World Bank Document...Value 0.00 354.00 1107.00 Revised Date 03-Feb-2014 30-Jun-2017 31-Mar-2019 Number of health professionals available in health facilities on a monthly basis Unit

The World BankCF-Health System Support Project (P119815)

REPORT NO.: RES31379

RESTRUCTURING PAPER

ON A

PROPOSED PROJECT RESTRUCTURING

OF

CF-HEALTH SYSTEM SUPPORT PROJECT

APPROVED ON MAY 17, 2012

TO

CENTRAL AFRICAN REPUBLIC

MINISTRY OF ECONOMY, PLANNING AND COOPERATION

HEALTH, NUTRITION & POPULATION

AFRICA

February 15, 2018

Regional Vice President: Makhtar Diop Country Director: Franck Bousquet

Senior Global Practice Director: Timothy Grant EvansPractice Manager/Manager: Trina S. Haque

Task Team Leader: Moulay Driss Zine Eddine El Idrissi

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ABBREVIATIONS AND ACRONYMS

CAR : Central African Republic

HIV : Human Immunodeficiency Virus

HMIS : Health Management Information System

HRITF : Health Results Innovation Trust Fund

IDA : International Development Association

PDO : Project Development Objective

PMTCT : Prevention of Mother to Child Transmission

RBF : Results-Based Financing

TF : Trust Fund


BASIC DATA

Product Information

Project ID Financing Instrument

P119815 Investment Project Financing

Original EA Category Current EA Category

Partial Assessment (B) Partial Assessment (B)

Approval Date Current Closing Date

17-May-2012 31-Mar-2019

Organizations

Borrower Responsible Agency

Ministry of Economy, Planning and Cooperation Ministry of Health, Public Hygiene and Population

Project Development Objective (PDO)

Original PDOThe development objective of the original operation is to increase utilization and improve the quality of maternal and child health services in targeted rural areas of the Recipient’s territory.

Current PDOThe revised project development objectives are to: (a) increase utilization and improve the quality of maternal and child health services in targeted rural areas of the Recipient’s territory; and (b) provide emergency health services to the general population.OPS_TABLE_PDO_CURRENTPDOSummary Status of Financing

Ln/Cr/Tf Approval Signing Effectiveness ClosingNet

Commitment Disbursed Undisbursed

IDA-D0610 22-May-2015 19-Jun-2015 11-Aug-2015 31-Mar-2019 12.00 4.10 8.39

IDA-51340 17-May-2012 31-Jul-2012 28-Oct-2012 31-Mar-2018 9.35 8.87 .26


IDA-H7840 17-May-2012 31-Jul-2012 28-Oct-2012 31-Mar-2018 7.65 7.25 .22

TF-13380 31-Jul-2012 31-Jul-2012 28-Oct-2012 31-Mar-2018 11.20 7.36 3.84

Policy Waiver(s)

Does this restructuring trigger the need for any policy waiver(s)?No

I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING

A. Project StatusThe Bank’s engagement in the health sector in CAR has been continuous for several decades. Prior to the crisis (2014), CAR authorities were planning to launch a US$28.2 million Health System Support Project (HSSP), supported by the World Bank. Initial funding for the HSSP was provided through a US$17 million combined IDA credit and grant (IDA-51340 and IDA-H7840, approved May 17, 2012) and a US$11.2 million grant from the Health Results Innovation Trust Fund (HRITF; TF-13380, approved July 31, 2012). In 2014, as a worsening security situation made implementation of the HSSP infeasible, the government requested that the HSSP be restructured to reallocate US$15 million (from IDA) to support delivery of emergency health services. UNICEF, UNFPA and WHO were contracted to continue delivering health services to communities affected by the crisis. As the security situation improved in 2015, an additional financing (AF) grant of US$12 million (IDA-D0610, approved May 22, 2015) was added to help the HSSP relaunch (in 2017) the results-based financing (RBF) activities that, during the crisis, had been almost completely halted. The activities financed by the HRITF could therefore resume as the HRITF funded RBF activities exclusively. In 2017, the project started focusing again on RBF, which covers more than 40% of the population in five regions (2,3,4,5, and 6). Despite delays pertaining to implementation of the activities financed by the HRITF (because of the crisis), the rating on both “Progress Towards Achievement of the PDO” and “Overall Implementation Progress” is Satisfactory. The disbursement rate for TF-13380 is 66% as of January 31, 2018.

B. Rationale for RestructuringThe aim of this restructuring is to extend the closing date of the HRITF (TF-13380) from March 31, 2018 to December 31, 2018. During the crisis, funding from the HRITF could not be used since it was for RBF activities only. In order to allow the government to fully utilize the HRITF funding, they requested an extension from March 31, 2018 to March 31, 2019. Ideally, the closing date of the TF would be aligned with the overall project closing date. However, the HRITF cannot be extended beyond December 31, 2018. Because the disbursement rates of the other IDA financing (IDA-51340 and IDA-H7840) exceed 97%, they will close as planned on March 31, 2018.


II. DESCRIPTION OF PROPOSED CHANGES

C. Closing dateTaking into consideration the constraints related to the HRITF, the closing date will be extended from March 31, 2018 to December 31, 2018.

D. Results Framework

The end target dates of the project indicators have been modified to be aligned with the end of the overall project implementation period (March 31, 2019).

III. SUMMARY OF CHANGES

Changed Not Changed

Change in Results Framework ✔

Change in Loan Closing Date(s) ✔

Change in Implementing Agency ✔

Change in DDO Status ✔

Change in Project's Development Objectives ✔

Change in Components and Cost ✔

Cancellations Proposed ✔

Reallocation between Disbursement Categories ✔

Change in Disbursements Arrangements ✔

Change in Disbursement Estimates ✔

Change in Overall Risk Rating ✔

Change in Safeguard Policies Triggered ✔

Change of EA category ✔

Change in Legal Covenants ✔

Change in Institutional Arrangements ✔

Change in Financial Management ✔


Change in Procurement ✔

Change in Implementation Schedule ✔

Other Change(s) ✔

Change in Economic and Financial Analysis ✔

Change in Technical Analysis ✔

Change in Social Analysis ✔

Change in Environmental Analysis ✔

IV. DETAILED CHANGE(S)

OPS_DETAILEDCHANGES_RESULTS_TABLE

RESULTS FRAMEWORK

Project Development Objective Indicators PDO_IND_TABLE

People with access to a basic package of health, nutrition, or reproductive health services (number)Unit of Measure: NumberIndicator Type: Custom

Baseline Actual (Current) End Target Action

Value 400000.00 1629091.00 2869330.00 Revised

Date 28-Sep-2012 30-Jun-2017 31-Mar-2019

Children immunized (number)Unit of Measure: NumberIndicator Type: Custom


Value 31360.00 49359.00 82716.00 Revised

Date 28-Sep-2012 30-Jun-2017 31-Mar-2019

Number of births attended by trained personnel in health facility in targeted areasUnit of Measure: NumberIndicator Type: Custom


Value 26500.00 69562.00 137071.00 Revised

Date 28-Sep-2012 30-Jun-2017 31-Mar-2019

Number of women victims of violence supported by social and medical health providers


Unit of Measure: NumberIndicator Type: Custom


Value 0.00 3391.00 3891.00 Revised

Date 04-Mar-2014 30-Jun-2017 31-Mar-2019

Direct Project beneficiaries,Unit of Measure: NumberIndicator Type: Custom


Value 0.00 1751403.00 3092508.00 Revised

Date 28-Sep-2012 30-Jun-2017 31-Mar-2019

Of which female (beneficiaries)Unit of Measure: NumberIndicator Type: Custom Supplement


Value 0.00 875702.00 1546256.00 Revised

Average score of the quality of care checklistUnit of Measure: PercentageIndicator Type: Custom


Value 32.85 44.00 67.85 Revised

Date 01-Feb-2015 30-Jun-2017 31-Mar-2019

Intermediate IndicatorsIO_IND_TABLE

Number of HIV+ pregnant women receiving PMTCT careUnit of Measure: NumberIndicator Type: Custom


Value 1049.00 3971.00 7529.00 Revised


Date 14-Feb-2014 30-Jun-2017 31-Mar-2019

Number of mothers in the project areas who received two doses of intermittent preventive treatment for malaria during last pregnancyUnit of Measure: PercentageIndicator Type: Custom


Value 1312.00 119434.00 335664.00 Revised

Date 28-Sep-2012 30-Jun-2017 31-Mar-2019

Number of health facilities operating on a daily basisUnit of Measure: NumberIndicator Type: Custom


Value 0.00 354.00 1107.00 Revised

Date 03-Feb-2014 30-Jun-2017 31-Mar-2019

Number of health professionals available in health facilities on a monthly basisUnit of Measure: NumberIndicator Type: Custom


Value 0.00 1239.00 1604.00 Revised

Date 03-Feb-2014 30-Jun-2017 01-Jul-2019

Percentage of health facilities in project areas with at least one qualified personnelUnit of Measure: PercentageIndicator Type: Custom Supplement


Value 36.00 72.00 80.00 Revised

Number of children under age of five treated for Severe Acute MalnutritionUnit of Measure: NumberIndicator Type: Custom


Value 14077.00 30931.00 52246.00 Revised


Date 30-Dec-2013 30-Jun-2017 31-Mar-2019

Number of health facilities submitting complete monthly HMIS reportsUnit of Measure: NumberIndicator Type: Custom


Value 0.00 354.00 354.00 Revised

Date 01-Jul-2015 30-Jun-2017 31-Mar-2019

Number of health personnel trained in HMISUnit of Measure: NumberIndicator Type: Custom


Value 0.00 372.00 708.00 Revised

Date 01-Jul-2015 30-Jun-2017 31-Mar-2019

OPS_DETAILEDCHANGES_LOANCLOSING_TABLE

LOAN CLOSING DATE(S)

Ln/Cr/Tf StatusOriginal Closing

Revised Closing(s)

Proposed Closing

Proposed Deadline for Withdrawal

Applications

IDA-51340 Effective 31-Mar-2018 31-Mar-2018 31-Jul-2018

IDA-D0610 Effective 31-Mar-2019 31-Mar-2019 31-Jul-2019

IDA-H7840 Effective 31-Mar-2018 31-Mar-2018 31-Jul-2018

TF-13380 Effective 31-Mar-2018 31-Dec-2018 30-Apr-2019

Documents

World Bank Document...Value 0.00 354.00 1107.00 Revised Date 03-Feb-2014 30-Jun-2017 31-Mar-2019 Number of health professionals available in health facilities on a monthly basis Unit