The Federal Republic of Nigeria is seeking approval from the World Bank to restructure a $650 million loan that was allocated for the Nigeria Improved Child Survival Program for Human Capital (ICSPHC).
This request is detailed in a “Restructuring Paper”, the ICSPHC is a vital part of Nigeria’s broader health sector reform efforts, aimed at reducing the under-five mortality rate from 132 per 1,000 births in 2018 to 79 per 1,000 by 2030.
According to the restructuring document, the request follows a mid-term review of the project, which identified the need for strategic adjustments to better align with the Nigerian government’s evolving approach to health sector reform, especially in the areas of child and maternal health.
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The document states: “This Restructuring Paper seeks the approval of the Country Director to carry out a Level-two restructuring of the Immunization Plus and Malaria Progress by Accelerating Coverage and Transforming Services Project (IMPACT P167156), the first phase of the Nigeria Improved Child Survival Program for Human Capital Multiphase Programmatic Approach (MPA).
“This Level 2 restructuring proposes to (a) revise the components and costs; (b) reallocate funds across disbursement categories; and (c) modify the Results Framework.
This is the second restructuring of the IMPACT Project, following a previous restructuring in July 2021, which included financing the construction of the Lagos vaccine Hub under Component 2.”
The restructuring proposal is based on the findings of the October 2023 Mid-Term Review (MTR) and agreements reached during extensive discussions between the Nigerian government and the World Bank, as detailed in a letter of request dated March 26, 2024 (Reference No. LF466: FMOFIER-240328).
Proposed Changes
While the project has been described as moderately satisfactory, the proposed restructuring involves several significant changes to its design and implementation strategy.
The Nigerian government plans to reallocate funds across disbursement categories to free up resources for expanding the Basic Health Care Provision Fund (BHCPF) to additional states. This expansion aims to enhance access to essential health services, particularly in regions with poor health indicators. Additionally, the government intends to revise the project’s results framework, incorporating alternative data sources such as the Multiple Indicator Cluster Surveys (MICS) to address monitoring and evaluation gaps.
The restructuring will also involve the removal of specific activities, such as the centralized procurement of Long-Lasting Insecticidal Nets (LLINs) and other malaria commodities. Instead, participating states will manage their own procurement processes to ensure timely delivery of malaria prevention tools. This change is expected to improve the efficiency of malaria control efforts and contribute to the broader goal of reducing under-five mortality.
Moreover, the restructuring includes the addition of a new sub-component focused on improving secondary health facilities and training institutions for healthcare workers.
