The World Bank Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) REPORT NO.: RES37424 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF HEALTH SYSTEM STRENGTHENING FOR BETTER MATERNAL AND CHILD HEALTH RESULTS PROJECT (PDSS) APPROVED ON DECEMBER 18, 2014 TO DEMOCRATIC REPUBLIC OF CONGO HEALTH, NUTRITION & POPULATION AFRICA Regional Vice President: Hafez M. H. Ghanem Country Director: Jean-Christophe Carret Senior Global Practice Director: Timothy Grant Evans Practice Manager: Trina S. Haque Task Team Leader: Hadia Nazem Samaha The World Bank Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) ABBREVIATIONS AND ACRONYMS AF1 First additional financing AF2 Second additional financing AF3 Third additional financing CERC Contingent Emergency Response component CERIP Contingent Emergency Response Implementation Plan EVD10 10th Ebola Virus Disease Outbreak GFF Global Financing Facility PDSS Projet du développement du system de la santé PEF Pandemic Emergency Facility SRP3 Third Strategic Response Plan SRP4 Fourth Strategic Response Plan WHO World Health Organization The World Bank Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) BASIC DATA Product Information Project ID Financing Instrument P147555 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 18-Dec-2014 31-Dec-2021 Organizations Borrower Responsible Agency Democratic Republic of Congo Ministry of Health,Ministry of Finance Project Development Objective (PDO) Original PDO The proposed project development objective is to improve utilization and quality of maternal and child health services in targeted areas within the Recipient's Territory. Current PDO To improve utilization and quality of maternal and child health services in targeted areas within the Recipient's Territory and, to provide an immediate and effective response to an eligible crisis or emergency. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-D4390 27-Feb-2019 06-Mar-2019 31-Dec-2021 120.00 0 118.25 IDA-59980 31-Mar-2017 19-Apr-2017 13-Feb-2018 31-Dec-2021 120.00 118.21 4.82 IDA-55720 18-Dec-2014 20-Jan-2015 30-May-2016 31-Dec-2021 130.00 83.46 38.88 IDA-D0210 18-Dec-2014 20-Jan-2015 30-May-2016 31-Dec-2021 90.00 55.68 28.98 The World Bank Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) TF-A6945 24-Jan-2018 14-Mar-2018 14-Aug-2018 31-Aug-2018 4.53 4.53 0 TF-A5096 24-May-2017 24-May-2017 22-Nov-2017 30-Jun-2019 3.50 3.49 .01 TF-A4579 19-Apr-2017 19-Apr-2017 18-Aug-2017 31-Dec-2021 40.00 7.32 32.68 TF-18375 20-Jan-2015 20-Jan-2015 30-May-2016 31-Dec-2021 6.50 3.68 2.82 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING 1. Project Implementation of the Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) is rated moderately satisfactory. Implementation of most activities, such as contracting of health facilities to support health, nutrition, and population services, is well underway with more than 3,000 contracts signed; in addition, mechanisms to pay health facilities and all purchasing agencies have been put in place. The implementation of other activities has faced some delays. Implementation of the single contract, both at the provincial and central levels, has been implemented, including quarterly performance evaluations. There remain, however, issues of on-time evaluations and partner coordination, as well as scaling up to the number of provinces targeted. Additional delays have been encountered with the new nutrition and early childhood development activities, which are part of the second additional financing (AF2). While the preparatory work was done, actual implementation has been delayed as all the funding going into these activities was reallocated to address the Ebola outbreaks. 2. For the 9th and 10th Ebola outbreaks, the Contingent Emergency Response component (CER) under the first additional financing (AF1, Credit H5998) was triggered, on May 24, 2018 to allocate US$80 million to combat the virus. The World Bank also triggered the Pandemic Emergency Facility (PEF) on May 24, 2018 and disbursed US$11.4 million directly to the World Health Organization (WHO) and UNICEF. In addition, activities for the Equateur response amounting to US$6.5 million were financed from component 4 (AF1, Credit H5998). 3. Disbursements have reached 61 percent, despite delays in declaring project effectiveness and meeting disbursement conditions, which now have all been met. The PDSS parent project (Credit H5572 and Grant D0210) became effective on May 30, 2016 and AF1 became effective on February 13, 2018. AF1 included Grant TF0A4579 from the Global Financing Facility (GFF) which became effective on August 18, 2017 and has disbursed 6.1%. Disbursement is low against the GFF TF as it is proportionally linked to Credit H5998. A grant from the Global Fund (TF0A6495) was approved on January 14, 2018, became effective on August 14, 2018 and closed on August 31, 2018 owing to limitations set by the donor. Over the course of less than one month, 45 percent was disbursed. The World Bank Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) II. DESCRIPTION OF PROPOSED CHANGES 4. The purpose of this level 2 restructuring is to: i) reallocate US$25 million from Category 1 of both H5572 and D0210 under the Parent Project to a newly created CER Category 5 for each, for a total of US$50 million for the CERC; and ii) reallocate US$30 million from Category 1 of GFF TF0A4579 under the First Additional Financing to a newly created CERC Category 2. The Recipient, with support from WHO, prepared and issued the Fourth Strategic Response Plan (SRP-4) for the 10th Ebola Virus Disease Outbreak (EVD 10), dated July 12, 2019, with an estimated budget of US$287.4 million for a 6-month intervention. The Recipient has requested a second activation of the CERC in the amount of US$80 million to finance SRP-4 whose main objective is to stop the chain of transmission and address the potential spread of Ebola within the country and across borders to neighboring countries. The intervention will be prolonged given the changing nature of the epidemic and unforeseeable evolution. 5. The first CERC, triggered in May 2018, reallocated US$80 million within H5998 from Categories 1, 2 and 3 to Category 4 (CERC). The additional funding required to replenish Categories 1, 2 and 3 was processed as part of AF3, which was approved in February 2019 but is not yet effective. The Effectiveness Deadline has been extended for the first time till November 4, 2019. Therefore, the proposed restructuring would reallocate funds within Grant D0210, Credit H5572 and TF0A4579 from Category 1 to newly-created expenditure CERC categories under the respective funding streams. The amount to be reallocated is US$25 million for Grant D0210, US$25 million for Credit H5572 and US$30 million for TF0A4579. 6. In addition to the changes listed above, minor adjustments are being in Schedule 1 -PDO and to the description of activities in the i) original Financing Agreement (FA) and Grant Agreement (GA), and ii) first Additional Financing FA and GGF GA to ensure full consistency across these documents. I. SUMMARY OF CHANGES Changed Not Changed Components and Cost ✔ Disbursements Arrangements ✔ Other Change(s) ✔ Implementing Agency ✔ DDO Status ✔ Project's Development Objectives ✔ Results Framework ✔ Loan Closing Date(s) ✔ Cancellations Proposed ✔ Reallocation between Disbursement Categories ✔ The World Bank Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) Disbursement Estimates ✔ Overall Risk Rating ✔ Safeguard Policies Triggered ✔ EA category ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Implementation Schedule ✔ Economic and Financial Analysis ✔ Technical Analysis ✔ Social Analysis ✔ Environmental Analysis ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_COMPONENTS_TABLE COMPONENTS Current Current Proposed Proposed Cost Action Component Name Component Name Cost (US$M) (US$M) Improve Utilization and Quality 0.00 No Change of Health Services at Health 182.00 Facilities through PBF Improve Governance, Purchasing and Coaching and 0.00 No Change Strengthen Health 92.70 Administration Directorates and Services through PBF Strengthen Health Sector 0.00 No Change Performance – Financing and 110.30 Health Policy Capacities Disease Surveillance System 0.00 No Change 135.00 Strengthening and Response TOTAL 0.00 520.00 The World Bank Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) .