Document of

The World Bank

Restructuring PAPER

ON A

PROPOSED Project restructuring

of

Credit NO. 4597

June 6,2009

TO

NIGERIA

February 2, 2011

Health, Population and Nutrition Unit (AFTHE)

Country Department AFCE1

Africa Region

ABBREVIATIONS AND ACRONYMS

ACTs: Artemisinin based Combination Therapy

AF: Additional Financing

NDHS:National Demographic Health Survey

CDI: Community Driven Intervention

IPT: Intermittent Preventive Treatment
FGoN: Federal Government of Nigeria

FMoF: Federal Ministry of Finance

FMoH:Federal Ministry of Health

HFA: Health Facility assessment

ICR: Implementation Completion and Results Report

IDF:Institutional Development Fund

ISR: Implementation Status and Results Report

KPI: Key Project Indicators

LGA: `Local Government Area/Authority

LLINs: Long Lasting Insecticide treated Nets

LMIS:Logistic Management Information System

LQAS: Lot Quality Assurance Sampling

MCHP: Maternal and Child Health Project

MDGs: Millennium Development Goals

MPP: Malaria Plus Package

RDT:Rapid Diagnostic Test

NGO: Non Governmental organization

NMBP: National Malaria Booster Program

PAD: Project Appraisal Report

PDO: Project Development objective

PFMU: Project Financial Management Unit

PIF: Project implementation Facilitators

PIM: Project Implementation Manual

PMV: Patent medicine Vendor

ITN:Insecticide Treated Net

SBD: Standard Bidding documents

SCM: Supply Chain management

SDR:Special drawing Rights

SMBP: State Malaria Booster Program

SUFI: Scaling Up for Impact

TTL: Task Team Leader

Regional Vice President: ObiageliKatrynEzekwesili

Country Director:OnnoRuhl

Sector Director Ritva. S. Reinikka

Sector Manager:Eva Jarawan

Task Team Leader: Dinesh Nair

Reallocation of Proceeds

nigeria - malaria control booster project

ADDITIONAL FINANCING

P115036

Credit No. 4597

Restructuring Paper

  1. Proceeds for the Nigeria, Malaria Control Booster Project (Additional Financing), Credit No. 4597, P115036 will be reallocated as follows:

Category of Expenditure / Amount of Credit Allocation (in SDR) / % of Expenditures to be financed (inclusive of taxes)
Current / Revised / Current / Revised / Current / Revised
Goods / Goods / 42,360,000 / 42,360,000 / Up to 100% / Up to 100% contracts
Operational Cost / Operational cost / 11,340,000 / 24,840,000 / Up to 100% / Up to 100%
Unallocated / Unallocated / 13,500,000 / 0
TOTAL AMOUNT / 67,200,000 / 67,200,000
  1. Project Implementation Progress: The World Bank in 2006 provided IDA credit of US$180 million to Nigeria to implement the National Malaria Control Booster Project. The project was approved on December 12, 2006 and became effective on March 15, 2007. As a result of program policy changes in the implementation of malaria interventions and the country decision to scale up malaria interventions to universal access levels, the Bank on June 6, 2009 further approved additional IDA credit of US$ 100 million as Additional Financing to the NMBP. The Additional Financing became effective on January 5, 2010. The Project Development Objectives are: i) to ensure that the target population will have improved access to, and utilization of well-defined set of Malaria Plus Package of interventions (MPP); and (ii) to strengthen Federal and States ability to manage and oversee delivery of malaria plus interventions.
  1. At midterm, the project is making satisfactory progress towards the achievement of its development objective. Implementation progress has been good in program areas that are operationally vertical with high visibility, e.g. rolling out bed nets. However challenges remain in areas that require strengthening ongoing health systems.To reflect these challenges overall implementation progress was moderately satisfactory for MTR; while all other ratings are satisfactory. Some key highlights include:

a)Much progress has been made in improving coverage with basic malaria preventive measures.By December 2010, 12.4 million LLINs/ITNs have been procured and distributed to reach a population of 35.6 million people. As of July 2010 - 81.3%[1] of the households own at least 1 ITN/LLIN (compared to 2.6% in 2006); 44.6% of children less than 5 that slept under an ITN the preceding night to the survey (compared to 6% in 2006) and 16.6% of pregnant women received 2 or more doses of IPT was (compared to 8.3%) in 2006. The last is disappointing as according to the NDHS 2008 and LQAS 2010 more than two thirds of pregnant women attend antenatal clinics. These show that there are a lot of missed opportunities which could be used to improve the uptake IPT 2. (See annex I)

b)Diagnosis and Treatment of malaria cases has not progressed. The percentage of children under 5 years with fever treated with an effective anti malarial medicine within 24 hours from onset of fever increased marginally from 3.7% in 2006 to 5.8% in 2010 and RDT and Microscopy services for diagnosis is still to achieve both coverage and quality parameters. Long delays in procurement of Artemisinin Combination Therapy (ACT) and Rapid Diagnostic Test (RDT) kits from the federal level has led to empty pipelines

c)New programming and innovations have been initiated but progress lag due to institutional weaknesses and capacity constraints - indoor residual spraying was started in the 7 states in 2009 and will benefit 2.8 million people in 14 LGAs by 2011 and capacity issues limit roll out of community driven initiatives and private sector engagement.

d)The objective of progressing malaria goals (Plus Package) within broader MCH interventions has not taken off – the % of children aged 0-23mnths with diarrhea in the last two weeks who received ORS increased marginally from 25.3% to 27.8% between 2006 and 2010 and ANC care decreased marginally from 63.1% to 53.8%. Percent of infants aged 0-6 months who were fed breast milk only in the last 24 hours decreased marginally from 27.8% in 2006 to 24.9%. The wide scope of these interventions, the absence of clear operational processes and interlocutors and scale of intervention required to impact the results limit effectiveness of using Malaria Programming for MCH goals.

e)The strengthening of health systems in the seven project states particularly procurement and supply chain management, monitoring and evaluation and communications have been initiated – but translation to results remain challenging. Further wherever these interface with procurement (e.g. procurement of RDT; civil works on stores); sourcing technical support (e.g. setting up guidelines for a lab quality assurance mechanism; drug and insecticide resistance monitoring) and rolling out program, both the Federal and States still require a lot of input to move the interventions forward

  1. Considering the need to refocus the program so that accelerated progress is achieved in malaria interventions and the malaria plus package; the delays experienced in starting up the project, the fund utilization to date, the time required for start up of crucial interventions such as CDI, PMV, Health Systems Strengthening measures, and the time necessary to have an impact on the project objectives – Ministry of health and Bank have agreed to carry out a project restructuring and seek project extension of upto two years. This formal restructuring will be processed by July 2011.
  1. The Governmentof Nigeria, on January 6, 2011 requested the Bankto finance the cost of distributing long lasting insecticide treated nets (LLIN) in 22 states of Nigeria, on an urgent basis. This follows the 2008 National Malaria Control Program (NMCP) decision to accelerate the provision of Long Lasting Insecticide Treated Net (LLINs)in all household in the States of Nigeria as a means of attaining universalLLIN coverage. In 2009, the GoN commenced this massive bed net campaign and Government and other Roll Back Malaria partners were able to secure pledges of 63 million nets; of which 24 million LLINs have been procured and distributed to date in 14 states of the country including the seven (7) World Bank supported Booster states. In addition, the Global Fund also supplied 30 million LLINs for another 17 states. However, these LLINS supplied by the Global Fund have not been distributed due to funding shortages for meeting the operating costs for distributing the nets. In addition five other states remain without operational costs for the LLIN campaigns bringing the total number of states without operational funds to 22. In total there is currently, a funding gap of US$22.30 million, required to meet the operational cost for distributing the 30 million LLINs to the 22 States. By definition, the operational cost for LLIN campaign includes cost of storage and transportation; training; production and distribution of IEC/BCC materials; M&E activities; radio and television advertisements; allowances for personnel and volunteers and communication.
  1. The request by GoN aims to meet this financing gap. We propose to reallocate the unallocated funds within the Malaria Booster Additional Financing to meet these costs. Therefore while project objectives remain the same the project scope expands for this activity to 22 additional states. The funds made available in this way will contribute to providing increased LLIN coverage to over 15 million households and will support the country’sobjective of attaining universal targets with LLINs. The coverage and usage of LLINs in households will be monitored at the end of the campaign in each state through a household survey.
  1. The Bank agrees with government justification for LLIN campaign in the states and the need to process this reallocation before the more major restructuring planned; consideringthat (i)there is a pressing need to get the LLINs distributed before the upcoming rainy season in order to save children’s lives.(ii) Government has developed and used successfully in other states well-worked out plans for the distribution of the LLINs (iii) thebenefitting states will receive extensive TA from the State Support team.(iii)There is also provision for an end process assessment through a household survey at the end of each state campaign. The survey will not only assess the processes of the campaign but also determine net ownership and utilization of the nets. The major indicators to track are: Percentage of household with at least one ITN/LLIN; Percentage children < 5 years who slept under an ITN the night preceding the survey and Percentage of pregnant women who slept under an ITN the night preceding the survey.To capture the expanded scope of activities the project results framework will include an additional intermediate indicator measuring the number of nets distributed in these additional states.
  1. The Bank and NMCP have established channels of disbursement, procurement and tracking of resources which will work through the Project Financial Management Unit (PFMU) in the states (See annex II). The same mechanism as agreed to in the financial arrangement for utilization of Booster Funds in the Original Project and the Additional Financing will be followed to ensure Funds provided to the States are tracked and accounted for. The Bank supported Project Financial Management Unit will be responsible for the fund management at the state level and will enable tracking and ensuring expedited report with accompanying evidence of the use of the funds after each State campaign, within at least three weeks after the activity. This arrangement will be supported by the FM team at the Bank and they would provide training to the accountants in various state PFMUs.
  1. The proposed reallocation is necessary to strengthen NMCP and the Government of Nigeria in meeting the national goal of reducing the burden of malaria morbidity and mortality by half by 2010. By providing the operation costs, to the other Non Booster States, the project will have contributed to ensuring that the entire country benefits in the implementation of these massive LLINs campaigns. Given the nature of malaria transmission and the need for population level coverage to achieve impact in interventions, the attainment of uniform level coverage in the States is critical in ensuring that the gains made in other States (including the 7 Booster States) are not brought down by lack of progress in adjacent States. The reallocation will require US$ 22.3 Million. This re-allocation while reflecting an expansion of scope of activities - does not change the PDO and strengthens federal capacity to manage and oversee the delivery of malaria control interventions throughout the country.

RestructuringStatus: Draft
Restructuring Type: Level Two
Last modified on date : 01/01/2012
1. Basic Information
Project ID and Name / P115036: Nigeria Malaria control Booster Project – Additional Financing
Country / Nigeria
Task Team Leader / Dinesh Nair
Sector Manager/Director / Eva Jarawan
Country Director / OnnoRuhl
Original Board Approval Date / 06/15/2009
Original Closing Date: / 03/31/2012
Current Closing Date / 03/31/2012
Proposed Closing Date [if applicable] / N/A
EA Category / B-Partial Assessment
Revised EA Category / No change
EA Completion Date / 04/01/2006
Revised EA Completion Date / N/A
2. Revised Financing Plan (US$)
Source / Original / Revised
Borrower / 0.00 / 0.00
IDA / 100.00 / 100.00
Total / 100.00 / 100.00
3. Borrower
Organization / Department / Location
Federal Ministry of Finance / International Economic Relations (IER) / Nigeria
4. Implementing Agency
Organization / Department / Location
FMoH, National Malaria Control Programme, State Malaria Control Programmes – Akwa Ibom, Anambra, Bauchi, Gombe, Kano, Jigawa and Rivers State / Abuja, and all State capital cities
5. Disbursement Estimates (US$m)
Actual amount disbursed as of 12/31/2011 = 7.0
Fiscal Year / Annual / Cumulative
2010 / 10.0 / 10.0
2011 / 60.0 / 70.0
2012 / 30.0 / 100.0
6. Policy Exceptions and Safeguard Policies
Does the restructured project require any exceptions to Bank policies? / N
Does the restructured project trigger any new safeguard policies? If yes, please select from the checklist below and update ISDS accordingly before submitting the package. / N
7a. Project Development Objectives/Outcomes
Original/Current Project Development Objectives/Outcomes
The Project Development Objectives are: i) to ensure that the target population will have improved access to, and utilization of well-defined set of Malaria Plus Package of interventions (MPP); and (ii) to strengthen Federal and States ability to manage and oversee delivery of malaria plus interventions.
7b. Revised Project Development Objectives/Outcomes [if applicable]
N/A

Annex: I

Table 1. Project Outcome Indicators: Baseline, Midline and End of Project target

Indicator / 2006* / 2010 / EOP
a. LLIN
Percentage of households with at least ONE ITN/LLIN / 2.2 / 88.0 / 80%
Percentage of children <5 years of age who slept under an LLIN the night preceding the survey / 3.0 / 44.6 / 80%
c. ACT
Percentage of children <5 years with fever treated with an effective antimalarial within 24 hours from the onset of symptom / 0.0 / 5.8 / 80%
d. IPT
Percentage of pregnant women who received two or more doses of IPT / 9.0 / 16.6 / 60%
F. ANC
Percentage of women with children <1 year of age who received ANC care during last pregnancy (one or more visits) / 62.0 / 72.0 / 80%
G.ORT
Percent of children aged 0-59 months with diarrhea in the last two weeks who received oral rehydration solution (ORS) and/or recommended home fluids (RHF) / 26.0 / 27.8 / 50%
H. Vaccination
Percent of infants aged 12-23 months that are vaccinated with the DPT3 vaccines / 12.0 / 38.0 / 80%
Percent of infants aged 12-23 months that are vaccinated with the Measles vaccines / 13.0 / 47.4 / 80%
I. Exclusive Breastfeeding
Percent of infants aged 0-6 months that were fed breast milk only in the last 24 hours / 27.0 / 25.9 / 50%

*All figures are in percent

Annex II: Financial Management Guideline for fund disbursement and utilization

The FM arrangements in place in Nigeria involve the use of Project Financial Management Units (PFMUs) to provide FM support for all projects activities taking place in the states. In this case, the PFMU in the beneficiary states will be used to provide the required FM support.

i)An approved budget for planned activities in each of the state will be required;

ii)The National Malaria Control Program (NMCP) will sign an MOU with PFMU of each of the participating state to provide financial management services for the relevant unit and its activities;

iii)The PFMU will open a new bank account for the project/activity in the state to ensure that the resources for this activities can be tracked and accounted for on completion, the authorized signatories would be determined and details of the new bank accounts communicated to the National Office;

iv)On approval and when the bank account is ready, each state “Malaria focal person” with the support of the PFMU will request for the transfer of funds into the state’s bank account;

v)Disbursement from the state bank account will be in accordance with the approved budget and will follow PFMU financial procedures manuals which will include:

a.A formal request for funds from the focal person to the PFMU;

b.Accepting to submit required accounting records and support documents to the PFMU on completion of the related activity;

vi)The PFMU will be required to submit full statement of accounts for the total amount received including original documents to NMCP at the end of the exercise;

vii)NMCP is fully responsible for the conduct of the audit at the end of the year;

viii)Given the fact that this is a specific and a time limit intervention, it is expected that on completion of the related activity, the PFMU in each state will submit documentation of all expenditures and financial report to NMCP.

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[1] All data from LQAS 2006 and 2010, unless otherwise noted.