The World Bank Swaziland Health, HIV/AIDS and TB Project (P110156) REPORT NO.: RES33350 DOCUMENT OF THE WORLD BANK RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF SWAZILAND HEALTH, HIV/AIDS AND TB PROJECT APPROVED ON MARCH 10, 2011 TO MINISTRY OF FINANCE HEALTH, NUTRITION & POPULATION AFRICA Regional Vice President: Makhtar Diop Country Director: Paul Noumba Um Senior Global Practice Director: Timothy Grant Evans Practice Manager/Manager: Magnus Lindelow Task Team Leader: Edit V. Velenyi, Christine Lao Pena The World Bank Swaziland Health, HIV/AIDS and TB Project (P110156) I. BASIC DATA Product Information Project ID Financing Instrument P110156 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 10-Mar-2011 30-Sep-2018 Organizations Borrower Responsible Agency Ministry of Finance Ministry of Health,Deputy Prime Minister's Office Project Development Objective (PDO) Original PDO The project development objectives (PDOs) are: (i) to improve access to and quality of health services in Swaziland with a particular focus on primary health care, maternal health and TB, and (ii) to increase social safety net access for OVC. Summary Status of Financing Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IBRD-80190 10-Mar-2011 14-Dec-2011 09-May-2012 30-Sep-2018 20.00 16.96 3.04 TF-11740 04-Apr-2012 04-Apr-2012 09-May-2012 30-Jun-2018 16.34 16.34 0 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No II. SUMMARY OF PROJECT STATUS AND PROPOSED CHANGES The World Bank Swaziland Health, HIV/AIDS and TB Project (P110156) Project Status: The Swaziland Health, HIV/AIDS and TB project (P110156) in the amount of a US$20 million (IBRD 80190) loan, and a €14.5 million European Union (EU) grant (TF011740), was approved by the World Bank Executive Board on March 10, 2011, and became effective on May 9, 2012. In May 2016, a level II restructuring extended the May 31, 2016 closing date by 22 months until March 31, 2018. Three subsequent level II restructurings were processed in September 2016, June 2017, and March 2018 to reflect the receipt of the second, third and fourth tranches of EU financing respectively, as well as extend the project closing date by an additional six months until September 30, 2018. To date, this co- financed World Bank loan and EU grant has disbursed a combined US$33.2 million or 91% of the total project funds, up from US$30.2 million (83.1%) in June 2017. The June 2018 Implementation Status and Results Report (ISR) maintained Implementation Progress (IP) rating as Satisfactory, and progress towards the achievement of the PDO as Moderately Satisfactory. Under Component 1, accelerated progress has been made on the Health Financing (HF) Technical Assistance (TA), including completion of Phase I which identified reform areas that would improve the effectiveness, efficiency, and equity of the health care system. Initially the take-off of Phase II which operationalizes the agreed priorities for reform was slow. However, following two Joint TA workshops, a series of Technical Working Group discussions and frequent stakeholder consultations, progress has been made in the areas identified for operationalization, including SWAP coordinating mechanism, the establishment of a health financing unit, and a national health insurance scheme. Beyond these three high priority areas, the TA has initiated support on strategic purchasing and efficiency assessment to support value for money. Meanwhile, under the hospital governance and management (HGM) TA, a situational analysis was delivered which identified areas for change within the current legal context that would allow hospitals to operate more effectively. While no predominant HGM model was identified due to both data and legal/institutional limitations, mechanisms to attain incremental progress were identified in the functional areas (HR, financing, HMIS, governance structure, procurement). Under Component 2, civil works at all sites under the project have been completed, including the Mbabane Government Hospital maternity and neonatal ward, Good Shepherd School of Nursing, Mkhuzweni, Nhlangano, and Matsanjeni Health Center maternity wards, Maternity Waiting Homes at Good Shepherd and RFM Hospitals, TB Center at Manzini, four health clinics (Mangweni, Ikhwezi, Dwalile, and Lavumisa), and the Biomed workshop at Piggs Peak. Physical works at Dvokolwako health center is completed with the tender process for equipment delivery well underway, while the ambulance (EPR) bay station is 55% complete following a site change. Ongoing Emergency Obstetric and Neonatal Care continuous on-the-job training and mentoring, and Continued Medical Education (CME) based on the protocol and guidelines developed also continues under Component 2. Furthermore, consultations with the MOH are ongoing regarding the establishment of the Improvement Support Team (IST) at the newly rehabilitated Maternity and Neonatal unit at MGH, in order to improve case management and treatment outcomes at the facility. Lastly, under Component 3, seven payments of the OVC Cash Transfer Pilot were completed, reaching 13,506 beneficiaries. A final payment to approximately 2400 members of the Control Group is expected by June 30, 2018. Regarding the Impact Evaluation, fieldwork was completed in March. Proposed Changes: Adjustment of the IBRD-EU Grant funding ratio from 55:45 to 100% IBRD financing. With the above mentioned six- month extension of the project closing date until September 2018, the June 30, 2018 "Grant Closing Date" of the EU co-financing will be surpassed. The "Grant Closing Date" remains unchanged (June 30, 2018) due to EU reporting requirements. Therefore, all expenditures under the grant need to be completed by this date, with a reduced one- month grace period to align with the administrative timeline of the co-financier. The project therefore seeks to adjust The World Bank Swaziland Health, HIV/AIDS and TB Project (P110156) the remaining expenditures incurred between July and the September 2018 closing date to 100% IBRD financing. In addition the restructuring will make minor reallocations across the disbursement categories as per the reallocations table below. With the closure of TF11740 that co-financed expenditures under all categories, the remaining activities shall now be fully financed under the IBRD loan. This restructuring is linked to the former restructuring (March 2018) that revised the closing date to September 30, 2018 in response to the request from the Ministry of Finance to extend the project closing date. The Request from the Borrower (August 29, 2017), the Letter to the Borrower from the Country Director (March 29, 2018), and the requisite legal documents have been filed as official documents as part of the March 2018 restructuring. III. DETAILED CHANGES REALLOCATION BETWEEN DISBURSEMENT CATEGORIES Current Current Actuals + Proposed Disbursement % Ln/Cr/TF Expenditure Allocation Committed Allocation (Type Total) Category Current Proposed IBRD- DISB - CIVIL 8,782,000.00 7,295,086.92 8,632,000.00 55.00 100 80190-001 WORKS Currency: USD DISB - GOODS 3,768,000.00 2,809,855.48 4,198,000.00 55.00 100 DISB - 4,008,000.00 3,112,454.75 4,008,000.00 55.00 100 CONSULTING DISB - TRAINING 981,000.00 832,409.71 981,000.00 55.00 100 GRANTS- PART 1,514,000.00 986,909.37 1,234,000.00 55.00 100 C(ii) DISB - OPERATING 897,000.00 668,751.39 897,000.00 55.00 100 COSTS UNALLOCATED 0.00 0.00 0.00 GD,CS,WK for Pt D (expt Pt A,B & 0.00 0.00 0.00 100.00 100.00 C) Total 19,950,000.00 15,705,467.62 19,950,000.00 The World Bank Swaziland Health, HIV/AIDS and TB Project (P110156) TF-11740- DISB - CIVIL 6,559,271.00 6,946,207.45 6,559,271.00 45.00 0 001 WORKS Currency: USD DISB - GOODS 3,501,426.00 2,695,403.26 3,501,426.00 45.00 0 DISB - 3,194,073.00 2,981,362.00 3,194,073.00 45.00 0 CONSULTING DISB - TRAINING 932,156.00 799,151.03 932,156.00 45.00 0 GRANTS- PART 1,377,401.00 948,207.03 1,377,401.00 45.00 0 C(ii) DISB - OPERATING 772,539.00 644,172.32 772,539.00 45.00 0 COSTS UNALLOCATED 0.00 0.00 0.00 Total 16,336,866.00 15,014,503.09 16,336,866.00