According to the Bank’s website, the objective of this project is to improve access to quality healthcare services and enhance the resilience and capacity for pandemic prevention, preparedness, and response of Tunisia’s health system.

The components are financed with US$108 million of IBRD financing and US$17 million RETF grant from the Pandemic Fund. This covers part of the investments needed to finance the ambition and scope of health reforms envisioned by the government. There is room to increase the scope of the Project and to scale up its financing during the design phase. The total scope and financing amount will be determined during appraisal.

The PDO will be achieved through a set of activities across four components:

- Component 1: Strengthening Health System Resilience (US$25M, including US$17M RETF from the Pandemic Fund);

- Component 2: Supporting reorganization of preventive and primary health services (US$50M);

- Component 3: Strengthening emergency medical services ($49M);

- Component 4: Implementation Support, Training and Project Management (US$1M).

The environmental risk rating is deemed moderate. The environmental risks identified at concept stage are two folds: 1. Risks associated with building infrastructure for data management systems (sub-component 1.1) and rehabilitation of PHCs (sub-component 2.2). Sites are located within existing government-owned lots, without land clearing or development, and are unlikely to be in environmentally sensitive areas, thus eliminating biodiversity-related risks. Construction risks are temporary and site-specific, with low probability of serious impacts. However, given the number of sites and varying capacities of local facilities, ensuring contractor compliance may be challenging. Risks include impacts on air quality, noise, wastewater, solid waste, and health and safety, particularly where work occurs in operational facilities. 2. Risks related to healthcare and outdated equipment waste management, particularly in handling and disposing of medical waste and E-waste in targeted facilities.

The social risk is considered as Moderate since adverse risks and impacts on human populations and/or the environment are not likely to be significant. Project social risks include stakeholders’ risks, such as risks of discontent, strike of personnel for planned reforms; risks of exclusion, discrimination and lack of information/participation of relevant stakeholders to project benefits, with anticipated impacts such as lack of access to health care; higher incidence/morbidity to communicable and non-communicable diseases; and higher costs for health care, medication and laboratory analysis for patients. Other risks include data privacy breach during case management and digitalization of medical records; OHS and community health and safety risks due to potential mismanagement of medical waste; noncompliance with bio-security protocols and other medical procedures. The project does not include personnel retrenchment.

Total Project Cost: US$ 125.16 million

International Bank for Reconstruction and Development (IBRD): US$ 108.00 million

Trust Funds (Special Financing): US$ 17.16 million

World Bank

Yassine Kalboussi
Health Specialist

Denizhan Duran
Senior Economist, Health

Fatima El Kadiri El Yamani
Senior Economist, Health

Borrower/Client/Recipient

Ministry of Economy and Planning
Imen Salem
Director
imen.salem@mpci.gov.tn

Implementing Agencies

Ministry of Health
Abderrezak Bouzouita
Director General of Health Services
dgs.ms@rns.tn

ACCESS TO INFORMATION

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ACCOUNTABILITY MECHANISM OF THE WORLD BANK

The World Bank Inspection Panel is the independent complaint mechanism and fact-finding body for people who believe they are likely to be, or have been, adversely affected by a World Bank-financed project. If you submit a complaint to the Inspection Panel, they may investigate to assess whether the World Bank is following its own policies and procedures for preventing harm to people or the environment. You can contact the Inspection Panel or submit a complaint by emailing ipanel@worldbank.org. Information on how to file a complaint and a complaint request form are available at: https://www.inspectionpanel.org/how-to-file-complaint