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Implementation Completion Report (ICR) Review - Third Emergency Services Support Project (essp Iii)

1. Project Data:   
ICR Review Date Posted:
West Bank & Gaza
Project Name:
Third Emergency Services Support Project (essp Iii)
Project Costs(US $M)
 10.0  18.0
L/C Number:
Loan/Credit (US $M)
 10.0  18.0
Sector Board:
Social Protection
Cofinancing (US $M)
 0  0
Board Approval Date
Closing Date
12/31/2009 06/30/2013
Health (50%), Central government administration (32%), General education sector (15%), Other social services (3%)
Health system performance (40% - P) Education for all (40% - P) Social safety nets (20% - S)
Prepared by: Reviewed by: ICR Review Coordinator: Group:
Judith Hahn Gaubatz
Judyth L. Twigg Christopher D. Gerrard IEGPS2

2. Project Objectives and Components:

a. Objectives:

    According to the Trust Fund Grant Agreement (page 5), the project objective was:
      • To mitigate the deterioration of the delivery of education, health and social care services to the Palestinian population in the parts of the West Bank and Gaza under the jurisdiction of the Palestinian Authority.

    The objective was articulated similarly in the Emergency Project Paper (page 7) : "To help mitigate the deterioration in the provision of essential public services in education, health and social services."

    The project was one of several Emergency Services Support Projects (ESSP I: US$59.1 million, 2002-2004; ESSP II: US$40.0 million, 2002-2004; Multi-Donor Trust Fund ESSP: US$55.0 million; 2006-2011) funded by the Bank. The Multi-Donor Trust Fund ESSP had the same objective as this project and was implemented concurrently, the only difference being the source of funding.

b. Were the project objectives/key associated outcome targets revised during implementation?

c. Components:

1. Financing Operating Costs for Education Services (Appraisal: US$3.0 million; Appraisal + 2 AFs: US$ 6.35 million, Actual: US$6.26 million): This component was to finance recurrent expenditures of school directorates and the Ministry of Education and Higher Education headquarters. These were to include: rent and maintenance of facilities; utilities; salaries of non-civil servant staff of universities; communications; consumables; fuel; and general exam proctors.

2. Financing Operating Costs for Health Services (Appraisal: US$6.25 million; Appraisal + 2 AFs: US$10.15 million; Actual: US$10.18 million): This component was to finance non-medical costs of operating and maintaining the Ministry of Health directorates and health facilities. These were to include: rent and maintenance of facilities; utilities; transportation; communications; consumables, fuel; and contracts with non-governmental and private health institutions providing tertiary services not available in public facilities.

3. Financing Operating Costs for Social Services (Appraisal: US$0.5 million; Appraisal + 2 AFs: US$1.1 million; Actual: US$1.2 million): This component was to finance recurrent expenditures for the Ministry of Social Affairs and its shelters, rehabilitations centers, and training centers.

4. Project Management and Monitoring (Appraisal: US$0.25 million; Appraisal + 2 AFs: US$0.4 million; Actual: US$0.18 million): This component financed costs related to project management including staff, operating costs, and external financial and physical audits.

d. Comments on Project Cost, Financing, Borrower Contribution, and Dates

Project cost

    • The original project cost at appraisal was US$10.0 million. Due to the approval of additional financing, the final project cost increased to US$18.0 million.
    • There were exchange rate losses of approximately US$0.2 million.

    • The project was financed entirely by a grant from the Bank's Trust Fund for Gaza and West Bank.
    • In 2009, Additional Financing of US$5.0 million was approved, in order to continue emergency support to the social sectors.
    • In 2010, another Additional Financing of US$3.0 million was approved.

Borrower contribution
    • There was no planned Borrower contribution.

    • The original project closing date of December 2009 was extended by one year to December 2010. This was to allow the full disbursement of ongoing contracts, particularly the tertiary health care contracts.
    • The closing dates for the first and second Additional Financings were December 2010 and June 2013. The second Additional Financing fully disbursed by June 2012, which was one year earlier than planned.

3. Relevance of Objectives & Design:

a. Relevance of Objectives:
High. The project objective was substantially relevant to the Palestinian Authority's ongoing fiscal crisis, in which the transfer of clearance revenues and external financing were significantly reduced starting in 2006. Domestic revenues were insufficient to finance operating budgets in the social sectors, resulting in serious disruptions and declines in service provision, with resulting declines in human development indicators including education quality, infant mortality, and child malnutrition, and large-scale underemployment. As West Bank and Gaza is not a member of the Bank, there is no formal Country Assistance Strategy. However, there is an Interim Strategy Note for FY2012-14, in which the first pillar is to support efficient management of public finances and ensure services to citizens, similar to the Palestinian Authority's National Development Plan (2011-2013) objective.

b. Relevance of Design:

Substantial. Due to the ongoing crisis in the government's fiscal situation, the project provided immediate emergency financing for operating costs in the key social sectors of education, health, and social assistance. This financing was critical to ensure provision of basic services such as primary education and hospital care, while also providing targeted support to vulnerable populations such as the disabled and youth (i.e. support to facilities that specifically served these populations).

4. Achievement of Objectives (Efficacy) :

To mitigate the deterioration of the delivery of education, health and social care services
is rated Substantial, due to substantial achievement of targeted outcomes in the education, health, and social assistance sectors. For all these sectors, the "target" outcome was to have service facilities operating at the same or at higher levels compared to the start of the project period. As noted in the ICR (page 6), it was likely that the project was having significant impact considering the counterfactual scenario of a collapse of key social services.

The grant disbursed against annual recurrent expenditure programs in the line ministries, each of which were prepared in consultation with the Bank, based on estimates of the financial needs of the sectors. According to the ICR of the MDTF project (page 14), this project, along with the concurrent MDTF ESSP, supported about 70% of operating costs (i.e. rent payments, utilities, transportation costs, fuel, communications, building maintenance) for the recipient entities. Therefore, the results reported below represent concurrent support from the MDTF funds and the ESSP III funds.

The Ministry of Education and Higher Education (MOEHE) administers 1,833 schools, which serve about 800,000 students.


    • Financing of incremental operating costs of the MOEHE, such as fuel for heating, utilities, rent, maintenance, and transportation.
    • Financing of salaries of 3,311 teaching staff at the 9 universities.

    • The number of primary schools in operation increased from 972 in 2007 to 1,192 in 2012. The total number of students attending those schools increased from 345,250 to 623,380.
    • The number of professors in the nine universities increased from 3,209 in 2010 to 3,311 in 2012. The number of students at the universities increased from 123,429 in 2007 to 136,070 in 2012.

The Ministry of Health (MOH) operates 22 government hospitals (with a total capacity of 2,815 beds), 472 primary health care centers, and 146 laboratories.

    • Financing of incremental operating costs of the MOH, including rent, fuel, electricity and water, cleaning contracts, maintenance, and insurance. The project also financed fuel costs for MOH ambulances, medical service vehicles, and generators.
    • Financing of ten tertiary health care contracts with various non-governmental health institutions. The ICR (page 14) reports that the competitive contracting process coupled with the introduction of minimum quality standards has been a positive contribution to the tertiary health sector.

    • The hospital occupancy rate decreased slightly in Shefa hospital from 76% in 2007 to 75% in 2012; the rate at Rafedia hospital increased from 67% to 72.9%.
    • The gynecology occupancy rate increased at Shefa hospital from 78% in 2007 to 99.5% in 2012, and at Rafedia hospital from 95% to 97.8%.
    • The number of outpatients at Shefa hospital increased from 12,683 in 2007 to 14,779 in 2012, and at Rafedia hospital from 3,243 to 4,452.

Social Assistance
The Ministry of Social Affairs (MOSA) operates 38 centers/shelters for vulnerable populations (elderly, orphans, disabled, and youth), which in total serve 2,150 beneficiaries.

    • Financing of incremental operating expenses of MOSA operating facilities, including rent, electricity and water, communications, and fuel.

    • The number of MOSA training centers in operation was maintained at 13. The number of students enrolled increased from 1,300 in 2007 to 1,600 in 2012.
    • The number of youth centers in operation increased from 3 in 2007 to 8 in 2012. The number of youth benefiting from services increased from 125 to 413.
    • The number of disability rehabilitation centers in operation was maintained at 7. The number of disabled benefiting from services increased from 800 to 850.

5. Efficiency:

Not Rated. As this operation did not involve financing of investments, an assessment of economic or financial return was not applicable. Project management costs comprised only about 1% of total disbursements, which the ICR (page 15) notes is low compared with other emergency-type and service delivery projects.

a. If available, enter the Economic Rate of Return (ERR)/Financial Rate of Return at appraisal and the re-estimated value at evaluation:

Rate Available?
Point Value
ICR estimate:

* Refers to percent of total project cost for which ERR/FRR was calculated

6. Outcome:

Satisfactory. The relevance of the project objectives is rated High, and relevance of the project design is rated Substantial. Achievement of the objective to mitigate the deterioration of basic services is also rated Substantial due to achievement of targeted outcomes in the education, health, and social assistance sectors. Efficiency is Not Rated due to the nature of the project in which there was no financing of investments.

a. Outcome Rating: Satisfactory

7. Rationale for Risk to Development Outcome Rating:

The implementation modalities utilized by the project have helped to establish an effective mechanism for funding the social sector line ministries, one that could be quickly scaled up or down. However, with the project closing, a financing gap for the provision of basic services has emerged and the ICR reports (page 11) that since the end of project funding, the provision of services had already deteriorated.

a. Risk to Development Outcome Rating: High

8. Assessment of Bank Performance:

a. Quality at entry:

The project drew upon lessons from the previous emergency social support operations, including simplicity and prioritization of activities in the project design to allow quick disbursement, and monitoring arrangements that allow close monitoring and responsiveness. The project risk level was appropriately assessed as High, given the volatile political and security situation, as well as precarious domestic fiscal conditions. Although mitigation measures for the political/security risks were limited, substantial donor support was expected to ensure adequate fiduciary management. The M&E framework was consistent with the previous ESSP operations and identified baseline and target data.

Quality-at-Entry Rating: Satisfactory

b. Quality of supervision:

Field-based Bank staff provided continuous and effective supervision support in spite of the challenging external environment. This support was supplemented by technical staff from headquarters offering policy and management guidance to line ministries. According to the ICR (page 8), the monitoring system and periodic spot checks helped signal potential operational problems, and these were effective in mitigating the limited budget management capacity of the line ministries. There were no problems reported in procurement or financial management.

Quality of Supervision Rating: Highly Satisfactory

Overall Bank Performance Rating: Satisfactory

9. Assessment of Borrower Performance:

a. Government Performance:

The government demonstrated strong commitment to the project, as reflected in its active engagement in policy dialogue and establishment of supportive implementation arrangements.

Government Performance Rating: Satisfactory

b. Implementing Agency Performance:

The Ministry of Finance was responsible for overall project implementation, including fiduciary tasks and coordination with line ministries. Project implementation was carried out by the project staff despite challenging circumstances including insecurity, limited fuel, power shortages, and restrictions on movement. The Ministries of Health, Education and Higher Education, and Social Affairs were responsible for day-to-day implementation of activities within their respective sectors, with regular reporting to the Ministry of Finance. Fiduciary management was satisfactory.

Implementing Agency Performance Rating: Satisfactory

Overall Borrower Performance Rating: Satisfactory

10. M&E Design, Implementation, & Utilization:

a. M&E Design:

The M&E framework was based on previous ESSP operations, and included intermediate outcome indicators on utilization of basic services. Baseline and target values were identified. M&E arrangements included quarterly spot check audits to provide information on implementation progress.

b. M&E Implementation:
Project data were collected as planned.

a. M&E Utilization:
According to the ICR (page 9), it is not known whether M&E data were used to inform decision-making and resource allocation.

M&E Quality Rating: Substantial

11. Other Issues:

a. Safeguards:
There were no safeguard policies triggered by the project.

b. Fiduciary Compliance:

Procurement: Given the emergency context and the limited procurement capacity of the line ministries, procurement was intended to be very limited and carried out according to the quickest and most efficient procurement arrangements. Most of the essential operating costs of the line ministries drew on long-standing service delivery contracts for which there was usually only a single-source provider. Therefore, according to the ICR (page 7), operating expenditures were not referenced in the Project Paper or in the procurement provision of the legal documents; instead, they were identified in the Grant Agreement section dealing with the disbursement category allocations. The awarding of tertiary health care contracts was the primary activity implemented under the Bank's procurement guidelines, and the ICR (page 10) reports that although there were some implementation delays, this process was overall satisfactory.

Financial management: The Ministry of Finance was responsible for overall financial management aspects of the project, with the Ministry of Education and Ministry of Health managing their own designated accounts. An independent external audit firm was contracted to conduct quarterly spot checks to verify the occurrence and completeness of expenses; annual independent audits of the project accounts were also conducted. External financial audit reports were submitted on time with no qualifications.

c. Unintended Impacts (positive or negative):
None reported.

d. Other:

12. Ratings:

IEG Review
Reason for Disagreement/Comments
Risk to Development Outcome:
Bank Performance:
Borrower Performance:
Quality of ICR:
- When insufficient information is provided by the Bank for IEG to arrive at a clear rating, IEG will downgrade the relevant ratings as warranted beginning July 1, 2006.
- The "Reason for Disagreement/Comments" column could cross-reference other sections of the ICR Review, as appropriate.

13. Lessons:

Lessons from the ICR (pp. 20-21), with adaption by IEG:
    • Field-based task team staff are highly beneficial in an emergency context. In the case of this project, implementing agency staff had quick and easy access to the Bank team, there was close monitoring of implementation progress, and there was quick responsiveness to government requests.
    • M&E can still be carried out effectively in an emergency context with low capacity in the line ministries. In the case of this project, the project team was still able to collect basic data on the functioning of education, health and social services to inform project implementation progress. Enabling factors likely included the fact that this project was the third in a series of identical projects that utilized the same indicators, and the intensive supervision (quarterly progress reports from line ministries, regular spot checks by an independent auditor, and quarterly supervision missions by the field-based task team).

14. Assessment Recommended?


15. Comments on Quality of ICR:

The ICR is concise and consistent with guidelines. The quality of the evidence was adequate to assess project outcomes. Lessons were specific and clearly drawn from the project experience, particularly relating to project implementation in an emergency context.

a. Quality of ICR Rating: Satisfactory

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