Total amount of EU budget contribution EUR 20,000,000 Aid method / Method of implementation

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1 ANNEX of the Commission Implementing Decision on the individual measure 2013 in favour of Bangladesh Action Fiche for EC support to health and nutrition of the poor in urban Bangladesh 1. IDENTIFICATION Title/Number EU support to health and nutrition of the poor in urban Bangladesh CRIS number: DCI-ASIE/2013/ Total cost Total estimated cost: EUR 25,200,000 Total amount of EU budget contribution EUR 20,000,000 Aid method / Method of implementation Project Approach Direct centralised management grants call for proposal and procurement of services Partially decentralised management with Bangladesh DAC-code Sector Basic health care 2. RATIONALE AND CONTEXT 2.1. Summary of the action and its objectives The project will support Civil Society Organisations, NGOs and other private organisations to work with municipalities to deliver innovative models of comprehensive primary health care and nutrition services to 700,000 poor residents of urban slums, guided by the Ministry of Health 1 and in cooperation with the Ministry of Local Government 2. The EU support will strengthen the capacity of the Ministry of Health to develop its stewardship to the urban health sector and the Ministry of Local Government to coordinate and support municipalities in building public private partnership Context Country context Economic and social situation and poverty analysis Bangladesh economy has experienced stable economic growth over the past decade, averaging at around 5.8% from , with projected increases to 8% by Real GDP per capita has nearly doubled in the last ten years from USD 330 in Ministry of Health and Family Welfare (MoHFW). More precisely, at central level, the Directorate General of Health Services (DGHS)/Essential Services Delivery (ESD)/Urban Health Unit and at deconcentrated level the Civil surgeon team More precisely, Ministry of Local Government, Rural Development and Cooperatives (MoLGRDC) / Local Government Division (LGD). City corporations and Municipalities being its decentralised bodies 1

2 to USD 640 in This positive trend is projected to be sustained reaching an estimated GDP per capita of USD 915 by Bangladesh s steady growth has enabled improvement in poverty reduction in recent decades attributed to substantial public and non-state investment in education, health, and social empowerment programmes. The national head count rate of poverty, measured by the upper poverty line, has declined from 58.8% in 1991 to 40.0% in 2005, and 32% in The compound poverty reduction rate per year is recorded at 1.8% over the period. Net enrolment rate in primary education has increased from 60.5% in 1990 to 93.9% in 2009 and with gender equity. Adult literacy rate also has improved from 35.3% in 1991 to 59.1% in Infant and child mortality has declined by half since 1990 and fertility rates declined similarly over the same period. Official development assistance (ODA) for Bangladesh has increased significantly in the past decade. Total ODA commitment has doubled from USD 1.23 billions in 2000 to USD 2.56 billion in 2009 with the World Bank, ADB (Asian Development Bank), DFID (Department for International Development - UK) and IMF as the largest donors. ODA disbursement has been uneven ranging between 60-85% of donor committed funds. Bangladesh however, is by no mean aid dependent, with ODA accounting to only around 2-3% of its GDP National development policy Bangladesh s Sixth Five Year Plan (SFYP) Accelerating Growth and Reducing Poverty provides a framework for implementing the Government s development agenda during Fiscal Year 11 FY15. The SFYP lays out the strategic directions and policy framework for achieving the main socio-economic targets set out in the first five-year period of the Government s Perspective Plan These targets are also articulated in Vision 2021, which envisages Bangladesh reaching middleincome economy status by the beginning of the next decade. The growth targets set out in the SFYP s are ambitious, with a high growth baseline anchoring Bangladesh s Poverty Reduction Strategy. The SFYP emphasizes raising growth and employment as the primary means for reducing poverty by 10 percentage points by the end of the plan period. According to the IMF assessment the SFYP poverty target of 22 % by 2015 is consistent with the SFYP growth target of 8 % given the success the Government has had in reducing the poverty rate to 31.5 % from 49 % between 2000 and SFYP focuses on strategies, policies and institutions that stress the private sector as the spearhead for industrial development and exports. The Plan emphasizes the creation of high productivity jobs and efficiency gains through increased competition. The Plan also provides some background on the past policies and programs for the management of urbanization as well as the institutional arrangements in the urban sector, together with an urbanization strategy which focuses on the development of sound urban institutions, improves city governance, and emphasizes urban resource mobilization. However, the Plan could have presented a more dynamic picture of urban development, integrating the growth dynamics of the Bangladesh economy into the urbanization process. 2

3 In June 2010, government and 18 development partners adopted a Joint Cooperation Strategy (JCS), including European Union and six EU Member States. The objective of the JCS is to create common platforms for national and sector dialogues and a national owned process for improving delivery of aid. In particular, the JCS aims to ensure effective collaboration between the government and development partners for the implementation of Sixth Five Year Plan Sector context: policies and challenges Rapid urbanisation in Bangladesh has been accompanied by deterioration of health conditions for urban poor. 28% of the population, i.e. 40 million people currently live in urban areas and it is expected that the urban population will reach 116 million (about half of the country's population) by The urban poor are increasing. 35% of the urban population in Bangladesh lives in slums and is poor. Slum population doubled from 1.5 to 3.4 million between 1996 and About 28% of the urban population is poor (consuming fewer than 1,805 kilocalories per day) and lives in slums, squatter settlements and informal housing. Hard core urban poor (under 1600 kcal/day) are now about 20% in Dhaka and 25% nation-wide 4. Bangladesh has made significant progress in reducing the infant mortality rate and under 5 mortality rate and is on track to meet its MDG maternal mortality rate target. However, progress has been highly inequitable and there remain significant gaps in health conditions between the rich and the poor and between the urban and rural poor. In urban settings, children that are poor are three times as likely to die compared to the urban rich, and 1.5 times as likely as the rural poor. Currently, the malnutrition rate among children of Bangladesh is the highest in the world. Malnutrition (underweight) is considerably higher among urban slum children (44%) than among poor rural children (39%). 43% of children under 5 years old are stunted (short for their age), including 56% of children in urban slum areas. Long term studies 5 show child stunting is correlated with lower academic and economic achievements and poorer health throughout a person s life 6. One in five preschool age children are vitamin A deficient and one in two are anaemic 7. Children from the poorest urban quintile are four times more likely to be chronically malnourished than children from the wealthiest urban quintile and rural areas. 8 The Ministry of Health is responsible for defining health policies, setting strategies, establishing technical standards, procuring and distributing vaccines, family planning contraceptives, and other essential commodities, and for monitoring and evaluating health programmes. The Directorate General of Health Services and the Directorate General of Family Planning are the main executing authorities and regulatory bodies under the Ministry of Health. Both Directorates operate the health care delivery system for the ministry all over the country extending to the village level. In urban and municipal areas, the Ministry of Health is responsible for providing policy and technical guidance, contraceptives and immunization supplies, monitoring and evaluation (M&E), and coordination, while the Ministry of Local Government Slums of Urban Bangladesh, Mapping and Census, 2005, NIPORT, 2006 HIES, 2005, BBS Cebu Longitudinal Study, , WHO, 2010 See also EU Communication COM(2013) 141 final: Enhancing Maternal and Child Nutrition in External Assistance: an EU Policy Framework Bangladesh Demographic and Health Survey (BDHS) 2007 BDHS,

4 is responsible for provision of primary health care services, including vaccination and family planning through city corporations and municipalities. It is also responsible for a wide range of public health services, including removal of garbage, prevention of infectious diseases; establishment of health centres, maternity hospitals and dispensaries; and water supply, drainage and sanitation 9. However, due to competing demands for scarce resources and the growing urban infrastructure needs, primary health care and public health get limited priority within the municipal budget system, and public health services remain at a much lower level than the need. Limited local revenue collection, heavy dependency on the central level for budget support, interference of national politics, and top-down administrative and human resource management are the other major impediments. Bangladesh has over 2500 registered NGOs and a social welfare society tradition. Funded by donors (Development Partners, Bill Gates Foundation, and international NGOs) NGOs have been the chief providers of publicly financed primary health care service delivery in urban Bangladesh since Urban primary health care projects, Smiling Sun BRAC-MANOSHI, Marie Stopes, BIRDEM health care network, Gonoshatta Nagar Hospital, AD-Din Hospital and other NGOs, and voluntary welfare associations are the major players offering health care services in urban areas for the poor. Private, out-of-pocket outlays for health care constitute 65% of total health expenditure in Bangladesh. The private sector dominates the provision of primary level care, nursing homes, laboratory and ambulatory diagnostic services in Bangladesh. The public sector, however, remains the main provider of inpatient care. The dependence on the private sector for curative care is even truer for the poor. A regulation or quality-control of the private sector by the Ministry of Health is virtually non-existent. There is no data on the quality on the private sector service provision but experience from elsewhere indicates that quality is often very variable and generally bad when provided to the poor. The unchecked principle-agent problem leads to overprovision of unnecessary care. E.g. the rate for caesarean sections in private hospitals in Bangladesh is 70%, one of the highest around the world. The private non-health sector is also an important entry-point as regards occupational health. Recent fire catastrophes have led to more attention to health and safety at work. In Dhaka it has been shown that many of the slum dwellers are in one way or another working for the garment industry and could be reached with innovative primary health care concepts through their employer Lessons learnt The EU has been a major player in the last two health sector programmes; therefore there is enough experience to understand the strengths/weaknesses of the Ministry of Health in areas dealing with urban health and NGOs. Although the urban population has been and will keep rapidly increasing, there have been few actions addressing the urban health issue. Furthermore, many of those actions are limited to the primary health care projects and voluntary welfare associations who provide health care services to the poorest, thus important unmet needs still remain. 9 Third Schedule, Section 41, Bangladesh Gazette, 14 May

5 Urban health projects demonstrate that NGOs are able to provide primary health care essential service delivery package with the best value for money. Nevertheless, when NGOs address the health and nutrition needs to the poorest, the system is not selfsustainable and needs substantial subvention (up to 50%), which can be provided by the Government of Bangladesh through Public-private partnerships. The EU experience working with NGOs also confirms similar findings. Currently, the Government is very supportive of such a partnership and considers that is the best approach to providing quality primary healthcare to the poorest in urban areas. Nevertheless, urban health projects don't offer comprehensive primary health care package and services offered differ from one project to another. Ministry of Local Government remains weak in addressing health issue at central and decentralised level. Ministry of Health doesn't comply fully to its mandate in urban health, especially in ensuring quality control, supervision and regulation of the services provided. Coordination between both Ministries at central and decentralised level is not effective enough. Recent institutionalisation of an urban health unit within each ministry is a good prospect for improvement of the daily coordination needed Complementary actions 10 The EU support to health, nutrition, and population was until 2011 channelled mainly through the health sector programmes. The current complementary contribution totalling EUR 30 million focuses more on nutrition and food security as Bangladesh is making improvements in general health while it continues to have the highest levels of malnutrition in the world. The EU urban health support will also complement: the activities implemented by the DFID-led NGOs urban health consortium, who will scale-up successful urban health projects and develop collaboration to make maximum use of the capabilities of each partner, including the Smiling Sun Franchise Program successor, BRAC MANOSHI community-based network, the Marie Stopes Clinic Society s clinical services. The EU project will be complementary to NGO urban health consortium in order to increase/improve the offer of comprehensive primary health care services. This NGOs urban health consortium will coordinate with the Government, but the projects under the NGO consortium will be implemented independently. As no technical cooperation with the Ministry of Health and Ministry of Local Government is envisaged through the NGO consortium, coordination responsibilities of both Ministries can be facilitated between them and with the private health services providers, through the EU support to the Ministry of Health and the Ministry of Local Government. the current Urban Primary Health Care Project in developing Ministry of Health stewardship capabilities. The EU support also will complement the work under way by the Urban Primary Health Care Project that includes NGO performance-based contracts and construction of health care facilities in slums. EU support will develop the Urban Primary Health Care Project concept of 10 See annex 3: Organisational set up of project, annex 4: organisational set up of the DFID led NGOs urban health Consortium, annex 5 organisational set up of ADB supported UPHCP&UPHCSDP and Annex 6: diagram of projects interactions 5

6 decentralizing primary health care delivery and add to the program by introducing health market improvements through innovative approaches proposed by the beneficiaries of the grants. the efforts of the Urban Environmental Health Program 11, in building a health unit within the Urban Development Wing of the Ministry of Local government. The Asian Bank of Development provided a programme loan for policy change including the Urban Development Wing and investments in sanitation, solid waste and medical waste, food safety, public and environmental health while the EU will provide technical assistance and other support to develop the Urban Health Unit of the Wing. These two projects are expected to work closely together Donor coordination The current health sector programme ( ) 12 is in line with the Paris declaration on Aid Effectiveness (2005) and the European Consensus on Development. The Development Partners Health Consortium is the forum for coordination between all Development Partners active in the health sector. The DP Health Consortium meets every Months and invites regularly Government representatives to update on implementation of the health sector programme. The chair of the Consortium is also the co-chair of the Health Local Consultative Group (formal coordination body between all stakeholder involved in the Bangladesh Health Sector) co-chaired by the Minister of Health. In addition, an Urban Health Task group has been formed as one of the subgroups of the Health Local Consultative Group. 3. DETAILED DESCRIPTION 3.1. Objectives The overall objective of the project is to contribute to improving health and nutrition status of the urban poor in Bangladesh. The specific objective is to improve the utilisation of sustainable, integrated and comprehensive health, nutrition and population services by the urban poor. The above objectives are consistent with the anticipated impact and outcomes of the current Health Sector Programme and the National Urban Health Strategy. The purpose is to contribute to improved access to and utilisation of essential health, population and nutrition related services, particularly to the poor. This will be achieved through two main expected results: 1) Increased utilisation by the urban poor of improved comprehensive essential health, nutrition and population services and 2) Effective government management of essential Health, Nutrition and Population services for urban poor at central and decentralised level Expected results and main activities The expected results of project activities are as follows: More precisely: Urban Public and Environmental Health Sector Development Program supported by ADB Health, Population and Nutrition Sector Development Programme - HPNSDP 6

7 1) Increased utilisation by the urban poor of improved comprehensive essential health, nutrition and population services. Increasing provision of integrated, comprehensive and urban poor friendly essential health services, through NGOs and private care providers. Developing sustainable financing Models for provision of services through permanent quality accreditation system of performance-based public private partnership contracts managed by Municipalities, with guidance and coordination from the Ministry of Local Government and under the regulatory and monitoring umbrella of the Ministry of Health. EU will support the delivery of comprehensive primary health care services including nutrition to poor residents of municipal and urban areas through grants managed by the EU Delegation. These grants will be attributed to Civil Society Organisations (CSO/NGO) and other Private bodies which have demonstrated an ability to work effectively at the urban and municipal community level delivering primary health care services and to work effectively with municipalities. EU will first identify project areas/municipalities which could work in this programme. The selection will be based on a balanced and weighed scoring, without exclusion criteria. The criteria for selecting project areas are as follows: (i) Municipalities with population above 150,000, with inadequate/poor primary healthcare services, without Medical Collage Hospitals or large health service facilities and having higher concentration of poor population; (ii) Municipalities with leaders committed to the principles and approach of partnership, having Medical Officer position/s filled, willing to deploy staff to take up project defined responsibilities, to absorb recruited new staff hired by the project within own budget support arrangement after the end of the project, to subscribe at least 1% of their revenue for Primary Health Care in sustainability fund and to impose public health Acts and use the collected fine to support Primary Health Care activities. EU would subsequently issue a call for Proposals to work in the targeted municipalities. The call would ask to present proposals including an agreement with prior agreement of the municipality for a collaborative program, either an agreement to work together or a joint venture for comprehensive primary health care work in the municipality. The Proposals would be evaluated with a detailed scoring checklist which would be shared with municipal authorities and with the project steering committee for ownership of the partnership process. 2) Effective government management of essential services for the urban poor (Contracting, Supervising, Regulating, etc.) Strengthening capacity of Ministry of Health to coordinate, develop and enforce Health, Nutrition and Population service quality standards, monitoring system and accreditation at central and decentralised level. 7

8 Strengthening capacity of municipalities to manage public private partnership contracts for delivery of essential Health, Nutrition and Population services for the urban poor and to coordinate with all stakeholders involved at decentralised level. Strengthening Capacity of Ministry of Local Government to manage delivery of essential services for the urban poor through public private partnership and to coordinate with all stakeholders involved in urban health, at central and decentralised level. EU support will strengthen collaboration between the Ministry of Health and the Ministry of Local Government by building mutually supportive capacity and in establishing models for urban essential health, nutrition and population services delivery through public-private partnerships at the municipal level. The project will provide technical assistance and other support (supplies, equipment, transport, etc) to the Urban Health Unit of the Ministry of Health to develop its role as national health steward and capabilities in managing regulations, service quality standards, accreditation and monitoring. The project will also provide technical assistance to the Health Unit of Urban Development Wing of the Ministry of Local Government to develop health program implementation capability. The project will work with qualified municipalities to improve their ability to manage health and nutrition service and enable them to manage public private partnership contracts to deliver a comprehensive package of essential health, nutrition and population services. The project will develop models for effective essential service delivery, introduce health market improvements and establish community-based health networks in city corporations and municipalities. At level of the municipalities, the Ministry of Health will maintain quality standards, monitor the programs and develop the models for replication and the Ministry of Local Government will implement the contracting model and coordinate with public and environmental health and other urban and municipal interests 3.3. Risks and assumptions 13 Main Risks City Corporations and municipalities with insufficient funds to implement programs and strategies for strengthening pro-poor urban primary health care delivery system. Mitigation Measures - Advice to municipalities on municipal fund raising including holding tax revisions and Ministry of Local Government block grants, - Allocation of fixed percentage of municipal budget to primary health care for the poor, - Technical Assistance to municipalities on allocation of funds for primary health care, and municipality local and Ministry of Local Government revenue sources, - Dialogue with Ministry of Local Government and municipalities on planning and use of block grants and other revenue sources for 13 For more detailed analysis: see annex 07 8

9 local use, Develop a strong dialogue between Ministry of Local Government and Ministry of Health in order to advocate the Ministry of Finance, - Linkage with Ministry of Health s Demand Side Financing Maternal Voucher Scheme and Service charges for all except the poor Municipalities are not interested in building institutional capacity and required measures for urban health Fraud and corruption and political instability - Selection of municipalities for project with interest and commitment to primary health care - Training and orientation for Ministry of Local Government, Ministry of Health and Municipalities officials - Capacity building of legal and regulatory institutions; application of additional safeguards; strengthened monitoring and evaluation, support to Electoral Commission Main assumptions: Ministry of Local Government, Municipalities and Ministry of Health are committed to timely implementation of the project. The cooperation between Ministry of Local Government and Ministry of Health for urban health development will be effective. Performance-based contracting models deliver increased efficiency and effectiveness Cross-cutting issues Climate Change Bangladesh is one of the most vulnerable countries to climate change as it is low lying and positioned in the delta of three major river systems at the top of the Bay of Bengal between India and Myanmar and therefore subject to floods and tidal bores. None of the project activities are likely to have any adverse climate effects. Similarly, climate change is not likely to affect project activities, except for the possible effects of floods and cyclones which may occur during the implementation period and would delay project activities and divert municipal resources from urban primary health care to relief and rehabilitation. Environmental Sustainability Bangladesh is the world s most densely populated country (except for a few city states) and has been experiencing severe degradation of the natural environment for decades through deforestation, river erosion soil quality depletion, water and air pollution, poor solid waste disposal, pollution from chemical fertilizer and pesticides, biodiversity loss and urban congestion. The EU support will work in cooperation with the ADB-supported Urban Environmental Health Program which supports policy initiatives and a number of actions to improve environmental health in Bangladesh and also in the EU project areas. The Urban Environmental Health Program is expected to have a positive impact on solid waste and clinical waste management as well as other environmental health programs. The EU support will focus on the health unit but also build overall capacity in the Urban Development Wing in the Local Government Division to coordinate environmental programs and 9

10 develop collaboration between Primary Health Care and Public and Environmental Health. Gender equality The EU support recognizes the role of women in household nutrition and especially the need to focus attention on the nutrition of adolescent girls, women during pregnancy and lactation and also on women s reproductive rights. Poor urban women, especially those living in slums, have limited access to public primary health care services. Therefore, the main project beneficiaries are poor urban women and the project emphasizes access and provision of women friendly services and promotes gender responsive behaviours by health care providers and household decision makers. Women will benefit from the strong focus on maternal and child health services. Even if the women will be the major target group of the EU support, attention will be given to poor men s specific needs. To achieve this gender approach, all the statistics and indicators will be distributed by sex and age and will be used to conduct an engendered follow-up of the impact of the project Stakeholders The main project stakeholders are the Government of Bangladesh organisations including Ministry of Health, Ministry of Local Government, eight or nine municipalities including Dhaka and about five to six CSO/NGO or other private provider to be engaged by the project. Other stakeholders are the development partners engaged with urban health including SIDA, ADB, USAID, DFID and the Urban Health network and NGOs working with urban health programmes. The beneficiaries are the approximately 2 million 14 urban residents of the municipalities where the project will be implemented, which will include about 700,000 poor. The private sector is an important stakeholder in ensuring public health. It is the main provider of health service in the urban settings, including to the poor. However, the services provided are of unknown quality and not affordable to the poor. The regulation and quality-control of this important sector is a crucial long-term goal for the Ministry of Health and needs to be developed in a participatory approach. The link to occupational health for e.g. companies working in the garment sector will be exploited through innovative means. Project s concept was shared with senior members of civil society including a former adviser to the Government and Secretaries, public health experts, NGO leaders and representatives of ADB, DFID, USAID, WHO, AusAID, SIDA and GIZ. Positive feedback has been received. Ministry of Local Government has the primary responsibility to support Municipalities in carrying out essential Health Nutrition and Population services. In addition the Ministry of Local Government has been managing a large Urban Primary Health Care project funded by development partners (ADB, DFID, SIDA, UNFPA, Orbis) for over 13 years. Recently Ministry of Local Government adopted an Urban Health Strategy (UHS,2011) and agreed to provide a permanent structure for managing urban health within the newly created Urban Development Wing. Ministry of Health defines health policies, sets strategies, establish technical 14 Estimated population of the probable Municipalities are: Nowabganj: 267,542; Mymensingh: 450,321; Jessore: 286,163; Dinajpur: 157,343; Bramanbaria: 147,894; Tangail:128,785; Narsingdi: 124,204; Jamalpur: 168,559; Pabna:181,000 10

11 standards, procure and distributes vaccines and family planning contraceptives for urban health. An important task of the Ministry of Health to monitor the technical standards of urban services is not undertaken satisfactorily due to shortage of human resources and other limitation. The project will provide Technical Assistance and logistic support to Ministry of Health to build its capacity for improved monitoring urban health services. 4. IMPLEMENTATION ISSUES 4.1. Financing agreement In order to implement this action, it is foreseen to conclude a financing agreement with the partner country, referred to in Article 184(2)(b) of the Financial Regulation Indicative operational implementation period The indicative operational implementation period of this action, during which the activities described in sections 3.2. and 4.3. will be carried out, is 60 months, subject to modifications to be agreed by the responsible authorising officer in the relevant agreements Implementation components and modules Grants: call for proposal EU support to health and nutrition of the poor in urban Bangladesh (direct centralised management) (a) Objectives of the grants, fields of intervention, priorities of the year and expected results The objective of the Call for Proposals is to improve and increase sustainable, integrated and comprehensive primary health cares services delivery including nutrition in urban areas. Priority issues: - Comprehensive primary health care service delivery in urban areas, including nutrition and population and - Innovative approaches in financing the services to the poorest (demand and supply side) and - Innovative approaches for prepayment of people who can afford payment of services (b) Eligibility conditions In accordance with Article 31 (1) and (2) of the DCI Regulation, the applicants should be Civil Society Organisations (CSO/NGO) or other Private bodies and be able to provide an agreement with municipalities of Bangladesh were the action will be implemented, or a plan to get this agreement or at least to demonstrate an ability to work effectively at the urban and municipal community level delivering primary health care services. 11

12 (c) Essential selection and award criteria The essential selection criteria are financial and operational capacity of the applicant. The essential award criteria are relevance of the proposed action to the objectives of the call; design, effectiveness, feasibility, sustainability and cost-effectiveness of the action. (d) Maximum rate of co-financing The maximum rate of co-financing for grants under this call is 75%. The maximum possible rate of co-financing may be up to 100 % in accordance with Article 192 of the Financial Regulation if full funding is essential for the action to be carried out. The essentiality of full funding will be justified by the responsible authorising officer in the award decision, in respect of the principles of equal treatment and sound financial management. (e) Indicative trimester to launch the call First trimester Procurement (direct centralised management) Subject in generic terms, if possible Type (works, supplies, services) Indicative number contracts of Indicative trimester of launch of the procedure Technical assistance to Ministry of Health and Ministry of Local Government Monitoring and evaluation (Frame Work Contract) Services 1 January 2014 Services 3 Oct. 2015, Oct. 2017, Oct 2019 Audit (FWC) Services 5 Jan 2016, Jan. 2017, Jan. 2018, Jan 2019, Jan Visibility and communication Services 1 June

13 Partially decentralised management with the partner country A part of this action with the objective of "Effective government management of essential services for the urban poor (Contracting, Supervising, Regulating, etc.)" will be implemented in partially decentralised management with Bangladesh in accordance with Article 53c and 56 of Financial Regulation 1605/2002 according to the following modalities: The partner country will act as the contracting authority for the procurement and grant procedures. The Commission will control ex ante all the procurement procedures except in cases where programme estimates are applied, under which the Commission applies ex ante control for procurement contracts > EUR 50,000 and may apply ex post for procurement contracts EUR 50,000. The Commission will control ex ante the contracting procedures for all grant contracts. Payments are executed by the Commission except in cases where programmes estimates are applied, under which payments are executed by the partner country for operating costs and contracts up to the ceilings indicated in the table below. Works Supplies Services Grants < 300,000 EUR < 300,000 EUR < 300,000 EUR 100,000 EUR The financial contribution partially covers, for an amount of EUR 200,000 the ordinary operating costs deriving from the programme estimates. The change of method of implementation constitutes a substantial change except where the Commission "re-centralises" or reduces the level of budgetimplementation tasks previously entrusted to the beneficiary partner country. In accordance with Article 262(3) of the Rules of Application, the partner third country shall apply for procurement rules of Chapter 3 of Title IV of Part Two of the Financial Regulation. These rules as well as rules on grant procedures in accordance with Article 193 of the Financial Regulation will be laid down in the financing agreement concluded with the partner country. The programme estimates will cover: - organisation of annual conferences, workshops, seminars, training, monitoring & evaluation etc.; development of a database, IT maintenance; publication of reports, newsletter, leaflet, etc. - some refurbishment of the urban health unit at Ministry of health and the health section of the Ministry of Local Government - computers and other office equipment for the urban health unit at Ministry of health, the urban health section of Ministry of Local government and for municipal health offices, etc. The contracting authority for the project is the Economic Relation Division of the Ministry of Finance 13

14 The project supervisor shall be the Planning Wing of the Ministry of Health and Family Welfare. A steering committee shall be set up to oversee and validate the overall direction and policy of the project. The project steering committee shall meet at least once a year. The project steering committee shall be made up of: - a representative the Economic Relation Division of the Ministry of Finance, - the supervisor, - a representative of Ministry of Local Government, - a representative of the Head of Delegation,. - CSO/NGOs and Technical Assistance involved in the project. The existing Urban Health Task Group under the Health Local Consultative Working Group will be used as the general coordination body of the project. The Urban Health Task group is chaired by the Ministry of Health (supervisor of the Project). Members are representatives of Ministry of Health, Ministry of Local Government, Development Partners, CSO/NGOs and Technical Assistance involved in urban health, and if necessary Municipalities and Civil surgeons. This committee should meet at least twice a year. Technical Assistance will work under terms of reference agreed by both the Executing Authority and the Commission, and support to the Urban Health Units of Ministry of Health and Ministry of Local Government Scope of geographical eligibility for procurement in direct centralised and decentralised management Subject to the following, the geographical eligibility in terms of place of establishment for participating in procurement procedures and in terms of origin of supplies and materials purchased as established in the DCI Regulation shall apply. The responsible authorising officer may extend the geographical eligibility in accordance with Article 31(8) of the basic act on the basis of the unavailability of products and services in the markets of the countries concerned, for reasons of extreme urgency, or if the eligibility rules would make the realisation of this action impossible or exceedingly difficult Indicative budget Module Call for proposals EU support to health and nutrition of the poor in urban Bangladesh (direct centralised) Amount in EUR thousands Third party contribution (indicative, where known) 15,600 5,200 14

15 Procurement (direct centralised) one Service contract Technical Assistance to Ministry of Health and to Ministry of Local Government 2,000 N.A Evaluation and audit 300 N.A Communication and visibility 100 N.A Decentralised management with Bangladesh Programme estimates 2,000 N.A. Totals 20,000 5, Performance monitoring Systematic monitoring of the project will be ensured through analysis and discussion of the evolution of the results indicators (LogFrame) by both Technical Committee and steering committee Evaluation and audit The Ministry of Health and the Ministry of Local Government will organise annual progress reviews and regular public audit of project expenditure under the programme estimates. External mid-term and final evaluations and annual audits will be carried out by independent consultants recruited directly by the European Commission through Frame Work Contracts 4.8. Communication and visibility All implementing Partners will ensure that sufficient information and communication activities are carried out that raise awareness of specific and general audiences of the reasons for EU support for the project, as well as the results and the impact of this support. The requirements and guidelines are contained in the EU Communication and Visibility manual 15. In addition, an overarching visibility and communication "programme" will be implemented through a specific service contract. 15 Communication and Visibility: Manual for EU External Actions, EC, June