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D1ai Bm m (I_ Specas, ad Jen Fh Pire Uer (Publc Heat SPeia. Ministy of Public llealth and Social/Family Action Credit Amount: US.2 million (SDR 21.2 million) Terms: Standard, with 40 years maturity Description: The project would assist the Govemment in its efforts to: (a) improve significantly the quality, coverage and utilization of basic health services for the Burkwnbe popuation, (b) enbance the nutritional status of the population, and (c) develop a national capacity for achieving sustainable control of endemic parasitic diseases. Pncips ppartoly docm-nt fr te t were pmpard by Caa M EMm Golde (&4ka Far. Ptw Pr&mm we te Dqm Diror nd mgi Divion Chbe, rtlve*. 1.1 Socio - Economic Indicators Annual Bank Staff Report to -the Executive Directors on the OCP Organigramme du Ministere de la Sante, de l 'Action Sociale et de la Famille 42 Organization Chart of the Ministry of Health, Social Development and the Family 2.3 Background on the Micronutrient Component Projet de Politique Ginmrale pour le secteur de la santd 48 Draft Letter of Health Sector Policy 3.1 Organisation du systeme des districts sanitaires 62 Organization of the Health District System 3.2 Les Plans de DUveloppement du district sanitaire 73 Development Plans for the Health District 3.3 Le systome d'organisations commautaires partclpa a 1e'ffort de sante 76 Community Organizations participating in the Health Movement 3.4 Formation du personnel des districts sanitaires 80 Health District Personnel Training 3.5 Programme de reddplolement et de recrutement du personnel de San W Publque 92 Redeployment and Ree.ruitment Programme of Public Health Personnel 3.6 Approvisionnement du pays en m&iicaments essentiels : La CAMEG 94 Supplying the country with Essential Drugs: the CAMEG 3.7 Micronutrient Component: Detailed Implementation Plan and Objectives Programme de lutte contre les dfflences en micron*rlents 101 Micronutrient Deficiency Control Program 3.9 Projet de note technique sur la reorganisation de la direction de la mddecine preventlve 104 Draft Technical Note on the Reorganization of Preventive Medicine Directorate 3.10 Projet dorganisation du service de mainenance 106 Draft Organization of the Maintenance Service 3.11 Financement des services de sante dans les districts sanitaires 108 Health Services Financing in the Health Districts 4.1 Plan de supervision 120 Supervision Plan 4.2 Termes de RNf Urences de l'ucp 122 Terms of Reference for the PCU 4.3 Procurement Plan and Timetable Disbursement Profile Project Cost Tables 131 MAPS: IBRD 25394, 25476, and 25477 BURKINA FASO BALTH AND NUIRB (PDSN) N PROJECr CREDIT AND PROJECT SUMMARY Govemment 'f Buddna Faso Beneficians:. Fifth, by sustining the achievements of the Onchocerciasis Control Programme (OCP), the endemic disease control comnponent would ensure that about 17% of Buddna's agricultural lands-with fertile soils-would remain available for the production of foodstuffs and other important agncultural commodities. Furthermore, dispensing of iodine and vitamin A should greatly reduce the incidence of goiter and mental retardation, and blindness resudting from vitamin A deficiency. To mitigate this risk, a moderate level of cost recovery would be gradually implemented so as not to result in a disincentive for people to utilize the primary level of the health care system. 3bh third risk is the time required for regaining confidence of the population in the health car centers, especially in light of the proposed cost recovery scheme coupled with the recent devaluation of the CFA franc. Fourth, the nutrition comronent would help reduce the high rates of anemia among expectant mothers which are a major cause of low birthweights.

A major contributing factor to this low life expectancy is high infant and child mortality caused by widespread cotious diseases, unfavorable hygienic conditions, malnutrition, and the limited capacity of the health system to preventhese conditions and to treat them effectively once contracted.

Public Disclosure Authorized ca AS5s t-a/ -)/a CURNCY OUIVLENT Curncy Unit = CFA Franc (CPAF) I US

A major contributing factor to this low life expectancy is high infant and child mortality caused by widespread cotious diseases, unfavorable hygienic conditions, malnutrition, and the limited capacity of the health system to preventhese conditions and to treat them effectively once contracted.

Public Disclosure Authorized ca AS5s t-a/ -)/a CURNCY OUIVLENT Curncy Unit = CFA Franc (CPAF) I US$1 = 270 CFAF (Rate prior to Janyary 12, 1994) Curmnt Rate = CFA Francl USSI = 580 CFAF WEIGHTS AND MEASURES Metric System I m. de sad pdmr I Primaq Health Care Post SA - Specal Accou SAFER - Soc#W ajhcbw d'icda a de Maksanom I Afica Firm for Stue sa Achievemnt Se P - Save the Childr Fund SPE - Sagqe mm d'di I Government Certified Mi A SIDA - Syndv me d'lmw Jfic cqids I AIDS SMI - Sawt mamelk aet infundk / Mote and Chld Heath SOEs - State of Expends_ SONAPHARM - Soc-M nanalk d'appavonmantph Iadque National Pharmaceul Supply Company SOSUCO - Soci Et acsq,v de Ia Como E I Como6 Company of Sugar Manufetus 3SP - Soins de sanapfar / Primary Health Care msu - Seually Trnmited Disea TDCI - Troubes Du ear Carncas an de Iodine Deficiency Diseses TRO - Ih Erapk de rfda"en par voe oral UCP - Unit d oorfinaton du projet 1 Project Coordini Unit UNDP - United Nations Development Programme UNFPA - Unitd Nations Fund for Populatn Acvies UNICEF - United Nations lntemaonad Children's Fund USAID - United Se Agecy for Inrnatinal Developm USC - Un W de souin des comosa VHW - Vllage Health Worker VITAL - Viamin A Fidd Support Project (JSAID) WHO - Wodtd Health O:anizaton WID - Women in Dealoment BURKINA EAS ', ALTH AND NUTRITON PROJECT fpdsn) TABLE OF CONTENTS Clr ET AND PROJCT SUMMARY...,.i I. 2.3 Maternal mortality is also high with 810 per 100,000 births (1988).

toa a I World Health Oaiza OR - Opeationa Reseah OSr - Ofca de sang ha auvai&ers I Bureau of Worker' Health PASE - Pogramme dppa a la su4weillanca ipudhmlgi q I Epidemiological Surveillaem Support Proje At PCU - Proect Coordinang Unit PDDS - Pk ide &wlppain & dibct Wa E I Dit Healh Development Plan PDSN - Proj.: devloppamaude sawn ade nurton I Hea and Nuti Development Poject PDSS - Proj es 4 dioppamaemes * ansfa de sam / Health Serviea Deveowmen Project PEG - Prevuuona Lc conrak dha and es goelsr a I Training Comm. About 18% of babies suffer from insufficient birthweight which limits their canaces of survival.

To address this risk, the Goverment has, prior to negotiations, developed a-d begun to implement an action plan, acceptable to IDA, to eosute the required redeployment and that the peonnel concerned reman where posted and carry out their assigned responsibilities.

The second risk is that tesistance to redeployment of doctors and other medical staff into ural areas will prevent adequa staffing of district health centers.

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A major contributing factor to this low life expectancy is high infant and child mortality caused by widespread cotious diseases, unfavorable hygienic conditions, malnutrition, and the limited capacity of the health system to preventhese conditions and to treat them effectively once contracted.Public Disclosure Authorized ca AS5s t-a/ -)/a CURNCY OUIVLENT Curncy Unit = CFA Franc (CPAF) I US$1 = 270 CFAF (Rate prior to Janyary 12, 1994) Curmnt Rate = CFA Francl USSI = 580 CFAF WEIGHTS AND MEASURES Metric System I m. de sad pdmr I Primaq Health Care Post SA - Specal Accou SAFER - Soc#W ajhcbw d'icda a de Maksanom I Afica Firm for Stue sa Achievemnt Se P - Save the Childr Fund SPE - Sagqe mm d'di I Government Certified Mi A SIDA - Syndv me d'lmw Jfic cqids I AIDS SMI - Sawt mamelk aet infundk / Mote and Chld Heath SOEs - State of Expends_ SONAPHARM - Soc-M nanalk d'appavonmantph Iadque National Pharmaceul Supply Company SOSUCO - Soci Et acsq,v de Ia Como E I Como6 Company of Sugar Manufetus 3SP - Soins de sanapfar / Primary Health Care msu - Seually Trnmited Disea TDCI - Troubes Du ear Carncas an de Iodine Deficiency Diseses TRO - Ih Erapk de rfda"en par voe oral UCP - Unit d oorfinaton du projet 1 Project Coordini Unit UNDP - United Nations Development Programme UNFPA - Unitd Nations Fund for Populatn Acvies UNICEF - United Nations lntemaonad Children's Fund USAID - United Se Agecy for Inrnatinal Developm USC - Un W de souin des comosa VHW - Vllage Health Worker VITAL - Viamin A Fidd Support Project (JSAID) WHO - Wodtd Health O:anizaton WID - Women in Dealoment BURKINA EAS ', ALTH AND NUTRITON PROJECT fpdsn) TABLE OF CONTENTS Clr ET AND PROJCT SUMMARY...,.i I. 2.3 Maternal mortality is also high with 810 per 100,000 births (1988). toa a I World Health Oaiza OR - Opeationa Reseah OSr - Ofca de sang ha auvai&ers I Bureau of Worker' Health PASE - Pogramme dppa a la su4weillanca ipudhmlgi q I Epidemiological Surveillaem Support Proje At PCU - Proect Coordinang Unit PDDS - Pk ide &wlppain & dibct Wa E I Dit Healh Development Plan PDSN - Proj.: devloppamaude sawn ade nurton I Hea and Nuti Development Poject PDSS - Proj es 4 dioppamaemes * ansfa de sam / Health Serviea Deveowmen Project PEG - Prevuuona Lc conrak dha and es goelsr a I Training Comm. About 18% of babies suffer from insufficient birthweight which limits their canaces of survival. To address this risk, the Goverment has, prior to negotiations, developed a-d begun to implement an action plan, acceptable to IDA, to eosute the required redeployment and that the peonnel concerned reman where posted and carry out their assigned responsibilities. The second risk is that tesistance to redeployment of doctors and other medical staff into ural areas will prevent adequa staffing of district health centers.

= 270 CFAF (Rate prior to Janyary 12, 1994) Curmnt Rate = CFA Francl USSI = 580 CFAF WEIGHTS AND MEASURES Metric System I m. de sad pdmr I Primaq Health Care Post SA - Specal Accou SAFER - Soc#W ajhcbw d'icda a de Maksanom I Afica Firm for Stue sa Achievemnt Se P - Save the Childr Fund SPE - Sagqe mm d'di I Government Certified Mi A SIDA - Syndv me d'lmw Jfic cqids I AIDS SMI - Sawt mamelk aet infundk / Mote and Chld Heath SOEs - State of Expends_ SONAPHARM - Soc-M nanalk d'appavonmantph Iadque National Pharmaceul Supply Company SOSUCO - Soci Et acsq,v de Ia Como E I Como6 Company of Sugar Manufetus 3SP - Soins de sanapfar / Primary Health Care msu - Seually Trnmited Disea TDCI - Troubes Du ear Carncas an de Iodine Deficiency Diseses TRO - Ih Erapk de rfda"en par voe oral UCP - Unit d oorfinaton du projet 1 Project Coordini Unit UNDP - United Nations Development Programme UNFPA - Unitd Nations Fund for Populatn Acvies UNICEF - United Nations lntemaonad Children's Fund USAID - United Se Agecy for Inrnatinal Developm USC - Un W de souin des comosa VHW - Vllage Health Worker VITAL - Viamin A Fidd Support Project (JSAID) WHO - Wodtd Health O:anizaton WID - Women in Dealoment BURKINA EAS ', ALTH AND NUTRITON PROJECT fpdsn) TABLE OF CONTENTS Clr ET AND PROJCT SUMMARY...,.i I. 2.3 Maternal mortality is also high with 810 per 100,000 births (1988).

toa a I World Health Oaiza OR - Opeationa Reseah OSr - Ofca de sang ha auvai&ers I Bureau of Worker' Health PASE - Pogramme dppa a la su4weillanca ipudhmlgi q I Epidemiological Surveillaem Support Proje At PCU - Proect Coordinang Unit PDDS - Pk ide &wlppain & dibct Wa E I Dit Healh Development Plan PDSN - Proj.: devloppamaude sawn ade nurton I Hea and Nuti Development Poject PDSS - Proj es 4 dioppamaemes * ansfa de sam / Health Serviea Deveowmen Project PEG - Prevuuona Lc conrak dha and es goelsr a I Training Comm. About 18% of babies suffer from insufficient birthweight which limits their canaces of survival.

To address this risk, the Goverment has, prior to negotiations, developed a-d begun to implement an action plan, acceptable to IDA, to eosute the required redeployment and that the peonnel concerned reman where posted and carry out their assigned responsibilities.

The second risk is that tesistance to redeployment of doctors and other medical staff into ural areas will prevent adequa staffing of district health centers.

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