28-Jun-2023 Date: __________________ His Excellency Ernesto Max Tonela Minister of Economy and Finance Ministry of Economy and Finance Av. 10 de Novembro, No. 929, 1o Andar Maputo Re: Republic of Mozambique Primary Health Care Strengthening Program (FCDO SDTF Grant Number TF0B4481) Corrigendum to Second Amendment to the Grant Agreement Excellency: We refer to the Grant Agreement for the above-captioned Project between the Republic of Mozambique (“Recipient”) and the International Bank for Reconstruction and Development and International Development Association (“World Bank”), acting as administrator of the Mozambique Primary Health Care Strengthening Program Single Donor Trust Fund, dated May 21, 2021, as amended (the “Agreement”). We also refer to the Second Amendment to the Grant Agreement dated April 12, 2023 (“Amendment”). It has come to our attention that due to an oversight, the Amendment does not refer to the correct amount of the Grant. We are therefore writing to rectify this error by making the following two corrections: 1. Section 3 of the Grant Agreement is hereby deleted in its entirety and replaced with the following: “3.01. The Bank agrees to extend to the Recipient a Grant in an amount not to exceed eight million seven hundred thousand (USD 8,700,000) (“Grant”) to assist in financing the Program.” 2. The withdrawal table in Section IV.A.2 of Schedule 2 to the Grant Agreement is replaced with the table shown in Annex of this Corrigendum. Please refer to this letter in all future correspondence relating to this Grant Agreement. All other provisions of the Grant Agreement remain in full force and effect, except as specifically amended by this Corrigendum. Sincerely, INTERNATIONAL DEVELOPMENT ASSOCIATION, acting as Administrator of the Mozambique Primary Health Care Strengthening Program Single Donor Trust Fund Idah Z. Pswarayi-Riddihough Country Director Mozambique, Comoros, Mauritius, Madagascar and Seychelles Africa Eastern and Southern Region 2 “Category Disbursement Linked Disbursement Calculation Amount of the Grant (including Result Formula Allocated Disbursement (as applicable) (expressed in USD) Linked Indicator as applicable) Previous: FY2018 - No scalability (1) DLI #1: The The Recipient has increased the FY2019 – FY Allocated Recipient has percentage of Amount x [Actual increased the Institutional Deliveries in the Achievement up to DLR 1.2 – number of 42 lagging districts defined in DLR 1.1] / [DLR 1.2 – DLR 1.1] districts, out of the the Investment Case + undisbursed amount from 42 defined as lagging previous targets met in the Investment DLR#1.1: The Recipient has Case, with at least 85 increased the percentage of FY2020 No scalability percent Institutional Institutional Deliveries in 42 FY2021 - FY Allocated Deliveries. Lagging Districts to 66.8% Amount x [Actual [FY 2018] Achievement up to DLR 1.4 – (Baseline: 66.1%) DLR 1.3] / [DLR 1.4 – DLR 1.3] + undisbursed amount from previous targets met DLR#1.2: The Recipient has FY2022 - FY Allocated increased the percentage of Amount x [Actual Institutional Deliveries in 42 Achievement up to DLR 1.5 – Lagging Districts to 81% DLR 1.4] / [DLR 1.5 – DLR 1.4] [FY 2019] + undisbursed amount from previous targets met. Revised: The Recipient has increased the number of districts, out of the 42 defined as lagging in the Investment Case, with at least 85 percent institutional deliveries DLR#1.3: The Recipient has increased the number of districts with at least 85 percent institutional deliveries to 29 [FY 2020] DLR#1.4: The Recipient has increased the number of districts with at least 85 percent institutional deliveries to 32 [FY 2021] DLR#1.5: The Recipient has increased the number of districts with at least 85 percent institutional deliveries to 37 [FY 2022] 3 (2) DLI #2: The DLR#2.3.1: The Recipient has USD 500,000 is allocated FY2020 - No scalability Recipient has increased the percentage of in FY 2021. FY2021 - increased the Secondary and Technical 2.4.1: FY Allocated Amount x percentage of Schools offering sexual and USD 800,000 is allocated [Actual Achievement up to Secondary and reproductive health services Technical Schools to 19% in FY2022 for DLR 2.5.1 DLR 2.4.1 – DLR 2.3.1] / [DLR 2.4.1 – DLR 2.3.1] + offering sexual and [FY 2020] undisbursed amount from reproductive health (Baseline: 0%) previous targets met services (information and 2.4.2: No scalability contraceptive DLR#2.3.2: The Recipient has 2.4.3: No scalability methods). completed a gaps identification of current Training Materials [FY 2020] FY2022 - 2.5.1: FY Allocated Amount x DLR#2.3.3: The Recipient has [Actual Achievement up to DLR finalized the harmonization of 2.5.1 – DLR 2.4.1] / [DLR 2.5.1 M&E Tools – DLR 2.4.1] + undisbursed [FY 2020] amount from previous targets met. DLR#2.4.1: The Recipient has 2.5.2: No scalability increased the percentage of Secondary and Technical Schools offering sexual and reproductive health services to 40% [FY 2021] DLR#2.4.2: The Recipient has approved updated Training Materials [FY 2021] DLR#2.4.3: The Recipient has approved updated Adolescent and Youth Friendly Services (SAAJ) Guidelines [FY 2021] DLR#2.5.1: The Recipient has increased the percentage of Secondary and Technical Schools offering sexual and reproductive health services to 50% [FY 2022] DLR#2.5.2: The Recipient has completed training for health providers and focal points on improved M&E tools [FY 2022] (3) DLI#3: The The Recipient has met the USD 800,000 is allocated FY2018 - No scalability Recipient has following targets for Couple for FY2022 FY2019 – FY Allocated increased Couple Years of Protection. Amount x [Actual Years of Achievement up to DLR 3.2 – Protection. 4 DLR#3.1: 2,135,012 DLR 3.1] / [DLR 3.2 – DLR 3.1] [FY 2018] + undisbursed amount from (Baseline: 1,722,692) previous targets met FY2020 - FY Allocated DLR#3.2: 2,336,463 Amount x [Actual [FY 2019] Achievement up to DLR 3.3 – DLR 3.2] / [DLR 3.3 – DLR 3.2] DLR#3.3: 3,190,000 + undisbursed amount from previous targets met [FY 2020] FY2021 - FY Allocated Amount x [Actual DLR#3.4: 3,360,000 Achievement up to DLR 3.4 – [FY 2021] DLR 3.3] / [DLR 3.4 – DLR 3.3] + undisbursed amount from DLR#3.5: 3,540,000 previous targets met [FY 2022] FY2022 - FY Allocated Amount x [Actual Achievement up to DLR 3.5 – DLR 3.4] / [DLR 3.5 – DLR 3.4] + undisbursed amount from previous targets met. (4) DLI#4: The DLR#4.1.1: The Recipient has FY2018 - No scalability. Recipient has trained at least 6 trainers, 100% FY2020 - FY Allocated increased the of district nutrition Amount x [Actual percentage of representatives, and 30% of Achievement up to DLR 4.3 – children between 0- Community Health Workers, Baseline] / [DLR 4.3 – Baseline] 24 months of age and identified 30% of + undisbursed amount from receiving the volunteers, in 6 of the 8 previous targets met Nutrition targeted provinces on the NIP Intervention Package [FY 2018] (NIP) in the eight FY2021 - provinces FY Allocated Amount x DLR#4.1.2: The Recipient has (Cabo Delgado, [Actual Achievement up to finalized the Monitoring and Inhambane, Evaluation System DLR 4.4 – DLR 4.3] / [DLR 4.4 Manica, Nampula, – DLR 4.3] + undisbursed [FY 2018] Niassa, Sofala, amount from previous targets Tete and met Zambezia) with a DLR#4.3: The Recipient has prevalence of ensured that 15% of children are benefiting from the FY2022 - FY Allocated stunting above 35 Modified NIP Amount x [Actual percent. [FY 2020] Achievement up to DLR 4.5 – (Baseline: 0) DLR 4.] / [DLR 4.5 – DLR 4.] + undisbursed amount from previous targets met DLR#4.4: The Recipient has ensured that 30% of children are benefitting from the Modified NIP [FY 2021] DLR#4.5: The Recipient has ensured that 40% of children are benefitting from the NIP [FY 2022] 5 (5) DLI#5: The DLR#5.1: Actual Domestic FY2018 - No scalability Recipient has Health Expenditure as a FY2019 – FY Allocated increased the percentage of total Domestic Amount x [Actual Domestic Health Government Expenditure at Achievement up to DLR 5.2 – Expenditures as a least 8.5% DLR 5.1] / [DLR 5.2 – DLR 5.1] percentage of total [FY 2018] + undisbursed amount from Domestic (Baseline: 7.9%) previous targets met Government FY2020 - FY Allocated Expenditures. DLR#5.2: Actual Domestic Amount x [Actual Health Expenditure as a Achievement up to DLR 5.3 – percentage of total Domestic DLR 5.2] / [DLR 5.3 – DLR 5.2] Government Expenditure at + undisbursed amount from least 8.5% previous targets met [FY 2019] FY2021 - FY Allocated Amount x [Actual DLR#5.3: Actual Domestic Achievement up to DLR 5.4 – Health Expenditure as a DLR 5.3] / [DLR 5.4 – DLR 5.3] percentage of total Domestic + undisbursed amount from Government Expenditure at previous targets met least 9% [FY 2020] DLR#5.4: Actual Domestic Health Expenditure as a percentage of total Domestic Government Expenditure at least 9.5% [FY 2021] (6) DLI#6: The DLR#6.3.1: Actual provincial FY2020 – Recipient has expenditures in the 6.3.1: Allocated Amount x increased health Underserved Provinces from [Actual achievement up to expenditures from the Sub-Account Resources DLR 6.3.1 – Baseline] / [DLR the Sub-Account increased to USD 9 million 6.3.1 – Baseline] Resources in [FY2020] Underserved Areas. (Baseline: 0) 6.3.2: Allocated Amount x [Actual achievement up to DLR 6.3.2 – Baseline] / [DLR DLR#6.3.2: Actual district 6.3.2 – Baseline] expenditures in the Underserved Districts from the 6.3.3: Allocated Amount x Sub-Account Resources [Actual achievement up to increased to USD 4 million DLR 6.3.3– Baseline] / [DLR [FY2020] 6.3.3 – Baseline] (Baseline: 0) FY2021 – DLR#6.3.3: Domestic Allocated Amount x [Actual Health Expenditures for the achievement up to DLR 6.4 – Underserved Areas maintained Baseline] / [DLR 6.4 – Baseline] as a share of provincial and district Domestic Health FY2022 – Expenditures Allocated Amount x [Actual [FY2020] achievement up to DLR 6.5 – (Baseline: 32% for Baseline] / [DLR 6.5 – Baseline] Underserved Provinces and16% + undisbursed amount from previous targets met 6 in Underserved Districts in 2019) DLR#6.4: The Recipient has signed Results Agreements with eleven provinces [FY 2021] (Baseline: 0) DLR#6.5: The Recipient has disbursed grants to 90% of primary health care facilities with internment in the three Underserved Provinces (Baseline: 0) [FY 2022] (7) DLI#7: The The Recipient has met the USD 2,000,000 is FY2018 - No scalability Recipient has following percentages of allocated in FY2020 FY2019 – increased the number Technical Health Personnel (USD 500,000 for 7.2.1: FY Allocated Amount x of Technical Health assigned to the primary health DLR#7.3.1 and [Actual Achievement up to Personnel assigned to care network: USD 1,500,000; and for DLR 7.2.1 – DLR 7.1] / [DLR the primary health DLR#7.3.2). 7.2.1 – 7.1] + undisbursed care network. DLR#7.1: 12,205 amount from previous targets [FY 2018] met (Baseline: 11,970) 7.2.2: FY Allocated Amount x [Actual Achievement up to DLR DLR#7.2.1: 15,431 7.2.21 – Baseline] / [DLR 7.2.21 – Baseline] [FY 2019] DLR#7.2.2: The Recipient has FY2020 - increased the number of health 7.3.1: FY Allocated Amount x facilities in the primary care [Actual Achievement up to DLR network that have at least two 7.3.1 – DLR 7.2.1] / [DLR 7.3.1 active maternal child health – DLR 7.2.1] + undisbursed (MCH) nurses to 688 amount from previous targets [FY 2019] met 7.3.2: FY Allocated Amount x DLR#7.3.1: 15,566 [Actual Achievement up to DLR [FY 2020] 7.3.2 – DLR 7.2.2] / [DLR 7.3.2 – DLR 7.2.2] + undisbursed DLR#7.3.2: The Recipient has amount from previous targets increased the number of health met facilities in the primary care network that have at least two FY2021 - active MCH nurses to 704 [FY 2020] 7.4.1: FY Allocated Amount x [Actual Achievement up to DLR DLR#7.4.1: 16,182 [FY 7.4.1 – DLR 7.3.1] / [DLR 7.4.1 2021] – DLR 7.3.1] + undisbursed amount from previous targets met DLR#7.4.2: The Recipient has increased the number of health 7.4.2: FY Allocated Amount x facilities in the primary care [Actual Achievement up to DLR 7.4.2 – DLR 7.3.2] / [DLR 7.4.2 7 network that have at least two – DLR 7.3.2] + undisbursed active MCH nurses to 728 amount from previous targets [FY 2021] met DLR#7.5.1: 17,153 FY2022 - [FY 2022] 7.5.1: FY Allocated Amount x [Actual Achievement up to DLR 7.5.1 – DLR 7.4.1] / [DLR 7.5.1 DLR#7.5.2: The Recipient has increased the number of health – DLR 7.4.1] + undisbursed facilities in the primary care amount from previous targets network that have at least two met active MCH nurses to 768 7.5.2: FY Allocated Amount x [FY 2022] [Actual Achievement up to DLR 7.5.2 – DLR 7.4.2] / [DLR 7.5.2 – DLR 7.4.2] + undisbursed amount from previous targets met (8) DLI#8: The DLR#8.1: The Recipient has USD 1,000,000 is FY2018 - No scalability Recipient has designed and piloted hospital allocated in FY 2020. FY2019 – FY Allocated increased the number scorecards in 6 district and Amount x [Actual of district and rural rural hospitals, which receive Achievement up to DLR 8.2 – hospitals receiving performance based allocations DLR 8.1] / [DLR 8.2 – DLR 8.1] performance-based according to their performance + undisbursed amount from allocations in [FY 2018] previous targets met accordance with a (Baseline: 0) minimum of one FY2020 - FY Allocated scorecard assessment Amount x [Actual in the previous Fiscal DLR#8.2: The Recipient has Achievement up to DLR 8.3 – Year (FY). demonstrated that 30% of DLR 8.2] / [DLR 8.3 – DLR 8.2] district and rural hospitals + undisbursed amount from received performance-based previous targets met allocations in accordance with a FY2021 - FY Allocated minimum of two scorecard Amount x [Actual assessments in the previous Fiscal Year Achievement up to DLR 8.4 – DLR 8.3] / [DLR 8.4 – DLR 8.3] [FY 2019] + undisbursed amount from previous targets met DLR#8.3: The Recipient has FY2022 - FY Allocated demonstrated that 15 district Amount x [Actual and rural hospitals receive Achievement up to DLR 8.5 – allocations based on prioritized DLR 8.4] / [DLR 8.5 – DLR 8.4] action plans that respond to + undisbursed amount from scorecard evaluations previous targets met [FY 2020] (Baseline: 0) DLR#8.4: The Recipient has demonstrated that 31 district and rural hospitals received performance-based allocations in accordance with a minimum of one scorecard assessment in the previous Fiscal Year [FY 2021] 8 DLR#8.5: The Recipient has demonstrated that 44 district and rural hospitals received performance-based allocations in accordance with a minimum of one scorecard assessment in the previous Fiscal Year [FY 2022] (9) DLI#9: The DLR#9.1: The Recipient has USD 1,100,000 is FY2018 - No scalability Recipient has designed and piloted health allocated in FY 2022 FY2019 – FY Allocated increased the number center scorecards with Amount x [Actual of health centers in community consultations in at Achievement up to DLR 9.2 – Priority Districts least 64 Rural Health Centers DLR 9.1] / [DLR 9.2 – DLR 9.1] receiving in Priority Districts, receiving + undisbursed amount from performance-based financial allocations according previous targets met allocations according to their performance to at least one FY2020 - FY Allocated [FY 2018] scorecard assessment Amount x [Actual (Baseline: 0) Achievement up to DLR 9.3 – with community consultations in the DLR 9.2] / [DLR 9.3 – DLR 9.2] previous fiscal year DLR#9.2: The Recipient has + undisbursed amount from (FY). demonstrated that 130 Rural previous targets met Health Centers in Priority FY2021 - FY Allocated Districts receive performance- Amount x [Actual based allocations according to at least two scorecard Achievement up to DLR 9.4 – assessments with community DLR 9.3] / [DLR 9.4 – DLR 9.3] consultations in the last Fiscal + undisbursed amount from Year previous targets met [FY 2019] FY2022 - FY Allocated Amount x [Actual Achievement up to DLR 9.5 – DLR#9.3: The Recipient has DLR 9.4] / [DLR 9.5 – DLR 9.4] demonstrated that 186 health + undisbursed amount from centers in priority districts receive financial allocations previous targets met. based on prioritized action plans that respond to scorecards evaluations [FY 2020] (Baseline: 0) DLR#9.4: The Recipient has demonstrated that 261 health centers in priority districts receive performance-based allocations according to at least one scorecard assessment with community consultations in the last Fiscal Year [FY 2021] DLR#9.5: The Recipient has demonstrated that 391 health centers in priority districts receive performance-based allocations according to at least one scorecard assessment with 9 community consultations in the last Fiscal Year [FY 2022] (10) DLI#10: The The Recipient has achieved the USD 2,500,000 is FY2018 - No scalability Recipient has following targets: allocated in FY 2021. FY2019 - FY Allocated increased the number Amount x [Actual of active community DLR#10.1: 4,723 CHWs Achievement up to DLR 10.2 health workers trained and active – Baseline] / [DLR 10.2 – (CHWs). [FY 2018] Baseline] + undisbursed amount from previous targets (Baseline: 3,380) met FY2020 - DLR#10.2: 6,523 CHWs FY Allocated Amount x trained and active [Actual Achievement up to [FY 2019] DLR 10.3 – DLR 10.2] / [DLR 10.3 – DLR 10.2] + undisbursed amount from previous targets DLR#10.3: 6,690 active CHWs met [FY 2020] FY2021 - FY Allocated Amount x DLR#10.4: 7,748 active CHWs [Actual Achievement up to [FY 2021] DLR 10.4 – DLR 10.3] / [DLR 10.4 – DLR 10.3] + undisbursed DLR#10.5.1: 8,800 active amount from previous targets CHWs met FY2022 - [FY 2022] 10.5.1: FY Allocated Amount x [Actual Achievement up to DLR DLR#10.5.2: 50% of CHWs 10.5.1 – DLR 10.4] / [DLR deliver services according to 10.5.1 – DLR 10.4] + quality standards undisbursed amount from [FY 2022] previous targets met (Baseline: 28%) 10.5.2: FY Allocated Amount x [Actual Achievement up to DLR 10.5.2 –Baseline] / [DLR 10.5.2 – Baseline] (11) DLI#11: The The Recipient has achieved the FY2018 - No scalability Recipient has following targets: FY2019 - FY Allocated increased the Amount x [Actual percentage of deaths Achievement up to DLR 11.2 DLR#11.1: 100% of hospitals in eligible health and 50% of health centers use – DLR 11.1] / [DLR 11.2 – 11.1] facilities certified by MGDH to generate information + undisbursed amount from a doctor or a on causes of death previous targets met qualified clinician with the cause of (Baseline: 70% of hospitals and FY2020 – death coded using 0% of health centers use 11.3.1: FY Allocated Amount x ICD10 or ICD11, MGDH to generate information [Actual Achievement up to DLR and the death on the cause of death) 11.3.1 – Baseline] / [DLR 11.3.1 record captured in [FY 2018] – Baseline] + undisbursed SISMA Hospital amount from previous targets Data Management DLR#11.2: 70% of the health met Module (Modulo de centers use MGDH to generate 11.3.2: FY Allocated Amount x Gestão de Dados information on the cause of [Actual Achievement up to DLR Hospitalares- death 11.3.2 – Baseline] / [DLR 11.3.2 MGDH) and [FY 2019] – Baseline] + undisbursed the Recipient has increased the 10 percentage of deaths LR#11.3.1: 50% of deaths in amount from previous targets registered, certified, eligible health facilities met and captured in the certified by a doctor or civil registration qualified clinician with the cause of death coded using FY2021 – system (SiRCEV) within one year of ICD10, and the death record 11.4.1: FY Allocated Amount x their occurrence captured in the SISMA [Actual Achievement up to DLR MGDH 11.4.1 – DLR 11.3.1] / [DLR [FY 2020] 11.4.1 – DLR 11.3.1] + (Baseline: 0) undisbursed amount from previous targets met 11.4.2: FY Allocated Amount x DLR#11.3.2: 15% of deaths [Actual Achievement up to DLR registered, certified, and 11.4.2 – DLR 11.3.2] / [DLR captured in the civil registration 11.4.2 – DLR 11.3.2] + system (SiRCEV) within one undisbursed amount from year of their occurrence previous targets met [FY 2020] (Baseline: 0) FY2022 – 11.5.1: FY Allocated Amount x DLR#11.4.1: 60% of deaths in [Actual Achievement up to DLR eligible health facilities 11.5.1 – DLR 11.4.1] / [DLR certified by a doctor or 11.5.1 – DLR 11.4.1] + qualified clinician with the undisbursed amount from cause of death coded using previous targets met ICD10 or ICD 11, and the 11.5.2: FY Allocated Amount x death record captured in the [Actual Achievement up to DLR SISMA MGDH 11.5.2 – DLR 11.4.2] / [DLR [FY 2021] 11.5.2 – DLR 11.4.2] + undisbursed amount from DLR#11.4.2: 20% of deaths previous targets met registered, certified and captured in the civil registration system DLR#11.5.1: 70% of deaths in eligible health facilities certified by a doctor or qualified clinician with the cause of death coded using ICD10 or ICD 11, and the death record captured in the SISMA MGDH [FY 2022] DLR#11.5.2: 25% of deaths registered, certified, and captured in the civil registration system (SiRCEV) within one year of their occurrence [FY 2022] 11 (12) DLR#12: The The Recipient has achieved the FY2021 - No scalability Recipient has following targets: FY2022 - No scalability introduced reforms DLR#12.4: Expansion of the to increase the Sistema de Informação, availability of Gestão, e Logística das essential maternal Unidades Sanitárias (SIGLUS) and reproductive to 85% of health facilities health medicines at primary health care [FY 2021] facilities. DLR#12.5.1: Approval by the Cabinet of a decree granting the Central de Medicamentos e Artigos Médicos (CMAM) autonomy to enable an optimized single command structure [FY 2022] DLR#12.5.2: Implementation of outsourcing of last mile transportation and distribution of medicines [FY 2022] TOTAL AMOUNT 8,700,000 12