Rwanda - First Population Project

. . - - Docwuw of The World Bank FOR OMFICIAL USE ONLY 2~~~~[ - I - ; i i Rpot NiL P-5465-RW 1EO NDIU AND RECOMMENDATION OF THE PRESIDENT OF THE INTERNATIONAL DEVELOP4ENT ASSOCIATION TO THE EXECUTIVE DIRECTORS ON A PROPOSED CREDIT OF SDR 14.5 MILLION TO TM AEPUBLIC OF RWANDA FOR A FIRST POPULATION PROJECT MAY 23, 1991 j-This documevt has a restricted distribution and may be used by recipiet oly in the perfoymace of dro*ca 4We. Its 'ontnt may not otherwise be di,lsed w,, World Boak a rtion.  CURRENCY EQUIVALENTS Currency Unit Rwandese Franc (FRW) US$ 1 FRW 118 (February 1991) MEASURES Metric British/US Equivalent 1 meter (m) = 3.28 feet 1 square meter (sq. m) - 10.76 square feet 1 kilometer (kim) 0.62 mile 1 square kilometer (sq. km) = 0.39 sq. mile Fiscal Year January 1 - December 31 ABBREVIATIONS AIDS Acquired Imiuno-Deficiency Syndrome FP Family Planning HC Health Center IDA International Development Agency IEC Information, Education and Communication MCH Maternal and Child Health MOH Ministry of Health NGO Non Governmental Organization ONAPO Office National de la Population (National Population Office) UNFPA United Nations Fund for Population Activities USAID United States Agency for International Development  MR OFF1Ci!AL UK ONLY RVANDA FIRST POPULATION PROJECT CREDIT AND PROJECT SUMMARY Bojr_gers Republic of Rwanda Beneficilares Milnistry of Health (MOH) and National Office of Population (Office National de la Population - ONAPO) SDR 14.5 million (US$19.6 million equivalent) t1'erms: tStandard with 40 years' maturity On Lendins Terms: Not applicable Financint Plans ------------USS million-------__ Local Foreign Total - IDA 8.3 11.3 19.6 - USAID -- 1.9 1.9 - UNFPA -- 1.2 1.2 - Government I/ 3.4 -- 3.4 Total 11.7 14.4 26.1 Economic Rate of Return: Not applicable Staff Appraisal Report: Report No. 9233-RW Han: IBRD No. 22802 1/ Including 0.1 million of taxes. This document has a restricted distribution and may be used by recipients only in te perfVe.manco of their official duties. Its contents may not otherwise be disclosed without World ,' v'munori2ation.  MEMORANDUM AND RECOMMENDATION OF THE PRESIDENT OF THE INTERNATIONAL DEVELOPMENT ASSOCIATION TO THE EXECUTIVE DIRECTORS ON A PROPOSED CREDIT OF SDR :4.5 MILLION TO THE REPUBLIC OF RWANDA FOR A FIRST POPULATION PROJECT 1. The following memorandum and recommendation on a proposed credit to the Republic of Rwanda, for SDR 14.5 million (US$19.6 million) is submitted for approval. The proposed credit, which would be on standard IDA terms with 40 years, maturity, would help support the implementation of the National Population Policy. 2. Background. With a population estimated at 7.3 million in 1989, a population density of 279 people per square kilometer (the highest in Africa) and a total fertility rate of 8.5 children per woman (also the highest in Africa), Rwanda's overwhelmingly rural economy faces a major population pressure. Almost 102 of farms are already too small to be sustainable and this percentage is rapidly increasing. If the current annual population growth rate remains constant (3.6Z), the total population will double in 20 years, putting an unbearable burden on all sectors of the economy, the social infrastructure and the environment. The prevalence of the AIDS epidemic (24S of adults in reproductive age in urban areas are seropositive) raises the important question of the demographic impact of this epidemic. However, recent studies conducted in Sub-Saharan Africa indicate that population growth rates, though reduced by the AIDS epidemic, will remain strongly positive. As early as 1966, the Government had expressed increasing concern about rapid population growth. At first, effort were mostly concentrated on the improvement of the nation's economic produc_Lvity, but in the second economic plan (1977-81) the emphasis was shifted from analysis to strategies aimed at reducing the population growth. In 1981, the Government created the Rwandese Population Office (ONAPO), whose mandate was to collect population data, propose population policies and develop Information Education and Communication programs tIEC) in Family Planning (FP). Following a long internal debate, the Government eventually issued a National Population Policy in June 1990. This policy is fully supported by the President of the Republic who, in his 1989 annual address, advocated a family of 4 children by year 2000. The major objective of the population policy is to reduce the population growth rate from the current level of 3.6 percent to 2.0 percent by yea- 2000. 3. Sectoral issues and strategy. For the past years, the Government has adopted a two-pronged strategy: the promotion of demand for PP services through ONAPO's activities, and the increased supply of FP services under the Ministry of Health (MOH)'s responsibility. While the IEC program implemented by ONAPO has generated a certain level of demand for PP services, MOH has had many difficulties in expanding these services nationwide. The main constraints are: (a) the poor quality of PP services offered in health centers, mainly due to insufficient training and supervision of health workers, and inadequate contraceptive supplies ; (b) the limited access to modern PP services of approximately 602 of the population; and (c) the insufficient level of demand for FP services, given the urgency of curbing the population growth rate. 4. Rationale for IDA's involvement. The proposed operation addresses Rwanda"s main development constraint and constitutes a cornerstone for IDA's  -2- lending strategy. in the absence of a reduction in the population growth rate, ongoing adjustments efforts are unlikely to be effective in reestablishing a sustainable growth. The project is fully consistent with the Bank's special programs of emphasis on women-in-development and population. IDA's support has been requested by the Government, which is now well aware of the serious environmental and social degradation in the country brought about by uncontrolled population growth, and of the positive conclusions of a cost/benefit analysis of the national family planning program carried out by ONAPO. The limited institutional capabilities of MOH to provide the necessary improvements to FP service delivery have led the Government to develop, with Bank's assistance, a more forceful approach to address Rwanda's population problems. In this new approach. IDA would support ONAPO's leading role in implementing the national population policy and assisting MOH's efforts to expand access to and use of FP services. IDA's resources will be used in close coordination with other donors, in order to avoid any duplication of efforts. 5. Proiect obiectives. The project objectives are to contribute tot (a) the reduction of the total fertility rate from 8.5 to about 7.2 by 1997; (b) a decrease in maternal and child mortality and morbidity; and tc) the integration of the demographic dimension in the overall socio-economic planning process. The proposed operation would complement other donors contributions to population and PP activities. The project is conceived as a comprehensive support to the implementation of the national population policy, with a special emphasis on improving the access to and quality of PP services. 6. Proiect descriDtion. Part A - Improvina the ouality and efficiency of PP services delivered by MOB facilitles - will consist in: (a) training approximately 1100 MOU paramedical ageuts in contraceptive technology and counselling, provision of PP services, and management of contraceptive supplies; (b) providing medical equipment, furniture and contraceptives to health centers, including NGOs facilities; and (c) strengthening the monitoring, supervision and evaluation of PP services. Part 3 - E=Wansion and promotion of PP services beyond the health center network - will increase access to PP services and will stimulate the demand for these services by Ca) developing an outreach strategy beyond the health center level; and (b) providing support to specific IEC activities. This will requiret (a) the establishment and the strengthening of PP posts which, operated as an integral part of the Health Center (RC) network, would constitute the most efficient way of increasing the PP coverage of the population; (b) the use of about 17,500 community volunteers for stimulating the demand for FP services, referring potential clLents to PP posts and health centers, and supplying current users with contraceptives; (c) the redesign of certain aspects of the national IEC program, vith a view of targeting specific ZEC activities towards neglected population groups (such as males, young adults, women with high parity); (d) the retraining of 1600 social workers in FP counselling; and (e) the promotion of PP within women's groups at the communal level. Part C - Suinortina pooulation studies and gromoting multisectoral activities - will consist ins (a) carrying out studies and surveys aimed at consolidating ONAPO's database in order to improve its input in the implementation of the population policy, including (i) migration flows; (ii) post census studies on maternal mortality; and (iii) monitoring the impact of the PP program through periodic analysis of  -3 FP service statisticss and (b) coordinating specific multisectoral activities with other ministries and institutions involved in the implementation of the population policy. 7. The total cost of the project is estimated at US$26.1 million equivalent, of which US$14.4 million would be in foreign exchange. Schedule A contains the project cost susmary and financing plan, Schedule B the amounts and methods of procurement and disbursements, as well as a disbursement schedule. A timetable of key project processing events is given in Schedule C. A map showing the locations of the PP posts is attached. The Staff Appraisal Report No. 9233-RW, dated May 15, 1991, is being distributed separately. 8. Agreed actions. During negotiations, the following actions were agreed with the Government as conditions of credit effectivenesss (a) the recruitment of a full-time local project coordinator, a long-term technical advisor and key project local staff; (b) the submission of a master training plan which will incorporate comments already made by IDA on the subject: and (c) the initial deposit of funds in the project account representing the Government's contribution to cover three months of local expenditures. S. Other agreements includes (a) the submission by ONAPO of a quarterly report on the status of project implementation and related expenditures: (b) the submission by ONAPO of a detailed annual work program, plans of action and budget for the following year by December 31 in each years (c) the review of curricula for the family planning training of health personnel; (d) a comprehensive mid-term evaluation to be carried out in 1994 to assess progress made and make necessary changes; (e) the organization of annual meetings of donors to review the implementation of the population policy: and Cf) the application of the collaboration mechanisms agreed upon between ONAPO and MOH at the central and regional levels for the implementation of VP related activities. 9. Benefits. The project is expected to generate both individual and macroeconomic benefits. Birth spacing will reduce maternal and child morbidity and mortality. In the longer term, the reduction In fertility levels, which will ultimately translate into declines in the rate of population growth, will have benefits at the national level, by alleviating population pressures on scarce land resources, fostering food security, generating cost savings in economic and social services and improving prospects for entrants into the labor market. 10. lisks. The first risk is that ONAPO's managerial capabilities could be overstretched by this operation. ONAPO's past performance, in term of financial and administrative management of other donor projects, has been uneven. To address this risk, a project administration unit will be established before credit effectiveness to assist ONAPO's management in all administrative, procurement and disbursement matters. In addition, a long term technical advisor will be responsible for train'ng key local staff in program planning, management and monitoring. The second risk is that coordination between ONAPO and MON would not be close enough, with the consequence of inefficiencies in project implementation. To address this risk, the  -4- implementation of mechanisms agreed upon during project preparation, aimed at strengthening the collaboration between ONAPO and MOH has been included in the credit agreement. In addition, many managerial decisions have been decentralized to the regional level where KOS and ONAPO staff have already developed, at least in certain regions, a good working relationship. Finally, a third risk relates to the capacity of Rwanda to find appropriate solutions to the lingering problems of Rwandese refugees in neighboring countries. Reinsertion of these refugees in Rwanda requires careful planning and a major support from the international communAty. 11. Recommendatlon. I am satisfied that the proposed credit would comply with the Articles of Agreement of the Association and recommend that the Executive Directors approve the proposed credit. Barber B. Conable President Attacbments Washington D.C. May 23, 1991  -5- &cheduleW A Page 1 of 1 nRSS POPULATION PROJECT ESTIMATED COSTS AND FINANCING PLAN ------ aUS$ al-lion----- Percentage EST-MATED COLS8 Local VorMiAn Total ore.AAn Ezchane A. lmrovement in oualitv and Efficiency of PP Services 0.6 5.4 6.0 90 B. Lcoansion and Promotion of FP Services 7.2 4.5 11.7 56 C. Studies and Multi- sectoral Activities 0.8 0.t 1.6 50 D. Project Manaaement 0.5 1.2 1.7 73 Total Base Costs 9.1 11.9 21.0 57 Physical Contingencies 0.1 1.0 1.1 - Price Contingencies 2.5 1.5 4.0 - TOTAL PROJECT COSTS 11.7 14.4 26.1 55 Perceniage Total Local Poraj Total Cost FINANCING PLAN IDA 8.3 11.3 19.6 75 USAID - 1.9 1.9 7 UNFPA - 1.2 1.2 5 Government j/ 3.4 - 3.4 13 11.7 14.4 2C.1 100 1J Including 0.1 million of taxes.  -6- Schetule I Page 1 of 2 RWANDA FIRST POPULATZON PROJECT PROCtURMENT AND DISBURSEMET (US$ million) PROCUREMENT ARRANGEMENTS Cateao^ ICB LCB ISILS B_ GCA TOTAL Equipmnst/laterials 2.0 0.8 2.8 (2.0) (0.7) (2.7) Contraceptives 8.5 - 8.5 (5.4) (5.4) Vehicles 0.5 0.5 (0.5) (0.5) Technical assistance 0.6 0.6 (0.6) (0.6) Studies/Training a. Consultants 1.0 1.0 (1.0) (1.0) b. Training materials 0.8 0.6 1.4 (0.7) (0.5) (1.2) c. In-service training allowances 6.6 6.6 (5.6) (5.6) d. Training abroad 0.1 0.1 (0.1) (0.1) Operating Costs 4.5 4.5 (2.5) (2.5) TOTAL 10.5 1.3 1.5 1.6 11.1 26.1 (7.4) (1.2) (1.3) (1.6) (8.1) (19.6) Note: Amounts in parenthesis represent IDA financing ICB : International Competitive Bidding LCB s Local Competitive Bidding IS/LS International Shopping/Local Shopping BGC s Bank Guidelines for Consultants N/A s Not Applicable  -7- Schedule B Page 2 of 2 RWANDA FIRST POPULATION PROJECT pROCUREMENT AND DISBURSEMENT (US$ million) DISBURSEMENT Category USSMillion Percentage Contraceptives 4.3 100 percent Equipment, vehicles, Teaching materials, supplies 2.3 100 percent of foreign exchange; 85 percent of local costs Training, studies and technical assistince 7.8 100 percent of foreign exchange; 85 percent of local costs incremental Operating Costs 1.9 lOO percent of foreign exchange; 85 percent of local costs PPF 0.7 100 percent Unallocated 2.6 TOTAL 19.6 ESTIMATED IDA DISBURSEMENTS (US$ million) E 9 FY93 4 FY9 Y96 FY97 FY98 Annual 1.0 6.0 4.0 5.0 2.0 1.2 0.4 Cumulative 1.0 7.0 11.0 16.0 18.0 19.2 19.6  -8- Schedule C Page I of 1 REPUBLIC OF RWANDA FIRST POPULATION PROJECT TIMETABLE AND KEY PROCESSING EVENTS (a) Time taken to prepare: One year (b) Prepared by: Government with IDA assistance (c) IDA Identification Mission: .'ebruary 1990 (d) Pre-Appraisal Mission; May 1990 Ce) Appraisal Missicn: October 1990 (f) Post Appraisal Mission: January 1991 (g) Negotiations: April 15-17, 1991 (h) Planned Date of Effectiveness: January 1992 Task Manager : Dr. Maryse Pierre-Louis Lead Advisor I Mr. Bruce Carlson Department Director s Mr. Francisco Aguirre-Sacasa Division Chief s Mr. Alain Colliou  -9- SCHEDULE D Page 1 of 1 THE STATUS OF BANK GROUP OPERATIONS IN RWANDA A. Statement of IDA Credits (as of March 31, 1991) Amount In USS million Loan or Fiscal (lose enncellltions) Undis- Closing Credit No. Yeor Borrower Purpose bank IDA bursed Date 22 Credit(s) closed 212.77 C12830-RWA 1983 Rwanda Bugesrs iI 16.30 .62 12/31/91 R) C16460-RWA 1985 Rwanda Agri. Research 11.60 3.98 12/31/91 O) C16660-RWA 1986 Rwanda TAS Poblic Sector Mg. 4.80 3.42 U"/92 (R) C16410-RWA 1986 Rwanda Highways VI 11.00 3.15 12/31/91 (O) C1SOO-RWA 1986 Rwanda 8RD IV 9.00 3.63 12/31/93 C18890-RWA 1986 Rwanda Citarama Svcs. Agr. 12.70 4.48 09/30/91 C16780-RWA 1988 Rwanda Family Health 10.80 9.82 06/30/92 C16830-RWA 1988 Rwanda Education III 15.60 11.41 12/31/91 C17830-RWA 1987 Rwanda Water Supply II 16.00 8.24 12/31/94 C17940-RWA 1987 Rwanda Public Sector Mg 7.40 7.35 12/31/94 Ce1O1-RWA 1987 Rwanda Forestry II 14.10 11.24 0e/30/93 CA0081-RWA 1988 Rwanda Highways VI 10.00 10.82 12/31/91 C20260-RWA 1989 Rwanda Agric. Services 19.90 19.92 06/30/95 C20410-RWA 1989 Rwanda Urban Inst. 32.00 32.10 12/31/98 C21130-RWA 1990 Rwanda Public Enterprise 4.40 4.50 12/31/94 C21360-RWA 1990 Rwanda Transport Sector 40.00 42.04 08/30/97 C21890-RWA 1991 Rwanda Second Communication 12.80 12.03 12/31/96 TOTAL number Credits 17 247.30 188.45 TOTAL 480.07 of which repaid 9.40 TOTAL held by Bank and IDA 480.81 TOTAL undisbursed 188.46 S. Statement of IFC nvestments (Cs of Ulrch 31. 1991) Investment Loan Equity Total Number FY Project Name Type of Business -------- million-------- 337-RW 1s78 SORMATHE Food & Food Proc 0.6 0.6 470-RW 1979 0.2 0.1 0.3 764-RW 0.8 0.3 1028-RW SORWAL Manufacturing 0 0.2 0.2 Total Gross Commitments 1.0 0.3 1.3 Lees: cancellations, terminations, exchange adjustments, repayments, write-offs, and sales 0.9 O.1 1.0 Total Commitments held by IFC 0.1 0.2 0.3 Total Und;sbureed 0.0 0.0 0.0 Total Disbursed 0.1 0.2 0.3 / Not yet effective (R) Indicates formally revitsed Closing Date * Loan guarentee of 22.1 million provided by IFC,  213r i x r 0 RWANDA FIRST POPULATION PROJECT uGANDA C) Ij(D\ }t r'\ TA NZANIA NUMBER OF FAMILY PLANING POST BY PREFECRRE: BLAC EXSTNG MD ~ ~ ~ ~ ~ ~ ~ ~ ~~~s ta AK| .. ^A | D NEW A I R E NATIO4A CAMBTJ PREFECTRE CAPITALS AND OP HEATIHEDQARER - COMMUNE SOUNIIARES - tRME BOUNMANES - 4TIONALBOUNDWIS POfLATON 0G4SM [J101 -200 E1w) ovo w 320 BURUN EX. . . ... . . . .. .. .. . ... j ... .B.RUNDI * M 1NZ.ANI ZAItE <!(t AN KIOMI 0510 1520 2530 354045 50 I. k~~~~~~~~~~~~~ZMBIQPN ~~~~~~~~~~~~~~~~~~AURS 5 10 15 20 2530