CREDIT NUMBER 7134-DJ GRANT NUMBER E054 DJ Financing Agreement (Djibouti Health System Strengthening Project) between REPUBLIC OF DJIBOUTI and INTERNATIONAL DEVELOPMENT ASSOCIATION CREDIT NUMBER 7134-DJ GRANT NUMBER E054 DJ FINANCING AGREEMENT AGREEMENT dated as of the Signature Date between REPUBLIC OF DJIBOUTI (“Recipient”) and INTERNATIONAL DEVELOPMENT ASSOCIATION (“Association”) for the purpose of assisting in financing the project described in Schedule 1 to this Agreement (“Project”). The Association has decided to provide this financing on the basis, among other things, of the existence of an adequate refugee protection framework. The Recipient and the Association 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 in the Appendix to this Agreement. ARTICLE II — FINANCING 2.01. The Association agrees to extend to the Recipient a grant and a credit, which are deemed as Concessional Financing for purposes of the General Conditions (collectively, “Financing”) in the following amounts to assist in financing the project described in Schedule 1 to this Agreement (“Project”): (a) an amount equivalent to three million seven hundred thousand-Special Drawing Rights (SDR 3,700,000) (“Grant”); and (b) an amount equivalent to ten million five hundred thousand Special Drawing Rights (SDR 10,500,000 ) (“Credit”). 2.02. The Recipient may withdraw the proceeds of the Financing in accordance with Section III of Schedule 2 to this Agreement. 2.03. The Maximum Commitment Charge Rate is one-half of one percent (1/2 of 1%) per annum on the Unwithdrawn Financing Balance. 2.04. The Service Charge is three-fourths of one percent (3/4 of 1%) per annum on the Withdrawn Credit Balance. 2.05. The Payment Dates are June 15 and December 15 in each year. -2- 2.06. The principal amount of the Credit shall be repaid in accordance with the repayment schedule set forth in Schedule 3 to this Agreement. 2.07. The Payment Currency is Dollar. ARTICLE III — PROJECT 3.01. The Recipient declares its commitment to the objective of the Project. To this end, the Recipient shall carry out the Project through MOH in accordance with the provisions of Article V of the General Conditions and Schedule 2 to this Agreement. ARTICLE IV — REMEDIES OF THE ASSOCIATION 4.01. The Additional Event of Suspension consists of the following, namely that the Recipient no longer has an adequate refugee protection framework. 4.02. The Additional Events of Acceleration consist of the following, namely that any of the events specified in Section 4.01 of this Agreement occurs and is continuing for a period of sixty (60) days after notice of the event has been given by the Association to the Recipient. ARTICLE V — EFFECTIVENESS; TERMINATION 5.01. The Additional Condition of Effectiveness consists of the following, namely that the Association is satisfied that the Recipient has an adequate refugee protection framework. 5.02. The Effectiveness Deadline is the date one hundred and eighty (180) days after the Signature Date. 5.03. For purposes of Section 10.05 (b) of the General Conditions, the date on which the obligations of the Recipient under this Agreement (other than those providing for payment obligations) shall terminate is fifteen (15) years after the Signature Date. -3- ARTICLE VI — REPRESENTATIVE; ADDRESSES 6.01. The Recipient’s Representative is its Minister of Economy and Finance in charge of Industry. 6.02. For purposes of Section 11.01 of the General Conditions: (a) the Recipient’s address is: Ministry of Economy and Finance in charge of Industry BP 13 Djibouti City Republic of Djibouti; and (b) the Recipient’s Electronic Address is: Email: cabinet@economie.gouv.dj aligadileh@yahoo.fr 6.03. For purposes of Section 11.01 of the General Conditions: (a) The Association’s address is: International Development Association 1818 H Street, N.W. Washington, D.C. 20433 United States of America; and (b) the Association’s Electronic Address is: Telex: Facsimile: Email: 248423 (MCI) 1-202-477-6391 mwes@wordlbank.org -4- AGREED as of the Signature Date. REPUBLIC OF DJIBOUTI By _____________________________________/s1/ Authorized Representative Ilyas Moussa Dawaleh Name: __________________________/n1/ Minister Title: __________________________ /t1/ 07-juin-2022 Date: __________________________/d1/ INTERNATIONAL DEVELOPMENT ASSOCIATION By _____________________________________/s2/ Authorized Representative Marina Wes Name: __________________________/n2/ Country Director Title: __________________________ /t2/ 06-Jun-2022 Date: __________________________/d2/ -5- SCHEDULE 1 Project Description The objective of the Project is to improve the utilization of quality RMNCAH-N services with priority given to underserved areas, refugees and host communities. The Project consists of the following parts: Part 1 - Strengthening Service Delivery Platforms 1.1: Service Delivery Optimization Support the Recipient to: (i) develop a national service optimization plan based on: (a) existing health system assets; (b) a modeling exercise using geospatial data to identify the optimal distribution of selected services such as CEmONC, essential emergency and critical care, and certain laboratory services; (c) a revision of the package of health services by level of care; (d) the recommendation from the CHVA; (ii) rehabilitate health facilities according to said national service optimization plan by incorporating adaptation measures as well as mitigation design measures; (iii) rehabilitate and/or transform existing buildings into maternal waiting homes to bring pregnant women from remote areas closer to CEmONC, according to the national service optimization plan; (iv) rehabilitate the CAMME according to service optimization plan; (v) support the supply of essential medicines (following a review of procurement process for essential medicines) and medical equipment (including equipment to manage complications during labor/childbirth due to FGM) using low carbon standards as one criterion for choosing suppliers, including energy-efficient cold chain equipment; (vi) improve the biomedical waste management system as part of the facility rehabilitation and equipment agendas; (vii) provide solar-powered mobile clinics and electric/hybrid/hydrogen-powered buses for hard-to-reach populations, such as nomadic groups; (viii) develop and implement a referral and counter-referral strategy to match patients with the appropriate level of care and improve effective coverage while enhancing efficiency in the care continuum, and reducing the carbon footprint of accessing care; including referral -6- network protocols based on population catchment areas, most climate vulnerable populations, maximum time to health facilities, and patient transportation; and (ix) improve RMNCAH-N workforce, such as, inter alia: (a) the establishment of communities of practice and other interventions to build a culture of excellence among service providers and improve their work environment; (b) strengthening pre-service and in-service training in RMNCAH-N, including the implementation of CHVA recommendations, FGM prevention, treatment and reporting, as well as malnutrition; and (c) clinical mentoring of health workers. 1.2: PBF Scheme and Pilot DFF Scheme Support: (i) the national PBF Scheme covering the quantity and quality of services in primary, secondary, and tertiary public health facilities; and (ii) the pilot DFF Scheme at the primary level in two regions, one in the North and the other in the South of the Recipient’s territory. 1.3: Community Health Platform (i) Support the development of a community health strategy to deliver a comprehensive community health package which includes SBCC and other community health interventions, such strategy to integrate, inter alia, the recommendations from the CHVA including on nutrition, WASH, prevention and treatment of vector- and water-borne conditions, adaptive capacity for climate-change related challenges, strengthening of the referral system as well as FGM prevention and care for FGM survivors; (ii) Support the implementation of said community health strategy, including training (based on existing training and certification programs as well as on topics such as climate resilience, nutrition, and legal literacy on FGM), equipment (including digital job aids), and travel assistance; and (iii) Develop an embedded learning agenda for evidence-based policy and studies to inform decision making. Part 2 - Strengthening Institutions, Citizen Engagement and Project Management 2.1: Strengthening Institutions Provide technical assistance and capacity building for various institutions which are critical to RMNCAH-N, including, inter alia: (i) strengthening various MOH departments for the development and implementation of relevant sector policies, strategies, regulations, standards, protocols, guidelines, and plans related to RMNCAH-N, PHC, quality of care, pandemic preparedness and response, digitalization and e-health strategy, integration of refugees and asylum seekers into the national health system, human resources for health, review of supply chain efficiency and -7- controls, prevention of the medicalization of FGM, health care waste management, “green” facilities and climate change mitigation and adaptation measures, including climate-change induced or exacerbated natural disasters and epidemics, and response, as well as high- leverage initiatives including the rollout of DHIS2, the development of and rollout of a national logistics management information system and activation and operationalization of a national nutrition surveillance system; and resolution of bottlenecks which prevent refugees from receiving free services to which they are entitled. (ii) carrying out CRVS activities within the health sector, periodic surveys, purposeful quality of care monitoring at facility level, other monitoring and evaluation as well as data initiatives and operational research, integrated health/environmental surveillance systems to monitor climate related diseases, and facilitation of refugees’ access to the national health system; and (iii) strengthening management and technical capacity for regional health teams to help them better carry out their mandates in the context of health decentralization, including training in “green” facilities and climate change adaptations. 2.2: Social Mobilization for Health Support positive behavior change for better health, help ignite people’s demand for better services and amplify people’s voices by financing: (i) Supplies for maternal waiting homes alongside a Voucher Scheme to cover transport and incidental expenses for patients and expectant mothers in maternal waiting homes and in health facilities with CEmONC capabilities; (ii) SBCC campaigns in health, including topics on the medical risks of FGM, climate- related mitigation and adaptation and other recommendations from the CHVA, at national, and regional, and facility levels, including in refugee villages; (iii) social accountability and transparency mechanisms such as: (a) the development and implementation of community scorecards linked to counter-verification of PBF activities at the facility including climate vulnerability and adaptation; (b) patient charters and, service standard displays at health facilities; (c) initiatives on citizen engagement and empowerment to build a social movement in health, including annual and regional health fora for all relevant stakeholders channeling their findings upward to an annual national health forum; (iv) data systems to create feedback loops from health system users (especially including refugees and climate refugees) to decision-makers, including ongoing user-experience surveys; the integration of user experience data into administrative systems’ facility self- evaluations; data on climate vulnerability/sensitivity and an annual thematic facility survey integrated into a national health forum process, to address topics including climate vulnerability and adaptation; and -8- (v) grievance redress mechanisms at different levels. 2.3: Project Management Strengthening the Project Implementation Team’s capacity to manage the Project, including, inter alia: coordination, supervision, financial management, procurement, ESCP implementation, monitoring and evaluation, PBF Payments and DFF Payments; all through the provision of technical assistance, Training, equipment and Operating Costs for the required purpose. Part 3: Contingent Emergency Response Providing immediate response to an Eligible Crisis or Emergency, as needed. -9- SCHEDULE 2 Project Execution Section I. Implementation Arrangements A. Institutional Arrangements 1. The Recipient shall carry out the Project through MOH and shall take all actions including the provision of funding, personnel and other resources necessary to perform its functions. 2. In order to ensure proper oversight of the Project and coordination among the Recipient’s ministries involved in the Project, the Recipient, through MOH, shall: (a) maintain at all times during the implementation of the Project, the Steering Committee for the Project, with composition and mandate adequate to carry out the Project and in charge of overall oversight and strategic guidance for the Project (including approval of the Annual Work Plans and Budgets); and (b) maintain discussions and collaboration among the Recipient’s relevant ministries involved in the Project, including, as the case may be, MEFI, MOHER, MOI, MASS and the National Committee for the Abandonment of All Forms of Excision; all as further detailed in the Project Operations Manual. 3. The Recipient, through MOH, shall maintain at all times during Project implementation, the Project Implementation Team (“PIT”) to be in charge of overall Project management and monitoring, with composition, mandate, staffing and other resources satisfactory to the Association, all in accordance with the provisions of the Project Operations Manual. To this end, the Recipient shall no later than one (1) month after the Effective Date, hire and thereafter maintain, throughout Project implementation, key staff under the PIT, all with experience and terms of reference, acceptable to the Association, as further detailed in the Project Operations Manual. B. Implementation Arrangements 1. Project Operations Manual (a) The Recipient shall adopt no later than one (1) month after the Effective Date and thereafter maintain the Project Operations Manual containing detailed guidelines and procedures for the implementation of the Project, including with respect to: administration and coordination, monitoring and evaluation, financial management, procurement and accounting procedures, environmental and social safeguards, corruption and fraud mitigation measures; a grievance redress mechanism; codes of ethics; Personal Data collection; roles and responsibilities for Project -10- implementation; eligibility criteria and selection procedures for Participating Health Care Facilities; compliance by Participating Health Care Facilities with relevant requirements for the Project including the Procurement Regulations, the Anti-Corruption Guidelines and the Environmental and Social Standards; the performance indicators and arrangements for the supervision, reporting, monitoring, evaluation, auditing and verification by the Independent Verifiers; the model form for the content of the Independent Verification Reports and the verification protocols for the PBF Scheme; the model forms including terms and conditions for the Participating Health Care Facilities Contracts for PBF and the Primary Health Care Facilities Contracts for DFF; and such other arrangements and procedures as shall be required for the effective implementation of the Project, in form and substance satisfactory to the Association. (b) The Recipient shall carry out the Project in accordance with the Project Operations Manual. (c) The Recipient shall ensure that the Project Operations Manual is not amended, suspended, repealed or abrogated without the prior written approval of the Association. (d) In the event of any conflict between the provisions of the Project Operations Manual and, this Agreement, the provisions of this Agreement shall prevail. 2. Annual Work Plans and Budget For purposes of implementation of the Project, the Recipient shall: (a) no later than May 31, 2022 prepare the first Annual Work Plan and Budget for the implementation of the Project, setting forth, inter alia: (i) a detailed description of the planned activities, including any proposed Operating Costs, Vouchers and Training, under the Project for the period covered by the plan; (ii) the sources and proposed use of funds therefor; (iii) procurement and environmental and social safeguards arrangements therefor, as applicable, including the procurement plan; and; (iv) responsibility for the execution of said Project activities, budgets, start and completion dates, outputs and monitoring indicators to track progress of each activity; (b) promptly furnish the draft Annual Work Plan and Budget to the Association for its review, and promptly thereafter finalize said draft first Annual Work Plan and Budget, taking into account the Association’s comments thereon, and the approval by the Steering Committee; and -11- (c) thereafter adopt and carry out such Annual Work Plan and Budget for the relevant period as shall have been agreed with the Association, such plan to be subsequently revised and updated on or around October 31 of each year for its implementation during the following calendar year during the Project implementation period and with the prior written agreement of the Association. C. PBF Scheme under Part 1.2 (i) of the Project 1. Eligibility of the Participating Health Care Facilities No proposed Participating Health Care Facility shall be eligible for financing under Part 1.2 (i) of the Project unless the Recipient shall have determined that the proposed Participating Health Care Facility satisfies the eligibility criteria specified in the Project Operations Manual, including, but not limited to, the following: (a) the proposed Participating Health Care Facility is a public or private health facility with the organization, management capacity (including an inventory management system) and resources necessary to carry out the delivery of the proposed health services; (b) the proposed health services satisfy the requirements of Part 1.2 (i) of the Project as described in detail in the Project Operations Manual; (c) the proposed health services comply with the requirements of the ESCP. 2. Participating Health Care Facility Contracts (a) To facilitate the carrying out of the PBF activities under Part 1.2 (i) of the Project, the Recipient, through MOH, shall make the proceeds of the Financing allocated to Category (1) of the table set forth in Section III.A of this Schedule available to eligible Participating Health Care Facilities under contracts between MOH and each of the selected Participating Health Care Facilities (“Participating Health Care Facility Contracts”), -12- under terms and conditions approved by the Association, including, but not limited to the following provisions: (i) a description of the health services to be provided, the applicable rates for the services thereunder, and applicable performance indicators; (ii) a requirement that the Participating Health Care Facility adheres to all requirements under this Agreement, including the ESCP, the Anti-Corruption Guidelines and the Procurement Regulations; (iii) that MOH provide quarterly PBF Payments to the Participating Health Care Facilities in accordance with the Project Operations Manual; (iv) that the Participating Health Care Facilities use the funds made available under the Participating Health Care Facility Contract in accordance with the provisions of the Project Operations Manual; (v) that the selected Participating Health Care Facilities maintain records and accounts for expenditures of the payments received pursuant to their Participating Health Care Facility Contract and submit their financial statements to the Recipient on a quarterly basis; and (vi) the right of the Recipient to: (A) inspect by itself, or jointly with the Association, goods, sites, documents and records relevant for the provided health services; (B) obtain all information as it, or the Association, may reasonably request regarding the administration, operation, and financial condition of the Participating Health Care Facility; and (C) suspend and terminate the right of the Participating Health Care Facility to use proceeds of the PBF Payments, or obtain a refund of all or any part of the amount thereof then withdrawn, as the case may be, upon failure by the Participating Health Care Facility to perform any of its obligations under the Participating Health Care Facility Contract. (b) The Recipient shall not make available any PBF Payment to a Participating Health Care Facility unless and until an Independent Verifier has verified that such Participating Health Care Facility has delivered the services in -13- accordance with the relevant Participating Health Care Facility Contract and the Project Operations Manual. 3. Independent Verification (a) The Recipient shall appoint and thereafter maintain, throughout the Project implementation, external monitoring and evaluation experts (“Independent Verifiers”) to act as third-party verifiers of the proper fulfilment of the performance indicators for provided health services under Part 1.2 (i) of the Project, as set forth in the Project Operations Manual and the respective Participating Health Care Facility Contract. (b) The Recipient shall cause the Independent Verifiers to, on a quarterly basis, carry out an assessment according to paragraph 3(a) above, and, on the basis of such assessment prepare and furnish to the Recipient and the Association, a report, prepared in accordance with the Project Operations Manual (“Independent Verification Report”). D. DFF Scheme under Part 1.2 (ii) of the Project 1. Eligibility of the Primary Health Care Facilities No proposed Primary Health Care Facility shall be eligible for financing under Part 1.2 (ii) of the Project unless the Recipient shall have determined that the proposed Primary Health Care Facility satisfies the eligibility criteria specified in the Project Operations Manual, including, but not limited to, the following: (a) the proposed Primary Health Care Facility is a public or private health facility with the organization, management capacity (including an inventory management system) and resources necessary to carry out the delivery of the proposed health services and is located in the north or the south of the Recipient’s territory; (b) the proposed health services satisfy the requirements of Part 1.2 (ii) of the Project as described in detail in the Project Operations Manual; (c) the proposed health services comply with the requirements of the ESCP. 2. Primary Health Care Facility Contracts (a) To facilitate the carrying out of the DFF activities under Part 1.2 (ii) of the Project, the Recipient, through MOH, shall make the proceeds of the Financing allocated to Category (2) of the table set forth in Section III.A of this Schedule available to eligible Primary Health Care Facilities under contracts between MOH and each of the selected Primary Health Care Facilities (“Primary Health Care Facility Contracts”), under terms and -14- conditions approved by the Association, including, but not limited to the following provisions: (i) a description of the health services to be provided, the applicable rates for the services thereunder, and applicable performance indicators; (ii) a requirement that the Primary Health Care Facility adheres to all requirements under this Agreement, including the ESCP, the Anti- Corruption Guidelines and the Procurement Regulations; (iii) that MOH provide quarterly DFF Payments to the Primary Health Care Facilities in accordance with the Project Operations Manual; (iv) that the Primary Health Care Facilities use the funds made available under the Primary Health Care Facility Contract in accordance with the provisions of the Project Operations Manual; (v) that the selected Primary Health Care Facility maintain records and accounts for expenditures of the payments received pursuant to their Primary Health Care Facility Contract and submit their financial statements to the Recipient on a quarterly basis; and (vi) the right of the Recipient to: (A) inspect by itself, or jointly with the Association, goods, sites, documents and records relevant for the provided health services; (B) obtain all information as it, or the Association, may reasonably request regarding the administration, operation, and financial condition of the Primary Health Care Facility; and (C) suspend and terminate the right of the Primary Health Care Facility to use proceeds of the DFF Payments, or obtain a refund of all or any part of the amount thereof then withdrawn, as the case may be, upon failure by the Primary Health Care Facility to perform any of its obligations under the Primary Health Care Facility Contract. E. Environmental and Social Standards 1. The Recipient shall ensure that the Project is carried out in accordance with the Environmental and Social Standards, in a manner acceptable to the Association. 2. Without limitation upon paragraph 1 above, the Recipient shall ensure that the Project is implemented in accordance with the Environmental and Social Commitment Plan (“ESCP”), in a manner acceptable to the Association. To this end, the Recipient shall ensure that: -15- (a) the measures and actions specified in the ESCP are implemented with due diligence and efficiency, and 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 Association 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 Recipient shall ensure that: (a) all measures necessary are taken to collect, compile, and furnish to the Association through regular reports, with the frequency specified in the ESCP, and promptly in a separate report or reports, if so requested by the Association, information on the 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 Association, setting out, inter alia: (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 Association 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 Recipient shall establish, publicize, maintain and operate an accessible grievance mechanism, to receive and facilitate 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 Association. 6. The Recipient shall ensure that all bidding documents and contracts for civil works under the Project include the obligation of contractors, and subcontractors to: (a) comply with the relevant aspects of ESCP and the environmental and social -16- instruments referred to therein; and (b) adopt and enforce codes of conduct that should be provided to and signed by all workers, detailing measures to address environmental, social, health and safety risks, and the risks of sexual exploitation and abuse, sexual harassment and violence against children, all as applicable to such civil works commissioned or carried out pursuant to said contracts. 7. Without limitation upon the provisions of paragraph 2 above, if sixty (60) days prior to the Closing Date, the Association determines that there are measures and actions specified in the ESCP which will not be completed by the Closing Date, the Recipient shall, through MOH : (a) not later than thirty (30) days before the Closing Date, prepare and present to the Association, an action plan satisfactory to the Association on the outstanding measures and actions, including a timetable and budget allocation for such measures and actions (which action plan shall be deemed to be considered an amendment of the ESCP); and (b) thereafter, carry out said action plan in accordance with its terms and in a manner acceptable to the Association. F. Contingent Emergency Response 1. In order to ensure the proper implementation of contingent emergency response activities under Part 3 of the Project (“Contingent Emergency Response”), the Recipient shall ensure that: (a) a manual (“CERC Manual”) is prepared and adopted in form and substance acceptable to the Association, which shall set forth detailed implementation arrangements for the Contingent Emergency Response, including: (i) any structures or institutional arrangements for coordinating and implementing the Contingent Emergency Response; (ii) specific activities which may be included in the Contingent Emergency Response, Eligible Expenditures required therefor (“Emergency Expenditures”), and any procedures for such inclusion; (iii) financial management arrangements for the Contingent Emergency Response; (iv) procurement methods and procedures for the Contingent Emergency Response; (v) documentation required for withdrawals of Financing amounts to finance Emergency Expenditures; (vi) a description of the environmental and social assessment and management arrangements for the Contingent Emergency Response; and (vii) a template Emergency Action Plan; (b) the Emergency Action Plan is prepared and adopted in form and substance acceptable to the Association; (c) the Emergency Response is carried out in accordance with the CERC Manual and the Emergency Action Plan; provided, however, that in the event of any inconsistency between the provisions of the CERC Manual -17- or the Emergency Action Plan and this Agreement, the provisions of this Agreement shall prevail; and (d) neither the CERC Manual or the Emergency Action Plan is amended, suspended, abrogated, repealed or waived without the prior written approval by the Association. 2. The Recipient shall ensure that the structures and arrangements referred to in the CERC Manual are maintained throughout the implementation of the Contingent Emergency Response, with adequate staff and resources satisfactory to Association. 3. The Recipient shall ensure that: (a) the environmental and social instruments required for the Contingent Emergency Response are prepared, disclosed and adopted in accordance with the CERC Manual and the ESCP, and in form and substance acceptable to the Association; and (b) the Contingent Emergency Response is carried out in accordance with the environmental and social instruments in a manner acceptable to the Association. 4. Activities under the Contingent Emergency Response shall be undertaken only after an Eligible Crisis or Emergency has occurred. Section II. Project Monitoring, Reporting and Evaluation The Recipient through MOH shall furnish to the Association each Project Report not later than forty-five (45) days after the end of each calendar semester, covering the calendar semester. Except as may otherwise be explicitly required or permitted under this Agreement or as may be explicitly requested by the Association, in sharing any information, report or document related to the activities described in Schedule 1 of this Agreement, the Borrower shall ensure that such information, report or document does not include Personal Data. Section III. Withdrawal of the Proceeds of the Financing A. General Without limitation upon the provisions of Article II of the General Conditions and in accordance with the Disbursement and Financial Information Letter, the Recipient may withdraw the proceeds of the Financing to finance Eligible Expenditures; in the amount allocated and, if applicable, up to the percentage set forth against each Category of the following table: -18- Amount of Percentage of Amount of Percentage of the Credit Expenditures the Grant Expenditures Allocated to be Allocated to be Financed (expressed Financed (expressed from the Category in SDR) from the in SDR) Grant Credit (inclusive of Taxes) (inclusive of Taxes) (1) PBF Payments to Participating Health Care Facilities under Part 1.2 (i) of the 2,679,000 74% 962,000 26% Project (2) DFF Payments to Primary Health Care 268,000 74% 96,200 26% Facilities under Part 1.2 (ii) of the Project (3) Goods, works, non- consulting services, 74% 2,641,800 consulting services, Training and 7,553,000 26% Operating Costs under Parts 1.1; 1.3 and 2 of the Project (4) Emergency Expenditures under 0 Part 3 of the Project 0 TOTAL AMOUNT 10,500,000 3,700,000 B. Withdrawal Conditions; Withdrawal Period 1. Notwithstanding the provisions of Part A above, no withdrawal shall be made: (a) for payments made prior to the Signature Date; or -19- (b) for payments made under Category (1) until and unless the Association has received the executed copy of: (i) the first two Participating Health Care Facility Contracts; and (ii) the contract for the Independent Verifiers; all in form and substance satisfactory to the Association; or (c) for payments made under Category (2) until and unless the Association has received the executed copy of first two Primary Health Care Facility Contracts (one in the North and the other in the South of the Recipient’s territory); all in form and substance satisfactory to the Association; or (d) under Category (4) for Emergency Expenditures, unless and until all of the following conditions have been met in respect of said expenditures: (i) (A) the Recipient has determined that an Eligible Crisis or Emergency has occurred, and has furnished to the Association a request to withdraw Financing amounts under Category 3; and (B) the Association has agreed with such determination, accepted said request and notified the Recipient thereof; and (ii) the Recipient has adopted the CERC Manual and Emergency Action Plan, in form and substance acceptable to the Association. 2. The Closing Date is May 31, 2027. Section IV. Other Undertakings A. By June 30, 2025, or such other date as the Association shall agree upon, the Recipient through MOH shall: (i) carry out jointly with the Association, a mid-term review and assessment of the implementation of operations under the Project, which shall cover the progress achieved in the implementation of the Project until then; and (ii) following such mid-term review and assessment, act promptly and diligently to take any corrective or adaptative action as shall be agreed with the Association. -20- SCHEDULE 3 Repayment Schedule Principal Amount of the Credit Date Payment Due repayable (expressed as a percentage)* On each June 15 and December 15 commencing on June 15, 2032 to and including 1% December 15, 2041 Commencing on June 15, 2042 to and including- 2% December 15, 2061 * The percentages represent the percentage of the principal amount of the Credit to be repaid, except as the Association may otherwise specify pursuant to Section 3.05 (b) of the General Conditions. -21- APPENDIX Definitions 1. “Annual Work Plan and Budget” or “Annual Work Plans and Budgets” means any or all work plans prepared annually by the PIT and approved by the Steering Committee, in accordance with the provisions of Section I.B.2 of Schedule 2 to this Agreement, as further detailed in the Project Operations Manual and as approved by the Association. 2. “Anti-Corruption Guidelines” means, for purposes of paragraph 5 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. “CAMME” means Centrale d’Achat des Médicaments et Matériels Essentiels, the Recipient’s central procurement unit for essential drugs and equipment, as established and operating under the Recipient’s Decree No. 2004-0059/PR/MS dated April 13, 2004, or any successor thereto acceptable to the Association. 4. “Category” means a category set forth in the table in Section III.A of Schedule 2 to this Agreement. 5. “CEmONC” means Comprehensive Emergency Obstetric and Neonatal Care. 6. “CERC Manual” means the manual referred to in Section I.F.1(a) of Schedule 2 to this Agreement, as such manual may be updated from time to time with the agreement of the Association 7. “CHVA” means Climate and Health Vulnerability Assessment. 8. “Contingent Emergency Response” means any activity or activities to be carried out under Part 3 of the Project to respond to an Eligible Crisis or Emergency. 9. “CRVS” means Civil Registration and Vital Statistics. 10. “DFF” means Direct Facility Financing. 11. “DFF Scheme” means all the arrangements for DFF Payments under Part 1.2 (ii) of the Project as included in Section I.D of Schedule 2 to this Agreement and in more details in the Project Operations Manual 12. “DFF Payment” or “DFF Payments” means any payment made or to proposed to be made to Primary Health Care Facilities under a Primary Health Care Facility -22- Contract, as referred to in Section I.D.2 of Schedule 2 to this Agreement and as further detailed in the Project Operations Manual. 13. “DHIS2” means District Health Information Software (version 2). 14. “Eligible Crisis or Emergency” means an event that has caused, or is likely to imminently cause, a major adverse economic and/or social impact to the Recipient, associated with a natural or man-made crisis or disaster. 15. “Emergency Expenditures” means any of the eligible expenditures set forth in the CERC Manual referred to in Section I.F of Schedule 2 to this Agreement and required for the Contingent Emergency Response. 16. “Emergency Action Plan” means the plan referred to in Section I.F.1 of Schedule 2, detailing the activities, budget, implementation plan, and monitoring and evaluation arrangements, to respond to the Eligible Crisis or Emergency. 17. “Environmental and Social Commitment Plan” or “ESCP” means the environmental and social commitment plan for the Project, dated April 26, 2022, 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 Recipient 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. 18. “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 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 Association. 19. “FGM” means Female Genital Mutilation. -23- 20. “General Conditions” means the “International Development Association General Conditions for IDA Financing, Investment Project Financing”, dated December 14, 2018 (revised on August 1, 2020, April 1, 2021 and January 1, 2022). 21. “Independent Verifiers” means an external independent verification agent appointed by the Recipient under Section I.C.3 of Schedule 2 to this Agreement in order to carry out independent verifications of the activities under Part 1.2 (i) of the Project and prepare the Independent Verification Reports. 22. “Independent Verification Report” means the quarterly reports to be provided to the Recipient and the Association by the Independent Verifier pursuant to section I.C.3(b) in Schedule 2 to this Agreement. 23. “MASS” means Ministère des affaires sociales et des solidarités, the Recipient’s Ministry of Social Affairs, or any successor thereto satisfactory to the Association. 24. “MEFI” means Ministère de l’économie et des finances chargé de l’industrie, the Recipient’s Ministry of Economy and Finance in charge of Industry, or any successor thereto satisfactory to the Association. 25. “MOH” means Ministère de la santé, the Recipient’s Ministry of Health, or any successor thereto satisfactory to the Association. 26. “MOHER” means Ministère de l’Enseignement superieur et de la recherche, the Recipient’s Ministry of Higher Education and Research, or any successor thereto satisfactory to the Association. 27. “MOI” means Ministère de l’interieur, the Recipient’s Ministry of Interior, or any successor thereto satisfactory to the Association. 28. “National Committee for the Abandonment of All Forms of Excision” means Comité National pour l'Abandon Total de toutes formes d'Excision, the national committee of the Recipient created through the Recipient’s Decree No. N°2009 - 048/PR/MPFBF dated March 1, 2009, under the administrative authority of the Recipient’s Ministry in charge of women and family, or any successor thereto satisfactory to the Association. 29. “Operating Costs” means reasonable and necessary incremental expenses incurred on account of Project implementation, including office supplies, vehicle rental, operation and maintenance, insurance costs, bank charges, rental of facilities, office administration and rental costs, utilities, travel, accommodation, per diem and supervision costs and salaries of locally contracted employees (excluding salaries of the Recipient’s civil service staff), all as approved by the Association. -24- 30. “Participating Health Care Facility” or “Participating Health Care Facilities” means one or several public or private health facilities, selected to deliver health services under Part 1.2 (i) of the Project pursuant to Section I.C.1 of Schedule 2 to this Agreement and the Project Operations Manual 31. “Participating Health Care Facility Contract” or “Participating Health Care Facility Contracts” means one or several contracts between the Recipient and a Participating Health Care Facility, setting forth the terms and conditions for the provision of health services and PBF Payments, according to Section I.C.2 of Schedule 2 to this Agreement. 32. “PBF” means performance-based financing. 33. “PBF Scheme” means all the arrangements for PBF Payments included in Section I.C of Schedule 2 to this Agreement and in more details in the Project Operations Manual. 34. “PBF Payment” or “PBF Payments” means any payment made or proposed to be made to Participating Health Care Facilities under a Participating Health Care Facility Contract, as referred to in Section I.C of Schedule 2 to this Agreement and as further detailed in the Project Operations Manual. 35. “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 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. 36. “PHC” means Primary Health Care. 37. “Procurement Regulations” means, for purposes of paragraph 87 of the Appendix to the General Conditions, the “World Bank Procurement Regulations for IPF Borrowers”, dated November 2020. 38. “Project Implementation Team” or “PIT” means the team within MOH established and operating under the Project Operations Manual as referred to in Section I.A.3 of Schedule 2 to this Agreement. 39. “Project Operations Manual” means the manual referred to in Section I.B.1 of Schedule 2 to this Agreement, as may be revised from time to time with the Association’s prior and written approval. -25- 40. “RMNCAH-N” means reproductive, maternal, neonatal, child, adolescent health and nutrition. 41. “SBCC” means social and behavior change communication. 42. “Signature Date” means the later of the two dates on which the Recipient and the Association signed this Agreement and such definition applies to all references to “the date of the Financing Agreement” in the General Conditions. 43. “Steering Committee” means Comité de Pilotage, the Project steering committee; with responsibilities under the Project further detailed in the Project Operations Manual, or any successor thereto acceptable to the Association. 44. “Training” means expenditures incurred by the Recipient in connection with carrying out training activities under the Project (excluding consulting services), including travel costs, accommodation, and per diem for local trainees, study tours, workshops, conferences, tuitions, scholarships, stipends, rental of facilities and equipment and training materials and related supplies. 45. “Voucher” or “Vouchers” means a stipend given or proposed to be given to a patient or an expectant mother to cover transportation and other incidental expenses while in health facilities or waiting homes under Part 2.2 (i) of the Project, as further detailed in the Project Operations Manual and in the Annual Work Plan and Budgets. 46. “Voucher Scheme” means all arrangements for the payment of Vouchers under Part 2.2 (i) of the Project and in more details in the Project Operations Manual 47. “WASH” means water, sanitation and hygiene.