ISLAMABAD, Sept 26: The ‘operation evaluation department’ of Asian Development Bank has expressed concern over what it calls inefficient and unsatisfactory implementation of Rs4.5 billion women’s health programme in Pakistan which failed to achieve its objectives because of project delays and corruption.

The outcome and output of the programme have been described as ‘less efficient’.

The five-year programme spread over 20 districts across the four provinces should have been completed in 2005 but it was delayed for more than two years and yet most of the objectives could not be achieved.

A report completed last month by the ADB’s operation evaluation department said the performance of Pakistani authorities was “less than satisfactory”.

It said the medical equipment supplied to the districts was of adequate quality but there was inadequate post-sale service and maintenance.

The overall performance of civil works contractors, the report said, was poor in terms of quality of works and timely completion, badly affecting cost-effectiveness.

“The federal project coordination units used ADB’s quality and cost-based selection procedures to recruit national consulting firm to carry out a post-project evaluation, but after finding the first inception report submitted by the firm unacceptable, the coordination unit terminated the firm’s contract and dropped the idea of post-project evaluation. This was a misguided economy,” the report further said.

The report said the major defect was the disproportionate focus by all project coordination units on inputs and physical progress that was not linked to outputs and outcomes during implementation. This was particularly true during the belated rush to complete the project before the extended loan closure.

Although the use of medical facilities provided under the programme increased, the provision of comprehensive emergency obstetric care was generally unsuccessful due to a shortage of female professional staff, the report noted.

“More than 50 per cent of the approved posts for gynaecologists, anaesthetists and female medical officers in the project districts remain vacant.”

The project mission found that 22 out of 56 approved posts for gynaecologists, 23 of 48 approved posts of anaesthetists and 95 of 304 approved posts for female medical officers in the project districts were vacant.

The provinces of Punjab, Sindh and Balochistan were subject to government ban on foreign training and thus converted the foreign fellowships into in-country fellowships. Against the original estimates of 44 foreign fellowships and 276 in-country fellowships, only eight health professionals attended foreign training and 567 received in-country fellowships for a master’s degree in public health or a diploma in obstetric surgery, emergency obstetrical services or anaesthesiology.

Two women health resource centres established in Islamabad and Karachi were to function as repositories and documentation centres for materials and publications related to women’s health with conference facilities.

“OED does not consider this an efficient use of project resources, given other more pressing outputs that were neglected,” the report said.

It said there was a two-year delay in establishing and staffing the project coordination units. Subsequently, there were frequent changes in key staff, including project directors. Delays in the completion of civil works were due mainly to weak project management and lack of close supervision by the building and communication departments.

“Had the civil works consultants been recruited as approved, the overall coordination and quality of work could have been far more satisfactory.

The coordination units made top-down procurement decisions without consultations and, as a result, in many cases the medical equipment procured was superfluous and unused. The performance of both international and national consultants fell short of expectations. Most of their outputs lacked the required quality and relevance to the project objectives,” the report said.