Input:
**service delivery significantly affect the health sector performance.** The main provider of health services
is the Government; however, there are multiple parallel service delivery systems, which include 12 distinct
vertical health programs [19] and subcontracting of PHC services to the People's Primary Healthcare Initiative
(PPHI). These separate programs remain siloed, each having their own reporting systems [20] and supply
chains, resulting in the duplication of efforts and inefficiencies. Further, contract management and
performance monitoring of these programs are limited or have not been established. Similarly, the private
sector (formal and informal) and nongovernmental HFs operate in a largely unregulated manner despite
the significant role they play. [21] In addition, the GoB lacks health information critical for planning,
budgeting, and management purposes, such as data on the availability of essential inputs for service
delivery. Data on service utilization at HFs are mostly collected manually using paper forms and data
controls and quality assurance mechanisms are largely nonexistent due to budget constraints. The GoB
also does not have a digital registry of health care providers with basic data to manage human resources,
such as job titles or professional profiles including education, work experience, and in‐service trainings.
Similarly, the supply chain management process is based on paper systems, except for two vertical
programs (immunization and family planning), often leading to delays in the delivery of drugs, extended
periods of medicine stockouts at public HFs, and high incidence of expired drugs.


Input:
17. **In Balochistan, children suffer from suboptimal learning outcomes and large disparities by**

**gender.** Despite significant efforts by the Secondary Education Department (SED), Balochistan performs
poorly compared to the national average across all education outcomes. In FY16/17, 64 percent of boys
and 78 percent of girls (between the ages of 5 and 16) were not enrolled in primary and secondary schools
in Balochistan, compared to 40 percent of boys and 49 percent of girls at the national level. [22] The overall
net enrollment and effective transition rates, from primary to middle school and middle to high school,
were low compared to national rates, especially among girls. When it comes to student learning metrics,
children in Balochistan also perform poorly in comparison to the same age groups in rural Pakistan
communities. For example, approximately 60 percent of children in grade 5 could not perform a two‐digit
division problem. The 2018 ASER report also highlighted a wide gender gap in student learning, with 31
percent of boys and 20 percent of girls (ages 5 to 16 years) being able to read second‐grade level sentences

---
[22] In Pakistan, primary schools cover grades 1 through 5 and secondary schools cover grades 6 to 10 with middle schools for grades 6 to 8 and


Input:
19 Expanded Program on Immunization (EPI), Tuberculosis, Malaria and Vector Borne Diseases Control Program, Maternal, Newborn, and Child
Health (MNCH), Lady Health Workers (LHW) Program, District Health Information System (DHIS), Nutrition Program, HIV‐AIDS, Prime Minister’s
Initiative for Hepatitis Control Program, Leprosy Control Program, National Program for Prevention and Control of Blindness, and Provincial
Disaster and Surveillance Unit.
20 In addition to the DHIS, there exist many parallel health management information systems (HMIS) (for example, one for each vertical
program, PPHI, and so on). Services delivered through the private sector are also not reported.
21 Less than 4 percent of the population seeks care at the public primary level HFs and 28 percent seeks care at higher‐level public HFs, while
more than 60 percent seeks care at private HFs (PSLSM Survey 2014–15. Pakistan Bureau of Statics, 2016).
Zaidi, S. A., M. Bigdeli, and E. V. Langlois, et al. 2019. “Health Systems Changes after Decentralization: Progress, Challenges and Dynamics in
Pakistan.” _BMJ Glob Health_ 4.


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

in Urdu. [23] Within the Afghan refugee population ages 12 and above, only 33 percent are reportedly able
to read and write, and female literacy is extremely low at 15 percent, compared to the male literacy rate
at 50 percent. Afghan refugee children were also shown to have a much lower net enrollment rate
compared to Pakistani children, 29 percent and 56 percent respectively. [24]

18. **Key factors that negatively affect learning outcomes, especially for girls, are limited access to**

**education services, quality of inputs, and inadequate student learning assessments to monitor**


Input:
**performance.** Currently, there are only 565 middle and 332 high schools for girls, compared to 830 middle
and 675 high schools for boys, resulting in high female dropout rates after grade 5. [25] Of the total public
schools, around 42 percent of schools have no water, 57 percent have no boundary walls, 71 percent have
no toilet facilities, and 79 percent are without electricity—key factors contributing to students, especially
female, dropping out from school. [26] Another major hurdle in attracting and keeping female students is
the lack of female teachers. The low levels of education attainment and traditional social norms, which
prioritize marriage and domestic work, limit female labor force participation to 8 percent compared to 20
percent at national level, [27] supported by the evidence that only around 35 percent of the total 45,663
teachers are females. The Provincial Institute for Teacher’s Education (PITE), the apex teacher training
institute in Balochistan, does not include a needs assessment to establish a baseline of existing
competencies, making it difficult to measure the impact of PITE’s teacher trainings. [28] The Balochistan
Assessment Examination Commission (BAEC) is mandated to improve the quality of student exams, at all
levels, thus ensuring a transition from memory testing toward more critical thinking. However, this is only
possible if other institutions also take ownership of this agenda and harmonize their efforts with the BAEC,
including the Directorate of Schools (DOS), Bureau of Curriculum and Extension Centre, and Board of
Intermediate and Secondary Education (BISE). The Balochistan Education Sector Plan (BESP) 2020–25
identified changing the current approach and improving the quality of assessments, at both the school
and external level (conducted by the DOS and the BISE), as a key priority.


Input:
19. **The performance of the education sector is affected by weak governance and limited use of**

**data to inform decision making.** The quality of education services at the local level is characterized by
poor ownership, weak accountability of teachers and local education managers, frequent teacher
absenteeism, and poor monitoring and measurement of student learning. To address these challenges,
BESP 2020–25 emphasizes the need to decentralize decision‐making power to the cluster level. [ 29] It also
entails the formation of a Local Education Council (LEC), allocation of a drawing and disbursement officer
(DDO) code to the head teacher, training of the LEC in school‐based and cluster‐level budgeting and
procurement, student learning assessments across all cluster schools, and the establishment of an
Education Management Information System (EMIS) cell for improved data management. [30] The SED’s
limited capacity in data analysis is also hampering its ability to make timely decisions and improve
planning.

---
[30] SED, GoB. 2014. _Policy, Devolution of Education Management and Services at Cluster Level._

Education Management Information System (EMIS)


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

20. **As with elsewhere in the country, schools are currently closed in Balochistan.** As part of the
national response to the COVID‐19 pandemic, the Ministry of Federal Education and Professional Training
launched a distance education ‘Teleschool’ television channel. Children in Balochistan are also benefiting
from it. The need to strengthen quality of education will be even more important to mitigate the lost time
of instruction. At the same time, the Teleschool delivery system can offer an opportunity to reach some
of the out‐of‐school children, including girls.

**C. Relevance to Higher Level Objectives**

21. **The Balochistan Human Capital Investment Project is aligned with the World Bank Group’s**


Input:
**Country Partnership Strategy (FY15–20)** [31] and with the twin goals of ending extreme poverty and
promoting shared prosperity. It is also aligned with the recent Pakistan@100 report which highlights the
necessary reforms required for Pakistan to become an upper‐middle‐income country by 2047. [32] It
contributes directly to the Strategy’s Results Area 4 (Service Delivery) and covers all sub‐results areas: 4.1.
Improved public resources management; 4.2. Improved access to maternal and child health services; 4.3.
Increased school enrollment and adoption of education quality assessment; and 4.4. Adaption of
performance and transparency mechanisms in selected institutions. In addition, it contributes to Results
Area 3 (Inclusion), through 3.2. Reduced vulnerability for groups at risk by improving girls’ gross primary
education enrollment and supporting effective and inclusive management of Afghan refugees and host
communities. The project also supports the federal and provincial governments to achieve their priorities
as outlined in the National Health and Education Plans, and Provincial Development Support Program.

22. **The project also contributes to the Human Capital Project, a global effort to accelerate more**

---
[32] World Bank. 2019. _Pakistan at 100: Shaping the Future_ . Washington, DC: World Bank.


Input:
**and better investments in people for greater equity and economic growth.** The project is one in a set of
World Bank‐supported federal and provincial operations that bring together core interventions that are
aligned with the policy reforms of the GoP in human capital supported by the World Bank under the
Development Policy Operation: Securing Human Investment to Foster Transformation.

23. **The project is fully aligned with the GoP’s response to the COVID‐19 crisis** . It supports the
emergency and early recovery response, while also strengthening health and education systems in
medium‐term. Social and behavior change communication and community outreach efforts under the
project will be essential to prevent COVID‐19 and its socio‐economic impact. It will also contribute to
mitigating the negative impact of the pandemic in livelihoods through creation of jobs. By taking a
medium‐term system strengthening approach, the project contributes to the preparedness of the GoB’s
response to health security challenges. Further, by taking an inclusive approach focusing on both host
communities and refugees it contributes to sustain the protection environment.

24. **The project is fully aligned to the Board Consultation on Eligibility for Funding under IDA18**


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

Investment Project, (c) the Balochistan Human Capital Investment Project, and (d) the Balochistan
Livelihoods and Entrepreneurship Project.

25. **The project is expected to contribute to the World Bank corporate commitments on gender,**

**fragility, and climate change.** The project will contribute to reducing the gender gap in the utilization of
education services. The project will also address issues related to fragility by mitigating the impact of the
protracted refugee situation existing in the province. On climate change, it will improve the resilience of
the target population through adaptation and mitigation especially in the health and education sectors.

**II.** **PROJECT DESCRIPTION**
.

**A. Project Development Objective**

**PDO Statement**

26. To improve utilization of quality health and education services in selected refugee hosting districts
of Balochistan.

**PDO Level Indicators**

27. Progress toward achieving the Project Development Objective (PDO) will be measured by the
following indicators in project areas:

- **PDO Indicator 1** : Deliveries attended by skilled health personnel (cumulative number,
corporate results indicator [CRI]);

- **PDO Indicator 2:** Children immunized [33] (cumulative number, CRI);

- **PDO Indicator 3:** Students benefiting from direct interventions to enhance learning [34]
(cumulative number, CRI);

---
[33] This indicator will be measured by cumulative number of children below 12 months immunized with the first dose of measles.
[34] This indicator will be measured by cumulative number of students enrolled in project schools.


Input:
- **PDO Indicator 4:** Female students enrolled in project schools (cumulative number); and

- **PDO Indicator 5:** Targeted schools meeting at least three out of five model‐school criteria [35]
(percent).

28. **The project aims to achieve the PDO by addressing development barriers affecting both health**

**and education sectors in the same districts**, that is, by investing to fill supply‐ and demand‐side gaps and
improving management and governance in the sectors. This two‐pronged approach will improve
utilization and quality of critical public services that support the accumulation of human capital. Given the
critical shortage of functional facilities close to refugee‐affected areas, the project will adopt a phased
approach filling supply‐side gaps first and then creating demand. The project will also focus on (a) gender
equity and (b) convergence of multisectoral interventions. Children and their families will benefit from

---
[35] Criteria include (a) dedicated early childhood education (ECE) classrooms and ECE teachers, (b) 50 percent of teachers trained


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

the synergistic effect of receiving both health and education interventions in the same target areas. The
project will also explore opportunities for multisectoral services. For example, skilled health workers at
the nearby HFs will provide school health education for students, while schools will provide a venue for
outreach health services to communities.

29. **The interventions designed to improve systems will be first implemented in target areas and**

**later scaled up at the provincial level.** The project targets four districts (that is, Chagai, Quetta, Pishin,
and Killa Abdullah) with (a) the highest presence of registered refugees or (b) the main border crossing
between Balochistan and Afghanistan constituting a major entry/exit point for refugees.

**B. Project Components**

**Component 1: Improving utilization of quality health services (US$18.25 million equivalent)**

30. **Component 1 aims to improve utilization of quality health services** by improving delivery of
essential preventive and curative services at existing primary and secondary HFs and strengthening health
sector stewardship in Balochistan. Interventions will be implemented in selected refugee hosting districts,
through two subcomponents.


Input:
31. **Subcomponent 1.1: Improving delivery of quality health services (US$14.86 million equivalent)**
will support improving delivery of quality health services in selected refugee hosting districts, with a focus
on RMNCHN, through: (a) carrying out works, implementing a health care waste management system,
and providing essential inputs (human resources, medical equipment, medicines, and supplies) necessary
to deliver critical health services at selected (i) basic health units (BHUs), (ii) RHCs, including basic EmONC,
and (iii) tehsil headquarter hospitals and district headquarter hospitals, including comprehensive EmONC;
(b) improving health service providers’ knowledge and competencies through, inter alia: (i) updating
training curricula and training of key health providers; and (ii) piloting a technology‐based innovation for
assessing health service providers’ clinical knowledge and filling the knowledge gaps identified thereby;
and (c) carrying out community‐based advocacy, outreach, and awareness raising activities among health
and education service beneficiaries. Select planned interventions may be adapted to support the response
of the health sector to the COVID‐19 outbreak and ensure that critical health services continue to be
delivered. For example, the project may support training of providers on infection prevention and control,
use of HMIS to strengthen reporting of cases and use of community interventions for sensitization and
behavior change (for example, self‐distancing, hygiene at home). The project will also consider financing
additional interventions such as transport for health care workers to reach the facilities or telemedicine
to address specific service delivery challenges that may emerge as a consequence of COVID‐19 and other
outbreaks.


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

staff have minimum hands‐on experience with deliveries. In addition to supporting project beneficiaries
to access improved health and education services, especially women and girls in host communities, the
project will support demand‐generating activities that target young and pregnant women; expectant
fathers (or husbands); and other household decision makers and community influencers. To mobilize
communities, the project will explore the possibility of leveraging key stakeholders, such as LHWs,
community groups, community/religious leaders, and the Commissionerate of Afghan Refugees. It will
also leverage schools for health promotion such as appropriate hand washing and personal hygiene.
Finally, it will strengthen HF‐level governance to increase service provider accountability by actively
engaging citizens and seeking their feedback.


Input:
33. **Subcomponent 1.2: Strengthening health sector stewardship (US$3.39 million equivalent)** will
support strengthening health sector stewardship in selected refugee hosting districts through: (a)
improving availability, quality, and use of routine health data via, inter alia, (i) developing and
implementing a digital human resources database, (ii) digitizing DHIS and integrating selected parallel
reporting systems, (iii) providing training, equipment, and operational support to health services providers
for implementation and operationalization of HMIS, (iv) creating a user‐friendly dashboard for decision
making; and (v) supporting data review meetings and data quality checks; and (b) providing training to,
and building capacity of, key managerial and technical staff on selected health system strengthening
subjects. The project will support a real‐time system monitoring of staff presence at HFs. Training of
managerial and technical staff at provincial and district levels in various health system strengthening areas
directly linked to improving effectiveness, efficiency, and sustainability of service delivery will include
contract management of private‐public partnerships, public financial management, monitoring and
supervision, human resources for health (HRH) management, and supply chain management. The project
will also support a Project Management Unit (PMU) to strengthen capacity by providing day‐to‐day project
management, including fiduciary and safeguards management, and monitoring and evaluation (M&E).


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

meet the academic and extracurricular needs of students. [38] The SED will recruit or depute qualified female
teachers for the upgraded schools. The subcomponent will also ensure that each target school meets the
model school criteria. [39]

36. **Subcomponent 2.2: Strengthening education sector stewardship (US$6.84 million equivalent)**
will support strengthening education sector stewardship in selected refugee hosting districts through: (a)
carrying out a functional review of selected secondary education institutions [40] as well as developing and
implementing a strategy for upgrading student assessment system; (b) carrying out a functional review of
PITE and developing an action plan to address recommendations proposed thereby; (c) implementing
cluster‐based governance and management system [41] at schools upgraded pursuant to subcomponent
2.1(a) above; and (d) developing and pilot‐testing of a technology‐based tool to enhance SED’s capacity
in regular planning and budgeting, resource rationalization, and decision making.

---
[40] They include BAEC, PITE, Bureau of Curriculum and Extension Center, DoS, and BISE.
[41] It includes (a) allocating DDO code to the cluster head; (b) LECs preparing cluster plans and budgets; and (c) organizing


Input:
38 The initial selection criteria include distances to the school being considered for upgradation and current enrollment of
students in its highest grades.
39 It means having (a) an operationalized early childhood component, with necessary supplies, a dedicated classroom, and a
dedicated teacher; (b) teachers trained to use scripted lessons; (c) boundary walls and functional toilets; (d) a desk and a chair
for each student; and (e) trained PTSMCs operationalized.


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

**C. Project Beneficiaries**

39. **Direct project beneficiaries will be children, adolescents, and women of reproductive age of**

**selected refugee hosting districts in Balochistan,** namely in Chagai, Pishin, Quetta, and Kila Abdullah.
These are among the most disadvantaged population groups in the province as many of them are located
in low‐income and hard‐to‐reach areas. The project will also support investments to strengthen the
management and governance of health and education sectors, and thus service providers, supervisors,
and managers at facility, district, and provincial levels will also benefit from the project. Project
interventions also include strengthening systems for increased efficiency, accountability, and
transparency (for example, public financial management of the Finance Department), and thus the project
benefits may spill over to other sectors over time.

**D. Results Chain**

40. **The results chain shows the relationship between sector challenges, activities, outputs, and**


Input:
**effectiveness.** The assumptions for Component 1 are the following: (a) utilization of health services will
increase due to better equipped HFs, presence of providers, and demand generation activities; (b)
development and implementation of a real‐time monitoring system of HRH will empower government
officials to take actions to reduce absenteeism; this in turn will improve trust in HFs and thus increase the
demand for and utilization of health services; (c) training will translate into better provider knowledge,
skills, and competencies, thus better health outcomes; and (d) data generation and capacity building to
monitor service delivery will lead to evidence‐based decision making. For Component 2, critical
assumptions include the following: (a) newly upgraded schools will increase enrollment of girls and boys;
(b) additional facilities in project schools will reduce dropout rates; (c) strengthening of LECs will increase
parents and larger communities’ ownership of cluster schools; and (d) results from student learning
assessments will be used to improve the quality of education services.

**E. Rationale for Bank Involvement and Role of Partners**

42. **The World Bank brings a mix of technical expertise and global knowledge that can help the GoB**


Input:
**in addressing the needs of the province to improve quality health and education services.** Given the
project’s alignment to the RSW, the World Bank can mobilize additional resources and global expertise to
support the GoB in addressing the challenges resulting from the prolonged presence of refugees. The
World Bank has closely collaborated with the UNHCR in the preparation of this project and will continue
to so during implementation. UNHCR has provided inputs for the design of projects under the RSW,
drawing on its rich experience of working with refugees in Pakistan. Finally, the World Bank’s involvement
will also have positive impacts in advancing national policy agendas, such as women’s empowerment,
climate, resilience, and citizen engagement (CE).

Page 17 of 47


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

**Figure 1. Theory of Change**

|Output  Challenges|Activities|Outputs|Outcomes (PDO)|Long‐term Outcomes|Impact|
|---|---|---|---|---|---|
|Inadequate infrastructure,
equipment, and medicine| Renovation/upgradation of selected HFs to
24/7
 Purchasing of equipment and medicines| Increased number of HFs renovated/upgraded
including female staff hostels*
 Increased number of HFs with essential inputs|Improved
utilization of
quality health
services in
selected refugee
hosting districts
in Balochistan
|Improved
child health
outcomes
(reduced
under‐five
mortality,
reduced
stunting)
among
refugees and
host
communities
in Balochistan|Improved human
capital among
refugees and host
communities in
Balochistan|
|Shortage, absence, low
productivity, and
competency of providers| Contracting of especially female providers*
 Creation of HRH database
 Competency‐based training| Increased availability of (especially female)
providers* at the HFs
 Functional HRH database
 Increased number of providers with minimum clinical
competency| Increased availability of (especially female)
providers* at the HFs
 Functional HRH database
 Increased number of providers with minimum clinical
competency| Increased availability of (especially female)
providers* at the HFs
 Functional HRH database
 Increased number of providers with minimum clinical
competency| Increased availability of (especially female)
providers* at the HFs
 Functional HRH database
 Increased number of providers with minimum clinical
competency|
|Low quality and
suboptimal use of health
data| Digitization and integration of the HMIS into
the DHIS with dashboards
 Data review meetings| HMIS (DHIS, vertical programs) digitized and
integrated into DHIS/DHIS2
 Improved quality of DHIS reports| HMIS (DHIS, vertical programs) digitized and
integrated into DHIS/DHIS2
 Improved quality of DHIS reports| HMIS (DHIS, vertical programs) digitized and
integrated into DHIS/DHIS2
 Improved quality of DHIS reports| HMIS (DHIS, vertical programs) digitized and
integrated into DHIS/DHIS2
 Improved quality of DHIS reports|
|Weak institutional capacity|  Capacity building (HMIS, monitoring,
supervision, and management)| Increased number of targeted staff with
basic/advanced competencies| Increased number of targeted staff with
basic/advanced competencies| Increased number of targeted staff with
basic/advanced competencies| Increased number of targeted staff with
basic/advanced competencies|
|Low demand of health and
education services| Advocacy and awareness‐raising activities in
targeted communities and groups such as
PTSMCs| Increased awareness of available health and
education services and benefits of utilizing them| Increased awareness of available health and
education services and benefits of utilizing them| Increased awareness of available health and
education services and benefits of utilizing them| Increased awareness of available health and
education services and benefits of utilizing them|
|Low demand of health and
education services| Advocacy and awareness‐raising activities in
targeted communities and groups such as
PTSMCs| Increased awareness of available health and
education services and benefits of utilizing them|Increased
utilization of
quality education
services in
selected refugee
hosting districts
in Balochistan|Improved
education
outcomes
(improved
learning‐
adjusted
years of
school)
among
refugees and
host
communities
in Balochistan|Improved
education
outcomes
(improved
learning‐
adjusted
years of
school)
among
refugees and
host
communities
in Balochistan|
|Fewer secondary schools
especially for girls near
their settlements*| Upgradation of girls and boys schools
 Transportation support for girls and female
teachers*| Increased number of middle and high schools
especially for girls*
 Improved accessibility to schools by girls and female
teachers*| Increased number of middle and high schools
especially for girls*
 Improved accessibility to schools by girls and female
teachers*| Increased number of middle and high schools
especially for girls*
 Improved accessibility to schools by girls and female
teachers*| Increased number of middle and high schools
especially for girls*
 Improved accessibility to schools by girls and female
teachers*|
|Unavailability of female
teachers, lack of basic
facilities and suboptimal
teacher training*| Implementation of SED's model school criteria
 Assessment of teacher training mechanisms
and upgradation of provincial teacher training| Increased number of schools satisfying model school
criteria (for example, staffing of qualified female
teachers and separate toilets for girls*)
 Concept‐based learning assessment for grades 5 and
8 students| Increased number of schools satisfying model school
criteria (for example, staffing of qualified female
teachers and separate toilets for girls*)
 Concept‐based learning assessment for grades 5 and
8 students| Increased number of schools satisfying model school
criteria (for example, staffing of qualified female
teachers and separate toilets for girls*)
 Concept‐based learning assessment for grades 5 and
8 students| Increased number of schools satisfying model school
criteria (for example, staffing of qualified female
teachers and separate toilets for girls*)
 Concept‐based learning assessment for grades 5 and
8 students|
|Ineffective student
assessments
| Review of student assessment mechanisms
and upgrading provincial student assessment
| Student learning assessment reforms strategy| Student learning assessment reforms strategy| Student learning assessment reforms strategy| Student learning assessment reforms strategy|
|Weak ownership of schools| Establishment and strengthening of LECs in
target clusters
 Training of PTSMCs| Increased number of school clusters with improved
management
 Improved knowledge of parents on education,
especially for their girls*| Increased number of school clusters with improved
management
 Improved knowledge of parents on education,
especially for their girls*| Increased number of school clusters with improved
management
 Improved knowledge of parents on education,
especially for their girls*| Increased number of school clusters with improved
management
 Improved knowledge of parents on education,
especially for their girls*|


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

**F. Lessons Learned and Reflected in the project Design**

43. Based on the global and local evidence, the project has adapted interventions that have
successfully contributed to the accumulation of human capital and adjusted less successful interventions
to maximize impact.

(a) **Quality care is a necessity to ensure that increases in health service utilization translate**

**into better health outcomes.** Poor quality of care is a leading cause of maternal and child
mortality and morbidity. There is an urgent need to assess and improve health workers’
knowledge, skills, and competencies in caring for patients. [42]

(b) **Multifaceted strategies work better.** Financing of targeted training, supervision, other
management techniques, infrastructure, medicines, and/or implementation of an improved
data system tend to achieve larger impacts than financing a single intervention. [43]

(c) **Previous efforts of monitoring and enforcing public sector attendance through a real‐time**

**monitoring technology have proven to be effective when political and bureaucratic**

**interference is low.** [44] The project will make the information publicly available to reduce
political interference.

(d) **ECE is critical in terms of providing children with equitable learning environments and**


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

recently approved Pandemic Response Effective in Pakistan Project will support the national
and provincial governments to respond to the COVID‐19 crisis, this project will support
strengthening of the health system to ensure it continues providing essential health services
to the target population groups safely by controlling infection risk at HFs. This is paramount
to maintain public trust in the health sector and ensure continued health care‐seeking
behavior, therefore avoiding higher mortality from non‐COVID conditions.

44. The design of project implementation and monitoring have also been informed by the experience
of previous and ongoing World Bank and other development partners’ (DPs) engagements especially in
Pakistan.

(a) **Coordination structures for effective multisector coordination.** Poor interdepartmental
coordination significantly slows down and fragments project implementation, thus limiting
the synergistic effects of the interventions. A coordination structure will be established to
ensure convergence and efficiency of the activities. Recognizing the difficulties in fund flows
across different line departments, the project will ensure that each implementing agency (IA)
plans and executes its activities and maintains its own fiduciary management.


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

(FMS), and an environmental and social safeguards specialist/officer. [47] The PMUs will be fully authorized
to implement the planned activities approved by the Project Steering Committee (PSC).

46. **A Project Coordination Committee (PCC) will be set up to coordinate project implementation**

**and a PSC will be set up to provide strategic guidance and oversight.** The PCC, co‐chaired by Secretaries
Health and Secondary Education, will meet quarterly. The PSC, chaired by the Additional Chief Secretary,
will meet biannually (see figure 2).

**Figure 2. Institutional and Implementation Arrangements**

**B. Results Monitoring and Evaluation Arrangements**

47. **Building on the results chain, the M&E framework identified indicators to track project**

**implementation progress and impact.** The PDO‐level health indicators are taken from the RMNCHN
indicators in the DHIS, while digitization and integration of various HMIS is an intermediate indicator. The
education indicators are taken from the EMIS. Where possible, relevant indicators will be disaggregated
by gender. Discussions with the GoB and the UNHCR have confirmed, however, that beneficiary data by
nationality will not be routinely collected or publicly released.

48. **The project M&E will leverage and strengthen existing routine information systems, and finance**

---
[47] During the early phase of implementation, the Governance and Policy Program (GPP) PMU will provide back‐up support.


Input:
**the generation of user‐friendly evidence for efficient service delivery.** Routine surveys will be used to
collate data from target facilities, which will be triangulated through the existing management
information system within the Health and Secondary Education Departments. The remote monitoring
system within the SED uses technology‐based data management solutions with a dashboard to display
the broader analysis. The project will support the Health Department to adopt a similar system and cater
for the monitoring needs of the project. The project will also support an innovative, technology‐based
pilot intervention to track the presence of providers at HFs and assess their knowledge to design
appropriate trainings. In addition, the project will train district‐ and cluster‐level education and health
teams in data collection, management, analysis, and timely course correction. Process evaluations will be
used to measure the quality of implementation. To tackle the challenges in evidence‐based decision
making and improved accountability within the Health Department, the project will support the GoB to
(a) establish or strengthen an HRH database, a health institutional database that routinely tracks facility

Routine surveys
management information system


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

functionality, and an integrated RMNCHN dashboard and (b) enhance capacity of government officials at
provincial, district, and facility levels in M&E.

**C. Sustainability**

49. **The project ensures sustainability by taking a stepwise approach in implementing activities and**

**strengthening the GoB capacity and sectors’ systems.** First, the project activities will be piloted in
targeted districts and facilities so that the GoB will have the opportunity to learn from the initial
implementation challenges and make course corrections before scaling them up, while focusing on the
first two years on mitigating the impacts of the COVID‐19 pandemic. Second, the project will support
interventions that improve the efficiency and accountability of existing public systems and thus are
expected to benefit the local population beyond the project duration. The project will also include
mechanisms to ensure that the GoB allocates sufficient funds to support recurrent costs after initial
investments to build and strengthen systems are made. Third, cognizant of the very frequent changes in
leadership, activities focused on institutional strengthening will prioritize mid‐level managers and
technical staff who are more likely to remain in their current positions over the project lifetime and longer.


Input:
**IV.** **PROJECT APPRAISAL SUMMARY**

**A. Technical, Economic, and Financial Analysis**

**(i)** **Technical Analysis**

50. **The project draws on the wealth of evidence, which ascertains that health and education**

**interventions are most effective and can have a synergistic impact if delivered in tandem.** Education has
shown to be a significant predictor of people’s health choices. Increased education level of parents
decreases the likelihood of home births in Pakistan. [48] Education of girls especially brings a high return for
health. There is also a strong correlation between outcomes such as TFR and mothers’ education: the TFR
is high at 4.2 among mothers with no education, compared to 2.6 among those who received higher
education. [49] Moreover, a 20‐year study of children in Jamaica has shown that investments in early
childhood development, including both nutrition and stimulation interventions, increased future earnings
by 25 percent. [50]

51. **The activities proposed under the health component are technically sound and fill identified**

---
[49] NIPS and ICF (2019).
[50] Gertler, P. 2014. _Labor Market Returns to an Early Childhood Stimulation Intervention in Jamaica._


Input:
**gaps at lower levels of care.** The project addresses key supply‐ and demand‐side barriers hampering
utilization of health services, with a focus on strengthening primary‐level HFs and building referral links
with secondary‐level facilities where more complicated cases must be handled. The activities financed
include a range of prioritized, evidence‐based RMNCHN interventions to provide a continuum of care from
the community level upwards. Areas of interventions aim to remove key barriers hampering effective
service delivery, including lack of critical inputs and low providers’ skills and competencies. The project
also finances health system strengthening investments that are critical to the achievement of broader

48 Javed, S. A., M.D. Anjum, W. Imran, et al. 2013. “Correlates of Preferences for Home or Hospital Confinement in Pakistan:
Evidence from a National Survey.” _BMC ‐ Pregnancy and Childbirth_ 13:137.


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

health sector goals. These include improving overall management of inputs (for example, HRH
management) and, thus, accountability of publicly managed resources and data quality and use for more
effective service delivery. A recent review showed that less than half the essential services recommended
at the PHC and community level are available, even though more than 80 percent of the population is
expected to get services from PHC facilities and community. This suggests a need to ramp up investments
at frontline HFs. [51]

52. **The project focuses on the poorest and the most vulnerable and contributes to building their**

**resilience to potential economic downturns that directly and indirectly affect their utilization of health**

---
[51] GoP and WHO (World Health Organization). 2019. _Review of Essential Health Services in Pakistan Based on DPC3._


Input:
**services.** Investing in PHC and improving the availability of medicine in public HFs were identified as the
most effective strategies for protecting the poor against health shocks during economic crises, while solely
making efforts to maintain current government health expenditures were not found to be successful. [52]
This is particularly important in the context of Pakistan, where out‐of‐pocket spending, mainly incurred
to cover drugs and diagnostics, make up two‐thirds of all health spending and reach ‘catastrophic’ levels
for 6 percent of the households. [53]

53. **The project is designed to support the GoB in fulfilling its commitment to the 2018 National**

**Education Policy Framework** [54] **by addressing issues related to school attendance and high dropout**

---
[52] World Bank. 2009. _Protecting Pro‐Poor Health Services during Financial Crises. Lessons from Experience._
[53] World Bank. 2018. _Health Financing Systems Assessment Pakistan using WHO Data._
[54] Ministry of Federal Education and Professional Training. 2018. _National Education Policy Framework._


Input:
**rates, as well as improving the quality of education.** The project plans to invest significant resources in
upgrading public schools in remote rural areas, thus creating opportunities to attract out‐of‐school
children and reduce dropout rates, especially among girls who may not attend due to the lack of schools
in or nearby their communities. The 2018 ASER report stated that children in Pakistan are learning too
little and too slow and found that out of 8.8 years of schooling in Pakistan, only 4.8 years of learning is
acquired; this highlights the low quality and inefficiency of the education system to facilitate children’s
learning, even if they attend school. [55] To meet these challenges, the project aims to strengthen the
capacity of SED to transform the teaching and learning experience, including the redesign of student
learning assessments that encourage/focus on critical thinking, as well as increase teacher competencies
to foster concept‐based learning among children.

54. **The project creates greater opportunities for the GoB to address key challenges in the education**

**sector and meet its commitment to Sustainable Development Goal 4: Inclusive and Equitable Quality**

---
[55] ASER Pakistan. 2018. _Annual Status of Education Report ‐ National._


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

**(ii)** **Economic Analysis**

55. **Investments in human capital, especially in early childhood, have large payoffs for individuals**

**and entire economies.** Investments in cognitive and physical development are most impactful if they
occur in early childhood, [56] which correlate to increased earnings and productivity later in life. In Pakistan,
each additional year of schooling is associated with 8 percent higher income, and the impact is even larger
for women. [57] Across developing countries, the average income penalty from stunting in early childhood
is 5 to 7 percent. [58] Also, across countries, 10 percent to 30 percent of GDP per capita is driven by different
levels of human capital endowments. [59]

---
[59] Hsieh, C. T., and P. J. Klenow. 2010. “Development Accounting” _American Economic Journal: Macroeconomics_ 2:207–23.


Input:
56. **The overall project as well as each of the two project components are cost‐beneficial.** A cost‐
benefit analysis (CBA) was carried out to assess the economic viability of the proposed interventions
(annex 1). Costs and benefits were discounted to present value using the value method and social rates
of 2.1 percent and 4.2 percent, respectively. Benefits for the health component were derived from
estimated reductions in infant and maternal mortality using the concept of value of statistical life (VSL),
while benefits for the education component were obtained by estimating incremental lifetime earnings
for children enrolled in schools targeted in the project. Cost estimates included project costs and potential
costs that the project may impose on private households. The combined health and education
components yielded benefit‐cost ratios (BCRs) between 1.4 and 2.1, net present values (NPVs) between
US$15.4 million and US$41.6 million, and an internal rate of return (IRR) of 6.9 percent.

**(iii) Financial Analysis**

57. **The project costs represent a small share of current public education and health spending in**


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

**Table 3. Balochistan Government Expenditure in FY14 (in current US$) and Project Amount**

|Col1|Total|Health|Education|
|---|---|---|---|
|Government expenditure, current US$, millions|1,564|134|295|
|Government expenditure per capita, current US$|140|12|26|
|Annual project disbursement, current US$, millions|7.2|3.6|3.6|
|Expenditure share of project disbursement, percent|0.46|2.69|1.22|

_Note:_ Government expenditure data from GoB audited financial statements. Per capita allocations computed using
population numbers from census 2017 and annualized population growth rate between 1998 and 2017. [ 60]

**B. Fiduciary**

**(i)** **Financial Management**

58. **The project financial management (FM) will mainly rely on country systems.** The GoB’s
budgeting process will apply, and the health and education component budget will be separately reflected
in the province’s Annual Development Plan. Both departments have experience in carrying out World
Bank‐funded projects through PMUs and have established FM arrangements. However, lack of financial
integration of the overall project due to two IAs and separate FM arrangements may delay the overall
project FM. These risks will be mitigated by: (a) having dedicated FM staff at the two established PMUs
and (b) maintaining separate books of accounts at each PMU. Other mitigation measures are mentioned
in annex 2.


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

red flags of fraudulent and corrupt practices. Support for IAs will be available from the GPP Balochistan
project to assist with early contracts, if needed

62. **The Project Operations Manual will include IA accountability and transparency** **measures**
including pre‐bid meetings to inform potential bidders/proposers about requirements on disclosure of
CoI and the consequences of engaging in fraud and corruption; and beneficial ownership disclosure will
be required for all high‐value contracts using the World Bank’s Standard Procurement Documents.

**C. Safeguards**

**(i)** **Environmental Safeguards**

63. **Low‐ to medium‐scale adverse environmental impacts are expected from the minor civil works**


Input:
**proper management of health care waste for health and safety reasons.** The project plans to provide
drinking water, sanitation, and hygiene facilities in schools where absent and rehabilitate these services
where nonfunctional. As most of the areas in Balochistan use underground water and lack proper drainage
system for the safe disposal of waste, there is a risk of soil and underground water contamination around
disposal areas. A water quality testing of the source water at the target facilities needs to be conducted
as part of environmental assessment to ensure provision of safe drinking water and to avoid water
poisoning.

65. **Considering the above potential environmental risks associated with the project activities, the**


Input:
**project has been categorized as B and OP 4.01 (Environmental Assessment) is triggered.** In line with OP
4.01 and to assess the potential environmental and social impacts, the GoB has prepared (a) an
Environmental and Social Management Framework (ESMF) for construction‐related activities for health
and education facilities and (b) an environmental and health care waste management plan (EHCWMP) for
issues related to health care waste management during construction and operations. The EHCWMP
incorporates the World Bank Group’s Environment, Health, and Safety Guidelines and Industry Sector
Guidelines for Health Care Facilities. The ESMF includes adequate mitigation measures for the identified
impacts, assesses the institutional capacity of the IAs, identifies capacity gaps, and proposes institutional
strengthening measures for effective compliance of safeguards documents. The safeguard documents
have been consulted upon, finalized, and cleared by the World Bank and publicly disclosed in country by
the GoB on their website and on the external website of the World Bank on February 20, 2020.

**(ii)** **Social Safeguards**

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environmental and health care waste management plan


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

66. **The project may have very small‐scale land needs for minor extensions of existing health and**

**education facilities.** Hence, OP 4.12 (Involuntary Resettlement) is triggered. Land needs (if any) will
primarily be met through voluntary land donation, the procedure for which is specified in the
Resettlement Policy Framework (RPF) included in the ESMF. In case voluntary land donation is not
possible, very small‐scale private land acquisition may be undertaken in accordance with the RPF. The
building extension and renovation activities will be done in a manner to ensure that the infrastructure
needs of women, children, and the differently abled are met. The scale of construction activity is not
expected to have major adverse social impacts (including gender‐based violence [GBV]) and the
associated social risk is relatively low. However, the remoteness of most project locations and the lack of
services for GBV survivors creates challenges for adequate risk mitigation. The qualitative social
assessment verified that there has been no incident of violence between host communities and refugees.
The ESMF includes screening and mitigation measures to address social impacts and the social assessment
provides an initial mapping of GBV support services.


Input:
**(iii)** **Grievance Redress and Citizen Engagement**

67. **The qualitative social assessment has facilitated the design of inclusive, accessible, and**

**transparent CE; a beneficiary feedback mechanism; and a GRM of the project** including specifications
required to address the specific needs of and challenges faced by the project areas including the
vulnerable groups for CE and redressal of health and education‐related grievances. The GRM design will
ensure that there is a fixed time frame for resolution and the feedback loop is closed. The CE and GRM
will be monitored, tracked, and reported on regularly, and relevant indicators will be included in the
Results Framework. CE and GRM data will be disseminated to strengthen accountability and improve
governance and inclusion of citizens’ voice and needs.

68. **Communities and individuals who believe that they are adversely affected by a WB‐supported**

**project may submit complaints to existing project‐level GRMs or the WB’s Grievance Redress Service**


Input:
**(GRS)** . The GRS ensures that complaints received are promptly reviewed in order to address project‐
related concerns. project affected communities and individuals may submit their complaint to the WB’s
independent Inspection Panel which determines whether harm occurred, or could occur, as a result of
WB non‐compliance with its policies and procedures. Complaints may be submitted at any time after
concerns have been brought directly to the WB's attention, and Bank Management has been given an
opportunity to respond. For information on how to submit complaints to the WB’s corporate GRS, please
visit [http://www.worldbank.org/en/projects‐operations/products‐and‐services/grievance‐redress‐
service]. For information on how to submit complaints to the WB Inspection Panel, please visit

[http://www.inspectionpanel.org].

**D. Gender**


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

staffed with male teachers. The project will take a two‐pronged approach to address these core
constraints and aims to achieve at least 50 percent of enrollment of girls in targeted schools. First, the
project will help foster enrollment across schooling levels by upgrading existing girls’ primary schools to
middle schools and middle schools to high schools with basic facilities and providing additional schooling
in the same facilities that are closer to the girls’ homes. Second, the project will motivate parents to let
girls enroll and stay in school by hiring qualified female teachers for all upgraded girls’ schools. Qualified
female teachers will be encouraged to apply by the DEA and/or through mobilization activities (for
example, PTSMC and community outreach) and will be trained to better deliver concept‐based learning.
Cumulatively, these actions will support girls to access education in the most underdeveloped areas in the
country. A PDO indicator on the cumulative number of female students enrolled in project schools and an
intermediate indicator on the percentage of targeted female teachers trained will track progress toward
closing the gender gap.

**E. Climate Co‐benefits**


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

GPP Balochistan (that is, for shared services) to fill any critical capacity gaps, especially in the early stages
of implementation.

73. **Macroeconomic risks are ‘High’.** The impacts of COVID‐19 will weaken ongoing stabilization
efforts and medium‐term structural reforms and add additional economic shocks. The government has
committed to staying the course and will be supported by the World Bank, International Monetary Fund
(IMF) and Asian Development Bank to ensure continued development investment, particularly in the
social sectors. However, contraction of the fiscal space will potentially decrease spending in social
sectors. Pakistan’s ability to weather the impact of the macro‐crisis, exacerbated by the COVID‐19 crisis,
will depend critically on whether growth will be pro‐poor and on how well the country will be able to
protect its human capital and cater for the poor and vulnerable. The IMF recently approved a US$1.4
billion Rapid Financing Instrument for bridge financing. Pakistan will also benefit from the fiscal space
created from the debt suspension initiative of bilateral creditors. However, despite these measures, the
impact of the projected fiscal deficit on development spending remains unpredictable.


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

experience (for example, Health PMU) or seeking support from the existing PMU of the GPP in Balochistan.
Also, institutional development and capacity building under the project will include strengthening
fiduciary management. The World Bank will also review the project IUFRs and other budget execution
reports to ensure compliance and quality and undertake regular supervision.


Input:
77. **Environmental and social safeguards risks are ‘Substantial’.** The scale of construction activity
under the project is not expected to have major adverse and/or irreversible environmental and social
impacts. However, institutional capacity is limited, and contextual societal issues pose considerable risk
to the project. The Health Department has very limited experience with the World Bank’s safeguards
requirements and environmental and social management including GRM and CE. There is also a lack of
dedicated and trained staff for safeguards, particularly social issues such as grievance redress and CE. The
SED PMU has better awareness and experience of the World Bank’s safeguards and CE requirements
under the World Bank‐supported Balochistan Education Project. There is a substantial risk of social
exclusion of vulnerable groups including the poor, Afghans, people living in remote locations and
scattered settlements, and women. In general, these groups have lack of or comparatively reduced access
to (a) services and facilities (including services and support for survivors of GBV, sexual abuse, and violent
conflict) and (b) lack of or reduced opportunities for voice, social accountability, grievance redress, and
other CE mechanisms. An ESMF has been prepared to manage environmental and social risks. In addition,
a qualitative analysis (focusing on both Afghan and host community women and men) has been conducted
to understand social issues pertaining to exclusion, gender, community mobilization, CE, and grievance
redress. Based on the findings of this analysis, requisite institutional strengthening measures and GRMs
to address social risks (including GBV related) have been incorporated into project design.


Input:
78. **Stakeholder risks are ‘Substantial’.** Given the existing ethnic and tribal sensitivities in Balochistan,
direct support to Afghan refugees could potentially experience opposition by certain groups of society.
The GoB plans to mitigate this by ensuring a carefully designed project that benefits both refugees and
host communities and a selection of districts that not only includes a high number of refugees but are also
representative of the major tribes in the province. Moreover, given that multiple partners are involved in
providing support to refugees and host communities, the project will focus on areas where limited support
is currently provided or planned, according to the mapping exercise being carried out by the GoB. The PCC
and the PSC will also be encouraged to engage key technical and implementation stakeholders to ensure
complementarity and alignment among partners.


Input:
**The World Bank**
Pakistan: Balochistan Human Capital Investment Project (P166308)

|Project Development Objective Indicators  RESULT_FRAME_TBL_PDO|Col2|Col3|Col4|
|---|---|---|---|
|**Indicator Name**
|**PBC**
|**Baseline**
|**End Target**
|
|**1. Improving utilization of quality health services**|**1. Improving utilization of quality health services**|**1. Improving utilization of quality health services**|**1. Improving utilization of quality health services**|
|People who have received essential health, nutrition, and
population (HNP) services (CRI, Number)||0.00|141,000.00|
|People who have received essential health, nutrition, and
population (HNP) services ‐ Female (RMS requirement) (CRI,
Number)||0.00|109,000.00|
|Number of deliveries attended by skilled health personnel
(CRI, Number)||0.00|77,000.00|
|Number of children immunized (CRI, Number)||0.00|64,000.00|
|Number of children immunized ‐ Female (Number)||0.00|32,000.00|
|**2. Improving utilization of quality education services**|**2. Improving utilization of quality education services**|**2. Improving utilization of quality education services**|**2. Improving utilization of quality education services**|
|Students benefiting from direct interventions to enhance
learning (CRI, Number)||0.00|200,000.00|
|Female students enrolled in project schools (Number)||13,530.00|58,276.00|
|Targeted schools meeting at least 3 model school criteria||0.00|70.00|

Page 31 of 47


Input:
**The World Bank**
Pakistan: Balochistan Human Capital Investment Project (P166308)

|Indicator Name|PBC|Baseline|End Target|
|---|---|---|---|
|(Percentage)
||||

**PDO Table SPACE**

|Intermediate Results Indicators by Components RESULT_FRAME_TBL_IO|Col2|Col3|Col4|
|---|---|---|---|
|**Indicator Name**
|**PBC**
|**Baseline**
|**End Target**
|
|**1. Improving utilization of quality health services**|**1. Improving utilization of quality health services**|**1. Improving utilization of quality health services**|**1. Improving utilization of quality health services**|
|Targeted HFs having majority of essential medicines for RMNCHN
services (Percentage)|
|20.00|75.00|
|Absenteeism among key staff to provide RMNCHN services
(Percentage)||50.00|25.00|
|Targeted health care providers with minimum knowledge and
competencies in RMNCHN services (Percentage)||0.00|80.00|
|Targeted HMIS digitally integrated into DHIS(2) (Number)||0.00|3.00|
|**2. Improving utilization of quality education services**|**2. Improving utilization of quality education services**|**2. Improving utilization of quality education services**|**2. Improving utilization of quality education services**|
|Targeted school clusters with improved cluster‐based
governance (Percentage)||0.00|50.00|
|Student learning assessment reforms strategy implemented
(Text)||No strategy exists|Dissemination of assessment results from 10% target
primary schools|
|Grade 5 and 8 students scoring at least 50% in concept‐based
learning assessment in project schools (Percentage)||0.00|20.00|
|Targeted female teachers trained (Percentage)||0.00|80.00|
|Grievances registered related to delivery of project benefits that
are addressed (Percentage)
||0.00|75.00|

**IO Table SPACE**

Page 32 of 47


Input:
**The World Bank**
Pakistan: Balochistan Human Capital Investment Project (P166308)

**UL Table SPACE**

|Monitoring & Evaluation Plan: PDO Indicators|Col2|Col3|Col4|Col5|Col6|
|---|---|---|---|---|---|
|**Indicator Name **|**Definition/Description **|**Frequency **|**Datasource **|**Methodology for Data**
**Collection **|**Responsibility for Data**
**Collection **|
|People who have received essential
health, nutrition, and population (HNP)
services||Bi‐annual
|DHIS, LHW,
MNCH, EPI
|Routine HMIS
|DoH, HMIS, LHW,
MNCH, EPI
|
|People who have received essential
health, nutrition, and population
(HNP) services ‐ Female (RMS
requirement)||Bi‐annual
|DHIS, LHW,
MNCH, EPI
|Routine HMIS
|DoH, HMIS, LHW,
MNCH, EPI
|
|Number of deliveries attended by
skilled health personnel||Bi‐annual
|DHIS, LHW,
MNCH
|Routine HMIS
|DoH, HMIS, LHW,
MNCH
|
|Number of children immunized||Bi‐annual
|EPI
|Routine HMIS
|DoH, EPI
|
|Number of children immunized ‐
Female|Cumulative number of girls
below 12 months
immunized with measles‐1
on time in target areas|Bi‐annual
|EPI
|Routine HMIS
|DoH, EPI
|
|Students benefiting from direct
interventions to enhance learning||Annual
|School
register
|School census
|SED, PMU
|
|Female students enrolled in project
schools|Cumulative number of
female students enrolled in
project supported schools|Annual
|School
register
|School census
|SED, PMU
|
|Targeted schools meeting at least 3 model
school criteria|Percentage of target schools
with at least three out of
five criteria covering: (a)
dedicated ECE classroom
and teacher; (b) 50% of|Annual
|School
Profiles
|Census based analysis
of model school
scorecard
|SED, PMU
|

Page 33 of 47


Input:
**The World Bank**
Pakistan: Balochistan Human Capital Investment Project (P166308)

|Monitoring & Evaluation Plan: Intermediate Results Indicators|Col2|Col3|Col4|Col5|Col6|
|---|---|---|---|---|---|
|**Indicator Name **|**Definition/Description **|**Frequency **|**Datasource **|**Methodology for Data**
**Collection **|**Responsibility for Data**
**Collection **|
|Targeted HFs having majority of essential
medicines for RMNCHN services|Percentage of targeted HFs
having > 75 percent of
essential RMNCHN
medicines.|Bi‐annual
|Health
institutional
database
|Self‐reported data
|Health Department,
HMIS, PPHI
|
|Absenteeism among key staff to provide
RMNCHN services|Percentage of key staff
present at HFs during duty
time to provide RMNCHN
services.
Baseline is a preliminary
estimate.|Bi‐annual
|Real time
monitoring
system
|Administrative data
|Health Department, PMU
|
|Targeted health care providers with
minimum knowledge and competencies in
RMNCHN services|Percentage of targeted staff
with minimum knowledge
and competencies in
RMNCHN services.|Bi‐annual
|PMU
|Training report
|Health Department, PMU
|
|Targeted HMIS digitally integrated into
DHIS(2)|Cumulative number of
RMNCHN relevant health
information systems
digitally integrated into
DHIS(2).|Annual
|DHIS(2)
|Administrative data
|Health Department,
HMIS, PMU
|

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Input:
**The World Bank**
Pakistan: Balochistan Human Capital Investment Project (P166308)

|Col1|Col2|Col3|Col4|Col5|Col6|
|---|---|---|---|---|---|
|Targeted school clusters with improved
cluster‐based governance|Percentage of targeted
school clusters providing
evidence for: (a) DDO code
allocated to cluster head; (b)
LECs preparing cluster plans
and budgets; (c) training of
head teachers at the cluster
head‐level on participatory
planning, school‐based
budgeting, cluster‐level
procurement, and
conducting summative and
formative student
assessments; and (d) EMIS
Cells gathering cluster data
and submitting to DEA and
SED|Annual
|Notification,
cluster plan
|Cluster census
|SED, PMU
|
|Student learning assessment reforms
strategy implemented|(a) development of a
strategy with assessment
framework; (b) completion
of an assessment as per the
framework; and (c) revision
of teacher training
integrating the results from
assessments, delineating a
time‐bound and costed
action plan with
responsibilities|Bi‐annual
|Implementati
on progress
report
|Strategy, assessment
reports
|SED, PMU
|
|Grade 5 and 8 students scoring at least
50% in concept‐based learning
assessment in project schools|Percentage of students
enrolled in grade 5 and 8
from project schools who|Annual,
from YR3
|Learning
assessment
results|Sample based
assessment
|SED PMU, BAEC
|

Page 35 of 47

Balochistan Human Capital Investment Project


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**The World Bank**
Pakistan: Balochistan Human Capital Investment Project (P166308)

|Col1|scored at least 50 percent in
concept‐based learning
assessments|Col3|Col4|Col5|Col6|
|---|---|---|---|---|---|
|Targeted female teachers trained|Percentage of targeted
female teachers trained|Annual
|Teachers
database
|Census
|PITE
|
|Grievances registered related to delivery
of project benefits that are addressed
|Percentage of project‐
related grievances
registered and addressed
within one month|Annual
|Grievance
registers
|Administrative data
|Health and Education
PMUs
|

Page 36 of 47

Balochistan Human Capital Investment Project


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

**ANNEX 1: Economic and Financial Analysis**

**COUNTRY: Pakistan**

**Balochistan Human Capital Investment Project**

1. **This annex outlines the economic rationale for the Balochistan Human Capital Investment**

**project** by presenting (a) the public intervention rationale, (b) the value added of World Bank
involvement, and (c) an economic and fiscal analysis.

**Public Intervention Rationale**

2. **Inequities and externalities in the education and health sectors of Balochistan provide a strong**


Input:
**rationale for public intervention.** Two types of market failure are of particular relevance for the
Balochistan health and education sectors: (a) under‐provision of services to the poor, where societal
preferences favor equitable outcomes but parts of the population are unable to afford essential health
care and education at market prices and (b) externalities, where market prices do not reflect the full
benefit of a good, leading to consumption levels below the societal optimum. Inequities in access to
quality education and health services abound in Balochistan: only 56 percent of pregnant women receive
antenatal care from a skilled provider in the province, compared to a national average of 86 percent.
Skilled birth attendance rates are 38 percent in Balochistan and 69 percent for the country as a whole; [61]
and two‐thirds of the Balochistan population older than 16 never attended school, compared to 49
percent across the entire country. [62] Access to essential health services is likely even lower than the
Balochistan average among the refugees that form part of the project target population. Large positive
externalities accrue from female education in particular—in Pakistan, under‐five mortality is 50 percent
higher among children whose mothers have no education or only primary education compared to mothers
who attended middle school. [63] In the health sector, immunization [64] and deworming [65] are prime examples
of epidemiological externalities.

---
[64] Boulier, B. L., T. S. Datta, and R. S. Goldfarb. 2007. "Vaccination Externalities." _The BE Journal of Economic Analysis & Policy_ 7 (1) _._
[65] Ozier, O. 2014. “Exploiting Externalities to Estimate the Long‐Term Effects of Early Childhood Deworming.” Policy Research Working


Input:
**Value Added of the World Bank**

3. **The World Bank is well positioned to provide technical and financial support to the Balochistan**

**health and education sectors.** The World Bank has ample technical and operational experience in health
and education sector improvement projects that are similar to the proposed interventions. This
experience comes from a large variety of low‐ and middle‐income countries, including those that suffer
from fragility and conflict. It includes projects in Pakistan—for example, similar education interventions
are currently being implemented in Balochistan and Punjab.

61 NIPS and ICF (2019).
62 Own calculations using data from HIES 2015–16.
63 NIPS and ICF (2019).
Pradhan, E, E. M. Suzuki, S. Martínez, M. Schäferhoff, and D. T. Jamison. 2018. “The Effects of Education Quantity and Quality on
Mortality”. In _Optimizing Education Outcomes: High‐Return Investments in School Health for Increased Participation and Learning_, edited
by Bundy, D. A. P., N. de Silva, S. Horton, D. T. Jamison, and G. C. Patton, Chapter 30. World Bank.


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

**Economic Analysis**

4. **An economic analysis (drawing on empirical evidence demonstrates that the project’s expected**

**benefits outweigh its costs.** Costs and benefits are assessed using the discounted value method, further
details of which are provided in the following paragraphs. The CBA is provided for the overall project and
separately for the health and education components.

_Health Component CBA_

5. **The CBA follows the Reference Case Guidelines for Benefit‐Cost Analysis in Global Health and**

**Development.** [66] The CBA assesses if a project is economically viable by comparing its costs with its
benefits, both of which are expressed in monetary terms and discounted to their present value.


Input:
6. **The social discount rate is calibrated to 2 percent to 4 percent.** Standard welfare analysis requires
that costs (and benefits, if expressed in monetary terms) of a project at different points in time be valued
according to their marginal impact on welfare at the time they occur. [67] Calibration of the discount rate
hence requires an estimate of (a) how much richer beneficiaries of the project will be, here approximated
using Pakistan’s annualized real GDP per capita growth rate over 1998–2018 [68] and (b) the change in the
marginal value of an additional dollar of benefits (the elasticity of marginal utility of consumption, MUC),
which is typically assumed to lie between 1 and 2. The social discount rate is the product of the GDP
growth rate and the MUC, amounting to 2.1 percent and 4.2 percent for MUCs of 1 and 2, respectively.

**Table 1.1. Social Discount Rate Calibration**

|Parameter|%|
|---|---|
|Real GDP growth per capitaa|2.01|
|Implied discount rate (lower bound, MUC = 1)|2.01|
|Implied discount rate (upper bound, MUC = 2)|4.02|

_Source_ : a. World Development Indicators (WDI)

---
[68] The data are from the WDI database. No time series of GDP growth is available for Balochistan.

World Development Indicators (WDI)
WDI database


Input:
7. **Discounted project costs amount to US$17 million to US$18 million.** The calculation of
discounted project costs follows the project disbursement schedule shown in the second column of table
1.2.

8. **Project benefits are operationalized as the number of maternal, neonatal, and under‐five**

**deaths averted.** The project is expected to result in improved quality and higher rates of utilization of
health services and hence better health outcomes for children in their teens and the general adult
population. In line with the PDO, however, this CBA focuses on improvements in the health of mothers
and under‐five children. Because reductions in morbidity are not accounted for (for example, from better

66 Robinson, L. A., J. K. Hammitt, M. Cecchini, et al. 2019. _Reference Case Guidelines for Benefit‐Cost Analysis in Global Health and_
_Development_ ;
Robinson, L. A., J. K. Hammitt, and L. O’Keeffe. 2018. “Valuing Mortality Risk Reduction in Global Benefit‐Costs Analysis.”
Guidelines for Benefit‐Cost Analysis Project, Working Paper #7.
67 Aart Kray. 2016. “Discounting Costs and Benefits in Economic Analysis of World Bank Projects.” Operations Policy and Quality Guidance
Note.


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

feeding practices that decrease the prevalence of child diarrhea), this CBA identifies only a lower bound
of project benefits.

**Table 1.2. Discounted Project Costs of Health Component (current US$)**

|Years|Present Value|Col3|
|---|---|---|
|**Years**|**2% Discount Rate**|**4% Discount Rate**|
|2020|2,478,360|2,430,581|
|2021|3,996,990|3,844,363|
|2022|4,445,516|4,193,332|
|2023|3,622,024|3,350,689|
|2024|3,326,210|3,017,714|
|Total|17,869,100|16,836,680|

9. **Mortality avoided is estimated based on the number of additional health services provided**


Input:
**under the project.** As a first step, utilization rates of reproductive, maternal, and child health services over
the project cycle—both with and without the project—are projected. Three types of services are
considered: skilled birth attendance, measles vaccination, and family planning visits. Baseline utilization
data for 2017 and 2018, in the target HFs came from the Balochistan DHIS. To project the 2019 utilization
for each service, the average over the two baseline years is used, accounting for increases in utilization
due to population growth by applying to this the mean annualized, district‐specific population growth rate
derived from the 1998 and 2017 Pakistan censuses. [69] It is assumed that the project benefits will
materialize from the second year over the period FY21–24 and that the magnitude of impacts is expected
to depend on the type of intervention that a facility receives: service utilization of facilities that will be
improved within their current level of care is assumed to increase by 30 percent between FY20 and FY24,
an annualized increase of 6.8 percent. For facilities being upgraded from BHU to RHC, a fourfold increase
is assumed in utilization over the project cycle, or 41 percent annually—a conservative estimate, as the
catchment area of RHCs is typically 10 times that of BHUs.


Input:
10. **The project is estimated to save the lives of 168 mothers and children under five** (table 1.3) **.** The
increase in service utilization is translated into deaths averted using published empirical studies; mortality
rates for Balochistan were taken from the 2012 and 2017–18 PDHS. [70] Effect sizes for the impacts of an
additional skilled birth on maternal and neonatal mortality rates come from Graham, Bell, and Bullough
(2001) [71] and Bhutta et al. (2014), [72] respectively. The effect size used to estimate the impact of measles
vaccination on mortality of children under five is based on McGovern and Canning (2015). [73] Because their
effect size is for full child vaccination, an adjustment factor of 0.89 is applied to the share of children with

---
[73] McGovern, M. E., and D. Canning. 2015. “Vaccination and All‐cause Child Mortality from 1985 to 2011: Global Evidence from the


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

measles vaccination in Balochistan who are fully vaccinated. [74] Data on under‐five mortality comes from
PDHS 2017–18. The impact of additional family planning visits on maternal mortality is based on the
maternal mortality effect of modern contraceptive use estimated by Ahmed et al. (2012). [75] It is assumed
that 50 percent of family planning visits to the project facilities result in modern contraceptive use. An
adjustment factor is applied throughout to account for crowding out of formal private health care services,
assuming that 95 percent of the additional benefits in project facilities would have occurred in the absence
of the project.

**Table 1.3. Estimated Lives Saved over the Project Cycle**

|Years|Neonatal|Under‐5|Maternal|Total|
|---|---|---|---|---|
|2020|0|0|0|0|
|2021|7|17|5|29|
|2022|8|22|7|36|
|2023|9|28|9|45|
|2024|10|37|11|58|
|Total|33|103|32|168|


Input:
11. **Lives saved by the project are converted into monetary terms using the concept of VSL,** that is,
individuals’ willingness to pay for small changes in their likelihood of dying in a certain time frame,
considering their budgetary constraints. These are then converted into a population‐level value of a
decrease in expected number of deaths—the so‐called VSL. For Pakistan, 2009 VSL estimates from Rafiq
and Shah (2010) [76 ] are adjusted to 2018 values using Pakistan’s real GDP per capita growth rate. This
results into lower‐ and upper‐bound estimates of US$146,814 and US$523,627. The lower‐bound
estimate is used to be conservative in the CBA.

12. **The estimated benefits of the health component outweigh its costs by a factor of 1.3.** To obtain
the monetary value of the benefits, the VSL is multiplied by the expected number of lives saved by the
project, and subsequently discounted to present values using the social discount rate introduced above
(table 1.4). The NPV estimates range between US$5 million and US$4.4 million.

**Table 1.4. CBA for Component 1: Improving Health Services**

|Col1|Benefits, Present Value
US$, current|Col3|Costs, Present Value
US$, current|Col5|BCR|Col7|NPV US$|Col9|
|---|---|---|---|---|---|---|---|---|
|**Years**|**2%**|**4%**|**2%**|**4%**|**2%**|**4%**|**2%**|**4%**|
|2020|0|0|2,478,360|2,430,581|0.00|0.00|−2,478,360|−2,430,581|
|2021|4,078,067|3,922,345|3,996,990|3,844,363|1.02|1.02|81,077|77,981|
|2022|4,945,713|4,665,155|4,445,516|4,193,332|1.11|1.11|500,197|471,822|
|2023|6,115,487|5,657,361|3,622,024|3,350,689|1.69|1.69|2,493,463|2,306,672|
|2024|7,702,585|6,988,195|3,326,210|3,017,714|2.32|2.32|4,376,375|3,970,480|
|Total|22,841,852|21,233,055|17,869,100|16,836,680|1.28|1.26|4,972,753|4,396,375|


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

_Education Component CBA_

13. **The project is estimated to generate a total of 22,550 additional years of schooling** by increasing
the number of children enrolled in project schools by 10 percent annual growth rate and the school
completion rate, that is, the share of students enrolled in grade 1 of a school level who graduate from it,
by 40 percent. In the absence of longitudinal data to estimate current completion rates, the CBA is limited
to the benefits of additional years of schooling due to the project’s impact on school enrollment. The sex
and grade distribution of students in each project district from Balochistan’s EMIS is used to determine
the share of girls and boys in each grade among the 18,000 students currently enrolled. Assuming no
impact in the first project year, the number of additional boys and girls enrolled in each grade for each
year in FY21–FY24 is then estimated using the targeted annual growth rate of enrollment (table 1.5).

**Table 1.5. Additional School Years Accrued Due to Project Impact**

|Col1|2021|Col3|2022|Col5|2023|Col7|2024|Col9|Total|
|---|---|---|---|---|---|---|---|---|---|
||**Girls**|**Boys**|**Girls**|**Boys**|**Girls**|**Boys**|**Girls**|**Boys**|**Boys**|
|Primary|672|909|1,417|1,914|2,240|3,027|3,151|4,258|**17,588**|
|Middle|116|185|245|389|388|616|545|866|**3,351**|
|High|53|92|111|194|176|307|247|432|**20,939**|
|Total|**841**|**1,185**|**1,773**|**2,497**|**2,803**|**3,949**|**3,944**|**5,556**|**22,550**|


Input:
14. **The CBA considers both project and private costs.** Project costs are assumed to accrue following
the same disbursement schedule as for the health component (see table 1.2). Private costs in the form of
spending on schooling (uniforms, books, and fees) by households enrolling children in school and in the
form of forgone income of children who would work if not enrolled in school are considered. Estimates of
both are based on HIES 2015–16 and are projected to later years using real per capita GDP growth rates
from the WDI. The present value of private costs incurred by the additional school years generated by the
project amounts to between US$1,752,481 and US$1,818,336, roughly 10 percent of discounted total
project costs

15. **Benefits are calculated using income premia for additional years of schooling over the work life**


Input:
**of beneficiating children.** The income premia for individuals ages 17–65 in the Balochistan subsample are
obtained from HIES 2015–16. Adjusted to the current year using real per capita GDP growth rates, the
premia are US$34 for women and US$60 for men. To capture the effects of the various activities in the
education component to enhance teaching quality, there is a 5 percent quality premium to the income
premia. It is assumed that these premia grow over the work life of the additionally enrolled children by
the average real annual rate at which Pakistan’s per capita GDP grew over 1998–2017. It is also assumed
that the work lives of the beneficiaries span from age 17 to 65. Finally, mortality in the treated cohorts
during their work lives, using annualized survival rates of men and women, is adjusted based on mortality
estimates for Pakistan that are found in Dicker et al. (2018). [77] Multiplying the additional years of schooling
in each project year and grade with the discounted and growth‐adjusted income premium for each year
in the work lives of surviving beneficiaries yields an estimate of the monetary benefit of the project.

---
[77] Dicker, D., G. Nguyen, D. Abate, et al. 2018. “Global, Regional, and National Age‐sex‐specific Mortality and Life Expectancy,


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

component, the benefit estimates provided here likely form a lower bound of the project’s true benefits,
as, for instance, the positive externalities of improved education are not considered.

|Col1|, Improving Education Services|Col3|
|---|---|---|
||**Social Discount Rate**|**Social Discount Rate**|
||**2%**|**4%**|
|Benefits, US$ present value|56,453,460|29,614,228|
|Costs, US$ present value|19,761,161|18,589,161|
|BCR|2.86|1.59|
|NPV, US$|36,692,299|11,025,067|
|IRR, %|5.86|5.86|

_Full Project CBA_

17. **The combined BCR across the education and health components lies between 1.4 and 2.1,**

**indicating the project is cost‐beneficial.** Table 1.7 shows the CBA outputs for the full project, which yields
a positive NPV between US$15.4 million and US$41.7 million and an IRR of 6.94 percent.

**Table 1.7. CBA for the Entire Project**

Page 42 of 47

|Col1|Social Discount Rate|Col3|
|---|---|---|
|<br>|**2%**|**4%**|
|Benefits, US$ present value|79,295,312|50,847,283|
|Costs, US$ present value|37,630,260|35,425,842|
|BCR|2.11|1.44|
|NPV, US$|41,665,052|15,421,442|
|IRR, %|6.94|6.94|


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

**ANNEX 2: Implementation Arrangements and Support Plan**

**COUNTRY: Pakistan**

**Balochistan Human Capital Investment Project**

**FM Arrangements**

1. There are two IAs—SED and Health Department. Both departments implement foreign fund
projects by PMUs; that is, Health PMU and Education PMU. These PMUs have established FM
arrangements and have experience in disseminating many foreign‐funded projects

2. **Staffing.** Each PMU will have an FMS to manage FM arrangements. The FMS will be hired in
accordance with the terms of reference acceptable to the World Bank. For the grace period until the
closing of the project DAs, the GoB will provide allocation for the FMS and related operational costs.


Input:
5. **Internal controls.** An Internal Audit Cell exists in both Health and Education Departments, but its
feasibility to conduct the project’s internal audit is in the process of finalization. A separate internal audit
firm, which is already on board in the Education PMU, will continue periodic internal audits of the project
and submit timely reports.

6. **Reporting.** Semiannual IUFRs and annual financial statements will be prepared by the FMS of each
PMU within 30 days of the end of each semester and be consolidated and submitted by the Education
PMU. IUFRs will be shared with the World Bank within 45 days of the end of semester. Annual financial
statements of the project will be shared with the Office of the Auditor General of Pakistan (AGP) within
two months at the end of each fiscal year. The audited financial statements for each period will be shared
with the World Bank no later than six months after the end of the fiscal year.


Input:
7. **Disbursements and fund flow.** The project will maintain four DAs: (a) IDA and IDA RSW credit and
(b) IDA RSW grant at each PMU, operated by two authorized signatories ensuring adequate segregation
of duties. Each PMU will prepare six‐monthly cash flow forecasts for the project based on the work plan
and submit the withdrawal applications and cash forecasts together with the cash request to the World
Bank after the effectiveness of the project. Subsequent withdrawal applications will be submitted

Page 43 of 47


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

semiannually with IUFRs accompanied by a cash forecast for the next six months. All modes of
disbursement will be made available to the project and the project cost financed by IDA will be inclusive
of taxes and duties.

8. **External audit.** The project’s financial statements will be audited annually by the AGP in
accordance with International Public Sector Accounting Standards. For each financial year closing on June
30, acceptable project audited financial statements together with the Management Letter will be
submitted to the World Bank within 6 months (that is, December 31). The PMUs will ensure that the AGP’s
audit plan includes audit of the project. Each PMU will be responsible for the audit of its component. The
AGP will provide the consolidated audit report for the project.

**Procurement Arrangements**


Input:
9. The World Bank’s standard procurement documents shall be used for Open International
Competition. Goods, works, and non‐consultancy services, following national market approach, shall be
initially procured using the World Bank’s relevant standard procurement documents. Upon finalization of
the customized suite of standard procurement documents, aligned with the World Bank’s Procurement
Regulations, by the Balochistan Procurement Regulatory Authority, these standard procurement
documents may be employed.

10. **Procurement responsibility.** The Government’s capacity to deliver the project will be
strengthened through the placement of qualified and experienced FM and procurement specialists in the
PMUs of the Health Department and SED.

11. **PPSD** is a living document and it is to be updated, at minimum, annually. As an output of the PPSD
exercise, an initial Procurement Plan has been prepared.

12. **Procurement risks.** Based on the above strategic analysis and assessment, the following risks are
identified that could be mitigated through the proposed procurement approach:


Input:
**The World Bank**
Balochistan Human Capital Investment Project (P166308)

|Risk Description|Mitigation Measure|Residual
Risk|
|---|---|---|
|issues in PMUs|perform Systematic Tracking of Exchanges in Procurement
(STEP) walkthrough
(b) Periodic procurement and contract management clinics
(remotely or clubbed through implementation supervision
missions)||
|Delays in delivery of procured
goods, works and services|(a) Development of realistic timelines and payment terms in
Standard Procurement Documents
(b) Execution of penalties for goods and works
(c) Documenting of poor/delayed performance of consulting
contract for instating remedial actions
(d) Seeking of proactive communications between borrowers and
their contractors/consultants for critical contracts|Substantial
|
|Risk of sustainability of upgraded
HFs due to absence of providers
(for example, lady medical
officer, gynecologist,
anesthesiologist, and so on) and
their subsequent relocation
from remote facilities|Recruitment of key specialists as individual consultants while
prescribing qualification and experience that ensures a larger
uptake and triggering termination on basis of any action to
influence relocation|Substantial|
|Suboptimal use of medical
equipment due to poor training,
and operations/maintenance|Review of technical specifications by the World Bank’s expert
panel for support|Substantial|
|Development of software
requirement specifications for
digitization in health and
education|(a) Outsourcing of assessment for bespoke development or off‐
the‐shelf procurement
(b) Proactive engagement in development of robust technical
specifications ideally with the World Bank’s oversight|Substantial|
|Timely closure of contracts|Development of contract management plans for all critical and
prior review procurements|Moderate|
|Low response to specialized
goods and services in local
markets|(a) Proactive information and outreach events before initiation of
procurements
(b) Advertisement in the national newspapers inviting national
level bidders/consultants|Moderate|

Balochistan Human Capital Investment Project

Systematic Tracking of Exchanges in Procurement


Input:
13. **National procurement arrangements.** In accordance with paragraph 5.3 of the Procurement
Regulations, when approaching the national market (as specified in the Procurement Plan tables in STEP),
the country’s own procurement procedures may be used. When the borrower uses its own national open
competitive procurement arrangements as set forth in the Balochistan Public Procurement Rules, such
arrangements shall be subject to paragraph 5.4 of the Procurement Regulations and the following
conditions:

(a) The eligibility of bidders shall be as defined under section III of the Procurement Regulations.
Accordingly, no bidder or potential bidder shall be declared ineligible for contracts financed
by the World Bank for reasons other than those provided in Section III of the Procurement
Regulations.

(b) For national open competitive procurement, only the model procurement documents
acceptable to the World Bank, shall be used.

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**The World Bank**
Balochistan Human Capital Investment Project (P166308)

(c) The request for bids/request for proposals document shall require that bidders/proposers
submitting bids/proposals present a signed acceptance (in the form attached) at the time of
bidding, to be incorporated in any resulting contracts, confirming application of, and
compliance with, the World Bank’s Anti‐Corruption Guidelines, including, without limitation,
the World Bank’s right to sanction and the World Bank’s inspection and audit rights.

(d) Procurement documents include provisions, as agreed with the World Bank, intended to
adequately mitigate against environmental, social (including sexual exploitation and abuse
and GBV), health and safety risks, and impacts.

(e) Access to procurement opportunities shall not be restricted to firms that have preregistered
and/or paid a registration fee.

(f) No preference of any kind shall be given to national bidders in the bidding process.

14. When other national procurement arrangements (other than national open competitive
procurement) are applied by the borrower, such arrangements shall be subject to paragraph 5.5 of the
Procurement Regulations.

**Strategy and Approach for Implementation Support**


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**The World Bank**
Balochistan Human Capital Investment Project (P166308)

office and will allow timely support to the PMUs and the IAs. The fiduciary and safeguards team will also
join implementation progress review meetings regularly to clarify any issues.

19. **M&E.** Each IA will implement and monitor their own activities. PMUs will consolidate biannual
financial and technical reports for project implementation and share with the PSC through the PCC,
copying the World Bank. The PCC will meet quarterly (possibly more often during the first two years of
implementation) to review progress with both IAs and build synergies for effective implementation. The
task team will work closely with the PMUs and PCC to plan and implement the required project M&E.
Considering security challenges in Balochistan and lack of the World Bank task team’s ability to travel to
all the project sites, the task team will work closely with the GoB to use various approaches to monitor
implementation progress including third‐party monitoring, community monitoring, and remote
monitoring using the real‐time monitoring system (already implemented in the education sector and to
be implemented in the health sector).

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## DISPLACEMENT DASHBOARD
###### **Mindanao, Philippines Forced Displacement Annual Report, 2015**


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#### **Armed Conflict Displacement: Central Mindanao**

time of the publication of this document, these issues remain a concern for populations repeatedly displaced by this conflict.

The Mamasapano incident had negative repercussions on the deliberation of the proposed Bangsamoro Basic Law (BBL) in the Congress and Senate hearings, while non-state armed actors also took advantage of the precarious state of the peace process to continue attacks on government and military targets throughout the year.

The BIFF harassment of military detachments in the towns of Datu Saudi Ampatuan (Barangay Salbo), Datu Salibo (Barangay Pagatin), Mamasapano, and Shariff Aguak (SPMS box) in Maguindanao during the height of the LEOs continued unabated. BIFF attacks on civilian communities in MILF-stronghold areas in North Cotabato and Maguindanao provinces, and in communities with identified internal conflict with other BIFF member, further confounded the complex security situation in the area.

Early November, the BIFF tried but failed to overrun a military detachment displacing 30 families (estimated 150

###### **MINDANAO PEACE PROCESS**

persons) in the municipality of Shariff Aguak. On Christmas Eve, the BIFF launched synchronized attacks on military detachments, which resulted in 232 families (estimated 1,039 persons) being displaced from their homes in Pigkawayan municipality in North Cotabato province.

Overall, during the last quarter of the year, incidents documented by Protection Cluster members resulted in the displacement of 260 families (estimated 1,189 persons) in central Mindanao.

A new armed-group called the Ansar Khilafah Philippines (AKP), claiming to support the Islamic State of Iraq and Syria (ISIS), emerged in Palimbang municipality of Sultan Kudarat province causing fear amongst communities in the area. The group’s activities were thwarted in a pursuit operation conducted by the Philippine Marines, which resulted in the displacement of 50 families (estimated 250 persons) in late November. This group, and other small radical groups, contributes to the displacement of civilian populations in areas where there are unresolved conflicts between the MILF, the Moro National Liberation Front (MNLF) and government forces.

The year concluded with no significant progress made in the Protection Cluster partners advocate for the pursuit of passage of the Bangsamoro Basic Law (BBL), which would peace in Mindanao as it is the primary condition for all the have laid down the foundation of an autonomous political population of Mindanao - particularly those most entity, the Bangsamoro, thus paving the way to lasting peace marginalized and under threat - to see their human rights with the MILF. In the absence of a law instituting the new fulfilled and for the displaced to find a durable solution to Bangsamoro entity, armed groups are likely to continue their plight.

engaging the AFP with ensuing LEOs and subsequent displacement.

**5**


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UNHCR Manila 6/F GC Corporate Plaza (JAKA 2 Building) 150 Legaspi Street Legaspi Village, 1226 Makati City, Manila Telephone: +63 (02) 403-2336 Website: www.unhcr.ph UNHCR Cotabato 26 Ilang-Ilang Street corner Rosales Street Rosales Heights 6, 9600 Cotabato City Telephone: +63 (064) 421-7940 Website: www.unhcr.ph Email: phicoprc@unhcr.org

**DISCLAIMER**

The Annual Mindanao Displacement Dashboard aims to provide a starting point for information and analysis that can help protection agencies, policy makers and other stakeholders concerning instances of forced displacement or solutions (repatriation, resettlement, integration). The number of people displaced / affected may differ from the number in need of humanitarian assistance. To the extent possible, the terminology used in the Dashboard reflects the _UN Guiding Principles on Internal_ _Displacement_ and other sources of international law and practice. The information reported in the Annual Mindanao Displacement Dashboard has been received from members of the Protection Cluster across Mindanao. Consequently, unreported cases of forced displacement and solutions are not reflected. Updates will be provided as and when more information is received from members.
Although efforts are made to verify the data, the UNHCR Mindanao, Philippines takes no responsibility for the incompleteness or inaccuracy of the information. The information provided in this Annual Mindanao Displacement Dashboard does not necessarily reflect the views of UNHCR or any individual member of the Protection Cluster.

© UNHCR Philippines / E. Monato

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