ZAMBIA MALARIA BOOSTER PROJECT PROJECT DATA SHEET

Transcription

1 Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized DATA SHEET Borrower: Republic of Zambia Responsible agency: Ministry of Health ZAMBIA MALARIA BOOSTER PROJECT PROJECT DATA SHEET Revised estimated disbursements (Bank FY/US$m) FY Annual Board approved X RVP approved - JarawadYaw Ansu Does the restructured project require any exceptions to Bank policies? Have these been approved by Bank management? Is approval for any policy exception sought from the Board? Yes XNo - Project development objective: To increase coverage of interventions for malaria prevention and treatment and other key maternal and child health interventions. PDO indicator 1: To increase the percentage of children under 5 years of age who sleep under an insecticide treated bednet from 41% to 55% by PDO indicator 2: To increase the percentage of pregnant women who receive a complete course of intermittent presumptive treatment for malaria from 66% to 75% by PDO indicator 3: To increase the percentage of people in indoor residual sprayingeligible districts who sleep in appropriately sprayed structures from 40% to 60% by PDO indicator 4: To increase the percentage of women delivering in facilities by skilled birth attendant from 34% to 50% by Does the restructured project trigger any new safeguard policies? No. IBRDADA Russian Federation Trust Fund 1

2 1. Introductory Statement 1. This Project Paper seeks the approval of the Executive Directors to introduce the following changes in the Zambia Malaria Booster Control Project, Credit No and any accompanying amendments to the project s legal documents. The major modifications proposed are to: (i) Broaden the project development objective from malaria prevention and treatment only to malaria prevention and treatment and other key maternal and child health interventions; (ii) Revise the project s specific objectives; (iii) Extend the closing date from January 31, 2010 to January 31, 2012; and (iv) Modify the project components and results framework to reflect the change in the project development objective. 2. Background and Reasons for Restructuring 2. The Zambia Malaria Booster Project (MBP) was approved on November 15,2005 and became effective on March 13, It is a US$20 million IDA credit being implemented over four years, with a closing date of January 31, The Project Development Objective (PDO) is to increase access to, and use of, interventions for malaria prevention and treatment by the target population. The target population is the population of Zambians living in all the 72 malarious districts of the country. The priority groups among this target population are children under the age of five years, pregnant women and all those infected with malaria. 3. The project has three main components which are further divided into subcomponents as listed below: C 1 a: Health System Strengthening, C 1 b: Improving environmental health management, C2: Strengthening the community response to malaria, and C3: Building capacity within the Ministry of Health (MOH)/National Malaria Control Center (NMCC) in the areas of coordination, implementation and technical leadership. 4. The project has performed very well and it has made a significant contribution to the recent substantial improvements in coverage of key malaria prevention activities in Zambia as described in the recent project ISR (04/20/2009). As of July 31, 2009, US$l9.09 million has been disbursed and US$1.97 million is remaining of the original credit.2 Thanks to the good performance in the scale up of preventive interventions, as summarized in table 1, as well as the excellent management of the NMCC, malaria has Component 1 a) supports health system strengthening activities through the district basket pooled funding arrangement whereby all 72 district health management teams receive additional allocations to improve malaria service delivery; Component 1 b) improves environmental health management by financing activities aimed at the improvement of the management of health care waste associated with malaria control and the environmental monitoring of the use of insecticides; Component 2) provides support to strengthen local capacities to effectively prevent, control and treat malaria and mitigate some of the demand-side constraints to effective malaria control programming; and Component 3) supports strengthening the capacity of the Ministry of Health/ National Malaria Control Centre to provide technical leadership and coordination of the implementation of the national program. There is an exchange rate gain of US$1.06 million, making total available funding for the project US$21.06 million. 2

3 been replaced by other diseases as the main cause of death for children under-five and pregnant womens3 5. As a result of these significant achievements, Zambia was successful in raising additional resources for the Project through a grant from the Russian Federation (US$6.85 million). The focus of this grant is to increase the coverage of key malaria interventions to contribute to achieving the objectives of the project. The funds have contributed specifically to the achievement of PDO indicator 1 and 3. As of July 3 1, 2009, US$4.49 million of this grant has been disbursed and US$2.36 million is remaining. The 2009 activity plan of the grant has been developed and implementation of activities is progressing according to schedule. The remaining funding has been fully committed. Indicator 1. Percentage of children under 5 years of age who sleep under an insecticide treated bednet from 30% to 40% by Baseline (2006) 30% 2. Percentage of pregnant women who receive a 45% complete course of intermittent presumptive 3. treatment for malaria from 45% to 55% by Percentage of people in IRS-eligible district areas 27% who sleep in appropriately sprayed structures from 40% to 60% by Source: Malaria Indicator Survey 2006 and Current Mid-term Status target achieved 41% Yes 66% Yes 93% Yes 6. The stewardship and coordination of the implementation of the project by the MOH and the NMCC has been satisfactory and the Government of the Republic of Zambia (GRZ) has shown a strong commitment to sustaining this success. 7. The GRZ has recently requested a restructuring of the project for the following reasons: a. Although there has been considerable progress in malaria control, there is still a significant gap to reach the government s target of at least 80% coverage.of the population at-risk with malaria control interventions. b. The health system component of the project has lagged behind. To sustain and improve the recent achievements, strengthening the health system is essential c. As malaria is no longer the main cause of maternal and child deaths in Zambia, the GRZ proposes to broaden the scope of the project to a wider set of maternal and child health interventions According to the 2007 Demographic and Health Survey causes of under-five mortality in Zambia include neonatal causes (22.9%), pneumonia (21.8%), malaria (19.4%), diarrhea (17.5%), HIV/AIDS (16. I%), measles (1.2%), and others (0.2%). The same survey shows that mothers are dying from hemorrhage (25%), puerperal infection (15%), eclampsia (13%), complicated abortion (13%), obstructed labor (7%), malaria (5%), tetanus YO), and non-specific (2 1 Yo). Baseline data were estimated during the design of the project and adjusted after a baseline study. 3

4 8. There are available co-financing resources to support this restructuring. The results-based financing (RBF) grant (US$l 1 million) that Zambia received through a competitive selection process provides an opportunity to maintain these gains while broadening the scope of the project. In the restructured project, the activities will use RBF as a tool for improving coverage of a core set of six interventions, which include the original malaria control interventions as well as additional maternal and child health interventions. 9. The additional maternal and child health interventions are widely known to have a significant impact on maternal and child survival.6 They include: institutional deliveries by skilled birth attendant, postnatal visits, immunization of children under one year, family planning and iron supplements at antenatal care. The grant will finance an outcome-based incentive scheme for health workers, training and capacity building and the procurement of reproductive health commodities. 10. The proposed changes are fully aligned with the Country Assistance Strategy7 (CAS) outcome 4.1. That is, to increase the percentage of institutional deliveries from 43 percent in 2006 to 50 percent by 201 1, and raise the percentage of children under 5 years of age who sleep under a treated bednet from 30 percent in 2006 to 60 percent by Moreover, the CAS recognizes that health is one of the Bank s comparative advantages in Zambia and one of the GRZ s priority areas. 3. Proposed Changes 1 1. The proposed changes to the current PDO and the associated objectives are: indicator 1 indicator 3 indicator 4 Original To increase access to, and use of, interventions for malaria prevention and treatment by the target population. To increase the percentage of children under 5 years of age who sleep under a treated bednet from 30% to 40% bv To increase the percentage of pregnant women who receive a complete course of intermittent presumptive treatment for malaria from 45% to 55% by To increase the percentage of people in IRSeligible district who sleep in appropriately sprayed structures from 40% to 60% by N/A I Modified malaria prevention and treatment and other key maternal and child health interventions. To increase the percentage of children under 5 years of age who sleep under an insecticide treated bednet from 41% to 55% by To increase the percentage of pregnant women who receive a complete course of intermittent presumptive treatment for malaria from 66% to 75% by To increase the percentage of people in IRSeligible district who sleep in appropriately sprayed structures from 40% to 60% by To increase the percentage of women delivering in facilities by skilled birth attendant from 34% to 50% by The RBF grant is a Bank-wide multi-donor trust fund, currently mainly supported by the Norwegian government, which promotes a results-based approach to health sector strengthening. Lancet Child Survival Series 2003/ Maternal Survival Series 2006 Dated March 28,2008 * PDO indicator 1,2 and 3 are not substantially changed under the restructured project. Minor modifications include the change of the wording of indicators 1 and 2 to be consistent with the Zambia Monitoring and Evaluation framework as well as revisions in end targets. Please note that the end target for PDO indicator 3 remains the same as in the original project since the restructured project will not support indoor residual spraying (IRS). 4

5 The revised results framework is attached at Annex Other proposed modifications are: a) Extension of the project end date. The current project end date is January 31, The new proposed end date for the project is January 3 1, b) Reallocation of resources and adjustments of percentage of financing. A revised allocation table is attached in Annex 2. c) Modification of the project components to reflect the change in the project development objectives. See details in Annex Fiduciary and Implementation Arrangements 13, The implementation arrangements and operational processes will remain as for the original credit. The successful implementation arrangements for the project will continue to be used. The project implementation manual will be updated to reflect the proposed changes and submitted to IDA for no objection by October 30,2009. Financial Management: There will be no major changes in the financial management arrangements. The MOH Accounting Unit will continue to have the responsibility to account and report on the funding using existing procedures as specified in the Malaria Booster Financial Procedures Manual. The Malaria Booster financial management system has been assessed as marginally unsatisfactory during supervision missions in June 2008 and February 2009." IDA has been working with the project management to address the identified weaknesses and it is expected that the full implementation of the actions recommended during the last supervision mission will provide full confidence that the financial management performance will improve to satisfactory. IDA will review the financial management performance during the next supervision mission. 14. Disbursement arrangements will remain the same with minor modifications to accommodate the results-based financing grant (RBF). The MOH will use the designated account (DA) in United States dollars for funds that will finance procurement of goods, management costs, and training at central level as well as incentive payments for the districts and health facilities. This arrangement will ensure a stronger fiduciary oversight of the expenditures under the project given the required separate reporting and monitoring systems for the designated account. 15. Audit reports and IFR's for the project are up to date. The latest audit report for the year ended December 31, 2009 issued by the Auditor General had an unqualified audit opinion. The auditors noted some internal control deficiencies and accountability issues in the Management Letter." The Bank has addressed a letter to MOH on the PDO indicator 4 has been newly introduced to reflect the Results Based Financing co-financing grant. The wording of the indicator includes 'delivering in facilities' and 'skilled birth attendant' because due to the HR crisis in Zambia many clinics do not have skilled staff providing services. '" This was due to non- adherence to the agreed reporting formats and contents for the quarterly Interim Financial Reports (IFRs), the delayed submission of the IFRs, the lack of evidence that budgets are used as a control tool, and the ineffective internal audit functions for the project. " These deficiencies and issues initially included unretired imprests, some missing payment vouchers, missing stores items and inadequately supported payment vouchers. However, the project management indicated availability of the missing vouchers and stores 5

6 Auditor General s recommendations with a request for full implementation of the recommendations by October 15, In their response dated September 24, 2009 the MOH indentified the actions already taken and indicated that all remaining recommendations would be implemented as advised by the Bank. As indicated in the management letter, the Auditor General will review the audit observations at the next audit of the project. 16. In May 2009, the Zambia Anti Corruption Commission reported a fraud in the MOH that raises potential concerns about the control environment in the MOH. The Commission is currently carrying out investigations and the Office of the Auditor General has completed a forensic audit for 2008 and To date, 13 MOH staff have been officially charged in court with theft by public servant, amounting to approximately US$6.4 million in total. There is currently no evidence that any IDA related fknding has been misappropriated. l2 17. The donors to the health sector, including IDA, are working together and have engaged government on addressing these allegations. On July 1, 2009, the GRZ adopted a Governance Action Plan for strengthening accountability and financial controls in the MOH with set targets and means of verification, which was agreed to with the health sector donors. 18. The Office of the Auditor General is providing additional oversight through continuous pre-audits on procurement and payments and post audits. The Governance Action Plan (GAP) includes a comprehensive systems audit of MOH and a special financial audit to cover the years 2006 to The government has developed the terms of reference for these audits which have been reviewed by the donor group. The audits will provide quick conclusions on the credibility of the existing financial management system and propose recommendations for improving the systems. The GAP will also address capacity building issues in the MOH, internal audit department, and the Office of the Auditor General. 19. The Auditor General will share the initial findings of the special financial audit with the health sector donors when it has been completed. IDA will follow-up actively with government on these findings and implementation of required follow-up actions. The audit also covers the Malaria Booster Project. In the light of the weaknesses noted in the control environment, the financial management risk has been rated high. The Bank will monitor the project closely and will provide additional support on the FM aspects during the next supervision mission. 20. Procurement: In preparation for the project restructuring, a revision of the procurement plan and a review of MOH procurement capacity took place. A Procurement Capacity Assessment for the MOH was carried out in 2006 for the Malaria Booster Project (MBP). This was updated in February The review included the assessment of the institutional arrangements and organizational structure, items in its response to the Auditor General s management letter, and this will be reviewed by the Auditor General during the next audit of the project. l2 Based on current information on the fraud allegations, it involved the contracting of ghost companies for training workshops. None of the companies involved in the scheme have been contracted as part of World Bank projects. 6

7 adequacy of staff qualifications, capacity, and experience of the various implementing agencies to carry out procurement under the project. The MOH was assessed to have adequate capacity to implement procurement for the restructured project largely based on consultants that have been engaged to complement the MOH capacity. The consultants have been involved alongside MOH staff in implementing the MBP since its inception and will continue in that capacity. MOH will also build its internal capacity in the interest of sustainability in the longer term. A procurement plan for the first 18 months of implementation (Annex 4) has been prepared. Procurement of new activities under the Additional Financing will be carried out in accordance with the World Bank's "Guidelines: Procurement under IBRD Loans and IDA Credits" dated May 2004 revised October 1, 2006; and "Guidelines: Selection and Employment of Consultants by World Bank Borrowers dated May 2004 revised October 1, 2006 and the provisions stipulated in the Financing Agreement. 21, Project Costs and Financing Plan: Allocation of credit proceeds and project costs are specified in Annexes 2 and 5, respectively. The total amount of the project including the proposed funding and the Russian Federation Trust Fund already under implementation is US$37.85 million. The largest percentage of the funding is allocated to Component 1 of the Project as highlighted in the annexes. 5. Analysis 22. The proposed changes have no major effect on the original economic, financial, technical, institutional, or social aspects of the project as appraised. 23. The original project was classified as category B given the risks associated with indoor residual spraying (IRS) of DDT and other pesticides and with the handling and disposal of health care waste. Two safeguard policies were triggered: Environment Assessment (OP/BP/GP 4.01) and Pest Management (OP 4.09). Two safeguard instruments (Integrated Vector Management Action Plan and Medical Waste Management Plan) were developed and disclosed in the country and InfoShop on September 15, The NMCC changed their policy on DDT in 2007 and the chemical is no longer being used. Furthermore, the restructured project will not support the procurement of insecticides. These changes lower the environmental risk of the project and the Integrated Safeguards Data Sheet (ISDS) has been updated to reflect this. Thus, the proposed restructuring does not create any new safeguard issues. The project is classified as category B partial assessment and only one safeguard policy is triggered: Environment Assessment (OP/BP/GP 4.0 1) due to potential risk arising from ineffective medical waste management in medical facilities. The inappropriate handling of infected materials constitutes a risk not only for health workers who are involved in health care waste handling and transportation, but also for families and street children who scavenge on inadequate dump sites. An amendment to the National Health Care Waste Management Plan is being finalized which provides an update on the implementation progress of the plan and future activities. The final version of this amendment will be disclosed to the public, in the Zambia as well as the InfoShop by October 15,

8 24. During the implementation of the original project, IDA financed a safeguards activity plan that included the procurement of incinerators, capacity building of MOH and provincial staff in health care waste management, preparation and dissemination of waste management guidelines, and rehabilitation of the environmental health school to start a Bachelor of Science Program in Environmental Health. The Bank also provided support for a survey to review health care waste management in Zambia, which was used to develop the updated Health Care Waste Management Plan During regular supervision missions, including from a Senior Environmental Specialist, progress on the implementation of the environmental activity plan was reviewed. Implementation has been consistently rated as satisfactory. 25. The restructuring does not involve any exceptions to Bank policies. 6. Expected Outcomes 26. The restructured project will continue to support part of the original malaria activities as well as broaden its focus to achieve improved coverage of maternal and child health interventions. The expected outcome of the project will be increased coverage of interventions for malaria prevention and treatment and other key maternal and child health activities. This will be measured through three PDO indicator^'^: 1. Percentage of children under 5 years of age who sleep under an insecticide treated bednet last night from 41% to 55% by Percentage of pregnant women who receive a complete course of intermittent presumptive treatment for malaria from 66% to 75% by Percentage of women delivering in facilities by skilled birth attendant from 34% to 50% by The original results framework has been revised and the revised results framework is attached in Annex Benefits and Risks 28. The following risks have been identified with mitigation measures and risk ratings: 1 Risks Risk Mitigation Measures The limited financing remaining in the project may not be sufficient to achieve the restructured PDO Project restructuring will burden implementation of the project Financing of US$I 1 million dollars will allow the project to sustain and build on results already achieved. Changes to already functioning implementation arrangements will be avoided. Existing MOH Operational Guidelines and implementation manual will be updated to ensure successful implementation of the project. Risk Rating L M l3 Since PDO indicator 3 was achieved during the duration of the original project and since indoor residual spraying will not be supported under the restructured project, this indicator will not be used for monitoring the restructured project and is therefore not included in this list. 8

9 Corruption investigation and weak capacity at MOH will delay project implementation Lack of a robust financial management system for monitoring resources. Coordination between various departments in the MOH is insufficient to achieve the expanded PDO. The handling, collection, disposal and management of health care waste and other infected materials is the most significant environmental issue associated with this proposed restructuring. The additional medical waste expected to be generated is that related to the diagnosis and treatment of malaria (needles and syringes, gloves, and glass slides). This material may be co-infected with HIV, viral hepatitis, etc, and needs to be handled with care. The Government has adopted a Governance Action Plan for strengthening accountability and financial controls in the MOH. The actions include capacity building for the MOH accounts department, internal audit department, and Office of the Auditor General The Office of the Auditor General is providing additional oversight through continuous pre and post-audits on procurement and payments. The MOH is also benefitting from a team of consultants to support implementat ion. The MOH has had challenges operating the upgraded Navision accounting package and has therefore resorted to the use of excel spreadsheets. However, necessary approvals and expenditure budgets have been provided by MOH to procure the accounting package operating license and hire and train IT personnel to assist in the operation of the system. Mechanisms to facilitate increased collaboration have already been put in place. One key example is that a steering committee for implementation, with representation from all relevant departments in the MOH, has been established. This committee will be working together to oversee the update to the implementation manual. Currently, the MOH is successfully implementing the National Health-Care Waste Management Plan The original project has rated the implementation of the National Health Care Waste Management Plan as satisfactory. The MOH is currently underway to update the plan and reinforce their commitment to it through the review of indicators, budget, and plan outcome since its adoption under the original project. Support to strengthening the medical waste management capacity of the MOH at all levels is included the proposed restructuring. L L The overall risk is considered to be moderate. Based on the above, the task team recommends the approval of the proposed restructuring which: (a) meets the conditions set out in the Project Restructuring guidelines as indicated above and (b) raises no new complex or controversial issues. 9

10 Annex 1. Results Framework Project Development Obi ective Increase coverage of interventions for malaria prevention and treatment and other key maternal and child health interventions. Project Outcome Indicators (i) percentage of children under 5 years of age who slept under an insecticide-treated net (ITN) last night (ii) percentage of pregnant women receiving a complete course (at least two doses) of intermittent preventive treatment (IPT) Baseline (Year> 41% 66% 55% Malaria Indicator Indicator Survey I I Frequency of data collection Every second year Every second year (iii) percentage of people in IRS-eligible districts who sleep in appropriately sprayed structures* (iv) percentage of women delivering in facilities by skilled birth attendant 40% (2006) 34% 60% 50% Malaria Indicator Survey HMIS Every second year Intermediate Outcomes 1. Prevention of malaria 2. Treatment of malaria Intermediate Outcome Indicators Component 1 (i) percentage of households with more than one ITN (ii) percentage of children under age five years who slept under an insecticide- treated net (ITN) last night (iii) percentage of household in indoorresidual spraying (IRS) eligible districts reporting IRS in the last 12 months. (i) percentage of children under 5 years of age with fever in previous two weeks who received antimalarial drug within 24 hours of onset of fever Baseline Target (year) (year) Support to the national healt, 30.9% 140% 1 I 41% 55% (20 12) (20 12) Data Source system Malaria Indicator Survey Malaria Indicator Survey Malaria Indicator Survey Malaria Indicator Survey Frequency of data collection Every second year Every second year Every second year Every second year I 10

11 3. Increase access to maternal health interventions (i) percentage of women attending postnatal visits by health center staff (delivery at home or in facility) (ii) percentage of women who received iron supplements at antenatal care visit (iii) percentage of women using any type of contraception (new acceptors) (iv) percentage of women who received at least one injection of tetanus toxoid during pregnancy (VI number of health facilities constructed, renovated, and/or equipped (with emergency obstetric and neonatal care equipment)* * * * 49% 90% (2007) 41% (2007) 74% 0 (2009) 55% 95% 55% (20 12) 85% 180 HMIS HMIS HMIS HMIS MOH 4. Increase access to key child health interventions (i) full immunization coverage of children under 1. (ii) percentage of children under six months exclusively breastfed (iii) percentage of household with properly hanging bednets (iv) percentage of children under five with diarrhea receiving oral rehydration salts (ORs) 68% 61% (2007) 64%* * * (2007) 60% (2007) 75% 70% 70%* * * 66% HMIS Community HMIS** Community HMIS** Community HMIS** Component 2: Commu 5. Improved (i) percentage of awareness of women years malaria risk, who recognize fewer transmission, as a symptom of and prevention malaria nodes 5. Increased iccess to :ommunity sub-project ity Booster R 71% (i) percentage of 0% malaria prone districts (2009) that have at least one CBONGO receiving 11 ponse to Ma 80% 90% ria (COMBOR) Malaria I Every second Indicator year Survey NMCC Annual ReDort Yearly

12 finding for malaria activities 7. Strengthened capacity of the MOH to provide technical and operational leadership in malaria and maternal and child health interventions grant to implement malaria control activities in communities Cornpc (i) disbursement, withdrawals and central procurement are done according to established standards and schedule (ii) Steering Committee for resultsbased financing, that meets at least 2 times per year, in place at the central level during the project period (iii) percentage of health facilities that report timely on indicators in RBF districts (iv) number of health personnel receiving training (in Results- Based Financing)** * * ent 3: Progr NIA (2009) Not established (2009) NIA (2009) 0 (2009) n Managerne 100% Established 80% 300 MOH program activity report and FMR Minutes from Steering Committee Meetings HMIS MOH Biannually Biannually 8. Determining the impact of the program (i) percentage of collection and analysis of end-line household 0% (2009) 100% Impact Evaluation report Once during the implementation and facility data completed (ii) case studies 0 Case 4 Case MOH Once during the documenting the studies studies implementation process of delivered delivered implementing results- (2009) (20 12) based financing Note: (1) Since the results-based financing program will only be implemented in 9 districts le targets for indicators directly related to the RBF (indicators under intermediate target 3 and 4) can only be expected to 12

13 Annex 2 Allocz Category ~~ 1.Goods,works, consultant services, training, operating costs (ii, v, vi)* 1 A.Goods,works, consultant services, training, operating costs (iii, iv, vii)** 2.District Basket sub-grants (i)*** 3.Community sub-grants Amount of Credit allocated (SDR) 10,290,000 Percentage of Expenditures to be financed 100% 2,050,000 Such Percentage of expenditures as the Association shall communicate to the Recipient in its Annual Confirmation 6,850,000 (I) The Financial Agreement stipulates that the Russian?deration resources will be fully spent before those from IDA, which allowsjbr 1 OO%financing of activities. *As indicated in the Financial Amendment, financing will support the following activities in Component 1: (ii) acquisition and installation of, inter alia, Insecticide Treated Nets (ITNs), Rapid Diagnostic Tests (RDTs), and other laboratory equipment; (v) strengthening the capacity of the MOH for case management; (vi) strengthening the capacity of the MOH for increased intermittent presumptive treatment and training of microscopists and other front-line health workers in the use of RDTs. **As indicated in the Financial Amendment, financing will support the following activities in Component 1: (iii) provision of reproductive health commodities; (iv) financing for incentive payments to support the retention and increased productivity of critical staff; (vii) strengthening the capacity of the MOH for implementation of the RBF scheme through the provision of Training and technical assistance. ***As indicated in the Financial Amendment, financing will support the following activities in Component 1 : (i) provision of District Basket Sub-Grants to the administrative Districts of the Recipient, through allocations out of the Common District Basket Account, to enable District-level Health management teams (DHMTs) to improve their service delivery and expand coverage in the areas of maternal health, child health, and malaria interventions. Total Amount I 13,700,000 I Amount of the grant (Russian) allocated US$ 5,050,000 1,500, ,000 Percentage of expenditures financed 100% (1) Such Percentage of expenditures as the Association shall communicate to the Recipient in its Annual Confirmation 100% Amount of the grant (MF) allocated US$ 10,000,000 I 1,000,000 I I I Percentage of expenditures to be financed 100% 13

14 Annex 3 Revised Project Components Component 1 (a): Strengthening the health system to improve service delivery: This sub-component will deal primarily with health system strengthening activities whereby all 72 district health management teams will receive incremental fund allocations to improve service delivery in the areas of maternal health, child health and malaria. Furthermore, one district per province (9 in total) will receive the results-based financing scheme which will be financed through a designated account linked to the Project under this component. The component will deal with the supply-side constraints for expanding coverage of key interventions, such as Insecticide Treated Nets (ITNs), Rapid Diagnostic Tests (RDTs) and other laboratory equipment, reproductive health commodities and contribute to alleviating the dire human resource situation in the health sector through support for non-monetary and monetary compensation to retain and increase productivity of critical staff. The implementation of this component will be through the district basket mechanism for malaria control interventions, whereby funds will be pooled with other partners to finance incremental operating costs for the districts. The RBF interventions will be financed through a designated account as stated above. Large ticket items such as ITNs, emergency obstetric and neonatal care equipment and laboratory supplies will be centrally procured and distributed to the District Health Management Teams. Component 1 (b): Improved environmental health management: This subcomponent of the project will finance activities aimed at improving the management of health care waste associated with malaria control and maternal and child health interventions. The project will support activities to address the weaknesses identified in the Health Care Medical Waste Plan. Component 2: Community Booster Response to Malaria (COMBOR): This component will deal with the demand-side constraints to effective malaria control programming. For example, while ITN ownership by households is rising, actual use is lagging behind. This project component will support community demand-driven interventions: (i) directly through financing of sub-proj ects by community based organizations, and (ii) through the facilitation of interventions by communities and local leaders to strengthen the malaria control activities of other implementers. The community response to malaria will help to both extend the geographic coverage of malaria interventions, particularly in the rural communities, and increase the use of the interventions. It will involve the communities to promote the behavior change that is necessary for effective malaria control interventions. The component piggy-backs on the brand name and network infrastructure of the Community Response to HIV/AIDS (CRAIDS) demand-driven fight against HIV/AIDS. This community demand-driven component (COMBOR) will complement the more supply-oriented malaria control activities, under Component 1. The activities to be supported under the COMBOR component will focus particularly on behavior change communication, advocacy on the appropriate use of malaria prevention interventions, and capacity building for malaria prevention and control at the community and district level. Component 3: Program Management: This component will support strengthening the MOH at all levels to provide technical leadership in the areas of malaria control, as well 14

15 as maternal and child health, coordination and implementation of the program, human resource capacity strengthening and M&E of the interventions including support to improve M&E systems. This component will support documenting the RBF implementation process and development of relevant case studies on the Zambia RBF experience for national and international dissemination. 15

16 Annex 4 Procurement Plan I. General Project ID Number: PO96131 Project Implementing Agencies: Ministry of Health 2. Bank s approval Date of the Procurement Plan: TBA 3. Date of General Procurement Notice: TBA 4. Period Covered by this Procurement Plan: November June II. Goods, Supply & Installation of Services Plant & Equipment, Works & non-consulting 5. Prior Review Threshold: Procurement decisions are subject to prior review by the Bank as stated in Appendix 1 to the Guidelines: Procurement under IBRD Loans and IDA Credits, dated May 2004, Revised October 1, Expenditure Category Procurement Method 1. Works ICB (Works/Supply & Installation) >=3,000,000 I NCB 2. Goods Contract Value Threshold (US$) Contracts Subject to Prior Review (US$ millions) All Contracts Shopping <50,000 ICB >=500,000 All Contracts Shopping Direct Contracting >=50,000 - <3,000,000 At least one to be identified in procurement plan I I I None I NCB >=50,00 < 500,000 At least one to be identified in procurement plan <50,000 <10,000 None All Contracts 6. Prequalification: N/A 7. Proposed Procedures for CDD Components (as per paragraph 3.17 of the Guidelines): These will apply in respect of activities under the Community Booster Response to Malaria (COMBOR) which will provide support aimed at strengthening local capacities of communities to effectively prevent and control and treat malaria and deal with the demand-side constraints to effective malaria control programming, based on community demand-driven interventions through: (i) financing on a grant basis of Community Sub-Grants of selected projects to be carried out by community based organizations using community participation in procurement procedures acceptable to the Bank as will be further elaborated in the project implementation manual. 16

17 8. Reference to (if any) Project Operational/Procurement Manual: MOH as the implementing Agency will amend its procurement procedures manual to incorporate the requirements of the RBF activities. The Procurement Plan and the procedures for implementing procurement activities for the COMBOR using CDD will also form part of the Project Procurement Manual. 9. Any Other Special Procurement Arrangements (including advance procurement and retroactive financing, if applicable): N/A. Procurement Packages with Methods and Time Schedule a) Works 1) Water DTF/ORD/O 1 / Reticulation 09 Lump NCB 900,000 Prior sum Supply and delivery of Emergency Obstetric and Neonatal Care Equipment DTFiORDi 396,375 ICB Prior /09 1 III. Selection of Consultants 10. Prior Review Threshold: Selection decisions are subject to prior review by the Bank as stated in Appendix I to the Guidelines: Selection and Employment of Consultants by World Bank Borrowers, dated May 2004 revised October 1, Table 3: Thresholds for Consultants Selection Methods and Prior Review Expenditure Category Procurement Method Contract Value Threshold Contracts Subject to Prior (US$) Review (US$ millions) 1. Consulting Services Firms QCBS, LCS, QBS, FBS (depending on the type of assignment, as per the Guidelines referenced above) All Contracts N/A >= 200, Individual Consultants CQS sss Individual Consultants (IC) < 100,000 None N/A All contracts 17

18 N/A All Contracts >= 100,000 and all Single Source Selections 11. Consultancy services estimated to cost above US$200,000 equivalent per contract and individual consultants assignments estimated to cost US$lOO,OOO and above and all individual consultants hired on single source basis will be subject to prior review by the Bank. 12. Terms of Reference (TOR) for all consultancy contracts as well as all single source selections, irrespective of the contract value, will be subject to prior review. 13. Short lists entirely of national consultants: Short lists of consultants for services estimated to cost less than US$200,000 equivalent per contract may be composed entirely of national consultants in accordance with the provisions of paragraph 2.7 of the Consultant Guidelines. 14. Any Other Special Selection Arrangements: None Consultancy Assignments and Training with Selection Methods and Time Schedule: c) Consultant Services Extensions and water reticulation at Various sites 1 I Preparation of Bills of quantities for water I 150,000 I LCS I Post I ~ I No. d) Training I I I I I I I Expected outcome I Activity Description Estimated Cost Estimated Duration Start Date I 1 Capacity building in various fields including procurement, Financial management, project management and operation. TBA 2 Capacity building in various fields including Obstetric and Neo Natal. TBA 18

19 Annex 5 Project Costs *Includes Russian Federation financing in the amount of US$6.85 million **Costs for the impact evaluation of the results-based financing grant will be covered through a World Bank executed impact evaluation grant from the Health Results Innovation Trust Fund. *** RBF Grant co-financing 19