The World Bank Mali - Accelerating Progress Towards Universal Health Coverage (P165534) REPORT NO.: RES59378 DOCUMENT OF THE WORLD BANK RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF MALI - ACCELERATING PROGRESS TOWARDS UNIVERSAL HEALTH COVERAGE APPROVED ON MARCH 19, 2019 TO REPUBLIC OF MALI HEALTH, NUTRITION & POPULATION WESTERN AND CENTRAL AFRICA Regional Vice President: Ousmane Diagana Country Director: Clara Ana Coutinho De Sousa Regional Director: Dena Ringold Practice Manager/Manager: Gaston Sorgho Task Team Leader(s): Laurence Elisabeth Marie-Paule Lannes, Alain-Desire Karibwami The World Bank Mali - Accelerating Progress Towards Universal Health Coverage (P165534) I. BASIC DATA Product Information Project ID Financing Instrument P165534 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 19-Mar-2019 30-Jun-2024 Organizations Borrower Responsible Agency Republic of Mali Ministère de la Santé et du Développement Social Project Development Objective (PDO) Original PDO The objective of the project is to improve the utilization and quality of reproductive, maternal, neonatal, child, adolescent health and nutrition services, especially among the poorest households, in targeted areas. Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-D4420 19-Mar-2019 31-May-2019 27-Dec-2019 30-Jun-2024 50.00 46.00 2.46 TF-B3548 31-May-2019 07-Jan-2021 07-Jan-2021 30-Jun-2024 30.40 24.89 5.51 TF-A9738 19-Mar-2019 31-May-2019 27-Dec-2019 30-Jun-2024 10.00 9.12 .88 The World Bank Mali - Accelerating Progress Towards Universal Health Coverage (P165534) Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No II. SUMMARY OF PROJECT STATUS AND PROPOSED CHANGES Seven months prior to the scheduled closure date of the "Mali - Accelerating Progress Towards Universal Health Coverage" (PACSU) Project, substantial progress has been made across all its components and objectives. Notably, the project has exceeded its end-of-project targets for five out of five PDO indicators, except for two sub-indicators relating to vaccination due to antigen shortages, and to the number of deliveries attended by skilled health personnel (which is likely to be achieved by project closure). Eight intermediate indicators have reached their end-project targets, while the remaining five show steady progress. In the December 2023 ISR, the project ratings improved significantly. Notably, the ratings for progress toward the Project Development Objective and Implementation Progress were upgraded from Satisfactory to Highly Satisfactory. These successive improvements in the project ratings reflect a positive trajectory towards the achievement of its core objectives. Component 1, which focused on strengthening health services through performance-based financing, has shown outstanding improvements in service provision. Component 2, focusing on community health activities, has demonstrated significant advancements in digitalizing health services via the DISC-Mali tool's deployment and its integration into the national health system. Component 3's efforts in enhancing health system performance and management have been commendable, including activities such as data collection, staff training, and the establishment of committees to promote the use of health services. Financial Management and Challenges: Financially, the project's management performance is rated satisfactory with moderate financial risk. By the time of the mission in November 2023, the disbursement rate across the International Development Association (IDA) (92.35%), the Global Financing Facility (GFF) (86.9%), and the Netherlands (88.90%) reflected a high use of the project's resources. However, a shortfall in IDA resources, attributed to currency exchange losses, presents a challenge. The decline in USD equivalent of the SDR from 50 million USD to less than 47,500,000 USD between 2019 and 2023 resulted in a potential loss of 2,500,000 USD. The current financing need of approximately 1,700,000 USD on this IDA funding is primarily due these exchange rate fluctuations. Therefore, anticipating a disbursement rate of 100% at the closing date in June 2024, a restructuring is necessary to realign the disbursement rates for sub-components 1.1 and 1.2 to optimize the use of the Dutch funds (MDTF) before project closure. This restructuring aims to complete essential activities and ongoing contracts before project closure. III. DETAILED CHANGES The World Bank Mali - Accelerating Progress Towards Universal Health Coverage (P165534) REALLOCATION BETWEEN DISBURSEMENT CATEGORIES Current Current Actuals + Proposed Disbursement % Ln/Cr/TF Expenditure Allocation Committed Allocation (Type Total) Category Current Proposed IDA-D4420- GDS,NCS,CS,OC, 001 TR excpt Pt A & 10,100,000.00 9,101,414.36 10,100,000.00 69.00 62 Currency: D XDR PBF GRANTS Pt 21,173,033.97 20,014,009.44 21,173,033.97 51.00 24 A.1 EMERGENCY EXPENDITIRE 0.00 0.00 0.00 100.00 100.00 Pt.D PPF 253,932.05 253,932.05 253,932.05 100.00 100.00 REFINANCING GDS,NCS,CS, TR 4,173,033.98 2,537,034.04 4,173,033.98 31.00 32 Pt A.2 Total 35,700,000.00 31,906,389.89 35,700,000.00 TF-A9738- GDS,NCS,CS,OC, 001 TR excpt Pt A & 6,000,000.00 5,173,662.27 6,000,000.00 31.00 38 Currency: D USD PBF GRANTS Pt 3,000,000.00 2,713,381.33 3,000,000.00 5.00 4 A.1 EMERG. EXP. Pt 0.00 0.00 0.00 100.00 100.00 D GDS,NCS,CS, TR 1,000,000.00 628,865.67 1,000,000.00 7.00 6 Pt A.2 Total 10,000,000.00 8,515,909.27 10,000,000.00 TF-B3548- PBF GRANTS Pt 22,870,000.00 19,420,077.02 22,870,000.00 44.00 72 001 A.1 Currency: Gds,NCS,CS&Tr USD 7,530,000.00 4,667,540.17 7,530,000.00 62.00 62.00 Pt A.2 Total 30,400,000.00 24,087,617.19 30,400,000.00 The World Bank Mali - Accelerating Progress Towards Universal Health Coverage (P165534)