The World Bank Cambodia Nutrition Project (P162675) REPORT NO.: RES46930 DOCUMENT OF THE WORLD BANK RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF CAMBODIA NUTRITION PROJECT APPROVED ON APRIL 4, 2019 TO KINGDOM OF CAMBODIA HEALTH, NUTRITION & POPULATION EAST ASIA AND PACIFIC Regional Vice President: Victoria Kwakwa Country Director: Mariam J. Sherman Regional Director: Daniel Dulitzky Practice Manager/Manager: Aparnaa Somanathan Task Team Leader(s): Ziauddin Hyder, Anne Marie Provo The World Bank Cambodia Nutrition Project (P162675) I. BASIC DATA Product Information Project ID Financing Instrument P162675 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 04-Apr-2019 30-Jun-2024 Organizations Borrower Responsible Agency Ministry of Health,National Committee for Sub-National Kingdom of Cambodia Democratic Development Secretariat Project Development Objective (PDO) Original PDO The PDO is to improve utilization and quality of priority maternal and child health and nutrition services for targeted groups in Cambodia. Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-63940 04-Apr-2019 22-Aug-2019 10-Oct-2019 30-Jun-2024 15.00 .63 14.73 TF-B0827 03-Jul-2019 22-Aug-2019 10-Oct-2019 30-Jun-2024 2.00 .38 1.62 TF-A9830 04-Apr-2019 22-Aug-2019 10-Oct-2019 31-Dec-2021 10.00 .41 9.59 TF-A9833 04-Apr-2019 22-Aug-2019 10-Oct-2019 30-Jun-2023 5.00 .21 4.79 TF-A9902 04-Apr-2019 22-Aug-2019 10-Oct-2019 30-Jun-2021 2.00 .12 1.88 The World Bank Cambodia Nutrition Project (P162675) Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No II. SUMMARY OF PROJECT STATUS AND PROPOSED CHANGES 1. The Cambodia Nutrition Project (CNP), with a total financing of US$53 million, was approved on April 4, 2019 and became effective on October 10, 2019. The project was financed by a US$15 million International Development Association (IDA) credit; a US$12 million counterpart financing from the Royal Government of Cambodia (RGC); and a US$26 million grant from the Multi-Donor Trust Funds for the Health Equity and Quality Improvement Program (TF0A9902), the Integrating Donor-Financed Health Program (IDFHP; TF0A9833), Global Financing Facility for Women, Children and Adolescents (GFF; TF0A9830)), and also from the KfW Single-Donor Trust Fund for the Cambodia Health, Nutrition and Population Sector (TF0B0827). The project development objective (PDO) is to improve utilization and quality of priority maternal and child health and nutrition services for targeted groups in Cambodia. 2. Project status: Although limited progress was noted against several intermediate results indicators due to the early stage of activity rollout, the progress towards achievement of the PDO remains moderately satisfactory, and several intermediate result indicators have already surpassed 2020 targets. 3. Component 1: Strengthening the delivery of priority health services: The component aims to improve the accessibility, affordability, and quality of these priority services by leveraging the Health Equity Fund (HEF) and Service Delivery Grants (SDGs) systems—existing results-based health sector platforms. The progress of this component is as follows: i. Subcomponent 1.1: Performance-based SDGs: The National Maternal and Child Health Center finalized the Maternal and Child Health and Nutrition Scorecard (MCHN-S) tools in August 2020 with support from the National Nutrition Program (NNP) and Quality Assurance Office (QAO), and in consultation with key partners. The MCHN-S’ user manual and a coaching guide for operational district (OD) assessors have also been finalized. The development of a digital platform for MCHN-S to implement MCHN-S is on-going, which is expected to become functional by August 2021. This activity will be followed by training of OD assessors, and the first round of quarterly assessment of the Health Centers (HCs) using MCHN-S is expected in September 2021. ii. Subcomponent 1.2: HEF: The Payment Certification Agency (PCA) has updated Patient Management Registration System (PMRS) to include children aged 0-2 years of informal workers as HEF beneficiaries. The PCA conducted a training of trainers (TOT) on the updated PMRS, HEF invoices’ processing, and verification of eligible cards for claims certification for all PCA HEF monitors in the seven CNP provinces in January 2021. Claims certification for this new target group will begin upon dissemination of the HEF Operational Manual to Provincial Health Departments (PHDs) and ODs expected to be in August 2021, depending on the COVID-19 situation. In 2021, PCA plans to conduct orientation training on the updated full PMRS to PHDs, ODs, and HCs in the seven CNP provinces and procure new equipment for 40 HCs out of a total of 165 HCs in the CNP target provinces. 4. Component 2: Stimulating Demand and Accountability at the Community Level: The component finances community-based interventions in the seven priority provinces to stimulate demand, increase utilization of facility- The World Bank Cambodia Nutrition Project (P162675) based priority services, and encourage the adoption of improved reproductive maternal neonatal child and adolescent health and nutrition behaviors. The progress of this component is as follows: i. Subcomponent 2.1: The rollout of Commune/Sangkat Service Delivery Grants (C/S-SDG) will be conducted in three rounds. Due to the COVID-19 outbreak and lockdown in February – April 2021, the first readiness assessment has been postponed from May 2021 to August 2021. The National Committee for Sub-National Democratic Development Secretariat (NCDDS) has finalized the TOT curriculum and materials for C/S-SDG assessment and is assessing the status of access to technology to identify alternatives to traditional, large group face-to-face training in order to adapt training to the current pandemic context. The assessments will be conducted manually for the first round and procurement of the firm to develop C/S-SDG Information Communication Technology (ICT) platform will be finalized by August 2021 as well. NCDDS continues to work closely with the National Center for Health Promotion (NCHP) to ensure alignment of C/S recruitment of the Village Health Support Groups (VHSGs) under the Project with NCHP’s VHSG training timeline. ii. Commune Program for Women and Children (CPWC): The development and rollout of CPWC is on track. NCHP has finalized associated plans and materials for (a) two TOT modules and 33 stepdown courses; (b) capacity building of core trainers at the national level; (c) VHSG coaching plan; and (d) supervision support from NCHP, NCDDS, and development partners (both jointly and separately). NCHP noted challenges related to insufficient human resources and administrative support as well as financial constraints due to delayed release of project funds according to the annual workplan and budget. iii. Subcomponent 2.2: Building Capacities, Monitoring, and Verifying C/S-SDG: To date, out of 7 targets across three DLIs for year 0, 6 targets are fully achieved (DLI C Target 2 is not achieved) - disbursement amount to date is US$450,000. Year 1: There was no submission for achievement of DLIs for Year 1; targets relate to the rollout of interventions which has been delayed due to slow startup and COVID -19 interference. 5. Component 3: Ensuring an effective and sustainable response. This component finances (a) central-level actions needed to enhance the effectiveness and sustainability of project investments; (b) development and delivery of modernized Social and Behavior Change Communication (SBCC) campaigns; (c) comprehensive monitoring, evaluation, and adaptive learning; and (d) project management. i. Subcomponent 3.1: Strengthening the functional and technical capacities at national and subnational levels. This sub-component finances the DLIs for Ministry of Health (MOH): Among eight DLIs for MOH, for Year 0, targets of seven DLIs have been all achieved leaving two DLI K targets unachieved. Total disbursement amount for Year 0 DLI targets for MOH to date is US$1.07 million. This excludes the disbursement of US$50,000 or the remaining 50% achievement of DLI J Target 1 for Year 0 that was achieved for March 2021 round (which has been verified but not yet paid). For Year 1, only 1 target of DLI F was achieved and verified for its achievement to date and US$0.1 million disbursed. The disbursement notification is expected to be sent to the MEF by the end of June 2021, which will include the remaining fund for DLI J Target 1 for Year 0 (US$50,000). Full achievement of Year 1 DLI targets are expected in the next submission round, pending ability to resume normal training and travel. ii. Component 3.2: Development of a Comprehensive Social and Behavior Change Communication (SBCC) Campaign: NNP has convened a series of meetings with key development partners to deploy a nationwide campaign for maternal nutrition, breastfeeding, complementary feeding, and child growth and development. The Maternal Infant and Young Child Nutrition Steering Committee has endorsed relevant inputs for a second round of prototype testing of Interpersonal Communication tools and the creative concept. The NNP is aiming to harmonize nutrition The World Bank Cambodia Nutrition Project (P162675) messages across tools and delivery channels; eventually, the updated SBCC approaches will be integrated in training curricula, MCHN-S tools, and coaching modules for HC staff and VHSGs for consistency. The first round of training for HC staff and VHSGs will utilize existing SBCC materials; once new tools are ready; the curricula will be updated for subsequent rounds. The NCHP is finalizing the terms of reference to recruit a firm to support the development of the HEF promotion SBCC campaign. 6. Project procurement, financial management, counterpart funding and monitoring and evaluation are rated satisfactory, while project management is rated moderately satisfactory due to COVID-19 pandemic which caused inevitable delays in the rollout of activities, such as project orientations and safeguards training, and roll out of activities related to SDGs, the C/S-SDG, and HEF. To date, approximately US$1.7 million (or 3% of total project financing) is disbursed. The Designated Account under the HEQIP Grant has been inactive for 10 months. The Withdrawal Application for documenting the expense is pending Ministry of Economy and Finance’s clearance. The task team is following up with both MOH and MEF to try to clear the status before June 30. There are no overdue auditreport and interim financial report. 7. Rational for restructuring: This restructuring paper recommends a no cost extension of TF0A9902 from June 30, 2021 to June 30, 2022 to align with end disbursement date of the of the Trustee, Cambodia Health Equity and Quality Improvement Program Multi-Donor Trust Fund (TF072541), which was extended by one year after the project’s approval. In addition, the extension will allow the project to utilize the available funds to implement planned activities which are being impacted due to COVID-19 related lockdown and travel restrictions. 8. This extension is needed as the spread of COVID-19 infection had limited the full take-off of the project, and the COVID-19 pandemic has resulted in reduced uptake of basic services due to fear of contracting the virus in health facilities by communities across the country. The emergency measures taken by Government to contain the spread, which included restriction of movement, home-base work and social distancing etc. had all negatively impacted the implementation of the project as planned as well. New arrangements have been made to ensure business continuity through adapted plans for training and rollout. As such, an initial one-year extension is requested to allow sufficient exposure time to activities intended to improve nutrition in the first 1,000 days of life. 9. A request for extension of the grant TF0A9902 closing date was received from the Ministry of Economy and Finance on June 22, 2021. III. DETAILED CHANGES LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications IDA-63940 Effective 30-Jun-2024 TF-A9830 Effective 31-Dec-2021 The World Bank Cambodia Nutrition Project (P162675) TF-A9833 Effective 30-Jun-2023 TF-A9902 30-Jun-2021 30-Jun-2022 31-Dec-2022 TF-B0827 Effective 30-Jun-2024