Document of The World Bank Report No. 15046-EGT STAFF APPRAISAL REPORT ARAB REPUBLIC OF EGYPT POPULATION PROJECT FEBRUARY 26,1996 Human Resources Divison Country Department II Middle East and North Africa Region CURRENCY EQUIVALENTS (As of January, 1996) Currency Unit = Egyptian Pound US$ I = LE3.4 LE I = US$0.29 FISCAL YEAR July 1 - June 30 WEIGHTS AND MEASURES Metric System ABBREVIATIONS AND ACRONYMS CPR Contraceptive Prevalence Rate GOE Government of Egypt ICB International Competitive Bidding IDA International Development Association IE&C Information, Education and Communications IMR Infant Mortality Rate MLG Ministry of Local Government MOHP Ministry of Health and Population MOI Ministry of Information MOSA Ministry of Social Affairs NCB National Competitive Bidding NGO Non-Governmental Organization NPC National Population Council OM Operating Manual PAP Population Activities Program PIU Project Implementation Unit SA Special Account SFD Social Fund for Development SOE Statement of Expenses TFR Total Fertility Rate UNFPA United Nations Population Fund USAID United States Agency for International Development THE ARAB REPUBLIC OF EGYPT POPULATION PROJECT STAFF APPRAISAL REPORT TABLE OF CONTENTS 1. SECTOR BACKGROUND ....................................................... I Population Trends ......................................................... Population Policy ........................................................ 3 Sector Financing ........................................................ 4 Main Sector Issues ........................................................ 4 2. BANK ASSISTANCE STRATEGY AND RATIONALE FOR BANK INVOLVEMENT ....................................................... 7 3. THE PROJECT ....................................................... 8 Objectives ........................................................ 8 Project Description ........................................................ 8 4. COSTS and FINANCING ....................................................... 9 Procurement ........................................................ I I Disbursement ........................................................ 12 5. PROJECT IMPLEMENTATION ....................................................... 13 Project Management Arrangements ........................................................ 13 Accounting and Auditing ........................................................ 14 Supervision Requirements and Monitoring ........................................................ 14 6. SUSTAINABILITY AND PARTICIPATION ....................................................... 14 7. PROJECT BENEFITS AND RISKS ....................................................... 1 5 Economic Analysis. ........ ................................................ 1 5 Benefits ......................................................... 16 Risks ........................................................ 16 8. AGREEMENTS AND RECOMMENDATION ................ ....................................... 17 Recommendation ........................................................ 17 This report is based on the findings of an appraisal mission which visited Egypt in October 1995. The team was led by David Steel (MN2HR) and consisted of: Randy Bulatao (Senior Demographer, PHN), Maria MacDonald (Principal Population Specialist, ASTHR), Egbe Osifo (Health Specialist, MN2HR), Pietronella Van Den Oever (Human Resource Specialist, EDIHR) and Prod Laquian (Consultant). The report was put together by Kamar Yousuf, Jackie Perry, and Sabine Mabrouk. Peer Reviewers are Maryse Pierre-Louis (Senior Health Specialist, MNIHR) and Ruth Levine (Population Specialist, AF2PH). The lead adviser is Paul Shaw (Principal Human Resource Specialist, EDIHR). The Division Chief is Jacques Baudouy (MN2HR) and the Department Director is Inder Sud (MN2DR). ii Population Project THE ARAB REPUBLIC OF EGYPT POPULATION PROJECT STAFF APPRAISAL REPORT TABLE OF CONTENTS (CONT.) ANNEXES I. Letter of Population Sector Policy 2. Fertility Determinants and Strategies to Address Them 3. The Institutional Framework in the Population Sector 4. Management Structure of the Population and Family Planning Departrnent, MOHP 5. MOHP Population and Family Planning Department Three Year Business Plan 6. Training and Research Programs for Population and Family Planning Department, MOHP 7. Management Structure of the Community Development Department of the Social Fund 8. Operational Manual for Population Activities Program and Memorandum of Understanding 9. Illustrative Subproject Costs in Population Activities Program 10. Performance Indicator and Monitoring and Evaluation Systems for PAP 11. Beneficiary Consultation Process Proposal 12. Project Cost Tables 13. Project Implementation Unit - Terms of Reference 14. Procurement Arrangements 15. Implementation Schedule 16. Economic Justification of Project 17. Supervision Plan 18. Mid-term Review Terms of Reference 19. Selected Documents and Data Available in Project File ARAB REPUBLIC OF EGYPT POPULATION PROJECT STAFF APPRAISAL REPORT CREDIT AND PROJECT SUMMARY Borrower: Arab Republic of Egypt Executing Agencies: Ministry of Health and Population Social Fund for Development Beneficiaries: Not applicable. Povrtye Calegory: Programs of Targeted Interventions (PTI). Project interventions will be targeted on low-income couples of reproductive age in areas of Egypt where fertility remains high, mainly in rural areas of Upper Egypt. This is expected to have a positive impact on the condition and status of women and children in those areas. Amount: SDR 11.9 million (US$17.2 million equivalent) Terms: Standard IDA with maturity of 35 years Commitment Fee: 0.5 percent on undisbursed credit balance, beginning 60 days after signing, less any waiver. Financing Plan: F US$ (million) Government Beneficiary IDA Total of Egypt Contribution Capacity Building 0.6 2.0 2.6 Population Activities Subprojects 1.0 1.9 15.2 18.1 Total 1.6 1.9 17.2 20.7 Economic Rate of Return: 19 percent. Environm=enaL RatMng: "C" Staff Appraisal Report: Report No. 1 5046-EGT Mu: Map No. IBRD 27482 Population Project 1 THE ARAB REPUBLIC OF EGYPT POPULATION PROJECT STAFF APPRAISAL REPORT 1. SECTOR BACKGROUND Population Trends 1.1 Egypt, the most populous Arab nation, has an estimated population of 57 million (1993) - almost six times greater than its population at the turn of the century. Population growth was highest in the early 1980s at 2.6 percent but has since declined to its current rate of 1.9 percent. Regardless of fertility decline in the short term, the population will reach between 63 and 64 million by the millennium. Thereafter, differences in the rate of fertility decline would show a noticeable impact on achieved population size (Figure 1). Assuming average fertility decline used in Bank projections, the population is expected to exceed 95 million by 2035. A more optimistic fertility decline scenario as demonstrated in figure I suggests that a population of 5 million less could be achieved in 2035. Figure 1: Population Projections for Egypt, 1995-2035 110 100 -1- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ------ -_- Slow Fertility Decline E 90 - - - - - - - - - - - - - - - - -; - - --- -.- Standard Fertility Decline _ / -- Rapid Fertility Decline C 77 _ s - -> - - - - -- -_ 0. 0 6 7 0 - - - - - - - - - - - - - - - - - - - - - - - - - - 50 1995 2000 2005 2010 2015 2020 2025 2030 2035 Years 2 Population Project 1.2 The rate of population growth depends on the rate of natural increase determined by fertility and mortality and the net rate of migration1. The demographic transition in Egypt is underway as indicated by a drop in total fertility rate from 5.0 children per woman in 1980 to 3.8 children in 1993. The drop in fertility has been due to a rise in age of marriage (increased by two years over the last 25 years); and a fall in the demand for children (four in 1980 to three in 1992) resulting in increased contraceptive prevalence from 21 percent in 1980 to 47 percent in 1992. 1.3 Mortality rates have fallen substantially over the last few decades and average life expectancy at birth increased from 46 years in 1960 to 64 years in 1993. The changes in mortality rates have also affected fertility trends - the substantial drop in infant (43 percent) and child (57 percent) mortality over the last fifteen years is partially responsible for the reduced demand for children2. However fertility levels in Egypt remain significantly higher than for other lower-middle income countries (Table 1). This is largely related to the relatively low levels of female education and formal female employment. Table 1 Selected Demographic and Health Indicators in Egypt and Selected Lower-Middle-Income (LMI) Countries3 (1990 - 1993 estimates) TFR Contraceptive Infant Life Female Share Girls Prevalence Mortality Rate expectancy of Labor Force Primary Enrollment M/F Egypt 3.S47 64 .. ..-. ,. 11 . _3 Morocco 3.6 42 66 62/66 21 57 Jordan 5AI 40 27 68/72 11 105 Tunisia 3.1 50 42 67/69 25 112 Turkey 3.3 63 62 65/69 34 107 Syria 5.8 40 36 65/69 18 103 LMI Countries 3.0 N/A 45 64/70 31 97 Source: WDR 1995, Social Indicators of Development, 1995 1 Although migration has been important in Egypt over the last two decades, due to poor statistics and volatile trends it will not be discussed here. 2 In countries with high infant mortality rates parents appear to take into consideration the probability of survival of their infants, and as a result have more children than they really desire. 3 Countries with 1993 GNP per capita between $696 - $2785. Population Project 3 1.4 The Egyptian population is young with 37 percent of the population under 15 while 4 percent are over 65. The proportion of the population in the reproductive age group (15-49), the target age for the family planning program, is expected to increase from 48 percent of the population in 1990 to 54 percent in 2020. Urbanization is increasing and the urban population is projected to increase to 75 percent of the total population by 2025 from 47 percent in 1990. Population density varies by govemorate fluctuating from 22 persons per square kilometer in Suez to 128,000 per square kilometer in parts of Alexandria. 1.5 Regional Variation. The overall reduction in fertility levels in Egypt masks significant disparities within the country as demonstrated in Table 2. Higher fertility levels in rural areas particularly in Upper Egypt are associated with lower educational levels and contraceptive prevalence. This is related in tum to the lower age of first marriage (four years earlier than urban governorates) and the higher demand for children (one child greater than urban governorates). In addition to the greater demand for children, rural women particularly in upper Egypt are less likely to achieve desired fertility rates. Table 2 Selected demographic indicators by region, 1992 Residence Total Fertility Rate Contraceptive Infant Mortality Rate % of ever-married Prevalence women with no education Urban Governorates 2.7 59.1 54.5 27.2 Lower Egypt - Urban 2.8 60.3 43.7 30.0 Rural 4.1 50.5 73.0 60.3 Upper Egypt - Urban 3.6 48.1 65.0 34.4 Rural 6.0 24.3 119.1 70.1 Source: Egypt Demographic Health survey, 1992. Population Policy 1.6 Egypt has had a formal population policy since 1964. It is based on seven premises: (a) each family has the right to decide on its fertility voluntarily on the basis of its religion and values, and to obtain information to make decisions within the framework of its religion; (b) the avoidance of the use of abortion or sterilization as a means of family planning; (c) recognition of a citizen's right to migrate and to move from place to place within Egypt; (d) adoption of a positive incentive system based on increased awareness of the role of the individual and the community and the avoidance of any coercion or negative incentives; (e) educational, cultural and health development of individuals to increase productivity; (f) assignment of local government bodies with the responsibility for implementing programs; and (g) encouragement of voluntary efforts and community participation in the solution of population related problems. 1.7 The population program remains a national priority for the government and in 1993 several targets were set for the year 2007. These targets include reducing the annual population growth rate to 4 Population Project 1.8 percent, the total fertility rate to 2.7, and raising the contraceptive prevalence rate to 65 percent. These targets, although ambitious, are achievable with sustained effort. Sector Financing 1.8 Total expenditure on population and family planning activities was estimated at approximately US$22 million in 1991 (assumes exchange rate of 3.3L.E=$1.00). Of this, 72.8 percent was spent in the not-for-profit sector (the public and NGO sector) and the rest in the for-profit sector. Table 3 provides an estimate of the relative contribution of the Government, donors mainly United States Agency for International Development (USAID) and United Nations Population Fund (UNFPA) and individuals to the program. USAID and UNFPA funding has concentrated mainly on supporting family planning supply and related programs. The cost per Couple-year of Protection in 1991 (CYP) was $5.40 in the not-for-profit sector compared to $2.40 in the for-profit sector. The major reasons for the disparity in costs are the differences in contraceptive mix and the service levels of both sectors. Both sectors are subsidized by donor agencies (table 3), which are committed to supporting population and family planning programs for the next 3-4 years. Table 3 Estimate of the relative contribution of the Government, Donor and Individual contribution to the Population and Family Planning Program Public and NGOs Private Sector GOE 44.4% 5.1% Donor Agencies 51.5% 69.5% User Fees 4.0% 25.4% Total 100.0% 100.00/% Source: Report on Trends of the Costs of the Family Planning Progran in Egypt, 1992. Main Sector Issues4 1.9 Family Size and Family Planning Demand. The demographic transition in Egypt has now entered a new phase, in which interventions to increase demand for smaller family size and for family planning services become essential if fertility rates are to fall further and contraceptive use to continue to increase. To achieve the targets of the national population program, it is necessary both to meet the present identified unmet need for family planning and to stimulate new demand, mainly in poor rural areas. Increasing demand for family planning services is not only essential to ensure growth of the program but it is also required to maintain its present success if the USAID contraceptive subsidy is 4 Fertility determinants and strategies to address them are reviewed in detail in Annex 2. Population Project 5 withdrawn (see below). The fact that six in ten births in the five years preceding 1992 occurred to mothers with one or more risk factors5 reinforces the need to extend the program. 1.10 Fertility levels in Rural Upper Egypt. The total fertility rate in rural Upper Egypt remains extremely high due to a combination of factors - higher demand for children, earlier age of marriage (median age is four years lower than in urban governorates), lower educational levels, greater proportion of women's family planning needs are unmet, and less urbanization. Creating a social climate that is more conducive to fertility decline in this region would require a multi-pronged approach. In addition to addressing broader developmental issues which affect demand for children (such as female education and gender role) specific issues such as access to family planning methods and attitude towards family planning need to be addressed. Upper Rural Egyptian women are ten times more likely than those in urban areas not to know a source for modem family planning methods, and only 60 percent of couples in Upper Rural Egypt approve of family planning methods compared to 80 percent elsewhere. These issues require involvement of religious and civic leaders at central, governorate and local levels. 1.11 National Leadership in the Population Sector. Although Egypt has had a population policy in place for many years, a consistently weak area has been the successive institutions responsible for sectoral leadership and population policy and planning. Part of this weakness stemmed from Government policy which until about eight years ago emphasized fertility reduction occurring as a result of economic development. The National Population Council (NPC), established in 1984, although effective at stimulating change at the local level, was not so effective in providing national leadership. To remedy this situation the Government established a Ministry of Population and Family Planning (MOPFP) in November, 1993 and then merged it into the Ministry of Health to create a new Ministry of Health and Population (MOHP) in January, 1996 as part of a streamlining reform. The purpose of raising population to ministerial status is to ensure that Government plays plays an active leadership role and helps accelerate the demographic transition in Egypt. The NPC will continue with policy, coordination and advocacy functions, but population questions are now brought directly to the attention of the Cabinet. The Population Department of the MOHP is in the process of capacity building. Progress is being made in defining structure, functions and staffing of the ministry and appointments to key management positions were made in January, 1996. A Three Year Business Plan is being prepared to provide a strategic framework to guide the Ministry (Annex 5). Consultants will play a role initially in helping with capacity building. 1.12 At the governorate level, local Population Councils chaired by the Governor direct and coordinate efforts and aid the planning and programming for their governorates. The governorate offices of the Population and Family Planning Department of the MOHP also provide staff, information and office space to carry out these activities. All governorates encourage voluntary activities, for example Women's Committees that work to mobilize communities to become actively involved in solving population related problems and utilizing family planning services. All governorates have a network of Local Information Centers (LIC) operated by the State Information Service of the Ministry of Information (MOI), which coordinate and conduct a wide range of Information, Education and Communications (IE&C) programs at the community level, including the population sector. The Ministry of Social Affairs (MOSA) operates a variety of population related programs and regulates 5 Associated with reduced child survival and maternal mortality. 6 Population Project NGOs. In many governorates links have been established with other institutions. For example family planning clinics have been set up in local agriculture cooperatives and factories, and village level IE&C activities are carried out by Ministry community social workers in association with NGOs. Although the level of local government involvement in population activities is very variable, the level of effectiveness is steadily improving. A large number of other institutions, both private and public play important roles in the sector. Their roles are described in Annex 3. 1.13 Expanding and Improving Reproductive Health Services. Although Egypt now has an extensive network of health care facilities and service quality is improving, quality remains a problem because of the expanding universe of clients and the need for continued face to face counseling particularly in the more conservative areas of the country. In the provision of family planning services there are two main quality issues: (i) limited level of provider/client communication; and (ii) the narrow range of methods available - 86 percent of current users are on the pill or IUD. These issues contribute to the high contraceptive discontinuation rate and the relatively high fertility level given the present contraceptive prevalence rate. About 60 percent of all births are in high-risk categories.6 Consequently improvement in family planning services provided particularly to women in high risk categories would improve the health status of women and children. Quality issues are now being addressed by the MOHP through its "Quality Improvement Project", supported by USAID, which is raising standards at 3200 clinics over five years. The contraceptive mix will be expanded through the introduction of new long acting contraceptives to the program. Workplace clinics and mobile clinics are also being introduced on a selective basis with bilateral donor support. There will need to be strong sectoral leadership (which will be encouraged by the proposed project) to ensure a sustained effort to improve quality of services provided. 1.14 Strengthening the Private Sector. The private sector and NGOs play an important role in the provision of family planning services in Egypt. Private doctors and pharmacies provide 63 percent of contraceptives under the family planning program and are an important source of IE&C as well to the population at large. There are about 400 NGOs of various size and capacity in the population sector. In addition to providing services, many of the NGOs are involved in general education, social marketing and IE&C activities. Religious organizations also provide population and family planning services through mosque based health and welfare centers. It is Government policy to further involve NGOs and to maintain the role of the private sector. However the sector has been heavily subsidized, which places financial limits on its further participation and absorptive capacity of NGOs is still limited. And the quality of family planning services (particularly in provider/client communication) rendered by private pharmacies needs improvement. The potential exists to try new public-private partnerships with less experienced NGOs. Raising the quality of the services provided by pharmacies through training of pharmacists and assistant pharmacists is one focus of USAID assistance. The Government intends to strengthen private sector involvement through a two pronged approach - capacity enhancement to improve the cost effectiveness of NGOs, and a more targeted approach to meeting the needs of the poor. 6High-risk births refer to infants who have a greater probability of dying because they are born to mothers who are too young or too old, born after a short interval or born to mothers with more than 3 children. Population Project 7 1.15 Decentralization. Although Egypt is relatively homogeneous in terms of language and culture, there are pronounced regional differences in values regarding the family and the status of women, which affect the utilization of family planning services, which consequently must fit the perspectives of local populations. Addressing this diversity will require decentralization and systematic testing of innovative approaches to lower social barriers to the use of family planning and to change reproductive behavior. It is Government policy to decentralize implementation of population activities to the governorate level to the extent possible, and one of the factors against which the performance of Governors is evaluated is their success in incorporating population concerns into their programs. As noted above the role of the private sector at the local level will be strengthened. These policies and programs will need vigorous implementation in support of demand stimulation now needed to accelerate Egypt's demographic transition. 1.16 Contraceptive Subsidy Policy. Two thirds of current users of modern methods of family planning services obtain their methods from the private sector. The private sector is heavily subsidized by USAID. In 1992 a monthly cycle of pills purchased in the private sector cost the user on average $0.137, a subsidy of approximately 60 percent. The Government's contraceptive policy aims to: (i) ensure that contraceptives are affordable to poorer sections of the population; (ii) expand the method mix available; (iii) strengthen social marketing programs; and (iv) have richer users pay market price. The Government also expects domestic production of certain contraceptives to begin soon. The Government has stated its commitment to continue addressing all these factors in a Letter of Population Policy to IDA of October 9, 1995 (Annex 1). 2. BANK ASSISTANCE STRATEGY AND RATIONALE FOR BANK INVOLVEMENT 2.1 Poverty remains a serious problem in Egypt (particularly in Upper Egypt) with between 22-30 percent of all households living in poverty. A resumption of economic growth and measures to increase productive employment opportunities for the poor are the first conditions of success for poverty reduction in Egypt. Given the heterogeneity of the poor, these reforms must be supported by human capital formation and welfare interventions targeted to needy groups, of whom women and children form a disproportionate proportion. These should include structural measures to improve equity and cost effectiveness of public expenditures in population, health and education, to provide an enlarged role for the private sector and NGOs in the provision of social services, and to achieve more efficient targeting of all secondary transfers. Population pressures on the education and health systems, social services, the employment market and labor migration, urban areas and the natural resource base will intensify for the foreseeable future, and will strain the Government's capacity to provide social services. The Government must improve its management of population growth, and provide the leadership and encourage the efforts of others if the social, employment, health and education status of women and children are to improve, and if fertility rates are to fall further. 2.2 Within this broad context the Bank is pursuing a two track human resources strategy. The first track supports the Government efforts to strengthen its social safety net as it deepens its economic 7UNFPA, 1993. 8 Population Project reform program and attempts to resume economic growth. IDA is preparing a second Social Fund Project to assist with this. The second track helps achieve realistic progress in the longer term effort in population, health and education. 2.3 The proposed project is in conformity with the Bank Group's Country Assistance Strategy described in the Memorandum of the President for the Agricultural Modernization Project (Report No. P- 6203-EGT) of March 3, 1994. The project addresses the longer term needs in the population sector at a time when the demographic transition has entered a distinct new phase. The project would help the Government incorporate more thoroughly the impact of population related factors into development planning, play an enlarged leadership role at the national level and encourage public and private interventions to stimulate increased demand for smaller family size and for family planning services. The project will also help deepen the Government's commitment to population and family planning programs, which is at present confined to a small high level group, assist in the institutional development of the new MOHP and by supporting NGO and local community activities, will expand their role and open a dialogue between the Government and a group of stakeholders, who have been relatively ignored until recently. Finally if successful, the project could have a demonstration effect for the Middle East as a whole, where population growth rates remain high by global standards. 3. THE PROJECT Objectives 3.1 The overall goals of the project are to help Egypt: (a) better manage population growth and prevent avoidable population growth by giving the MOHP the institutional capacity to play the lead role in the population sector; and (b) improve the conditions and status of women and children in areas where fertility remains high, mainly in rural areas of Upper Egypt, by stimulating additional demand for smaller family size and for family planning services. These objectives will reinforce and expand the goals of the national family planning program. Project Description Part A: Capacity Building ($2.6 million) 3.2 This component would help install capacity in the Population and Family Planning Sector of MOHP for a set of key functions including policy and program development, business planning, sectoral manpower development and training, research programming, planning, resource mobilization, supervision, monitoring and evaluation, and public/NGO/local community program coordination, all based on a 'functional matrix' agreed with the Government. It would complement support being provided under an ongoing UNFPA funded Management Development Project, which will be completed in 1997. A Three Year Strategic Business Plan will provide the overall framework, a set of organizing principles and objectives, indicators against which to monitor progress, and resource requirements for the installation of this capacity. The project would finance project management costs, technical assistance for the priority functions, policy studies, and training for Sector managers and staff. By project completion, the Ministry would have capacities in the population sector to: (a) conduct high level Population Project 9 advocacy and research; (b) undertake strategic leadership of planning, management and interdepartmental coordination for population growth; (c) monitor and evaluate the overall progress of population programs; (d) mobilize and allocate resources for population programs in an efficient way; and (e) support NGO and local community initiatives. Part Ri Population Activities Program (_18.1 milion. 3.3 The Population Activities Program (PAP)8 is designed to stimulate demand for family planning and smaller family size where fertility remains high and demand low, mainly in rural areas of upper Egypt. This component would support grants to NGOs, local community organizations and relevant public sector agencies for small, decentralized proposals. These would include projects to increase awareness of population issues, to strengthen motivation for couples to plan their families, to facilitate access to and use of reproductive health services, and to educate and motivate people in such related areas as child nutrition, safe motherhood, male awareness, and delayed age of marriage. It would also include projects to extend and improve the quality of social change agents, development of capacity to produce local informational material, rural internships for urban youth and professionals, counseling and referral programs for youth, and youth-to-youth campaigns/programs. To ensure that activities are well targeted, proposals would be evaluated using a strategic framework and a typology of interventions with clear, simple criteria, transparently applied. The activities would be monitored and evaluated against specified outcome indicators. By project completion, a series of population activities and interventions would have been carried out, which would contribute to attitudinal and behavioral change in the population of targeted areas towards some of the key determinants of fertility. A project implementation period of five years is required to achieve results. Annex 8 describes the Program in more detail. 4. COSTS AND FINANCING 4.1 The total cost of the project is estimated at US$20.7 million, net of taxes and duties, including US$2.6 million for the capacity building component for the MOHP and US$18.1 million for the PAP component. Foreign exchange costs amount to US$5.5 million and local costs to US$15.2 million. The proposed IDA credit of US$ 17.2 million would finance US$2 million of the capacity building component and US$15.2 million of the PAP component, or 83 percent of the project costs (foreign and local). The Govemment would finance 7 percent of the project costs and NGOs and local community organizations would finance at least 10 percent of the PAP costs. The project has been designed in collaboration with The Family Development Project is an ongoing example of the kind of project that would be financed under the PAP. It is an innovative approach being carried out by the MOHP and the SFD to encourage 30,000 newly married couples in three poor Governorates in Upper Egypt to lower their fertility rates through a process of "family empowerment". Social Change Agents, who are well educated and trained members of their local communities, provide peer counseling, motivational, and family advisory services to 50-75 target families, and guide families to such services as wellness care, health and family planning, literacy programs, job search assistance, access to credit and income generating opportunities. Participating families must pay monthly dues of US$0.30. The project draws from similar programs tried earlier. The project was launched in late 1994. It is too early to evaluate results. 10 Population Project UNFPA and with USAID, which is supporting Governorate level capacity building as well as national family planning programs. Detailed project costs are shown in Annex 12. 4.2 It is expected that about 87 percent of project funds would be provided to NGOs and local community organizations (public and private) under the PAP. It is estimated that the PAP would finance around 100 projects and programs over a five year period, that average project size would be about $180,000, and that average grant size to a single community or village would be about US$20,000 under any single project. Any increase in the average grant size would result in a reduced number of projects funded. Average project size is estimated as a composite average of nine sub-project categories using cost data from the Social Fund for Development (SFD) (see para. 5.2) and several NGOs, which are already implementing these kinds of programs. Beneficiary organizations would make a minimum contribution of 10 percent of project costs, and could contribute more if they wish. There is evidence from ongoing programs to suggest that they will contribute substantially more. Beneficiary organizations could also seek additional funding from other sources for a project, provided that this was justified during project evaluation. 4.3 Since the largest project component is a demand driven financial internediary type operation, there are no physical or price contingencies under this component. Physical contingencies amount to US$0.1 million and price contingencies to US$0.3 million uider the capacity building component. Table 4 Summary Project Costs (US$ million) Local Foreign Total Capacity Building 1.2 1.1 2.3 Population Activities 13.8 4.2 18.0 Subproject l l Total Baseline Costs 15.0 5.3 20.3 Physical Contingencies 0.0 0.1 0.1 Price Contingencies 0.2 0.1 0.3 Total Project Costs 15.2 5.5 20.7 Population Project 11 Table 5 Financing Plan (US$ million) Government of Beneficiary IDA Total Egypt Contribution Capacity Building 0.6 2.0 2.6 Population Activities Subprojects 1.0 1.9 15.2 18.1 Total 1.6 1.9 17.2 20.7 Procurement 4.4 The majority (87 percent) of the procurement under the project is related to the PAP component. It will be carried out under SFD Procurement Procedures using its community participation in procurement procedures, which are in accordance with World Bank Procurement Guidelines (1995). The SFD will use its standardized local bidding procedures and contract forms. These were developed for the Social Fund Project (Cr. 2276-EGT) and the SFD has now had extensive experience with this type of procurement administration, which has proven to be economic and efficient. There will be no civil works contracts financed under the project. The implementing NGO or community organisation would sign contracts and procure goods in accordance with the SFD's procurement guidelines. Small items of equipment, materials and supplies for programs and interventions funded under the PAP would be purchased by the implementing NGO. Contracts for goods would be in the range of US$1,000-20,000, and for services in the range of US$5,000-40,000. Because of the demand driven nature of the sub- projects it is not possible to estimate the cost of respective components in advance. About one-quarter of bid documents (those for contracts with a value of US$100,000 or more) will be subject to the Bank's prior review. However as indicated above the SFD is familiar with the Bank's procurement requirements and uses them well. Packaging of sub-projects in adjacent communities would be undertaken by the SFD and the implementing NGO only when significant implementation efficiencies would result. The SFD will apply its normal ex-post review procedures, which are satisfactory to the Bank. 4.5 Given the small total cost (US$0.6 million) and the small size of contracts within this amount, it is expected that about two-thirds of the goods to be procured under the capacity building component will be contracted through national shopping procedures. Goods estimated to cost less than US$50,000 per contract up to an aggregate amount of $0.2 million will be procured through local shopping procedures soliciting at least three bids from qualified suppliers. In those cases where there is grouping of contracts for goods as a result of packaging of sub-projects, goods estimated to cost between US$50,000 and US$250,000 per contract will be procured through international shopping. Contracts estimated to cost above US$250,000 will be procured following international competitive bidding (ICB) procedures. 4.6 Consultants will be appointed following the World Bank Consultant Guidelines using the World Bank's standard forms of contract for consultant services. Many consultant assignments will be small in 12 Population Project value and will require specialized staff with knowledge of local language and traditions working on long term assignments. This will necessitate their selection from among local consultants. Egypt has qualified local consulting firms with the expertise required. The threshold for prior review of individual consultants is US$50,000 and US$100,000 for firms. The SFD will be responsible for monitoring procurement activities of project beneficiaries, and compliance of suppliers with contract provisions. Detailed procurement arrangements are spelt out in Annex 14. Disbursement 4.7 The proposed IDA credit will be disbursed over a period of about five years and be completed by June 30, 2001, which is the project completion date. The last date for presentation of sub-projects to the Social Fund is expected to be about September 30, 2000. The Closing Date of the IDA credit will be December 31, 2001. The expected disbursement profile is shorter than for MENA projects in the social sectors, but is consistent with the profiles for social fund type projects. The schedule of estimated disbursements is shown in Table 6. Table 6 Estimated Disbursement Schedule (Summary) (US$ million) Fiscal Year 1997 j 1998 1999 {2000 12001 j2002 Annual 1.7 3.4 5.1 4.25 1.7 1.05 Cumulative 1.7 15.1 10.2 14.45 16.15 17.2 Percentage 9.9% 29.7% 59.4% 84.1% 94% 100% 4.8 The proceeds of the credit will be disbursed against the following categories of expenditure: (a) Equipment, furniture, vehicles and supplies: 100 percent of eligible foreign expenditures, 100 percent of local expenditures (ex-factory cost) and 80 percent of locally procured items; (b) Consultant services and training for MOHP: 100 percent of eligible foreign expenditures and 80 percent of local expenditures; and (c) PAP subprojects: 100 percent of disbursements by the SFD against eligible subprojects. 4.9 Disbursements for expenditures under contracts of less than US$100,000 for goods and consulting firms, and less than US$50,000 for individual consultants will be made on the basis of statements of expenditure (SOE) and payments under grants for which supporting documents would be maintained by the MOHP and the SFD and made available for review by Bank staff. Supporting documents will include subproject agreements and subproject contracts. Because the average subproject cost will be less than US$100,000, and most of the consultant contracts will be less than US$100,000, it is expected that the large majority of subprojects and contracts will be documented on the basis of SOEs. To get a prompt start to implementation under the capacity building component, retroactive financing up to US$140,000 is proposed for expenditures incurred after February 1, 1996 but before credit signing for consultant sevices and office equipment. To ensure that funds are readily available, two Special Accounts for the capacity building and the PAP components respectively will be opened in a commercial Population Project 13 bank on terms and conditions satisfactory to IDA. An initial deposit of US$0.2 million to the Special Account for the capacity building component and US$1.0 million to the Special Account for the population activities program, corresponding to about four months of expenditures under each part of the project, will be advanced to the account from the IDA credit. The Special Accounts will be replenished monthly. 5. PROJECT IMPLEMENTATION Project Management Arrangements 5.1 The MOHP will be responsible for implementation of the capacity building component of the project and for general oversight of the PAP. A PIU in the Population and Family Planning Sector of the MOHP will be responsible for implementing the capacity building component. The PIU's terms of reference are set out in Annex 13. The MOHP is preparing a Three Year Strategic Business Plan to provide a framework for the Capacity Enhancement component agreed with IDA (Annex 5). Terms of reference, a timeframe and funding for consultants to assist with the final steps of project preparation have been agreed. These final steps are completion of the Business Plan for the Population and Family Planning Sector of the MOHP, establishing capacity within the MOHP to oversee the PAP component, and a review of "social change agent" experience to benefit the PAP component. This work will be completed by June, 1996. The Government will strengthen the MOHP in accordance with the mission statement in the Outline Business Plan. At negotiations the Government agreed that the MOHP would implement the capacity building component in accordance with a Strategic Business Plan satisfactory to IDA, and maintain a PIU with a Project Director and staff and resources under terms of reference satisfactory to IDA. 5.2 The MOHP will contract with the SFD to administer the PAP component, including funds management. An Executive Committee chaired by the Minister of Health and Population will provide general management. Govemorate level committees will oversee the program at the local level and have authority to approve projects of less than US$20,000. The SFD was selected because it is a competent national secular organization. The SFD is a semi autonomous agency established in 1991 that is exempt from Government personnel and procurement policies and regulations and is run on private sector lines. It is responsible for managing US$650 million of funds. Its Community Development Department has a proven management and financial track record, and selection/targeting criteria and operating and monitoring procedures are in place. As feasible the SFD will use qualified NGOs to act as promoters and "wholesalers". During the life of the project certain responsibilities for management of the PAP will be transferred from the SFD to the MOHP. The SFD will provide training and other support to the MOHP to help with this transition. These arrangements are set out in the Operating Manual (see Annex 8). At negotiations the Government agreed to ensure that the SFD manage the Population Activities Program in accordance with an Operating Manual satisfactory to IDA, and that the MOHP conduct evaluations of the Program, using procedures and indicators satisfactory to IDA. The Government also agreed to furnish IDA with annual reports on the implementation of the project and ensure that the MOHP and the SFD carry out an annual review of the PAP. The Government agreed to ensure that the SFD submits semi-annual and annual progress reports on the PAP within 14 Population Project three months of the end of each semester or fiscal year. Annex 15 shows the project implementation schedule. Accounting and Auditing 5.3 The MOHP and the SFD would maintain separate accounts for all expenditures under the project. Private external auditors acceptable to the Bank would conduct annual audits of all project accounts. They would cover MOHP's project accounts; the SFD's project related accounts; procurement compliance with the Guidelines; adequacy of internal controls system. At negotiations the Government agreed that auditors acceptable to IDA would conduct annual audits of project accounts, including those for the Special Accounts, and that certified copies of the audit would be submitted to IDA within nine months of the end of the Government's fiscal year. Under the PAP, the SFD would maintain consolidated accounts for the component and detailed accounts for each sub- project grant. Implementing NGOs and beneficiary agencies would be required by the SFD to establish appropriate accounting systems in the subproject agreement. The SFD and the implementing NGOs would assist beneficiary agencies to develop appropriate accounting systems. Supervision Requirements and Monitoring 5.4 The project will be supervised three times in the first eighteen months, and twice a year subsequently. Staff involved in the preparation of the project will be involved in project launch and supervision. The project is well suited to supervision by the Egypt Resident Mission, which will be given this responsibility at an early date. At negotiations the Government agreed to carry out a mid- term review of the project to evaluate progress to date, to make recommendations for adjustments, and to implement the actions agreed with the Bankl Annex 16 sets out the supervision plan and Annex 17 contains draft terms of reference for the mid-term review. 6. SUSTAINABILITY AND PARTICIPATION 6.1 The resources, both investment and recurrent, ($0.3 million per year during the life of the project and $0.05 million thereafter) required from the Government are affordable (less than 1.0 percent and one-sixth of I percent respectively of current expenditures in the population sector). The population sector falls within the priority human resource sectors slated for expanded resources under the current Five Year Plan. The project does not include any expansion of family planning services, which donors are committed to supporting for the next 3-4 years at about present levels. By contributing to the efficiency of the MOHP, the project will help limit the incremental recurrent costs of the MOHP to a level compatible with public sector budget constraints. Over the short term the population activities program will help develop a sustainable supplement to public sector programs. Over the longer term it will help to reduce future pressures on Government services and the natural resource base. The sustainability of individual proposals under this program would be assessed when they are presented. A principal assessment criterion is that beneficiaries must contribute to ensure financial sustainability. The project incorporates two participatory tools - a beneficiary assessment and a community level monitoring and evaluation system, which will build in continuous consultation and adjustment and ensure that impact can be assessed. Annexes 10 and 11 provide further details. The Social Fund, which will Population Project 15 implement the program, has a proven management and financial track record and will keep administrative costs lean (under 10 percent of program costs). 6.2 The Bank has engaged the stakeholders and the principal donors in the capacity building component in an ongoing dialogue over the past year. There is a consensus on the overall role and strategic direction of the MOHP in the population sector. There has been broad consultation with the stakeholders in the PAP component (the implementing agencies, interested public sector agencies, potential NGOs, local community organizations and local Governorate offices of the Ministry of Social Affairs, Ministry of Information, Ministry of Education with programs requiring support, beneficiary communities and donors, which support similar interventions). This component will support an expansion of an approach that has proved successful in a pilot phase. The basic approach is to work closely with local organizations, which help families feel "empowered" to decide on family size and related family issues. This is consistent with the Government's policy of "voluntary choice" with respect to contraceptive use. The Bank's Economic Development Institute will support a Population Workshop on plans for the next five years in Upper Egypt for a wide range of stakeholders at the same time as the project launch. 7. PROJECT BENEFITS AND RISKS Economic Analysis 7.1 Population growth is a fundamental problem facing Egypt today. Further reductions in the fertility rate and improvements in planning for and managing population growth are basic to achieving the overall sustainable growth and poverty reduction strategy adopted by the Government following its successful stabilization program. Egypt must increase its contraceptive use rate by nearly 50 percent (from 50 to 74 percent) over the next 20 years to achieve the Government's long-term goal of a net replacement rate of one (equivalent to a two-child family) by 2015. The project is expected to contribute to fertility reduction, to be cost effective and to improve the planning and management of population growth. An internal rate of return (IRR) for the project has been calculated using the following assumptions: (a) project benefits are based on the number of births averted in rural Upper Egypt; (b) 75 percent of project exrnditures will be in upper rural Egypt; and (c) the public expenditure saving per birth averted is $470 . It is estimated that the project would account for about 15 percent of all births averted in rural upper Egypt between 1996-2015. On this basis the project has an estimated IRR of 19 percent. If the number of births averted by the project declined to 10 percent of all births averted, the IRR would be 12 percent. If on the other hand 15 percent of all births were averted by the project but the saving per birth averted was $350, the IRR would be 14 percent. The economic analysis is conservative as it assumes that the only benefit is aversion of births. It excludes maternal health or education benefits, benefits to other family members or to the local community. The IRR is also likely to be underestimated as savings are based on public expenditure only and do not take into account any private savings, which are substantial. 7.2 The project will be monitored against four performance indicators for the capacity building component and fourteen for the population activities program (eleven process and three outcome 9 'Me cost-benefit study of family planning in Egypt: NPC and RAPID IV 16 Population Project indicators). A community level evaluation system will measure the impact of the population activities program. It will measure change in three fertility preference outcome indicators and three resulting behavioral indicators. Cost effectiveness will be measured by relating changes in these indicators to the cost of particular interventions. Surveys will be done just before the mid term review and again at the end of the project's life. Survey results will be compared with data covering communities not included in the project using statistical analysis. This will cover descriptive tables for fertility and fertility preferences, their levels and differentials, trends and tabular comparisons between project and non- project communities, and multivariate analysis to isolate to the extent possible any project effects. The surveys and beneficiary assessment will be supplemented by a few qualitative studies, which will concentrate on a few of the most interesting project communities to document plan versus actual operation, effective mechanisms, and any side effects of the project whether bad or good on social patterns in the community. The capacity building component is not susceptible to economic analysis but is necessary to help achieve the goals of the national population program and includes explicit cost control objectives. Benefits 7.3 The project would, first of all, contribute to increasing the present level of contraceptive use. It would do so by addressing the root causes of families' fertility decisions and in doing so would facilitate and catalyze the effectiveness of already available family planning services. Secondly, the project would contribute to broadening support for family planning among hitherto reluctant audiences, by incorporating the social complexity which leads to fertility decisions in the first place. Third, the project would develop capacity within the MOHP to produce good quality population planning, analysis and evaluation within the Government, and the introduction of the population dimension into national economic and sectoral planning. Fourth, the project would raise the visibility of population issues and the level of debate among national decision makers, and enlarge the voice of NGOs and similar organizations in that debate and in population policy planning. Fifth, the project would coordinate and concentrate now scattered population activities undertaken by NGOs and PVOs, and encourage operational public-private partnerships and cooperation in pursuit of the common goal of accelerating Egypt's demographic transition. Sixth, the project would contribute to improved donor coordination in the population sector. Seventh, the project will stimulate concurrent improvements in the social, employment, education and health status of women and children. Risks 7.4 The main risk in the capacity building component is the inherent difficulty of establishing an efficient and effective public sector organization in Egypt. This risk has been addressed in the following ways. There is a prior consensus between the Government, IDA and other donors on the broad roles of the MOHP and of the other ministries and agencies involved in the population sector. There is up-front agreement on the functions, management and staffing structure of the new Population and Family Planning Department in the MOHP incorporated in the Three Year Business Plan, which will be the "blueprint" for implementation. 7.5 The PAP component faces three short term risks: insufficient demand, lack of selectivity when choosing projects and ineffective project implementation (including poor targeting). There are many Population Project 17 organizations in Egypt operating population related programs, and the demand issue will be more one of supporting the most effective and ensuring that they operate in areas of need. There is a "pipeline" of projects with a cost of about $5 million, which are being prepared and will be ready by about June, 1996. The project selectivity and implementation risks have been addressed by devising clear criteria for project selection and by entrusting implementation to the SFD, which now has a proven track record in working with private and public sector agencies at the community level. It is effective at promotion, project evaluation, targeting and supervision. The sustainability of individual sub-projects would be reviewed during appraisal, and the SFD would provide technical support to strengthen the capacity of NGOs for fund raising, operations and administration. 7.6 The third risk would be if effective family planning services were not accessible to new clients. This risk is being minimized by the enlarged role given to NGOs and the private sector in providing clinical services as well as by the MOHP's "Quality Improvement Project", which is raising quality standards at 3,200 MOH health clinics. The first phase of the USAID supported project in 2200 clinics resulted in MOH clinics increasing their share of clients from 24 to 32 percent of all clients served nationally. 8. AGREEMENTS AND RECOMMENDATION 8.1 During negotiations the Government agreed: (a) that the MOHP would implement the capacity building component in accordance with a Strategic Business Plan satisfactory to IDA, and maintain a PIU with a Project Director and staff and resources under terms of reference satisfactory to IDA (para. 5.1); (b) that the Social Fund for Development would manage the Population Activities Program in accordance with an Operating Manual satisfactory to IDA, and that the MOHP would conduct evaluations of the Program, using procedures and indicators satisfactory to IDA (para. 5.2); (c) to furnish IDA with annual reports on the implementation of the project and ensure that the MOHP and the Social Fund for Development carry out annual reviews of the Population Activities Program (para. 5.2); (d) that the Social Fund for Development would submit semi-annual and annual progress reports on the Population Activities Program within three months of the end of each semester or fiscal year (para. 5.2); and (e) to carry out a mid-term review of the project to evaluate progress to date, to make recommendations for adjustments, and to implement the actions agreed with IDA (para. 5.4); Recommendation 8.2 Subject to the above assurances and conditions, the proposed project would constitute a suitable basis for an IDA Credit of US$17.2 million equivalent to the Government of Egypt on standard IDA terms. ANNEX I Page I of 6 Pvliiiistry of ae1o Population & Family Planniiig Cairo, Egypt 9.10.1995 Mr. Caio Koch-Weser Vice President North Africa and Middle East Region World Bank Dear Mr. Koch-Weser, In the context of the renewed collaboration in the population sector between the Government of Egypt and the World Bank, I would like to update you on the Governnent's current population policy, status and issues. The Government considers the annual population growth of 2.2 percent (1992) as one of the central constraints to the country's performance in per capita income, productivity, education and health. The Government remains firmly committed to reducing fertility levels - through encouraging and facilitating the voluntary practice of safe and effective contraception - and to managing the inevitable increase in population size in a perspective of minimizing negative environmental impact. The President, H.E. Mr. Hosni Mubarak and influential religious leaders such as the Grand Mufti and the Pope of the Coptic Church frequently call attention to the importance of family planning and the consequences of rapid population growth. Earlier Developments in the Population Sector. The first systematic effort on the part of the Egyptian Government to address population issues dates from 1953 when the National Commission for Population Affairs was established. The Commission considered that population growth was an obstacle in raising overall standards of living and its conclusions generated dialogue in the country and a rising awareness of the issue. In 1965, the Supreme Council for Family Planning was established as a coordinating body for population policy; the Council was chaired by the Prime Minister and included the Ministers of Health, Education, Information, Waqf, Planning, Local Government, Agriculture, Social Affairs and the chairman of CAPMAS. In each of the 25 governorates a similar group was formed: the governorate Family Planning Advisory Commnittee. The focus was on broadening access to family planning services affordable to the population. Though modest increases in contraceptive prevalence were achieved and access to services improved, the results of this first .phase of the program were considered disappointing. ANNEX I Page 2 of 6 Ministry of Populatioii & Family Planiiing Efforts over the next decade were directed at changing the underlying social factors in high fertility in addition to promoting and providing family planning services mainly through community outreach. The new broad approach to population issues, the Population and Development Planning (PDP) initiative, received major donor support with the World Bank participating through two projects (1973-77 and 1979-84). By the late 1970s, USAID also became a donor to PDP and the overall Egyptian population effort and remains the largest donor until these days. Evaluations and surveys undertaken in the early/mid 1980s to assess the impact of the PDP approach could not find evidence that contraceptive prevalence or fertility had been affected by the program's social development activities nor that economic development had improved. In hindsight, it is acknowledged that access to quality family planning services had been relatively neglected and that socio-economic activities were too scattered and low intensity to have measurable impact. The practical weaknesses of the program had overwhelmed the apparent conceptual strength of the approach. Since 1985 contraceptive prevalence has risen sharply - to 47 percent in 1992 - and fertility has fallen dramatically - to 3.7 children per women in 1992 - which is credited to a number of program improvements and developments: refocused mass media programs, private sector/NGO involvement, expanded method choice and quality of services and greater management capacity and commitment in the MOH. In addition, the creation of the National Population Council (NPC) in 1985 (taking over from the Supreme Council) - with fill authority to manage all the functions of the family planning board - and, most importantly, the enhanced political commitment by Egypt's highest leadership - the President and the Governors - were major factors in legitimizing the use of contraception at the community level. This, together with changes in the social environment, had a cumulative effect on contraceptive prevalence and fertility. Though the results of the efforts over the last decade have been encouraging, the challenges for the future remain immense. For instance, to achieve the contraceptive prevalence goals, the number of contraceptive acceptors is projected to increase from 4.5 million in 1994 to 6.7 million in 2003 which implies reaching more rural, poor and illiterate clients. Current Population Efforts and Chalenges Strong political commitment and increased awareness of the importance of population issues to the national development effort culminated in October, 1993 in the creation of a Ministry of Population and Family Planning which, together with the NPC, are under my leadership as Mnister of State and Secretary General respectively. Elevation of the status of the program has the advantage that the population program now has a direct voice in the Cabinet. The MOPFP is charged with strategic leadership in the multi-sectoral population sector and with oversight responsibilites for farmily ANNEXI Ministry of Page 3 of 6 Population & Family Planiiiiig - planning service delivery of the MOH and NGOs/private sector. The NPC - Technical Secretariat is being reorganized as a strategic think-tank on inter-sectoral population issues in close coordination with the MOPFP. The quantitative goals of the overall population program are by 2007 to reduce the annual rate of population growth to 1.8 percent, to increase contraceptive prevalence to 65 percent and to reduce the total fertility rate to 2.7 children per women. Nine strategies have been adopted to guide future action. Six of those strategies are concerned with creating a social context conducive to fertility decline: Population Information & Communications; Family Planning; Maternal and Child Welfare; Education and Eradication of Mlliteracy; Improving the Status of Women; and Youth Programs. The other three strategies are concemed with minimizing the negative consequences of population growth and density: Labor and Employment; Land Use and Population Distribution; and Environmental Protection. The role of MOPFP is to ensure that the various ministries concemed take into account the relevant population facts in their respective functions and contribute their share of efforts needed to realize the potential of the synergistic national strategy to reduce population growth and ensure the sustainability of Egypt's development efforts. Main Issues in the Population Sector Four main issues presently limit the ability of the sector to achieve the stated objectives Role and Capabilities of MOPFP. The new Ministry is in the process of operationalizing its role and mission and of implementing a new organizational structure. This will require staff with a background in different disciplines, efficient management and administrative systems, modem human resource management practices and further introduction of office technology and communication systems. Recruiting highly qualified staff to carry out those functions - and retaining such staff - is hindered by the low level of salaries in the public sector and the competition from the private sectors and donor agencies which also are in need of such expertise. Improving and Expanding FP/MCH services. Though Egypt now has an extensive network of health care facilities and much improved quality of services, the challenge of meeting client expectations for an expanded range of services of higher quality for the vastly expanding universe of clients - because of the age structure and the higher prevalence to be achieved- remains a severe financial and operational challenge. Furthermore, even if clients live close to service points, cultural and financial barriers to making use of those services remain significant and face-to-face counseling continues to be a necessity, particularly in more conservative areas of the country. ANNEX I Page 4 of 6 Ministry of Populationi & Family Plaiiiiing . ~~~~~~~~~~~~~~~~~~~~~~-IN Privte Sector Capacity. NGOs as well as the for-profit private sector have played an important role in the achievements so far - as pioneers and service providers. It is Government policy to firther involve NGOs in achieving the goals of the population policy. However, both NGOs and the private sector have been heavily subsidized posing financial limitations to their participation and absorptive capacity is still quite limited. The potential exists to extend public-private partnerships to new and inexperienced NGOs - many of which were formed in the aftermath of the International Conference on Population and Development - but this will require capacity building over an extended period. Decentralization. Though Egypt is relatively homogeneous in terms of language and culture, there are pronounced underlying differences in values regarding the family and the status of women which affects the utilization of family planning services. in particular in high fertility areas, promotion and delivery of family planning services needs to fit the perspectives of the local populations and overcome barriers of illiteracy, customs favoring early age at marriage, and limited mobility of women. Addressing the diversity of local needs and values will require decentralization and systematic testing of innovative approaches to lower social barriers to the use of family planning and to change reproductive behavior. Future Policy Directions The Government will take the following approaches to the issues identified above: Institutional Development. MOPFP and NPC are undertaking a concerted effort to acquire the expertise and systems needed for effective and efficient implementation of the Government's population policy and to maximize the impact of the new Ministry and role of NPC. The new organizational structure for MOPFP/NPC - which corresponds to carefilly identified roles and functions - is being implemented through the development of clear mission statements and operational plans for each department. Recruitment and reassignment of staff is underway. The overall and departmental operational plans will be expressed through a three-year Business Plan with quantifiable goals and identified products to be updated year-by year. These efforts are being supported by UNFPA and the Government has requested assistance from the World Bank to supplement and add to the scale and scope of the institutional development effort. Expanding and Improving FP/MCH Services. The MOH will continue to be the key provider of clinical family planning methods through its network of facilities which now are reasonably accessible to the large majority of the populatiori. Concerted efforts will be made to meet the reproductive health needs of women and to improve the quality of services overall through a pased program of pre- and in-service training of staff and ANNEX I Page 5 of 6 Miniistry of Population & Family Planninilg - through upgrading of facilities and equipments. The contraceptive method mix will be further expanded through the introduction of long-acting contraceptives new to the program e.g. injectables and implants. USAID and other bi-lateral donors are assisting the MOH and private sector providers to achieve those goals. In addition, mobile reproductive health services are being expanded to reach remote and nomadic populations who have difficulty in accessing the network of static facilities. These mobile services are supported by the Governors and receive assistance from a variety of bi-lateral donors and private sources. MOPFP is also active in facilitating the creation of FP/MCH clinics in the workplace such as agricultural cooperatives and small factories. Strengthening the Private Sector. Ifn accordance with Government policy and MOPFP's record of partnership with the private sector, MOPFP will henceforth register, support and coordinate NGOs active in the population sector. The Governent intends to strengthen private sector involvement through a two-pronged approach: capacity strengthening to improve cost-effectiveness of NGO operations; and, a sharper focus on meeting the needs of the poorest sectors of the society. To that end, the Government has requested World Bank support for a Population Activities Program - which would address social factors inhibiting the use of family planning - to finance a number of sub- projects designed on the basis of systematic beneficiary assessments and with strong participation of the target communities. MOPFP will engage the assistance of the Social Fund to administer the support to NGOs making use of instruments developed by the Social Fund to promote, facilitate, appraise and monitor NGO sub-projects which would be targeted at high fertility and poor areas in particular in Upper Egypt. Decentralization. It is Government policy to decentralize implementation of population activities to the governorate level to the extent possible. MOPFP is in the process of strengthening its offices in the governorates which work closely with the Governors and the inter-sectoral Population Committees at that level. USAID is supporting that effort. These offices take the lead in developing population plans - to be implemented by the relevant sectoral departments at that level - and monitor implementation of those plans in close coordination with the Governors. To make communications more efficient and speed up solution of problems encountered, MOPFP intends to create a Local Area Network between the central office and the governorate population offices. It is to be noted that the performance of Governors is evaluated by Government partially on the basis of their diligence in incorporating population concerns into their initiatives. ANNEX I Page 6 of 6 Ministry of Population & Family Planninig Potential for Success While further progress in lowering the rate of population growth remains a challenge, the Govermment is confident that a major breakthrough can be achieved in the years ahead. Determinants of fertility are moving in a positive direction: female literacy, education and participation in the workforce are up while infant and child mortality are down. Less measurable, but noticeable, is a spreading public preference for smaller families - with healthier and better educated mothers and children - and political commitment is broadening. In addition, family planning service delivery has achieved a solid capacity and can be relied upon to build and improve on the achievements so far. The potential for future success is further strengthened by the fact that donor support to the population sector remains strong and - as demonstrated by the joint USAID, UNFPA, World Bank Mission in 1994 - donor agencies are effectively collaborating with the Government and each other to support the Egyptian program in a coordinated way. The Government appreciates the intention of the World Bank to renew its technical and financial support to the program after an interval of more than a decade and, because of it, is the more confident that the demographic transition will be completed in Egypt in the foreseeable future. Yours Sincerely, r Dr.=Maher Mahran Minister of State for Population and Family Planning cc. - H.E Dr. Atef Sedki, Prime Minister -H.E.Dr. Yousef Boutros-Ghali, Minister of International Cooperation . ,~~~~~~~~~~~~~~~~~~~~~~ ANNEX2 Page 1 of 10 ARAB REPUBLIC OF EGYPT POPULATION PROJECT FERTILITY DETERMINANTS AND STRATEGIES TO ADDRESS THEM 1. Egypt's population is about 56 million and is projected to reach 73 million by 2010 and 86 million by 2025. Population pressures on the education and health systems, social services, the employment market and labor migration, urban areas, and the natural resource base will intensify the foreseeable future. Recognizing the impending problems, the Government of Egypt has made population a national priority, setting targets for raising contraceptive prevalence to 65 percent by 2007, which should bring total fertility down to 2.7 and population growth to 1.8 percent. 2. This challenge can be met, with appropriate effort, because fertility is already on the decline. The forces behind this decline are similar to those in some other developing countries: a family planning program that, after many fits and starts, seems to have hit its stride; long-term improvements in human capital; and, at the same time, a perceived economic squeeze on households that discourages having large families. The prospects for fertility are also typical of the prospects in many other countries: continued fertility decline appears likely but is not guaranteed. The path to replacement-level fertility is still long, and stalls in decline are always possible. In fact, as will be discussed below, some factors that could produce stalls are already evident. 3. Recent trends in the total fertility rate, from national survey data, are shown in Figure 1 (El-Zanaty et al. 1993:34). The downward trend is unmistakable (but the sharp downturn at the end may be illusory, due to variations in survey procedures). Nevertheless, total fertility remains high, just under four children per woman. And fertility is of course variable across regions, being higher than the national average by 50 percent, or two children per woman, in rural Upper Egypt (Figure 2; El-Zanaty et al. 1993:33). Figure 1. Total fertility rate, 1979-92 1.23 1.0 4.J 4A' 4.2 4.0 7J iF7B 1060 ¶602 064 064 ¶606 ItO 1002 ANNEX-2 Page 2 of 10 Figure 2. Total fertility rate by region, 1990-92 Urbon governorates Urbon Lower Egypt Rural Lower Egypt Urban Upper Egypt Rural Upper Egypt 0 1 2 3 4 5 6 4. Because all these total fertility rates are still so far above replacement fertility-and because of previous population momentum--population growth is still rapid. Figure 3 illustrates this by comparing crude birth and death rates: the gap between the rates remains large and allows population growth of 2.1 percent a year (Robinson and El-Zanaty et al. 1995:15). Figure 3. Crude birth and death rates, 1980-93 50__ _ _ _ _ _ _ _ 45 40- 398 3. 35~~~~~~~~~~~~~~~~. 30- 25- 20 10.0 10 - - 9i4_ S- Crude deoth rote 078 1978 1980 1982 1984 1986 19B8 1990 1962 1994 ANNEX2 Page 3 of 10 Fertility decline 5. Recent fertility decline has been predominantly due to increased contraceptive use. As the topmost line in Figure 4 shows, contraceptive prevalence has risen fairly steadily and is now close to 50 percent. Analysis of the "proximate determinants" of fertility, which attempts to partition change in fertility into its inmmediate behavioral causes, confirms that contraceptive use has played the largest role in fertility decline in Egypt as a whole (Osheba 1992). In 1980, contraceptive use accounted for under 30 percent of the difference between actual fertility and maximum theoretical fertility (around 15 children per woman); marriage delay accounted for 40 percent and breastfeeding for 30 percent. By 1992, however, contraceptive use accounted for 45 percent of the difference between actual and maximum fertility, marriage delay for 35 percent, and breastfeeding for 20 percent (Robinson and El-Zanaty 1995:74). The importance of contraceptive use increased substantially even in Upper Egypt, though in that region its contribution to lower fertility is still roughly on a par with that of marriage delay. Figure 4. Contraceptive prevalence, total and selected methods 50 40 30 217.9 20 2 22.8 16 66 1 6.5 51 1 0 1 2.9 411 0 r I- i r -v-- w-- - - 1978 1980 1982 1984 1986 1988 1990 1992 1994 K -- All methods - Modern melhods r Pills -X lUDs 6. Figure 4 raises the question whether contraceptive use has reached a plateau. The last two surveys appear to have shown little increase. However, various reasons exist to doubt that this is anything more than a statistical aberration. As Figure 1 showed, fertility actually declined more sharply than usual over roughly the same period. Also, the second line in Figure 4 shows that prevalence of modern contraceptive methods did not plateau. It kept increasing, suggesting that any decline in prevalence was due largely to traditional methods, the identification of which is NNEX 2 Page 4 of 10 notoriously unreliable from survey to survey. The bottom two lines in Figure 4 provide the most important evidence. IUD use has expanded significantly, while pill use continued a secular decline. Given the substantial evidence that many Egyptian women do not follow the proper regimen for contraceptive pills, this switch to a more reliable method could in fact account for lower fertility. At the same time, one should not entirely discount the possibility that pill use may have declined for supply-side reasons, because of some disorganization in provision. 7. Improved supply of contraceptives has been an important reason for fertility decline over the 1980s and into the 1990s. The family planning program has been massively supported by international donors and seemed finally, in the mid-1980s, to have put all the essential pieces together. Figure 5 juxtaposes the contraceptive supply situation with the growth in contraceptive prevalence (estimated from service statistics) over the same period (Robinson and El-Zanaty 1995:42). While both grew together, the difference in their tracks is an important comment on the initial ineffectiveness of the family planning program and its much improved performance in the last decade. Figure 5. Family planning service delivery points and estimated contraceptive prevalence 4500 --- 60 -50 4000 1 X40 3500 Family planning 30 3000 service points //Estimoled se 2/ contraceptive -20 I / / ~~~~~~~~~~~prevoulence 2500'/~l 2000 -- T- -T -v,,,C 1965 1970 1975 1980 1985 1990 8. Robinson and El-Zanaty (1995) chronicle the changes in population program strategy over the period represented in Figure 5. Beginning in the mid-1960s with the growth of population awareness and an official commitment to family planning, the program has gone through three distinct phases, each lasting about a decade. Initially the Government of Egypt created an interministerial Supreme Council for Family Planning and began to deliver services through Ministry of Health facilities (and to some extent through NGOs supervised by the Ministry of ANNEX2 Page 5 of 10 Social Affairs). With these services treated as incremental to other health services, funding was limited, staff were inadequately trained, and even the contraceptive supply was uncertain. 9. Results were predictably disappointing, and the program was transformed in the mid- 1970s, adopting a trendy "population and development" approach. Instead of focusing on contraceptive supply, the program now emphasized creating demand with a broad range of local development activities. Village outreach workers (called raidat, or "pioneers") were added and assigned to work with village women not only on family planning but also on "nutrition, sanitation, environmental concerns, female income-generation activities, maternal and child health" (Robinson and El-Zanaty 1995:32). Since many earlier weaknesses of the contraceptive supply system were not addressed, and since the raidat, though strongly motivated, were clearly overstretched, this phase of the program made limited progress and was quietly deemphasized by the mid-1980s. 10. The third phase saw management of the program passing to a new National Population Council. Perhaps the most significant result was new leadership with a considerable appetite for public promotion of family planning. In previous phases, IEC efforts were low-key and general, not focused specifically on promotion of contraceptive use. By the time the new council was instituted, however, IEC strategies had developed and a variety of media were used to provide direct factual straightforward information, underpinned by stronger and more frequent endorsements from top leaders. At the same time, contraceptive supply improved in two critical ways: social marketing of pills quickly became a major source for the public, and an improved IUD became increasingly popular. This third phase of the program appears to have been associated with the most recent, most rapid growth in contraceptive use. Yet this success itself probably represents not an entirely new departure but the cumulative effect of many previous investments in the program. 11. To some extent the growth in contraceptive use also reflects general improvements in human capital. As Figure 6 shows, infant mortality has fallen over the decades, while female education and literacy have risen. Attitudes toward fertility have changed, creating receptivity as family planning services have also become more available. ANNEX2 Page 6 of 10 Figure 6. Female education, literacy and infant mortality, 1960-90 1 80 60 1960 195 90 17 19 95 90 Fertilyty reoosnpet 1 4 0\/ - 40 1 20 F./1 so XoO0 t-20 80 \ 0t 6 0' ° 1 9 60 1 9 65 1 970 9'75 1 980 19 85 1990 Fertility prospects 12. Declines in fertility as substantial as those in Egypt over the last two decades are unlikely to be reversed and are usually followed by further declines at least until replacement-level fertility is reached. Nevertheless the pace of future declines is uncertain, and stalls often characterize the process. Stalls can occur, and have occurred in developing countries, for all kinds of different reasons: because of limits on the types of contraceptives available, which fail to meet the needs of all potential users; because of ethnic, regional, cultural, religious, or linguistic barriers that hamper the diffusion of the idea of fertility control; because of son preference, which sets a limit on how low fertility can fall; or because of contraceptive supply interruptions. Enough such factors exist in the Egyptian setting to cause concern. 13. Consider first issues of contraceptive supply. The Egyptian program remains essentially a two-method program, with IUDs and pills accounting for 87 percent of all contraceptive use. Sterilization--now the leading method in many developing countries (even in some other strongly Islamic ones)--is largely unavailable, and interestingly, at the other end of the continuum of methods, condoms can hardly be discussed in public. Couples who need, want, or could be attracted by such methods as these are correspondingly more difficult to reach. Injectables are slowly being introduced, and could fill some of the need, but the program may limp along essentially with one hand tied behind its back. 14. A reliable supply of the contraceptives in the program is not currently guaranteed. Relying substantially on foreign donors, the program has gradually irnproved its logistics but is vulnerable to interruptions should donor policies change. The potential problems were heralded a few years ANNEX 2 Page 7 of 10 ago when the local agency responsible for social marketing had to be replaced, and supplies were temporarily disrupted. 15. A related problem is the poor quality of family planning and related reproductive health services, particularly in the public sector. The network of facilities is in general sufficiently dense across Egypt to provide reasonable access to family planning, but technical standards and the quality of care require considerable improvement, and reproductive health care is generally deplorable (Zurayk, Younis, and Khattab 1994). The limitations probably contribute to much ineffective contraceptive use. 16. Potential barriers to increasing contraceptive demand also exist, including regional differences. Figure 7 shows how contraceptive prevalence and unmet need for contraception vary across governorates (excluding the frontier governorates, which were not covered in the Demographic and Health Survey; the data are from unpublished tabulations). In practically all the urban governorates and the governorates of Lower Egypt, contraceptive prevalence is above 50 percent; in all but one of the governorates of Upper Egypt, contraceptive prevalence is below 35 percent. Unmet need, which averages around 15 percent in the urban governorates and in Lower Egypt, averages around 25 percent in Upper Egypt. Whereas satisfying unmet need would bring prevalence in Lower Egypt up to 70 percent, in Upper Egypt it would bring prevalence only up to 55 percent. Clearly demand for family planning still needs to be increased, particularly in Upper Egypt. Figure 7. Contraceptive prevalence and umnet need by governorate, 1992 90 1 - 90 T Urban so Goveernorotes Lower Egypt Upper Egypt 7 0 -~~ 701 30 -~ 20 -~ 10 -~ 0 t r i Cairo Porl Soid DamitlaoSha,kKofr-[I Shihnouli Ismailia Bei Suel ktenyc Souhog Aswon AI.oodrio S,ez 0Oak.hNi. Kcyubio Gho,bio Behero Gio Foyoum Assiul Oeno ANNEX-2 Page 8 of 10 17. Some further understanding of the psychosocial barriers to expanding contraceptive use can be obtained by looking at women's reasons for not using family planning. Table I compares reasons from the Egypt Demographic and Health Survey with reasons given in other recent Middle Eastem surveys (Westoff and Bankole 1995:16). Four things are especially worthy of note. First, health concems are prominent in Egypt, but no more than in other countries; concem with side effects, in particular, appears muted by comparison. Second, infrequent sex is a common answer, more common than in the other Middle Eastem countries and indeed than in any of two dozen countries surveyed recently. Combined with the frequency with which women report difficulty in getting pregnant, these responses indicate a need for better understanding of sexual relations and possible sexual problems. Third, a fatalistic view of childbearing is more common in Egypt than in any other country. This may reflect cultural pattems that need to be understood and addressed by IEC efforts. Finally, religious and social opposition are decidedly minor factors in nonuse. However, this may change, and the influence of militant Islamic ideology merits attention, especially in parts of Upper Egypt. ANNEX-2 Page 9 of 10 Table 1. Reasons for not using contraception, Egypt and three other Middle Eastern countries, around 1990 Egypt Jordan Morocco 1hrey Percent not intending to use 43.8 54.9 44.8 37.0 Wants children 12.0 11.2 23.9 14.0 Difficult to get pregnant 25.3 27.1 3.9 32.6 Infrequent sex 13.0 2.6 8.0 12.5 Health concerns 15.5 11.5 18.0 3.1 Fatalistic 12.7 9.1 0.7 5.4 Partner opposed 6.3 8.0 11.7 4.9 Side effects 5.3 7.4 18.5 5.0 Religion 1.4 6.8 4.1 6.9 Opposed to family planning 0.8 1.1 0.7 0.4 Inconvenience 0.5 1.5 0.5 1.6 Lack of knowledge 0.3 2.0 6.3 4.3 Costs too much 0.2 0.2 0.7 0.4 Others opposed 0.1 0.2 0.2 0.0 Hard to get 0.0 0.0 0.2 1.1 Other reasons 3.5 6.1 2.2 3.7 Don't know 2.4 5.1 0.0 4.0 18. All these individual obstacles to greater contraceptive use would be less daunting if there were some agency capable of anticipating them, planning to overcome them, and marshalling resources and efforts from all the other agencies involved in family planning to implement preventive or corrective measures. Such an agency now exists in the new Ministry of Health and Population. 19. Donors have not been insensitive to the pitfalls lying in wait for the Egypt population program. USAID is continuing its substantial involvement with the program, including providing contraceptives and improving the quality of clinical services. UNFPA is committed to strengthening central program management. Other donors such as the European Union and some European countries have targeted particular governorates and are attempting to improve services or promote contraceptive demand. How such contributions mesh with government resolve and private-sector efforts will determine whether the fourth phase of the population program, which can be said to have started with the new ministry, will continue the successes of the third phase. ANNEX 2 Page 10 of 10 References Cochrane, Susan H., and Emest E. Massiah. 1995. Egypt: Recent changes in population growth. HRO Working Paper 49. Washington, D.C.: World Bank. El-Zanaty, Fatma H., et al. 1993. Egypt Demographic and Health Survey 1992. Cairo, Egypt and Calverton, Md.: National Population Council and Macro Inernational. Osheba, I. K. 1992. The proximate determinants of fertility change in the regions of Egypt. Cairo Demographic Center Working Paper 26. Cairo. Robinson, Warren C., and Fatma H. El-Zanaty. 1995. The Impact of Policy and Program on Fertility in Egypt: The Egyptian Family Planning Success Story. Cairo, Egypt, and Washington, D.C.: National Population Council, USAID/Cairo, and Options for Population Policy. Westoff, Charles F., and Akinrinola Bankole. 1995. Unmet need: 1990-1994. Demographic and Health Surveys Comparative Study 16. Calverton, Md.: Macro International. Zurayk, Huda, Nabil Younis, and Hind Khattab. 1994. Rethinking family planning policy in the light of reproductive health research. Intemational Social Science Journal 46(3):423-438. ANNEX-3 Page I of 3 ARAB REPUBLIC OF EGYPT POPULATION PROJECT THE INSTITUTIONAL FRAMEWORK IN THE POPULATION SECTOR 1. The institutional environment in the population sector in Egypt is well developed. However the effectiveness of the different institutions varies. A consistently weak area has been the successive institutions responsible for sectoral leadership and population policy and planning. Part of this weakness stemmed from Government policy which until about eight years ago emphasised fertility reduction occurring as a result of economic development The National Population Council (NPC), established in 1984, although effective at stimulating change at the local level, was not so effective at providing national leadership. To remedy this situation the Government established a Ministry of Population and Family Planning (MOPFP) in November, 1993 and then merged it into the Ministry of Health to create a new Ministry of Health and Population (MOHP) in January, 1996 as part of a streamlining reform. The premier demographic research institution in Egypt, the Cairo Demographic Center (CDC) reports to the Central Agency for Public Mobilization and Statistics (CAPMAS), Egypt's central statistical organization. The purpose of raising population to ministerial status is to ensure that the Government plays an active leadership role and helps accelerate the demographic transition in Egypt. The Population Department of the MOHP is in the process of capacity building. Progress is being made in defining structure, functions and staffing of the ministry and appointments to key management positions were made in January, 1996. A Three Year Business Plan is being prepared to provide a strategic framework to guide the Ministry (Annex 5). Well qualified consultants will play an important role initially in helping with capacity building. 2. As the primary governmental body responsible for family planning service delivery, the MOHIP has over 3800 public health care facilities including hospitals, outpatient clinics, health bureaus, MCH centers, health centers and units. Through this range of facilities, the MOHP's Population and Family Planning department, with support from USAID and UNFPA, offers integrated family planning serves throughout urban and rural Egypt. The MOHP is also responsible for the importation, approval and quality control of locally produced contraceptives. Clinical training in family planning is carried out by the Regional Training Center at Ain Shams University. 3. The NPC will remain an interministerial body with policy research, advocacy, and interministerial coordination functions. The NPC is obtaining institutional development support from USAID. 4. At the governorate level, local population councils chaired by the Governor direct and coordinate efforts and aid in the formulating of detailed planning and programming for their governorates. The governorate offices also provide staff, information and office space available to carry out these activities. All governorates have organized Women's' Committees that work to mobilize communities to become actively involved in solving population related problems and utilizing family planning services. All governorates have a network of Local Information Centers (LIC) operated by the State Information Service of the Ministry of Information (MOI), ANNEX3 Page 2 of 3 which coordinate and conduct a wide range of Information, Education and Communications (IE&C) programs at the community level. In many governorates links have been established with other institutions. For example family planning clinics have been set up in local agriculture cooperatives and factories, and village level IE&C activities are carried out by Ministry community social workers in association with NGOs. Although the level of local government involvement in population activities is very variable, the level of effectiveness is steadily improving. 5. Of the other agencies involved in the population sector, the most important is the State Information Service (SIS) of the Ministry of Information MOI). The SIS manages and operates a full spectrum of IE&C programs at the national and local levels in cooperation with both public, private and NGO agencies. These range from national mass media campaigns and television productions to targeted community level programs through the LICs. 6. The Ministry of Social Affairs (MOSA) and the Ministry of Local Government (MLG) operate a variety of population related programs. These range from targeted income supplement and training to child care, illiteracy and rural resettlement programs. They are of varying effectiveness. The MOSA also regulates Non Governmental Organizations (NGOs) under Law 32 of 1964. However the MOHP has been given supervisory authority over population and development NGOs including those that provide contraceptive services such as the Egyptian Family Planning Association. MOSA is also responsible for the training of workers and community leaders involved in population policy implementation and family planning. The Ministry of Education incorporates population education into both formal and non formal education. 7. The private sector and NGOs play an important role. Private doctors and pharmacies provide 63 percent of contraceptives under the family planning program and are an important source of IE&C as well to the population at large. There are about 400 NGOs of various sizes and capacity in the population sector. In addition to providing services, many of the NGOs are involved in general education, social marketing and IE&C activities. Religious organisations are also an important source of population and family planning services through mosque based health and welfare centers. 8. The Social Fund for Development (SFD) is an autonomous institution established in 1991 (with the assistance of the Bank and many donors) to create job opportunities, minimize adverse effects of economic reform and raise the living standards of the poor (especially in rural areas). The Social Fund's Community Development Departnent has a US$40 million program supporting a wide array of community programs, many of which are related to population. It has helped strengthen the role of NGOs working in population and development in Egypt. It has effective management, operating, and financial policies and procedures in place. One major new initiative is an innovative Family Development Project implemented by the Egyptian Family Planning Assciation, a major NGO. It contains many components of a population demand project, and is testing a new type of social change agent at the community level, who is a qualified peer counselor and motivator dealing with all aspects of family life. The Social Fund will establish a Population Program Office to implement the Population Activities Program included in the proposed project. ANNEXi3 Page 3 of 3 ARAB REPUBLIC OF EGYPT POPULATION PROJECT POPULATION SECTOR-FUNCTIONAL MATRIX Fundon/Agency MOHP NPC SIS GO VS NGOs Private Pubic(l) Eh _____ ____ _ _ _ _ _ __ ___ _ ____Sham s A. Strategic Leadership Policy Development X X X X X X X National Population Program X Legal/Regulatory Affairs X Strategic Plans X National Advocacy X X Local Advocacy X X X X X International Cooperation X Community Mobilization X X X X Interorganizational Coordination X X NGO/Private Sector Coordination X Research X X X Domestic/International Resource X Plans B. Service Delivery Strategic Directions X Program Development X(2) Resource Mobilization X X X X Operations Plans X X X X X X Clinical Services X X X X X Outreach X(3) X X X X C. ProcurementtLogistics Procurement Plan X Procurement X(4) X(5) Logistics X X D. Human Resource Development Sector Manpower Planning X Management Training X x Population Training X Clinical Training X X X X X IEC Training X X X X Other Training X X X X E. Monitorlng/Evaluation Quality/Standards X X X X X X Follow-Up and Monitoring X X X X X X Evaluation X X X X X X EQOTNOTES I. Public includes Ministries of Defense, Interior etc. 2. Translation of strategic directions into specific programs to be carried out by public and private sector service delivery organizations. 3. Includes MOHP experimental projects of limited scope and duration 4. MOHP procures except for EFPA and other NGOs. 5. IPPF supplies to EFPA. ARAB REPUBLIC OF EGYPT POPULATION PROJECT Management Structure of the Population and Family Planning Sector, Ministry of Health and Population, Arab Republic of Egypt IMINISTER |Minister's Technical Ofrice|I POPULATION AND FAMILY GA for Foreign Affairs and PLANNING SECTOR Unit for Administration and Agrements PLNIG SECTO Decision Support CA for Training, Research, and CA for IE&C and Population Education || CA for Population and Family Population Statistics Planning Services and Methods GA for IE&C and IE&C Materils GA for NGOs and Private GA for Contraceptve and GA for Public Sector GA for Research Production Sector Services Logistics Management Services | GAfor Training lGA for Population Education and Forecastng and GA for Training Rned2t Rifisat Planning Unit Distribution Unit Planning Unit GA for Population Statistics Registration *nd Control Availability and Prieing Monitoring and Unit Unit Evaluation Unit |Monitoring and Evaluation Monitoring and Control Unit Unit li7ooilo a& and '~~n ANNEX-5 Page 1 of 7 ARAB REPUBLIC OF EGYPT POPULATION PROJECT MNISTRY OF HEALTH AND POPULATION (MOHP) POPULATION AND FAMILY PLANNING SECTOR OUTLINE BUSINESS PLAN I. INTRODUCTION 1. National Population Objectives The Ministry of Health and Population (MOHP) was created in January, 1996 as the Govenument of Egypt's leading institution in the population sector. The Government's Population Policy specifies quantitative targets for population growth, fertility and contraceptive prevalence - up to the year 2012 - and has adopted nine strategies to guide future action. Six of those strategies are concerned with creating a social context conducive to fertility decline: Population Information and Communications; Family Planning; Maternal and Child Welfare; Education and Eradication of Illiteracy; Improving the Status of Women; and Youth Involvement. The other three strategies aim to minimize the negative consequences of already inevitable population growth and resulting density: Labor and Employment; Land Use and Distribution; and, Environmental Protection. The family planning program is singled out as of the highest immediate priority because of the significant level of unmet needs for family planning recorded for all parts of the country and because improvements in the social context will lead to further demand for family planning and will need to be met to achieve the desired fertility decline. 2. Mission and Role of MOHP with respect to Population and Family Planning Sector As presently formulated, the mission of MOHP with respect to the Population and Family Planning Sector can be classified under six basic functions as in Table 1: ANNEX 5 Page 2 of 7 Table 1. Main functions of the Population and Family Planning Sector in Ministry of Health and Population (MOHP) * Report on population progress to Government and People's Assembly * Promote legal, policy and regulatory reform * Establish population, family planning and reproductive health objectives * Develop sectoral plans * Conduct and apply policy and JEC research * Review progress in sector * Conduct human resource development in sector * Conduct contraceptives planning, logistics and management * Conduct and support govemorate population planning Service delivery and Support * Provide public sector family planning and reproductive health services * Provide technical support to private and NGO population program and family planning service providers * Support and provide IEC programs Resource mobilization * Liaise with international agencies for resource mobilization purposes * Mobilize public sector resources and assist NGOs and private sector with resource mobilization * Monitor and evaluate public, NGO and private population program and family planning services * Monitor and evaluate IEC and population education * Promote population policies * Promote demand for smaller family size and for family planning There are in addition internal functions that need to be handled, such as administration, finance and human resources development within the Population and Family Planning Sector of MOHP itself. 3. Organizational Structure of the Population and Family Planning Sector in MOHP To implement the strategies and functions mentioned above, the Ministry is now in the process of defining the division of work within the Population and Family Planning Sector, establishing priorities and acquiring the staff expertise and systems needed to fulfill its mission. During the on-going formative period, a flexible strategy has been adopted to gradually shift staff with appropriate skills from other parts of the MOHP as well as some qualified staff from the former Ministry of Population and Family Planning. 4. Capabilities. To achieve its mission and shape the new organization into an efficient and effective implementing agency, the following capabilities have to be developed in the different Central Administration Departments of the Population and Family Planning Sector of the Ministry: ANEX 5 Page 3 of 7 Table 2. Capabilities to be developed in Population and Family Planning Sector of the Ministry of Health and Population (MOHP) Unit Main function Capabilities to develop Undersecretary's Decision Support System Population Sector decision support system Office CA for Training, Policy, research, statistics Ability to plan and manage policy, research and statistical programs and Research and services, sectoral manpower sectoral manpower and training. Ability to interpret research reports from Population development and training any source and formulate and present their policy implications within and Statistics outside MOHP. Ability to manage extemal contracts for research and evaluation. CA for IEC and Planning, promotion, delivery, Ability to plan, promote, deliver, support and monitor national and local Population support and monitoring IEC and Population Education Programs. Education Ability to conceptualize IEC needs and discuss them with professionals who can design promotional campaigns. Ability to promote and monitor population education programs. Ability to formulate appropriate specifications for market research. Ability to manage contracts with external agents for IEC campaigns and market research. Ability to plan, manage and evaluate national community development worker programs. CA for Population and Family A continuously updated database on population and family planning Population and Planning service delivery, activities nationwide. Family Planning planning, support, monitoring A system to manage population, family planning and reproductive health Services and and evaluation services. Methods A monitoring system for population and family planning services. Ability to formulate important operational research questions and develop requests for proposals Ability to manage external contracts for evaluation and research Ability to digest, summarize, interpret, and present data on population and family planning services in a timely manner Ability to set quality standards for family planning and reproductive health services Ability to assess clinic, provider, and outreach worker performnance against standards Ability to coordinate service provision among all public and private agencies Ability to mobilize resources to pay for contraceptive commodities from donors and government sources Ability to provide central support to local level population and family planning programs Unit for Internal administration and Ability to conduct financial follow up Administration finance Ability to plan and manage funds (disbursements to executing agencies, and Finance project accounts administration, internal auditing) Ability to manage and support grantees 5. Staffing The staff strength for the Population and Family Planning Sector of MOHP will be about 150, of which about 50 will have been appointed by the end of FY 1995/96. The distribution of those posts will be approximately: ANNEX5 Page 4 of 7 * 5 for the Undersecretary's Office * 40 for the Central Administration (CA) for Training, Research and Population Statistics * 40 for the CA for IEC and Population Education * 60 for the CA for Population and Family Planning Services and Methods, and * 10 Unit for Administration and Finance. About 30 percent of those posts would be filled during FY1995/96, including all senior appointments. Task Forces will be convened in the near future to further analyze specific staffing needs for each of the different Units of the Population and Family Planning Sector in accordance with their specific functions, prepare the corresponding job descriptions and continue the recruitment process. 6. Staffing Strategies Given that it is difficult to attract high level experienced staff at current levels of civil service salaries, a judicious mix of permanent staff and consultants may be desirable to achieve the required technical quality of the Population and Family Planning Sector staff at the earliest possible date. Staffing decisions would therefore be guided by a strategy aimed at the use of some qualified consultants for senior technical positions who will, in addition, have the immediate responsibility to mentor junior civil servants whose potential for excellence is recognized. Criteria for selection of new staff and consultants needs to be guided by the capabilities described in Table 2 and job descriptions prepared accordingly. 7. Population and Family Planning Sector Budget for FY 1996/97: Bab 1, H and m To be further specified during preparation of full Business Plan. II. OUTLINE BUSINESS PLAN FY1997-1999 8. Objectives of Business Plan The completed Business Plan for FY1997- 1999 will provide direction to the process of institution building in the Population and Family Planning Sector of the MOHP by linking the key functions of the Sector, as expressed in Table I to specific organizational units and the priorities (to be) identified for the period 1997-1999 under the Action Agenda for each Unit. The Business Plan is meant to be a flexible instrument to be reviewed on a yearly basis to reflect achievements so far and functional and institutional needs arising for the following three-year period. The "Mission Statements" expressed in the "Business Plan for FY1997-1999" reflect the role and function of each Unit contributing to the overall objectives of the Population and Family Planning Sector of the MOHP over the medium-term. "Capacity" provides a baseline (beginning 1996) from which each Unit starts in terms of staff strengths and expertise. The Budget for FY 1997/98 will record an actual baseline for resources allocated to specific Units. The "Action Agenda" (to be completed) describes planned activities for the next few years including references to donors support. World Bank support for the action agenda will be focused on: ANNF.X5 Page 5 of 7 * selected organizational Units specific to their mission and future agenda; * selected Units supporting institutional development objectives across the board; and * a new (temporary) unit charged with the implementation of World Bank support to the Population Sector (which includes the Capacity Building Component as well as a Population Activities Program). The World Bank's Egypt Population Project will support capacity building in the Population and Family Planning Sector of the MOHP. The total amount allocated to this component is approximately US$ 2.4 million for five years, including an "unallocated" category in the budget (approximately US$ 300,000 ), the use of which will be specified during the mid-term review of the Egypt Population Project in 1999. Two consultants will help finalize the Business Plan by June 30, 1996, and the Capacity Building component will be used to help the Sector achieve its key objectives. 9. Strengthening Organizational Units in MOHP A. The Undersecretary's Office Mission Statement: The main function of the Undersecretary's Office with respect to population, family planning and reproductive health issues is to support the Minister of Health and Population to: i) meet the expectations of the country's top leadership i.e. the President, the Prime Minister, the Cabinet and individual ministers/ministries regarding policy development, information and program implementation on population, family planning and reproductive health issues; ii) channel policy and program relevant information - from diverse sources - to the Minister; iii) manage advocacy and promotional work; and iv) advise and support the Minister in his role of chief executive of MOHP and prime advocate for the population sector. Capacity: Ability to make informed planning, management and policy making decisions and recommendations with respect to the Sector. Ability to conduct planning, implementation, advocacy, promotion and resource mobilization work on population, family planning and reproductive health matters and to support Minister and other senior Government officials at central and Governorate levels with the same. Ability to monitor and evaluate overall Sector programs and service quality and effort, and to stimulate the provision of quality programs and services by NGOs and the private sector. Action Agenda: The Undersecretary's Office will, in addition to its ongoing tasks: * periodically organize and support Senior Management Meetings linking the policy function of the Undersecretary and her Office with the line functions of the Population Sector (vertical co-ordination) and strengthening co-ordination between the GAs (horizontal co- ordination); * the Population Activities Program under the Egypt Population Project will be managed through a new Executive Committee to be chaired by the Minister of Health and Population or the Undersecretary as his appointed deputy and with participation from at least one Social Fund for Development representative, MOHP staff, an NGO representative and such other membership as considered desirable. This Committee will require staff support and systematic follow-up to its decisions by the Undersecretary's Office. * It has been agreed that the Capacity Building component of the World Bank Egypt Population Project would be managed by a Project Implementation Unit (PIU) with a Project Director, a Training Officer, an Administration Officer, a Project Accountant, a Data ANNEX S Page 6 of 7 Management Specialist and support staff. The Undersecretary's Office will be responsible for installing and staffing the PIU. Population and Family Planning Sector Budget FY 1997/98: To be further specified during preparation of full Business Plan. B. Central Administration for Training, Research and Population Statistics. Mission Statement: This Unit's mission is to develop policies for population, family planning and reproductive health, plan and develop the human resources required for population, family planning and reproductive health programs, manage and disseminate the results of biomedical and operational research programs in order to maximize their benefits, and to provide statistics and information for management and policy making purposes. Capacities: * Ability to plan and manage policy, research and statistical programs and sectoral manpower and training. i Ability to interpret research reports from any source and formulate and present their policy implications within and outside MOHPAbility to manage external contracts for research and evaluation. Action Agenda: to be further specified during preparation of full Business Plan. Budget FY 1997/98: to be completed during preparation of full Business Plan. C. Central Administration for IEC and Population Education Mission Statement: This CA's main objectives are to create awareness about population issues and about family planning and reproductive health among all segments of society in order to increase demand for smaller family size as well as for family planning and reproductive health services. The CA will give a special focus to population education both inside and outside the formal education system. Capacities: * Ability to plan, promote, deliver, support and monitor national and local IEC and Population Education Programs. * Ability to conceptualize IEC needs and discuss them with professionals who can design promotional campaigns. * Ability to promote and monitor population education programs. * Ability to formulate appropriate specifications for market research. * Ability to manage contracts with external agents for IEC campaigns and market research. * Ability to plan, manage and evaluate national community development worker programs. ANNEX- Page 7 of 7 Action Agenda: to be further specified during preparation of full Business Plan. Budget FY1997198: to be completed during preparation of full Business Plan. D. Central Administration for Population and Family Planning Services and Methods Mission Statement: The objectives of this Unit are to provide quality population, family planning and reproductive health programs and services to all segment of society regardless of ability to pay through the public sector; to provide an appropriate enabling regulatory environment for NGOs and the private sector and to stimulate the provision of quality programs and services by the same; to mobilize resources for these programs and services from international donors as well as from domestic private and public sources of finance; to improve the quality of programs and services by addressing issues of access, client satisfaction and program and service delivery standards in both the public and private sectors. Capacities: * A continuously updated database on population and family planning activities nationwide. * A system to manage population, family planning, and reproductive health services. * A monitoring system for population and family planning services. * Ability to formulate important operational research questions and develop requests for proposals. * Ability to manage external contracts for evaluation and research. * Ability to digest, summarize, interpret, and present data on population and family planning services in a timely manner. * Ability to set quality standards for family planning and reproductive health services. * Ability to assess clinic, provider, and outreach worker performance against standards. * Ability to coordinate service provision among all public and private agencies. * Ability to mobilize resources to pay for contraceptive commodities from donors and government sources. * Ability to provide central support to local level population and family planning programs. Action Agenda: to be further specified during preparation of full Business Plan. Budget FY 1997/98: to be completed during preparation of full Business Plan. 10. Further Analysis Several Population Sector Units have not been analysed for Business Plan purposes i.e. the Unit for Administration and Finance. They will also need to be reviewed individually for the completion of the Business Plan. The two consultants preparing the full Business Plan will include these units in their work. ANNEXS Page 1 of 2 ARAB REPUBLIC OF EGYPT POPULATION PROJECT SUMMARY OF TRAINING ACTIVITIES COMPONENT SUBJECT PARTICIPANTS YEARI COST (S) Proed Managmen Tearn Building #1 Project Steering Conmmittee 2 15,000.00 Tearn Building #2 Project Steering Committee 4 15,000.00 30,000.00 Bud Planning & Staff Upgrading Mamgers and Deciion Support Staff 10,000.00 Prfic Deepmu Staff Upgrading Managers and Decsbion Support Staff 2 14,000.00 Staff Upgrading Mangers and Decision Support Staff 4 4,000.00 Monit. & Eval. Population Sector Staff 2 16,000.00 Monit. & Eval. Population Sector Staff 3 16,000.00 Mnt. h Eval. Population Sector Staff 4 16,000.00 onit. & Eval. Governorate Staff, PlU Director, NPC 4 16,000.00 verseas Study Tour -Dec. Support Populat. Sector Staff, PIU Director, NPC 2 53,000.00 Promotion & raining for NG Leaders NGO Leaders12 145,000.00 Promutot n & Training for NGO Leaders NGO Leaders 2 15,000.00 Commonitks, Training for NGO Leaders NGO Leaders 3 15,000.00 Montoring & Training for NGO Leaders NGO Leaders 4 15,000.00 EvWulon Training for NGO Leaders NGO Leaders 5 15,000.00 and PAP Support Traing. for Community Leaders Community Leaders 2 15,000.00 raing. for Community Leaders Community Leaders 3 15,000.00 Traing. for Community Leaders Comnmunity Leaders 4 15,000.00 Traing. for Community Leaders Community Leaders 5 15,000.00 Overseas Study Tour Religious Leaders 3 30,000.00 Overseas Study Tour Religious Leaders 4 23,000.00 EEC Training Population Sector Staff 2 15,000.00 C Training Population Sector Staff 3 15,000.00 EC Training Population Sector Staff 4 15,000.00 EC Training Population Sector Staff 5 15,000.00 Population Education Population Sector Staff I 10,000.00 Population Education opulation Sector Staff 2 10,000.00 Population Education Population Sector Staff 3 10,000.00 Population Education Population Sector Staff 4 10,000.00 Population Education Population Sector Staff 5 10,000.00 Overseas Study Tour Community Leaders 2 53,500.00 Monitoring & Evaluation Population Sector Staff 3 16,000.00 Monitoring & Evaluation Population Sector Staff 5 16,000.00 Teambuilding for PAP Population Sector Staff 1 15,000.00 Teambuilding for PAP Population Sector Staff 2 15,000.00 Teambuilding for PAP Population Sector Staff 3 15,000.00 Teambuilding for PAP Population Sector Staff 4 15,000.00 Tearnbuilding for PAP opulation Sector Staff 5 15,000.00 443,500.00 Gen. Adminiration Management Training Population Sector Managerent 2 10,000.00 & Managment Managemnent Training Population Sector Management 3 10,000.00 Management Training Population Sector Management 4 10,000.00 Mangement Training Population Sector Management 5 10,000.00 Finance Training Workshop Population Sector Finance Staff 1 6,000.00 Finance Training Workshop opulation Sector Finance Staff 4 6,000.00 52,000.10 670,500.00 ANNEX 6 Page 2 of 2 SUMMARY OF RESEARCH ACTIVITIES COMPONENT 1TEM IMPLEMENTED BY: YEAR COST (SD Pobcy D _ebpnit Annual Report on Egyptian Population CA for Training, Research, and 2 10,000.00 and Family Planning Achievements 3 10,000.00 Population Statistics 4 10,000.00 _ _________________ ___________________________________ ________________________ S 10,000.00 40,000.00 Promotn & (1) Evaluation of Mass Communications |CA for IEC & Populaton 2 15,000.00 COnm s 1cado (2) Evaluadon of Interpersonal Communications 4ducadon 15,000.00 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 30,000.00 Qual=ty Laprovwet (1) Study on Client Satisfaction 2 20,000.00 Research (2) Study of Provider KAP CA for Training, Research, and 3 20,000.00 1(3) QOC Research Population Statistics 4 20,000.00 -__ _ _ _ _ _ _ _ _ .__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 60,000.00 MI-TemI 1() Preparation |Unit for Administration and 1 2 10,000.00 Evaluti 1(2) Follow-up Workshops |Decision Support | 3 20,000.00 30,000.00 TOTAL 160,000.00 ANNEX7 ARAB REPUBLIC OF EGYPT POPULATION PROJECT POPULATION ACTIVITIES PROGRAM (PAP) MANAGEMENT STRUCTURE OF THE COMMUNITY DEVELOPMENT DEPARTMENT OF THE SOCIAL FUND Board of Directors Executive Committee Managing Director Community Development l ~~~~~~~~~~~~~ProgramPPExctv Social Income Women in Director General /Committee Development Generating Developmentl/ Activities Population ProgramoI OfSteering I _ 0 . l l ~~~~~~~~~~~~~~~~Committee Admin. Senior Operations Fnancial Officer |2 Project Officers| Assistant Officer I 1 i ~~~~~~~~~~~~~~~~~~SFD Regional Office Managers |Population | I Officer I ANNEX 8 Page 1 of 10 ARAB REPUBLIC OF EGYPT POPULATION PROJECT THE POPULATION ACTIVITIES PROGRAM OPERATIONAL MANUAL 1. The Population Activities Program is a program for funding community activities that promote smaller families and create social conditions conducive to lower fertility. The program will operate for five years from late 1996 as one component of the Egypt Population Project, supported by an IDA credit from the World Bank. This manual first discusses the substance of the program, describing community and activity coverage and listing the criteria to be used in evaluating applications. Then it describes how the program is managed and explains the application process to be followed. 2. The primary objective of the program is to create social conditions favorable to lower fertility, especially in disadvantaged, high-fertility communities in Upper Egypt. Favorable social conditions would encompass, but are not limited to, such things as a better educated population, especially better educated women, later age at marriage, greater public awareness of population issues, and greater acceptance of contraception. 3. The program operates by providing grant funds to local organizations to implement activities clearly focused on promoting lower fertility. The activities to be funded include many types of informational, educational, and welfare-enhancing activities, especially those that benefit women in low-income communities. Examples of possible activities are given below. Specifically excluded is the delivery of clinical family planning services. However activities which increase the impact of existing family planning services by making communities more receptive to them are covered under the program.' Communities Covered 4. A substantial gap exists between levels of contraceptive use in Lower Egypt and in Upper Egypt. In practically all the urban govemorates and the governorates of Lower Egypt, contraceptive prevalence is above 50 percent; in all but one of the governorates of Upper Egypt, contraceptive prevalence is below 35 percent.2 Accordingly this program concentrates on communities in Upper Egypt, especially rural communities, where prevalence is generally only half as high as in urban areas. In this context only and to provide outreach, supply side support items not to exceed 10 percent of any grant may be covered. These might include some supplemental payments and training for clinicians and clinic staff, basic equipment such as sterilisers and painting of clinics. 3 Fauta H. El-Zanaty et al., 1993, Egypt Demographic and Health Survey 1992 (Cairo, Egypt, and Calverton, Maryland: National Population Council and Macro International), p. 75. ANNIEX-8 Page 2 of 10 5. To the extent possible, promotion and outreach for the program will cover all eight govemorates of Upper Egypt. The initial focus will be on the capitals of each govemorate, in order to obtain official sanction for the program within the govemorate and because some of the possible activities should be carried out at the governorate level. Subsequently the focus will shift to rural areas in these govemorates. The priority areas to reach will be those where officials are most receptive and contraceptive use is particularly low.3 To a large extent, the program is meant to be demand-driven, so that, once initial promotion is completed, program focus should depend on the volume and quality of proposals approved, as assessed against the criteria given below. Activities Covered 6. A variety of activities that promote small-family preferences and the acceptance of contraceptive use may be funded under the program. Activities may be funded in such areas as nonformal population education, population and family planning communication and public advocacy, measures to improve women's status in the home and in the community, outreach activities supporting the clinic network. In each case, however, a reasonable link must be drawn between the activity and lower fertility. 7. Here are illustrations of possible projects. Awareness creation. Local communities may use periodic public meetings, lectures, household visits, and similar mechanisms to increase awareness of population issues, as well as to educate and motivate people in such related areas as appropriate child nutrition and the need for female education. Different groups may be targeted sequentially, such as young girls or husbands. These activities may extend beyond awareness creation to include, for example, parenthood education for young married couples. Development of a network of change agents. In governorates without community outreach workers of this type, a similar system might be introduced. Through home visits, these workers provide motivational support and information for family planning as well as other forms of household assistance. Development of capacity to produce information-education-communication materials. The paucity of print material in clinics and in communities may be due partly to the absence of capacity to produce such material locally. This capacity could be developed, where it does not now exist, in the major cities of each governorate, through staff training and the provision of some necessary equipment. For refernce, levels of conrctive use in each governorae (as of the 1992 Denograpthc and Health Survey, in percent) are as follows: Giza 50. Beni Suef 29, Fayoum 33, Menya 22, Assiut 28, Souhag 20, Qena 25, and Aswan 32. ANNEX-8 Page 3 of 10 Training for community influenftals. Such professionals as teachers, nurses, and even doctors are not always adequately informed about population issues and the rewards and risks of family planning. Training programs for such professionals, public officials, and other influentials working and living in small communities might be conducted at appropriate training sites, with provision being made to allow them to be absent from their regular duties during training. Population education for religious leaders. The endorsement of family planning by top religious leaders may not have filtered down to all local clerics, especially those without government positions. Opportunities to communicate the message and to educate the religious leaders of small communities need to be created. These might be training seminars, visits by senior clerics, distribution and organized discussions of materials on Islamic views of family planning, and similar approaches. Rural internships for urban youth and professionals. Organized programs to put urban students or young professionals to work for some period in rural communities may increase their sensitivity to rural problems as well as acting as a modernizing influence in these communities. Appropriate training prior to postings will be needed, and specific work programs for them will have to be defined in advance. Programs that involve medical professionals would be especially useful. Family planning competitions. As already happens on television, governorates may wish to establish annual competitions in the family planning area, providing prizes for communities that have made the greatest improvements, service providers and outreach workers who have performed the best, and possibly even couples or households who have contributed in particular ways to population stabilization. Other activities. The preceding activities do not cover all the possibilities. This program is meant to encourage experimentation, and new approaches to the problem of promoting lower fertility will be welcomed. 8. The program generally does not fund research. The only exceptions are community needs assessments and pilot testing of particular community interventions. The community would have to be actively involved in the assessment or the pilot test and be ready to implement appropriate activities afterwards. AMEX 8 Page 4 of 10 Criteria for Approval 9. Proposals will not be approved unless the following three essential criteria are met: * The activities proposed have reasonable probability to reduce fertility preferences and are of sufficient scope and weight, by themselves or in connection with other concurrent interventions, eventually to affect fertility.4 * The community is committed to the project, as evidenced in some consultative process, and is willing to make some contribution, in cash or in kind, to ensure its success. * The proponents can demonstrate that the proposal is likely to be effectively implemented. 10. A proposal that meets these three criteria will be considered more favorably the more of the following characteristics it has: * effective targeting of interventions to the lower-income population • the presence of adequate contraceptive supply, so that any increased demand is likely to be satisfied * sustainability of the proposed activities or of their effects, such that they will be able to continue, or their effects will be permanent, even after the termination of the grant * a favorable impact on health and welfare, in addition to the fertility impact * synergies in the activities proposed, such that they are mutually reinforcing or reinforce the effects of other development initiatives. 11. Most grants will not exceed LE 65,000 and will cover periods of two years or less. The program will attempt to expedite approval of such grants, but larger grants will require the approval of the Executive Committee that oversees the program. Researchers have determined that the main proximate determinants of fertility-the behaviors that result direcy in higher or lower fertility-are marriage timing, breastfeeding, contraceptive use, abortion, and sterility. These behaviors in turn are more or less common depending on an individual or couple's socioeconomic characteristics. For instance, later marriage and more frequent contraceptive use tend to be more common when the wife is more educated, sometmes but to a lesser extent when the husband is more educated, when the wife is employed, when the community level of infant mortality is low, when the household has a higher income, and when they reside in an urban area. Access to good quality contraceptive services and effective information-education-communication also of course help to raise contraceptive use. Any project that involves an attempt to directly influence proximate determinants may be assumed to be fertility-related for purposes of this program. Any project to affect acceptance of services may also be assumed to be fertility-related. A proposal to affect some of the socioeconomic characteristics related to the proximate determinants may or may not be acceptable under the program, depending on the closeness of the link to fertility. ANNEX-8 Page 5 of 10 Program Administration 12. General oversight of the program will be provided by an Executive Committee chaired by the Minister of Health and Population. The four other committee members may represent the Ministry of Health and Population (MOHP), the Social Fund for Development, the Ministry of Economy and International Cooperation, NGOs or whomever the chair selects, except that the Social Fund for Development should always have at least one member (see Figure 1). Flre1 Egypt Population Project: Population Activities Program (PAP) Proposed Implementation Structure Responsibilities Executive Committee Policy and program management World Bank Chair: Minister, MOHP Project approval (above LE reports 4 additional members 65,000) Financial oversight Ex-post monitoring Responsibilities Governorate Steering Project approval (up to LE 65,000) IDA Committees Promotion, outreach I funds Semi-annual portfolio review decisions 1 t reports Responsibilites Funds management Ministry for Social Fund for Managing and supporting grantees Economy and Development Promotion, outreach International fi&ndsfor (Population Program Project appraisal Cooperation PAP and regional offices) Field supervision Reporting funds for 1 capacity fiunds proposals building Responsibilities MOHP pro- NGOs and Proposal preparation rnotion, governorate agencies Project execution support Reporting ANINEX-8 Page 6 of 10 13. The Executive Commnittee's deliberations will follow written procedures it wiDl adopt at its first meeting. The Executive Committee will be responsible for approving the Operating Manual for the program, for policy and program management, financial oversight, individual project approval (though it may delegate this responsibility for grants up to LE 65,000), and ex-post monitoring. 14. A Project Approval Authority will be established in each governorate of Upper Egypt with a representative from governorate office of MOHP and a representative from the regional office of the Social Fund for Development. As determined by decision of the Executive Committee, it will have authority to approve grants up to LE 65,000 and will conduct semi-annual portfolio reviews. A key role for the MOHP representative will be reviewing the link of the proposed project to the main determinants of fertility. 15. Execution of the project will be the responsibility of the Social Fund for Development, through a newly established Population Program and through regional offices. It will administer the program in accordance with its established operating policies and procedures, except where specified otherwise in this manual or determined subsequently by decision of the Executive Committee. The fund wil receive and be accountable for donor funds and be responsible for funds management. It will provide promotion and outreach, appraise projects, manage and support grantees, supervise projects in the field, and prepare reports on the program for the Executive Committee. 16. Additional promotion and outreach for the program and support for grantees will be provided by MOHP, which will also be responsible for mobilizing governors and relevant governorate agencies to assist in this effort. Under the direction of the Executive Committee, MOHP will also be responsible for systematic monitoring and evaluation of the effects of the program as a whole. Each individual project will also have its own monitoring system, which will be implemented by the proponent. ANNEX8 Page 7 of 10 Table 1 Capabilities for MOHP to develop to allow it to take over increased management of the Population Activities Program and equivalent programs A. By effectiveness Initial capability to support Executive Committee Some promotion and outreach capability B. By midterm review Policy and program review Financial follow up and portfolio review Ex-post monitoring and follow up C. By end of project life (capabilities to be effective for equivalent future projects) Funds management (disbursements to executing agencies, project accounts administration, internal auditing) Management and support to grantees Functions to be left with executing agencies: Project execution (preparation, appraisal, supervision) Field supervision Reporting Disbursements to grantees 17. The ministry will develop the capability to handle, on its own, many of the tasks initially assigned to the Social Fund for Development (see Table 1). Depending on progress in this regard, participating agencies may discuss with the donor the transfer of certain responsibilities for program administration to the ministry at the time of the midterm review of the World Bank- supported Egypt Population Project. However, certain functions listed in Table 1 will remain with other agencies, as it is the intention of MOHP to be a facilitator and program manager, not an executing agency. The Application Process 18. The application process will be designed to minimize delays and to provide as much assistance as possible, from the Social Fund for Development and from MOHP, to small nongovernmental associations (NGOs) in preparing their proposals. 19. Applications may be accepted from any NGOs of any size. Small, informal community associations with little previous project experience will be given equivalent attention to large NGOs with wide experience. Governorate agencies will also be invited to apply. The "sponsoring" arrangement envisioned for the Community Development Program, where larger national NGOs team up with several smaller local NGOs to prepare and implement projects, will be one possible arrangement, but direct applications from smaller NGOs will also be encouraged. ANNEX8 Page 8 of 10 20. Applicants should have or will have to obtain independent legal status so as to be authorized to receive grants and to carry out activities in the specific sector, whether it be population or more generally education, health, communications, or other areas of community activity. 21. Initially, an applying organization should provide a brief description of the proposed project to the Social Fund, at its central office or govemorate offices. If this is acceptable in principle, the organization will be invited to submit a formal proposal. Appendix A explains what this proposal should contain. 22. One part of the proposal should be a detailed budget, covering items necessary for the project, such as operating costs, supplies and equipment, and training. The budget should not include recurrent organizational costs unrelated to the proposed project, nor can it include infrastructure or construction. Administrative costs (excluding technical inputs) generally should not exceed 10 percent of total project costs. Whenever possible it is preferred that the proposing organization or the beneficiaries contribute to the project, financially or in kind, to cover, for example, 10 percent of project costs. 23. Projects of LE 65,000 or less may be approved at the govemorate level. Larger projects require the approval of the Executive Committee for the program. Upon approval, a framework agreement will be signed between the Social Fund for Development and the grantee specifying terms and conditions of the grant and the obligations of the grantee. Responsibilities of Grantees 24. A grantee (or "sponsoring agency") is responsible for executing a project in accordance with the framework agreement. Funds are to be spent only for the designated purposes. 25. Funds for approved projects will usually be provided in tranches. The first tranche will be deposited in the grantee's bank account upon signature of the framework agreement. Subsequent tranches will be provided upon receipt of expenditure statements and accompanying progress reports from the grantee and their review and approval by Social Fund for Development staff. 26. In procuring goods and services under this program, the grantee should follow World Bank procedures as specified in the loan agreement for the Egypt Population Project. This involves local purchasing procedures, obtaining reasonable prices after consulting at least three suppliers, with due regard for such factors as the reliability of the goods, delivery periods, and after-sale services. 27. Through the life of a project, the grantee will provide access to its facilities and activities to program staff after receiving adequate notice of a request for a visit. 28. The grantee will submit periodic reports on project activities, as specified in the framework agreement, as well as a final report covering all project activities and some discussion of their impact. ANNEX 8 Page 9 of 10 29. The Social Fund for Development will irnpose on grantees the general conditions it applies to its community development projects, as well as additional conditions as may be necessary for effective and efficient project implementation. In all cases, however, these conditions will be reflected in the framework agreement. Appendix A. Outline for a project proposal The project idea should initially be discussed with the Social Fund for Development. For this discussion, all that are needed are (a) a general description of the project concept and how it would be implemented and (b) identification of the communities and organizations involved. If this initial discussion is favorable, a formal proposal should be prepared, covering such items as the following. 1. Project title. Provide a concise title reflecting the main activity of the project and its geographical coverage. Use this title on all documents. 2. Objectives. State what the project seeks to achieve either quantitatively or qualitatively, as precisely as possible. 3. Organizations involved. Specify the agencies to irnplement the project and briefly describe them. List addresses, telephone numbers, and key contact persons. If an organization is registered, provide registration information. (For nongovernmental organizations, or NGOs, also fill out Social Fund for Development Form 13.) 4. Beneficiaries. Indicate which communities, groups, or agencies will benefit from the project. If any groups are specifically targeted, make this clear, and indicate any specific focus on women, youth, or other social groups. 5. Rationale. Provide any relevant historical background to the project. Describe the motives and experiences leading up to it and the community setting or settings in which it is to be implemented. Where appropriate, provide statistics. Explain how the project is expected to reduce fertility. 6. Project description. Describe the specific activities that constitute the project, as well as any goods or services to be provided. Give the location and frequency of each activity. 7. Method of implementation. Specify how these activities will be organized and supervised, who will be responsible for each aspect of them, what initial training will be needed, what assistance from other agencies is desired, and how follow-up will be provided if needed. 8. Period of implementation. Give the period required for implementation, and divide it if desirable into phases, with specified goals for each phase and the costs associated with each. 9. Monitoring plan. Explain how project activities will be monitored, their outputs tracked, and their outcomes assessed. Discuss how this monitoring process will be used to improve the ANNEX-8 Page 10 of 10 project over time. 10. Budget. Include in the budget all the expenses connected with the project, classified into such categories as equipment, salaries, training, supplies, etc. Specify which costs can be covered from other sources and for which costs funding is being sought. As noted above, applicants are encouraged to make provision to cover, on their own or from beneficiary contributions, 10 percent or so of total project costs. 11. Organizational aspects. Note any special legal, financial, managerial, and organizational aspects of the project. If more than one organization is involved, clarify their respective roles. 12. Additional information. Provide other relevant information, such as (a) community endorsements of the project and indications of local demand for it, (b) guarantees for sustainability or success, (c) possible side effects that can be anticipated and for which provision should be made, and (d) environmental impacts and measures for dealing with any negative impacts. ANNEX-9 Page 1 of 5 ARAB REPUBLIC OF EGYPT POPULATION PROJECT THE POPULATION ACTIVITIES PROGRAM ILLUSTRATIVE PROJECT COSTS 1. This document provides illustrative costs for three hypothetical projects that might be funded under the Population Activities Program and, on this admittedly limited basis, attempts to estimate an appropriate level of funding for the program. Costs are given in local currency (LE) unless indicated. Family Development Project 2. This illustrative project is assumed to be an extension to new areas of the current Family Development Project, supported by the Social Fund for Development in three governorates of Upper Egypt. Like the current project, this illustrative project basically involves the use of well- trained outreach workers (called "change agents") to provide households with a continuing source of education and motivation and a reliable link to social services. Unlike the current project, this illustrative project does not include a small-loan component (which, if desirable, would have to be funded outside the Population Activities Program). 3. Costs are estimated per governorate, assuming that this project should be initiated at the governorate level. It should be implemented, however, not in all governorate villages but only in those villages where the need exists, other outreach workers (such as the raidat) are not active, and where village leadership is favorable. The current project reaches 12,500 households per governorate, a small fraction (typically around 2.5 percent) of all households. This same scope is maintained in the illustrative project, recognizing that an actual project, particularly in a more backward province, might prefer wider coverage. 4. It is assumed that the project will last 41/2 years, but the first few months will be mainly organizational. Change agents are expected to be active for 31/2 years, one year longer than under the current project because enough should have been learned to allow a quicker start. The project director is expected to be able to manage three governorates at a time, with the help of assistant directors in each governorate. As Table I indicates, total costs under these and other assumptions are LE 2.5 million. IEC Capacity Building 5. This illustrative project involves development of the capacity to produce printed IEC materials in a governorate, presumably within governorate State Information Services offices. If such materials could be prepared locally, they could have substantial local content, relate to local perceptions, and respond to local issues. ANNEX9 Page 2 of 5 Table 1. Illustrative costing for a "family development" project in one governorate Item Units Cost per Months Total Subtotals Unit Salaries 1,739,220 Project director 0.33 1,000 54 17,820 Assistant director 1 750 54 40,500 Supervisors 10 200 42 84,000 Change agents 250 150 42 1,575,000 Secretary 1 175 48 8,400 Driver 1 250 54 13,500 Training 120,000 Program preparation 10,000 Training materials 10,000 Program implementation 100,000 IEC 240,000 Materials for home visits 50,000 Weekly meetings 360 250 90,000 Conferences 20 5,000 100,000 Equipment and maintenance Vehicle 1 70,000 Operating costs 350 54 18,900 Financial and technical support 250,000 Health unit support 10 25,000 250,000 Administrative costs (5% of all other items) 117,461 TOTAL LE 2,466,681 6. Over three years, three regular staff, who will remain on the government payroll, will receive an average of two months' training each in Cairo in materials production or market research. Trainers will supervise them and visit them subsequently in the governorate to provide technical assistance. Equipment for desktop publishing will be provided; such additional equipment as video decks and overhead projectors are assumed to be already available from other donors, but may be added if necessary. 7. Staff will then produce pamphlets and posters relating to family planning. At least some of these materials will be entirely pictorial so as to reach illiterates. For instance, pictorial guides to proper pill use or pictorial explanations of Islamic teaching about family planning might be produced. An important aspect of the project will be the conduct of materials pretests and market research to determine the types of messages that are needed and the types of materials that can best reach the desired audience. 8. It is expected that staff will not be occupied full-time on these materials and will also be able to apply the expertise they develop to other development communication initiatives. The total cost for the illustrative project is LE 390,000. ANNEX-9 Page 3 of 5 Table 2. Illustrative costing for an IEC capacity-building project in one governorate Item Units Cost per Months Total Subtotals Unit Salaries 5,400 Incentives for fEC staff 3 50 36 5,400 Training 45,960 Travel (round-trips to Cairo) 6 660 3,960 Subsistence 3 5,000 2 30,000 Course materials 6 2,000 12,000 Equipment and supplies 104,800 Computers, printers, software 3 20,000 60,000 Office furniture 16,000 Office supplies 800 36 28,800 Materials production and distribution 64,000 Booklets, pamphlets 5,000 2 4 40,000 Posters 2,000 1 12 24,000 Market research 76,000 Surveys, focus groups 3 20,000 60,000 Materials pretesting 16 1,000 16,000 Technical assistance 72,840 Materials production expert 0.25 1,500 36 13,500 Market researcher 0.25 1,500 36 13,500 Travel (round trips from Cairo) 24 660 15,840 Subsistence 2 5,000 3 30,000 Administrative costs (5% of all other items) 18,450 TOTAL LE 387,450 Awareness creation project 9. An awareness creation project for a village might begin with a locally conducted needs assessment, followed by various nonformal education activities and some community improvement initiatives. All these activities may be coordinated by a community development association, with possible assistance from a larger NGO or from technical experts provided by MOHP. 10. A three-year project is used as an illustration, with elements that may or may not apply for any specific community. The estimated cost is approximately LE 120,000, more than half of this for sending influentials, such as professionals or clerics, for population training. ANNEX9 Page 4 of 5 Table 3. Illustrative costing for an awareness-creation project in one vilage Item Units Cost per Months Total Subtotals Unit Salaries 20,700 Community director (incentives) 1 50 36 1,800 Community assistants 2 200 36 14,400 Health unit incentives 1 150 30 4,500 Training 66,000 Visits to other communities 12 500 6,000 Population training for influentials 12 5,000 60,000 Community outreach 3,000 Meetings and seminars 2 50 30 3,000 Community improvement initiatives (costs per year) 10,500 Community services improvements 1,500 3 4,500 Youth group activities 500 3 1,500 Women's handicrafts 1,000 3 3,000 Hygiene and beautification campaigns 500 3 1,500 Needs assessment 1,000 Initial study 1,000 Technical assistance (NGO-provided) 14,000 Advisers on community activities 5,000 Lecturers 2 150 30 9,000 Administrative costs (5% of all other items) 5,760 TOTAL LE 120,960 Appropriate program funding 11. Assuming these three projects are somewhat typical in regard to their costs of projects to be funded under the program, we can make a stab at estimating an appropriate funding level. Table 4 summarizes three alternatives. Table 4. Estimated alternatives for total program costs Cost per Saturation approach Medium approach Minimalist project approach Family development 2,500 29 72,500 13 32,500 5 12,500 IEC capacity 400 40 16,000 24 9,600 8 3,200 Awareness creation 120 1,600 192,000 80 9,600 40 4,800 ToTAL (LE) 1,669 280,500 117 51,700 53 20,500 TOTAL(US$) 82,500 15,206 6,029 Mean project cost (LE) 168 442 387 ANNEX 9 Page 5 of 5 12. In the saturation approach, we assume that each governorate should get the equivalent of three family-development type projects (counting the three projects that already exist). This does not mean that each of the projects would be similar. They might be quite different but, we assume, would have roughly equivalent total costs. Similarly, we assume that each governorate would have five IEC-capacity type projects and that each village in Upper Egypt should get an awareness-creation type project. All these projects across all governorates would then cost LE 280 million, or US$82 million. Recall that this is only for demand-creation activities, including outreach, and includes clinical support only to the extent of possible incentives for providers. 13. The minimalist approach, on the other hand, assumes one family-development type project in each govemorate (again counting those that already exist) and one IEC-capacity type project, plus awareness-creation projects in 2.5 percent of Upper Egypt villages. Total cost would be LE 20 million, or US$6 million. 14. In the wide gap between these two estimates, we can define a third, intermediate approach: two family-development type projects per governorate (including existing projects), three IEC-capacity type projects per governorate, and awareness-creation type projects for 5 percent of Upper Egypt villages. This intermediate approach cost LE 52 million, or over US$15 million. 15. Note how this compares with Community Development Program experience to date. After two years, that program has approved 47 projects totaling LE 125 million (US$37 million). This total amount is 31/2 times the total from the intermediate approach above, which covers five years rather than two. This could provide some justification for applying a slight increase to the intermediate approach above. However, a fund to create demand for lower fertility is more limited in the activities it can cover than a community development fund and can seldom justify coverage of such expensive items as infrastructure. Therefore a total amount substantially smaller than that committed to date by the Community Development Program may have some justification. 16. Among the Community Development Program projects to date, mean project size has been LE 2.7 million, but median size is much lower, at LE 500,000. This suggests that our estimates lean too heavily toward small projects. It is much more likely that larger NGOs, or the govemorates themselves, would "package" several small village projects together and present them as one. This would raise mean project costs but should affect totals only marginally. ANNEX 10 Page 1 of 6 ARAB REPUBLIC OF EGYPT POPULATION PROJECT THE POPULATION ACTIVITIES PROGRAM PERFORMANCE INDICATORS AND THE MONITORING AND EVALUATION SCHEME 1. This document describes indicators to be used and procedures to be followed to (a) monitor individual projects under the Population Activities Program, (b) monitor the program as a whole, (c) evaluate its effects and cost-effectiveness, and (d) learn from program experiences. Monitoring Individual projects 2. Monitoring an individual project under the Population Activities Program will be the responsibility of the grantee, who will be required to include a monitoring plan in the proposal. This plan should be specific to each project, since projects will involve a variety of activities linked to fertility in different ways. The plan should emphasize indicators that reflect the actual activities to be carried out. Indicators may also be suggested for fertility or the fertility-related variables meant to be affected by these activities, but these need not be emphasized: accurate measurement is difficult, and impacts of fertility may be delayed. The purpose of individual project monitoring is to enable the grantee to keep track of progress and adjust effort accordingly. Monitoring the program as a whole 3. To monitor the program as a whole, the Ministry of Health and Population (MOHP) and the Social Fund for Development should use simple statistics, collected by govemorate, updated at least every quarter, and included in all progress reports. Here is an initial list, subject to modification based on experience. Track the number or quantity of * Villages contacted for promotional purposes, through actual visits or other contacts with community leaders * Villages actually visited * Proposals submitted * Proposals approved * Funds committed * Funds disbursed to grantees or "sponsoring agencies" * Projects currently in progress * Current projects whose progress is rated satisfactory or unsatisfactory, or unrated (because of lack of data, because the project has just started, or for other similar reasons) * Projects completed with satisfactory reports * Projects terminated for other reasons * Ceremonial visits to project sites (as an indicator of the time grantees lose greeting dignitaries). NEX10 Page 2 of 6 4. Except for "projects currently in progress" and "project ratings," these indicators are more conveniently reported as cumulative totals within the governorate. "Project ratings" are the one subjective set of process indicators; once a proposal is approved, staff should devise criteria for rating progress on the project. Evaluating the program 5. Neither the monitoring system for individual projects nor the monitoring system for the program as a whole will give any idea of whether the ultimate goal of the program-creating demand for contraception and reducing fertility--is being met. Day-to-day or even quarter-to- quarter monitoring is ineffective for this purpose. It does not provide reliable measures of fertility, and fertility anyway changes too slowly to be observed on a quarterly basis. To ascertain any real progress in fertility reduction, one must rely instead on an occasional evaluation. Evaluation does not provide data for day-to-day management decisions about the program, but should instead provide information for longer-term strategic decisions, such as which types of projects should receive greater encouragement in the latter years of the program. 6. To evaluate the program, one can focus on six key output or outcome indicators, three having to do with fertility preferences or related attitudes and three having to do with resulting behavior: * Desired number of children-number of living children plus any additional children desired * Approval of family planning - Intention to use contraception, among nonusers - Contraceptive prevalence - Contraceptive discontinuation rate (excluding discontinuation deliberately to become pregnant, because of reduced exposure to risk, or to switch methods) - Total fertility.' 7. Other variables may become equally important indicators if several projects focus on them. For instance, birth interval length may become an important indicator if some projects attempt to promote longer birth spacing. Additional indicators will also be needed for cost-effectiveness, but these can be devised by relating changes in the key indicators above to the costs of particular projects. 8. Ascertaining progress on these key indicators is not a simple process. The data have to be gathered in a systematic fashion and have to be representative rather than biased. Fair comparisons have to be made between project areas and other areas. And one has to take into account the effects of other variables that can influence the indicators--for example, a poor harvest that makes economic conditions even more difficult and leads couples to restrict childbearing regardless of program effects. 9. The following sections discuss what needs to be done to provide the necessary data on these indicators and to interpret them properly. 'The period to which this indicator applies-typically a year or two preceding the survey-should be carefully noted. Page 3 of 6 Variables to consider in evaluation 10. Because the indicators camot be interpreted in a vacuum, it will be necessary to measure a number of other variables at the same tirne. Table 1 illustrates the types of variables that need to be measured, including the indicators themselves. Some of the added variables are alternative measures of the indicators that can be used to verify indicator levels. Others are "control" variables that might affect the levels of the indicators regardless of any specific project, and which therefore need to be held constant in interpreting the results. Table 1. Variables needed for evaluation Topic Variables Fertility preferences desire for more children, ideal number of children, child spacing preferences Fertility children ever born, birth intervals Contraceptive use current method use, ever use, consistency of use, discontinuation and method switching, unmet need for contraception Knowledge and knowledge of methods and sources, knowledge about how to use, attitudes toward approval of use, intentions to use, reasons for nonuse contraception Other proximate age at marriage, breastfeeding practices determinants Socioeconomic age, parity, education (wife and husband), urban-rural residence, determinants wife's work status Community facilities distance to nearest clinic, level of schooling available in community 11. Good measures of these variables can be obtained from demographic surveys, and in a few cases from censuses. In fact, current data on most of these variables should become available from the Demographic and Health Survey in late 1995, from a survey of 70,000 households by the Center for Public Mobilization and Statistics (CAPMAS) about the same time, and from the 1996 census. Later data may also become available from a Demographic and Health Survey in 2000. However, these data may not cover the specific communities to be included in the program and therefore may not have anything to say about the program effects. It will be necessary therefore to mount specific surveys of the program communities. Timing and sample for evaluation surveys 12. Because of the effort and expense involved in such surveys, they will be conducted only twice: in late 1998 and in 2000. The first survey should provide data for the midterm review, and the second for evaluation of the program at the time it is scheduled to terminate. 13. Doing only two surveys is a necessary simplification. Ideally, one would survey each project community both before and after the project, but this would lead to dozens of small surveys, which would be very difficult to manage. Doing only two surveys will not give as good data, but with appropriate analysis of the results could still be adequate for evaluation. ANNEX 1Q Page 4 of 6 14. Communities implementing projects under the program will be included in the midterm and final surveys. Where projects have been implemented for the entire governorate, a random sample of communities, perhaps one in 10, will be drawn within the governorate. Households will be selected randomly in the communities to be studied, taking perhaps one in 20 households or some similar fraction. The same questionnaire will be used in all project communities. However, separate modules may be added to it in different project communities relating to the specific intervention implemented there. 15. Project communities will be included in the midterm survey only if their projects are completed or well-advanced. A simple criterion might be that the project should have been active for at least 1 'h years. The same criterion will hold for the final survey, which means that all those studied in the midterm survey will be covered a second time. Since project communities may be studied soon after completion of the intervention, some time later, or even before completion, one may be able to assess both transient and lasting intervention effects. Interpreting and reporting on evaluation surveys 16. A critical part of the interpretation of midterm and final survey results will be making comparisons with nonproject communities. It will not be enough to show, for example, fertility decline in project communities; one also has to show the absence of a similar decline in nonproject communities, to indicate that the projects did make a difference. Such comparisons will require using data not only from these surveys themselves but also from other surveys, probably the Demographic and Health Surveys, which cover communities in Upper Egypt where projects under this program will not be implemented. 17. Such comparisons also have to be done statistically, because many complex influences on fertility and fertility preferences have to be taken into account. The statisfical analysis should cover these areas: * Descriptive tables for fertility and fertility preferences, their levels and differentials * Trends and tabular comparisons between project communities and nonproject communities, the data for the latter coming from Demographic and Health Surveys or similar sources that may become available * Multivariate analysis to isolate, to the extent possible, any project effects. 18. The descriptive tables should be similar to tables produced for Demographic and Health Surveys, but less extensive given a more limited variable list. The comparison tables should differentiate among project communities subject to different types of interventions. The multivariate analysis will focus on project effects on contraceptive use and fertility preferences. 19. One report should be prepared on the midterm survey and another on the final survey. Besides laying out the analysis and drawing appropriate conclusions, these reports will address the implications of the findings for the Population Activities Program and for future MOHP activities that may seek to stimulate contraceptive demand. The report on the midterm survey should be prepared in time for and become a critical part of the midterm project review, and the report on the final survey should be a critical part of the final evaluation of the Egypt Population Project. ANNEXJ1 Page 5 of 6 Learning from program experiences 20. These survey reports should provide a reasonably reliable verdict on the different projects funded under the program: which worked and which did not work. They may not provide enough explanation, however, for why some things worked and others did not. And, if few things worked, they may provide only limited insight into what else might be tried. 21. The two surveys will be supplemented, therefore, with a few qualitative studies focused on particular communities: a baseline consultation of a few Upper Egypt communities and subsequent studies, at least one a year, of the most interesting project communities. 22. The purposes of the baseline consultation2 will be to verify the assumptions underlying the Population Activities Program and to provide additional ideas about the types of projects it should support and the ways in which they should be implemented. In a sense this baseline consultation will be an attempt to determine how acceptable the projects envisioned under the program are likely to be to potential beneficiaries. 23. Since so many studies on these types of questions have already been conducted, the first part of the baseline consultation will be a thorough review of the literature (in Arabic, English, and French) on fertility, family planning, family structure and decision-making, community structure, and the status of women in Upper Egypt. This review and its implications for the study will be completed and discussed with the MOHP before any fieldwork is conducted. 24. Fieldwork will be conducted in not fewer than three and not more than six villages of Upper Egypt. It will be guided by specific research questions tied to the purposes of the baseline consultation, formulated based on the literature review. These questions may nevertheless change in the course of fieldwork. Interviews with key informants, observation, and possibly focus groups will be the main tools in fieldwork. A report will be prepared summarizing the fieldwork and addressing the specific research questions, as well as the main purposes of the baseline consultation. 25. If the results warrant it and funding is available, these baseline consultations will be extended over the life of the project, with the same communities being visited periodically to determine how conditions change over time. This may occur whether or not these communities become part of the program. 26. A few communities that do become part of the program, at least one a year (except in the first year) should be studied in detail. Whereas the evaluation surveys will verify project impact, these community studies will have different purposes: to document how the project actually operated in practice, as opposed to its initial design; to further elucidate the mechanisms through which the project had its effect; and to identify any side effects, intended or not, positive or negative, the project may have had on social patterns in the community. 27. The particular communities to be studied, to be determined by the Executive Committee, should be those with projects with the greatest potential impact, from the perspective of effect on MThis study is to be funded, outside the Egypt Population Project, by a grant to be arranged out of World Bank trust funds. ANNEX-10 Page 6 of 6 fertility, replicability, cost-effectiveness, sustainability, and similar factors. Since the types of projects to be studied cannot be predicted in advance, a particular design for these community studies will not be proposed here. It is anticipated, nevertheless, that, like the baseline consultations, these studies will require conmmuity observation, focus groups, intensive interviews with key informants, or some similar qualitative approach, coupled with review of any available records and quantitative data. Implementing the monitoring and evaluation scheme 28. MOHP will supervise the monitoring and evaluation scheme,. It will conduct monitoring itself with assistance from the Social Fund for Development. For evaluation, it will select contractors to implement the surveys and the community studies, review the reports, and send them to the Executive Committee for further review and transmittal to the donor. It will also assure that the reports, or appropriate condensations of them focusing on key evidence and policy issues, are widely disseminated within the population community in Egypt in uncensored form. 29. The contractor for the surveys, to be chosen from a short list prepared by MOHP and approved by the World Bank, will be an agency capable of mounting national sample surveys and following up this effort over time. The contractor will be responsible for each phase of the evaluation scheme: designing the sample; drafting, pretesting, and revising the questionnaire; recruiting, training, and supervising field staff; entering and verifying data; conducting analysis; and preparing survey reports and responding to questions on them. 30. The contractor for the community studies, which may or may not be the same agency, will similarly be selected from a short list. It will be responsible for providing experienced staff for the community studies, providing logistical support for their efforts, and producing the appropriate reports. The baseline consultation may be contracted for separately, under the terms of a grant still to be arranged. ATTACHMENT I Page 1 of 3 DRAFT MEMORANDUM OF UNDERSTANDING BETWEEN THE MINISTRY OF HEALTH AND POPULATION (MOHP) AND THE SOCIAL FUND FOR DEVELOPMENT CONCERNING THE ADMINSTRATION OF A POPULATION ACTIViTIES PROGRAM Introduction 1.1 The Ministry of Health and Population (MOHP) is initiating a Population Activities Program (PAP) to fund community level activities that promote smaller families and create social conditions conducive to lower fertility, especially in disadvantaged high fertility communities in Upper Egypt. The Program will operate for five years beginning in late 1996. The Program is one component of a Population Project to be supported by an IDA Credit from the World Bank. The program will operate by providing grant funds to local organisations (NGOs and Governorate level public agencies) to implement activities that are clearly focused on promoting lower fertility. The MOHP has agreed with the Social Fund for Development that the Social Fund will assist the MOHP with the administration of the Program. This Memorandum of Understanding describes the responsibilities of each agency and the support the Social Fund will provide. Overall Implementation Arrangements 2.1 General management and oversight of the Program will be provided by an Executive Committee chaired by the Minister of Health and Population. The Committee would have four other members including at least one from the Social Fund. It would also be desirable to have one member as an NGO representative. Executive Committee's deliberations will be governed by written procedures to be adopted by the Committee at its first meeting. The Executive Committee will be responsible for approving the Operating Manual for the Program, for policy and program management, financial oversight, individual project approval (although for projects involving grants up to LE65,000 it may delegate responsibility as described below), and for ex-post monitoring. It will be responsible for approving the first ten projects presented to the Program. 2.2 A Project Approval Committee will be established in each Governorate in Upper Egypt with a representative from the Governorate office of the Ministry of Health and Population and a representative from the Regional office of the Social Fund for Development and a member to represent NGOs. As determined by decision of the Executive Committee, it will have authority to approve grants of up to LE 65,000 and will conduct semi-annual portfolio reviews. A key role for the Ministry representative will be reviewing the link of the proposed project to the main determinants of fertility. 2.3 Execution of the Program will be the responsibility of the Social Fund for Development through its Community Development Department and central and Govemorate offices with representation from permanent staff, as feasible. It will administer the program in accordance with its established operating policies and procedures, except where determined otherwise as set out in the approved Operating Manual for the Program (e.g. certain decentralised project approval authority) or determined subsequently by decision of the Executive Committee. The Social Fund will receive and be accountable for donor funds and will be responsible for funds management. It will provide outreach and promotional services, ATTACHMENT I Page 2 of 3 appraise projects, manage and support grantees, supervise projects and provide regular reports to the central Executive Committee. Under agreement with the Ministry of International Cooperation, the Social Fund will resource the Incremental Operating Costs resulting from the Program from sources other than the IDA Credit from the World Bank. 2.4 Additional promotion and outreach for the program and for support to grantees during the application process will be provided by the MOHP and govemorate offices as feasible and as capacity develops. The MOHP will also be responsible for systematic monitoring and evaluation of the effects of the program as a whole. The MOHP is also expected to mobilise the Governors and relevant Governorate level agencies to assist with promotion and outreach efforts. Each individual project will have its own monitoring system, which will be implemented by the proponent. 2.5 The sponsoring agencies, in the case of this program NGOs, other community level bodies with legal entity, and governorate level and below public agencies, will be responsible for preparation and presentation of their proposals, for project execution and for fulfilling reporting requirements. The obligations of the Sponsoring Agency will be set out in a Framework Agreement between the Social Fund for Development and the Sponsoring Agency. Transition of Responsibility Arrangements 3.1 As part of a broader effort to strengthen the capacity of the population and family planning operations of the MOHP in key functional areas, certain responsibilities for management of the Program will be transferred from the Social Fund for Development to the MOHP during the five year life of this project. At the start of the Program, the MOHP will begin to develop capacity in policy and program review, financial follow-up and portfolios review, and ex-post monitoring and follow up. The objective is for the MOHP to achieve these capacities by mid project (1999). 3.2 The MOHP will also develop capacity in funds management (disbursements to executing agencies, project accounts administration, and internal auditing), and in program management and support to grantees (promotion and outreach, project preparation advisory services, and capacity development services for NGOs and other sponsoring agencies) with the objective of being able to take over these functions from the Social Fund for Development by the end of the Program's life (2001) for future equivalent activities. All other functions will remain with sponsoring agencies, as it is the intention of the MOHP to be a facilitator and program manager, not an executing agency. 3.3 The Social Fund for Development agrees to provide the following categories of support to the MOHP to help it achieve its capacity building objectives with respect to management of the Program. The exact types and quantities of support will be determined on the basis of joint discussion. It will provide "on the job" training for senior MOHP managers and staff responsible for the Program, it will provide initial "check lists" or guidelines to help ministry staff responsible for supporting the Executive Committee with policy and program review, financial monitoring, and ex-post program monitoring review and follow up. It will train certain Governorate level staff of MOHP so that they are able to undertake promotion and outreach work, and to support the Ministry representative on the Govemorate Project Approval Committees. A1TACHMENT I Page 3 of 3 3.4 With respect to funds management, and management and support to grantees, as well as how to manage and present the reporting system for the Program, the Social Fund will provide training slots in its own training courses on a selective basis to Ministry staff who will have these responsibilities. Attachment For: Ministry of Health and Population For: Social Fund for Development Date: Cairo, Egypt ANNEXI1 Page 1 of 4 ARAB REPUBLIC OF EGYPT POPULATION PROJECT PROPOSAL FOR ACTION RESEARCH FOR EGYPT POPULATION PROJECT BENEFICIARY CONSULTATION PROCESS Background and Justification 1. Preparations have been completed for an Egypt Population Project, under the auspices of the Ministry of Health and Population (MOHP), to be financed with assistance of the World Bank. The primary objective of the Project is to support activities that would strengthen couples' motivation for having smaller families, and to practice family planning to achieve that goal. The main strategy of the proposed Project is to promote activities which are likely to influence social patterns and conditions, such as early age at marriage, low level of schooling especially of girls, relatively low status and decision making opportunities of younger women in the family, and others that contribute to keeping fertility at a high level in several areas of the country. Activities will be conducted by a variety of MOHP partners, under the overall umbrella of a Population Activities Program (PAP). 2. At present, contraceptive prevalence is lowest in the predominantly rural Govemorates of Upper Egypt. While for Egypt as a whole almost 50 percent of all married couples are using some form of contraceptive, the aggregate percentage in Upper Egypt is only 31 percent. The latter includes the more urbanized parts of the region. Contraceptive prevalence in the 7 rural Govemorates ranges from 19.8 percent in Souhag to 33.3 percent in Fayoum (CAPMAS 1994). Therefore, to narrow the gap in contraceptive prevalence and fertility between different regions, Upper Egypt has been selected as the primary target area for activities proposed under the PAP. Objectives of Action Research 3. Activities conducted under a project of this kind need to be inspired by the reality of families' lives. Therefore, a process of consultation - or action research - with potential future target groups will be initiated, prior to the Project's launching, expected in early fall 1996. This activity represents the first stage of a series of on-site consultations and action-research activities, intended to gather information and to keep track of changes over time in people's motivations, preferences, and actual fertility behavior during the life of the Project. Specifically, it allows the MOHP to achieve the following two immediate objectives: * Consultation with potential beneficiaries before the actual Project starting date, to identify barriers to contraceptive use by interested couples who are as yet non-users, and to explore underlying motivations for large families amongst other groups of non-users. This information will serve to better focus field activities to be undertaken under the Project's Population Activities Program; * Gathering of qualitative baseline data to complement other baseline data and Monitoring and Evaluation (M&E) systems to measure and monitor progress of the Population Activities Program at regular intervals, and its ultimate impact over the 5-year Project period. ANNEX 1I Page 2 of 4 4. Subsequent stages of the consultation process, undertaken while the Project is underway, will accomplish the important longer-term objective of: Assessing the relative effectiveness of different types of interventions in changing couples' fertility preferences, contraceptive acceptance, and, ultimately, fertility decline. This knowledge is a sine qua non for a Population Project of this kind, which is experimental in nature, and has as yet not been tried in a systematic way, either in Egypt or in other countries. Research Design and Special Considerations 5. The main purpose of the initial phase of the client consultation, or action research, presented in this paper, is to collect baseline data, before the starting date of the Population Project. It will consist of intensive village surveys in 5 randomly selected nual localities in Upper Egypt, which will subsequently serve as "sentinel" sites for comparison with other villages in which activities under the Population Activities Program are taking place. A first repeat research will be undertaken at the Project's mid-term review, and a second one by the end of the Project. At each repeat research, additional villages will be randomly selected from regions in which Project activities have taken place. Findings from both groups of villages will be compared, to make inferences about the most effective strategies to accomplish optimal impact, and to report and disseminate the results to interested parties. 6. To achieve the specific objectives of this action research, predominantly qualitative research methods such as focus groups, in-depth interviews, participant observation, etc. will be used. These will complement information from aggregate data sources such as the Egypt Demographic and Health Survey (last issue in 1992, new version scheduled to appear in 1996), the Egypt Population Census, scheduled to take place in 1996, and the USAID survey on "Unmet Need", to be carried out in several high-fertility Governorates in Upper Egypt during 1996. These sources of data provide the larger context for the Action Research. They provide the framework for comparisons between aggregate populations, sentinel villages, and other villages included in the survey. 7. To ensure maximum effectiveness, an initial survey will be carried out in one pilot village, serving as a test site for methodological approaches and content of research instruments. The test results will be summarized and presented by the executing agency to the MOHP Population and Family Planning Sector's Research unit, which will comment on it and give its approval for further work, provided that strict criteria of quality and appropriateness are met. 8. Hence the first phase of the action research will consist of the following five steps, to be carried out within a four-months interval in the early part of 1996: * Preparation (selection of executing agency, briefing, establishment of initial contract, preparation of survey personnel, selection of locality for pre-test); * Pre-test of data-gathering instruments, and presentation of methods and content to MOHP; * Refining methodology, random selection of sentinel villages and on-site research; ,ANNEX I I Page 3 of 4 * Data processing and analysis; * Reporting. 9. It is expected that on-site research teams will be composed of about four persons, of which half or more should be women. Recruitment of highly qualified, culturally sensitive researchers is essential, given the delicate nature of the subject to be explored. Researchers should have degrees in one of the social sciences such as sociology, anthropology, ethnography, social work, community development, or related disciplines. In addition, researchers should have extensive prior field experience in qualitative research. Information to be gathered 10. The details of questions to be asked and information to be gathered in the survey villages will be the task of the Executing Agency, in agreement with the responsible parties at the MOHP. However, the following seven different categoriesof information need to be gathered in the initial Beneficiary Consultation Process, in order to achieve its intended immediate and longer-term objectives. Fertility: Present fertility (family size, child spacing, etc., trends during the past five years and actual Total Fertility Rates (TFR) of the survey villages; Contraceptive use: Present contraceptive use, and trends during the last five years, perceptions/unmet demands and needs; Fertility preferences: Ideal and actual number of children, son preferences, of various groups of household members; Proximate determinants of fertility of survey population; Current marital status, presence of spouse, postpartum abstinence, etc. breastfeeding, age at first marriage; Education/labor force participation/attendance of development programs (literacy, adult learning, etc.), household production, and male/female division of labor; Household and community communication patterns and decision dynamics: Flows of information among and between household members, and community members and groups. Who decides on what subjects in the household. Roles/rights/responsibilities of men and women, of older people, children, friends, community influentials, government officials; Village infrastructure, and economic, social and cultural capacity/capital: Village amenities: Schools, health services, cooperatives, traditional and modem village organizations, including women's groups, cultural heritage/resources. ANNEX I I Page 4 of 4 Implementation Arrangements 11. Eunding for the initial action research, to be carried out in the first half of 1996, will be provided by the Canadian - Consultant Trust Fund for Egypt and other grant funding being identified. Repeat research, reporting, packaging and dissemination, as well as regular input of relevant information into the Population Project's M&E system will be funded by the Project. 12. Oversight of the action research will be the responsibility of the MOHP, which will also be in charge of coordination and quality control of subsequent action research activities, and summarizing and dissemination of findings for use by agencies and persons involved in the implementation of activities under the Population Activities Program and other relevant audiences. The Research Unit will prepare a request for proposal (RFP), appraise proposals, and select the most promising one. 13. An Egyptian Exeuting Agency will be selected according to criteria developed jointly by the MOHP and the World Bank. Criteria will emphasize capacity of the Executing Agency to carry out field research with avant-garde "beneficiary assessment methods," including focus group discussions, participant observation, in-depth interviewing, Rapid Rural Appraisal, community self-assessment, etc. In addition, the Executing Agency will be carefully scrutinized for its experience in field research, and its capacity to explore complex social issues especially related to fertility decisions, and to analyze family and community dynamics at grassroots level. Timetable and Products of Action-Research for Life-of-Project Phase 1. Initial survey: Early spring 1996 (* Specific Product to be delivered to Research Unit of MOHP) Step l: Preparation and advertisement of RFP: Jan./Feb., 1996 Step 2: Selection of Executing Agency: March, 1996 * Workplan to RU, March 15, 1996 Step 3: Preparation of field research: March, 1996 Step 4: Pretest: April, 1996 * Pretest Report to RU, April 30, 1996 Step 5: Fieldwork: May/June, 1996 * Progress Report to RU, June 30, 1996 Step 6: Data processing, analysis, reporting, July/August, 1996 * Final report and diskette to RU, August 31, 1996 Phase 2. Providing data input into PAP M&E system: At time of Population. Project effectiveness, about September, 1996 Phase 3: Repeat field research, reporting and dissemination # l: Midterm Review Phase 4: Repeat field research, reporting and dissemination # 2: End of project ANNEXI1 Page 1 of 3 ARAB REPUBLIC OF EGYPT POPULATION PROJECT Expenditure Accounts by Years - Totals Including Contingencies (USS '000) Toftal Including Contingencies 9U97 971N 9U9 99/00 00/01 ToWl 1. Invesmnt Cods A. Vehcles 114.7 117.7 - - - 232.5 B. Sub-Project Activits 1,700.0 3,400.0 5,100.0 4,250.0 2,550.0 17,000.0 C. Equipment 94.1 87.1 - - 181.2 D. Overseas Training - 131.7 45.8 48.7 17.0 241.2 E. In-country Training 32.0 122.6 106.7 136.1 87.3 484.7 F. Intemational Consultants 26.3 27.0 27.5 28.0 - 108.6 G. Local Consultants 131.8 139.1 130.2 109.0 120.4 830.5 H. Fumiture 29.8 12.5 - - - 42.3 I. Studies 10.7 105.3 96.6 101.1 83.1 396.7 J. Awards 11.0 11.6 11.5 11.4 11.3 56.8 K. Project Management 245.4 233.4 231.1 228.1 224.9 1,162.9 Total Investment Cosbt 2,396.7 4,387.9 5,749.5 4,910.5 3,094.0 20,537.6 11. Recurrent Cost A. Operation and malntainance 13.5 21.5 21.5 21.4 21.3 99.3 C. Supplies and Consumables 6.0 5.0 5.1 5.2 5.2 26.5 Total Recurrent Costs 19.5 26.5 26.6 26.6 26.5 125.8 Total PROJECT COSTS 2,416.2 4,414.5 6,776.1 4,937.0 3,120.5 20,163.4 Project Components by Year - Totals Including Contingencies (US$ '000) Totabl Including Contingencbs 96U97 97/98 9m99 91900 00101 Tota A. Capacity Building Project Management 105.0 88.4 71.0 87.6 70.1 422.2 Business Planning 114.3 233.4 110.3 121.5 51.8 631.3 Promotion and communication 21.7 202.7 158.7 176.6 130.4 690.1 Monitoring and Evaluation & PAP suppo 208.2 211.9 70.7 53.7 48.0 592.4 General Administration and Managemen 45.0 44.7 34.3 19.5 45.2 188.8 Subtotal Capacity Building 494.2 781.1 445.0 458.9 345.5 2,524.8 B. Population Activies Program 1,921.0 3,633.4 5,331.1 4,478.1 2,774.9 18,138.6 Total PROJECT COSTS 2,416.2 4,414.5 5,776.1 4,937.0 3,120.4 20,1143A ANX12A.XLS ARAB REPUBLIC OF EGYPT POPULATION PROJECT Components Project Cost Summary (LE. V00) (USS '000) % % Total % % Totai Foreign Bae Foreign Bae Local Foreign Totdal Exchange Coast Local Forign To4ti Exchange Coast A. Capacity Building Proet Mnagmet 951.6 316.7 1,268.3 25 2 279.9 93.2 373.0 25 2 Business Planning 1,017.9 888.3 1,906.1 47 3 299.4 261.3 560.6 47 3 Promotionandcommunication 918.3 1,213.8 2,132.1 57 3 270.1 357.0 627.1 57 3 Monitoring and Evaluation & PAP support 637.8 1,137.6 1,775.4 64 3 187.6 334.6 522.2 64 3 General Administration and Management 340.8 226.8 567.7 40 1 100.2 66.7 167.0 40 1 Subtotal Capacity Building 3,866.4 3,783.3 7,649.7 49 11 1,137.2 1,112.7 2,249.9 49 11 B. Population Activites Program 46,818.0 14,450.0 61,268.0 24 39 13,770.0 4,250.0 18,020.0 24 89 Total BASEUNE COSTS 50,684.4 18,233.3 68,917.7 26 100 14,907.2 5,362.7 20,269.9 26 100 Physical Contingencies 79.0 128.3 207.3 62 - 23.2 37.7 61.0 62 - Price Contingencies 1,432.9 449.9 1,882.8 24 3 256.1 76.4 332.5 23 2 Total PROJECT COSTS 52,196.4 18,811.4 71,007.8 26 103 15,186.5 5,476.9 20,663.4 27 102 Expenditure Accounts Project Cost Summary (L.E. '000) (USS '000) # % Total % %Total Forign Base Foreign Base Local Forelgn Total Exchange Costs Local Foreign Total Exchag Costs 1. Investment Costs A. Vehicles 69.4 615.7 685.0 90 1 20.4 181.1 201.5 90 1 B. Sub-Proeod ActivWes 43,350.0 14,450.0 57,800.0 25 84 12,750.0 4,250.0 17,000.0 25 84 C. Equiprment 54.1 480.2 534.3 90 1 15.9 141.2 157.2 90 1 D. Overseas Training 77.0 683.4 760.4 90 1 22.6 201.0 223.6 90 1 E. In-country Training 1,185.5 292.3 1,477.8 20 2 348.7 86.0 434.6 20 2 F. lnternatIonal Consukants 35.0 310.3 345.3 90 1 10.3 91.3 101.5 90 1 G. LocalConsutants 1,501.5 370.2 1,871.7 20 3 441.6 108.9 550.5 20 3 H. Furniture 85.0 35.9 120.9 30 - 25.0 10.6 35.6 30 - 1. Studies 372.1 556.4 1,228.5 70 2 109.5 251.9 361.3 70 2 J. Awards 164.7 8.6 173.3 5 - 48.5 2.5 51.0 5 - K Projec Manageen 3,537.4 - 3,537.4 - 5 1,040.4 - 1,040.4 - 5 Total Investment Costs 50,431.6 18,103.0 68,534.6 26 99 14,832.8 5,324.4 20,157.2 26 99 11. Recurrent Costs A. Operation and malntainanoo 228.9 75.2 304.1 25 - 67.3 22.1 39.5 25 - C. Supplies and Consumes 23.9 55.1 79.0 70 - 7.0 16.2 23.2 70 - Total Racurnt Coast 252.8 130.3 383.1 34 1 74.4 38.3 112.7 34 1 Total BASEUNE COSTS 50,684.4 18,233.3 68,917.7 26 100 14,097.2 5,362.7 20,269.9 26 100 Physical Confingendes 79.0 128.3 207.3 62 - 23.2 37.3 61.0 62 - Price Cerngendc 1,432.9 449.9 1,882.8 34 3 256.1 76.4 332.5 23 2 o TOWa PROJECT COSTS 52,i96A 4 ,8t11A 71,n07.8 26 103 15,186.6 6,476.9 20,811.4 27 102 ARAB REPUBLIC OF EGYPT POPULATION PROJECT Expenditure Accounts by Components - Totals :nclud:ng Contingencies (USS 000) Capacity Building P. A. P Monitoring General Promotion and Administration Population Project Business and Evaluation & and Activities Management Planning Communication PAP support Management Program Total 1. Investment Costs A. Vehicles - - - 232.5 - - 232.5 B. Sub-Project Activities - - - - - 17,000.0 17.000.0 C. Equiprnent 24.1 42.3 - 86.8 28.1 - 181.3 D. Overseas Training - 57.8 183.4 - - - 241.2 E. In-country Training 34.2 105.2 181.9 104.5 58.8 - 484.7 F. lntemational Consultants - 108.8 - - - - 108.8 G. Local Consultants 333.8 272.2 - - 24.5 - 630.5 H. Fumiture 11.9 - - 24.4 6.0 - 42.3 I. Studies - 22.2 268.0 66.3 40.2 - 396.7 J. Awards - - 56.8 - - - 56.8 K. Project Management - - - - 24.3 1,138.6 1,162.9 Total Investment Costs 404.0 608.5 690.1 514.5 181.9 18,138.6 20,537.7 II. Recurrent Costs A. Operation and maintenance 11.3 11.3 - 74.5 2.3 - 99.3 C. Supplies and Consumables 6.9 11.6 - 3.5 4.6 - 26.5 Total Recurrent Costs 18.2 22.9 - 78.0 6.9 - 125.8 Total PROJECT COSTS 422.2 631.4 690.1 592.5 188.8 18,138.6 20,663.5 Taxes - - - - - - Foreign Exchange 103.1 284.6 386.7 378.0 74.5 4,250.0 5,476.9 I. ANEX 13 Page I of 4 ARAB REPUBLIC OF EGYPT POPULATION PROJECT CAPACITY BUILDING COMPONENT PROJECT IMPLEMENTATION UNIT TERMS OF REFERENCE A. Organisation I. A Project Implementation Unit (PIU) will be established to implement the Capacity Building component of the proposed IDA Credit supported Egypt: Population Project. The PIU will be headed by a full time director, who will be responsible for implementation. He/she will report directly to the Undersecretary for Population and Family Planning in the Ministry of Health and Population (MOHP). The PIU will consist of a full time project director, an administrative officer, a training officer, an accountant, a data management specialist, and two support staff. 2. The PIU will be provided with office space, and will be equipped satisfactorily and provided with operating funds. B. Responsibilities of the PIU 3. Responsibilities of the PIU will include: (a) preparation of Requests for Proposals (RFPs) for consultant services, evaluation, recommendation for award of contract, and management of contracts. (b) assistance to the Central Administration Departments with arranging and managing consultant services, training, overseas tours. (c) managing procurement of goods (vehicles, equipment, furniture, and supplies) to be procured under the component. (d) open, maintain and replenish the Special Account for the capacity Building component. (e) preparation of semi-annual reports on project implementation progress; preparation of reports on IDA credit status. (f) provision of other management and administrative services as may be needed for successful project implementation. C. PIU Job Descriptions 4. Project Director. The Project Director will be a university graduate with experience in management and administration either in the population or a related sector. Post graduate training in demography or medicine is desirable. The Project Director will need to be well acquainted with public administration in the social sectors and with the institutional organisation of the MOHP in particular. Fluency in Arabic and English is required. The Project Director will be responsible for the overall management of the Capacity Building component, including the administration of financial resources ANNEX 13 Page 2 of 4 and the monitoring of project accounts and costs. The Project Director will supervise the activities of all PIU staff, and will ensure that the PIU carries out the responsibilities set out above. 5. Administrative Officer. The Administrative Officer will be a university graduate with at least five years experience in project administration, including goods, consultant and training program procurement and contract administration. Fluency in English is required. The Administrative Officer will be responsible for all procurement and subsequent procurement administration under the Capacity Building component, including the preparation of bid documents and RFPs, administration of the bid evaluation and award process, and subsequent contract management. The Administrative Officer will also assist with the preparation of project implementation reports to MOHP and to IDA. 6. Training Officer. The Training Officer will have an appropriate university degree and will have at least five years experience in the managment and administration of population or health training programs. Good English is required. The Training Officer will be responsible for the management and administration of all training to be provided under the project and for supporting the Central Administration Departments with the implementation of all training and overseas study tours. The Training Officer will also be responsible for preparing the relevant sections of progress and implementation reports to MOHP and IDA. 7. Project Accountant. The Project Accountant will have a university degree in accounting and will be well acquainted with public administration. Fluency in English is required. The Project Accountant will be responsible for all project accounts under the Capacity Building component, for all financial administration, including the operation of the IDA Special Account and the preparation of disbursement and replenishment requests, and for the monitoring of project accounts and costs. The Project Accountant will also be responsible for implementing recommendations made as a result of the annual audits of the accounts. 8. Data Management Specialist. The data management specialist will have a university degree in information science or related discipline, and at least five years related work experience. He/she will assist in procuring and installing computer equipment, help with the development of appropriate software programs for the project, and help with the development of the Population and Family Planning Sector's part of the MOHP decision support system. POPULATION ACTIVITIES PROGRAM COMPONENT PROJECT IMPLEMENTATION ARRANGEMENTS TERMS OF REFERENCE A. Organisation 1. The MOHP will contract with the Social Fund for Development to administer the Population Activities Program (PAP). A separate Executive Committee will provide general management. This Committee will be chaired by the Minister of Health and Population or his assigned deputy and will have four other members of whom at least one will be a representative of the Social Fund. The Executive Committee's deliberations will follow written procedures to be adopted at its first meeting. A Project Approval Committee will be established in each Govemorate in Upper Egypt with representatives from the regional offices of the MOHP, the Social Fund and a representative from an NGO. The Social Fund will establish a new Population Program with an experienced manager to administer the program. It will use its Community Development Department to provide technical support. Projects prepared under the Population Program will be presented either to the Executive ANNEX 13 Page 3 of 4 Committee (for the first ten projects and all other projects of LE65,000 or more, or to the Governorate level Project Approval Committee (if less than LE65,000). The Social Fund will administer the Population Program in accordance with the general plans, criteria and procedures set out in the draft Operating Manual for the Program (see Annex 8). During the life of the project certain responsibilities for management of the Program will be transferred from the Social Fund to the Population and Family Planning Sector of the MOHP. The Social Fund will also provide training and other support to the Population and Family Planning Sector of the MOHP during the life of the project. The details of these arrangements will be included in a Memorandum of Understanding (MOU) between the MOHP and the Social Fund (see Annex 8). 2. The Government (Ministry of Economy and International Cooperation) will ensure that the Social Fund is provided with the necessary donor grant funds to fund the incremental operating costs of the Program. B. Responsibilities of the Executive Committee, the Governorate level Project Approval Committees, and the Social Fund for Development 3. (a) The Executive Committee will be responsible for policy and program management, approving the Operating Manual for the Program, project approval for the first ten projects presented under the Program, and for projects of LE65,000 or more, financial oversight, and for ex-post monitoring. (b) The Govemorate level Project Approval Committees will initially be responsible for project approval of projects that are less than LE65,000, for promotion and outreach, and for conducting a semi- annual portfolio review of the projects funded within the Govemorate. (c) The Social Fund will execute the Population Activities Program and will be responsible for funds management, managing and supporting grantees, promotion and outreach, project appraisal, field supervision, and for regular reporting to the Executive Committee. It will appoint a full time manager for the Program supported by a senior program manager, a financial officer, two population officers and an administrative officer at the central office and a population officer in each of the eight Governorate offices of the Social Fund in Upper Egypt. The Social Fund will also provide training and other support to the Population and Family Planning Sector of the MOHP during the life of the project to help the MOHP carry out its immediate and transitional responsibilities. C. Population Program Job Descriptions 4. Program Manager. The Program Manager will have a postgraduate degree in demography, sociology, development economics or a related discipline and at least eight years of experience operating similar programs. Experience with NGO operations and community level programs is required. It will be desirable if the appointment is made from within the existing staff of the Social Fund as institutional experience within the Social Fund is strongly preferred. Fluency in English is required. The Program Manager will be responsible for the overall management and coordination of the Program, including relations with the Executive Committee, the administration of financial resources and the monitoring of project accounts and costs. The Program Manager will manage and supervise the activities of all Program staff at the central and Governorate office levels, and will ensure that the Program carries out the responsibilities set out above. He will also be responsible for ensuring that the Community Development Department of the Social Fund and the Governorate offices of the MOHP provide the cross ANNEX 13 Page 4 of 4 support agreed under the Program. He will be responsible for organising the cross support and training to be provided by the Social Fund to the MOHP. 5. Senior Operations Officer. The Senior Operations Officer will have a university degree in demography, sociology, development economics or a related discipline and at least five years of experience operating similar programs. Experience with NGO operations and community level programs is required. Fluency in English is required. The Senior Operations Officer will be responsible for supporting the Program Manager with the planning and programming of the Program as well as for day to day monitoring and supervision, and for regular liaison with the Governorate level Program staff. He/she will also appraise and prepare the larger or more complicated projects. 6. Financial Officer. The Financial Officer will have a university degree in accounting, will have at least five years experience with financial management of similar programs and be well acquainted with public administration. Fluency in English is required. The Financial Officer will be responsible for the financial management of the Program, for the administration of financial resources, including the operation of the IDA Special Account and the preparation of disbursement and replenishment requests, and for the monitoring of project accounts and costs. He/she will be responsible for ensuring the provision of cross support to the Program from the Finance and Administration Departnent of the Social Fund. The Financial Officer will also be responsible for implementing recommendations made as a result of the annual audits of the accounts. ANNEX 14 ARAB REPUBLIC OF EGYPT POPULATION PROJECT PRCUREMNT ARAGMN (USS'OO0) Category ICB NCB Other NIF Total Equipment, Furniture 232 3492 581 Vehicles, Goods (199) (261) (460) Consultants 1,2563 1,256 Technical Assistance (930) (930) Training 7262 726 (510) (510) PAP subprojects 17,000r 17,000 Goods and Services (15,300) (15,300) PAP subproject management 1,100 1,100 | Total 232 19,331 1,100 20,663 (199) (17,001) (0) (17,200) E-STIMATED DISBURSEMENT SCHEDUL- (-SUMMAR (US$ million) IDA Fiscal 1997 1998 1999 2000 2001 2002 Year Annual 1.7 3.4 5.1 4.25 1.7 1.05 Cumulative 1.7 5.1 10.2 14.45 16.15 17.20 Percentage 9.9% 29.7% 59.4% 84.1% 94% 100% I Figures in parenthesis are the respective amounts financed by the IDA credit. Procurement through international (50%/a) or local shopping (50%). The Bank's Consultants Guidelines apply. Procured under Social Fund Procurement Procedures. Community participation in procurement as presented in the Bank's Procurement Guidelines. ARAB REPUBLIC OF EGYPT POPULATION PROJECT IMPLEMENTATION SCHEDULE 96 1997 1998 1999 2000 2001 2002 ID Task Name Dur. Start 0304010203040Q102034 01 2 03 |Q4 0 Q2 0Q3 Q4 10102030410203 1 Capacity Building Component 1308d 911196 _ 2 loan Effectiveness Od 9/1/96 * 911 3 Project Management 1305d 9/96 __ 4 Technical Assistance 261w 9/2/96 5 Equip for PIU 16w 9/V296 I 6 Team 8uilding iRetreat 1 2w 9/1/97 : 7 Team Buildimg Relreat 2 2w 911/99 8 Business Planning and Policy Development 1308d 9296 __ 9 TA/Equilpment for Decision Support System 1308d 912196 _ 10 National Consultants 200w 9/2/96 11 Training and Technical Assistance 13w 7/11/97 12 Equipment Procurement 13w 10/1/97 13 Overseas Study Tour - Decision Support System 13w 4/3/00 14 Business Plan Development and Updates 252 2w 11/6/96 15 Annual Report 213w 7/1/97 16 Train staff in Monitoring/Evaluation 1 13w 9/2/98 17 Train staff in Monitoring/Evaluation 2 13w 9/2/99 il 18 Train Staff in Monitoring/Evaluation 3 13w 4/3/00 I 19 Train staft in Monitoring/Evaluation 4 13w 9/3/00 20 PronotIon and Communication 1308d 912/96 21 Advocacy- Awards & Publiations 261w 9/2/96 .~~~~~~~~~__ _ .V _ V 22 Publicatons and Disseminations 1218d 1/6/97 23 Training for NGO Leaders 1 4w 7/1/97 24 Training for NGO Leaders 2 4w 4/29/98 I ! o _ 0 ARAB REPUBLIC OF EGYPT POPULATION PROJECT IMPLEMENTATION SCHEDULE 96 1997 1998 1999 2000 2001 2002 ID Task Name Dur. Start Q30Q40Q1 02 Q3 Q4 01 Q20Q30Q40Q10Q2Q03104101 02 Q3 0Q40Q10Q2Q3040|1Q20Q3 25 Training for NGO Leaders 3 4w Mon 9/2/96 26 Training for NGO Leaders 4 4w Fri 10/1/99 27 Training for Community Leaders 1 4w Mon 9/1/97 28 Training for Community Leaders 2 4w Tue 9/1/98 3 29 Training for Community Leaders 3 4w Wed 911199 30 Training for Community Leaders 4 4w Fri 9/1/00 31 Overseas Study Tour Religious Leaders 1 4w Thu 4/1/99 32 Overseas Study Tour Religious Leaders 2 4w Mon 4/3/00 33 Training -lEC 1 2w Tue 7/1/97 | 34 Training -lEC 2 4w Wed 4/1/98 3 35 Training -tEC 3 4w Fn 1011199 36 Training -IEC 4 4w Mon 1/1/01 37 Training -Pop Education 1 4w Sun 2/1/98 38 Training -Pop. Education 2 4w Mon 2/1/99 39 Training -Pop. Education 3 4w Tue 2/1/00 | 40 Training -Pop Education 4 2w Thu 2/1/01 41 Overseas Study Tour -Communications 26w Wed 10/1/97 42 Policy Research on Communications 104w Wed 10/1/97 43 Monitoring and evaluation & PAP Support 998d Mon 9/2/96 44 Vehicles/EquipmenttFumiture for PAP Support 520d Mon 9/2/96 45 Training- Monitoring and Evaluation QOC 4w Thu 7/1/99 46 PAP Team building Workshop 1 4w Wed 7/1/98 3 47 PAP Team building Workshop 2 4w Fri 10/1/99 48 Operations Research on Service Delivery 104w Wed 7/1/98 1, e ARAB REPUBLIC OF EGYPT POPULATION PROJECT IMPLEMENTATION SCHEDULE r- ____--_____ ___ 3_ 6 t 99 i - 1998 1-1999 ~ 2000 2 2002 ID Task Name _ _ Dur. _ Start 002212034 01 Q2 03 49 Gelneral Administration and Managenient 1087d 912t96 _ 50 Tranzition Support 12w 9t2196 51 General Management Training 1 4w 10/1/97 52 General Management Training 2 4w 10/1/98 53 General Managernent Training 3 4w 10/1/99 54 General Management Training 4 4w 10/1/00 55 Training Workshop tor Finance Staff 4w 10/1/97 56 In-House Training for Finance Staff 4w 10/1/00 57 Finance/Administration Department, Computers Upgrading 104w 9/2/96 58 Midterm Review Preparation and Follow-up 30 10/1/98 > ARAB REPUBLIC OF EGYPT POPULATION PROJECT IMPLEMENTATION SCHEDULE 1996 1997 1998 1999 2000 2001 2002 ID Task Name Dur. Start 01 IQ21 03 Q4 01 02 a304 "01 Q2 0Q3 1 04 01 00i 30Q2 400 3040 203 04 10203040 1 Population Activities Program 1566d 1/1/96 2 Beneficiary Assessment and Monitoring 1408d 4/1/96 7 Develop capacity to support executive commite 52w 1/4/96 8 Board Approval Od 1/16/96 1(16 9 Loan Effectiveness Od 9/9* 9/1 10 Promotion and Outreach 239,2w 1/1/96 iiF _ ~~~~__ ___ ___ I - 1 1 Sub-Project Appraisal 186.6w I/I/97 12 Sub-Project Approval 186 8w 2/3/97 _ 13 Sub-project supervision 252 2w 3/3/97 . 14 Closure of IDA Credit Od 12/31/01 12/31 12/31 Annex 1 Page I of 2 EGYPT POPULATION PROJECT ECONOMIC JUSTIFICATION OF PROJECT 1. The project is expected to contribute to fertility reduction and to be cost effective. The US$ value of economic benefits of averting births was estimated in constant 1991 prices based on a Government of Egypt cost -benefit study of family planning in Egypt. Deducting from these benefits the estimated costs of the project, a stream of net benefits was projected for a period of 20 years (1996-2015). A. The following assumptions have been used to calculate the IRR: (i) 75% of project expenditure will be in rural Upper Egypt to be disbursed over five years (ii) Public expenditure savings per birth averted is $470 over 20 years. Public expenditures savings were estimated for education, health, water and sewage, food subsidies and housing. (iii) 15% of births averted in rural Upper Egypt between 1996- 2015 is a consequence 2 of the project. (iv) The population in upper rural Upper Egypt will remain stable over 20 years B. The economic analysis is conservative as it assumes the only benefit of the project is aversion of births. It excludes any maternal health or education benefits, benefits to other family members or the local community. It also does not take into account any private savings which are likely to be substantial. 2. Based on these assumptions, the IRR would be about 19%. Sensitivity Analysis Two variables (number of births averted and savings per birth averted) were found to have a major effect on the IRR. Sensitivity analysis for these variables (keeping other assumptions constant) for the range described below is shown. A. The number of births averted as a result of the project may be less than 15%. The effect on IRR is shown in graph I for a range of births averted due to the consequences of the project. If only 10% of the births averted in rural upper Egypt are due to the project, the IRR drops to 12%. B. The public expenditure savings per birth averted may be less than $470. The effect on IRR is shown in graph 2 for a range of estimated public expenditure savings per birth. If public expenditure saved per birth is estimated to be just $350, the IRR is 14%. 1The Cost-Benefit Study of Family Planning in Egypt, Government of Egypt, 1994. 2Assumptions derived from Annex 9. Annex 16 Page 2 of 2 Graph 1: Relationship between IRR and percentage of births averted in rural Upper Egypt 30 25 I + IRR 20 15 10 i° 15 Percentage of total births averted 20 25 Graph 2: Relationship between IRR and savings in public expenditure 2 5 -------.---------. ... . . .... .. .. __ _ 20 z ;_- : i _ ~~~~~~~~~~~~~~~~~~~~~~~~IRRI 10 5 oL 300 400 500 600 Public expenditure savings per birth averted ARAB REPUBLIC OF EGYIPT POPULATI ION iRo.j ECT r SUPEI'RVISION PLAN I'mancial ciirs (11P) FY9 7 IY98 FY99 FIY(OO I:Yl)l I:'Y02 'iuplvbl eellS \ e 3 4 5 Misslown launch 7 2 I 2 I (1LI term 2 1 2 1 2 ren ie\v) Estimates in Staff Weeks I isi % Lkilager (I ln/R Ni)!/ 4 3 3 3 3 3 2 3 2 3 2 P'opilanoll Specialist 2 1 1 2 2 ; I limpimmentatmon(izX Speciaflist 2 2 1 i)eiographer 2 2 Imistitutional l)eveiopillcit >Spec 2 2 2 2 I 3 1 2 1 1 1 Procurement Spcclalst 0.5 i)Ol)uiifrilfltlt ()Oicelr 0(.5 IotalS I 1 7 7 h8 3 6 I1 5 5 I/ I he project is \scii suiIeid tol supervision by the Fgypt Resideint Nlission, which will be given this respon-sibilit) at an early dlate. ANNEX 18 ARAB REPUBLIC OF EGYPT POPULATION PROJECT MID-TERM REVIEW-TERMS OF REFERENCE Objectives The objective of the midterm review is to examine the components of the population project and to determine what, if any, adjustments should be made in either or both component's objectives, organization and procedures. Capacity Building For this component, the following questions need to be answered: What is the progress to date? How does actual performance compare with expected performance as indicated in the business plan (Annex 5)? Based on the answers to these questions, revision of the three year rolling business plan and the rest of the capacity building component should be made. Population Activities Program For this component, the principal set of questions to be answered are the following: I. Are the programs objectives and role clearly defined? How agile and efficient is the PAP at achieving its objectives? 2. Is the existing institutional framework appropriate for achieving its fundamental objective of accelerating fertility decline? Should their be any changes in the institutional framework? Has the MOHP attained its expected midterm milestones and making progress towards achieving terminal milestones? Policy and Program review Funds management -disbursements to executing agencies, project accounts administration and internal auditing Financial oversight Management and Support to grantees Ex-post monitoring and follow up 3. How well does the PAP coordinate its activities with other synergistic activities organized by other agencies? 4. Have the PAP sub-projects reached the target groups? Have operations being sustained? These questions can be answered by reviewing monitoring indicators which will be collected at least quarterly (see Annex 10). 5. Is there any evidence of increasing demand for contraception or reducing fertility decline? This fundamental question should be answered in the mid-term evaluation survey report which would form a critical part of the review (see Annex 10 for further details) MAP SECTION ARAB REPUBLIC OF EGYPT POPULATION PROJECT IBRD 27482 280 320 360 Mediterranean Sea I 320 O - 1?-. o,iefth Marsa Matruh Alixandr&.0, 0 4. Said ISRAEL JORDAN '~~~~~~~~~~~~~Dmou ann I4,hnur }'VZs - C v Shibinol riliya OSuez \ ! Rd :ElFaom 0 ARAB REPUBLIC Suef OF EGYPT ElMinyao SAUDI2 - 280 j _ _ _ _ _ ARABIA 0 Ass ut Hurghoda Sohog oQena O SELECTED CITIES , | * NATIONAL CAPITAL xor RIVERS Matan .' CULTIVATED AREAS -~ -. -~ GOVERNORATE BOUNDARIES , > ~~~~~~~~~~~~~~~Kom COmbo OCCUPIED TERRITORIES o 240 Aswan 240 I ~~~~~~~~~~~~~~~~~~~~~Aswon Dam 0 50 100 150 MILES 0 50 100 150 KILOMETERS T hcr b-d.o-, -i-,, o ond .yoCrnrow AI - Ar, shoron dbism&ooi 0 on#0p000500lrd 8n SUDAN Gr-p oo-y j dq- - 0n AWi.gl 5t0 of-y t oy, or 32y eod-.fmenl or -cceptnce of such bondries 32 360 IMARCH 1996 IMAGING Report No: 15046 EGT Type: SAR