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Implementation Completion Report (ICR) Review - Emergency Services Support Program Multi-donor Trust Fund

1. Project Data:   
ICR Review Date Posted:
West Bank & Gaza
Project Name:
Emergency Services Support Program Multi-donor Trust Fund
Project Costs(US $M)
 55.75  81.32
L/C Number:
Loan/Credit (US $M)
 55.75  81.32
Sector Board:
Social Protection
Cofinancing (US $M)
 0  0
Board Approval Date
Closing Date
06/30/2008 06/30/2011
Health (40%), Other social services (30%), General education sector (20%), Water supply (5%), Power (5%)
Conflict prevention and post-conflict reconstruction (67% - P) Other human development (33% - S)
Prepared by: Reviewed by: ICR Review Coordinator: Group:
Judith Hahn Gaubatz
Judyth L. Twigg Soniya Carvalho IEGPS1

2. Project Objectives and Components:

a. Objectives:
According to the Program Document (page 4), the objective was:

  • to mitigate the deterioration of basic services brought about by the inability of the Palestinian Authority to meet its budget requirements, by providing financing for non-salary operating expenditures in key social and service delivery sectors.

In 2006, the European Commission (EC) proposed a temporary international mechanism for providing direct delivery of assistance to the Palestinian population. A Multi-Donor Trust Fund (MDTF) was launched as part of that international mechanism, to be financed by international donors and administered by the Bank. The proposal for the Trust Fund (Initiating Brief for the Trust Fund - IBTF) was approved in July 2006, with the Program Document (in the form of a Technical Annex) approved in September 2006. As the project was fully funded by a trust fund, there was no Bank requirement to prepare a standard Project Appraisal Document.

The project was one of several Emergency Services Support Projects (ESSP I: US$59.1 million, 2002-2004; ESSP II: US$40.0 million, 2002-2004; ESSP III: US$18.0 million; 2007-2013) funded by the Bank, the only difference from the concurrent ESSP III being the source of funding.

b. Were the project objectives/key associated outcome targets revised during implementation?

c. Components:

1: Financing Non-Salary Recurrent Expenditures: (Appraisal: US$55.34 million; Actual: US$81.32 million): This component aimed to assist the Borrower in meeting its operating budget requirements in the following sectors: education (Appraisal: US$18.97 million; Actual: US$29.2 million); health (Appraisal: US$28.87 million; Actual: US$42.65 million); social assistance (Appraisal: US$1.0 million; Actual: US$0.8 million), and electricity, water and sanitation (Appraisal: US$6.5 million; Actual: US$7.96 million). The financing covered recurrent expenses such as rent payments, transportation costs, utilities, communication, and maintenance. Other sector-specific expenses covered included final exam materials, teaching materials, salaries of higher education staff, essential drugs, medical supplies, contracts with non-governmental health facilities, nutrition supplements, and food.

2: Project Management and Monitoring (Appraisal: US$0.41 million; Actual: US$0.71 million): This component financed costs related to project management.

d. Comments on Project Cost, Financing, Borrower Contribution, and Dates
Project cost:

  • Donor contributions were expected to be provided in tranches, and therefore project budgets were prepared on the basis of a six month cycle of expenditures. The budgets were to be updated regularly in line with Grant Agreements and procurement plans.
  • The first six month cycle was budgeted at US$55.75 million.
  • The Grant amount was increased four times - in December 2006, December 2007, March 2008, and April 2009 - for a total amount of US$88.04 million, due to the additional tranches from donors.

  • The project was financed entirely by donors, including the EC and the following countries: Australia, Austria, Belgium, France, Italy, Norway, Spain, Sweden, Switzerland, and the United Kingdom.

Borrower contribution:
  • There was no planned Borrower contribution.

  • The project closing date was extended from June 30, 2008, to June 30, 2010 in order to fully disburse ongoing contracts that had been delayed due to border restrictions, as well as new funds from donors.
  • The project closing date was extended a second time, from June 30, 2010 to June 30, 2011, due to additional contributions from the EC, which would finance priority emergency items such as fuel and water. The ICR (page 80) also notes that the Borrower wanted to ensure that the Trust Fund remained open due to its prominent role in the management of the emergency response.

3. Relevance of Objectives & Design:

a. Relevance of Objectives:
Substantial. The project objective reflected the emergency nature of the situation, in which the Government was experiencing a severe fiscal crisis. Domestic revenues were insufficient to finance operating budgets, resulting in serious disruptions and declines in service provision. As West Bank and Gaza is not a member of the Bank, there is no formal Country Assistance Strategy. However, there is an Interim Strategy Note for FY2012-14 (finalized at the time of this review, though not at the time of writing of the ICR), in which the first pillar is to support efficient management of public finances and ensure services to citizens, although the emphasis is on strengthening institutions to carry out these aims, rather than simply preventing deterioration of services in the context of the crisis. The National Development Plan (2011-2013) also prioritizes improving citizens' access to basic public services.

b. Relevance of Design:
Substantial. With the Government experiencing a severe fiscal crisis, the project provided emergency financing for non-salary recurrent expenditures in the key social sectors of education, health, social assistance, and utilities. This direct fiscal support was likely to prevent the deterioration of the social service system, particularly as there were no conditionality or reform requirements and therefore could be a quick-disbursing mechanism for responding to the crisis situation.

4. Achievement of Objectives (Efficacy) :

To mitigate the deterioration of basic services Substantial, due to substantial achievement of targeted outcomes in the education, health, and social assistance sectors, although more modest evidence of outcomes in the utility sectors. For all these sectors, the "target" outcome was to have service facilities operating at the same or at higher levels than at the start of the project period.

According to the ICR (page 14), the project, along with the concurrent ESSP III, supported about 70% of operating costs (i.e. rent payments, utilities, transportation costs, fuel, communications, building maintenance) for the recipient entities. Therefore, the results reported below represent concurrent support from the MDTF funds and the ESSP III funds.

The Ministry of Education and Higher Education (MOEHE) administers 1,500 schools, which serve about 800,000 students and employ 21,431 teachers.

  • Financing of minor school rehabilitation (originally 9 contracts signed for 56 schools, with 2 contracts later cancelled), school furniture (benefiting 9,000 students), printing materials (to enable 60,000 students to take final exams) and cleaning materials. Utilities in all 1,500 schools and 17 MOEHE directorate offices were also financed.
  • Financing of salaries of 2,000 teaching staff at the 9 universities. (Note: According to the project team, financing for these expenditures was permissible as the staff were non-civil servants).

  • The number of primary schools in operation increased from 972 in 2007 to 1,155 in 2011. The average number of students per school increased from 400 to 542.
  • The number of academic staff in the 9 universities was maintained at 3,209. The number of students at the universities increased from 123,429 in 2007 to 132,750 in 2011.

The Ministry of Health (MOH) operates 22 government hospitals (with a total capacity of 2,815 beds), 430 primary health care centers, and 146 laboratories.

  • Financing of essential drugs and vaccines (350 out of 550 items on MOH's basic drug list), laboratory and blood bank materials (to enable 1.2 million medical tests to be conducted), medical consumables, equipment (65% of spare parts needed for 6,000 pieces of equipment), textiles (81% of total needs for lab coats, bedding and curtains), electricity, and water.
  • Financing of emergency treatment services at 45 non-governmental facilities, benefiting 16,654 patients.
  • The ICR (page 15) notes that there were some shortages of drugs and other materials because of the difficulty in delivering them to health facilities, particularly in Gaza.

  • The overall hospital occupancy rate increased slightly from 76% in 2007 to 78% in 2011. The occupancy rate at Shefa hospital decreased from 76% to 70%; the rate at Rafedia hospital increased from 67% to 87.2%. There is no information provided on average length of stay (ALOS).
  • The gynecology occupancy rate increased at Shefa hospital from 78% in 2007 to 91% in 2011, and at Rafedia hospital from 95% to 102.5%. There is no information provided on ALOS, and it is not clear from the ICR whether the latter facility experienced overcrowding due to the occupancy rate.
  • The number of outpatients at Shefa hospital increased from 12,683 in 2007 to 17,775 in 2011, and at Rafedia hospital from 3,243 to 10,782.

Social Assistance
The Ministry of Social Affairs (MOSA) operates 38 centers/shelters for vulnerable populations (elderly, orphans, disabled, and youth), which in total serve 2,150 beneficiaries.

  • Financing of tools and small machines (for 12 vocational training centers) and food for shelters and daily care centers (3 meals a day for 300 overnight beneficiaries and 1 meal a day for 620 daily beneficiaries).

  • The number of MOSA training centers in operation was maintained at 13. The number of students enrolled increased from 1,300 in 2007 to 1,600 in 2011.
  • The number of youth centers in operation increased from 3 in 2007 to 8 in 2011. The number of youth benefiting from services increased from 125 to 413.
  • The number of disability rehabilitation centers in operation was maintained at 7. The number of disabled benefiting from services increased from 800 to 850.

Water/Sanitation and Electricity

  • Financing of basic goods, works and services directly related to the operation and maintenance of the utility networks, such as minor rehabilitations, electricity supplies, water wells, and waste water equipment.

No outcomes reported in terms of service levels; however, there were likely improvements in living conditions through the provision of secure drinking water, waste water treatment, and continuous electricity.

Other Outcomes
  • The project contributed to safeguarding social cohesion, in conjunction with the ongoing Social Safety Net Reform Project (approved in 2004 for US$28.4 million). According to the ICR (page 16), the security conflict in the country was "perpetuating an internal cycle of violence, fragmenting social cohesion, and affecting psychosocial well-being. The operation funded operating expenditures for health facilities, schools, and social centers for disabled, elderly and youth to strengthen the social fabric and community cohesion." The project team further noted that project interventions for these excluded groups (youth, disabled, elderly) promoted inclusion/social cohesion.
  • The project structure and mechanisms are now considered Borrower-administered mechanisms that can be scaled up or downwards to fund non-salary recurrent expenditures for social sector ministries. According to the ICR (page 15), such mechanisms ensure that key public services are not disrupted, and therefore can benefit the poorer segments of the population (Note: There are no specific data reported in the ICR on improved outcomes for the poor, per se).
  • The project developed new contracting modalities for tertiary health care providers with a competitive and transparent process.

5. Efficiency:

Not Rated. As this operation did not involve financing of investments, an assessment of economic or financial return was not applicable. However, it is noted that the cost of managing the project (Component 5) was only US$0.71 million, or 0.8%, of the total disbursements.

a. If available, enter the Economic Rate of Return (ERR)/Financial Rate of Return at appraisal and the re-estimated value at evaluation:

Rate Available?
Point Value
ICR estimate:

* Refers to percent of total project cost for which ERR/FRR was calculated

6. Outcome:

Satisfactory. The relevance of the project objectives and design are rated Substantial. Achievement of the objective to mitigate the deterioration of basic services is also rated Substantial due to substantial achievement of targeted outcomes in the education, health, and social assistance sectors, although more modest evidence of outcomes in the utility sector. Efficiency is Not Rated due to the nature of the project in which there was no financing of investments.

a. Outcome Rating: Satisfactory

7. Rationale for Risk to Development Outcome Rating:

The project was not intended to achieve sustainable development outcomes. However, as the security situation remains unstable and project funding was entirely dependent on donor contributions, the risk to continued provision of basic services is significant. The Bank is continuing emergency fiscal support through its ongoing emergency services support projects.

a. Risk to Development Outcome Rating: Significant

8. Assessment of Bank Performance:

a. Quality at entry:
The project provided emergency fiscal support, which had already been provided through the previous ESSP I, II and III. According to the Program Document (page 3), ESSP I and II had been confirmed by a Bank review and by stakeholders as having been critical for maintaining adequate levels of municipal, social, health and education services. Lessons from the Bank review were incorporated into the project design, including the following: delegation of implementation responsibility to the relevant units led to more effective and efficient implementation; creation of a multi-donor trust fund, in which donors pooled their resources into a single trust fund, rather than donors contributing through a series of individual trust funds that specified the use of resources, could be a more suitable mechanism; despite the emergency nature of the project, implementation could still be closely monitored through clear output and outcome indicators. An additional management layer introduced in the project design - the President's Office, which had overall program oversight and sign-off authority - created complexity in the project management structure without any apparent benefits. However, according to the project team, this arrangement (i.e. administering the project through the President's Office) was required by donors due to the highly politically sensitive environment. At the earliest opportune time, the Bank then sought agreement with donors to modify the management structure. The Program Document did not provide key performance indicators, while the IBTF provided vague outcome indicators ("continued operation of schools, health care facilities and social assistance programs") and output indicators ("availability of pre-identified school supplies," "availability of sufficient amounts of drugs and medical supplies"). Procurement was appropriately assessed as a high risk aspect of the project, due to the implementing agencies’ limited knowledge of international public procurement principles and limited knowledge of the local and international market and supplies; however, mitigation measures included capacity building and technical assistance support.

Quality-at-Entry Rating: Satisfactory

b. Quality of supervision:
Continuity in staffing and adaptability of the Bank team, high quality of aide-memoires and implementation supervision reports, and pro-active field presence (in both West Bank and Gaza territories) enabled close monitoring of implementation, as well as timely responsiveness to the changing political and economic environment. For example, the project was simplified (i.e. disbursement and procurement processes) when faced with issues of restricted access to project areas and frequent power shortages. Although the Bank had sole supervision responsibility for the project, the Bank team convened a steering committee of participating donors on a quarterly basis to discuss implementation progress. According to the project team, the project helped to create an enabling environment to attract donor resources and channel them towards essential social services. Quarterly spot check audits enabled the Bank team to closely monitor the delivery of essential goods and services and ensure satisfactory fiduciary performance. Due to initial slow disbursement levels, the focus of procurement was shifted to quick-disbursing items (such as incremental operating costs and higher education salaries). Implementation responsibility was also shifted from the President's Office to the Economic Affairs Department to simplify the initial complex project management structure. Shortcomings in M&E were addressed with the adoption of indicators from the ESSP III. The project was eventually adopted as a "best practice" instrument in the Bank for countries in similar crisis situations, as an effective mechanism for channeling emergency funds under critical circumstances.

Quality of Supervision Rating: Satisfactory

Overall Bank Performance Rating: Satisfactory

9. Assessment of Borrower Performance:

a. Government Performance:
The Government provided consistent support to the project to ensure effective implementation arrangements, although initially the management layer of the President’s Office increased processing time significantly. Implementation arrangements were eventually changed in Sept. 2007, with responsibility for oversight shifted to the Economic Affairs Department of the Ministry of Finance. There were clearly assigned roles for the PCU and the line ministries.

Government Performance Rating: Satisfactory

b. Implementing Agency Performance:
The project relied on the existing project coordinating unit (PCU) within the Ministry of Finance, which had previous Bank experience through managing the ESSP projects. With restrictions on movement of people and goods between West Bank and Gaza, the PCU staff worked under highly challenging circumstances with limited fuel and severe power outages, but was still effective in fiduciary performance.

The line ministries (MOEHE, MOH, MOSA, utility companies) were also overall effective in procuring outputs and ensuring delivery of services, although they had more limited knowledge of Bank procedures which led to some delays.

Implementing Agency Performance Rating: Satisfactory

Overall Borrower Performance Rating: Satisfactory

10. M&E Design, Implementation, & Utilization:

a. M&E Design:
The project design, as laid out in the Grant Agreement and Program Document, did not discuss M&E issues. The IBTF provided vague outcome indicators ("continued operation of schools, health care facilities and social assistance programs") and output indicators ("availability of pre-identified school supplies," "availability of sufficient amounts of drugs and medical supplies").

b. M&E Implementation:
Intermediate outcome indicators were identified for the ESSP III (with baseline data as of September 2007) and eventually adopted for this project. Quarterly spot check audits provided information on implementation progress.

a. M&E Utilization:
The ICR (page 10) states that it is not known whether the M&E data were used to inform decision-making and resource allocation.

M&E Quality Rating: Modest

11. Other Issues:

a. Safeguards:
The project financed only non-salary recurrent expenditures and no investments. It was identified as an Environmental Category “C” project, with no safeguard policies triggered.

b. Fiduciary Compliance:
Financial management: Due to previous experience with ESSP I and II, the financial management risk was considered moderate. Financial audits were all unqualified and submitted on time. After project closing, the Bank identified one instance in which funds reimbursed by the Bank to the borrower for eligible expenditures that the Borrower had financed with its own resources were not transferred immediately to the Central Treasury Account as required. However, at the request of the Bank, the Borrower took corrective action.

Procurement: Procurement risk was appropriately assessed as High due to limited knowledge of the implementing agencies regarding international procurement principles and markets. Procurement was initially slow, particularly for pharmaceuticals, but improved with the focus on quick-disbursing items (such as incremental operating costs and higher education salaries). An ex-post procurement review in March 2008 found that the Bank had done its part with regard to transparency and efficiency, with satisfactory performance in the education sector and utilities. The ICR (page 11) reports that “Procurement for the education sector and the utilities was satisfactory, but there were some problems for health and social welfare: a) There were problems with two contracts with a pharmaceutical company which committed fraud. The fraud was identified by the PA [Palestinian Authority] who brought it to the Bank‘s attention. The case was investigated by the PA and the World Bank Integrity Vice Presidency (INT). The PA took immediate action: the two contracts were canceled, the amounts were reallocated to fuel and electricity bills for hospitals and clinics in Gaza, and the PA returned to the Bank the small amount already paid to the firm. The case remains under both judicial and administrative investigations by the PA‘s Attorney General, and pending the final decision by the PA‘s Supreme Court. b) There was one case of misprocurement for the procurement of materials for training centers in Gaza. The amount involved was small (about US$40,000 equivalent) and was refunded to the Special Account (SA).”

c. Unintended Impacts (positive or negative):

d. Other:

12. Ratings:

IEG Review
Reason for Disagreement/Comments
Risk to Development Outcome:
Bank Performance:
Borrower Performance:
Quality of ICR:
- When insufficient information is provided by the Bank for IEG to arrive at a clear rating, IEG will downgrade the relevant ratings as warranted beginning July 1, 2006.
- The "Reason for Disagreement/Comments" column could cross-reference other sections of the ICR Review, as appropriate.

13. Lessons:
  • Even with the emergency nature of a project, implementation can still be closely monitored through clear output and outcome indicators. In the case of this project, indicators were eventually clarified and provided a stronger basis for assessing project achievements.

In addition, according to the ICR (page 22):
  • Field-based task team leadership, with intensive supervision and adaptability, enables responsiveness of a project to emergency situations. In this project, the implementing units had easy access to the Bank team and project issues were identified early.
  • Spot check audits conducted by an external auditor can be useful for monitoring implementation progress and proper use of project funds. In this project, the spot checks were critical monitoring tools in the absence of mid-term reviews or more formal assessments.

14. Assessment Recommended?


15. Comments on Quality of ICR:

The ICR quality is overall Satisfactory. The ICR provides an adequate analysis of project outputs and outcomes - including details on project scope (i.e. number of schools supported vs. number of schools in country) to more fully assess impact - as well as candid and relevant observations of implementing a project in a very challenging environment.

a. Quality of ICR Rating: Satisfactory

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