OFFICIAL DOCUMENTS FCDO SDTF GRANT NUMBER TFOB4481 Mozambique Primary Health Care Strengthening Program Single Donor Trust Fund Grant Agreement (Primary Health Care Strengthening Program) between REPUBLIC OF MOZAMBIQUE and INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT AND INTERNATIONAL DEVELOPMENT ASSOCIATION (acting as administrator of the Mozambique Primary Health Care Strengthening Program Single Donor Trust Fund) FCDO SDTF GRANT NUMBER TFOB4481 SINGLE DONOR TRUST FUND FOR THE MOZAMBIQUE PRIMARY HEALTH CARE STRENGTHENING PROGRAM GRANT AGREEMENT AGREEMENT dated as of the Signature Date between REPUBLIC OF MOZAMBIQUE ("Recipient") and INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT/INTERNATIONAL DEVELOPMENT ASSOCIATION ("World Bank" or "Bank"), acting as administrator of the Mozambique Primary Health Care Strengthening Program Single Donor Trust Fund. The Recipient and the Bank hereby agree as follows: Article I Standard Conditions; Definitions 101. The Standard Conditions (as defined in the Appendix to this Agreement) apply to and form 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 Standard Conditions or in the Appendix to this Agreement. Article It The Program 20L The Recipient declares its commitment to the objective of the program described in Schedule 1 to this Agreement ("Program"). To this end, the Recipient shall carry out the Program through MISAU in accordance with the provisions of Article II of the Standard Conditions and Schedule 2 to this Agreement. Article III The Grant 3.01. The Bank agrees to extend to the Recipient a grant in an amount not to exceed three million Dollars (USD 3,000,000) ("Grant") to assist in financing the Program. 3.02. The Recipient may withdraw the proceeds of the Grant in accordance with Section IV of Schedule 2 to this Agreement. 2 3.03. The Grant is funded out of the abovementioned trust fund for which the Bank receives periodic contributions from the donor to the trust fund. In accordance with Section 3.02 of the Standard Conditions, the Bank's payment obligations in connection with this Agreement are limited to the amount of funds made available to it by the donor under the abovementioned trust fund, and the Recipient's right to withdraw the Grant proceeds is subject to the availability of such funds. Article IV Recipient's Representative; Addresses 4,01. The Recipient's Representative referred to in Section 7.02 of the Standard Conditions is its Minister of Economy and Finance. 4.02. For purposes of Section 7.01 of the Standard Conditions: (a) the Recipient's address is: Ministry of Economy and Finance Pra9a da Marinha Popular Av. 10 de Novembro no 929 Maputo, Caixa Postal 272 Republic of Mozambique; and (b) the Recipient's Electronic Address is: Facsimile: [E-mail:] +258 21313747 4.03. For purposes of Section 7.01 of the Standard Conditions: (a) the Bank's address is: International Bank for Reconstruction and Development/International Development Association 1818 11 Street, N.W. Washington, D.C. 20433 United States of America; and (b) the Bank's Electronic Address is: Telex: Facsimile: 248423 (MCI) or 1-202-477-6391 64145 (MCI) 3 AGREED as of the Signature Date. REPUBLIC OF MOZAMBIQUE By Authorized Representative Name: Adriano Afonso Maleiane Title: Minister of Economy and Finance Date:2{ / /4 INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT/ INTERNATIONAL DEVELOPMENT ASSOCIATION (acting as administrator of the Mozambique Primary Health Care Strengthening Program Single Donor T ust Fund) By us,/ /'Authorized Representative Name: %da Pswarayi Riddihough Title: iColintry Director Date1 4 SCHEDULE I Program Description The objective of the Program is to improve the utilization and quality of reproductive, maternal, child, and adolescent health and nutrition services, particularly in Underserved Areas. The Program consists of the following activities: 1. enhancing coverage, access and quality of primary health care services, including high-impact supply and demand side interventions, with a focus on Underserved Areas; 2. strengthening the health system for improved stewardship, financial sustainability, expenditure efficiency and equity and gender responsive service delivery, together with improved civil registration and vital statistics systems; and 3. enabling MISAU to effectively manage the implementation of its Investment Case, through technical assistance, capacity building, monitoring and evaluation and coordination of the activities of health partners. 5 SCHEDULE 2 Program Execution Section 1. Implementation Arrangements A. Program Fiduciary, Environmental and Social Systems Without limitation upon the provisions of Article II of the Standard Conditions, the Recipient shall carry out the Program, or cause the Program to be carried out, in accordance with financial management, procurement and environmental and social management systems acceptable to the World Bank ("Program Fiduciary, Environmental and Social Systems") which are designed to ensure that: (a) the Grant proceeds are used for their intended purposes, with due attention to the principles of economy, efficiency, effectiveness, transparency, and accountability; and (b) the actual and potential adverse environmental and social impacts of the Program are identified, avoided, minimized, or mitigated, as the case may be, all through an informed decision-making process. B. Anti-Corruption Without limitation upon the provisions of Part A of this Section, the Recipient shall carry out the Program, or cause the Program to be carried out, in accordance with the provisions of the Anti-Corruption Guidelines. C. On-Financing Arrangements (a) To facilitate the carrying out of the Program, the Recipient shall make the proceeds of the Grant available to institutions and entities involved in Program implementation in accordance with the Recipient's standard arrangements for health sector financing. (b) Notwithstanding paragraph I above, in the event that any provision of this Agreement, including the instructions that the World Bank shall have specified by notice to the Recipient pursuant to Section IV.A. I of this Schedule, were to be found inconsistent with the Recipient's standard arrangements for health sector financing, the provisions of this Agreement and related instructions shall prevail. (c) The Recipient shall protect its own interests and the interests of the World Bank while implementing the on-financing arrangements, in order to accomplish the purposes of the Grant. 6 D. Program Institutions (a) MISAU (i) The Recipient's MISAU shall be responsible for the overall implementation of Program activities at all times during the implementation of the Program and the Recipient shall take or cause to be taken, all actions, including, the provision of funding, personnel and other resources to enable MISAU to perform its respective functions under the Program. (ii) The Recipient shall ensure that MISAU causes provincial and district health institutions to implement Program activities at the local level and that provincial and district health institutions are maintained at all times during the implementation of the Program with mandate, staffing and resources satisfactory to the World Bank, including trained accounting technicians in districts. The Recipient shall ensure that relevant local government entities in the health sector shall: (A) carry out its activities under the Program with due diligence and efficiency and in accordance with the Program Fiduciary, Environmental and Social Management Systems Assessment, the Anti-Corruption Guidelines, and the Program Operations Manual; (B) maintain policies and procedures adequate to enable it to monitor and evaluate the progress of its activities under the Program and the achievement of the Program's objective; (C) enable the Recipient (and the World Bank, if the World Bank shall so request) to inspect the activities within each Program jurisdiction, its operation and any relevant records and documents; (D) prepare and furnish to the Recipient and the World Bank all such information as the Recipient or the World Bank may reasonably request relating to the foregoing; (E) monitor implementation activities to be carried out under the Program; and (F) ensure that procurement is carried out in a timely fashion, in accordance with the Program Operations Manual and this Agreement, as applicable. (iii) The Recipient shall ensure that MISAU works in close cooperation with other relevant ministries, agencies and departments, and ensure that they are assigned with technical, social and environmental safeguards, fiduciary and other responsibilities for implementing the Program, with all powers, functions, institutional capacity and staffing acceptable to the World Bank and with resources adequate to fulfill their respective functions under the Program. 7 (b) Program Management Unit The Recipient shall maintain a program management unit within DPC to provide administrative and logistical support to the Program. The Recipient shall appoint not later than ninety (90) days after the Effective Date, and thereafter maintain, at all times during the implementation of the Program, the following specialists to strengthen the management capacity of the program management unit: (i) a Program manager, (ii) a senior procurement specialist, (iii) a financial management specialist, (iv) two (2) procurement assistants; (v) two (2) financial management assistants, and (vi) an administrative assistant. E. Program Operations Manual (a) Without limitation of the generality of Part A of this Section 1, the Recipient shall maintain in form and substance satisfactory to the World Bank, the Program Operations Manual containing detailed institutional, administrative, financial, environmental and social, technical and operational guidelines and procedure for the implementation of the Program, and thereafter, carry out the Program in accordance with such operations manual, as shall have been approved by the World Bank ("Program Operations Manual"). (b) The Recipient shall not amend, abrogate or suspend, or permit to be amended, abrogated, or suspended, any provision of the Program Operations Manual, without the prior written agreement of the World Bank. Notwithstanding the foregoing, if any provision of the Program Operations Manual is inconsistent with the provisions of this Agreement, the provisions of this Agreement shall prevail. F. DLR Verification Arrangements 1 . During the implementation of the Program, Independent Verification Agent(s), appointed under terms of reference acceptable to the World Bank, shall verify the data and other evidence supporting the achievement of Disbursement Linked Results under all Categories as set forth in the table in Section IV.A.2 of this Schedule 2 and recommend corresponding payments to be made, as applicable. 2. The Recipient shall: (a) ensure that the independent Verification Agent(s) carries out verification process(es) in accordance with the Verification Protocol agreed with the World Bank; and (b) submit to the World Bank the corresponding verification reports in a timely manner and in form and substance satisfactory to the World Bank. 8 3. In the event there is a need for verification services prior to the appointment of the Independent Verification Agent(s) in accordance with paragraph I above, the Recipient shall put in place adequate interim arrangement satisfactory to the World Bank and approved in writing by the World Bank for verification of the DLRs. G. Additional Program Implementation Arrangements The Recipient shall carry out the Program Action Plan or cause the Program Action Plan to be carried out, in accordance with the schedule set out in said Program Action Plan in a manner satisfactory to the World Bank. Section II. Excluded Activities The Recipient shall ensure that the Program excludes any activities which: (a) in the opinion of the Bank, are likely to have significant adverse impacts that are sensitive, diverse, or unprecedented on the environment and/or affected people; or (b) involve either: (i) contracts exceeding twenty-five percent of the total Program expenditure or (ii) the procurement of: (A) works, estimated to cost USD 50,000,000 equivalent or more per contract; (B) goods, estimated to cost USD 30,000,000 equivalent or more per contract; (C) non-consulting services, estimated to cost USD 20,000,000 equivalent or more per contract; or (D) consulting services, estimated to cost USD 15,000,000 equivalent or more per contract, whichever is lower; or (c) involve non-performance-based salary payments; or (d) involve construction of new "level three" or "level four" health facilities and hospital as described in Ministerial Diploma no. 127/2002, of July 31, 2002, or health centers that would be classified as category A or category A+ under Decree 54/2015, of December 31; or (e) involve high-tech medical and surgical equipment intended for specialized care and use in levels three and four health facilities. Section III. Program Monitoring, Reporting and Evaluation A. Program Reports 1. The Recipient shall monitor and evaluate the progress of the Program and prepare Program Reports in accordance with the provisions of Section 2.06 of the Standard Conditions. Each Program Report shall cover the period of one calendar semester and shall be furnished to the World Bank not later than two (2) months after the end of the period covered by such report. 9 2. The Recipient shall furnish to the World Bank: (a) each Program Report not later than two (2) months after the end of each calendar semester, covering the period covered by such report; (b) unaudited budget execution reports for the economic and social plan not later than four (4) months after the end of each calendar quarter, covering period covered by such report; and (c) annual accounts of the health economic and social plan audited by the Recipient's Tribunal Administrativo not later than twelve (12) months after the end of each Fiscal Year, covering the Fiscal Year. B. Program Financial Audits The Recipient shall have the Financial Statements for the Program audited in accordance with the provisions of Section 2.07(b) of the Standard Conditions, Each such audit of the Financial Statements shall cover the period of one Fiscal Year of the Recipient. The audited Financial Statements for each such period shall be furnished to the World Bank not later than twelve months after the end of such period. Section IV. Withdrawal of Grant Proceeds A. General 1. The Recipient may withdraw the proceeds of the Grant in accordance with the provisions of Article III of the Standard Conditions, this Section, and such additional instructions as the Bank may specify from time to time by notice to the Recipient to finance Program Expenditures (inclusive of Taxes), on the basis of the results ("Disbursement Linked Results" or "DLRs") achieved by the Recipient, as measured against specific indicators ("Disbursement Linked Indicators" or "DLIs"); all as set forth in the table in paragraph 2 of this Part A. 2. The following table specifies each category of withdrawal of the proceeds of the Grant (including the Disbursement Linked Indicators as applicable) ("Category"), the Disbursement Linked Results for each Category (as applicable), and the allocation of the amounts of the Grant to each Category: 10 Category Disbursement Linked Amount of the Grant Disbursement Calculation (including Result Allocated Formula Disbursement (as applicable) (expressed in USD) Linked Indicator as applicable) (1) DLI #1: The Previous: FY2018 - No scalability Recipient has The Recipient has FY2019 - FY Allocated increased the increased the percentage Amount x [Actual number of districts, of Institutional Deliveries Achievement up to DLR 1.2 - out of the 42 in the 42 lagging districts DLR 1.1] [DLR 1.2 -DLR defined as lagging defined in the Investment 1.1] undisbursed amount in the Investment Case. from previous targets met Case, with at least 85 percent of FY2020 No scalability Institutional DLR# 1. : The Recipient FY2021 - FY Allocated Deliveries. has increased the Amount x [Actual percentage of Institutional Achievement up to DLR 1.4 -i Deliveries in 42 Lagging DLR 1.3] / [DLR 1.4 - DLR Districts to 66.8% [FY 1.3] - undisbursed amount 20181 from previous targets met (Baseline: 66.1%) FY2022 - FY Allocated Amount x [Actual DLR#1,2; The Recipient Achievement up to DLR 1 .5 - DLRsln2reTe Reen DLR 1.4] / [DLR 1.5 - DLR has increased the eof Institutional 14] + undisbursed amount Deliveries in 42 Lagging from previous targets met. Districts to 81% [FY 2019] Revised: The Recipient has increased the number of districts, out of the 42 defined as lagging in the Investment Case, with at least 85 percent of institutional deliveries. DLR#1.3: The Recipient has increased the number of districts with at least 85 percent of institutional 11 deliveries to 29 [FY 2020] DLR#1.4: The Recipient has increased the number of districts with at least 85 percent of institutional deliveries to 32 [FY 202 ] DLR#1.5: The Recipient has increased the number of districts with at least 85 percent of institutional deliveries to 37 [FY 2022] (2) DLI #2: The DLR#2.3.1: The Recipient FY2020 - No scalability Recipient has has increased the FY2021 - increased the percentage of Technical 2.4.1. FY Allocated Amount x percentage of Schools offering sexual 2.4.uaF Acat ut Secondary and and reproductive health [Actual Achievement up to Technical Schools services to 19% [FY 2020] [DLR 2.4.1 - DLR 2.3.1] offering sexual and (Baseline: 0%) [dRbu24.d aDount from] reproductive health unisursed services Dprevious targets met (information and has completed a gapsNo scalability contraceptive identification of current 2.4.3: No scalability methods), Training Materials [FY 2020] FY2022 - 25.1: FY Allocated Amount x DLR#2.33: The Recipient [Actual Achievement up to has finalized the DLR 2.5.1 - DLR 2.4.1] / harmonization of M&E [DLR 2.5.1 - DLR 2.4.1] + Tools undisbursed amount from [FY 2020] previous targets met. 2.5.2: No scalability DLR#2.4.1: The Recipient 2.5.2: No scalability has ncrasedthe2.5.3: No scalability has increased the percentage of Secondary and Technical Schools FY2023 - FY Allocated 'offering sexual and Amount x [Actual reproductive health Achievement up to DLR 2.6.1 services to 40% [FY - DLR 2.5.11 / [DLR 2.6.1 - 2021] DLR 2.5.1] + undisbursed 12 amount from previous targets DLR#2.4.2: The Recipient met. has approved updated Training Materials [FY 2021] DLR#2.4.3: The Recipient has approved updated Adolescent and Youth- Friendly Services (SAAJ) Guidelines [FY 2021] D LR#2.5 1: The Recipient has increased the percentage of Secondary and Technical Schools offering sexual and reproductive health services to 60% [FY 2022] DLR#2,5,2: The Recipient has completed training for health providers using new Training Materials [FY 2022] DLR#2.5.3: The Recipient has completed training for health providers and focal points on improved M&E Tools [FY 2022] DLR#2.6. 1: The Recipient has increased the percentage of Secondary and Technical Schools offering sexual and reproductive health services to 80% [FY_2023] 13 (3) DLI#3: The he Recipient has met the FY2018 - No scalability Recipient has following targets for FY2019 - FY Allocated increased Couple Couple Years of Amount x [Actual Years of Protection. Achievement up to DLR 3.2 - Protection. DLR 3.1] /[DLR 3.2 - DLR DLR#3.1: 2,135,012 [FY 3,1] +t undisbursed amount 2018] (Baseline: from previous targets met 1,722,692) FY2020 - FY Allocated Amount x [Actual DLR#3,2: 2,336,463 [FY Achievement up to DLR 3.3 - 2019] DLR 3.2] / [DLR 3.3 - DLR 3.2] + undisbursed amount from previous targets met DLR#33. 3,190.000 [FY FY2021 - FY Allocated 2020] Amount x [Actual Achievement up to DLR 3.4 - DLR3.4: 3,360,000 [FY DLR 3.3] / [DLR 3.4 - DLR 2021] 3.3] + undisbursed amount from previous taracts met DLR#3.5: 3,540,000 [FY FY2022 - FY Allocated 2022] Amount x [Actual Achievement up to DLR 3,5 - DLR 3.4] /[DLR 3.5 - DLR 3.4] + undisbursed amount from previous targets met. (4) DLI#4: DLR#4. 1.1: The Recipient FY2018 - No scalability. The Recipient has has trained at least 6 FY2020 - FY Allocated increased the trainers, 100% of district Amount x [Actual percentage of nutrition representatives, Achievement up to DLR 4.3 - children between and 30% of Community Baseline] / [DLR 4.3 - 0-24 months of age Health Workers, and Baseline] - undisbursed receiving the identified 30% of amount from previous targets Nutrition volunteers, in 6 of the 8 met Intervention targeted provinces on the Package (NIP) in NIP [FY 2018] the eight provinces FY2021 - (Cabo Delgado, DLR#4.1.2: The Recipient 4.4.1 Inhambane, has finalized the FY Allocated Amount x Manica, Nampula, Monitoring and Evaluation [Actual Achievement up to Niassa, Sofala, System [FY 2018] [DLR 4.4,1 - DLR 4.3]! [DLR Tete and .441 l-DLR{4.3] + ambezia) with a undisbursed amount from prevalence of previous targets met 14 stunting above 35 DLR#4.3: The Recipient 4.4.2 percent, has ensured that 15% of FY Allocated Amount x children are benefiting [Actual Achievement up to from the Modified NIP DLR 4.4.2 -Baseline] / [DLR [FY 2020] (Baseline: 0) 4.4.2 - Baseline] DLR#4.4. 1: The Recipient FY2022 - FY Allocated has ensured that 40% of Amount x [Actual children arc benefitting Achievement up to DLR 4.5 - from NIP [FY 2021] DLR 4.4.1] / [DLR 4.5 - DLR 4.4.1] - undisbursed amount DLR#4,4.2: The Recipient from previous targets met has ensured that 75% of nutrition sites meet the FV2023 - minimum quality standard 4.6.1: FY Allocated Amount x as determined in [Actual Achievement up to accordance with Section DLR 4.6.1 - DLR 4.5] / [DLR .E.5 of Schedule 2 to this 4.6.1 - DLR 4.5] - Agreement. [FY 20213 undisbursed amount from (Baseline: 0) previous targets met 4.6.1: FY Allocated Amount x DLRI#4.5: The Recipient [Actual Achievement up to has ensured that 60% of DLR 4.6.2 - DLR 4.4,2] / children are benefitting [DLR 4.6.2 - DLR 4.4.2] + from NIP [FY 2022] undisbursed amount from previous targets met DLR#4.6.1: The Recipient has ensured that 80% of children are benefitting from NIP [FY 2023] DLR#4.6.2: The Recipient has ensured that 90% of nutrition sites meet minimum quality standards as determined in accordance with Section .E.5 of Schedule 2 to this Agreement. [FY 2023] (5) DLI#5: The DLR#5.1: Actual FY2018 - No scalability Recipient has Domestic Health 15 increased the Expenditure as a FY2019 - FY Allocated Domestic Health percentage of total Amount x [Actual Expenditures as a Domestic Government Achievement up to DLR 5.2 - percentage of total Expenditure at least 8.5% DLR 5.1] / [DLR 5.2 - DLR Domestic [FY 2018] (Baseline: 5.1] + undisbursed amount Government 7.9%) from previous targets met Expenditures, FY2020 - FY Allocated DLR#5.2: Actual Amount x [Actual Domestic Health Achievement up to DLR 5.3 - Expenditure as a DLR 5.2] / [DLR 53 - DLR percentage of total 5.2] + undisbursed amount Domestic Government from previous targets met Expenditure at least 8.5% FY2021 - FY Allocated [FY 2019] Amount x [Actual Achievement up to DLR 5.4 - DLR#5.3: Actual DLR 5.3] / [DLR 5.4 - DLR Domestic Health 5.3] + undisbursed amount Expenditure as a from previous targets met percentage of total Domestic Government Expenditure at least 9% [FY 2020] DLR#5.4: Actual Domestic Health Expenditure as a percentage of total Domestic Government Expenditure at least 9.5% [FY 2021] (6) DLI#6: The DLR#6.3.1: Actual FY2020 - No scalability Recipient has provincial expenditures in increased health the Underserved Provinces FY2021 - expenditures from from the Sub-Account the Sub-Account Resources to USD 9 6.4.1: Allocated Amount x Resources in million [FY2020] [Actual achievement up to underserved (Baseline: 0) DLR 6.4.1 -DLR 6.3.l] provinces [DLR 6.4.1 - DLR 6.3.1] + (Nampula, undisbursed amount from ' DLR#6,3,2: Actualviutags t Zambezia, Tete). district expenditures in the pre Underserved Districts 6.4.2: Allocated Amount x from the Sub-Account [Actual achievement up to fuDLR 6.4.2 - DLR 6.3.21 / 16 Resources to USD 4 [DLR 6.4.2 - DLR 6.3.2] + million [FY2020] undisbursed amount from (Baseline: 0) previous targets met 6.4.3: No scalability DLR#6.3.3: Domestic 6.4.4: No scalability Health Expenditures for the Underserved Areas maintained as a share of domestic provincial and FY2022 - district expenditures 6.5.1: Allocated Amount x [FY2020] (Baseline: [Actual achievement up to Domestic Health DLR 6.5.l - DLR 6.4.1]/ Expenditure for the [DLR 6.5.1 - DLR 6.4.1] Underserved Districts was undisbursed amount from 19.5% of total district previous targets met expenditures in 2015) 6.5.2: Allocated Amount x [Actual achievement up to DLR#6.3.4: The Recipient DLR 6.5.2 - DLR 6.4.2] / has signed Program [DLR 6.5.2 - DLR 6,4.2] + Contracts (Results undisbursed amount from Agreements) with three previous targets met Underserved Provinces 6.5.3: No scalability [FY2020] (Baseline: 0) FY2023 - DLR#6.4, 1: Cumulative 6.6.1: Allocated Amount x provincial expenditures in [Actual achievement up to the Underserved Provinces DLR 6.6.1 - DLR 6.5. 1] / from the Sub-Account [DLR 6.6.1 - DLR 6.5.1] - Resources to USD 18 undisbursed amount from million [FY2021] previous targets met (Baseline: 0) 6.6.2: Allocated Amount x [Actual achievement up to DLR#6.4.2: Cumulative DLR 6.6.2 - DLR 6.5.2] / district expenditures in the [DLR 6.6.2 - DLR 6.5.2] + Underserved Districts undisbursed amount from from the Sub-Account previous targets met Resources to USD 8 6.6.3: No scalability million [FY2021 ](Baseline: 0) DLR#6.4.3: Domestic Health Expenditures for 17 the Underserved Areas maintained as a share of domestic provincial and district expenditures [FY2021] (Baseline: Same as 6.1.3) DLR#6.4.4: The Recipient has signed Program Contracts (Results Agreements) with eleven provinces [FY 2021] DLR#6.5.1: Cumulative provincial expenditures in the Underserved Provinces from the Sub-Account Resources to USD 27 million [FY2022] (Baseline: 0) DLR#6.5.2: Cumulative district expenditures in the Underserved Districts from the Sub-Account Resources to USD 12 million [FY2022] (Baseline: 0) DLR#6.5 3: Domestic Health Expenditures for the Underserved Areas maintained as a share of domestic provincial and district expenditures [FY 2022] (Baseline: Same as 6.1.3) DLR#6.6.1: Cumulative provincial expenditures in the Underserved Provinces from the Sub-Account 18 Resources to USD 36 million [FY2023] (Baseline: 0) DLR#6.6.2: Cumulative district expenditures in the Underserved Districts from the Sub-Account Resources to USD 16 million [FY2023] (Baseline: 0) DLR#6.6.3. Domestic health expenditures for Underserved Areas maintained as a share of domestic provincial and district expenditures [FY 2023] (Baseline: Same as 6.1.3) (7) DLI#7: The The Recipient has met the USD 2,000,000 is FY2018 - No scalability Recipient has following percentages of allocated in FY2020 FY2019 - increased the Technical health personnel (USD 500,000 for number of assigned to the primary DLR#7.3.1 and USD 7.2.1: FY Allocated Amount x Technical health health care network: 1,500,000; and for [Actual Achievement up to personnel assigned DLR47.3.2) DLR 7.2.1 - DLR 7. 11 / [DLR 7.2.1 - 7. ] - undisbursed thDLR#7.1: 12,205 [FY amount from previous targets heathre 2018] (Baseline: 11,970) met network.me 7.2.2: FY Allocated Amount x DLR#7.2.1: 15,431 [FY [Actual Achievement up to 2019] DLR 7.2.1 - Baseline] / [DLR 7.2.1 - Baseline] DLR#7.2.2: The Recipient has increased the number FY2020 - of health facilities in the 7.3.1: FY Allocated Amount x primary care network that [Actual Achievement up to have at least two active DLR 7.3.1 - DLR 7.2.l] / maternal child health [DLR 7.3.1 - DLR 7.2,1] + (MCH) nurses to 688 [FY undisbursed amount from 2019] previous targets met 7.3.2: FY Allocated Amount x [Actual Achievement up to 19 DLR#3.: 15,566 [FY DLR 7.3.2 - DLR 7.2.2]! 2020] [DLR 7.3.2 - DLR 7.2.2] + undisbursed amount from DLR#7.3.2: The Recipient previous targets met has increased the number of health facilities in the FY2021 - primary care network that 7.4.1: FY Allocated Amount x have at least two active [Actual Achievement up to MCII nurses to 704 [FY DLR 7.4.1 - DLR 7.3,1] / 2020] [DLR 7,4.1 - DLR 7.3.1] + undisbursed amount from DLR#t7.4.1: 16,182 [FY previous targets met 2021] 7.4.2: FY Allocated Amount x [Actual Achievement up to DLR#7.4,2: The Recipient [DLR 7.4.2 - DLR 7.3.2] / has increased the number of health facilities in the undisbursed amount from primary care network that previous targets met have at least two active MCH nurses to 728 [FY FY2022 - 2021] 7.5.1: FY Allocated Amount x [Actual Achievement up to DLR#7.5.1: 17,153 [FY DLR 7.5.1 - DLR 74.1] / 2022] [DLR 7.5.1 - DLR 7.4.1] + undisbursed amount from previous targets met DLR#7.5.2: The RecipientAllocated Amount x has increased the number [Ac2al Achievement tip to of health facilities in the DLR 7.5.2 - DLR 7.4.2] / primary care network that DLR 752 DIM 7.4.2] have at least two active+ undisbursed amount from 202] nprevious targets met 2022] DLR#7.6,1: 18,163 FY2023 - [FY 2023] 7.6.1: FY Allocated Amount x [Actual Achievement up to DLR 7.6.1 - DLR 7.5.1]/ DLR#7.6.2: The Recipient [DLR 7.6.1 - DLR 7.5.l] has increased the number undisbursed amount from of health facilities in the previous targets met primary care network that 7 6.2: FY Allocated Amount x have at least two active [Actual Achievement up to 20 MCH nurses to 838 FY DLR 7.6,2 - DLR 7.5.2] / 2023] [DLR 7.6.2 - DLR 7.5.2] + undisbursed amount from previous targets met (8) DLI#8: The DLR#8.1: The Recipient USD 1,000,000 is FY2018 -No scalability Recipient has has designed and piloted allocated in FY 2020 FY2019 - FY Allocated increased the hospital scorecards in 6 Amount x [Actual number of district district and rural hospitals, Achievement up to DLR 8.2 - and rural hospitals which receive DLR 8.1] / [DLR 82 - DLR receiving performance-based 8.1] + undisbursed amount performance-based allocations according to from previous targets met allocations in their performance [FY FY2020 - FY Allocated accordance with a 2018] (Baseline: 0) Amount x [Actual minimum of one Achievement up to DLR 8.3 - scorecard DLR#8.2: The Recipient DLR 8.2] / [DLR 8.3 - DLR assessments in the has demonstrated that 30% 8.2] + undisbursed amount previous Fiscal of district and rural from previous targets met Year (FY). hospitals received FY2021 - FY Allocated performance-based Amount x [Actual allocations in accordance Achievement up to DLR 8.4 - with a minimum of two DLR 8.3] / [DLR 8.4 - DLR scorecard assessments in 8.3] + undisbursed amount the previous Fiscal Year from previous targets met [FY 2019] FY2022 - FY Allocated Amount x [Actual DLR#8.3: The Recipient Achievement up to DLR 8.5 - has demonstrated that 15 DLR 8.4] / [DLR 8.5 - DLR district and rural hospitals 8.4] - undisbursed amount receive allocations based from previous targets met on prioritized action plans that respond to scorecard evaluations [FY 2020] (Baseline: 0) DLR#8.4: The Recipient has demonstrated that 31 district and rural hospitals received performance-based allocations in accordance with a minimum of one scorecard assessment in 21 the previous Fiscal Year [FY 2021] DLR#8.5: The Recipient has demonstrated that 44 district and rural hospitals received performance- based allocations in accordance with a minimum of one scorecard assessment in the previous Fiscal Year [FY 2022] (9) DLI#9: The DLR#9. 1: The Recipient FY2018 - No scalability Recipient has has designed and piloted FY2019 - FY Allocated increased the health center scorecards Amount x [Actual number of health with community Achievement up to DLR 9.2 - centers in Priority consultations in at least 64 DLR 9. 11/ [DLR 9.2 - DLR Districts receiving Rural Health Centers in 9. 1] - undisbursed amount performance-based Priority Districts, from previous targets met allocations receiving financial FYZ020 - FY Allocated according to at allocations according to Amount x [Actual least one scorecard their performance [FY Achievement up to ILR 9.3 - assessments with 20181 (Baseline: 0) DLR 9.2] / [DLR 9.3 DLR communt i 9.2] + undisbursed amount consultations in the DLR#9.2: The Recipient from previous targets met previous fiscal year has demonstrated that 130 FY2021 - FY Allocated ( Rural Health Centers in Amount x [Actual Priority Districts receive Achievement up to DLR 9.4 - performance-based DLR 9.3] / [DLR 9.4 - DLR allocations according to at 9.3] - undisbursed amount least two scorecard from previous targets met assessments with FY2022 - FY Allocated community consultations Amount x [Actual in the last Fiscal Year [FY Achievement up to DLR 9.5 - 20 19] DLR 9.4] / [DLR 9.5 - DLR 9.4] + undisbursed amount DLR#9.3: The Recipient from previous targets met, has demonstrated that 186 health centers in priority districts receive financial allocations based on prioritized action plans that respond to scorecards 22 evaluations [FY 2020] LBaseline: 0) DLR#9.4: The Recipient has demonstrated that 261 health centers in priority districts receive performance-based allocations according to at least one scorecard assessment with community consultations in the last Fiscal Year [FY 2021] DLR/19.5; The Recipient has demonstrated that 391 health centers in priority districts receive performance-based allocations according to at least one scorecard assessment with community consultations in the last Fiscal Year [FY 2022] (10) DLlI10: The The Recipient has FY2018 - No scalability Recipient has achieved the following FY2019 - FY Allocated increased the targets: Amount x [Actual number of active Achievement up to DLR community health DLR#10.1: 4,723 CHWs 10.2.1 -Baseline]! [DLR workers (CHWs). trained and active [FY 10.2.1 - Baseline] + 2018] (Baseline: 3,380) undisbursed amount from previous targets met FY2020 - DLR#10.2: 6,523 CIIWs 10:3.1: FY Allocated Amount trained and active [FY x [Actual Achievement up to 2019] DLR 10.3.2 - DLR 10.2.1] / [DLR 10.3.2 - DLR 10.2.1] + DLR#10.3.1: 6,690 active undisbursed amount from CIWs [FY 2020] previous targets met 10:3.2: FY Allocated Amount x [Actual Achievement up to 23 DLR#10.4.1: 7,748 active DLR 103.2 - Baseline] / CHWs [FY 2021] [DLR 10.3.2 - Baseline] + undisbursed amount from DLR# 10.42: 60% of previous targets met CHWs deliver services FY2021 - according to minimum 10:4.1: FY Allocated Amount quality standards [FY x [Actual Achievement up to 2021] (Baseline: 28%) DLR 10.4.2 - DLR 10.3.1] / [DLR 10.4.2 - DLR 10.3.1] + undisbursed amount from DLR#10.4.3: Approval of previous targets met The Recipient has 10:4.2: FY Allocated Amount approved a Decree x [Actual Achievement up to recognizing CFWs as state DLR 10.4.2 - Baseline] / agents of the National [DLR 104.2 - Baseline] Health System (Baseline: undisbursed amount from No) [FY 2021] previous targets met FY2022 - DLR#10.5.1: 8,800 active 10:5.1: FY Allocated Amount CHWs [FY 2022] x [Actual Achievement up to DLR 10.5.2 - DLR 104.1]/ [DLR 105.2 - DLR 10.4.1] - DLR#10.5.2: 80% of undisbursed amount from CHWs deliver services previous targets met according to minimum 10:4.2: FY Allocated Amount quality standards [FY x [Actual Achievement up to 20221 DLR 10.5.2 - DLR 10.4.2] / [DLR 10.5.2 - DLR 10.4.2] undisbursed amount from previous targets met (11) DLJ# 11: The Recipient has FY2018 - No scalability Percentage of achieved the following FY2019 - FY Allocated deaths in eligible targets: Amount x [Actual health facilities Achievement up to DLR 11.2 certified by a DLR#11.1: 100% of - DLR 11.1] / [DLR 11.2 - doctor or a hospitals and 50% of 11 .1] + undisbursed amount qualified clmician health centers use MGDH from previous targets met with the cause of to generate information on FY2020 - FY Allocated death coded using causes of death [FY 2018] Amount x [Actual ICD10, and the (Baseline: 70% of Achievement up to DLR 11.3 death record hospitals and 0% of health - Baseline] / [DLR 11.3 - captured in SISMA centers use MGDH to Baseline] + undisbursed Hospital Data 24 Management generate information on amount from previous targets Module (Modudo causes of death) met de Gesido dle Dados DLR#11.2: 100% of the FY2021 - FY Allocated Hospitalares- health centers use MGDIT Amount x [Actual MGDH). to generate information on Achievement up to DLR 11.4 causes of death [FY 2019] - DLR 11.3] / [DLR 11.4 - DLR 11.3] + undisbursed DLR#1 1.3.1: 50% of amount from previous targets deaths in eligible health met facilities certified by a doctor or qualified FY2022 - FY Allocated clinician with the cause of Amount x [Actual death coded using ICD10, Achievement up to DLR 11.5 and the death record - DLR 11.4] / [DLR 11.5 - captured in the SISMA DLR 11.4] undisbursed MGDH amount from previous targets met DLR#11.3.2: 15% of deaths registered, certified and captured in the civil registration system (SiRCEV) within one year of their occurrence [FY 2020] (Baseline: 0) DLR#I11.4,1: 75% of deaths in eligible health facilities certified by a doctor or qualified clinician with the cause of death coded using ICD 10, and the death record captured in the SISMA MGDH [FY 2021] DLR#11.4.2: 30% of deaths registered, certified and captured in the civil registration system (SiRCEV) within one year of their occurrence [FY 20211] 25 DLR#11.5.1: 80% of deaths in eligible health facilities certified by a doctor or qualified clinician with the cause of death coded using ICDIO, and the death record captured in the SISMA MGDH [FY 2022] DLR# 11. 5.2: 45% of deaths registered, certified and captured in the civil registration system (SiRCEV) within one year of their occurrence [FY 2022] DLR411.6.1: 90% of deaths in eligible health facilities certified by a doctor or qualified clinician with the cause ofd death coded using ICD 10, and the death record captured in the SISMA MGDH [FY 2023] DLR#1 1.62: 70% of deaths registered, certified and captured in the civil registration system (SiRCEV) within one year of their occurrence [FY 2023] (12) DLR# 12: The The Recipient has FY2019 -No scalability Recipient has achieved the following FY2020 - FY Allocated increased the targets: Amount x [Actual average availability DLR#12.2: 70% [FY Achievement up to DLR 12.3 of tracer essential 2019] (Baseline: 62%) DLR 12.2] / [DLR 12.3 - maternal and DLR 12.2] - undisbursed reproductive health 26 medicines at DLR#12.3: 75% [FY amount from previous targets primary health care 2020] met facilities. FY2021 - FY Allocated DLR# 12.4: 80% [FY Amount x [Actual 2021] Achievement up to DLR 12.4 - DLR 12.3] / [DLR 12.4 - DLR 123] + undisbursed DL22.: 8amount from previous targets 2022] met FY2022 - FY Allocated Amount x [Actual Achievement up to DLR 12.5 - DLR 12.4] / [DLR 12.5 - DLR 12.4] + undisbursed amount from previous targets met TOTAL 3,000,000 AMOUNT B. Withdrawal Conditions; Withdrawal Period 1I Notwithstanding the provisions of Part A of this Section, no withdrawal shall be made: (a) for purposes of Section 3.04 of the Standard Conditions (renumbered as such pursuant to paragraph 5 of Section 11 of the Appendix to this Agreement and relating to Program Expenditures), for DLRs achieved prior to the date of this Agreement. (b) for any DLR until and unless the Recipient has furnished evidence satisfactory to the World Bank that said DLR has been achieved and verified, all in accordance with the Verification Protocol. 2 Notwithstanding the provisions of Part B.1 1(b) of this Section, the Recipient may withdraw an amount not to exceed 25 percent of the Grant amount as an advance, provided, however, that if the DLRs in the opinion of the World Bank, are not achieved (or only partially achieved) by the Closing Date, the Recipient shall refund such advance to the World Bank promptly upon notice thereof by the World Bank, Except as otherwise agreed with the Recipient, the World Bank shall cancel the amount so refunded, Any further withdrawals requested as an advance under any Category shall be permitted only on such terms and conditions as the World Bank shall specify by notice to the Recipient. 27 3. Notwithstanding the provisions of Part B.l(b) and Part A.2 of this Section, disbursements will be scalable in proportion to DLR achievement. DLRs will only be paid if they are validated for the year in which corresponding prices are due or thereafter. 4. Notwithstanding the provisions of Part B.1(b), Part B.2 and Part A.2 of this Section, if any of the DLRs under any Category has not been achieved by the date by which the said DLR is set to be achieved, the World Bank may, by notice to the Recipient authorize the withdrawal of such lesser amount of the unwithdrawn proceeds of the Financing then allocated to said Category which, in the opinion of the World Bank, corresponds to the extent of achievement of said DLRI said lesser amount to be calculated in accordance with the formulas set out in Part A.2 of this Section. 5. The Closing Date is June 30, 2021 Section V. Other Undertakin2s 1. The Recipient shall not report as Counterpart Funding any expenditures financed either by the World Bank or by any other health development partners. 2. Not later than twelve (12) months after the end of each Fiscal Year, a procurement review under terms of reference satisfactory to the World Bank will be carried out by an independent firm hired by the World Bank. 28 APPENDIX Section 1. Definitions 1. "Actual Achievement up to DLR" means the validated achievement the Recipient has attained up to the DLR in a given Fiscal Year. 2. "Adolescent and Youth-Friendly Services (SAAJ) Guidelines" means an outline of the health services to be provided at SAAJ facilities, in alignment with the Strategy for School, Youth, and Adolescent Health approved by MISAU in 2019. 3. "Anti-Corruption Guidelines" means the World Bank's "Guidelines on Preventing and Combating Fraud and Corruption in Program-for-Results Financing," dated February 1, 2012, and revised July 10, 2015. 4. "Category" means a category set forth in the table in Section IV.A.2 of Schedule 2 to this Agreement. 5. "Community Health Workers" or "CHWs" means Agentes Polivalentes Elementares, the individuals selected from the community they live in and trained by MISAU to deliver health promotion, prevention and basic curative services to their communities under the technical oversight of the nearest health center. 6. "Counterpart Funding" means the amounts committed by the Recipient and recorded in its budget for each year of Program implementation to finance activities under the Program and to make them available in a timely manner to ensure adequate Program implementation. 7. "Couple Years of Protection" means the estimated protection provided by family planning services during a one-year period, based upon the volume of modern contraceptives methods sold or distributed free of charge to users during that period, as defined in the Program Operations Manual. 8. "Disbursement Linked Indicator" or "DLI" means in respect of a given Category, the indicator related to said Category as set forth in the table in Section IV.A.2 of Schedule 2 to this Agreement. 9. "Disbursement Linked Result" or "DLR" means in respect of a given Category, the result under said Category as set forth in the table in Section IV.A.2 of Schedule 2 to this Agreement, on the basis of the achievement of which, the amount of the Financing allocated to said result may be withdrawn in accordance with the provisions of said Section IV. 10. "District/Rural Hospitals" means health facilities as defined in Ministerial Diploma no, 127/2002, of July 31, 2002. 29 11. "Domestic Government Expenditures" means the sum of all government expenditures on operations (fncionamento) and internal investment as reported in e-SISTAFE and the Recipient's report on budget execution for each fiscal year. 12. "Domestic Health Expenditures" means the sum of health expenditures on operations (funcionanento) and internal investment as reported in the e-SISTAFE and the Recipient's report on budget execution for each Fiscal Year. 13. "DPC" means Direcq-ao de Planificagdo e Cooperagdo, the directorate of planning and cooperation. 14. "DPS" means the Direcdo Provincial de Saude, the Recipient's provincial directorate of health. 15. "e-SISTAFE" means the Recipient's integrated financial management information system. 16. "ESSA" means the environmental and social system assessment and the safeguards action plan dated October 31, 2017, and amended on October 25, 2018, built into the Program Action Plan, and applicable to the Program which assesses the Recipient's environmental and social management systems, detailing the Program's environmental and social benefits, risks and impacts and recommending remedial measures to strengthen the social and environmental systems performance, 17. "Fiscal Year" or "FY" means each fiscal year of the Recipient commencing on January I and ending on December 31. i8. "FY Allocated Amount" means the Financing amount allocated to reward the full achievement of a DLR in a given Fiscal Year. 19. "Hospital Data Management Module" or "MGDIH" means a module, that is part of the SISMA, dedicated to record hospital data on several domains including deaths that occur in a health facility. 20. "ICD 10" means the international classification of diseases (10th revision). 21. "Independent Verification Agents" means the verification agents referred to in Section LF of Schedule 2 to this Agreement. 22. "Institutional Delivery" means a child birth taking place in a public health facility, usually attended by a health professional. 23. "Investment Case" means the Recipient's program for enhanced delivery of priority reproductive, maternal, newborn, child and adolescent health and nutrition services approved in April 2017. 30 24. "Lagging Districts" means the districts described as such in the Investment Case. 25. "M&E Tools" means the consultation register for adolescent and youth-friendly services (SAAJ) and its integration into the digital information system used by the Ministry of Health (SISMA) 26. "MISAU" means Minisl6rio da Sade, the Recipient's Ministry of Health. 27. "Modified Nutrition Package" means five of the seven key interventions detailed in the Program Operations Manual. The two excluded interventions are: 1) growth monitoring sessions; and 2) provision of micronutrient powder 28, "Monitoring and Evaluation System" means a routine monitoring information flow involving Community Health Workers, health centers, provincial and district health institutions, and MISAU as detailed in the Program Operations Manual. 29. "Nutrition Intervention Package" or "NIP" means the basic nutrition intervention package comprising seven key interventions as detailed in the Program Operations Manual. 30. "Primary Healthcare Network" means all the health facilities classified as Rural Health Centers and Urban Health Centers including health posts. 31. "Priority Districts" means the districts described as such in the Investment Case. 32. "Program Action Plan" means the Recipient's plan dated and referred to in Section 1.G of Schedule 2 to this Agreement, as may be amended from time to time with the agreement of the World Bank. 33. "Program Contracts" means agreements established between the central-level MISAU and provincial-level health institutions on agreed results to be achieved in a given year. 34. "Program Operations Manual" means the manual for the Program referred to in Section I.E of Schedule 2 to this Agreement, to facilitate the fiduciary and coordination mechanisms under the Program, as the same may be amended from time with the prior written approval of the World Bank. 35. "Health Centers" means health facilities as defined in Ministerial Diploma no. 127/2002, of July 31, 2002, including health posts. 36. "Sccondary and Technical Schools" means public educational facilities providing secondary level general education, and public, semi-public and private educational facilities providing technical education. "Signature Date" means the later of the two dates on which the Recipient and the Bank signed this Agreement and such 31 definition applies to all references to "the date of the Grant Agreement" in the Standard Conditions. 37. "SiRCEV" means the civil registration information system used for registering births, deaths, and other vital events. 38. "SISMA" means MISAU's health information system. 39. "Standard Conditions" means the "Standard Conditions for Grants Made by the World Bank Out of Various Funds", dated February 15, 2012, with the modifications set forth in Section II of this Appendix. 40. "Sub-Account Resources" means the channeling of the Financing to a sub-account of the treasury single account of the Recipient. 41. "Technical Health Personnel" means health trained professionals in the special health regime career (Regime Especial dle Saude) as detailed in Program's Operations Manual. 42. "Technical Schools" means public institutions that offer professional and vocational education and training. 43. "Underserved Areas" means Underserved Districts and Underserved Provinces. 44. "Underserved Districts" means the twenty-eight (28) districts with low per capita health expenditure as identified in the Program Operations Manual. 45. "Underserved Provinces" means the three (3) provinces with low per capita health expenditure as identified in the Program Operations Manual. 46. "Verification Protocol" means the protocol set forth in the Program Operations Manual as agreed with the World Bank, setting forth actions and mechanisms required for verifying the achievement of DLRs, and referred to in Section I.F.2 of Schedule 2 to this Agreement as the same may be amended from time to time with prior written approval of the World Bank. Section II. Modifications to the Standard Conditions The Standard Conditions are modified as follows: 1. Wherever used throughout the Standard Conditions, the term "the Project" is modified to read "the Program", the term "Project Report" is modified to 32 read "Program Report", and the term "Eligible Expenditure" is modified to read "Program Expenditure". 2. Section 3.03, Special Commitment by the World Bank, is deleted in its entirety, and the subsequent Sections in Article III are renumbered accordingly. 3. In Section 3.03 (originally numbered as Section 3.04), the phrase "or to request the World Bank to enter into a Special Commitment" is deleted, 4. The section originally numbered as Section 3.05, Designated Accounts, is deleted in its entirety, and the subsequent Sections in Article III are renumbered accordingly. 5. Paragraph (a) of Section 3.04 (originally numbered as Section 3.06), Eligible Expenditures (renamed "Program Expenditures" in accordance with paragraph I of this Section II), is modified to read: "(a) the payment is for the reasonable cost of expenditures required for the Program and to be financed out of the proceeds of the Grant in accordance with the provisions of the Grant Agreement;". 6. Paragraph (a) of Section 3.05 (originally numbered as Section 3.07), Financing Taxes, is modified to read: "(a) The Grant Agreement may specify that the proceeds of the Grant may not be withdrawn to pay for Taxes levied by, or in the territory of, the Member Country on or in respect of Program Expenditures, or on their importation, manufacture, procurement or supply. In such case, if the amount of any such Taxes decreases or increases, the World Bank may, by notice to the Recipient, exclude such amount or such Tax from the Program Expenditures to be financed out of the proceeds of the Grant specified in the Grant Agreement, as required to ensure consistency with such limitation on withdrawals." 7. The last sentence of Section 3.05 (originally numbered as Section 3.07), Financing Taxes, is modified to read: "To that end, if the World Bank at any time determines that the amount of any such Tax is excessive, or that such Tax is discriminatory or otherwise unreasonable, the World Bank may, by notice to the Recipient, exclude such amount or such Tax from the Program Expenditures to be financed out of the proceeds of the Grant specified in the Grant Agreement, as required to ensure consistency with such policy of the World Bank.". 33 8. Section 3.06 (originally numbered as Section 3.08), Reallocation, is modified to read: "Notwithstanding any allocation of an amount of the Grant to a withdrawal category under the Grant Agreement, the World Bank may, by notice to the Recipient, reallocate any other amount of the Grant to such category if the World Bank reasonably determines at any time that such reallocation is appropriate for the purposes of the Program." 9. Section 4.01, Cancellation by the Recipient, is modified to read: "The Recipient may, by notice to the World Bank, cancel any unwithdrawn amount of the Grant." 10. Paragraph (d) of Section 4.03, Cancellation by the World Bank, entitled "Misprocurement", is deleted, and subsequent paragraph (e) is re-lettered accordingly. 11. Section 4.04, Amounts Subject to Special Connitment Unaffected, is deleted in its entirety, and subsequent Sections in Article IV and references to such Sections are renumbered accordingly. 12. In the Appendix, Definitions, all references to Section numbers are modified, as necessary, to reflect the modifications set forth above, In addition, the definition of the term "Special Commitment" set forth in paragraph 22 is deleted in its entirety, and all subsequent paragraphs are renumbered accordingly.