Côte d'Ivoire Health, Nutrition, and Early Childhood Development Program

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The proposed Additional Financing (AF) will (1) cover the financing gap due to exchange rate fluctuations and financing shortfall of the Global Fund co-financing; (2) ensure the achievement of the Project Development Objective (PDO) of Phase 1 of the Program by sustaining the continuity of critical activities beyond July 2025 when current funds will be exhausted; (3) support the scale up of existing activities to accelerate results and enhance the development impact of Phase 1 of the program. The parent project, Cote D'ivoire Health, Nutrition, and Early Childhood Development Program (P179550) is a 10-year (2023-2033) program, which was approved by the World Bank Board of Executive Directors on June 30, 2023.The MPA aims to contribute towards the Government’s objective to improve human capital accumulation, preservation and use. The World Bank Groups Country Partnership Framework (CPF) for Cote d'Ivoire for FY 2022-2026 (Report No. IDU-CPF-0000012), focuses on three Higher Level Objectives (HLOs): HLO1- Improved human capital; HLO2 - Reduced spatial disparities and strengthened resilience and, HLO3 - Jobs created through private sector-led growth. The MPA is in line with the Government’s 2030 National Stregic Plan, the 2040 National Prospective study, the national health sector strategic plan (PNDS 2021-2025) and sectoral strategies for health, social protection and multisectoral nutrition and early childhood development. In addition, it is also fully aligned with the World Bank’s Western & Central Africa Regional Priorities, aimed at “supporting a resilient recovery” (2021-2025). It is also strongly linked to the IDA20 overarching theme, “Building, Back Better from the Crisis – Toward a Green, Resilient and Inclusive Future” specifically contributing towards key priorities, such as human capital, FCV, gender and climate change. The MPA builds-on, consolidate and expand on the successes and lessons learned under the recently closed Strategic Purchasing and Alignment of Resources and Knowledge in Health Project (SPARK-Health, P167959, 2019-2025), and Multisectoral nutrition and Child Development Project (P161770), and strengthens institutional and operational linkages between interventions under the education, social protection, governance and finance sector operations such as Social Safety Nets Program (PforR) (P175594), Cote d’Ivoire Strengthening Primary Education System Program (SPESP - P177800, Youth Employment and Skills Development Project – Phase 3 (P172800), Enhancing Government Effectiveness for Improved Public Services Program for Results, Competitive Value Chains for Jobs and Economic Transformation Project (P172425) to, together, support a comprehensive and coordinated approach towards human capital development, preservation and use. The MPA includes three overlapping phases: (i) Phase 1 (2023-2027 ) is aimed at increasing coverage of Cote d’Ivoire’s Social Health Protection System (CI-SHPS), enhancing the quality and efficiency of health services, and expanding the coverage of early childhood nutrition and development interventions; (ii) Phase 2 (2026-2030) will improve financing and delivery systems’ efficiency of health, nutrition and early childhood development (ECD) services; (iii) Phase (2029-2033) will develop equitable and resilient health, nutrition and ECD systems through integrated financing regimes. Phase 1 of the MPA (“the Project”) was declared effective on October 12, 2023, and is expected to close on June 30, 2028. Phase 1 strengthens four priority areas to ensure more equitable access to quality health, nutrition, and ECD services, by building a consolidated and resilient Social Health Protection system (SHP), coupled with improved demand for services, led by the community, ultimately increasing utilization of quality services. Specifically, Phase 1 seeks to increase coverage of a functional and effective CMU scheme (Priority area 1), improve the quality of service delivery (Priority area 2), increase the coverage of early years nutrition and development interventions (Priority area 3) and improve demand for services and promote community mobilization (transversal priority).The Additional Financingis structured around the same complementary components and sub-components as the Parent project:Component 1: Strengthen and expand the Social Health Protection System.Sub-component 1.1: Operationalize and scale-up the CMU; Sub-component 1.2: Institutionalize PBF and support health financing reforms. This component will be implemented by CNAM, technical units within the MSHP-CMU and MEPS and their operational branches at the regional, and district/ departmental level. Component 2: Improve quality of health, nutrition and ECD services. Sub-component 2.1: Improve human resource management; Sub-component 2.2: Improve availability of essential medicines and nutritional inputs; Sub-component 2.3 Strengthen governance; Sub-component 2.4: Increase access to quality clinical, radiology and laboratory services through public-private-partnerships; Sub-component 2.5: Equip health facilities and extend WASH services. This component will be implemented by technical directions within the MSHP-CMU and operational branches at the decentralized level, as well as through partnership with private sector providers. Component 3: Strengthen delivery of nutrition, ECD and RMNCAH-N services. Sub-component 3.1: Strengthen delivery of RMNCAH, nutrition and ECD services; Sub-component 3.2: Strengthen delivery of RMNCAH-N services; Sub-component 3.3: Demand creation and behavior change. The implementation of this component will be led by CONANUT who will coordinate all stakeholders involved in the implementation of activities. Operationalization of activities at the community level will be done by the Regional Councils, social centers, the FRANCs, and key line Ministries. Component 4: Institutional strengthening, M&E, and Project Management, will involve the three implementation agencies, namely MSHP-CMU, MEPS and CONANUT. Component 5: Contingent Emergency Response Component (CERC). The overall project will finance, through its above components, (i) construction, rehabilitation, and/or upgrading of public buildings and health facilities, and will support (ii) the national scale-up of the national health insurance scheme to the population and the scale-up of performance-based financing (PBF) to all health facilities; (iii) Village Model Farms for production of nutrient rich crops and poultry, (iv) an “integrated systems reform”, and development and adoption of strategic policy documents, as well as (vi) Technical Assistances (TA), training. The project will also support an “Integrated Diagnostic PPP” model and co-finance the PPP implementation. In addition to the implementing agencies, the primary beneficiaries of the project are low-income households and indigents, especially children, women, youth (girls and boys), vulnerable groups, and migrants and host communities in regions bordering FCV countries.