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  • Project Completion Report

    Project Number: 27086 Loan Number: 1606/1607 June 2007

    Philippines: Early Childhood Development Project

  • CURRENCY EQUIVALENTS

    Currency Unit peso (P)

    At Appraisal At Project Completion 29 December 1997 30 November 2005

    P1.00 = $0.02502 $0.00185 $1.00 = P39.975 P54.12

    ABBREVIATIONS

    ADB Asian Development Bank ADF Asian Development Fund ARI acute respiratory infection ASIN Act for Salt Iodization Nationwide CDW child development worker CWC Council for the Welfare of Children DCM day care mom DCW day care worker DepEd Department of Education DOH Department of Health DSWD Department of Social Welfare and Development EA executing agency ECCD early childhood care and development ECD early childhood development ECDP Early Childhood Development Project ECE early childhood education EPI expanded program on immunization FIC fully immunized children GMP growth monitoring program IEC information, education, and communication IMCI integrated management of childhood illnesses LGU local government unit M&E monitoring and evaluation MDFO Municipal Development Finance Office MTR midterm review NDHS National Demographic and Health Survey NGO nongovernment organization NNC National Nutrition Council NPMO national project management office OCR ordinary capital resources PCR project completion report PEM protein-energy malnutrition PES parent effectiveness service PMO project management office R&D research and development RHM rural health midwife TT2 tetanus toxoid 2

  • iv

    NOTE

    In this report, $ refers to US dollars.

    Vice President L. Greenwood, Jr., Operations Group 2 Director General A. Thapan, Southeast Asia Department (SERD) Director S. Lateef, Social Sectors Division, SERD Team leader K. Schelzig Bloom, Poverty Reduction Specialist, SERD Team member C. Fajardo, Project Officer, SERD

  • CONTENTS Page

    BASIC DATA ii MAP vii I. PROJECT DESCRIPTION 1 II. EVALUATION OF DESIGN AND IMPLEMENTATION 1

    A. Relevance of Design and Formulation 1 B. Project Outputs 2 C. Project Costs 7 D. Disbursements 8 E. Project Schedule 8 F. Implementation Arrangements 9 G. Conditions and Covenants 9 H. Related Technical Assistance 9 I. Consultant Recruitment and Procurement 9 J. Performance of Consultants, Contractors, and Suppliers 10 K. Performance of the Borrower and the Executing Agency 10 L. Performance of the Asian Development Bank 11

    III. EVALUATION OF PERFORMANCE 11 A. Relevance 11 B. Effectiveness in Achieving Outcomes 12 C. Efficiency in Achieving Outcomes and Outputs 12 D. Preliminary Assessment of Sustainability 13 E. Impact 14

    IV. OVERALL ASSESSMENT AND RECOMMENDATIONS 15 A. Overall Assessment 15 B. Lessons 15 C. Recommendations 16

    APPENDIXES 1 Annotated Design and Monitoring Framework 18 2 Comparison of Planned Investments and Actual Equity Contributed by LGUs 42 3 Project Implementation Schedule 42 4 PMO Staff Mainstreamed/Absorbed by DSWD and CWC 45 5 Status of Compliance with Loan Covenants 46 6 Sustainability Indicators for Selected LGUs 53 7 Overall Assessment Summary Table 56

  • BASIC DATA

    A. Loan Identification

    1. Country Philippines 2. Loan Number

    Loan Number 1 1606-PHI Loan Number 2 1607-PHI (SF)

    3. Project Title Early Childhood Development Project 4. Borrower Republic of the Philippines 5. Executing Agency Department of Social Welfare and Development 6. Amount of Loan

    Loan 1606-PHI $15.70 million Loan 1607-PHI (SF) SDR 6.487 ($8.8 million)

    7. Project Completion Report Number PHI 981

    B. Loan Data

    1. Appraisal Date Started 18 August 1997 Date Completed 19 September 1997

    2. Loan Negotiations

    Date Started 13 December 1997 Date Completed 15 December 1997

    3. Date of Board Approval 27 January 1998 4. Date of Loan Agreement

    Original 15 April 1998 Amended and Restated 22 December 2002

    (for OCR Loan)

    5. Date of Loan Effectiveness In Loan Agreement 20 July 1998 Actual 28 September 1998 Number of Extensions 0

    6. Closing Date

    In Loan Agreement 31 January 2005 Actual Loan account still open Number of Extensions 1

    7. Terms of Loan

    1606-PHI Interest Rate Pool-based, LIBOR-based (15 December 2002) Maturity 25 years Grace Period 5 years Commitment Charge 0.75% per annum 1607-PHI (SF) Interest Rate 0 Maturity 35 years Grace Period 10 years Service Charge 1% per annum

  • iii

    8. Disbursements

    a. Dates

    Initial Disbursements Final Disbursement Time Interval

    1606-PHI 22 January 1999 15 November 2005 6.8 years 1607-PHI (SF) 22 January 1999 15 November 2005 6.8 years

    Effective Date Original Closing Date Time Interval

    1606-PHI 28 September 1998 31 January 2005 6.8 years 1607-PHI (SF) 28 September 1998 31 January 2005 6.8 years

    b. Amounts

    Category Original Allocation Last

    Revised Allocation

    Amount Cancelled

    Net Amount

    Available Amount

    Disbursed Undisbursed

    Balance

    LOAN 1606-PHI ($) Civil Works 1,400,000 2,678,468 0 2,678,468 2,647,790 30,678 Equipment 2,900,000 1,885,294 0 1,885,294 1,940,647 -55,353 Micronutrients and Food Supplements 2,600,000 1,421,075 0 1,421,075 1,418,407 2,668 Workshops and Seminars 400,000 1,983,403 0 1,983,403 1,297,112 686,291 Materials 1,400,000 1,289,120 0 1,289,120 783,812 505,308

    Training 1,600,000 1,388,359 0 1,388,359 1,217,817 170,542 Operating Costs 1,900,000 2,554,281 0 2,554,281 2,008,316 545,965 Interest and Commitment Charge 2,500,000 2,500,000 0 2,500,000 1,905,381 594,619 Unallocated 1,000,000 Imprest Account 208,700 -208,700

    Total 1606-PHI 15,700,000 15,700,000 0 15,700,000 13,427,982 2,272,018 LOAN 1607-PHI (SF) (SDR)

    Social Marketing and IEC 221,000 448,630 0 448,630 419,931 28,699

    Materials and Supplies 2,875,000 4,591,394 0 4,591,394 3,949,432 641,962 Special Studies and Surveys 1,253,000 639,030 0 639,030 433,438 205,592

    Consulting Services 1,032,000 512,946 0 512,946 537,109 -24,163 Service Charge 295,000 295,000 0 295,000 151,142 143,858 Unallocated 811,000 0 0 0 0 0 Imprest Account 0 0 0 0 0 0

    Total 1607-PHI (SF) 6,487,000 6,487,000 0 6,487,000 5,491,044 995,948 IEC = information, education, and communication. Note: There were over disbursements in some categories.

    The expenditures were incurred towards the end of the Project and it was decided not to process a reallocation of loan proceeds.

  • iv

    Disbursement

    9. Local Costs Financed (1606-PHI) Amount ($000) 8,629 Percent of Local Costs 40 Percent of Total Cost 18

    10. Local Costs Financed (L1607-PHI) Amount ($000) 4,007 Percent of Local Costs 19 Percent of Total Cost 8

    C. Project Data

    1. Project Cost ($000)

    Cost Appraisal Estimate Actual Foreign Exchange Cost 20,700 25,700 Local Currency Cost 44,300 21,500 Total 65,000 47,200

    2. Financing Plan ($000)a

    Appraisal Estimate Actual Costs

    Foreign Local Total Foreign Local Total Implementation Costs Borrower Financed 0 18,100 18,100 0 8,800 8,800 ADB Financed 7,400 14,300 21,700 6,300 12,700 19,000 World Bank Financed

    17,300

    Subtotal 13,600 44,300 57,800 23,600 21,500 45,100 IDC Costs Borrower Financed 0 0 0 0 0 0 ADB Financed 2,900 0 2,900 2,100 0 2,100 World Bank Financed 4,300 0 4,300 0 0 0 Subtotal 7,200 0 7,200 2,100 0 2,100 Total Cost 20,700 44,300 65,000 25,700 21,500 47,200 ADB = Asian Development Bank, IDC = interest during construction. a Calculations are based on the exchange rate to the dollar for each fiscal year. The actual cost in ADB

    financing is the dollar equivalent as of 1 March 2007. Full data on World Bank financing still awaited from Department of Social Welfare and Development.

  • v

    3. Cost Breakdown by Project Component ($000)

    Component Appraisal Estimate Actual Foreign Local Total Foreign Local Total Civil Works 200 2,200 2,500 1,300 2,700 4,000 Equipment and Vehicles 3,900 1,700 5,600 4,900 1,200 6,100

    Materials and Supplies 2,200 9,000 11,100 5,800 7,900 13,700 Micronutrients and Food Supplements 4,800 2,000 6,800

    3,000 0 3,000

    Special Studies and Surveys 400 1,700 2,000 100 800 1,000 Social Marketing and IEC 200 1,400 1,600 500 1,000 1,500 Training 600 5,800 6,400 1,900 3,500 5,400 Workshops and Seminars 0 1,200 1,200 0 1,400 1,400 Monitoring and Evaluation 400 1,200 1,600 0 0 0 Operation and Maintenance 0 200 200 0 100 100 Project Staff Salaries 0 1,900 1,900 0 2,000 2,000 Caregiver Incentives 0 7,500 7,500 0 0 0 Specialized and NGO Consulting

    Services 100 1,700 1,800 5,800 800 6,600 Taxes and Duties 0 1,700 1,700 0 0 0 Imprest Account 0 0 0 200 200 200 Contingencies 900 5,300 6,200 0 0 0 Service Charges 7,200 0 7,200 2,100 0 2,100 Total 20,700 44,300 65,000 25,700 21,500 47,200 IEC = information, education, and communication, NGO = nongovernment organization. Notes: Appraisal estimate based on the Report and Recommendation of the President. Totals may not add due to rounding. Cost breakdown is based on dollar equivalents as of 1 March 2007. 4. Project Schedule

    Item Appraisal Estimate Actual Establish Core and Full PMO From Q3 1997 to Q1 1998 From Q2 1998 to Q4 1999 Hiring of Consultants for PMO From Q1 1998 to Q1 1998 From Q1 1998 to Q4 2002 Installation of Cold Chain From Q3 1998 to Q4 1998 From Q3 2001 to Q4 2004 Orientation and Seminars on IMCI andTraining From Q2 1998 to Q2 2000 From Q3 1999 to Q4 2004 Establish Training Centers From Q3 1998 to Q4 1998 From Q4 1999 to Q3 2000 Hiring of Consultants for Food Fortification From Q2 1998 to Q2 1998 From Q1 1999 to Q3 2002 Communication Plan Development andImplementation From Q4 1998 to Q4 2004 From Q3 2001 to Q4 2005 Manual and Materials Development and Training for PES From Q2 1998 to Q4 2001 From Q1 1999 to Q4 2004 Development of Training Manuals and Materials for ECE and Training From Q1 1998 to Q1 2001 From Q2 1998 to Q1 2001 Procurement of Manipulative Toys From Q2 1998 to Q2 1998 From Q2 1999 to Q3 2001 Pilot ImplementationBatch 1 LGUs From Q3 1998 to Q4 2001 From Q2 2000 to Q4 2005 Pilot ImplementationBatch 2 LGUs From Q1 1999 to Q4 2001 From Q1 2001 to Q4 2005 Pilot ImplementationBatch 3 LGUs From Q3 1999 to Q4 2002 From Q1 2002 to Q4 2005 Baseline Survey From Q3 1998 to Q2 1999 From Q1 2002 to Q4 2003 Research Studies From Q2 1998 to Q4 2003 From Q1 1999 to Q2 2006 Indicators Survey From Q2 1998 to Q4 1999 From Q4 2000 to Q2 2002 Midterm Evaluation From Q3 2001 to Q4 2001 From Q3 2001 to Q4 2001 Longitudinal Study (Phases 1 to 3) From Q1 2000 to Q3 2002 From Q2 2001 to Q2 2005 First Procurement Q1 1998 15 September 2000 Last Procurement Q4 2003 20 September 2005 ECE early childhood education, IMCI = integrated management of childhood illnesses, LGU = local government unit, PES = parent effectiveness service, PMO = project management office.

  • vi

    5. Project Performance Ratings Ratings Implementation Period Development Implementation Objective Progress From 30 November 1998 to 30 March 2002 Satisfactory Satisfactory From 31 March 2002 to 29 June 2002 Satisfactory Highly Satisfactory From 30 June 2002 to 30 August 2003 Satisfactory Satisfactory From 31 August 2003 to 28 February 2004 Satisfactory Highly Satisfactory From 29 February 2004 to 29 November 2005 Satisfactory Satisfactory From 30 November 2005 to 31 January 2007 Satisfactory Highly Satisfactory

    D. Data on Asian Development Bank Missions

    Name of Mission Date No. of

    Persons No. of

    Person-Days Specialization of Members

    Loan Inceptiona Loan Review/Supervision 1225 Oct 2000 3 33 a, b Loan Review 28 May1 Jun 2001 2 10 a, b Midterm Review Missiona 14 Nov3 Dec 2001 Loan Review 1329 May 2002 3 14 a, b Loan Review 1416 Jan 2004 2 6 a, b Loan Review/Supervision 711 Feb 2005 2 10 a, b Loan Review (Final), Supervision 2729 Sep, 811 Nov 2005 2 14 a, b Project Completion Review 29 Jan9 Feb 2007 3 30 a, b, c a - project officer, b - project analyst, c - consultant. a Loan Inception and Midterm Review Mission back-to-office reports are not available.

  • P A C I F I C O C E A N

    S o u t h C h i n a S e a

    S u l u S e a

    Panay Gulf

    LeyteGulf

    C e l e b e s S e a

    M o r o G u l f

    Babuyan Channel

    P h i l i p p i n e S e a

    VisayanSea

    Sibuyan Sea

    Bohol Sea

    Oroquieta

    Malaybalay

    Cagayan de Oro

    MarawiTubod

    Siquijor

    Mambajao

    Dipolog

    Dumaguete

    Zamboanga

    Isabela

    IpilPagadian

    Jolo

    Panglima Sugala

    San Jose

    IloiloBacolod

    Jordan

    KaliboRoxas

    Romblon

    Boac

    Mamburao

    Calapan

    Lucena

    Puerto Princesa

    Cebu

    Tagbilaran

    Catarman

    Tacloban

    Catbalogan

    Naval

    Daet

    PiliVirac

    Sorsogon

    Legaspi

    Trece Martires

    ManilaBalangaBinangonan

    Sta. Cruz

    Batangas

    Palayan

    Baler

    Tarlac

    San Fernando

    Malolos

    Iba

    Lingayen

    San Fernando

    Baguio

    La Trinidad

    Lagawe

    Cabarroguis

    IlaganBontoc

    Bayombong

    Laoag

    Vigan

    BanguedTuguegarao

    Tabuk

    Kabugao

    Masbate

    Borongan

    Maasin

    Surigao

    Butuan

    Prosperidad

    Tandag

    Koronadal

    Alabel

    Isulan

    Shariff AguakKidapawan

    Digos

    Mati

    Tagum

    Nabunturan

    Davao City

    Basco

    Itbayat

    Sabtang

    AKLAN

    CAPIZ

    ILOILO

    ANTIQUE

    GUIMARASCEBU

    PALAWAN

    BOHOL

    SIQUIJORCAMIGUIN

    MASBATE

    MARINDUQUE

    ROMBLON

    ALBAY

    SORSOGON

    CATANDUANES

    SURIGAODEL NORTE

    SURIGAO DEL SUR

    BUKIDNON DAVAODEL

    NORTE

    COMPOSTELA VALLEY

    DAVAO ORIENTAL

    DAVAO DEL SUR

    SARANGANI

    SOUTHCOTABATO

    SULTAN KUDARAT

    MAGUINDANAO

    BASILAN

    SULU

    TAWI-TAWI

    ZAMBOANGADEL NORTE

    ZAMBOANGASIBUGAY

    ZAMBOANGADEL SUR

    NORTH COTABATO

    KALINGA

    APAYAO

    CAGAYAN

    ISABELA

    MT. PROVINCE

    ABRA

    ILOCOS SUR

    ILOCOS NORTE

    BENGUET

    QUIRINO

    AURORAPANGASINAN

    ZAMBALES

    TARLAC

    BATAAN

    BULACANPAMPANGA

    NUEVAECIJA

    NUEVAVIZCAYA

    QUEZON

    CAVITE LAGUNA

    BATANGAS

    RIZAL

    Polillo

    LA UNION

    IFUGAO

    CAMARINESNORTE

    CAMARINESSUR

    AGUSANDEL SUR

    AGUSANDEL NORTE

    MISAMISOCC.

    MISAMISORIENTAL

    LANAODEL SUR

    LANAODEL NORTE

    LEYTE

    BILIRAN

    SOURTHERNLEYTE

    WESTERNSAMAR

    EASTERNSAMAR

    NORTHERN SAMAR

    NEGROS OCCIDENTAL

    OCCIDENTALMINDORO ORIENTAL

    MINDORO

    NEGROSORIENTAL

    Burias

    Ticao

    BATANES

    REGION IV-ACALABARZON

    REGION IV-BMIMAROPA

    CAR

    REGION IIlocos REGION II

    Cagayan Valley

    REGION IIICentral Luzon

    REGION VBicol

    REGION VIIIEastern Visayas

    REGION VIWestern Visayas

    REGION VIICentral Visayas

    NCR

    REGION IXZamboanga Peninsula

    A R M M

    REGION XIIICARAGA

    REGION XIDavao Region

    REGION XIISOCCSKSARGEN

    REGION XNorthern Mindanao

    NCRARMM

    CALABARZONCAR

    CARAGA

    MIMAROPASOCCSKSARGEN

    - National Capital Region- Autonomous Region in Muslim Mindanao- Cavite, Laguna, Batangas, Rizal, Quezon- Cordillera Administrative Region- Agusan del Norte, Agusan del Sur, Surigao del Norte, and Surigao del Sur- Mindoro, Marinduque, Romblon, Palawan- South Cotabato, North Cotabato, Sultan Kudarat, Sarangani, and General Santos

    National Capital

    City/Town

    Main Road

    Provincial Road

    Provincial Boundary

    Regional Boundary

    Boundaries are not necessarily authoritative.

    Regions VII and XII

    Region VI

    World Bank Financed

    ADB Financed (includingLanao del Norte formerlyRegion 12)

    Note: Lanao del Norte formerly under Region XII

    PHILIPPINES

    EARLY CHILDHOODDEVELOPMENT PROJECT

    Kilometers

    0 50 100 150

    N

    07-1079 HR

    125 00'Eo

    125 00'Eo

    119 00'Eo

    119 00'Eo

    8 00'No 8 00'No

    16 00'No16 00'No

    122 00'Eo

    122 00'Eo

    21 00'No

    21 00'No

  • 1

    I. PROJECT DESCRIPTION 1. The Early Childhood Development Project was approved on 27 January 1998 and became effective on 28 September 1998. The total project cost was estimated at $65 million, to be comprised of $24.5 million from Asian Development Bank (ADB), $22.4 million from the World Bank and $18.1 million from the Government of the Philippines. ADB financing was to include $15.7 million from ordinary capital resources (L1606-PHI) and $8.8 million from the Asian Development Fund (L1607-PHI). Both loans were approved and became effective at the same time. 2. The executing agency (EA) was the Department of Social Welfare and Development (DSWD), working in close coordination with three implementing agencies: the Department of Health (DOH), Department of Education (DepEd), and Council for the Welfare of Children (CWC). The overall purpose (impact) of the Project was to support government efforts to improve child survival and increase readiness for productive life. The Projects outcomes were (i) to provide integrated early childhood development (ECD) service delivery under local government unit (LGU) management, (ii) to provide support systems for the integrated ECD service delivery, and (iii) to support research and development for improved ECD service delivery and management. The project had 10 key performance indicators (see Table A1.1). The project design and monitoring framework with project performance at the time of the Project Completion Review Mission is in Appendix 1. 3. The Project was implemented in 132 LGUs in 10 provinces in regions VI, VII and XII.1 The Project was financed on a parallel basis by ADB and the World Bank, with ADB financing ECD interventions in regions VII and XII and the World Bank covering Region VI.

    II. EVALUATION OF DESIGN AND IMPLEMENTATION A. Relevance of Design and Formulation

    4. The Project was the first investment project designed to operationalize the Governments 10-year (19982007) National Early Childhood Development Program, which called for increased investment to strengthen the countrys child health, nutrition, and early education programs. The Project was a timely and appropriate response, given the poor health, nutrition, and psychosocial development of children in the country. 5. The Project responded to young childrens needs with a comprehensive and integrated package of cost-effective ECD interventions and services. A complex undertaking across the health, education, and nutrition sectors, the Project provided services at each stage of child development from prenatal care to birth to enrolment in the first grade. It geographically targeted poor children and tailored interventions to indigenous peoples groups. The service packages included integrated management of childhood illnesses, an expanded immunization program, supplemental feeding, micronutrient supplementation, and deworming. All of these are known to be effective measures in ensuring child survival. The Project also promoted an enriched, 8-week early childhood education (ECE) curriculum, proven in a pilot initiative to be an effective intervention for ensuring school readiness for entrants to the first grade.

    1 The 10 Project provinces were Antique, Capiz, Guimaras, Iloilo, and Negros Occidental in Region VI; Bohol, Cebu,

    and Negros Oriental in Region VII; and Lanao del Norte and North Cotabato in Region XII (although Lanao del Norte later became part of region X). The provinces were selected based on a national ranking of all regions, cities, and municipalities with high need for ECD services. That need was defined by high infant and child mortality rates, high prevalence of protein-energy malnutrition and micronutrient malnutrition, and high dropout rates in primary schools. Also considered was expressed local support and willingness to strengthen ECD service delivery.

  • 2

    6. The Project was adapted to the devolved health and social service delivery, thus ensuring the participation and involvement of the LGUs now mandated to deliver the services. The design appropriately incorporated capacity building for ECD program policymakers, managers, and service providers at the national, regional, and local levels. It also incorporated establishing ECD coordination mechanisms and management support systems to address early childhood needs in a harmonized and integrated manner. The Project interventions and capacity building efforts were based on numerous research and development (R&D) studies supported by the Project. The R&D component assured evidenced-based policy and guidelines formulation, and focused ECD actions on actual needs. On the whole, the Project as designed was timely, appropriate, and comprehensive. B. Project Outputs

    7. The Project had three outputs, or components, with numerous subcomponents. Of the 10 key performance indicators (see Table A1.1), three are output-level indicators: the proportion of municipalities with functional protein-energy malnutrition prevention, the proportion of municipalities with active child development workers, and the proportion of targeted municipalities with ECD subprojects.2 All three of these indicators show that targets were either met or exceeded. The proportion of LGUs with active child development workers is 63% (as against the target of 50%), and, as of the Project Completion Review Mission, LGUs continue to fund most of their child development workers in a cost-sharing arrangement with barangay councils. The target of 132 LGUs implementing ECD subprojects was fully achieved. The targeted 50% of LGUs with functional programs to address protein-energy malnutrition was exceeded, as 90% of LGUs had implemented the growth monitoring program and 69% had implemented the feeding program.

    1. Component 1: Program Support for Provinces 8. Component 1 upgraded the ECD service delivery system through five service packages, and supported the integration of service delivery through an LGU financing facility.

    a. Province-wide ECD Service Delivery Upgraded

    9. Five ECD service packages were designed to strengthen the capacity of the project provinces to administer adequate integrated child survival and development programs to address health, nutrition, and psychosocial concerns. These were: (i) expanded program on immunization (EPI), (ii) integrated management of childhood illnesses (IMCI), (iii) micronutrient malnutrition prevention and control, (iv) parent effectiveness service (PES), and (v) Grade 1 early childhood education.

    10. Expanded Program on Immunization (EPI). Under this component, the Project upgraded the cold chain facilities of all three regional health offices and installed new cold chain equipment in rural health units and city health offices to increase the proportion of health facilities with functional cold chain systems3 from 227 in 2000 (67%) to 277 in 2004 (84%). The Project improved the skills of 95 public health nurses regarding the revised system of cold chain management and trained 75% of the targeted service providers in basic EPI services. This resulted in better management and administration of immunization services. A total of 4,575 2 The original design and monitoring framework did not have specific or measurable targets. The 10 key

    performance indicators (a separate appendix in the project document) were not attributed to the impact, outcome, and output levels. This attribution was done for purposes of the project completion report.

    3 A rural health unit with a functional cold chain system is defined as having at least a refrigerator, thermometer, and vaccine carriers with complete sets of ice packs for each midwife within the rural health units catchment area.

  • 3

    copies of the EPI basic skills modules and posters on measles and tetanus immunization were also provided as reference materials. However, only a very low 53% of the total 330 rural health units and city health offices were found to be in strict compliance with proper cold chain management protocol.4 11. Integrated Management of Childhood Illnesses (IMCI). The Project helped introduce the country to the World Health Organization IMCI protocol in managing and treating six common childhood illnesses.5 The Project (i) developed an 11-day course and IMCI training curriculum; (ii) established nine IMCI training centers that deliver training for service providers nationwide; (iii) trained 61% of health service providers lacking IMCI skills; (iv) improved IMCI counseling skills of 1,507 service providers through a 5-day course focused on 14 core health and nutrition messages; (v) integrated the IMCI module into the curriculum of 45 midwifery schools, 60 nursing schools, and seven medical schools in collaboration with the Association of the Philippine Midwifery Schools, the Association of Deans of Philippine Colleges of Nursing, and the Association of Philippine Medical Colleges; and (vi) established functional rural health units and barangay health and nutrition posts, although only half of these (49%) have fully adopted the IMCI protocol.

    12. Micronutrient Malnutrition Prevention and Control. This component supported the prevention and control of iron, iodine, and vitamin A deficiencies through direct supplementation, deworming, protein-energy malnutrition prevention, and food fortification. In particular, the Project supported the iron supplementation of low birth weight infants, infants 611 months old, Grade 1 students, and pregnant women in all ECD areas;6 as well as vitamin A supplementation for infants 611 month old, children 1271 months old, and lactating women.7 The Projects longitudinal study8 showed an increase in the proportion of children who received iron and vitamin A supplements from 2001 to 2003 in Regions VI and VII. Deworming tablets (albendazole) were also provided to Grade 1 pupils and children 2471 months old. For protein-energy malnutrition prevention, the Project (i) enhanced the food supplementation guidelines, which adopted the International Reference Standards and protocol, with a menu list as a guide for local supplemental feeding; (ii) trained child development workers and nutritionists on the use of the guidelines; (iii) regularly monitored the growth of children 023 months old (monthly) and of children 2471 months old (quarterly); and (iv) enrolled children found to be underweight in a 90-day feeding program, although only half of them were considered rehabilitated at the end of the program. 13. The Project spearheaded drafting of the 2000 Food Fortification Law (RA 8976) and its implementing rules and regulations. As a result of the intensified promotion of RA 8976, the staple foods began to be fortified. As of December 2006, all 12 Philippine flour millers are fortifying flour with vitamin A and iron, six received the Diamond Sangkap Pinoy Seal for their 49 brands. Thirty-six of the 46 oil refineries fortify their cooking oil with vitamin A (42 brands with 4 Proper cold chain management requires the presence of an EPI refrigerator thermometer, a monitoring chart

    posted on or near the storage facility, two-time temperature charting (morning and afternoon), maintenance of proper temperature in the freezer (-15 to -25 degrees centigrade) and in the body of the refrigerator (+2 up to +8 degrees centigrade), proper placement of polio and measles vaccine in the freezer and the BCG, DPT and TT vaccines and diluents in the body of the refrigerator, absence of expired vaccines and of other items aside from vaccine in the refrigerator, and a power failure plan.

    5 Diarrhea, pneumonia, tuberculosis, measles, malaria, and anemia (including dengue fever). 6 Iron supplementation was provided for 65,415 low birth weight infants, 734,969 infants 611 months old, 883,405

    grade 1 students, and 1,092,224 pregnant women (Government PCR). 7 Vitamin A supplementation was provided for 956,285 infants 611 month old, 4,991,913 children 1271 months

    old, and 852,576 lactating women (Government PCR). 8 The longitudinal study was conducted in regions VI and VII (with Region VIII as the control) over three rounds in

    2001, 2002, and 2003.

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    the Diamond Sangkap Pinoy Seal). One sugar trader fortifies refined sugar with vitamin A (two brands with the Diamond Sangkap Pinoy Seal) while 30% of the National Food Authority rice for the Food for School Program is fortified with iron. The regular Sangkap Pinoy Seal has been awarded to 98 voluntarily fortified processed foods. The Project strongly promoted the Act for Salt Iodization Nationwide, or ASIN, RA 81729 and a 2005 Food and Nutrition Research Institute survey found that 95% of salt on the market tested positive for iodine and 75% of households used iodized salt. 14. Parent Effectiveness Service (PES). The Project enhanced the delivery of PES in the Project sites and upgraded the skills of day care workers and child development workers for delivering these services through (i) development of reference guides, including an enhanced PES manual with nine modules10 and a revised day care manual; (ii) development, procurement, and distribution of ECD advocacy materials for parents; and (iii) training of supervisors and service providers in the PES modules, use of the revised day care manual, supervised neighborhood play, and integrated ECD. These inputs contributed to parents increased awareness of PES, and the longitudinal surveys showed their participation doubling from 17% in 2001 to 34% in 2003 (although participation of fathers in PES was very low). The Project introduced tools to track services in an integrated manner, such as the Mother and Child Book (for recording the services provided to the mother during pregnancy and postpartum and those provided to her child from birth to 6 years), as well as the Early Childhood Care and Development (ECCD) Checklist (to assess the childs progress from birth to 6 years in terms of health, nutrition, and psychosocial development). 15. Grade 1 Early Childhood Education (ECE). The Project institutionalized the 8-week ECE curriculum in all elementary schools nationwide, which was a remarkable achievement. Aiming to improve the readiness of children 56 years old for elementary education, the ECE curriculum is based on a set of stimulating, innovative, and participatory learning approaches for school entrants. Grade 1 classrooms were equipped with educational materials, manipulative toys, and other supplies. The Project enhanced the provision of appropriate ECE interventions by developing a school readiness assessment tool to identify school entrants as either ready or not ready for elementary education. Results of the assessment guide teachers and focus attention on the not-ready (in larger schools with multiple Grade 1 sections the children are divided into ready and not ready classrooms). DepEd, through the Commission for Higher Education, integrated the 8-week ECE curriculum into the pre-service teacher education curriculum in all universities and colleges.

    b. LGU Financing Facility for Integrated ECD Service Delivery Provided 16. An LGU financing facility for integrated ECD service delivery was made available under the Project to 132 LGUs with a high need for ECD services.11 Through this subcomponent, the Project supported LGUs in formulating a 3-year investment plan that addressed local ECD needs and established a multisectoral ECD team responsible for ensuring the continuous 9 Strengthening efforts included the passage of local ordinances and resolutions; social marketing and several media

    relations activities; quarterly market, warehouse and port inspections (known as patak sa asin); mobilization of the leagues of local officials; formation of food fortification task forces; organization of cooperatives; and formulation of various guidelines (e.g., Patak sa Asin Guidelines, Handbook on ASIN Law Enforcement, and Handbook on Enhancing Capability to Implement Social Marketing).

    10 The nine modules are: (i) Myself as a Person and a Parent, (ii) The Filipino Family, (iii) Challenges of Parenting, (iv) Child Development, (v) Keeping Your Child Safe from Abuse, (vi) Building Childrens Positive Behavior, (vii) Health and Nutrition, (viii) Home Management, and (ix) Keeping a Healthy Environment for Your Children.

    11 The original target at appraisal was 165 LGUs. This target was reduced to 132 based on the pilot implementation and in order to increase the financing available to each LGU.

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    provision of ECD services to children in their areas. The facility increased local officials awareness of and support for ECD. They pledged counterpart funds, formulated and issued ECD-supportive local ordinances and resolutions, and established multisectoral councils for the welfare and protection of children. This subcomponent operationalized the relationship between LGUs and the national, regional, and provincial levels for the delivery of ECD services in the context of devolved health and social services delivery. 17. The facility supported the delivery of four core ECD service packages: rural health midwife, day care worker, child development worker, and day care mom. In particular, the facility (i) constructed and equipped new ECD facilities and repaired old ones to cater especially to children and women in remote areas and poorer segments of the population;12 (ii) hired and deployed 1,680 new midwives, 4,087 day care workers, 1,630 child development workers, and 18 day care moms in areas where ECD services were absent or inaccessible; and (iii) trained the new and existing service providers on several ECD-related programs and processes. A total of 105 LGUs established ECD resource centers, which at the time of the Project Completion Review Mission continued to offer ECD learning materials, manipulative toys and other materials to ECD workers and, to a lesser extent, parents.

    2. Component 2: Support to Service Delivery

    18. This component complemented the financial assistance to LGUs with technical support in four areas: (i) communications; (ii) planning, targeting, and management information systems; (iii) training and human resource development; and (iv) institutional development at all levels of operations. It developed the capacity of policymakers, program managers, and ECD service providers; strengthened the CWC as the coordinating body for ECD programs and services; and mobilized the support of the private sector on food fortification.

    19. Support to Communications. The Project promoted ECD awareness among policymakers, program managers, service providers, and families with regard to their respective responsibilities in ensuring the physical, mental, and psychosocial development of their children. Local officials support for ECD was mobilized and resulted in 132 municipalities and cities participating and contributing a total of P274.1 million as equity, representing 25% of the total investment. Actual disbursements of some LGUs were much higher than their expected counterpart contributions (see Appendix 2). After project closure in 2005, several LGUs have continued to allocate funds for ECD services. Communication efforts also resulted in strengthened project teams and local councils for ECD. Several resolutions and ordinances were passed to improve ECD services at the local level. The Project substantially supported the Bright Child campaign (under Executive Order No. 286) as the single brand for all ECD-related efforts. This campaign is an offshoot from passage of the Early Childhood Care and Development (ECCD) Act in December 2000. 20. The Project developed communication planning skills in the EA and in regional and local implementing agency offices. Local communication plans were formulated with a focus on the benefits of the interventions supported by the Project (e.g., immunization, food fortification, PES, prenatal care, day care centers, and so on). It also fostered better linkages and coordination among concerned agencies at the national, regional, provincial, and city or municipal levels.

    12 The ECDP constructed 254 new barangay health stations and repaired or renovated 505; constructed 945 new day

    care centers and renovated or repaired 1,009; and renovated or repaired 28 day care moms houses and child minding centers. Barangay health stations were equipped with basic health instruments (blood pressure apparatus, weighing scales), televisions and VCD players, karaoke machines, typewriters, oscillating fans, and supplies in the form of albendazole tablets for deworming, as well as ferrous sulfates and vitamin A capsules for preventing anemia and vitamin A deficiency.

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    Promotional activities and materials were developed to advance understanding of the ECCD and related laws (e.g., Food Fortification Law, ASIN). Private food corporations and companies joined the Government in developing and promoting fortified foods. Local offices joined together in ensuring the compliance with ASIN (e.g., salt producers and manufacturers, police,) while some organized community groups participated in selling iodized salts. 21. Support to Planning, Targeting, and Management Information Systems. The Project developed an automated needs-based ECD planning template as a guide to formulating the LGUs 3-year investment plans. Several management information systems were developed to facilitate project implementation: (i) a financial management system to track the Projects physical and financial targets; (ii) a procurement management system to track the procurement, delivery, and disbursement of goods and civil works; (iii) an ECD service delivery information system that generates information on the services received by the Project beneficiaries through the ECD service providers; and (iv) a document and contract tracking system to facilitate communication and transactions. The Project initiated development of a child identification system to track all services received by a child from service providers, but this initiative never got off the ground.13 22. Support to Training and Human Resource Development. The training and human resource development outputs of the Project were numerous and covered a broad array of relevant topics. Table A1.8 enumerates the training by type and group of stakeholders covered. The human development efforts resulted in a cadre of more competent ECD policymakers, program managers, service providers, and ECD advocates at various levels. 23. Support to Institutional Development. The Project instituted coordination mechanisms among agencies involved in ECD programs and activities at all levels that were still functioning at the time of the Project Completion Review Mission. Multisectoral committees for the welfare and protection of children were formed at the national, regional, and local levels. Regular coordination meetings were held to provide updates, formulate policies and guidelines, and make decisions on project implementation issues. Program implementation reviews to assess the progress of ECD work became an integral activity of the various agencies and committees. At the time of the Project Completion Review Mission, ECD teams at the local (municipal) level continued to serve as the focal coordinating bodies for all ECD activities. Many stakeholders reported that the Project significantly improved their coordination and rapport with one another. At the regional level, a series of workshops (e.g., regarding investment planning, financial information systems, and procurement systems) was undertaken, enabling the committee members regularly to track the progress in financial disbursements and procurement. The regions demonstrated the capacity to manage pooled procurements of ECD goods and services needed by the LGUs. ECD resource centers were established in 105 LGUs,14 and now continue to be operated by the LGUs. These resource centers aim to meet the information needs of ECD service providers and parents, as well as to serve as loci for child development learning and local ECD-related meetings and events. 24. The Project strengthened the capacity of the CWC as the lead agency for coordinating implementation of the ECCD Law. The Project provided training to CWC officials and staff and

    13 However, the CWC is now reviewing systems developed under the Project, including the child identification

    system, in order to identify which can be modified and/or enhanced to support implementation of the ECCD Law. 14 ECD resource centers serve as (a) mechanisms for barangay-level coordination and meetings on ECD concerns,

    (b) venues for a distance learning program envisaged for continuing education of service providers under the ECCD Law, (c) lenders of ECD toys and learning materials for both service providers and parents, and (d) areas where children in the community can go for special ECD sessions.

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    equipped the office with advocacy and communication equipment and materials. As the lead agency in managing the R&D component after the Projects midterm review, the CWC established an R&D unit and strengthened its capacity to manage research studies, as well as to disseminate findings and advocate their use in policy formulation, program planning, and designing interventions. At the time of the Project Completion Review Mission, the CWC R&D unit continued to manage contracted research and to conduct in-house studies. A national ECD resource center was established in CWC to serve as the repository of various project studies.

    3. Component 3: Research and Development 25. Pilot-Test of Project Interventions in Five LGUs. This subcomponent aimed to test and enhance service delivery interventions prior to project expansion. The pilot services included protein-energy malnutrition prevention, upgraded PES, and the ECD service delivery packages (rural health midwives, day care workers, and so on). The pilot test was implemented much later and took much longer than originally designed. From the original five pilot LGUs it expanded to 10 LGUs. 15 The original plan to test ECD interventions in traditional and nontraditional settings was not implemented, nor was the adequacy of the IMCI referral care tested. There were delays in completing the pilot, and there was pressure to implement the expanded project in the first batch of LGUs. Implementation of the Project in the first batch of LGUs thus overlapped with the pilot. 26. Research and Development Studies. Fifteen research studies were completed, most of which were not part of the original list identified at appraisal. Of the 16 original research topics, only five were implemented. The rest were deemed no longer relevant at the time of the midterm review. Ten new research agendas were identified in 2002 and were ultimately completed. The Project organized workshops and other venues for disseminating findings at various levels. Some studies were turned into popularized versions using flyers, brochures, and posters. Ten of the completed studies are available for downloading from the CWC website. The CWC continues to advocate use of the research findings, some of which have served as inputs to the formulation of policies, guidelines, and ECCD tools and interventions. The research studies undertaken under the Project are summarized in Table A1.9. 27. Monitoring and Evaluation. Four monitoring tools were implemented to assess the outcomes and benefits of the Project: (a) the baseline indicator survey, the results of which were used to validate the project objectives and targets (completed quite late, in 2001); (b) the baseline survey of indigenous peoples access to and utilization of ECD services (2001); (c) longitudinal surveys (Phases 13 in 2001, 2002, and 2003); and (d) the end-of-project survey. (See Table A1.9.) C. Project Costs

    28. At appraisal, the Project costs were estimated at $65.0 million equivalent and were to be financed by (i) ADB loans of $24.5 million, sourced from the Asian Development Fund (ADF) ($8.8 million) and ordinary capital resources (OCR) ($15.7 million); (ii) a World Bank loan of $22.4 million; and (iii) the Philippine Government, with $18.1 million to be contributed by the EA and LGUs. No part of the loan was cancelled during project implementation. At completion, the actual project cost amounted to $47.2 million, made up of (i) ADB lending of $21.0 million ($13.4

    15 The pilot LGUs were Alimodian, Lambunao, and Passi City in Iloilo Province; Bais City in Negros Oriental;

    Buenavista and Jordan in the Province of Guimaras; Dalaguete in Cebu Province; Iligan City in Lanao del Norte; Pilar in Capiz Province, and Tagbilaran in Bohol Province.

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    million from OCR and $7.6 million from ADF) (44% of total); (ii) World Bank lending of $17.3 million (37%); and (iii) the Governments contribution of $8.8 million (19%). D. Disbursements

    29. Disbursements were sluggish at the start. At the time of the midterm review, utilization of the two loans was at a very low 9% and 14%. This was caused by (i) the delayed start of the Project; (ii) challenges in establishing the system for fund releases, and especially for the LGU financing facility subcomponent; (iii) the difficulty of some participating LGUs to secure equity; and (iv) cumbersome procurement processes. As designed, the loan proceeds for the use of the national agencies (DOH, DepEd, and DSWD) were channeled through the Department of Finance. The financing facility was initially coursed through the Municipal Development Fund Office (MDFO) but an adjustment was made after the midterm review so that financing facility funds were channeled directly from DOF to DSWD and then transferred to the LGUs. 16 Separate accounts were established by each national agency and in each of the participating LGUs. The LGUs had to establish another separate account for their counterpart funds. 30. Reprogramming of funds across components and subcomponents was effected after the midterm review had identified gaps. Additional amounts were provided to procure goods for the national implementing agencies, civil works, workshops and seminars, operating costs, social marketing, and supplies and materials. The allocation for research studies was reduced, as was that for procuring micronutrients, since substantial quantities of iron and vitamin A were already being procured by the Womens Health and Safe Motherhood Project (also funded by ADB and the World Bank). E. Project Schedule 31. Both the OCR and ADF loans became effective on 28 September 1998. The Project was officially launched in March 1999 and was originally scheduled to end by 31 December 2004. The Project was extended once, for 11 months, to 30 November 2005. As of the Project Completion Review Mission, however, ADB had still not officially closed the financial accounts pending the submission of additional requirements from the EA. Appendix 3 compares the original project schedule with actual implementation. 32. The Project was implemented under three different political administrations from loan effectiveness to project closure. Top project management (at the director and coordinator levels) also changed several times. There was a substantial delay in establishing fully functional project management offices (PMOs) at the national and regional levels. Consultants to be hired early on in the Project were not deployed, and neither was the external service to conduct the baseline studies. The ECD pilot was expanded from five to 10 LGUs and was not completed as originally envisaged, while the financial management systems for the LGU financing facility took time to get off the ground. The turnover of leadership, termination of services, and changes in management structure contributed to the implementation delays, and especially during the first half of the Project.

    16 In April 2002, ADB approved a request to transfer the Loan 1607 imprest account from MDFO to DSWD on the

    justification that MDFO added a cumbersome layer to the process, causing delays in fund releases. The imprest account transfer to DSWD resulted in faster review, approval, and release of funds. DSWD assigned staff from its Finance Service Office and hired new staff to handle the project account. MDFO had been unable to respond promptly to the ECDP account as a result of its other commitments: at the time, the MDFO was handling a total of 22 projects. Only two staff had been assigned (not exclusively) to handle the ECDP in MDFO.

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    F. Implementation Arrangements

    33. The DSWD was the executing agency, working with three implementing agencies: DOH, DepEd, and CWC. The LGUs, as beneficiaries of the financing facility, were directly responsible for implementing local ECD service packages, while the provincial governments managed the province-wide ECD assistance together with the regional offices of DSWD, DOH, and DepEd. A multi-agency project steering committee was established at the national level and in each project region to provide overall policy direction and technical oversight 17 Six technical consultative committees were initially established at the national level to provide technical guidance in implementing each major component and subcomponent, 18 but only two, the Communications Consultative and Research and Development committees, functioned throughout the life of the Project. 34. At the outset, day-to-day operations at the national level were managed by a 28-person national project management office (NPMO) based at DSWD. Another two to three NPMO staff were assigned in DOH and DepEd. Corresponding regional PMOs were established in each of the three project regions. Project teams were also organized at the provincial and municipal or city levels. By the midterm review in late 2001 and early 2002, the NPMO staff had been mainstreamed into the offices mandated to manage the components and subcomponents, with only a small staff remaining at NPMO. Four were deployed to CWC for project monitoring, research and development, and management information systems. The EAs mainstreaming of NPMO staff was a highly commendable move that paved the way for institutionalizing ECD management capacities beyond the life of the Project. Appendix 4 lists the project personnel absorbed at the national and regional DSWD offices as of the Completion Review Mission. G. Conditions and Covenants

    35. Compliance with the covenants of the ADF and OCR loan agreements was satisfactory. Six additional conditions were required prior to the effectiveness of the OCR loan agreement. The Government satisfactorily complied with these. Appendix 5 shows that all loan covenants were met. H. Related Technical Assistance

    36. There was no related technical assistance under these loan agreements. I. Consultant Recruitment and Procurement

    37. A total of 6 person-months of international consultant services (on food fortification) and 870 person-months of local consultant services were originally planned for (i) food and nutrition situation analysis, (ii) design of community monitoring surveys, (iii) LGU appraisals, and (iv) development of a financial performance monitoring and referral system operations plan. Modifications were made over the course of implementation, and some consultants originally envisaged were not recruited. Terms of reference for some consultants were modified and new ones were developed. Recruiting consultants for the various components followed ADB procedures while changes in terms of reference necessitated prior ADB concurrence.

    17 The national-level project steering committee comprised the DSWD (Secretary as Chair), DOH, DepEd,

    Department of the Interior and Local Government, the National Economic and Development Authority, DOF, CWC, and National Nutrition Council. The regional project steering committees were chaired by the Regional Director of DSWD, with membership from the same line agencies, and including a civil society representative.

    18 The technical consultative committees were for (i) service delivery; (ii) communications; (iii) planning, targeting, and management information systems; (iv) training and human resource development; (v) institutional development; and (vi) research and development.

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    38. The Project procured goods, works, and services in accordance with ADBs procurement guidelines. Various procurement methods were applied depending on the package and estimated cost. Four major groups of goods were procured: (i) micronutrients and supplements, (ii) manipulative toys and other learning aids and materials, (iii) cold chain equipment and supplies, and (iv) computers and other office equipment. The NPMO administered all the procurement activities according to the 1998 interagency memorandum agreement among the DSWD, DOH, and DepEd. The latter two agencies assisted with procurement for their particular subcomponents. Under the LGU financing facility, LGUs procured their own goods and services. For some items, bulk procurement was managed by the regional DSWD office. Despite the development of a project procurement plan, updated on an annual basis, there were still some delays in procurement. Notably delayed procurement included for (i) consultancy services, (ii) research studies, and (iii) cold chain equipment and micronutrients. Delays were caused mainly by a lack of understanding (at all levels) of ADB procurement procedures. The services of an external international procurement agency hired during the initial phase of the Project were terminated, which caused further delays. An in-house procurement consultant was later hired. J. Performance of Consultants, Contractors, and Suppliers 39. The performance of consultants is rated partly satisfactory. Some consultant contracts were not renewed due to poor performance (e.g., the five original consultants hired for the food fortification subcomponent and the external procurement agency). Significant delays were encountered in completing research studies contracted to various consulting firms and organizations, caused not only by poor consultant performance but also delays in finalizing terms of reference, processing other requirements, and the iterative consultations with stakeholders on various levels at different stages of the study. The performance of the contractors for the construction and renovation of ECD facilities at LGU level was satisfactory. K. Performance of the Borrower and the Executing Agency

    40. DSWD, DOH, DepEd, CWC, and LGUs demonstrated strong commitment to successfully implementing the Project. Given the delayed release of project funds during the initial phase, DepEd proceeded with the training of school teachers on the 8-week ECE curriculum using its own budget. Several pilot and Batch 1 LGU financing facility participants advanced payment for activities that were meant to be financed by loan proceeds. Project start-up was slow given DSWDs inexperience in managing large externally funded projects. The rigorous government procedures and varied requirements on the part of ADB and the World Bank compounded these problems. Technical committees took time to be established and become functional. There were initial difficulties in project ownership at various levels and in high-level managements attendance at the regular committee meetings. Despite the slow start-up, DSWD made solid progress in project implementation from the midterm review. Key management and operations issues were addressed and several reforms instituted to strengthen project management. 41. The Projects complexity must be emphasized. An endeavor necessitating multi-agency collaboration, it involved three large government departments and other national-level agencies, plus multi-level coordination (national, regional, provincial, and municipal). It required adaptive responses to the devolved context of health and social service delivery.19 These elements alone would make coordination challenging before adding in the difficulties of having two major funding sources and the relative inexperience of DSWD in handling large foreign-funded projects. Multiple changes in project directorship and project coordinators contributed to the 19 The delivery of education services was never decentralized, so coordination of the ECE subcomponent was easier.

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    initially slow progress. Project implementation was also affected by organizational changes within each agency (e.g., reengineering of the DOH, changes in leadership at the DSWD and DepEd), transitions in national and provincial political leaderships, and the internal movement of project staff. Despite these challenges, the Project accomplished a majority of its objectives. Project performance greatly improved during the second half of the Project. Overall, the performance of DSWD, DepEd, DOH, CWC, and the LGUs is rated satisfactory. L. Performance of the Asian Development Bank

    42. ADB performance is rated satisfactory. ADB fielded successful missions over the life of the Project, although there were too few during its first half. The first documented ADB mission came a year after loan effectiveness. Given the delayed start-up of the Project, ADB missions early on should have been more frequent. ADB review mission aide memoires were often prepared together with the World Bank, which, while commendable, also meant delays in finalizing and returning to the EA. ADB supervisory missions and project management improved over the life of the Project, with faster turnaround of communications and a steady increase in utilization rates. Upon the DSWDs request, ADB approved an 11-month extension of the Project, which allowed the Project to achieve a number of deliverables.

    III. EVALUATION OF PERFORMANCE

    A. Relevance 43. The Project was highly relevant at the design stage and remained so a decade later at the time of the Project Completion Review Mission in 2007. The Project was a timely response to low child survival and development indicators in the country. Although there has been a decrease in the under-5 mortality rate over the past 30 years, the decline has decelerated in the last decade and the rate remains at levels much higher than in other Asian countries. Childrens poor health and nutritional status can lead to low completion rates for Grade 1, which in turn perpetuates poverty. The Projects integrated approach to providing services helped address these issues in a holistic manner. Focusing assistance on poorer LGUs and poorer children by directing financial support to localities with high unmet ECD needs was strategic. The Project was implemented in the newly devolved health and social service delivery context, thus helping to operationalize relationships among the national, provincial, and local governments in delivering ECD services. The Project was highly relevant, as it motivated, equipped, and tasked the LGUs to fulfill their mandate as lead providers of ECD services. 44. The Project paved the way for the passage and implementation of the December 2000 ECCD Act, a fundamental reform supporting human development in the Philippines. The Project introduced the Child 21 plan and the Bright Child brand nationwide as the Governments overarching ECD framework. When the Philippines became one of the 189 signatories to the Millennium Declaration in 1999, the significance of the Project became all the more pronounced as it directly supported achieving five of the 10 Millennium Development Goals.20 The Project addressed the institutional capacity gaps and limited coordination among agencies mandated to work in ECD. Foremost was the strengthening of the CWC as the overall coordinator of ECD-related efforts and the harmonization of ECD policies, guidelines, and interventions relative to child survival and development. The (revised) R&D component of the Project was highly relevant, as it supported studies that addressed information gaps necessary for developing and establishing more responsive ECD policies, interventions, and standards. 20 The five goals supported by ECDP: eradicate extreme poverty and hunger, halve the proportion of the population

    below the minimum level of dietary energy consumption and halve the proportion of underweight children below 5 years old, achieve universal primary education, reduce child mortality, and improve maternal health.

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    B. Effectiveness in Achieving Outcomes

    45. Four of the 10 key performance indicators can be assigned as project outcomes. These are the proportion of children aged 6 months to 4 years with anemia, the proportion of children aged 12 years who are fully immunized, the proportion of children 04 years old below average in overall psychosocial development (according to a combined index of child development), and the proportion of children aged 35 years in targeted municipalities attending day care centers. Results are mixed: two of these indicators saw positive change, two did not. On balance, however, the Project is rated effective (see tables A1.1 to A1.5). 46. The proportion of children 04 years old below average in overall psychosocial development was significantly reduced from 2001 to 2003, with the most pronounced improvement in the area of gross motor development. The proportion of children 35 years old attending day care rose from 2001 to 2003, but the overall participation rate remained below the 75% target. The proportion of children 04 years old with anemia was not reduced by the target of 30% despite the Projects iron supplementation and deworming efforts. National-level data show only a slight decrease in the overall proportion of children under 6 years old with anemia, which was 31.8% in 1998 and still 29.1% in 2003. The target of 90% fully immunized children was also not met. Unfortunately, routine reports show a consistent decrease in the latter figure over the period 20002005. The national rate of fully immunized children also decreased (from 73% in 1998 to 70% in 2003, according to the National Demographic and Health Survey). 47. Performance in other relevant indicators can be gleaned from the longitudinal study and routine LGU and national government reports. The proportion of children 04 years old receiving vitamin A supplementation increased, two thirds were reported to consume fortified food products, and participation in the deworming program grew. Participation of underweight children in feeding programs more than doubled. Mothers awareness of iodized salt was high, and the proportion of those who took iron supplements during their most recent pregnancies grew. There was also an increased awareness of PES among mothers (from 18% at baseline to 34% in the end-of-project survey) C. Efficiency in Achieving Outcomes and Outputs 48. Overall, the Project is rated less efficient. There were substantial implementation delays from start-up to midterm review, but efforts were then redoubled and implementation caught up toward the end. The Project only required a one-time extension of 11 months. Fund disbursements at closing on 30 November 2005 reached 86% of total estimated cost. The Project aimed at providing pro-poor health, nutrition, and psychosocial services by targeting the poorest provinces and municipalities as pilot and expansion areas. The LGU financing facility was properly targeted to poorer LGUs where access to ECD services was very limited. 49. The delayed project start-up limited full utilization of the outputs of the various components. The piloting of ECD intervention packages in 10 LGUs took longer than anticipated, and Batch 1 LGUs ran parallel with the pilot, missing the opportunity to benefit from lessons learned in the pilot. Other less efficient aspects of the Project were that the baseline survey was only completed near project midterm, limiting its usefulness in further sharpening the focus of the ECD interventions and approaches in the initial phase. The updated and more relevant R&D agenda was commendable, but the delay meant that half of the studies were only completed towards the end of the Project. Application of their findings under the Project was thus limited.

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    50. Installing support systems and completing the ECD manuals, references, and tools (e.g., Mother and Child Book, ECCD Checklist) took longer than anticipated. Utilization of these systems and tools was thus not fully maximized. As of the Project Completion Review Mission, the CWC had yet to assess the applicability of the systems and tools for the ECCD implementation. The production of the Mother and Child Book came near the end of the Project, thus preventing full adoption by the service providers. Several providers interviewed were not aware of its existence. Reproduction and translation of materials into dialects understood by the mothers was left to the discretion of the LGUs and depended on the availability of funds. Health staff were not convinced of the importance of the ECCD Checklist and tended to find it too cumbersome to administer given their workload. There was also little advocacy for the use of the checklist by teachers in DepEd preschools. A number of strong communication campaigns were mounted under the Project, but coordination was not always effective (the Project-supported Bright Child campaign overlapped with a similar CWC program). 51. Interventions were not always properly synchronized. For example, in some schools deworming drugs were delivered only after the school feeding program had been undertaken. The Project Completion Review Mission found that Grade 1 teachers in some schools were not trained in the 8-week ECE curriculum but were assigned to the non-ready classes of school entrants, while those classes comprising primarily ready children were handled by more senior and ECE-trained teachers. D. Preliminary Assessment of Sustainability 52. Available evidence and recent developments at national and local levels show project gains as very likely sustainable. At national level, passage of the ECCD Law and its ongoing implementation nationwide indicate that ECD remains high on the national leaderships agenda. The Governments focus on localization of the Millennium Development Goals and mobilizing the support of the private and NGO sector provides fertile ground for continued utilization of project outputs. Concern for the Millennium Development Goal targets in hunger and malnutrition are reflected in the DepEd food-for-school program (1 kg of rice per child per day) and DSWDs continued supplementary feeding that aims to mitigate hunger and possibly address the issue of malnutrition among poor children. Advocacy events at the local government level, such as the annual Child-Friendly Awards, help sustain the support of local officials for childrens welfare and development. 53. The intensive capacity development efforts provided to ECD stakeholders at all levels have strengthened the institutional system for delivering quality ECD services. The continued strengthening of the CWC and the post-project regular meetings of the councils for the welfare of children at various levels are likely to carry on the Projects momentum. There is continued effort on the part of the national government in implementing the Food Fortification Law and the ASIN in tandem with LGUs and the private sector, creating a supportive policy and strengthened regulatory environment to address long-term micronutrient malnutrition in the country. The DOH continues to offer the IMCI curriculum in medical, nursing, and midwifery schools. DepEd has integrated the ECE curriculum into the Bachelor of Education course offered by all colleges and universities. It has also issued a memorandum to all elementary schools to adopt the School Readiness Tool. DSWD has made the ECCD Checklist one of the criteria for day care center accreditation. It is also one of the criteria by which Child-Friendly LGUs are judged. 54. At the local level, the commitment of provincial and municipal officials to instituting ECD mechanisms and the Bright Child vision is evident. The local ECD teams and councils for the welfare of the children continue to meet regularly and undertake joint activities, passing local

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    resolutions to support ECD services and allocating funds for selected ECD interventions. Many LGUs (including all of those visited during the Project Completion Review Mission) have fully or partially absorbed the service providers hired under the Project (midwives, child development workers, day care workers, resource center custodians). Health facilities that have attained the Sentrong Sigla Certification and PhilHealth Accreditation are able to deliver quality health care especially for children with the availability of additional resources.21 E. Impact 55. The Projects intended impact (as per the design and monitoring framework) was to support government efforts to improve child survival and increase readiness for productive life. The target was to strengthen DSWD, DOH and DepEd capacity to manage the ECD program. In this vague sense, the impact has been achieved. The Project supported government efforts, and agencies capacity was strengthened. But for impact evaluation purposes, the Project Completion Review Mission chose to assess child survival and increased readiness for productive life. The three remaining key performance indicators are used as proxies: reduced under-5 mortality, reduced proportion of malnourished children, and increased Grade 1 completion rate. Changes in these indicators show that the impact has not yet been achieved, but some trends are promising.22 56. The targeted reduction in the under-5 mortality rate by 30% has not yet been attained. The national rate fell from 55 per 1,000 live births in 1998 to 42 in 2003. DOH analysis shows that a significant proportion of the under-5 mortality rate in the Philippines can be attributed to neonatal deaths (

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    IV. OVERALL ASSESSMENT AND RECOMMENDATIONS

    A. Overall Assessment 59. Based on the preceding assessment of the Project as highly relevant, less efficient, effective, and likely sustainable, the overall project rating is successful. The Project supported incremental reforms and strengthened capacity at the national, regional, and local levels to manage and deliver ECD services. It was instrumental in formulating and operationalizing a number of laws, policies, and guidelines aimed at addressing gaps in child survival and development. It expanded access for poor children in poor LGUs to better quality ECD services and institutionalized systems for integrated delivery of services at the local level. The Project strengthened coordination and communication among stakeholders at national and local government levels, in the concerned agencies, and in the private and public sectors. Though the Project did not meet all the key performance indicators, it put in place the basic building blocks for strengthened and integrated ECD service delivery. Evidence also suggests that the Project improved the willingness of local officials to prioritize ECD and to sustain project gains. Despite the initial implementation delays, many of the Projects objectives were ultimately achieved. B. Lessons Learned

    60. First, while certain child survival and development issues can be addressed within a relatively short timeframe through targeted assistance, others will require much more long-term assistance because they are so inextricably linked with the larger challenge of poverty. Children from poor families are three times more likely to die before age 5 than children from well-off families. Chronic malnutrition is largely the result of mothers poor nutrition. Low Grade 1 completion rates are also a function of poverty: students tend to drop out because their families are unable to pay for daily transport, food, uniforms, or supplies. The Project expanded the ECD service delivery points and made an effort to bring services closer to the clients, but many potential clients lacked the money to take full advantage of those services.

    61. Second, integrated ECD services take time to become truly operational. By the Projects end, some of the mechanisms intended to facilitate integration (e.g., the ECCD Checklist, Mother and Child Book) had not been fully maximized. The interface of the various actors expected to provide services to children prior to birth, postpartum, and throughout their development up to Grade 1 has not yet been fully integrated at the community level. ECD service delivery requires a conscious effort to harmonize policies, interventions, and systems in support of ECD at all levels. Such efforts are ongoing. 62. Third, child development, protection, and survival require the commitment and participation of many stakeholders at various levels of operations. The Project demonstrated that partnership between the national and/or regional agencies and local governments in addressing child-related issues and concerns is feasible under a devolved system. Strong national government support coupled with local officials political will contributed in large part to the Projects successes. The Project underscored the critical role of the regional offices and the provincial government in continuously providing technical assistance and guidance to the LGUs even after the Project ended.

    63. Fourth, management of large externally funded projects necessitates overall direction and regular guidance from senior management, and it requires ownership of the project goals and strategies by the offices and staff mandated to run the programs and activities. The

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    assignment of a committed DSWD undersecretary as project director significantly sped up project implementation after the midterm review. Mainstreaming NPMO staff into the structure of the EA and implementing agencies is a good way to ensure sustainability. C. Recommendations 1. Project-Related

    64. As the lead ECCD implementing agency, the CWC should continue to monitor ECD programs at the local level to ensure that the sustainability plans developed by each LGU at project closure are supported and implemented. It should continue to support the LGUs in integrating ECD service delivery. This can be done by strengthening the councils for the protection and welfare of children at the municipal and barangay levels (2007 and beyond). The CWC should furthermore disseminate the completed body of research and consider preparing and publicizing a consolidated list of recommendations drawn from the research (by end 2007). 65. The EA and implementing agencies must continue to promote the project gains in order to sustain the momentum for ECD activities at the national, subnational, and local levels. The CWC should assess the project-designed management information systems for possible adoption in implementing the ECCD Law (by end 2007). The CWC (in collaboration with DOH, DepEd, and DSWD) should assess utilization of the ECCD Checklist, with a particular focus on acceptability and ease of use among midwives and its possible adoption by DepEd preschools. The study should establish how results of the ECCD Checklist assessment will be addressed by service providers at the local level (by end 2007). DepEd should work toward refining the School Readiness Assessment with the goal of integrating it into the curriculum of higher education (by end 2008). 66. Access to services is problematic for the poor. Where physical access is the problem, mobile ECD resource centers could serve hard to reach areas. This would particularly benefit mountainous indigenous peoples communities. The CWC should consider this in its ECCD activities (2007 and beyond). Where financial constraints hamper access, supply-side projects that develop services should be complemented with demand-side interventions to encourage and motivate beneficiaries to make full use of those services. A conditional cash transfer programwhere poor families receive a cash benefit on the condition that they make human capital investments such as enrolling children in school and making sure they attend regularly or taking part in nutrition seminars or a PES session, for examplecould be designed to enhance results in the ECD agenda. DSWD should explore the design and pilot testing of a conditional cash transfer program (by end 2008).

    67. With a rapidly growing population and little progress in poverty reduction, the challenges of child survival and development in the Philippines are substantial and will require an investment and effort of gargantuan proportions. The Project only targeted 10 of the 79 provinces and a mere 8% of the more than 1,600 LGUs in the country. While the ECCD Act provides for the allocation of P2 billion to cover all provinces, P16.7 million per province for 3 years (the current CWC allocation) will likely be insufficient to make an impact and cover interventions in all municipalities in each province. Given the official commitment to achieving Millennium Development Goal targets in under-5 mortality, poverty alleviation, and hunger mitigation by 2015, the agencies concerned should consider an ECDP follow-on activity that builds on the many institutional development gains and lessons learned (by end 2008).

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    2. General 68. Recognizing that the MDFO has grown much more experienced in the last 5 years, it nevertheless should make sure that sufficient staff is allocated to particular projects in order to maximize efficiency and avoid implementation delays. ADB should work with the Government to further develop direct lending to subsovereign borrowers in order to reduce transaction costs. 69. In designing projects, EA capacity should be carefully assessed at appraisal, so that early steps may be taken to fill any gaps. This would contribute to more efficient project start-up, which would ultimately enhance project results. Monitoring and evaluation should be afforded a much higher priority in project implementation. One unfortunate aspect of the project monitoring and evaluation system was a baseline survey that was undertaken only near project midterm. Where evidence-based impact evaluation shows positive results, political support can be generated. Where problems are uncovered, program adjustments can be made. Where successes are publicized, additional funding might be mobilized. The importance of monitoring cannot be overstated.

  • 18 Appendix 1

    ANNOTATED PROJECT DESIGN AND MONITORING FRAMEWORK Design Summary Targets Project Monitoring

    Mechanism Status as of the Project Completion Review

    1. Sector/Area Goal (Impact) To support government efforts to improve child survival and increase readiness for productive life

    To strengthen the Department of Social Welfare and Development (DSWD), Department of Health (DOH), and Department of Education (DepEd) in their capacities to manage the Early Childhood Development Project (ECDP)

    Policy dialogue and supervision missions

    The Project significantly strengthened the capacities of DSWD, DOH, and DepEd to manage programs and activities related to early childhood development (ECD). Several national laws, policies, and guidelines were generated to provide a supportive policy environment at national and local levels for ECD (e.g., the Early Childhood Care and Development [ECCD] Law, Food Fortification Law and its implementing rules and regulations, Guidelines in the Implementation of National Supplemental Feeding, Operational Guidelines on the Food for the School Program, DOH Guidelines on Vitamin A and Iron Supplementation). Technical staff competencies improved in various programs, and capacity in planning, communications, and training was enhanced, which enabled staffs to provide technical assistance to local counterparts. Close coordination among concerned agencies at national and local levels continues, as evidenced by regular meetings and attendance of key officials in major ECD events.

    2. Objective/Purpose (Outcome) 2.1 To provide integrated service delivery under local government unit (LGU) management

    To reach targeted geographical areas, poor families, and children at risk

    Baseline and other project-supported surveys

    Please refer to Component 1 (Section 3.1).

    2.2 To provide support systems for ECD service delivery

    To improve monitoring and project management through communications, information systems, and planning

    Baseline, midterm, and project completion survey; ADB missions; performance-based annual budget reviews

    Please refer to Component 2 (Section 3.2).

    2.3 To support research and development for improved ECD services delivery and management

    To take corrective actions based on research findings for improved management

    Annual planning and budget reviews, research and development (R&D) proposal screening and review team

    Please refer to Component 3 (Section 3.3).

  • 19 Appendix 1

    Design Summary Targets Project Monitoring

    Mechanism Status as of the Project Completion Review

    3. Project Components (Outputs) 3.1 ECD Service Delivery

    Sustained reduction in infant and child mortality through province-wide support for:

    Baseline and project surveys, evaluation indicators, project management office (PMO) semiannual reports, service statistics, indicators measuring school readiness and improved achievement scores monitored by primary schools

    Sustained reduction in under-5 mortality is difficult to ascertain as of the project completion report (PCR). The 1998 and 2003 National Demographic and Health Surveys show that under-5 mortality worsened in regions VI and VII but significantly declined in Region XII over the same period. Program performance varied across project regions and provinces. Six of the 10 key performance indicators improved (Table A1.1) but others did not. Other indicators (see Table A1.2) also reveal mixed outcomes. Comparing the 20002005 routine Field Health Service Information System reports of the project regions and provinces (Table A1.3) and selected LGUs visited by the Projection Completion Review Mission (Table A1.4) showed varying results. Dropout rates in Grade 1 also varied from school to school (Table A1.5)

    immunization program

    Very slight improvements in fully immunized children (FIC) and tetanus toxoid 2 (TT2) immunizations were noted at almost all project sites. FIC increased very slightly in regions VI and VII from 2001 to 2003 (Table A1.1). Only four of the project provinces registered an improved FIC from 2000 to 2005 (Table A1.3) The 1998 and 2003 National Demographic and Health Surveys further confirm a declining FIC nationwide, which is considerably below the 95% benchmark (Table A1.1). The proportion of pregnant mothers given TT2 plus immunization slightly increased from 2001 to 2003 (Table A1.2). Only four of project provinces registered an improved level of TT2 immunization from 2000 to 2005 (Table A1.3).

    micronutrient supplementation

    The proportion of children 911 months old given routine vitamin A supplementation improved in most of the project sites and regions (Table A1.3). The proportion of children 04 years old taking iron supplements grew significantly from 13.8% in 2001 to 24.3% in 2003 (Table A1.2). The proportion of pregnant mothers taking iron supplements also improved from 2001 to 2003 (Table A1.2).

    Upgrade province-wide ECD program support.

    integrated management of childhood illnesses

    Refer to Component 2.1LGU Financing Facility

  • 20 Appendix 1

    Design Summary Targets Project Monitoring

    Mechanism Status as of the Project Completion Review

    Reduced dropouts and improved academic achievement in Grade 1 through strengthening of parent effectiveness service and early child education curriculum enrichment in Grade 1

    The proportion of mothers aware of parent effectiveness service (PES) and those attending PES sessions increased from 2001 to 2003, but overall levels were quite low. The same low participation is seen in the proportion of children 35 years old attending day care services, which barely increased from 33.7% in 2001 to 34.1% in 2003. The proportion of children enrolled in Grade 1 decreased from 56.7% in 2001 to 42.6% in 2003. The proportion of children completing Grade 1 also decreased slightly from 2001 to 2003 in regions VI and VII. Grade 1 completion rates in regions VI and VII did not reach the expected level of 90% (Table A1.2). Dropout data from DepEd and several schools visited also confirmed unimproved Grade 1 dropout rates. (Table A1.4). However, the overall psychosocial development among children 04 years old improved. There was a significant reduction in the proportion of children with below-average psychosocial development in regions VI and VII from 2001 to 2003 (Table A1.1).

    Provide LGU financing facility for integrated service delivery at municipal and city levels

    Delivery of an appropriate package of health, nutrition, and early education services to children under 6 in each LGU; development and generation of resources for ECD advocacy and program support

    The Project expanded the provision of ECD services in 132 municipalities and cities through constructing or renovating ECD facilities and deploying service providers in priority areas where access to ECD services was very limited. This included:

    - 254 new barangay health stations constructed - 945 new day care centers constructed - 505 barangay health stations and 1,009 day care centers renovated - 4,087 day care workers hired - 1,680 rural health midwives hired - 1,630 child development workers hired - 18 day care moms hired

    A total of 105 ECD resource centers were established and now serve as sources of information materials for ECD service providers and parents, spaces where children can attend learning sessions, and loci for meetings of ECD service providers. Field visits affirmed their continued utilization. Visits to selected project sites showed that LGUs absorbed most of the ECDP-hired service in partnership with barangay councils. Review of actual disbursements showed that LGUs provided funds much greater than their required equity. Some of them continue to allocate budget for ECD, mainly from the 20% development fund.

  • 21 Appendix 1

    Design Summary Targets Project Monitoring

    Mechanism Status as of the Project Completion Review

    Reduction in incidence of acute respiratory infection (ARI) and diarrhea

    Service statistics performance indicators; annual budget review; ADB missions, service statistics; project indicators; baseline, midterm, and project evaluation surveys; PMO semiannual reports

    The prevalence of cough, fever and ARI cases increased from 2001 to 2003. The proportion of diarrhea cases seeking treatment from health facilities and service providers declined (Table A1.2), but an incr