Madagascar - Second Health Sector Support Project

Documentof TheWorld Bank FOROFFICIAL USEONLY ReportNo. 32215-MG INTERNATIONAL DEVELOPMENT ASSOCIATION PROPOSED SUPPLEMENTALCREDIT TO THE =PUBLIC OFMADAGASCAR INTHE AMOUNT OFUS$lS.OMILLION (SDR 12.3 MILLIONEQUIVALENT) FORTHE SECONDHEALTHSECTOR SUPPORT PROJECT May 25,2005 HumanDevelopment 3 CountryDepartment 8 AfricaRegion This document has a restricted distribution andmay be used by recipients only inthe performance of their official duties. Its contents may not otherwise be disclosed without WorldBank Authorization.  CURRENCYEQUIVALENT Currency Unit - US$ 1 - - Ariary @=A) Ar 1952.04 SYSTEMOFWEIGHT AND MEASURES Metric US Equivalent 1meter (m) 3.28 feet (ft.) 1squarekilometer (km2) 0.386 squaremiles (sq. mi.) 1hectare 2'47 acres (a) 1metricton (mton) 2,204 pounds (lb.) MALAGASYFISCAL YEAR January 1- December 31 ABBREVIATIONS AND ACRONYMS CAS Country Assistance Strategy CRESAN SecondHealthSector Support Project DCA Development Credit Agreement ICB International Competitive Bidding IDA InternationalDevelopment Agency GoM Government o fMadagascar GTZ GermanDevelopment Agency MIS Management InformationSystem MDG MillenniumDevelopment Goal M o H MinistryofHealth NCB NationalCompetitiveBidding NGO Non-Governmental Agency PIU Project Implementation Unit PRilPS Multi-sectoralAids Project PRSC Poverty ReductionStrategy Credit PRSD Poverty ReductionStrategy Document PRIMATW PrimeMinister's Office SAP Structural Adjustment Program SDP StandardDisbursement Percentage UNFPA UnitedNationsPopulationFund UNICEF UnitedNations Children's Fund USAID UnitedStatesAgency for InternationalDevelopment Vice President : GobindNankani CountryDirector: James P. Bond Sector Manager: LauraFrigenti Task Team Leader: Jean-Pierre Manshande  FOR OFFICIAL, USEONLY REPUBLICOFMADAGASCAR SECOND HEALTHSECTORSUPPORT SUPPLEMENTAL FINANCING CREDIT AND PROJECT SUMMARY Borrower: Republic o f Madagascar ImplementingAgency: PIUSecondHealth Sector Support Project, Ministryo fHealth Beneficiaries: Ruralandurbanpoor communities Amount: SDR 12.3 million (US$ 18.0 millionequivalent) Terms: Standard IDAterms with 40 years maturity Commitment fee: 0.5% FinancingPlan: IDA $ 18.0million (US$ million) Government $ 1.85 TOTAL $ 19.85 million EconomicRateofReturn: Not Applicable ProgramObjective Category: Health, NutritionandPopulation. ProjectIDNumber: PO51741 Map: 33439 There is no Project Appraisal Document. This memorandum i s basedon the findings o fthe emergencycyclone project appraisal mission(May 2000), the emergencyeconomic recovery credit (September 2002), the Govemment's findings for the mid-term review (January 2004), and the most recent supervision mission(April2005). The Bank team was comprised o fJean-Pierre Manshande, Senior Health Specialist (TTL); Raj Soopramanien, Senior Counsel; Jean-Charles DeDaruvar, Senior Counsel; MichaelP. Fowler, Senior Finance Officer; M.Thomas E. Walton, LeadRegional Coordinator; Environnement; M. SylvainRambeloson, Procurement Specialist; M.Gervais Rakotoarimanana,FinancialManagementSpecialist ;NorosoaAndrianaivo, Program Assistant; AndrianinaRafamantanantsoa, ProgramAssistant. James P. Bond i s the Country Director, andLaura Frigenti i s the Sector Manager. This document has a restricted distribution and may be used by recipients only inthe performance of their official duties. Its contents may not otherwise be disclosed without World Bank Authorization.   INTERNATIONAL DEVELOPMENTASSOCIATION PROPOSEDSUPPLEMENTALCREDIT TO THE REPUBLICOFMADAGASCARFOR THE SECONDHEALTHSUPPORT PROJECT A. Introduction 1. The following is a proposed supplemental credit of SDR 12.3 million (US$ 18.0 million equivalent) to Development Credit No. 3302-MAG (Second Health Sector Support Project) to cover the increased costs o f meeting the project's development targets following a series o f unforeseen circumstances including natural disasters and socio-economic upheaval as well as political conflict andreform. B. Background 2. Project Obiectives and Description. The Second Health Sector Support Project was approved onDecember 2,1999 (withthe DCA signed onFebruary3,2000) andbecame effective on August 25, 2000. The closing date i s December 31, 2006. The total project cost i s US$44.4 milliono fwhich US$40million IDAcredit, andUS$4.4 million Government funds. 3. The project's overall development objective is to contribute to the improvement of the health status o f the population through more accessible and better quality health services. Specific project activities seek to: (i) improve the access to and quality o f primary health care services with a focus on rural areas; (ii) support priority health programs with emphasis on endemic infectious diseases, reproductive health (including family planning, sexually transmitted diseases and HN/AIDS) and nutrition; and (iii)strengthen sector management and administrative capacity within the Ministry o f Health, and at provincial and district levels, to enable successfuldecentralization and sector reform 4. Context. After project effectiveness, a series o f natural disasters and unforeseen political events occurred, which led to deteriorating health and poverty indicators that in turn put in jeopardy the project's achievement o fits development objectives. 5. First, in late 2000, Madagascar was struck by three cyclones over a three month period; more than a million people were directly affected, and the Bank responded by usingproject funds to provide immediate emergency assistance to some 300,000 persons inneed and to organize the rehabilitation o f some 315 severely damaged health facilities in two o f the six provinces. The initial objective of rehabilitating and re-equipping 250 health centers and 15 district level health facilities was partiallymet when the Project agreedto rehabilitate and equip 208 health centers and 40 district levelhealth facilities damagedbythe cyclones. While the actual cost for the civil works was lower thanestimated during appraisal, the actual cost of the equipment for the first 115 health centers was higher; as a result the Project was able to avoid a cost overrun but was unable to achievethe originalobjectives. 6, Subsequently, in December 2001, a political crisis triggered by contested first round presidential elections produced severe economic and social consequences. Many public social  services were discontinued in2002, causingwidespread social suffering andincreasingthe poverty rate (according to simulations based on the actual welfare changes in the different sectors) to 73 percent o f the population and the extreme poverty rate to 62 percent of,the population. The average availability o f basic medicines inrural health centers fell from 91 percent to 69 percent, while availability o f the immunization service was down 10 percent. Health service utilization declined from 50 percent to 36 percent countrywide. Especially worrisome was the decline in assistedbirths (minus 19 percent) and prenatal care for pregnant women (minus 11percent). Both urban andrural families reported decreasedfood consumption, especially the intake o f meat (up to two thirds less thanbefore for the extremely poor). Again, the project respondedto the emergency needs o f the country, but on this occasion, the project was unable to absorb the costs; rather the project incurredadditional costs by: o Supporting the GoM's decision to suspend the existing cost recovery system for health services and drugs thereby helpingto mitigate the impact o f the crisis on the population, in particular, children and pregnant women. The Health project was mobilized to share the GoM's cost burden and to ensure the availability o f all necessary drugs at the hospital and health center level, an activity within the scope o f the project but one that could not have been envisaged at the time ofproject preparation. Inthe new circumstances, this assistance also included the purchase of anti-tuberculosis drugs that the pre-crisis GoM had initially committed itself to subsidizing and o f contraceptives within the framework o f the contraceptive security program. Additional costs stemming from these increasedinputs are estimated at more thanUS$1.0 million. o Combating the impact of decreased food consumption on the nutritionalcondition of the population resulting from soaring (30-100%) price increases for basic food products (salt, sugar, vegetable oil, and rice). Complementing the expansion o f nutritional community centers inurban areas under SEECALINE (the Second Community Nutrition Project), the Healthproject supported the creation o f 36 rehabilitationcenters for severelymalnourished children(CREW subcontractedto 19NGOs. Within a year, the admissionrate o f severely malnourished children more than doubled while the mortality rate was halved. The additional cost for nutritionrehabilitation i s approximately $1.7 million. o Implementingthe GoM's strategy for decentralizing health services delivery at the district and community levels. Given the difficulties in reaching the poor and maintaining drug supply at the periphery during the crisis, the Bank respondedby strengthening the district decentralization during the IDA portfolio review in December 2002 which resulted in enhanced availability o f drugs, consumables, medical equipment andvehicles, andrelevant specialized personnel and money directly to the district level to support their activities and programs. The project has also sub-contracted NGOs to provide technical assistance to the districts because o f their weak capacity in planning and budgeting as well as in financial management. The total cost for the district decentralization amounts to about US$13.6 million o f which US$5.9 million for financial support to the districts, US$4.2 million for goods, and US$3.5 million for technical assistance. More than half (i.e.; the financial support to the districts and the technical assistance) o f this amount constitutes an overrun vis-&vis the initialprojectionfor this component. 2  7. Finally, after the resolution of the political crisis which followed the 2001 presidential elections, the entire IDA portfolio was revised in December 2002 to increase the flexibility of projects inthe portfolio inorder to support the Government's efforts to respond to existing needs and to implement proposed reforms. The Health Project DCA was amended accordingly in January 2003. In line with this policy and CAS support o f the GoM's ambitious reform program (to recover the ground lost duringthe political crisis and to achievebroad-basedgrowth rates well above those experienced before the crisis), the project providedadditional support for a number o f reforms in the health sector, including strengthening decentralization at district level, re- introducingmore equitable cost recoverymechanisms, etc. 8. The project has made important progress in meeting its development objective of contributingto the improvement o fthe healthstatus o fthe population through more accessible and better quality health services. The publicationo fthe results o fthe recent Demographic andHealth Survey provide some interim results o f the project's efforts to support priority health programs with emphasis on endemic transmissible diseases, reproductive health(including familyplanning, sexually transmitted diseases and HIV/AIDS) and nutrition. Except for its performance on maternal mortality, Madagascar would seem to be on track for achieving its objectives within the framework o fthe MDGs. e Infant mortality: The mortality rate has been considerably reduced from 96 per 1000 (1997) to 58 (2003) and would seem to be on track to achieve the MDG objective o f 34 perthousandby2015. e Under-five mortality: The mortality rate has been significantly reduced fkom 159 per thousand (1997) to 94 per thousand (2003) and would seem to be on track to achieve its objective o f 56 per thousand (or atwo-thirds reduction) by2015. e Maternalmortality: The mortalityrate hasbarely beenreduced from 488 per 100,000 live births (1997) to 469 per 100,000 (2003) which is far from the interim objective of 245 (in2005) inorder to achievetheMDGof 123by2015. e HrV/AIDS, malaria and tuberculosis: reliable quantifiedindicators for these diseases do not exist for 1997 andonly now are beingdeveloped to measureprogress. However there i s m p l e evidence that progress has been made for example in reducing malaria hospital mortalityor inincreasingthe number o fpatients cured for tuberculosis (see below). C. ProposedSupplementalCredit 9. The proposed supplemental credit is necessary to ensure that the project's overall development obiectives will be met and that specific progress made to date will not be jeopardized. The credit willbeusedto e continue current financing to the 111 health districts for the development o f health services ($7.0 million) and to extend support to the 22 newly created regional health directorates (which replace the existing6 provincial healthdirectorates)($l .5 million); "Can Africa reachthe internationalTargetsfor HumanDevelopment?"The World bankSeptember, 2001 3  0 expand existing dental and obstetrical care services at district hospitals and recruit VNU to provide surgical andanesthetist specialists($1.5 million); increase the accessibility o f the poor to quality health services at hospital level through theprocurement ofadditional drugs ($2.5 million); 0 ensure adequate funding for ongoing activities to: (i) infectious diseases and control STI/HIV/AIDS ($0.5 million); (ii) strengthenfamily planning ($3.0 million); and (iii) to to maintainthe 36 nutritionalrehabilitation centers($1.0 million); and 0 promote ongoing sectoral reforms infacility planning, humanresources, healthfinancing, managementinformation, etc. ($1.O million). 10, Rationale for Supplemental Credit. The proposed supplemental credit meets the requirements o f OP 13.20 on Supplemental Financing as follows: (a) The cost overrun is due to exceptional circumstances beyond the borrower's control. Confronted by deteriorating health indicators, resulting from both natural disasters and political strife, the project initiated a series o f innovative, short-term measures to attenuate the effects o f these successive shocks on the delivery o f health services. The implementation o f these measureshas succeeded inreversing the negative trends (and dramatically improving some indicators) but over a longer period and at significantlyhigher costs thanoriginally estimated. (b) The existing credit is being implemented in compliance with all covenants. The overall project performance has been satisfactory during implementation, including duringthe crisis. Project andfinancial management, compliance withagreedprocurement schedules, and compliance with safeguards has been satisfactory throughout implementation. Monitoring and evaluation have been rated highly satisfactory inrecent project status reports. (c) It is not possible to reduce the scope of the project at this point. Since January 2003, after most post-crisis interventions were prepared and implemented, the disbursement rate o f the Second Health Sector project has increased significantly. The credit i s presently 88.6 percent disbursed to date and i s expected to be nearly fully disbursedbyJuly 2005. A reduction inthe scope or the elimination of ongoing initiatives (such as district hospital nutritional services for severely malnourished children; increasedsupplies o f drugs, contraceptives, and other consumables; procurement o f long lasting impregnated bed nets; and financial and technical assistanceto strengthen district level planningandmanagement o fhealth services) wouldjeopardize current progress and severely compromise achievement o fthe development objectives. (d) The borrower is unable to$nance the additional costs and to obtain additional fundsfiom other lenders on reasonable terms or reasonable time. The GoM managedto find complementary funding for certain project activities, but not at the level required. Additional fbnding for HIV/AIDS (through PMPS and the Global Fund) and for malaria and tuberculosis have been obtained fiom the Global Fund. Most traditional donors, however, continue to focus on selected levels (e.g., USAID which is focusing on central 4  andcommune levels) or a limitednumber ofdistricts (e.g., GTZ) or on specific activities (e.g., UNICEF and UNFPA), while others (including the European Union and the Bank) are shifting financial aid to direct budget support, which makes protection o f proven interventions through earmarkedfunds difficult. Only the current IDA credit has (i) the capacity to support the project's demonstrably successfid interventions during the transition to PRSC financing and (ii) the flexibility to intervene rapidly to support immediate needs or potentiallyinnovative solutions. (e) The time available is too short to process afurther freestanding Bank loan. Given the immediate needs arid current level o f disbursement, the time required to prepare a freestanding loan, and the fact that any new credit would be virtually identical to the existing one in its design and objectives, the required time and additional financial resources to prepare such a project would be neither practical nor desirable. Further, preparinga,fleestanding health project within the context o f the PRSC process would be far less acceptable than providing a form o f bridge financing for targeted services while ensuring that the MoHhas masteredthe methods for effectivelyimplementing the budget support. (r) The borrower is committed to the project, and the implementing agencies have demonstrated competence in carrying it out. As indicated in the 1999 Letter o f Sector Policy, confirmed in the Business Plan 2002-2005, and reconfirmed in the Poverty Reduction Strategy Paper, the GoM is committed to increasing the pace of reforms and strengthening service delivery at all levels. The mainhealth objectives ofthe PRSP are to improve maternal and childhood health and to reduce transmissible diseases. Wlvle public sector spending on health has increased in nominal terms (with a very large increase for 2005), it has remained virtually unchanged in real terms over the past four years. Current efforts to cany out a national health accounts exercise, to update the national healthpolicy, to introduce a medium-term expenditure framework, andto usethe marginal budgeting for bottlenecks approach should contribute to a more sustained growth in the health budget over the period 2006-2008. The proposed supplemental would cover important sectoral expensesduringthis period. The project implementation unit has demonstrated its capacity both to manage IDA'S procurement and disbursement procedures and to innovate effectively at all levels of the health care system to improve the accessibility and quality o f health services. In particular, to ease the administrative burden o f procurement, the project has increasingly relied on UN suppliers (UNICEF, IAPSO, etc.). Previous supervision missions have determined that: (a) an acceptable accounting system has worked efficiently during project implementation and will be maintained; (b) appropriate accounting staff is in place and able to produce timely financial reports for managing and monitoring project activities as defined inthe project implementation manuals; and (c) independent auditors acceptable to IDA will continue to audit the use o f all funds available under the Supplemental Credit with annual audit reports to be submitted to IDA no later than six months after the end o f the fiscal year. 5  I).Implementationconsiderations 11. SafeguardsIssues. Inlight o f a recent reassessmento f the environmental impact because o f the Project's use o f pesticides for malaria and plague control as well o f the increasing importance of disposing medical waste in the context of the HIV/AIDS epidemic, the environmental classification category has been revised to B. The most significant safeguards issue i s ensuring safe disposal o fmedical waste. The Medical Waste Management Planthat was preparedin March 2002 for the Madagascar PMPS (Multi-Sectoral AIDS Project) has proven satisfactory and will be applied to the supplemental project. It has been re-disclosed inMarch 7, 2005 for this purpose. Furthermore, although the M O H abandonedDDT infavor of pyrethroids for indoor sprayings, the insecticides and impregnatedbednets will be strictly handledaccording to WHO guidelines. 12. Sustainabilitv: After providing for free drug distributionduringthe post-crisis period, the GoM recently reinstated a modest cost-recovery system for drugs at the periphery, At the same time, to prevent financial shocks to poor households in case o f catastrophic illness, the GoM continues to provide free health care services and accommodation at hospital level. Inaddition, the M o H is starting piloting initiatives such as mutual insurance schemes and equity funds to support the indigent population. 13. Risks. Key risks that were identified at the outset o f the project and, although still relevant, have been substantially attenuated by the recent political developments: (i) political stability and ownership of the project were much improved and should improve favorably; (ii) future economic performance i s promising in view o f the resolute GoM orientation on tax and trade policy; (iii) capacity will no doubt improve given MoH's willingness to rely on sector technical assistance to strengthen district capacity as well as to contract out specific responsibilities to NGO or private firms where there i s an added value; and (iv) donor support has quickly resumed since the crisis and should significantly increase in view o f improving governance. 14. Effectiveness conditions and agreements. Inaddition to the submission o f a satisfactory legal opinion on the Agreement Amending the Development Credit Agreement, several substantive changes inthe DCA are proposedbecause o f the increasingly decentralized nature of project funding. First, given (i) amount o f money to be allocated to the regions and districts the and (ii) time required to spend, to collect andsubmit receipts, andto control expenditures by the districts prior to submitting the withdrawal application, an increase inthe amount o f the special account will be needed. Second, a new category will be requestedto fund implementationo f the annual program plans o fthe health regions anddistricts (administrative subdivisions). Insupport o f this proposedmodification, the project has prepared an implementation manual indicating the amounts to be allocated, the use o f the funds, and the modalities for managing and reporting on their use. The addition of the region anddistrict operating costs will be reflected inthe amended project implementation manual to ensure the compliance with the existing procedures and arrangements. Third, the Medical Waste Management Plan dated March 2002 will be explicitly referred to in the DCA in order to ensure the safe disposal of medical waste under the Project. 6  Fourth, utilization o f UN procurement agencies (UNICEF, IAPSO, etc.) will be extended for goods andcommodities to bepurchasedunderthe supplementalCredit. 7   Annex 1 PaPe1of3 REPTJBLICOFMADAGASCAR SUPPLEMENTALSECONDHEALTHSECTORSUPPORTPROJECT ESTIMATEDADDITIONAL PROJECTCOSTSAND FINANCINGPLAN (inUS$ million) EstimatedCosts 1 FOREIGNAS Government LOCAL FOREIGN TOTAL Yo OF Counterpart I TOTAL Funding &d insecticides ........... ~ (4) Consultants'" services, training _.-__.....__I-.-.___ and audits 1 (5) Operating 9.579 . 19.448 49.3% 1.848 TotalProjectCosts FinanciugPlan IDA 18.000 Government 1.848 Total 19.848 8  Annex 1 Pwe 2 of3 REPUBLICOFMADAGASCAR SUPPLEMENTALSECONDHEAL,TH SECTORSUPPORT PROJECT SUMMARY OFPROPOSEDPROCUREMENTARRANGEMENTS (in US$million) ProcurementMethods Other methodsinclude use ofconsultants according to Bankguidelines andnationalshopping. 9  Annex 1 Pape3 of3 REPUBLICOFMADAGASCAR SUPPLEMENTALSECONDHEALTH SECTORSUPPORTPROJECT ALLOCATIONAND DISBURSEMENTOFTHE SUPPLEMENTALIDA CREDIT (inSDRequivalent) Amount of Financing Yoof AI lcated Expenditures Initial Additional to beFinanced Financing3 Financing (1) Civilworks 6,641,600 836,000 100%of foreign expenditures and 85% of localexpenditures (2) Goods 7,396,700 2,788,000 100%of foreign expenditures and 85% oflocal expenditures (3) Drugs, materials, 3,153,900 3,362,000 100%of foreign expenditures and 85% insecticidesandbed of local expenditures nets (4) Consultants' 6,825,300 1,689,000 100% for Initial Financing; 85% of services, training foreign expendituresand75% of local andaudits expenditures for consultants' services andaudits, and 100%of training for Additional Financing (5) Operating Costs 4,982,500 836,000 85% (6) District Operating 2,789,000 85% costs TOTAL 29,000,000 12,300,000 IDAFY 2005 2006 Annual 8,000,000 10,000,000 Cumulative 8,000,000 18,000,000 Annual disbursementto progressivelydecrease over time becausePRSC will be introduced startingin2005 andprogressivelyreplaceproject's expenditures. InitialFinancingreflects the February 2005 reallocation 10  Annex 2 PaPe 1of 1 REPUBLICOFMADAGASCAR SUPPLEMENTALSECONDHEALTH SECTORSUPPORTPROJECT KEYPERFORMANCEINDICATORS Baseline Mid-TermReview Current Source (Janua 2004) (March 2005) OutcometImpactIndicator Target Actual Fatalityrateinseverely malnourished 20% 15% 13% 12% Project's children0-5 years hospitalizedfor report nutrition rehabilitation Infantmortality rate 9611000 8611000 8511000 5811000 (MICS 2000) Maternalmortality rate 4881100,OO 4501100,000 4881100,000 4691100,000 (MICS 2000) 0 HIV prevalenceinpregnantwomen 0.13 ~0.25 1.1% 0.95% December03 National survey OutputIndicators %ofpopulationwithprimary healthcare 65% 75% 60% 60% Health facilities within a5kmradius facilities mapping (2000) Numberofhealthfacilities rehabilitated 0 50 200 i- 208 +40 37 Project's dentaloffices report Numberof contactsper patientperyear 0.20 0.40 0.70 0.45 Annual statistics2003 Bedutilization inhospitals 50% 65% 41.% N A Annual statistics 2003 Hospitalfatality rateof severemalaria TBD 7.3% 7.0% Annual statistics2003 NumberofTB cases detectedannually 18,693 in 12966 24,000 AnnUal 2002 statistics2003 NumberofTB cases noncompliantto 10%(2001) 16% 20% Annual treatment statistics 2002 Regulationadoptedon decentralizationto Regulations Regulations Regulations Regulations MoH districts finalized adopted implemented implemented M& Ecarriedout annually M& Edone M62 Edone done twice a done twice ayear MoH year Humanresourcesdevelopmentplans Plansbeing Plans Human ICB underway MoH completed prepared completed resources (submission ofbid development documents planto be 04118105) implemented this CY District developmentplanscompleted Plansbeing Plans 100% 100% MoH prepared completed Number ofprivatehealthfacilities inrural 212 I 20% increase NA NA Health fiomthe facilities baseline mapping (2000) Number ofhealthfacilities with appropriatemedicalwaste management equipment andcapacity 11  Annex 3 Pape1of 1 StatusofBankGroupOperationsinMadagascar OperationsPortfolio -* Totd Disburses(Actlve) of which has Lmenrepaid Totd D i s b u d(Closed) of which has be%n repaid Totid Disbursed(AActive +Cb&) of which he8 beenrepaid Totd Undisbud (Activa) Tot4 UndisburSBd( C W ) Tolai Undlsbud(Active+ C W ) AdIw Proled. - Oitlm-" 8.twnn Expated andAclusl ' ~ Dbbur"nts PmjeclID ProjectNanv FlralYear l6RD IDA GRANT C m d . Undlsb. Odg, FmRev'd Po01588 2nd CommunityNutrition 1998 37.6 5.5 6.2 PO51741 2nd HealthSectorSupport 2000 40 5.6 6.3 PO01559 Educ, SectorDev, 1998 65 5.7 4.5 0.8 PO72160 - PSD2 2002 23.8 PO52208 MG MGTranspSector Reform8 Rehab 2000 65 7.5 17 3.5 8 PO55166 MGCommunityDevelopmentFundSIL (FYOI) 2001 160 29 -78.2 -19.3 PO01533 MG-EnegySec DevPrj(FY05) 1896 46 6.5 9.2 9.2 PO74235 MG-EnvlmnmentProgram 3 (FY04) 2004 40 37.1 -0.6 PO74236 MGGEF EnvironmentProgram3 (FY04) 2004 9 8.7 0.7 PO74448 MGGovemance8 lnst DevTAL(FY04) 2004 30 29 4.4 PO72987 MGMuItiSecSTVHlVlAlDSPmvAPL (FY02) 2002 20 9.4 -6.1 PO51922 MGRural DevelopmentSupport SiL (FYOI) 2001 89.05 59.2 -43.3 -7.9 PO73689 MGRuralTranspwlAPL 2 (FY03) 2003 80 53.1 -6.3 PO82806 MGTransportlnfrastrInvestP i (FY04) 2004 150 145.7 34.8 PO52186 MICROFINANCE 1899 18.4 4.4 3.4 PO76245 MINERALRESOURCESGOVERNANCEPROJECT 2003 32 26.2 6.6 PI301564 RURALWATER SEC.PIL0 1998 17.3 5.3 4.7 PO48697 URBANINFMSTRUCTURE 1997 35 2.7 2.3 2.4 Overall Result 947.15 9 457.6 -64.9 -14.8 Intended disbursements t o date minus actual disbursements t o date as projected a t appraisal Note: Disbursement data i s updated a t the end of the f i r s t week of the month 12  Annex 4 Page 1of 1 TIMETABLEOFKEYPROJECTPROCESSINGEVENTS (a) Time taken to prepare 2 months (b) Preparedby Jean-PierreManshande(Task Team Leader); Raj Soopramanien(Senior Counsel), Jean-CharlesDe Daruvar (Senior Counsel), MichaelP. Fowler (Senior Finance Officer), Thomas E.Walton (Lead Regional Coordinator, Environment), Sylvain Rambeloson(Procurement Specialist); Gervais Rakotoarimanana(Financial Analyst); NorosoaAndrianaivo (Program Assistant) and Andrianina Rafamantanantsoa(Program Assistant). (c) Appraisal May 2004 (d) Planneddate o fEffectiveness: July2005 (e) Project Closing December31,2006  MAP SECTION