OFFICIAL DOCUMENTS CREDIT NUMBER 6316-LC Financing Agreement (Health System Strengthening Project) between SAINT LUCIA and INTERNATIONAL DEVELOPMENT ASSOCIATION CREDIT NUMBER 6316-LC FINANCING AGREEMENT AGREEMENT dated as of the Signature Date between SAINT LUCIA ("Recipient") and INTERNATIONAL DEVELOPMENT ASSOCIATION ("Association"). The Recipient and the Association hereby agree as follows: ARTICLE I - GENERAL CONDITIONS; DEFINITIONS 1.01. The General Conditions (as defined in the Appendix to this Agreement) apply to and form part of this Agreement. 1.02. Unless the context requires otherwise, the capitalized terms used in this Agreement have the meanings ascribed to them in the General Conditions or in the Appendix to this Agreement. ARTICLE II - FINANCING 2.01. The Association agrees to extend to the Recipient a credit, which is deemed as Concessional Financing for purposes of the General Conditions, in the amount of twenty million dollars (US$20,000,000) (variously, "Credit" and "Financing"), to assist in financing the project described in Schedule 1 to this Agreement ("Project"). 2.02. The Recipient may withdraw the proceeds of the Financing in accordance with Section III of Schedule 2 to this Agreement. 2.03. The Maximum Commitment Charge Rate is one-half of one percent (1/2 of 1%) per annum on the Unwithdrawn Financing Balance. 2.04. The Service Charge is the greater of: (a) the sum of three-fourths of one percent (3/4 of 1%) per annum plus the Basis Adjustment to the Service Charge; and (b) three-fourths of one percent (3/4 of 1%) per annum; on the Withdrawn Credit Balance. 2.05. The Payment Dates are June 1 and December 1 in each year. 2.06. The principal amount of the Credit shall be repaid in accordance with the repayment schedule set forth in Schedule 3 to this Agreement. -2- 2.07. The Payment Currency is Dollar. ARTICLE III - PROJECT 3.01. The Recipient declares its commitment to the objective of the Project. To this end, the Recipient shall carry out: (a) Parts 1 through 3 of the Project through MOHW; and (b) Part 4 of the Project through the Coordinating Authority; all in accordance with the provisions of Article V of the General Conditions and Schedule 2 to this Agreement. ARTICLE IV - EFFECTIVENESS; TERMINATION 4.01. The Effectiveness Deadline is the date ninety (90) days after the Signature Date. 4.02. For purposes of Section 10.05(b) of the General Conditions, the date on which the obligations of the Recipient under this Agreement (other than those providing for payment obligations) shall terminate is twenty (20) years after the Signature Date. ARTICLE V - REPRESENTATIVE; ADDRESSES 5.01. Except as provided in Section 2.02 of this Agreement, the Recipient's Representative is its minister responsible for finance. 5.02. For purposes of Section 11.01 of the General Conditions: (a) the Recipient's address is: Ministry of Finance, Economic Growth, Job Creation, External Affairs and Public Service 5' Floor, Greaham Louisy - Administrative Building Waterfront, Castries Saint Lucia, West Indies; and (b) the Recipient's Electronic Address is: Facsimile: E-mail: 1758 452 6700 pm.sec@govt.Ic -3- 5.03. For purposes of Section 11.01 of the General Conditions: (a) the Association's address is: International Development Association 1818 H Street, N.W. Washington, D.C. 20433 United States of America; and (b) the Association's Electronic Address is: Telex: Facsimile: E-mail: 248423 (MCI) 1-202-477-6391 tsavedAworldbank.org AGREED as of the Signature Date. SAINT LUCIA By_ Authorized Representative Name: The Honourable Allen M. Chastanet Title: Prime Minister and Minister of Finance, Economic Growth, Job Creation, External Affairs and the Public Service Date: November 27, 2018 INTERNATIONAL DEVELOPMENT ASSOCIATION By Authorized Representative Name: Tahseen Saved Title: Country Director, Caribbean Country Management Unit, Latin American and the Caribbean Region Date: November 27, 2018 -4- SCHEDULE 1 Project Description The objective of the Project is to improve the accessibility, efficiency and responsiveness of key health services. The Project consists of the following parts: Part 1: Design and Implementation of an Essential Benefits Package 1.1: Review of the Essential Benefits Package Support the review of the Essential Benefits Package, including (i) a review of public sector expenditure in health, including recommendations for efficiency gains and improvements in equity, and recommendations for the development of National Health Accounts; (ii) an analytical review of current insurance payment systems and coverage, including reviews of existing structural or institutional mechanisms (such as the NIC) with a potential role for the financing and/or costing of the Essential Benefits Package; (iii) an evaluation of coverage options for persons in the informal and nonwork sectors; (iv) reviews and simulations of the Essential Benefits Package to identify possible phases for rollout and associated cost and coverage implications; (v) the development of standard operating procedures and clinical procedures for disease case management; (vi) an in-depth assessment of the national HIS, including interoperability and integration; and (vii) a review and development of legislation governing the proposed Essential Benefits Package. 1.2: Implementation of the Essential Benefits Package Support direct actions to roll out the implementation of the Essential Benefits Package, including: (i) an assessment of and investments in IT systems for administration of the Essential Benefits Package, including the HIS, standard operating procedures for data entry/management, computer equipment, and a management system for the Essential Benefits Package (which will also track referrals); (ii) the development/review of purchaser provider agreements; (iii) the review of and improvements to existing and proposed financial control mechanisms and technical audits (such as financial audits and strategic purchasing arrangements); (iv) a communications campaign surrounding the Essential Benefits Package; (v) capacity building and training programs for MOHW staff, as well as the rollout of the existing benefits packages for the population, including a helpline for the startup phase; and (vi) the definition of the selection criteria and targeting mechanisms for the potential beneficiaries of the Essential Benefits Package ensuring the inclusion of the vulnerable population, based on the outcomes of the evaluation of coverage under Part 1.1. -5- Part 2: Strengthening Service Delivery in Support of the Essential Benefits Package 2.1: Improving Service Delivery through Performance-Based Financing Provide bonuses based on performance and results (Performance-Based Financing) to health facilities, focused on NCD (diabetes and hypertension) to improve the efficiency of health expenditure, upon the achievement of certain performance targets based on standard care protocols, including (i) the revised design of the proposed Performance-Based Financing, including monitoring and evaluation plans and utilization of indicators from the HIS; (ii) health facility outreach; and (iii) PBF payments based on performance. 2.2: Strengthening the Supply of Health Care Services Strengthen the integration of primary care systems to enhance the role of primary care facilities and encourage their use as the first point of contact for health services, particularly NCD, including: (i) a comprehensive survey of health facilities to ensure institutional readiness to deliver NCD services under the Essential Benefits Package; (ii) the improvement of health facilities, i.e., refurbishment, provision of equipment and medical supplies; (iii) the development of a health facility network to improve tracking of patients across the care pathway; and (iv) the roll-out of mobile clinics, geographic information systems, and radio systems for communication with health facilities. 2.3: Public Health Emergency Preparedness and Response Strengthen surveillance and information systems, laboratory capacity, and preparedness for public health emergencies, including: (i) the development of protocols and the provision of equipment to primary health care centers to enable them to serve as the first point of detection for selected infectious diseases; (ii) investments (including in IT systems) and equipment in laboratory facilities, data management, transportation and storage to enable rapid testing for pathogens of interest, including those associated with vector-borne diseases; and (iii) the development of health emergency preparedness and response plans, establishment of emergency operation centers and rapid response teams for public health emergencies, and outbreak communications as well the update of the national health care waste management plans to include measures for how to manage equipment distribution and installation in the case of a disease outbreak. Part 3: Institutional Capacity Building, Project Management and Coordination Support the Project implementation efforts, including project management, supervision, fiduciary tasks and monitoring and evaluation as well as oversight of refurbishing projects as well as compliance with safeguards (including compliance with the Health Care Waste Management System) and local permit requirements during refurbishment/rehabilitation of health facilities. -6- Part 4: Contingent Emergency Response Component (CERC) Provision of support upon occurrence of an Eligible Emergency. -7- SCHEDULE 2 Project Execution Section I. Implementation Arran2ements A. Institutional Arrangements 1. Ministry of Health and Wellness ("MOHW") The Recipient shall designate MOHW to be responsible for the implementation of the Project and, to this effect, shall provide MOHW with the staffing and other resources, satisfactory to the Association, required for the purpose of ensuring the prompt and efficient overall coordination, monitoring, reporting, evaluation and communication of Project activities. 2. MOHW Project Implementation Unit ("MOHW-PIU") (a) The Recipient shall maintain at all times until the completion of the Project the MOHW-PIU within MOHW, with staff, terms of reference, mandate and resources satisfactory to the Association; including a Project Manager, a PBF Coordinator, a financial management specialist, a procurement specialist, and a monitoring and evaluation specialist, all with experience, qualifications, expertise and terms of reference acceptable to the Association. (b) Without limitation to sub-paragraph (a), the MOHW-PIU is responsible for the day-to-day implementation of the Project as detailed in the POM, including, inter alia: (i) ensuring timely implementation in accordance with the POM; (ii) financial management and procurement; (iii) preparing interim financial reports and arrangements for the annual financial audit of Project financial statements, as well as preparing quarterly and annual Project Reports and their subsequent submission to the Association by the Recipient in a timely manner; (iv) preparing Annual Work Plans and Budgets and annual Procurement Plans; (v) coordinating Project activities; (vi) maintaining consolidated Project accounts; (vii) ensuring adherence to the ESMF of all agencies involved in the implementation of the Project; and (viii) developing and maintaining a system of monitoring the Project key performance indicators. -8- B. Project Operations Manual 1. The Recipient shall maintain the Project Operations Manual (POM) in form and substance satisfactory to the Association. 2. The Recipient shall carry out the Project or cause the Project to be carried out in accordance with the POM. 3. Except as the Association shall otherwise agree, the Recipient shall not amend, waive or fail to enforce the POM, or any provision thereof. 4. In case of any conflict between the provisions of this Agreement and those of the POM, the provisions of this Agreement shall prevail. C. Performance-Based Financing Payments 1 . To facilitate the carrying out of Part 2.1 of the Project, the Recipient, through MOHW, shall: (a) maintain the PBF Manual in form and substance satisfactory to the Association; (b) carry out Part 2.1 of the Project or cause Part 2.1 of the Project to be carried out in accordance with the PBF Manual; (c) except as the Association shall otherwise agree, the Recipient shall not amend waive or fail to enforce the PBF Manual, or any provision thereof, (d) in case of any conflict between the provisions of this Agreement and those of the PBF Manual, the provisions of this Agreement shall prevail; and (e) sign Management Agreements through MOHW, with participating Primary Health Care Facilities and the Supervising Health Region, under terms and conditions as further described in the POM and the PBF Manual. 2. The Recipient shall: (a) exercise its rights under the Management Agreement in such manner as to protect its interests and those of the Association to accomplish the purposes of the Financing. Except as the Association shall otherwise agree, the Recipient shall not assign, amend, abrogate or waive the Management Agreements or any of their provisions. (b) cause the health facilities to exercise their rights under the Management Agreement in such manner as to protect the interests of the Recipient and -9- the Association to accomplish the purposes of the Financing. Except as the Association shall otherwise agree, the Recipient shall cause the health facilities not to assign, amend, abrogate or waive the Management Agreement or any of their provisions. 3. In case of any conflict between the terms of the Management Agreement and the terms of this Agreement, the terms of this Agreement shall prevail. 4. The Recipient shall: (a) hire under a service contract with terms and conditions and in form and substance satisfactory to the Association (including the obligation to present regular Verification Reports, as further described in the POM) and thereafter maintain the Independent Verification Agency in charge of verifying quantity and quality of services provided under Part 2.1 of the Project. (b) exercise its rights under said service contract with the Independent Verification Agency in such manner as to protect its interests and those of the Association to accomplish the purposes of the Financing. Except as the Association shall otherwise agree, the Recipient shall not assign, amend, abrogate or waive the service contract with the Independent Verification Agency or any of its provisions. D. Annual Work Plans and Budgets 1. The Recipient, through the MOHW-PIU, shall prepare and furnish to the Association for its approval, no later than December 31 of each year during the implementation of the Project, or such later date as the Association may agree, an Annual Work Plan and Budget, and an updated Procurement Plan containing all eligible Project activities and expenditures planned for the following fiscal year, including a specification of the source or sources of financing for all eligible expenditures, modified in a manner satisfactory to the Association, taking into account the Association's comments and reviews on the matter. 2. The Recipient shall implement the Project in accordance with the Annual Work Plan and Budget and original or updated Procurement Plan approved for the respective fiscal year; provided, however, that in case of any conflict between the Annual Work Plans and Budgets and Procurement Plan and the provisions of this Agreement, the provisions of this Agreement shall prevail. E. Contingency Emergency Response In order to ensure the proper implementation of Part 4 of the Project ("Contingency Emergency Response Component" or "CERC Part"), the Recipient shall take the measures set forth below: -10- The Recipient, through the MOHW, shall: (a) prepare and furnish to the Association for its review and approval, a CERC Manual which shall set forth detailed implementation arrangements for the CERC Part, including: (i) designation of, terms of reference for and resources to be allocated to, the entity to be responsible for coordinating and implementing the CERC Part ("Coordinating Authority"); (ii) specific activities which may be included in the CERC Part, a sound and actionable country-level response plan, Eligible Expenditures required therefor ("Eligible Emergency Expenditures"), and any procedures for such inclusion; (iii) financial management arrangements for the CERC Part; (iv) procurement methods and procedures for Eligible Emergency Expenditures to be financed under the CERC Part; (v) documentation required for withdrawals of Eligible Emergency Expenditures; (vi) environmental and social safeguards management frameworks for the CERC Part, consistent with the Association's policies on the matter; and (vi) any other arrangements necessary to ensure proper coordination and implementation of the CERC Part; (b) afford the Association a reasonable opportunity to review said proposed CERC Manual; (c) promptly adopt such CERC Manual for the CERC Part as shall have been approved by the Association; (d) ensure that the CERC Part is carried out in accordance with the CERC Manual; provided, however, that in the event of any inconsistency between the provisions of the CERC Manual and this Agreement, the provisions of this Agreement shall prevail; and (e) not amend, suspend, abrogate, repeal or waive any provision of the CERC Manual without prior approval by the Association. 2. The Recipient shall, throughout the implementation of the CERC Part, maintain the Coordinating Authority, with adequate staff and resources satisfactory to the Association. 3. The Recipient shall undertake no activities under the CERC Part (and no activities shall be included in the CERC Part) unless and until the following conditions have been met in respect of said activities: (a) the Recipient has determined that an Eligible Emergency has occurred, has furnished to the Association a request to include said activities in the CERC Part and an action plan in order to respond to said Eligible -11- Emergency, and the Association has agreed with such determination, accepted said request and notified the Recipient thereof, (b) the Recipient has prepared and disclosed all safeguards instruments required for said activities, in accordance with the CERC Manual, the Association has approved all such instruments, and the Recipient has implemented any actions which are required to be taken under said instruments; and (c) the Recipient has ensured that no activities under the CERC Part fall under the prohibited activities mentioned in CERC Manual. F. Procurement of Eligible Emergency Expenditures under the CERC Part of the Project The Recipient shall procure the Emergency Expenditures required for the CERC Part of the Project in accordance with the procurement methods and procedures set forth in the CERC Manual. G. Safeguards 1. The Recipient shall carry out the Project in accordance with rules and procedures defined in the ESMF. 2. The Recipient shall not amend or waive, or permit to be waived, the ESMF or any provision of any one thereof, without the prior written consent of the Association. 3. The Recipient shall ensure that all measures for carrying out the recommendations of the ESMF are taken in a timely manner. 4. Without limitation upon its other reporting obligations under this agreement and under Section 5.08 of the General Conditions, the Recipient shall include in the Project Reports referred to in Section II of this Schedule adequate information on monitoring the measures defined in the ESMF giving details of: (a) measures taken in furtherance of such ESMF; (b) conditions, if any, which interfere or threaten to interfere with the smooth implementation of such ESMF; and (c) remedial measures taken or required to be taken to address such conditions and to ensure the continued efficient and effective implementation of such ESMF.. Section H. Project Monitoring, Reporting, and Evaluation The Recipient shall furnish to the Association each Project Report not later than forty-five days after the end of each calendar quarter, covering the calendar quarter. -12- Section HI. Withdrawal of the Proceeds of the Financing A. General Without limitation upon the provisions of Article II of the General Conditions and in accordance with the Disbursement and Financial Information Letter, the Recipient may withdraw the proceeds of the Financing to finance Eligible Expenditures in the amount allocated and, if applicable, up to the percentage set forth against each Category of the following table: Percentage of Amount of the Credit Expenditures to be Allocated Financed Category (expressed in USD) (inclusive of Taxes) (1) Goods, works, non-consulting services, consulting services, Operating Costs and Training for the Project (except for 14,880,000 100% Performance-Based Financing Payments under Category (2) below) (2) Performance-Based Financing Payments under Part 2.1 of the 4,000,000 100% Project (3) Eligible Emergency Expenditures for Part 4 of the 0 100% Project Amount payable (4) Refund of Preparation Advance 1,120,000 pursuant to Section 2.07 (a) of the General Conditions TOTAL AMOUNT 20,000,000 B. Withdrawal Conditions; Withdrawal Period 1. Notwithstanding the provisions of Part A above, no withdrawal shall be made for payments made prior to the Signature Date, unless the following conditions are met or fulfilled in a manner acceptable to the Association; 2. under Category (2) until and unless the Association has received adequate evidence that: (a) the first two Management Agreements have been signed; (b) the contract with the Independent Verification Agency has been signed; (c) the first Verification Report has been completed; and (d) the PBF Manual has been -13- adopted; all in form and substance satisfactory to the Association and as further detailed in the POM. 3. under Category (3), for Emergency Expenditures under Part 4 of the Project, unless and until the Association is satisfied, and has notified the Recipient of its satisfaction, that all of the following conditions have been met in respect of said activities: (a) the Recipient has determined that an Eligible Emergency has occurred, has furnished to the Association a request to include said activities in the CERC Part and an action plan in order to respond to said Eligible Emergency, and the Association has agreed with such determination, accepted said request and notified the Recipient thereof; (b) the Recipient has prepared and disclosed all safeguards instruments required for said activities, and the Recipient has implemented any actions which are required to be taken under said instruments, all in accordance with the provisions of Section E of this Schedule; (c) the Recipient's Coordinating Authority has adequate staff and resources, in accordance with the provisions of Section E of this Schedule, for the purposes of said activities; and (d) the Recipient has adopted the CERC Manual in form, substance and manner acceptable to the Association and the provisions of the CERC Manual are maintained or updated in accordance with the provisions of Section E of this Schedule so as to be appropriate for the inclusion and implementation of said activities under the CERC Part. 4. The Closing Date is October 31, 2023. Section IV. Other Undertakin2s 1. By June 30, 2020, or such other date as the Association shall agree upon, the Recipient, through MOHW, shall: (i) carry out jointly with the Association, a mid- term review of the implementation of operations under the Project, which shall cover the progress achieved in the implementation of the Project; and (ii) following such mid-term review, act promptly and diligently to take any corrective action as shall be agreed by the Association. 2. With respect to the withdrawals under Category (2), payments shall be made as needed during Project implementation upon submission by the Recipient to the Association of a Verification Report in form and substance acceptable to the Association (as further detailed in the POM and in the PBF Manual), indicating the amount to be withdrawn from said Category (2). -14- SCHEDULE 3 Repayment Schedule Date Payment Due Principal Amount of the Credit repayable (expressed as a percentage)* On each June 1 and December 1: commencing December 1, 2028 to and 1% including June 1, 2038 commencing December 1, 2038 to and 2% including June 1, 2058 * The percentages represent the percentage of the principal amount of the Credit to be repaid, except as the Association may otherwise specify pursuant to Section 3.05 (b) of the General Conditions. -15- APPENDIX Definitions 1. "Annual Work Plan and Budget" means the work plan and budget for the Project prepared annually, and consolidated by the Project Implementation Unit in accordance with Section I.D of Schedule 2 to this Agreement. 2. "Anti-Corruption Guidelines" means, for purposes of paragraph 5 of the Appendix to the General Conditions, the "Guidelines on Preventing and Combating Fraud and Corruption in Projects Financed by 1BRD Loans and IDA Credits and Grants", dated October 15, 2006 and revised in January 2011 and as of July 1, 2016. 3. "Basis Adjustment to the Service Charge" means the Association's standard basis adjustment to the Service Charge for credits in the currency of denomination of the Credit, in effect at 12:01 a.m. Washington, D.C. time, on the date on which the Credit is approved by the Executive Directors of the Association, and expressed either as a positive or negative percentage per annum. 4. "Category" means a category set forth in the table in Section III.A of Schedule 2 to this Agreement. 5. "CERC Manual" means the Immediate Response Mechanism Manual to be prepared by the Recipient under Part 4 of the Project. 6. "Contingency Emergency Response Component" or "CERC Part" means Part 4 of the Project. 7. "Coordinating Authority" means the Recipient's entity or institution in charge of implementing Part 4 of the Project ("Contingency Emergency Response Component" or "CERC Part"). 8. "Eligible Emergency" means the imminent or actual occurrence of a natural or man-made crisis or disaster, which, in the opinion of the Association, has the capacity to cause major adverse economic, health and/or social impacts in the Recipient's population. 9. "Eligible Emergency Expenditures" means the Eligible Expenditures required to finance the cost of the approved goods (excluding pesticides), works, consulting services, non-consulting services, Operating Costs and Training necessary under Part 4 of the Project to respond to an Eligible Emergency. 10. "ESMF" means the Recipient's framework disclosed in the Recipient's territory on June 7, 2018 and on the Association's website on June 7, 2018, in form and substance satisfactory to the Association, outlining environmental and social -16- implementation procedures, mitigation measures and monitoring procedures for the Project, including for the Healthcare Waste Management System, as said framework may be amended from time to time with the Association's prior written approval, and such term includes any schedules or annexes to the framework. 11. "Essential Benefits Package" means a defined set of health services offered to selected beneficiaries under Part 1 of the Project, as further detailed in the POM. 12. "General Conditions" means the "International Development Association General Conditions for IDA Financing, Investment Project Financing", dated July 14, 2017. 13. "HIS" means Health Information System, the Recipient's national health information system, established by the Recipient on June 12, 2005 and operating under the Recipient's Department of Health and Wellness structure. 14. "HWMS" means Healthcare Waste Management System, the Recipient's national healthcare waste management system, established and operating under the Recipient's Waste Management Act No. 8 of 2004. 15. "Independent Verification Agency" means the national or international entity in charge of verifying the quantity and quality of services provided by contracted health facilities under Part 2.1 of the Project. 16. "IT" means information technology. 17. "Management Agreements" means any or all the agreements to be signed among MOHW, the participating Primary Health Care Facilities and the Supervising Health Regions to carrying out activities under Part 2.1, as further detailed in the Project Operations Manual 18. "MOHW" means Ministry of Health and Wellness, the Recipient's Ministry of public health, or any successor thereto. 19. "National Health Account" means a systematic activity carried out by MOHW to map the flow of health sector funds for each fiscal year of the Recipient, as established and operating under MOHW's National Strategic Plan for Health for the period of 2006-2011 dated June 2005. 20. "NCD" means non-communicable diseases. 21. "NIC" means National Insurance Corporation, the Recipient's national social security administration, established and operating under the Recipient's National Insurance Corporation Act dated 31 December 2005, or any successor thereto acceptable to the Association. -17- 22. "Operating Costs" means the reasonable incremental expenses incurred in connection with Project implementation, including consumable materials and supplies, utilities, fuel and oil, communications, administrative fees, surveys and census costs, scholarships and stipends, mass media and printing services, vehicle rental, operation and maintenance, charges for the opening and operation of bank accounts required for the Project, travel, lodging and per diems, but excluding salaries of officials of the Recipient's civil service and Training. 23. "PBF Manual" means a manual dated July 31, 2018 satisfactory to the Association, containing or referring to detailed arrangements and procedures for the implementation of Part 2.1 of the Project, including with respect to: (i) institutional administration, coordination and day-to-day execution of activities of Part 2.1 of the Project; (ii) disbursement and financial management, including the financial management system; (iii) monitoring and evaluation; (iv) eligibility criteria and procedures for Performance-Based Financing and Performance-Based Financing Payments; (v) independent verification and payment mechanisms to be carried out for Performance-Based Financing Payments by the Independent Verification Agency, including the detailed content of the Verification Reports; (vi) such other administrative, financial, technical, and organizational arrangements and procedures as shall be required for Part 2.1 of the Project, as such manual may be amended and supplemented from time to time, with the prior written approval of the Association, and such term includes all schedules and annexes to said manual. 24. "Performance-Based Financing" or "PBF" means a bonus or an incentive mechanism to finance, at least partially, health facilities based on their performance to meet targets or undertake specific actions under Part 2.1 of the Project, as further detailed in the POM and in the PBF Manual. 25. "Performance-Based Financing Payment" or "PBF Payments" means an amount withdrawn from the proceeds of the Financing to pay health facilities for services rendered and activities carried out under Part 2.1 of the Project. 26. "Primary Health Care Facilities" means the wellness centers that make up the Recipient's public health system and provide primary care services to the population. 27. "Procurement Regulations" means, for purposes of paragraph 87 of the Appendix to the General Conditions, the "World Bank Procurement Regulations for IPF Borrowers", dated July 2016, revised November 2017. 28. "Project Implementation Unit" or "MOHW-PIU" means the unit created within MOHW in charge of the day-to-day management of the Project as further detailed in the Project Operations Manual. -18- 29. "Project Operations Manual" or "POM" means a manual dated July 31, 2018 satisfactory to the Association, containing or referring to detailed arrangements and procedures for the implementation of the Project, including with respect to: (i) institutional administration, coordination and day-to-day execution of activities of the Project; (ii) disbursement and financial management, including the financial management system and the financial management action plan; (iii) procurement; (iv) monitoring and evaluation; (v) reporting, information, education and communication; (vi) the grievance mechanism for the Project and the code of conduct; (vii) the eligibility criteria and procedures for Performance-Based Financing and Performance-Based Financing Payments; and (viii) such other administrative, financial, technical and organizational arrangements and procedures as shall be required for the Project, as such manual may be amended and supplemented from time to time, with the prior written approval of the Association, and such term includes all schedules and annexes to said manual. 30. "Project Preparation Advance" or "PPA" means the advance referred to in Section 2.07 (a) of the General Conditions, granted by the Association to the Recipient pursuant to the letter agreement signed on June 28, 2018. 31. "Signature Date" means the later of the two dates on which the Recipient and the Association signed this Agreement and such definition applies to all references to "the date of the Financing Agreement" in the General Conditions. 32. "Supervising Health Region" means the Ministry of Health authority overseeing one of the health regions into which the public health system is divided. 33. "Training" means the training of persons under the Project, including through seminars, workshops, knowledge sharing activities and study tours, and covers the following costs associated with such activity: travel and subsistence costs for training participants, costs associated with securing the services of trainers, rental of training facilities, preparation and reproduction of training materials, and other costs directly related to training preparation and implementation. 34. "Verification Report" or "Verification Reports" means one or several reports to be prepared on a regular basis by the Independent Verification Agency and furnished to the Recipient and the Association, as further detailed in the POM and in the PBF Manual and which includes a recommendation for disbursement under Category (2), all in form and substance satisfactory to the Association.