Report No: RES00356 INTERNATIONAL DEVELOPMENT ASSOCIATION RESTRUCTURING PAPER ON A PROPOSED PROGRAM RESTRUCTURING OF BENIN HEALTH SYSTEM ENHANCEMENT PROGRAM (P172940) APPROVED ON 27-APR-2022 TO THE REPUBLIC OF BENIN HEALTH, NUTRITION AND POPULATION GLOBAL PRACTICE WESTERN AND CENTRAL AFRICA REGION This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization. The World Bank Benin Health System Enhancement Program (P172940) (P172940) CURRENCY EQUIVALENTS (Exchange Rate Effective {September 30, 2024}) West Africa CFA Currency Unit = Franc FCFA 586 = US$1.00 EURO .89 = US$1.00 SDR .74 = US$1.00 FISCAL YEAR January 1 - December 31 Regional Vice President: Ousmane Diagana Country Director: Marie-Chantal Uwanyiligira Regional Director: Trina S. Haque Global Director: Juan Pablo Eusebio Uribe Restrepo Practice Manager: Moulay Driss Zine Eddine El Idrissi Task Team Leader(s): Netsanet Walelign Workie, Fatoumata Binta Maama Barry i The World Bank Benin Health System Enhancement Program (P172940) (P172940) ABBREVIATIONS AND ACRONYMS ABE Beninese Agency for the Environment AISEM Agence Nationale des Infrastructures Sanitaires, des Equipements et de la Maintenance Agency for Health Infrastructure, Equipment and Maintenance) ANC Antenatal Care ANSSP Agence Nationale des Soins de Santé Primaires (National Agency for Primary Health Care) ARS Autorité de Régulation du Secteur de la Santé (Health Regulation Authority) BEmONC Basic Emergency Obstetric and Newborn Care (Soins Obstétricaux et Néonataux d’Urgence de Base) (SONUB) CEGCC Cellule Environnementale, Genre et Changement Climatique (Environmental, Gender, and Change Unit) DPPD Document de Programmation Pluriannuelle des Dépenses (Multi Annual Expenditures Programming) DHIS2 District Health Information Software DLI Disbursement Linked Indicator DLR Disbursement Linked Result DPAF Direction de la Planification, de l’Administration et des Finances (Directorate of Planning, Administration and Finance) E&S Environmental and Social FM Financial Management IDA International Development Association IGF Inspection Générale des Finances (General Inspectorate of Finance) IGM Inspection Générale du Ministère (General Inspectorate of Ministry) IRI Intermediate Result Indicator IRSP Institut Régional de Santé Publique Comlan Alfred Auguste QUENUM (Regional Public Health Institute) LQAS Lot Quality Assurance Sampling M&E M&E Monitoring and Evaluation MOH Ministry of Health PAP Program Action Plan PDO Program Development Objective PCU Program Coordination Unit PHC Primary Health Care PNDS Plan National de Développement Sanitaire (National Health Development Plan) POM Program Operational Manual PforR Program for Results RA Results Areas RMNCAH+N Reproductive, maternal, neonatal, child, adolescent health, and nutrition @#&OPS~Doctype~OPS^dynamics@pfrrestrhybridbasicdata#doctemplate ii The World Bank Benin Health System Enhancement Program (P172940) (P172940) BASIC DATA Product Information Operation ID Operation Name P172940 Benin Health System Enhancement Program (P172940) Product Operation Acronym Program-for-Results Financing (PforR) Benin Health System Enhancement Program Operation Status Approval Date Active 27-Apr-2022 Does this operation have an IPF component? No ACCOUNTABILITY Region/Country Who is the primary beneficiary of this operation? Beneficiary country/countries (borrower, recipient) Country or Group of Countries Benin Requesting Unit AWCF2 (6551) Will regional institutions act as the borrower/implementer? Implementing Unit Responsible Unit (e.g. EECG1) Practice Area (Lead) HAWH2 (9542) Health, Nutrition & Population Contributing Practice Areas @#&OPS~Doctype~OPS^dynamics@pfrrestrhybridoperationstatus#doctemplate OPERATION STATUS Development Objective (DO) iii The World Bank Benin Health System Enhancement Program (P172940) (P172940) Development Objective To improve the quality of and access to primary health care services with a focus on reproductive, maternal, neonatal, child, adolescent health and nutrition (RMNCAH+N) and strengthen public health emergency preparedness and response capacity Disbursement Summary (in USD million) Source of Funds Net Commitment Disbursed Undisbursed % Disbursed IBRD -- -- -- 0 IDA 187.00 61.07 111.90 32.66 Grants -- -- -- 0 Policy Waivers Does this restructuring trigger the need for any policy waiver(s)? No @#&OPS~Doctype~OPS^dynamics@restrhybridmpa#doctemplate iv The World Bank Benin Health System Enhancement Program (P172940) (P172940) TABLE OF CONTENTS I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING ........................................................................................1 II. DESCRIPTION OF PROPOSED CHANGES ....................................................................................................................3 III. PROPOSED CHANGES ................................................................................................................................................4 IV. DETAILED CHANGE(S) ...............................................................................................................................................4 ANNEX 1: RESULTS .........................................................................................................................................................6 ANNEX 2: PROGRAM ACTION PLAN ............................................................................................................................13 The World Bank Benin Health System Enhancement Program (P172940) (P172940) I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. Project Status 1. The Program Development Objective (PDO) of the Benin Health System Enhancement Program (BHSEP) is two- folds: (i) to improve quality of and access to primary health care services with a focus on reproductive, maternal, neonatal, child, adolescent health, and nutrition (RMNCAH+N) and (ii) to strengthen public health emergency preparedness and response capacity. The BHSEP, a Program-for-Results (PforR), was approved by the World Bank Board of Directors on April 27, 20222, and declared effective on July 27, 2022. The Program has a total grant and credit financing of US$187 million equivalent from International Development Association (IDA) with 35 percent disbursement as of September 30, 2024. The Program is supporting the implementation of the National Health Development Plan (Plan National de Développement Sanitaire – PNDS) 2018-2022 and the National Health Policy (Politique Nationale de Santé, PNS) 2018-2030. The PNDS 2018-2022 is organized under six Strategic Areas (SA): (i) leadership and governance development; (ii) service delivery; (iii) development of human resources for health (HRH); (iv) development of infrastructure, equipment, and health products; (v) improvement of the health information system and promotion of health research; and (vi) improvement of the financing mechanism for better Universal Health Coverage (UHC). A follow-on PNDS for the period 2024-2030, with the same SAs, is currently in its final phase of validation by the Ministry of Health (MOH) in consultation with development partners and is expected to be completed by end of October 2024. The Institute for Public Health research (Institut de Recherche en Santé Publique – IRSP) is the verification agency of the BHSEP. 2. The Program has two Results Areas (RAs) that mirror the PDO: (i) Access and Quality, and (ii) Health System Capacity and Emergency Preparedness and Response, which are aligned with and contribute to three of the six SAs of the PNDS: SA2: Service delivery and improving the quality of care; SA3: Development of human resource for health; and SA4: Development of infrastructure, equipment, and health products. 3. The Access and Quality RA is aligned with PNDS SA2: Service delivery and improving the quality of care, and SA3: Development of human resource for health. This RA supports improvements to access to and delivery of quality primary health care (PHC) services focusing on RMNCAH+N services. Financing is provided through six Disbursement Linked Results (DLRs) that measure improvements in: maternal and neonatal care, particularly Basic Emergency Obstetric and Newborn Care (BEMonC); delivery and coverage of family planning services; child immunization coverage; health facilities that are adequately equipped to provide maternal and child health services; quality and coverage of skilled delivery; and operationalization of the health sector quality assurance system. 4. The Health System Capacity and Emergency Preparedness and Response RA is aligned with PNDS SA4: Development of infrastructure, equipment, and health products. This RA supports investments in key components of Primary Health Care (PHC) service delivery, including infrastructure, equipment, and supply of medicines and consumables as well as investments in emergency preparedness and response. Financing is provided through two Disbursement Linked Indicators (DLIs) that measure improvements in epidemiologic and laboratory capacity and new health facilities constructed and equipped. 5. The progress towards achievement of the PDO and overall implementation progress are both rated Moderately Satisfactory (MS). Notable implementation progress has been observed since the last mission in May 2024. Three DLRs - DLR#5.1, DLR#7.1, and DLR#8.1 – have achieved their annual targets. Withdrawal of financing proceeds for Page 1 The World Bank Benin Health System Enhancement Program (P172940) (P172940) these three DLRs and replenishment of the first advance have been completed. As of September 30, 2024, disbursement stands at 35 percent (US$61.07 million equivalent). One of the PDO indicators, operationalization of the health sector quality assurance system, is already achieved. Four out of the twelve Intermediate Results Indicators (IRIs) have reached their annual targets. The IRIs which have achieved their annual targets are: (i) Number of health professionals who have completed an epidemiology or laboratory training on surveillance, preparedness, and response to public health emergencies; (ii) Number of Health Facilities with new health care buildings constructed and equipped as further detailed in the Program Operational Manual (POM); (iii) Proportion of long-acting contraceptive users; and (iv) Proportion of full immunization coverage for children between the ages of 12 to 23 months. The Monitoring and Evaluation (M&E) system is now fully operational. The M&E plan has been completed and will be updated on a quarterly basis. The rating for M&E has been upgraded from Moderately Unsatisfactory to Moderately Satisfatory. Following the mission, the task team has had follow up meetings with the Program Coordination Unit (PCU), the National Agency for Primary Healthcare (Agence nationale des soins de santé primaires – ANSSP), to review and to discuss revisions to the results framework as well as other changes in the Program Expenditure Framework (PEF). The details of the changes to the M&E framework are reflected in Table 2. 6. Fiduciary aspects are rated Moderately Unsatisfactory, but progress is being made. Following the May 2024 implementation support mission, the Government has initiated measures to strengthen coordination across agencies. The Minister of Health has informed the Bank, via a letter dated May 31, 2024, about the appointment of focal persons in each of the agencies involved in the PforR. These individuals will assist in supporting the implementation of the Program and will facilitate the coordination role assigned to ANSSP. A key role of the focal points will include coordination on the Annual Work Plan and Budget (AWPB); the half-yearly interim financial reports (IFRs), and the Program's annual financial statements. Training was conducted by the World Bank FM and Procurement team on July 23, 2024, to ensure comprehension of the Program and the fiduciary aspects. There are delays in the execution of the contracts. Out of a total of twenty-eight contracts, only two (7%) are currently being implemented. The main challenges to implementing the procurement plan are related to (i) significant delays in contracting process from preparation to signature of the awarded contracts and (ii) the centralized role of the Program’s Procurement Plan which was not fully understood by the ANSSP. However, after the World Bank Financial Management (FM) and Procurement Team training in July 2024, these aspects should now all be resolved to accelerate implementation of the Procurement Plan. 7. Environmental and Social Standards (ESS) is rated Moderately Satisfactory. There has been progress in key ESS activities in the Program Action Plan. The Stakeholder Engagement Plan (SEP), the Grievance Redress Mechanism (GRM), and the Waste Management Plan have all been prepared and have been validated by the World Bank's ESS team. B. Rationale for Restructuring 8. The need for restructuring of the PforR was formally conveyed by the Government in a letter dated April 5, 2024, and further discussed with the World Bank during implementation support missions. The proposed restructuring has four key objectives: (i) to revise the baseline data and annual targets of the DLIs following the Bank team's validation of the revisions of the Baseline Survey Report and to also clarify DLR#8.2, DLR#8.3, and DLR#8.4 to take into account the new objectives of the Health Regulations Authority (ARS); (ii) to update the Program's results framework in line with the changes to the baseline data and annual targets of the DLIs after the Baseline Survey Report of IRSP in 2022 that revealed discrepancies with the baseline during Program preparation; (iii) to update Page 2 The World Bank Benin Health System Enhancement Program (P172940) (P172940) the Program Action Plan (PAP); and (iv) to re-adjust the Program Expenditure Framework to align the contribution of government funding with the new costing of the draft PNDS 2024-2030 and other partners within the Program. II. DESCRIPTION OF PROPOSED CHANGES 9. This paper seeks the Country Director’s approval to carry out a Level II Restructuring with the following proposed changes: (a). Revision of baseline data and annual targets of the DLIs. The 2022 Baseline Survey Report, carried out by IRSP, which serves as the Program's verification agency, revealed differences from the baseline figures estimated by the Government during the project's preparation phase. The restructuring proposes to revise the baseline figures per the Survey results and adjust the end targets taking into account the formula and financing for each DLI as detailed in the “Withdrawal Financing Proceeds” section of the Financing Agreement. The proposed changes are detailed in Table 1 with a summary below: i. Revise the baseline data and the progress margins for DLIs #1, #2, #3, #4, #5, and #6, in accordance with the IRSP’s 2022 Baseline Survey Report. The total amounts allocated to each DLI have not been modified and will remain as stipulated in the Financing Agreement. However, the annual allocations have been revised. ii. Clarify DLR#8.2, DLR#8.3, and DLR#8.4, considering the new objectives of the ARS on the quality assurance approach in the health sector. (b). Updating the Results Framework. The revision of the DLIs as noted above, will require an update of the Results Framework to reflect the changes to the baseline data and the annual targets of the DLIs. Additionally, some indicators are proposed to be revised based on lessons from the two years of implementation and challenges in data availability. The details and specific changes to be made to each of the indicators are reflected in the M&E Framework in Table 2. (c). Updating the Program Action Plan (PAP). The implementation of several PAP actions has faced challenges due to inconsistencies with the Government's processes. For instance, it was unclear who would conduct the internal audits for the Program and who would report on potential fraud and corruption. After discussions with the General Inspectorate of Finance (Inspection Générale des Finances – IGF), the Government has informed the World Bank team that the reporting will be done on an ad-hoc basis, once a year, by the General Inspectorate of the MOH - Inspection Générale du Ministère – (IGM) based on the semi-annual audit reports carried out by the internal auditors of the agencies in charge of the implementation of the Program. Table 3 presents the proposed revisions of the PAP. (d). Readjust the Program Expenditure Framework (PEF). The PNDS is the guiding framework for the health sector for the period 2024-2030. Its adoption, appropriation, and methodical implementation by the various stakeholders will significantly contribute to improving the performance indicators of the health system for the population of Benin. The estimated overall cost of the PNDS 2024-2030, is XOF 1.44 trillion, equivalent to USD2.4 billion. This cost is below the estimated cost of the initial PNDS 2018-2022, whose budget amounts to XOF 1.91 trillion, equivalent to USD 3.48 billion. The change in the amount of the PNDS involves a change in the amount that Benin Government is going to contribute for the Program. To this end, the PEF will be re- adjusted to align the contribution of government funding, with the new costing of the PNDS 2024-2030 and other partners within the Program. Table 4 and Table 5 provide the proposed revisions of the Program Expenditure Framework. Page 3 The World Bank Benin Health System Enhancement Program (P172940) (P172940) TABLE 1: REVISION OF DLIS DLI#1 Current Formulation: Proportion of Targeted Health Facilities Offering Basic Emergency Obstetric and Newborn Care (BEmONC) Services Proposed Formulation: Health facilities offering basic emergency obstetric and neonatal care (BEmONC) services (Percentage) Unit of measure: Amount of Current Allocation Amount of Proposed Allocation Percentage Total Amount As of % of Total Amount Total Amount As of % of Total Amount Allocated Allocated (SDR) (SDR) 14,400,000 10.59 14,400,000 10.59 Current Proposed Allocated Formula Allocated Formula Period Value Value amount (SDR) amount (SDR) Baseline 35.00 27.42 CY 2022 40.00 27.42 2,880,000.00 SDR 576,000 for each percentage point 0.00 - increase from a base line of 35%. CY 2023 45.00 32.42 2,880,000.00 SDR 576,000 for each percentage point 3,600,000.00 SDR720,000 for each percentage point increase from a base line of 35%. increase over the 27.42% baseline. CY 2024 50.00 37.42 2,880,000.00 SDR 576,000 for each percentage point 3,600,000.00 SDR720,000 for each percentage point increase from a base line of 35%. increase over the 27.42% baseline. CY 2025 55.00 42.42 2,880,000.00 SDR 576,000 for each percentage point 3,600,000.00 SDR720,000 for each percentage point increase from a base line of 35%. increase over the 27.42% baseline. CY 2026 60.00 47.42 2,880,000.00 SDR 576,000 for each percentage point 3,600,000.00 SDR720,000 for each percentage point increase from a base line of 35%. increase over the 27.42% baseline. DLI#2 Current Formulation: Proportion of Long-Acting Contraceptive Users Proposed Formulation: Long-acting contraceptive users (Percentage) Amount of Current Allocation Amount of Proposed Allocation Total Amount As of % of Total Amount Total Amount As of % of Total Amount Allocated Allocated Unit of measure: (SDR) (SDR) Percentage 14,000,000.00 10.48 14,000,000.00 10.48 Current Proposed Allocated Formula Allocated Formula Period Value Value amount (SDR) amount (SDR) Page 1 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Baseline 6.20 5.56 CY 2022 6.80 5.56 2,400,000.00 SDR 2,000,000 for each ½ percentage 0.00 - point increase from a baseline of 6.2%. CY 2023 7.50 6.20 2,800,000.00 SDR 2,000,000 for each ½ percentage 3,394,398.57 SDR 2,651,515.15 for every 1/2 point increase from a baseline of 6.2%. percentage point increase from a base of 5.56%. CY 2024 7.80 6.90 1,200,000.00 SDR 2,000,000 for each ½ percentage 3,711,960.46 SDR 2,651,515.15 for every 1/2 point increase from a baseline of 6.2%. percentage point increase from a base of 5.56%. CY 2025 8.80 7.20 4,000,000.00 SDR 2,000,000 for each ½ percentage 1,590,840.24 SDR 2,651,515.15 for every 1/2 point increase from a baseline of 6.2%. percentage point increase from a base of 5.56%. CY 2026 9.70 8.20 3,600,000.00 SDR 2,000,000 for each ½ percentage 5,302,800.73 SDR 2,651,515.15 for every 1/2 point increase from a baseline of 6.2%. percentage point increase from a base of 5.56%. DLI#3 Current Formulation: Proportion of full immunization coverage for children between the ages of 12 to 23 months Proposed Formulation: Full immunization coverage for children aged 12-23 months (Percentage) Unit of measure: Amount of Current Allocation Amount of Proposed Allocation Percentage Total Amount As of % of Total Amount Total Amount As of % of Total Amount Allocated Allocated (EUR) (EUR) 20,000,000.00 11.76 20,000,000.00 11.76 Current Proposed Allocated Formula Allocated Formula Period Value Value amount (EUR) amount (EUR) Baseline 57.00 54.90 CY 2022 58.00 54.90 EUR 2,500,000 for each percentage point 0.00 2,500,000.00 increase from a baseline of 57%. CY 2023 60.00 55.90 EUR 2,500,000 for each percentage point EUR 2,857,142.86 for each percentage 5,000,000.00 increase from a baseline of 57%. 2,857,142.86 point increase from a base of 54.90%. CY 2024 62.00 57.90 EUR 2,500,000 for each percentage point EUR 2,857,142.86 for each percentage 5,000,000.00 increase from a baseline of 57%. 5,714,285.72 point increase from a base of 54.90%. Page 2 The World Bank Benin Health System Enhancement Program (P172940) (P172940) CY 2025 64.00 59.90 EUR 2,500,000 for each percentage point EUR 2,857,142.86 for each percentage 5,000,000.00 increase from a baseline of 57%. 5,714,285.71 point increase from a base of 54.90%. CY 2026 65.00 61.90 EUR 2,500,000 for each percentage point EUR 2,857,142.86 for each percentage 2,500,000.00 increase from a baseline of 57%. 5,714,285.71 point increase from a base of 54.90%. DLI#4 Current Formulation: Proportion of Health Facilities with no stock-out of Maternal and Child Health Tracer Drugs in the past three (3) months Proposed Formulation: Health facilities with no stock-out of tracer drugs for maternal and child health in the last three (3) months (Percentage) Amount of Current Allocation Amount of Proposed Allocation Total Amount As of % of Total Amount Total Amount As of % of Total Amount Allocated Allocated Unit of measure: (SDR) (SDR) Percentage 14,500,000.00 10.70 14,500,000.00 10.70 Current Proposed Allocated Formula Allocated Formula Period Value Value amount (SDR) amount (SDR) Baseline 70.00 32.11 CY 2022 71.00 32.11 1,450,000.00 SDR 1,450,000.00 for each percentage 0.00 point increase (from a baseline of 70%). CY 2023 73.00 35.00 2,900,000.00 SDR 1,450,000.00 for each percentage SDR 810,508.66 for each percentage point increase (from a baseline of 70%). 2,342,370.04 point increase (from a base of 32.11%). CY 2024 75.00 40.00 2,900,000.00 SDR 1,450,000.00 for each percentage SDR 810,508.66 for each percentage point increase (from a baseline of 70%). 4,052,543.32 point increase (from a base of 32.11%). CY 2025 78.00 45.00 4,350,000.00 SDR 1,450,000.00 for each percentage SDR 810,508.66 for each percentage point increase (from a baseline of 70%). 4,052,543.32 point increase (from a base of 32.11%). CY 2026 80.00 50.00 2,900,000.00 SDR 1,450,000.00 for each percentage SDR 810,508.66 for each percentage point increase (from a baseline of 70%). 4,052,543.32 point increase (from a base of 32.11%). DLI#5 Current Formulation: Number of Health Professionals who have completed an epidemiology or laboratory training on surveillance, preparedness, and response to public health emergencies Proposed Formulation: Health professionals trained in epidemiology or laboratory in public health emergency surveillance, preparedness and response (Number) Page 3 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Amount of Current Allocation Amount of Proposed Allocation Total Amount As of % of Total Amount Total Amount As of % of Total Amount Allocated Allocated Unit of measure: (EUR) (USD) Percentage 26,460,000.00 16.17 26,460,000.00 16.17 Current Proposed Allocated Formula Allocated Formula Period Value Value amount (EUR) amount (EUR) Baseline 119.00 134.00 CY 2022 196.00 134.00 EUR105,000 for each medical or 0.00 8,085,000.00 laboratory health professional from a baseline of 119. CY 2023 273.00 197.00 EUR 105,000 for each medical or 6,615,000.00 EUR 105,000 for each medical 8,085,000.00 laboratory health professional from a professional (doctor or lab technician), baseline of 119. based on a baseline of 134 CY 2024 315.00 260.00 EUR 105,000 for each medical or 6,615,000.00 EUR 105,000 for each medical 4,410,000.00 laboratory health professional from a professional (doctor or lab technician), baseline of 119. based on a baseline of 134 CY 2025 336.00 323.00 EUR 105,000 for each medical or 6,615,000.00 EUR 105,000 for each medical 2,205,000.00 laboratory health professional from a professional (doctor or lab technician), baseline of 119. based on a baseline of 134 CY 2026 371.00 386.00 EUR 105,000 for each medical or 6,615,000.00 EUR 105,000 for each medical 3,675,000.00 laboratory health professional from a professional (doctor or lab technician), baseline of 119. based on a baseline of 134 DLI#6 Current Formulation: Proportion of births attended by a Skilled Health Professional Proposed Formulation: Births attended by skilled health professionals (Percentage) Unit of measure: Amount of Current Allocation Amount of Proposed Allocation Percentage Total Amount As of % of Total Amount Total Amount As of % of Total Amount Allocated Allocated (SDR) (SDR) 12,780,000.00 9.63 12,780,000.00 9.63 Current Proposed Allocated Formula Allocated Formula Period Value Value amount (SDR) amount (SDR) Page 4 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Baseline 90.50 90.50 CY 2022 91.00 90.50 1,420,000.00 SDR 1,420,000 for each ½ percentage 0.00 increase from a baseline of 90.5% CY 2023 92.00 91.00 2,840,000.00 SDR 1,420,000 for each ½ percentage 1,825,714.29 SDR 1,825,714.29 for every 1/2 increase from a baseline of 90.5% percentage increase over a 90.5% base. CY 2024 93.00 92.00 2,840,000.00 SDR 1,420,000 for each ½ percentage 3,651,428.57 SDR 1,825,714.29 for every 1/2 increase from a baseline of 90.5% percentage increase over a 90.5% base. CY 2025 94.00 93.00 2,840,000.00 SDR 1,420,000 for each ½ percentage 3,651,428.57 SDR 1,825,714.29 for every 1/2 increase from a baseline of 90.5% percentage increase over a 90.5% base. CY 2026 95.00 94.00 2,840,000.00 SDR 1,420,000 for each ½ percentage 3,651,428.57 SDR 1,825,714.29 for every 1/2 increase from a baseline of 90.5% percentage increase over a 90.5% base. DLI#7 Current Formulation: Number of Health Facilities with new health care buildings constructed and equipped as further detailed in the POM Proposed Formulation: Health facilities built and equipped as further detailed in the POM (Number) Unit of measure: Amount of Current Allocation Amount of Proposed Allocation Number Total Amount As of % of Total Amount Total Amount As of % of Total Amount Allocated Allocated (EUR) (EUR) 33,250,000.00 20.05 33,250,000.00 20.05 Current Proposed Allocated Formula Allocated Formula Period Value Value amount (EUR) amount EUR) Baseline 0.00 0.00 CY 2022 4.00 0.00 5,320,000.00 EUR 1,330,000.00 for each Health Facility 0.00 with new constructed and equipped health care buildings CY 2023 11.00 6.00 9,310,000.00 EUR 1,330,000.00 for each Health Facility 7,980,000.00 $1,330,000.00 for each health care with new constructed and equipped facility with new health care buildings health care buildings constructed and equipped. CY 2024 18.00 11.00 9,310,000.00 EUR 1,330,000.00 for each Health Facility 6,650,000.00 $1,330,000.00 for each health care with new constructed and equipped facility with new health care buildings health care buildings constructed and equipped. Page 5 The World Bank Benin Health System Enhancement Program (P172940) (P172940) CY 2025 23.00 18.00 6,650,000.00 EUR 1,330,000.00 for each Health Facility 9,310,000.00 $1,330,000.00 for each health care with new constructed and equipped facility with new health care buildings health care buildings constructed and equipped. CY 2026 25.00 25.00 2,660,000.00 EUR 1,330,000.00 for each Health Facility 9,310,000.00 $1,330,000.00 for each health care with new constructed and equipped facility with new health care buildings health care buildings constructed and equipped. DLI#8 Operationalization of the health sector’s quality assurance system (Y/N) Unit of measure: Amount of Current Allocation Amount of Proposed Allocation Yes/No Total Amount As of % of Total Amount Total Amount As of % of Total Amount Allocated Allocated (EUR/SDR) (EUR/SDR) EUR SDR 10.70 EUR SDR 10.70 3,790, 14,32 3,790 14,32 000 0,000 ,000 0,000 Current Proposed Allocated Formula Allocated Formula Value Value amount amount Period EUR/SDR) (EUR/SDR) Baseline No 0.00 CY 2022 Yes Yes EUR 3,790,000 As noted under DLR8.1, DLR8.2, DLR8.3, EUR As outlined in DLR8.1 DLR8.4 3,790,000.00 CY 2023 Yes Yes SDR As noted under DLR8.1, DLR8.2, DLR8.3, 0.00 - 3,580,000.00 DLR8.5 CY 2024 Yes Yes SDR As noted under DLR8.1, DLR8.2, DLR8.3, SDR As outlined in DLR8.2 3,580,000.00 DLR8.6 2,910,000.00 CY 2025 Yes Yes SDR As noted under DLR8.1, DLR8.2, DLR8.3, SDR As outlined in DLR8.3, DLR8.4 3,580,000.00 DLR8.7 6,675,517.24 CY 2026 Yes Yes SDR As noted under DLR8.1, DLR8.2, DLR8.3, SDR As outlined in DLR8.4 3,580,000.00 DLR8.8 1,834,482.76 DLI#8.1 A Regulatory Health Sector Authority is established and operational as evidenced by the achievement of specific milestones detailed in the POM on or before December 31, 2022 (Y/N) Period Amount of Current Allocation Amount of Proposed Allocation Page 6 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Unit of measure: Total Amount As of % of Total Amount Total Amount As of % of Total Amount Yes/No Allocated Allocated (EUR) (EUR) 3,790,000 2.14 3,790,000 2.14 Current Proposed Allocated Formula Allocated Formula Value Value amount (EUR) amount (EUR) Baseline No No CY 2022 Yes Yes 3,790,000 Not Scalable 3,790,000.00 Non extensible CY 2023 Yes Yes 0.00 Not Scalable 0.00 Non extensible CY 2024 Yes Yes 0.00 Not Scalable 0.00 Non extensible CY 2025 Yes Yes 0.00 Not Scalable 0.00 Non extensible CY 2026 Yes Yes 0.00 Not Scalable 0.00 Non extensible DLI#8.2 Current formulation: The Health Sector Quality Assurance Policy has been adopted by the Regulatory Health Sector Authority on or before December 31, 2024 Proposed Formulation: Adopted Patient Safety Assessment Manual (Y/N) Unit of measure: Amount of Current Allocation Amount of Proposed Allocation Yes/No Total Amount As of % of Total Amount Total Amount As of % of Total Amount Allocated Allocated (SDR) (SDR) 2,910,000 2.14 2,910,000.00 2.14 Current Proposed Allocated Formula Allocated Formula Period Value Value amount (SDR) amount (SDR) Baseline No No CY 2022 Yes No 2,910,000 Not Scalable 0.00 Non extensible CY 2023 Yes No 0.00 Not Scalable 0.00 Non extensible CY 2024 Yes Yes 0.00 Not Scalable 2,910,000.00 Non extensible CY 2025 Yes Yes 0.00 Not Scalable 0.00 Non extensible CY 2026 Yes Yes 0.00 Not Scalable 0.00 Non extensible Page 7 The World Bank Benin Health System Enhancement Program (P172940) (P172940) DLI#8.3 Current Formulation: 70% of Health Districts that have begun implementing the Health Sector Quality Assurance Policy as evidenced by the achievement of key milestones further detailed in the POM Proposed Formulation: Establishment of patient safety assessment system (Y/N) Unit of measure: Amount of Current Allocation Amount of Proposed Allocation Current Total Amount As of % of Total Amount Total Amount Allocated As of % of Total Amount (Percentage); Allocated (SDR) (SDR) 5,600,000 4.28 2,910,000 2.14 Current Proposed Allocated Formula Allocated Formula Value Value amount (SDR) amount (SDR) Period (Yes/NO) Baseline 0.00 No CY 2022 0.00 No 0.00 SDR 80,000 for each percentage point 0.00 Non extensible increase from a baseline of 0% CY 2023 0.00 No 0.00 SDR 80,000 for each percentage point 0.00 Non extensible increase from a baseline of 0% CY 2024 0.00 No 0.00 SDR 80,000 for each percentage point 0.00 Non extensible increase from a baseline of 0% CY 2025 50.00 Yes 4,000,000.00 SDR 80,000 for each percentage point 2,910,000.00 Non extensible increase from a baseline of 0% CY 2026 70.00 Yes 1,600,000.00 SDR 80,000 for each percentage point 0.00 Non extensible increase from a baseline of 0% DLI#8.4 Current formulation: The Ministry of Health has approved an accreditation process for health personnel and certification process for Health Facilities on or before December 31, 2026 Proposed Formulation: Healthcare facilities that have completed a patient safety assessment verified by ARS (Number) Amount of Current Allocation Amount of Proposed Allocation Period Page 8 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Unit of measure: Total Amount As of % of Total Amount Total Amount As of % of Total Amount Current (Yes/No) Allocated Allocated (SDR) (SDR) 2,910,000 2.14 5,600,000 4.28 Current Proposed Allocated Formula Allocated Formula Value Value: amount (SDR) amount (SDR) (Number) Baseline No 0.00 CY 2022 No 0.00 0.00 Not Scalable 0.00 Non extensible CY 2023 No 0.00 0.00 Not Scalable 0.00 Non extensible CY 2024 No 0.00 0.00 Not Scalable 0.00 Non extensible CY 2025 No 117.00 0.00 Not Scalable 3,765,517.24 SDR 32,183.91 for each health facility that has completed a patient safety assessment verified by ARS. CY 2026 Yes 174.00 2,910,0004 Not Scalable 1,834,482.76 SDR 32,183.91 for each health facility that has completed a patient safety assessment verified by ARS. Page 9 The World Bank Benin Health System Enhancement Program (P172940) (P172940) 11. Update the Results Framework (Table 2) (a). Revising the PDO indicators: Some indicators have been moved to IRI section as they are output indicators and also allow to take into account the new World Bank Corporate Scorecard. Other indicators have been changed (definition as well as the baseline, the data source and targets) due to the results from IRSP’s 2022 Baseline Survey Report. Finally, some indicators have been deleted as it is difficult to track given its multiple interventions. (b). Revising the IRIs: Some indicators have been deleted and changes on the remaining indicators have been made to the title, definition, baseline, objectives, and source of data, all based on the IRSP 2022 Baseline Survey Report. Other indicators have been deleted due to the unavailability of data in district health information software (DHIS2). Table 2 below presents the details of changes proposed. TABLE 2: RESULTS FRAMEWORK PDO-LEVEL INDICATORS Indicator Indicator DLI Baseline End Target Source Observations Name Definition / Description 2022 2026 Objective/Outcome: Quality 1 Original Original Original Original Original This indicator will be PDO1: Pregnant women The percentage of women ages 15-49 who 70.00 80.00 MOH moved to the who attend four antenatal had a live birth in a given period and Intermediate Results care (ANC) visits received antenatal care four or more times. Indicators (IRI) section (Percentage) as it is an outcome Numerator: The number of women ages 15- indicator. Revised 49 who had a live birth in a given period and Changes were made IRI2: Pregnant women who received antenatal care four or more times. to the definition as receive four antenatal care Denominator: Total number of women ages well as to the baseline (ANC) consultations 15-49 who had a live birth during the same and targets after the (Percentage) period. assessment by the Regional Institute of Revised Revised Revised Revised Public Health (IRSP). Pregnant women who receive four 47.00 49.50 DHIS2 antenatal care visits (ANC) are the percentage of pregnant women who Page 1 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Indicator Indicator DLI Baseline End Target Source Observations Name Definition / Description 2022 2026 received at least four antenatal care visits during pregnancy. The indicator is calculated as follows: Numerator: Number of pregnant women who had a live birth and received four prenatal consultations during pregnancy (at least one prenatal consultation per trimester and a fourth prenatal consultation in the ninth month of pregnancy) Denominator: Number of expected pregnancies PDO 2: Long-Acting Original DLI#2 Original Original Original Changes to the Contraceptive users (DLI 2) The indicator is defined as the number of 6.20 9.70 MOH definition as well as (Percentage) women who are currently using at least one the baseline and modern contraceptive method out of the targets were made number of women of reproductive age who after the assessment are using any method of contraception or of the IRSP. whose family planning needs are unmet. Revised Revised Revised Revised Numerator: Number of women of 5.56 8.20 IRSP/ reproductive age (15-49 years) who are new DHIS2 users of intrauterine devices (IUDs) and implants Denominator: Total number of women of reproductive age (15-49 years) in the population. 3 PDO 3: Full immunization Original DLI#3 Original Original Original Changes were made coverage for children aged This indicator measures the percentage of 57.00 65.00 MOH to the definition as 12-23 months (Percentage) one-year-old children who have received well as to the baseline (DLI3) one dose of Bacille Calmette-Guérin (BCG) Revised Revised Revised and targets after the vaccine, three doses of polio vaccine, three 54.90 61.90 LQAS IRSP was assessed. Page 2 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Indicator Indicator DLI Baseline End Target Source Observations Name Definition / Description 2022 2026 doses of diphtheria, tetanus and pertussis Survey Benin has selected combined vaccine (DTP3) and one dose of Report Penta antigens (all 3 measles vaccine. The indicator is calculated doses) and measles as follows: and rubella (MR) as Numerator: Number of children aged 12-23 the tracer of a fully months who received one dose of BCG vaccinated child. The vaccine, three doses of polio vaccine, three data source was also doses of DTP3 vaccine, and one dose of changed from the PHE measles vaccine. to the Lot Quality Denominator: Total number of children Assurance Sampling aged 12-23 months surveyed. In some (LQAS) survey report. countries, the period of 12 to 23 months has been adjusted to align with other national immunization periods (18 to 29 months or 15 to 26 months). Revised Numerator: Number of children aged 12-23 months who received three doses of pentavalent vaccines and one dose of measles and rubella (MR) vaccines. Denominator: Total number of children aged 12-23 months 4 Original Original DLI#4 Original Original Original Changes were made PDO4: Health facilities with Numerator: Duration in days of the 70.00 80.00 MOH to the title, definition, no stock-out of essential reporting period-Number of days out of and baseline and tracer drugs for maternal stock objectives after the and child health, as defined Denominator: Total duration in days of the IRSP was assessed. by the national health reporting period / % ratio The data source was protocol, in the last three Revised Revised Revised also changed from months (Percentage) (DLI4) Revised 32.11 50.00 DHIS2/ MOH to DHIS2.The list IRSP of essential medicines report (subject to change) is: Page 3 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Indicator Indicator DLI Baseline End Target Source Observations Name Definition / Description 2022 2026 Revised Numerator: Health facilities with no stock- IUD, Implants, Oral PDO4: Health facilities with out of tracer drugs for maternal and child emergency no stock-out of essential health in the last three (3) months. contraceptive pill tracer drugs for maternal Denominator: Total number of health (Levonorgestrel), and child health in the last facilities Misoprostol, three (3) months (DLI 4) Magnesium Sulfate, (Percentage) Amoxicillin and ORS Zinc. Objective/Outcome: Access 5 To be deleted No definition is included in the PAD. 50.00 70.00 IRSP This indicator is being deleted as it is PDO 5: Pregnant women of difficult to track given reproductive age access its multiple health facilities for interventions. In reproductive health addition, the ANC consultations (in indicator already percentage) captures consultations for pregnant women and would therefore be repetitive. 6 Original Number of new outpatient visits, hospital Original Original Original This indicator and its PDO 6: People receiving visits, outreach visits, people reached by 0.00 8,700,000 MOH sub-indicators are essential health, nutrition campaigns, and/or telemedicine visits. moved to the IRI and population Services section. This indicator (CRI, Number) has been reformulated to Revised Revised Revised Revised adhere to the new IRI1: People who have 6,492,740 8,568,618 DHIS2 World Bank Corporate received quality health, Scorecard. This nutrition, and population indicator is similar to services (Corporate the previous indicator Scorecard, number) but places more emphasis on quality of Page 4 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Indicator Indicator DLI Baseline End Target Source Observations Name Definition / Description 2022 2026 services. There are changes to the baseline and final target. 6.1 New Sub-Indicator Number of women who participated in 3,622,304 4,792,894 Original This new sub- outpatient consultations, hospital visits, MOH indicator is included IRI1.1 People who received outreach visits, campaigns and/or to determine how quality health, nutrition and telemedicine consultations. many women have population services Revised access to quality (women) (CS sheet, DHIS2 essential health number) services. 6.2 Original Number of children aged five years and Original Original Original Reformulated to take Sub-Indicator 1: Children under who have completed the vaccination 0.00 2,800,000 MOH into account the WB's vaccinated (number) series (Pentavalent 3 and RR) and are new Corporate considered fully immunized. Scorecard. Revised IRI1.2: Children immunized Revised Revised Revised (Number) 856,495 1,053,596 DHIS2 6.3 IRI1.3: Women and children Number of women and children Original Original Original Reformulated to take have received basic participating in direct feeding programs, 0.00 4,000,000 MOH into account the WB's nutrition services (Number) promoting proper infant and young child new Corporate feeding, iron and micronutrient Revised Revised Revised Scorecard. supplementation, deworming, and 1,540,702 2,163,625 DHIS2 treatment of severe acute malnutrition. 6.4 Original Number of births attended by skilled health Original Original Original Reformulated to take Sub-Indicator 3: Deliveries personnel 90.50 1,900,000 MOH into account the WB's attended by skilled health new Corporate personnel (Number) Scorecard. Revised Revised Revised 455,007 549,772 DHIS2 Page 5 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Indicator Indicator DLI Baseline End Target Source Observations Name Definition / Description 2022 2026 Revised IRI1.4: Deliveries attended by skilled health personnel (Number) Objective/Outcome: Emergency preparedness and response 7 Original Original DLI#8 Original Original Original This indicator has PDO 7: Operationalization DLI 8 will enable Z (number) health zones to No Yes MOH been modified to of the Health Sector Quality adopt and use the Quality of Care (QoC) ensure better Assurance System (Yes/No) scorecard to oversee primary health care in monitoring and to (DLI 8) their jurisdiction. In the meantime, the ARS ensure will be established and adopt a Quality of implementation of the Care policy to guide the accreditation of new quality assurance health workers and measure the quality of policy. The services provided at the primary care level. government plans to implement a pilot Revised Revised Revised Revised project and expand it DLI 8 will allow hospitals and primary No Yes ARS/IRSP after learning from healthcare facilities to benefit from the report experience. assessment for the safety of patients with a There has been a request for compliance of the health facility change in the baseline assessment. and the final target. The source of the indicator includes the ARS report and the IRSP. New Sub-Indicator A decree appointing the members of the DLI#8.1 No Yes ARS/IRSP This sub-indicator was 7.1: A Regulatory Health college of the Health Sector Regulatory report included in the DLI Sector Authority is Authority (ARS), a decision appointing the section but not in the established and operational staff of the Executive Secretariat and other results framework. It as evidenced by the ARS bodies, and a building housing the is therefore being achievement of specific headquarters of the ARS with a sign. rectified. Changes to milestones detailed in the the indicator title and POM on or before definition. Page 6 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Indicator Indicator DLI Baseline End Target Source Observations Name Definition / Description 2022 2026 December 31, 2022 (Yes/No) (DLI8.1) New Sub-Indicator The Patient Safety Assessment Manual is DLI#8.2 No Yes ARS/IRSP This sub-indicator was 7.2 Adopted Patient Safety adopted by the ARS by December 31, 2024. report included in the DLI Assessment Manual section but not in the (Yes/No) (DLI8.2) This manual includes 21 patient safety results framework. It standards for hospital facilities and 19 is therefore being patient safety standards for primary rectified. Changes to healthcare centers in the following areas: (i) the indicator title and administration/leadership and definition. management, (ii) patient and public/community involvement, (iii) safe clinical practices, (iv) safe environment, and (v) continuous learning. New Sub-Indicator The patient safety assessment system is DL#8.3 No Yes ARS/IRSP This sub-indicator was 7.3 Establishment of operational by December 31, 2025 at the report included in the DLI patient safety assessment latest. A decree will be adopted by the section but not in the system (Yes/No) (DLI8.3) Council of Ministers for its results framework. It institutionalization. This system aims at is therefore being preventing the occurrence of adverse rectified. Changes to events (medical error, drug overdose, delay the indicator title and in diagnosis, patient injuries, among others) definition. and limit the associated harm (disability, prolonged hospitalization, and death). The decree will include a set of institutional, regulatory and operational measures based on the Patient Safety Assessment Manual that the Health Facilities have to comply with to ensure patient and staff safety and well-being throughout the care pathway and to restore public confidence in the use of health services in the country. Page 7 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Indicator Indicator DLI Baseline End Target Source Observations Name Definition / Description 2022 2026 New Sub-Indicator At least 24 hospitals (public and private) and DL#8.4 0.00 174 ARS/IRSP This sub-indicator was 7.4: Healthcare facilities 150 primary health care facilities (public and report included in the DLI that have completed a private) (cumulative) have completed a section but not in the patient safety assessment patient safety assessment verified by ARS by results framework. It verified by ARS (Number) December 31, 2026. is therefore being (DLI8.4) rectified. Changes to the indicator title and definition. Page 8 The World Bank Benin Health System Enhancement Program (P172940) (P172940) INTERMEDIATE RESULTS INDICATORS Indicator Indicator DLI Baseline Intermediate Objectives End Source Observations Name Definition / Description Target 2022 2023 2024 2025 2026 2026 Objective/Outcome: Access and Quality 1 Original Original DLI#6 90.50 Origina Origina Origina Original 94.00 Original This indicator IRI1: Proportion of Disbursement Linked Result: l l l 94.00 MOH will become a births attended by 4.5% increase in births 91.00 92.00 93.00 PDO indicator. skilled personnel attended by a skilled health The indicator (Percentage) (DLI 6) professional title has changed, and it is Revised DLI 6 will measure the no longer PDO5: Births proportion of women of necessary to attended by skilled reproductive age who will be include health personnel monitored by a skilled health intermediate (percentage) (DLI 6) personnel (doctor, midwife or targets. The nurse). Skilled birth reduces baseline and the the risk of death of a woman end target or her child during childbirth. remain the same Therefore, it assesses both as in the original. the quality and coverage of delivery Revised DHIS2/IRSP Revised Report Births attended by skilled health personnel measures the percentage of live births attended by skilled health professionals, such as doctors, nurses, or midwives. Numerator: Number of births attended by skilled health personnel Denominator: Number of expected births Page 9 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Indicator Indicator DLI Baseline Intermediate Objectives End Source Observations Name Definition / Description Target 2022 2023 2024 2025 2026 2026 2 To be deleted Percentage of newborns 41.00 44.00 48.00 52.00 60.00 60.00 DHIS2 The indicator IRI2: Percentage of attended by a health care will be deleted newborns attended provider during the first 48 due to the by a skilled caregiver hours after birth. unavailability of within 48 hours of data in DHIS2. birth (Percentage) In addition, this indicator is similar to other indicators such as assisted deliveries. 3 Original Original Origina Origina Origina Origina Original Original Original This indicator IRI3: Number of Number of children under five l l l l 89.00 65.00 DHIS2 has been revised children under 5 treated for moderate and 85.00 86.00 87.00 88.00 to put more treated for moderate severe acute malnutrition emphasis on acute malnutrition treatment of (MAM) or severe Revised Revised Revised Revised children with acute malnutrition Numerator: Number of Revised Revised Revised Revised 90.00 90.00 DHIS2 SAM as (SAM) children aged 6-59 months 85.00 87.00 88.00 89.00 additional (Percentage) reported cured of severe efforts are acute malnutrition (SAM) needed to Revised Denominator: Total number ensure higher IRI3: Children cured of discharges aged 6 to 59 cure rates. from severe acute months (total number cured + Changes have malnutrition deceased + confirmed been made to (Percentage) dropouts + unconfirmed the title, dropouts + non-responders) definition, baseline, objectives, and source of data. These changes Page 10 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Indicator Indicator DLI Baseline Intermediate Objectives End Source Observations Name Definition / Description Target 2022 2023 2024 2025 2026 2026 are based on the IRSP report. 4 To be deleted No definition was provided 0.00 10.00 20.00 30.00 40.00 50.00 Not This indicator IRI4: Number of disclosed will be deleted adolescent and youth as it is not centers available in DHIS2 and will be difficult to collect. 5 To be deleted Original Origina Origina Origina Origina Original Original Original This indicator will IRI5: Children under Numerator: Number of l l l l 55.00 55.00 Population- be deleted as it is 6 months of age children under six months of 42.00 44.00 46.00 50.00 based included in the exclusively breastfed age exclusively breastfed * survey (for WB Corporate (Percentage) 100 example, Scorecard’s sub- Denominator: Number of Demograph indicator children under six months in ic and the same area and time Health period Survey (DHS) or Multiple Indicator Cluster Survey (MICS) 6 Original Original Origina Origina Origina Origina Original Original Original Changes have IRI6: Percentage of Collecting, recording and l l l l 70.00 80.00 Not been made to beneficiaries satisfied reporting on inputs received 0.00 40.00 50.00 60.00 disclosed the title, with access, quality from beneficiaries definition, of services, quality of baseline, facilities and Revised Revised Revised Revised objectives and response to needs Number of customers satisfied Revised Revised Revised Revised 80.00 80.00 LQAS source of data. (Percentage) with access, quality of services, 60.00 65.00 70.00 75.00 Report Page 11 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Indicator Indicator DLI Baseline Intermediate Objectives End Source Observations Name Definition / Description Target 2022 2023 2024 2025 2026 2026 facilities, and responsiveness to needs Revised Numerator: Number of clients IRI4: Clients satisfied satisfied with access, quality of with care received services, and facilities (Percentage) Denominator: Number of clients 7 IRI5: Grievances Original Origina Origina Origina Origina Original Original Original Changes have addressed and/or This is an indicator on l l l l 70.00 80.00 Grievance been made to resolved within beneficiary feedback. The 0.00 40.00 50.00 60.00 Redress the definition, stipulated service indicator collects citizens' Mechanism baseline, standards for feedback and will monitor the : Hotlines, objectives, and response times number of grievances Complaint data source. (Percentage) addressed and/or resolved Boxes within the stipulated service standards for response times. Revised Revised Revised Revised Revised Revised Revised 80.00 80.00 LQAS Revised 60.00 65.00 70.00 75.00 Report Numerator: Number of grievances resolved within 48 hours Denominator: Total number of grievances received 8 Original Original DLI#1 Origina Origina Origina Origina Original Original Original This IRI will IRI7: Proportion of Disbursement Linked Result: l l l l 55.00 60.00 MOH become a PDO health facilities 25% increase in targeted 35.00 40.00 45.00 50.00 indicator. The providing basic health facilities offering indicator has emergency obstetric BEmONC services. been and neonatal care reformulated to (SONUB) (DLI1) DLI 1 reflects improvements reflect the in maternal and neonatal availability of all Revised care, particularly basic Revised Revised Revised 7 BEmONC Page 12 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Indicator Indicator DLI Baseline Intermediate Objectives End Source Observations Name Definition / Description Target 2022 2023 2024 2025 2026 2026 PDO1: Health emergency obstetric care Revised Revised Revised Revised 47.42 47.42 SONUB functions. facilities offering (BEmONC). This is necessary 27.42 32.42 37.42 42.42 Annual Changes have basic emergency to further reduce maternal Report been made to obstetric and mortality, which remains the title, neonatal care high. Currently, 35 percent of definition, (BEmONC) relevant health facilities have baseline, (Percentage) (DLI1) the capacity to handle objectives and obstetric emergencies, and source of data. the PforR will help the The 7 functions government reach a target of of BEmONC are 60 percent by the end of the as follows: implementation period. This 1- Parenteral DLI will assess both service administration of delivery capacity and antibiotics, elements of quality of care. 2- administration of uterotonics, Revised 3- administration Health facilities that provide d'anticonvulsivan basic emergency obstetric ts, and neonatal care (BEmONC) 4-Manual are equipped to provide a removal of package of essential placenta, interventions to address 5-Debris common and serious Removal, obstetric complications and 6-vaginal neonatal emergencies. The delivery with indicator is calculated as instrumental follows: assistance (suction cup or Numerator: Number of health forceps), and facilities with 7 BEmONC functions Page 13 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Indicator Indicator DLI Baseline Intermediate Objectives End Source Observations Name Definition / Description Target 2022 2023 2024 2025 2026 2026 Denominator: Total number 7-Basic neonatal of health facilities selected resuscitation (mask with bag) Health Systems Capacity and Emergency Preparedness and Response 9 Original Original Origina Origina Origina Origina Original Original Original Changes have IRI8: Proportion of No definition provided l l l l 65.00 75.00 Non fourni been made to health facilities with 0.00 35.00 45.00 55.00 the title, the minimum definition, number of qualified objectives and health workers per Revised source of the national guidelines Revised Revised Revised DHIS2 data. Numerator: Number of Revised Revised Revised Revised 91.49 91.49 Revised complete health facilities with 72.38 74.06 83.26 91 .49 IRI6: Health facilities at least one trained maternity with at least one and dispensary staff. qualified staff in the Denominator: Total number dispensary and of health facilities maternity ward 10 Original Original Origina Origina Origina Origina Original Original Original Changes have IRI9: Proportion of No definition was provided. l l l l 65.00 75.00 MOH been made to private health 0.00 35.00 45.00 55.00 the title, facilities with data definition, fully integrated in Revised Revised Revised Revised baseline, HMIS Numerator: Number of Revised Revised Revised Revised 70.00 70.00 DHIS2/ objectives and private health facilities, 38.00 56.30 62.00 68.00 DNSP data source of data. Revised including faith-based health IRI7: Private health facilities, with data fully facilities, including integrated into DHIS2 faith-based health Page 14 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Indicator Indicator DLI Baseline Intermediate Objectives End Source Observations Name Definition / Description Target 2022 2023 2024 2025 2026 2026 facilities, with data Denominator: Total number fully integrated into of private health facilities, DHIS2 (Percentage) including faith-based health facilities 11 Original Original DLI#5 Origina Origina Origina Origina Original Original Original Changes have IRI10: Number of Disbursement Linked Result: l l l l 336.00 371.00 MOH been made to health professionals 252 health professionals 119.00 196.00 273.00 315.00 the title, trained in received epidemiological or definition, epidemiology or laboratory training on baseline, laboratory on public surveillance, preparedness, objectives and health emergency and response to public health source of data. surveillance, emergencies. preparedness and Revised Revised Revised response (DLI 5) DLI 5 will measure the Revised Revised Revised Revised 386 386 ANSSP (number) number of health 134 197 260 323 activity professionals who have reports; Revised received epidemiological or IRSP IRI8: Health laboratory training in public reports professionals trained health emergency in epidemiology or surveillance, preparedness, laboratory in public and response. Therefore, DLI5 health emergency will strengthen the surveillance, epidemiological and preparedness and laboratory capacity of the response (number) public health workforce by (DLI 5) providing training that will enable the country to respond effectively to a wide range of epidemics and other public health priorities by the end of the implementation period. Page 15 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Indicator Indicator DLI Baseline Intermediate Objectives End Source Observations Name Definition / Description Target 2022 2023 2024 2025 2026 2026 Revised Number of health professionals trained in epidemiology or laboratory related to public health emergency surveillance, preparedness, and response 12 Original Original DLI#7 0.00 4.00 11.00 18.00 25.00 25.00 Original To be moved to IRI11: Number of Number of health facilities MOH the PDO health facilities with with new health care Indicators new health care buildings, constructed and section on buildings constructed renovated Access. The title, and equipped as per equipped to focus on the definition, and POM (DLI 7) functionality of healthcare Revised source of data (Percentage) facilities. Activity have been reports, changed for Revised Revised AISEM, IRSP clarity. PDO5: Health Number of health facilities reports facilities built and and health buildings These include equipped as further constructed and equipped as maternity, detailed in the POM further detailed in the POM dispensary, (number) (DLI7) laboratory, and housing blocks. 13 New Numerator: Number of health 75 75 80 85 90 90 MOH This new IRI9: Health facilities facilities that submit weekly indicator has that submit weekly PED reports on time been included to reports on epidemic ensure adequate potential diseases Denominator: Total number oversight of (EPDs) on time of health facilities EPDs. (Percentage) Page 16 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Indicator Indicator DLI Baseline Intermediate Objectives End Source Observations Name Definition / Description Target 2022 2023 2024 2025 2026 2026 The current EPDs (subject to change) are as follows: 1. Acute haemorrhagic fever 2. Anthrax 3. Bacterial Meningitis 4. Chikungunya 5. Cholera 6. Dengue Fever 7. Bloody Diarrhea (Shigella) 8. Listeriosis 9. Trachoma 10. Severe Acute Respiratory Syndrome (SARS) 11. Human influenza of avian origin caused by a highly pathogenic subtype (e.g. H5N1) 12. Monkeypox 13. Plague 14. Typhoid fever Page 17 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Indicator Indicator DLI Baseline Intermediate Objectives End Source Observations Name Definition / Description Target 2022 2023 2024 2025 2026 2026 15. Yellow fever 16. Zika Virus Disease Page 18 The World Bank Benin Health System Enhancement Program (P172940) (P172940) 12. Update the Program Action Plan. Three of the initial activities (as shown in Table 3 below) of the PAP are revised to provide: (a). a detailed explanation of the action with examples to be more precise, such as actions related to "Capacity building (technical and institutional) of actors and stakeholders”, and “Strengthening the Program's Environmental and Social Management System”. (b). a revision of the action related to Report on Fraud and Corruption to clarify the frequency of the audit and the role of IGM and ANSSP’s internal audit. The full PAP is presented in Annex 2. TABLE 3: MODIFICATIONS ON PROGRAM ACTION PLAN Number Action Description Current Completion Measurement Proposed Completion Measurement 1 Capacity building (technical and Information/Awareness-raising Information and awareness institutional) of actors and actions on the environmental and activities on environmental and stakeholders social management of the Program. social management will be The Initiatives should implemented in the first year take place during the first year of the and continue throughout the Program and to be maintained Program. This includes throughout the life cycle of the information sessions, program. workshops, and media, with communication specialists involved. 2 Strengthening the Program's Development and implementation of An agreement between ANSSP Environmental and Social the and Benisese Environmental Management grievance mechanism (GRM). No later Agency (ABE) will be concluded system. than six (6 months) after the date of by June 30, 2025. entry into force of the program and its implementation throughout the life cycle of the program. 3 Report on and investigate fraud and Report on suspected cases of Two annual internal audit corruption corruption and fraud, and on the missions will be conducted: for status of investigations. first semester by internal Based on the allegations, the IGM/IGF auditors of implementing will conduct investigations and follow structures, with reports up actions. Report to be produced per compiled by ANSSP's internal semester to be shared with the Bank auditor. For second semester by and the MOH. IGM, based on reports from all implementing structures. 13. Readjust the Program Expenditures Framework (Table 4 and Table 5) Page 1 The World Bank Benin Health System Enhancement Program (P172940) (P172940) (a). Over the five-year period spanning 2022-2027 which refers to the implementation period of the PforR, the MOH’s projected financial contribution (including other donors that follow the national procedures) is nearly USD517 million with a contribution of the World Bank which is still USD187 million. The budget lines to be financed were identified based on how they will contribute to the achievement of the DLIs. By providing financing to budget line items 045 and 047, this additional investment will help achieve the six DLIs under RA1. The RA2 aligns with budget line item 046 regarding prevention and health security and will support the achievement of the two DLIs. Moreover, budget line item 046 presents a breakdown of capital expenditures of which a larger share will go to the health zone and health infrastructure development in primary health care facilities. (b). The implementation budget for the PforR is aligned with the overall budget of the PNDS 2024-2030. Indeed, with the PNDS budget amounting to XOF 1.44 trillion, equivalent to USD2.4 billion, the PforR’s budget represents approximately 21 percent of the PNDS 2024-2030 budget, approximately XOF 302.57 billion equivalent to USD516.72 million. In the PEF developed for the implementation of the program's activities, the World Bank's contribution is estimated at XOF 109.46 billion, or USD187 million. The Beninese government will contribute USD329.72 million, and the contribution from other development partners will amount to USD3.47 million. (c). Table 4 outlines the allocation of resources by intervention areas, and Table 5 breaks down the same resources by budget line and implementing structure. The changes made to the Program Expenditure Framework are justified primarily by the new orientations of the PNDS (2024-2030), which have led to cancellations, replacements, or additions of activities at the level of the implementing structures. These changes do not require a Fiduciary System Assessment. TABLE 4: BUDGET ALLOCATION PER INTERVENTION (2022-2026) No Interventions Areas Amount in million USD 1 Development of Leadership, Governance, and Project Management 8.30 2 Strengthening Maternal and Childcare 82. 47 3 Production and Recruitment of Human Resources 5.00 4 Strengthening Infrastructure 368.59 5 Strengthening Equipment 50.75 6 Strengthening the Pharmaceutical System 0.51 7 Strengthening the Health Information System and e-Health 0.74 8 Health Emergencies and Response 0.36 Total Funds 516.72 Page 2 The World Bank Benin Health System Enhancement Program (P172940) (P172940) TABLE 5: BUDGET ALLOCATION PER AGENCY AND BUDGET CODE (2022-2026) Budget Implementation agencies Budget World Bank National Budget Other donor’s Code Allocation in Contribution contribution in contribution in million USD in million USD million USD million USD The Benin Agency for medications and other health products 047 (Agence Béninoise du 0.51 - 0.51 - Médicament et des autres produits de santé – ABMED) Agency for Infrastructure, Health Equipment, and Maintenance 047 (Agence des Infrastructures, 418.14 103.76 314.38 3.47 Sanitaires, des Equipements et de la Maintenance - AISEM National Agency for the Quality Control of Health Products and 047 Water (Agence nationale de 1.19 - 1.19 - Contrôle de Qualité des produits de santé et de l’eau – ANCQ) 046 ANSSP 63.85 56.30 7.55 - National Agency for Blood Transfusion (Agence Nationale 047 27.29 26.94 0.35 - pour la Transfusion Sanguine – ANTS) Directorate of Planning, Administration, and Finance 045 (Direction de la Planification, de 5.00 - 5.00 - l’Administration et des Finances - DPAF) Directorate for Information 045 Systems (Direction des Systèmes 0.74 - 0.74 - d'Information – DSI) Total Funds 516.72 187.00 329.72 3.47 Page 3 The World Bank Benin Health System Enhancement Program (P172940) (P172940) @#&OPS~Doctype~OPS^dynamics@restrhybridsummarychanges#doctemplate Summary changes III. PROPOSED CHANGES Operation Information Proposed Changes Operation Information Proposed Changes Results Yes Loan Closing Date Extension No Disbursements Estimates Yes Loan Cancellations No Program Action Plan Yes Reallocations No Development Objective No Financial Management No MFD/PCE No Procurement No Risks No Institutional Arrangement No Legal Operational Policies No Implementation Schedule No Legal Covenants No Conditions No Implementation Modalities No Disbursements Arrangements No Clients No Program Scope No @#&OPS~Doctype~OPS^dynamics@pfrrestrhybriddetailedchanges-disclose#doctemplate IV. DETAILED CHANGE(S) COSTS & FINANCING Is this an MFD-Enabling Project (MFD-EP)? Is this project Private Capital Enabling (PCE)? DISBURSEMENTS Operation Dates & Projection Details Reasons to change the full Disbursement date and/or the projection Restructuring Page 4 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Implementation Start Date Operation Closing Date 27-Apr-2022 30-Jun-2027 Projected Date for Full Disbursement 31-Oct-2027 Expected Disbursements (in US $) (Absolute) Original Estimation at Preparation Actual Year Revised Estimation (Approval Package – 27 Apr 2022) FY2022 560,252.00 0.00 0.00 FY2023 31,253,684.00 42,053,580.25 42,053,580.25 FY2024 57,225,740.00 19,013,829.50 19,013,829.50 FY2025 53,953,240.00 40,000,000.00 0.00 FY2026 41,935,124.00 60,000,000.00 0.00 FY2027 2,071,960.00 25,932,590.25 0.00 FY2028 0.00 0.00 0.00 LEGAL Environmental Assessment (EA) Category Change in EA Category? No Page 5 The World Bank Benin Health System Enhancement Program (P172940) (P172940) ANNEX 1: RESULTS COUNTRY: Benin Benin Health System Enhancement Program (P172940) @#&OPS~Doctype~OPS^dynamics@pfrrestrannexpolicyandresult#doctemplate PDO Indicators by PDO Outcomes Quality Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year Revise Health facilities offering basic 27.42 Dec/2022 0.00 06-May-2024 0.00 06-May-2024 47.42 Dec/2026 emergency obstetric and neonatal care (BEmONC) (DLI1) (Percentage) DLI ReviseLong-Acting Contraceptive users 5.56 Dec/2022 6.88 06-May-2024 6.88 06-May-2024 8.20 Dec/2026 (DLI 2) (Percentage) DLI ReviseFull immunization coverage for 54.90 Dec/2022 49.56 06-May-2024 49.56 06-May-2024 61.90 Dec/2026 children between the ages of 12 to 23 months (DLI 3) (Percentage) DLI Revise Births attended by skilled health 90.50 Dec/2022 99.60 06-May-2024 99.60 06-May-2024 94.00 Dec/2026 personnel (DLI 6) (Percentage) DLI Revise Health facilities with no stock- 32.11 Dec/2022 0.00 06-May-2024 0.00 06-May-2024 50.00 Dec/2026 out of essential tracer drugs for maternal and child health in the last three (3) months (DLI 4) (Percentage) DLI Access Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year Page 6 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Revise Health facilities built and 0.00 Dec/2022 6 06-May-2024 6 05-May-2024 25.00 Dec/2026 equipped as further detailed in the POM (DLI7) (Number) DLI Emergency Preparedness and Response Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year ReviseOperationalization of the health No Dec/2022 Yes 06-May-2024 No 06-May-2024 Yes Dec/2026 sector quality assurance system (DLI 8) (Yes/No) DLI New A Regulatory Health Sector No Dec/2021 Yes 06-May-2024 Yes Dec/2022 Authority is established and operational as evidenced by the achievement of specific milestones detailed in the POM on or before December 31, 2022 (Yes/No) DLI New Adopted Patient Safety No Dec/2021 No 06-May-2024 Yes Dec/2024 Assessment Manual (DLI8.2) (Yes/No) DLI New Establishment of patient No Dec/2021 No 06-May-2024 Yes Dec/2025 safety assessment system (DLI 8.3) (Yes/No) DLI New Healthcare facilities that 0.00 Dec/2021 0 06-May-2024 174 Dec/2026 have completed a patient safety assessment verified by ARS (DLI8.4) (Number) DLI Intermediate Results Indicators by Results Areas Access and Quality Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year Page 7 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Revise Pregnant women who receive 47.00 Dec/2022 46.48 06-May-2024 46.48 06-May-2024 49.50 Dec/2026 four ante-natal care (ANC) consultations (Percentage) Revise Children cured from severe 85.00 Dec/2022 0.00 06-May-2024 0.00 06-May-2024 90.00 Dec/2026 acute malnutrition (Percentage) Revise People who have received 6,492,740 Dec/2022 0.00 06-May-2024 0 06-May-2024 8,568,618 Dec/2026 quality health, nutrition, and population services (Corporate Scorecard (CS), number) (Number) NewPeople who received 3,622,304 Dec/2022 0.00 06-May-2024 4,792,894 Dec/2026 quality health, nutrition and population services (women) (Number) Revise Clients satisfied with care 60.00 Dec/2022 0.00 06-May-2024 0.00 06-May-2024 80.00 Dec/2026 received (Percentage) Revise Grievances responded and/or 60.00 Dec/2022 0.00 06-May-2024 0.00 06-May-2024 80.00 Dec/2027 resolved within the stipulated service standards for response times (Percentage) NewNumber of children immunized 856,495 Dec/2022 0 06-May-2024 1,053,596 Dec/2026 (Number of people) CRI New Number of women and children 1,540,702 Dec/2022 0 06-May-2024 2,163,625 Dec/2026 who have received basic nutrition services (Number of people) CRI New Number of women receiving 455,007 Dec/2022 0 06-May-2024 549,772 Dec/2026 deliveries attended by skilled health personnel (Number of people) CRI Health System Capacity and Emergency Preparedness and Response Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year Page 8 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Revise Health facilities with at least one 72.38 Dec/2022 0.00 06-May-2024 0.00 06-May-2024 91.49 Dec/2026 qualified staff in the dispensary and maternity ward (Percentage) Revise Private health facilities, 38.00 Dec/2022 0.00 06-May-2024 0.00 06-May-2024 70.00 Dec/2026 including faith-based health facilities, with data fully integrated into DHIS2 (Percentage) Revise Health professionals trained in 134 Dec/2022 57 06-May-2024 57 06-May-2024 386 Dec/2026 epidemiology or laboratory in public health emergency surveillance, preparedness and response (DLI 5) (Number) DLI New Health facilities that submit 75 Dec/2022 0 06-May-2024 90 Dec/2026 weekly reports on epidemic potential diseases (EPDs) on time (Percentage) Disbursement Linked Indicators (DLI) Actual (Previous) Actual (Current) DLI Name Baseline End Target Result Date Result Date Revise 1 Proportion of Value 27.42 47.42 Targeted Health Facilities Offering Basic Emergency Obstetric and Newborn Care Allocated 0.00 06-May-2024 0.00 06-May-2024 (BEmONC) Services 0.00 3,600,000.00 (Percentage) Amount Total Allocation:14,400,000.00 Value 5.56 6.88 06-May-2024 6.88 06-May-2024 8.20 Page 9 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Revise 2 Proportion of Long- Acting Contraceptive Users Allocated (Percentage) 0.00 5,302,800.73 Amount Total Allocation:14,000,000.00 Revise3 Proportion of full Value 54.90 61.90 immunization coverage for children between the ages of 12 to 23 months 49.56 06-May-2024 49.56 06-May-2024 Allocated (Percentage) 0.00 5,714,285.71 Amount Total Allocation:20,000,000.00 Revise4 Proportion of Health Value 32.11 50 Facilities with no stock-out of Maternal and Child Health Tracer Drugs in the past Allocated 0.00 06-May-2024 0.00 06-May-2024 three (3) months 0.00 4,052,543.32 (Percentage) Amount Total Allocation:14,500,000.00 Revise5 Health professionals Value 134 386 trained in epidemiology or laboratory in public health emergency surveillance, Allocated 57 06-May-2024 57 06-May-2024 preparedness and response 0.00 6,615,000.00 (DLI 5) (Number) Amount Total Allocation:26,460,000.00 Revise 6 Proportion of births Value 90.50 94 attended by a Skilled Health Allocated 99.60 06-May-2024 99.60 06-May-2024 Professional (Percentage) 0.00 3,651,428.57 Amount Page 10 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Total Allocation:12,780,000.00 Revise 7 Health facilities built Value 0.00 25.00 and equipped (number) (DLI7) (Number) 6 06-May-2024 6 06-May-2024 Allocated Total 0.00 9,310,000.00 Amount Allocation:33,250,000.00 Revise 8 Operationalization of Value No Yes the Health Sector Quality Assurance System (Yes/No) No 06-May-2024 No 06-May-2024 Allocated Total 0.00 1,834,482.76 Amount Allocation:11,420,000.00 Revise 8.1 DLR 8.1: A Value No Yes Regulatory Health Sector Authority is established and operational as evidenced by the achievement of specific Yes 06-May-2024 Yes 06-May-2024 Allocated milestones detailed in 0.00 0.00 Amount the POM on or before December 31, 2022 (Yes/No) Total Allocation:3,790,000.00 New Adopted Patient Value No Yes Safety Assessment Manual (DLI8.2) Allocated No 06-May-2024 (Yes/No) 0.00 0.00 Total Amount Allocation:2,910,000.00 Value No No 06-May-2024 Yes Page 11 The World Bank Benin Health System Enhancement Program (P172940) (P172940) New Establishment of patient safety assessment system (DLI Allocated 0.00 0.00 8.3) (Yes/No) Amount Total Allocation:2,910,000.00 New Healthcare facilities Value 0.00 174 that have completed a patient safety assessment verified by 0 06-May-2024 Allocated ARS (DLI8.4) (Number) 0.00 1,834,482.76 Amount Total Allocation:5,600,000.00 Page 12 The World Bank Benin Health System Enhancement Program (P172940) (P172940) ANNEX 2: PROGRAM ACTION PLAN . @#&OPS~Doctype~OPS^dynamics@pfrrestrannexprogramactionplan#doctemplate PROGRAM ACTION PLAN PAP_CHANGE_TBL Action Description Source DLI# Responsibility Timing Completion Measurement Action Recruitment by the Technical NA Project Due Date Recruitment of: - The firm Ministry of Health of Coordination Unit in charge of the detailed the firm and working (PCU) design and supervision of group in support of the construction, works. rehabilitation, and 30-Nov-2022 extension works of the No change health infrastructures supported by the programme - The working group for the preparation of tender documents Development of the Technical NA Ministry of Due Date The Program's Procedure Procedure Manual Health (MOH), Manual is developed by ANSSO the ANSSP. The World 31-Dec-2022 Bank approves the No change Procedure Manual. 120 days after entry into force of the programme. Page 13 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Strengthening the Environmental NA UCP, Beninese Due Date Development of a Civic Program and Social Environment Engagement Plan and Environmental and Systems Agency (ABE) implementation of the Social Management civic engagement system. mechanism. No later than 15-Feb-2024 six (6) months after the No change date of entry into force of the program and its implementation throughout the life cycle of the program. Strengthening the Environmental NA PCU, Beninese Due Date An agreement between Program and Social Environmental ANSSP and Beninese Environmental and Systems Agency (ABE) 29-Jun-2025 Environmental Agency Revised Social Management (ABE) will be concluded by system. June 30, 2025. Strengthening the Environmental NA UCP, MS (CEGCC), Due Date Development and Program's and Social ABE, ANDF implementation of the Environmental and Systems Technical Manual for Social Management Environmental and Social System. 30-Jun-2024 Management of the No change Program. Preparation no later than three (3) months after the date of entry intro force of the program and Page 14 The World Bank Benin Health System Enhancement Program (P172940) (P172940) implementation throughout the life cycle Strengthening the Environmental NA UCP, MS, ABE, Recurrent Organization of training technical and and Social ANDF, DDS, sessions directly targeting institutional Systems DDCVDD the parties involved in the capacities of actors implementation of the and stakeholders project. Start of sessions Continuous No change in the first half of the year after the date of entry into force of the program. Refresher sessions throughout the life Capacity building Environmental NA UCP, MS (CEGCC) Due Date Appointment/recruitment (technical and and Social of four environmental institutional) of Systems specialists (2) and social actors and specialists (2), for the PCU stakeholders and within MOH (CEGCC) 30-Aug-2022 No change and within the MOH (Gender Environment Unit (1) and Climate Change (1) (CEGCC) at the start of implementation. Capacity building Environmental NA UCP, MC Recurrent Information and awareness (technical and and Social (CEGCC), ABE activities on environmental institutional) of Systems Continuous and social management will Revised be implemented in the first year and continue Page 15 The World Bank Benin Health System Enhancement Program (P172940) (P172940) actors and throughout the Program. stakeholders This includes information sessions, workshops, and media, with communication specialists involved. Strengthening the Environmental NA UCP, MS (CEGCC), Due Date Development and Program and Social DPHAB implementation of a Environmental and Systems guide for the Social Management development of waste System. management plans (biomedical waste). No 30-May-2024 later than 90 days after No change the date of entry into force of the program. (Biomedical and other waste). NB: waste produced in health facilities Strengthening the Environmental NA PCU, MOH Due Date Two annual internal audit Program's and Social (CEGCC), DPHAB missions will be conducted: Environmental and Systems for first semester by Social Management internal auditors of system. 29-May-2024 implementing structures, Revised with reports compiled by ANSSP's internal auditor. For second semester by IGM, based on reports from all implementing structures Page 16 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Report on and Fiduciary NA MOH Recurrent Two internal audit missions investigate fraud and Systems will be conducted: Semester corruption 1 by internal auditors of implementing structures, Semi-Annually with reports compiled by Revised ANSSP's internal auditor. Semester 2 by IGM, based on reports from all implementing structures. Implement the 2020 Fiduciary NA MS/SOBAPS Due Date - SOBAPS procurement Public Procurement Systems regulations are enacted Code so SOBAPS by decree (see CCJ) operates with 30-Sep-2022 No change appropriate procurement regulations. Procurement of Fiduciary NA Ministry of Recurrent Update the standard works Systems Health plans for the construction Continuous No change of health infrastructure (see DG AISEM) Management of Fiduciary NA Ministry of Due Date Works contract works contracts Systems Health management manual. Establishment of a 30-Nov-2022 contract performance No change management plan, definition of roles and responsibilities of Page 17 The World Bank Benin Health System Enhancement Program (P172940) (P172940) stakeholders. A first manual is needed and thereafter it must be continuously updated. Budget planning Fiduciary NA Ministry of Recurrent Transmission of the draft Systems Health budget N + 1 budget and the DPPD N + 1 DPPD (Multi Annual expenditure Programming Document) Yearly No change to IDA for technical opinion before 30/09/N (share with the Bank the draft budget each year, at the latest on 30 September. Cash Management Fiduciary NA MOH/MEF Recurrent Transmission of the Systems quarterly statement of payment arrears on the 60 days program at the end of each quarter. Quarterly No change (DPAF/DAF will have to issue the instances of payment of benefits. Clarify the situation with the Treasury. Page 18 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Conduct Internal Fiduciary NA MoH/ MEF Recurrent Conduct two internal Audits Systems audit missions of the Program per year by the IGF and the IGM with transmission of reports to Semi-Annually IDA 60 days after the end No change of the semester. Compilation of the reports of the different missions in one semester: IGM/IGF. Transmission of Fiduciary NA MOH Recurrent Transmission of the external audit reports Systems external audit report nine Yearly (9) months after the end No change of each budgetary year (i.e. 30 September). Recruitment of Fiduciary NA MOH/SAI Due Date Recruitment of an independent external Systems independent external auditor auditor within six (6) months of entry into 28-Jan-2022 No change force to conduct an annual audit of the Program. (Legal Commitment) Proposed Page 19 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Action Description Source DLI# Responsibility Timing Completion Measurement Strengthening the Environmental and NA PCU, Beninese Due Date 29-Jun-2025 An agreement between ANSSP Program Social Systems Environmental Agency and Beninese Environmental Environmental and (ABE) Agency (ABE) will be Social Management concluded by June 30, 2025. system. Capacity building Environmental and NA UCP, MC (CEGCC), ABE Recurrent Continuous Information and awareness (technical and Social Systems activities on environmental institutional) of actors and social management will and stakeholders be implemented in the first year and continue throughout the Program. This includes information sessions, workshops, and media, with communication specialists involved. Strengthening the Environmental and NA PCU, MOH (CEGCC), Due Date 29-May-2024 Two annual internal audit missions Program's Social Systems DPHAB will be conducted: for first Environmental and semester by internal auditors Social Management of implementing structures, system. with reports compiled by ANSSP's internal auditor. For second semester by IGM, based on reports from all implementing structures Page 20 The World Bank Benin Health System Enhancement Program (P172940) (P172940) Report on and Fiduciary Systems NA MOH Recurrent Semi-Annually Two internal audit missions will be investigate fraud and conducted: Semester 1 by corruption internal auditors of implementing structures, with reports compiled by ANSSP's internal auditor. Semester 2 by IGM, based on reports from all implementing structures. . . . Page 21