Burkina Faso - Health and Nutrition Project (PDSN)

Dc.ment of The World Bank FOR OFFMClAL USE ONLY - 7)~~~~~~~~~~~~~~~~- Report No. P-6297-BUR MEMORANDUM AND RECOMMENDATION OF THE PRESIDENT OF THE INTERNATIONAL DEVELOPMENT ASSOCIATION TO THE EXECUTIVE DIRECTORS ON A PROPOSED CREDIT OF SDR 21.2 MILLION TO BURKINA FASO FOR A HEALTH AND NUTRITION PROJECT (PDSN) MARCH 9, 1994 MICROGRAPHICS Report No: P- 6297 BUrs Type: MOP This document has a restricted distribution and . - their official duties. Its contents may not otherwise be disclosed without World Bank authorization.  CURRENCY EQUIVALENT Currency Unit = CFA Franc (CFAF) / US$1 - 270 CFAF (Rate prior to January 12, 1994) Current Rate = CFA Franc/US$1 = 580 CFAF WEIGHTS AND MEASURES Metric System 1 m. = 1.09 yd. I sq.m. = 10.76 sq. ft. GLOSSARY OF ACRONYMS CAMEG Centre d 'approvisionnement des medicaments essentiels generiques or Procurement Center for Essential Generic Drugs CHR Centre hospitalier regional or Regional Hospital Center CMA Centre medical avec antenne chirurgicale or Medical Center with Surgical Unit CSPS Centre de sante et de promotion sociale or Health and Social Development Center FHP First Health Project MSASF Ministry of Public Health and Social/Family Action OCP Onchocerciasis Control Program PDSN Projet de developpement de sante or Health and Nutrition Development Project UNICEF United Nations Children's Fund Fiscal Year July I - June 30  FOR OFFICIAL USE ONLY BURKINA FASO HEALTH AND NUTRITION PROJECT (PDSN) CREDIT AND PROJECT SUMMARY Borrower: Burkina Faso Beneficiaries: Ministry of Public Health and Social/Family Action Credit Amount: SDR 21.2 million (US$29.2 million equivalent) Terms: Standard, with 40 years maturity Financing Plan: ID,^ 29.2 (in US$ million) GOV 2.0 KfW 4.1 UNICEF 3.6 Total 38.9 Economic Rate of Return: Not applicable. Poverty Category: Program of Targeted Interventions. Staff Appraisal Report: Report No. 12416-BUR Map: IBRD 25394 This document has a restricted distribution and may be used by recipients only in the pe1formance of their official duties. Its contents may not othenvise be disclosed without World Bank authoinziuon.  MEMORANDUM AND RECOMMENDATION OF THE PRESIDENT OF THE IDA TO THE EXECUTIVE DIRECTORS ON A PROPOSED CREDIT TO BURKINA FASO FOR A HEALTH AND NUTRITION PROJECT (PDSN) 1. I submit for your approval the following memorandum and recommendation on a proposed development credit to Burkina Faso for SDR 21.2 million, the equivalent of US$29.2 million on standard IDA terms with a maturity of 40 years to help finance a health and nutrition project. The Government of Burkina Faso would contribute US$2.0 million. Parallel cofinancing of about US$4.1 million and US$3.6 million is expected from the Federal Republic of Germany (KfW) and UNICEF respectively. 2. Country Economic Backgrround. Burkina Faso is a landlocked country with a population of about 9.5 million. With a per capita GNP of about US$290 in 1991, Burkina Faso is among the poorest countries in the world. In particular, the level of ht.,nan resources development is extremely lo-v. In a 1993 UNDP ranking of 173 countries according to their level of human resources development, Burkina ranked 170th. Basic social services are relatively undeveloped. The economy is dominated by the agricultural sector, which accounts for about 30% of GDP, generates over 60% of export earnings and employs almost 90% of the economically active population. With the other 12 countries of the CFA franc zone, Burkina Faso devalued its currency by 50% relative to the French franc in January 1994. 3. Sector Background. The health status of the Burkinabe population is poor as reflected by a life expectancy of only 48 years (1991) compared with the average for Sub-Saharan Africa (SSA) of 51 years (1991). A major contributing factor to this low life expectancy is high infant and child mortality caused by widespread contagious diseases, unfavorable hygienic conditions, malnutrition, and the limited capacity of the health system to prevent these conditions and to treat them effectively once contracted. The maternal mortality rate is also high at 810 per 100,000 births (1988). Less than half of all pregnant women receive any prenatal care, and only a third have births attended by health personnel. Nearly one in five babies has a low birthweight, greatly increasing the risk of infant morbidity and mortality. Only 19 percent of children under five are completely immunized, and the leading causes of infant and child mortality are measles, meningitis, malaria, respiratory infection and diarrheal disease. The impact of infectious disease is compounded by malnutrition. Nutritional surveillance data from 1991 indicate that 30-40 percent of children age one to four are at least moderately malnourished and nearly 13 percent are severely malnourished. Micronutrient deficiencies are widespread, resulting in high incidence of anemia, goiter, xerophthalmia and other nutrition-related illnesses. 4. Burkina Fasc, has traditionally been one of the countries in the world most severely afflicted with onchocerciasis (riverblindness). By the mid-1970s, this disease had reached epidemic proportions in 85% of Burkina and constituted a severe public health problem and major constraint to socioeconomic development of the rural areas. It was estimated that 15 % of the population at that time was infected with the disease. The blindness rate in the most heavily infected villages averaged 10% generally and 50% among villagers over 40 years of age. Through the Onchocerciasis Control Program (OCP), a regional Program now supported by 22 donors, including the Bank, and covering eleven West African Countries, transmission of onchocerciasis has since 1975 been interrupted throughout the entire country and the disease has ceased to be a public health problem. However, without further action at the national level to detect possible recurrence of the disease and provide treatment, the prospect of a resurgence of the disease in Burkina and a spillover into neighboring countries remains. 5. Project Objectives. The project would assist the Government in its efforts to: (a) improve significantly the quality, coverage and utilization of basic health services for the  2 Burkinabe population, (b) enhance the nutritional status of the population, and (c) develop a national capacity for achieving sustainable control of endemic parasitic diseases. 6. Project Description. (Percentage ef total project costs are indicated for each sub- component.) To achieve the above objectives, the Project (PDSN --Projet de DWveloppement de Sante et Nutrition) would support policy reforms and investment designed to: (1) improve qualihy, coverage, and utilization of health services by: (a) strengthening the health system pyramid (49.6% of total project costs) through : (i) functional upgrading/construction of health facilities and increased supervision of staff operations and of referrals at the primary and secondary levels which comprise the "health district"; (ii) establishing an effective maintenance system for "district" facilities; and (iii) improving operations of regional and national hospitals; (b) rationalizing staff use and promoting staff development (3.1 %) by: (i) establishing realistic and efficient staffing nLrms and implementing a staff redeployment action plan based in part on the results of the hospital sector study; (ii) supporting in-service training for district medical officers in supervision procedures; and (iii) upgrading skills of district level physicians in emergency surgical procedures; (c) decentralizing tlte public health system (10. 1%) by: (i) defining a country-wide system of health districts; (ii) providing for increased autonomy in planning and budgeting at the district and sub-district levels; and (iii) providing for community co-management of primary health services; (d) increasing availability of essential drugs (9.0%) by: (i) supporting policy reforms and implementing actions to promote importation and distribution throughout the health system of low cost quality generic drugs as a substitute for high cost specialty drugs; and (ii) establishiing an effective cost recovery policy which would ensure a sustained supply of essential drugs at the primary and secondary levels; (2) Reduce 'nicronutrient deficiencies by: (a) supporting supplementation of vitamin A, iodine, and iron in severely deficient areas (10.5%); and (b) developing a longer-term, durable national strategy for reducing micronutrient deficiencies, which would include inter alia dietary modification and/or food fortification (1.6%); (3) Achieve control of endemic parasitic diseases by: (a) strengthening the capacities of the health system to carry out epidemiological surveillance and treat detected cases of onchocerciasis (riverblindness), trypanosomiasis (sleeping sickness), and dracunculiasis (Guinea worm) through training and supervision of mobile teams and local health workers (2.7%); and (b) sensitizing target populations regarding prevention of transmission of these three diseases, through training and IEC campaigns (1.0%); (4) Strengthen the Ministry of Public Health and Social/Family Action (MSASF) by: (a) enhancing and rationalizing its capacity to more effectively concrol endemic parasitic diseases (1.8%); (b) strengthening its capacity to implement the reform of the pharmaceutical sector (0.7%); (c) establishing a management information system to track physical assets and personnel throughout the public health system (1.4%); (d) improving capacity to coordinate, monitor, and evaluate donor-supported health projects (4.3%); and (e) enhancing capacity to coordinate implementation of PDSN (3.9%). 7. Project Imnlementation. The project components would be managed and implemented by the MSASF. However, UNICEF will be the executing agency for the nutrition component, and subcomponents to decentralize the public health system and promote staff development related to the distribution of essential, generic drugs, under an agreement to be signed between the Government and UNICEF as a condition of project effectiveness. The Project Coordination Unit, set up under the First Health Project (FHP), would be responsible for interacting with IDA and for coordinating with MSASF directorates at the central and district levels as well as with the Ministries of Finance and Plan, and outside organizations such as NGOs, the Onchocerciasis Control Program, and UNICEF. 8. Project Sustainability. A major objective of the project is to promote sustainability in the health system by: (a) enhancing the autonomy and financial independence of the first and second tiers of the system, (b) redeploying personnel from urban to rural areas and  3 ensuring that they remain where posted, and (c) restoring the confidence of the population in the system to ensure effective use of existing health infrastructure. The project's emphasis on substituting generic for expensive brand-name drugs would make possible a partial cost recovery system (i.e.; covering at least the cost of essential drugs), which would help in sustaining the functioning of health services at all levels of the system. The nutrition component, in addition to immediate micronutrient supplementation, would pursue sustainable solutions to micronutrient deficiency based upon dietary modification and, where feasible, food fortification, (e.g. ensuring iodized salt). The principal objective of the project's endemic disease control component is to enable Burkina to sustain its single greatest health achievement in the past 20 years - full control over onchocerciasis. Simultaneously, the devolution component would aim to sustain control of trypanosomiasis in the onchocerciasis-fTeed areas and eradicate dracunculiasis. 9. Lessons Learned. The design of the proposed project corrects two weaknesses identified in the Operations Evaluation Department audits of World Bank health projects. These weaknesses have also hampered implementation of the First Health Project (FHP) in Burkina Faso. They are: (1) lack of decentralization, and (2) lack of improvement in the quality of care. PDSN emphasizes decentralization coupled with training and supervision through district management teams designed to improve the quality of care, and priority is given to improving the quality of services through existing structures. There are three other lessons to be learned from the implementation of the FHP. First, emphasis on providing buildings and other infrastructure will accomplish little if complementary changes in health care policy are not forthcoming. It became clear by 1988 that decentralization of health care services would be essential to project success but virtually all project activities were concentrated on the implementation of the investment component. Dialogue on the need to give the peripheral health facilities inore autonomy and discussions on the drug supply/distribution/import situation did not start until after the 1988 mid-term review of the FHP-too late to achieve timely adoption of the necessary complementary policy reforms. Under the proposed project these policy issues have been addressed during preparations and most necessary actions have been taken prior to negotiations. Second, despite a sizable project/Government input for training in the FHP, the impact of the training on improved health care is unknown. To avoid such a recurrence in the proposed project, IDA will review and approve the content of iraining programs prior to their implementation, and the Government will introduce a rmonitoring system under which supervisors will--at regular intervals-report on the accomplishments/shortcomings of former trainees. Third, introduction of the necessary policy reforms urder the FHP took too long because agreement on these reforms was only sought through policy dialogue during implementation rather than earlier during the processing of the Project. Under the proposed project virtually all policy reforms have been addressed up front, prior to negotiations. 10. Rationale for IDA Involvement. Low life expectancy ard high infant and maternal mortality rates partly reflect the low quality, unavailability, and underutilization of Burkina's health services. The second Five Year Development Plan calls for an ambitious program of construction and upgrading of health facilities during the 1991-95 period. To reach the rural and urban poor, improvements in, and expansion of. basic health facilities receive highest priority. Budgetary constraints preclude financing the basic health program without donor assistance. System-wide reforms such as those proposed by this project invK,lving the organizational structure of the health delivery system, redeployment of staff. basic financing mechanisms, and the refcn'm of the pharmaceutical sector go beyond most aonors' scope of intervention because of the extensive analytical work and policy dialogue required to get these reforms accepted and ensure that they are implemented. Health problems caused by micronutrient deficiencies such as blindness, cretinism, anemia, etc., could be corrected through relatively low-cost remedial action. The proposed development credit is consistent with the Bank's countiy assistance strategy (CAS) for Burkina Faso which was discussed by the Board in  4 February 1992. The proposed pzzJect address>z the CAS objectives of strengthening of basic health services with emphasis on the delivery of essential generic drugs, and improving the nutritional status of the population, so as to promote human resources development and poverty alleviation. The next CAS Board discussion for Burkina Faso is scheduled for May 1994. The country's tight financial situation would make it difficult to continue the wativities necessary for surveillance of the areas cleared from onchocerciasis and to prevent recrudescence of the disease. Integrating trypanosomiasis control and dracunculiasis eradication actMities with control maintenance of onchocerciasis, as defined in Burkina's "devolution plan", would be a cost-effective approach to eliminating these endemic diseases and would make a significant contribution to rendering oncho-freed areas safer for resettlement. Burkina has sought bilateral sources of financing for its devolution plan since 1989 without result. Supporting Burkina's devolution plan would safeguard a major donor investment of US$500 million in the Onchocerciasis Control Program--including US$50 million in grant financing from the Bank-to successfully rid the West African region of this endemic disease which has been a major constraint to development. 11. Aereed Actions. During negotiations, the Government provided assurance that it will: (a) complete the hospital sector study by June 30, 1995, and implement a resulting action program, acceptable to IDA, by March 31, 1997; (b) complete preparations of a national redeployment plan consistent with the conclusions of the hospital sector study, by June 30, 1995, and implement said plan by March 31, 1997; (c) ensure that each operating Health District, once its Medical Center has been fiully upgraded with a Surgical Unit (CMA), has in place throughout the duration of the project: (1) minimal personnel based upon norms defined in Decision No. 93- 304/SASF/SG to staff the CMA and each of its constituent Health and Social Development Centers (CSPS); (2) a District Health Plan for the district concerned; (3) a trained district health team; (4) a financial accounting system for the CMA and each of its constituent CSPS responsible for stocking and selling essential generic drugs; and (5) legal registration of community management committees for the CMA concerned and for each of its constituent CSPS; (d) ensure that the Procurement Center for Essential Generic Drugs (Centre d'approvisionnement des medicaments essentiels generiques or CAMEG) meets the performance criteria which were agreed upon between IDA and the Government and are incorporated in the Letter of Sector Policy, throughout the life of the project; (e) integrate micronutrients in the algorithms, supervision manuals, training curricula for the health district teams, patient cards, and ongoing training sessions of Maternal and Child Health and the Expanded Program on Immunization services by October 31, 1994; (f provide a detailed implementation plan of the micronutrient component for the first year of the project by the Project Launch Workshop; (g) conduct a feasibility study, prior to the project launch workshop, concerning the promotion of the importation of iodized salt; (h) based on the results of the feasibility study, take actions to promote the importation of iodized salt according to WHO standards and implement appropriate legal regulations thereto by March 31, 1996; (i) complete a national prevalence survey on dracunculiasis by July 31, 1995; 0) complete a survey of ongoing external financing in the health sector in Burkina Faso by July 1995, and implement a monitoring, coordination, and evaluation system for such support by July 31, 1996; (k) ensure that the Project Coordination Unit (PCU) functions according to terms of reference acceptable to IDA and not recruit any key staff of the PCU without the prior consent of IDA; (1) ensure that a budget and deposit account in a commercial bank in Ouagadougou is arranged by January 1, 1996, with an initial amount of US$100,000 deposited to meet expenditures under the project (the remainder to be deposited in subsequent quarters in advance); (m) following the results of the mid-term review, prepare and implement an action plan which is acceptable to IDA for further implementation of the project; and (n) submit to IDA annual audit reports, of reasonable scope and detail, within six months of the end of each fiscal year, and, in the case of SOEs, semi-annual reports shall be submitted within three months after the end of each audit period.  5 12. As a condition of Board presentation, the Government adopted the approved letter of sector development poli;.y and an accompanying action plan, including quantitative, annual targets for the 1995-2000 period. As a condition of credit effectiveness, the Government agreed to: (i) sign the Government-UNICEF Agreement regarding components to promote staff development and decentralize the health system in order to promote the distribution and cost- recovery of essential, generic drugs, and to reduce micronutrient deficiencies, (ii) sign the contract with Faso Baara for the management of civil works financed under the project, (iii) ersure that the PCU is fully operational, with the Director and two professional staff in their posts, (iv) recruit a qualified accounting company, acceptable to IDA, experienced in working according to international accounting standards, and (v) appoint an independent auditor under a multi-year contract, with terms of reference, acceptable to IDA. 13. Environmental Aspects. T'his is a category C project. Improved coverage and quality of basic health care services will have a positive impact on the environment through increased provision of family planning services, and its expected effect on pcpulation growth. Other components, such as devolution, woula also have a positive impact on the environment. One possible concern is how the district health facilities dispose of medical waste. This is an issue which wiil be explicitly addressed in the training of, and supervision by, the district medical teams. 14. Program Obiective Categories. The project responds primarily to the country's antipoverty and human resource development strategies by addressing largely the rural poor, and in particular groups that have traditionally been marginalized such as women and children. 15. Project Benefits. By reversing present trends of low CSPS utilization, the project will address the basic needs of some of the poorest segments of the Burkinabe population, improve the productivity of sectoral investments including those financed under the FHP, and support the Government's efforts in establishing a more responsive decentralized health care system. The health services component has been designed to directly benefit about 3 million people (30% of Burkina Faso's population) who will gain access to quality health care. With special attention to be paid to maternal and infant care, the project should have a major impact on reducing inaternal and infant mortality rates. The project's emphasis on substituting expensive brand-name drugs with low cost generic drugs will both benefit patients by reducing their financial burden during sickness episodes, and also make possible the introduction of cost recovery, wvhich would provide the Government with additional revenue required for more efficient functioning of health services at all levels of the system. Short supplies of drugs have been one of the major problems of the present CSPS system, which has led to the underutilization of basic health facilities. Stocking the CSPS with essential generic drugs coupled with instituting cost-recovery would help overcome this major problem. It is also expected that community participation in the management of the CSPS would greatly enhance the population's trust in the reorganized health care system. 16. Provision of additional surgical facilities at the district level should contribute to more immediate medical/surgical interventions in emergency cases, and at the same time, reduce the overcrowding at the Regional and National Hospitals. Training of general practitioners in abdominal surgery would break an existing bottleneck by increasing the supply of doctors capable of performing acute abdominal surgeries such as appendectomies. Additional training of doctors at the district level would improve their skills in coping with increased supervision of the CSPS, thus assuring improved performance of the basic level health facilities in the new decentralized health care system.  6 17. The nutrition component would be a major complement to the IDA-financed Food Security and Nutrition Project (Credit 2414-BUR) by providing supplies of necessary micronutrients to the diet. In particular, high rates of anemia among expectant mothers leading to low birthweights will be reduced due to supplementary iron to be administered during pre-natal care. Dispensing of iodine and vitamin A should greatly reduce incidences of iodine deficiency and vitamin A deficiency caused blindness and death. A feasibility study to be financed by UNICEF under the project should lead to actions to promote the importation of iodized salt. 18. [he endemic parasitic disease control component would contribute to sustai,ling the success of the OCP. Possible reintroduction of onchocerciasis through immigrants settling in the oncho-freed areas would be prevented through the devolution component's control system. Simultaneously, similar controls should make it impossible for new outbreaks of trypanosomiasis to occur. Through these measures, seven million Burkinabe would remain protected from any recurrence of onchocerciasis. And about 17% (43,000 km2) of Burkina's agricultural lands--with relatively fertile soils--would remain safe for agricultural production. 19. Through improved surveillance and education of the population, substantial reductions in the incidence of dracunculiasis would be achieved. Although dracunculiasis is not a mortal disease, it leads to economic losses due to absence from work and/or school. Official estimates, based on village surveys, indicate that about 34% of the villages in Burkina are afflicted by dracunculiasis. Preventive action taken under the project would reduce the incidence of dracunculiasis considerably and make a substantial contribution to worker productivity in the rural areas. The estimated economic loss avoided through eradication would be a miniYnum of US$3 million per annum. 20. Project Risks. The project faces three major risks. The first risk is that the expected procurement of essential generic drugs and their distribution may be slow to materialize. The Government has approved the required legislation and, with Bank assistance, established CAMEG, an organization likely to undertake imports and distribution more efficiently than its predecessor, SONAPHARM, since CAMEG would be freer from the influence of the Burkinabe pharmaceutical lobby. The Government has provided assurances that it will operate CAMEG in compliance with "satisfactory performance" criteria as defined jointly by ,ne Government and the Bank during negotiations. Supervision during the first half of the project will focus heavily on ensuring satisfactory cost-recovery and a continuous supply of essential drugs at the district level. The second risk is the resistance to redeploying doctors and other health staff to rural areas and ensuring that they remain there in order to fulfill their assigned responsibilities. This risk has begun to be addressed through implementation of the redeployment action plan. The third risk is the time required for regaining the confidence of the population in the CSPS especially in light of the proposed cost recovery scheme and the recent devaluation of the CFA franc. Special attention needs to be paid to the level and pace of implementing cost assessment so as not to prevent people from seeking help at the primary level of the health care system. This last concern is closely linked to the first, i.e. the widespread availability of low cost generic drugs. 21. Recommendation. I am satisfied that the proposed credit would comply with the Articles of Agreement of the Bank and recommend that the Executive Directors approve it. Lewis T. Preston President Attachments Washington, D.C. March 9, 1994  7 Schedule A ESTIMATED PRO.EC3T COSTS AND FINANCING PLANS (Net of Taxes and Duties) LOCAL FOREIGN TOTAL (US$ Million) 1. Improve Quality of Health Services 2.1 21.7 23.8 2. Reduce Micronutrient Deficiencies 0.5 3.4 3.9 3. Achieve Control of Endemic Parasitic Diseases 0.6 0.5 1.1 4. Satrengthen the Ministry of Health (MSASF) 0.6 3.5 4.1 Total Base Costs 3.8 29.1 32.9 Physical Contingencies 0.2 1.7 1.9 Price Contingencies 1.6 2.6 4.2 TOTAL PROJ'ECT COSTS 5.6 33.3 38.9 FINANCING PLAN (in US$ miilions) IDA 29.2 GOV'T. 2.0 KfW 4.1 TOTAL 38.9 Estimated IDA Disbursements (in US$ million) --------------IDA FISCAL YEAR---------------- IDA FY 95 96 97 98 99 2000 Annual 1.5 5.5 7.6 8.1 4.8 1.7 Cumulative 1.5 7.0 14.6 22.7 27.5 29.2  8 Schedule B Page 1 of 2 BURKINA FASO HEALTH AND NJTRITION PROJECT Table 2: Summary of proposed Procurement Arrangements Category of Expenditure Methods for 1rP Finanoing Not Bank Total Financed ICa LCB Other 1. CIiV Works 1.1 Health infrstructures 0.4 10.0 1 .2 11.e (0.4) 110.0) (10.4) 1.2 Others 0.4 0.4 (0.4) (0.4) 2. Coods 2.1 Medical Equipment 3.1 0.3 0.98 4.3 (3.11 (0.3) (3.4) 2.2 Office/Malntanance Equipment 1.0 0.4 1.4 (1.0) (0.4) (1.4) 2.3 Vehicl1e/IMotorayolew 1.9 1.9 (1.9) (1.8) 3. Dfugs 3.1 Essential / Generic Drugs 0.4 3*0b 3.4 (0.4) (0.4) 3.2 Vaccines 0.1 01 (0.1) (0.1) 3.3 MAcronutrients 3.2 3.2 (3.2) (3.2) 4. Sp.c!ellst Sencse 4.1 Specialsts/lnternationi 1.4 1.60 3.0 (1.4) (1,4) 4.2 Audits 0.4 0.4 (0.4) 10.4) 4.3 Speocalists/Local 0.8 0.8 (0.8) (0.8) 4.4 ArchteiotlEnginaer/Supervlcion 0.8 0,9a 1.5 (0.6) (0.6) S. Training 5.1 Lood Seminars/Tramning 0.4 0.4 (0.4) (0.4) 5.2 Trading Abroad 0.5 0.5 (0.5) (0.5) lI.E.C. 0.3 0.3 (0.3) (0.3) 7. Inoemental Operating Ceost 7.1 Supplies, spare parts, materidels 1.2 1.2 (1.2) (1.2) 7.2 Other Operating coso 2.6 2,0d 4.5 (2.5) (2.5) Total Costs 6.8 10.7 11.8 9.6 38.9 IDA Credit (6.8) (10.7) (11.1) 0 (29.2) Note: Figures may not add up due to mounding. Figures in parentheses as anounts financed by the IDA credit. 'Financed by KfW. bFinanced by KIW (USSI million) and UNICEF (USS2 million). CFm0ced by UNICEF. dFucnced by the Govenmment.  9 Schedule B Page 2 of 2 BURKINA FASO HEALTH AND NUTRITION PROJECT (PDSN) Allocation and Disbursement of the IDA Credit Category of Expenditure Proposed IDA Aliocation % of Expenditure Financed by IDA (US$ million) 1. Civil Works 9.7 100 2. Equiprmient, furniture, and vehicles 3.0 100 3. Supplies and spare parts 3.0 100 4. Drugs 0.4 100 5. Vaccines, and micronutrients 3.0 100 6. Consultant services 2.9 100 7. Training 0.8 100 8. IEC 0.3 100 9. Incremental Operating Costs 3.3 Declining basis' 10. Unallocated 2.8 N/A TOTAL 29.2 'Declining basis: 100% through December 31, 1995 65% through December 31, 1997 35% thereafter Estimated IDA Disbursements (in US$ million) --------------IDA FISCAL YEAR--------------- IDA FY 95 96 97 98 99 2000 Annual 1.5 5.5 7.6 8.1 4.8 1.7 Cumulative 1.5 7.0 14.6 22.7 27.5 29.2  10 Schedule C BURKINA FASO HEALTH AND NUTRITION PROJECT (PDSN) TIMETABLE OF KEY PROJECT PROCESSING EVENTS (a) Time taken to prepare: 14 months (b) Prepared by: Government with IDA assistance/2 (c) First IDA mission: June 1992 (d) Appraisal mission: June 1993 (e) Negotiations: February-March 1994 (f) Planned date of effectiveness: July 1, 1994 2/ The President's report is based on the findings of a Bank appraisal mission which visited Burkina Faso in June, 1993, comprised of Messrs./Mmes. Bruce Benton (Task Manager and mission leader), Slaheddine Ben-Halimna (Operations Officer), Yves Cenevier (Public Health Specialist), Tonia Marek (Nutrition Specialist), Denis Broun (Pharmaceutical Specialist), and lean-Pierre Unger (Public Health Specialist). Messrs. Bernhard Liese (HDSDR) and Eugene Boostrom (AFIHR) were the peer reviewers. Principal preparatory documents for the project were prepared by Consultants Ms. Ellen Goldstein (Bur*ina Faso, Publc Expend/ture Review: Health and Social We(fare Sector and Ms. Paola Ciardi (Quatimadive Survey of Uilzation of Health Services, Panicipadon and Healh Needs in Burkina Faso 's Rural Communtdies) following missions to Burkina Faso in 1992. Ms. Katherine Marshall and Mr. Birger Fredrikser are the Department Director and managing Division Chief, respectively.  II Schedule D Page I of 2 BURKINA FASO HEALTH AND NUTRITION PROJECT (PDSN) STATUS OF BANK GROUP OPERATIONS IN BURKINA FASO (as of 1/18/94) Amount in US$ million (less cancellations) Loan or Fiscal Undis- Closing Credit No. Year Purpose Bank D A bursed Date Credits 29 Credits closed 227.76 15980-BUR 1985 Education III 21.60 3.09 3/31/94(R) 16070-BUR 1985 Health 1 26.60 6.57 7.31/94(R) 18960-BUR 1988 Ag. Research 17.90 7.29 3/31/95(R) 19790-BUR 1989 Agric. Services 42.00 21.98 12/31/94 20670-BUR 1990 Urban 22.20 11.59 06/30/96 22290-BUR 1991 Environmental Mgmt. 16.50 13.22 12/31/98 22440-BUR 1991 Education IV 24.00 23.69 06/30/98 22810-BUR(S) 1991 SAL I 80.00 41.43 06/30/94(R) 22820-BUR 1991 Public Works & Emplo 20.00 3.89 06/30/95 23320-BUR 1992 Transport Secal 66.00 50.91 12/31/96 23780-BUR 1992 Public Institutional 15.00 13.35 03/31/97 23810-BUR(S) 1992 Ag. Secal 28.00 23.09 12/31/94 24140-BUR 1993 Food Security 7.50 6.79 06/30/99 24720-BUR 1993 Private Sector Assis 7.00 7.04 12/31/97 25190-BUR 1993 Engineering Credit 4.25 4.14 06/30/96 TOTAL number Credits = 15 398.55 238,06 Loans No loans closed TOTAL*** 626.31 of which repaid 13.99 TOTAL held by Bank & IDA 612.32 Amount sold of which repaid TOTAL undisbursed 238.06 Notes: * Not yet effective. ** Not yet signed. *** Total approved, repayments, and outstanding balance represent both active and inactive loans ar.j credits. (R) Indicates formally revised closing date. (S) Indicates SAL/SECAL loans and credits. The net approved and Bank repayments are historical value, all others are market value. The signing, effective, and closing dates are based on the Loan Department official data and are not taken from the Task Budget file.  BURKINA FASO: IhEALTII AND NUTRITION PROJIECT (PDSN) ACTION PLAN FOR IMPROVING DISBURSEMENT PERFORMANCE CRT. N