Tunisia - Health and Population Project

Document of The World Bank FILE COPY FOR OFFICIAL USE ONLY Report No. P-3063-TUN REPORT AND RECOMMENDATION OF THE PRESIDENT OF THE INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT TO THE EXECUTIVE DIRECTORS ON A PROPOSED LOAN TO THE REPUBLIC OF TUNISIA FOR A HEALTH AND POPULATION PROJECT May 6, 1981 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.  REPUBLIC OF TUNISIA CURRENCY EQUIVALENTS Currency Unit - Tunisian Dinar (D) The exchange rate of the Tunisian Dinar is floating. The rate used in the President's and Staff Appraisal Reports, which appro- ximates the current rate, is: US$l - D 0.400 Dl - US$2.50 Dl million = US$2.5 million FISCAL YEAR January 1 to December 31 PRINCIPAL ABBREVIATIONS AND ACRONYMS USED CNSS - Caisse Nationale de Securite Sociale (National Social Security Fund) CNI - Centre National d'Informatique (National Computer Center) CRFP - Centre de Recherches et de Formation Pedagogique pour le Personnel Sanitaire (Health Research and Training Center) INE - Institut National de l'Enfance (National Institute of Child Health) INNTA - Institut National de Nutrition et de Technologie Alimentaire (National Institute of Nutrition and Food Technology) IUD - Intra-Uterine Device MCH - Mother and Child Health MIS - Management Information System MOPH - Ministry of Public Health MWRA - Married Women of Reproductive Age ONPFP - Office National de la Population et du Planning Familial (National Office of Population and Family Planning) PCU - Project Coordination Unit UNFPA - United Nations Fund for Population Activities USAID - United States Agency for International Development  FOR OFFICIAL USE ONLY TUNISIA HEALTH AND POPULATION PROJECT Loan and Project Summary Borrower: Republic of Tunisia Amount: US$12.5 million equivalent Terms: 17 years, including 4 years of grace, with interest at 9.6 percent per annum. Project Description: The project would support Government efforts to extend basic health care to the whole population by 1990, through the provision of better and more cost-effective health, family planning and nutrition services to lower income groups in eight selected governorates. It would strengthen the Ministry of Public Health's management capacity, improve and expand the basic health care delivery system and health education programs, upgrade the training system, and train project personnel. The project would include: (a) the provision of equipment and supporting staff and services to the Ministry of Public Health; (b) the construction and/or remodelling, equipping and furnishing of about 140 health posts, 325 dispensaries, 90 staff houses, two regional health education centers, 6 paramedical schools, and 8 vehicle maintenance workshops; (c) additional equipment for 21 district hospitals; (d) the provision of appropriate transportation facilities; and (e) technical assistance in support of all project components. Benefits and Risks: The project would make a significant contribution to meeting the basic health needs of about 2.25 million people in under-priviledged areas. It would support the Government policy of improving health and nutrition con- ditions while slowing down the population growth rate. Risks are related to the management of the project's large set of activities and programs, to possible resistance to the shift to preventive care and to the difficulty of recruiting health personnel to serve in rural areas. However, the Government's commitment to the integrated health policy, the broad national support for the project, the substantial positive results already achieved through pilot projects in similar areas, and a well planned program of technical assistance are expected to minimize these risks. 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.  - ii - Estimated Cost: US$ Million Local* Foreign Total Management 2.0 1.2 3.2 Strengthening Basic Health Care infratructure 6.9 5.0 11.9 service delivery 9.4 1.4 10.8 Health and population communications 0.3 0.8 1.1 Training 1.7 0.4 2.1 Project administration 0.3 0.2 0.5 Subtotal (base costs) 20.6 9.0 29.6 Physical contingencies 1.3 0.7 2.0 Price contingencies 6.6 2.8 9.4 Subtotal (contingencies) 7.9 3.5 11.4 TOTAL PROJECT COST 28.5* 12.5 41.0 Financing Plan IBRD - 12.5 12.5 Government 28.5 - 28.5 Total 28.5 12.5 41.0 Estimated Disbursements: FY82 FY83 FY84 FY85 FY86