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i
Document of
The World Bank
Report No: ICR00003278
IMPLEMENTATION COMPLETION AND RESULTS REPORT
(IBRD-82830)
ON A
LOAN
IN THE AMOUNT OF US$150 MILLION
TO THE
HASHEMITE KINGDOM OF JORDAN
FOR AN
EMERGENCY PROJECT TO ASSIST JORDAN PARTIALLY MITIGATE IMPACT
OF SYRIAN CONFLICT
January 21, 2015
Social Protection and Labor Global Practice
Iran, Iraq, Jordan, Lebanon, Syria Country Department (MNC02)
Middle East and North Africa Region
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CURRENCY EQUIVALENTS
(Exchange Rate Effective: July 31, 2014)
Currency Unit = Jordanian Dinar (JOD)
JOD 0.708 = US$ 1.00
US$ 1.41 = JOD 1.00
FISCAL YEAR
January 1–December 31
ABBREVIATIONS AND ACRONYMS
CIDA Canadian International Development Agency
CBJ Central Bank of Jordan
CPS Country Partnership Strategy
DRC Democratic Republic of Congo
DA Designated Account
FM Financial Management
GDP Gross Domestic Product
GOJ Government of Jordan
IEG Independent Evaluation Group
IMF International Monetary Fund
JFDA Jordan Food and Drug Administration
JPD Joint Procurement Department
JPRC Jordanian Petroleum Refinery Company
LPG Liquefied Petroleum Gas
MOF Ministry of Finance
MOH Ministry of Health
MOIT Ministry of Industry and Trade
MOPIC Ministry of Planning and International Cooperation
NEPCO National Electric Power Company
NGO Non-governmental Organization
PDO Project Development Objective
SBA Stand-by Arrangement
SPF State and Peace Building Fund
TB Tuberculosis
UNHCR United Nations High Commissioner for Refugees
UNICEF United Nations Children’s Fund
WDR World Development Report
Acting Vice President: Gerard Byam
Senior Global Practice Manager: Arup Banerji
Country Director: Ferid Belhaj
Practice Manager: Yasser El-Gammal
Project Team Leader: Haneen Sayed
ICR Team Leader: Maniza Naqvi
iii
HASHEMITE KINGDOM OF JORDAN
EMERGENCY PROJECT TO ASSIST JORDAN PARTIALLY MITIGATE IMPACT
OF SYRIAN CONFLICT
Data Sheet ................................................................................................................................................. iv
1. Project Context, Development Objectives and Design .......................................................................... 1
2. Key Factors Affecting Implementation and Outcomes .......................................................................... 9
3. Assessment of Outcomes ......................................................................................................................14
4. Assessment of Risk to Development Outcome .....................................................................................20
5. Assessment of Bank and Borrower Performance .................................................................................20
6. Lessons Learned ...................................................................................................................................23
7. Comments on Issues Raised by Borrower ............................................................................................24
Annex 1. Project Costs and Financing ......................................................................................................26
Annex 2. Outputs by Component .............................................................................................................27
Annex 3. Economic and Financial Analysis .............................................................................................29
Annex 4. Bank Lending and Implementation Support/Supervision Processes .........................................32
Annex 5. Summary of Borrower's ICR and/or Comments on Draft ICR .................................................34
Annex 6: Lessons Learned From Fiduciary Perspective...........................................................................40
Annex 7. List of Supporting Documents ..................................................................................................46
MAP ......................................................................................................... Error! Bookmark not defined.
iv
Data Sheet
A. Basic Information
Country: Jordan Project Name:
Emergency Project to
Mitigate the Impact of
Syrian Displacement on
Jordan
Project ID: P145865 L/C/TF Number(s): IBRD-82830
ICR Date: 12/08/2014 ICR Type: Core ICR
Lending Instrument: IPF Borrower:
Ministry of Planning
and International
Cooperation
Original Total
Commitment: US$150.00 million Disbursed Amount: US$149.7 million
Revised Amount: US$150.00 million
Environmental Category: C
Implementing Agencies: Ministry of Finance
Cofinanciers and Other External Partners: n.a.
B. Key Dates
Process Date Process Original Date Revised / Actual
Date(s)
Concept Review: 05/06/2013 Effectiveness: 08/21/2013
Appraisal: 06/04/2013 Restructuring(s): n.a. n.a.
Approval: 07/18/2013 Mid-term Review: n.a. n.a.
Closing: 07/31/2014 07/31/2014
C. Ratings Summary
C.1 Performance Rating by ICR
Outcomes: Satisfactory
Risk to Development Outcome: Low
Bank Performance: Highly Satisfactory
Borrower Performance: Satisfactory
C.2 Detailed Ratings of Bank and Borrower Performance (by ICR)
Bank Ratings Borrower Ratings
Quality at Entry: High Government: Satisfactory
Quality of Supervision: Satisfactory Implementing
Agency/Agencies: Satisfactory
Overall Bank
Performance: Satisfactory
Overall Borrower
Performance: Satisfactory
v
C.3 Quality at Entry and Implementation Performance Indicators
Implementation
Performance Indicators
QAG Assessments
(if any) Rating
Potential Problem Project
at any time (Yes/No): No NA None
Problem Project at any
time (Yes/No): No
Quality of
Supervision (QSA): None
DO rating before
Closing/Inactive status: Satisfactory
D. Sector and Theme Codes
Original Actual
Sector Code (as % of total Bank financing)
Health 40 40
Other social services (Social Protection) 60 60
Theme Code (as % of total Bank financing)
Child health 33 33
Health system performance 7 7
Nutrition and food security 37 37
Other economic management 7 7
Other social protection and risk management 16 16
E. Bank Staff
Positions At ICR At Approval
Acting Vice President: Gerard Byan Gerard Byam
Country Director: Ferid Belhaj Ferid Belhaj
Practice
Manager/Manager: Yasser El-Gammal Yasser El-Gammal
Project Team Leader: Haneen Ismail Sayed Haneen Ismail Sayed
ICR Team Leader: Maniza B. Naqvi Maniza B. Naqvi
ICR Primary Author: Maniza B. Naqvi Maniza B. Naqvi
F. Results Framework Analysis
Project Development Objectives (from Project Appraisal Document)
The project objective is to help the Borrower maintain access to essential health care
services and basic household needs for the Jordanian population affected by the large and
increasing influx of Syrian refugees.
vi
Revised Project Development Objectives (as approved by original approving authority)
Not Applicable
(a) PDO Indicator(s)
The PDO indicators and the intermediate outcome indicators reflect values at the baseline
level, original target values, and cumulative actual values achieved at completion.
Baseline levels are of the same magnitude as the completion levels, as the objective of the
project was to maintain the same level and coverage of access that the government has
been providing to the Jordanian population in terms of access to essential household
needs and medical services. Therefore, the number of beneficiaries at the baseline level
who received services from the government remained the same by the end of the project.
Indicator Baseline Value
Original Target
Values (from
approval
documents)
Formally
Revised
Target Values
Actual Value
Achieved at
Completion or
Target Years
Direct project beneficiaries
(number), of which women (%)
- beneficiaries of drugs and
vaccines
- beneficiaries of medical
treatments
6.23 million1
48.6%
6.23 million
48.6%
6.37 million
48.6%
Beneficiaries of safety net
programs (subsidies), of which
women (%)
2.5 million
48.6%
2.5 million
48.6%
2.5 million
48.6%
Children immunized (0–6
years) 97% 97% 97%
Per capita outpatient utilization
rates at Primary Health Care
Centers to remain at or above
baseline value
0.58% 0.58% 0.58%
Per capita inpatient admission
rates at hospitals to remain at or
above baseline value 1.10 1.10 1.10
Number of uninsured patients
from the northern governorates 0 2,500 See footnote2
1 This represents the population of Jordan. The subsidy is a universal subsidy. The project team relied on
this indicator as provided by the Ministry of Finance.
2 This subcomponent provided for financing of health care services for Jordanians in non-MOH health
facilities (US$20 million) if they were crowded out from MOH hospitals due to Syrian refugees. According
to the design, the project required that MOH provide evidence of this through an independent auditor to be
hired by the project. Due to delays in hiring the auditor, at the time of audit there were not enough cases.
Hence, there was underspending in the subcomponent and the ‘reallocation’ of the funds to drugs and
vaccines with Bank approval.
vii
referred to non-MOH facilities
for medical treatment
(b) Intermediate Outcome Indicator(s)
Indicator Baseline Value
Original Target
Values (from
approval
documents)
Formally
Revised
Target
Values
Cumulative
Actual Value
Achieved at
Completion or
Target Years
MOH warehouses in target
areas with no drug stock-outs
in the last week
7 2 2
Vaccination/medicines
purchased by the JPD as per
the Rational Drug List 90 112 117
Wheat purchased (Metric Ton) 44,972 64,811 77,773
LPG purchased (Metric Ton) 21,293,782 18,09,409 3,196,622
G. Ratings of Project Performance in ISRs
No. Date ISR
Archived DO IP
Actual
Disbursements
(US$, millions)
1 03/07/2014 Satisfactory Satisfactory 81.00
H. Restructuring (if any)
Not Applicable
I. Disbursement Profile
1
1. Project Context, Development Objectives and Design
1.1 Context at Appraisal
Country Background
1. At the time of appraisal, the project approach responded to the emergency
caused by a huge increase in Syrian refugees, which threatened to set back Jordan’s
strong achievements in human development and poverty reduction. The crisis further
strained the government of Jordan’s (GOJ) already increasing fiscal and external balances.
In the summer of 2013, there was concern about the risk of major outbreaks of disease.
Jordan risked being unable to maintain its health and basic needs support for its citizens.
There was concern of possible social unrest due to an already strained economy and as a
result of the Syrian refugees who had crossed the border into Jordan, beginning 2011. By
January 2012, there was an influx of 3,063 people which swelled to 42,000 by August that
year. At the time of project effectiveness a year later, the refugee influx had taken on
emergency proportions, with a total number of registered 523,059 Syrian refugees in
Jordan after two years of the conflict in Syria3 and threatened to continue to increase. By
the time the project closed, an estimated 619,163 million Syrian refugees had crossed the
border into Jordan according to the United Nations High Commissioner for Refugees
(UNHCR), by September 2014. At the time the UNHCR estimated that by the end of 2013,
the number of refugees in Jordan would surpass the one million mark, constituting more
than 16 percent of the population. The GOJ was concerned that achievements in health
would be reversed because diseases that had been eliminated in Jordan, for example,
measles and polio, had reappeared since the influx of refugees.
2. The project responded to the need for alleviating the strain on the economy
which had experienced large exogenous shocks over the past years and had resulted
in a sharp and unsustainable deterioration of its fiscal and external balances. Jordan
imports almost all of its input for electricity generation, mostly in the form of gas from
Egypt (contracted at preferential rates). Due to gas pipeline explosions, gas supplies from
Egypt had drastically shrunk in 2012 to 16 percent of contractual obligations. To meet its
generation needs, Jordan had to substitute cheap gas with expensive oil imports. This
resulted in a drastic and unsustainable widening of both the current account and the fiscal
balance deficits. Faced with mounting macroeconomic vulnerabilities, including a large
deterioration in its foreign exchange reserves, Jordan entered into an International
Monetary Fund (IMF) Stand-by Arrangement (SBA) program in August 2012. Given the
magnitude of the vulnerabilities and financing needs of the country, the SBA required
exceptional access from the IMF. Given Jordan’s low employment elasticity to growth, the
country’s already high unemployment rate further deteriorated, from 12.5 percent at end-
3 UNHCR Data: http://data.unhcr.org/syrianrefugees/country.php?id=107
2
2012 to 12.8 percent in the first quarter of 2013, with unemployment levels particularly
high among women and youth.
Sector Background
3. Universal subsidies for LPG and bread and free health care to the poor and
lower-middle-income groups are provided by the GOJ. The accelerating influx of
Syrian refugees since 2011 increased the demand for LPG and bread and increased the
costs (bill/aggregate cost) of vaccines, drugs, and medical treatment (annex 3). While some
of the Syrian refugees are living in camps, the large majority (estimated to be as much as
70 percent of refugees) are living in Jordanian communities. In addition to its commitment
not to close its borders, the GOJ decided early on to allow Syrian refugees access to public
services (health facilities, schools) and subsidies extended to Jordanian citizens (energy,
water, bread, and gas), hence putting pressure on delivery of services and public finances.
The immediate impact of the exponential increase in users over such a short period strained
the budget for subsidies and caused a depletion of Jordanian drugs and vaccination stocks.
Refugees attending the Ministry of Health (MOH) hospitals increased from 300 to 10,330
from 2012 to 2013; this was associated with a sharp increase in the number of surgeries
performed at these hospitals from 105 to 622. The GOJ is strongly committed to protecting
not only its poor and lower-middle-income citizens but also the refugees within its borders.
One of the elements of its poverty-reduction approach has been to provide access to basic
household commodities for the population, particularly bread and LPG household
cylinders (used for cooking and space heating). The bread and LPG cylinders programs are
simple in their design and enable all households living in Jordan to access basic necessities,
as these are universal untargeted programs.
4. Subsidy expenditures for health, bread, and LPG are channeled by the
Ministry of Finance (MOF) to the Ministry of Industry and Trade, (MOIT), Jordan
Petroleum Refinery Company (JPRC), and the MOH. The MOF manages the budget
for the subsidies program, which is more than half of the project, and implements the large
cash transfer program for subsidy compensation (supported by a World Bank project),4
which requires a large amount of budget handling, payments, and advanced information
technology (IT) systems. Owing to these considerations, the need to act with speed in an
emergency, and to not burden the GOJ system further, it was appropriate that the project
be implemented by the MOF.
5. The subsidies program for bread and LPG cylinders is simple in its design and
translates into price controls at the points of sale which enable all households in
Jordan to access basic necessities, as these are universal untargeted programs. Both
programs are on-budget, as opposed to subsidies on water or electricity so the link between
increased consumer demand and the GOJ budget is clearer. Bread and LPG are heavily
consumed products by Jordanian households. Poorer households spend a larger share of
4 National Unified Registry and Outreach Worker Program for Targeted Social Assistance
3
their total expenditure on these two products.5 They account for about 7 percent of poor
households’ total consumption but only 2 percent of the richest Jordanian households’ total
consumption. More specifically, Jordanian households in the bottom decile spend 3.6
percent of their expenditures on subsidized food items, whereas for the richest 3 deciles
this share falls to below 1 percent. Similarly, the poorest 20 percent of Jordanian
households spend 2.3 percent of their total spending on LPG compared to 1 percent for the
richest 20 percent households.6 Bread and LPG also account for a relatively large share of
poor households’ total spending so disruption to their supply would have a material impact
on these households.
6. One of the key sectors that is facing pressures as a result of the influx of Syrian
refugees is the health sector. According to Jordanian law, Jordanians are eligible for free
health care in MOH facilities, so while the MOH provides health services to the refugees,
efforts continue to maintain Jordanians’ access to health care services. To accommodate
the needs of the Jordanian population, the MOH has referred patients to non-MOH
hospitals at a higher cost than at its own facilities. The MOH’s system for referring patients
to non-MOH facilities is as follows: treatment of the uninsured is under the auspices the
Royal Diwan for Medical Services - Department of the Uninsured, based at the MOH. This
program is only for the uninsured Jordanians. The department has the responsibility of
receiving, reviewing, validating, and approving referrals to non-MOH facilities. Uninsured
patients referred from MOH providers for lack of availability of needed treatment have to
submit an application with a medical report to the department. The department first
conducts a screening to validate that the patient is uninsured and that he/she does not have
any other sources of coverage. Once verified, the department refers the patient to the MOH
employees’ clinic department to conduct a medical check-up to validate the medical
diagnosis and need for treatment. Based on the results, the MOH recommends the patient’s
referral to the most appropriate and cost-effective hospital. The referral documents are then
approved by the director of the department of the Royal Diwan for Medical Services.
Consequently, the MOH receives monthly bills from the hospitals with listings of all
patient names and invoices. The MOH has medical auditors who select 10 percent of the
bills for detailed review and auditing. The medical auditing is considered both a technical
and financial audit since it validates the appropriate utilization of services based on the
medical condition of the patient as well as the billing of these services according to the set
rates.
7. Continuity and sustainability of health service delivery in Jordan is at risk of
being compromised, and past achievements in the sector are potentially threatened. According to UNHCR data, 78 percent of the Syrian refugees are vulnerable, requiring
additional assistance. This includes women (49 percent), children under the age of 12 (40
percent), and elderly (2.1 percent). In addition, 23 percent of Syrian refugees have chronic
5 World Bank (2009, 2015).
6 World Bank. 2012. Hashemite Kingdom of Jordan: Options for immediate fiscal consolidation and longer
term fiscal consolidation. Report No. 71979-JO. Washington DC.
4
diseases or serious medical conditions that require medical follow up. Comparative
morbidity data show a different disease profile with increased levels of morbidity for
Syrians refugees than Jordanians which may affect the disease burden in the future.
According to Jordan’s national cancer statistics, Syrian refugees presenting with cancer at
health facilities rose from 134 in 2011 to 169 in the first quarter of 2013, representing a 14
percent increase in Jordan’s total cancer disease burden. Similarly, morbidity data from the
MOH show a rise in selected communicable diseases. For example, tuberculosis (TB) case
notification increased from 5 per 100,000 in 2009 among Jordanians to 13 per 100,000
among Syrian refugees in 2013. While no measles cases have been reported in Jordan since
2009, MOH data show that 18 Jordanians and 23 Syrians have been diagnosed with the
disease in 2013. Polio, which had been eliminated since 1999 in Jordan, was also detected
in two cases in 2013. Demand for services by refugees at MOH facilities has increased
significantly. MOH data show that the number of outpatient visits to MOH primary health
care centers (PHCCs) by Syrian refugees increased from 68 in January 2012 to 15,975 in
March 2013. Similarly and during the same period, the number of surgeries performed at
these hospitals went up from 105 to 622. With the higher demand for health services and
the GOJ’s policy to provide refugees with access to the country’s health care services, the
health sector is facing significant financial pressures and shortages, particularly in drugs
and vaccines, as these are being depleted at a faster rate.
Rationale for Bank Involvement
8. The appraisal was embedded in the flexible strategic framework and
overarching strategic objective of the World Bank Group’s Jordan Country
Partnership Strategy (CPS) for 2012–2015 which recognizes Jordan’s vulnerability
to shocks and is focused on building resilience to internal and external shocks through
laying a foundation for inclusive growth and job creation.7 The flexible manner of the
strategic framework of the CPS was formulated to allow for needed adjustments including
additional operations in response to GOJ’s demand. One key pillar identified in the CPS to
help mitigate risks, and to which the proposed emergency project speaks, is enhancing
inclusion through social protection and local development. Under this pillar, the CPS
places enhancement of inclusion and improvement of living standards of the population at
the center of the strategy, with social protection and local development as one of the means
for reducing regional imbalances. More than three years of violent conflict in Syria has
resulted in massive movements of people within Syria, as well as into neighboring
countries. The worsening of the conflict over the last two years has profoundly changed
the landscape in neighboring countries, in particular Lebanon and Jordan, in terms of the
immediate security, social and fiscal challenges facing the country and in terms of the
potential impacts on development gains down the road. At about 10 percent of Jordan’s
population, the large influx of refugees is straining the availability and quality of public
7 The World Bank Group. 2012. Country Partnership Strategy for the Hashemite Kingdom of Jordan for
the Period FY12–FY15. Report 58114-JO. MNC02 Country Management Unit. Middle East and North
Africa Region.
5
services, especially in the northern governorates. The additional demand for public services
(electricity, water, solid waste management, education, and health) is adding a significant
burden to Jordan’s already weak public finances.8 Such increases in the number of refugees
into Jordan are threatening the country’s strong achievements in human development and
poverty reduction. The rationale for the project was to support the basic needs of Jordanian
households (through financing bread and household gas subsidies) and maintain Jordan’s
achievements in poverty reduction. As the Syrian conflict clearly impacted development
achievements in already vulnerable areas, the operation, in alignment with the CPS,
addressed poverty, as well as human development services to vulnerable groups.
9. The project appraisal focused on the Jordanian population because in spite of
the significant impact felt by the Jordanian state and communities, the majority of
the international support has been channeled to the needs of the displaced Syrians. UN agencies such as the UNHCR and the United Nations Children’s Fund (UNICEF),
supported by donors, international non-governmental organizations (NGOs), and charities,
cater to the needs of those residing in camps and cover some social services of those
outside.9 Very little has been targeted to mitigate the impact of the influx of Syrians on
livelihoods and service delivery of Jordanians.
10. Given the emergency situation, the project was appraised according to the
World Bank Operational Policy OP 10.00, paragraph 11, which allows for 40 percent
retroactive financing and for certain exceptions to the investment project financing policy
requirements if the Bank deems the borrower to be in urgent need of assistance because of
a man-made disaster or conflict (among other factors). The evolving situation in Jordan
reflected both the impact of conflict (in neighboring Syria) and of a man-made disaster
(resulting from the influx of refugees fleeing the conflict). These are two of the specific
situations that the provisions of OP 10.00, paragraph 11 were developed to address. The
appraisal was focused on an implementation period of one year but with a two-year
financing horizon taking into account the GOJ’s expenditures 12 months prior to project
effectiveness given the influx of refugees that swelled in July 2012. Therefore, a key
element of the project, retroactive financing of up to US$60 million, equivalent to 40
percent of the loan amount, was provided to finance US$21 million under Component 1
(vaccines and drugs) and US$39 million under Component 2 (bread and LPG cylinders)
for payments made before the loan signing date, but on or after June 30, 2012.
1.2 Original Project Development Objectives (PDO) and Key Indicators (as approved)
8 A recent study by the United States Agency for International Development estimates the 2014 fiscal cost of
the refugees in Jordan to reach 2.4 percent of GDP, up from 1.8 percent of GDP in 2013 (The Fiscal Impact
of the Syrian Refugee Crisis on Jordan dated January 5, 2014 produced for USAID).
9 Even though, it has been difficult to raise sufficient funds to cover these needs, the last UN appeal of
US$500 million has been met with a 50 percent response as of May 16, 2013.
6
11. The project objective was to help the GOJ maintain access to essential health care
services and basic household needs for the Jordanian population affected by the large and
increasing influx of Syrian refugees. Progress toward the PDO was to be monitored through
the following key indicators:
1. Direct project beneficiaries (6.23 million), of which women (48.6%) (Core
indicator). This indicator was to track the total beneficiaries of the immunization
program, and inpatient and outpatient medical treatment.
2. Children immunized (97%) (Core indicator). This indicator was to track the
percentage of children immunized over the project period.
3. Beneficiaries of social safety net program; subsidies (2.5 million), of which women
(48.6%) (Core indicator). This indicator was to track the total beneficiaries of the
bread and LPG cylinder subsidy.
4. Overall outpatient and inpatient utilization rates (0.58%) at health facilities remain
at or above baseline value. This indicator was to measure the increase in the rate of
utilization at the health facilities in the governorates most affected by Syrian
refugees.
1.4 Main Beneficiaries
12. The project beneficiaries consisted of:
Jordanian children aged 0–6 years: Children aged 0–6 years were to
receive vaccinations, which was to prevent and control transmission of
vaccine-preventable diseases.
Jordanian households particularly of the poor and lower middle classes:
The Jordanian population as a whole was to benefit from the project through
the continuation of the basic food (bread) and fuel (LPG) subsidies, as well
as the medicines financed under the project.
Jordanian patients: The project was to benefit approximately 2,500
Jordanian patients, particularly those living in the north, were to continue to
have access to health services.
Health facilities: The project was to provide health facilities with the needed
drugs and vaccines and ensure the stocks were available.
1.5 Original Components (as approved)
13. The project consisted of these three components: (i) maintaining access to essential
health care services; (ii) supporting basic household needs; and (iii) project monitoring,
auditing, and verification.
14. The project was implemented over 12 months, given the urgent needs. It included
provision for retroactive financing of up to US$60 million (40 percent of loan amount) for
expenditures (identified under the project) incurred 12 months prior to loan signing. While
indicative allocations were agreed upon during project appraisal for Component 1 and
7
Component 2, the project was designed to accommodate the changes in needs during
implementation. Disbursements were to be made either based on a positive list (agreed
upon during appraisal to be the Rational Drug List) or on transactions.
Project Components
Component 1: Maintaining Access to Essential Health Care Services (US$70 million)
15. This component aimed to sustain the provision of essential health care services to
the Jordanian population which is at risk due to the stress on resources resulting from the
large influx of Syrian refugees. This was to be achieved by financing needed vaccines and
drugs, and the treatment of Jordanians who are being crowded out from public hospitals as
a result of the increasing use of public services by Syrian refugees.
16. Provision of vaccines and essential drugs to ensure adequate and continuous
supply at all public health care facilities (US$50 million). The project was to finance a
total of US$50 million of drugs and vaccines.10 This figure was estimated based on (i) the
gross rate of pre-crisis consumption in medicine, namely in 2010 and 2011; (ii) projected
increase in the procurement of generic drugs at the rate of 3 percent (this rate was estimated
based on pre-crisis rates of increase, as well as the standard rate of increase set by the GOJ
given its goal of increasing the share of generic drugs procured); and (iii) actual
procurement of medication.
17. Financing of health care services for Jordanians in non-MOH health facilities
(US$20 million). This subcomponent aimed to mitigate the financial impact of referring
Jordanian patients to non-MOH hospitals and health facilities as a result of the increased
demand for public facilities by Syrian refugees. Specifically, the project financed the costs
of health care for approximately 2,500 Jordanian patients who the MOH needed to refer to
non-MOH hospitals and health facilities, based on criteria agreed upon with the MOH. This
was to help alleviate the burden of the Syrian crisis on affected communities, improve the
fiscal ability of the MOH to reimburse the non-MOH hospitals and health facilities for their
services, and assisted the MOH maintain its commitment for timely access to health care
to its citizens.
Component 2: Supporting Household Basic Needs (US$79.9 million)
18. Financing universal subsidies for household basic needs. The objective of this
component was to help the GOJ ensure uninterrupted supply of basic household
10 Medications received by the MOH from JPD—which procures drugs and vaccines for the MOH—are
distributed to seven MOH warehouses around the country. The inventory is then distributed to the PHCCs
and hospitals according to their projected need. Upon receipt of medications, representatives from PHCCs
and hospitals sign documents listing the names and quantities of drugs received prior to transporting the
inventory to the facilities.
8
commodities for poor and lower middle class households. The two subsidized products
financed under this component were bread (wheat) and LPG cylinders.
19. Bread (US$55 million). The project financed part of the increase in the cost of the
bread subsidies worth US$55 million which was the estimated cost—based on a regression
analysis—arising from the Syrian conflict and the associated increase in bread demand.
Specifically, the component financed the subsidy cost of 77,773 metric tons of flour for the
retroactive period from July 2012–June 2013, and an estimated 64,811 metric tons of flour
for the period July 2013–June 2014. The average subsidy cost per metric ton of flour was
estimated at US$385.7 based on the historical cost from July 2012–May 2013. Jordan’s
bread subsidy program is indirect as the government subsidizes wheat but also sets the
price of bread at the bakery level. The bread subsidy chain runs from the MOIT which is
the sole importer of wheat in the country. The MOIT sells imported wheat (along with
small quantities of domestically procured wheat) to mills at a preset price. This price is
established with a view to (i) keep the price of the subsidized bread constant at the bakery
level and (ii) maintain a given profit margin for mills. Mills transforms the wheat into flour
which is then sold on to bakeries. This flour is used specifically for this type of bread.
Bakeries sell the subsidized bread at a regulated retail price of JD 0.16 per kg. This price
has been unchanged since 1996. While this universal subsidy system is not efficient, in the
absence of any targeted system it is the only mechanism available to stabilize prices of
basic commodities to the poor and lower middle class.
20. LPG Cylinders (US$25 million). For the LPG cylinders, which are mostly used by
households for cooking and space heating, the project financed the increase in the cost
US$25 million worth of LPG subsidies which was the estimated cost arising from the
Syrian conflict and the associated increase in LPG demand. Jordan’s subsidized LPG
cylinder program is a direct subsidy scheme administered by the MOF and implemented
by the JPRC, which is the sole importer of LPG in Jordan (more generally, JPRC is the
sole provider of petroleum products in the country). Through its LPG cylinder factory, it
sells two types of LPG cylinders in Jordan: a 12.5-kg cylinder, the price of which is
subsidized and regulated by the government. This cylinder is aimed at households and it is
used for home cooking and also space heating. Specifically, the component financed the
subsidy cost of 1.8 million standard (12.5 kg) LPG cylinders for the retroactive period
(June 2012–June 2013), and an estimated 3.2 million cylinders for the period July 2013–
June 2014. The average subsidy cost per LPG cylinder was estimated at US$4.97 based on
the historical cost from June–December 2012 which was the latest data available at the
time of appraisal.
Component 3: Project Monitoring, Auditing and Verification (US$100,000)
21. This component financed (i) the costs of two special purpose audits (see below) as
required for Component 1 and (ii) the cost of an external auditor, acceptable to the World
Bank, who was appointed to audit the project financial statements covering the project’s
12-month lifetime for both Components 1 and 2.
9
22. For Component 1, an audit firm was to be contracted within three months of
effectiveness to perform an audit of the funds disbursed under retroactive financing for
vaccines and drugs. The auditor was to issue a special opinion on supporting documents
related to the Rational Drug List and the Designated Account (DA) to be established in the
Central Bank of Jordan (CBJ) to deposit the loan proceeds. Also, a consultancy firm was
to be contracted to perform a technical and financial verification of the list of medical bills
of patients who would be referred to non-MOH hospitals and health facilities before being
further processed for payment by the MOF. The project costs and financing are in annex 2.
1.6 Revised Components
23. Project components remained unchanged for the life of the project.
1.7 Other Significant Changes
24. Project design, scope and scale, implementation arrangements, and schedule
remained unchanged for the life of the project. There was a fund reallocation with Bank
approval from Component 1 subcomponent for financing of health care services for
Jordanians in non-MOH health facilities (US$20 million) to drugs and vaccines.11
2. Key Factors Affecting Implementation and Outcomes
2.1 Project Preparation, Design and Quality at Entry
25. The project preparation was completed in a record six weeks, following a request
at the Spring Meetings, in April 2013, made by His Highness the King of Jordan to the
World Bank President. The preparation thereafter, pivoted on the GOJ request, and
responded on an emergency basis following the guidelines set in OP 10.00, paragraph 11.
The project was prepared in collaboration with the GOJ and was led by the Ministry of
Planning and International Cooperation (MOPIC) and the MOF and a multisectoral Bank
team led by the Human Development department and included economic management;
social development; and fiduciary, social, and environmental safeguards specialists in
collaboration with the MOF. The project was approved by the Board on July 18, 2013.
26. The project design was based on the context of a crisis and emergency and therefore
followed the emergency procedures for processing. The fiduciary elements of the design
played a key role and are described in detail in annex 6. The project was designed for
disbursements of funds to be conditioned on the government demonstrating the shortfall
created in financing for Jordanian citizens by the assistance provided to Syrian refugees
for basic needs and LPG. A key element of the design was the 40 percent retroactive
financing. Because of the nature of the crisis and the burden on the GOJ budget from its
considerable expenditures due to the Syrian refugees, the project was prepared under
emergency procedures and was the first in the region to pilot OP 10.00, paragraph 11 which
11Ibid.
10
allows for retroactive financing of up to 40 percent. The quality of the project was high and
the design was relevant, learning from lessons of other emergency projects and on subsidies
which are reflected in the Project Appraisal Document (PAD). It was a time-bound (1 year)
discreet intervention which relied upon channeling support though existing and tested
structures, mechanisms, and institutional systems.
27. Risks taken into account during preparation. The project used existing
mechanisms that had been already assessed and reviewed by the World Bank’s fiduciary
team. Due to the emergency nature of this operation and the need to respond quickly, the
financial management and procurement approach was streamlined and based on more
simplified ex ante requirements, while relying more heavily on ex post requirements as
additional fiduciary controls and review. The risk mitigation measures were designed to
suit the available capacity during implementation (see annex 6). The preparation of the
project focused on maintaining access to basic services. While it was recognized that
universal or untargeted subsidies have drawbacks and come at a high fiscal cost in Jordan
as is the case elsewhere the crisis, however, necessitated a short-term intervention to
support the burden of the incremental increase in the volumes of bread and gas consumed
after the onset of the Syrian conflict. The project was designed to only address a temporary
shock while maintaining through other operations the dialogue on safety nets reforms. The
team wrote into the PAD a thorough economic analysis on the usage of subsidies, the status
of subsidies in Jordan, the policy dialogue underway to remove fuel subsidies and the
experience globally on the benefits and pitfalls of subsidies. There are, of course risks
inherent to all emergency operations including that they may not be prepared and
implemented in time or may not be sufficiently flexible to adapt to rapidly changing
circumstances. This project was able to mitigate these risks by taking advantage of OP
10.00 which provided the flexibility and ability to respond quickly and adequately. It was
able to mitigate risks by assessing the impact on critical social services and by using
existing systems. The political and social risk of not responding to the GOJ’s need should
also be taken into account. In addition, since this was an emergency project prepared under
emergency procedures it was not the vehicle for advancing ongoing policy reform dialogue.
2.2 Implementation
28. The supervision of the project by the Bank was carried out by the team based in the
region and able to respond to the client on a daily basis. The project was appraised to be
implemented by the MOF through its regular budget implementation and monitoring
mechanisms. There was no separate project implementation/management unit established.
Implementation of the project was primarily related to financial management of bills,
payments, and verifications/audits of the health and safety nets expenditures. The MOF
implemented the project through its regular budget implementation and monitoring
mechanisms and no separate project implementation/management unit was established.
Implementation of the project was primarily related to financial management of bills,
payments, and verifications/audits. Because such transactions are part of the MOF’s
function, it was considered logical that it be the implementing agency. More than half of
the project is related to LPG and bread subsidies, the MOF is also responsible for the
implementation of the large cash transfer program for subsidy compensation (supported by
11
a World Bank project),12 which requires a large amount of budget handling, payments, and
advanced IT systems. However, the MOF had limited experience with the World Bank
financial management (FM) and disbursement guidelines therefore training was provided
to a qualified accountant who was appointed by the MOF from its staff who followed up
on the FM and disbursement aspects of the project. In addition, the project financed the
following additional support for the MOF: (i) the hiring of the audit firms which verified
retroactive expenditures on vaccines, drugs, LPG, and bread; (ii) the hiring of the audit
firm to perform the annual audit on the project (could be same firm); (iii) the hiring of the
consulting firm from the project funds to perform a technical and financial verification of
medical bills for patients referred to non-MOH health facilities.
29. For the procurement of drugs and vaccines, the project relied on Jordan’s existing
system for procurement through the Joint Procurement Department (JPD). The JPD is the
central organization in Jordan which procures most of the pharmaceuticals in the kingdom.
The JPD, which began operations in 2004, based on by-law No. 91 of 2002 - Medicines
and Medical Supplies, was assessed by the Bank for conducting the procurement of
pharmaceutical and medical goods in a transparent, well-organized, and sound manner.
2.3 Monitoring and Evaluation (M&E) Design, Implementation and Utilization
30. The project was prepared within a very short period in response to an emergency
to maintain benefits. Given the need and context, the project relied on the indicators,
database and system that were in place for monitoring of the universal subsidies
implementation. Because the financing for the subsidies is based on universal subsidies,
the indicators for the basic needs reflect the entire population. The baseline levels are of
the same magnitude as the completion levels as the objective of the project was to maintain
the same level and coverage of access that the government has been providing to the
Jordanian population in terms of access to essential household needs and medical services.
Therefore, the number of beneficiaries at the baseline level who received services from the
government remained the same at the end of the project. The monitoring and verification
of project results were based on a FM and verification system which is designed to
routinely collect data in a timely fashion for the disbursement of subsidies. This data
collection resides in the MOF and provides for systematic monthly reports on the
disbursement of funds for the purpose of the universal subsidies. The MOF coordinated the
reporting on the project indicators which were generated from the payments and invoices
incurred for vaccines, drugs, medical treatment to and from the MOH; and wheat subsidies
to MOIT and LPG subsidies to JPRC. The MOF provided the requisite baseline data from
the MOH, the MOIT and JPRC with which to measure outcomes by the end of the project.
The MOF established a technical group/monitoring committee to ensure the achievement
of the agreed results.
31. Specifically, there were two key monitoring aspects in this project: (i) monitoring
of the retroactive payments incurred for the goods and services already delivered and (ii)
12 National Unified Registry and Outreach Worker Program for Targeted Social Assistance
12
monitoring and verification of payments for the bills for goods and services to be procured
prospectively. For the retroactive payments, the audit firm and the technical firm verified
the supporting documents related to the goods and services (vaccines and drug lists, and
subsidies). For the payments, the bills for goods and services submitted to the MOF were
tracked to monitor the results, and measured against the baseline set up in the results
framework.
2.4 Safeguard and Fiduciary Compliance
32. Social and Environmental Safeguards Compliance: The design, nature and
scope of the project did not result in social safeguards issues and therefore the safeguards
policies were not triggered as a result of project interventions. The project was an
investment financing operation which financed specific line items for vaccines, LPG, and
wheat and was classified as Category C according to the World Bank Operation Policy on
Environmental Assessment (OP 4.01). There were no civil works within the project. The
design, nature and scope of the project did not result in environmental safeguards issues
and therefore safeguards policies were not triggered as a result of project interventions.
33. Fiduciary Compliance (see annex 6): Due to the emergency nature of the project
and the need to respond immediately, the FM approach was streamlined and based on more
simplified ex ante requirements, while relying more heavily on ex post requirements as
additional fiduciary controls and review. The risk mitigation measures for the project were
to design the project to use existing institutional mechanisms which had been reviewed by
the Bank for the implementation of other operations. The Bank updated the assessment of
the FM systems within the MOF that was previously conducted during the preparation of
the Support to Implementation of a National Unified Registry and Outreach Program for
Targeting Social Assistance Project. The assessment concluded that, with the
implementation of agreed-upon actions, the proposed FM arrangements would satisfy the
minimum requirements under OP/BP 10.00. The inventory management system at the
Directorate of Purchases and Supplies/MOH was assessed to ensure that reasonable
assurance existed to safeguarding the vaccines and drugs and collection by beneficiary
hospitals and health centers. The MOF was responsible for all FM and disbursement
functions under the project through its Finance Department. A qualified accountant was
identified from within the MOF and was trained by the World Bank in the World Bank’s
FM and disbursement policies and procedures. The accountant was from the MOF’s
Finance Department and was responsible for following up on the FM and disbursement
aspects. In addition, a Coordination Officer was designated from the JPD, who coordinated
with the MOF accountant and was responsible for providing the MOF with the necessary
information and documentation. The MOF has limited experience and knowledge with the
World Bank FM and disbursement guidelines. Therefore, adequate training was provided
to the accountant in order to ensure full understanding and application of the World Bank
FM and disbursement policies and procedures.
34. The main fiduciary safeguards measures for mitigating FM risks were:
13
a) Project staffing relied on the available FM capacity at the MOF where a qualified
accountant was identified from the MOF’s own Finance Department to follow on
the FM and disbursement tasks.
b) Flow of funds arrangements included the use of a DA opened at the CBJ with a
high ceiling of US$60 million. Funds were transferred to the government treasury
account against submitted Statement of Expenditures (SOEs).
c) The MOPIC was responsible for submitting withdrawal applications on behalf of
the MOF due to its long experience with the World Bank disbursement policies
and procedures.
d) Project was provided with retroactive financing of a value US$60 million (US$21
million for vaccines and drugs and US$39 million for bread and LPG) against
submitted SOEs.
e) The government inventory management system at the Directorate of Purchases
and Supplies/MOH was used after being carefully examined by the Bank team
and it was found that reasonable assurance existed in the safeguard of the
vaccines and drugs until collection by beneficiary hospitals and health centers.
f) An external audit firm conducted a special purpose audit of vaccines and drugs
financed under the retroactive financing of US$21 million. The audit was
conducted after the retroactive financing amount was transferred to the
government treasury account.
g) A consultancy firm performed technical (medical) and financial audit of medical
bills of patients referred to non-MOH hospitals and health facilities.
h) The same audit firm conducted the special purpose audit on refractive financing
of vaccines and drugs, and will complete the final audit of project’s activities after
project closure up to the end of the four-month grace period.
35. The risk mitigation design features for procurement were:
a) The JPD was assigned for the procurement of contracts under Component 1
(Provision of vaccines and essential drugs). Procurement practice by JPD was
assessed by visiting the agency, interviewing its staff, and reviewing the past
assessments done on the agency.
b) It was concluded that the JPD is successfully running annual procedures of drug
procurement on behalf of its partner institutions in Jordan, and based on a Rational
Drug List that is updated from time to time as needed, conducts the procurement of
pharmaceutical/medical goods in a transparent and well-structured manner. It is a
well-managed organization that is successfully dealing with the procedures
throughout the kingdom.
c) Considering the urgency of the project and that the implementation period was only
one year, it was decided for the procurement of pharmaceutical and medical
equipment to be undertaken using the existing JPD procedures for contracts up to
the threshold of US$5 million per contract from the Rational Drug List (The
Positive List of Goods).
d) To minimize the number of transactions and required documents, a positive list of
goods (contracts with estimated cost of US$200,000 and above) was used for
pharmaceuticals and vaccines to be procured, that included items cleared by the
Jordan Food and Drug Administration (JFDA).
14
e) To facilitate disbursement, the necessary documents to be provided by the
Borrower were defined and minimized as (i) proof of advertisement, (ii) proof of
purchase (purchase order), and (iii) proof of payment to suppliers.
f) Retroactive financing: The JPD procurement practice used to procure goods up to
US$5 million was considered acceptable for retroactive financing from the Rational
Drug List (The Positive List of Goods) cleared by the JFDA.
g) Anti-Corruption Guidelines: The JPD contracts and standard bidding documents do
not explicitly contain clauses related to fraud and corruption, as these contracts are
governed by the national anti-corruption rules providing for the exclusive
jurisdiction of the Anti-Corruption Commission (ACC) of Jordan, an independent
agency, in cases of fraud and corruption. Therefore, a waiver of some provisions of
the World Bank Anti-Corruption Guidelines was sought to rely on the Borrower’s
national ACC to investigate cases of fraud and corruption. The waiver specifically
proposed the modification of paragraph 9 and deleting paragraph 10, as detailed
below.
h) Modifications to the Anti-Corruption Guidelines: Paragraph 9 was modified (see
annex 6).
2.5 Post-completion Operation/Next Phase
Not Applicable
3. Assessment of Outcomes
3.1 Relevance of Objectives, Design and Implementation
Rating: High
36. Relevance of Objectives: The relevance of the project objectives is rated as High.
The project objectives were highly relevant when they were prepared and implemented and
remain valid at the time of the ICR preparation because the refugee crisis and its underlying
reasons remain and are ongoing. The project objectives were consistent with the GOJ’s
priorities as well as with the World Bank’s assistance priorities as outlined in the CPS
framework. Jordan’s economy was affected by the regional conflict, political upheaval and
instability, the refugee crisis and the large exogenous shocks over the past several years
that have had a negative impact on its citizens. Sharp increases in oil and food prices, the
removal of fuel subsidies, and the huge refugee influx have put pressure on the living
standards of many Jordanians, particularly those at the bottom of the income distribution.
Jordan’s social and economic situation is undermined by challenges, including
unemployment and poverty. Given these considerations, the objectives of this project were
highly relevant in supporting and enabling the GOJ to maintain the level of access to basic
health and the safety net interventions (supported by the World Bank) which the GOJ had
put in place.
37. Relevance of Design: The relevance of the design is rated as High. The key design
feature of this emergency project, prepared under OP 10.00 was its usage of paragraph 11
which allowed for quick preparation and retroactive financing and made the design highly
effective and relevant. The design of the project was simple and based on maintaining
15
financing for existing budget supported activities for universal subsidies and services
delivered through existing implementation and monitoring mechanisms at existing costs.
The project design was relevant for the time frame in which the financing was requested
by the government and remains relevant after closing because the design supports
maintaining health and basic needs coverage according to the health and basic needs
policies in place. The project provided 40 percent retroactive financing against payments
for relevant expenditures for the prior year before project effectiveness and financing for
the year following effectiveness. The same design would be relevant to the health policy
which replaced the policy at the time of project preparation and implementation. Because
of the flexible nature of the financing mechanism which was that disbursements were made
against payments for relevant expenditures, the project mechanism would have remained
relevant to any changes in policy regarding health and basic needs coverage. The project
design was prepared in response to the demand from the GOJ for support to maintain its
current health and subsidies programs in 2013 which included free health care services to
Syrian refugees. On December 1, 2014 five months after project closing, GOJ announced
its decision to stop providing free health care to Syrian refugees. While free health care to
the refugees was one of the underpinnings of the project at preparation, the need to alleviate
Jordan’s additional fiscal pressures due to the refugee influx remains and the flexibility of
the project design remains relevant.
38. Furthermore, the design was highly relevant to the needs of poor Jordanian
households, as previous studies (World Bank 2009, 2011) have shown that bread and LPG
cylinders tend to be heavily consumed by poorer households. Simulation exercises
performed by the team revealed that inability to provide bread and fuel at their subsidized
prices would further increase poverty, which could also result in significant social unrest.
The project’s design was also highly relevant to the need for mitigating the risks of reversal
in health outcomes and outbreak of disease if the level of access to essential health services
(vaccines, medicines, and medical treatment) could not be maintained, particularly on poor
and lower middle class households who were more likely to be impacted by the situation
as they cannot afford health services outside MOH facilities and are more likely to be
infected by outbreaks of diseases.
39. Additionally, the design of the project was highly relevant as both LPG and bread
subsidies continue to pose a heavy fiscal burden on the government’s budget. In 2012,
spending on these two programs reached 1.6 percent of the gross domestic product (GDP).
40. Relevance of Implementation: The relevance of implementation is rated as High.
Implementation arrangements were highly relevant. The project supported the ongoing
program for the health, bread, and LPG subsidies by the MOF and ensured that
implementation continued without a gap.
3.2 Achievement of Project Development Objectives
Highly Satisfactory
41. The achievement of the project objective is rated as Highly Satisfactory. The project
objective, and the key indicators and mechanisms to monitor and verify the results, as
16
stated in the PAD, were fully met. The project objective was to help the GOJ maintain
access to essential health care services and basic household needs for the Jordanian
population affected by the large and increasing influx of Syrian refugees. The indicators
set for achieving this objective of ‘maintaining access’ were those that were based on the
FM and verification system of the MOF for health and for subsidies to households, and
constituted the baseline for the Results Agreement.
42. Maintenance of access to essential health care services: The baseline of 6.23
million total beneficiaries of the immunization program, and inpatient and outpatient
medical treatment in the MOF system was maintained. The percentage of children
immunized remained at a baseline of 97 percent was maintained. And overall outpatient
and inpatient utilization rates with a baseline of 0.58 percent at health facilities were
maintained and remained at or above baseline value.
43. Maintenance of access to basic household needs: Subsidies, for LPG and bread,
under the Social Safety Net Program, which have a baseline of 2.5 million, were maintained.
Project Objective for Component 1: Maintaining Access to Essential Health Care
Services (US$70 million)
Rating: Highly Satisfactory
44. This component sustained and maintained the provision of essential health care
services to the Jordanian population which is at risk due to the stress on resources resulting
from the large influx of Syrian refugees. The project financed, as designed, a total of US$50
million of drugs and vaccines, including costs of drugs and vaccines procured and paid
from June 30, 2012 to June 30, 2013, retroactively, and from July 1, 2013 to June 30, 2014.
The invoices for the retroactive financing, included payments for vaccines in 2011 prior to
June 30, 2012. These were for the eligible list of vaccines within the period of the refugee
crisis and were in keeping with the component’s selection criteria and its objectives as well
as the overall objective of the project. This component also provided for financing of health
care services for Jordanians in non-MOH health facilities (US$20 million) if they were
crowded out from MOH hospitals due to Syrian refugees. The project required per design
that MOH provide evidence of this through an independent auditor to be hired by the
project. Due to delays in hiring the auditor, at the time of audit there were not enough cases
hence the underspending in the subcomponent and the ‘reallocation’ of the funds to drugs
and vaccines with Bank approval.
Project Objective for Component 2: Maintaining uninterrupted supply of
subsidized bread and LPG cylinders for Supporting Household Basic Needs
(US$79.9 million)
Rating: Highly Satisfactory
45. This component sustained and maintained the financing of universal subsidies for
household basic needs. The objective of this component was to help the GOJ ensure the
17
uninterrupted supply for two subsidized products: bread (US$55 million for wheat) and
LPG cylinders (US$25 million) for poor and lower middle class households. The
continuation of the supply of these universal goods and services supported poor and lower
middle class households in maintaining their standard of living.
Project Objective for Component 3: Monitoring, Auditing and Verification of
Project Financing for Eligible Payments (US$0.1million)
Rating: Satisfactory
46. The MOF coordinated the reporting on the project indicators which were generated
from the payments and invoices incurred for vaccines, drugs, and medical treatment and
bread and LPG subsidies to individual households. The MOF, the MOH, and the MOIT
provided the requisite baseline data from which to measure outcomes by the end of the
project. A technical group/monitoring committee appointed by the MOF agreed that the
results were achieved. The expenditures for the vaccines and for the LPG and bread
subsidies have been carried out and expenditures have been verified by the auditor as was
stipulated in the project design and reflected in the PAD. Specifically, there were two key
monitoring aspects in this project: (i) monitoring of the retroactive payments incurred for
the goods and services already delivered; and (ii) monitoring and verification of payments
for the bills for goods and services to be procured in the period of July 1, 2013 till the
project closed on July 31, 2013 (with a grace period of 4 months for disbursements). For
the retroactive payments, the audit firm and the technical firm verified the supporting
documents related to the goods and services (vaccines and drug lists, and subsidies). For
the payments, the bills for goods and services submitted to the MOF were tracked to
monitor the results, and measured against the baseline set up in the results framework.
47. This component financed: (i) the costs of two special purpose audits as required for
Component 1. These audits were for the retroactive financing for vaccines and medical
costs and for LPG and bread subsidies; and (ii) the cost of an external auditor, who was
with the Bank’s agreement appointed to audit the project financial statements covering the
project’s 12-month lifetime and for both Components 1 and 2. The audit for vaccines and
medical costs was submitted in May 2014. The audit found that there were a number of
invoices which were dated from 2011 and others which were dated in 2012 but prior to
June 30, 2012. Because the language for retroactive financing in the Loan Agreement (LA)
referred to payments after June 30, 2012 and not to invoice dates, this was deemed by the
Bank as being in keeping with the LA and therefore satisfactory. The audit for LPG and
bread would be submitted by end of January 2015 to the Bank.
48. The GOJ (represented by the MOF) hired Saba & Co. auditing company (Deloitte)
as the external auditing company to audit all the SOEs and statements of gas and bread
subsidies for the concerned period - retroactive period from June 30, 2012 till June 30,
2013 and prospective period from July 1, 2013 till July 30, 2014. The first auditing report
issued by the company for the retroactive period was sent to the IBRD. The second report
and final audit is expected to be submitted in January 2015.
3.3 Efficiency
18
Rating: Satisfactory
49. The project’s economic analysis (annex 3) presented in the PAD was framed in the
context of the project objective of mitigation of a temporary fiscal shock and to maintain
(not reduce or expand) services particularly of vaccines so as to prevent the outbreak of
disease rather than in the context of efficiency. Because of the temporary nature of the
project interventions, the structural fiscal balance of the government (which is the fiscal
balance remaining once the impact of cyclical and one-off shocks on both revenue and
expenditures have been eliminated) was unaffected by the project. The project, therefore,
did not impact the GOJ’s ongoing and medium-term domestic and international
commitments to fiscal consolidation. Given this commitment to targeting, it was expected
that the GOJ would be able to improve the efficiency of the current universal bread and
LPG programs but clearly not through this project because that was not the intent of the
project. The economic analysis argues that ex ante cost-benefit analysis shows that
financing of US$80 million worth of supply of basic goods at their current price would
prevent both the incidence of poverty and its depth from worsening. And that simulations
based on the SUBSIM model (Abdelkrim and Verme 2012)13 showed that the proposed
US$55 (US$25) million in financing for the wheat (LPG) program would prevent prices of
wheat (LPG) from rising by 35 (15) percent. Such price increases would, in turn, push
about 45,000 people into poverty, which represents a 5 percent increase in the number of
the poor in Jordan. Keeping the prices stable would also prevent the existing 14.4 percent
(almost 1 million people) of the Jordanian population that is already in poverty from
becoming even poorer. With respect to health services, the team acknowledged that the
economic benefit from maintaining access to essential health care services, and in
particular drugs (medicines, vaccines) and medical treatments is significant. Disruption to
access of such services could have severe and lasting impacts both in terms of health
outcomes and fiscal cost for the budget that would be commensurately larger than the short-
term cost of ensuring continuous access. For instance, disruptions of vaccine supplies could
lead to outbreaks of diseases or even epidemics.14 Additionally, immunizations are among
the most cost-effective activities provided by government in the time of crisis without
additional financial burden to families. That being said, the benefits of maintaining access
were not quantified against the determined costs. Therefore, determining ‘the value for
money’ of the project is not feasible.
3.4 Justification of Overall Outcome Rating
13 Araar, Abdelkrim and Paolo Verme. 2012. “Reforming Subsidies. A Tool-kit for Policy Simulations.”
Policy Research Working Paper No. 6148, World Bank, Washington, DC.
14 For example, TB case notification increased from 5 per 100,000 in 2009 among Jordanians to 13 per
100,000 among Syrian refugees in 2013. While no measles cases have been reported in Jordan since 2009,
the MOH data show that 18 Jordanians and 23 Syrians have been diagnosed with the disease in 2013. Polio,
which had been eliminated since 1999 in Jordan, was also detected in two cases in 2013.
19
Rating: Satisfactory
50. The PDO for this project ‘maintaining access’ to essential health services is simple
and clear. Maintaining access referred to vaccines for 6.23 million beneficiaries, hospital
care for the insured 1.10 million beneficiaries and the non-insured 2,500 beneficiaries to
non-MOH health care services; and basic household needs, LPG and bread/wheat to 2.5
million beneficiaries. The results framework aligned to the PDO, defines the time frame
for the maintaining of this access for the period 2012–2014. It can be argued given the
invoices for the vaccines cover the period from 2011 at the start of the crisis, the Bank team
should have foreseen this and the retroactive financing should have covered the entire
period from the beginning of the crisis. After all, the PAD framed the need for the project
on basis of the influx of Syrian refugees which not only strained the government’s coffers
and ability to meet its own population’s needs but also threatened the overall health
situation by the possibility of a break out of epidemic and also social unrest similar to that
in other parts of the region. It can be argued that since neither took place in Jordan in the
project time frame, the project achieved its unstated objectives as well. Furthermore, the
maintenance of access allowed for the outcome that safety net and health systems continue
to work as designed without interruption or reduction in activities thereby, avoiding erosion
in health or safety net services. Since the PDO was tightly formulated and clear, it can
further be argued, that the project outcome of access being maintained, households
continuing to receive health care and basic household needs, was fully met and therefore
the overall outcome was Satisfactory.
3.5 Overarching Themes, Other Outcomes and Impacts
(a) Poverty Impacts, Gender Aspects, and Social Development
51. As noted earlier, bread and LPG are heavily consumed products by Jordanian
households and account for a relatively large share of poor households’ total spending so
disruption to their supply or increases in prices would have a material impact on these
households. Furthermore, poverty simulations on price increases for bread or LPG show
that an additional 45,000–53,000 Jordanians would have been pushed into poverty
representing a 5 percent increase in the number of poor Jordanians (see annex 3). Poorer
households spend a larger share of their total expenditure on bread and LPG than the richer
households. These items constitute for approximately 7 percent of poor households’ total
consumption while they comprise only 2 percent of the consumption of the richest
Jordanian households. In terms of expenditures, households in the bottom decile spend 3.6
percent on subsidized food items, whereas for the richest 3 deciles this share falls to below
1 percent. Similarly, the poorest 20 percent of Jordanian households spend 2.3 percent of
their total spending on LPG compared to 1 percent for the richest 20 percent households.
Female beneficiaries constitute 48 percent of the project’s beneficiaries. The project
maintains the living standards of poorer households through provision of subsidies for
health and basic household needs. At a time of regional conflict, it can be argued that the
project assisted in mitigating the social risks of instability within Jordan through the
maintenance of economic and social services for the population. Furthermore, the project
20
maintained the Safety Nets systems development for health and basic needs within the
MOF and ensured that these were not eroded in the context of the emergency and crisis.
(b) Institutional Change/Strengthening
52. The project did not have the objective of instilling change or strengthening
institutional capacity. It was a one-year emergency operation. In this regard, the project
maintained the disbursements of benefits through the MOF’s existing subsidies
disbursement system which would have, without the project, been disrupted and possibly
eroded. However, the fiduciary arrangements and daily supervision as noted in the ICR and
annex 6 supported the MOF in strengthening its institutional capacity.
53. The MOF had limited experience and knowledge with the World Bank FM and
disbursement guidelines. Therefore, training was provided to the accountant in order to
ensure full understanding and application of the World Bank FM and disbursement policies
and procedures.
(c) Other Unintended Outcomes and Impacts
54. This was the first project to be prepared in the region using OP 10.00 paragraph 11.
The results of the project have had a positive effect on the preparation of similar projects
in the region such as in Yemen.
3.6 Summary of Findings of Beneficiary Survey and/or Stakeholder Workshops
N/A
4. Assessment of Risk to Development Outcome
Rating: Low
55. The Risk to Development Outcome is Low. The project had met its target, as
articulated by the PDO, Results Framework in the PAD, supervision reports, and the audit
reports at completion. Development outcomes are likely to remain on course due to the
maintenance of the safety nets for health and basic needs through the project intervention.
5. Assessment of Bank and Borrower Performance
5.1 Bank Performance
(a) Bank Performance in Ensuring Quality at Entry
Rating: Satisfactory
56. The project built on an excellent Borrower and Bank relationship with the MOF
and on an existing system of disbursements within the MOF for the subsidies for health
21
and basic needs. The quality of analysis of the country and sector background was High in
the PAD. The World Bank updated the assessment of the FM systems within the MOF that
was previously conducted during the preparation of the Support to Implementation of a
National Unified Registry and Outreach Program for Targeting Social Assistance Project.15
The assessment concluded that, with the implementation of agreed-upon actions, the
proposed FM arrangements satisfy the minimum requirements under OP/BP 10.00.
Furthermore, the Bank examined the inventory management system at the Directorate of
Purchases and Supplies/MOH to ensure that reasonable assurance exists to safeguarding
the vaccines and drugs and collection by beneficiary hospitals and health centers. A
qualified accountant was identified from the MOF’s Finance Department to follow up on
the FM and disbursement aspects. In addition, a Coordination Officer was designated from
the JPD who coordinated with the MOF accountant and was responsible for providing
MOF with the necessary information and documentation. The MOF had limited experience
and knowledge with the World Bank FM and disbursement guidelines. Therefore, training
was provided to the accountant in order to ensure full understanding and application of the
World Bank FM and disbursement policies and procedures. To make sure that funds would
be readily available for project implementation, a DA was opened at the Central Bank of
Jordan (CBJ). However, this took some time and caused minor delays, after project
effectiveness and should have been done before effectiveness.
(b) Quality of Supervision
Rating: Satisfactory
57. The project implementation period was one year, while disbursements spanned two
years with retroactive financing. The formulation of the retroactive financing eligibility
was differently articulated as noted earlier in the PAD, LA, and Aide Memoires (AMs).
However, the LA takes precedence and the clause in the Legal Agreement can be
interpreted to have put an emphasis on payments in the period on or after June 2012. The
implementation of the retroactive financing was therefore, according the Loan Agreement.
58. There were two formal missions, two AMs and one ISR submitted for the project.
Interaction with the Bank was on a regular day-to-day basis with the supervision team
based in the region. Monitoring as agreed with the Borrower relied on invoices submitted
by the MOF during the project life and the audit reports for these invoices at project
completion.
(c) Justification of Rating for Overall Bank Performance
Rating: Highly Satisfactory
15 World Bank. 2013. “Support to Implementation of a National Unified Registry and Outreach Program for
Targeted Social Assistance Project.”
22
59. Given the emergency nature of the project and the highly proactive, high quality
and appropriate design response by the Bank to an emergency request by the GOJ, the
overall rating of the Bank performance is Highly Satisfactory.
60. The Bank was proactive in responding the GOJ request in an emergency situation.
The Bank had foreseen the possibility of emergencies and had provided for such a
contingency in its framing of the CPS. The Bank team was proactive and took advantage
of the OP 10.00 procedures for the design and preparation of the project. The project was
the first in the region to pilot OP 10.00 procedures. The project preparation quality was
high, given the short period of only 6 weeks between the request from GOJ and Board
Approval. The project preparation and supervision was conducted in keeping with these
procedures. The Bank team for supervision was based in the region throughout
implementation and provided support on a day-to-day basis, supported by two formal
supervision missions within the period of the one-year implementation.
5.2 Borrower Performance
Rating: Satisfactory
(a) Government Performance
Rating: Satisfactory
61. The GOJ identified the need and requested the support of the Bank in a timely
fashion. The GOJ ensured that the project preparation and implementation received the full
support and was coordinated with all the relevant ministries. However, the delay in the
external audits caused the inability on the part of the GOJ to recover its expenditures for
financing of health care services for Jordanians in non-MOH health facilities if they were
crowded out from MOH hospitals due to Syrian refugees. At the time of audit, there were
not enough cases hence the underspending in the subcomponent and the reallocation of the
funds to the drugs and vaccines with Bank approval.
(b) Implementing Agency or Agencies Performance
Rating: Satisfactory
62. The implementing agencies were able to continue to deliver the subsidies in
accordance with their agreed procedures.
(c) Justification of Rating for Overall Borrower Performance
Rating: Satisfactory
63. The Borrower has implemented and disbursed 98.759 percent of the loan at the time
of Implementation Completion Results Report (ICRR) in accordance with the objectives,
design and implementation agreements of the project.
23
6. Lessons Learned
64. Simplicity of operation through existing delivery mechanisms for existing
services which allowed for quick preparation and implementation. Reliance on
existing structures and tested implementation approaches facilitated a rapid and effective
disbursement and response to the crisis. This operation relied on the MOF as the main
implementing agency which has experience with implementation of large cash transfer
programs and subsidies in Jordan. In addition, the project used the existing national systems
of the JPD, which has proven experience in large-scale procurement of drugs and vaccines
for the kingdom.
65. Flexibility of financial response through the inherent flexibility of the newly
introduced OP 10.00 helped expedite preparation and the World Bank’s overall
ability to respond with speed to an urgent need. This operation was the first in the MNA
region (and the first Bank-wide) to apply OP 10.00, paragraph 11 (Projects in Situations of
Urgent Need of Assistance or Capacity Constraints) and under condensed procedures. The
project was specifically designed to minimize the need for time-intensive FM assessments
and procurement reviews. It relied on the country system already assessed by the Bank and
was able to provide the higher proportion of retroactive financing permitted under OP
10.00, paragraph 11 which was critical to the success of the operation and to reduce the
burden on the GOJ budget.
66. The FM approach was streamlined and based on more simplified ex ante
requirements, while relying more heavily on ex post requirements as additional
fiduciary controls and review which allowed for timely disbursements. The specific FM
ex post requirements included a special purpose audit that was conducted on all goods and
a technical (medical) and financial audit that was performed by a specialized firm of
medical bills of patients referred to non-MOH hospitals and health facilities. The scope of
this special purpose audit included: (i) verifying that referrals are issued in accordance with
MOH procedures; (ii) ensuring appropriateness of referrals and use of services according
to health needs; (iii) reasonableness of medical bills of the non-MOH hospitals and health
facilities; and (iv) adherence to the cost ceiling of US$10,000 per patient. A final audit
started after project closure on all the project’s components and activities. The available
audit tools were used to have a reasonable assurance of the values of the bread and LPG
subsidies that were retroactively financed by US$39 million. These audit tools included the
review of the most recent issued audit reports of: (i) the Special Trade Account of the
MOIT which reports on bread subsidy, and (ii) the Petroleum Refinery Company (sole
supplier of LPG in Jordan) for any irregularities.
67. Flexibility in the design mechanism which provided for disbursements against
payments for expenditures allowed for the project design to remain relevant and be
responsive to any changes during implementation in policies towards health and basic
social needs coverage and expenditures (annex 6). The disbursement requirements for each
component were made very clear to the counterpart and for that a table was used to
summarize those requirements and included in the PAD. This contributed significantly in
minimizing any confusion by the counterpart of those requirements. Considering the large
number of small contracts being procured by the JPD, the imposed limitation on a positive
24
list of contracts with an estimated cost of US$200,000 and above, minimized the number
of transactions and required documents to be audited. To avoid excessive transaction costs
of SOEs, the minimum amount for direct payment and reimbursement was set at 20 percent
of the Designated Account ceiling amount along with necessary supporting documents.
However, two agencies (MOPIC and MOF) were engaged in the FM and disbursement
arrangements; the MOF was responsible for the overall FM and disbursement arrangements,
while the MOPIC was responsible for submitting withdrawal applications to the Bank. This
was not considered an ideal model and lack of coordination on a few occasions caused
delays in submission of withdrawal applications to the Bank.
68. Retroactive financing for a substantial amount of 40 percent was key to the
success of the emergency operation. The project was able to provide up to 40 percent
under OP 10.00, paragraph 11 and enabled the World Bank to pivot effectively in
responding to the GOJ’s request for assistance and allowed for immediately reimbursing
the GOJ on its expenditures for vaccines, LPG, and bread. However, while the rules for
retroactive financing under OP 10.00, paragraph 11 are meant to respond to need, they
allow up to 40 percent of retroactive financing, however these rules are limited to not
exceed a period of more than 12 months prior to loan agreement signing date. The
retroactive financing eligibility in the loan agreement was agreed to begin for payments on
or after June 30, 2012 onwards, though the crisis started in 2011.
69. Temporary time-bound support in emergency situations to help meet essential
household needs. These pro-poor interventions through subsidies and price controls
can help mitigate the potential for social instability. While, the economic case, for
subsidies in normal circumstances is not compelling, it can be argued that in the absence
of social instability in Jordan which has been burdened by a large refugee population,
universal subsidies have played a role in the ongoing emergency in mitigating the crisis.
70. A strong relationship between the Bank and the government on the ground
allowed for a rapid response. The World Bank’s existing working relationship with the
MOF permitted the necessary intensive and sustained technical and fiduciary
implementation support. In addition, the World Bank team, based in the region, was able
to provide intensive and frequent implementation support throughout the project drawing
on multi-sectorial staff based in Amman and the Lebanon country office.
71. The smooth coordination between the different units within the World Bank
(FM, CTR, Procurement, Social Protection and Labor and Social Development) was
outstanding and significantly contributed to the timely project preparation and as well the
smooth implementation.
7. Comments on Issues Raised by Borrower (a) Borrower/implementing agencies
72. The Borrower noted the ongoing refugee crisis beyond the project closing date
and its implication for future further financing by donors. The Borrower concluded
that the implementation of the project has been successful due to the project design,
25
particularly the retroactive financing of 40 percent. The Borrower noted the strong
cooperation between all involved ministries and urged future support by the Bank and
donor community in the form of soft loans and grants to help mitigate the budget deficit.
73. The GOJ’s ICR, however, did not provide any information on the monitoring
and evaluation aspects of the project or whether the data collection was conducted in a
timely manner or on the outcome indicators and targets as outlined in the PAD.
Additionally, it does not contain information on any potential problems encountered during
implementation and potential lessons to be learned for the future from this experience.
(b) Cofinanciers
Not applicable
(c) Other partners and stakeholders
Not applicable
26
Annex 1. Project Costs and Financing
(a) Project Cost by Component (in US$ Million equivalent)
Components
Appraisal
Estimate
(US$)
Actual/Latest Estimate
(US$)
Percentage of
Appraisal
Component 1: Maintain Access to Essential Health Care Services
Drugs and vaccines 50,000,000 61,525,368 123
Medical treatment 20,000,000 8,333,81716 42
Total subcomponent 1 70,000,000 69,859,158 99.8
Component 2: Supporting Household Basic Needs
Bread 55,000,000 55,000,000 100
LPG (cylinders) 24,525,000 24,525,000 100
Total subcomponent 2 79,525,000 79,525,000 100
Component 3: Monitoring, Auditing and Verification
Total subcomponent 3 100,000 100,000 100
Total Baseline Cost 149,625,000
Physical Contingencies – –
Price Contingencies – –
Total Project Costs 149,625,000 149,484,158 99.9
Front-end fee PPF
Front-end fee IBRD 375,000 375,000 100
Total Financing Required 150,000,000 149,859,185 99.9
(b) Financing
Source of Funds Type of Cofinancing
Appraisal
Estimate
(US$)
Actual/Latest
Estimate
(US$)
Percentage of
Appraisal
Borrower
International Bank for
Reconstruction and
Development
The Bank is the sole financer 150,000,000 149,859,185 99.9
16 The remaining US$11.65 million from the medical treatment item was allocated to the drugs and
vaccines item, as the GOJ cited the unavailability of the required documents (that is, medical bills of all
patients referred to the non-MOH hospitals and health facilities) in the Health Insurance Department to
process the full payments, per the Bank’s agreement.
27
Annex 2. Outputs by Component Two main outputs have been set for this emergency program. The first output was to maintain
access to essential health care services through (i) the provision of vaccines and essential drugs to
all public health care facilities; and (ii) financing of health care services for Jordanians in non-
MOH health facilities. The second output was to support households’ basic needs through (i)
financing part of the increase in cost of bread subsidies arising from increased demand from the
Syrian conflict; and (ii) financing the increase in the cost of LPG cylinders arising from increased
demand from Syrian conflict. The following table provides the measured outcome indicators for
the two main outputs.
Table 2.1: Measured Outcome Indicators
Component 1: Maintain Access to Essential Health Care Services
Target Actual
estimate
Indicator Name Unit of
Measure
Baseline
(June
2012)
2012/13
(Year 1)
includes
retroactiv
e
2013/14
(Year 2)
January
2014
End target Frequenc
y
Data Source/
methodology
Direct project
beneficiaries (number), of
which women (%)
- Beneficiaries of drugs
and vaccines
- Beneficiaries of medical
treatments
Number,
million
(%)
6.23
(48.6)
6.23
(48.6)
6.30
(48.6)
6.23
(48.60)
6.37
(48.60)
Monthly
MOH
JPD for drugs
and medical
supplies
MOF
Beneficiaries of safety
net programs (subsidies),
of which women (%)
Number,
million
(%)
2.5
(48.6)
2.5
(48.6)
2.5
(48.6)
2.50
(48.60)
2.5
(48.6)
Monthly MOF
Children immunized (0-6
years)
Number,
Million
1.10 1.10 1.10 1.10 1.10 Annual MOH
Per capita outpatient
utilization rates at PHCCs
to remain at or above
baseline value.
Yes/No 0.58 Yes Yes Yes Yes Monthly MOH
Per capita inpatient
admission
rates at hospitals to
remain at or above
baseline value.
Yes/No 1.10 Yes Yes Yes Yes Monthly MOH
Number of uninsured
patients from the northern
governorates referred to
non-MOH facilities for
medical treatment
Number 0 1000 1500 0 2500 Monthly MOH
MOH warehouses in
target areas with no drug
stock-outs in the last
week
Number 7 2 2 7 2 Monthly MOH, JPD
Vaccination/medicines
purchased by the JPD as
per the Rational Drug
List
US$,
million
90 112 117 90 117 Annual MOH, JPD
Component 2: Supporting Household Basic Needs
Wheat purchased (flour) Metric
ton
44,972 64,811 77,773 44,972 77,773 Monthly MOIT
LPG purchased Metric 21,293,782 1,809,409 3,196,622 21,937,82 3,196,622 Monthly MOF
28
ton
29
Annex 3. Economic and Financial Analysis
Component 1: Maintain Access to Essential Health Care Services
Due to the emergency nature of this operation and the need to respond quickly, measures
of efficiency to determine whether the costs involved in achieving this component were
reasonable in comparison with both the benefits and ‘value for money’ were not
applicable.17 While the team recognized that the economic benefit of maintaining access to
health services is significant as disruptions could have long lasting impacts on health
outcomes and shortages in vaccines could lead to outbreaks of diseases, measuring such
long-term benefits (by estimating the counterfactual scenario of what could have happened
in the absence of this operation) against the components’ costs was, understandably, not
feasible in the short term. Financing this component was based on economic analysis that
estimated the costs of the influx of the Syrian refugees on the rise in prices of essential
health care needs, as detailed in the following:
Drugs and vaccines: The project financed US$50 million of drugs and vaccines.
Estimates for this figure were based on (i) the gross rate of pre-crisis consumption
in medicine, namely in 2010 and 2011; (ii) projected increase in procurement of
generic drugs at the rate of 3 percent (this rate was estimated based on pre-crisis
rates of increase, as well as the standard rate of increase set by GOJ given its goal
of increasing the share of generic drugs procured); and (iii) actual procurement of
medication. The program was designed to compensate the MOH for the increase in
cost of drugs procured as a result of influx of Syrian refugees. In 2012, the program
financed six months’ worth of drugs procured between July–December 2012,
totaling US$5 million; the full cost of drugs procured in 2012 totaling US$29.4
million; and the first six months of 2014 (January–June) at US$16 million. This
amounted to US$50 million.
Medical treatment: The project financed US$20 million towards the cost of
treatment of Jordanian patients with the highest need for care referred by the MOH
to non-MOH facilities, focusing on patients living in the most affected areas in
Jordan and who have urgent medical needs. The estimates were based on data
showing an increasing trend in the numbers and costs of referrals from before the
influx of refugees to the present time. In 2012, the overall cost of treatment in non-
MOH facilities totaled US$242 million indicating a 50 percent increase from 2011.
Using El-Hussein Cancer Center as a baseline for analysis, there were 10,069 cases
of referrals in 2012 (compared to 9,066 cases in 2011) and the unit cost for
treatment increased from US$6,158 in 2011 to US$7,600 in 2012. Payments of
around 2,500 invoices were projected to be made from the loan.
17 Projects in situations of urgent need of assistance or capacity constraints financed by a Bank Loan may
be processed under special procurement arrangements referred to in paragraph 20 of OP 11.00 and may
finance a positive list of goods procured in a manner that satisfies the considerations of economy and
efficiency (including national procurement procedures of the Borrower).
30
Component 2: Supporting Household Basic Needs
Ex ante cost-benefit analysis done by the team indicated that the financing of US$80
million worth of supply of basic goods (bread and LPG cylinders) at their current prices
would prevent both the incidence of poverty and its depth from worsening. Using
simulations based on the SUBSIM model (Abdelkrim and Verme 2012), the team
illustrated that the financing of US$55 million for bread and US$25 million for LPG
cylinders would prevent prices of wheat from rising by 35 percent and prices of LPG by
15 percent. Such price increases would push 45,000 people into poverty, which represents
a 5 percent increase in the number of the poor in Jordan. Keeping the prices stable would
also prevent the existing 14.1 percent (almost 1 million people) of the Jordanian population
that is already in poverty from becoming even poorer. The team used the GOJ’s plan to
eliminate subsidies on petroleum in 2012 as an illustrative example. The increase in prices
would have pushed similar magnitude of Jordanians into poverty (for example, 53,000).
Therefore, to avoid such impact on the poor, the government accompanied the subsidy
phase out with a cash transfer program of about US$420 million per year. Financing this
component was based on econometric analyses that estimated the costs of the influx of the
Syrian refugees on the rise in prices of essential household needs, as detailed in the
following:
Financing bread subsidies: The team conducted econometric analysis to illustrate
that the Syrian crisis has significantly and materially increased the demand for
subsidized bread in Jordan. Regression results confirmed that the determinants of
subsidized flour volumes, which steadily increased starting in 2011, are expected
to have primarily risen by an increase in consumer numbers, as the retail price
remained unchanged (the refugee variable is statistically significant with a
relatively stable coefficient in most specifications used). Based on the regression
coefficients of the econometric analysis, the increase in consumption related to the
crisis was estimated at 77,773 metric tons of flour from June 2012–June 2013. This
accounted for the 80 percent increase in volume observed since the 2010 pre-crisis
and 12.2 percent of total flour demand. With an estimated average subsidy of
US$385.7 per metric ton of flour, the estimated retroactive financing reached
US$30 million. For the period of July 2013–June 2014, assuming the unit subsidy
cost was unchanged, the project financed 64,811 metric tons of flour for a cost of
US$25 million. This amounted to a total of US$55 million for this component.
Financing LPG cylinders: The team performed an analysis of the demand in
response to the LPG prices pre and post the Syrian crisis, which revealed that the
increased demand was driven by increases in numbers of Syrian refugees. The
impact of Syrian-related effect on LPG demand was inferred by analyzing two large
price changes of similar magnitude: one that took place in 2008 and one after the
crisis in 2012. Analysis has shown that demand for LPG with price increases is
expected to be dampened (as it is an inferior good). In 2008, a price increase of 53
percent led to a 4 percent decrease in consumption. Nonetheless, in 2012, a similar
price increase (54 percent) led to an 8 percent increase in consumption. Such stark
differences in consumption, as argued by the team, could only be explained by a
large influx of new gas consumers. To quantify the impact of the crisis on demand,
31
it was assumed that the rise in consumption could be captured by the number of
Syrian refugees. Based on the number of Syrian refugees and their average
consumption, the project was estimated to finance a subsidy cost of 1.8 million
standard (12.5 kg) LPG cylinders (for a total cost of US$9 million) for the
retroactive period (June 2012–June 2013), and an estimated 3.2 million cylinders
for the period July 2013–June 2014 (for a total cost of US$16 million). The average
subsidy cost per LPG cylinder was estimated at US$4.97 based on historical cost
from June–December 2012. Therefore, a total of US$25 million was financed for
this component.
In summary, measures of efficiency to determine whether the costs involved in financing
the project were reasonable when compared to its benefits and ‘value for money’ were not
applicable in this case, due to the emergency nature of this program. Nonetheless, financing
the project was based on economic analysis that estimated the costs of the influx of the
Syrian refugees on the rise in prices of essential health care and household needs, and
comes in line with the social procurement arrangements referred to in paragraph 20 of OP
11.00 whereby the Bank may finance a positive list of goods procured in a manner that
satisfies the considerations of economy and efficiency.
32
Annex 4. Bank Lending and Implementation Support/Supervision Processes
(a) Task Team Members
Names Title Unit Responsibility/
Specialty
Lending
Haneen Sayed Lead Operations Officer MNSHD Task Team Leader
Eric Le Borgne Lead Economist MNSED Economic and Fiscal
Balakrishna Menon
Parameswaran Lead Social Development Specialist MNSSO Social Development
Caroline Bahnson ET Consultant MNSSO Refugee context
Nadwa Rafeh Sr. Economist MNSHH Preparation of Health
component
Piers Merrick Sr. Operations Officer MNADE Justification, operational
procedures, RA
Hassine Hedda Finance Officer CTRLA Disbursement arrangements
Maya Abi Karam Counsel LEGAM Legal Agreement
Iqbal Kaur Sr. Social Protection Specialist MNSHD Overall support to PAD
drafting
Janette Uhlmann Sr. Country Officer MNCA2 Package preparation and
approvals
Jad Mazahreh Sr. Financial Specialist MNAFM Financial Management
Sepehr Fotovat Sr. Procurement Specialist MNAPR Procurement
Banu Setlur Environmental Specialist MNSEN Environmental Safeguards
Nina Bhatt Sr. Social Scientist MNSSO Social Safeguards
Hala Ballout Program Assistant MNSHD Team Assistant
Supervision
Haneen Sayed Lead Operations Officer MNSHD Task Team Leader
Hassine Hedda Sr. Finance Officer CTRLA
Nadwa Rafeh Sr. Economist MNSHH
Economic Analysis for
drugs ,vaccines, medical
treatment
Sepehr Fotovat Ahmadi Sr. Procurement Specialist MNAPC Procurement
Jad Raji Mazahreh Sr. Financial Management Specialist MNAFM Financial Management
ICR
Maniza Naqvi Sr. Social Protection Specialist GSPDR Task Team Leader-
Drafting the ICR
Jumana Alaref Junior Professional Associate GSPDR Annexes
(b) Staff Time and Cost
Stage of Project Cycle
Staff Time and Cost (Bank Budget Only)
No. of staff weeks US$, thousands (including
travel and consultant costs)
Lending
Total: 20.15 139, 825
Supervision
33
Total: 23.95 78,780
ICR 10 50,000
Total:
34
Annex 5. Summary of Borrower's ICR and/or Comments on Draft ICR
IMPLEMENTATION COMPLETION AND RESULTS REPORT
(IBRD loan No.-82830 JO dated 28/7/2013)
December 1, 2014
Introduction
The government of Jordan (GOJ) requested assistance from the donor countries
to provide grants and loans to face and mitigate the budget deficit as well as the
financial and economic situation which occurred from the Syrian refugees. One
of these donors is the World Bank. According to Jordan’s request, the GOJ
signed an emergency loan agreement on 28/7/2013 with the International Bank
for Reconstruction and Development (IBRD) for an amount of US$150 million
to assist Jordan mitigate the impact of the Syrian refugees on the budget deficit.
Project Development Objectives
The project objective is to help the GOJ maintain access to essential health care
services and basic household needs for the Jordanian population affected by the
large and increasing influx of Syrian refugees.
Project Beneficiaries
The project beneficiaries consist of the following:
1. Jordanian children aged 0–6 years: Children aged 0–6 years received
vaccinations which would prevent and control transmission of vaccine-
preventable diseases.
2. Jordanian households particularly of the poor and lower middle classes: The
Jordanian population as a whole benefited from the project through the
continuation of the basic food (bread) and fuel (LPG) subsidies, as well as
the medicines financed under the project. During the one-year
implementation of this project, women, who constitute 48.6 percent of the
population, will continue to benefit from the universality of the subsidies and
medicines. In addition, poor and lower middle class households particularly
35
benefited as they were disproportionately impacted if universal access to
these goods and services was interrupted.
3. Jordanian patients: The project benefited approximately 2,500 Jordanian
patients, particularly those living in the north, to continue to have access to
health services.
Project Components
Component 1: Maintaining access to essential health care services (US$70 million)
This component aims to sustain the provision of essential health care services to
the Jordanian population which is at risk due to the stress on resources resulting
from the large influx of Syrian refugees. This was achieved by financing needed
vaccines and drugs, and the treatment of Jordanians who are being crowded out
from public hospitals as a result of the increasing use of public services by
Syrian refugees.
Component 2: Supporting household basic needs (US$79.9 million)
Financing universal subsidies for household basic needs. The objective of this
component is to help the GOJ ensure uninterrupted supply of basic household
commodities for poor and lower middle class households. The two subsidized
products financed under this component are bread and LPG cylinders.
Component 3: Project monitoring, auditing, and verification (US$100,000)
This component financed the cost of an external auditor acceptable to the World
Bank.
Project Cost
The cost for this project is US$150 million and IBRD funded this amount in
two phases:
1. Retroactive financing: US$60 million, equivalent to 40 percent of the
loan amount, which was distributed to the two components for payments
made from June 30, 2012 till June 30, 2013 as follows:
Component 1: Vaccines and drugs - US$21 million
Component 2: Bread and LPG cylinders - US$39 million
2. Prospective financing: US$90 million, equivalent to 60 percent of the
loan amount, which was distributed to the two components for payments
made from July 1, 2013 till July 30, 2014 as follows:
Component 1: Drugs and vaccines, medical treatment - US$49 million
36
Component 2: Bread and LPG cylinders - US$40.525 million.
Project Cost (US$)
Retroactive
(June 2012-
June 2013)
Prospective
(July 2013-
June 2014)
Total
Project
Costs
Disbursement
Amount Component
Progress%
Component 1: Maintain Access to Essential Health Care Services
Drugs and vaccines * 21,000,000 29,000,000 50,000,000 61,525,368 123%
Medical treatment 0 20,000,000 20,000,000 8,333,817 42%
Sub-total 21,000,000 49,000,000 70,000,000 69,859,158 99.8%
Component 2: Supporting Household Basic Needs
Bread 30,000,000 25,000,000 55,000,000 55,000,000 100%
LPG (cylinders) 9,000,000 15,525,000 24,525,000 24,525,000 100%
Sub-total 39,000,000 40,525,000 79,525,000 79,525,000 100%
Component3: Monitoring, Auditing and Verification
Sub-total 100,000 100,000 100,000 100%
Fontend loan fee 375,000 375,000 375,000 100%
Grand Total 60,000,000 90,000,000 150,000,000 149,859,185 99.91%
Due to the unavailability of the required documents in the Health Insurance
Department (HID) and according to the IBRD Agreement, the GOJ
transferred the remaining balance of US$11.65 million which was allocated
to the Medical Treatment item according to the Project Appraisal Document
(PAD) to the Drugs and Vaccines item. In this case, the amount for the
Medical Treatment item becomes US$61.65 million instead of US$50
million and the amount for the Drugs and Vaccines item becomes US$8.33
million instead of US$20 million.
Disbursements Procedure (Phases One and Two)
1. Drugs and Vaccines
The Joint Procurement Department (JPD) (which was responsible for
purchasing all the government goods and services including drugs and
vaccines) was paid through the Statements of Expenditures (SOEs) through its
budget allocation in the Budget Law under the Ministry of Health item. The
Ministry of Finance (MOF) provided the Ministry of Health (MOH) with the
cash flow to meet all its obligations including the obligations of the JPD. The
JPD paid the amounts due to the suppliers on behalf of the government.
The JPD processed the SOEs to the MOF, including the proof of advertisement;
purchase order; supplier invoice; proof of payment to suppliers; and delivery
evidence to the Directorate of Purchases and Supplies.
37
The MOF provided the Ministry of Planning and International Cooperation
(MOPIC) with the required SOEs duly cleaned and audited from its side.
MOPIC requested the World Bank to transfer the equivalent amount of these
SOEs in U.S. dollars to the special account of the loan, Designated Account
(DA), which was opened at the Central Bank of Jordan. The MOF requested the
Central Bank of Jordan to transfer the equivalent amount in JD from the DA to
the Treasury Account (TA).
2. Bread
The MOF paid the amount of the bread subsidies which was allocated in the
Budget Law on a monthly basis. The government subsidies equation can be
summarized as: (Sales + Ending inventory – cost).
During the concerned period, the government subsidy for bread was higher than
the allocated amount in the loan agreement in both phases (retroactive and
prospective period). The allocated amount for the retroactive period in the loan
was US$30 million which covered bread subsidies for 10 months only and the
allocated amount for the prospective period was US$25 million which covered
bread subsidies for 6 months only.
The MOF prepared and audited the statements of the bread subsidies which were
issued according to the Special Trade Account opened at the Central Bank of
Jordan and the financial reports provided by the Ministry of Industry and Trade.
The MOF provided MOPIC with the required statements of subsidies duly
cleaned and audited from its side. The MOPIC requested the World Bank to
transfer the equivalent amount of these statements in U.S. dollars to the DA. The
MOF requested the Central Bank of Jordan to transfer the equivalent amount in
JD from the DA to the TA.
3. Gas
The government subsidized gas based on the following equation: (Selling price
– Cylinder cost). The gas subsidy paid by the government during the concerned
period was higher than the allocated amount in the loan agreement in both
phases (retroactive and prospective period). The allocated amount for the
retroactive period in the loan was US$9 million which covered gas subsidies for
1 month only and the allocated amount for the prospective period was
US$15.525 million which covered gas subsidies for 6 months only.
The MOF prepared and audited the statements of gas subsidies according to the
financial reports issued by the Jordan Petroleum Refinery Company (JPRC).
The MOF provided the MOPIC with the required statements of subsidies duly
cleaned and audited from its side. The MOPIC requested the World Bank to
transfer the equivalent amount of these statements in U.S. dollars to the DA. The
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MOF requested the Central Bank of Jordan to transfer the equivalent amount in
JD from the DA to the TA.
4. Medical Treatment
The SOEs for Medical Treatment are paid by the HID through its allocation in
the Budget Law which is funded by the MOF.
The SOEs were audited by the Medexa Company which was appointed by the
MOH as an external medical auditing company; this company provides the
MOF through the HID with financial reports of the Medical Treatment.
The MOF provided the MOPIC with the required statements of subsidies duly
cleaned and audited from its side. The MOPIC requested the World Bank to
transfer the equivalent amount of these statements in U.S. dollars to the DA. The
MOF requested the Central Bank of Jordan to transfer the equivalent amount in
JD from the DA to the TA.
5. External Auditing
Through a competitive proposal, the GOJ (represented by the MOF) hired Saba
& Co. auditing company (Deloitte) as the external auditing company to audit all
the SOEs and statements of gas and bread subsidies for the concerned period
(retroactive period from June 30, 2012 till June 30, 2013 and prospective period
from July 1, 2013 till July 30 2014). The MOF paid services fees for the
company from its resources. The first auditing report issued by the company for
the retroactive period was sent to IBRD. The second report will be issued soon.
Conclusion
1. The loans provided by IBRD remain an important instrument to financing
government needs to help Jordan alleviate its debt burden due to its
concessionality.
2. The emergency loan helped Jordan compensate the budget deficit due to
the Syrian refugee impact. The MOF has successfully implemented the
loan with full cooperation from the MOPIC, MOH, Ministry of Industry
and Trade, Ministry of Energy, HID, JPD, JPRC, and the Central Bank of
Jordan
3. The government recommends that the World Bank continues to assist
Jordan through grants or soft loans from the donors to mitigate and face the
impact of Syrian Refugees and reduce the burden on the General Budget.
Indicators and targets
A. Immunization Coverage
39
(% of Infant by One Year of Age & Pregnant Women with TT2+ During 2011–2013))
Immunization
Years
Measles
%
MMR
%
OPV3
%
OPV4
%
DPT3
%
HBV3
%
HIB
%
TT2+
%
2011 97 94 95 97 95 95 95 40
2012 99 99 99 99 99 99 99 36
2013 94 97 94 97 97 97 97 22
Source: Communicable Diseases Directorate
B. MOH HOSPITAL
Year 2011 2012 2013
Admissions 332,607 339,628 347,929
Surgical Operations 79,567 88,317 87,422
Deliveries 73,340 73,399 74,188
Year 2011 2012 2013
Deliveries in JORDAN 168,122 165,536 168,129
C. Visits to PHC Centers
Year 2011 2012 2013
Physicians 9,841,736 10,492,749 10,673,292
Nurses 2,258,192 2,362,141 2,332,157
Total 12,099,928 12,854,890 13,005,449
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Annex 6: Lessons Learned From Fiduciary Perspective
Background
To assist with the mitigation of impact, the project was prepared and implemented
according to paragraph 11 of the World Bank Operational Policy 10.00, which allows for
certain exceptions to the investment project financing policy requirements when the
borrower is deemed to be in urgent need of assistance because of a man-made disaster or
conflict (among other factors). The evolving situation in Jordan reflects both the impact of
conflict (in neighboring Syria) and of a man-made disaster (resulting from the influx of
refugees fleeing the conflict) - two of the specific situations that the provisions were
developed to address.
Fiduciary Arrangements
Financial Management: Due to the emergency nature of this operation and the need to
respond quickly, the FM approach was streamlined and based on more simplified ex ante
requirements, while relying more heavily on ex post requirements as additional fiduciary
controls and review. The risk mitigation measures were designed to suit the available
capacity during implementation. The main FM and disbursement arrangements of this
project were:
a) Project staffing relied on the available FM capacity at the MOF where a qualified
accountant was identified from the MOF’s own Finance Department to follow on
the FM and disbursement tasks.
b) Flow of funds arrangements included the use of a DA opened at the Central Bank
of Jordan with a high ceiling of US$60 million. Funds were transferred to the
government treasury account against submitted SOEs.
c) The MOPIC was responsible for submitting withdrawal application on behalf of the
MOF due to its long experience with the World Bank disbursement policies and
procedures.
d) The project was provided with retroactive financing of a value US$60 million
(US$21 million for vaccines and drugs, and US$39 million for bread and LPG)
against submitted SOEs.
e) The government inventory management system at the Directorate of Purchases and
Supplies/MOH was used after being carefully examined by the Bank team and it
was found that reasonable assurances existed in the safeguard of the vaccines and
drugs until collection by beneficiary hospitals and health centers.
f) An external audit firm conducted a special purpose audit of vaccines and drugs
financed under the retroactive financing of US$21 million. The audit was
41
conducted after the retroactive financing amount was transferred to the government
treasury account.
g) A consultancy firm performed technical (medical) and financial audit of medical
bills of patients referred to the non-MOH hospitals and health facilities.
h) The same audit firm that conducted the special purpose audit on retroactive
financing of vaccines and drugs will complete the final audit of project’s activities
after project closure up to the end of the four-month grace period.
Procurement:
a) The JPD was assigned for the procurement of contracts under Component 1
(Provision of vaccines and essential drugs). Procurement practice by the JPD was
assessed by visiting the agency, interviewing its staff, and reviewing the past
assessments done on the agency.
b) It was concluded that the JPD is successfully running annual procedures of drug
procurement on behalf of its partner institutions in Jordan, and based on a Rational
Drug List that is updated from time to time as needed, conducts the procurement of
pharmaceutical/medical goods in a transparent and well-structured manner. It is a
well-managed organization that is successfully dealing with the procedures
throughout the kingdom.
c) Considering the urgency of the project and that the implementation period was only
one year it was decided for the procurement of pharmaceutical and medical
equipment to be undertaken using the existing JPD procedures for contracts up to
the threshold of US$5 million per contract from the Rational Drug List (The
Positive List of Goods).
d) To minimize the number of transactions and required documents, a positive list of
goods (contracts with estimated cost of US$200,000 and above) was used for
pharmaceuticals and vaccines to be procured, that included items cleared by JFDA.
e) To facilitate disbursement the necessary documents to be provided by the Borrower
were defined and minimized as (i) proof of advertisement, (ii) proof of purchase
(purchase order), and (iii) proof of payment to suppliers.
f) Retroactive financing: The JPD procurement practice used to procure goods up to
US$5 million was considered acceptable for retroactive financing from the Rational
Drug List (The Positive List of Goods) cleared by JFDA.
g) Anti-Corruption Guidelines: The JPD contracts and standard bidding documents do
not explicitly contain clauses related to fraud and corruption, as these contracts are
governed by the national anti-corruption rules providing for the exclusive
jurisdiction of the Anti-Corruption Commission (ACC) of Jordan, an independent
42
agency, in cases of fraud and corruption. Therefore, a waiver of some provisions of
the World Bank Anti-Corruption Guidelines was sought to rely on the Borrower’s
national ACC to investigate cases of fraud and corruption. The waiver specifically
proposed the modification of paragraph 9 and deleting paragraph 10, as detailed
below.
h) Modifications to the Anti-Corruption Guidelines: Paragraph 9 was modified as
summarized below:
The Borrower will:
Take all appropriate measures to ensure that the project is carried out in
accordance with these guidelines.
Take all appropriate measures to prevent corrupt, fraudulent, collusive,
coercive and obstructive practices in connection with the use of the Loan
proceeds.
Immediately report to the Bank any allegations of fraud and corruption in
connection with the use of the loan proceeds that come to its attention.
If the Bank determines that any person has engaged in corrupt, fraudulent,
collusive, coercive or obstructive practices in connection with the use of the
Loan proceeds, take timely and appropriate action, satisfactory to the Bank,
to address such practices when they occur.
Investigate all credible and material allegations of fraud and corruption (i)
upon the completion of any such investigation, report to the Bank the
findings thereof and (ii) if the Borrower or the Bank determines that any
person or entity has engaged in fraud or corruption in connection with the
project, take appropriate action, in accordance with the Borrower’s laws and
regulations and satisfactory to the Bank, to address the situation and prevent
its recurrence.
In the event that the Bank declares any recipient of the Loan proceeds
ineligible, (i) exercising the Borrower’s right to terminate early or suspend
the agreement between the Borrower and such recipient and/or (ii) seeking
restitution.
Ensure that any person or entity debarred or suspended by the Bank is not
awarded a contract.
Fiduciary Lessons Learned
The FM approach was streamlined and based on more simplified ex ante requirements,
while relying more heavily on ex post requirements as additional fiduciary controls and
review. The specific FM ex post requirements included:
a. A special purpose audit was conducted on the vaccines and drugs of value
US$21 million financed retroactively. The audit was completed after the
amount was transferred from the DA to the government treasury account.
43
The audit firm conducted a review of: (i) proof of advertisement, (ii) proof
of purchase, (iii) supplier invoice, (iv) proof of payment to suppliers, and
(v) delivery evidence to the Directorate of Purchases and Supplies/MOH
warehouses.
b. A technical (medical) and financial audit was performed by a specialized
firm of medical bills of patients referred to the non-MOH hospitals and
health facilities. The scope of this special purpose audit included: (i)
verifying that referrals are issued in accordance with the MOH procedures;
(ii) ensuring appropriateness of referrals and use of services according to
health needs; (iii) validating the reasonableness of the medical bills of the
non-MOH hospitals and health facilities; and (iv) adherence to the cost
ceiling of US$10,000 per patient.
c. A final audit started after project closure on all the project’s components
and activities. The auditor will issue professional opinions on whether: (i)
the General Purpose Project Financial Statements (PFS) present fairly, in
all material respects, the cash receipts and payments of the project, in
accordance with the International Public Sector Accounting Standards
(IPSAS), under the cash basis of accounting; (ii) internal control over
financial reporting involved in the preparation of replenishments, direct
payments, payments through special commitments, and reimbursements i.e.
expenditures reimbursed on the basis of SOEs can be relied upon to support
the related withdrawals, (iii) the project was in all material respects in
compliance with the laws, regulations, guidelines and provisions governed
by the Loan agreement, and (iv) the drugs were procured and paid as per
the Rational Drug List, the corresponding stocks registers, and inventory
controls in the assigned warehouses. The audit report is expected to be
issued by December 31, 2014.18
d. The available audit tools were used to have a reasonable assurance of the
values of the bread and LPG subsidies that were retroactively financed by
US$39 million. These audit tools included the review of the most recent
issued audit reports of: (i) the Special Trade Account of the MOIT, which
reports on bread subsidy, and (ii) the Petroleum Refinery Company (sole
supplier of LPG in Jordan) for any irregularities.
18 To be issued by end of January 2015
44
The coordination between the different units within World Bank (FM, CTR,
Procurement, Social Protection, and Labor) was outstanding and significantly
contributed to the timely project preparation and as well the smooth implementation.
Considering the large number of small contracts being procured by the JTD, the
imposed limitation on a positive list of contracts with estimated cost of US$200,000
and above, minimized the number of transactions and required documents to be
audited.
To avoid excessive transaction costs of SOEs, the minimum amount for direct payment
and reimbursement was set at 20 percent of the DA ceiling amount along with
necessary supporting documents.
Two agencies (MOPIC and MOF) were engaged in the FM and disbursement
arrangements; the MOF was responsible for the overall FM and disbursement
arrangements, while the MOPIC was responsible of submitting withdrawal
applications to the Bank. This was not considered an ideal model and lack of
coordination on a few occasions caused delays in submission of withdrawal
applications to the Bank.
The disbursement requirements for each component were made very clear to the
counterpart and for that, a table was used to summarize those requirements and
included in the PAD. This has significantly contributed in minimizing any confusion
by the counterpart of those requirements.
45
The procurement approach, to use JTD procurement practice based on the Jordanian
Rational Drug List helped to prevent delays in supplying the medicines and vaccines
by accessing the many global pharmaceutical companies and generic producers with a
presence (or agency) in Jordan.
The relatively large percentage of retroactive financing combined with using JTD
procurement practice was instrumental in fast disbursement.
It was shown that the Bank Procurement Guidelines have the required flexibility to
accommodate for such emergency cases.
Reliance on the national ACC allowed for using the national bidding documents
already in use, resulting in both large retroactive and speedy new procurement.
46
Annex 7. List of Supporting Documents
Implementation Completion Report: December 1, 2014
External Audit for Medicine and Vaccines: May 2014
External Audit for Bread and Gas: January 2015
Aide Memoires for Supervision Missions
Project Appraisal Document IBRD-82830
47
MAP
48