The World Bank CAR Health Service Delivery & System Strengthening Project (SENI-Plus) (P177003) Project Information Document (PID) Appraisal Stage | Date Prepared/Updated: 23-Feb-2022 | Report No: PIDA33207 Feb 21, 2022 Page 1 of 12 The World Bank CAR Health Service Delivery & System Strengthening Project (SENI-Plus) (P177003) BASIC INFORMATION OPS_TABLE_BASIC_DATA A. Basic Project Data Country Project ID Project Name Parent Project ID (if any) Central African Republic P177003 CAR Health Service Delivery & System Strengthening Project (SENI-Plus) Region Estimated Appraisal Date Estimated Board Date Practice Area (Lead) AFRICA WEST 07-Mar-2022 28-Apr-2022 Health, Nutrition & Population Financing Instrument Borrower(s) Implementing Agency Investment Project Financing Central African Republic Ministry of Health and Population, Central African Republic Proposed Development Objective(s) To increase utilization of quality essential health services for women and chidren in targeted areas in the Central African Republic. Components Component 1: Supporting Essential Health Service Delivery Component 2: Strengthening Health System Performance and Preparedness Component 3: Project Management, Coordination and Monitoring & Evaluation (M&E) Component 4: Contingent Emergency Response Component (CERC) PROJECT FINANCING DATA (US$, Millions) SUMMARY -NewFin1 Total Project Cost 70.00 Total Financing 70.00 of which IBRD/IDA 58.00 Financing Gap 0.00 DETAILS -NewFinEnh1 World Bank Group Financing Feb 21, 2022 Page 2 of 12 The World Bank CAR Health Service Delivery & System Strengthening Project (SENI-Plus) (P177003) International Development Association (IDA) 58.00 IDA Grant 58.00 Non-World Bank Group Financing Trust Funds 12.00 Global Financing Facility 12.00 Environmental and Social Risk Classification Substantial Decision The review did authorize the team to appraise and negotiate Other Decision (as needed) B. Introduction and Context Country Context 1. The Central African Republic (CAR) experiences recurrent conflicts, political volatility, and extreme poverty. CAR is considered the third most fragile and violent country in Africa according to the Global Peace Index (2020). By August 2021, 2.8 million people in CAR needed humanitarian assistance, out of a population of 5.4 million.1 Democratic elections were held in 2016 when President Touadera was elected president and the Khartoum Peace Accord was signed between 14 major armed groups and the government in February 2019. Touadera was re-elected for a second term as president in late January 2021, regardless of the coalition of armed groups that forcefully intimidated voters and inflicted violence upon the population. By April 2021, one-fifth of the population (738,000) was internally displaced—nearly half of them being children,2 due to the presidential electoral turmoil caused by the rebellious opposition earlier in the year. By the end of May 2021, the government had pushed back the rebels and reported that most of the country was under government control. 2. The level of poverty remains high in CAR. The latest 2020 World Bank projections suggest that approximately 70 percent of the population is living below the international poverty line (defined as US$1.90 per day in terms of Purchasing Power Parity (PPP)). Gross Domestic Product (GDP) per capita in CAR plummeted from US$1,102 (PPP) current international dollar in 2012 to US$739 in 2013 due to conflict, and has still not reached pre-crisis levels, standing at US$980 in 2020. The Coronavirus (COVID-19) pandemic has had a profound impact on CAR’s economy. While the number of COVID-19 1World Bank, 2021. 2UNICEF, 2021 https://www.unicef.org/press-releases/central-african-republic-nearly-370000-children-now-internally- displaced-amidst) Feb 21, 2022 Page 3 of 12 The World Bank CAR Health Service Delivery & System Strengthening Project (SENI-Plus) (P177003) related deaths recorded in CAR remains relatively low, most likely due to underestimation of recorded COVID-19 related deaths due to limited testing and mortality statistics, disruption in global value chains, low external demand, and domestic containment measures have significantly affected trade, transport, and tourism. CAR’s economy decelerated in 2020 as compared to 2019. However, its GDP growth of 0.8 percent in 2020 was higher than regional peers (−2.9 percent) and countries affected by fragility, conflict and violence (FCV) (−1.7 percent).3 The GDP per capita in 2021 is expected to be about the same as in 2019, indicating that the country is expected to lose two years in per capita income growth due to the pandemic. 3. Years of conflict and the lack of essential services for human development have translated into low human capital outcomes. CAR is ranked the lowest in the world on the human capital index. A child born in CAR today can only expect to be 29 percent as productive when s/he grows up as s/he could have been if s/he had benefitted from full health status and complete education.4 This is 27 percent lower than the worldwide estimate of 56 percent. One out of ten children5 born in CAR today will not survive to age five, and only 59 percent of 15-year-olds will survive to age 60. Life expectancy was 53 years in 2019, roughly nine years lower than the sub-Saharan African (SSA) average the same year (61.6 years) and has been consistently below the SSA average for the past 40 years.6 Sectoral and Institutional Context 4. CAR has one of the highest maternal mortality and fertility rates in the world. Despite a slight improvement as compared to 2010, maternal deaths are estimated at 829 per 100,000 live births in 2017, significantly higher than the SSA average of 534.7 The total fertility rate is high, estimated at 6.4 children with a gap between urban (4.9 children) and rural areas (7.3 children). Twelve percent of women aged 20-24 had given birth before the age of 15 years, and 43 percent by the age of 18 years.8 High maternal mortality and fertility, including adolescent pregnancies and short births pacing, are linked to the country’s poor underlying social determinants of health – including women’s lack of empowerment – and limited access to and quality of health services. Only 14 percent of women of reproductive age use modern contraception, 41 percent of pregnant women receive four antenatal care visits and 58 percent deliver in a health facility. 5. Child mortality and chronic malnutrition (stunting) levels are extremely high. Despite the measurable improvement between 2010 and 2018, these rates are still highest in the world.9 Likewise, CAR has the second highest neonatal mortality rate in the world, at 28 deaths per 1000 live births. 3World Bank, 2021. 4This is based on 2020 pre-Covid 19 estimates from the World Bank Human Capital Project. 5 88 out of 100 children born in CAR survive to age 5. 6 World Development Indicators, 2021. 7 World Development Indicators, 2021. 8 Unless otherwise stated, all data in paragraphs 4,5 and 6 are from Multiple indicators cluster survey, Final report. Bangui, CAR: UNICEF, UNFPA, WHO, World Food Program, World Bank, ICF international. (MICS 2018-2019) 9 Infant mortality rate decreased from 116 to 65 deaths per 1000 live births and under five years mortality rate from 179 to 99 deaths per 1000 live births between 2010 and 2018. ICASEES. (2010) and MICS 2018-2019 Feb 21, 2022 Page 4 of 12 The World Bank CAR Health Service Delivery & System Strengthening Project (SENI-Plus) (P177003) The three main causes of child mortality include diarrhea, respiratory infection and malaria.10 They have not changed since 1990 and constitute more than half of child deaths. Four children out of ten are stunted and at risk of cognitive and physical limitations. Access to basic health services remains limited – in 2018, only 34 percent of infants received their third diphtheria, tetanus toxoids and pertussis (DPT3) vaccination, substantially lower than the SSA average of roughly 73 percent in 2018. Low uptake of key preventive and promotive behaviors also explain these poor outcomes: for example, only one third of children younger than six months old were exclusively breastfed and up to about two thirds of households do not have a dedicated setting or installation for hand washing. 6. Inequalities in access to and utilization of health services across geographical location and income level are significant. Low-income women and children, as well as those living in rural areas fare much worse than those who are better-off or settled in urban areas. For instance, while about a third of poorest women have no access to antenatal care, only 3 percent among the wealthiest women are in this situation; for family planning these figures are 33 percent (wealthiest) and 12 percent (poorest). Similarly, children born in wealthier household are three times more likely to be vaccinated and twice less likely to be stunted than those in poor households, with similarly large gaps observed to the detriment of children in rural areas. Differences across regions (not presented here) also show large inequalities in access to services between the capital of Bangui where health service coverage is higher than the rest of the country. 7. Poor women and child outcomes are also a direct consequence of the prevailing conflict and violence. In particular, despite widespread under-reporting, one incident of gender-based violence (GBV) is reported every hour by the humanitarian alert system which covers less than half the country.11 Humanitarian actors have recorded almost a doubling in the number of GBV cases as a result of COVID-19 related restrictions and 45 percent of respondents to a rapid survey believed that there has been an increase in domestic violence during the COVID-19 crisis.12 Sexual and physical violence are prevalent not only in the context of war, but also in everyday activities, including at home and in schools.13 Across CAR, children continue to be exposed to risks: one in four families fears for the safety of their children, mainly in regard to sexual violence, forced labor and recruitment by armed groups.14 8. The COVID-19 pandemic, with the large disruption in essential health services felt by the most vulnerable groups, has proven that health system strengthening, and preparedness go hand in hand. CAR is particularly vulnerable to outbreaks because it is landlocked and surrounded by six fragile countries15 that have weak disease surveillance capacity and a history of outbreaks, including Ebola Virus Disease, Yellow Fever, Rabies and Measles. The movement of people and the crossing of borders for commercial purposes increase the risk of importing emerging diseases. Further, there are internal 10 Institute for Health Metrics and Evaluation, 2021. 11 UNOCHA, Central African Republic: Situation Report, 5 January 2021; CAR Gender-based violence Information Management System (GBVIMS), 2020 12 2020 rapid COVID-19 survey: Enquête rapide sur les effets de la COVID-19: Une perspective genre en RCA jointly published in July 2020 by ICASEES (The CAR National Statistical Office). 13 Rapport d’enquête menée en 2014 par le ministère des Affaires Sociales avec l’appui de FNUAP sur les VBG en République Centrafricaine. 14 UNOCHA, Central African Republic: Situation Report, opus. Cit. 15 DRC, Republic of Congo, Cameroon, Chad, Sudan and South Sudan Feb 21, 2022 Page 5 of 12 The World Bank CAR Health Service Delivery & System Strengthening Project (SENI-Plus) (P177003) risks of cholera and other diseases due to low vaccination coverage. CAR’s Joint External Evaluation score, which measures a country’s capacities to prevent, detect and rapidly respond to public health risks, of 1.4 out of 5 indicates that the country is not prepared to respond to a new disease threat. On the Global Health Security Index,16 CAR ranked 189 out of 195 countries in 2021 with an overall score of 18.6 out of 100, illustrating an extremely low capacity to prevent, detect and respond to disease outbreaks. 9. CAR’s health system is characterized by profound supply- and demand-side constraints that are inherently linked to the country’s longstanding fragility, conflict and violence. The recurrent military and political crises in CAR have profoundly disrupted the delivery of basic social services. On the supply side of health service delivery, critical bottlenecks include: (i) severe shortage of health workers, infrastructure, medical equipment and other critical inputs for health facilities to deliver basic health services, coupled with difficulty in physical access to health services due to poor road conditions and persisting insecurity; (ii) lack of a functioning national supply chain to efficiently deliver drugs and medical supplies; (iii) limited coverage of community based interventions to more efficiently promote health, prevent and treat diseases among the most remote and vulnerable populations. On the demand side, barriers to increase the uptake of health services include: (i) inability to afford the costs of health services due to high level of poverty, and (ii) a large number of vulnerable populations, including GBV survivors and internally displaced populations (IDP), who require specialized care but are unable to access it. In addition, there are considerable system level constraints that prevent the government from being able to deliver quality health services to the population include: (i) weak governance of the health system due to limited administrative capacity, regulations and mechanisms to promote accountability and transparency including weak public financial management; (ii) low and inefficient health spending, with high reliance on donor funding that is difficult to coordinate; and (iv) scarce health related data to inform policy. 10. With the return of peace and stability in some areas of CAR since 2016, the government has a window of opportunity to re-build the country’s health system and make progress on reducing maternal and child mortality. In 2020, the Ministry of Health (MOH) outlined ten core domains of action17 to initiate progress towards Universal Health Coverage (UHC) by 2030. The key domains of reform include bringing health services closer to the population, providing universal access to essential medicines and vaccination, fighting against epidemics and communicable diseases such as HIV/AIDS, tuberculosis and malaria, and ensuring safe childbirth and equitable access to family planning. Building on these principles, the third generation National Health Development Plan for 2022-2026 (NHDP III), currently being finalized, intends “to make CAR a country where access to quality health services is ensured for all social strata, with full participation of the population within the framework of UHC.� 11. The government has launched policy initiatives in support of UHC. The 2018 Presidential Decree for Targeted Free Healthcare guaranteeing access to basic care, including drugs, for all pregnant, post- 17 The ten domains of Presidential impetus for Universal Health Coverage in CAR are to: 1) bring health services closer to the population, 2) provide access to essential medicines, 3) provide access to vaccination and to fight against epidemics, 4, 5, 6) fight against HIV/AIDS, tuberculosis (TB) and malaria, 7) provide access to good child nutrition and clean water and sanitation, 8) enhance girls' education, 9) to ensure safe childbirth and family planning needs, and 10) provide road safety. Feb 21, 2022 Page 6 of 12 The World Bank CAR Health Service Delivery & System Strengthening Project (SENI-Plus) (P177003) partum women, children under-five, and survivors of GBV constitutes a major step, indicative of the government support to these vulnerable groups. The Decree was reinforced with the adoption of Performance-Based Financing (PBF) as a national strategy for service provision. To tackle the persisting challenge of high maternal and child mortality, the MOH, with support from the Global Financing Facility (GFF), drafted the Investment Case for the Rapid Reduction of Maternal and Child Mortality18 to prioritize the sector around key health systems strengthening strategies and a core package of high impact interventions to be delivered by health facilities and CHWs.19 CAR is making progress, but the transition from emergency relief to a sustainable and domestically funded health system that provides UHC is long. 12. As for sub-sectoral strategies, the government is keen for a collaborative development and adoption of different strategies and plans which would clarify the government priorities in each domain, including strategies on national health supply chain, human resources for health, and community health as stated earlier. In addition, the government intends to create an environment of zero tolerance for GBV. The National Strategy to Combat GBV, Harmful Practices and Child Marriage for 2019-23 aims to reduce the incidence of GBV. The strategic plan calls on the health sector to strengthen capacity of health workers in the clinical management of GBV survivors and to document cases, equip health facilities to accommodate GBV survivors, increase availability of free treatment, train health care staff to provide psychological support, and a community-wide behavior change mobilization to prevent GBV. C. Proposed Development Objective(s) Development Objective(s) (From PAD) To increase utilization of quality essential health services for women and chidren in targeted areas in the Central African Republic. Key Results The achievement of the PDO will be measured through the following PDO-level indicators. • Number of deliveries attended by a skilled health personnel • Number of children who receive three doses of Pentavalent vaccine (Penta 3) • Women and adolescents receiving long-term or permanent family planning methods • Average quality score of health centers and district hospitals in targeted areas • Percentage of availability of tracer drugs in targeted health facilities 18The Investment Case was launched by the President of the Republic in April 2020 and is being updated with recent data. 19The Investment case is currently being updated in order to incorporate evidence from the latest Multiple Indicator Cluster Survey 2019 and to align with the PNDSIII as it is developed. Feb 21, 2022 Page 7 of 12 The World Bank CAR Health Service Delivery & System Strengthening Project (SENI-Plus) (P177003) D. Project Description 13. The project is fully aligned with the strategic priorities of the NHDP III and build on the gains made under SENI while ensuring complementarity with other health sector engagements and beyond. The project aims to support the government in its effort to attain Universal Health Coverage by: (i) continuing support to delivery of essential quality health services at health facilities and extending its reach to communities; (ii) providing holistic support to GBV survivors. The project will further strengthen the various pillars of the health system through: (iii) developing a functional national health supply chain; (iv) supporting targeted investments to improve hospital capacity especially at subnational levels; (v) supporting sectoral reforms in the areas of human resources for health, health management information systems (HMIS) and performance measurement, and public financial management. The project will further help the country prepare for future pandemics and emerging diseases by integrating these activities as part of health system strengthening. 14. Component 1 seeks to: (i) continue the delivery of essential health services and provision of Targeted Free Health care through use of an adapted PBF delivery model; (ii) support the delivery of community-level interventions by financing a basic package of services delivered by CHWs, and (iii) provide holistic support to GBV survivors in target districts. 15. Component 2 will address critical bottlenecks to a functioning health system in CAR. A first set of investments will directly facilitate the delivery of essential services to women and children by accelerating the development of a functional national health supply chain (2.1) and through targeted investments to equip and conduct minor rehabilitation in priority hospitals outside of the capital region (2.2). The project will also support selected government reforms that are key to moving towards a stronger and sustainable health system, while ensuring the performance and sustainability of the project’s investment is met. This component will further contribute to building a sustainable and resilient health system (2.3) that is prepared to respond to future pandemics and emerging diseases (2.4). 16. Component 3 will help ensure effective and efficient technical and fiduciary management and implementation of the project. The component will support project implementation through the financing of (i) operating costs, training, and equipment; (ii) paying salaries of international and national consultants; (iii) audits and communications, and (iv) implementation and monitoring of environmental and social standards as well as project results indicators. The PIU responsible for day-to-day management of the project will be the current SENI- REDISSE4- COVID19 PIU that will also assume the responsibilities of the implementation of the SENI-plus project. 17. Component 4 is a Contingency Emergency Response Component (CERC) which will be included under the project in accordance with World Bank IPF Policy’ paragraphs 12 and 13, for projects in Situations of Urgent Need of Assistance or Capacity Constraints. This will allow for rapid reallocation of project proceeds in the event of a natural or man- made disaster or crisis that has caused, or is likely to imminently cause, a major adverse economic and/or social impact. 18. The project is designed to help the country achieve the high-level health objectives and support health system reforms. The project’s development objective is aligned with the Presidential Roadmap for UHC that prioritizes RMNCAH-N and bringing services closer to the population and more generally with the draft NHDP III. The project supports policies and strategies to achieve UHC, notably the Targeted Free Health Care and PBF, as well as the implementation of the key sub sectoral plans that are currently under development, including the National Health Workforce Strategy, National Supply Chain Policy, and the National Community Health Strategy, as well as the Feb 21, 2022 Page 8 of 12 The World Bank CAR Health Service Delivery & System Strengthening Project (SENI-Plus) (P177003) Roadmap for Health Management Information System. Similarly, the project is guided by and helps implement the government’s Investment Case to accelerate progress on RMNCAH-N. 19. This project is the driver of the World Bank’s coordinated engagement in CAR’s health sector. SENI-plus will build on the lessons learned from the current health sector project (SENI), which supported health service delivery through PBF and piloted comprehenive GBV interventions. Other World Bank projects in the sector were designed to complement SENI and will continue to enhance synergies with SENI-Plus in response to specific health sector needs . The Regional Disease Surveillance System Enhancement project (REDISSE IV) (IDA US$15 million) builds national and regional intersectoral capacities for collaborative disease surveillance and epidemic preparedness, while SENI-plus will support targeted investments to enhance pandemic preparedness by fully integrating it in the health system strengthening. The COVID-19 Strategic Preparedness and Response (COVID-19 Project) (IDA US$7.5 million) and its additional financing (US$25.5 million) directly addresses the COVID-19 response, including the deployment of vaccines and in doing so, will invest in the country’s immunization system. The Human Capital and Women and Girl’s Empowerment (Maïngo) Project (US$50 million) aims to increase essential health services, education and employment opportunities that empower women and adolescent girls. It will use a community-based approach to generate demand for health services, whereas SENI Plus will primarily focus on improving the supply of health services. Beyond health sector operations, the Bank-executed Programmatic Advisory Services and Analytics will be instrumental in supporting the government in its evidence-based policy decisions for critical reforms, and to inform the design and implementation of World Bank-financed operations including this project. . . Legal Operational Policies Triggered? Projects on International Waterways OP 7.50 No Projects in Disputed Areas OP 7.60 No Summary of Assessment of Environmental and Social Risks and Impacts . 20. The environmental risk rating is substantial. The implementation of project activities will generate risks and potential reversible impacts on the environment. The improvement in the provision of essential services in health facilities and communities through PBF under component 1 will lead some beneficiary hospitals and health facilities to carry out small-scale rehabilitation of delivery rooms, laboratories, and treatment rooms, in addition to enabling a safe structure for GBV survivors to access services without being exposed. The improvement in the provision of services in health facilities will also lead to an increase in the amount of biomedical waste, as well as an increase in the health and safety risks for staff and, to a lesser extent, to communities, especially if the waste is not properly managed. In component 2, some activities will involve civil engineering works, notably the construction of a national and regional supply warehouses under the subcomponent 2.1. The civil works will generate negative impacts such as: construction waste, noise pollution, space conversion, destruction of vegetation cover, increase in aerosols and engine fumes, risks of transmission of STIs/HIV/AIDS due to the arrival of working personnel, occupational health and safety risks (including Feb 21, 2022 Page 9 of 12 The World Bank CAR Health Service Delivery & System Strengthening Project (SENI-Plus) (P177003) the risk of spreading Covid 19). All of these potential risks and impacts will be assessed in detail in the ESMF that will be prepared along with other instruments prior to project appraisal. 21. The social risk rating is substantial. Under Component 1, Improving essential service delivery at health facilities and in communities, activities to be developed include the PBF interventions support targeted free healthcare for maternal and child primary healthcare, preventative interventions, and survivors of GBV, and for the marginalized and poor households. TA and improvements of health service quality within health facilities and communities. All these activities will target beneficiaries such as vulnerable groups (women, GBV survivors, IPs) and poor households will need to ensure that any risks of discrimination and exclusion are addressed. Moreover, the criteria for providing free healthcare services should be clearly designed, fixed and publicly disclosed in a transparent process of selection of beneficiaries. An inappropriate or flawed selection process could create social tension among communities. Same attention should be paid under Component 2 concerning the recruitment of community workers (Indigenous people, young people) in the construction of different warehouses. In addition, measures need also to be taken to mitigate risks related to the expansion of transmissible diseases (STI, HIV/AIDS, Covid-19) given that through these activities, the project will be able to reach a wide range of populations, disseminate training, information. However, while the overall social benefits are expected to be positive, the anticipated social risks and impacts include: - Insecurity risks - New wave of COVID-19 risks -Risks to increase HIV/AIDS transmission - Risks of exclusion of households led by women and other vulnerable individuals- Sexual Exploitation and Abuse/Sexual Harassment (SEA/SH) E. Implementation Institutional and Implementation Arrangements 22. SENI-plus will broadly rely on the same institutional arrangements as SENI. The MOH will be the main line ministry for the implementation of the project. Under coordination by the Minister and the Cabinet Director, technical activities will be undertaken by the relevant directorates and units within the Ministry. As with the current project, a National Health Steering Committee (Comite national de suivi) will be in charge of validating the Annual Work Plan and Budget (AWPB) and ensuring its follow- up, will oversee the achievement of the project’s objectives. Project execution will take place at all levels (at the communities, community health post, health centers, district health facilities and hospitals) of the health system. Learning from implementation challenges experienced under SENI, the project will ensure strong focus on governance as well as close supervision at central and subnational levels, including the General Health Inspection and National Public Health Institute to oversee project implementation through counter verification activities. 23. Day to day implementation will be managed by the PIU that manages World Bank projects in health. This PIU, established by SENI under the MOH, currently also serves as the PIU for the REDISSEIV and COVID-19 projects. The PIU is currently being strengthened with the additional recruitment of procurement and financial management specialists (under recruitment funded by REDISSE4), as well as additional resources to implement the new COVID-19 Additional Financing for vaccine acquisition Feb 21, 2022 Page 10 of 12 The World Bank CAR Health Service Delivery & System Strengthening Project (SENI-Plus) (P177003) and deployment,20 such as the supply chain specialist, the COVID-19 focal point, accountant and logistician. The SENI-plus technical focal point will be hired to overview the technical implementation of the project. The PIU will continue to assume, among others, fiduciary management responsibilities, overall planning, internal audit and M&E. To cope with an increased workload for SENI-plus, the PIU’s capacity will be further assessed and strengthened with additional human resources, including international staff as needed. Concrete staffing arrangements will be informed by the ongoing fiduciary assessment, a review of environmental and social aspects, and other technical needs. These aspects will be reflected in the revised Project Operational Manual. . CONTACT POINT World Bank Tomo Morimoto Senior Health Specialist Mahoko Kamatsuchi Senior Health Specialist Borrower/Client/Recipient Central African Republic Implementing Agencies Ministry of Health and Population, Central African Republic Pierre Somse Minister of Health psomsep@gmail.com Jean Baptiste Roungou Coordinator, SENI-REDISSE4 projects jbroungou@gmil.com 20With COVID-19 AF, an immunization specialist/COVID-19 focal point, logistic specialist, one supply chain expert, a monitoring and evaluation specialist on digital tracking and surveillance, and an accountant specifically for the AF will be recruited. Feb 21, 2022 Page 11 of 12 The World Bank CAR Health Service Delivery & System Strengthening Project (SENI-Plus) (P177003) FOR MORE INFORMATION CONTACT The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects APPROVAL Tomo Morimoto Task Team Leader(s): Mahoko Kamatsuchi Approved By Practice Manager/Manager: Country Director: Han Fraeters 17-Mar-2022 Feb 21, 2022 Page 12 of 12