Amendment No. 2 to the Grant Agreement between the Bill & Melinda Gates Foundation and the
      International Bank for Reconstruction and Development and the International Development
       Association concerning the Primary Health Care Transformation Single Donor Trust Fund
             (Trust Fund No. 073408; Donor Reference Nos. INV-015707 and INV-002827)


1.       Reference is made to the Grant Agreement between the Bill & Melinda Gates Foundation
(the “Foundation”) and the International Bank for Reconstruction and Development (“IBRD”) and the
International Development Association (“IDA”) (collectively, the “Bank” and together with the
Foundation, the “Parties” and each a “Party”) concerning the Primary Health Care Transformation Single
Donor Trust Fund (TF No. 073408) (the “Trust Fund”) effective as of November 14, 2019, as amended
(the “Agreement” ).

2.       The Parties agree to amend the second sentence of paragraph 1 of the Agreement to read as follows:

         “The Grant Funds will be held in the Primary Health Care Transformation Single Donor Trust
         Fund (TF No. 073408) (the “Trust Fund”) in accordance with the terms of this grant agreement
         (“Agreement”) for the purpose of conducting activities as described in sections 2.2 and 2.3 of the
         proposal and budget, dated November 1, 2019, amended on December 19, 2019, and further
         amended on October 15, 2020 (collectively, the “Proposal”) submitted by the Bank to the
         Foundation (the “Project”).”

3.      In addition, the Bank acknowledges that the Donor agrees to provide the additional sum of four
million eight hundred sixty-six thousand nine hundred sixty-six United States Dollars (US$ 4,866,966) (the
“Grant Funds”) for the Trust Fund in accordance with the terms of the Agreement.

4.      The Donor shall deposit the Grant Funds in accordance with the following schedule and in the
currency specified in paragraph 3 above into such bank account designated by the Bank (each amount
deposited referred to as an “Installment”) upon submission of a payment request by the Bank:

         A.   Promptly following Foundation’s receipt of countersigned agreement – $1,539,081
         B.   By November 1, 2020 – $517,328
         C.   By September 30, 2021 – $450,000
         D.   By October 31, 2021 – $1,084,346
         E.   By September 30, 2022 – $726,961
         F.   By October 31, 2022 – $512,800
         G.   By September 30, 2023 – $36,450

5.       When making a deposit, the Donor shall instruct its bank to include in its deposit details information
(remittance advice) field of its SWIFT deposit message, information indicating: the amount deposited, that
the deposit is made by the Donor for Trust Fund No. 073408 (the Primary Health Care Transformation
Single Donor Trust Fund), and the date of the deposit (the “Deposit Instructions”). In addition, the Donor
shall provide a copy of the Deposit Instructions to the Bank’s Accounting Trust Funds Division by e -mail
sent to tfremitadvice@worldbank.org or by fax sent to (202) 614-1315.

6.       All other terms of the Agreement shall remain the same.
7.     Each of the Parties represents, by confirming its agreement below, that it is authorized to enter into
this Amendment and act in accordance with these terms and conditions. The Parties are requested to sign
and date this Amendment, and upon possession by the Bank of this fully signed Amendment, this
Amendment shall become effective as of the date of the last signature.

INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT
INTERNATIONAL DEVELOPMENT ASSOCIATION


                                                                           21-Oct-2020
By:     ___________________________________/s1/                    Date: _______________________/d1/
        Mamta Murthi/n1/
        Vice President, Human Development/t1/
/d1/


BILL & MELINDA GATES FOUNDATION


                                                                           23-Oct-2020
By:     ___________________________________/s2/                    Date: _______________________/d2/
        Sameer Kumta/n2/
        Senior Program Officer, TB /t2/
/d2/
                                                                           29-Oct-2020
By:     ___________________________________/s2/                    Date: _______________________/d2/
        Christy Hanson/n2/
        Deputy Director, Neglected Tropical Diseases/t2/




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