ZAMBIA FY Annual MALARIA BOOSTER PROJECT 10 11 12 2.5 4 5 PROJECT DATA SHEET Is approval for any policy exception sought from the Board? DATA SHEET JarawadYaw Ansu Borrower: Republic of Zambia Responsible agency: Ministry of Health Revised estimated disbursements (Bank FY/US$m) Yes XNo - Board approved X RVP approved - Does the restructured project require any exceptions to Bank policies? Have these been approved by Bank management? Project development objective: To increase coverage o f interventions for malaria prevention and treatment and other key maternal and child health interventions. PDO indicator 1: To increase the percentage o f children under 5 years o f age who sleep under an insecticide treated bednet from 41% to 55% by 2012. PDO indicator 2: To increase the percentage o f pregnant women who receive a complete course o f intermittent presumptive treatment for malaria from 66% to 75% by 2012. PDO indicator 3: To increase the percentage o f people in indoor residual spraying- eligible districts who sleep in appropriately sprayed structures from 40% to 60% by 2008. PDO indicator 4: To increase the percentage o f women delivering in facilities by skilled birth attendant from 34% to 50% by 2012. Does the restructured project trigger any new safeguard policies? No. IBRDADA Russian Federation Trust Fund 1 Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized
Transcript
ZAMBIA
FY Annual
MALARIA BOOSTER PROJECT
10 11 12 2.5 4 5
PROJECT DATA SHEET
I s approval for any policy exception sought from the Board?
DATA SHEET
JarawadYaw Ansu
Borrower: Republic of Zambia Responsible agency: Ministry o f Health Revised estimated disbursements (Bank FY/US$m)
Yes X N o -
Board approved X RVP approved -
Does the restructured project require any exceptions to Bank policies? Have these been approved by Bank management?
Project development objective: To increase coverage o f interventions for malaria prevention and treatment and other key maternal and child health interventions. PDO indicator 1: To increase the percentage o f children under 5 years o f age who sleep under an insecticide treated bednet from 41% to 55% by 2012. PDO indicator 2: To increase the percentage o f pregnant women who receive a complete course o f intermittent presumptive treatment for malaria from 66% to 75% by 2012. PDO indicator 3: To increase the percentage o f people in indoor residual spraying- eligible districts who sleep in appropriately sprayed structures from 40% to 60% by 2008. PDO indicator 4: To increase the percentage o f women delivering in facilities by skilled birth attendant from 34% to 50% by 2012. Does the restructured project trigger any new safeguard policies? No.
IBRDADA Russian Federation Trust Fund
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1. Introductory Statement
1. This Project Paper seeks the approval o f the Executive Directors to introduce the following changes in the Zambia Malaria Booster Control Project, Credit No. 41260 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, 2006. I t i s a US$20 mill ion IDA credit being implemented over four years, with a closing date o f January 31, 2010. The Project Development Objective (PDO) i s to increase access to, and use of, interventions for malaria prevention and treatment by the target population. The target population i s the population o f Zambians living in all the 72 malarious districts o f the country. The priority groups among this target population are children under the age o f five years, pregnant women and all those infected with malaria.
3. The project has three main components which are further divided into subcomponents as listed below: C 1 a: Health System Strengthening, C 1 b: Improving environmental health management, C2: Strengthening the community response to malaria, and C3: Building capacity within the Ministry o f Health (MOH)/National Malaria Control Center (NMCC) in the areas o f coordination, implementation and technical leadership.
4. The project has performed very well and it has made a significant contribution to the recent substantial improvements in coverage o f key malaria prevention activities in Zambia as described in the recent project ISR (04/20/2009). As o f July 31, 2009, US$l9.09 mil l ion has been disbursed and US$1.97 mil l ion i s remaining o f the original credit.2 Thanks to the good performance in the scale up o f preventive interventions, as summarized in table 1 , as well as the excellent management o f 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 o f the management o f health care waste associated with malaria control and the environmental monitoring o f the use of insecticides; Component 2) provides support to strengthen local capacities to effectively prevent, control and treat malaria and mitigate some o f the demand-side constraints to effective malaria control programming; and Component 3) supports strengthening the capacity o f the Ministry o f Health/ National Malaria Control Centre to provide technical leadership and coordination o f the implementation of the national program.
There i s an exchange rate gain o f US$1.06 million, making total available funding for the project US$21.06 million.
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been replaced by other diseases as the main cause o f death for children under-five and pregnant womenS3
Indicator Baseline
(2006) 30% 1. Percentage o f children under 5 years o f age who
sleep under an insecticide treated bednet f rom 30% to 40% by 2008.
complete course o f intermittent presumptive treatment for malaria from 45% to 55% by 2008.
who sleep in appropriately sprayed structures from
2. Percentage o f pregnant women who receive a 45%
3. Percentage o f people in IRS-eligible district areas 27%
5. As a result o f 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 o f this grant i s to increase the coverage o f key malaria interventions to contribute to achieving the objectives o f the project. The funds have contributed specifically to the achievement o f PDO indicator 1 and 3. As o f July 3 1 , 2009, US$4.49 mi l l ion o f this grant has been disbursed and US$2.36 mi l l ion i s remaining. The 2009 activity plan o f the grant has been developed and implementation o f activities i s progressing according to schedule. The remaining funding has been fully committed.
Current Mid-term Status target achieved
41% Yes (2008)
66% Yes
93% Yes
40% to 60% by 2008. Source: Malaria Indicator Survey 2006 and 2008.
6. The stewardship and coordination o f the implementation o f the project by the M O H and the N M C C has been satisfactory and the Government o f the Republic o f Zambia (GRZ) has shown a strong commitment to sustaining this success.
7. The GRZ has recently requested a restructuring o f the project for the following reasons: a. Although there has been considerable progress in malaria control, there i s s t i l l a
significant gap to reach the government’s target o f at least 80% coverage .of the population at-risk with malaria control interventions.
b. The health system component o f the project has lagged behind. To sustain and improve the recent achievements, strengthening the health system i s essential
c. As malaria i s no longer the main cause o f maternal and child deaths in Zambia, the GRZ proposes to broaden the scope o f the project to a wider set o f maternal and child health interventions
According to the 2007 Demographic and Health Survey causes o f under-five mortality in Zambia include neonatal causes (22.9%), pneumonia (21.8%), malaria (19.4%), diarrhea (17.5%), HIV/AIDS (16. I%), measles (1.2%), and others (0.2%). The same survey shows that mothers are dying from hemorrhage (25%), puerperal infection (15%), eclampsia (13%), complicated abortion (13%), obstructed labor (7%), malaria (5%), tetanus YO), and non-specific (2 1 Yo).
Baseline data were estimated during the design o f the project and adjusted after a baseline study.
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8. There are available co-financing resources to support this restructuring. The results-based financing (RBF) grant’ (US$l 1 million) that Zambia received through a competitive selection process provides an opportunity to maintain these gains while broadening the scope o f the project. In the restructured project, the activities will use RBF as a tool for improving coverage o f a core set o f 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 o f 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 o f 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 o f institutional deliveries from 43 percent in 2006 to 50 percent by 201 1, and raise the percentage o f children under 5 years o f age who sleep under a treated bednet from 30 percent in 2006 to 60 percent by 201 1. Moreover, the CAS recognizes that health i s one o f the Bank’s comparative advantages in Zambia and one o f 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 I
Original To increase access to, and use of, interventions for malaria prevention and treatment by the target population.
To increase the percentage o f children under 5 years o f age who sleep under a treated bednet f rom 30% to 40% bv 2008. To increase the percentage o f pregnant women who receive a complete course o f intermittent presumptive treatment for malaria from 45% to 55% by 2008. To increase the percentage o f people in IRS- eligible district who sleep in appropriately sprayed structures f rom 40% to 60% by 2008. N/A
Modified
malaria prevention and treatment and other key maternal and chi ld health interventions.
To increase the percentage o f children under 5 years o f age who sleep under an insecticide treated bednet from 41% to 55% by 2012. To increase the percentage o f pregnant women who receive a complete course o f intermittent presumptive treatment for malaria from 66% to 75% by 2012. To increase the percentage o f people in IRS- eligible district who sleep in appropriately sprayed structures from 40% to 60% by 2008.8 To increase the percentage o f women delivering in facilities by skilled birth attendant f rom 34% to 50% by 2012.’
’ The RBF grant i s a Bank-wide multi-donor trust fund, currently mainly supported by the Norwegian government, which promotes a results-based approach to health sector strengthening.
’ Dated March 28,2008 * PDO indicator 1,2 and 3 are not substantially changed under the restructured project. Minor modifications include the change o f 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).
Lancet Child Survival Series 2003/ Maternal Survival Series 2006
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The revised results framework i s attached at Annex 1.
12. Other proposed modifications are: a) Extension o f the project end date. The current project end date i s January 31, 2010.
The new proposed end date for the project i s January 3 1 , 2012. b) Reallocation o f resources and adjustments o f percentage o f financing. A revised
allocation table i s attached in Annex 2. c) Modification o f the project components to reflect the change in the project
development objectives. See details in Annex 3.
4. 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 M O H 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 i s expected that the full implementation o f 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 M O H will use the designated account (DA) in United States dollars for funds that will finance procurement o f 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 o f 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 M O H on the
PDO indicator 4 has been newly introduced to reflect the Results Based Financing co-financing grant. The wording o f 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 o f 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 o f the missing vouchers and stores
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Auditor General’s recommendations with a request for full implementation o f the recommendations by October 15, 2009. In their response dated September 24, 2009 the M O H 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 o f the project.
16. In May 2009, the Zambia Anti Corruption Commission reported a fraud in the M O H that raises potential concerns about the control environment in the MOH. The Commission i s currently carrying out investigations and the Office o f the Auditor General has completed a forensic audit for 2008 and 2009. To date, 13 M O H staff have been officially charged in court with theft by public servant, amounting to approximately US$6.4 mill ion in total. There i s 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 M O H with set targets and means o f verification, which was agreed to with the health sector donors.
18. The Office o f the Auditor General i s providing additional oversight through continuous pre-audits on procurement and payments and post audits. The Governance Action Plan (GAP) includes a comprehensive systems audit o f M O H and a special financial audit to cover the years 2006 to 2009. The government has developed the terms o f reference for these audits which have been reviewed by the donor group. The audits will provide quick conclusions on the credibility o f 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 o f the Auditor General.
19. The Auditor General will share the initial findings o f 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 o f required follow-up actions. The audit also covers the Malaria Booster Project. In the light o f 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 o f the procurement plan and a review o f M O H procurement capacity took place. A Procurement Capacity Assessment for the M O H was carried out in 2006 for the Malaria Booster Project (MBP). This was updated in February 2009. The review included the assessment o f the institutional arrangements and organizational structure,
items in its response to the Auditor General’s management letter, and th i s will be reviewed by the Auditor General during the next audit o f the project. l2 Based on current information on the fraud allegations, it involved the contracting o f ghost companies for training workshops. None o f the companies involved in the scheme have been contracted as part o f World Bank projects.
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adequacy o f staff qualifications, capacity, and experience o f the various implementing agencies to carry out procurement under the project. The M O H was assessed to have adequate capacity to implement procurement for the restructured project largely based on consultants that have been engaged to complement the M O H capacity. The consultants have been involved alongside M O H staff in implementing the M B P since i ts inception and will continue in that capacity. M O H will also build i t s internal capacity in the interest o f sustainability in the longer term. A procurement plan for the first 18 months o f implementation (Annex 4) has been prepared. Procurement o f 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 o f 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 o f credit proceeds and project costs are specified in Annexes 2 and 5, respectively. The total amount o f the project including the proposed funding and the Russian Federation Trust Fund already under implementation i s US$37.85 million. The largest percentage o f the funding i s allocated to Component 1 o f 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 o f the project as appraised.
23. The original project was classified as category B given the risks associated with indoor residual spraying (IRS) o f DDT and other pesticides and with the handling and disposal o f 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, 2005. The N M C C changed their policy on DDT in 2007 and the chemical i s no longer being used. Furthermore, the restructured project will not support the procurement o f insecticides. These changes lower the environmental risk o f 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 i s classified as category B partial assessment and only one safeguard policy i s 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 o f 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 i s being finalized which provides an update on the implementation progress o f the plan and future activities. The final version o f this amendment will be disclosed to the public, in the Zambia as well as the InfoShop by October 15,2009.
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24. During the implementation o f the original project, IDA financed a safeguards activity plan that included the procurement o f incinerators, capacity building o f M O H and provincial staff in health care waste management, preparation and dissemination o f waste management guidelines, and rehabilitation o f the environmental health school to start a Bachelor o f 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 2008- 20 10. During regular supervision missions, including from a Senior Environmental Specialist, progress on the implementation o f the environmental activity plan was reviewed. Implementation has been consistently rated as satisfactory.
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 o f the project
Financing o f U S $ 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 o f the project.
25. The restructuring does not involve any exceptions to Bank policies.
Risk Rating L
M
6. Expected Outcomes
26. The restructured project will continue to support part o f the original malaria activities as well as broaden i t s focus to achieve improved coverage o f maternal and child health interventions. The expected outcome o f the project will be increased coverage o f interventions for malaria prevention and treatment and other key maternal and child health activities. This will be measured through three PDO indicator^'^:
1. Percentage o f children under 5 years o f age who sleep under an insecticide treated bednet last night from 41% to 55% by 2012. 2. Percentage o f pregnant women who receive a complete course o f intermittent presumptive treatment for malaria from 66% to 75% by 2012. 3. Percentage o f women delivering in facilities by skilled birth attendant from 34% to 50% by 2012.
27. The original results framework has been revised and the revised results framework i s attached in Annex 1.
7. Benefits and Risks 28. The following risks have been identified with mitigation measures and risk ratings:
l3 Since PDO indicator 3 was achieved during the duration of the original project and since indoor residual spraying wil l not be supported under the restructured project, this indicator will not be used for monitoring the restructured project and i s therefore not included in this list.
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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 i s insufficient to achieve the expanded PDO.
The handling, collection, disposal and management of health care waste and other infected materials i s the most significant environmental issue associated with this proposed restructuring. The additional medical waste expected to be generated i s 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 o f the Auditor General The Office o f the Auditor General i s providing additional oversight through continuous pre and post-audits on procurement and payments. The MOH i s also benefitting from a team o f consultants to support implementat ion. The MOH has had challenges operating the upgraded Navision accounting package and has therefore resorted to the use o f 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 o f the system.
Mechanisms to facilitate increased collaboration have already been put in place. One key example i s 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 i s successfully implementing the National Health-Care Waste Management Plan The original project has rated the implementation o f the National Health Care Waste Management Plan as satisfactory.
The MOH i s currently underway to update the plan and reinforce their commitment to it through the review o f indicators, budget, and plan outcome since its adoption under the original project.
Support to strengthening the medical waste management capacity o f the MOH at all levels i s included the proposed restructuring.
The overall risk i s considered to be moderate.
L
L
Based on the above, the task team recommends the approval o f 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.
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Annex 1. Results Framework
60% (2008)
50% (2012)
Project Development Obi ective
Malaria Indicator Survey
H M I S
Increase coverage o f interventions for malaria prevention and treatment and other key maternal and chi ld health interventions.
Target (year)
Intermediate Outcomes
1. Prevention o f malaria
Data Source
2. Treatment o f malaria
Project Outcome Indicators
(i) percentage o f children under 5 years o f age who slept under an insecticide-treated net (ITN) last night
(ii) percentage o f pregnant women receiving a complete course (at least two doses) o f intermittent preventive treatment (IPT)
(iii) percentage o f people in IRS-eligible districts who sleep in appropriately sprayed structures* (iv) percentage o f women delivering in facilities by skilled birth attendant
Intermediate Outcome Indicators
Component 1 (i) percentage o f households wi th more than one ITN
(ii) percentage o f children under age five years who slept under an insecticide- treated net (ITN) last night (iii) percentage o f household in indoor- residual spraying (IRS) eligible districts reporting IRS in the last 12 months. (i) percentage o f
children under 5 years o f age with fever in previous two weeks who received anti- malarial drug within 24 hours o f onset o f fever
Baseline (Year>
41% (2008)
66% (2008)
40% (2006)
34% (2008)
Baseline (year)
55% Malaria (2012) Indicator
I
(2012) Indicator Survey
I
Support to the national healt, 30.9% 140%
1 (2012) (2008)
I
41% 55% (2008) (20 12)
(2008) (20 12)
(2008) (2012)
I 10
system Malaria Indicator Survey
Malaria Indicator Survey
Malaria Indicator Survey
Malaria Indicator Survey
Frequency o f data collection Every second year
Every second year
Every second year
Routinely collected
Frequency of data collection
Every second year
Every second year
Every second year
Every second year
3. Increase access to maternal health interventions
Component 2: Commu 5. Improved (i) percentage o f awareness o f women 15-49 years
4. Increase access to key chi ld health interventions
ity Booster R 71% (2008)
(i) percentage o f women attending postnatal visits by health center staff (delivery at home or in facility) (ii) percentage o f women who received iron supplements at antenatal care visit (iii) percentage o f women using any type o f contraception (new
malaria risk, transmission, and prevention nodes 5. Increased iccess to :ommunity sub-project
acceptors) (iv) percentage o f
who recognize fewer as a symptom o f malaria
(i) percentage o f 0% malaria prone districts (2009) that have at least one C B O N G O receiving
women who received at least one injection o f tetanus toxoid during pregnancy ( V I number o f health facilities constructed, renovated, and/or equipped (with emergency obstetric and neonatal care equipment)* * * *
N M C C Annual ReDort
(i) full immunization
Yearly
coverage o f children under 1.
(ii) percentage o f children under six months exclusively breastfed (iii) percentage o f household wi th properly hanging bednets (iv) percentage o f children under five w i th diarrhea receiving oral rehydration salts (ORs)
49% (2008)
90% (2007)
41% (2007)
74% (2008)
0 (2009)
68% (2008)
61% (2007)
64%* * * (2007)
60% (2007)
55% (2012)
95% (2012)
55% (20 12)
85% (2012)
180 (2012)
75% (2012)
70% (2012)
70%* * * (2012)
66% (2012)
ponse to Ma 80% (2012)
90% (2012)
H M I S
H M I S
H M I S
H M I S
MOH
H M I S
Community HMIS**
Community HMIS**
Community HMIS**
Routinely collected
Routinely collected
Routinely collected
Routinely collected
Routinely collected
Routinely collected
Routinely collected
Routinely collected
Routinely collected
ria (COMBOR) Malaria I Every second Indicator Survey
year
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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
8. Determining the impact of the program
Note: (1) Since the results-based financing program will only be implemented in 9 districts indicators directly related to the RBF (indicators under intermediate target 3 and 4) can only
Cornpc (i) disbursement, withdrawals and central procurement are done according to established standards and schedule (ii) Steering Committee for results- based financing, that meets at least 2 times per year, in place at the central level during the project period (iii) percentage of health facil i t ies that report timely on indicators in RBF districts (iv) number of health personnel receiving training (in Results- Based Financing)** * * (i) percentage of collection and analysis of end-line household and facility data completed (ii) case studies documenting the process of implementing results- based financing
2,050,000 Such Percentage o f expenditures as the Association shall communicate to the Recipient in its Annual Confirmation
3 .Community sub-grants
Total Amount I 13,700,000 I (I) The Financial Agreement stipulates that the Russian
Amount o f the grant
(Russian) allocated
US$ 5,050,000
1,500,000
300,000
6,850,000
Percentage o f
expenditures financed
100% (1)
Such Percentage o f expenditures as the Association shall communicate to the Recipient in i ts Annual Confirmation
Amount o f the grant (MF)
allocated U S $
10,000,000
100%
Percentage o f
expenditures to be
financed
100%
I 1,000,000 I I 11.000.000 I
?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 o f the MOH for increased intermittent presumptive treatment and training of microscopists and other front-line health workers in the use o f 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 o f critical staff; (vii) strengthening the capacity o f the MOH for implementation o f the RBF scheme through the provision o f 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 o f 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 o f maternal health, child health, and malaria interventions.
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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 o f 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 o f 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 o f critical staff. The implementation o f 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 I T N s , 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 sub- component o f the project will finance activities aimed at improving the management o f 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 i s rising, actual use i s lagging behind. This project component will support community demand-driven interventions: (i) directly through financing o f sub-proj ects by community based organizations, and (ii) through the facilitation o f interventions by communities and local leaders to strengthen the malaria control activities o f other implementers. The community response to malaria will help to both extend the geographic coverage o f malaria interventions, particularly in the rural communities, and increase the use o f the interventions. It will involve the communities to promote the behavior change that i s necessary for effective malaria control interventions. The component piggy-backs on the brand name and network infrastructure o f 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 o f 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 M O H at all levels to provide technical leadership in the areas o f malaria control, as wel l
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as maternal and child health, coordination and implementation o f the program, human resource capacity strengthening and M&E o f the interventions including support to improve M&E systems. This component will support documenting the RBF implementation process and development o f relevant case studies on the Zambia RBF experience for national and international dissemination.
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Annex 4 Procurement Plan
Contract Value Threshold (US$)
Procurement Method Expenditure Category
1. Works ICB (Works/Supply & Installation) >=3,000,000
I. General
Contracts Subject to Prior Review
(US$ millions) All Contracts
Project ID Number: PO96131 Project Implementing Agencies: Ministry o f Health
2. Goods
2. Bank’s approval Date of the Procurement Plan: TBA
Shopping <50,000 ICB >=500,000 All Contracts
3. Date of General Procurement Notice: TBA
Shopping
Direct Contracting
4. Period Covered by this Procurement Plan: November 2009 - June 201 1
None <50,000
<10,000 All Contracts
II. Goods, Supply & Installation of Plant & Equipment, Works & non-Consulting Services
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, 2006.
I NCB
>=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
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 o f 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.
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8. Reference to (if any) Project Operational/Procurement Manual: M O H as the implementing Agency will amend i ts procurement procedures manual to incorporate the requirements o f the RBF activities. The Procurement Plan and the procedures for implementing procurement activities for the COMBOR using CDD will also form part o f the Project Procurement Manual.
1) Water DTF/ORD/O 1 / Reticulation 09
9. Any Other Special Procurement Arrangements (including advance procurement and retroactive financing, if applicable): N/A. Procurement Packages with Methods and Time Schedule
Lump NCB 900,000 Prior 27.1 1.09 12.03.10 23.04.10 10.09.10 sum
a) Works
Supply and delivery o f Emergency Obstetric and Neonatal Care Equipment
Procurement Method Contract Value Threshold Contracts Subject to Prior (US$) Review
(US$ millions)
All Contracts N/A >= 200,000 QCBS, LCS, QBS, FBS
(depending on the type of assignment, as per the Guidelines referenced
above)
CQS
< 100,000 None sss
Individual Consultants (IC) N/A All contracts
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 o f Consultants by World Bank Borrowers, dated May 2004 revised October 1 , 2006.
Table 3: Thresholds for Consultants Selection Methods and Prior Review
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N/A
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.
All Contracts >= 100,000 and al l Single Source
Selections
12. source selections, irrespective o f the contract value, will be subject to prior review.
Terms o f Reference (TOR) for all consultancy contracts as well as al l single
1
13. Short lists entirely o f national consultants: Short l is ts o f consultants for services estimated to cost less than US$200,000 equivalent per contract may be composed entirely o f national consultants in accordance with the provisions o f paragraph 2.7 o f the Consultant Guidelines.
Capacity building in various fields including procurement, Financial management, project management and operation.
TBA
14. Any Other Special Selection Arrangements: None
2 Capacity building in various fields including Obstetric and Neo Natal.
Consultancy Assignments and Training with Selection Methods and Time Schedule:
TBA
c) Consultant Services
Extensions and water reticulation at Various sites 1 I Preparation o f Bills o f quantities for water I 150,000 I LCS I Post I 15.12.09 ~ 1 5 . 0 1 . 1 0
d) Training I I I I I I I I No. Expected outcome I
Activity Description Estimated Cost Estimated Duration Start Date I
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Annex 5 Project Costs
*Includes Russian Federation financing in the amount of US$6.85 million **Costs for the impact evaluation o f 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
