S 8 DOCUMEVTS The World Bank New Delhi Office PlPne: +911141479301/+911149247601 INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT 7OWgiEsjtat J1Aa1ling Address P.0 Box 416 INTERNATIONAL DEVELOPMENT ASSOCIATION NewDehi-110OIM1 India March 23, 2016 Mr. Raj Kumar Joint Secretary (MI) N'.' Department of Economic Affairs Ministry of Finance Government of India North Block New D Ihi 110 001 De Mr. Raj Kumar: A: Additional Financing for the Karnataka Health System Development and Reform Project (Credit N-umIer3l N) Amendment to Financing Agreement We refer to the Financing Agreement between India (the Recipient) and the International evelopment Association (the Association) dated November 21, 2012, as amended to date (the Financing Agreement) and the Project Agreement between the Association and the State of Karnataka of the same date (the Project Agreement) for the above-referenced project (the Project). We also refer to your letter dated February 11, 2016 requesting an extension of the Closing Date to facilitate implementation of the Project. \ L We are pleased to inform you that the Association concurs with the request, and the Closing Date in Section IV.D.2 of Schedule 2 to the Financing Agreement is hereby extended to March 31, 2017. Accordingly, the Key Performance Indicators referred to in Section II.A of Schedule 2 to the Financing Agreement and Section II.A.1 of Schedule 1 to the Project Agreement are hereby amended to reflect the extended Closing Date, as set out in the Attachment to this letter. Except as specifically amended by this letter, all other provisions of the Financing Agreement and the Project Agreement shall remain in full force and effect. Please confirm your agreement to the amendment to the Financing Agreement set out above by having an authorized representative of the Recipient sign and date the form of confirmation on the enclosed duplicate original of this letter and return it to us for our files. Headquarterill Washington DC Q USA Mr. Raj Kumar - 2 - March 23, 2016 Upon receipt of the copy of this letter countersigned on behalf of the Recipient, this amendment letter will become effective as of the date of countersignature. Sincerely, Onno Ruhl Country Director, India South Asia Region CONFIRMED: INDIA B /RRAJ KUMAR By: f-). iits crtr f Yt rF8/Nnis v of Finance fa r TOc 4;fett of Eco. Affairs Name: *Trd RGovt of India Title: Date: cc: Shri M. Lakshminarayana Principal Secretary Department of Health & Family Welfare Government of Karnataka Secretariat, Vikas Soudha Bangalore 560001 ATTACHMENT KEY PERFORMANCE INDICATORS Karnataka Health System Development and Reform Project (P071160): Results Framework Indicator Name Core Unit of Measure Baseline End Target Project Development Objective Indicators Direct project beneficiaries X Number Value 0.00 306000000.00 Date 31 -Mar-2006 31-Mar-2016 Comment Female beneficiaries X Percentage Value 0.00 50.00 Sub Type Supplemental Percent of births/deliveries Percentage Value 65.00 90.00 occurring in a health facility Date 31-Mar-2006 31-Mar-2016 Comment Percent of birth/deliveries Percentage Value 37.00 55.00 occurring in a health facility Date 31-Mar-2004 31-Mar-2016 among the poor Comment Percent of population receiving Percentage Value 46.00 78.00 outpatient care in government Date 31 -Mar-2006 31-Mar-2016 Comment Karnataka Health System Development and Reform Project (P071160): Results Framework Indicator Name Core Unit of Measure Baseline End Target facilities in 7 less-developed districts Number of health claims paid Number Value 0.00 150000.00 by health insurance pilot Date 31-Mar-2006 31-Mar-2017 program benefitting Below Comment Poverty Line (BPL) households Number of women screened for Number Value 0.00 1000.00 cervical cancer in pilot districts Date 31-Mar-2006 31-Mar-2017 Comment The end target is shifted to next year. percent change in number of Percentage Value 0.00 10.00 road traffic accident patients Date 31-Mar-2006 31-Mar-2016 transported by government Comment ambulance system (108 system) in pilot districts Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline End Target Health personnel receiving X Number Value 0.00 25500.00 training (number) Date 22-Aug-2006 31-Mar-2016 Karnataka Health System Development and Reform Project (P071160): Results Framework Indicator Name Core Unit of Measure Baseline End Target Comment Births (deliveries) attended by X Number Value 0.00 5200000.00 skilled health personnel Date 31-Mar-2005 31-Mar-2016 (number) Comment Health facilities constructed, X Number Value 0.00 375.00 renovated, and/or equipped Date 31-Mar-2006 31-Mar-2017 (number) Comment Percent of government Primary Percentage Value 0.00 47.00 Health Centers (PHCs) Date 31 -Mar-2006 31 -Mar-2016 providing round-the-clock Comment services Training materials on non- Yes/No Value No Yes communicable disease Date 31-Mar-2006 31-Mar-2016 activities for clinical staff are Comment developed Guidelines and standards for Yes/No Value No Yes trauma care services are Date 31 -Mar-2016 developed Comment number of claims paid to Number Value 0.00 120000.00 private sector hospitals by the Date 31-Jan-2015 31-Mar-2017 Karnataka Health System Development and Reform Project (P071160): Results Framework Indicator Name Core Unit of Measure Baseline End Target government health insurance Comment program supported by the project (cumulative) number of private hospitals Number Value 0.00 50.00 empaneled by SAST that have Date 31-Mar-2006 31-Mar-2016 submitted at least 100 claims Comment (cumulative) number of hospitals empaneled Number Value 0.00 150.00 to provide care to road accident Date 31-Jan-2015 31-Mar-2017 victims under the government Comment program (cumulative)