8144188934

through service delivery at the primary and secondary levels, and conununity co-management of primary health services. Management committees (Combi de gestion-CG) will be established comprised of elected community representatives and a district-level medical officer. Each CG will have the authority to detennine charges for its services and to approve the budget and manage the finances for its respective CMA and CSPS. During negotiations, the Govcrament gave assurances that for each district with a folly upgraded CSA, CGs would be established and legally registered for the CMA concerned and for each of its constituent CSPS.

3.21 The project would support decentralization by fmancing one all-purpose supervision vehicle per CMA for DMOs to continuously supervise primary health care activities at all CSPS within that respective district and to provide technical assistance to the Comitśs de gestion. Hence 29 supervision vehicles would be purchased over the life of the project. Such vehicles would permit frequent visits to the CSPS. DMOs at the CMA would set aside 1.5 days per week for supervision of CSPS activities, which would correspond to about 1 visit per month to each of the District CSPS. In addition the project would finance the recurrent costs of these supervisory activides, on a decreasing basis. To encourage adequate staffing at the CMAs and CSPS, the project would finance the construction of nurses' living quarters at 35 CSPS and doctors' living ąuarters at 2 CMAs. Quarters would be provided for selected rural CSPS without such facilities and for new CSPS to be constructed in the rural areas.

3.22 Implementation. UNICEF will oversee decentralization activities under this subcomponent with the exception of construction of living ąuarters, based upon an agreement between the Govemment and UNICEF to be signed as a condition of credit efyectiveness. Implementation of the construction of living ąuarters would fali under the responsibility of Faso Baara which is tasked with contract management of civil works entailing the upgrading of CMs into CMAs and construction of the CSPS (para. 3.14).

(d) Creating fflpatity to wsurs systafoed mUafailitŁ of essential. generic drugs

(US$3.5 million)

3.23 Obiectives and Description. Bearing in mind the population's Iow incomes, cost recovery, if łt is to succeed, must proceed carefolly. Costs cannot exceed the threshold of tolerability of the local population without driving down utilization of health services even forther and excluding many of those at greatest risk within the population. Hence, successfol cost recovery at the CSPS and CMA levels depends critically upon low-cost generic drugs becoming widely available.

3.24 A new non-profit institution-the CAMEG-has been established to purchase and supply essential, generic drugs to the country's public health facilities (para 2.37). The project would contribute to developing the drug distribution chain to make CAMEG*s operations morę efficient. Transport for distribution of essential, generic drugs from Ouagadougou to regional warehouses would be financed by the project through the Directorate of Pharmaceutical Services (DSPH). District level pharmacies would acąuire supplies from the regional warehouses or from other sources if a lower price is available. In tura, these pharmacies would supply the district CMA or CHR and all outlying CSPS within that district with essential generic drugs, to be stored in 400 storage sheds to be constructed within the premises of the CSPS. District doctors would be responsible for supervising the rationalization of prescription methods and the application of standardized therapeutic schemes at the CSPS level, for overseeing control over CSPS financial management and accounting for drug supplies, and for closely cooperating with local health committees. During negotiations, the Government gave assurances that the CAMEG will be

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