The World Bank North East and Red River Delta Regions Health System Support Project (P122629) REPORT NO.: RES43784 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF NORTH EAST AND RED RIVER DELTA REGIONS HEALTH SYSTEM SUPPORT PROJECT APPROVED ON MAY 31, 2013 TO SOCIALIST REPUBLIC OF VIETNAM HEALTH, NUTRITION & POPULATION EAST ASIA AND PACIFIC Regional Vice President: Victoria Kwakwa Country Director: Carolyn Turk Regional Director: Daniel Dulitzky Practice Manager/Manager: Aparnaa Somanathan Task Team Leader(s): Huong Lan Dao The World Bank North East and Red River Delta Regions Health System Support Project (P122629) BASIC DATA Product Information Project ID Financing Instrument P122629 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 31-May-2013 31-Dec-2020 Organizations Borrower Responsible Agency Socialist Republic of Vietnam Ministry of Health Project Development Objective (PDO) Original PDO The Project Development Objective is to increase the efficiency and equity in the use of hospital services in selected provinces ofthe North East and Red River Delta Regions. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-52590 31-May-2013 01-Aug-2013 17-Oct-2013 31-Dec-2020 150.00 109.98 28.96 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No The World Bank North East and Red River Delta Regions Health System Support Project (P122629) I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. Project Status 1. The project, financed from an IDA credit in the amount of SDR 100,100,000 (US$150 million equivalent), closes on December 31, 2020, and is 79.2 percent disbursed as of this restructuring. The project has completed almost all planned activities for 2020. The draft end-project evaluation has been submitted to IDA, and all indicators in the results framework have achieved (or surpassed) their end-target values. 2. Progress toward achievement of the project development objective and implementation progress remains satisfactory. As indicated above, all three project development objective indicators and the nine intermediate results indicators have been achieved, with the following highlights: (a) Project Development Objective Indicators: More than 12,800 patients are benefiting from new clinical techniques in five intervention areas transferred by the project in provincial hospitals and 29,107 patients benefiting new clinical techniques in three intervention areas transferred by the project at district hospitals. The results surpassed the end target of 12,500 patients and 29,000 patients at provincial and district hospitals respectively. The service utilization of the local hospitals by the poor and near-poor people exceeded the end target values by 15 percent and 52 percent for outpatient and inpatient services, respectively. (b) Intermediate Results Indicators: The project contributed to the increase in health insurance coverage to 100 percent of the near poor in 13 project Provinces in 2020. This achievement is above the 70 percent target set for the end of the project. In total, 2,288 new techniques were transferred; 834 at provincial level and 1,454 at district level. This surpassed the original target of 2,200 techniques by the end of the project. Project hospitals implementing a continuous quality improvement process was 100 percent, overachieving the end target of 75 percent. 3. Progress of the Implementation Completion and Results (ICR) Report: The preparation of the implementation completion report is underway. A draft report will be shared with the Ministry of Health (MoH) as well as central and provincial project management units by March 15, 2021. MoH has already drafted their completion report. The ICR is expected to be completed by June 30, 2021. The decision review for the Implementation Completion and Results Report is currently scheduled for April 20, 2021. B. Rationale for Restructuring 4. On October 22, 2020, the recipient, through its Ministry of Finance, has requested the cancellation of US$24 million (SDR 16 million equivalent) from the original commitment, as the funds will not be used prior to the closing date. With this cancellation, given the project progress to date, it is expected that 96 percent of the remaining funds will be utilized by the closing date and disbursed by the end of the project’s disbursement grace period, April 30, 2021. 5. The amount proposed for cancellation comes from two main sources: (a) savings from procurement activities and (b) unused funds from the component supporting health insurance. An amount of almost US$6 million has been saved from the original estimate for procurement of medical equipment. Savings arising from the component relating to insurance support to the near poor is the result of a decision by local government to use their own budget to support the health insurance premium; this has resulted in an amount of US$14 million allocated for the activity not being used. Other unused funds arise from savings with respect to the hospital quality improvement interventions (many hospitals The World Bank North East and Red River Delta Regions Health System Support Project (P122629) decided to use their own budget for the interventions), and savings from training activities due to lower government cost norms than originally planned. 6. By cancelling this unused amount, the cancelled funds can potentially be recommitted and reprogrammed in the Vietnam country program for FY21. II. DESCRIPTION OF PROPOSED CHANGES A. Project Cancellation and Re-allocation of Funds 7. The proposed change is for a cancellation in the amount of SDR 16 million from the original commitment out of the undisbursed funds. This in turn will require a reallocation between the disbursement categories. III. SUMMARY OF CHANGES Changed Not Changed Cancellations Proposed ✔ Reallocation between Disbursement Categories ✔ Implementing Agency ✔ DDO Status ✔ Project's Development Objectives ✔ Results Framework ✔ Components and Cost ✔ Loan Closing Date(s) ✔ Disbursements Arrangements ✔ Disbursement Estimates ✔ Overall Risk Rating ✔ Safeguard Policies Triggered ✔ EA category ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Implementation Schedule ✔ Other Change(s) ✔ The World Bank North East and Red River Delta Regions Health System Support Project (P122629) Economic and Financial Analysis ✔ Technical Analysis ✔ Social Analysis ✔ Environmental Analysis ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_CANCELLATIONS_TABLE CANCELLATIONS Value Reason Current Cancellation New Ln/Cr/Tf Status Currency Date of for Amount Amount Amount Cancellation Cancellation LOAN Disburs IDA-52590- 100,100,000.0 RESTRUCTUR ing&Re XDR 16,000,000.00 22-Oct-2020 84,100,000.00 001 0 ING, COST paying SAVINGS OPS_DETAILEDCHANGES_REALLOCATION _TABLE REALLOCATION BETWEEN DISBURSEMENT CATEGORIES Financing % Current Allocation Actuals + Committed Proposed Allocation (Type Total) Current Proposed IDA-52590-001 | Currency: XDR iLap Category Sequence No: 1 Current Expenditure Category: GDS,WORKS,NON-CS,CS,IOC & WS-TR PT1 77,400,000.00 68,392,136.67 70,400,000.00 100.00 100.00 iLap Category Sequence No: 2 Current Expenditure Category: INS,CAT PMT,GD,NONCS,CS,OC&WS-TR P2 19,350,000.00 6,456,329.61 11,350,000.00 100.00 100.00 iLap Category Sequence No: 3 Current Expenditure Category: GDS,NON-CS,CS,IOC & WS-TR PT.3 3,350,000.00 1,772,304.30 2,350,000.00 100.00 100.00 The World Bank North East and Red River Delta Regions Health System Support Project (P122629) Total 100,100,000.00 76,620,770.58 84,100,000.00 .