Document of The World Bank FOR OFFICIAL USE ONLY Report No: ICR00005334 IMPLEMENTATION COMPLETION AND RESULTS REPORT TF015846 ON A SMALL GRANT IN THE AMOUNT OF US$ 567,694 TO THE Development Policy Institute (DPI) FOR Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) September 24, 2020 Health, Nutrition & Population Global Practice Europe And Central Asia Region Regional Vice President: Anna M. Bjerde Country Director: Lilia Burunciuc Regional Director: Fadia M. Saadah Practice Manager: Tania Dmytraczenko Task Team Leader(s): Asel Sargaldakova ICR Main Contributor: Alina Frederieke Koenig ABBREVIATIONS AND ACRONYMS ARIS Community Development and Investment Agency AVHC Association of Village Health Committees CfP Call for Proposals CSOs Civil Society Organizations DPI Development Policy Institute GOK Government of the Kyrgyz Republic GPSA Global Partnership for Social Accountability ICT Information and Communications Technology JAP Joint Action Plan LSGs Local Self-Governments MOH Ministry of Health MHIF Mandatory Health Insurance Fund M&E Monitoring and Evaluation PDO Project Development Objective PRA Participatory Rural Assessment Rayon Administrative District RHC Rayon Health Committee SDC Swiss Agency for Development and Cooperation SDS Sustainable Development Strategy VHCs Village Health Committees TABLE OF CONTENTS DATA SHEET ....................................................................... ERROR! BOOKMARK NOT DEFINED. I. PROJECT CONTEXT AND DEVELOPMENT OBJECTIVES ....................................................... 4 II. OUTCOME .................................................................................................................... 10 III. KEY FACTORS THAT AFFECTED IMPLEMENTATION AND OUTCOME ................................ 19 IV. BANK PERFORMANCE, COMPLIANCE ISSUES, AND RISK TO DEVELOPMENT OUTCOME .. 22 V. LESSONS LEARNED AND RECOMMENDATIONS .............................................................. 24 ANNEX 1. RESULTS FRAMEWORK AND KEY OUTPUTS ........................................................... 27 ANNEX 2. PROJECT COST BY COMPONENT ........................................................................... 37 ANNEX 3. RECIPIENT, CO-FINANCIER AND OTHER PARTNER/STAKEHOLDER COMMENTS ...... 38 ANNEX 4. SUPPORTING DOCUMENTS (IF ANY) ..................................................................... 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) DATA SHEET BASIC INFORMATION Product Information Project ID Project Name Voice of Village Health Committees and social P147876 accountability of local self-government bodies on health determinants Country Financing Instrument Kyrgyz Republic Investment Project Financing Original EA Category Revised EA Category Not Required (C) Organizations Borrower Implementing Agency Development Policy Institute (DPI) Development Policy Institute (DPI) Project Development Objective (PDO) Original PDO The PDO is "to build the capacity of Village Health Committees (VHCs) to collaborate with Local-Self-Governments (LSGs) on local issues associated with health determinants through the joint programs and increased involvement in local budget decisions." Page 1 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) FINANCING FINANCE_TBL Original Amount (US$) Revised Amount (US$) Actual Disbursed (US$) Donor Financing TF-15846 598,833 567,694 567,694 Total 598,833 567,694 567,694 Total Project Cost 598,833 567,694 567,694 KEY DATES Approval Effectiveness Original Closing Actual Closing 16-Oct-2013 29-Jan-2014 31-Jan-2018 31-Jan-2018 RESTRUCTURING AND/OR ADDITIONAL FINANCING Date(s) Amount Disbursed (US$M) Key Revisions KEY RATINGS Outcome Bank Performance M&E Quality Satisfactory Moderately Satisfactory Substantial RATINGS OF PROJECT PERFORMANCE IN ISRs Actual No. Date ISR Archived DO Rating IP Rating Disbursements (US$M) 01 04-Sep-2020 Satisfactory Satisfactory 0.57 ADM STAFF Role At Approval At ICR Regional Vice President: Laura Tuck Anna M. Bjerde Page 2 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) Country Director: Saroj Kumar Jha Lilia Burunciuc Director: Ana L. Revenga Fadia M. Saadah Practice Manager: Daniel Dulitzky Tania Dmytraczenko Task Team Leader(s): Asel Sargaldakova Asel Sargaldakova ICR Contributing Author: Alina Frederieke Koenig Page 3 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) I. PROJECT CONTEXT AND DEVELOPMENT OBJECTIVES Context 1. The Project’s context was set within the Government of the Kyrgyz Republic (GOK) decision to opt -in to the Global Partnership for Social Accountability (GPSA), established by the World Bank in 2012. The country became one of the first countries to opt-into the GPSA, which allowed civil society organizations (CSOs) with a legal presence in the country to apply to the program’s first global call for proposals (CfP), launched in December 2013. In close cooperation with the Country Management Unit (CMU), and following GPSA operational procedures, two priority issues were identified as the focus areas for the country’s CfP:1 (i) monitoring and reporting on key sectors for the public and national authorities to use information to improve access and quality of public services; and (ii) strengthening the monitoring and evaluation (M&E) capacity of local CSOs, such as conducting beneficiary feedback surveys. 2. Following the competitive CfP, the GPSA selected the proposal submitted by Development Policy Institute (DPI), whose mission is to improve the quality of life of citizens through the development of local government and capacity building of local communities.2 The proposal was selected after undergoing a technical review by the GPSA’s roster of experts and a subsequent eligibility review by the CMU. The proposal was also shared with the GOK for comment and then published for public comments. The main rationale for this project was to pilot an enhanced local governance model aimed at improving active participation and engagement of rural communities with Local Self- Government (LSG) by supporting more effective collaboration between LSGs and Village Health Committees (VHCs)3 to address health determinants,4 including local budget allocations. The model was based on strengthening the country’s existing community-driven budgetary framework through a partnership between DPI and the Association of VHCs (AVHC), a national non-profit umbrella organization, as a strategy to develop a scalable and sustainable model that could be replicated across the organization’s national network of 51 Rayon Health Committees (RHCs) and 1,600 VHCs covering 80 percent of the country’s villages. 3. At the country level, the Project’s context was favorable to strengthening the ability of citizens to engage more effectively with government. The country had elected its first president under the new parliamentary system in 2011, the first peaceful transfer of presidential power in the Kyrgyz Republic’s independent history. In January 2013, the President approved the National Sustainable Development Strategy for 2013-2017, which called for governance reforms including increasing transparency in decision making and budgeting, and strengthening civil society’s active involvement in controlling corruption. According to the World Bank’s Country Partnership Framework (CPF) for the period FY19-22, this 6-year presidency was marked by “related stability (albeit with numerous cabinet changes) and 1 See https://www.thegpsa.org/Data/gpsa/files/archives/first_call/GPSACFPKyrgyzstan.pdf . 2 DPI was created in 2009 by Kyrgyz experts in the field of local self-government (LSG) and community development. DPI experts have contributed to the national legislation on municipal property, Chapter VIII of the Constitution of the Kyrgyz Republic (KR) devoted to LSG issues, regulations on financial and economic basis of LSG and other regulations on government decentralization. For more information see http://dpi.kg/en/. 3 VHCs are registered as community-based organizations in rural LSG bodies with the purpose of empowering rural communities to act independently to improve their health. VHCs merge into 51 Rayon Health Committees (RHCs), which are registered with the national Ministry of Justice as non-governmental organizations. 4 “Social determinants of health are the conditions in which people are born, live, work and age� https://www.who.int/health-topics/social- determinants-of-health#tab=tab_1. These are uneven across different population groups. In the case of rural residents, the conditions include access to clean water, safe housing, sanitation, hygiene, and the epidemiological situation and protection from infection. In the KR, the AVHC devotes all its activities to health determinants of the rural population. Source: GPSA project’s original grant application. Page 4 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) the country made progress towards the restoration of social peace.�5 4. At the subnational level, LSGs are responsible for the provision of most local public services critical for health determinants. However, in many rural municipalities, LSGs do not link local service provision—cleaning, sanitation, watering—to health determinants, which in turn are not reflected in local policy, planning, and budget allocations. In addition, while provided with autonomy, they often lack capacity and financial resources needed to address pressing problems. Furthermore, the location of the executive bodies (aiyl okmotu) in central villages constitute a barrier for residents of remote and hard-to-reach villages, especially for their engagement in planning and budget allocation. Therefore, their living conditions and priorities remain overlooked. Another challenge was the lack of local policies on health determinants that specifically addressed local issues related to factors affecting the health and well-being of the population of the entire pilot municipality. In many rural municipalities local strategic documents had never been developed, although the legislation clearly states that each municipality must have its own Social and Economic Development Plans, which is the main guiding document in the formation of local budgets and LSGs’ main strategic document. 5. The Project was aligned with objective 2 of the World Bank's FY14-17 Country Partnership Strategy: expanding access to and increasing the efficiency and quality of education, health, and other public services. Moreover, the Project was intended to inform health policy making and implementation as well as the conditions for enabling citizen participation at the village level. The Project was also aligned with the Second Health and Social Protection Project— SWAp-2 (P126278). Project Development Objectives (PDOs) 6. The PDO was “to build the capacity of VHCs to collaborate with LSGs on local issues associated with health determinants issues through the joint programs and increased involvement in local budget decisions.� The PDO was to be achieved by promoting knowledge, training, mentoring, institutional development to involve VHCs (and the AVHC) in local policy on health determinants, planning, providing budget allocations to empower citizens, and to improve LSGs’ accountability in the provision of public services focused on health determinants. 7. The Project relied on a partnership between the lead implementing agency, DPI and the AVHC. One of the main objectives of the AVHC was to strengthen the ability of the VHCs - and the rural civic communities that they represent - to effectively interact with the LSGs, especially regarding budget decisions. The AVHC includes 1,600 VHCs covering about 80 percent of the country’s villages and thus has a wide reach. Accordingly, the Project aimed to strengthen the capacity of the VHCs (and AVHC) and provide them with the tools to empower them and for more effective cooperation with LSGs to improve local health outcomes. At the time of project design and inception, there were no other similar programs in the country. 5Country Partnership Framework for the Kyrgyz Republic for the Period FY19-FY22 (Report No. 130399-KG, discussed by the Board on November 13, 2018. The World Bank Group, http://documents1.worldbank.org/curated/en/358791542423680772/pdf/kyrgyz-cpf-fy19-22-oct102018- 10122018-636780024730768882.pdf. Page 5 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) Key Expected Outcomes and Outcome Indicators 8. Three PDO-level indicators were used to measure the success of the Project, as outlined below. These indicators were not changed throughout the Project’s lifetime. • Number of joint activities of VHCs with LSGs within the Project framework. • Number of improvements on public service delivery focused on health determinants as per joint VHCs and LSGs action plans. • Number of public events conducted by LSGs, where local budgets are disclosed. 9. To achieve the PDOs, the Project involved the local community represented by VHCs in the LSG system, using the approach shown in Figure 1. The outer circle shows the LSG mechanism, which consists of: (i) planning LSG activities, which includes development of municipal programs and plans; (ii) budget preparation based on the programs and plans developed; and (iii) budget implementation and execution of functions aimed at addressing local problems based on local priorities and delegated powers. The inner circles indicate the participatory mechanisms for rural residents represented by VHCs in the decision-making process at the local level through the following collaborative social accountability mechanisms and are further described below. • Py Rural Assessment (PRA) is a tool for identifying local health needs and priorities of communities with the participation of communities themselves, and data analysis. Project activities focused on increasing the capacity of villagers to engage in PRAs to identify their priority needs and channel the feedback to aiyl okmotus (LSG). The choice of this tool was based on its simplicity, accessibility, and minimum financial and time costs. The tool’s methodology consisted of structured discussions of existing problems in the municipality's territory and ranking them in priority order. Secondly, an analysis of cause-effect relationships involving the community is conducted. The community itself provides information on the causes of the problems and makes recommendations for their solution. All this is recorded in the form of a document, which at the next stage is used as a basis for development of joint action plans. • Joint Action Plans (JAPs) enable co-creation of solutions through joint consultations of the local community represented by VHCs and LSGs. Some of the topics discussed in such joint consultations include: (i) choosing the most optimal and effective ways to solve problems; (ii) assessment and allocation of local resources (financial, human) to address problems identified; and (iii) distribution of roles in solving problems. Following joint discussions, JAPs are discussed with a wide range of stakeholders at public gatherings and are approved by the head of LSG. • Budgetary hearings (BH) are a tool of LSGs that engage the local community in joint planning of local budgets. Since local budget funds are an essential means available to the local communities, participation in local community planning is an important part of the budget cycle. • Joint M&E (JM&E) allows the local community to monitor and evaluate progressing and LSGs’ performance in addressing the identified problems. Page 6 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) Figure 1. Project's approach 10. The Project sought to implement the objectives in a sequenced, iterative cycle annually, using adaptive management and learning consistent with the GPSA’s approach to collaborative social accountability . The above approach aimed at: (i) improving the capacity of VHCs and LSGs, facilitate the further strengthening of the AVHC; (ii) assisting VHCs and LSGs in the implementation of accountability tools: PRAs, development of JPAs, and public hearings; (iii) assisting the pilot municipalities—aiyl okmotus—in developing local strategic programs aimed at improving the health determinants; and (iv) scaling-up the Project’s approach through the VHC network. In addition, two additional objectives were included as a result of the Project’s adaptive management and learning, namely to: (i) strengthen social accountability at the local level through increased horizontal accountability by working with the Chamber of Accounts; and (ii) develop a mechanism for bottom-up feedback on priority problems from local communities to the structural units of the Ministry of Health (MOH) through the VHC network led by their association. Components 11. The Project had three components: (i) capacity-building of VHCs and AVHC to strengthen working relationships with LSGs, especially regarding budget decisions; (ii) identifying local priorities using PRAs to influence policies of LSGs; and (iii) provision of technical assistance to LSGs on social accountability tools. 12. Component 1: Capacity building of VHCs and the AVHC to strengthen working relationships with LSGs, especially regarding budget decisions. This component aimed at providing training for VHC and AVHC representatives in the areas of: (i) budget planning and execution, with emphasis on local inclusion; (ii) improving collaboration with LSGs on health issues by training VHCs and their representatives on LSGs on the practice of local self-government, citizen participation in the budget process, and upgrading skills for interacting with LSG executives and local councils; and (iii) conducting PRAs to more reliably identify local health priorities and data analysis. Page 7 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) 13. Component 2: Use of data Results of PRAs to better target local health priorities. VHC staff were trained to conduct PRAs in their communities to identify local priorities and needs, with a special focus on health determinants. Information collected was then used by LSGs to more strategically formulate local policy and make planning and budget allocation decisions taking into consideration health determinants. In addition, VHCs of the pilot municipalities communicated the PRA health determinants focused results to the local health authorities through RHCs for further dissemination. 14. Component 3: Provision of technical assistance to LSG on social accountability tools. The objective of this component was to provide customized technical assistance to LSG staff to use social accountability tools for improved delivery of local services. Ten selected LSGs conducted public hearings in all 30 targeted municipalities. Moreover, LSG leaders, VHCs, and citizens in the 10 LSGs received technical assistance to develop local policies and programs to address the health determinants affecting local communities the most— especially vulnerable groups such as children, youth, women, and young mothers—through improvement of local public service delivery. Finally, VHCs in the 30 targeted municipalities received training in the use of information and communications technology (ICT) tools to monitor local budgets. Stakeholders and Implementation arrangements: 15. The Project’s social accountability model incorporated the GPSA's approach to fostering coalitions and broad-based partnerships that leverage different types of organizations, expertise, and capacities. DPI was one of a technical CSO with extensive experience on decentralization and territorial development, central level public policy analysis and advocacy, and social accountability tools' design and implementation. DPI was the main counterpart for project implementation, responsible for leading the Project’s strategy and operational sequencing, and overseeing content, financial, fiduciary, and reporting aspects. In its assessment at concept stage, DPI justified the rationale of working through two organizations with longstanding ties and territorial presence. • The Association of VHC entered into an implementation agreement with DPI to perform a role focused on: (i) strengthening its internal capacity to support VHCs-LSGs collaborative engagement by increasing its skills and knowledge about how health determinants could be included in local budgets; and (ii) developing a strategy for scaling up the Project’s support to additional VHCs and RHCs. • VHCs were involved in the Project as representatives of local communities to interact with the local self- government bodies and to represent the local community voices in order to address the priority problems of the community. The choice of VHCs, according to DPI, was based on their sustainability and clarity of mission at the village level, despite not having legal status as other local organizations 16. In addition, the Project coordinated its activities with the Community Development and Investment Agency (ARIS). The ARIS was the implementing agency for most participatory projects and activities financed by the World Bank and other international development agencies. The Project benefitted from ARIS serving in an advisory capacity and learned from its interventions. 17. The main participants involved in the Project at the local level were: • Pilot VHCs. These were selected at the village level and acted in the interests of representatives of a village. They were the main actors and partners of the Project. The VHCs, an existing participatory institutionalized space, were strengthened to act as an effective intermediary of local citizens' "voice." • Neighboring VHCs. These were from the villages that were not selected as pilot, but existed in the same municipality as the pilot. The role of the neighboring VHCs was important in extending the coverage to the Page 8 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) entire municipality. The pilot VHCs had the task of involving neighboring VHCs to disseminate project practices and increase municipal-level coverage. In addition, the pilot VHCs also worked with VHCs from neighboring municipalities, thus facilitating the dissemination of practice to neighboring municipalities. The scheme of the Project’s work with the neighboring VHCs is shown below in Figure 2. • LSG bodies. These representative and executive bodies provided solutions to local issues through local resources and in the interests of local communities: o Aiyl okmotu is the rural government administration at the level above the village head as it might cover several neighboring villages. It ensures the preparation and execution of decisions for local self- government. o Kenesh (local councils) are elected collegial bodies of local parliament. The kenesh is elected directly by the population of the corresponding administrative-territorial unit and has the authority to resolve local issues. • Rayon Health Committees (RHC) are association of VHCs at the rayon (district) level and cover all VHCs located in the rayon. Rayon VHCs hold regular meetings to exchange experience at the level of each rayon. In the Project’s work with pilot VHCs, active participation of VHCs at regular VHC meetings and dissemination of the experience gained was a necessary condition. Figure 3 below presents how pilot VHCs interact with neighboring counterparts at the rayon level. Figure 2. Figure 3. Project work with the neighboring VHCs Interaction of pilot VHCs at rayon level 18. The main participants involved in the Project’s implementation at the national level were the Chamber of Accounts and the MOH. The Chamber of Accounts is one of the state bodies that ensures the mechanism of horizontal accountability of state bodies within the system of public administration. The function of the Chamber of Accounts also includes audit of local budgets. The MOH is responsible for policy making on health, and organization and provision of guaranteed medical services by the central government. In addition, the Mandatory Health Insurance Fund (MHIF) acts as the purchaser of medical services. Functions of the MHIF include assessment of the quality of the health services delivered to the population and subsequent payment to service providers. Page 9 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) II. OUTCOME Assessment of Achievement of Each Objective/Outcome 19. The PDO was “to build the capacity of VHCs to collaborate with LSGs on local issues associated with health determinants issues through the joint programs and increased involvement in local budget decisions� to be measured through the following results indicators and outcomes. • Number of joint activities of VHCs with LSGs within the Project framework. • Number of improvements in public service delivery focused on health determinants per joint VHC and LSG action plans. • Number of public events conducted by LSGs where local budgets are disclosed. 20. By the Project closing date, the Project’s PDO-level indicators were met, with two indicators exceeding the original targets and one indicator meeting the original target. These indicators remained relevant by the end of the Project, as they reflect the Project’s ability to establish a collaborative social accountability model based on the cooperation between LSGs and VHCs to identify priority issues related to health determinants at the village level, and to agree on follow-up actions through JAPs aimed at service improvements and corrective measures. Thus the PDO could be considered “achieved� by the time DPI submitted their final completion report at the end of December 2017 (closing date: January 2018). 21. Regarding Intermediate Results Indicators, six out of nine met or exceeded their targets. The targets for the remaining three were mostly achieved. Achievements for these indicators were slightly below the target because they refer to the total number of LSGs that were effectively engaged in the Project (25) instead of the initial 30 planned by the Project. This number was duly communicated to the Task Team Leader and the GPSA Secretariat and justified by the project team, given political economy considerations that affected the selection of LSGs from more than 300 VHCs that had applied to participate in the Project at the inception phase. Five LSGs initially selected were unwilling to commit to the Project’s objectives. Therefore, the Project operated in 25 LSGs throughout the whole implementation period. Overall then, the Intermediate Results Indicators could also be considered “achieved� the end of December 2017. 22. Following GPSA procedures, grant projects define milestones against which they receive annual disbursements. These milestones are drawn from the initial strategy and operational plan elaborated during project preparation and are basically qualitative progress markers of overall project progress. To this extent, they must also be consistent with the Project’s results framework and overall monitoring, evaluation and learning strategy. 23. The GPSA Secretariat and the grantee had agreed on the following milestones to be achieved by the end of the Project, to be evaluated as follows. Specific deliverables are provided in the Annex): • Use of social accountability for generating citizen feedback: A social accountability model applied to monitoring health service delivery, particularly health determinants, including budget allocation and execution in Kyrgyz Republic, as revised based on the iterations to the model from its implementation throughout the Project’s lifetime, and recommendations for scaling-up and/or replicating beyond the Project’s intervention areas. • Public sector engagement: The MOH, the State Agency for Local Self-Government , LSGs, and other key public stakeholders at the local, district, and national levels have used the information generated by the Project through social accountability to introduce changes to and to improve the performance of public policies and Page 10 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) programs regarding social determinants of health as evidenced by cross-sector public policy and management instruments—for example, official regulations, budget directives and memorandums, operational processes and procedures at the national, district, and local levels—which have been included in the Project Completion Report. • Monitoring and Evaluation (M&E): The Project’s Results Framework was refined and constitutes a critical tool to be used for evaluating the Project’s final results and the grantee has improved its M&E system as a result of the Project’s experience as evidenced by: (i) revised end-of-project Results Framework; and (ii) proposal – methodology and process – for end-of-project evaluation included in the Project Completion Report. • Knowledge and Learning: The grantee has developed and refined a social accountability model applied to public health service delivery in Kyrgyz Republic as evidenced by the set of knowledge products agreed under the Project’s Knowledge and Learning Plan and delivered successfully by the end of the Project. Evaluation of the social accountability model for generating citizen feedback 24. The actual execution of the Project took place between April 2014, when first disbursement was received, and December 2017, when final report was submitted. DPI participated in GPSA-organized knowledge and learning activities, such as the Annual Global Partners Forum and Grantees Workshop. 25. The Project’s implementation consisted of two main phases: The first cycle of activities from January 2015 to December 2016. • The second cycle of activities from January 2017 until January 2018. 26. During the first phase of the Project, DPI focused on increasing capacity of the pilot VHCs and their partner organization, the AVHC, to act as effective intermediaries representing the voice and needs of target village populations, particularly remote and hard-to-reach villages, to LSGs. The Project’s collaborative social accountability model was based on engaging local citizens and LSGs to identify priority needs, using PRAs, that informed the preparation of JAPs. Subsequent budget hearings were then used to provide concrete progress markers for the execution and monitoring of village-level priority needs. Where needed, the mechanisms were simplified for VHCs and LSGs. These collaborative, participatory activities helped the local population and LSGs to re-allocate funding or raise additional funds to finance public works and other priorities related to health determinants. 27. During the second phase, when the pilot VHCs had acquired capacity to independently conduct target villages’ collaborative process, the Project’s strategy focused on investing in a series of activities aimed at laying the groundwork for sustaining and scaling up the collaborative social accountability model beyond the Project’s duration. Consistent with the GPSA’s adaptive learning and management approach to social accountability, (see Box 1 below: GPSA’s adaptive learning and management approach) the Project learned from the experience of the first phase and adjusted its strategy accordingly. Page 11 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) Box 1: GPSA’s adaptive learning and management approach The GPSA considers adaptive learning and management – conceived as an iterative process set within complex and dynamic socio-political contexts – as an important driver of collaborative social accountability. GPSA has found that an effective route toward supporting results is to broker multistakeholder coalitions composed of civil society, government, and private and international institutions that engage in collaborative social accountability processes using a problem-solving mindset. Integrating sectoral and governance interventions, as GPSA’s collaborative social accountability efforts do, opens new pathways to obtain scalability and sustain results. Social accountability is “collaborative� when citizens, civil society groups, and public sector institutions engage in joint, iterative problem solving to improve service delivery, sector governance, and accountability. This is opposed to confrontational, advocacy-based social accountability strategies that are based on the development of civil society’s countervailing power.6 The GPSA’s adaptive programming approach cannot always be adequately measured through standardized criteria, as an attempt to formalize milestones and indicators at the start of the Project can risk derailing the iterative approach needed for success. Despite the above, this ICR sought to examine if adaptative approaches helped to solve the problems the Project targeted at the initial design phase, and whether the capacity of individuals, beneficiaries, and implementing partners improved under the Project. By carrying out interventions through a collective identification of tangible, locally relevant problems, collaborative social accountability mechanisms developed under the Project sought relevance, legitimacy, and practicality. In line with the principles of adaptive programming, the Project favored flexibility in its design, with a view towards scaling up support where the likelihood of sustainable reforms is greatest. GPSA projects adopt principles of adaptive programming as part of design, in line with the recognition that not every facet of the Project can be planned, and that implementing partners will inevitably face some level of uncertainty during implementation. Course-correction during project implementation is thus encouraged and rewarded based on effective supervision and implementation. For example, as information is gathered during implementation about what is happening and how it is measured, project indicators may subsequently need to be adapted to the reality on the ground. The measure of success is therefore based on the extent to which projects help implementing partners solve problems identified by local stakeholders using collaborative social accountability mechanisms.7 28. To develop social accountability, the Project worked at the local and national levels, undertaking efforts to build social accountability across health issues for local communities and ending with the highest government bodies in the country. This was in response to the Project's political economy analysis that pointed to a critical missing link—the lack of feedback from citizens about the health system and the allocation and execution of local budgets and their investments in health determinants. 29. Pilot VHCs mobilized local communities to participate in PRAs in 25 pilot municipalities. • 3,163 community members participated in the PRA in 2015. • 3,964 community members participated in the PRA in 2017. 6 Guerzovich, F. and Scommer, P. “Social Accountability and Open Government: Different Types of Collaborative Engagement.� Les Éditions de l'IMODEV. Vol. 7 (2018). Available at: https://ojs.imodev.org/index.php/RIGO/article/view/247/395. 7 See: Guerzovich, Maria F., Maria Poli, and Emilie Fokkelman. 2020. “The Learning Crisis and Its Solutions: Lessons from Socia l Accountability for Education.� Global Partnership for Social Accountability Note 13. World Bank, Washington, DC. Available at: https://gpsaknowledge.org/knowledge- repository/the-learning-crisis-and-its-solutions-lessons-from-social-accountability-for-education. Page 12 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) • 1,592 community members participated in the PRA in 20 villages as part of an exchange of experience. • 1,527 members of the community to participate in events to discuss local budgets in 2016. 30. The positive progress of the Project is reflected in the change in priorities identified in 2017 PRA activities, compared to 2015. For example, while access to clean drinking water supply was raised during the 2015 PRA, in 2017 residents rated this as second or third. This indicates that drinking water supply provided by LSG bodies had improved, together with the living conditions of the pilot villages. In addition, due to a better understanding of the LSG’s role and responsibilities, the citizens have become less vocal in demanding that LSGs should solve problems outside their authority. The Project encouraged VHCs and LSGs to jointly participate in raising donor funds to address some of their problems. For this, two competitions provided opportunities for LSGs together with VHCs to win technical support to implement their initiatives. This enabled LSGs to consider VHCs as an equal partner and facilitator in solving local problems. Figure 4. Priority problems based on PRAs conducted in 2015 and 2017 Source: Final Completion report 2017 31. In March-April 2015, Project staff traveled to pilot VHCs to support meetings with village activists aimed at identifying the cause-effect relationships of priority problems detailed in PRAs, and to develop steps to address them. The document developed together with the village activists, became the basis for the creation of JAPs. 32. On-site visits in May-September 2015 to the pilot villages helped VHCs to finalize the JAPs. In addition, project staff also moderated the negotiations of VHCs with the aiyl okmotus. This facilitated agreement in the municipalities to approve the VHC-proposed JAPs with LSGs. Guided by the JAPs and depending on the local budget and possibilities for fundraising from external sources—incentive grants from the budget of the Republic, grants from donor organizations, voluntary contributions from local residents and other private individuals—LSGs then proceeded to respond to citizens’ interests. 33. The Project also provided support to the pilot municipalities in the implementation of JAPs. In 2016, a competition was held in support of the local initiative, “Partnership between VHC and LSG.� The purpose was to: (i) encourage more active participation of the population through the pilot VHC in the life of the community and the decision-making process on the ground; (ii) identify the most successful examples of local initiatives in addressing cases Page 13 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) of local importance related to determinants of health with a view to encouraging and disseminating information about them; and (iii) to promote use of best practices and new ways to address local issues related to the determinants of health in partnership with VHC and LSG in the country. This competition reviewed local initiatives—activities, mechanisms or methods initiated and implemented jointly by the local community through the VHC in conjunction with LSG that addressed cases of local importance related to the determinants of health, and which require continuation and may be replicated in the applicant municipality or other villages. Winner municipalities were awarded prizes and later assisted to implement joint VHC- LSG initiatives. Evaluation of the engagement with public sector agencies using information generated through social accountability 34. ln helping to address the many needs of the population, VHCs used data generated after PRA in pilot villages to develop JAPs with LSG. Selected issues from JAPs were included in local budgets for 2015, 2016 and 2017. For 2017, the year the Project ended, LSGs solved 87 percent of the 102 problems identified that year. In contrast, 2016 witnessed 72 percent of cases solved, with only 7 percent of problems in the process of being addressed; only 6 percent were not yet solved. 35. To address health determinant priorities of the communities, LSGs allocated 24,874,097 Kyrgyz soms (about US$360,500) from the local budgets. From other sources 16,700,827 Kyrgyz soms (US$242,000) were spent to solve these priority problems. In order to address priority issues of the communities LSGs attracted 16,700,827 Kyrgyz soms (US$242,000) beyond local budget resources. 36. When reviewing the survey dynamics of the pilot municipalities’ beneficiaries, a significant increase of about 17 percent—from 34 percent in 2015 to 51 percent—according to the survey results in 2017— was recorded in answer to the question of whether the issues of local importance identified during PRA were completely resolved . This indicates that LSGs follow up on the adopted JAPs and allocate funds from the local budget. Figure 5. Have problems been solved or being solved that were initiated by VHCs this year? Source: Final completion report 2017 37. The level of cooperation between VHCs and LSGs measured on a 5-point scale at the beginning of the Project, the midpoint and the end of the Project indicates sustainability of cooperation between pilot VHCs and LSGs. From 2016, the Project moved from active assistance to pilot VHCs to monitoring and dissemination of successful experiences. The growth in the indicator from the beginning of the Project was 0.6 on the scale —from 3.6 points in 2014 to 4.2 points in 2017—indicating increased cooperation between VHCs and LSGs. During project implementation, pilot VHC’s achievements were recognized by LSG bodies and without project efforts further VHCs are involved in LSG activities. Now the aiyl okmotus recognize pilot VHCs as a necessary channel of communication to work with local communities. In places, where the heads actively work with VHCs, better linkage has been established between LSGs, and local communities. Forward-thinking heads use VHCs as a tool for implementing tasks relevant to local community. In some municipalities, VHC chairpersons are regularly invited to planning sessions of the aiyl okmotu. Page 14 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) Evaluation of the Project’s M&E system 38. At the beginning of 2016, the Project carried out surveys among villagers of the pilot villages; the analysis was attached to the semi-annual project progress report. 39. To carry out M&E, project specialists regularly visited the pilot municipalities to review the progress of activities carried out by pilot VHCs and execution of JAPs by LSGs. 40. As new information became available, the Project revised its mode of implementation and made necessary adjustments, following GPSA’s adaptive learning and management approach. In this context, planned activities were adjusted and new activities were introduced to improve the implementation of the Project activities. 41. The Project's results are timely in the current pandemic context and should hopefully contribute to inform social accountability approaches linking central to subnational level mechanisms to ensure that health services intersect with health determinants, and appropriately target with fiscal transfers. Evaluation of the knowledge and learning produced by the Project and Project sustainability 42. The Project generated new learning about the political economy of bottom-up approaches to collaborative social accountability in local governance and health determinants, particularly in rural settings and hard-to-reach areas. It also underlined the importance of using an adaptive management and learning approach driven by a systems-based analysis of engagement mechanisms at the national and sub-national level, rather than on using specific participatory "tools." The Project combined the use of PRAs as a participatory tool to gather and systematize feedback from rural villages to produce JAPs between LSGs and citizens aimed at identifying priority issues and problems and developing solutions. The model was then strengthened with the provision in the Budget Code that JAPs and budget hearings should feed into local Social and Environmental Development Plans. 43. The Project's model embedded a sustainability and scalability strategy. This was achieved by: • Working through the AVHCs as a vehicle for scaling up the model to other villages and municipalities, which the Project did quite successfully. Pilot VHCs provided on-site and telephone consultations to neighboring VHCs and VHCs in other municipalities. In 2016, the 25 pilot VHCs trained 25 neighboring VHCs. In 2017, the same pilot VHCs trained 25 more VHCs from other municipalities. A significant step the Project made aimed at ensuring the sustainability of results was an activity to disseminate the Project's experience among non-pilot VHCs and RHCs throughout the country. Eight events at the oblast level brought together 285 representatives of the VHCs around the Kyrgyz Republic to exchange experience on a peer-to-peer basis. These activities helped to give pilot VHCs the opportunity to act as mentors. The AVHC intend to continue the work initiated by the Project and to actively promote the implementation of project practices in other VHCs. The success of the Project’s approaches and methods formed the basis for design of a new project, which replicated the Voice of VHC project. This was implemented in all rural municipalities in three rayons of Issyk-Kul oblast by the AVHC, supported by the Swiss Agency for Development and Cooperation (SDC) . • Bridging the Project's interventions to other projects supported by DPI by scaling up practices to other municipalities and generating cross-learning, and replicating the model through a new project supported by SDC. • Sustaining the model by linking it to the new Budget Code provision related to budget hearings, and by introducing the specific intervention related to producing feedback that can be used to inform the MOH and Mandatory Health Insurance Fund. Page 15 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) 44. From the perspective of social inclusion, the Project's model was able to include the voices of otherwise excluded and vulnerable groups, especially women living in remote villages, by working through VHCs . This approach allowed the Project to reduce the gap and asymmetries between remote villages and central villages where aiyl okmutu are located. The Project also generated learning on the role of women as leaders in the context of VHCs and leadership of LSGs which tends to be dominated by men. Relevance for country strategic context 45. The PDO remained aligned with the GOK’s National Development Plan, including its most recent edition, “Sustainable Development Strategy� (SDS) to 2040, which emphasized the need for higher growth, driven by the private sector, greater trade integration, and human capital investments . The SDS to 2040 anchors the long-term development of the country around three core objectives: (i) economic well-being of the people including sustainable jobs, decent work and stable incomes; exports, especially from labor intensive sectors; and regional development; (ii) social welfare including health and education, social equity, and cultural revival; and (iii) governance and sustainability including public order, civil service efficiency and accountability, and environmental sustainability. The long-term national strategy is supported by a medium-term plan covering 2018-2022 and entitled “Unity, Trust, Creation.� This plan articulates comprehensive policy reforms with supporting investments. It accords high priority to addressing governance issues in a wide range of areas from economic management to public services delivery, complemented by efforts to improve human capital, defined as improvements in education and health quality, better social protection, and cultural development. 46. The Project also remained relevant vis-a-vis the Kyrgyz Republic Country Partnership Framework for the Period 2019-2022. Specifically, it relates to Area 3: Enhance economic opportunities and resilience, and Objective 7: Develop human capital. Overall Outcome Rating 47. Given the time lag in the preparation of the final ISR and ICR (project closed January 2018), and noting the strong results observed from project implementation, the team recommends that the final implementation progress rating be assessed as Satisfactory. 48. The DPI reported increasing demand from municipal stakeholders for scaling up the project services, which further demonstrates relevance of the project objective. 49. The GPSA Secretariat, in collaboration with the project team, provided continued technical assistance and supervision during the Project’s duration. DPI submitted all technical and financial reports in a timely and satisfactory manner throughout the Project’s duration. Furthermore, the GPSA Secretariat provided technical assistance to DPI through its Capacity & Implementation Support Area. DPI participated in all the capacity-building activities organized annually by the GPSA namely, the Annual Grantees’ Workshops and Global Partners Forum. The Project’s experience, results, and lessons learned were presented and discussed at these events. Other Outcomes and Impacts Local Level Page 16 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) 50. Based on PRA activities, the Project also supported VHCs and LSGs to develop a local policy on health determinants that specifically addressed local issues related to factors affecting the health and well-being of the population of the entire pilot municipality. As a result of this work, the local policy, “My aimak - healthy aimak� (2016- 2020) was developed by a working group consisting of VHCs and LSGs and approved both by the local community at rural gatherings and by the local kenesh in 12 pilot municipalities, which then became a part of the Social and Economic Development Plans—the main guiding documents in the formation of local budgets and the LSGs’ main strategic document. In addition, a decision was made to scale up the policy to the level of the entire municipality, which may include several villages, instead of developing programs for only one village where the pilot VHC is located. The actions taken based on the policy were formulated following the PRA results in 2017 conducted throughout the aimak8, that includes all villages, not just pilot ones. This prevents the dominance of the interests of only pilot VHCs and ensures fair consideration of all groups’ interests in the community. This ensured a wide public discussion and consideration of the population's priorities on health issues. Institutional cooperation between VHC and LSG has increased. In the past, cooperation depended entirely on the political will of municipal leaders, but during the Project cooperation became institutionalized and embedded in the program documents. 51. Many municipalities have expressed their intention to engage with the Project. For this purpose, each of the municipalities signed a memorandum, which frames the work that will continue. By signing the memorandum, the LSGs undertook certain obligations to implement joint tasks with the Project. Central Level 52. The engagement of collaborative social accountability at the national level was not included in the original plans of the Project, but the need for this work became clear only after the Project worked with VHCs on PRA and assessed their capacity, and during the GPSA Global Partners Forum in 2014. The Project generated new learning about the interventions that are needed to link citizen feedback to appropriate response channels, via LSGs and other important channels, such as the Budget Code provisions (Jan 2017), and specific mechanisms for engaging through the MOH’s Insurance Fund as laid out below. • Building on implementing the PRA and identifying priority health problems through pilot VHCs, the AVHC included a new mechanism for VHCs to interact with the MOH and the MHIF to identify and transfer priority problems related to the quality of medical services from the local communities to the structural units of the MOH, from territorial to the national level. The MHIF was very interested in receiving the opinions of rural communities on purchased medical services . The Project's work led to a formal agreement between the AVHC and the MHIF to gather and systematize rural communities’ feedback on the quality of health services. By the end of the Project, through pilot VHCs in 12 municipalities, information was collected about the health services problems considered as priority by the population across the country. This information was discussed at a conference on the health determinants. For the MHIF, this served as additional information for making decisions regarding the quality of services provided. • The Project also strengthened horizontal accountability by engaging with the Chamber of Accounts and the Ministry of Finance to advocate for the inclusion of budget hearings in the Budget Code approved in 2017. Earlier, the Project was challenged by budgetary hearings because the heads of LSG did not want to hold budget hearings using imperfect legislation in this area. In January 2017, the new edition of the Budget Code became effective, making public budget hearings a mandatory part of the budget process in addition to taking into account the priority needs of local communities in planning social and economic development and formation of local of the budget, and requiring LSGs to disseminate information about the local budget. The Chamber of 8 Ayil aimak is an administrative-territorial unit which covers several villages managed by the LSG Page 17 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) Accounts monitors whether LSGs meet the legal requirements in this respect. With the introduction of the new Budget Code, all municipalities have moved towards program budgeting, which means that the planning and execution of the local budget should now be based on their adopted programs of social and economic development. The Project sees continued active participation of VHCs in the implementation of local policies both in the immediate implementation of individual tasks in conjunction with LSGs, and in monitoring the implementation of activities conducted by LSGs. 53. Positive Deviance: This project produced many additional unintended positive impacts, including, but not limited to the following: • As a result of the joint work of LSGs and VHCs, a change in the attitude of the population towards the LSGs in general was revealed. A survey in 2017 recorded a 10 percent increase in the number of respondents that consider LSG bodies to be open and transparent. It is important to note the reduction in the number of those who found it difficult to answer this question – from 9 percent in 2015 to 3 percent in 2017, as presented in Figure 6. This suggests that by the end of the Project, people better understood the responsibility of the LSG to citizens and could judge its closeness or openness, compared to the beginning. In addition, VHCs are now more willing to seek help from the heads of LSGs and they, in turn, are more committed to support VHCs. Figure 6. In your opinion, how open are the representatives of aiyl okmotu to the public in their activities? Source: Final Completion report 2017 • The AVHC planned to continue the work initiated by the Project and to actively promote the implementation of project practices in other VHCs. The Project’s approaches and methods formed the basis for design of a new project, which the AVHC implemented with the support of the SDC replicating this Voice of VHC project in three rayons of Issyk-Kul oblast. Recommendations and Sustainability 54. In May 2017, the Project’s representative took part in the Central Asian and European Forum on Water Management organized by Oxfam and GPSA. The forum presented experiences from various countries of the World Bank’s Europe and Central Asia region. The Project presented its own experience in implementation and learned about tools used by other projects promoting social accountability. One of the tools shared during the forum, creation of public committees or councils under state bodies or enterprises, is similar to what pertains in the Kyrgyz Republic— where each state body has a public council including civil society representatives. However, it is impossible to translate this experience to the LSG without adaptation because it already has representative bodies - local kenesh. Therefore, any imposition of an additional council creates parallel structures within the LSG, which would not be proper or effective. At the LSG level, with respect to health care it is reasonable to adapt and use this experience to create intermunicipal or RHCs that would include the heads of LSG bodies, state bodies, VHCs and other CSOs. The creation of intersectoral councils for health protection is also possible in large municipalities with many villages and presence of the MOH subdivisions. This would address some of the existing problems, such as: Page 18 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) • Each VHC operates within the boundaries of its village and lobbies for solving problems of that village. The Project observed that active VHCs can lobby for the solution of all the problems raised in their village, while the interests of neighboring villages belonging to the same municipality remain unaccounted for because their VHCs are less active or experienced. This gives rise to a negative attitude to the more active VHCs and LSGs from the weaker VHCs. To ensure participation of all VHCs at the municipal level on equal terms, regular meetings should be held to contribute to gradual growth of weaker VHCs. • Among the CSO representatives in the field, there are people experienced in fundraising and the project implementation that the LSGs are not tapping. Their experience and those of other local experts could be leveraged by the LSGs in order to attract additional resources including funding. • Due to limited resources, LSGs have difficulties working with local communities. This function should be taken up by deputies of the local council, but experience shows that often many deputies have inadequate knowledge and skills for effective interaction with communities. Representatives of CSOs, including VHCs are closely linked with local communities and can provide the necessary communication between LSGs and citizens. LSGs could use these links to work with their local communities. • Lack of coordination among VHCs in one municipality and their isolation from each other makes it difficult to unite in addressing problems or to effectively share knowledge with each other and other organizations in aimak. For more harmonious interaction at municipality level, unity is necessary. • Some health issues go beyond the powers of LSGs and cannot be resolved only between VHCs and LSGs. This requires closer operational interaction with the government agencies and healthcare institutions at the local level. 55. Replication of this model goes beyond the mandate of the Project. But the Project cooperated on this issue with a project on hospital autonomy commissioned by the Government of Switzerland. Also, the AHVC considered this model and strengthened the role of VHCs in health protection at the rayon level in three rayons of Issyk-Kul oblast in this Swiss supported project. Thus Project introduced this model in a truncated form (with limited participation of state bodies and the MOH) in 10 municipalities. At the same time, the Project in order to avoid parallel structures and weakening of local councils, created councils as helpers to the respective standing commissions of local keneshes. III. KEY FACTORS THAT AFFECTED IMPLEMENTATION AND OUTCOME 56. For this project, the methodology of intervention was modified and based on an adaptive learning approach to adapt more closely to the local context by strengthening the collaborative social accountability model with regards to the links between municipal and village-level participatory mechanisms and national level legislation and entry points. Initially, it was assumed that the Project would mostly focus its work at the local level. At the national level, activities were planned to inform government authorities about the Project’s progress and results. Most of the planned impact of the Project was expected to be obtained at the municipal level, since the problems were mainly at the local level. During project design, there were no significant problems at the national level requiring project interventions. National legislation in the field of social accountability, according to the DPI estimates, allowed the implementation of the project mechanism without expected difficulties. However, as the Project progressed, it became evident that legislation was poorly executed at the local level, and, in some places, regulations regarding citizen participation in the decision-making process were completely ignored by the local authorities. The Project also found that citizens could convey their concerns to government bodies. Given the new circumstances, the Project revised its approaches at the national level. Figure 7 depicts the revised strategy with linkage to central-level policy making and implementation. Page 19 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) Figure 7. Revised project strategy Source: Final completion report 2017 57. Also, at the national level, the Project supported a study that evaluated the system of accountability in the Kyrgyz Republic. The results of the research showed that the system of accountability, including social accountability, exists in the Kyrgyz Republic, but it functions only at 43 percent of its capabilities. The Project used this study to engage the authorities and civil society about which areas of the accountability system require additional efforts. 58. Following the study, it was decided to change the course of the Project and to develop a mechanism to facilitate the interaction of VHCs with the structures of the MOH and MHIF regarding health services received by respective communities. Twelve pilot VHCs were selected to conduct PRA activities to collect priority problems related to health services at the municipality level. An analysis of stakeholders helped to identify exactly who was interested in this partnership and to adjust implementation accordingly. When the Project presented the MHIF and MOH with a proposal to introduce the mechanism, it received the support of the MHIF leadership, 59. Another change in the Project’s course was the decision to work with the Accounts Chamber of the Kyrgyz Republic. The importance of working with institutions of horizontal accountability was discussed at the global GPSA Global Partners Forum in 2014. . The Chamber of Accounts had revised the methodology for auditing local budgets, since the previous methodology was outdated and has not been revised for many years. In addition, the Chamber of Accounts of the Kyrgyz Republic sees its role in the audit of local budgets not only as an inspecting body, but also as an advisory body that not only can identify a violation, but also helps avoid such violations in the future. In general, the new approach to auditing local budgets should be based on the principles of performance audit, including aspects of transparency, accountability, and the needs of local communities. 60. Other key factors that positively affected implementation and outcome are summarized below: • Local policy: “My aimak - healthy aimak� (2016-2020). Originally, the Project planned to develop local policies for 10 villages, but considering the increased capacity of the pilot VHCs, it was decided to increase the number of “champions� capable of developing policies to 12. In addition, it was decided to scale up the policy to the cover the entire municipality, which included several villages, instead of developing programs for only one village where the pilot VHC is located. Pilot VHCs in most cases were able to cope with the task, which indicates that the pilot VHCs had grown so much that they could spread their influence on the level of the whole aimak. In addition, they became real local leaders, since VHCs from other villages that had not previously been involved in the Project activities also took part in PRA activities. Page 20 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) • In partnerships with other two projects, the Project shifted its status from purely local to the sub-national level to address the issue of more accountable health care services to the local communities . o The Project decided to expand its PRA activities and carry out needs assessment of the communities of all 13 municipalities of the Jety-Oguz district in order to collect the information to be discussed at the district councils’ level. To this end, the Project teamed up with the “Social and Economic Development of Aiyl Aimaks Based on Needs of Local Community� project financed by the German Society for International Cooperation (GIZ). The GIZ project undertook the study of public opinion on problems with civil registries and social issues. The two projects’ joint activities sought to generate information and translate it to LSG bodies and regional structures to strengthen decision-making. Another project, the “Health Providers Autonomy� was engaged to handle the task, while this project was occupied with supporting the RCH Council that was created in Jeti-Oguz rayon to provide recommendations on the current health situation to the regional structures of MOH. o Likewise, this project participated in a pilot exercise by another project financed by the SDC to ensure that the needs of local communities are communicated to the district-level health promotion councils, given that both projects had similar goals. During the first six months of the Project’s implementation, the “Health Providers’ Autonomy in Kyrgyzstan� was launched with the support of the Embassy of Switzerland. Under the said project health promotion councils were established in three districts being composed of representatives of civil society and subdivisions of state authorities at district level. One of the objectives of the council is coordination of health care services delivery in the district with the aim of improving the access of villagers to health care services. The goal of the pilot councils is to establish intra-sector interaction in the district and to consider needs of the local communities, in order to make the health care system more accountable. • As a result of another project implemented by DPI in the Issyk-Kul and Jalal-Abad regions closer partnership relations could be established with the LSG bodies. Based on this, two villages hold public hearings of the budget on a regular basis, while another eight villages had the experience of organizing such events in the past, but those were done rarely. 61. Other key factors that negatively affected implementation and outcome are summarized below: • Reducing the number of target LSGs. Initially, the Project planned to work with 30 pilot VHCs that were selected among more than 300 VHCs that applied for participation in the Project. However, at the very first events of the Project, five pilot VHCs raised problems with the heads of their LSGs—the leaders’ reluctance to work with accountability tools led to the inability of the Project to help the VHC change the situation on the ground. Despite the VHCs’ desire to actively continue working with the Project, the heads of their LSGs refused to facilitate Project work in their communities as they were unwilling to commit to the Project’s objectives. Therefore, 25 VHCs were effectively engaged in the Project. This number was duly communicated to the Bank and the GPSA Secretariat and justified by the project team given the political economy considerations that affected the selection of LSGs at the Project’s inception phase. Thus, the Project operated in 25 LSGs throughout the whole implementation period. • At the beginning of the Project, difficulties arose in the implementation of activities regarding the participation of the LSG heads. The heads were reluctant to attend meetings since the Project did not provide grant support to address and solve the priority problems identified in the local communities. But LSGs were expected to raise funds on their own. The Project had to persuade the heads to participate in the Project, and thanks to the involvement of the VHCs in the project activities, the heads did so. It does make sense for Projects working with government bodies Page 21 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) to involve local communities. • Another factor that negatively affected project work and sustainability of results was high turn-over rate of deputies of local councils. The success of many pilots was tied to relationships that pilot VHCs built with LSGs, deputies, and the respective community. In November 2016, elections for deputies of local councils were held throughout the country followed by elections of LSG heads. Out of 25 pilot municipalities, 14 (56 percent) heads of LSGs lost the elections and new leaders came on board. With the departure of the former heads, municipalities lost their experience of working with local communities, because it is often a practice that that the new head brings a new team. In cases where the previous heads and deputies left, these links were cut off and VHCs had to demonstrate their importance in the community life to the new LSG management team. With new LSG heads, policies often change. To resolve this issue the Project prioritized testing of its mechanism for formulating local policy related to health determinants. The Project planned to develop local policies at village level, where pilot VHCs operate. But given the increased capacity of pilot VHCs it was decided to extend the policy for the entire municipality, which averaged five to eight villages. To do so, it was necessary to conduct PRA activities in every village of the municipality, as PRAs were among the most important sources to inform the policy. IV. BANK PERFORMANCE, COMPLIANCE ISSUES, AND RISK TO DEVELOPMENT OUTCOME A. Bank Performance 62. World Bank Performance is rated as Moderately Satisfactory. Quality at entry 63. The quality at entry for the Project is rated as Satisfactory. The Project’s context was set within the Government of the Kyrgyz Republic (GOK) decision to opt-in to the GPSA, established by the World Bank in 2012. The Kyrgyz Republic became one of the first countries to opt-into the GPSA, which allowed civil society organizations (CSOs) with a legal presence in the country to participate in the program’s first global call for proposals (CfP). The GPSA selected the proposal submitted by the Development Policy Institute after a technical review by the GPSA’s roster of experts and a subsequent eligibility review by the CMU. The proposal was also shared with the GOK for comment, and published for public feedback. 64. Project documents were prepared by the GPSA Secretariat that had staff with the mix of skills to design the operation, based on the original DPI proposal, in line with the World Bank's FY14-17 Country Partnership Strategy. Following GPSA procedures, four milestones, consistent with the Project’s results framework and overall monitoring, evaluation and learning strategy, were defined during project preparation. They were drawn from the initial strategy and operational plan to serve as qualitative progress markers of overall project progress. The Project’s overall risk rating was estimated by the Bank Project team as moderate. A detailed description of the main risks and mitigation measures identified during preparation was included in the project paper (Operational Risk Assessment Framework). GPSA projects adopt principles of adaptive programming as part of its design, in line with the recognition that not every facet of the project can be planned, and that implementing partners will inevitably face some level of uncertainty during implementation. Thus course-correction during project implementation is encouraged and rewarded based on effective supervision and implementation. The Project's model also embedded a sustainability and scalability strategy in its design, use of which allowed the Project to scale up its activities beyond the initial design. Page 22 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) 65. Fiduciary aspects: The World Bank carried out a procurement assessment in September 2013 and concluded that DPI’s procurement risk was high. An Integrated Assessment Framework of the DPI to undertake Project Financial Management and Procurement was conducted in July 2013. Proposed mitigations measures were included in Annex 2 of the project paper. Quality of Supervision 66. The Bank team based in the region provided supervision and regular support to the counterpart in close cooperation with the GPSA Secretariat. In addition to continued technical assistance and capacity building support to DPI, the GPSA Secretariat engaged the counterpart in knowledge and learning activities. For the most part, WB and GPSA Secretariat teams were responsive to client needs and demonstrated flexibility in adapting to evolving priorities within the parameters of the PDO. No changes in the results framework occurred during the project implementation. 67. As this was one of the first GPSA projects, it was a learning experience for all three parties—the GPSA Secretariat, assigned World Bank team and DPI—to work together on implementation of GPSA project. DPI initially faced an initial challenge with an application of World Bank operational and fiduciary procedures as this was its first experience to implement a World Bank-funded project. Finally, the DPI complied with and submitted all required progress reports, namely: one Annual Technical Progress Report by the end of the 2016 calendar year, and two mid- term Technical Progress Report by the end of July 2016 and 2017, throughout the whole project implementation period. Reporting packages also included the following updated documents: Results Framework, Disbursement Table with annual milestones (Annex 4 of Disbursement Letter, as per GPSA Operations, included “qualitative milestones� to be achieved by the end of annual disbursement tranches); Procurement Plan; Operational Plan and Budget. At the end of the Project’s implementation period, the lead implementing agency, DPI, submitted a Final Completion Report in March 2018. 68. Project financial reports and independent audit report were submitted on time and were all acceptable, with no significant issues observed. As the DPI’s procurement risk was identified as high due to DPI’s lack of experience with competitive bidding and Bank procurement procedures as well as absence of a qualified procurement specialist, a part- time procurement specialist from the Community Development and Investment Agency (ARIS) was hired to provide guidance to DPI on the purchase of goods and services to be procured under this Project. An independent post procurement review was commissioned by DPI and submitted to the Bank. This was acceptable and no significant issues were observed. B. Compliance Issues 69. No safeguards policies were triggered. The grant’s activities were rated “C� for Social and Environmental Screening as it was not expected to have any direct social and environmental impacts. C. Risk to Development Outcome 70. The Project’s overall risk rating was estimated by the Bank Project team as moderate. A detailed description of the main risks and mitigation measures identified during preparation was included in Annex 3 of the project paper. Two main risks and mitigating measures were identified: • Potential coordination risks associated with the involvement of multiple stakeholders—World Bank, CSOs, local communities, local and central government—in the implementation of the Project. As foreseen in the project Page 23 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) paper, this risk was mitigated by the Project’s collaborative framework established with participating LSGs, VHCs, and primary beneficiaries including the population of target villages. The framework envisioned continuous mentoring of VHCs - and capacity-building to including LSG representatives, which DPI successfully implemented in close coordination with the AVHC-. Furthermore, DPI was also able to successfully engage with relevant public sector institutions at the national level. • Implementation risks were associated with the variable capacity of VHCs whose capacity development was a main objective of project implementation. Similarly, low capacity among LSGs was identified to be a potential risk during implementation. To mitigate these risks, the Project implemented an iterative capacity development approach aimed at providing continuous mentoring and technical assistance to target VHCs and LSGs. Another risk was associated with differences in starting technical capacities of the DPI and AVHC in certain areas. DPI had a longstanding record of working with LSG and budget-related issues, but lacked an experience of working with community-based organizations such as VHCs. AVHC had more than a decade experience in community mobilization, but no experience in engaging with LSGs on budget related issues. V. LESSONS LEARNED AND RECOMMENDATIONS 71. Outreach and communication activities are key to creating trust and receiving less complaints from the local communities to the LSGs. The practice showed that in municipalities where the public activities were carried out frequently and the heads of aiyl okmotu duly conducted explanatory and outreach work, the population had fewer complaints to the LSG bodies. At the same time, in municipalities where the public events are not carried out, the residents voice negative experiences when they interface with LSGs. Due to such negative feedback, many heads of aiyl okmotu are wary of gathering the villagers for meetings, thus committing another mistake. The main principle behind working with the local population is to give them an opportunity to speak up. Unspoken complaints or claims are accumulated and may serve as a catalyst for larger conflicts inside the community. Therefore, the Project worked individually with the LSG bodies’ managers and undertook efforts to convince them of the importance of information disclosure. In addition, during the second half of implementation, the Project organized exchange visits within the municipalities to share knowledge on how municipalities are contributing to the development of communities by strengthening social accountability in the LSGs. 72. Citizen engagement is most effective when citizens have a real say, and the feedback loop is closed, when the government acts upon citizens demands. During project implementation, the LSGs faced challenges in mobilizing the local community to participate in budget hearings. As most of the rural population is usually engaged in seasonal work, the attendance rate of such events was rather low. Many experienced heads of aiyl okmotu organized concerts with the help of residents or students to incentivize increasing attendance rates. The Project found that the community is highly interested in participating in the budget hearings if their opinion would be considered during the local budget planning process. Yet their opinions were often ignored, and their recommendations were not considered in the local budget, resulting in a decline of trust in the LSGs. The practices of the Project and other activities of the DPI demonstrated that the attendance of citizens starts increasing when budget planning activities have an impact on the resulting budget. 73. Citizen engagement is most effective when information is understandable and accessible to the local communities. According to the Project’s observations communities are highly interested in discussing the local budget if the information is presented to them in an easily understandable and accessible format. On the contrary, if the information is unclear, it is unlikely that a person will attend such an event again. The Project helped to visualize the budget information in the form of infographics and to provide a simple, clear, and understandable description of the Page 24 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) budget for ordinary people. Previously, employees of aiyl okmotu during public budget hearings did not customize the information for the population; instead, the heads of financial and economic units simply read out the information on the budget items at meetings with the public. Consequently, the participants of the hearings developed a feeling of dissatisfaction toward the hearings, as the information received is unclear and too complicated for those not conversant with the budget issues. The more citizens understand, the more questions they ask, and the more useful proposals they can make. 74. Reform champions are key to project success. Key to the Project’s success and sustainability has been be the readiness of LSGs to include civil society priorities in local budget planning and implementation. Another observation of the Project was that the situation in the municipality largely depended on who oversaw the LSG. Active progressive leaders solved community problems faster, while passive leaders slowed down processes and did not take the necessary decisions to solve problems. The presence of CSOs like VHCs in the municipality is a catalyst for activating such passive heads. However, this does not work in all cases and the state should think about the fact that local communities should have a direct lever of pressure on non-functional leaders in addition to informing the local kenesh, which itself may not be properly performing its role. 75. It is best to consider several options for partnership with different stakeholders. When the Project appealed to the MOH with a proposal to introduce the mechanism, the leadership of MOH structural units accepted the proposal without enthusiasm. But when the Project appealed to the MHIF, it was possible to get support of the MHIF leadership. This suggests that among potential partners it is necessary to learn about the roles and interests of different stakeholders and find the one who would be interested in, foresee, and benefit from cooperation. The analysis of stakeholders helped find exactly who will be interested in this partnership. 76. VHCs are a powerful vehicle to change the relationships system between citizens the local authorities. As a result of the joint work of LSGs and VHCs, a change in the attitude of the population towards the LSGs in general occurred. This suggests that people are better able to understand the responsibility of LSGs to citizens and can judge its closeness or openness, whereas when the Project began people did not understand the openness and transparency required of LSGs. 77. VHCs can contribute to institutional memory in LSGs. Due to the high turnover rate among LSG heads, VHCs are key and a more promising institution for preserving the sustainability of project results at the local level. Turnover in VHCs happens less often, since the VHC members are not only permanent residents of the villages where they operate but they are leaders in their respective communities on the ground. Thus for the duration of the Project, only four VHCs out of 25 had changes in management, with two cases associated with the death of the VHC chairpersons. They were replaced by members of the same VHC that were actively involved in the work, so the continuity of accumulated experience is more assured in the VHCs. VHCs also act in the interests of their communities and do not pursue mercenary goals, as they do not have access and cannot make decisions on spending the local budget and dispose of local resources such as land. Strengthening of such CSOs in the field is necessary to ensure the accountability of LSG bodies. They can keep the bar of social accountability of LSGs at a high level, if they are equipped with the appropriate tools. 78. Established ties can serve as accelerator for change. As a result of relationships developed in another project implemented by DPI in the Issyk-Kul and Jalal-Abad regions, closer partnership relations could be established with the LSG bodies. Therefore, out of these, two villages hold public hearings of the budget on a regular basis, while another eight villages had the experience of organizing such events in the past, but those were done rarely. Page 25 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) 79. Working with implementation partners is key to project success. The Project coordinated its activities with the country’s Community Development and Investment Agency (ARIS). This was the implementing agency for most participatory projects/activities financed by the World Bank and other international development agencies. The Project benefitted from ARIS serving in an advisory capacity and learn from its interventions. In addition, such collaboration allowed the Project's approach to social accountability to better contribute to activities in the ongoing and pipeline Bank portfolio in the Kyrgyz Republic. . Page 26 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) ANNEX 1. RESULTS FRAMEWORK AND KEY OUTPUTS A. RESULTS INDICATORS A.1 PDO Indicators Unit of Formally Revised Actual Achieved at Indicator Name Baseline Original Target Measure Target Completion Number of joint activities of Number 0.00 0.00 50.00 59.00 VHCs with LSGs within the Project framework. 31-Dec-2013 01-Jan-2018 01-Jan-2018 01-Jan-2018 Comments (achievements against targets): Unit of Formally Revised Actual Achieved at Indicator Name Baseline Original Target Measure Target Completion Number of local service Number 0.00 0.00 85.00 89.00 delivery improvements focused on 31-Dec-2013 01-Jan-2018 01-Jan-2018 01-Jan-2018 health determinants jointly by Page 27 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) VHCs and LSGs as per action plans. Comments (achievements against targets): Unit of Formally Revised Actual Achieved at Indicator Name Baseline Original Target Measure Target Completion Number of public events Number 0.00 0.00 50.00 50.00 conducted by LSGs, where local budgets are disclosed. 31-Dec-2013 01-Jan-2018 01-Jan-2018 01-Jan-2018 Comments (achievements against targets): A.2 Intermediate Results Indicators Unit of Formally Revised Actual Achieved at Indicator Name Baseline Original Target Measure Target Completion Number of VHCs successfully Number 0.00 0.00 30.00 53.00 working with LSGs on key relevant to local services health 31-Dec-2013 01-Jan-2018 01-Jan-2018 01-Jan-2018 issues Page 28 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) Comments (achievements against targets): Unit of Formally Revised Actual Achieved at Indicator Name Baseline Original Target Measure Target Completion Number of participants from Amount(USD) 0.00 0.00 140.00 171.00 VHCs, LSGs, National Government, Agencies, CSOs, 31-Dec-2013 01-Jan-2018 01-Jan-2018 01-Jan-2018 media participating in public discussions on health determinants (National level events) Comments (achievements against targets): Unit of Formally Revised Actual Achieved at Indicator Name Baseline Original Target Measure Target Completion Number of developed case Number 0.00 0.00 12.00 12.00 studies/lessons learned. 31-Dec-2013 01-Jan-2018 01-Jan-2018 01-Jan-2018 Page 29 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) Comments (achievements against targets): Unit of Formally Revised Actual Achieved at Indicator Name Baseline Original Target Measure Target Completion Number of times LSGs use PRA Number 0.00 0.00 30.00 35.00 data analysis when making decisions that affect local 31-Dec-2013 01-Jan-2018 01-Jan-2018 01-Jan-2018 services focused on health determinants and budget priorities. Comments (achievements against targets): Unit of Formally Revised Actual Achieved at Indicator Name Baseline Original Target Measure Target Completion Number of LSGs, where local Number 0.00 0.00 30.00 53.00 priorities identified, analyzed (using DPI's comparative 31-Dec-2013 01-Jan-2018 01-Jan-2018 01-Jan-2018 analysis) and disseminated Comments (achievements against targets): Page 30 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) Unit of Formally Revised Actual Achieved at Indicator Name Baseline Original Target Measure Target Completion Number of joint action plans Number 0.00 0.00 30.00 24.00 with a focus on health service delivery jointly developed by 31-Dec-2013 01-Jan-2018 01-Jan-2018 01-Jan-2018 LSGs and VHCs. Comments (achievements against targets): Unit of Formally Revised Actual Achieved at Indicator Name Baseline Original Target Measure Target Completion Number of LSGs using social Number 0.00 0.00 30.00 24.00 accountability mechanisms when taking action on local 31-Dec-2013 01-Jan-2018 01-Jan-2018 01-Jan-2018 policies or programs focused on health determinants. Comments (achievements against targets): Page 31 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) Unit of Formally Revised Actual Achieved at Indicator Name Baseline Original Target Measure Target Completion Number of LSGs, who allocate Number 0.00 0.00 30.00 24.00 funds for improvements of local services which are critical 31-Dec-2013 01-Jan-2018 01-Jan-2018 01-Jan-2018 for health based on the result of PRAs and Public Hearings. Comments (achievements against targets): Unit of Formally Revised Actual Achieved at Indicator Name Baseline Original Target Measure Target Completion Number of issues of Number 0.00 0.00 3000.00 3000.00 “Municipalitet� magazine, through which LSGs social 31-Dec-2013 01-Jan-2018 01-Jan-2018 01-Jan-2018 accountability best practices will be disseminated throughout the whole country Comments (achievements against targets): Page 32 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) Page 33 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) B. ORGANIZATION OF THE ASSESSMENT OF THE PDO Objective/Outcome 1: Build the capacity of VHCs to collaborate with LSGs on local issues associated with health determinants issues through the joint programs and increased involvement in local budget decisions� to be measured through the following results indicators and outcomes. 1. Number of joint activities of VHCs with LSGs within the Project framework. 2. Number of improvements in public service delivery focused on Outcome Indicators health determinants per joint VHC and LSG action plans. 3. Number of public events conducted by LSGs where local budgets are disclosed. Intermediate Results Indicators N/A 1. 59 joint activities of VHCs with LSGs within the Project framework. 2. 89 improvements in public service delivery focused on health Key Outputs by Component determinants per joint VHC and LSG action plans. (linked to the achievement of the Objective/Outcome 1) 3. 50 public events conducted by LSGs where local budgets are disclosed. Objective/Outcome 2: Build capacity of VHCs and the AVHC to strengthen working relationships with LSGs, especially regarding budget decisions. Outcome Indicators N/A 1. Number of VHCs successfully working with LSGs on key relevant to local services health issues. 2. Number of participants from VHCs, LSGs, National Government, Intermediate Results Indicators Agencies, CSOs, media participating in public discussions on health determinants (National level events) 3. Number of developed case studies/lessons learned. Page 34 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) 1. 53 VHCs successfully working with LSGs on key relevant to local services health issues. Key Outputs by Component 2. 171 participants from VHCs, LSGs, National Government, (linked to the achievement of the Objective/Outcome 2) Agencies, CSOs, media participating in public discussions on health determinants (National level events)3. 12 developed case studies/lessons Objective/Outcome 3: Use of Data Results of PRAs to Better Target Local Health Priorities. Outcome Indicators N/A 1. Number of times LSGs use PRA data analysis when making decisions that affect local services focused on health determinants and budget priorities. Intermediate Results Indicators 2. Number of LSGs, where local priorities identified, analyzed (using DPI's comparative analysis) and disseminated 3. Number of joint action plans with a focus on health service delivery jointly developed by LSGs and VHCs. 1. 35 times LSGs use PRA data analysis when making decisions that affect local services focused on health determinants and budget priorities. Key Outputs by Component 2. 35 LSGs, where local priorities identified, analyzed (using DPI's (linked to the achievement of the Objective/Outcome 3) comparative analysis) and disseminated 3. 24 joint action plans with a focus on health service delivery jointly developed by LSGs and VHCs. Objective/Outcome 4: Provision of technical assistance to LSG on social accountability tools. Outcome Indicators N/A Page 35 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) 1. Number of LSGs using social accountability mechanisms when taking action on local policies or programs focused on health determinants. 2. Number of LSGs, who allocate funds for improvements of local Intermediate Results Indicators services which are critical for health based on the result of PRAs and Public Hearings. 3. Number of issues of “Municipalitet� magazine, through which LSGs social accountability best practices will be disseminated throughout the whole country. 1. 24 LSGs using social accountability mechanisms when taking action on local policies or programs focused on health determinants. 2. 24 LSGs, who allocate funds for improvements of local services Key Outputs by Component which are critical for health based on the result of PRAs and Public (linked to the achievement of the Objective/Outcome 4) Hearings. 3. 3,000 issues of “Municipalitet� magazine, through which LSGs social accountability best practices will be disseminated throughout the whole country. Page 36 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) . ANNEX 2. PROJECT COST BY COMPONENT Components Amount at Approval (US$M) Actual at Project Closing (US$M) 1. Creating through a collaborative stakeholder process, a benchmarking and .34 .33 monitoring system to assess quality of pre-school services. 2. Establishing a national mechanism for capacity development of preschool .14 .13 service providers for bettering service delivery. 3. Facilitating Knowledge and Lalrning to enhance effectiveness of Social .11 .11 Accountability Interventions and project management. Total .59 0.57 Page 37 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) ANNEX 3. RECIPIENT, CO-FINANCIER AND OTHER PARTNER/STAKEHOLDER COMMENTS N/A Page 38 of 39 The World Bank Voice of Village Health Committees and social accountability of local self-government bodies on health determinants (P147876) ANNEX 4. SUPPORTING DOCUMENTS (IF ANY) 1. Project multimedia Website: http://dpi.kg/en/activity/projects/full/0/86.html (English version) http://dpi.kg/ru/activity/projects/full/0/57.html (Russian) DF files - Project success stories in Russian - posted on the DPI website: http://dpi.kg/upload/file/GPSA_DPI_SKZ_Shor-Bulak_SStory.pdf.pdf http://dpi.kg/upload/file/GPSA_DPI_SKZ_Manas_SStory.pdf.pdf http://dpi.kg/upload/file/GPSA_DPI_SKZ_Ak-Korgon_SStory.pdf http://dpi.kg/upload/file/GPSA_DPI_SKZ_Kyzyl-Kyshtak_SStory.pdf.pdf http://dpi.kg/upload/file/GPSA_DPI_SKZ_Alexandrovka_SStory.pdf.pdf 2. Team composition Name Title Office Phone City Development Policy Institute (DPI) Ainura Dzhunushalieva Project Manager +996 555 21 70 75 Bishkek Tatyana Beletskaya Financial Management +996 312 976 530 Bishkek Sabina Gradwal Cooperation Specialist +996 550 300 301 Bishkek Azamat Mamytov Public finance and +996 312 976 530 Bishkek projectmanagement specialist Anara Musaeva Expert on community involvement +996 312 976 530 Bishkek Jyldyz Kerimova Expert on community involvement +996 312 976 530 Bishkek Asel Mambetova Communication, exchange of +996 312 976 530 Bishkek experience and best practice specialist Rahat Talkanbaeva Monitoring and evaluation specialist +996 312 976 530 Bishkek Association of Village Health Committees (AVHC) Gulina Otunchieva Manager +996 557 261 115 Bishkek Venera Toktogonova Manager on interaction with LSG +996 557 261 115 Bishkek Gulzama Kanaeva Accountant +996 557 261 115 Bishkek To be hired upon Rayon Health Committee Bishkek signing the Implementation Agreement Participation Manager To be hired upon Project Assistant Bishkek signing the Implementation Agreement Page 39 of 39