Bulgaria

Ratings for the Health Sector Reform Project (HSRP) for Bulgaria were as follows: outcomes were moderately satisfactory, the risk to development outcome was moderate,... Show More + Bank performance was moderately satisfactory, and Borrower performance was also moderately satisfactory. Some lessons learned included: monitoring and evaluation (M&E) frameworks should be well developed at the time of project effectiveness. Several aspects of the HSRP M&E framework lacked a clear link to project activities, and it was made in the absence of good baseline data. Surveys undertaken during project effectiveness were not consistent, making it difficult to compare data over time. A simple insistence on using the same core questionnaire in each survey from start to finish will be a big step forward. Although Bank-financed projects can not always be coordinated with election cycles, starting an ambitious health reform project less than one year before an election is fraught with risk. To the extent possible, reform projects should be mindful of electoral considerations. There are valuable synergies between investment operations and Development Policy Loans (DPLs) that should be exploited wherever feasible. Investment projects can open policy dialogue and build trust as a precursor to policy-based lending, as well as finance Technical Assistance (TA) that can inform DPL activities once they are operational. DPLs can help shape the policy environment to maximize the return to a traditional project's investments. Show Less -