The World Bank Investing in Early Years and Fertility in Burundi (NKURIZA) (P165253) REPORT NO.: RES60061 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF INVESTING IN EARLY YEARS AND FERTILITY IN BURUNDI (NKURIZA) APPROVED ON SEPTEMBER 5, 2019 TO REPUBLIC OF BURUNDI Health, Nutrition and Population Global Practice Eastern and Southern Africa Regional Vice President: Victoria Kwakwa Country Director: Albert G. Zeufack Regional Director: Daniel Dulitzky Practice Manager/Manager: Francisca Ayodeji Akala Task Team Leader(s): Omer Ramses Zang Sidjou, Olivier Basenya The World Bank Investing in Early Years and Fertility in Burundi (NKURIZA) (P165253) ABBREVIATIONS AND ACRONYMS CYP Couple-Years Protection MoH Ministry of Health NGO Non-Governmental Organization PDO Project Development Objective SEA/SH Sexual Exploitation and Abuse, and Sexual Harassment The World Bank Investing in Early Years and Fertility in Burundi (NKURIZA) (P165253) BASIC DATA Product Information Project ID Financing Instrument P165253 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 05-Sep-2019 30-Jun-2024 Organizations Borrower Responsible Agency Republic of Burundi Project Development Objective (PDO) Original PDO Increase the coverage of community based nutrition interventions among women of reproductive age and children under two and to increase utilization of family planning services in targeted areas OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-D5140 05-Sep-2019 19-Sep-2019 28-Feb-2020 30-Jun-2024 30.00 20.20 8.79 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No The World Bank Investing in Early Years and Fertility in Burundi (NKURIZA) (P165253) I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. Rationale for Restructuring 1. This Restructuring Paper (RP) seeks approval for a proposed Level 2 restructuring of The Investing in Early Years and Fertility in Burundi Project (NKURIZA, P165253), consisting of (i) a 12-month no-cost extension of the project’s closing date from June 30, 2024 to June 30, 2025; and (ii) a revision of some targets of the project’s results framework based of implementation progress and the availability of updated data. The extension period will be used to consolidate the package of activities deployed and refocus on activities deemed necessary to sustain the gains of the project, including the income generating activities. The World Bank received a request from the Government of Burundi for a no-cost extension of the closing date of the project on May 12, 2023. In agreement with the Government, the Bank purposely delayed the processing of the restructuring to allow for further progress in implementation and ensure that requested extension period will be sufficient to fully complete the project and build more sustainability. B. Project Background 2. The Investing in Early Years and Fertility in Burundi Project (NKURIZA, P165253) was approved by the World Bank Board on September 5, 2019 and became effective on February 28, 2020. The total project amount is US$30 million equivalent. The current closing date of the project is June 30, 2024. The Project Development Objective (PDO) is to Increase the coverage of community based nutrition interventions among women of reproductive age and children under two and to increase utilization of family planning services in targeted areas. The project targets 6 provinces out of 18 in Burundi: Kirundo, Muyinga, Cancuzo, Makamba, Bubanza and Cibitoke. Beneficiaries are mainly children and women. C. Project Status 3. Progress towards the PDO is rated Satisfactory (as noted in Implementation Status and Results Report of March 11, 2024). Four of the six1 PDO indicators have exceeded their targets. Two of the seven intermediate results indicators have already exceeded their target and the other five are on track. Overall, the PDO remains on track to be achieved, though a restructuring is necessary to update some targets in light of implementation experience. As of today, the disbursement rate stands at 70 percent. After a delayed start, implementing Non-Governmental Organizations (NGOs) were urged to propose and execute a catch-up plan for speedy completion of activities at the community level. A transition plan developed by the Ministry of Health (MoH), prior to the recruitment of the NGOs, established a strong foundation for the NGOs and has helped accelerate progress. Key areas where the pace of implementation has picked up are: training of community health workers, central procurement of key inputs, facilitation with importations and other livestock safety requirement procedures. Additionally, the task team and the MOH team are maintaining momentum on the implementation of the activities through field visits, enhanced monitoring, and monthly check-in meetings with the NGOs. 1 The six indicators include one sub-indicator for the Corporate Results Indicator. The World Bank Investing in Early Years and Fertility in Burundi (NKURIZA) (P165253) 4. Project implementation is rated Moderately Satisfactory, based on overall performance across the components and project management. Under Component 1 (Community interventions to increase coverage of nutrition services and uptake of family planning), the project has completed three rounds of nutrition-specific activities. These activities include home food fortification with micronutrient powders, growth monitoring and promotion in appropriate and equipped sites, screening for malnutrition, rehabilitation of children suffering from moderate malnutrition, and capacity building of health facility providers, community health workers and enlightened mothers (Mamans Lumieres). Additionally, a number of nutrition-sensitive activities have been carried out in the project intervention areas. These include distribution of selected seeds of fortified organic beans (32,573 kg for 11,162 households), maize (22,316 kg for 13,423 households), market garden crops (1,102 kg for 24,125 households), fruit plants (16,558 plants for 14,371 households), and bunches of mushrooms (5,288 bunches for 174 beneficiary groups). In addition, several small livestock animals were distributed to vulnerable households, including goats (660 in 660 households), laying hens (6400 in 12600 households), pigs (1021 in 1021 households), boars (430), rabbits (12910 in 4031 households). In addition, 4,171 households benefited from water disinfection tablets. The self-injectable contraceptive SAYANA PRESS has been introduced in the six provinces of project intervention and is administered by Community Health Workers. The project supported the organization of high-level forums for women leaders on the fight against malnutrition and demographic control, the production of communication tools (advertising spots, image boxes), the organization of radio broadcasts, community mobilization sessions on the management of malnutrition, community debates on family planning, training of journalists on the integrated nutrition- family planning approach, training of peer educators for youth in and out of school, and awareness campaigns through mobile cinema. 5. Under Component 2 (Strengthening institutions, leadership and monitoring and evaluation), the project supported the operation of provincial and municipal food security and nutrition platforms, steering committees at the level of 872 communes and the revitalization of the network of journalists for food security and nutrition. The project is financing master’s level training courses for 8 students (3 in Nutrition, 2 in Environmental Health and 3 in Reproductive Health) of which 3 have already completed their course and 5 will complete theirs by September 2024. 6. Fiduciary and Safeguards Performance: The performance in financial and accounting management is rated Moderately Satisfactory with no pending audits. Procurement and safeguards performance are also rated Moderately Satisfactory. Additionally on safeguards, the complaint management mechanism is now introduced at the community level in all communes. Complaints management committees are set up at the health pyramid level. Training of these committees is underway, in addition to the training already provided to the focal points of provincial offices and health centers. The risks of sexual exploitation and abuse, and sexual harassment (EAS/HS) and gender-based violence are better controlled in the project. The project code of conduct is now signed by all workers involved in the project. The review and update of the EAS/HS action plan, including the development of a worker and community awareness strategy, as well as for community consultations is now implemented. II. DESCRIPTION OF PROPOSED CHANGES The World Bank Investing in Early Years and Fertility in Burundi (NKURIZA) (P165253) A. Results Framework 7. The proposed changes to the Results Framework is as follows. The target of the PDO-level indicator "People who have received essential health, nutrition, and population (HNP) services" is revised up from 1 million to 5 million given that the impact of the community mobilization was underestimated during preparation. Likewise, the target of the PDO- level indicator "Number of women and children who have received basic nutrition services" is revised up from 1 million to 3 million. It was established that the target of the indicator "Couple-Years Protection (CYP) in targeted areas" was an overly ambitious. Hence, the National Program for Reproductive Health recommended a reduction of target from 1,102,523 CYP, to 550,000 for this project covering 6 provinces out of 18 in the country. The original target assumed that the government would sustain a parallel mass vasectomy program. However, with the mobilization campaign stopped, this target is no longer feasible. Also, new evidence from the United Nations Population Fund has necessitated a revision of the 2017 baseline to 276,191 CYPs. 8. The target of the intermediate result indicator "Community steering committee meeting quarterly and providing inputs into the project's quarterly reports, including on quality of and satisfaction with community nutrition interventions" is revised up from 133 to 1,000 to reflect the decision of the government to organize these meetings at the most granular level of the territorial division hierarchy, the "sous-colline". B. Closing date 9. The restructuring proposes to extend without costs, the closing date of the project by 12 months, from June 30, 2024 to June 30, 2025. C. Risks 10. The proposed restructuring introduces no new risks to the Project. III. SUMMARY OF CHANGES Changed Not Changed Results Framework ✔ Loan Closing Date(s) ✔ Implementing Agency ✔ DDO Status ✔ Project's Development Objectives ✔ PBCs ✔ Components and Cost ✔ Cancellations Proposed ✔ Reallocation between Disbursement Categories ✔ The World Bank Investing in Early Years and Fertility in Burundi (NKURIZA) (P165253) Disbursements Arrangements ✔ Disbursement Estimates ✔ Overall Risk Rating ✔ Safeguard Policies Triggered ✔ EA category ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Implementation Schedule ✔ Other Change(s) ✔ Economic and Financial Analysis ✔ Technical Analysis ✔ Social Analysis ✔ Environmental Analysis ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_LOANCLOSING_TABLE LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications IDA-D5140 Effective 30-Jun-2024 30-Jun-2025 30-Oct-2025 . The World Bank Investing in Early Years and Fertility in Burundi (NKURIZA) (P165253) . Results framework COUNTRY: Burundi Investing in Early Years and Fertility in Burundi (NKURIZA) Project Development Objectives(s) Increase the coverage of community based nutrition interventions among women of reproductive age and children under two and to increase utilization of family planning services in targeted areas Project Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 Increase the coverage of community based nutrition interventions among women and children People who have received essential health, nutrition, and population 0.00 2,000,000.00 3,000,000.00 4,000,000.00 5,000,000.00 (HNP) services (CRI, Number) Rationale: The targets of this indicator was revised up as it was reached very quickly after the deployment of NGOs in the field. The effect of community-based Action: This indicator has been mobilization was obviously underestimated. Revised The actual value is updated and the end date is postponed. Number of women and children who have received basic 0.00 500,000.00 1,000,000.00 2,000,000.00 3,000,000.00 nutrition services (CRI, Number) The World Bank Investing in Early Years and Fertility in Burundi (NKURIZA) (P165253) RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 Rationale: The targets of this indicator was revised up as it was reached very quickly after the deployment of NGOs in the field. The effect of community based Action: This indicator has been mobilization was obviously underestimated. Revised The actual value is updated and the end date is postponed. Children 0-23 months receiving essential community-based nutrition and early stimulation 0.00 5.00 10.00 20.00 30.00 services in targeted areas (Percentage) Rationale: Action: This indicator has been The actual value is updated and the end date is postponed. Revised Children 0-23 months showing adequate weight gain in targeted 0.00 25.00 30.00 40.00 55.00 areas (Percentage) Rationale: Action: This indicator has been The actual value is updated and the end date is postponed. Revised Increase utilization of family planning services Women using modern contraceptive methods in targeted 19.90 22.40 24.90 27.40 29.90 areas (Percentage) Rationale: Action: This indicator has been The actual value is updated and the end date is postponed. Revised The World Bank Investing in Early Years and Fertility in Burundi (NKURIZA) (P165253) RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 Couple-Years Protection (CYP) in 276,191.00 280,000.00 350,000.00 450,000.00 550,000.00 targeted areas (Number) Rationale: It was established that the target of this indicator was had considered that an ongoing subsidized vasectomy program will keep pushing up the Action: This indicator has been indicator. However, the mobilization has stopped and the high demand as well. This project does not support that. Hence the National Program for Revised Reproductive Health recommended a reduction of target from 1,102,523 CYP to 550,000. PDO Table SPACE Intermediate Results Indicators by Components RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 Community interventions to increase coverage of nutrition services and utilization of FP Community steering committees meeting quarterly and providing inputs into the project's quarterly 0.00 200.00 500.00 800.00 1,000.00 reports, including on quality of and satisfaction with community nutrition interventions (Number) Rationale: The target of the indicator "Community steering committees meeting quarterly and providing inputs into the project's quarterly reports, including on Action: This indicator has been quality of and satisfaction with community nutrition interventions" is revised up to 1000 to reflect the decision of the government to organize these Revised meeting at the most granular level of the territorial division hierarchy, the "sous-colline". The World Bank Investing in Early Years and Fertility in Burundi (NKURIZA) (P165253) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 Mothers participating in behavior change activities (cumulative) 0.00 57,167.00 120,050.00 264,111.00 607,454.00 (Number) Rationale: Action: This indicator has been Update of the current value and reflection of the revised end date. Revised Targeted households with targeted groups (children under two, pregnant and lactating women, 0.00 8,281.00 27,604.00 33,125.00 35,886.00 adolescent girls) benefiting from nutrition sensitive community initiatives (Number) Rationale: Action: This indicator has been Update of the current value and reflection of the revised end date. Revised Pregnant women benefiting from iron and folic acid supplementation 0.00 170,091.00 369,098.00 800,943.00 1,738,047.00 (cumulative) (Number) Rationale: Action: This indicator has been Update of the current value and reflection of the revised end date. Revised Community Health workers trained to deliver Sayana Press 0.00 30.00 50.00 75.00 100.00 (Percentage) Rationale: Action: This indicator has been Update of the current value and reflection of the revised end date. Revised The World Bank Investing in Early Years and Fertility in Burundi (NKURIZA) (P165253) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 Strengthening institutions, leadership and monitoring Faith-based health facilities staff trained on family planning methods 0.00 40.00 50.00 60.00 80.00 and referrals in in targeted areas (Percentage) Rationale: Action: This indicator has been Update of the current value and reflection of the revised end date. Revised Number of people trained in Masters level training (1 year) (nutrition, reproductive health, and 0.00 3.00 6.00 9.00 environmental public health) (Number) Rationale: Action: This indicator has been Update of the current value and reflection of the revised end date. Revised IO Table SPACE The World Bank Investing in Early Years and Fertility in Burundi (NKURIZA) (P165253)