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+[
+ {
+ "input_text": "",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 0
+ ]
+ }
+ },
+ {
+ "input_text": "CURRENCY EQUIVALENTS\n\n\n(Exchange Rate Effective December 31, 2023)\n\n\nCurrency Unit = [KENYA SHILLING ]\n\n(KES)\n\nKES 157.00 = US$1\n\nEURO 0.90= US$1\n\nSDR 0.75 US$1\n\n\nFISCAL YEAR\nJuly 1 - June 30\n\n\nRegional Vice President: Victoria Kwakwa\n\nRegional Director: Daniel Dulitzky\n\nCountry Director: Keith E. Hansen\n\nPractice Manager: Francisca Ayodeji Akala\n\nTask Team Leader: Jane Chuma\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 1
+ ]
+ }
+ },
+ {
+ "input_text": "ABBREVIATIONS AND ACRONYMS\n\n\n|AM|Accountability Mechanism|\n|---|---|\n|
ANC
|
Antenatal Care
|\n|
AWPB
|
Annual Work Plan and Budget
|\n|
AWP
|
Annual Work Plan
|\n|
BREHS
|
Building Resilient and Responsive Health Systems
|\n|
CBK
|
Central Bank of Kenya
|\n|
CHERP
|
COVID-19 Health Emergency Response Project
|\n|
CHU
|
Community Health Unit
|\n|
CO2e
|
Carbon dioxide equivalent
|\n|
COVID-19
|
Coronavirus Disease 2019
|\n|
CPF
|
Country Partnership Framework
|\n|
CRA
|
County Revenue Allocation
|\n|
CRF
|
County Revenue Fund
|\n|
DA
|
Designated Account
|\n|
DP
|
Development Partner
|\n|
DPHK
|
Development Partners Health Kenya
|\n|
DRS
|
Department of Refugees Services
|\n|
EDGE
|
Excellence in Design for Building Efficiencies
|\n|
ERP
|Enterprise Resource Planning
|\n|
E&S
|
Environmental and Social
|\n|
ESCP
|
Environmental and Social Commitment Plan
|\n|
ESIA
|
Environmental and Social Impact Assessment
|\n|
ESMF
|
Environmental and Social Management Framework
|\n|
ESMP
|
Environmental and Social Management Plan
|\n|
ESRS
|
Environmental and Social Review Summary
|\n|
ESS
|
Environmental and Social Standards
|\n|
ESSD
|
Environmental and Social Due Diligence
|\n|
FM
|
Financial Management
|\n|
GDP
|
Gross Domestic Product
|\n|
GFF
|
Global Financing Facility
|\n|
GISEDP
|
Garissa Integrated Socioeconomic Development Plan
|\n|
GRM
|
Grievance Redress Mechanism
|\n|
GRS
|
Grievance Redress Service
|\n|
HFMC
|
Health Facility Management Committee
|\n|
HIV/AIDS
|
Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome
|\n|
HMIS
|
Health Management Information System
|\n|
HPT
|
Health Products and Technologies
|\n|
IBRD
|
International Bank for Reconstruction and Development
|\n|
IDA
|
International Development Association
|\n|
IEC
|
International Electrotechnical Commission
|\n|
IFMIS
|
Integrated Financial Management Information System
|\n|
IPC|
Integrated Food Security Phase Classification|\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 2
+ ]
+ }
+ },
+ {
+ "input_text": "|IPF|Investment Project Financing|\n|---|---|\n|
KEMSA
|
Kenya Medical Supplies Authority
|\n|
KISEDP
|
Kalobeyei Integrated Socio-Economic Development Plan 2
|\n|
KHIS
|
Kenya Health Information System
|\n|
KHSSP
|
Kenya Health Sector Strategic Plan
|\n|
KISEDP
|
Kalobeyei Integrated Socio-Economic Development Plan
|\n|
LMP
|
Labor Management Plan
|\n|
M&E
|
Monitoring and Evaluation
|\n|
MoH
|
Ministry of Health
|\n|
MPDSR
|
Maternal and Perinatal Death Surveillance and Response
|\n|
MWMP
|
Medical and Waste Management Plan
|\n|
NCCF
|
National Climate Change Framework Policy
|\n|
NCCRS
|
National Climate Change Response Strategy
|\n|
NCD
|
Non-Communicable Disease
|\n|
NDC
|
Nationally Determined Contribution
|\n|
NHIF
|
National Health Insurance Fund
|\n|
NT
|
National Treasury
|\n|
OAG
|
Office of the Auditor General
|\n|
O&M
|
Operations and Maintenance
|\n|
OP
|
Operational Policy
|\n|
ORS
|
Oral Rehydration Salts
|\n|
PA
|
Project Account
|\n|
PAD
|
Project Appraisal Document
|\n|
PFM
|
Public Financial Management
|\n|
PHC
|
Primary Health Care
|\n|
PDO
|
Project Development Objective
|\n|
PMT
|
Project Management Team
|\n|
PNC
|
Postnatal Care
|\n|
POM
|
Project Operations Manual
|\n|
PP
|
Procurement Plan
|\n|
PPH
|
Postpartum Hemorrhage
|\n|
PPSD
|
Project Procurement Strategy for Development
|\n|
PS
|
Principal Secretary
|\n|
QoC
|
Quality of Care
|\n|
RMNCAH
|
Reproductive, Maternal, Newborn, Child, and Adolescent Health
|\n|
SEA / SH
|
Sexual Exploitation and Abuse / Sexual Harassment
|\n|
SEP
|
Stakeholder Engagement Plan
|\n|
SDPHS
|
State Department for Public Health and Professional Standards
|\n|
SHA
|
Social Health Authority
|\n|
SHIF
|
Social Health Insurance Fund
|\n|
SPA
|
Special Purpose Account
|\n|
STEP
|
Systematic Tracking of Exchanges in Procurement
|\n|
STEPS
|
STEPwiseApproach to NCD Risk Factor Surveillance
|\n|
THS-UCP|
Transforming Health Systems for Universal Care Project|\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 3
+ ]
+ }
+ },
+ {
+ "input_text": "|UHC|Universal Health Coverage|\n|---|---|\n|
UN
|
United Nations
|\n|
UNHCR
|
United Nations High Commissioner for Refugees
|\n|
VGPF
|
Vulnerable Groups Planning Framework
|\n|
WBG
|
World Bank Group
|\n|
WHO
|
World Health Organization
|\n|
WHR|
Window for Host Communities and Refugees|\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 4
+ ]
+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\nTABLE OF CONTENTS\n\n**DATASHEET .......................................................................................................................... 1**\n\n**I.** **STRATEGIC CONTEXT ..................................................................................................... 9**\n\nA. Country Context ............................................................................................................................... 9\n\nB. Sectoral and Institutional Context* ................................................................................................. 9\n\nC. Relevance to Higher Level Objectives ............................................................................................11\n\n**II.** **PROJECT DESCRIPTION ................................................................................................ 12**\n\nA. Project Development Objective (PDO) ..........................................................................................12\n\nB. Project Components ......................................................................................................................13\n\nC. Project Beneficiaries ......................................................................................................................15\n\nD. Results Chain ..................................................................................................................................16\n\nE. Rationale for Bank Involvement and Role of Partners ...................................................................16\n\nF. Lessons Learned and Reflected in the Project Design ....................................................................17\n\n**III.** **IMPLEMENTATION ARRANGEMENTS ........................................................................... 17**\n\nA. Institutional and Implementation Arrangements ..........................................................................18\n\nB. Results Monitoring and Evaluation Arrangements ........................................................................18\n\nC. Sustainability ..................................................................................................................................18\n\n**IV.** **PROJECT APPRAISAL SUMMARY .................................................................................. 19**\n\nA. Technical, Economic and Financial Analysis (if applicable) ............................................................19\n\nB. Fiduciary .........................................................................................................................................20\n\nC. Legal Operational Policies ..............................................................................................................22\n\nD. Environmental and Social ..............................................................................................................23\n\n**V.** **GRIEVANCE REDRESS SERVICES .................................................................................... 24**\n\n**VI.** **KEY RISKS .................................................................................................................... 24**\n\n**VII.** **RESULTS FRAMEWORK AND MONITORING .................................................................. 26**\n\n**ANNEX 1: Implementation Arrangements and Support Plan ................................................ 36**\n\n**ANNEX 2: Climate Change ................................................................................................... 40**\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 5
+ ]
+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n\n\n\n\n|Project
Beneficiary(ies)
Kenya|Operation Name
Building Resilient and Responsive Health Systems|Col3|Col4|\n|---|---|---|---|\n|Operation ID
P179698|Financing Instrument
Investment Project
Financing (IPF)|Environmental and Social Risk
Classification
Moderate|
|\n\n\n|Financing & Implementation Modalities|Col2|\n|---|---|\n|[ ] Multiphase Programmatic Approach (MPA)|[ ] Contingent Emergency Response Component (CERC)|\n|[ ] Series of Projects (SOP)|[ ] Fragile State(s)|\n|[ ] Performance-Based Conditions (PBCs)|[ ] Small State(s)
|\n|[ ] Financial Intermediaries (FI)|[✓] Fragile within a non-fragile Country|\n|[ ] Project-Based Guarantee|[ ] Conflict|\n|[ ] Deferred Drawdown|[ ] Responding to Natural or Man-made Disaster|\n|[ ] Alternative Procurement Arrangements (APA)|[ ] Hands-on Expanded Implementation Support (HEIS)|\n\n\n|Expected Approval Date
13-Mar-2024|Expected Closing Date
30-Jun-2029|\n|---|---|\n|Bank/IFC Collaboration
No|
|\n\n\n\n\n\nPage 1 of 43\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 6
+ ]
+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n|Components Component Name Strengthening institutional capacity for health service delivery towards|Cost (US$)|\n|---|---|\n|Strengthening institutional capacity for health service delivery towards
achieving UHC|55,000,000.00|\n|Improving utilization of quality health services at primary care level|150,000,000.00|\n|Project management and evaluation|10,000,000.00|\n\n\n\n\n\n\n|SUMMARY|Col2|\n|---|---|\n|**Total Operation Cost**|**215.00**|\n|**Total Financing**
|**215.00**
|\n|**of which IBRD/IDA**|**200.00**|\n|**Financing Gap**|**0.00**|\n\n\n|World Bank Group Financing International Development Association (IDA)|200.00|\n|---|---|\n|International Development Association (IDA)|200.00
|\n|IDA Credit|160.00
|\n|IDA Grant|40.00|\n\n\n\n\n\nPage 2 of 43\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 7
+ ]
+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n\n\n\n\n\n\n\n\n\n\n|Col1|Credit Amount|Grant Amount|SML Amount|Guarantee
Amount|Total Amount|\n|---|---|---|---|---|---|\n|Window for Host
Communities and
Refugees (WHR)|0.00|40.00|0.00|0.00|40.00|\n|National
Performance-Based
Allocations (PBA)|160.00|0.00|0.00|0.00|160.00|\n|**Total**|**160.00**|**40.00**|**0.00**|**0.00**|**200.00**|\n\n\n\n\n\n\n|WB Fiscal
Year|2024|2025|2026|2027|2028|2029|\n|---|---|---|---|---|---|---|\n|**Annual**
|5.00|40.00|55.00|55.00|55.00|5.00|\n|**Cumulative**|5.00|45.00|100.00|155.00|210.00|215.00|\n\n\n\n\n\n@#&OPS~Doctype~OPS^dynamics@padrisk#doctemplate\n\n\n\nPage 3 of 43\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 8
+ ]
+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n|E & S Standards|Relevance|\n|---|---|\n|ESS 1: Assessment and Management of Environmental and Social Risks and
Impacts|Relevant|\n|ESS 10: Stakeholder Engagement and Information Disclosure|Relevant|\n|ESS 2: Labor and Working Conditions|Relevant|\n|ESS 3: Resource Efficiency and Pollution Prevention and Management|Relevant|\n\n\n\nPage 4 of 43\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 9
+ ]
+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n|ESS 4: Community Health and Safety|Relevant|\n|---|---|\n|ESS 5: Land Acquisition, Restrictions on Land Use and Involuntary Resettlement
|Not Currently Relevant|\n|ESS 6: Biodiversity Conservation and Sustainable Management of Living Natural
Resources
|Relevant|\n|ESS 7: Indigenous Peoples/Sub-Saharan African Historically Underserved
Traditional Local Communities|Relevant|\n|ESS 8: Cultural Heritage|Not Currently Relevant|\n|ESS 9: Financial Intermediaries
|Not Currently Relevant
|\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPage 5 of 43\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 10
+ ]
+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n|Type|Citation|Description|Financing Source|\n|---|---|---|---|\n|Effectiveness|Article V. 5.01(a)|The Association is satisfied
that the Recipient has an
adequate refugee
protection framework.
|IBRD/IDA|\n|Effectiveness|Article V. 5.01(b)|The Recipient and the
Project Implementing
Entity have executed a
Subsidiary Agreement in
accordance with Section I.B
of Schedule 2 to this
Agreement.
|IBRD/IDA|\n|Effectiveness|Article V. 5.01(b)|The Co-financing
Agreement has been
executed and delivered and
all conditions precedent to
its effectiveness or to the
right of the Recipient to
make withdrawals under it
(other than the
effectiveness of this
Agreement) have been
fulfilled.
|IBRD/IDA|\n|Effectiveness|Article V. 5.01(c)|The Recipient has prepared
and adopted the Project
Operations Manual
(“POM”) in form and
substance satisfactory to
the Association, in
accordance with the
provisions of Section
I.C.1(b)ii of Schedule 2 to
this Agreement.
|IBRD/IDA|\n|Effectiveness|Article V. 5.01(d)|The Recipient has
established a dedicated
Project Management Team
(“PMT”), with adequate
resources and facilitation,|IBRD/IDA|\n\n\n\nPage 6 of 43\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 11
+ ]
+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n|Col1|Col2|key staff holding such
qualifications and under
terms of reference
acceptable to the
Association, such staff to
include a project manager,
Project components
coordinators, assistant
coordinators, a monitoring
and evaluation specialist, at
least one dedicated
specialist for each of social
risks and environmental
risks management and any
other technical and
fiduciary specialists as may
have been agreed with the
Association and as further
detailed in the POM.|Col4|\n|---|---|---|---|\n|Effectiveness|Article V. 5.01(e)|The Recipient has
prepared, consulted upon,
adopted and publicly
disclosed the
Environmental Social and
Management Framework,
the Vulnerable Groups
Planning Framework, the
Medical Waste
Management Plan, the
Stakeholder Engagement
Plan and the Labor
Management Procedures.
|IBRD/IDA|\n|Effectiveness|Article V. 5.01(f)|The Recipient has assessed
the security risks of the
Project and included
measures to mitigate such
security risks in the POM.
|IBRD/IDA|\n|Effectiveness|Article V. 5.01(g)|KEMSA has assigned an
environmental and social
risks management (E&S)
focal person to maintain
coordination and support
E&S implementation of the
Project.|IBRD/IDA|\n\n\n\nPage 7 of 43\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 12
+ ]
+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n\n\n\n\n\n\n\n\n\nPage 8 of 43\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 13
+ ]
+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n**I.** **STRATEGIC CONTEXT**\n\n\n**A. Country Context**\n\n1. **The Kenya economy has continued to recover from the impacts of the COVID-19 pandemic, but the growth has**\n**slowed down in the last year.** Real gross domestic product (GDP) increased by 4.8 percent in 2022, a decrease from 7.5\npercent annual growth in 2021, largely due to the weather shocks experienced in the last two years, domestic\nmacroeconomic policies, and challenging global conditions. [1] The economy is expected to grow by 5.0 percent in 2023 and\n5.2 percent on average in 2024-2025, higher than the pre-pandemic average of 5.0 percent in 2010-2019. While growth\nprospects remain optimistic, the economy remains vulnerable to shocks such as drought, rising inflation and food\ninsecurity.\n\n2. **Kenya is highly vulnerable to climate change, particularly extreme floods, and droughts, which has affected**\n**food security for millions of people particularly in the arid and semi-arid north and north-east of the country** . [2] Floods\nare the most significant and frequent climate-related hazard in Kenya making up 40.0 percent of all-natural hazards from\n1980-2020. [3 ] Flooding is particularly impactful to communities around Kenya’s lakes and waterways. For example, a 2021\nUnited Nations (UN) report [4] projected climate change induced flooding may cause the expansion of Lake Turkana,\ndisplacing communities while impinging on agriculture and livelihoods. Simultaneously, drought is likely to adversely affect\nthe country’s agriculture sector, which is predominantly dependent on seasonal rains and is expected to negatively impact\nthe economy and food security, reversing the gains in health and nutrition outcomes. Since 2015, Kenya has experienced\na steady increase in the prevalence of severe food insecurity from 15.0 percent to 26.1 percent. [5] Between July and\nSeptember 2022, an estimated 3.5 million people (24.0 percent of the Kenya population in arid-and semi-arid counties)\nexperienced acute food insecurity. [6]\n\n3. **For more than three decades, Kenya has been home to a significant population of refugees and asylum seekers.**\nThere are 691,868 refugees and asylum seekers in the country, including in cities such as Nairobi, Mombasa, Nakuru, and\nEldoret, but the majority live in two designated refugee camps [7] - with 320,572 in Dadaab Camp in Garissa County and\n271,995 in Kakuma Camp and Kalobeyei Settlement in Turkana County. [8] The two camps are under the management of\nthe Government of Kenya’s Department of Refugee Services (DRS), with support from the United Nations High\nCommissioner for Refugees (UNHCR) and humanitarian partners who provide operational support and humanitarian\nassistance, including primary and secondary health and nutrition services. The Government has demonstrated its\ncommitment to the Global Compact on Refugees by enacting the Refugees Act of 2021, which grants refugees more rights\nand protections, and by supporting the Shirika Plan, [ 9] which seeks to create integrated settlements where refugees can\nlive, access social services, and work alongside Kenyans.\n\n\n**B. Sectoral and Institutional Context***\n\n\n1 Kenya Economic Update, June 2023\n2 World Bank, Climate Change Knowledge Portal\n3 World Bank Climate Change Knowledge Portal - Kenya.https://climateknowledgeportal.worldbank.org/country/kenya/vulnerability\n4 United Nations Environment Program: “Climate change could spark floods in world’s largest desert lake: new study”, 2021.\n\n5 World Bank data. Prevalence of food insecurity in the population – Kenya **Error! Hyperlink reference not valid.**\n6 Kenya: IPC Acute Food Insecurity and Acute Malnutrition Analysis (July - December 2022)\n7 For a detailed map see: https://data2.unhcr.org/en/country/ken\n8 UNHCR Statistics package. Kenya registered refugees and asylum seekers (31 July 2023)\n9 The Shirika Plan is a Government of Kenya socioeconomic development plan outlining the transition from refugee encampment to integrated\nsettlements.\n\nPage 9 of 43\n\n\n",
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+ "publication_year": {
+ "text": "2023",
+ "confidence": 0.6225712299346924,
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+ "reference_year": {
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+ "is_used": "False",
+ "usage_context": "background"
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+ "confidence": 0.7313182353973389,
+ "start": 521,
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+ "publication_year": {
+ "text": "2023",
+ "confidence": 0.5423882007598877,
+ "start": 640,
+ "end": 641
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+ "reference_year": null,
+ "reference_population": {
+ "text": "asylum seekers",
+ "confidence": 0.5976148247718811,
+ "start": 450,
+ "end": 452
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+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n4. **The health status of Kenyans has improved in the last five years, but significant geographic and socioeconomic**\n**inequities remain, affecting women and children.** The life expectancy of Kenyans has improved from 63 years in 2013 to\n67 years in 2020 but fell to 61 years in 2021 owing to the COVID-19 pandemic. [10] Under-five and infant mortalities dropped\nfrom 52 and 39 deaths per 1,000 live births in 2014 to 41 and 32 in 2022, respectively, partly due to improved coverage\nof primary healthcare services and significant progress in malaria and HIV/AIDS response. [11] Despite the number of women\ndelivering under the care of a skilled health worker increasing significantly, challenges remain around neonatal mortality,\nwhich is high at 21 deaths per 1,000 live births in 2022: a marginal decline from 22 per 1,000 live births in 2014. Similarly\nmaternal mortality remains high at 342 maternal deaths per 100,000 live births, [12] suggesting challenges related to quality\nof care (QoC). Teenage pregnancy declined only slightly from 18.0 percent in 2014 to 15.0 percent in 2022. While the\ncountry has recorded improvements in childhood nutrition, 18.0 percent of children aged below 5 years are stunted, a\ndecline from 26.0 percent in 2014. Despite improvements in coverage and utilization of health care services, especially for\nmaternal and child health, geographic and socioeconomic inequities remain. Although 89.3 percent of pregnant women\ndeliver under the care of a skilled health worker, five counties reported skilled delivery below 66.0 percent (Turkana-53.0\npercent; Mandera-55.0 percent; Wajir-57.0 percent; Samburu-57.0 percent; Tana River-59.0 percent). Wider gaps are\nreported for utilization of antenatal care (ANC), with only 32.1 percent of women in Garissa County attending at least 4\nANC visits, compared to 82.2 percent in Nyeri County. Only 53.9 percent of women from the lowest wealth quintile\nattended at least 4 ANC visits compared to 82.0 percent of women from the highest wealth quintile.\n\n5. **In Garissa and Turkana counties, refugees and their host communities face barriers to healthcare services,**\n**mostly affecting women and children.** Garissa and Turkana counties record the lowest percentages of women receiving\nat least 4 ANC visits (31.2 percent) in 2022 and deliveries by a skilled provider (52.6 percent) respectively. [13 ] In the refugee\ncamps, most health services are provided by UNHCR and non-governmental organizations in collaboration with the\nGovernment. The overcrowded conditions, clean water supply shortages and hygiene challenges present heightened risks\nof communicable disease outbreaks such as cholera. Other recent outbreaks in the refugee camps include polio, dengue\nfever, and chikungunya. Refugees and host communities have also been affected by prolonged drought in the region and\nthe food security of refugees has been further affected by cuts in the general food assistance. From 2020 to July 2022,\nthere has been a steady and significant increase in malnutrition cases across all refugee camps, with children under 5 years\nbeing particularly affected by malnutrition and micronutrient deficiencies. [14]\n\n6. **The devolution of health service delivery in 2013 has presented mixed results** . Decentralization of responsibility\nfor public sector health service delivery to the 47 county Governments has been accompanied by a 34.0 percent increase\nin the number of facilities, a 46.0 percent improvement in public health worker density between 2014 and 2020, and many\ncounties have equipped their health facilities to respond to the evolving health needs. County Governments are also\nexploring approaches to strengthen primary care service delivery through governance and financial management reforms,\nsuch as the Facility Improvement Fund. However, county Governments have faced significant challenges in management\nof human resources for health, ensuring availability of Health Products and Technologies (HPTs), improving quality of care,\n\n\n[10 World Bank Estimates: https://data.worldbank.org/indicator/SP.DYN.LE00.IN?locations=KE](https://data.worldbank.org/indicator/SP.DYN.LE00.IN?locations=KE)\n\n11 Kenya Demographic Health Survey, 2022. Key Indicators Report\n12 Ministry of Health Kenya (2020) Kenya Progress Report on Health and Health-Related SDGs.\n13 Kenya Demographic Health Survey, 2022\n14 UNHCR & WFP, Joint Assessment Mission Kenya-Refugee Operations (2022)\n\nPage 10 of 43\n\n\n",
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+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\nand facilitating effective governance of health facilities to deliver comprehensive networked primary care. [15,16,17,18]\nStockouts of essential medicines persist and access to essential diagnostics remains low with only 17.0 percent of facilities\nassessed as having a full set of basic diagnostic items. [19]\n\n7. **The Government initiated various reforms aimed at strengthening capacity of the National Health Insurance**\n**Fund (NHIF) and the Kenya Medical Supplies Authority (KEMSA).** Both institutions play a critical role in Kenya’s universal\nhealth coverage (UHC) agenda. NHIF reforms include changes to governance arrangements, re-engineering business\nprocesses, modernization, and realignment of the information and communications technology, modification of provider\npayment mechanisms and payment systems among others. To fast-track progress towards UHC, the Government\nintroduced four laws in October 2023 (Social Health Insurance Act, Primary Health Care Act, Facility Improvement\nFinancing Act, and the Digital Health Act). Under the new health financing arrangement, all Kenyan citizens and residents\nwill be required to be members of the Social Health Insurance Fund (SHIF). Primary health care will be purchased through\nthe primary care fund and financed through tax allocation by the national Government. Additionally, management of\nchronic illnesses and health emergencies will be through the emergency, chronic and critical illness fund, which will be\ndrawn upon once a member has exhausted their SHIF benefits. The Government is in the process of developing the\nregulations and implementation arrangements to operationalize these Acts. Key issues in KEMSA relate to: (a) inadequate\nfunding to stock commodities leading to long turnaround times; (b) suboptimal use of information systems in procurement\nprocesses; (c) weak business processes; (d) weak governance; (e) weak human resource realignment; (f) outdated\nEnterprise Resource Planning (ERP) system; and (g) weak credit control systems among others. Significant progress has\nbeen made in implementing reforms to address these challenges, however major gaps remain. The World Bank continues\nto provide technical support, but operational support is required for KEMSA to function efficiently.\n\n\n**C. Relevance to Higher Level Objectives**\n\n8. **The project is fully aligned with the World Bank’s mission and the Regional priorities** by contributing to\nincreasing the number of people receiving essential health services in Kenya. **The project is strongly aligned with the**\n**World Bank Group’s (WBG) FY23-28 Country Partnership Framework (CPF) for Kenya, discussed by the Board of**\n**Executive Directors on November 22, 2022 (Report No. 172255) and Government health sector priorities.** Objective 2 of\nthe CPF aims to “improve public expenditure transparency and efficiency”, a focus of the project. The CPF also aims for\n“greater equity in service delivery outcomes”, which will be achieved partly through reducing disparities in health\noutcomes (objective 4). The project is also aligned to objective 6, “increase household resilience to, and national\npreparedness for shocks”, highlighted in the CPF through the need to increase access to social health insurance, improving\naccess to quality health care services and expanding UHC reforms. In addition, the project will directly contribute to the\npriorities identified in the Kenya Health Policy 2014-2030, the Kenya Health Sector Strategic Plan (KHSSP, 2018-2023), the\nKenya UHC Policy (2020-2030), and the Kenya Health Financing Strategy (2020-2030).\n\n\n15 Waithaka, D., Kagwanja, N., Nzinga, J. et al. Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers\nand local communities in Kilifi County. Int J Equity Health 19, 23 (2020).\n16 Nyawira, L., Tsofa, B., Musiega, A. et al. Management of human resources for health: implications for health systems efficiency in Kenya. BMC\nHealth Serv Res 22, 1046 (2022).\n17 McCollum R, Limato R, Otiso L, et al. Health system governance following devolution: comparing experiences of decentralisation in Kenya and\nIndonesiaBMJ Global Health 2018;3:e000939\n18 Kairu, A., Orangi, S., Mbuthia, B. et al. Examining health facility financing in Kenya in the context of devolution. BMC Health Serv Res 21, 1086\n(2021).\n19 Ministry of Health Kenya Harmonized Health Facility Assessment 2018-19. The diagnostic tests were: HIV, malaria, and syphilis rapid test; urine\ntest for pregnancy; blood glucose; urine dipstick for glucose and protein; and hemoglobin levels\n\nPage 11 of 43\n\n\n",
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+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n9. **The project is consistent with Kenya’s Nationally Determined Contribution (NDC, updated 2020)** **[20]** **[21]** **, the**\n**National Climate Change Framework Policy (NCCF, 2016) and National Climate Change Response Strategy (NCCRS,**\n**2010).** The project is anticipated to have a considerable contribution to improving climate adaptation and resilience in the\ncountry and is not anticipated to contribute to greenhouse gases emissions. Kenya’s climate policies emphasize key actions\nwhich the project supports including: integration of climate change adaptation into county level development planning;\nimproving resilience of vulnerable populations to climate-related shocks; addressing vector-borne disease transmission\n(malaria, dengue), water-borne disease outbreaks, food insecurity and malnutrition; reducing direct injuries and mortality;\nand minimizing damage to infrastructure. Further, the Kenya Health Policy (2014) and KHSSP [22] acknowledge the role of\nclimate change in increasing the burden of disease in the country. [23]\n\n10. **The World Bank, following consultation with UNHCR, confirms that the protection framework for refugees** **[24]**\n**continues to be adequate in Kenya for accessing financing from the IDA20 Window for Host Communities and Refugees**\n**(WHR).** Kenya’s treatment of refugees is governed by the Refugees Act of 2021 and is largely in line with the international\nand regional refugee protection standards and Kenya’s commitments under the Global Compact on Refugees. The Act\nrecognizes the rights of refugees to participate in economic and social development and supports refugee inclusion in\nnational and county development planning. In 2023, the second phase of the Kalobeyei Integrated Socio-Economic\nDevelopment Plan 2 (KISEDP) and the Garissa Integrated Socioeconomic Development Plan (GISEDP) were launched, which\nhighlight the key role being played at the County level to support local solutions that benefit refugees and host\ncommunities, including in the health sector. In its IDA20 WHR Strategy Note, the Government identified as a priority\nsupporting social services needs in health and addressing the health priorities outlined in the KISEDP and GISEDP. The\nRefugee Regulations, to operationalize the Refugees Act of 2021 are in the final stages of development and are due for\npublication. The regulations will provide clarity in the Act’s operationalization, which will strengthen the protection\nframework. In September 2023, Kenya gazetted Legal Notice No. 143 of 2023, recognizing refugee identification\ndocuments for the purposes of acquiring services provided by the Government, including health. The Shirika Plan, which\nis currently under development, is a multi-sectoral plan that delineates development solutions that benefit both refugees\nand host communities through an integrated service delivery approach, building on the KISEDP and GISEDP. The Ministry\nof Health (MoH) is involved in the Plan’s drafting and this operation will ensure close alignment of refugee health policy\npriorities and county level implementation.\n\n\n**II.** **PROJECT DESCRIPTION**\n\n\n**A. Project Development Objective (PDO)**\n\n\n**PDO Statement**\n11. To improve utilization and quality of primary healthcare services and strengthen institutional capacity for\nservice delivery.\n\n\n20 Government of Kenya. (April, 2010) National Climate Change Response Strategy.\n21 Government of Kenya (2016). National Climate Change Framework Policy. Accessed.\n22 Government of Kenya (2018) Kenya Health Sector Strategic Plan.\n23 Ministry of Health (July, 2014) Kenya Heath Policy 2014-2030.\n24 Based on UNHCR’s Kenya Refugee Protection Assessment Update No. 5 from January to June 2023.\n\nPage 12 of 43\n\n\n",
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+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n**PDO Level Indicators**\n12. The PDO level indicators are: (a) Percentage of women receiving postnatal care within 48 hours, including in\nrefugee hosting counties; (b) Percentage of children immunized with three doses of Pentavalent vaccine; (c) Percentage\nof pregnant women attending 4 or more ANC visits, including in refugee hosting counties; (d) Proportion of Children Under\n5 with diarrhea treated with Zinc/ORS Co-Pack; (e) Order fill rate for priority health products and technologies (HPTs); (f)\norder turnaround time.\n\n\n**B. Project Components**\n13. The project will comprise three Components focusing on both the national and county level, with clear linkages\nbetween the two levels of Government.\n\n14. **COMPONENT 1: STRENGTHENING INSTITUTIONAL CAPACITY FOR HEALTH SERVICE DELIVERY TOWARDS**\n**ACHIEVING UHC (US$55 million)** : Component 1 will focus on (a) strengthening the institutional capacity of KEMSA and\navailability of HPTs; (b) supporting health financing reforms; and (c) improving availability and use of quality data for\ndecision making.\n\n\n15. **Sub-component 1.1: Institutional and operational reforms to enhance efficiency and transparency of KEMSA**\n**(US$30 million):** This sub-component will support: (a) building up buffer stocks in KEMSA to ensure timely availability of\nHPTs at primary care level, thus increasing the order-fill rate, reducing the order turn-around time, and promoting\nefficiency. Funds will be earmarked for the procurement and distribution of HPTs for primary care services (levels 1-3) in\nall 47 counties during the life of the project. Counties will draw down HPTs from an agreed list, based on their resource\nallocation as described in sub-component 2.1. To ensure transparency and accountability in the procurement process, an\nHPT governance committee incorporating key stakeholders will be established. Climate sensitive planning for HPTs\ndistribution will be included; (b) automation of the procurement processes, through rolling out a new ERP system with\nextended supply chain modules to ensure end-to-end visibility; and (c) strengthening governance and accountability,\nincluding development and implementation of an accountability dashboard that provides visibility of the procurement\nprocess and distribution of HPTs to various stakeholders. The project will use seasonal data to inform pharmaceutical\nplanning for climate sensitive conditions (e.g., malaria, cholera, anti-diarrheal medicines, etc.). The Directorate of HPTs,\nMoH will work closely with KEMSA to ensure maximum efficiency in implementation of this sub-component.\n\n16. **Sub-component 1.2: Health financing and quality of care reforms (US$15 million):** This sub-component will\nsupport the recently introduced Government UHC reforms, including but not limited to the transition from the NHIF to\nthe Social Health Authority (SHA). Areas of support include development of regulations and implementation roadmaps,\ndesign and rationalization of a benefit package, developing a framework for review of the benefit package including\nstrengthening capacity for the health technology assessment, design of business processes and claims processing,\nstakeholder engagement among others. Additionally, the project will support the MoH to establish/strengthen regulatory\nbodies and operationalize quality of care reforms for improved strategic purchasing.\n\n17. **Sub-component 1.3: Improve availability and use of quality data for decision making (US$10 million):** This subcomponent will support the Government to improve generation and use of strategic information for decision making,\nspecifically through conducting relevant cross-sectional surveys including, but not limited to, the WHO STEPwise approach\nto non-communicable diseases (NCD) risk factor surveillance (STEPS) survey, and the Household Health Expenditure and\nUtilization Survey. Climate sensitive planning for surveys will be used and questions on climate and health impacts will be\nincluded in the survey to generate relevant data to inform decision making. Support will also be provided towards\ndissemination of findings to the lowest level.\n\n\nPage 13 of 43\n\n\n",
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+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n18. **COMPONENT 2: IMPROVING UTILIZATION OF QUALITY HEALTH SERVICES AT PRIMARY CARE LEVEL (US$150**\n**million consisting of a US$95 million IDA credit, a US$40 million IDA grant, and a US$15 million Global Financing Facility**\n**(GFF) grant):** This Component will support delivery of quality services at the primary care level (levels 1-3: community,\ndispensary, health center) in all 47 counties, ensuring availability of selected HPTs. Additional support will include\nimplementation of: (a) key primary care level interventions in all 47 counties; (b) a package of evidence-based, high impact\ninterventions for selected counties lagging on key Reproductive, Maternal, Newborn, Child, and Adolescent health\n(RMNCAH) indicators; and (c) key interventions aimed at improving access to and quality of health services in refugee\ncamps and host communities of Garissa and Turkana counties. Details on Component 2 operationalization will be\ndescribed in the Project Operations Manual (POM).\n\n\n19. **Sub-component 2.1: Improving availability of essential HPTs and delivery of key quality services at the primary**\n**care level (US$90 million):** This Sub-component will support (a) procurement and distribution of selected HPTs to primary\ncare facilities; and (b) implementation of key quality of care related interventions delivered at the primary care level.\n\n\n20. **Counties will receive an annual allocation that is based on the Government’s Equitable Share ratio.** The\nallocation will consist of two parts: (a) drawing rights for selected HPTs; and (b) funds to support implementation of key\ninterventions in their annual work plans (AWPs). All counties will be required to meet the agreed upon eligibility criteria.\n\n\n - **Availability of essential HPTs at the primary care level.** Counties will be issued with drawing rights earmarked\nfor levels 1-3. A reliable and steady supply of HPTs will be established through providing KEMSA with resources\nto purchase essential HPTs for the primary care level, as well as other supply chain reforms described under\nSub-component 1.1. Support will focus on selected HPTs which have been identified jointly with county\nGovernments. HPTs to support NCD screening and treatment will also be included to address the changing\nburden of disease in Kenya.\n\n - **Implementation of selected interventions in county AWPs.** Funds will be disbursed to each county to\nimplement key interventions, from a positive list of activities, agreed upon with county Governments and\nprioritized into four thematic areas: (a) strengthening community health services; (b) supporting levels 2 and 3\nfacility operations and maintenance and functionality of Health Facility Management Committees (HFMC); (c)\nsupporting drivers of quality improvement described in the positive list; and (d) strengthening intercounty\ncoordination and learning. Each year, counties will select and implement interventions from the positive list\nas part of their AWPs. This approach gives flexibility to counties to choose relevant activities to implement\nbased on their specific needs.\n\n21. **Sub-component 2.2:** **Improving delivery of quality health services in selected counties (US$20 million, consisting**\n**of a US$5 million IDA credit and a US$15 million GFF grant):** This Sub-component will provide additional targeted support\nto 10 under-performing counties lagging on key RMNCAH indicators. All level 2 and 3 health facilities, and selected level\n4 health facilities, will receive support to implement high impact and evidenced based RMNCAH interventions within the\nfollowing 5 priority areas: (a) emergency obstetric care with emphasis on management of post-partum hemorrhage (b)\nessential newborn care; (c) nutrition services to address stunting among children and anemia in pregnant women; (d)\nenhance coverage and quality of ANC and PNC, including post-partum family planning; and (e) institutionalization of\nmeasures to improve quality of clinical practice by frontline providers. Specifically, the Sub-component will support: (a)\ndissemination of standards, guidelines, standard operating procedures, and job aides; (b) strengthening capacity of\nfrontline healthcare workers; (c) procurement of relevant essential medicines and commodities; (d) support for relevant\n\n\nPage 14 of 43\n\n\n",
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+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\nquality of care committees (e.g., the Maternal and Perinatal Death Surveillance and Response (MPDSR) committees); (e)\nsupport for quality monitoring activities; and (f) demand generation activities.\n\n22. **Sub-component 2.3: Improving access to and utilization of quality health services in refugee camps and host**\n**communities in Garissa and Turkana Counties (US$40 million):** The Sub-component aims to address the barriers to\naccessing and utilizing quality services in refugee camps and their host communities in Garissa and Turkana counties. More\nspecifically, the Sub-component will support: (a) strengthening community health services; (b) improving availability of\nessential HPTs for services at levels 1-4 (level 4 is the sub-county hospital); (c) improving the availability of energy efficient\ndiagnostic and medical equipment; (d) training of community enrolled health nurses through the Kenya Medical Training\nCollege; (e) recruitment of health workers; (f) strengthening referral systems; (g) climate resilient and energy efficient\nrenovation of health facilities; and (h) support towards management of the transition process of health facilities and health\nworkers to County Governments. Analytical work and capacity support will be provided to the refugee hosting counties\nand DRS to support county planning and coordination with humanitarian stakeholders in the management of the transition\nof health services. Both counties will develop AWPs, under the County Integrated Development Plans focusing on the\nidentified areas of support. This will build on counties’ refugee and host communities plans that include health priorities,\nthe KISEDP and GISEDP.\n\n23. **COMPONENT 3: PROJECT MANAGEMENT AND EVALUATION (US$10 million):** This Component will support\nproject management activities at national and county level. Key areas of support will include (a) providing operational\ncosts and logistical services for day-to-day management of the project; (b) project monitoring and evaluation activities;\n(c) environmental and social risk management; (d) stakeholder engagement; (e) fiduciary management; (f) contracting of\nstaff on a need basis; (g) technical assistance and county peer-to-peer learning among others; and (h) development of a\nclimate emergency plan at the national level, which will inform county level actions to reduce the risk of climate change\non health service delivery activities. Counties will be encouraged to include relevant climate mitigation actions in their\nAWPs.\n\n\n**C. Project Beneficiaries**\n\n\n24. **The project will benefit all Kenyans;** however, the main beneficiaries are women and children from the poorest\npopulation who tend to utilize primary care services more, including refugees and host communities in Garissa and\nTurkana. The project will provide support to all 47 counties to address key priority areas that impact on primary health\ncare (PHC) and focus on addressing inequities in counties that have poor RMNCAH service coverage and outcomes.\nStrengthened health services will support the needs of about 1.8 million host community members in Garissa and Turkana\n(100 percent) and more than 590,000 refugees in these counties (100 percent).\n\n\nPage 15 of 43\n\n\n",
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+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n**D. Results Chain**\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n|Suboptimal availability
and use of data for
decision making|Col2|\n|---|---|\n|
Suboptimal availability
and use of data for
decision making
||\n\n\n|Component 1 Finance key health surveys|Col2|\n|---|---|\n|
Finance key health surveys
|
|\n|
Finance key health surveys
||\n\n\n|Improved availability of
quality data|Col2|\n|---|---|\n|
Improved availability of
quality data
||\n\n\n\n\n\n\n\n\n\n\n|Upgrade of ERP system at
KEMSA|Col2|\n|---|---|\n|Upgrade of ERP system at
KEMSA
||\n\n\n\nReduced\nmortality and\nmorbidity, and\ngreater human\ncapital\nattainment\n\n\n\n\n|Suboptimal funding,
inefficiency, and lack of
transparency at KEMSA|Col2|\n|---|---|\n|
Suboptimal funding,
inefficiency, and lack of
transparency at KEMSA
|
|\n|
Suboptimal funding,
inefficiency, and lack of
transparency at KEMSA
||\n\n\n|Build up buffer HPTs stock in
KEMSA|Col2|\n|---|---|\n|
Build up buffer HPTs stock in
KEMSA
||\n\n\n\n\n|Frequent stockouts of
essential commodities
at PHC level|Col2|\n|---|---|\n|
Frequent stockouts of
essential commodities
at PHC level
||\n\n\n|Component 2 Procure and distribute HPTs,|Col2|\n|---|---|\n|
Procure and distribute HPTs,
including HPTs for NCDs
|
|\n|
Procure and distribute HPTs,
including HPTs for NCDs
||\n\n\n\n\n\n\n\n\n\n\n|Implement priority interventions
at PHC facilities in all 47 counties|Col2|\n|---|---|\n|Implement priority interventions
at PHC facilities in all 47 counties
||\n\n\n|Support processes to strengthen
clinical quality of care related to
RMNCAH services in selected
counties|Col2|\n|---|---|\n|Support processes to strengthen
clinical quality of care related to
RMNCAH services in selected
counties
||\n\n\n|Low quality of maternal
and child health
services at PHC level
Inequitable geographic
health outcomes
particularly for
RMNCAH
Shortages of skilled
human resources for
health (HRH)
Parallel health services
for refugees with
limited county
engagement|Col2|\n|---|---|\n|Low quality of maternal
and child health
services at PHC level
Inequitable geographic
health outcomes
particularly for
RMNCAH
Shortages of skilled
human resources for
health (HRH)
Parallel health services
for refugees with
limited county
engagement
|
|\n|Low quality of maternal
and child health
services at PHC level
Inequitable geographic
health outcomes
particularly for
RMNCAH
Shortages of skilled
human resources for
health (HRH)
Parallel health services
for refugees with
limited county
engagement
|
|\n|Low quality of maternal
and child health
services at PHC level
Inequitable geographic
health outcomes
particularly for
RMNCAH
Shortages of skilled
human resources for
health (HRH)
Parallel health services
for refugees with
limited county
engagement
||\n\n\n|Support processes to strengthen clinical quality of care related to RMNCAH services in selected counties Implement priority interventions|Col2|\n|---|---|\n|Implement priority interventions
in Garissa and Turkana, including
refugee hosting areas (including
support to HRH, renovations of
health facilities)||\n|Implement priority interventions
in Garissa and Turkana, including
refugee hosting areas (including
support to HRH, renovations of
health facilities)||\n\n\n|PROJECT OUTCOMES|Col2|\n|---|---|\n|
Improved
utilization and
quality of primary
healthcare
services and
strengthened
institutional
capacity for
service delivery,
including for
refugees and host
communities
|
|\n|
Improved
utilization and
quality of primary
healthcare
services and
strengthened
institutional
capacity for
service delivery,
including for
refugees and host
communities
|
|\n\n\n\nAssumptions: A1- Beneficiaries have access to system performance information; A2- Policy makers utilize information to improve project implementation.\n\n25. **The above diagram presents the results chain.** The project aims to \"improve utilization and quality of primary\nhealthcare services and strengthen institutional capacity for service delivery”. This will be achieved by addressing key\nhealth challenges including inefficiencies at KEMSA leading to frequent stockouts of essential commodities at PHC level,\ninequitable geographic health outcomes, shortages of HRH, parallel health services for refugees with limited county\nengagement, and suboptimal availability and use of data. By investing in high impact activities the project will contribute\ntowards improving delivery of quality PHC services and evidence-based decision making. The project is anticipated to\ncontribute to increasing utilization of PHC services, quality of PHC services, and strengthening institutional capacity.\nSpecific PDO level indicators are detailed under paragraph 12.\n\n\n**E. Rationale for Bank Involvement and Role of Partners**\n\n26. **The World Bank has a solid track record in supporting Kenya’s health sector.** Over the years, the World Bank\nhas supported several projects, including two regional operations: the East Africa Public Health Laboratory Networking\n\n\nPage 16 of 43\n\n\n",
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+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\nProject (P171915) and the African Medicine Regulatory Harmonization Project (P155163) to strengthen core public health\nfunctions following a harmonized regional approach. The recently completed Transforming Health Systems for Universal\nCare Project (THS-UCP, P152394) supported the Government to improve access to RMNCAH services, through\ninterventions at the national and county level. The project builds on the lessons learnt from these projects.\n\n27. **The Development Partners for Health Kenya (DPHK) plays a coordination role among development partners**\n**(DPs) and works closely with the MoH to ensure that investments are aligned to Government priorities.** Several DPs are\nsupporting delivery of quality PHC services, as outlined in the Government’s Community Health Strategy (2020-2025). A\nrecent mapping exercise identified 14 DPs supporting various aspects of PHC. However, this support is targeted to only a\nfew counties. To reduce fragmentation of development support, the MoH is working towards ensuring that all partners\nsupport implementation of a one health plan, with a joint monitoring and evaluation (M&E) framework. Implementation\nof this project will be aligned to the MoH plan. The World Bank works closely with other DPs to promote coordination and\nalignment and will continue to do so during project implementation. For example, the World Bank has worked closely with\nthe Government of Denmark, through the Danish International Development Agency (Danida) and the Government of\nJapan to support the Government’s health financing and UHC agenda. Additionally, the World Bank is collaborating with\nthe Bill and Melinda Gates Foundation to strengthen county capacity to deliver quality PHC services.\n\n\n**F. Lessons Learned and Reflected in the Project Design**\n\n28. **The project design incorporated lessons learned from previous World Bank engagements in the sector and at**\n**the devolved level in Kenya.**\n\n - **Focus on equity.** Amongst the 47 counties, there is variation in the coverage of key primary care services and\nRMNCAH outcomes. For the counties that are lagging, it is critical to provide sufficient and tailored support to\nachieve meaningful change.\n\n - **Balance standardization of interventions for cross-cutting issues while allowing for flexibility to address county**\n**specific gaps.** There are cross cutting issues that affect most, if not all, counties which can be addressed with a\nstandard package of interventions; however, there are differences amongst the 47 counties which call for a flexible\napproach to support appropriate, context-specific, and efficient implementation of interventions.\n\n - **Support reforms at national level to facilitate improved implementation of key interventions at county level.**\nWeak information, logistics management and quality assurance systems at KEMSA are a barrier to timely,\nresponsive, and transparent distribution of HPTs to the counties. To improve the availability of selected HPTs, the\nproject will support building-up a buffer stock at KEMSA as well as strengthening of the management information\nand quality assurance systems.\n\n - **Implementation efficiency.** The design of the project will draw from implementation experience from the THSUCP and other World Bank-financed projects implemented at county level that revealed weaknesses in fiduciary\ncapacity at the county level. Therefore, the project will maintain a project team at the Council of Governors to\nsupport and monitor county implementation and limit procurement to the national level.\n\n - **Building on refugee reforms.** The design is informed by and builds on the reforms supported by DRS and UNHCR\nwhich have progressed the integration of refugee health services into county management, including human\nresource management and the coding of humanitarian managed health services.\n\n\n**III.** **IMPLEMENTATION ARRANGEMENTS**\n\n\nPage 17 of 43\n\n\n",
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+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\nthe project includes a wide range of capacity building activities that will further enhance institutional capacities of the\nimplementing entities.\n\n34. **The project funds will complement domestic resources and not replace them.** Under THS-UCP, counties were\nrequired to allocate at least 20 percent of their budget to health and increase the allocation from the previous year. This\nproject will build on this experience to ensure that project funds do not crowd out Government investments.\n\n\n**IV.** **PROJECT APPRAISAL SUMMARY**\n\n\n**A. Technical, Economic and Financial Analysis (if applicable)**\n\n\n35. **The project will support delivery of core health interventions at primary care level, with a focus on RMNCAH in**\n**selected counties.** RMNCAH remains a major contributor to the high disease burden in Kenya. The country is investing\nheavily in the primary care level, as a foundation for UHC. The Government recently launched a community health program\nthat promotes preventive and promotive health services at the community level. This project is therefore relevant as it is\ndesigned to strengthen primary care services, improve quality of care, and reduce inequities in access to health care\nservices. Additionally, these primary care facilities mainly benefit the poor and rural populations; strengthening their\ncapacity will ensure that these facilities are able to provide services to most of the population in the country. It is\nrecognized that without improving the health of the population, Kenya will not realize its aspirations enshrined in the\nconstitution.\n\n36. **There is a strong justification for Government intervention and public financing of PHC services.** By investing at\nthe PHC level, the project will contribute towards laying a strong foundation for the delivery of health services in Kenya.\nFinally, the project is technically sound, and the design considers the respective mandates of the key entities involved in\nimplementation. The project is adequately structured with clear linkages between activities and the results. It focuses on\nthe key challenges facing delivery of essential health services at the primary level and is geared to addressing inequities\nin access to quality health services.\n\n37. **Investments in PHC show that every US$1 invested in PHC interventions saves up to US$16 in spending on**\n**conditions such as stunting, NCDs, anemia, tuberculosis, malaria, and maternal and child morbidity.** [25] The project aims\nto support investments in improving performance of PHC services at county level to enhance access to high impact\ninterventions. Global evidence shows that investing in RMNCAH has a significant economic impact. Every additional US$1\ninvested in women’s and children's health translates to US$9 of economic and social benefit. [26] In Kenya, guided by the\nRMNCAH Investment Framework, priority areas for investment and action have been identified at national and county\nlevel. The project will support effective delivery of high impact evidence-based interventions to improve RMNCAH\noutcomes particularly in low performing counties. Analyses in Uganda [27 ] show the significant savings in integrative\napproaches to hosting refugees; integrating refugees into national systems, including health and jobs, which have reduced\nthe total costs of supporting refugees by forty-five percent.\n\n\n25 Mwai D, Hussein S, Olago A, Kimani M, Njuguna D, Njiraini R, et al. (2023) Investment case for primary health care in low- and middle-income\ncountries: A case study of Kenya. PLoS ONE 18(3): e0283156. 6\n26 Global Strategy for Women’s Children’s and Adolescent’s Health 2016-2030, UN\n27 Aziz Atamanov, Johannes Hoogeveen and Benjamin Reese. The Costs Come before the Benefits. Why Donors Should Invest More in Refugee\nAutonomy in Uganda.2023. World Bank.\n\n\nPage 19 of 43\n\n\n",
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+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n38. **The project is consistent with the adaptation and mitigation goals of the Paris Agreement, Kenya’s NDC**\n**(updated 2020) and is consistent with Kenya’s country climate policies.** Details on the project activities are in Annex 2.\n\n39. **Adaptation goal and risk reduction measures.** The main identified climate-related hazards which are anticipated\nto pose risk to project activities include floods, high heat, landslides, and coastal storms. To reduce the risk of climaterelated shocks to the project activities, adaptation measures are integrated within each activity. Under Sub-component\n1.1, the project will support KEMSA to procure buffer stocks of HPTs to ensure timely availability of HPTs and improved\nuptake of health services at the primary care level. To reduce the risk of floods and extreme heat to the buffer stocks,\nclimate-sensitive planning for distribution of HPTs will be supported under the project. Under Sub-component 1.3, climate\nsensitive planning for surveys will be used and questions on climate and health impacts will be included in the survey to\ngenerate relevant data to inform decision making. To reduce the risk of climate shocks to health service delivery in Subcomponent 2.1, 2.2, and 2.3 the MoH will prepare a national climate emergency preparedness and response plan which\nwill inform county level actions depending on their locations and anticipated disaster risks. Building rehabilitation under\nSub-component 2.3 will include climate resiliency measures to prevent damage from climate shocks.\n\n40. **Mitigation goal and risk reduction measures.** Most activities in the project are on the universally aligned list for\nclimate change mitigation. Minor rehabilitation activities under Sub-component 2.3 will ensure at least 20.0 percent more\nenergy efficiency than standard practice, aligning with the Excellence in Design for Building Efficiencies (EDGE) level 1\nbuilding criteria. Sub-component 2.3, will also finance the purchase and installation of solar panels for sustainable health\nfacility electrification, where applicable.\n\n\n**B. Fiduciary**\n\n\n**(i)** **Financial Management**\n41. **A Financial Management (FM) assessment has been carried out for the project in accordance with the World**\n**Bank Policy and directives on Investment Project Financing (IPF).** The assessment was carried out on MoH, KEMSA and\nselected counties during project preparation. Based on the assessment conducted, the FM risk of the project is rated\nSubstantial. The implementing entities have adequate experience in managing World Bank financed operations and have\ncomplied with key FM deliverables. However, the following key risks are identified: (a) irregularities noted in procurement\nprocess for health commodities leading to ineligible expenditures; (b) issues on long-outstanding imprests; (c) inaccuracies\non financial reporting due to use of manual system for financial reporting at the MoH; (d) inadequate budget allocations\nwhich has been hindering implementation of activities; and (e) weak financial management in some counties - among\nthem delays in transfers of funds from the county revenue fund account to a dedicated special purpose account for health,\ncommingling of funds at some counties, frequent transfers of staff without adequate handover leading to disruptions of\nfinancial reporting for the project, long-outstanding imprests, and errors in financial reports.\n\n42. **Mitigation measures have been incorporated in the project.** The project will inherit various strengths of the\ncountry’s public financial management system and the experience gained in the implementation of the other World Bank\nfinanced projects. The following measures have been incorporated: (a) the Office of the Auditor General will provide\noversight of project resources and conduct the role of an independent integrated fiduciary review agent; (b) the Chief\nFinance Officer, MoH will liaise with the PMT to ensure adequate budget allocation; (c) the World Bank will organize a\ntraining to sensitize PMT staff on World Bank FM requirements. The internal audit at MoH will provide regular reviews\nand recommendations for continued strengthening of internal controls at national and county levels; (d) all implementing\nentities under MoH will be required to sign memorandums of understanding clearly highlighting the requirements for a\n\n\nPage 20 of 43\n\n\n",
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+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\nseparate bank account, financial reporting, and other financial management requirements; and (e) preparation of a POM\nwith a detailed FM section to address FM aspects of the proposed project. These mitigation measures will provide\nreasonable assurance that the project resources will be used for the intended purposes.\n\n\n**(ii)** **Procurement**\n43. **Procurement Regulations:** Procurement activities under the project will be carried out in accordance with “The\nWorld Bank’s Procurement Regulations for IPF Borrowers, First published July 2016 and revised Fifth Edition September\n2023”, hereafter referred to as “Procurement Regulations”; the World Bank’s “Guidelines on Preventing and Combating\nFraud and Corruption in Projects Financed by IBRD Loans and IDA Credits and Grants (revised as of July 1, 2016) and other\nprovisions to be stipulated in the project’s Legal Agreement with the Borrower.”\n\n44. **A Project Procurement Strategy for Development (PPSD) has been prepared by the Borrower** to support the\nimplementation and achievement of development objectives of the project and deliver Value for Money. The PPSD will\nform the basis for preparation of the Procurement Plan (PP), providing justification for procurement decisions including\nthe selection methods and market approaches. The PP has been prepared for the first 18 months of project\nimplementation and will be updated at least annually, or as required, to reflect the actual project implementation needs.\n\n45. **Systematic Tracking of Exchanges in Procurement (STEP):** The project will use STEP, the World Bank’s online\nprocurement planning and tracking tool to record all procurement actions including planning, updating, and clearing PP\nand seeking and receiving World Bank’s review and No Objection to procurement actions as needed and establish\nbenchmarks, monitor delays, and measure procurement performance.\n\n46. **Profile of Procurement Activities:** The key procurements of the project comprise of (a) Goods: purchase of buffer\nHPTs stock in KEMSA; Procurement and distribution of HPTs; (b) Non-consulting services: Upgrade of ERP system at\nKEMSA; (c) Works: Renovation of works under Component 2.3; and (d) Consulting Services: institutional reforms, key\nhealth surveys; project monitoring and evaluation activities; environmental and social safeguards related activities;\nfiduciary management, contracting of staff on a need basis; technical assistance etc.\n\n47. **National Procurement Procedures:** The country’s own procurement procedures may be used when approaching\nthe national market as agreed in the procurement plan. When the Borrower uses its own national open competitive\nprocurement procedures as set forth in the Public Procurement and Asset Disposal Act 2015 (revised Edition 2022) and\nthe attendant Regulations 2020 such arrangements shall be subject to the provisions of paragraph 5.3-5.6 of the\nProcurement Regulations. The other national procurement arrangements (other than national open competitive\nprocurement), that may be applied by the Borrower shall be required to be consistent with the requirements set out in\nparagraphs 5.3 and 5.4 d as appropriate of the Procurement Regulations.\n\n48. **Institutional Arrangements for Procurement:** The MoH will be the implementing agency responsible for\nprocurement activities at the national level, while KEMSA will be responsible for procurement and distribution of HPTs to\nprimary care facilities. Counties will also conduct procurement on a need-by-need basis under Sub-components 2.2 and\n2.3, based on their AWPs. All entities have gained significant experience in implementing World Bank-financed projects.\nThe MoH and the 47 counties implemented a Bank-financed THS-UCP using Procurement Guidelines in the period 20162023. Furthermore, the MoH and KEMSA have been implementing the World Bank-financed COVID-19 Health Emergency\nResponse Project (CHERP, P173820) since 2020 using Procurement Regulations. Implementation of these Bank-financed\noperations have enhanced and continue to strengthen the agencies’ institutional procurement capacities in implementing\n\n\nPage 21 of 43\n\n\n",
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+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\nWorld Bank-financed projects. The procurement decision making process will utilize the internal institutional structures\nof the MoH, KEMSA and the counties.\n\n49. **Procurement Capacity Assessment:** The MoH’s, KEMSA’s and counties’ procurement capacities to implement the\nproject have been assessed and confirmed at project appraisal stage to be reasonably adequate to implement the\nenvisaged project procurements. The MoH, KEMSA and counties have previous institutional experiences in implementing\nWorld Bank-financed projects. The MoH and KEMSA have qualified procurement staff who have experience in the\napplication of the Bank’s Procurement Regulations. Subject to addressing the key risks identified in the next paragraph,\nthe MoH, KEMSA and counties are assessed to have reasonably adequate capacity to execute the envisaged profile of\nprocurements under the project.\n\n50. **Procurement Risk Assessment and Management:** Based on the current assessment conducted for this Project\nthe MoH, KEMSA and counties as the implementing agencies, the overall residual procurement risk rating is “Substantial”.\nThe procurement risk rating for THS-UCP and CHERP is “Substantial”. The risk ratings have been reviewed and confirmed\nat project appraisal stage. The assessment applied the five risk factors of the Procurement Risk Assessment and\nManagement System Risk Framework that may affect the overall project implementation. The key risks identified include\nthe frequent transfers of procurement staff, inadequate number of experienced procurement staff assigned to the project\nprocurement activities, inadequate capacity and delays in preparation of project procurement requirements and readiness\nactivities, lengthy administrative processes in evaluation of proposals/bids and contract awards, insufficient preparation\nof procurement records and delayed upload of records in STEP, inadequate inspection, testing and acceptance procedures\nand limited contract management capacity. To mitigate the identified risks, the MoH, KEMSA, and counties will deploy\nadditional qualified and experienced procurement and relevant technical staff to enhance procurement capacity and\nretain them for the project period, provide focused training on procurement and contract management and streamline\ntheir internal procurement processes to minimize procurement delays. The World Bank will provide regular and targeted\ncapacity building on procurement and contract management to MoH and other implementing agencies and monitor the\nperformance of fiduciary systems for smooth project implementation.\n\n51. **Record Keeping and Asset Management:** All records pertaining to the procurement and contract management\nactivities including contract monitoring and payment records and contract completion will be retained by the\nimplementing agencies in procurement files for each procurable activity in accordance with requirements of the financing\nagreement and uploaded in the STEP system on a timely basis. The MoH will also ensure that all inventory, stores, and\nassets procured are received by respective beneficiary counties, taken on charge, and used by the counties for intended\npurposes.\n\n\n**C. Legal Operational Policies**\n\n\nPage 22 of 43\n\n\n",
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+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n**D. Environmental and Social**\n\n\n52. **The project’s Environmental and Social (E&S) Risk has been classified as Moderate.** The project has a national\nscope where Component 1 and Sub-component 2.1 are being implemented across all 47 counties in Kenya while Subcomponent 2.2 (improving delivery of quality primary care services in selected counties) will be executed in selected\ncounties. The project also targets refugees and refugee host communities in Turkana and Garissa counties (subcomponent 2.3).\n\n53. The project’s key environmental and social risks and impacts based on the World Bank’s Environmental and Social\nDue Diligence (ESSD) which is detailed in the Appraisal Environmental and Social Review Summary (A-ESRS) include: (a)\noccupational health and safety risks; (b) air, soil and water pollution from solid, liquid and hazardous waste; (c) increased\ngeneration of medical waste; (d) exclusion of other vulnerable groups such as indigenous people meeting the criteria in\nEnvironmental and Social Safeguards (ESS7), persons with disability, and women from project benefits under Component\n1 and 2; (e) sexual exploitation and abuse/sexual harassments (SEA/SH) which is rated Moderate; (f) community health\nand safety risks such as the transmission of communicable diseases, including HIV/AIDS and COVID-19, due to interactions\namong project workers and between the project workforce and local communities despite low risk due to minimal civil\nworks in the project; (g) security related risks associated with counties in the north and northeastern part of the country\nthat may affect project personnel associated with implementation of project; and (h) improvement in access to healthcare\nto the project host population’s, vulnerable and marginalized groups including refugees and host communities.\n\n54. **The ESS relevant to the Project are ESS 1,2,3,4,6,7 and 10.** Based on the E&S risks and the relevant standards, the\nproject has prepared and consulted on the following framework documents between October 26 to 30, 2023: (a)\nEnvironmental and Social Management Framework (ESMF); (b) Medical Waste Management Plan (MWMP); (c)\nStakeholder Engagement Plan (SEP); (d) Labor Management Procedures (LMP); (e) Vulnerable Groups Planning Framework\n(VGPF); and (f) Environmental and Social Commitment Plan (ESCP). The project has also prepared a Grievance Redress\nMechanism (GRM) as part of the SEP to be adopted and implemented under each of the sub-project activities. The ESS\nstandard documents have been disclosed in-country on December 5, 2023, and the World Bank’s website on December\n6, 2023.\n\n55. **Citizen Engagement.** The project will ensure citizen engagement [28 ] in the design and implementation of the\nproject. A SEP was prepared as part of project preparation. Under the Project, stakeholders including healthcare providers\nfor level 1-3 facilities, the refugees, and refugee host communities will be engaged through the guidelines prescribed in\nthe project’s Stakeholder Engagement Plan (SEP). The project will leverage the GRM developed under the CHERP and THSUCP to collect community complaints about all project-related services, following guidelines in the SEP and involve DRS in\nhost community and refugee areas to ensure the applicable GRM is practical and can effectively mitigate any conflicts\namong refugees and between refugees and host communities. Community health units (CHUs) will also be encouraged to\nsensitize their catchment area on the different avenues to channel complaints and engagement with refugee community\nhealth workers in Dadaab and Kakuma/Kalobeyei will also be supported. In addition, under Component 1, the project will\nsupport the development of an accountability dashboard as part KEMSA support. This will give the community more\nvisibility on the HPTs procurement and distribution processes.\n\n\n28 Citizen engagement (CE) here means a two way-interaction between the state and stakeholders that gives stakeholders a stake in decision\nmaking with the objective of improving development outcomes.\n\nPage 23 of 43\n\n\n",
+ "datasets": [],
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+ "pages": [
+ 28
+ ]
+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n56. **Gender.** A gender gap analysis has identified disparity in access to ANC services in a subset of counties, which can\nlead to disproportionate health outcomes for mothers and newborns. This is largely due to demand side barriers, including\nlimited awareness of the availability and benefits of attending ANC visits, as well as supply side barriers including stockouts\nof essential health products and technologies and non-adherence to maternal health standards of care. The project will\naddress this gender gap by: (a) encouraging counties to include ANC as a topic for all CHUs dialogue days with the\ncommunity; and (b) supporting ANC service delivery described under Sub-component 2.2, and support for procurement\nand distribution of ANC related HPTs under Sub-component 2.1. A sub-indicator measuring the percentage of pregnant\nwomen attending four or more ANC visits in the selected counties where coverage has been lower is included in the results\nframework as a PDO level sub-indicator, to monitor how this gender gap will be closed.\n\n\n**V.** **GRIEVANCE REDRESS SERVICES**\n\n\n57. **Grievance Redress.** Communities and individuals who believe that they are adversely affected by a project\nsupported by the World Bank may submit complaints to existing project-level grievance mechanisms or the Bank’s\nGrievance Redress Service (GRS). The GRS ensures that complaints received are promptly reviewed in order to address\nproject-related concerns. Project affected communities and individuals may submit their complaint to the Bank’s\nindependent Accountability Mechanism (AM). The AM houses the Inspection Panel, which determines whether harm\noccurred, or could occur, as a result of Bank non-compliance with its policies and procedures, and the Dispute\nResolution Service, which provides communities and borrowers with the opportunity to address complaints through\ndispute resolution. Complaints may be submitted to the AM at any time after concerns have been brought directly to\nthe attention of Bank Management and after Management has been given an opportunity to respond. For information\n[on how to submit complaints to the Bank’s Grievance Redress Service (GRS), visit http://www.worldbank.org/GRS. For](https://www.worldbank.org/en/projects-operations/products-and-services/grievance-redress-service)\ninformation on how to submit complaints to the Bank’s Accountability Mechanism, visit\n[https://accountability.worldbank.org.](https://www.worldbank.org/en/programs/accountability)\n\n\n**VI.** **KEY RISKS**\n\n\n58. **The overall risk rating for the project is Moderate.** The risk areas rated Substantial include macroeconomics,\nfiduciary, and others (refugee protection). While the project involves many implementing entities, the potential risks will\nbe mitigated by strengthening coordination through the Council of Governors, rationalizing the distribution of HPTs,\nlimiting project activities to a “positive list of interventions” in the majority of the counties, and providing technical\nassistance and fiduciary support to the 10 selected counties, including the two counties that host refugees. Furthermore,\nthe project will work in close collaboration with UNHCR and other implementing agencies providing services to the refugee\npopulation.\n\n59. **Macroeconomics risk is rated Substantial.** Although Kenya’s medium-term economic prospects remain optimistic,\nthe ongoing shocks, including prolonged drought, continued turbulence in the global economy and rising inflation and\nassociated increases in the prices of commodities are creating challenges for Kenya to sustain economic recovery. So far,\nthe macroeconomic risks have not had an adverse impact on the financing of the sector; however, the possible impacts\non project implementation will be regularly monitored and discussed with the Government. Recently, the Government\npassed new health financing laws with the potential to impact the project. The Primary Health Care, Facility Improvement\nFinancing and Social Health Insurance Acts of 2023 will establish several funds to be managed by the SHA, while giving\npublic health facilities greater financial autonomy. The transition will include making health insurance mandatory,\nincreasing contribution rates to 2.75 percent for those in the formal sector, introducing income rated contributions for\n\nPage 24 of 43\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 29
+ ]
+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\nthe informal sector, changes in the benefit package, claims management processes and provider payment systems, among\nothers. The transition process from the NHIF to SHIF, if not carefully implemented, poses a risk that may affect overall\nhealth system performance. The project is designed to support the Government to implement some of the new reforms,\nwhich will help mitigate the potential risks. To mitigate risks associated with flooding, KEMSA will develop and use a risk\ncalendar in the distribution of HPTs.\n\n60. **Fiduciary risk is rated Substantial.** Based on an assessment carried out on MoH, KEMSA and selected counties,\nthe FM risk of the project is rated “Substantial”. The implementing entities have adequate experience in managing World\nBank financed operations and have complied with key FM deliverables. However, the following key risks are identified: (a)\nirregularities noted in procurement process for health commodities leading to ineligible expenditures; (b) issues on longoutstanding imprests; (c) inaccuracies on financial reporting due to use of manual system for financial reporting at the\nMoH; (d) inadequate budget allocations which has been hindering implementation of activities; and (e) weak financial\nmanagement in some counties. FM risk mitigation measures are described in paragraph 42. The overall residual\nprocurement risk rating is “Substantial”. The key risks identified include the frequent transfers of procurement staff,\ninadequate number of experienced procurement staff assigned to the project procurement activities, inadequate capacity\nand delays in preparation of project procurement requirements and readiness activities, lengthy administrative processes\nin evaluation of proposals/bids and contract awards, insufficient preparation of procurement records and delayed upload\nof records in STEP, inadequate inspection, testing and acceptance procedures and limited contract management capacity.\nProcurement risk mitigation measures are described in paragraph 50.\n\n61. **Other risks, defined here as refugee protection, are rated Substantial.** While offering a range of benefits to\nrefugee protection in Kenya, there are a range of resourcing, operational, policy and context specific challenges in the\nimplementation of the Refugee Act 2021 that could be addressed to ensure full compliance with the relevant provisions\nof the 1951 Refugee Convention. There are protection risks regarding: delays and a backlog in the processing of refugee\nstatus determinations, the freedom of movement and residence, as well as a lack of simplified access to work permits and\ndocumentation. Security challenges and social cohesion risks linked to equitably accessing health services present a\nsubstantial risk across refugees and host community members. These risks will be managed through policy dialogue with\nGovernment led by the DRS, and joint engagement with relevant agencies such as UNHCR and other stakeholders\nsupporting the development of the Shirika Plan and the development of the Refugee Regulations. In addition, the World\nBank, in collaboration with the DRS and UNHCR, will undertake periodic reviews of Kenya’s refugee protection, policy and\ninstitutional environment under its Refugee Policy Review Framework.\n\n\nPage 25 of 43\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 30
+ ]
+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems(P179698)\n\n\n**VII.** **RESULTS FRAMEWORK AND MONITORING**\n\n\n\n\n\n|Baseline|Period 1|Closing Period|\n|---|---|---|\n|**Improve utilization of quality primary health care services**
|**Improve utilization of quality primary health care services**
|**Improve utilization of quality primary health care services**
|\n|**Percentage of women receiving postnatal care within 48 hours (Percentage)**
|**Percentage of women receiving postnatal care within 48 hours (Percentage)**
|**Percentage of women receiving postnatal care within 48 hours (Percentage)**
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|57.3
|61
|65|\n|Percentage of women receiving postnatal care within 48 hours in the 10 selected counties (Percentage)
|Percentage of women receiving postnatal care within 48 hours in the 10 selected counties (Percentage)
|Percentage of women receiving postnatal care within 48 hours in the 10 selected counties (Percentage)
|\n|56.6
|60
|65
|\n|Percentage of host community women receiving postnatal care within 48 hours in Garissa and Turkana (Percentage)
|Percentage of host community women receiving postnatal care within 48 hours in Garissa and Turkana (Percentage)
|Percentage of host community women receiving postnatal care within 48 hours in Garissa and Turkana (Percentage)
|\n|57.3
|61
|65|\n|Percentage of refugee women receiving postnatal care within 48 hours in Garissa and Turkana (Percentage)
|Percentage of refugee women receiving postnatal care within 48 hours in Garissa and Turkana (Percentage)
|Percentage of refugee women receiving postnatal care within 48 hours in Garissa and Turkana (Percentage)
|\n|83.5
|84.5
|86|\n|**Percentage of children immunized with three doses of Pentavalent vaccine (Percentage)**
|**Percentage of children immunized with three doses of Pentavalent vaccine (Percentage)**
|**Percentage of children immunized with three doses of Pentavalent vaccine (Percentage)**
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|77.2
|81
|85
|\n|Percentage of children immunized with three doses of the Pentavalent vaccine in the 10 selected counties (Percentage)
|Percentage of children immunized with three doses of the Pentavalent vaccine in the 10 selected counties (Percentage)
|Percentage of children immunized with three doses of the Pentavalent vaccine in the 10 selected counties (Percentage)
|\n|76|79
|82|\n|**To improve quality of primary health care services**
|**To improve quality of primary health care services**
|**To improve quality of primary health care services**
|\n|**Percentage of pregnant women attending 4 or more ANC visits (Percentage)**
|**Percentage of pregnant women attending 4 or more ANC visits (Percentage)**
|**Percentage of pregnant women attending 4 or more ANC visits (Percentage)**
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|50.1
|53
|56|\n|Percentage of pregnant women attending 4 or more ANC visits in the 10 selected counties (Percentage)
|Percentage of pregnant women attending 4 or more ANC visits in the 10 selected counties (Percentage)
|Percentage of pregnant women attending 4 or more ANC visits in the 10 selected counties (Percentage)
|\n|42.7
|46
|50
|\n|Percentage of host community pregnant women attending 4 or more ANC visits in Garissa and Turkana (Percentage)
|Percentage of host community pregnant women attending 4 or more ANC visits in Garissa and Turkana (Percentage)
|Percentage of host community pregnant women attending 4 or more ANC visits in Garissa and Turkana (Percentage)
|\n|51.6
|53.5
|56|\n|Percentage of refugee pregnant women attending 4 or more ANC visits in Garissa and Turkana (Percentage)
|Percentage of refugee pregnant women attending 4 or more ANC visits in Garissa and Turkana (Percentage)
|Percentage of refugee pregnant women attending 4 or more ANC visits in Garissa and Turkana (Percentage)
|\n|80|83|86|\n\n\nFeb 21, 2024 Page 26 of 43\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 31
+ ]
+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems(P179698)\n\n\n|Proportion of Children Under 5 with diarrhea treated with Zinc/ORS Co-Pack (Percentage)|Col2|Col3|\n|---|---|---|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|57.7
|64
|70
|\n|Proportion of Children Under 5 with diarrhea treated with Zinc/ORS Co-Pack in the 10 selected counties (Percentage)
|Proportion of Children Under 5 with diarrhea treated with Zinc/ORS Co-Pack in the 10 selected counties (Percentage)
|Proportion of Children Under 5 with diarrhea treated with Zinc/ORS Co-Pack in the 10 selected counties (Percentage)
|\n|48.8|54
|60
|\n|**To strengthen institutional capacity for service delivery**
|**To strengthen institutional capacity for service delivery**
|**To strengthen institutional capacity for service delivery**
|\n|**Order fill rate for priority health products and technologies (HPTs) (Percentage)**
|**Order fill rate for priority health products and technologies (HPTs) (Percentage)**
|**Order fill rate for priority health products and technologies (HPTs) (Percentage)**
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|43
|66|90|\n|**Order turnaround time (Days)**
|**Order turnaround time (Days)**
|**Order turnaround time (Days)**
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|13|12|10|\n\n\n\n\n\n|Baseline|Period 1|Closing Period|\n|---|---|---|\n|**Strengthening institutional capacity for health service delivery towards achieving UHC**
|**Strengthening institutional capacity for health service delivery towards achieving UHC**
|**Strengthening institutional capacity for health service delivery towards achieving UHC**
|\n|**Number of functional ERP modules (Number)**
|**Number of functional ERP modules (Number)**
|**Number of functional ERP modules (Number)**
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|0
|35|71|\n|**Number of surveys completed (Number)**
|**Number of surveys completed (Number)**
|**Number of surveys completed (Number)**
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|0
|1|2|\n|**Health insurance benefits package developed (Yes/No)**
|**Health insurance benefits package developed (Yes/No)**
|**Health insurance benefits package developed (Yes/No)**
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|No
|No
|Yes
|\n|**Improving utilization of quality health services at primary care level**
|**Improving utilization of quality health services at primary care level**
|**Improving utilization of quality health services at primary care level**
|\n|**Proportion of functional community health units (CHUs) (Percentage)**
|**Proportion of functional community health units (CHUs) (Percentage)**
|**Proportion of functional community health units (CHUs) (Percentage)**
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|75
|82
|90|\n|**Percentage of quarterly priority HPTs orders placed within the required timeframe (Percentage)**
|**Percentage of quarterly priority HPTs orders placed within the required timeframe (Percentage)**
|**Percentage of quarterly priority HPTs orders placed within the required timeframe (Percentage)**
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|0
|50
|100|\n|**People who have received essential health, nutrition, and population (HNP) services (Number)CRI**|**People who have received essential health, nutrition, and population (HNP) services (Number)CRI**|**People who have received essential health, nutrition, and population (HNP) services (Number)CRI**|\n\n\nFeb 21, 2024 Page 27 of 43\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 32
+ ]
+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems(P179698)\n\n|Oct/2023|Jun/2027|Jun/2029|\n|---|---|---|\n|0
|4500000|9000000|\n|Number of children immunized (Number)CRI
|Number of children immunized (Number)CRI
|Number of children immunized (Number)CRI
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|0
|2000000
|4000000|\n|Number of deliveries attended by skilled health personnel (Number)CRI
|Number of deliveries attended by skilled health personnel (Number)CRI
|Number of deliveries attended by skilled health personnel (Number)CRI
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|0
|2500000
|5000000|\n|**Number of community enrolled health nurses trained in Garissa and Turkana (Number)**
|**Number of community enrolled health nurses trained in Garissa and Turkana (Number)**
|**Number of community enrolled health nurses trained in Garissa and Turkana (Number)**
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|0
|50
|100
|\n|**Number of refugee health facilities supported under the project, as part of the transition to county management, in Garissa and Turkana (Number)**
|**Number of refugee health facilities supported under the project, as part of the transition to county management, in Garissa and Turkana (Number)**
|**Number of refugee health facilities supported under the project, as part of the transition to county management, in Garissa and Turkana (Number)**
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|0
|10
|20
|\n|**People in Garissa and Turkana who have received essential health, nutrition, and population (HNP) services (Number)**
|**People in Garissa and Turkana who have received essential health, nutrition, and population (HNP) services (Number)**
|**People in Garissa and Turkana who have received essential health, nutrition, and population (HNP) services (Number)**
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|0
|158000
|316000|\n|Number of children immunized among the host community in Garissa and Turkana (Number)
|Number of children immunized among the host community in Garissa and Turkana (Number)
|Number of children immunized among the host community in Garissa and Turkana (Number)
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|0
|42000
|84000|\n|Number of children immunized among refugees in Garissa and Turkana (Number)
|Number of children immunized among refugees in Garissa and Turkana (Number)
|Number of children immunized among refugees in Garissa and Turkana (Number)
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|0
|18000
|36000
|\n|Number of deliveries attended by skilled health personnel among the host community in Garissa and Turkana (Number)
|Number of deliveries attended by skilled health personnel among the host community in Garissa and Turkana (Number)
|Number of deliveries attended by skilled health personnel among the host community in Garissa and Turkana (Number)
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|0
|68600
|137200|\n|Number of deliveries attended by skilled health personnel among refugees in Garissa and Turkana (Number)
|Number of deliveries attended by skilled health personnel among refugees in Garissa and Turkana (Number)
|Number of deliveries attended by skilled health personnel among refugees in Garissa and Turkana (Number)
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|0|29400
|58800|\n|**Project management and evaluation**
|**Project management and evaluation**
|**Project management and evaluation**
|\n|**Percentage of complaints in the GRM satisfactorily addressed within 4 weeks of initial complaint being recorded (Percentage)**
|**Percentage of complaints in the GRM satisfactorily addressed within 4 weeks of initial complaint being recorded (Percentage)**
|**Percentage of complaints in the GRM satisfactorily addressed within 4 weeks of initial complaint being recorded (Percentage)**
|\n|Oct/2023
|Jun/2027
|Jun/2029
|\n|0
|40
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|\n|Data source
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Every six months
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|\n|Responsibility for Data|MoH|\n\n\n\nFeb 21, 2024 Page 30 of 43\n\n\n",
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|\n|
Data source
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KHIS|\n|Methodology for Data
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|\n|
Data source
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|\n|Frequency
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|\n|Data source
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|**Percentage of refugee pregnant women attending 4 or more ANC visits in Garissa and Turkana (Percentage)**
|\n|Description
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Denominator: Total number of expected live births during the reporting period within the refugee community of Garissa
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|\n|Frequency|Every six months
|\n|Data source
|UNHCR reports|\n|Methodology for Data
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|\n|**Proportion of Children Under 5 with diarrhea treated with Zinc/ORS Co-Pack (Percentage) **|**Proportion of Children Under 5 with diarrhea treated with Zinc/ORS Co-Pack (Percentage) **|\n\n\nFeb 21, 2024 Page 31 of 43\n\n\n",
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Denominator: Total number of children under 5 years with diarrhea|\n|---|---|\n|Frequency
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Every six months
|\n|Data source
|KHIS|\n|Methodology for Data
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**Order fill rate for priority health products and technologies (HPTs) (Percentage) **
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**Number of functional ERP modules (Number) **
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|\n|Frequency|Every six months|\n\n\n\nFeb 21, 2024 Page 32 of 43\n\n\n",
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+ "reference_population": null,
+ "is_used": "False",
+ "usage_context": "supporting"
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+ "end": 667
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+ "end": 722
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+ "producer": null,
+ "geography": null,
+ "publication_year": {
+ "text": "2024",
+ "confidence": 0.7464223504066467,
+ "start": 794,
+ "end": 795
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+ "reference_year": null,
+ "reference_population": null,
+ "is_used": "False",
+ "usage_context": "supporting"
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+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n|Data source|Project report|\n|---|---|\n|Methodology for Data
Collection
|Project monitoring|\n|Responsibility for Data
Collection
|MoH
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|**Health insurance benefits package developed (Yes/No) **
|\n|Description
|A health insurance benefits package is developed, rationalized, and disseminated.
|\n|Frequency
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|\n|
Data source
|
Routine ERP data|\n|Methodology for Data
Collection
|ERP|\n|Responsibility for Data
Collection
|KEMSA, MoH
|\n|**Improving utilization of quality health services at primary care level**
|**Improving utilization of quality health services at primary care level**
|\n|**Proportion of functional community health units (CHUs) (Percentage) **|**Proportion of functional community health units (CHUs) (Percentage) **|\n|Description
|
Numerator: Number of CHUs scoring at least 80% on the CHU assessment. Denominator: Total number of existing CHUs.
Comment: At appraisal, the total number of functional CHUs was 7,780 and the total number of existing CHUs
(functional, non-functional, and semi-functional) was 10,382.
|\n|Frequency
|
Every six months
|\n|Data source
|Project report|\n|Methodology for Data
Collection
|Project monitoring|\n|Responsibility for Data
Collection
|MoH
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|Percentage of quarterly priority HPTs orders placed by Counties within the required timeframe. The required timeframe
is by the 15th of the ordering month.
|\n|Frequency
|
Every six months
|\n|Data source
|Project report|\n|Methodology for Data
Collection
|Project monitoring|\n|Responsibility for Data
Collection
|KEMSA, MoH
|\n|**People who have received essential health, nutrition, and population (HNP) services (Number)CRI**
|**People who have received essential health, nutrition, and population (HNP) services (Number)CRI**
|\n|Description
|Total number of deliveries attended by skilled health personnel and total number of children immunized.
|\n|Frequency
|Every six months
|\n|Data source
|KHIS|\n|Methodology for Data
Collection|Routine HMIS data collection|\n|Responsibility for Data
Collection
|MoH
|\n|**Number of children immunized (Number)CRI**
|**Number of children immunized (Number)CRI**
|\n|Description
|Total number of children immunized.
|\n|Frequency
|Every six months
|\n|Data source|KHIS|\n|Methodology for Data
Collection|Routine HMIS data collection|\n|Responsibility for Data
Collection
|MoH
|\n|
**Number of deliveries attended by skilled health personnel (Number)CRI**|
**Number of deliveries attended by skilled health personnel (Number)CRI**|\n\n\n\nFeb 21, 2024 Page 33 of 43\n\n\n",
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+ "reference_population": null,
+ "is_used": "False",
+ "usage_context": "primary"
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+ "dataset_name": {
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+ "author": null,
+ "producer": null,
+ "geography": null,
+ "publication_year": null,
+ "reference_year": null,
+ "reference_population": {
+ "text": "CHUs",
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+ "start": 278,
+ "end": 279
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+ "is_used": "False",
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+ "reference_population": null,
+ "is_used": "False",
+ "usage_context": "supporting"
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+ "end": 409
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+ "acronym": null,
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+ "start": 531,
+ "end": 534
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+ "reference_year": null,
+ "reference_population": null,
+ "is_used": "False",
+ "usage_context": "background"
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+ {
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+ "confidence": 0.8688958287239075,
+ "start": 645,
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+ "reference_population": null,
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+ "reference_population": null,
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+ "confidence": 0.8471167087554932,
+ "start": 827,
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+ "reference_year": null,
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+ "start": 794,
+ "end": 797
+ },
+ "is_used": "False",
+ "usage_context": "background"
+ }
+ ],
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+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
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+ ]
+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n|Description|Total number of deliveries attended by skilled health personnel|\n|---|---|\n|Frequency
|Every six months
|\n|Data source
|KHIS|\n|Methodology for Data
Collection
|Routine HMIS data collection|\n|Responsibility for Data
Collection
|MoH
|\n|**Number of community enrolled health nurses trained in Garissa and Turkana (Number) **
|**Number of community enrolled health nurses trained in Garissa and Turkana (Number) **
|\n|Description
|
Total number of community enrolled health nurses trained in Garissa and Turkana
|\n|Frequency
|Every six months
|\n|Data source|Project report|\n|Methodology for Data
Collection|Project monitoring|\n|Responsibility for Data
Collection
|MoH
|\n|
**Number of refugee health facilities supported under the project, as part of the transition to county management, in Garissa and Turkana**
**(Number) **
|
**Number of refugee health facilities supported under the project, as part of the transition to county management, in Garissa and Turkana**
**(Number) **
|\n|Description
|Total number of refugee health facilities supported under the project, as part of the transition to county management, in
Garissa and Turkana (registration in the master facility list, provision of non-program HPTs from KEMSA, staffing).
|\n|Frequency
|Every six months
|\n|Data source
|Project report|\n|Methodology for Data
Collection|Project monitoring|\n|Responsibility for Data
Collection
|MoH
|\n|**People in Garissa and Turkana who have received essential health, nutrition, and population (HNP) services (Number) **
|**People in Garissa and Turkana who have received essential health, nutrition, and population (HNP) services (Number) **
|\n|Description
|Total number of deliveries attended by skilled health personnel and total number of children immunized among the host
community and refugees in Garissa and Turkana.
|\n|Frequency
|Every six months
|\n|Data source
|KHIS|\n|Methodology for Data
Collection|Routine HMIS data collection|\n|Responsibility for Data
Collection
|MoH
|\n|**Number of children immunized among the host community in Garissa and Turkana (Number) **
|**Number of children immunized among the host community in Garissa and Turkana (Number) **
|\n|Description
|Total number of children immunized among the host community in Garissa and Turkana.
|\n|Frequency
|Every six months
|\n|Data source|KHIS|\n|Methodology for Data
Collection|Routine HMIS data collection|\n|
Responsibility for Data
Collection
|MoH
|\n|**Number of children immunized among refugees in Garissa and Turkana (Number) **
|**Number of children immunized among refugees in Garissa and Turkana (Number) **
|\n|Description
|Total number of children immunized among refugees in Garissa and Turkana.
|\n|Frequency
|Every six months
|\n|Data source|UNHCR reports|\n|
Methodology for Data
Collection
|
Routine UNHCR data collection|\n|Responsibility for Data
Collection|MoH|\n\n\n\nFeb 21, 2024 Page 34 of 43\n\n\n",
+ "datasets": [
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+ "data_type": null,
+ "acronym": null,
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+ "confidence": 0.5088197588920593,
+ "start": 2,
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+ "geography": {
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+ "start": 105,
+ "end": 108
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+ "publication_year": null,
+ "reference_year": null,
+ "reference_population": {
+ "text": "community enrolled health nurses",
+ "confidence": 0.9616738557815552,
+ "start": 99,
+ "end": 103
+ },
+ "is_used": "False",
+ "usage_context": "supporting"
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+ "confidence": 0.9513296484947205,
+ "start": 105,
+ "end": 108
+ },
+ "publication_year": null,
+ "reference_year": null,
+ "reference_population": {
+ "text": "community enrolled health nurses",
+ "confidence": 0.9613131880760193,
+ "start": 99,
+ "end": 103
+ },
+ "is_used": "False",
+ "usage_context": "supporting"
+ },
+ {
+ "dataset_name": {
+ "text": "master facility list",
+ "confidence": 0.9399701952934265,
+ "start": 345,
+ "end": 348
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+ "dataset_tag": "non-dataset",
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+ "data_type": null,
+ "acronym": null,
+ "author": null,
+ "producer": null,
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+ "start": 163,
+ "end": 166
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+ "publication_year": null,
+ "reference_year": null,
+ "reference_population": {
+ "text": "refugee health facilities",
+ "confidence": 0.9807338714599609,
+ "start": 227,
+ "end": 230
+ },
+ "is_used": "False",
+ "usage_context": "supporting"
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+ "start": 383,
+ "end": 385
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+ "data_type": null,
+ "acronym": null,
+ "author": null,
+ "producer": null,
+ "geography": {
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+ "start": 338,
+ "end": 341
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+ "reference_population": null,
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+ {
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+ "start": 786,
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+ }
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+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n|Number of deliveries attended by skilled health personnel among the host community in Garissa and Turkana (Number)|Col2|\n|---|---|\n|Description
|Total number of deliveries attended by skilled health personnel among the host community in Garissa and Turkana.
|\n|Frequency
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|\n|Data source|KHIS|\n|Methodology for Data
Collection|Routine HMIS data collection|\n|Responsibility for Data
Collection
|MoH
|\n|
**Number of deliveries attended by skilled health personnel among refugees in Garissa and Turkana (Number) **
|
**Number of deliveries attended by skilled health personnel among refugees in Garissa and Turkana (Number) **
|\n|Description
|Total number of deliveries attended by skilled health personnel among the refugees in Garissa and Turkana
|\n|Frequency
|Every six months
|\n|Data source|UNHCR reports|\n|
Methodology for Data
Collection
|
Routine UNHCR data collection|\n|Responsibility for Data
Collection
|PMT
|\n|**Project management and evaluation**
|**Project management and evaluation**
|\n|**Percentage of complaints in the GRM satisfactorily addressed within 4 weeks of initial complaint being recorded (Percentage) **
|**Percentage of complaints in the GRM satisfactorily addressed within 4 weeks of initial complaint being recorded (Percentage) **
|\n|Description
|Numerator: Number of complaints to the GRM satisfactorily addressed within 4 weeks of initial complaint being
recorded. Denominator: Total number of recorded complaints to the GRM.
|\n|Frequency
|Every 6 months
|\n|
Data source
|
Project report|\n|Methodology for Data
Collection
|Project monitoring|\n|Responsibility for Data
Collection
|MoH
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|**A vulnerable and marginalized group plan is developed and disseminated (Yes/No) **
|\n|Description
|A vulnerable and marginalized group plan is developed and disseminated
|\n|Frequency
|Every six months
|\n|Data source
|Project report|\n|Methodology for Data
Collection
|Project monitoring|\n|Responsibility for Data
Collection
|MoH
|\n|
**Percentage of transfers of project funds to the CRF that occur within 7 business days after the project funds are transferred into the MoH**
**Development Account**
|
**Percentage of transfers of project funds to the CRF that occur within 7 business days after the project funds are transferred into the MoH**
**Development Account**
|\n|Description
|Numerator: Number of transfers of project funds to the CRF that occur within 7 business days after the project funds are
transferred into the MoH Development Account
Denominator: Total number of transfers of project funds to the CRF that occur after the project funds are transferred
into the MoH Development Account in a given year
|\n|Frequency
|Every six months
|\n|Data source|Project report|\n|Methodology for Data
Collection|Project monitoring|\n|
Responsibility for Data
Collection|MoH|\n\n\n\nFeb 21, 2024 Page 35 of 43\n\n\n",
+ "datasets": [
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+ "start": 174,
+ "end": 177
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+ "reference_population": {
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+ "start": 172,
+ "end": 173
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+ "is_used": "False",
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+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n**ANNEX 1: Implementation Arrangements and Support Plan**\n\n\n**COUNTRY: Republic of Kenya**\n**Building Resilient and Responsive Health Systems**\n\n**Project institutional and implementation arrangements**\n\n1. **The implementation support plan for the project is based on the following considerations:** (a) for Component\n2, the annual planning, budgeting, implementation, and monitoring will follow county public financial management (PFM)\nprocess and county Governments will be responsible for implementation with support from KEMSA for procurement and\ndelivery of HPTs to primary care facilities; (b) all activities under Component 1 will be implemented by the MoH and KEMSA\nas part of their work program; (c) all implementing entities will put in place a management team to oversee project\nimplementation; (d) in refugee camps, implementation will be undertaken in close coordination with DRS and UNHCR;\nand (e) the PMT will coordinate both the county and national level activities.\n\n\n**Financial Management**\n\n2. **Planning and Budgeting** . The project budgeting will be done in accordance with existing Government procedures.\nThe budget shall be based on the Annual Work Plan and Budget (AWPB) developed by the MoH including activities to be\ncarried out by Counties and KEMSA. The project planning and budgetary process shall be implemented in accordance with\nthe standard Government fiscal year which begins on 1st July of each financial year as provided for by the Public Financial\nManagement Act 2012 and the Government Financial Regulations and Procedures. These will form the basis for defining\nthe project activities and ensuring that sufficient funds are allocated to achieve the agreed results. There are possible\nchallenges on inadequate budget allocations in the printed estimates at MoH which may delay implementation of project\nactivities. Coordination timing of the Government budgeting activities/calendar across the two project levels (National\nand County) may be a challenge. The Chief Finance Officer at MoH will be tasked to liaise with the PMT to ensure there is\nadequate budget provided **.**\n\n\n3. **Accounting and Staffing.** All implementing entities including the participating counties will be required to\ndesignate project finance staff with adequate qualifications and experience to ensure project financial processes are well\ncoordinated, including preparations of financial reports for the project. The proposed staff will be reviewed and cleared\nby the World Bank as an effectiveness condition. The MoH maintains projects’ books of account using the integrated\nfinancial management information system (IFMIS) and manual ledgers. There will be comprehensive start-up workshop\nwhere finance staff of the implementing entities will be sensitized on FM requirements for the project to build capacity\non managing the project. Additional training will be provided on a need basis during project implementation.\n\n\n4. **Internal Control and Internal Audit.** The project expenditure initiation, authorization and payments will be in line\nwith PFM Act 2012 and PFM regulations (2015) of Kenya as elaborated and customized in the FM manual. Project work\nplans will be integrated into the internal audit work plans. Internal Audit reports covering project activities will be shared\nwith the World Bank on a semi-annual basis (i.e. 30 June and 31 December). Regular internal audit, implementation\nsupport, monitoring and reporting will be undertaken. There have been material weaknesses on imprest management at\nMoH regarding long outstanding imprest and multiple imprest contravening PFM regulations. The internal audit at MoH\n\n\nFeb 21, 2024 Page 36 of 43\n\n\n",
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+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\nwill continue to provide this assurance and recommendations for continued strengthening of internal controls. The\nInternal Audit Department reports to the Audit Committee of the MoH that is required to meet on a quarterly basis. The\naudit committees are independent of the MoH and are appointed in accordance with the PFM Act 2012.\n\n\n5. **Financial Reporting.** The PMT Project Accountant will be responsible for preparation of financial reports for the\nproject. An interim unaudited Financial Report shall be prepared by the counties and submitted to the PMT by the 15th\nday after the end of the quarter. The PMT shall consolidate and submit to the World Bank 45 days after the end of the\nquarter. The annual project financial statements shall be consolidated and submitted to the Office of the Auditor General\n(OAG) for external audit on or before September 30 of each financial year. There have been regular trainings provided to\nCounties teams for THS-UCP which has improved financial reporting. The dedicated Project Accountants at national and\ncounties levels will be provided with capacity building trainings at the commencement of the project which will include\nrefresher financial reporting requirements among other financial management procedures. PMT finance team will\nregularly review financial reports by counties and identify any further tailored support that may be provided.\n\n\n6. **External Audit.** On an annual basis, the financial statements for the project will be audited by OAG and audited\nfinancial statements submitted to the World Bank within six months after the financial year end in accordance with World\nBank’s FM guidelines. The terms of reference for the external audit shall be cleared by the World Bank.\n\n\n**Disbursement**\n\n7. **Disbursements and Funds Flow.** The disbursements from IDA will be report based. The initial advance will be\ndisbursed based on initial cash flow requirement for at least the first six months. Subsequent disbursement will be based\non the advance amount requested as per the approved Interim Financial Report submitted in every quarter by the MoH\nfor both national county level activities. The banking arrangements for purposes of funds flow will consist of (a) three DAs\ndenominated in US dollars or Euros as shall be agreed with the NT (DA-A for national level activities disbursement category\n1 part 1 and 3 DA-B for county-level activities category 1 and 3 part 2.1 and 2.3, DA-C for county level activities category\n2 part 2.2 financed by both IDA Grant and GFF. These accounts shall be opened at the CBK and managed by the National\nTreasury (NT). One project account shall be opened by the Ministry for receipt of funds from DA-A. The funds received\nthrough DA-B, and DA-C shall be transferred through the exchequer to the MoH Development Account for transfer to the\nCounty Revenue Fund and to the County Special Purpose Account. The project account shall be opened in Kenyan shillings\nat the CBK or financial institution acceptable to IDA and shall be to pay for eligible project activities. (b) Each participating\ncounty shall open a Special Purpose Account (SPA), at CBK. Triggers for the initial transfer from DA-B and DA-C to SPA will\ninclude the signing of the intergovernmental participation agreement, and approved county AWP&B. Subsequent transfer\nof funds from DA-B, and DA-C shall be based on consolidated advance request by the MoH through the approved IFR. To\nresolve the funds flow delays observed in devolved projects, the funds transferred from the Ministry Development\nAccount to the CRF shall be within 7 working days. The funds transfer from CRF to project’s SPA shall be within 15 working\ndays failure to which an adjustment shall be applied as described in the POM. There will be continuous engagement with\nthe MoH, Council of Governors and the NT to unlock challenges impacting on the fund flows.\n\n\nFeb 21, 2024 Page 37 of 43\n\n\n",
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+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\nDiagram 1: Funds Flow\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n|Project Account in Kshs|Col2|\n|---|---|\n|||\n\n\n|County Revenue Fund|Col2|\n|---|---|\n|||\n\n\n|County Special Purpose
Account|Col2|\n|---|---|\n|||\n\n\nPayments for goods, services, and other eligible expenditures\n\n\n**Procurement**\n\n8. **Institutional Arrangements for Procurement:** The MoH will be the implementing agency responsible for\nprocurement activities at the national level, while KEMSA will be responsible for procurement and distribution of HPTs to\nprimary care facilities. Counties will also conduct procurement on a need-by-need basis under Sub-components 2.2 and\n2.3, based on their AWPs. All entities have gained significant experience in implementing World Bank-financed projects.\nThe MoH and the 47 counties implemented a Bank-financed THS-UCP using Procurement Guidelines in the period 20162023. Furthermore, the MoH and KEMSA have been implementing the World Bank-financed COVID-19 Health Emergency\nResponse Project (CHERP, P173820) since 2020 using Procurement Regulations. Implementation of these Bank-financed\noperations have enhanced and continue to strengthen the agencies’ institutional procurement capacities in implementing\nWorld Bank-financed projects. The procurement decision making process will utilize the internal institutional structures\nof the MoH, KEMSA and the counties.\n\n\nFeb 21, 2024 Page 38 of 43\n\n\n",
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+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n9. **Record Keeping and Asset Management:** All records pertaining to the procurement and contract management\nactivities including contract monitoring and payment records and contract completion will be retained by the\nimplementing agencies in procurement files for each procurable activity in accordance with requirements of the financing\nagreement and uploaded in the STEP system on a timely basis. The MoH will also ensure that all inventory, stores, and\nassets procured are received by respective beneficiary counties, taken on charge, and used by the counties for intended\npurposes.\n\n\n**Strategy and Approach to Implementation Support**\n\n10. **Implementation Support.** A core World Bank technical team, including a task team leader (TTL) and Forced\nDisplacement Officers will provide implementation support to implementing entities. The World Bank will provide hands\non operational support to PMT members and county Government teams with no prior direct experience with\nimplementation of World Bank-financed projects. This will be in addition to the support provided during bi-annual\nmissions, especially at the beginning of project implementation. The task team will use a risk-based approach to\noperational support given the large number of implementing entities. Cross-county knowledge sharing and learning will\nbe encouraged throughout project implementation.\n\n\n**Implementation Support Plan and Resource Requirements**\n\n11. **Bi-annual Review and Midterm Review.** Biannual World Bank visits will be organized to review progress and\nmitigate risks. A midterm review will be organized in due time to assess project implementation progress and make the\nnecessary changes to accelerate implementation.\n\n\n12. **Fiduciary and Safeguards.** World Bank fiduciary and E&S staff are all based in Nairobi which will allow timely\nsupport to the PMT and implementing entities. During the bi-annual implementation support missions, the fiduciary and\nsafeguards team will join the field trips and provide hands-on support to the county counterparts.\n\n\n13. **M&E.** The World Bank will work closely with the PMT to plan and implement the required project M&E and ensure\ndisaggregation of results for refugees and host community members.\n\n\nFeb 21, 2024 Page 39 of 43\n\n\n",
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+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n**ANNEX 2: Climate Change**\n1. **The project has been screened for climate disasters and risks and been found to be highly exposed, while the**\n**risk to project activities is low.** Kenya is highly vulnerable to the impacts of climate change and is ranked 152 out of 181\ncountries in the 2019 Notre Dame Global Adaptation Index (ND-GAIN). Kenya’s topography is highly diverse including\nvaried formations of plains, escarpments, and hills, as well as low and high mountains which has an influence on varying\nclimatology and related climate vulnerability across the country. Kenya’s mean annual temperature is 24.3°C, with average\nmonthly temperatures between 22°C in the coolest months (July/August) and 25.6°C in the warmest months\n(February/March). The mean annual temperature across Kenya is projected to increase by 1.0°C in the 2030s, 1.7°C in the\nmid-century and 3.5°C by the end of the century, with rapid warming in the northern and coastal parts of the country,\nintensifying droughts, heat waves with impacts on heat health risks, and food insecurity and malnutrition. The mean\nannual precipitation (1901-2020) is 668.6mm and is projected to remain highly variable and uncertain, with an increase in\naverage rainfall in the 2050s with increased extreme rainfall events (frequency, intensity, duration) triggering floods and\nlandslides with implications for vector-borne disease transmission, water-borne disease outbreaks, direct injuries, and\nmortalities; and impacts on health infrastructure. Floods and droughts are the most significant and frequent climaterelated hazards accounting for 40.0 percent and 10.0 percent respectively of all-natural hazard occurrences in Kenya\nbetween 1980-2020.\n\n2. **Climate change has significant impacts on health in Kenya** . Food insecurity and malnutrition remain high\nparticularly in the Arid and Semi-Arid Lands of Kenya. Increased precipitation variability and related prolonged droughts\nand erratic rainfall induced floods are posing significant impacts on food security, driving hunger and malnutrition in the\ncountry and projected increases in temperature and decrease in precipitation will worsen food insecurity and associated\nmalnutrition in the country by the 2030s and 2050s. Three consecutive years of below than average rains, prolonged\ndrought and erratic rains have significantly reduced crop yields and livestock productivity leaving 17.0 percent (2.8 million\npeople) facing acute food insecurity, and 940,000 children 6-59 months and 145,000 pregnant or lactating women acutely\nmalnourished. [29] Furthermore, warming temperatures and precipitation variability are already increasing vector-borne\ndisease transmission risk (especially for malaria, dengue, schistosomiasis, chikungunya, yellow fever, rift valley fever) in\nthe country. For instance, in Kenya, malaria is a major cause of death and disease with an estimated 3.5 million cases and\n10,700 deaths each year; with 31 million people at risk in the endemic Lake Western, Nyanza and Coastal regions. [30] [31]\nProjected increasing temperatures and rainfall variability are predicted to increase habitat suitability and seasonal\ntransmission in traditionally low malaria risk areas such as the Central highlands and Nairobi. Women, children, and\npregnant mothers, particularly those from poor households and in rural areas are the most vulnerable to malaria. Climate\nchange is also exacerbating water-borne diseases especially diarrhea and cholera outbreaks in Kenya. Flash floods are\noverwhelming sewage systems contaminating drinking water sources and prolonged droughts are reducing the quantity\nand quality of water and compromising the functioning of Water, Sanitation, and Hygiene infrastructure even in health\nfacilities. In the aftermath of heavy rains during March-May 2018, flooding across the country led to a major increase in\ncholera outbreaks of 5,470 cases and 78 deaths in 19 counties with over 700 cases in Turkana and Garissa Counties. [32] [33]\nFloods, storms, landslides, and extreme heat threaten the functioning of health infrastructure and hinder health service\ndelivery and access especially in flood prone Coastal regions, Tana River region, the Lake Victoria Basin, and rural remote\nareas of the country.\n\n\n29 Kenya: IPC Acute Food Insecurity and Acute Malnutrition Analysis (July 2023 - January 2024)\n30 https://www.cdc.gov/malaria/malaria_worldwide/cdc_activities/kenya.html\n31 Kenya Malaria Indicator Survey, 2020.\n32 Kenya Humanitarian Situation Report. 31 December 2018.\n33 MSF responds to cholera outbreak amid heavy rains and flooding. Project update. 18 May 2018.\n\n\nFeb 21, 2024 Page 40 of 43\n\n\n",
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+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n3. The project intends to implement measures to adapt to climate change while mitigating greenhouse gas\nemissions, as outlined in the Table below.\n\n**Table 1: Climate Adaptation Measures Financed by the Project**\n\n\n\n\n\n\n|Components/Sub-component|Climate Action|\n|---|---|\n|Sub-component 1.1: Institutional and
operational reforms to enhance efficiency
and transparency of KEMSA (US$30 million)|**HPTs for Climate Sensitive diseases:** The list of selected HPTs will include
those related to climate sensitive diseases and conditions (malaria, diarrheal
diseases, etc.). Availability of HPTs for climate related diseases will lead to
enhanced and continued quality health service delivery for poor and rural
populations even during extreme events (floods, heat waves).**(adaptation)**
|\n|Sub-component 1.3: Improve availability of
quality data for decision making (US$10
million)|
**Climate measures in surveys:** To improve decision making and planning for
climate sensitive diseases and conditions, and climate impacts on health
infrastructure and health service delivery, there is need for availability of
reliable health data. Therefore, questions on climate and health impacts will
be included in the survey.**(adaptation)**
|\n|
Sub-component 2.1: Improving availability of
essential HPTs and delivery of key RMNCAH
and NCDs interventions at the primary care
level (US$90 million):|
**HPTs for Climate Sensitive diseases**: Pharmaceuticals for climate sensitive
conditions such as malaria, diarrheal diseases, and other climate sensitive
conditions will be included in the pharmaceutical list. This will improve the
capacity of primary care level facilities to provide better health services in
the face of the increasing burden of disease due to climate change. Seasonal
case and pharmaceutical consumption data will be used to inform
procurement of the pharmaceuticals to ensure adequate supplies based on
seasonal patterns to address climate sensitive conditions.**(adaptation)**
|\n|Sub-component 2.3: Improving access to and
utilization of quality health services in
refugee and host communities (US$40
million)|
**Climate sensitive community health service planning:** Climate sensitive
planning including the use of climate vulnerability and meteorologic data
will be used to guide the distribution of essential HTPs, diagnostic and
medical equipment avoiding stormy, heavy rains and heavy flooding days.
Specifically, data on climate vulnerable locations and data on previous use
of HPTs for climate sensitive diseases as well as patterns of pharmaceutical
use following climate shocks will be used to ensure adequate quantities of
pharmaceuticals are being used. To ensure pharmaceuticals are available
ahead of shocks and that these do not impact distribution, funding will be
made available, and planning will be done to ensure distributions ahead of
shocks. This will reduce the risk of damage to HPTs and medical equipment
by floods and storms but will also improve the acquisition and availability of
adequate amounts of essential HPTs (for climate sensitive diseases such as
malaria, diarrhea) for improved health service delivery.**(adaptation)**
**Availability of climate sensitive essential HPTs, diagnostic and medical**
**equipment:**This Sub-component will finance the procurement of HPTs for
climate sensitive diseases, particularly malaria and diarrhea, which are|\n\n\n\nFeb 21, 2024 Page 41 of 43\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 46
+ ]
+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n34 Noting that there are currently no national energy efficiency standards for medical equipment in Kenya, this would be promoting best-available\ntechnology.\n35 International Electrotechnical Commission. 2020 report. Medical electrical equipment - Part 1-9: General requirements for basic safety and\nessential performance - Collateral Standard: Requirements for environmentally conscious design. IEC. 2020. IEC 60601-19:2007+AMD1:2013+AMD2:2020 CSV - Consolidated version.\n\n\nFeb 21, 2024 Page 42 of 43\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 47
+ ]
+ }
+ },
+ {
+ "input_text": "**The World Bank**\nBuilding Resilient and Responsive Health Systems (P179698)\n\n\n\n\n\n\n|Col1|exact cost estimates of equipment purchases are not possible given cost
fluctuations and county autonomy in choosing activities, a conservative
minimum estimate of ten percent of the Sub-components’ financing is
anticipated to go to energy efficient equipment purchases. (mitigation)|\n|---|---|\n|Sub-component 2.2: Improving delivery of
quality health services in selected counties
(US$5 million, IDA)|**Climate change and undernutrition:** This Sub-component will finance
nutrition services to address stunting in children and anemia in pregnant
women including provision of micronutrient supplements and growth
monitoring. Undernutrition in Kenya is climate related, particularly in arid
and semi-arid parts of the country which will be covered under this Sub-
component. These nutrition services will help the population adapt to the
health impacts of climate change. (adaptation)
|\n|
Component 3: Project management and
evaluation (US$10 million):|Under this Component, the MoH will develop national climate emergency
preparedness and response plan which will inform county-level actions to
reduce the risk of climate change on health service delivery activities.
Counties will be encouraged to include relevant climate mitigation actions
in their AWPs.**(adaptation)**|\n\n\n\nFeb 21, 2024 Page 43 of 43\n\n\n",
+ "datasets": [],
+ "document": {
+ "source": "http://documents1.worldbank.org/curated/en/099022324094562763/pdf/BOSIB1554c314c0a2187c019d7e85bc2a91.pdf",
+ "pages": [
+ 48
+ ]
+ }
+ }
+]
\ No newline at end of file