The World Bank Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) REPORT NO.: RES30061 DOCUMENT OF THE WORLD BANK RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF HEALTH SYSTEM STRENGTHENING FOR BETTER MATERNAL AND CHILD HEALTH RESULTS PROJECT (PDSS) APPROVED ON DECEMBER 18, 2014 TO MINISTRY OF HEALTH HEALTH, NUTRITION & POPULATION AFRICA Regional Vice President: Makhtar Diop Country Director: Ahmadou Moustapha Ndiaye Senior Global Practice Director: Timothy Grant Evans Practice Manager/Manager: Trina S. Haque Task Team Leader: Hadia Nazem Samaha The World Bank Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) I. BASIC DATA Product Information Project ID Financing Instrument P147555 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 18-Dec-2014 31-Dec-2021 Organizations Borrower Responsible Agency Ministry of Health,Democratic Republic of Ministry of Health Congo,Ministry Of Finances Project Development Objective (PDO) Original PDO The proposed project development objective is to improve utilization and quality of maternal and child health services in targeted areas within the Recipient's Territory. Summary Status of Financing Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-59980 31-Mar-2017 19-Apr-2017 13-Feb-2018 31-Dec-2021 120.00 59.44 63.52 IDA-55720 18-Dec-2014 20-Jan-2015 30-May-2016 31-Dec-2021 130.00 52.73 70.02 IDA-D0210 18-Dec-2014 20-Jan-2015 30-May-2016 31-Dec-2021 90.00 40.93 43.93 TF-A6945 24-Jan-2018 14-Mar-2018 14-Aug-2018 31-Aug-2018 10.00 4.48 5.52 TF-A5096 24-May-2017 24-May-2017 22-Nov-2017 30-Jun-2019 3.50 3.39 .11 TF-A4579 19-Apr-2017 19-Apr-2017 18-Aug-2017 31-Dec-2021 40.00 2.27 37.73 TF-18375 20-Jan-2015 20-Jan-2015 30-May-2016 31-Dec-2021 6.50 2.04 4.46 The World Bank Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No II. SUMMARY OF PROJECT STATUS AND PROPOSED CHANGES The project has been performing in a satisfactory manner for project implementation, PDO achievement and monitoring and evaluation. In terms of implementation progress, the overall progress over the last twelve months has been rated satisfactory; all performance-based financing (PBF) contracts between the purchasing agencies in Equateur, Bandundu, and Maniema and the health facilities in these provinces have been signed (more than 2,873 contracts). A number of activities have been carried out, including: a) the quality baseline survey at the level of all the health facilities being contracted; b) a business plan to determine how the investment funds will be used to improve quality; c) the investment funds as a first PBF payment have been released from the health facility bank accounts to more than 1,500 health facilities; d) the investment case for the GFF has been presented to the national health committee and adopted; e) the health financing strategy has been finalized and is awaiting validation by the minister of health; and f) the supply chain strategy has been validated by the minister of health in September 2017. Furthermore, progress on project components has been satisfactory to date as well. PBF was rolled out in several provinces: first in Bandundu (February-March 2017), followed by Maniema (April-June 2017), Equateur (May-June 2017) and then Kantaga (August-September 2017). As of October 2017, more than 2,873 contracts have been signed and essential health services are being provided to a larger population. Looking at the initial results of PBF, the project seems not to only have improved health service coverage but also advanced the governance and health financing system by strengthening transparency and reporting at all levels of the system. It has also facilitated the autonomation of health facilities. To ensure sustainability, the project invested in institution strengthening by setting up purchasing agencies (11 agencies) as part of the national system. The Etablissements d’Utilité Publique are purchasing agencies that oversee the contracting mechanisms between local authorities and health providers at the provincial level and play a role in ensuring that health facilities are providing quality maternal and child health services to the population. The project also invested in people by training more than 6,000 providers by developing tools that are used by all parties (partners and government) in order to ensure efficiency, alignment, and harmonization among the stakeholders. The Additional Financing was approved March 31, 2017 and was discussed by the Parliament and Senate at the end of October 2017. Effectiveness is expected by end of November 2017. The GFF Trust fund was declared effective on August 18, 2017 and is starting to disburse. As a result of the XDR and USD exchange rate fluctuations, as well as the amounts originally allocated to component 2 for the UNICEF contracts and yellow fever management, it is proposed to reallocate funds under IDA 5572-ZR to: (i) increase the available amount under category 2 to meet the client’s revised forecasts; (ii) cancel the unused amount under category 5; and (iii) adjust the amount under category 4 (PPA refinancing) to reflect the actual disbursed amount against this category. The government request didn’t consider the adjustments to be completed under category 4 and 5 since the PPA has been ref inanced and is actually closed. Therefore we’ve revised the table to reflect these changes as well. The World Bank Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) III. DETAILED CHANGES REALLOCATION BETWEEN DISBURSEMENT CATEGORIES Current Current Actuals + Proposed Disbursement % Ln/Cr/TF Expenditure Allocation Committed Allocation (Type Total) Category Current Proposed IDA-55720- PBF GRANT 65,446,154.00 17,135,297.91 65,446,154.00 60.00 60 001 PART 1 AND 2 Currency: GD, N/CS, OP XDR COST, TR, 18,248,846.00 11,643,093.51 18,248,846.00 100.00 100 WORKSHOP PPF 4,305,000.00 4,304,678.43 4,305,000.00 REFINANCING PPF REFINANCING 0.00 0.00 0.00 SUPPLEMENTAL Total 88,000,000.00 33,083,069.85 88,000,000.00