Page  1
CONFORMED COPY 
 
LOAN NUMBER 7643-PE 
 
Loan Agreement 
 
(Health Reform Program - Second Phase) 
 
between 
 
REPUBLIC OF PERU 
 
and 
 
INTERNATIONAL BANK FOR RECONSTRUCTION 
AND DEVELOPMENT 
 
Dated November 16, 2009 
Page  2
LOAN NUMBER 7643-PE 
 
LOAN AGREEMENT 
 
Agreement dated November 16, 2009, between REPUBLIC OF PERU 
(“Borrower”) and INTERNATIONAL BANK FOR RECONSTRUCTION AND 
DEVELOPMENT (“Bank”).  The Borrower and the Bank hereby agree as follows: 
 
ARTICLE I 
—
GENERAL CONDITIONS; DEFINITIONS 
 
1.01. 
The General Conditions (as defined in the Appendix to this Agreement) 
constitute an integral part of this Agreement. 
 
1.02. 
Unless the context requires otherwise, the capitalized terms used in this 
Agreement have the meanings ascribed to them in the General Conditions or in 
the Appendix to this Agreement. 
 
ARTICLE II 
—
LOAN 
 
2.01. 
The Bank agrees to lend to the Borrower, on the terms and conditions set forth or 
referred to in this Agreement, the amount of fifteen million Dollars 
($15,000,000), as such amount may be converted from time to time through a 
Currency Conversion in accordance with the provisions of Section 2.07 of this 
Agreement (“Loan”), to assist in financing the project described in Schedule 1 to 
this Agreement (“Project”). 
 
2.02. 
The Borrower may withdraw the proceeds of the Loan in accordance with 
Section IV of Schedule 2 to this Agreement.
 
The Borrower’s Representative for 
purposes of taking any action required or permitted to be taken pursuant to this 
Section is the Borrower’s Minister of Economy and Finance or the Borrower’s 
Director of Public Indebtedness, or any person whom any of them shall designate 
in writing.  
 
2.03. 
The Front-end Fee payable by the Borrower shall be equal to one quarter of one 
percent (0.25%) of the Loan amount.  The Borrower shall pay the Front-end Fee 
not later than 60 days after the Effective Date. 
 
2.04. 
The interest payable by the Borrower for each Interest Period shall be at a rate 
equal to LIBOR for the Loan Currency plus the Variable Spread; provided, that 
upon a Conversion of all or any portion of the principal amount of the Loan, the 
interest payable by the Borrower during the Conversion Period on such amount 
shall be determined in accordance with the relevant provisions of Article IV of 
the General Conditions. Notwithstanding the foregoing, if any amount of the 
Withdrawn Loan Balance remains unpaid when due and such non-payment 
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2
continues for a period of thirty days, then the interest payable by the Borrower 
shall instead be calculated as provided in Section 3.02 (d) of the General 
Conditions. 
 
2.05. 
The Payment Dates are February 15 and August 15 in each year. 
 
2.06. 
The principal amount of the Loan shall be repaid in accordance with the 
amortization schedule set forth in Schedule 3 to this Agreement. 
 
2.07. 
(a) 
The Borrower may at any time request any of the following Conversions 
of the terms of the Loan in order to facilitate prudent debt management: 
(i) a change of the Loan Currency of all or any portion of the principal 
amount of the Loan, withdrawn or unwithdrawn, to an Approved 
Currency; (ii) a change of the interest rate basis applicable to all or any 
portion of the principal amount of the Loan withdrawn and outstanding 
from a Variable Rate to a Fixed Rate, or vice versa; and (iii) the setting 
of limits on the Variable Rate applicable to all or any portion of the 
principal amount of the Loan withdrawn and outstanding by the 
establishment of an Interest Rate Cap or Interest Rate Collar on the 
Variable Rate. 
 
(b) 
Any conversion requested pursuant to paragraph (a) of this Section that 
is accepted by the Bank
 shall be considered a “Conversion”, as defined 
in the General Conditions, and shall be effected in accordance with the 
provisions of Article IV of the General Conditions and of the Conversion 
Guidelines.  
 
ARTICLE III 
—
PROJECT 
 
3.01. 
The Borrower declares its commitment to the objectives of the Project and the 
Program.  To this end, the Borrower shall, through its PCU, carry out the Project 
in accordance with the provisions of Article V of the General Conditions. 
 
3.02. 
Without limitation upon the provisions of Section 3.01 of this Agreement, and 
except as the Borrower and the Bank shall otherwise agree, the Borrower shall 
ensure that the Project is carried out in accordance with the provisions of 
Schedule 2 to this Agreement. 
 
ARTICLE IV 
—
REMEDIES OF THE BANK 
 
4.01. 
The Additional Event of Suspension consists of the following, namely that the 
Borrower’s Law No. 26842 of 1997 (
Ley General de Salud
)
or
the Borrower’s 
Law No. 27783, dated July 20, 2002 (
Ley de Bases de la
 Descentralización
)
shall 
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3
have been amended, suspended, abrogated, repealed or waived so as to affect 
materially and adversely the ability of the Borrower to perform any of its 
obligations under this Agreement. 
4.02. 
The Additional Event of Acceleration consists of the following, namely, that the 
event specified in Section 4.01 of this Agreement occurs. 
 
ARTICLE V 
—
TERMINATION
 
5.01. 
Without prejudice to the provisions of the General Conditions, the Effectiveness 
Deadline is the date ninety (90) days after the date of this Agreement, but in no 
case later than 
the eighteen (18) months after the Bank’s approval of the Loan 
which expires on August 17, 2010. 
 
ARTICLE VI 
—
REPRESENTATIVE; ADDRESSES
 
6.01. 
The Borrower’s representative is its Minister of Economy and Finance, provided 
that the Borrower’s Director of Public Indebtedness may, by him or herself, 
represent the Borrower to sign amendments to this Agreement which are 
considered of an administrative and non-financial nature.  The signing by such 
Director of an amendment shall constitute a representation by the Borrower that 
any such amendment is considered to be administrative and non-financial in 
nature.  
 
6.02. 
The Borrower’s Address is: 
 
Ministry of Economy and Finance 
Jr. Junín 319 
Lima, Perú 
 
Facsimile:   
(511) 626-9921 
 
6.03. 
The Bank’s Address is: 
 
International Bank for Reconstruction and Development 
1818 H Street, N.W. 
Washington, D.C. 20433 
United States of America 
 
Cable 
address: 
 Telex: 
  Facsimile: 
 
INTBAFRAD  
248423(MCI) 
or 
1-202-477-6391 
Washington, D.C. 
 64145(MCI) 
 
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AGREED at Lima, Peru, as of the day and year first above written. 
 
REPUBLIC OF PERU 
 
By /s/ Luis Carranza Ugarte 
 
Authorized Representative 
 
INTERNATIONAL BANK FOR 
 
RECONSTRUCTION AND DEVELOPMENT 
 
By /s/ C. Felipe Jaramillo 
 
Authorized Representative 
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5
SCHEDULE 1 
 
Project Description 
 
The objectives of the Project are to continue supporting the Borrower’s efforts to 
reduce maternal and infant mortality rates in intervened rural areas in Selected Regions in 
the Borrower’s territory, in particular through: (i) the improvement of family care 
practices for women (during pregnancy, delivery and breast-feeding) and children under 
the age of three; (ii) the strengthening of health services networks with capacity to solve 
obstetric, neonatal and infant emergencies, and to provide comprehensive health services 
to women (during pregnancy, delivery and breast-feeding) and children under the age of 
three; and (iii) the supporting of MINSA’s governance functions of regulation, quality, 
efficiency and equity for improving the new health delivery model of maternal and child 
health care in a decentralized environment. 
 
The Project constitutes the second phase of the Program, and consists of the 
following parts: 
 
Part 1
:
Improving Health Practices at the Household Level for Women (during 
pregnancy, delivery and breast-feeding) and Children Under the Age of Three in 
Rural Areas of Selected Regions
.
(a) 
Design, implementation and monitoring of a behavioral change 
communication and education program aimed to promote healthy 
practices at the household level including increased demand for health 
services, focusing on mothers during pre-natal and post-natal periods and 
children under the age of three, through, 
inter alia
:
(i) the carrying out of 
studies to identify current practices, beliefs and attitudes, including the 
use of health services; (ii) the preparation of behavioral change 
communication programs tailored by region; (iii) the development and 
production of culturally sensitive printed and audio-visual materials; (iv) 
the provision of training to staff from MINSA, DIRESA, networks, 
micro-networks, as well as community agents for the local 
implementation of behavioral change communication and education 
programs; (v) the provision of equipment for dissemination activities; 
(vi) the carrying out of learning workshops; and (vii) the provision of 
technical assistance for the implementation of the behavioral change, 
communication and education program, including monitoring and 
evaluation. 
 
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(b) 
Promotion of SIS enrollment rights and identity rights among women 
during pregnancy, delivering and breast-feeding and children under the 
age of three, through, 
inter alia
:
(i) the design and implementation of a 
campaign promoting SIS enrollment rights and identity rights, including 
the design, production and dissemination of materials for Selected 
Regions; and (ii) the provision of training to health staff and local 
authorities on the promotion of SIS enrollment rights identity rights. 
 
Part 2
:
Increasing the Capacity to Provide Better Maternal and Child Health Services for 
the Poor
.
(a) 
Improvement of the quality of services in health facilities, through, 
inter 
alia
:
(i) the carrying out of refurbishing and expanding works in about 
115 health facilities, as well as the provision of the necessary medical 
equipment and communication equipment; and (ii) the provision of 
technical assistance and training for health personnel to improve the 
quality of services; and (iii) the inclusion of inter-cultural focus in 
service provision. 
 
(b) 
Provision of support for the integrated health delivery model and the 
development of support systems to raise the efficiency and effectiveness 
of health networks, through, 
inter alia
:
(i) the strengthening of the 
management systems at network level; (ii) the improvement of the 
reference and counter-reference system; and (iii) the provision of support 
for the regulation of the health networks. 
 
Part 3
:
Strengthening Government Capacities to Offer a More Equitable and Efficient 
Health System in a Decentralized Environment
.
(a) 
Provision of support for the development of a regulatory framework and 
implementation plan to increase quality in the provision of health 
services in the following areas: (i) accreditation and certification 
systems; (ii) infrastructure maintenance systems; (iii) reference 
laboratory systems; (iv) hemotherapy; (v) hospital financing; (vi) 
pharmaceutical purchasing and logistic systems; and (vii) 
communication and promotion systems. 
 
(b) 
Provision of support to the SIS in the development of the public 
insurance system, through, 
inter alia
:
(i) the development of its 
regulatory framework; (ii) the strengthening of the SIS information 
system and quality assurance mechanisms; and (iii) the implementation 
of the SISFOH targeting system to ensure adequate targeting of the 
health insurance financing in urban areas. 
 
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7
(c) 
Provision of support to SIS and SIGA for the strengthening of their 
monitoring data in order to increase the accountability in the system. 
 
(d) 
Provision of support to the decentralization of health services, through, 
inter alia
:
(i) the provision of support for the continued implementation 
of the Management Agreements; (ii) the provision of technical assistance 
and training to MINSA and regional health staff to support the 
implementation of the Management Agreements; and (iii) the design of 
an incentive/penalty system to ensure that the Management Agreements 
are effective instruments to promote decentralization of health services. 
 
Part 4
:
Project Coordination and Monitoring and Evaluation
.
Provision of support for Project coordination, through the provision of technical 
assistance, financing of incremental operating costs and external and concurrent audits, 
monitoring and evaluation activities, as well as the provision of the necessary goods and 
equipment required for such coordination. 
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SCHEDULE 2
 
Project Execution 
 
Section I. 
Implementation Arrangements
A.  
Institutional Arrangements 
 
1. 
The Borrower shall, not later than 30 days after the Effective Date, create and 
thereafter maintain, until completion of the Project, a Project Steering Committee 
to oversee the implementation of the Project and approve annual operational 
plans. Said committee shall have membership and functions detailed in the 
Project Operational Manual and acceptable to the Bank, and shall meet at least 
once every six months and submit the minutes of said meetings to the Bank not 
later than one month after each said meeting has taken place. 
 
2. 
Maintain, until completion of the Project, the unit within MINSA (the PCU), 
created by the Borrower’s Law No. 29258, of September 11, 2008 with staff, 
structure and functions satisfactory to the Bank, responsible for the management, 
coordination, supervision, monitoring and evaluation of the Project. Said unit 
shall have competent staff in adequate numbers (as detailed in the Project 
Operational Manual) with qualifications and experience satisfactory to the Bank. 
 
3. 
For purposes of the implementation of the Project, the Borrower shall, through 
MINSA:  (a) maintain its agreements with the Selected Regions for which such 
agreements, with terms and conditions satisfactory to the Bank, are already in 
place; and (b) prior to committing Project funds (including Loan proceeds) for 
Selected Regions for which such agreements are not already in place, enter into 
such agreements with the relevant Selected Region, with terms and conditions 
satisfactory to the Bank.  All such agreements cited in (a) and (b) herein (the 
Convenios de
 Adhesión
)
shall detail the obligations of each Selected Region in 
the implementation of Parts 1, 2 and 3 of the Project.  
 
4. 
The Borrower shall exercise its rights under each 
Convenio de Adhesión
 in such 
manner as to protect the interests of the Borrower and the Bank and to 
accomplish the purposes of the Loan.  Except as the Bank shall otherwise agree, 
the Borrower shall not assign, amend, abrogate or waive any 
Convenio de 
Adhesión
 or any of its provisions. 
 
5. 
No later than the mid-term review of the Project, the Borrower shall strengthen 
and integrate the PCU’s financial management system for the Project, in a 
manner satisfactory to the Bank. 
 
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B. Anti-Corruption 
 
The Borrower shall ensure that the Project is carried out in accordance with the 
provisions of the Anti-Corruption Guidelines. 
 
C. 
Safeguards and Operational Manual
 
1. 
The Borrower shall carry out the Project in accordance with the provisions of:  
 
(a) 
the Environmental Impact Assessment;  
 
(b) 
the Indigenous Peoples Plan; and 
 
(c) 
a manual (the Project Operational Manual), satisfactory to the Bank, that 
will include, 
inter alia
:
(i) the procedures for the carrying out, 
monitoring and evaluation of the Project; (ii) the indicators to be used for 
Project monitoring and evaluation; (iii) the organizational structure of the 
Project, including the structure and terms of reference of personnel of the 
PCU and the composition functions and responsibilities of the Project 
Steering Committee; (iv) the Project procurement and financial 
management requirements and procedures; (v) the Project’s chart of 
accounts and internal controls; (vi) the format of: (A) the unaudited 
interim financial reports referred to in Section II. B.2 of Schedule 2 to 
this Agreement; and (B) the Financial Statements; (vii) the terms of 
reference for carrying out the Project audits under Section II.B.3 of 
Schedule 2 to this Agreement; and (viii) the model form for the 
Convenios de
 Adhesión
.
In case of any inconsistency between any 
provision of the Project Operational Manual and this Agreement, the 
provision of this Agreement will prevail. Any amendment to the Project 
Operational Manual can occur only if acceptable to the Bank.  
 
Section II. 
Project Monitoring Reporting and Evaluation
A. 
Project Reports   
 
1. 
The Borrower shall monitor and evaluate the progress of the Project and prepare 
Project Reports in accordance with the provisions of Section 5.08 of the General 
Conditions and on the basis of indicators set forth in the Project Operational 
Manual.  Each Project Report shall cover the period of one calendar semester, 
and shall be furnished to the Bank not later than one month after the end of the 
period covered by such report.  
 
2. 
For purposes of Section 5.08 (c) of the General Conditions, the report on the 
execution of the Project and related plan required pursuant to that Section shall 
be furnished to the Bank not later than six months after the Closing Date. 
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B.
 
Financial Management, Financial Reports and Audits   
 
1. 
The Borrower shall maintain or cause to be maintained a financial management 
system in accordance with the provisions of Section 5.09 of the General 
Conditions. 
 
2. 
Without limitation on the provisions of Part A of this Section, the Borrower shall 
prepare and furnish to the Bank not later than forty five days after the end of each 
calendar quarter, interim unaudited financial reports for the Project covering the 
quarter, in form and substance satisfactory to the Bank. 
 
3. 
The Borrower shall have its Financial Statements audited in accordance with the 
provisions of Section 5.09 (b) of the General Conditions.  Each audit of the 
Financial Statements shall cover the period of one fiscal year of the Borrower.  
The audited Financial Statements for each such period shall be furnished to the 
Bank not later than six months after the end of such period.
 
Section III. 
Procurement
A. General
 
1.
 
Goods and Works.  
 All goods and works (including non-consultant services) 
required for the Project and to be financed out of the proceeds of the Loan, shall 
be procured in accordance with the requirements set forth or referred to in 
Section I of the Procurement Guidelines, and with the provisions of this Section. 
 
2.
 
Consultants’ Services.  
All consultants’ services required for the Project and to 
be financed out of the proceeds of the Loan, shall be procured in accordance with 
the requirements set forth or referred to in Sections I and IV of the Consultant 
Guidelines and with the provisions of this Section.   
 
3. 
Definitions.
 
The capitalized terms used below in this Section to describe 
particular procurement methods or methods of review by the Bank of particular 
contracts refer to the corresponding method described in the Procurement 
Guidelines, or Consultant Guidelines, as the case may be. 
 
B. 
Particular Methods of Procurement of Goods and Works (Including Non-
Consultant Services) 
 
1.
 International 
Competitive 
Bidding.
 
Except as otherwise provided in paragraph 
2
below, goods and works (including non-consultant services) shall be procured 
under contracts awarded on the basis of International Competitive Bidding 
procedures.
 
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2.
 
Other Methods of Procurement of Goods and Works (including Non-
Consultant Services)
.
The following table specifies the methods of 
procurement, other than International Competitive Bidding, which may be used 
for goods and works (including non-consultant services).  The Procurement Plan 
shall specify the circumstances under which such methods may be used. 
 
Procurement Method
(a) National Competitive Bidding, subject to the additional provisions set forth 
in Part E of this Section III. 
(b) Shopping. 
(c) Direct Contracting. 
C. Part
icular Methods of Procurement of Consultants’ Services
1.
 Quality- 
and 
Cost-based 
Selection.
 
Except as otherwise provided in paragraph 
2
below, consultants’ services shall be procured under contracts awarded on the 
basis of Quality and Cost-based Selection.
 
2.
 
Other Methods of Procurement of Consultants’ Services
.
The following table 
specifies the methods of procurement, other than Quality and Cost-based 
Selection, which may be used for consultants’ services.  The Procurement Plan 
shall specify the circumstances under which such methods may be used. 
 
Procurement Method
(a) Quality-Based Selection 
(b) Selection based on the Consultant’s Qualifications 
(c) Single Source Selection 
(d) Least-Cost Selection 
(e) Fixed Budget Selection 
D.
 
Review by the Bank of Procurement Decisions
 
The Procurement Plan shall set forth those contracts which shall be subject to the 
Bank’s Prior Review.  All other contracts shall be subject to Post Review by the 
Bank. 
 
E. Special 
Provisions 
 
1. 
In addition and without limitation or restriction to any other provisions set forth 
in this Section or the Procurement Guidelines, the following provisions shall 
govern the procurement of goods, works and non-consultants’ services with 
National Competitive Bidding procedures under this Section: 
 
(a) 
Foreign bidders shall not be required to be locally registered as a 
condition of participation in the selection process. 
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12 
(b) 
No reference value shall be required for publication in the bidding 
documents. 
 
(c) 
Award of contracts shall be based exclusively on price and, whenever 
appropriate, shall take into account factors that can be quantified 
objectively, and the procedure for such quantification shall be disclosed 
in the invitation to bid.  
 
(d) 
Foreign bidders shall not be required to authenticate (
legalizar
)
their 
bidding documents or any documentation related to such bidding 
documents with either Peruvian Consulates, the Ministry of Foreign 
Affairs, or any Peruvian authorities as a prerequisite of bidding. 
 
(e) 
The Borrower, through MINSA, shall use standard bidding documents 
and standard evaluation formats, all satisfactory to the Bank. 
 
2. 
In addition and without limitation or restriction to any other provisions set forth 
in this Section or the Consultant Guidelines, the following provisions shall 
govern all employment of consultants: 
 
(a) 
Foreign consultants shall not be required to be locally registered as a 
condition of participation in the selection process. 
 
(b) 
Foreign consultants shall not be required to authenticate (
legalizar
)
any 
documentation related to their participation in the selection process with 
either Peruvian Consulates, the Ministry of Foreign Affairs, or any 
Peruvian authorities as a condition of participation in said selection 
process. 
 
(c) 
The Borrower, through MINSA, shall use standard requests for proposals 
and standard evaluation formats; all satisfactory to the Bank. 
 
(d) 
Foreign consultants, either individuals or firms, shall not be required to 
pay fees to the Peruvian Consultants’ Association that are different from 
those required for Peruvian consultants. 
 
(e) 
No consultant hired for the Project, at the time he or she is carrying out 
his or her contractual obligations as consultant, hold civil service office 
or any other position in any agency of the Borrower, nor shall such 
consultant have any right to re-entry into any such office or position 
upon the conclusion of his or her consulting services. 
 
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Section IV. 
Withdrawal of Loan Proceeds
A. 
General   
 
1. 
The Borrower may withdraw the proceeds of the Loan in accordance with the 
provisions of Article II of the General Conditions, this Section, and such 
additional instructions as the Bank shall specify by notice to the Borrower 
(including the “World Bank Disbursement Guidelines for Projects” dated May 
2006, as revised from time to time by the Bank and as made applicable to this 
Agreement pursuant to such instructions), to finance Eligible Expenditures as set 
forth in the table in paragraph 2 below. 
 
2. 
The following table specifies the categories of Eligible Expenditures that may be 
financed out of the proceeds of the Loan (“Category”), the allocation of the 
amounts of the Loan to each Category, and the percentage of expenditures to be 
financed for Eligible Expenditures in each Category. 
 
Category
Amount of the Loan 
Allocated 
(expressed in USD
)
Percentage of 
Expenditures  
to be financed
(1) Goods, works,  
 
consultants’ services and 
 
Training under Part 1 of 
 the 
Project 
 
2,987,788 100% 
(2) Goods, works,  
 
consultants’ services and 
 
Training under Part 2 of 
 the 
Project 
 
9,163,781  
100% 
(3) Goods, works,  
 
consultants’ services and 
 
Training under Part 3 of 
 the 
Project 
 
2,594,708 100% 
(4) Goods, Consultant’s 
 
services, including audits 
 
and Operating Costs 
 
253,723 100% 
TOTAL AMOUNT 
 
15,000,000
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For the purposes of this Section, the terms:  
 
(i) 
“Operating Costs” means the non-consultant expenditures incurred by 
the Borrower in connection with the daily operation of the PCU, rental 
and maintenance of equipment and vehicles, rental of office facilities, 
office utilities, supplies and materials, and domestic travel and per diem 
of PCU staff, which expenditures would not have been incurred absent 
the Project; and 
 
(ii) 
“Training” means the non-consultant expenditures incurred by the PCU 
in connection with training activities under the Project, including the 
rental of facilities, refreshments, training materials and travel and per 
diem of trainers and trainees. 
 
B. 
Withdrawal Conditions; Withdrawal Period   
 
1.
 
Notwithstanding the provisions of Part A of this Section, no withdrawal shall be 
 made: 
 
(a) 
from the Loan Account until the Bank has received payment in full of the 
Front-end Fee; or  
 
(b) 
for payments made prior to the date of this Agreement, except that 
withdrawals up to an aggregate amount not to exceed $1,500,000 
equivalent may be made for payments made prior to this date but on or 
after December 9, 2008, for Eligible Expenditures.   
 
2.
 
The Closing Date is January 31, 2015. 
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SCHEDULE 3 
 
Amortization Schedule 
 
1. 
The following table sets forth the Principal Payment Dates of the Loan and the 
percentage of the total principal amount of the Loan payable on each Principal 
Payment Date (“Installment Share”).  If the proceeds of the Loan have been fully 
withdrawn as of the first Principal Payment Date, the principal amount of the 
Loan repayable by the Borrower on each Principal Payment Date shall be 
determined by the Bank by multiplying:  (a) Withdrawn Loan Balance as of the 
first Principal Payment Date; by (b) the Installment Share for each Principal 
Payment Date, such repayable amount to be adjusted, as necessary, to deduct any 
amounts referred to in paragraph 4 of this Schedule, to which a Currency 
Conversion applies. 
 
Principal Payment Date 
Installment Share 
(Expressed as a Percentage)
 
February 15, 2020 
3.57% 
August 15, 2020 
3.57% 
February 15, 2021 
3.57% 
August 15, 2021 
3.57% 
February 15, 2022 
3.57% 
August 15, 2022 
3.57% 
February 15, 2023 
3.57% 
August 15, 2023 
3.57% 
February 15, 2024 
3.57% 
August 15, 2024 
3.57% 
February 15, 2025 
3.57% 
August 15, 2025 
3.57% 
February 15, 2026 
3.57% 
August 15, 2026 
3.57% 
February 15, 2027 
0% 
August 15, 2027 
3.57% 
February 15, 2028 
3.57% 
August 15, 2028 
3.57% 
February 15, 2029 
3.57% 
August 15, 2029 
3.57% 
February 15, 2030 
3.57% 
August 15, 2030 
3.57% 
February 15, 2031 
3.57% 
August 15, 2031 
3.57% 
February 15, 2032 
3.57% 
August 15, 2032 
3.57% 
February 15, 2033 
3.57% 
Page  17
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Principal Payment Date 
Installment Share 
(Expressed as a Percentage)
 
August 15, 2033 
3.57% 
February 15, 2034 
3.61% 
2. 
If the proceeds of the Loan have not been fully withdrawn as of the first Principal 
Payment Date, the principal amount of the Loan repayable by the Borrower on 
each Principal Payment Date shall be determined as follows: 
 
(a) 
To the extent that any proceeds of the Loan have been withdrawn as of 
the first Principal Payment Date, the Borrower shall repay the 
Withdrawn Loan Balance as of such date in accordance with paragraph 1 
of this Schedule. 
 
(b) 
Any amount withdrawn after the first Principal Payment Date shall be 
repaid on each Principal Payment Date falling after the date of such 
withdrawal in amounts determined by the Bank by multiplying the 
amount of each such withdrawal by a fraction, the numerator of which is 
the original Installment Share specified in the table in paragraph 1 of this 
Schedule for said Principal Payment Date (“Original Installment Share”) 
and the denominator of which is the sum of all remaining Original 
Installment Shares for Principal Payment Dates falling on or after such 
date, such amounts repayable to be adjusted, as necessary, to deduct any 
amounts referred to in paragraph 4 of this Schedule, to which a Currency 
Conversion applies.
 
3. 
(a) 
Amounts of the Loan withdrawn within two calendar months prior to any 
Principal Payment Date shall, for the purposes solely of calculating the 
principal amounts payable on any Principal Payment Date, be treated as 
withdrawn and outstanding on the second Principal Payment Date 
following the date of withdrawal and shall be repayable on each 
Principal Payment Date commencing with the second Principal Payment 
Date following the date of withdrawal. 
 
(b) 
Notwithstanding the provisions of sub-paragraph (a) of this paragraph, if 
at any time the Bank adopts a due date billing system under which 
invoices are issued on or after the respective Principal Payment Date, the 
provisions of such sub-paragraph shall no longer apply to any 
withdrawals made after the adoption of such billing system.  
 
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17 
4. 
Notwithstanding the provisions of paragraphs 1 and 2 of this Schedule, upon a 
Currency Conversion of all or any portion of the Withdrawn Loan Balance to an 
Approved Currency, the amount so converted in the Approved Currency that is 
repayable on any Principal Payment Date occurring during the Conversion 
Period, shall be determined by the Bank by multiplying such amount in its 
currency of denomination immediately prior to the Conversion by either: (i) the 
exchange rate that reflects the amounts of principal in the Approved Currency 
payable by the Bank under the Currency Hedge Transaction relating to the 
Conversion; or (ii) if the Bank so determines in accordance with the Conversion 
Guidelines, the exchange rate component of the Screen Rate.  
 
5. 
If the Withdrawn Loan Balance is denominated in more than one Loan Currency, 
the provisions of this Schedule shall apply separately to the amount denominated 
in each Loan Currency, so as to produce a separate amortization schedule for 
each such amount. 
 
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18 
APPENDIX 
 
Section I.  Definitions 
 
1. 
“Anti-Corruption Guidelines” means the “Guidelines on Preventing and 
Combating Fraud and Corruption in Projects Financed by IBRD Loans and IDA 
Credits and Grants”, dated October 15, 2006. 
2. 
“Category” means a category set forth in the table in Section IV of Schedule 2 to 
this Agreement. 
3. 
“Consultant Guidelines” means the “Guidelines: Selection and Employment of 
Consultants by World Bank Borrowers” published by the Bank in May 2004 and 
revised in October 2006. 
 
4. “
Convenios de Adhesion
”
means the agreements referred to in Section I.A.3 of 
Schedule 2 of this Agreement. 
 
5. 
“General Conditions” means the “International Bank for Reconstruction and 
Development General Conditions for Loans”, dated July 1, 2005 (as amended 
through February 12, 2008). 
 
6. 
“Environmental Impact Assessment” means the document prepared by the 
Borrower, dated February 2005, which sets out the environmental protection 
measures in respect of the Project, including: (i) a negative list of 
environmentally sensitive investments ineligible for Project financing; (ii) an 
environmental screening checklist for Project interventions; (iii) environmental 
supervision, monitoring and evaluation procedures for the Project; and (iv) 
measures to be taken to minimize the risk of negative impacts from the disposal 
of liquid and solid waste (including medical waste), including the development of 
a
waste management manual to be used by all health facilities under the Program. 
 
7. 
“Indigenous Peoples Plan” means the document prepared by the Borrower, dated 
June 30, 2006, which sets out the measures to be taken to ensure that indigenous 
peoples will not be harmed by the Project and to ensure their participation and 
involvement in the implementation and monitoring of the Project as it affects them. 
 
8. 
“Management Agreements” means the sectoral agreements entered into by 
MINSA, the regional governments and the municipal governments, for results-
based management and financing of health services. 
 
9. “MINSA” 
means 
Ministerio de la Salud
,
the Borrower’s Ministry of Health. 
 
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19 
10. 
“PCU” means the unit referred to in Section I.A.2 of Schedule 2 to this 
Agreement. 
 
11. 
“Procurement Guidelines” means the “Guidelines: Procurement under IBRD 
Loans and IDA Credits” published by the Bank in May 2004 and revised in 
October 2006. 
 
12. 
“Procurement Plan” means the Borrower’s procurement plan for the Project, 
dated December 11, 2008 and referred to in paragraph 1.16 of the Procurement 
Guidelines and paragraph 1.24 of the Consultant Guidelines, as the same shall be 
updated from time to time in accordance with the provisions of said paragraphs. 
 
13. 
“Program” means the Borrower’s health reform program designed to build an 
equitable efficient and high quality health sector capable and set forth or referred 
to in the letter dated November 1, 1999 from the Borrower to the Bank. 
 
14. 
“Project Operational Manual” means the manual, dated December 5, 2008, 
referred to in Section I.C.1(c) of Schedule 2 to this Agreement. 
 
15. 
“Project Steering Committee” means the committee referred to in Section I.A.1 
of Schedule 2 to this Agreement. 
 
16. 
“Selected Regions” means the Borrower’s Departments of 
Amazonas, Huánuco, 
Huancavelica, Ayacucho, Apurímac, Cusco, Puno, Cajamarca
 and 
Ucayali
,
and 
any other area, acceptable to the Bank, that may be selected by the Borrower. 
 
17. 
“SIGA” means 
Sistema Integrado de
 Gestión Administrativa
,
the Borrower’s 
management and administration system. 
 
18. “SIS” 
means 
Seguro Integral de Salud
,
the Borrower’s integrated public health 
care insurance created through Law No. 27657, dated January 2002. 
 
19. “SISFOH” 
means 
Sistema de
 Focalización de Hogares
,
the Borrower’s system 
for household targeting. 
 
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Section II.  Modifications to the General Conditions 
 
The modifications to the General Conditions are as follows:   
 
1. 
Paragraph (a) of Section 2.07 is modified to read as follows:  
 
“Section 2.07. 
Refinancing Preparation Advance; Capitalizing Front-end Fee 
and Interest 
 
(a) 
If the Loan Agreement provides for the repayment out of the 
proceeds of the Loan of an advance made by the
 
Bank or the Association 
(“Preparation Advance”), the Bank shall, on behalf of such Loan Party, withdraw 
from the Loan Account on or after the Effective Date the amount required to 
repay the withdrawn and outstanding balance of the advance as at the date of 
such withdrawal from the Loan Account and to pay all accrued and
 
unpaid 
charges, if any,
 
on
the advance as at such date. The Bank shall pay the amount so 
withdrawn to itself or the Association, as the case may be, and shall cancel the 
remaining unwithdrawn amount of the advance.” 
 
2. 
Paragraph (l) of Section 7.02 is modified to read as follows: 
 
“Section 7.02. 
Suspension by the Bank 
 
... (l) 
Ineligibility
.
The Bank or the Association has declared the Borrower 
(other than the Member Country) or the Project Implementing Entity ineligible to 
receive proceeds of any financing made by the Bank or the Association or 
otherwise to participate in the preparation or implementation of any project 
financed in whole or in part by the Bank or the Association, as a result of a 
determination by the Bank or the Association that the Borrower or the Project 
Implementing Entity has engaged in fraudulent, corrupt, coercive or collusive 
practices in connection with the use of the proceeds of any financing made by the 
Bank or the Association.” 
3. 
The following terms and definitions set forth in the Appendix are modified or 
deleted as follows, and the following new terms and definitions are added in 
alphabetical order to the Appendix as follows, with the terms being renumbered 
accordingly: 
 
(a) 
The term “Project Preparation Advance” is modified to read “Preparation 
Advance” and its definition is modified to read as follows: 
 
“‘Preparation Advance’ means the advance referred to in the Financing 
Agreement and repayable in accordance with Section 2.07.” 
 
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(b) 
The definition of the term “Conversion Date” is modified to read as 
follows: 
 
“‘Conversion Date’ means, in respect of a Conversion, the Execution 
Date (as herein defined) or such other date as requested by the Borrower 
and accepted by the Bank, on which the Conversion enters into effect, 
and as further specified in the Conversion Guidelines.”