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INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT.         Washington, D.C. 20433   Cable Address: INTBAFRAD
INTERNATIONAL DEVELOPMENT ASSOCIATION                          U.S.A.                   Cable Address: INDEVAS


                                                                               CONFORMED COPY
                                                                                     June 6, 2011


Mr. Dimitri Gvindadze
Minister of Finance
Ministry of Finance
Tbilisi, Georgia


Dear Mr. Gvindadze:


        Re:       Credit No. 3702-GE
                  Health Sector Development Project
                  Amendment to the Amended and Restated Financing Agreement

         We refer to the Amended and Restated Financing Agreement (Credit No. 3702-GE) for
the above-referenced Project, dated May 20, 2009between Georgia (the Recipient) and the
International Development Association (the Association) as amended (the Financing Agreement).
We also refer to your letter dated June 2, 2011, requesting certain amendments to the Financing
Agreement.

       We are pleased to inform you that, after due consideration, the Association has agreed to
amend the Financing Agreement as follows:

1.      Part C under Schedule 1 to the Financing Agreement is amended to read as follows:

        “Part C: Project Management Support

                Provision of technical assistance, goods and training for NCDC&PH for the
        purposes of project implementation; financing of the operating costs of NCDC&PH; and
        carrying out of rehabilitation works of NCDC&PH’s existing office space.�

2.      Section I.A.3(a) of Schedule 2 to the Financing Agreement is amended to read as follows:

        “3.      (a)      Except as the Recipient and the Association shall otherwise agree, the
        Recipient shall provide, through MOF, evidence satisfactory to the Association, by no
        later than thirty (30) days after the annual budget has been approved by the Recipient’s
        Parliament of each year during Project implementation, starting as of 2003, that sufficient
        resources have been allocated in the Recipient’s annual budget to cover all the
        counterpart funding requirements under this Project for the year in question, including
        counterpart funding requirements for NCDC&PH; and�

3.      Section I.A.4 of Schedule 2 to the Financing Agreement is amended to read as follows:

        “4.    The Recipient, through MOLHSA, shall maintain, during the course of Project
        implementation, the NCDC&PH with the responsibility to assist MOLHSA in the
        management, coordination, and monitoring of the Project, with a structure and functions

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        agreed with the Association, and sufficient staff with qualifications, experience, and
        terms of reference agreed with the Association.�

4.     Category (5) in the table under Section IV.A.2 to Schedule 2 to the Financing Agreement
is amended to read as follows:

        “(5) Incremental Operating Costs of NCDC&PH under the Original Project�

5.    The definition under paragraph 7 of the Appendix to the Financing Agreement is
amended to read as follows:

        “7. NCDC&PH� means the National Center for Disease Control and Public Health of the
        Recipient established by virtue Presidential Decree No. 66, dated February 9, 2011,
        operating for the purposes of the Project as referred to in Section I.A.3 and I.A.4 of
        Schedule 2 of this Agreement.�

6.      All the terms and conditions of the Credit Agreement that have not been amended hereby
shall remain unchanged and in full force and effect.

        Please confirm your agreement with the foregoing by signing, dating and returning to us
the enclosed copy of this letter. This amendment shall become effective upon our receipt of the
countersigned copy of this amendment letter and the written notification from the Borrower of the
completion of necessary domestic procedures for the entry into force of this amendment.


                                           Sincerely,


                    INTERNATIONAL DEVELOPMENT ASSOCIATION


                                        B:/s/ Asad Alam

                                       Country Director
                                 South Caucasus Country Unit
                                Europe and Central Asia Region


AGREED AND CONFIRMED:

GEORGIA

By: /s/ Mr. Dimitri Gvindadze

Title: Minister of Finance

Date:   June 28, 2011