The World Bank South Sudan Health Rapid Results Project (P127187) REPORT NO.: RES30170 DOCUMENT OF THE WORLD BANK RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF SOUTH SUDAN HEALTH RAPID RESULTS PROJECT APPROVED ON APRIL 13, 2012 TO MINISTRY OF FINANCE AND ECONOMIC PLANNING HEALTH, NUTRITION & POPULATION AFRICA Regional Vice President: Makhtar Diop Country Director: Carolyn Turk Senior Global Practice Director: Timothy Grant Evans Practice Manager/Manager: Trina S. Haque Task Team Leader: Paul Jacob Robyn, Bernard O. Olayo, Noel Chisaka The World Bank South Sudan Health Rapid Results Project (P127187) I. BASIC DATA Product Information Project ID Financing Instrument P127187 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 13-Apr-2012 30-Sep-2017 Organizations Borrower Responsible Agency Ministry of Finance and Economic Planning Ministry of Health Project Development Objective (PDO) Original PDO The Objectives of the Project are: (i) to improve the delivery of High Impact Primary Health Care Services in Upper Nile andJonglei states; and (ii) to strengthen the coordination, monitoring and evaluation capacities of the Ministry of Health. Summary Status of Financing Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-D1250 27-Jun-2016 02-Feb-2017 23-Mar-2017 30-Mar-2018 40.00 15.85 25.08 IDA-54010 13-Mar-2014 09-May-2014 09-Sep-2014 30-Mar-2018 10.00 9.24 .01 IDA-H9210 13-Mar-2014 09-May-2014 09-Sep-2014 30-Mar-2018 25.00 23.70 .01 TF-12272 20-Apr-2012 20-Apr-2012 02-Aug-2012 30-Sep-2017 28.00 27.96 .04 The World Bank South Sudan Health Rapid Results Project (P127187) Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No II. SUMMARY OF PROJECT STATUS AND PROPOSED CHANGES The second additional financing (AF) was approved in May 2016. Soon after, the country entered into conflict, which led to a delay in the government meeting the requirements for the AF to become effective for almost one year. The financing agreement was signed only in March 2017 and implementation of service delivery began in July 2017. The project operates in the former states of Upper Nile and Jonglei, where there is continued conflict and insecurity. The Coordination and Service Delivery Organization (CSDO) contract for the delivery of basic health services was expected to close on December 31, 2017. Given the delays in starting service delivery, the Bank agreed to a no-cost extension of the CSDO contract to March 31, 2018 to ensure that the time lost was recouped and deliverables achieved. In order to ensure that there is no interruption in service delivery while the new health project is being prepared, the borrower requested an extension of the closing date of AF2 from March 31, 2018 to September 30, 2018. This would entail a costed extension of the CSDO contract; there is US$5.2 million in uncommitted funds in component 1 that would be used to fund this contract extension. This would allow the provision of basic health services to continue without interruption until a new CSDO is hired under the new project under preparation for FY19. The project has disbursed 34 percent as of end-February 2018. Component 3 (US$15 million allocated), which includes procurement and distribution of pharmaceutical commodities, has not been implemented as yet owing to a protracted dialogue with the borrower on which firm to contract. A new market analysis was carried out by the borrower in December 2017, which concluded that International Procurement Agency (IPA) is the main firm supplying and distributing drugs in South Sudan, and it has established systems and warehousing facilities across the country. Other service providers, such as UN agencies and NGOs, have limited or no direct in-country experience in supply and distribution of pharmaceutical supplies. As such, the team received conditional clearance from OPRC on March 7, 2018 to enter into a direct contract with IPA to procure and distribute pharmaceuticals; this is subject to the closing date being extended from March 31, 2018 to September 30, 2018. Although these drugs will mainly be distributed in the former states of Upper Nile and Jonglei, the financing agreement allows for drugs to be distributed to other states in the country at the request of the borrower. Although service delivery was interrupted from July 2016 through June of 2017, the project is on track to meet many of the expected service delivery results for which there is available data from DHIS (collected from the counties and submitted at the central level). The Ministry of Health and CSDO conducted several assessments of the level of functionality of the implementing partners and facilities. The DHIS data also provides information on implementation of service delivery in the functioning facilities. Some health centers are being rehabilitated so they can resume service provision. It is not surprising, given the implementation delays as well as the difficult security situation on the ground, that some indicators (HMIS functionality, routine supervision, and availability of essential medicines at facilities) are below their targets; however, they are showing forward progress. The project is up to date regarding the submission of quarterly IFRs to the Bank with the latest IFR for the quarter ended December 31, 2017 having been submitted before the deadline of February 14, 2018. The final independent audit of the CSDO covering the period from August 1, 2014 to September 30, 2016 will be submitted to the Bank The World Bank South Sudan Health Rapid Results Project (P127187) before the end of March 2018. The audit report on the project financial statements for the year ended June 30, 2017 will also be submitted to the Bank by June 30, 2018. Environmental and Social Safeguards: drafts of the Social Assessment and the Environmental and Social Management Framework (ESMF) are being finalized and will be disclosed once cleared by the regional safeguards advisor. III. DETAILED CHANGES LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications 30-Jun-2015, 30-Jun- IDA-54010 Effective 31-Oct-2015 2016, 30-Sep-2017, 31-Mar-2018 31-Jul-2018 30-Mar-2018 IDA-D1250 Effective 30-Sep-2017 30-Mar-2018 30-Sep-2018 30-Jan-2019 30-Jun-2015, 30-Jun- IDA-H9210 Effective 31-Oct-2015 2016, 30-Sep-2017, 31-Mar-2018 31-Jul-2018 30-Mar-2018 31-Oct-2015, 30-Jun- TF-12272 Closed 31-Oct-2014 2015, 30-Jun-2016, 30-Sep-2017