Madagascar - Second Health Sector Support Project

Document of The World Bank Report No: 19801-MAG PROJECT APPRAISAL DOCUMENT ONA PROPOSED CREDIT IN THE AMOUNT OFSDR 29 MILLION (US$40.0 MILLION EQUIVALENT) TO THE REPUBLIC OF MADAGASCAR FORA SECOND HEALTH SECTOR SUPPORT PROJECT November 4, 1999 Human Development IV Country Department 8 Africa Region  (Exchang(e Rate Effective) Currency Unit =FMG 1 FMG' US$ 0.000176 US$ 1 = 5687 FMG FISCAL YEAR January l - December 31 ABBREVIATIONS AND ACRONYMS AfDB African Development Bank MOH/MINSAN Ministry of Health/Ministere de la santd AIDS Acquired Immune Deficiency Syndrome MIS/SIG Management Infornation Systeme/Systeme d'Inforrnation pour la Gestion APL Adjustable Programn Lending MMR Maternal MortaIity Rate ARI Acute Respiratory Irnfections MOH Ministry of Health BHA Better Health in Africa MSF M6decins sans fronti6res CAS Country Assistance Strategy NCB National Competitive Bidding CDC Centers for Disease Prevention and Control NGO Non-Governmental Organizatior CRESAN Health Sector Improvement Project (Credit Sant6) PAIGEP Public Management Capacity Btilkling Project PA Project Account CRESE,D Education Sector Reinforcement Project (Credit PAM Programme Alimentaire Mondia. Education) CRS Catholic Relief Services PCU Project Coordination Unit CSBI Health center category I (Centre de sante de base 1) PER Public Expenditures Review PIM Project Implementation Manual CSB2 Health center category 2 (Centre de sante de base 2) PPF Project Preparatiion Facility DALY Disability Adjusted Life Year PNLS Programxne National de Lutte contre le SIDA/MST/VIH DHS Demographic and Health Survey PTA Plan de Travail Annuel DIRDS Directions Inter-Regionales de Developpement RH Regional Hospital Sanitaires EPI Extended Program olF Imnunizations Salama Centrale d'Achal; de Medicamene; Essentiels EU European Union SECALINE Food Security and Nutrition ProJ -cl: FAO Food and Agriculture Organization SEECALINE Community Nutrition II Project FID Regional Development Fund (Fonds dintervention SBD Standard Bidding Documents pour le developpement) FP Family Planning SIL Structural Investment Loan GAIN Groupe d'Action Intersectorielle de Nutrition SMP Severely Malnourished Children Program GDP Gross Dornestic Product SOE Staternent of Expenditures GTZ Germnan Agency for Technical Cooperation STD Sexually Transmiitted Diseases HIV Human Immuno-deficiency Virus TB Tuberculoses HSDP Health Sector Development Plan (Plan Directeur) UNDP United Nations Development Program IAPSO United Nations Inter-Agency Procurement Services tJNFPA United Nations Fund for Population Activities IBRD International Bank for Reconstruction and UNICEF United Nations Children's Fund Development UNIPAC United Nations Plrocurement & Assembly Cen:.r ICB International Competitive Bidding USAID United States Agency for Interna ional DevelopirLent ICR Implementation Completion Report UNV United Nations Volunteer IDA International Development Agency WDR World development Report IEC Information, Education and Communication WFP World Food Program IMCI Integrated Management of Childhood Illness WHO World Health Organization IMR Infant Mortality Rate Vice President: Callisto Madavo Country Director: Michael N. Sarris Sector Manager: Arvil Van Adams Task Team Leader: loan S. Luculescu  MADAGASCAR SECOND HEALTH SECTOR SUPPORT PROJECT CONTENTS A. Project Development Objective Page 1. Project development objective 3 2. Key performance indicators 3 B. Strategic Context 1. Sector-related Country Assistance Strategy (CAS) goal supported by the project 3 2. Main sector issues and Government strategy 4 3. Sector issues to be addressed by the project and strategic choices 11 C. Project Description Summary 1. Project components 15 2. Key policy and institutional reforms supported by the project 15 3. Benefits and target population 16 4. Institutional and implementation arrangements 17 D. Project Rationale 1. Project alternatives considered and reasons for rejection 18 2. Major related projects financed by the Bank and other development agencies 22 3. Lessons learned and reflected in proposed project design 24 4. Indications of borrower commitment and ownership 25 5. Value added of Bank support in this project 25 E. Summary Project Analyses 1. Economic 26 2. Financial 26 3. Technical 28 4. Institutional 28 5. Social 29 6. Environmental assessment 29 7. Participatory approach 30 F. Sustainability and Risks 1. Sustainability 31 2. Critical risks 31 3. Possible controversial aspects 33  G. MainLoanconditions 1. Effectiveness conditions 33 2. Other 33 H. Readiness for Implementation 34 I. Compliance with Bank Policies 35 Annexes Annex 1: Project Design Summary 36 Annex 2: Detailed Project Description 43 Annex 3: Estimated Project Costs 51 Annex 4: Economic Analysis 52 Annex, 5: Financial Summary for Revenue-Earning Project Entities, or Financial Summary 69 Annex 6: Procurement and Disbursement Arrangements 70 Annex 7: Project Processing Schedule 78 Annex 8: Documents in Project File 79 Annex. 9: Statement of Loans and Credits 80 Annex 10: Country at a Glance 82 Annex 11: Annex 12: Annex I - Attachment 1: Letter of Sector Policy - Annex 6 - Attachment 1: Procurement Capacity Assessment MAP(S)  MADAGASCAR Second Health Sector Support Project Project Appraisal Document Africa Regional Office Africa Region, Human Development 4 Date: November 4, 1999 Team Leader: loan S. Luculescu Country Manager/Director Michael N. Sarris Sector Manager/Director Arvil Van Adams ProjectLM P051741 Sector(s): HT - Targeted Health Lending Instrument: Specific Investment Loan (SIL) Theme(s): Poverty Targeted Intervention N Project Financing Data O Loan N Credit O Grant El Guarantee O Other (Specify) For Loans/CreditslOthers: Amount (US$m)US$40.0 million Proposed Terms: O To be defined 1S Multicurrency O Single currency 1 Standard Variablet] Fixed E LIBOR-based Grace period (years): 10 Years to maturity: 40 Commitment fee 0 Service charge 0.75% Government 4.38 0.00 4.38 IBRD IDA 13.81 26.19 40.00 Total: 18.19 26.19 44.38 Borrower: GOVERNMENT Guarantor: NA Responsible agency MOH Other Agency(ies): Ministry of Health Address: UGP Projet CRESAN, Ex-Ecole de Medicine, Befelataninana, Antananarivo, Madagascar Contact Person: Dr. Paur-Richard Ralainirina, Coordinateur du projet CRESAN & Dr. Dieudonne Robert Rabeson, Directeur des Etudes et de la Planification, Ministere de la sante, Antananarivo, Madagascar Tel: 261-20-22-32-544/261-222-32-524 Fax: 261-20-22-32-524/261-20-22-32-524 Email: ugpcresan@simicro.mg Estimated disbursements( Bank FYIUS$M): Annual