Document of The World Bank Report No: 65747 - RO RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF THE HEALTH SECTOR REFORM PROJECT - PHASE II (APL2) LOAN NO. 4760-RO January 28, 2005 TO ROMANIA December 12, 2011 ABBREVIATIONS AND ACRONYMS DPL Development Policy Loan EIB European Investment Bank ER Emergency Room EUR Euro ICU Intensive Care Units GoR Government of Romania MOH Ministry of Health MOPF Ministry of Public Finance TA Technical Assistance WB World Bank Regional Vice President: Philippe Le Houérou Country Director: Peter C. Harrold Sector Director: Ana L. Revenga Sector Manager : Daniel Dulitzky Task Team Leader: Richard Florescu 2 ROMANIA HEALTH SECTOR REFORM PROJECT – APL 2 P093096 CONTENTS Page A. SUMMARY………………………………………………………………………… ……………………4 B. PROJECT STATUS…………………………………………………………………………………… 4 C. PROPOSED CHANGES……………………………………………………………………………..5 ANNEX 1: REVISED RESULTS FRAMEWORK AND MONITORING…………………… 7 ANNEX 2: REALLOCATION OF LOAN PROCEEDS……………………………………………11 ANNEX 3: ACTIVITIES REMAINING TO BE COMPLETED IN 2012………………….12 3 HEALTH SECTOR REFORM PROJECT – (APL 2) P078971 LOAN NO. 4760-RO RESTRUCTURING PAPER SUMMARY This Restructuring Paper seeks approval to: (i) extend the current Closing Date by 12 months from December 15, 2011, to December 15, 2012; (ii) introduce new technical assistance activities to support the ongoing sector reforms; (iii) introduce a minor reallocation of loan proceeds among categories of expenditures; and (iv) revise and fine- tune the Results Framework. This will be the third extension of the Closing Date, which will result in a cumulative extension of three years from the original Closing Date (December 31, 2009). The proposed restructuring will help complete ongoing activities, for the attainment of the overall APL Program Development Objectives1, and will implement new technical assistance (TA) activities to assist the Ministry of Health in the implementation of the National Strategy for Hospital and Sanitary System Rationalization, and for the preparation of the future reforms in the health sector. These modifications were requested by the Government of Romania (GoR) through a letter to the Bank dated October 27, 2011. PROJECT STATUS The Health APL 2, financed with a loan in the amount of EUR 65.1 million, has five components: (1) Maternity and Neonatal Care (EUR 17.21 million); (2) Emergency Care Services (EUR 35.33 million); (3) Primary Health Care and Rural Medical Services (EUR 0.25 million); (4) National Health Accounts and Planning (EUR 0.41 million); and (5) Project Management (EUR 2.38 million). The European Investment Bank (EIB) is co- financing the Project with a loan of EUR66.49 million, mainly covering the works for the physical rehabilitation of the maternity wards. According to the agreement with the EIB, the World Bank bears the fiduciary responsibilities (procurement) for both projects, while the EIB is responsible for the clearance of technical/architectural designs. 1 APL Program refers to the Health Sector Reform Project – Phase I financed through the Loan Agreement no. 4568-RO dated July 7, 2000 (closed on June 30, 2004) and Health Sector Reform Project - Phase II financed through the Loan Agreement no. 4760-RO dated January 28, 2005. 4 The Project was approved on December 16, 2004 and became effective on June 27, 2005. The Project was restructured in November 2008, and a first closing date extension of 12 months was granted in 2009, from December 31, 2009 to December 31, 2010. This was followed by a second extension up to December 15, 2011. The overall project performance is rated Satisfactory. There are no outstanding audits. Disbursements (in EURO terms) have reached 85.5 percent of the loan amount with an additional 5.7 percent committed (contracts signed), bringing the total of disbursement and commitment to 92 percent of the loan amount. The activities remaining to be implemented (ongoing contracts and new TA) until the new closing date will absorb the remaining balance of the loan. All TA activities initially included in the Project, for neo-natal care (quality assurance, referral system, training of medical staff) and for the development of the National Health Accounts have been completed, and most of the medical equipment has been delivered to the beneficiary hospitals (maternity wards and emergency centers). The Borrower has allocated the appropriate budgetary resources for 2012, in order to cover the financing of all the remaining activities. The Bank has acknowledged the request from the Ministry of Public Finance (MoPF) to extend the closing date of the Project and informed the Borrower on November 22, 2011 about the possibility of granting an extension of 12 months under certain conditions, which form the basis for this Restructuring. PROPOSED CHANGES Results Indicators. Although the Project Development Objective remains unchanged, an adjustment of the target values for some of the project monitoring indicators from the Results Framework is considered necessary in order to improve their measurability and relevance to project specific investments. Annex 1 presents the revised Results Framework and Monitoring for the Project. More specifically: • For the indicator “24-hour death rate for patients treated in the Emergency Rooms (ERs)�, the goal will be revised from 20 percent decrease to 15 percent decrease. The patients treated initially in Emergency Departments (ED) and then transferred to Intensive Care Units (ICU) are critically ill patients whose vital signs are unstable or whose diseases may cause irreversible complications. Also, international clinical studies on corticosteroids in patients with cranial traumas were aimed at decreasing the death rate only 5 by 2 percent. Therefore, the target of a 20 percent decrease in the baseline death rate for this group of patients was unrealistic. • Change the frequency on collecting data, from “monthly� to “every 6 months� for the following indicators: (i) “24-hour death rate among patients treated in the Emergency Rooms, then admitted to Intensive Care Units�, (ii) "Death rate in ER�, (iii) “Fatality rate for patients treated in small ERs� and (iv) “Decreased fatality rate after 24 hours from admission of patients treated in hospital ICUs�. These indicators will not exhibit measurable changes when measured on a month to month basis. • Removal of the reference related to the number of emergency units/rooms for the indicator “Fatality rate for patients treated in small ERs�. The removal is justified by the ongoing implementation of the National Strategy for Hospital and Sanitary System Rationalization, which calls for the reduction/merger of some hospitals. • Revision of the baseline value for the intermediate indicator “Decreased fatality rate after 24 hours from admission of patients treated in hospital ICUs� to reflect the year 2007, which is the year before the project intervention in the emergency units. • Inclusion of two IBRD Core Indicators: (i) Health personnel receiving training- number; and (ii) Maternity and neo-natal facilities and emergency facilities constructed, renovated and/or equipped-number. Project Components. New technical assistance activities are introduced in Component 5: Project Management. The Project would finance these technical assistance activities (estimated at EUR2.2 million) to assist the Ministry of Health in: the implementation of the National Strategy for Hospital and Sanitary System Rationalization, and for the preparation of the future reforms in the health sector. Reallocation of Loan Proceeds. The proposed reallocations of the loan proceeds among categories of expenditures are minor. The reallocation is justified by the variation of contract prices for some goods and services during contracts execution. The proposed reallocation of loan proceeds (in EUR currency) is presented in Annex 2. Project Closing Date. This third extension of the Project from December 15, 2011 to December 15, 2012 is recommended to: (i) implement the new technical assistance (TA) 6 activities to support the health sector reform program; (ii) finalize the upgrade of the vaccine production facility at Cantacuzino Institute; and (iii) complete ongoing contracts, including final deliveries of medical equipment, and consulting services for the public awareness campaign, definition of basic package of health services, and the development of strategy for the delivery of primary health care in underserved areas. This extension of the closing is subject to the Regional Vice President clearance as per para 7 of BP13.30 as it goes beyond the cumulative two year extension from the original closing date. The requirements of OP/BP 13.30 have been met, namely, (i) the project objectives are achievable; (ii) the performance of the Borrower and other project implementing agencies is satisfactory; and (iii) the Borrower has prepared a specific Action Plan acceptable to the Bank for completion of the project within the proposed requested extended timeframe, i.e. December 15, 2012. 7 ANNEX 1 Revised Results Framework and Monitoring ROMANIA: HEALTH SECTOR REFORM PROJECT (APL 2) Project Development Objective (PDO): The objectives of the overall APL Program are as follows: (a) improve efficiency and equity in the planning and regulation of the health service delivery system; (b) reduce preventable deaths among emergency medical cases; (c) improve access and quality health care in poor and remote areas; and (d) help the Romanian health sector to better focus on priority public health problems, thereby reducing preventable illness and deaths. The specific objectives of Phase 2 are as follows: (i) Provide more accessible services, of increased quality and with improved health outcomes for those requiring maternity and newborn care and emergency medical care; and (ii) Provide support for the preparation of the primary health care strategy. Revised Project Development Objective: not applicable D=Droppe Cumulative Target Values** d Responsibili Core Key Performance C=Continu Unit of Baseline Data Source/ e YR Frequency ty for Data Indicators Measure (2004) YR YR End of Project Methodology N= New 2011 (first 6 Collection 2009 2010 (2012) R=Revised months) PDO Level Results Indicators* 1. Maternal Mortality 20% decrease Annual National PMU & Number MM: 52 MM: 31 MM: 33 MM: 18 MM: 41 National Reporting hospitals (MM) and Rate (MMR) C and Statistics System (NRS), rate/000 MMR: 0.24‰ MMR: 0.14‰ MMR:0.15‰ MMR: 0.19‰ MMR: 0.19/1000 (ANS) hospital data 2. Neonatal Deaths and 25% decrease NRS, hospital PMU & Number Deaths: 2068 Deaths: 1270 Deaths: 1160 Deaths: 546 Deaths: 1551 ANS data hospitals Rate C and rate/000 Rate: 9.6‰ Rate: 5.7‰ Rate: 5.5‰ Rate: 5.9‰ Rate: 7.2/1000 3. Post-Neonatal Deaths 25% decrease ANS NRS PMU Number Deaths: 1573 Deaths: 980 Deaths: 918 Deaths: 408 Deaths: 1180 and Rate C and rate/000 Rate: 7.3‰ Rate: 4.1‰ Rate: 4.3‰ Rate: 4.4‰ Rate: 5.5/1000 8 D=Droppe Cumulative Target Values** d Responsibili Core Key Performance C=Continu Unit of Baseline Data Source/ e YR Frequency ty for Data Indicators Measure (2004) YR YR End of Project Methodology N= New 2011 (first 6 Collection 2009 2010 (2012) R=Revised months) 4. 24-hour death rate 15% decrease 6 months, Info System of PMU, LHA, R % 5.78% 3.67% 6.11% 4.81% 4.91% yearly Emergency EMS, hospital among patients treated in target and (for 6 ICUs) (for 6 ICUs) (for 6 ICUs) (for 6 ICUs) (for 6 ICUs) aggregate Dept. ER dept. the ER, then admitted to frequency Baseline 2007 ICU. INTERMEDIATE RESULTS Intermediate Result (Outcome 1): MATERNAL AND NEONATAL CARE Revised Intermediate Result (Outcome One): 1.1 Maternal Mortality Annual NCOAIISH PMU and Level 1: 0.09‰ Level 1: 0.06‰ Level 1: Level 1: Level 1: 10% decr hospitals Rate (MMR) by level of C rate/1000 Level 2: 0.07‰ Level 2: 0.12‰ 0.255‰ 0.303‰ Level 2: 10% decr MCH facilities. Level 3: 0.17‰ Level 3: 0.28‰ Level 2: Level 2: Level 3: 3.5% decr 0.133‰ 0.166‰ Level 3: Level 3: 0.023‰ 0.328‰ 1.2 Neonatal Mortality Annual NCOAIISH PMU and Level 1: 1.14‰ Level 1: 2.13‰ Level 1: Level 1: Level 1: 3.7 hospitals Rate by level of MCH C Rate/1000 Level 2: 8.40‰ Level 2: 5.36‰ 8.04‰ 9.02‰ Level 2: 7.6 facilities. Level 3: 10.6‰ Level 3: 7.50‰ Level 2: Level 2: Level 3: 9.6 5.68‰ 6.01‰ Level 3: Level 3: 2.02‰ 2.46‰ 1.3 Patient satisfaction Surveys: Patient PMU, Level 1: 109/140 Level 1: Level 1: Level 1: Level 1: 10% baseline; Satisfaction monitors and with maternity and Level 2: 110/140 Level 2: Level 2: Level2: improvement MTR; End of Survey surveyors neonatal services C % Level 3: 109/140 Level 3: Level 3: Level 3: Level 2: 10% Project improvement Baseline 2008 Level 3: 3.5% 1.4 Maternity and neo- Annual MoPH monitors Monitors, Maternities Maternities Maternities PMU natal facilities renovated: 0 renovated: 0 renovated: 21 constructed, renovated X N number (financed by EIB) (financed by (Financed by EIB) and/or equipped Maternities EIB) Maternities receiving Maternities receiving equipment: 0 receiving equipment: 205 9 D=Droppe Cumulative Target Values** d Responsibili Core Key Performance C=Continu Unit of Baseline Data Source/ e YR Frequency ty for Data Indicators Measure (2004) YR YR End of Project Methodology N= New 2011 (first 6 Collection 2009 2010 (2012) R=Revised months) equipment: 134 1.5 Health personnel 831 600 Annual MoPH monitors Monitors, X N number 0 PMU receiving training Revised Intermediate Result (Outcome 2): EMERGENCY HEALTH SERVICES 2.1 Response time for URBAN URBAN URBAN URBAN URBAN 6 months, Ambulance data PMU R & Y: 18 min R & Y: 15 min R & Y: 15 R & Y: 15min 7 R & Y: 15 minutes yearly (electronic case emergency services by 25 sec 4 sec min 25 sec sec Green: 8% less than aggregate forms) urgency category (color R Green: 52 min Green: 28 min Green: 40 min Green: 43 min 12 baseline coded – Red, Yellow, Frequency 33sec 1 sec 5 sec sec Green) and urban/rural Time unit RURAL RURAL RURAL RURAL RURAL areas R & Y: 24 min 43 R & Y: 21 min R & Y: 23 R & Y: 24 min R & Y: 20 min. sec 5 sec min 10 sec 20 sec Green: 8% less than Green: 36 min 2 sec Green: 25 min Green: 36 min Green: 34 min 33 baseline Baseline 2007 50 sec 25 sec sec 2.2 Death Rate in 6 months, MoPH monitors PMU yearly emergency departments R % 0.079% 0.071% 0.074 0.077 0.064% aggregate (dead patients/total alive Frequency (from 63 ERs presentations) Baseline 2007 equipped) 2.5 Decreased fatality rate 6 months, Small ERs data Monitors, R % 0.040% 0.042% 0.045% 0.053% 5% decrease yearly PMU for patients treated in Frequency aggregate Baseline 2008 small ERs 2.6 Decreased fatality rate 6 months, Intervention Monitors, R % 2.84% 1.55% 3.27% 2.45% 5% decr yearly ICU data PMU within first 24 hours from Baseline aggregate admission of patients Frequency Baseline 2007 treated in hospital ICUs 2.7 Emergency health Annual MoPH monitors Monitors, ERs renovated: 0 ERs renovated: ERs renovated: 16 PMU facilities constructed, N number 10 renovated and/or ERs/ICUs receiving equipped X equipment: 0 ERs/ICUs ERs/ICUs receiving receiving equipment: 253 equipment: 185 10 D=Droppe Cumulative Target Values** d Responsibili Core Key Performance C=Continu Unit of Baseline Data Source/ e YR Frequency ty for Data Indicators Measure (2004) YR YR End of Project Methodology N= New 2011 (first 6 Collection 2009 2010 (2012) R=Revised months) Intermediate Result (Outcome 3): PRIMARY HEALTH CARE 3.1 Development of a End of year MoPH PMU, MoPH C Yes / No assessment documents primary health care rural No No In progress In progress Yes strategy Intermediate Result (Outcome 4): NATIONAL HEALTH ACCOUNTS AND PLANNING 4.1 Appropriate Annual MoPH PMU Contract for Contract for NHA in place 3 out of 3 regulations issued with No regulations in NHS ongoing NHA C Number respect to main areas: (i) place completed internationally comparable Romanian matrixes; (ii) institutional responsibilities; and (iii) timeframe for data flow. Intermediate Result (Outcome 5): None Revised Intermediate Result (Outcome5): PROJECT MANAGEMENT 5.1 Average lag time At least Monitoring by PMU quarterly PMU implementing project C No of 0 Lag < 5 months Lag < 4 Lag < 3 months activities beyond critical months months Lag>3 months dates agreed at the MTR 5.2 Timely submission of Bi-annually Monitoring by PMU project progress reports C Report 0 On time On time On time On time PMU *Please indicate whether the indicator is a Core Sector Indicator (see further http://coreindicators) **Target values should be entered for the years data will be available, not necessarily annually. 11 ANNEX 2 Reallocation of Loan Proceeds Amount of the Loan Allocated Category of Expenditures % of Financing (expressed in EURO) Current Revised Current Revised Current Revised 100% of foreign expenditures, 100% of foreign expenditures, 100% of local expenditures (ex 100% of local expenditures (ex (1) Dispatch equipment (1) Dispatch equipment 2,850,059 2,850,059 factory) and 80% of local costs factory) and 80% of local costs for other items procured for other items procured locally; locally; 100% of foreign expenditures, 100% of foreign expenditures, 100% of local expenditures (ex 100% of local expenditures (ex (2) Goods (other than (2) Goods (other than 30,341,139 30,412,960 factory) and 80% of local costs factory) and 80% of local costs dispatch equipment) dispatch equipment) for other items procured for other items procured locally; locally; 75% of expenditures incurred 75% of expenditures incurred (3) Consultant's services (3) Consultant's services by local consultants, and 85% by local consultants, and 85% 999,742 999,742 (including audit) (including audit) of expenditures incurred by of expenditures incurred by foreign consultants; foreign consultants; 100% of foreign expenditures 100% of foreign expenditures (4) Training (4) Training 80,218 80,218 and 75% of local expenditures; and 75% of local expenditures; (5) Sub-loans under Part C (5) Sub-loans under Part C 0 0 of the Project of the Project (6) Works (6) Works 338,865 338,865 80% 80% (7) Operating costs (7) Operating costs 414,764 414,764 45% 45% (8) Unallocated (8) Unallocated 0 0 12 (9) Goods, dispatch 9) Goods, dispatch equipment, equipment, consultant's consultant's services services (including audit), (including audit), training, 30,075,213 30,003,392 74% 74% training, works and operating works and operating costs as costs as of November 26, 2008 of November 26, 2008 Total 65,100,000 65,100,000 ANNEX 3 ROMANIA – HEALTH SECTOR REFORM PROJECT (APL 2) – IBRD Loan 4760-RO ACTIVITIES REMAINING TO BE COMPLETED IN 2012 Ref No. CONTRACT DESCRIPTION TOTAL IBRD GOR COMPLETION COMMENTS/ EXPENDITUR ESTIMATED FINANCING FINANCING DATE CONTRACT STATUS CATEGORY COST (EURO) (EURO) (EURO) of COMPONENT “A� – MATERNITY and CHILD HEALTH CARE MCH 3 Design for civil works for 22 maternities (phase 1) MCH 3.1 Design for Moldova Region CS 279,453 209,590 69,863 Dec-2012 Contract ongoing MCH 3.2 Design for Dobrogea Region CS 286,024 214,518 71,506 Dec-2012 Contract ongoing MCH 3.3 Design for Moldova (center) CS 190,794 143,095 47,698 Dec-2012 Contract ongoing MCH 3.4 Design for Ardeal Region CS 243,183 182,388 60,796 Dec-2012 Contract ongoing MCH 6 Design for civil works for 3 maternities (phase 2) MCH 6.1 Design for OG Ploiesti Hospital CS 41,512 30,719 10,793 Dec-2012 Contract ongoing MCH 6.2 Design for Bacau Hospital CS 57,312 42,411 14,901 Jun-2012 MCH 12 Procurement of medical equipment (phase 2) MCH Lot VI: Surgical instruments for Gynecology G 545,542 403,701 141,841 Mar-2012 Contract awarded MCH 13 TA – Preparation of BDs for Civil Works CS 207,071 153,233 53,839 Mar-2012 Contract ongoing Sub-TOTAL Component “A� 1,850,892 1,379,655 471,237 COMPONENT “B� – EMERGENCY HEALTH SERVICES 13 EMS 14 Civil works for ERU SMURD Tg. Mures Hospital CW 1,225,524 906,888 318,636 Mar-2012 Contract ongoing EMS 15 Design Rehabilitation of ER Tg. Mures Hospital CS 79,805 59,055 20,749 Mar-2012 Contract ongoing EMS 23 Equipment for Ambulance and SMURD Personnel Training Centers – ICB 11 EMS 23.1 Lot I: Basic Cardio-Pulmonary Simulator G 64,491 47,724 16,768 Mar-2012 Final delivery EMS 23.2 Lot II: I.V. Simulator G 82,132 60,778 21,354 Feb-2012 Final delivery EMS 23.3 Lot III: Basic Cardio-Pulmonary Simulator with Digital G 112,331 83,125 29,206 Feb-2012 Final delivery Ev System and Semi-Automatic Defibrillator System EMS 23.4 Lot IV: Intubation Simulator G 42,034 31,105 10,929 Feb-2012 Final delivery EMS 23.5 Lot V: Accessories for Simulator G 36,010 26,647 9,362 Feb-2012 Final delivery EMS Lot VI: Advanced Cardio-Pulmonary Resuscitation G 94,580 69,989 24,591 Feb-2012 Final delivery 23.6 Simulator EMS 23.7 Lot VII: Multi-Functional Advanced Neo-Natal Simulator G 47,880 35,431 12.449 Feb-2012 Final delivery (resuscitation-trauma) EMS 24 Update the existing telemedicine system for imaging data transmission and extending it to other regions. EMS 24.1 Lot I: Upgrade and extension of the existing Emergency G 1,550,000 1,147,000 403,000 May-2012 Contract signing Telemedicine A/V Conference System EMS 24.2 Lot II: Extension of the Emergency Telemedicine Data G 365,056 270,141 94,915 May-2012 Contract signing System EMS 24.3 Lot III: Emergency Telemedical Imaging System G 86,490 64,003 22,487 May-2012 Contract signing EMS 25 Medical Equipment for Emergency Rooms, Intensive Care and Cardiology Units – ICB 10 EMS 25.1 Lot I: Intra-Hospital Transportation G 557,823 412,789 145,034 Ian -2012 Final delivery EMS 25.2 Lot III: Ventilation Equipment G 378,820 280,327 98,493 Ian -2012 Final delivery EMS 25.3 Lot IV: Resuscitation, Airway Mgmt - Immobilization G 166,656 123,325 43,331 Ian -2012 Final delivery EMS 25.4 Lot V: Computer Tomography Equipment G 985,800 729,492 256,308 Feb-2012 Final delivery EMS 25.5 Lot VI: Radiology Equipment G 330,136 244,301 85,835 Feb-2012 Final delivery EMS 26 Weak-currents equipment for Tg. Mures Hospital G 200,000 148,000 52,000 Mar -2012 IS to be launched Sub-TOTAL Component “B� 6,405,567 4,740,120 1,665,448 COMPONENT “C� – PRIMARY HEALTH CARE PHC 3 TA to Design a Strategy for PHC in Underserved Areas CS 276,160 204,359 71,802 Mar -2012 Contract ongoing Increase Influenza Vaccine Production Capacity G (Cantacuzino Institute) PHC 4 Rehabilitation Works Influenza Vaccine Production Unit G 1,606,621 1,188,900 417,721 May -2012 Contract ongoing PHC 5 Rehabilitation Works Influenza Vaccine Filling and G 2,096,497 1,551,408 545,089 Feb -2012 Contract ongoing 14 sealing Line PHC 6 Upgrade/Modification of the Filling Line G 466,216 345,000 121,216 Sep - 2012 BER completed PHC 7 Site Supervision for the Rehabilitation Works G 13,166 9,743 3,423 Apr -2012 Contract ongoing PHC 8 Designs for the Vaccine Production Unit CS 54,685 40,467 14,218 May -2012 Contract ongoing PHC 9 BSL 3 Equipment G 148,649 110,000 38,649 PHC 10 BSL 3 Certification CS 59,713 44,187 15,525 Jun - 2012 To be launched Sub-TOTAL Component “C� 4,721,708 3,494,064 1,227,644 Jun -2012 To be launched COMPONENT “E� – PROJECT MANAGEMENT (inc. TA to support forthcoming health sector reforms) PM 14.2 Audit Services 2011-2012 CS 27,027 20,000 7,027 Apr -2012 Contract ongoing PM 15 Local Monitoring – Region 6 and 7 CS 4,000 2,960 1,040 Apr -2012 Contract ongoing PM 16 Local Monitoring – Region 1 and 2 CS 4,000 2,960 1,040 Apr -2012 Contract ongoing PM 17 Local Monitoring – Region 4 and 5 CS 4,000 2,960 1,040 Apr -2012 Contract ongoing PM 18 Local Monitoring – Region 3 and Bucharest CS 4,000 2,960 1,040 Apr -2012 Contract ongoing PM 22 Public Information Campaign on Health Reforms CS 556,757 412,000 144,757 Jul - 2012 Draft contract with WB for review PM 24 Legal Assistance to PMU CS 16,216 12,000 4,216 Dec -2012 Contract ongoing PM 26 Translation Services CS 6,757 5,000 1,757 Dec -2012 Contract ongoing PM 28 TA for INTRASTAT CS 2,703 2,000 703 Dec -2012 Contract ongoing PM 29 TA for Accounting System (CIEL) CS 405 300 105 Dec -2012 Contract ongoing PM 30 Evaluation Committees Members CS 10,811 8,000 2,811 Dec -2012 Contract ongoing PM 31 Logistic Services for PMU OC 13,514 10,000 3,514 Dec -2012 Contract ongoing PM 33 Training for PMU Staff TR 82,000 60,680 21,320 Dec -2012 As needs identified PM 34 Consumable/Communication/Supplies for PMU OC 108,108 80,000 28,108 Dec -2012 As needed PM 37 PMU Staff Salaries OC 516,000 381,840 134,160 Dec -2012 Contracts ongoing PM 39 TA for Basic Package of Health Services (NICE – UK) CS 90,396 66,893 23,503 Feb -2012 Contract ongoing PM 39 TA for future Health DPL/RBF/P4R Programs CS 2,972,973 2,200,000 772,973 Dec -2012 Sub-TOTAL Component “E� 9,349735 3,270,553 1,149,113 15 16