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World Bank Document Document of The World Bank Public Disclosure Authorized FOR OFFICIAL USE ONLY Report No: 94188-DJ INTERNATIONAL DEVELOPMENT ASSOCIATION PROJECT PAPER Public Disclosure Authorized ON A PROPOSED ADDITIONAL FINANCING IN THE AMOUNT OF US$7 MILLION FUNDED FROM HEALTH RESULTS INNOVATION TRUST FUND TO THE REPUBLIC OF DJIBOUTI Public Disclosure Authorized FOR THE IMPROVING HEALTH SECTOR PERFORMANCE PROJECT April 8, 2015 Health, Nutrition and Population Global Practice Middle East and North Africa Public Disclosure Authorized This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization. CURRENCY EQUIVALENTS (Exchange Rate Effective February 28, 2015) 1 USD = 178 FDJ FISCAL YEAR January 1 – December 31 ABBREVIATIONS AND ACRONYMS ADDS Djiboutian Agency for Social Development (Agence Djiboutienne pour le Développement Social) CAMME Drug Fund (Centrale d’Achat des Médicaments et Matériels Essentiels) CAS Country Assistance Strategy CAP Purchasing Unit (Cellule d’achat de Performance) CMH Regional Health Centers (Centres medico-hospitaliers) COGES Health Management Committees (Comités de Gestion de Santé) COSAN Health Committee (Comité de santé) CREN Centers for Recovery and Nutrition Education CSC Community Health Centers (Centres de Santé Communautaire) DEPCI Direction des Etudes, Planification et Coopération Internationale DISED National Statistics Office (Direction Statistique de Djibouti) DOTS Directly Observed Treatment Short-course DPS Heath Promotion Directorate (Direction de la Promotion de la Santé) DRHF Directorate of Human and Financial Resources (Direction des Ressources Humaines et Financières) DRS Regional Health Directorates (Direction des Régions Sanitaires) DSME Directorate of Maternal and Infant Health (Direction de Santé Maternelle et Infantile) EEP Eligible Expenditure Payments EIA Environmental Impact Assessment EMP Environmental Management Plan FDI Foreign Direct Investment HRITF Health Results Innovation Trust Fund HSDP Health Sector Development Project IGSS Inspectorate General of Health Services (Inspection Générale des Services de Santé) IFR Interim Financial Report IMCI Integrated Management of Childhood Illnesses INDS National Initiative for Social Development (Initiative Nationale de Développement Social) MBB Marginal Budgeting for Bottlenecks MDG Millennium Development Goal MEFIP Ministry of Economy and Finance, in charge of Industry and Planning MNH Maternal and Neonatal Health MOH Ministry of Health PAPSS Projet d’Amélioration de la Performance du Secteur de la Santé PBF Performance Based Financing ii POM Project Operational Manual PAPFAM Pan Arab Project for Family Health PEV Expanded Programme for Immunization (Programme Elargi de Vaccination) PFS Project Financial Statements PIU Project Implementation Unit PNDS National Health Development Plan (Plan National de Développement de la Santé) PRSP Poverty Reduction Strategy Paper RBF Results-Based Financing SIS Health Information System (Système d’Informations Sanitaires) SOE Statement of Expenditure STI Sexually Transmitted Infections VCT Voluntary Counseling and Testing WHO World Health Organization Regional Vice President: Hafez Ghanem Acting Country Director: Poonam Gupta Senior Global Practice Director: Timothy Evans Practice Manager/Manager: Enis Barış Task Team Leader: Emre Özaltın iii DJIBOUTI HEALTH HRITF PROJECT CONTENTS Project Paper Data Sheet…………………………………………………………………………...v Project Paper I. Introduction……………………………………………………………………….8 II. Background and Rationale for Additional Financing…………………………….9 III. Proposed Changes……………………………………………………………….13 IV. Appraisal Summary……………………………………………………………..16 V. World Bank Grievance Redress…………………………………………………17 Annexes 1. Revised Results Framework and Monitoring Indicators…………………..........18 2. Systematic Operations Risk-rating Tool……………………………………...…21 3. Performance-Based Financing Indicators………………………..…….………..22 4. Additional Financing Budget…………………………………………………....23 5. Quality Assessment Tool Summary……………………………………...……..24 6. Project Results to Date………………………………………………………….25 7. Financial Management……..……………………………………………………27 iv DJIBOUTI HEALTH HRITF PROJECT ADDITIONAL FINANCING DATA SHEET Basic Information - Additional Financing (AF) Acting Country Director: Poonam Gupta Sectors: Health (100%) Practice Manager/Senior Global Practice Themes: Health system performance Director: Enis Barış/Timothy Evans (40%), Child health (25%), Population and Team Leader: Emre Özaltın reproductive health (25%), HIV/AIDS Project ID: P152705 (5%), Other communicable dis eases (5%) Expected Effectiveness Date: June 30, 2015 Environmental category: B Lending Instrument: IPF Expected Closing Date: December 31, Additional Financing Type: Scale up 2018 Joint IFC: No Joint Level: Basic Information - Original Project Project ID: P131194 Environmental category: B Project Name: Improving Health Sector Expected Closing Date: December 31, Performance 2018 Joint Level: No Joint IFC: No Lending Instrument: Investment Project Fragility or Capacity Constraints [ ] Financing Financial Intermediary [ ] Series of Projects [ ] AF Project Financing Data [ ] Loan [ ] Credit [ X ] Grant [ ] Guarantee [ ] Other: Proposed terms: AF Financing Plan (US$m) Source Total Amount (US $m) Total Project Cost: 7 Cofinancing: Borrower: Total Bank Financing: 7 IBRD IDA HRITF Grant 7 New Recommitted Client Information v Recipient: Ministry of Finance Responsible Agency: Ministry of Health Contact Person: H.E. Dr Kassim Issak Osman Telephone No.: 253-21356300 Fax No.: Email: AF Estimated Disbursements (Bank FY/US$m) FY 2015 2016 2017 2018 Annual 1 1 2.8 2.2 Cumulative 1 2 4.8 7 Project Development Objective and Description Original project development objective: to improve the utilization of quality health care services for maternal and child health and communicable disease control programs (HIV/AIDS, tuberculosis and malaria). Revised project development objective: to improve the utilization of quality health care services for maternal and child health and communicable disease control programs (HIV/AIDS and tuberculosis). The revised PDO will be applicable to the original IDA Credit as well. Project description: Component 1: Improving health service delivery performance. This component supports the delivery of improvements in: (i) child health services such as immunization, Integrated Management of Childhood Illnesses (IMCI), and treatment of malnutrition; (ii) maternal child health services such as prenatal care, family planning, skilled-attended delivery, and emergency obstetric care; and (iii) prevention and treatment services of HIV/AIDS and other prevalent communicable diseases. (Component 1 of the original Project as well as the additional financing is amended to exclude malaria.) Component 2: Strengthening health system management. This component supports activities aimed at strengthening the management capacity of the Ministry of Health (MOH) and improving the performance of the different health systems in support of health services. Component 3: Strengthening project management and monitoring and evaluation capacity. This component supports the Project Implementation Unit (PIU) in managing project activities and fiduciary functions, including financial management, procurement, and environment. Component 2 exists in the original project but not in the additional financing. For the purposes of the additional financing, and hereafter in this document, Component 1 is referred to as Component A and Component 3 is referred to as Component B. Safeguard and Exception to Policies Safeguard policies triggered: Environmental Assessment (OP/BP 4.01) [ X ]Yes [ ] No Natural Habitats (OP/BP 4.04) [ ]Yes [ X ] No Forests (OP/BP 4.36) [ ]Yes [ X ] No Pest Management (OP 4.09) [ ]Yes [ X ] No Physical Cultural Resources (OP/BP 4.11) [ ]Yes [ X ] No Indigenous Peoples (OP/BP 4.10) [ ]Yes [ X ] No Involuntary Resettlement (OP/BP 4.12) [ ]Yes [ X ] No Safety of Dams (OP/BP 4.37) [ ]Yes [ X ] No Projects on International Waterways (OP/BP 7.50) [ ]Yes [ X ] No Projects in Disputed Areas (OP/BP 7.60) [ ]Yes [ X ] No vi Is approval of any policy waiver sought from the Board (or MD if RETF [ ]Yes [ X ] No operation is RVP approved)? Has this been endorsed by Bank Management? (Only applies to Board [ ]Yes [ ] No approved operations) Does the project require any exception to Bank policy? [ ]Yes [ X ] No Has this been approved by Bank Management? [ ]Yes [ ] No Conditions and Legal Covenants: Financing Agreement Reference Description of Condition/Covenant Date Due Article IV, 4.01 (a) The execution and delivery of this By effectiveness Agreement on behalf of the Recipient have been duly authorized or ratified by all necessary governmental action; Article IV, 4.01 (b) The Project Steering Committee By effectiveness (PSC) has been established with a composition and terms of reference acceptable to the Association. Schedule 2, Section II.B.4 The Recipient shall recruit an external Not later than two (2) months auditor whose qualifications, after Effective Date experience and terms of reference shall be acceptable to the Association. Schedule 2, Section I.F.1(a) The Recipient shall appoint external Not later than one (1) month monitoring and evaluation experts after the Effective Date (“Independent Verifiers”), to act as third-party verifiers of the proper fulfillment of the DLIs set forth in RBF Manual and the respective Participating Health Care
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