Guinea-Bissau - Strengthening Maternal and Child Health Service Delivery Project

Overview & Synopsis

Ratings of the Guinea-Bissau Strengthening Maternal and Child Health Service Delivery for Guinea-Bissau were as follows: outcome was satisfactory, Bank performance was satisfactory, and monitoring and evaluation quality was substantial. Lessons and recommendations included the following. In fragile, conflict, and violence settings, agility in project design and implementation is essential because government systems often lack capacity and reach; the recommendation is for the World Bank and governments to identify and engage capable implementing partners early, clearly define roles in service delivery and procurement, and calibrate government-led and partner-executed functions to comparative advantage. Close, continuous, hands-on support is critical for responsiveness and problem solving; the recommendation is to ensure Task Team Leader presence in country when feasible or establish regional supervision arrangements that enable rapid fiduciary oversight and adaptive decision-making. Implementing performance-based financing in a fragile setting with limited capacity offers learning opportunities but requires readiness; the recommendation is to build foundational systems before rollout, including a comprehensive performance-based financing manual, trained staff, a staffed national technical committee, robust verification and counter-verification mechanisms, and compatible accounting systems to enable phased, feasible implementation. Embedding community engagement in project design drives access and utilization when formal institutions are weak; the recommendation is to integrate a fully funded community engagement protocol from the outset—leveraging traditional leaders, women’s groups, and community health workers—with clear operational procedures and reliable, timely incentive payments to sustain community outreach and achieve better maternal and child health outcomes.