8144188932

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3.12    The project will also fmance intermittent specialist services and training through GTZ to organize an equipment maintenance system in the CMAs, using regional hospital maintenance technicians as supervisors and CMA laboratory assistants to perform maintenance functions. Six regional hospital (CHR) technicians would be trained under a six month course at the GTZ sponsored maintenance training center in Senegal. Laboratory assistants from each CMA would serve one month internships in the regional hospital centers to learn selected techniques.

3.13    The project will finance specialist services to carry out a thorough 3tudy of the hospital sector, and to propose actions to be taken to strengthen the tertiary level of the health system as well as to redeploy, recniit, and/or train CHN, CHR, and OST staff as part of the national redeployment plan (para. 3.18). As noted above (para. 2.26), operations of the national hospitals are having an adverse impact on the effectiveness of the health system pyramid and the generał population is being deprived of complez, referral health care. As a condition for negotiations, terms of reference acceptable to IDA for this study have been prepared by MSASF and submitted to IDA. During negotiations, the Govemment gave assurances that the study would be completed by June 30, 1995 and that a resulting action program acceptable to IDA would be fully implemented by March 31, 1997.

3.14 Implementation Contract management of civil works construction under this sub-component would be implemented through Faso Baara (a Contract Management Agency with NGO status, established in 1991 under the Burkina Faso Public Works and Employment Project, Credit Number 2282 BUR) for the CMAs and for the CSPS. Receipt of a draft contract between the Govemment and Faso-Baara for the delegation of civil works contract management was a condition of negotiations. Signing of a contract acceptable to IDA, delegating the management of the civil works related contracts, will be a condition of credit effectiyeness. The establishment of a maintenance system will be the responsibility of the DAAF and the provision of technical assistance to carry out a study of the hospital sector would be overseen by the DEP.

(b)

(US$1.2 million)

3.15 Obiectives and Description. To strengthen the operations at the district level (CSPS and CMAs), the project would, in continuity with efforts under the FHP, fmance the training of District Medical Officers (DMOs). The MSASF'c Centre de formation pour le dćveloppement sanitaire (CFDS) attached to the Ecole nationale de santć publiąue (ENSP) will continue the training fonction assigned to it under the FHP. Focus of the training activities would be on (i) generał aspects of public health; (ii) anticipated activities of the first and second tiers of the health services, in particular the development of instruction and reference manuals and the implementation of health care strategies; (iii) health services management with special attention to drug management, establishment of a financial accounting system, organization of essential, generic drug distribution; (iv) preparation, evaluation, and, if necessary, modification of District Health Plans (Plan de dćveloppement de district santć - PDDS), the content of which is described in Annex 3.2. A description of the training program is in Annex 3.4. Participants in the training program would include all generał practitioners from the medical centers and regional hospital centers with preference being given to medical staff of the CMs/CMAs. The Government gave assurances during negotiations that each district, once a fully upgraded CMA has been established, would have in place throughout the duration of the project: (a) a trained district health 'eam, (b) a District Health Plan (PDDS), and (c) a financial accounting system for the CMA and each of its constituent CSPS responsible for stocking and selling essential generic drugs.