THE WORLD BANK
1R WZ                KGROUP
Adylbek A. Kasymaliev               DO     CU    M   ENTS                      June 23, 2017
Minister of Finance
Ministry of Finance
Bishkek
KYRGYZ REPUBLIC
Dear Mr. Kasymaliev,
Re: Kyrgyz Republic: Health Results-Based Financing Pilot Project
Amendment Letter to the Grant Agreement (TF013310)
We refer to the Multi-Donor Trust Fund for Health Results Innovation Grant Agreement for Health
Result-Based Pilot Project between the Kyrgyz Republic (the Recipient) and the International Development
Association (the Association), acting as administrator of the Multi-Donor Trust Fund for Health Results
Innovation dated December 30, 2013 (the Grant Agreement). We also refer to the letter of the Minister of
Finance, dated December 9, 2016 requesting the Association to restructure the Project and to make certain
amendments to the Grant Agreement in view of the proposed restructuring. The capitalized terms used in
this amendment letter and not defined herein have the meanings ascribed to them in the Grant Agreement.
We hereby propose to amend the Grant Agreement as follows:
1. Part 1 of Schedule 1 to the Grant Agreement shall be amended to include a new paragraph (b)
to read as follows:
"(b) Conducting a pay-for-performance pre-pilot scheme at the primary health care level,
including financing of the performance-based payments against the performance score."
Consequently, the current paragraph (b) shall become paragraph (c).
2. Section I.B in Schedule 2 to the Grant Agreement shall be amended to read as follows
(modifications are shown in italics):
"B.        Participating Provider Agreements
To facilitate the carrying out of Part I of the Project, the Recipient shall make part of
the proceeds of the Financing allocated from time to time to Category 1 of the table set forth
in Section IV.A.2 of this Schedule available to Participating Providers under agreements
between MHIF and each of the Participating Providers ("Participating Provider Agreements"),
under terms and conditions approved by the Association and based on the guidelines set forth
in the Project Operational Manual, including but not limited to the following provisions."
3. Section II.A. 1 (b) shall be amended to read as follows (modifications are shown in italics):
"4(b)      The performance indicators referred to above in sub-paragraph (a) consist of the
following:


(ii The proportion of eligible rayon hospitals that received the authorized performance-based
payments within two weeks after the MHIF's receipt of RBF payment to its bank account;
(ii) The proportion of quarterly peer verification records for Groups 1 and 2 rayon hospitals
submitted to MHIF within 30 days after the end of the quarter;
(iii) The number of counter-verifications carried out for a subset of Group 1 rayon hospitals
(20) and Group 2 rayon hospitals (20) every six (6) months; and
(iv) The completion of Impact Evaluation surveys in accordance with the schedule set forth in
the Project Operations Manual."
4. Section IV.B.1 (b) in Schedule 2 to this Grant Agreement shall be deleted.
All the terms and conditions of the Legal Documents that have not been amended hereby shall
remain unchanged and in full force and effect.
Please confirm your agreement to the foregoing amendments on behalf of the Recipient, by signing,
dating and returning two originals of this amendment letter and returning one fully signed original to us.
The provisions of this amendment letter will become effective on the date upon which the Recipient
dispatches to the Association notice that the execution and delivery of this amendment on behalf of the
Recipient have been duly authorized or ratified.
Sincerely,
INTERNATIONAL DEVELOPMENT ASSOCIATION
ByJ? L_j_
Sascha Djumena
Acting Regional Director
Central Asia
CONFIRMED AND AGREED:
KYRGYZ REPUBLIC
By:              *    Z-
Authorized Iepresentative
Name:     ?       Kl q-1
Title: Ive__er______
Date:     YO-0     -    O/