The World Bank Regional Program of Cancer Registries (P163187) REPORT NO.: RES36641 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF REGIONAL PROGRAM OF CANCER REGISTRIES APPROVED ON AUGUST 24, 2017 TO GOVERNMENTS OF BURUNDI, KENYA, RWANDA, TANZANIA AND UGANDA HEALTH, NUTRITION & POPULATION AFRICA Regional Vice President: Hafez M. H. Ghanem Country Director: Paul Noumba Um Senior Global Practice Director: Timothy Grant Evans Practice Manager/Manager: Magnus Lindelow Task Team Leader: Miriam Schneidman The World Bank Regional Program of Cancer Registries (P163187) ABBREVIATIONS AND ACRONYMS AFCRN The African Cancer Registry Network CDC Centers for Disease Control and Prevention, United States COPECSA The College of Pathologists of East Central and Southern Africa CHUK Centre Hospitalaire Universitaire de Kamenge, Burundi EAC East African Community ECSA-HC East, Central, and Southern Africa Health Community EDPS Economic Development and Poverty Reduction Strategy FM Financial Management FMS Financial Management System FY Fiscal Year GIS Geographic information system KEMRI Kenya Medical Research Institute IARC International Agency for Research on Cancer ICT Information and Communications Technology M&E Monitoring and Evaluation MoH Ministry of Health NSS National Statistical System NCI National Cancer Institute NCDs Non-Communicable Diseases NSDS2 National Strategy for the Development of Statistics of Rwanda ORCI Ocean Road Cancer Institute, Tanzania PDO Project Development Objective UBOS Uganda Bureau of Statistics WHO World Health Organization The World Bank Regional Program of Cancer Registries (P163187) BASIC DATA Product Information Project ID Financing Instrument P163187 Investment Project Financing Original EA Category Current EA Category Not Required (C) Not Required (C) Approval Date Current Closing Date 24-Aug-2017 01-May-2019 Organizations Borrower Responsible Agency Governments of Burundi, Kenya, Rwanda, Tanzania and East Central and Southern Africa Health Community Uganda Financing (in USD Million) FIN_SUMM_PUB_TBL SUMMARY Total Project Cost 0 Total Financing 0 Financing Gap 0 DETAILS -NewFin3 Project Development Objective (PDO) Original PDO The Project Development Objective (PDO) is to strengthen capacity for collecting, analyzing and sharing data on cancers in the five East Africa member states. OPS_TABLE_PDO_CURRENTPDO The World Bank Regional Program of Cancer Registries (P163187) Summary Status of Financing Net TF Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed TF-A4973 27-Apr-2017 04-May-2017 04-May-2017 01-May-2019 .50 .45 .05 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 RESTRUCTURING The World Bank Regional Program of Cancer Registries (P163187) Note: Formatting instructions for this document. A. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING The US$0.5 million Regional Program on Cancer Registries Project [P163187] has been supporting five East African member states (Burundi, Kenya, Rwanda, Tanzania and Uganda) to strengthen capacity for collecting, analyzing and sharing data on cancers. To this end, the project has provided technical support to establish/strengthen population-based cancer registries and publish a regional compilation of cancer statistics. While solid progress has been made and disbursements are largely on track (i.e. 90% disbursement rate), an 8-month no cost extension of the closing date is required to allow countries to complete all program activities and consolidate achievements. The extension will enable countries to complete the data collection and analysis; develop/finalize case studies, and the GIS mapping exercise; and disseminate findings. Significant progress has been made in implementing project activities, including establishment of new cancer registries, provision of equipment for the cancer registries, and initiation of data collection, as explained in detail below. Nevertheless, the project encountered some delays in start-up and implementation, stemming from lengthy discussions in completing the contractual arrangements between ESCA-HC and IARC (technical implementation agency), and the limited (Rwanda, Tanzania) or no experience (Burundi) with population-based cancer registries. The main achievements to date can be summarized as follows: (a) Component 1: Establish Core Capacities for Cancer Registration and Statistics. Each country has established a population-based registry (PBCR). The Ministries of Health have played a crucial role in supporting the establishment of these cancer registries, working with their National Cancer Institutes to allocate office space; and to designate staff to work on the registries. With support of the project, critical equipment was procured, and operating budgets were provided (internet services, office supplies, logistical support) to operate the registries and facilitate data collection. (b) Component 2: Statistical Capacity Building and Mentorship. The ECSA-HC has partnered with in-country experts from existing cancer registries to organize and facilitate basic training on cancer registration. Key topics covered included: data sources for cancer registration, cancer surveillance tools, ethical considerations and measures to ensure confidentiality, use and release of registry data, data abstraction, coding in cancer registration, international classification of diseases for oncology, and installation, use and management of CanReg5. The training was accompanied by the adoption of a standardized instruction manual and data collection tools. Advanced training was conducted in Entebbe, Uganda by the technical partners (i.e. IARC, AFCRN) on data presentation, and report production. The project has also provided critical support to facilitate the cost of data collection in public and private hospitals, hospices and births & deaths registration bureaus. The set-up has been completed in all countries, and data collection is currently ongoing, with the ambitious goal of collecting retrospective data covering 3-5 years. (c) Component 3: Advocacy and Knowledge Exchange. Several workshops have been organized (i.e. Nairobi, Dar es Salam) to bring together experts from existing cancer registries, ministries of health, statistical offices and technical partners and institutions, including CDC, IARC and AFRCN, to share experiences in setting up and operating cancer registries and to conduct south-south knowledge sharing. Participants discussed modalities of implementation; shared experiences in their respective countries, highlighting key achievements, lessons and challenges faced by the registries; discussed the project work plan and the implementation road map and linkages with ongoing work to strengthen oncology services in the countries and to foster partnerships with key stakeholders. To promote knowledge sharing, representatives from the ECSA-HC have also been facilitating conference calls for countries to jointly review progress, share challenges, and offer suggestions to improve implementation and address challenges experienced during the data collection process. Finally, representatives from cancer registry sites in Burundi and Uganda had an opportunity to visit a well-established cancer registry in Kenya to see first-hand how these registries function. The World Bank Regional Program of Cancer Registries (P163187) B. DESCRIPTION OF PROPOSED CHANGES Note: Formatting instructions for this document. Extension of the Closing Date The proposed change concerns a no-cost extension of the closing date of the original grant of US$500,000 by 8 months (from May 1, 2019 to December 31, 2019) to allow full disbursement against originally planned activities. The extension will allow countries to complete the data collection process, publish results and disseminate findings. Note to Task Teams: The following sections are system generated and can only be edited online in the Portal. I. SUMMARY OF CHANGES Changed Not Changed Loan Closing Date(s) ✔ Disbursement Estimates ✔ Implementation Schedule ✔ Implementing Agency ✔ Project's Development Objectives ✔ Results Framework ✔ Components and Cost ✔ Cancellations Proposed ✔ Additional Financing Proposed ✔ Reallocation between Disbursement Categories ✔ Disbursements Arrangements ✔ Change in Overall Risk Rating ✔ Safeguard Policies Triggered ✔ The World Bank Regional Program of Cancer Registries (P163187) EA category ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Other Change(s) ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_LOANCLOSING_TABLE LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline TF Status Closing Closing(s) Closing for Withdrawal Applications TF-A4973 Effective 01-May-2019 31-Dec-2019 30-Apr-2020 OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE DISBURSEMENT ESTIMATES Change in Disbursement Estimates Yes Year Current Proposed 2018 0.00 0.00 2019 0.00 0.00 2020 0.00 0.00 Note to Task Teams: End of system generated content, document is editable from here.