diff --git "a/annotation_data/wbg_extractions/doc_100/raw/doc_100_raw.json" "b/annotation_data/wbg_extractions/doc_100/raw/doc_100_raw.json" new file mode 100644--- /dev/null +++ "b/annotation_data/wbg_extractions/doc_100/raw/doc_100_raw.json" @@ -0,0 +1,2537 @@ +[ + { + "input_text": "Document of\n# **The World Bank**\n\n**FOR OFFICIAL USE ONLY**\n\nReport No: PAD2358\n\nINTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT\n\n\nPROJECT APPRAISAL DOCUMENT\n\n\nON A\n\n\nPROPOSED FINANCING\n\n\nIN THE AMOUNT OF US$120 MILLION\n(INCLUDING AN IBRD LOAN AND SUPPORT FROM THE CONCESSIONAL FINANCING FACILITY)\n\n\nTO THE\n\n\nLEBANESE REPUBLIC\n\n\nFOR A\n\n\nLEBANON HEALTH RESILIENCE PROJECT\n\n\nJune 13, 2017\n\n\nHealth, Nutrition & Population Global Practice\nMiddle East And North Africa Region\n\n\nThis document has a restricted distribution and may be used by recipients only in the performance of\ntheir official duties. Its contents may not otherwise be disclosed without World Bank authorization.\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 0 + ] + } + }, + { + "input_text": "CURRENCY EQUIVALENTS\n\n\n(Exchange Rate Effective April 30, 2017)\n\n\nCurrency Unit = Lebanese Pound (LBP)\n\n\nLBP 1,507.5 = US$1\n\n\nFISCAL YEAR\nJanuary 1 - December 31\n\n\nRegional Vice President: Hafez M. H. Ghanem\n\n\nActing Country Director: Kanthan Shankar\n\n\nSenior Global Practice Director: Timothy Grant Evans\n\n\nPractice Manager: Ernest E. Massiah\n\n\nTask Team Leader(s): Nadwa Rafeh\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 1 + ] + } + }, + { + "input_text": "**ABBREVIATIONS AND ACRONYMS**\n\nCDR Council for Development and Reconstruction\nGCFF Global Concessional Financing Facility\nCPF Country Partnership Framework\n\n\n\nCDR Council for Development and Reconstruction\nGCFF Global Concessional Financing Facility\nCPF Country Partnership Framework\n\nEHS Environmental, Health, and Safety\nEPHRP Emergency Primary Healthcare Restoration Project\n\n\n\nEHS Environmental, Health, and Safety\nEPHRP Emergency Primary Healthcare Restoration Project\n\nESIA Environmental and Social Impact Assessment\nESMF Environmental and Social Management Framework\nESMP Environmental and Social Management Plan\nFM Financial Management\nFO Financial Officer\nGBV Gender-Based Violence\nGDP Gross Domestic Product\n\n\n\nGBV Gender-Based Violence\nGDP Gross Domestic Product\n\nGOL Government of Lebanon\nHIS Health Information System\nICU Intensive Care Unity\n\n\n\nHIS Health Information System\nICU Intensive Care Unity\n\nIPSAS International Public Sector Accounting Standards\nIsDB Islamic Development Bank\nLCRP Lebanon Crisis Response Plan\n\n\n\nIsDB Islamic Development Bank\nLCRP Lebanon Crisis Response Plan\n\nM&E Monitoring and Evaluation\nMCH Maternal and Child Health\nMENA Middle East and North Africa Region\nMOF Ministry of Finance\nMoPH Ministry of Public Health\nMoSA Ministry of Social Affairs\nNCD Non-Communicable Disease\nNGO Nongovernmental Organization\nNPF New Procurement Framework\nNPTP National Poverty Targeting Program\nOHS Occupational Health and Safety\n\n\n\nNPTP National Poverty Targeting Program\nOHS Occupational Health and Safety\n\nPDO Project Development Objective\nPFS Project Financial Statements\nPHCC Primary Health Care Center\nPMU Project Management Unit\nPOM Project Operations Manual\nPPSD\n\n\n\nPOM Project Operations Manual\nPPSD Project Procurement Strategy for Development\n\nSAP Safeguards Action Plan\nTOR Terms of Reference\nTPA Third-party Agency\nUHC Universal Health Coverage\n\n\n\nTOR Terms of Reference\nTPA Third-party Agency\nUHC Universal Health Coverage\n\nUN United Nations\nUNFPA United Nations Population Fund\n\n\n\nUN United Nations\nUNFPA United Nations Population Fund\n\nUNHCR United Nations High Commissioner for Refugees\nUNICEF United Nations Children’s Fund\nVAT Value-Added Tax\n\n\n\nUNICEF United Nations Children’s Fund\nVAT Value-Added Tax\n\nWB World Bank\nWHO World Health Organization\n\n\n\nWorld Bank\nWorld Health Organization\n\n\n", + "datasets": [ + { + "dataset_name": { + "text": "ESIA Environmental and Social Impact Assessment", + "confidence": 0.9608486890792847, + "start": 63, + "end": 69 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "HIS Health Information System", + "confidence": 0.6956948041915894, + "start": 105, + "end": 109 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.8596711158752441, + "start": 104, + "end": 105 + }, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "NPTP National Poverty Targeting Program", + "confidence": 0.5087152123451233, + "start": 197, + "end": 202 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + } + ], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 2 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n\n\n\n\n|Is this a regionally tagged project?|Country(ies)|Financing Instrument|\n|---|---|---|\n|No
||Investment Project Financing|\n\n\n\n\n\n\n|Approval Date|Closing Date|Environmental Assessment Category|\n|---|---|---|\n|26-Jun-2017|30-Jun-2023|B - Partial Assessment
|\n|Bank/IFC Collaboration|

|

|\n|No|||\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPage 1 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 3 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n|[ ]
Counterpart
Funding|[ ✔ ] IBRD|[ ] IDA Credit
[ ] Crisis Response
Window
[ ] Regional Projects
Window|[ ] IDA Grant
[ ] Crisis Response
Window
[ ] Regional Projects
Window|Col5|[ ✔ ] Trust
Funds|[ ]
Parallel
Financing|\n|---|---|---|---|---|---|---|\n|~~FIN COST OLD ~~
Total Project Cost:
120.00
|~~FIN COST OLD ~~
Total Project Cost:
120.00
||||||\n|~~FIN COST OLD ~~
Total Project Cost:
120.00
|~~FIN COST OLD ~~
Total Project Cost:
120.00
|
Total Financing:
120.00
Of Which Bank Financing (IBRD/IDA):

95.80|
Total Financing:
120.00
Of Which Bank Financing (IBRD/IDA):

95.80|
Financing Gap:
0.00
|
Financing Gap:
0.00
|
Financing Gap:
0.00
|\n||||||||\n\n\n|Financing (in US$, millions) FIN_SUMM_OLD|Col2|\n|---|---|\n|
**Financing Source **
**Amount**
||\n|Concessional Financing Facility
24.20
|Concessional Financing Facility
24.20
|\n|IBRD-87710
95.80
|IBRD-87710
95.80
|\n|**Total**
** 120.00**
|**Total**
** 120.00**
|\n\n\n\n\n\nPage 2 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 4 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPage 3 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 5 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPage 4 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 6 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n\n\n\n\n\n\n\n\n\n\n\nPage 5 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 7 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n\n\n\n\n\nPage 6 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 8 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\nLebanon Health Resilience Project\n\n\n**TABLE OF CONTENTS**\n\n\n**I.** **STRATEGIC CONTEXT ...................................................................................................... 9**\n\n\n**A. Country Context** ................................................................................................................. 9\n\n\n**B. Sectoral and Institutional Context** ................................................................................... 11\n\n\n**C. Higher-level Objectives to which the Project Contributes** .............................................. 16\n\n\n**II.** **PROJECT DEVELOPMENT OBJECTIVES ............................................................................ 17**\n\n\n**A. PDO** ................................................................................................................................... 17\n\n\n**B. Project Beneficiaries** ......................................................................................................... 17\n\n\n**C. PDO-level Results Indicators** ............................................................................................ 17\n\n\n**III.** **PROJECT DESCRIPTION .................................................................................................. 18**\n\n\n**A. Project Components** ......................................................................................................... 18\n\n\n**B. Project Cost and Financing** ............................................................................................... 21\n\n\n**C. Lessons Learned and Reflected in the Project Design** ..................................................... 22\n\n\n**IV.** **IMPLEMENTATION ........................................................................................................ 23**\n\n\n**A. Role of Partners** ................................................................................................................ 23\n\n\n**B. Institutional and Implementation Arrangements** ........................................................... 24\n\n\n**C. Results Monitoring and Evaluation** .................................................................................. 25\n\n\n**D. Sustainability** .................................................................................................................... 26\n\n\n**V.** **KEY RISKS ..................................................................................................................... 27**\n\n\n**A. Overall Risk Rating and Explanation of Key Risks** ........................................................... 27\n\n\n**VI.** **APPRAISAL SUMMARY .................................................................................................. 29**\n\n\n**A. Economic and Financial Analysis** ..................................................................................... 29\n\n\n**B. Technical** ........................................................................................................................... 31\n\n\n**C. Financial Management** ..................................................................................................... 31\n\n\n**D. Procurement** ..................................................................................................................... 35\n\n\n**E. Social (including Safeguards)** ............................................................................................ 38\n\n\n**F. Environment (including Safeguards)** ................................................................................ 38\n\n\n**G. Other Safeguard Policies (if applicable)** .......................................................................... 39\n\n\n**H. World Bank Grievance Redress** ....................................................................................... 39\n\n\nPage 7 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 9 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n**VII. RESULTS FRAMEWORK AND MONITORING .................................................................... 40**\n\n\n**ANNEX 1. ENVIRONMENTAL AND SOCIAL SAFEGUARDS ACTION PLAN (SAP) ........................ 46**\n\n\nPage 8 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 10 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n**I.** **STRATEGIC CONTEXT**\n\n\n**A. Country Context**\n\n\n1. **Six years into the Syrian conflict, Lebanon, a small country of 4 million people, hosts the**\n**highest per capita concentration of refugees in the world.** The latest Government of Lebanon (GoL)\nestimates are that the country hosts 1.5 million displaced Syrians, along with 31,502 Palestinian\nrefugees from Syria, and a preexisting population of more than 277,985 Palestinian refugees. [1]\nAccordingly, the population of Lebanon has grown by around 30 percent in just six years. This influx has\nput enormous pressure on the country's already scarce resources, stretched its public services, and\ncontributed to rising tensions in a nation vulnerable to conflict and instability.\n\n2. **Lebanon faces stark economic and social challenges due to the impact of the prolonged Syrian**\n**conflict** . According to the Economic and Social Impact Assessment (ESIA) carried out by the World Bank\n(WB) [2], the fiscal costs related to the Syrian crisis have amounted to an estimated US$2.6 billion over\n2012-2014. The ESIA also highlighted the large negative impact on access to and quality of public\nservices that is due to the substantial increase in demand for these services. In 2014, it was estimated\nthat the dire economic situation has added 170,000 Lebanese to the 1.5 million nationals living below\nthe poverty line. Along with the displaced Syrians and Palestinian refugees, the total vulnerable\npopulation in Lebanon today is estimated to be more than 3.3 million, representing around 55 percent\nof the overall population. Lebanon also faces considerable unemployment, which is estimated to have\nincreased from 11 percent before the crisis to around 35 percent, with the highest rates among women\nand youth.\n\n3. **Lebanon’s fragile stability is vulnerable to the spillover of violence.** The crisis has deepened the\nvulnerability of Lebanon as both displaced Syrians and Lebanese communities compete for limited\nresources, leading to growing social tension. In addition, separation from families, absence of basic\nstructural and social protection, and concerns about access to basic services have increased the\nvulnerability of displaced Syrians. Because more than 70 percent of the displaced Syrians in Lebanon are\nwomen and children, these groups warrant special attention [3] . Despite the profound impact of the crisis,\nLebanon has done remarkably well in maintaining stable community relations and accommodating\ndisplaced persons from Syria. However, the impact of population pressure on host communities,\nexacerbating the issues Lebanon faced before the Syrian crisis, remains the key underlying factor for\npotential instability.\n\n4. **The Syrian refugee influx has resulted in an unprecedented increase in demand for health**\n**services in Lebanon, putting considerable strain on the country’s resources and public services.** The\ncapacity of the health system is still falling short of demand, further straining Lebanon’s public finances\nand services. According to the latest Lebanon Crisis Response Plan [4] (LCRP 2017-2020), US$308 million\n\n\n1 Lebanon Crisis Response Plan (LCRP), 2017-2020.\n2 The World Bank. (2014). Lebanon Economic and Social Impact Assessment of the Syrian Crisis.\n3 Lebanon Crisis Response Plan (LCRP), 2017-2020.\n4 Ibid.\n\n\nPage 9 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 11 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\nand US$300 million will be needed in 2017 and 2018, respectively, to meet the health needs of\nvulnerable populations in the country (Lebanese, displaced Syrians, and Palestinian refugees).\n\n5. **The Ministry of Public Health (MoPH) is adopting a two‐pronged approach aimed at**\n**responding to the immediate health needs of the population while meeting the sector’s medium- to**\n**longer‐term development goals** . To meet immediate health needs, the MoPH is working with multiple\npartners, stakeholders, and UN agencies, as well as leveraging the private sector and civil society, to\nmaintain service delivery, prevent disease outbreaks, and sustain utilization and functional institutions.\nThe LCRP 2017-2020 details short-term funding needs, activities, and coordination mechanisms. The\nproposed project complements the programs currently run by UNHCR, UNICEF, UNFPA, WHO, and other\ndevelopment partners and contributes to LCRP outcome 1, “Improved access to comprehensive health\ncare” and outcome 2, “Improved access to hospital and advanced referral care.” The medium- to longterm strategy of the MoPH is to rapidly strengthen its systems to absorb the impact of the crisis and\nmaintain health outcomes. In 2013, the MoPH articulated its strategic direction: an overall goal of\nexpanding health coverage to the uninsured, with special focus on the poor and underserved Lebanese\npopulation through a Universal Health Coverage (UHC) program. Accordingly, with the help of the donor\ncommunity, the MoPH is allocating resources to upgrade the capacity of the primary health care (PHC)\nprogram, strengthen the skills of health workers, and subsidize health costs for poor Lebanese through a\npackage of essential health care services. The MoPH is also working with the UN and donor partners to\nalign current subsidization modalities of primary health services for Syrians to the UHC model to\nimprove quality and retention and reduce implementation costs.\n\n**Situations in Urgent Need of Assistance**\n\n\n6. **This project has been prepared and will be implemented under paragraph 12 of the WB**\n**Operational Policy (OP) 10.00,** **Investment Project Financing** . The situation in Lebanon is both a manmade crisis (arrival of large refugee populations) and a result of conflict (taking place in Syria). Currently,\naround half of the displaced Syrians in Lebanon are unable to meet their survival needs. This\nhumanitarian crisis – which has morphed into a development crisis – has also affected the lives and\nsocioeconomic outcomes of Lebanese communities as pressure on public services, especially education\nand health, is reaching unsustainable levels. With no end to the Syrian conflict in sight, and therefore no\nnear prospect that refugee communities will be able to return safely to their homes, Lebanon continues\nto endure the most of hosting the world’s largest per capita number of refugees. The number of\nrefugees accessing Lebanon’s PHC network and hospitals has increased significantly since the start of\nthe crisis, straining the health system and leading to such deleterious effects as a rising incidence of\ninfectious diseases and limited capacity to address non-communicable diseases (NCDs). With severely\nstrained resources, therefore, the GoL is relying mainly on support from the international community to\ncontinue to provide support for the refugee and Lebanese populations, and to maintain the provision of\npublic services. The justification for processing this operation under paragraph 12 of OP 10.00 is the\nurgent need to address the capacity needs of both primary and hospital-level institutions to respond to\ngrowing health demands and reemerging health concerns in the face of the refugee crisis.\n\n7. **This project is also eligible for funding under the Global Concessional Financing Facility (GCFF),**\nwhich was established to support the middle-income countries in the Middle East and North Africa\n(MENA) Region that are most affected by the presence of large numbers of refugees. Lebanon meets all\nof the GCFF eligibility criteria, including hosting a significant number of refugees (substantially higher\n\n\nPage 10 of 54\n\n\n", + "datasets": [ + { + "dataset_name": { + "text": "Lebanon Health Resilience Project", + "confidence": 0.5933237075805664, + "start": 7, + "end": 11 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.8898138403892517, + "start": 7, + "end": 8 + }, + "publication_year": null, + "reference_year": { + "text": "2017-2020", + "confidence": 0.9813412427902222, + "start": 155, + "end": 156 + }, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "LCRP", + "confidence": 0.9013540148735046, + "start": 154, + "end": 155 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": { + "text": "2017-2020", + "confidence": 0.9147742390632629, + "start": 155, + "end": 156 + }, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "UHC model", + "confidence": 0.5244326591491699, + "start": 362, + "end": 364 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.8282768130302429, + "start": 429, + "end": 430 + }, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "displaced Syrians", + "confidence": 0.6207209229469299, + "start": 460, + "end": 462 + }, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "health system", + "confidence": 0.8199707865715027, + "start": 582, + "end": 584 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.8492832183837891, + "start": 463, + "end": 464 + }, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "displaced Syrians", + "confidence": 0.6299100518226624, + "start": 460, + "end": 462 + }, + "is_used": "False", + "usage_context": "background" + } + ], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 12 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\nthan 0.1% of country’s population) that have had a direct socioeconomic impact on host communities.\nFurthermore, Lebanon has been, and still is, committed to developing sustainable long-term programs\nand solutions that benefit both refugees and host communities through, for instance, strengthening the\nPHC program and investing in increasing hospital capacity. Lebanon’s s fiscal constraints have been\nfurther exacerbated by the refugee crisis. Despite support from donors, the Government still faces a\nstark gap between the total financing needed to respond to the crisis—estimated at US$2.48 billion in\n2016—and the actual assistance received (US$1.04 billion, or 46%).\n\n**B. Sectoral and Institutional Context**\n\n\n8. **The Lebanese health system is highly diverse, including a mix of public and private payers and**\n**providers.** Health financing comes from a range of resources, including general government revenues,\nsocial security contributions, and the private sector. Total health expenditures constitute 6.4 percent of\nnational GDP, 40 percent of which is accounted for by hospitals alone. The private sector also accounts\nfor 71 percent of health care financing, of which 37 percent are out-of-pocket payments made by\nhouseholds. PHC is provided either through private clinics or through a network of primary health\ncenters, which are mainly run by non-governmental organizations (NGOs) (see Box 1).\n\n\n**Box 1. Lebanon’s National PHC Network**\nAs part of reform efforts in the 1990s to improve access to PHC services for low-income groups, the\nMoPH established the National PHC Network of Primary Health Care Centers (PHCCs). Participating\ncenters were selected on the basis of their size, coverage, and the range of services they provide.\nUnder contractual agreements with the centers, the MoPH and UNICEF, provide them with in-kind\nsupport, including generic drugs, vaccines, medication for acute and chronic conditions, staff support,\nrunning costs, laboratory and medical supplies, training, and IT support. In return, the PHCCs provide\ntheir communities with essential health care services at discounted rates, as well as free essential\ndrugs.\n\nToday the PHC network includes 204 contracted PHCCs (out of 1,085 PHC centers and dispensaries in\nthe country), of which 67 percent are affiliated with NGOs, 20 percent with local municipalities, 11\npercent with MoPH, and 2 percent with the Ministry of Social Affairs (MoSA). The network has the\nlargest and most comprehensive PHC centers providing a wide range of services\n(obstetrics/gynecology, pediatrics, dentistry, cardiovascular) at nominal fees for low-income\nhouseholds.\n\nThe network plays a major role in the provision of PHC services for vulnerable populations, including\nlow-income Lebanese and displaced Syrians. In 2016, the number of visits for both Lebanese and\nSyrians at the PHC network exceeded 1.5 million, compared to 700,000 in 2009. [a] This sudden\nincrease in demand put significant pressure on the country’s PHC system.\n\n____________\na Ministry of Public Health, 2016.\n\n\n9. **In terms of hospitals, though the public sector is the main payer for hospital care, the private**\n**sector dominates hospital service provision.** Of the 165 hospitals in Lebanon, 82 percent are privately\nowned and managed by physicians or by charitable organizations. Public hospitals operate under a semiautonomous model: the hospital boards are composed of various stakeholders so they have a certain\n\n\nPage 11 of 54\n\n\n", + "datasets": [ + { + "dataset_name": { + "text": "Lebanon Health Resilience Project", + "confidence": 0.8815869092941284, + "start": 7, + "end": 11 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.9888489246368408, + "start": 7, + "end": 8 + }, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "Lebanese health system", + "confidence": 0.5635608434677124, + "start": 159, + "end": 162 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": { + "text": "MoPH", + "confidence": 0.7507425546646118, + "start": 317, + "end": 318 + }, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.9862246513366699, + "start": 290, + "end": 291 + }, + "publication_year": null, + "reference_year": { + "text": "1990s", + "confidence": 0.761813223361969, + "start": 305, + "end": 306 + }, + "reference_population": { + "text": "low-income groups", + "confidence": 0.8510492444038391, + "start": 313, + "end": 315 + }, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "National PHC Network", + "confidence": 0.8284572958946228, + "start": 320, + "end": 323 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": { + "text": "PHCCs", + "confidence": 0.5983269214630127, + "start": 329, + "end": 330 + }, + "author": { + "text": "MoPH", + "confidence": 0.5709339380264282, + "start": 361, + "end": 362 + }, + "producer": null, + "geography": { + "text": "country", + "confidence": 0.5595313906669617, + "start": 445, + "end": 446 + }, + "publication_year": null, + "reference_year": { + "text": "1990s", + "confidence": 0.75745689868927, + "start": 305, + "end": 306 + }, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "PHC system", + "confidence": 0.854468584060669, + "start": 584, + "end": 586 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": { + "text": "Ministry of Public Health", + "confidence": 0.6517465710639954, + "start": 589, + "end": 593 + }, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.8213493227958679, + "start": 636, + "end": 637 + }, + "publication_year": { + "text": "2016", + "confidence": 0.8743382096290588, + "start": 539, + "end": 540 + }, + "reference_year": null, + "reference_population": { + "text": "low-income\nhouseholds", + "confidence": 0.6232548952102661, + "start": 512, + "end": 514 + }, + "is_used": "False", + "usage_context": "background" + } + ], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 13 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\ndegree of autonomy. Around 47 percent of the Lebanese population have health insurance coverage;\nand 53 percent who lack any formal coverage are covered by the MoPH, which serves as an “insurer of\nlast resort.” This means a strong role for the ministry, not only in preventive care, public health\nleadership, and regulation, but also in curative care. To provide hospital coverage to about 250,000\ncases per year, the MoPH contracts 26 public and 105 private hospitals. Individual patient copayment to\nthe hospital constitutes 5 percent (public hospital) or 15 percent (private hospital) of the hospitalization\ncosts, and the MoPH directly reimburses the hospital for the 85–95 percent difference.\n\n10. **Despite the considerable resilience of Lebanon’s health system, the health sector indicators**\n**are regressing since the start of the Syrian crisis** . The gains that Lebanon made in meeting the\nMillennium Development Goals (MDGs) before the Syrian crisis are rapidly declining. The latest MoPH\nhospital data show significant setbacks in neonatal and maternal mortality indicators (this excludes\ndeliveries outside the hospitals). As of 2017, the data indicate that the neonatal mortality rate has\nincreased from 3.4 per 10,000 in 2012 to 4.9 per 10,000, with the rate among displaced Syrians (7 per\n10,000) almost double that among Lebanese (3.7 per 10,000). Similarly, the maternal mortality ratio\nincreased from 12.7 per 100,000 in 2012 to 21.3 per 100,000, with the rate among displaced Syrians\n(30.4 per 100,000) double that among Lebanese (15.8 per 100,000). [5]\n\n11. **Lebanon also faces epidemiological risks, the reemergence of some diseases that had been**\n**controlled before the Syrian crisis, and a growing need for mental health services.** Despite intensive\nvaccination campaigns, outbreaks of measles, mumps, and waterborne diarrheas are increasing, mainly\nin areas with high concentrations of refugees. While the vulnerable population in Lebanon shares a\ncommon disease burden, especially from chronic illnesses, the disease burden among displaced Syrians\nis largely concentrated around maternal and child health, communicable diseases, and mental health.\nThe majority of displaced Syrians visit providers for infections and communicable diseases (40 percent). [6]\nThere is also a significant demand for antenatal care. According to an assessment conducted in 2015, 20\npercent of displaced Syrian households have either a pregnant or a lactating woman, compared to 6.5\npercent among Palestinian refugees from Syria. [7] There is also a growing need for specialized mental\nhealth services for both Lebanese and displaced Syrians. A research study conducted in 2016 reported a\nclear increase in mental health disorders among the displaced Syrian youth and adult population. [8]\nPrevalence rates of depression were found to be 16.8 percent among displaced Syrians and 13.3 percent\namong Lebanese. Similarly, prevalence rates for anxiety were found to be 56 percent among displaced\nSyrians and 50.7 percent among Lebanese.\n\n12. **Since the onset of the crisis, the MoPH has used an integrated approach to service delivery by**\n**embedding displaced Syrians’ health care in the national health system.** This integration of public\nservice is a result of displaced Syrians settling in Lebanese communities rather than in camps. Like\nLebanese, displaced Syrians access PHC services through the MoPH network of 204 primary health care\ncenters (PHCCs), 220 MoSA Social Development Centers (SDCs), and an estimated 700 dispensaries\naround the country. Currently, displaced Syrians receive subsidized services at around 100 health\nfacilities, including MoPH-PHCCs, MoSA-SDCs, and other health outlets, supported by international\n\n\n5\nMinistry of Public Health; Presentation, Biostatistics Department, March 2017.\n6 LCRP 2015-2016.\n7 LCRP 2015-2016; WFP, UNICEF, and UNHCR, Vulnerability Assessment of Syrian Refugees in Lebanon, 2015.\n8 Lebanon: Mental health system reform and the Syrian crisis. Elie Karam et al. _BJPSYCH International_ 13 (4). November 2016.\n\n\nPage 12 of 54\n\n\n", + "datasets": [ + { + "dataset_name": { + "text": "Lebanon Health Resilience Project", + "confidence": 0.5820198655128479, + "start": 7, + "end": 11 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.997433602809906, + "start": 7, + "end": 8 + }, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "Lebanese population", + "confidence": 0.6760649085044861, + "start": 23, + "end": 25 + }, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "MoPH\nhospital data", + "confidence": 0.9885504841804504, + "start": 205, + "end": 208 + }, + "dataset_tag": "descriptive", + "description": { + "text": "neonatal and maternal mortality indicators", + "confidence": 0.773749589920044, + "start": 212, + "end": 217 + }, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.9908995628356934, + "start": 155, + "end": 156 + }, + "publication_year": { + "text": "2017", + "confidence": 0.8876957893371582, + "start": 228, + "end": 229 + }, + "reference_year": { + "text": "2012", + "confidence": 0.608190655708313, + "start": 249, + "end": 250 + }, + "reference_population": { + "text": "displaced Syrians", + "confidence": 0.9227102398872375, + "start": 263, + "end": 265 + }, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "assessment", + "confidence": 0.9623066782951355, + "start": 482, + "end": 483 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.7855433821678162, + "start": 349, + "end": 350 + }, + "publication_year": null, + "reference_year": { + "text": "2015", + "confidence": 0.9468124508857727, + "start": 485, + "end": 486 + }, + "reference_population": { + "text": "displaced Syrians", + "confidence": 0.5362070202827454, + "start": 317, + "end": 319 + }, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "research study", + "confidence": 0.9444150328636169, + "start": 536, + "end": 538 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": { + "text": "2016", + "confidence": 0.9821220636367798, + "start": 540, + "end": 541 + }, + "reference_population": { + "text": "displaced Syrians", + "confidence": 0.6927632093429565, + "start": 452, + "end": 454 + }, + "is_used": "False", + "usage_context": "supporting" + }, + { + "dataset_name": { + "text": "national health system", + "confidence": 0.8785515427589417, + "start": 641, + "end": 644 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.9347025752067566, + "start": 768, + "end": 769 + }, + "publication_year": { + "text": "2015", + "confidence": 0.6506083011627197, + "start": 770, + "end": 771 + }, + "reference_year": { + "text": "2015-2016", + "confidence": 0.8630054593086243, + "start": 749, + "end": 750 + }, + "reference_population": { + "text": "displaced Syrians", + "confidence": 0.9909583330154419, + "start": 634, + "end": 636 + }, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "LCRP", + "confidence": 0.6678034663200378, + "start": 748, + "end": 749 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.9654102325439453, + "start": 768, + "end": 769 + }, + "publication_year": { + "text": "2016", + "confidence": 0.6334779262542725, + "start": 797, + "end": 798 + }, + "reference_year": { + "text": "2015-2016", + "confidence": 0.9533671736717224, + "start": 749, + "end": 750 + }, + "reference_population": { + "text": "displaced Syrians", + "confidence": 0.885916531085968, + "start": 634, + "end": 636 + }, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "LCRP", + "confidence": 0.6764049530029297, + "start": 752, + "end": 753 + }, + "dataset_tag": "named", + "description": null, + "data_type": null, + "acronym": null, + "author": { + "text": "WFP, UNICEF, and UNHCR", + "confidence": 0.6738381385803223, + "start": 755, + "end": 761 + }, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.998847484588623, + "start": 768, + "end": 769 + }, + "publication_year": { + "text": "2015", + "confidence": 0.6645801067352295, + "start": 770, + "end": 771 + }, + "reference_year": { + "text": "2015-2016", + "confidence": 0.9960299134254456, + "start": 753, + "end": 754 + }, + "reference_population": { + "text": "Syrian Refugees", + "confidence": 0.9672995209693909, + "start": 765, + "end": 767 + }, + "is_used": "False", + "usage_context": "background" + } + ], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 14 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\npartners subsidizing around 85 percent of PHC consultations and laboratory fees. Partners also provide\nsimilarly subsidized services to a limited number of vulnerable Lebanese as a way of addressing critical\nneeds and mitigating potential sources of social tension. However, service provision and funding by\ninternational partners have become more fragmented as the crisis continues, affecting cost efficiency\nand quality. Currently, UNHCR and other international partners work through international and local\nNGOs to contract PHC centers for the provision of services to displaced Syrians based on fee-for-service\nmechanisms. This modality increases the operating cost by around 25 percent, resulting in less value for\nmoney. UNHCR has held discussions with the MoPH since 2016 to reduce these costs through a more\ndirect link with PHCCs, avoiding layers and harmonizing PHC services to refugees with the current UHC\nunder the National Poverty Targeting Program (NPTP). In addition, a new modality under development\nthrough MoPH with UNICEF, UNHCR, and WHO – the “THRIVE Lebanon” initiative – will shift\nsubsidization for Syrian Maternal and Child Health (MCH) services to a direct contracting and\nprepayment model. Since MCH services account for at least half of all preventive and curative healthseeking among Syrians, this model is expected to reduce service costs substantially, while supporting\nretention and quality.\n\n13. **To meet the increased demand and strengthen primary care services, the MoPH launched the**\n**Emergency Primary Health Care Restoration Project (EPHRP) in 2015.** This project is the building block\nof the MoPH’s long-term strategy for UHC, which aims to ”provide a specified package of benefits to all\nmembers of a society with the end goal of providing financial risk protection, improving access to health\nservices and health outcomes.” [9] Financed from the Lebanon Syria Multi-Donor Trust Fund, the project\naims to strengthen and improve access to PHC services, especially for the low-income host communities\ncrowded out by the increased demand for PHC services from refugees. The project strengthens the\ncapacity of 75 MoPH network centers, expands the package of services provided, and subsidizes the cost\nof care to 150,000 poor Lebanese enrolled in the NPTP (see Box 2). However, strengthening the capacity\nof the network clinics also extends benefits to low-income non-subsidized Lebanese and displaced\nSyrians covered by the international community. The latest MoPH data show that improving the\ncapacity of the network centers through the EPHRP is having a positive impact on access to services for\nhost communities and displaced Syrians alike. While before the project access to PHC services was\nrelatively low, especially for host communities in areas with high concentration of displaced Syrians, it\nincreased steadily after the start of the project for both poor Lebanese (28 percent) and displaced\nSyrians (47 percent). [10] The project demonstrates that strengthening the integrated PHC model benefits\nboth communities.\n\n\n9 WHO, SDGs, 2016.\n10 Ministry of Public Health data, 2017.\n\n\nPage 13 of 54\n\n\n", + "datasets": [ + { + "dataset_name": { + "text": "Lebanon Health Resilience Project", + "confidence": 0.5871107578277588, + "start": 7, + "end": 11 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.9479809999465942, + "start": 7, + "end": 8 + }, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "Emergency Primary Health Care Restoration Project", + "confidence": 0.5735102891921997, + "start": 271, + "end": 277 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.7695397138595581, + "start": 190, + "end": 191 + }, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "MoPH data", + "confidence": 0.976718544960022, + "start": 446, + "end": 448 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "supporting" + }, + { + "dataset_name": { + "text": "EPHRP", + "confidence": 0.6811715364456177, + "start": 459, + "end": 460 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": { + "text": "2017", + "confidence": 0.8765357136726379, + "start": 557, + "end": 558 + }, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "Ministry of Public Health data", + "confidence": 0.579524040222168, + "start": 551, + "end": 556 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": { + "text": "2017", + "confidence": 0.7549738883972168, + "start": 557, + "end": 558 + }, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + } + ], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 15 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n**Box 2. Lebanon Emergency Primary Healthcare Restoration Project (EPHRP)**\n**Objective**\nThe objective of the EPHRP is to assist the GoL in reducing the social, economic, and health impacts of the Syrian\ncrisis on poor Lebanese by subsidizing a package of essential health care services.\n**Beneficiaries**\nThis project targets 150,000 of the 340,000 poor Lebanese identified by the NPTP as living below the poverty\nline, using a proxy means testing targeting mechanism.\n**Essential Health Care Package**\nThe project provides beneficiaries with a package of essential health care services comprising the following:\n(i) three age- and gender-specific wellness packages (age 0-18, females 19 years and above, males 19 years and\nabove); (ii) two care packages for the most common non-communicable diseases in Lebanon, diabetes and\nhypertension; and (iii) an antenatal package.\n**Providers**\nServices are provided to beneficiaries through 75 of the 204 MoPH network centers. Network facilities are\nmanaged by NGOs (67 percent), local municipalities (20 percent), MoPH (11 percent), and MoSA (2 percent).\nProvider participation is voluntary and is governed by the legal agreement between the MoPH and the managing\nentity.\n**Quality of Care**\nQuality of care is monitored through the PHCC accreditation program implemented by the MoPH in collaboration\nwith Accreditation Canada International. Currently, all 75 PHCCs are within the accreditation program. The\nquality of clinical care is also monitored by the MoPH through clinical indicators captured in the Health\nInformation System.\n**Contracting and Provider Payment Mechanism**\nThe MoPH purchases the package of services for the beneficiary population from PHCCs. Provider payment is\nbased on capitation and is output-based. The average per capita cost is estimated at US$60, based on the actual\nprices that prevail in the markets for medical goods and services and MoPH rates. Contracts between the MoPH\nand PHCCs define the responsibilities and obligations of each party, the number of NPTP beneficiaries to be\ntargeted, services offered, contract value, clinical and financial reporting requirements, disbursement\nrequirements, and payment mechanisms. The PHCCs are responsible for ensuring that all diagnostic tests are\nreceived according to clinical guidelines set by the MoPH. To set correct incentives for PHCCs, the per capita\npayment is divided into three parts: (i) one part is a contract advance, (ii) the second is based on the use of\nservices by beneficiaries, and (iii) the third is based on user satisfaction, which is monitored through third party\nassessment and internally by the MoPH.\n\n\n14. **While the EPHRP has generated some promising results, it has also highlighted some early**\n**lessons, including the need to expand the scale and scope of primary-level service delivery.**\nConcerning the _scale_, there is an urgent need to support the Government’s plan to expand the ability of\nthe PHC system to meet the growing demand by increasing the capacity and the number of contracted\nnetwork centers from 75 to 204 and the number of beneficiaries from 350,000 to 925,000 for both\ndisplaced Syrians and host communities (see Table 1). The _scope_ of the services also requires expansion\nto take into account the growing needs in the areas of reproductive care (including GBV dimensions),\nmental health, NCDs, and elderly care. Because of the growing social and behavioral challenges affecting\n\n\nPage 14 of 54\n\n\n", + "datasets": [ + { + "dataset_name": { + "text": "NPTP", + "confidence": 0.8889504075050354, + "start": 93, + "end": 94 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.9065471291542053, + "start": 7, + "end": 8 + }, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "poor Lebanese", + "confidence": 0.9737289547920227, + "start": 60, + "end": 62 + }, + "is_used": "False", + "usage_context": "supporting" + }, + { + "dataset_name": { + "text": "Health\nInformation System", + "confidence": 0.9910005927085876, + "start": 312, + "end": 315 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": { + "text": "clinical indicators", + "confidence": 0.542912483215332, + "start": 307, + "end": 309 + }, + "acronym": null, + "author": { + "text": "MoPH", + "confidence": 0.5448567271232605, + "start": 383, + "end": 384 + }, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "supporting" + }, + { + "dataset_name": { + "text": "EPHRP", + "confidence": 0.6795127391815186, + "start": 517, + "end": 518 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": { + "text": "MoPH", + "confidence": 0.8214524388313293, + "start": 509, + "end": 510 + }, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "PHC system", + "confidence": 0.6562965512275696, + "start": 574, + "end": 576 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + } + ], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 16 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\nthe Lebanese and displaced Syrian populations, it is critical to expand the activities of community\noutreach to reach the vulnerable and to generate demand for service. There is also a need to strengthen\nthe MoPH accreditation program to ensure the quality of health services and strengthen facilities’\ncapacity to meet the accreditation standards. Improving the efficiency and workflow within the PHC\nnetwork will improve not only the quality of services provided, but also the value for money, which is\ncrucial in achieving the desired health outcomes for both host and displaced communities.\n\n15. **Like PHC services, hospital care for displaced Syrians is integrated in the national hospital**\n**system.** Coverage for hospital care for displaced Syrians is provided mainly by UNHCR through 52\ncontracted public and private hospitals across the country. [11] UNHCR budgetary constraints limit\ncoverage to obstetric and life-threatening conditions, and it reimburses up to 75 percent of\nhospitalization fees for these services. In 2016, UNHCR covered hospitalization fees for 73,000\nadmissions for displaced Syrians, 15,405 of which were in public hospitals. Deliveries account for around\nhalf of these hospital admissions. [12] In 2016, the tertiary care unit of Hariri University Public Hospital\nadmitted 5,210 displaced Syrians (52 percent of total admissions) and intensive care unit (ICU) admitted\n206, representing 55 percent of total ICU admissions. [13] MoPH sources indicate that the increase in\ndemand for hospitalization, especially for emergency and ICU care, is resulting in significant resource\nshortages in public hospitals.\n\n16. **Despite the support from donors through the UNHCR, coverage for hospital care for displaced**\n**Syrians does not meet the growing demand** . UNHCR’s limited admission criteria leave a significant\nnumber of patients and conditions not covered. The fact that the hospitalization rate among displaced\nSyrians (6 percent) is half that of Lebanese (12 percent) [14] raises concerns about unmet needs. The MoPH\nauthorized the treatment of around 4,000 displaced Syrians [15] with conditions not subsidized by UNHCR,\nincluding dialysis, treatment for cancer, catastrophic illnesses, and acute cases. This resulted in accrued\nfees of US$15 million to public hospitals. However, efforts by the MoPH, international agencies, and\nNGOs to fill the coverage gap remain inadequate. Thus, there is a pressing need to support and sustain\nthe Government’s efforts to provide hospital care for displaced Syrians, especially for those with serious\nchronic conditions.\n\n17. **The refugee situation has also exacerbated the challenges the hospital sector was facing**\n**before the Syrian crisis.** Although the GoL covers hospital care for all uninsured nationals (around 1.6\nmillion), the ceiling and the tariffs at which the Government reimburses hospitals are historically low.\nBefore the crisis (2002-2011), the MoPH had a sizable budget deficit, delaying some US$80 million in\npayments to contracted hospitals. [16] This problem has worsened considerably with the increased\ndemand generated by the refugee crisis, affecting access by uninsured Lebanese. Between 2011 and\n2013, the proportion of Lebanese patients admitted to public hospitals decreased from 89 percent to 71\npercent. Results from an analysis of unmet needs over the last five years [17] indicate that approximately\n\n\n11 LCRP 2017-2020.\n12 UNHCR data, 2016.\n13 Hariri University Hospital data, 2017.\n14 LCRP 2017-2020.\n15 MoPH data, 2012-2015.\n16 Interview with Syndicate of Private Hospitals, Lebanon. March 2017.\n17 The analysis is based on a model that examined the change in patient proportions under the assumption that any change in\npatient proportions from one nationality comes at the expense of patients from another nationality.\n\n\nPage 15 of 54\n\n\n", + "datasets": [ + { + "dataset_name": { + "text": "Lebanon Health Resilience Project", + "confidence": 0.606623113155365, + "start": 7, + "end": 11 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.8397452235221863, + "start": 7, + "end": 8 + }, + "publication_year": null, + "reference_year": { + "text": "2016", + "confidence": 0.5692903399467468, + "start": 192, + "end": 193 + }, + "reference_population": { + "text": "displaced Syrians", + "confidence": 0.6225809454917908, + "start": 124, + "end": 126 + }, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "hospitalization rate", + "confidence": 0.5767245888710022, + "start": 358, + "end": 360 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "displaced\nSyrians", + "confidence": 0.956547200679779, + "start": 361, + "end": 363 + }, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "analysis of unmet needs", + "confidence": 0.6115782856941223, + "start": 624, + "end": 628 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": { + "text": "UNHCR", + "confidence": 0.9312484860420227, + "start": 644, + "end": 645 + }, + "producer": null, + "geography": null, + "publication_year": { + "text": "2016", + "confidence": 0.9953542947769165, + "start": 647, + "end": 648 + }, + "reference_year": { + "text": "2017-2020", + "confidence": 0.9831892251968384, + "start": 641, + "end": 642 + }, + "reference_population": { + "text": "Lebanese patients", + "confidence": 0.8898872137069702, + "start": 607, + "end": 609 + }, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "LCRP 2017-2020.\n12 UNHCR data", + "confidence": 0.7102563977241516, + "start": 640, + "end": 646 + }, + "dataset_tag": "named", + "description": { + "text": "analysis of unmet needs", + "confidence": 0.7824313044548035, + "start": 624, + "end": 628 + }, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.9937305450439453, + "start": 675, + "end": 676 + }, + "publication_year": { + "text": "2016", + "confidence": 0.8538876175880432, + "start": 647, + "end": 648 + }, + "reference_year": { + "text": "2017-2020", + "confidence": 0.8760613203048706, + "start": 641, + "end": 642 + }, + "reference_population": { + "text": "Lebanese patients", + "confidence": 0.9380776882171631, + "start": 607, + "end": 609 + }, + "is_used": "False", + "usage_context": "supporting" + }, + { + "dataset_name": { + "text": "Hariri University Hospital data", + "confidence": 0.6615012884140015, + "start": 650, + "end": 654 + }, + "dataset_tag": "named", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.771639347076416, + "start": 675, + "end": 676 + }, + "publication_year": { + "text": "2017", + "confidence": 0.6977903246879578, + "start": 655, + "end": 656 + }, + "reference_year": { + "text": "2017-2020", + "confidence": 0.6589086055755615, + "start": 641, + "end": 642 + }, + "reference_population": { + "text": "Lebanese patients", + "confidence": 0.7423956990242004, + "start": 607, + "end": 609 + }, + "is_used": "False", + "usage_context": "supporting" + }, + { + "dataset_name": { + "text": "MoPH data", + "confidence": 0.5399609208106995, + "start": 662, + "end": 664 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.7790727615356445, + "start": 675, + "end": 676 + }, + "publication_year": { + "text": "2017", + "confidence": 0.6082442402839661, + "start": 678, + "end": 679 + }, + "reference_year": { + "text": "2017-2020", + "confidence": 0.621984601020813, + "start": 641, + "end": 642 + }, + "reference_population": { + "text": "Lebanese patients", + "confidence": 0.7011510133743286, + "start": 607, + "end": 609 + }, + "is_used": "False", + "usage_context": "supporting" + } + ], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 17 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n15,847 Lebanese patients were not able to access public hospitals because of increased pressure from\nthe Syrian crisis.\n\n18. **The accumulated deficits among public hospitals resulted in inadequate investments in**\n**upgrades, large maintenance backlogs, deterioration in quality of equipment, and costly repairs.** Over\ntime unpaid bills had a significant impact on the hospitals’ cash flow, keeping public hospitals from\nexpanding their technical capacity and maximizing efficiency even as demand was growing. Many public\nhospitals suffer from obsolete or non-functional equipment and lack of human and technical resources\nin specific departments with high demand, such as emergency and ICUs. Since the high demand for\nhospital care is likely to continue for the next several years, immediate investment in upgrading public\nhospitals, to support the resilience of the health sector and maintain the operation of its institutions, is\nessential.\n\n\n19. **Accordingly, there is a critical need to focus on strengthening the capacity and resilience of**\n**both primary and hospital-level institutions.** This requires expanding the package and quality of\nservices provided to vulnerable populations at the PHC level, and strengthening the physical, technical,\nand organizational capacity at the hospital level to address the budget limitations hampering the\nprovision of care. Given the integrated service delivery model under which both Lebanese and displaced\nSyrians access services in the same facilities, such efforts are expected to benefit both populations in\nLebanon.\n\n\n**C. Higher-level Objectives to which the Project Contributes**\n\n\n20. **The proposed project is** **aligned with** **the priority of the Lebanon Country Partnership**\n**Framework** to mitigate the immediate and long-term impacts of the Syrian crisis, and specifically with its\nobjective to ensure improved delivery of health services. It is also directly aligned with the World Bank\nGroup’s twin goals of ending extreme poverty and promoting shared prosperity in a sustainable manner,\nand with the Health, Nutrition and Population strategy, which aims to ensure UHC and equitable\nfinancial protection.\n\n21. **The proposed project is aligned with the World Bank Group’s MENA** **strategy** . It will support\nthe pillar on renewing the social contract by providing access to health care to Lebanese and displaced\nSyrians. It will also assist with resilience to shocks by expanding the package of services available to\naddress the needs of host communities and displaced population and by providing technical support to\ncreate a more efficient health system for all. In addition, the MENA strategy calls for a “strategic shift” in\nengagement and identifies the need to leverage partnerships with other regional development\ninstitutions.\n\n22. **The project is also aligned with Lebanon’s Health Strategy, and with the WB’s MENA health**\n**sector strategy (2013-2018).** The project will support the MoPH strategy for achieving UHC and longterm institutional development. It will also support creating fair and accountable health systems\nthrough: (i) ensuring a health benefits package for the poor; (ii) reducing regional income and gender\ndiscrepancies in access to health care; (iii) incentivizing primary care; (iv) addressing the financing and\ncapacity constraints of the public hospital sector; and (v) addressing the rising burden of NCDs, GBV,\nmental health, and reemerging communicable diseases in Lebanon.\n\n\nPage 16 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 18 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n23. **The Islamic Development Bank (IsDB) will provide parallel financing to strengthen the physical**\n**capacity of public hospitals.** Under this arrangement, IsDB will provide parallel financing (US$30 million)\nto fund the replacement and upgrading of priority equipment in public hospitals: diagnostic equipment\n(including medical imaging machines); treatment machines (such as medical ventilators, incubators\nheart-lung machines); medical monitors (including electrocardiograms, electroencephalograms, and\nothers); therapeutic equipment (such as continuous passive motion machines); and electro-mechanical\nequipment (such as generators). IsDB’s support will give priority to public hospitals located in areas with\nthe highest concentration of displaced Syrians and vulnerable populations, hospitals with the greatest\ndemand for services, and hospitals with the greatest need for critical equipment.\n\n\n**II.** **PROJECT DEVELOPMENT OBJECTIVES**\n\n\n**A. PDO**\n\n\n24. The project development objective (PDO) is to increase access to quality health care services to\npoor Lebanese and displaced Syrians in Lebanon.\n\n**B. Project Beneficiaries**\n\n\n25. **Beneficiaries of this project will be:**\n(i) **Poor Lebanese and displaced Syrians.** These vulnerable populations will benefit from\nimproved health services and a more comprehensive package of PHC services that\naddresses their health needs.\n(ii) **Primary Health Care Centers.** The project will benefit MoPH network by upgrading the\ncapacity of the PHCCs and the skills of health workers and managers to effectively manage\nthe increased demand for health care while delivering quality care during and after the\ncrisis.\n(iii) **Public hospitals.** The project will benefit public hospitals by upgrading and refurbishing their\nequipment, training their staff, and improving the cash flow to enhance the quality and\nefficiency of their operation.\n(iv) **The** **MoPH.** The project will contribute to maintaining the MoPH’s commitment to deliver\nservices to vulnerable populations and will build central-level capacity for planning and\nproject management.\n\n**C. PDO-level Results Indicators**\n\n\n26. Progress toward the PDO will be monitored through the following key indicators:\n\n\n1. Number of primary care beneficiaries (Lebanese and displaced Syrians)\n2. Percent of total beneficiaries who are female\n3. Percent of pregnant women receiving at least four antenatal care visits\n4. Number of public hospital admissions above the MoPH contracted ceiling\n5. Number of health facilities accredited\n\n\nPage 17 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 19 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n6. Percent of children fully vaccinated under the age of two according to national\n\nimmunization policy\n\n\n**III.** **PROJECT DESCRIPTION**\n\n\n**A. Project Components**\n\n\n27. **Component 1: Scaling up the scope and capacity of the PHC UHC program (US$76.5 million).**\nThis component builds on and scales up the ongoing EPHRP which provides subsidized package of PHC\nservices to poor Lebanese through capitation payment mechanisms. This project aims to expand and\nstrengthen the ongoing UHC program to reach a larger number of beneficiaries with a more\ncomprehensive package of enrollment-based preventive health services to meet the growing needs of\npoor and vulnerable [18] Lebanese. The displaced Syrians will benefit from the increased network of\nparticipating primary healthcare facilities as well as the expanded package of health services to be\nprovided by the increased network. It is expected that the number of displaced Syrians that will access\nthe centers and the scaled up package of services under various subsidy mechanisms will increase from\n130,000 to 375,000 (Table 1). More specifically, this component will:\n\n\n - Scale up the provision of capitation payments to participating PHCCs for delivery of outputbased packages of essential health services to vulnerable Lebanese, as elaborated in the\nrespective Health Service Provider Agreements. This will increase the number of Lebanese\nreceiving subsidized PHC services from 150,000 to 340,000 and the number of contracted\nnetwork PHCCs from 75 to 204 (Table 1).\n\n - Strengthen the capacities of participating PHCCs for provision of quality healthcare services,\nthrough: (i) expanding the scope of said output-based packages of essential health services to\ninclude, inter alia, core preventive and curative healthcare services in areas such as reproductive\nhealth, non-communicable disease case management, healthcare for the elderly, general\nwellness, mental health and provision of medication to patients (Table 2); (ii) improving the\ntechnical, managerial and physical capacities of participating PHCCs for delivery of said outputbased packages of essential health services; (iii) supporting communications and outreach to\ntargeted communities to facilitate enrolment and/or access to said output-based packages of\nessential health services; and (iv) strengthening the accreditation program to, inter alia, include\nall participating PHCCs.\n\n\n18 Vulnerable Lebanese means Lebanese nationals who have met the eligibility criteria set out in the Project Operations Manual\n(POM) and are the beneficiaries of Packages of Essential Health Services under Part 1.1 of the project.\n\n\nPage 18 of 54\n\n\n", + "datasets": [ + { + "dataset_name": { + "text": "Lebanon Health Resilience Project", + "confidence": 0.5773030519485474, + "start": 7, + "end": 11 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.8859201669692993, + "start": 7, + "end": 8 + }, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "UHC program", + "confidence": 0.5623133778572083, + "start": 67, + "end": 69 + }, + "dataset_tag": "non-dataset", + "description": { + "text": "subsidized package of PHC\nservices", + "confidence": 0.5029007196426392, + "start": 92, + "end": 97 + }, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.5677002668380737, + "start": 7, + "end": 8 + }, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "displaced Syrians", + "confidence": 0.7967491745948792, + "start": 148, + "end": 150 + }, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "outputbased packages of essential health services", + "confidence": 0.5769004225730896, + "start": 239, + "end": 245 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "displaced Syrians", + "confidence": 0.7164927124977112, + "start": 185, + "end": 187 + }, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "output-based packages of essential health services", + "confidence": 0.9403770565986633, + "start": 318, + "end": 324 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "supporting" + }, + { + "dataset_name": { + "text": "Project Operations Manual", + "confidence": 0.7232891917228699, + "start": 454, + "end": 457 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "Vulnerable Lebanese means Lebanese nationals", + "confidence": 0.6811845302581787, + "start": 439, + "end": 444 + }, + "is_used": "False", + "usage_context": "background" + } + ], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 20 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n**Table 1. Targeted Project Beneficiaries**\n\n\n\n_**NUMBER**_\n\n_**OF**_\n_**PHCCS**_\n\n\n\n_**SUBSIDIZED**_\n\n_**LEBANESE**_\n\n_**using**_\n_**PHCCS**_\n\n\n\n_**DISPLACED**_\n\n_**SYRIANS**_\n\n_**using**_\n_**PHCCS**_\n\n\n\n_**TOTAL beneficiaries**_\n\n\n\n\n\n\n\nTargeted\n\nthrough\n\nproject\n\n\n\n204 340,000 375,000 715,000\n\n\n**Table 2. Description of the Essential Package of Services**\n\n\n\n_**Package**_ _**Description**_\n\n\n\n\n\n|Wellness
package|0-18 years:
 Immunization, doctor consultations, screening for malnutrition and abuse, general health
counseling (oral health, sexual health, abuse)
19+ years females:
 Immunization, doctor consultations, routine lab tests, mammography, screening for NCDs,
counseling on health topics (sexual health, lifestyle, abuse)
19+ years males:
 Immunization, doctor consultations, routine lab tests, screening for NCDs, counseling on
health topics (sexual health, lifestyle, abuse)|\n|---|---|\n|_Reproductive_
_health (including_
_GBV)_| Family planning visits, modern contraception methods, counseling on sexual and
reproductive health, family planning, and GBV for women and men
**Pregnant women:**
 Additional visits, antenatal care, counseling on health topics, flu and Tetanus-Diphtheria (Td)
vaccines|\n|_NCD package_| Case management of diabetes (yearly EKG, lab tests, foot exam, medications)
 Case management of hypertension (yearly EKG, lab tests, counseling, medications)
 Case management of coronary artery disease (yearly EKG, echo cardio, lab tests, counseling,
medications)|\n|_Elderly package_| Additional center and home visit, ultrasound for abdominal aortic aneurysm, mini mental
test, activities of daily living and gait and balance assessment
 Medication management, counseling (fall prevention, social and elder abuse)|\n|_Mental health_
_package_| Screening for mental health disorders, case management of depression, psychosis,
developmental disorder, and alcohol / substance abuse
 Consultations with psychiatrists, psychologists, general practitioners, and social workers; lab
tests and medication treatment|\n\n\nPage 19 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 21 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n28. **Component 2: Provision of health care services in public hospitals (US$36.4 million).** This\ncomponent will finance:\n\n\n - Provision of special capitation payments to participating public hospitals for delivery of medical\nand paramedical services to uninsured Lebanese and delivery of emergency healthcare services\nto eligible beneficiaries, as elaborated in the respective Health Service Provider Agreements.\n\n - Strengthening of the technical and organizational capacities of participating public hospitals for\nprovision of quality healthcare services, through: (a) provision of training to clinical and nonclinical staff; and (b) strengthening the health information management system targeting\nparticipating public hospitals, participating PHCCs and the MoPH.\n\n29. The project will allow the MoPH to respond to the increased demand at public hospitals by\nauthorizing admissions of uninsured Lebanese and will alleviate the financial burden of non-covered\nemergency cases based on post-review by the MoPH. [19] Currently, MoPH contracts with hospitals are\nbased on pre-set rates for surgical and fee-for-service payments for non-surgical cases, covering medical\n(cost of medical services) and paramedical services (room and board). [20]\n\n30. In this project, payment authorization for hospital admissions will be based on two levels: (i)\ncontracted third party agency (TPA) which verifies eligibility of all admissions based on the ministry’s\ncriteria and international guidelines, and conducts prior verification of invoices; and (ii) medical auditors\nwho would review a sample of admissions based on criteria set for 40 high-cost, high-volume, and/or\nmisuse- and abuse-prone conditions. [21] At the request of the World Bank, an additional technical audit\nmay be conducted to review expenses covered by Bank financing (refer to Financial Management\nsection). The MoPH admission criteria will be further elaborated as part of the Project Operations\nManual (POM) that will be adopted by the borrower no later than four months after loan effectiveness.\n\n\n31. **Component 3: Strengthening project management and monitoring (US$6.8 million).** This\ncomponent will finance:\n\n\n - Strengthening the capacities of the MoPH and Project Management Unit for implementation,\ncoordination and management of activities under the project (including, inter alia, procurement,\nfinancial management, technical and financial audits, environmental and social safeguards,\ngrievance redress mechanisms, monitoring and evaluation, health information management,\nsupervision and reporting aspects), all through the provision of consulting services, nonconsulting services, training and workshops, operating costs, and acquisition of goods for the\npurpose.\n\n - Carrying out of a comprehensive assessment of hospitals focusing on accuracy of hospital case\nmix, use of hospitalization data in medical auditing, development of performance indicators\nincorporating actual patient outcomes, resource allocation decisions, and\ninstitutional/organization structures, so as to identify gaps and make recommendations for\nimprovement. Results of the assessments will inform the MoPH in refining their hospital\n\n\n19 On average, hospitalization costs US$1,000. This component could finance additional admissions to approximately 33,000\npatients.\n20 Salaries are not covered by the contract.\n21 National Institute for Healthcare Excellence (NICE), U.K.\n\n\nPage 20 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 22 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\ncontracting reforms to ensure more efficient reimbursement system. Implementation of revised\ncontracting measures is contingent on legislative approvals by the government.\n\n - Carrying out of an independent evaluation of project activities and results. An independent\nproject evaluation will be conducted to assess the achievements of the project on household\nservice utilization and the capacity of providers to deliver services effectively and costefficiently.\n\n\n**B. Project Cost and Financing**\n\n\n32. **The total project cost is US$120 million, and the financing instrument is Investment Project**\n**Financing.** The financing will be provided by IBRD in the amount of US$120 million, including a\nconcessional part of the loan to be financed by the GCFF (see Box 3). The financing will be supported by\nan IBRD loan in the amount of US$95.80 million, and the GCFF will extend US$24.20 million on\nconcessional terms approved by the GCFF Steering Committee on April 20, 2017. The concessional\nportion of the loan shall be made on a grant basis.\n\n33. **The Islamic Development Bank (IsDB) will provide parallel financing in the amount of US$30**\n**million, which will also include a concessional part of the loan to be financed by the GCFF.**\n\n\n**Box 3. Global Concessional Financing Facility**\n\n\nThe Global Concessional Financing Facility (GCFF) is a partnership sponsored by the World Bank, the UN, and the\nIslamic Development Bank Group to mobilize the international community to address the financing needs of\nmiddle-income countries hosting large numbers of refugees. By combining donor contributions with multilateral\ndevelopment bank loans, the GCFF enables eligible middle-income countries that are facing refugee crises to\nborrow at concessional rates for providing a global public good. The GCFF represents a coordinated response by\nthe international community to the Syrian crisis, bridging the gap between humanitarian and development\nassistance and enhancing the coordination between the UN, supporting countries, multilateral development\nbanks, and benefitting (hosting) countries. The GCFF is currently supported by Canada, Denmark, the European\nCommission, Germany, Japan, Netherlands, Norway, Sweden, the United Kingdom, and the United States.\n\n\n**Project components** **IBRD financing (US$)**\n\n\nComponent 1 76,500,000\nComponent 2 36,400,000\nComponent 3 6,860,000\n\n\n**Total costs**\nTotal project costs 119,760,000\nFront-end Fee 240,000\n\n\n**Total financing though IBRD** **120,000,000**\n\n**IsDB parallel financing** **30,000,000**\n\n\nPage 21 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 23 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n**C. Lessons Learned and Reflected in the Project Design**\n\n\n34. **In emergency situations, temporary support to meet essential health needs through**\n**integrated, pro-poor interventions can mitigate the potential for social instability.** Experience in\nLebanon has demonstrated that strengthening integrated, pro-poor PHC interventions can benefit both\nrefugee and host populations. Increased access for both populations decreases the possibility that one\ngroup accumulates grievances against another, reducing problems with social cohesion. In addition,\naccess to quality care increases trust in the government, creating a stronger social contract that can also\nimprove government accountability and citizen engagement.\n\n35. **Building on existing initiatives and delivery mechanisms can facilitate quick preparation and**\n**implementation.** Reliance on existing programs, structures, and tested implementation approaches can\nhelp facilitate rapid and effective disbursement and response to a crisis. Evaluation of the WB’s\nexperience in responding to the global financial crisis indicates that, in the interest of providing timely\nassistance, 74 percent of responses were channeled through existing programs. This operation builds on\nthe interventions supported under the ongoing EPHRP, and relies on the MoPH and existing national\nsystems and structures for implementation.\n\n36. **Lessons from past projects provide useful guidance for the technical design of new projects.**\nKey lessons from the ongoing EPHRP have been taken into account in the technical design of the\nproposed project: (i) the need to invest more in outreach and communication activities to stimulate\ndemand for health services; (ii) the need to expand the package of services to make it more\ncomprehensive and responsive to the health needs of vulnerable populations affected by conflict; and\n(iii) the need to also invest in the hospital sector to improve the overall cohesion of services provided as\nwell as the functionality and efficiency of hospital management and operations. The ongoing project,\nwith a significantly smaller size and shorter timeframe, did not invest in the hospital sector.\n\n37. **Effective implementation requires intensive and sustained WB support** _**.**_ Experience from rapid\nresponses undertaken in the context of the global financial crisis emphasizes the importance of\nsustained implementation support from the WB. The ongoing health project, as well as similar\noperations in the Democratic Republic of Congo, Ethiopia, and Jordan, needed careful implementation\nsupport to introduce project modifications and to resolve unanticipated issues. In Lebanon, the WB’s\nexisting working relationship with the MoPH is expected to permit the necessary intensive and sustained\ntechnical and fiduciary implementation support. In addition, the WB expects to provide intensive and\nfrequent implementation support throughout the project, drawing on multi-sectoral staff based in\nWashington and the Lebanon Country Office.\n\n38. **The inherent flexibility of OP 10.00 helped expedite project preparation and the WB’s overall**\n**ability to respond to a situation of urgent need.** This operation was prepared under condensed\nprocedures according to OP 10.00, paragraph 12 (Projects in Situations of Urgent Need of Assistance or\nCapacity Constraints). As the WDR 2011 noted, the imperative to respond quickly in fragile situations\nplaces a “particular premium on speed” in an overall attempt to build confidence in the state’s ability to\nrespond to challenging circumstances. The project has made full use of the additional flexibility\npermitted under OP 10.00 provisions and the streamlined processing to enable the WB to pivot\neffectively in responding to GoL’s request for assistance.\n\n\nPage 22 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 24 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n**IV.** **IMPLEMENTATION**\n\n\n**A. Role of Partners**\n\n\n39. **The interventions proposed under this project will complement ongoing support by other**\n**partners at both the PHC and the hospital level to support the refugee and host population in**\n**Lebanon.** Because the project was prepared in close collaboration with international partners—UNHCR,\nUNFPA, UNICEF, WHO, and IsDB—the project design reflects a cohesive and integrative approach to\nstrengthening the health sector, with no duplication of activities between the UN organizations and\nother partners.\n\n40. **IsDB.** As mentioned above, IsDB will finance the cost of procuring essential equipment in a set of\npublic hospitals whose bed utilization rate has increased over the past few years. This will entail scaling\nup and replacing critical equipment which may include diagnostic equipment, treatment machines,\nmedical monitors, therapeutic equipment, and electro-mechanical equipment (such as generators). The\nprioritized list of equipment will be agreed on between IsDB and MoPH. The IsDB will apply the World\nBank Procurement Regulations for the procurement of activities it finances. Impacts related to the safe\ninstallation, use, and maintenance of such equipment and the disposal of any old equipment will be\nassessed and managed in accordance with World Bank safeguards policies which IsDB has committed to\nas part of its engagement under the GCFF.\n\n\n41. The Council for Development and Reconstruction (CDR) will be the implementing agency for\nIsDB funding. The World Bank will have no liability for procurement and safeguards for the IsDB-funded\nproject. The World Bank and IsDB will each supervise their respective projects and will coordinate their\nsupervision. Each party will have clear lines of responsibility with respect to their respective operational\nrequirements, and issues related to the operationalization of this procedure, if any, will be discussed by\nboth parties during implementation. With respect to the IsDB’s application of the WB procurement\nregulations and environmental and social safeguards, as committed to by the IsDB in support of its\nengagement under the GCFF, the IsDB will operate on the basis of terms agreed with the World Bank.\nThese terms reflect the IsDB’s responsibility for all procurement and safeguards decisions related to\nIsDB-financed activities, including with respect to any claims or remedies, while also clarifying the scope\nof any World Bank advisory or other appropriate support.\n\n\n42. **UN organizations** . The THRIVE Lebanon initiative, a joint UN program, will introduce an\nenrollment-based package of preventive and diagnostic MCH services for Syrians, directly contracted\nwith PHCCs across the MoPH network and free at point of uptake. This package is aligned with the child\nand reproductive health packages offered to Lebanese under the UHC, with a defined number of\ncurative visits also covered for pregnant women and children under five years old. UNHCR will continue\nto cover the cost of other non-MCH PHC services and diagnostic procedures for Syrian refugees through\na similar modality. At the secondary and tertiary levels, UNHCR covers 75 percent of all emergency lifesaving care and cost of deliveries for refugees. UNICEF will continue to support the PHC system to\nbenefit both refugee population and Lebanese, including by financing nationwide immunization services,\nvaccination campaigns, life-saving medical supplies and essential drugs, and screening for malnutrition\nand provision of micronutrients. UNFPA will continue to promote and support access to reproductive\n\n\nPage 23 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 25 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\nhealth and GBV services. WHO will continue to support the Government and health authorities at the\ncenter and local levels in strengthening health services, especially disease surveillance and early warning\nsystems, and addressing public health issues.\n\n43. **Other partners.** Other donors and agencies, such as the European Union and some bilateral\nprograms (Belgium, France, Greece, Italy, Spain, Sweden, and Turkey) will finance interventions in health\nthat will be complementary to the interventions proposed under this project. NGOs will continue to\nprovide complementary subsidies for PHC assistance to Syrian refugees and some vulnerable Lebanese\nhouseholds.\n\n**B. Institutional and Implementation Arrangements**\n\n\n44. **The implementation arrangements for the project** are based, in part, on those used under the\nongoing EPHRP. Project management is supported under Component 3 of the proposed project. The\nspecific roles, responsibilities, and staff of the PMU and CDR are reflected in Figure 1.\n\n45. **The oversight for the project will be provided by the MoPH through MoPH Steering**\n**Committee,** which was established under the EPHRP. However, under the proposed project, it would be\nexpanded to include a representative from the MoPH hospital sector and CDR. The new expanded\nSteering Committee will be established no later than one month after project effectiveness. This\ncommittee will continue to coordinate interagency policies and programs to ensure a cohesive approach\nto project implementation and to resolve any strategic and implementation issues that may arise during\nthe project life. The Steering Committee is headed by the MoPH Director General and includes\nrepresentatives from civil society, public hospitals, and academia, as well as the PMU—that is, the PHCC\nCoordinator and the Hospital Coordinator. The Steering Committee would meet quarterly.\n\n46. **The PMU will be responsible for managing the day-to-day implementation of the project.** The\nPMU includes two project coordinators - a PHCC Coordinator and a Hospital Coordinator, a financial and\naccounting manager, and a procurement officer. The PHCC Coordinator is currently responsible for the\nimplementation of the EPHRP and will continue in the same role under the proposed operation.\nSpecifically, the PHCC Coordinator will ensure the implementation of Component 1 and relevant parts of\nComponent 3. The Hospital Coordinator will be a new appointment by the MoPH, to manage the\nimplementation of Component 2.\n\n\nPage 24 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 26 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n**Figure 1. Project Implementation Arrangements**\n\n\n**C. Results Monitoring and Evaluation**\n\n\n47. **The project will be monitored and evaluated on the basis of objectives, indicators, and their**\n**targets set out in the results framework.** The ongoing EPHRP developed a detailed monitoring and\nevaluation (M&E) plan and established a system for routine reporting and follow-up, supported by the\nupgraded health information system (HIS). This project’s M&E will build on the EPHRP M&E system, and\nwill consist of five parts: (i) internal oversight by MoPH of the PHCCs and hospitals, including continuous\nmonitoring of the activities to inform program implementation and day-to-day management decisions;\n(ii) independent project evaluation, including periodic and objective assessments of planned and\nongoing project activities; (iii) beneficiary assessment and grievance redress mechanisms; (iv) external\nmedical auditing will be conducted as post-review, as explained in paragraph 71, to validate appropriate\nfunding of emergency hospital admissions; and (v) project’s final evaluation to assess how the\ninterventions affected the intended outcomes of the project.\n\n\nPage 25 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 27 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n48. **The MoPH, through the PMU’s two coordinators (PHCC and hospital), will be responsible for**\n**monitoring the daily progress of the project,** focusing on improved accessibility of beneficiaries to the\npackage of services, proper procurement, and capacity building of hospitals. The PMU will be\nresponsible for preparing and submitting semiannual progress reports that, among other things, provide\ndetailed reporting on services, procurement, and expenditures. It will also conduct mid-term and postcompletion evaluations to gauge progress toward the PDO and assess the impact of the project on\ntargeted beneficiaries.\n\n49. **The HIS system developed by the MoPH will be further refined and expanded under the**\n**project to all newly enrolled PHCCs to support the implementation and monitoring of the program** .\nData will be collected and used to: (i) supervise the performance of PHCCs; (ii) monitor the progress of\nbeneficiary accessibility; (iii) monitor hospital improvements; and (iv) improve the provision of services\non the basis of intermediate output and outcome data. The data will be verified directly by MoPH\nsupervisory systems and external evaluation, and indirectly through triangulation with other data\nsources such as hospital claims.\n\n50. **Beneficiary feedback and grievance redress mechanisms will also play an important role in**\n**monitoring the project.** The EPHRP made significant progress toward establishing grievance redress\nmechanisms at the central and facility levels. This project will continue to strengthen the system by\nsupporting the MoPH hotline and finalizing the automated Grievance Module to create one platform\nthat integrates registration databases from the different sources to track and manage grievances. This\nwill provide the MoPH with timely access to grievance data to address grievances.\n\n\n51. **The WB will conduct regular implementation support missions** during which implementation\nprogress, outputs, and work plan updates will be assessed, and adjustments made as necessary. On the\nbasis of these missions, regular implementation status and results reports will be prepared.\n\n**D. Sustainability**\n\n\n52. **The project’s sustainability is reinforced through three elements.**\n\n\n(a) **Alignment with GoL priorities and the national health sector strategy.** This alignment will\n\nbe achieved as follows: (i) short-term stabilization by addressing the immediate health\nneeds of poor Lebanese and displaced Syrians through an expanded package of services and\nimproved staff and physical capacities at the PHC and hospital levels; (ii) medium-term\nresilience of the system to ensure sustainability by laying the ground for a more effective\nPHC model focusing on prevention and outpatient case management; and (iii) long-term\nsupport to the MoPH strategy for UHC.\n(b) **Ownership.** The project was conceived, planned, and designed by MoPH, and all levels of\n\nthe ministry have demonstrated steadfast commitment and ownership. MoPH will have an\noverall responsibility for project implementation and oversight.\n(c) **Strengthened MoPH management capacity.** The project supports MoPH management\n\ncapacity in critical areas such as contracting, financial management, M&E, procurement, and\ngrievance redress mechanisms.\n\n\nPage 26 of 54\n\n\n", + "datasets": [ + { + "dataset_name": { + "text": "semiannual progress reports", + "confidence": 0.8185304403305054, + "start": 82, + "end": 85 + }, + "dataset_tag": "descriptive", + "description": { + "text": "reporting on services, procurement, and expenditures", + "confidence": 0.6058255434036255, + "start": 93, + "end": 101 + }, + "data_type": null, + "acronym": null, + "author": { + "text": "MoPH", + "confidence": 0.5952581167221069, + "start": 19, + "end": 20 + }, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.8518858551979065, + "start": 7, + "end": 8 + }, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "supporting" + }, + { + "dataset_name": { + "text": "HIS system", + "confidence": 0.9820720553398132, + "start": 132, + "end": 134 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": { + "text": "system", + "confidence": 0.573293924331665, + "start": 133, + "end": 134 + }, + "acronym": null, + "author": { + "text": "MoPH", + "confidence": 0.8861486315727234, + "start": 19, + "end": 20 + }, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "newly enrolled PHCCs", + "confidence": 0.635554850101471, + "start": 153, + "end": 156 + }, + "is_used": "False", + "usage_context": "supporting" + }, + { + "dataset_name": { + "text": "intermediate output and outcome data", + "confidence": 0.8595134615898132, + "start": 215, + "end": 220 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "PHCCs", + "confidence": 0.7474614381790161, + "start": 155, + "end": 156 + }, + "is_used": "False", + "usage_context": "supporting" + }, + { + "dataset_name": { + "text": "registration databases", + "confidence": 0.761222243309021, + "start": 317, + "end": 319 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "supporting" + }, + { + "dataset_name": { + "text": "PHC model", + "confidence": 0.6812040209770203, + "start": 501, + "end": 503 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + } + ], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 28 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n**V.** **KEY RISKS**\n\n\n**A. Overall Risk Rating and Explanation of Key Risks**\n\n|Systematic Operations Risk-Rating Tool (SORT)|Col2|\n|---|---|\n|**Risk Category**|**Rating**|\n|1. Political and Governance|High|\n|2. Macroeconomic|Moderate|\n|3. Sector Strategies and Policies|Moderate|\n|4. Technical Design of Project or Program|Substantial|\n|5. Institutional Capacity for Implementation and Sustainability|Substantial|\n|6. Fiduciary|Substantial|\n|7. Environment and Social|Moderate|\n|8. Stakeholders|Substantial|\n|**OVERALL**|**Substantial**|\n\n\n\n53. The overall risk rating for the project is substantial. The key risks and mitigation measures are\ndescribed below:\n\n\na) **Political and governance risks** associated with stalemate in the executive and legislative\n\nbranches of the Government are high and may affect the project approval process by the\nCabinet of Ministers or lead to delays in parliamentary approval of the proposed loan. This could\nsignificantly delay project effectiveness. In addition, failure to reach an agreement on a new\nelection law may result in a parliamentary vacuum, as a third extension for the current\nParliament has been ruled out by both the President and the Speaker of Parliament. Changes in\npolitical leadership could also potentially affect commitment to the sustainability of the project.\n_Mitigation:_ This risk affects all WB-financed operations and cannot be fully mitigated. Lebanese\npoliticians at the highest level have expressed to the donor community and the WB their\nreadiness to expedite and facilitate the approval of development loans and grants, especially\nthose linked to the GCFF. The WB has also been engaging with government counterparts to raise\nawareness of the importance of timely implementation and to seek political commitment to\nensure swift loan ratification and approval that are required for effectiveness and the\ncommencement of activities.\n\n\nb) **Technical design** **risks** associated with the contracting process involving NGOs and the inability\n\nto attract and enroll targeted beneficiaries is substantial. There are also risks related to potential\nerrors and fraud in enrollment of beneficiaries. _Mitigation:_ The proposed project builds on the\nexisting interventions and lessons learned from the ongoing health project. Risks related to the\ncontracting process will be mitigated by requiring PHCCs and hospitals to develop a detailed\nproject implementation readiness plan, based on the results of rapid facility assessments that\nfocus on the project’s goals, design, and expected outcomes. The readiness plans will clearly\n\n\nPage 27 of 54\n\n\n", + "datasets": [ + { + "dataset_name": { + "text": "Systematic Operations Risk-Rating Tool", + "confidence": 0.9716084599494934, + "start": 41, + "end": 45 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.8878897428512573, + "start": 7, + "end": 8 + }, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "supporting" + }, + { + "dataset_name": { + "text": "rapid facility assessments", + "confidence": 0.7191709280014038, + "start": 482, + "end": 485 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + } + ], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 29 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\nstate the capacity needs of the PHCCs while the contract will state the targets to be achieved,\nquality measures, and payment terms and modalities. Contracting with PHCCs will rely on the\nexisting draft contracts already used by the MoPH. To mitigate the risk of inability to attract and\nenroll beneficiaries, as well as possible fraud and errors in enrollment of beneficiaries, the\nproject will support: (i) expanding the outreach program; (ii) a timely information campaign at\nthe community level, engaging community volunteers for outreach and demand generation; and\n(iii) utilization of the existing NPTP system and individualized photo identification cards to\nensure that the project reaches the targeted poor, avoids potential enrollment errors, and\nminimizes fraud.\n\nc) **Institutional capacity for implementation and sustainability risks** are substantial and are\n\nassociated with: (i) inadequate capacity at the central and facility levels, especially for managing\nthe additional load of beneficiaries and enhanced requirements for monitoring and supervision;\n(ii) expected delays in implementation due to the time required to start the enrollment process,\nand contracting with PHCCs; and (iii) slow disbursement due to the flow of funds mechanism\nbetween the Ministry of Finance (MOF) and MoPH. _Mitigation:_ Component 3 of the project will\nstrengthen the capacity of the existing PMU. In addition, the MoPH is already undertaking\ntested measures that will be further supported by the project, including: (i) providing a lump\nsum up-front budget to PHCCs as part of their contracts to advance their implementation\nreadiness and provide flexibility to recruit additional health workers and provide training as\nneeded; (ii) completing a facility survey that will help identify needs and gaps among the PHCCs\nand hospitals to allow for targeted capacity strengthening; (iii) preparing and maintaining a\ndisbursement plan that will be based on the overall budget and the procurement plan; and (iv)\nintegrating the interventions supported under the project into existing government structures\nand plans to sustain the project.\n\nd) **Fiduciary risks** are substantial and are associated with: (i) limited dedicated staff to undertake\n\nthe FM activities within MoPH and within the current PMU; (ii) lack of an accounting system\nwithin MoPH to record and produce financial reports according to WB reporting requirements;\n(iii) limited internal control system; and (iv) limited external audit function where the Court of\nAccounts mandate is mainly consumed on ex-ante control. _Mitigation:_ The project will draw on\nand expand the existing fiduciary capacity of the PMU and will expand existing mechanisms—\nthe accounting software with specifications acceptable to the Bank to record expanded daily\ntransactions and produce the periodic financial reports, as well as appropriate FM manuals—\nand will ensure that an independent qualified external auditor to provide oversight is contracted\naccording to terms of reference (TOR) acceptable to the Bank, including a requirement that the\naudit report will be delivered to the Bank no later than six months after the end of each fiscal\nyear. Procurement risks will be addressed through the expansion of procurement capacity in the\nPMU (under Component 3), and the development of a detailed and regularly updated POM that\nwill include a relevant procurement plan and guidelines for procurement planning and\nmanagement for each component.\n\n\ne) **Stakeholder risks** are substantial and are associated with a potential duplication of activities,\n\nbut more importantly, a potential reduction in funding by partner institutions that currently\ncover service provision for displaced Syrians and others at PHC and hospital levels. This includes\n\n\nPage 28 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 30 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\nUN organizations such as UNHCR, which might no longer subsidize service delivery for the\nrefugee population at both levels. _Mitigation:_ Throughout implementation, the project will build\nconsensus and share project achievements among all the stakeholders to ensure ownership of\nthe project and integration with partner activities.\n\n\n**VI.** **APPRAISAL SUMMARY**\n\n\n**A. Economic and Financial Analysis**\n\n\n_**Economic Analysis**_\n\n54. **The proposed project aims to enhance the resilience of the health sector in Lebanon to**\n**provide quality health care services to populations affected by the Syrian crisis.** The project will\ncontribute to Lebanon’s long-term development agenda through the following pathways: improving\nLebanese and displaced Syrians’ survival and reducing mortality related to communicable and noncommunicable diseases; saving unnecessary health care costs and social care costs; increasing the\nproductive labor force; improving health system efficiency; and promoting equity and shared prosperity.\n\n55. **The interventions financed by the project will contribute to improving the health status and**\n**survival of Lebanese and displaced Syrians, and to reducing mortality related to communicable and**\n**non-communicable diseases.** Increased access to the proposed package of services (including screening,\npreventive, and health promotion visits; clinical and diagnostic tests; prenatal and postnatal care visits;\nconsultation visits for the treatment of diabetes and hypertension; and prescription medications) is\nexpected to have a direct impact on the top causes of disability-adjusted life years in the country. [22] As a\nresult, the project will contribute to saving health care costs related to disease treatment by focusing on\ncost-effective preventive and curative measures, and to saving the socioeconomic burden that is related\nto the extra care needed for preventable diseases. Preventing disease and supporting a healthy\npopulation will affect the economy positively in several ways: (i) increased productivity, labor supply,\nand human capital; (ii) increased consumption or production of goods and services that would otherwise\nnot have been consumed or produced; and (iii) increased household earnings.\n\n56. **The project will contribute to improved technical and allocative efficiency in the health service**\n**delivery system.** As institutional capacity is strengthened and the availability and quality of key inputs\nare improved, more facilities will be pushed to the production function frontier, and will therefore\ndeliver better services at a given cost. The project will also contribute to improved allocative efficiency\nat health facilities by shifting funding from hospital-level to PHC facilities. Component 1 in the project\nfocuses on PHC, which is the most cost-effective modality for providing a defined package of highimpact services. Countries with robust primary care systems are associated with improved population\nhealth outcomes for all-cause mortality, all-cause premature mortality, and cause-specific premature\nmortality from major respiratory and cardiovascular diseases. [23] More specifically, primary care has been\n\n22 Institute of Health Metrics and Evaluation (2015), Global Burden of Disease Lebanon. Retrieved from\n_[http://www.healthdata.org/lebanon](http://www.healthdata.org/lebanon)_ . See also Graham et al. (2006) and Jamison et al. (2008), who review low-cost\ninterventions to reduce communicable and non-communicable diseases.\n23 Atun, R. (2004). What are the advantages and disadvantages of restructuring a health care system to be more focused on\nprimary care services? World Health Organization.\n\n\nPage 29 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 31 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\nassociated with reduced infant and maternal mortality [24] and reduced morbidity from NCDs, all of which\nare very relevant to Lebanon. Early screening under primary care for diabetes and hypertension has\nbeen shown to be highly cost-effective. [25] Furthermore, improving hospital capacity through the\nprocurement of needed equipment and training of health personnel will play a disproportionately\ninfluential role in enabling diagnostic and clinical efficiencies. Finally, the project will also support the\nLebanese health system in being more results-focused and getting greater value for money. By building\ncapacity and supporting the M&E system, it will enable decision-makers and managers at all levels to be\nmore efficient in planning and implementing activities.\n\n57. **The project will contribute to promoting equity in access to health care services and reducing**\n**the financial burden on poor households.** The evidence shows that primary care, in contrast to specialty\ncare, is correlated with a more equitable distribution of health services: a finding that holds in both\ncross-national and within-national studies. [26] Studies from various countries demonstrate that a health\ncare system oriented toward specialist care creates inequity in access. However, health systems in lowincome countries with well-established primary care systems tend to be more pro-poor, equitable, and\naccessible. In addition, it is expected that redirecting resources from expensive hospital care to relatively\ninexpensive basic PHC would reduce spending on higher levels of care, as well as the out-of-pocket\npayments poor individuals would incur.\n\n58. **Public sector engagement is justified by the critical role of the MoPH and public health**\n**facilities in providing affordable health care services to poor Lebanese and displaced Syrians.**\nInvestments funded through the project will strengthen health service delivery and improve institutional\ncapacity. Public sector intervention is vital to provide PHCCs with critical inputs so that they can in turn\nprovide essential health care services to communities, along with free essential drugs. Project\ninterventions are also expected to have positive externalities for health system resilience, management\nof epidemiological risk and public health, and important spillovers—all of which advocate for public\nsector intervention.\n\n59. **The value-added of WB support to Lebanon** **is:** (i) the WB’s technical input based on\ninternational experience in strengthening health systems and managing emergencies, and (ii) its\nexperience from the implementation of the EPHRP.\n\n_**Financial analysis**_\n\n60. **Lebanon’s economy is severely affected by the Syrian crisis.** Up to 1.5 million Syrians have\ntaken refuge in Lebanon since the conflict started in March 2011. This has strained Lebanon’s public\nfinances, service delivery, and environment. The crisis is expected to worsen poverty incidence and\n\n\n24 WHO (2008), World Health Report; WB (2010), “Plan Nacer: Health Insurance for the Poor in Argentina”; Cortez R. et al.\n(2012), World Bank HNP Discussion Paper – “Results Based Financing for Health in Argentina: The Plan Nacer Program”; Knaul\nF.M. et al. (2012), “The quest for universal health coverage: Achieving social protection for all in Mexico,” _The Lancet_, August\n16; Dukpa W. et al. (2014), “Is diabetes and hypertension screening worthwhile in resource-limited settings? An economic\nevaluation based on a pilot of a package of essential non-communicable disease interventions in Bhutan,” Health Policy and\nPlanning, October 8, 2014.\n25 Dukpa W. et al. (2014), op. cit.\n26 Starfield B, Shi L, Macinko J. (2005). Contribution of Primary Care to Health Systems and Health. _The Milbank Quarterly_ 83(3):\n457-502. doi:10.1111/j.1468-0009.2005.00409.x.\n\n\nPage 30 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 32 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\nwiden income inequality among Lebanese. In this challenging environment, GDP growth in Lebanon is\nestimated to have decelerated to 1.3 percent in 2015 from an estimated 1.8 percent in 2014, despite\ncontinued Central Bank stimulus, an improved security stance, and lower oil prices. Public finances\nremain structurally weak, and they are in urgent need of reforms. Public debt is projected to continue to\nrise (148 percent of GDP by end-2017) because of low growth and the relatively high cost of debt\nfinancing. [27]\n\n61. **It is expected that this project will be financially sustainable, but close monitoring of the**\n**macroeconomic and budget situation will be needed.** The proposed project investment, US$120 million\nover a five-year period, accounts for 5 percent of the annual government expenditure on health. [28]\n\n**B. Technical**\n\n\n62. **The technical design of the project is based on the ongoing EPHRP in PHC, with an additional**\n**focus on the hospital sector.** The interventions are designed not just to meet urgent health care needs,\nbut also to focus on governance, accountability, management, and expansion of essential health care\nservices to the poor. The pro-poor interventions supported under this project are well-known and have\nbeen tested in numerous countries around the world. In addition to reflecting the priority needs\nidentified in the national health plan, the investment rationale is supported by a large body of global\nevidence, including recent analyses of the benefits of prioritizing PHC to reach the poor, and connecting\nsectors and systems to achieve health results. The particular focus on strengthening health care services\nat the lowest level, addressing both demand- and supply-side constraints while providing some support\nto ensure functioning services at higher levels of the health system, builds on this knowledge as well as\nin-country experience. Strengthening the continuum of care, from community to health center to\nhospital, to address the many health challenges of refugees and host populations, building critical\ncapacity, and freeing resources at all levels, is the basic premise for this operation.\n\n**C. Financial Management**\n\n\n63. **The Bank assessed the adequacy of the project FM arrangements at the MoPH,** the\nimplementing entity for the components financed by the WB (IsDB will parallel-finance separate\nactivities through the CDR). The MoPH is currently carrying out the implementation of the EPHRP\nthrough a PMU that includes a Financial Officer (FO). The FM performance of this project at the start\nwas Moderately Satisfactory, and was upgraded to Satisfactory during the last mission in October 2016.\nThe same PMU will carry out the implementation of the proposed project, but additional staff will be\nhired to carry out the additional work required. In particular, additional FM staff will need to be hired to\nsupport the FO who has gained adequate experience in handling FM arrangements and WB reporting\nrequirements.\n\n64. **The FM risk is assessed as substantial before mitigation** . The key risks are the following: (i)\nlimited dedicated staff to undertake the FM activities within MoPH and within the current PMU; (ii) lack\nof an accounting system within MoPH to record and produce financial reports according to WB reporting\n\n\n27 . IMF Lebanon Country Report No 17/19, January 2017.\n28 Based on World Bank Development Indicators (2014).\n\n\nPage 31 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 33 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\nrequirements; (iii) limited internal control system; and (iv) limited external audit function where the\nCourt of Accounts mandate is mainly consumed on ex-ante control.\n\n65. **The MoPH will need to implement several mitigating measures to reduce the FM risk level to**\n**Moderate:** (i) recruit an FM staff with adequate experience, in addition to the current FO, based on TOR\nacceptable to the Bank; (ii) adopt accounting software with specifications acceptable to the Bank to\nrecord daily transactions and produce the periodic financial reports; (iii) prepare an FM chapter of the\nPOM; (iv) ensure that an independent qualified external auditor is contracted, based on TOR acceptable\nto the Bank, with the audit report to be delivered to the Bank no later than six months after the end of\neach fiscal year; and (v) expand the scope of the TOR of the Third Party Agency (TPA) to a level\nacceptable to the Bank, to include the audit of hospital expenditure bills financed under Component 2 of\nthis project.\n\n_**Financial Management Arrangements**_\n\n66. **Staffing and organization.** The MoPH is understaffed, and the civil servants working in the\naccounting department have limited capacity and knowledge of the WB requirements. Nevertheless, the\nPMU for the ongoing EPHRP has an FO who has gained adequate experience in carrying out FM\narrangements in line with WB requirements. This same PMU will be implementing the new project, but\nadditional staff will be hired to cover the additional workload. Among the additional staff will be FM\nstaff, recruited in addition to the FO as part of the PMU team, to carry out the FM arrangements under\nthe project’s components. The WB will provide the necessary training and support in FM procedures and\nreporting guidelines for the newly recruited FM staff.\n\n67. **Internal controls.** The MoPH has limited internal controls functions. The internal controls are set\naccording to the MoPH’s internal bylaws. For this operation, the PMU will prepare an FM chapter for the\nPOM, containing detailed information about the FM procedures and rules governing the flow of funds\nand internal control procedures, as well as the specific responsibilities of each member of the unit.\n\n68. **Budgeting** The WB funds will be channeled through the Ministry of Finance Treasury Account for\n“Loans” and will be transferred to the designated account of the project as follows:\n\n\ni. To facilitate the efficient management of the financial management system, the Borrower shall,\nthrough MOF, channel the proceeds of the Loan from the loans treasury account in the Loan\nCurrency at BDL to the Designated Account of the Project by a letter signed by both the Head of\nTreasury and the Central Treasury Cashier of the MoF. Upon each withdrawal of the proceeds of\nthe Loan, the Borrower shall, through MoF, open Additional Budget Lines (budget classification\nnumber 1-12-1-734-14-1-3, 1-12-1-734-16-9-1, 1-12-1-732-16-7-1) equivalent to the amount of\nsuch withdrawal of the Loan proceeds, provided that the total amount allocated to all such\nbudget lines during the life of the Project up until the disbursement deadline date (as defined in\nthe Disbursement Guidelines and the additional instructions of the Bank referred to in Section\nIV.A.1 of Schedule 2 to the Loan Agreement) shall not exceed the amount of the Loan.\n\n\nPage 32 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 34 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\nii. For the purposes of this Loan, the said Additional Budget Lines could be opened in the budget of\na specific year up until 31 January of the following year and those contracted or not contracted\nare carried forward per the request of the MoPH.\n\n69. **Accounting system and financial reporting.** The MoPH does not have an accounting information\nsystem to process accounting transactions. However, it has an information system for public health that\nconnects to the PHCCs. In the EPHRP, each health center has been using the financial module of the HIS\nto record daily transactions and submit requests for payments. The connection has been installed in all\ncenters, and training and follow-up are conducted by the PMU. For Component 1, which scales up\nactivities under the existing emergency project, the same financial module will be used by the expanded\nnumber of PHCCs to record daily transactions and account for the data on treated patients.\n\n70. **The system allows the MoPH to monitor and control expenditures made by the PHCCs in the**\n**context of the project.** The flow of activity and expenditure cycle is as follows:\n\n - Any contract to be signed by the PHCCs with a third party is submitted in the system to the\nMoPH for clearance.\n\n - Once the contract is cleared by the MoPH and then signed, any subsequent payment on this\ncontract will be through a “payment request” submitted by the PHCC in the system to the\nMoPH for review and clearance.\n\n - Once the payment request is cleared by MoPH, the FO prepares the payment (check or bank\ntransfer) to be signed by the project coordinator and the Director General.\n\n - The funds are then transferred from the Designated Account to the PHCC’s bank account\n(which is a segregated bank account opened exclusively for the project). Payments are made\non a periodic installment basis.\n\n - Once the payment request is sent to the MoPH, the PHCC cannot modify or alter any data\nfrom the system.\n\n - All the data entered at the PHCC level are available at the MoPH. In addition, the PHCCs\nsubmit semi-annual bank reconciliation statements to MoPH.\n\n - These activities are checked by the reviewing unit at the MoPH, which regularly visits a\nsample of centers to audit and check the accuracy of what is fed into the system. The\nfindings of the review have been satisfactory; no material misstatements have been found\nin what relates to the EPHRP.\n\n71. **For Component 2, which will finance patient bills exceeding the ceiling set under the MoPH**\n**budget,** as well as other emergency admissions expenses that are not covered by the MoPH (defined\ncriteria will be set to ensure eligibility), the Bank loan will finance the eligible expenditures incurred,\nstarting from project effectiveness. Retroactive financing up to an aggregate amount of US$3,600,000\nmay be made for eligible expenditure under Component 2, for payments made prior to signing of the\nLoan Agreement but on or after September 1, 2016. Under the control system in place at the MoPH, the\nexpenditures incurred during the project implementation period will be reviewed prior to payment by a\nTPA contracted to conduct this technical service for the MoPH for a fixed annual fee. The MoPH medical\naudit team will also review a sample of admissions and audit these expenditures to ensure compliance\nand accuracy. In addition, to gain even greater assurance about the use of Bank funds under this project,\nthe PMU will negotiate an increased scope of the TPA TOR to ensure that the expenditures incurred\n\n\nPage 33 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 35 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\nfrom the WB financing are eligible, are in compliance with the criteria set, and are accounted for once,\nand in an appropriate way, given that the health sector is supported by multiple donors. Once\nimplementation starts, the Bank may at any time request a technical audit to review the portion of such\nexpenses that is covered by Bank financing, either through an independent technical/medical auditor to\nbe hired under TOR that are acceptable to the Bank, or through the financial external audit.\n\n72. **The PMU at the MoPH will be required to prepare** the project interim unaudited financial\nreports for submission to the WB by no later than 45 days after the end of each quarter.\n\n73. **The Bank will provide further training and guidance, as needed, on the implementation of the**\n**FM arrangements.** The interim unaudited financial reports will be in compliance with the International\nPublic Sector Accounting Standards (IPSAS) format of financial statements, as the project will record the\nloan transactions using the cash basis of accounting. The interim financial reports will be composed of\nthe following:\n\n\n(a) A “Statement of Cash Receipts and Payments by Component”; and\n\n\n(b) Accounting policies and explanatory notes, including a footnote disclosure on schedules:\n\n(i) detailed expenditures by component; (ii) “the list of all signed contracts per component,”\nshowing contract amounts committed, paid, and unpaid under each contract;\n(iii) reconciliation statement for the balance of the project’s Designated Account;\n(iv) statement of cash payments made using Statements of Expenditures; (v) a list of\npayments by region, health care center, type, and beneficiary; (vi) a list of payments by\nhospital, type, and beneficiary; and (vi) Statement of Fixed Assets.\n\n\n74. **The Project Financial Statements (PFSs), prepared in accordance with IPSAS - Cash Basis -**\n**should contain the same information as the quarterly interim financial reports (IFRs) but cover an**\n**annual period.** The audited PFSs would be submitted to the Bank no later than six months after the end\nof each fiscal year (see External Audit Arrangements below).\n\n75. **Flow of funds and cash management.** The project funds will be channeled from the World Bank\nto the MoF Treasury account for “Loans” and then transferred to the Designated Account opened for\nthe project at the Central Bank of Lebanon in US dollars. Deposits into and payments from the\nDesignated Account will be made in accordance with the provisions set out in both the Loan Agreement\nand disbursement letters and as outlined in the WB’s “Disbursement Guidelines for Projects’’. For the\npurposes of the Loan, transfer of funds between different budget lines will be carried out and approved\nby both the Minister of Finance and the Minister of Public Health. The Borrower shall, through MoF,\nopen an account for the Loan in its Chart of Accounts to record all disbursement amounts that are\nchanneled to the Designated Account mentioned in paragraph 1 of the Loan Agreement. The said\naccount shall be settled periodically based on expenditures statements in the loan currency signed by\nthe Minister of Public Health and provided to MoF before end of each fiscal year for expenditures\nincurred up to October 31 of said Fiscal Year, and before end of January 31 of the following year for\nexpenditures incurred in November and December for the previous fiscal year.\n\n76. **External auditing.** The PFSs will be audited by an independent private external auditor\nacceptable to the WB. The audit will cover the WB financing to the MoPH and will be carried out in\n\n\nPage 34 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 36 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\naccordance with International Standards on Auditing. The audit TOR will be cleared by the WB and will\ncover, among other things, compliance with the FM chapter of the POM, the effectiveness of the\ninternal controls system, and compliance with the Loan Agreement. The audit will be accompanied by a\nmanagement letter that contains the external auditor’s assessment of the internal controls, accounting\nsystem, and compliance with the financial covenants in the Loan Agreement. The audit report and\naudited PFSs, along with the management letter, will be submitted to the WB no later than six months\nafter the end of each fiscal year. The external audit TOR will be finalized and agreed with the Bank\nwithin three months after project effectiveness, and the external auditor is expected to be engaged\nwithin six months after project effectiveness. The Bank makes publicly available the Borrower’s audited\nannual financial statements for all investment operations. According to the WB disclosure policy, the\nPMU will ensure that the yearly project audit report is made public in a manner satisfactory to the WB.\n\n77. **Disbursement arrangements.** To ensure that funds are readily available for project\nimplementation, the MoPH through MOF will open one Designated Account (DA) in US dollars at the\nCentral Bank of Lebanon to receive the transfers from the Treasury account at the Central Bank of\nLebanon for the portion of the loan financed by the World Bank. Deposits into, and payments from, the\nDA will be made in accordance with the provisions set out in the Loan Agreement and as outlined in the\nWB’s “Disbursement Guidelines for Projects” by means of advances, replenishment, and\nreimbursements. Replenishments of the Designated Account will be against Withdrawal Applications.\nRetroactive financing up to US$3,600,000 may be made available for eligible expenditures under\nComponent 2 for payments made prior to signing of the Loan Agreement but on or after September 1,\n2016.\n\n\n\n**Financial Management Action Plan**\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n|Action|Responsible|Due date|\n|---|---|---|\n|Recruit FM staff to support the FO|MoPH|During the first 3 months of
implementation|\n|Prepare the FM chapter as part of the POM|MoPH|During the first 3 months of
implementation. The POM will be
adopted no later than 4 months
after loan effectiveness.|\n|Expand the current information system to cover the
additional PHCCs|MoPH|During the first 3 months of
implementation|\n|Expand the TPA TOR to cover the hospital bills related
to Component 2.|MoPH|During the 3 months of
implementation|\n|Recruit an external auditor to audit PFSs for WB
financing.|MoPH|During the first 6 months of
implementation|\n\n\n\n**D. Procurement**\n\n\n78. **Project proceeds.** The proposed project will be implemented by the PMU and financed by the\nIBRD loan, and the IsDB-financed project will be implemented by the CDR following WB procurement\nregulations. Each financier will be responsible for procurement associated with activities subject to its\nown financing. Given that the project is prepared under emergency procedures, the Project\nProcurement Strategy for Development (PPSD) resulting in the final procurement plan will be prepared\n\n\nPage 35 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 37 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\nduring implementation. Meanwhile, a preliminary procurement plan was prepared and included as part\nof the Loan Agreement.\n\n79. **The procurement capacity assessment** covers the MoPH using the expanded PMU of the EPHRP\nfor goods and related works and for non-consulting and consulting services.\n\n\n(a) **Implementing agency and past experience.** The MoPH will use an expanded PMU of the\n\nongoing EPHRP. MoPH abides by Public Accounting Law No. 14969, dated December 30, 1963,\nsupplemented by several decrees, allowing for internationally financed projects to use the\ndonor’s guidelines. MoPH is currently implementing the EPHRP that supports services provided\nby the PHCCs, and it also has extensive experience in implementing internationally funded\nprojects. It continues using a PMU that outsources qualified staff for implementing projects. The\nPMU has proven to be diligent in processing activities under the ongoing project and has made\nitself familiar with implementation obstacles, maintained satisfactory records, and produced\nevaluations of acceptable quality. However, the nature of activities under the EPHRP differs\nfrom the proposed project, and additional skills may need to be put in place.\n\n\n(b) **Current ministry staffing.** Two committees process procurement: Supply Committee and\n\nAcceptance Committee. The PHC department processes purchases of medicine and related\nmaterial by commissioning UNICEF for procurement processing. The PMU is staffed with three\nprocurement personnel. More resources will be allocated for an expanded project.\n\n\n(c) **Applied taxes.** The following taxation principles would be observed: (i) stamp duties of three per\n\nthousand (3‰) of the contract price for contract registration at MOF, and three per thousand\n(3‰) on each payment; (ii) value-added taxes (VAT) of 10 percent applied on consultants and\ncontractors who are registered and eligible for VAT; and (iii) income taxes at a flat rate of 7.5\npercent for non-registered consultants and variable for registered consultants, depending on\ntheir job classification at MOF. Consultants may be exempt from income taxes if they are\nregistered in countries that have entered with Lebanon into agreements prohibiting double\ntaxation. Contracts financed by international donor proceeds are exempted from VAT (Law No.\n379 dated December 14, 2001).\n\n80. **Risks and mitigation measures.** The identified risks are related to: (i) the capacity of PHCC/PMU\nto undertake a more sophisticated procurement than the one under the EPHRP; (ii) limited bidding\ncompetition; (iii) the implementing agency’s weak familiarity with the WB’s new procurement\nframework (NPF), effective in July 2016; and (iv) weak public oversight. The following mitigation\nmeasures will be taken to reduce risk during implementation: (i) the POM will clearly define the relevant\nNPF process and map procurement decision-making; (ii) the Ministry will ensure that the PMU has\nappropriate support (staff, training, tools) to carry out project procurement planning, implementation,\nand monitoring; (iii) the PMU will establish advertising policy and develop sample advertisements in line\nwith the requirements of Bank regulations; (iv) the PMU will develop a standard template for the\nevaluation report for the project/agency and ensure compliance; (v) the PMU will improve its system for\naddressing complaints; (vi) the PMU will develop and implement quality assurance arrangements; and\n(vii) an external auditor will be recruited.\n\n\nPage 36 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 38 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n_**Market Analysis Summary**_\n\n81. **Consultants.** The required consultants are mainly individual consultants for the PMU who are\nalready hired under the EPHRP. Any additional consultancies are expected to be small contracts under\nwhich both local and international capacity may be tapped as needed.\n\n82. **Goods.** The project will purchase simple equipment and supplies, and will commission\ninformation systems to strengthen the ministry’s capacity in managing the hospitals and PHCCs. Most\nsuch goods are available locally, and the external market may be called on for the information systems.\n\n83. **Proposed Procurement Arrangements** are as follows:\n\n\n - **Procurement Regulations.** The following shall be applied to the project: (i) “Guidelines on\nPreventing and Combating Fraud and Corruption in Projects Financed by IBRD Loans and IDA\nCredits and Grants,” dated October 15, 2006 and revised in January 2011, and as of July 1,\n2016 (“Anti-Corruption Guidelines”); (ii) “World Bank Procurement Regulations for\nBorrowers under Investment Project Financing,” dated July 1, 2016 (“Procurement\nRegulations”), and the provisions of the Borrower’s procurement plan for the project\n(“Procurement Plan”) provided for under Section IV of the Procurement Regulations, as it\nmay be updated from time to time in agreement with the WB.\n\n - **Procurement methods.** Selection methods and arrangements:\n\n\n(a) _Goods and non-consulting services._ The project is expected to purchase equipment\n\nusing” (i) Request for bids (RFB) for both international (replacing ICB) and national\nmarkets (replacing NCB), (ii) Request for quotations (or Shopping); and (iii) Direct\nselection (old Direct contracting).\n(b) _Consulting services._ The project is expected to use Request for Proposals with the\n\nfollowing methods: Quality- and Cost-Based Selection (QCBS), Fixed Budget-based\nSelection (FBS), Least-Cost-based Selection (LCS), Consultants’ Qualification-based\nSelection (CQS), Direct Selection (formerly, single sourcing); and Selection of Individual\nConsultants.\n(c) _Particular contracts._ The PHCCs will continue to use a performance-based contract\n\nunder which they will account for enrolled patients receiving services, and for the\nreturn of the same patients to the center based on their satisfaction with the services.\n\n\n - **Prior review thresholds.** Based on the procurement assessment risk rating, the project will\nbe subject to moderate risk prior review thresholds as defined under NPF.\n\n84. **STEP.** The Government leads the development of the Project Procurement Strategy\nDevelopment (PPSD), which will define the market approach options, the selection methods and\ncontractual arrangements, and the WB’s reviews. The main outcome of the PPSD is a well-informed\nprocurement plan for the life of the project. A preliminary procurement plan was prepared as part of the\nLoan Agreement and will be uploaded in the Systematic Tracking of Exchanges in Procurement (STEP)\nsystem. Procurement activities shall be packaged in an efficient and economic manner.\n\n\nPage 37 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 39 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n85. **Frequency of supervision.** Implementation support missions will take place twice yearly. Postprocurement review will be carried out once a year and cover a sample of 10 percent of contracts\neligible for post review.\n\n**E. Social (including Safeguards)**\n\n\n86. **The project is expected to have positive social impacts.** The project will improve access to\nhealth services for vulnerable individuals living in Lebanon. The project design includes mechanisms to\nensure that project beneficiaries are well targeted and are aware of their eligibility for services, and a\nsolid grievance redress mechanism that will provide information on any aspects of the project that are\nproblematic or could be improved. The MoHP Steering Committee will include civil society, increasing\nthe voice of beneficiaries in project management.\n\n87. **The project does not have any significant social risks that cannot be mitigated.** Given project\nactivities, key issues to address include: (1) ensuring that the project targets the poor, and especially\nthose belonging to social groups that may be excluded; (2) guaranteeing that those eligible to receive\nproject services, and especially the most vulnerable among them, are aware of their eligibility and of the\nways they can access services; (3) putting in place a strong grievance redress mechanism that is\naccessible and responsive; and (4) ensuring that the project does not create or increase tensions\nbetween social groups. Risks that certain groups will be excluded are mitigated by a strong targeting\nmechanism, and risks related to tensions between Lebanese and Syrian communities are mitigated by\nproject mechanisms to ensure that both groups benefit from activities. The project design also includes\ncommunications and outreach activities that would actively inform and educate vulnerable populations\non the services and benefits available.\n\n88. **The project does not include any land acquisition and will not involve any displacement of**\n**people from land or have negative impacts on livelihoods.** Thus OP 4.12, _Involuntary Resettlement_, is\nnot triggered.\n\n**F. Environment (including Safeguards)**\n\n\n89. **Given the nature of environmental, health, and safety (EHS) impacts associated with health**\n**care facilities** —PHCCs, hospitals, and so on—basic EHS standards/protocols are mandated at the facility\nlevel through an accreditation system. A summary of the accreditation system in place in Lebanon as\nwell as an overview of general occupational health and safety (OHS) practices on the ground will provide\nthe basis for the development of an Environmental and Social Management Framework (ESMF), which\nwill include a medical waste management plan, to fill any gaps or enhance current practices to help\nmanage the increased capacity challenges. The project aims at increasing the number of users and types\nof services provided including comprehensive package of services (Component 1). The essential\npackages of services will include activities such as immunization, lab tests, mammography, and\nscreening. These activities are expected to have environment, health, and safety impacts on the\nsurrounding environment, including the generation of medical health care wastes, air emissions,\nwastewater, occupational health and safety concerns, and community health and safety concerns. Given\n\n\nPage 38 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 40 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\nthe scale and nature of the project, the environmental risks associated with the project activities are\nconsidered moderate, and the project is therefore classified as environmental category B, in accordance\nwith OP 4.01.\n\n90. **In accordance with Bank policy (OP 10.00, paragraph 12), the development of the ESMF is**\n**deferred to the implementation stage,** given the urgent nature of the proposed operation. A Safeguards\nAction Plan (Annex 1) sets out the roadmap for the development of the ESMF: content, timeframe,\ndisclosure, and consultation for the ESMF. The borrower, through the MoPH, will prepare the ESMF no\nlater than three months after effectiveness.\n\n**G. Other Safeguard Policies (if applicable)**\n\n\n91. The project activities do not trigger any other safeguard policies.\n\n**H. World Bank Grievance Redress**\n\n\n92. **Communities and individuals that believe that they are adversely affected by a WB-supported**\n**project may submit complaints** to existing project-level grievance redress mechanisms or the WB’s Grievance\nRedress Service, which ensures that complaints are promptly reviewed and project-related concerns\naddressed. Project-affected communities and individuals may submit their complaint to the WB’s independent\nInspection Panel, which determines whether harm occurred, or could occur, as a result of the WB’s noncompliance with its policies and procedures. Complaints may be submitted at any time after concerns have\nbeen brought directly to the World Bank's attention and Bank Management has been given an opportunity to\nrespond. For information on how to submit complaints to the World Bank’s corporate Grievance Redress\nService, please visit [http://www.worldbank.org/en/projects-operations/products-and-services/grievance-](http://www.worldbank.org/en/projects-operations/products-and-services/grievance-redress-service)\n[redress-service. For information on how to submit complaints to the World Bank Inspection Panel, please visit](http://www.worldbank.org/en/projects-operations/products-and-services/grievance-redress-service)\n[www.inspectionpanel.org.](http://www.inspectionpanel.org/)\n.\n\n\nPage 39 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 41 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Emergency Health Project (P163476)\n\n\n**VII. RESULTS FRAMEWORK AND MONITORING**\n\n\n\n\n\n\n\n\n\n\n\n\n\n|Col1|Indicator Name|Core|Unit of
Measure|Baseline|End Target|Frequency|Data Source/Methodology|Responsibility for
Data Collection|Col10|\n|---|---|---|---|---|---|---|---|---|---|\n||**Name:**Primary care
beneficiaries||Number|280000.00|715000.00|Bi-annual
|HIS
|PMU
|PMU
|\n||Poor Lebanese||Number|150000.00|340000.00|||||\n|||||||||||\n||
Displaced Syrians||Number|130000.00|375000.00|||||\n||Description:Number of beneficiaries who will have access to the essential healthcare services package.|Description:Number of beneficiaries who will have access to the essential healthcare services package.|Description:Number of beneficiaries who will have access to the essential healthcare services package.|Description:Number of beneficiaries who will have access to the essential healthcare services package.|Description:Number of beneficiaries who will have access to the essential healthcare services package.|Description:Number of beneficiaries who will have access to the essential healthcare services package.|Description:Number of beneficiaries who will have access to the essential healthcare services package.|Description:Number of beneficiaries who will have access to the essential healthcare services package.||\n\n\n|Col1|Name: % female of total
beneficiaries|Col3|Percentage|50.00|50.00|Bi-annual|HIS|PMU|Col10|\n|---|---|---|---|---|---|---|---|---|---|\n|||||||||||\n\n\nPage 40 of 54\n\n\n\n\n\n\n\n\n\n\n", + "datasets": [ + { + "dataset_name": { + "text": "Lebanon Emergency Health Project", + "confidence": 0.7718493342399597, + "start": 7, + "end": 11 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": { + "text": "The World Bank", + "confidence": 0.6148363947868347, + "start": 2, + "end": 5 + }, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.950509250164032, + "start": 7, + "end": 8 + }, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "Poor Lebanese", + "confidence": 0.5041267275810242, + "start": 150, + "end": 152 + }, + "is_used": "False", + "usage_context": "primary" + }, + { + "dataset_name": { + "text": "essential healthcare services package", + "confidence": 0.7099392414093018, + "start": 215, + "end": 219 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "Displaced Syrians", + "confidence": 0.5019965767860413, + "start": 184, + "end": 186 + }, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "essential healthcare services package", + "confidence": 0.923872172832489, + "start": 300, + "end": 304 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "beneficiaries", + "confidence": 0.9414127469062805, + "start": 310, + "end": 311 + }, + "is_used": "False", + "usage_context": "background" + } + ], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 42 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n|Indicator Name|Core|Unit of
Measure|Baseline|End Target|Frequency|Data Source/Methodology|Responsibility for
Data Collection|\n|---|---|---|---|---|---|---|---|\n|Description:Percent of female beneficiaries of the total number of beneficiaries who will have access to the essential healthcare services package.|Description:Percent of female beneficiaries of the total number of beneficiaries who will have access to the essential healthcare services package.|Description:Percent of female beneficiaries of the total number of beneficiaries who will have access to the essential healthcare services package.|Description:Percent of female beneficiaries of the total number of beneficiaries who will have access to the essential healthcare services package.|Description:Percent of female beneficiaries of the total number of beneficiaries who will have access to the essential healthcare services package.|Description:Percent of female beneficiaries of the total number of beneficiaries who will have access to the essential healthcare services package.|Description:Percent of female beneficiaries of the total number of beneficiaries who will have access to the essential healthcare services package.|Description:Percent of female beneficiaries of the total number of beneficiaries who will have access to the essential healthcare services package.|\n\n\n\n\n\n\n\n\n\n\n\n\n|Col1|Name: Pregnant women
receiving at least four
antenatal care visits|Col3|Percentage|50.00|70.00|Annual|HIS|PMU|Col10|\n|---|---|---|---|---|---|---|---|---|---|\n||Description:Percent of pregnant women (from among the cumulative number of enrolled beneficiaries) who receive at least four antenatal visits during their complete
term of pregnancy.|Description:Percent of pregnant women (from among the cumulative number of enrolled beneficiaries) who receive at least four antenatal visits during their complete
term of pregnancy.|Description:Percent of pregnant women (from among the cumulative number of enrolled beneficiaries) who receive at least four antenatal visits during their complete
term of pregnancy.|Description:Percent of pregnant women (from among the cumulative number of enrolled beneficiaries) who receive at least four antenatal visits during their complete
term of pregnancy.|Description:Percent of pregnant women (from among the cumulative number of enrolled beneficiaries) who receive at least four antenatal visits during their complete
term of pregnancy.|Description:Percent of pregnant women (from among the cumulative number of enrolled beneficiaries) who receive at least four antenatal visits during their complete
term of pregnancy.|Description:Percent of pregnant women (from among the cumulative number of enrolled beneficiaries) who receive at least four antenatal visits during their complete
term of pregnancy.|Description:Percent of pregnant women (from among the cumulative number of enrolled beneficiaries) who receive at least four antenatal visits during their complete
term of pregnancy.|Description:Percent of pregnant women (from among the cumulative number of enrolled beneficiaries) who receive at least four antenatal visits during their complete
term of pregnancy.|\n\n\n\n\n\n\n\n\n\n\n|Col1|Name: Public hospital
admissions above the MoPH
contracted ceiling|Col3|Number|0.00|34000.00|Annual|MoPH|PMU|Col10|\n|---|---|---|---|---|---|---|---|---|---|\n||Description:Number of admissions at public hospitals above the MoPH contracted ceiling with hospitals|Description:Number of admissions at public hospitals above the MoPH contracted ceiling with hospitals|Description:Number of admissions at public hospitals above the MoPH contracted ceiling with hospitals|Description:Number of admissions at public hospitals above the MoPH contracted ceiling with hospitals|Description:Number of admissions at public hospitals above the MoPH contracted ceiling with hospitals|Description:Number of admissions at public hospitals above the MoPH contracted ceiling with hospitals|Description:Number of admissions at public hospitals above the MoPH contracted ceiling with hospitals|Description:Number of admissions at public hospitals above the MoPH contracted ceiling with hospitals|Description:Number of admissions at public hospitals above the MoPH contracted ceiling with hospitals|\n\n\n\n\n\n\n\n\n|Col1|Name: Health facilities
accredited|Col3|Number|30.00|140.00|Annual|MoPH|PMU|Col10|\n|---|---|---|---|---|---|---|---|---|---|\n||Description:Number of PHC contracted health facilities that receive accreditation|Description:Number of PHC contracted health facilities that receive accreditation|Description:Number of PHC contracted health facilities that receive accreditation|Description:Number of PHC contracted health facilities that receive accreditation|Description:Number of PHC contracted health facilities that receive accreditation|Description:Number of PHC contracted health facilities that receive accreditation|Description:Number of PHC contracted health facilities that receive accreditation|Description:Number of PHC contracted health facilities that receive accreditation|Description:Number of PHC contracted health facilities that receive accreditation|\n\n\n\n\n\n\n\n\n\n|Col1|Name: Children fully
vaccinated under the age of
two according to national
immunization policy|Col3|Percentage|50.00|80.00|Annual|MoPH|PMU|Col10|\n|---|---|---|---|---|---|---|---|---|---|\n||Description:Percentage of enrolled children under the age of two receiving all routine vaccinations as per national calendar|Description:Percentage of enrolled children under the age of two receiving all routine vaccinations as per national calendar|Description:Percentage of enrolled children under the age of two receiving all routine vaccinations as per national calendar|Description:Percentage of enrolled children under the age of two receiving all routine vaccinations as per national calendar|Description:Percentage of enrolled children under the age of two receiving all routine vaccinations as per national calendar|Description:Percentage of enrolled children under the age of two receiving all routine vaccinations as per national calendar|Description:Percentage of enrolled children under the age of two receiving all routine vaccinations as per national calendar|Description:Percentage of enrolled children under the age of two receiving all routine vaccinations as per national calendar|Description:Percentage of enrolled children under the age of two receiving all routine vaccinations as per national calendar|\n\n\nPage 41 of 54\n\n\n", + "datasets": [ + { + "dataset_name": { + "text": "Lebanon Health Resilience Project", + "confidence": 0.6983394026756287, + "start": 7, + "end": 11 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.9396136999130249, + "start": 7, + "end": 8 + }, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "beneficiaries", + "confidence": 0.9018430709838867, + "start": 86, + "end": 87 + }, + "is_used": "False", + "usage_context": "supporting" + }, + { + "dataset_name": { + "text": "essential healthcare services package", + "confidence": 0.8911271691322327, + "start": 171, + "end": 175 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "Pregnant women", + "confidence": 0.9028834700584412, + "start": 278, + "end": 280 + }, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "essential healthcare services package", + "confidence": 0.5291731357574463, + "start": 195, + "end": 199 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "Pregnant women", + "confidence": 0.7947726845741272, + "start": 278, + "end": 280 + }, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "term of pregnancy", + "confidence": 0.6554489135742188, + "start": 454, + "end": 457 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "pregnant women", + "confidence": 0.93923020362854, + "start": 463, + "end": 465 + }, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "immunization policy", + "confidence": 0.5577399730682373, + "start": 1098, + "end": 1100 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "national calendar", + "confidence": 0.8241379261016846, + "start": 1181, + "end": 1183 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "enrolled children", + "confidence": 0.726849377155304, + "start": 1168, + "end": 1170 + }, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "national calendar", + "confidence": 0.996025800704956, + "start": 1201, + "end": 1203 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "enrolled children", + "confidence": 0.7898638248443604, + "start": 1208, + "end": 1210 + }, + "is_used": "False", + "usage_context": "background" + } + ], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 43 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\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\n|Indicator Name|Core|Unit of
Measure|Baseline|End Target|Frequency|Data Source/Methodology|Responsibility for
Data Collection|\n|---|---|---|---|---|---|---|---|\n|**Name:**Health facilities
contracted||Number|75.00|204.00|Bi-annual
|HIS
|PMU
|\n|Description:Number of Health facilities contracted under the program to deliver the essential healthcare package to the project beneficiaries.|Description:Number of Health facilities contracted under the program to deliver the essential healthcare package to the project beneficiaries.|Description:Number of Health facilities contracted under the program to deliver the essential healthcare package to the project beneficiaries.|Description:Number of Health facilities contracted under the program to deliver the essential healthcare package to the project beneficiaries.|Description:Number of Health facilities contracted under the program to deliver the essential healthcare package to the project beneficiaries.|Description:Number of Health facilities contracted under the program to deliver the essential healthcare package to the project beneficiaries.|Description:Number of Health facilities contracted under the program to deliver the essential healthcare package to the project beneficiaries.|Description:Number of Health facilities contracted under the program to deliver the essential healthcare package to the project beneficiaries.|\n|||||||||\n|**Name:**Number of children
vaccinated per year||Number|0.00|22000.00|Annual
|MoPH
|PMU
|\n|Description:Number of children vaccinated per year|Description:Number of children vaccinated per year|Description:Number of children vaccinated per year|Description:Number of children vaccinated per year|Description:Number of children vaccinated per year|Description:Number of children vaccinated per year|Description:Number of children vaccinated per year|Description:Number of children vaccinated per year|\n|||||||||\n|**Name:**Target population 40
years and above who were
screened for diabetes
mellitus||Percentage|0.00|60.00|Annual
|HIS
|PMU
|\n|Description:Percent of beneficiaries above the age of 40 (from among the cumulative number of enrolled beneficiaries) screened for Diabetes Mellitus according to
MoPH guidelines.|Description:Percent of beneficiaries above the age of 40 (from among the cumulative number of enrolled beneficiaries) screened for Diabetes Mellitus according to
MoPH guidelines.|Description:Percent of beneficiaries above the age of 40 (from among the cumulative number of enrolled beneficiaries) screened for Diabetes Mellitus according to
MoPH guidelines.|Description:Percent of beneficiaries above the age of 40 (from among the cumulative number of enrolled beneficiaries) screened for Diabetes Mellitus according to
MoPH guidelines.|Description:Percent of beneficiaries above the age of 40 (from among the cumulative number of enrolled beneficiaries) screened for Diabetes Mellitus according to
MoPH guidelines.|Description:Percent of beneficiaries above the age of 40 (from among the cumulative number of enrolled beneficiaries) screened for Diabetes Mellitus according to
MoPH guidelines.|Description:Percent of beneficiaries above the age of 40 (from among the cumulative number of enrolled beneficiaries) screened for Diabetes Mellitus according to
MoPH guidelines.|Description:Percent of beneficiaries above the age of 40 (from among the cumulative number of enrolled beneficiaries) screened for Diabetes Mellitus according to
MoPH guidelines.|\n|||||||||\n\n\nPage 42 of 54\n\n\n", + "datasets": [ + { + "dataset_name": { + "text": "Lebanon Health Resilience Project", + "confidence": 0.6659557819366455, + "start": 7, + "end": 11 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.9272206425666809, + "start": 7, + "end": 8 + }, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "project beneficiaries", + "confidence": 0.7201967835426331, + "start": 139, + "end": 141 + }, + "is_used": "False", + "usage_context": "supporting" + }, + { + "dataset_name": { + "text": "Number of children vaccinated per year", + "confidence": 0.9770470261573792, + "start": 352, + "end": 358 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "MoPH guidelines", + "confidence": 0.6165528297424316, + "start": 516, + "end": 518 + }, + "dataset_tag": "descriptive", + "description": { + "text": "Percent of beneficiaries above the age of 40", + "confidence": 0.5076879262924194, + "start": 489, + "end": 497 + }, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "enrolled beneficiaries", + "confidence": 0.8024400472640991, + "start": 504, + "end": 506 + }, + "is_used": "False", + "usage_context": "supporting" + }, + { + "dataset_name": { + "text": "MoPH guidelines", + "confidence": 0.9669148325920105, + "start": 615, + "end": 617 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "enrolled beneficiaries", + "confidence": 0.7445980906486511, + "start": 603, + "end": 605 + }, + "is_used": "False", + "usage_context": "supporting" + } + ], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 44 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\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\n\n|Indicator Name|Core|Unit of
Measure|Baseline|End Target|Frequency|Data Source/Methodology|Responsibility for
Data Collection|\n|---|---|---|---|---|---|---|---|\n|**Name:**Health personnel
receiving training||Number|0.00|1000.00|Bi-annual
|PMU
|PMU
|\n|Description:Number of health personnel receiving training through the project|Description:Number of health personnel receiving training through the project|Description:Number of health personnel receiving training through the project|Description:Number of health personnel receiving training through the project|Description:Number of health personnel receiving training through the project|Description:Number of health personnel receiving training through the project|Description:Number of health personnel receiving training through the project|Description:Number of health personnel receiving training through the project|\n|||||||||\n|**Name:**Maintain Client
Satisfaction (PHCCs &
Hospitals)||Percentage|75.00|75.00|Annual
|Client satisfaction survey
|PMU
|\n|Description:Share of users satisfied by the received health care services|Description:Share of users satisfied by the received health care services|Description:Share of users satisfied by the received health care services|Description:Share of users satisfied by the received health care services|Description:Share of users satisfied by the received health care services|Description:Share of users satisfied by the received health care services|Description:Share of users satisfied by the received health care services|Description:Share of users satisfied by the received health care services|\n|||||||||\n|**Name:**Grievances registered
related to delivery of project
benefits addressed||Percentage|40.00|75.00|Bi-annual
|Grievance database
|PMU
|\n|Description:Percentage of grievances registered related to the delivery of project benefits that were addressed|Description:Percentage of grievances registered related to the delivery of project benefits that were addressed|Description:Percentage of grievances registered related to the delivery of project benefits that were addressed|Description:Percentage of grievances registered related to the delivery of project benefits that were addressed|Description:Percentage of grievances registered related to the delivery of project benefits that were addressed|Description:Percentage of grievances registered related to the delivery of project benefits that were addressed|Description:Percentage of grievances registered related to the delivery of project benefits that were addressed|Description:Percentage of grievances registered related to the delivery of project benefits that were addressed|\n|||||||||\n|**Name:**Hospital Assessment
carried out||Text|NA|Assessment
completed|Once
|MoPH
|MoPH/PMU
|\n|Description:Hospital Assessment carried out|Description:Hospital Assessment carried out|Description:Hospital Assessment carried out|Description:Hospital Assessment carried out|Description:Hospital Assessment carried out|Description:Hospital Assessment carried out|Description:Hospital Assessment carried out|Description:Hospital Assessment carried out|\n|
|
|
|
|
|
|
|
|\n\n\n\nPage 43 of 54\n\n\n", + "datasets": [ + { + "dataset_name": { + "text": "Lebanon Health Resilience Project", + "confidence": 0.6472780108451843, + "start": 7, + "end": 11 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.9458592534065247, + "start": 7, + "end": 8 + }, + "publication_year": null, + "reference_year": null, + "reference_population": { + "text": "Health personnel", + "confidence": 0.8362982869148254, + "start": 87, + "end": 89 + }, + "is_used": "False", + "usage_context": "supporting" + }, + { + "dataset_name": { + "text": "Client satisfaction survey", + "confidence": 0.9840354323387146, + "start": 265, + "end": 268 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": { + "text": "survey", + "confidence": 0.7528110146522522, + "start": 267, + "end": 268 + }, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "supporting" + }, + { + "dataset_name": { + "text": "Hospital Assessment", + "confidence": 0.8847042322158813, + "start": 594, + "end": 596 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "Assessment", + "confidence": 0.5148317217826843, + "start": 607, + "end": 608 + }, + "dataset_tag": "descriptive", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + } + ], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 45 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n\n\n\n\n|Indicator Name|Baseline|YR1|YR2|YR3|YR4|YR5|End Target|\n|---|---|---|---|---|---|---|---|\n|Primary care beneficiaries|280000.00|290000.00|390000.00|500000.00|625000.00|715000.00|715000.00|\n|Poor Lebanese|150000.00|150000.00|200000.00|250000.00|300000.00|340000.00|340000.00|\n|Displaced Syrians|130000.00|140000.00|190000.00|250000.00|325000.00|375000.00|375000.00|\n|% female of total beneficiaries|50.00|50.00|50.00|50.00|50.00|50.00|50.00|\n|Pregnant women receiving at least four
antenatal care visits|50.00|50.00|55.00|60.00|65.00|70.00|70.00|\n|Public hospital admissions above the
MoPH contracted ceiling|0.00|5000.00|12000.00|19000.00|27000.00|34000.00|34000.00|\n|Health facilities accredited|30.00|30.00|50.00|85.00|125.00|140.00|140.00|\n|Children fully vaccinated under the age of
two according to national immunization
policy|50.00|65.00|70.00|75.00|80.00|80.00|80.00|\n\n\n\n\n\nPage 44 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 46 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n|Indicator Name|Baseline|YR1|YR2|YR3|YR4|YR5|End Target|\n|---|---|---|---|---|---|---|---|\n|Health facilities contracted|75.00|75.00|130.00|170.00|204.00|204.00|204.00|\n|Number of children vaccinated per year|0.00|2000.00|7000.00|12000.00|17000.00|22000.00|22000.00|\n|Target population 40 years and above
who were screened for diabetes mellitus|0.00|30.00|35.00|45.00|55.00|60.00|60.00|\n|Health personnel receiving training|0.00|500.00|750.00|850.00|950.00|1000.00|1000.00|\n|Maintain Client Satisfaction (PHCCs &
Hospitals)|75.00|75.00|75.00|75.00|75.00|75.00|75.00|\n|Grievances registered related to delivery
of project benefits addressed|40.00|40.00|50.00|55.00|60.00|75.00|75.00|\n|Hospital Assessment carried out|NA|NA|NA|Completed|||Assessment
completed|\n\n\n\nPage 45 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 47 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n**ANNEX 1. ENVIRONMENTAL AND SOCIAL SAFEGUARDS ACTION PLAN (SAP)**\n\n**LEBANON HEALTH RESILIENCE PROJECT**\n\n\n**I.** **Objectives**\n\n1. **The Environmental and Social Safeguards Action Plan (SAP)** is a time-bound plan for the\nenvironmental and social safeguards instruments, the preparation of which has been deferred into the\nproject implementation period under paragraph 12 of OP 10.00. This SAP provides general policies,\nguidelines, codes of practice, and procedures to be integrated into the implementation of the World\nBank-financed Lebanon Health Resilience Project.\n\n2. **The objective of the SAP** is to ensure that the proposed project activities and related\nenvironmental and social (E&S) assessment and management instruments and processes are in\ncompliance with the national legislation of Lebanon as well as the World Bank’s operational safeguards\npolicies, and are duly and diligently implemented in a logical sequence with the environmentally and\nsocially relevant project activities. This means that, as a general principle, E&S assessments and\ninstruments will be completed, disclosed, and consulted on before: (i) project-funded activities with\nrelevant E&S footprints may commence; and (ii) in case of more complex/large-scale activities, before\ndesigns are finalized and contracts awarded.\n\n3. **This SAP, prepared by the task team, complies with World Bank safeguards policies,**\nspecifically OP 10.00, paragraph 12, and OP 4.01, paragraph 12.\n\n**II.** **Project Scope and Context**\n\n4. **The project scope** is described in detail in Section III of the PAD. The project aims to strengthen\nthe primary health care (PHC) system and community outreach to address the basic health needs of\npoor Lebanese and displaced Syrians, and to address the immediate capacity constraints of public\nhospitals serving high concentrations of displaced Syrians. The project development objective is to\nincrease access to quality health care services by poor Lebanese and displaced Syrians in Lebanon.\n\n5. **Six years into the Syrian conflict, Lebanon, a small country of 4 million people, has the highest**\n**per capita concentration of refugees in the world.** The latest Government of Lebanon (GoL) estimates\nare that the country hosts 1.5 million displaced Syrians, along with 31,502 Palestinian refugees from\nSyria, and a preexisting population of more than 277,985 Palestinian refugees. Accordingly, the\npopulation of Lebanon has grown by around 30 percent in just six years. This influx has put enormous\npressure on the country's already scarce resources, stretched its public services, and contributed to\nrising tensions in a nation vulnerable to conflict and instability.\n\n\n6. **The Syrian refugee crisis has resulted in an unprecedented increase in demand for health**\n**services, putting considerable strain on the country’s resources and public services.** As the number of\ndisplaced Syrians continues to increase, the capacity of the health system will no longer be sufficient to\nmeet the excess demand, imposing further burdens on Lebanon’s already stretched public finances.\nAccording to the latest Lebanon Crisis Response Plan (LCRP 2017-2020), coping with the health needs of\nvulnerable populations in Lebanon will require some US$308 million in 2017 and US$300 million in 2018.\n\n\nPage 46 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 48 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n7. **The Ministry of Public Health (MoPH) is adopting a two‐pronged approach aimed at**\n**responding to the immediate health needs of the population while meeting the sector’s medium- to**\n**longer‐term development goals** . To meet immediate health needs, the MoPH networked with multiple\npartners, stakeholders, and UN agencies and leveraged the private sector and civil society to maintain\nservice delivery, prevent disease outbreaks, and sustain utilization and functional institutions. The LCRP\n2017-2020 details short-term funding needs, activities, and coordination mechanisms. The proposed\nproject contributes to LCRP outcome 1, “Improved access to comprehensive health care” and outcome\n2, “Improved access to hospital and advanced referral care.” The MoPH’s medium- to long-term strategy\nis to rapidly strengthen its systems to absorb the impact of the crisis and maintain health outcomes. In\n2013, the MoPH articulated its strategic direction: an overall goal of expanding health coverage to the\nuninsured, with special focus on the poor and underserved population, through a Universal Health Care\n(UHC) program. Accordingly, with the help of the donor community, the MoPH is allocating resources to\nupgrade the capacity of the PHC program, strengthen the skills of health workers, and provide coverage\nfor the poor with a package of essential health care services.\n\n\n**III.** **Compliance with World Bank Safeguards Policies**\n\n8. Considering the nature and magnitude of the proposed project, the potential negative\nenvironmental impacts from project activities are expected to be moderate to low; therefore, the\nproposed operation is classified as category B. This SAP has been developed specifically for these\nproposed activities to ensure due diligence, avoid causing harm, and ensure consistent treatment of\nenvironmental and social issues by the GoL. The purpose of this plan is also to assist the Lebanese\nMoPH/PMU and CDR in screening all the subprojects for their likely environmental and social impacts,\nidentifying E&S management requirements, and prioritizing the investments. The World Bank’s policy on\nEnvironmental Assessment (OP/BP 4.01) is triggered for this project. No subcomponents or subprojects\nthat fall into category A will be eligible for funding.\n\n\n9. Given the nature of the EHS impacts associated with health care facilities—PHCCs, hospitals, and\nso on—basic EHS standards/protocols are mandated at the facility level through an accreditation\nsystem. A summary of the accreditation system in place in Lebanon as well as an overview of general\nOHS practices on the ground will provide the basis for the development of an Environmental and Social\nManagement Framework (ESMF), which will include a medical waste management plan, to fill any gaps\nor enhance current practices to help manage the increased capacity challenges.\n\n\n10. Because the proposed project triggered OP10.00, paragraph 12, the requirement to carry out an\nEnvironmental and Social Management Framework (ESMF), including a medical waste management\nplan, is deferred to project implementation. At the same time, before subprojects are appraised, the\nimplementing agency will agree to implement environmentally and socially sound options for disposal of\nhealth care wastes, and to include environmental requirements in the procurement/maintenance of\nmedical equipment, provisions for adequate budget, and satisfactory institutional arrangements for\nmonitoring effective implementation.\n\n\n11. For any project components/subcomponents that may include rehabilitation activities, a social\nand environmental safeguards screening tool, part of the ESMF, will be applied along with the specific\nsubproject-level instruments, including a subproject-specific Environmental and Social Management\nPlan (ESMP), that may be necessary to cover both social and environmental aspects. Additional\n\n\nPage 47 of 54\n\n\n", + "datasets": [ + { + "dataset_name": { + "text": "LCRP", + "confidence": 0.9248578548431396, + "start": 112, + "end": 113 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.9026180505752563, + "start": 7, + "end": 8 + }, + "publication_year": null, + "reference_year": { + "text": "2017-2020", + "confidence": 0.9796080589294434, + "start": 113, + "end": 114 + }, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "SAP", + "confidence": 0.5164730548858643, + "start": 327, + "end": 328 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.9448148012161255, + "start": 485, + "end": 486 + }, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "supporting" + }, + { + "dataset_name": { + "text": "accreditation\nsystem", + "confidence": 0.5312093496322632, + "start": 473, + "end": 475 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": { + "text": "Lebanon", + "confidence": 0.7899380326271057, + "start": 485, + "end": 486 + }, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "Environmental and Social\nManagement Framework", + "confidence": 0.7732363939285278, + "start": 507, + "end": 512 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "social\nand environmental safeguards screening tool", + "confidence": 0.8867047429084778, + "start": 655, + "end": 661 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + }, + { + "dataset_name": { + "text": "subproject-specific Environmental and Social Management\nPlan", + "confidence": 0.6109737753868103, + "start": 679, + "end": 685 + }, + "dataset_tag": "non-dataset", + "description": null, + "data_type": null, + "acronym": null, + "author": null, + "producer": null, + "geography": null, + "publication_year": null, + "reference_year": null, + "reference_population": null, + "is_used": "False", + "usage_context": "background" + } + ], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 49 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\nmeasures will support the implementation and monitoring of, and compliance with, the ESMF, and Bank\nimplementation support missions will include E&S implementation expertise to support the client during\nthe entire project cycle.\n\n\n**OP 4.01,** _**Environmental Assessment**_\n\n12. The proposed project aims to strengthen the PHC system and community outreach to address\nboth the basic health needs of Lebanese and displaced Syrians affected by the crisis, and the immediate\ncapacity constraints of public hospitals serving high concentrations of displaced Syrians. This will be\nachieved by scaling up the scope and capacity of the PHC UHC program; providing health care services in\npublic hospitals, and strengthening project management and monitoring.\n\n\n13. The project will support existing health care facilities and will not include the construction of any\nnew facilities. The identification of the actual areas to be included in the project will be based on\nextensive guidance by an ongoing needs assessment. However, the focus of the Bank’s interventions is\nhost communities in areas with high concentrations of displaced Syrians.\n\n\n14. As part of the contracts with the PMU, the health care providers will be required to provide\nevidence that their existing or planned health care waste management, storage, collection, occupational\nhealth and safety (OHS), treatment, and disposal systems are adequate and can accommodate any\nadditional waste quantities that could occur as a result of the expanded coverage. This requirement will\nalso be reflected in the Project Operations Manual (POM).\n\n\n**IV.** **Sequencing and Tentative Implementation Schedule for Safeguards Processing**\n\n15. As a general principle, the implementing agency will agree to apply provisions for adequate and\nsatisfactory budget and institutional arrangements for monitoring effective implementation. The\nfollowing time-bound deployment of the safeguards instruments is anticipated to manage and mitigate\npotential adverse impacts:\n\n\n(a) _**Immediately after project effectiveness, during the first quarter of implementation:**_ Start\n\nof development of the ESMF, which will be the overarching safeguards document governing\napproach, processes, and specific instruments for all the project components.\n\n\n(b) _**During implementation phase, from the second quarter onwards:**_ Implementation of the\n\nESMF requirements, including the medical waste management plan, will take place. For the\nexpected scope of the project components, a simple checklist-type ESMP may need to be\nused, especially if minor rehabilitation civil works are to take place, especially under\ncomponent 3. The checklist ESMP would become part of the works contracts, set the E&S\nstandards and compliance mechanisms, and serve as a contractual basis for supervision and\nenforcement of good E&S practice during the works. This may entail filling any gaps for\nsound E&S management at the facilities, or measures to enhance current practices to help\nmanage the increased capacity challenges. Comprehensive ESIAs or ESMPs will not be\nrequired.\n\n\nPage 48 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 50 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n16. **Preparation time for safeguards instruments, including Bank review, revisions, clearance, and**\n**approval steps.** The preparation of the ESMF, including the health care waste management plan, is\nestimated to require about three months, including Bank review and approval, disclosure, consultations,\nand finalization. The ESMF will be adopted by the borrower no later than three months after loan\neffectiveness. The preparation of checklist ESMPs will not require more than one month, including any\nBank review, approval, and disclosure needed.\n\n\n17. **Consultations and disclosure.** The ESMF will be the subject of consultations with key\nstakeholders and will be disclosed in-country and at the Infoshop after Bank review as a final draft\nversion for a period no less than 30 days, during which the client will organize consultations for the\naffected stakeholders. The consultation mechanism for checklist ESMPs will be designed with\nappropriate depth and breadth, depending on the complexity and dimensions of the specific situation.\n\n\n18. **No further safeguards instruments are foreseen to be required.** No tender package will be\nissued without an attached ESMF and no contract signed without respective clauses obliging the\nContractor to the ESMF’s use and implementation.\n\n\n19. **Implementation monitoring.** Safeguards compliance will be monitored throughout project\nimplementation. The PMU will dedicate an E&S officer/consultant to ensure compliance with the E&S\nsafeguards requirements. The TOR for the assigned officer/consultant will specify the approach for\nsafeguards monitoring, recording, and reporting, as well as measures for rectification in case of noncompliance. The TOR will be reviewed and cleared by the Bank safeguards specialists.\n\n\n**V.** **Consultation and Disclosure**\n\n20. **The ESMF will be prepared** and consulted upon with key stakeholders, who may include health\ncare workers and regulatory agencies. The ESMF will identify the key stakeholders to be consulted,\nmethods of consultation, and the process for addressing E&S concerns and grievances. The\nimplementing agency will initiate consultations as early as possible, and for meaningful consultations,\nwill provide relevant material in a timely manner prior to consultation, in a form and language that are\nunderstandable and accessible to the groups being consulted.\n\n\n**VI.** **Roles and Responsibilities**\n\n\n21. **The responsibility for the implementation of the safeguards instruments and processes will be**\n**with the implementing agency** that will be responsible for compliance with national environmental\nregulations and the Bank’s E&S safeguards policies. The PMU will assign the MoPH Medical Engineer to\nfollow up on the preparation and implementation of the safeguards instruments and may recruit\nqualified consultants as needed.\n\n\n22. **The Bank task team will monitor timely commencement** of the preparation of the required\nsafeguards instruments by the client. The task team will ensure that no works that have negative\nenvironmental impacts will commence unless the required safeguards instruments are in place.\n\n\n23. **The Bank will also review TORs and the ESMF** to ensure that their scope and quality are\nsatisfactory to the Bank. In addition, the Bank task team will review tender documents and contracts to\nensure that they give due consideration to the safeguards instruments and include effective and\n\n\nPage 49 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 51 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\nenforceable contractual clauses. Finally, the ESMF will determine the monitoring parameters,\nresponsibilities, and frequency in alignment with the existing regular EHS monitoring, which will also be\nassessed under the ESMF.\n\n\n**VII.** **Estimated Costs for the Safeguards Preparation and Implementation Process**\n\n24. **The cost of preparing the required safeguards instruments** is estimated to be about US$20,000 for\n\nthe preparation of the ESMF and approximately US$20,000 for the subsequent safeguards\ninstruments.\n\n\n25. **The implementation of safeguards is expected to cost only a small fraction of the design and**\n\n**construction cost,** as most mitigation measures will be generic, off-the-shelf, and implementable\nwithout specialized skills, experience, or equipment. Assuming a proportion of about 0.5 percent for\nevery US$1 million spent on components 1 and 3, therefore, approximately US$500,000 would be\nsufficient to implement environmental mitigation and management measures.\n\n\n**VIII.** **Safeguard Screening and Mitigation**\n\n\n26. **The selection, design, contracting, and monitoring and evaluation of the project components**\n**and subcomponents** will be consistent with the following guidelines, codes of practice, and\nrequirements:\n\n\n - A list of negative characteristics rendering proposed subcomponents ineligible for support,\nAttachment 1; and\n\n - A proposed checklist of likely environment and social impacts to be filled out for each\nsubcomponent or group of subcomponents, Attachment 2.\n\n\nPage 50 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 52 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n**Attachment 1**\n**List of Negative Subproject Attributes**\n\n\nSubcomponents with any of the attributes listed below will be ineligible for support under the proposed\nHealth Resilience project.\n\n\nPage 51 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 53 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n**Attachment 2**\n\n**Checklist of Possible Environmental and Social Impacts of Projects**\n\n**I. Subcomponent-related Issues**\n\n|S No|ISSUES|YES|NO|Comments|\n|---|---|---|---|---|\n|**A.**|**Zoning and Land Use Planning**||||\n|1.|Will the subproject affect land use zoning and planning or
conflict with prevalent land use patterns?||||\n|2.|Will the subproject involve significant land disturbance or site
clearance?||||\n|3.|Will the subproject land be subject to potential encroachment
by urban or industrial use or located in an area intended for
urban or industrial development?||||\n|**B.**|**Utilities and Facilities **||||\n|4.|Will the subproject require the setting up of ancillary
production facilities?||||\n|5.|Will the subproject require significant levels of accommodation
or service amenities to support the workforce during
construction (e.g., contractor will need more than 20 workers)?||||\n|**C **|**Water and Soil Contamination**||||\n|6.|Will the subproject require large amounts of raw materials or
construction materials?||||\n|7.|Will the subproject generate large amounts of residual wastes
or construction material waste, or cause soil erosion?||||\n|8.|Will the subproject result in potential soil or water
contamination (e.g., from oil, grease, and fuel from equipment
yards)?||||\n|9.|Will the subproject lead to contamination of ground and
surface waters by herbicides for vegetation control or chemicals
(e.g., calcium chloride) for dust control?||||\n|10.|Will the subproject lead to an increase in suspended sediments
in streams affected by road cut erosion, decline in water
quality, and increased sedimentation downstream?||||\n|11.|Will the subproject involve the use of chemicals or solvents?||||\n|12.|Will the subproject lead to the destruction of vegetation and
soil in the right-of-way, borrow pits, waste dumps, and
equipment yards?||||\n|13.|Will the subproject lead to the creation of stagnant water
bodies in borrow pits, quarries, etc., encouraging mosquito
breeding and other disease vectors?||||\n|**D.**|**Noise and Air Pollution Hazardous Substances**||||\n|14.|Will the subproject increase the levels of harmful air emissions?||||\n|15.|Will the subproject increase ambient noise levels?||||\n\n\n\nPage 52 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 54 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n|16.|Will the subproject involve the storage, handling, or transport
of hazardous substances?|Col3|Col4|Col5|\n|---|---|---|---|---|\n|**E.**|**Fauna and Flora**||||\n|18.|Will the subproject involve the disturbance or modification of
existing drainage channels (rivers, canals) or surface water
bodies (wetlands, marshes)?||||\n|19.|Will the subproject lead to the destruction of or damage to
terrestrial or aquatic ecosystems or endangered species,
directly or by induced development?||||\n|20.|Will the subproject lead to the disruption/destruction of wildlife
through interruption of migratory routes, disturbance of
wildlife habitats, and noise-related problems?||||\n|**F.**|**Destruction/Disruption of Land and Vegetation**||||\n|21.|Will the subproject lead to unplanned use of the infrastructure
being developed?||||\n|22.|Will the subproject lead to long-term or semi-permanent
destruction of soils in cleared areas not suited for agriculture?||||\n|23.|Will the subproject lead to the interruption of subsoil and
overland drainage patterns (in areas of cuts and fills)?||||\n|24.|Will the subproject lead to landslides, slumps, slips, and other
mass movements in road cuts?||||\n|25.|Will the subproject lead to erosion of lands below the roadbed
receiving concentrated outflow carried by covered or open
drains?||||\n|26.|Will the subproject lead to health hazards and interference with
plant growth adjacent to roads by dust raised and blown by
vehicles?||||\n|**G.**|**Cultural Property**||||\n|27.|Will the subproject have an impact on archaeological or
historical sites, including historic urban areas?||||\n|28.|Will the subproject have an impact on religious monuments,
structures, and/or cemeteries?||||\n|29.|Have Chance Finds procedures been prepared for use in the
subproject?||||\n|**H.**|**Expropriation and Social Disturbance**||||\n|30.|Will the subproject involve land expropriation or demolition of
existing structures?||||\n|31.|Will the subproject lead to induced settlements by workers and
others, causing social and economic disruption?||||\n|32.|Will the subproject lead to environmental and social
disturbance by construction camps?||||\n\n\n\nPage 53 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 55 + ] + } + }, + { + "input_text": "**The World Bank**\nLebanon Health Resilience Project (P163476)\n\n\n**II. Site Characteristics**\n\n\n\n\n\n\n\n|S.No|ISSUES|YES|NO|Comments|\n|---|---|---|---|---|\n|1.|Is the subproject located in an area with designated natural
reserves?||||\n|2.|Is the subproject located in an area with unique natural
features?||||\n|3.|Is the subproject located in an area with endangered or
conservation-worthy ecosystems, fauna, or flora?||||\n|4.|Is the subproject located in an area falling that is within 500
meters of national forests, protected areas, wilderness
areas, wetlands, biodiversity, critical habitats, or sites of
historical or cultural importance?||||\n|5.|Is the subproject located in an area in which it would create
a barrier for the movement of conservation-worthy wildlife
or livestock?||||\n|6.
|Is the subproject located close to groundwater sources,
surface water bodies, watercourses, or wetlands?||||\n|7.|Is the subproject located in an area with designated
cultural properties such as archaeological, historical, and
religious sites?||||\n|8.|Is the subproject in an area with religious monuments,
structures, and/or cemeteries?||||\n|9.|Is the subproject in a polluted or contaminated area?||||\n|10.|Is the subproject located in an area of high visual and
landscape quality?||||\n|11.|Is the subproject located in an area susceptible to
landslides or erosion?||||\n|12.|Is the subproject located in an area of seismic faults?||||\n|13.|Is the subproject located in a densely populated area?||||\n|14.|Is the subproject located on prime agricultural land?||||\n|15.|Is the subproject located in an area of tourist importance?||||\n|16.|Is the subproject located near a waste dump?||||\n|17.|Does the subproject have access to potable water?||||\n|18.|Is the subproject located far (1-2 km) from accessible
roads?||||\n|19.|Is the subproject located in an area with a wastewater
network?||||\n|20.|Is the subproject located in the urban plan of the city?||||\n|21.|Is the subproject located outside the land use plan?||||\n\n\n**Signed by Environment Specialist** **Signed by Project Manager**\nName: _______________________________ Name: _______________________________\nTitle: _______________________________ Title: _______________________________\nDate: _______________________________ Date: _______________________________\n\n\nPage 54 of 54\n\n\n", + "datasets": [], + "document": { + "source": "http://documents1.worldbank.org/curated/en/616901498701694043/pdf/Lebanon-Health-PAD-PAD2358-06152017.pdf", + "pages": [ + 56 + ] + } + } +] \ No newline at end of file