GFF GRANT NUMBER TF0C6790 Global Financing Facility Grant Agreement (Innovative Systems to Promote Integrated, Resilient and Enhanced Responses to Women and Girls’ Health Project) between FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA and INTERNATIONAL DEVELOPMENT ASSOCIATION (acting as administrator of the Global Financing Facility for Women, Children and Adolescents Multi-Donor Trust Fund) GFF GRANT NUMBER TF0C6790 GLOBAL FINANCING FACILITY GRANT AGREEMENT AGREEMENT dated as of the Signature Date between FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA (“Recipient”) and INTERNATIONAL DEVELOPMENT ASSOCIATION (“Bank”), acting as administrator of the Global Financing Facility for Women, Children and Adolescents Multi-Donor Trust Fund. The Recipient and the Bank hereby agree as follows: Article I Standard Conditions; Definitions 1.01. 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 II The Project 2.01. The Recipient declares its commitment to the objectives of the project described in Schedule 1 to this Agreement (“Project”). To this end, the Recipient shall carry out the Project through its Ministry of Health 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 ten million ninety-six thousand United States Dollars ($10,096,000) (“Grant”) to assist in financing the Project. 3.02. The Recipient may withdraw the proceeds of the Grant in accordance with Section III of Schedule 2 to this Agreement. 3.03. The Grant is funded out of the abovementioned trust fund for which the Bank receives periodic contributions from the donors 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 donors -2- 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 Effectiveness; Termination 4.01. This Agreement shall not become effective until evidence satisfactory to the Bank has been furnished to the Bank that the conditions specified below have been satisfied: (a) The execution and delivery of this Agreement on behalf of the Recipient have been duly authorized or ratified by all necessary governmental action. (b) The Recipient has prepared and adopted the Project Implementation Manual in form and substance acceptable to the Bank. (c) The financing agreement dated the same date as this Agreement, between the Recipient and the International Development Association, providing a grant in support of the Project (“Financing Agreement”), has been executed and delivered and all conditions precedent to its effectiveness or to the right of the Recipient to make withdrawals under it (other than the effectiveness of this Agreement) have been fulfilled. 4.02. By signing the Grant Agreement, the Recipient shall be deemed to represent and warrant that on the Signature Date, the Grant Agreement has been duly authorized by, and executed and delivered on behalf of, the Recipient and is legally binding upon the Recipient in accordance with its terms, except where additional action is required to make such Grant Agreement legally binding. Where additional action is required following the Signature Date, the Recipient shall notify the Bank when such additional action has been taken. By providing such notification, the Recipient shall be deemed to represent and warrant that on the date of such notification the Grant Agreement is legally binding upon the Recipient in accordance with its terms. 4.03. Except as the Recipient and the Bank shall otherwise agree, this Agreement shall enter into effect on the date upon which the Bank dispatches to the Recipient notice of its acceptance of the evidence required pursuant to Section 4.01 (“Effective Date”). If, before the Effective Date, any event has occurred which would have entitled the Bank to suspend the right of the Recipient to make withdrawals from the Grant Account if this Agreement had been effective, the Bank may postpone the dispatch of the notice referred to in this Section until such event (or events) has (or have) ceased to exist. 4.04. Termination for Failure to Become Effective. This Agreement and all obligations of the parties under it shall terminate if it has not entered into effect by the date 120 days after the date of this Agreement, unless the Bank, after consideration of the -3- reasons for the delay, establishes a later date for the purpose of this Section. The Bank shall promptly notify the Recipient of such later date. Article V Recipient’s Representative; Addresses 5.01. The Recipient’s Representative referred to in Section 7.02 of the Standard Conditions is its minister responsible for finance. 5.02. For purposes of Section 7.01 of the Standard Conditions: (a) the Recipient’s address is: Ministry of Finance P. O. Box 1905 Addis Ababa Federal Democratic Republic of Ethiopia; and (b) the Recipient’s Electronic Address is: Telex: Facsimile: MINFIN 21147 (251-111) 551355 5.03. For purposes of Section 7.01 of the Standard Conditions: (a) the Bank’s address is: International Development Association 1818 H 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) -4- AGREED as of the Signature Date. FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA By: _________________________________ Authorized Representative Ahmed Shide Name: __________________________________ Minister of Finance Ethiopia Title: __________________________________ 23-Feb-2025 Date: __________________________________ INTERNATIONAL DEVELOPMENT ASSOCIATION (acting as administrator of the Global Financing Facility for Women, Children and Adolescents Multi-Donor Trust Fund) By: ___________________________________ Authorized Representative Maryam Salim Name: ___________________________________ Country Director Title: ___________________________________ 03-Feb-2025 Date: ___________________________________ -5- SCHEDULE 1 Project Description The objective of the Project is to improve women and girl’s health outcomes and strengthen health systems in Climate-Stressed Areas. The Project consists of the following parts: Part 1. Expand Access to Quality Interventions for Women and Girls, Including through Tech-enabled Care (a) (i) Strengthening the system of integrated cervical cancer screening and prevention and referral for better care through capacity building and technical assistance; and (ii) acquiring and operationalization of a digital HPV targeting and tracking module to help HEWs reach in-school and out-of-school girls and institutionalizing single-dose HPV vaccination. (b) Enhancing HEWs capacity through the design and establishment of digital learning platforms for continuing education performance management and certification of skill development to deliver basic preventive and promotive health services for women and girls. (c) Acquiring portable Artificial Intelligent-enabled ultrasound machines for selected health centers and provision of training to health workers for the purpose. (d) (i) Implementation of M-Mama Emergency Response System through technical assistance and capacity building for improved remote triage, digitalized dispatch system, patient outcome tracking using public ambulances and private ambulances, public awareness raising; and (ii) carrying out institutional capacity building to the Recipient’s health sector stakeholders. Part 2: Improved Service Delivery through Innovative Interventions in Climate- Stressed and Conflict-Affected Areas (a) Acquiring renewable solar energy and associated appliances for health centers and retrofitting of health centers and primary hospitals in climate stressed and conflict affected areas with climate sensitive and digital health infrastructure. (b) Acquiring waterless toilet technologies to improve water, sanitation, and hygiene systems in high patient volume health facilities. -6- (c) Acquiring and implementing innovative environmental technology for medical waste management in selected hospitals to support medical waste treatment and recycling processes. (d) Providing technical assistance to update health facility infrastructure design standards to include alternative renewable energy sources; digital connectivity standards; and materials to ensure facility resilience in times of climate related shocks. Part 3. Strengthen Data Systems and Reinforce Decision-making to Ensure High Quality Care (a) Providing technical assistance and capacity building to health sector institutions to implement health sector innovations including integration of data generated through Project-supported innovations. (b) Providing technical assistance to develop health data governance standards and establishment of a certification process for web-based applications including mobile applications. (c) Providing capacity building and technical assistance in big data analytics, modeling, and proactive surveillance using metrological, environment and public health data so as to predict the impact of climate change and design appropriate innovative solutions. Part 4: Project Implementation and Monitoring (a) Providing the Ministry of Health (MOH) of management, implementation, supervision and monitoring support of Project activities. (b) Carrying out of mid-term and endline evaluation of the implementation of innovative interventions supported by the Project including impact evaluation of the M-Mama Emergency Response System. (c) Providing technical assistance to uptake key innovations and sector reforms to address lingering women and girls’ issues. -7- SCHEDULE 2 Project Execution Section I. Institutional and Other Arrangements A. Institutional Arrangements 1. Ministry of Health (MOH) The Recipient shall designate, at all times during the implementation of the Project, the MOH to be responsible for prompt and efficient oversight and coordination of the implementation of activities under the Project and shall take all actions including the provision of funding, personnel and other resources necessary to enable the MOH to perform its functions. 2. Project Steering Committee The Recipient shall establish, not later than sixty (60) days after the Effective Date, a Project Steering Committee (“PSC”) at the federal level, and thereafter maintain such PSC at all times during the implementation of the Project, with a composition, mandate, resources and functions satisfactory to the Bank. The PSC shall be comprised of the heads of the ministry in charge of health (chair), ministry in charge of finance, and representative from the Ethiopian public health institute, Ethiopian pharmaceutical supply services, and representative from the Regional Health Bureaus and shall be responsible for, inter alia: (a) providing overall strategic and policy guidance and oversight on the implementation of the Project; (b) reviewing progress made towards achieving the Project’s objectives; (c) approving Project’s budgets and annual work plan; and (d) facilitating coordination of Project activities and removal of any obstacle(s) to the implementation of the Project, subject to such changes as the Recipient and the Bank may agree upon from time to time. 3. Project Technical Committee The Recipient shall establish, not later than sixty (60) days after the Effective Date, a Project Technical Committee, throughout the Project implementation period. To this end the Technical Committee shall, inter alia, be responsible for providing technical advice in respect to the pertinent component, as detailed in the Project Implementation Manual. 4. Project Management (a) The Recipient shall: (i) maintain, at all times during the implementation of the Project, the Grants Management Unit within the Ministry of Health, with -8- composition, powers, functions, staffing, facilities and other resources satisfactory to the Bank; and (ii) designate the Grants Management Unit to be responsible for day-to-day management and implementation of the Project, including inter alia, preparation of work plans, environmental and social safeguards management, financial management, procurement, monitoring and evaluation, and reporting. (b) The Recipient shall maintain, at all times during the implementation of the Project, EPHI, EPSS, and RHBs with composition, powers, functions, staffing, facilities and other resources satisfactory to the Bank, all with qualifications, experience and terms of reference acceptable to the Bank to fulfill their respective functions under the project. (c) Without limiting the foregoing, the Recipient shall, by no later than one (1) month after the Effective Date, recruit or assign a finance officer, a procurement officer, and an environmental and social safeguards officer for the Grants Management Unit, in each case, with qualifications, experience and terms of reference acceptable to the Bank. B. Implementation Arrangements 1. Project Implementation Manual (a) The Recipient shall prepare, in accordance with terms of reference acceptable to the Bank and furnish to the Bank for review, a Project implementation manual, which shall include provisions on the following matters: (i) capacity building activities for sustained achievement of the Project’s objectives; (ii) arrangements on financial management, setting forth the detailed policies and procedures for financial management under the Project; (iii) procurement management procedures, including a manual to guide procurement at the local level; (iv) institutional administration, coordination and day to day execution of Project activities; (v) monitoring and evaluation; (vi) reporting; (vii) information, education and communication of Project activities; (viii) guidelines for assessing potential environmental and social impacts of Project activities and designing appropriate mitigation, management and monitoring measures in respect of said impacts; and (ix) such other technical and organizational arrangements and procedures as shall be required for the Project. (b) The Recipient shall afford the Bank a reasonable opportunity to exchange views with the Recipient on said Project implementation manual, and thereafter, shall adopt such Project implementation manual, as shall have been approved by the Bank (“Project Implementation Manual”). (c) The Recipient shall ensure that the Project is carried out in accordance with the Project Implementation Manual; provided, however, that in case of any conflict -9- between the provisions of the Project Implementation Manual and the provisions of this Agreement, the provisions of this Agreement shall prevail. (d) Except as the Bank shall otherwise agree, the Recipient shall not amend, abrogate or waive any provision of the Project Implementation Manual. 2. Annual Work Plan and Budget (a) The Recipient shall, not later than sixty (60) days after the Effective Date, for the first EFY (and thereafter by April 30 of each subsequent EFY) prepare and furnish to the Bank, a work plan and budget containing all activities proposed for implementation in the following calendar year including: (i) a detailed timetable for the sequencing and implementation of said activities; (ii) the types of expenditures required for such activities, including a proposed financing plan; and (iii) a budget establishing the proposed amounts and sources of financing. (b) The proposed annual work plan and budget shall specify any Training activities that may be required under the Project, including: (i) the type of Training; (ii) the purpose of the Training; (iii) the personnel to be trained; (iv) the institution or individual who will conduct the Training; (v) the location and duration of the Training; and (vi) the estimated cost of the Training. (c) The Recipient shall afford the Bank a reasonable opportunity to exchange views with the Recipient on such proposed annual work plan and budget by providing a draft annual work plan and budget not later than April 30 of each EFY and thereafter ensure that the Project is implemented with due diligence in accordance with such work plan and budget as shall have been approved by the Bank (“Annual Work Plan and Budget”). (d) The Recipient shall not make or allow to be made any change to the approved Annual Work Plan and Budget without prior approval in writing by the Bank. C. Environmental and Social Standards 1. The Recipient shall ensure that the Project is carried out in accordance with the Environmental and Social Standards, in a manner acceptable to the Bank. 2. Without limitation upon paragraph 1 above, the Recipient shall ensure that the Project is implemented in accordance with the Environmental and Social Commitment Plan (“ESCP”), in a manner acceptable to the Bank. To this end, the Recipient shall ensure that: - 10 - (a) the measures and actions specified in the ESCP are implemented with due diligence and efficiency, as provided in the ESCP; (b) sufficient funds are available to cover the costs of implementing the ESCP; (c) policies and procedures are maintained, and qualified and experienced staff in adequate numbers are retained to implement the ESCP, as provided in the ESCP; and (d) the ESCP, or any provision thereof, is not amended, repealed, suspended or waived, except as the Bank shall otherwise agree in writing, as specified in the ESCP, and ensure that the revised ESCP is disclosed promptly thereafter. 3. In case of any inconsistencies between the ESCP and the provisions of this Agreement, the provisions of this Agreement shall prevail. 4. The Recipient shall ensure that: (a) all measures necessary are taken to collect, compile, and furnish to the Bank through regular reports, with the frequency specified in the ESCP, and promptly in a separate report or reports, if so requested by the Bank, information on the status of compliance with the ESCP and the environmental and social instruments referred to therein, all such reports in form and substance acceptable to the Bank, setting out, inter alia: (i) the status of implementation of the ESCP; (ii) conditions, if any, which interfere or threaten to interfere with the implementation of the ESCP; and (iii) corrective and preventive measures taken or required to be taken to address such conditions; and (b) the Bank is promptly notified of any incident or accident related to or having an impact on the Project which has, or is likely to have, a significant adverse effect on the environment, the affected communities, the public or workers, including, explosions, spills, and any workplace accidents that result in death, serious or multiple injury, pollution, or any violent labor unrest or dispute between the Recipient or the Project Implementing Entity or security forces (assigned to protect the Project) and local communities, any case of sexual exploitation and abuse, sexual harassment and violence against minors, or any incidents in or related to international waterways or disputed areas, in accordance with the ESCP, the environmental and social instruments referenced therein and the Environmental and Social Standards. 5. The Recipient shall establish, publicize, maintain and operate an accessible grievance mechanism, to receive and facilitate resolution of concerns and - 11 - grievances of Project-affected people, and take all measures necessary and appropriate to resolve, or facilitate the resolution of, such concerns and grievances, in a manner acceptable to the Bank. 6. The Recipient shall ensure that all bidding documents and contracts for civil works under the Project include the obligation of contractors, subcontractors and supervising entities to: (a) comply with the relevant aspects of ESCP and the environmental and social instruments referred to therein; and (b) adopt and enforce codes of conduct that should be provided to and signed by all workers, detailing measures to address environmental, social, health and safety risks, and the risks of sexual exploitation and abuse, sexual harassment and violence against children, all as applicable to such civil works commissioned or carried out pursuant to said contracts. D. Grievance Redress Mechanism The Recipient shall no later than two (2) months from the Effective Date establish and thereafter maintain at all times during the implementation of the Project, a grievance redress mechanism, under terms and structure in accordance with the ESCP. Section II. Project Monitoring, Reporting and Evaluation A. Project Reports The Recipient shall ensure that each Project Report is furnished to the Bank not later than one month after the end of each calendar semester, covering the calendar semester. Section III. Withdrawal of Grant Proceeds A. General 1. The Recipient may withdraw the proceeds of the Grant in accordance with the provisions of: (a) Article III of the Standard Conditions; and (b) this Section; to finance Eligible Expenditures in the amount allocated and, if applicable, up to the percentage set forth against each Category of the following table: - 12 - Category Amount of the Grant Percentage of Allocated Expenditures to be (expressed in USD) Financed (inclusive of Taxes) (1) Goods, works, non- consulting services, consulting services, 10,096,000 100% Operating Costs and Training under Part 1, 2, 3 of the Project TOTAL AMOUNT 10,096,000 B. Withdrawal Conditions; Withdrawal Period 1. Notwithstanding the provisions of Part A of this Section no withdrawal shall be made for payments made prior to the Signature Date. 2. The Closing Date is June 30, 2029. - 13 - APPENDIX Definitions 1. “Anti-Corruption Guidelines” means, for purposes of paragraph 2 of the Appendix to the Standard Conditions, the “Guidelines on Preventing and Combating Fraud and Corruption in Projects Financed by IBRD Loans and IDA Credits and Grants”, dated October 15, 2006, and revised in January, 2011, and as of July 1, 2016. 2. “Category” means a category set forth in the table in Section III.A of Schedule 2 to this Agreement. 3. “Climate-Stressed Areas” means Recipient’s territories and areas which are vulnerable to drought, heat waves, and flooding. 4. “Conflict-Affected Areas” means the Recipient’s territories and areas where conflict is prevalent and has a negative impact on people's lives. 5. “Environmental and Social Commitment Plan” or “ESCP” means the environmental and social commitment plan for the Project, dated November 7, 2024, as the same may be amended from time to time in accordance with the provisions thereof, which sets out the material measures and actions that the Recipient shall carry out or cause to be carried out to address the potential environmental and social risks and impacts of the Project, including the timeframes of the actions and measures, institutional, staffing, training, monitoring and reporting arrangements, and any environmental and social instruments to be prepared thereunder. 6. “Environmental and Social Standards” or “ESSs” means, collectively: (i) “Environmental and Social Standard 1: Assessment and Management of Environmental and Social Risks and Impacts”; (ii) “Environmental and Social Standard 2: Labor and Working Conditions”; (iii) “Environmental and Social Standard 3: Resource Efficiency and Pollution Prevention and Management”; (iv) “Environmental and Social Standard 4: Community Health and Safety”; (v) “Environmental and Social Standard 5: Land Acquisition, Restrictions on Land Use and Involuntary Resettlement”; (vi) “Environmental and Social Standard 6: Biodiversity Conservation and Sustainable Management of Living Natural Resources”; (vii) “Environmental and Social Standard 7: Indigenous Peoples/Sub- Saharan African Historically Underserved Traditional Local Communities”; (viii) “Environmental and Social Standard 8: Cultural Heritage”; (ix) “Environmental and Social Standard 9: Financial Intermediaries”; (x) “Environmental and Social Standard 10: Stakeholder Engagement and Information Disclosure”; eff ective on October 1, 2018, as published by the Bank. 7. “EFY” means end of fiscal year. - 14 - 8. “EPHI” means the Ethiopian Public Health Institute, established pursuant to the Ethiopian Public Health Institute Establishment Council of Ministers Regulation No. 301/2013, or any successor thereto. 9. “EPSS” means Ethiopia Pharmaceutical Supply Service, the institution of the Recipient in charge of enabling public health institutions to supply quality assured essential pharmaceuticals at affordable prices in a sustainable manner to the public, established and operating pursuant to Drug Fund and Pharmaceuticals Supply Agency Establishment Proclamation no. 553/2007 (as amended). 10. “Grants Management Unit” means the Grants Management Unit within the Ministry of Health, or any successor thereto. 11. “HEW” means the Recipient’s health extension workers. 12. “HPV” means Human Papilloma Virus. 13. “Ministry of Health” or “MOH” means the Recipient’s Ministry of Health, or any successor thereto. 14. “M-Mama Emergency Response System” means the Recipient’s emergency transportation system for mothers and newborns which connects women to care through a national network of community drivers and ambulances. 15. “Operating Costs” means the reasonable incremental operating costs, based on Annual Work Plans and Budgets, incurred by the Recipient on account of Project implementation including: office equipment and supplies, maintenance of equipment, insurance costs, office administration costs, rental, consumables, accommodation, vehicle operation and maintenance costs, utilities, communication charges, per diems, travel allowances, and salaries of the Recipient’s locally contracted staff, but excluding salaries, fees, honoraria, bonuses, and any other salary supplements of members of the Recipient’s civil service. 16. “Procurement Regulations” means, for purposes of paragraph 20 of the Appendix to the Standard Conditions, the “World Bank Procurement Regulations for IPF Borrowers”, dated September 2023. 17. “Project Implementation Manual” means the manual referred to in Section I.B.1 of Schedule 2 to this Agreement, as such manual may be amended by the Recipient from time to time, with the prior written approval of the Bank. 18. “Project Technical Committee” means the technical committee established pursuant to Section I.A.3 of Schedule 2 to this Agreement. - 15 - 19. “Regional Health Bureaus” means the Health Bureaus established and operating under the auspices of the Regional States of the Recipient. 20. “Signature Date” means the later of the two dates on which the Recipient and the Bank signed this Agreement and such definition applies to all references to “the date of the Grant Agreement” in the Standard Conditions. 21. “Standard Conditions” means the “International Bank for Reconstruction and Development and International Development Association Standard Conditions for Grant Financing Made by the Bank out of Trust Funds”, dated February 25, 2019. 22. “Training” means the reasonable costs associated with training under the Project, based on the relevant Annual Work Plan and Budget, and attributable to study tours, training courses, seminars, workshops and other training activities, not included under service providers’ contracts, including costs of training materials, space and equipment rental, travel, accommodation and per diem costs of trainees and trainers, trainers’ fees, and other training related miscellaneous costs.