Pakistan.Malakand Rural Development Project

Among the government’s strategic objectives at the time of project approval were poverty reduction and human resource development. Regional and area development projects targeting less developed areas were the main approaches to reducing rural poverty. The 1995 country operational strategy of the Asian Development Bank (ADB) specified sustained economic growth and simultaneous poverty reduction as objectives of ADB assistance to Pakistan.3 The strategy also emphasized human resource development, with particular focus on women, and enhanced productivity of natural resources.

According to the revised project framework in the RRP, the project was expected to (i) raise the per capita income of the project area beneficiaries to attain or exceed the poverty line, and (ii) improve the human resource and income-generating potential of women in the project area. The framework did not directly mention specific baselines and targets for the expected impact.

Asian Development Bank.Reference Number: PCV: PAK 2011-43.Project Number: 29603.Loan Number: 1672-PAK(SF).November 2011. Pakistan: Malakand Rural Development Project

Pakistan.Malakand Rural Development Project

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Pakistan.Road Sector Development Program

Access to markets and social services in rural areas of Sindh was poor because substantial portions of the provincial and rural road networks were in bad condition. Interventions were needed in line with the strategies of the Government of Pakistan and ADB to improve key sections of the provincial highway network, improve and rehabilitate rural access roads (RAR) in areas with pervasive poverty, strengthen institutional capacity in the provincial works and services department (WSD),4 and initiate policy reforms toward managing roads more effectively.

The anticipated social and poverty impacts, particularly from RARs, included increased income and employment opportunities, improved access to social services, and strengthened food security. The main impact of the PSDP was expected to be (i) local economic growth that would generate employment, (ii) lower transaction costs, and (iii) improved economic efficiency. Although poverty indicators for the country and for four provinces including Sindh are given in the report and recommendation of the President (RRP), no performance indicator or target was offered. Para. 125 of the RRP estimates that 20%–35% of national benefits from improved provincial highways would accrue to the poor.

The PSDP was to enhance access to markets and social services in rural areas by (i) improving and rehabilitating the RAR network; (ii) preserving key road assets by rationalizing road maintenance, including creating a provincial road maintenance fund; (iii) improving important provincial highways to facilitate trade and create income and employment opportunities; (iv) improving the efficiency and effectiveness of the Sindh WSD in planning, managing, and maintaining the provincial road network; (v) supporting reforms in the road sector; and (vi) promoting private sector participation in road development and maintenance.

The policy and institutional reform component initiated a process of change in the province intended to transform the WSD into an efficient institution that, in partnership with district governments and the private sector, could provide a safe, cost-effective, and well-maintained network of provincial and rural roads. Some of the targets in the RRP were (i) lower vehicle operating costs, (ii) lower transport costs for farm inputs and outputs, (iii) alternative financing mechanisms that would reduce the burden on public sector resources, and (iv) fewer road accidents.
 
Asian Development Bank.Reference Number:PCV:PAK 2011-42.Project Number:32058-02.Loan Numbers:1892-PAK,1893-PAK (SF)

Pakistan: Road Sector Development Program

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Pakistan.KP/FATA Governance Reforms

Approval Date 01-NOV-2011.Closing Date N/A. Total Project Cost** 6.Region South Asia.Major Sector (Sector) (%) Public Administration, Law, and Justice (General public administration sector) (100%).Themes (%) Other public sector governance (40%). Other accountability/anti-corruption (30%). Administrative and civil service reform (10%). Public expenditure, financial management and procurement (10%)

World Bank. KP/FATA Governance Reformsm

Pakistan.Punjab Irrigation Productivity Improvement Program Project

Major Sector (Sector) (%) Agriculture, fishing, and forestry (Irrigation and drainage) (70%) Agriculture, fishing, and forestry (Agricultural extension and research) (30%).Themes (%) Water resource management (40%) Rural services and infrastructure (40%) Other environment and natural resources management (20%).Environmental Category B. Bank Team Lead Ahmad,

World Bank.Masood.Borrower/Recipient GOVERNMENT OF PUNJAB.Implementing Agency PUNJAB OFWM DIRECTORATE

Punjab Irrigation Productivity Improvement Program Project Phase-Is

Pakistan.Cost-effectiveness and financial consequences of new vaccine

This series is produced by the Health, Nutrition, and Population (HNP) Family of the World Bank's Human Development Network. The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. Pakistan has one of the highest infant mortality rates in the world, and over 50 percent of deaths in post-neonatal children are attributable to pneumonia, diarrhea, or meningitis diseases that can be prevented through vaccination. The purpose of the study is to compare the cost-effectiveness and financial implications of introducing pneumococcal (PCV-10), rotavirus (Rota-Teq), and Homophiles influenza type B (Hib) vaccines in Pakistan.

The cost-effectiveness analysis was conducted using the Tri-Vac model, which is a static model that estimates the burden of disease and the costs of treatment and for the immunization program of children up to five years old in ten annual birth cohorts (2010 to 2019). Sensitivity analyses were conducted testing key assumptions related to disease burden, vaccine efficacy, and vaccine cost. The analysis of financial implications included a projection of cold chain needs and costs associated with the introduction of each new vaccine, as well as the financial outlays required by the government. Sensitivity testing was also conducted on major assumptions.

All three vaccines were found to be cost-effective, with Hib vaccine the most cost-effective option at $22 per disability-adjusted-life-year (DALY). The cost-effectiveness figures for PCV and rotavirus vaccines were $225/DALY and $201/DALY, respectively. Sensitivity testing did not significantly alter the results. The combined financial requirement for the three new vaccines would peak in 2017 if GAVI assistance reduced to five rather than eight years ($213m). This cost would account for 40 percent of national immunization expenditures, and 15 percent of government health expenditures. Required cold chain investments would be small relative to the expenditure on vaccines, and represents a good return on investment.

While the investment would be worthwhile from an economic perspective, introducing all three vaccines in Pakistan will present financial challenges unless overall health spending increases. Careful consideration needs to be given to long-term financing after GAVI support ends

Author:Brenzel, Logan ; Sanderson, Colin ; Galayda, Victor ; Masud, Tayyeb ; Haq, Inaaml ul.Document Date:  2011/10/01.Document Type:  Working Paper.Report Number:65830.Volume No:  1 of 1

Pakistan.Cost-effectiveness and financial consequences of new vaccine

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