TEMPLATE FOR SUBMISSION OF EPP TO RAPID RESPONSE …



Document of

The World Bank

FOR OFFICIAL USE ONLY

Report No. 43670-IQ

THE MINISTRY OF HEALTH OF THE KURDISTAN REGIONAL GOVERNMENT OF THE REPUBLIC OF IRAQ

PROPOSED TRUST FUND GRANT

IN THE AMOUNT OF US$8.7 MILLION

FOR A

REGIONAL HEALTH EMERGENCY RESPONSE PROJECT

EMERGENCY PROJECT PAPER

June 19, 2008

Human Development Sector

Middle East and North 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.

CURRENCY EQUIVALENT

(Exchange Rate Effective May 27, 2008)

Currency Unit = US$

US$ 1 = Iraqi Dinar 1,188

FISCAL YEAR

January to December

ABBREVIATIONS AND ACRONYMS

|BLS |Basic Life Support |OFFP |Oil for Food Program |

|CQS |Selection based on Consultants’ Qualifications |PAC |Project Advisory Committee |

|ECC |Emergency Coordination Center |PCU |Project Coordination Unit |

|EPP |Emergency Project Paper |PFS |Project Financial Statements |

|ESSAF |Environmental and Social Screening and Assessment |PIM |Project Implementation Manual |

| |Framework | | |

|FMR |Financial Monitoring Report |PP |Procurement Plan |

|GDP |Gross Domestic Product |QCBS |Quality and Cost Based Selection |

|IBRD |International Bank for Reconstruction and Development |RHERP |Regional Health Emergency Response Project |

|ICB |International Competitive Bidding |SBD |Standard Bidding Document |

|IDA |International Development Association |SOE |Statement of Expenses |

|ITF |World Bank Iraq Trust Fund |TA |Technical Assistance |

|KRG |Kurdistan Regional Government |FMA |Fiduciary Monitoring Agent |

|MOF |Ministry of Finance |TOR |Terms of Reference |

|MOH |Ministry of Health |UNDB |United Nations Development Business |

|MOI |Ministry of Interior |UNOPS |United Nations Office of Project Services |

|MOPDC |Ministry of Planning and Development Cooperation |UNOPS IQOC |UNOPS Iraq Operations Center |

|NCB |National Competitive Bidding |USAID |United States Agency for International Development |

|NGO |Non-governmental Organization | | |

|Vice President |Daniela Gressani |

|Country Director |Hedi Larbi |

|Sector Director |Steen Jorgensen |

|Sector Manager |Akiko Maeda |

|Task Team Leader |Jean Jacques Frere |

Emergency Project Paper

Table of Contents

EMERGENCY OPERATION PROJECT PAPER DATA SHEET i

A. Introduction 1

B. Emergency Challenge: Country Context and Rationale for Proposed Bank Emergency Project 1

C. Bank Response: The Project 6

D. Appraisal of Project Activities 10

E. Implementation Arrangements and Financing Plan 12

F. Project Risks and Mitigating Measures 13

Annex 1: Detailed Description of Project Components 16

Annex 2: Results Framework and Monitoring 20

Annex 3: Summary of Estimated Project Costs 24

Annex 4: Financial Management and Disbursement Arrangements 25

Annex 5: Implementation and Procurement Arrangements 32

Annex 6: Project Preparation and Appraisal Team Members 39

Annex 7: Documents in Project Files 40

Map No. 33422

EMERGENCY OPERATION PROJECT PAPER DATA SHEET

IRAQ: REGIONAL HEALTH EMERGENCY RESPONSE PROJECT (RHERP)

MIDDLE EAST AND NORTH AFRICA REGION

|Date: June 16, 2008 |Team Leader: Jean Jacques Frere |

|Country Director: Hedi Larbi |Sectors: Health (100%) |

|Sector Manager: Akiko Maeda |Themes: Health system performance (S) |

|Sector Director: Steen Jorgensen |Environmental category: B |

|Lending instrument: Emergency Recovery (Grant) | |

|Type of Operation: |

|New Operation [X] Additional Financing [ ] Existing Financing (restructuring) [ ] |

|Financing type: Loan [ ] Credit [ ] IDA Grant [ ] Other [X] |

|Project ID(s): P107698 |Total Amount: US$8.7 million |

|Proposed terms: Grant from the Trust Fund for Iraq (World |Expected implementation period: July 1, 2008 –June 30, 2010 |

|Bank/Recipient-executed) | |

|Expected effectiveness date: July 1, 2008 |Expected/revised closing date: June 30, 2010 |

|Recipient: Ministry of Health of Kurdistan Regional Government of |Responsible agency: Ministry of Health of Kurdistan Regional |

|the Republic of Iraq |Government of the Republic of Iraq |

|Development Objective: |

|The objective of the RHERP is to assist the Kurdistan Regional Government to build capacity in the establishment of rapid, coordinated |

|and effective response services to health emergencies, including those resulting from acts of violence, accidents, or natural |

|disasters. |

|Short Description: |

|The project would achieve its objective through the following four components: |

|(i) Emergency Coordination Centers. The objective of this component is to strengthen emergency coordination and response in the three |

|Northern Governorates of Erbil, Sulaymaniya and Dohuk through establishment and equipping of Emergency Coordination Centers in each of |

|the three Governorates, and creation of a reliable communication system for pre-hospital emergency services; |

|(ii) Capacity Building and Training in Emergency Procedures. The objective of this component is to build capacity for patient |

|treatment in medical and paramedical staff providing pre-hospital emergency services; |

|(iii) Blood Banks. The objective of this component is to upgrade the capacity of existing blood transfusion services in the three |

|Northern Governorates to provide a timely supply of safe blood and blood products banks to respond to the needs resulting from an |

|emergency; |

|(iv) Project Management. The objective of this component is to ensure effective administration and coordination of project activities.|

|Financing Plan (US$m) |

|Source |Local |Foreign |Total |

|Borrower | | | |

|Total IBRD/IDA | | | |

|Trust Funds |2.3 |6.4 |8.7 |

|Others | | | |

|Total |2.3 |6.4 |8.7 |

|Estimated disbursements (Bank FY/US$m) |

| |2009 |2010 |2011 |2012 |

|Total IBRD/IDA | | | | |

|Trust Funds |4.5 |4.2 | | |

|Does the emergency operation require any exceptions from Bank policies? |Yes [ ] No [X] |

|Have these been approved by Bank management? |Yes [X] No [ ] |

|Are there any critical risks rated “substantial” or “high”? |Yes [X] No [ ] |

|What safeguard policies are triggered, if any? |Yes [ ] No [X] |

|Significant, non-standard conditions, if any: Conditions of Bank Management approval will be: (i) execution of the Project |

|Implementation Agreement between KRH MOH and UNOPS; and (ii) Project Implementation Manual (PIM) acceptable to the Bank has been |

|adopted by the Recipient. |

A. Introduction

This Project Paper seeks the approval of the Vice President for the Middle East and North Africa Region to provide a grant from the World Bank Iraq Trust Fund (ITF) in the amount of US$8.7 million for the Regional Health Emergency Response Project (RHERP).

The project will be implemented by the Kurdistan Regional Government Ministry of Health (KRG MOH) and has received approval from the Iraq Strategic Review Board on September 10, 2007, in the amount of US$6 million and again on February 25, 2008, for an additional funding of US$2.7 million.

This grant is being prepared under emergency procedures, like other projects financed through the ITF. In addition, because of the lack of experience in project management, financial management and procurement in the main agency implementing the project (KRG MOH), the Government has requested that the United Nations Office of Project Services (UNOPS) act as Implementing Agent for the project.

B. Emergency Challenge: Country Context and Rationale for Proposed Bank Emergency Project

Country Context

The health system in Iraq was considered as very good in the 1980s in terms of infrastructure, quality of care, and access, and benefited from a well-trained health workforce. However, it was highly centralized, hospital based and costly, requiring large-scale imports of medicines, equipment and service workers such as nurses. The deterioration of the health system which had begun during the Iran-Iraq War (1980-88) when resources became scarce for non-military health services worsened during the first years that followed the 1991 Gulf War and the following imposition on sanctions. In 1989, health sector imports totaled US$500 million and fell dramatically, after the First Gulf War, to US$50 million in 1991 and to US$22 million in 1995. Furthermore, many Iraqi physicians of the “old generation” started to leave the country to practice in neighboring countries or in Europe. However, a steep decline in infant and child mortality took place during the 1980s. The IMR fell from 80 per 1,000 live births[1] in 1974 to 60 in 1982 and to 40 in 1989. Following the 1991 invasion of Kuwait and the First Gulf War, sanctions imposed by the international community further eroded the capacity to deliver essential health services to the Iraqi population. Bombing by coalition forces had put most pumping and sewage treatment plans out of action and “with the loss of water supply, water treatment and electricity –generating capacity, the contamination of the water supply started a whole sequence of events that caused health to deteriorate drastically”[2]. Diarrheal diseases, in particular, spread rapidly.

Data collected in 1999 by donor agencies[3] indicated that the under 5 and maternal mortality rates had risen dramatically between 90 and 100 for infants and 110 to 125 for children under five. These were comparable to the rates found in low-income countries. Within a decade, the health status of Iraqis had changed from that of a relatively advanced middle-income country to a poor and underdeveloped one. Measuring trends in Maternal Mortality always poses a challenge, but it was estimated at 117/100,000 in 1989 and is believed to have reached 294/100,000 during the period 1989-1998. During this time, malnutrition among children became a growing concern. Children born in the 1990s had a much greater risk of becoming malnourished than those born in the 1980s. The prevalence of underweight prior to 1990 was around 12%, somewhat better than the regional average.

The sanctions were amended under the Oil for Food Programme (OFFP) in 1996 to allow the procurement of pharmaceuticals and medical equipment which improved the situation somewhat, although unlike with malnutrition[4], there is very limited evidence about the impact of this program on infant and under 5 mortality. While it can be assumed that there was a decline, it cannot be quantified.

With the change of regime that followed the 2003 occupation of Iraq by multinational forces, there were hopes that, with substantial resources, sound management and strong leadership, the Iraqi health system would recover. The Ministry of Health (MOH) completed a health needs assessment with the assistance of UN Agencies and the Coalition Provisional Authority (CPA). The Government also prepared a national health strategy which was approved by the Parliament in 2004. The strategy emphasized family health care as the model to be followed, and in collaboration with several donors, including the World Bank, substantive discussions took place about topics such as health care financing, public-private partnerships, national health accounts and master planning.

However, implementing this vision would have required long lasting stability and commitment. This did not happen and, the health system is itself a casualty of the war. In a climate increasingly dominated by sectarian violence, terrorism, and crime, the health system has almost entirely collapsed. Half of the Iraqi physicians who were registered in 2003 have fled the country, including the best clinicians and those with faculty positions. There are very few qualified nurses, and in some parts of the country, including Baghdad, both providers and patients are too fearful to use existing facilities or to ensure 24 hour emergency services.

Since May 2003, there have been six Ministers of Health in Baghdad with a resulting high turnover of senior staff, including central and provincial directors and hospital managers. At the central Ministry of Health, many competent managers have left or have been forced from their posts. The situation in some provinces less affected by violence and political pressures is thought to be more stable than in the central government, although the managerial capacity of provincial MOH staff remains weak. Several attempts to restructure KIMADIA, the State Company for the Marketing of Drugs and Medical Appliances, have not been successful, and consequently the state capacity to procure and distribute critical drugs, medical devices and supplies remains dysfunctional.

Recent information, which has yet to be confirmed, and seems largely anecdotal, suggests that the situation of Iraqi children has deteriorated since 2003. Access to health care has deteriorated during the past 12 months as a result of continuing sectarian and criminal violence and the resulting exodus of qualified medical personnel. However, a recent survey carried out by UNICEF in February 2006 suggested figures[5] less dramatic than previous estimates but the results have not been officially released. According to this survey, which included anthropometric measurement, less than 10% of Iraqi children from 0-59 months suffer from moderate to severe malnutrition (weight for age).[6] During this period, access to qualified obstetric services has become problematic and many Iraqi women are known to deliver at home with the help of poorly qualified traditional midwives (birth attendants).

In 2006 and 2007, the Iraq family Health Survey (IFHS) was conducted by Iraqi institutions with the support of WHO. This survey provides new estimates of violence-related mortality from March 2003 through June 2006. The estimated number of violent deaths is 151,000 (104.000 to 223.00 with 95% uncertainty range), is lower than other recent survey-based estimates but it confirms that violence is a leading cause of deaths for Iraqi adults and the main cause of deaths in men between the ages of 15 and 59 years.

In the face of this challenging environment, implementation of the two on-going health projects financed by the Iraq Trust Fund (Emergency Health Rehabilitation Project (EHRP) and Emergency Disabilities Project (EDP)) has proved especially challenging. The central MOH continues to be highly centralized, and coordination with the regional teams remains weak. Furthermore, the security situation has prevented central MOH staff from traveling outside of Baghdad to the project sites. The continuous turn over and consequent lack of familiarity with Bank guidelines and procedures has also exacerbated the effective implementation of the projects.

Health Sector in the Iraq Kurdistan Region

Historically, the three Northern Governorates have been less developed than the rest of the country. The population is more rural, infrastructure is less developed than in the South-Center, and administration of the region has traditionally been under the control of delegates from Baghdad. In addition, the population has suffered from large-scale displacements and isolation. In the first years of the 1990s, the situation deteriorated more rapidly than in the Center/South, but it also has improved more quickly since that time. After the no-fly zone was established at the end of the first Gulf War, the Kurdish region received additional assistance through bilateral channels (US Government congressional program) and the UN, and benefited from the presence of several international NGOs on the ground. Health indicators are thought to be better than those of the rest of Iraq but, again, there are no robust data to support this assertion.[7]

Although the Kurdish Region has generally been protected from the climate of violence and insecurity that affects other regions of Iraq, the health situation generally mirrors that of the rest of Iraq. The Kurdish Regional Government (KRG) MOH manages the health services in three Northern Governorates: Erbil, Dohuk and Sulaymaniya. The population in these three governorates includes internally displaced people (IDP) and totals around 5 million (one-fifth of the population of Iraq). Each Governorate has its own Directorate of Health (DOH), which includes eight departments: planning and health education, technical affairs, preventive health, engineering, administration, finance, central pharmacy, and medical operations and specialized services. This structure is the same in all Iraqi DOHs. The Kurdish Region also includes three medical colleges, two colleges of dentistry, one college of pharmacy and two colleges of nursing.

The KRG MOH enjoys a wide degree of autonomy with regard to the management of health facilities, staffing and the organization of health services. However, it is dependent on Baghdad for its budget allocation and for the provision of pharmaceuticals and medical equipment. Since the system does not respond to the actual needs of the population, 70% of essential drugs are purchased by the KRG MOH from the private sector.

KRG MOH manages a network of health facilities comprising 48 secondary or tertiary hospitals, 760 Primary Care Centers and Sub-Health Centers. Shortage of beds is not a major constraint, except for obstetric beds, with ongoing investments supported by donors or by the private sector. The Bed Occupancy Ratio (BOR) is a little less than 70% and with new investments supported by the Government and by donors, the hospital capacity should be adequate within the coming two to three years. Rather, the constraint lies with the lack of qualified staff.: only one-third of the MOH primary health centers are staffed by physicians and many specialist positions in hospitals are vacant. Most physicians in the public sector also have private practices, sometimes using public health facilities to provide their services.

Some facilities, such as the Emergency Medical Center in Erbil which provides emergency care and rehabilitation services to victims of violence and acts of war, were established in 1997 by international NGOs with external donor funding. Following the invasion of Iraq and the fall of the Baghdad regime in 2003, international donor support ceased and such facilities were transferred to the local government. This is also the case for two rehabilitation centers in Erbil and Sulaymaniya where a well-trained staff struggles to continue providing critical services to amputees or patients with spinal cord injuries.

It is important to note that many KRG health facilities, in addition to serving the local population, also serve a relatively large number of patients referred from other parts of Iraq, in particular those evacuated from the neighboring cities of Mosul and Kirkuk. Recently, a large number of victims of the horrific August 2007 bombing of Yazidi villages in Al Sinjar were evacuated to Dohuk and completely overwhelmed the capacity of the recently renovated emergency hospital.

Table 1: Iraq Kurdistan Region- Distribution of Physicians by Governorate

| |ERBIL |DOHUK |SULAYMANIYA |TOTAL |

|Population[8] |1,478,426 |985,946 |1,534,425 |3,998,797 |

|Specialists |160 |73 |129 |362 |

|District Physicians |212 |50 |41 |303 |

|GPs |247 |161 |104 |512 |

|Hospital Physicians |215 |192 |287 |694 |

|Hospital Consultants |222 |75 |177 |474 |

|Total number of Physicians[9] |1,056 |551 |738 |2,345 |

|Total number of Nurses and |6,944 |1,924 |8,412 |17,280 |

|auxiliaries | | | | |

Status of emergency response. Recent emergency events have highlighted the very limited local capacity to respond to emergencies, e.g., assessment, communication, provision of pre-hospital care, referral system. Lack of adequately equipped ambulances, staff (including physicians) unprepared to respond to emergency needs, vulnerability of the communication system, and the disorganized response at the level of hospital emergency departments are a few of the most critical weaknesses. Even with the very limited resources of the existing system, there is considerable scope for improving the quality and effectiveness of emergency responses by providing targeted support to mitigate critical bottlenecks in the system and to make better use of the existing scarce staff resources. In particular, the capacity to provide pre-hospital care can be significantly enhanced by the provision of communication and transportation equipment, the training of staff, and the establishment of a functioning command center in each of the three provinces covered by the project.

Status of blood and blood products supply. Another critical area requiring attention is to ensure a safe supply of blood and blood products through the provision of adequate facilities for collection, testing, storage and distribution. Currently, there is no effective blood bank in Erbil and in the Sulaymaniya Province: the existing facility is in need of rehabilitation and additional equipment. The blood bank in Dohuk is adequate but requires some rehabilitation[10] . Blood supply is generally stored in refrigerators scattered over several hospitals. Blood is often not adequately tested for HIV/AIDS or Hepatitis. Staff are also poorly trained on collection, management and distribution of blood, leaving the population at great public health risk.

Donor Support to the Health Sector in the Kurdish Region. A number of UN agencies are currently active in the health sector in the Kurdish Region, including UNOPS, UNFPA, WHO, and UNICEF. In addition, the US, Korea and Japan provide bilateral support to the health sector in the form of reconstruction and/or rehabilitation of several hospitals and primary care centers.

Rationale for the Bank's Involvement

The Bank has gained considerable experience in Iraq, having now more than three years of involvement in the Iraqi health sector, with (i) two ITF-financed projects – EHRP and EDP) – implemented by the central Ministry of Health in Baghdad, and (ii) two Post-Conflict Fund projects – Emergency Health Assistance Program to the Burn Unit in Karama Teaching Hospital in Baghdad and Emergency Assistance Program for Primary Healthcare in the Southern Iraqi Marshlands – at the sub-national level. As noted above, the projects managed by the central Ministry of Health have been facing considerable implementation challenges arising from the security problems that have especially affected the functioning of the central Government and their ability to coordinate with the regional authorities. For example, the EHRP includes the allocation of US$1 million for the rehabilitation of the emergency department of Rizgari Teaching Hospital in Erbil, for which the construction has just been completed. However, due to difficulties in coordination between the Central Government and KRG, the plans for adequate staffing and training of hospital emergency staff supported by the EHRP have not materialized.

This project, with a regional focus, represents a departure from the two on-going centrally implemented projects, and will make use of the limited resources available through the ITF to support targeted interventions in a decentralized context. To address the shortcomings in EHRP and EDP, this KRG project proposes a regional approach to: (i) build local ownership and accountability; (ii) ensure active engagement of local decision makers in assessing and responding to the needs of the population; and (iii) provide close supervision of project implementation on the ground. The project is also designed in response to a request from KRG to support their urgent needs in addressing the shortcoming of their emergency medical services. However, there is also recognition that the KRG MOH has no experience with the direct implementation of Bank projects, and the Bank team field visits to the Kurdish Region confirmed their limited capacity to manage a project. The KRG authorities have recognized this constraint, and following thorough discussions of different options to support the implementation of the project, they requested to contract UNOPS as the project implementing agent to facilitate the provision of works, goods and services. At the same time, UNOPS will also contribute to building the capacity of KRG MOH to implement projects in the future. This project structure represents a new model for operations in Iraq in that it will be implemented in a more stable region than the rest of Iraq (as explained below) and will make use of the services of UNOPS, which is already operating successfully on the ground in the Kurdish Region.[11]

Given the many serious problems facing the health sector in Iraq, there are many competing priorities and addressing all these priority areas will require, in the future, long term investments as well as substantial resources. Within the time frame available under the Iraq Trust Fund, this project has been selected based on the following criteria: relevance and needs, simplicity of design, commitment of implementing institution, acceptable local security conditions, potential for replicability, the possibility of delivering training within country, and the ability of Bank staff to carry out supervision on the ground.

For the proposed project, the Bank will be able to provide resources and advice needed on technical aspects, including the establishment of rapid response emergency services, safe blood products used in emergency services, and related medical training, on which the Bank has considerable global experience. The Bank will also be able to assist the Government and KRG in project implementation, based on experience and lessons learned, both in Iraq and in other similar contexts, and to provide the periodic reviews and guidance needed during project implementation.

C. Bank Response: The Project

1. Brief description of Bank’s strategy of emergency support

The World Bank Second Interim Strategy Note (ISN) for Iraq (September 2005) builds on the achievements of the First ISN. The Bank’s overarching objective is to help Iraq build efficient, inclusive, transparent, and accountable institutions as needed for stability, good governance, and sustainable economic prosperity. Better institutional frameworks, policies and systems will improve the efficiency and effectiveness of both national expenditures and international aid. Under the umbrella of institution building, the Bank Group’s work program is organized into four pillars, supporting government efforts to: (i) restore basic service delivery; (ii) enable private sector development; (iii) strengthen social safety nets; and (iv) improve public sector governance. The proposed project supports the first pillar, in providing assistance to restoration of basic service delivery in the area of emergency medicine.

The strategy relies on the World Bank ITF and IDA to finance projects, and on the World Bank budget for the economic and sector work and policy advice that is needed. The World Bank is financing 16 projects (US$436.7 million), of which 14 are active (US$393.1 million), and two have closed. Aimed at building country systems, 12 of the 14 active ITF-financed projects (for education, health, water supply/sanitation and urban services, community infrastructure, private sector development, social protection and a household survey), amounting to US$384.6 million, are grants implemented directly by the Government of Iraq. The other two projects (US$8.5 million) are executed by the Bank on behalf of the Government at the request of the Ministry of Planning and Development Cooperation, and finance capacity building and technical assistance activities.

2. Project Development Objectives

The objective of the RHERP is to assist the Kurdistan Regional Government to build capacity in the establishment of rapid, coordinated and effective response services to health emergencies, including those resulting from acts of violence, accidents, or natural disasters.

The project would achieve its objective through:

(i) Strengthening emergency coordination and response in the three Northern Governorates of Erbil, Sulaymaniya and Dohuk through establishing and equipping of Emergency Coordination Centers in each of the three Governorates, and creation of a reliable communication system for pre-hospital emergency services;

(ii) Building Capacity and Training for medical and paramedical staff providing pre-hospital emergency services;

(iii) Upgrading the capacity of existing blood transfusion services in the three Northern Governorates to provide a timely supply of safe blood and blood products banks to respond to the needs resulting from an emergency; and

(iv) Ensuring effective administration and coordination of project activities.

By the end of the project, it is expected that the project will lead to improved emergency medical services in terms of timeliness of response and effectiveness of response to major medical emergencies; improved survival rates and outcomes for the patients; and strengthened KRG MOH project management capacity through its collaboration with UNOPS in implementing the Project. These will be achieved through the following outputs:

• Three Emergency Coordination Centers will have been established, including an emergency communication system, fully equipped and operational, and provision of 12 ambulances.

• Technical Staff Training Completed:

o 12 Master Trainers

o 37 Emergency Physicians

o 150 Nurses and Paramedics

o 4 Senior Physicians for Emergency Management Training

o 90 Ambulance Drivers

• Three Blood Banks Constructed/Rehabilitated

3. Summary of Project Components

The Project, with an estimated total cost of US$8.7 million, will comprise four components, to be implemented over a period of two years. The component activities will be executed by KRG MOH, with assistance from UNOPS. The project will be grant financed under the Iraq Trust Fund, operating under OP 8.00, Emergency Recovery Assistance.

Project Components:

Component 1: Emergency Coordination Centers (ECC) (Estimated cost: US$4.38 million)

The objective of this component is to strengthen emergency coordination and response in the three Northern Governorates of Erbil, Sulaymaniya and Dohuk. In order to carry out rapid situation assessments, and to organize the provision of timely and adequate responses, provincial Emergency Coordination Centers (ECCs) must be established. These centers would be adequately staffed with trained personnel, and they must be able to rely on effective and robust communication systems connecting ambulances, health facilities, and other government agencies. The project will support the construction of three ECCs on three sites selected by the KRG MOH. These centers will receive equipment, including IT, telecommunications and HF/VHF communications equipment. Financing will also be provided for the procurement of 12 ambulances that will be under the control of the three KRG Health Directorates and for which the local capacity for maintenance is already in place. Capacity building training of the staff for these centers and for the ambulances is covered under Component 2 below. Equipment-related training linked to equipment procurement will be provided by the suppliers.

Component 2: Capacity Building and Training in Emergency Procedures (Estimated cost US$0.33 million)

The objective of this component is to build capacity for patient treatment in medical and paramedical staff providing pre-hospital emergency services. The project will finance technical assistance for the development of new procedures for health staff assigned to pre-hospital emergency services, and requisite training and retraining of doctors, emergency medical technicians (including nurses and paramedics), and ambulance drivers reporting to the ECCs and the other existing emergency health centers in the Kurdish Region. The French Ministry of Foreign Affairs has indicated that it would support additional technical assistance to supplement the technical training under the project. This would be carried out through sending international experts or through using NGOs active in the area to provide support to the technical training activities. Annex 5 includes a table showing estimated number of training courses, participants and costs for this component.

Component 3: Blood Banks (Estimated cost: US$2.22 million)

The objective of this component is to upgrade the capacity of existing blood transfusion services to provide a timely supply of safe blood and blood products to respond to the needs resulting from an emergency. The component will support improvements in the quality of collection, screening, testing, processing, storage, and distribution of blood and blood products. The project will, more specifically, provide funding for civil works rehabilitation, and equipping of the blood banks. One new blood bank will be constructed and equipped in Erbil and one existing blood bank will be renovated and equipped in Sulaymaniya. A third existing blood bank in Dohuk will receive equipment only and the air conditioning system will be rehabilitated.

Component 4: Project Management (Estimated cost: US$1.77 million)

The objective of this component is to ensure effective administration and coordination of project activities. This component will support the establishment of a small Project Coordination Unit (PCU) within the KRG MOH in Erbil. The PCU will be a central point in the Ministry to coordinate project activities and communicate with the Bank, UNOPS and other relevant agencies or bodies involved in the Project. This will be the first Bank-financed project to be implemented by the KRG MOH which has no experience to date with Bank policies and procedures. This represents a significant risk to achieving the project outcomes, and therefore it has been agreed that the implementation model will include substantial support through a contract with UNOPS as Implementation Agent to assist with implementation of the project activities, including civil works, goods and training. The PCU will work closely with UNOPS, which will have staff dedicated to the project in both its Erbil office and its Amman office.

Project Monitoring and Evaluation. The PCU will carry out monitoring of project results indicators on a quarterly basis, using the Results Framework monitoring tool agreed with the Bank. Training on use of this monitoring tool will be provided to the PCU during the Project Launch Workshop shortly after Project Effectiveness. This monitoring will be carried out in coordination with UNOPS. The monitoring table format is presented in Annex 1.

Project Implementation Arrangements. The implementing agency for the project will be the KRG MOH. KRG MOH will contract directly UNOPS as Implementing Agent for the project under a Project Implementation Agreement between UNOPS and KRG MOH. The KRG MOH will be responsible for managing the contract with UNOPS, and will be involved, on a day to day basis, with UNOPS in implementing the project activities. A small Project Coordination Unit (PCU) has been established within the KRG MOH to coordinate the project. The PCU will be staffed by: a Project Director, a Deputy Project Director, a technical specialist (emergency response physician), a Senior Engineer, and an accountant. UNOPS, which has an office in Erbil, will have staff working on a day to day basis with the PCU in the KRG MOH to facilitate close cooperation on the project. The KRG MOH has appointed “focal points”, a MOH engineer and a MOH medical doctor, for each of the project sites. The “focal point” engineers will provide oversight of the civil works activities, and the “focal point” medical doctors will provide oversight of the technical training of the medical and paramedical staff.[12] The PCU staff and the “focal points” will receive periodic technical training in various aspects of project management by the World Bank at the Iraq Country Office in Amman, Jordan. The schedules for civil works, equipment and training have been finalized following agreements with KRG MOH and UNOPS on realistic deadlines for the critical activities.

Resources are included within the project to support the implementation needs of the project, including funding for the UNOPS contract to manage the project. The rationale for using UNOPS in this capacity is that they are already operational and have been implementing 27 projects on the ground in Iraq. UNOPS was established by the UN General Assembly in September 1994 to provide, inter alia, management and other support services for the benefit of UN member countries, impartially, efficiently and on a non-profit basis. UNOPS has its own security system and procedures for operating in a conflict environment such as Iraq. Most private sector organizations that could provide similar services are not interested in operating in conflict environments. UNOPS has successfully established required field procedures for needs identification, consultation, contracting, supervision, disbursement of funds, and auditing/financial management, and for coordination with KRG MOH and other provincial and district entities which is a significant achievement in the current country environment. UNOPS will be using a balanced mix of local and international staff, and will be operating out of its Amman and Erbil offices. The two year timeframe of the project will require this support to the KRG MOH from UNOPS to ensure completion of project activities by the Project Completion Date. It has been agreed that the KRG MOH will provide the requisite staff and operations budget to implement this project.

Project Readiness. The project is well-positioned to begin implementation activities immediately upon Grant Effectiveness. The details of the Project Implementation Agreement between KRG MOH and UNOPS have been agreed between the two parties, and the Bank has reviewed the draft agreement. Execution of the Project Implementation Agreement and preparation of a Project Implementation Manual will be conditions of Bank Management approval. KRG MOH has appointed a core team for the PCU, and meetings between the PCU and the Bank team have occurred in Erbil and Amman during the project appraisal.

Partnership Arrangements. WHO had provided initial technical inputs to the KRG MOH concerning improvements to the current blood banks in the three northern Governorates. The French Ministry of Foreign Affairs has indicated interest in supporting the technical training under the project (see paragraph 29 above) and an international NGO, Doctors of he World has prepared a proposal that includes the training of primary respondent in emergency care as well as community-based training in obstetrics and mental health.

4. Eligibility for Processing under OP/BP 8.0

GOI has requested that the proposed project be financed from the World Bank ITF. The Interim Strategy Note for Iraq stipulates the use of OP/BP 8.50 for all ITF-funded projects[13]. OP/BP 8.00 (Rapid Response to Crisis and Emergencies), issued in March 2007, now replaces OP/BP 8.50. The proposed Project is fully consistent with OP 8.00 criteria, and, in fact, will address the following priorities (as defined in Paragraph 4 of OP 8.00): (a) establishing and/or preserving human, institutional, and/or social capital, (b) assisting with the crucial initial stages of building capacity for longer-term reconstruction, disaster management, and risk reduction; and (c) supporting measures to mitigate or avert the potential effects of imminent emergencies or future emergencies or crisis in countries at high risk.

5. Consistency with Country Strategy (CAS or ISN)

The proposed project is fully consistent with the World Bank Interim Strategy Note (ISN) for Iraq, which envisions a continuing significant role for the World Bank Group in social sector activities, given its recent experience in Iraq and its comparative advantage (see paragraphs 26 and 27 above). This project supports the first pillar of the ISN, namely, restoration of basic services delivery.

6. Expected Outcomes

Progress towards achieving the Project objectives will be measured by two key outcome indicators: (i) improvements in the timeliness of response to medical emergencies. Timeliness is based on the response time between call and admission to a health facility; and (ii) effectiveness of the response to medical emergencies. The effectiveness of the response is based on the capacity to carry out a rapid assessment of the situation, to make the decision to mobilize appropriate resources in a coordinated way, to provide adequate pre-hospital care and reorganize patients/victim referrals (See Annex 2: Results Framework and Monitoring).

D. Appraisal of Project Activities

Financial Management (FM). The FM arrangements proposed for the Project are acceptable to the Bank in providing reasonable fiduciary assurance that the proceeds of the ITF grant are used for the purposes for which they were granted with due regard to economy, efficiency and the sustainable achievement of the project’s development objective. UNOPS will carry out the financial management for the project in coordination with KRG MOH through a Project Implementation Agreement. The Bank has hired an independent firm, the Fiduciary Monitoring Agent (FMA), to ensure that project funds for all ITF-financed projects in Iraq are used for the purposes intended and to help carry out project supervision on the ground, including this project. [14] Most of the usual FM risks associated with Bank administered and financed projects in Iraq are reasonably mitigated by having UNOPS as Implementing Agent. However, there is a risk associated with this new implementation arrangement in Iraq and the possible limited coordination and cooperation between KRG MOH, UNOPS, and the FMA exist. This risk will be reasonably managed through agreement on clear responsibilities, documented in the Project Implementation Agreement (PIA) and the Project Implementation Manual (PIM). Details of the risk assessment and further arrangement governing the exchange of data among the KRG MOH, UNOPS, the FMA and the Bank, including a diagram on the flow of funds, are disclosed in Annex 4.

Disbursement Management. A blanket commitment for the full amount of the project will be set up for UNOPS by which disbursements are made to the New York account of UNOPS, and UNOPS then makes its own arrangements to transmit the funds to Iraq, thereby reducing the risks undertaken by the Bank. UNOPS will be able to draw down the grant periodically under this blanket commitment. Each drawdown by UNOPS is treated as an advance, and requires quarterly interim un-audited financial reports (IFRs) from UNOPS to account for use of funds. At the end of the project, UNOPS will be required to return all unused funds to the Bank. This procedure will be part of the Project Implementation Agreement.

Procurement Management. All procurement of works, goods, and services shall be carried out by UNOPS in accordance with Bank policies, guidelines and procedures, and in accordance with the procurement arrangements stipulated in the Iraq Trust Fund Grant. Agreement entered into between IDA (as administrator of ITF) and the KRG MOH. The following procedures have been determined to be the most suitable for the country-specific conditions and the urgency for execution of the project: (i) International Competitive Bidding (ICB) and Limited International Competitive Bidding (LICB); (ii) National Competitive Bidding (NCB); and (iii) International and National Shopping (IS and NS).

Selection and employment of consultants shall be carried out by UNOPS in accordance with Bank policies, guidelines and procedures, and in accordance with the procurement arrangements stipulated in the Iraq Trust Fund Grant Agreement entered into between IDA (as Administrator of ITF) and the KRG MOH. The following selection methods have been determined to be applicable to the project specific needs: (i) Consultants’ Qualifications (CQ); (ii) Least Cost Selection (LCS); and (iii) Single-Source Selection (SSS).

Bank prior review is shown in the procurement plan. Other Bank prior review of selection of consultants would be limited to the review of terms of reference for training activities and the pre-selection of available training providers. Bank review ex-post of a representative sample of all contracts for works, goods, services and consultants, and field verification of works and good will be carried out on a periodic basis by the FMA, as indicated in the PIM.

Details on procurement management are found in Annex 5.

Policy Exceptions and Readiness. No policy exceptions are foreseen. Terms of Reference for the contract between UNOPS and the KRG MOH have been drafted. Selection of design consultants for the civil works, and selection of the training institution to carry out the technical training, as well as procurement of goods, will be initiated as soon as the Grant is effective.

Lessons learned and reflected in the Project design. Based on the World Bank’s experience with the ongoing investment program in Iraq, in particular with regard to the two on-going health projects – EHRP and EDP – and other post-conflict countries such as Afghanistan, a number of important lessons have been learned and introduced into the design of the proposed project. Below are key lessons learned:

• For emergency recovery projects, a simple project design that can be quickly and visibly implemented is most effective.

• In a new client context, design could include support from an experienced implementing agency, with professional bid evaluation procedures, thereby increasing the possibility that qualified firms and individuals will be contracted to carry out the activities; and sound financial management practices and tools to provide effective cost control and overall financial management of project expenditures.

• If projects are not able to be effectively implemented at the central level ministries, because of either political or security reasons, choose to have projects at the sub-national level in areas where there is more political stability and fewer security concerns, and where there is the possibility for the Bank to carry out direct supervision of the project.

E. Implementation Arrangements and Financing Plan

An implementation structure has been agreed between the Bank and KRG MOH. At the KRG MOH, the Bank will liaise directly with the Project Director of the PCU on matters related to implementation of the project activities. The PCU Director will report directly to the Minister of Health. UNOPS will be contracted as the Implementation Agent by the KRG MOH to implement the project activities.

Project implementation will be carried out by UNOPS under a Project Implementation Agreement (PIA) to be entered into between the Iraq Ministry of Health for the Kurdistan Regional Government (KRG MOH). The selection of UNOPS as an Implementing Agent for this project is not subject to the selection procedures set forth in the Consultants Guidelines since the execution of the PIA between the Recipient and UNOPS is a direct requirement of the Grant Agreement, and moreover is an effectiveness condition of the Grant Agreement (see paragraph 61 below). This approach is in full compliance with paragraph 1.1 of the World Bank Consultant Guidelines which states that provisions of the Guidelines apply to projects financed by trust funds administered by the Bank to the extent that the agreement providing for the trust fund or the grant does not conflict with these provisions, in which case the agreement will prevail. The agreement shall be in accordance with the standard agreement for UN Agencies and Bank Borrowers, a draft of which has been reviewed by the Bank. Execution of the PIA between KRG MOH and UNOPS shall be a condition of Bank Management approval.

Environmental and Social Safeguards. The project will include construction of three new emergency response centers and one Blood Bank. In addition, the Sulaymaniya and Dohuk Blood Banks will be renovated. Therefore, the Project has been categorized as Environmental Category B. The requirement to carry out a limited Environmental Analysis as part of project preparation will be waived but, for sub-projects with adverse environmental impact, a limited Environmental Analysis will be done during project implementation but before sub-project approval. At the same time, before appraisal, the implementing agency should agree to apply the following minimum standards during implementation: (i) inclusion of standard environmental codes of practice (ECOP) in the repair and reconstruction bid documents of all sub-projects; (ii) review and oversight of any major reconstruction works by specialists; (iii) implementation of environmentally and socially sound options of disposal of debris and medical waste[15]; and (iv) provisions for satisfactory budget and institutional arrangements to monitor effective implementation and adequately maintain sanitary facilities after completion.

Resettlement and Land Acquisition. The project will include both new construction and renovation of emergency response centers and Blood Banks on 5 sites on Government-owned land without squatters. Therefore, World Bank Operational Policy (OP4.12) on Involuntary Resettlement would not be triggered since there would not be any involuntary relocation of populations or expropriation of privately owned land. However, the Bank-approved Environmental and Social Screening and Assessment Framework (ESSAF), specifically elaborated for due diligence of emergency projects in Iraq, should be used to ensure that this is indeed the case and, should there be any need for expropriation of privately owned land and/or involuntary relocation of population, the same guidelines would be followed. Quarterly and annual implementation progress reports should include a section for reporting compliance with World Bank safeguard policies.

Terms and Conditions for Project Financing. The project is financed through a grant made under the ITF, and 100% of the grant will be disbursed through a Project Implementation Agreement with UNOPS to carry out works, goods, consultants’ services and training, including workshops. Annex 5, Table A describes the allocation of the grant proceeds according to each expenditure category.

Sustainability. Support to establishing a rapid, coordinated and effective response to health emergencies is the central project objective. To this end, three Emergency Coordination Centers and three blood banks will be rehabilitated and equipped, and the emergency staff will be trained in new protocols and procedures, thereby developing and improving on in-country capacity in emergency response. All interventions planned in this project are already part of the KRG MOH funded activities, so that ongoing sustainability is assured.

F. Project Risks and Mitigating Measures

Risks. The project builds on the experience in Iraq over the past three years with different ministries and agencies, including MOH, UN agencies and NGOs. Nevertheless, the project carries significant risks, including the possibility of a deteriorating security situation. In addition, this will be the first project under the ITF to be implemented at the regional level. The Kurdistan Regional Government does not have experience to date with Bank-financed projects, and therefore has no familiarity with Bank policies and procedures. In addition, the capacity of the MOH to carry out an investment project is low, given lack of exposure to operations of this type. Because of these risks, the implementation management model to be used will involve significant support from UNOPS which is already operating on the ground in the Kurdish Region, and this will go far to mitigate the risks associated with the new client. The activities envisaged under the project will place technical and managerial challenges on the government agencies. UNOPS involvement as Implementing Agent will mitigate significantly these challenges. UNOPS will work in close coordination with the KRG MOH and, in particular, the PCU which will be the coordinating unit for the project. The KRG Minister of Health is strongly committed to the project objectives, and meetings during recent missions have indicated that reform of the emergency response system for the Kurdish Region is at the top of his agenda. The Bank will also provide regular supervision of activities, both in Erbil and in neighboring countries, and will have a local procurement specialist on the ground in Erbil to undertake day-to-day monitoring of procurement activities. There is also an added risk in the process of building ownership within the KRG MOH which may cause implementation delays. Implementation arrangements call for the involvement of the KRG MOH in: (i) identifying needs jointly with the World Bank; (ii) reviewing and validating terms of reference; and (iii) monitoring, reviewing, and endorsing key decisions arising from consultant deliverables. To mitigate this risk, the proposed project will have a full-time Project Coordinator and a Financial Officer, to be financed under the UNOPS contract, and to be located in Erbil to work closely with the KRG MOH PCU to follow up on the implementation of all activities.

The table below provides a summary of the key project risks that have been identified, and the measures to be taken to mitigate those risks.

|Risk |Rating |Mitigation Measures |

|From Outputs to Objectives |

|Administration changes in MOH – jeopardizing | |Keeping project simple and focused on well-defined priorities|

|current commitment to project design and inputs. | |and activities. Using UNOPS as management support. Working |

| |M |closely with MOH officials to ensure commitment and |

| | |continuity. |

|Multiple efforts and parallel tracking by the | |Maintain close communication with key donor agencies active |

|various agencies and bilateral donors causing |M |in Iraq and in particular in the Kurdish Region. |

|fragmented reform effects. | | |

|From Components to Outputs |

|Rise in insurgency and acts of terrorism could | |Adopt procedures of confidentiality, low visibility and avoid|

|impact on local consultants and contractors |M |unwarranted publicity in the press. |

|Lack of experience of KRG MOH in implementing | |Building into the project design substantial support from |

|Bank-financed projects |S |UNOPS as Implementation Agent. Bank supervision of the |

| | |project at regular intervals, both in Amman and in the |

| | |Kurdish Region. |

|Collection of comprehensive information on the | |KRG MOH has already identified the sites, and the Bank is |

|status of facilities to enable planning and |M |helping to identify the types of data needed for planning |

|priority setting may not be collectable within | |purposes. UNOPS will also provide support in this respect. |

|the time constraints of the project. | | |

|Failure of government to meet the incremental | |Establish with KRG MOH what the O&M costs would be through |

|operating and maintenance costs of the |S |the costing exercise and agreement from Government prior to |

|investments under the Project | |grant effectiveness that the running costs for the facilities|

| | |financed under the project would be provided effectively. |

| FM Risks |

|Possibility of limited coordination between UNOPS|S |The PIA and the PIM define all related terms, including FM |

|and KRG MOH with regard to the FM | |responsibilities and accountabilities. UNOPS staff, KRG MOH |

|responsibilities, coupled with the involvement of| |accountant, and the FMA will participate in the Project |

|the FMA. Lack of knowledge of Bank policies and | |Launch Workshop and periodic meetings with the Bank. |

|guidelines, on the part of UNOPS and KRG MOH. | | |

|UNOPS entity-wide audit might not be useful to |H |The project audit TORs are part of the PIM. KRG MOH will |

|get project specific audited information. UNOPS | |ensure that the project is audited by an independent external|

|may have restrictions on the sharing of audit | |auditor who will be given full access to the project |

|reports and providing access to auditors. | |documents. |

|Overall Risk |S | |

H = High Risk; S = Substantial Risk; M = Modest Risk

Actions to be Completed Prior to Negotiations. The following actions will need to be completed prior to Negotiations:

• Draft Project Implementation Agreement between KRG MOH and UNOPS prepared, acceptable to the Bank,

• Terms of Reference for PCU staff (Project Director, Deputy Director, Technical Specialist, Senior Engineer, Accountant) prepared, acceptable to the Bank

• “Focal point” physician for each of the three Governorates designated by KRG MOH

• “Focal point” engineer for each of the three Governorates designated by KRG MOH

According to the decision of the Rapid Response Committee, execution of the Project Implementation Agreement and approval of the Project Implementation Manual are conditions of Bank Management approval of this project. Both of these conditions have been complied with.

Annex 1: Detailed Description of Project Components

Component 1: Emergency Coordination Centers (estimated cost US$4.38 million total, including contingencies)

The objective of this component is to strengthen emergency coordination and response in the three Northern Governorates of Erbil, Sulaymaniya and Dohuk. A functional emergency medical system requires well-planned and quality pre-hospital management, as well as a standardized response to emergencies. In order to carry out rapid situation assessments, and to organize the provision of timely and adequate responses, provincial Emergency Coordination Centers must be established. These centers would be adequately staffed, and they must be able to rely on effective and robust communication systems connecting ambulances, health facilities, and other government agencies. The project will support the construction of three emergency response centers on the three sites selected by the KRG MOH. These centers will receive equipment, including IT, telecommunications and HF/VHF communications equipment. Financing will also be provided for the procurement of 12 ambulances that will be under the control of the three directorates and for which the local capacity for maintenance is already in place. Alternatively, some of the 30 ambulances recently received from Baghdad and donated by the Japanese Government could be put at the disposal of the centers and the project might support the costs of the reconditioning of a number of existing ambulances that could be repaired and subsequently used for routine transfers of patients. As a next step, the PCU is requested to complete a detailed assessment of the condition of existing ambulances in each governorate, as well as a management plan for the ambulances.

Capacity building training of the staff for these centers and for the ambulances is covered under Component 2 below. Equipment-related training linked to equipment procurement will be provided by the suppliers.

The Emergency Coordination Centers will be staffed by two radio operators and one physician (or well-trained Emergency Medical Technician) and will operate 24 hours a day seven days a week. In each province, the ECC will be accessed through a unique telephone number which will be communicated to the public through a mass media communication campaign.

The population served is expected to be mainly urban since approximately 70% of the population live in urban and periurban areas. The ECCs will in responsible for the following tasks:

• Answering of calls through a dedicated telephone number

• Assessment of the needs for immediate response, pre-hospital care and referral

• Mobilization of existing resources according to the needs

• Communication with referral facilities to ensure that patients are admitted and treated with no delays

• Coordination and monitoring of the movement of vehicles to provide the optimal time response and maximize efficiency

• Mobilization of additional resources whenever appropriate

• Communication between governorates and with law enforcement agencies and firefighters

Communication between the ECCs and the ambulances will use traditional radio UHF communication with THURAYA communication as a back-up system to ensure communication when the radio coverage is interrupted or insufficient. The radio system will be compatible with the system used by the Ministry of Interior (MOI). GPS installed in each ambulance will ensure that the dispatchers will know precisely the location of each vehicle, allowing close monitoring of the response as well as coordination and the most efficient mobilization of one or several vehicles.

The MOI and the MOH will need to agree on the use of MOI infrastructure (communications towers) already in place to install the MOH Radio communication equipment.

Component 2: Capacity Building and Training in Emergency Procedures (estimated cost US$0.33 million total, including contingencies)

The objective of this component is to build capacity in medical and paramedical staff providing pre-hospital emergency services. The project will finance technical assistance for the development of new procedures for health staff, and requisite training and retraining of doctors, paramedics, and emergency medical technicians in these emergency coordination centers and selective emergency health centers in the Kurdish Region. Also included will be training of ambulance drivers. The project will not support the training of primary respondents at the community level. This could be undertaken by the Ministry of Health, possibly with the support of NGOs or other agencies.

The training will focus on new emergency services systems and protocols for pre-hospital care, including safe evacuation and referral of patents in a timely manner, with improved response time and referral practices. The training will include inter alia life-saving interventions, stabilization techniques, and safe handling of patients.

Clinical training programs for emergency medical personnel should be implemented as soon as the Project becomes effective. The training programs should address the needs of both pre-hospital care providers (EMTs nurses and paramedics) who need basic life support skills, as well as clinical providers (physicians and nurses) at the hospital who need to acquire the necessary skills for effective management of emergencies.

The first phase of the Emergency (EM) training program will be the training of 12 “master” trainers (3 from Dohuk, 4 from Sulaymaniya, and 5 from Erbil). Ideally, this training should be conducted in Erbil but it might be easier, as well as cheaper, due to the high cost of providing security to international consultants, to train the trainers in one of the neighboring countries.

Once this first phase is completed, 1-2 months lead time will be necessary to identify a list of the trainees who will undergo Phase II of the EM training program and to organize the in-country training.

Phase II of the EM training for pre-hospital and emergency health care providers will be led by the “master” trainers. It will be divided into two seven-day sessions for the physicians. These trainers will follow the training curriculum used in Phase I to train a total of 37 physicians divided into two or three groups. The content of the course will be determined during a training planning workshop that will be organized before the training of trainers. A modular approach will be used in order to cover the most important basic and advanced knowledge to be transferred.

Training will also be provided in country to a total of 150 nurses and paramedics. The seven day course is expected to be very basic and will include training in CPR, as well as basic rules for airway management, trauma management, and management of spine injuries.

Ninety ambulance drivers will be trained in CPR, safe driving and transportation techniques and basic maintenance and cleaning of ambulances.

A group of four physicians will be trained abroad in the management of emergencies and the organization of emergency response. This specialized course is expected to be delivered in a two week period. A similar course was organized in 2006 in Cairo at the National Training Institute and several Iraqi physicians participated. It is expected that the selection of training providers and management of training activities will be carried out efficiently and effectively, given UNOPS operational skills and experience.

Component 3: Blood Banks (US$2.22 million estimated total cost, including contingencies)

The objective of this component is to upgrade the capacity of existing blood transfusion services to provide a timely supply of safe blood and blood products to respond to the needs resulting from an emergency. The component will support improvements in the quality of collection, screening, testing, processing, storage, and distribution of blood and blood products. The project will, more specifically, provide funding for civil works rehabilitation, equipping of the blood banks and training/re-training of the staff. One new blood bank will be constructed and equipped in Erbil and one existing blood bank will be renovated and equipped in Sulaymaniya. A third existing blood bank in Dohuk will receive equipment only and the air conditioning system will be rehabilitated. Reagents and other consumables that account for a significant proportion of operating costs will not be funded from the project and the Ministry will have to ensure that sufficient funding will be allocated from its operating budget to cover these recurrent costs after the first year of project implementation.

Component 4: Project Management (US$1.77 million estimated total cost, including contingencies)

The objective of this component is to ensure effective administration and coordination of project activities. This component will support the establishment of a small Project Coordination Unit (PCU) within the KRG MOH in Erbil. The PCU will be a central point in the Ministry to coordinate project activities and communicate with the Bank, UNOPS and other relevant agencies or bodies involved in the Project. The PCU will comprise: a Project Director, a Deputy Project Director, a Technical Specialist (emergency response physician), a Senior Engineer, and an accountant. This will be the first Bank-financed project to be implemented by the KRG MOH which has no experience to date with Bank policies and procedures. This represents a significant risk to achieving the project outcomes, and therefore it has been agreed that the implementation model will include substantial support through a contract with UNOPS as Implementation Agent to assist with implementation of the project activities, including civil works, goods, services, and training. The PCU will work closely with UNOPS to facilitate close cooperation on the project. UNOPS will have staff dedicated to the project in both its Erbil office and its Amman office. In coordination with UNOPS, the PCU will ensure the necessary technical inputs are available to the project. UNOPS will arrange for civil works design preparation through hiring of appropriate consultants, and in addition will hire equipment experts, as necessary, to prepare the detailed specifications for the telecommunications and medical equipment.

Project Monitoring and Evaluation. The PCU will carry out monitoring of project results indicators on a quarterly basis, using the Results Framework monitoring tool agreed with the Bank. Training on use of this monitoring tool will be provided to the PCU during the Project Launch Workshop shortly after Project Effectiveness. This monitoring will be carried out in coordination with UNOPS. The monitoring table format is presented in Annex 2.

A Project Advisory Committee (PAC), comprising key resource persons within the MOH, will be established to provide overall guidance on technical, medical and training aspects of the Project. The KRG MOH will appoint three “focal point” engineers for the project sites in Erbil, Sulaymaniya and Dohuk. The KRG MOH engineers will provide oversight of the civil works activities, and the KRG MOH medical doctors will provide oversight of the technical training of the medical and paramedical staff. The PCU staff and the “focal points” would be provided with periodic technical training in various aspects of project management by the World Bank at the Iraq Country Office in Amman, Jordan. This component will also cover the investment costs for the PCU necessary to coordinate the project, including provision of office equipment, materials and supplies, and the costs for periodic project review meetings with the Bank, beginning with the Project Launch Workshop. These will be financed under the UNOPS contract. Salary costs of the PCU, with the exception of consultants, will be covered by the KRG MOH recurrent budget. The Project Launch Workshop will be held at the start of the project and will include planning and project management exercises, covering all aspects of management, coordination, and teamwork.

Annex 2: Results Framework and Monitoring

| |Project Outcome Indicators |Use of Outcome Information |

|Project Development Objective | | |

|To assist the Kurdistan Regional Government |Utilization rate at the 3 Emergency Coordination |To track progress of project outcomes and |

|to build capacity in the establishment of |Centers: number of people transported and |identify corrective measures as needed. |

|rapid, coordinated and effective response |appropriately referred by the emergency ambulance | |

|services to health emergencies, including |system | |

|those resulting from acts of violence, | | |

|accidents, or natural disasters. |Reduction in response time: between call and | |

| |admission to a health facility[16] | |

|Intermediate Outcome |Intermediate Outcome Indicators |Use of Outcome Monitoring |

|by Component | | |

|Component One: Emergency Coordination | |To track progress of project outcomes and |

|Centers |A functional emergency medical system with a |identify corrective measures as needed. |

|Emergency coordination and response in the |standardized response to emergencies established | |

|three Northern Governorates of Erbil, |in 3 centers. | |

|Sulaymaniya and Dohuk strengthened | | |

| |At least 1 coordinator, 1 paramedic, and 1 driver| |

| |with an ambulance on duty 24/7 per center | |

| | | |

| |System of data collection in place and number of | |

| |patients registered at each center | |

|Component Two: | |To track progress of project outcomes and |

|Capacity Building and Training in Emergency |Technical staff trained in pre-hospital emergency |identify corrective measures as needed. |

|Procedures |services and applying skills learned in their | |

|Capacity built in medical and paramedical |daily work. | |

|staff providing pre-hospital emergency | | |

|services. | | |

|Intermediate Outcome |Intermediate Outcome Indicators |Use of Outcome Monitoring |

|by Component | | |

|Component Three: Blood Banks | |To track progress of project outcomes and |

|Capacity upgraded in existing blood |3 blood banks have been built/rehabilitated, |identify corrective measures as needed. |

|transfusion services to provide a timely |equipped and operating. | |

|supply of safe blood and blood products to | | |

|respond to the needs resulting from an |# of blood units collected and supplied for | |

|emergency. |emergency use. | |

|Component Four: Project Management |The project activities are implemented according |To track progress of project outcomes and |

|Effective administration of project |to the implementation plan. |identify corrective measures as needed. |

|activities. | | |

Arrangements for Results Monitoring

|Project Outcome Indicators | |Target Values | | |

| |Baseline |Year 1 |Year 2 |Data Collection Instruments |Responsibility for Data |

| | | | | |Collection |

|X% lower response time at the 3 centers than average in other|Baseline will be | |Reduction of 50% |ECC Logbook |KRG MOH/UNOPS |

|facilities in the governorates: between call and admission to|collected as soon as | | | | |

|a health facility |the Project becomes | | | | |

| |effective. | | | | |

|Intermediate Outcome Indicators | |Target Values | | |

| |Baseline |Year 1 |Year 2 |Data Collection Instruments |Responsibility for Data |

| | | | | |Collection |

|Construction completed in the emergency coordination center |0 | |3 sites |Site visits |KRG MOH/UNOPS |

|sites | | | |Monthly project implementation | |

| | | | |briefs | |

|Communication equipment in place and functioning |0 | |3 sites |Site visits |KRG MOH/UNOPS |

| | | | |Monthly project implementation | |

| | | | |briefs | |

|Ambulances in place and equipped with radio equipment |0 |12 | |Site visits |KRG MOH/UNOPS |

| | | | |Monthly project implementation | |

| | | | |briefs | |

|Component 2. | | | | | |

|Planning workshop completed and training plan finalized for |0 |1 | |Monthly project implementation |KRG MOH/UNOPS |

|TOT program | | | |briefs | |

|Intermediate Outcome Indicators | |Target Values | | |

| |Baseline |Year 1 |Year 2 |Data Collection Instruments |Responsibility for Data |

| | | | | |Collection |

|Number of physicians trained in emergency clinical procedures|0 | |37 |Monthly project implementation |KRG MOH/UNOPS |

| | | | |briefs | |

|Number of senior Physicians trained in management of |0 | |4 |Monthly project implementation |KRG MOH/UNOPS |

|emergencies | | | |briefs | |

|Number of paramedics trained in BLS |0 | |150 |Monthly project implementation |KRG MOH/UNOPS |

| | | | |briefs | |

|Number of ambulance drivers trained |0 | |90 |Monthly project implementation |KRG MOH/UNOPS |

| | | | |briefs | |

|Component 3. | | | | | |

|Renovation of Sulaymaniya Blood Bank completed |0 | |1 |Site visits |KRG MOH/UNOPS |

| | | | |Monthly project implementation | |

| | | | |briefs | |

|Reparation of ventilation system in Dohuk Blood Bank |0 | |1 |Site visits |KRG MOH/UNOPS |

|completed | | | |Monthly project implementation | |

| | | | |briefs | |

|Construction of Erbil Blood Bank completed |0 | |1 |Site visits |KRG MOH/UNOPS |

| | | | |Monthly project implementation | |

| | | | |briefs | |

|Equipment delivered and installed in the three Blood Banks |0 | |3 sites |Site visits |KRG MOH/UNOPS |

| | | | |Monthly project implementation | |

| | | | |briefs | |

|Component 4 | | | | | |

|PCU established and staff in place by Project Effectiveness. | | | |Monthly project implementation |KRG MOH/UNOPS |

| | | | |briefs | |

|Contract between KRH MOH and UNOPS finalized and signed by | | | |Monthly project implementation |KRG MOH/UNOPS |

|Project Effectiveness. | | | |briefs | |

Annex 3: Summary of Estimated Project Costs

Expenditure Accounts by Components

Totals Including Contingencies (US$ ‘000)

[pic]

Annex 4: Financial Management and Disbursement Arrangements

I. Financial Management (FM)

FM Assessment

Due to the lack of experience in project management, financial management and procurement in the main agency implementing the project (KRG MOH), the Government has requested that the United Nations Office of Project Services (UNOPS) provide support to project management as an implementation agent. All project funds for eligible transactions will be managed and paid by UNOPS. A visit was conducted to the UNOPS Iraq Operations Centre in Amman, in addition to a number of meetings, to assess whether the FM arrangements proposed for the project are acceptable to the Bank in providing reasonable fiduciary assurance that the proceeds of the ITF grant are used for the purposes for which it was granted with due regard to economy, efficiency and the sustainable achievement of the project’s development. Most of the usual FM risks (See below a list of FM risks) associated with Bank administered and financed projects in Iraq are reasonably mitigated with having UNOPS as implementing agent. However, specific project FM risks associated with the new implementation arrangements, the need for cooperation and coordination between KRG MOH, UNOPS, the Bank, and the ITF Fiduciary Monitoring Agent (FM), coupled with the continuous high Country FM risk, render the overall FM risk as substantial. The documentation of the assessment is available in the project files.

Country FM Risk: A Country Financial Accountability Assessment (CFAA) has not yet been undertaken for Iraq; however, Iraq has been defined as one of the “high risk-weak control environment countries” that requires special attention, from the Bank, at various levels. Major reasons for this categorization are the impact of the security conditions and years of isolation, the weaknesses of the public FM system, the inefficiencies of the banking system, and the continuous high corruption rating. Country FM risk, despite the UNOPS element, remains high, since this is the first ITF-financed project focusing exclusively on the Kurdistan Region..

Project FM Risk:

|Risk |Rate |Mitigating Measure |

|Possibility of limited cooperation and coordination between |S |The PIA and the PIM define all related terms, including FM|

|UNOPS and KRG MOH with regard to the FM responsibilities, | |responsibilities and accountabilities. UNOPS staff, KRG |

|coupled with the involvement of the FMA. Lack of knowledge of | |MOH accountant, and the FMA will participate in the |

|Bank policies and guidelines, on the part of KRG MOH and | |Project Launch Workshop and periodic meetings with the |

|UNOPS. | |Bank. UNOPS staff have participated in a Bank-managed |

| | |capacity building workshop on Bank procurement, FM, and |

| | |disbursement guidelines. They met the FMA and discussed |

| | |respective roles and responsibilities. The Project Launch |

| | |Workshop will also include the KRG MOH designated |

| | |accountant. |

|UNOPS entity-wide audit might not be useful to get project |H |The project audit TORs are part of the PIM. KRG MOH will |

|specific audited information. UNOPS may have restrictions on | |ensure that the project is audited by an independent |

|the sharing of audit reports and providing access to auditors.| |external auditor who will be given full access to the |

| | |project documents. |

|With UNOPS as the implementation agent, KRG MOH might have |S |KRG MOH designating a FM staff/accountant to the PCU to |

|limited ownership and FM involvement because of the use of an | |manage the FM aspects of the contract with UNOPS, and to |

|external implementing agent. | |monitor compliance with the FM conditions of the PIA would|

| | |help KRG MOH to gain some knowledge about Bank-financed |

| | |project management. |

| | |The FMA will interact with both UNOPS and KRG MOH in |

| | |carrying out its monitoring of procurement and FM |

| | |implementation in the field. |

|UNOPS accounting system might not be able to generate project |M |Reports generated from UNOPS accounting software were |

|IFRs according to the usual Bank project classifications. | |reviewed and assessed to reflect the IFR requirements as a|

| | |minimum. A mapping to link project categories as per the |

| | |Grant agreement to UNOPS reporting classification was |

| | |prepared and agreed upon. The IFRs would be part of the |

| | |PIA between KRG MOH and UNOPS. |

|Delay in flow of funds from UNOPS to final beneficiaries. |L |UNOPS has experience in efficiently getting funds into |

| | |Iraq using money transfer companies rather than |

| | |traditional banks, with minimal risk. |

|Overall FM project risk |S | |

H = High Risk; S = Substantial Risk; M = Modest Risk; L = Low or Negligible Risk

Project FM Arrangements

UNOPS background: UNOPS is one of the UN agencies responsible for project implementation. UNOPS Iraq Operations Center (IQOC) is a self-financed entity focused on emergency response operations, post conflict rehabilitation and social and economic reconstruction in Iraq. UNOPS IQOC administers part of the Iraq Trust Fund. Through a network of regional offices, NGOs, and individuals, UNOPS IQOC is currently implementing 27 projects in Iraq in widely dispersed sectors and geographical areas, including the health sector in KRG. UNOPS has successfully established required field procedures for needs identification, consultation, contracting, supervision, disbursement of funds, financial management, and for coordination with KRG MOH and other provincial and district entities.

UNOPS IQOC in Amman has a finance department comprising four professional staff. The office in Erbil is staffed with 12 employees, including a financial and administrative professional who will collect the payments’ supporting documentation, conduct a preliminary review and then have the payment requests approved by each project manager. The payment requests are then sent to the office in Amman for further review and processing. The funds are transferred to beneficiaries in Iraq through cash transfer companies and commercial banks. UNOPS confirms that the flow of funds mechanism is very efficient and risk-free. The accounting and reporting of projects’ financial activities are done at the Amman office. As for the audit, it is performed by UNOPS internal auditor.

Staff: UNOPS will utilize its FM consultants/staff in both the Erbil office and the Amman office to cover the FM and disbursement responsibilities of the project. A share of their salaries will be allocated to the project budget. KRG MOH will designate a FM staff/accountant to be part of the established PCU to monitor the FM aspects of the contract between UNOPS and KRG MOH, coordinate the finalization of the first withdrawal application, and receive the project reports submitted by UNOPS. This accountant will have the opportunity to participate in the Project Launch Workshop and other events organized to build capacity in Bank policies on FM.

Internal Control: For the payment authorization process, invoices and payment requests for completed and delivered works, goods, and services will be technically and financially reviewed and certified by UNOPS and shared with the KRG MOH PCU.

Budgeting and Forecasting: UNOPS will maintain a project budget and detailed disbursement plan per quarter. This plan will be developed based on the initial procurement plan and estimated payments cycles, and revised upon need. It will be used as a monitoring tool to analyze budget variances as well as providing a basis for requesting disbursements.

Accounting, Records Keeping and Reporting: UNOPS will be using its own integrated web-based information system combining procurement, accounting, and budgeting integrated modules to account for and report on the project financial activities.

Reporting: Samples of the reports generated by the information system were already reviewed and assessed to cover most of the Bank reporting requirements. A mapping to link project categories as per the Grant agreement to UNOPS reporting classification was prepared and agreed on. UNOPS will ensure that adequate measures will be taken to comply with the reporting requirement and will prepare and send the reports as follows to the Bank with a copy to the FMA and KRG MOH. The reporting formats were agreed upon and are part of the PIA and PIM.

• Simplified Quarterly Interim un-audited Financial Reports/IFRs submitted to the Bank within one month of the quarter just ended. These reports consist of a statement of sources and uses of funds by project category and UNOPS classification, and a contract commitment control sheet. A form of quarterly payment request will be added to the IFRs and submitted to the Bank to report on the payments made during each quarter, forecasted payments for the next six months and the balance of funds left in the bank account. These IFRs will be the basis of disbursement and will be reviewed by the FMA.

• Annually Project Financial Statements (PFS) and audited PFS with the independent auditor opinion submitted to the Bank not later than six months after the end of each fiscal year. The PFS include: (i) an annual statement of sources and uses of funds by project category and UNOPS classification, and (ii) a control list of contract commitments.

Auditing Arrangements: An external independent auditor acceptable to the Bank will be engaged to carry out the project audit in accordance with international standards of auditing, issue the required independent opinion, and prepare the management letter. The audit report and management letter will be submitted by the KRG MOH to the Bank not later than six months after the end of each fiscal year. An escrow account will be used to pay the auditor after the project’s closing date. The audit terms of reference are included in the PIM.

Fiduciary Monitoring Agent (FMA): The Bank has hired an independent firm that is currently operating in Iraq covering ITF-financed projects as follows:

• Verifying and validating to the Bank the projects’ FM and procurement arrangements and internal controls agreed upon with the implementing agencies.

• Monitoring the physical progress of Project activities.

• Providing advisory services and technical support to the Iraqi government and the ITF-financed projects relating to the projects’ FM and procurement arrangements and the generation of periodic and reliable financial reports.

To perform their responsibilities, the FMA will be granted access to the project documents at KRG MOH and UNOPS in Erbil and Amman. The FMA responsibilities and right to access project records will be documented in the Project Implementation Agreement. For further detailed information concerning the role and responsibilities of the FMA, please refer to the Project Implementation Manual (PIM).

Project Implementation Manual (PIM): KRG MOH, through UNOPS, has prepared a PIM based on the Master Implementation Manual (MIM) prepared for all Bank-financed projects implemented in Iraq. This manual will give guidance on the policies and procedures of implementing the project, procuring its activities, and managing its finances and records. The preparation of this manual is one of the conditions of Bank management approval.

The KRG MOH has a Project Implementation Agreement with UNOPS covering compliance with the project FM arrangements required by the Bank.

Flow of Funds: KRG MOH will submit a Withdrawal Application to the Bank to set up a Blanket Commitment for UNOPS to allow for the periodic drawdown of Grant Funds (see Disbursement section for more details). UNOPS will make the payments to contractors, suppliers and consultants through a money transfer company that delivers cash money to Iraq for a certain percentage. The risk of losing the money is almost nil as UNOPS requests this company to make the payment and, upon receipt of confirmation from the beneficiary, the company is reimbursed.

Supervision

The Bank, as ITF administrator, will supervise ITF-financed operations in accordance with the Bank’s applicable policies and procedures. Supervision of recipient-executed operations in the Kurdish Region will be carried out by a small Bank team, and supplemented by use of consultants and the FMA. If security conditions and affordability make travel to Iraq impossible for Bank staff, supervision missions will be undertaken from an alternative location. The Bank team will closely monitor financial management arrangements throughout the project life. Supervision during the first year will be conducted quarterly.

FM Action Plan

|Action |By Whom |Date |

|Identify project FM staff from UNOPS and KRG MOH in Erbil |KRG MOH/UNOPS |By negotiations |

|Finalize FM section in project implementation agreement |UNOPS/KRG MOH |By negotiations |

|Start external auditor selection process |UNOPS |Upon effectiveness |

II. Disbursement

The project will be financed through a Grant made under the ITF, and 100% of the Grant will be disbursed through a Project Implementation Agreement between KRG MOH and UNOPS to carry out works, goods and consultant services and training, including workshops. The KRG MOH will provide implementation support, including the assignment of KRG MOH staff to the PCU. The KRG MOH will finance staff salaries and some related operating expenses.

Advances can be directly made to UN agencies under a special arrangement called a blanket commitment. The disbursement is made to the New York account of UNOPS, and they make their own arrangements to send the funds to Iraq, thereby reducing the risks undertaken by the Bank. KRG MOH, through UNOPS, will submit a withdrawal application requesting the Bank to set up a Blanket Commitment for UNOPS for the full value of the project. This withdrawal application authorizes UNOPS to draw down periodically under this blanket commitment. Each drawdown by UNOPS is treated as an advance, and requires quarterly interim un-audited financial reports (IFRs) from UNOPS to account for use of funds. At the end of the project, UNOPS will be required to return all unused funds to the Bank. This procedure will be part of the Project Implementation Agreement.

The contents of the IFRs are disclosed above in the FM section. They are part of the Project Implementation Agreement. UNOPS will be required to keep KRG MOH informed at all times on financial progress of the project. The use of the Blanket Withdrawal procedure, however, does not preclude KRG MOH from disputing direct disbursement requests made by UNOPS to the Bank, at any given time.

The proceeds of the Grant will be disbursed in accordance with the Bank’s guidelines and project disbursement letter. The proposed Project has been designed to be implemented over a 24 month period. Grant funds are expected to be disbursed fully by the Project Closing Date of June 30, 2010. The disbursement categories and amounts and percentages to be financed under each category are presented in Table A below.

Table A: Allocation of Grant Proceeds

|Disbursement Category |Amount of the Grant Allocated |Percentage of Expenditures |

| |(expressed in USD) |to be Financed |

| | |(inclusive of Taxes) |

|1. Works |1,620,000 |100% |

|2. Goods |4,450,000 |100% |

|3. Consultancy Services |200,000 |100% |

|4. Training |320,000 |100% |

|5. UNOPS fee |415,000 |100% |

|6. Operating costs | |100% |

|(a) UNOPS |1,185.000 | |

|(b) PCU |75,000 | |

|7. Unallocated |435,000 |100% |

|Total Amount |8,700,000 | |

Table B: Disbursement Schedule (US$ million)

|Fiscal Year (FY) |FY08 |FY09 |FY10 |

|(July – June) | | | |

|Annual |0.1 |4.4 |4.2 |

|Cumulative |0.1 |4.5 |8.7 |

Annex 5: Implementation and Procurement Arrangements

Introduction

The proposed project responds to the KRG MOH request for emergency funds from the Iraq Trust Fund (ITF) to assist the MOH in improving its emergency response system and safe blood supply in the three provinces of the Kurdish Region.

Project Implementation Arrangements

The implementation arrangements are described below.

KRG MOH

The agency that is the beneficiary of the funds from the project is the KRG MOH. An implementation structure has been discussed and agreed upon with the KRG MOH. The structure takes into account the need for: (i) accelerated implementation; (ii) building ownership at the KRG MOH; and (iii) building MOH project implementation capacity. A key element guiding implementation at the KRG MOH will be the contracting of UNOPS as an Implementation Agent to provide support in management of the works, goods, consultants, workshops and training activities under the project.

Bank review of UNOPS experience in implementation of procurement has been limited to meetings with operational staff based in Amman, Jordan, of its procurement manual and a sample of bidding documents and information contained in its website. UNOPS’ fundamental procurement principles are the same as those of the Bank, as are most of its procurement guidelines and procedures for procurement of small works and goods, and selection of consultants. A Bank procurement workshop will be conducted during the project launch workshop to ensure UNOPS procurement staff who will be involved in project implementation are familiar with Bank procurement guidelines and procedures to be used in the project as stipulated in the PIM.

Project Supervision and Monitoring

The World Bank team of sector specialists will provide regular technical oversight support to project activities, as sequenced through the Implementation Schedule, and through 3-4 supervision missions each year. The Bank also has hired a local procurement staff on the ground in Erbil to follow up on the procurement aspects of the project. Bank project supervision shall be in accordance with Bank policy and procedures. The project will also be supervised on a periodic basis by the Trust Fund Fiduciary Monitoring Agent. The role of the FMA will include: (i) monitoring the physical progress of the project; (ii) validating that the Recipient is in compliance with financial management and procurement procedures of the Bank; and (iii) providing technical assistance, in the form of on-the-job training, to the KRG MOH staff involved in the project.

Procurement Arrangements

I. General

1. Project Information:

Country: Republic of Iraq

Recipient: KRG MOH

Project Name: Regional Health Emergency Response Project

Project No: P107698

Trust Fund Grant Amount: US$8.7 million

Project Implementing Agency (PIA): KRG MOH

2. Bank’s approval Date of the Procurement Plan: March 15, 2008

3. Date of General Procurement Notice: May 5, 2008

4. Period covered by this Procurement Plan: Two years

II. Works, Goods, and Services other than Consultant Services

1. All procurement of works, goods, and services other than consultants’ services shall be carried out by UNOPS in accordance with Bank policies, guidelines and procedures, and in accordance with the procurement arrangements stipulated in the Iraq Trust Fund Grant Agreement entered into between IDA (as Administrator of ITF) and the Iraqi Ministry of Health for Kurdistan Regional Government. The following procedures have been determined to be the most suitable for the country-specific conditions and the urgency for execution of the project:

• International Competitive Bidding (ICB) and Limited International Competitive Bidding (LICB). These methods would be suitable for the procurement of goods when contracts are large (exceed US$500,000 equivalent per contract) and when such goods are not readily available in the country.

• National Competitive Bidding (NCB). This method of procurement would be suitable for the procurement of works as the size of contracts would not be of interest to international contractors; and for procurement of goods when the size of each contract does not exceed US$500,000 equivalent and such goods are readily available in the country, and for which in-country after-sales services would be required.

• International (IS) and National Shopping (NS). These procedures would be suitable for small purchases (not exceeding US$100,000 equivalent per contract) which shall consist of requesting price quotations from at least three qualified suppliers. IS shall be used when such goods are not available in the country, and NS procedures shall be used when such goods are readily available in the local market.

2. Reference to Project Implementation Manual. A simple Project Implementation Manual (PIM) has been prepared. The PIM is based on the Iraq Master Implementation Manual (MIM) prepared by an international consulting firm financed under the Capacity Building Trust Fund for Iraq.

3. Procurement packages with respective procurement methods and time schedule are given in the attached procurement plan, which will be included in the PIM.

III. Selection of Consultants

1. Selection

Selection and employment of consultants shall be carried out by UNOPS in accordance with Bank policies, guidelines and procedures, and in accordance with the procurement arrangements stipulated in the Iraq Trust Fund Grant Agreement entered into between IDA (as Administrator of ITF) and the Iraqi Ministry of Health for Kurdistan Regional Government. The following selection methods have been determined to be applicable to the project specific needs:

• Consultants’ Qualifications (CQ) Selection. Since the size of consultancy contracts will be small (less than US$200,000 equivalent per contract), Consultants may be selected from a short-list of at least three firms which may have been pre-qualified based on previous experience in the country, and select the firm with the most appropriate qualifications and references. It should be noted, however, that country-specific conditions may limit consultants to those who generally operate along geographic boundaries and in such instances the short-list should follow such local conditions. Short-lists consisting of less than three firms may be acceptable when there are very few qualified firms who may be interested in participating in the competitive selection.

• Least-Cost Selection (LCS). This method may be used for the selection of the external auditing firm to carry out the annual independent audits of project accounts, as well as the selection of engineering/architectural firms for the design and construction supervision of the civil works included in the project.

• Single-Source Selection (SSS). Consultants may be selected in accordance with SSS procedures for: (a) very small assignments (less than US$100,000 equivalent); (b) when only one firm is proven to be qualified based on previous knowledge of country-specific conditions; and (c) emergency cases where expeditious implementation of the services due to country-specific conditions is the most-effective way to implement the assignment. This method of selection may be the most suitable for the selection of qualified training providers as the specific nature of specialized training being considered under the project would not be suitable for competitive selection. The selection would then be determined after undertaking direct consultations with the few qualified training providers who would be interested to provide such services within the timetable required and in accordance with terms of reference for the specific assignment.

2. Bank prior review and review ex-post. Bank prior review is shown in the procurement plan. Other Bank prior review of selection of consultants would be limited to the review of terms of reference for training activities and the pre-selection of available training providers. The Bank reserves the right to undertake a review ex-post of a representative sample of all contracts for works, goods, services and consultants, as indicated in the Project Implementation Manual.

Implementation Schedule and Procurement Plan

The following chart provides the draft implementation schedule and the draft procurement plan for all project activities. The schedule will be updated periodically as needed to account for changing requirements.

Attached

Regional Health Emergency Response Project (RHERP)

Consultant Selection, Design, Bidding and Construction Activities*

[pic]

The above Implementation Schedule will be discussed and revised in accordance with the UNOPS Work Plan during the Project Launch in July 2008.

Procurement Arrangements

(US$ ‘000)

[pic]

Regional Health Emergency Response Project

Procurement Plan

[pic]

The above Procurement Plan will be discussed and revised in accordance with the UNOPS Work Plan during the Project Launch in July 2008.

[pic]

The above Procurement Plan will be discussed and revised in accordance with the UNOPS Work Plan during the Project Launch in July 2008.

Annex 6: Project Preparation and Appraisal Team Members

|Jean Jacques Frere |Sr. Health Specialist, Task Team Leader |

|Virginia Jackson |Sr. Operations Specialist |

|Vasilios Demetriou |Sr. Implementation Specialist, Architect |

|Mario Zelaya |Sr. Procurement and Safeguards Specialist |

|Nikolai Soubbotin |Sr. Legal Counsel |

|Mona el Chami |Financial Management Specialist |

|Colin Scott |Social Safeguards Specialist |

|Nazaneen Ali |Procurement Specialist |

|Mira Hong |Operations Analyst |

|Emma Etori |Program Assistant |

Annex 7: Documents in Project Files

Republic of Iraq: Interim Strategy Note (2005)

-----------------------

[1] Child Health Survey 1989,

[2] The Impact of the Oil for Food Programme on the Iraqi People, UN Independent Inquiry Committee, Sept 2005

[3] Child and maternal mortality surveys, UN, 1999

[4]In the North, the serious nutritional situation existed prior to 1991 but it improved between 1991 and 2000. By 2002, the prevalence of underweight among children was 8.6%in the North and 9.4% in the Center/South.

[5] .UNICEF Third Multiple Indicator Cluster Survey (MICS3): in Kurdistan, 32 deaths per thousand live births for the IMR and 39 per thousand deaths for under 5 mortality. There are no significant differences with the figures obtained for the rest of Iraq (IMR: 34/1000 and U5 MR: 41/1000). At this stage, without further review, there is no reason to question the validity of the survey, but these rates probably underestimate infant and child mortality and they should be compared with the most recent figures from Egypt where the U5 MR is 38/1000 and from Morocco where the U5 MR is 50/1000. Another recent survey supported by UNDP in 2004 had also produced what is generally considered as low estimates for infant and child mortality.

[6] According to the same survey about nine per cent of children are overweight.

[7] The 1999 data for the three Northern Governorates of Dohuk, Erbil and Sulaymaniya showed significantly lower infant and under-5 mortality than in Southern and Central Iraq (60/1000 for the IMR and 72/1000 for U5MR, with a relatively more favorable situation in Sulaymaniya than in Erbil and Dohuk.) More recent data are not available.

[8] The 1997 census, which is the most recent source of information on population, did not cover the three Northern provinces, and population figures for Erbil, Dohuk and Sulaymanyia are based on estimates. In addition, a presumably large number of IDPs from other parts of Iraq have moved to Kurdistan.

[9] Excluding physicians in training, such as interns and residents.

[10] The air conditioning system is not functioning, which puts additional strain on the refrigeration system.

[11] Background on UNOPS is presented in paragraph 38 below.

[12] For more details on the responsibilities of the “focal points” in the project, please refer to the PIM, page 4.

[13] The ITF Board Paper indicates the following: “The preparation of ITF-funded projects would be carried out on an accelerated basis using the procedures outlined in OP 8.50 (Emergency Recovery Assistance) in order to provide near-term recovery assistance. Streamlined procurement and disbursement procedures, consistent with Bank guidelines and used in other post-conflict situations, would be employed. Given the Government’s severely strained fiscal position, the Bank would finance 100 percent of eligible expenditures under ITF-funded projects. To ensure appropriate accountability and transparency in the use of funds, projects would be designed consistent with Bank financial management requirements, and accounts would be audited according to Bank guidelines.”

[14] Further information on the responsibilities of the FMA can be found in Annex 4 of this document, and in Annex A of the Project Implementation Manual.

[15] If necessary, training will be provided to relevant KRG MOH staff on medical waste disposal, in collaboration with WHO.

[16] A standard EMS indicator. This need to be monitored beyond the life of the project as there are not enough centers in KRG’s 3 governorates.

[17] Projected maximum capacity of each center equipped with 4 ambulances would be around 40 interventions per day.

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Documents

Funds

Payments

Disbursement

FMA

Blanket WA

IFRs

Reviewed IFRs

UNOPS

Contractors, Suppliers and Consultants

Invoices

ITF

IFRS/ supp doc

Request Payment/ IFRS

KRG MOH

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