OFFICIAL DOCUMENTS The World Bank E-32, Agargaon, Sher-e-Bangla Nagar, Dhaka 1207, Bangladesh Phone: (880-2) 5566-7777, (880) 96-0440-4000 Facsimile: (880-2) 5566-7778, 5566-7779 Abdoulaye Sock Country Director for Bangladesh and Bhutan Dated: June 12, 2023 Secretary Sharifa Khan Economic Relations Division Ministry of Finance Block 8, Room 3 Sher-e-Bangla Nagar Agargaon, Dhaka Dear Secretary Khan: Bangladesh: Health Sector Support Project (Credit No. 6127-BD, Credit No. 6302-BD, Grant No. D361-BD) Amendment to the Financing Agreement and the Additional Financing Agreement We refer to (i) the Financing Agreement between the People's Republic of Bangladesh ("Recipient") and the International Development Association ("Association"), dated August 28, 2017 as amended, in respect of Credit No. 6127-BD ("Financing Agreement"), and (ii) the financing agreement for the additional financing between the Recipient and the Association dated September 20, 2018, as amended, in respect of Credit No. 6302-BD and Grant No. D361-BD ("Additional Financing Agreement"), for the above-mentioned Project ("Project"). We also refer to your letter dated January 26, 2023, requesting the Association to extend the closing date and restructure the Project. We are pleased to inform you that the Association, after due consideration, proposes to amend the Financing Agreement and the Additional Financing Agreement as set forth below: A. Financing Agreement 1. Section ILI.B.4. of Schedule 2 to the Financing Agreement is amended to read as follows: "4. The Closing Date is June 30, 2024." 3. The Disbursement Linked Results set forth in the Annex to Schedule 2 to the Financing Agreement are revised to read as set forth in Annex-I to this Amendment Letter. B. Additional Financing Agreement Section III.B.2. of Schedule 2 to the Additional Financing Agreement is amended to read as follows: "4. The Closing Date is June 30, 2024." -2- Except as specifically amended by this Amendment Letter, all other provisions of the Financing Agreement and the Additional Financing Agreement shall remain unchanged and in full force and effect. The Association will disclose this Amendment Letter and related information in accordance with the World flank's Policy on Access to Information. By entering into this Amendment Letter, the Recipient consents to disclosure of this Amendment Letter and related information. Please confirm your acceptance to the foregoing by signing and dating the two originals of this Amendment Letter, retaining one original for your records and returning the other original to the Association. Upon receipt by the Association of the original Amendment Letter countersigned by you, in a manner satisfactory to the Association, this Amendment Letter will become effective as of the date of the countersignature. Sincerely, INTERNATIONAL DEVELOPMENT ASSOCIATION By Abdoulaye Seek AGREED: PEOPLE'S REPUBLIC OF BANGLADESH By: Authorized Representative Name: Md. Shahrnar Kader Siddiky Additional Secretary Title: Economic Relations Division T :ry of Finance Govt of The People's Re ubc of Bangladesh Date: O 0T 0ot -3- Annex-1 ANNEX TO SCHEDULE 2 Revised DLI Matrix (in SDR) Disbursement-Linked Indicators, Disbursement Linked Results and Allocated Amounts Disbursement-Linked Indicators, Disbursement-Linked Results and Allocated Amounts Applicable to the Project DLR Period FY20] 7 FY20] 8 FY2019 FY2020 FY2021 FY2022 FY2023 FY2024 Component I Governance and Stewardship DLI I Citizen feedback system is strengthened - SDR 18,050,000 DLRs DLR 1.1 DLR 1.2 GRS DLR 1.3 An annual GRS performance report for previous CY is published (1) Assessment of guidelines are current GRS is approved (1) completed (1) Targets 1 annual report I annual report 1 annual 1_ _ _report Allocated DLR 1.1 - DLR 1.2 - DLR 1.3 - 10,830,000.00 (3,610,000 per annual report) Amounts (in 3,610,000 3,610,000 SD R) DLI 2 Budget planning and allocation are improved - SDR 52,690,000 DLRs DLR 2.1 OPs DLR 2.2 Increase in the percentage (%) from FY2016 baseline in repair and maintenance approved expenditure at the levels of Upazila and below (2) including activities and budgets for achievement of DLIs (1) Targets 13 OPs Up to 470% Increase Allocated DLR 2.1 - DLR 2.2 - 33,840,000 (72,000 per 1% increase from FY 2016 baseline) Amounts (in 18,850,000 SDR) (1,450,000 per OP) -4- Disbursement-Linked Indicators, Disbursement-Linked Results and Allocated Amounts Applicable to the Project DLR Period FY2017 - FY2018 FY2019 FY2020 FY2021 FY2022 FY2023 FY2024 Component 2 HNP Systems Strengthening DLI 3 Financial management system is strengthened - SDR 36,850,000 DLRs DLR 3.1 MOHFW DLR 3.2 MOPA DLR 3.3 MOF DLR 3.4 MOPA DLR 3.5 At least submits FMAU endorses FMAU concurs to FMAU approves FMAU 50% of required recruitment rules recruitment rules recruitment rules recruitment rules FMAU staff are to MOPA(1) (1) (1) (1) recruited (1) DLR 3.6 An internal audit for the previous FY is completed by FMAU (1) Targets 1 internal audit 1 internal audit Allocated DLR 3.1 - DLR 3.2 - DLR 3.3 - DLR 3.4 - DLR 3.5 - Amounts (in 2,170,000 2,1 70,000 7,225,000 3,610,000 7,225,000 SD R) DLR 3.6 - 14,450,000 (7,225,000 per audit) DLI 4 Asset management is improved - SDR 9,899,500 DLRs DLR 4.1 Assessment and plan are approved for AMS scale-up (1) DLR 4.2 Number of District Hospitals in which AMS is implemented (2) Targets Up to 14 Hospitals Allocated DLR 4.1 - Amounts (in 3,398,500 SDR) -5- Disbursement-Linked Indicators, Disbursement-Linked Results and Allocated Amounts Applicable to the Project .DLR Period FY201 7 FY2018 FY2019 FY2020= FY2021 FY2022 FY2023 FY2024 DLR 4.2 - 6,501,000 (216,700 per District Hospital) DLI 5 Procurement process is improved using information technology - SDR 14,300,000 DLRsv DLR 5.1 e-GP is DLR 5.2 NCTs using e-GP as percentage (%) of all specified NCTs issued initiated for by MOHFW (2) procurement by MOHFW (1) Targets 25% of NCTs 35% of NCTs 50% of NC 75% of I - ! NCTs Allocated DLR 5.1 - DLR 5.2 - 10,690,225 (57,785 per 1% of NCTs) Amounts (in 3,609,775 SDR) DLI 6 Institutional capacity is developed for procurement and supply management - SDR 7,340,000 DLRs DLR 6.1 CMSD DLR 6.2 MOF DLR. 6.3 MOPA restructuring concurs to CMSD approves CMSD proposal is restructuring restructuring endorsed by proposal (1) proposal (1) MOPA and submitted to MOF Allocated DLR 6.1 - DLR 6.2 - DLR 6.3 - Amounts (in 2,170,000 2,170,000 3,000,000 SDR) DLI 7 Availability of midwives for maternal care is increased - SDR 32,850,000 DLRs DLR 7.1 At least DLR 7.2 Number of Upazila Health Complexes with at least 2 accredited diploma midwives for 2,500 midwife the previous CY (2) posts are created by MOHFW and recruitment of -6- Disbursement-Linked Indicators, Disbursement-Linked Results and Allocated Amounts Applicable to the Project DLR Period FY2017 FY2018 FY2019 FY2020 FY2021 FY2022 FY2023 FY2024 midwives is underway (1) Targets 150 Upazila Health Maintain 150 Maintain 150 Maintain 150 Maintain 150 Complexes Upazila Health Upazila Health Upazila Health Upazila Complexes Complexes Complexes Health Complexes Allocated DLR 7.1 - DLR 7.2 - 18,401,250 (24,535 per Upazila Health Complex) Amounts (in 14,448,750 SDR) DLI 8 Information system is strengthened, including gender-disaggregated data - SDR 14,450,000 DLRs DLR 8.1 Number of Community Clinics providing complete essential data to DHIS2, including gender-disaggregated, reported for the previous CY (2) Targets 1,000 Community 2,000 Community 4000 Comm 6,000 Community 7,000 Clinics Clinics Clinics Clinics Community Clinics Allocated DLR 8.1 - 14,450,000 (722.5 per 1 Community Clinic) Amounts (in SDR) Component 3 Provision of Quality HNP Services DLI 9 Post-partum family planning services are improved - SDR 23,650,000 DLRs DLR 9.1 Facility DLR 9.2 Reporting DLR 9.3 readiness criteria and training Assessment and and assessment guidelines for action plan are instrument for PPFP services are completed for PPFP services are approved (1) expansion of approved (I) PPFP services in targeted health facilities in Sylhet -7- Disbursement-Linked Indicators, Disbursement-Linked Results and Allocated Amounts Applicable to the Project DLR Period FY2017 FY2018 FY2019 FY2020 FY2021 FY2022 FY2023 FY2024 and Chattogram divisions (1) DLR 9.4 Percentage (%) of targeted Public Health Facilities meeting readiness criteria for delivery of PPFP services in Sylhet and Chattograrn divisions, reported for the previous CY (2) Targets 5% 15% 25% 5% Allocated DLR 9.1 - DLR 9.2 - DLR 9.3 - Amounts (in 3,610,000 2,170,000 3,760,000 SDR) DLR 9.4 - 14,110,000 (176,375 per 1% of targeted facilities) DLI 10 Utilization of maternal health care services is increased - SDR 15,231,877 DLRs DLR 10.1 Number of normal deliveries in Public Health Facilities in Sylhet and DLR 10.2 Number of normal Chattogram divisions, reported for the previous CY (2) deliveries in Public Health Facilities in Sylhet, Chattogram and Barisal divisions, reported for the previous CY (2) Targets 107,772 119,963 129,276 157,153 160,000 170,000 Allocated DLR 10.1 - 9,277,443 (18.043742 per 1 delivery) Amounts (in DLR 10.2 - 5,954,434 (18.043742 SDR) per 1 delivery) DLI 11 Emergency obstetric care services are improved - SDR 28,300,000 DLRs DLR 11.1 Facility DLR 11.2 assessment Assessment and instrument for action plans are CEmONC is approved for approved (1) development of CEmONC services in targeted District Hospitals in Sylhet -8- Disbursement-Linked Indicators, Disbursement-Linked Results and Allocated Amounts Applicable to the Project DLRPeriod Ff2017 FY2018 FY2019 FY2020 FY2021 FY2022 FY2023 FY2024 and Chattogram divisions (1) DLR 11.3. Number of District Hospitals with capacity to provide CEmONC services in Sylhet and Chattogram divisions, reported for the previous CY (2) Trgets 5 District 6 District Hospitals 7 District 8 District 9 District 10 District Hospitals Hospitals Hospitals Hospitals Hospitals Allocated DLR 11.1 - DLR 11.2 - Amounts (in 2,170,000 3,395,010 SD R) DLR 11.3 - 22,734,990 (505,222 per District Hospital) DLI 12 Immunization coverage and equity are enhanced - SDR 37,234,665 DLRs DLR 12.1 Immunization micro-plans for CYI7 are approved for each district in Sylhet and Chattogram divisions (1) DLR 12.2 Number of districts reaching at least 85% coverage of measles-rubella DLR 12.3 Number of districts vaccination among children ages 0-12 months in Sylhet and Chattogram divisions, reaching at least 85% coverage of reported for the previous CY (2) measles-rubella vaccination among children ages 0-12 months in Sylhet, Chattrogram and Barisal divisions of Bangladesh, reported for the previous CY (2) Targets 13 districts 15 districts 15 districts 12 districts 18 districts 20 districts DLR 12.1 - 3,610,050 -9- Disbursement-Linked Indicators, Disbursement-Linked Results and Allocated Amounts Applicable to the Project DLR Period FY2017 FY2018 FY2019 FY2020 FY2021 FY2022 FY2023 FY2024 Allocated Amounts (in DLR 12.2 -19,885,525 (361,555 per district) SDR) DLR 12.3 - 13,739,090 (361,555 per district) DLI 13 Maternal nutrition services are expanded - SDR 21,996,000 DLRs DLR 13.1 DLR 13.2 DLR 13.3 Technical Reporting and Assessment is standards for quality assessment completed of maternal nutrition guidelines for maternal nutrition services are maternal nutrition service quality in approved (1) services are Sylhet and approved (1) Chattogram divisions (1) DLR 13.4 Percentage (%) of registered pregnant mothers receiving specified maternal nutrition services in Sylhet and Chattogram divisions, reported for the previous CY (2) Targets 1% 29% 55% 60% 65 Allocated DLR 13.1 - DLR 13.2 - DLR 13.3 - Amounts (in 2,170,000 2,170,000 5,056,000 SD R) DLR 13.4 - 12,600,000 (60,000 per 1% of registered pregnant mothers) DLI 14 Infant and child nutrition services are expanded - SDR 24,707,152 DLRs DLR 14.1 DLR 14.2 DLR 14.3 Technical Reporting and Assessment is standards for quality assessment completed of infant and child guidelines for infant and child nutrition services infant and child nutrition service are approved (1) nutrition services quality in Sylhet are approved (1) and Chattogram divisions (1) -10- Disbursement-Linked Indicators, Disbursement-Linked Results and Allocated Amounts Applicable to the Project DLR Period FY2017 FY2018 FY2019 FY2020 FY2021 FY2022 FY2023 FY2024 DLR 14.4 Percentage (%) of registered infants and children aged under 2 years receiving specified nutrition services in Sylhet and Chattogram divisions, reported for the previous CY (2) Targets 24% 24% 41% 48% 54% Allocated DLR 14.1 - DLR 14.2 - DLR 14.3 - Amounts (in 2,170,000 2,170,000 5,165,080 SD R) DLR 14.4 - 15,202,072 (79,592 per 1% of registered infants and children aged under 2 years) DLI 15 School-based adolescent HNP program is developed and implemented - SDR 12,790,000 DLRs DLR 15.1 Revised DLR 15.2 DLR 15.3 DLR 15.4 DLR 15.5 teacher training Assessment of MOHFW Budget for MOHFW manual is approved current school- completes training implementation of implements (1) based services in for MOHFW's MOHFW's MOHFW's Sylhet and school-based school-based school-based Chattogram adolescent HINP adolescent INP adolescent divisions is jointly program in at program is HNP completed with least 50 schools in included in the program in the education targeted districts relevant MOHFW targeted sector (1) of Sylhet and operational plan schools in at Chattogram (1) least 7 divisions (1) districts in Sylhet and Chattogram divisions (1) Allocated DLR 15.1 - DLR 15.2 - DLR 15.3 - DLR 15.4 - DLR 15.5 - Amounts (in 2,170,000 3,610,000 2,010,000 2,000,000 3,000,000 SDR) DLI 16 Emerging challenges are addressed - SDR 10,860,806 DLRv DLR 16.1 Urban DLR 16.2 DLR 16.3 Plan DLR 16.4 DLR 16.5 Health Guidelines for and technical Hypertension Assessment Coordination screening, referral materials are diagnosis and is completed Disbursement-Linked Indicators, Disbursement-Linked Results and Allocated Amounts Applicable to the Project DLR? Period FY2017 FY2018 FY2019 FY2020 FY2021 FY2022 FY2023 FY2024 Committee meets and treatment of approved for referral services of and agrees on hypertension are implementation of are implemented at hypertension actions to improve approved (1) hypertension the primary level diagnosis coordination on diagnosis and in at least 2 and referral urban health (1) referral services Upazilas (1) services at (1) the primary level in at least 2 Upazilas (1) Allocated DLR '16.1 - DLR 16.2 - DLR 16.3 - DLR 16.4 - DLR 16.5 - Amounts (in 2,170,000 2,170,000 2,170,000 2,180,806 2,170,000 SD?)