Togo Essential Quality Health Services For Universal Health Coverage Project

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The parent project, Togo Essential Quality Health Services for Universal Health Coverage Project, with a total financing of US$70 million equivalent, was approved on March 11, 2021, and became effective on August 5, 2021, with a closing date of April 30, 2026. The proposed Additional Financing (AF) will add to the existing operation, with revisions planned to broaden the range of activities and address identified challenges to help the project achieve its development objective. This AF will provide US$70 million (IDA credit) and a US$1 million grant to address funding gaps, cost overruns, and supports new activities to improve health service delivery, digitalization, and emergency preparedness. This AF aims to expand the scope of the parent project to address critical gaps in the supply and demand of quality health and nutrition services, particularly as partner resources in Togo are declining. The operation will also address cost overruns due to underestimated construction and renovation costs. A Level II restructuring of the project is also planned, which will include: (i) the addition of new activities under Components 1 and 3; (ii) revisions to the results framework to more accurately capture implementation progress and reflect the expanded scope; (iii) revisions to the implementation arrangements with the adoption of a new constitution in March 2024; and (iv) an extension of the project’s closing date for the original financing to December 31, 2027 and for the AF to April 30, 2029, to allow adequate time for the completion of planned activities. All revisions are consistent with the World Bank’s Country Partnership Framework (CPF) for Togo for FY25-FY29 (Report No. 185419-TG), which was approved in May 2024, where this proposed AF is aligned with High Level Outcome 2 (HLO2), Improving Human Capital) that will support Togo’s progress towards Universal Health Coverage (UHC) by improving access to health facilities, increasing human resources in the health sector, and foster a higher coverage of the National Social Health Insurance (NSHI) Scheme. It is also aligned with the Corporate Scorecard Commitment on crisis preparedness and health emergency preparedness and response.The Additional Financing is structured around the same complementary components and sub-components, except in Component 1 with the addition of a sub-component on Strengthening health emergency preparedness and response. The five components are as follows: (a) Component 1: Increasing the demand for and supply of quality health and nutrition services, which is implemented through PBCs to improve the quality of health services; (b) Component 2: Bringing health facilities and services closer to households, which aims to build, renovate, and equip 200 health facilities; (c) Component 3: Strengthening the NSHI, which aims to lay the foundations for UHC; (d) Component 4: Improved stewardship, oversight, and management, which helps ensure proper management of project activities; and (e) Component 5: Contingent Emergency Response Component (CERC), which allows the rapid reallocation of project resources in response to a natural and manmade disaster that has caused, or is likely to imminently cause, significant adverse economic and/or social impacts. Under the parent project, the Project Coordination Unit (PCU) is under the Office of the President with two Project Implementation Units (PIUs): one at the Ministry of Health and Public Hygiene and one at the Institute of National Health Insurance (Institut National de l’Assurance Maladie, INAM) at the Ministry of Access to Care and Universal Health Coverage. Due to a governmental reform, the PCU is now under the Office of the President of the Council and the reform in the health sector has merged the two ministries into a single entity: the Ministry of Health, Public Hygiene, Universal Health Coverage, and Insurance (MoH-UHC).