노트 : Evaluation period: Jun 1976-May 197

Brady, James R.

USAID(Mission to Korea)

K-Developedia(KDI School) Repository

-g0-O I I Project Evaluation SurnnlarY (Terminal) .4ission or ALD/W Cffice Name 2. Project Number USAID /orea 489-11-590-708 Project Title Health Planning 1hey project dates (fiscal years) 5. Total U.S. Froject 6/29/74 b. Final c. Final 12/31/77 funding-life of Agreement and Obli- 5/30/75 input (projected) project soine' 5/30/75 gation delivered $702,000 tvaluation nunber as 7. Period covered by this evaluatiwa . Date of this i'tcud in Eval. Schedule Evaluation Review PAI'. 77-10 From: 6/76 To: 5/77 . 5/31/77 Action Decisions Iteached at Evaluation Rleview, 10. Cfficer or Unit 11. Date Action iacludin, iteins needing further study responsible for to be follow-uO comnpleted Continue to administer health research funds USAID/GDO 12/31/1977 "ote: Activities under tis project have been largely coinpleled except for the ad­• iirlatration of selected health research activities. Sone provision of advice and technical assistance and inonitoring of I,C,FG progress in health planning will be appropriate during CY 1977. . gntures: Project Cficer -: Signature; _ , " Signature: Typed Typed Name: .__Jv.e. R, Brpy Name: Dennis P. Barrett iate: Date: . / ./ 13. Summary Much of the information contained in the last PAR and trazomittal Airgram (TOAID A-37. May 28, 1976) is still curreang The Westinghouse Health Planning Contract was terminated on December 31, 1976, anl is reviewed in the final Contractor Performance Evaluation Report submWed Jaauary 31, 1977. Major events would Include: (a) The completion and appv-oval of the first oubstantive national health pl*, (as a component of the 4th Five Year Economic Plan. 1977-81). (b) Per the instructions of the President, a opecLi Medical Assistance Program for the Poor was added to the Fourth Five Year Program. This program was initiated in January 1977 to provide free or oubsitdied primary and secondary care to about 2. 1 million Koreans classified as Indigent or low income. The first year's budget for this program was proJec1ed to be about $17 million, but lower than estimated demands for servce may result in a .lowering of this projection. Hf initial efforts are successful, natiomnl plawnero would like to double the target population, tkereby reachlng 11-1.2% of the population. If this program continues to receive the peronal interest of the President, It could have a nignificant positive impact on the overall plannitS and delivery of health services. (c) Creation of the Office of Policy Coordination wi*.in the Ministry of Heai­and Social Affairs (MHSA) at the Bureau Director's level. This new onice absorbed the Planning, StatisIcal, and Pudgtifng Sectior.a-nd reports to the Director General for Pl-aning and Coordination. This ofice is currently .working on projections of long range national health needsx aud resources. It 'is responsible for coordirating "inter-bueau" programs within MSA but still e-nercises rather limited control over the declioms made within each bureau. If properly euplolted. the higher personsl rank of the Policy Coordinator and his control over statistical and budgeting activities could lead to greater influence over internal MHSA planning procesaes. It im still too early to epeculate on the probability of this rccurring. (d) The National Health Secreiarlat was created at the Korea Development Inatitate with initial support from thim project and lWaer atnport from the Health Demonstration Loan Project. The Secrelarlat adminatezed ",7 research studies totaling X754, 672, 282 ($113, ,23) in cc erpari fUnd3. The major problem has been the inability to recirnit qualified and intersted economists for the vacant senlor poitlons. in the SecretrYiat. Best Available Documne"I's 14. Evaluatlon Methodology This resular annual review/based largely on small Informal discusaions among Koreans, Americans. and other country nationals (WHO, UNCEF,etc.)concerned with-health planntag activities. A rev".3w of project files was alea made to extract appropriate inforuation. 15. Documents to be revised to reflect decision* noted on page 1: None 16. Evaluation Findings abo'A External Factors As suggested in Sction 13 above and in the Luat PAR, one of the keyinfluences c improvemnts in ealth planning is the priority accorded to health by top ROXG policy mabkers. Press9ure for :na~ow change must come from above the bureaucratic (i. e. bureau) level of the minitrIe s coucerned. Once the bursaucracy acceps the decision for chazge, impl enaion Will otill move at different opeoia. The major Innovations now undeway are the Mdical Program for the Poor (_ushed by the President); a jolut RTOG-AID Health Deraonetrafion Loat Project (pushed by the Deputy Prime Mi ister in the earlier stages and now generally auppotad by tha Minlisto'z of Health appoiyed in Decamnaer 1975); and a health iuaurauce ocheme 'tocover about one-fouxth of the popalation during th t five yeaas (puaked by the Minister of Health). The Health P anning Project is credit d with creati% wa atnosphere wlhiich was more conducive to the cocep ion and developmeat ci now prograrns at the Caiftative of the top policy nmaia. Staf trained by the project Lava been heavily inolved in maay of the new activities. 17. Evaluation Findings about Goal/Sgoal The Sector Goal is "Enhanced public welf"a in rural areas through expasdedhealth saultation, and social security pzograns and facilitlea based on economicaUy aound and site-tested paning oyonlem." Th-i9 goal asumes that expansion will b! based on imall oyalernatlc pilot toots of programs. While &hiA will be teme of cerain types of Innovations (use of phy.riciau euteiders, prepayment achaeres et:c.), the ROXG 13 already Best Docm proceeding to expand health services to the poor ad initlating major insurance programs without much pilot testing. The top political leadership has decided that the need is too urgent to postpone for 2-3 years while smal tests are carried out. This project has aasisted by providilg new pnninU strategies. procedures, and trained persoanel in an effort to reduce the number of errors made. The project and some of the new efforts are also n~utually supportive in that the project hoped to have some impact oa the Improvement of health delivery for the poor, ad this Improvement has' begun in 1977. 18. Evaluation Finding about Pu ,-!,e The Project Purpose is to "Asmist the ROKG to establish a health sector planning capability which is based on systematic armlysis- meearch, ad data assessment." Comments on Progress and Problema (a) A skeletal central policy and lring unit ncw e.dats within the Mnistry of Health at the Bureau level, compared to the absence of even a plni officer three years ago. 'Three returned parIcipats, traied in Health ad eoDevelopment, have been assigned aa oaection chief* in three hey bureas, the quality of planning in these bureup.. has improved. While a etrong, centralized planning office has nc=4 yet evolved, tba tread io txaad more professinalbned planning within the bumeaub a be coo.1=%ltcn of lnteO-bureau programs. (b) Research and development data on which to base new programs will clo now come from three new souzces: (1) the new MN3SA Policy Coordizator'o office, (Z) the Korea Health Developmnt Intittue =d (3) the Haflona Healt Secrearia. Theas Lceaaed iWforwional impke. should lead t6 more Osatenatic and rational plianing. (c) The Project iscurrently eupporting a raeaarch atudy by tha Korea Development Iatitute to sopport recoruuendation3 for a new "ealth sector infor=tion uystem (repowt e=pected by July 1977). (d) Several health research activities were supportood by the Pr.,Jet. Th quality of the work and the findings has been mized. Mazy of the better researchers are being utilied as consultants by operating agncies. (e) A national health plan has been approved for 1977-81. This plan provides an adequaU met of objectives and program fra=ework for im­proving national health care. It needs to be further elaborated and refined in order to serve as an effective gulde for annual operatons. 19. Evaluat on Findings about Izputs and Outputs In USAID/RCKG.s opinion, the Westinghouse Health Plnnii3 Corrctwas too costly in relation to tha output# produced. Tho two long tar con. oultants were as effective as could be expected midai the circumatance. Home office and overhead cost. were high. Luss participa As were traned than progranuned --- primarily due to the lack of EngjUrlh Lu uage qualied candidatea. 20. Evaluation Findings about Unplanned Effects (a) The Ministry of HeaUlh did not provide a ver., conducive en-2rorwezt fo? innovation, priucipally because it igmuch moie cmatezevoive and roultne-oswited than ether Kowean agencias which have been more in the rniA.am of Xorea's &ocio-econowic daecmnt Thia oitugicn olowed down the trauslation into action program3 ce.ttain vbjeclives in the Project A reemeL. The oituati ncmow Oezms to be improving some­what under the leadership of Minister ShIn, H Hwac!knd due to factor*ion outside of MWSA. which were described earlier. (b) The ithlernentation of aguoaed-on pToSaxns was aI3o hampered by a generaI ROKG policy of shifting key ROXG pa crnnal every 1Z-18 montbs. 21. Changea in Design or Execution Certalin chazges were made as irequired by comditiona. No new rnodicatioars a'e proposed sb.ice thia ig a terminating pvoject. Best Available Docure 7 2. Lessons earned (a) Allow a longer time frame for InstItWIon-building projects of this sort. (The situaton in Korea wan perhaps unusual since the ovoraill USAJID program phaseout required the development of a Health Loan Demonstration Project at the same time as this grant-funded project wax working on vational program planning capabilities. In other activities of this nature, it is ight' be at= appropriate to complete the planning assistance project before chaneling ia funds for specific field demonstration activities). (b) A. I. D. should be better prepared to provide abort and long term technIcal support for such projects. Reliance on contractors, versu3 a core of well.. trained, direct-hire specialists, should be reviewed. (c) Several activities related to this project will be continued under the Health Demonstration Loan Project. 23. Special Comments or Remam None .71AmI OCUI n 

Health planning

http://pdf.usaid.gov/pdf_docs/PDAAN718.pdf

Health planning

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