LOAN NUMBER 9541-AR Loan Agreement (Strengthening The Digital Health Agenda in the Province of Buenos Aires Project) between PROVINCE OF BUENOS AIRES and INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT LOAN AGREEMENT AGREEMENT dated as of the Signature Date between INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT ("Bank") and the PROVINCE OF BUENOS AIRES ("Borrower"). The Borrower and the Bank hereby agree as follows: ARTICLE I - GENERAL CONDITIONS; DEFINITIONS 1.01. The General Conditions (as defined in the Appendix to this Agreement) apply to and form part of this Agreement. 1.02. Unless the context requires otherwise, the capitalized terms used in this Agreement have the meanings ascribed to them in the General Conditions or the Appendix to this Agreement. ARTICLE H - LOAN 2.01. The Bank agrees to lend the Borrower the amount of fifty million Dollars (US$50,000,000), as such amount may be converted from time to time through a Currency Conversion ("Loan"), to assist in financing the project described in Schedule 1 to this Agreement ("Project"). 2.02. The Borrower may withdraw the proceeds of the Loan in accordance with Section III of Schedule 2 to this Agreement. The Borrower's Representatives for purposes of taking any action required or permitted to be taken pursuant to this Section are its Minister of Treasury and Finance, its Undersecretary of Finance, or its Provincial Director of Multilateral Organisms and Bilateral Financing. 2.03. The Front-end Fee is one quarter of one percent (0.25%) of the Loan amount. 2.04. The Commitment Charge is one quarter of one percent (0.25%) per annum on the Unwithdrawn Loan Balance. 2.05. The interest rate is the Reference Rate plus the Variable Spread or such rate as may apply following a Conversion, subject to Section 3.02(e) of the General Conditions. 2.06. The Payment Dates are April 15 and October 15 in each year. 2.07. The principal amount of the Loan shall be repaid in accordance with Schedule 3 of this Agreement. ARTICLE III - PROJECT 3.01. The Borrower declares its commitment to the objectives of the Project. To this end, the Borrower shall carry out the Project through PDMOBF, in coordination with the PMOH, all in accordance with the provisions of Article V of the General Conditions and Schedule 2 to this Agreement. 1 ARTICLE IV - EFFECTIVENESS 4.01. The Additional Condition of Effectiveness consists of the following: the Borrower, through PDMOBF, has adopted the Project Operational Manual (POM) in form and substance acceptable to the Bank. 4.02. The Effectiveness Deadline is the date ninety (90) days after the Signature Date. ARTICLE V - REPRESENTATIVE; ADDRESSES 5.01. Except as provided in Section 2.02 of this Agreement and in the ESCP, the Borrower's Representative is its Minister of Treasury and Finance. 5.02. For purposes of Section 10.01 of the General Conditions: (a) the Borrower's address is: Calle 8 entre 45 y 46 B1900TGR, La Plata Province of Buenos Aires Argentine Republic; and (b) the Borrower's Electronic Address is: E-mail: finanzas.dpornAec.gba.gov.ar Facsimile: (+54) 221 429 4503 / 4489 5.03 For purposes of Section 10.01 of the General Conditions: (a) the Bank's address is: International Bank for Reconstruction and Development 1818 H Street, N.W. Washington, D.C. 20433 United States of America; and (b) the Bank's Electronic Address is: Telex: Facsimile: E-mail: 248423(MCI) or 1-202-477-6391 mfav@worldbank.org 64145(MCI) 2 AGREED as of the Signature Date. PROVINCE OF BUENOS AIRES By Authorized Representative Name: Tile: 7 Date: 22 Ve3 INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT By Authorized Representative Name:Q2wGi(t Title:Ž g\ x G Date: C - 3 SCHEDULE 1 Project Description The objective of the Project is to increase access to health services and improve coordination and continuity of care in the public healthcare network of the Province of Buenos Aires. The Project consists of the following parts: Part 1. Strengthening the implementation of Electronic Medical Records (EMRs/Integrated Health Records (IRs) 1.1. Adopting IHR in public health facilities of municipalities and provincial hospitals Provision of support to expand the utilization of IHR in provincial hospitals and primary health care facilities of Participating Municipalities, including providing energy-efficient ICT infrastructure, connectivity in provincial hospitals, and training on the use of IHR and change management process. 1.2. Promoting interoperability across health information systems of municipalities Provision of support to promote interoperability across health information systems Participating Municipalities with their own EMRs or that have a software service agreement, subject to the conditions set forth in Section I.C.2 of Schedule 2 to this Agreement, including developing a normative framework and providing technical solutions to ensure the adoption of information system's quality and interoperability standards. 1.3. Expanding IHRfunctionalities Provision of support to expand IHR's functionalities with the development of new modules to integrate different health services and care levels, including providing technical assistance to: (a) integrate IHR with radiology information systems, laboratory information systems, and pharmacy; (b) organize a two-way digital referral system, and its integration with the appointment booking system; (c) develop a clinical decision support system for health facilities; and (d) develop a data visualization tool showing key performance indicators, consolidating, and organizing them on a single screen. Part 2. Developing and implementing virtual tools for health provision and communication 2.1. Enabling a chatbot and implementing a virtual healthcare center Provision of support to develop a telemedicine solution, including: (a) enabling a chatbot within the Borrower's citizen web portal to provide information and guidance to citizens on prioritized lines of care; (b) implementing a virtual healthcare center; and (c) developing and adapting existing software, clinical protocols, and patient pathways to the healthcare service delivery models developed under this Part 2. 4 2.2. Implementing a virtual network ofPHC facilities with hospital specialists Provision of support to implement a virtual network of primary health care facilities with hospital specialists in selected pilot localities, including strengthening the network of telemedicine consultations in primary health care facilities, providing training on the use of telemedicine, adapting software for consultations between health professionals, and financing the costs of health specialists. Part 3. Project manapement Provision of administrative and operational support for the administration, monitoring and evaluation, coordination, and supervision of the Project's activities, including environmental and social management and audit financial aspects, and carrying out Project strategic evaluation activities in coordination with the National Ministry of Economy through the Undersecretariat of International Financial Relations for Development, as responsible for technical-methodological advice. 5 SCHEDULE 2 Project Execution Section I. Implementation Arrangements A. Institutional Arrangements The Borrower, through PDMOBF, shall: (a) operate and maintain, throughout Project implementation, a Project management team with functions and responsibilities acceptable to the Bank, including, but not limited to: (i) procurement, financial management, and disbursement functions for the Project; (ii) environmental and risk management responsibilities; and (iii) technical, environmental, and social implementation in coordination with PMOH; and (b) staff said team with a coordinator, technical experts, and other personnel, all in number and with qualifications acceptable to the Bank. B. Project Operational Manual 1. The Borrower shall carry out the Project in accordance with the provisions of the Project Operational Manual ("POM"), acceptable to the Bank, which shall include, inter alia: (a) the detailed description of all Project implementation activities, their sequencing and prospective timetable and benchmark in relation thereto; (b) the institutional arrangements for the Project, including the roles and responsibilities of PDMOBF and PMOH; (c) the Project's administrative, financial, accounting, auditing, procurement, and disbursement procedures; (d) the procedures for the monitoring, evaluation, and reporting of the Project; (e) the eligibility criteria and the detailed procedures for the selection of the Participating Municipalities, including the model forms of the Addendum Participation Agreements and the Participation Agreements; and (f) Personal Data collection and processing in accordance with applicable national law and good international practice. 2. In case of any conflict between the terms of the POM and those of this Agreement, the terms of this Agreement shall prevail. C. Addendum Participation Agreements and Participation Agreements 1I For purposes of implementing Part 1.1 of the Project, the Borrower, through PMOH, shall enter into an Addendum Participation Agreement to the existing Framework Agreement with each Participating Municipality under terms and conditions acceptable to the Bank, which shall consist of, inter alia, the obligation of each of the Participating Municipalities referred to under Part 1.1 of the Project: (a) to establish, or assign to, and after that maintain a team responsible for implementation of the activities defined in such Addendum Participation Agreement; (b) to comply with the technical requirements set forth in the applicable environmental and social instruments, assuming the obligations derived from those, in accordance with their terms and those of this Agreement, the ESCP, and the POM, as applicable; (c) to comply with Project indicators; and (d) to take or permit to be taken all actions to enable the Borrower to comply with its obligations referred to in this Agreement, 6 2. For purposes of implementing Part 1.2 of the Project, and prior to adding to the Project any of the municipalities referred to in Part 1.2. of the Project, the Borrower, through PMOH, shall carry out adequate assessments which shall conclude that the electronic medical records and the data storage strategies of each of those municipalities comply with the technical requirements, quality and national cybersecurity standards set forth in the POM. After concluding such assessments in a satisfactory manner, the Borrower, through PMOH, shall enter into a Participation Agreement with each Participating Municipality under terms and conditions acceptable to the Bank, including those provisions set forth in the POM and the ESCP. 3. The Borrower, through PMOH, shall exercise its rights and carry out its obligations under each Addendum Participation Agreement and Participation Agreement, as applicable, in such a manner as to protect the interest of the Borrower and the Bank and to accomplish the purposes of the Loan. Except as the Bank shall otherwise agree, the Borrower, through PMOH, shall not assign, amend, terminate, abrogate, waive, or fail to enforce any Addendum Participation Agreement and/or Participation Agreement, or any provision thereof, that affects Project implementation. D. Environmental and Social Standards 1. The Borrower shall ensure that the Project is carried out in accordance with the Environmental and Social Standards in a manner acceptable to the Bank 2. Without limitation upon paragraph I above, the Borrower shall ensure that the Project is implemented in accordance with the Environmental and Social Commitment Plan ("ESCP") in a manner acceptable to the Bank. To this end, the Borrower shall ensure that: (a) the measures and actions specified in the ESCP are implemented with due diligence and efficiency, as provided in the ESCP; (b) sufficient funds are available to cover the costs of implementing the ESCP; (c) policies and procedures are maintained, and qualified and experienced staff in adequate numbers are retained to implement the ESCP, as provided in the ESCP; and (d) the ESCP, or any provision thereof, is not amended, repealed, suspended, or waived, except as the Bank shall otherwise agree in writing, as specified in the ESCP, and ensure that the revised ESCP is disclosed promptly thereafter. 3. In case of any inconsistencies between the ESCP and the provisions of this Agreement, the provisions of this Agreement shall prevail. 4. The Borrower shall ensure that: (a) all measures necessary are taken to collect, compile, and furnish to the Bank through regular reports, with the frequency specified in the ESCP, and promptly in a separate report or reports, if so requested by the Bank, information on the 7 status of compliance with the ESCP and the environmental and social instruments referred to therein, all such reports in form and substance acceptable to the Bank, setting out, including but not limited to: (i) the status of implementation of the ESCP; (ii) conditions, if any, which interfere or threaten to interfere with the implementation of the ESCP; and (iii) corrective and preventive measures taken or required to be taken to address such conditions; and (b) the Bank is promptly notified of any incident or accident related to or having an impact on the Project which has, or is likely to have, a significant adverse effect on the environment, the affected communities, the public, or workers, in accordance with the ESCP, the environmental and social instruments referenced therein and the Environmental and Social Standards. 5. The Borrower shall establish, publicize, maintain, and operate an accessible grievance mechanism to receive and facilitate the resolution of concerns and grievances of Project- affected people and take all measures necessary and appropriate to resolve or facilitate the resolution of such concerns and grievances in a manner acceptable to the Bank. Section II. Project Monitoring Reporting and Evaluation The Borrower shall furnish to the Bank each Project Report by not later than forty-five (45) days after the end of each calendar semester covering the calendar semester. Section II. Withdrawal of Loan Proceeds A. General Without limitation upon the provisions of Article II of the General Conditions and in accordance with the Disbursement and Financial Information Letter ("DFIL"), the Borrower may withdraw the proceeds of the Loan to: (a) finance Eligible Expenditures; (b) pay: (i) the Front-end Fee; and (ii) each Interest Rate Cap or Interest Rate Collar premium; in the amount allocated and, if applicable, up to the percentage set forth against each Category of the following table: Category Amount of the Loan Percentage of Expenditures to Allocated be financed (expressed in USD) (inclusive of Taxes, except for fees levied from financial transactions) (1) Goods, Minor Civil 49,875,000 100% Works, consulting services, non-consulting services, Training Costs, and Operating Costs under the Project 8 (2) Front-end Fee 125,000 Amount payable pursuant to Section 2.03 of this Agreement in accordance with Section 2.07 (b) of the General Conditions (3) Interest Rate Cap or 0 Amount due pursuant to Section Interest Rate Collar premium 4.05 (c) of the General Conditions TOTAL AMOUNT 50,000,000 B. Withdrawal Conditions; Withdrawal Period 1. Notwithstanding the provisions of Part A above, no withdrawal shall be made for payments made prior to the Signature Date, except those withdrawals up to an aggregate amount not to exceed US$10,000,000 may be made for payments made twelve (12) months prior to the Signature Date, for Eligible Expenditures. 2. The Closing Date is April 30, 2027, 9 SCHEDULE 3 Disbursement-Linked Amortization Repayment Schedule - Level Repayment 1. Subject to the provisions of Section 3.03 of the General Conditions, the Borrower shall repay each Disbursed Amount in semiannual installments payable on each April 15 and October 15, the first installment to be payable on the thirteenth (13"') Payment Date following the Maturity Fixing Date for the Disbursed Amount and the last installment to be payable on the sixtieth- (60*i) Payment Date following the Maturity Fixing Date for the Disbursed Amount. Each installment except for the last one shall be equal to one-forty eighth (1/48) of the Disbursed Amount. The last installment shall be equal to the remaining outstanding amount of the Disbursed Amount. 2. If any one or more installments of principal of the Disbursed Amount would, pursuant to the provisions of paragraph 1 of this Schedule, be payable after October 15, 2056, the Borrower shall also pay on such date the aggregate amount of all such installments. 3. The Bank shall notify the Loan Parties of the amortization schedule for each Disbursed Amount promptly after the Maturity Fixing Date for the Disbursed Amount. 10 APPENDIX Definitions 1. "Addendum Participation Agreement" means any of the agreements referred to in Section I.C. 1 of Schedule 2 to this Agreement; and "Addendum Participation Agreements" means more than one Addendum Participation Agreement. 2. "Anti-Corruption Guidelines" means, for purposes of paragraph 6 of the Appendix to the General Conditions, the "Guidelines on Preventing and Combating Fraud and Corruption in Projects Financed by IBRD Loans and IDA Credits and Grants", dated October 15, 2006, and revised in January 2011 and as of July 1, 2016. 3. "Category" means a category set forth in the table in Section III.A of Schedule 2 to this Agreement. 4. "DFL" means the Disbursement and Financial Information Letter referred to in Section llI.A of Schedule 2 to this Agreement. 5. "EMRs" means electronic medical records. 6. "Environmental and Social Commitment Plan" or the acronym "ESCP" means the environmental and social commitment plan for the Project, dated May 3, 2023, as the same may be amended from time to time in accordance with the provisions thereof, which sets out the material measures and actions that the Borrower shall carry out or cause to be carried out to address the potential environmental and social risks and impacts of the Project, including the timeframes of the actions and measures, institutional, staffing, training, monitoring, and reporting arrangements, and any environmental and social instruments to be prepared thereunder. 7. "Environmental and Social Standards" or "ESSs" means, collectively: (i) "Environmental and Social Standard 1: Assessment and Management of Environmental and Social Risks and Impacts"; (ii) "Environmental and Social Standard 2: Labor and Working Conditions"; (iii) "Environmental and Social Standard 3: Resource Efficiency and Pollution Prevention and Management"; (iv) "Environmental and Social Standard 4: Community Health and Safety"; (v) "Environmental and Social Standard 5: Land Acquisition, Restrictions on Land Use and Involuntary Resettlement"; (vi) "Environmental and Social Standard 6: Biodiversity Conservation and Sustainable Management of Living Natural Resources"; (vii) "Environmental and Social Standard 7: Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities"; (viii) "Environmental and Social Standard 8: Cultural Heritage"; (ix) "Environmental and Social Standard 9: Financial Intermediaries"; (x) "Environmental and Social Standard 10: Stakeholder Engagement and Information Disclosure"; effective on October 1, 2018, as published by the Bank. 8, "Framework Agreement" means the agreement entered into between the PMOH and the municipalities for the establishment of a cooperation framework for the progressive implementation of the HIS. 11 9. "General Conditions" means the "International Bank for Reconstruction and Development General Conditions for IBRD Financing, Investment Project Financing" dated December 14, 2018 (revised on August 1, 2020, December 21, 2020, April 1, 2021, and January 1, 2022). 10. "ICT" means information and communication technology. 11. "IHR" means Historia de Salud Integral, the integrated health record system developed by the National Ministry of Health of the Argentine Republic jointly with the Nacional del Centro University from the Province of Buenos Aires, which stores all of an individual's procedural information and health records in a digital format. 12. "Minor Civil Works" means the refurbishing and/or the installation of network adaptations of small complexity and with minimum environmental and social risks and impacts. 13. "MOTF" means the Borrower's Ministry of Treasury and Finance, Ministerio de Hacienda y Finanzas, or any successor thereto acceptable to the Bank. 14. "Operating Costs" means the reasonable incremental recurrent expenditures that would not have been incurred by the Borrower absent the Project, for Project administration costs (including office rent), operation and maintenance of office equipment, banking fees, non- durable goods, and salaries of civil servants assigned to carry out administrative responsibilities under the Project. 15. "Participation Agreement" means any of the agreements referred to in Section I.C.2 of Schedule 2 to this Agreement; and "Participation Agreements" means more than one Participation Agreement. 16. "PDMOBF" means the Direcci6n Provincial de Organismos Multilaterales y Financiamiento Bilateral, the Borrower's Provincial Directorate of Multilateral Organizations and Bilateral Financing under MOTF, or any successor thereto acceptable to the Bank. 17. "Personal Data" means any information relating to an identified or identifiable individual. An identifiable individual is one who can be identified by reasonable means, directly or indirectly, by reference to an attribute or combination of attributes within the data or a combination of the data with other available information. Attributes that can be used to identify an identifiable individual include, but are not limited to, name, identification, number, location data, online identifier, metadata, and factors specific to the physical, physiological, genetic, mental, economic, cultural, or social identity of an individual. 18. "PMOH" means the Borrower's Provincial Ministry of Health or any successor thereto acceptable to the Bank. 19. "Procurement Regulations" means, for purposes of paragraph 84 of the Appendix to the General Conditions, the "World Bank Procurement Regulations for IPF Borrowers", dated November 2020. 12 20. "Project Operational Manual" or "POM" means the manual referred to in Section LB of Schedule 2 to this Agreement, as the same may be amended from time to time with the prior written approval of the Bank. 21. "Participating Municipality" means: (a) any of the Borrower's municipalities, which has met the eligibility criteria set forth in the POM to be supported under Part 1.1 of the Project; and/or (b) any of (5) Borrower's municipalities, which has met the eligibility criteria set forth in the POM to be supported under Part 1.2 of the Project; and "Selected Municipalities" means more than one Selected Municipality. 22. "Signature Date" means the later of the two dates on which the Borrower and the Bank signed this Agreement, and such definition applies to all references to "the date of the Loan Agreement" in the General Conditions. 23. "Training Costs" means the expenditures (other than those for consulting services) incurred by the Borrower to finance reasonable transportation costs and per-diem of trainees and trainers, training registration fees, training materials, and rental of training facilities and equipment for the purposes of, and directly related to, the activities described in the Project. 13