The World Bank Health Service Delivery & System Support Project (P153064) REPORT NO.: RES33463 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF HEALTH SERVICE DELIVERY & SYSTEM SUPPORT PROJECT APPROVED ON JUNE 23, 2016 TO MINISTRY OF FINANCE AND ECONOMIC DEVELOPMENT HEALTH, NUTRITION & POPULATION AFRICA Regional Vice President: Hafez M. H. Ghanem Country Director: Henry G. R. Kerali Senior Global Practice Director: Timothy Grant Evans Practice Manager/Manager: Gaston Sorgho Task Team Leader: Shiyong Wang The World Bank Health Service Delivery & System Support Project (P153064) ABBREVIATIONS AND ACRONYMS BEmONC Basic Emergency Obstetric and Newborn Care CBE Competency-Based Education CD Country Director CEmONC Comprehensive Emergency Obstetric and Newborn Care CHC Community Health Center CHW Community Health Worker CMO Chief Medical Officer CPD Continuous Professional Development CUAMM Doctors with Africa, CUAMM DHMT District Health Management Team DPPI Directorate of Policy, Planning and Information ESICOME Expanded Sanitary Inspection Compliance Monitoring and Enforcement EHO Environmental Health Officer GFF Global Financing Facility GRM Grievance Redress Mechanism HIV Human Immunodeficiency Virus HMIS Health Management Information Systems HSDSSP Health Service Delivery and Systems Support Project IHPAU Integrated Health Project Administration Unit IP Implementation Progress LQAS Lot Quality Assurance Sampling MDCT Multi-Disciplinary Clinical Team MoHS Ministry of Health and Sanitation M&E Monitoring and Evaluation MSG Mothers Support Group MTR Mid-Term Review MUAC Mid-Upper Arm Circumference NCD Non-Communicable Disease nEMS National Emergency Medical Service NGO Non-Governmental Organization PBF Performance Based Financing PSC Project Steering Committee PDO Project Development Objective PHA Public Health Aide PHI Public Health Inspector PHU Peripheral Health Unit RMNCAH Reproductive, Maternal, Neonatal, Child and Adolescent Health SARA Service Availability and Readiness Assessment SCS School of Clinical Sciences SDI Service Delivery Indicators SLA Service Level Agreement TB Tuberculosis TT Tetanus Toxoid The World Bank Health Service Delivery & System Support Project (P153064) Note to Task Teams: The following sections are system generated and can only be edited online in the Portal. BASIC DATA Product Information Project ID Financing Instrument P153064 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 23-Jun-2016 30-Sep-2019 Organizations Borrower Responsible Agency Ministry of Finance Ministry of Health and Sanitation Project Development Objective (PDO) Original PDO The project development objective (PDO) of the Health Service Delivery and System Support Project is to (a) increase the utilization and improve the quality of essential maternal and child health services; and (b) in the event of an Eligible Crisis or Emergency, to provide immediate and effective response to said Eligible Crisis or Emergency. Current PDO The project development objective (PDO) of the Health Service Delivery and System Support Project is to (a) increase the utilization and improve the quality of essential maternal and child health services; and (b) in the event of an Eligible Crisis or Emergency, to provide immediate and effective response to said Eligible Crisis or Emergency. OPS_TABLE_PDO_CURRENTPDO The World Bank Health Service Delivery & System Support Project (P153064) Summary Status of Financing Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-58460 23-Jun-2016 04-Aug-2016 02-Nov-2016 30-Sep-2019 10.00 1.99 8.30 TF-A2598 23-Jun-2016 04-Aug-2016 02-Nov-2016 30-Jun-2018 5.50 3.43 2.07 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. Project Status 1. The Project was approved on June 23, 2016 and became effective on November 2, 2016 with a closing date of September 30, 2019. The Project was designed (a) to increase the utilization and improve the quality of essential maternal and child health services; and (b) in the event of an Eligible Crisis or Emergency, to provide immediate and effective response to said Eligible Crisis or Emergency. It is supported with two sources of funding: 10 million USD from a credit (IDA 58460-SL) and 5.5 million USD from a grant (TF0A2598). The latter was completed on June 30, 2018. The proposed restructuring is for the credit (IDA 58460) and TF0A2598. By the time of this restructuring paper is developed, 1.99 million USD has been disbursed under IDA 58460-SL and 3.42 million under TF0A2598. 2. Progress towards achievement of the PDO has been rated constantly Moderately Satisfactory since the beginning of the project. The overall implementation progress (IP) was rated Moderately Satisfactory in the last Implementation Status and Result Report (ISR). Three out of five targets at the PDO level have been surpassed by the end of the first quarter, 2018. Good progress has been made for the remaining two as well. However, the project implementation progress has been slow, which is mainly due to significant delays in financial and procurement management. As of December 2017, the project barely disbursed 6 percent of project funds. Although the disbursement under the Project has picked up the momentum recently, it has only increased from 6 percent in December 2017 to 19.4 percent in June 2018. The project has only less than one year for implementation. The following achievements have been observed: 2.1. Component 1: Health Service Delivery a. Launch of Community Health Worker (CHWs) Program: training of all CHWs in Kailahun and Koinagudu districts has been completed and CHW activities are under implementation. The first round of supervision in the first The World Bank Health Service Delivery & System Support Project (P153064) quarter of 2018 was completed. The internationally competitive procurement for technical assistance on the CHW Program is underway. b. The National Emergency Medical Services (nEMS) has been launched. The implementing agency (CUAMM) has been contracted for nEMS management. All the ambulances have been checked and GPS equipment installed. About 126 are ready for deployment. The national nEMS call-in number and the designated number for hospitals for ambulance service have been created. Training of operators is ongoing. Refresher training of 900 (450 each of paramedics and drivers) is expected to be completed in the next three months. The nEMS operation in Pujehun will be started in Pujehun district in October and in Western Urban in November, 2018. c. Under the Environmental Health and Sanitation Program, 57 staff including waste handlers, hospital secretaries, maintenance technicians and Environmental Health Officers (EHOs), from 22 health facilities, have been trained in medical waste management and segregation. As a result, waste is now being segregated at George Brook Community Health Center (CHC), and no more open burning at Macaulay Street Government Hospital. Twenty- three sub-committees on healthcare waste management have been established in health facilities. The roles of EHOs and established committees have been harmonized to ensure that the committees are functional at the health facility level. The Environmental Sanitation Policy and Strategy has been drafted and awaiting for validation. The refresher training for 276 Public Health Aides (PHAs) and Public Health Inspectors (PHIs) was conducted. 2.2. Component 2: Health Systems Support a. Human resource development: the Auxiliary Health Worker Training at the School of Clinical Sciences (SCS) in Makeni has been progressing well. Sixty two out of 92 students enrolled in the School have completed the pre- admission course and entered into the formal medical training. The second cohort of 77 trainees have enrolled for their first year; Ninety nine midwives completed their training and took the final exams; Ninety one foreign health professionals have been deployed to a majority of districts and all regional government hospitals since the project effectiveness. b. Service Delivery Indicator (SDI) survey has been completed. SDI 2018 preliminary findings include, but not limited to, (i) high absenteeism among health workers; (ii) low capacity in establishing correct diagnosis; (iii) low compliance in clinical management guidelines, and (iv) very few facilities met the requirements for basic emergency obstetric and neonatal care. The study provided useful information on how to strengthen the health system in the Country. c. Design for performance-based financing for health services in Kailahun and Koinadugu distrcits has been going on and is expected to be completed by the end of October 2018. d. Key directorates in Ministry of Health and Sanitation (MoHS) have been supported for their operations. e. The Service Level Agreement (SLA) database has been created using the Kobo toolbox with facilities to collect data using mobile phones, and a web browser. All the implementers have been registered before the projects start. B. Rationale for Restructuring 3. Increasing flexibility to allow timely disbursement under the Grant. The Country context and donor support have been constantly under changes. Such change will affect the activities implemented under the Project, which in turn legitimize the reallocation. The World Bank Health Service Delivery & System Support Project (P153064) 4. Some of the same activities are and will be co-financed by both the credit and the grant under the Project. Disbursement percentage needs to be revised to prevent duplication of investments. II. DESCRIPTION OF PROPOSED CHANGES A. Summary of Proposed Changes 5. A Level 2 restructuring aims to amend Financing Agreement (IDA 58460) Grant Agreement (TF0A2598) in the following aspects: for (i) reallocation amount of funds across disbursement categories, and amending expenditure percentage. B. Amendment of the Financing Agreement 6. Changes of expenditure category, allocation and percentage of expenditure 6.1. The percentage of expenditure to be finance (inclusive of taxes) under Expenditure Category (2) is redefined as “0% until the proceeds under Expenditure Category (2) of TF0A2598 are depleted, then 100%”. 6.2. The percentage of expenditure to be finance (inclusive of taxes) under Expenditure Category (8) is redefined as “0% until the proceeds under Expenditure Category (8) of TF0A2598 are depleted, then 100%”. C. Amendment of the Grant Agreement 7. Changes of expenditure category, allocation and percentage of expenditure 7.1. The 1,000,000 USD under Expenditure Category (4) is reallocated to Expenditure Category (2). 7.2. The percentage of expenditure to be finance (inclusive of taxes) under Expenditure Category (2) will be increased from 0% to 100%. 7.3. The percentage of expenditure to be finance (inclusive of taxes) under Expenditure Category (4) will be changed from 100% to 0%. D. Any other issues 8. This is the urgent request from the Government. The Bank team was only notified in the week of October 15 2018. The clients are fully aware that it will take time for processing the request and they might run the risk of losing the implicated remaining proceeds in case the request would not be processed in a timely manner and the Government will not be able to counter-signed the Amendment. The team has double-checked with IHPAU, the project management unit, and the team lead has confirmed the changes mentioned in this restructuring paper. 9. The team confirm that there has been no duplicating investments from the Grant and the EERP (P152359) for the activities covered under the Category (5) of this Grant. The World Bank Health Service Delivery & System Support Project (P153064) III. SUMMARY OF CHANGES Changed Not Changed Results Framework ✔ Reallocation between Disbursement Categories ✔ Disbursement Estimates ✔ Overall Risk Rating ✔ Implementing Agency ✔ DDO Status ✔ Project's Development Objectives ✔ Components and Cost ✔ Loan Closing Date(s) ✔ Cancellations Proposed ✔ Disbursements Arrangements ✔ Safeguard Policies Triggered ✔ EA category ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Implementation Schedule ✔ Other Change(s) ✔ Economic and Financial Analysis ✔ Technical Analysis ✔ Social Analysis ✔ Environmental Analysis ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_REALLOCATION _TABLE REALLOCATION BETWEEN DISBURSEMENT CATEGORIES The World Bank Health Service Delivery & System Support Project (P153064) Financing % Current Allocation Actuals + Committed Proposed Allocation (Type Total) Current Proposed IDA-58460-001 | Currency: XDR iLap Category Sequence No: 1 Current Expenditure Category: GD,WK,CS,NCS,TRG,OC A.1(1),A.1(1b) 2,130,000.00 0.00 2,130,000.00 0.00 100 iLap Category Sequence No: 10 Current Expenditure Category: GD,WK,CS,NCS,TRg,OC B2 (1b)(1c) 852,000.00 0.00 852,000.00 0.00 100 iLap Category Sequence No: 11 Current Expenditure Category: GD,WK,CS,NCS,TRg,OC B3 142,000.00 0.00 142,000.00 0.00 100 iLap Category Sequence No: 12 Current Expenditure Category: GD,WK,CS,NCS,TRg,OC Part C 0.00 0.00 0.00 0.00 0.00 iLap Category Sequence No: 2 Current Expenditure Category: Inc. pay for eligib. Com heal A1(1b 2,343,000.00 0.00 2,343,000.00 0.00 0 iLap Category Sequence No: 3 Current Expenditure Category: GD,WK,CS,NCS,TRG,OC A.1(2) 355,000.00 0.00 355,000.00 0.00 100 iLap Category Sequence No: 4 Current Expenditure Category: GD,WK,CS,NCS,TRG,OC A.2(1a),(1b) 0.00 0.00 0.00 100.00 0 iLap Category Sequence No: 5 Current Expenditure Category: GD,WK,CS,NCS,TRG,OC A.2(2a),2b,2c 355,000.00 0.00 355,000.00 0.00 0 iLap Category Sequence No: 6 Current Expenditure Category: GD,WK,CS,NCS,TRg,OC B.1(1a), (1d) The World Bank Health Service Delivery & System Support Project (P153064) 142,000.00 0.00 142,000.00 0.00 100 iLap Category Sequence No: 7 Current Expenditure Category: Stip.elig post grad Med Stu B1(1b) 142,000.00 0.00 142,000.00 100.00 100 iLap Category Sequence No: 8 Current Expenditure Category: GD,WK,CS,NCS,TRg,OCB1(1c) 497,000.00 336,255.65 497,000.00 70.00 0 iLap Category Sequence No: 9 Current Expenditure Category: GD,WK,CS,NCS,TRg,OC B2 (1a) 142,000.00 0.00 142,000.00 0.00 100 Total 7,100,000.00 336,255.65 7,100,000.00 TF-A2598-001 | Currency: USD iLap Category Sequence No: 1 Current Expenditure Category: GD,WK,CS,NCS,TRG,OC A.1(1),A.1(1b) 0.00 0.00 0.00 0.00 0.00 iLap Category Sequence No: 10 Current Expenditure Category: GD,WK,CS,NCS,TRg,OC B.2(1b),(1c) 0.00 0.00 0.00 0.00 0.00 iLap Category Sequence No: 11 Current Expenditure Category: GD,WK,CS,NCS,TRg,OC B.3 0.00 0.00 0.00 0.00 0.00 iLap Category Sequence No: 12 Current Expenditure Category: GD,WK,CS,NCS,TRg,OC under part C 0.00 0.00 0.00 0.00 0.00 iLap Category Sequence No: 2 Current Expenditure Category: Inc. pay for eligib. Com heal A1(1b 0.00 0.00 1,000,000.00 0.00 100 The World Bank Health Service Delivery & System Support Project (P153064) iLap Category Sequence No: 3 Current Expenditure Category: GD,WK,CS,NCS,TRG,OC A.1(2) 0.00 0.00 0.00 0.00 0.00 iLap Category Sequence No: 4 Current Expenditure Category: GD,WK,CS,NCS,TRG,OC A.2(1a),(1b) 1,000,000.00 0.00 0.00 100.00 100.00 iLap Category Sequence No: 5 Current Expenditure Category: GD,WK,CS,NCS,TRG,OC A.2(2a),2b,2c 3,000,000.00 2,932,494.95 3,000,000.00 100.00 100.00 iLap Category Sequence No: 6 Current Expenditure Category: GD,WK,CS,NCS,TRg,OC B.1(1a), (1d) 0.00 0.00 0.00 0.00 0.00 iLap Category Sequence No: 7 Current Expenditure Category: Stip.elig post grad Med Stu B1(1b) 0.00 0.00 0.00 100.00 0 iLap Category Sequence No: 8 Current Expenditure Category: GD,WK,CS,NCS,TRg,OCB1(1c) 1,500,000.00 951,477.32 1,500,000.00 100.00 100.00 iLap Category Sequence No: 9 Current Expenditure Category: GD,WK,CS,NCS,TRg,OC B2 (1a) 0.00 0.00 0.00 0.00 0.00 Total 5,500,000.00 3,883,972.27 5,500,000.00 OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE DISBURSEMENT ESTIMATES Change in Disbursement Estimates Yes Year Current Proposed 2017 2,000,000.04 500,000.00 2018 6,500,000.04 8,000,000.00 The World Bank Health Service Delivery & System Support Project (P153064) 2019 3,999,999.96 5,000,000.00 2020 3,000,000.00 2,000,000.00 2021 0.00 0.00 OPS_DETAILEDCHANGES_SORT_TABLE SYSTEMATIC OPERATIONS RISK-RATING TOOL (SORT) Risk Category Rating at Approval Current Rating Political and Governance  Moderate  Substantial Macroeconomic  Substantial  Substantial Sector Strategies and Policies  Moderate  Moderate Technical Design of Project or Program  Substantial  Substantial Institutional Capacity for Implementation and  Substantial  Substantial Sustainability Fiduciary  Substantial  Substantial Environment and Social  Moderate  Moderate Stakeholders  Moderate  Moderate Other Overall  Substantial  Substantial The World Bank Health Service Delivery & System Support Project (P153064) . Results framework COUNTRY: Sierra Leone Health Service Delivery & System Support Project Project Development Objectives(s) The project development objective (PDO) of the Health Service Delivery and System Support Project is to (a) increase the utilization and improve the quality of essential maternal and child health services; and (b) in the event of an Eligible Crisis or Emergency, to provide immediate and effective response to said Eligible Crisis or Emergency. Project Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_PDO Indicator Name DLI Baseline Intermediate Targets End Target 1 2 3 to increase the utilization and improve the quality of essential maternal and child health services (Action: This Objective is New) Percentage of pregnant women attended 4 or more times by any 78.90 83.00 86.00 89.00 91.00 health personnel (Percentage) percentage of maternal deaths reviewed, among suspected 0.00 60.00 maternal deaths (Percentage) Percentage of births attended by skilled health personnel (doctors, 72.40 76.00 79.00 81.00 83.00 midwives, nurses and MCH Assistants) (Percentage) percentage of CHWs rated as good performer by their 0.00 70.00 communities (Percentage) The World Bank Health Service Delivery & System Support Project (P153064) RESULT_FRAME_TBL_PDO Indicator Name DLI Baseline Intermediate Targets End Target 1 2 3 Action: This indicator has been Marked for Deletion Percentage of pregnant women receiving Tetanus Toxoid (TT) 2 or 89.30 92.00 94.00 95.00 96.00 more times (Percentage) percentage of routine HMIS reporting units submitting 75.00 80.00 complete reports according to national guidelines (Percentage) percentage of routine HMIS reporting units submitting 75.00 80.00 timely reports according to national guidelines (Percentage) Percentage of children (0-11 months) fully vaccinated 86.50 89.00 91.00 92.00 93.00 (Percentage) Direct project beneficiaries 6,190,280.00 6,327,301.00 6,467,355.00 6,610,508.00 6,756,831.00 (Number) percentage of hard to reach communities with at least one 37.00 45.00 active CHW present (Percentage) Action: This indicator has been Revised percentage of households safely storing adn handling drinking 4.50 10.00 water (inspected) (Percentage) The World Bank Health Service Delivery & System Support Project (P153064) RESULT_FRAME_TBL_PDO Indicator Name DLI Baseline Intermediate Targets End Target 1 2 3 number of outpatient visits per 5,709.00 6,000.00 10,000 population (Number) to provide immediate and effective response to said Eligible Crisis or Emergency. (Action: This Objective is New) Percentage of public health emergencies responded within a 50.00 85.00 week's time and with good quality (Percentage) Action: This indicator is New PDO Table SPACE Intermediate Results Indicators by Components RESULT_FRAME_TBL_IO Indicator Name DLI Baseline Intermediate Targets End Target 1 2 3 Component 1: Health service delivery (Action: This Component is New) Percentage of hard-to-reach communities with at least one 37.00 45.00 70.00 90.00 90.00 active CHW present (Percentage) Percentage of households safely storing & handling drinking water 4.30 10.00 15.00 20.00 30.00 (inspected population) (Percentage) Number of outpatient visits per 5,709.00 6,000.00 6,300.00 6,615.00 6,950.00 10,000 population (Number) The World Bank Health Service Delivery & System Support Project (P153064) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline Intermediate Targets End Target 1 2 3 Percentage of CHWs rated as "good performer" by their community 0.00 0.00 50.00 70.00 80.00 (Percentage) Component 2: Health system support (Action: This Component is New) Student Intakes: Clinical Specialization (including Surgery, Pediatrics, Internal Medicine, 2.00 10.00 12.00 14.00 14.00 Obstetrics and Gynecology, Family Medicine (Number) Student Intakes: Midwives 0.00 60.00 120.00 120.00 120.00 (Number) Percentage of routine/HMIS reporting units submitting timely 75.00 80.00 85.00 90.00 95.00 and complete reports according to national guidelines (Percentage) Percentage of maternal deaths reviewed among suspected 0.00 60.00 70.00 80.00 90.00 maternal deaths (Percentage) Percentage of SLA applications approved (or recommended for resubmission) within 6 weeks from 0.00 100.00 100.00 100.00 100.00 the date of submission (Percentage) Contigency emergency response (Action: This Component is New) percentage of public health 50.00 85.00 emergencies responded within a The World Bank Health Service Delivery & System Support Project (P153064) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline Intermediate Targets End Target 1 2 3 week's time adn with good quality (Percentage) Action: This indicator is New IO Table SPACE Click here to enter text. The World Bank Health Service Delivery & System Support Project (P153064) Annex 1. Revision and Reallocation by Expenditure Category in the Financing Agreement (IDA 58460) Original Proposed Amendment Percentage of Amount of Amount of Percentage of Expenditures the Financing the Financing Expenditures to be Category Allocated Category Allocated to be Financed Financed (expressed in (expressed in (inclusive of (inclusive of SDR) SDR) Taxes) Taxes) (1) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part A.1 (1) of 2,130,000 100% the Project (except Part A.1 (1.b) of the Project) 0% disbursement until the trust fund (2) Incentive Payments for Eligible Community Health Workers under Part 2,343,000 100% (TF0A2598) A.1 (1.b) of the Project fully disbursed, 100% thereafter (3) Goods, works, consultant services, non-consulting services, Training and 355,000 100% Operating Costs under Part A.1 (2) of the Project (4) Goods, works, consultant services, non-consulting services, Training and 0% Operating Costs under Part A.2 (1.a) and (1.b) of the Project The World Bank Health Service Delivery & System Support Project (P153064) (5) Goods, works, consultant services, non-consulting services, Training and 355,000 100% 355,000 Operating Costs under Part A.2 (2.a), (2.b) and (2.c) of the Project (6) Goods, works, consultant services, non-consulting services, Training and 142,000 100% Operating Costs under Part B.1 (1.a) and (1.d) of the Project (7) Stipends for Eligible Post-Graduate Medical Students and Eligible Trainee 142,000 100% Nurses under Part B.1 (1.b) of the Project (8) Goods, works, consultant services, 0% non-consulting services, Training and disbursement Operating Costs under Part B.1 (1.c) of until the trust the Project fund 497,000 30% (TF0A2598) fully disbursed, 100% thereafter (9) Goods, works, consultant services, non-consulting services, Training and 142,000 100% Operating Costs under Part B.2 (1.a) of the Project (10) Goods, works, consultant services, non-consulting services, Training and 852,000 100% Operating Costs under Part B.2 (1.b) and (1.c) of the Project (11) Goods, works, consultant services, non-consulting services, Training and 142,000 100% Operating Costs under Part B.3 of the Project The World Bank Health Service Delivery & System Support Project (P153064) (12) Goods, works, consultant services, non-consulting services, Training and 0% Operating Costs under Part C of the Project TOTAL AMOUNT 7,100,000 7,100,000 The World Bank Health Service Delivery & System Support Project (P153064) Annex 2. Revision and Reallocation by Expenditure Category in the Grant Agreement (TF0A2598) Original Proposed Amendment Percentage of Amount of Amount of Percentage of Expenditures the Financing the Financing Expenditures to be Category Allocated Category Allocated to be Financed Financed (expressed in (expressed in (inclusive of (inclusive of SDR) SDR) Taxes) Taxes) (1) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part A.1 (1) of 0% the Project (except Part A.1 (1.b) of the Project) (2) Incentive Payments for Eligible Community Health Workers under Part 0% 1,000,000 100% A.1 (1.b) of the Project (3) Goods, works, consultant services, non-consulting services, Training and 0% Operating Costs under Part A.1 (2) of the Project (4) Goods, works, consultant services, non-consulting services, Training and 1,000,000 100% 0 0% Operating Costs under Part A.2 (1.a) and (1.b) of the Project (5) Goods, works, consultant services, non-consulting services, Training and 3,000,000 100% Operating Costs under Part A.2 (2.a), (2.b) and (2.c) of the Project (6) Goods, works, consultant services, non-consulting services, Training and 0% Operating Costs under Part B.1 (1.a) and (1.d) of the Project The World Bank Health Service Delivery & System Support Project (P153064) (7) Stipends for Eligible Post-Graduate Medical Students and Eligible Trainee 0% Nurses under Part B.1 (1.b) of the Project (8) Goods, works, consultant services, non-consulting services, Training and 1,500,000 100% Operating Costs under Part B.1 (1.c) of the Project (9) Goods, works, consultant services, non-consulting services, Training and 0% Operating Costs under Part B.2 (1.a) of the Project (10) Goods, works, consultant services, non-consulting services, Training and 0% Operating Costs under Part B.2 (1.b) and (1.c) of the Project (11) Goods, works, consultant services, non-consulting services, Training and 0% Operating Costs under Part B.3 of the Project (12) Goods, works, consultant services, non-consulting services, Training and 0% Operating Costs under Part C of the Project TOTAL AMOUNT 5,500,000 5,500,000