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Aide Memoire June 23, 2015

AIDE MEMOIRELao PDR Health Service Improvement Project

P074027, IDA H1830 and H6950, HRITF 010518

Project Implementation Support Mission June 15–23, 2015

I. Key Project Data and Performance Rating

Key Project Data Key Performance RatingPrevious Rating Current Rating

Board Approval September 13, 2005 Progress towards achievement of Project Development Objectives

Moderately Satisfactory Moderately Satisfactory

Effectiveness date February 22, 2006 Overall Implementation Progress

Moderately satisfactory Satisfactory

Closing Date December 31, 2015 Disbursed IDA: 8,969,362.01 USDTF: 2,223,396.30 USD

Total Project Cost 12.4 % disbursed IDA: 99.14%TF: 92.64%

II. Introduction

1. A World Bank team comprising Mr. Phetdara Chanthala (Health Specialist and TTL) and Ms. Pema Lhazom (Senior Operations Officer), Ms. Siriphone Vanitsaveth (Financial Management Specialist), Mr. Khamphet Chanvongnaraz (Procurement Specialist), Mr. Satoshi Ishihara (Senior Social Development Specialist), Ms. Sophavanh Thitsy (Consultant) and Ms. Boualamphan Phouthavisouk (Team Assistant) undertook an implementation support mission of the Project from June 15-23, 2015 to review the implementation status and next steps for Project closure. The mission team worked with the National Project Coordination Office (NPCO) and key implementing agencies. A wrap-up meeting was held under the chairmanship of Dr. Prasongsidh Boupha, the Director of the Department of Planning and International Cooperation, and key representative of the implementing agencies on June 23, 2015 to discuss the key mission findings. The list of persons met is provided in Annex 1.

2. This Aide Memoire, which was shared and discussed with the NPCO and key representatives of the Ministry of Health at the wrap-up meeting on June 23, 2015, summarizes the main mission findings and agreed actions. It reflects the views of the mission team only and is subject to World Bank management clearance and will be publicly disclosed.

III. Implementation Status Overview

3. The parent HSIP (H1830) closed on June 30, 2012, with all activities completed. Free maternal health was piloted1 under H1830 which provided a platform for launching the national policy on free maternal and child health, supported human resource development, infrastructure; social health protection (Heath Equity Funds); District Grant Allowances (DGA) and critical recurrent costs.

4. The HSIP (H6950) became effective on January 4, 2012. The Project Development Objective is to increase utilization and quality of health services, particularly for poor women and children in rural areas in Project provinces. The Project Components are: (a) Improving the Quality and Utilization of Health Services;

1 Nong and Thapangthong Districts in Savanakhet Provinces 1


(b) Strengthening Institutional Capacity for Health Service Provision; and (c) Improving Equity, Efficiency and Sustainability of Heath Care Financing. H6950 implementation modality transitioned to results based financing.

5. Overall progress toward development objectives is Moderately Satisfactory. Results indicators covering the period of October 2014 to March 2015 (6 months) is on track for most indicators and some have exceeded its target.(Refer Annex 2: Project Results Indicators).

6. Overall Project implementation status is Satisfactory. All actions agreed during the last supervision mission have been implemented. The Free Maternal Health and Child Health was implemented in 8 districts2 under a third-party (Swiss Red Cross-SRC) financed by the Project from January 2013. In addition, Free Maternal Health continued to be implemented in all five Project provinces (except for districts covered by SRC). Paying for Quality (PfQ), Paying for Preventive Services (PPS) and Free <5 Child Health (CH) interventions commenced implementation from July 2014 in three of the project provinces3 and ended in December 2014 because of shortage of funds under the project. Health facility upgrades, procurement of medical equipment, long-term and short-term trainings have been completed. There are no procurement activities or packages under the Project.

7. Disbursement for both financing source has improved significantly: disbursement rates for H6950 and TF10518 were 99 percent and 92 percent respectively. The remaining funds will cover the reimbursement to facilities in Savanakhet and Attapu and final payments to the external verification firm and the third party implementation agencies upon submission of the final reports.

IV. Implementation Details

Component 1: Improving the Quality and Utilization of Health Services

Figure1: Free MH Services in Project Provinces4

8. Free MH: For operational purposes, free maternal and child health (MCH) is divided into free maternal health (MH) and free child health (CH). Free MH was officially launched in March 2013, and continued to be implemented in 42 districts of 5 project provinces5 in 5 Provincial Hospitals (PH), 32 District Hospitals (DHs), and 202 Health Centers (HCs). From the HMIS data (taking 2012 as the baseline), increased utilization of antenatal care, postnatal care, facility births (including assisted deliveries through outreach) is noted in the Project

provinces. Even after the Project funding ended in Dec, 2014, MH services were being provided, although it cannot be confirmed whether patients are paying out of pocket (for 2015- data is only from Jan- March 2015) or service provided free of cost. From the HIMS data, it is also noted that deliveries tended to place mostly at the District and Provincial Referral Hospital with high number of C-sections at the Provincial level.

2 4 districts in Xekong, 3 districts in Savanakhet and one in Salavan. 3 Xekong, Salavan and Attapu4 For a period of October 2014 to September 2015, figures was collected from October 2014 to March 2015 only. 5 Savanakhet, Salavan, Xekong, Attapu, Champasak

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Source: DHIS2 hmis.gov.la (June 25, 2015)


9. This could be attributed to a number of factors (i) by passing lower level facilities and not adhering to the referral system (ii) perception that quality of services is better at higher level facilities; and (iii) easy access and services are free (See Figure 2).

Figure 2: Number of C-Sections in District and Provincial Hospitals (2012/13-2014/15)

10. Measures were taken by MOH to inform hospitals that only C-sections (life threatening conditions for mother and child) would be permissible and reimbursed. MOH would also not reimburse for food and transport cost.11. Verification of results: The National Health Insurance Bureau (NHIB) conducted round 6 and 7 internal verifications (for services delivered from July- December 2014) with the assistance of the external verification team. No external verification could be carried for the 7 th round because of budget constraint. Reimbursement to facilities of Savanakhet and Attapu Provinces (for services delivered from Oct-Dec, 2014) have not been made yet. The mission recommends that NPCO complete these payments no later than July 15, 2015.

12. Free CH was co-managed by HEF Management Agency- Swiss Red Cross (SRC) in 8 districts from January 2013 until March 2015. The experience from the early implementation of this intervention managed by SRC helped in the development of guidelines and manuals for rolling out Free CH implementation in the other Project provinces.

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Source: DHIS2 hmis.gov.la (June 22,


Provinces

IPD children <5 OPD curative

care children

<5

Major surgery

Medium surgery

Minor surgery

No surgery

Xekong6 3 1 8 979 17,415Salavan 1 14 328 2,605 20,094Attapu 0 0 6 845 3,904

Total 4 15 342 4,429 41,413

Figure 3: Free Child Health Implementation July- Dec 2014 Under the Project, Free CH implementation started in mid July 2014 and could be implemented only until December 2015 because of shortage of funds under the Project. The number of beneficiaries varies in each Province (see Figure 3), with Attapu at the lowest. From the information provided, it is also seen that demand for services were incremental, levelling off only in the last 2 months of the intervention, but higher than when it commenced. Despite the short implementation period, it can be concluded that there is demand for these services.

13. Paying for Preventive Services (PPS): PPS began also began implementation in Salavan, Attapu and Xekong provinces in mid July 2014. The following table provides PPS implementation in the 6 months of Project financing (See Figure 4). These service can be provided at the facility or through outreach

14. Paying for Quality (PfQ): PFQ also began implementation in Salavan and Attapu in mid July 2014. (Xekong was covered under SRC until March 2015) until December 2015. The quality score results verification for two rounds was carried out by the NHIB. Using Round 1 as the baseline, it is noted that quality scores increased slightly at the Provinical and the Heath Center level (except for Xekong Province). The results at the District hospitals vary, in Salavan, a majority of the hospitals show improvements while scores in Attapu and Xekong decreased (See Annex 3- Quality

Scores). A minimum score of 50 percent was set for any facility in order to receive bonuses for quality improvements. Since the implementaion duration was only for 6 months, it would be too early to make any concrete conclusions.

15. Verification: Verification of services for Free MH, Free CH, PPS and PfQ have been completed (for services delivered from July-Dec, 2014) by the NHIB supported by the external verification team. Based on the information provided, there were no over reporting of services in Round 1 Verification, but significant over reporting of services in Round 2 verification is noted in all provinces and for all types of services. The mission recommends adjustments be made for the over billing for services for Savanakhet and Attapu for which where reimbursement to facilities have not been made yet.

16. Project Support Transition: Since the Project funding ended in December 2014, the mission was informed that the MOH had directed all Provinces continue to provide services through their own resources

6 Updated data provided by SRC, June 23rd, 20154

Figure 4: Pay for Preventive Services in 3 project provinces

PPS indicators July-Dec, 2014 TotalJul Aug Sep Oct Nov DecNumber of children <1 fully immunized 503 681 1,068 559 649 1,459 4919

No. of children <5 provided Vitamin A and de-worming

6,258 4,548 1,165 866 33,849 837 47523

Number of malnourished children <5 detected

242 218 133 88 103 305 1089

Number of women received counseling on IYCF

500 1,010 1,830 1,475 3,186 3,393 11394

No. women on modern contraceptives at end of month

4,339 7,697 5,937 6,687 6,693 8,615 39,968

Total 11,842 14,154 10,133 9,675 44,480 14,609 104,893


and reimbursement would be available under the proposed Health Governance and Nutrition Development Project. From the information provided (January to March 2015), it is noted that ANC, PNC and delivery services continue to be provided, with C-sections dropping drastically. The mission is unable to confirm if these services are provided free or patients are paying out of pocket.

17. District Grant Allocations (DGAs): The Project financed recurrent costs of service delivery through the DGAs to all Provincial Health Office (PHO), District Health office (DHO), District Hospital (DHs) and Heath Centers (HCs) for in service training, meetings, supervision and recurrent costs. In general, most districts and provinces have used the funds appropriately, helped improve their planning and provided critical funding for outreach services for immunization, antenatal care and skilled birth attendance. The project also helped in involving the technical department to approve the plan, conduct integrated MCH outreach and supervision under the oversight of the national MOH technical departments. HSIP also provided some funding for MOH technical departments to coordinate, plan and supervise these activities and helped improved coordination mechanism. High compliance burden for DGA planning and financial management for small amounts of money and payment delays proved significant challenges during the project. There will be continued need to strengthen planning and reporting system in MOH.

18. Health Facility Upgrading: The Project financed the upgrading and equipping of district and health centers, and renovations at the University of Health Sciences, Mahosot and Mittapahb and Salavan Hospitals. 333 number of health centers were renovated and completed under the Project. The health centers were also provided with basic medical equipment. Most of the civil works met their objectives, however, the complexity of the design of the waste water treatment system slowed down construction. The renovations of HCs were executed by the Department of Health Care.

Component 2: Strengthening Institutional Capacity for Health Service Provision

19. Training and Curriculum Development: Support under the HSIP focused on short-term and long-term training to improve the skills of existing and new health staff at community level, especially existing HCs staff and health volunteers from ethnic groups in remote and rural communities to enable them to provide better health care services to the poor, pregnant women, and children under five years of age in project areas. The original financing IDA H1830 of the project supported the training on improving primary health care and management skills to health staff at all levels in project areas. The additional financing IDA H6950 adopted 10-year Health Personnel Development Strategy 2020, which training on health professional skills to health staff in providing MCH services. The implementation of training activities under the IDA Grant H1830 and H6950 was from February 2006 to June 2011 and from January 2012 to September 2014 respectively. The long-term training under the Grant H6950 in upgrading existing and new health staff has been completed as plan. Annex 4 shows list of training courses and results of the short- and long-term training under the IDA Grant H1830 and H6950.

Component 3: Improving Equity, Efficiency and Sustainability of Heath Care Financing20. Health Management Information System (HMIS): The web-based DHIS2, initiated in mid-2014, has functioned well and been used for data collection, reporting, providing feedback, as well as monitoring project performance and health service delivery in all forty-two districts in five provinces under HSIP. The Health Information System Program of Vietnam (VN HISP) and NPCO has successfully built capacity on management and implementation of DHIS2 for the central MOH DHIS2 core team. The DHIS2 now expanded to all Provinces in the country.

21. Health Equity Funds (HEFs): HEFs, including free MCH services, have continued to be implemented in the same nine districts. The current number of program beneficiaries stands at 149,193 (comprising 107,441 poor beneficiaries under HEFs and 41,752 non-poor beneficiaries who benefited from free MCH services). Since the mission in November 2014, there has been an increase in the number of

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beneficiaries: approximately six percentage point increase in the number of poor beneficiaries and seven percentage points increase in the number of non-poor beneficiaries. There have not been major changes in the level of utilization of health care services by beneficiaries, except for an increase in the number of deliveries, and an increase in out-patient department visits and in-patient department admissions among <5 children. The implementation of HEF at health facilities ended in April 2015.Contract with the Swiss Red Cross as a third party implementing agency will close in June 2015 and will submit its report upon the contract closing and last payment will be completed before end of July 2015. In the meantime, the NPCO has already informed the 9 districts on the project closure and advised the districts to get financial support for the HEF from other sources of financing.

Monitoring and Evaluation

22. The Project is using the revised Project Result Framework as a basis for monitoring and evaluation of the Project results. See Annex 2 for the latest project indicator results.

Financial Management and Procurement

23. Audit report and interim unaudited financial reports (IFR) have been submitted but with delays. Audit reports for FY12/13 and FY13/14 were disclosed only during the mission. The final audit report is due for submission no later than June 30, 2016, six months after the project closing date. Audit report shall be disclosed immediately after submission to the World Bank. The mission team is pleased to note that the project financial closure is underway and final audit of the project will commence in August 2015 . As final payments is expected to conclude by the end of September, only two IFRs will be required to be submitted for the quarter ended June and September. The final withdrawal application should also be submitted no later than April 30, 2016. The agreed actions are provided in Annex 5.

24. Procurement: The mission reviewed the progress of procurement under the project, the capacity of the implementing agency and found that the overall procurement performance has remained ‘Moderately Satisfactory’. A post review was carried out during the last mission in October 2014. Procurement activities have been completed.

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Social Safeguards

25. The project triggered two safeguard policies i) Environmental Assessment (OP/BP 4.01); and ii) Indigenous Peoples (OP/BP 4.10). The additional financing (H-6950) of the project supported minor renovation of health facilities at all level and set on improving access to health care for ethnic groups. Environmental Management Plan (EMP) and Ethnic Group Development Plan (EGDP) were developed and used during the project operation. A social assessment was conducted, following the assessment a set of Information Education and Communication materials was developed to help improve the ethnic groups understanding on the health education messages communicated during the health education campaigns.

Key Lessons Learned

26. The implementation of RBF under HSIP stimulated the increase in demand side while the supply side readiness was still an issue at health center and district level. While building demand, it is equally important to ensure that the service provision side is strengthened and facilities and providers are adequately equipped to provide timely, efficient and quality services to beneficiaries. Therefore supply side considerations are equally important. The following are some specific lessons:

(i) Project Management: The management remains strong. Under the additional grant, Project Components were streamlined into the existing Technical Departments of MOH taking responsibility for implementation with the technical backstopping and coordination provided by NPCO. The facilities upgrading and capacity building implementation were fully owned by the Technical Departments. The last two rounds of internal verifications were also conducted by NHIB successfully transitioning to the government system with capacity building provided by the external verification firm. Currently, only critical consultants and fiduciary staff have been retained to enable successful Project closure.

(ii) Slow Start up of Results Based Financing (RBF) Activities: While HSIP had experience in implementing RBF (DGA was implemented as output based financing in the parent Project) the scaling up of Free MCH, Child Health and PPS and PfQ under a RBF modality proved challenging. Recruitment of Technical assistance and development of manuals, guidelines and external independent verification agent took time. This also entailed extensive training of all key stake holders which was not only time consuming but added to the project costs which had not been envisaged. However, with the experience of the RBF, MOH has now transitioned to using Disbursement Liked Indicators for the proposed new Project. Project support will be nationwide.

(iii) Project Cost: The under budgeting of the cost of the interventions and increased utilization/ uptake of services added to the Project cost overrun. Strong monitoring of project expenses analysis, budget forecast against fund availability would have been helpful during the implementation. The Project was extended by 18 more months to allow time for full RBF (CH, PPS and PfQ) implementation in Project provinces, but did not have sufficient budget to implement until Project closure.

The following key next steps were agreed, detailed action plan is provided in Annex 6.

(i) The NPCO will clear reimbursement to the facilities of Savanakhet and Attapu no later than July 15, 2015 and simultaneously complete final payments to the external verification firm and the Third Party Management (Swiss Red Cross).

(ii) The final audit of the project will commence in the first week of August 10, 2015 and will be completed by September 30, 2015.

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(iii) The final audit report is due for submission no later than June 30, 2016, six months after the project closing date and the last Withdrawal application will be submitted no later than April 30, 2016.

27. The mission discussed Project closure and the deadline for Implementation Completion Report (due no later than June 30, 2016), including MOH’s responsibility in the completion of its own report. The mission requested that a senior official familiar with the Project be nominated for drafting its own report and to assist the Bank in the drafting of its own ICR (for documentation and if surveys are needed to be carried out). An outline for the ICR was shared.

List of Annexes:1. List of Officials Met- Annex 12. Results Framework- Annex 23. Results of Quality Score- Annex 34. Results of training under IDA Grant H1830 and H6950- Annex 45. Financial Management – Annex 56. Action Plan – Annex 6

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Annex 1: List of Persons Met

Name Position OrganizationDr. Prasongsidh Boupha Director General DPIC, MOHAssoc. Prof. Dr. Bounnack Saysanasongkham

Deputy Director General DHC, MOH

Dr. Somchan Director General DOI, MOHDr. Bouaphat Phonvisay Deputy Director NHIB, MOHDr. Somvang Bouphaphanh Deputy Admin MCHC, MOHDr. Sommana Rattana Deputy Head of Division DHC, MOHDr. Kitsada Noraseng Deputy Head of Division NHIB, MOHDr. Suphab Panyakeo Deputy Chief of Division DOF, MOHDr. Sayavone Khounnorath Head of Division MCHC, MOHDr. Manivanh Savatdy Head of Division DHC, MOHMs. Phaladsamy Haksinh Technical Staff DIC, MPIMr. Phouvanh Tanthaly Technical staff DHHP, MOHDr. Chansaly Phommavong Assistant to NPCO NPCOMr. Phisith Xaysomphou Finance Officer NPCOMr. Phanthanou Luangxay Procurement Officer NPCOMs. Oulayvanh Chanthavong Administrative Officer NPCOMr. Viengthong Chonglasong IT officer NPCOMr. Khamsen Southisack Assistant to ANPC NPCOMr. Jean-Marc Thome Country Coordinator SRCMr. Aaron Blaalanar Team Leader EPOSMr. Maikho Vongxay Project Office Manager EPOSMr. Southsaviene Vilay Coordinator EPOS

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Annex 2: Project Results Indicators

Indicator Type No Revised Indicator

Result from Oct

2014- March 2015

YR4 Target (Sept 2015)

Remark& Sources of data

PDO 1 Percentage of deliveries occurring in a health facility 15.2% 35% DHIS2:

hmis.gov.la

PDO 2 Child under-five inpatient discharges per capita 0.07 0.08 DHIS2: hmis.gov.la

PDO 3People with access to a basic package of health, nutrition, or reproductive health services (number)

896,320 500,000MOH estimate target Population

PDO 4Average balanced scorecard quality score among health facilities implementing Paying for Quality

62% 85%Internal Verification Report

PDO 5 Number of poor households with access to a basic package of health services 19,066 17,000 HEF quarterly

report

Int C1-1 6 Number of health facilities providing free

maternal health services 295 290 DHIS2: rbf.gov.la

Int C1-2 7 Pregnant women receiving antenatal care during

a visit to a health provide (number) 180,313 180,417 54974+33580+61,841

Int C1-3 8 Health facilities constructed, renovated, and/or

equipped 333 185 DHC report

Int C1-4 9 Number of supervision visits to health centers

in the last quarter 183 200 DGA technical report

Int C1-5 10 Children immunized (number)

… under 12 months against DPT3 (number) 163,167 183,588 53,120+28157+56177

Int C1-6 11 Direct project beneficiaries (number) 351,767 350,000 Project ReportInt C1-7 12 … of which female (percentage) 81.3% 70% Project Report

Int C2-1 13 Health personnel receiving training (number) 1,518 1,212

DTR completion report

Int C3-1 14 Number of cases of HEF assistance for the

payment of health care costs 465,703 250,000 HEF report

Int C3-2 15

Number of districts reporting HMIS indicators using the web-based system according to schedule

134 42 current hmis.gov.la

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Annex 3: Quality Score Results

No. Name of FacilitiesI. Salavan Province 1st Round 2nd Round

1 Salavan Provincial hospital 64% 70%2 Lao Ngam DH 60% 65%3 Vapi DH 56% 60%4 Lakonpeng DH 54% 53%5 Kongsedone DH 73% 70%6 Toumlan DH 70% 72%7 Samoi DH 71% 73%8 Taoi DH 69%

Health centers Average 53% 61%

II. Attapue Province 1st Round 2nd Round1 Attapue Provincial hospital 70% 71%2 Xaysetha DH 76% 68%3 Phouvong DH 63% 60%4 Sanxay DH 73% 53%5 Sanamxay DH 77% 71%


III. Sekong Province 1st Round 2nd Round1 Provincial hospital 65% 40%2 Thateng 52% 69%3 Kaluem 48% 42%4 Dakjung 44% 42%


Verification

Source: NHIB Internal verification report of 1st and 2nd round, (SLV, ATP. No. 0603/0166).

Source: NHIB Internal verification report of 1st and 2nd round, (SLV, ATP. No. 0603/0166).

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Annex 4: Result of Training under IDA Grant H1830 and H6950

No.

Activities Unit H1830 H6950 Total2006-2011 2012-2014

A Short Term Training 3,656 1,039 4,655I Skilled birth Attendant short-term training1 IMCI (MNCH 5-modules course) to District and HC

staffpers. 183 183

2 FP & IMCI modules (MNCH 5-module course) pers. 324 3243 MNCH 5-modules training (Module 1-3) pers. 11 114 1254 EmOC training for MDs, Mas and Nurses pers. 85 855 IP training for MDs, Mas, and Nurses at central and local

levelpers. 121 121

6 TBAs training pers. 455 4557 Specialized clinical training (In-service training) to

District staffpers. 151 151

8 Pathology (at Mahidol University, Thailand) pers. 1 19 Microbiology (at Chiangmai University, Thailand) pers. 1 110 Parasitology (at Chiangmai University, Thailand) pers. 1 1II Health Management training1 Pedagogy to Teachers in UHS and Health Colleague in

SLV,CPS,SVKpers. 35 49 84

2 Health Center Management (TOT) to Provincial Health Staff

pers. 35 29 64

3 District Health Management (TOT) to Provincial Health staff

pers. 40

4 MNCH package and outreach activities to PHO (TOT) pers. 38 385 Health Center Management Training to District Health

Managers and HCpers. 628 194 822

6 District Health Management to District Staff pers. 357 3577 MNCH package and outreach activities to District and

HC Staffpers. 746 746

8 Health Promotion and Supervision Village Drug Kits to Village Health Committee

pers. 356 356

9 Village Drug Kits to Health Volunteer pers. 451 45110 10 Minimum Requirement to District staff pers. 167 16711 Health Care Research (at Choulalongkorn University,

Thailand)pers. 10 10

12 English Language Training to Health Staff from MOH, and Health Collage in SLV,CPS, SVK

pers. 113 113

B Long Term Training 292 479 771I Upgrading existing staff and new staff1 Medical Assistant in PHC* pers. 64 107 1712 Medical Associate in PHC pers. 116 101 2173 Technical Nurses pers. 60 604 Registered Nurses pers. 10 105 Bachelor of Nursing pers. 11 116 Bachelor of Anesthesiology & Resuscitation Nurse pers. 4 47 Community Midwife* pers. 115 1158 Registered Midwife* pers. 29 29

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Aide Memoire June 23, 20159 Diploma of Health Management pers. 8 8II Specialist training -1 Family Medicine (FAMED) pers. 90 902 Obstetrics-Gynecology (ObGyn) pers. 1 5 63 Pediatrics pers. 4 44 Anesthesiology & Resuscitation pers. 5 5 105 Surgery pers. 11 3 146 Internal Medicine pers. 2 27 Cardiology pers. 2 2III Professional development for Teachers from Health

Colleges in SVK, CPS, SLV -

1 Master of Public Health (at UHS, Lao PDR) pers. 6 62 Master of Education Management (at National

University, Lao PDR)pers. 3 3

3 Master in Nutrition (at Konkean University, Thailand) pers. 2 24 Master in Nurses (at Konkean University, Thailand) pers. 4 45 Master in Biochemistry (at Konkean University,

Thailand)pers. 1 1

6 Master in Physiology (at Konkean University, Thailand) pers. 1 17 Master in Pharmacy (at Konkean University, Thailand) pers. 1 1

Total (A+B) 3,948 1,518 5,426

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Annex 5: Financial Management

1. Disbursement (H6950 and TF010518)

28. Disbursement is at 99.14 % for H6950 and 92.64% for TF010518 as of June 23, 2015. The project updated its expenditure forecast and expects to incur expenditure amounted to US$578,238 on H6950 and US$575,599 on TF010518 between June and September. The expenditure will result in the overdrawn of IDA H6950 Category 1 but not exceeding 15%. The project is advised to monitor the overdrawn after submission of each withdrawal application. The project expects to finalize payments and submit final withdrawal application between September and the closing date of December 31, 2015. 2. Advance

29. To date of this mission, advance amounting to US$ 356,725 remains to be cleared. As all activities related to the advance have been completed, we strongly encouraged the Project to clear the advance by June 30, 2015.

3. Fixed asset management and control

30. We were informed that one project vehicle was involved in a serious accident and was badly damaged. The mission team advises that the project inform the task team of the status of the vehicle immediately. The vehicle only has third party insurance. Physical count of project assets is currently being carried out at provincial level. All assets financed by the projects should be verified and FAR updated. This is to be completed by the end of June to comply with the MOF requirement for reporting of assets six month prior to the closing of the project.

4. Financial Reporting

31. The IFRs have been submitted. Timing of submission has improved but still not on the due date. Comments on the March quarter end IFR will be provided separately. As final payments is expected to be made by the end of September, two IFR for the quarter ended June and September remain to be submitted.

5. External Audit

32. The audit report for FY14 was submitted with one week delay. Acknowledgement letter and comments have been provided. We strongly encourage the project to review the auditor recommendations and ensure that recommendations have been implemented. Based on discussion and review of transactions, we observed that some recommendations may not have been fully implemented.

33. Closure of project accounts is underway. It is expected that the project’s final accounts will be completed by end of June or early July. Auditors have been appointed to carry out the final audit. The auditors will commence the audit of the final project account in August 2015.

34. Disclosure of the audit report for FY13 and FY14 have not yet been completed by the project at time of our visit. However, disclosure was subsequently made on newspaper as well as on MoH website. We highly recommend that the project adhere to the disclosure requirement timely in future years.

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Aide Memoire June 23, 20156. Findings from transaction review

35. The mission team reviewed a sample of transactions, our findings are summarized below:

We observed delays in making payments to suppliers and contractor; Actual expenditure, in particular expenditure on per diem and accommodation, was in access of plan

e.g. number of actual travelers exceeds the planned number; Insufficient details on some receipts making it unclear as to the purpose of the expenditure; Cash receipts voucher or payment vouchers were not attached to advance clearance to evident receipt

of excess cash or reimbursement. Cash payment/receipt vouchers are kept separately by the cashier.

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Annex 6: Action Plan for Project Closure

Issue Recommendation/Action Responsible Agency

Due Date

1 Preparation for Project closures

NPCO will draft the Project Closure Plan and share with the WB

NPCO August 17, 2015

2 Project budget NPCO will review the budget until December 2015 and submit for the WB comments including the date for string the fund recovery

NPCO July 30, 2015

3 Last payments for the HEF and Free MCH managed by SRC

SRC support final report of the HEF intervention in 9 districts and submit its last payment (by end of June, 2015)

NPCO and SRC End of July 2015

4 Last payment to external verification agency (EPOS)

NPCO monitor with EPOS for its final payment

NPCO and EPOS

End of July 2015

5 ICR report writing NPCO will allocate time for the WB ICR author

WB and NPCO To be confirmed

6 Financial Management Submit IFR for April to June 2015 NPCO August 15, 20157 Financial Management Submit final audit report NPCO No later than

June 30, 20168 Financial Management Submit IFRs for the quarter ended

June and September 2015NPCO August 15, 2015

November 15, 2015

9 Financial Management Clear the remaining advance items NPCO July 30, 201510

Financial Management Complete physical inspection of assets financed by the project and update of asset register

NPCO June 30, 2015

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