The World Bank Transforming Egypt's Healthcare System Project (P167000) REPORT NO.: RES50000 DOCUMENT OF THE WORLD BANK RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF TRANSFORMING EGYPT'S HEALTHCARE SYSTEM PROJECT APPROVED ON JUNE 27, 2018 TO MINISTRY OF INVESTMENT AND INTERNATIONAL COOPERATION HEALTH, NUTRITION & POPULATION MIDDLE EAST AND NORTH AFRICA Regional Vice President: Ferid Belhaj Country Director: Stephane Guimbert Regional Director: Fadia M. Saadah Practice Manager/Manager: Michele Gragnolati Task Team Leader(s): Avril Dawn Kaplan The World Bank Transforming Egypt's Healthcare System Project (P167000) I. BASIC DATA Product Information Project ID Financing Instrument P167000 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 27-Jun-2018 31-Dec-2023 Organizations Borrower Responsible Agency Ministry of Investment and International Cooperation Ministry of Health and Population Project Development Objective (PDO) Original PDO The proposed Project Development Objective is to (i) improve the quality of primary and secondary health care services, (ii) enhance demand for health and family planning services, and (iii) support the prevention and control of Hepatitis C. Current PDO The proposed Project Development Objective is to (i) improve the quality of primary and secondary health care services, (ii) enhance demand for health and family planning services, (iii) support the prevention and control of Hepatitis C, and (iv) to provide immediate and effective response to an eligible crisis or emergency. Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IBRD-88950 27-Jun-2018 10-Jul-2018 07-Sep-2018 31-Dec-2023 530.00 323.76 206.24 The World Bank Transforming Egypt's Healthcare System Project (P167000) Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No II. SUMMARY OF PROJECT STATUS AND PROPOSED CHANGES This restructuring paper seeks to extend the closing date of Loan No. 8895-EG: Transforming Egypt’s Healthcare System Project (TEHSP), which was approved on June 27, 2018 and became effective on September 7, 2018. The request for a two-year extension from December 31, 2023 to December 31, 2025 is the second restructuring of the loan and first extension of the loan closing date. The Project responds to the Ministry of Health and Population's (MOHP) healthcare sector reform agenda within the framework of Egypt’s Vision 2030, the National Plan of Action for Elimination of Viral Hepatitis 2017, and the Universal Health Insurance Law (No.2/2018). The Project Development Objectives (PDOs) are to (i) improve the quality of primary and secondary health care services, (ii) enhance demand for health and family planning services, (iii) support the prevention and control of Hepatitis C, and (iv) to provide immediate and effective response to an eligible crisis or emergency. It uses the Investment Project Financing (IPF) with Performance Based Conditions (PBCs) modality. The Project has five components: i) Strengthen Primary Healthcare, Family Planning and Community Activities, ii) Strengthen Secondary Level Care, iii) Institutional Capacity Building and Project Management, iv) Early COVID-19 Response; and v) Contingent Emergency Response Category (CERC). The Project was restructured in April 2021 to record the activation of the CERC in response to the COVID-19 pandemic, reallocate funds among disbursement categories, revise PBCs and make changes to procurement arrangements. During its first two years, the Project supported the government's 100 Million Healthy Lives campaign, which resulted in nearly 50 million people being screened for Hepatitis C and over one million receiving Hepatitis C treatment. The Project has improved the quality of care in 500 primary healthcare centers and has invested in multiple initiatives – including the National Community Health Worker Campaign, the Al Wissam Initiative, and the Visiting Doctors Program – that have contributed to increasing contraceptive prevalence from 58 percent in 2018 to 66 percent in 2022 in target regions. After these initial successes, implementation has now slowed. Component 2, which aims to strengthen secondary level care, requires substantial procurement of medical equipment. The government's requirement for the Unified Procurement Agency to start handling all medical procurement (rather than the Ministry of Health and Population) and the foreign currency crunch have led to delays in procurement. In addition, there were major cost savings in Hepatitis C treatment, as the Project was successfully in working with the government and pharmaceutical sector to decrease the price of treatment. The Project has therefore disbursed only US$17 million over the past two years and 39 percent of loan funds are undisbursed. Achievement towards the PDO and Implementation Progress are rated Moderately Satisfactory, as are Procurement and Financial Management, as well as Environmental and Social Safeguards. All PDO indicators are on track to be achieved, except for one, that is linked to the national blood bank network. The World Bank Transforming Egypt's Healthcare System Project (P167000) The proposed extension is needed to enable Project activities to be completed and to have a greater impact for beneficiaries. It will enable MOHP to extend open contracts, which are set to close on September 30, 2023. A larger technical restructuring is also being prepared, which will integrate co-financing from the French Development Agency (Agence Fraincais de Developpement - AFD) to support quality improvement at primary health centers, including continuous improvement in infection prevention control. The proposed extended loan closing date will align with the closing date of AFD’s co-financing. The Project objectives continue to be achievable; the performance of the Borrower is satisfactory; an updated procurement plan, which has been reviewed by the Bank and is considered realistic, has been developed to complete the Project within the revised closing date; there are no outstanding audit reports (or unresolved audit observations) as well as outstanding Interim Financial Reports; there are no open INT investigations related to the sector or Project; and no contract has been awarded to or is in the process of being awarded to a debarred firm(s). III. DETAILED CHANGES LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications IBRD-88950 Effective 31-Dec-2023 31-Dec-2025 30-Apr-2026