THE WORLD BANK IBRD * IDA I WORLD BANKOROUP ARUP BANERJI RegiorW Country Director Eastern Europe Eumpe and Central Asia IAM, o H. E. Sergii Marchenko Minister of Finance Ministry of Finance of Ukraine 12/2 Hrushevskoho Street Kyiv 01008 Ukraine Re: Loan No. 9110-UA (Ukraine - Serving People, Improving Health Project) Amendment No. 2 to the Loan Areement Excellency: We refer to the Loan Agreement ("Loan Agreement") between Ukraine ("Borrower") and the International Bank for Reconstruction and Development ("Bank"), dated May 15, 2020, for the above-mentioned Project. The capitalized terms used in this letter (the "Amendment Letter") and not defined herein have the meaning ascribed to them in the Loan Agreement. We further refer to your letter, dated May 29, 2024, requesting the Bank for specific amendments to the Loan Agreement. We are pleased to inform you that the Bank hereby agrees to your request. Accordingly, the Loan Agreement is amended as follows: 1. For the purpose of this restructuring, the Project Operations Manual set forth in Section LB of Schedule 2 to the Loan Agreement shall be amended, not later than one (1) month after the Effective Date ofthis Amendment Letter, to detail the changes in financial management arrangements, including reporting, annual auditing, and flow of funds for the EEP under Parts 2.2 and 3.2 of the Project. 2. Schedule 4 to the Loan Agreement is hereby amended (by dropping DLR 5.3 and adding a new DLI 9) as set forth in the Annex to this Amendment Letter. Except as specifically amended in this Amendment Letter, all other provisions of the Loan Agreement remain in full force and effect. Please confirm the agreement of the Borrower to the foregoing by countersigning and dating the confirmation set forth below and returning one fully signed original of this Amendment -2- to us. One fully signed original should be retained by the Borrower. Upon receipt by the Bank of the copy of this Aiendment Letter duly countersigned by the authorizd repnntative of te fmwer, this Amendment Leer shall become effective as of the date of countegnature of this jtter by the Borrower and receipt by the Bank of one fully executed original of ts Amendment Letter. Very truly yours UTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT By Arup Banerji Regional Country Director Eastern Europe Europe and Central Asia Region AGREE: UKRAIN By: Date,: ,g e r .3- ANNEX Disbursenient-Linked Results Total "Disbursement-Linked Indicator Financing Allocated to DIRs DLI 1: Hospitals from the Capable Network contracted by NHSU using case-based DLR 1: 210 $7,000,000 payments from a baseline of 0 as of January 1, 2020 DLI 2: Hospitals reprofiled or merged from a $200,000 per baseline of 0 as of January 1, 2020 DIR 2: 100 each hospital merged or reprofiled up to an amount of $20.000,000 DLI 3: NHSU has monitored contracted DLR 3.1: Algorithms for the (a) $2,000,000 providers and reviewed records from detection of anomalies have been Contracted Facilities developed by NHSU and are acceptable to the Bank. DLR 3.2: At least 50 percent of (b) $2,000,000 all Contracted Facilities with detected anomalies have mitigation plans approved, if fraud was confirmed by NHSU by December 31, 2021. DLI 4: Percentage of stroke patients that have DLR 4.1: At least 70 percent of (a) $2,000,000 received Appropriate Treatment all patients with strokes during a period of six (6) consecutive months have been admitted to hospitals contracted by NHSU for the provision of stroke care. DLR 4.2: At least 8 percent of all (b) $8,000,000 Eligible Patients with confirmed ischemic stroke during a period of twelve consecutive months have undergone intravenous thrombolysis and/or mechanical thrombus removal, -4- Disbursement-Linked Results Total "Disbursement-Linked Indicator Financing Allocated to DLRs DLI 5: Increased percentage of outpatient-based DLR 5.1: 10% (a) $3,000,000 procedures and day surgeries, from a Validated DLR 5.2: 20% (b) $3,000,000 Baseline, that have been undertaken by health care providers contracted by the NHSU_______________ DLI 6: removed as per Amendment Letter DLI 7: Number of hospitals COVID-19 cases DLR 7:10,000 $10,000,000 treated following agreed protocols and reimbursed by NHSU DLR_8:_12,5_0_$5_000_00 DLI 8: Number of COVID-19 patients with DLR 8:1, $5,000,000 complications attended by emergency medicine services following agreed protocols and reimbursed by NHSU DLI 9: A specialized healthcare institution of DLR 9: 1 3,000,000 national level has been contracted by NHSU and started performing services under the Program of Medical Guarantees Total $65,000,000"