, Temmerman M, and Walker N. editors. 2016. “Reproductive, Maternal, Newborn, and Child Health. Disease Control Priorities, third edition, volume 2”. Washington, DC: World Bank. doi:10.1596/978-1-4648-0348-2. License: Creative Commons Attribution CC BY 3.0 IGO

19^ The study found that infrastructure investments and training supported the prevention of blood loss (above 500 milimeters) for an average cost of US$3328 per case (and US$29,897 for a case with blood loss above 3,000 mililiters). Evaluating Interventions to reduce maternal mortality: evidence from Peru’s PARSalud program, Journal of Development Effectiveness, Volume 1, Issue 4, 2009).

20^ See annex 2 for detailed information on indicator achievement.

21^ This chart does not include the almost USD$17 million spent on monitoring, evaluation, administration and auditing.

22^ The method converts the loss of mortality/incapacity avoided years into years of life gained.

23^ The study focuses on: complicated abortion, normal birth, hemorrhaging, eclampsia, sepsis and obstructed cesarean.

24^ National Epidemiological Network

25^ At the time of project preparation more than ¼ of women between 15 and 49 suffered from anemia largely because of inadequate nutrition..

26^ Estimates developed by the UN Inter-agency Group for Child Mortality Estimation (UNICEF, WHO, World Bank, UN DESA Population Division) at www.childmortality.org.

27^ (http://www.parsalud.gob.pe/factibilidad-del-programa, Estudio de Factibilidad: Resumen Ejecutivo, p. XIII).

28^ PARSALUD II. Módulo II: Identificación, definición del problema y sus causas. pág 344.

29^ PARSALUD II. Módulo II: Identificación, objetivos del proyecto pág. 377

30^ El nivel de riqueza es un indicador disponible para su uso en las bases de datos de la ENDES. De acuerdo a su metodología, se construye a partir de los activos de los hogares, siguiendo la metodología de Shea Rutstein y Kiersten Johnson de Macro Internacional Inc. y Deon Filmer y Lant Pritchett del Banco Mundial (The DHS Wealth Index: Approaches for Rural and Urban Areas. DHS Working Papers.USAID. 2008)