Document of The World Bank FOR OFFICIAL USE ONLY Report No: 75555-AR RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF EMERGENCY PROJECT FOR THE PREVENTION AND MANAGEMENT OF INFLUENZA TYPE ILLNESS AND STRENGTHENING OF ARGENTINA'S EPIDEMIOLOGICAL SYSTEM LOAN 7843-AR APPROVED BY THE BOARD ON FEBRUARY 23, 2010 TO THE ARGENTINE REPUBLIC February 25, 2013 Human Development Sector Management Unit Argentina, Paraguay and Uruguay Country Management Unit Latin America and the Caribbean Region This document will be made publicly available on the Bank website in accordance with the Bank’s Policy on Access to Information. ABBREVIATIONS AND ACRONYMS A/H1N1 Influenza A type illness (sub-type H1N1) EPI Expanded Program on Immunization MOH Ministry of HealthMinisterio de Salud de la Nación. PDI Project Intermediate Outcome Indicator PDO Project Development Objective SNVS National Health Surveillance System Regional Vice President: Hasan A. Tuluy Country Director: Penelope J. Brook Sector Manager: Joana Godinho Task Team Leader: Vanina Camporeale 2 ARGENTINA — EMERGENCY PROJECT FOR THE PREVENTION AND MANAGEMENT OF INFLUENZA TYPE ILLNESS AND STRENGTHENING OF ARGENTINA'S EPIDEMIOLOGICAL SYSTEM PP117377 LOAN 7843-AR DATA SHEET Restructuring Status: Draft Restructuring Type: Level two Last modified on date: 02/12/2012 1. Basic Information Project ID & Name P117377: Emergency Project for the Prevention and Management of Influenza Type Illness and Strengthening of Argentina’s Epidemiological System Country Argentina Task Team Leader Vanina Camporeale Sector Manager/Director Joana Godinho/ Keith Hansen Country Director Penelope J. Brook Original Board Approval Date 02/23/2010 Original Closing Date: 03/31/2012 Current Closing Date 03/31/2013 Proposed Closing Date [if applicable] 12/31/2013 EA Category B-Partial Assessment Revised EA Category B-Partial Assessment EA Completion Date 12/31/2009 Revised EA Completion Date 04/21/2010 2. Revised Financing Plan (US$m) Source Original Revised BORR 0 88 IBRD 229 141 Total 229 229 3. Borrower Organization Department Location Argentine Republic Argentina 4. Implementing Agency Organization Department Location Ministry of Health Argentina 3 5. Disbursement Estimates (US$m) Actual amount disbursed as of 02/11/2013 139.48 Fiscal Year Annual Cumulative 2013 0.50 140.0 2014 1.52 141.0 Total 141.0 6. Policy Exceptions and Safeguard Policies Does the restructured Project require any exceptions to Bank policies? N Does the restructured Project trigger any new safeguard policies? N 7a. Project Development Objectives/Outcomes Original/Current Project Development Objectives/Outcomes The objective of the Project is to strengthen the capacity of the Borrower’s epidemiological health surveillance system to: (a) prevent, monitor and evaluate influenza activity and (b) control epidemic waves of A/H1N1 influenza. 7b. Revised Project Development Objectives/Outcomes [if applicable] N/A 4 ARGENTINA - EMERGENCY PROJECT FOR THE PREVENTION AND MANAGEMENT OF INFLUENZA TYPE ILLNESS AND STRENGTHENING OF ARGENTINA'S EPIDEMIOLOGICAL SYSTEM Restructuring Paper A. SUMMARY 1. This paper proposes a second extension of the closing date for the Argentina, Emergency Project for the Prevention and Management of Influenza Type Illness and Strengthening of Argentina’s Epidemiological System (Loan No 7483-AR) by 9 months, from March 31, 2013 until December 31, 2013. The cumulative extension would be for 21 months, and no further extensions are expected. B. PROJECT STATUS 2. The A/H1N1 Project was prepared under OP/BP 8.00 Rapid Response to Crisis and Emergencies, and was approved by the Board of Executive Directors of the World Bank on February 23, 2010. It was declared effective on April 14, 2010. Two restructurings have been approved. On April 27, 2011 the Project was restructured to: (i) process a partial cancelation of US$88 million of the loan amount; and (ii) reallocate loan proceeds. A second restructuring was approved on March 9, 2012 to: (i) extend the Project’s closing date by 12 months from March 31, 2012, to March 31, 2013, (ii) adjust the Project indicators in Table 1 of the Emergency Project Paper, and (iii) reallocate loan proceeds. As of February 15, 2013, the Project disbursed US$139.5 million of the loan amount (98.9%), and has an undisbursed balance of US$1.5 million (1.1%). 3. The Project’s Development Objective is to support the Nation’s high-level objective to reduce its burden of disease related to infectious and transmitted diseases, and specifically acute respiratory infections (ARI). This requires improvements to the Expanded Program on Immunization (EPI) and its epidemiological surveillance system for the prevention and control of influenza-related illness, through strengthening the capacity of Argentina’s epidemiological health surveillance system to: (a) prevent, monitor and evaluate influenza activity; and (b) control epidemic waves of A/H1N1 influenza. 4. The Project's implementation progress and progress towards achieving the Project Development Objectives (PDO) are rated satisfactory, especially because of the achievement of the A/H1N1 influenza vaccination coverage indicator, the Project's contribution to strengthening the National Health Surveillance System (SNVS), and the reduction of all types of influenza-like illness in the country. In addition, the Project demonstrated highly satisfactory compliance with safeguards, and achieved high levels of coordination between the Ministry of Health (MOH) and the provinces, through the implementation of Provincial health situation rooms. To date the Project already achieved the PDO indicator and met the target for 12 out of 14 intermediate outcome indicators (PDI). 5 5. The proposed extension will allow the Project to achieve the targets of the two remaining PDIs: (i) Number of situation analysis rooms certified and (ii) Number of situation rooms that achieve a highly satisfactory level of accreditation at the end of the Project (above 80 percent). These indicators are associated with one of the results-based activities (output) financed by the Project under Component 1: "Health Situation Rooms Certification". This output aims at strengthening the epidemiological surveillance system for influenza and at improving the technical analysis carried out by the health situations rooms that have been established in all 24 Provinces. The current value of these indicators is zero because they have been introduced during the last Project restructuring (March 2012) and the Provincial Ministries of Health need additional time to gather all the documentation required to complete the third and last independent certification process currently underway. This documentation will provide the necessary information to measure both indicators and is expected to be completed by December 2013. 6. Moreover, the extension would allow three ongoing activities, related with the strengthening of the Argentine epidemiological surveillance and mobile emergency systems, to be completed. These activities are: (i) operational research activities at the Provincial level; (ii) epidemiological postgraduate courses for training more than 200 officials; (iii) purchase of ambulances for emergencies. In all cases, remedial actions have been taken and implementation has moved forward. The Borrower has put an action plan in place to complete all the activities related to the Project. Completion of project activities and full disbursement of loan proceeds is expected by December 2013. 6