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INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT     .1. 20433     Cable Address: INTBAFRAD
INTERNATIONAL DEVELOPMENT ASSOCIATION           U.S.A.                  Cable Address: INDEVAS
.O.e<e~i~e0 192012-
Her Excellency
E. Viviana Caro Hinojosa
Minister of Development Planning
Ministry of Development Planning
Avenida Mariscal Santa Cruz Esquina Oruro #1092
Ex Edificio Comibol
La Paz, Bolivia
Re: Plurinational State of Bolivia: Credit No. 4382-BO (Expanding Access to
Reduce Health Inequities Project -APL III)
First Amendment to the Financing Agreement
Excellency,
We refer to the Financing Agreement between the International Development
Association (the "Association") and the Plurinational State of Bolivia (the "Recipient") dated
September 19, 2008, with respect to the above-captioned Project (the "Agreement").
Pursuant to your letter dated June 4, 2012 and the Aide Memoire dated November 8,
2012, requesting the Association to: (a) amend the Agreement; and (b) to cancel a total
amount of SDR 4,850,000 from the Credit, we are pleased to inform you that the Association
acknowledges your partial cancellation request as of June 5, 2012, and agrees to amend the
terms of the Agreement as follows:
1. The designation of "Republic of Bolivia" is hereby amended and replaced throughout
the Agreement by "Plurinational State of Bolivia".
2. Part 1 of Schedule 1 to the Agreement is hereby amended and replaced in its entirety
to read as follows:
"Part 1. Stewardship Role of Health Authorities - Essential Functions in Public
Health
(a)    Strengthening the SNIS in the areas of data gathering, analysis, reporting,
monitoring, supervision, evaluation, management and research, through:
(i)   the design and adaptation of the technical standards, processes,
procedures and standards of the SNIS in public health and
epidemiological surveillance, including: (A) identification and
evaluation of new sectoral and intersectoral information needs
caused by implementation of new health policies; (B) development
of instruments for the capture and validation of the data from
primary and secondary sources of information, securing flows of
information, frequency, quality control, and definition of levels of
information; and (C) development of complementary computer tools
and software for implementation and operation at the national,
departmental and Project-targeted municipalities level;


(ii)  the development of an index to monitor the progress of mothers and
children during the children's two first years of life; and
(iii)  the organization of a national health summit ("Cumbre de Salud") to
define health sector strategies.
(b)    Strengthening the capacity of MSD and of the Recipient's departmental and local
health authorities in order to apply modem management methodologies and
instruments, to design programming based on priority and goal selection, and to
establish a results-based management system, through:
(i)    the provision of technical assistance to develop and implement
standard practices and management tools, including: (A) the
preparation and validation of norms, processes, methodologies, and
management tools; and (B) the carrying out of training for national
and departmental level public health staff in the use of new standard
practices, processes, methodologies and management tools,
monitoring, project and programs evaluations;
(ii)  the dissemination of the health results achieved by the Recipient's
national, departmental and municipals governments during their
respective management periods, through community meetings,
workshops and publications financed by the Project; and
(iii)  the strengthening of MSD's human resources policy, including the
upgrading of the human resources data captured by SNIS in order to
identify gaps, limitations of training, evaluation of performance and
the updating of regulatory framework for the management of human
resources of the sector."
3. Part 2 of Schedule 1 to the Agreement is hereby amended and replaced in its entirety
to read as follows:
"Part 2. Family, Community and Intercultural Health
(a)    Development and strengthening of health referral networks, through:
(i)   the carrying out of a study to analyze and determine the status of
resources and existing capacities of the health networks in the Target
Areas;
(ii)  the renovation of public health facilities, public housing, the
purchase of medical equipment therefore, the carrying out of the
Social Investment and Productive Fund (FPS), financial audits and
the financing of FPS operating costs;
(iii)  the development of capacity in quality management concepts; and
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(iv)   the development and implementation of standards and instruments of
quality management in the provision of health services."
4. Part 3 of Schedule 1 to the Agreement is hereby amended and replaced in its entirety
to read as follows:
"Part 3. Health Insurance Program
(a)    Support the rollout of a universal health insurance program record system for
the enrollment of families and individuals, through:
(i)    the carrying out of training in use of the enrollment system for key
personnel, operational personnel and community leaders; and
(ii)   the design, printing and distribution nation-wide of a family health
enrollment form ("Carpeta Familiar"). "
5. Section I.B.2 of Schedule 2 to the Agreement is hereby amended and replaced in its
entirety to read as follows:
"2.    At all times during the execution of the Project, MSD shall maintain a team
responsible for the implementation of the Project (UGESPRO and Technical Area),
with staffing numbers, qualifications, functions and responsibilities satisfactory to the
Association, including, inter alia, the following responsibilities:
(a)    overall planning, coordination, monitoring and evaluation of Project
activities; and
(b)    the updating of the Procurement Plan and the elaboration of the annual
implementation plan."
6. Section I.C.2 (c) of Schedule 2 to the Agreement is hereby amended and replace in its
entirety to read as follows:
"(c)   Project implementation indicators and the procedures for the monitoring and
evaluation of the Project, including for compliance with Section II of
Schedule 2 to this Agreement;"
7. Section I.E.3 of Schedule 2 to the Agreement is hereby amended and replaced in its
entirety to read as follows:
"3.     Not later than 90 days after the Effective Date, the Recipient shall ensure
that the UGESPRO and the Technical Area are fully staffed and operational, and
shall maintain them thereafter throughout the implementation of the Project."
8. Section IV.A.2. of Schedule 2 to the Agreement is hereby amended and replaced in
its entirety to read as follows:
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"2. The following table specifies the categories of Eligible Expenditures that may be
financed out of the proceeds of the Financing ("Category"), the allocations of the
amounts of the Credit to each Category, and the percentage of expenditures to be
financed for Eligible Expenditures in each Category:
Amount of the Credit   Percentage of Expenditures
Allocated              to be Financed
Category                  (expressed in SDR)       (inclusive of Taxes)
(1) Goods, consultants' services,          1,510,000                   100%
Training and MSD Operating
Costs for Part 1 of the Project
(2) (a) Goods, consultants' services,        400,000                   100%
training and MSD Operating Costs
for Part 2 of the Project except for
Part 2 (a) (ii);
(b) Works, goods and consultants'
services (including audits) under
Part 2 (a) (ii) of the Project; and
(c) FPS Operating Costs under Part
2 (a) (ii) of the Project                200,000           5% of the total cost of the
works, goods and services
under Part 2 (a)(ii) of the
Project paid in tranches as set
forth in the Operational
Manual
(3) Goods, consultants' services,           127,761
Training and MSD Operating  Costs                                      100%
for Part 3 of the Project
(4) Good, consultants' services             512,239
(including audits) and MSD Operating                                   100%
Costs for Part 4 of the Project
(5) Unallocated
TOTAL AMOUNT                           6,850,000"
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9. Section IV.A. 3 (b) of Schedule 2 to the Agreement is hereby amended and replaced
in its entirety to read as follows:
"(b)   "FPS Operating Costs" means reasonable recurrent expenditures (other than
those for consultants' services) incurred by FPS for the purposes of the
Project and directly related to the activities described in the Project,
including, inter alia, salaries of staff, office materials and supplies, operation
and maintenance of office equipment, insurance, vehicle and equipment
operation, bank charges on the Designated Account, transportation, media
publications, travel and per diem of FPS officials for purposes of Project
supervision and printing of materials; and"
10. Section IV.A.3 (c) of Schedule 2 to the Agreement is hereby amended and replaced
in its entirety to read as follows:
"(c)   "MSD Operating Costs" means reasonable recurrent expenditures (other than
those for consultants' services) incurred by MSD for the purposes of the
Project and directly related to the activities described in the Project,
including, inter alia, operation and maintenance of office equipment, bank
charges on the Designated Account, rental of office space, travel and per
diem of MSD officials for purposes of Project supervision and printing of
materials."
11. Section IV.B.3 of Schedule 2 to the Agreement is hereby amended and replaced in its
entirety to read as follows:
"3.    No withdrawals shall be made for payments under Categories (1), 2(a), (3)
and (4) of the table in paragraph A above, until MSD has signed the contracts
of: (i) the UGESPRO's financial management specialist and procurement
specialist; and (ii) the Technical Area's technical coordinator."
12. Section I of the Appendix to the Agreement is hereby amended as follows:
(a)    The following definitions are deleted (and the existing definitions are
consequently renumbered to keep the alphabetical order):
"DILOS" means Directorios Locales de Salud, created pursuant to the
Recipient's Law No. 2426, dated November 21, 2007.
"SU SALUD" means Seguro Universal de Salud, the Recipient's universal
health insurance to be created pursuant to the Recipient's Bill No. 005, dated
2007, submitted to the Recipient's Congress for approval.
"UCOFI" means the administrative unit within MSD which will carry out
financial management and procurement activities, created pursuant to the
Recipient's Resolution No.1059, dated December 13, 2007.
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(b)    The following definition is added, placed in alphabetical order (and the
existing definitions are consequently renumbered to keep the alphabetical
order), to read as follows:
"UGESPRO" means the administrative unit within MSD which will carry out
the financial management and procurement activities, created pursuant to the
Recipient's Resolution No.1028, dated October 16, 2008.
Please confirm your agreement with the foregoing amendment by signing, dating and
returning to us the enclosed copy of this amendment letter. This amendment letter shall be
executed in two counterparts, each of which shall be an original.
The provisions set forth herein shall become effective upon receipt by the
Association of a fully executed original of this Letter Amendment.
Please note that the Restructuring Paper dated November 29, 2012 will be disclosed
on the Association's external website.
Very truly yours,
INTERNATIONAL DEVELOPMENT ASSOCIATION
Susan G. Goldmark
Director
Bolivia, Chile, Ecuador, Peru and Venezuela
Latin America and the Caribbean Region
AGREED:
PLURINATIO AL STATE OF BOLIVIA
By:       7
(Auth rized Representative)
Name: Viviana Caro Hinojosa
Title: Minister of Development Planning
Date:   '___il-U       __LU 0  _
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