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Health Care in a Decentralized Environment

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Health Care in a Decentralized Environment Document of The World Bank FOR OFFICIAL USE ONLY Public Disclosure Authorized Report No: 35901-PE PROJECT APPRAISAL DOCUMENT ON A Public Disclosure Authorized PROPOSED LOAN IN THE AMOUNT OF US$15.0 MILLION TO THE REPUBLIC OF PERU FOR A SECOND PHASE APL Public Disclosure Authorized OF THE HEALTH REFORM PROGRAM January 2 1, 2009 Human Development Sector Unit Bolivia, Ecuador, Peru and Venezuela Country Management Unit Latin America and the Caribbean Region Public Disclosure Authorized This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents mav not otherwise be disclosed without World Bank authorization. CURRENCY EQUIVALENTS (Exchange Rate Effective 0 1/2 1/09) Currency Unit = Nuevo Sol 3.15 - US$l US$ 0.32 - 1 Nuevo Sol FISCAL YEAR January 1 - December31 ABBREVIATIONS AND ACRONYMS AECI Spanish Agency for International IMR Infant Mortality Rate Cooperation (Agencia Espafiola para la Cooperacidn Internacional) APL Adaptable Program Loan INEI National Statistics and Information Technology Institute (Instituto CA Convenios de Adhesidn Nacional de Estadistica e Informhtica) CAS Country Assistance Strategy IRA Acute Respiratory Infectious (Infeccidn Respiratoria Aguda) CLAS Local Committees for Health JICA Japan International Cooperation Administration (Comite's Locales de Agency Administracidn de Salud) COSUDE Swiss Agency for Development and KOICA Korea International Cooperation Cooperation (Agencia Suizapara el Agency Desarrollo y la Cooperacidn) CENAN National Center of Food and Nutrition MOE-MEF Ministry of Economics and Finance (Centro nacional de alimentacidn y Nutricidn) DGPROMS General Directorate for Health Promotion M&E Monitoring and Evaluation (Direccidn General de Promocidn de la MA Management Agreement Salud) DGSP Individual Health General (Direccidn MDG Millennium Development Goal General de Salud de las Personas) DIRESAs Regional Health Office, Direcciones MINSA Ministry of Health Regionales de Salud DISAs Health Directorates, also Regional Health MMR Maternal Mortality Rate Office (Direcciones de Salud) DNI National Identity Document (Documento NGO Non Governmental Organization Nacional de Identidad) DOTS Directly Observed Treatment Strategy OEI Iberoamerican States Organization (Organizacion de estados Iberoamericanos). DPT Diphteria-Tetanus-Pertussis vaccines OGP Planning General Office ECAD The Egyptian Co. for Agricultural PAAG Program to Administer Management Development Agreements (Programa de Administracidn del Acuerdos de Gestidn) EDA Acute Diarrhea Diseases (Enfermedades PAHO-OPS Pan American Health Organization Diarre'icas Agudas) Organizacidn Panamericana de la Salud i FOR OFFICIAL USE ONLY ELITES Itinerant Local Team for Extramural PARSALUD Program for the Support of Health Healthcare Reform (Programa de Apoyo a la Reforma en Salud) ENAHO National Household Survey (Encuesta PCN Project Concept Note Nacional de Hogares) ENDES- National Demographic and Health Survey PCU Project Coordination Unit DHS (Encuesta Nacional de Demografla y PSP Programa Social Protegido Salud) EPS Private Healthcare Insurer PIC Project ImplementationCommittee ESSALUD Social Security in Health of Peru POA Annual Operating Plan (Plan Operativo Anual) ESW Economic Sector Work PSBPT Program for Basic Health for All (Programa de Salud Bhsica Para Todos) EU European Union QUALY Quality Adjusted Life Years FMR Financial Management Report RVP Regional Vice President FONB Basic Obstetric and Neonatal Facilities SBD Standard Bidding Document (Facilidades Obste'tricas Bhsicas) FONE Specialized Obstetric and Neonatal SIS Comprehensive Health Insurance Facilities (Facilidades Obste'tricas (Seguro Integral de Salud) Especializadas) SISFOH Household Targeting System (Sistema de Focalizacidn de Hogares) GDP Gross Domestic Product SIVICOS Community Surveillance System (Sistema de Vigilancia Comunitaria) GOP Government of Peru SNIP National Public Investment System (Sistema Nacional de Inversibn Pziblica) GTZ German Technical Cooperation USMR Under-Five Mortality Rate HIV/AIDS Acquired Immune Deficiency Syndrome UNFPA United Nations Population Fund IADB Inter-American Development Bank UNICEF United Nations Children's Fund IBRD International Bank for Reconstruction and USAID US Agency for International Development Development IDA International Development Association VIGIA Fighting the threats of emergening infectious deseases (Enfrentando las Amenazas de las Enfermedades Infecciosas Emergentes y Reem ergentes) IFC International Finance Corporation WHO-OMS World Health Organization (Organizaci6n Mundial de la Salud) Vice President: Pamela Cox Country Director: Carlos Felipe Jaramillo Sector Director Evangeline Javier Sector Manager Keith Hansen Sector Leader: Omar Arias Task Team Leader: Fernando Lavadenz This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not be otherwise disclosed without World Bank authorization. PERU HEALTH REFORM PROGRAM (SECOND PHASE APL) TABLE OF CONTENTS Page A. STRATEGIC CONTEXT AND RATIONALE ............................................................................... 1 1. Country Context and Sector Issues .................................................................................................. 1 2 . Rationale for Bank Involvement ...................................................................................................... 6 3 . Higher Level Objectives to which the Project Contributes .............................................................. 7 B. PROJECT DESCRIPTION............................................................................................................... 9 1. Lending Instrument .......................................................................................................................... 9 2 . Program objectives and Phases ........................................................................................................ 9 3 . Project Development Objectives and Key Indicators .................................................................... 11 4 . Project components ........................................................................................................................ 13 C. IMPLEMENTATION ...................................................................................................................... 18 1. Partnership Arrangements .............................................................................................................. 18 2 . Institutional and Implementation Arrangements ............................................................................ 18 3 . Monitoring.. and Evaluation of OutcomeslResults .......................................................................... 19 4 . Sustainability .................................................................................................................................. 20 5 . Critical Risks and Possible Controversial Aspects ........................................................................ 21 6 . Loadcredit Conditions and Covenants ......................................................................................... 25 D. APPRAISAL SUMMARY ............................................................................................................... 25 1. Economic and Financial Analysis .................................................................................................. 25 2 . Technical ........................................................................................................................................ 26 3 . Fiduciary ........................................................................................................................................ 26 4 . Social .............................................................................................................................................. 27 5 . Environment................................................................................................................................... 28 6 . Safeguard Policies .......................................................................................................................... 29 7 . Policy Exceptions and Readiness.................................................................................................. -29 Annex 1: Country and Sector or Program Background .............................................................................. 30 Annex 2: Major Related Projects Financed by the Bank and/or other Agencies ........................................ 41 Annex 3: Results Framework and Monitoring ............................................................................................ 48 Annex 4: Detailed Project Description ....................................................................................................... 54 Annex 5: Project Costs ................................................................................................................................ 60 Annex 6: Implementation Arrangements .................................................................................................... 64 Annex 7: Financial Management and Disbursement Arrangements ........................................................... 66 Annex 8: Procurement Arrangements ......................................................................................................... 79 Annex 9: Economic and Financial
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