World Bank Documentdocuments.worldbank.org/curated/en/910771533322068806/pdf/Dis… · The World Bank Sahel Malaria and Neglected Tropical Diseases (P149526) The staffing, equipment,

The World BankSahel Malaria and Neglected Tropical Diseases (P149526)

REPORT NO.: RES31977

RESTRUCTURING PAPER

ON A

PROPOSED PROJECT RESTRUCTURING

OF

SAHEL MALARIA AND NEGLECTED TROPICAL DISEASES

APPROVED ON JUNE 11, 2015

TO

BURKINA FASO

THE REPUBLIC OF MALI

THE REPUBLIC OF NIGER

AND

THE ECONOMIC COMMUNITY OF WEST AFRICAN STATES (ECOWAS)

HEALTH, NUTRITION & POPULATION

AFRICA

Regional Vice President: Makhtar Diop Country Director: Rachid Benmessaoud

Senior Global Practice Director: Timothy Grants EvansPractice Manager/Manager: Gaston Sorgho

Task Team Leader: Andy Chi Tembon, Haidara Ousmane Diadie, John Paul Clark

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ABBREVIATIONS AND ACRONYMS

ACT Artemesinin-based Combination Treatment (Malaria)AQ+SP Amodiaquine plus Sulfadoxine-PyrimethamineCAMEG Central d’Achat des Médicaments Essentiels Génériques (Burkina Faso)

(National Drug Procurement Agency)CHO Community Health OfficerCHW Community Health WorkerCPS Chemoprevention of Seasonal MalariaCSCOM Community Health CenterDPS Direction pour la Promotion de la Santé (Health Promotion Directorate)DRS Direction Régionale de la Santé (Regional Health Directorate)DS Direction de la Santé (Health Directorate)ECOWAS Economic Community of West African StatesHKI Helen Keller InternationalIP Implementation ProgressLQAS Lot Quality Assurance SamplingMDA Mass Drug AdministrationMOU Memorandum of UnderstandingMTR Mid-Term ReviewNCU National Coordination UnitNGO Non-Governmental OrganizationNTD Neglected Tropical DiseasesPADS Programme d’Appui au Développment Sanitaire (Support Program for

Health Development, Burkina Faso)PDO Project Development ObjectivePNLP Programme National de Lutte contre le Paludisme (National Malaria

Control Program)POM Project Operations ManualSMC Seasonal Malaria ChemopreventionSP + AQ Sulfadoxine-pyrimethamine + AmodiaquineTOR Terms of ReferenceUNICEF United Nations Children’s FundUSAID United States Agency for International DevelopmentWAHO West African Health OrganizationWHO World Health Organization


BASIC DATA

Product Information

Project ID Financing Instrument

P149526 Investment Project Financing

Original EA Category Current EA Category

Partial Assessment (B) Partial Assessment (B)

Approval Date Current Closing Date

11-Jun-2015 31-Dec-2019

Organizations

Borrower Responsible AgencyMinistry of Economy and Finance,Ministry of Economy and Finance,Ministre du Plan, de l'Aménagement du Territoire et du Développement Communautaire

West African Health Organisation (WAHO)

Project Development Objective (PDO)

Original PDOThe project development objective is to increase access to and use of harmonized community-level services for the prevention and treatment of malaria and selected neglected tropical diseases in targeted cross-borders areas in participating countries in the Sahel region.OPS_TABLE_PDO_CURRENTPDOSummary Status of Financing

Ln/Cr/Tf Approval Signing Effectiveness ClosingNet

Commitment Disbursed Undisbursed

IDA-56670 11-Jun-2015 28-Jul-2015 05-Jan-2016 31-Dec-2019 37.00 16.00 20.92

IDA-56680 11-Jun-2015 08-Jul-2015 04-Feb-2016 31-Dec-2019 37.00 19.14 19.05

IDA-56690 11-Jun-2015 27-Jul-2015 04-Feb-2016 31-Dec-2019 37.00 14.09 23.94

IDA-D0710 11-Jun-2015 02-Dec-2015 03-May-2016 31-Dec-2019 10.00 2.78 7.71


Policy Waiver(s)

Does this restructuring trigger the need for any policy waiver(s)?No

I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING

A. Project Status

The Sahel Malaria and Neglected Tropical Diseases is a regional project implemented in Burkina Faso, Mali and Niger. It was approved by the Board on June 11, 2015 and became effective in Mali on January 5, 2016, in Burkina Faso and Niger on February 4, 2016; and for the West African Health Organisation (WAHO) on May 3, 2016. The overall total approved amount of US $121 million project includes US$ 37 million each for Burkina Faso, Mali and Niger and US $10 million for WAHO for Regional Coordination. The project’s interventions areas are in targeted cross-borders areas of the three countries: 20 border districts in Burkina Faso, 19 in Mali, and 17 in Niger. This is a four-year project that is slated to close on December 31, 2019. To date, (July 23rd) 42% of the funding has been disbursed. Both PDO and IP have been rated Moderately Satisfactory (MS). The Project PDO continues to be relevant and achievable and mitigating measures are being taken to ensure the satisfactory level of these ratings.

This regional project had significant implementation delays due to the long time it took to become effective, especially the Regional Project implementation Unit, WAHO. The delays were due mainly to (i) the difficulty of coordinating the actions of ECOWAS headquarters in Abuja (Nigeria) with those of WAHO based in Bobo Dioulasso (Burkina Faso), and (ii) the political crisis and insecurity that was within the sub-region at the time, making it impossible for the respective parliaments to meet and deliberate on the project.

A.1 IMPLEMENTATION STATUS BY COUNTRY

A.1.1 – BURKINA FASO

Under component 1 (Improve regional collaboration for stronger results across participating countries ), 93% (14 out of 15) of the planned activities for the first semester have successfully been carried out. The country team participated in several regional steering committee meetings organized by WAHO. Several national steering committee meetings organized by PADS, NTD, and PNLP have taken place over the course of the current implementation period. Critically needed drugs have been purchased for the mass drug administration campaigns for seasonal malaria and the neglected tropical diseases; and the MoU with WHO to provide capacity building/technical assistance to the country team has been signed. In terms of coordination activities, supervision


had been organized and cross-border activities such as planning, communication, joint supervision have been taking place and will be ongoing.

Under Component 2 (Support coordinated implementation of technical strategies and interventions ), 76% (124 out 162) of the planned activities have been carried out to support the implementation of the coordinated strategy and technical interventions. The communication strategy implemented by the different technical entities (PADS, PNLP, NTD, DRS, DS, and DPS) is progressing well. The communication medium/tool, drama, sketches, newsletters, has been created. Implementation of all mass drug administration campaigns planned in 2016 and 2017 have been carried out even though most of the 2016 campaigns were exclusively funded by USAID. The seasonal malaria treatment of children 3-59 months with SP+AQ has been carried out. In terms of capacity building, Trachoma Trachiasis (TT) surgeons have been trained. Several other training sessions related to (i) passive surveillance for laboratory agents, (ii) TT surgery for medical ward members, and as well as training of the other stakeholders have been done. The Trachoma Impact Survey has been finalized and camps to operate on hydroceles have been organized. Finally, the project’s results sharing workshop stemming from the outcome of the studies has taken place.

Implementation of activities under Component 3(Strengthen institutional capacity to coordinate and monitor implementation) have a 76% completion rate (75 out of 99 planned activities). The relevant institutions (PADS, DPS, DS, DRS, NTD, PNLP) have developed their annual work plans and the data collection tools have been revised. The assessment of sentinel sites has been done. The DRS and DS have held micro planning workshops, and they have been implementing the planned activities. Capacity building of the project team has been done.

A.1.2 – NIGER

The overall implementation of project activities is progressing well despite the effectiveness delays and implementation bottlenecks. Under Component 1, 10 activities were planned and 6 have been completed (60%). 86 out of 104 (83%) activities planned have been completed under component 2. Component 3 had 86 out of 115 planned activities completed (45%).

In terms of Chemo-prevention of Seasonal Malaria, seven SMC campaigns, three in 2016 and four in 2017, have been organized where close to 5,507,264 tablets have been distributed in 14 districts. Two large awareness-raising campaigns including 7 advocacy meetings were held in the districts implementing the SMC in 2016 and 2017. The community-based diagnosis and treatment of malaria activities are underway.

All logistical needs have been assessed and acquired to ensure a successful achievement of the objective of the integrated treatment of neglected tropical diseases. Important results have been obtained from the implementation of the NTD campaigns. We note a gradual reduction of the schistosomiasis, geohelminthiasis and trachoma prevalence. As for the treatment of the reversible consequences of the NTD, 11,526 cases of Trichiasis were treated including 4,085 in 2016 and 7,441 in 2017; 1,094 hydroceles have been recorded in 480 villages and the census is progressing in other villages.


The staffing, equipment, and institutional capacity building have been completed. A Memorandum of Understanding (MoU) has been signed with WHO to provide technical assistance and build capacity for project implementation. Finally, the Monitoring and Evaluation activities have started and will be ongoing to ensure the attainment of the project intended objectives.

A.1.3 – MALI

The project is progressing well despite a little over 10 months’ startup delays due to institutional difficulties to establish the Project Coordination Unit (PCU) including hiring key personnel needed to carry out the planned activities. Under component 1, activities to improve regional collaboration for stronger results among participating countries are underway. Mali has taken part in several regional steering committee meetings organized by WAHO and Mali has organized several national steering committee meetings. An MoU with WHO to provide capacity building activities has been signed and activities to support the project are ongoing. The essential drugs for the seasonal malaria chemoprevention campaigns have been purchased through CAMEG in Burkina Faso.

Support for the coordinated implementation strategies and technical intervention under component 2 is underway through effective communication campaigns. The validation workshop for the communication tools took place with priority NTD messages shared with the participants at the NTD campaign launch in Bamako on April 16, 2018. These messages were subsequently transmitted at all levels through different media. TV and radio spots have also been developed and their broadcast is in progress.

The 2017 Seasonal Malaria Chemoprevention campaign data validation workshop was held and the 2018 campaign chronogram has been disseminated at all levels. The ACT Requirements for 2018 are being finalized by the PNLP for the Community-Based Malaria Diagnosis and Treatment. The mass drug administration (MDA) campaign for the integrated treatment of neglected tropical diseases is underway in all the endemic health districts supported by the project. The project also provided support for the surgical treatment of the reversible consequences of NTD in Bougouni and Kolondièba, where 153 cases of hydrocele were operated and 131 other cases of hydrocele operated in the districts of Sikasso, Koutiala, Yorosso, Bankass, Koro, Douentza and Tominian. The 2018 surgical activities will occur after NTD treatment campaigns.

As concerns component 3, the Strengthening of institutional capacities for coordination is critical to ensure the effective and efficient monitoring and evaluation of project implementation. The project coordinating unit now has a full complement of staff and is functional. The operational research protocols have been signed, and the research is ongoing. The LQAS survey was carried out and the results were presented and the LQAS report validated on April 26-27.

A.1.4 – WAHO


Despite the long delay after effectiveness and implementation bottlenecks (For example, the long process for the development of research protocols with research institutions, delay in obtaining the clearance for the award of contracts resulting in delays in the implementation of the research activities, delay in conducting LQAS surveys in Burkina Faso and Niger, low disbursement rate, and insecurity in some cross-border areas) the Economic Community of West African States (ECOWAS) is fulfilling its mandate and is making significant progress towards achieving its intended objectives. The end-targets of some of the main indicators have been achieved, evidence of the need to review the results framework.

Specific achievements from the implementation of activities pertaining to both components are outlined therein: The Regional Steering Committee has been established; Cross-border activities have been harmonized and joint implementation/mass drug administration

campaigns conducted; Activity package of Community Health Workers and awareness tools and messages in the fight against

malaria and NTD have been harmonized; Regional consultation framework for monitoring the activities of the malaria and NTD project in the Sahel

has been created; Mechanism for joint annual planning of activities between the three project countries has been established; Pooled drug procurement mechanism for seasonal malaria chemoprevention campaigns has been

established; Ongoing revitalization of cross-border sub-committees and establishment of cross-border meetings

between regions and border health districts; Support for the organization of hydrocele surgery camps have been provided to three countries; Definition of priority themes (40) for research in the field of Malaria and Neglected Tropical Diseases that

have resulted in the development of three research protocols in collaboration with research institutions has been done.

In terms of institutional capacity building activities, 19 staff have been trained on MS Project and 1 staff trained on Communication leadership management; 7 district chief medical officers trained in surgical techniques for the management of hydroceles; Purchase of minibus, computer equipment and video conference to strengthen WAHO's logistical capacity; 5 implementation support missions to countries have been conducted; Several data collection tools for CPS and MDA / NTD campaigns have been harmonized; Needs assessment for strengthening the functionality of sentinel sites conducted as well as 3 semi-annual and 2 annual reviews. A Mid-term internal evaluation of the project has been undertaken.

B. Rationale for Restructuring


The review of project implementation progress during the Mid-Term Review (MTR) held from 4th to 9th December 2017 revealed that to achieve the project’s outcome targets, it will be necessary for all stakeholders to accelerate the pace of project implementation and make some adjustments to the budget, to the results framework, the legal covenant regarding the payment to Community Health Workers, and to the closing date of the project.

Therefore, the proposed restructuring seeks to: (i) reallocate funds between expenditure categories and components; (ii) revise selected target indicators; (iii) to revise selected Legal Covenant, and (iv) extend the project closing date. The extension will provide time for the project to complete all the intended activities and would enable it to make up for the initial delays that resulted in the project not being rolled out at once in all the countries concerned.

II. DESCRIPTION OF PROPOSED CHANGES

Pursuant to the following: (i) the letter No 2018/00421/MINEPID/SG/DGCOOP/DCM/AS dated February 19, 2018 from Burkina Faso Ministry of Economy, Finance and Development; (ii) the letter No.000396/MP/DGPD/DFI dated May 18, 2018 from the Niger Ministry of Planning; (iii) the letter No.01147/MEF-SG dated March 20, 2018 from the Malian Ministry of Economy and Finance; (iv) the letter No. A19/UGP-PMTN/D/2018/398/ad dated May 31, 2018 from the Director General of the West African Health Organisation (WAHO); submitted to the World Bank requesting the restructuring of the project based on the recommendations of the Mid-Term Review held in Ouagadougou from 4th to 9th December 2017; the Aide-Memoire of the follow-up project support mission held in Bobo-Dioulasso from 3rd to 11th May 2018 provides the detailed elements of the restructuring requests. These include: (i) reallocation of funds between expenditure categories and components; (ii) revision of the results framework; (iii) revision of Legal Covenant about payment of community health workers, (this does not concern WAHO), and (iv) extending the project closing date to ensure that all remaining activities will be finalized.

(1) REALLOCATION OF FUNDS BETWEEN EXPENDITURE CATEGORIES AND COMPONENTS

BURKINA FASO

A reallocation of the proceeds from Categories 3 (Unallocated) and 2 (Payments to Community Health Workers under Component 2 of the project) to Category 1 (Goods, Non-Consulting Services, Consultants’ Services, Operating Costs, Workshops, and Training) of the financing agreement is requested to fill the funding gap created by an underestimation of the costs of the drugs purchased through CAMEG for seasonal malaria chemoprevention as well as high costs associated with the chemoprevention campaigns for seasonal malaria chemoprevention and an underestimation of the allocated amount dedicated for the treatment of reversible complications of the NTDs. The reallocation from Category 2 to Category 1 is proposed because countries have introduced a request not to


use Category funding to hire an agency or an NGO to carry out payments to Community Health Workers (see rationale under the proposed Change of Legal Covenant below). The revised table is proposed below:

REVISED EXPENDITURE CATEGORIES (BURKINA FASO)

Category Amount of the Credit Allocated (expressed in SDR)

Revised Amount of the Credit Allocated (expressed in SDR)

Percentage of Expenditures to the be Financed by the Credit (inclusive of Taxes)

(1) Goods, Non-Consulting Services, Consultants' Services, Operating Costs, Workshops and Training for the Project

24,600,000 26,900,000 100%

(2) Payment to Community Health Workers under Component 2 of the Project

1,500,000 0 Marked for deletion

(3) Unallocated

800,000 0 Marked for deletion


TOTAL AMOUNT

26,900,000 26,900,00

As concerns the reallocation within components, there is a reallocation from Component 3 to Component 2 and to component 1 to take care of the high cost for the purchase of the medicines for SMC through CAMEG, and for the high cost of the seasonal Malaria chemoprevention and NTD campaigns. The breakdown of the reallocation by components is provided in Annex 1.

NIGER

A reallocation of the proceeds from Category 3 (Unallocated) and 2 (Payments to Community Health Workers under Component 2 of the project) to Category 1 (Goods, Non-Consulting Services, Consultants’ Services, Operating Costs, Workshops, and Training) of the financing agreement is requested to fill the funding gap created by an underestimation of the costs of the drugs purchased through CAMEG for seasonal malaria chemoprophylaxis as well as the high costs associated with the chemoprevention campaigns for seasonal malaria and an underestimation of the allocated amount dedicated to national coordination and institutional capacity building activities. The reallocation from Category 2 to Category 1 is proposed because Niger has introduced a request not to use Category funding to hire an agency or NGO to carry out payments to Community Health Workers (see rationale under the proposed Change of Legal Covenant below).

The revised table is proposed below:

REVISED EXPENDITURE CATEGORIES (NIGER)





24,600,000 26,900,000 100%



(3) Unallocated 1,150,000 0 Marked for deletion


TOTAL AMOUNT 26,900,000 26,900,00

As concerns the reallocation within components, there is a reallocation of funds from components 2 to component 1 to take care of the high cost for the purchase of the medicines for SMC through CAMEG. Even though there is this reallocation from component 2, there is an increase noted for seasonal malaria chemoprevention and NTD campaigns within the component. The total amount allocated to component 3 does not change though there is an intra- reallocation of $500,000 from monitoring and evaluation sub-component to the national coordination sub-component. The breakdown of the reallocation by components is provided in Annex 2.

MALI

A reallocation of the proceeds from Category 3 (Unallocated) and 2 (Payments to Community Health Workers under Component 2 of the project) to Category 1 (Goods, Non-Consulting Services, Consultants’ Services, Operating Costs, Workshops, and Training) of the financing agreement is requested to fill the funding gap created by an underestimation of the costs of the drugs purchased through CAMEG for seasonal malaria chemoprevention as well as high costs associated with the chemoprevention campaigns for seasonal malaria and underestimation of the costs associated with the monitoring and evaluation. The reallocation from Category 2 to Category 1 is proposed because Mali has introduced a request not to use Category funding to hire an agency or an NGO to carry out payments to Community Health Workers (see rationale under the proposed Change of Legal Covenant below). The revised table is proposed below:

REVISED EXPENDITURE CATEGORIES (MALI)





24,300,000 26,400,000 100%



(3) Unallocated 1,050,000 0 Marked for deletion


TOTAL AMOUNT 26,400,000 26,400,00

As concerns the components, funds have been reallocated from component 2 and allocated to components 1 to cater for the increase in the cost of procuring the SMC medicines through CAMEG, and to component 3 for monitoring and evaluation. Even though funds have been reallocated away from component two to components 1 and 3, there is a noticeable increase in the resources allocated for seasonal malaria chemotherapy campaigns in component 2. The breakdown of the reallocation by components is provided in Annex 3.

WEST AFRICAN HEALTH ORGANISATION (WAHO)

The financing agreement signed by WAHO includes a single category 1 “Goods, Non-Consulting Services, Consultants' Services, Operating Costs, Workshops and Training for the Project" for an amount of 7,300,000 SDR or US$10,000,000, hence no reallocation between expenditure categories.

REVISED EXPENDITURE CATEGORIES (WAHO)

Category Amount of the Credit Allocated (expressed in

SDR)

Revised amount of the Credit

Allocated (expressed in

SDR)

Percentage of Expenditures to be Financed by the Credit

(inclusive of Taxes)

(1) Goods, Non-Consulting Services, Consultants’ Services, Operating Costs, Workshops and Training for the Project

7,300,000 7,300,000 100%

TOTAL AMOUNT 7,300,000 7,300,000

Annex 4 shows the reallocation breakdown between the different components and sub-components for WAHO. Considering the progress made in implementation of the Project and the mixed or little progress made with some of the planned interventions, there will be some changes in activities and costs in sub-component 1.2, which will result in a budget for the sub-component which is revised downwards. This is expected to speed up disbursement and achievement of the PDO. The proposed changes (project description and reallocation amongst components) will be reflected in an amendment to the Grant Agreement. The rationale for the proposed changes includes the following:


Subcomponent 1.1. Establishment of a regional committee and cross-border committees: The budget has been increased to cover the costs of country coordination and support activities by WAHO (RSC, cross-border meetings, annual planning...) related to the one-year extension period of the project;

Sub-component 1.2. Regional research: The budget has been revised downwards in view of the limited time remaining for the implementation of the project and the fact that only 4 research protocols on priority themes could be developed (the results of which would be used for the implementation of the national programmes) before the end of the project for an estimated cost of US$ 2 900 000.

Considering the above, the following sentence outlined in the PAD under sub-component 1.2 “Regional networks for monitoring and evaluation and regional research, including drug and insecticide resistance monitoring will be established or strengthened to increase the usefulness (timeliness, simplicity and reliability) of the information generated by country monitoring and surveillance systems” should read as “Regional networks for monitoring and evaluation and regional research will be established or strengthened to increase the usefulness (timeliness, simplicity and reliability) of the information generated by country monitoring and surveillance systems”. The reference to “drug and insecticide resistance” is no longer pertinent in the design and implementation of this sub-component.

Sub-component 2.1. National coordination and institutional strengthening: The budget has been increased to cover the additional administrative and management costs arising from the one-year extension of the project proposed by the countries;

Sub-component 2.2. Monitoring and evaluation: The budget has been reduced in view of the activities to be carried out and their costs, as well as the fact that we have included surveys and coverage evaluation in sub-component 1.2. “Regional research" to ensure there is implementation of project monitoring and evaluation activities related to the one-year extension of the project proposed by the countries.

(2) CHANGES IN THE RESULTS FRAMEWORK

The Project Development Objectives (PDO) will not change. Three PDO indictors will be revised. The first of these three indicators will be revised to include the establishment of the baseline that was missing for the PDO indicator (i.e. indicator “Children under five years old with fever in last two weeks who had a finger or heel stick (for malaria diagnosis) in the targeted di stricts” should read as “Children under five years old with fever in last two weeks and were diagnosed with malaria by Microscopy or Rapid Screening Test or who had a finger or heel stick (for malaria diagnosis) in the targeted districts” using data from the DHS for the baseline. The target values for the last two years of the project for the second indicator, “Border districts that initiate SMC campaigns within two weeks of planned time line”, will be revised upwards to 90%. The last of the three PDO indicators, “Project beneficiaries, of which female”, will be revised to show separate beneficiaries and female percentages for NTD and SMC. The remaining two PDO indicators stays unchanged. As for the nine intermediate indicators (IO), the target values of the last two years of the project for two indicators will be changed; one indicator will have its


target value revised and the way it is calculated has been revised, and one where the way the calculation of the indicator is made has been revised. Three (3) IO indicators will remain unchanged. In addition, two new IOs indicators: “Number of Trichiasis Trachomatous cases operated” and “Number of people with hydrocele operated” were added, and their baseline and target values, bringing the total IO to eleven (11). The data source for these indicators will be monthly reports from the health facilities, and quarterly supervision reports. All the end target dates of the PDO and Intermediate objective indicators will be adjusted to reflect the revised closing date of December 31, 2020. The details of the proposed changes are presented in Annexes 5 and 6.

(3) REVISION OF LEGAL COVENANT ABOUT PAYMENT OF COMMUNITY HEALTH WORKERS (CHW)

One of the agreed legal covenants is to enter into an agreement with an acceptable Service Provider to carry out payments of Community Health Workers (CHW). Burkina Faso, Mali and Niger accommodated the legal requirement to hire a Service Provider but encountered difficulties in finding suitable Service Providers to carry out the required tasks. In addition, the countries contended that hiring a Service Provider will significantly disrupt the existing payment systems followed by the other development partners such as HKI, UNICEF, PSI, etc. These systems use Community Health Workers (CHW)/ Relays / Drug Distributors and their payments are handled by the Technical Directors of the Community Health Centers. This payment is made with a remittance slip. After the campaigns, the Technical Director of the health centers provide receipt signed by each CHW/Relay / Drug Distributor as justification of payment. This payment receipts are also signed by the Technical Directors, the Chief Medical Officers and the District Accountants. This process has been in place for a long time and is working well. The Task Team, therefore, supports the request to maintain the existing system of payment of CHW/Relays/Drug Distributors. In addition to maintaining the existing system, the Task Team discussed and agreed with the countries that additional checks and balances that include conducting mandatory financial supervision after each campaign and ensuring that a financial report is produced with proof of payment; conducting periodic internal control and external financial audits with the support of the Project’s Financial Management Specialist; amending the Project’s Operations Manual (POM), if necessary, to include the details of the payment mechanism and the required supporting financial documentation by the auditor (i.e. vouchers, receipts etc.); and finally, training the accountants on the amended procedures contained in the Operations manual.

(4) CHANGE IN THE LOAN (PROJECT) CLOSING DATE

An extension of the closing date from December 31, 2019 to December 31, 2020 has been proposed. The rationale for this extension rests on (i) The political instability in some country (Mali) that delayed the establishment of the Project Coordination Unit; (ii) The political crisis and insecurity in project countries that resulted in delay in effectiveness; (iii) The lack of familiarity with Bank Fiduciary requirements; (iv) Delay in obtaining NO objection for the award of contracts; (v) the long procurement processes in the countries; (vi) The long process


for the development of research protocols with research institutions; and (vii) The delay in conducting the Lot Quality Assurance Sampling (LQAS) surveys in Burkina Faso and Niger.

The extension will be necessary (i) to allow the remaining planned activities under components 1, 2 and 3 to be finalized (i.e. SMC and NTD treatment campaigns, treatment of reversible NTD complications; research studies, LQAS surveys, etc.), and (ii) to disseminate project outcomes including lessons learned among stakeholders.

During the last project support mission, countries indicated that there has been substantial improvement in the political situation in the countries, and that the procurement processes have been improved. Countries have provided revised action plans and disbursement schedules to ensure that the remaining activities will be finalized within the requested extension period to achieve the intended development objectives of the projects.

III. SUMMARY OF CHANGES

Changed Not Changed

Change in Results Framework ✔

Change in Components and Cost ✔

Change in Loan Closing Date(s) ✔

Reallocation between Disbursement Categories ✔

Change in Disbursement Estimates ✔

Change in Legal Covenants ✔

Change in Implementing Agency ✔

Change in DDO Status ✔

Change in Project's Development Objectives ✔

Cancellations Proposed ✔

Change in Disbursements Arrangements ✔

Change in Overall Risk Rating ✔

Change in Safeguard Policies Triggered ✔

Change of EA category ✔

Change in Institutional Arrangements ✔

Change in Financial Management ✔

Change in Procurement ✔

Change in Implementation Schedule ✔


Other Change(s) ✔

Change in Economic and Financial Analysis ✔

Change in Technical Analysis ✔

Change in Social Analysis ✔

Change in Environmental Analysis ✔

IV. DETAILED CHANGE(S)

OPS_DETAILEDCHANGES_RESULTS_TABLE

RESULTS FRAMEWORK

Project Development Objective Indicators PDO_IND_TABLE

Target districts with at least 70%coverage of 3 or more courses of SMC for children under five years oldUnit of Measure: PercentageIndicator Type: Custom

Baseline Actual (Current) End Target Action

Value 0.00 100.00 50.00 Revised

Date 25-Mar-2015 31-Dec-2017 31-Dec-2020

Children under five years old with fever in last two weeks who had a finger or heel stick (for malaria diagnosis) in the targeted di strictsUnit of Measure: PercentageIndicator Type: Custom


Value 0.00 0.00 80.00 Revised

Date 25-Mar-2015 31-Dec-2017 31-Dec-2020

Targeted districts providing integrated annual treatment for schistosomiasis and STH for school aged children 5-14 yearsUnit of Measure: PercentageIndicator Type: Custom


Value 0.00 100.00 80.00 Revised

Date 26-Mar-2015 31-Dec-2017 31-Dec-2020

Border districts that initiate SMC campaigns within two weeks of planned time lineUnit of Measure: PercentageIndicator Type: Custom




Date 25-Mar-2015 31-Dec-2017 31-Dec-2020

Direct project beneficiariesUnit of Measure: NumberIndicator Type: Custom


Value 0.00 26078318.00 21078000.00 Revised

Date 25-Mar-2015 31-Dec-2017 15-Dec-2019

Female beneficiariesUnit of Measure: PercentageIndicator Type: Custom Supplement



Intermediate IndicatorsIO_IND_TABLE

Extent to which the members report that their regional collaboration has harmonized defined aspects of malaria and NTD program management (average rating)Unit of Measure: TextIndicator Type: Custom


Value undeveloped Highly developed. highly developed Revised

Date 25-Mar-2015 31-Dec-2017 31-Dec-2020

Countries that provide their procurement plans on time to the regional purchasing agency (number)Unit of Measure: NumberIndicator Type: Custom




Date 25-Mar-2015 31-Dec-2017 31-Dec-2020

Children under five years receiving at least 3 courses of SMC compared to the targeted number (percent)Unit of Measure: PercentageIndicator Type: Custom



Date 25-Mar-2015 31-Dec-2017 31-Dec-2020

Coverage of preventive chemotherapy achieved by project campaigns among eligible population in the targeted districts (percent)Unit of Measure: PercentageIndicator Type: Custom



Date 25-Mar-2015 31-Dec-2017 31-Dec-2020

Districts with local leaders participating in the planning of campaigns (percent)Unit of Measure: PercentageIndicator Type: Custom


Value 0.00 100.00 75.00 Revised

Date 25-Mar-2015 31-Dec-2017 31-Dec-2020

Community health agents who have received a quarterly supervision visit during which registers or reports were reviewed (percent)Unit of Measure: PercentageIndicator Type: Custom


Value 40.00 100.00 70.00 Revised

Date 25-Mar-2015 31-Dec-2017 31-Dec-2020

Countries with new/revised standards/guidelines for recruitment and retention of community-based health agent/distributer volunteers (number)Unit of Measure: NumberIndicator Type: Custom




Date 25-Mar-2015 31-Dec-2017 31-Dec-2020

Completeness of target district reporting on SMC and PC-NTD distribution (%)Unit of Measure: PercentageIndicator Type: Custom


Value 0.00 100.00 100.00 Revised

Date 25-Mar-2015 31-Dec-2017 31-Dec-2020

Results of learning/evaluation from the project implementation are re-incorporated into the project plan annually (Y/N)Unit of Measure: TextIndicator Type: Custom


Value N Y Y Revised

Date 25-Mar-2015 31-Dec-2017 31-Dec-2020

Number of Trichiasis Trachomatous cases operatedUnit of Measure: NumberIndicator Type: Custom


Value 9271.00 8493.00 2500.00 New

Date 31-May-2017 30-May-2018 31-Dec-2020

Number of people with hydrocele operatedUnit of Measure: NumberIndicator Type: Custom


Value 1792.00 2650.00 4200.00 New

Date 31-May-2017 30-May-2018 31-Dec-2020


OPS_DETAILEDCHANGES_COMPONENTS_TABLE

COMPONENTS

Current Component Name

Current Cost

(US$M)Action Proposed

Component NameProposed

Cost (US$M)

Component 1: Improve regional collaboration for stronger results across participating countries

26.50 Revised


30.70

Component 2: Support coordinated implementation of technical strategies and interventions

74.10 Revised

Component 2: Support coordinated implementation of technical strategies and interventions

73.70

Component 3: Strengthen institutional capacity to coordinate and monitor implementation

20.40 Revised


16.60

TOTAL 121.00 121.00

OPS_DETAILEDCHANGES_LOANCLOSING_TABLE

LOAN CLOSING DATE(S)

Ln/Cr/Tf StatusOriginal Closing

Revised Closing(s)

Proposed Closing

Proposed Deadline for Withdrawal

Applications

IDA-56670 Effective 31-Dec-2019 31-Dec-2020 30-Apr-2021



IDA-D0710 Effective 31-Dec-2019 31-Dec-2020 30-Apr-2021

OPS_DETAILEDCHANGES_REALLOCATION _TABLE

REALLOCATION BETWEEN DISBURSEMENT CATEGORIES

Current Allocation Actuals + Committed Proposed Allocation Financing %(Type Total)

Current Proposed

IDA-56670-001 | Currency: XDR

iLap Category Sequence No: 1 Current Expenditure Category: GD, NCS, CS, OC, WKSHP, TR


24,300,000.00 9,665,443.23 26,400,000.00 100.00 100.00

iLap Category Sequence No: 2 Current Expenditure Category: PAYMENT COMMUN. HLTH WORKERS COMP 2

1,050,000.00 0.00 0.00 100.00 0

iLap Category Sequence No: 3 Current Expenditure Category: UNALLOCATED

1,050,000.00 0.00 0.00

Total 26,400,000.00 9,665,443.23 26,400,000.00



24,600,000.00 11,682,852.54 26,900,000.00 100.00 100.00


1,500,000.00 0.00 0.00 100.00 0


800,000.00 0.00 0.00

Total 26,900,000.00 11,682,852.54 26,900,000.00



24,600,000.00 8,390,295.75 26,900,000.00 100.00 100.00


1,150,000.00 0.00 0.00 100.00 0.00



1,150,000.00 0.00 0.00

Total 26,900,000.00 8,390,295.75 26,900,000.00

IDA-D0710-001 | Currency: XDR


7,300,000.00 1,357,833.97 7,300,000.00 100.00 100.00

Total 7,300,000.00 1,357,833.97 7,300,000.00

OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE

DISBURSEMENT ESTIMATES

Change in Disbursement EstimatesYes

Year Current Proposed

2016 25,200,000.00 25,200,000.00

2017 40,000,000.00 40,000,000.00

2018 40,000,000.00 29,000,000.00

2019 11,000,000.00 10,000,000.00

2020 5,000,000.00 9,800,000.00

2021 0.00 7,000,000.00

OPS_DETAILEDCHANGES_LEGCOV_TABLE

LEGAL COVENANTS

Loan/Credit/TF Description Status Action

IDA-D0710

Finance Agreement :WAHO - Recruitment of an external auditor acceptable to IDA | Description :On or before six months after the Effective Date, the Recipient shall hire an external auditor, with terms of reference,

Complied with No Change


experience and skills acceptable to the Association. | Due Date :03- November-2016

IDA-D0710

Finance Agreement :WAHO - Conventions for Technical Assistance | Description :The Project Implementing Entity shall enter into, no later than three months after the Effective Date, and thereafter maintain, agreements between the Project Implementing Entity and the Participating Countries with terms and conditions approved by the Association, as further described in the Project Operations Manual. | Due Date :03-August-2016


IDA-D0710

Finance Agreement :WAHO – Representative at the Regional Steering Committee | Description :WAHO shall establish not later than two months after the Effective Date and thereafter maintain throughout the period of Project implementation its representative in the Regional Steering Committee to provide overall regional guidance and oversight for the Project and to participate in the regular meetings. | Due Date :03-July-2016


IDA-D0710

Finance Agreement :ALL COUNTRIES - Sign agreement with WHO/AFRO | Description :The Recipient shall, no later than one month after the Effective Date, make part of the proceeds of the Financing allocated from time to time to Category (1) of the table set forth in Section IV.A.2 of this Schedule available to WHO/AFRO under an agreement between the Recipient and WHO/AFRO with terms and conditions approved by the Association. | Due Date :30-May-2018


IDA-56670

Finance Agreement :ALL COUNTRIES - Sign cooperation agreement with CAMEG | Description :The Recipient shall, no later than one month after the Effective Date, make part of the proceeds of the Financing allocated from time to time to Category (1) of the table set forth in Section IV.A.2 of this Schedule available to CAMEG a under cooperation agreement between the Recipient and CAMEG, respectively with terms and conditions approved by the Association. | Due Date :04-March-2016



IDA-56680

Finance Agreement :ALL COUNTRIES - Sign service agreement for payment of Community Health Workers | Description :The Recipient shall enter into, no later than six months after the Effective Date, and thereafter maintain an agreement with an adequate Service Provider to carry out Payments to Community Health Workers with terms and conditions approved by the Association | Due Date :30-May-2018

Partially complied with

Marked for Deletion

IDA-D0710

Finance Agreement :WAHO- Adoption of Project Operations Manual | Description :The Project Implementing Entity shall adopt no later than one month after the Effective Date the Project Operations Manual in form and substance satisfactory to the Association. Due Date :04-March-2016



ANNEX 1 - Burkina Faso - Reallocation of Proceeds by Components (US$)

Components and sub- components Initial Budget

Reallocated amount

Revised amount Revised Budget

Component 1: Improve Regional Collaboration for Stronger Results Across Participating Countries

8 000 000 - 1 000 000 2 255 000 9 255 000

1.1: Regional technical committee 1.2: Technical Assistance 2 000 000 - 1 000 000 1 000 000 1.3: Regional Monitoring and Evaluation networks -

1.4: Regional pooled drugs procurement 6 000 000 2 255 000 8 255 000

Component 2: Support Coordinated Implementation of Technical Strategies and Interventions

23 200 000 - 5 153 000 6 700 000 24 747 000

2.1. Community mobilization and intensive information, education and communication campaigns

1 400 000 - 13 000 1 387 000

2.2. Seasonal malaria chemoprevention 8 200 000 2 100 000 10 300 0002.3. Community-based diagnosis and treatment of malaria 7 100 000 - 4 440 000 2 660 000

2.4. Integrated treatment of neglected tropical diseases (NTDs) 3 800 000 4 600 000 8 400 000

2.5. Treatment of the reversible consequences of NTDs 2 700 000 - 700 000 2 000 000

Component 3 : Renforcement des capacités pour coordonner et suivre la mise en œuvre

5 800 000 - 2 802 000 - 2 998 000

3.1. National Coordination and institutional strengthening 3 300 000 - 1 920 000 1 380 000

3.2: Monitoring and Evaluation 2 500 000 - 882 000 1 618 000TOTAL 37 000 000 - 8 955 000 8 955 000 37 000 000


ANNEX 2: Niger - Reallocation of Proceeds by Components (US$)

Project Components and sub-components Initial Budget (USD)

Reallocated amount

Revised amount

Revised Budget

Component 1: Improve Regional Collaboration for Stronger Results Across Participating Countries1.1. Establishing Regional Committee and cross-

border committees0 0 0 0

1.2. Technical Assistance 2 000 000 -1 000 000 0 1 000 000

1.3. Regional pooled drugs procurement 2 800 000 0 1 700 000 4 500 000

S/Total 1 4 800 000 -1 000 000 1 700 000 5 500 000

Component 2: Support Coordinated Implementation of Technical Strategies and Interventions2.1. Community mobilization and intensive information, education and communication campaigns

3 300 000 -1 000 000 0 2 300 000

2.2. Seasonal malaria chemoprevention 8 500 000 0 2 500 000 11 000 000

2.3. Community-based diagnosis and treatment of malaria

3 200 000 -200 000 0 3 000 000

2.4. Integrated treatment of neglected tropical diseases (NTDs)

7 800 000 0 1 000 000 8 800 000

2.5. Treatment of the reversible consequences of NTDs

5 300 000 -3 000 000 0 2 300 000

S/Total 2 28 100 000 -4 200 000 3 500 000 27 400 000

Component 3: Strengthen Institutional Capacity to Coordinate and Monitor Implementation3.1. National Coordination and institutional strengthening

1 700 000 0 500 000 2 200 000

3.2. Monitoring and Evaluation 2 400 000 -500 000 0 1 900 000

S/Total 3 4 100 000 -500 000 500 000 4 100 000

TOTAL 37 000 000 5 700 000 5 700 000 37 000 000


ANNEX 3: Mali - Reallocation of Proceeds by Components (US$)

Revised amount Components and Activities

Allocated amount (USD) (USD)

Difference


1.1. Regional pooled drugs procurement 5,000,000 8,779,000 +3,779,000

1.2. Technical Assistance 2,000,000 365,400 -1,634,600

Total Component 1 7,000,000 9,144,400 +2,144,400Component 2: Support Coordinated Implementation of Technical Strategies and Interventions2.1. Community mobilization and intensive information, education and communication campaigns

2,000,000 1,478,600 -521,400

2.2. Seasonal malaria chemoprevention 3,600,000 8,725,000 +5,125,000

2.3. Community-based diagnosis and treatment of malaria 8,900,000 5,231,000 -3,669,000

2.4. Integrated treatment of neglected tropical diseases (NTDs) 4,700,000 3,501,000 -1,199,000

2.5. Treatment of the reversible consequences of NTDs 3,600,000 2,661,000 -939,000

Total Component 2 22,800,000 21,596,600 -1,203,400

Component 3 : Renforcement des capacités pour coordonner et suivre la mise en œuvre

3.1. National Coordination and institutional strengthening 5,500,000 4,550,000 -950,000

3.2. Monitoring and Evaluation 1,700,000 1,709,000 +9,000Total Component 3 7,200,000 6,259,000 -941,000TOTAL 37,000,000 37,000,000 0


ANNEX 4: WAHO - Reallocation of Proceeds by Components (US$)

Component and sub-components Initial AmountDisbursed as of March 31, 2018

Available budget as of March 31, 2018 including commitments

Revised Amount


6 700 000,00 1 482 576,49 5 217 423,51 6 775 836,49

1.1. Establishing Regional Committee and cross-border committees

2 700 000,00 1 410 714,57 1 289 285,43 3 803 974,57

1.2. Regional Research4 000 000,00 71 861,92 3 928 138,08 2 971 861,92

1.3. Regional pooled drugs procurement

- - -

Component 2: Strengthen Institutional Capacity to Coordinate and Monitor Implementation

3 300 000,00 908 663,95 2 391 336,05 3 224 163,95

2.1. National coordination and institutional strengthening

1 600 000,00 788 485,06 811 514,94 2 478 985,06

2.2. Monitoring and Evaluation 1 700 000,00 120 178,89 1 579 821,11 745 178,89

TOTAL 10 000 000,00 2 391 240,44 7 608 759,56 10 000 000


ANNEX 5: REVISED RESULTS FRAMEWORKResults Framework

Project Development ObjectivesPDO StatementThe objective of the Project is to increase access to and use of harmonized community-level services for the prevention and treatment of malaria and selected neglected tropical diseases in targeted cross-borders areas in Participating Countries in the Sahel region. 1

Project Development Objective Indicators

R=ReviseU = UnchangedD = Deleted Target Values

Indicator Name Core

Unit of Measure

Country/regional

Baseline YR1 YR2 YR3 YR4 YR5

Frequency

Data Source/

Methodology

Responsibility for

Data Collectio

nRegional 0 20 40 50 50 50Burkina Faso 0 20 40 50 50 50

U Mali 0 20 40 50 50 50

(i) Target districts2 with at least 70% coverage of 3 or more courses of SMC for children under five years old

Percent

Niger 0 20 40 50 50 50

Annual District reports LQAS

PNLP in each country

Regional 25 NA NA NA 65 80R Burkina Faso 40

(DHS 2014)

NA NA NA 65 80

Mali 15.1 (MICS 2016)

NA NA NA 65 80

(ii) Children under five years old with fever in last two weeks before survey who were diagnosed with malaria by Microscopy or Rapid Screening Test or who had a finger or heel stick (for malaria diagnosis) in the targeted districts3

Percent

Niger 14 (DHS 2012)

NA NA NA 65 80

Every 2 years

Malaria reportingLQAS


Regional 25 50 70 80 80U Burkina Faso 25 50 70 80 80

Mali 25 50 70 80 80

(iii) Targeted districts providing integrated annual treatment for schistosomiasis and STH for school aged children 5-14 years

Percent

Niger 25 50 70 80 80

Annual District reports, Campaign reports

NTD program in each country

(iv) Border districts that initiate SMC campaigns within two weeks of planned time line

R Percent Regional 0 40 50 70 90 90 Annual Campaign reports plans

WAHO with regional

1 A list of target districts in each country will be compiled for each country for monitoring purposes. Baselines are often zero given the Project interventions are yet to be implemented in the border areas. The Project will review experiences of districts that have piloted the drugs where there is already experiencing to ensure targets are realistic and sufficiently ambitious.2 Indicators will be disaggregated by country where relevant; regional indicators will be reports at the regional level.3 The baseline is the percentage of children who had fever two weeks before the survey


committee

Regional SMC2910343 3387841 4016849

R

Regional NTD

0 734,900 1,470,090

23167975 17928873 17061151

Annual District reports

MOH in each country

Burkina Faso SMC

1261430 1239874 1313386

Burkina Faso NTD

0 270,900 541,800

5358733 3209972 2050242

Mali SMC 1202792 1635797 2224685Mali NTD

0 204,200 408,500 3853921 4458664 6063782

Niger SMC 446121 462170 478778

(v) Project beneficiaries, of which female4

Number (percent)

Niger NTD0 259,800 519,7

00 13955321 10260237 8947127

Target Values Data Collection and Reporting

Intermediate

Outcome Indicators Country/regional

R=ReviseU = Unchanged

D = Deleted Baseline 2016 2017 2018 2019 2020

Frequency and

reports

Data Collection

Instruments

Responsibility for Data

CollectionExtent to which the members report that their regional collaboration has harmonized defined aspects of malaria and NTD program management (average rating) 5

Regional U Undeveloped Largely undeveloped

Developed Developed Highly developed

Highly developed

Annual Member survey, regional reports

WAHO with regional committee

Component 1: Improved regional collaboration Results of

learning/evaluation from the project implementation are re-incorporated into the project plan annually (Y/N)

Regional U N N Y Y Y Y Annual Review of project plans


4 Project beneficiaries include only those persons who receive a service provided by the project and does not include caregivers. Beneficiaries of SMC interventions for malaria are children 3-59 months of age; beneficiaries of community based diagnosis and treatment of malaria include people (all age groups) who are tested for suspected malaria; beneficiaries of NTD treatment/drugs for schistosomiasis are school age children and other high risk groups; beneficiaries of treatment for STH are school age children in targeted districts; beneficiaries of treatments for trachoma, LF and onchocerciasis are total eligible populations in endemic districts.5 Aspects for harmonization include policies and guidelines for community services; training and skill building; monitoring and data collection tools; and research and surveillance.


Countries that provide their procurement plans on time to the regional purchasing agency (number)

Regional U 0 3 3 3 3 3 Annual Regional reports


Regional C 0 20 40 50 80 80Burkina Faso C 0 20 40 50 80 80Mali C 0 20 40 50 80 80

Children under five years receiving at least 3 courses of SMC compared to the targeted number (percent)

Niger C 0 20 40 50 80 80

Annual District reportsLQAS


Regional C 0 40 60 70 80 80

Burkina Faso C 0 40 60 70 80 80

Mali C 0 40 60 70 80 80

Coverage of preventive chemotherapy achieved by project campaigns among eligible populations in the targeted districts (percent)-- disaggregated for onchocerciasis, schistosomiasis, STH, LF, and trachoma

Niger C 0 40 60 70 80 80


NTD programs in 3 countries

Regional U 0 40 70 75 75 75Burkina Faso U 0 40 70 75 75 75Mali U 0 40 70 75 75 75

Districts with local leaders participating in the planning of community campaigns (percent) Niger U 0 40 70 75 75 75

Annual Campaign reports

WAHO with regional committees

Regional C 40 50 60 70 70Burkina Faso C 40 50 60 70 70Mali C 40 50 60 70 70

Community health agents who have received a quarterly supervision visit during which registers or reports were reviewed (percent)6

Niger C 40 50 60 70 70


MOH in 3 countries

Régional N NA NA 9271 8493 2800 2500Burkina Faso N NA NA 136 600 800 500Mali N NA NA 1694 5893 0 0

Number of Trichiasis Trachomatous cases operated

Niger N NA NA 7441 2000 2000 2000

Annual District reports of the number of TT Cases

NTD Programs in 3 countries

Régional N NA NA 1792 2650 6100 4200Burkina Faso N NA NA 1256 1500 900 900Mali N NA NA 136 150 200 300

Component 2: Improved service delivery

Number of people with hydrocele operated

Niger N NA NA400 1000 5000 3000

Annual District reports on the number of hydrocele cases

NTD Programs in 3 countries

6 The focus is specifically on health agents distributing the malaria and NTD services of the Project, which are being newly scaled-up.


Countries with new/revised standards/guidelines for recruitment and retention of community-based health agent/distributer volunteers (number)

Regional U 0 0 3 3 3 3 Annual MOH reports


Regional C 0 40 70 80 100 100Burkina Faso C 0 40 70 80 100 100Mali C 0 40 70 80 100 100

Component 3: Capacity strengthening

Completeness of target district reporting on SMC and PC-NTD distribution (%)

Niger C 0 40 70 80 100 100

Annual MOH reports

MOH in each country

Table 1: Definition and Interpretation of PDO and Intermediate IndicatorsIndicator Name Description (Definition etc.)PDO indicatorsPercent of target districts with at least 70% coverage of 3 or more courses of SMC for children under five years old

Numerator: Number of target districts where at least 70% of children <5 years old received at least 3 courses of SMC. Denominator: Total number of districts targeted for SMC distribution among children <5 in the same year. *100 for percentage. This indicator provides information on coverage of SMC interventions for malaria in targeted districts.

Percent of children under five years old with fever in last two weeks who had a finger or heel stick (for malaria diagnosis) in the targeted districts

Numerator: Number of children <5 years old with fever in the previous two weeks who had a finger/heel stick. Denominator: Total number of children under five years old who had a fever in the previous two weeks. *100 for percentage. This indicator provides a proxy measure of the level of access of children under five years old to diagnostic testing for malaria infection. This is a malaria core indicator.

Percent of targeted districts providing integrated annual treatment for schistosomiasis and STH for school aged children 5-14 years

Numerator: Number of districts providing integrated annual treatment for schistosomiasis and STH for school aged children 5-14 years. Denominator: Total number of districts targeted for NTD treatment distribution in the same year. *100 for percentage. This indicator provides information on coverage of integrated NTD treatment among school children in targeted districts.

Percent of border districts that initiate SMC campaigns within two weeks of planned time line

Numerator: Number of health districts that initiate SMC Campaign within two weeks of planned time line Denominator: Total number of health districts that initiate SMC campaign during the same period *100 for percentage. The indicator provides information on the coordinated timing of SMC delivery, which is critical for impact on malaria.

Project beneficiaries, (%) of which female Direct project beneficiaries are people or groups who directly derive benefits from a project intervention (including children <5 receiving SMC, persons receiving NTD treatments or surgical interventions, persons reached by community heath agents). The definition of direct project beneficiaries is a number, specifying what percentage of the beneficiaries are female. This is a mandatory core indicator.

Component 1: Improve regional collaboration for stronger results across participating countriesExtent to which the members report that their regional collaboration has harmonized defined aspects of malaria and NTD program management (average rating)

Numerator: Sum of ratings provided by members of the coordination committees on a five-point scale: (5) Very highly developed, (4) highly developed, (3) developed, (2) largely undeveloped, (1) undeveloped, when they are asked about the extent that their regional collaboration has developed harmonization of key aspects of the community-based service delivery, including policies and guidelines for community services, training and skill building, monitoring and data collection tools, and research and surveillance. Denominator: Total number of members from the regional coordination/implementation committees that are surveyed.Verified by review of documentation from regional activity reports.

Results of learning/evaluation from the project implementation are re-incorporated into the project plan annually (Y/N)

This is whether the results of learning/evaluation during the project implementation are re-incorporated into the project plan annually, such as findings/lessons from process evaluation, operational research and knowledge exchange. The indicator is Yes or No.

Countries that provide their procurement plans on time to the regional purchasing agency (number)

This is the number of countries that provide their annual procurement plan for SMC and other drugs/supplies included in the project by the set time line to the purchasing country. This output indicator provides information on the drug supply chain and possible delays in campaigns. This is a yes/no indicator for country level reporting.


Component 2: Support coordinated implementation of technical strategies and interventionsChildren under five years receiving at least 3 courses of SMC compared to the targeted number (percent)

Numerator: Number of children <5 that received at least 3 courses SMCs. Denominator: Total number of children targeted during the same one year reporting period. *100 for percentage. The indicator provides information on annual progress on planned SMC interventions.

Coverage of preventive chemotherapy achieved by project campaigns among eligible population in the targeted districts (percent)-- disaggregated for onchocerciasis, schistosomiasis, STH, LF, and trachoma

Numerator: Number of eligible population who received preventive chemotherapy for the NTD in the project’s target districts in the reporting year. Denominator: Total number of eligible population in the same targeted districts in the same one year reporting time frame. *100 for percentage. The indicator provides information on NTD coverage in the target districts. This is a core indicator used for NTDs. It will be disaggregated for the 5 PC-NTDS addressed by the project.

Districts with local leaders participating in the planning of campaigns (percent)

Numerator: Number of districts where local leaders participated in the planning of the malaria and or NTD campaigns. Denominator: Number of districts targeted in the same reporting time period. *100 for percentage. The indicator provides information on citizen engagement.

Community health agents who have received a quarterly supervision visit during which registers or reports were reviewed (percent)

Numerator: Number of Community health agents who have received a quarterly supervision during which registers or reports were reviewed. Denominator: Total number of Community health agents working in the district during the same period *100 for percentage. The indicator provides information on the quality of supervision.

Number of Trichiasis Trachomatous cases operated Number of Trichiasis Trachomatous cases operated in the Project target districts of the project during the year

Number of people with hydrocele operated Number of people operated for hydrocele in the Project target districts during the year

Component 3: Strengthen institutional capacity to coordinate and monitor implementationCountries with new/revised standards/guidelines for recruitment and retention of community-based health agent/distributer volunteers (number)

This is the number of countries in the project that adopt new/revised standards/guidelines for recruitment and retention of community-based health agent/distributer volunteer. This addresses a common bottleneck identified by the countries to project success.

Completeness of target district reporting on SMC and PC-NTD distribution (percent)

Numerator: Number of SMC and MDA/NTD reports transmitted by the targeted health districts . Denominator: Total number of SMC and MDA/NTD reports expected from the health Districts surveillance Team .


Annex 6:

P149526: Sahel malaria and Neglected Tropical Diseases Project

Revised Results framework

Comments/Rationale for Change

Project Development Objectives (PDO)Current PDO (PAD) Proposed

The objective of the project is to increase access to and use of harmonized community-level services for the prevention and treatment of malaria and selected neglected tropical diseases in targeted cross-borders areas in Participating Countries in the Sahel region.

Project has three components: 1) Improve regional collaboration for stronger results across participating countries, 2) Support coordinated implementation of technical strategies and interventions, and 3) Strengthen institutional capacity to coordinate and monitor implementation.

The PDO is unchanged

Sub-component 1.2 will change The following sentence

outlined in the PAD under sub-component 1.2, “Regional networks for monitoring and evaluation and regional research, including drug and insecticide resistance monitoring will be established or strengthened to increase the usefulness (timeliness, simplicity and reliability) of the information generated by country monitoring and surveillance systems” should read as “Regional networks for monitoring and evaluation


and regional research will be established or strengthened to increase the usefulness (timeliness, simplicity and reliability) of the information generated by country monitoring and surveillance systems”. The reference to “drug and insecticide resistance” is no longer pertinent in the design and implementation of this sub-component.

PDO Indicators Proposed change1. Percent of target districts with at least 70 percent coverage of three or more courses of SMC for children under five years old.

Unchanged Target values

The end target date of the original PDO indicator will be adjusted to reflect the revised closing date of December 31, 2020. The targets values remain unchanged.

2. Children under five years old with fever in last two weeks who had a finger or heel stick (for malaria diagnosis) in the targeted districts

Revised Revised to read as follows: Percent of children under five years old with fever in last two weeks before the survey and were diagnosed with malaria by Microscopy or Rapid Screening Test; or who had a finger or heel stick (for malaria diagnosis) in the targeted districts.


Target values for the project years which were absent have been added based on extrapolation from DHS and MICS

3. Percent of targeted districts providing integrated annual treatment for schistosomiasis and STH for school-aged children 5-14 years.

Unchanged Target values

The end target date of the original PDO indicator will be adjusted to reflect the revised closing date of December 31, 2020. The targets values remain unchanged.

4. Percent of border districts that initiate SMC campaigns within two weeks of planned timeline

Revised The end target date of the original PDO indicator will be adjusted to reflect the revised closing date of December 31, 2020. The target values for the last two years have been increased based on existing data. The formula to calculate indicator has been changed to: Numerator: Number of health districts that initiate SMC Campaign within two weeks of planned timeline. Denominator: Total number of health districts that initiate SMC campaign during the same period *100.

5. Number of direct project beneficiaries,

Revised The end target date of the original PDO indicator will be adjusted to reflect the revised closing date of


percent of which female.

December 31, 2020. Separated into beneficiairies aggregated by neglected tropical diseases, and direct beneficiairies for SMC

Intermediate ObjectivesCurrent (PAD) Proposed

6. Extent to which the members report that their regional collaboration has harmonized defined aspects of malaria and NTD program management (average rating) 7

Unchanged The end target date of this original IO indicator will be adjusted to reflect the revised closing date of December 31, 2020. The targets values remain unchanged.

7. Results of learning/evaluation from the project implementation are re-incorporated into the project plan annually (Y/N)



8. Countries that provide their procurement plans on time to the regional purchasing agency (number)


Component 2: Support coordinated implementation of

9. Children under five years receiving at least 3 courses of SMC

Revised Initial target values of the last two years have been increased. The end target date

7 Aspects for harmonization include policies and guidelines for community services; training and skill building; monitoring and data collection tools; and research and surveillance.


compared to the targeted number (percent)

of this original IO indicator will be adjusted to reflect the revised closing date of December 31, 2020.

10. Coverage of preventive chemotherapy achieved by project campaigns among eligible populations in the targeted districts (percent)-- disaggregated for onchocerciasis, schistosomiasis, STH, LF, and trachoma

Revised Target values for the last two years of the project have been increased considering existing data.The end target date of this original IO indicator will be adjusted to reflect the revised closing date of December 31, 2020.

11. Districts with local leaders participating in the planning of community campaigns (percent)

Unchanged Target values have remained unchanged.The end target date of this original IO indicator will be adjusted to reflect the revised closing date of December 31, 2020.

technical strategies and interventions

12. Community health agents who have received a quarterly supervision visit during which registers or reports were reviewed (percent)8

Revised Maintain the initial target values but the way the indicator is calculated has been revised to: Numerator: Number of Community health agents who have received a quarterly supervision during which registers or reports were reviewed. Denominator:

8 The focus is specifically on health agents distributing the malaria and NTD services of the Project, which are being newly scaled-up.


Total number of Community health agents working in the district during the same period *100.The end target date of this original IO indicator will be adjusted to reflect the revised closing date of December 31, 2020.

13.Number of people operated with trichiasis

NEW This is an important intervention of the project that warants an indicator that is calculated as: Number of Trichiasis Trachomatous cases operated in the Project target districts of the project during the year.

14. Number of people operated for hydrocele

NEW This is an important intervention of the project that warants an indicator that is calculated as: Number of cases of hydrocele operated in the Project target districts during the year.

15. Countries with new/revised standards/guidelines for recruitment and retention of community-based health agent/distributer volunteers (number)

Unchanged The target values remain unchanged. The end target date of this original IO indicator will be adjusted to reflect the revised closing date of December 31, 2020.


16. Completeness of target district reporting

Revised The target value of the last two years have been increased and


on SMC and PC-NTD distribution (%)

the calculation of the indicator has been revised as: Numerator: Number of SMC and MDA/NTD reports transmitted by the targeted health districts. Denominator: Total number of SMC and MDA/NTD reports expected from the health Districts Surveillance Team. The end target date of this original IO indicator will be adjusted to reflect the revised closing date of December 31, 2020.

World Bank Documentdocuments.worldbank.org/curated/en/910771533322068806/pdf/Dis… · The World Bank Sahel Malaria and Neglected Tropical Diseases (P149526) The staffing, equipment,

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