2000 Project Evaluation Results
Prepared by the UNCDF Evaluation Unit

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Bhutan

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I. Basic Project Data

Project Number:	BHU/92/CO1
Type of Evaluation:	Final
Project Title:	Primary Schools and Basic Health Units in Eastern Bhutan
UN Cooperating Organization:	UNDP, UNICEF
Government Executing Agency:	Ministry of Health and Education
Sector:	Education and Health
Sub-sector:	Sector Planning
Date Project Approved:	12 April 1994
Date Project Began:	January 1995
Date Project Ended:	March 2000
Date Project Evaluated:	January/February 2001
UNCDF Budget:	US$     4,417,345
Gov't. Budget:	832,564
UNDP Budget:	426,415
UNICEF Budget:	54,000
Total Budget:	US $ 5,715,324
Actual UNCDF Expenditures:	$4,381,319

 

II. Background

In the Royal Government of Bhutan's (RGOB) Seventh Five-Year Plan 1992-1997 (7FYP), better health and education are important means of achieving human resource development towards ensuring the spiritual and emotional well being of the country's population. The government seeks to ensure that development services reach the people, especially in least developed and isolated regions. This, combined with the poor condition of the health and education infrastructure in Eastern Bhutan, and a desire to experiment with decentralized government, provide the rationale for the present project. The project is an essential part of UNDP/UNCDF's program strategy to support to Bhutan.

Following an initial UNCDF Project Planning and Identification Mission in 1991, proposals were made for two projects totaling US$5 million over five years for the construction of 30 Primary Schools and 20 Basic Health Units (BHUs) in Eastern Bhutan. UNCDF's capital assistance aimed to complement the efforts of other donors in the area, including UNICEF's Support for Teacher and Basic Health Worker Training and WFP's Food Supply to Schools, Hospital and Road Worker Project. Upon completion of the Project Formulation Mission in May/June 1993, the proposed two projects were combined into one. A Project Agreement (PA) was prepared and signed by UNDP, UNCDF, UNICEF and RGOB in April 1994.

III. The Project

Development Objective

The development objective was to assist the RGOB in improving the human development status of Eastern Bhutan, specifically in both education and health sectors, in accordance with the Government's Seventh Five-Year Plan. Specifically:

1. To increase the literacy rate through a larger primary school enrolment (especially of girls) from the current 57.9 percent of primary aged children (aged 6-12 or above) to 81 percent in 1997; and
2. To extend primary health care coverage to the entire population by improving the network of Basic Health Units, and thereby, to enhance the life expectancy by cutting the infant mortality rates.

Immediate Objectives

1. To assist the RGOB in achieving its objective to increase primary school enrolment and extend primary health care coverage in the rural areas by expanding the network of primary schools and BHUs in the Districts of Lhuntsi, Mongar, Trashigang, Trashiyangtse, Pemagatsel and Samdrup Jongkhar.
2. Through the rehabilitation, upgrading, reconstruction, relocation and new construction of these social facilities, to promote a sustainable construction as well as suitable and cost effective designs, that will also substantially reduce the maintenance costs so it can be replicated and implemented by the Government elsewhere in Bhutan.
3. To strengthen the institutional capacity of the Department and of the Districts to deal with construction programs of this kind in a cost-effective manner, and
4. To create a community-based system of regular preventive maintenance, emphasizing the primary responsibility to the community and school supervisory management boards.

The expected outputs of the project are:

1. Reconstruction, rehabilitation, relocation, and new construction of 14 primary schools (PSs) and 15 basic health units (BHUs), while promoting an improved design;
   
2. Community-based maintenance system;
   
3. Strengthened engineering capabilities in six districts.

IV. Findings

Assessment of the project design

The project design demonstrated a number of weaknesses that have affected the project's achievement. These include: lack of clarity as to project structure, with some overlap between objectives and outputs; unrealistic expectations of capacity building given project activities and resources; lack of performance indicators; lack of risk assessment; lack of clear rationale for the staffing structure proposed; unrealistic timeframes and gross under-estimation of cost.

Results

The project succeeded in achieving its major output - the construction of 14 PSs and 15 BHUs in remote locations in Eastern Bhutan. These facilities are now fully utilized and are resourced in a manner commensurate with current RGOB capacity. The network of primary schools and BHUs did not expand, as the project strategy involved reconstruction of existing facilities.

It is difficult to assess whether access to basic health care improved as a result of the project, and if the upgraded facilities are more attractive to both clients and staff leading to increased utilization of facility-based health services. The project confirmed the general suitability of the PSs and BHU designs for remote locations, whilst recommending a number of minor modifications. Efforts were made towards establishing a community-based maintenance system. However, further work is required in this area. On-the-job experience with limited training opportunities were provided for inexperienced contractors in Eastern Bhutan, several of whom were upgraded as a result of project experience. Capacity enhancement of district administration for construction management was less than anticipated, although commensurate with project effort to this end. Overall, many lessons may be observed from the experience of the present project that point to the need for more effective project design and management strategies.

Impact

Literacy and life expectancy increased and infant mortality declined over the project period, although these are not directly nor solely the result of project interventions. Total enrolment increase in lower grades reflects the national trend and thus is not necessarily a result solely from project support. Enrolment increase in project schools in Classes VII and VIII is considerable, and increased dormitory facilities are likely to have been a major contributing factor. Although great advances were made in increasing the enrolment of girls, gender gaps remained.

Assessment of Project Efficiency and Relevance

Despite the above-mentioned achievements, the project was not implemented in an efficient manner, with initial delays in recruitment of technical staff and subsequent significant cost and time over-runs. Nevertheless, the project was and remains highly relevant.

The future RGOB education strategy includes the continuing expansion of basic education to the entire population, improving quality and relevance, and developing a highly motivated and competent teaching cadre. It is planned that all children will be enrolled in primary school by end of the 9th five year plan in 2007. Achieving this goal will require more community schools in under-served remote locations, more dormitory facilities at existing schools and more trained teachers. In this context, the project was highly relevant.

With regard to health, Bhutan's national health system exemplifies an ideal model in primary health care. It is a well-thought out, well-planned system that actually works. The present project embraced the mainstay of the system, through the upgrading, renovation and new construction of fifteen health centers in the Eastern region. Infrastructure is one of the central necessities to promote accessibility and equity. This project assisted in this endeavor and succeeded.

Furthermore, it is a tribute to the project's extraordinary commitment to rural development that it took on the challenge of working in rural areas, far from road access. It was a major player in developing remote areas in the Eastern region. The RGOB's strategy behind building large and standardized facilities is to have the population gravitate towards them, resulting in slower migration to urban centers such as Thimphu or Phuntsoling.

Assessment of Sustainability

Beyond infrastructure, there is the ongoing need for resourcing and maintenance of facilities. As in most developing countries, RGOB is operating within severe budgetary constraints. However, the commitment to the equitable delivery of high quality education and health services is impressive, as reflected in budgetary allocations that have increased over consecutive five-year plans. The national push for expanded and improved services is matched by an awareness of the increasing costs of education and health services and efforts to find ways to further finance the system without jeopardizing quality.


V. Recommendations

Construction

The MHE should prepare 'as-built' drawings for future maintenance purposes and follow up on the status, implementation and effectiveness of Maintenance Agreements initiated under this project. It should also review the functional use of BHU space, as well as review and reiterate the need for safe disposal of clinical waste. Sanitation and waste disposal training should be provided to all BHU staff, maintenance and management committees.

Mud mortar walls with cement plastering and pointing should be constructed in the remote areas, with additional supervision to ensure quality, in line with the local technology, to eliminate the transportation cost of cement and to enable community maintenance. Also, the stepping of retaining walls (shorter heights can be constructed with dry walls or semi dry walls) should be considered to avoid huge foundations.

Construction tendering

Attendance at pre-bid meetings and site visits should be included as an essential precondition for submission of tenders for construction activities, with failure to do so resulting in rejection of the bid. Construction projects involving petty contractors should include enhanced capacity building activities, including: ensuring contractor's are fully aware of tender and cost implications, providing assistance in the preparation of tender documentation, assisting successful contractors in preparation of work plans, cash-flow and risk management, etc.

Education

The District Education Officer and Head teachers should utilize the population statistics collected by BHU staff to assess numbers and location of out-of-school children in school catchment areas, to inform school planning. The MHE should monitor the home location of children enrolled in schools to assess coverage of schools and changes in access from an equity perspective. Once identified, District Education Officer and Head Teachers should target out-of-school student populations, especially girls, and make concerted social marketing efforts to bring these children to school. The DEOs should liaise with DHSO, and Head teachers with BHU staff, to ascertain the possibility for BHU staff to advocate for primary school enrolment and attendance, and to monitor the same, on their routine community visits. The MHE, in collaboration with Districts, should prepare five-year District Education Plans detailing local socio-economic, geographic and demographic contexts, current education situation, and forward education goals, strategies, development activities, budgetary allocations, and monitoring framework, for the achievement of education for all targets at the district level.

Health

The MHE should launch a larger campaign about the benefits of BHU services through social marketing to promote BHU services, involving religious leaders, Gups and other formal and informal leaders. This would be the next step after achieving access - to ensure utilization. A Health Facility Assessment (HFA) should be conducted to measure the quality of BHU service delivery and client satisfaction. The 'Model Village Concept' should be extended to the BHUs. Model BHUs would be the exemplary BHUs, which are well run and well maintained and functioning to their maximum capacity. (Also consider extension to PSs - establishment of model primary schools in terms of school facility maintenance.) BHU Staff Awards should be awarded to recognize good performance by the districts as an added incentive to the BHU Staff.

VI. Lessons learned

A considerable number of lessons were learnt from the experience of this project, including the following:

Project Design

An extended project preparatory phase enables thorough and complete site surveys, documentation, costing and preparation of project document. Inadequate initial site surveys and costing of project management and technical assistance requirements led to under-budgeting of the entire project, delays in staffing with consequent delays in implementation, escalation of project costs, and overall negative impact on project quality and outcomes. A phased approach should be taken with a few construction sites piloted first to establish lessons to inform subsequent expansion, rather than starting all construction simultaneously and replicating implementation problems on a larger scale.

Monitoring and Evaluation

Health and education performance indicators should be ones that can be measured over the life of a project, rather than long-term development goals. With regard to the monitoring and evaluation of construction work, there is a need to develop and implement a construction quality assessment strategy.

Capacity Building

Capacity building objectives should be clearly defined and specified; i.e., specification of whose capacity is to be built, capacity building targets, activities, resources, monitoring and impact assessment, including a work plan for post-project application of skills learnt. Technical assistance provision should also specify targets and activities to this end. Institutionalization of 'transparency, accountability, efficiency, participation and equity' procedures should be included as explicit capacity building targets.

VII. Evaluation Team

The evaluation was carried out by:

• Karen Munce, Education, Gender and Project Design Consultant, Team Leader,
  
• Donna Sillan, International Public Health Consultant
  
• Mahendra Chhetri, Civil Engineer
  
• Yadu Acharya, Architect.