The World Bank ESV:Addressing Non-Communicable Diseases (P164356) REPORT NO.: RES36556 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF ESV:ADDRESSING NON-COMMUNICABLE DISEASES PROJECT APPROVED ON SEPTEMBER 13, 2018 TO REPUBLIC OF EL SALVADOR HEALTH, NUTRITION & POPULATION LATIN AMERICA AND THE CARIBBEAN REGION Regional Vice President: J. Humberto Lopez Country Director: Yaye Seynabou Sakho Global Director: Muhammad Ali Pate Practice Manager/Manager: Michele Gragnolati Task Team Leader: Amparo Elena Gordillo-Tobar The World Bank ESV:Addressing Non-Communicable Diseases (P164356) ABBREVIATIONS AND ACRONYMS HPV Human Papillomavirus IEC Information, Education and Communication NCD Non-Communicable Diseases PAHO Pan-American Health Organization PHC Public Health Care WHO World Health Organization The World Bank ESV:Addressing Non-Communicable Diseases (P164356) BASIC DATA Product Information Project ID Financing Instrument P164356 Investment Project Financing Original EA Category Current EA Category Not Required (C) Not Required (C) Approval Date Current Closing Date 13-Sep-2018 31-Mar-2020 Organizations Borrower Responsible Agency Republic of El Salvador Ministry of Health Financing (in USD Million) FIN_SUMM_PUB_TBL SUMMARY Total Project Cost 0 Total Financing 0 Financing Gap 0 DETAILS -NewFin3 Project Development Objective (PDO) Original PDO The objective of the Project is to support the Government of El Salvador in piloting an integrated health care service delivery model to improve the prevention, early detection, and treatment of cervical cancer as well as the prevention of NCD risk factors in selected regions of El Salvador. OPS_TABLE_PDO_CURRENTPDO The World Bank ESV:Addressing Non-Communicable Diseases (P164356) Summary Status of Financing Net TF Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed TF-A8267 03-Aug-2018 19-Dec-2018 19-Dec-2018 31-Mar-2020 1.80 1.28 .52 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING 1. Project Status. The Project is advancing well and in full implementation. As expected in a pilot project, the first year of Project implementation was necessary for the development of protocols for prevention and care of NCDs. As indicated in the results framework, intermediate indicators will only be measurable once the actions of the pilot have been implemented. Key Project activities are taking place in the regions to roll-out the pilots in the three selected regions, as follows: a) A full review of actions directed towards integration of treatment at the Primary Health Care (PHC) level under principles of equity and quality. b) Preparation of technical specifications (along with administrative procedures) for the procurement of goods that would support administration of the Human Papillomavirus (HPV) test (medical equipment and clinical furniture, HPV identification tests, cryotherapy supplies and refrigeration to protect the samples). c) Establishment of administrative procedures for logistics supporting the planned training activities, including contracts for the reproduction of materials, venue rental and refreshment for training events. d) Establishment of logistic coordination channels (teams, leaders, coordinators) with technical teams from the regions of the project areas (including Non-Communicable Diseases -NCDs- and HPV). e) Guidelines for the inclusion of the HPV vaccine into the national vaccination scheme have been adapted and formalized. The adapted guidelines have been the framework for the development of a Vaccine Introduction Plan, and include educational, communication and informational materials for the population, which can be accessed at the following electronic address: http://asp.salud.gob.sv/regulacion/pdf/lineamientos/lineamientosinclusionvacunapapilomahumanoesque manacional2019.pdf The World Bank ESV:Addressing Non-Communicable Diseases (P164356) f) Health promotion and prevention of NCDs: In 2019, 16 materials were prioritized to be reproduced in support of the Information, Education and Communication process (IEC), in the three micro networks of the Project implementation. Regarding HPV materials, all the designs are in the process of elaboration. Some materials are expected to be received April 2020. g) 14,000 HPV vaccines (approximately US$300k) were fully procured using the PAHO/WHO Revolving fund h) Four workshops of innovative educational techniques for the prevention of NCDs were held with the participation of health care practitioners. i) One training of trainers for facilitators/promotors of physical exercise: “Exercise is Medicine”. 2. Rationale for Restructuring. The Government of El Salvador requested an extension of the grant closing date for 24 months in a letter from the Minister of Finance dated January 28, 2020. The additional time will allow the Project to: (i) evaluate potential changes in the piloting areas of NCDs (diabetes and cervical cancer); (ii) accommodate the HPV vaccine within the school calendar setting for the upcoming school year; and (iii) achieve the Grant development objectives and allow enough time to measure results of the pilot program. The extension period will compensate for the delays encountered in starting project implementation due to: (a) change in the type of Bank account to a commercial Bank from the Central Bank account originally opened; (b) ten-month delay between the Project’s effectiveness date and the signature of the agreement between MINSAL and WHO/PAHO to purchase the HPV vaccines which took place on October 17, 2019; and (c) time that was required to complete safeguards documents. 3. As demonstrated by the progress detailed above, the performance of the Recipient remains Satisfactory taking into account that project activities are progressing well, satisfactory performance on Procurement, Financial Management and Safeguards, and the effective coordination of MINSAL’S implementing unit. In addition, the Recipient does not have any outstanding audit reports nor audit reports which are not satisfactory to the Bank. Finally, the Project Development Objective remains achievable and relevant. A detailed action plan reflecting a revised implementation schedule has been submitted by the Government and accepted by the Bank. 4. The Bank has agreed to extend the Grant for 23 months. II. DESCRIPTION OF PROPOSED CHANGES 5. The closing date of Grant TF-A8267 will be extended for the first time for 23 months from March 31, 2020 to February 28, 2022. The additional time will allow the completion of all Project activities, the achievement of the Grant development objective and full disbursement of the Grant funds. The disbursement estimates have been adjusted accordingly. The World Bank ESV:Addressing Non-Communicable Diseases (P164356) III. SUMMARY OF CHANGES Changed Not Changed Loan Closing Date(s) ✔ Disbursement Estimates ✔ Implementation Schedule ✔ Implementing Agency ✔ Project's Development Objectives ✔ Results Framework ✔ Components and Cost ✔ Cancellations Proposed ✔ Additional Financing Proposed ✔ Reallocation between Disbursement Categories ✔ Disbursements Arrangements ✔ Change in Overall Risk Rating ✔ Safeguard Policies Triggered ✔ EA category ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Other Change(s) ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_LOANCLOSING_TABLE LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline TF Status Closing Closing(s) Closing for Withdrawal Applications TF-A8267 Effective 31-Mar-2020 28-Feb-2022 28-Jun-2022 The World Bank ESV:Addressing Non-Communicable Diseases (P164356) OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE DISBURSEMENT ESTIMATES Change in Disbursement Estimates Yes Year Current Proposed 2018 0.00 0.00 2019 300,000.00 300,000.00 2020 1,250,000.00 379,012.41 2021 250,000.00 500,000.00 2022 0.00 520,987.59