The World Bank - Global Financing Facility

1 Document of The World bank FOR OFFICIAL USE ONLY Report No: 112244 PROGRAM PAPER ON A PROPOSED RESTRUCTURING AND A PROPOSED ADDITIONAL Financing IN THE AMOUNT OF SDR MILLION (US$150 MILLION EQUIVALENT) TO THE FEDERAL DEMOCRATIC REPUBLIC OF ethiopia WITH A PROPOSED GRANT FROM THE Global Financing Facility FOR EVERY WOMAN AND EVERY CHILD IN THE AMOUNT OF US$60 MILLION AND A PROPOSED GRANT FROM THE POWER OF NUTRITION TRUST FUND IN THE AMOUNT OF US$20 MILLION IN SUPPORT OF THE HEALTH SUSTAINABLE DEVELOPMENT GOALS PROGRAM FOR RESULTS April 20, 2017 Health, Nutrition & Population Africa Region This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World bank authorization.

2 Public Disclosure AuthorizedPublic Disclosure AuthorizedPublic Disclosure AuthorizedPublic Disclosure Authorizedii CURRENCY EQUIVALENTS (Exchange Rate Effective as of March 31, 2017) Currency Unit = Ethiopian Birr (ETB) ETB = US$1 US$1 = SDR FISCAL YEAR July 08 July 07 ABBREVIATIONS AND ACRONYMS ACG Anti-Corruption Guidelines ANC Antenatal Care APTS Auditable Pharmaceuticals Transactions and Services BPR Business Process Reengineering BSC Balanced Score Card CASH Clean and Safe Health Facility Initiative CBHI Community Based Health Insurance CHD Community Health Days CHMIS Community Health Management Information System CIFF Children s Investment Fund Foundation CPR Contraceptive Prevalence Rate CPS Country Partnership Strategy CRVS Civil Registration and Vital Statistics CSA Central Statistics Agency CSC Community Score Card DHS Demographic and Health Survey DLI Disbursement Link Indicator DQA Data Quality Assurance EHIA Ethiopian Health

3 Insurance Agency EHNRI Ethiopian Health and Nutrition Research Institute EOS Enhanced Outreach Services EPHI Ethiopian Public Health Institute ESAP ethiopia Social Accountability Program ESPES Enhancing Shared Prosperity through Equitable Services ESSA Environmental and Social Safeguards Assessment EWEC Every Woman and Every Child FEACC Federal Ethics and Anti-Corruption Commission FM Financial Management FMOH Federal Ministry of Health FPPA Federal Public Procurement and Property Administration Agency FTA Financial Transparency and Accountability GAVI Global Alliance for Vaccines and Immunization GDP Gross Domestic Product GFF TF Global Financing Facility Trust Fund GFF Global Financing Facility iii GMP Growth Monitoring and Promotion GMU Grant Management Unit GRM Grievance Redress Mechanism GRS Grievance Redress Service GTP Growth and Transformation Plan HAPCO HIV/AIDS Prevention and Control Office HCF Health Care Financing HCMIS Health Commodities Management Information System HEW Health Extension Worker HFS Health Financing Strategy HIV/AIDS Human Immunodeficiency Virus/Acquired Immuno-Deficiency Virus HMIS Health Management Information System HNP Health Nutrition and Population HPN Health Population and Nutrition HRH Human Resources for Health HRITF Health Results Innovation Trust Fund HSDP Health Sector Development Plan HSS Health System Strengthening HSTP Health Sector Transformation Plan ICT Information and Communication Technology IDA International Development Association IEC Information.

4 Education and Communication IFA Integrated Fiduciary Assessment IFA Iron and Folic Acid Tablets IFAC International Federation of Accountants IFMIS Integrated Financial Management Information System IFRs Interim Financial Reports IGFT Intergovernmental Fiscal Transfer IHP+ International Health Partnership Plus IMR Infant Mortality Rate IP Implementation Progress IPF Investment Project Financing IPPSC Infection Prevention and Patient Safety Committees ISR Implementation Status Report IT Information Technology JANS Joint Assessment of national Health Strategies JCCC Joint Core Coordination Committee JCF Joint Consultative Forum JFA Joint Financing Agreement JRIS Joint Review and Implementation Support KPIs Key Performance Indicators M&E Monitoring and Evaluation MCH Maternal and Child Health MDGs Millennium Development Goals MDGs PF Millennium Development Goals Performance Fund MEFCC Ministry of Environment, Forest and Climate Change MNCH Maternal.

5 Neonatal and Child Health MOFEC Ministry of Finance and Economic Cooperation MTR Mid Term Review MWM Medical Waste Management NBE national bank of ethiopia iv NERs Net Enrollment Rates NGOs Non-Governmental Organizations NNCB national Nutrition Coordination Body NNP national Nutrition Program OFAG Office of the Federal Auditor General PAP Program Action Plan PBS Promoting Basic Services PDO Program Development Objective PEFA Public Expenditure and Financial Accountability PFM Public Finance Management PFM Public Finance Management PforR Program for Results PFSA Pharmaceuticals Fund and Supply Agency PHC Primary Health Care PIM Project Implementation Manual PMU Project Management Unit PN Power of Nutrition PP Program Paper PPD Policy and Plan Directorate PPSD Project Procurement Strategy for Development PSNP Productive Safety Nets Project QCBS Quality and Cost Based Selection REACC Regional Ethics and Anti-Corruption Commission RFB Request for Bid RHBs Regional Health Bureau RMNCAH Reproductive, Maternal, Newborn, Child and Adolescent Health RMNCH Reproductive, Maternal, Newborn and Child Health SA Skilled Birth Attendance SARA Service Availability and Readiness Assessment SBD Standard Bidding Document SDG Sustainable Development Goal SDGPF Sustainable Development Goal Pool Fund SDR Special Drawing Rights SHI Social Health Insurance SNNP Southern Nations.

6 Nationalities and Peoples SPA+ Service Provision Assessment Plus SPL Social Protection and Labor STEP Systematic Tracking of Exchanges in Procurement STIs Sexually Transmitted Infections TA Technical Assistance TFR Total Fertility Rate TWGs Technical Working Groups UHC Universal Health Coverage UNICEF United Nations Children's Fund UNIS Unified Nutrition Information System UNOPS United Nations Office for Project Services USAID United States Agency for International Development VAS Vitamin A Supplement VERA Vital Events Registration Agency WASH Water, Sanitation and Hygiene WHO World Health Organization v Regional Vice President: Senior Global Practice Director: Makhtar Diop Timothy G. Evans Country Director: Carolyn Turk Practice Manager: Trina S.

7 Haque Task Team Leader(s): Anne Bakilana vi ethiopia Health Sustainable Development Goals Support Program for Results Additional Financing Table of Contents A. Data Sheet .. vii B. Program Paper .. 1 I. Introduction .. 1 II. Background: Sector Context and Challenges .. 4 III. The Rationale for Proposed Additional Financing and Restructuring .. 15 IV. The Original Program and Progress to date .. 20 V. Proposed Restructuring and Additional Financing to the Program .. 23 VI. Implementation Arrangements for the Program for Results .. 28 VII. Risks for the Program .. 29 VIII. Corporate 31 Annex I: Appraisal Summary for Investment Project Financing (IPF) Component .. 33 Annex II: Results Matrix for IPF Component .. 47 Annex III: DLI Disbursement and Results progress to date .. 48 Annex IV: Program Action Plan Progress to date.

8 50 Annex V: Summary of Technical Assessment Update .. 52 Annex VI. Program Economic Evaluation .. 63 Annex VII: Summary of Integrated Fiduciary Assessment .. 67 Annex VIII: Summary of Environmental and Social System Assessment (ESSA) Update .. 76 Annex IX: Results Framework and Monitoring Indicators .. 80 Annex X: Disbursement Linked Indicators, Disbursement Arrangements and Verification Protocol . 86 Annex XI: Revised Program Action Plan .. 112 Annex XII: ethiopia - Global Financing Facility in Support of Every Woman and Every Child .. 116 vii A. DATA SHEET Program ID: P160108 Regional Vice President: Makhtar Diop Country Director: Carolyn Turk Practice Manager: Trina S. Haque Team Leader: Anne Bakilana Lending Instrument: Program for Results Current Approval Date: February 28, 2013 Current Closing Date: June 30, 2018 Report No: 112244 Borrower: Federal Democratic Republic of ethiopia Responsible Agency.

9 Federal Ministry of Health Federal Vital Events Registration Agency Financing Information Key Dates Program Ln/Cr/TF Status Approval Date Signing Date Effectiveness Date Current Closing Date Revised Closing Date P123531 CR#5209 Active February 28, 2013 March 29, 2013 June 17, 2013 June 30, 2018 July 31, 2021 P123531 TF#14107 Active March 29, 2013 March 29, 2013 March 29, 2013 June 30, 2018 July 31, 2021 P123531 TF#14815 Active December 23, 2013 December 23, 2013 December 23, 2013 February 28, 2017 - Disbursements (in Millions) Program Ln/Cr/TF Status Currency Current Revised/ Cancelled Disbursed Un- disbursed % Disb. P123531 CR#5209 Active USD - P123531 TF#14107 Active USD - P123531 TF#14815 Active USD - Policy Waivers Does the Program require any waivers of bank policies applicable to Program-for-Results operations?

10 Yes [ ] No [X ] Has the waiver(s) been endorsed or approved by bank Management? Yes [ ] No [ ] B. Summary of Proposed Changes Change in Program s Development Objectives Yes [ ] No [X] Change in Program Scope Yes [X] No [ ] Change in Results Framework Yes [X] No [ ] ethiopia Health Sustainable Development Goals Additional Financing (P160108) PROGRAM PAPER AFRICA REGION HEALTH, NUTRITION AND POPULATION Global PRACTICE viii Change in Legal Covenants Yes [X] No [ ] Change in Loan Closing Date(s) Yes [X] No [ ] Cancellations Proposed Yes [ ] No [X] Change to Financing Plan Yes [X] No [ ] Reallocation between and/or Change in DLI Yes [X] No [ ] Change in DLI Verification Protocol Yes [X] No [ ] Change in Key Parameters (Disbursement Arrangements, Institutional Arrangements, Technical, Fiduciary, and Environmental and Social aspects)