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D. Project Scope

3.4 The principal component of the proposed project would be nationwide and would aim to improve the ąuaiity, coverage, and utilization of health services through four sub-components totaling US$28.0 million (72% of the project's total costs). These sub-components consist of: (1) strengthening the health system pyramid through: functional upgrading/construction of health facilities at the primary and secondary levels which comprise the health districts (CSPS and CMAs), organizing and establishing an effective maintenance system for the district facilities, and improving operations regarding referral care of the regional and national hospitals (CHRs and CHNs); (2) promoting Staff development and rationalizing staff use by: supporting in-service training for district medical officers and nurses in supervision procedures, upgrading skills of district level physicians in emergency surgical procedures, establishing realistic and efftcient staffing norms, and implementing a Staff redeployment action plan involving both intra-provincial and rural to urban transfers nationwide; (3) decentralizing the public health system by: defining a country-wide system of health districts, providing for increased autonomy in planning and budgeting at the "health district" leve!s, and providing for community co-management of primary health services; and (4) increasing the availability of essential drugs by: supporting importation and distribution throughout the health system of Iow cost generic drugs as a substitute for high cost specialty drugs, establishing an effective cost recovery policy which would ensure a sustained supply of essential drugs at the district Ievels, developing a logistics system for the procurement, distribution, and management of essential, generic drugs, and supporting the expanded program of immunization (EPI) for infants and young children.

3.5 The proposed project would also enhance the nutritional status of the Burkinabe population living in malnourished areas through a component designed to reduce micronutrient deficiencies (US$4.7 million-12% of total project costs). It would consist of two sub-components. The first would support immediate supplementation of vitamin A, iodine, and iron in severely deficient areas. The second would complement supplementation through the preparation and implementation of a longer-term strategy to reduce micronutrient deficiencies through dietary modification and to the extent feasible food fortification.

3.6    In addition, the proposed project would aim at maintaining control over widespread endemic parasitic diseases, which have either been largely brought under control or have been demonstrated to be eradicable. This component would total US$1.4 million (4% of total project costs) and consist of (1) strengthening the capacities of the health system to carry out epidemiological surveillance and treat detected cases of onchocerciasis, trypanosomiasis, and dracunculiasis through training and supervision of mobile teams and local health workers, and (2) increasing awareness among target populations regarding prevention of transmission of onchocerciasis, trypanosomiasis, and dracunculiasis, through training and IEC campaigns.

3.7    Finally the project would strengthen various units within the MSASF so as to help ensure successful implementation of the above three components. This institutional strengthening component totals US$4.7 million (12% of total project costs). It includes five sub-components: (1) strengthen the Directorate of Preventive Medicine (DMP) to implement epidemiological surveil!ance and control of onchocerciasis, trypanosomiasis, and dracunculiasis, (2) strengthen the Directorate of Pharmaceutical Services (DSPH) to achieve its responsibility in promoting essential, generic drugs and controlling their ąuaiity, (3) improve c^ministration of the public health system through the establishment of a management information system within the Ministry^łs Directorate of Administration and Finance (DAAF) for tracking personnel and physical assets at all levels of the health pyramid, (4) strengthen the capacity of the Ministry's Directorate