Kenya - Additional Financing for the Health Sector Support Project : restructuring

 Document of The World Bank FOR OFFICIAL USE ONLY Report No: 65612-KE PROJECT PAPER ON A PROPOSED ADDITIONAL CREDIT IN THE AMOUNT OF SDR35.9 MILLION (US$56.8 MILLION EQUIVALENT) FROM THE IDA CRISIS RESPONSE WINDOW RESOURCES TO THE REPUBLIC OF KENYA FOR A HEALTH SECTOR SUPPORT PROJECT NOVEMBER 30, 2011 Health, Nutrition, and Population Unit (AFTHE) Human Development Department Africa Region This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization.  CURRENCY EQUIVALENTS (Exchange Rate Effective October 31, 2011) Currency Unit = Kenyan Shilling K.Sh.93 = US$1 US$ = SDR0.6306 FISCAL YEAR July 1 – June 30 ABBREVIATIONS AND ACRONYMS AF Additional Financing CPS Country Partnership Strategy CRW Crisis Response Window DA Designated Account DANIDA Danish International Development Agency DHMT District Health Management Team EMMS Essential Medicines and Medical Supplies FBO Faith Based Organizations FM Financial Management FY Fiscal Year GAM Global Acute Malnutrition GIZ German International Cooperation GoK Government of Kenya HSCC Health Sector Coordination Committee HSSF Health Sector Services Fund IBRD International Bank for Reconstruction and Development ICB International Competitive Bidding IDA International Development Association IFR Interim Financial Report IIFRA Independent Integrated Fiduciary Review Agency IPPs Indigenous Peoples Plans IPSAS International Public Sector Accounting Standards KDHS Kenya Demographic Health Survey KEMSA Kenya Medical Supplies Agency KHSSP Kenya Health Sector Support Project MOMS Ministry of Medical Services MOPHS Ministry of Public Health and Sanitation NCB National Competitive Bidding NGO Non Governmental Organizations OP Operational Policy OPRC Operations Procurement Review Committee PDO Project Development Objective RUSF Ready-to-Use Supplementary Food RUTF Ready-to-Use Therapeutic Food SWAp Sector Wide Approach program UNHCR United Nations High Commission for Refugees UNICEF United Nations Children’s Emergency Fund UOM Unit of Measurement USG United States Government VMPPs Vulnerable and Marginalized People’s Plan WA Withdrawal Application WFP World Food Program WHO World Health Organization Vice President: Obiageli Katryn Ezekwesili Country Director: Johannes Zutt Sector Director: Ritva Reinikka Acting Sector Manager: Jean-Jacques de St. Antoine Task Team Leader: Gandham N. V. Ramana  KENYA Health Sector Support Project – Additional Financing CONTENTS I.  Introduction .......................................................................................................................... 1  II.  Background and Rationale ................................................................................................... 3  III.   Proposed Changes ................................................................................................................ 9  IV.   Appraisal Summary ........................................................................................................... 12  Annexes Annex 1: Results Framework and Monitoring............................................................................. 16  Annex 2: Operational Risk Assessment Framework (ORAF) ...................................................... 23  Annex 3: Detailed Description of New Project Activity ............................................................. 26  Annex 4: Procurement Arrangements ........................................................................................... 29  Annex 5: Map Section ................................................................................................................. 32    List of Figures Figure 1: Trends in Admission of Severely Malnourished Children in Drought Affected ............ 5   KENYA HEALTH SECTOR SUPPORT PROJECT- ADDITIONAL FINANCING ADDITIONAL FINANCING DATA SHEET Basic Information - Additional Financing (AF) Country Director: Johannes Zutt Sectors: Health Acting Sector Manager/Director: Jean-Jacques Themes: Child Health, Nutrition, Health de St. Antoine/Ritva Reinikka System Team Leader: Gandham N.V. Ramana Environmental category: B- Partial Project ID: P128663 Assessment Expected Effectiveness Date: January 15, 2011 Expected Closing Date: March 31, 2015 Lending Instrument: Investment Lending Additional Financing Type: Financing Gap, Scale-up and Restructuring Basic Information - Original Project Project ID: P074091 Environmental category: B- Partial Assessment Project Name: Kenya Health Sector Support Expected Closing Date: March 31, 2015 Project (KHSSP) Lending Instrument: Specific Investment Lending AF Project Financing Data [ ] Loan [ x ] Credit [ ] Grant [ ] Guarantee [ ] Other: Proposed terms: Standard IDA terms, 40 years maturity including a grace period of 10 years. AF Financing Plan (US$m) Source Total Amount (US $m) Total Project Cost: 56.8 Cofinancing: 0.0 Borrower: 0.0 Total Bank Financing: 56.8 IBRD from IDA Crisis Response Window Resources IDA New 56.8 Recommitted i  Client Information Recipient: Republic of Kenya Office of the Deputy Prime Minister and Ministry of Finance Contact Person: Permanent Secretary Treasury Building P.O. Box 30007-00100, Nairobi, Kenya Telephone No.: +254 (20) 2252299 Fax No.: +254 (20) 2240045 Email: ps@treasury.go.ke Responsible Agencies: Ministry of Public Health and Sanitation Contact Person: Permanent Secretary Afya House, Cathedral Road P.O. Box 30016-00100 Nairobi, Kenya Telephone: +254 (20) 2717077 Fax No.: +254 (20) 2715239 Email: psph@health.go.ke Ministry of Medical Services Contact Person: Permanent Secretary Afya House, Cathedral Road P.O. Box 30016-00100 Nairobi, Kenya Telephone No.: +254 (20) 2717077 Fax No.: +254 (20) 2735236 Email: mary.ngari@health.go.ke ii  AF Estimated Disbursements (Bank FY/US$m) FY 2012 2013 2014 2015 Annual 12.8 44.0 0.0 0.0 Cumulative 12.8 56.8 56.8 56.8 Project Development Objective and Description Original project development objective: To support the Program1 and improve: (i) the delivery of essential health services in the Recipient’s territory, especially for the poor; and (ii) the effectiveness of planning, financing and procurement of pharmaceuticals and medical supplies. Revised project development objective: To support the Program and improve: (i) the delivery of essential health services in the Recipient’s territory, especially the poor and the drought affected populations; and (ii) the effectiveness of planning, financing and procurement of pharmaceuticals and medical supplies. Project description: The proposed additional financing (AF) from the IDA Crisis Response Window (CRW) to the Kenya Health Sector Support Project (KHSSP) would support the emergency response to deliver essential health and nutrition services for the drought affected arid and semi-arid regions of Kenya. The AF will include new activities to address the nutrition and health needs of children under five, and pregnant and lactating women as well as scale-up of ongoing activities to improve the supply of essential medicines to mitigate the risk for infections and communicable disease outbreaks. There will be several new indicators added for activities supported under the emergency response and minor refinements to several existing indicators and targets. The project includes two components. Component 1: This component supports the delivery of Kenya Essential Package for Health and Nutrition Services. The proposed AF will support a new activity (US$12.8 million) which complements ongoing efforts by Government of Kenya (GoK) and its partners to deliver essential health and nutrition services to populations affected by the drought. Specifically this involves supply of nutrition commodities to manage acute malnutrition among children under five years, and pregnant and lactating women2. The AF will also provide support for blanket supplementary feeding3, if the need arises, as a part of a wider package of ongoing nutrition interventions. Services of UNICEF will be contracted for the supply of nutrition commodities. Component 2: This component supports increased availability of essential medicines and medical supplies and reinforcement of the supply chain management. The proposed AF will support scale-up (US$44 million) of these activities with an enhanced focus on the drought affected districts with a view to prevent and control infectious and outbreak prone diseases. The AF will also strengthen the ongoing reform to move towards a “pull