FOR OFFICIAL USE ONLY Report No: RES36717 INTERNATIONAL DEVELOPMENT ASSOCIATION RESTRUCTURING PAPER ON A PROPOSED PROGRAM RESTRUCTURING OF STRENGTHENING PRIMARY HEALTH CARE FOR RESULTS PROGRAM APPROVED ON MAY 28, 2015 TO THE UNITED REPUBLIC OF TANZANIA Date Health, Nutrition & Population Global Practice Esat Africa Region Country Cluster 1 Africa Region Regional Vice President: Hafez M. H. Ghanem Country Director: Bella Bird Global Practice Director: Muhammad Ali Pate Practice Manager: Ernest E. Massiah Task Team Leader(s): Peter Okwero, Mariam Ally The World Bank Strengthening Primary Health Care for Results (P152736) ABBREVIATIONS AND ACRONYMS ANC Antenatal Care ANIS Achieving Nutrition Impact at Scale BEmONC Basic Emergency Obstetric and Neonatal Care BSC Balance Score Card CAG Controller and Auditor General CEmONC Comprehensive Emergency Obstetric and Neonatal Care CHW Community Health Worker DHIS District Health Information System DLIs Disbursement-linked Indicators DPs Development Partners EmOC Emergency Obstetric Care GFF Global Financing Facility GoT Government of Tanzania HBF Health Basket Fund HCWM Health Care Waste Management HFs Health Facilities HMIS Health Management Information System HSSP Health Sector Strategic Plan IAG Internal Auditor General ICT Information and Communication Technology IDA International Development Association IPT Intermittent Preventive Treatment LGAs Local Government Authorities M&E Monitoring and Evaluation MMR Maternal Mortality Ratio MNCH Maternal, Neonatal, and Child Health MoFP Ministry of Finance and Planning MOHCDGEC Ministry of Health, Community Development, Gender, Elderly and Children MTR Mid-term Review OPD Outpatient Department PDO Program Development Objective PHCforR Primary Health Care Program for Results PHC Primary Health Care PoN Power of Nutrition PORALG President’s Office Regional Administration and Local Government RBF Results-based Financing The World Bank Strengthening Primary Health Care for Results (P152736) RMNCAH Reproductive, Maternal, Neonatal, Child and Adolescent Health USAID United States Agency for International Development The World Bank Strengthening Primary Health Care for Results (P152736) DATA SHEET (Strengthening Primary Health Care for Results - P152736) BASIC DATA Project ID Financing Instrument IPF Component P152736 Program-for-Results Financing No Approval Date Current Closing Date 28-May-2015 30-Jun-2020 Organizations Borrower Responsible Agency Presidendt's Office Regional Administration and Local Ministry of Finance Finance and Planning Government,Ministry of Health, Community Development, Gender, Elderly and Children Program Development Objective(s) The Program Development Objective is to improve the quality of primary health care (PHC) services nationwide with a focus on maternal, neonatal and child health (MNCH) services. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing Net Approval Effectiveness Closing Ln/Cr/TF Signing Date Commitment Disbursed Undisbursed Date Date Date 28-May- IDA-56430 25-Aug-2015 05-Nov-2015 30-Jun-2020 200.00 159.43 41.83 2015 01-Aug- TF-A9831 01-Aug-2019 20-Sep-2019 30-Jun-2020 10.02 0 10.02 2019 23-May- TF-A1567 23-May-2016 20-Jul-2016 30-Jun-2020 4.50 3.98 .52 2016 28-May- TF-A0261 23-May-2016 20-Jul-2016 30-Jun-2020 20.00 8.78 11.22 2015 28-May- TF-A0270 23-May-2016 20-Jul-2016 30-Jun-2020 40.00 26.89 13.11 2015 Page 1 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) Policy Waiver(s) Does the Program require any waivers of Bank policies applicable to Program-for-Results operations? No Page 2 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) I. PROGRAM STATUS AND RATIONALE FOR RESTRUCTURING 1) The Tanzania Strengthening Primary Health Care for Results Program (PHCforR) has contributed to strengthening primary health care (PHC) services in Tanzania. In particular, the Program has contributed to expanding coverage of core Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) services, especially emergency obstetric care. In order to strengthen overall implementation and results focus of the Program, this Restructuring Paper seeks approval to restructure the Program with a focus on: (i) revising the results framework, (ii) revising the disbursement linked indicator (DLI) payment framework, (iii) reallocating funds between the DLIs, (iv) revising the disbursement estimates, (v) revising the institutional arrangements and (vi) changing implementation schedule by extending the Program closing date by one year. In addition, the Grant Agreement dated August 1, 2019 for the USAID grant (TF0A9831) would be amended to allow disbursement against results delivered during the full Program period. 2) The PHCforR was approved on May 28, 2015, became effective on November 5, 2015 and is due to close on June 30, 2020. The Program Development Objective (PDO) to improve the quality of primary health care services nation- wide with a focus on maternal, neonatal and child health (MNCH) services is consistent with the objectives of the Health Sector Strategic Plan (HSSP IV) and One Plan II1 of accelerating reduction of maternal and neonatal mortality through improving performance, governance and accountability in delivery PHC services. The PHC component of the HSSP IV with an estimated budget of US$2.620 billion over a five-year period constitutes the program. Total PHCforR financing of US$306 million to the program includes: (i) IDA credit (IDA-56430, US$200 million), (ii) USAID grant (US$46 million)2, (iii) Power of Nutrition grant (TF-A0261, US$20 million), and (iv) a Global Financing Facility (GFF) grant (TF- A0270, US$40 million). US$290 million was to be contributed by other development partners. The PHCforR, as of October 31, 2019, had disbursed US$198.5 million, representing a disbursement rate of 65 percent against the seven disbursement-linked indicators (DLIs) as summarized in Table 1. Overall, there are no known significant fiduciary or safeguards issues associated with the Program. 3) Based on the 2018 verified results, the Program has surpassed four out of five end of Program outcome targets and overall progress towards achievement of the PDO is rated Satisfactory. The PDO indicator (“share of health facilities achieving a 3-star rating based on the quality assessment”) remains behind schedule on achieving its annual target. Of 13 intermediate outcome indicators, 7 have achieved the annual targets, 2 are on-track with annual targets, and the rest are not on-track with annual targets. Overall Implementation Progress in the last Implementation Status Report ((ISR) archived June 28, 2019) was rated Moderately Unsatisfactory because of the suspension of RBF payments to health facilities in July 2018, which disrupted RBF implementation. RBF disbursements were resumed in June 2019, and implementation has picked up and normalized. With normalization of RBF disbursements the Implementation Progress rating has been upgraded to Moderately Satisfactory (December 2019). External audits of the Program are carried out on time and previous ones reported a clean opinion on the financial statements. 1 One Plan II is the National Road Map/Strategic Plan for Improvement of Reproductive, Maternal, Newborn, Child & Adolescent Health in Tanzania (2016 - 2020) and serves as the RMNCAH Investment Case. 2 The contribution from USAID based on the Program Appraisal Document is stated as US$40 million whereas the amount stated in the Administrative Agreement signed after Board approval is US$46.5 million. The World Bank Strengthening Primary Health Care for Results (P152736) Table 1. Disbursement Summary by DLI (US$) DLI Category Total original Disbursed Disbursed Disbursed Disbursed Total allocation Disbursed SDR - IDA US$- IDA TF A0261 TF A0270 TF A1567 56430 56430 DLI 1 20,000,000 7,250,000 10,000,000 4,000,000 14,000,000 DLI 2 75,000,000 31,375,970 43,000,000 2,200,000 45,200,000 DLI 3 106,000,000 8,963,285 12,303,543 5,699,151 8,185,582 3,979,000 30,166,546 DLI 4 82,000,000 29,396,167 40,350,942 1,622,384 41,973,326 DLI 5 2,400,000 1,117,936 1,534,546 1,534,546 DLI 6 5,600,000 2,674,961 3,671,812 3,671,812 DLI 7 15,000,000 3,625,000 5,000,000 2,500,000 7,500,000 306,000,000 84,403,319 115,860,843 7,321,535 16,885,582 3,979,000 144,046,230 DLI advance not Advance 26,542,602 36,433,968 1,462,289 10,000,000 54,480,000 accounted Total 110,945,92 306,000,000 1 152,294,811 8,783,824 26,885,582 3,979,000 198,526,230 4) The Program has contributed towards expanding coverage of core RMNCAH services. Between 2014 and 2018, mothers attending 4 antenatal care (ANC) visits, deliveries in health facilities, children receiving vitamin A supplementation, and availability of tracer medicines increased from 35 percent, 64 percent, 70 percent and 30 percent, to 60 percent, 78 percent, 100 percent and 77 percent, respectively. Over the same period, a total of 178 out of 304 Health Centers were refurbished to deliver emergency obstetric care, of which 81 are functional3. A step-wise star rating quality assessment of health facilities was launched and rolled out nationally. While still low, the percentage of health facilities rated 3 stars and above increased from 1 percent to 20 percent over the course of three years. Results Based Financing (RBF) has been rolled out in nine regions. These regions compared with non-RBF regions fare much better in their performance. In addition, the Program has (a) supported the introduction and use of Health Basket Fund (with a focus on RMNCAH indicators) performance scorecards in all regions and Local Government Authorities (LGAs); (b) jointly with other Health Basket Fund (HBF) partners contributed as a catalyst to launch and rollout direct health facility financing (DHFF) in Tanzania; and (c) strengthened governance, planning and budgeting at the LGA and health facility levels to manage RBF and DHFF. 5) Sustaining the Program’s achievements requires continued attention to tackling the major bottlenecks in a concerted manner. Many of the refurbished facilities are not fully functional and require adequate staffing and equipment to become operational; a focus of the Program. Government is in the process of procuring the first batch of medical equipment to equip the recently refurbished facilities. Government recruited over 7,680 new staff in 2018; however, overall staffing levels remain low with a shortage of 40 percent in the public sector. While funding for the LGAs and health facilities has increased following RBF and DHFF implementation, RMNCAH planning at the LGA and health facility levels remains weak. The government will continue to strengthen RMNCAH planning at the LGA level with the aim of ensuring RMNCAH programs are adequately reflected in the council plans and budgets. 3 100 Health Centers were refurbished with Program support. The World Bank Strengthening Primary Health Care for Results (P152736) 6) The Program’s implementation arrangements remain relatively robust and no major changes are envisioned4. The Program will continue using the current institutional arrangements for the delivery of PHC services. The Ministry of Health, Community Development, Gender, Elderly and Children as the steward of the health sector will be responsible for coordinating and providing oversight to the Program. PORALG, on the other hand, in accordance with the devolution arrangement will be responsible for coordinating and providing administrative support to the regions, LGAs and health facilities in the implementation of the Program. Finally, the Internal Auditor General and Controller and Auditor General will continue to be responsible for carrying out verification of the Program’s results. For annual audits of procurement contracts to be carried out timely as part of verification, the Internal Auditor General (IAG) will take over the audit responsibility from the Public Procurement Regulatory Authority. 7) The midterm review recommended revision of the results framework and the DLI payment framework. Since the original Program baseline data and targets were based on estimates, the results framework would be revised to incorporate the findings of the validation exercise of the Program baseline data and targets carried out in the first year of implementation. In addition, the results framework would be revised dropping indicators which are no longer applicable with the aim of strengthening overall implementation and results focus of the Program towards RMNCAH. The approach of using seven DLIs as seven platforms for performance-based financing at different levels in the system remains relevant. Together, they form a cascade of PHC-related accountability and performance at all levels. However, some sub-indicators of selected DLIs need to be updated to reflect the changes in the Program context. 8) Changes in DLI payment framework and reallocating funds between the DLIs are proposed in order to maximize the Program outcomes. However, some sub-indicators of selected DLIs need updating to reflect the changes in the Program context. Furthermore, changes in DLI payment framework and reallocation of funds between DLIs are proposed to maximize the Program outcomes. This will include simplification of the DLI 4 verification and payment method and reallocation of funds to support activities to ensure functionality of the refurbished CEmNOC facilities. The Disbursement Linked Results would also be updated to reflect revision of the results framework. In order to pay for results already achieved, the Grant Agreement for the USAID grant (TF0A9831) would be amended to permit disbursement against results delivered prior to the grant’s signing date. 9) The Program closing date would be extended by one year to June 30, 2021. The current disbursement projections for the last DLI payments cover only six months, and to align the last DLI payments with a full annual implementation cycle, the Program closing date would be extended by one year to June 30, 2021. 10) The task team confirms that: (a) the PforR PDO remains achievable; (b) the performance of the Borrower remains satisfactory; and (c) the World Bank and the Borrower have agreed on actions that will be undertaken by the Borrower to complete the PforR Program. II. DESCRIPTION OF PROPOSED CHANGES 11) The following are the proposed changes: a) Revision of the results framework (Refer to Table 8 for the revised results framework): 4Program implementation is coordinated by Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) and President’s Office, Regional Administration Local Government (PORALG) at the center, and the main implementing entities include: Regional councils, LGAs and health facilities. The World Bank Strengthening Primary Health Care for Results (P152736) (i) Dropping indicator on “annual employment permits for PHC given to the 9 critical regions”. This indicator has not been met since Program inception and the mandate for recruitments falls outside the MoHCDGEC. (ii) Replacing indicator “health facilities with continuous availability of 10 tracer medicines in the past year” with “health facilities with continuous availability of the tracer medicines in the past year (based on MoHCDGEC medicine list)” to reflect expected changes in tracer medicine list5; (iii) Replacing indicator “health facilities with CEmONC” with “health facilities with functional CEmONC” to shift attention to ensuring CEmONC facilities become operational; (iv) Replacing indicator “RHMT’s required annual supportive supervision visits for LGAs that meets national supervision standards” with “RHMTs conduct quarterly supportive supervision that meets national standards and is reported in the DHIS2”; and (v) Revision of the annual targets. b) Revision of the DLIs and DLI Payment Framework (Tables 2 - 7) (i) DLI 1. Revised to “Recipient has completed foundational activities” and payment period extended to cover entire Program period. Since the original DLRs were completed, a new one “Recipient has made refurbished health facilities CEmONC functional” will be added. For each facility with CEmONC made functional, the Recipient would be reimbursed US$262,500 (these facilities should be different from the 8 facilities which met CEmONC standards and triggered payment under DLI 1 previously); (ii) DLI 2. Revised to “Recipient has achieved Program annual results in institutional strengthening”, to drop all or nothing principle and introduce scalability, to drop DLR “annual employment permits for PHC given to the 9 critical regions”; and to add a new DLR “Recipient has carried out annual audit of procurement contracts”; (iii) DLI 3. Revised payment framework to exclude 28-day time frame for RBF payment; (iv) DLI 4. Simplify the payment calculation formula. Formula revised to reward health facilities that maintain high level performance (>80%); (v) Reallocated funds from DLI 2, 3 and 4 to DLI 1 to support functionality of refurbished facilities and to DLIs 5 and 6; and (vi) To enhance cost-savings and efficiency, the counter-verification sample size is proposed to be reduced from 25 percent to 10 percent of the health facilities in the selected areas. c) Extension of the Program closing date. The Program closing date will be extended from June 30, 2020 to June 30, 2021 to align the last DLI payments with a full annual implementation cycle, providing government adequate time to complete verification and submit the payment notification. The proposed closing date extension is applied to IDA, GFF and the Power of Nutrition’s (PoN) Achieving Nutrition Impact at Scale (ANIS) Multi-donor Trust Fund, but it is not applied to the USAID Grant as the task team agreed with the donor to keep the current closing date. d) Revision of DLI allocation and financing source. Reallocation of fund between DLIs is proposed based on the resource needed for each DLR as well as the remaining balance of each financing source. It also reflects the downward revision of absorption of USAID Grant based on the projection of disbursement by the Program closing date. The estimated grant amount to be absorbed is US$26 million, hence, US$26 million is included in the Disbursement Estimates, and the rest of US$20 million remain unallocated. 5 The revised list includes 15 tracer drugs. The World Bank Strengthening Primary Health Care for Results (P152736) e) Revision of the Disbursement Estimates. In accordance with the extension of the Program closing date, the Disbursement estimates are revised. Refer to Table 6 for the revised Disbursement Estimates. f) Other changes. The restructuring proposes to remove one of the Withdrawal Conditions on the USAID Grant (TF0A9831). Specifically, the paragraph under 1. of B. Withdrawal Conditions; Withdrawal Period, Section IV. Of Schedule 2 of the Agreement, “(a) for purposes of Section 3.04 of the Standard Conditions (renumbered as such pursuant to paragraph 5 of Section II of the Appendix to this Agreement and relating to Program Expenditures), for DLRs achieved prior to the date of this Agreement;” needs to be removed. The USAID Grant becomes available in tranches and there have been three installments made as of October 31, 2019. To-date, a total of US$16.82 million has been obligated under the original Trustee account (TF072444) and the parallel account (TF0730026). Although there are two Trustee accounts, the purpose and implementation arrangements remain unchanged. The rationale for the parallel account was to accommodate the change in the World Bank’s cost recovery framework. Following the 1st Grant Agreement, the 2nd Grant Agreement (TF0A9831) was signed on August 1, 2019, however, it erroneously includes a paragraph which restricts disbursement against the results achieved prior to the date of the Agreement, i.e. August 1, 2019. Because this Trust Fund should be co-financing the Program continuously, this restriction needs to be removed. 6While the 1st contribution was transferred under TF072444, the 2nd and the 3rd contribution has been transferred or is to be transferred under TF073002. The World Bank Strengthening Primary Health Care for Results (P152736) Table 2: Changes to DLIs/DLRs in the PHCforR (amounts reported in US$). DLI/DLR Original Description Original Amount Proposed Change to DLI/DLR Proposed Amount DLI 1 Recipient has 20,000,000 Recipient has completed 35,000,000 completed all (IDA 10,000,000; foundational activities. (IDA 25,000,000; foundational GFF 10,000,000) GFF 10,000,000) activities Previous DLRs were completed. Revision of DLI allocation DLR 1.7 Recipient has made refurbished health facilities CEmONC functional - at US$262,500 per CEmONC facility functional. DLI 2. Recipient has 75,000,000 Recipient has achieved Program 65,000,000 achieved all of the (IDA 70,000,000; annual results in institutional (IDA 60,000,000; Program annual GFF 5,000,000) strengthening. GFF 5,000,000) results in institutional Dropped all or nothing principle strengthening and introduced scalability. Revision of DLI allocation DLR 2.5 Annual employment Dropped. Indicator not met since - permits for PHC Program inception, and mandate to given to the 9 recruit is outside MoHCDGEC critical regions. DLR 2.7 Recipient has carried out annual audit of procurement contracts. Payment for the DLR – US$1,000,000 per year for the two remaining years. DLI 3 PHC facilities have 100,000,000 No change to DLI description. 81,000,000 improved MNCH (IDA 30,000,000; Dropped the 28-day time frame for (IDA 30,000,000; service delivery and GFF RBF payment. GFF 15,000,000; PoN quality as per 20,000,000; PoN Revision of DLI allocation 10,000,000; verified results and 10,000,000; USAID 26,000,000) received payments USAID on that basis each 40,000,000) quarter DLI 4 LGAs have improved 82,000,000 80,500,000 annual MNCH (IDA 72,000,000; No change to DLI description (IDA 65,500,000; service delivery and PoN 10,000,000) Revision of DLI allocation GFF 5,000,000; quality as measured PoN 10,000,000) by the LGA Balance Score Card DLR 4.9 Health facilities with Payment is based Health facilities with continuous continuous on the LGA availability of the tracer medicines availability of 10 balanced score in the past year - based on tracer medicines in card MoHCDGEC medicine list. the past year DLI 5 Regions have 2,400,000 (IDA 3,100,000 improved annual 2,400,000) No change to DLI description (IDA 3,100,000) The World Bank Strengthening Primary Health Care for Results (P152736) DLI/DLR Original Description Original Amount Proposed Change to DLI/DLR Proposed Amount performance in Revision of DLI allocation supporting PHC as measured by Regional Balance Score Card DLR 5.2 RHMT’s required RHMTs conduct quarterly annual supportive supportive supervision that meets supervision visits for national standards and is reported LGAs that meets in the DHIS2 national supervision standards 0.6 score for every 1% of required quarterly supportive 0.6 score for every supervision visits 1% of required annual supportive supervision visits that meets national supervision standards DLI 6 MoHCDGEC and PO- 5,600,000 6,400,000 RALG have (IDA 5,600,000) No change to DLI description (IDA 6,400,000) improved PHC Revision of DLI allocation performance as measured by the National Balance Score Card DLI 7 Completion of 15,000,000 15,000,000 annual institutional (IDA 10,000,000; No change to DLI description (IDA 10,000,000; strengthening GFF 5,000,000) Revision of DLI allocation GFF 5,000,000) activities at all levels Unallocat USAID 20,000,000 ed Total 300,000,000 306,000,000 The World Bank Strengthening Primary Health Care for Results (P152736) Table 3: Revised Total Financing and Disbursement per Financier Total Balance Total amount % of total Financier Disbursement (US$) Payment (US$) (US$) USAID 46,000,0005 3,979,000 8.65% 42,021,000 IDA-56430 200,000,000 115,860,843 58% 84,139,157 Power of 20,000,000 7,321,535 37% 12,678,465 Nutrition GFF 40,000,000 16,885,582 42% 23,114,418 Total 306,000,000 144,046,230 47% 161,953,770 Table 4: Allocation of Remaining Balances to each DLI from each Source Total Total New DLI DLI Remaining Balance Remaining Allocation Payment Balance IDA 56430 IDA 56430 TF A1567 TF A0261 TF A0270 (USD) (SDR) TF A9831 DLI 1 35,000,000 14,000,000 15,000,000 10,875,000 6,000,000 21,000,000 DLI 2 65,000,000 45,200,000 17,000,000 12,124,030 2,800,000 19,800,000 DLI 3 81,000,000 30,166,546 17,696,000 12,786,715 4,300,849 6,814,418 22,022,187 50,833,454 DLI 4 80,500,000 41,973,326 25,149,058 18,089,833 8,377,616 5,000,000 38,526,674 DLI 5 3,100,000 1,534,546 1,565,454 1,142,464 1,565,454 DLI 6 6,400,000 3,671,812 2,728,188 1,953,639 2,728,188 DLI 7 15,000,000 7,500,000 5,000,000 3,625,000 2,500,000 7,500,000 Unallocated 20,000,000 5 Based on the projection, it is estimated that the Program will be able to absorb maximum US$26 million from the USAID Grant. The World Bank Strengthening Primary Health Care for Results (P152736) Table 5: Revised DLI Financing as per Financing Source DLI Credit 5643 TF0A0270 TF0A0261 TF0A1567/ Total TF0A9831 IDA GFF ANIS (Power of USAID Nutrition) SDR USD USD USD USD USD DLI 1 18,125,000 25,000,000 10,000,000 - 35,000,000 DLI 2 43,500,000 60,000,000 - 65,000,000 5,000,000 DLI 3 21,750,000 30,000,000 15,000,000 10,000,000 26,000,000 81,000,000 DLI 4 47,486,000 65,500,000 5,000,000 10,000,000 80,500,000 DLI 5 2,260,400 3,100,000 - - 3,100,000 DLI 6 4,628,600 6,400,000 6,400,000 DLI 7 7,250,000 10,000,000 5,000,000 - 15,000,000 Unallocate 20,000,000 d Total 145,000,000 200,000,000 40,000,000 20,000,000 46,000,000 306,000,000 The World Bank Strengthening Primary Health Care for Results (P152736) Table 6: Proposed Adjustments to SPHCforR: DLIs, Disbursement Estimates Status DLIs Total Financing As % of Achievements to date under the Indicative timeline for future achievements Allocated to DLI Total DLI under the DLI (US$) Financing Results Financing amount 2018/19 2019/20 2020/21 Change in total Amount achieved disbursed* financing Revised DLI 1 Current allocated 20,000,000 6.7% 70% 14,000,000 - - - amount: Modified allocated 35,000,000 12% 70% 14,000,000 - 15,000,000 6,000,000 US$15 M added to amount: this DLI Revised DLI 2 Current allocated 75,000,000 25% 70% 45,000,000 15,000,000 15,000,000 - amount: Modified allocated 65,000,000 23% 60% 45,000,000 - 10,000,000 10,000,000 US$10 M amount: reallocated to DLI 1 Revised DLR 2.1 Modified allocated 4,000,000 2,000,000 2,000.000 amount: Revised DLR 2.2 Modified allocated 4,000,000 2,000,000 2,000,000 amount: Revised DLR 2.3 Modified allocated 4,000,000 2,000,000 2,000,000 amount: Revised DLR 2.4 Modified allocated 2,000,000 1,000,000 1,000,000 amount: Dropped DLR 2.5 Modified allocated - - - - - - - - amount: Revised DLR 2.6 Modified allocated 4,000,000 2,000,000 2,000,000 amount: New DLR 2.7 2,000,000 1,000,000 1,000,000 Revised DLI 3 The World Bank Strengthening Primary Health Care for Results (P152736) Status DLIs Total Financing As % of Achievements to date under the Indicative timeline for future achievements Allocated to DLI Total DLI under the DLI (US$) Financing Results Financing amount 2018/19 2019/20 2020/21 Change in total Amount achieved disbursed* financing Current allocated 100,000,000 33.3% 19% 19,000,000 25,000,000 25,000,000 - - amount: Modified allocated 81,000,000 28% 19% 19,000,000 22,000,000 20,000,000 20,000,000 - Reflected the amount: downward estimate for USAID TF. Allocated $26M from USAID TF. - Reallocated US$5 M to DLI 1 DLI 4 Current allocated 82,000,000 27.3% 54% 44,000,000 20,500,00 20,500,000 - amount: Modified allocated 80,500,000 28% 54% 44,000,000 16,000,000 10,500,000 10,000,000 Less $1.5 M to be amount: allocated 0.7 M to DLI 5 and 0.8 M to DLI 6 Maintained DLI 5 Current allocated 2,400,000 0.8% 67% 1,600,000 600,000 600,000 - amount: Modified allocated 3,100,000 1% 67% 1,600,000 500,000 500,000 500,000 amount: DLI 6 Current allocated 5,600,000 1.9% 66% 3,700,000 1,400,000 1,400,000 - amount: Modified allocated 6,400,000 2% 66% 3,700,000 1,100,000 800,000 800,000- amount: MOH PORALG DLI 7 The World Bank Strengthening Primary Health Care for Results (P152736) Status DLIs Total Financing As % of Achievements to date under the Indicative timeline for future achievements Allocated to DLI Total DLI under the DLI (US$) Financing Results Financing amount 2018/19 2019/20 2020/21 Change in total Amount achieved disbursed* financing Current allocated 15,000,000 5% 51% 7,500,000 3,750,000 3,750,000 amount: Modified allocated 15,000,000 5% 51% 7,500,000 1,675,000 3,750,000 1,675,000 amount: UNALLOCATED 20,000,000 TOTAL 306,000,000 - The World Bank Strengthening Primary Health Care for Results (P152736) Table 7. Bank Disbursement Table No. DLI Bank Deadline for DLI Minimum DLI Maximum DLI Determination of Financing Amount to be disbursed against achieved and financing Achievement value to be value(s) verified DLI values allocated achieved to expected to be to the DLI trigger achieved for (US$ disbursements Bank million) of Bank disbursements Financing purpose 1 Recipient has 35 Every year, for No minimum 100% Formula: Disbursement amount is US$2 million for each of the five results, completed Year 1, 2,3, 4, 5 threshold US$10 million for sixth result, and US$21 million for the 7th result. foundational and 6 There are three activities within the sixth result with the following formulas6: activities  US$2 million for completion of BEmONC and CEmONC assessment;  US$0.5 million for each health center meeting CEmONC standards, with total amount not exceeding US$4 million;  US$57,143 for each 1% of health centers meeting BEmONC standards, with total amount not exceeding US$ 4 million7 There is one activity under the 7th result with the following formula  US$262,500 for each functional health facility which has been refurbished recently to provide CEmONC services, with total amount not exceeding US$ 21 million (80 facilites); 2 Recipient has 65 Feb 15 every No minimum 100% Formula: Disbursement is US$15 million annually for Year 1, 2, 3, 4 and achieved year threshold Disbursement of US$10 million annually for Year 5 and 6. Program  US$2 million per annum for the achieved target of “share of health in annual results total government budget” in institutional  US$2 million per annum achieved target of “percentage of council strengthening whose annual comprehensive Council Health Plan (CCHP) passes the first round of assessment” for Year 5 and 6.  US$2 million per annum for achieved target of “Action Plans of Audits of PORALG and MOHCDGEC received within 2 months of the official release of the Controller and Auditor General (CAG) report” for Year 5 and 6. 6 First five results (DLR 1.(a)-1.(e)) and two sub-results under sixth result (DLR 1. (f) (i)&(ii)) were achieved. No disbursement will be made in Year 4-6. 7 This activity is partially completed and passed the intended timeline. Therefore, no disbursement will be made in Year 4-6. The World Bank Strengthening Primary Health Care for Results (P152736) No. DLI Bank Deadline for DLI Minimum DLI Maximum DLI Determination of Financing Amount to be disbursed against achieved and financing Achievement value to be value(s) verified DLI values allocated achieved to expected to be to the DLI trigger achieved for (US$ disbursements Bank million) of Bank disbursements Financing purpose  US$2 million of achieved target of «percentage of PHC facilities with bank accounts opened according to guidelines from Ministry of Finance (MoFP)/CAG” for Year 5 and 6.  US$1 million per annum of achieved target of «percentage of completion of “Star rating" assessment of PHC facilities” for Year 5 and 6.  US$1 million per annum of achieved target of “recipient has carried out annual audit of procurement contracts” for Year 5 and 6. 3 PHC facilities 81 30 days after No minimum 100% Formula: Quarterly disbursement amount = (Sum of actual RBF payments in the have improved the end of each threshold past quarter) * 1.15 MNCH service quarter delivery and quality as per verified results and received payments on that basis each quarter 4 LGAs have 80.5 Every year, for No minimum 100% Formula: First, performance score for the past FY will be generated for each improved Year 2,3, 4, 5 threshold LGA, using the LGA BSC (expressed as %). Second, weighted average (by annual MNCH and 6 population) of LGA scores in the past FY will be calculated service delivery and Each year disbursement would be as follows: quality as Year 2: US$292,857 for every 1 percentage point between 1% and 70%, measured by US$ 516,667 for every 1 percentage point of achievement between 71% and the LGA 100%, with total disbursement not exceeding US$36 M in Year 2 Balance Score Year 3: US$256,250 for every 1 percentage point between 1% and 80%, Card US$ 775,000 for every 1 percentage point of achievement between 81% and 100%, with total disbursement not exceeding US$36 M in Year 3 Year 4(2018/19): US$227,778 for every 1 percentage point, with total disbursement not exceeding US$18 M in Year 4 The World Bank Strengthening Primary Health Care for Results (P152736) No. DLI Bank Deadline for DLI Minimum DLI Maximum DLI Determination of Financing Amount to be disbursed against achieved and financing Achievement value to be value(s) verified DLI values allocated achieved to expected to be to the DLI trigger achieved for (US$ disbursements Bank million) of Bank disbursements Financing purpose Year 5 (2019/20): US$100,000 for every 1 percentage point, with total disbursement not exceeding US$10.5 M in Year 5 Year 6 (2020/21): US$105,000 for every 1 percentage point, with total disbursement not exceeding US$10 M in Year 6 Allocation to each LGA will then be a function of its performance score and a government equity formula8 5 Regions have 3.1 Every year, for No minimum 100% Formula: First, performance score for the past FY will be generated for each improved Year 2,3, 4, 5 threshold region, using the Regional BSC (expressed as %). Second, weighted average (by annual and 6 population) of regional scores in the past FY will be calculated performance in supporting Each year disbursement would be as follows: PHC as Year 2: US$8,571 for every 1 percentage point, with total disbursement not measured by exceeding US$0.6 M in Year 2 Regional Year 3: US$7,500 for every 1 percentage point, with total disbursement not Balance Score exceeding US$0.6M in Year 3 Card Year 4 (2018/19): US$7,500 for every 1 percentage point, with total disbursement not exceeding US$0.5 M in Year 4 Year 5 (2019/20): US$5,000 for every 1 percentage point, with total disbursement not exceeding US$0.5 M in Year 5 Year 6 (2020/21): US$5,000 for every 1 percentage point, with total disbursement not exceeding US$0.5 M in Year 6 Allocation to each region will be a function of its performance score and population 8The government’s equity-based formula for the allocation of funds to LGAs will be the same as the one used for the Health Basket Fund and includes weighting by population, poverty, LGA BSC score and geographical constraints (to adjust for distances). The World Bank Strengthening Primary Health Care for Results (P152736) No. DLI Bank Deadline for DLI Minimum DLI Maximum DLI Determination of Financing Amount to be disbursed against achieved and financing Achievement value to be value(s) verified DLI values allocated achieved to expected to be to the DLI trigger achieved for (US$ disbursements Bank million) of Bank disbursements Financing purpose 6 MOHCDGEC 6.4 Every year, for No minimum 100% See operational manual and Annex 10. and PO-RALG Year 2,3, 4, 5 threshold have improved and 6 First, performance score for the past FY will be generated for MOHCDGEC and PHC PO-RALG, using the National BSC (expressed as %) performance as measured Annual disbursement amount for MOHCDGEC will be calculated as follows: by the National Year 2: US$17,143 for every 1 percentage point, with total disbursement not Balance Score exceeding Card US$1.2 M in Year 2 Year 3: US$15,000 for every 1 percentage point, with total disbursement not exceeding US$1.2 M in Year 3 Year 4: US$15,000 for every 1 percentage point, with total disbursement not exceeding US$0.9 M in Year 4 Year 5: US$6,850 for every 1 percentage point, with total disbursement not exceeding US$0.68 M in Year 5 Year 6: US$6,850 for every 1 percentage point, with total disbursement not exceeding US$0.68 M in Year 6 Annual disbursement amount for PO-RALG will be calculated as follows: Year 2: US$2,857 for every 1 percentage point, with total disbursement not exceeding US$0.2 M in Year 2 Year 3: US$2,500 for every 1 percentage point, with total disbursement not exceeding US$0.2 M in Year 3 Year 4: US$2,500 for every 1 percentage point, with total disbursement not exceeding US$0.2 M in Year 4 Year 5: US$1,150 for every 1 percentage point, with total disbursement not exceeding US$0.12 M in Year 5 Year 6: US$1,150 for every 1 percentage point, with total disbursement not exceeding US$0.12 M in Year 6 The World Bank Strengthening Primary Health Care for Results (P152736) No. DLI Bank Deadline for DLI Minimum DLI Maximum DLI Determination of Financing Amount to be disbursed against achieved and financing Achievement value to be value(s) verified DLI values allocated achieved to expected to be to the DLI trigger achieved for (US$ disbursements Bank million) of Bank disbursements Financing purpose Annual disbursement amount for PO-RALG = US$ 0.4 M * performance score by PO-RALG 7 Completion of 15 June 30every No minimum 100% Each year the rate of implementation of the annual Capacity Building Plan is annual year (for threshold calculated. This rate will be defined in accordance to a methodology set forth in institutional completion of the Program Operations Manual. strengthening activities the activities at all previous year) DLI allocation is US$37,500 per one percentage point of Capacity Building Plan levels implementation rate per year in Year 1,2,3,4 and 5. Year 6: US$16,750 for every 1 percentage point, with total disbursement not exceeding US$1.675M in Year 6 Disbursement is once a year, when verified results are available Unallocated 20 TOTAL 306 The World Bank Strengthening Primary Health Care for Results (P152736) Table 8: Revised Results Framework PDO INDICATORS UNIT BASELINE TARGET VALUES 2014/15 Y1 Y2 Y3 Y4 Y5 Y6 1. PHC facilities with 3-star ratings and % Original 0 10 15 25 35 50 50 above Achieved 0 1 2 22 19 Revised 1 4 9 NA 29 NA 35 2. Pregnant women attending four or % Original 41.2 45 49 53 57 60 64 more ante-natal care (ANC) visits Achieved 35 38 42 46 64 Revised 35 38 42 46 50 53 56 3. ANC attendees receiving at least 2 % Original 42.52 45 49 53 57 60 64 doses of intermittent preventive Achieved 34 57 60 66 81 treatment (IPT2) for Malaria Revised 34.3 37 41 53 57 60 80 4. Institutional Deliveries % Original 44.7 48 51 54 57 60 70 Achieved 64 63 65 70 79 Revised 64.3 67 70 70 70 70 80 5. Proportion of children 12-59 months % Original 51 53 55 57 61 65 80 receiving at least one dose of Achieved 63 72 100 100 100 100 Vitamin A supplementation during Revised 70 72 74 76 78 90 100 the previous year INTERMEDIATE RESULTS 1. Share of health in total government % Original 8.5 8.75 9.0 9.25 9.5 9.75 10 budget Achieved 8 9.4 8.1 10.3 8 Revised 8 8.75 9 9.25 9.5 9.75 10 2. Councils with unqualified opinion in % Original 80 82 84 86 88 90 92 the annual external audit report Achieved 80 29 81 90 96 Revised 90.6 100 34 86 88 90 92 3. Completion of “Star rating” % Original 0 20/0 30/0 50/20 0/30 0/50 0/50 assessment of PHC facilities as per Achieved 0 46.4 100 100/41 100 the two-year cycle Revised NA 50/0 100 NA 100 0/50 The World Bank Strengthening Primary Health Care for Results (P152736) 4. RBF facilities receiving timely RBF % Original 0 75 80 85 90 95 - payment on the basis of verified Achieved 0 0 0 0 results every quarter Revised 0 75 80 85 90 95 100 5. LGAs with functional Council Health % Original 86.3 88 91 94 97 100 100 Service Boards Achieved 57 85 90 79 84 Revised 64.6 100 90 94 97 100 100 6. Annual employment permits for PHC % Original 32 30 40 40 30 30 35 given to the 9 critical regions Achieved 25 32 NA NA 30 Dropped Dropped Revised 25 40 NA 20 30 40 35 7. Dispensaries with skilled HRH % Original 91 93 95 97 99 100 100 Achieved N/A 90 81 75 83 Revised NA NA 92 83 85 87 100 8. Health facilities with continuous % Original 30.6 35 40 45 50 55 80 availability of the tracer medicines in Achieved 30 45 60 82 96 the past year Revised 29.5 34.5 50 60 67 70 80 9. Health facilities with functional Unit Original 79 91 104 104 104 104 CEmNOC Achieved 79 NA NA 124 NA Revised NA 91 104 104 81 120 160 10. Completeness of quarterly % Original 89.5 91 92 93 94 95 96 HMIS data entered in DHIS by LGA Achieved 88 89 97 96 99 (by the end of month after quarterly Revised 87.3 89.3 90 93 94 95 96 ends) 11. RHMT's required biannual % Original 0 50 60 70 80 90 80 data quality audits (DQA) for LGAs Achieved 0 0 19.2 51 68 that meets national DQA standards. Revised 0 100 100 40 55 70 80 12. RHMT's conduct quarterly % Original 0 50 60 70 80 90 100 supportive supervision visits for Achieved 0 77 85 92 67 LGAs that meets national Revised 9 100 100 70 80 90 100 supervision standards. 13. Completion of annual capacity % Original NA 90 90 90 90 90 90 building activities compared to Achieved NA 0 100 39 50 The World Bank Strengthening Primary Health Care for Results (P152736) agreed annual plans. Revised NA 90 90 90 90 90 90 The World Bank Strengthening Primary Health Care for Results (P152736) III. SUMMARY OF CHANGES Changed Not Changed Change in Results Framework ✔ Change in Loan Closing Date(s) ✔ Reallocation between and/or Change in DLI ✔ Change in Disbursement Estimates ✔ Change in Institutional Arrangements ✔ Change in Implementation Schedule ✔ Other Change(s) ✔ Change in Implementing Agency ✔ Change in Program's Development Objectives ✔ Change in Program Scope ✔ Change in Cancellations Proposed ✔ Change in Disbursements Arrangements ✔ Change in Systematic Operations Risk-Rating Tool ✔ (SORT) Change in Safeguard Policies Triggered ✔ Change in Legal Covenants ✔ Change in Technical Method ✔ Change in Fiduciary ✔ Change in Environmental and Social Aspects ✔ The World Bank Strengthening Primary Health Care for Results (P152736) IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_LOANCLOSING_TABLE LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/TF Status Closing Date Closing(s) Date Closing Date for Withdrawal Applications IDA-56430 Effective 30-Jun-2020 30-Jun-2021 30-Oct-2021 TF-A0261 Effective 30-Jun-2020 30-Jun-2021 30-Oct-2021 TF-A0270 Effective 30-Jun-2020 30-Jun-2021 30-Oct-2021 TF-A1567 Effective 30-Jun-2020 30-Jun-2020 30-Oct-2020 TF-A9831 Effective 30-Jun-2020 30-Jun-2020 30-Oct-2020 OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE DISBURSEMENT ESTIMATES Year Current Proposed 2015 0.00 0.00 2016 16,986,800.00 0.00 2017 34,418,400.00 0.00 2018 46,127,600.00 0.00 2019 44,213,600.00 41,475,000.00 2020 34,752,800.00 56,050,000.00 2021 23,500,800.00 53,475,000.00 OPS_DETAILEDCHANGES_EA_TABLE . The World Bank Strengthening Primary Health Care for Results (P152736) ANNEX 1: RESULTS FRAMEWORK . . Results framework Program Development Objectives(s) The Program Development Objective is to improve the quality of primary health care (PHC) services nationwide with a focus on maternal, neonatal and child health (MNCH) services. Program Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_PDO Indicator Name DLI Baseline End Target To improve the quality of PHC services nationwide with a focus on MNCH services PHC facilities with 3- Star Ratings and Above (Percentage) 0.00 30.00 Rationale: Action: This indicator has been Revised Added end project target in light of extension of closing date Pregnant women attending 4 or more ante-natal care (ANC) 41.20 68.00 visits (Percentage) Rationale: Action: This indicator has been Revised Added end project target in light of extension of closing date Page 25 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) RESULT_FRAME_TBL_PDO Indicator Name DLI Baseline End Target ANC attendees receiving at least 2 doses of intermittent 42.52 80.00 preventive treatment (IPT2) for malaria (Percentage) Rationale: Action: This indicator has been Revised Added end project target in light of extension of closing date Institutional deliveries (Percentage) 44.72 70.00 Rationale: Action: This indicator has been Revised Added end project target in light of extension of closing date Proportion of children 12-59 months receiving at least one dose 51.00 90.00 of Vitamin A during the previous year (Percentage) Rationale: Action: This indicator has been Revised Added end project target in light of extension of closing date PDO Table SPACE Intermediate Results Indicators by Result Areas RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Intermediate Results Indicators Share of health in total government budget (Percentage) 8.50 9.75 Page 26 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Rationale: Action: This indicator has been Revised Added end project target in light of extension of closing date Councils with unqualified opinion in the annual external audit 80.00 92.00 report (Percentage) Rationale: Action: This indicator has been Revised Added end project target in light of extension of closing date Completion of “Star rating" assessment of PHC facilities as per 0.00 50.00 the two-year cycle (Percentage) Rationale: Action: This indicator has been Revised Added end project target in light of extension of closing date RBF facilities receiving timely RBF payment on the basis of 0.00 100.00 verified results every quarter (Percentage) Rationale: Action: This indicator has been Revised Added end project target in light of extension of closing date LGAs with functional Council Health Service Boards (Percentage) 86.30 100.00 Rationale: Action: This indicator has been Revised Added end project target in light of extension of closing date Annual employment permits for PHC given to the 9 critical 32.00 30.00 regions (Percentage) Page 27 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Rationale: Action: This indicator has been Marked for Deletion Recruitment is outside the mandate of the Ministry of Health Health facilities with continuous availability of the tracer medicines in the past year based on MoHCDGEC medicine list 30.60 80.00 (Percentage) Rationale: Action: This indicator has been Revised This is to reflect the regular revision of the list of tracer medicines Health facilities with functional CEmOC (Number) 0.00 160.00 Rationale: Action: This indicator has been Revised In order to monitor functionality and not mere construction Completeness of quarterly HMIS data entered in DHIS by LGA (by 89.50 96.00 the end of month after quarter ends) (Percentage) Rationale: Action: This indicator has been Revised Added end project target in light of extension of closing date RHMT’s required biannual data quality audits (DQA) for LGAs 0.00 80.00 that meets national DQA standards (Percentage) Rationale: Action: This indicator has been Revised Added end project target in light of extension of closing date Page 28 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Completion of annual capacity building activities compared to 0.00 90.00 agreed annual plans (Percentage) Rationale: Action: This indicator has been Revised Added end project target in light of extension of closing date Dispensaries with skilled HRH (Percentage) 91.00 90.00 Rationale: Action: This indicator has been Revised Added end project target in light of extension of closing date RHMTs conduct quarterly supportive supervision visits for the LGAs that meets national supervision standards and is reported 0.00 100.00 in DHIS2 (Percentage) Rationale: Action: This indicator has been Revised To provide for clarity (quarterly) and ensure the supervision visits are reported in the system. People who have received essential health, nutrition, and 0.00 30,000,000.00 population (HNP) services (CRI, Number) Number of children immunized (CRI, Number) 0.00 10,000,000.00 Number of women and children who have received basic 0.00 10,000,000.00 nutrition services (CRI, Number) Number of deliveries attended by skilled health personnel 0.00 10,000,000.00 (CRI, Number) IO Table SPACE Page 29 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) Disbursement Linked Indicators Matrix DLI IN00760848 ACTION DLI 1 DLI 1: Recipient has completed foundational activities Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output Yes Yes/No 20,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No 2015-16 Yes 20,000,000.00 2016-17 0.00 2017-18 0.00 2018-19 0.00 2019-20 0.00 2020-21 0.00 Action: This DLI has been Revised. See below. DLI IN00761600 ACTION DLI 1 DLI 1: Recipient has completed foundational activities Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output Yes Yes/No 35,000,000.00 40.00 Period Value Allocated Amount (USD) Formula Page 30 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) Baseline No 2015-16 Yes 0.00 2016-17 10,000,000.00 2017-18 4,000,000.00 2018-19 0.00 2019-20 15,000,000.00 2020-21 6,000,000.00 Rationale: The majority foundational DLRs (1 - 5) were achieved and fully paid out. DLR 6 was partly achieved leaving a balance of US$4 million. With the achievement, the original DLRs are discontinued. However, a new DLR, Recipient has made refurbished health facilities functional is to added to focus attention to ensuring refurbished CEmNOC facilities become functional. Out of 304 CEmNOC facilities refurbished, 178 have been completed and 81 are functional. The proposal is to get the additional 80 facilities functional over the next two years. DLI IN00760851 ACTION DLI 2 DLI 2: Recipient has achieved all of the Program annual results in institutional strengthening at all levels Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Yes/No 75,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No 2015-16 Yes 15,000,000.00 2016-17 Yes 15,000,000.00 Page 31 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) 2017-18 15,000,000.00 2018-19 15,000,000.00 2019-20 15,000,000.00 2020-21 0.00 Action: This DLI has been Revised. See below. DLI IN00761658 ACTION DLI 2 DLI 2: Recipient has achieved Program annual results in institutional strengthening Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Yes/No 65,000,000.00 69.23 Period Value Allocated Amount (USD) Formula Baseline No 2015-16 Yes 15,000,000.00 2016-17 Yes 15,000,000.00 2017-18 15,000,000.00 2018-19 0.00 2019-20 10,000,000.00 2020-21 10,000,000.00 Rationale: Page 32 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) To drop all or nothing principle and introduce scalability, and in that way avoid penalizing the client even when one out of six DLRs are not met. The DLR annual employment permits for PHC given to the 9 critical regions is to be dropped as it has never been met and falls outside the mandate of the Ministry of Health and PORALG. ;In addition, a new DLR “Recipient has carried out annual audit of procurement contracts” is to be added to encourage government carries out the audits timely. DLI IN00760854 ACTION DLI 3: PHC facilities have improved maternal, neonatal and child health services delivery and quality as per verified results DLI 3 and received payments on that basis each quarter Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Number 100,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 2015-16 20,000,000.00 2016-17 20,000,000.00 2017-18 20,000,000.00 2018-19 20,000,000.00 2019-20 20,000,000.00 2020-21 0.00 Action: This DLI has been Revised. See below. Page 33 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) DLI IN00769691 ACTION DLI 3: PHC facilities have improved maternal, neonatal and child health services delivery and quality as per verified results DLI 3 and received payments on that basis each quarter Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Number 81,000,000.00 37.24 Period Value Allocated Amount (USD) Formula Baseline 0.00 2015-16 0.00 2016-17 10,000,000.00 2017-18 11,000,000.00 2018-19 20,000,000.00 2019-20 20,000,000.00 2020-21 20,000,000.00 DLI IN00760857 ACTION DLI 4: LGAs have improved annual maternal, neonatal and child health services delivery and quality as measured by the DLI 4 LGA Balance Score Card . Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Outcome Yes Percentage 82,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 Page 34 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) 2015-16 80.00 16,000,000.00 2016-17 16,000,000.00 2017-18 16,000,000.00 2018-19 17,000,000.00 2019-20 17,000,000.00 2020-21 0.00 Action: This DLI has been Revised. See below. DLI IN00769640 ACTION DLI 4: LGAs have improved annual maternal, neonatal and child health services delivery and quality as measured by the DLI 4 LGA Balance Score Card . Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Outcome Yes Percentage 80,500,000.00 52.14 Period Value Allocated Amount (USD) Formula Baseline 0.00 2015-16 80.00 16,000,000.00 2016-17 14,000,000.00 2017-18 14,000,000.00 2018-19 16,000,000.00 Page 35 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) 2019-20 10,500,000.00 2020-21 10,000,000.00 DLI IN00760860 ACTION DLI 5 DLI 5: Regions have improved annual performance in supporting PHC services as measured by Regional Balance Score Card. Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Outcome Yes Percentage 2,400,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 2015-16 80.00 480,000.00 2016-17 480,000.00 2017-18 480,000.00 2018-19 480,000.00 2019-20 480,000.00 2020-21 0.00 Action: This DLI has been Revised. See below. Page 36 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) DLI IN00769696 ACTION DLI 5 DLI 5: Regions have improved annual performance in supporting PHC services as measured by Regional Balance Score Card. Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Outcome Yes Percentage 3,010,000.00 50.98 Period Value Allocated Amount (USD) Formula Baseline 0.00 2015-16 80.00 500,000.00 2016-17 500,000.00 2017-18 510,000.00 2018-19 500,000.00 2019-20 500,000.00 2020-21 500,000.00 DLI IN00760862 ACTION DLI 6 DLI 6: MOHSW and PMO-RALG have improved annual PHC service performance as measured by National Balance Scorecard Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Percentage 5,600,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 2015-16 80.00 1,120,000.00 Page 37 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) 2016-17 1,120,000.00 2017-18 1,120,000.00 2018-19 1,120,000.00 2019-20 1,120,000.00 2020-21 0.00 Action: This DLI has been Revised. See below. DLI IN00769697 ACTION DLI 6: MoHCDGEC and PO-RALG have improved annual PHC service performance as measured by National Balance DLI 6 Scorecard Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Percentage 6,400,000.00 57.37 Period Value Allocated Amount (USD) Formula Baseline 0.00 2015-16 80.00 1,100,000.00 2016-17 1,100,000.00 2017-18 1,200,000.00 2018-19 1,400,000.00 2019-20 800,000.00 Page 38 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) 2020-21 800,000.00 DLI IN00760864 ACTION DLI 7 DLI 7: Completion of annual capacity building activities at all levels as per the agreed annual plans. Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Yes/No 15,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No 2015-16 Yes 3,000,000.00 2016-17 3,000,000.00 2017-18 3,000,000.00 2018-19 3,000,000.00 2019-20 3,000,000.00 2020-21 0.00 Action: This DLI has been Revised. See below. DLI IN00769698 ACTION DLI 7 DLI 7: Completion of annual capacity building activities at all levels as per the agreed annual plans. Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Yes/No 15,000,000.00 50.00 Period Value Allocated Amount (USD) Formula Page 39 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) Baseline No 2015-16 Yes 0.00 2016-17 3,750,000.00 2017-18 3,750,000.00 2018-19 1,875,000.00 2019-20 3,750,000.00 2020-21 1,875,000.00 Page 40 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) ANNEX 2: PROGRAM ACTION PLAN . . PAP_CHANGE_TBL Action Completion Description Source DLI# Responsibility Timing Measurement Action Appoint Internal Client Due Date 25-Nov-2015 No Change Auditor General as the independent verification entity. Submit basic Client Due Date 30-Dec-2016 No Change reporting requirements for the sector as per the HBF requirement. Implement the Client Recurrent Yearly No Change ESSA through the following: i) Inclusion of HCWM in the CCHP ii) Monitor and report on the implementation of HCWM activities in the CCHP. Review the Client Due Date 30-Jan-2017 No Change existing procurement vetting mechanisms with a view to reducing backlog Operationalize Client Due Date 31-May-2018 No Change MSD system that issues out stock notices to facilities within one day as prescribed in the 2013 Public Procurement Regulation Act (Section 140) and Page 41 of 43 The World Bank Strengthening Primary Health Care for Results (P152736) the 2013 Public Procurement sub- regulations (Subsections 1 to 6). Conduct annual Fiduciary Systems Client Recurrent Yearly Submission of No Change procurement report audits of the program as well as Value for Money (VFM) audits by PPRA and CAG Establish a Technical Permanent Recurrent Quarterly Minutes of New PHCfoR Technical Secretary Meetings Committee and hold regular meetings to monitor implementation progress Promote the use Technical RCH Director Recurrent Yearly Score Cards New of performance and Project reports scorecard to Coordinator enhance accountability . Page 42 of 43