Participation is open to all 24 provinces. The provinces will express their intention of participating in the Project’s activities through a Letter of Intent (Carta de Adhesión) that has been signed by 13 provinces. The effective participation of the provinces will be governed by an Umbrella Agreement (Acuerdo Marco) to be signed by each province and NMOH, wherein each party agrees with the following: the Project’s design, legal framework, and conditions for Project execution; the EEPs and TLIs to be used to reimburse resources to the provinces; safeguard policies and reporting and verification mechanisms; and conflict resolution mechanisms. The Project’s Operational Manual will be an annex to this Umbrella Agreement.
Annual Performance Agreements will be signed by NMOH and the PMOHs. These agreements will include: the PMOH’s annual activity plan, setting annual targets to be met and specific commitments between the parties. The Umbrella Agreement and Annual Performance Agreements must be acceptable to the Bank.
UFI-S and an independent auditor with qualifications under terms of reference acceptable to the World Bank will verify that the execution of the EEPs complies with the agreed ratio (70 percent). Compliance with TLIs will be verified by DNCDs, with the support of a third-party agent for two indicators.
All activities under Component 3 of the Project will be implemented at the national level by NMOH. This component will use traditional Bank transaction-based procedures, including the national procurement of goods and services that will be distributed to the provinces based on progress in Project implementation.
Results Monitoring and Evaluation
NMOH’s monitoring and evaluation (M&E) system will be used to assess Project outcomes and targets. Several information sources and instruments will be used, including: (i) a health risk factors surveillance system; (ii) biannual Project management reports (prepared by DNCD and UFI-S); (iii) biannual progress monitoring reports of the implementation of the NCD strategy at the provincial level, measured through TLIs and the execution of EEPs; (iv) midterm and final assessments; (v) evaluations of interventions at the provincial level; and (vi) laboratory evaluation of interventions aimed at reducing sodium and trans fats in processed foods. Although the Project development indicators related to the vulnerable population protected against risk factors are measured globally, the government tracks the indicators by gender, with data provided by the National Risk Factor Surveys.
The Project will use intermediate indicators to track progress in the implementation of the supported activities at the provincial level. These indicators are related to the TLIs and will provide information on provincial progress toward the implementation of the NCD strategy at public health facilities and in municipalities, including, among other things: (i) improving the access of vulnerable people to quality NCD-related services and (ii) implementing various promotion interventions to improve healthy living. The Project will support the NMOH M&E system through the following activities: (i) supporting the surveillance of NCDs, injuries, and risk factors, through conducting national surveys and supporting other mechanisms, such as telephone-based risk factor surveillance; (ii) supporting NMOH’s digital information systems and the development of electronic medical records; and (iii) contributing to the evaluation of the interventions financed by the Project.
Sustainability
The activities to be financed will be sustainable as: (i) they represent a marginal additional expenditure for the NMOH (less than 3 percent of total expenditure), while the reimbursement of the provincial EEPs for activities in Components 1 and 2 represent on average about 2 percent of the EEPs’ actual budgets; (ii) health authorities at all levels of government are committed to prevent and control NCDs to reduce the burden of disease in the country and this commitment will likely remain; and (iii) these activities are needed to ensure the efficiency and effectiveness of the entire health system, generating benefits that far outweigh their cost.
KEY RISKS AND MITIGATION MEASURES
Risk Ratings Summary Table
Risk Category
|
Rating
|
Stakeholder Risk
|
Substantial
|
Implementing Agency Risk
| | |
Moderate
| | |
Moderate
|
Project Risk
| | |
Substantial
| | |
Low
| | |
Moderate
|
Delivery Monitoring and Sustainability
|
Moderate
|
Overall Implementation Risk
|
Substantial
|
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