Document of The World Bank FOR OFFICIAL USE ONLY Public Disclosure Authorized Report No.: 63857 - MD PROJECT PAPER ON A PROPOSED ADDITIONAL CREDIT Public Disclosure Authorized IN THE AMOUNT OF SDR 6.6 MILLION (US$10.2 MILLION EQUIVALENT) TO THE REPUBLIC OF MOLDOVA FOR A HEALTH SERVICES AND SOCIAL ASSISTANCE PROJECT Public Disclosure Authorized November 9, 2011 Human Development Sector Unit Europe and Central Asia Region This document has a restricted distribution and may be used by recipients only in the performance of Public Disclosure Authorized their official duties. Its contents may not otherwise be disclosed without World Bank authorization CURRENCY EQUIVALENTS (Exchange Rate Effective: August 2011) Currency Unit = Moldova Leu (MDL) MDL 11.44 = US$1 USD 1.561619 = SDR 1 FISCAL YEAR January 1 – December 31 ABBREVIATIONS AND ACRONYMS AF Additional Financing HSSAP Health Services and Social Assistance Project CIS Commonwealth of Independent IDA International Development States Association CNAM Compania Nationala de Asigurari in IP Implementation Progress Medicina CPS Country Partnership Strategy KPI Key Performance Indicators DP Development Partners MoF Ministry of Finance DPO Development Policy Operation MoH Ministry of Health EC European Community MoLSPF Ministry of Labor, Social Protection, and Family EMP Environmental Management Plan PDO Project Development Objective ECA Europe and Central Asia PHC Primary Health Care EU European Union POM Project Operational Manual FD Family Doctor RHC Rural Health Center FM Financial Management SAAIS Social Assistance Automated Information System FMR Financial Monitoring Report SIL Specific Investment Loan GFPCRG Global Food Price Crisis Response SP Social Protection Grant GoM Government of Moldova SWAp Sector Wide Approach HCWM Health Care Waste Management WHO World Health Organization HMIS Health Management Information System Vice President: Philippe Le Houérou Country Director: Martin Raiser Sector Director: Ana Revenga Sector Manager: Daniel Dulitzky Task Team Leader: Paolo Belli i REPUBLIC OF MOLDOVA ADDITIONAL FINANCING FOR HEALTH SERVICES AND SOCIAL ASSISTANCE PROJECT CONTENTS DATA SHEET ............................................................................................................................... iii I. Introduction ......................................................................................................................... 1 II. Background and rationale for Additional Financing in the amount of USD 10.2 million equivalent ............................................................................................................................ 1 III. Proposed Changes ............................................................................................................... 8 IV. Appraisal Summary of Proposed Additional Financing ................................................... 10 V. Operational Risk Assessment Framework ........................................................................ 15 VI. Financial Terms ................................................................................................................ 16 Annex 1: Results Framework and Monitoring ....................................................................... 17 Annex 2: Operational Risk Assessment Framework (ORAF) ............................................... 26 Annex 3: List of the selected 35 RHC facilities to be constructed/renovated under the AF ........................................................................................................... 30 Annex 4: Technical Assistance Activities to Support Primary Health Care and Hospital Reforms .................................................................................................... 33 Annex 5: Procurement Plan ................................................................................................... 35 Map IBRD 33448 ii REPUBLIC OF MOLDOVA ADDITIONAL FINANCING FOR HEALTH SERVICES AND SOCIAL ASSISTANCE PROJECT DATA SHEET Basic Information - Additional Financing (AF) Country Director: Martin Raiser Sectors: Health (78%); Other social services Acting Sector Director: Ana Revenga (22%) Sector Manager: Daniel Dulitzky Themes: Health system performance (P); Social Team Leader: Paolo Carlo Belli safety nets (P); Social risk mitigation (S) Project ID: P125719 Environmental category: B Expected Effectiveness Date: February 2012 Expected Closing Date: August 31, 2013 Lending Instrument: SIL Joint IFC: N/A Additional Financing Type: Scale-up Joint Level: N/A Basic Information - Original Project Project ID: P095250 Environmental category: B Project Name: Health Services and Social Expected Closing Date: August 31, 2013 Assistance Lending Instrument: SIL Joint IFC: N/A Joint Level: N/A AF Project Financing Data [ ] Loan [ X ] Credit [ ] Grant [ ] Guarantee [ ] Other: Proposed terms: with 25 years maturity, including 5 years of grace period AF Financing Plan (USD million) Source Total Amount (US $m) Total Project Cost: 10.2 Cofinancing: Borrower: Total Bank Financing: IBRD IDA 10.2 New Recommitted Client Information Recipient: Republic of Moldova Responsible Agency: Ministry of Health; Ministry of Labor, Social Protection and Family Contact Person: Viorel Soltan/Valentina Buliga Telephone No.: 373 22 268883/269387 Fax No.: 373 22 738781/269310 Email: [email protected]/[email protected] iii AF Estimated Disbursements (Bank FY/USD million) FY 2012 2013 2014 Annual 3.7 6.4 0.1 Cumulative 3.7 10.1 10.2 Project Development Objective and Description Original Project development objective: The Project Development Objectives are to increase access to quality and efficient health services, with the aim of reducing premature mortality and disability for the local population, and to improve targeting of social transfers and services to the poor. Revised Project development objective: Not applicable Project description: Component 1: Health System Modernization. This component supports the reform and further development of four key blocks of the health care system, following the Healthcare System Development Strategy for period 2008-2017. Component 1.1: Capacity Development and Sector Regulation. This component contributes to spearhead new policy developments in the areas of Public Private Partnership, monitoring of health financing flows in the healthcare sector (with the preparation of National Health Accounts (NHAs), and human resources’ management development and reform. Component 1.2: Health Care Financing and Provider Payment. This component contributes to reform the way healthcare services are ―paid‖ by government, with a change in the payment system for hospitals, as well as to design strategies to progressively expand health insurance coverage in a fiscally sustainable manner. Component 1.3: Primary Health Care Development. This component supports the: (i) rehabilitation of primary health care facilities in rural areas (Rural Health Facilities, or RHAs); and (ii) updating the curriculum of Family Doctors, and providing training opportunities for them. Component 1.4: Hospital Capacity Assessment and modernization. This component contributes to the: (i) modernization of the Republican Clinical Hospital (RCH), the largest referral facility in the country; (ii) finalization of a new Hospital Master Plan with further hospital optimizations; and (iii) strategy to modernize the Oncologic Institute in Chisinau, and reform the way cancer treatment services are organized. Component 2: Social Assistance and Welfare Component. This component supports the first implementation steps of a new targeted social assistance program, called Ajutor Social, to strengthen government’s capacity to identify the poor, and to efficiently collect and process information for appropriate decision-making. Activities under this Component establish a hardware and software infrastructure supportive to further rolling out Ajutor Social. iv Component 3: Institutional Support. This component supports operating costs of the Project, both in Ministry of Health (MoH), as well as in Ministry of Labor, Social Protection, and Family (MoLSPF). Component 4: Protecting Health and Nutritional Status. This component was introduced as part of the Global Food Price Crisis Response Grant approved in August 2008 and closed on August 28, 2011. The component provided cash support to selected social institutions (mainly kinder-gardens, orphanages, and long-term care institutions), and in-kind nutrition supplement to at-risk pregnant women, lactating mothers, and infants/young children. 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 Does the Project require any waivers of Bank policies? [ ] Yes [X] No Have these been endorsed or approved by Bank management? [ ] Yes [ ] No v I. INTRODUCTION 1. This Project Paper seeks the approval of the Executive Directors to provide an additional credit in an amount of SDR 6.6 million (USD 10.2 million equivalent) to the Moldova Health Services and Social Assistance Project (HSSAP, P095250).