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of Studies and Planning (DEP) to plan, coordinate, and monitor health development projects, and (5) provide management support for the Project Coordination Unit (PCU) of PDSN.

E. Project Description

1. Improye ouality. coyerąge. and utllizatlon of Health seryices (US$28.0 million) (a) Strenęthen the health system pyramld (US$19.3 million)

3.8 Obiectiyes and Description. The proposed project would assist the Govemment in its efforts to complete decentralization of the health system, by supporting the establishment and effective functioning of Health Districts and basie health facilities (Annex 3.1). The project would give highest priority to optimizing the use of existing facilities, but would also support the construction of a limited number of new facilities. This will involve (see para. 2.9-2.11 for a description of the present system):    0) the upgrading of CMs into CMAs and (ii) the

constmction/upgrading of CSPS. Both are important steps in differentiating seryice provision at primary, secondary and tertiary facilities. Hospitals could then concentrate on tertiary care. As a condition for appraisal of PDSN, the Goverament, through an official decree in January 1993, inereased the rinancial and managerial auconomy of District Health facilities (CSPS and CMAs) by allowing them to retain receipts through the sale of drugs and services and to be co-managed by local communities.

3.9    In the rura! areas, the focus would be on rendering operational 30 CSPS which have been non-fonctioning mainly due to lack of Staff (para. 2.24). Once the Govemment has demonstrated that these 30 CSPS are operating, the project would finance the construction of an additional 30 CSPS in the rural areas fUS$82.000 ner CSPSi. The project would also finance the construction of 15 new CSPS in the urban areas. As a condition of negotiations, the Govemment bas proyided to IDA the list of sites for these 15 CSPS along with proof of transfer and consignment for construction purposes.

3.10 The project would support upgrading of CMs into CMAs nJS$419.000 ner upgradeJ CM) so as to strengthen the first level of referral by enabling each district to perform emergency surgery. Upgrading would consist of adding an operating room, surgical equipment and other eąuipment reąuired for each CM as determined by a detailed survey. The Directorate of Studies and Planning (DEP) has prioridzed the CMs to be upgraded, based upon selection criteria prepared by the DEP. Upgrading of CMs into CMAs will take place gradually over the project period (1994-1999) at a target ratę of 3 per year. Hence, 15 CMs would be upgraded over the life of the project, bringing the total number of CMAs in Burkina to 29, which, including the nine regional hospitals, would cover 72% of die health districts throughout the country. Germany’s KfW would upgrade three CMAs through parallel cofinancing, leavlng 12 of the 15 to be covered under the project to be financed by IDA.

3.11    The project will finance (US$200,000) a one year initial stock of essential drugs for 45 CSPS built over the life of the project. This stock will provide the initial capital for a revolving fund for drug cost-recovery. Stocks will be distributed to a CSPS when the nurse in charge has bera trained by the district management team and when the security of the drugs and receipts therefrom have been assured, in part through the establishment of a workable financial accounting system, as determined by die district management team.