Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1698833973837.pdf (Sierra Leone)
?Ro 1s Document of lte World Bank FOR OFFICIAL USE ONLY Report No: 70811-SL.

PROJECT PAPER ONA PROPOSED AFzuCA CATALYTIC GROWTH FUND r\DDITIONAL FINANCING IN T}IE AMOTINT OF us$ 5,690,614 TOTI# REPUBLIC OF SIERRA LEONE FORA REPRODUCTIVE AND CHILD HEALTH PROJECT.

PHASE 2 AUGUST 9,20I2 This document has a restric:ed distribution and may be used by recipients only in the performance of their official duties.

Its conterts may not olherwise be disclosed without World BanI authorization.
* r -,) 1., ,; ' \ll $i'llt -9rr\'-,- I t- P 10\l tR \\ltl Second Phase of Sierra Leone Reproductive and Child Healtb Project (PI10535) T,1',:?H,l'fixt' Annex I AlhajiBannieEillahSei say .Qcl"er!

!gs.Cf thc Re Alpha L Sesay- J j uelene Cole Adams 4 5.

I Alpha U. Jalloh 1 6.

8 o Augusta Peter-Karnara Dr. Michael Amara Dr. Edward M br Dr. D.r\.BashTaqi 10.

-l Fodie J. Konneh ll.

1?


Amara Kamara KeikuraBangura blic of Sierrs Leone on Seu.ior Deputy Finaocial Secretar; , MoFED and Head of Dei Pro grammeCoordinator, IPAU,MOFED Head of Finar:ce, IPAUA{OFED Director LGFD,4vIOFED Senior Economist, LGFDA4OFED Project IEC Offica, IPAU/MOFED Health Economist, MoHS M&E Offrcer, MoHS MoIIS Director Senior Procuemenr Omcer MoHS of Health and Sanitation Principal State Attomey, MoJ Dcl Awittor, Eve Christine Makori Luis Shwarz ViorelVelea Peter Ganda 14.

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18. tion of the tB Devel ment Association ons Officer and TTL Senior O Counsel Senior Finance Oflicer alisl Procurement Operations Ofliccr 1.- i'ffi.

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Drall Procurencnt Plrn: The delegations reviewed the draft Procurement PIan.

The is d.ted August 9b,2012, and is anachment 04to tlese MinuEs.

negotiated t€xt 6.

Revised Operational Manual: The deiegations revie*'ed.

the revised Operauonai Manuat.

The final version will bc subtnitted to the Bank on Augusl 16th 2012.

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Closiug Date:Il was agrced thal dl exlcnsion of the Clositrg Date of the Projert q'ill be considered laler, 8.

Approvat of Proposcd Additiond Financiug, The IDA Represeotativcs clarified to the Sierra Leone Delegation that tbe final negotiatd package will be submitted to the Vice Presideot, Africa Region for agproval in accordance with relevart policies and procedures on Au8usr3l'r, 2012.

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World B.Dk Access to InforDrrtion Policy aud Disclosure of the PAD:The Siena Leone Delegation also revieued the Project Paper for any text or data that may be confidential or sensitive, or that may adversely a$ect the relations between the Recipient and the Association.

Under tbe Association's Acc€ss to hformation Policy date July lst, 2010, the Project Paper, related legal agrcements and other information related to the legal agrcements, includiag any supplemental letters u'ill be disclosed.
The Siera Leone Delegation conlirmed that IDA may publicly release the version of the Project Paperagreed upon during negoiiationsr and also agreed to the releas€ of the audited financial statcments of the project account, as these become available, Pursualt to tLis policy, in due course, the Association will also disclose the Implerneatation Status snd Results (ISR) repofts for t}le Project.
Sigrred on August lf ,2012, in Freetown, Sierra Leone: On behalf of the IDA On ofthe RepubLic of Si Evelyn Awittor Senior Operaions OIIicer World Bank ZtA#- r t> Date t ets Senior Deputy Financial Secretary, Ministry of Financing & Economic Development Dale t () (J Sierra Leone Reproductive and Child Health Project Phase 2 Additional GranS.
(P127527) Agreed Minutes of Negotiations l. Negotiations for a proposed Africa Catalytic Growth Fund C'ACGF') Additional Financiog in t}re amount oiUSD 5,690,614for the Second Phase of the Reproduclive and Child I-lealth Project were held vimrally by representatives of tbe Republic of Sierra l-cone ("Sierra Leone Delegation") and rr:presentatives of thc international Development Association acting as administrator of the Africa Caralytic Growth Fund ('IDA Representatives") between August 76-grh" 2012.
The members of the Sierra Leone Delegation and the IDA Represcnradves are listed in Annex I of thcse Minutes.

The Sierra Leone Delegation informed the IDA Representatives that Alhaji B. E Seisay (Senior Deputy Financial Secretary', Ministry ofFinarce and Economic Development) was the designated head of the Delegation.

These Minutes of Negotiations ("the Mjnutes') record rhe underslandinS,s reached between the Sierra Leone Delegation and dre IDA Represeolatives (collectively, the Delegations).
The Reciprcnt and the Association agrecd on the: (r) Drafl Project Paper (-attachment 0I to these minutes); (il) Draft Amendment to the Orant Agrcement bct\4€en the Recipient and the Association datcd August 96, 2012 (attachmert 02to th€se minutes)i (iiD Draft Disbursement Leter (rttachment 03to these minutes); (iv) Drafl Procurcment plan (ettachment (Hto these minutes); and the (v) Updated Operational Manual 2.

Technical Discussioos ou Project Paper ("PP'),The draft Project Paper was reviewed.
'fhe datc frrr tlre retroactivc financing was changed from September 1", 2011 !o Novembcr l'r, 201 I .

'Ihc agrccmenls reached are reflected in a revise<i Yersion dated Augusl 9t, 2012.

3.

Draft Amendm€at to the GraDt AgreeEcnt.

The draft Amendment to th€ Grart Agreement was rcviewed.
'Ilre IDA Representatives clarified that the draft Amendment should be read in conjunction witr the: (i) Stardard Conditiors for Credits and Grants; (ii) Procuremenr Guidelines; (iii) Consultants Guidelines; (iv) draft Disbursement Letter; and (iv) the Anti- Comrption Guidelines- The Sierra [eone Delegation confrrned that the Draft Amendment Lelter fo the Grant Agreement was satisfactory.The agreements reached by the l)elegations are reflected in the (negotiated) draff Amendmenrda&d August 9rn, 2012.
The Effectiveucss Deadtine for the Additiona.l Financing is ninety (90) days from date of the countersigned Amendment Letter.

The Grant Agreemenl (as amended) requires parliamenlary ratificalionas well as a Legal Opinion.

The Sierra Leone Delcgation express'rd concem about timely approval of the Graut by parliament since Parliament is scheduled to be on recess from September 2 5.",2012.

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Disbursement Letler: lhe Delegations reviewed the draft Disbursement ktter.
lhe negotiated text is dated August 9th, 2012.

The Disbursement Letter *ill be siped arrd issucd by the Association at the timr: of signing of the Amendmed to lhe Grant Agreemenl.
& CURRENCY EQUIVAIENTS Exchange Rate Effective Auglst 9,2012 Currency Unit Leones 4387 US$ I = Lrone = US$l = SDR0.569 FISCAL YEAR January I - December 3l ABBREVIATIONS AND ACRONYMS Atica Catalgic aud Orowth Fund A.frica Development Bank Anti-Natal Care A.nnual Work Plan Community H'-slth Offi cers College of Medicine and Allied Health Scienccs Selection based on Consultants Qualifications Civil Society Organization Designated Account Department for lntemational Development District Health Information System District Healtl MaDagetnent Team Demographic Healft Survey Director of Planr,iog and Informatiou Diphtheria Pertussis and Tetanus 3 Decenl&lized Service Delivery Progr-am Emergency Obsterric and Neonatal Care Financiai Maoagement lree Health Care Initiative Fiscal Year Governmenl of Sierra leone Health Information System Human Irnmunodefi ciency Virus Heal& Nuritioa and Population Individua.l Consultant Intemationel Competitive Bidding Intemational Competitive Selection International Development Association lnterim Fimncial Report lntcgrded koject Admid stration Unit ACGF ADB ANC AWP CHOs COMHAS CQS CSO DA DflD DHIS DHMT DHS DPI DPT3 DSDP EmONC FM FHCI FY GoSL HIS Hry HNP IC ICB ICS IDA IITR IPAU <1A-- I'IN LC LCS I,GFD M&E MCH MCHP MDG MICS MoFED MoHS MWM NGO OP PAD PBF PEHS PID PCN PHC PHU PPA PRSP QCBS RCr(SP) StsD SECHNs SSS TA U5MR UNICEF wHo WMP lnsecticide l.reated Nets Local Council Least Cost Selection Local Covemrnent Finance Depaftrnent Monitoring and Evaluation \'tatemal and CtLild I lcalth
 Matsrnal arrd Child Health Posl Millerurium Dcvelopment Goals Muhiple Indicator Clu$sr Survey Ministry of Fina:rce and Economic Developmen Ministry of Ha th and Sanitation Medical \taste Management Non-Covemmental Organi zati on Operational Policy Project Appraisal Document Performance-tsased Financing Package of Esserrtial Hcalth Services Project Informaric n Documcnt Project Concept Note Primary l{ealth Care Peripheral Heath Unit Public Procurement Acl Poverty Reduction Stategy Papcr Quality and Cost Based Selection Reproductive and Child Health (Srategic Plan) Standard Bidding Docurnent State Enmlled Community Health NursEs Single Source Selection Technicai Assistance Under-Five Monality Rate United Nations Children Ftmd world Health Organization Wasre Management Plan Vice President: Country Direclor: Country Manager Sector Manager: 'I'ask Tear^r Leader: MakhtarDiop Yusupha Crookes Vijay Pillai Trins S. Haque Evelyn Awittor I Ij --..\ -ll SIERRALEONE REPRODUCTIVE AND CHILD IIEALTH PROJECT PHASE 2 CONTENTS Mandatory Anaores l. Action on Results Framework and Moniroring lndicaron.
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Operational Risk Assessment Framework l4 ,# 'r SIERRA LEO:{E REPRODUCTIVE AND CI{ILD HEALTII PROJEC'T PHASE 2 ADDI'TIONAL G R.t^*T DATA SHEET Basic Information - Additional Fimncilg (AF) Country Director: Yusupha Crookes Sector Manager/Dkector: Jean J.
De S1 Antoine 'Ieam lcader: Evelvn Awil,tor Project lD:P I24127 Expected Effectiveness Date: 09 D8/2012 knding lnstrument: Additional Fi.nancing Type: ACGF Sectors: Health, Nutrition and Popularion Themes: Chitd Health Environmental category : B Expected Closing Date: l0/l li l3 Project ID: Pl 10535 Project Name : RCHP2 Lending lnstrument: Grant [ ]Loan Pnr I J Credit terrns: Basic Informgtion - Original Irroiect Environmenlal cate gory : B Expected Closing Date: l0/31113 AF Pro ect Fioancing Data IX lGrant [ ]Guarantee[ ] Other: Sourcc AF !
'inan Plan SSm Total Amount million Total Pmject Cost: Cofinancing: Borrower: Total Bank Financing IBRD IDN ACGF New Recommined 5.69 0.00 0.00 5.69 0.00 0.00 5.69 i I Client Infonnaiion Recipieut Rcpublie Of Sierra Leoue ResponsibleAgency:Ministr/ of Finance and Economic Development and Ministr.v of Health and Sanitation Contact Person: Edmond Korom4 Financial Secretary, Ministry of Finance and Economic Development Telephone No.

: +232 22-222-211 Fax No.


: +232 22 228 472 Email: AF Estimated I)isbursemcnts k FY/USSm FY Aluual C:umulative 12 l3 5.690614 s.690614 and_.Dr994p.gioq- - .-_l J I I I I [t- I I I I t* Original Project Development Objective: To ilcrease urilization ofa package of essential health serviccs by PreBnant and lactating women and children under the age of fivc.
Projea Description: The addirional grant will finance activities that were initia.lly included in the original Project Concept, butlater scaled dor^n to accommodate an additional activity, namely, procurement and distribution of malaria bed nets at the request of the Governmeat of Sierra Leone (GoSL).

The additional grant vrill go tr) suppott compooent 2 (Capacity Building) of the restrucnued projecr.
It will provide $3.0 million for sub-componat 2.1 (Superrision, Monitoring and Evaluetiou) to continue to support capaciry building in M&E ar all levels of lhe health system.

The grant n'ill provide $2.69 millioo to sub.couponent 2.2 (Ce,pacity Buildiog of Njala Univenity ald University of Siera Leoue for provision of prc-service and postgraduate medicsl trsining).
I I I Safeguard and Ereeption to Policies Safeguard policies triggered: Enviroomenlal AssessmeDl (OP/BP 4.01) Narural Habitars (OP/BP 4.04) Forests (OPIBP 4.36) Pest Management (OP 4.09) Physical Culoral Resource s (OP/BP 4.

I I ) Indigenous Peoplcs (OP/BP 4. l0) lnvoluntary Resettlemeut (OPiBP 4.
12) Safety of Dams (OP/BP 4.37) Projecrs or htemationat Water*zys (OP/BP 7.50) ftojects in Disputed Arcas (OP/BP 7.60) 1 [X ]Yes [ ]Yes l Yes t l Yes t Yes t l Yes t l Yes t Y t es I lY es I t lYes Does the project require any waivers of Bank policies?

Have these been endorsed or approved by Bank management?
I t lYes [X lYes [X [] No 0No 0No INo INo UNo 0No INo 0No INo l N l N o o *+ b) Orant Agreement Reference 1 Section II.A.l of Schedulc 2 Scctioo ll.A.2 of Schedule 2 Section lI.B.2 ofSchedule 2 Section Il.B.3 of Schedule 2 I I I I I I I i I I I I I I I .
',i\ Conditions and Legal Covcnants: i Description of Conditron/Covenant The Rccipient shall monior and eyaluatc the pmgrcss of the Project and prepare Project Repons in accordance with thc provisions of S€ction 2.06 of the Standard Condirions aad on the basis of indicators agreed rvith the World Bank.
Each Project Repon shall cover the period of one calendar qoarter, and shall b: fumished to th€ World Bank r not later than forty five (45) days Efter lh€ cnd of tle period covered The Recipient shall prepare the Complelion Repon in accordance rrith thc provisions of Section 2.06 of the Shndard Conditions.
lhe Completion 1 Report shall be fumistred to the i World Bank nor latcr lhsn six such Dare Due Not later thao forty-l'ive (45) days after the end of the period covercd by such repon I I l I Not laler thsn six months after rhe Closing Datc I I I Date.
moqths after Ihe C The Recipient shall ensure that ;nterim unaudited financial reports tbr the Projoct are prepared and fumished to the V,rorld Bank not later than forq five (45) days after thc eod of each calendar qusrter, covering the guarter, in form 8nd substance satisfactoD.

to tlle World Bank.

The Recipient shall have its ' Financial Statements for the ftoject audited in accordarce I with thc provisions of Section 2.0'7 (b) of rhe Standard I Conditions.
Each such audit of I the Financial Satcments shall I cover the Jrcriod of one Fiscal Year of thc Rccipient.
l I Not later than forty-live days aftcr the end of calendar qu | (4s) each arter I Not Applicable I I __.1 / No withdrawal shall be madc for p.rlDents msde Prior to &e date of thc Amendmsnt, e.rcept that withdra*zls from the Additioml Grant Cff0l269l) up to an agg€gale amounl nol to g(coed US$1,138,000 cquivalent mal,, be made for payments madc prior to this d8te but on or efter September l, 2011, for Eligible Exp€rditues undcr Catcgories 5 Under category (6) for Training unless fto memoranda of undentanding refdred to in scgtion I.8.2 ofSchcdule 2 of the Grana Agr€emert have been s and 6 Disbursement Condition I I Disbursement Condition Sectiou IV.B.l (a) of Schedule 2 i Section IV.B.l (d) ofSobcdule 2 I I I {* I.
Introduction l. This project paper seeks the approval of the Vice President to provide an addirional Srant in an amorurt of US$5.69 million to tbe Republic of Sierra Leone for Phase 2 of the Reproductive and Child Health Project (P110535).

This is in response to the Governrnent's request dated March 8, 2012.

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2.

The proposed addirional grant would help finance the costs associated with tlre implementation of additional activities rhar scale up the ongoing Reproductive and Child Health Project - Phase 2's impact ar.d development effectiveness (Crart No: TF095812) in line with OP/BP 13.20.
The additionai grant will frnance activities that were initia.lly included in the original Pmjecl, butthat werc scaled down from tbe origina.l Project to actommodate an urg€nl request from the Govenrment for priority fiurding for the procurement aad djstibution of malaria bed nets.
As a result ofa change in the govemment stralegy on malaria control loward universal coverage of bed ners as a major preventive nrategy, I request for financing of US$5,690.6'14 million to support the natiooal malaria bed net cmrpaigr was received from the Ministry of Finance and Ecanomic Development on July 26, 2010.
The request couJd not be processed as an additionsl gantat the time as the Project was notyet elfective, so instead the Project was restructured in August, 2010 to reallocate funds to support the malaria bed net campaign with the objective of having at least 80 perc€nt of tbe population slee.ping under a long lasting insecticide treated bed trets.
The Projecr was restructured to accorrunodate the Govemrnent's request, and duriog the rcstructnring, it was agreed with the Country Management Unit (CMI-I) that an additional grant would be made available tbrough the Africa Catalytic Growth Fund (ACGF) to cover the activities that u'ere scaled down.No changes are proposed to the original project obj ectives.

3.

No multilateral or bitateral agencies are co'financing the project.
However, other development partners ae fundiag various aspects ofthe reproductive and child health strategy in Sierra Leone.

ll.Beck ground rnd Rrtionale for Additiond Finaocirg in the .Eount of$5,690,614 4.

The Oricinal Proioct: An ACGF grant to suppon the original Project was approved by fte Regional Vice President in Jure 2010.

The graot amouat was US$20 million equivalenl.


The closing dare of the projecl is October 31, 2013 and the lead implernentation agencies arc the Ministies of Finance and Economic Developmenl and Heath aad Saniution.

The objective of the project is to increase utilizdion of a package of essential health services by pregna:rt and lacating womerr and children under the age of five.'
The original project had two components, namely: Component l: Strengthening Service Delivery - US$12.5al with 3 zub-components (oput-Based Financing Gratrts-Us36.5m; Performance-Based Firnncing-US$5.7m; and Grants Management-US$ L5m); and I The PEHS rcprcsenB thc omciat policycosL rod lhe MoHS lo incMsc utilizatioo of a pckage of ossentia.l heakh scwices).

zft-r r .
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Comrynenl 2: Capacity Building - US$6.5 million with 2 sub-componenls (Supervision' Monitoring and Evaluation-US$3.5m and Medic*l Traiuing - US$3.0m)' 5.

The Resructured Proie{: As oote4 Lr July, 2010, the Government of Sierra Leone requcsted additional funds for the prccueme$ and distributioa of malaria bed nets which were not included in the original project concept.

To respond to the GoSL request, the project was restrucrured in August 2010, and it became effeclive on October 1, 2010.
Under the resEuctured project, Component 2 a.tivities were scaled down atd their implementation delayed until funding became available.

A new subcompooent - procutemeot and distribution of bed ncts - US$5.69m) - was approved for inclusion under Compooent 1.
The restructured projecl had the following components: a Componea l. Strengthening Semice Deliwry (US$19.19 mlllion), narnely: l,ocal Council Grants fUS$5.3 million)- Under this sub'component gralts aJe provided ro 19 Local Cormcils (LCs) to finance development projects to enharce provision of core hasic services in the health sector.

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The Performance- Gmnts Bosed Financing (PBF) mechanism started implementation in April,201l io about l, 200 peripheral health units (PHUS) in the country.
5.7 Procurement and distribution of bed nets ruS$5.69 mitlion).

Financing for l, 161,502 loogJasting insectiri& teated bed nets (LLINs).

r Local Couucil Gran!

Administation (US$I.S millioa).

Component 2.

CaWciD Butlding (W80.E1 million), inchtdiog: .

Capacitv buildine of the MOHS for supervision monitorim ad .qdtratiar (US$0.5 million).

Capaci8 buildins ofNiala University and University of Siexra Leone for provision of pre-service and postsaduate medical training (US$ 0.

3 I miliionl.

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3 I miliionl.

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The Foposed additional granr is aligned with the Joint Assistance Strategy (JAS) which was app ovedby the Board on April 6, 2010.

The proposed additional grant will suppon pillar oae of the JAS which focuses on investncnts in human development tkough support to deceatralized delivery in health, eduoatior, aad water supply, as $€Il as dedicated support to primary education and reprodrrctive and ehild health.
The project is also aligned with pillar 2 of the World Bar*'s Afiica Stategy: 'Vulnerability and Resilienoe".The opemtion supports MDGs4 (reduce child mortajiry); 5 (reduce mstemal mortality); and 6 (combat HIV, malaria gnd other diseases).

Finally this prqiect is corxistent with the objectives of &e Bank's strategy for healtlr, nurrition and pnpulatioai: (i) to improve the level and distibution ofkey HNP outcomes ?

HeaJthy Developmcrr The World Bank StrEt€S/ for Healtlr, Nutrition aed Populatior Results.
CODEzOOT- 00016.

71+ 2 w (e.g.

MDCs), outputs, and sys.em performance to improve living conditiors, particularly fbr the poor and the vulnerable; (ii) to improvc financial sustainability in the HNP sector: and (iii) to improve governance, accountability, and transparency in the health sector.
7. objective (PDO) and satisfacrorl for implernentalion progress (lP) respectively the restructured prqect is currently rated highly satisfsclory for project development 8. lo terms ofactivities implemented to dale under the restructured project, a projecr launch was carried out 10 inroducc the project, its objectives, eligible activities, implementation armngements.

social and environroent safeguards and rcsults framework" monitoring and evaluation system as well as rhe PBF to the stakeholders.
Component ooe activities undertaken by the local councils with the input-based funds include immunization, training of MCH Aides, rehabilitation of EmONC centers, and training on HMIS data collection.

Operational costs were also covercd.

The PBF systern has been implemented for a year now and payment glarts are being rel*sed quarterly to the eligible beneficiaries based on the result achievcd in the delivery of packages of essendal health services covering preventive and curative services.
These servjces arc primar)' health care and pieventive services for pregnant women, delivery and post-pamrm care, care and immunization ftrr children under the age offive years ofage, and t'amily plaruring scn'ices.

And there is evidence that overall rhe indicators are improving in the country.

Since December 201l, rvhich was the last reporting period for the project, drugs availability and child immunization levels har.e improved.
A total of L 16 million H nets were procured and distributed, and the immediate posnnalaria bed net campaign assessment showed a high coveroge level(98.7%).

9.

A number of capacity I'u-lding activities were carried out for the local councils' stafT to improve procurement and fina.nciai managemenl capacity at that level.

Capacity of the Local Government Finalcing Departmel1 (LGFD) was also strengthened for supen ision and moniloring of local council activities.
'I'he medical waste managemenl manual and environmenta.l monitoring framswork for the restructured projecr has been rolled out to all 19 local councils and health care worken rained on proper disposal of medical waste management, Capacity was built at tre nltional, local counci.l aod district aod PHU levels for rhe implementation of the PBF Suhprojecrs.

Iu total, aboul 1,500 people were trained.

10.


With funding under component two, the Ministry of Health and Sanitation has intensifiedits supen'ision activities for lhe lou'er levels of sewice delivery.

Supewision check liss have beea prepared and validated for each level and relevant staff has been trainEd on their use.
The process is underway for the recruitment ofan inlemational consultancy tean to support the Ministry of I'Iealth and Sanitation 1o revitalize the health infonnation management system, the districl health information system (DHIS) aad support the introduction of a sftengtl€n hospital inforuration system.
Ihe faculties and throughput of students at the University of Sierra Leone and Njala University is being strenghened, by improving their skills in matemal and reproductive health- child health, emergency care, and basic sciences.

It is supporting a numk"r of visiting professors to teach in pre-sen'ice and poslgraduate progams, improve rhe skills of existing staff (in tbe areas of natemal and reproductive health, chitd health, emergency care and other areas of shortages).
It is also helping to build partnerships rvith regional and intemational associations and universities to fill in the teaching gaps in clinical and science areas.

share knowledge, and develop curricula.

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'\ hP.t\ \ ru*t ;-io\liN .-''-+ I I l. As ofMay 31,2012, an arnount ofUS$l1.758 million had been disburse4 equ.ivalent to 58.79 percent of total project grant, Procurcment under the restructuted projcct has been carried out under World Bank procurement rules and the Sierra Leone Procurement Act of 2004.

Procuement has bcen rated satisfactory to date.


Procurement capacity is now available for Component I and is rated high, while that in the Minisry of Health is being beefed up with to mitigate the high procurement risk idcntified during the addiuonal stalt and Eaining.
In ord€r preparation of the original graol aDd as indicated in the ORAF, UMCEF rvas used to procure t}e malaria bed nets with funds &om the rcskuctured project and from other development partners to assist Sierra l,eone ashieve utiversal covemge of bed nets.

ll.

All legal coveaants have been complied with for the restructured project, and a]l aspects of fiduciary performance are ratcd as Satisfactory.

The ratings for Monitoring and Evaluation and Projecl Management 8re a,so satisfactory.
Safeguards ratings have consistently been rated as satisftctory.

Fiaancial management is rated higbly satisfactory.

Financial reports have been consistantly suhmitted and tlere are no audis due.

12.

The additional grant is required to furd those activities that were scalcd down tom Component 2 during the restucturing and are now being reintroduced and scaled up.

13.
13.

The proposed additional gzntis not expected to lead to the extension oftbe Closiag Date as the parent Africa Catalytic Growth Fund (ACGF) will close in April 2014 and hence the closing date of the original poject is mainlained Bt October 3 l, 2013.

IlI.

Proposed Changes 14.

The development objective, dcsign and fiduciary anangements of the restructued prcjert and additional granr will remafr the same.

With the proposcd additional granr the scop€ ofthe project will incrcase.
Activities to be funded a'r cstimated to cosr US$5,690,614.

15.

The proposed additional graat will pmvide approximately $3,000,614 (Component 2.1) to coutinue to support (i) capacity building in monitoring aad evaluation (M&E) at all levels of the health system; and (ii) the inroduotion ofa hospital information system.

It will also finance indepen&nt data quality audits.
which are the basis of the Performance-Based Finarcing, and surveys of a sample of health facilities to revi.ew patient registers, aod assess the reliability of reported statistics and rccord-keeping praoicas;(iii) two mljor survcys: a Deorographic and Heal6 Survey (DHS) at the eod of the project 8rd a health facility survey; (iv) operating cost and procurement of vehicles for thc Ministry of Health and Sanitation to enhaucc performance of their oversight role.

16.
16.

The proposed additional grant will provide $2.69 milliou (Componeot 2.2) to contiue firuncing the capacity building of two instinxions - NjalaUniversity and the University of Sierra Leone - to offer quality pre-service and post-graduate training (Component 2.2).

It wilt continue to support a number of visiting professors to teac\ whjle improving the skills of existing staff in areas such as maternal and reproductive health, child healrh, and emErgency care.
Th€ h o universities will be provided with teaching materials rrd laborarory enuipment.

An assessmcnt v4q- 4 ofthe needs for the upgrading of the physical infrastructrue of the reaching facilities (classrooms, tcaching laboratories and dormitories for students *ill also be administration oifices €tc), uadedaken.

Vehicles \a'ill be provided to the institutions lor the use of the visiting professors.

17.
17.

The indicators for the additional actiyities are already included in the results framework so thcre will be no changes in any ofthe indicators.The costs are presented in the tables below.
Table 1; Cost of the ect additional com ent in US$ Componenl Original Grant l: S hengthening Service Detivery 2: Capacity Building Total 13,500,000 6,500,000 20,000,000 Grsnt after res tru ct u rin g r 9,190,000 I 810,000 20,000.000 Table 2: Disburseme nt Table in GraDt Agreement (USS) Additional Gmnt Revised cost 19,190,000 ti9q,q4 I o,soo,ooo 5,690,614 25.690,611 Components/category (l) Goods, wor*s. consultants' services, tratning and operating costs financed by LC Granc under Part I (axi) olthe Pro ect (2) Goods and consultancies' serviccs for PBF Services Subprcjects under Part of the ect.
l1 (3) Goods and services for Pan l(a[iii) ofrhe Project (4) Goods, consultsnts' services, Training and Openring Cosrs under Psrt I of the cct (5) Goods, colsultants' services, Traioing and Operaring Cose unda Part 2(a) under the Pro ect.

(6) Goods, works, consultants' services.


Training ald Operating Costs under Pan I I I '-:7,k Original Grant 6,300,000 Crant afler restructuri 5,290.000 Additional Granl Revised C'ost 5,290,000 i I 5,700,000 5,700,000 I 6,700,000 l,s00,000 1,500,000 3,500,000 500.000 3.000.614 3.000,000 I I i 5.700.000 i 6,700,000 I I I,500,000 3,500.614 I !

i I I { I I 3 r 0,000 2,690,000 3,000,000 I I I }(+ f+.

under the Project.

Total 20,000,000 20,000,000 s,690,614 25,690,514 18.
Implemetrtetion orrrngettrents: The implementation arrangements will remain the same for the reinstated (additional) activiries.

The two oversight coinmittees namely; the IRCBP Technical Steering Committee and the Technical Coordinating Committee On Reproductive and Child Health will be maintairred.

The Chief Medical Officer (CMO) of the MoHS will continue to be the Project Dkector and will provide the technical oversigbt for the restuctued proiecr and tlre activities financed by fte additional grant.
Ttrc Technical Coordinating Committee for Reproductive and Child Health chaired by the Chief Medical Officer of the MoHS, will continue to be responsible for the lechnical supervision of both grants.

19.

The proposed additional grantwill be implemented by staff of the Minisry of Health and Sanitation (MoHS) and coordinated by the Director of the Reproductive od Child Health Direc,torare.
The Directorate of Planning and Information will tead the implemenration of the preparation of the monitoring and evaluation activities of the MoHS.

lmplementation of the rehtroduced activities of the medical training subaomponed will be led by the Directomte of Postgraduate Studies, Res:B8rcI and Non Communicable Diseases of the MoHSand will liaise with the CoUege of Medicine.a.od Allied Health Sciences (COMAHS) and Njala University.
The Pemanent Secretary will supervise the activities of the financial managemeol, procurement and intemal audit firctions under the proposed additioqal grant.

20.

Procuruent: The procurcment capacity of Ministry of Health and Sanitation improved during the implementation of the restructured project and is available for implemeatation of the proposed additional grant.

The procuremed activities of the universities will be done by the MoHS.

21.
21.

Disbursement aud Financiat M.nrgement: The MoHS,Financt Directorate will be responsible for the disbursement and financial management of the proposed additional gant.

The IPAU/LGFD aud the MoHS will arange for a single audit of both the rcs8uctured and the additional grant activities, in occordaace with systems and procedures acceptable to IDA.

22.
22.

At the rcquest of the GoSL, the proposed additional granr \#ill make provision for reEoactive financing of up to Fxenty percenr of the funds (approximately US$1,138,000 for paymeds madc on or afler November I , 20 I I ).

23.

Sociel aad Environment Safcguards: There will be no change in the arrangemenu for the oversight of lbe social and environment safeguards.

A- EcpNoMTc AND FTNANCIAL ANALYSE ry.

APPRAISAL SUMMARY * 6 24.


The proposed additional grant *ill not require any changes in &e economic and financial analysis that is in the original Project Appraisal Document (PAD) datcd June 2012, since the activities for the proposed additional grant were already included in thc original project- B. TEcrNrcAL 25.

There will be no chaoges from the technical design in the original PAD.

C. FIDUCIARY 26.

Financial Management.


The existing firrancial management procedures and systems at the Ministry of I'Iealth and Saniration will remain unchanged.

The MoHS has adequate financia.l manaSemenr systems.

The staff at the Ministry is adequare and has understanding of the Bank's FM requirements.

They prepare satisfactor-v withdrawal applications and all the financial repoiing under the existing project have been done on timely basis.
The performance of the Ministry ha-s been assessed as adequate and satislactory and meets the minimum requirement lbr lhe financial management under OP/BP10.02.

27.

The additional grant will have the same disbursement categories as the original project as restructued in Augusr 2010.
Monitoring of expenditures will contioue to be done through ap,proval and monitoring of the irnplemenotion of arurual work plans (procedure in place under the project will continue durinEi implementation of the additional granQ.

28.

There is no audit overdue 29.

Procur€meut.


Under the restruclured project rhe "Guidelines: ProcuJemcnt under IBRD Loans and IDA Credits" and "Guidelines: Selectioo and Employment of Consultants by World Bantri Borrowers" published by the World Bank in l"{ay 2004 and revised in October 2006 were applicable.

But since rhen the guidelines have been revised and new versions issued.

So, for both the unutilized firnds ofrhe original project and the additional graot the "Cuidelines: Procurement of Goods.
Works and rr-on-consulting Services under IBRD Loans and IDA Credits and Grants by World Bank Borrouers" and "Guidclines: Selection and Employmenr of Consultants under IBRD Loans and IDA Credits and Grants by World Bank Borrowers" both dated January 201 l. as well as "Guidelines on Preventing and Combating Fraud and Comrption in Projecs Financed by IBRD Loans aod IDA Credits and Grants", dated October 15,2006, as revised in Janu:uy 201 lwill be applied following Effectiveness.

30.
30.

An assessment of the capacity of the implementing agcncies (LCs and MoHS) was c€ried out in February 2009 by Bank staff ald the capBcity was assessed during project implementadon.

It concluded th&t at the start of the implernentation of t}te restruclurcd pmject.

the Ministry of Health and Sanitation (MoHS) lacked the capacity lo perform the procurement function.
The Procurement Unit was suffed by only one professional with limited hands-on experience- There had been frequent instances of senior management interference in the decisions of the legally maldated Ministerial hocurenent Committee.

To reduce risks associated wit-h these shortcomings, the prcject contracted UMCEF to procure pharmaceuticals aad medical supplies.

Institutionally, the Ministry proposes to bring under one unil, the '7 .

't.
't.

\ procuremealt activities of all sland-alone donor-tinanced project units to enhance procurement capacity.

The procurement risk for Component 2 was mted high urder the resEucturBd project.
Since then the number of procurement staff has incrcased to tfuee procurement specialists and their capacity has increasd as a result of training by World Bank Comtry Offic€ and specialize<i extemal institutions.The procruement of the additional activitiss that will benefit the universities \vill be caried out by the MoHS.The procureEctrt risk for the impleDentatioE of tbe rBtructured projccl aDd additional grrrt k kcpt rt High.

Thc Bank will continuc 10 closely supervise procuremenl.

C. Soc'rAL 3l .
C. Soc'rAL 3l .

The additional grant vrill have no advetse effect on the social aspects of the restrucured project.

Rarher i1 is expe<ted to contribute to improvements in social indicators of health by enhaocing the knowledge and skills of health \ orkers to deliver matemal urd child health care seryices.

D, ENVTR0NMENT 32.

The additional glant is not expected to generate any major adverse environmental impact and like tbe restuctured project" remains classilied as B.
If will not support ilterventions that lesult in lasd take leading to desauction of natural habitats, forests or cultrual resources.

Civil rvorks under the additional grant will be limited ro minor repairs of existing classrooms and offices of the univsrsities.

33.
33.

Tbe rcstructured project and additional grant ProjecBwi use the updated Eovircnmenral and Socia.l Management Framework (ESMF)which includes a Medical Waste Management Plan (MWMP)of the Additional Financing for the Health Sector Reconstruction and Development Project.

This wasreviewed t'y the Banlq and redisclosedin-country oa Aprii 7 and at the Info Shop on April 9,2010, and May 15,2010.

It was again redisclosed in-courry on May 18, 2012 and at thc Info Shop on May 25, 2012.
Local Council Environmeotal Committces have rcceived training in medical waste managemetrt in order o improve their monitoring capacity.

by the Proicct Sefeguard Polici€s Environmenlal Asscssmq (QP4BP 4.01) Natur8l Habitats (QPIBP 4.04) Pest Managsmenr (OP 4.09) Physical Cultural Resouoes COP/BP 4.1 I ) Involuntary Rese{tlcment (Q!i!f 4. l2) Indigenous Peoples (OP/BI 4.
I 0) Forests (QEIBE 4.36) Safcty of Darns (OPIEE 4.37) hojccs in Disputed Areas (QP,EP 7.60)' Projeots on Intcfiatioo8l Wsterways @e/BP 7.50) Yes txl 1 l l 1 l l l l l No I] tn txI txI txl txl txl txI txl rxI 'Ay atpportiag the propated proj.ct, th4 \an* does no, t tt d to Faltdice tlg frnal daarntina,aon d?h, F4as, claifis oli th.

,F+- 8 !

F. PoLrcy ExcEprloNs AND R-EADrNEss 34.

Regdiness.Annual work plars and pmcuremenl plans are prcpared armually and reviewed and approved by the World Banl.
The same will apply to the additioDal grant.

As part of the implementation of the restruchred projecl some sections of the operationai manual u,erc updated.

The draQ Procurement Plan for the Additional Fimneing is &ted XX and the revised Operational Manua.l for the Additional Finalcing is dated XX.

35.

The proposed additional financing does not require any exceptions from Bank policies.

It meets the Regional criteria for r')adiness for implementation.
W,t - l'--l--- 9 Anner l: Results Frrmcwork rnd Monitoring SIERRA LEOITIE: Reproductive And Ch[d llerlth Proiect Phrse 2 Results FraDework Revisions to the Results Framework I Comuenls/ Rotionale for C _-l PDO No c.haagc No change i I i The objective ofthe original project Phase 2 ofthe RCH Project is to incrcase utilization of a package ofessential health services by pregoant and lactatiDg women and childrern i under the agp offive.3 I PDO indicators of ('ttent (PAD) Childrcn trrlder fivc \Yho slepl tbe previou night uldcr En rTN (7") ChildrcD lercivbg Perta-3 bcfore l2 'l!on6s C h i I dren innan bed Qufier) tsirdD delivtrcd ir bcslth fscilities Prcgnrd women an€oding at l€&st 2 ANC Yisils (9/o) P regdant votn en r ec e ivi ng dn enzral care dvting o yitit to o heabh Dired proie.l benelicia es(rwnber Ofwhich ore fenale (Yo) Intermcdiate Resultr iodicatorr H e ql t h lq ci I it i es co ns hE t e4 f erroeo!.
d, dnd/or aga Wed (tsnb*) PHU3 pmviditrg Baslc ctn€rgency obstat'ic carc (nurnber) roposed chzt€e* Cooti!ucd : Conti[ued Continued Contiaued Continuei Continued Contirruod Conlinued Continued Cooti!ucd I I No change No chargc No c-tungc No chaoBc No change No cbangc No chaoge No change No chaage No chaagc I Thc PEHS represeds the oflicial policycosL srd 6e MoHS to ilrr!

se qtjlizatior ofa packaga ofesscorirl hqalth soryices), This is discussed funhcr in Annex 4.
J--:, l-- l0 Revisions to thc Results Framework Commcntsl __ __ 8g!rq!1" for a!*_1g".
_ \rith an ITN (o/o) Hous€holds Lon{-last i hg ins ecl icide- ,realed hd.tia nats pwchoscd and,lot dis t i bul e d I Clinics having all l0 essesrial drugs availabtc (%) I Graduates hsving received a I I six.mooth training in I D€diaric.r trd obsletrics C/o) I I Health penonvl receiving I Infarts exclusively breastfcd for 6 montbs Hospitals with fu Dclioning health information rystcm PHUS joind) supervised by DHMT and local council s{aff at lc.lt once in tbc last drEe mol0u usiog thc mtionally cbecklist Qraderly mecrings held bctweal LCFD and MoHS PHUs for which RCH rcporls can b€ produced for the ous mooth starF t-ained in medical wast€ i I I I I l i I I Conlinued Continued Continued Continued Continued Continued Conlinued Contioued I I I I I I I No change No change No change No change No charge No change No change No change Continued No change Continucd - -i_- I _.
-- n"o change Continued No chalge r.,,l+-- {+= --l .

'-k'l{ ll ANNEX 2: UPDATE ON PERFORMANCE FRAMEWORK FOR RCIIP 2 (DECEMBEN 20r l).
Project ludicaton Bsselbe Children undcr five who slept the previous night under an rTN(%) Children receiving Peuta-3 before 12 months of age (%)' Childreo ismunized (number) Births delivered ia health facilities (%) Pregnant women attcnding at least 2 ANC visits (0/6) 59.6 (DHrS 2009) 26%(200,8 DHS) 58.6% DIIIS 2ot9) s4.6% (2008 DHS) 178,450 30.3 (DHIS 2009) 42o/o (20Q8 DHS) s4.6 (DHrS 2009) st.6% (2008 DHS) YRI Target Actual in Year I (December 20ll) 60% 73.h 64% 82.9Yo 165,964 237,933 (Under ooe population) 40% 54.40 60% 82.1o/" Pregnant women recciving antenalal care during a visit to a bealt provider(number) Direct projcct beneficiaries(number 0 0 2t2,877 4t9,632 706,858 r2s4g29 t2 "-r.{\{\- Comments This is bascd on data from a 201 1 Malaria survey Report.
The Survey was completed in August 2OI I- TARGET MET Based on data fiom HMIS from Jatruary - Dccemb€r 201 I .

TARGETMET I Out of237,933 childrcn expected to be firlly immunized, betwee[ Januafy and December 2011, 165,!

)64 were immunized, equivalent to 707o.

TARGET NOTMET Based on 2011 data from HMIS for the period Jan- Dec 201 I .

Out of an expecte d,241,492 deliveries l3l5l5 were conducted in health faciliries.

TARGETMET Based on 2011 dau from HMS.


Ort of an expecred 241,000 pregmnt \ ometr in 201 I, 198456 made at least 2 ANC visits between Jan- Dec 201 !

.

Subsequent reports will focus on ANC 46 visit.

TARGET MET Basod on 201 I data from HMIS.

Some women made multiple visits.

TARGET MET This includes 707o ofchildren under five, and all women of child bcaring age (pregnant women) in the country benefils.
TARGETMET k Projecl Indicators Baseline YRI Ta rget Of which are female (%) 0 600/o Actual in Ycsr I (December 20t t) 79o/" Health facilities constructed, renovated, and/or equipped (number) t6 0 l8 PHUs providing Basic emergency obstetric care (number) 0 l5 26 Households with an ITN (%) 36.6%(2008 DHS) 40% 870 0 383,5s3 I,l10,000 32% 35o/a lo/o I i I I Commenls Based on populations in of children under five a.nd rronren of child bearing age (including pregrant women) in the country TARGETMET Taiama CHC, Shenge CHC.
Bonthe hospital, Pujehun hospital, Damballa CllC.

Koribindo CllC, Barmoi lr,Iunu CHC, Kamassa CHC.

Yele CHC, Matoroka CHC, Tongo CHC, Ngeigbema CHC, Largo CHC, Gandorhun CHC, JaiamaSewafe CHC, Yor:ni CHC and Bendu-Cha CI{C and Kenema Ho ital According to the recenl Faciliry Improvement Team report nooe ofthe facilities currently fully qualify as an EmONC service centre, however 26 facilities me€t most of the criteria and these are providhg sen,ices, TARGET IVTET This is based on data liom a 201l.
Malarja survcy Repon TARGETMET This is based on report of a national-wide Bed net distribution campa.ign conducred in December 2010.
TARGET MET .TARGET NOT MET I Long-lasting insecticide- treated malaria nets purchased and/or distributed (number) Clinics having all l0 essential drugs available (7o) Graduates having received a six (6) month training in paediatrics and obstetrics (%) Health persormel receiving trainilg(number) 0 0 0 0 Programme not yet started 936 2,050 452 staff training in use of revised data collection tools.
A IJ .$ Project Indicators Bsseline YRI Target Actual in Year I (December 2011) Commenis Infants exclusively breasfed for 6 months (7o) 37.4 (DHIS 2008) I l% (200E DHS) 40% t1.6Vo Hospiuls with fimctioning health hformatron syslem (number) PHUs joinrly supervised by DHMT ald local eouncil staff at leasl once i[ the lsst thxee moDlhs usitrg the nationally approved checklist (%o) Qr:arrerly meetiags held between LGFD and MoHS (number) PHUs for which RCH reports can be produced for the previous roonth (%) Health stafftrained in medical wase management (o/o) I 0 5 I I 10% 50o/o 89o/o 0 4 t4 gw/o (2009) 8U/c E9.zvo 0 t0% rcul of 1,378 stalf werc trained r in PBF and 30 trained in the use of DHIS.
190 health workers have also been lrained in various skills.

TARGET MET Data for this indicator is being comprtred from tbe DHIS for 201 1- It is based of c.hil&en exclusively breast feP'd at 14 week.

TARGET NOT MET This process has started with OIa During Hospital.

A consulhnt is being recruiled to support the Minist-y in establishing lhese sysrems.

TARGET NOT MET TARGET MET Several meetings have held between LGFD and MoHS.
TARGETMET A total of 999 out of I I I 9 PHUs submitted their rcpons for Decernber 201 l. TARGET MET The first set of training for 65 staffhas been conductrd.

These trainees \r/ill serve as traincrs iot subsequent cascade traiaings of PHU staff.
TARGET NOT MET + l4 t I I I I I I I l tlll I ll REVTSED PROJECT RESULTS FRAMEWORK Projcct llcycloDmcnt Objective (PDO): Unir Of Mclsnre- mcnt Progmss To Detc Baselioc Valuc for Originrl Proie{t Target Vrlue Frc-quency ?017 20t3 Det, sou rca./ Mcthodolos Contuctr ts Rerpon- slblllty for D&ta Colle.li!rl lndicator PDO l,cvcl Rlsults I[dic.tor3 Children under five who slept the previons night under an rrN Children receiving Penta- 3 before 12 months ofage (%)* Q i I U Numbcr X tr Children immuaized Blrths delivered in health facilities -tr- Preglant women attending at least 2 ANC visils 7#- 73v, 65o/o '7ty/o Monthly ICS MoHS E2.gYo '10 14 Monthly ICS MoHS 2.5 yclls DIISA,{ICS 2.5 ye3rs DHS/l\,tICS r65164 s4.4 311,3t9 358.40t Monthty HMIS MollS 45 50 Moodrly ICS I t'totts 82.1 65 10 Monthlv ics MollS 2.5 years DHS/MICS 59.6 (DHIS 2009)__.1 26 (2008 I DHS) I 58,60/o DHIS 2009) 54.6 I (2008 ] _DgqL.l 178,450 30.3 (DHrS 200e) 42 (200E) 54.6 (DHIS 2009) I I t5 M 13.
?50 EZ;.

?tt =93.

05l" ABIE 6Eor 4X:i!E eeSEe"E 1 -1:.ikI 9,2.= co:t 3 9r fr€ e i{ ao o + EA8* E3tsF 3t ..^ qU 6-B E:6 z Corc ; t;35:_ z 3 !

-l _L lr o < E ^l;=.

E g U,o:o: -J t-) \o t-, z r Z gb.

--jr.- cl 3\ -lcl 3 a 3 o a>tc= ae v, E; !o> E2 EZ B= ; €3 L I s - -x-*r$ -{ ',?

,.1 C I r g o c I i o A:I BED 2 E E Zi{ x TgSE < : e.e d =00 aa a z r t a- oi.

\o \) \) o - 1..) !
g z o € I I I I I I ll I t I I tll ll I Graduatos having roccivcd a six- month trahing ir paedi.trics a.d obstcflcs Health persomel rcceiving traioirg Infantr cxctusivcly br€$tfcd Hospitals funr*ioaing health infiormrtion PHUS iointly supervis.d by DHMT snd local council st!ff at lcast oncc in tie las( thloo mon$s using thc nationally ch€.klist Quarterly mcditrgs lpld b,etwoco LGFD and MoHS PHUs RCH reporb can be produced for the which mon*r Heslth stsff D-ahcd in rncdkal vastc ent tr M tr tr tr 0 0 3'1 .4 r l (2008, DHs) 0 Number o/o Number I % l0 tr- tr tr vo 0 80 0 936 r7.6 t E90/.
t4 89.2 0 40 50 Aanuitl Univer3itv rccords MoHSI'lvloE ST MoHVMoE ST I t52 t440 Atutual Training reports 45 l0 -50 l8 90 90 20 A|rnu{l 2.5 ycu IC54 MoHS DIIS/MICS Annual Supervisioo rcpo(s MoHS Quarterly Discia supcrvision repod MoHS I I Quancrly Minutes of meetiu MoHS Annual HIS MoIJS I Annual Trainin8 rcpodr MoIJS 7 t5 ANNEX 3: OpERATToNAL RISK AssLssMENT FRAMEWoT( (ORAF) Siena Leone: REPRODUCTIVE AND CHILD IIEALTH PROJECT PHASE 2 Stage: RVP APProval l7 I I I I I I I I I I I I giect Statcholder llirk\.
_- _- 'iption: The RCH program is being supported by many donors.

Il' )nor pulls out its supporr it will dcstabilizc the entire program and sults may not be achicved.

pcraling EnYironment Risks !.qoun!a-_ 'ipdon nal olcctions s,ill be hcld in Nor.cmber 20 | l, Depcnding on thc ;, it may inrpact on thc program negatively.

2.

Sector/mulli-scctor 'iption: 'cnlial capacity at thc sectors and dilcctoratcs nlily rcsult irr riclays jcct implemcntation as sornc have *'eak capacity.

0plc.

!llg_!1llg 4gcr!.


:y_Bt$: fuglud-1_t4.

[( u (:li!

I fapucity 'iption: procurcmcnt capacity at the Ministry of llcalth and SanitBtion esult in dclaycd proiect implementation.
: F*- ---fL"" llntirr Risk Managemcnl: To dal.e no donor has pullcd out and thc Ministry ol'Hcalth and Saniution is engaging them rcgularly in dialogue to ensurc this docs not hrppon I Due Datc: october I sarus, I stege: .l Implerrrcrrtarioj ]_Zo1f _ __ Respr MollS '_1l-tUCl!,S.-..- Low lkting: Risk Management: Although this risk is ouLsidc the purvicw of the pmjcct.

thc governmcnt is comlnitted to lico and fair clections and dcvelopment panne,s.
including the IJN, art helping to put mechanisms in place to ensure pcace.

Ilesp: S(ugc: lrn lcmenta tioo Inw Due l)atc : Octobsr 20r3 Slrr(us: otuging- - Bclrr.

Risk Managcnrent: Mcchanisnrs have bccn put in plocc lo help thc rveak ortes Status: Resp: Ongoing i\{ol'liD/MoIIS Inrplcmcntstion Due Dal!

: 0ctober 20r3 i Stagc: I _.1_ I , ltr(irrg | !ltc!

Risk Managemerrl: I'rcviously dcvclopmcnt paflncr.s uscd Ljr.\{(--hlF and othcr IJN agcncies lo prociilc bulk items.
Thc same arrangement will bc used for the additional grant.

l8 (a Li, /\.L .Y- _ I l I I lr t , I I rlrlllllll )w absorptive capa€ity may lead to inabiliry ofrhe Molls to utilize ditional gant.

Capacity is being increascd for procurement and together witlr the fall ba,ck situation ot using UN agencies project, implementation will movc fust and funds will be utiliz.cd on time.

2.Goveroanse 'iption: Low coordination copacity may lead to inefiiciencics in rm implcmentation.
I & Corruption (sub+.atcgory of Govcrnonce risk) 'iptlon: quste human capacity and wcak sysrcms ar thc Dl{Ml'and in the r frcilities may lead to fraud.

.g9",B{L l 'iption: There is no risk to projcct d$ign as the design has not ed from the original onc.

2.Social & Eovironmcntal 'iption: The additional grant is not expected to generale any 'adverse social and onvimnmental impact.
3.Progrrm { Dono{ 'iption: The sometimes tense r€lationship between the local nment Finance Department (LGFD)/lv{oFED (fiduciary agcncy) loHS (technical agency) may slow down projcct implementation , non-rcsponsiveness ofone ofthc parties.

fA- Resp: Task Tcam Stagc: Implemenletion l)ue Date : October 20t3 Hi h lYy.
":u"'g Rating: Rkk Mrnrgcment: A coordination mcchanism has been put in place in thc sector aod this will continuc ro bc monitffcd Bnd suppo Resp: MoHS/I)onors Rating: I)ue Crte: Octuber 2013 Status: Ongoing Stagc: lm lrtion rtcd.
lligh Risk Managemcnt Oversight" monitoring and evaluation of DHMTs and health facilities is being Resp: MoFED/MoH/STask Tcsm Due Datc: October 20t3 Steger lmplemontation to avoid occurrence of fraud tatus: Ongoing Ratin Risk Mauagcmcnt: Capacily building at all levcls and including sren superv ision will contributc to improve coordination.
N/A $hened : N/A : N/A Due N/A Ls,rtggJ.l1a _ N/A N/A S Mod€ratc Ra Risk Managemcnt: N/A Res : N/A Rutin Risk Management: Measurcs have bccn put in placc to ensure both inslitutions work togethcr and this is being monitorcd using indicators that arc includcd in thc rcsults lramework.

Resp: Task TeamMoHS/llloFE i fft"'*,'ut"ntoti I D,,e Dste : october i statusonsoing: I Due Date: N/A -]-!.rs*{.u4 19 W I t I I I I I I I 1._tl4iv,e5llrUlgt".s s !

!!!?ttiU!!!.
!!!?ttiU!!!.

!I_ _ 'iption: There is no risk to the sustainability ofadditional grants as stems put in placc will continue to b€ used aftcr project closurc.
I I ln Ratinp: _ Risk Management : N/A Resp: N/A --.LltIA_ isclossble lnformatinn for Manngemcot Attcnaioo (Optiooal) Resp: Task Tesm Stage; N/A Stage: Im lcrncotrtion Due Date I N/A Du€ Dat€ 20t3 : October nents: tojgg.Ic!,rt P l. Preparaliorr Risk Ratilg:l,nw Review 5.2 Implcmcntution Itls k Ratrng: High crents:Preparution has nol cncountered any major risks as the ties to be lirnrJed by the additi(h'dl grant were all u5'reed upon J the preporrtio[ of tlre original and restructr.rrcd pmjcct as rvcll :paration of fiis additional grant.
l Comments:'lo dato thc project has not expcrienced any ntajor challenges durirrg implementation iir r"i* t trq,g*q-"_B[t1_R GltZl _-- mentr: _ _ _ ".oll ni*L f.ff o*ini nc"i"": 1,.tr:E_$tif,p Ilisk l{ating: rcnts: I\*/A '--l.t+--- 6.2 |mplenren talion Risk RatingModcrale Commcnts:l'he risks idcntified and the mitigution measures arc bcing nronito,-cd closely by thc l ask Tcam to cnsure thcir conl Iiancc .21 lemcntation Risk Ratilt g.l\/A Commcnts: N/A 20 ) !
h. +,lr Slatus: N/A Slrtu3: Qlg"olng i I I I I I AttscheDent 02 The World Bank IXTERNANOflAI SAXX FOR RMHSTRI TO AND DEVELOP'IENT INTERIIATO|IIAI DEVEIOPI'ENT ASSOCIAIION '1816 H Stre.t |1.W.

Wa.hiBtoi.

D.C. Z!a1l:l u.s.A. (204177-123'4 CrbL Add!r!

: IMBAFRAD Cabh Addr..!

: IM)€VAS Augusr XX, 2012 Hon.
Dr. SamuraKamara Minister of Finance and Economic Development Ministry of Finance and Economic Development George Street Freetown Sierra Leone Honorablc Mhisten Rc: Aftlca Cdolttb Gmwth Fl/4,d (ACGF) Grunr Naaba Tml269l Seo.nd PhoE o{ rhe R@rodttcth'e old ChlU lleakh l'rula - Addbionol Fhonchp We refer to the Grant Agreement (tlrc Agr€ement) dated August 12, 20lOfor the abovc-referenced Project (ACGF Granr Number TT096E 12) beween the Republic of Sierra l,eonc ("the Recipient") and tbe lnternalional Development Association ("the World Bank") acting as sn administraror of the Africa Cstal)'tio GroMh Fund, and to your request dated March E, 2012.
We are pleascd to inlorm you thst the World Bank hereby agrccs to your rrgue$ and to provi& to the Recipient an Additional Fiuaacing in the smount of five million six age€s hundrd and nirety thousand six hundred and fourteen United States Dollars ($5,690,614) lo assist in thc financing of the Pmject describcd in Schodulc I to the Agre€menl.To this effocr, the World Bank proposes to amcnd the Agrccment as sct forth ill th€ Attachrnent to thrs [et&r (Oe Amendmant).
Efscriveness.This Amcndment sball not b€come effectivc until evidenc€ satisfactory to the World Bank has been fur.rished to the World Bsok that the condition specified below has been salisfied, namely, thar the exccution and delivery of this Amendmcnl on behalf of the Recipient has becn duly att&orizcd or rEtifi€d by aII neccssary Sovernmenal aDd corporat€ action.
As paft of the cvidenc.c to bc furnished pursoant to the paragraph immediately above, there shall be fumished to the World Bank En opinion or opinions satisfactory to ttc Wortd Banl of coungel acceptabls to the World Bank or, if the World Bank so rcquests, a cenificate satisfaclory to lhe World Bank ofa competent oflicill of the Reoipient, showing, on behalf of the Rccipicnl, that this Amendment has be€n duly authorized or ratified by, and executed and delivered on ils behalfand is legally binding upon it in accordance wi6 its temts.
Except as the Recipient and the World Bank shall otherwisc agrce, this Amendment shall eotcr into effcct on lhe darc upon which the World Bank dispatche$ to thc Recipient notic€ of its acceplance of the evidence rcqul€d pursusnt to the paragr&ph immediately above ("Effective fl-+- 2l Date of the Additional CranC')- tl before the Effective Date of the Additional Grant, ary event has occurred which rvould have entirled the World Bank to suspend the right oflhe Recipient to malte withdrar*als from thc Grant Account if tlljs Amendment had been effective.
rhe World Bank may postpone the disparch of said noticc unlil such cvent (or events) has (or have) ceased to cxisl.

Termhrction for Failnz to Become Efecrive.

This Amendment aod all obligations of tlc parties under it shall tcrminate if it has not entercd into effect by the date 90 days after the date of this Amendment, unless tle World Balk, after coosideration of the reasons for the delay.
esablishes a later date for the purpose of fiis paragraph- The World Baak strall pronptly notil, the Recipient of such later dale.

Il thit Afuend ent sholl terminate uader the provisions of this paragraph, the Agreement shall continue in full/orce ord efecl, an if this Ammtlnent hqd ot existed.

A1l other provisiorrs of the Agreement, except as herein amended.

shail remain in full lorce and effect.


Please confirnr your agre€msol \iith the proposed Amendment, on behalf of the RecipienE by coontersigling and dsting the two original copies of this Amendmenl and retuming one countersigned and dated original to us.

Upon receipt by dre World Bank of the countersigned and dated original copy.

this Arnendment shall become effe,:tive as of the date sPecited by the World Bank (Effective Date of the Additiotral Grant).
SincerelY, TIITERNA'IIONAL DEVELOPMENT ASSOCIATION (acting as administrator of the Afiica Catalltic Gro',r'th Fund) Yusupha B. Crookes Country Director for Siera l,eone Africa Region 2?

,:- +-+, AGREED: REPUBUC OT' SIERRA LEONE By Name: Title: Date: Enclosures: (l) (2) (3) (4) (5) Slsrdad Conditions for Grants Made by rhe World Bank Oul of Various Funds, dated February 15, 2012.
Disbursement Letter of the sarlre date 8s this Agreement, ogether with World Bank Disbursemeut Guidelines for Projecs, &red May l, 2006.

Procurement Guidelin€s dat€d January 201 l. Consultants Guidetines da&d January 201 l. Grant Ageement dated August 12,2010.

=+\- 23 1P.

\\\LL ry -{ttac hm€ ol Anletldmeots to lhe AgreeEcDt A nerv ACGF Grant Number Tl'012691 is inserted on the upper righr corner of title pagc and the first page, immediately belolv the current ACGF 6rant NumberTF0968l2.
Section | .0I of Aflicle I (Srandard Conditions: Definitio s) of the Agreement is amcnded to read as follorvs: "1.01.

The Sradard Conditiols for Grarts Made by the World Bank Out of Vrious Funds, dated Februarl, 15, 2012 C'Standrd Conditions").

constintte an inregral p8rt of this Agreemenr."

Sectiors 3.01 aod I 03, respectivel), of Article lll (The Grant) of the Agreement are smgnded to rrad 8s lbllows: "3.0i The World Bank agrees to extend to the Recipient.
on the terms and condltions set fofth or refeffed to in this Agreement, a grant in an amount equal to tv/entyfive million six hundred and ninety thousand six hundred and fourteen United States Dollars ($25,690,514) ("Grant-l which consists oi (a) tr,venty million United States Dollxs ($20,000.0001 ("OriginalGrant") (TF0968121; and [b) five million six hundred and nlnety thousand six hundred and fourteen Uoited States Dollars ($5,590,614) ("Additional Granf') $F012691), to assist in financing the proiect described in Schedule 1to the Agreement ["Project'').'
"3.03.

The Grant is funded out of the abovemention€d trust fund for which the World Bank receives periodic coDtributions from the donors to the trust fund In accordance with Section 3.02 of the Standard Conditions, the lvorld Bank's payment obltBations in connection with this Agreement are limited to the amouot of funds made available to it by the donors under the abovernenti(,ned trust fund, and the Recipient's riSht to withdraw the Grant proceeds is subject to the availability ofsuch funds.'
4 Section lll(Pracuren tnr)ofSchedule 2 to the Agrecmelt is amended to read as follows: 'A.

Gcoeral t. Pro,clIremcDt and Cousullanl Guidelines.
Alt goods, \vorks,non- consulting-services md consuhanls' services required for the Projeo and to be irnanced out of the procecds of the Original Grant and the Additiorul Grant, as tbe case may be, shall be procured in accordance rvith tbe rcquirements sel fonh or referrod to in: (a) Section I of (he Procurement Cuideliuesia lhe casc of goods, works 8nd non-consuking services, and Scctions I arrd IV ofthe Consultan( Cuidelines in the case ofconsulta s' services; and (b) rhe provisions of this Section tlr.
as the sante shali tre elaboratcd rn the procuremenl plan prepared and updated from tirLe to time by thc .

:,,Ff 24 .FT Itecipicnt for the Projcct in accordsrce with paragraph l.l8 of the Procurement Guidclincs and paragraph 1.25 of the Consultant Cui&lines ("Procurement Plan').
1 Definifions- The capitalized terms used bolow in this Sectiou to describe particulal procuremenl methods or melho6 of rwiew by the Wortd Bank of particular contracts, refer ro fte corresponding mcthod dcscribed in Scctiors lI atrd ru of the Procurcment Guidelincs, or Sections II, I , lV and V ofthe Consultant Guidelines, as tlre crse may be.
B, Particulrr Metbods of PmcureneDt of Goods, Works and No*tonsoltiog Services t. 2 J Iutcrnatiolal Competitive Biddirg, Except as otherwis€ provided in paragraph 2 below, goods, works and non-consuhilg serviccs shall be procured under contracts awarded oo the bssis of Intemational Conrpctitive Bidding.
Other Mertodr of ProcuremcDl of Goods, Works aud Noo- consultiog Servic?s, The following metlnds, other than Intenntional Competirive Bidding may be uscd for procurrmdrt of goods, works and non-consulting sewices for tbose cootracts specified in thc Proourement Plan: (a) National Compctitive Bidding (iubjecl to the ddirionol ptovisions in Wagrdph J below.

); (b) Shopping; (c) Direct Contracting; and (d) Procurement from Udted Nalions Offrcc and UNICEF for goods and Project servicrs.
Exceptions to National Compcritiyc Biddtng (NCB) Procedures.
The proccdures to be followed for NCB shall be those set forti in tlre Pubtic Procurernert Act ('lhe Acf'), subject to the follolyiDg additional procedures: (a) hocuriog e$tities shall use apprcprialc staldard bidding documenls acceprable ro the Wo d Bant: (b) The eligibility of biddcrs shall be as dcfincd undor Section I of lhe Procuremsnt Guidelines; accordingly, no biddff or potcotial biddcr shall bc declared ineligible for contraca fiDanc€d by the World Bank for rcasons otbcr than tlose providcd in Segion I ofthe Procurerncnt Guidelines; (c) No re$dctio$ in rcspect of eligibiliry to participate in bidding for contracts shsll be placcd on ric besis of nationality of the biddct audror the odgin of goods other than thos€ inposed by primary boycotts; (d) ForeiSn bidders shall be allowed to psrticipar€ in National Competitive Bidding proc€dures; (e) No domcstic prpference shall be given for domestic bidden and/or for domestically manufacturcd goods; z) effi- h (0 Bidding sball not be restricted to pre-registered firms, and foreign bidders shall not be required to be registered with local authorities as a prerequisite for submitting bids; G) Foreig[ firms sball not be reqsired to associale with a local partflct in order lo bid as a joint venture, and joint venture or consortiuor partners sball be joiotty and severally liable for their obligations; (h) Govemment-o*ned eoterprises shall be eligible ro participate lr bidding onll, if thel can establish that they are lcgslly and financiall]- autonomousj operate uoder sommercial law and are not dependgnt agencies of the Recipient.
Such enterprises shall b€ subject to the srrrr.e bid and performance socurit) requiremcnts as other bidders; (i) gubject to these pruvisions, procurement shall be carried out it accordance with the "Open Competitive Biddirrg" procedures ser lorth in the Act; 0) Bidders shall be givcn at least thirty (30) days from the dare of the invitalion to bid or &e date of availability of bidding documents, tvhichever is later, to prepare and submit bids; (k) Eids shall be submiced in a single envelope: (l) An extensioo of bid validity, if justified by exceptional cicumstances, may be rcquested in uriling from all bidders beforc the expiration date aod for a minimrm period required to complete tbe evaludion or avard a contract, but not to exc€ thirty (30) days.
No further extensions shall be rpguested without the prior con;urence of the World Bank; €d (m) All bids (or thc sole bid if orly one bid is rcceived) shall not te rejected, thc procurement process shalt not be cascelled, and new bids shall no1 be solicited wirhout the World Bank's prior concurlence: (n) QualificBtion critcria shall be applied on a pass or fail basis; (o) Bidders shall bc given at leasr r,enry-eight (28) days from the receipr of notifi cation of awajd lo submit performance sccuriti€s; (p) Eacb bidding document and contact fuunc€d out oFthe proceeds of tie Graat shall include provisions on matlers penaining to fraud aad corruptioo as deflmcd in paragaph l.l6(a) of the Procurement Guidelines.
The World Bank will sanction a firm or al individual, at any time, in accordance with prevailing Wodd Bank sanoions procedures, including by publicly declaring such firm or individual ineligible, either indefinitely or for a staled period of time: (i) to be awerded an World Benk-financed contractt End (ii) to be a nominated sub-contractor, consullanr, manufacturer or supplier, or >* *.

___l.

tl 26 ( (rYl sen icc provider of an othcrwis€ eligible firm bcing awarded aa World Bsnk-fi nenc€d coreac!
(q) In aocordance with paragragh l.l6(e) ofthe Procurement Cuidelines, each bidding document aod contraci financed out of Ore procecds of rhe Grant shall p,rovide that: (i) the bidders, suppliers and cotrtraciors, and their subcontractors, ageBts, p€nrcDnel, consultants, service providers, or suppliers shall prmit rhe World Bank, at irs r€quest, to inspect lheir accounts, records, and oser documeots relating to the bid submission and p€rformancr of the cotrtr8cl, and to hsve said accounts and records audited by auditors appointcd by rhe World Bank; and (ii) the deliberate and msterial violation by the bidders, supplien rnd contractors, and their subcontactors, ageots, pgrsofln€I, consultrnE, service providers, or suppliersof such pro'risioo may mormt to an obstuctive practice as defined in prnrgpph I .16(aXv) ofthe Procurement Guidelines; and G) The World Bank may recognizE if rcqrrcsted by the Borrowcr, exclusion from participation as a result of debarme[t un&r thc uationll s)Btem, pmvided thst the debarment is for offeoscs involving fiaud, comrption or similar misconduct, and fi:nher providcd th&t the World Bank conlirms tltat tte particulsr debarment procedure afforded due process and the debsment d€cision is final.
C. Psrtlcular l[elbods of PmcuremeDl of Consultants' Serviccs l. 1 Qurlity- srd Cost-based Selectiou.

Exc€pt as otherwise provided in paragraph 2 below, consultants' s€rvica shall be procured undcr contracts awarded on tlrc basis of Quatity- and Cost{ased Selection.

Otber Mettods of Procurenent of Coudtarts' Scrvic6.
The fo[owing methods, other than Quality-&nd Cost-b&sed Sclection, may be used for procurcrncnt of coosultEnts' servir-s for thosc assignments ntrich are spccified i, the Procurement Plan (a) Quality-based Selccrion; (b) SelecrioD under g Fixed Budg€ri (c) Ifrst Cost Selectioq, (d) Selection based on Consulants' Qualific{riom; (c) Single-source Seler"tion of coosulling frms; (0 Selection of Individual Consultans; and (g) Siagle-source prccedues for ttre Selection of lndividual Coosultants.
D. Revierr by thc World Brnk ofProcurement Decisions forth those clntacts which sball be subject to the The Procurprncnl Pl8n sh8ll s€t World Bank's Prior Review.

All olher contasls shall be subject to Post Review by the World Bank.
E, Procrreuacrt Coumcuced uldcr the Origiral Graut Prlor to theEllectiye Dat3 of tle Additi,ond Graat to be trinarced under tte Additlonsl Grant Notwithsranding the acrms aod conditions of this Amcudmcnt: (i) to rhe €xteot the Initiation of Procurement Process in respect of a good, rvork or corsultants' * 27 service to be fiuanced our of the proce€ds ofthe Original Crant occurred prior to the Effectiv.
: Date of thc Additional Grant; and (ii) thcre are no procceds remaining uncier the Original Grant to finance sucb good, work or consultants' service; then cn an exceptional basis onll,anC subjert to the World Bank's pior noobjection- the terms snd conditions of this Amendmen!
in pafiicular (a) the Anri4omrption Guidelines (including the related provisions uoder the Standard Cooditions); and (b) the provisions on Procurement (including the related provisions under the Stsndard Conditioos), shall not apply to the procecds of tle Additional Grant utilized !o finance such good, work or consultants' service; provided, h9*ever, that dre provisions of Sections LC and IIi of Schedule 2 to the Agreement shall apply to the procurement of such good, work or consulrans' service.
[' Procurcmcnt Commeaced uoder the Origiral Gratrt ou or after theEffective Date ofthe .Additionsl Grent lo be Finauced utrder the Additional Grant Notwithstandiug tle tems and cooditions of the Agreement and to the extent the Initiation of Precurement Process in rtspect of a good, worlq non-consulting service or ccnsnhants' scrvice to be fmanced, at leasr in pan, oul ofthc proceeds of the Original GraDt occured on or afier fie Effective Date of the Additional Grant, the Recipient acknowlcdges and agrees that the provisions sel forth or rcfened to iu paragraph 4 A, B, C and D of this Amendmenl, irr particular: (a) dre Anti-Comrption Guidelines (including the related provisions under the Standard Conditions) shall apply to the procecds of the Original Grant utilized to fioance such good, rvork, non-consulting servica or consultants' service, antl (b) the provisions on Procurcment (including thc related provisions under the Standard Conditioos) rJrall apply to the procuremenl of such good, work, non-oonsulting service or ccnsultants' sen'ice-" ) Serliotr lY.A (WitMrowal oJ Grunt Proceeds,Gezeraf) of Schedule 2lo the Agreement is amended to read as follows: t. The Recipicnr may withdraw the proceeds of the Grant in accordancc \Yith thc pmvisions of:(a) .Article III of the Standard Conditions; (b) dris Section; and (c) such addjtionat krstructions as the World Bank may spccify by notice to the Recipient (i.r;lrrdingthe "World Bank Disbursement Guidelines fur Projects ' dated May 2006, as rcvised [rom time to time
 by rhe World Bank and as made applicable to this Agreement pursuant to such instructions), to fioance EliSiblc Expenditures as set forth in lhe table in paragraph 2 belo*- The following uble specifies the categories of Eligible Expendilures that nray be financod out of the proceeds of the Original Grant and the Additional Crant ("Category"), respectively, the allocations of the arnounts of the Original Grant to €ach Category, and the percellage of and Additio[al Grant, ,esp€ctivel]', expenditule..i to be financed for Eligible Expenditures in each Category.
Categorr- Amount ofthe Original G raa(TFll968 t2 ) Allocated I Amouot oflhe AdditioDal Grart (fFal269l)Alloca led (erDrcssed in I I Perceutsge of ErpeEditrres to bt Fiuanced (irclusive of -- In 28 $ (erprerscd iu usD) I 5,290,000 5,700,000 6,700,000 I,500,000 usD) Teres) Such pcrcentage as shall be specified in thc Annual Work Plan for thc respective Fiscsl Year 1007o of amounS of PBF Services Grans disbursed I I I t}v/o I0070 500,000 3,000,614 l00Yo 3 t 0,000 2,690.000 l00o/o I ( I )Goods, works, consultants' servicei, Trainingand Operating Costs fioaoced by LC Grants under Pan l(a[i) ofthe Project.
(2) Goods and consultants' seryiccs for PBF Sen,ices Subprojects under Prrrt l(a) (ii) of the Projcct.

(1) Goods and consultants' servic€s under Part l(a{iii) rf the Project I (4) Goods, consultants' services, Training and Operating Costs under Psrr l(b) ofth€ Project.

I (5)Goods.

consultants' serYic€s, Training Eod Operating Costs uDde, Part 2(a) oftbe Projecl.

(6) Goods, works, consultants' serdces, Tr8ining and Operatilg Costs under Pan 2(b) of the Projecr.
I I I I I TOTALA.UOINYT 20,000,000 5,690,614 I I 6 Seotion IV.B.I {a) (Witfuawal Conditions; YilMr*?al Perid) of Schedulc 2 to the Agre€ment is amended D rcad as follo*sr "Notwithstanding the provisions ofParl A ofthis Section, no wlthdraw.l shall be made: (a) (D undcr the Original Graot for pnlments made prior to th€ datc of the Agrccrnenl, cxccpt th8t wi&drawals from the Original 6rant CIF096E lz)up to an aggregale amount not to sxcccd US$4,000,000 equivalentnay bc made for payments mad€ pdor to this datc but on or affer August l, 2010, for Eligible *- 79 @ Expenditures under Cstcgory (3); ard (ii) under the Additional Granl lbr o. except that withdrawals from tie paymsnts made prior to Additiooal Gralt (TF0l269l)up to an aSgregate amourt not to exceed US$1,118,000 oquivalent may be mado for payalents made prior to this dare bur on or aflcr Novembcr I, 201 I, for Eligible Ext'eoditures under Caregories (5) and (6)."
7.

TIre Appendix (Delinitiot s) lo the Ageement is amended as follows (al A nel.

paragraph 2 is inserted to read as follows: "Additional Grant" rneans an amount of five million six hundred and ninety thousand six hundred and fourteen U:rited States Dollars ($5,690,614) provided by the World Bank acting as an administrator of the Africa Catalytic Crowth Fund, to assist in RnancinB tbe Second Phase ofthe Reproductive and Child Healti Project."
(b) (c) (d) (e) (f) (g) Ncw paragraph 4 is amended (o read as follows: ""Anti-Com:ption Guidelines" means the "Guidelines on Preveoling and Combating Fraud and Corruption in Projects Financed by IBRD toans and IDA Credis snd Crants", dared October 15, 2006and revised in January 201 1."

New paragaph 6 is amended to read as lbllows: '''Consultant Ouidelincs" means the "Guidelines: Selection and Employmenl of Consultaots under IBRD Loans and IDA Crrdits and Grants by World Bank Borrowers" datedJanuary 201I."
A new pamgraph 8 is ioserted to read as follows: "Effective Date of the Additional Grant" means the dEte on which rhisAmendmenl enters into effect.
New paragraph 9 is amended to read as follows: "'Environmeslal and Social Mrnagemcnt Framework" and "ESMF' means dre Recipieot's fiamework, prepared in form and substance satisfactory to the World Bank dared July 6, 2009, amended Bs of May 18, 2012 and re-disclosed on May 25, 20 t2, describing meagures for tie mitigation of thc potetrtial adversc environmenul aod social impact of pmposed Subprojects. "
A new paragrafr 12 is insened to rcad as follows; "lnitiation of Procurement Process" medos, in connectioo rvith the procurernent of a gqod, work, oon- consulting sen'icc (as thc case may be), or service, the date on which the invitation to bid or the quote is requested for such good rvork or non-consulting sewice (as tle case may be), or the request lbr proposals for such consultant service is issued.

",and subsequent paragraphs renumbered aocordingly.
New paragraph l7 is amerded to read as follows: ""Medical Waste Management Plan" means &e Recipietrt's plan included in the ESMF, agreed wifi the World Bank and secing out the measures to be taken for thc development and implementatim of medical waste manag€ment and safe handling of said waste.

as the same may be modified from timc to time in accordance with the lerms of this Agreement, aod such term includes any annexes or schedules to said plan."
'Thc negc*iating panies agrced that this will bc the Si$ing Date 30 :=fl tt .V*r (h) (i) 0) (k) (l) A now paragnph 22 is inscrted to read as follows 'l3riginal Grant" meam an amount oftwerty million United Ststss Dollars (US$20,000,000) provided by the World Banlq acting as an adminisuator of fie Africa Caalytic Gror*th Fund, to assist in fuiancing the Second Phase of lhe Reproductive aod Child Health Project."
New paragraph 28 is amended to resd as follows: *'Procurcmenl Cuidelin€s" means the 'Guidclines: Ptocuremenl of Goods, Works and Non-consuhing Scrvic.es under IBRD Loans snd IDA Crcdits and Gronts by World Bank Borrowers ' dated Jgnuary' 201 I ."
New paragraph 29 is amended to read as follows: *?rocuremont Plsn" mearu the Recipient's pK)curement plan for thc Projoct, dated August 9, 2012 and referred to in paragraph 1.18 of the Procurement Guidelines and paragrapb 125 of tbe Consultant Guidetines, as the same shall be rrpdated from time to lime in accordance with &e provisions of said pragraphs."
A ncw paragraph 3l is insened to read as ficllows: "Public Procuremeot Act'' means the Public ProcurcmeDt Act Numbcr 14 of 2004 of rhe laws of the Recipienr New Paragrapb 32 C'Stsnd8rd Coflditions")is deleted in [s entirety 8nd subsequent p8ragraphs renumbered acccrdingly."

F1+- 3i The World Bank INIERI{ATIONAT AATK FOR RECOXSTRUCNOT INTEBNATIOl.

{AL OEV€LOPMENT ASSOClANOfl ^!
{D OEVELOP"€NI 1818 H Sl&et N.W tt'ashington, D.C. 20433 tJ S,A (202) 473-'1 0o0 Cat o Add.6ss: INT8AFRAO Ceble AddrBsi: INOEVAS Attachmcnt 03 DRA-FT August XX, 2012 Ilonorabie SamuaKamara Minister ofFinance & Ecoaomic Development Ministry of Finance & Economic Development Ministerial Buitding Gcorgc Sfeet Frectown Sierra Lcone Excellcncy Re: AL:GF Trusr Fund Grant fFol269l (Reproduaive and Child Health Phase 2 Project - Additional Financing) Additional lnstructions: Disbursement I refer to the Original Grant Agre€ment betwees tte Republic of Siera Leooe (thc "Recipictrt") and the lntemati.
)nal Development Association (lhe "World Bank").

acting as an administralor of the Africa Catalyric Growth Fund for tie abovc-referenced projecu dared August 12, 2010, and the Disbursement Letter of even dale containing additional insu-uctions regarding the withdrawal ofthe proceeds ofthe Grant No.TF0968l2- SL ("Financing").This leuer ("Disburscment l-ctser"), as revised from time to time, constilutes lhe sdditional instructions.

Thc aflaohed llorld Bonk Disbursenwnt Guidelines Jor Projects, daled May I.
2006.

("Disbursement Guidelines") (Anachment I), arc afl iotegral pan of the Disbrrrsement Lener.

'lhe manner in which the provisions in the Disbursement Guidelines apply to the Financing is specificd below.

Sections and subsectioos in parentheses bclow refer to the relsvarlt s€ctiols and subsections in the Disburss;neot Guidelines and, unless o&erwise defrned in lhis letter.

rhe capiralized terms used have the meanings ascribcd to them in the DisbuRment Guidelines.
I. Disbursement ArranBemenls (i)Ditbusement Met ods (section 2,).

Thc following DisbuNement Methods mal be uscd under the Original Grant (TF096812) and the Additionsl GraDt (Tf'o12691): o Reimbursenrent e Adr.ancc r l)irect Paymont .=i--+ )!

t -r, ..{.

i\ -r-fi- Special Commiunent @) Dlsbarsen an, D.adllne t are (subsedion 3.

/.

The Disburseme[t D€adliqe Date is 4 months affer the Closing Date spccified in tte amcndcd Grant Agrcement.

Any changes to this dste will be uotifled by the World Bank.

II.
II.

Withdrawal of Grant Proceeds (i)Adhodzed Stgnoturct (sabsedlon J..1,).

A lettcr h the Form attached (Attschment 2) should be fumishod to tha World BsnI at the sddrcss indicatcd bclow providing the nEm(s) and specim€n signafi.u€(s) ofth€ official(s) authorized to sign Applications: The World Bank AAicanus House l3A Howe Steet Frcetown, Sierm l,cone Attenliotr: Mr. Yusupha D. Crookos,Country Dir€ctor for Sierm L€onc (ii)Arylkatioro (subsccllons 3.2 - 3.3).
Please provide eomplded srtd signed applications for withdraw&I, togelhcr wirh supporting documents to the addrEss indicated below: The World Bank Africanus Housc 134 Howe StrEet Freetowr!

Siera Loone Att€ntion; Financial Management & Disburs€menl U[it (lii) Elecrroatc Dcliycq (subectlon J.

{,) The World Bsnk may permit the Recipieut to to thc World Bank Applicatioos (with supporling documents) through the elcctronically d€liver World Ba*'s Clieot Cour.tion, weFbased portEl.
The option to deliyer Applicotions to the World Bank by elecronic means may be cffectcd it (a) thc Rccipicnt has designarcd in writing pursu.

:rot to tlre tcrms of subparagragh (i) of this Sectiott, its officials who are authorized to sign and dcliver Applications and tr rec€ive secur€ idenrificatioo devices ('"Tokem") from the Wotld Bank for the purposc of delivering sucl Applications by electonic moan$ rmd (b) all sucb offcials desipated by ttc Recipild havc regisercd as users of Client Coorection.
If thc World Btnk agrees, the World Bant will provide the Recipied with Tokens for the designated officials.

Foilowing whic[ the desigrated offrcials may doliver Applications elcctroaically by complaing Form 2380, wlfch Con rcrtion (bups://clientconnection.woridbqnkorE).

Thc Recipieat may cootinuc to c)cefcisa the optioD of prsparinS and delivering Applications in paper forru.
Thc World Bank rcserves the righl Erd may, in its soh discr€tion, temporarily or pcrmancndy disallow the elecEonic delivery of Applications by the Rocipiert.

acccssiblc through Cticfl is (tu) Tcnt aad Condlttons of Use of Tokenr to P'ac'ss Appllcsrlons.
By designding officials to acccpt Tokens snd by choosing to delivcr the Applications elcctronically, tbc Rccipient conl-lrms through thc authorized signatory ldrer iB agrecEsnt to: (a) rbide by the Tarrns 6nd Conditiow of Use of *cwe ldentificotion Devices in cotnection with Use of Elearonic Meots to Process Applicatiots and &ryprling Docunenaim(te'ltrs snd Conditions of Use of Tokons) provided in Attachment [3]; atrd (b) to dcliver the Terms aod Conditions ofUso ofTokeus to each such ofhcial and to cause such official to abidc by thG3a terms ard conditions.
#- 33 (v)Minimum yolae of Applicstions (subsection J.f).

Thelr,linimum Value of Applications sball be $ 100,000- (vi) Adlonces (sections 5 arrd 6).

Type of Desigaaled Accounls (sabsecTiol 5.J)- The same DA used for the original opemtio'l.

Designaled Account 4 will be managed by lntegrated Project Admiristration Unit (IPAU) at the Ministry of f inance.
Desigratd Accounl B rvill be nranaged Ministry of Health & Sanhation (lltOl IS) Currenc) of Desi|noled Accounts (subsection 5.1): L'S Dollars Finarcisl Institution sl hthlch the DegE ded Accout ts Will Be Opened (subsection 5.5/.

a commercial bank / financiai institution acceptable ro the Association.

Ceiliag (s ubsectio n 6.

I ) - Ceiling for Designsled Account A will be flexible and will be determined annually.

- Ceiling for De3ienaled Accounr B: US$700,000.

trI.
Reporting ou Use of Granl Proceeds Othet S rqporting Documentdion lddrBctio ns : r Copies of bank slatement ofthe Desig[8ted Accounts and a reconcilialion statement should be atbch€d to each Application for witbdrawal- o For funds transferred from tre Dcsignated Account A for Calegory l,2,3and 4 expeodihres lo ,-ocal Councils' RCHP2 Heahb Accounts, the name(s) of dre Local Council receiving fundg the rcfercnce numbcr and date ofthe Subsidiar)' Ag,reemert execured bet*een tre l,ocal Council and Ministrl' of Finance & Econom ic Developmcnt [MoFED] should be indicated in the Application.
.

For reportinB on eligible cxpenditurc paid from DesiBnaled Account A for Categoe' 1,2,3 and 4, including funds rcmined to Local Comcils' RCHP2 Health Accounts, the Int€rim Financial Repon (Anachment 5) should include supplemenmry intbrmation on the amounts advanced, expenditu€s accounted for and the balances outsta.lding unaccounted at each Local Council for the reporting qMfter.
lV.Withdrawal ConditioEs; Withdrrwel Period l. Notwithstanding thc provisions of Pan A of Ssction lV of Schedule 2 to thc amcnded Grant Agre€mefit no withdrawal shall be made: (a) (D for payments made prior to the dalc of the Ori8inal Grsnt AgrEemsn!
that 'rithdrawals from the OriSinal Grant (TF096812)up to an aggre8ate exc€pt amount not ro oxceed US$4,000,000 equivalent may be made for payments made prior to this dEte but on or afler August l, 2010, for Eligible Expenditures under Category (3); and (ii) for gayments made prior to the dBte of th€ a{ncndment leurr, cxcept that withdrarf,?ls from the Additional Grant 'i* 34 :t r -:- (TFo1269l) up to atr sggregate amou not to exc€od UStl,l38,000 cquivalert mEy bG madc for payments madc prior to this date but on or after February 29, 2012, for Eligibh Expenditures uuder Catcgories (5) 8nd (6)).
(b) under Category (l) for an tC Grant unle*nhe World Bank has approved the Subprojeain eccordance v/ith Section I.E of Schcdule 2 to tfie amended Grant Agrecment and theRecipient has fumished to the World Bank evidencc satisfactory to the World Bank thrt (i) the Recipieol has coocluded a Subsidiary €ment with the concerned Locgl Council for such rc Grant under tcrEts &rd Ag€ conditions satisfactory to ths World Bank; ssd (ii) all financial ststemerts of the concemcd l,ocal Council havc been audited by an audhor in a manner borb satisfactory lo the World Bank and eitlrer: (A) the auditor's opinion is uoqualified; or (B) the conoemed Locsl Coupil ha: prepared a$ 8ction plan scc"F8ble to rlre World Bank to addrrss any qualifications in auditor's opinion arising &om such audit.
(c) (d) Under Cslegory (2) for a PBF Serviccs Gratrl uoless: (i) the Recipient has adopted the PBF Operations Manual in accordrnce with seotion LF.

of Schedule to b Sectiotr I.G 2 to dre amended Grant Agreem€nq (ii) dre coasultant refefl€d of Schoduh 2 to the amesded Grsnt Agre€me{tt h8s b€en Bppoirtcd; and (iii) the Recipieot has concluded a PBF Serviccs Gra AgrE€meor wirh the eligible Bencficimy for such PBF S€rviccs Grant.
Under category (6) for Training unlcss t})e menroranda of understanding referred to in section I.B.2 of Schcdulc 2 to th€ amend€d 6rant AgrEcment have bcen signed.

Ifyou have any queries iu relation to the above, please contsct Senior Finsnc€ Officer at service account email address LOA-AFR@worldbank.org using the above refercnce.
Yours sincerely, Yusupha D. Crookes Couutry Director Sierra Leone zn- 35 H Clcared with and cc: Cbristine Makori (LEG-AF) Eveiyn Awiflor (AFTHE) Cc with copies: Project Administratioo Unit Ircal Covemment Finance Dept, Ministry of Finance 8'td F-coIlomic Development Freetown Siena Lcone lntegratcd Project Administration Unir (IPALD Ministry of l-inance & Economic Development Treasury Building George Strcet Fr€ Sicrra l-one €town Ministry of Health & Sanitation Govemment of Sierra Leone Freetown Sierra l,eone F l6 s ils $FiE'itsl C\n .
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