PROJECT INFORMATION DOCUMENT (PID) APPRAISAL STAGE Project Name Region Sector Project ID Borrower(s) Implementing Agency Environment Category Date PID Prepared Date of Appraisal Authorization Date of Board Approval Report No.: AB5869 Additional Financing for the 2nd Health System Modernization Project (APL2) in Support of the 2nd Phase of the Health Sector Reform EUROPE AND CENTRAL ASIA Health (86%);Central government administration (11%);Tertiary education (3%) P121728 REPUBLIC OF ARMENIA Ministry of Health [ ] A [X] B [ ] C [ ] FI [ ] TBD (to be determined) July 6, 2010 September 17, 2010 December 21, 2010 1. Country and Sector Background The economic framework has had strong fundamentals. Until 2009, growth averaged over 10% per annum, and fiscal deficits and public debt were modest. 2009 has been a difficult year for Armenia, including a fall in GDP estimated at about 15%. The country has experienced its most severe economic crisis since the early years of transition, with a dramatic contraction in economic growth and an increase in poverty that threatens to reverse the earlier gains in living standards. Consequently, poverty and unemployment are expected to rise. At the same time, the basic economic and financial sector framework remains sound, and growth is expected to return to positive territory in 2010. 2. Objectives The objective of the Project is to strengthen the Ministry of Health’s (MoH) capacity for more effective system governance, scaling up family medicine-based primary health care and upgrading selected healthcare service delivery networks in Administrative unit in Armenia (marzes) to provide more accessible, quality and sustainable health care services to the population. 3. Rationale for Bank Involvement The Government of Armenia has requested the Bank to provide additional financing (AF) to scale up the activities initiated by the ongoing project. The AF, which has the strong support of the Government of Armenia (GoA), is a better mechanism to maximize development impact and results than a repeater project, a completely new operation, or non-lending instruments. 4. Description Component A: Family Medicine Development. This component will continue supporting the strengthening of institutional capacity to train well-qualified family physicians and nurses as first line PHC providers and improve their physical and material working environment. Component B: Hospital Network Optimization. This component will support the implementation of the optimization plans in the remaining eight marzes by upgrading the facilities and refurbishing them with modern the medical and waste management equipment. Component C: Institutional Strengthening. This component will help to strengthen the capacity of the Ministry of Health, its allied agencies and the State Medical University to better plan, monitor and evaluate for effective system governance and improve the skills base of the health workforce. Component D: Project Management. The objective of this component is to provide institutional support to the MOH and Project Unit related to the operations, audits, project monitoring and evaluation. 5. Financing ($m.) Source: Borrower International Bank for Reconstruction and Development Total 5.00 15.00 20.00 6. Implementation Project design and implementation arrangements will remain the same, including the same financial management and procurement arrangements. The AF will be implemented by the Ministry of Health supported by the Health Project Implementation Unit, which has extensive capacity to fulfill Bank’s requirements. 7. Sustainability The AF will continue to support Government’s health reform agenda as it moves towards the second generation of health sector reforms. 8. Lessons Learned from Past Operations in the Country/Sector The AF will continue to build on the positive results from Phases 1 and 2 of the Adaptable Program Lending (APL) series. 9. Safeguard Policies (including public consultation) Adequate attention has been paid to date to safeguards requirements under the APL series, including appropriate site-specific Environmental Management Plans (EMPs) and the preparation of a draft Health Care Waste Management Plan under APL1 and APL2. Works have been carried out on existing hospital sites; safeguard checklists duly filled; and mitigation measures, as stated in EMP, have been followed. The proposed scale-up activities will not trigger any safeguard policy not triggered by the original Project. The AF will support civil works of the same nature and magnitude as the original Project and the environmental procedures outlined in the existing Framework Environmental Management Plan (EMP) will remain applicable. 10. List of Factual Technical Documents Project Appraisal Document for the Health System Modernization Project (APL2) – Report No. 38149-AM dated February 7, 2007; Environmental Management Plan, Disclosed July 15, 2010; Country Partnership Strategy (CPS, 2009-2012). 11. Contact point Contact: Susanna Hayrapetyan Title: Sr Health Spec. Tel: 5251+250 Fax: (202) 477-0574 Email: shayrapetyan@worldbank.org Location: Yerevan, Armenia (IBRD) 12. For more information contact: The InfoShop The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 458-4500 Fax: (202) 522-1500 Email: pic@worldbank.org Web: http://www.worldbank.org/infoshop