Project Appraisal Document

115 Pages·2013·1.73 MB·English

Document of
The World Bank

Report No: 75232-LS

PROJECT APPRAISAL DOCUMENT

ON A

PROPOSED CREDIT

IN THE AMOUNT OF SDR 7.8 MILLION
(US$12 MILLION EQUIVALENT)

AND

PROPOSED GRANT
IN THE AMOUNT OF US$4 MILLION
FROM THE HEALTH RESULTS INNOVATION TRUST FUND

TO THE

KINGDOM OF LESOTHO

FOR A

MATERNAL AND NEWBORN
HEALTH PERFORMANCE-BASED FINANCING PROJECT

MARCH 15, 2013

Health, Nutrition and Population, Eastern and Southern Africa
Country Department AFCS1
Africa Region

This document is being made publicly available prior to Board consideration. This does not
imply a presumed outcome. This document may be updated following Board consideration and
the updated document will be made publicly available in accordance with the Bank‟s policy on
Access to Information.
CURRENCY EQUIVALENTS

(Exchange Rate Effective January 31, 2013)

Currency Unit = LSL
LSL 8.97 = US$ 1
US$ 1.5413403 = SDR 1

FISCAL YEAR
April 1 – March 31

ABBREVIATIONS AND ACRONYMS

ADF Africa Development Fund
AFTME Africa Region Financial Management - East unit
AFTHE Africa Health, Nutrition & Population East/South unit
AFTSG Africa Region Safeguards Group
AIDS Acquired Immune Deficiency Syndrome
AJR Annual Joint Review
ANC Antenatal Care
ARV Antiretroviral Drugs
BCG Bacillus Calmette Guerin
BOS Bureau of Statistics
CAS Country Assistance Strategy
CBA Cost Benefit Analysis
CBO Community-Based Organization
CHAL Christian Health Association of Lesotho
CIPS Center for International Policy Studies
CLNHCWMP Consolidated Lesotho National Health Care Waste
Management Plan
CPA Complementary Package of Activities
CPAR Country Procurement Assessment Report
CQS Selection Based on Consultants‟ Qualifications
CS Cesarean Section (surgical delivery of a baby)
DA Designated Account
DC District Council
DHIO District Health Information Officer
DHMT District Health Management Team
DHS Demographic and Health Survey
DOTs Directly Observed Treatment
DP Development Partner
DPT Diphtheria, Pertussis and Tetanus
ii
EGPAF Elisabeth Glaser Pediatric AIDS Foundation
EmONC Emergency Obstetric and Neonatal Care
EMR Electronic Medical Record
ERR Economic Rate of Return
ESAMI Eastern and Southern African Management Institute
FBS Fixed Budget Selection
FMO Financial Management Officer
GDP Gross Domestic Product
GOL Government of the Kingdom of Lesotho
GPOBA Global Partnership on Output-based Aid
HCGW Health Care General Waste
HCRW Health Care Risk Waste
HDI Human Development Index
HDNHE Human Development Network Health Unit
HIV Human Immunodeficiency Virus
HMIS Health Management Information System
HPSD Health Planning and Statistics Department
HRH Human Resources for Health
HRITF Health Results Innovation Trust Fund
IBRD International Bank for Reconstruction and Development
ICAP International Center for HIV/AIDS Programs
ICB International Competitive Bidding
ICT Information and Communication Technology
IDA International Development Association
IFAC International Federation of Accountants
IFC International Finance Corporation
IFMIS Integrated Financial Management Information System
IFR Interim unaudited Financial Report
IHM Institute for Health Measurement
IMF International Monetary Fund
LCS Least Cost Selection
LRCS Lesotho Red Cross Society
LSL Lesotho Loti
M&E Monitoring and Evaluation
MCA Millennium Challenge Account
MCC Millennium Challenge Corporation
MDG Millennium Development Goal
MNH Maternal and Newborn Health
MMR Maternal Mortality Ratio
MODP Ministry of Development Planning
MOF Ministry of Finance
iii
MOH Ministry of Health
MOLGC Ministry of Local Government and Chieftainship
MOU Memorandum of Understanding
MPA Minimum Package of Activities
MTEF Mid-Term Expenditure Framework
MVA Manual Vacuum Aspiration
NCB National Competitive Bidding
NDSO National Drug Service Organization
NGO Non-Governmental Organization
NPV Net Present Value
NSDP National Strategic Development Plan
NSRHSC National Sexual and Reproductive Health Steering Committee
ORAF Operational Risk Assessment Framework
ORS Oral Rehydration Solution
PAD Project Appraisal Document
PAU Project Accounting Unit
PBF Performance-based Financing
PDO Project Development Objective
PEFA Public Expenditure and Financial Accountability
PEPFAR The U.S President's Emergency Plan For AIDS Relief
PFM Public financial management
PFMA Public Financial Management and Accountability
PIH Partners in Health
PIM Project Implementation Manual
PMTCT Prevention of Mother-to-Child Transmission of HIV
PO Procurement Officer
PPA Project Preparation Advance
PPAD Procurement Policy Advisory Division
PPP Public Private Partnership
PPR Public Procurement Regulation
PPTA Performance Purchasing Technical Assistance
QBS Quality-Based Selection
QCBS Quality and Cost-Based Selection
RBF Results-Based Financing
RHAP Reproductive Health Action Plan
SACU South Africa Customs Union
SBD Standard Bidding Document
SOE Statement of Expenditures
STI Sexually Transmitted Infection
TA Technical Assistance
TB Tuberculosis
iv
TOR Terms of Reference
TWG Technical Working Group
UN United Nations
UNDP United Nations Development Programme
UNFPA United Nations Population Fund
UNICEF United Nations Children's Fund
USAID United States Agency for International Development
VHW Village Health Worker
WHO World Health Organization

Regional Vice President: Makhtar Diop
Country Director: Asad Alam
Sector Director: Ritva S. Reinikka
Sector Manager: Olusoji O. Adeyi
Task Team Leader: Kanako Yamashita-Allen
v
LESOTHO
Maternal and Newborn Health Performance Based Financing Project

TABLE OF CONTENTS

Page
I. STRATEGIC CONTEXT .................................................................................................1
A. Country Context ............................................................................................................ 1
B. Sectoral and Institutional Context ................................................................................. 1
C. Higher Level Objectives to which the Project Contributes .......................................... 5
II. PROJECT DEVELOPMENT OBJECTIVES ................................................................5
A. PDO............................................................................................................................... 5
Project Beneficiaries ........................................................................................................... 5
PDO Level Results Indicators ............................................................................................. 6
III. PROJECT DESCRIPTION ..............................................................................................6
A. Project Components ...................................................................................................... 6
B. Project Financing ........................................................................................................ 10
Lending Instrument ........................................................................................................... 10
Project Cost and Financing ............................................................................................... 10
C. Lessons Learned and Reflected in the Project Design ................................................ 11
IV. IMPLEMENTATION .....................................................................................................13
A. Institutional and Implementation Arrangements ........................................................ 13
B. Results Monitoring and Evaluation ............................................................................ 17
C. Sustainability............................................................................................................... 18
V. KEY RISKS AND MITIGATION MEASURES ..........................................................19
A. Risk Ratings Summary Table ..................................................................................... 19
B. Overall Risk Rating Explanation ................................................................................ 20
VI. APPRAISAL SUMMARY ..............................................................................................20
A. Economic and Financial Analyses .............................................................................. 20
B. Technical ..................................................................................................................... 21
C. Financial Management ................................................................................................ 22
D. Procurement ................................................................................................................ 23
vi
E. Social (including Safeguards) ..................................................................................... 24
F. Environment (including Safeguards) .......................................................................... 24
G. Other Safeguards Policies Triggered (if required)...................................................... 25
Annex 1: Results Framework and Monitoring .........................................................................26
Annex 2: Detailed Project Description .......................................................................................33
Annex 3: Implementation Arrangements ..................................................................................44
Project Institutional and Implementation Arrangements .................................................. 44
Financial Management, Disbursements and Procurement ................................................ 49
Environmental and Social (including safeguards) ............................................................ 67
Monitoring & Evaluation .................................................................................................. 67
Annex 4: Operational Risk Assessment Framework (ORAF) .................................................71
Annex 5: Implementation Support Plan ....................................................................................74
Annex 6: Performance-Based Financing ...................................................................................77
Annex 7: Economic and Financial Analysis ..............................................................................85
Annex 8: Development Partners Support to Maternal and Newborn Health ........................97
Annex 9: Country Map ..............................................................................................................103

vii
PAD DATA SHEET
Lesotho
Lesotho Maternal & Newborn Health PBF (P114859)
PROJECT APPRAISAL DOCUMENT
.
AFRICA
AFTHE
Report No.: 75232-LS
.
Basic Information
Project ID Lending Instrument EA Category Team Leader
P114859 Specific Investment B - Partial Assessment Kanako Yamashita-Allen
Loan
Project Implementation Start Date Project Implementation End Date
11-April-2013 30-June-2017
Expected Effectiveness Date Expected Closing Date
1-July-2013 30-June-2017
Joint IFC
No
Sector Manager Sector Director Country Director Regional Vice President
Olusoji O. Adeyi Ritva S. Reinikka Asad Alam Makhtar Diop
.
Borrower: Kingdom of Lesotho
Responsible Agency: Ministry of Health, P.O. Box 514, Maseru 100, Lesotho
Contact: Mr. Lefu Manyokole Title: Principal Secretary
Telephone No.: [phone] Email: [email protected]; [email protected]
?
Project Financing Data(US$M)
[ ] Loan [ X ] Grant [ X ] Term: The proposed credit will be on standard IDA
terms with a forty-year maturity, including a ten year
[ X ] Credit [ ] Guarantee
grace period.
For Loans/Credits/Others
Total Project Cost (US$M): 20.00
Total Bank Financing 12.00
(US$M):
.
Financing Source Amount(US$M)
BORROWER/RECIPIENT 4.00
viii
International Development Association (IDA) 12.00
Health Results Innovation Trust Fund 4.00
Total 20.00
.
Expected Disbursements (in USD Million)
Fiscal Year 2013 2014 2015 2016 2017
Annual 0.63 2.00 4.62 4.37 4.38
Cumulative 0.63 2.63 7.25 11.62 16.00
.
Project Development Objective(s)
The overall project development objective is to improve the utilization and quality of maternal and
newborn health (MNH) services in selected districts in Lesotho.
.
Components
Component Name Cost (USD Millions)
Component 1: Improving Maternal and Newborn Health 13.70
(MNH) Service Delivery at Community, Primary and
Secondary levels through PBF.
Component 2: Training of health professionals and Village 2.30
Health Workers (VHWs) and improving Monitoring and
Evaluation (M&E) capacity.
.
Compliance
Policy
Does the project depart from the CAS in content or in other significant Yes [ ] No [ X ]
respects?
.
Does the project require any waivers of Bank policies? Yes [ ] No [ X ]
Have these been approved by Bank management? Yes [ ] No [ ]
Is approval for any policy waiver sought from the Board? Yes [ ] No [ X ]
Does the project meet the Regional criteria for readiness for implementation? Yes [ X ] No [ ]
.
Safeguard Policies Triggered by the Project Yes No
Environmental Assessment OP/BP 4.01 X
Natural Habitats OP/BP 4.04 X
Forests OP/BP 4.36 X
Pest Management OP 4.09 X
Physical Cultural Resources OP/BP 4.11 X
Indigenous Peoples OP/BP 4.10 X
Involuntary Resettlement OP/BP 4.12 X
ix
Safety of Dams OP/BP 4.37 X
Projects on International Waterways OP/BP 7.50 X
Projects in Disputed Areas OP/BP 7.60 X
.
Legal Covenants
Name Recurrent Due Date Frequency
Financial Management software: No one (1) month after Once
Financing Agreement Reference Section the Effective Date
II. B. 4 of Schedule 2
Description of Covenant
The Recipient shall procure, no later than one (1) month after the Effective Date, additional financial
management software (TOMPRO) licenses, in accordance with the provisions of Section III of this
Schedule 2 to the Financing Agreement.
Annual Work Program and Budget: Yes one (1) month after Annual
Financing Agreement Reference Section the Effective Date
I D. 1 of Schedule 2 and every Feb. 28
thereafter
Description of Covenant
Each Fiscal Year, the Recipient shall prepare a program of activities(including Training and Operating
Costs) proposed for inclusion in the Project during the following Fiscal Year, including: (a) a detailed
timetable for the sequencing and implementation of such activities; and (b) a proposed budget and
financing plan for such activities. The Recipient shall furnish such program of activities to the
Association as soon as available and in any case no later than February 28 of each year, for its review
and approval by the Association; except for the program of activities for the first year of Project
implementation, which shall be furnished no later than one (1) month after the Effective Date.
MOH Procurement Unit Staffing: No six (6) months after Once
Financing Agreement Reference Section the Effective Date
I. A. 2 (b) of Schedule 2
Description of Covenant
The Recipient shall (i) maintain within the MOH, throughout the period of Project implementation, a
procurement unit, with terms of reference and resources satisfactory to the Association, and supported by
qualified and experienced staff in adequate numbers and (ii) recruit a procurement manager and two (2)
procurement officers, each with terms of reference and qualifications and experience satisfactory to the
Association, no later than six (6) months after the Effective Date.
.
Conditions
Name Type
HRITF Grant Agreement cross-effectiveness: Effectiveness
Financing Agreement Reference Section 4.01 (a)
Description of Condition
The Trust Fund Grant Agreement has been executed and delivered and all conditions precedent to its
effectiveness or to the right of the Recipient to make withdrawals under it (other than the effectiveness
of the Financing Agreement) have been fulfilled.
x