Document of The World Bank FOR OFFICIAL USE ONLY PROJECT PAPER ON A PROPOSED ADDITIONAL FINANCING TO THE FEDERAL REPUBLIC OF NIGERIA FOR A

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1 Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Human Development I11 West Africa Africa Region Office Document of The World Bank FOR OFFICIAL USE ONLY PROJECT PAPER ON A PROPOSED ADDITIONAL FINANCING IN THE AMOUNT OF SDR MILLION (US$50 MILLION EQUIVALENT) TO THE FEDERAL REPUBLIC OF NIGERIA FOR A PARTNERSHIPS FOR POLIO ERADICATION PROJECT September 8,2008 Report No: NG 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.

2 CURRENCY EQUIVALENTS (Exchange Rate Effective August 3 1, 2008) Currency Unit = Naira US$1 = Naira 118 US$1 = SDR FISCAL YEAR January 1 - December31 AAP CDC CIDA CPS DCA DHS EU ERC FGN FMOH GPEI GoN IBRD ICC IDA IEC IPDs KfW ABBREVIATIONS AND ACRONYMS Africa Action Plan MDGs Millennium Development Goals Centers for Disease Control MOPVl Monovalent Oral Polio Vaccine 1 Canadian International Development NEEDS National Economic Empowerment and Agency Development Strategy Country Partnership Strategy NID National Immunization Day Development Credit Agreement NPHCDA National Primary Health Care Data Health System NPI Development Agency National Program for Immunization European Union OPV Oral Polio Vaccine Expert Review Committee PAD Project Appraisal Document Federal Government of Nigeria REW Reaching Every Ward Federal Ministry of Health RI Routine Immunization Global Polio Eradication Initiative SDR Special Drawing Right Government of Nigeria SIAS Supplemental Immunization Activities International Bank for Reconstruction SIPDs Supplementary Immunization Plus Days and Development Interagency Coordinating Committee UNESCO United Nations Education, Scientific and Cultural Organization International Development Agency UNICEF United Nation Children s Funds Information, Education and USD United States Dollar Communication Immunization Plus Days WHO World Health Organization Kreditanstalt fur Wiederaufbau (German Development Agency) Vice President: Country Director: Sector Manager: Task Team Leader: Obiageli Katryn Ezekwesili. Onno Ruhl Lynne Sherburne-Benz Ramesh Govindaraj

3 FOR OFFICIAL USE ONLY Project Paper Data Sheet Country: Nigeria Project Name: Partnerships for Polio Sector Manager: Lynne Sherburne-Benz Country Director: Onno Ruhl Environmental Category: C Responsible Agency: National Primary Health Care Development Agency Current closing date: April 30,2009 Revised closing date [if applicable]: April 29,2012 (Expected date of effectiveness December 3 1, 2008) Bank policies? Have these been approved by Bank management? Revised project development obj ectives/outcomes [If applicable] oyes XNo oyes XNo Does the scaled-up or restructured project trigger any new safeguard policies? If so, SR] I ; No For Additional Financing [ ] Loan [ XI Credit [ ] Grant For Loans/Credits/Grants: Total Bank financing (US$SOm.): Proposed terms: Borrower IBRD/IDA Others Total Source Local I Foreign I Total This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not be otherwise disclosed without World Bank authorization... 11

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5 NIGERIA PARTNERSHIPS FOR POLIO ERADICATION PROJECT ADDITIONAL FINANCING Table of Contents I. I1. I11. IV. V. VI. VI1. VI11. IX. Introduction... 1 Project Background and Performance... 2 Rationale for Additional Financing... 5 Proposed Changes... 6 Consistency with CPS, MDGs and AAP... 7 Appraisal Summary... 7 Expected Outcomes Benefits and Risks Financial Terms and Conditions for the Additional Financing. 12 SCHEDULE A SCHEDULE B SCHEDULE C

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7 I. INTRODUCTION 1. This Project Paper seeks the approval of the Executive Directors to provide an additional credit in an amount of US$ 50 million to the Federal Republic of Nigeria Partnerships for Polio Eradication (P080295; Cr and P090652; Cr UNI). The proposed credit will be on standard International Development Association (IDA) terms with a special "buy-down" provision, whereby third party funded trust funds will cover the service and commitment fees and purchase the credit at its net present value if the project has been successfully completed in accordance with the terms of the Development Credit Agreement (DCA). 2. The proposed additional credit would finance the increased resources required for the procurement of Oral Polio Vaccine (OPV) in support of Nigeria's efforts to eradicate poliomyelitis. The financing gap is a result of a public perception problem that slowed down initial implementation, and led to a large spurt in poliomyelitis cases (as described below). Addressing this resurgence of the polio virus required a scale up of project activities including much stronger information, education and communication activities than anticipated, as well as the development of a new and innovative OPV delivery mechanism by the Government of Nigeria (GoN) with extensive technical support and guidance from the international development community. The proposed additional financing would ensure that the project maximizes the achievement of the development objective by supporting the implementation of the new OPV delivery system (which has already shown significant results), thereby overcoming the persistence of the wild polio virus transmission in certain pockets of the country. Despite the considerable monies being invested by the GoN, the recipient is unable to finance the additional financing needs on it own, or to obtain additional funds from other support agencies on reasonable terms and in good time. Furthermore, Nigeria is one of only four countries (along with Pakistan, Afghanistan and India) where polio is still endemic, and the project, which supports a last push to eradicate this disease globally, thus not only benefits Nigeria, but the rest of the world. As such, the project represents support for a global public good. 3. Two scenarios are planned for Nigeria's polio eradication activities by the Expert Review Committee (ERC), a group comprised of global and national polio experts that guides Nigeria's polio initiative (these scenarios are described in detail in the economic analysis section). The baseline scenario assumes 2 nation-wide and 4 subnational immunization campaigns in 2008 and 2009, while a contingency scenario in case of an unexpected resurgence in polio virus transmission will require 2 nation-wide, 4 subnational and 2 mop-up immunization campaigns in 2008 and The total estimated cost for the procurement of OPV for 2008 and 2009 is US$42.69 million and US$35.14 million respectively under the "baseline" scenario and US$51.23 million and US$43.93 million respectively under the "contingency" scenario, with an additional US$18.08 required for 2010 (see attached). The additional financing through the IDA credit would therefore cover between 59 percent and 64.2 percent of the overall cost of OPVs.

8 4. Under the Additional Financing, the project's development objectives would remain unchanged, and the project will continue to assist Nigeria in the purchase of adequate OPVs to intensify the ongoing polio eradication program. The project is part of a multi-donor financed framework which requires a total amount of US$ 141 million for 2008 activities and US$ 128 million for 2009 projected activities ("baseline" scenario) and US$ 164 million for 2008 and US$ 152 million (l'contingency'l scenario). Only US$ 3.3 million remains from the original and supplemental IDA credits, and this amount is expected to be spent in the first or second quarter of 2008 for the procurement of OPV. Besides the IDA credit, principal financers of the different aspects of the polio eradication project (procurement of OPV, operational and surveillance costs) are the European Union, KfW, CIDA, Rotary International, the Bill and Melinda Gates Foundation, and the US Centers for Disease Control (CDC). The GoN covers the operational costs of the nation-wide immunization campaigns (e.g., it recently provided Naira 1.5 billion or US$ 13 million to cover operational costs of the program) and the Government is committed to continue providing additional funding to support both the immunization campaigns and the routine immunization program. 5. The expected outcome of the procurement of the additional OPV vaccines and of its administration during planned immunization campaigns is the interruption of wild polio virus transmission in Nigeria. The target is to interrupt transmission of the type 1 polio virus by end-2008 and the type 3 polio virus by end PROJECT BACKGROUND AND PERFORMANCE 6. The original Credit agreement in the amount of SDR 20.9 million (US$ million equivalent) was approved on April 29, 2003 and became effective on August 6, The Project was amended on May 10, 2005 to reflect an additional financing assistance of SDR 33.4 million (US$ million) provided to the Borrower. The original closing date of the Project of December 31, 2006 was extended recently for the third time until April 30, For the additional financing, the closing date will be April 29, An Implementation Completion Report will be prepared within six months after the closing of the project. As of May 2008, SDR million, or 99.8 percent of the Original Credit, and SDR million, or 99.6 percent of the Supplementary Credit have been disbursed. 7. The development objective of the project is to assist, as part of a global polio eradication effort, the GoN to achieve its goal of interrupting the transmission of wild polio virus, and sustain these efforts throughout the project period, through effective Oral Polio Vaccine (OPV) coverage of the target population. The ongoing Partnership for Polio Project has three components: a) The procurement of OPV; b) Supplemental operations including cold chain, social mobilization, and training; and c) Surveillance. IDA finances the first component, while the other two components are financed by the GoN, several bilateral donors and agencies such as Rotary International and the Gates Foundation within the framework of a multi-donor framework. 2

9 Status of Project Implementation 8. Implementation progress is satisfactory, as is the progress towards the attainment of the project development objectives. Overall, the project performance as well as compliance with the legal covenants has been rated satisfactory for the last couple of years. Financial management, procurement and monitoring and evaluation are all satisfactory. There are no unresolved fiduciary, environmental, social and safeguards problems. The recipient has a deep commitment and sufficient ability to smoothly process and implement the additional financing, as evidenced by the successful implementation of the project to date, the satisfactory programmatic performance, and the financial and human resource contributions that continue to be made by the government. 9. Project implementation started off briskly at the onset, but immunization activities were suspended in the latter half of 2003 in the Northern parts of Nigeria, leading to a major setback to the national polio eradication effort. The suspension was a result of circulating rumors that the OPV contained anti-fertility agents. It took almost a year of intense information, education and communication (IEC) campaigns and high-level advocacy with political and religious leaders, accompanied by in-country and international testing of the vaccines, for these activities to be resumed. During this period there was a significant resurgence of the wild polio virus. Indeed, from the country had the highest numbers of polio cases in the world (see Table 1). In order to address the resurgent virus, and based on the recommendations of the ERC, several extra Supplemental Immunization Activities (SIAs) had to be organized, necessitating an IDA supplemental financing that was approved in 2005, as noted. While implementation picked up thereafter, large numbers of missed immunizations continued among the target population, resulting in high levels of polio prevalence in 2005 and type I 555 I 1045 I 1716 I 1666 I However, the implementation of the program rapidly regained momentum after the introduction in late with the advice and active support of the World Bank - of a new approach to the delivery of OPVs that includes the use of Immunization Plus Days (IPDs) instead of OPV-alone campaigns, the use of a new monovalent oral polio vaccine (MOPVl), which was shown to be three times more effective than the trivalent vaccine (Grassly et al., 2007), and a strategy of Reaching Every Ward (REW) with routine immunization services. In this strategy, multiple antigens are offered to all eligible children through the use of temporary fixed posts, which are usually the health facilities 3

10 in the ward itself, as well as house-to-house teams. Improved program management, micro-planning, training and supervision, as well as marked improvements in community acceptance and participation, have since resulted in substantial increases in vaccination coverage rates, particularly in the high-risk areas with persistent wild polio virus transmission. The Polio eradication initiative has also contributed significantly to institutional and capacity strengthening in the health sector at all levels of government in Nigeria, and particularly in the delivery of immunization services and disease surveillance Programmatic and epidemiological data demonstrates that, subsequent to the implementation of the new strategy, much of Nigeria is now polio free; only 197 cases of wild polio were documented in the first 38 weeks of 2007 compared to 919 cases for the same period in In fact, 2007 was the year with the lowest polio incidence since 2002 and the lowest incidence ever of type 1 polio (a 90 percent reduction), the most virulent of all polio viruses. In 2006 the reported incidence of wild polio virus Type 1 in Jigawa, Kano, and Katsina was greater than 560; in 2007 these states reported only 12 cases. In 2007, Nigeria accounted for only 22 percent of the wild polio virus cases globally and 78 percent of the wild polio virus cases in Africa, as compared to 60 percent and 94 percent respectively in The following results table presents key baseline, current and anticipated end-of-project outcomes for the project. The trend presented in the Table 2 augers well for the attainment of the Development Objectives of the Project, and significantly increases the probability of global polio eradication. Indicator Establishment and full operationalization of the Baseline March 2006 December Current End of 2006 Status Project Target Very Partial Virtually Completed Completed Limited complete 12. The stewardship and coordination of the implementation of the Polio Eradication program by the National Primary Health Care Development Agency (NPHCDA) has been satisfactory. As part of a reform undertaken recently by the Federal Ministry of Health (FMOH), the National Program for Immunization (NPI), which was overseeing the Bank project, was merged with the NPHCDA in order to rationalize the Federal institutional structures and strengthen management capacities. Despite this significant change at the helm, program implementation has been on track, and the NPHCDA has demonstrated a positive commitment towards polio eradication, as well as the strengthening of routine immunization. Furthermore, procurement and financial management activities have been satisfactory and have proceeded smoothly. 4

11 111. RATIONALE FOR ADDITIONAL FINANCING 13. Despite the significant recent gains noted above, there are still a number of areas, in the country where immunization coverage has remained sub-optimal, and eligible children are being missed in the vaccination campaigns, and these areas continue to have wild polio virus transmission. The national authorities, with the support of partners, are deeply committed to the interruption of the wild polio virus transmission, and have devised innovative strategies (as described above) to ensure better immunization service delivery and community participation in these high risk areas. However, implementation of these strategies, and successful interruption of wild polio virus transmission, constitutes a significant scale up of activities and requires the investment of additional resources, and this has created an overall programmatic financing gap (Le. for OPVs and for the supplemental and surveillance activities) of about $158 million. 14. Alternatives to additional financing were considered, such as the preparation of a new Bank project, use of government funds and financing by other donors. The new project option was rejected because of the relatively longer time required to prepare such operations, which is inconsistent with the emergency nature of the request from the GoN. Furthermore, while OPV coverage rates have expanded significantly under the project, they are likely to fall just short of the 80 percent coverage required to trigger the buydown arrangements under the project. A failure to benefit from the buy-down, particularly when the project is so close to meeting these targets, would compromise the ability of the GoN to access additional IDA funding, and would constitute a huge setback to the Nigerian polio eradication program in particular, and the global effort in general. On the other hand, should the government be able to build on the gains noted above, the coverage rates are likely to easily exceed the required 80 percent rate over the life of the additional financing. Consistent with the principles of the financing of a global public good (as described below), this would enable the government to benefit from the buydown arrangement for the entire amount of the IDA credits. 15. Financing of the program entirely through government resources and/or through donor funds was also rejected as unrealistic and impractical. While both the government and other partners have come forward with additional commitment of resources (e.g. CDC, KfW, Japan and Korea along with the government have committed a total of US$ 45 million), there is still as shortfall in the resources available to fill this gap of about US$ 11 3 million (of which the proposed IDA additional financing will cover US$ 50 million). 16. The additional financing would ensure the completion of on-going activities. As noted, the additional financing would also ensure that the project maximizes the achievement of the development objective by supporting the implementation of the intensified national and sub-national vaccination campaigns using the innovative strategies that have been developed by the GoN. In this regard, it should be emphasized that the GoN is already covering the entire costs of the routine immunization vaccines and injection devices, as well as a significant amount of the operational costs of the Polio Eradication initiative with the exception of OPVs. It would be difficult for the government to also provide the additional funding for these vaccines. Most importantly, 5

12 any compromise at this stage in OPV security, when an even stronger push is required to interrupt the transmission of the wild polio virus, would pose a grave risk to the rest of the country, the rest of Africa and the rest of the world, and would adversely affect the global polio eradication campaign. This eradication effort is thus also a global public good, an important justification for World Bank financing. IV. PROPOSED CHANGES 17. The proposed additional financing of US$50 million would retain the objectives and implementation procedures of the original project and would be allocated, as requested by the recipient, as a supplementary credit to the Federal Government. As such, there are no proposed changes to the project s development objectives or to the scope of the project, and IDA funds will continue to be used to finance the procurement of OPVs through UNICEF. 18. As described above, the project has already adopted new institutional arrangements to better respond to the evolving demands of the program. Specifically, the previous polio eradication strategy, also called National Immunization Days or NIDs, was based on an OPV and Vitamin A-only strategy. As this strategy did not achieve its desired result, and following consultations with key stakeholders including the World Bank, a new and innovative Immunization Plus Days (IPD) Strategy was adopted. In this strategy, multiple antigens are offered to all eligible children. For polio eradication, all children under the age of 5 receive OPV during every campaign and vitamin A twice a year through temporary fixed posts and house-to-house teams. Other vaccine preventable antigens are administered to all children under the age of 1 at the temporary fixed post. This strategy, which boosts routine immunization through the use of vaccination cards and, where possible, the use of temporary fixed posts in health facilities within the settlements or wards, will be continued. 19. Further, the proposed Additional Financing will continue to make use of the innovative IDA buy-down mechanism, in which the IDA credit becomes a buy-down mechanism if the following two indicators are met: a) Timely arrival at national level of OPV procured through UNICEF (Target: Vaccines arrive at least 6 weeks before the SIAs in the national strategic store in Abuja); and b) Immunization coverage of Supplemental Immunization Activities (SIAs) (Target: At the end of the credit, immunization coverage of OPV of at least 80 percent is reached in each endemic state. Tool: cluster sample survey according to WHO approved methodology). 20. Given the currently global OPV production constraints (for which neither the GoN or UNICEF can be held responsible), it is proposed that the target for the first performance (process) indicator, relating to timely arrival at national level of OPV procured through UNICEF, is changed from vaccines arriving at least 6 weeks before the SIA in the national strategic store in Abuja (as currently proposed) to vaccines arriving at least 3 weeks before the SIA in the national strategic store in Abuja. 21, Project Costs and Financing: Total project costs, including taxes and duties, is estimated at US$50 million. The breakdown of estimated costs is shown in Schedule A. 6

13 Schedule B lays out the project s financing plan and disbursement schedule. A summary of procurement arrangements is given in Schedule C. 22. Revised Project Closing Date: The closing date for the additional financing will be April 29, An Implementation Completion Report will be prepared within six months after the closing of the project. V. CONSISTENCY WITH CPS, MDGS AND AAP 23. The proposed additional financing is consistent with the objectives and approach of the current CPS ( ) that supports Nigeria s National Economic Empowerment and Development Strategy (NEEDS). The main objectives of the CPS are improved: (i) service delivery for human development; (ii) environment and services for non-oil growth; and (iii) transparency and accountability for better governance. Consistent with the CPS s first objective, the main focus of the Partnership for Polio Eradication Project is to assist the Federal and State Governments in the strengthening of polio eradication as well as routine immunization services, thereby contributing to overall health systems development. In addition, the project supports strengthened monitoring and evaluation capacity, policy formulation and implementation, which are critical for improved accountability under the remaining focus areas of the CPS. 24. Furthermore, the proposed project includes activities that are central to achieving the Millennium Development Goals (MDGs) for Health. Finally, the proposed project also supports the objectives laid out in the Africa Action Plan (AAP), including with respect to the results framework for achieving impact and the development of national capacity and management of health systems. 25. As described above, the project is financing a multi-donor financed framework and IDA S support for the project is thus fully embedded in the national program for polio eradication and the strengthening of routine immunization services. VI. Appraisal Summary Economic Analysis 26. Justification for Government intervention: Vaccinations, including polio, create positive externalities as an immunized child reduces the risk of spreading diseases to others. However, since parents do not take into account these benefits when deciding whether to vaccinate a child, the number of children immunized would be less than optimal without Government intervention. Government intervention is also justified for References: I. Grasslv NC. Wenger J, Durrani S, Bahl S. DeshDande JM, Sutter RW. Hevmann DL, and Avlward - RB Protective efficacy of a monovalent oral type 1 polio virus vaccine: a case-control study. The Lancet. Apr 21;369(9570): ; 2. WHO Conclusions and Recommendations of the Advisory Committee on Poliomyelitis Eradication, Geneva, November, Weeklv E~idemioloeical Record, January 1 fh, No. 3, 2008; (83): 25-36; 3. Report on the 13 h Meeting of the Expert Review Committee (ERC) on Polio Eradication and Routine Immunization in Nigeria. Abuja, Nigeria, 8-9 November 2008; 4. Thompson KM, Tebbens RJ Eradication versus control for poliomyelitis: an economic analysis. The Lancet Apr 2 1;369(9570): ; and

14 equity concerns as the poor are the least likely to be immunized. For instance, data from the Nigeria DHS 2003 shows that among the richest 20 percent of the population children are several times more likely to be fully immunized than children belonging to the poorest 20 percent. 27. Justification for World Bank s support: The resources needed in the short term to eradicate poliomyelitis are substantial; Nigeria could not possibly finance the entire effort due to insufficient resources and competing needs, as well as given the relatively small share polio represents in the country s burden of disease. However, the benefits to the entire world and to Africa, in particular, of the elimination of poliomyelitis in Nigeria (the only endemic country in the continent) are enormous, as no more resources will be needed to prevent or control the disease or to offer care to those affected by it. At the moment, the presence of the wild polio virus in Nigeria represents a threat to the regional and global eradication effort as the virus has spread from this area to other countries, most recently to Chad, Benin and Niger. As described above, substantial progress has been achieved last year due to the demonstrated commitment of the government and the use of new and innovative strategies, and a final effort is likely to eliminate the transmission of the wild polio virus. 28. Cost-effectiveness of the eradication approach: As the eradication effort approaches its goal, the marginal cost of finalizing the campaign increases significantly. This creates the dilemma of whether it is more cost-effective to eliminate the transmission of the wild polio virus or just control the spread of the remaining cases. A recent study using data from India (Thompson, K.M. and Tebbens, R. 2007) shows that the effort to eradicate polio implies lower longer-term total costs than a control strategy. This study shows that a low-case control scenario, that keeps the number of cases at about 1500 per year, could cost around US $10,000 million discounted over 20 years. In contrast, the Global Polio Eradication Initiative (GPEI) has estimated a need of US$ 525 million for and US$ 491 million for to fund the global campaign. The goal is expected to be reached in the near future if the effort continues. For instance, the GPEI milestone for endemic countries in 2008 is to have interrupted the polio transmission or to have at least another 50 percent reduction in the number of infected districts relative to Financial Analysis 29. Financial Gap analysis: In Nigeria, to reach the goal in the shortest time possible the Expert Review Committee (ERC) of recognized national and international experts recommended the following: (a) reduce the numbers of children that have received no polio immunization at all ( 0-dose cases) among the infected states to less than 10 percent through activities to better reach communities; (b) fully exploit the MOPV vaccines as choices for the next IPDs and SIPDs; (c) supplement IPDs with large scale follow-up campaigns (labeled mop-ups in the government strategy); (d) consider Borno as a high risk state given the regular exportation of the virus to Chad, Cameroon, and neighboring states; and (e) schedule 2 full IPDs and 4 SIPDs for 2008 and

15 30. Based on the ERC recommendations, the Government of Nigeria together with the WHO and UNICEF estimated the total funding gap for under two scenarios. The first scenario or baseline scenario assumes that no mop-ups will be needed. Under this scenario the total finding gap is US$ million; the funding gap for the procurement of OPV vaccines is of US$ million. The second scenario assumes the need of 2 mop-ups in 2008 and The total funding gap under this scenario is US$ million (excluding all tentative funding). The funding gap for the procurement of vaccines is US$ million. 31. The World Bank financed Partnership for Polio Eradication Project and its first supplemental credit have only financed the procurement of vaccines, as the Government and other development partners are better placed to finance the other activities needed for the campaign. Indeed, the GoN has financed the procurement of other antigens and injectable devices; the GoN, EU, UNICEF, WHO, and CIDA have all contributed to operational costs and surveillance. 32. The additional financing for the Partnership for Polio Eradication Project will also finance the procurement of vaccines. As seen in Table 3, the resources fiom this supplemental will finance the entire finding gap for the procurement of polio vaccines in 2008 and 2009 and about 90 percent of the 2010 gap after factoring in funding from other sources. Under the contingency scenario they will finance 100 percent of the gap for the procurement of vaccines in 2008 and 95 percent of the gap in

16 Table 1: Immunization Plus Days in Nigeria: Financial Resource Requirements, Confirmed and Tentative Funding, and Funding Gap for the procurement of Polio vaccines I I Baseline Nation-wide IPDs Sub-national IPDs MOP-UPS Addition of OPV to measles campaign Requirements Confirmed Funding Korea Nat Com CDC KfW World Bank Japan 2007 Grant TOTAL Tentative Funding Japan 2008 Grant Funds to be mobilized through the WB TOTAL Funding Gap (exclusive of tentative funding) Funding Gap (inclusive of tentative funding) Source: National Primary Health Contingency I $42.69 $35.14 $18.08 $95.91 $51.23 $43.93 $18.08 $ $0.09 $0.09 $0.09 $0.09 $3.93 $3.93 $3.93 $3.93 $14.30 $14.30 $28.60 $14.30 $14.30 $28.60 $3.30 $3.30 $3.30 $3.30 $1.84 $1.84 $1.84 $1.84 $23.46 $14.30 $0.00 $37.76 $23.46 $14.30 $0.00 $37.76 $6.00 $6.00 $6.00 $6.00 $13.23 $20.84 $15.93 $50.00 $21.77 $28.23 $50.00 $19.23 $20.84 $15.93 $56.00 $27.77 $28.23 $0.00 $56.00 $19.23 $20.84 $18.08 $58.15 $27.77 $29.63 $18.08 $75.48 $0.00 $0.00 $2.15 $2.15 $0.00 $1.40 $18.08 $19.48 Care Development Agency, WHO, UNICEF. January Institutional Arrangements 33. The proposed additional financing does not require additional implementation capacity beyond what is already in place for the existing project, namely the use of existing public health structures at Federal, and State level with oversight by the Ministry of Health and technical assistance from the Expert Review Committee and the World Health Organization (WHO). The additional financing will be monitored through the existing monitoring mechanisms and already functional surveillance system. Fiduciary 34. Financial management: Simplified acceptable financial management arrangements as specified in the Development Credit Agreement of the original project, including accounting and reporting systems, are in place for the project and will continue for the additional financing. In accordance with Bank policy and procedures, the financial management arrangements of the project have been reviewed recently. The review determined that the financial management arrangements for the current project are satisfactory. All external audit reports and quarterly financial management reports have been duly submitted. 10

17 3 5, Procurement and disbursement arrangements: The existing procurement and disbursement procedures applied under the present project, which have been assessed to be satisfactory, will continue. UNICEF will undertake the procurement and supply of OPV through its international procurement division, based in Copenhagen as agreed in the present project. The extensiodupdating of the existing procurement agreement (MOU) between the FGN and UNICEF for the duration of the additional financing will be agreed to by both parties and submitted for Bank s clearance prior to October 31, Under the Agreement, UNICEF will buy the vaccines from the most advantageous source, while taking into account its other obligations to respond to the global needs for OPV and its own institutional requirements. With respect to disbursement arrangements, we envisage no change in the existing disbursement arrangements for this operation. 36. Environmental and Social Aspects: The project is not envisaged to cause environmental risks and the environmental category for the additional financing is Cy as for the parent project. In terms of social aspects, the project has a strong poverty focus. Poor people living in unsanitary conditions are at greatest risk for polio. In addition, children in poor families tend to have the lowest immunization coverage. The project specifically aims to benefit vulnerable groups and previously neglected groups by providing polio immunization. Poor families, particularly children, would be the primary beneficiaries of the project. VII. EXPECTED OUTCOMES 37. Key performance indicators: The project s success would be measured by the following key indicators and targets that will also serve to determine whether or not the IDA buy-down is triggered. 0 Timely arrival at national level of OPV procured through UNICEF. Target: vaccines arrive at least 3 weeks before the SIA in the national strategic store in Abuja. Tool: UNICEF/NPHCDA vaccine arrival report. 0 Immunization coverage of SIA: Target: at the end of the credit, immunization coverage of OPV is at least 80 percent in each endemic state. Tool: cluster sample survey according to a WHO approved methodology. VIII. BENEFITS AND RISKS 38. Benefits: The procurement and supply of additional OPV through the proposed additional financing will assist in achieving the original project objective. As designed, the project will benefit all Nigerian children below the age of five, but will most benefit poor and disadvantaged children. Specifically, the prevention of disability due to the disease would alleviate human suffering and mitigate the disease s economic and social impact. The project will also help build human capacities and strengthen general health systems. The project will assist Nigeria in eliminating polio as a public health problem, thereby freeing up resources for other sectoral priorities. Finally, as the project is part of the global effort to eradicate polio, its benefits will accrue to the entire world and also to future generations. 11

18 39. Risks: Most of the risks mentioned in the original PAD with respect to the achievement of the project development objectives remain valid, especially with respect to financing and financial management, political support and the weakness of routine immunization services. The financing risk is being mitigated by the system that has now been established to adequately capture the financing gap, and the demonstrated willingness of the partners to fill this gap and support the GoN in its polio eradication efforts. Also procurement risk is being mitigated with the appointment of UNICEF as the Procurement Agent that will undertake the procurement and supply of OPV through its international procurement division, based in Copenhagen as it is presently practice in the present project. The assistance of IDA and other development partners has helped in strengthening the financial management systems at the NPHCDA and the Interagency Coordinating Committee (ICC), although more needs to be done in this regard. Political support for the polio eradication program, and the active involvement of local, religious and traditional leaders, has been secured through high-level advocacy that has been an integral part of the implementation of the polio eradication program. The issue of strengthening routine immunization systems is being addressed through the implementation of the IPDs, which has resulted in increased capacities and strengthened systems for routine immunization (RI) as well. In addition, RI is now receiving more attention from the GoN and several international partners. IX. FINANCIAL TERMS AND CONDITIONS FOR THE ADDITIONAL FINANCING 40. The proposed Additional Financing would be provided on standard IDA terms with a maturity of 40 years including a grace period of 10 years, and a commitment fee not to exceed 0.5 percent. 41. Other than submission of a satisfactory legal opinion on the Financing Agreement, there are no conditions of effectiveness. Covenants to be included are standard and pertain to financial management, including the auditing of project financial statements by independent auditors acceptable to IDA. 12

19 NIGERIA ADDITIONAL FINANCING FOR THE PARTNERSHIPS FOR POLIO ERADIATION PROJECT ESTIMATED PROJECT COSTS (in US$ million equivalent) SCHEDULE A Page 1 or 1 Project Costs by Component Oral Polio Vaccine Procurement Total Baseline Costs Physical Contingencies Price Contingencies Total Project Costs Total Financing Rewired Local Foreign Total US $ million US $ million US $ million Project Cost by Category Local Foreign Total US $ million US $ million US $ million Goods Works Services Training Total Project Costs Total Financing Required SOURCE OF FINANCING (in US$ million equivalent) IDA Local Foreign Total Percentage of Foreign Expenditures % Total 50 Total project costs including contingencies. Identifiable taxes and duties are US$ 0 and the total project costs, net of taxes, is US$ million. 13

20 NIGERIA ADDITIONAL FINANCING FOR THE PARTNERSHIPS FOR POLIO ERADICATION PROJECT SCHEDULE B Page 1 of 2 DISBURSEMENT SCHEDULE (in US$ million equivalent) IDA FY Existing Credit Additional Financing Million 20 million 28 million 2 million ALLOCATION AND DISBURSEMENT OF ADDITIONAL FINANCING (in SDR) Allocation of Original Credit Amount Credit Amount 1. Goods 2. Works I 3. Services 4. Training TOTAL I million 1 100% 31.8 million I 14

21 (0.00) NIGERIA ADDITIONAL FINANCING FOR THE PARTNERSHIPS FOR POLIO ERADIATION PROJECT PROCUREMENT ARRANGEMENTS (in US$ million equivalent) SCHEDULE C Page 1 of 1 Category Procurement Method International National Other# Total Competitive Competitive Methods NIF Bidding Bidding 1. Goods 2. Works 3. Services 4. Training Total (0.00) (0.00) (50.00) (0.00) (50.00) ~ (0.00) (0.00) (0.00) (0.00) (0.00) (0.00) (0.00) (0.00) (0.00) (0.00) (0.00) (0.00) (0.00) (0.00) (0.00) (0.00) (50.00) (0.00) (50.00) N.I.F. = Not IDA-financed. Figures in parenthesis are the amounts to be financed by the IDA Additional Financing. Slight differences may result from rounding of figures. # The Credit will finance OPV under agreement with UNICEF for the supply of OPV in accordance with the provisions of procurement guidelines. 15

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23 SEPTEMBER N To Lomé 5 N NIGER To Kandi BENIN To Bori Abeokuta OGUN To Kandi OYO LAGOS Lagos Rima KEBBI Niger Ibadan Birnin Kebbi Kainji Reservoir Wawa Oshogbo OSUN Gulf of Guinea To Tahoua To Agadez 10 E To Nguigmi 15 E SOKOTO NIGER Nig er KWARA Ilorin This map was produced by the Map Design Unit of The World Bank. The boundaries, colors, denominations and any other information shown on this map do not imply, on the part of The World Bank Group, any judgment on the legal status of any territory, or any endorsement or acceptance of such boundaries. Illela Sokoto EKITI Ado-Ekiti Akure ONDO Benin City Sokoto Gusau ZAMFARAARA Kontagora Sapete N i g EDO Kaura Namoda FEDERAL CAPITAL AL Baro TERRITORY Lokoja KOGI ANAMBRA KATSINA KADUNA Bauchi Plateau NASARAWA Benue ENUGU Enugu S a h e l EBONYI KANO BENUE J o s Udi Hills CROSS DELTA Owerri Umuahia Warri RIVER IMO ABIA RIVERS Aba Uyo Yenogoa A- AKWA- Calabar Port BAYELSA Harcourt IBOM e r D Niger Kaduna Asaba e l t a Minna Awka Zaria Katsina Kaduna ABUJA Kano Makurdi Abakaliki Bioko I. (EQ. GUINEA) Lafia JIGAWA A Jos P l a t e a u Dutse BAUCHI To Doula Hadejia Bauchi PLATEAU Shendam Wukari 5 E 10 E Nguru Jamaari Jamaari Komadugu Gongola GOMBE Taraba Be nue Bali TARABA NIGER Chappal Waddi (2,419 m ) G YOBE o Yobe Pokiskum Gana Gombe Jalingo t h M ts. Damaturu Biu ADAMAWA A Yola a r a d n a M CAMEROON Kilometers Yob e Oamasak BORNO Maiduguri 5 N Miles t M. s 1963 Level 1973 Level Lake Chad 2001 Level CHAD NIGERIA NIGERIA SELECTED CITIES AND TOWNS STATE CAPITALS NATIONAL CAPITAL RIVERS MAIN ROADS RAILROADS STATE BOUNDARIES INTERNATIONAL BOUNDARIES 10 N IBRD 33458