Ebola Sector Budget Support –Fight Back Programme (Efbp)

AFRICAN DEVELOPMENT BANK GROUP

REPUBLICS OF CÔTE D’IVOIRE, GUINEA, LIBERIA AND SIERRA LEONE

EBOLA SECTOR BUDGET SUPPORT –FIGHT BACK PROGRAMME (EFBP)

OSHD DEPARTMENT

September 2014

TABLE OF CONTENTS

Contents LOAN AND GRANT INFORMATION ...... ii PROGRAMME EXECUTIVE SUMMARY ...... iii RESULTS-BASED LOGICAL FRAMEWORK ...... iv I. THE PROPOSAL ...... 1 II. COUNTRY AND PROGRAMME CONTEXT IN COTE D’IVOIRE, GUINEA, LIBERIA AND SIERRA LEONE ...... 1 2.1 Recent socioeconomic developments, perspectives, constraints and challenges ...... 1 2.2 Political developments ...... 3 2.3 Governance ...... 4 2.4 Impact of the Ebola Epidemic: ...... 4 2.5 Bank Group portfolio status ...... 5 III. RATIONALE, KEY DESIGN ELEMENTS AND SUSTAINABILITY ...... 6 3.1 Link with the CSPs, country readiness assessments and analytical works underpinnings .. 6 3.2 Collaboration and coordination with other donors ...... 10 3.3 Outcomes of past and on-going similar operations and lessons ...... 10 3.4 Relationship with on-going Bank operations ...... 11 3.5 Bank’s value added and comparative advantages ...... 11 3.6 Application of good practice principles on conditionality ...... 12 3.7 Application of Bank Group non-concessional borrowing policy ...... 12 IV THE PROPOSED PROGRAMME ...... 12 4.1 Programme’s purpose and Goal ...... 12 4.2 Programme’s components, operational policy objectives and expected results ...... 15 4.3 Financing needs and arrangements ...... 20 4.4 Programme’s beneficiaries ...... 21 4.5 Programme’s impact on gender ...... 21 4.6 Environment and Climate Change ...... 22 V. IMPLEMENTATION, MONITORING AND EVALUATION ...... 22 5.1 Implementation arrangements ...... 22 5.2 Monitoring and evaluation arrangements ...... 23 VI. LEGAL DOCUMENTATION AND AUTHORITY ...... 23 6.1 Legal documentation ...... 23 6.2 Compliance with Bank Group policies ...... 24 VII. RISK MANAGEMENT ...... 24 VIII. RECOMMENDATION ...... 25

List of Tables

Table 1: Real GDP growth in beneficiary countries Table 2: Situation in targeted countries Table 3. Lessons learnt and actions taken Table 4: Financing gap Table 5: Programme disbursement conditions Table 6: Risks, probability and mitigation measures List of Appendixes

Annex 1: Matrix of measures Annex 2: Economic indicators of beneficiary countries Annex 3 : Economic Context in beneficiary countries Annex 4: Political context and governance fact sheets Annex 5: Safety nets Annex 6: Government requests

Currency Equivalents As of September 2014

1 UA = 1.53 USD 1 UA = 755.23 XOF 1 UA = 10765.96 GNF (Guinean Franc) 1 UA = 126.33 LRD (Liberian Dollar) 1 UA = 6812.03 SLL (Sierra Leonean Leone)

Fiscal Year Côte d’Ivoire: January 1st – December 31th Guinea: January 1st – December 31th Liberia: 1st July – 30th June Sierra Leone: January 1st – December 31th

Weights and Measures

1metric tonne = 2204 pounds (lbs) 1 kilogramme (kg) = 2.200 lbs 1 metre (m) = 3.28 feet (ft) 1 millimetre (mm) = 0.03937 inch (") 1 kilometre (km) = = 0.62 mile 1 hectare (ha) = 2.471 acres

Acronyms and Abbreviations ADF African Development Fund AfDB African Development Bank CSP Country Strategy Paper DHS Demographic and Health Survey ECOWAS Economic Community of West African States EU European Union EVD Ebola Virus Disease FAO Food and Agriculture Organization FRA Fiduciary Risk Assessment FY Fiscal Year GDP Gross Domestic Product HHA Harmonization for Health in Africa IMF International Monetary Fund MRU Mano River Union NHA National Health Accounts PBO Policy Based Operation PCR Project Completion Report PFM Public Finance Management RMC Regional Member Country RPG Regional Public Good TSF Transition Support Facility UA Unit of Account USD United States Dollar WAHO West African Health Organisation WB World Bank WHO World Health Organization

LOAN AND GRANT INFORMATION

BORROWERS: The Republics of Côte d’Ivoire, Guinea, Liberia and Sierra Leone

EXECUTING AGENCIES

Côte d’Ivoire: Ministry of Health and HIV/AIDS Guinea: Ministry of Health Liberia: Ministry of Health and Social Welfare Sierra Leone: Ministry of Health and Sanitation

FINANCING PLAN (UA million)

Country Loan Grant RO Loan RO Grant Total ADF TSF ADF TSF ADF TSF ADF TSF Côte d'Ivoire 0 0 2 0 0 0 4 0 6 Guinea 2.4 2.6 2 0 10 0 4 0 21 Liberia 8.2 5.2 0 0 26.8 0 0 0 40.2 Sierra Leone 3.4 4.8 0 2.8 16.4 0 5.6 0 33 Total 14.0 12.6 4 2.8 53.2 0 13.6 0 100.2

TIMEFRAME – MAIN MILESTONES

Programme approval October 2014 Effectiveness Grant October 2014 Disbursement Grant October 2014 Effectiveness Loan October 2014 Disbursement Loan October 2014 Completion December 2016

PROGRAMME EXECUTIVE SUMMARY

The Fight Back Ebola Programme complements the recently approved emergency operations for the ECOWAS region in response to the Ebola epidemic. It is an emergency operation that will contribute towards addressing the financial needs of Côte d’Ivoire, Guinea, Liberia and Sierra Leone. The three latter countries are the most affected by the epidemic and their economies are experiencing a major shock affecting economic growth, fiscal revenues and the overall socio-economic environment, in particular for women. The programme is a response to Programme both the emergency created by the Ebola epidemic, and the need to address the longer term overview requisites for the economic resilience of the concerned countries through strengthened systems and improved preparedness. The programme will also help preserve Côte d’Ivoire, the economic hub of the sub-region, against the epidemic. Côte d’Ivoire is threatened by the epidemic and although its preparedness is judged satisfactory, incurs additional expenditures arising from the implementation of preparedness plans. The operation is a coordinated PBO. The promotion of gender equality is an important aspect of this programme given its expected contribution to addressing the current crisis, enhancing resilience and promoting social cohesion. The programme aims to bring the Ebola epidemic to an end and strengthen the critical foundations for effective control of unusual public health events, especially those of the current regional scale. In so doing, the programme is expected to have positive effects beyond its Programme beneficiary countries, as the Ebola epidemic has economic consequences for non-affected outcomes countries, not only in the region but also on other continents, as demonstrated by the effects that trade restrictions to these countries are having on the rice value chain in Asia. The longer term horizon of the programme is to pave the way for sustainable improvement of systems and capacities for post-crisis resilience. In all affected countries, the financial requirements to combat the spread of the Ebola Virus Disease (EVD) are expected to be substantial and far beyond previous budgets for the health sector. Currently, 5,843 Ebola cases have been registered, among which 2,803 deaths. This requires increase in expenditure to be met with declining revenues, while the countries are also facing economic downturns. In Côte d’Ivoire, the government will have to increase expenditure Needs significantly to prevent and combat the spread of EVD. In Guinea, the projected budget deficit assessment has been revised upwards, to USD 376 million against an initial target of USD 61 million and the direct financial impact of Ebola is estimated at USD 125.8 million or 1.9% of GDP Liberia has prepared a USD20 million package to combat Ebola, and is expecting an overall financing shortfall of up to USD 120 million. Sierra Leone’s health care budget is grossly insufficient to address pressing needs in the sector to contain the EVD epidemic, compounded by revenue shortfalls projected at 12%. The size of the epidemic affects the concerned economies, nationally, regionally and beyond. Guinea, Liberia and Sierra Leone will experience an unprecedented reduction in economic growth and related fiscal revenues, which makes their key international financial and technical partners including the Bank the primary recourse for support to ensure the continuity of their Bank’s added operations and facilitate the resilience of their economies. The Bank has considerable value experience in managing operations in the region and in fragile states, as well as in strengthening health systems. The Bank has already engaged in important regional initiatives with the concerned countries, including the Mano-River Union Initiative, launched in 2013 to boost transformative infrastructure in the four country members of the sub-region The Bank has funded several emergency operations for natural disasters and disease epidemics, giving it the experience and capacity to respond effectively to the Ebola epidemic. Institutional development The programme’s measures will contribute to strengthen national institutions in Côte d’Ivoire, and Guinea, Liberia and Sierra Leone, as well as regional institutions (ECOWAS/WAHO and the knowledge Mano River Secretariat). building

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RESULTS-BASED LOGICAL FRAMEWORK Programme Name: Ebola Sector Budget Support –Fight Back Programme Purpose of the programme: To support the efforts of the four targeted countries (Côte d’Ivoire, Guinea, Liberia and Sierra Leone) in controlling the Ebola outbreak, mitigating its socio-economic effects and enhancing their preparedness. PERFORMANCE INDICATORS MEANS OF RISKS/MITIGA RESULTS CHAIN VERIFICATI TION Indicator Baseline Target ON MEASURES Sustained momentum toward GDP growth Initial forecast for 2014: Same for 2017 (recovery after Ebola): IMF reports Political risks, inclusive growth and poverty Côte d’Ivoire: 8.5% Côte d’Ivoire: 8.5% including risk of reduction Guinea 4.5% Guinea 4.5% reversal. The Liberia 5.9% Liberia 5.9% security situation Sierra Leone 11.3% Sierra Leone 11.3% is generally stable % of population Côte d’Ivoire: 42.7% Baseline values (No aggravation because of WB data base albeit fragile under poverty line Guinea : 55.2 % Ebola) owing to the Liberia : 56.3% current epidemic. Sierra Leone : 52.9 % Mitigation: The Estimated earned Côte d’Ivoire: Côte d’Ivoire: 56% Gender related epidemic has been income gaps per (1866f/3648m)= 51% Guinea 71.6% development elevated to the capita (2011 Guinea (913f/1370m)= Liberia 78% index level of a national PPPSs) state of 66,6% Sierra Leone 85% female/male in emergency in the 2013 without Liberia affected countries, reduction of total (634F/868M)73% which facilitates income of men and Sierra Leone the invocation of women (1617F /2017 M° 80% legal measures on Child malnutrition Underweight children < SMART survey disease five MICS-DHS prevention,

Côte d’Ivoire:29.4% Côte d’Ivoire:25% surveillance, Guinea: 16.3% Guinea: 14% control, and Liberia: 20.4% Liberia: 18% response.

Sierra Leone: 39.7% Sierra Leone: 37% IMPACT 1. The employment situation Female labor force Côte d’Ivoire: Baseline values (No aggravation because of World Macroeconomic is stabilized participation Guinea: 65.4% Ebola) Development risk: The

Liberia: 58.2% Indicators outbreak of Ebola

Sierra Leone: 65.7% has adverse 2.The Ebola epidemic ends Number of EVD Côte d’Ivoire: 0 No new case for a period of 3 weeks (April WHO/WAHO effects on the cases Guinea: 1008 2015) reports economy Liberia: 3022 including a

Sierra Leone: 1813 reduction of OUTCOMES

3. Current account deficit Current account Pre-crisis levels (initial Baseline values (Recovery at pre-crisis levels) IMF WEO government stabilized deficit (% of GDP) forecast 2014) revenues. Côte d’Ivoire: -2.2% Mitigation: Partners are Guinea: -18.0% working to avail Liberia: -48.3% resources and Sierra Leone: 9.4% support including 4. The Response capacity is Occurrence of Unprecedented Ebola No new major disease outbreak in the three WHO/WAHO through budget strengthened major disease Epidemic in the three countries. reports and sectoral outbreaks countries No transmission from one country to the other. support, and policy dialogue is ongoing. Component I. Enhancing systems and human resources 1.1 The management and Governance Discussions ongoing Decrees from governments establishing a Evidence of Fiduciary risk. coordination of the Ebola structure for the gender balanced governance structure of the Decree Despite the response are strengthened and Ebola funds created respective instruments and providing for various gender sensitive in beneficiary membership of crisis response teams. safeguards, the countries; crisis fiduciary risk is management teams fairly substantial firmed up in particular 1.2 Regional management and Membership Ad hoc meetings Circular from Ministry of Health designating Evidence of around emergency coordination structures to Technical the members of the Technical Surveillance Circular and donor funds. respond to Ebola crisis are Surveillance Group Group and providing for related Terms of Mitigation: The strengthened is institutionalised Reference budget support approach followed by the 1.3 The response is financially Government Initial contribution made Beneficiary governments contribute (see Evidence of sustained and owned by contribution to their in Liberia specifications in Table 4 of this report) transfer of funds programme entail Governments in an respective Ebola from National measures to accountable manner funds/budget lines Treasuries improve the governance of the Governments Ad Hoc reporting Government Orders mandating the production Evidence of Ebola response. prepare timely of quarterly fiscal outturns Orders

comprehensive Stretched quarterly fiscal implementation outturns including capacity. contribution to their Weak institutional respective Ebola and human funds/budget lines resources and related capacity, expenditure heightened by the 1.4 Sustained engagement of Level of protection Complaints of health Ministries of Health’s circulars providing for Evidence of

disruptions and OUTPUTS

v health workers in the response of frontline health staff for not being eligibility to protective clothing and distribution circular uncertainties due workers against the protected to the Ebola crisis Ebola virus could hamper Health workers are - A compensation/incentive framework is put in programme compensated and place in Guinea, Liberia and Sierra Leone implementation incentivised and the broader 1.5 Measures are taken for Actions taken to Exclusive focus on short Orders from ministries of health mandating the poverty reduction response gaps to be learn lessons from term response following and setting corresponding targets and benefits. diagnosed; remedies the epidemic and timelines: (i) Assessment of country identified and emphasise a take corrective preparedness plan; and (ii) Identification of Mitigation: The gender perspective action, emphasising critical systems strengthening actions, including ongoing technical gender perspective collaboration with the private sector. assistance and Component II. Ensuring appropriate Nutrition, Food Security and Social Protection capacity building projects, funded 2.1 The short and medium Measures adopted Reflection in progress Elaboration of a plan for emergency distribution by The Bank and terms effects of the epidemic to ensure access to with support from WFP of food aid and agricultural production inputs other donors. on agricultural production and food and and FAO to affected communities This Policy-based nutrition are mitigated considering gender operation perspective particularly 2.2 The institutional and Consideration of Development of short Elaboration of a community nutrition support Evidence of the targets enhancing effective food security and food security and and medium term plan to plan of action affected communities and areas at plan of action health sector nutrition support at nutrition response address nutrition based risk in Côte d’Ivoire effectiveness. community level is effective at community level on the scaling up for and gender oriented nutrition platform and the national nutrition Risk plans Governments 2.3 Strengthen structures in Development of a Adoption and launching Ministries of Health’s reports might charge of nutrition nutrition of nutrition sensitization inadequately communication for sensitization plan campaign prioritize the behavioural change for the most strengthening of affected and at risk safety nets in the zones country Budget allocation to Baseline to be At least 20% increase in public budgets of the Budget nutrition established three countries for nutrition programmes documents Mitigation: The programmes Programme Actions toward None Cabinet meeting is held to examine insurance Communiqué of includes advocacy safety nets for options: (i) Group Life Cover* insurance for all Cabinet meeting events and communities faced with similar threats sensitization on affected by health Evidence of the importance of disasters Framework for economic adoption* mechanism concerned strengthening the to support health workers and households framework

2.4 Strengthen the supply Actions toward Baseline to be Elaboration of Plan of procurement and Min. of safety nets chain management of the procurement of established distribution of agricultural inputs Agriculture systems agriculture sector agricultural inputs Ministry in to rural farmers charge of local collectivities 2.5 Strengthen surveillance Actions toward Baseline to be Establishment of guidelines for animal health and prevention of animal capacity building established control and measures for suspected Ebola cases health and improve the for the diagnostic observation network and and response monitoring of wildlife 2.6 Enhanced community Existence of None Ministerial Order providing for establishment of Evidence of the involvement in the response, community check community check posts and modalities for the Order including civil society, points rapid training of community youth volunteers professional networks and the other community groups 2.7 Reinforce community Mechanism to Baseline to be Government order to establish at least Evidence of the response to provide care to the temporarily adopt established 1neighbourhood care center in the affected order children and orphans neighbourhood care households in place points for orphans and vulnerable children 2.8 Strengthen safety nets in Actions toward Cabinet meeting is held Communiqué of Cabinet meeting the countries for greater safety nets for to examine insurance inclusiveness and resilience to communities options including Group income shocks affected by health Life Cover* insurance disasters for all faced with similar threats Evidence of concerned framework Framework for economic adoption* mechanism to support health workers and affected households cted

*Pease see Annex on Safety Nets

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REPORT AND RECOMMENDATIONS OF THE MANAGEMENT TO THE BOARD OF DIRECTORS ON A PROPOSED LOAN AND GRANT FOR THE EFBP PROGRAMME

I. THE PROPOSAL

1.1 Management submits the following proposal and recommendation for a loan of UA 79.8 million and grant of UA 20.4 million to the Republics of Côte d’Ivoire, Guinea, Liberia and Sierra Leone to finance the Fight Back Ebola programme. This programme is complementary to previously approved Ebola operations. It was designed as an emergency response to the call of the four beneficiary countries to the Bank, to help face the economic effects of the Ebola crisis and the related increased budget deficit.

1.2 The Fight Back Ebola programme is aligned with the Bank’s Ten Years Strategy (TYS). It emphasises Governance, Skills and Regional Integration and promotes related key measures. The governance focus of this operation generally conforms to the beneficiary countries’ CSPs, which all have governance among their pillars. Similarly, the RISP for West Africa has capacity building as a core priority and the programme comprises a Regional Integration Strategy Paper for West Africa may have to take into account the need for a regional disease surveillance centre, to take over the tasks currently performed by international centres, in order to ensure faster reaction. However, the CSPs of the beneficiary countries will be strengthened at the time of country CSP Mid-Term Reviews to better take into account the need for strengthening sector governance, skills development1 and technology, which are components of the response deployed by beneficiary governments. This operation is aligned with the Bank’s energy policy and strategy, its new strategy for engaging in fragile situations, Human Capital Strategy, Gender Strategy as well as its regional integration strategy which is under revision.

1.3 The purpose of the proposed emergency programme is to support the efforts of the four targeted countries in controlling the Ebola outbreak, mitigating its socio-economic effects and enhancing their preparedness. The programme will support Côte d’Ivoire, Guinea, Liberia and Sierra Leone’s efforts to overcome effects of the Ebola epidemic and foster momentum toward inclusive growth and poverty reduction. The operation has a specific aim to support the capacity of beneficiary countries to handle similar events in the future. It is complementary to Ebola operations previously approved by the Bank, as it addresses the economic impact of the epidemic and its consequences on government revenues.

II. COUNTRY AND PROGRAMME CONTEXT IN COTE D’IVOIRE, GUINEA, LIBERIA AND SIERRA LEONE 2.1 Recent socioeconomic developments, perspectives, constraints and challenges Economic context 2.1.1 Ebola is likely to substantially reduce Macroeconomic growth in affected countries. While Guinea has been affected since the beginning of the year, Liberia has recently faced the most acute impact, with Ebola Virus Disease (EVD) spreading widely and rapidly in its capital.

1 It is estimated that an additional 53,000 health workers need to be trained in the four beneficiary countries.

Estimates for growth are still preliminary and can be expected to change, especially given data limitations and lack of high-frequency data. Some initial impact assessments are underway in all countries. For Guinea, an initial 2014 growth forecast of 4.5% was reduced to 3.5% in May and may be reduced further to 2.5%. In Liberia, an earlier estimate of 5.9% is now Table 1. Real GDP growth in beneficiary countries expected to only reach 2.5%. Sierra Leone is reducing its 11.3% growth forecast to 8%. For Côte 2013 2014 2014 (initial est.) (latest est.) d’Ivoire, the economic impact may be marginal, Real GDP Growth (percent) largely in transport. The agriculture, transport, Côte d’Ivoire 8.7 8.5 8.5 trade, and hotels and restaurant sectors are being Guinea 2.3 4.5 2.5 affected in the three hardest hit countries, as is Liberia 8.7 5.9 2.5 cross-border trade, especially in hard hit rural Sierra Leone 15.2 11.3 8.0 areas. Iron ore mining is a major source of foreign exchange in the countries and is largely continuing, though an extended crisis could slow production and investment. An extended crisis will slow public and private investment, which will reduce prospects for inclusive growth. Trade constraints and reduced agricultural production are straining on food supplies in some areas, increasing prices for food and other essentials. With most employment in the informal economy, this will reduce purchasing power for the large part of each country under the poverty line, estimated at 42.7% in Côte d’Ivoire, 55.2% in Guinea, 56.3% in Liberia, and 52.9% in Sierra Leone. (See detailed information for each programme country in annexes 2 and 3) 2.1.2 Government finances are being strained, due to declining revenues and higher expenditure demands. This calls for increased budget support and funding from development partners. In Guinea, the decrease of revenues is estimated at USD 74.6 million, including USD 50 million for fiscal revenues. Liberia’s Government has prepared a USD 20 million response package for which it has allocated an initial USD 5 million. It is expecting about a 20% decline in revenues, which will further constrain government operations and payment of salaries across Ministries and Agencies. In Sierra Leone, revenue receipts at 12.8% of GDP would be adversely affected and are projected to decline by USD 66 million, reducing government’s projected annual revenue by 12%. Preliminary estimates indicate the primary deficit would increase to 9% of GDP. With much of international support in loans, the countries could see an increase in their debt profiles. Social context 2.1.3 The Ebola epidemic has heightened the fragility caused by decades of social and economic turmoil. The governments of Guinea, Liberia and Sierra Leone have struggled to reconstruct and develop systems of governance for renewed economic growth and improved livelihoods. But reinvigorating rapid, inclusive, and sustained economic growth has been difficult to shoulder, posing overwhelming challenges. The epidemic also results from the fragility of health systems, which translates into ineffective service delivery and barriers to access. The EVD epidemic is also affecting the social fabric.

2.1.4 The four countries are poverty stricken with a human population of about 27 million, more than 75% living in rural areas and deriving their livelihoods from agriculture. These populations have now been severely affected by the necessary measures aimed to control the further spread of the Ebola virus. Productive activities for livelihood including agriculture have collapsed and about 1.5 million people directly and indirectly affected are in quarantine areas.

2.1.5 All four countries suffer from high levels of malnutrition. The share of children under age 5 years who suffer from chronic malnutrition is 27.3% in Côte d’Ivoire 39.4% in Guinea, 40% in Liberia and 43% in Sierra Leone. Child mortality rates are between 83.2 and 184.8 per 1,000 live births in the MRU countries compared to 97.4 per 1,000 in Africa. There are also high levels of anemia amongst women in these four countries. Governments have banned the handling, commercialization and consumption of wild animals, a main source of protein especially among the poor. Most people in the affected areas depend on agriculture for their livelihoods. The gap in access to food is difficult to be closed through the ongoing food assistance programmes. The result is serious hardship and untold suffering for the affected communities. The food insecurity is likely to worsen as the current planting season has suffered due to the epidemic.

2.1.6 The EVD outbreak has impeded free movement people to farm, interact and engage in trade for fear of contamination. The situation has eroded food security, increasing the vulnerability of the communities already affected and will increase the risk of malnutrition among the most vulnerable. Closing the borders of Guinea, Liberia and Sierra Leone will affect the availability of food in the market. In addition, there is a lack of alternatives to substitute bush meat in providing protein. The World Food Programme (WFP) announced in August that it would provide food aid to people living in the quarantine areas. The distribution is ongoing but significantly inadequate to meet the needs of the populations of the quarantined areas. So more support for communities is needed and a multi-sectoral approach is essential. 2.1.7 The epidemic takes a huge toll on women’s health and economic livelihoods. Reduced economic growth in the three most affected countries will affect employment, though this has yet to be quantified. This will hit women in informal employment, such as petty traders who represent 70% of cross border traders in the MRU, seriously affected by travel restrictions. In addition, the EVD death toll is higher for women. In Liberia, 75% of the victims are women. Traditional gender segregation facilitates the contagion to women (please see 4.5 for details). It is also expected that women’s health and livelihoods will worsen as a result of the increased burden of home care.

2.2 Political developments

The MRU countries, Cote D’Ivoire, Guinea, Liberia and Sierra Leone not only share common borders but are all in transition, emerging from prolonged period of civil war and conflict. Cote d’Ivoire has made remarkable strides in political stability and economic resilience after almost a decade of civil strife. Presidential elections were held in December 2010 and legislative and communal elections in 2011 and 2013 respectively. The government is committed to improving social cohesion, national reconciliation and sustaining the development momentum. The war in Sierra Leone ended in 2002 and that in Liberia ended a year later. Since then, both countries have held democratic elections and made significant progress in several areas of civil liberties and governance. Guinea, after a chequered period including military coups, since independence, held its first democratic presidential election in 2010. The legislative elections held in September 2013 after several postponements established a pluralistic national assembly, which has created an enabling environment for structural reforms addressing key constraints to development.

2.3 Governance

Despite some improvements in participatory governance and rule of law, accountability particularly as relates to the governance of natural resources continues to be a serious challenge in Guinea, Liberia and Sierra Leone. In 2013 Sierra Leone ranked 123 of 177 on Transparency International’s Corruption Perception Index and Guinea ranked 154. Côte d’Ivoire ranked 136/177, down from 130/174 in 2012 despite the measures taken to improve public sector management Although Liberia improved by ranking at 83/175 on the 2013 Index, corruption and a perceived culture of impunity remain a fundamental governance problem. Other issues include gaps in Public Finance Management (PFM) systems, low domestic resource mobilization and poor coordination and implementation capacity.

2.4 Impact of the Ebola Epidemic:

2.4.1 The Ebola epidemic presents a real challenge to the modest gains in political stability, governance and development in these countries. There is a risk of reversal to fragility. Liberia, Sierra Leone and Guinea are the most affected countries by the most serious Ebola epidemic in recent history. Given its gravity, the WHO has formally designated the Ebola epidemic in West Africa a public health matter of international concern and the various governments declared a national state of emergency, invoking various legal measures on disease prevention, surveillance, control, and response. Traditional practices, beliefs and nutrition habits have also contributed to the spread with many refusing to believe or heed the advice of medical personnel. This has caused and enhanced political tensions in an erstwhile fragile situation. The following must be noted:

o Apart from the serious risks to security, health and life, the restricted movement of goods, people and money taken as measures to combat the virus places a considerable strain on already overstretched governments trying to lead the countries from fragility to resilience. Recent decisions by some international airline companies to suspend their flights will also negatively impact on the technical assistance and FDI in particular from the extractive industries. In addition, the crisis presents these countries with greater responsibilities in securing communities and securing borders.

o The main impediment to the containment of the epidemic stems from a political economy with inefficient institutional structures that lack adequate capacity and functional accountability at nearly all levels. High poverty rates, growing youth unemployment, low economic, social and infrastructural indices, weak governance practices particularly in the natural resource sector and gender inequality are catalysts for possible reversal of the stability and development progress made so far. All these are bound to implode in the face of the Ebola crisis calling for support to ensure that the economic nerve center, social and moral fabric of the society remains in these difficult times.

o Unless immediate steps are taken to support the governments in these countries to manage the crisis there is a great potential of reversing the recent development gains and reverting back to fragility.

2.4.2 The epidemic has also heightened the poor health sector governance in this region which already has some of the poorest health indicators in the world. Liberia for example has one doctor for 77.000 people while Sierra Leone has one for 120.000. Most of the health

care delivery system in these countries with the exception of Côte D’Ivoire is still in a nascent phase and is heavily reliant on additional external resources in order to increase primary health care coverage and build human and institutional capacity. Health care costs remain very high resulting in poor utilization. For example, in Sierra Leone, out of pocket expenses of about 70% remain among the highest in Africa (NHA Report, 2007). Statistics show that there is on average 0.5 visits per person per year. Similarly for Guinea, the WHO estimates total health expenditure as a percentage of GDP to be very low 6.3%. These are all strong indications of under resourced and inefficient health sector, which would be extremely poorly equipped to deal with a crisis on the scale of the Ebola crisis.

2.5 Bank Group portfolio status

2.5.1 The Bank Group’s active portfolio for Côte d’Ivoire comprises 12 national operations with a total commitment of UA 258 million. This includes USD 105 million under the public window and UA 123 million under the private window. The portfolio is fairly young, with an average age of less than 2 years, and has no problematic or at risk project. The portfolio review in May 2013 showed that the speed in the preparation and approval of emergency operations, timeliness in meeting the conditions for implementation and signing of agreements, and the use of master of 'works' deputies enabled increases in activity completion.

2.5.2 The Bank’s portfolio in Guinea as of June 30, 2014, includes 11 operations for a total of UA 112.3 million. The multinational project for the interconnection of electricity networks of Côte d’Ivoire, Liberia, Sierra Leone and Guinea (CLSG), amounting UA 40.8 million, was approved in November 2013 and has been signed but is not yet effective. In June 2014 the Bank approved the Economic and Financial Reform support programme (PAREF II), amounting UA 12 million including UA 5.61 million as a loan and UA 6.39 million as a grant. Signing in October 2014 will push the active portfolio up to UA 124.3 million. The net portfolio commitments are UA 60.4 million and cumulated disbursements are UA 33.27 million, for a disbursement rate of 61.4%.

2.5.3 At the end of August 2014, the Bank’s portfolio in Liberia comprised 20 operations for UA 217.12 million. The top three sectors in approved amounts are agriculture, roads and governance. The annual disbursement rate stands at 14%, below the 20% set as Bank target for ADF operations. The overall portfolio performance is satisfactory, and no project is rated problematic. The Labor Based Public Works Project is rated as potentially problematic and is due for completion at end of 2014. The factors that slow down performance are implementation delays with respect to procurement plans, weak contract management leading to low quality of construction, and irregular fulfilment of secondary covenants during project implementation. Taking into account the impact of the Ebola Virus Disease Crisis, the Government of Liberia has informed the Bank that all on-going operations would probably require an extension of six months at least in order to achieve planned activities. The impact is expected to be high in infrastructure works such as in the water and sanitation programme.

2.5.4 At the end of August 2014, the Bank Group’s active portfolio for Sierra Leone comprised 14 national operations with a total commitment of UA 187.64 million, including one operation for emergency assistance (UA 0.65 million), one for budget support (UA 4 million), five for institutional support (UA 8.76 million) and six for investment projects (UA 162.34 million). The overall portfolio performance is satisfactory

with no projects at risk. The Ebola crisis might delay implementation of most on-going operations with some likely requiring extensions, to be determined case by case.

III. RATIONALE, KEY DESIGN ELEMENTS AND SUSTAINABILITY 3.1 Link with the CSPs, country readiness assessments and analytical works underpinnings 3.1.1 Link with CSPs and the regional integration strategy The operation is aligned with the Bank’s TYS. It emphasises Governance, Skills and Regional Integration. The governance focus of this operation generally conforms to the beneficiary countries’ CSPs, which all have governance among their pillars. Similarly, the RISP for West Africa has capacity building as a core priority. However, CSPs of the beneficiary countries will be strengthened at the time of country CSP Mid-Term Reviews to better take into account the need for enhanced sector governance, skills development (it is estimated that an additional 53,000 health workers need to be trained in the four beneficiary countries), technology (which is a key component of the response deployed by beneficiary governments), Similarly, the regional strategy will have to take into account the need for a regional disease surveillance centre, to take over the bulk of the tasks already performed by international centres and thereby ensure faster reaction.

3.1.2 Country readiness assessments, compliance with Bank Group safeguards policy. The situation in the four countries targeted by the programme is summarised in the below table. Table 2. Situation in targeted countries Comments on Current Situation

Prerequisites Côte d’Ivoire Guinea Liberia Sierra Leone

All four countries have adopted short-term emergency measures to deal with the Ebola epidemic. The short term responses in each of the affected countries focus on prevention and treatment of Ebola case as per WHO guidelines. In Cote d’Ivoire the focus is on ensuring adequate prevention and preparedness to deal with any potential cases. This has entailed substantial government commitment in terms of increased expenditures to address the crisis, establishment of special task teams and deployment of health workers and security forces. In Sierra Leone and Liberia Special Funds have been established to address Ebola. Work is being done towards strengthening the regional response. On 28th August 2014, under the auspices of ECOWAS/ WHO- Ministers of Health agreed to form a Regional Technical Surveillance Group. The Governments of the concerned countries have committed to development and poverty reduction and are in the process of implementing either a NSDP or PRSP, focussed on addressing the main development challenges in their respective countries. They are all recognisant of the damaging effects that the Ebola crisis can have on the implementation of these programmes, but also on the potential for reversal of the significant strides that have been made to address poverty and social challenges, especially in the countries Government emerging from civil strife. commitment NSDP/PRSP: NSDP/PRSP: PRSP NSDP/PRSP: Second NSDP/PRSP: The current National III adopted in May edition of the PRSP administration has just Development Plan 2013. the Agenda for concluded the (2012-2015) Transformation 2012- implementation of its first Priority: PRSP 2017 PRSP since the changeover Priority: five covers (i) governance of power in 2007 (the strategic pillars (i) and strengthening of Ebola Response: On Agenda for Change – A4C) people living in human and July 26 the President in 2012, and launched a new harmony in a secure institutional announced that Ebola PRSP, the Agenda for society in which good capacities; is a national Prosperity (A4P) 2013-2017. governance is acceleration, emergency and also ensured; (ii) the diversification and set up a national task Progress/ Commitment: creation of national sustainability of force to coordinate all Implementation of successive wealth is increased, economic growth; (iii) interventions for Poverty Reduction Strategies sustained and its fruits development of containing the has achieved progress in

are shared in an infrastructure and (iv) epidemic including addressing the enormous equitable manner; (iii) strengthening access border crossing poverty and social challenges the population, in to basic social restrictions, that arose from a decade of particular women, services. Priority compulsory health domestic conflict and state children and other given to key sectors screening, quarantine collapse. The country moved vulnerable groups as regards public and vigorous from the very bottom of the have fair access to investment. enforcement of rules Human Development Index quality social by health workers in 2000 (score of 0.252) to services; (iv) people backed by security ranking 177 out of 187 live in a healthy and forces. The (0.359 in 2012). adequate living Government has also environment; and (v) set up an Ebola Trust Ebola Response: Sierra Côte d’Ivoire’s stature Fund which is already Leone declared a state of on the regional and receiving contribution. emergency in August and international scene is called in security forces to enhanced. support the quarantine patients. Government also Ebola Response: successfully completed a 3- closure of ports and day house-to-house campaign border crossings and a to contain the epidemic. massive public service campaign. The current crisis constitutes a major risk to macro-economic stability. Initial projections from the AfDB and the IMF point to reduction in GDP growth rates between 1.5% and 3.4% for the affected countries. The significant expenditures required to respond to the emergency health situation has had serious budget implications, with widening fiscal gaps that are expected to be further aggravated by the dwindling revenues due to reduced productivity and trade. (section 2.1) Prior to the crisis all four countries have demonstrated the ability to achieve macroeconomic stability and successfully implement IMF programmes.

Côte d’Ivoire The authorities The last IMF Despite a fragile economic macroeconomic managed to stabilize assessment dated July context and vulnerability to stability was restored the situation inherited 2014, Liberia’s growth external shocks, over the past three from the military performance remains macroeconomic stability years Real economic transition period and strong with real GDP improved during 2010-2013, growth improved successfully growth estimated at with economic growth markedly in 2012 and implement the three- 8.7 per cent in 2013 accelerating and inflation 2013 and is expected year economic and with output projected declining. The country to be sustained over financial programme to continue to expand completed four successful an average of 7% real with the IMF, thus over the medium term reviews of an IMF Extended growth in the medium enabling the country as new mining Credit Facility, with the term. Inflation is to achieve the projects come on program coming to an end in contained with the completion point of stream and non- May 2013. A new three year Macro- limits of the 3% the HIPC Initiative by mining activities pick ECF was approved by the Economic convergence criteria 2012. up, supported by the IMF Board in October 2013, Stability of the West Africa implementation of which will provide a credible Economic and large public basis for the country’s Monetary Union infrastructure projects. macroeconomic framework (WAEMU). The ECF This optimism is going forwards. supported economic however bound to be and financial program tempered by the Ebola is on track following crisis which has the satisfactory five already taken a toll on reviews conducted by government revenues the IMF. Côte and FDI, and should it d’Ivoire benefited continue may affect from the Enhanced availability of food Heavily Indebted and fuel for the import Poor Countries dependent country. (HIPC) and Nonetheless, for the Multilateral Debt time being, the Relief Initiative fundamentals of the (MDRI) in June 2012. economy remain strong. Public debt is expected to remain at manageable levels in the near term.

Year of FRA: 2013 Year of FRA: 2014 Date of FRA: 2013 Date of FRA: February 2014

Main conclusions: Main conclusions: Main conclusions: Main conclusions: the PFM systems have public financial overall performance of country’s PFM system could improved since 2011 management reforms the PFM systems be relied upon for the and ongoing reforms put the country on a continued to improve, efficient and economical and planned support positive path towards with the most utilization of program funds. by the AfDB will help greater transparency significant step being The conducive fiduciary address the remaining and efficiency in State the adoption of the environment in Sierra Leone weaknesses. financial operations, IFMIS HR module in is further manifested by the as confirmed by July 2013. continuously strengthened Recent update: In PEFA 2013. Government also engagement of the main Fiduciary risk 2014, the Government publicises on an development partners, viz., assessment prepared a public annual basis a IMF, DFID, World Bank and (FRA) finance reform master Citizen’s Guide to EU. plan, with the support Budget providing of the donor transparency of budget Recent Update: The community (including commitments to publication of revenues and the Bank), which will priority investments expenditures relating to the support key public and transfers to local Ebola crisis on a Government sector reforms, communities, which Website is a positive step including public will facilitate the towards budget transparency procurement, budget tracking of the control and oversight, resources from this public expenditures programme. efficiency and effectiveness.

The political situation The last multi-party In August 2013, Since the civil conflict in the country has parliamentary Liberia celebrated the ended in 2001, Sierra Leone improved following elections completed tenth anniversary of has held three presidential the November 2010 the return to the Ghana Peace and general elections, presidential elections, constitutional order Accord that brought judged free and fair by the and the rule of law. an end to its conflict, international community. In A new Parliament and the President now 2007, the country was installed in 2012, serving a second term. experienced a peaceful following the There is a strong changeover of power, with December 2011 political will and the then opposition leader, legislative elections commitment to Ernest Bai Koroma, winning and the communal enhance governance the presidency and going on elections in April reform and maintain to win a second term in 2013. Risks of peace and stability in 2012. The next elections are revival of previous Liberia. Nonetheless, scheduled for 2017. civil wars are the ruling party lacks Risk of conflict remains but considerably reduced an absolute majority in is seen as manageable, with but the upcoming the House and the sporadic though localized Presidential elections, Senate, which poses episodes of political violence Political in November 2015, challenges in the between supporters of the Stability may be source of passage of legislation. ruling and opposition parties. limited political The political violence if a environment continues consensus is not to be contentious, with reached for the regular allegations of smooth management corruption. With of the electoral UNMIL drawing process. The down on its military Government is personnel, the committed to promote Government will be political reconciliation faced with significant and restore social budgetary and cohesion despite the capacity challenges, strong challenges. assuming greater security responsibilities, including in the counties as well, as at its borders with Côte d’Ivoire, Guinea, and

Sierra Leone. Unless immediate steps are taken to support the government to contain and manage the crisis, while meeting its commitments and continuing with its regular development and reform agenda, it presents a great potential of reversing the development gains made and reversing back into fragility. At the regional level- DPs and Governments are coordinating response to Ebola crisis through the following mechanisms: The AfDB filed offices are engaging in close dialogue with DPs and Governments around the national response to the epidemic- with situation changing rapidly on the ground The Prime Minister’s Harmonization of This PBO, like Delivery of budget support in office coordinates aid interventions of previous operations, Sierra Leone is highly provided by donor various donors and will be closely harmonized, with an community. Seven their policies, based coordinated with other established donor group thematic groups are in on the country’s donor interventions to comprising the EU, UK DFID place, both at the priorities, have greatly ensure consistency. and the World Bank, as well as policy dialogue and improved with the Specific to Ebola, the the African Development working levels, to implementation of program is Bank. Under normal conditions, Budget support is support sector-based clusters complimentary to the delivered under the guidance of implementation of the and this has led to Bank’s earlier a Multi-Donor Budget Support National sustained coordination contribution to (MDBS), based on a Common Development Plan. efforts, particularly as ongoing efforts in the Progress Assessment regards economic and sub-region to combat Framework (PAF) that brings financial governance. Ebola. Notably, a together the key indicators grant of 1m UA to measuring the performance of Liberia and a 40 m the program and providing the UA emergency key platform for policy package for West dialogue. Policy dialogue is Harmonization Africa, as well as to centered in a the Budget the efforts of other Support Group (BSG), partners including comprising the four MDBS WHO and UNICEF. It donors and Government, which also coordinated with meets at the policy level (Head initiatives on the of Mission/Financial Secretary) ground on the matter and at the working level, to monitor progress against the of civil service reform PAF and the risks to the including the Public objectives of the program. A Sector Modernization review of the PAF is jointly Project by the World conducted once a year. Donors Bank, USAID and and Government have agreed other partners, and the to undertake a comprehensive multi-donor IPFMRP review of the PAF with a view jointly led by the to streamline the number of AfDB and the World indicators and align it with the Bank, with A4P. An interim one-year PAF participation from was put in place for 2013. The SIDA, USAID and fact that good coordination others. systems are in place, will facilitate the coordination around the crisis response and also enable joint dialogue with other DPs.

3.1.3 Analytical work underpinning the programme Key weaknesses of health systems that have led to the Ebola epidemic are well documented, in particular through the WHO’s annual reports and country strategic reports. The Bank itself contributed to some of this work, in collaboration with the WHO and other partners2. These are the arguments developed in this report regarding agriculture, nutrition or governance. But the unprecedented magnitude of this epidemic highlights knowledge gaps on various health systems constraints that are impeding the response to the epidemic. Gender inequality is related to fragility and can weaken the response of states and the community if not addressed. Anthropological research has tried to identify community perceptions, practices, cultural beliefs and behaviours that are associated with disease transmission, for example burial practices (bodies tend to be washed by women), patients’ fear of going to the hospital, the role of traditional healers in disease transmission and practices that enhanced or impeded disease control. Others studies have also found that Ebola survivors frequently report stigmatization and women tend to be more stigmatized than men. These pose serious threats on social cohesion and post-crisis resilience. The increased risk of transmission among women due to their gendered roles as caregivers has been another important finding emerging from research on Ebola.

3.2 Collaboration and coordination with other donors The programme is part of a joint response supported by donors. In the four countries, joint government-donor teams have been established to strategize and organise the fight against Ebola. The Bank takes an active part in these groups, and is a privileged partner of WHO and other donors, as part of its engagement in the Harmonisation for Health in Africa. Due to the socio-economic impact of the EVD, dialogue with the Government of the beneficiary countries has been intensified. In Côte d’Ivoire, even though there in not yet any case, dialogue with partners and government is ongoing to help the country which have borders with two affected countries to be ready to handle any suspected and confirmed case. 3.3 Outcomes of past and on-going similar operations and lessons

Table 3. Lessons learnt and actions taken

Lessons learnt Actions taken to integrate lessons into the programme

(i) Ownership and There is a marked commitment and ownership of the Ebola response, as measured during the commitment to the Ebola visit of the Bank’s President to Sierra Leone and Liberia. These two countries, together with response Guinea, have established financing instruments for the response to the Ebola epidemic, which are aimed at hosting funds from development partners and the respective governments. Côte d’Ivoire has a specific budget line on “epidemics and catastrophe” to facilitate preparedness. (ii) Selectivity and Programme measures have been selected according to the Bank’s adoption of a three-pronged sequencing of programme strategy mixing short term response while also addressing the longer term system issues measures grounding the propagation of the epidemic as well as the root causes of the transmission of EVD. The measures supported by the programme have also been selected so as not to overload beneficiary governments, whose efforts are currently rightly targeted at the short term response to the outbreak. However the programme encourages the adoption of a longer term vision to build capacity to avoid similar health threat in the future, through a limited set of measures.

(iii) Risks and mitigation All identified risks in this type of operation have been identified and are taken into account.

(iv) Address capacity The above mentioned prudent approach aimed at avoiding to overburden beneficiary constraints in program governments will also allow to tackle capacity constraints, which are exacerbated by the crisis. implementation Note that Governments receive substantial support from DPs during the present crisis.

2 See “Investing in Health for Africa: the case for Strengthening Systems for Better Health Outcomes”, 2010

3.4 Relationship with on-going Bank operations 3.4.1 In Côte d’Ivoire, there is currently no evidence of slowing down of investment. However it is likely that the socio economic impact of the Ebola crisis will also affect the implementation of the Bank’s projects specifically the regional project which are at the borders between Côte d’Ivoire and Guinea, and Côte d’Ivoire and Liberia. International meeting have been postponed and could also affect the implementation of Bank projects. In this regard, the current program will allow the government to continue its efforts to implement the necessary preventive measures and to strengthen its capacity to better manage the eventual cases. An Ebola outbreak would jeopardise social cohesion, and the efforts that have been fostered with support from the budget support on the social cohesion financed by the Bank.

3.4.2 In Guinea, the programme will allow consolidating gains from the last three years in managing public finance and governance of the extractive industry sector. It will contribute to support the ambitious public finance reform programme, in particular budget management and resource allocation. The Bank supported these reforms and capacity building for the Guinean Administration through the first economic and finance reform programme (PAREF, June 2011), the economic and finance management support programme (PARCGEF, February 2011) and the economic planning and mining governance support projects (PAPEGM, November 2013). The proposed programme will allow to confront the decrease of fiscal revenues and unexpected additional expenditures resulting from the response to the Ebola epidemic. If no action is taken, the implementation of the major mining investments planned for the next three years –in particular the Simandou Project, will be negatively impacted. 3.4.3 In Liberia, the Ebola epidemic is undermining progress on Bank operations. Most international consultants and contractors have departed from the country, slowing, if not putting a halt to operations. The Bank’s work in Governance, particularly Budget Support and Public Financial Management Reforms, is critical for the payment of not only health professionals, but the rest of the civil service across sectors, which is necessary to support the Ebola response. Halting the Ebola epidemic will be necessary to allow for continuing work on energy, roads, agriculture and water and sanitation projects. 3.4.4 In Sierra Leone, the Ebola epidemic is also taking its toll on major Bank funded operations, especially in the Water and transport sectors where major international contractors have suspended operations. The impact of the epidemic is also felt in the governance sector where procurement of major consultancy and technical assistance work is being delays. Furthermore, the outbreak has also undermined the possibility of fielding project cycle missions, which have all been put on hold indefinitely. These disruptions might significantly delay implementation and require probable extension of some projects that will be discussed in due course. 3.5 Bank’s value added and comparative advantages 3.5.1 The size of the epidemic affects the concerned economies, nationally, regionally and beyond. Guinea, Liberia and Sierra Leone will experience an unprecedented reduction of their economic growth and related fiscal revenues, which makes their key international financial and technical partners including the Bank the primary recourse to ensure the continuity of their operations and facilitate the resilience of their economies. The Bank has also considerable experience in regional integration, fragile states and health systems strengthening. The Bank has launched in 2013 the Mano-River Union Initiative in order to

boost transformative infrastructures in the four member countries of the sub-region. The Bank has also funded a number of emergency operations for natural disasters and disease epidemics, through which it has gained an experience that will augment the capacity to respond to the Ebola epidemic. The Bank has been among the first partners to provide support to fight the epidemic, with the approval of an emergency grant of UA 2 million in April 2014. This was complemented by a US$60 million support which was approved by its Board in August 2014. Most importantly, the Bank as the Premier African financial institution has a privileged relationship with RMCs, which will be an asset to enter into policy dialogue related to the Ebola epidemic and ways to prevent similar events in the future. This policy dialogue will enhance Bank’s visibility. 3.5.2 The Bank has also considerable experience and a comparative advantage in regional integration, fragile states, systems strengthening, capacity development and sector policy dialogue. The Bank is a founding member of the Harmonization for Heath in Africa, which is very active on the continent and whose 15 member agencies foster privileged working relationships at the country level. The Bank being among the first development partners to approve an emergency operation to respond to the epidemic in April 2014, it has therefore been able to deepen its capacity to accompany the efforts against the epidemic and interact with key actors such as the WHO and WAHO. More generally, the Bank has substantial experience with budget support operations in the four beneficiary countries. 3.6 Application of good practice principles on conditionality Good practice principles on conditionality have been applied. This concern justifies the limitation of the number of measures triggering disbursements. The measures focus on key realistic and feasible actions that will affect positively and significantly progress toward programme objectives.

3.7 Application of Bank Group non-concessional borrowing policy The proposed operation complies with the principles of the Bank Group policy on non- concessional borrowing and debt accumulation. Specifically, for Guinea, Liberia and Sierra Leone, (i) there is strong partnership and coordination with multilateral and bilateral development partners, (ii) measures are effective and implementable; (iii) only concessional financing is considered; and (iv) diversity in country circumstances has been taken into account.

IV. THE PROPOSED PROGRAMME 4.1 Programme’s purpose and Goal 4.1.1 The purpose of the proposed emergency programme is to support the efforts of the four targeted countries in controlling the Ebola outbreak, mitigating its socio-economic effects and enhancing their preparedness. As noted in paragraph 1.3, the programme will support Côte d’Ivoire, Guinea, Liberia and Sierra Leone’s efforts to overcome the effects of the Ebola epidemic and foster momentum toward inclusive growth and poverty reduction. The operation has the specific aim to strengthen the capacity of beneficiary countries to handle similar events in the future. It is complementary to Ebola operations previously approved by the Bank, as it addresses the economic impact of the epidemic and its consequences on government revenues. 4.1.2 The programme will help beneficiary governments to confront the budget deficit resulting from the Ebola epidemic.

Table 4: Budget gap of the countries

Original Budget Budget Gap Bank support Bank support First Tranche Second Tranche

Côte d’Ivoire FY 2014 FY 2014

National budget USD 7,776 million USD 234 million UA 4 million UA 2 million

Guinea FY 2014 FY 2014

National budget USD 1,362.7 USD 125.8 million UA 14 million UA 7 million million

Liberia FY 2014/2015 FY 2014/2015

National budget USD 559 million USD 120 million UA 22.5 million UA 22.5 million

Sierra Leone FY 2014 FY 2014

National budget USD 950 million USD108 million UA 14.1 million UA 14.1 million

In Côte d’Ivoire, the spread of EVD in neighbouring countries prompted authorities to take preventive measures to avoid EDV outbreak in the country. Those measures (which include closing of borders; suspension of air traffic with affected countries; sensitization and awareness campaigns country-wide; and so on) which were not budgeted in the 2014 Finance Law will have economic impact, which is yet to be evaluated. Specifically, trade activities in areas close to affected neighbouring countries will decrease and are likely result to in revenue loss for the population. In Guinea, the loss of fiscal revenues will reach at least USD 50 million according to estimates computed in late July 2014. The cost of the Ebola emergency plan for the next six months (August 2014-January 2015) has been estimated at USD 134 million for 2014. Funds to finance this plan will come essentially from development partners including the Bank. The government just instructed key ministries (agriculture, mines, transports, trade, commerce, social affairs, tourism, security and defense) to evaluate the impact of EVD on their respective budgets. Support from the Bank and other development partners will allow sustaining health and other key sectors’ expenditures at an acceptable level. The country will also have to address the issue of food supply and other basic goods in the affected remote areas, particularly important in the hunger gap period. Failing this the country could be exposed to social instability. In Liberia, the Government has prepared a draft USD 559 million Budget for FY2014/15, which included a USD 49.8 million allocation for the Ministry of Health and Social Welfare. With the Government expecting USD 120 million in revenue shortfalls this year, it will have to adjust the priorities in the Budget, and increase the allocation to the Ebola response. While there have already been challenges with making regular payments to health workers, increased incentives for working during the Ebola epidemic would help in the response. Continued Government operations in other sectors will also be necessary to support the Ebola response and to support the economy.

In Sierra Leone, implementing the government’s 2014 Budget of USD 950 million would be a real challenge given the expected revenue shortfalls projected at 12% and increased expenditure to contain the EDV outbreak. Budget allocation to the Ministry of

Health declined in 2013 due to high management staff turnover and delays in program implementation. This affected the annual Budget allocation to the Ministry in 2014 and distorted health service delivery prior to the outbreak. Therefore the health sector was disadvantaged prior to the outbreak. There is a real need for the extra resource flow to be directed to the Ministry of Health to help contain the EVD epidemic and strengthen health care systems. Another effect not to be overlooked is the expected general decline in economy-wide total productivity due to the restrictions imposed to curb the spread of the epidemic.

4.1.3 The proposed programme has a strong regional dimension. The fast progression of the epidemic made the outbreak a regional issue and poses a very serious threat to the regional economy, because Guinea, Liberia and Sierra Leone form a high risk zone and neighboring Côte d’Ivoire is threatened. The eradication of EVD and the medium term improvement of health systems, relevant governance aspects and promotion of community resilience will benefit the three targeted countries and their neighbors. The resulting benefits are characterized by the absence of rivalry and exclusion. Moreover, as it will allow the concerned States to bring an adequate response in terms of social service delivery, the operation will contribute to strengthen their governance and accountability and their effectiveness in the delivery of public policies. The operation will also contribute to develop sustainable working relationships between the authorities of the three beneficiary countries and between themselves and the West African Institutions (ECOWAS, WAHO and MRU). Through such a contribution to regional governance and integration, the operation is aligned with the operational priorities of the Bank’s Ten-Year Strategy. The operation fulfils the criteria of Regional Public Goods (RPG) and cost sharing exemption as defined in Bank policy.

4.1.4 The Ebola epidemic in Guinea, Liberia and Sierra Leone is the worst ever; it was declared a global public health emergency by WHO classification3 and threatens Côte d’Ivoire. According to WHO data, as of 22 September 2014, Ebola infected 5843 people in these four countries, of whom 2803 died4. Liberia is the most affected country, with 3022 cases with 1578 deaths. Sierra Leone registers 1813 cases with 593 deaths and Guinea has 1008 cases with 632 deaths. Liberia is the country where the largest number of new cases is currently being registered, and all its counties are affected including those along the border with Côte d’Ivoire. It is estimated that 6-9 months will be needed to halt the epidemic.

3 WHO Statement on the Meeting of the International Health Regulations Emergency Committee Regarding the 2014 Ebola Outbreak in West Africa. 8 August 2014 .

4 WHO Ebola Virus Update-West Africa-22 September 2014.

Figure 1: Combined Epidemiological Curves

4.2 Programme’s components, operational policy objectives and expected results 4.2.1 To achieve the above-mentioned objectives, the programme prioritises two components critical for the enhancement of response and preparedness capacity. These components are: (i) Enhancing systems and human resources (ii) Ensuring appropriate Nutrition, Food Security and Social Protection. Each of these two components entails measures touching upon both the short term management of the crisis and the longer term capacity building preventing similar shocks in the future. This chronology is also reflected in the conditions triggering the two tranches of budget support foreseen in this programme. In parallel, the Bank is preparing a Technical Assistance operation focussing on the compensation framework in Guinea, Liberia and Sierra Leone to attract additional health workers and incentivise them for a period of six to eight months.

Component I. Enhancing systems and human resources 4.2.2 Context.

4.2.2.1 The unprecedented magnitude of the epidemic is such that its negative effects reach beyond health dimension and affect the economy. The outbreak increasingly disrupts and reduces economic activity and increases unemployment and poverty in the three countries targeted by the programme. The virus is spreading rapidly in Liberia’s capital Monrovia, curtailing economic activity in Liberia’s economic center, affecting the services industry, particularly trade, transportation, hotels, and restaurants. Agriculture has also been affected due to the fact that rural workers have fled farming areas in the affected zones.5 Ebola is affecting both planting and the harvest seasons, and quarantines could lead to food shortages. A number of mining companies have withdrawn personnel from Sierra Leone, Guinea and Liberia6 and much of the international population has departed. Long term investment projects are being delayed. Schools and markets have closed in Liberia and Sierra

5 The World Bank- Press release –August 4, 2014. 6 West Afica Ebola Outbreak forces miners to loxk down operations delays projects. MINING.com. 2014-08-10. Retrieved 2014-08-20.

Leone, and cross-border trade has halted between the countries. An initial World Bank-IMF assessment for Guinea projects a full percentage point fall in GDP growth from 4.5% to 3.5%. Ongoing IMF consultation with the Guinean government indicate that the GDP growth forecast could be revised downwards to 2.4%. This is in part due to the fact that the areas affected by the virus, which are close to forests where the disease originates, are the main agriculture production areas. A larger impact could be expected in Liberia and Sierra Leone, where cases have been higher and it has spread to urban areas. Other African countries which are not directly affected by the virus have also reported adverse effects on tourism7. 4.2.2.2 The epidemic is negatively impacting the capacity of health systems to deliver services, inducing a vicious circle. The WHO noted that “the outbreak of Ebola virus disease in West Africa is unprecedented in many ways, including the high proportion of doctors, nurses, and other health care workers who have been infected”. To date, more than 240 health workers have developed the disease in the four affected West African countries and more than 120 have died. This has a dramatic impact on the capacity of health systems to address Ebola and other diseases. Moreover, decision by some countries to close boarders and airline companies to suspend their flights from and to affected countries further jeopardises the international Ebola response. Because of the epidemic, individuals non- affected by the EVD reduce their demand on the health service, because of fear and lack of confidence in the health service, thus putting themselves at risk and inducing a general regression of health status. 4.2.2.3 The Ebola epidemic and similar threats that may emerge in the future require a three-pronged action. The need is for a mix of emergency response, the medium term improvement of systems and addressing the root causes of the outbreak in the affected fragile states in the longer term. 4.2.3 Rationale. 4.2.3.1 The beneficiary countries’ short term responses focus on the prevention and treatment of Ebola cases as per WHO guidelines, and entails substantial expenditures. The objective is to stop the transmission of the EVD and prevent its spread. The programme will ensure that safety measures are embedded in the Ebola response programme to reduce the risk of transmission to women. The engagement of civil society groups promoted by the programme will be essential to reach and mobilize women in communities. To reduce the risk of transmission among women working as frontline health workers, beneficiary governments will be encouraged to invest in training for nurses and female health workers to include barrier-nursing methods which have been found to be effective in previous Ebola outbreaks. Barrier-nursing involves adoption of strict infection control practices including use of protective gear at all times while caring for patients suffering from highly contagious life- threatening diseases.

4.2.3.2 The rapid spread of the epidemic can be attributed to the weakness of public health systems, particularly in human resources. The main challenges include lack of laboratory capacity for rapid virology tests, health worker shortages and insufficiently trained personnel for conducting diagnosis, treatment, logistics management and contact-tracing. As already noted above, the real challenge is the critical shortage of health workers of whom 240 have been infected and 120 have died as a result of the epidemic. Health workers are

7 Cham, Kemo (10 August 2014). "Another Sierra Leone doctor contracts Ebola". Africa Review. Retrieved 14 August 2014

confronted with a daunting task, coupled with the psychological trauma of seeing colleagues affected by the virus. 4.2.4 Measures supported The programme will support key measures related to systems strengthening for response and preparedness, with a key focus on human resources compensation and incentivization. Measures supported by the programme also include the establishment of governance structures for the financing instruments established by the beneficiary countries to enhance the effectiveness and efficiency of the Ebola response, namely: the emergency budget line in the Côte d’Ivoire budget, the Special account opened at the central Bank by the Government of Guinea, the Liberia Ebola Trust Fund and the Sierra Leone Health Emergency Fund. The programme will also encourage the four beneficiary governments to contribute financial resources to these financing instruments. With a view to promote a regional coordinated response to the Ebola epidemic, the programme will also support the membership of concerned countries to the regional Technical Surveillance Group whose creation was decided by the meeting of Ministers of Health held in Accra on 28 August 2014 under the Chairmanship of Ghana’s Minister of Health and under the auspices of ECOWAS/WAHO. The programme will support beneficiary governments in diagnosing and counteracting response gaps in a gender responsive manner. These measures will contribute to increase regional capacity in a permanent manner in preparedness for future similar threats. The programme also promotes the production of timely comprehensive quarterly fiscal outturns including contribution to their respective Ebola funds/budget lines and related expenditure.

4.2.5 Expected results The expected result of the proposed operation is the end of the epidemic within six to nine months, thereby contributing to preserve beneficiary countries’ economic growth and poverty reduction trajectories. Component II. Ensuring Nutrition, Food Security and Social Protection 4.2.6 Context and challenges. 4.2.6.1 The affected populations are faced with severe food shortages. In the Mano River Region, agriculture accounts for between 25% to 50% of GDP. Before the epidemic the agricultural production was expected to rise by 4%, a performance which will be at least halved. With the exodus of people form farming areas in the affected zone and the disruption in agricultural production, it is anticipated that agricultural production will grow by only about 2% depending on the length of the epidemic. The affected countries’ staple food is rice, cassava, cowpea, maize, soybeans, vegetables, and so on. Much of the rice consumed in Guinea, Liberia and Sierra Leone is imported from Asia. The Ebola outbreak has further aggravated shortage of food as shipping from as far away as Asia has stopped in fear of the disease. The FAO warns that food in countries affected by the virus has become more expensive. It further says some farmers cannot reach their fields and food imported by ship and air is now unlikely to arrive as often. The immediate access to caloric and nutritional food during the undetermined Ebola plague transitory period is imperative to minimize deaths of hunger.

4.2.6.2 The World Food Programme (WFP) announced in August that it would provide food aid to the roughly one million people living in the quarantine zones. The distribution is currently ongoing but reports indicate that the food aid is significantly inadequate to meet

the needs of the populations of the quarantine areas. Before Ebola hit, hunger was already a problem in the affected countries, particularly in rural areas. The malnutrition rates are already high in the region and there is a need to support vulnerable communities in order to improve their nutrition, health and livelihood of the affected communities. Further, given this the lack of alternative to substitute bush meat in providing protein may put local communities at risk of food and nutrition insecurity.

4.2.6.3 There is a need to prevent and bridge the “hunger gap” that will occur between the emergency food crisis period caused by the Ebola epidemic and the full engagement of the population in productive activities. This will have to be done by providing farmers in the affected rural communities, in particular women, sets of production inputs (improved early maturing varieties of rice, cassava, soybean, maize, cowpea, groundnuts, vegetables, fertilizers, agro-chemicals, and so on) As for livestock, the operation will provide improved breeding stocks (small ruminants, pigs, fish fingerlings, poultry (improved cockerel) and for tools (power tillers, motor pumps, etc.). In this regard the programme will promote the augmentation of budget allocation to nutrition programmes. Through nutrition programme sspecific nutrition support will be given to infants and young children who cannot be breastfed because their mothers are infected or suspected, as well as orphans children from 0 to 12 months of age. Specific nutrition counselling will be given in Ebola treatment centres to ensure adequate infant feeding practices in Ebola treatment units and holding/care centres. UNICEF is already coordinating with WFP to meet specific nutrition requirements of hospitalized and convalescent Ebola patients, specially children and women of child bearing age in order to burst recovery and prevent deterioration of the nutritional status. Growth monitoring activities, sensitisation, and communication for behavioural change will be done. Activities related to community nutrition support could be coordinate with WFP and UNICEF.

4.2.6.4 Health shocks can cause significant adverse outcomes for households and economies, particularly in low- and middle-income countries. It is estimated that sudden adult deaths could reduce household income by up to 50% besides causing decline or undesirable substitution is labour supply and participation (Alam and Mahal, 2014). Other health shocks could push household spending and poverty incidence by up to 30%. All these require huge amount of government resources to repair the damage so as to restore economic growth and development.

4.2.7 Rationale.

4.2.7.1 Once the epidemic is contained, the next action will be implementing strategies to reducing the vulnerability and rebuilding the resilience of the affected communities with productive means. One way of addressing this among others will be the support to food and nutrition security of communities affected by Ebola Virus Disease outbreak in Mano River Union. In addition to previously mentioned nutrition aspect related to the EVD are issues on breastfeeding and infected mothers, nutrition for patients under treatment or convalescence.

4.2.7.2 Affected communities are in need for social protection, as will be similarly affected communities in the future. Economic and social systems targeting shocks need to have emergency and short-, medium- and long-term measures. They also need to have two perspectives – affected households and health workers. Tools available for that purpose in particular comprise:

o Community checkpoints - Emergency measures aim at early diagnosis, treatment, prevention of disease spread and temporary restoration of the household economic status. It is important to deploy health workers, diagnostics, and medicines at the earliest stages. Appropriate health worker incentives need to be designed and kept ready for use at the time of such emergencies in order to avoid delays in deploying health workers during the time of distress. Community involvement is important for preventing the spread of disease. Earlier experiences have shown that communities are the first rescuer. Creation of community checkpoints staffed by community youth volunteers (with minimal necessary training) is a possible solution to prevent disease spread before it is tackled professionally. Transitory cash support for the affected, volunteers and staff could be built into the emergency measures. o Economic adoption of the affected households – When households lose their main income earners, they need to be supported in two ways. First, they need transitory monetary support to smoothen their consumption till their household economy stabilises. Second, economic support for skill development and/or investment is necessary to restore the household economy. Skill development should aim at labour or investment substitution in place of the one held by the deceased or disabled. Economic adoption could employ transitory and permanent methods such as grants and flexible loans for a reasonable period of time till the household reaches a critical point in its economic growth trajectory. This is equally applicable to the households of a healthcare delivery staff affected by the health shock. o Group life insurance and safety nets – Group life insurance is another instrument that can replace the need for transitory cash transfers. Premiums for group life insurance cover for a specific cause (such as Ebola) are normally low as they have low joint probability for the groups to be covered. This is a preventive measure to minimise the future financial burden imposed on the governments. Besides, it prepares the communities and health workers to anticipate and face such shocks. Group life insurance can be easily used for government health workers and their premiums can be paid by the government. This will be cheaper than the heavy financial burden in terms of compensation packages to be offered by the government in future in the absence of such insurance. Where insurance is not well-developed, use of cash transfers cannot be avoided as the governments act as an insurer in such situations. In parallel to these activities, safety nets programmes will be established in the beneficiary countries to reduce vulnerability for the affected households including neighbourhood care centres to support orphans and other vulnerable children whose relatives were killed by the EVD.

4.2.8 Measures supported under the EFBP programme The Ministries of health with the support of UNICEF and other partners of the nutrition sector in the four countries will elaborate interim guidelines on infant and child feeding in the context of Ebola. Specific practices as micronutrient supplementation will be strengthen in the Ebola context for the most vulnerable groups. In addition, the programme will target specific measures pertaining to economic and social support for affected populations, as follows: o In the short-term, the program will support creation of community checkpoints staffed by community youth volunteers (with minimal necessary training) to prevent disease spread before it is tackled professionally. Transitory cash support for the affected households, volunteers and staff will form part of the short-term economic support measures. The program will also entail support to food and nutrition security of

communities relying on bush meat and affected by Ebola, as well as gender equality and women empowerment. o For the long-term, the programme will aim at reducing vulnerability and building resilience of affected communities to fight back. A sustainable economic and social support system will be promoted by the programme to empower communities and households to fight back. More specifically the programme will encourage the beneficiary governments to assess the possibility of (i) establishing group life insurance scheme aimed at paying cash to the affected people, their relatives and health workers in future; and (ii) establishing a mechanism to economically adopt the affected households of the deceased, disabled and health workers; the mechanism will include both transitory and permanent methods. The long term response supported by the programme will also support the enhancement of community nutrition interventions based on behavior change communication and improvement of feeding practices among the most vulnerable, such as children under five years old and women.

4.2.9 Expected results Interim nutrition guidelines will be elaborated, endorsed by the Ministries of health and effectively used. The program will also support early economic and social response to crises so that economic losses are prevented or kept at minimum and households are empowered to fight back from such losses. 4.3 Financing needs and arrangements In Côte d’Ivoire, a Task force on Ebola has been set up and meets regularly. The National Institute of Health and Hygiene coordinates the Ebola response under the leadership of the Ministry of Health. The financial need has been estimated at USD 28 million.

In Guinea, the evaluation of the full impact of Ebola is yet to be finalized. Based on the preliminary assessment, the Bank’s PAREF2, ongoing discussions with the IMF, and the revised growth figures (2.4% revised from 3.5% planned), the revised 2014 budget will display a gap of about USD 125.8 million due to the direct impact of Ebola on revenues and expenses. The contribution from the Bank through this sector budget support as well as the World Bank and other donors will help close the gap and give room to the Government of Guinea and its partners to better coordinate the technical and financial responses.

Liberia’s draft FY2014/15 budget of USD 559 million included an allocation of USD 49.8 million for the Ministry of Health and Social Welfare. With revenue shortfalls anticipated to be between USD 20 million and USD 120 million, it will face a significant challenge to finance increased needs in the health and other sectors while continuing supporting Government operations.

Sierra Leone’s health care budget is grossly insufficient to address pressing needs in the sector to contain the EVD epidemic and strengthen the health care sector to a reasonable and adequate level. Even with the current injection of resources from other Development Partners, there would be financing gaps to fill. Donors await a comprehensive assessment from government of the financing requirements at the national and sector level to make an informed decision.

4.4 Programme’s beneficiaries

4.4.1The programme will benefit the economy of the four targeted countries. Guinea, where the epidemic started, together with Liberia and Sierra Leone, are the three most affected countries. While there is not case registered in Côte d’Ivoire, and the country’s response preparedness is judged satisfactory compared to its neighbouring countries, the situation is unpredictable. The country is still at risk at risk and is mobilising resources to implement its preparedness plan. The programme will ensure that the situation confronted by the other target countries does not affect Côte d’Ivoire, thus preserving the country as the sub-regional economic lifeblood and also the social cohesion which is still fragile.

4.4.2 The programme’s beneficiaries include the population of the target countries at large, through the mitigation of the effects of the epidemic on national budgets, thus countries’ capacity to deliver public services. More specifically, the Bank’s budget support will benefit: - Community members including youth, women, men and children in Ebola affected communities in rural and urban areas especially in trans-border areas. - Health facility staff such as doctors, nurses, midwives, and other support staff who are responsible for treating sick patients and disposing contagious waste. - Community surveillance workers who are responsible for contact tracing and monitoring disease transmission.

4.5 Programme’s impact on gender The Ebola epidemic affects women more than men and women will significantly benefit from the operation. Gender inequality affects the capacity of State actors and community to successfully face the epidemic. Data from previous Ebola epidemics show that index cases in several outbreaks are men, who are more likely than women to go into forests and come in contact with infected animals. Although men may be at greater risk of infection at the onset of an outbreak, women’s exposure to the virus increases as the epidemic progresses. This incidence pattern suggests that gender-related factors are key determinants of exposure to, and infection with, the Ebola virus. This is in particular because women tend to function as caregivers of household members who may be infected and are expected to participate in funeral rituals including preparing bodies for burial- a significant mode of transmission. Similarly, in hospital settings, nurses, midwives and ward cleaners are most often women who are entrusted with high-risk tasks of caring for sick patients, and disposing highly contaminated waste. Nursing staff generally tend to be the health care workers who come in direct contact with patients in the greatest numbers, so they have a high vulnerability. In addition, pregnancy increases the risk of contracting the disease as pregnant women come into contact with health workers and visit health facilities where the risk of infection transmission can be high. Male survivors transmit EVD through sexual relations during three months, which in particular in the context of polygamy may increase the gender imbalance observed in the Epidemic. Ebola hemorrhagic fever causes spontaneous abortions with heavy bleeding in the first and second trimesters. Transmission in maternal healthcare settings was important in some of the largest outbreaks previously experienced. Finally, lack of autonomy and decision making ability also increases women’s vulnerability to infectious diseases such as Ebola. As observed in some settings, men expect women to assume high risk tasks Women’s vulnerability is thus amplified by the cultural factors that determine their gendered roles. Available data at the time of writing the present report indicate that the women represents a large proportion of registered deaths, with 55% in Guinea, 52% in Sierra Leone

and 75% in Liberia. The programme promotes a gender mainstreaming approach, emphasising gender in relevant measures and associated policy dialogue.

4.6 Environment and Climate Change

The programme is a Sector Budget Support operation, and its supported policy measures will not have any direct negative impact on the environment. The overall response to the epidemic and its longer term developments may highlight a relationship between the emergence of Ebola outbreaks and deforestation, whose effect is to augment the geographical concentration of animals carrying the virus –especially bats, thus raising the risk of epidemic. This is an area for further intervention.

V. IMPLEMENTATION, MONITORING AND EVALUATION 5.1 Implementation arrangements 5.1.1 Responsible institutions. The institutions primarily responsible for the operation are the Ministries of Health of Côte d’Ivoire, Guinea, Liberia and Sierra Leone, who will act in collaboration with other relevant ministries in particular Ministries of Finance, Agriculture ,Civil Service and ministries in charge of gender. 5.1.2 Disbursement and funds flow. On fulfilment of the disbursement conditions, the proposed UA 100.2 million will be disbursed in two tranches to Côte d’Ivoire, Guinea, Liberia and Sierra Leone to fund the execution for the concerned fiscal years’ budgets. The first tranche is intended to be paid early in October 2014. The second tranche will be paid as per request from the respective beneficiary governments. This two-tranche system will allow conducting policy dialogue related to programme’s measures. 5.1.3 Procurement arrangement. As a budget support operation and in line with the Bank Group Policy on Program Based Operations, procurement for the EFBP programme will be done following country procurement systems in accordance with the Public Procurement Laws of Côte d’Ivoire, Guinea, Liberia and Sierra Leone8. In 2011, the Bank carried out an evaluation of national procurement procedures of the four beneficiary countries covering in particular the legislative and regulatory framework. This evaluation concluded that national procurement systems for Guinea, Liberia and Sierra Leone have weaknesses and necessitate strengthening measures although the national procurement system for Côte d’Ivoire has been evaluated globally satisfactory according to the international procurement standards. These measures are to be implemented gradually and don’t pre-empt the proposed budget support operation due to its particularity, its conditionalities and the risk mitigation measures it entails.

5.1.4 Audit arrangements. In line with the Bank Policy on PBOs and the Paris, Accra and Busan declarations, the implementation, monitoring and evaluation arrangements for the programme will follow existing country FM systems, including the arrangements for audit. According to PFM national systems of Côte d’Ivoire and Guinea, accounting for all payments effected under the programme will be done by national treasuries. The audit of financial flows will be done by the “Cour des Comptes” for Côte d’Ivoire, and by an independent audit firm for Guinea.

As for Liberia and Sierra Leone,, the Accountant General produces annual financial statements of the Consolidated Fund as well as for individual ministries, which statements are in turn audited by the Auditor General of each country (Government Auditing Commission in Liberia and Audit Service Sierra Leone in Sierra Leone respectively). While in each of the four countries the Bank will not require a separate audit of the programme, the institutions with primary responsibility for the implementation of the programme in Liberia and Sierra Leone will be required to share copies of their audited annual financial statements for the implementation period once these are cleared for distribution by the Auditor General. In addition the flow of funds audits for Liberia and Sierra Leone will be conducted by the respective auditor generals within six months of the end of each financial year audited.

5.2 Monitoring and evaluation arrangements

5.2.1 Institutions responsible. Ministries of Health, Ministries of Finance, Ministries of Agriculture and ministries in charge of gender will be primarily responsible for the monitoring of the programme. Monitoring will be facilitated by the close follow up of the evolution of the Ebola epidemic by the WHO. 5.2.2 Monitoring system. The Bank will make use of the regular reports from the WHO on the epidemic. Bank Field Offices in Liberia and Sierra Leone, together with Bank personnel managing the Guinea and Côte d’Ivoire portfolios, will provide information and data on the evolution of the outbreak and the realisation of measures foreseen in the programme. 5.2.3 Evaluation system. A Project Completion Report (PCR) will be prepared jointly by the Bank and the governments of Côte d’Ivoire, Guinea, Liberia and Sierra at the end of the programme.

VI. LEGAL DOCUMENTATION AND AUTHORITY 6.1 Legal documentation 6.1.1 Entry into force of the ADF Grant agreements. The grant agreements shall enter into force upon its signature by the parties. 6.1.2 Conditions precedent to first disbursement of the ADF Grants. The obligation of the Fund to make the first disbursement of the grant shall be conditional upon entry into force of the agreement for each respective recipient and the following: i) Provide evidence to the Fund of having opened a Bank account to receive the funds according to the table below. ii) Duly completed and signed disbursement request from the same. 6.1.3 Entry into force of the ADF Loan Agreements. The entry into force of the loan agreements shall be subject to the fulfilment by the borrowers of the provisions of section 12.01 of the General Conditions. 6.1.4 Conditions precedent to first disbursement of the ADF Loans. The obligation of the Fund to make the first disbursement of the Loan shall be conditional upon entry into force of the agreement for each respective borrower and the following: i) Provide evidence to the Fund of having opened a Bank account to receive the fund according to the table below. ii) Duly completed and signed disbursement request from the same.

6.1.5 Conditions precedent to the disbursement of funds are presented in the below table:

Table 5: Programme disbursement conditions

Côte d’Ivoire Guinea Liberia Sierra Leone

Action: Open a bank Action: Open a bank Action: Open a bank account Action: Open a bank account to receive account to receive Fund to receive Fund resources. account to receive Fund Fund resources. resources. resources. Evidence: Transmission to the Evidence: Evidence: Transmission Fund of the details for a Evidence: Transmission to Transmission to the to the Fund of the details Treasury account at the Central the Fund of the details for Fund of the details for for a Treasury account at Bank of Liberia for purposes a Treasury account at the a Treasury account at the Central Bank of of receiving the resources of Central Bank of Sierra the Central Bank of Guinea for purposes of the Grant and the Loan. Leone for purposes of

Côte d’Ivoire for receiving the resources of receiving the resources of purposes of receiving the Grant and the Loan. the Grant and the Loan the resources of the Grant and the Loan. Action: Ensure Action: Ensure protection Action: Ensure protection of Action: Ensure protection

First Tranche First protection of health of health workers health workers of health workers workers Evidence: Provide the Evidence Provide the Evidence: Provide the Fund Evidence Provide the Fund Fund with a Ministry Fund with a Ministry of with a Ministry of health with a Ministry of health of Health Circular health circular providing circular providing for circular providing for aimed at ensuring the for eligibility to protective eligibility to protective eligibility to protective protection of all health clothing and distribution clothing and distribution clothing and distribution workers involved in given care to infected patients Action: Contribution to Action: Contribution to the Action Contribution to the Action: Contribution the Ebola Trust Fund Ebola Trust Fund from the Health Emergency to the “Catastrophe

from the Borrower/Recipient in an Account from the and epidemic” budget Borrower/Recipient in an amount of at least 50% of the Borrower/Recipient in an line amount of at least 20% of first tranche of ADF funding amount of at least 50% of

the first tranche of ADF the first tranche of the Evidence: funding ADF funding Transmission to the

Fund of the Evidence: Proof of Evidence: Proof of transfer to Evidence: Proof of transfer Second Tranche notification of the transfer to the Ebola the Ebola Trust Fund to the Health Emergency Minister of finance Special Account Account

Action: Elaboration of Action: Elaboration of a Action: Elaboration of a plan Action: Elaboration of a a plan for prevention plan for emergency for emergency distribution of plan for emergency of nutrition and food distribution of food aid food aid and agricultural distribution of food aid and consequences of the and agricultural production inputs to affected agricultural production

epidemic at production inputs to communities inputs to affected community level. affected communities communities Evidence: Plan transmitted to Evidence: Plan Evidence: Plan the Fund Evidence: Plan transmitted transmitted to the Fund transmitted to the Fund to the Fund

6.2 Compliance with Bank Group policies The EFBP programme complies with all applicable Bank Group policies and guidelines, including the Bank’s PBO policy. VII. RISK MANAGEMENT The following risks and mitigation measures have been identified:

Table 6: Risks, probability and mitigation measures Risk Probability Mitigation Measure 1 - Political risks, including risk of moderate The World Health Organization has reversal: The security situation is formally designated the outbreak as a generally stable albeit fragile owing to the public health emergency of international current Ebola epidemic affecting the concern while the same has been elevated region. to the level of a national state of emergency in the affected countries and facilitates the invocation of legal measures on disease prevention, surveillance, control, and response. Government and development partners are employing all efforts to bring the epidemic under control.

2 - Macroeconomic risk: The outbreak of moderate Partners including the Bank, the World Ebola has had adverse effects on the Bank and the IMF are working to avail economy including a reduction of resources and support including through government revenues, including from the budget and sectoral support. Policy extractive industry which will affect the dialogue is also ongoing. Once the macroeconomic situation and government pandemic is contained it is anticipated that programmes. The closure of borders and the economies will slowly return to ports to is also bound to have a severe normal. impact for a country highly dependent on on imported food and fuel as well as on primary exports and FDI. 3-Implementation capacity constraints: moderate This PBO particularly targeted at Weak institutional & human resources enhancing health sector effectiveness. capacity, heightened by the disruptions and ORFS is preparing a TA operation which uncertainties due to the Ebola crisis could will facilitate programme implementation. hamper the implementation & the broader poverty reduction benefits. The health sector is particularly affected 4-Lack of adequate resources and moderate The affected countries, RMCs and the possibility of virus mutating elsewhere international community and affected within the region: Very porous borders, countries employing all efforts to bring the have the possibility of the crisis mutating virus under control. to a regional contagion with inadequate resources or capacity to mitigate. 5. Fiduciary risk including corruption high Despite the various safeguards, the fiduciary risk is fairly substantial in particular around emergency and donor funds. The budget support approach followed by the programme entail measures aimed at improving the governance of the Ebola response.

VIII. RECOMMENDATION Management recommends that the Boards of Directors approve the proposed Loan of UA 79.8 million and Grant of UA 20.4 million from the resources of ADF-13 to the Republics of Côte d’Ivoire, Guinea, Liberia and Sierra Leone for the purposes and subject to the conditions stipulated in this report

ANNEX 1 –EBOLA SECTOR BUDGET SUPPORT –FIGHT BACK PROGRAMME – MATRIX OF COMMON MEASURES FOR COTE D’IVOIRE, GUINEA, LIBERIA AND SIERRA LEONE

MEASURES AND INSTITUTIONS IN CHARGE OUTPUT INDICATORS OBJECTIVES MEASURE 2014 MEANS OF OUTCOME INDICATORS MEASURE 2015 INSTITUTION 2014 2015 VERIFICATION Component I. Enhancing systems and human resources

Strengthen Chairs of the Government Orders At least 1 report issued by 1. The employment situation is Establish gender Production of Existence of the management concerned establishing a gender each of the beneficiary stabilized sensitive governance technical and Orders and financial reports governance balanced governance countries coordination structure for the structures Reports Ebola funds created on the activities structure of the respective 2.The Ebola epidemic ends of the Ebola financed under the Ministries in instruments and firming response in beneficiary charge of gender countries and firm concerned up membership of crisis 3. Current account deficit is up membership of financing management teams stabilized crisis management instruments teams. 4. The Response capacity is strengthened Strengthen Ensure and Participation of Ministries of Circular from Ministry of Input and leadership from Evidence of regional institutionalise appointed health Health designating the the four beneficiary Circular management membership in members in all members of the Technical countries to regional and Technical meetings Surveillance Group and dialogue and coordination coordination Surveillance convened providing for related structures to Group Terms of Reference respond to Ebola crisis

Owned, Beneficiary Transmission to Ministries of Contribution to Ebola Evidence of transfer sustained governments the Bank of the Economy and response financing of funds and contribute at least proof of transfer Finance instruments increase accountable XX% of the first to the accounts of Ebola tranche of Bank the four concerned response support financing instruments

Governments Ministries of Fiscal outturns prepared Evidence of reports prepare timely Health and quarterly comprehensive Finance quarterly fiscal outturns including contribution to their respective Ebola funds/budget lines and related expenditure I

MEASURES AND INSTITUTIONS IN CHARGE OUTPUT INDICATORS OBJECTIVES MEASURE 2014 MEANS OF OUTCOME INDICATORS MEASURE 2015 INSTITUTION 2014 2015 VERIFICATION

For Sierra Leone MoFED 55% of the agreed Database Provided only: Audit Sierra recommendations made in by ASSL. Leone in the Auditor General’s Collaboration report on the 2012 with the Internal accounts of Sierra Leone audit Department are implemented by Vote in MoFED review Controllers and action’s recommendations reviews done by ASSL of the 2012 during subsequent audits accounts during of affected entities. the 2013 Audit exercise.

Ensure Transmission to Ministries of Circulars providing for Evidence of circular sustained the Bank of MOH health eligibility to protective engagement circulars closing and distribution of health providing for workers in eligibility to the response protective closing and distribution Note: Policy dialogue with countries will also cover other aspects of systems Health workers Implement the Ministries of A compensation/incentive . Evidence of the are compensated framework Health framework is put in place compensation/incen and incentivised in Guinea, Liberia and tive frameworks Sierra Leone, as well as Côte d’Ivoire

Component II. Ensuring appropriate Nutrition, Food Security and Social Protection

MEASURES AND INSTITUTIONS IN CHARGE OUTPUT INDICATORS OBJECTIVES MEASURE 2014 MEANS OF OUTCOME INDICATORS MEASURE 2015 INSTITUTION 2014 2015 VERIFICATION Mitigate the Elaboration of a Ministries of Plan for emergency Evidence of the plan short and plan for Agriculture, distribution of food aid medium terms emergency health and and agricultural effects of the distribution of social affairs production inputs to epidemic on food aid and affected communities agricultural agricultural production production and nutrition inputs to affected communities

Enhance Development of Ministries of Evidence of the plan of National community Evidence of the plan nutrition and short and Agriculture, action nutrition support plans food security medium term health and of action for affected support at plan to address social affairs communities and areas community nutrition based at risk level on the scaling up for nutrition platform and the national nutrition plans Strengthen Development of Ministries of Nutrition campaign MOH reports structures in a nutrition Health, launched charge of sensitization Agriculture and nutrition plan for the Social Affairs communicatio most affected n for and at risk behavioural zones change

Increase budget Ministries of At least 20% increase in Budget documents allocations to health and public budgets of the nutrition social affairs four countries for programmes nutrition programmes Strengthen Hold ministerial Relevant A framework for Minutes of the safety nets for meeting to institution in economic adoption* ministerial meeting greater examine each country i.e. mechanism to support inclusiveness insurance Ministry of health workers and Evidence of and resilience options: (i) health, finance households. concerned to income Group Life and others framework shocks Cover* insurance for all faced with similar threats

III

MEASURES AND INSTITUTIONS IN CHARGE OUTPUT INDICATORS OBJECTIVES MEASURE 2014 MEANS OF OUTCOME INDICATORS MEASURE 2015 INSTITUTION 2014 2015 VERIFICATION Strengthen the Elaborate a Plan Follow up Ministry of A plan for procurement Existence of the supply chain for procurement execution of the Agriculture or and distribution of plan management and distribution plan other relevant agricultural inputs of the of agricultural ministry in the agriculture inputs respective sector beneficiary countries. Ministry in charge of local collectivities Enhance Ministerial Ministries of Order providing for Evidence of the community Order providing health or other establishment of Order involvement in for relevant community check posts the response, establishment of institutions in and modalities for the including civil community the respective rapid training of Existence of society, check posts and countries, such community youth community check professional modalities for as local volunteers points networks and the rapid governments, the other training of internal affairs, community community youth, etc. groups youth volunteers Evidence of the Reinforce Establish Ministries of At least 1neighbourhood order community mechanism to Follow up social affairs care center for the response to temporarily implementation affected households provide care adopt to the children neighbourhood and orphans care points for orphans and vulnerable children *: See Annex on Safety Nets

Annex 2: Comparative Socio-Economic Indicators of Guinea, Liberia and Sierra Leone Côte d’Ivoire

Develo- Develo- Côte Year Africa ping ped d'Ivoire Countries Countries

Basic Indicators GNI Per Capita US $

Area ( '000 Km²) 1800 2011 322 30 323 98 458 35 811 1600 1 1400 Total Population (millions) 2013 20,3 5 909,3 1 252,8 1200 109,0 1000 Urban Population (% of Total) 2013 52,8 40,2 47,7 78,3 800 600 Population Density (per Km²) 2013 62,5 46,9 70,7 23,5 400 GNI per Capita (US $) 2012 1 220 1 719 3 815 38 412 200

2005 2006 2007 2008 2009 2010 2011 2012 2012- 2004 Labor Force Participation - Total (%) 39,4 37,4 67,9 72,1 2013 2012- Côte d'Ivoire Africa Labor Force Participation - Female (%) 38,5 42,5 38,6 44,6 2013 2007- Gender -Related Development Index Value 0,468 0,502 0,694 0,911 2011 Human Develop. Index (Rank among 187 countries) 2012 168 ...... 2008- Popul. Living Below $ 1.25 a Day (% of Population) 23,8 40,0 20,6 ... 2011

Demographic Indicators Population Growth Rate - Total (%) 2013 2,4 2,5 1,3 0,3 Population Growth Rate - Urban (%) 2013 3,8 3,4 2,5 0,6

Population < 15 years (%) 2013 41,3 40,9 28,3 16,4 Population Growth Rate (%)

Population >= 65 years (%) 2013 3,2 3,5 6,1 16,8 3,0 Dependency Ratio (%) 2013 78,5 77,9 52,4 49,9 2,5 Sex Ratio (per 100 female) 2013 104,0 100,0 103,3 94,4 2,0 Female Population 15-49 years (% of total 1,5 population) 2013 23,7 24,0 53,1 45,2 1,0 0,5 Life Expectancy at Birth - Total (years) 2013 50,7 59,2 68,4 77,8

0,0

2010 2006 2007 2008 2009 2011 2012 2013 Life Expectancy at Birth - Female (years) 2013 51,8 60,3 70,3 81,2 2005 Crude Birth Rate (per 1,000) 2013 36,6 34,8 21,2 11,2 Crude Death Rate (per 1,000) 2013 14,2 10,4 7,6 10,4 Côte d'Ivoire Africa Infant Mortality Rate (per 1,000) 2013 74,4 61,9 39,8 5,5 Child Mortality Rate (per 1,000) 2013 106,2 97,4 56,3 6,6 Total Fertility Rate (per woman) 2013 4,9 4,6 2,6 1,7 Maternal Mortality Rate (per 100,000) 2010 400,0 415,3 240,0 16,0 Women Using Contraception (%) 2013 20,0 34,9 62,6 71,3

Life Expectancy at Birth (years) Health & Nutrition Indicators

71 2004- 61 Physicians (per 100,000 people) 14,4 47,1 117,8 297,8 51 2011 41 31 2004- 21 Nurses (per 100,000 people)* 48,3 132,6 202,7 842,7 11

2008 2006 2007 2009 2010 2011 2012 2013 2011 2005 2006- Births attended by Trained Health Personnel (%) 56,8 52,6 66,3 ... 2011 Côte d'Ivoire Africa Access to Safe Water (% of Population) 2012 80,2 68,8 87,2 99,2 Access to Health Services (% of Population) 1988 60,0 65,2 80,0 100,0 Access to Sanitation (% of Population) 2012 21,9 39,4 56,9 96,2

Percent. of Adults (aged 15-49) Living with HIV/AIDS 2012 3,2 3,9 1,2 ... Incidence of Tuberculosis (per 100,000) 2012 172,0 223,6 144,0 23,0 Child Immunization Against Tuberculosis (%) 2012 99,0 83,0 81,5 96,1 Child Immunization Against Measles (%) 2012 85,0 74,0 83,0 94,3 2005- Underweight Children (% of children under 5 years) 29,4 19,7 17,0 1,4 2012 Daily Calorie Supply per Capita 2009 2 670 2 481 2 675 3 285 2011- Public Expenditure on Health (as % of GDP) 1,8 2,9 3,0 7,5 2012

Education Indicators Gross Enrolment Ratio (%)

Primary School - Total 2012 94,2 101,9 109,4 100,9 Infant Mortality Rate

( Per 1000 ) Primary School - Female 2012 86,6 97,9 107,6 100,6 100 1999- 90 Secondary School - Total 24,3 47,4 69,1 100,2 80 70 2012 60 50 1999- 40 Secondary School - Female 17,0 44,0 67,8 99,7 30 2012 20 10

2006 2007 2008 2009 2010 2011 2012 2013 Primary School Female Teaching Staff (% of Total) 2012 24,4 46,6 58,0 84,3 2005 Adult literacy Rate - Total (%) 2012 41,0 62,0 80,3 99,2 Adult literacy Rate - Male (%) 2012 51,6 70,7 85,9 99,3 Adult literacy Rate - Female (%) 2012 30,5 53,7 74,9 99,0 Côte d'Ivoire Africa 2008- Percentage of GDP Spent on Education 4,6 5,3 4,3 5,5 2012

Environmental Indicators Land Use (Arable Land as % of Total Land Area) 2011 9,1 7,6 10,7 10,8 2000- Annual Rate of Deforestation (%) 3,1 0,6 0,4 -0,2 2009 Forest (As % of Land Area) 2011 32,7 23,0 28,2 35,0 Per Capita CO2 Emissions (metric tons) 2010 0,3 1,2 3,0 11,6

Sources: AfDB Statistics Department mai last update : Databases; 2014 United Nations Population Division, World Population Prospects: The 2012 Revision; World Bank: World Development Indicators; UNAIDS; UNSD; WHO, UNICEF, WRI, UNDP; Country Reports. For any given interval, the value refers to the most recent year available during the period Note : n.a. : Not Applicable ; … : Data Not Available.

Guinea

Develo- Develo- Year Guinea Africa ping ped Countries Countries

Basic Indicators GNI Per Capita US $

Area ( '000 Km²) 1800 2011 246 30 323 98 458 35 811 1600 1 1400 Total Population (millions) 2013 11,7 5 909,3 1 252,8 1200 109,0 1000 Urban Population (% of Total) 2013 36,4 40,2 47,7 78,3 800 600 Population Density (per Km²) 2013 41,6 46,9 70,7 23,5 400 GNI per Capita (US $) 2012 440 1 719 3 815 38 412 200

2005 2006 2007 2008 2009 2010 2011 2012 2012- 2004 Labor Force Participation - Total (%) 36,6 37,4 67,9 72,1 2013 2012- Guinea Africa Labor Force Participation - Female (%) 45,3 42,5 38,6 44,6 2013 2007- Gender -Related Development Index Value 0,425 0,502 0,694 0,911 2011 Human Develop. Index (Rank among 187 countries) 2012 178 ...... Popul. Living Below $ 1.25 a Day (% of 2007- 43,3 40,0 20,6 ... Population) 2011

Demographic Indicators Population Growth Rate - Total (%) 2013 2,5 2,5 1,3 0,3 Population Growth Rate - Urban (%) 2013 3,9 3,4 2,5 0,6

Population < 15 years (%) 2013 42,3 40,9 28,3 16,4 Population Growth Rate (%)

Population >= 65 years (%) 2013 3,1 3,5 6,1 16,8 3,0 Dependency Ratio (%) 2013 84,2 77,9 52,4 49,9 2,5 Sex Ratio (per 100 female) 2013 100,3 100,0 103,3 94,4 2,0 Female Population 15-49 years (% of total 1,5 population) 2013 23,3 24,0 53,1 45,2 1,0 0,5 Life Expectancy at Birth - Total (years) 2013 56,1 59,2 68,4 77,8

0,0

2008 2006 2007 2009 2010 2011 2012 2013 Life Expectancy at Birth - Female (years) 2013 56,9 60,3 70,3 81,2 2005 Crude Birth Rate (per 1,000) 2013 36,9 34,8 21,2 11,2 Crude Death Rate (per 1,000) 2013 11,5 10,4 7,6 10,4 Guinea Africa Infant Mortality Rate (per 1,000) 2013 72,7 61,9 39,8 5,5 Child Mortality Rate (per 1,000) 2013 125,7 97,4 56,3 6,6 Total Fertility Rate (per woman) 2013 4,9 4,6 2,6 1,7 Maternal Mortality Rate (per 100,000) 2010 610,0 415,3 240,0 16,0 Women Using Contraception (%) 2013 12,9 34,9 62,6 71,3

Health & Nutrition Indicators Life Expectancy at Birth

2004- (years) Physicians (per 100,000 people) 10,0 47,1 117,8 297,8 2011 71 61 2004- 51 Nurses (per 100,000 people)* 4,3 132,6 202,7 842,7 41 2011 31 21 2006- 11

Births attended by Trained Health Personnel (%) 46,1 52,6 66,3 ... 1

2006 2007 2008 2009 2010 2011 2012 2013 2011 2005 Access to Safe Water (% of Population) 2012 74,8 68,8 87,2 99,2 Access to Health Services (% of Population) 2000 80,0 65,2 80,0 100,0 Guinea Africa Access to Sanitation (% of Population) 2012 18,9 39,4 56,9 96,2

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Percent. of Adults (aged 15-49) Living with HIV/AIDS 2012 1,7 3,9 1,2 ... Incidence of Tuberculosis (per 100,000) 2012 178,0 223,6 144,0 23,0 Child Immunization Against Tuberculosis (%) 2012 84,0 83,0 81,5 96,1 Child Immunization Against Measles (%) 2012 58,0 74,0 83,0 94,3 Underweight Children (% of children under 5 2005- 16,3 19,7 17,0 1,4 years) 2012 Daily Calorie Supply per Capita 2009 2 652 2 481 2 675 3 285 2011- Public Expenditure on Health (as % of GDP) 1,6 2,9 3,0 7,5 2012

Education Indicators Gross Enrolment Ratio (%)

Primary School - Total 2012 90,8 101,9 109,4 100,9 Infant Mortality Rate

( Per 1000 ) Primary School - Female 2012 83,1 97,9 107,6 100,6 100 Secondary School - Total 2012 38,1 47,4 69,1 100,2 90 80 70 2011- 60 Secondary School - Female 29,4 44,0 67,8 99,7 50 2012 40 30 Primary School Female Teaching Staff (% of Total) 2012 29,7 46,6 58,0 84,3 20 10

2006 2007 2008 2009 2010 2011 2012 2013 2010- 2005 Adult literacy Rate - Total (%) 25,3 62,0 80,3 99,2 2012 2010- Adult literacy Rate - Male (%) 36,8 70,7 85,9 99,3 2012 Guinea Africa 2010- Adult literacy Rate - Female (%) 12,2 53,7 74,9 99,0 2012 2011- Percentage of GDP Spent on Education 2,5 5,3 4,3 5,5 2012

Environmental Indicators Land Use (Arable Land as % of Total Land Area) 2011 11,6 7,6 10,7 10,8 2000- Annual Rate of Deforestation (%) 0,5 0,6 0,4 -0,2 2009 Forest (As % of Land Area) 2011 26,5 23,0 28,2 35,0 Per Capita CO2 Emissions (metric tons) 2010 0,1 1,2 3,0 11,6

UNICEF, WRI, UNDP; Country Reports. For any given interval, the value refers to the most recent year available during the period Note : n.a. : Not Applicable ; … : Data Not Available.

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Liberia

Sierra Leone

ANNEX 3 – Economic Context in Beneficiary Countries

1. Cote d’Ivoire is one the top performing economy since civil war ends in 2011. Real GDP growth was estimated at Table: Key Macroeconomic Indicators 8.7 and 9.8 % in 2013 and Sources: IMF and GoCI ; * Projections 2012 respectively following a sharp decrease of 4.7% in 2011. Economic growth in 2011 2012 2013 2014* 2013 was buoyed by strong growth performance among Annual Growth Rate (%) all three sectors: primary GDP -4.7 9.8 8.7 8.5 (6.7%); secondary (9.1%) and Inflation 4.9 1.3 2.6 1.2 tertiary (10.1%). The main drivers of growth are the In % of GDP Total revenue and grants 18.7 19.1 19.9 20.8 export sector (coffee; cocoa; etc.) and public investment in Total Expenditures 23.9 22.2 22.2 23.1 infrastructure (energy; Primary Balance -2.7 -1.2 -0.1 -0.2 transport; etc.). Inflation was Fiscal Balance -5.2 -3.2 -2.3 -2.3 contained with the 3% of the WAEMU convergence Current Account Balance 11.9 -1.2 -1.6 -3.2 criteria in 2012 and 2013 Public Sector Debt 67.9 45.1 40.1 38.2 thanks to the food surplus Of Which External Public Debt 50.8 28.2 26.5 26.6 generated in the agriculture sector (37% increase of rice production in 2013). Economic growth forecast in 2014 was recently maintained at 8.5% in 2014. However it’s likely that the ongoing Ebola outbreak in the neighboring countries of Guinea and Liberia will have some adverse economic impact (transport sector mainly, as borders are closed and air traffic suspended) as those countries are not part of the main trading partners of Cote d’Ivoire.

2. Guinea Negative economic effects have been amplifying since the beginning of the Ebola virus epidemic. The initial GDP growth forecast for 2014 was at 4.5% but was reduced to 3.5% in May 2014. Ongoing negotiations Table : Guinea Key Macroeconomic Indicators : between Government of Guinea and 2010 2011 2012 2013 2014* IMF point to a GDP growth rate of Annual Growth Rate (%) 2.5-2.8%. According to the GDP 1,9 3,9 3,8 2,3 4,5 Amending Finance Law passed in Inflation 20,8 19 12,8 10,5 8,5 July 2014, fiscal revenues will go in % of GDP down by Guinean Francs 350 billion Recettes (hors dons) 15,3 16,8 20,1 18,4 19,3 (USD 50 million). The mobilisation Recettes (dons compris) 15,7 20,2 22,9 19,8 24,9 of fiscal revenues registered a sharp Dépenses 20,5 16,3 15,9 16,2 15,6 decrease at the end of July 2014. The Solde budgétaire de base -12,6 -1,6 -2,5 -2,8 -4 exchange rate on the informal market Solde de la balance courante -10,3 -21,4 -27,1 -21,5 -18,8 registered a peak this summer, In months of imports unique since the last three years. An impact, which is not yet precisely Reserve internationale 0,6 4,4 3,4 3,6 3,7 evaluated at this stage, is already Sources : FMI et GdG; * Prévisions measurable in the agriculture sector and in transports, hotels, mines, trade, etc. The Office of the Prime Minister launched a light survey whose results will be available for the consultation of Government and Development Partners on 17 September 2014. A more in-depth survey will be undertaken soon by Ministry

XI of Economy and Finance with a view to evaluate the economic, financial and social impact of the Ebola Virus Disease (EDV) as well as trade with neighboring countries.

3. Liberia,

Despite strong growth since the end of Table : Liberia Key Macroeconomic Indicators the conflict in 2003, growth was already (In per cent of GDP, 2014 2015 2016 2017 expected to reduce in 2014 to 5.9%. unless otherwise 2013 With the Ebola crisis affecting services, indicated) Prel. Proj. Proj. Proj. agriculture, and mining, and spreading throughout Monrovia, growth will fall Annual GDP growth, with iron ore 8.7 5.9 6.8 7.2 9.4 below 5.9%, and a prolonged epidemic Inflation rate (CPI, annual average) 7.6 8.3 7.7 7.2 6.7 will have severe consequences on public and private investment, which will further Fiscal balance (including grants, % GDP) -1.6 -3.8 -7.1 -5.4 -5.4 reduce prospects for inclusive growth in Total revenue and grants (% GDP) 30.2 27.1 24.9 25.6 24.9 the medium term. The Government has prepared a $20 million response package Total expenditure and net lending (% GDP) 31.7 30.9 32.0 31.0 30.3 for which it has allocated $5 million. In Of which: capital expenditure (% GDP) 4.9 9.9 12.3 11.2 10.3 the face of increased funding pressures, it is experiencing potentially a 20% decline External current account balance (incl. official grants, % GDP) -34.7 -46.5 -35.4 -21.5 -24.1 in revenues due to decreased economic International reserves (excluding UNMIL and iron ore imports, months of imports) 2.7 2.8 3.0 3.0 3.0 activity, which will further constrain Government operations and the payment Public external debt (% GDP) 15.1 20.4 25.2 28.3 30.3 of salaries across Ministries and Agencies. Public domestic debt ( % GDP) 16.1 14.0 12.4 12.1 11.6

Table : Sierra Leone Key Macroeconomic Indicators 4. In Sierra Leone, the overall economic impact in the short to 2014 2015 2016 medium term is expected to be (In per cent of GDP, unless otherwise indicated) 2013 substantial with a projected Prel. Proj. Proj. decline of 3% of GDP in 2014, Annual GDP growth, with iron or e 20.1 11.3 8..9 8.2 mainly from non–iron ore sources such as agriculture, Services and Inflation rate (CPI, annual average) 8 . 5 7.7 6.7 5.7 non-mining industry. Growth in Fiscal balance (including grants, % GDP) -1.8 -4.2 -4.0 -3.8 economic activity is now projected at 8% instead of 11.3%. Inflation Total revenue and grants (% GDP ) 12 .4 12.8 13.6 13.7 which had been in the single digits Total expenditure and net lending (% GDP) 17.6 20.7 20.4 20.4 for the first time in 5 years at 6.5% in April 2014 aided by a sound External current account balance (incl. official grants, % GDP) -12.4 -10.5 -9.4 -8.7 monetary policy. Inflation is International reserves (excluding iron ore imports, months of imports) 3 . 4 3.4 3.7 4.0 currently at 7.9% with higher predicted Inflation expectations in External Public debt Including IMF % GDP) 25.1 27.4 25.3 25.9 the months ahead. Revenue receipts currently at 12.8% of GDP and low even at SSA levels would be adversely affected and projected to decline by US$ 66 million reducing government’s projected annual revenue by 12%. With revenue decline and anticipated expenditure increases to contain the EVD epidemic, there would pressure on deficit financing currently 4.2% of GDP. Preliminary estimates indicate the primary deficit would increase to 9.0% of GDP. Further budget support and extra financing from development partners would be required to close this financing gap.

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There would also be challenges in managing the debt profile as government considers borrowing from domestic sources increasing pressures on interest rates and cost of borrowing. Trade balance positions had improved significantly due to increased exports from iron ore. Projections from iron ore companies indicate a minimal impact on exports, however exports of other commodities such as cocoa and coffee would be severely impacted.

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ANNEX 4 – Political Context and Governance Fact Sheets

A. Côte d’Ivoire

Governance and Political Developments

Political Context: Political stance improved markedly since the resolution of the civil unrest which resulted from the Presidential elections of November 2010. General elections were held in December 2011 (legislative elections) and April 2013 (communal). However, the main opposition party (FPI) boycotted those elections. The next Presidential elections are scheduled in November 2015 and it is expected that all main political parties will participate to the contest. However, in the absence of a consensual autonomous electoral commission, social unrests may occur but will likely be manageable by the authorities of Côte d’Ivoire.

Governance: Authorities stepped up efforts to improve the country’s governance situation over the last three years. Côte d’Ivoire scores improved slightly in the Mo Ibrahim Governance Index from 46 in 2010 to 44th in 2013. The government has embarked on a wide program to address governance issues pertaining to enhancing tax administrations efficiency; adoption of a new wage bill strategy spanning the medium-term in May 2014. Other reforms include streamlining public procurement; strengthening of budget control and oversight institutions. These efforts resulted in increased revenue mobilization. However, the management of internal arrears is still of concern and perception of corruption is still high within the public sector sphere as the country was ranked 136th in the 2013 Transparency International Corruption perception index (130th in 2012).

B. Guinea

Governance and Political Developments

Political Context: The recent political context has been marked by the holding of multi- party elections, after several postponements, and the subsequent formation of a new Government. The legislative elections held in September 2013, after a wave of protests and social unrest, led to the establishment of a pluralistic National Assembly where the Presidential Coalition has an absolute majority of seats. Political tensions may arise in the run up to the to the Presidential elections of 2015, making the socio-political climate in the country is fragile. This fragility could be exacerbated by the raging Ebola epidemic if not contained.

Governance : Despite the significant efforts made, Guinea is still among the countries that are struggling to improve governance in the management of public affairs. The country ranked 42nd out of 52 countries in Africa with a score of 43.2, compared to the continental average of 51.6 on the Mo Ibrahim Index. Furthermore, although several institutions have been established, such as the National Anti-Corruption Agency set up in 2004 with Bank support5, the General State Inspectorate, the General Inspectorate of Finance, and Sector Inspectorates, corruption continues to plague the Government administrative machinery. According to Transparency International, in 2011 Guinea ranked 150th out of 175 countries in the world, 11th in Africa, and 2nd in West Africa. However, as from 2012, there has been a slight improvement since the country has moved to 154th out of 175 countries in the world and 8th in Africa. The weak capacity of institutions and lack of coordination

XIV between them, as well as low salaries and operating budgets, have slowed down the achievement of positive results in terms of improved governance.

C. Sierra Leone

Governance and Political Developments

Political environment. Since the end of the civil conflict in 2001, Sierra Leone has had three free and fair presidential elections. Power was handed over peacefully in 2007 to President Ernest Bai Koroma, who won a second mandate in 2012. Risk of conflict remains latent but broadly manageable. While assessed to be transitioning out of fragility, Sierra Leone is still under risk of reversal, with many underlying fragility drivers, including high rates of youth unemployment, high levels of corruption, and disputes over access to resources and property rights around extractive sites.

The Ebola epidemic has only further amplified an already fragile situation, beyond constituting a critical health crisis, it is having important knock on effects on the economy and livelihoods. Government institutions are under serious strain to deal adequately with the situation, and on 30th July 2014, the President proclaimed a public state of Emergency. Soldiers have been deployed to enforce the strict quarantine on neighborhoods affected by the virus, and a law was passed by parliament on 23rd August making is a crime to hide Ebola patients. The quarantine of certain areas has sparked some tension, primarily due to food insecurity. Following criticism on the Governments response to the crisis, the President appointed a new Minister of Health and Sanitation on 29th August 2014. Tensions have also been growing among medical staff, due to poor pay, insufficient protection or compensation for dealing with Ebola patients.

Governance Overview: Corruption, particularly related to the management of mineral resources, continues to be a serious challenge for the country’s public and private sectors. In 2013, Sierra Leone scored 30 on the Corruption Perception Index, 0 being highly corrupt and 100 highly clean, ranking it 119/177, an improvement from last year’s ranking of 123. Governance of health sector- public health institutions: Sierra Leone has some of the poorest health indicators in the world, with life expectancy of 47 years, an under-five mortality rate of 182 per 1,000 live births and a maternal mortality ratio of 1100 per 100,000 births (WHO, 2012). Health care costs remain very high in Sierra Leone, resulting in poor utilization (on average 0.5 visits per person per year). Out of pocket expenses of about 70% remain among the highest in Africa (NHA Report, 2007). There is an average of 2 physicians per 1000 population and 17 nurses, which is a fraction of the regional average. These are all strong indications of under resourced and inefficient health sector, which would be extremely poorly equipped to deal with a crisis on the scale of the Ebola crisis. The government launched the National Health Sector Strategic Plan (NHSSP) 2010-2015 in 2009 to help achieve the health sector priorities identified in Poverty Reduction Strategy Paper 2 and the health-related MDGs. The NHSSP aims to ensure the successful implementation of the Basic Package of Essential Health Services (BPEHS), so that service delivery can be improved. The goal of the overall package is to ensure the provision of minimal essential quality care for all, and it includes services that have the greatest impact on major health problems, especially maternal and child health. In addition, the Free Health Care Initiative (FHCI) for pregnant women, lactating mothers and children under five years was launched by the President in April 2010. The objective is to provide a package of fully

XV subsidized services free of charge. Since the launch of NHSSP, health expenditures have risen as a percentage of total expenditure from 10.9% in 2008 to 12.3% in 2012.

In response to the Ebola Crisis the Government has created a designated website to provide information on Ebola, including information of Government expenditures and donations to deal with Ebola. This is an important initiative towards not only ensuring access to critical information to the public around the disease, but also ensuring full transparency.

D. Liberia

Political Situation

While Liberia is clearly still a country in transition, the Ghana Peace Accord (2003) that brought to an end the civil conflict that previously bedevilled the country has been in place for more than ten years now (the country celebrated the tenth anniversary of the peace accord in August 2013). The current President is serving a second term, and there is a strong political will and commitment to maintain peace and stability and enhance governance reform. However, mutual distrust among the primary political players and institutions continues to hamper effective political governance. The current downsizing of the UN mission in Liberia (UNMIL) is confirmation of greater confidence in the political stability of Liberia but presents the country with greater responsibilities, especially for security in some counties along its borders with Côte d’Ivoire, Guinea, and Sierra Leone. Strong leadership on political stability remains vital especially with the upcoming mid-term legislative elections which will be held in October 2014, to be followed by the next presidential elections in 2017.

Governance Developments

Impressive progress has been made starting around 2006 in the areas of political rights, civil liberties, and freedom of the press (as demonstrated by the 2012 Mo Ibrahim Index of Participation and Human Rights, noting an improvement from a rank of 30th in 2006 to 22nd of 52 participating countries in 2012. Liberia has also made reasonable progress establishing anti-corruption and oversight institutions, as demonstrated by the improvement in the country’s ranking in the Transparency International Corruption Index from 150th in 2007 to 83rd of 177 countries in 2013. However, the political environment continues to be contentious, with regular allegations of corruption. A USAID report notes that the fundamental governance problem in Liberia has to do with lack of governmental accountability and effectiveness at every level of government and a perceived culture of impunity. Despite increased transparency in dealing with cases of alleged corruption, the follow through has been weak and many cases have not been prosecuted. As part of the reform process, the Government is supporting decentralization to improve inclusive governance although this will be constrained by poor infrastructure and lack of capacity at local levels.

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Governance of the Health Sector

Several years of conflict have contributed to the deterioration of health care services in Liberia. Estimates put the number of full time and part time health workers at 5000 to service a population of 3.8 million. The total number of doctors is estimated at around 50. According to the WHO the health care delivery system in Liberia is still in the emergency phase and is heavily reliant on additional external resources in order to increase primary health care coverage and build human and institutional capacity. The government contribution to total health expenditures, estimated at 16.8 percent, is one of the lowest in the world (the average for sub-Saharan Africa is 50 percent). Donors finance 50 percent of total health expenditures and households 33.3 percent. About 80 percent of the health services are provided by NGOs. Access to basic and secondary health care services is still a major problem as more than 75% of the population has no access to referral care services such as essential and emergency obstetric care. A heavily donor-dependent country with an under-five mortality rate of 235/100,000 (compared to the sub-Saharan average of 102/100,000) and one of the highest maternal mortality rates in the world (580/100,000), Liberia is Taking action to transform and strengthen its weakened health sector. In 2007, MOHSW launched the National Health Policy and Plan, addressing human resource needs to better deliver services. It was expanded in 2011 to strengthen the previous policy and to provide qualified health workers at all levels of care. At the core of this policy was the establishment of a variety of payment schemes and related incentive packages, a mix whose original aim was to attract and retain good health workers, especially in rural areas of the country.

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