Document of The World Bank FOR OFFICIAL USE ONLY Public Disclosure Authorized Report No: 58498-SV PROJECT APPRAISAL DOCUMENT ON A Public Disclosure Authorized PROPOSED LOAN IN THE AMOUNT OF US$80 MILLION TO THE REPUBLIC OF EL SALVADOR FOR THE Public Disclosure Authorized STRENGTHENING PUBLIC HEALTH CARE SYSTEM PROJECT June 9, 2011 Human Development Management Unit Central America Country Management Unit Latin America and the Caribbean Public Disclosure Authorized This document is being made publicly available prior to Board consideration. This does not imply a presumed outcome. This document may be updated following Board consideration and the updated document will be made publicly available in accordance with the Bank‘s Policy on Access to Information. CURRENCY EQUIVALENTS Exchange Rate: Effective April 29, 2011 Currency Unit = US Dollar US$1 = SDR 0.6 FISCAL YEAR January 1, 2011 – December 31, 2011 ABBREVIATIONS AND ACRONYMS CLAP Latin American Center for Perinatology CPHC Comprehensive Primary Health Care Strategy CPS Country Partnership Strategy FESAL National Health Survey FOSALUD Solidarity Fund for Health GDP Gross Domestic Product IADB Inter-American Development Bank IBRD International Bank for Reconstruction and Development ICB International Competitive Bidding IDA International Development Association IFR Interim Unaudited Financial Report IPPF Indigenous Peoples Planning Framework ISSS Salvadorian Social Security Institute MDG Millennium Development Goals MINSAL Ministry of Health NCB National Competitive Bidding NGO Non-Governmental Organization NHS National Health Service OP/BP Operational Policy/Bank Policy ORAF Operational Risk Assessment Framework PAHO Pan American Health Organization PCU Project Coordination Unit PDO Project Development Objectives PTAC Technical Advisory Committee of the Project RHESSA Hospital Reconstruction and Health Service Extension Project RIISS Integral and Integrated Health Care Service Networks SAFI Integrated Financial Management System SBD Standard Bidding Document SEM National Medical Emergencies System SDR Standard Drawing Rights SIBASI Integrated Health Basic System SUIS Single Unified Health Information System UACI Institutional Procurement and Contracting Unit UFI Institutional Financing Unit USAID United States Agency for International Development WHO World Health Organization Vice President: Pamela Cox Country Director: Carlos Felipe Jaramillo Sector Director: Keith Hansen Sector Manager: Joana Godinho Task Team Leader: Rafael Cortez ii Table of Contents I. STRATEGIC CONTEXT ............................................................................................................ 1 A. Country Context ........................................................................................................... 1 B. Sectoral and Institutional Context ................................................................................ 1 C. Higher Level Objectives to which the Project Contributes .......................................... 7 II. PROJECT DEVELOPMENT OBJECTIVES (PDO) ...................................................................... 7 A. PDO .............................................................................................................................. 7 III. PROJECT DESCRIPTION ....................................................................................................... 8 A. Project Components ...................................................................................................... 8 B. Project Financing .......................................................................................................... 9 C. Lessons Learned and Reflected in the Project Design ............................................... 10 IV. IMPLEMENTATION ............................................................................................................. 10 A. Institutional and Implementation Arrangements ........................................................ 10 B. Results Monitoring and Evaluation ............................................................................ 11 C. Sustainability .............................................................................................................. 12 V. KEY RISKS ............................................................................................................................ 12 VI. APPRAISAL SUMMARY ....................................................................................................... 13 A. Economic and Financial Analysis .............................................................................. 13 B. Technical .................................................................................................................... 13 C. Financial Management ............................................................................................... 14 D. Procurement ................................................................................................................ 14 E. Social .......................................................................................................................... 15 F. Environment ............................................................................................................... 15 Annex 1: Results Framework and Monitoring.............................................................................. 16 Annex 2: Detailed Project Description ........................................................................................ 21 Annex 3: Implementation Arrangements ..................................................................................... 33 Annex 4: Operational Risk Assessment Framework (ORAF) ...................................................... 47 Annex 5: Implementation Support Plan ........................................................................................ 51 Annex 6: Team Composition ........................................................................................................ 54 Annex 7: Economic Analysis........................................................................................................ 55 iii PAD DATA SHEET Republic of El Salvador Strengthening Public Health Care System Project PROJECT APPRAISAL DOCUMENT Latin American and the Caribbean Region LCSHH Date: June 9, 2011 Sector(s): Health (100%) Country Director: Carlos Felipe Jaramillo Theme (s): Child health (20%); Health system Sector Director: Keith Hansen performance (60%); and Population and Sector Manager: Joana Godinho reproductive health (20%) Team Leader(s): Rafael Cortez EA Category: C Project ID: P117157 Joint IFC: n/a Lending Instrument: Specific Investment Joint Level: n/a Loan Project Financing Data: Proposed terms: Commitment-linked, fixed-spread loan payable in 30 years, including a grace period of 5 years. [x] Loan [ ] Credit [ ] Grant [ ] Guarantee [ ] Other: Source Total Amount (US$M) Total Project Cost: US$80 Cofinancing: Borrower: Total Bank Financing: US$80 IBRD IDA New US$80 Recommitted Borrower: Republic of El Salvador Responsible Agency: Ministry of Health (MINSAL) San Salvador, El Salvador Tel: (503-2) 205-7332 Fax: (503-2) 271-0008 Estimated Disbursements (Bank FY/US$ m) FY 2012 2013 2014 2015 Annual 25.0 25.0 25.0 5.0 Cumulative 25.0 50.0 75.0 80.0 Project Implementation Period: January 1, 2012 - December 31, 2015 Expected effectiveness date: November 1, 2011 Expected closing date: June 30, 2016 iv Does the project depart from the CAS in content or other ○ Yes X No significant respects? If yes, please explain: Does the project require any exceptions from Bank policies? ○ Yes X No Have these been approved /endorsed (as appropriate by Bank ○ Yes ○ No management? Is approval for any policy exception sought from the Board? ○ Yes X No If yes, please explain: N/A Does the project meet the Regional criteria for readiness for X Yes ○ No implementation? If no, please explain: N/A Project Development Objective: The objectives of the Project are to: (i) expand the coverage, quality, and equity in utilization of priority health services provided under the Integral and Integrated Health Care Service Networks (RIISS); and (ii) strengthen the Ministry of Health‘s (MINSAL) stewardship capacity to manage essential public health functions. Project Description: Component 1: Expansion of Priority Health Services and Programs (US$45 million) 1. Strengthening the quality and delivery capacity of priority health services under the RIISS through: (a) the gradual implementation of the Comprehensive Primary Health Care (CPHC) strategy, which includes the acquisition of medical equipment and the maintenance and minor rehabilitation of facilities; and (b) the improved delivery of selected priority public health programs, including those addressing maternal health, reproductive and sexual health, teenage pregnancy, child health, nutrition, dengue control, and chronic kidney disease. 2. Supporting the implementation of the National Medical Emergencies System (SEM) in about 16 Eligible Hospitals through: (a) improving the coordination between the national hospital system and other entities such as MINSAL, Salvadorian Social Security Institute (ISSS), Ministry of Defense, the National Civil Police, Solidarity Fund for Health (FOSALUD), and the Red Cross; (b) supporting the installation of a national call system for emergencies; (c) improving the resuscitation room equipment and the ambulance fleet; (d) training of medical and paramedic staff in the management of medical emergencies;