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The World BankHealth Service Delivery & System Support Project (P153064)

REPORT NO.: RES35996

RESTRUCTURING PAPER

ON A

PROPOSED PROJECT RESTRUCTURING

OF

HEALTH SERVICE DELIVERY & SYSTEM SUPPORT PROJECT

APPROVED ON JUNE 23, 2016

TO THE

REPUBLIC OF SIERRA LEONE

HEALTH, NUTRITION & POPULATION

AFRICA

Regional Vice President: Hafez M. H. Ghanem Country Director: Henry G. R. Kerali

Senior Global Practice Director: Timothy Grant EvansPractice Manager/Manager: Gaston Sorgho

Task Team Leader: Shiyong Wang

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ABBREVIATIONS AND ACRONYMS

BEmONC Basic Emergency Obstetric and Newborn Care

CBE Competency-Based Education

CD Country Director

CEmONC Comprehensive Emergency Obstetric and Newborn Care

CHC Community Health Center

CHW Community Health Worker

CMO Chief Medical Officer

CPD Continuous Professional Development

CUAMM Doctors with Africa, CUAMM

DHMT District Health Management Team

DPPI

EERP

Directorate of Policy, Planning and Information

Ebola Emergency Response Project

ESICOME Expanded Sanitary Inspection Compliance Monitoring and Enforcement

EHO Environmental Health Officer

GFF

GPS

Global Financing Facility

Global Positioning System

GRM Grievance Redress Mechanism

HIV Human Immunodeficiency Virus

HMIS

HNP

Health Management Information Systems

Health, Nutrition and Population

HSDSSP Health Service Delivery and Systems Support Project

iCCM Integrated Community Care Management

IDA International Development Association


IHPAU Integrated Health Project Administration Unit

IP Implementation Progress

LQAS Lot Quality Assurance Sampling

MDCT

MEAL

Multi-Disciplinary Clinical Team

Monitoring, Evaluation, Accountability and Learning Specialist

MoHS Ministry of Health and Sanitation

M&E Monitoring and Evaluation

MSG Mothers Support Group

MTR Mid-Term Review

MUAC Mid-Upper Arm Circumference

NCD Non-Communicable Disease

nEMS National Emergency Medical Service

NGO Non-Governmental Organization

PBF Performance Based Financing

PDO Project Development Objective

PHA Public Health Aide

PHI Public Health Inspector

PHU Peripheral Health Unit

PSC Project Steering Committee

RMNCAH Reproductive, Maternal, Neonatal, Child and Adolescent Health

RRI

SARA

Rapid Result Initiative

Service Availability and Readiness Assessment

SCS School of Clinical Sciences

SDI Service Delivery Indicators


SLA Service Level Agreement

TB Tuberculosis

TF Trust Fund

TT Tetanus Toxoid


Note to Task Teams: The following sections are system generated and can only be edited online in the Portal.

BASIC DATA

Product Information

Project ID Financing Instrument

P153064 Investment Project Financing

Original EA Category Current EA Category

Partial Assessment (B) Partial Assessment (B)

Approval Date Current Closing Date

23-Jun-2016 30-Sep-2019

Organizations

Borrower Responsible Agency

Ministry of Finance Ministry of Health and Sanitation

Project Development Objective (PDO)

Original PDOThe project development objective (PDO) of the Health Service Delivery and System Support Project is to (a) increase the utilization and improve the quality of essential maternal and child health services; and (b) in the event of an Eligible Crisis or Emergency, to provide immediate and effective response to said Eligible Crisis or Emergency.

Current PDOThe project development objective (PDO) of the Health Service Delivery and System Support Project is to (a) increase the utilization and improve the quality of essential maternal and child health services; and (b) in the event of an Eligible Crisis or Emergency, to provide immediate and effective response to said Eligible Crisis or Emergency.OPS_TABLE_PDO_CURRENTPDOSummary Status of Financing

Ln/Cr/Tf Approval Signing Effectiveness ClosingNet

Commitment Disbursed Undisbursed

IDA-58460 23-Jun-2016 04-Aug-2016 02-Nov-2016 30-Sep-2019 10.00 2.96 6.99


TF-A2598 23-Jun-2016 04-Aug-2016 02-Nov-2016 30-Jun-2018 5.50 5.06 .44

Policy Waiver(s)

Does this restructuring trigger the need for any policy waiver(s)?No

Note to Task Teams: End of system generated content, document is editable from here.

I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURINGA. Project Status

1. The Project was approved on June 23, 2016 and became effective on November 2, 2016 with a closing date of September 30, 2019. The Project was designed (a) to increase the utilization and improve the quality of essential maternal and child health services; and (b) in the event of an Eligible Crisis or Emergency, to provide immediate and effective response to said Eligible Crisis or Emergency. It is supported with two sources of funding: 10 million USD from a credit (IDA 58460-SL) and 5.5 million USD from a grant (TF0A2598) from the Ebola Recovery and Reconstruction Trust Fund. The completion date for the grant was June 30, 2018. The proposed restructuring is for the credit (IDA 58460) and the Grant (TF0A2598). A total of 2.89 million USD had been disbursed under IDA 58460-SL and 5.06 million USD under TF0A2598 by March 18, 2019.

2. Progress towards achievement of the PDO has been rated Moderately Satisfactory (MS). The overall implementation progress (IP) was rated Moderately Satisfactory (MS) in the latest Implementation Status and Result Report (ISR). Three out of five targets at the PDO level have been surpassed by the end of the second quarter, 2018. Good progress has been achieved for the remaining two as well. However, the project implementation progress has been slow. The Mid-Term Review (MTR) mission in June-July 2018 identified bottlenecks and built consensus with the government partners on the way forward. As a result, the project implementation has been significantly accelerated and the disbursement under the Project has picked up the momentum, increasing from 6 percent in December 2017 to 46.5 percent as of November 2018 (92% for TF and 20% for IDA). However, procurement management remains a challenge and causes significant delays while the recruitment of project specialists is underway. The project has only less than one year for implementation. The following results have been observed:

2.1. Component 1: Health Service Delivery a. Community Health Worker (CHW) Program: Training of all the CHWs in Kailahun (1,100) and Koinagudu districts

(1,208) has been completed. Patients have been referred or treated by CHWs as the Integrated Community Care Management (iCCM). 71 percent of CHWs in Kailahun and 54 percent of CHWs in Koinadugu districts have been paid through mobile money, based on their performance. The internationally competitive procurement for technical assistance on the CHW Program is underway.


b. The National Emergency Medical Services (nEMS): The nEMS has been launched in Western Area (Freetown), Pujehun and Koinagudu districts, following refresher training for 450 paramedics and 450 drivers. The implementing agency, Collegio Universitario Aspiranti Medici Missionari (CUAMM), has been contracted for nEMS management for the coming two years with gradual transition to and capacity building for the government. All the ambulances have been checked and GPS equipment installed. The national nEMS call-in number and the designated number for hospitals for ambulance service have been created. The preparation for the launching and training for paramedics and drivers are ongoing in Bo, Kenema, Bombali and Port Loko districts.

c. Environmental Health and Sanitation Program: The assessment of healthcare waste management facilities and practices at 40 health facilities has been conducted and the report has been produced. The concept note of the National Healthcare Waste Management Plan was developed. 57 staff including waste handlers, hospital secretaries, maintenance technicians and Environmental Health Officers (EHOs), from 22 health facilities, have been trained in medical waste management and segregation. As a result, waste is now being segregated at George Brook Community Health Center (CHC), without any open burning at Macaulay Street Government Hospital. Twenty-three sub-committees on healthcare waste management have been established in health facilities. The roles of EHOs and established committees have been harmonized to ensure that the committees are functional at the health facility level. The Environmental Sanitation Policy and Strategy has been drafted and comments at the validation workshop are being incorporated for finalization. The refresher training for 276 Public Health Aides (PHAs) and Public Health Inspectors (PHIs) was conducted.

d. Nutrition Program: The project orientation has been conducted among stakeholders from different Directorates at the national level as well as in Kailahun district. The design of an impact evaluation has been developed, stratifying treatment and control groups. The weekly meetings among the Directorate of Food and Nutrition, the CHW Hub, Directorate of Policy, Planning and Information (DPPI) and UNICEF are ongoing as a steering committee.

2.2. Component 2: Health Systems Supporta. Human Resource Development: The Auxiliary Health Worker Training at the School of Clinical Sciences (SCS) in

Makeni has been progressing well. Sixty two out of 92 students enrolled in the School have completed the pre-admission course and entered into the formal medical training. The second cohort of 77 trainees have enrolled for their first year; Ninety-nine midwives completed their training and 80 of them graduated in midwifery; Ninety one foreign health professionals have been deployed to a majority of districts and all regional government hospitals since the project effectiveness.

b. Service Delivery Indicator (SDI) Survey: The data collection has been completed. SDI 2018 preliminary findings include, but not limited to, (i) high absenteeism among health workers; (ii) low capacity in establishing correct diagnosis; (iii) low compliance in clinical management guidelines, and (iv) very few facilities met the requirements for basic emergency obstetric and neonatal care. The study provided useful information on how to strengthen the health systems in the country.

c. Performance-Based Financing (PBF): The PBF design for health services in selected district has been completed. Some of the CHCs and hospitals have been identified as Hubs to be the recipients of the PBF incentives.

d. Key Directorates in Ministry of Health and Sanitation (MoHS) have been supported for their operations. e. The Service Level Agreement (SLA): The SLA database has been created using the Kobo toolbox, which contain

facilities to collect data using mobile phones, and a web browser. Sixty-eight implementing partners have been registered with the MoHS in 2018 before any of their start-ups.


B. Rationale for Restructuring

3. Although the PDOs and design of components remain pertinent to the needs of the population in Sierra Leone, better targeting and focusing on achieving results, such as quality of services, improvement in health outcomes are needed under the Project. 3.1. There are newly emerging demands: The new leadership in MoHS was on board in April, 2018. The MoHS articulated

that: (a) supply of basic equipment to peripheral health units (PHUs) in rural areas where majority of the population reside; (b) incentivizing and retaining health workers in rural and remote settings and (c) improving quality of health services are of its priorities. These priorities correspond to the challenges highlighted in the preliminary findings from the SDI 2018, which include poor efficiency and poor quality of the health services in the country.

3.2. There is a need for focusing more on attributable results under the Project: The Project’s current design is largely focusing on input and process, rather than output and outcome. Besides, with limited funds available under the Project, it would make sense for the project to: (a) target a selected number of districts that are most in need for the improvement of essential reproductive, maternal, neonatal, child, adolescent health and nutritional interventions, where the best possible convergence could be expected; (b) invest in most cost effective interventions; and (c) pilot incentive mechanisms to retain health workers at frontline and encourage them for better performance.

3.3. The project implementation arrangements need to be adjusted and strengthened: The Project has been suffering from serious implementation challenges: (a) the structure of the Integrated Health Project Administration Unit (IHPAU) has been dysfunctional, particularly in procurement management since resignation of the ex-international procurement specialist; (b) there is lack of proper financing mechanisms to encourage focusing on results and allow disruptive innovations to be implemented under the Project; (c) there are some cumbersome review and approval processes within the MoHS that have been imposed upon the Project, yet, that are not supported by the Project’s Financing Agreement. Such practice further delayed procurement and disbursement under the Project; (d) the responsible Directorates of the MoHS have competing priorities and delayed the preparation and communication on needed concept notes, terms of reference, technical specifications for goods to be procured, etc.; mechanisms need to be designed to enable technical directorates and districts for project implementation; (e) the project monitoring and evaluation (M&E) function has been weak in design and implementation. The M&E system has not provided valuable data to measure the Project’s attributable contributions or inform any necessary adjustments.

3.4. Disbursement conditions need to be updated: Since the closing date for the Ebola Emergency Response Project (EERP) has been extended till March 2021, there is no longer urgency to prioritize spending under the EERP over the HSDSSP. On the contrary, it is imperative to expedite implementation of the HSDSSP before its closing date.

3.5. Project implementation needs more time. The originally estimation of the duration for the project implementation was not realistic. The Country has the lowest number of health workers per 100,000 population over the years. The small health workforce was further devastated during the EVD outbreak in 2014 and 2015. The low capacity means slow project implementation compared to other countries with a higher level of health workforce. The planned new refurbishment of health facilities could only be done during the dry season between December and next May each


year. The presidential election during the project implementation and the follow up change of the government caused some delays as well.

3.6. The need for retroactive extension of the Grant Closing Date. There are about 440 thousand USD saved under the Grant. The Government of Sierra Leone proposed to make full use of this amount for the field works under the new round of Demography and Health Survey (DHS). Such an internationally standardized survey takes place every 5 years, for measuring representatively the population health outcomes that is a reflection on whether the national health strategy in the previous years has been effective and the investment in the health sector, including the project, has achieved its intended results or not. It is a planned activity under the Project, is underway and will be completed by March 31, 2019.

II. DESCRIPTION OF PROPOSED CHANGES

A. Summary of Proposed Changes4. A Level 2 restructuring aims to amend the Financing Agreement (5846-SL) in the following aspects: for (i) streamlining and

strengthening the implementation arrangement for the project monitoring and evaluation; (ii) amending the disbursement categories, reallocation amount of funds across disbursement categories as well as expenditure percentage; (iii) revision of withdrawal conditions; (iv) adding new activities corresponding to the priorities set by the new Government and (v) extending the project completion date from September 30, 2019 to June 30, 2021.

5. A level 2 restructuring aims to amend the Grant Agreement (TF0A2598) in the following aspects: for (i) retroactive extension of the Grant Closing Date and (ii) reallocation amount of funds across disbursement categories.

6. The project results framework will be revised.

B. Amendment of the Grant Agreement7. The Grant Closing date will be retroactively extended from June 30, 2018 to March 31, 2019.8. For categories (2), (5) and (8): Lock the disbursed amounts and reallocate the respective undisbursed amounts of

126,337, 67,506 & 247,001 under those Categories to Category (10)”. 9. For Category (10): Change the expenditure percentage from “0” to “100”.

The detailed reallocation proposal is documented in Annex 2.

C. Amendment of the Financing Agreement10. The Project completion date will be extended from September 30, 2019 to June 30, 2021.

11. One change made for the implementation arrangements11.1.The Schedule 2, Section I, A (5) will be revised to add the following: “The Directorate of Policy, Planning and Information

(DPPI) of the MoHS shall be responsible for the development of operational M&E guidelines, facilitating data collection and analysis needed for monitoring and evaluation of the Project. The project monitoring, evaluation, accountability and learning specialist (MEALS) will be stationed at the M&E Unit of the DPPI.”


12. Changes proposed to the withdrawal schedule:12.1.For Category (1): Lock the disbursed amount and reallocate the undisbursed balance to the new created Category (13).12.2. For category (2): change the financing percentage from 0% until the trust fund (TF0A2598) fully disbursed, 100%

thereafter to become 100%.12.3.For categories (3), (5), (6), (7), (8), (9), (10) and (11): lock the disbursed amount and reallocate the undisbursed

amounts under those categories to the new created category (13)”. 12.4.For category (4): delete the category entirely as is to be now covered under category 13 for parts A 2 (1.a & 1.b). 12.5.Create a new category (13) described as “(13) Goods, works, consulting services, non-consulting services, training,

operating costs, incentives to eligible community health workers, and stipends for eligible post-graduate medical students and eligible trainee nurses under Part A.1 (1), A.2 (1.a), (1.b), (1.c), A.2 (2), Part B.1 (1.c), B.1 (1.d), B.2 (1) and Part B.3 except Part A.1 (1.b) and Part B.2 (1.b), B.2 (1.c) of the Project,” to which allocate an amount of “3,723,965” SDR from the reallocations mentioned above with 100%.

The detailed reallocation proposal is documented in Annex 1.

13. Changes made in withdrawal conditions13.1.The one in Schedule 2, Section 4, B.1 (a) is revised as “No withdrawal shall be made for payments made prior to the

date of this Agreement except that withdrawals up to an aggregate amount not to exceed SDR 1,420,000 may be made for payments made prior to this date but on or after April 5, 2016 for Eligible Expenditures under Category (1), (8), (10) and (11).”

13.2.The withdrawal condition in Schedule 2, Section 4, B.1 (b) is to be cancelled. 13.3.The withdrawal condition in Schedule 2, Section 4, B.1 (d) is to be cancelled since the activity in Schedule 1, Part B.1.1

(b) of the Project is canceled (see below).

14. Revision of project activities corresponding to the priorities set by the Government14.1.The following activities are to be add:

Under Schedule 1, Part A.1.1, add activity (f) defined as “supporting community based nutritional interventions for pregnant and lactating women and children under five.”

Under Schedule 1, Part A.2.1, add activity (c) defined as “providing essential supplies, equipment, infrastructure, and operating costs for implementing performance-based financing (PBF) and rapid result initiative (RRI) for essential health services in the selected districts.”

Under Schedule 1, Part B.2.1, add activity (d) defined as “supporting evidence generation and policy dialogues on prevention and control of non-communicable diseases and increase tobacco tax.”

Under Schedule 1, Part B.2.1, add activity (e) defined as “supporting evidence generation and policy dialogues on reduction of teenage pregnancy and gender-based violence.”

14.2.The following activities are to be cancelled: Under Schedule 1, delete Part A.1.2 and the original activities (a), (b), (c), (d), (e) and (f). Under Schedule 1, delete Part A.2.2. and the original activities (a), (b) and (c). Under Schedule 1, Part B.1.1, the activity (a) and (b) to be deleted.


D. Revision of the Results Framework15. A quality indicator will be added at the PDO level. The intermediate indicators have been revised as well. For the details,

please refer to Annex 3 and 4. 15.1.The new PDO indicators include the following:

Percentage of pregnant women attended 4 or more times by skilled health personnel Percentage of births attended by skilled health personnel (doctors, midwives, nurses and MCH Aides) Percentage of children (0–11 months) fully vaccinated Average Score of Health Facility Quality of Care1

15.2.The intermediary indicators include the following:Part A or Component 1: Health Service Delivery Percentage of hard-to-reach communities with at least one active CHW present Percentage of inspected households with improved sanitation facilities Percentage of pregnant women receiving Tetanus Toxoid (TT) 2 or more times Percentage of health facilities that comply with medical waste management guidelines Number of outpatient visits per 10,000 population People who have received essential health, nutrition and population (HNP) services

Part B or Component 2: Health System Support Number of graduates for midwifery Percentage of routine/HMIS reporting units submitting timely and complete reports according to national

guidelines Percentage of maternal deaths reviewed among suspected maternal deaths Percentage of SLA applications approved (or recommended for resubmission) within 6 weeks from the date of

submission

Part C or Component 3: Contingency Emergency Response Percentage of public health emergencies responded to within a week's time and with good quality

Note to Task Teams: The following sections are system generated and can only be edited online in the Portal.

1 The composite score comprises the following components: (a) average score of diagnostic accuracy and correct treatment for 1, Severe dehydration; 2, Pneumonia; 3, Diabetes mellitus type2; 4, Malaria and anemia and 5, Neonatal Asphyxia; (b) adherence to clinical guidelines; (c) availability of Standard Treatment Guidelines; (d) management of maternal and neonatal complications by all cadre; and (e) availability of all priority drugs.


III. SUMMARY OF CHANGES

Changed Not Changed

Results Framework ✔

Components and Cost ✔

Loan Closing Date(s) ✔

Reallocation between Disbursement Categories ✔

Disbursement Estimates ✔

Legal Covenants ✔

Institutional Arrangements ✔

Implementing Agency ✔

DDO Status ✔

Project's Development Objectives ✔

Cancellations Proposed ✔

Disbursements Arrangements ✔

Overall Risk Rating ✔

Safeguard Policies Triggered ✔

EA category ✔

Financial Management ✔

Procurement ✔

Implementation Schedule ✔

Other Change(s) ✔


Economic and Financial Analysis ✔

Technical Analysis ✔

Social Analysis ✔

Environmental Analysis ✔

IV. DETAILED CHANGE(S)

OPS_DETAILEDCHANGES_COMPONENTS_TABLE

COMPONENTS

Current Component Name

Current Cost

(US$M)Action Proposed

Component NameProposed

Cost (US$M)

Health Service Delivery 11.10 Revised Health Service Delivery 12.40

Health System Support 4.40 Revised Health System Support 3.10

Contingency Emergency Response 0.00 No Change Contingency Emergency

Response 0.00

TOTAL 15.50 15.50

OPS_DETAILEDCHANGES_LOANCLOSING_TABLE

LOAN CLOSING DATE(S)

Ln/Cr/Tf StatusOriginal Closing

Revised Closing(s)

Proposed Closing

Proposed Deadline for Withdrawal

Applications

IDA-58460 Effective 30-Sep-2019 30-Jun-2021 30-Oct-2021

TF-A2598 Closed 30-Sep-2019 30-Jun-2018


OPS_DETAILEDCHANGES_REALLOCATION _TABLE

REALLOCATION BETWEEN DISBURSEMENT CATEGORIES

Current Allocation Actuals + Committed Proposed Allocation Financing %(Type Total)

Current Proposed

IDA-58460-001 | Currency: XDR

iLap Category Sequence No: 1 Current Expenditure Category: GD,WK,CS,NCS,TRG,OC Part A and Part B except Part A.1 (1.b)

2,130,000.00 22,863.04 3,746,827.91 100.00 100.00

iLap Category Sequence No: 10 Current Expenditure Category: GD,WK,CS,NCS,TRg,OC B2 (1b)(1c)

852,000.00 625,204.60 625,204.60 100.00 100.00

iLap Category Sequence No: 11 Current Expenditure Category: GD,WK,CS,NCS,TRg,OC B3

142,000.00 18,755.77 18,755.77 100.00 100.00

iLap Category Sequence No: 12 Current Expenditure Category: GD,WK,CS,NCS,TRg,OC Part C

0.00 0.00 0.00 0.00 0.00

iLap Category Sequence No: 2 Current Expenditure Category: Inc. pay for eligib. Com heal A1(1b

2,343,000.00 0.00 2,343,000.00 100.00 100.00


iLap Category Sequence No: 3 Current Expenditure Category: GD,WK,CS,NCS,TRG,OC A.1(2)

355,000.00 0.00 0.00 100.00 0

iLap Category Sequence No: 4 Current Expenditure Category: GD,WK,CS,NCS,TRG,OC A.2(1a),(1b)

0.00 0.00 0.00 0.00 0.00

iLap Category Sequence No: 5 Current Expenditure Category: GD,WK,CS,NCS,TRG,OC A.2(2a),2b,2c

355,000.00 0.00 0.00 100.00 0

iLap Category Sequence No: 6 Current Expenditure Category: GD,WK,CS,NCS,TRg,OC B.1(1a), (1d)

142,000.00 0.00 0.00 100.00 0

iLap Category Sequence No: 7 Current Expenditure Category: Stip.elig post grad Med Stu B1(1b)

142,000.00 0.00 0.00 100.00 0

iLap Category Sequence No: 8 Current Expenditure Category: GD,WK,CS,NCS,TRg,OCB1(1c)

497,000.00 366,211.72 366,211.72 100.00 100.00

iLap Category Sequence No: 9 Current Expenditure Category: GD,WK,CS,NCS,TRg,OC B2 (1a)

142,000.00 0.00 0.00 100.00 100.00


Total 7,100,000.00 1,033,035.13 7,100,000.00

OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE

DISBURSEMENT ESTIMATES

Change in Disbursement EstimatesYes

Year Current Proposed

2017 500,000.00 500,000.00

2018 8,000,000.00 8,000,000.00

2019 5,000,000.00 4,000,000.00

2020 2,000,000.00 2,000,000.00

2021 0.00 1,000,000.00

OPS_DETAILEDCHANGES_LEGCOV_TABLE

LEGAL COVENANTS

Loan/Credit/TF Description Status Action

IDA-58460

The one in Schedule 2, Section 4, B.1 (a) is revised as “No withdrawal shall be made for payments made prior to the date of this Agreement except that withdrawals up to an aggregate amount not to exceed SDR 1,420,000 may be made for payments made prior to this date but on or after April 5, 2016 for Eligible Expenditures under Category (1), (8), 10, and (11).”

Not yet due New


IDA-58460 The condition in Schedule 2, Section 4, B.1 (b) is cancelled Not yet due New

IDA-58460 The condition in Schedule 2, Section 4, B.1 (d) is cancelled Not yet due New

.

.Results framework

COUNTRY: Sierra LeoneHealth Service Delivery & System Support Project

Project Development Objectives(s)

The project development objective (PDO) of the Health Service Delivery and System Support Project is to (a) increase the utilization and improve the quality of essential maternal and child health services; and (b) in the event of an Eligible Crisis or Emergency, to provide immediate and effective response to said Eligible Crisis or Emergency.

Project Development Objective Indicators by Objectives/ OutcomesRESULT_FRAME_TBL_PDO

Indicator Name DLI Baseline Intermediate Targets End Target

1 2 3

to increase the utilization and improve the quality of essential maternal and child health services

Percentage of pregnant women attended 4 or more times by skilled health personnel (Percentage)

78.90 83.00 86.00 89.00 91.00

Action: This indicator has been Revised


RESULT_FRAME_TBL_PDO


1 2 3

percentage of maternal deaths reviewed, among suspected maternal deaths (Percentage)

0.00 60.00

Action: This indicator has been Marked for Deletion

Percentage of births attended by skilled health personnel (doctors, midwives, nurses and MCH Assistants) (Percentage)

72.40 76.00 79.00 81.00 83.00


Percentage of pregnant women receiving Tetanus Toxoid (TT) 2 or more times (Percentage)

89.30 92.00 94.00 95.00 96.00


percentage of routine HMIS reporting units submitting complete reports according to national guidelines (Percentage)

75.00 80.00


percentage of routine HMIS reporting units submitting timely reports according to national guidelines (Percentage)

75.00 80.00




1 2 3


Child 0-23 months fully immunized for age with all the recommended vaccines (BCG, OPV 0-3, Penta 1-3, PCV 1-3, Rota 1-2, MCV1, YF & MCV2) (Percentage)

49.00 55.00 60.00 60.00


Direct project beneficiaries (Number) 6,190,280.00 6,327,301.00 6,467,355.00 6,610,508.00 6,756,831.00


percentage of hard to reach communities with at least one active CHW present (Percentage)

37.00 45.00


percentage of households safely storing adn handling drinking water (inspected) (Percentage)

4.50 10.00


number of outpatient visits per 10,000 population (Number) 5,709.00 6,000.00




1 2 3


Average Health Facility Quality of Care Score (Percentage) 0.00 36.50 40.00

Action: This indicator is New

Rationale:

The recent evidence from SDI and other data source confirmed the poor quality of health services while the coverage of services kept increasing. The maternal mortality ratio (MMR) and other health outcomes have been improved as expected when compared with these indicators in neighboring countries and the countries with the similar income.

There was no measurement of service quality under the Project.

to provide immediate and effective response to said Eligible Crisis or Emergency.

Percentage of public health emergencies responded within a week's time and with good quality (Percentage)

50.00 85.00


PDO Table SPACE

Intermediate Results Indicators by ComponentsRESULT_FRAME_TBL_IO


1 2 3

Component 1: Health service delivery


RESULT_FRAME_TBL_IO


1 2 3

Percentage of hard-to-reach communities with at least one active CHW present (Percentage)

37.00 90.00 90.00


Rationale:

Availability of CHW at the hard to reach communities will improve access to health services.

Percentage of households safely storing & handling drinking water (inspected population) (Percentage)

4.30 10.00 15.00 20.00 30.00


Number of outpatient visits per 10,000 population (Number) 5,709.00 6,000.00 6,300.00 6,950.00


Percentage of CHWs rated as "good performer" by their community (Percentage)

0.00 0.00 50.00 70.00 80.00


Percentage of health facilities that comply with medical waste management guidelines (Percentage)

0.00 80.00

Action: This indicator is New Rationale:


RESULT_FRAME_TBL_IO


1 2 3

Medical waste has been poorly managed at most all the health facilities. After the restructuring, the project intends to improve the solid medical waste management in 42 hospitals.

Percentage of pregnant women receiving Tetanus Toxoid (TT) 2 or more times (Percentage)

89.30 95.00 96.00


This indicator is not measuring the health outcome. It is an output indicator.

percentage of inspected households with improved sanitation facilities (Percentage)

15.00 30.00


People who have received essential health, nutrition, and population (HNP) services (CRI, Number)

0.00 6,467,355.00 6,610,508.00 8,046,931.00


to measure beneficiaries under the Project

People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (CRI, Number)

0.00 4,058,623.00


RESULT_FRAME_TBL_IO


1 2 3


Rationale:

measuring female beneficiaries.

Number of children immunized (CRI, Number) 0.00 251,355.00


Number of women and children who have received basic nutrition services (CRI, Number)

0.00 61,120.00


Number of deliveries attended by skilled health personnel (CRI, Number)

0.00 280,717.00


Rationale:

measuring beneficiaries.

Component 2: Health system support

Student Intakes: Clinical Specialization (including Surgery, Pediatrics, Internal Medicine, Obstetrics and Gynecology, Family Medicine (Number)

2.00 10.00 12.00 14.00 14.00


Student Intakes: Midwives (Number) 0.00 60.00 120.00 120.00 120.00


RESULT_FRAME_TBL_IO


1 2 3


Percentage of routine/HMIS reporting units submitting timely and complete reports according to national guidelines (Percentage)

75.00 80.00 85.00 90.00 97.40


Percentage of maternal deaths reviewed among suspected maternal deaths (Percentage)

0.00 60.00 70.00 80.00 90.00


Percentage of SLA applications approved (or recommended for resubmission) within 6 weeks from the date of submission (Percentage)

0.00 100.00


Number of graduates for midwifery (Number) 0.00 120.00


Measuring output for HRH supported by the Project

Contigency emergency response


RESULT_FRAME_TBL_IO


1 2 3

percentage of public health emergencies responded within a week's time adn with good quality (Percentage)

50.00 85.00

IO Table SPACE


Annex 1. Revision and Reallocation by Expenditure Category of Financing AgreementAmended as of October 2018 Proposed Amendment

Category

Amount of the Financing

Allocated (expressed in

SDR)

Percentage of Expenditures to

be Financed (inclusive of

Taxes)

Category

Amount of the Financing

Allocated (expressed in

SDR)

Percentage of Expenditures

to be Financed (inclusive of

Taxes)(1) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part A.1 (1) of the Project (except Part A.1 (1.b) of the Project)

2,130,000 100%

(1) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part A.1 (1) of the Project (except Part A.1 (1.b) of the Project) (Pro Memoria)

Lock the disbursed amount at 22,863 SDR

and reallocate the undisbursed to the new Category (13), then

cancel Category (1).

0

(2) Incentive Payments for Eligible Community Health Workers under Part A.1 (1.b) of the Project 2,343,000

0% disbursement until the trust

fund (TF0A2598) fully disbursed,

100% thereafter

(2) Incentive Payments for Eligible Community Health Workers under Part A.1 (1.b) of the Project 2,343,000 100%

(3) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part A.1 (2) of the Project

355,000 100%

(3) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part A.1 (2) of the Project (Pro Memoria)

0 0%


(4) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part A.2 (1.a) and (1.b) of the Project

0% 0 0%

(5) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part A.2 (2.a), (2.b) and (2.c) of the Project

355,000 100%

(5) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part A.2 (2.a), (2.b) and (2.c) of the Project (Pro Memoria)

0 0%

(6) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part B.1 (1.a) and (1.d) of the Project

142,000 100%

(6) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part B.1 (1.a) and (1.d) of the Project (Pro Memoria)

0 0%

(7) Stipends for Eligible Post-Graduate Medical Students and Eligible Trainee Nurses under Part B.1 (1.b) of the Project

142,000 100%

(7) Stipends for Eligible Post-Graduate Medical Students and Eligible Trainee Nurses under Part B.1 (1.b) of the Project (Pro Memoria)

0 0%

(8) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part B.1 (1.c) of the Project

497,000

0% disbursement until the trust

fund (TF0A2598) fully disbursed,

100% thereafter

(8) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part B.1 (1.c) of the Project (Pro Memoria)

Lock the disbursed amount at

366,212 SDR and

reallocate the undisbursed to the new Category (13), then

cancel Category (8).

30%


(9) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part B.2 (1.a) of the Project

142,000 100%

(9) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part B.2 (1.a) of the Project (Pro Memoria)

0 0%

(10) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part B.2 (1.b) and (1.c) of the Project

852,000 100%

(10) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part B.2 (1.b) and (1.c) of the Project (Pro Memoria)

Lock the disbursed amount at

625,205 SDR and

reallocate the undisbursed to the new Category (13), then

cancel Category (10)

100%

(11) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part B.3 of the Project

142,000 100%

(11) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part B.3 of the Project (Pro Memoria)

Lock the disbursed amount at 18,756 SDR

and reallocate the undisbursed to the new Category (13), then

cancel Category (11)

100%


(12) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part C of the Project

0%


0 100%

(13) Goods, works, consulting services, non-consulting services, training, operating costs, incentives to eligible community health workers, and stipends for eligible post-graduate medical students and eligible trainee nurses under Part A.1 (1) except A.1 (1.b), A.2 (1), Part B.1 (1.c), (1.d), B.2 (1.a), (1.d), (1.e), and Part B.3

3,723,965 100%

TOTAL AMOUNT 7,100,000 7,100,000

Annex 2. Revision and Reallocation by Expenditure Category of Grant Agreement

Amended as of October 2018 Proposed Amendment

Percentage of Expenditures to

be Financed

Percentage of Expenditures

to be FinancedCategory

Amount of the Grant Allocated

(expressed in USD)

(inclusive of Taxes)

Category

Amount of the Grant Allocated

(expressed in USD)

(inclusive of Taxes)

(1) Goods, works, consultant Services, non-consulting services, Training and Operating Costs under part A.1 (1) of the Project (except Part A.1 (1.b) of the Project

(1) Goods, works, consultant Services, non-consulting services, Training and Operating Costs under part A.1 (1) of the Project (except Part A.1 (1.b) of the Project

0%


(2) Incentive Payment for Eligible Community Health Workers under Part A.1 (1.b) of the Project

1,000,000 100%

(2) Incentive Payment for Eligible Community Health Workers under Part A.1 (1.b) of the Project (Pro Memoria)

873,663 100%



0%


0 0%


100%

(5) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part A.2 (2.a), (2.b) and (2.c) of the Project

3,000,000 100%

(5) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part A.2 (2.a), (2.b) and (2.c) of the Project (Pro Memoria)

2,932,494 100%



0%



0%

(8) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part B.1(1.c) of the Project

1,500,000 100%

(8) Goods, works, consultant services, non-consulting services, Training and Operating Costs under Part

1,252,999 100%


B.1(1.c) of the Project (Pro Memoria)



0%



440,844 100%



0%



0%

Total Amount 5,500,000 5,500,000


Annex 3. Revised Project IndicatorsPDO/INDICATOR PROPOSED CHANGES COMMENTS/RATIONALE

The PDO is to: (a) increase the utilization and improve the quality of essential maternal and child health services, and (b) in the event of eligible crisis and emergency, to provide immediate and effective response to the said eligible or emergency crisis.

No change The PDO is still relevant to country and sector context and situation.

PDO level indicatorsPDO indicator 1 - Percentage of pregnant women attended 4 or more times by skilled health personnel Re-defined Kept as utilization indicator.

PDO indicator 2 - Percentage of births attended by skilled health personnel (doctors, midwives, nurses and MCH Aides) Retained Kept as utilization indicator.

PDO indicator 3 - Percentage of pregnant women receiving Tetanus Toxoid (TT) 2 or more times

Move to intermediate outcome indicators section.

This is part of ANC which is captured in PDO indicator 1.

PDO indicator 4 - Percentage of children (0–11 months) fully vaccinated Re-defined Kept as utilization indicator.

PDO indicator 5 - Direct project beneficiaries (number), of which (a) female (percentage) and (b) located at more than 5 km from a PHU Dropped

Average Score of Health Facility Quality of Care* NewA composite Health Facility Quality Index on scale of 0-100 could be computed for all project health facilities and the average score reported.

Percentage of public health emergencies responded to within a week's time and with good quality New

Denominator: total number of public health emergencies reportedNumerator: number of public health emergencies responded in a timely manner and with good quality

Intermediate outcome level indicatorsComponent 1: Health Service Delivery Percentage of hard-to-reach communities with at least one active CHW present Retained

Percentage of households safely storing and handlingdrinking water (inspected population) Dropped

Percentage of inspected households with improved sanitation facilities New New indicator introduced to address household level

sanitation


PDO/INDICATOR PROPOSED CHANGES COMMENTS/RATIONALE

Percentage of health facilities that comply with medical waste management guidelines New

New indicator introduced to address compliance with medical waste management guidelines in health facilities

Number of outpatient visits per 10,000 population Retained Percentage of CHWs rated as ‘good performers’ by their community DroppedPeople who have received essential HNP servicesi) Number of female who have received essential HNP servicesii) Number of children immunizediii) Number of deliveries attended by skilled health personneliv) Number of women and children who have received basic

nutrition service

NewNew indicators introduced to comply with the requirements for the WB’s corporate results indicators

Component 2: Health System SupportStudent intakes:Clinical specialization (including Surgery, Pediatrics, Internal Medicine, Obstetrics and Gynecology, Family Medicine)Midwives

Dropped

Number of graduates for midwifery New New introduced to address shortage of midwivesPercentage of routine/HMIS reporting units submitting timely and complete reports according to national guidelines Retained

Percentage of maternal deaths reviewed among suspected maternal deaths Retained

Percentage of SLA applications approved (or recommended for resubmission) within 6 weeks fromthe date of submission.

Re-defined Denominator: Number of applications coming into SLA

Component 3: Contingency Emergency Response

Percentage of public health emergencies responded to within a week's time and with good quality New

Denominator: total number of public health emergencies reportedNumerator: number of public health emergencies responded in a timely manner and with good quality

*Average diagnostic accuracy and correct treatment for 1, Severe dehydration; 2, Pneumonia; 3, Diabetes mellitus type2; 4, Malaria and anemia and 5, Nenotal Asphyxia; Adherence to clinical guidelines; Availability of Standard Treatment Guidelines; Management of maternal and neonatal complications by all cadre; Availability of priority drugs - All priority drugs.


Annex 4. Revised Results FrameworkCumulative Target Values

Indicator Core Unit of MeasureBaseline 2017 2018 2020

PDO level indicatorsPercentage of pregnant women attended 4 or more times by skilled health personnel

Percentage 78.9 (2013) 86.0 89.0 91.0

Percentage of births attended by skilled health personnel (doctors, midwives, nurses and MCH Aides)

X Percentage 72.4 (2013) 79.0 81.0 83.0

Child 0-23 months fully immunized for age with all the recommended vaccines (BCG, OPV 0-3, Penta 1-3, PCV 1-3, Rota 1-2, MCV1, YF & MCV2)

X Percentage 49.0 (2016) 55.0 60.0 60.0

Average Health Facility Quality of Care Score* X Percentage 0.0 36.5 40.0 40.0

Percentage of public health emergencies responded to within a week's time and with good quality

Percentage 50.0 (2016) 85.0

Intermediate outcome level indicatorsComponent 1: Health Service DeliveryPercentage of pregnant women receiving Tetanus Toxoid (TT) 2 or more times

Percentage 89.3 (2013) 96.0

Percentage of hard-to-reach communities with at least one active CHW present

Percentage 37.0 (2015) 70.0 90.0

Percentage of inspected households with improved sanitation facilities Percentage 15.0 (2018) 30.0 30.0

Percentage of health facilities that comply with medical waste management guidelines

Percentage 0.0 (2018) 80.0

Number of outpatient visits per 10,000 population Number 5,709 (2013) 6,300 6,615 6,950


Cumulative Target ValuesIndicator Core Unit of Measure

Baseline 2017 2018 2020People who have received essential HNP services X Number 0 (2016) 6,467,355 6,610,508 8,046,931

i) People who have received essential HNP services Female X Number 0 (2016) 4,058,623

ii) Number of children immunized X Number 0 (2016) 251,355iii) Number of deliveries attended by

skilled health personnel X Number 0 (2016) 280,717

iv) Number of women and children who have received basic nutrition service

X Number 0 (2018) 61,120

Component 2: Health System SupportNumber of graduates for midwifery X Number 0.0 (2013) 120 120Percentage of routine/HMIS reporting units submitting timely and complete reports according to national guidelines

Percentage 75.0 (2015) 85.0 90.0 95.0

Percentage of maternal deaths reviewed among suspected maternal deaths

Percentage 0.0 (2013) 80.0 90.0

Percentage of registered health NGOs whose SLA applications were approved (or recommended for resubmission)

Percentage 0 (2013) 90.0

Component 3: Contingency Emergency ResponsePercentage of public health emergencies responded to within a week's time and with good quality

Percentage 50.0 (2016) 85.0

* Note: Quality of Care Score will be based on a composite Health Facility Quality Index covering domains of (1) common diseases (severe dehydration, pneumonia, diabetes mellitus type 2, malaria and anemia, and neonatal asphyxia), (2) adherence to clinical guidelines, (3) availability of standard treatment guidelines, (4) management of maternal and neonatal complications by all cadres, and (5) availability of priority drugs.


Annex 5. Action Plan for the Remaining Phase by component

BudgetCodes Component / Sub-component Responsible Persons HSDSSP program

Budget (US$) Component 1: Health Service Delivery Sub-component: CHW Program

Payment of incentives, Logistical support, and material support to CHWs and PS and PHU's in Charge DPHC 715,231.79

TA for CHW Program DPHC 370,000.00 Operationalization of CHW Program DPHC 370,000.00 sub-total 1,455,231.79 DPPI Total 1,455,231.79 Component 3: Medical Waste Management Provide sanitary tools to 40 healthcare facilities DEH 331,842.00

Collect and analyse Swabs from critical locations (Labour rooms and operating theatre) in 40 Healthcare facilities to ascertain compliance with national swab protocols DEH 33,920.00

Procurement of 5 incinerators to BEmONCs DEH 37,500.00 sub-total 403,262.00 ESICOME Total 403,262.00 Component 4: Nutrition Sub-component: Finalization of MSG Guidance Document among health and nutrition stakeholders including DHMTs DSA, 1-day, district-based staff Nutrition 250.00 Transport, return-trip, district-based staff Nutrition 175.00 Catering, 30 participants Nutrition 750.00 Hall rental, 1-day per meeting Nutrition 150.00 Stationery, 30 participants Nutrition 90.00 Communication Nutrition 5.00 Subtotal 1,420.00 Total of component 1,420.00 Component: Programme planning and orientation Sub-component: Quarterly district planning and review meetings DSA, 4 days, DHMT chiefdom-based staff Nutrition 6,720.00 Transport, return-trip, DHMT chiefdom-based staff Nutrition 210.00 Transport, return-trip, DHMT chiefdom-based staff from hard-to-reach areas Nutrition 480.00


Catering, 20 participants Nutrition 4,000.00 Fuel for district meeting area per day for each district Nutrition 800.00 Stationery, 20 participants Nutrition 240.00 Communication Nutrition 20.00 Subtotal 12,470.00 Component: Trainings and coordination meetings Sub-component: Cascade trainings on the package of community nutrition interventions including nutrition data collection, analysis and reporting in four phases starting with set of priority chiefdoms

DSA, 4 days, DHMT chiefdom-based staff Nutrition 2,887.88 PHU in-charges training, 1 day training, chiefdom-level Nutrition 1,249.55 Peer supervisor training, 3 days training, chiefdom-level Nutrition 1,619.20 CHW training, 2 days training, PHU-level Nutrition 16,191.96 MSG lead mother training, 2 days training, PHU-level Nutrition 6,315.00 Monthly 2-day supervision of trainings by MoHS in Kailahun Nutrition 4,326.36 Subtotal 32,589.95 Sub-component: Monthly meetings of peer supervisors, CHWs and lead mothers including short refresher sessions on nutrition Transport, return-trip to/from PHU Nutrition 14,400.00 Printing of job aids Nutrition 4,140.00 Subtotal 18,540.00 Sub-component: Monthly planning of activities and reporting of results between CHWs and MSGs Printing of forms Nutrition 10,800.00 Subtotal 10,800.00 Sub-component: Bi-weekly MSG meetings Printing of forms Nutrition 5,760.00 Livelihood package per MSG Nutrition 36,000.00 Feasibility study for local production of RUTF (NRI) Nutrition 89,422.00 Subtotal 131,182.00 Total of component 205,581.95 Component: Delivery of comprehensive package of community nutrition services Sub-component: Service delivery by CHWs Printing of referral forms and tally sheets Nutrition 3,600.00

Community baseline screening of malnutrition children under-five lasting 3 days in the chiefdoms (cost for personel per day, printing of tools, summary sheets, analysis) + data collection of pregnant women

Nutrition 18,657.22

Subtotal 22,257.22 Sub-component: Service delivery by MSGs


Printing of referral forms and tally sheets Nutrition 1,920.00 Subtotal 1,920.00 Sub-component: Quarterly community promotion campaigns on optimal IYCF, sanitation and hygiene practices

Technical assistance and support for the development and pre-testing of communication materials Nutrition 5,113.80

Daily airing of key radio messages nutrition, sanitation, hygiene and appropriate care seeking practices Nutrition 9,720.00

Subtotal 14,833.80 Total of component 39,011.02 Component: Supervision and monitoring Sub-component: Monthly supportive supervision and monitoring by peer supervisors of CHWs Printing of summary sheets and reporting forms Nutrition 540.00 Subtotal 540.00 Sub-component: Monthly supportive supervision and monitoring of peer supervisor, CHWs and MSGs activities by DHMT specifically zonal supervisors, District Nutritionists, and CHW focal point

Printing of summary sheets and reporting forms Nutrition 8,280.00 Monthly supervision by DHMT DMO and Nutritionist to chiefdoms Nutrition 5,455.63 Subtotal 13,735.63 Sub-component: Quarterly supportive supervision and monitoring of DHMT activities with random spot checks to implementation areas by MoHS (DFN, DPHC, DPPI), and UNICEF

DSA, 5-days quarterly Nutrition 4,000.00 Transport, return-trip Nutrition 560.00 Laptop Nutrition 5,395.94 Communication Nutrition 480.00 Subtotal 10,435.94 Total of component 24,711.57 Component: Data management and reporting Sub-component: Monthly reporting of activity results Communication 4,800.00 Timely reporting from DHMTs to MoHS

Nutrition2,571.85

Subtotal 7,371.85 Sub-component: Monthly HMIS data review, cleaning and analysis by DHMT No additional cost incurred Nutrition - Subtotal - Sub-component: Quarterly data presentation and discussions by DHMT (M&E officer, district nutritionist, CHW focal point) during PHU in-charges meeting


DSA, 1 day Nutrition 9,000.00 Transport, return-trip Nutrition 2,700.00 Communication Nutrition 20.00 Subtotal 11,720.00 Sub-component: End of programme review meeting to wider health and nutrition stakeholders DSA, 2-days (including before and after meeting) Nutrition 1,000.00 Transport, return-trip Nutrition 750.00 Catering, 30 participants Nutrition 750.00 Hall rental, 2-days per meeting Nutrition 300.00 Stationery, 30 participants Nutrition 90.00 Communication Nutrition 5.00 Endline impact evaluation Nutrition 35,000.00 Subtotal 37,895.00 Sub-component: Report writing and submission led by MoHS No additional cost incurred Nutrition - Subtotal - Total of component 56,986.85 Nutrition Total 327,711.39 Component 5: NCDs Sub-component: Develop a Non-Communicable Diseases (NCDs) policy, strategic and implementation plan

Organise national and district consultative meetings on the 2013-2017 Non-Communicable Diseases (NCD) policy, strategic and implementation plan NCDs 1,200.00

Review the 2013-2017 NCD policy, strategic and implementation plan NCDs 10,000.00 Draft the 2019-2023 NCD policy, strategic and implementation plan NCDs -

Conduct National Consultations to Review the zero draft of the 2019 -2023 NCD policy, strategic and implementation plan with Relevant Stakeholders NCDs 5,000.00

Conduct National Consultations to Review the first draft of the 2019 -2023 NCD policy, strategic and implementation plan NCDs 5,000.00

Organize a consultative meeting to validate the final draft NCD policy, strategic and implementation plan with relevant stakeholders NCDs 5,000.00

Printing of validated NCD, strategic and implementation plan NCDs 7,500.00 Printing of final NCD policy NCDs 2,250.00

Launching, dissemination and mobilization of resources for the implementation of the NCD policy, strategic and implementation plan NCDs 8,000.00

sub-total 43,950.00 Sub-component: Develop the Tobacco Bill (law enforcement for tobacco consumption)


Collaborate with the law officers department to develop a tobacco control bill NCDs 2,820.00 Organize a Multisectoral Consultation (or Public Consultations) Forum on the Bill NCDs 5,000.00

Organize a public awareness campaign on the importance of strong tobacco control laws nationwide (16 districts). NCDs 3,200.00

Organize an advocacy meeting for parliamentarians on the tobacco control bill provisions NCDs 10,000.00 sub-total 21,020.00 NCDs Total 64,970.00 Component 6: Medical trainingSub-component: SCS in Makemi Educational Training Training

Procurement of books, teaching aids and other training supports Training 59,475.50 Capacitate the Library Training 29,737.75 Capacitate the ICT Department Training 34,694.04 Print finalized curriculum for the SCS Training 529.80 Operations of SCS - External examiners fees (incl. air fare and accommodations) Training 9,912.58 Salaries of Lecturers and other office management costs Training 118,950.99 Supervision, support & office costs for auxiliary worker training Training 39,650.33 Upgrading and equipment of SCS Training - Completion of phase 1 constructions/ rehabilitation Training 99,125.83 Design and supervision of phase 2 rehabilitation/ reconstruction Training 2,973.77 sub-total 395,050.60 SCS Makeni Total 395,050.60 Component 7: PBF in Kailahun District PBF TA DPPI 500,000.00 PBF implementation DPPI 1,000,000.00 PBF infrastructure upgrading DPPI 2,800,000.00 sub-total 4,300,000.00 DPPI Total 4,300,000.00 Component 8: Rapid results initiatives (RRI) RRI DPPI 1,000,000.00 RRI Total 1,000,000.00 Component 9: Prevention of teenage pregnancy Teenage pregnancy-related activity DPPI 100,000.00


Teenage Pregnancy Total 100,000.00

Component 10: Project Management Project management (MoHS) 209,353.33 Project management (IHPAU) 284,838.39 Final Evaluation 100,000.00

Project Management Total 594,191.73

Grant-Total: 8,640,417.50


Annex 6. Revised HSDSSP Disbursement CategoryKey Components Schedule 1 Category HSDSSP (IDA) EERP

Health service Delivery 7,486,205.18 8,079,137.64 A.1.1 (a), (c), (d), (e) 1 740,000.00 -

CHW Program and CHW Hub operationsA.1.1 (b) 2 715,231.79 -

NEMS renovation A.2.2 (to be deleted) 5 - 1,107,019.87 Hardship incentives for HWs at rural settings A.1.1. (b) 2 - 2,842,808.50 Equipment for health facilities by DRCH A.2.1 (a) 4 1,107,000.00

A.1.2 (to be deleted) 3 - 424,605.62 B.2.1 (a) 9 - 242,451.70 ESICOME B.2.1 (b) 10

Medical Waste Management A.2.1 (a) 4 403,262.00 A.1.1 (e) 1 127,638.37

Nutrition in Kailahun DistrictA.1.1 (f) new 1 200,073.02

MDCT A.2.1 (b) 4 - 1,253,251.95 PBF implementation in Kailahun A.2.1 (c) new 4 4,300,000.00 - RRI A.2.1 (c) new 4 1,000,000.00 - Rehabilitation of DHMT at Waterloo new activity - 302,000.00 Installation of dialys equipment for Freetown Teaching Hospital/Connaught Hospital A.2.1 (a) 4 - 800,000.00

Health system support 1,169,212.32 3,479,152.94 B.2.1 (a) 9 215,840.00

DRCHB.2.1 (b) 10 15,000.00 370,800.00

B.2.1 (a) new 9 20,164.00 NCDs

B.2.1 (d) new 1 new 64,970.00 SLA B.2.1 (c) 10 - 287,150.00 SCS Makeni B.1.1 (c) 8 395,050.60 DPPI operations + DHS B.2.1 (a) 9 - 1,587,831.99 ISSV B.2.1 (a) 9 - 348,795.23 Teenage pregnancy B.2.1 (e) new 1 new 100,000.00 Project Management B.3 11 594,191.73 648,571.73 8,655,417.50 11,558,290.58


Documents

World Bank Documentdocuments.worldbank.org/curated/en/368401553808397575/pdf/Dis… · validation workshop are being incorporated for finalization. ... The SLA database has been created