Document of The World Bank FOR OFFICIAL USE ONLY Public Disclosure Authorized Report No: PAD3547 INTERNATIONAL DEVELOPMENT ASSOCIATION PROJECT PAPER ON A PROPOSED ADDITIONAL GRANT IN THE AMOUNT OF SDR 16.8 MILLION (US$23 MILLION EQUIVALENT) OF WHICH SDR 11 MILLION (US$15 MILLION EQUIVALENT) IS Public Disclosure Authorized FROM THE IDA18 REGIONAL SUB-WINDOW FOR REFUGEES AND HOST COMMUNITIES TO THE ISLAMIC REPUBLIC OF MAURITANIA FOR THE HEALTH SYSTEM SUPPORT PROJECT Public Disclosure Authorized March 9, 2020 Health, Nutrition and Population Global Practice 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. CURRENCY EQUIVALENTS (Exchange Rate Effective December 31, 2019) Currency Unit = Mauritania Ouguiya (MRU) MRU 36.61 = US$1 US$1 = SDR 0.723 FISCAL YEAR January 1 – December 31 ABBREVIATIONS AND ACRONYMS AF Additional Financing CBO Community-based Organization CCT Conditional Cash Transfer CERC Contingent Emergency Response Component CF Counterpart Funding CNCR National Consultative Commission on Refugees (Commission Nationale Consultative sur les Réfugiés) DAF Directorate of Financial Affairs (Direction des Affaires Financières) PSHC/EPCV Permanent Surveys on Household Living Conditions (Enquête Permanente sur les Conditions de Vie des ménages) ESMF Environmental and Social Management Framework FM Financial Management GAVI Global Alliance for Vaccines and Immunization GBV Gender Based Violence GDP Gross Domestic Product GEMS Geo-Enabling initiative for Monitoring and Supervision GFF Global Financing Facility HCI Human Capital Index HMIS Health Management Information System IBM Iterative Beneficiary Monitoring ICER Incremental Cost-Effectiveness Ratio IMF International Monetary Fund INAYA1 Health System Support Project IRI Intermediate Results Indicator M&E Monitoring and Evaluation MICS Multiple Indicator Cluster Survey MoH Ministry of Health NCHS National Community Health Strategy 1 INAYA: means taking care in Arabic NGO Nongovernmental Organization OAU Organization for African Unity PBF Performance-based Financing PCU Project Coordination Unit PDO Project Development Objective PHCPI Primary Health Care Performance Initiative PNDS National Plan of Health Development (Plan National de Développement Sanitaire) RBF Results-based Financing RVC Regional Verification Committee RMNCH Reproductive, Maternal, Neonatal and Child Health RSW Regional Sub-window for Refugees and Host Communities SARA Service Availability and Readiness Assessment Index of Availability and Operational Capacity of Services SBCC Social and Behavioral Change Communication SG Secretary General UNHCR United Nations High Commissioner for Refugees UNICEF United Nations Children’s Fund WDI World Development Indicators WFP World Food Programme Regional Vice President: Hafez M. H. Ghanem Country Director: Nathan M. Belete Country Manager: Laurent Msellati Regional Director: Amit Dar Practice Manager: Gaston Sorgho Task Team Leader(s): Moussa Dieng/Christophe Rockmore MAURITANIA HEALTH SYSTEM SUPPORT PROJECT- ADDITIONAL FINANCING TABLE OF CONTENTS I. BACKGROUND AND RATIONALE FOR ADDITIONAL FINANCING ........................................ 7 II. DESCRIPTION OF ADDITIONAL FINANCING .................................................................... 14 III. CLIMATE SCREENING AND CLIMATE CO-BENEFITS ......................................................... 25 IV. KEY RISKS ..................................................................................................................... 25 V. APPRAISAL SUMMARY .................................................................................................. 27 VI. WORLD BANK GRIEVANCE REDRESS .............................................................................. 31 VII. SUMMARY TABLE OF CHANGES ................................................................................... 32 VIII. DETAILED CHANGE(S) .................................................................................................. 32 IX. RESULTS FRAMEWORK AND MONITORING ..................................................................... 36 ANNEX 1: OUTCOMES ON SELECTED RMNCH AND NUTRITION INDICATORS ......................... 47 ANNEX 2: REFUGEES AND HOST COMMUNITIES—WORLD BANK PROGRAM IN MAURITANIA 48 ANNEX 3: THEORY OF CHANGE ............................................................................................ 52 ANNEX 4. FINANCIAL MANAGEMENT AND DISBURSEMENTS ARRANGEMENTS ..................... 54 ANNEX 5. CLIMATE CHANGE SCREENING AND CLIMATE CO-BENEFITS................................... 55 ANNEX 6. MAURITANIAN MAP OF REFUGEES AND HOST COMMUNITIES .............................. 57 The World Bank Health System Support Additional Financing (P170585) BASIC INFORMATION – PARENT (Health System Support - P156165) Country Product Line Team Leader(s) Mauritania IBRD/IDA Moussa Dieng Project ID Financing Instrument Resp CC Req CC Practice Area (Lead) P156165 Investment Project HAFH3 (9542) AFCF1 (6550) Health, Nutrition & Financing Population Implementing Agency: Ministry of Health ADD_FIN_TBL1 Is this a regionally tagged project? No Bank/IFC Collaboration No Expected Original Environmental Approval Date Closing Date Guarantee Current EA Category Assessment Category Expiration Date 19-May-2017 30-Jun-2021 Partial Assessment (B) Partial Assessment (B) Financing & Implementation Modalities Parent [ ] Multiphase Programmatic Approach [MPA] [ ] Contingent Emergency Response Component (CERC) [ ] Series of Projects (SOP) [ ] Fragile State(s) [ ] Disbursement-Linked Indicators (DLIs) [ ] 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) Page 1 of 57 The World Bank Health System Support Additional Financing (P170585) Development Objective(s) The Project Development Objective is to improve utilization and quality of Reproductive Maternal Neonatal and Child Health (RMNCH) services in selected regions, and, in the event of an Eligible Crisis or Emergency, to provide immediate and effective response to said Eligible Crisis or Emergency. Ratings (from Parent ISR) RATING_DRAFT_NO Implementation Latest ISR 24-Jul-2017 16-Jan-2018 24-Aug-2018 13-Mar-2019 04-Nov-2019 Progress towards achievement of S S S S S PDO Overall Implementation S S MS MS S Progress (IP) Overall Safeguards S S MS MS MS Rating Overall Risk M M M M S BASIC INFORMATION – ADDITIONAL FINANCING (Health System Support Additional Financing - P170585) ADDFIN_TABLE Urgent Need or Capacity Project ID Project Name Additional Financing Type Constraints P170585 Health System Support Restructuring, Scale Up No Additional Financing Financing instrument Product line Approval Date Investment Project IBRD/IDA 30-Mar-2020 Financing Projected Date of Full Bank/IFC Collaboration Disbursement 30-Apr-2023 No Is this a regionally tagged project? Page 2 of 57 The World Bank Health System Support Additional Financing (P170585) No Financing & Implementation Modalities Child [ ] Series of Projects (SOP) [ ] Fragile State(s) [ ] Disbursement-Linked Indicators (DLIs) [ ] 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) [✓] Contingent Emergency Response Component (CERC) Disbursement Summary (from Parent ISR) Net Source of Funds Total Disbursed Remaining Balance Disbursed Commitments IBRD % IDA 17.00 4.95 12.32 29 % Grants % PROJECT FINANCING DATA – ADDITIONAL FINANCING (Health System Support Additional Financing - P170585) PROJECT FINANCING DATA (US$, Millions) SUMMARY-NewFin1 SUMMARY (Total Financing) Proposed Additional Total Proposed Current Financing Financing Financing Total Project Cost 19.00 24.50 43.50 Total Financing 19.00 24.50 43.50 of which IBRD/IDA 17.00 23.00 40.00 Financing Gap 0.00 0.00 0.00 Page 3 of 57 The World Bank Health System Support Additional Financing (P170585) DETAILSNewFinEnh1- Additional Financing World Bank Group Financing International Development Association (IDA) 23.00 IDA Grant 23.00 Non-World Bank Group Financing Counterpart Funding 1.50 Borrower/Recipient 1.50 IDA Resources (in US$, Millions) Credit Amount Grant Amount Guarantee Amount Total Amount Mauritania 0.00 23.00 0.00 23.00 National PBA 0.00 8.00 0.00 8.00 Refugee 0.00 15.00 0.00 15.00 Total 0.00 23.00 0.00 23.00 COMPLIANCE Policy Does the project depart from the CPF in content or in other significant respects? [ ] Yes [ ✔ ] No Does the project require any other Policy waiver(s)? [ ] Yes [ ✔ ] No INSTITUTIONAL DATA Practice Area (Lead) Health, Nutrition & Population Contributing Practice Areas Social Protection & Jobs Page 4 of 57 The World Bank Health System Support Additional Financing (P170585) Climate Change and Disaster Screening This operation has been screened for short and long-term climate change and disaster risks PROJECT TEAM Bank Staff Name Role Specialization Unit Team Leader (ADM Moussa Dieng Economist HAFH3 Responsible) Christophe Rockmore Team Leader HAFH2 Procurement Specialist (ADM Brahim Hamed Procurement EA2RU Responsible) Mohamed El Hafedh Procurement Specialist EA2RU Hendah Financial Management Fatou Fall Samba Financial