The World Bank Mozambique Primary Health Care Strengthening Program (P163541) FOR OFFICIAL USE ONLY Report No: RES50186 INTERNATIONAL DEVELOPMENT ASSOCIATION RESTRUCTURING PAPER ON A PROPOSED PROGRAM RESTRUCTURING OF MOZAMBIQUE PRIMARY HEALTH CARE STRENGTHENING PROGRAM APPROVED ON DECEMBER 20, 2017 TO THE REPUBLIC OF MOZAMBIQUE Health, Nutrition and Population Global Practice Eastern and Southern Africa Region The World Bank Mozambique Primary Health Care Strengthening Program (P163541) CURRENCY EQUIVALENTS (Exchange Rate Effective April 1, 2022) Currency Unit = New Mozambique Metical MZN 64.1 = US$1 US$1.3824 = SDR 1 FISCAL YEAR January 1 - December 31 The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DATA SHEET (Mozambique Primary Health Care Strengthening Program - P163541) BASIC DATA Project ID Financing Instrument IPF Component P163541 Program-for-Results Financing No Approval Date Current Closing Date 20-Dec-2017 31-Dec-2023 Organizations Borrower Responsible Agency Ministry of Economy and Finance Ministry of Health Program Development Objective(s) The Program Development Objective is to improve the utilization and quality of reproductive, maternal, child and adolescent health and nutrition services, particularly in underserved areas. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Approval Effectiveness Closing Ln/Cr/TF Signing Date Commitment Disbursed Undisbursed Date Date Date IDA-D2650 20-Dec-2017 02-Mar-2018 18-Apr-2018 31-Dec-2022 80.00 61.19 18.61 21-May- TF-B4481 21-May-2021 21-May-2021 31-Dec-2023 3.00 1.44 1.56 2021 TF-B3368 01-Oct-2020 16-Oct-2020 16-Oct-2020 31-Dec-2023 7.00 5.61 1.39 TF-A9398 28-Feb-2019 21-Mar-2019 21-Mar-2019 31-Dec-2023 44.95 32.65 12.30 TF-A6152 20-Dec-2017 02-Mar-2018 18-Apr-2018 31-Dec-2023 25.00 14.45 10.55 Policy Waiver(s) Does the Program require any waivers of Bank policies applicable to Program-for-Results operations? No Page 1 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) I. PROGRAM STATUS AND RATIONALE FOR RESTRUCTURING A. Program Status 1. The Mozambique Primary Heath Care Strengthening Program (P163541, “the Program”) was approved on December 20, 2017. Following the signing of the legal agreements on February 12, 2018, the Program was declared effective on April 18, 2018. The program aims to improve the utilization and quality of reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH-N) services, particularly in underserved areas. The Program is co- financed by the IDA, the Global Financing Facility (GFF), Global Affairs Canada, the United Kingdom’s Foreign, Commonwealth and Development Office (FCDO), the Netherlands, the United States Agency for International Development (USAID), and the Government of Mozambique (GoM). This Program supports Mozambique’s Investment Case (IC) to mobilize and align financing for high-impact investments in RMNCAH-N services and health systems. The Program has made critical contributions to achieve key results, particularly in the context of COVID-19 in which essential health services have been strained. Progress toward achieving the Program Development Objective (PDO) and Implementation Progress were both rated Moderately Satisfactory in January 2022. As of April 1, 2022, the disbursement rate is at 72 percent of the total commitment amount. A broader restructuring will be processed following this restructuring to adjust the DLI matrix and results framework to progress and challenges to date, and to the reduced financing envelope of the Program, as elaborated below. 2. Despite the continued challenges associated with COVID-19, the Program has contributed to important results of the sector in a range of critical areas, as highlighted by key DLI achievements. The number of districts that reached the target of 85 percent institutional deliveries increased from 28 in 2019 to 32 in 2020 (with an increase in the district average from 71 to 88 percent); couple years of protection increased from 1,722,692 in 2017 to 3,111,723 in 2020; the number of active Community Health Workers almost doubled from the start of the Program, from 3,380 to 6,690; clinical staff at primary care facilities increased by 25 percent; and the share of domestic resources spent on the health sector increased from 7.8 (average from 2014-2016) to 9.6 in 2020. Facility scorecards and performance-based allocations have been rolled out in 34 district and rural hospitals and 297 health centers in high impact districts as identified in the IC, with civil society financed by the Ministry of Health (MISAU) implementing complementary community scorecards to engage citizens in service delivery. B. Rationale for Restructuring 3. The proposed restructuring is in response to the request submitted by the GoM on March 29, 2022, to introduce changes to the Grant Agreement for the recipient executed Single Donor Trust Fund (SDTF; TF0B4481) financed by FCDO, required to enable disbursements that are due. FCDO’s co-financing was integrated into the Program based on a letter of indicative commitment expressing their intent to finance the Program in the amount of GBP 25 million, as reflected in the approved Program Paper dated March 1, 2019. The first Administration Agreement (AA) with FCDO was signed on September 18, 2020, with the closing date of December 31, 2021. In line with the FCDO’s programming cycle at the time, the Grant Agreement for one year of financing in the amount of GBP 2.5 million was signed and became effective on May 21, 2021, with the closing date of June 30, 2021. 4. The restructuring involves two changes, namely retroactive inclusion of a clause in the Grant Agreement of the SDTF to enable disbursement against prior results and an extension of the IDA grant. The retroactive inclusion of a clause was articulated in a memorandum approved by the Regional Vice President on December 21, 2021. The memorandum enabled the extension of the End Disbursement Date (EDD) of FCDO’s AA (TF073542) to co-finance the Program from Page 2 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) December 31, 2021, to June 30, 2024, as well as a retroactive extension of the closing date for the FCDO Grant Agreement.1 Following this approval, FCDO has provided an additional contribution in the amount of GBP 6.3 million to the Trustee Account linked to the SDTF. The additional contribution to this TF was noted as part of the AFE’s Strategic External Funding Framework (SEFF). These funds will be integrated through an additional restructuring, once the initial funds under the SDTF are disbursed to the GoM. Retroactive inclusion of a clause in the Grant Agreement will enable the initial funds to be fully disbursed. The additional subsequent restructuring will involve broader revisions to the DLI matrix and results framework. 5. The closing date of the IDA grant (D265-MZ) is proposed to be extended through this restructuring from December 31, 2022, to December 31, 2023, to align with the closing date of other sources of funding that support the Program. II. DESCRIPTION OF PROPOSED CHANGES 6. This restructuring involves two changes: (i) enabling prior results disbursement as part of the FCDO Grant Agreement; and (ii) the extension of the closing date for the IDA grant (D265-MZ) to December 31, 2023. The Program Development Objective (PDO), institutional arrangements, results framework, Program Action Plan (PAP) and overall design remain unchanged. Of the FCDO financing initially received (GBP 2.5 million, approximately US$3.8 million equivalent), US$3 million was channeled through a Recipient-Executed Trust Fund (TF0B4481) to finance 2020 results under the Disbursement Linked Indicators (DLIs) 7 and 8. While the Grant Agreement indicated the amounts of allocation against FY20-specific results, namely for disbursement-linked results (DLRs) #7.3.1, #7.3.2, and #8.3, the Agreement was only signed on May 21, 2021, in conjunction with a broader mid-term restructuring. The clause to enable disbursement against prior results under DLIs 7 and 8 was omitted in error. This restructuring will correct this internal inconsistency, and the Grant Agreement will include reference to withdrawals against DLRs achieved on or after September 18, 2020, to be allowed. The inclusion of prior results in the Grant Agreement will enable not only the full disbursement of the initial FCDO funding, but also additional funds received from FCDO to be channeled through the Agreement. Once the initial FCDO funds are disbursed, another restructuring will be processed to incorporate the additional funds, to adjust the Program to the reduced financing envelope expected from FCDO and USAID, and to progress and challenges to date. Finally, the closing date of the IDA Financing Agreement (D265-MZ) is also proposed to be extended from December 31, 2022, to December 31, 2023, to align with the other Grant Agreements financing the Program. 1This was the first EDD extension request, and it exceeded two years from the original EDD of this TF. Along with retroactively extending the closing date of the Grant Agreement by two years, RVP approval was required. Page 3 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) III. SUMMARY OF CHANGES Changed Not Changed Change in Loan Closing Date(s) ✔ Change in Disbursements Arrangements ✔ Change in Implementing Agency ✔ Change in Program's Development Objectives ✔ Change in Program Scope ✔ Change in Results Framework ✔ Change in Cancellations Proposed ✔ Reallocation between and/or Change in DLI ✔ Change in Disbursement Estimates ✔ Change in Systematic Operations Risk-Rating Tool ✔ (SORT) Change in Safeguard Policies Triggered ✔ Change in Legal Covenants ✔ Change in Institutional Arrangements ✔ Change in Implementation Schedule ✔ Other Change(s) ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_COMPONENTS_TABLE OPS_DETAILEDCHANGES_LOANCLOSING_TABLE LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/TF Status Closing Date Closing(s) Date Closing Date for Withdrawal Applications IDA-D2650 Effective 31-Dec-2022 31-Dec-2023 30-Jun-2024 TF-A6152 Effective 31-Dec-2021 31-Dec-2023 TF-A9398 Effective 31-Dec-2023 Page 4 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) TF-B3368 Effective 31-Dec-2023 TF-B4481 Effective 30-Jun-2021 31-Dec-2023 OPS_DETAILEDCHANGES_EA_TABLE . Page 5 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) ANNEX 1: RESULTS FRAMEWORK . . Results framework Program Development Objectives(s) The Program Development Objective is to improve the utilization and quality of reproductive, maternal, child and adolescent health and nutrition services, particularly in underserved areas. Program Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_PDO Indicator Name DLI Baseline End Target Improve utilization of RMNCAH and Nutrition in underserved areas Number of districts, out of the 42 identified as lagging in the Investment Case, with at least 85 percent institutional deliveries 28.00 37.00 (Number) Number of Couple Years of Protection (Number) 1,722,692.00 3,450,000.00 Percentage of children aged 0-24 months receiving a Nutrition DLI 4, Intervention Package in eight priority provinces (with the 0.00 80.00 4.3 prevalence of stunting of above 35 percent) (Percentage) Improve the quality of RMNCAH-N in underserved areas Number of lagging districts (as defined in the IC) that provide four doses of intermittent preventive treatment of malaria to at 10.00 30.00 least 70 percent of pregnant women (Number) Page 6 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) PDO Table SPACE Intermediate Results Indicators by Result Areas RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Service delivery outputs Percentage of women who had at least four antenatal visits 42.00 66.30 during their pregnancy (Percentage) People who have received essential health, nutrition, and 0.00 19,760,000.00 population (HNP) services (CRI, Number) Number of children immunized (CRI, Number) 0.00 5,100,000.00 Number of women and children who have received basic 0.00 9,720,000.00 nutrition services (CRI, Number) Number of deliveries attended by skilled health personnel DLI 1.1 0.00 4,940,000.00 (CRI, Number) Number of provinces meeting annual Couple Years of Protection 7.00 11.00 growth targets (Number) Service readiness and availability Number of health facilities providing Basic Emergency Obstetric 68.00 300.00 and Newborn Care (Number) Number of health facilities providing Comprehensive Emergency 33.00 60.00 Obstetric and Newborn Care (Number) DLI 2, Percentage of secondary and technical schools offering sexual 2.1, and reproductive health services (information and contraceptive 0.00 80.00 2.3, methods) (Percentage) 2.5, Page 7 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target 2.6, 2.7 Average availability of tracer essential maternal and reproductive 62.00 85.00 health medicines at primary health care facilities (Percentage) Human Resources for Health (HRH) Number of active community health workers (Number) DLI 10 3,380.00 8,800.00 Number of technical health personnel assigned to the primary 11,970.00 18,163.00 health care network (Number) Number of technical staff assigned to type II rural health 3,787.00 6,325.00 centers (Number) Number of primary health care facilities that have at least two 638.00 838.00 maternal child health nurses (Number) Quality Number of district and rural hospitals that received performance-based allocations in accordance with a minimum of DLI 8 0.00 44.00 one scorecard assessment in the previous fiscal year (Number) Number of health centers in priority districts that received performance-based allocations in accordance with at least one 0.00 391.00 scorecard assessment with community consultations in the previous FY (Number) Percentage of pregnant women who receive four doses of intermittent preventive treatment of malaria during their 60.00 70.00 pregnancy (Percentage) Health Financing Page 8 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Domestic health expenditures as a percentage of total domestic 7.90 9.50 government expenditures (Percentage) Health sub-account expenditures in 3 historically underserved 0.00 36,000,000.00 provinces (Nampula, Zambezia, and Tete) (Amount(USD)) Health sub-account expenditures in 28 historically underserved 0.00 16,000,000.00 districts (Amount(USD)) Information for decision making Percentage of deaths in eligible health facilities certified by a doctor or qualified clinician with cause of death coded using 0.00 90.00 ICD10, and the death record captured in the SISMA MGDH (Percentage) Percentage of deaths registered, certified and captured in the DLI civil registration system (SiRCEV) within one year of their 0.00 70.00 11.3 occurrence (Percentage) IO Table SPACE Disbursement Linked Indicators Matrix DLI IN01100620 ACTION The Recipient has increased the number of districts, out of the 42 identified as lagging in the Investment Case, with at least DLI 1 85 percent institutional deliveries Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Number 11,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Page 9 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Baseline 28.00 December 2018 0.00 December 2019 0.00 December 2020 29.00 4,500,000.00 No scalability Allocated Amount x [Actual December 2021 32.00 4,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 37.00 3,000,000.00 improvement for the DLR/Targeted] December 2023 0.00 DLI IN01100621 ACTION The Recipient has increased the percentage of institutional deliveries in the 42 lagging districts defined in the Investment DLI 1.1 Case Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Outcome Yes Number 10,700,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 66.10 December 2018 66.80 5,700,000.00 No scalability Allocated Amount x [Actual December 2019 81.00 5,000,000.00 improvement for the DLR/Targeted] December 2020 0.00 December 2021 0.00 Page 10 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) December 2022 0.00 December 2023 0.00 DLI IN01100622 ACTION The Recipient has increased the percentage of secondary and technical schools offering sexual and reproductive health DLI 2 services (information and contraceptive methods) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 11,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 December 2020 0.00 Allocated Amount x [Actual December 2021 40.00 3,000,000.00 improvement for the DLR / Target] Allocated Amount x [Actual December 2022 60.00 3,000,000.00 improvement for the DLR / Target] Allocated Amount x [Actual December 2023 80.00 5,500,000.00 improvement for the DLR / Target] Page 11 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01100623 ACTION The Recipient has increased the percentage of technical schools offering sexual and reproductive health services DLI 2.1 (information and contraceptive methods) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome No Percentage 4,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 December 2020 19.00 4,000,000.00 No scalability December 2021 0.00 December 2022 0.00 December 2023 0.00 DLI IN01100624 ACTION DLI 2.2 The Recipient has completed an identification of gaps in training materials Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 1,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No Page 12 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) December 2018 0.00 December 2019 0.00 December 2020 Yes 1,000,000.00 No scalability December 2021 0.00 December 2022 0.00 December 2023 0.00 DLI IN01100625 ACTION DLI 2.3 The Recipient has finalized the harmonization of monitoring and evaluation tools Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 1,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No December 2018 0.00 December 2019 0.00 December 2020 Yes 1,000,000.00 No scalability December 2021 0.00 December 2022 0.00 December 2023 0.00 Page 13 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01100626 ACTION DLI 2.4 The Recipient has approved updated training materials Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 1,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No December 2018 0.00 December 2019 0.00 December 2020 0.00 December 2021 Yes 1,000,000.00 No scalability December 2022 0.00 December 2023 0.00 DLI IN01100627 ACTION DLI 2.5 The Recipient has approved updated Adolescent- and Youth-friendly Services Guidelines Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 1,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No December 2018 0.00 Page 14 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) December 2019 0.00 December 2020 0.00 December 2021 Yes 1,500,000.00 No scalability December 2022 0.00 December 2023 0.00 DLI IN01100628 ACTION DLI 2.6 The Recipient has completed training for health providers using new training materials Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 1,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No December 2018 0.00 December 2019 0.00 December 2020 0.00 December 2021 0.00 December 2022 Yes 1,000,000.00 No scalability December 2023 0.00 Page 15 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01100629 ACTION DLI 2.7 The Recipient has trained health providers and focal points on improved monitoring and evaluation tools Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 1,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No December 2018 0.00 December 2019 0.00 December 2020 0.00 December 2021 0.00 December 2022 Yes 1,500,000.00 No scalability December 2023 0.00 DLI IN01100630 ACTION DLI 3 The Recipient has increased Couple Years of Protection Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Number 20,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 1,722,692.00 December 2018 2,135,012.00 3,500,000.00 No Scalability Page 16 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Allocated Amount x [Actual December 2019 2,336,463.00 5,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2020 3,190,000.00 4,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2021 3,360,000.00 4,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 3,540,000.00 3,500,000.00 improvement for the DLR/Targeted] December 2023 0.00 DLI IN01100631 ACTION The Recipient has increased the percentage of children between 0-24 months of age receiving the Nutrition Intervention DLI 4 Package in the eight provinces with a prevalence of stunting above 35 percent Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 15,750,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 Allocated Amount x [Actual December 2020 15.00 6,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2021 40.00 2,750,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 60.00 5,000,000.00 improvement for the DLR/Targeted] Page 17 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Allocated Amount x [Actual December 2023 80.00 2,000,000.00 improvement for the DLR/Targeted] DLI IN01100632 ACTION The Recipient has trained at least 6 trainers, 100% of district nutrition representatives, and 30% of Community Health DLI 4.1 Workers, and identified 30% of volunteers, in 6 of the 8 targeted provinces Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output No Yes/No 2,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No December 2018 Yes 2,500,000.00 No scalability December 2019 0.00 December 2020 0.00 December 2021 0.00 December 2022 0.00 December 2023 0.00 DLI IN01100633 ACTION DLI 4.2 The Recipient has finalized the Monitoring and Evaluation System Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 1,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Page 18 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Baseline No December 2018 Yes 1,000,000.00 No scalability December 2019 0.00 December 2020 0.00 December 2021 0.00 December 2022 0.00 December 2023 0.00 DLI IN01100634 ACTION DLI 4.3 The Recipient has increased the percentage of nutrition sites meeting the minimum quality standards Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 4,750,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 December 2020 0.00 December 2021 75.00 2,750,000.00 December 2022 0.00 Page 19 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) December 2023 90.00 2,000,000.00 DLI IN01100635 ACTION The Recipient has increased the Domestic Health Expenditures as a percentage of total Domestic Government DLI 5 Expenditures. Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Percentage 13,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 7.90 December 2018 8.50 3,750,000.00 No scalability Allocated Amount x [Actual December 2019 8.50 3,250,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2020 9.00 3,250,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2021 9.50 3,250,000.00 improvement for the DLR/Targeted] December 2022 0.00 December 2023 0.00 Page 20 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01100636 ACTION The Recipient has increased health expenditures from the Sub-Account Resources in underserved provinces (Nampula, DLI 6 Zambezia, Tete) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Amount(USD) 4,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 December 2020 9,000,000.00 1,000,000.00 No scalability Allocated Amount x [Actual December 2021 18,000,000.00 1,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 27,000,000.00 1,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2023 36,000,000.00 1,000,000.00 improvement for the DLR/Targeted] DLI IN01100637 ACTION The Recipient has increased health expenditures from the Sub-Account Resources in the 28 underserved districts in the DLI 6.1 three underserved provinces Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Amount(USD) 4,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Page 21 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Baseline 0.00 December 2018 0.00 December 2019 0.00 December 2020 4,000,000.00 1,000,000.00 No Scalability Allocated Amount x [Actual December 2021 8,000,000.00 1,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 12,000,000.00 1,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2023 16,000,000.00 1,000,000.00 improvement for the DLR/Targeted] DLI IN01100638 ACTION The Recipient has maintained Domestic Health Expenditures for the three underserved provinces (Nampula, Zambezia, DLI 6.2 Tete) as a share of provincial expenditures Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Amount(USD) 2,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 36.60 December 2018 0.00 December 2019 0.00 December 2020 36.60 500,000.00 No scalability December 2021 36.60 500,000.00 No scalability Page 22 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) December 2022 36.60 500,000.00 No scalability December 2023 36.60 500,000.00 No scalability DLI IN01100639 ACTION The Recipient has maintained Domestic Health Expenditures for the 28 underserved districts in the three underserved DLI 6.3 provinces as a share of district expenditures Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Amount(USD) 2,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 19.50 December 2018 0.00 December 2019 0.00 December 2020 19.50 500,000.00 No scalability December 2021 19.50 500,000.00 No scalability December 2022 19.50 500,000.00 No scalability December 2023 19.50 500,000.00 No scalabilty Page 23 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01100640 ACTION DLI 6.4 The Recipient has increased the number of provinces with Program Contracts Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Number 1,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 December 2020 3.00 500,000.00 No scalability December 2021 11.00 500,000.00 No scalability December 2022 0.00 December 2023 0.00 DLI IN01100641 ACTION DLI 7 The Recipient has increased the number of technical health personnel assigned to the primary health care network Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 12,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 11,970.00 December 2018 12,205.00 3,500,000.00 No Scalability Page 24 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Allocated Amount x [Actual December 2019 15,431.00 2,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2020 15,566.00 2,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2021 16,182.00 1,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 17,153.00 1,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2023 18,163.00 1,000,000.00 improvement for the DLR/Targeted] DLI IN01100642 ACTION The Recipient has increased the number of health care facilities in the primary care network with at least two active DLI 7.1 Maternal Child Health Nurses Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 6,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 638.00 December 2018 0.00 Allocated Amount x [Actual December 2019 688.00 1,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2020 704.00 1,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2021 728.00 1,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 768.00 1,000,000.00 improvement for the DLR/Targeted] Page 25 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Allocated Amount x [Actual December 2023 838.00 1,000,000.00 improvement for the DLR/Targeted] DLI IN01100643 ACTION Number of district and rural hospitals that received performance-based allocations in accordance with a minimum of one DLI 8 scorecard assessment in the previous fiscal year Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 18,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 6.00 4,000,000.00 No Scalability Allocated Amount x [Actual December 2019 30.00 5,500,000.00 improvement for the DLR/Targeted] December 2020 0.00 Allocated Amount x [Actual December 2021 31.00 4,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 70.00 4,000,000.00 improvement for the DLR/Targeted] December 2023 0.00 Page 26 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01100644 ACTION The Recipient has increased the number of district and rural hospitals that receive allocations based on prioritized action DLI 8.1 plans that respond to scorecard evaluations Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 5,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 FY Allocated Amount x [Actual December 2020 15.00 5,500,000.00 Achievement up to DLR target/DLI target] December 2021 0.00 December 2022 0.00 December 2023 0.00 DLI IN01100645 ACTION The Recipient has increased the number of health centers in priority districts receiving PBA according to one scorecard DLI 9 assessment with community consultations in the previous fiscal year Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 21,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Page 27 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Baseline 0.00 December 2018 64.00 4,000,000.00 No scalability Allocated Amount x [Actual December 2019 130.00 6,500,000.00 improvement for the DLR/Targeted] December 2020 0.00 Allocated Amount x [Actual December 2021 261.00 5,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 391.00 5,000,000.00 improvement for the DLR/Targeted] December 2023 0.00 DLI IN01100646 ACTION The Recipient has increased the number of health centers in priority districts that received allocations to implement DLI 9.1 prioritized action plans responding to scorecards evaluations Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 6,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 Allocated Amount x [Actual December 2020 186.00 6,000,000.00 improvement for the DLR/Targeted] Page 28 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) December 2021 0.00 December 2022 0.00 December 2023 0.00 DLI IN01100647 ACTION DLI 10 The Recipient has increased the number of active Community Health Workers Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Number 15,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 3,380.00 December 2018 4,723.00 3,500,000.00 No scalability Allocated Amount x [Actual December 2019 6,523.00 3,000,000.00 improvement for the DLI/Targeted] Allocated Amount x [Actual December 2020 6,690.00 3,000,000.00 improvement for the DLI/Targeted] Allocated Amount x [Actual December 2021 7,748.00 3,000,000.00 improvement for the DLI/Targeted] Allocated Amount x [Actual December 2022 8,800.00 3,000,000.00 improvement for the DLI/Targeted] December 2023 0.00 Page 29 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01100648 ACTION The Recipient has increased the percentage of Community Health Workers that deliver services according to minimum DLI 10.1 quality standards Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 7,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 28.00 December 2018 0.00 December 2019 0.00 December 2020 0.00 Allocated Amount x [Actual December 2021 60.00 4,000,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 80.00 3,500,000.00 improvement for the DLR/Targeted] December 2023 0.00 DLI IN01100649 ACTION DLI 10.2 The Recipient has approved a Decree recognizing Community Health Workers as state agents of the National Health System Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 3,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No Page 30 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) December 2018 0.00 December 2019 0.00 December 2020 0.00 December 2021 Yes 3,500,000.00 No scalability December 2022 0.00 December 2023 0.00 DLI IN01100650 ACTION The Recipient has increased the percentage of deaths in eligible health facilities certified by a qualified clinician with the DLI 11 cause of death coded using ICD10, and the death record captured in SISMA Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Percentage 10,240,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 0.00 December 2019 0.00 Allocated Amount x [Actual December 2020 50.00 3,200,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2021 75.00 3,200,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 85.00 1,840,000.00 improvement for the DLR/Targeted] Page 31 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Allocated Amount x [Actual December 2023 90.00 2,000,000.00 improvement for the DLR/Targeted] DLI IN01100651 ACTION The Recipient has increased the percentage of hospitals using the Hospital Data Management Module (MGDH) to generate DLI 11.1 information on causes of deaths Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Percentage 1,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 70.00 December 2018 100.00 1,500,000.00 No scalability December 2019 0.00 December 2020 0.00 December 2021 0.00 December 2022 0.00 December 2023 0.00 Page 32 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) DLI IN01100652 ACTION The Recipient has increased the percentage of health centers using the Hospital Data Management Module (MGDH) to DLI 11.2 generate information on causes of deaths Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Percentage 6,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 December 2018 50.00 1,500,000.00 No scalability Allocated Amount x [Actual December 2019 100.00 4,500,000.00 improvement for the DLR/Targeted] December 2020 0.00 December 2021 0.00 December 2022 0.00 December 2023 0.00 DLI IN01100653 ACTION The Recipient has increased the percentage of deaths registered, certified and captured in the civil registration system DLI 11.3 (SiRCEV) within one year of their occurrence Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 2,060,000.00 0.00 Period Value Allocated Amount (USD) Formula Page 33 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Baseline 0.00 December 2018 0.00 December 2019 0.00 December 2020 15.00 600,000.00 No scalability Allocated Amount x [Actual December 2021 30.00 800,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 45.00 460,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2023 70.00 200,000.00 improvement for the DLR/Targeted] DLI IN01100654 ACTION The Recipient has increased the average availability of tracer essential maternal and reproductive health medicines at DLI 12 primary health care facilities Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Outcome No Percentage 10,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 62.00 December 2018 0.00 December 2019 70.00 3,000,000.00 No scalability Allocated Amount x [Actual December 2020 75.00 2,500,000.00 improvement for the DLR/Targeted] Page 34 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Allocated Amount x [Actual December 2021 80.00 2,500,000.00 improvement for the DLR/Targeted] Allocated Amount x [Actual December 2022 85.00 2,000,000.00 improvement for the DLR/Targeted] December 2023 0.00 Page 35 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) ANNEX 2: PROGRAM ACTION PLAN . . PAP_NOT_CHANGE_TBL Action Description Source DLI# Responsibility Timing Completion Measurement The Program Operations Manual shall be adopted by the Recipient in a manner satisfactory to the Ministry of Health Association. Technical (MOH) - DPC Due Date 30-Jun-2019 Approved POM The Program Management Unit (PMU) shall be assembled with a Terms of Reference and composition satisfactory to the Association (including experienced fiduciary personnel). Technical MOH - DPC Due Date 29-Jun-2018 PMU ToR IC/PES Alignment: (i) Annual discussions on the analysis of spending alignment with the Investment Analysis and discussions held on Case's priorities IC spending alignment as part of led by MISAU's MISAU (DAF and the Balanço do PES in Q1 focal point. Fiduciary Systems DPC) Recurrent Yearly annually. IC/PES Alignment: (ii) Provincial Program Contracts reviewed and updated annually with PES, including disaggregated DLI and results framework (i) Provincial Program Contracts indicators. Fiduciary Systems DPC Recurrent Yearly updated annually. Annual accounts (i) Audit Report of the health Economic and (ii) Report on Action Plan Social Plan (PES) Fiduciary Systems MOH -DAF Recurrent Yearly implementation Page 36 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) audited within 12 months after the end of the fiscal year by the Administrative Tribunal; Resulting action plan produced, implemented, and reported on annually. Annual procurement review of PES within 12 months of the FY's end by an independent firm, covering regulatory compliance, performance, and VFM; Action plans implemented and reported on; Remedies against ineligible (i) Audit Report (n-1) expenditures and (ii) Report on Action Plan misprocurement. Fiduciary Systems MISAU & WB Recurrent Yearly implementation Annual updates on the implementation of the medium-term capacity development plan for the fiduciary staff at central, provincial, and district levels, Annual report on the including for implementation of the capacity ADUS. Fiduciary Systems MISAU (DAF) Recurrent Yearly development plan. A roll-out plan developed to implement direct facility financing (ADUS), including training on the Financial Management Manual and disbursement method for each Roll-out plan for ADUS facility. Fiduciary Systems DLI 8 MISAU Due Date 31-Jan-2021 implementation. Page 37 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) An Environmental Health Training Plan (including the EIA process, Waste Management, and Infection Semi-annual updates on the Prevention and implementation of the Control) and a Environmental Health Training monitoring tool Plan and Monitoring Tool, developed and including semi-annual scorecard updated semi- Environmental and Social results, submitted to the World annually. Systems DSA Recurrent Semi-Annually Bank. Gender and socio- cultural responsiveness (I): Engagement of a social development specialist to: (i) provide oversight for gender and socio-cultural sensitivity in the sector; (ii) lead the PAP IR review and enhancement of ToR developed and agreed with complaint the Bank handling Environmental and Social Social Development Specialist mechanisms Systems MISAU Due Date 29-Mar-2019 engaged Gender and socio- cultural responsiveness (II): Ensure approaches to gender and socio- cultural sensitivity are reflected in PAP IR; the curriculum Curriculum; and training of Training materials available at community health health centers and district/rural workers and hospitals; and health staff and supported by MISAU DRH, Number of trained staff in general appropriate Environmental and Social DSNP and MOH's and per province. materials. Systems Gender Unit Recurrent Continuous A three-year plan identifying and PAP IR addressing gaps and needs for Annual reporting on GRM improving the strengthening and results on health system's Environmental and Social MOH (DNSP, nature and number of complaints GRM developed Systems DNAM) Recurrent Yearly registered and resolved. Page 38 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) and implemented, including clear flows of information, accountability, and triage mechanisms. CMAM to retain a Pharmaceutical Waste Management specialist at all times during the Pharmaceutical Waste duration of the Environmental and Social Management Specialist hired and program. Systems CMAM Recurrent Continuous retained. An annual national report on pharmaceutical waste management produced by CMAM based on terms of reference agreed with the Environmental and Social Annual reports on pharmaceutical World Bank Systems CMAM Recurrent Yearly waste management. Develop and implement a Stakeholder Engagement Plan on Pharmaceutical Waste Disposal for district, provincial, and central hospitals and medical stores, identifying key players' roles from identification and preparation to Environmental and Social Stakeholder Engagement Plan monitoring. Systems CMAM Due Date 31-Mar-2022 completed and monitored. Establish, implement, and regularly monitor of an action plan to improve eSIP, including the integration of community health Semi-annual updates on the workers. Technical DLI 7 MISAU - DHR Recurrent Semi-Annually action plan for eSIP improvement. Page 39 of !Syntax Error The World Bank Mozambique Primary Health Care Strengthening Program (P163541) Develop a plan to gradually incorporate contracted personnel to the civil service and regularly report reductions in contracted staff (fora do quadro) in Semiannual reports on fora do primary health quadro personnel in primary care facilities. Technical DLI 7 MISAU - DHR Recurrent Semi-Annually health care facilities. . Page 40 of !Syntax Error