Date of Submission to Coordination Unit:
April 18, 2017
A. GENERAL INFORMATION
1. Activity Name
The Libya Health Sector Support Advisory Services and Analytics (ASA) Program
2. Requestor Information
Name: H.E. Mr. Al-Taher Al Juhaimi;
Title: Minister of Planning;
Mr. Esam Garbaa
Director of International Cooperation
Organization and Address: Ministry of Planning,
Tripoli, Libya
Telephone/Fax: +218 21 444 2448.
Email:
[email protected]
3. Recipient Entity
Name:
Title: Country Director
Mrs. Marie Francoise Marie-Nelly
Maghreb Department
Regional Middle East and North Africa Office
World Bank
Organization and Address: World Bank, Regional MENA Office
7, Rue Larbi Ben Abdellah,
Rabat-Souissi, Morocco
Telephone: 527 54 42 00
Email:
4. ISA SC Representative
Name: Mrs. Ayat Soliman
Title: Practice Manager,
GSU11 – Urban, DRM MNA
World Bank
Organization and Address: World Bank,
Room J 6-111,
1818 H Street
NW Washington, DC 20433
Telephone: (202) 458-7441
Email: [email protected]
5. Type of Execution (check the applicable box)
√
√
Type
Country-Execution
Joint Country/ISAExecution
ISA-Execution for Country
ISA-Execution for
Parliaments
Endorsements
Attach written endorsement
from designated ISA
Attach written endorsement
from designated ISA
Please see attached
Attach written endorsements
from designated Ministry and
ISA
Justification
(Provide justification for ISA-Execution)
Government capacity remains weak, and
therefore the ISA will administer activities.
Additionally, there are several activities that
are advisory support and analytics (ASA).
6. Geographic Focus
√
Individual country (name of country): Libya
Regional or multiple countries (list countries):
7. Amount Requested (USD)
Amount Requested for direct Project Activities:
(of which Amount Requested for direct ISA-Executed Project Activities):
Amount Requested for ISA Indirect Costs: 1
Total Amount Requested:
2,373,600
26,400
2,400,000
8. Expected Project Start, Closing and Final Disbursement Dates
Start Date:
July 1, 2017
Closing
Date:
June 20, 2020
End Disbursement
Date:
December 30,
2020
9. Pillar(s) to which Activity Responds
Pillar
(One only)
Secondary
(All that apply)
Pillar
Investing in Sustainable Growth.
Enhancing Economic Governance.
This could include such topics as
innovation and technology policy,
enhancing the business environment
(including for small and medium-sized
enterprises as well as for local and
foreign
investment
promotion),
competition policy, private sector
development strategies, access to
finance, addressing urban congestion and
energy intensity.
This could include areas such as
transparency,
anti-corruption
and
accountability policies, asset recovery,
public financial management and
oversight, public sector audit and
evaluation,
integrity,
procurement
reform,
regulatory
quality
and
administrative simplification, investor
and consumer protection, access to
economic
data
and
information,
management of environmental and social
impacts, capacity building for local
government
and
decentralization,
support for the Open Government
Partnership, creation of new and
innovative government agencies related
to new transitional reforms, reform of
public service delivery in the social and
infrastructure sectors, and sound banking
systems.
Inclusive Development and Job
Creation. This could include support of
Competitiveness and Integration.
policies for integrating lagging regions,
skills and labor market policies,
increasing
youth
employability,
enhancing
female
labor
force
participation, integrating people with
disabilities, vocational training, pension
reform, improving job conditions and
regulations,
financial
inclusion,
promoting equitable fiscal policies and
social safety net reform.
1
Primary
√
Primary
(One only)
Secondary
(All that apply)
√
This could include such topics as logistics,
behind-the-border
regulatory
convergence,
trade
strategy
and
negotiations, planning and facilitation of
cross-border
infrastructure,
and
promoting and facilitating infrastructure
projects, particularly in the areas of urban
infrastructure,
transport,
trade
facilitation
and
private
sector
development.
ISA indirect costs are for grant preparation, administration, management (implementation support/supervision) including
staff time, travel, consultant costs, etc.
B. STRATEGIC CONTEXT
10. Country and Sector Issues
Country-wide Challenges
Six years after the 2011 popular revolution against Gaddafi and the subsequent NATO-led military intervention, the
country’s political and security environment remains uncertain.
Libya faces a governance challenge as two parallel health authorities are governing. There are currently two parallel
health authorities in Libya: Al Bayda and Tripoli. Cooperation between these authorities is however reportedly ongoing
through both formal and informal channels.
Given the conflict, the country’s socioeconomic and demographic situation has worsened. Households are becoming
vulnerable, as many Libyans have lost their jobs and income, and price inflation of goods and services are rising faster than
wage inflation. The population is vulnerable given their economic situation and the insecure environment that they live in.
Sector-wide Challenges
a.
Health Service Use
Given the epidemiological transition, and the conflict situation, there is need to highlight a few concerns. Among children
under-5, there is a concern of them falling through the cracks and not receiving essential public health program (e.g.
immunization) in a timely manner. Among adolescents, there is a concern of limited commodities, resulting in high fertility.
Quality of basic care, such as essential maternal, obstetric, neonatal and child care, is lacking. There is concerns of new
emerging problems on mental health and trauma, gender based violence. Among adults, there is a concern from lifestyle
illnesses (cardiovascular, diabetes), and a rising burden from accidents and injuries – a result of the conflict.
b.
Health Service Delivery System
Resulting from its conflict, Libya has faced a drastic and adverse effect on its health service delivery. While demand for
health care is rising, including for new and reemerging needs, service delivery has not adequately responded to these
demands. The problem lies in the service delivery model and capacity: from primary care to hospital care. The reasons for
the failing delivery systems, include: staffing, financing, and governance, and in-access to adequate care and to services,
among others.
The bigger challenge is that many hospitals are unable to provide the required services. Most hospitals lack capacity to
offer general emergency services and specialty surgical services. Recent information is suggesting that despite a new burden
for hospital emergency care, a result of armed conflict and accidents, public hospitals are unable to be responsive. Recent
staffing challenges with the exodus of expats has created high distress for hospital responsiveness.
Access to many basic primary health care services are lacking in quantity and quality. Staff shortages, drug stock outs,
and limited funding for recurrent budgets, made many of these facilities ineffective. There are serious concerns on not only
in-access, but also on hindering quality of care. Many programs, such as mental health, and control of noncommunicable
diseases do not exist.
Since the onset of the conflict, the number of health personnel is expected to be inadequate, as a result of:


Displacement/departure of health personnel from insecure areas, predominantly specialists (anaesthetists, surgeons,
obstetricians, etc.).
High dependency on foreign health personnel (especially in nursing), many of whom left the country following the
renewed onset of violence in mid-2014, and who have not been replaced yet.
The phenomenon of “ghost health personnel”, whereby health workers are on payroll but do not turn up for work.
c.
Health Finance and Governance

Budgets have sharply declined and most of the resources are allocated towards salaries, but not operations. Some basic
care, including immunization, are covered as part of the basic package but release of funds seem to be slow. Many staff are
complaining of not being paid. Many programs are delayed in its delivery, as there is limited or no operations budgets. For
operations, there is high reliance on external financing coming through humanitarian assistance – most of which are offbudget and through nongovernment organizations. This of course creates further fragmentation and lack of coherence in
adequately responding to needs.
Governance structures, and accountability mechanisms are lacking and provider performance is a concern. Many
mechanisms and controls and monitoring systems do not exist.
The Libyan health sector reflects the weaknesses of institutions of the country at large. Many policies and strategies
remain outdated.
Lack of data is a concern. Routine health information systems are not reliable. Provider performance information is not
available.
To address these health concerns, there is dire need to build strategy for a new model of care that strengthens the health care
delivery system: from primary health care program to essential hospital services. Special emphasis is required on governance
and access.
11. Alignment with Transition Fund Objective
This proposed ASA is well aligned with the Transition Fund objectives. Its primary alignment is with enhancing economic
governance, as it will support the government to reform public service delivery in the health sector. While doing this, it
will help develop accountability mechanisms, and enhance financial management and oversight. Furthermore, the proposed
ASA is also aligned with the scope of inclusive development and job creation. Under this secondary alignment, it seeks to
conduct a workforce analysis with the health sector that should help the government develop human resources in health
policies and strategies, including enhancing female labor force participation.
12. Alignment with Country’s National Strategy
Among Ministry of Health (MOH) priorities identified for the coming years (2017 and beyond), include the need to develop:
A reproductive maternal, neonatal, child and adolescent health care (RMNCAH) strategy along with an implementation
plan. This includes strengthening basic and comprehensive Emergency maternal obstetric and neonatal care (EmONC), and
training in basic and comprehensive EmONC services.
A multi-sectoral non-communicable disease control (NCD) and mental health strategy and implementation plan.
MOH is already leading efforts on a Service Availability and Readiness Assessment (SARA). This is providing a situation
assessment of health facilities. MOH also aims to have future/upcoming surveys conducted, including maternal and infant
mortality survey, and a Noncommunicable disease (NCD) risk factor survey [STEPwise approach to surveillance (STEP)].
MOH has identified a need for a strategic review of and assistance in the budget and need-based financial allocations,
capacity building of program managers and mid-level decision makers on results-based management, project management
including financial management and fiscal controls and emergency preparedness and response. They have also highlighted
their need to have a mechanism to respond to the current emergency situation, by identifying alternate means of financing.
Another area of priority identified is the need for an efficient and a relatively quick mechanism for enhancing the capacity
of types of health workforce. MOH has requested for a workforce analysis.
MOH is also seeking for better coordination of the international community when it comes to donors support.
[These priorities were presented by the National Center for Disease Control (NCDC, 2016-2017), in February 2017.]
The Libya MOH has requested for technical assistance from the Bank in the following three areas: (a) health financing
and governance, (b) human resources for health (HRH), and (c) health care service delivery.
The Bank team has a comparative advantage in the area of health financing and public financial management. MOH has
requested the Bank team to have a forward-looking perspective. Their immediate needs are to understand how to allocate
their budget in such a budget constraint environment. They are keen to understand how to use their budget more efficiently
towards value for money, and to allocate it more equitably within the country. The government has also requested for some
capacity building in health financing. From the Bank team’s recent engagement among some key partners, it seems that
currently this remains as a technical assistance gap.
The Bank has provided assistance in many countries to diagnosing the human resource situation through a workforce
analysis, and to providing evidence for development of the HRH strategy. This is key element to address the shortcomings
of health service delivery. MOH has requested for Bank’s assistance, and the Bank team could help with this first step.
From the Bank team’s recent engagement among some key partners, it seems that currently this remains as a technical
assistance gap.
The Bank team has been helping several countries, including fragile, conflict and violence (FCVs), address their weak
primary health care program and help them to streamline and strengthen the health delivery systems including essential
hospital services. Many partners are coming to provide humanitarian assistance in Libya. Several partners are engaged at
some level of care, but no one is looking at the situation comprehensively and strategically. This could lead to fragmentation
in the model of care, and not benefit from the effects of economies of scope and scale. MOH has requested for the Bank’s
assistance. From the Bank team’s recent engagement among some key partners, it seems that currently this remains as a
technical assistance gap.
C. PROJECT DESCRIPTION
13. Project Objective
To support the strengthening of health service delivery to the population in Libya.
14. Project Components
The Project or ASA (Analytics and Advisory Services) will focus on aspects that will help strengthen the health service
delivery needs. It will address areas to use cost effective interventions, to find alternate solutions to bring health care to the
devastated population in a timely and affordable manner, to improve efficiency, and governance and management of service
delivery. There are three components:



Component 1: Human resources for health
Component 2: Health service delivery model
Component 3: Health financing and governance
Component 1: Human resource management, enhancing staffing skills, and management systems
In Libya MOH, many policies do not exist or policies and strategies remain outdated. MOH does not have a recent HRH
strategy. While hospitals relied upon expats, clinics relied upon locally trained health personnel. As many expats have left
the country, the hospitals are understaffed and cannot perform. While the country had adequate physicians, it had many
more nurses/midwives. Libya could benefit from planning and forecasting their staffing needs and linking it to production
of these cadres and to their recruitment and placement. The preservice education systems are outdated. There is need to
upgrade the curriculums. The private sector is growing, but there is no private sector policy in place. Staff performance has
been a concern. Staff skills mix are inadequately responding to population health needs. A comprehensive workforce
analysis and a HRH strategy will be key.
Activities: Three specific activities are planned: (i) a workforce analysis, (ii) a report and recommendations towards
interventions in human resources for health 2, and (iii) health workforce training needs assessment/consultation.
A workforce analysis will be conducted for health service providers. For this a proposal will be developed. The study will
consider the following: (a) stock of health workers, (b) distribution of health workers, and (c) performance of health workers.
The World Bank has tools for health provider assessments under the “Service Delivery Indicators (or SDI)”. This study
should provide information on the quality and performance of care provided. It should also provide information on the
presence of health service providers in facilities, as well as, a better understanding of constraint and disincentives to
providing quality care. This type of an assessment will be conducted at both primary care level and at secondary hospital
level. It will review both public and private providers. This study will also provide input in to the dynamics damage and
needs assessment, which looks at the effect of the conflict and how health service delivery has been effected in both hard
and software components.
Report and recommendations will follow the workforce analysis. For this report, the following will be reviewed: (a) Public
sector role in planning and forecasting human resource needs for health, (b) interventions to increase stock and improve
distribution and performance of human resources in health, and (c) financing available for policy and interventions.
Emphasis will be provided for female labor force participation, such as the programs on nursing and midwifery, and on their
barriers to environments in which they work. The Report will include international lessons learned for MOH to
prepare/update their HRH policy and strategy.
In a conflict setting, there is little time and resources to invest in the development of education programs. There is however
urgency to provide the appropriate skills to service providers and easy access to services for the population. The ASA will
therefore start with (a) exploring online training programs, and (b) mapping out the internet technology readiness in Libya
for online training programs to be accessible to service providers. Many international education institutions are now
providing online training programs. The ASA will seek examples of other successful online education and training
approaches in fragile or conflict settings that might serve as models for addressing health workforce and service delivery
issues. Additionally, the ASA will map the availability of online or virtual programs and platforms for delivering life-saving
medical services and medical education, training, and counselling to providers, with consideration provided to their funding
sources, levels of uptake, and impact. This will be connected with for component 2 of this ASA. The ASA will also assess
the barriers to the adoption and scale-up of online or virtual programs in training and in service provision.
Partnership: Institutional assessment would be considered as an exercise partnered with UNICEF. Efforts would be
coordinated with several partners working on strategies for capacity building, including with WHO on the nursing program
and with UNFPA on the midwifery program.
Component 2: Designing health delivery system including PHC and essential hospital services
The health delivery system is fragmented. There are several reasons for this: (a) different levels of health facilities and
services report to different administrative authorities, (b) limited policies and strategies building the health delivery systems.
Importantly, Libya is a country in conflict: only one-third of primary health care (PHC) clinics are fully functional and only
40% offer basic maternal and child health care. General medical curative services, general surgical services, patient services,
and emergency services are available in at least 60% of hospitals, but only 50% of hospitals have the capacity to offer
maternity services. Only 9% of hospitals have appropriate staffing and care for mental health patients. Hospitals are
2
Reference: World Bank. 2012. Directions in Development. Toward Interventions in Human Resources for Health in Ghana:
Evidence for Health Workforce Planning and Results.
therefore unable to provide the essential package of care. Quality of care and motivation of providers are a concern, and the
budget and payment mechanisms do not incentivize performance of care. Medical supplies are in short supply. [SARA,
2017].
The health delivery system lacks the planners to develop a system responsive to the current health needs of the population
and its new demographics. The government is looking at a new model of care, concentrating on primary health care and
essential hospital services. To make the system more cost effective and efficient, the building of the health delivery system
will be critical. An alternate model of care is required to respond to the existing situation in the country.
Activities: The activities will be divided into three phases: (i) rapid diagnostics, and design of the integrated model of care,
(ii) advisory support for the implementation of the integrated model of care (on pilot basis), and (iii) evaluation of the pilots
with lessons learnt, and recommendations for refinement and scale up.
For phase (i), a rapid diagnostics will be run along with designing the integrated model of care. The rapid diagnostics will
provide mapping of service providers, service provision and constraints. It will also examine administrative and
programmatic links between primary and secondary health care, especially for programs such as maternal, obstetric and
neonatal care and referrals, mental health, trauma and gender based violence, and non-communicable diseases. It will also
explore internet technology readiness in Libya for exploring online service provision, such as for counsellors. Additionally,
the review will assess patient’s preferences for service delivery, barriers and constraints. The rapid diagnostics will also
provide input in to the dynamics damage and needs assessment, which looks at the effect of the conflict and how health
service delivery has been effected in both hard and software components. This phase should provide some baseline
information for the pilot sites.
The Pilot design in service delivery (using the integrated model of care) will focus on identifying the innovations necessary
to ensuring continued service delivery to provide essential health services for the population. It will identify: (a) the package
of essential primary and secondary services appropriate to a conflict situation; this will be developed in collaboration with
WHO. Based on the diagnostics above the package will address options for service delivery, including contracting out to
nongovernment service providers, and to off-site/virtual service provision. Emphasis will also be provided (a) to community
based health services, including mobile and outreach services; (b) to opportunities for public private partnerships; (c) to
options for improving the efficiency of governance structures, accountability mechanisms, and performance incentives; (d)
to a financing mechanism that respond to the existing regional constraints; and, (e) to mechanisms for monitoring provider
performance and patient satisfaction.
For phase (ii), pilot sites will be identified whereby the service delivery strengthening modality will be introduced. The
ASA will provide advisory support to the government (who is the implementing agency). Most financing for service
provision (salaries and operations costs) are expected to be mobilized through budgets. While design, systems strengthening,
capacity building, and monitoring and oversight could be provided through the ASA and through partnership with the other
development partners. Third party monitoring (or remote sensing technology) will be put in place. For this, appropriate
entities will be selected, such as international nongovernment organizations (INGOs) and local NGOs. Provider
performance monitoring as well as patient satisfaction aspects will be considered. However, close monitoring will be
observed to learn and to modify activities within the pilot sites. For phase (iii), pilot sites should be evaluated through process
evaluation using administrative data after 18-24 months of implementation. Methodological approaches will be explored to
monitoring and evaluation of these initiatives to ensure good value and quality. Recommendations will be provided for
refinement and scale-up.
Partnership: Close collaboration will be maintained with partners, especially European Union (EU) and the GIZ, who are
also supporting pilot implementation to strengthen service delivery. EU is also interested in partnering on the development
of the public private partnership framework. Close coordination and collaboration will also be maintained with WHO, who
are leading the efforts in preparing the essential benefits package of care.
Component 3: Health financing and governance
Budgets have sharply declined and most resources are allocated towards salaries, and away from operations budget. Some
basic care, including routine immunization, are covered as part of the budget but release of funds seem to be often delayed.
Many staff are complaining of not being paid. Many programs are delayed in its delivery, as they have limited or no
operations budgets. For operations, there is high reliance on external financing coming through humanitarian assistance,
which is off-budget and through nongovernment organizations. This of course creates further fragmentation and lack of
coherence in adequately responding to needs. MOH realizes its resources are not spent efficiently. For example, it is
expected that Libya pays much higher prices for vaccines then what can be secured through UNICEF, it is also expected
that drugs are procured at above international reference pricing. Many drugs procured by Libya are branded rather than
generics. Libya can benefit from several cost reducing policies.
Activities: Three specific activities are planned: (a) advisory support on planning and budgeting (2018-2020), (b) capacity
building in health financing, and (c) design of a resource pooling mechanism.
MOH is quite constraint as budgets have fallen drastically. Of the budget that is available to them, most are for staff salaries.
Operations budget has declined several-folds. MOH has requested the Bank team for assistance to help them rationalize their
budget and spending. Their immediate needs are to understand how to allocate their budget in such a budget constraint
environment. They are keen to understand how to use their budget more efficiently towards value for money, and to allocate
it more equitably within the country. The Bank team will provide advisory support to MOH in reviewing their budgets, and
in providing recommendations. Additionally, the Bank team will also provide a report and recommendation on areas where
MOH can achieve some allocative efficiency.
When resources are constraint, they must be used more carefully. While budgets have declined, external financing, through
humanitarian assistance is providing the much needed resources, such as for cold chain, drugs and vaccines, personnel
training, and facility rehabilitation. There is keen interest among all development partners to strengthen and improve service
delivery. It will be key to harmonize our efforts to help in this area. Pooling of resources around the essential health delivery
package may be key to scaling up this support. The Bank team will lead efforts to consider this support among partners, as
well as, to design a pooling mechanism.
For a better understanding of health financing functions and lessons learnt from other countries, the ASA will support
participation of Libyan delegation for training programs and south-south learning events. Among capacity building
exercises, will include, a custom built flagship course for the Libyan needs, and which will be held in Tunis (or an appropriate
setting).
Partnerships: Close coordination will be maintained with the WHO, who is taking lead in conducting a national health
accounts (NHA) for previous years. Partnership will also be formed with the Bank’s governance and public finance
management teams.
15. Key Indicators Linked to Objectives
Overall, through a collaborative and coordinated approach in engagement, the country is expected to benefit several folds:
(a) in developing evidence based policies and strategies; (b) in allocating budgets in a more efficient manner to respond to
needs; (c) in developing a monitoring mechanism and indicators to monitor health sector performance; (d) in reaching the
vulnerable and displaced; and (e) in building capacity and steps towards building an “effective” health delivery system.
Indicators under the Fund Development Objectives include Cross Pillar 5: Documents produced and endorsed; and Staff
trained.
Other indicators include:
 Interventions for human resources for health recommendations (Y/N);
 Allocative efficiency measure recommendations (Y/N);

Refined model of health care recommendations (Y/N).
D. IMPLEMENTATION
16. Partnership Arrangements (if applicable)
Health was identified as among the priority sector’s for Bank’s engagement in Libya. This was identified through the
Bank supported Libya Economic Dialogue platform that brings together a broad spectrum of Libyans to discuss and consult
on issues of urgency for Libya. The Bank management has supported this platforms recommendation, and is starting to
engage.
Development partners are eager for Bank to be engaged on Libya Health. The Bank team met up with several development
partners and has received overwhelming support for engagement. WHO and UNICEF are eager for the Bank to engage in
the health sector considering the Bank's technical and financial comparative advantage. The Bank team expects to develop
close technical partnerships with them in the areas of human resource for health. Several other development partners, such
as the European Union, expressed their interest to form partnership with the Bank. The Bank team expects to develop close
coordination and collaboration with the EU in the area of service delivery model development. The Bank is entering into the
engagement in health in Libya after several years of the conflict. Other development partners have been already engaged in
Libya through humanitarian assistance. As humanitarian assistance is ongoing, and the reconstruction phase is just
beginning, this engagement from the Bank is timely. It is still a period of transition from humanitarian assistance to
reconstruction.
17. Coordination with Country-led Mechanism/Donor Implemented Activities
The World Health Organization (WHO) is the co-lead in donor coordination, along with the European Union (EU). A Health
Sector Coordination meeting on health activities in Libya has been set-up, where all partners, including representatives from
both sides of the governments meet in Tunis or other suitable venues. Among partners include the UN agencies, bilaterals
and INGOs. The Bank team is also coordinating closely with all partners, especially with WHO and UNICEF. This helps
the Bank team keep abreast of the happenings on the ground.
Data is a challenge. There may be plans to conduct some diagnostics or secondary data, while consideration may be given
to collecting primary data. The Bank team is coordinating closely with other partners so that there is a culture of sharing of
data and information. Additionally, the Bank team expects to engage with other local nongovernment agencies and
consulting firm(s) to be more engaged in the country. The composition of team that the Bank brings are appropriate to
respond to needs of a FCV country.
18. Institutional and Implementation Arrangements
The World Bank team has continued its technical assistance to Libya during the conflict. The only way it could do so, is by
using a “reverse” mission model. This is a well-accepted model for operating in extremely difficult environments of fragility,
conflict and violence (FCV). The ASA team will follow this practice and will be inviting government counterparts to Tunis
(or other places) to engage in technical discussions through workshops, and training programs. The team has included within
the budget resources to allow for such visits and stay of the government.
The proposed ASA will use a third party mechanism (TPM) and Feedback mechanism (FM) process (see footnote for
description)3. TPM and FMs have been employed in many World Bank-financed projects around the world.
3
Third party monitoring (TPM) is defined as monitoring by parties that are external to a projects direct beneficiary chain and management
structure (e.g., local or international civil society organizations, academia representatives, consulting firms, etc.) to assess whether desired
The proposed ASA has been fully prepared according to World Bank policies and procedures. It is proposed as a
programmatic ASA financed under a World Bank executed trust fund. It would follow the World Bank’s standard
operational policies and procedures, including procurement and financial management policies.
19. Monitoring and Evaluation of Results
For TPM, an independent consultancy firm or non-government organization will be selected for this assignment. In order to
combine the independent expertise of the selected firm with local knowledge, the firm will employ local consultants to
implement some of the assigned activities.
The assigned activities may consist of some or all of the following:





Preparation and capacity building
Periodic site visits
Periodic assessment of local context and conditions
Design and management of a shared feedback mechanism for the projects (including for quality of services and
patient satisfaction)
Qualitative patient satisfaction feedback
Firm qualification criteria may include some or all of the following:






Provide information showing that they are qualified in the field of the assignment.
Provide information on the technical and managerial capabilities of the firm.
Provide information on their core business and years in business.
Provide information on the qualifications of key staff.
Provide an indication of the methodologies to be employed in the assignment, including cross-verification of
findings
Provide information on the recruitment methods for the consultants
For various activities, the Bank team will be meeting government counterparts at least every six months (if not more
regularly) to jointly review progress of the various activities supported under the ASA. For the pilot sites, quarterly progress
reports will be requested to be shared with both government counterparts and the Bank team. Joint progress reviews will be
done (remotely) in Tunis between the government counterparts and the Bank team. The Reports will be developed and
disseminated, and workshops will be held inviting various key stakeholders to engagement for change. Towards the end of
each fiscal year, there will be a workshop to discuss the findings of that FY, as well as plan activities for the next FY. The
Project Development Objective (PDO) indicators will be reviewed annually, while the intermediate indicators will be
reviewed bi-annually.
The Bank will use the monthly health coordination platform (WHO is co-leading the effort where all partners, government,
UN, development partners, INGOs are invited) for consultation, sharing and moving agendas. Presentations and Report
summaries (and reports at times) will be translated into Arabic.
social, environmental, or other impacts are being achieved and undesirable impacts avoided. It can significantly improve the knowledge about
project implementation, impacts, targeting, and problems; gain the support of project beneficiaries and other stakeholders; give credibility to
project findings; and ultimately improve project development effectiveness. Feedback mechanisms (FMs) constitute a locally-based,
formalized way to accept, assess, and resolve community feedback or complaints (typically referred to as grievance redress mechanisms GRMs). They are increasingly used to improve the outcome of development projects by providing timely and results-oriented information
about project implementation and ensure that the projects reflect beneficiary needs.
E. PROJECT BUDGETING AND FINANCING
20. Project Financing (including ISA Direct Costs 4)
Cost by Component
Component 1: Human Resources for Health
(a) Sub-component 1.1:
(b) Sub-component 1.2:
Component 2: Health Service Delivery
(a) Sub-component 2.1:
(b) Sub-component 2.2:
Component 3: Health Finance and Governance
(a) Sub-component 3.1:
(b) Sub-component 3.2:
Total Project Cost
Transition
Fund
(USD)
500,000
4
Other CoFinancing
(USD)
Total
(USD)
0
0
0
1,573,600
300,000
2,373,600
21. Budget Breakdown of Indirect Costs Requested (USD)
Description
For grant preparation, administration and implementation support:
Grant administration
Total Indirect Costs
Country CoFinancing
(USD)
Amount (USD)
26,400
26,400
ISA direct costs are those costs related to the ISA’s direct provision of technical assistance within the project. Also see
Paragraph 47 of the Operations Manual.
F. Results Framework and Monitoring
Project Development Objective (PDO):
Cumulative Target Values**
PDO Level Results
Indicators*
Unit of
Measure
Baseline
YR 1
YR 2
YR3
YR 4
YR5
Frequency
Data Source/
Methodology
Responsibility
for Data
Collection
Indicator One: Patient
satisfaction
Index
X
X
X
Bi-annually
Pilot sites.
Third party
monitoring
World Bank
Indicator Two: Outpatient
services per capita
Index
X
X
X
Quarterly
World Bank
Indicator Three: Personnel
attendance rate at health
facilities (or reduction in staff
absenteeism)
Index
X
X
X
Quarterly
Indicator Four: Government
health spending as share of
total government spending
Percent
X
X
X
Annually
Pilot sites.
Facility based
information
system, and
third party
monitoring
Pilot sites.
Facility based
information
systems, and
third party
monitoring
World Bank;
International
Monetary
Fund; World
Health
Organization;
National
Health
Accounts;
Government
4.9%
(2014),
WDI
World Bank
World Bank
Description
(indicator
definition
etc.)
Baseline
data will be
collected at
the start of
the pilot
Baseline
data will be
collected at
the start of
the pilot
Baseline
data will be
collected at
the start of
the pilot
budget
sources
MENA TF Indicator:
Documents produced and
endorsed
MENA TF Indicator:
Public sector staff trained.
Number
X
X
X
Annually
World Bank
Number
X
X
X
Annually
World Bank
INTERMEDIATE RESULTS
Intermediate Result (Component One): Human Resources
Intermediate Result indicator
X
One: Workforce analysis
study initiated (contributing
towards the dynamic damage
and needs assessment)
Intermediate Result indicator Report/
X
Two: Report and
Workshop
recommendations prepared
on Workforce analysis and
toward interventions in
human resources for health
Intermediate Result (Component Two): Health Service Delivery Model
World Bank
Intermediate Result indicator
One: Service delivery
assessment initiated
(contributing towards the
dynamic damage and needs
assessment)
Intermediate Result indicator
Two: Report and
recommendation prepared on
health service delivery model
pilot design with monitoring
indicators
X
World Bank
X
World Bank
Report/
Workshop
World Bank
Intermediate Result indicator
Three: Pilot site program
initiated
Intermediate Result indicator
Four: Pilot site program
annual monitoring report
Intermediate Result indicator
Five: Pilot site program
evaluated
Workshop
World Bank
X
Report/
Workshop
World Bank
X
Report/
Workshop
X
World Bank
Evaluation
is Year 4
(beyond life
of this ASA)
Intermediate Result (Component Three): Health Finance and Governance
Intermediate Result indicator
One: Custom made flagship
course for the Libyans
Workshop
X
World Bank
Intermediate Result indicator
Two: Report and
recommendations prepared
on where cost reducing and
efficiency gains can be
achieved
Intermediate Result indicator
Three: Resource Pooling
Mechanism designed
Intermediate Result indicator
Four: National Health
Accounts reported (this
includes resource allocation
information)
Report/
Workshop
X
World Bank
Workshop
Report/
Workshop
World Bank
X
X
World Health
Organization
Pre- and
post-test on
participant
knowledge