Document of The World Bank FOR OFFICIAL USE ONLY Report No: PAD5522 INTERNATIONAL DEVELOPMENT ASSOCIATION PROJECT PAPER ON A PROPOSED ADDITIONAL GRANT IN THE AMOUNT OF SDR 111.8 MILLION (US$150 MILLION EQUIVALENT) TO THE UNITED NATIONS CHILDREN’S FUND AND THE UNITED NATIONS OFFICE FOR PROJECT SERVICES AND THE WORLD HEALTH ORGANIZATION FOR THE BENEFIT OF THE REPUBLIC OF YEMEN FOR A SECOND ADDITIONAL FINANCING YEMEN EMERGENCY HUMAN CAPITAL PROJECT September 6, 2023 Health, Nutrition & Population Global Practice Middle East And North Africa Region This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization. CURRENCY EQUIVALENTS (Exchange Rate Effective July 31, 2023) US$0.74463491= SDR 1 FISCAL YEAR January 1 - December 31 Regional Vice President: Ferid Belhaj Country Director: Stephane Guimbert Regional Director: Fadia Saadah Practice Manager: Michele Gragnolati Task Team Leader(s): Sherin Varkey, Naif Mohammed Abu-Lohom, Takahiro Hasumi ABBREVIATIONS AND ACRONYMS AF Additional Financing IYCF Infant and Young Child Feeding APA Alternate Procurement Arrangements LMP Labor Management Procedures AU Autonomous Utilities LWSC Local Water and Sanitation Corporation CEN Country Engagement Note M&E Monitoring and Evaluation CERC Contingent Emergency Response MICS Multiple Indicator Cluster Survey Component MNH Maternal and newborn health CHNV Community Health and Nutrition Volunteer MSP Minimum Service Package CHW Community Health Worker NCD Noncommunicable Disease CRI Corporate Results Indicators NGO Non-governmental Organization CoS Continuum of Support NWSA National Water and Sanitation Authority CWIS City-Wide Inclusive Sanitation O&M Operation and Maintenance DCT Direct Cash Transfer OF Original Financing DFC Direct Financial Cooperation OHS Occupational Health and Safety DHIS II District Health Information System II PDO Project Development Objective DHO District Health Office PHC Primary Health Care DHS Demographic and Health Survey PPSD Project Procurement Strategy for DTC Diarrhea Treatment Center Development EHCP Emergency Human Capital Project PWP Public Works Project EHNP Emergency Health and Nutrition Project RMNCH Reproductive, Maternal, Newborn, Child eIDEWS Electronic Integrated Disease Early Warning and Adolescent Health System SEA Sexual Exploitation and Abuse EmONC Emergency Obstetric and Neonatal Care SEP Stakeholder Engagement Plan ESCP Environmental and Social Commitment Plan SH Sexual Harassment ESF Environmental and Social Framework SMART Standardized Monitoring and Assessment ESMF Environmental and Social Management of Relief and Transitions Framework TOR Terms of Reference FCV Fragility, Conflict, and Violence TPM Third-Party Monitoring FM Financial Management TPMA Third Party Monitoring Agency GARWSP General Authority for Rural Water and UN United Nations Sanitation Project UNICEF United Nations Children’s Fund GBV Gender-Based Violence UNOPS United Nations Office for Project Services GHO Governorate Health Office USAID United States Agency for International GHG Greenhouse Gas Development GRM Grievance Redress Mechanism UW- Urban Water-Project Management Unit GRS Grievance Redress Service PMU WASH Water, Sanitation, and Hygiene HACT Harmonized Approach to Cash Transfer WHO World Health Organization IDP Internally Displaced Person WSS Water Supply and Sanitation IFR Interim Financial Report WWTP Wastewater Treatment Plant INDC Intended Nationally Determined Contribution YIUSEP Yemen Integrated Urban Services Emergency Project ISR Implementation Status and Results Report Yemen, Republic of Second Additional Financing Yemen Emergency Human Capital Project TABLE OF CONTENTS I. BACKGROUND AND RATIONALE FOR ADDITIONAL FINANCING ........................................ 8 II. DESCRIPTION OF ADDITIONAL FINANCING .................................................................... 11 III. KEY RISKS ..................................................................................................................... 17 IV. APPRAISAL SUMMARY .................................................................................................. 20 V. WORLD BANK GRIEVANCE REDRESS .............................................................................. 26 VI SUMMARY TABLE OF CHANGES ..................................................................................... 27 VII DETAILED CHANGE(S) .................................................................................................... 27 VIII. RESULTS FRAMEWORK AND MONITORING ................................................................... 30 ANNEX 1: ENVIRONMENTAL AND SOCIAL ............................................................................ 58 ANNEX 2: ADDITIONAL DETAILS ON APPRAISAL SUMMARY.................................................. 60 ANNEX 3: DETAILED FINANCIAL MANAGEMENT ARRANGEMENTS ........................................ 63 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) BASIC INFORMATION – PARENT (Yemen Emergency Human Capital Project - P176570) Country Product Line Team Leader(s) Yemen, Republic of IBRD/IDA Sherin Varkey Project ID Financing Instrument Resp CC Req CC Practice Area (Lead) P176570 Investment Project HMNHN (9320) MNC03 (1491) Health, Nutrition & Financing Population Implementing Agency: ADD_FIN_TBL1 Is this a regionally tagged project? No Bank/IFC Collaboration No Expected Approval Date Closing Date Guarantee Environmental and Social Risk Classification Expiration Date 30-Jun-2021 30-Jun-2025 Substantial Financing & Implementation Modalities Parent [ ] Multiphase Programmatic Approach [MPA] [✓] Contingent Emergency Response Component (CERC) [ ] Series of Projects (SOP) [✓] Fragile State(s) [ ] Performance-Based Conditions (PBCs) [ ] Small State(s) [ ] Financial Intermediaries (FI) [ ] Fragile within a Non-fragile Country [ ] Project-Based Guarantee [✓] Conflict [ ] Deferred Drawdown [✓] Responding to Natural or Man-made disaster [✓] Alternate Procurement Arrangements (APA) [ ] Hands-on Expanded Implementation Support (HEIS) Page 1 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) Development Objective(s) The project development objective is to provide essential health, nutrition, water and sanitation services to the population of Yemen. Ratings (from Parent ISR) RATING_DRAFT_NO Implementation Latest ISR 05-Oct-2021 11-Jan-2022 08-Jul-2022 12-Jan-2023 27-Apr-2023 Progress towards achievement of S S S S S PDO Overall Implementation S S S S S Progress (IP) Overall ESS Performance S S S S S Overall Risk H H H H H Financial Management S S MS MS MS Project Management S S S S S Procurement S S S S S Monitoring and Evaluation S S S S S BASIC INFORMATION – ADDITIONAL FINANCING (Second Additional Financing Yemen Emergency Human Capital Project - P181317) ADDFIN_TABLE Urgent Need or Capacity Project ID Project Name Additional Financing Type Constraints P181317 Second Additional Scale Up Yes Financing Yemen Emergency Human Capital Page 2 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) Project Financing instrument Product line Approval Date Investment Project IBRD/IDA 22-Sep-2023 Financing Projected Date of Full Bank/IFC Collaboration Disbursement 31-Dec-2025 No Is this a regionally tagged project? No Financing & Implementation Modalities Child [ ] Series of Projects (SOP) [✓] Fragile State(s) [ ] Performance-Based Conditions (PBCs) [ ] Small State(s) [ ] Financial Intermediaries (FI) [ ] Fragile within a Non-fragile Country [ ] Project-Based Guarantee [✓] Conflict [ ] Deferred Drawdown [✓] Responding to Natural or Man-made disaster [✓] Alternate Procurement Arrangements (APA) [ ] Hands-on Expanded Implementation Support (HEIS) [✓] Contingent Emergency Response Component (CERC) Disbursement Summary (from Parent ISR) Net Source of Funds Total Disbursed Remaining Balance Disbursed Commitments IBRD % IDA 300.00 286.60 1.14 100 % Grants % PROJECT FINANCING DATA – ADDITIONAL FINANCING (Second Additional Financing Yemen Emergency Human Capital Project - P181317) PROJECT FINANCING DATA (US$, Millions) SUMMARY -NewFi n1 Page 3 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) SUMMARY (Total Financing) Proposed Additional Total Proposed Current Financing Financing Financing Total Project Cost 300.00 150.00 450.00 Total Financing 300.00 150.00 450.00 of which IBRD/IDA 300.00 150.00 450.00 Financing Gap 0.00 0.00 0.00 DETAILS - Additional Financing NewFinEnh1 World Bank Group Financing International Development Association (IDA) 150.00 IDA Grant 150.00 IDA Resources (in US$, Millions) Guarantee Credit Amount Grant Amount SML Amount Total Amount Amount Yemen, Republic of 0.00 150.00 0.00 0.00 150.00 National Performance-Based 0.00 150.00 0.00 0.00 150.00 Allocations (PBA) Total 0.00 150.00 0.00 0.00 150.00 COMPLIANCE Policy Does the project depart from the CPF in content or in other significant respects? [ ] Yes [ ✔ ] No Does the project require any other Policy waiver(s)? [ ✔ ] Yes [ ] No Explanation Two policy waivers were sought under the proposed AF2: (i) waiver of the application of the Bank's Anti-Corruption Page 4 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) Guidelines, in favor of relying on the fraud and corruption procedures of UNICEF, WHO, and UNOPS, as per the legal agreements; (ii) waiver of the use of the Bank's procurement arrangements (procurement policy and procedures) in favor of those of UNICEF, UNOPS and WHO as Alternative Procurement Arrangements (APA). The proposed AF2 sought approval for the application of the IPF Policy (Projects in Situations of Urgent Need of Assistance or Capacity Constraints), paragraph 12, section III, including the application of condensed procedures. Has the waiver(s) been endorsed or approved by Bank Management? Approved by Management [ ] Endorsed by Management for Board Approval [✔] No [ ] Explanation - OPCS VP concurred and LEG VP and General Counsel has cleared the waiver of the application of the Bank's Anti- Corruption Guidelines, in favor of relying on the fraud and corruption procedures of UNICEF, WHO, and UNOPS, as per the legal agreements on July 25, 2023. The OPCS UN Program Team reviewed the waiver the application of the Bank's Anti-Corruption Guidelines on July 5, 2023. - The Chief Procurement Officer approved the use of the procurement arrangements (procurement policy and procedures) of the UNICEF, UNOPS and WHO as Alternative Procurement Arrangements (APA) on July 7, 2023. - The CMU approved the application of the IPF Policy (Projects in Situations of Urgent Need of Assistance or Capacity Constraints), paragraph 12, section III, including the application of condensed procedures on July 12, 2023. Page 5 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) ESStandards Environmental and Social Standards Relevance Given its Context at the Time of Appraisal E & S Standards Relevance Assessment and Management of Environmental and Social Risks and Impacts Relevant Stakeholder Engagement and Information Disclosure Relevant Labor and Working Conditions Relevant Resource Efficiency and Pollution Prevention and Management Relevant Community Health and Safety Relevant Land Acquisition, Restrictions on Land Use and Involuntary Resettlement Relevant Biodiversity Conservation and Sustainable Management of Living Natural Relevant Resources Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Not Currently Relevant Local Communities Cultural Heritage Not Currently Relevant Financial Intermediaries Not Currently Relevant ESStandardsNote NOTE: For further information regarding the World Bank’s due diligence assessment of the Project’s potential environmental and social risks and impacts, please refer to the Project’s Appraisal Environmental and Social Review Summary (ESRS). INSTITUTIONAL DATA Practice Area (Lead) Health, Nutrition & Population Contributing Practice Areas Fragile, Conflict & Violence Water Climate Change and Disaster Screening This operation has been screened for short and long-term climate change and disaster risks Page 6 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) PROJECT TEAM Bank Staff Name Role Specialization Unit Team Leader (ADM Sherin Varkey Public Health HMNHN Responsible) Naif Mohammed Abu- Water Resources Team Leader SMNWA Lohom Management Takahiro Hasumi Team Leader Public Health HMNHN Leena Mohammed Khider Procurement Specialist (ADM Procurement EMNRU Al Abbasy Responsible) Financial Management Enagnon Ernest Eric Adda Financial Management EMNGU Specialist Amer Abdulwahab Ali Al- Environmental Specialist (ADM Environmental Standards SMNEN Ghorbany Responsible) Ibrahim Ismail Mohammed Social Specialist (ADM Social Standards SMNSO Basalamah Responsible) Andrianirina Michel Eric Team Member Disbursement WFACS Ranjeva Arsala Deane Team Member Operations HMNHN Casey Katriel Roth Team Member Data Science HMNHN Friedman Daria Goldstein Counsel Legal Support LEGAM Ebrahim Mohammed Team Member Communications ECRMN Yahya Al-Harazi Georges Tony Abou Rjaily Team Member Disbursement WFACS Heba Yaken Aref Ahmed Team Member WASH SMNWA Minh Thi Hoang Trinh Team Member Program Support HMNHN Mohini Kak Team Member Nutrition HMNHN Murat Cengizlier Counsel Legal Support LEGAM Rim Atoui Team Member M&E HMNHN Wael Ahmed Elshabrawy Team Member Financial Management EMNGU Extended Team Name Title Organization Location Page 7 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) I. BACKGROUND AND RATIONALE FOR ADDITIONAL FINANCING A. Introduction 1. This Project Paper seeks the approval of the World Bank Board of Executive Directors (Board) of an International Development Association (IDA) grant to provide a second Additional Financing (AF2) to the Yemen Emergency Human Capital Project (EHCP, P176570) in the amount of SDR 111.8 million (US$150 million equivalent). The AF2 will aim to preserve and continue service provision of essential health, nutrition, and water supply, sanitation, and hygiene (WASH) services. As of June 27, 2023, a total of US$286.6 million (99.6 percent of the total financing) has been disbursed to the implementing agencies. Existing project funds for the delivery of essential health and nutrition services will be exhausted by September 30, 2023. Project funds for WASH interventions, such as fuel supply to WASH facilities and water trucking to health facilities, will be fully committed by September 30, 2023. The AF2 will avert essential service delivery disruption and potential adverse impacts on human capital in Yemen. 2. The EHCP, financed by an IDA grant of SDR 103.9 million (US$150 million equivalent), was approved by the Board on June 30, 2021, and was followed by an additional financing (AF1) of SDR 111.3 million (US$150 million equivalent), which was approved by the Board on July 25, 2022. The implementing agencies (and recipients of the grants) are the United Nations Children’s Fund (UNICEF), the United Nations Office for Project Services (UNOPS), and the World Health Organization (WHO). Under the original financing (OF), the WHO grant of US$45.46 million and the UNOPS grant of US$30.00 million became effective on September 27, 2021, while the UNICEF grant of US$74.54 million became effective on October 2, 2021. Under the AF1, UNICEF received a grant of US$74.54 million which became effective August 6, 2022; UNOPS received a grant of US$30 million which became effective on August 8, 2022; and WHO received a grant of US$45.46 million, which became effective on August 8, 2022. The closing date for the Project is June 30, 2025. 3. The Project Development Objective (PDO) is to provide essential health, nutrition, water and sanitation services to the population of Yemen. The Project has four components: (i) improving access to healthcare, nutrition, and public health services; (ii) improving access to water supply and sanitation and strengthening local systems; (iii) project support, management, evaluation, and administration; and (iv) a contingent emergency response component (CERC). Both the Development Objective and the Implementation Progress are rated Satisfactory as per the latest Implementation Status and Results report of April 27, 2023. 4. The EHCP has made significant progress, and end-targets under health PDO indicators have already been surpassed. As of March 31, 2023, over 8.4 million beneficiaries (compared to a target of 5.18 million) have received health and nutrition services at over 2,200 supported health facilities and through outreach and mobile teams. Over 4.49 million women and over three million children have received health and nutrition services (compared to targets of 2.34 million and 2.17 million, respectively). Implementation of water supply and sanitation activities has progressed well, with over 450,000 people receiving access to improved water supply and sanitation, of which 48.5 percent are female beneficiaries (compared to a target of 48 percent). Page 8 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) 5. While preservation of the health system is essential in the current context, the Project continues to strengthen health, nutrition and WASH systems in critical areas. These include: (i) rolling out the District Health Information System II (DHIS II) in 22 governorates which produces aggregate data for program design, implementation, and monitoring; (ii) developing the electronic integrated disease early warning system (eIDEWS) for disease surveillance; (iii) building capacities in hospital management, and service provision by community health workers (CHWs) and primary health care staff and strengthening project management skills of the Ministry of Public Health and Population (MOPHP); (iv) establishing protocols for non- communicable diseases (NCD) care and quality of care; (v) empowering subnational health entities; and (vi) establishing and sustaining community health network. A capacity building program is targeting 35 local water and sanitation corporations. The Project is also investing in the rehabilitation of sustainable water supply and sanitation facilities, which will be handed over upon completion to the decentralized utilities. 6. The EHCP is in compliance with the Environmental and Social Framework (ESF) and fiduciary requirements. UNICEF, UNOPS, and WHO developed, published and disclosed all required environmental and social (E&S) instruments. All three implementing agencies have established a Grievance Redressal Mechanism (GRM) equipped with dedicated staff and multiple uptake channels for receiving and handling complaints including issues related to gender-based violence (GBV)/Sexual Exploitation and Abuse (SEA)/Sexual Harassment (SH) and grievances related to workers. The Project has also met fiduciary requirements in accordance with the Financial Management Framework Agreement (FMFA) and Alternative Procurement Arrangements (APA) with United Nations (UN) Agencies. B. Country Context 7. Yemen’s nine-year armed conflict has devastated its economy and deepened the country’s humanitarian crisis. Physical damage to infrastructure in most governorates, depleted institutions, and a sharply contracted economy has left Yemenis extremely vulnerable. In addition to the conflict, multiple shocks such as the COVID-19 pandemic, measles outbreaks, a cholera epidemic, a locust invasion, rising food prices, food insecurity, and floods, have worsened conditions. Of all the economic challenges posed by the conflict, diverging monetary policies, foreign-exchange flows, and monetization of fiscal deficits are among the most consequential.1 Parallel institutional structures in the North and South of the country have resulted in further fragmentation of service delivery. 8. The scale of human capital deterioration has placed a heavy toll on all populations in Yemen. In 2023, an estimated 21.6 million people, almost three-quarters of the population, including 12.9 million children, needed humanitarian assistance and protection. Over four million people, including two million children, are displaced, and over 17 million people are experiencing acute food insecurity. Two million children and 1.3 million pregnant and lactating women suffer from acute malnutrition.2 C. Sectoral Context 9. Yemen’s health and WASH sectors have been devastated by almost a decade of conflict, institutional weakness, and economic volatility. Significant damage to public infrastructure has led to 1 https://blogs.worldbank.org/arabvoices/economic-consequences-war-yemen-macroeconomic-shocks-microeconomic-pain 2 OCHA, Yemen Humanitarian Needs Overview 2023. December 2022 Page 9 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) service disruption and reduced functionality of basic services. A Dynamic Needs Assessment (DNA) conducted in 2020, estimated recovery and reconstruction needs for the short- and medium-term in the water and sanitation sector to be between US$763 million and US$932 million, respectively. About 38 percent of WASH facilities were damaged, only 21 percent are fully functioning, and 54 percent are partially functioning while 25 percent are non-functioning.3 In addition, 38 percent of the health facilities were damaged or destroyed. Furthermore, lack of fuel, electricity, water, and operations and maintenance (O&M) budget have further compromised the country’s ability to deliver public services. D. Rationale for Additional Financing 10. The World Bank’s continued engagement remains critical given the challenges of the fragile health, nutrition, and WASH systems. The existing Project funds for the delivery of essential health and nutrition services will be exhausted by September 30, 2023, resulting in a significant disruption in health and nutrition service delivery. Funds for critical WASH interventions, such as fuel supply to WASH facilities and water trucking to health facilities will be fully committed by September 30, 2023, adversely impacting sustained availability of clean water for beneficiaries and health facilities. 11. The AF2 will continue to support institutional capacity building and strengthening of the health system to improve its resilience to shocks. The Project has supported building and strengthening systems through improving surveillance and information systems, improving health, nutrition, and WASH service delivery, including prevention and early detection services; and strengthening clinical and managerial competencies of health workers. The DHIS II has enabled availability of data for program design, implementation, and monitoring as well as NCD surveillance. NCD protocols have been finalized to improve prevention, early detection, and management of NCDs. The Project also supports the enhancement of the project management skills at the MOPHP. The Project will also continue to address demand-side barriers to service utilization. Through an integrated health service package of integrated management of childhood illnesses (IMCI), maternal and newborn health (MNH) counseling and nutrition support, the Project will continue to create increased demand from women and men for healthcare services. 12. The AF2 is strategically aligned both with the Yemen Country Engagement Note (CEN) 2022-2023 discussed by the Board of Executive Directors on April 14, 2022, the World Bank Fragility, Conflict and Violence (FCV) Strategy 2020-2025 and the IDA 20 program. The World Bank’s FCV Strategy 2020-2025 outlines that during conflict, the priority should be engagements that preserve institutional capacity and human capital which are critical for the country’s future recovery. The Yemen CEN emphasizes: (i) supporting basic service delivery and human capital preservation; and (ii) promoting food security, resilience, and livelihood opportunities. Reflecting the evolution of the World Bank’s ambition and operational approach in FCV countries, the CEN emphasizes working at the local level through a decentralized approach to mitigate any potential political or institutional disruptions and to continue to stay engaged in Yemen. 13. The AF2 is consistent with Yemen’s Intended Nationally Determined Contribution (INDC) submitted in 2015. Yemen’s INDC addresses climate change despite its limited resources, ongoing conflict, and long-term fragility. The country’s ability to act upon climate adaptation and mitigation measures will depend on the availability of resources and resolution of its political and economic challenges. The INDC 3 World Bank, 2020, “Damage and Need Assessment.” Page 10 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) highlights the following health impacts of climate change in Yemen: increased incidence of vector-borne diseases, water scarcity and poor sanitation, food insecurity and malnutrition. The Project contributes to adaptation measures, namely strengthening disease surveillance, enhancing healthcare resilience, improving water management and water use and enhancing early warning systems for natural disasters. II. DESCRIPTION OF ADDITIONAL FINANCING 14. The AF2 will finance all eligible activities under the current original Project (OF and AF1) to sustain essential health, nutrition, population, and WASH services until the Project closing date. The PDO, implementation/institutional arrangements, including fiduciary and disbursement arrangements in place for the OF will be applicable to the proposed AF2. 4 However, the end-targets of the Result Framework will be revised, reflecting expected impacts from the additional funds. The closing date of the Project will remain unchanged. Component 1: Improving Access to Healthcare, Nutrition, and Public Health Services (implemented by UNICEF (US$67.58million equivalent) and WHO (US$41.98 million equivalent)) 15. The AF2 will finance all eligible activities that are currently supported by the Project (both OF and AF1). Component 1 aims to help sustain essential health and nutrition services at currently supported health facilities (including over 2,200 primary health care facilities and approximately 80 hospitals, laboratories, and other facilities in Yemen). The component will also contribute towards national health system preparedness capacity and support the building of individual and institutional capacity in health information and quality of care. Equipment financed by this component will be selected based on its power and water use efficiency and use of existing and available solar energy resources where possible. Subcomponent 1.1: Improving Access to the Minimum Service Package (MSP) at Primary Healthcare Level (UNICEF - US$47.61 million equivalent, WHO - US$1.5 million equivalent) 16. This subcomponent will continue to ensure uninterrupted delivery of health services to meet escalating climate-related health needs through MSP service delivery at the primary level. Specifically, the following will be provided: (i) critical inputs for the operation of primary health care centers (PHCs) (permanent and temporary fixed sites), including provision of operational costs and essential supplies, health worker per-diems for regular outreaches by health workers, and for conducting integrated support supervision; (ii) integrated outreach (outreach and mobile teams for the population in remote areas and IDPs); (iii) service delivery at the community level through CHWs; and (iv) four basic services including IMCI, immunization, nutrition and MNH services. 17. Under this subcomponent, UNICEF will continue to work with WHO to provide support through development of protocols, provision of basic medical supplies, and training of healthcare workers on MNH and NCD prevention and care services at the primary care level. The Project continues to support minor refurbishment to create the required space/room to conduct deliveries in selected health centers. The availability and retention of a general practitioner (GP) in selected health centers will be supported through 4For details of the implementation arrangement and support plan, refer to pg. 65 of the Project Appraisal Document for the Emergency Human Capital Project: https://documents1.worldbank.org/curated/en/557741624540469303/pdf/Yemen- Emergency-Human-Capital-Project.pdf. Page 11 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) per-diem payments for conducting clinical mentoring and on-the-job training for health workers on delivery of MNH and NCD prevention and care services. Subcomponent 1.2: Improving Access to Essential Preventive and Curative Nutrition Services (UNICEF - US$19 million equivalent) 18. UNICEF will provide essential nutrition services at all EHCP supported health facilities, including malnutrition screening, monitoring and treatment, referral, infant and young child feeding (IYCF) and micronutrient supplementation services. The AF2 will continue to finance the procurement of nutrition supplies and micronutrient powders. In the absence of mass polio campaigns, standalone Vitamin A and multiple micronutrient powder supplementation campaigns are being introduced. The AF2 will also support the strengthening of referral services for severe acute malnourished children with medical complications from the outpatient therapeutic feeding programs to therapeutic feeding centers (TFCs); strengthening the quality of services through supportive supervision, on-the-job training at the facility level and review meetings to monitor and evaluate the program at district and governorate levels. Efforts to strengthen the supply chain in ensuring the availability of nutrition supplies and avoiding stockouts at all levels will increase the resilience of the system. Information system strengthening to ensure data flow at all health system levels will be supported by building capacity, improving DHIS II, implementing the nutrition information system action plan, and generating evidence through Standardized Monitoring and Assessment of Relief and Transitions (SMART) surveys. Additionally, the Project is shifting TFCs to pediatric hospitals to improve the efficiency of service delivery. 19. To strengthen beneficiary outreach, UNICEF will continue to support the provision of curative and preventive health and nutrition services through mobile teams and health outposts. UNICEF will support the deployment of mobile teams to hard-to-reach areas, climate-vulnerable populations and IDPs’ settlements and will expand the provision of health and nutrition services through outposts. In addition, support to community health and nutrition volunteers (CHNVs) would continue to ensure community referral and provision of preventive services to pregnant and lactating women, adolescents and under five children. UNICEF will also continue to partially support the Scaling Up Nutrition (SUN) Secretariat to advocate for and strengthen the Yemen SUN Action Plan. Subcomponent 1.3: Improving Access to the MSP at Secondary and Tertiary Care Level (WHO - US$26.42 million equivalent) 20. This subcomponent will continue to ensure continuum of care at secondary and tertiary health facilities, as well as sustaining blood bank and central public health laboratory capacities. Inputs will include provision of fuel, oxygen, supplies, equipment, training, and supportive supervision of the supported health facilities. Training will include raising awareness of measures to manage climate risk and climate-induced diseases, such as vector-borne diseases and heat-related illness. This training will be delivered through virtual sessions and decentralized, smaller group events to minimize carbon emissions. 21. The subcomponent will target health facilities based on the same vulnerability assessment criteria that have continued since the Emergency Health and Nutrition Project (EHNP). Approximately 80 hospitals will be supported by the Project. Fuel monitoring devices will improve fuel efficiency and increase the transparency of greenhouse gases (GHG) emissions in new hospitals. The AF2 will continue to support diarrhea treatment centers (DTCs) to manage cholera cases as needed. The subcomponent will continue to Page 12 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) support operationalizing the MSP, through training, development of guidance documents and by updating essential medicines and equipment lists. Subcomponent 1.4: Sustaining National Health System Preparedness and Public Health Programs (implemented by WHO - US$11.06 million equivalent) 22. This subcomponent will continue to support nationwide public health programs and measures. Activities under this subcomponent will contribute to climate adaptation by monitoring climate-sensitive diseases through eIDEWS, updating seasonal mapping, forecasting, and conducting preventive campaigns to reduce the impacts of potential outbreaks. Climate change adaptation will also be strengthened by enhancing preparedness to respond to the health and nutrition impacts of acute events such as flooding, drought, and locusts, including by ensuring continuity of essential health and nutrition services during and after climate- related emergencies and providing such services to areas expected to be affected by climate change. Capacity-building activities under this subcomponent will also include sessions focused on awareness-raising for climate change adaptation. Subcomponent 1.5: Health System Strengthening (UNICEF - US$0.97 million equivalent and WHO - US$3 million equivalent) 23. The subcomponent will strengthen institutional capacities and health information systems. The capacity of Governorate Health Offices (GHOs) and District Health Offices (DHOs) will be strengthened on quality-of-care and enhanced public financial management. DHIS II data supported by WHO will be stratified based on seasonality to inform decision-making aimed at managing climate risks related to undernutrition and seasonal disease trends. 24. UNICEF and WHO will continue to roll out DHIS II in Yemen, based on global WHO metadata packages to ensure data comparability across countries. UNICEF and WHO will work together on building capacity and ensuring coherence across DHIS II platforms used in Yemen. To improve efficiency, paper-based data collection by CHNVs and CHWs has been integrated into DHIS II reporting. Based on an assessment conducted by WHO in the southern governorates and lessons from UNICEF-led implementation in the northern governorates, UNICEF and WHO will support the MOPHP in developing policy and guidelines, training, improving data quality and strengthening DHIS II infrastructure. Component 2: Improving Access to Water Supply and Sanitation and Strengthening Local Systems (implemented by UNOPS US$22.38 million equivalent) 25. All eligible activities funded under EHCP (OF and AF1) including sanitation, water and hygiene will be supported under this component and its subcomponents. Improved water and sanitation services play a crucial role in promoting better health and nutrition outcomes. This component will focus on rehabilitation of water supply and sanitation facilities, including water and sanitation networks, Wastewater Treatment Plants (WWTPs), Water Treatment Plants (WTPs), water wells, boosters and pumps station, development and utilization of solar panels, and hygiene support to the functionality of water supply and sanitation systems in schools and health facilities. The AF2 will continue to support fuel provision to water and sanitation facilities, water trucking provision to 126 health facilities (urban, pre-urban and rural areas). This component will ensure that emergency fuel and water trucking provisions are subject to time-bound Page 13 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) pragmatic exit strategies to avoid carbon lock-in. The AF2 will not finance solar technology but will leverage solar technology previously financed under the OF and AF1. 26. Capacity building activities have been expanded under the Yemen Integrated Urban Services Emergency Project (YIUSEP II) and AF, and EHCP and AF1 to cover the additional specific needs of Local Water and Sanitation Corporation (LWSCs) that are not covered previously. Activities under this component will continue to preserve and strengthen the resiliency of national and local institutions such as the Urban Water-Project Management Unit (UW-PMU), the Public Works Project (PWP), LWSCs and their branches, branches of the General Authority for Rural Water Supply Projects GARWSP,, etc.) through supporting, among others, procurement and contract management, low carbon and climate resilient infrastructure, technical design, asset management, operations and maintenance of water supply and sanitation facilities for medium and long term, information management, safeguards, and leadership capacities of local water and sanitation institutions. Subcomponent 2.1: Restoring Access to and Improving Quality of Water Supply and Sanitation Services in Selected Urban and Rural Areas (UNOPS - US$2.5 million equivalent) 27. This subcomponent will support the eligible interventions as under the EHCP (OF and AF1). This will cover WWTP networks, booster and pumping stations, wells, water meters, procurement and delivery of operations and maintenance materials, equipment, and machine tools such as spare parts, measuring devices, manholes, sewage maintenance vehicles, laboratory equipment and supplies. The Project will aim to increase LWSCs’ sustainability through enhancing their institutional capacity including institutional revenues through improving the collections, and reducing NRW, conducting community campaigns for the mutual benefit of water supply and fees payments. This subcomponent will improve energy efficiency as part of the fuel exit strategy by supporting the operation of main water and wastewater facilities by providing efficient electro-mechanical equipment. Subcomponent 2.2: Emergency Support for WASH Interventions to Prevent and Respond to Communicable Diseases (UNOPS - US$ 19.88 million equivalent) 28. This subcomponent will continue to strengthen Yemen’s readiness and capacity to prevent and respond to communicable diseases, caused by natural disasters, climate change and/or exacerbated by poor sanitation and hygiene. It addresses basic needs of WASH requirements and supplies in priority urban, peri-urban and rural areas at the decentralized levels based on transparent selection criteria that include vulnerability to climate change. The AF2 will support key emergency interventions, fuel provision and water trucking. In term of hygiene, WASH rehabilitation in health facilities and schools is ongoing under EHCP (OF and AF1) based on clear and transparent criteria to ensure integration and complementarities with health, nutrition and energy interventions funded by the World Bank and to maximize impact on the ground. 29. Emergency fuel supply, mainly diesel, has become a critical activity to ensure the functionality of WWTPs and water supply facilities. Fuel supply is required to ensure continuity of safe water supply and sanitation services under 37 LWSCs, National Water and Sanitation Authority (NWSA) branches and Autonomous Utilities (AUs) in 15 governorates. UNOPS will continue to coordinate with UNICEF and other implementing partners and donors to ensure that the AF2 supports the emergency needs of fuel provisions with fuel exit strategies in place and implemented, to the extent possible under the funding limitations, as agreed with UNOPS. Page 14 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) 30. Access to clean water for health facilities is critical, and emergency water trucking will continue to be supported to the agreed list of health facilities and DTCs. Monitoring of the water quality is ongoing at water sources, distribution points, tanker trucks, and household levels through water quality testing for public and private providers. UNOPS is engaging with qualified private water trucking suppliers to ensure supply of the urgent and required water to the needed health facilities and DTCs. For the health facilities that are connected to sustainable water sources, the costs of the water supply will be paid directly to the LWSC after the health facilities confirm delivery following the same approach used by WHO under EHNP and EHCP (OF+AF1). Third-Party Monitoring Agency (TPMA) and UNOPS’ technical team will monitor the delivery of all water supplies supported by the Project. 31. Exit strategies from fuel supply: UNOPS has assessed the actual fuel needs for the 37 LWSCs, branches of NWSA and AUs and is working with them to finalize the exit strategies; before fuel can be supplied to these utilities. The exit strategies will be implemented on a case-by-case basis, due to the variation in the capacity of these utilities. Implementation of the fuel exit strategies will start in parallel to the fuel provision and progress of the implementation will be regularly monitored. 32. Exit strategies from water trucking: UNOPS will share the details of exit strategies on a case-by-case basis for health facilities. For the 17 health facilities already connected to the public water networks by WHO under the EHNP, UNOPS is paying the bills to the LWSCs for 12 months only as a short-term measure to enable health facilities to manage the payment of the cost of water. UNOPS will ensure the implementation of exit strategies from water trucking. UNOPS will share a monitoring and evaluation matrix of the agreed Fuel and Water Trucking exit strategies indicators in its regular progress reports which will be reviewed and assessed periodically. Subcomponent 2.3: Enhanced Capacity Building of Water and Sanitation Institutions at the Local Level (US$0) 33. Strengthening the resilience of local water supply and sanitation institutions at the decentralized levels will continue under this subcomponent as planned and financed under the OF and AF1. As part of the consolidation of WASH interventions under the ongoing operations, a detailed capacity building and training plan for system strengthening at national and decentralized level has been developed under the ongoing urban project YIUSEP-II and its AF with focus mainly on urban areas. Capacity building has started for LWSCs, NWSA’s branches and AUs. Capacity building activities include technical training including supporting the local institutions to assume their service delivery mandate more effectively beyond the boundaries of the Project, taking women’s access into consideration. This will cover topics such as procurement and contract management, social and environmental standards, low carbon and climate resilient infrastructure, technical design, asset management, grievance redress and gender-sensitive stakeholder engagement, capacity building of LWSCs’ on gender parity in recruitment, gender diversity in the workplace, and other critical needs. Per diem for key LWSC staff will be provided if needed based on clear Terms of Reference (TOR). Component 3: Implementation Management and Monitoring and Evaluation (implemented by UNICEF US$10.42 million, WHO - US$6.02 million equivalent, and UNOPS US$ 1.62 million equivalent) 34. This component will continue to support the implementation, administration, management, monitoring and evaluation, and environmental and social aspects of the Project, including: (i) direct cost; (ii) indirect cost; (iii) provision of consultancy services required for Project monitoring, evaluation and Page 15 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) coordination at the local level; (iv) audit conducted by the implementing agencies; and (v) third-party monitoring (TPM). The Project will build on the robust coordination among the three implementation agencies undertaken during AF1 and OF. Component 4: Contingent Emergency Response Component (CERC) (implemented by UNICEF, WHO, and UNOPS - US$0) 35. This component description remains unchanged with the CERC in place to provide an agile response in case of an emergency. 36. TPMAs will provide implementation agencies and the World Bank with evidence on results progress, and identification of risks, mitigation strategies and feedback from beneficiaries on service utilization and quality. Significant efforts have been made under the Project to improve the quality of field work, data collected, and analysis of the TPM reports, which has significantly improved supervision. The implementing agencies and the World Bank will expand data-sharing arrangements grounded in strong data privacy and data protection arrangements. Enhanced data sharing will give rise to enhanced monitoring and analytical work supporting innovations in the Project design. 37. As part of its supervision, the World Bank may engage a monitoring agent to complement the implementation agencies’ physical and financial monitoring activities. This would include TPM activities to complement the TPM to be executed by UNICEF, UNOPS and WHO. The TORs for a World Bank hired monitoring agent for Project activities carried out by implementation agency local partners and/or vendors, including TORs addressing information sharing between the implementation agencies hired TPMAs and the World Bank’s monitoring agent, will be consulted with the implementation agencies. Proposed Changes to the Results Framework 38. Changes in the Results Framework include an update of the targets reflecting the increased financing and revision of the methodology for some indicators to better reflect the scope of the Project. Additional changes for health, nutrition, and population (HNP) services under Component 1 include: (i) making consistent the package of services monitored across sub-indicators of a PDO indicator; and (ii) clarification of the definition of select indicators to improve interpretation. For the WASH services under Component 2, two Corporate Results Indicators (CRI) under the intermediate results will be deleted because they do not capture the Project scope. They will be replaced with other similar indicators to enable the Project to continue to track achievements. The revisions to the indicators and the rationale for each revision are described in Table 1 and the percentage increase in targets are detailed in the POM. Table 1: Proposed Changes to the Results Framework Indicator Rationale Description of changes PDO Indicators Beneficiaries of health, To clarify the indicator definition, Only the first dose administered of a series of nutrition, and/or reflecting the methodology vaccines is counted to avoid double counting population services employed to date. children under 5 who benefit from two or provided through the more vaccination campaigns project (and all Page 16 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) Indicator Rationale Description of changes relevant sub-indicators) In cases where a district has more than one vaccination campaign during one year targeting the same age group, only the campaign reaching the most beneficiaries is included. In cases where a district has more than one chemoprevention campaign during one year targeting the same age group, only the campaign reaching the most beneficiaries is included. Beneficiaries of health, To improve consistency in Added one service to the definition, which is nutrition, and/or methodology with the parent already included in the parent indicator: population services indicator (Beneficiaries of health, Vaccinations during campaigns (MRI and provided through the nutrition, and/or population OCV1) project - of which services provided through the Removed the following services, which are children under 5 project) not included in the parent indicator: 1) Nutrition screening at hospitals; 2) acute malnutrition care at WHO TFCs Intermediate Results Indicators People who have To clarify the indicator definition, In cases where a district has more than one received essential reflecting the methodology vaccination campaign during one year health, nutrition, and employed to date. targeting the same age group, only the population (HNP) campaign reaching the most beneficiaries is services (CRI) and included. relevant sub-indicators Percentage of Severe To monitor the quality of care New indicator Acute Malnutrition provided by project-supported (SAM) cases cured nutrition activities People provided with To reflect the impact of the The indicator will be replaced to capture access to improved project on ensuring sustained rehabilitation and not new construction water sources in access to improved water sources selected urban and and sanitation services. World rural areas (CRI) Bank guidance stipulates that People provided with Water sector CRIs only include The indicator will be replaced to capture access to improved beneficiaries newly gaining access, rehabilitation and not new construction sanitation services (CRI) and therefore excludes rehabilitation. III. KEY RISKS 39. The overall risk rating is High, based on the residual risks identified. High risks include macroeconomics, political and governance, fiduciary and stakeholders. Environmental and social residual risks are rated Substantial. Page 17 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) 40. Macroeconomic risk is High. The ongoing turmoil makes Yemen’s economic prospects dim. Weak external financing coupled with the effects of the pandemic are expected to constrain an expansion of production. A continuation of the hostilities is predicted to trigger additional demand- and supply-side shocks, and to further drain consumers and business confidence, thus negatively impacting both consumption and investment. On the other hand, the successful organization of a public foreign exchange auction system has contributed to relieving pressure on the exchange rate and demonstrated renewed efforts toward macroeconomic stabilization. GDP growth is expected to be stagnant – albeit slightly positive – through 2023, also reflecting overall improved global economic conditions. 41. Political and governance risks are rated High. Efforts to end the conflict in Yemen are underway, but significant security risks, uncertainty about future outbreaks of violence and impediments to delivery of assistance in parts of the country will continue to pose risks to the overall Project implementation. The challenging environment also poses sector strategies/policies risks due to the presence of different health authorities in the country. Coordination with different governance structures and health authorities will continue to affect the operational environment and Project supervision. The implementation agencies have continuously engaged health authorities and facilities, LWSCs, AUs and branches of the General Authority for Rural Water Supply Project (GARWSP) and with institutions with a demonstrated delivery record, impartiality, operational ability, and mandate to work across the country. This has proven to be an effective mitigation strategy in delivering services during times of instability. The TPM mechanism and the reports have helped verify implementation progress and challenges. The TPM reports allow the Project to take corrective actions and resolve complaints in a timely manner. 42. Fiduciary risks are rated as high due to the overall high-risk operating environment in Yemen. Financial management risk is rated as high and procurement risk is rated as substantial. The financial management risk is being mitigated using TPMAs that provide an additional layer of Project monitoring to help identify risks and appropriate mitigation actions. The implementing agencies have introduced a system to report financial values related to high-risk issues which have been persistent for more than six months. Other financial management risks include the use of direct financial cooperation (DFC) and Direct Cash Transfer Modalities which are being addressed through additional financial controls, such as replacing the reliance on such modalities and limiting the use of the DCT modality to 30 percent of the total financing provided to each recipient. UNICEF is using the Harmonized Approach to Cash Transfers (HACT) to monitor their implementation partners on financial management capacities and conducts micro-assessment for all its implementing partners on their financial management capacities. In addition, UNOPS carries out spot checks of specific transactions reported in the Interim Financial Reports (IFRs) and selected by the World Bank. Procurement risks are substantial due to the composition of the marketplace, and the nature of Project activities that might be affected by the situation on the ground in conflict or post-conflict zones. Disruptions in logistical services, global market fluctuations affecting goods’ prices, general constraints related to limited production capacities and limited availability of quality-assured goods, all affect the overall procurement cycle. Procurement risks may also evolve from engaging local implementing partners who may be subject to political interference and insufficient fiduciary oversight at the local level. This risk is mitigated by continuous monitoring of activities and review of comprehensive semi-annual reports, review and approval of procurement plans and their updates, review of the TPMA TORs with summary of their qualifications before finalizing and signing the contract for services of the TPMAs, and review of the TPM reports and taking actions Page 18 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) as needed (The TPMAs’ scope of services will also include checking the quality of services provided by the implementing agencies). 43. Overall environmental and social risks are Substantial. Medical waste management, and health and safety issues of workers and communities are key risks. Each of the implementation agencies has updated their respective Environmental and Social Management Frameworks (ESMFs), Labor Management Procedures (LMP) for the AF2, and UNICEF and WHO have updated their own Infection Prevention Control and Medical Waste Management Plan (MWMP). The implementation agencies are supporting mitigation and potential adverse environmental and social impacts, and the Project supported installation of incineration units for selected health facilities in AF1 and ensuring adequate management of rehabilitation activities. There are other potential environmental and social risks and impacts that are associated with activities under Component 2, such as the generation of dust emissions, debris, sludge and other solid waste generation, ground/surface water contamination, social annoyance, and community safety due to traffic increase, blocked streets, noise and unsafe construction sites, including occupational health and safety. UNOPS has updated its own instruments (ESMF and LMP), including the Resettlement Framework. The TPM will be used under this AF2 to also monitor environmental and social performance. Additionally, the Security Management Plans developed for the Project have been updated for the AF2 by each agency and cleared by the World Bank. Moreover, it was agreed that if there is any security risk at any subproject, no activities will be conducted unless it is safe. 44. The AF2 activities entail social risks and impacts such as inequality and discriminatory practices, particularly due to gender, vulnerability, and other social and economic factors, in the provision of health and nutrition services, and in the access to WASH services. Additionally, Sexual Exploitation and Abuse (SEA)/Sexual harassment (SH)/Gender Based Violence (GBV) are key social risks that could occur during the implementation of this AF2. The GBV Action Plans (GBV-AP) have been updated for AF2 by each agency and cleared by the World Bank. Labor influx could also lead to conflicts between non-local workers and host communities, discriminatory practices in employment, and possible use of child labor in the Project. Learning from the COVID-19 pandemic, the spread of communicable diseases is a serious risk to stakeholders during Project implementation, including Project workers as well as targeted beneficiaries. The updated ESMFs and MWMPs provide the necessary mitigation measures to address the above. 45. Stakeholder risk is rated High. The AF2 may involve risks arising from implementation issues related to stakeholders, and the lack of official government counterparts, and separate health authorities in the North and South of the country. As the situation stabilizes, the implementing agencies will continue to collaborate with government stakeholders and proactively engage with authorities if a transition towards a more stable governance environment takes place. Should the situation reverse into increased tensions and violence, implementing agencies would mitigate such risks by following the business continuity plan and continue project implementation with remaining local staff and implementation partners on the ground. Page 19 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) IV. APPRAISAL SUMMARY A. Economic and Financial Analysis 46. The essential health services supported by the Project, which will benefit Yemenis of all ages, are among the most cost-effective medical and public health interventions known. Health interventions are conventionally considered “highly cost-effective” if they cost less than per-capita GDP (US$702 in Yemen, as of 2018) per disability-adjusted life year (DALY) averted. The core set of childhood vaccines (EPI-6: against tuberculosis, diphtheria, tetanus, pertussis, measles, and polio) are estimated to cost less than US$100 per disability-adjusted life year (DALY) averted. A forthcoming study estimates that key NCD interventions – aspirin for suspected heart attack, early-stage breast cancer treatment, epilepsy treatment, and heart failure chronic treatment—range from US$84 to US$120 per DALY averted.5 The impact of free and targeted maternal programs on the utilization of health services ranges from as low as a 50 percent increase to 200 percent increase in some cases. If the AF2 will directly prevent maternal mortality of the target population over a 10-year societal perspective, the AF2 would be expected to save around 1,050 additional mothers’ lives. Assuming that these lives are saved over a period of two years starting at the end of the first year of implementation of AF2 activities, the total number of life years saved attributable to the AF2 would be 8,925 [(525x9) + (525x8)]. 47. Nutrition interventions aimed at young children have the potential to generate substantial economic returns in terms of generations of children with better health and increased productivity as adults. According to the global investment framework for RMNCH, US$1 invested in the essential package of maternal and child health and nutrition interventions is estimated to yield about US$9 in economic benefits. Nutrition interventions such as micronutrient supplementation, salt iodization, and growth monitoring, rank among the highest across all developmental interventions having the highest economic returns. Carneiro and Heckman6 show that investing in the early years has a higher rate of return than interventions targeted at any other life stage. World Bank research identifies returns on every dollar invested in nutrition are about US$4 for the wasting target, US$11 for the stunting target, US$12 for the anemia target, and US$35 for the exclusive breastfeeding target7. 48. The conflict severely impacted water sector infrastructure. The damage to WASH infrastructure was assessed for 16 urban cities at US$283 million to US$345.9 million. The WASH sector’s recovery and reconstruction costs were estimated between US$763 and US$932 million.8 Water service coverage decreased from average 68 percent before the crisis (2014) to 59 percent (2017) with water consumption (availability of water to customers) on average at 41 liters per capita per day (LPCD). The wastewater service coverage decreased from average 52 percent before the crisis (2014) to 44 percent (2017). A 2023 World 5 David Watkins, Sali Ahmed, and Sarah Pickersgill, forthcoming, “Priority setting for NCD control and health system investments,” Background Paper for World Bank Healthy Longevity Initiative Commission. 6 MIT Press; 2003. Carneiro P, Heckman JJ. Human Capital Policy. In: Heckman J, Krueger A, editors. Inequality in America: What Role for Human Capital Policy? 7Kakietek et al 2017, An Investment Framework for Nutrition: Reaching the Global Targets for Stunting, Anemia, Breastfeeding, and Wasting. Directions in Development. Washington, DC 8Damage and Need Assessment (DNA), the World Bank, 2020. Page 20 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) Bank telephone survey found that only 29 percent of Yemeni urban households access their drinking water through pipes directly into their dwelling, but this is much lower in rural areas at 16 percent.9 49. As a result of the conflict, the state of LWSCs finances had deteriorated markedly, leading to services failing and the LWSCs becoming dependent on external support to keep operating. The conflict also hampered the water and sanitation reform objectives that had been in place before the conflict. To date, more than 500,000 people were provided with access to improved water and sanitation services in rural and urban areas, and 128 sub-projects were prepared in 37 areas to improve water and sanitation facilities. One hundred and nine health facilities have been provided with water trucking of around 11,056m3 per month. The implementation of the capacity building program for 37 LWSCs, branches and autonomous utilities is ongoing. Despite the challenges, the financial situation seems to be improving, based on the annual budget plans of 21 LWSCs. In 2015, only 50 percent of the average operation costs were covered with the LWSCs own revenues, while by 2022 this had increased to 70 percent. Before the conflict, the main source of financing for capital expenditures in the water sector was public budget subsidies (taxes). For the period 2000-2004, the water sector capital expenditures were financed mainly by public budget subsidies to the sector (42 percent) and by transfers from external sources, mainly soft loans and grants (30 percent). Tariffs or “internally generated revenues” (i.e., cost sharing, cost recovery) accounted for only 28 percent of finance for the investment program.10 In this period, expenditures in the water sector accounted for between 7.3 percent (2001) and 9.2 percent (2004) of total budget expenditures.11 Within the sector, allocations were heavily skewed to the urban population, even though Yemen’s large poor population was overwhelmingly concentrated in rural areas. Thus, 55 percent of water sector expenditures were allocated to urban water and sanitation, benefiting just 25 percent of the Yemeni population. Rural water supply and sanitation received only 19 percent of total expenditures, to serve the remaining 75 percent of the population.12 B. Technical Analysis 50. This AF2 builds on past projects specifically designed to ensure that the population of Yemen continues to have access to critical health, nutrition, and WASH services. The design reflects important lessons learned from World Bank experience in the country, notably the EHNP and EHCP, the Yemen COVID- 19 Response Project, YIUSEP, as well as from previous World Bank engagements in emergency health, nutrition, and WASH operations in countries with similar FCV situations. Two key principles were used in selecting the activities to be supported by the AF2. The first principle was based on achieving a balanced approach to provide a package of essential health and nutrition services to support the continuum of care throughout the lifecycle and using diverse models of service delivery. The second principle includes supporting the delivery of an integrated package of services, building on the experience of three ongoing IDA-funded health and nutrition operations. 51. The AF2 is aligned with the goals of the Paris Agreement. The Project is being implemented in an emergency context and current Project activities will not cause any increase in GHG emissions or create any persistent barriers to transition to low-GHG emissions over existing levels and are considered Universally 9 World Bank. 2023 (Unpublished). Monitoring food insecurity and vulnerability in Yemen: Results from the Yemen 10 World Bank. 2005. Country Water Resources Assistance Strategy. Report No. 31779-YEM 11 Idem 12 Idem Page 21 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) Aligned from a mitigation perspective (UAL #40 – Activities associated with emergency preparedness and immediate response in the aftermath of a crisis or disaster, that are temporary and timebound). Activities such as trucking of water, fuel for water supply and purchase of fuel are all temporary interventions with timebound exit strategies. Risks from climate hazards are unlikely to have an adverse effect on the components’ contribution to the PDO. The impact of climate change is taken into consideration while preparing the technical design of the rehabilitation activities. The rehabilitation of the existing wells will be considered after ensuring the sustainability of water sources in terms of quality and quantity to ensure access to safe water supply. Similarly, the impact of water scarcity, drought and floods is taken into consideration through resilient climate design for all the rehabilitation activities. Climate adaptation and mitigation activities are integrated in the Project and described in Annex 2. C. Financial Management 52. The Financial Management (FM) risk is High. The Project’s FM arrangements will be governed by the FMFA between the World Bank and the UN Agencies, which provides for the use of the UN Financial Regulations and Rules. No changes to the FM arrangements are foreseen for this AF2. 53. UNICEF, UNOPS and WHO (recipients for the benefit of the Republic of Yemen), will maintain separate accounts for the Project and ensure that original supporting documents of expenditures are retained. The Project will use IFRs for disbursements and will submit the reports to the World Bank as stated in the Disbursement and Financial Information Letters (DFILs). Funds will flow from the Bank to the recipients’ corporate accounts before flowing to their local bank account or the bank accounts of their implementing partners and onward to the ultimate recipients/beneficiaries. The Project will follow the audit arrangements agreed between the World Bank and UN agencies as per the FMFA. In case the Association and the Recipient agree that additional due diligence measures are needed, the Recipients shall ensure that any additional due diligence measures of its Respective Part of the Project are carried out exclusively in accordance with its Financial Regulations and Rules, and in conformity with the single audit principle observed by the UN system. Detailed FM arrangements are outlined in the POM and Annex 3. D. Procurement 54. Alternate Procurement Arrangements (APA) will be applied as currently done in the OF and AF1. Each of the UN implementing agencies (UNICEF, WHO and UNOPS) will continue to apply its own procurement procedures as the APA is found acceptable to the World Bank under other agreements and allowed by the Procurement Framework Policy Section III. F. Currently, each implementing agency is implementing a few IDA projects in Yemen under APA. The World Bank’s procurement oversight of the APA under these projects has not raised concerns on procurement implementation. 55. All Project activities under this AF2 will be a continuation or similar to the OF and AF1, which include under Component 1, the procurement of basic supplies, equipment, maintenance, medical and non-medical supplies, essential drugs, vaccines, micronutrients, fortified nutritious supplements, and minor rehabilitation of existing facilities. For Component 2, the Project will procure basic supplies (water and fuel), equipment and maintenance for water supply and sanitation facilities, WASH consumables and kits and rehabilitation of existing medium and large water and sanitation facilities. The AF2 will not finance any new procurement of solar powered technology. The main procurement activity under Component 3 is hiring Page 22 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) TPMAs. The procurement risk of the Project is rated Substantial, mainly due to the security situation in Yemen, the composition of the marketplace (limited competition and availability of service delivery), and the impact of the conflict or post-conflict zones on Project activities. 56. Each implementing agency is responsible for: (i) implementing the Procurement Plan and its updates as agreed with the World Bank; (ii) preparing a semiannual report on the progress of procurement implementation; and (iii) ensuring pre-screening of companies/individuals before award of any contract financed by the Project against the World Bank’s lists of sanctioned or temporarily suspended companies and will continue to ensure that all implementing partners which will be engaged by the implementing agency have procedures in place for such screening. The implementing agencies will continue their work with the same local partners which have acceptable performance. For WASH, UNOPS will partner with autonomous national and local partners including UW-PMU in Sana’a and Aden, PWP, respective LWSCs, AUs, respective branches of GARWSP and National Water and Sanitation Authority based on the level of the risk and the results of the micro-assessment to be carried out by UNOPS. The main local implementation partners for UNICEF and WHO are the TPMAs, the MOPHP including GHOs, and health facilities included in the Project through which the delivery of Component 1 activities are being implemented. Thus, engagement of such local partners will follow UN agency procurement framework and the UN agency remains the only responsible vis-a-vis to the World Bank for the implementation of the Project. 57. There is no change in the procurement arrangement. However, each implementing agency is asked to maintain a sufficient number of capable staff in its Procurement Unit to conduct day-to-day procurement functions. 58. The EHCP Procurement Strategy for Development (PPSD) provides more details on the procurement arrangements adopted, risks and mitigation measures proposed. Since this is an emergency operation, and given the tight preparation timeline, update of the EHCP PPSD for the AF2 will be deferred to the implementation phase. Each implementing agency has submitted a Procurement Plan, cleared by the World Bank, using the agreed template covering at least the first 12 months. 59. Regarding complaints received by the Association relating to the Recipient’s procurement of goods, works, non-consulting services and consulting services to be financed out of the proceeds of the Financing, the implementing agencies agreed to continue to discuss the process to be carried out between the World Bank and UNOPS, WHO and UNICEF for handling procurement complaints. The outcome of these discussions is expected to be reflected in the updated POM within three months from the Effective Date of the financing agreements. . A. Legal Operations Policies Triggered? Projects on International Waterways OP 7.50 No Projects in Disputed Areas OP 7.60 No . Page 23 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) B. Environmental and Social 60. The main environmental and social risks associated with AF2 interventions are: (i) medical waste management and community health and safety issues related to transportation, handling, and disposal of vaccines, laboratory materials and tests, medical consumables and associated medical waste; and (ii) Occupational, Health and Safety (OHS) issues related to vaccination, laboratory testing, and handling of medical supplies. Furthermore, potential environmental and social impacts might result from supporting Component 2, including dust emissions, debris and other solid waste generation and management, ground/surface water contamination, social annoyance, and community safety due to traffic increase, blocked streets, noise, dust, and unsafe construction sites as well as workers safety including occupational health and safety. Nonetheless, such risks and impacts are expected to be site-specific, reversible and of low magnitude that can be mitigated following appropriate measures. Moreover, the application of adequate occupational and community safety precautions following the World Bank Environmental, Health and Safety Guidelines is expected to be sufficient to prevent any associated impacts. The POM will be updated (as applicable) to include a clause stating that the financing of activities that use or risk polluting water of transboundary aquifers are not eligible for financing under the Project. 61. To address potential environmental and social risks and impacts, the ESMFs of the OF and AF1 are being updated under this AF2 including the IPC and MWMP. The ESMFs provide detailed procedures and measures for managing different types of medical wastes and handling medical consumables starting from distribution, use, waste collection, temporary storage, transportation, and final safe disposal. Furthermore, the ESMFs include infection control measures to limit the spread of communicable diseases during the Project’s activities. The updated ESMFs will also include a section for gender and GBV action plan to address potential risk of SEA/SH in the Project implementation process, as well as requirements and measures to ensure accessibility to vaccination locations for individuals with disabilities and to address potential risks of exclusion and elite capture in service provisions under the Project. The UNOPS ESMF will also include a Resettlement Framework to be developed in line with ESS5 to address any land-related impacts. 62. The LMP will be updated under this AF2 to address labor risks such as occupational health and safety risks for Project workers administering vaccines, lab tests, rehabilitation works and other interventions under the Project. Subprojects, including those that might be supported by the CERC, will be screened against environmental and social criteria that will be included in each ESMF, and subsequent site- specific environmental and social instruments will be prepared, if needed, during the implementation phase and before the commencement of any activities. All relevant E&S instruments, including the LMP, will be disclosed once updated. 63. The Project activities may entail social impacts and risks. These risks are mainly related to possible inequality and discrimination practices, particularly due to gender, vulnerability, forced labor and other social and economic factors, in the provision of healthcare and nutrition services, and in the access to water supply and sanitation services under the Project including the AF2. There could also be risks of SEA/SH in the provision and access to Project services. Labor influx due to the Project could also lead to conflicts between non-local workers and host communities, discriminatory practices in employment as well as possible use of child labor in the Project. Learning from the COVID-19 pandemic, the spread of communicable diseases is a serious risk to stakeholders in the Project implementation process, including both Project workers as well as targeted beneficiaries. The civil works that are likely to be supported under Component 2 may impose Page 24 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) temporary restrictions on land use, thus affecting communities and owner persons. But these restriction impacts are expected to be insignificant due to the rehabilitation and temporary nature. Gender 64. All gender challenges identified in the Project (OF and AF1) remain. Yemen has the largest gaps in women’s access to health and nutrition, WASH, economic opportunities, and political participation with a very low rate of births attended by a skilled birth attendant (44.7 percent)13, a low percentage of pregnant women with access to prenatal care (60 percent),14 women’s low literacy rate (35 percent)15, women absence from political life, low female labor force participation (6.2 percent)16, limited access to WASH services etc. Increased vaccine hesitancy as of 2021, particularly in some parts of the country, has affected women and children’s health. The stronger enforcement of the Mahram requirement17 further constrains women’s participation in public activities. 65. The AF2 continues the implementation of the same activities that have supported gender inclusion and equity. Almost all of results indicators are disaggregated by gender. Going forward, WHO and UNICEF will report the number of female beneficiaries receiving the remaining services in their progress reports, particularly mental health, and psychosocial support. 66. The AF2 will build on and continue successful gender engagement activities to increase demand in health and nutrition service utilization. Under the ECHP OF and AF1, a decentralized approach leveraging mobile teams for provision of health services has brought health and nutrition care closer to women. An integrated health service package with trained female health workers provided IMCI, MNH counseling and nutrition support. SBC activities reached over one million people with hygiene promotion and preventive messaging. Over 1,500 mother-to-mother clubs, reaching about 112,000 households every month, function as an effective platform for long-term engagement with caregivers, particularly pregnant and lactating women, and engaging grandmothers. AF2 will continue to deploy community midwives to increase skilled birth attendants. 67. In Component 2, the AF2 will continue to ensure availability, accessibility, acceptability, and quality of WASH services in health facilities, taking into consideration gender equality and social inclusion. The water supply and sanitation facilities will be designed to be more gender sensitive and inclusive. When applicable, the Project will ensure facilities for women are equipped for menstrual health and hygiene. Indicators measuring closure of the gender gaps are part of the results matrix. Citizen Engagement 68. A key element of the Project is community engagement and outreach underpinned by facility- based outreach and community-based service delivery models in close collaboration with public health institutions. The engagement of communities is critical to build community knowledge and confidence, establish trust, ensure that the government responds to community needs and to ultimately maximize the 13 https://www.emro.who.int/yemen/news/who-advocacy-to-empower-female-health-workers-in-yemen.html 14 https://www.emro.who.int/yemen/news/who-advocacy-to-empower-female-health-workers-in-yemen.html 15 World Development Indicators 16 Modeled International Labour Organization (ILO) estimates of working age 15-64 years 17 Mahram requirement means that women should be accompanied by a male guardian when travelling. Page 25 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) utilization of essential health, nutrition, and WASH services. Building on the intensive consultation that the implementing agencies carried out for the OF and AF1, the AF2 was prepared taking into considerations the inputs received by the key stakeholders through the Grievance Mechanism, the TPM reports and the agencies’ monitoring mechanisms. The Project will elaborate citizen engagement activities in the POM. Climate Change 69. Under the Project, several adaptation and mitigation measures have been incorporated to address climate change enhancements. These include capacity building to manage and mitigate climate risks for health, water, and sanitation workers, improving medical waste management, strengthening access to nutrition and health services for vulnerable groups, enhancements to DHIS II to address climate risk related to disease and undernutrition, and supporting exit strategies from water trucking and fuel support. Annex 2 describes the country’s exposure to climate change and the Project’s climate change adaptation and mitigation measures. V. WORLD BANK GRIEVANCE REDRESS 70. Grievance Redress. Communities and individuals who believe that they are adversely affected by a Project supported by the World Bank may submit complaints to existing Project-level grievance mechanisms or the World Bank’s Grievance Redress Service (GRS). The GRS ensures that complaints received are promptly reviewed in order to address Project-related concerns. Project affected communities and individuals may submit their complaint to the World Bank’s independent Accountability Mechanism (AM). The AM houses the Inspection Panel, which determines whether harm occurred, or could occur, as a result of World Bank non-compliance with its policies and procedures, and the Dispute Resolution Service, which provides communities and borrowers with the opportunity to address complaints through dispute resolution. Complaints may be submitted to the AM at any time after concerns have been brought directly to the attention of World Bank Management and after Management has been given an opportunity to respond. For information on how to submit complaints to the World Bank’s Grievance Redress Service (GRS), please visit http://www.worldbank.org/GRS. For information on how to submit complaints to the Bank’s Accountability Mechanism, please visit https://accountability.worldbank.org. Page 26 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) VI SUMMARY TABLE OF CHANGES Changed Not Changed Results Framework ✔ Components and Cost ✔ Implementing Agency ✔ Project's Development Objectives ✔ Loan Closing Date(s) ✔ Cancellations Proposed ✔ Reallocation between Disbursement Categories ✔ Disbursements Arrangements ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Implementation Schedule ✔ Other Change(s) ✔ VII DETAILED CHANGE(S) COMPONENTS Current Component Name Current Cost Action Proposed Component Proposed Cost (US$, (US$, millions) Name millions) Improving Access to 209.90 Revised Improving Access to 319.46 Healthcare, Nutrition, and Healthcare, Nutrition, Public Health Services and Public Health Services Improving Access to Water 52.50 Revised Improving Access to 74.88 Supply and Sanitation and Water Supply and Strengthening Local Systems Sanitation and Strengthening Local Page 27 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) Systems Project Support, 37.60 Revised Project Support, 55.66 Management, Evaluation Management, and Administration Evaluation and Administration Contingent Emergency 0.00 Contingent Emergency 0.00 Response Response TOTAL 300.00 450.00 Expected Disbursements (in US$) DISBURSTBL Fiscal Year Annual Cumulative 2021 0.00 0.00 2022 97,904,275.60 97,904,275.60 2023 83,520,000.00 181,424,275.60 2024 140,380,000.00 321,804,275.60 2025 128,195,724.00 449,999,999.60 2026 0.00 449,999,999.60 SYSTEMATIC OPERATIONS RISK-RATING TOOL (SORT) Risk Category Latest ISR Rating Current Rating Political and Governance ⚫ High ⚫ High Macroeconomic ⚫ High ⚫ High Sector Strategies and Policies ⚫ Substantial ⚫ Substantial Technical Design of Project or Program ⚫ Substantial ⚫ Substantial Institutional Capacity for Implementation and ⚫ Substantial ⚫ Substantial Sustainability Fiduciary ⚫ High ⚫ High Environment and Social ⚫ Substantial ⚫ Substantial Stakeholders ⚫ High ⚫ High Other Overall ⚫ High ⚫ High Page 28 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) LEGAL COVENANTS2 LEGAL COVENANTS – Second Additional Financing Yemen Emergency Human Capital Project (P181317) Sections and Description OPS_LEGAL_CONVENANT_CHILD_NODATA No information available Conditions Page 29 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) VIII. RESULTS FRAMEWORK AND MONITORING Results Framework COUNTRY: Yemen, Republic of RESULT_NO_PDO Second Additional Financing Yemen Emergency Human Capital Project Project Development Objective(s) The project development objective is to provide essential health, nutrition, water and sanitation services to the population of Yemen. Project Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_ PD O Indicator Name PBC Baseline Intermediate Targets End Target 1 2 Provision of essential health and nutrition services (Action: This Objective has been Revised) Beneficiaries of health, nutrition and/or population services provided through the 0.00 2,000,000.00 8,424,590.00 18,944,654.00 project (Number) Action: This indicator has been Revised Beneficiaries of health, nutrition, and/or population services provided through the project, of which female 0.00 1,500,000.00 4,490,420.00 9,997,652.00 (Number) September 6, 2023 Page 30 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) RESULT_FRAME_TBL_ PD O Indicator Name PBC Baseline Intermediate Targets End Target 1 2 Action: This indicator has been Revised Beneficiaries of health, nutrition, and/or population services provided 0.00 1,500,000.00 2,170,000.00 7,420,982.00 through the project - of which children under 5 (Number) Action: This indicator has been Revised Percentage of beneficiaries of health, nutrition, and/or population services provided through the project - IDPs 0.00 10.00 10.00 8.00 (Percentage) Action: This indicator has been Revised Provision of Essential Water and Sanitation Services (Action: This Objective has been Revised) People provided with access to improved water and sanitation services in selected 0.00 180,000.00 670,000.00 2,000,000.00 urban and rural areas (Number) Action: This indicator has been Revised People provided with access to improved water and sanitation 0.00 48.00 48.00 48.00 services in selected urban and rural areas - female (Percentage) Action: This indicator has been Revised PDO Table SPACE Page 31 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) Intermediate Results Indicators by Components RESULT_FRAME_TBL_ IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 Improving Access to Health, Nutrition, and Public Health Services (Action: This Component has been Revised) Number of outreach rounds conducted (Number) 0.00 14,000.00 23,480.00 61,736.00 Action: This indicator has been Revised Health facilities provided with equipment and medical/non-medical supplies 0.00 2,000.00 2,300.00 2,610.00 (Number) Action: This indicator has been Revised Pregnant women receiving antenatal care during a visit to a health provider 0.00 120,000.00 240,000.00 932,242.00 (Number) Action: This indicator has been Revised Health personnel receiving training 0.00 2,000.00 4,000.00 15,603.00 (Number) Action: This indicator has been Revised Number of people receiving mental health and psychosocial support 0.00 105,000.00 160,000.00 241,077.00 (Number) Action: This indicator has been Revised Number of facility-based nutrition sentinel sites (Number) 0.00 237.00 287.00 340.00 Action: This indicator has been Revised Page 32 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) RESULT_FRAME_TBL_ IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 Women receiving breastfeeding and complementary feeding counselling 0.00 184,000.00 493,409.00 1,519,360.00 (Number) Action: This indicator has been Revised People receiving essential drugs for non- communicable diseases (Number) 0.00 40,000.00 80,000.00 196,365.00 Action: This indicator has been Revised Training on good hygiene and sanitation practices to prevent the spread of diseases exacerbated by climate change No Yes Yes Yes (Yes/No) New electronic integrated disease early warning system (eIDEWS) data collection 1,991.00 2,100.00 2,379.00 2,379.00 sites established (Number) People who have received essential health, nutrition, and population (HNP) 0.00 1,300,000.00 4,443,201.00 10,727,911.00 services (CRI, Number) Action: This indicator has been Revised People who have received essential health, nutrition, and population 0.00 1,200,000.00 1,800,000.00 6,709,459.00 (HNP) services - Female (RMS requirement) (CRI, Number) Action: This indicator has been Revised Number of children immunized (CRI, Number) 0.00 1,200,000.00 2,000,000.00 1,651,905.00 Page 33 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) RESULT_FRAME_TBL_ IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 Action: This indicator has been Revised Number of women and children who have received basic nutrition services 0.00 500,000.00 1,500,000.00 8,350,095.00 (CRI, Number) Action: This indicator has been Revised Number of deliveries attended by skilled health personnel (CRI, Number) 0.00 100,000.00 150,000.00 724,565.00 Action: This indicator has been Revised Percentage of severe acute malnutrition 90.00 90.00 cases cured (Percentage) Action: This indicator is New Improving Access to Water Supply and Sanitation and Strengthening Local Systems People provided with access to improved 0.00 70,000.00 230,000.00 450,000.00 water sources (CRI, Number) Action: This indicator has been Marked for Deletion People provided with access to improved water sources - Female 0.00 33,600.00 110,400.00 216,000.00 (RMS requirement) (CRI, Number) Action: This indicator has been Marked for Deletion People provided with access to improved water sources - rural (CRI, 0.00 50,000.00 100,000.00 150,000.00 Number) Page 34 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) RESULT_FRAME_TBL_ IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 Action: This indicator has been Marked for Deletion People provided with access to improved water sources - urban (CRI, 0.00 60,000.00 240,000.00 300,000.00 Number) Action: This indicator has been Marked for Deletion People provided with access to improved sanitation services (CRI, Number) 0.00 200,000.00 625,000.00 825,000.00 Action: This indicator has been Marked for Deletion People provided with access to improved sanitation services - Female 0.00 52,800.00 211,200.00 396,000.00 (RMS requirement) (CRI, Number) Action: This indicator has been Marked for Deletion People provided with access to improved sanitation services - rural 0.00 10,000.00 40,000.00 75,000.00 (CRI, Number) Action: This indicator has been Marked for Deletion People provided with access to improved sanitation services - urban 0.00 100,000.00 400,000.00 550,000.00 (CRI, Number) Action: This indicator has been Marked for Deletion Percentage of WASH focus groups attendees who were satisfied with the 0.00 80.00 80.00 80.00 participatory approach in the planning process of the project (Percentage) Page 35 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) RESULT_FRAME_TBL_ IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 Percentage of WASH focus groups attendees who were satisfied with the participatory approach in the planning 0.00 40.00 40.00 40.00 process of the project - of which female (Percentage) Number of people trained from government institutions to improving 0.00 50.00 150.00 300.00 local WASH capacity at the institutional level (Number) Schools with improved WASH facilities 0.00 10.00 20.00 30.00 (Number) Health care establishments with 0.00 10.00 10.00 20.00 improved WASH facilities (Number) IDPs benefiting from emergency WASH response (rural and urban) (Number) 0.00 1,000.00 4,000.00 7,500.00 People who have access to water monitored for quality using critical 0.00 50,000.00 150,000.00 200,000.00 parameters related to cholera and water borne diseases (Number) Water and sanitation facilities using solar 0.00 10.00 20.00 30.00 power generation (Number) Energy generation supported through the 0.00 5,000.00 Project (Megawatt hour(MWh)) People provided with restored access to rehabilitated water supply services 0.00 1,025,000.00 (Number) Rationale: This is a newly added indicator to replace the CRI indicator "People provided with access to improved water sources" since the project is measuring Action: This indicator is New the number of people provided with access to rehabilitated water supply services. Page 36 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) RESULT_FRAME_TBL_ IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 People provided with restored access to rehabilitated water supply services 0.00 492,000.00 - female (Number) Action: This indicator is New People provided with restored access to rehabilitated water supply services 0.00 150,000.00 - rural (Number) Action: This indicator is New People provided with restored access to rehabilitated water supply services 0.00 875,000.00 - urban (Number) Action: This indicator is New People provided with restored access to rehabilitated sanitation services 0.00 975,000.00 (Number) Rationale: This is a newly added indicator to replace the CRI indicator "People provided with access to improved sanitation services" since the project is Action: This indicator is New measuring the number of people provided with access to rehabilitated utilities. People provided with restored access to rehabilitated sanitation services - 0.00 468,000.00 female (Number) Action: This indicator is New People provided with restored access to rehabilitated sanitation services - 0.00 75,000.00 rural (Number) Page 37 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) RESULT_FRAME_TBL_ IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 Action: This indicator is New People provided with restored access to rehabilitated sanitation services - 0.00 900,000.00 urban (Number) Action: This indicator is New Project Support, Management, Evaluation and Administration Local NGOs involved in service provision 0.00 10.00 10.00 12.00 (Number) Action: This indicator has been Revised Beneficiaries satisfied with services 0.00 85.00 85.00 85.00 provided (Percentage) An action plan to follow up on the findings from TPM surveys is prepared No Yes Yes Yes and monitored (Yes/No) IO Table SPACE Monitoring & Evaluation Plan: PDO Indicators Mapped Methodology for Data Responsibility for Data Indicator Name Definition/Description Frequency Datasource Collection Collection Number of all people who Service Collecting data from have benefited from Beneficiaries of health, nutrition and/or Every 6 providers at service providers at health, nutrition, and/or WHO and UNICEF population services provided through the months different different levels; GHOs population services project levels and DHOs provided through the project. Page 38 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) This indicator and sub- indicators only includes project-supported facilities and the outreach activities associated with project- supported facilities. It is the sum of the following quantities, grouped by reporting agency. UNICEF: the number of nutrition screenings for children under 5 at the primary care level; the number of ANC1 sessions at the primary level WHO: - The number of non-emergency outpatient consultations at hospitals. - The number of children vaccinated during campaigns, calculated as follows to avoid double counting children who benefit from two or more different vaccination campaigns. Only the first dose of a series (e.g., MR1, OCV1) is included. Only Page 39 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) doses administered to children under 5 are included. Each year, in each district, only the vaccination campaign (i.e., the antigen) reaching the most children under 5 is included. The number of doses is summed across all districts. - The number of ANC1 sessions at the hospital level. - The number of children aged 6-18 years receiving preventive chemotherapy against schistosomiasis, onchocerciasis or trachoma, calculated as follows to avoid double counting children who benefit from two or more different chemoprevention campaigns. Each year, in each district, only the chemoprevention campaign reaching the most children is included. The number of doses is summed across all districts. Page 40 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) The sum of the following quantities, grouped by reporting agency. Typically, service utilization data is not disaggregated by sex. Whenever sex- disaggregated data is available for a specific service, the actual number of services delivered to female beneficiaries replaces the estimate described below (i.e., the estimate reached by Service Collecting data from multiplying by 50%). providers at Beneficiaries of health, nutrition, Every 6 service providers at different WHO and UNICEF and/or population services provided months different levels; GHOs UNICEF: 50% of the levels and through the project, of which female and DHOs number of nutrition TPM Reports screenings for children under 5 at the primary care level and the number of ANC1 sessions at the primary level WHO: 50% of the number of non-emergency outpatient consultations at hospitals; 50% of the number of children vaccinated (see definition of parent indicator); the number of ANC1 sessions Page 41 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) at the hospital level; 50% of the number of people receiving preventive- chemotherapy against schistosomiasis, onchocerciasis or trachoma (see definition of parent indicator). The sum of the following quantities, grouped by reporting agency. UNICEF: the number of nutrition screenings for children under 5 at the primary care level. WHO: Service Collecting data from Beneficiaries of health, nutrition, - The number of Every 6 providers at service providers at and/or population services provided WHO and UNICEF non-emergency outpatient months different different levels; GHOs through the project - of which consultations at hospitals, levels and DHOs children under 5 multiplied by an estimate of the percentage of Yemenis under 5 years (18%); - The number of children vaccinated during campaigns, calculated as follows to avoid double counting children who benefit from two or more Page 42 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) different vaccination campaigns. Only the first dose of a series (e.g., MR1, OCV1) is included. Only doses administered to children under 5 are included. Each year, in each district, only the vaccination campaign (i.e., the antigen) reaching the most children under 5 is included. The number of doses is summed across all districts. Note: This sub-indicator definition was changed at the second Additional Financing (September 2023) to improve consistency with the overall PDO indicator. It previously included admissions for acute malnutrition at TFCs and nutrition screenings for children under 5 at hospitals, multiplied by an estimate of the share of children screened at WHO facilities who are not referred to TFCs (77%). It Page 43 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) previously excluded MR1 and cholera vaccine doses. Numerator: number of beneficiaries included in the overall PDO indicator Service who received services via a Percentage of beneficiaries of health, Every 6 providers mobile team. Data from mobile teams UNICEF nutrition, and/or population services months working in Denominator: number of provided through the project - IDPs mobile teams beneficiaries included in the overall PDO indicator. The indicator measures the Aggregating data from cumulative number of Service service providers and people who benefited from providers and implementing agency improved sanitation implementing People provided with access to improved Every 6 (including M&E report). facilities that have been agency UNOPS water and sanitation services in selected months Only the highest number rehabilitated through (including urban and rural areas of beneficiaries, either operations supported by M&E report) water or sanitation, will the World Bank. Peri-urban be considered. areas will be considered as part of urban areas. The indicator measures the cumulative percentage of Service females out of the total providers and Aggregating data from People provided with access to number of people who Every 6 implementing service providers and improved water and sanitation benefited from improved UNOPS months agency implementing agency services in selected urban and rural water and sanitation (including (including M&E report). areas - female facilities that have been M&E report) constructed/rehabilitated through operations supported by the World Page 44 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) Bank. The project is expected to achieve a minimum percentage of 48% female beneficiaries. Peri-urban areas will be considered as part of urban areas. ME PDO Table SPACE Monitoring & Evaluation Plan: Intermediate Results Indicators Mapped Methodology for Data Responsibility for Data Indicator Name Definition/Description Frequency Datasource Collection Collection Number of routine outreach rounds provided by health workers who normally work at a health Every 6 GHOs and Aggregating data from UNICEF Number of outreach rounds conducted facility. 90 percent of the months DHOs GHOs and DHOs facilities are conducting outreach visits each month over 12 months. Number of primary or secondary/tertiary health UNICEF and facilities provided with Every 6 WHO supply WHO and UNICEF supply Health facilities provided with equipment WHO and UNICEF equipment and months logistics and and distribution reports and medical/non-medical supplies medical/non-medical delivery data supplies provided by the project This indicator measures the Every 6 Service Aggregating data from Pregnant women receiving antenatal care WHO and UNICEF cumulative number of months providers at service providers; during a visit to a health provider pregnant women receiving different GHOs/DHOs Page 45 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) at least one antenatal care levels visit (ANC1) to a health provider as a result of Bank-financed activities This indicator measures the UNICEF and cumulative number of Every 6 WHO reports Aggregating data from health personnel of WHO and UNICEF Health personnel receiving training months on training UNICEF and WHO different cadres receiving activities training through the project. Number of consultations GHOs, DHOs from services at primary and Ministry Aggregating data from health care facilities with a Every 6 of Social Number of people receiving mental health GHOs, DHOs, and WHO and UNICEF child friendly space; plus months Affairs and and psychosocial support MOSAL hospitals providing mental Labour health services and (MOSAL) referrals. Number of nutrition The Integrated Nutrition facility-based sentinel sites Surveillance System in Hospital and Primary Every 6 GHOs and Number of facility-based nutrition monitors and receives WHO health care integrated or months DHOs sentinel sites information from the not in maternal and child participating facilities. health service delivery platform. Women with a child 0 to 24 months of age receiving Every 6 GHOs and Aggregating data from Women receiving breastfeeding and UNICEF breastfeeding and months DHOs GHOs and DHOs complementary feeding counselling complementary feeding counselling. Cumulative number of Every 6 Service Aggregating data from WHO (UNICEF may start People receiving essential drugs for non- beneficiaries diagnosed months providers at service providers & from reporting during communicable diseases with NCD and who received different National NCD implementation once a Page 46 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) NCD drugs for at least one levels surveillance system DHIS system to collect this time during the duration of 2. data is set up) project. Conducting training in selected areas to promote Service Training on good hygiene and sanitation good hygiene/sanitation Every 6 providers and Confirming campaigns WHO, UNICEF and practices to prevent the spread of practices to prevent the months implementing and training conducted UNOPS diseases exacerbated by climate change spread of diseases agencies exacerbated by climate change The number of health Health facilities New electronic integrated disease early facilities reporting to the Every 6 GHOs and reporting to the eIDEWS WHO warning system (eIDEWS) data collection eDIEWS platform through months DHOs platform sites established immediate, weekly, and monthly reports Service Collecting data from People who have received essential Every 6 providers at service providers at WHO and UNICEF health, nutrition, and population (HNP) months different different levels; GHOs services levels and DHOs and from TPM Service Collecting data from People who have received essential Every 6 providers at service providers at health, nutrition, and population WHO and UNICEF months different different levels; GHOs (HNP) services - Female (RMS levels and DHOs requirement) Every 6 Campaign Aggregating data from a WHO and UNICEF Number of children immunized months databases campaign database Every 6 Service Aggregating data from Number of women and children who WHO and UNICEF months providers at service providers have received basic nutrition services different Page 47 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) levels Service Every 6 providers at Aggregating data from Number of deliveries attended by WHO and UNICEF months different service providers skilled health personnel levels Numerator: The total number of cured children discharged from the severe acute malnutrition (SAM) Data program. Denominator: Percentage of severe acute malnutrition collected The total number of cases cured by UNICEF children discharged from the SAM program with all outcomes (cured, defaulted, non-responded or died). Service providers and Aggregating data from Every 6 implementing service providers and People provided with access to improved UNOPS months agency implementing agency water sources (including (including M&E report) M&E report) This indicator measures the Service cumulative number of providers and Aggregating data from People provided with access to people who benefited from Every 6 implementing service providers and UNOPS improved water sources - Female improved water supply months agency implementing agency (RMS requirement) services that have been (including (including M&E report) constructed through M&E report) operations supported by Page 48 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) the World Bank. Service providers and Aggregating data from Every 6 implementing service providers and People provided with access to UNOPS months agency implementing agency improved water sources - rural (including (including M&E report) M&E report) Service providers and Aggregating data from Every 6 implementing service providers and People provided with access to UNOPS months agency implementing agency improved water sources - urban (including (including M&E report) M&E report) Service providers and Aggregating data from Every 6 implementing service providers and People provided with access to improved UNOPS months agency implementing agency sanitation services (including (including M&E report) M&E report) The indicator measures the Service cumulative number of providers and Aggregating data from people who benefited from People provided with access to Every 6 implementing service providers and improved sanitation UNOPS improved sanitation services - Female months agency implementing agency facilities that have been (RMS requirement) (including (including M&E report) constructed through M&E report) operations supported by the World Bank. People provided with access to Every 6 Service Aggregating data from UNOPS Page 49 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) improved sanitation services - rural months providers and service providers and implementing implementing agency agency (including M&E report) (including M&E report) Service providers and Aggregating data from Every 6 implementing service providers and People provided with access to UNOPS months agency implementing agency improved sanitation services - urban (including (including M&E report) M&E report) Service The first 6 providers and Aggregating data from Percentage of WASH focus groups The level of satisfaction of months of implementing service providers and attendees who were satisfied with the the participatory approach the project UNOPS agency implementing agency participatory approach in the planning by the focus groups in the implement (including (including M&E report) process of the project planning process ation M&E report) Service The first 6 Percentage of WASH focus groups The level of satisfaction of providers and Aggregating data from months of attendees who were satisfied with the the participatory approach implementing service providers and the project UNOPS participatory approach in the planning by the focus groups in the agency implementing agency implement process of the project - of which planning process, of which (including (including M&E report) ation female female M&E report) Service Aggregating data from Number of people trained from Number Staff of local Every 6 providers and service providers and government institutions to improving government institutions UNOPS months implementing implementing agency local WASH capacity at the institutional who received agency (including M&E report) level training/capacity building (including Page 50 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) M&E report) Number of schools for which the WASH facilities have been rehabilitated Service according to specific providers and Aggregating data from selection criteria and Every 6 implementing service providers and integrated planned UNOPS Schools with improved WASH facilities months agency implementing agency activities/ interventions (including (including M&E report) under the other project M&E report) subcomponents to improve the basic functionalities of target facilities and to ensure sustainability. Number of health facilities for which the WASH facilities have been Service rehabilitated according to providers and Aggregating data from specific selection criteria Every 6 implementing service providers and Health care establishments with improved and integrated planned UNOPS months agency implementing agency WASH facilities activities/ interventions (including (including M&E report) under the other project M&E report) subcomponents to improve the basic functionalities of target facilities and to ensure sustainability. Number of IDPs benefiting Service IDPs at targeted from services such as water providers, locations (including Every 6 IDPs benefiting from emergency WASH tracking, latrine local refugee camps) where UNOPS months response (rural and urban) construction, rehabilitated authorities, an the activities are wells and water d conducted and captured distribution points, and implementing Page 51 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) hygiene kits agency (including M&E report) Basic parameters (turbidity, free chlorine, PH, bacteriological presence or absence) will be performed Service directly through using Number of people who providers and potable water quality People who have access to water have access to water Every 6 implementing testing kit: chemical monitored for quality using critical source which has gone UNOPS months agency analysis of critical parameters related to cholera and water through regular water (including parameter (arsenic borne diseases testing for water borne M&E report) nitrate, fluorides, iron,) diseases as water and sanitation local corporations implementing partners to be sent to the central lab Number of water and Onsite verification sanitation facilities that will Quarterly Water and sanitation facilities using solar UNOPS/TPMA UNOPS reports power generation be using solar power generation units The indicator will estimate Onsite verification the total amount of energy reports, project generated cumulatively quarterly progress Energy generation supported through the Quarterly UNOPS/TPMA UNOPS through the various types reports, supervision Project of energy sources provided engineer's monthly under the project since progress reports and their installation. TPM reports Page 52 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) Estimation of beneficiaries based on population in catchment Monitoring area of sub-projects. and This indicator will be Evaluation measured This indicator measures the Reports.TPM disaggregating for total number of Every 6 People provided with restored access to reports. Estim gender. When UNOPS beneficiaries of water months rehabilitated water supply services ates from aggregating the number supply restoration activities local of beneficiaries across financed under the project. implementati the various project on partners. activities efforts will be made to ensure that there is no double counting. Estimation of beneficiaries based on Monitoring population who are and women in the This indicator measures the Evaluation catchment area of sub- total number of female Reports. TPM projects. People provided with restored access Every 6 beneficiaries of water reports. Estim When aggregating the UNOPS to rehabilitated water supply services months supply restoration activities ates from number of beneficiaries - female financed under the project local across the various who are women. implementati project activities efforts on partners. will be made to ensure that there is no double counting. Page 53 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) Estimation of beneficiaries based on population in catchment Monitoring area of sub-projects. and This indicator will be This indicator measures the Evaluation measured total number of Reports. TPM disaggregating for People provided with restored access Every 6 beneficiaries of water reports. Estim gender. When UNOPS to rehabilitated water supply services months supply restoration activities ates from aggregating the number - rural in rural areas financed local of beneficiaries across under the project. implementati the various project on partners. activities efforts will be made to ensure that there is no double counting. Estimation of beneficiaries based on Monitoring population in catchment and area of sub-projects. This indicator measures the Evaluation This indicator will be total number of Reports. TPM measured People provided with restored access Every 6 beneficiaries of water reports. Estim disaggregating for UNOPS to rehabilitated water supply services months supply restoration activities ates from gender. When - urban in urban areas financed local aggregating the number under the project. implementati of beneficiaries across on partners. the various project activities efforts will be made to ensure that there is no double Page 54 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) counting. Estimation of beneficiaries based on population in catchment Monitoring area of sub-projects. and This indicator will be Evaluation measured This indicator measures the Reports. TPM disaggregating for total number of Every 6 People provided with restored access to reports. gender. When UNOPS beneficiaries of sanitation months rehabilitated sanitation services Estimates aggregating the number activities financed under from local of beneficiaries across the project. implementati the various project on partners. activities efforts will be made to ensure that there is no double counting. Estimation of beneficiaries based on Monitoring population who are and women in the Evaluation This indicator measures the catchment area of sub- Reports. TPM People provided with restored access total number of female Every 6 projects. reports. UNOPS to rehabilitated sanitation services - beneficiaries of sanitation months When aggregating the Estimates female activities financed under number of beneficiaries from local the project. across the various implementati project activities efforts on partners. will be made to ensure that there is no double counting. Page 55 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) This indicator will be measured Monitoring disaggregating for and gender. When Evaluation This indicator measures the aggregating the number Reports. TPM People provided with restored access total number of Every 6 of beneficiaries across reports. UNOPS to rehabilitated sanitation services - beneficiaries of sanitation months the various project Estimates rural activities in rural areas activities efforts will be from local financed under the project. made to ensure that implementati there is no double on partners. counting This indicator will be measured Monitoring disaggregating for and gender. When Evaluation This indicator measures the aggregating the number Reports. TPM People provided with restored access total number of Every 6 of beneficiaries across reports. UNOPS to rehabilitated sanitation services - beneficiaries of sanitation months the various project Estimates urban activities in urban areas activities efforts will be from local financed under the project. made to ensure that implementati there is no double on partners. counting Local non-governmental Every 6 Agencies monitor the UNICEF UNICEF Local NGOs involved in service provision organizations hired for months engagement with NGOs project activities Page 56 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) Beneficiaries satisfied with TPM agencies Every 6 WHO, UNICEF, UNOPS Beneficiaries satisfied with services health, nutrition and WASH TPM conducting interviews months and TPM agencies provided services provided (neutral during field visits + satisfied) An action plan to follow up An action plan to follow up on the Every 6 WHO, UNICEF WHO, UNICEF and WHO, UNICEF and on the findings from findings from TPM surveys is prepared months and UNOPS UNOPS UNOPS surveys is prepared and and monitored monitored ME IO Table SPACE Page 57 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) Annex 1: Environmental and Social 1. The environmental risks and impacts of this AF2 are expected to be generated from activities to be financed under Component 1: ‘Improving Access to Healthcare, Nutrition and Public Health Services’ especially under Subcomponent 1.1 which will support some cholera preparedness and prevention activities including, but not limited to, facilitating the rapid response teams, and cholera case management as well as routine delivery of selected public health programs and immunizations. Furthermore, Subcomponent 1.4 will finance nationwide public health campaigns, including vaccination and neglected tropical diseases, to prevent disease outbreaks; and system strengthening and resilience-building measures to support the epidemiological and diagnostic laboratory capacity of the local institutions particularly the reference labs at the governorate level. The main environmental and social risks associated with such interventions are: (a) medical waste management and community health and safety issues related to transportation, handling, and disposal of vaccines, laboratory materials and tests, medical consumables and associated medical waste; and (b) OHS issues related to vaccination, laboratory testing, and handling of medical supplies. Furthermore, potential environmental and social impacts might result from supporting Component 2, particularly, Subcomponent 2.1 which will finance rehabilitation and scaling up of medium to large scale water and sanitation facilities including solarization of water supply and sanitation facilities, rehabilitation of water and sanitation infrastructure, main water and sewerage pipelines and networks, WTPs, WWTPs, water wells, pumping and booster stations. Potential environmental and social impacts of such interventions include dust emissions, debris and other solid waste generation and management, ground/surface water contamination, social annoyance and community safety due to traffic increase, blocked streets, noise, dust and unsafe construction sites as well as workers safety including OHS. Nonetheless, such risks and impacts are expected to be site-specific, reversible and of low magnitude that can be mitigated following appropriate measures. Moreover, the application of adequate occupational and community safety precautions following the World Bank Environmental, Health and Safety Guidelines is expected to be sufficient to prevent any associated impacts. 2. To address potential environmental and social risks and impacts, the ESMF of the Project has been updated under this AF2 including the Infection Prevention Control and Medical Waste Management Plan. The ESMF provides detailed procedures and measures for managing different types of medical wastes and handing medical consumables starting from distribution, use, waste collection, temporary storage, transportation, and final safe disposal. Furthermore, the ESMF includes infection control measures to limit the spread of communicable diseases during the Project’s activities. The updated ESMF also includes a section for gender and GBV action plan to address potential risk of SEA/SH in the Project implementation process, as well as requirements and measures to ensure accessibility to vaccination locations for individuals with disabilities and to address potential risks of exclusion and elite capture in service provisions under the Project. The ESMF also includes a Resettlement Framework to be developed in line with ESS5 to address any land-related impacts. 3. The LMP has been updated under this AF2 to address labor risks such as OHS risks for Project workers administering vaccines, lab tests, rehabilitation works and other interventions under the Project. Subprojects, including those that might be supported by the CERC, will be screened against environmental and social criteria that will be included in the ESMF, and subsequent site-specific environmental and social Page 58 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) instruments will be prepared, if required, during the implementation phase and before the commencement of any activities. All relevant Environmental and Social instruments have been updated and disclosed. 4. The Project activities may entail social impacts and risks. These risks are mainly related to possible inequality and discrimination practices, particularly due to gender, vulnerability, and other social and economic factors, in the provision of healthcare and nutrition services, and in the access to water supply and sanitation under the Project. There could also be risks of SEA/SH in the provision and access to Project services. Labor influx due to the Project could also lead to conflicts between nonlocal workers and host communities, discriminatory practices in employment and possible use of child labor in the Project. Learning from the COVID-19 outbreak, the spread of communicable diseases is a serious risk to stakeholders in the Project implementation process, including both Project workers as well as targeted beneficiaries. The civil works that are likely to be supported under the WASH component may impose temporary restrictions on land use, thus affecting communities and owner persons. But these restriction impacts are expected to be insignificant due to the rehabilitation and temporary nature. Page 59 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) Annex 2: Additional Details on Appraisal Summary A. Climate Change 1. Yemen is one of the most vulnerable and least ready countries in the world against climate change, ranking 174 out of 185 countries.18 Over the last 50 years, temperatures in Yemen increased by 1.8 degrees Celsius and are predicted to increase between 1.2 degrees Celsius and 3.3 degrees Celsius by 2060. Yemen emits less that 1 percent of global GHG emissions. Yemen is experiencing rising temperatures, decreasing rainfall, and increasing frequency of extreme weather events such as droughts, floods, and storms. The effects of climate change and the environmental degradation due to the conflict have further increased water scarcity, food insecurity, and displacement of people, exacerbating the ongoing humanitarian crisis in the country. Increase in temperatures is known to be a direct cause of mortality and morbidity from heat-related illnesses, such as skin cancer and heat stroke, which are forecasted to rise. 2. Extreme weather events have also degraded the land and exacerbated the impacts of climate change on land, water and food. In 2021 and 2022, severe floods wrecked many areas of the country, killing and displacing thousands of people. Frequent storms and flooding are expected to heighten the incidence of infectious diseases such as cholera, diphtheria, and dengue, which spread through water and mosquito- borne vectors. Flooding, droughts, locus infestation, and other climate-related hazards have further compounded the impact on people and country systems, underscoring their vulnerability to shocks.19 3. Water stress in the country is high and is observed to be increasing with groundwater resources likely to be depleted in the next 2-3 decades, which will lead to 40 percent agricultural output reduction and food shortages causing malnutrition among vulnerable people such as children and the elderly. Yemen’s water basins have declined and many of the country’s wells have dried up. Enormous pressure is placed on limited water resources. As the number of IDPs grows, urban pockets become increasingly congested and unsanitary conditions prevail. Suboptimal living conditions of IDPs and impoverished communities create the ideal environment for the spread of communicable diseases such as COVID-19, cholera and rotavirus. B. Climate Co-Benefits 4. Climate change adaptation and mitigation measures incorporated in the Project include: a. Capacity building on treatment and introduction of protocols for healthcare practitioners to use prevention measures to manage climate risks such as water borne diseases, and extreme weather-related disease (subcomponent 1.3). b. Support to vulnerable groups (for example people with pre-existing conditions and in sensitive life stages) to manage extreme heat or climate related diseases (subcomponent 1.1). 18Notre Dame Global Adaptation Index : Rankings // Notre Dame Global Adaptation Initiative // University of Notre Dame (nd.edu) Page 60 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) c. Disaster risk management/response to ensure beneficiaries' access to health and nutrition services in case of extreme weather events or other climate induced disruptions to health service delivery (subcomponent 1.4). d. Strengthened nutrition and supply chain systems and deployment of mobile teams to climate-vulnerable areas to support vulnerable groups (subcomponent 1.2). e. Raising awareness of beneficiaries and health practitioners on WASH and nutrition practices to manage climate risks such as water-borne diseases, extreme precipitation, and extreme weather-related disease (subcomponents 2.2 and 2.3). f. Use of fuel monitoring devices in hospitals to improve fuel efficiency and/or increase transparency on GHG emissions. This activity is aligned with the Joint MDB List of Eligible Mitigation Activities (under 12.8 Systems or transparency tools for monitoring GHG emissions). (Subcomponent 1.3). g. Monitoring climate-sensitive diseases and increasing disease surveillance capacity through eIDEWS, updated seasonal mapping, forecasting and conducting preventive campaigns, enhanced preparedness to respond to health and nutrition impacts of acute climate events. (Subcomponent 1.5) h. Strengthening the health information system with the intention to foresee expected health needs arising from climate change. (Subcomponent 1.5) i. Improving medical waste management and Infection Prevention & Control (IPC) capacity in health facilities to ensure proper hygiene practices and treatment of medical equipment, protective gear, and other medical waste, especially in flood-prone areas. UNICEF has budgeted US$100,000 in training of health workers on medical waste management and up to US$100,000 in maintenance of incinerators for proper waste management through limiting harmful emission into the environment. (Component 1). j. Mitigation co-benefits may be expected as cold store will be explored to ensure steady access to electricity and minimize the use of fuel; and technical trainings (including integrated management of childhood illnesses) will continue to manage diarrheal diseases, fevers and respiratory infections which are exacerbated by increased pollution, floods and drought. (Subcomponents 1.1 and 1.3) 5. Under WASH activities (Component 2), the Project is supporting rehabilitation and scaling up of water supply infrastructure and improving water efficiency and resource, a mitigation activity on the universally aligned list. Climate change adaptation and mitigation measures are considered as part of the technical design of the rehabilitation activities. For example, rehabilitation of the existing wells is only considered after ensuring the sustainability of water source. Similarly, the impact of climate induced water scarcity, drought and floods are considered through ensuring resilient climate design of all rehabilitation activities. The activities under the AF2 complement water mitigation and adaptation measures that are being implemented under the OF and AF1. Such activities include: Page 61 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) a. Bespoke training on rehabilitation and construction of rainwater systems (Subcomponent 2.3). b. Rehabilitation of water sources to access safe drinking water (subcomponent 2.1). c. Rehabilitation of sewage networks and WWTPs, and the inclusion of solar photovoltaic solutions to WASH facility rehabilitation activities (subcomponent 2.1). d. Training on emergency response to improve access to safe water and basic sanitation at the health facilities and for service continuity, during sudden-onset or protracted natural disasters, in areas where climate change is expected based on disaster risk planning to affect water availability (subcomponent 2.3). e. The Project will continue to implement exit strategies from water trucking building on the exit strategies developed by UNICEF and WHO under the closed EHNP and will ensure implementation of these exit strategies under the AF2 (subcomponent 2.2). 6. The Project is supporting a transition from use of fuel (already started under AF1) and reducing dependency on fuel support to health facilities by increasing use of renewable sources and strengthening systems for water supply (under subcomponent 2.2). The fuel exit strategies that are being implemented align with the Joint MDB List of Eligible Mitigation Activities (under 9.1 Energy efficiency, on-site renewable energy, CO2 emission reduction, and carbon sinks in buildings). The Project is providing fuel support only when necessary for preserving essential services and when no other feasible alternatives are available. On mitigation, solar energy solutions (financed under the EHCP and AF1) to support water and sanitation infrastructure are being introduced to support a transition from fuel use for health and water supply and sanitation facilities. Page 62 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) Annex 3: Detailed Financial Management Arrangements 1. The Project’s Financial Management (FM) arrangements will be governed by the Financial Management Framework Agreement (FMFA) between the World Bank and the UN Agencies, which provides for the use of the UN Financial Regulations and Rules. No changes to the FM arrangements are foreseen for this AF2. The FM risk is High. 2. UNICEF, UNOPS and WHO (recipients for the Benefit of the Republic of Yemen) will maintain separate accounts for the Project and ensure that original supporting documents of expenditures are retained. The Project will use Interim Unaudited Financial Reports (IFRs) for disbursements and will submit the reports to the Bank as stated in the Disbursement and Financial Information Letters (DFILs). Funds will flow from the Bank to the recipients’ corporate accounts before flowing to their local bank account or the bank accounts of their implementing partners and onward to the ultimate recipients/beneficiaries. The Project will follow the audit arrangements agreed between the Bank and UN agencies as per the FMFA. In case the Association and the Recipient agree that additional due diligence measures are needed, the Recipients shall ensure that any additional due diligence measures of its Respective Part of the Project are carried out exclusively in accordance with its Financial Regulations and Rules, and in conformity with the single audit principle observed by the UN system. 3. Accounting and financial reporting: The recipients will: (i) maintain an FM system, including records and accounts, adequate to reflect the transactions related to the activities, in accordance with the requirements of the UN Financial Regulations and Rules; (ii) maintain a separate ledger account (Grant Control Account) in their books to record the financial transactions of this Project; and (iii) prepare unaudited IFRs, in accordance with the DFIL and the accounting standards established pursuant to the UN Financial Regulations and in the format agreed with the World Bank during negotiation of this Project, adequate to reflect the expenditures related to the Project. 4. Internal controls: To ensure proper controls are applied over the use of funds, the recipients (UNICEF following their HACT approach and WHO and UNOPS following their alternative measures) will ensure the following: a. The finance teams located in the field is comprised of sufficient qualified staff to review and properly maintain (and cause to be maintained) all original supporting documents of the Project. The finance team will also ensure that proper controls are in place over the use of funds and that payments are made for eligible expenditures with consideration to economy and efficiency. b. The compliance team or its equivalent will assist their finance teams to ensure arrangements are in place for funds to reach the legitimate beneficiaries. c. Finance and compliance (or its equivalent) teams will ensure proper controls are in place for management and recording of inventory. In addition, they will ensure that proper measures are in place to prevent double-dipping of activities. d. Adequate financial and technical reviews are conducted regularly by the TPMAs and recipients’ finance and/or M&E teams. Page 63 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) e. Where applicable, the TOR of the financial TPMA20 will include the review of funds transfers by implementing partners to monitor the use of market exchange rate. f. In case of payments to individuals in return for goods or services rendered, recipients will use mobile banking (where feasible), payment agencies or other methods available in the country that can provide a high level of assurance that funds reached the intended beneficiaries. g. Recipients will ensure that IFRs are properly reviewed and approved before submission to the World Bank. In addition, IFRs reported expenditures will include no advances other than those agreed with the World Bank and disclosed in the IFR. h. Adequate controls over the use of DFC and DCT modalities which will include the following items agreed with the World Bank. ii. Replacing the reliance on such modalities, as deemed appropriate, with the direct disbursement and reimbursement modalities. iii. Limiting the use of such modalities to 30 percent of the total financing provided to each recipient. i. An initial financial assessment of implementing partners will be carried out to assess the FM arrangements of the potential implementing partner under the DFC/DCT modalities. Based on the assessment results and the risk rating provided through the assessment, recipients will decide on whether the IP maintains the required level of FM arrangements to receive funds through such modality. j. Implementing partners that will receive more than a threshold as agreed with each agency in one financial year will be subject to financial review21. k. WHO, UNICEF and UNOPS will maintain systems in place to timely follow up and address findings of financial reviews of implementing partners. WB UN AGENCY IPs THROUGH DIRECT DISBURSEMENT METHODS ULTIMATE BENEFICIARY 20 Financial TPMA is a third-party entity engaged by the recipient agencies to support financial monitoring, risk management, and internal control. 21 Financial TPM, and other assurance mechanisms such as audit. Page 64 of 65 The World Bank Second Additional Financing Yemen Emergency Human Capital Project (P181317) 5. Flow of funds: The Project will use the IFR method for the flow of funds to WHO, UNICEF and UNOPS. The form and substance of the IFR reports will be agreed during negotiation. For this Project, recipients will use the Direct Implementation modality as much as possible, to mitigate any risk associated with advances to implementing partners, by which funds will flow from the World Bank to their corporate accounts and then to the ultimate beneficiaries/recipients without going through intermediary accounts. 6. Funds will flow from the World Bank to the UN agencies corporate accounts. Transfer from the UN corporate accounts to UNICEF, WHO and UNOPS in Yemen will be based on semi-annual forecasts. UN agencies disburse in USD and the implementing partners obtain market rates based on the Yemeni association for money exchangers. Implementing partners follow the market rates and ensure that the commercial banks they are dealing with apply the same rate. a. Use of advances to implementing partners should be limited. In cases when advances are used, recipients (the UN agencies) will ensure proper controls are in place, such as: (i) the advances will not exceed certain thresholds; (ii) no new advances are released to implementing agencies unless previous advances are fully settled (in cases of partial settlement, additional funds can be provided within the limit of the partial settlements made); (iii) all supporting documents for expenditures incurred under the Project are maintained; and (iv) all advances have proper audit trails. b. Recipients (the UN agencies) will exert all efforts to ensure that funds reach the ultimate beneficiaries with sufficient evidence provided. This includes ensuring that no funds are transferred to the central government or personal accounts of individuals unless those individuals are the legitimate recipients of cash for work or services rendered. c. Audit: The Recipient shall ensure that the audit of its Respective Part of the Project is carried out exclusively by its Financial Regulations and Rules. In addition, as agreed by the Recipient and the Association, the Recipient shall carry out any additional due diligence activities as agreed by the Recipient and the Association in separate terms of reference. 7. Implementation Support Plan: The World Bank will carry out semi-annual implementation support of Project activities. This will include a desk review of financial TPM reports, as applicable, provided by the recipients. In addition, reviewing samples of expenditures and control procedures may apply, only if both the World Bank and the implementing agency(ies) agree. Such review will not imply access to Recipient books and records, except if agreed, and will be compliant with the UN Single Audit Principle. Page 65 of 65