Equatorial Guinea - Health Improvement Project

The World Bank FOR OfflCIAL UE ONLY MI CROFICHE COPY Report No. P- 5508-EG Typ.: (PM) RemrNc. P-5508-EG BOYA /X34725 //AF1PH 1EMORANDUM AND RECOMENDATION OF THE PRESIDENT OF TRE INTERNATIONAL DEVELOPMENT ASSOCIATION TO TRE EXECUTIVE DIRECTORS ON A PROPOSED CREDIT OF SDR 3.9 MILLION TO TRE REPUBLIC OF EQUATORIAL GUINEA FOR A IEALTR IMPROVEMENT PROJECT FEBRUARY 6, 1992 This document b*s a restricted d~sribution ad may be sed by recipeuts only in the performace of their edIcia dutis. Its coutets may not oterwise be disle~d wihat World Bank authori.ation. CURRENCY EQUIVALENTS The rate of CEA francs 288 to the US dollar is used for cost projections as of January 1992. The CPA franc (CFAF) is tied to the French franc (FF) in the ratio of FF 1 to CFAP 50. MEASURES 13 1.09 yd. 1 a? - 10.76 sq.ft. 1 km? - 0.38 sq.mi. ABBREVIATIONS AND ACRONYMS AFDB African Development Bank AFU Administration and Finance Unit AIDS Acquired Imune Deficiency Syndrome BRAC Banque Centrale des Etats d'Afrique Centrale BPI Expanded Program of Lmmnization EQG Equatorial Guinea FP Family Planning FY Fiscal Year ICB International Competitive Bidding IEC Information, Education and Communication IFC International Finance Corporation MC Managing Committee MHBIFP Mother and Child Health and Family Planning MR Ministry of Health NCO Non-Governmental Organization OCRAC Organisation de coordination pour la lutte contre les endfmies en Afrique Centrale PHC Primary Health Care PU Planning Unit STD Senually Transmitted Disease UNDP United Nations Development Program UNFPA United Nations Fund for Population Activities UNICEF United Nations Children's Fund HO World Health Organization FISCAL YEAR January 1 - December 31 FOR OFFICIAL USE ONLY UMATORIAL GUINEA EALT MROVEMENT PROJECT CREDIT AND PROJECT SUIARY Borrowers Government of Equatorial Guinea Beneficiary: Ministry of Health (M0) Amountt SDR 3.9 million (US$5.5 million equivalent) Termst Standard IDA terms, with 40 years maturity Financing Plan: Government US$ 0.5 million IDA US$ 5.5 million TOTAL US$ 6.0 million Rate of Return: Not applicable Staff Appraisal Reporti 9421-1Q aIB No. 22929 This document has a restricted distribution and may be used precipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorizAtion. MEhNDRADhN AND * TION OF THE PRESIDENT OF THE INTERATIONAL DEVELOMEMT ASSOCIATION TO THE EXECUTIVE DIRECTORS ON A PROPOSED CREDIT TO TIM REPUBLIC OF EQUATORIAL GUINEA FOR A VALTH IMOVEMENT PROJECT 1 *The following memorandum and recommendation on a proposed Development Credit to the Republic of Equatorial Guinea (EQG) for SDR 3.9 million (US 5.5 million equivalent) is submitted for approval. Part I of the document discusses developmat performance and constraints of RQG, its medium- term macroeconomic and structural policies, and the Bank Group's assistance strategy. It draws upon the Policy Framework Paper covering the period 1991- 1994, which was approved by the Committee of the Vhole on December 3, 1991. Part II of the document describes the proposed Credit. I. Country Policies and Bank Group's Assistance Strategy Development Performance and Constraints 2. Past Performance. Ytth a population estimated at 350,000 inhabitants and a per capita income of US$450- in 1990, EQG has one of the world's smallest and least developed economies. Although EQG is generously endowed with natural resources, its economic performance has been inadequate since it gained independence from Spain in 1968. Economic performance was the weakest during the first ten years following independence (1968-1979). A new economic program was initiated in 1980 but was not sustained. In 1985, EQG became a member of the Bank of Central African States (BEAC), and adopted the CFA franc as its currency, a reform which involved a sharp devaluation of the exchange rate. In that year, efforts to rebuild the economy were renewed, but overall economic growth was marginal. Although timber production increased appreciably, and activity in the comerce and trade sectors expanded, the production and export of cocoa stagnated at levels far below those achieved prioi to independence. Moreover, a deterioration in the terms of trade contz. %uted to large and unsustainable fiscal and external Imbalances. 3. Against this background, in 1988 the Government adopted its first medium-term adjustment program coveri-g the period 1988-1991. This program was supported byt a first annual arrangement under the structural adjustment facility (SAP) of the Fund, in an amount equivalent to SDR 3.7 million; a rehabilitation Import credit (RIC) and sectoral loans from IDA; and assistance from other international organisations and bilateral donors. 4. However, during 1988-1989 economic performance fell well short of what had been envisaged uder the adjustment program. Many of the program's objectives were not met owing to slippages in policy implementation, caused in part by limited administrative capacity and in part by the continued erosion in world market prices of cocoa and coffee, the country's principal export crops. After having grown by about 2.5 percent in 1986-87, real GDP growth slowed to an average increase of less than 2 percent in 1988-89, as production and exports of timber and cocoa declined. The overall fiscal balance *2* (comitment basis) soved from a modest surplus in 1987 to a deficit equivalent to about 7 percent of GDP In 1988. Although expenditure was brought under control In 1989, the fiscal deficit only declined to 6 percent of GDP because of a weakening in revenue performance. 5. Export performance was also disappointing even though, following EqG's entry Into the CFA franc zone, external competitiveness was maintained by holding down domestic production costs, Including producer prices and labor costs. Falling export earnings from cocoa and timber, combined with an increase in taports of goods and services, contributed to a weakening of the balance of payments. The external current account deficit, excluding official transfers, amounted to an average of 49 percent of GDP in 1988-89, considerably higher than the program target of 30 percent. Overall weak performance is explained not only by the terms of trade shock but also by delays in the introduction of stronger incentives for food crop producers and the failure to introduce other measures for the strengthening of the private sector, such as the revision of the Investment code and the labor law, the clarification of property rights, and the restructuring of the banking sector. 6. Develomients In 1990-91. In view of the failure of its first adjustment program, the Government took a n2umber of Important steps in 1990-91 to bring the structural adjustment program back on track. The reforms consisted mainly of efforts to diversify economic activity and to strengthen the productive sectors. In this regard, the most significant actions taken weret the launching, in October 1990, of a new IDA-financed project to diversify agriculture in favor of food crops and non-traditional exports; the reduction of the cocoa producer price, in line with levels prevailing in neighboring countries and trends in international trade which, accompanied by cuts in marketing costs, contributed to a reduction in the cocoa export subsidy; and the adoption of a forestry action plan aimed at revitalizing production and exports, while strengthening the management and conservation of the country's natural resources. 7. In order to further diversify economic activity, in April 1990, the Government signed a new contract with a foreign company to start the exploitation of the country's oil resources. The company will begin to export in the first quarter of 1992. Production is estimated at 3,000 barrels per day in 1992 and will Increase to at least 4,000 barrels per day in subsequent years. The development of the oil sector is a new factor in EQG's strategy. If managed prudently, the oil reserves will help to accelerate the pace of economic growth and improve EQG's public finances and balance of payments over the medium term. According to the terms of the oil contract, total oil revenues accruing to the Government from 1992 to 1994 will be about US$12 million. They will Increase substantially afterwards, especially from 1997 when profit sharing will start. The Government could receive some US$60 million, on a cumulative basis, during the period 1995-2000. The balance of payments will also be significantly affected by oil exports. The external current account deficit, excluding official transfers, is expected to be reduced to about 30 percent of GDP in 1994, from an estimated 80 percent of GDP in 1991, maly reflecting the decline in Imports needed to develop the oil sector and the start of oil exports. It will be very important for the future development of the economy that the new oil revenues during the period 1992-94, which will amount to an annual average of 2.4 percent of GDP and 13.5 percent of budget revenue, be used wisely. 3- 8. With regard to other structural reforms, considerable progress was achieved In 1990-91 stregthening the management and performance of key public otilities and towards the completion of the liquidation of the two Insolvent banks. A nualor of changes were also made In the legal framework, Including a revision in the labor Um to free up the labor markett the liberalization of price control, In particular, the number of imported products subject to price controls was sgifcantly reduced, leaving only bread, petroleum products, and agricultural Inputs under each control. A civil service census was completed an the basis of which a new civil service registry has been prepared. 9. Central Development Issues. Despite its economic difficulties since iadependence, E*'s relatively rich natural resource base, if properly managed, could support enhanced growth and development in the medium-term. Although the country has enjoyed Increased access to external technical and financial assistance, especially after joining the CPA franc zone, the economy faces several Important development constraints. These includes (a) domestic resource mobilization that is hapered by the weaknesses of the tax administration (tax revenues have grown at a lower rate than GDP, sad their ratio to GDP has decreased to about 11 percent in 1991 compared to an average of 14 percent in 1985-90)1 (b) the constraint of the debt service burden on budgetary expenditures (debt service payments due in 1991 represented 90 percent of total revenue, and are projected to be about 70 percent of total revenues during the period 1992-94)g (c) lack of private foreign and domestic entrepreneurship due tot uncertain property rights, a weak banking sector, and cumbersome regulatory and Incentive frameworks; and (4) an extremely weak human capital base, accompanied by very poor access to educatica and health services, and related weak administrative and technical capacity across the public sector. Medium-term Macroeconomic and Structural Policies 10. Policy Framework Paper Objectives. With the commencement of oil production, and building upon the progress made during 1990-1991, the Government extended the adjustment program to cover the period through 1994 and prepared a Policy Framework Paper (PPP) that was discussed at the IDA and IMP Boards in early December 1991. This second medium-term adjustment program is supported by a second annual arrangement under the structural adjustment facility (SAP), in an amount equivalent to SDR 5.52 million. The program has the following macroeconomic objectivest (a) accelerate the rate of real GDP growth to an average of 6 percent per annum, with a major Impetus fros the oil sector; (b) limit the annual rate of inflation to 3 percent annually; and (c) reduce the external current account deficit to a sustainable level of 28.5 percent of GDP. The key quantitative targets for achieving needed structural changes in the economy area (a) the investment ratio to GDP should be maintained at an average of 21 percent over the program period, and (b) exports in real terms should grow by about 20 percent on avera3e, reflecting the start of oil exports. In addition, the fiscal deficit (comitment basis), which is estimated at 2.42 of GDP In 1991, needs to be Improved steadily over the period 1992-94 to reach a surplus equivalent to 2.2 percent of GDP In 1994. 4 11. The following table shows the key macroeconomic variables that need to be monitored to see If the program Is achieving its intended results. Equatorial 2SIaa Mey Macroeconomic Tndicators Item AvEM Actual Proiections 1985-89 1990 1991 1992 1993 1994 Targets Basic PIP Objectives GDP Growth Rate 1.8 3.1 -1.0 14.8 6.0 2.7 6.0 (a) ConsUMr Price Growth 11.8 1.4 2.0 3.0 3.0 3.0 3.0 (a) Current AcctGDP 11 -36.2 -51.5 -78.4 -34.7 -29.6 -28.5 -28.5 (Y94) e Uantitative targets Exports Growth Rate (r) 10.3 --8.7 -8.2 43.5 12.3 3.0 20.0 (a) InvestmentGDP 17.7 24.3 51.5 20.8 21.1 20.9 21.0 (a) Govt. RevenueDP 18.3 18.5 18.3 17.4 17.8 17.7 Govt. Expendit/refGDP 22.6 20.7 20.7 17.7 15.8 15.5 Budget BalanceGDP 21 -4.2 -2.2 -2.4 -0.3 2.0 2.2 2.2 (Y94) 11 Excluding Official Transfers 21 Comitment Basis (a) Three-Year Average 12. Policies and Reforms. Although the petroleum sector alone will have a substantial Impact on growth and the balance of payments, to achieve the macroeconmic objectives of the program, the Government intends to: (a) Improve fiscal perfomance, In particular expenditure control, the efficiency of public Investment and resource mobilization, (efficient use of new oil resources for priority purposes and Improved tax collection and administration); (b) continue restructuring the public enterprise sector; (c) Implement reforms conducive to expanding private sector activity; (d) step up human resources development (education and health) through increased budget allocations and Improved sector management; and (e) revitalize the forestry sector and Implement a natural resource management plan. 13. Macroeconomic Management. ZQG's public finances will be strengthened over the medium-tem as a result of revenue from the oil sector and Improved mon-ol revenue performance. 1on-oil revenues should improve in response to efforts to overhaul tax administration and to reforms envisaged in the MDAC's Indirect tax system. The tariff and tax system of IDAC (Central African Customs Union) has been distorted and has severely limited ZQ's ability to raise budgetary revenues. The system has been characterized by a camon external tariff that has not functioned as such because of the superimposition of a variety of Import levies. Cumulative tariff rates are exceptionally high but are applied in a non-unifom manner due to the ad-hoc use of exemptions. A trade and tax reform package, adopted by the UDAC Heads of State In early December 1991, once implemented in January 1993, would -5- reduce distortions aud Improve budgetary revenues. The major elements of the reform are the followIgs (a) reduction of the camon external tariff to three rate* - 5 percent for essential camodities. 15 percent for raw materials and equipent, and 70 percent for all other imports (the latter rate Is to be reduced to 35 percent In phases by all countries within a five year period)l (b) Atroduction of a preferential tariff for intra-Union tradet (c) replacement of the present complicated indirect tax system by a generalized sales tax, the rat** of Ahich would be determined on a country specific basist (4) introduction of excise duties on a regionally determined list of products; and (e) elimination of most categories of custom duty exemptions. 14. Aid flow are an important source of capital In support of the adjustment program. In 1992-94 annual net disbursements of grants of US$47 million, equivalent to about 60 percent of annual average gross financing needs, are expected. Despite this high level of concessional inflows, budget expenditure remains constrafted by the debt service burden. EQG's external debt, including arrears, aiwuanted to about US$ 242 million (160 percent of GDP) at the end of 1991, and debt service obligations were equivalent to 61 percent of estimated exports of goods and non-factor services and to 90 percent of budget revenues. In view of this heavy debt burden, the Government has requested a comprehenive rescheduling from Paris Club and other bilateral official creditores this is expected to take place in 1992. In 1991-94 total external financing requiremets are projected at about US$235 million. Total disbursements in the same period are currently projected at same US$150 million, leaving a financing gap of about US$85 million. It Iv expected that concessional debt relief would cover about US$75 million and taat the residual gap of about US$10 million would be financed through additional resources from multilateral and bilateral sources. 15. Private Sector Incentives. To promote private sector entrepreneurship, the Government recently amended the labor legislation affecting the conditions under which foreign workers may be hired. It is taking steps to restore viability to the banking system by completing the liquidation of the two insolvent banks and creating a second comercial bank. These efforts will be accompanied by the enactment, by end-March 1992, of a revised Investment Law which will clarify Incentives for private Investors and by the enactment In December 1992 of legislation governing individual property rights, based on the conclusivns of a land tenure study that was concluded in January 1992. 16. Poverty Alleviation and Ruman Resources Development. Because of EQG's low per capita Income, broad based, sustained growth in employment and incomes is essential for poverty alleviation. As discussed above, growth will be achieved primarily through bringing the country's oil reserves into production, diversifying agriculture, and revitalizing the forestry sector. Efforts to promote employment in the productive sectors will be reinforced through the development of the human resource base by strengthening the education system and basic health services. The educational system, which wa: closed down during the Macias regime (1968-1979), leaving a whole generativ of children unschooled. Is characterized by overcrowded classrooms, high student/teacher ratios, and l- sality and efficiency. The health status of the population is generally poor, especially among mothers and children in rural areas. The Infant mortality rate of 120 per 1,000 exceeds the average *6- rate of 100 per 1,000 for Sub-Saharan Africa. Life expectancy at birth is 48.S years and the maternal death rate ranges frem 420 to 600 per 100,000 live births. 1Q**a public health car7 system Is ftuarced through the national budget, external aid flows and private funds. However, an overriding issue Is the small amount spent on the sector. Goverament budgetary allocations to health over the last decade remained well below the 6 percent average of other Sub-aharan countries. DurIng the PPP program period, the Government will expand budgetary allocations directed toward primary education and health care by 10 and 12 percent per annum in real teras. It will strengthen human resaurce developent through the -aplementation of projects In primary education and health Mproveaent with the assistance of the donor camnity. 17. Environment. EQ is endowed with vast forestry reserves covering some 2.2 allion heetares, or 80 percent of the country's land surface. Of this natural forest, about 0.6 million hectares are being partially exploited. Despite the limited capacity to control access to and the use of the forest zone In more remte regions of the continental territory, the Government has indicated its comitment to preserving its forest resources, promoting their rational use and protecting their biodiversity. It recognizes the global significance of the natural forest and the pressure on it from logging, shifting cultivation, and hunting. The Goverament's concern for the preservation of the natural resources and the environment has been manifested through the recent creation of a National Comittee for the Protection of the Enviroment and the preparation of a number of environmental related studies. The medium-tern focus of the action plan to revitalize the forestry sector, adopted in February 1991, will be on developing a framework for strengthening the overall management of land and forestry resources, with an emphasis on reforestation and environmental protection (see paragraph 30 below). Bank Assistance StrateY 18. The Composition of Past Lending. Before the present Government came to power In 1979, the Bank Group had made only one credit of US$2.0 million to RQG, for highway maintenance. This was canceled in 1981 at the Government's request. Since 1982, six IDA credits totalling US$35.1 million equivalent and one Special Africa Facility Credit of US$4.0 million have been approved. Two credits were for technical assistance, two for agriculture, one for education, and one for rehabilitation of Imports (IC). The RIC was designed to support the Government's reform program and provide assistance for the rehabilitation of the agricultural sector and selected infrastructure. Three operations are closed and three are still being iplemented. OCMPOSITION OF IDA LEDING FT 82-91 (as of Dec. 31, 1991) Date of Aguat Percentage Approval (US4MItton) share of total leading Ariculture 44.4 Cocoa Rehabilitation ProjectIl 2119185 9.30 Crop Diversification Project 10130190 6.30 Technical Assistance 24.0 T.A. Petroleum sector 11 11130182 2.40 Technical Assistance 1 5131184 6.00 Human Resources 14.5 Primary Education Project 5/21187 5.10 Polic Lending 17.1 RIC If 5108/86 6.00 TOTAL (6 projects) 35.10 100.0 11 Closed 19. Project lIplementation Issues. Project Uaplementation has been constrained both by an ineffective public administration and by uncertainties in the provision of local counterpart financing. One of the most serious problems affecting project performance is the comparatively weak Implementation capacity within key Institutions In the sectors receiving assistance. Projects are implemented in an environmnt where management and administration skills are very poor and where there is little knowledge of modern work methods and systems. tfforts to train local staff have been fr.strated by the limited skills and the lack of basic education of counterpart staff assigned to the technical assistance personnel. 20. Project Implementation has also suffered from difficulties and delays In payments of counterpart funds. This problem has derived primarily from the weak financial performance of the public sector. This situation, coupled with occasional suspensions of disbursements by co-financiers, has had a negative Impact on the execution of projects. Another major constraint to project iaplementation has been the difficulty of attracting effective technical assistance to work in the country. -8- 21. In view of these problems. IDA has made several adjustments to Improve portfolio performance. IDA-financed experts, Increasingly contracted for short-tom assigments rather than as substitutes for local staff, are helping the Goveaoekt put In place training program for local staff in poject financial Vanagement and accounting. IDA Io also emphasising skills transfer In the signment and evaluation of technical assistants. Finally, IDA io Intensify project supervision to address problems before they seriously prejudice the attainment of project goals. In December 1991 IDA assigned to its resident representatire (based In Brassaville, Congo) a more regional role, including responsIbilities for first line supervision of IDA's activities In UQG. 22. Country Lending Strategy and Objectives. The overall objective of the Bank's assistance strategy will be to support government efforts to% (a) strengthen economic management In a manner that will create a favorable climate for private sector production and Investment; (b) promote long-term sustainable growth conducive to poerty reduction and jarovement of basic livg conditions; and (c) develop a framework for strengthening the management of land and forestry resources, with special emphasis on reforestation and natural environment protection. 23. Quantitative Targets and PolicZ Benchmarks. For the purpose of monitoring progress In the Implementation of the country strategy, a number of quantitative targets and policy reform benchmarks have been established. The key quantitative targets for 1992-94 are set out in paragraph 10 and the table on key macroeconomic Indicators. These will be closely -anitored to determine whether the eionay is performing as desired or whether policy adjustments are needed in light of changing circumstances. 24. In addition, to monitor the Implementation of agreed reforms, the following key policy benchmarks are incorporated in the PFP: (a) adoption of annual government budgets that are consistent with the targets and objectives of the programt (b) enactment by end-March 1992 of the revised Investment Law; (c) completion by end-March 1992 of negotiations with debtors regarding 40 percent of unreibursed bank loanas (4) completion by October 1992 of the process of tailoring the size of concession areas to the installed capacity of the logging companiest (e) enactment by end-December 1992 of legislation clarifying Individual property rights; (f) Initiation of an inventory of forestry resources on the island of Bioko and of a land utilization study which would serve as the basis for the formulation of a comprehensive natural resource management program. 25. IDA Leading Program. In response to the failure of the first economic reform program initiated in 1988, IDA revised its lending strategy in 1990-1991 to link its operations much more closely to country performance. The approval of the PFP program In December 1991 reactivated IDA lending. The current base case lending program consists of institution-building projects which address long-tem development issues, amounting to a total projected investment of about US$ 18 million over the period 1992-94. The base lending progra would comprise a Second Petroleum Technical Assistance Project (US$2.5 aill.on) that would assist the Government in the management of the petroleum resourcest the proposed Realth Improvement ProJect (US$5.5 million) that would address key sectoral constraints to the delivery of basic health services,- focusing an improving human and financial resources use and combating the most debilitating endemic diseases; and, gatural Resarces Management and Conservation Project (US$10 million) that would strengthen government* a capacity to preterve as well as ratlonally use its forest resource and protect its blodiversity. ID** current best estimate of the financing gap for the PFP period (1992-94) 1# about t8i10 million. If achievement of PPP targets and benchmarks is satisfactory, and a financing gap still remains, IDA would be willing to deploy some of its scarce staff resources an a preparation of a SAL in aid-199i. This operation could supplement the Fund's conditionality in the light of the results of IDA's Public Expenditure Review, the ongoing affectation of oil revenues and additional key reforms leading to long-term growth. 26. IcEamic Nanamat. To Aplement the above strategy over the next three )ears, IDA's economic and sector work program, as well as its lending operations, will focus on public sector management and the critical petroleum sector. A first Public Expenditure Review, to be carried out in F9, aims at providing guidance to Government on the allocation of resources and at improving public expenditure -anagement and domestic resource mobilization. The study will be conducted in close collaboration with the Government a results will be phared with donors. A Diagnostics Study of the functions and seapower resources of the Ministry of Economy, Commerce and Planning will be launched In 1992. The results of this study should suggest how existing resources could be redeployed to increase the efficiency of public administration. Building on previous petroleum sector work and the first Petroleum Technical Assistance Pkoject (Cr. 1304-EG), a planned second Petroleum Technical Assistance Project, scheduled for Board presentation in Juno 1992, will assist the Government to: (a) increase production and revenues from the petroleum sector through appropriate policies (b) prevent energy waste and pollution by putting in place methods of utilizing natural gas produced as a by-product; and (c) strengthen the Ministry of Hydrocarbons's technical capabilities. 1QG became a member of the International Finance Corporation (IFC) lnty on January 10, 1992. Hence, although private sector development is a central feature of the PPP program (see paragraph 15 above), there have as yet been no 10 Investments. However, following on IDA's proposed second Petroles Technical Assistance Project, IFC will look into possible cooperation In the petroleum sector. 28. Poverty Alleviation. IDA strategy in regard to poverty . alleviation is two-folds (a) to initiate the longer-tern actions needed to achieve sustained GDP and employment growth; and (b) to provide assistance with an immediate impact on the most vulnerable groups. The implementation of the IDA-financed Crop Diversification and Agricultural Service Project (Cr. No. 2181-MG), approved in October 1990, will help reduce rural poverty, improve nutrition and food security, enhance the role of women farmers, and raise foreign exchange earnings. A key objective of the operation Is to ensure that the rural poor participate more fully In the benefits of economic growth by improving extension services. In addition, the Government has established a Poverty Alleviation Fund to supplement village-level credit requirements for smallholders. Esy policy benchmarks to be achieved under the Crop Diversi- fication Project are tot (a) establish by March 1992 an institution to provide credit to small farmers; (b) complete by June 1992 a study of the marketing - 10 - outlook for the nontraditional export crops; and (c) create by December 1992 a marketiag Infosation system for food crops. 29. Human Resources Development. IDA's activities In the human resources fic cd would seek to improve access to basic social services. The Primary Education Project (Cr. No. 1797-IG), approved In May 1987, is aimed at combatting illiteracy in the rural areas, where the majority of the poor live. The major objective of this project Is to assist the development of primary education by supporting goverament efforts to reorganize and expand primary education and strengthen the Ministry of Education. The Health Improvement Project proposed to this Memorandum will focus on providing basic services for vulnerable groups, Including women and children and the rural populations. The project would help raise Investment as well as increase capacity for service delivery In the critical areas of primary health care, including mother and child health, family planning and endemic diseases control. 30. Environment. Significant IDA technical and financial resources will be allocated to strengthening the overall management of natural resources, particularly, reforestation and environmental protection. The country has adopted the Tropical Forestry Action Plan (TFAP), and a National Forestry Action Plan (HRAP) was prepared with the technical support from the IDA-financed Technical Assistance Project. With funds from a Japanese grant, administered by IDA. the Government is currently preparing two environmental studies on the Impact of forestry exploitation on the island of Bioko and the elaboration of an action plan for natural resource management. Until the results of these studies are available, the Goverament has agreed to allocate no new forestry concessions. In addition, with support from the Norwegian Consultant Trust Fund, the Government will undertake complementary studies on concessions policy, forest fees and taxes, and on forestry and environmental protection policy. The trust fund is also financing the environmental assessment for a proposed IDA-financed Natural Resource Management and Cocervation Project. The project's overall objective would be to assist the Goverament to Implement a national natural resource management plan, leading to a sustainable and environmentally sound utilisation of forest resources. Aid Coordination and Relations with the INF 31. The international donor connity expressed support for EQG's first adjustment program during the UNDP Round Table conference, held in Geneva in November 1988. In view of the need for active efforts by donors, it was agreed that sectoral meetings ould be organized to allow more specific coordination among all the parties Involved. This task has been facilitated by the commitment made by the UNDP as the lead agency for sector coordination in the field. Accordingly, under U1DP auspices, a sectoral meeting on agriculture took place in November 1989; an infrastructure follow-up meeting was held in early July 1990; and donor consultations on health and education took place in February 1992. IDA and the IMP have collaborated closely on the design, Implementation and monitoring of EQG's structural adjustment program. This collaboration has been particularly effective in getting the government to focus on key macroeconomic measures as well as long-term structural reforms. 32. IDA is helping the government to Improve aid coordination through its work on public expenditure programing (see paragraph 26 above). It is also helping Improve coordination by advising donors of the reforms needed, monitoring performance Implementation and financing needs, and encouraging donors to support areas of the adjustment program where they have specific expertise. Now that the PPP bas been approved by the IDA and IMF Boards, 8RW will be proposed for Inclusion in the Special Program of Assistance (SPA) at the April 1992 meting. If SG Is Included in the SPA, that venue would be an appropriate forum for seeking additional donors' assistance as well as for regular reporting by ID& on country performance. Sumary Assessment 33. Although 8V* Is generously endowed with natural resources which, if properly managed, could support enhanced growth, economic perfousance has . been Inadequate and the country still faces several development constraints. These constraints are reflected In the Government's Policy Framework Paper for the next three years, as well as in IDA's assistance strategy over the same period. This strategy has three objectives. First, through economic and sector work and Investment leading, IDA will help strengthen economic management in key areas set out in the PPP program, the main elements of which have been identified above. Second, through investment lending, IDA will assist the Government In promoting sustainable growth conducive to poverty alleviation and improving basic services. Third, through sector work and Investment lending. IDA will assist the Government develop a framework for strengthening the management of natural resources, with especial emphasis on reforestation and environmental protection. Progress in strategy implementation will be evaluated on the basis of agreed quantitative targets and policy reform benchmarks. iI. The Proposed Credit 34. The proposed credit would be made on standard IDA terms with 40 years maturity and would help finance a Health Improvement Project. The principal implementing agency would be the Ministry of Health (NO). 35. The Government assigns a high priority to Improving the basic health of its population as an Integral part of its economic and social development strategy. With donor assistance it has been attempting to revamp health activities which were severely disrupted by political and economic upheaval between 1969 and 1979. Despite Government's efforts to restore essential health services, endemic and parasitic diseases continue to be rampant, causing high morbidity and mortality. the dominant pathologies are malaria, tropical endemic and infectious diseases, intestinal parasites, traumas, childhood Infections, diarrhea, respiratory diseases and nutritional deficiencies. MalarIa accounts for about 402 of all deaths of children under five and over 202 of all deaths in the general population. There are programs to combat tuberculosis, onchocerclasis, leprosy and schistosomiasia. Sexually transmitted diseases are a growing concern but, except for the WHO-sponsored AIDS project, no program currently exists to control them. Sanitary, housing and water supply conditions are poor, and the incidence of infectious diseases, and related morbidity and mortality are high. The intant mortality rate (12011000) is high. Life expectancy at birth averages 48 years. With a total population of 350,000 inhabitants, the estimated population growth rate * 12 - of 2.4Z is compatible with the projected average GDP growth rate of 62 over the next few years. This balance to fragile however, and family planning focused an safe motherhood remains necessary to iUprove mother and child health. 36. Until recently the health sector lacked a clear strategic framework to guide the Goverament's and donor's resource allocation decisions. This situation was compounded by MR's weak planning and management capacity, insufficient and poorly qualified and distributed health personnel, and limited operating budgets with the resulting chronic shortage of essential drugs, materials and service equipment and facilities. During preparation of the proposed project, the Government drafted a new strategy to address the country's health problems. The strategy identifies two broad goals to be achieved over the medium-temns (a) institution building and human resources development in the sector, and (b) morbidity and mortality reduction through promotion of primary health care (PEC). There is also a need to strengthen central coordination of foreign assistance to the sector to eliminate the present duplication of efforts. Indeed, a large part of EQ's health needs is met by external donors but the programs financed are not coordinated by MOR, and in most cases do not address the fundamental constraints of the health system and policy issues that must be overcome in order to improve care delivery. MDB needs to build up a functioning public sector service to cushion unforeseen changes in donor contributions over the longer term. Hospitals suffer from the same deficiencies, and their infrastructure (buildings and equipment) is old and In total disrepair. The Government is committed to irproving the health indicators by strengthening health policy formulation and sector management, developing sector human resources, and gradually building up its own capacity to deliver basic health care for the most vulnerable groups. Rationale for IDA Involvement 37. The project would address the health sector's structural weaknesses and basic policy and management issues of the health system, and would lay the basis for more effective interventions by the Government and the donors in the future. The infusion of badly needed drugs and work equipment would help mitigate the social consequences of the current economic and financial crisis in qQG, and protect vital human resources objectives. IDA has a comparative advantage in addressing sectorwide and policy issues such as sector management, ministry restructuring and cost recovery, all of which are needed to ensure the long-term viability of the health system and the sustainability of the Government's economic and social reforms. The project is a suitable vehicle for applying Improved health strategies, developing human resources and external aid coordination as well as strengthening field operations. Project Objectives 38. The objectives of the project are to% (a) strengthen the capacity of MR to plan, coordinate and monitor EQG's health sector activities, based on a coherent sector policy and strategy, by instituting management reforms, gradually building up a credible management system and team, and training of health personnelt (b) Improve the quality of its field services in critical areas (primary health care, mother and child health and family planning, - 13 - supply of essential generic drugs, and control of major diseases); and (c) strengthen its PbIlity to guide and coordinate donors, contributions to the health sector. These measures are designed to reinforce the Ministry's capacity to put in place an effective and sustainable health delivery system. Project Description 39. The project has four major components* I) Institutional Strenathening of the Ministry of Health (20% of base costs) to reorganise MR's central structure and decentralise functionst help institute a process of continuous health policy and strategy review, planning and programming of activities by a permanent oversight committee (a Managing Committee - MC) of senior managers of MR led by the Minister (with periodic participation of representatives of donors and service users) responsible for sector management and overall supervision of MO's services and coordination of foreign assistance; and Improve basic care delivery through provision of material support and training of MR staff. The project would finance the costs associated with the restructuring of MDR services, training workshops and seminars for staff at all levels, and health center reconstruction and N08 office rehabilitation works, furniture and medical equipment. Reforms aimed at management and financial autonomy for the main hospitals of Malabo and Data would be initiated in collaboration with French aid. 11) Health Strategy Development and Implementation (62 of bass costs) to establish a management information system and a health planning unit in MB to carry out investment analysis, programing and monitoring of its execution, and to refine and revise periodically the national health strategy. Other measures would strengthen financial management and budgeting within MR and establish accounting procedures and controls for cost recovery funds. The project would finance health data collection and processing, material and equipment for statistical work; technical assistance and consultant services for studies. iii) Human Resource Development (62 of base costs) to train health sector personnel and Improve MON's technical and management capacity at all levels of the health system. Short-tera technical assistance would reinforce existing personnel capacity. Training would Include in-service and formal training in EQ for nurses, traditional birth attendants and village health workers; selective specialised training abroad for doctors; and support for the National School of Health in Bata with training equipment and furniture; and iv) Strengthening of Priority Health Programs (552 of base costs) to improve MDR's operational capabilities and test new approaches to health care delivery by strengthening field work in malaria control, mother and child health and family planning, and sexually transmitted diseases, and by providing essential generic drugs, with a special focus on most vulnerable groups, i.e. mothers, children and the rural poor. The project would finance the rehabilitation of four rural health centers in the remote rural districts of Micomiseng and Acurenam which are currently underserved, equipment for the mother and child and family planning clinics in Malabo and Bata, and supplies of essential medical materials and drugs to all these facilities. Cost recovery would be introduced through a differentiated fee structure favoring vulnerable groups, thus perAitting cross-subsidisation to help sustain the program and protecting the poor from hardship. 14 - 40. Project Finanacfgs The total cost of the project estimated at about US$6.0 million would be shared by IDA (US$5.5 million) and the Government (US$0.5 million). ProJect Implementation 41. The MO would be responsible for the overall implementation and management of project activities, which will be Integrated into its existing services. The Managing Comittee (MC) described in paragraph 39 (1) would supervise and monitor the execution of the project by the various technical services and line units of MDB. The MC would be supported by two units. A health Planning Unit (PO), to be reinforced by the project and reporting through the Director General of Public Health and Planning and the Secretary General of the Ministry of Health, would act as a secretariat for the MC and a focal point for planning, programming and coordinating all health sector activities and coordination of external aid. The Administration and Finance Unit (AMU) of the Ministry, In addition to its normal functions, would support the MC in the areas of accounting, procurement and general administration of the project. The technical assistance included in the project is designed to strengthen these structures which would serve not only the IDA-financed project but also all other projects undertaken by the Government. Comuanities' and NGOs* active participation and cooperation would be sought in implementing the malaria control and the essential generic drug components. Major project components are expected to be implemented over four years and the closing date for the IDA credit would be December 31, 1998. The disbursement forecasts are In line with the Africa Region's historical disbursement profile for ZQG. IDA would fund both the incremental recurrent costs and developmental costs. Resource allocation across major health programs and services and investment plans for the sector would be prepared by MOH and discussed with IDA at the beginning of each calendar year; and a mid- term review of the entire project would be undertaken jointly by the Government and IDA after two years of implementation to assess progress and, if necessary, refocus the project objectives in light of the experience gained (Sections 3.04 and 3.10 of the Development Credit Agreement). 42. Project Sustainability: Adoption of a clear operational strategy, improved sector planning and management by MO, regular supervision of the health services and more competent health personnel would result in increased institutional sustainability of the Project. The internal mobilization of resources through the cost recovery system would promote self-reliance for increased levels of recurrent spending for health care, and is designed to provide sustained additional resources for the sector. The project would require an infusion of additional budgetary resources from the Government that is deemed fully compatible with its resources and priorities. 43. Lessons from Previous IDA Involvement: The experience with other IDA projects suggests that weaknesses in project management, lack of government counterpart funds, deviations from agreed procurement rules, and delays in submitting project audits may occur during Implementation. Problems have also been reported with respect to the statement of expenditure disbursement procedure. To counter these problems, a Managing Committee of MOR senior managers with a strong supervisory role would oversee the project execution process; local staff have been trained (with PPF funds) In IDA-style contract award procedures and disbursement, and would handle procurement and disbursements; and independent private sector auditors would be selected by - 15 the Government before credit effectiveness to assist with the audit requirements throughout the project life. Daring project execution the Government would aske annual deposits of CPAF 150.8 million (about US$525,000) to be disbursed in four quarterly Installments of CFAP 37.7 million (about US$131,000), in a Counterpart Fund Account in the Central Bank (BEAC) for use by MDH to finance the non-wage recurrent expenditures of the health sector (Section 3.07 of the Development Credit Agreement). Areed Actions 44. Agreements reached with the Government Includes 1) as conditions of IDt credit effectiveness, (a) payment of the first quarterly Installment of CFAF 37.7 million as part of the increase of the MDR budget by March 31, 1992, for deposit in a project Counterpart Fund Account at the Central Bank (EAC) to help meet the non-wage recurrent expenditures of the health sector and the Government's initial share of project costas (b) formal approval by the Government of the new organisational structure of MDR establishing and staffing the Managing Comittee (MC) of senior managers, the Planning Unit (PU) and the Administration and Finance Unit (APU) as permanent structures of MON, responsible for health sector management and coordination, investment and program planning, and project accounting and general administration respectivelyg and (c) establishment of an adequate accounting system for the Malabo and Data hospitals and training of staff to operate itt and 2) as a condition of disbursement of IDA funds for drugs, enactment of decrees authorizing the collection and management of cost recovery funds from drug sales and medical services by the project health centers and their retention for financing non-wage operating expenditures (Paragraph 3 (b) of Schedule 1 of the Development Credit Agreement); and 3) satisfactory arrangements for project execution, including annual reviews of new health Investment and budget resource allocation across programs and services with IDA and a joint Government/IDA mid-ter review of the entire project after two years of implementation progress as well as an impact evaluation of cost recovery measures on health care services utilization (Sections 3.04 and 3.10 of the Development Credit Agreement). 45. Environmental Aspectss The environmental category assigned to this project is C. There are no significant environmental and natural resource management issues Involved in project design; consequently no special actions relating to the environment are proposed. However, under 'e malaria control program, we would use limited quantities of household insecticides to control mosquitoes in homes, and only environmentally sound and hataless Insecticide products would be purchased. * 46. Program Objective Categoriess The proposed project addresses EQG's antipoverty strategy by expanding essential primary health care services to rural populations in remote and underserved districts and to vulnerable groups (mostly women and children under five). It would Improve the quality of and access to basic health care for about 60,000 in those areas, representing 172 of the total population of EQG. - 18 - 47. Prodect Senefites The project is expected to improve the efficiency and effectiveness of health sector programs and to strengthen coordination of intra-sectoral activities and donor aid. Reinforcing MDN's institutional and management capacity, through strengthening of the MC, PU and AFV, would lead to better planning of policies and programs, and improved management of the health sector, thereby enhancing its effectiveness. Strengthening the priority programs would establish the beginning of the development of a sustainable primary health care strategy while Improving the capacity of Goverment-run health units to deliver quality care. Cost recovery measures would Initiate Internal mobilisation of resources needed to operate the health centers and to ensure regular availability of essential drugs in the public health system. About 60,000 women and children and their families would benefit from the primary health care program in the Continental Region. Malaria control activities would protect an additional 80,000 people living on Bioko Island from a major public health threat. Increased availability of essential drugs and improvements in the quality of care would lead to greater utilisation of health services by the general public in EQG, thereby reducing illnesses and premature deaths from preventable and curable diseases. 48. Risks& The project would be the first IDA-financed operation in the health sector in EQG and MDB has no experience in implementing a project of this scope. There is therefore a risk of delays in Implementation. In addition, HDR's capacity to plan, manage and coordinate health programs is weak, and the qualifications of local staff are inadequate. The risks were first addressed through streamlining of project objectives and a simplified project design, and would be further mitigated through technical assistance, training of MO staff at all levels, a strong supervisory role for the Managing Committee of MO0 senior managers, annual reviews of the work programs and a mid-term review of overall performance of the project as well as intensive supervision by IDA. Recoendation 49. I am satisfied that the proposed credit would comply with the Articles of Agreement of the Association and recomend that the Executive Directors approve the proposed credit. Lewis T. Preston President Washington, D.C. February 6, 1992 Attachments - 17 - Schedule A Z=qua"t Mmaa MALTB IPROVSEIT PROJECT Swumary of Project Cost Estimates (net of taxes and duties, in US$ 000) Local Foreign Total 1. Institutional Strengthening of (a) MR's organitsation, planning and 435 353 788 management (b) Rehabilitation of MR offices in Malabo and Bata 61 148 209 2. Realth Strategy Development and Implementation 266 41 307 3. Strengthening Priority ealth Programs (a) Malaria Control 94 210 304 (b) PRC and MCRIPP Centers (works and equipment) 35 1,137 1,172 (c) Sexually Transmitted Diseases 60 166 226 (d) Pilot Program for Essential 33 967 1,000 Drugs (including repairs to drug warehouses) 4. Ruman Resource Development Training, Fellowships and Studies 235 70 305 5. Project Preparation Advance 0 750 750 Total Base Costs 1,219 3,842 5,061 Physical Contingencies 122 309 431 Price Contingencies 149 359 508 TOTAL PROJECT COSTS 1,490 4,510 6,000 Financing Plan (in US$ million) IDA 1.17 4.33 5.50 Government 0.18 0.32 0.50 TOTAL 1.35 4.65 6.00 - 18 - Schedule B Page 1 of 2 EQUATORIAL GUINEA REALTH IMPROVEMENT PROJECT PROCURUEENT MBTHODS AND DISBURSEMENTS Procurement Arrangements (US$ '000 equivalent) Procurement Methods Project element ICB LCB Other N.I.F.' Total Cost Civil Works 908 311 1,219 (908) (311) (1,219) Furniture and materials 90 90 (90) (90) Medical/Technical 1,875 1,875 Equip. and Drugs (1,703) (1,703) Vehicles 149 149 (149) (149) Technical Assistance 4971 497 (497) (497) Training. Fellowships 773 773 and Studies (773) (773) Incremental Operating Costs (travel, subsis- tence, fuel, supplies, maintenance, project staff salaries) 300 347V 647 (177) (142) (319) PPF Repayment 750 750 (750) (750) TOTALS 3,022 611 2.367 6,000 (2,850) (488) (2,162) (5,500) af Employment of technical assistance would be in accordance with IDA Guidelines. kI Includes minor items (repair contracts, office supplies, etc.) costing US$10,000 or less which would be procured internationally or locally on the basis of price quotations from at least three reputable suppliers. * .I.F.t Not IDA Financed Lotgt Figures In parenthesis are the respective amounts financed by the IDA credit. - 19 - Schedule B Page 2 of 2 Disbursements Amount of Credit Allocation 2 of IDA Category (US$ '000) Disbursement 1. Civil Vorks 1,020 1002 of expenditures 2. Furniture, equipment, 943 1002 of expenditures vehicles and materials 3. Drugs 631 902 through Dec. 31, 1994 60Z thereafter 4. Consultants' services, 1,093 1002 of expenditures training and fellowships 5. Incremental Operating Costs 273 90% through Dec. 31, 1993 (net of salaries) 602 through Dec. 31, 1995 30X thereafter 6. Refunding of PPF advance 750 Amount due as specified in Section 2.02(c) of, the Credit Agreement 7. Unallocated 790 TOTAL 5,500 Estimated Disbursements IDA Fiscal Year (in US$ million) 1992 1993 1994 1995 1996 1997 1998 Amount Disbursed 1.031 0.98 1.59 1.36 0.33 0.19 0.02 Cumulative Amount 1.03 2.01 3.60 4.96 5.29 5.48 5.50 )f Includes repayment to 1DA of PPF advance of US$ 750,000 - 20 - Schedule C gUATO L GUINE EiALTm DTROYUM? PROJECT TIMTa5 07 mE PROJECT POCESSING EVElTS (a) Time taken to prepare: One and balf years (b) Prepared by: Goverment and IDA (c) FIret IDA migsion: November 1988 (d) Appratsal Departure: October 1991 (e) NegotiatIons: January 1992 (f) Planned Date of Effectiveness: April 1992 (S) List of relevant PCRa and Prs: None - 21 - Schedule D EMRA? DefOum~I LSJC m ~m In EMATIAL GUINE A p Of stat t of LM fil IDA credits (t.A data of 1213n1 - li data as of 02//92) Auat ln USSilIIon (less caeilatfons) Lmn or Fisc&I Urnla- closing Credit No. Ysar BorrT PWrose . uan* tDA bursd Date CrIdIts 5 Crodita(s> olasd 21.70 Cl14-6 1984 EWATIIAS QUINXA TWIICAIi A MSSSTaCE 8.0 .64 OSM/MI) C1TO4-E 197 EMATOIL GulINEA EUCATION 1 5.10 3.84 0~ C21810.m 1981 (OATiIAL A CIN w iV & AMIC 8 6.30 5.27 12/M1/S TOAt nm Credits 3 17.40 9.5 TOTAa 38.10 of *Ich roaid TOTA. held by k* a* IDA 39.10 Anaatt sold of xhich rmpuld TOTAL uglsbrusd 9.nd l kit y4 fftiv * A ~ RMI~ , ldi ustanding balma rprset b»t ective and itive LaM and Crdits. m adiet amtrevisd Clg OMt. Indie .aons fad m its. he Nit ArM9 and k* R0~ayuts arG hltorical value, all ~tturs ar uarke t vale. SS~ising, Efft ve, and Closing dates ars basd Ua. th% LM OPrt nt offloal data and ar nst tal1n Tk ~ ;udt e. .&&. & 奮 . __!-.！〕｝〕｝!!．…’&1&.，…’- . 23 - ÄN N EX Page 2 of 5 ~TMDL GUSNU 841~ of Pa~ta of uffi J909 lom tuff nu im im im im lm 19" len marchandlco I&Ap~ *bl 28.4 34.6 ~ 44.4 Uj 475 Gå.o, wl 89.4 marelsandi m luffru {of Ifs -tt a -41.1 -64,9 -a st -a 4 -«.0 -92.7 .48.1 -64.3 -GILJ -«.4 Tr~ Dc~ -73 -446 -14.4 -»:# -19:7 -26-15 -49.6 -8.1 2.7 4.9 4.0 N~ *~ I e UrvIcom (~ ) 0.6 6.1 6.6 8.4 6.0 4.7 4,7 4.9 6.1 6.4 Kon-Facur servIcoa ~ %) -moi -WIN -~ -47.0 -46.6 -47.9 -«.& -44.6 RG~rcm 4914~9 -7.4 -68.0 ý«.$ -47-6 -100.9 -mJ -43.7 -43.4 F«mr,servle** ~) -4.3 -4.4 -4.8 -6.6 -6.7 -63 -4.1 -8.9 -4.3 -11.0 Fachor servIcow (CMI%) 0.0 2.1 2.1 2.4 2.4 t-t 2.8 2.1 2.8 2.8 2.9 Factor servicow (dohN) -4.3 -6.9 -6.6 -7.9 -7.9 -4.6 -4.3 -7.4 -6.9 -6.9 -6.9 alv 1~~ Pa~ta -4.3 -6.9 -4.6 -7.9 -7.9 -6.4 -4.4 -7.4 -6.9 -9.9 -6.9 G" and sorvlc« %1~ -11.9 -26.4 -49.4 -0.19 -94.4 -73.2 -106.9 -61.0 -47.0 -47.6 -4.4 Cur~ T~ wo 9.7 29.3 24.2 48.6 41.9 84.4 N. 1 44.9 47.0 47.7 46.7 PM la Traneforc 4.7 243 ».* 49.9 46.1 5114 59.6 46.9 61.0 61.1 54.2 *iv PIP Grant* 7.8 19.6 24.6 29. 9 a. a 48.9 UA 44.4 41.6 44.6 49.4 8~ rT *id 1.1 2.6 1.4 1.9 2.4 2.0 1.6 0.4 0.4 0.4 0.7 currcut, ~ fit sölancc -4.1 -2.1 -16.0 -12.9 -19.9 -60.6 -4.2 0.0 0.1 2.9 currant Act~ gala~ 1/ 10.7 21.7 49.6 44.6 90.6 411.7 108.2 41.6 41.8 46.4 41.0 Capita; Accomfit solanom -11.4 2.5 6.8 8.6 1.8 11.9 29.3 -11.? -16.7 -16.6 -19.8 Pub$ Ic & Guer. Capita§ (not) -7.0 -1.0 9.6 11.4 2.8 6.7 -9.6 -4.8 0.9 1.6 1.4 Oldunm~tg (Ulm) 8-2 10-9 22.7 21.6 11.6 14.0 6.4 It.4 16.0 _14 a 16.8 Amortjaatlon -11.2 -9.4 -9.9 -6.1 -7.3 -8.9 -14.3 -1,9.7 - 14.2 143 -18.7 Capita# avbacel löna -2.0 -2.6 -3.2 -2.1 -1.9 -1.6 -0.7 0.0 0.0 0.0 0.0 Oth,er LT Taf f mm ( 0.0 0.0 2.9 1.9 0.4 11.0 40.4 -10.9 -18.6 -16.2 -16.2 0~ W Inflowe (mg) -4.4 3.6 -7.2 -6.9 -1.6 -4.2 -1.7 -0.6 -1.0 -0.9 -0.9 Orom bred OmInelonc 0.9 -1.0 -0.4 -fJ -8.4 -8.1 0.0 0.0 0.0 0.0 0.0 ov*re I l got anew -13.7 -0.4 -20 -14.6 -9.4 -21.3 -17.9 -16.7 -34.6 -13.0 Flnafflows 19.7 0.6 29.1 11 14.4 9.4 21.9 17.9 18.7 18.4 13.0 o~ - " ~ R«ervm (;Acr 4.0 -4.9 14.1 1,3 8.1 -1.2 6.6 0.1 -0.6 -0.6 -0.4 Oporatlo~ accouftt 6.6 -7.0 9.9, 1.0 2.6 1.6 -0.7 0.1 0.0 0.0 0.0 Ula of c~ h f pm U* 1 -1.6 -1.6 0.0 -.6 -8.4 -2.4 6.9 0.0 0.0 -1.0 -0.9 Porchö*** 6.6 0.0 0.0 1,1 * 0.0 0.0 7.4 0.0 0.0 0.0 0.0 R"mrch*c« -7.0 -1.6 0.0 -0.4 -9.6 -2.4 -0.6 0.0 0.0 -1.0 -0.9 0~ R~r« c~ -0.1 2.4 6.4 -7.2 4.3 -0.4 -0.4 0.0 -0.6 0.5 0.4 change N gerffre -30.1 8.6 6.6 9.7 8.9 10.8 11.8 -80.0 0.0 0.0 0.0 0~ rellef Ohulffiw 9.4 2.9 0.0 0.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 ftancl ng Up 90.4 0.0 0.0 0.0 4.4 0.0 4.1 47.9 16.2 16.0 13.6 0~ Relief 90.4 0.0 0.0 0.0 4.8 0.0 0.0 46.9 19.3 13.0 12.9 0~ r*# Icf ma 0.0 0.0 0.0 0.0 0.0 0.0 0.0 16.2 16.9 133 12.4 R~~ Ing of arreara 80.4 0.0 0.0 0.0 4.4 0.0 0.0 30.1 0.0 0.0 04 Romalftlös fl D' mine lag 0.0 0.0 0.0 0.0 0.0 0.0 4.1 1.6 0.9 2.1 1.0 1/ «cl. off. 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IORD 22!% 10, RIAL GUINEA HEALTH IMPROVEMENT MALABO PROJECT A PROJECT HEALTH CENTERS Hosprms EKISTING ASPHALT ROADS Grande EYJSTING LATEVTE ROADS 11111pa <\ PLANNED ROADS 8 1 0 K 0 ba RIVERS PORTS + AIRPORTS BRIDGES NATIONAL CAPITAL INTERNATIONAL BOUNDARIES (Dulf of 0U;n'-cj Ebol 10 ae 2 'KILOMMT& 0 10 20 :;0 ;0 5,0wim CAMEROON Pic cam Mi Ayaml Ken 8eQY*P Andoc 0 Ebebion lu Ion ANNOSON I. Ebain k 0 Wang iIN 0 N- r3w Anisoc I Ntobo nga Sony* R I M U N I Mongomo V, Mw Acc bet z It K) 0 NIGER Ov-ng Evincyong coloffwom Asok M < NIGERIA CHAD Aconibe Acclayong C AFRCAN Nguelensoc Nsork BIOKO Remy CAIOM renom aCW GRANDE IS Arnim L'UWA ABON GABON AIRE This has been prepared by The World Bank's staff exclusifv= o the conven once of readers and is exclusively for the intemal use of World Bank Group. The denominations used and the boundaries sho" on this map do not imply, on the part of The World Bank Group, any judgment on Ow legal status of any ferMory or any endorsement or acceptance of ANGOLA such boundaries. 10, DECAMBER 1991