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Egypt-Supporting-Egypt-S-Universal FOR OFFICIAL USE ONLY Report No: PAD3633 Public Disclosure Authorized INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT PROJECT APPRAISAL DOCUMENT ON A PROPOSED LOAN IN THE AMOUNT OF US$400 MILLION TO THE Public Disclosure Authorized ARAB REPUBLIC OF EGYPT FOR A SUPPORTING EGYPT’S UNIVERSAL HEALTH INSURANCE SYSTEM PROJECT May 26, 2020 Public Disclosure Authorized Health, Nutrition, and Population Global Practice Middle East and North Africa Region 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. Official Use The World Bank Supporting Egypt’s Universal Health Insurance System (P172426) CURRENCY EQUIVALENTS (Exchange Rate Effective May 19, 2020) Currency Unit = Egyptian Pound (EGP) EGP 15.75 = US$1 FISCAL YEAR July 1 – June 30 ABBREVIATIONS AND ACRONYMS AFD Agence Française de Développement (French Agency for Development) CAPMAS Central Agency for Public Mobilization and Statistics CCO Curative Care Organization CERC Contingent Emergency Response Component CHVA Climate and Health Vulnerability Assessment COVID-19 Coronavirus Disease CPF Country Partnership Framework DA Designated Account DALY Disability-Adjusted Life Year DP Development Partner EASPMTM Egyptian Authority for Standard Procurement and Medical Technology Management EE Eligible Expenditure EEC Eligible Expenditure Category EGYCAP Egypt Certified Auditor Program EHSS Environment, Health, and Safety Standards EJU Economic Justice Unit ESCP Environmental and Social Commitment Plan ESF Environmental and Social Framework FFS Fee-for-Service FM Financial Management FMIS Financial Management Information System GAHAR General Authority for Healthcare Accreditation and Regulation GOE Government of Egypt GDP Gross Domestic Product GP General Practitioner GRM Grievance Redress Mechanism GRS Grievance Redress Service HCO Health Care Organization Hep C Hepatitis C Virus The World Bank Supporting Egypt’s Universal Health Insurance System (P172426) HIECS Household Income, Expenditure and Consumption Survey HIO Health Insurance Organization HQIP Healthcare Quality Improvement Project HNP Health, Nutrition, and Population HTA Health Technology Assessment IFC International Finance Corporation IFR Interim Financial Reports IMPD International Medical Procurement Department IPF Investment Project Financing IT Information Technology IVA Independent Verification Agent JICA Japan International Cooperation Agency KPI Key Performance Indicator M&E Monitoring and Evaluation MOE Ministry of Environment MOF Ministry of Finance MOHP Ministry of Health and Population MOSS Ministry of Social Solidarity NCD Noncommunicable Disease NGO Nongovernmental Organization OOP Out-of-Pocket PBC Performance-Based Condition PBR Performance-Based Result PDO Project Development Objective PHC Primary Health Care PMU Project Management Unit POM Project Operations Manual PTES Program of Treatment on the Expense of the State RF Results Framework SC Steering Committee SEP Stakeholder Engagement Plan SESA Strategic Environmental and Social Assessment SHI Social Health Insurance SIA Social Impact Assessment STEP Systematic Tracking of Exchanges in Procurement TA Technical Assistance TEHSP Transforming Egypt’s Healthcare System Project TFR Total Fertility Rate THIO Teaching Hospitals and Institutes Organization TOR Terms of Reference UHC Universal Health Coverage UHIA Universal Health Insurance Agency UHIL Universal Health Insurance Law The World Bank Supporting Egypt’s Universal Health Insurance System (P172426) UHIS Universal Health Insurance System USAID US Agency for International Development WHO World Health Organization Regional Vice President: Ferid Belhaj Country Director: Marina Wes Regional Director: Keiko Miwa Practice Manager: Rekha Menon Task Team Leader(s): Amr Elshalakani, Elizabeth Mziray The World Bank Supporting Egypt’s Universal Health Insurance System (P172426) TABLE OF CONTENTS I. STRATEGIC CONTEXT ...................................................................................................... 6 A. Country Context................................................................................................................................ 6 B. Sectoral and Institutional Context .................................................................................................... 8 C. Relevance to Higher Level Objectives ............................................................................................. 18 II. PROJECT DESCRIPTION .................................................................................................. 19 A. Project Development Objective ..................................................................................................... 21 B. Project Components ....................................................................................................................... 21 C. Project Beneficiaries ....................................................................................................................... 33 D. Results Chain .................................................................................................................................. 35 E. Rationale for Bank Involvement and Role of Partners ................................................................... 36 F. Lessons Learned and Reflected in the Project Design .................................................................... 37 III. IMPLEMENTATION ARRANGEMENTS ............................................................................ 38 A. Institutional and Implementation Arrangements .......................................................................... 38 B. Results Monitoring and Evaluation Arrangements......................................................................... 39 C. Sustainability ................................................................................................................................... 39 IV. PROJECT APPRAISAL SUMMARY ................................................................................... 40 A. Technical, Economic and Financial Analysis ................................................................................... 40 B. Fiduciary .......................................................................................................................................... 47 C. Legal Operational Policies ............................................................................................................... 49 D. Environmental and Social ............................................................................................................... 49 V. GRIEVANCE REDRESS SERVICES ..................................................................................... 56 VI. KEY RISKS ..................................................................................................................... 57 VII. RESULTS FRAMEWORK AND MONITORING ................................................................... 61 ANNEX 1: Sources for Eligible Expenditure Categories for Project-financed Performance Based Conditions ........................................................................................................................... 84 ANNEX 2: UHIS Implementation Schedule ............................................................................ 87 The World Bank Supporting Egypt’s Universal Health Insurance System (P172426) DATASHEET BASIC INFORMATION BASIC_INFO_TABLE Country(ies) Project Name Egypt, Arab Republic of Supporting Egypt’s Universal Health Insurance System Project ID Financing Instrument Environmental and Social Risk Classification Investment Project P172426 Substantial Financing Financing & Implementation Modalities [ ] Multiphase Programmatic Approach (MPA) [✓] Contingent Emergency Response Component (CERC) [ ] Series of Projects (SOP) [ ] Fragile State(s) [✓] Performance-Based Conditions (PBCs) [ ] Small State(s) [ ] Financial Intermediaries (FI) [ ] Fragile within a non-fragile Country [ ] Project-Based Guarantee [ ] Conflict [ ] Deferred Drawdown [ ] Responding to Natural or Man-made Disaster [ ] Alternate Procurement Arrangements (APA) Expected Approval Date Expected Closing Date 16-Jun-2020 31-Oct-2024 Bank/IFC Collaboration Joint Level Yes Complementary or Interdependent project requiring active coordination Proposed Development Objective(s) To (i) increase the coverage of Egypt’s Universal Health Insurance System in Phase I Governorates, (ii) strengthen UHIS-related governance and institutions, and (iii) provide temporary financial protection against high out of pocket health expenditures for vulnerable populations outside Phase I Governorates. Page 1 of 91 The World Bank Supporting Egypt’s Universal Health Insurance System (P172426) Components Component Name Cost (US$, millions) Component 1:Enrollment and empanelment of the population into UHIS 208.00 Component 2: Strengthening UHIS governance, systems and facilitating environment 132.00 Component 3: Providing temporary financial protection against high out of pocket 50.00 health expenditures for vulnerable populations outside Phase I Governorates Component 4: Institutional Capacity Building, Technical assistance and Project 10.00 Management Component 5: Contingent Emergency Response Component (CERC) 0.00 Organizations Borrower: Arab Republic of Egypt Implementing Agency: Ministry of Finance PROJECT FINANCING DATA (US$, Millions) SUMMARY-NewFin1
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