FOR OFFICIAL USE ONLY Report No: RES38183 INTERNATIONAL DEVELOPMENT ASSOCIATION RESTRUCTURING PAPER ON A PROPOSED PROGRAM RESTRUCTURING OF ETHIOPIA HEALTH SUSTAINABLE DEVELOPMENT GOALS PROGRAM FOR RESULTS {APPROVED ON FEBRUARY 28, 2013} TO THE Federal Democratic Republic of Ethiopia Health, Nutrition & Population Global Practice Africa Region Regional Vice President: Hafez M. H. Ghanem The World Bank Ethiopia Health MDG Support Operation (P123531) Country Director: Carolyn Turk Regional Director: Amit Dar Practice Manager: Ernest Massiah Task Team Leader(s): Paul Jacob Robyn, Roman Tesfaye The World Bank Ethiopia Health MDG Support Operation (P123531) ABBREVIATIONS AND ACRONYMS AF Additional Financing APTS Auditable Pharmaceuticals Transactions and Services CBHI Community Based Health Insurance CHD Community Health Days CMU Country Management Unit CPR Contraceptive Prevalence Rate CRVS Civil Registration and Vital Statistics DLI Disbursement Link Indicator DQA Data Quality Assurance EOS Enhanced Outreach Services FEACC Federal Ethics and Anti-Corruption Commission FM Financial Management FPPA Federal Public Procurement and Property Administration Agency VERA Vital Events Registration Agency GFF Global Financing Facility GMP Growth Monitoring and Promotion HMIS Health Management Information System HNP Health Nutrition and Population HRITF Health Results Innovation Trust Fund ICT Information and Communication Technology IDA International Development Association IFA Iron and Folic Acid INVEA Immigration, Nationality and Vital Events Agency IPF Investment Project Financing KPIs Key Performance Indicators MCH Maternal and Child Health MDG Millennium Development Goals MOF Ministry of Finance MOH Ministry of Health MTR Mid Term Review OFAG Office of the Federal Auditor General PAP Program Action Plan PDO Program Development Objective PforR Program for Results PFSA Pharmaceuticals Fund and Supply Agency PHC Primary Health Care OPCS Operations Policy and Country Services SARA Service Availability and Readiness Assessment The World Bank Ethiopia Health MDG Support Operation (P123531) SBD Standard Bidding Document SORT Systemic Operations Risk-Rating Tool UN United Nations UNICEF United Nations Children's Fund UNOPS United Nations Office for Project Services VERA Vital Events Registration Agency The World Bank Ethiopia Health MDG Support Operation (P123531) DATA SHEET (Ethiopia Health MDG Support Operation - P123531) BASIC DATA Project ID Financing Instrument IPF Component P123531 Program-for-Results Financing No Approval Date Current Closing Date 28-Feb-2013 31-Jul-2021 Organizations Borrower Responsible Agency Ministry of Health (MOH), Immigration Nationality and Vital Ministry of Finance (MOF) Events Agency (INVEA) Program Development Objective(s) To improve the delivery and use of a comprehensive package of maternal and child health services. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing Net Approval Effectiveness Closing Ln/Cr/TF Signing Date Commitment Disbursed Undisbursed Date Date Date 09-May- IDA-60900 18-May-2017 27-Jun-2017 30-Jun-2021 150.00 126.81 28.95 2017 IDA-52090 28-Feb-2013 29-Mar-2013 17-Jun-2013 31-Jul-2021 100.00 79.41 14.69 18-May- TF-A4689 18-May-2017 13-Nov-2017 30-Jun-2021 20.00 13.25 6.75 2017 18-May- TF-A4705 18-May-2017 13-Nov-2017 30-Jun-2021 20.00 13.71 6.29 2017 29-Mar- TF-14107 29-Mar-2013 29-Mar-2013 31-Jul-2021 20.00 13.80 6.20 2013 Page 1 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) Policy Waiver(s) Does the Program require any waivers of Bank policies applicable to Program-for-Results operations? No Page 2 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) I. PROGRAM STATUS AND RATIONALE FOR RESTRUCTURING A. Program Status 1. The Project Development Objective (PDO) of the Ethiopia Health SDGs Program for Results (PforR) (“the Program”) is to improve the delivery and use of a comprehensive package of maternal and child health services. Project financing includes: (i) an original allocation of US$100 million IDA (International Development Association) and a grant of US$20 million from the Health Results Innovation Trust Fund (HRITF) (FY13); and (ii) an Additional Financing (AF) of US$150 million IDA with grants of US$60 million from the Global Financing Facility (GFF) and US$20 million from the Power of Nutrition (FY17). 2. The Program is supported by a hybrid of two financing instruments: the PforR instrument which finances the Program with 15 core Disbursement Linked Indicators (DLIs) focusing on maternal and child health results (see Results Framework), and the Investment Project Financing (IPF) instrument, which finances three sub- components: (a) Sub-Component 1: Support to Civil Registration and Vital Statistics System (US$15 million) (b) Sub-Component 2: Technical Assistance and Capacity Building to Support National Nutrition Program II (US$5 million); and (c) Sub-Component 3: Technical Assistance and Capacity Building (US$1 million). 3. Overall the Program is performing well, both in terms of progress towards achieving the development objective as well as on disbursement, with an overall disbursement ratio of 80% between IDA and trust fund sources (see figures from Data Sheet). Some of the key results, as measured by the Results Framework PDO indicators, show substantial improvements in coverage of essential services for maternal and child health (Table 1). With regards to process-related DLIs progress remains mixed. The Ministry of Health (MOH) has missed annual deadlines for some timebound DLIs, and progress on DLIs and Program Action Plan (PAP) actions related to fiduciary and safeguards elements is slow (see Annex II on status of PAP actions). For example, PAP actions 4, 5, 6 and 8, related to governance, financial management and procurement elements, as well as PAP actions 14-16, related to environmental and social safeguards, are off track to meeting their achievements and milestones. To reflect these challenges, while the project previously had ratings of Moderately Satisfactory for Fiduciary and Safeguards aspects, they have been downgraded to Moderately Unsatisfactory in the ISR for March 2019 that is currently being processed. The lack of progress on these actions and the needs for restructuring were a key topic of discussion and action during the Mid-Term Review (MTR) of the Program’s AF in early February 2020 and summarized in the aide memoire and management letter communicated to government on April 5 ,2020. Discussions are ongoing with the Ministries of Health and Finances on the specifics of future program restructuring with the intention to complete the forthcoming restructuring in the coming months. Table 1: Progress on PDO indicators, July 2019 AF baseline Actual End Target PDO Indicator (2016) (July 2019) (2021) Deliveries attended by Skilled Birth Provider 28% 50% 40% Deliveries attended by Skilled Birth Provider for the bottom 3 Performing Regions (Afar, Oromia and Somali) 19% 33.4% 28% Page 3 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) Pregnant women receiving at least four antenatal care visits 32% 43% 38% Children 12-23 months Immunized with Pentavalent 3 Vaccine 65.7% 65.7%* 76.7% Contraceptive prevalence rate (CPR) 27% 35% 35% Contraceptive prevalence rate (CPR) (for rural women only) 32% 37.7% 38% Percent of pregnant women taking iron and folic acid (IFA) 42.1% 60% 54.1% Percent of Children 6-59 months receiving Vitamin A Supplements 45% 45%** 53% Percent of Woredas in non-emerging regions delivering Vitamin A Supplements to children through routine systems 48% 69% 80% *As a Household Cluster Survey has not been conducted since baseline, no updates on results have been documented. The survey is planned for 2020. ** Will be verified by next DHS survey planned for 2021 Data sources: Ethiopia Demographic Health Survey (EDHS) 2016 report; 2019 Mini-DHS; Nutrition Data Verification Joint Review Mission Report, Dec 2018; 2012 HMIS Data Quality Assessment (DQA) Report; 2014 HMIS DQA and current data from 2018 SARA report. 4. With regard to the three IPF sub-components, the program status is as follows: (a) Sub-Component 1: Support to Civil Registration and Vital Statistics System: The missions from December 2018 and May 2019 noted substantial progress on improving civil registration and vital statistics (CRVS) outcomes. A total of 19,839 (89%) of Kebeles currently offer civil registration services. As of August 2019, 56% of planned birth registrations and 60% of planned death registrations for the 2019 calendar year had been achieved. Most births (46.6%) were current registrations (registered within 90 days); 27.6% late registration (registered after 90 days but within the year of occurrence); and the remaining 25.8% registered after a year of occurrence. At national level, 80% of birth registered in 2018/19 were issued with birth certificates and 77% issued with death certificates. Wide disparities were noted by region in different processes of civil registration. For example, the completeness of birth registration was over 20% in Addis Ababa, Amhara and Tigray and less than 5% in Somali. While good progress has been made, there were institutional changes at the Federal level for civil registration in the past year. (b) Sub-Component 2: Technical Assistance and Capacity Building to Support National Nutrition Program II and Sub-Component 3: Technical Assistance and Capacity Building: There were substantial delays in the first year due to extended negotiations between the MOH and UNICEF on the contractual agreements for these sub-components. The United Nations contractual agreements, budgets and workplans to support technical assistance in 2019 and 2020 was finalized during the December 2018 mission. Since January 2019, the implementation of activities under these sub-components is moving forward smoothly. 5. Exclusion of expenditure incurred under high value contract: The Financing Agreement for the AF stipulates that the Recipient shall ensure the Program excludes any activities which involve procurement of goods estimated to cost US$50 million or more per contract; provided however that such activities may be included if procured under contracts for which the Recipient has requested, and received, prior written approval from the Bank. 6. Despite the provision in the Financing Agreement of the AF (approved April 2017), during the first implementation support mission for the AF, conducted the first week of November 2017, a High Value Contract Page 4 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) (HVC) for the procurement of ambulances was identified by the task team. Specifically, the Federal Ministry of Health (FMOH) had entered into a contract in August 2017 with MOENCO (The Motor & Engineering Company of Ethiopia Ltd. S.C.) for the procurement of 2,614 Ambulances with a contract amount of JPY 11.45 million (US$104 million). This contract with MOENCO combines two budget sources: (i) the SDG Performance Fund (SDG-PF), an account managed by the federal level of the Ministry of Health that is supported by eleven development partners and the defined program boundary of the PforR to which the Program contributes; and (ii) contributions from the state level, specifically the annual budgets from the 11 Regional Health Bureaus (RHB) in the country. 7. Of the 2,614 ambulances included in the contract, the cost of 1,114 ambulances costing around US$ 43.5 million is being covered by SDG-PF over the contract period. Resources from the RHB budgets are not considered as within the program boundary. Within this framework for institutional arrangements, the Government of Ethiopia had interpreted the PforR HVC policy in a way that led them to believe they were adhering to the policy by funding only US$ 43.5 million from within the PforR program boundary, as the other resources contributing to the contract were seen as outside the program. 8. The expenditure framework for the PforR is the SDG-PF, which has a strong focus on reproductive, maternal and child health interventions through strengthening of primary health care services. Hence the SDG supports the sub-set of the overall government program and has a total cost of US$ 750.1 million as shown on the Project’s Additional Financing paper. 9. While the procurement of ambulances will still be supported by the broader SDG-PF (with financing from other SDG-PF contributors) total amount of US$ 43.5 million for procurement of ambulances will be excluded from the PforR program expenditure framework and not supported by the Program’s financing. 10. To avoid such incidents in the future, a briefing has been made to the Ministry of Health regarding high value contracts and their implications. It has also been agreed that with every quarterly IFR submission for the program, the Ministry will also submit the list of contracts with contract amount, supplier name, type of procurement and other relevant information for analysis by the Bank. The ambulance delivery monitoring sheet will also be submitted to the Bank quarterly to ensure that only the cost of the 1,114 ambulances is recorded in the accounts of the SDG PF and the remaining cost of 1500 ambulances is properly recorded in the regional government’s contribution account. In addition to the quarterly financial reports, the audited annual financial statement of the SDG PF will incorporate a note to the financial statement which shows the number of ambulances received and the expenditure recorded for that financial year. This will be complied with until all procured ambulances are delivered and recorded. 11. The details of the expenditure recorded so far in the program and the amount disbursed by the Bank is shown in Annex IV for reconciliation purposes. As can be noted, there will be adequate expenditure to cover the Bank’s payment to the SDG fund even with the exclusion of the amounts paid for the ambulances. B. Rationale for Restructuring Impact of the Change in implementation arrangements for Sub-component 1: Support to Civil Registration and Vital Statistics System Page 5 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) 12. The implementation arrangements for the AF include Federal Vital Events Registration Agency (VERA) as the implementing agency for Sub-Component 1 under the IPF. The activities to be financed through this sub- component included providing technical support and capacity building for VERA to convert from a paper-based registration to an electronic system; procuring motorcycles, field vehicles and storage and archival equipment; and creating public awareness and advocacy on the importance of civil registration. However, in October 2018 VERA was merged with Immigration and Nationality services to form a new agency, Immigration, Nationality and Vital Events Agency (INVEA), and moved from the Ministry of Justice to the Ministry of Peace. As such, in addition to the change in the name, VERA ceased to exist as an independent agency. Given the changes in the name and the structure of the implementation agency, and the lack of a clear framework on how the new agency is going to operate, there was a need to review potential implications of these new developments and the Bank's ability to continue its support for CRVS. Assessment missions took place in May and June 2019, respectively, to review the institutional arrangements at regional, zonal, woreda and kebele levels, as well as a Financial Management Assessment at INVEA. 13. The technical mission held in May 2019 identified significant variations across regions on how the merger of immigration, nationality and vital events registration functions were adopted at regional level. The four Regional VERA offices that were visited (Amhara, Oromia, SNNP and Tigray) fall under four different regional bureaus (President’s office; Attorney General; Peace and Administration; and Justice, respectively). Except for Tigray region, all regional VERA offices remain independent agencies providing civil registration services only while regional VERA in Tigray was merged with Documentation and Authentication. It was further noted that civil registration activities at the regional level have not merged with immigration and nationality and that at the kebele level, Kebele managers continue to issue kebele identity documents. The FM assessment findings conducted at the federal level concluded that the systems currently in place satisfy the Bank’s minimum requirement to manage a Bank-financed operation. While procured assets will be transferred to the regions, actual transfer of funds to the regions was not included in the original project design and this will still apply going forward. However, attention should be given to action points identified during previous missions which intend to strengthen the system further. Although the team has identified the reputational risk in consultation with the Country Management Unit and social safeguards team, a more thorough safeguards assessment will be undertaken as part of the Bank-wide assessments being undertaken on information sharing and privacy for various projects where the Ministry of Peace is associated through project implementation arrangements. The Project Implementing Unit (PIU) supporting the implementation of CRVS activities, originally established within VERA, is now within INVEA. Currently, except for the ICT, three of the four positions of the PIU are filled. INVEA will maintain this unit, with the three positions, for the implementation of the project. Status of ICT Related Activities and Rationale for replacing with TA and capacity building at lower administrative levels 14. With the establishment of INVEA, the framework for the electronic integration of immigration services, national ID and VERA has not yet been developed. While immigration and vital events registration services were offered under the new agency, decisions were yet to be made on the implementation of the national ID. It was noted that planned activities for the conversion of the CRVS system from paper to electronic supported by the IPF component of the Ethiopia Health SDG PforR, including the development of the IT strategy, have not yet been initiated. From the field visits undertaken, the mission noted that three of the four regional VERAs had electronic systems in place that captured all the information on the registration forms. The mission was informed that only aggregate data had been shared with the federal agency, but not individual records. Page 6 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) 15. Based on the interviews and observations made during the May 2019 mission field visits, registration forms and blank copies of vital events certificates at the kebele level were still not stored in a secure manner, undermining the confidentiality and safekeeping of these legal documents. In addition, there was inadequate storage facilities at some regional offices for copies of registration forms kept at this level for authentication and issuance of duplicate copies. Procurement of filing cabinets for safe storage of registers and certificates at kebele level was included for financing under Sub-Component 1. At the time of the mission, the bidding documents were still under preparation. The transfer of copies of registration forms from kebele to woreda, from woreda to zone and from zone to regional offices was also considered insecure as the forms were usually transported by public transport or on foot, without use of appropriate document holder bags. Due to lack of transport, there was also limited supervision and monitoring. INVEA reported that the procurement of motorcycles has been completed through UNOPS, while procurement of a field vehicle is currently being processed. Continued Support for Activities related to advocacy and awareness 16. The May 2019 mission was informed of activities undertaken at regional, woreda and kebele level to create public awareness on the importance of CRVS. These include mobilization at community level; use of public and social gatherings for advocacy; and use of different types of media to promote CRVS (for example radios, television, social media and posters). The activities to support advocacy and public awareness from the IPF component of the Ethiopia Health SDG PforR had not been initiated. The mission was informed of the need to support ongoing work on advocacy and public awareness aimed at increasing the completeness of civil registration. Inclusion of lagged financing of US40m from GFF and corrective revisions in legal agreements 17. As per the Program Appraisal Document, the GFF allocation for Ethiopia is US$60m. However, during project negotiations the GFF was only able to commit US$20m. The agreement was to amend the grant agreement by adding the remaining US$40 million when it became available without the need to go through any additional operational steps as the full amount of US$60 million is included in the PAD. As such the current IDA Financing Agreement (IDA-60900), GFF Grant Agreement (TF-A4689) and Power of Nutrition Grant Agreement (TF-A4705) reference US$20m GFF financing. However, now that the GFF US$40 million in additional funds have been made available, the team, in consultation with OPCS and legal colleagues, has identified revisions for the AF grant agreements and the Financing Agreement to reflect the lagged financing amount (US$40m) in addition to the legal amendment for the restructuring. A description of the proposed changes and a more detailed description of the program status is presented in subsequent sections of this paper. II. DESCRIPTION OF PROPOSED CHANGES Change in implementation arrangements and activities for Sub-component 1: Support to Civil Registration and Vital Statistics System 18. Based on the recent government restructuring that has resulted in the dissolving of VERA and integration of CRVS activities into the newly created INVEA, along with the abovementioned status of the CRVS program, it is proposed to restructure Sub-Component 1 of the IPF to (i) change the implementing agency for the Page 7 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) component from VERA to INVEA; (ii) drop activities that aimed to support the creation of a national electronic registration system; and (iii) add new activities in place of those dropped that focus primarily on strengthening civil registration at lower administration level, including training of officials responsible for notification and registration of vital events, awareness raising and logistics support for the paper-based registration system. All the new activities will be supported centrally by INVEA at federal level, where required funds will be transferred. The change in scope of activities does not have any implications on the allocated financing amount nor the existing procurement arrangements. The detailed budget breakdown is presented in Annex III(a). 19. Due to the lack of an established framework of operation having merged the civil registration agency responsibilities with immigration and nationality agencies, changes in the name of the implementing agency from VERA to INVEA, it is proposed that the support for a centralized electronic CRVS system be dropped and resources initially allocated for this activity reprogrammed. Establishing the operational framework for the new agency; undertaking an information technology (IT) assessment for CRVS; and developing the civil registration IT system may take a long time, which is not sufficient given the remaining period of the project. In addition, the development of a centralized electronic system in Ethiopia needs to be guided by policies on data protection and privacy, which are yet to be put in place. Activities related to the establishment of the electronic systems had not yet been initiated at the time of the implementation support mission. 20. To provide guidance in the newly established agency with regard to civil registration activities, it is proposed that a comprehensive assessment of CRVS be undertaken in the country from which a costed national CRVS strategic plan will be developed. The first national CRVS strategic plan was developed in 2013 for the period 2013–2018 and has thus lapsed. Developing a strategic plan for CRVS in Ethiopia is timely given the recent changes in institutional arrangements for civil registration which have implications on business processes for vital events registration, as well as implications for modernizing the CRVS system in the country. Additionally, the last strategic plan did not include any activities to strengthen death registration and identification of causes of death. A new strategic plan for 2020–2025 will help the country to define its goals and outcomes and identify its strategic interventions to strengthen the CRVS system holistically. 21. There remains limited capacity for civil status officers and health extension workers who undertake registration and certification and notification of vital events, respectively, at the local level. Face-to-face training is required for officials to improve the quality of civil registration processes through understanding the laws governing CRVS, undertaking notification, registration and certification processes, collaboration between key stakeholders and advocacy for CRVS at the local level. Training manuals will be developed for the face-to- face training but for sustainability, self-learning courses (e.g. e-learning courses) adapted for the Ethiopia context should be considered. 22. The agency responsible for civil registration in Ethiopia (VERA) was established in 2013 and officially launched the registration of births, deaths, marriages and divorces in August 2016. Civil registration activities have not been well-funded in the country since then and INVEA continues to have the same problem. Among other challenges faced is the lack of funding for printing vital events registry books and blank certificates. As an immediate step, funds will be directed towards printing in selected regions, procured centrally by INVEA, to ensure constant supply of registration documents to facilitate continuous registration of events and issuance of certificates. 23. While the CRVS component in the SDG PforR included safe storage of registration forms at Kebele level, it did not include the safe transfer of registration forms from Kebele to woreda level, where three copies of each Page 8 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) registration form are sent for further processing. Currently, the forms are transported by foot or public transport, using inappropriate document holder bags. Waterproof and locking bags are thus required to protect confidential documents during transit from kebeles to woredas. The procurement of filing cabinets for safe storage of registration and certification materials as well as motorcycles and field vehicles to support supervision and secure transfer of forms will be maintained in the project. The revised activities and budget for sub-component 1 are presented in Annex III (A) and the revised results framework is presented in Annex III (B). Inclusion of lagged financing of US$40m from GFF and corrective revisions in legal agreements 24. Inclusion of GFF US$40 million lagged financing: The GFF has confirmed the availability of the additional US$40 million funds from the donors of TF-A4689 to support the activities of the Project. An amendment of the AF Grant Agreements (GFF and PON) and of the Financing Agreement has been prepared to allocate these funds by category and DLI indicators. Other minor revisions to legal agreements 25. Correcting total GFF allocation: While the total contribution from GFF is US$60m, $1million was “missed” both in the PAD and in Schedule 2 of the original agreement that was supposed to be reflected under DLI-7. Hence, the restructuring will include reference to an additional US$1 million under DLI 7. 26. Category 18: Under the IPF Sub-Component II, US$1 million is allocated for technical assistance and capacity building. The terms “unallocated” and “technical assistance” are used interchangeably throughout the PAD. On the other hand, only the term “unallocated” is reflected in the legal agreements and should be replaced with “technical assistance”. To address this issue, the restructuring will include changing the terminology in Category 18 from “unallocated” to “technical assistance”. 27. DLI14.1: Proportion of Woredas with functional Community Based Health Insurance (CBHI) schemes has four targets. However, three of the targets were not incorporated in the original financing agreement as categories. The only category included in the Agreement that was attached with the GFF first tranche was Category 14.1a (2017): Establishment of a baseline for the Percent of Woredas with functional community- based health insurance schemes (Prior Result) (IDA: SDR 4,800,000; GFF: US$ 3,014,600). Hence, the restructuring will add the additional three categories in the amended agreement to ensure consistency with the PAD: b, c, d: Increase in the proportion of Woredas with functional community-based health insurance schemes up to a maximum of 30 percentage points from baseline). The full allocation from GFF to the DLI categories b, c and d is US$ 10,485,400.00m and the maximum DLI increment for disbursement is 30 percentage points. Specifically: (a) Category 14.1b (2018): 20 percentage points increase from baseline; US$ 5,485,400 (b) Category 14.1c (2019): 25 percentage points increase from baseline; US$ 2,500,000 (c) Category 14.1d (2020): 30percentage points increase from baseline; US$ 2,500,000 Page 9 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) III. SUMMARY OF CHANGES Changed Not Changed Change in Implementing Agency ✔ Change in Results Framework ✔ Reallocation between and/or Change in DLI ✔ Change in Disbursements Arrangements ✔ Change in Disbursement Estimates ✔ Change in Institutional Arrangements ✔ Other Change(s) ✔ Change in Program's Development Objectives ✔ Change in Program Scope ✔ Change in Loan Closing Date(s) ✔ Change in Cancellations Proposed ✔ Change in Systematic Operations Risk-Rating Tool ✔ (SORT) Change in Safeguard Policies Triggered ✔ Change in Legal Covenants ✔ Change in Technical Method ✔ Change in Fiduciary ✔ Change in Environmental and Social Aspects ✔ Change in Implementation Schedule ✔ Page 10 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_IA_TABLE IMPLEMENTING AGENCY Implementing Agency Name Type Action Implementing Ministry of Health (MOH) No Change Agency Immigration Nationality and Vital Events Implementing New Agency (INVEA) Agency OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE DISBURSEMENT ESTIMATES Year Current Proposed 2013 778,800.00 32,285,036.40 2014 11,347,200.00 32,404,630.64 2015 19,078,400.00 136,275.00 2016 23,200,700.00 5,163,755.83 2017 20,237,900.00 6,427,252.93 2018 17,511,900.00 79,814,439.57 2019 7,845,100.00 78,047,729.89 2020 0.00 115,720,879.74 2021 0.00 0.00 OPS_DETAILEDCHANGES_EA_TABLE . Page 11 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) ANNEX 1: RESULTS FRAMEWORK . . Results framework Program Development Objectives(s) To improve the delivery and use of a comprehensive package of maternal and child health services. Program Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_PDO Indicator Name DLI Baseline End Target To Improve the delivery and use of comperhensive package of Maternal and Child Health (MCH) Services Deliveries attended by skilled birth providers (Percentage) 10.00 40.00 Deliveries attended by skilled birth providers for the bottom 3 19.00 28.00 performing regions(Afar,Oromia&Somal (Percentage) Pregnant women receiving at least four antenatal care visits 32.00 38.00 (Percentage, Custom) (Percentage) Children 12-23 months immunized with Pentavalent 3 vaccines 65.70 76.70 (Percentage) Contraceptive prevalence rate (Percentage) 27.30 35.00 Contraceptive Prevalence Rate ( for Rural women only) 32.00 38.00 (Percentage) Page 12 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) RESULT_FRAME_TBL_PDO Indicator Name DLI Baseline End Target Percent of pregnant women taking Iron Folic Fcid (IFA) 42.10 54.10 (Percentage) Percent of children 6-59 month receiving Vitamin A supplements 45.00 53.00 (Percentage) Percent of Woredas in non emerging regions delivering vitamin A 48.00 80.00 supplements to children (Percentage) PDO Table SPACE Intermediate Results Indicators by Result Areas RESULT_FRAME_TBL_IO Indicator Name DLI Baseline Intermediate Targets End Target 1 Improve delivery and utilization of a comperhensive package of maternal and child health services Introduction of Procurement Key Performance Indicators developed by Federal Public No Yes Procurement Agenc (Yes/No) Automate the PFSA Core Business Fiduciary System using selected software in PFSA HQ and No Yes Addis Ababa (Yes/No) PFSA submission of Backlog audit reports and No Yes timely quality audit reports thereafter (Yes/No) Percent of Children 0- 23 month participating in 27.00 51.00 GMP (Percentage) Page 13 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline Intermediate Targets End Target 1 Percent of Woredas in emerging Regions transitioning from EOS to Community Health Days- 0.00 50.00 CHD (Percentage) Percent of PHC Facilities having all drug from the 42.00 47.00 MOH list of drug available (Percentage) Developed and Implement postnatal Care Service directive to improve the quality of Postnatal No Yes service (Yes/No) Improve quality of adolescent services (Yes/No) No Yes Percent of Woreda with Functional Community 23.00 53.00 Health Insurance Schemes (Percentage) Undertake CBHI review every two Years (Yes/No) No Yes Devise and implement a mechanism for No Yes documenting consultations (Yes/No) Development and implementation of health No Yes sector community score card (Yes/No) Health Centers reporting HMIS data in time 50.00 86.00 86.00 (Percentage) Development and implementation of Annual No Yes Rapid Facility Assessment (Yes/No) Improved transparency of Pharmaceutical Fund and Supply Agency (PFSA) procurement process No Yes (Yes/No) Page 14 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline Intermediate Targets End Target 1 People who have received essential health, nutrition, and population (HNP) services (CRI, 0.00 88,943,602.00 Number) People who have received essential health, nutrition, and population (HNP) services - 0.00 45,091,862.00 Female (RMS requirement) (CRI, Number) Number of children immunized (CRI, Number) 0.00 2,203,481.00 Number of women and children who have 0.00 85,500,000.00 received basic nutrition services (CRI, Number) Number of deliveries attended by skilled health 0.00 1,240,121.00 personnel (CRI, Number) Sub-Component 1: Civil Registration and Vital Statistics (Action: This Result Area is New) Percent of births occurring in a given year 15.00 40.00 registered (Percentage) Action: This indicator is New Percent of deaths occurring in a given year 0.00 25.00 registered (Percentage) Action: This indicator is New Strategic plan developed (Yes/No) No Yes Action: This indicator is New Percentage of kebeles storing and transferring 0.00 90.00 registration forms safely (Percentage) Action: This indicator is New Page 15 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) IO Table SPACE Disbursement Linked Indicators Matrix DLI IN00766674 ACTION DLI 1 Deliveries attended by skilled birth providers (Scaled DLI- 1a) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 45,430,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 10.00 N/A 40.00 45,430,000.00 DLI IN00766687 ACTION DLI 2 Deliveries attended by skilled birth providers for the bottom 3 performing regions -Afar, Oromia & Somali- (New DLI- 1b) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 20,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 19.00 N/A 28.00 20,000,000.00 Page 16 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) DLI IN00766690 ACTION DLI 3 Children 12-23 months immunized with Pentavalent 3 vaccine (Scaled- DLI- 2c) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 8,130,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 65.70 N/A 75.70 8,130,000.00 DLI IN00766693 ACTION DLI 4 Pregnant women receiving at least four antenatal care visits (New DLI -3a) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 20,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 32.00 N/A 38.00 20,000,000.00 DLI IN00766696 ACTION DLI 5 Contraceptive prevalence rate for rural women only (New DLI -4a) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 17,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 32.00 Page 17 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) N/A 38.00 17,000,000.00 DLI IN00766699 ACTION DLI 6 Health Centers reporting HMIS data in time (restructured -DLI- 5a) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Percentage 7,770,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 68.00 N/A 86.00 7,770,000.00 DLI IN00766702 ACTION DLI 7 Development and implementation of Annual Rapid Facility Assessment (restructured-DLI- 7c) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 10,950,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No N/A Yes 10,950,000.00 DLI IN00766706 ACTION DLI 8 Transparency of PFSA procurement process (scaled - DLI 8c) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 10.86 0.00 Period Value Allocated Amount (USD) Formula Page 18 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) Baseline No N/A No 10.86 DLI IN00766708 ACTION Introduction of Procurement Key Performance Indicators developed by Federal Public Procurement Agency at PFSA (New DLI 9 DLI- 9(1)) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 2,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No N/A Yes 2,000,000.00 DLI IN00766712 ACTION Automate the PFSA Core Business Fiduciary System using selected software in PFSA HQ and Addis Ababa City (New_ DLI- DLI 10 9(2) ) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 7,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No N/A Yes 7,000,000.00 Page 19 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) DLI IN00766714 ACTION DLI 11 PFSA submission of Backlog audit reports and timely quality audit reports thereafter (New - DLI 9(3) ) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 6,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No N/A Yes 6,000,000.00 DLI IN00766715 ACTION DLI 12 Percent of children 6-59 months receiving Vitamin A supplements (New- DLI -10a) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 5,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 45.00 N/A 53.00 5,000,000.00 DLI IN00766717 ACTION Percent of Wordas in non-emerging Regions delivering Vitamin A Supplements to children through routine system – Health DLI 13 Facilities (New- DLI-10b) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Percentage 5,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Page 20 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) Baseline 48.00 N/A 80.00 5,000,000.00 DLI IN00766719 ACTION DLI 14 Percent of Pregnant women taking Iron Folic Acid (IFA) tablets (New- DLI- 11) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Intermediate Outcome Yes Percentage 5,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 17.00 N/A 25.00 5,000,000.00 DLI IN00766722 ACTION DLI 15 Percent of Children 0- 23 month participating in GMP (New DLI-12a) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Percentage 15,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 27.00 N/A 51.00 15,000,000.00 Page 21 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) DLI IN00766723 ACTION DLI 16 Percent of Woredas in emerging Regions transitioning from EOS to Community Health Days- CHD (NewDLI- 12b) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Percentage 5,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 N/A 50.00 5,000,000.00 DLI IN00766724 ACTION DLI 17 Percent of PHC Facilities having all drug from the MOH list of drug available(New- DLI DLI-13(1)) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Percentage 7,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 42.00 N/A 47.00 7,000,000.00 DLI IN00766725 ACTION DLI 18 Developed and Implement postnatal Care Service directive to improve the quality of Postnatal services (New- DLI-13(2)) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 5,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No Page 22 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) N/A Yes 5,000,000.00 DLI IN00766726 ACTION DLI 19 Improve quality of adolescent services (New- DLI 13(3)) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 6,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No N/A Yes 6,000,000.00 DLI IN00766727 ACTION DLI 20 Percent of Woreda with Functional Community Health Insurance Schemes (New- DLI-14 (1)) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process Yes Percentage 19,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 20.50 N/A 50.50 19,500,000.00 DLI IN00766729 ACTION DLI 21 Undertake CBHI review every two Years (New- 14- (2)) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 5,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Page 23 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) Baseline Yes N/A Yes 5,000,000.00 DLI IN00766730 ACTION Devise and implement a mechanism for documenting consultations when communal Private land is used for construction DLI 22 of health facilities (New- DLI-15(1)) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 4,500,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No N/A Yes 4,500,000.00 DLI IN00766731 ACTION DLI 23 Development and implementation of health sector community score card(New- DLI- 15(2)) Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 5,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline No N/A Yes 5,000,000.00 Note to Task Teams: End of system generated content, document is editable from here. Please delete this note when finalizing the document. Page 24 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) ANNEX II: PROGRAM ACTION PLAN . . PAP_NOT_CHANGE_TBL Action Description Source DLI# Responsibility Timing Completion Measurement Development and implementation of a Postnatal Care Developed Postnatal Care Directive/policy Technical Client Due Date 31-Dec-2020 Directive. Commodity distribution process - Roll out of APTS and provide progress update to ensure existence of adequate monitoring mechanism of delivery to ultimate beneficiaries at the branch level Technical Client Recurrent Yearly Rolled out APTS PFSA launches an open call for pre- qualifications bidders as per the Recipient's law at least once and introducing Framework Contracting Methods for common and repetitive Launched an open call procurement prequalification and introduced items. Fiduciary Systems Client Recurrent Yearly framework contract methods. Ensure a system of recording fraud and corruption complaints at all levels including Woredas; Ensure the deployment of Ethics and Anticorruption Liaison Officer and experts at all levels (PFSA; PFSA Recorded complaints and regional Hubs; deployed ethics and RHBs, offices). Fiduciary Systems Client Due Date 31-Dec-2018 anticorruption liaison officers. Page 25 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) Automation of Automated fiduciary system at PFSA Fiduciary Systems Client Recurrent Yearly PFSA FPPA undertaking annual procurement audit and FMOH and Bank team to consult OFAG on the feasibility of undertaking Report on feasibility of financial and value undertaking financial and value for money audits for Money audits for SDGPF by for SDGPF. Fiduciary Systems Client Recurrent Yearly FPPA Review and improve the SBD and agree with FPPA; and review current Bid Evaluation reporting methods and develop a template that keeps and records all relevant evaluation Improved Standard Bidding information Fiduciary Systems PSA Recurrent Yearly Document Improve tracking system of monitoring contracts with UN agencies and disclose award Disclosed award decisions of UN decisions to the Agencies based on the developed public Fiduciary Systems Client Recurrent Yearly tracking system Undertake assessment study and develop coding and categorization Developed and implemented the system of coding and categorization system procurable items Fiduciary Systems Client Recurrent Yearly of procurable items Gender based violence strategy for the health sector is prepared and implemented and analysis of gender disaggregated Developed health sector Gender HMIS data is Based Violence strategy and conducted disclosed gender analysis from Technical Client Recurrent Yearly HMIS. Page 26 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) Conduct Training and regular implementation support of health workers at the facility level on cause of death as per national disease notification codes, registration of births and other VE registration Provided training for health requirements. Technical Client Recurrent Yearly workers on CRVS. MoH Provides and Federal Ethics and Anti- corruption ( FEACC) verify and submit to the Bank quality and timely biannual report on Fraud and Corruption complaints and Biannual report on fraud and priority actions corruption complaints verified related to the and submitted by Federal Ethics program Fiduciary Systems MOH and FEACC Recurrent Semi-Annually and Anti Corruption Commission. Ensure inclusiveness of Fraud and Corruption and complaint handling processes or priority actions in FMOH and Regional Health Fraud and corruption and Bureaus joint compliant handling process forum discussions discussed at joint FMOH- RHB semiannually. Fiduciary Systems Client Recurrent Continuous meeting Availing appropriate temporary storage facilities for collection of hazardous wastes until final disposal, enforce compliance with MWM and Availed temporary storage Disposal Directive Environmental and Social facilities for collection of in HF constructed Systems MOH Recurrent Continuous hazardous medical wastes. Page 27 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) before issuance of the Directive Update relevant documents to incorporate environmental impact and risk criteria in site selection screening for all health facilities, strengthen the coordination and reporting Developed a document/checklist mechanism on to incorporate environmental social and impact and risk criteria in the site environmental Environmental and Social selection template for safeguard in MOH. Systems Both Due Date 31-Dec-2018 constructing health facilities. Documenting consultations and participatory nature of discussions where communal land is used for construction of health centers and where applicable compensation for Report on documenting land and Environmental and Social consultations using the developed livelihood paid. Systems Client Recurrent Continuous checklist. Documenting outreach and specific actions focused on providing services to all vulnerable Report on actions taken on persons Technical Client Recurrent Continuous vulnerable group Implementation of the postnatal care Implemented Postnatal Care directive/policy. Technical FMOH Due Date 31-Dec-2020 directive . Page 28 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) Table II.1: Current status of PAP Actions, December 2019 No Actions Current Status Need for Restructuring 1 Development and implementation of a Postnatal Completed in 2019 No Care Directive/policy 2 Commodity distribution process - Roll out of APTS Report on track No and provide progress update to ensure existence of adequate monitoring mechanism of delivery to ultimate beneficiaries at the branch level 3 PFSA launches an open call for pre-qualifications Launched an open call prequalification No. bidders as per the Recipient's law at least once and and introduced framework contract introducing Framework Contracting Methods for methods common and repetitive procurement items. 4 Ensure the deployment of Ethics and Off track. No. As this is a requirement by Anticorruption Liaison Officer and experts at all government law and is also a levels (PSA; PSA regional Hubs; RHBs, woreda requirement in the PforR, the offices) and establish a system of recording fraud action remains. and corruption complaints at all levels including woredas 5 Automation of EPSA Off track. No. The long-term intervention is captured as DLI. 6 FPPA undertaking annual procurement audit and PSA 2010 EFY procurement audit done; Off track. Procurement audit is a FMOH and Bank team to consult OFAG on the Action Plan developed in Amharic that legal covenant for fiduciary feasibility of undertaking financial and value for needs to be translated to English assurance. The 2010 EFY audit money audits for SDGPF report has not been received to date. 7 Review and improve the SBD and agree with FPPA; Completed No. Bid Evaluation Template and review current Bid Evaluation reporting remains to be done. methods and develop a template that keeps and records all relevant evaluation information 8 Improve tracking system of monitoring contracts Progress with limitations. Tracking sheet No with UN agencies and disclose award decisions to needs improvement the public. 9 Undertake assessment study and develop coding Completed No and categorization system of procurable items 10 Gender-based violence strategy for the health GBV Strategy development underway; No. The draft Strategy was sector is prepared and implemented and analysis discussion with MOH PPD is required on submitted in mid-December 2019 of gender disaggregated HMIS data is conducted gender disaggregated HMIS data analysis 11 Conduct training and regular implementation Integrated training conducted – report No support of health workers at facility level on cause will be shared soon of death as per the national disease notification codes, registration of births and other VE registration requirements 12 MoH Provides to Federal Ethics and Anti-corruption On track – PSA has reported to Anti- No (FEACC) verify and submit to the Bank quality and Corruption. MOH needs to follow up to timely biannual report on Fraud and Corruption make sure the Bank receives the letter complaints and priority actions related to the program Page 29 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) 13 Ensure the deployment of Ethics and Ethics officers in regional hubs have No. As this is a requirement by Anticorruption Liaison Officer and experts at all resigned due to insufficient work loads. government law and is also a levels (PSA; PSA regional Hubs; RHBs, woreda PSA management is assessing the most requirement in the PforR, the offices) and establish a system of recording fraud efficient approach to clustering hubs so action remains. and corruption complaints at all levels including that each ethics officer covers several woredas regions 14 Availing appropriate temporary storage facilities MoH and PSA have established No. Evidence has been provided for collection of hazardous wastes until final incinerator in Adama which can handle bythe MoH on the reported disposal, enforce compliance with MWM and 1000 kg/hr and also MoH has planned progress (established/assigned a disposal directives in health facility constructed to assess the country overall hazardous unit for safeguards coordination). before issuance of the directive wastes burden and produce disposal guidelines this year. 15 Update relevant documents to incorporate MoH working on strengthening the No. environmental impact and risk criteria in site coordination and reporting mechanism selection screening for all health facilities, on social and environmental safeguard strengthen the coordination and reporting mechanism on social and environmental safeguard 16 Documenting consultations and participatory Off track. Discussions ongoing with No. nature of discussions where land acquisition is MOH on improved template and required for construction of health centers and methodology. where applicable compensation for land and livelihood paid 17 Documenting outreach and specific actions focused MOH will have a discussion with the on providing services to all vulnerable persons different directorates and collect No. related documents to strengthen the system to support vulnerable groups Page 30 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) ANNEX III: REVISIONS TO ACTIVITIES AND BUDGET FOR SUB-COMPONENT 1 Table III.A: Summary of the proposed changes in activities and budget for Sub-Copmponent 1: Civil Registration and Vital Statistics Current activities Proposed activities Main activities Budget item Cost Total cost Budget item Cost Total cost Field vehicle for INVEA 115,000 Field vehicle for INVEA 115,000 Support for 4,559,445 4,559,445 supervision Motorcycles for Motorcycles for 4,444,445 4,444,445 woredas woredas Filing cabinets for Filing cabinets for 4,916,266 4,916,266 Safe storage and kebeles kebeles 4,916,266 5,551,555 transfer of forms Document transit bags - - 635,289 for kebeles Project Project Implementation Project Implementation 523,333 523,333 523,333 523,333 management Unit Unit End line project Consultancy for Consultancy for 250,000 250,000 250,000 250,000 evaluation evaluation evaluation IT Consultant 120,000 - - Consulting services for Support for ICT CRVS system design, 0 4,550,956 software development 4,430,956 - and training; ICT strategy Training of CRVS staff at Federal and Regional -Training of registration 1,150,000 Training and level and civil status officials & stakeholders 200,000 200,000 1,650,000 capacity building officers in kebeles Training of health 500,000 workers in kebeles Support for Printing blank vital - - 1,710,368 printing events certificates 0 2,000,000 registration Printing vital events - - 289,632 documents registry books Undertake Strategic plan comprehensive CRVS - - 0 350,000 350,000 (new) assessment and develop strategic plan Advocacy and Printing advocacy awareness - - 0 materials and 115,667 115,667 creation undertaking workshops Total 15,000,000 15,000,000 (B) Revised results framework for Sub-Component 1: Civil Registration and Vital Statistics Page 31 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) Indicator Unit of Baseline Target Frequency Data source Responsibility measurement (2018) Y1 Y2 INVEA % of births administrative occuring in a % 15 25 40 Annual data; INVEA, CSA given year population registered estimates INVEA % of deaths administrative occuring in a % 12 15 25 Annual data; INVEA, CSA given year population registered estimates INVEA Strategic plan Yes/No No Yes - Once administrative INVEA developed data % of kebeles storing and INVEA transferring % 0 50 90 Annual administrative INVEA registration data forms safely Page 32 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) ANNEX IV: EXCLUSION OF EXPENDITURE INCURRED UNDER HIGH VALUE CONTRACT 1. The detail of the expenditure recorded so far in the program and the amount disbursed by the Bank is shown below for reconciliation purposes. In the program’s financial reporting, the procurement of the ambulances is recorded under the expenditure code of 6311 (under the Maternal health component) when the vehicles are delivered and goods receiving notes are made available. As the delivery is done in batches, the status of the 1,114 ambulances is as follows: (i) 602 ambulances have been delivered hence cost of US$ 24,732,308.24 has been completed and reported in the program’s financial statement as shown in the table below; (ii) 154 ambulances have been delivered and documentation completed but the cost of ETB 175,898,713.51 (approximately USD 6 million) will be recognized as expenditure in the 2nd quarter IFR covering the period of October 10, 2019 to January 7, 2020; (iii) the delivery of the final 358 ambulances is at the final stages and expected to be recognized as expenditure once the delivery and documentation is completed. Subsequent IFRs of the program will include the status of the delivery of the remaining ambulances. As can be noted, there will be adequate expenditure to cover the Bank’s payment to the SDG fund even with the exclusion of the amounts paid for the ambulances. Table IV.I: Expenditure of ambulances recognized in the program financial statement as of July 7, 2019 IFR for the quarter Amount in ETB Amount in USD Remark ended 7-Jul-18 401,290,858.48 14,718,757.52 Delivery of 350 ambulances. Account already audited by external auditor 8-Jan-19 278,958,497.23 10,013,550.72 Delivery of 252 ambulances. Amount under audit by external auditor Total 680,249,355.71 24,732,308.24 Page 33 of 35 The World Bank Ethiopia Health MDG Support Operation (P123531) Table IV.II: Expenditure reported by health sector program category, as of July 2019 under the SDG PF Description of activity July 2014 July 2015 July 2016 July 2017 July 2018 July 2019 Total Public Health Commodity Procurement 95,380,265.60 61,798,718.67 80,756,747.06 22,303,682.61 6,757,282.13 38,527,725.83 305,524,421.90 Maternal Health 14,729,305.10 343,505.82 317,983.05 15,442,704.68 24,736,634.43 27,123,929.76 82,694,062.84 Child Health 6,359,391.64 3,542,972.41 15,306,287.67 13,089,271.26 4,473,012.94 11,630,954.44 54,401,890.36 Prevention and Control of Communicable and non-communicable - 71,712,204.96 Diseases 4,027,635.35 16,024,684.62 12,163,093.92 10,528,453.42 28,968,337.65 Health Service Delivery 266,253.83 947,973.28 5,307,712.49 2,316,129.59 1,848,820.94 4,304,708.10 14,991,598.23 Health System Strengthening 4,816,877.72 26,650,908.51 75,797,191.18 19,442,273.54 31,156,862.75 55,859,880.42 213,723,994.12 Health Extension program 5,770,461.38 2,454,086.60 15,623,760.57 3,287,439.60 2,294,903.74 4,723,067.22 34,153,719.11 Human resource development - - - - - 3,448,466.71 3,448,466.71 Miscellaneous 87,850.01 777,939.96 315,842.42 1,058,543.18 368,216.42 1,088,231.91 3,696,623.90 Total 130,858,871.99 100,543,740.60 209,450,209.06 89,103,138.38 82,164,186.77 172,226,835.33 784,346,982.13 Table IV.II: Total amount paid by the Bank so far under the original project and the Additional financing Total amount so far paid Total allocation by IDA and TFs IPF component Amount paid with DLIs IDA 52050 90,000,000.00 75,300,000.00 - 75,300,000.00 TF14107 20,000,000.00 13,800,000.00 - 13,800,000.00 TFA4689 20,000,000.00 13,000,000.00 5,517,480.00 7,482,520.00 IDA 60900 153,000,000.00 123,800,000.00 - 123,800,000.00 TFA4705 20,000,000.00 13,800,000.00 589,082.00 13,210,918.00 Total 303,000,000.00 239,700,000.00 6,106,562.00 233,593,438.00 Page 34 of 35