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B. Risks

5.6    The project faces three major risks. The first risk is that the expected procurement

of essential generic drugs and their distribution may be slow to materialize. The Govemraent bas approved the required legislation and, with Bank assistance, established CAMEG, an organization likely to undertake imports and distribution morę efficiently than its predecessor, SONAPHARM, sińce CAMEG would be freer from the influence of the Burkinabe pharmacist lobby. The Govemment has provided assurances that it will operate CAMEG in compliance with "satisfactory performance" criteria as defined jointly by the Govemment and the Bank during negotiations. Supervision during the first half of the project will focus heavily on ensuring satisfactory cost-recovery and a continuous supply of essential drugs at the district level. The second risk is the resistance to redeploying doctors and other health Staff to rural areas and ensuring that they remain there in order to fulfill their assigned responsibilities. To address this risk, the Govemment has begun to develop and implement a redeployment action plan, which would be acceptable to IDA. The third risk is the tirne required for regaining the confidence of the populadon in the CSPS especially in light of the proposed cost recovery scheme and the recent devaluation of the CFA ffanc. Special attention needs to be paid to the level and pace of implementing cost assessment so as not to prevent people from seeking help at the primary level of the health care system. In this respect the third risk is closely linked to the first, i.e. widespread availability of Iow cost generic drugs.

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> BE HEACHEP ANP_EECOMM£NPAHONS

6.1 The Goverament met the conditions of negotiations by providing the following documentation and by taking the following actions:

(a)    The finał draft of a letter of sector development policy, with quantifiabie and monitorable sectoral objectives beyond the life of the project. (para. 2.33, 3.2);

(b)    A list of sites for the 15 CSPS to be constructed in the urban areas and proof of their transfer and consignment for construction purposes (para. 3.9);

(c)    Terms of Reference, acceptable to IDA, for a study of the hospital sector (para. 3.13);

(d)    A forma! draft of contract for delegation of civil works contract management to Faso Baara between Faso Baara and the Goverament (para. 3.14);

(e)    Staffing norms approved by the Government to allow medical facilities to operate with the minimal Staff reąuired to function (para. 3.18);

(f)    Outlines of a plan, acceptable to IDA, which would provide for adequate staffing of flie health facilities thiough redeployment of existing Staff, pre-service and in-service training and new recruitment, including implementation of the first stage of this plan (para. 3.18);

(g)    Issuance of a Decree providing for increased autonomy of the CMAs and CSPS by aliowing these facilities to retain receipts through the sale of drugs and services and to be co* managed by the local communities (para. 3.20);