Natural Habitats OP/BP 4.04 X Forests OP/BP 4.36 X Pest Management OP 4.09 X Physical Cultural Resources OP/BP 4.11 X Indigenous Peoples OP/BP 4.10 X Involuntary Resettlement OP/BP 4.12 X Safety of Dams OP/BP 4.37 X Projects on International Waterways OP/BP 7.50 X Projects in Disputed Areas OP/BP 7.60 X . Legal Covenants Name Recurrent Due Date Frequency Recipient shall appoint an Independent Verification Evaluation Agency 30-Oct-2014 Description of Covenant The Independent Verification Evaluation Agency is responsible for verification of outputs achieved under the Project, as elaborated in the Operations Manual. Name Recurrent Due Date Frequency The Recipient shall carry out the Project in accordance with the Op. Manual X Continuous Description of Covenant The describes the operational arrangements and processes for the project Name Recurrent Due Date Frequency Carry out the project in accordance with HCWMP and Guidance Notes X Quarterly Description of Covenant The Recipient shall, through the Ministry of Health, ensure that the Project is carried out in accordance with the National Health Care Waste Management Plan and in accordance with the Health Care Waste Guidance Note. Name Recurrent Due Date Frequency Provide independent verification reports X Quarterly Description of Covenant The Recipient shall, through the Independent Verification Evaluation Agency, and in accordance with terms of reference satisfactory to the Association, conduct independent
Annex 1: Results Framework and Monitoring Country: Uganda Project Name: UGANDA REPRODUCTIVE HEALTH VOUCHER PROJECT (P144102) . Project Development Objective: The project development objective is to increase access to skilled care among poor women living in rural and disadvantaged areas during pregnancy and delivery. These results are at Project Level Project Development Objective Indicators Cumulative Target Values Data Source/ Responsibility for Indicator Name Core Unit of Measure Baseline YR1 YR2 YR3 YR4 End Target Frequency Data Collection Deliveries assisted under the project (%); Percentage 0.00 19,860 (15%) 52,960 (40%) 92,680 (70%) 132,400 (100%) half yearly VMA Vouchers distributed and redeemed for deliveries under the project (%); Percentage Sub-Type 0.00 19,600 (10%) 53,000 (30%) 92,000 (50%) 132,400 (70%) Half yearly VMA Women attending at least one ANC visits under the project (%) Percentage 28,400 (15%) 66,000 (35%) 123,000 (65%) 170,000 (90%) Half yearly VMA
Direct Project beneficiaries (number) of which female (percent) Number 0.00 38,000 105,000 186,000 264,000 Half yearly VMA Intermediate Results Indicators Cumulative Target Values Data Source/ Responsibility for Indicator Name Core Unit of Measure Baseline YR1 YR2 YR3 YR4 End Target Frequency Data Collection Vouchers distributed and redeemed for postnatal care under the scheme (%) Percentage 0.00 7,500 (4%) 15,000 (8%) 38,000 (20%) 66,000 (35%) Half yearly VMA Fresh still births Numbers 0.00 30 80 270 330 Half yearly VMA Pregnant women tested for HIV (%) Percentage 0.00 15,800 (12%) 46,000 (35%) 86,000 (65%) 119,000 (90%) Half yearly VMA Pregnant women with HIV who received EMTCT. Percentage 0.00 900 2,700 5,000 7,100 Half yearly VMA Mothers referred (%) Percentage 0.00 4,000 (3%) 9,000 (7%) 13,240 (10%) 18,500 (14%) Half yearly VMA
project and number of project beneficiaries are core indicators. The denominator and numerator for each indicator have been clearly specified to ensure that definitions do not change over time. Baseline data are available and targets have been set for all indicators. The project team intends to conduct an impact evaluation of the project and plans to seek funding for the exercise internally within the Bank. Annex 2: Detailed Project Description Uganda: Uganda Reproductive Health Voucher Project The project comprises two components. These are: (1) Package of safe delivery services to poor pregnant women, and (2) Capacity Building and Project Management. The proposed activities under each component are presented below. Component One - Package of Safe Delivery Services to Poor Pregnant Women (GPOBA US$9.5 million). The objective of the component is to provide 132,400 pregnant women access to a defined package of safe delivery services from contracted private and public providers. The package of services consists of: four antenatal visits, safe delivery, one postnatal visit, treatment and management of selected pregnancy-related medical conditions and complications (including caesarian sections), and emergency transport. The package also includes services for EMTCT as part of antenatal care. Voucher scheme. The component will be implemented through a voucher scheme administered by a Voucher Management Agency (VMA). The VMA is responsible for managing the overall scheme including the contracting of selected service providers and training of community distributors to distribute vouchers to eligible clients in the targeted communities. The voucher entitles pregnant women to access a defined package of safe delivery services from contracted service providers. Upon providing the specified services, the service providers submit claims together with the appropriate voucher coupons to the VMA for settlement on the basis of the negotiated rates. Advantages of voucher schemes. A recent review of existing voucher programs demonstrated their potential to increase utilization of health services among beneficiary populations. Vouchers were found to assist with targeting services to vulnerable population groups; providing consumer choice and facilitating greater transparency in the service delivery process while ensuring the services meet the specified standards and for which the participating service providers receive commensurate financial rewards. Service Provider Selection Criteria. The scheme will use both public and private service providers licensed to practice by the relevant medical councils. The selection of service providers will be guided by the following principles: Location in the areas mapped under the project; Expression of interest to provide safe delivery services;
Budgeting MoH. There are huge variances between the budgeted and actual expenditure. Expenditure outside the approved budget. Substantial Project budget plans to be prepared in sufficient detail and be used as a management tool. The IFRs will be used to monitor variance analysis with budget. Both the MoH and VMA will be expected to adhere to the budgeting process and execution. Moderate Accounting and Information system. Inability for the MoH to manage the Project Accounts with sound systems, which will slow down the project activities. Substantial The MoH installed Navision Accounting system for all project accounting. ToRs for the VMA and IVEA include adequate FM provisions. Substantial Staffing at MoH may be stretched to implement the requisite control procedures as intended such as accounting and internal controls Substantial Project accountant is qualified and experienced in Bank funded projects. Recruitment of accounts assistant underway. The VMA will employ adequate and qualified accounting staff to manage the project and put in place the required controls. Moderate Funds Flow Delays in disbursing funds to the VMA. Delays in effecting payments to suppliers and contractors. Substantial Funds will be paid to the VMA directly from the DA when it becomes operational. Moderate Reporting- financial information may be unreliable and submitted late. Substantial The project reports will be verified by the IVEA. The VMA will submit report to MoH for consolidation within 30 days after end of each quarter. Moderate Internal control: The MoH lacks a comprehensive fixed assets register and may lose track of assets procured under the project. There are weaknesses in the management of advances. Delays in submitting internal audit reports High The project is based on OBA model and will not advance funding to MoH entities to implement project activities. The MoH is developing a fixed assets and enforcement of advances regulations. The Internal Audit department will incorporate the project in their annual work plans. The VMA will ensure there are strong internal control requirements. Substantial
part of the project, MoH has conducted an assessment of the costing of the different medical packages and established price ceilings to be used as a basis for determining the prices of the different service providers. Applicable Guidelines Procurement under the Project will follow the Guidelines: Procurement under IBRD Loans and IDA Credits (January 2011) and Guidelines: Selection and Employment of Consultants by World Bank Borrowers (January 2011). Procurement Thresholds to be applied in the Procurement Plan Expenditure Category Contract Value Threshold (US$) Procurement Method Contracts Subject to Prior Review (US$ ) Consulting Services and Training With firms above US$ 300,000 With individuals above US$ 100,000 With firms up to US$ 300,000 With Individuals up to US$ 100,000 Quality and Cost Based Selection Individual Qualifications/Other Individual All contracts All Contracts None None All types of contracts All contracts Sole source / direct contracting and terms of reference As specified in PP Procurement Plan and Procurement Packages Consulting Services 1 2 3 4 5 6 Ref No Description of Assignment Estimated Cost (US$) Selection Method Review by Bank (Prior/Post) Expected Proposals Submission Date 1 Voucher Management Agent (VMA) 3,400,000 QCBS Prior 30-Oct-14 2 Independent Verification of project outputs and integrity of the processes and systems. (IVEA) 400,000 CQBS Prior 30-Oct-14 Procurement Risks and Mitigation Measures