Document of The World Bank FOR OMCIAL USE ONLY Reped No. P-3631 S REPORT AND RECOMMENDATION OF THE PRESIDENT OF THE INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT TO THE EXECUTIVE DIRECTORS ON A PROPOSED LOAN IN AN AMOUNT EQUIVALENT TO US$34 MILLION TO TEF FEDERAL GOVERNMENT OF NIGERIA FOR A SOKOTO HEALTH PROJECT February 21, 1985 This dmneNst bss a netiekd diatnbefie _d may be use by rex**ns ody in the peofonsuxe io { tlir offWdaichl Its bmm a ols odli be disoe withu Weld BRk wtorizon. CURRENCY EQUIVALENTS Calendar 1983 December 1984 Currency Unit - Naira (N) N US$1 - N 0.72 N 0.81 Ni - US$1.38 US$1.24 ABBREVIAIIONS BESS Basic Health Services Scheme FMG Federal Military Government FMOE Federal Ministry of Health LGA Local Government Area MCH Maternal and Child Health PEC Project Executive Committee FEC Primary Health Care PMU Project Management Unit Sr-OH Sokoto State Ministry of Health SSG Sokoto State Government UNDP United Nations Development Progranme WHO World Health Organization ZHO Zonal Health Office FISCAL YEAR Ja:uary 1 - December 31 FOR OFFICIAL USE ONLY NIGERIA SOKOTO HEALTH PROJECT LOAN MAD PROJECT SUMARY Borror: Federal Republic of Nigeria Beneficiary: Federal Republic of Nigeria Sokoto State of Nigeria Amount: US$34.0 million. Terms: Payable over 20 years, including 5 years of grace, at the standard variable interest rate. Relending Terms: US$31.0 million of the loan would be onlent to the Sokoto State Government on the same terms as the Bank loan. The Borrower and the Sokoto State Government would share the foreign exchange risk on a pro rata basis. Project Description: The project would help expand and improve the delivery of 2rinary health and family planning services as well as immunization coverage in Sokoto State. It would also strengthen the technical advisory capacity of the federal health authorities. At the state level, it would include: the construction, equipping, and staffing of about 60 health clinics; the upgrading of 120 dispensaries; the provision of vaccines and equipment for the immunizition program; and the establishment of an adequate training and supervision program. At the federal level, it would provide for equipment, technical assistance, and training. Project implementation could be affected by inadenuate counterpart funding and a shortage of qualified female health workers. To minimize the funding -isk, the scope of the project has been scale down, and stringent funding arrangements have been agreed uLoDn. The second risk is being reduced through the training of female workers under the project. This document has a restricted distribution and may FJe used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Biank authorization. Estimated Cost: Local Foreign Total - US;f l1ion- A. Sokoto State Activities Primary Health Services Development 10.2 5.6 15.8 Expanded Iamunization Program 1.7 2.7 4.4 Training and Supervision 4.0 1.2 5.2 Institutional Support, Monitoring, and Evaluation 5.3 5.1 10.4 Sub-Total 21.2 14.6 35.8 B. Federal Support Activities 1.3 2.3 3.6 Total Base Costs 22.5 16.9 39.4 Physical Contingencies 1.0 0.6 1.6 Price Contingencies 8.8 3.2 12.0 Total Project Costs (including taxes aqd duties of US$1.6 Million) 32.3 20.7 53.0 Financing Plan: Local Foreign Total - $US$ Million- BRBD 13.3 20.7 34.0 Federal Military Government 10.9 - 10.9 Sokoto State Government 4.4 - 4.4 Local Governments 3.7 3.7 Total 32.3 20.7 53.0 Estimated Disbursements: Bank Fiscal Year 1986 1987 1988 1989 1990 1991 Annual 1.2 3.9 5.1 7.5 9.5 6.8 Cumulative 1.2 5.1 10.2 17.7 27.2 34.0 Rate of Return: not applicable Staff Appraisal Report: 4599-UNI, Dated February 21, 1985. INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT REPORT AND RECOMMENDATION OF THE PRESIDENT TO THE EXECUTIVE DIRECTORS ON A PROPOSED LOAN TO THE FEDERAL REPUBLIC OF NIGERIA FOR A SOKOTO HEALTH PROJECT 1. I submit the following report and recommendation on a proposed loan to the Federal Republic of Nigeria for the equivalent of US$34.0 g million to help finance a project to expand and improve the delivery of primary health and family planning services as well as immunization coverage in Sokoto State and to strengthen the technical advisory capacity of the federal health authorities. The loan would have a term of 20 years, including 5 years of grace, at the standard variable interest rate. US$31.0 million of the loan would be onlent to the Sokoto State Government on the same terms as the Bank loan. The Borrower and the Sokoto State Government would share the foreign exchange risk on a pro rata basis. PART I - THE ECONOMY 1/ 2. The assessment of the Nigerian economic situation in this report is based largely on the work of an economic updating mission of November 1984 supplemented by further analysis undertaken by Bank staff on the basis of the 1985 budget speech. The findings of a 1982 economic mission were more fully reflected in a Country Economic Report (No. 4506-UNI) which was distributed to the Executive Directors on August 15, 1983. Annex 1 presents selected social and economic indicators for Nigeria. Background 3. Nigeria, with a population of about 94 million in 1984, is the most populous country in Africa. Among sub-Saharan Bank members, in 1980 Nigeria accounted for about 45 percent of gross output and more than 60 percent of regional investment. Its GNP per capita is estimated at about US$760 in 1983, which is twice the average for sub-Saharan Africa. While Nigeria as a major oil exporter since the early seventies enjoyed a sub- stantially improved resource base from increased oil revenues, it still remains at a very early stage of development in terms of socio-economic indicators, in which it compares with other sub-Saharan countries. 4. Following a civil war and 13 years of military rule, a new federal constitution was adopted, and an elected civilian government came 1/ Except for minor changes to reflect the 1985 Federal Budget, this section is substantially unaltered from Part I of the President's Report for the Technical Assistance Project (P-3648-UNI), approved by the Executive Directors on December 20, 1984. into power in 1979. This Government was reelected in September 1983. However, a military government (FHG) led by Major-General Mohammadu Buhari, took power in December of the same year. Macro-economic Developments 5. Nigeria has been undergoing a rapid socio-economic transformation since the upsurge of oil prices in 1973-74 which dramatically altered the country's resource position. Between then and the late seventies, Nigeria's development strategy was based on sustaining a high rate of growth and diversifying the economy through the resources generated by the oil sector. The principal objective of the policies pursued by the Nigerian decision-makers was to translate the large oil revenues accrued--about US$100 billion in current prices during the 1973-81 period--into investments in economic, social, and physical infrastructure. While there have been some "non-economic" investments and waste, significant development gains were made in both economic and social infrastructure. Transport infrastructure, particularlv roads and ports, expanded considerably. Power generating capacity tripled, and refining capacity has more than quadrupled since 1973. Manufacturing grew at an average annual rate of 10 percent during the 1973-82 period, although there was a highly distorted investment structure due to large variations in the rates of effective protection provided to various industrial sub-sectors. There also has been a rapid spread of educatior at all levels; in particular, the primary enrollment ratio which was about 35 percent in the early seventies has more than doubled. 6. Developments were not as positive in some other areas. According to official statistics, overall output in agriculture remained virtually stagnant during the 1973-83 period, with the prcduction of grains increas- ing probably at the same rate as the population growth rate, but the production of root and export crops declining substantially. Within a decade, Nigeria became a major food importer (US$2.7 billion of imports in 1982) as domestic terms of trade moved against agriculture. Inflation, coupled with an appreciating domestic currency, pushed up domestic costs of production, thus putting the commodity-producing sectors at a disadvantage vis-a-vis imports and non-traded goods. This encouraged diversion of resources from commodity production to services (including trade and construction). Both agriculture and industry became "high-cost" activi- ties. Trade and exchange rate policies, which were formulated in response to frequent swings in oil export earnings, were largely used to dampen inflationary pressures or ration imports rather than to provide appropriate incentives to domestic production. This was partly due to the fact that, as a result of the fluctuations in the world oil markets and their impact on the balance of payments and government revenues, Nigerian policy-makers were preoccupied with short-term crisis management. This diverted atten- tion from the formulation of longer-term policies to reduce the country's dependence on cil and to strengthen the domestic productive sectors. 7. The Fourth Development Plan (1981-85) was prepared in 1980 when the world oil markets presented a favorable outlook. Nigeria's oil exports for the year amounted to US$25 billion and foreign exchange reserves stood at US$10 billion. The Plan, accordingly, reflected an ambitious investment -3- program. It envisaged a total capital investment of N80 billion (about US$145 billion at the 1980 rate of exchange) over the period 1981-85, half of which was to be invested directly by the Federal Goverment and a quarter directly by the states-with the remaining quarter to be invested by the private sector. Emphasis was placed on the development of agriculture (through statewide agricultural suppoft programs and massive irrigation schemes) and on heavy industry based on cheap energy (steel, petrochemicals, fertilizers, etc.), both supported by substantial investments in infrastructure. 8. Nigeria's development plans, however, were overtaken by the sharp decline in oil export revenues since 1981. Its economic problems during 1981-83 were exacerbated by the inabili:y of Nigerian decision-makers to cut back the public investment program sufficiently, partly because of a continuing belief that oil markeL.i would soon recover. Nigeria's imports reached US$24.2 billion in 1981, while oil production fell by one-third from its 1980 level of 2.06 mbd to 1.44 mbd. Although the oil price peaked at US$39 per barrel, oil export revenues declined from US$23.4 billion in 1980 to US$17.4 in 1981, resulting in a current account deficit of US$6.5 billion, which was financed largely through the drawing down of foreign exchange reserves and external borrowing. 9. Confronted by a worsening balance of payments situation, the Government reacted in April 1982 by introducing a number of austerity measures aimed at stabilizing the domestic and external financial situation. However, these measures failed to achieve their stabilization objective: oil production declined further and, coupled with a decline in the oil price to US$34.4, oil export reve.-ues fell to US$12.8 billion. Imports of goods for the year declined crly imarginally to US$17 billion (from the 1981 level of US$19.1 billion), resulting in a wider current account deficit of US$7.7 billion. Reserves declined further to onlv US$1.4 billion by the end of 1982, whilst trade payment arrears of US$4 billion were accumulated. 10. By 1983, previous measures in the form of quantitative restric- tions together with a growing reluctance of the trading partners to extend further trade credits to Nigeria led to a reduced import level of US$12.2 billion. Oil export revenues continued to fall, however, reaching US$10.1 billion in 1983. The trade deficit was largely financed by further accumulation of trade payment arrears (US$3.8 billion), a process which had already begun during 1982. Discussions with major overseas creditor banks resulted in the rescheduling of the arrears owed to these institutions (for confirmation of letters of credit) of about US$2.1 billion accumulated prior to August 31, 1983, with repayments to be made over a period of 31 months starting January 1984. In April 1984, the Government completed negotiations to reschedule US$4-5 billion of the remaining arrears incurred throug1, "open-account" intvr--ompany import financing. This agreement includea -ily those arrears not covered by export credit insurance and rescheduled the payments over a period of six years including a grace period of two and half years at an interest rate of 1 percent over LIBOR. Outstanding arrears at this point are US$2 billion insured by export credit agencies (ECAs). The terms under negotiation for these remaining arrears are similar although formal agreement to reschedule has been made conditional by the ECAs on Nigeria reaching an agreement with the IMF. The mllitary go-vernment (FMG) has so far been regular in making repayments due on earlier medium- and long-term debt, as well as on the 1983 reschedulings. 11. The deterioration in the external financial situation had a severe impact on the fiscal position of the Federal and State Governments as well as on growth. Federally collected revenues fell from N15.2 billion in 1980 to N12.0 billion in 1983, because oil revenues account for such a large percentage of total revenues (about 80 percent in 1980 and almost 60 percent in 1983). Until 1984, the Federal Government did not reduce expenditures in line with the reduced revenues, thus large budget deficits emerged over the period 1981-83, with the deficit/GDP ratio in excess of 8 percent. In order to finance these deficits, the Government borrowed from the Central Bank. This, coupled with the physical shortages of many imported commodities, led to an acceleration in the inflation rate which rose to about 23 percent in 1983. As a result of a decline in imports of about 30 percent in real terms, domestic output contracted by 6.0 percent in 1983 following declines of 5.9 percent in 1931 and 2.3 percent in 1982; as a consequence, most manufacturing industries, starved of imported raw materials and spare parts, are now operating at very low capacity levels. In addition to the decline in manufacturing output, the construction sector suffered from an almost one-third decline in gross output in 1983. 12. In order to get the balance of payments situation under control, and accommodate the increase in debt service to about US$4.2 billion in 1984, the FMGN imposed in early 1984 very strict limitations on imports through the use of an import licencing/foreign exchange allocation scheme. As a result there was a sharp curtailment of imports which is estimated to have amounted to only about $10 billion in 1984. Since oil export revenues increased by about US$1.3 billion over the 1983 level to US$11.4 billion, due to an increase in oil exports that more than offset the US$2 per barrel reduction in price in October 1984, there was also a drastic improvement in the external balance. The current account deficit is estimated to have amounted to only about $150 million in 1984. The improvement of the external balance through measures to constrain imports carried with it, however, very high costs for the economy in the form of further decreases in industrial production, construction and investment, accelerated inflation (officially estimated at 37 percent in 1984) as well as increased unemployment. The manufacturing sector as a whole is estima-_ed to have operated at only about one-third of capacLty i.: 1984. However, due to the increased oil revenues as well as good perform-nce in the agricultural sector - in part explained by a return of workers to farming fcllowing recent years increases in agricultural prices - Nigeria was able to break three consecutive years of declines in overall production, and held production about constant in 1984. Adjustment Policy Issues 13. At present, the Nigerian economy faces two critical issues: first, the management of the short-run financial crisis ard stabilization of the economy; and second, the longer-term structural adjustment of the economy by stimulating productive sectors, lessening dependence on oil, and -5- developing a wider resource base. With regard to the short term, the measures that the FMG has taken since Ja.nuary 1984 to rescheildle trade arrears, control imports and restrain domestic expenditures which were reconfirmed in the 1985 budget released in January, may help to arrest a further deterioration of the external and internmal financial situation. However, the remaining external arrears need to be rescheduled, particularly in view of the need for substantial external borrowing in the near future. 14. While a rebound in oil revenues would help Nigeria to overcome the current crisis, it will not resolve the structural issues facing the economy. More vigorous and consistent policies, beyond the measures taken to restore financial stability, will be needed to bring about structural change. The chief requirements comprise: (i) further incentives for efficient export promotion and import substitution, including appropriate exchange rate, tariff, and credit policies; (ii) complementary steps to strengthen the balance of payments through judicious management of foreign borrowing and external reserves; (iii) continued control of aggregate demand through prudence in monetary, fiscal, and wage policies; (iv) improvements in the composition and implementation of public investment to increase its efficiency; and (v) steps, such as raising interest rates and improving tax collection, to increase private and public savings and investment. Prospects and Financing of Development 15. Although Nigeria's exportable crude oil surpluses are expected to be significantly reduced well before the turn of the century, the bulk of its foreign exchange resources will continue to come from the hydrocarbon sectors during the next twenty years. In additior to oil exports, this could include exports of liquefied natural gas (LNG)--although the market prospects for LNG during the 1990s are more uncertain than before--and some exports of petrochemicals. To maintain economic growth, major structural changes are needed in order to adapt the economy to lower levels of oil export earnings. In the short-run, the volume of Nigeria's oil exports is likely to be determined by the uncertain conditions of the world oil markets rather than by the deliberate extraction policies of the Govern- ment. It is projected that oil production would rise gradually, possibly attaining a level of 1.6 mbd in 1987, from its estimated level of 1.3 mbd in 1984. 16. The prospects for the Nigerian economy over the medium term are closely related to the kind of economic policies the Government pursues over the next few years. One option open to the Government is to pursue a "high growth/economic reform" strategy comprising policy measures which have bean discussed in the context of a possible Extended Fund Facility (EFF, with the IMF and a Structural Adjustment Loan (SAL) from the Bank. Such a strategy would also give Nigeria renewed access to international borrowing from commercial banks, although the amounts that would be available are difficult to quantify. On the estimation that about US$2-3 billion per year of international lending would be available from all different sources, this would permit a moderately high growth rate of about 4 percent per annum over the period 1984-1992. It would prevent a further - 6 - deterioration in the average standard of living and allow employment to expand broadly at the same pace as population growth. In addition, it would, over time, stimulate non-oil exports, which, in the longer run will need Lo replace oil as the engine of import growth. In the "low" case, on the other hand, assuming no agreement is reached on an EFF/SAL package, and the only "reform" is in maintaining enough macro-economic discipline to avoid the reemergence of trade arrears as a maior problem, the possibility of foreign borrowing would be very limited and balance of payments constraints would necessitate the continuation of restrictive policies. The result would be lower growth rates for the rest of the decade leading to a further deterioration of the average standard of living, low capacity utilization rates in many sectors and increasingly severe unemplovment problems. 17. At present the Government is pursuing an intermediate strategy. In addition to the adjustments in the investment program mentioned above (para. 12), the Government has recently introduced new schedules of customs and excise duties that move in the direction of equalizing effective protection across industries. In the 1984 budgets dhe Government made reductions in public expenditures in line with Bank recommendations and, to help rationalize future investments. instituted a Project Review Committee which has reviewed projects funded under the capital budqet. The Committee has proposed that all projects be categorized as "core" cr "non-core" with the former to receive full funding and the latter being shelved pending availability of funds or abandoned. The recommendations of the Review Committee are currently being reviewed by the Government. Measures to streamline public sector employment have resulted in a reduction of some 55,000 employees; and a freeze on public sector salaries and wages has also been introduced. Together these measures are estimated to have resulted in a reduction of the Federal budget deficit from about 23 percent of GDP in 1981 to about 5 percent in 1984. The 1985 budget continues with the policy of stabilization and the sectoral allocation of public expenditures is once again in line with the Bank's recommendations. The new Government has also enforced much greater financial discipline on State Governments which has resulted in greater revenue raising efforts by the states together with improved focus on development priorities. Tighter monetary policies including increases of 1.; to 2 percent in interest rates have also been introduced. With this progress on fiscal reform, but little progress on incentive reform, growth would be higher than in the low case, but would result at best in a stagnation of per capita incomes. 18. The three policy scenarios differ more from each other in their impact on growth than in their impact on Nigeria's ability to service external debt. This is because in the low and intermediate cases, lack of confidence on the part of commercial lenders would mean severely limited access to international borrowing. Of course, if the moderate fiscal discipline assumed even in the low case is not maintained, there would be pressure on imports and an eventual risk of a build-up of trade arrears with a resultant further decline in access to external credits. At the present time, though, this does not appear likely, given the Government's firm commitment to austerity. Under all these scenarios there will be severe liquidity problems over the next few years with the debt service ratio likely to range from 39 to 45 percent between 1985 and 1987. Under - 7 - all the sconariom also, the debt service ratio begins to decline after 1987. The decline is somewhat slower--although still marked--in the high came, becaue with better growth policies, access to international borrowing is higher. Tn the high came, the debt service ratio in 1992 would be 22 percent, while in the intermediate and low case. it would be about 10 percent. The volume and composition of Bank lending would be determined by the polinies pursued by the Government--ranging from an expanded lending program including a Structural Adjustment Loan in the high case to a limited program focumsina primarily on social and physical infrastructure in the low case. PART II - BANK GROUP OPERATIONS lId NIGERIA 2/ 19. Bank and IDA lending to Nigeria as of September 30, 1984, amounted to US$2,514.4 million (net of cancellations). The amount of loans and credits disbursed as of September 30, 1984 was US$1,338.5 million, leaving an undisbursed balance of US$1,175.9 mil'lion. Agriculture accounts for about 50 percent of total commitments; transport, power, and water supply together for about 34 percent; and education, industry, urban, and the post-war rehabilitation loan for the remaining 16 percent. There have been only two IDA credits to Nigeria, for US$35.3 million; both are fully disbursed. IFC has made six loans to borrowers totalling US$24.7 million, and six equity investruents totalling US$4.6 million. Of these amounts, US$7.5 million have been repaid, terminated, cancelled, or sold. Annex II contains a summary statement of Bank loans, IDA credits, and IFC investments. 20. As a result of the abrupt decline in earnings from oil, publ'c revenues have fallen sharply, causing many of the ongoing projects to run into serious counterpart funding problems. The Bank, the Federal Government, and the relevant state governments are making concerted efforts to alleviate the situation. The Bank, under the Special Action Program, has agreed to the reallocation of loan proceeds and the upward revision of disbursement percentages to speed up disbursements. Working within the resource constraints (which are like]y to continue in the near future), the Federal Government is supplementing the funding for selected projects for 1984 and has agreed to ensure that adequate funding will be provided for projects for 1985 on the basis of updated estimates of funding requirements. The state governments are instilling a greater degree of discipline in their budgeting processes and cutting back on new capital expenditures in order to fund existing obligations. As a result, the prospects for counterpart funding for Bank-assisted pro.ects are expected to improve. 2/ This section is substantially unchaged from Part II of the President's Report for the Technical Assistance Project (P-3648-UNI) approved by the Executive Directors on December 20, 1984. 21. Provided appropriate policy changes are undertaken, the Bank's lending program would aim primarily at the urgent diversification of Nigeria's economy to reduce its excessive dependence upon petroleum as a source of foreign exchange and fiscal revenue. At the same time, the Bank would continue to support efforts to raise the productivity of the lowest income groups and thereby diminish the incidence of absolute poverty in Nigeria. As in recent years, the Bank would continue to provide support for agriculture and rural development with emphasis on institution-building and transfer of technology. These objectives are in line with the Federal Government's priorities and with the emphasis it is placing on the need to use the proceeds of the country's oil revenues to increase the productive capacity of the economy, and thereby raise the standard of living of its population, particularly the rural poor. The Bank would similarly support efforts to stimulate a well-balanced and integrated development of Nigeria's industrial sector. This approach would entail a combination of intensive sector work and policy dialogue with the Government, as well as Bank assistance for industrial projects in crucial subsectors. 22. Projects in the agriculture, water supply and urban sectors together should account for a large share of Bank lending in the coming two to three years. Effective support for the commodity producing sectors will also require strategic investment in production-related infrastructure. There are good opportunities for the Bank to make a significant contribution in energy and highway maintenance. Similarly, thero is a strong case of continued lending for education. In this context, vocational, technical, and teacher training would be given special emphasis. Finally, the Bank would support the Federal and State Governments' efforts to spread the benefits of growth to the social sectors. It is envisaged that some of thc pressing problems of rapid urbanization will continue to be addressed through a number of urban development projects focussed on the needs of the urban poor and resource mobilization for urban areas. The Bank is also assisting the Government in overcoming the country's health problems with a project aimed at both federal and state (Sokoto) levels, and is continuing a dialogue with the Government on population issues, perhaps leading to lending in this area. 23. Although annual disbursements have increased from US$52 million in FY1978 to nearly US$272 million in FY1984, Nigeria's disbursement performance has lagged behind that of other countries in the region. The undisbursed balance now stands at 47 percent of the US$2.5 billion in loans and credits approved. One of the reasons for this development is the rapid expansion of the Bank's loan portfolio since 1979 as well as the fact that a number of large loans, with relatively large, planned disbursements during the early years, were extended during this period, mainly for agricultural projects. In many cases, however, disbursements have been slowed by long delays in loan effectiveness and institutional and management problems. Recently, the inadequate counterpart funding of projects bv federal and state governments, resulting from lower oil revenues, has further slowed disbursements. The FMG, with the arsistance of the Bank's Resident Mission, is now carefully monitoring loan disbursements with a view to identifying problems early and taking corrective action. Also, the Bank has recently agreed to a series of - 9 - measures aimed at accelerating disbursements under both ongoing and new projects (para. 20). These efforts are beginning to show results. PART III - THE HEALTH SECTOR Health Status IL 24. Despitc. the rise in life expectancy at birth from 39 years in 1960 to 50 years in 1982, general health conditions in Nigeria are still poor by international standards. In fact, Nigeria is more comparable with poorer nations like Benin, with an average life expectancy of 48 years, than with other middle-income oil exporting countries, with an average of 57 years. Infant mortality and child death rates are very high and claim about 50 percent of total deaths. Maternal mortality is also high. High mortality rates can be explained by the fact that: (a) 80 percent of recorded deaths occur because of infections and parasitic diseases such as measles, malaria, and diarrhea; (b) more than two-thirds of the pregnant women have no access to ante-and post-natal care; (c) traditional medical practices, particularly for child delivery, are inadequate and unhygienic; and (d) high fertility rates adversely affect the general health of mothers and infants. Ocher significant health problems in Nigeria include diseases like pneumonia, gonorrhea, chicken pox, whooping cough, and filariasis. Health Service System 25. In the last two decades, Nigeria has expanded its health service systen in the public and private sectors. For example, the number of health establishments increased from 3,500 in 1965 to over 10,200 in 1981, and the population-to-bed ratio was almost halved to about 1,100:1 over the same period. Tertiary, secondarv, and primary level care is provided through hospitals, health centers, maternity centers, health clinics, and dispensaries, of which more than three-quarte-s are in the public sector. Private facilitics are heavily concentrated in the south. However, many of the fecilities, particularly at the primoary level, are inadequately supplied and staffed. Also, as in many other countries, the urban population is better covered by the health system than the population in rural areas. Drug distribution rests mainly with the private sector, although drug availability at government health facilities has improved considerably in recent years. 26. Nigeria has undertaken a vast and successful effort to train and deploy health manpower. The number of medical practitioners increased from about 700 in 1960 to 8,000 in 1981, and the ratio of population to nursing personnel improved from about 16,000:1 to 1,300:1 over the same period. Nevertheless, if the country is to provide widely accessible primary health care (PHC) services, it will have to train additional health personnel, in particular auxiliary level public and community health workers and medical technologists. In addition, in northern Nigeria, it will have to train and deploy female health workers to provide for maternal and child health (MCR) services, including family planning. % - 10 - 27. The responsibility for health is currently divided between the federal, state, and local governments. The Federal Ministry of Health (FMOH) has overall responsibility for the sector. It establishes national healt'- policies and program guidelines, and monitors state and local government health programs for compliance with these policies and guidelines. In addition, FMOH has direct operational responsibility for: (a) training of medical doctors and setting of accreditation standards for all categories of health manpower; (b) operating teaching institutions and psychiatric and orthopedic hospitals; (c) monitoring and controlling contagious and communicable diseases; and (d) controlling drugs and vaccines. In each of the 19 states, the State Ministry of Health is responsible for planning and implementing all health programs not explicitly reserved for FMOH, including: (i) planning and coordinating the devele-ment of the health system within the state, (ii) operating and maintaining all secondarv and non-specialized tertiary level health facilities, (iii) implementing public health programs, (iv) training nursing and auxiliary health personnel, and (v) assisting the local government authorities (LGAs) with the management and operation of the network of primary level health facilities. LGAs are responsible for operating clinics and dispensaries, including the provision of basic outpatient and community health, hvgiene, and sanitation services. 28. FeCeral capital expenditures for health have increased in recent years rising from 0.7 percent of the Federal Government's total capital budget in 1975 to 2.8 percent in 1982. Among the various items of expenditure, teaching and other hospitals have dominated, accounting for about two-thirds of total FMOR capital allocations on average. The Basic Health Service Scheme (BHSS, para. 31) received on average about one-quarter of this, while national public health programs, training institutions, laboratories, and other supporting institutions received the remainder. Recurrent health expenditures of FMOH have increased considerably in recent years, and amounted to about 3.5 percent of the Federal Government's total recurrent expenditures in 1982. Almost 90 percent of these expenditures represent FMOR subventions and grants to teaching and other federal hospitals and health institutions. 29. The public health system is almost entirely financed out of budgetary resources. Only a few states arI hospitals recover costs through user charges for hospitalization. Both the Federal and state governments are committed to the provision of free basic health care for all citizens, despite evidence of willingness end ability to pay on the part of beneficiaries. Because budgetary resources allocated to the health sector are not likely to grow at a pace commensurate with the rapidly rising costs of Nigeria's heilth system, priority should be given to identifying and adopting meas' -es to broap..en the health sector's resource base. National Health Policies 30. Since 1960, the national health policy has aimed at developing the health system, manpower, and training and at strengthening the delivery of preventive health services, especially in the rural areas. The First Plan (1962-68) introduced innovative pilot programF that successfully delivered MC-d and health education services using paramedical personnel. - 11 - The Second Plan (1970-74) gave priority to the reconstruction of health infrastructure in the war zones. At the end of this period, when Nigeria enjoyed rather ample financial resources and an expanded health manpower base, the country's health authorities came under increasing pressure to improve the quality and sophistication of hospital care. However, this emphasis on curative and capital-intensive care led to an increasing gap between actual expenditure patterns and the overriding national objectives of promoting basic and preventive health care. 31. To remedy this situation, the Federal Government developed the BHSS as the focus of the Third Plan (1975-80). The major objectives of the BHSS were: (a) to improve access to comprehensive health services, particularly in rural areas; (b) to emphasize the celivery of key preventive services at all health facilities, especially of MCH services, including childhood immunizations and family planning; (c) to train and deploy new cadres of para-medical community-oriented health workers; and (d) to strengthen the management of the health system. FMOH was to implement these objectives by establishing a modular, three-tiered network of health facilities to be staffed by new cadres of community health workers. However, full-scale implementation of this ambitious program was almost immediately constrained by limitee funding, a low level of commitment on the part of most state governments, and limited construction capacity at the state level. Nevertheless, a total of W168 million was spent on the BHSS between 1976 and 1981. A special commission established by the Federal Government and chaired by the WHO Country Coordinator for Nigeria, concluded that the objectives and policy framework of the BHSS were appropriate vehicles to achieve PHC objectives - but the health facility program had been a costly failure. The commission also underlined the need for a strategy of decentralization, under which the states, LGAs, and communities would participate in the provision of health care. 32. The Government accepted the special commission's recommendations as a strategy for PHC, and recognized the need for full integration of existing facilities and manpower in t.e desired health system, and the development of less costly and more appropriate facility designs and equipment lists. It also recognized that, if the PHC program were to be successful, the state Ministries of Health would have to develop their planning, coordination, and technical control functions, particularly with respect to the LGAs which operate most of the first-level health facilities and are in direct contact with the communities. National Health Issues 33. The major issues facing Nigeria in increasing the effectiveness of its health system include: (a) Planning for PHC. The strategy of decentralizing planning responsibility to the state level places a considerable new responsibility or the state Ministries of Bealth. Although most have become competent administrators of the existing health system, they lack experienced planning staff. Despite this handicap, the states have accepted the challenge, adopting segments of the BHSS proposals to respond to the most pressing needs. Sokoto is the first state to have prepared, with - 12 - assistance from consultants, a PHC-oriented project suitable for external financing. Nevertheless, all of the states requir's technical assistance to help strengthen their planning and evaluation capacity. It is, therefore, important that FMOH develop, as soon as possible, a technical capacity to provide ae states with planning advice, particularly for developing a.,. implementing a consistent and efficient approach to PHC projects. (b) Access to Care. Despite the considerable expansion of Nigeria's health facility network, about 15 percent of the urban and 30 percent of the rural population still lack access to basic health services. Data on health facilities also show a wide variation in the average population served by health facilities, and indication of unequal access to health care. Construction of new facilities in unserved areas is required to remedy this. (c) MCH and Preventive Services. Many primary health facilities are not able, because of lack of qualified staff and equipment, to provide key MCH services, including immunization, family planning, health education, and environmental sanitation services, which are essential for the overall effectiveness of PHC. There is also a shortage of midwives, particularly in the northern states. Although Nigeria is firmly committed to an expanded immunization program, technical and administrative factors have constrained reliable program delivery. Consequently, less than one-third of the children are protected against the major communicable childhood diseases. ,d) Family Planning. The Government is well aware of the implications of high population growth for development. However, it has yet to develop a population policy with eplicit demographic objectives, largely because of the sensitive ethnic, cultural, and political implications of the population issue. The National Population Commission has a mandate for census operations, demographic studies, and registration of vital statistics. The coordination and implementation of family planning services falls beyond the Commission's jurisdiction; it is considered an integral element of PHC and falls under the responsibility of FMOR. To date, the Government's approach to family planning has been cautious, and limited to encouragement and some financial support for private sector programs. The number of family planning acceptors remains low (only 14 percent of all married women are estmanted to have ever used any form of contraception, including abstinence), and is mostly limited to urban areas. Before it can become more widespread in Nigeria, contraception, whether modern or traditional, has to overcome serious socio-cultural barriers, such as the low level of education of women, cultural and religious traditions, high infant mortality, and inadequate; MCH services. Meanwhile, the strategy of introducing MCI services at primary level health facilities and of training health workers and traditional birth attendants in family planning services will facilitate the - 13 - introduction of modern family planning services throughout Nigeria. (e) Efficiency of Service Delivery. The quality of the health service delivery system needs to be improved to enhance the cost-effectiveness of Nigeric's health services. The state mi.,istries are, therefore, making effort to develop technical supervision, regular in-service training, and evaluation systems. The efficiency of the health service would also be improved by better logistics, including transport, which is a constraint particularly in the southern states. The Bank's Rcle 34. The Bank's assistance to the health sector in Nigeria began with the financing of a health component in an urban project. A dispensary construction component was included under the First Urban Project in Bauchi State (Loan 1767-UNI) and subsequently a health education/hygiene promotion component was included in the Water Supply and Sanitation Project in Anambra State (Loan 2036-UNI). The implementation of these components is proceeding fairly satisfactorily. In addition, the Bank has also studied government policies, performance, and issues in the population, health, and nutrition sectors as part of the Basic Economic Mission in 1979-80 (No. 3341-UNI). 35. The proposed project, which would be the first Bank-financed health project in Nigeria, originated with a request from the Sokoto State Government in 1978 to include a health component in the agricultural development project being prepared at that time. Folloving the decision to upgrade the health component into a freestanding health project, the Federal Government and the Bank agreed that this project would also provide technical assistance to FMOH to strengthen its planning and program evaluation capability. Sokoto State was selected as the Bank's entry point in the health sector because of the state's poor health sta is and its shortage of trained personnel and health infrastructure, as well as its long experience with pilot health projects and the interest shown in preparing a health component under the agricuiltural project. 36. As a complement to the Bank's involvement in the health sector, progress has been made in the Bank's dialogue with the Federal Military Government on population issues. Nigeria does not yet have an explicit poptlation policy with demographic objectives. Furthermore, until very recently, the Federal Government was not receptive to discussing population and family planning issues because of their political and cultural sensitivity. However, there has been a growing awareness in recent years among senior government officials of the impact of rapid population growth on future economic development and on public sector financing requirements. For instance, making its fi-:st public commitment to population policy, the Government announced during a recent WDR seminar that it would "develop a well-articulated population policy" to improve the health of mothers and children. The Government also recognized the effects of rapid population growth on the general quality of life causing strain on health, food production, education and all other social services. Consequently, during - 14 - population reconnaissance missions to Nigeria in November/December 1984, wide-ranging discussions were held with the National Population Commission and the Federal Ministry of Health. Based on these discussions, we proposed to the Government the possibility of Bank support for the population sector. Possible areas for Bank assistance include strengthening the population planning capacity of the existing federal agencies, developing the demographic data collection, processing and monitoring capacity of the Federal Government, and providing central support to national efforts to promote and support delivery of family planning services by both the private and public sectors. Further support of family planning activities is also envisaged as part of future state-level population and health projects. PART IV - THE IROJECT 37. The project was prepared by the Sokoto State Government (SSG) assisted by consultants. It was appraised in November 1982 and negotiations were held in Washington in November 1983. The project was not presented to the Board sooner because the new Military Government's overall review of its external borrowing program had only been completed in October 1984. A Staff Appraisal Report (No. 4599-UNI) is being circulated separately. Supplementary project data are provided in Annex III. Project Area 38. The project area is located in Nigeria's northern savannah zone and covers the total area of Sokoto State. The 1983 population of Sokoto State is officially estimated at about 7.8 million, and is estimated to be growing at 3.0 percent per annum. The project area is predominantly rural and agricultural. The disease pattern is similar to that of the country as a whole. Measles is the leading reported cause of death, followed by pneumonia, tuberculosis, and tetanus, reflecting the inability of the State to cope with the situation. The problems in the health sector in Sokoto State are similar to the problems at the national level discussed above-insufficient access to primary health facilities; limited capacity to deliver MCH services, including family planning and immunizations; low quality of care due to weak technical supervision and in-service training systems; and gaps in the institutional framework for directing and coordinating state and LGA health programs. Project Objectives 39. The health project is the first effort by a state government to implement the new PHC policies and to address priority issues in a manner that is adapted to local needs and consistent with local resource availability. It has two major parts with distinct objectives. 40. First, under Part A, the project aims to support SSG's efforts to reduce mortality and morbidity due to preventable and infectious diseases, by focussing on the first level of health care provided through the dispensary system of the LGAs in Sokoto State. In particular, i- aims to - 15 - increase accass to and improve the quality of PHC by supporting: (a) an expansion of the health network; (b) the strengthening of MCH service delivery, including faw'ty planning; (c) the expansion of the simunization program; and (d) the development of regular technical supervision and in-service trainir.- programs. In addition, through the establishment of a zonal management system, the project would support the development of institutional mechanisms for the Sokoto State Ministry of Realth (SMOH) to provide LGAs with technical support and to better coordinate public sector health activities. 41. Second, under Part B, the project aims to strengthen FMOH's technical advisory capacity for sector planning and programming and develop a capability for the p;-eparation, evaluation, and replication of state health programs, including the Sokoto health project. Project Description 42. The project would consist of: Part A. Sokoto State Activities Ca) Primary Health Services Development The project would provide for the construction of about 60 new health clinics in unserved rural areas. Each clinic would be fully equipped and staffed and would serve between 8,000 - 15,000 people. The project would also help introduce regular MCH and family planning services at the dispensary level by providing for the construction, equipment, and staffing of MCH annexes to upgrade about 120 existing dispensaries to health clinic standards. The health clinics and upgraded dispensaries would provide key preventive and basic curative services, both in clinics and through community meeting and house visits, while the more serious cases would be referred to health centers and hospitals. Training of 300 female health staff for MCH and family plannlng services would be provided under the project. (b) Expanded Immunization Program To increase immunization coverage, the project would establish static vaccination delivery points in about 240 health factlities, strengthen the four existing mobile units to service remote populations, provide vaccines and the requisite equipment, and strengthen the management and supervision of immunization activities. The existing staff would receive additional training in vaccinating procedures. To ensure the ready availability of potent vaccines, a cold chain would be established at state stores, to be located at headquarters of the Project Management Unit (PMU) and four zonal health offices, to be established under the proiect (para. 4.2(d). About six man-months of technical assistance would be provided to help organize and strengthen the administration of the cold chain operations. To help implement the immunization program, a zonal immunization unit would be established in each of the four zona' health offices with responsibility for overall planning, monitorirg, and technical supervision in their respective zones. The immunization units at -I A, headquarters and each zonal health office would be provided with equipment, vehicles and funds for training, incremental salaries, and operating expenses. (c) Training and Supervision (i) In view of the socio-cultural need to have female staff for delivering MCH and family planning services, the project would reimburse the LGAs for the cost of pre-service training at about 250 female community health aides and 50 health assistants to help staff project facilities. After completion of training, these female workers would be expected to provide MCH care and immunization, and advise mothers on family planning, breast feeding, health education and nutiition. The project would also support SSG's ongoing program to improve the capability of traditional birth attendants by training about 600 and providing refresher training for about 1050 attendants. (ii) The project would establish a training resource center at PMU headquarters and four zonal training units at the zonal health offices. The center would design and organize the in-service training system, train the trainers and supervisors, prepare and produce training materials, and evaluate the training activities. The four zonal units, with guidance and support from the center, would provide quarterly in-service training for all LGA health workers, develop and produce health, family planning, and nutrition education materials aimed at government officials, village leaders, and the general public, and train SMOH staff in equipment and vehicle maintenance. The training facilities would be provided with equipment and funds for irncremental salaries and operating expenses. (iii) To reoriert and strengthen the LGA health supervision system, existing LGA supervisors would receive training in management and supervision methodologies and various :echnical topics. An additional 60 LGA sipervisors, to be recruited from existing rural health superintendents and community health assistants, would be formally trained as health supervisors at one of Nigeria's medical schools. Also, about 18 man-months of short-term consultancy services would be provided for the preparation of detailed training and supervision materials and for program evaluation. (d) Institutional Support, Monitoring and Evaluation To strengthen SMOH's management, coordination and project implementation capacity, the project would establish a PMU within SUiOR (Section 2.01 (c) of the Project Agreement) and introduce a zonal - 17 - management system. It was agreed during negotiations that four conal health offices (ZHos) would be established and fully staffed by May 31, 1986 (Section 2.01 (d) of the Project Agreement. They would operate with the support of the PMU. The project would provide for the construction, furnishing, and equipping of PMU headquarters and zonal offices, staff housing, vehicles, and funds for incremental salaries awed operating expenses. To evaluate project progress and impact and to provide adequate data for health planning, a state-level monitoring and evaluation capibility would be establisohed within PMU which could form the basis for a statewide management information system for the health sector. Specifically, the project will provide about 24 man-months of consulting services, incremental salaries, and funds to carry out sample surveys. Sample surveys will be undertaken to determine, inter alia, actual vaccination coverage, change in prevalence of tracer diseases such as neonatal tetanus, and validation of data obtained from routine reporting. Part B. Federal Support Activities 43. To strengthen the presently limited capacity of FMOH to support the states in health sector planning and programming and in developing and implementing PHC programs, the project would enhance the program planning and evaluation capacity of FMOH by providing about 120 man-months for long-term advisors (consultancy) services, about 60 man-months of short-term consultancy services, and six overseas fellowships. The long-term advisors would include a health planner, a health economist, and a statistician; the short-term advisors would be sought for project evaluation, logistical systems, health manpower planning, and PHC implementation. To support and institutionalize the knowledge and experience, FMOR would assign staff to work closely with the advisors. The project would also provide for vehicles, office equipment, and workshops as well as funds to help states prepare future health projects and to develop an institutional capacity within FMOH which would provide technical and financial assistance for projects meeting federal guidelines. Among the first tasks of the long-term advisors would be the preparation of a study on health financing and possibilities for increased cost recovery in the health system, to be completed by May 31, 1987 (Section 3.03 (b) of the Loan Agreement). Project Implementation 44. Part A of the project would be implemented by SMOH and Part B by FMOH. The administration and implementatior of each Part would be the separate responsibility of the respective agencies. The project has been designed so that the FMOH activities (Part B) would complement and help replicate the experience gained under Part A of the project, thereby strengthening institutional linkages in the health sector. 45. While SMOH would have overall responsibility for implementation of Part A of the project, operation of the project health facilities would be carried out by the LGAs under the supervision of the Sokoto State Ministry of Local Government. To ensure proper coordination between these agencies and to establish an effective mechanism for policy guidance and implementation, SSG would establish and thereafter maintain a Project - 18 - Executive Committee (PEC) (Section 2.01 (b) of the Project Agreement). The PEC would be chaired by the Commissioner of Health and would include as members the Permanent Secretaries of the Ministries oi Health, Economic Planning, Finance, and Local Government, the project managers of the Sokoto health and agricultural development projects, as well as four representatives of the LGAs. The PEC would: (a) determine operational 6 policies; (b) coordinate relevant activities between entities 'nvolved; (c) review project implementation and approve annual action plans and budgets; (d) approve contracts exceeding 1100,000; and (e) appoint senior project staff. The PEC would be empowered to form technical sub-committees as required, including a sub-committee on staff recruitment and deployment. 46. As mentioned in paragraph 42(d), the project would be managed by the PMU working through four ZHOs to be established and functionally integrated into SMOR's structure. Each ZHO would serve about 4-5 LGAs and be responsible for: (a) the coordination of all health activities of the LGAs under its jurisdiction; (b) the development and implementation of ar. in-service training program and a technical supervision systeu for LGA health facilities; and (c) the implementation and technical supervision of immunization activities. As in other parts of Nigeria, senior and middle-level staff with experience in managing development programs are in short supply in Sokoto State. The project has, therefore, been designed to limit recruitment of new management staff to 13 positions. Five of these: the project manager, the financial controller, the chief architect, the immunization coordinator, and the training coordinator would be internationally recruited and funded under the project. The appointment of the project manager, deputy project manager, and financial controller of the PMU would be a condition of loan effectiveness (Section 6.01(d) of the Loan Agreement). 47. By the end of the project, PMU's technical capacity would have been strengthened, and a pattern of coordinated operations established. The PEC, the PMU, except for the training center, and the four ZHOs are expected to form the nucleus of a proposed Rural Health Services Management Board to manage the LGA health facilities not covered by the existing Health Services Management Board. It is also anticipated that by project completion the senior Nigerian staff of the PMU would have acquired sufficient on-the-job training and experience to take over from the internatioral staff provided under the project. 48. The Permanent Secretary of FMOH would have overall responsibility for implementing Part B of the project, including recruiting the long-term advisors and selecting the recipients of the overseas fellowships. To attract qualified candidates and facilitate recruitment of these advisors, UNDP has agreed to act as the administrative agent and service the contracts under prevailing arrangements that include the provision of housing and purchase of equipment and vehicles for the staff advisors. Responsibility for the technical supervision of these advisors would remain with FMOH. - 19 - Project Cost 49. Total couts fur the project are estimated at US$53.0 miLlion (including taxes and duties of US$1.6 million) of which the foreign exchange component would amount to TTS$?0.7 million or 39 percenrlt. Cost include US$10.8 million in incremer.tal optrating costs that would be incurred by SSG and the LGAs over the project period. Project costs are based on December 1983 prices. A breakdown of costs by major categories is given in the Loan and Project Summary. Physical contingencies have been estimated at 10 percent for civil works. Price contingencies for foreign costs are estimated at 3.5 percent ir. 1984, 8.0 pe:cent in 1985, and 9 percent thereafter; and for local costs at 22 percent in 1984 and 14 percent thereafter. Project Financing 50. The proposed loan of US$34.0 million would finance about 66 percent of total project cost, net of taxes and duties. It would cover the full foreign exchange cost and 41 percent of the local cost of the project. Of the total, US$31.0 million would be onlent to Sokoto State on the same terms as the Bank loan and the execution of a subsidiary loan agreement between Borrower and SSG would be a condition of loan effectiveness (Section 6.01(a) ef the Loan Agreement). The Borrower and SSG would share the foreign exchange risk on a pro rata basis. Of the rempining project costs (net of taxes and duties), the FMG would finance US$10.9 million or 21 percent, SSG US$i2.8 million or 6 percent, and the LGAs US$3.7 million or 7 percent. Bank financing for the incremental recurrent costs has been calculated on the basis of a declining proportion of these costs. The federal share in financing Part A of the project would be made in the form of grants to the project account. The LGA share would be contributed in the form of meeting the incremental recurrent expenditures to operate project health facilities. No cofinancing was sought for this project. Because this is the first Bank-assisted project in Nigeria's health sector the Gwvernment and the Bank wished to keep the financing, procurement and sui-e,vision of the project simple and the scope of the project small. 51. To ensure the timely and adequate provision of funding,. assurances were obtained during negotiations that: (a) as a condition of loan effectiveness, SSG would open a project account with a commercial bank for Part A of the project into which the FMG and the SSG would each pay their initial contributions 01300,000 for the FMG and W100,000 for the SSG) (Section 6.01(b) of the Loan Agreement); and that subsequent contributions would be made quarterly and in advance, in accordarce with the approved annual budgets (Section 3.02(b) of the Loan Agreement, Section 2.02(c) of the Project Agreement; (b) in the event the project does not receive timely funding from the SSG, the FMG would pay directly to the project's commercial bank account that part of the State's statutory allocation corresponding to its agreed financial contribution for the project (Section 2.09 of the Project Agreement); (c) as a further condition if loan effectiveness, PMU would establish overdraft facilities of N0.5 million guaranteed by SSG (equivalent to about three month's expenditure) (Section 6.01(c) of the Loan Agreement); (d) SSG would open and thereafter maintain a Special Account (Section 2.02(a) of the Project Agreement) and the Bank - 20 - would provide advances into this Special Account equivalent to about three months' anticipated disbursements, but not exceeding US$1.0 million equivalent; and (e) the Bank may refrain from making deposits into the Special Account upon failure of the FMG and SSG to pay their contributions into the project account (Schedule 4 para. 3 of the Loan Agreement). The FMG would also establish and maintain with adequate funds a project account with the Central Bank of Nigeria for Part B of the project (Section 3.02(a) of the Loan Agreement). 52. The very high costs of implementing the pilot BHSS programs and the prospects of continued pressure on Nigeria's financial resource required careful consideration of the affordability of the project, both in terms of its capital and incremental operating cost. This is also a condition of its replicability elsewhere in Nigeria. As a consequence, construction equipment standards were closely scrutinized for possible cost savings, taking into account the conditions under which the health facilities will be operating. The base costs of constructing and equipping a primary health clinic are estimated at N45,000, a 75 percent reduction over the cost of establishing an equivalent BHSS clinic. Furthermore, the decision to upgrade dispensaries instead of constructing new clinics has resulted in significant savings, making the project less expensive and more affordable to SSG than the BHSS program. 53. The financial requirements of the proposed investment program on SSG are modest and affordable: they average NO.75 million per annum (about US$0.15 per capita), or about 9 percent of SMOH's capital expenditures in 1982. The recurrent cost implications of operating the project facilities and services are also modest. By Year 6, when the project will have been completed, total incremental operating costs are estimated at N1.8 million per annum (in 1983 prices) of which NO.7 million will be borne by the LGAs for the operation of the health clinics, and N1.1 million by SSG. The incremental recurrent cost burden for the LGAs corresponds to about 9 percent of their health expenditures in 1982. The incremental recurrent cost burden to SSG corresponds to about 6 percent of the 1982 state level recurrent expenditures on health. These increases in recurrent budgetary expenditures are reasonable, even under conservative projections of Nigeria's likely resource availability. Procurement 54. All civil works (totalling about US$16.2 million) for the proposed project are small and widely scattered and would be completed over a period of time. While the threshold for the international competitive bidding for civil works contracts is US$2 million, the average value of the civil works contracts would be about US$400,000, and only one would exceed US$1.0 million. Therefore, all civil works contracts for the proposed project would be let on the basis of local competitive bidding (LCB) in accordance with local procurement procedures acceptable to the Bank. Contracts for the supply of equipment, vaccines, contraceptives, and vehicles, for US$300,000 or more, would be procured through ICB in accordance with Bank guidelines. LCB, in accordance with procedures acceptable to the Bank, would be employed for equipment contracts estimated to cost US$60,000 or more but less than US$300,000. Local competitive - 21 - shopping would be employed for contracts of less than US$60,000. Items for procurement would be bulked to permit optimum use of competitive bidding. Domestically manufactured goods procured under ICB would be allowed a 15 percent preference or the applicable import duty, whichever is lower, for purposes of bid evaluation. The aggregate cost of these items is estimated at about US$2.0 million. The services of internationally recruited staff and consultants (about 35 man-years of long-term and 9 man-years of short-term technical assistance) would be obtained on terms and cona:tions satisfactory to the Bank. Type of Procurement (in US$ millions) Type of Procurement Total Cost including Project Element ICB LCB Other N.A. Contingencies Land Acquisition - - - 0.1 0.1 Civil Works - 22.2 - - 22.2 (18.9) - - (18.9) Vaccines, Vehicles, and Equipment 2.0 2.8 0.3 - 5.1 (2.0) (2.4) (0.2) - (4.6) Advisorv Services and - - - 3.8 3.8 Fellowships - - - (3.8) (3.8) Studies, Training - - - 21.8 21.8 and Recurrent Costs - (6.7) (6.7) Total 2.0 25.0 0.3 25.7 53.0 (2.0) (21.3) (0.2) (10.5) (34.0) Note: Figures in parentheses are the respective amounts that would be financed by the Bane loan. Disbursements 55. The proposed loan would be disbursed as follows: 90 percent of total expenditures for civil works; 100 percent of foreign expenditures, and 85 percent of local expenditures for equipment, vehicles and vaccines; 100 percent of total expenditures for salaries and allowances of international recruited staff, consultant services, and overseas training; and 60 percent of local expenditures for local training, incremental local staff salaries, and operating costs of PMU and the zonal health offices. Disbursements would be made against full documentation, except for local training, incremental local staff salaries, operating costs and contacts of less then $100,000 equivalent, in which case - 22 - disbursements would be made against certified statements of expenditures. The loan would provide for retroactive financing up to US$0.2 million to help cover eligible expenditures incurred after December 31, 1984 to facilitate start-up activities, such as the recruitment and posting of key expatriate project staff. Justification and Risks 56. The proposed project directly addresses two of the most pressing problems facing the health authorities in Nigeria: (a) the develapment of an affordable, widely accessible, and efficient system to deliver the basic health services that could accelerate improvement in the health status of the population; and (b) the development of FMOR's role in promoting and coordinating the preparation, evaluation, and replication of state health programs. 57. Part A would provide direct benefits to three distinct population groups. First, the expansion of the health network would provide reasonable access to modern health services for the first time to an estimated population of about 700,000 rural inhabitants and raise population coverage of the health system from about 65 to 80 percent of the total rural population. Second, through improved MCH services and through training and deployment of some 300 female health workers and 600 traditional birth attendants, about 450,000 mothers and children under 5 would benefit from basic MCH, family planning, and community health serJices. Third, the expansion of the immunization program would protect about 50 percent of children in Sokoto State against childhood diseases. Since death of children below 5 years of age account for about 50 percent of all death, project impact on infant and child mortality is expected to be substantial. 58. Strengthening the supervision and in-service training progrrAms under Part A is expected to generate significant benefits through improved quality and increase efficiency of care delivered at all primary level facilities. One of the more important institutional features of the project is the introductiv. of a zonal management system which would provide an institutisnal linkage between the SMOH and the LGAs and would strengthen the LGAs' capacity to manage their health programs. Under Part B, the technical assistance would strengthen FMOH's institutional capability in the areas of health sector planning and programming and would help accelerate the development of PHC programs. The experience gained under this project would also be of major benefit in preparing projects of a s-imilar nature for the other states in Nigeria. 59. Timely project implementation could be affected by funding and staffing constraints. Insufficient counterpart funding has affected a number of ongoing projects receiving Bank support, including the Sokoto Agricultural Development Project. The problem stems in part from inadequate financial management on the part of the state governments, and has been exacerbated by the drop in Nigeria's oil revenues. This problem and possible measures to limit its impact in the future have been discussed with the Federal and State governments, and corrective measures have been and are being taken (para. 20). As a result, the funding of the Sokoto - 23 - Agricultural Development Prodect has improved in recent months. Nevertheless, to mini-mie this risk, the proposed Sokoto Health Project has been reviewed and scaled down with the objective of cost-minimization, and the financial requirements of the project on SSG and the state's LGAs are considered affordable. The requirements have also been discussed in detail with and accepted by the responsible state ministries. 60. The attainment of some of the MCK objectives could also be constrained by a shortage of qualified female health warkers. The Sokoto health authorities are conscious of the risk and are taking measures to encourage enrollment of female students in existing medical training facilities and to retrain all present female health workers tc BESS standards. The financial support provided by the project for training female vorkers is aimed at reducing this risk. PART V - LEGAL INSTRUMENTS 61. The draft Loau Agreement between the Federal Republic of Nigeria and the Bank. the draft Project Agreement betwecn the Bank and Sokoto State of Nigeria, and the report of the Committee provided for in Article III, Section 4(iii) of the Articles of Agreement are being distributed to the Executive Directors separately. 62. Special conditions of the project are listed in Section III of Annex III. These include the following conditions of loan effectiveness (Section. 6.01 of the Loan Agreement): (a) execution of a Subsidiary Loan Agreement between the Borrower and Sokoto State; (b) appointment by Sokoto State Government of a Proiect Manager, a Deputy Project Manager, and a Financial Controller for the EMU; and (c) opening by Sokoto State of a commercial bank account for PML, and establishment of an overdraft facility for PMU guaranteed by Sokoto State Government. 63. I am satisfied that the proposed loan would comply with the Articles of Agreement of the Bank. PART VI - RECOMMENDATIONS 64. I recommend that the Executive Directors approve the proposed loan. A.W. Clausen President Attachments February 21, 1985 Washington, D.C. - 24- AM I Page 1 of 5 NIGERIA - SOCIAL NrDCATOI M NIGI FUCC CR0015 (UEIG n lZUAS1) /s Nosr (MOST micEtr ETUIAE) /b z,~aL m: RS& LDa DECE MItlE 111 1960& 1970L ES= Lb AFRICA S. OF SARUM 3L AFRICA G MID UlST AIEA CThIOSAN SIQ. RR) TOTAL 923.8 9Z3.8 923.8 AQRICULTURAL 471.0 4.97. 513.1 Cw Ha CAPt (1$) 200.0 330.0 860.0 11129 1149.6 HUeS CO3WEI0E PM CAPi (KILOGRAMS OF OrL EQUIvALENT) 20.0 35.0 143.0 5D9.0 622.1 PoPLATIO AmI VIL STATIsIS POPMATION.NID-IEAR (TOOAJS) 515980 6618.0 90572.0 URBAN POPULATION ( OF TOTAL) 13.1 16.4 21.4 29.7 as.2 POPULATION PROJECTIONS POPULATION iN TA 200o CL) 169.3 STATIONARY POPULATION (HILL) 617.7 POPULATION NMOENT 2.0 POPMATION DESSr PER SQ. KM. 55.9 71.6 94.8 55.8 36.3 PER SQ. 1!. ARXL LAN 109.6 133.0 170.7 111.5 461.7 POPULATI AGE STRCTURE (Z) 0-15 IRS 65.4 46.6 47.8 45.4 43.6 15-64 IRS 52.3 51.0 49.6 51.7 53.1 65 AND ABOVE L.3 2.4 2.4 2.9 3.3 POPULATION CROI RATE (2) TOTAL 2.4 2.5 2.6 Z.8 L8 URUS 4.7 4.7 4.9 5.2 4.5 CRUDE BIRTH RATE (PEt TSI) 52.0 50.7 49.5 47.0 40.4 CRUDE DEATH RATE (PER 05) 25.3 20.8 16.2 15.2 11.5 GROSS REPROUCtION RATE 3.4 3.4 3.4 3.2 2.8 FAMILY PIAMNING ACCEPTORS. ANAL (TR00S) .. 7.6 USERS (: OF KARRIED O .. .. 6.0 ._ 22.2 PUOD AMD NUDEITUE INDEX OF FOOD PRDF. PER CAPITA (1969-71-.O1) 100.0 102.0 92.0 91.6 97.3 PER CAPrIA SUPPLY OF CALORIES t- OF REQUIREMENTS) 83.0 84.0 91.0 98.2 110.8 PROTEINS (CRAMS PER DY) 45.0 45.0 49.0 56.7 70.1 OF WHICH AND(AL AND PULSE 10.0 11.0 11.0 /C 17.0 17.8 CHILD (ACES 1-4) DATH RAI 50.0 34.0 20.0 18.7 14.6 LIFE EXPECT. AT BIRT (YEAPS) 38.7 43.7 49.6 51.7 57.5 DFASr NTMRT. RATE (PER THS) 190.0 154.0 109.0 102.7 101.5 ACCESS TO SAFE WJATER (CPOP) TOTAL .. .. . 35.6 59.7 URAN .. .. 54.1 84.5 RURAL .. .. .. 27.3 38.4 ACCESS TO EXCRETA DISPOSAL (C OF POPULATION) TOTAL . -' URBAN .. . RURAL .. - POPULATION DER PHYSICIAN 73710.0 24670.0 12550.0 Id 11948.3 4345.1 POP. PER NURSING PERSON 4040.0 /I 5070.0 3010.0 rd 2248.9 1831.1 POP. PER HOSPITAL BED TOTAL 3020.0 If z220.0 1180.0 Id 986.9 632.9 U3RBAN 430.0 ," 490.0 30 368.7 545.5 RURAL 25630.0 I. 18490.0 5&90.0 £012.1 2513.5 AD1IISSIOS PER HOSPAL RED .. .. . .. 26.2 ;siR AVERAGE SIZE OF DUSEHOL TOTAL .. -- URBAN .. *.7/h RURAL --.- AVERAGE N0. OF PERSONSIROCK TOTAL .. .. URBA 3.0 2.2 /h RURAL .. .. ACCESS To ELEcr. (2 oF DwELLS) TOAL .. .. 4. .. 46.2 URBaN 81.3 42.4 lh 77.7 RURAL .. .. ,, ,, 16.1 AN1M I - 25. - Page 2 o5 SIGCMUA -SOCIAL IlBCAS DATA SIIRfT SlCGRWA R1FRECZ GOIIPS (WGUIIZD AVERAGES) la 205?r (os rKT ESTME) /b RECENT DE DCIE 3DLZ D N960!_t 197QL AFRtICA S. oF sAHARA S. AFRICA 6MD EASr ADJUSTED ESRMLfST RATOS PRZMM: TOTAL 36.0 37.0 98.0 AL 91.0 88.3 !IAr.* 46.0 47.0 . 90.5 102.5 FrLuLE 27.0 2;.0 .. 73.6 73.6 IL SECOSDaRY` ToTAL 4*0 4.0 16.0 IL 17.4 43.0 HALE 6.0 6.0 . 23.7 52.3 FmIALE 1.0 3.0 .. 14.8 33.0 VOCATIONAL C: OF SECOSMUY) 4.8 8.5 3.1 /.j 5.3 10-3 PPIL-TEAC9EX R=AO 'aRIAR 30.0 34.0 .. 38.6 30.3 SECOsDAr 19.0 21.0 ,, 24.3 23-1 ADULT LITIRAC! RATE CZ) 15.4 a .. 34.0 35.6 43.5 ainTJ~E PASSESR CARS/TBOUSAND POP 0.6 0.9 1.4 /I 20.7 17.8 RAWI RECEIVERS/7S0gSASD POP 2.8 19.3 66.1 100.8 138.8 TV UEEvERS/TEUSAND POP 0.0 1.1 5.3 18.5 6.1 BEDSPAPEA C-DALY GERsAL INTEST-) CIRCLATION PER MUSASD POUUXION 5.5 4.8 6.9 A 17.2 31.2 Cl5EA ASSAL ATDAc CAPITA . .. 0.0 f 0.3 1.7 TOTAL LABO0 PORCE (TEOUS) 22788.0 25992.C 32478.0 F;iZE (pRICEs?) 41.3 40.6 39.7 33.8 10.8 AGRICCLT (PERCENS) 71.0 62.0 54.0 57.1 42.4 INUST (PEET) 10.0 14.0 19.0 17.4 27.9 PARTICIPASIOS RATE (PERCENS) ,VTAL 42.2 39.3 35.9 36.3 26.2 HALe 50.3 47.3 43-7 47.6 46.6 FEMALE 34.4 31.5 28.2 25.1 5.8 ECM0EC DEPXEECY RATIO 1.1 1.2 1.4 1.4 1.8 ZlOU DXSTEUJuTI PERCT OF PRITVA ISC! RECErVED 81 EXdEMST 5Z OF lUSED.DS .. .. RIGr ZO 0F OS S .. ..H..S..O. L-WST 2 OF OC.SE.O..S L06ES 605 OFr ROGSD LS ,. .. POV=r B ROM ESTIMATED ABSOLSTE POVEll IUCM LEVEL (rSS PE1 CAPITA) LRIMAS . . 696.0 525.3 274.8 AL.. 341.0 249.0 177.2 ESTINATED RELATIVE POVERTT IRCMM LEEL CUS$ PEA CoAI) EiS 621.0 477.4 402.6 RMRAL 207-0 196.0 284.9 ESTMATEZD POP. DLF ABSOLUT XE POVERTY ISCO LEVEL (2) Ellr .. .. . .. _ RL .. .. ...... Sgl AVAILABLE NOT APPLICABLE SOT ES A Min gr*uP Avarages for each indicator are population- eghted aritbdc mans. Coverage of couutr?ar amng the ndIcAtor. den7enC an Sealcb±lity od data and to not unlfrn. /b Cnler othoerise noted. 'Dta for 1960' refer to ra yar between 1959 sad 1961. Data for 1970r betwen 1969 and 1971; and data for -Ioet Pacent etlsate" between O980 end 1932. /c 1977; Id 1979; la 1962; It Including ex-Vort Cameroon under Britih 2ta 176; Ih 1972; /I 1979; .a Ceria fields of *tufr proviouIy cleeified under other eacosd Ise oe duchi octoel or tiCEae nature "r now reported under gnral educatlon. JM. 1934 -PS"3134 a. - ft. - an..4" ean-ee.af a- mnin ft S.. 5 3*at ~ 303 "53 231 3 in 3-1 33.24_1 Ase 133-313 a.3 --ij.j.434 -u.a0.as p1. a. -wa -- e.dTinj aw 0.3331 32W Am ft - 5.55303 333 l333 leas3 -ft 3 30335.3 PI-RiP3s 33ee seet J. "3333333 W.in - 933.333 33'3 33 as cal d- - P333 ..~ f -- 53 534. -3 3:3 13143534.3 3)333 . J- -111--en - "itee At..=3 -323 ves431343p33-33 aM -a 3532 3 - 3 W _1.Tss..cs--j anaana eal 3.3ant333in05 " 132Sm -I..5 - 333 331 -.3 . T13 M - J. 4) -ft3 .5.15,-3 31~~~~51 j- = -01. -6 -n 3-za._a333333- hl0£ e4 -3 SsI3. 5*. tI-Z -A as --n--- - ~ -a - - T'taf lti - *)*33 *:*iv n 31 -am ,-. .i 33.t *3t33 - - la- - ,a) 333133~ a3J3d- =33 bIbe, -oa 53 33- 33 I3 30333 -11a3) e 33m -at e Best3 rigi 3333 - 3.3.335 13~3 -33 I"a- 3 -3333 -----. 1- a33£4*) 335d33 es 3ll3 n3. -.3. .sl.a-Il a. -- ,a-~1s I a.aa. I"- 3 !.3*l I3.. M W ~ inI33. 33 3-.-dasaaa 16£4*321. i £5*SI T33 533ai3a *3343 0 53 a 3333 31 £333334 33,- ftWImass333 fl eeet 350 3333 -J elb33 -Beai als 43 30 - in 3. -(331- .33 335 23 3-353 3a335313, 33-333 f in A - - - 1-33 -4 5in30 ate D33 33*` , J 3. -"- 213 - .3 .in3. p~a~3 :w.a-e .31 3-a. ...3.* '35333533 sat - 35.3 1.t0.5 53 - 3-333J 35533 33ov*3tan .3*5 intIa 1 M33 c e-i 1-i ml * .3 -ft.i., n a. 34 Ij 33.a - 33W - 03 33 l.3.3aa 333 3 i-u- a. 32 It i~~n-T v-~333 13t-a a- d - a P- -919-st P.3130. -13, 5 -t.a 323 3 3,5333 n.3 223 -a -a3 a. 333334. 333333333 33333 3!a..a.3 3.ft ~ 33-5 33 333- S ni1hna a- Sa P *se au An sttst -i el3. £ 333*- pnai P- -333 n *l, 3an 33333 ~ pk..a .35333 33et Tsal-5 -M5- eellp - 3-a .1.33 v. .... .3 .3 33-a-3 ~in 33.330 3133Sa. .33, - 3a- 5-..a-s. £3-3. a-a. 33l .W1133 -tweet 314 *q. a.3a.- P. " 33 lnIaraa£ - *ia -in *. ..... - -J 333333 3333 .a3333aad 003 -I,tea. I-...33 *.5-. ..... 3..~33 33 a3. a n ua.a 33 r333 33.. -ans.1 .~ an:-a. .s.3 -3 a......4- T.a.sa3j 3najo- d 3333,5 e-*1a sat-33a. S * n P-ePle- 3J 333-= I *.... a* *s -Ia- 'Ml.-ua-.~aa ... - . a... *.J3 .3 5.-38 a....ss3.. 3 33 sea- a-r 53 - la.3a3.3333 3,33*3a 33.5 - .1.5- et...1 -A54cg AI.e-fl33. ft a a. 333, aes-e esa ps.i :..s in....33!3J !3333333 3313:3as v;- as - ajn. 353a ;,33-I 33.S 3 35 .M3' 33533335 .a. *333 *3a3 3~3- 3 .1 in 3.33 .3330 a.- 35 .J. *a .153333 3 e"J !- .33 3 -53-3.r33 33 -% 3a ia135- a - x '30 Wn.f ninafl ** _T_:3- 3_3. _ft -n S , f-v. a . -PleC 3.- 33J 33- -e -33£333 a53 .31 1- 5333.433 - (33533130 ~S3a 03 351.333d53 .303333 ..-I3~ aCS O - 3353 Cla 3343 t *3£a3 a an - I a 33350..3 - .si a3 1ania ..-sPa a .39-M b V 3.33133-44 3355 .31.2333 '3.15323= in0.3 334 353333 1333nS 333- 33.3 *1.33~t-W6 5 30 3- W 3 .5 33in3 33 .33)33344- 5533 3-3*3) 3 4 023 a ~ 5~ 33 130 3-0. 053, 333 3.3 3343353 p33t333 .31*303 *J.*_- a3 ..T .A in'33 3- 33-I 133 iza~ _ ~ ft--9 -t-aw - 3-.-( 33333-3 13-3-3 53 3J..33- .-a P- n..a. -Uk -- .333.. -r23333 -13 !.3 .33 333 a - --. --s 353.. 3 T.3 £31in353 303 -.32 -.1.s. 335t33333.311" 3.)53333 ge.5 T"S3 553 £43aw -333" .- .343 - .3 333 3d3 -f**~-SaPes tsts333' *553- 333 ,. (33 3-.nS£.lea -, ---e 35 1s-e -33-I' 13l- 3iv333 3-33d)3 - 3333.J.3.'T-" 3S5 Sels - 5333333 533.333 3133.a 3533 5553..3*3 3 - 1-S AM33.353 33t 33-i *3.533 -all .33 a q 3 5.-3--3 total- v-93.3 33 3)),53. 3 3 3aai tams- 0-5 5353- -e3 33 33 3,33 an, 3_ 3 33)t-3 pl a3s- 133 3353 333531 aa 313 ..335 n a 333. p30. 332133 34¶31 a11333-.1.3353323 a-I s 43a 33 r-r-33 il a. -Ians.-. *23153 1--a333£ 333-S- 323 sn.333333-P-33- V- .3. AV a- 5333.s 1133 333a In- 1,3.33 - = AIL.3 .-£03 a_ ..", _: "% Iesel33 in333a 3 )033,-335330.3.2 in .33533a3 353=43- 3-a-3 0 3. -A3-saa3a3. OIsiA 5235= in5113331 in _ -3 i .0. a- 43 334i3 3.333 .a & 3-a -U31-333 - .s3 Se3 31- ft.- apSta- 3-3.. 4.- eel-a 3-13533,-(.3 . 3)335310 3 33a3.in.33..5. 133-s- 333 23.3 ..33333l3 03333 - ft -do3- eaa-f --p "-es elesev- $.N%lee 20. "Pins 0a.5 e-0 II&3a.3 - Z *M- -J331 --J 3 )!3 - 33USt 33~30.31. a. ist- -aa3, ~13)33-A - -a.CZ 3 - F-..s. 4 -a. I as --B in1 &a3 3353l 3333333333 a._.3 533-15-Mir34 *3 .'3as3' 3 -333333-~ 3P- e-a. 3-3.1 -l lA323la al. 43333- inee 3-35in3 33 -3 33lS530 -M -3 533 333)£ ftg433-.3 131 533 t e3V %9 .33-3 r- 35533=3- 3 l-34 t.J.3 - 3-- asestee dna- in 51333-33 d33 le. .543 13)3 33a- vl M 33. 3*33p = f~aP"Alssaaeee- - - ll.1-3e- l*5a) 334333 0.33..4 .033333. W33334an 33.333 3.P 3.3 n i335 0so ]O 3313 2 3.a.3a 33 - 3a43 333 i3i53 33 r3 333 11 3 5 333333.-33133 33*a 2*33.p3533.P 33345334i 13 3 q133333 33 33533 3393n 3 i 0i Eai. - -27 MAIN I PaT-of 5 ICOIOmzC INDICATORS gl1053 NATIONAL PRODUCT to 1lea ANNUAL KATZ Or ONOVTU(5. CogInmt Ppigeg) .... ... _ ----- ........ . ............ . ,._ ,,,,_,,,_,,,,,_,_,_ ... VI NI... /i I 1975.30 911 /1 It" cuP at Market Prieto 10,106 100.0 3.1 -7.6 -4.1 * Gross Oememtle Invegtment 10l.15 16.0 1.3 7.6 .11.1 Gre$ nstisonal Saving 9.OTO 12.9 5.2 .11.6 -.1.0 Current AecoiRt anlon*e .7,341 .10.5 - mport. oaf Goeosf s 13 .31.6 -1. 1 Imps rt. or Geve,arsI 15.6 -T.1 .31.9 Or PUT. 1.633 VOICe AND PlROa'.rsvIT1 IN 1931 Ce*._. . ....... . Ue un s un I Vii s 4rieulture 1,6 71.8 19.6 *0.o Agriculture 1 "11ls 27,709 39.0 6.2 119 1,320 195.5 Services 6 Mining127,117 39.2 T.0 21.3 3.971 1.3.T Total/Awerse T71,020 100.0 31.3 100.0 2.16S 100.0 EINNuT rI"NcE Generel Goverent Central Goeernment CM KIn.) S of GOP (m lIn.) 5 of GOP 19 /1/ 1962 1 1979.31 /4 1981 1982 /if 1 9 lf; al st, Current Receipts 12.620 W6.1 29.5 7.320 15.3 21.3 Current Eupanditure 69.12 20.1 20.1 6,678 10.2 10.8 Corrant Surplus 3,008 6.3 9.4 2,52 5.1 10.5 Capital Expenditrer 9.547 20.0 13.0 6.2T0 13.1 12.9 External asststanceCuet) .. .. .. 264 0.6 0.6 NONE?. CRtDIT AID PRECES 19T6 19TT 1978 19T9 lgJO 1981 1982 i(Million d Outatsnding End Period) Nmner and Quasi Nones 5,83 7,313 T,521 9,369 14,390 15,239 16,694 Dank Credit to Public S-eztor(neti 551 2,309 3,1t3 3.313 3,539 6,299 10,328 lank Credit to Prtvate Sector 1,332 3,659 6,635 5,126 6,766 8.917 10,S67 APercentages or Index Numbers) Money * Ouasi Money ar * or GOP 21.6 26.7 22.2 24.3 30.9 32.3 3 .9 General Price Inue1(1975.100) 123.9 163.0 166.7 186.3 204.9 267.5 266.5 A"nal1 Percentage Changes in: General Price Inede 21.7 15.1 16.6 11.S 10.0 20.3 7.7 lank Credit to Pubivc Sector .. 319.1 36.1 5.6 6.1 7r.0 64.0 Dank Credit to Privete Sactor 3.38 65.2 29.7 14.3 31.6 32.2 18.5 Note: *ll conversions to dollars in this table are at the avarage sexange rate prevaling during period covered. /I/ levised astmsates. I2/ Offtclal estimtes. /a/ Provisional. /3/ The data is derived rrom plaelng documents and refers to the number of 'gglrnully employed. ..Not Available. April 1i, 1986. - 28 - ANNEX I Page 5 of 5 TRADE P81133Tn AND CAPITAL FLOWS SALAUCE OF PAYMENTS MERCHANDISE EXPORTS AEtCRACE 1981-1903) /#/ 1981 t/I 1982 t/Z 1983 /3/ USt Win. s (WIllioes US 8) boports of Goods f.o.b. 17,718 12.930 10,730 Crude Oil 13.421 96.7 of which:Petral0um 17.162 12.751 10,350 Cocoa Products 22S 1.6 Imports et Ceeds r.e.b. 15,390 16.838 12.251 Palo Products aS 0.6 Services A rncome -1.103 -3.060 -3,208 Tnn 2S 0.2 let Transfers -567 -373 -260 Other Commodities 127 0.9 Current sccount Delance -6.002 -7.31" -..992 Total 13.U32 100.0 EXTERNAL DUET. DECERtDE 31. 1983 /5/ Olrect Foreign nvest-mnt 165 358 365 Set Official NL? Borrowing 311 755 980 U05 ml. of which: AmortIzation _583 -477 1200 - - _ __ Public Debt. Inel. Undlabursoe 15.501 tther Capitel(Slort-Tera) 109 *96 -6.3 Ron-Cuaranted Prlvate Debt Net Errors A OaIsSIOns -1543 -689 0 Total Outatanding A Disbursed 1"756 Overall Balance -6200 -6118 -4290 lsnineIng 6200 61l *290 __7T SEIVICE RATO For 1933 t6t Reserve wovement3i1scr.-I 6.200 2.367 51i Arrears 0 *.0S1 3.770 s 2eserve Levels * 261 1.429 1.092 eser-re as Month or Imports 0o18 0.07 0-07 PublIc Debt. ecl. Guarant-ee 17.9 Mon-Guarantee Private Debt Imports 13,390 16.838 12.2S' of ublei: Food 3,15 2 7e6 1.87S Total Outatandlag * Disbursed 17-9 Consumer Goods *.612 4 141 3.259 Inter.edlte Goods * 682 1,342 3,13T Capital Good3 5,942 5S569 3.963 IBRD/IDA LERDING (Feb. 29.1984) (Clillons $S RATI OF EXCNRAGE islD ID& /7/ 1978: 11.00 z 0581.57 1979: R1.00 a 0581.66 Outstanding & Dlabursed 8t8.0 36.T 1910: 31.00 a US0813 Undlabursed 1,091.t - 1981: 31.00 z US0163 - - 1912: t1.00 z US01.9 OutStandIng lecl. Undlsbursed 1'939.1 ' 6.T 1983: 11.00 z tS8139 1?f Provisional. 12/ Official estimates. /3/ Staff etiustes. /4/ Official estimates ror 1961 and 1982. tsr Eacluding 15.9 billion short-term arrears. /6/ Ratio of IL? debt service to exports of goods and non-ractor services. /T7 As of February 1968. eot Available April 15. 1954 -29- .29 IN sITATUE at 3:x IoUP @oPsToU3 A. TTmSIIs 0TV C9OUt OPSS0 1 19 Sl NIGRUtA 1/ (a o p rO loa or U9J iliSeu Credit (l tlee cocellstoc) Twunty ci loa1a and two credits fully diebored 682.1 35.3 2/ 1191 197b Nigeria LC. state oil Pals 19.o 3.7 1454 1677 Nigeria Igric. Dev. Lafia 27.0 0.5 145 1977 igecia Agric. Dev. Ayaegba 33.0 0.2 1392 1973 Nieria NBc. got. a"llholder Oil 30.0 3.7 1597 1978 Nun Induetrial Deloe_nct 3.. 18.J 1887 1937 Xi4rtia Agrc. Dow. Nid 23.0 *.2 1lt8 1979 Nigri4a Agric. Dev. alermn 27.0 10.5 1l79 1379 3 Niria YJeatry 31.0 3.3 1711 1973 Nigeria Water lupply - Naduna 92.0 70.7 1719 1679 Nigfri AgrIc. a Rural vast. Smt. 9.0 3.7 17tt 1960 mrA power Logoc 100.0 85.9 17b7 1960 Nigeia Urban D velopment - Sw.ceb 17.6 10.3 1836 1930 Nigeria Agri. Doev. - Oyo-Nortb 21.0 21.9 164 1930 Nigeria Ag4ic. Dev. - Zhiti-Akoko 32.5 20.4 1U3 1630 iepria loads 7O.0 25.8 1931 19e1 Nigeria Agilc. Dev. - Daucbi 132.0 55.9 1932 1901 Ligeria Agric. Dov. - Kano 142.0 97.4 2029 19e1 Nigeria Tech. Assistanca-Agric. 47.0 31.3 2036 1932 Nigeria Water Supply - A!REbra 67.0 54.4 20W5 1982 NEA Power - Dlitribution 100.0 82.1 Z185 1982 Nlgeria Agric. Dev. - Sokoto 147.0 11i.& 2299 193 NIDS :nduutrmal Developent 120.0 11B.2 2345 1934 Nigeri frrtillser Import 250.0 159.8 2376 1934 NRIC Small 4 Ndium Scale Indusery 41.0 40.9 * 2390 1934 NMP Tech. A et. - Coe 2nginering 25.0 25.0 * 2436 1954 Nigeria Agric. Dew. - Kadun 122.0 122.0 Total 2.479.1 35.3 1175.9 Of which baa bean repaid 293.3 4.0 Total Outstcanding 2.135.8 3i.3 Amount sold 16.8 Of vbicb bas been repaid 16.8 0.0 Total nov held by Bank 4 IDA 2.185.o 31.5 Total undiebured 1.175.9 3. STAT-EMS o0 IFC LNvESTNTS (As of septmber 30. 1984) Fiscal Type of Aount in USS Million Tear Business Loan E Sotal 1964. 1967. Arews Textiles Ltd. Textile Ofg. 1.0 0.6 1.6 1970 1964 Nigeria Industrial Dev. Fin. Co. 1.4 1.4 Developmnt Sank Lrd. 1973 Funtua Cottonseed Vag. oil 1.6 1.6 Crushing Ltd. Crushing 1973 Nigerian Aluminiu AluSinium 1.0 0.3 1.3 Extr slon Lcd. Proceseing 1974 Litfige Sugar Sugar 0.1 0.1 Zotate 1980 NIH Textiles t.2 0.7 6.9 1981 ueJA llotel Tourim 10.2 1.5 11.7 1985 Timer Battery Dry-cell 4.7 - 6.7 atteries Total Grses ComeitmetC 26.7 6.8 29.3 Lace cancellations. terming- tcons, repaymnts and sales 5.9 1.6 7.5 .otal Co_itent now hbld by 7IC 11.8 3.0 21.8 Undiebureed 7.2 1.4 3.6 ' Not yet signod. f The statue of the projects listod In Pert A Is described in a separate report on all Sank/IDA finaned projects In exscution. which i1 updated twice yearly and circulated to the Zecutive tirectors on April 30 and October 31. 7/ Prior to exchange rate adjusccen. - 30 - ANNEX III SUPPLEMENTARY PROJECT DATA SHEET Sokoto Health Project Section I: Timetable of Key Events (a) Time taken by the country to prepare the project: 18 months (b) The agency which has prepared the project: Sokoto State Government (c) Date of first presentation to the rank: February 1980 (d) Date for first Bank mission to consider the project: April 1980 (e) Date of departure of appraisal mission: November 1982 (f) Date of completion of negotiations: November 1983 Cg) Date of Government's confirmation of intention to borrow: October 1984 Ch) Planned date of effectiveness: September 1985 Section II: Special Bank Implementation Actions None Section III: Special Conditions (a) Execution of a Subsidiary Loan Agreement between the Borrower and the Sokoto State Government (Condition of Effectiveness; para. 50). (b) Appointment of a project manager, a deputy project manager, and a financial controller for the PMU (Condition of Effectiveness; para. 46); (c) Opening by Sokoto State Government of a project account in a local commercial bank, and establishment of overdraft facilities for PMU, guaranteed by the State Government, equivalent to about three months' expenditure (Condition of Effectiveness; para. 51); (d) Establishment and staffing of four zonal health offices by May 31, 1986 (para. 42 (d); (e) Completion by the Federal Ministry of Health of a study on healtb financing and possibilities for increased cost-recovery by Mav 31, 1987 (para. 43); and (f) Authorization by Sokoto State Government that the Borrower would deduct and pay to the project Sokoto State's contribution directly from its statutory allocation in the event Sokoto State fails to pay (para. 51). 4-~~~~~~~~~~~~5 N IG E R .m ISA - WURN&~~~~~~' ~Sh 13' RGUNC, da 4 - I TALATA MAFARA do~~~~~~~~~~~~~~~~~~~~~~~~~~~s' 'BODINGA 12 @ vt a Gml I Ai . < 37\ ti rj -11- Zur "- ' @\ R , AN.Kfr- n ,au rv NIGER STA TE KADUd-- -: n~~~~~~~ zUr W A R A - E 40 80 KGLOt.l J sTr A Tr E .;-et,,Th.s raD has beer? £repared fry The I~b1 tiks f eS5WER A hK r D the raders and s aexcssvety for Me jemrna use of The WVVO Bank arKr Fiarce Coparakon The denonrmartons used and ihe bouri1anes 5'?-.En .Viity. on te Mr of The Wbork ank ard She hltematrn fic Capo on the leDga sgatus of arr ternory or an endorserne or accetarce Off , , _~~~~~~~~ IBRDp 17017R O ~~~~~~~~~~~~7- 8 N IGERIA SOKOTO HEALTH PROJECT Proposed: * Project Management Unit AN. > ^\Heodquarters GE AX 4p~~~~~~~ Zonal Offices ;c % e <2>v ISA '\ T Upgraded Dispensaries and I~~SA Primary Health Clinics SIinkoaF Existing -~ u-:- N v8_, wj< * ;;-- \r_ Dispensaries and Clinics I - w :t, > < 1 /\ Health Centers -TALALATA 77 ~ C Hospitals MAFARA Roads SO l4p Railroads NAMODA" *~~~~ State Capitol _ ~ ~ ~~~ ~Airport Rivers @ -\5 :Local Government Boundaries State Boundaries * ~~~~Zonal Boundaries International Boundaries Population density per sq. km.- ~i \ '. GU SAU 160 120 __ / ~~~~~~~~~~~80 *+/ ANKA /4O * s ~~~~~~~~~~~~~~~~~~~~~~~~~8- &fF KA DIJNA NiGEA L I N *' . , -'5 N I G E R 91 B~~~~~~~~~URKINA~~ SOKOTO, rE ~ADNASTA TE L 25 50 MILES (| 0 40 80 KILOMETERS l Lgos Wamd tY The WOW Brs staff exck wo e f enc of --CAME ROON f _ _w tor the wdemat use ot The rwbl fank awn the kiternabonat - -'to denOnwaf used and ft bourxanes stIm 7 on VW m do not N., 7 ie Uebd Banic and hebarnat.onat F y Coroton. anl ,cgenw - -IMY or ary (fOrsnllet or accepftace of sudc botmwnes EQUATORIAL GUINEA _ DECEMBER 1984