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1988. It consists of (i) active epidemiological surveillance of both diseases by four trained mobile teams, and (ii) passive surveillance, treatment of cases, and increasing awareness of the characteristics of these diseases among popuiations by CSPS health workers who will be trained and supervised by District Health Workers.

2.42    Regarding dracunculiasis, the Govemment has stated its intention to eradicate this disease before 1996. The eradication program entails: (i) establishment of epidemiological surveillance through case reports by village health workers; (ii) information and education campaigns; (iii) provision of water-filters to all households in endemic villages; (iv) treatment of detected cases; and (v) supply of endemic viflages with safe water.

F. The Bank Group's Role

2.43    The Bank's first involvement in the health sector in Burkina Faso was through the successfiil regionJ Onchocerciasis Control Program (OCP), launched in 1974, of which Burkina is one of the principal beneficiaries (Annex 2.1). The Bank's Country Economic Memorandum and Health and Nutrition Sector Review set the stage in 1982 for a strategy of Bank assistance in health to Burkina beyond the OCP interventions. Based upon the findings and recommendations of these reports, and forther preparatory work, IDA approved Credit 1607-BUR with an amount of US$26.6 million in 1985 for the First Health Project.

2.44    The FHP was designed to assist the Govemment in: 0) strengthening basie health and family planning services, with initial emphasis on the control of communicable diseases; (ii) forther formulating nadonal health and population policies and promoting their application; and (iii) strengthening the MSASF's institutional capability in planning, evaluation, project implementation and monitoring.

2.45 During the mid-term review of the project in October 1988, it was recognized that the investment components of the project had madę progress, but that the required cbanges in the national health policy had not been fortheoming. As a result, many health facilities were non-fonctioning or underutilized. The mid-term review led to a refocusing of the project towards policy reforms in three main areas. First, it was concluded that the vertical naturę of the health system reąuired reform. It was fbund that the different health services-meant to tackle only specific health/disease problems-led to duplication of efforts, a waste of scarce personnel resources, and high cost, resulting in the need for reorganization and integration of services. Second, Bank efforts were directed at helping make the peripheral health facilities morę autonomous, both administratively and financially, to enhance community "ownership* and commitment. It was concluded that financial autonomy would ultimately depend, to a large extent, on the availability of essential generic drugs. Third, the short supply of drugs at CSPS level and the high cost of the few availab!e drugs were seen to be an important factor in the extremely Iow utilization rates. To address this issue, the CAMEG (para. 2.25) was established as a legał entity in 1992 through legislation approved by the Govemment.

2.46 With regard to the physical accomplishments of the FHP, it has established 142 CSPS in the rural and urban areas and three surgical CMAs. In the area of population/family planning, it extended family planning services to six provinces of the country which had not been covered by other donors. To prepare doctors at the district level for their new managerial and technical responsibilities, two training programs are underway. One is to train generalist doctors to perform emergency operations. The other program provides supplementary training to district medical officers in management, planning, technical supervision, statistics and epidemiology. A