Document of The World Bank FOR OFFICIAL USE ONLY Report No. T7663-IQ THE MINISTRY OF HEALTH OF THE REPUBLIC OF IRAQ PROPOSED TRUST FUND GRANT OF US$19.5 MILLION FOR AN EMERGENCY DISABILITIES PROJECT TECHNICAL ANNEX November 23, 2005 Human Development Sector Middle East and North Africa Region This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization. CURRENCY EQUIVALENT (Exchange Rate Effective September 11, 2005) Currency Unit = US$ US$ 1 = Iraqi Dinar 1,465 FISCAL YEAR January to December ABBREVIATIONS AND ACRONYMS CPA Coalition Provisional Authority CQ Selection based on Consultants' Qualifications ECOP Environmental Codes of Practice EDP Emergency Disabilities Project EHRP Emergency Health Rehabilitation Project ESSAF Environmental and Social Screening and Assessment Framework FMA Fiduciary Monitoring Agent FMR Financial Monitoring Report FMS Financial Management Specialist GDP Gross Domestic Product IBRD International Bank for Reconstruction and Development ICB International Competitive Bidding ICRC International Comn-ittee of the Red Cross IDA International Development Association IRFFI International Reconstruction Fund Facility for Iraq ITF World Bank Iraq Trust Fund MIM Master Implementation Manual MOF Ministry of Finance MOH Ministry of Health MOLSA Ministry of Labor and Social Affairs MOPDC Ministry of Planning and Development Cooperation NCB National Competitive Bidding NGO Non-governmental Organization OFFP Oil for Food Programme PIM Project Implementation Manual PFS Project Financial Statements PMO United States Program Management Office PMT Project Management Team PP Procurement Plan PTSD Post Traumatic Stress Disorder PWD Persons with Disability QCBS Quality- and Cost-Based Selection SBD Standard Bidding Document SOE Statement of Expenses TA Technical Assistance TOR Terms of Reference UNDB United Nations Developmental Business UNDG United Nations Development Group UNICEF United Nations Children's Fund USAID United States Agency for International Development WHO World Health Organization Vice President Christiaan Poortman Country Director Joseph P. Saba Sector Director Michal Rutkowski Sector Manager Akiko Maeda Task Team Leader Jean-Jacques Frere MINISTRY OF HEALTH OF THE REPUBLIC OF IRAQ EMERGENCY DISABILITIES PROJECT TABLE OF CONTENTS GRANT AND PROJECT SUMMARY ..............................I A. BACKGROUND AND STRATEGY .2 B. BANK RESPONSE AND STRATEGY .7 C. DETAILED PROJECT DESCRIPTION .8 D. INSTITUTIONAL ARRANGEMENTS AND PROJECT IMPLEMENTATION .10 E. FINANCIAL AND ECONOMIC JUSTIFICATION .17 F. RISKS.18 Annex 1. Result Framework and Monitoring .22 Annex 2: Summary Cost Tables .23 Annex 3: Project Management .26 Annex 4: Procurement Arrangements and Procurement Plan .29 Annex 5: Financial Management and Disbursement .35 Annex 6: Results-Based Supervision Plan .42 Annex 7: Environmental and Social Screening and Assessment Framework .43 Annex 7A. Codes of Practice for Prevention and Mitigation of Environmental Impacts .44 Annex 7B: Safeguards Procedures for Inclusion in the Technical Specifications of Contracts .49 Annex 8A. Proposed Inputs by Center .53 Annex 8B. Cost Estimates by Phase and Center .54 Annex 9: Project Implementation Schedule .55 Annex 10: International Donor Health Activities in the Republic of Iraq .56 Annex 11: Timetable of Key Project Processing Events .60 Annex 12: Names of Staff/Consultants Who Worked on the Project .61 MINISTRY OF HEALTH OF THE REPUBLIC OF IRAQ EMERGENCY DISABILITIES PROJECT GRANT AND PROJECT SUMMARY Grant Recipient: Ministry of Health, Republic of Iraq Beneficiary: Ministry of Health Implementing Agency: Ministry of Health Loan/Credit/Grant: Grant Amount & Terms: US$19.5 million on grant terms Objectives & The overall objective of the Project is to support the Description: delivery of improved rehabilitation and prosthetic services that reduce the burden of physical disability. Specifically, the Project will: (i) support the development of a national policy on disabilities; (ii) increase the capacity of Iraqi institutions and other stakeholders to meet the needs of disabled persons; (iii) strengthen the partnerships between the Government and civil society in provision of services to disabled persons; and (iv) upgrade the infrastructure and equipment of selected rehabilitation and prosthetic centers throughout Iraq. Technical Annex: This Project has been prepared in accordance with Emergency Recovery Assistance procedures (Operational Policy 8.50). There is no Project Appraisal Document for this Project. Disbursement: The Grant is expected to be fully disbursed by September 30, 2007. Closing Date: September 30, 2007 Project ID Number: P096774 Map No. IBRD 34363 MINISTRY OF HEALTH OF THE REPUBLIC OF IRAQ EMERGENCY DISABILITIES PROJECT TECHNICAL ANNEX A. BACKGROUND AND STRATEGY Country Background 1. Abundant natural and human resources enabled Iraq to attain the status of a middle-income country in the 1970s. The country developed good infrastructure and well-performing healthcare and education systems, widely regarded as among the best in the Middle East. Income per capita rose to over US$3,600 in the early 1980s. Since that time, successive wars and a repressive, state-dominated economic system have stifled growth and development and debilitated basic infrastructure and social services. International trade sanctions imposed in 1991 took a further toll on the economy. 2. After hitting a low in the wake of the 2003 invasion, real GDP rose by about 47 percent in 2004, reflecting strong oil prices and partial recovery of the oil sector. Per capita income, which was around US$3,600 in the early 1980s, fell to US$770 by 2001, with a slight increase to US$940 in 2005 - only a quarter of what Iraqis enjoyed twenty-five years ago. Although data remain unreliable, surveys suggest that poverty has worsened in recent years, and unemployment is estimated to be at least 30 percent. The Government continues to provide large untargeted subsidies for food, fuel, and utilities, amounting in total to about 50 percent of GDP. Although the subsidies provide important support for the poor and vulnerable, they distort markets, disproportionately benefit the wealthy, encourage black markets and smuggling, and burden the budget, crowding out potentially more efficient spending on targeted social programs. 3. Real GDP growth is projected at about 2.6 percent in 2005, due to stagnating oil production and exports. Growth is expected to accelerate to about 10 percent in 2006, predicated on increased security and political stability, higher oil production and exports, and continued strong world oil prices. Strong growth also depends on introducing targeted safety nets and implementing structural reforms-including a gradual reduction in subsidies-to contain recurrent spending and allow for sufficient investment and reconstruction. Iraq's overriding challenge, for both stability and economic sustainability, is to improve the management and transparency of oil revenues. Current Challenges 4. Over the past year, Iraq has had two political transitions, taking steps toward a constitutionally- elected government. Nevertheless, the country faces a violent insurgency that is impeding reconstruction and economic recovery. The pressing and immediate challenges are to restore the rule of law, establish political legitimacy, and begin to build credible and inclusive institutions. The ability of the Iraqi Transitional Government to include ethnic and religious groups in the political process will be an important factor in determining whether a future constitutionally-elected government will improve security and stability, which are preconditions for successful reconstruction. In October 2005, a referendum was held on the new constitution. In December 2005, national elections for the establishment of a new government were held. 5. Persistent violence has affected most parts of the country, and continues to hinder reconstruction efforts, economic recovery, and institutional reform. The instability has hindered the delivery of basic services to the population by slowing reconstruction efforts, impeding private investment, and adding 2 significantly to security costs. Most services have not returned to their pre-2003 levels, and regional disparities continue. Disabilities and the Health Sector 6. The ongoing violence, large number of war veterans from recent conflicts, and the breakdown of community support systems with limited access to health and rehabilitation services are having a devastating effect on persons with disabilities (PWD) in Iraq, and increasing the already high burden of disease. The burden imposed on Iraqi society by disabilities is huge. Given the high unemployment rates and poor community services, becoming disabled poses a serious risk for the entire family to slip into poverty. Incomes foregone by PWD are compounded by the opportunity cost to the family caregiver who might otherwise be participating in the labor force. When disability affects the head of a household, the impact on a family's welfare can be devastating. In many cases, women in families with PWD, in addition to caring for the family, including the disabled family member, face the additional burden of providing an income for the household and dealing with the social stress that often results from shifting gender roles in the household. This double burden takes a serious toll on women. Children in families with PWD are also less likely to attend school or have higher drop-out rates. 7. Persons with Disabilities. Disabled persons in Iraq represent a distinctly underserved and growing segment of the population. The past two decades of consecutive wars and associated violence have resulted in an ever increasing number of war-related injuries and disabilities among the population. Although current data are not reliable, the on-going conflict continues to exert a heavy toll on the population, and the cumulative number of persons suffering from physical disabilities (excluding blindness, deafness, and disabilities resulting from chronic diseases) is estimated at 250,000. Within this, the number of amputees was 80,000 to 100,000 in 2002, with 80 percent from lower limb amputations and the number of people suffering from spinal cord damage was 8,000. It is estimated that 70 percent of disabled people are male, and 30 percent are female. The specific burden on children is as yet unknown. 8. Key issues for disabled persons include the following: 9. Poverty and lack of social services have emerged as significant issues over the past two decades. In 1980, Iraq's income, education, and health measures were high compared to regional averages. However, in the intervening years, the situation reversed itself. It is estimated that at least two million people are unemployed - about 30 percent of the total workforce - and underemployment is also high. At the same time, due largely to the conflicts and mismanagement of resources, social sector services have declined steadily, in terms of quality of care and resource allocations. This has had the greatest impact on those groups which are the most vulnerable, including PWD. 10. Once considered one of the best in the region, the Iraqi health system has declined significantly over the past two decades. During the 1980s, Iraq's health sector consisted of a highly advanced curative system, with minimal focus on public health. During the 1990s, funds available for health were reduced by 90 percent and health outcomes became among the poorest in the region, and well below levels found in countries of comparable income. According to the 2003 UNICEF/WHO Health and Nutrition Watching Brief, Iraq has the region's second highest infant mortality (83/1,000 live births in 2002) and under-five mortality rates (117/1,000 in 2001), a stark reversal from the improvements in these areas in the late 1970s and early 1980s. During the 1990s, maternal mortality grew three-fold, with about 30 percent of women giving birth without a qualified health worker in attendance. Adult mortality increased and life expectancy fell to under 60 years for men and women by 2000. This is within the context of an expanding population which has doubled in the past 25 years. The population now stands at 27.1 million and is growing at about three percent per year. Over this same period, there has been a serious decline in accessibility and quality of health services. Significant budget cuts, coupled with poor management, neglect, and looting due to recent conflicts, have resulted in deteriorating health services infrastructure. Training opportunities for health professionals also suffered during this period, and as a 3 result, health professionals became isolated from the outside world, and were not able to keep up with advances in the field of medicine. Many in fact chose to leave the country. 11. Care of disabled people has deteriorated significantly over the past two decades as a result of conflicts and mismanagement. The breakdown of community support systems and the limited access to health services and rehabilitation services have had a devastating effect on PWD. The Government's difficulties in providing basic health services have had a particularly negative impact on recent victims of acts of violence. Complications from injuries are common and can result in severe additional disabilities due to lack of appropriate treatment. The capacity of the Government to provide treatment to the victims of war and other violent acts is limited; many complications occur and reconstructive surgery is almost impossible. In the current context, the Government has the double burden of providing adequate care to the recent victims of violence, as well as maintaining care of those whose disabilities are not related to the recent and on-going conflicts. 12. Existing centers dedicated to the rehabilitation of disabled patients and the manufacture of prosthetic limbs have been looted and most of the facilities have suffered heavy physical damage in recent years. There are currently 12 rehabilitation centers in Iraq, and 12 prosthesis workshops, including four in the Kurdistan region, most of which have suffered damage since May 2003. Several workshops are operated with the assistance of international NGOs such as Handicap International and the International Committee of the Red Cross (ICRC), but in most facilities, equipment is obsolete, and medical supplies and raw materials are insufficient. Moreover, it must be noted that the technology has dramatically evolved during recent years, and once the centers are rehabilitated, new equipment reflecting updated technology will need to be provided and the staff retrained. 13. There are also three hospitals for spinal injuries (located in Baghdad and Salah-il-Deen), as well as one former army hospital that provides special care for disabled persons. The existing capacity in- country for the manufacture of artificial limbs could reach 5,000 per year if raw materials were available. This is far below the annual requirement of 20,000 protheses. 14. In addition to the services provided through the Ministry of Health (MOH), the Ministry of Labor and Social Affairs (MOLSA) provides welfare services, as well as some equipment and vocational training, to PWD and their families. The MOLSA operates several specialized institutes for the physically handicapped, the deaf, the blind, and the mentally disabled. It employs most of the social workers in Iraq and was traditionally responsible for the social protection systems put in place in the 1 980s. It is not apparent that close coordination of activities for disabled people exists between the MOH, MOLSA and other ministries and agencies providing disability services, especially in the absence of a coherent national policy on disabilities. For these reasons, participation of the MOLSA in preparation of the Project has been necessary in order to avoid duplication and ensure optimal coordination with the MOH. 15. There has been a dramatic increase in the incidence of Post Traumatic Stress Disorder (PTSD) as a result of the recent conflict. Poverty, instability, and the recent conflict have also taken a toll on the mental health of the population. It is difficult to assess the extent of the mental health burden in Iraq, but research under the recent Bank-financed Post-conflict Mental Health Project in Bosnia showed that in post-conflict societies, mental disorders are widespread and represent a major obstacle to economic development. Poor mental health also reduces job opportunities for affected individuals and stands in the way of development of human and social capital. 16. Given the breadth of the needs in the disabilities area and the limited resources and timeframe, this Project will not focus directly on mental health and depression, although these dimensions of disability will be taken into account in the development of the national framework on disabilities. Addressing the needs of people with these disabilities will also require stabilization of the general security situation, personal safety and job security, strong community support and social support as well as the 4 restoration of adequate health and rehabilitation services. However, the Bank is actively seeking donors to provide parallel support in this area and is also exploring options for supporting these activities with future IDA financing. 17. Many NGOs are now operating in Iraq to help disabled people, but most lack resources and capacity. Establishment of NGOs, except in the northern part of the country where NGOs have been active for a few years, has begun only recently in Iraq. Around 6,000 NGOs have been created in Iraq within the past two years which poses a major coordination challenge. Many of these NGOs are very small, lacking in resources, and poorly organized. In addition, the scope of their activities is not well- defined. Without support, the newly established NGOs working on different aspects of disability have very limited capacity to be effective partners in addressing the needs of disabled people. Partnership with NGOs operating at the community and regional levels presents an opportunity for addressing disabilities issues more efficiently and effectively. Also, given the limited experience of the Government in working with NGOs, both the Government and the NGO sectors will have to invest substantial efforts to learn to work as effective partners in the future, respecting differences in approach and the comparative advantages of each sector. The commitment of the Government to work with the NGO sector in the area of disabilities was re-confirmed during the appraisal mission. 18. The inter-ministerial oversight commission for disabilities has been proposed but not yet formally established under the new Government. Before the 2003 war, a special commission established by the armed forces was responsible for the care of PWD. When this commission was abolished and the facilities operated by the army were transferred to MOH authority, the responsibilities for the care of PWD became unclear. Through the leadership of the Directorate of Medical Operations and Specialized Services of the MOH, a commission - the Iraqi Commission for the Disabled - to be attached to the Council of Ministers, was being considered by in interim Government in 2004. Members of the Board of Directors were to include representatives from eight ministries, representatives of community groups, and representatives of disabled persons. This commission, however, has not yet been formally established under the new Government. Government Strategy and Donor Involvement 19. National Development StrateMv. In July 2005, the Iraqi Transitional Government presented a National Development Strategy (NDS) aimed at placing Iraq on a course toward a diversified market- based economy. The strategy focuses on good governance, private sector-led growth, and strong social safety nets. The four pillars of the NDS are: (i) strengthening the foundations of economic growth; (ii) revitalizing the private sector; (iii) improving the quality of life through, among other things, investing in the social sectors; and (iv) strengthening good governance and improving security. The NDS gives priority in the short term to restoring basic services and creating employment. Although donors pledged US$32 billion at the International Conference for Iraq in Madrid in October 2003, continued lack of security has complicated delivery of donor assistance and lessened its impact on the ground. At the recent Iraq International Conference in Brussels in June 2005, donors were urged to find ways to expedite project implementation and, if necessary, to re-allocate funds to faster disbursing activities. Donors have deposited about US$1 billion in the International Reconstruction Fund Facility for Iraq (IRFFI), which consists of two trust funds, one administered by the World Bank and another by the United Nations. Nearly all donor deposits to IRFFI have been allocated to projects that are ongoing. takes the form of bilateral assistance, mainly from the United States. Japan is the second largest donor. 20. Government Strate2v for Disabled Persons. The Iraq Transitional Government placed high priority on improving its services to support rehabilitation of disabled persons, and their re-entry into productive life. Initiating its response to the above-mentioned challenges, in 2004, the Iraqi Interim Government prepared a strategy document outlining the underlying principles for development of a plan 5 for the recovery of the country's health sector.' The overall objective of the short to medium term strategy is to improve access to and quality of health services for the population of Iraq. The key challenges identified in the strategy include: (i) meeting the most urgent needs of the sector, including rebuilding the health services infrastructure and the human resource capacity of the sector; (ii) strengthening management of the health system; (iii) re-organizing the pharmaceutical sector and providing for an efficient drug-supply chain; (iv) reducing health risks in the population; and (v) tackling the causes for the recent rise in communicable and non-communicable diseases. 21. Within these broad areas, a reform of the physical and psycho-social rehabilitation services is recognized as one of the priority areas of the MOH. In November 2004, the MOH prepared a draft national strategy for the physically disabled which includes an outline of planned interventions to improve the quality of and access to care for people with disabilities.2 Main areas of the plan were identified as: medical rehabilitation of individuals who have suffered serious physical injuries; and psychological rehabilitation of both the individual and the community involved. 22. In this context, the MOH has developed a broad framework for care of disabled people, with realistic targets to be achieved within the next five years. The Project, which would meet only a very small portion of the real needs in the area of medical rehabilitation, could be followed by a more comprehensive project, provided sufficient resources and donor partnerships and support are available, and the security context in the country has improved. 23. Donor Involvement. The MOH, in a recent review of donor support, estimates that donor support to the health sector, totaling about US$1 billion, is committed from four main international donors, i.e., the United States (including the Iraq Reconstruction Management Office, the Department of Defense Iraq Projects and Contracting Office, and USAID), the United Nations (UN) agencies (including WHO, UNICEF and UNFPA), the World Bank, and the Government of Japan. In addition, many other countries have contributed to the effort through the UN and World Bank Trust Funds. The leading donor is the United States with its Supplemental Aid commitment totaling about US$800 million, to support infrastructure rehabilitation and construction (selected hospitals and primary health care centers), equipment, and technical assistance and training for health care workers and MOH management and administration staff. The UN agencies are committed to providing about US$70 million in assistance, primarily to selected hospital emergency wards, National Drug Control Laboratory, ambulances, equipment and supplies, and training programs. WHO support is focused on a non-communicable diseases and mental health program as well as on Primary Care and micronutrient deficiencies. The Government of Japan, which is contributing direct assistance to the health sector in the amount of approximately US$600 million, is supporting rehabilitation of 13 hospitals in southern Iraq; provision of ambulances; and medical equipment for selected hospitals and primary health care centers. Some countries, like the Gulf States, have provided bilateral assistance, and the Multinational Forces and a number of NGOs have given support. A table showing current and planned international donor health activities in Iraq can be found in Annex 10. 24. Most of the recovery support to the health sector - about US$650 million - is going towards improving the infrastructure. About US$260 million is being provided for equipment; and for training and technical assistance, about US$1.0 million is available. The substantial investment in buildings and equipment reflected above is a rational priority for the Iraqi Government, given the years of neglect and deterioration of basic infrastructure and services. 25. Although the total amount of funding committed by the donors to Iraq's overall reconstruction program is very large, the security situation on the ground in Iraq is significantly impeding progress in ' Health, Labor and Social Affairs, Defense, Human Rights, Planning, Education, Sports and Youth, Housing and Reconstruction. Health in Iraq. Ministry of Health. September 2004 2 Rehabilitation and Caring for the Disabled in Iraq. Ministry of Health. November 2004 6 implementing the various donor programs. Recovery of the health sector requires stability and security, and the current violence has created an environment where donors and NGOs cannot freely operate and provide direct support to the recovery program. B. BANK RESPONSE AND STRATEGY 26. The World Bank Second Interim Strategy Note for Iraq was presented to the Bank's Board of Executive Directors in September 2005. The strategy builds on the achievements of the First Interim Strategy Note, and is aligned with the Iraqi Transitional Government's National Development Strategy. The Bank's overarching objective is to help Iraq build efficient, inclusive, transparent, and accountable institutions as needed for stability, good governance, and sustainable economic prosperity. Better institutional frameworks, policies, and systems will improve the efficiency and effectiveness of both national expenditures and international aid. Under the umbrella of institution building, the Bank Group's work program is organized into four pillars, supporting government efforts to: (i) restore basic service delivery; (ii) enable private sector development; -(iii) strengthen social safety nets; and (iv) improve public sector govemance. 27. The strategy relies on the World Bank Iraq Trust Fund (ITF) and IDA to finance projects, and on the World Bank budget for the economic and sector work and policy advice that is needed. The ITF has about US$370 million to cover nine projects which are currently under implementation. The IDA resources that are now available to Iraq amount to US$500 million which are allocated to four selected sectors: water and sanitation, transportation (roads), power, and education. The first IDA project - the Third Emergency Education Project - was approved by the World Bank's Board of Executive Directors on November 29, 2005. The Bank strategy also includes building blocks of analytical work to support the transition to a diversified market economy and the development of a social protection system. Analytical work has been grouped into three clusters: economic reform and transition, public sector management, and poverty and safety nets; and two sectors: health and education. A multi-sectoral institutional capacity building program is ongoing. Rationale for Bank Involvement 28. The World Bank has already begun to focus on supporting the recovery of the health system in Iraq. The first project - the Emergency Health Rehabilitation Project (EHRP) financed through the ITF - aims to improve access to quality emergency services in selected health facilities to serve the urgent needs of the Iraqi population. This objective is being carried out through rehabilitation and equipping of selected emergency services units throughout the country, provision of emergency pharmaceuticals to these units, and strengthening of the planning and management capacity of the central and provincial health administrations. 29. The MOH approached the Bank in October 2004 concerning support to PWD resulting from the war and related accidents. This is an area which has obvious and direct links to the recent conflict and which can unambiguously be considered as an urgent priority for the Government, especially considering the continuous increase in the number of victims as a result of the. current instability and violence. Improving the rehabilitation of the physically disabled can have an immediate and visible impact. The rehabilitation will, in particular, include disabled ex-combatants who are unlikely to be reintegrated into a community if they do not acquire some physical capabilities making it possible for them to re-enter the workforce. This area has not yet been specifically addressed by the donor community, and the Government has recently signaled that this is an urgent priority. The proposed project is consistent with the objectives of the Bank's Human Development Strategy for Iraq, including helping to stem the deterioration of health services, in terms of infrastructure, human resources, and management, and builds logically on the support being provided through the EHRP to restore key services to the most vulnerable in the society. It is also in line with the World Bank Middle East and North Africa Department's current 7 efforts to develop a strategy to support disabled people as a group disproportionately represented among the world's poorest.3 30. The Bank has extensive global experience in supporting these types of interventions in post- conflict and emergency contexts. The Bank's priority is not only to provide immediate assistance in areas of particular need, but also to ensure that sector development takes place through establishment of a sound policy framework that will provide the basis for sustainability and for further reform measures. In addition, decision-makers in Iraq will have the benefit of the Bank's understanding of global good practices in supporting equity, quality, access and accountability in health system reform. 31. Lessons from Post-Conflict Experience. Based on the World Bank's experience with the ongoing EHRP and recent experiences both in Iraq and in post-conflict countries such as Afghanistan, East Timor, Bosnia, Algeria, Sierra Leone and Kosovo, a number of important lessons have been learned and introduced into the design of the proposed project. Below are key lessons learned: * For emergency recovery projects, a simple project design that can be quickly and visibly implemented is most effective. * Close guidance and support to the counterparts implementing the project is essential, given the lack of familiarity with international practices and low level of implementation capacity. * The project should be part of a programmatic framework based on a needs assessment of the sector and close collaboration with other key donors. * Support to emergency priorities should be coupled with capacity building for the implementing institutions and entities in order to improve their ability to implement current and consecutive programs. * In contexts where direct Bank supervision is not possible, adequate training should be provided to local representatives to carry out oversight of the project activities. * In post-conflict situations where there are numerous donor agencies involved, support should be provided to the MOH in establishing an effective coordinating mechanism. This support could be in the form of technical assistance and training in setting up the mechanism within the framework of the project, as well as through "informal" technical advice from the Bank team itself to the relevant MOH counterparts. In addition, the Bank needs to maintain good and frequent collaboration with development partners. C. DETAILED PROJECT DESCRIPTION Project Objectives 32. The overall objective of the Project is to support the delivery of improved rehabilitation and prosthetic services that reduce the burden of physical disability. Specifically, the Project will: (i) support the development of a national policy on disabilities; (ii) increase the capacity of Iraqi institutions and other stakeholders to meet the needs of disabled persons; (iii) strengthen the partnerships between the Government and civil society in provision of services to disabled persons; and (iv) upgrade the infrastructure and equipment of selected rehabilitation and prosthetic centers throughout Iraq. Project Description 33. There will be three project components, namely: (i) Policy Development and Partnerships; (ii) Delivery of Services to Disabled Persons; and (iii) Project Management. 3"A Note on Disability Issues in MENA Region", MNSHD working paper, April 2005. 8 Component 1: Policy Development and Partnerships (US$0.8 million total, including contingencies) 34. The objectives of this component are to: (i) develop a comprehensive policy and legislative framework for disabilities; and (ii) initiate an enabling environment for development of partnerships between the MOH, other ministries, and civil society in the area of disabilities. 35. Policy Development. The Project will support the establishment of a multi-sectoral Disability Working Group (DWG) as a first step in the policy development process. Technical assistance will be provided under the Project to assist in organizing the DWG and preparing its work program. The technical assistance will also support the preparation of a draft national policy framework on disabilities, to be presented to the Prime Minister's Office and the National Assembly for review and adoption. 36. This policy framework will encompass the medical aspects of the rehabilitation process, and will take into account the following aspects of disability in Iraq: prevalence and main causes of disability, economic and social consequences of disabilities, prevention and risk mitigation mechanisms, and policies and strategies to create the enabling environment which permits PWD full participation in society, including access to education and the labor force, and participation in decision making. It will take stock of current knowledge of disability issues in the country, and open the door to new ideas and initiatives that will help mainstream disability as a theme across sectors. 37. Partnerships. The Project will support data collection and assessment of existing NGOs in the area of disabilities in Iraq, as a basis for understanding what kinds of services the NGOs are currently providing throughout the country. To begin building partnerships between NGOs and Government, the Project will also finance a series of conferences/workshops for NGOs and Government officials at an early stage of project implementation. These meetings will provide a forum for exchanging information on ongoing strategies and activities for disabled people, and identifying areas of potential cooperation. The workshops will also be an opportunity to learn more about the current capabilities and resources of the NGOs operating in the field. The Project will also support a public awareness campaign to sensitize the public about the needs of disabled people. 38. In addition, the Project will provide support, on a limited pilot basis (not to exceed US$50,000 in total), to the MOH to contract NGOs for provision of a selected number of specific services, e.g., assisting with registration of disabled persons, distribution of wheelchairs, and community-based surveys. Component 2: Delivery of Services to Disabled Persons (US$18.0 million total, including contingencies) 39. The objective of this component is to improve the delivery of community-oriented rehabilitation and prosthetic services for disabled persons in selected sites throughout the country. The approach is in line with international best practice and with WHO recommendations for the development of community- oriented services for the disabled, and represents a change in direction from the current unsustainable and discriminatory practice in Iraq where rehabilitation, isolation in specialized institutions and primary health care services are provided in large institutions, separate from services for the general population. The new approach promotes provision of services in the community, increasing access and efficiency as well as promoting an inclusive environment. If positive results are achieved during this Project, the next phase would include establishment of a network of additional small community-oriented rehabilitation centers, and further strengthening of the production workshops. 40. The Project will support the construction of six new basic rehabilitation centers, and three new rehabilitation centers with prosthetic workshops. In addition, five existing rehabilitation centers will be renovated. Another four existing rehabilitation centers are in satisfactory condition and therefore will benefit only from training and limited equipment, while the others will receive support in civil works renovation, equipment and training. A table showing the details by rehabilitation center/workshop is in Annex 8A. 9 41. The Project will support procurement of specialized equipment and materials for prosthetic workshops, equipment for rehabilitation centers, computer workstations for management and registration of beneficiaries, and office equipment and furniture for the selected locations. The Project will also support procurement of medical aids, such as wheelchairs and walking aids. A table indicating the comprehensive list of these goods is in Annex 8B. 42. The Project will support training activities to improve the services for physical rehabilitation, including: (i) specialized training for production and fitting of prostheses; (ii) training for physiotherapists; (iii) management training for workshop and rehabilitation center managers; and (iv) specialized training in physical therapy for hospital-based physicians. Training for technicians in the prosthetics workshops will be linked to the procurement of equipment, and any tenders for equipment would include the relevant training. Training of trainers for staff in existing facilities will be organized in appropriate centers in neighboring countries. In addition, the Project will support the training of new physiotherapists to be employed in the new centers. Component 3: Project Management (US$0.7 million total, including contingencies) 43. The objective of this component is to ensure effective administration and coordination of the project activities. Overall project coordination will be carried out by a Project Management Team (PMT) in the MOH. The lead implementing agency for the Project will be the MOH. Responsibility for implementation of the components will rest with the relevant departments of the MOH and other agencies involved in the project. The PMT will build on the capacities already established under the ongoing Emergency Health Rehabilitation Project (EHRP), sharing a Director and the "business office" functions, e.g., procurement, financial, and secretarial/logistical. One PMT Director will be responsible for both EHRP and EDP. Likewise, the Technical Coordinator will be shared by the two projects and will report directly to the PMT Director. Terms of Reference for this position will include day-to-day management of the Project. An Assistant Technical Coordinator will be selected solely for the EDP, and this individual's responsibilities will involve supporting the Technical Coordinator and monitoring and evaluation of the Project. Procurement, financial management and administrative staff of the PMT will be increased to absorb the additional work of the EDP. The DWG will play an advisory role on policy issues relating to the Project. 44. The Project will finance: (i) adequate office equipment and supplies, and one project vehicle; (ii) technical assistance and training for PMT staff in project management, procurement and financial management; (iii) annual external audits of the project; and (iv) operating costs for the PMT, including vehicle and equipment operation and maintenance, communications costs, banking fees, transportation costs, meeting expenses, advertisement fees, representation, and office security arrangements. D. INSTITUTIONAL ARRANGEMENTS AND PROJECT IMPLEMENTATION 45. This section describes in detail the implementation of the EDP, which will provide urgent support in the areas described above. Implementation Arrangements 46. This Project is the second in the health sector to be financed from the ITF. The Ministry of Planning and Development Cooperation (MOPDC) is the Government's designated donor coordination agency for Iraq's reconstruction program. The MOH will be the implementing agency for the Project. 10 47. The PMT in the MOH, which is also the implementing agency for the EHRP, will be expanded to coordinate and manage the EDP. The PMT will have the responsibility for the day-to-day management, coordination and monitoring of the Project activities. The management structure for the Project is reflected in Annex 3. 48. Specifically, the PMT will: (i) coordinate project implementation, and manage the resources of the project; (ii) procure all Grant-financed goods and services under the Project; (iii) operate the financial management system according to World Bank requirements; (iv) act as liaison between the technical agencies involved in the Project and the World Bank; and (v) carry out, on an annual basis, an independent audit of the project. Specifically, in its management capacity, the PMT will ensure that: (a) the project activities are well-coordinated; (b) issues affecting or potentially affecting project implementation are identified and addressed in a timely manner; (c) technical advice is provided to relevant MOH staff in how to develop work plans, write terms of reference, and effectively manage consultant services; (d) safeguard issues are addressed in compliance with the Environmental and Social Assessment Framework (ESSAF); (e) necessary project inputs are provided in a timely and cost-effective manner; (f) project resources are appropriately managed in accordance with Bank requirements for procurement and financial management; (g) effective project monitoring and progress reporting are carried out; (h) there is a systematic outreach to various stakeholders to promote project objectives; and (i) provide secretarial services to facilitate the activities of the DWG. 49. Since most of the project activities will take place in selected rehabilitation centers and prosthetics workshops, the PMT and the MOH Directorates at the Governorate level will need to agree on operational and administrative procedures prior to implementation. As ownership, participation and commitment of the local health authorities are critical for the successful implementation of the project, much attention will be given to this process. A detailed implementation plan for each of the components is in Annex 9. 50. All procurement for project activities will be carried out at the central MOH level, with participation as needed from the MOH Directorate level. Implementation of Component 1: Policy Development and Partnerships 51. Policy Development. The PMT will initiate and be responsible for development of the policy framework for disabilities, and will collaborate in this activity with the DWG. The PMT will be responsible for providing administrative support to the DWG. Activities under this component include technical assistance to develop the policy framework. As the MOH has only a partial role in developing the overall disability policy, it was agreed that the DWG will comprise representatives from other relevant ministries and Government agencies, including the Prime Minister's office and the National Assembly and representatives of the disabled. 52. Technical assistance will involve a senior Iraqi specialist who will lead the establishment of the DWG for the MOH as well as the development of a policy framework. This specialist could work closely with a senior international consultant with expertise in disabilities policy who would provide advisory support. The DWG will also have the support of locally recruited consultants who will undertake surveys and data collection as determined by the DWG. Once established, the DWG, as a first step, will prepare a Mission Statement and a work plan. 53. Partnerships. Implementation of the activities that aim to enhance partnerships with NGOs will rest with the MOH. The MOH will carry out a data collection exercise to gather key information on existing NGOs in the area of disabilities operating in Iraq, to be followed by an assessment of the status and performance of these NGOs. The assessment will yield a classification of NGOs according to the following categories: (i) those providing social support to the disabled; (ii) advocacy groups; (iii) those delivering direct services to the disabled; (iv) those working on prevention, public education and 11 reintegration of the disabled into society; and (v) those working on monitoring the status of the disabled, including registration. 54. The MOH will organize a series of conferences and workshops with regional and local authorities and NGOs at an early stage of project implementation. The key NGOs will be invited to participate in a series of two-three hour coordination meetings with MOH staff, where NGOs will have the opportunity to present their work and areas of interest. The MOH will designate staff to attend these workshops and to serve as focal points for coordination of activities with NGOs. Through this process, the MOH will identify areas of cooperation with NGOs and support capacity building of NGOs, possibly through actively engaging larger experienced NGOs in training and support activities, and will provide limited support to NGOs in implementing specific priority tasks, e.g., distribution of wheelchairs, support to registration of the disabled; data collection and survey work. 55. For the public awareness campaign, a public agency will be used or a suitable firm will be contracted to: (i) develop a public information strategy, defining target audience, approach, and implementation plan; and (ii) support the MOH in carrying out the activities included in the campaign. Implementation of Component 2: Delivery of Services to Disabled Persons 56. Responsibility for the implementation of this component will rest with the PMT in coordination with the health authorities at the Governorate and Directorate levels. The MOH Directorate of Operations and Specialized Medical Services will be responsible for overseeing the delivery and distribution of the medical equipment, prostheses, orthoses and medical aids. The PMT will coordinate to ensure that the activities are carried out according to the project implementation plan. To accelerate the start-up process for civil works supported under this component, the MOH will make necessary preliminary assessments while selected consulting firms will be hired prior to project effectiveness to prepare the design and supervise construction works for the first group of project sites. These firms will be managed by the PMT in cooperation with Governorate level engineers. In addition, a preliminary prototype for the workshops is being prepared by the MOH with the help of consultants, and a list of inputs for completion of the Terms of Reference for these firms is being finalized. 57. The MOH has already prepared draft specification lists for procurement of medical equipment for prosthetic workshops. Equally, draft specification lists are being prepared for equipment for rehabilitation centers and for prostheses, orthoses, medical aids, and raw materials. The delivery of the equipment for the workshops and physical rehabilitation sites will be carried out in coordination with the civil works activities, to ensure that the delivery and installation take place at the appropriate point in the rehabilitation process. Development of the distribution plan for the essential medical aids will be the responsibility of the MOH in close collaboration with other stakeholders. 58. The distribution plan that includes eligibility criteria for medical aids will be carefully prepared and monitored to enable quick distribution of goods without administrative obstacles and with minimal burden on the beneficiaries. Development and implementation of a comprehensive distribution and monitoring plan presents an opportunity for MOH to obtain information on beneficiaries, and to establish close cooperation with other stakeholders in the process of distribution of medical aids to the disabled, including local and international NGOs, clinics, hospitals, and other government agencies working in the field. 59. Activities in this component cover the capacity-building and training activities under the Project. PMT will coordinate the training activities with the Directorate of Specialized Medical Services and will ensure that the following training activities are conducted: (i) technical training for prosthetic technicians; (ii) training for physiotherapists; (iii) management training for managers at all 18 sites; and (iv) specialized training in physical therapy for hospital-based physicians. 12 60. Training for technicians in the workshops will be packaged together with procurement of specialized equipment for these workshops, and the training will be conducted in well-established prosthetic centers. The schedule for the training will also be included in the bidding documents for the equipment. Identification of participants for the training will be the responsibility of MOH in cooperation with the Govemorates. The Project will support the travel arrangements and accommodations for this specialized training, while it is expected that the tuition fees will be covered by other donors or through direct arrangements made by the MOH. 61. The MOH will prepare a detailed plan for training of physiotherapists in cooperation with the Governorates. As is the case for technicians in the workshops, MOH is responsible for recruitment and retaining of staff for the physical rehabilitation centers. In this respect, a detailed plan covering human resources, staffing, and recurrent operational budget for the centers will be prepared early in the Project. 62. Specification of furniture and IT equipment for registration and management purposes will be completed after the design of the centers is finished. Implementation of Component 3: Project Management 63. The MOH will be responsible for ensuring that the PMT is expanded and staffed with sufficient expertise and skills to carry out the implementation of the project. In addition, the MOH is responsible for securing adequate office space within the Ministry for the PMT to accommodate the additional staff that will be added to manage the EDP. The PMT will act as both the coordinating unit for technical implementation of the components, and the "business office" for the Project. The PMT will also provide secretarial support to the DWG. 64. The PMT will comprise: (i) a Director who will be responsible for coordinating the day-to-day activities of both EHRP and EDP, as well as the business office functions of project management, and liaising with the World Bank and the MOH Departments implementing project components; (ii) a Technical Coordinator who will ensure coordination of the technical aspects of both projects; (iii) an Assistant Technical Coordinator who will support the Technical Coordinator and who will be dedicated to the EDP, including project monitoring and evaluation; (iii) a Procurement Officer who will be strengthened by the addition of three specialists (civil works, equipment/medical aids and safeguards); (iv) a Financial Officer to be shared by both projects; (v) two accountants dedicated to the EDP; (vi) an Office Manager; and (vii) an Administrative Secretary. Additional engineers may be hired to support the Project, as needed. In addition, there will be a driver for the EDP project vehicle and a messenger. 65. Experience with the EHRP and other health projects within the region has shown that clear definition of implementation procedures, including PMT responsibilities and support to project activities, is a very important element of a successful project. In order to achieve this objective, the MOH will select well-qualified staff for the PMT, including a full-time Technical Coordinator to support the PMT Director, to ensure that the appropriate oversight and management of the project activities are in place. The Project Implementation Manual (PIM) is being prepared to provide guidance in project management and financial and procurement guidelines and procedures. The PIM will be based on the recently finalized and adopted Master Implementation Manual (MIM) that includes procurement and financial management guidelines and procedures, as well as documents to be used for both ITF-financed projects. It is recognized that the PIM is intended to provide guidance on project implementation and administration to ensure clear understanding between the implementing agency and the Bank. The PIM will be revised during project implementation with the mutual agreement of the Bank and MOH. 13 Procurement 66. Annex 4 of the Technical Annex gives a detailed analysis of the Recipient's institutional capacity to implement procurement, as well as the procurement plan and arrangements for the Project. The procurement plan was agreed with the Recipient, paying particular attention to the initial procurement activities. In order to expedite the initial activities, agreement was reached on the selection of a short list of architectural and engineering (A/E) firms from the pre-qualified long list recently prepared for the EHRP. These short-listed firms will be grouped by geographical location (by governorate and by region), with two or more facilities in each package. The selected firms will be responsible for the design and preparation of the bidding documents and construction supervision of the new rehabilitation centers (with and without workshops) and the renovation and upgrading of existing rehabilitation centers. Terms of Reference (TOR) for the selection of consultants for the initial services have been drafted and the recruitment process is planned for completion within four months of Grant effectiveness. Consultants will be selected based on the Least-Cost Selection (LCS) method. The first packages of civil works contracts (Phase 1), estimated to cost, in the aggregate, about US$2.1 million, will be ready for tendering within about five to six months after Grant effectiveness. Preparation of design and bidding documents for the remaining civil works contracts will be completed in July-August 2006, and completion of such contracts is scheduled for August-September 2007. 67. Procurement of goods (rehabilitation and workshop equipment, medical aids and consumables and other equipment) will be carried out in parallel with the works contracts in order to ensure that installation and testing of the equipment is coordinated with completion of the civil works. Under Project Component 1, Policy Development and Partnerships, NGOs will be contracted for the provision of specific services such as distribution of medical aids to eligible beneficiaries and carrying out of beneficiary surveys. NGOs will be selected in accordance with paragraph 3.16 of the Bank Guidelines for the Selection and Employment of Consultants. Workshops to inform the NGOs about the project and how they can participate will be carried out before the short-listing and selection process. It should be noted, however, that due to the security situation, there may be only a limited number of NGOs with access to specific locations, in which case direct contracting or subcontracting of local NGOs may be the only viable option. Disbursement 68. The proposed Grant of US$19.5 million is expected to be disbursed by Septemnber 30, 2007. Annex 5, Table A describes the allocation of the grant proceeds according to each expenditure category. 69. The Bank's strategy in Iraq is to ensure Iraqi ownership and strengthen institutional capacity by financing operations that are implemented by Iraqi ministries and other recipient entities. Trained PMTs will facilitate implementation and help ensure compliance with fiduciary and other safeguards. PMTs will be employed and paid by the implementing agency at regular salary levels, thereby avoiding the disadvantages of stand-alone Project Implementation Units, which can erode civil service institutional capacity over the medium and long term. The Project will finance specialized technical support in procurement, financial management and other areas, as needed. In addition, to ensure that project funds are used for the purposes intended and to help carry out project supervision on the ground in Iraq, the Bank has hired an independent firm as Fiduciary Monitoring Agent (FMA). 70. As a further compensating control, disbursements will be made primarily through direct payment by the Bank to the contractors, consultants, and vendors. Once authorized by the MOH, direct payments will be made by the World Bank directly into the account of the contractor, consultant, or vendor in a commercial bank capable of receiving funds transferred from the international banking system. 14 71. The project management component and payments below the threshold of US$10,000 normally will be made through payments by the Recipient from its own resources. These payments made from the Recipient's own resources will be reimbursed, on a periodic basis, by the Bank to the MOH upon presentation of full supporting documents, proof of payment and a signed withdrawal application. The Bank may later require the use of Statements of Expenditure (SOE) for payments below US$10,000. The PMT and the main financial counterparts from the MOH will be subject to intensive training in Bank disbursement procedures. Financial Management 72. The project financial resources are extended through the ITF and will be managed within the framework of the MOH systems, regulations and controls. Presently, the MOH is also implementing the EHRP. A financial management assessment was undertaken through meetings with representatives from MOH and the EHRP PMT to update knowledge of the MOH financial management system and to determine the arrangements to be adopted in order to enhance the existing controls and fulfill the reporting requirements of the Project. 73. Based on the result of the assessment and the outcome of the various reports issued by independent auditors and other donors, the fiduciary risk of the Grant not being used for the intended purposes, with due regard to economy, efficiency, and the sustainable achievement of the Project's development, is considered as high. The financial management risk as an element of the fiduciary risk is also high. 74. The financial management arrangements of the Project are basically similar to those being followed under the EHRP, taking into consideration the specific activities under the Project and the hurdles being faced during the implementation of the EHRP. This financial management risk will be partly managed through: (i) reinforcing the present controls as applied by the MOH; (ii) the engagement of a dedicated financial officer and an accountant to manage the project financial activities; (iii) payments to most contractors, consultants and vendors will be made through direct payment method, while payments below the threshold of US$10,000 will be reimbursed to the ministry upon presentation of supporting documentation and proof of payment; (iv) gathering and monitoring the generation of monthly reports by the Directorates/centers on implementation activities; (v) maintaining a fixed assets spreadsheet for purchased and delivered equipment; (vi) using a spreadsheet application to keep track of the project accounts and to generate the project reports; (vii) having a FMA inside Iraq to monitor the project activities and support the PMTs; (viii) the engagement of an independent auditor, with international experience acceptable to the Bank, to perform the project audit and issue an independent auditor's opinion; and (ix) documenting project arrangements in a chapter of the PIM based on the Master Implementation Manual. 75. Despite the above, the residual risks, where possible, will be managed during project implementation through close monitoring and supervision by the Bank team's Financial Management Specialist (FMS). 76. The financial management-related risks and risk management tools are included in tabular form in the detailed risk analysis (Section F). The project financial management arrangements and identified risks are detailed in Annex 5. 15 Project Supervision 77. Project activities will be completed by September 2007. Supervision, to be carried out by the Bank's local consultants and the FMA, will include visits to the MOH, MOF, MOPDC, and MOLSA as well as to the rehabilitation centers and prosthetic workshop sites for the purpose of reviewing implementation progress, impact of project activities, and related documentation. 78. The PMT will prepare and send to the Bank a quarterly progress report. The first report will be due starting at the end of the first quarter following the initial disbursement. The format of the report was agreed during appraisal. 79. The Bank, as the ITF Administrator, will supervise ITF-funded operations in accordance with the Bank's applicable policies and procedures. While staff travel to Iraq is restricted, supervision of recipient- executed operations will be carried out through consultants and the FMA. Each ITF-funded operation is required to include a results-based supervision plan that reflects realities on the ground. 80. Reporting to Donors. The Bank will maintain separate records and ledger accounts in respect of the funds deposited by the donors with the Bank under the ITF. Within ninety (90) days of the end of each quarter (March 31, June 30, September 30, and December 31), the Bank will prepare, on a cash basis, an un-audited statement of receipts, disbursements, and fund balance with respect to the ITF and forward a copy to each donor. Each such statement will be expressed in United States Dollars, the currency in which the ITF funds will be maintained by the Bank. In addition, within one hundred and eighty (180) days of the completion of all disbursements relating to activities financed from the ITF, the Bank will prepare on a cash basis an un-audited financial statement of receipts, disbursements, and fund balance with respect to the ITF and forward a copy to each donor. 81. The Bank will furnish the donors: (a) on a semi-annual basis, a consolidated report describing the operations of the ITF (including contributions, disbursements, and implementation progress) in the preceding six months; and (b) on an annual basis, a management assertion, together with an attestation from the Bank's external auditors, concerning the adequacy of internal control over cash-based financial reporting for trust funds as a whole. 82. The Bank will require a financial statement audit of the ITF to be performed by the Bank's external auditors on an annual basis. The costs of such an audit, including the internal costs of the Bank with respect to the audit, will be charged to the ITF. The Bank will provide each donor with a copy of the auditor's report. 83. The Bank will maintain close consultation and coordination with the donors. The Bank will provide each donor to the ITF with semi-annual reports on its quarterly ex-post evaluation of the activities undertaken by the FMA. Within six months of completion of the activities, or of full disbursement of the contributions, whichever comes later, the Bank will provide a final progress report to each donor, together with a copy of the independent review of the performance of the FMA. Upon request by any donor, the Bank will send to such donor the draft and final reports received by the Bank from the FMA on the activities financed by the contributions. 16 Environmental and Social Safeguards 84. Environmental Safeguards: The Project is rated category "B". Impacts would be those associated mainly with (i) new construction and renovation of Disability Rehabilitation Centers and Workshops (e.g., safety, dust, noise, waste material, and vehicular traffic); (ii) provision of sanitary services, water supply and waste management; and (iii) operation and maintenance of Disability Rehabilitation Centers and Workshops. Because of the emergency conditions, the requirement to carry out a limited Environmental Analysis as part of project preparation will be waived. However, for sub-projects with possible moderate or minor adverse environmental impacts, a limited Environmental Analysis will be carried out during project design for World Bank approval prior to execution of such works. The Environmental and Social Screening and Assessment Framework (ESSAF) was disclosed in the country and in the Infoshop in November 2005. Based on the ESSAF, the following standards will be applied during implementation: (i) inclusion of standard environmental codes of practice (ECOP) in the bid documents for rehabilitation and extension works (Annex 7A); (ii) use of Safeguard Procedures for Inclusion in the Technical Specifications of Contracts (Annex 7B); (iii) use of the Checklist of likely Environmental and Social Impacts of Subprojects; (iv) review and oversight of any major reconstruction works by specialists; (v) implementation of environmentally and socially sound options for civil works; and (vi) provision for adequate budget and satisfactory institutional arrangements to monitor effective implementation and adequately operate and maintain sanitary facilities after project completion. Capacity building on Safeguards and on the implementation of the ESSAF has already been undertaken with the Ministry of Environment and other line Ministries under the EHRP. 85. Resettlement, and Land Acquisition: The Project will include both new construction and renovation of rehabilitation centers and workshops in 18 sites on Government-owned land without squatters. The building extensions will be carried out within existing govemment-owned plots of land which are not occupied by squatters. Therefore, World Bank Operational Policy (OP 4.12) would not be triggered since there would not be any involuntary relocation of populations or expropriation of privately owned land. However, the ESSAF, specifically elaborated for due diligence of emergency projects in Iraq, will be used to ensure that this is indeed the case and, should there be any need for expropriation of privately owned land or/and involuntary relocation of population, the same guidelines would be followed. Quarterly and annual implementation progress reports should include a section for reporting compliance with World Bank safeguard policy. E. FINANCIAL AND ECONOMIC JUSTIFICATION 86. This Project is prepared as part of the interim strategy of the World Bank in addressing the pressing needs of the sector and according to the emergency recovery assistance procedures (OP 8.50). The lack of reliable statistics, the limited economic information, and the speed at which the project has been prepared have prevented more detailed analysis, a familiar constraint in such operations. However, the benefits of the Project's investment are expected to be substantial compared to its costs, as it addresses urgent needs in an environment of devastated infrastructure, deteriorating quality, and escalating needs. The Project will support the construction of six new basic rehabilitation centers, and three new rehabilitation centers with prosthetic workshop. In addition, five existing rehabilitation centers will be renovated. Another four existing rehabilitation centers are in satisfactory condition and therefore will benefit only from training and limited equipment, while the others will receive support in civil works renovation, equipment and training. These facilities are situated in 15 of Iraq's Governorates, and will serve the needs of up to 250,000 PWD who would otherwise not have access to quality rehabilitation services and would be denied the right to work and to lead a productive life. 87. This Project will support expansion of the capacity of the rehabilitation centers to provide for the needs of the disabled, and the prosthetic workshops to provide the prosthetic and orthotic devices needed by those individuals who have suffered loss of limbs. The technical capacity of these centers to handle the needs of the disabled will be improved through technical assistance and training to be provided under 17 the Project. In addition, a total of approximately 1.4 million Iraqis, representing the families of the disabled, will be direct beneficiaries of the Project. It is well-known that the disabled who receive appropriate care and medical aids are less dependent, are once again in a position to contribute to the family income, experience a reduction of social stigma, and are able to resume schooling and other available opportunities, and have the chance once again to become productive members of society. This Project will support expansion of the capacity of the rehabilitation centers to provide for the needs of the disabled, and the prosthetic workshops to provide the prosthetic and orthotic devices required by those disabled without limbs. The technical and management capacity of the system to handle the needs of the disabled will be improved through technical assistance and training to be provided under the Project. By supporting the NGOs, the Project will establish partnerships between the Government and the communities, and stimulate private entrepreneurship in the area of disabilities. Recurrent costs of the facilities renovated and constructed under the Project will be met from the MOH operational budget. Future maintenance costs of these facilities will be covered by the overall MOH budget and do not constitute a sustainability problem. F. RISKS 88. The Project will be implemented in a high-risk environment. Iraq's security environment is unstable, and the country is undergoing a major political transition. The table below provides a summary of the key project risks that have been identified, and the measures to be taken to mitigate those risks. Risk Analysis Risk Rating Mitigation Measures From Outputs to Objectives Transition from Iraq Transitional Government Keeping project simple and focused on well- to new Iraq government after December 2005 S defined priorities. Working closely with elections. Unknown outcomes that could Ministry officials to ensure ownership and affect project implementation. continuity. Administration changes in MOH - Building relationships at the technical level jeopardizing current commitment to project M with current officials to ensure continuity in design and inputs. the event of changes. Multiple efforts and parallel tracking by the Current multi-agency group, chaired by the various agencies and bilateral donors causing MOH, seeks to harmonize efforts and fragmented reform efforts. M responsibilities. Also, the Iraqi Strategic Review Board (ISRB) and its required approval before project financing will ensure minimal overlap. From Components to Outputs Collection of comprehensive information on Working with MOH to identify the major the status/condition of facilities to enable project sites by Governorate and on the basis planning and priority setting may not be N of agreed criteria. The MOH has already collectable within the time constraints of the identified the sites. Project. Rise in insurgency and acts of terrorism could Adopt procedures of confidentiality, low impact on local consultants and contractors. H visibility, and avoid unwarranted publicity in the press. Security conditions deteriorate, making access Use of local contractors and local staff for by contractors to sites and supervision H supervision, plus carefully crafted monitoring difficult. arrangements by governorate/directorate assigned staff. 18 Financial management--inability to comply The current disbursement process of direct with Bank requirements due to systemic WB payments for large contracts will be problems in banking and accounting practices. adopted. Early consultation will be sought M from Financial Management consultants to design a simple system that meets project needs and the Bank's financial management requirements. The Bank's inability to carry out in-country Use of local consultants, two of whom are supervision. already familiar with Bank procedures, to S assist in supervision. Also, use of Fiduciary Monitoring Agents to monitor and do site visits. Failure of government to meet the incremental The capacity building component of the operating and maintenance costs of the Project will provide support to the MOH in investments under the Project. health services management budgeting and S planning. This will include development of monitoring tools to track maintenance of health services facilities and equipment. Difficulties in establishing a functioning The capacity building component of the Disabilities Working Group (DWG) and Project will provide technical assistance to subsequent national strategy on disabilities. H support establishment and on-going operations of the DWG, including preparation of a national strategy on disabilities. Procurement Risks A decree was issued by the Minister of Health The lack of adequate laws and regulations, of rectifying shortcomings in the current moder standard documentation, and procurement practice at the MOH. Periodic persistence of habits acquired by procurement H training is being provided by the Bank in staff in the previous era may take time to Amman, and consultancy funding for change. procurement is included in the project design. Close supervision by Bank staff, including Bank hired procurement consultant based in Lack of experience of procurement staff in Baghdad. Periodic training will be provided procurement planning and unfamiliarity with H to the procurement staff. Capacity building Bankprocurement planningli and unfamiliarity wworkshops given by international consultants Bank procurement guidelines and sound international procurement practice. are planned outside Iraq until conditions permit international experts to work in relative security within Iraq. Post reviews and other procurement matters Inability of Bank procurement staff to H will be covered in the first instance by the supervise the project in the field. local procurement consultant working for the Bank and the Fiduciary Monitoring Agent. Use of Bank local consultants to oversee the Construction delays due to volatile security project activities and to assist the PMT in conditions in Iraq. H managing unforeseen delays. Contract will include provisions to manage such contingencies. High demand of local construction industry Provision has been made in the Project budget may result in shortage of materials and labor for price and physical contingencies and causing delays and high inflation in H contracts would include price adjustment construction prices and contractors might be clauses. unwilling to honor their bid prices. 19 Periodic training will be provided by Bank Contractors lack experience of Bank staff and consultants in Amman. A pre bid procurement procedures. M meeting will be planned before bidders submit bids and MOH will stress the requirement for responsive bids in this meeting. Use of local contractors and local staff and consulting firms for supervision, plus Security condition deteriorate, makingaccmonitoring arrangements by MOH directorate Securty conditions detteroate, makin a staff. A clause in the bidding document will difficult. r be introduced requesting bidders to provide a methodology for accessing the site and conducting work in the rehabilitation and workshops centers. Financial Management Risks Initial Risk Risk Rating Country Level Limited direct knowledge of the Bank about Use of MOH controls strengthened by the the Iraqi government financial systems, PMT verification, parallel accounting system, controls, and procedures. mainly the Direct payment method, hiring of H external auditors, acceptable to the Bank, with international experience, engaging a Monitoring Agent inside Iraq, and documenting all needed procedures in a PIM based on the MIM. Limited knowledge about the Bank's policies Regular communication between the Bank and guidelines by the Iraqi authorities leading M and the PMT and frequent training. to non-compliance. Project Level Limited capacity to meet financial Engaging a dedicated qualified FO and an management requirements of the project at accountant to maintain the financial MOH, directorates and centers. H management function that records commitments, processes payments, maintains project accounts and generates reports. The security conditions which do not allow Requiring both the Fiduciary Monitoring timely visits by the Bank project team to Agent and the external auditor to do periodical perform physical inspections on the H physical inspection for sites under rehabilitation centers and prosthetic workshop rehabilitation, each within his TOR. sites. The lack of a fixed assets management system Having the PMT maintain a fixed assets at MOH. H spreadsheet for purchased and delivered equipment. Delays in issuing authorizations for payments Arranging for streamlined arrangements for leading to overdue contractors' payments and H processing of contract approvals and payment thus undermining competitiveness and leading authorizations. to higher costs. The banking payment system shortfalls, where The Bank issuing payment advices and giving payments may be delayed or lost. M PMT access to ClientConnection to monitor in a timely way the payment date and investigate any significant delays. 20 Possible low level of coordination and Having clear responsibilities and reporting insufficient reporting arrangements between arrangements among all parties involved and the PMT, the directorates and the centers addressing any problem immediately. leading to different results and discrepancies M between reporting on physical progress and related expenditures. Not being able to maintain a project account PMT submitting formal request to MOF and for payment of small amount (less than ensuring account guaranteed throughout the US$10,000) throughout the life of the project H project life. leading to shortages and delays in payments and reimbursements. Overall FM Risk H Overall risk H H = High Risk; S = Substantial Risk; M = Modest Risk: N = Low or Negligible Risk 21 ANNEX 1: RESULT FRAMEWORK AND MONITORING Component Key Performance Indicators Source/Resp Part) Outputs Outcomes 1. Policy Development Policy Development Policy Development * Progress reports (PMT) and Partnerships Disabilities Working Group (DWG) established and mission Policy framework for the disabled statement and work plan prepared. developed and adopted by the Policy framework for disabilities prepared. Government. Partnerships Partnerships Conferences and workshops held for Government officials and At least 3 NGOs have an official NGOs. agreement with the Government to NGOs providing services on a pilot basis to the disabled. deliver services to disabled and their families. 2. Delivery of Services to 6 new basic rehabilitation centers constructed. Number of disabled who received . Procurement reports the Disabled 3 new rehabilitation centers with prosthetic workshop prosthetic devices or other specialized . Field visits (PMT) constructed equipment from the rehabilitated * Progress reports (PMT) 5 existing rehabilitation centers renovated. facilities. Number of staff trained in the area of physical rehabilitation. Number of staff trained in the area of production and fitting of prostheses and orthoses. 3. Project Management Project management team trained to prepare, monitor and The MOH is capable of managing, . PMT reports and Monitoring and manage project activities. supervising and monitoring the project. Evaluation 22 ANNEX 2: SUMMARY COST TABLES (US$ million) Project Cost Summary Cost Trust Including % of Fund % Contingencies Total Financing Financing 1. Component 1. Policy Development 0.75 3.9 0.75 100.0 2. Component 2. Service Delivery 18.04 92.5 18.04 100.0 3. Component 3. Support to Project Management 0.71 3.6 0.71 100.0 Total PROJECT COSTS 19.50 100.0 19.50 100.0 Components by Financiers The Government Trust Fund Total For. Amount % Amount % Amount % Exch. 1. Component 1. Policy Development - - 0.75 100.0 0.75 3.9 - 2. Component 2. Service Delivery - - 18.04 100.0 18.04 92.5 13.25 3. Component 3. Support to Project Management - - 0.71 100.0 0.71 3.6 0.23 Total PROJECT COSTS - - 19.50 100.0 19.50 100.0 13.48 Expenditure Accounts by Financiers The Government Trust Fund Total For. Amount % Amount % Amount % Exch. I. Investment Costs A. Civil Works - - 4.79 100.0 4.79 24.5 1.76 B. Goods Workshop Equipment - - 1.29 100.0 1.29 6.6 1.29 Rehab Equipment - - 1.54 100.0 1.54 7.9 1.54 Prosthesis Materials - - 2.78 100.0 2.78 14.2 2.78 Orthosis Materials - - 0.93 100.0 0.93 4.7 0.93 Medical Aids - - 4.62 100.0 4.62 23.7 4.62 Computers & Peripherals - - 0.10 100.0 0.10 0.5 0.10 Vehicles - - 0.03 100.0 0.03 0.1 0.03 Furniture - - 0.15 100.0 0.15 0.8 0.15 Subtotal - - 11.45 100.0 11.45 58.7 11.45 C. Training - - 1.09 100.0 1.09 5.6 0.09 D. Consultants' Services 1. Firms Design & Supervision Consultants - - 0.85 100.0 0.85 4.4 - Procurement Support - - 0.20 100.0 0.20 1.0 0.18 Other TA - - 0.51 100.0 0.51 2.6 - Subtotal - - 1.57 100.0 1.57 8.0 0.18 2. Individual Consultants - - 0.50 100.0 0.50 2.5 - Subtotal - - 2.06 100.0 2.06 10.6 0.18 E. Operating Costs - - .0.11 100.0 0.11 0.6 - Total PROJECT COSTS - - 19.50 100.0 19.50 100.0 13.48 23 Expenditure Accounts by Components (US$ million) Component Component Component 2. 3. Support 1. Policy Service to Project Development Delivery Management Total I. Investment Costs A. Civil Works - 4.79 - 4.79 B. Goods Workshop Equipment - 1.29 - 1.29 Rehab Equipment - 1.54 - 1.54 Prosthesis Materials - 2.78 - 2.78 Orthosis Materials - 0.93 - 0.93 Medical Aids - 4.62 - 4.62 Computers & Peripherals - 0.09 0.01 0.10 Vehicles - - 0.03 0.03 Furniture - 0.15 - 0.15 Subtotal - 11.41 0.04 11.45 C. Training - 0.99 0.09 1.09 D. Consultants' Services 1. Firms Design & Supervision Consultants - 0.85 - 0.85 Procurement Support - - 0.20 0.20 Other TA 0.45 - 0.06 0.51 Subtotal 0.45 0.85 0.26 1.57 2. Individual Consultants 0.30 - 0.20 0.50 Subtotal 0.75 0.85 0.46 2.06 E. Operating Costs - - 0.11 0.11 Total PROJECT COSTS 0.75 18.04 0.71 19.50 Taxes Foreign Exchange - 13.25 0.23 13.48 24 Procurement Arrangements (US$ million) Procurement Method International National Consulting Competitive Competitive Consulting Services: Bidding Bidding Services LCS Shopping Other N.B.F. Total A. Civil Works - 4.79 4.79 (4.79) (4.79) B. Goods 1. Workshop Equipment 1.29 - - - - - - 1.29 (1.29) (1.29) 2. Rehab Equipment 1.54 - - - - - - 1.54 (1.54) (1.54) 3. Prosthesis Materials 2.78 - - - - - - 2.78 (2.78) (2.78) 4. Orthosis Materials 0.93 - - - - - - 0.93 (0.93) (0.93) 5. Medical Aids 4.62 - - - - - - 4.62 (4.62) (4.62) 6. Computers & Peripherals - - - - 0.10 - - 0.10 (0.10) (0.10) 7. Vehicles - - - 0.03 - - 0.03 (0.03) (0.03) 8. Fumiture - 0.15 - - - - - 0.15 (0.15) (0.15) C. Training - - - - 1.21 - 1.21 (1.21) (1.21) D. Consultants' Services 1. Firms Design & Supervision - - - 0.85 - - - 0.85 (0.85) (0.85) Procurement Support - - 0.08 - - - 0.08 (0.08) (0.08) Other TA - - - 0.51 - - - 0.51 (0.51) (0.51) 2. Individual Consultants /a - - 0.50 - - - - 0.50 (0.50) (0.50) E. Operating Costs/b - - - - - 0.11 - 0.11 (0.11) (0.11) Total 11.16 4.94 0.50 1.45 0.13 1.32 - 19.50 (11.16) (4.94) (0.50) (1.45) (0.13) (1.32) (19.50) Note: Figures in parenthesis are the respective amounts financed by Trust Fund \a To assist in the preparation of equipment lists & specifications, bid evaluations, financial management, etc. \b For Project Management 25 ANNEX 3: PROJECT MANAGEMENT A. Project Management Structure Minister of Health . .. . . .. .. ........ I Disabilities Working Group ... PMT Director --- MOH Internal Auditor (DWG) Assistant Technical Coordinator Technical Coordinator Procurement Officer Finance Officer Office Manager ArchitectslEngineers tAccountants (2) dministrative j 2)Acoutats(2) Secretary 4 Engiiieers (2) | Driver Ir (2)Messenger Key: EquipmenVMedical Aids MOH Assigned Staff Specialist Contracted Staff Safeguards Specialis_ MOH Assigned Staff also working on EHRP _ Safeguards Specialist* _ Contracted Staff also working on EHRP 26 B. Responsibility Matrix Nit. A As,041 , -I ,- , . w L L ,,,, .r- i E..s h. w r 1.00 Financial Management 1.01 Make available funds from own resources E N N N 1.02 Launch Workshop N N S E E 1.03 Document Accounting, Reporting & Auditing N N E S R Procedures 1.04 Appoint Project Auditor (external) N E R S R 1.05 Appoint Consultants 4/ E S R 1.06 Remit Specimen of signatures N E N N N 1.07 Request for reimbursement of own funds from the WB N N E S R 1.08 Prepare requests for direct payments N R E S R 1.09 Review claims and authorize payments N N E 1.10 Make payments within 10 days of payment N N E authorization 1.11 Monitor payments for timeliness E N 1.12 Keep project accounts S E S 1.13 Prepare monthly and quarterly Financial Reports N E S S N 1.14 Supervise FM aspects N N N S E 2.00 Planning, Monitoring & Evaluation 2.01 Establish project preparation, implementation, technical N E S S R monitoring (supervision) & reporting procedures at center and at the Directorate level 2.02 Review PMT procurement procedures S N N S E N 2.03 Conduct Annual audits R R S S E R 2.04 Review implementation progress E N N S N 2.05 Review Technical Documentation and Contracts N S S S E 2.06 Compare Project Estimates with Actual Prices N E S N S 2.07 Recommend improvements to quality of construction N E N N 2.08 Follow up on environmental mitigation measures S E S S N 2.09 Review timeliness of implementation E S S N N 2.10 Conduct site visits to assess progress of work and E S S quality 2.11 Prepare Quarterly Progress Reports for the MOH and N N E S R the World Bank Financial Management consultants 27 No. Activilirs fr C, C rS - n I 3.00 Procurement 3.01 Prepare and revise Procurement Plan in consultation A E S S A with each Directorate/Govemorate 3.02 Select Consultants 5/ N R E S R 3.03 Establish a procurement monitoring system at the MOH R E S R 3.04 Prepare simplified bidding documents for shopping R E S S R procedures for smaller contracts 3.05 Prepare and revise a project implementation manual R E S S S S R 3.06 Prepare Standard Bidding Documents for Works and R E S S R Goods 3.07 Prepare specific contract documents for each center N E S S R package/lot. 3.08 Invite bids/quotes N S ? N N 3.09 Evaluate bids E ? S R R 3.10 Obtain WB No objection if required N E N 3.11 Award and sign contracts N N E N N S 3.12 Monitor progress of works under construction S E S S S S 3.13 Conduct physical inspection of completed hospitals E S S 3.14 Coordinate procurement training of MOH and PMT N N E S N staff 3.15 Conduct training on procurement to Iraqi staff N N N N S E 3.16 Keep records on procurement for all projects. E S Directorate will keep a copy of its project. 3.17 Follow up on complaints N E S N 3.18 Conduct post review E S Key: R=Review/Clear E=Execute S=Support A=Approve N=Notified Legend: MOF: Ministry of Finance; MOH: Ministry of Health; MOH-PMT: Project Management Team (in MOH); DIR: Directorate of Health at Governorate level; Center: Rehabilitation Center; AUD: Financial Auditor; FMA: Fiduciary Monitoring Agent (in the case of civil works, FMA includes the private consultants hired to prepare construction documents and provide design & supervision services); WB: World Bank (Administrator of the Trust Fund) 5 Consultants hired to prepare design, construction documents and administration of the contract and supervision of the works during construction. 28 ANNEX 4: PROCUREMENT ARRANGEMENTS AND PROCUREMENT PLAN I. General 1. Project information: Country: Republic of Iraq Recipient: Ministry of Health Project Name: Emergency Disabilities Project Project No.: P096774 Trust Fund Grant Amount: US$19.5 million Project Implementing Agency (PIA): The Ministry of Health 2. Bank's approval Date of the Procurement Plan: November 17, 2005 3. Date of General Procurement Notice: December 12, 2005 4. Period covered by this procurement plan: Two years II. Goods and Works and Non-Consulting Services 1. Prior Review Threshold: Procurement Decisions subject to Prior Review by the Bank as stated in Appendix 1 to the Guidelines for Procurement: Procurement Method Prior Review Threshold Comments 1. Shopping (Goods and Works) First three purchase orders/contracts 2. NCB (Goods) First three contracts >=US$ 100,000 3. NCB (works) All >=US$200,000 Could be revised during project implementation 4 Direct Contracting/Purchase All 5 ICB (Goods/works) All 2. Reference to Project Implementation Manual The Project Management Team (PMT) will prepare a simple Project Implementation Manual (PIM) by March 2006. The PIM will be based on the MIM which was prepared by an intemational consulting firm financed under the Capacity Building Trust Fund for Iraq. 3. Procurement Packages with Methods and Time Schedule It is not expected at this time that intemational construction contractors will be interested in the works contracts under this project, especially given the current security situation in Iraq and the relatively small size contracts, which will be scattered over 15 Govemorates. Therefore, all civil works contracts will be procured using National Competitive Bidding (NCB) procedures. However, if the security conditions improve during project implementation, the PMT would consider packaging smaller contracts into larger contracts suitable for Intemational Competitive Bidding (ICB) that may attract intemational companies. Procurement of goods will be primarily through ICB, and it will consist primarily of supply and installation of equipment for physical disability rehabilitation centers and equipment for prosthesis workshops, medical aids, consumables, fumiture and office equipment and vehicles. There is no domestic preference under the Project. A detailed procurement plan is attached at the end of this annex. 29 III. Selection of Consultants 1. Selection Due to the emergency nature of the Project, advance procurement will be used for the contracting of Architectural/Engineering (A/E) consultants for the design and supervision of construction of physical rehabilitation centers and workshops located in about fifteen Governorates. About six design/supervision contracts, each estimated to cost about US$200,000 equivalent, are anticipated. Selection of these consulting firms will be based on the Least-Cost Selection (LCS) method. For each of the six groups, a short-list consisting of at least three firms will be prepared based on a long-list of qualified firms, which were developed under the EHRP. Due to the security situation in Iraq, it is not expected that these design/supervision contracts would be of interest to foreign consultants. However, there will be an advertisement in the UJNDB and dgMarket for expression of interest for contracts estimated at US$200,000 or more. NGOs would be needed for the distribution of medical aids to eligible beneficiaries and possibly to undertake other project related activities at the community level. NGOs would be selected in accordance with the provisions in paragraph 3.16 of the Bank Guidelines for the Selection of Consultants and Employment of Consultants. NGOs would be identified, for the preparation of short lists, after holding project-briefing workshops. The criteria for the selection of NGOs would be determined after holding these workshops to better understand how these organizations are established and organized, and the specific conditions under which they can operate. Due to the security situation, there may be cases where direct contracting or subcontracting of NGOs may be the only viable option. 2. Prior Review Threshold Selection decisions subject to Prior Review by the Bank as stated in Appendix I to the Guidelines Selection and Employment of Consultants: Selection Method Prior Review Threshold Comments 1. Competitive Methods (Firms) First three contracts >=US$100,000 2. Single Source (Firms) All 3. Individual Consultants All >=US$50,000 4. Single Source (individual) All 3. Short list comprised entirely of national consultant Based on the response for expression of interest to be advertised in UNDB and dgMarket, a short list of consultants for services may be comprised entirely of national consultants in accordance with the provisions of paragraph 2.7 of the Consultant Guidelines. 4. Any Other Special Selection Arrangements The PMT is considering the employment of individual consultants with experience in Bank procurement, and technical experts with experience in physical disability and workshop equipment, as well as environmental and social safeguards to assist the PMT in the implementation of the project. It is expected that international consulting firms and individuals may not be interested in providing consultancy services within the country while the security situation is as volatile as is the case now in Iraq. However, should the security conditions improve and international consultants show interest, the participation of international consultants would be assessed by the PMT and the Bank team for their inclusion. It is also expected that consulting offices associated with local universities may be included in the short lists. University-based consultants shall not have preference over private consultants. 30 5. Consultancy Assignments with Selection Methods and Time Schedule These are indicated in the procurement plan below. IV. Implementing Agency Capacity Building Activities with Time Schedule The agreed Capacity Building Activities are listed with time schedule Expected outcome / Estimated Estimated Start Date Comments Activity Description Cost (US$) Duration Training on procurement, setting up 200,000 20 months January Local/regional a procurement monitoring system at 2006 to consulting firm the ministry of health, support the September and/or PMT in bidding document 2007 individuals, preparation, technical and training specifications, evaluation of bids and consultants' proposals, inspection of goods and spot physical inspection, and contract management and reporting. 31 Initial Procurement Plan for Works As Agreed with the PMT on November 17, 2005 Etmtd z a ,~ Review Submis- Noxnvta cted u W Procurement Estimated E ~~~~~~~~~~WB No nviat Evau- No Contract Comple- Procurement Locatlon/ Com by Bank sion Ojction ton Opning mar System Eot MI Bid-io to ation & Objec- Award Starte to Ref. # (USS) Ic Decripion DateesOenn a Om Ref. (US$) /c E a' =0 2~~~~~~ (Priori/ edns Date Date Dat cDtioeaeDt Description ~~~~~~ ~~~~~Post) Date ReDm.tan Dte Dt 1. WORKS 1.1 Phase I - Construction of 6 New Rehabilitation Centers EDP.WN.NCB.1.AM.PH.1 Missan Gov./NewAmara Rehab. Center $ 358,000 1 NCB PRIOR 15-Jun-06 30-Jun-06 01-Jul-06 31-Jul-06 30-Aug-06 14-Sep-06 21-Sep-06 05-Oct-06 03-Aug-07 EDP.WN.NCB.2.BAS.PH.1 Basrah Gov./New Basrah Rehab. Center $ 358,000 1 NCB PRIOR 15-Jun-06 30-Jun-06 01-Jul-06 31-Jul-06 30-Aug-06 14-Sep-06 21-Sep-06 05-Oct-06 03-Aug-07 EDP.WN.NCB.3.SAM.PH.1 Muthanna Gov./New Samawa Rehab. Center $ 358,000 1 NCB PRIOR 15-Jun-06 30-Jun-06 01-Jul-06 31-Jul-06 30-Aug-06 14-Sep-06 21-Sep-06 05-Oct-06 03-Aug-07 EDP.WN.NCB.4.BAQ.PH.1 Diyala Gov./New Baquba Rehab. Center $ 358,000 1 NCB PRIOR 15-Jun-06 30-Jun-06 01-Jul-06 31-Jul-06 30-Aug-06 14-Sep-06 21-Sep-06 05-Oct-06 03-Aug-07 EDP.WN.NCB.5.RAM.PH.1 Anbar Gov./New Ramadi Rehab. Center $ 358,000 1 NCB PRIOR 15-Jun-06 30-Jun-06 01-Jul-06 31-Jul-06 30-Aug-06 14-Sep-06 21-Sep-06 05-Oct-06 03-Aug-07 EDP.WN.NCB.6.KAR.PH.1 Karbala GovJNew Karbala Rehab. Center $ 358,000 1 NCB PRIOR 15-Jun-06 30-Jun-06 01-Jul-06 31-Jul-06 30-Aug-06 14-Sep-06 21-Sep-06 05-Oct-06 03-Aug-07 Subtotal 1.1 $ 2,148,000 1.2 Phase 2 - Construction of 3 New Rehabilitation Centers with Workshops EDP.WN.NCB.1.BAG.K.PH.2 Baghdad Gov.New Baghdad/Karkh Rehab. $ 609,000 1 NCB PRIOR 15-Jul-06 30-Jul-06 31-Jul-06 30-Aug-06 29-Sep-06 14-Oct-06 21-Oct-06 04-Nov-06 30-Sep-07 Center & Worksh. EDP.WN.NCB.2.DlW.PH.2 Oadissiyah Gov./New Diwaniyah Rehab. $ 609,000 1 NCB PRIOR 15-Jul-06 30-Jul-06 31-Jul-06 30-Aug-06 29-Sep-06 14-Oct-06 21-Oct-06 04-Nov-06 30-Sep-07 Center & Worksh. EDP.WN.NCB.3.KUT.PH.2 Wassif Goy./New kut Rehab. Center & Worksh $ 609,000 1 NCB PRIOR 15-Jul-06 30-Jul-06 31-Jul-06 30-Aug-06 29-Sep-06 14-Oct-06 21-Oct-06 04-Nov-06 30-Sep-07 Subtotal 1.2 $ 1,827,000 1.3 Phase 3 - Renovation of 5 Existing Rehabilitation Centers EDP.WRNCB1HAMpH3 BaghdadGOVCKarkh/Renov.HamzaRehab. $ 171,000 1 NCB Post 15-Aug-06 N.A. 15-Aug-06 14-Sep-06 29-Sep-06 N.A. 15-Oct-06 29-Oct-06 24-Sep-07 EDP.WR.NCB.2.HIL.PH.3 Babel Gov./Renov. Hilla Rehab. Center $ 171,000 1 NCB Post 15-Aug-06 N.A. 15-Aug-06 14-Sep-06 29-Sep-06 N.A. 15-Oct-06 29-Oct-06 24-Sep-07 EDP.WR.NCB.3.KIR.PH.3 Kirkuk Gov./Renov. Kirkuk Rehab. Center $ 85,000 1 NCB Post 15-Aug-06 N.A. 15-Aug-06 14-Sep-06 29-Sep-06 N.A. 15-Oct-06 29-Oct-06 24-Sep-07 EDP.WR.NCB.4.NAS.PH.3 &h QarGov.Renov NasiriyahRehab Center $ 291,000 1 NCB PRIOR 15-Aug-06 30-Aug-06 31-Aug-06 30-Sep-06 30-Oct-06 15-Nov-06 20-Nov-06 04-Dec-06 30-Sep-07 EDP.WR.NCB.5.TIK.PH.3 Salah Al-Din Gov./Renov. Tikrit Worksh. $ 91,000 1 NCB Post 15-Aug-06 N.A. 15-Aug-06 14-Sep-06 29-Sep-06 N.A. 15-Oct-06 29-Oct-06 27-Aug-07 Subtotal 1.3 $ 809,000 Total 1. Works $ 4,784,000 32 Initial Procurement Plan for Goods As Agreed with the PMT on November 17, 2005 > Lo,,tion/ (Ustimated uZ o = Reie submis- WB No invita- Bid- Evalu- No Contract Comple- 2. GOODS 2.1 Equipment EDP.G.E.rCB.1.PH.0-3 Worshop Equipment u 1,290,000 1 ICB PRIOR 15-Febs 6 02-Mar-06 09-Mar-06 08-Apr-06 08-May-06 23-May-06 07tun-06 07-Ju1-06 31-Aug-07 EDP.G.E.ICB.2.PH.0-3 Rehabilimt Don Equipment S 1,540,000 1 ICB PRIOR 15-Feb-06 02-Mar-06 09-Mar-06 08-Apr-06 08-May06 23-May-06 07-Jun-06 07tul-06 31-Aug-07 Sub-Total 2.1 S 2,830,000 2.2 Materials EDP.G.M.ICB.3.PH.0-3 Prosthesis Materials S 2,780,000 1 [CB PRIOR 314Jan-06 17-Feb-06 18-Feb-06 20-Mar-06 04-Apr-06 20-Apr-06 27-Apr-06 I11-May-06 07-Nov-06 EDP.G.M.ICB.4.PH.0-3 Orthosis Materials S 930,000 1 ICB PRIOR 314-an-06 15-Feb-06 16-Feb-06 18-Mar-06 02-Apr-06 17-Apr-06 27-Apr-06 I11-May-06 07-Nov-06 EDP.G.M.ICB.5.PH.0-3 Medical Aids S 4,620,000 thd ICB PRIOR 154Jan-06 304Jan-06 314Jan-06 02-Mar-06 17-Mar-06 01-Apr-06 1 1-Apr-06 25-Apr-06 22-Oct-06 Sub-Total 2.2 S 8,330,000 2.3 Furnfture, Ofce Equipment & Vehicles EDP.G.F.NCB.1.PH.0-3 Fumiture S 150,000 1 NCB PPJOR 154Jan-06 304Jan-06 31-Jan-06 02-Mar406 17-Mar-06 02-Apr-06 09-Apr-06 23-Apr-06 19-Dec-06 EDP.G.OE.NCB.3.PH.0-3 Computers & Petpherals $ 100,000 1 NCB PRIOR 15-Fan-06 302-an-06 310-an-06 02-Mar-06 17-Mar-06 02-Apr-06 09-Apr-06 23-Apr-06 19-Dec-06 EDP.G.V.SH.1.PH.0 Vehicles (One e $ 30,000 1 SH Post 021an-06 n.a. 15Feb-06 17-Ma02-Mar0609Mar-0108-Ar-06 08-MAy-06 23-MAy-06 07-Jun-06 0-Jul-06 093-un-06 Sub-Total 2.3 $ 280,000 Total 2. Goods $ 11,440,000 33 Initial Procurement Plan for Consultants' Services As Agreed with the PMT on November 2005 Procure- 5.1ev.~~~~~~~~~~~~~~~~~~~~S, Review Adv.rti- Short No 1ii. Eapeetad Tohia , F- .Deslg. oWn ipLoctionl Estlmtfed by Bank name Lisfing & No Ivtto "Poooi Tehia No Fina No Contract Str COOWI.- SProten Pckg. Dourp IonfAio Coolt Pr.io bor EI Dn - Rt Obton f RFP SubmInuion Evaluation Objection Ev aluation Obction Award Dat tion Method Pro . O .t Dote Ot. Date D afe Date D at Dte Date Date Ref.# (USS Million) po t Date RFP/TOR Date 3. CONSULTANTS' SERVICES 3.1 Consuatnt Finno EDP LCS.D&S I.KAR.PH.1 No.1 KarbalaGovJNewiKarbalaRehab. Center $ 65,000 LCS PRIOR 29-Dec-OS 04-Jan-06 09-Jan-06 29-Jan-06 12-Feb-06 19-Feb-06 26-Feb-06 06-Mar-06 12-Mar-06 17-Mar-06 15-Jun-06 EDP.LCS.D&S.2.HIL.PH.3 No.1 BabybDn Gov /Renov. Hila Rehab. Center S 27,000 LCS PRIOR 29-Dec-OS 04-Jan-06 09-Jan-06 29-Jan-06 12-Feb-06 19-Feb-06 26-Feb-06 08-Mar-06 12-Mar-06 17-Mar-06 04-Aug-06 EDP LCS D&S 3.BAG.PH.2 No.2 Baghdad Gon /Kadd'/New Baghdad Rehab. $ 98,000 LCS PRIOR 29-Jan-06 04-Feb-06 09-Feb-06 01-Mar-06 15-Mar-06 22-Mar-06 29-Mar-06 05-Apr-06 10-Apr-06 15-Apr-06 14-Jui-06 Center & Workshop EDP LCS D&S 4.DEW PH.2 No.3 Oadiuuiyah Govn/New Denaniyah Rehab $ 109,000 LCS PRhOR 29-Jan-6 04-Feb-06 09-Feb-06 01-Mar-06 15-Mar-06 22-Mar-06 29-Mar-06 05-Apr-06 10-Apr-06 15-Apr-06 14-Jul-06 Center & Workshop. EDP.LCS.D&S 5.RAM.PH 1 No4 Anbar GovJNew Ramadi Rehab. Center $ 72,000 LCS PRIOR 29-Dec-O5 04-Jan-06 09-Jan-06 29-Jan-06 12-Feb-S6 19-Feb-06 29-Feb-06 06-Mar-06 12-Mar-06 17-Mar-06 15-Jun-06 EDP.LCS.D&S.6.SAM.PH.1 No S Muthnna Gov./NN Samawa Rehab. $ 65,000 LCS Post 29-Dec-O5 044Jan-06 09-Jan-S6 29-Jan-06 12-Feb-06 N.A. 26-Feb-06 NA. 05-Mar-06 19-Mar-06 08-Jun-06 Center EDP.LCS.D&S.7 NAS PH.3 No S Thi Oar GovifRenov NasiryahbReabu. 5 52,000 LCS Post 28-Feb-06 06-Mar-06 11-Mar-06 31-Mar-06 14-Apr-06 N.A. 28-Apr-06 NA. 05-May-O6 10-May-06 08-Aug-06 EDP.LCS.D&S.8 BAD PH 1 No.6 Diyala GovnNew, Baquba Rehab. Center $ 65,000 LCS Pont 29-Dec-O5 04-Jan-06 09-Jan-06 29-Jan-06 12-Feb-06 N.A. 26-Feb-06 N.A. Ob-Mar-06 10-Mar-06 08-Jun-06 EDP.LCS.D&S.9.AMA.PH.1 No 7 Missan GonNew Anara Rebab. Center $ 65,000 LCS PRIOR 29-Dec-05 04-Jan-06 09-Jan-06 29-Jan-06 12-Feb-S6 19-Feb-06 26-Feb-06 05-Mar-06 12-Mar-06 17-Mar-06 15-Jun-O6 EDP.LCS .D&. 10.BAS.PH.1 No 7 Banrah GovJNew Barah Rehab. Center $ 65,000 LCS PRIOR 29-Dec-05 04-Jan-06 09-Jan-S6 29-JanO-6 12-Feb-S6 19-Feb-06 26-Feb-06 05-Mar-06 12-Mar-06 17-Mar-06 15-Jun-06 EDP.LCS.D&Sl1.UT.PH.2 No.8 WanossGov./NeoKutfRehab Center& $ 109,000 LCS PRIOR 29-Jan-06 04-Feb-06 09-Feb-06 01-Mar-06 15-Mar-06 22-Mar4- 29-Mar-06 0-Apr-06 10-Apr-06 15-Apr-06 14-Jui-06 Wotrksh. EDP.LCS.D&S.12.HAMPH3 No.9 Baghdad/KarkhGovJRenov. Hamnsa Rehab. $ 27,000 LCS Post 29-Feb-06 06-Mar-06 11-Mar4-6 31-Mar4-6 14-Apr-06 N.A. 29-Apr4-6 N.A. 05-May-06 10-May-06 0-Aug-0S Center EDP.LCS.D&S.13.KIR.PH.3 No.9 Kirkuk GonjRnev Kirkuk Rehab. Center 5 15000 LCS Post 29-Feb-06 06-Mar4-6 11-Mar4-6 31-Mar-06 14-Apr-06 N.A. 29-Apr-06 N.A. 05-May-06 10-May-06 09-Aug-06 EDP.LCS.D&.1 4.TIK.PH.3 No.9 Salah Al-Din Gov./Renov. TikrktWorksh $ 16000 LCS Post 29-Feb-06 06-Mar-06 11-Mar-6 31-Mar4-6 14-Apr-06 N.A. 28-Apr-06 N.A. 06-May-06 10-May-06 09-Aug-06 EDP.SSS.NGO NGOs To Be ldenmed $ 100,000 SSS PRIOR 02-Apr-S6 0O-Apr-06 13-Apr-06 03-May-06 17-May-06 N.A. 31-Mayr06 N.A. 07-Jun4-6 12-Jun-06 09-Dec-06 EDPLCS.AUDIT Audrtor $ 61,000 LCS PRIOR 15-Jan-06 05-Feb-06 11-Feb-06 16-Feb-06 08-Mar-06 22-Mar-S6 N.A. 29-Mar-06 NA. 06-Apr-06 10-Apr-S6 11-Dec-07 Sub-Tobtl 3.1 $ 1S01100 3.2 indIvidual Conottonts Dsabiltes Working Group (DWG) Local Consutant $ 73.000 IC PRIOR 02-Jan-6 16-Jan-06 23-Jan4-6 29-Jan-06 11-Feb-06 25-Feb-S6 04-Mar-S6 11-Mar-06 18-Mar-Oh 25-Mar-06 01-Apr-06 29-Sep-06 DSabil,ie Policy InternatbonalConsutant $ 227,000 IC PRIOR 02-Jan-S6 16-Jan-06 23-Jan4-6 29-Jan-S6 11-Feb-06 26-Feb-S6 04-Mar-Se 11-Mar-S6 18-Mar-06 25-Mar-06 01-Apr-06 28-Sep-S6 Dsabllte Equ,p.&Med,calAxisEExpert nternationalConsutand $ 81,000 IC PRIOR 02-Jan-06 16-Jan-06 23-Jan-06 28-Jan-06 11-Feb-06 25-Feb-06 04-Mar4-6 11-Mar-06 18-Mar-S6 25-Mar-06 01-Apr-06 28-Sep-06 PMT Coenutants Local M&E, Safeguand,Fduciary $ 136,000 IC PRIOR 02-Jan-S6 16-Jan-S6 23-Jan4-6 28-Jan-06 11-Feb-S6 25-Feb-S6 04-Mar-06 11-Mar-06 18-Mar-Oh 25-Mar-06 01-Apr-06 23-Sep-07 Sub-Total 3.2 $ 517.000 Total 3. Consutant Services 9 1,520U000 34 ANNEX 5: FINANCIAL MANAGEMENT AND DISBURSEMENT Financial Management I. Executive Summary and Conclusion 1. The project financial resources are extended through the ITF and will be managed within the framework of the Ministry of Health systems, regulations and controls. Presently, the MOH is implementing the EHRP that is also financed through the ITF. A preliminary financial management assessment was performed and will be completed during project appraisal. Consequently, the financial management arrangements of the Project would be adapted to enhance the existing controls and to cater to the reporting requirements of the Project. 2. The fiduciary risk of the Grant not being used for the intended purposes, with due regard to economy, efficiency, and the sustainable achievement of the project's development objective, is considered as high. The financial management risk as an element of the fiduciary risk is also considered as high. This rating is the result of the preliminary assessment performed by the Bank team and the outcome of the various reports issued by independent auditors and other donors. 3. The financial management arrangements for this Project are expected basically to be somewhat similar to those being followed under the EHRP, but would be revised based on the specific project arrangements, taking into consideration the hurdles being faced during the implementation of the EHRP. This financial management risk will be partly managed through: (i) reinforcing the present controls as applied by the MOH; (ii) the engagement of a dedicated financial officer and an accountant to follow-on the project financial activities; (iii) payments to most contractors, consultants and vendors will be made through direct payment method, while payments below the threshold of US$10,000 will be reimbursed to the ministry upon presentation of supporting documentation and proof of payment; (iv) gathering and monitoring the generation of monthly reports by the Directorates/centers on implementation activities; (v) maintaining a fixed assets spreadsheet for purchased and delivered equipment; (vi) using a spreadsheet application to follow on the project accounts and to generate the project reports; (vii) having a Monitoring Agent inside Iraq to monitor the project activities and support the PMTs; and (viii) the engagement of an independent auditor, with intemational experience acceptable to the bank, to perform the project audit and issue an independent auditor opinion. All the above activities and procedures will be documented in a chapter of the PIM based on the MIM. 4. Despite the above, the residual risk, where possible, will be managed during project implementation through close monitoring and supervision by the project FMS. 5. The financial management related risks and risk-management tools are included in tabular form in the detailed risk analysis (Section F). The project financial management arrangements and identified risks are detailed at the end of this Annex. 35 II. Managing Financial Management Risk Country Financial Management Risk 6. A Country Financial Accountability Assessment (CFAA) was not undertaken for Iraq. However, many reports, including the IMF-World Bank Report of April 2005 on Iraq Public Financial Management6 , show a high inherent risk in almost all the main functions of a financial management system (budgeting, internal controls, accounting, reporting). The security situation, the huge weaknesses of the banking system which hamper the domestic payment system and the accuracy of the budget reporting, and the many years of isolation that Iraq has encountered also add to that risk. This risk will be partly managed through the implementation and management of the Project by the PMT. Project Financial Management Risk. 7. The project FM risk remains high. A detailed assessment is enclosed within the overall project risk (Section F). It can be summarized by the following: * Limited capacity to meet FM requirements of the Project at MOH and Governorates; * The inability of carrying out on-site supervision missions and physical inspections; * The lack of a fixed assets management system to maintain purchased and delivered equipment and furniture; * Delays in issuing authorizations for payments leading to overdue contractors' payments and thus undermining competitiveness and leading to higher costs; * The banking payment system shortfalls, where payments may be delayed or lost; * Possible low level of coordination and reporting arrangements between the PMT, the directorates and centers; * Not being able to maintain a project account for payment of small amount (less than US$10,000) throughout the life of the project, leading to shortages and delays in payments and reimbursements. III. MOH Project Arrangements 8. The FM risk is partly managed through a set of procedures classified as follows: 9. Payment Authorization and Flow of Information. The project activities, including invoices for advance payments or for actual incurred expenditures, are subject to MOH applicable controls and procedures in addition to the PMT verification and approval. Streamlined arrangements for processing of contract approvals and payment authorizations would be put in place to overcome delays experienced in the current project. 10. Accounting System. The PMT has a financial team composed of a financial officer and an accountant. This team will undertake the project request for payments, accounting and reporting activities. It will coordinate closely with the MOH financial department and the other related points of contact at the MOH directorates. Spread sheet applications will be used to record the project transactions and to track the project accounts and generate the financial reports needed for monitoring and decision-making. 6 Enhancing Sound PFM-Short -to Medium-Terms Reforms 36 Flow of Funds and Controls E-mail Notification of Disbursement --------------------------------------- MOF MOPDC Request Payment . ~~~~MOH/PMT Grant ----------- Account 0| MOHPMT Proiect Account Reimbursements > Contractors, Supplier and Direct Payment Consultants Reporting 11. Ouarterlv: The MOH will generate interim unaudited financial reports/Financial Monitoring Reports (FMRs) and submit them to the Bank within 45 days from the end of the period. These reports are made up of: * Financial Reports: to include a statement of sources and uses of funds by category, uses of funds/expenditure report by directorate and category comparing actual and planned expenditures. Also, a narrative report explaining all variances that exceed 15% when compared to plan and the proposed corrective actions should be included as an annex to the financial reports. * Contracts Reports: to provide information on contracts, including information on all authorized contract variations, showing contracts' financial status against plan, and percentage of works completed against payments. * Equipment and furniture Reports: to provide information on goods purchased and delivered under the project per governorate. 12. The proposed format of the reports is in the project files and has been agreed upon with the MOH representatives during appraisal/negotiations. 13. Annuallv: Audited Project Financial Statements (PFS), showing yearly and cumulative balances, will be submitted to the Bank. PFS will include: * Statement of sources and uses of funds by component. * Appropriate schedules classifying project expenditures by category. * List of commitments or signed contracts. * Statement of equipment and furniture purchased. 37 14. Audit Arrangements. An external independent auditor with international experience will be engaged to perform the project audit and issue an independent opinion on the project financial statements (PFS) and compliance with World Bank Procurement Guidelines and terms of the Grant Agreement. The external audit report will encompass all of the Project's activities and will be in accordance with internationally accepted auditing standards. MOH will remit a project audit report to the Bank not later than four months after the end of each fiscal year. The auditor selection process will be launched directly after the Grant Agreement is signed. An escrow account will be used to pay the auditor after the project Closing Date. In addition to the audit reports, the auditor will prepare a "management letter" identifying any observations, comments, and deficiencies in the system and controls that the auditor considers pertinent, and will provide recommendations for their improvements. 15. Project Implementation Manual. All the above activities and procedures will be documented. within a financial management chapter of the PIM. This manual will be based on the recently finalized and adopted MIM that includes procurement and financial management guidelines and procedures, as well as documents to be used for both ITF-financed projects. 16. Fiduciary Monitoring Agent (FMA). The Bank has engaged an independent firm that will operate in Iraq as FMA for ITF-financed projects. This FMA has dual roles: * Verifying and validating to the Bank the project's financial management and procurement arrangements and internal controls agreed upon with the implementing agencies. * Providing advisory services and technical support to the Iraqi Government and the ITF-financed projects relating to the projects' financial management and procurement arrangements and the generation of periodical and reliable financial reports. IV. Bank Financial Management Supervision 17. Where security conditions make travel to Iraq impossible for Bank staff, supervision missions will be undertaken in an alternative country. The Bank supervision mission after Project Effectiveness will take the form of a Project Launch Workshop where further training on Bank procedures and guidelines will be provided. Intensive supervision will be required initially to ensure that the PMT and the qualified staff from the MOH Finance Department are well-trained in implementation of Bank- financed projects. Action Due Date Start Auditor selection process After Grant Agreement signature Finalize the financial chapter of the PIM December 31, 2005 Engage a financial officer and an accountant December 31, 2005 38 Financial Management Risks Initial Risk Risk Mitigation Measures Rating Country Level Limited direct knowledge of the Bank about Use of MOH controls strengthened by the the Iraqi government financial systems, PMT verification, parallel accounting system, controls, and procedures. mainly the Direct payment method, hiring of external auditors, acceptable to the Bank, with H international experience, engaging a Monitoring Agent inside Iraq, and documenting all needed procedures in a PIM based on the MIM. Limited knowledge about the Bank's policies Regular communication between the Bank and guidelines by the Iraqi authorities leading M and the PMT and frequent training. to non-compliance. Project Level Limited capacity to meet financial Engaging a dedicated qualified FO and an management requirements of the project at accountant to maintain the financial MOH, directorates and centers. H management function that records commitments, processes payments, maintains project accounts and generates reports. The security conditions which do not allow Requiring both the Fiduciary Monitoring timely visits by the Bank project team to Agent and the external auditor to do periodical perform physical inspections on the H physical inspection for sites under rehabilitation centers and prosthetic workshop rehabilitation, each within his TOR. sites. The lack of a fixed assets management system Having the PMT maintain a fixed assets at MOH. H spreadsheet for purchased and delivered equipment. Delays in issuing authorizations for payments Arranging for streamlined arrangements for leading to overdue contractors' payments and H processing of contract approvals and payment thus undermining competitiveness and leading authorizations. to higher costs. The banking payment system shortfalls, where The Bank issuing payment advices and giving payments may be delayed or lost. M PMT access to ClientConnection to monitor in a timely way the payment date and investigate any significant delays. Possible low level of coordination and Having clear responsibilities and reporting insufficient reporting arrangements between arrangements among all parties involved and the PMT, the directorates and the centers M addressing any problem immediately. leading to different results and discrepancies between reporting on physical progress and related expenditures. 39 Not being able to maintain a project account PMT submitting formal request to MOF and for payment of small amount (less than ensuring account guaranteed throughout the US$10,000) through out the life of the project H project life. leading to shortages and delays in payments and reimbursements. Overall FM Risk H Overall risk H H = High Risk; S = Substantial Risk; M = Modest Risk: N = Low or Negligible Risk Disbursement Arrangements 18. The Bank's strategy in Iraq is to implement projects though the Iraqi Ministries (rather than through project implementation units outside government structures), ensuring that appropriate and effective financial controls are in place over the use of funds provided by the Bank, while at the same time working together to strengthen the Ministries' own financial control processes and procedures. Taking into consideration the high risk environment assessed for the Project, including the assessed high financial management risk, the disbursement arrangements will compensate by continuing to use conservative disbursement methods. The disbursement methods to be used will be: (i) Direct Payments to contractors, suppliers and consultants for eligible expenditures, for disbursements over US$10,000. (ii) Reimbursement to the MOH for eligible expenditures under US$10,000 paid from the MOH resources. (iii) Special Commitments to a commercial bank to reimburse the commercial bank for payments made to a supplier against Letters of Credit issued at the request of the MOH for eligible expenditures. 19. These are the disbursement methods that have been used for the existing World Bank ITF projects currently under implementation and which have proven to be effective. Extensive training has been provided to the PMT of the EHRP on the Bank's disbursement processes. Supporting documentation, e.g., copies of invoices and receipts, is required to be provided with all requests to disburse funds. The original copies of the supporting documentation will be maintained by the MOH and made available for review by Bank representatives upon request. 20. The agreements with the Donors to the WB ITF allow for the financing of 100 percent of project expenditures. The MOH contributes implementation support, including the assignment of MOH staff to the PMT, MOH staff support in the MOH Directorates, and some related operating expenses. 21. The allocation of the proceeds of the Grant by expenditure category is as follows: 40 Allocation of Grant Proceeds Amount of Grant Allocated % of Category (Expressed in Expenditures US$ Equivalent) to be Financed (1) Civil works 4,700,000 100% (2) Goods 11,230,000 100% (3) Consultants' services 1,920,000 100% (4) Training 1,190,000 100% (5) Operating costs 110,000 100% (6) Unallocated 350,000 100% Total 19,500,000 41 ANNEX 6: RESULTS-BASED SUPERVISION PLAN (Expected Project Outputs) Quantity VaBlue in AC I li l lYDESCRIPTION DATE Q iS$ uillion Plan Actual Plan Ac[ual Construction of 9 New Rehabilitation Centers and Renovation of 5 Existing Centers at 15 Governorates Phase I: Construction of 6 New Rehabilitation Centers (Rehabilitation Facilities only) at 6 Governorates A Bidding Documents Completed /a June 15, 2006 6 B Construction Contracts Awarded September 21, 2006 6 2.15 C Centers Completed August 3, 2007 6 Phase II: Construction of 3 New Rehabilitation Centers (Rehabilitation Facilities and Prosthesis Workshop) at 3 Governorates A Bidding Documents Completed July 15, 2006 3 B Construction Contracts Awarded October 21, 2006 3 1.83 C Centers Completed September 30, 2007 3 Phase III: Renovation of 5 Existing Centers at 5 Governorates A Bidding Documents Completed August 15, 2006 5 B Construction Contracts Awarded October 29, 2006 5 0.81 C Centers Completed September 24, 2007 5 Equipping and Furnishine of 18 (9 New and 9 Existine) Rehabilitation Centers at 15 Governorates Medical Aids to be distributed through the 18 Project Centers (Wheelchairs, Crutches, Walking Sticks, etc) A Bidding Documents Completed January 31, 2006 - B Contracts Awarded April 11, 2006 - 4.62 C Equipment Delivered July 15-October 22, 2006 Equipment for 18 Project Centers (Rehabilitation Equipment, Workshop Machines and Tools, Prosthesis/Orthosis Materials) A Bidding Documents Completed January 31, 2006 - B Contracts Awarded April 27, 2006 - 6.54 C Equipment Delivered August 31, 2007 Computers & Peripherals for 18 Project Centers A Bidding Documents Completed January 15, 2006 - B Contracts Awarded April 9, 2006 - 0.10 C Equipment Delivered July - December 2006 Furniture for 17 Project Centers A Bidding Documents Completed January 15, 2006 - B Contracts Awarded April 9, 2006 - 0.17 C Equipment Delivered July - December 2006 42 ANNEX 7: ENVIRONMENTAL AND SOCIAL SCREENING AND ASSESSMENT FRAMEWORK Introduction The Environmental and Social Screening and Assessment Framework (ESSAF) will provide the general policies, guidelines, codes of practice and procedures to be integrated into the implementation of the Project (see Annex 7A). Potential Adverse Impact The activities supported by the Project comprise renovation and expansion of disability rehabilitation centers and workshops. Potential adverse environmental impacts (summarized below) are restricted in scope and severity: * Dust and noise due to demolition and construction; * Dumping of demolition and construction wastes and accidental spillage of machine oil, lubricants, etc; * Risk for inadequate use of hazardous anti termite chemicals during foundation works; and * Risk for inadequate handling of wastewater, and waste material during operation of workshops. Handling of Non-medical Wastes It will be the responsibility of MOH to provide training courses for all staff involved in the management of wastes from rehabilitation centers and workshops to make them aware of hazards, as well as to educate patients and visitors on proper hygiene and cleanliness with respect to waste. Public awareness campaigns should be held at the community level. The training of personnel should not solely explain routine procedures, but should also cover emergency procedures, such as what action should be taken as a result of a spillage of particular types of waste. It would also be the responsibility of MOH to develop and monitor supplies and consumer policies which aim to minimize the level of waste generated as a result of the provision of services. In order to ensure the safe and efficient handling and disposal of waste generated in the rehabilitation centers and workshops, it will be necessary to develop operational policies. These should be based upon the central MOH principle of strict segregation between medical and domestic waste and appropriate disposal of waste. In order to be compliant with emerging guidelines and promote an environmentally-conscious approach to waste management, operational policies should also be based on the segregation of domestic waste into organic, non-organic and recyclable categories. Workshops Waste Management Plans The establishment of Workshop Waste Management Plans is not included in the proposed project for renovation and extension of rehabilitation centers and workshops, but the issue should be considered in future projects in Iraq. Factors that govern waste management strategies are the legislative and regulatory framework, and the waste treatment and disposal costs. The waste should be collected by specialist contractors for proper disposal in approved landfills elsewhere in the municipality. 43 ANNEX 7A: CODES OF PRACTICE FOR PREVENTION AND MITIGATION OF ENVIRONMENTAL IMPACTS X~~ H i!| Disease caused by poor water quality: * contamination by seepage from . Prioritize leak detection and repair of pipe networks. latrines, municipal waste or agricultural areas. * Chemical and bacteriological testing of water quality from * high mineral concentrations. adjacent comparable sources prior to installation of new sources. w creation of stagnant pools of Redesign to prevent contamination if adjacent comparable sources are found to be contaminated. * Subsequent monitoring of installed or rehabilitated sources. * Appropriate location, apron and drainage around tubewells and dug wells to prevent formation of stagnant pools. * Provision of cover and hand-pump to prevent contamination of dug wells. * Where pit latrines are used they should be located more than 1 Om from any water source. The base should be sealed and separated by at least 2m of sand or loamy soil from the groundwater table. * Where nightsoil latrines or septic tanks are built they should be sealed. Outflows should drain either to a soak away located at least 1 Om from any water source or be connected to a working drain. 44 Social Risks: * Lack of clear division of rights/ * Ensure sufficient community participation and organization for responsibilities may result in effective planning and management of infrastructure. maintenance problems of maintenanell/u problems o* Include downstream water users (e.g. water supply, irrigation, livestock watering) in planning of water storage reservoirs. * Lack of clear definition of user rights ofoclear definiond f pumpse m * Identify proper mechanism of rights and responsibilities over rights for wells and pumps may well/pump/reservoir usage through participatory village focus create exclusion of vulnerable groups. groups. * Ensure that local accessible materials are used when by interest groups. developing/rehabilitating wells in order to provide maintenance. * Use of foreign equipment! * For each pump/well/reservoir/ borehole establish clear materials may hinder maintenance of pumps/wells. guidelines of user rights through participatory focus groups; Ensure that access to water pumps/reservoirs is equitable to * Potential impacts to cultural prevent capture by interest groups. property. * Use archaeological chance find procedures and coordinate with ap ropriate agencies. S_~~~~~~~~~~~~~~M Contamination of water supplies: * contamination of groundwater * Where pit latrines are used they should be located more than n10m from any water source. The base should be sealed and separated vertically by not less than 2m of sand or loamy soil * contamination of surface waters from the groundwater table. due to flooding or over-flowing. * Where nightsoil latrines or septic tanks are built they should be sealed. Outflows should drain either to a soak away located at least 1 Om from any water source or be connected to a working drain. * Maintenance training to be delivered along with new latrines. Disease caused by poor handling * Training and health education to be provided to nightsoil practices of nightsoil. handlers where affected by interventions. * Protective clothing and appropriate containers for nightsoil transportation to be provided. 45 PotrIT' * ' -YVV '-o^S'~, Disease caused by inadequate * Nightsoil should be handled using protective clothing to excreta disposal or inappropriate prevent any contamination of workers skin or clothes. use of latrines. * Where nightsoil is collected for agricultural use it should be stored for a sufficient period to destroy pathogens through composting. At the minimum it should be stored in direct sunlight and turned regularly for a period of at least 6 weeks. * Septic tanks should not be constructed nor septic waste collected unless primary and secondary treatment and safe disposal is available. * Health and hygiene education to be provided for all users of latrines. * Awareness campaign to maintain sanitary conditions. Potential health and environmental * Secondary treatment of wastewater and chlorination of final risks associated with use of treated effluent followed by aeration prior to restricted wastewater wastewater effluent for irrigation: reuse; initial monitoring of irrigation water quality in irrigation channels in addition to effluent monitoring at treatment plant * Socio-Economic Risk outfall. * Permanent loss of productive * Purchase of replacement land. land * Reduction in local property * Monetary compensation. values * Reconsideration of rate structures. * Ability to pay of poorer segments of o-oulation. IC 3 iL_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Disease caused by inadequate collection and disposal, including health risks from: * insects, rats. * Sufficient frequency of collection from tansfer stations. * burning of waste. * industrial/medical waste. * Containment of waste during collection and transfer. * Promote separation at source to reduce spreading by rag-pickers * Odors during operation. during recycling. * Minimize burning. * Separate collection and disposal system for medical or hazardous wastes. * Assess requirement for additional investment in final disposal site. * Provide daily soil covering. 46 Contamination of water supplies: * Site transfer stations should have sealed base and be located at least 1 5m away from water sources with the base separated * lateral seepage into surface vertically by not less than 2m of sand or loamy soil from the waters. groundwater table. * seepage of contaminants into * Assess requirement for additional investment in final disposal aquifers. site to protect water sources. * contamination from * Monitoring of site to prevent illegal dumping. clandestine dumping. Injury and death from earthquake. * Apply low-cost seismic structural designs. Disease caused by inadequate * Ensure designs include adequate sanitary latrines and access to provision of water and sanitation. safe water. Damage to historical buildings. * Ensure actions involving historical buildings are reviewed/desig ned by qualified specialists. Environmental Impacts: * Improper disposal of wastes. * Ensure inclusion of adequate sanitation facilities and * Improper disposal of medical maintenance. wastes. * Ensure planning, design and maintenance of infrastructure is * Sanitation problems. appropriate to local needs, traditions, culture and desires. * Some construction related * Proper disposal of all solid wastes, containers, infectious * Someconstrctlon elatedwastes. problems but usually minor in nature. * Public health awareness. * Medical waste disposal. * Priority given to rehabilitation of toilets in rehabilitation of * Storage of hazardous materials. /clinics. * Undertake awareness activities to reduce risk of transmission of * Spread of disease from incoming diseases. laborers. 47 Social Impacts: * The vulnerable groups (women, * Before the start of each infrastructure project, develop poor children, migrants, comprehensive organizational and maintenance plan, pastoralists and the poor) may commitment from local government and public to maintain not benefit from infrastructure school supplies, medical supplies, etc. construction and rehabilitation. * health posts may become abandoned due to the lack of commitment. * Building infrastructure system alone without needs assessment may not benefit the community. * Infrastructure investments may be misappropriated by governments. 48 ANNEX 7B: SAFEGUARDS PROCEDURES FOR INCLUSION IN THE TECHMNCAL SPECIFICATIONS OF CONTRACTS I. General 1. The Contractor and his employees shall adhere to the mitigation measures set down and take all other measures required by the Engineer to prevent harm, and to minimize the impact of his operations on the environment. 2. The Contractor shall not be permitted to unnecessarily strip clear the right of way. The Contractor shall only clear the minimum width for construction and diversion roads should not be constructed alongside the existing road. 3. Remedial actions which cannot be effectively carried out during construction should be carried out on completion of each Section of the road (earthworks, pavement and drainage) and before issuance of the Taking Over Certificate: (a) these sections should be landscaped and any necessary remedial works should be undertaken without delay, including grassing and reforestation; (b) water courses should be cleared of debris and drains and culverts checked for clear flow paths; and (c) borrow pits should be dressed as fish ponds, or drained and made safe, as agreed with the land owner. 4. The Contractor shall limit construction works to between 6 am and 7 pm if it is to be carried out in or near residential areas. 5. The Contractor shall avoid the use of heavy or noisy equipment in specified areas at night, or in sensitive areas such as near a hospital. 6. To prevent dust pollution during dry periods, the Contractor shall carry out regular watering of earth and gravel haul roads and shall cover material haulage trucks with tarpaulins to prevent spillage. II. Transport 7. The Contractor shall use selected routes to the project site, as agreed with the Engineer, and appropriately sized vehicles suitable to the class of road, and shall restrict loads to prevent damage to roads and bridges used for transportation purposes. The Contractor shall be held responsible for any damage caused to the roads and bridges due to the transportation of excessive loads, and shall be required to repair such damage to the approval of the Engineer. 8. The Contractor shall not use any vehicles, either on or off road with grossly excessive, exhaust or noise emissions. In any built up areas, noise mufflers shall be installed and maintained in good condition on all motorized equipment under the control of the Contractor. 9. Adequate traffic control measures shall be maintained by the Contractor throughout the duration of the Contract and such measures shall be subject to prior approval of the Engineer. 49 III. Workforce 10. The Contractor should whenever possible locally recruit the majority of the workforce and shall provide appropriate training as necessary. 11. The Contractor shall install and maintain a temporary septic tank system for any residential labor camp and without causing pollution of nearby watercourses. 12. The Contractor shall establish a method and system for storing and disposing of all solid wastes generated by the labor camp and/or base camp. 13. The Contractor shall not allow the use of fuel wood for cooking or heating in any labor camp or base camp and provide alternate facilities using other fuels. 14. The Contractor shall ensure that site offices, depots, asphalt plants and workshops are located in appropriate areas as approved by the Engineer and not within 500 meters of existing residential settlements and not within 1,000 meters for asphalt plants. 15. The Contractor shall ensure that site offices, depots and particularly storage areas for diesel fuel and bitumen and asphalt plants are not located within 500 meters of watercourses, and are operated so that no pollutants enter watercourses, either overland or through groundwater seepage, especially during periods of rain. This will require lubricants to be recycled and a ditch to be constructed around the area with an approved settling pond/oil trap at the outlet. 16. The contractor shall not use fuelwood as a means of heating during the processing or preparation of any materials forming part of the Works. IV. Quarries and Borrow Pits 17. Operation of a new borrow area, on land, in a river, or in an existing area, shall be subject to prior approval of the Engineer, and the operation shall cease if so instructed by the Engineer. Borrow pits shall be prohibited where they might interfere with the natural or designed drainage patterns. River locations shall be prohibited if they might undermine or damage the river banks, or carry too much fine material downstream. 18. The Contractor shall ensure that all borrow pits used are left in a trim and tidy condition with stable side slopes, and are drained ensuring that no stagnant water bodies are created which could breed mosquitoes. 19. Rock or gravel taken from a river shall be far enough removed to limit the depth of material removed to one-tenth of the width of the river at any one location, and not to disrupt the river flow, or damage or undermine the river banks. 20. The location of crushing plants shall be subject to the approval of the Engineer, and not be close to environmentally sensitive areas or to existing residential settlements, and shall be operated with approved fitted dust control devices. 50 V. Earthworks 21. Earthworks shall be properly controlled, especially during the rainy season. 22. The Contractor shall maintain stable cut and fill slopes at all times and cause the least possible disturbance to areas outside the prescribed limits of the work. 23. The Contractor shall complete cut and fill operations to final cross-sections at any one location as soon as possible and preferably in one continuous operation to avoid partially completed earthworks, especially during the rainy season. 24. In order to protect any cut or fill slopes from erosion, in accordance with the drawings, cut off drains and toe-drains shall be provided at the top and bottom of slopes and be planted with grass or other plant cover. Cut off drains should be provided above high cuts to minimize water runoff and slope erosion. 25. Any excavated cut or unsuitable material shall be disposed of in designated tipping areas as agreed to by the Engineer. 26. Tips should not be located where they can cause future slides, interfere with agricultural land or any other properties, or cause soil from the dump to be washed into any watercourse. Drains may need to be dug within and around the tips, as directed by the Engineer. VI. Historical and Archeological Sites 27. If the Contractor discovers archeological sites, historical sites, remains and objects, including graveyards and/or individual graves during excavation or construction, the Contractor shall: (a) Stop the construction activities in the area of the chance find. (b) Delineate the discovered site or area. (c) Secure the site to prevent any damage or loss of removable objects. In cases of removable antiquities or sensitive remains, a night guard shall be present until the responsible local authorities and the Ministry of Culture take over. (d) Notify the supervisory Engineer who in turn will notify the responsible local authorities and the Ministry of Culture immediately (less than 24 hours). (e) Contact the responsible local authorities and the Ministry of Culture who would be in charge of protecting and preserving the site before deciding on the proper procedures to be carried out. This would require a preliminary evaluation of the findings to be performed by the archeologists of the Ministry of Culture (within 72 hours). The significance and importance of the findings should be assessed according to the various criteria relevant to cultural heritage, including the aesthetic, historic, scientific or research, social and economic values. (f) Ensure that decisions on how to handle the finding be taken by the responsible authorities and the Ministry of Culture. This could include changes in the layout (such as when the finding is an irremovable remain of cultural or archeological importance) conservation, preservation, restoration and salvage. (g) Implementation for the authority decision concerning the management of the finding shall be communicated in writing by the Ministry of Culture; and 51 (h) Construction work will resume only after authorization is given by the responsible local authorities and the Ministry of Culture concerning the safeguard of the heritage. VII. Disposal of Construction and Vehicle Waste 28. Debris generated due to the dismantling of the existing structures shall be suitably reused, to the extent feasible, in the proposed construction (e.g., as fill materials for embankments). The disposal of remaining debris shall be carried out only at sites identified and approved by the project engineer. The contractor should ensure that these sites (a) are not located within designated forest areas; (b) do not impact natural drainage courses; and (c) do not impact endangered/rare flora. Under no circumstances shall the contractor dispose of any material in environmentally sensitive areas. 29. In the event any debris or silt from the sites is deposited on adjacent land, the Contractor shall immediately remove such, debris or silt and restore the affected area to its original state to the satisfaction of the Supervisor/Engineer. 30. Bentonite slurry or similar debris generated from pile driving or other construction activities shall be disposed of to avoid overflow into the surface water bodies or form mud puddles in the area. 31. All arrangements for transportation during construction including provision, maintenance, dismantling and clearing debris, where necessary, will be considered incidental to the work and should be planned and implemented by the contractor as approved and directed by the Engineer. 32. Vehicle/machinery and equipment operations, maintenance and refueling shall be carried out to avoid spillage of fuels and lubricants and ground contamination. An "oil interceptor" will be provided for wash down and refueling areas. Fuel storage shall be located in proper bunded areas. 33. All spills and collected petroleum products shall be disposed of in accordance with standard environmental procedures/guidelines. Fuel storage and refilling areas shall be located at least 300m from all cross drainage structures and important water bodies or as directed by the Engineer. 52 ANNEX 8A: PROPOSED INPUTS BY CENTER Facility Equipment New New Renov Renov Medic IT Furniture Name of Center Governorate Rehab Wshop Rehab Wshop Rehab Wshop Pros. Ortho. Aids Equip 1 Baghdad Center Baghdad/Karkh * * * * * * 2 Salam Baghdad/Risafa * * * 3 Hamza Baghdad/Karkh S * * 4 Medical Rehab Center Baghdad/Risafa * * * * 5 Amara Missan * * * 0 6 Baquba Diyala * * 7 Basrah Basrah - 0 0 * * * 0 8 Diwaniyah Qadissiyah _ * * * * * * * 0 9 Erbil Erbil * * 0 * 0 10 Hilla Babel 0 * * 0 * * * 11 Karbala Karbala :t41 i4 0 * * 12 Kirkuk Kirkuk 0 * 0 0 13 Kut Wassit * - * * * * * * 14 Mousil Ninewa * * * 15 Nasiriyiah Thi Qar 0 0 * * * * 0 16 Ramadi Anbar 0 0 0 0 17 Samawa Muthanna 0 * * * 18 Tikrit Salah Al-Din 0 0 * * 0 Totals 18 9 3 4 2 15 5 9 9 18 18 17 Key: IIII::IIIIPhase 1- 6 Centers * Phase II - 3 Centers /,/, Phase IlIl - 5 Centers 53 ANNEX 8B: COST ESTIMATES BY PHASE AND CENTER (in US$ '000) Phase Center Total Phase 0 - Existing Centers to be Equipped & Furnished Salam - - 9 362 371 MRC - - 9 668 677 Erbil - - 9 668 677 Mousil - - 9 362 371 Subtotal Phase 0 - - 36 2,060 2,096 Phase 1 - New Rehabilitation Centers Amara 358 65 9 364 796 Basrah 358 65 9 775 1,207 Karbala 358 65 9 364 796 Samawa 358 65 9 364 796 Baquba 358 65 9 364 796 Ramadi 358 72 9 364 803 Subtotal Phase 1 2,148 397 54 2,595 5,194 Phase 2 - New Rehabilitation Centers with Workshops Baghdad Center 609 98 - 1,036 1,743 Dewaniyah 609 109 9 1,037 1,764 Kut 609 109 9 1,037 1,764 Subtotal Phase 2 1,827 316 18 3,110 5,271 Phase 3 - Existing Centers to be Renovated Hamza 171 27 9 367 574 Kirkuk 85 15 9 367 476 Tikrit 91 16 9 678 794 Hilla 171 27 9 1,039 1,246 Nasiriyah 291 52 9 1,039 1,391 Subtotal Phase 3 809 137 45 3,490 4,481 Grant Total 4,784 850 153 11,255 17,042 Note I Rehabilitation Equipment, Workshop Equipment, Prosthesis Materials, Orthosis Materials, Medical Aids, Computers & Peripherals 54 ANNEX 9: PROJECT IMPLEMENTATION SCHEDULE Calendar Years CY-2005 CY-2006 CY-2007 Months Sep Oct Nov Dec Jan Feb Mar Apr May Jun I Jul Avg Sep 0c Nec Dec Jan Feb Mar Arr May Jun 1Jul Aug Sep Oct Nov Dec Weeks 12341 23412341234123412341234123412341234p 23412341234123 412341234123 May J I A Consultant Selection Process (LCS) I I I PMT finalizes TORFii 3 PMT prepares RFP document & consultant shorthst 4 IDA issues its N.0 I to proceed with invitation I S Consultants prepare & submit technical & financial proposals i 6 PMT evaluates technical proposals & recommends awards - 7 IDA issues its "NO." to PMT to open financial pnoposats I I 8 PMT prepares draft contract and requests N0 t fnom IDA i 9 IDA issues its "NO. to proceed with signing - I 10 PMT signs contractvith consultant - r B Execution of Design Assignment I Desin 3m 1 Consultant conducts Soil Investgation r 2 Consultant submits Schemabc Designs I 3 Client reviews and approves _ 4 Consultant prepares Room & Equip. Layouts 5 Consultant prepares Final Designs F F 6 Client reviews and approves * i . 7 Consultant prepares Bidding Documents WNW C Bidding, Contracting I I Phase I - Now Construction (New Sites) - f I F 1 PMT submits Bidding Documents bo IDA i h 2 IDA issues its N.O to proceed with bidding Construction of Rehabilitation Units at 3 Bidding period 6 New Locations 4 Bid evaluation S IDA issues its 'NO.' (if required) I 15 [ Fumiture/Equi montDelivery B Contract is signed & Contractor moves into site . 1II I . lp 7 Construction period (9-mo 272 days) I _ Phase 11 - New Construction (New Sites) C l; iI l .jig:ii. i T __ .. 1 PMT submits Bidding Documents to IDA I I 7 2 IDA issues its 'NO." to proceed with bidding I Construction of Rehabilitation Units and 3 Bidding period Prosthetic Workshops at 3 New Locations 4 Bid evaluation rho 5 IDA issues its N.O.' (if required) F urnhtureEqu m nt tetivery 6 Contract is signed & Contractor moves into site. 7 Constructon period (12-mo 364 days) AIA Phase iII - Renovation (Existing Centers) -l fI' I PMT submits Bidding Documents to IDA I I 2 IDA issues its 'N O to pnoceed with bidding1 3 Bidding period F Renovation of 5 Existing Centers 4 Bid evaluation-I S IDA issues its 'N.O. (if required) I j [|||[[|Furnhurt Ilpwt Jlvry 6 Contract is signed & Contractor moves into site I 7 Constnctbon period (9-mo, 272 days) g ,IIIhIIj Ndte: 0 Signing th D&S Coaultants 0 Critg al btEahtun AotMti"s 1 Phase I will be designed by the Firms selected under EHRP 2 Phases Il-Ill will be designed and suprevsed by Fims selected under OBS procedure Phase 1(6 Centers): Phase 11(3 Centers): Phase Ill (5 Centers): Amara Baghdad Center Hamsa Basrah DOwaniyah Kirkut Karbala Kut Tikrit Samawa Hilla Baquba Nasiriyah Ramadi 55 ANNEX 10: INTERNATIONAL DONOR HEALTH ACTIVITIES IN THE REPUBLIC OF IRAQ Donor Agency Description of Health-related Activities US$ Funding Source World Bank The Iraq Emergency Rehabilitation Project activities include: 25,000,000 IRRFI * Emergency rehabilitation of 12 emergency health facilities; * Urgent provision of basic medical and laboratory equipment and essential emergency drugs to the 12 rehabilitated sites; and * Strengthening of planning and management capacity within the central and provincial health administrations. The Iraq Emergency Disabilities Project activities include: 19,500,000 * Emergency reconstruction/renovation of rehabilitation centers and prosthetics workshops in 18 locations; * Urgent provision of basic medical and specialized equipment for the centers and workshops; and * Preparation of a national policy framework for the disabled; * Strengthening the partnerships with key NGOs active in the area of disabilities Additional technical assistance in health policy and health systems development has been provided through EU, IRFFI and World Bank funding. UN Health UN Health Cluster approved projects: IRRFI Cluster * Emergency Obstetric Care - UNFPA 12,603,000 * Supporting Primary Health Care System - WHO 37,363,000 (other (WHO, UNICEF, * Re-establishing the National Drug Quality Control 5,977,000 donors such UNFPA) Laoaoy-WOas USAID, * Strengthening non-communicable diseases and mental 11,000,000 EU have health controls - WHO funded Pipeline: Specific activities not available but budget in pipeline: vactriteis US$ 78,000,000 ~~~~~~~~~~~~~~~under their project objectives) USIPCO Construction: US The Buildings, Health and Education Sector (BHE) will spend 786,000,000 (United States $786 million on healthcare facilities and healthcare-related Iraq Project equipment. To date, roughly $70 million of the total $916 million and allocated to general renovation and construction projects have Contracting been spent. More specifically, the BHE Sector has begun Office) renovations on five hospitals. The BHE to-do list includes rehabilitating and constructing approximately 150 primary healthcare centers and renovating 19 hospitals. Non-construction: * Equipment Procurement/Modernization - Equipment for clinics/hospitals, staff training * Capacity Building - Infectious disease control, national health policy reform, institutional decentralization 56 USAID Grant to UNICEF: us Grant provides fQr: restoration/provision of basic health services 8,000,000 1st (United States to the most vulnerable populations, focusing on women and year (up to Agency for children; support for primary health care services; fund essential 40,000,000) International medicines, vaccines and micronutrients; establishment a rapid Development) referral and response system for the most serious cases; and publishing and distribution relevant health education materials and nutritional assessments. Grant to WHO: Grant provides for: identification of crucial immediate and short- 10,000,000 term health care needs of the population; rapid restoration of essential health services for the population; and strengthening of the capacity of a reformed Iraqi Ministry of Health to manage the health sector including review and further development of health policies and health system management. JICA Humanitarian Assistance for Iraq 29,500,000 JICA (a) World Food Programme (WFP): food supply (combined with (Japan (b) United Nations Children's Fund (UNICEF): child care, other sectors)) International education Cooperation (c) International Committee of the Red Cross (ICRC): distribution Agency) of medical supplies (d) United Nations High Commissioner for Refugees (UNHCR): assistance for refugees Assistance for the emergency medical activities of NGOs 3,300,000 (a) Japan Plafform Joint Team operating in Jordan (b) Peace Winds Japan operating in Northern Iraq Humanitarian and Recovery Assistance 90,000 Grassroots Assistance to Umm Qasr Community: provision of vehicles, pharmaceutical kits and potable water tanks Assistance to the following NGO activities 2,700,000 (a) Medical projects and distribution of emergency supplies in Iraq carried out by Japan Platform (Japanese NGOs) (b) Project distributing medical supplies including antibiotics in Iraq run by Hashemite Charity Organization (Jordanian NGO, May 16) (c) Project distributing medical equipment such as Infant Intravenous Kits run by CARE International (International NGO, May 16) Further consideration will be given to implementing the 24,450,000 following projects: (combined with (a) Emergency Assistance for Hospital Rehabilitation and other sectors) Equipment Activities: rehabilitate general hospitals for which Government of Japan had provided loan aid in the past. (b) Emergency Water and Sanitation Rehabilitation Programme Activities: provide support for projects in the areas of water supply, drainage and sanitation. (c) Reconstruction of Public and Other Facilities in Iraq Activities: rehabilitate public facilities as "reconstruction models." 57 EU/ECHO (a) Emergency relief operations of the following partners were 12,377,000 EU funded: (combined with (European other sectors) Union/Europea * The International Committee of the Red Cross: for food, n Community medical kits and rehabilitation of water/sanitation Humanitarian facilities in conflict-affected areas. Aid * UNICEF: for water tankering, sanitation, emergency Department) rehabilitation of primary healthcare centers and hospitals in the centre and south of Iraq. * CARE: for emergency water supply in the Baghdad region as well as Al Anbar governorate (west) where 30,000 people had no access to water. * Premiere Urgence: for basic repairs to health institutions, tents to boost hospital capacity, back-up generators and water supplies in the Baghdad area, in support of up to 20,000 civilian victims of the fighting. * UN Office for the Coordination of Humanitarian Affairs (OCHA): for coordination activities in countries of the region neighboring Iraq. (b) This funding was meant to meet urgent medical needs in 13,029,000 Iraq, following bomb damage and widespread looting that (combined with affected hospitals and other health facilities. The funding covered other sectors) the provision of medical and hygiene supplies to medical facilities (the first consignment was airlifted to Baghdad on May 9), rehabilitation of damaged or looted infrastructures, including the restoration of water and electricity supplies, support for emergency medical and surgical care, and emergency vaccination campaigns. Partners for this decision were Medecins du Monde (Spain and Greece), Terre des Hommes (IT), GOAL, Gruppo di Volontariato Civile (GVC), Aide Medicale Internationale (France), Premiere Urgence (France), CARE (NL), Telecommunications sans Frontieres and UNICEF. (c) This funding was meant to complement the "Oil-for-Food" 48,208,000 programme, which was then managed by the United Nations (combined with humanitarian agencies. Projects funded included: other sectors) * Health and nutrition: rehabilitation of health and social infrastructures, training in disease surveillance, distribution of essential medicines, materials and equipment, provision of fresh food for hospital patients, and complementary food supplies. * Other sectors: water and sanitation; coordination, logistics and technical assistance, including the opening in Baghdad of an ECHO support office shortly after the war ended. The partners were Acted, Action contre la faim, Alisei, Aide Medicale Internationale, Care-UK, Comite d'aide medicale, COOPI, COSV, Dan Church Aid, Enfants du monde-Droits de I'homme, Gruppo di Volontariato Civile, Help Age, the International Organization for Migrations, INTERSOS, Merlin, Movimondo, Oxfam, Pharmaciens sans Frontieres, Premiere Urgence, Solidarites, T6lecommunications sans Frontieres, Terre des Hommes, Un Ponte per..., the United Nations Development Programme, UNICEF, the World Food Programme, and the World Health Organisation. 58 (d) The objective of this funding, to be implemented in 2004, is 41,364,000 to respond effectively to the continuing humanitarian needs in (combined with Iraq. Activities include: other sectors) * Health: rehabilitation of primary health centers, provision of medical equipment and drugs, support for mother and child health actions, promotion of safe blood transfusion programs and support for disease surveillance and the development of accurate health information systems. * Other sectors: water and sanitation; education; de-mining; emergency relief for IDPs; and security strengthening. NGOs NGOs are subcontracted by the above donors whose activities NA Various are delineated above. To avoid duplication of activities, they are not included in this table. Sources: UN Health Cluster: http://www.irffi.orc/\WBSITE/EXTERNAUIRFFI/O. .contentMDK;20241686-menuPK:497875--paqePK:64168627-piPK: 64167475-theSitePK:491458,00.html US/PCO: http://www.rebuildinc- iraq.netlportal/pacie? paqeid=75,80102& dad=Dortal& schema=PORTAL&p tab id=1571&P) link id=1573&Reqid=1 USAID: http://www.usaid.qov/iraa/activities.html EU/ECHO: http://europa.eu.int/comm/echo/field/irac/fundinq2Q03 en.htm JICA: htto://www.embiapan.orq/enqlish/html/policies/political/assistanceforiraasummary.htm World Bank: http://www- wds.worldbank.orq/servletVWDS I Bank Servlet?pcont=details&eid=000104615 20041005091901 59 ANNEX 11: TIMETABLE OF KEY PROJECT PROCESSING EVENTS Sequence Timing Time taken to prepare and process the Project 7 months Identification and preparation mission July 21, 2005 Appraisal November 14, 2005 Negotiations November 17, 2005 Grant approval November 23, 2005 Effectiveness December 28, 2005 Closing Date September 30, 2007 60 ANNEX 12: NAMES OF STAFF/CONSULTANTS WHO WORKED ON THE PROJECT Names of staff/consultants who worked on the project: Name Function Jean Jacques Frere Task Team Leader, Sr. Health Specialist Virginia Jackson Sr. Operations Officer/Consultant Vasilios Demetriou Sr. Implementation Specialist/Consultant Mario Zelaya Sr. Procurement and Environmental Specialist/Cons. Nedim Jaganjac Health and Disabilities Specialist/Consultant Goran Cerkez Rehabilitation Specialist/Consultant Nazaneen Ismail Ali Procurement Specialist/Consultant David Webber Lead Finance Officer, Fiduciary Assurance Hiroko Imamura Sr. Counsel Mona el-Chami Financial Management Specialist Vikram Raghavan Legal Counsel Colin Scott Lead Social Safeguards Specialist Mira Hong Operations Analyst Emma Etori Language Program Assistant Ad Hoc Advisory Committee Name Function Joseph Saba Country Director Akiko Maeda Health Sector Manager Alfred Nickesen Manager, OPCS Representative Nadjib Sefta Regional Procurement Advisor Sherif Arif Regional Environmental and Safeguards Advisor Aloysius Ordu Manager, Operations Services Samia M'sadek Regional Financial Management Manager Faris Hadad-Zervos Head of Mission, World Bank Iraq Office in Amman Kathryn Funk Sr. Country Officer Hadi Abushakra Chief Counsel David Webber Lead Finance Officer, Fiduciary Assurance Colin Scott Lead Social Safeguards Specialist Robert Bou Jaoude Sr. Financial Management Specialist Hiba Tahboub Sr. Procurement Specialist Daniel Mont Peer Reviewer Olusoji Adeyi Peer Reviewer P:\1RAQ\HD\96774\NEG\DisabilTA Jan 05 2006.doc 1/11/2006 1:34:00 PM 61 IBRD 34363 I RAQ EMERGENCY DISABILITIES PROJECT (EDP) o PHASE 0 - EXISTING CENTERS TO BE EQUIPPED & FURNISHED o SELECTED CITIES AND TOWNS - MAIN ROADS O PHASE 1 - NEW REHABILITATION CENTERS GOVERNORATE CAPITALS RAILROADS o PHASE 2 - NEW REHABILITATION CENTERS WITH WORKSHOPS ® NATIONAL CAPITAL - GOVERNORATE BOUNDARIES oE) PHASE 3 - EXISTING CENTERS TO BE RIVERS INTERNATIONAL BOUNDARIES RENOVATED 4 40E i _ A2E AAR ALE _E 4BE TURKEY A'. 1 > - _ -* d' [G>L M jl'?l _ S, O~~~~~~~~~~~ 50 ICu rM,IL I I I In_Jr. ", I jII I - _ ,5^ _t °"cP, r: . . !\ 'S Ir E , . J c 361N ' ) | t J ''''i ISLAMIC SYRIAN H: -, '' ;t-' ;: *|;t;r'l REPUBLIC AYRIABN :A OF IRAN REP. / r ,,.- I - - - \4 ... N) _ L~~~~~ z - - ~~; r! fi a e , v ¢ , < _i - -°~~~~~ r I CJ e - * . , 0 t' y r ~ ~ ~ ~ ~ ~ ~ ~~K 32ti ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ t . .> v. Diwd'niyah tt* -> 32N . D \ - . > , '~ ,' II II /-- -; rjAh I m;ih II t } F1 oi r - * * l f:; / 1 r r 5 | . \.* -r- - s - J _; _- r \ . .~~~~~~~ ~ 30 . IRA \ *\ ' .---- 30rq --j NSAUDI ARABIA -_-_-.--- ML J.. ._ ?BrJ -~~~~~~~~~~~~~F I; 'd . oIo.s7M~n. ~" y..-on 28S Nrvv .rZ 40E 42E 4JE ' ,E 4dE DECEMBER 2005 -- ---