The World Bank Nigeria States Health Investment Project (P120798) REPORT NO.: RES42057 DOCUMENT OF THE WORLD BANK RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF NIGERIA STATES HEALTH INVESTMENT PROJECT APPROVED ON APRIL 12, 2012 TO FEDERAL MINISTRY OF FINANCE HEALTH, NUTRITION & POPULATION AFRICA Regional Vice President: Hafez M. H. Ghanem Country Director: Shubham Chaudhuri Regional Director: Amit Dar Practice Manager/Manager: Magnus Lindelow Task Team Leader(s): Gyorgy Bela Fritsche, Fatimah Abubakar Mustapha The World Bank Nigeria States Health Investment Project (P120798) I. BASIC DATA Product Information Project ID Financing Instrument P120798 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 12-Apr-2012 30-Jun-2020 Organizations Borrower Responsible Agency National Primary Health Care Development Agency Federal Ministry of Finance (NPHCDA) Project Development Objective (PDO) Original PDO To increase the delivery and use of high impact maternal and child health interventions and improve quality of care at selectedhealth facilities in the participating states. Current PDO To increase the delivery and use of high impact maternal and child health interventions and improve quality of care available to the people in Nasarawa and Ondo and all the States in the NE. Summary Status of Financing Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-58510 07-Jun-2016 30-Aug-2016 27-Feb-2017 30-Jun-2020 100.00 76.25 21.19 IDA-50940 12-Apr-2012 16-Apr-2013 20-Aug-2013 31-May-2020 150.00 138.13 0 TF-A2591 02-May-2016 30-Aug-2016 27-Feb-2017 30-Jun-2020 20.00 10.91 9.09 TF-13432 16-Apr-2013 16-Apr-2013 20-Aug-2013 31-May-2020 21.70 20.17 1.53 The World Bank Nigeria States Health Investment Project (P120798) Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No I. SUMMARY OF PROJECT STATUS AND PROPOSED CHANGES Project status: Overall, the progress towards achievement of the Project Development Objective (PDO) is satisfactory. All 18 PDO indicators are moving in the right direction, ten have been met already and surpassed their targets – number of out-patient visits per year in the 2 parent States and the NE 8,411,969 (target 300,000) and 19,918,419 (target 500,000) respectively; proportion of children with Pentavalent 3 vaccination in the 2 parent states and the NE 66% (target 65%) and 49% (target 35%) respectively; Number of children immunized with Pentavalent 3 vaccine in the 2 original states and in the NE 828,563 (target 270,000) and 2,732,091 (target 500,000) respectively; deliveries attended by skilled providers 1,291,448 (target 88,503); number of births occurring in a health facility in the 2 parent states and in the NE 323,691 (target 62,000) and 967,757 (target 150,000) respectively; direct project beneficiaries 21,684,788 (target 1,400,000). Seven PDO indicators are partially achieved while one will not be achieved at the end of the project. The intermediate indicators are progressing in the right direction and most will all attain their targets. Additionally, the Implementation Progress also is satisfactory. Project funding: To date, approximately US$283.16 million of the total project funds, has been disbursed. The original credit which was approved in 2012 (IDA credit 50940 and TF 13432) is fully disbursed and closed on May 30, 2020. The AF credit has disbursed $73.4m USD and cancelled $25m. The project has an undisbursed balance of IDA $23.4m. Rationale for restructuring: The Government has requested a no cost extension of the closing date from June 30, 2020 to October 31, 2020. A formal letter from the borrower - Federal Ministry of Finance dated June 3, 2020 was received by the Task Team on June 9, 2020. This restructuring paper recommends a no cost extension to the IDA credit 58510 to the Nigeria State Health Investment Project for a duration of four months (from 30 June till 31 October 2020). The reasons for the restructuring are due to; (i) compensate for the delay in implementation of project activities for the second quarter of 2020 due to stringent lock-downs in project states and FCT following the Covid-19 pandemic, effectively bringing about a halt to many planned project activities; and (ii) allow for the continuation of the delivery of RMNCH services within a Covid-19 pandemic by procuring necessary protective personal equipment, medicines and other medical equipment and commodities that would contribute to the achievement of the project development objective. Further, the rife insurgency in parts of Borno, Adamawa and Yobe states had limited the full scale-up of the project in those states amid the Covid19 pandemic resulting in reduced uptake of basic services due to fear of contracting the virus in health facilities by communities across the country. In addition, the emergency measures undertaken by Federal and State Governments to contain the spread of Covid-19, included restriction of movement, home-base work and social distancing etc., all had negatively impacted the implementation of the project as planned. II. DETAILED CHANGES LOAN CLOSING DATE(S) The World Bank Nigeria States Health Investment Project (P120798) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications IDA-50940 Closed 30-Jun-2018 31-May-2020 IDA-58510 Effective 30-Jun-2020 31-Oct-2020 28-Feb-2021 TF-13432 Closed 30-Jun-2018 31-May-2020 TF-A2591 Effective 30-Jun-2020 31-Oct-2020 28-Feb-2021