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Fourth, the nutrition comronent would help reduce the high rates of anemia among expectant mothers which are a major cause of low birthweights. Third, provision of additional swugical facilities at the district level and trmg of general pmrtitioners in swrgey should contibute to more immediate medical/surgical interventions in emergecy cases, and at the same time, reduce clogging at Hospitals. lan IDA 29.2 GOV 2.0 Kf W 4.1 UNICEF 3 TOTAL 38.9 Estimated IDA Disbursements: US$ million. The Federal Republic of Germany will contribute approximately US.1 million (up to the equivalent of 9 million DM) and UNICEF will contibute US.6 million in parallel cofinancing during the period FY95-FY99. iii BUR1A ESO HIEALT AND NUTRMON PRO13a SYl AND PRORECT cos Z (US$ million)' ESTIMATED BASE PROJECr COSTS 2 LOCAL FOREIGN TT Jmprove Quality of Hea Mth Servies Reduce icrnutrient Defidiencds Achieve Control of Endemic Parasitic Diseases 0.6 It S 1.1 Stengthen the Mnistry of Health (MSASF) TOTAL BASE COSTS Physical Contingencies Price Contingencies TOTAL IPROJECT COSTS S FS4g I! 1.2 Total project costs are estil-ted at US.9 million equivalent (net of taxes and duties), with a foreign exchnge compown.. lhe Government and local communies would contribute US.0 million. To address this risk, the Goverment has, prior to negotiations, developed a-d begun to implement an action plan, acceptable to IDA, to eosute the required redeployment and that the peonnel concerned reman where posted and carry out their assigned responsibilities.

It would also prevent recurrence of onchocerciasis and major outbreaks of human trypanosomiasis as well as eradicate draunculiasis which affects about 34% of the villages in Burlina-the highest prevalence of any Sahelian country. The first risk is that the expected procurement of essential generic dgs and their distribution may be slow to matialize. With the other 12 countries of the CFA franc zone, Burkina Faso devalued its curency by 50% relative to the French franc in January A. SECRAL CONM 2.1 The health status of the Burkinabe population is poor with a life expectancy at birth of only 48 years (1991), compared with the average for Sub-Saharan Africa (SSA) of 51 years (1991). In a 1993 UNDP rankdig of 173 countries according to their level of human resources development, Burkina ranked 170th. The economy is dominated by the agricutural sector, which accounts for about 30% of GDP, generaes over 60% of export earnings and employs almost 90% of the economically active population. u_ Heat Ned In &u9ia Pam's Rra C.uuada) folowing mrio to Ruh PIwo in 192 Ms Katede Mara ad Mr.High infant and materwal mortality levels are associated with inadequate pre-natal services, a low proportion of isttutionalized deliveries, and low detection and referral of high risk cases from the villages, where most deliveries are overseen by untrained traditional birth attendants under unsafe conditions.

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The health comn_ nent would dirjct benefit about three million people (30% of Bukidna Faso's population) who will gain access to quality health care.