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FOR OFFICIAL USE ONLY

Report No: PAD3039

INTERNATIONAL DEVELOPMENT ASSOCIATION

PROJECT APPRAISAL DOCUMENT

ON A

PROPOSED CREDIT

IN THE AMOUNT OF SDR 18 MILLION (US$25 MILLION EQUIVALENT)

TO THE

LAO PEOPLE'S DEMOCRATIC REPUBLIC

FOR A

SCALING-UP WATER SUPPLY, SANITATION AND HYGIENE PROJECT

February 21, 2019

Water Global Practice East Asia And Pacific Region

This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization.

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CURRENCY EQUIVALENTS

(Exchange Rate Effective December 31, 2018)

Currency Unit = Lao Kip (LAK)

LAK 8,555.78= US$1

US$ 1 = 0.719 SDR

FISCAL YEAR

January 1 - December 31

Regional Vice President: Victoria Kwakwa Country Director: Ellen A. Goldstein Senior Global Practice Director: Jennifer Sara Practice Manager: Takuya Kamata Task Team Leader(s): Pratibha Mistry

ABBREVIATIONS AND ACRONYMS ADB Asian Development Bank CDD Community Driven Development CERC Contingent Emergency Response Component CERM Contingent Emergency Response Manual CLTS Community-Led Total Sanitation cm Centimeter CMU Component Management Unit CPF Country Partnership Framework DA Designated Account DHHP Department of Hygiene and Health Promotion DHIS District Health Information System DOF Department of Finance DONRE District Office of Natural Resources and Environment DPWT Department of Public Works and Transport DWS Department of Water Supply ECOPs Environmental Codes of Practice EHS Environmental Health and Safety ESD/PTRI Environmental and Social Division of the Public Works and Transport Research

Institute ESMF Environmental and Social Management Framework ESMP Environmental and Social Management Plan FM Financial Management FMM Financial Management Manual GDP Gross Domestic Product GNI Gross National Income GoL Government of Lao People’s Democratic Republic HCI Human Capital Index HGNDP Health Governance and Nutrition Development Project ICT Information and Communication Technologies IFRs Interim Financial Reports JICA Japan International Cooperation Agency KfW Kreditanstalt für Wiederaufbau (German Development Bank) Lao PDR Lao People's Democratic Republic LSIS Lao Social Indicator Survey MAF Ministry of Agriculture and Forestry MoU Memorandum of Understanding MFD Maximizing Finance for Development MOES Ministry of Education and Sports MOF Ministry of Finance MOH Ministry of Health MONRE Ministry of Natural Resources and Environment M&E Monitoring and Evaluation MPI Ministry of Planning and Investment MPWT Ministry of Public Works and Transportation Nam Saat National Center for Environmental Health and Water Supply NGOs Non-Governmental Organizations

NGPES National Growth and Poverty Eradication Strategy NSEDP National Socio-Economic Development Plan ODF Open Defecation Free O&M Operation and Maintenance PIU Project Implementation Unit PMU Project Management Unit PNPs Provincial Nam Papa PDO Project Development Objective POM Project Operations Manual PONRE Provincial Office of Natural Resources and Environment PPCC Provincial Project Coordinating Committee PPSD Procurement Strategy for Development PRF Poverty Reduction Fund PSC Project Steering Committee SBCC Social and Behavior Change Communications SDGs Sustainable Development Goals SOE Statement of Expenditure STEP Systematic Tracking of Exchanges in Procurement TORs Terms of Reference UNICEF United Nations Children's Fund WASH Water Supply, Sanitation and Hygiene VDC Village Development Committee WHO World Health Organization WSP Water and Sanitation Program

The World Bank Scaling-Up Water Supply, Sanitation and Hygiene Project (P164901)

TABLE OF CONTENTS

DATASHEET ................................................................................. Error! Bookmark not defined.

I. STRATEGIC CONTEXT ...................................................................................................... 9

A. Country Context................................................................................................................................ 9

B. Sectoral and Institutional Context .................................................................................................. 10

C. Relevance to Higher Level Objectives ............................................................................................. 16

II. PROJECT DESCRIPTION .................................................................................................. 17

A. Project Development Objective ..................................................................................................... 17

B. Project Components ....................................................................................................................... 18

C. Project Beneficiaries ....................................................................................................................... 23

D. Results Chain .................................................................................................................................. 23

E. Rationale for Bank Involvement and Role of Partners ................................................................... 25

F. Lessons Learned and Reflected in the Project Design .................................................................... 26

III. IMPLEMENTATION ARRANGEMENTS ............................................................................ 27

A. Institutional and Implementation Arrangements .......................................................................... 27

B. Results Monitoring and Evaluation Arrangements......................................................................... 28

C. Sustainability ................................................................................................................................... 28

IV. PROJECT APPRAISAL SUMMARY ................................................................................... 28

A. Technical, Economic and Financial Analysis ................................................................................... 28

B. Fiduciary .......................................................................................................................................... 29

C. Safeguards ...................................................................................................................................... 30

V. KEY RISKS ..................................................................................................................... 32

A. Overall Risk Rating and Explanation of Key Risks ........................................................................... 32

VI. RESULTS FRAMEWORK AND MONITORING ................................................................... 35

ANNEX 1: WORLD BANK COUNTRY PORTFOLIO RESULTS CHAIN FOR AN INTEGRATED APPROACH TO TACKLING CHILDHOOD STUNTING ................................................................ 50

ANNEX 2: INTEGRATED WASH PROJECT CYCLE ..................................................................... 59

ANNEX 3: IMPLEMENTATION ARRANGEMENTS .................................................................... 65

ANNEX 4: IMPLEMENTATION SUPPORT PLAN ...................................................................... 76

ANNEX 5: ECONOMIC ANALYSIS ........................................................................................... 78

ANNEX 6: FRAMEWORK FOR A COMMON SBCC AND COMMUNICATION STRATEGY FOR THE NUTRITION CONVERGENCE APPROACH ............................................................................... 83


ANNEX 7: MONITORING AND EVALUATION FRAMEWORK FOR THE NUTRITION CONVERGENCE APPROACH .......................................................................................................................... 88

ANNEX 8: MAP .................................................................................................................... 96


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DATASHEET

BASIC INFORMATION BASIC_INFO_TABLE

Country(ies) Project Name

Lao People's Democratic Republic

Scaling-Up Water Supply, Sanitation and Hygiene Project

Project ID Financing Instrument Environmental Assessment Category

P164901 Investment Project Financing

B-Partial Assessment

Financing & Implementation Modalities

[ ] Multiphase Programmatic Approach (MPA) [✓] Contingent Emergency Response Component (CERC)

[ ] Series of Projects (SOP) [ ] Fragile State(s)

[ ] Disbursement-linked Indicators (DLIs) [ ] Small State(s)

[ ] Financial Intermediaries (FI) [ ] Fragile within a non-fragile Country

[ ] Project-Based Guarantee [ ] Conflict

[ ] Deferred Drawdown [ ] Responding to Natural or Man-made Disaster

[ ] Alternate Procurement Arrangements (APA)

Expected Approval Date Expected Closing Date

14-Mar-2019 31-Mar-2024

Bank/IFC Collaboration

No

Proposed Development Objective(s)

To provide access to improved water supply, sanitation and hygiene services in selected areas identified for nutrition convergence, and strengthen capacity of select institutions to improve service delivery.


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Components

Component Name Cost (US$, millions)

Component 1: Delivery of Infrastructure and Sustainability of Water Supply and Sanitation

22.00

Component 2: Sustainability of Community Water Supply, Sanitation and Hygiene Support

1.50

Component 3: Implementation Support and Sector Development 2.40

Component 4: Contingent Emergency Response 0.00

Organizations

Borrower: Lao People's Democratic Republic

Implementing Agency: The Ministry of Public Works and Transport Ministry of Health

PROJECT FINANCING DATA (US$, Millions)

SUMMARY-NewFin1

Total Project Cost 25.90

Total Financing 25.90

of which IBRD/IDA 25.00

Financing Gap 0.00

DETAILS-NewFinEnh1

World Bank Group Financing

International Development Association (IDA) 25.00

IDA Credit 25.00

Non-World Bank Group Financing

Counterpart Funding 0.90

Borrower/Recipient 0.90


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IDA Resources (in US$, Millions)

Credit Amount Grant Amount Guarantee Amount Total Amount

National PBA 25.00 0.00 0.00 25.00

Total 25.00 0.00 0.00 25.00

Expected Disbursements (in US$, Millions)

WB Fiscal Year 2019 2020 2021 2022 2023 2024

Annual 0.05 0.25 1.20 5.00 8.60 9.90

Cumulative 0.05 0.30 1.50 6.50 15.10 25.00

INSTITUTIONAL DATA Practice Area (Lead) Contributing Practice Areas

Water Health, Nutrition & Population

Climate Change and Disaster Screening

This operation has been screened for short and long-term climate change and disaster risks

Gender Tag

Does the project plan to undertake any of the following?

a. Analysis to identify Project-relevant gaps between males and females, especially in light of country gaps identified through SCD and CPF

Yes

b. Specific action(s) to address the gender gaps identified in (a) and/or to improve women or men's empowerment

Yes

c. Include Indicators in results framework to monitor outcomes from actions identified in (b) Yes

SYSTEMATIC OPERATIONS RISK-RATING TOOL (SORT)

Risk Category Rating

1. Political and Governance ⚫ Substantial

2. Macroeconomic ⚫ Substantial


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3. Sector Strategies and Policies ⚫ High

4. Technical Design of Project or Program ⚫ Moderate

5. Institutional Capacity for Implementation and Sustainability ⚫ High

6. Fiduciary ⚫ Substantial

7. Environment and Social ⚫ Moderate

8. Stakeholders ⚫ Moderate

9. Other

10. Overall ⚫ Substantial

COMPLIANCE

Policy Does the project depart from the CPF in content or in other significant respects?

[ ] Yes [✓] No

Does the project require any waivers of Bank policies?

[ ] Yes [✓] No

Safeguard Policies Triggered by the Project Yes No

Environmental Assessment OP/BP 4.01 ✔

Performance Standards for Private Sector Activities OP/BP 4.03 ✔

Natural Habitats OP/BP 4.04 ✔

Forests OP/BP 4.36 ✔

Pest Management OP 4.09 ✔

Physical Cultural Resources OP/BP 4.11 ✔

Indigenous Peoples OP/BP 4.10 ✔

Involuntary Resettlement OP/BP 4.12 ✔

Safety of Dams OP/BP 4.37 ✔

Projects on International Waterways OP/BP 7.50 ✔


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Projects in Disputed Areas OP/BP 7.60 ✔

Legal Covenants

Sections and Description Memorandum of Understanding (Section I.B.3 of Schedule 2 to the Financing Agreement) The Recipient shall ensure that by not later than three months after the Signature Date, MPWT, MOH, MOES and the Governors of Xiengkhuang, Huaphanh, Oudomxay and Phongsaly provinces shall enter into a memorandum of understanding, which clarifies the roles and responsibilities of each of the parties to the memorandum of understanding for the purposes of Project implementation at the national and subnational levels.

Sections and Description PNP Corporate Plan (Section I.B.4 of Schedule 2 to the Financing Agreement) The Recipient shall ensure that the participating PNPs shall update their respective corporate plans annually to ensure the sustainability of the water service and submit such updated plans to the Association for its annual review by the end of each Calendar Year, commencing on the year following the completion of the construction of the water supply system in each respective province

Sections and Description Service Agreement (Section I.B.5 of Schedule 2 to the Financing Agreement) The Recipient shall ensure that the Service Agreements shall be updated and submitted to the Association for review every eighteen (18) months beginning from the first eighteen (18) months after the Signature Date.

Sections and Description Institutional arrangements at the national level: PSC, PWG, PMU and CMU (Section I.A.1 of Schedule 2 to the Financing Agreement) At the national level, the Recipient shall establish by three months after the Signature Date, and thereafter maintain, throughout the Project implementation period: a) a Project Steering Committee, with a mandate, composition and resources satisfactory to the Association. Without limitation to the foregoing, the Project Steering Committee shall: (i) be co-chaired by the Vice Minister of MPWT and the Vice Minister of MOH and include representatives from MPWT, MOH, Ministry of Education and Sports (“MOES”), Ministry of Natural Resource and Environment, Ministry of Agriculture and Forests and Ministry of Planning and Investment, Ministry of Finance and provincial vice governors; (ii) meet at least once a year or as often as required; (iii) be responsible for overseeing the overall Project implementation, including to: (A) provide guidance for Project implementation and coordination; (B) monitor progress; (C) provide Project implementation guidance to the Project Management Unit and the Component Management Unit; (D) review and endorse the annual implementation action plans and budgets; (E) review and approve major implementation issues as set out in the Project Operations Manual; and (F) review and approve policies and activities related to the convergence approach to address malnutrition (stunting and wasting);


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(b) a Project Working Group, with functions, resources and staff in numbers and with terms of reference and qualifications satisfactory to the Association, which shall: (i) be responsible for ensuring coordination and effective implementation of – and timely resolution of issues related to – Parts 1 and 2 of the Project; (ii) meet quarterly or as often as required; and (iii) report Project plans and progress to the Project Steering Committee; (c) a Project Management Unit, with functions, resources and staff in numbers and with terms of reference and qualifications satisfactory to the Association, which shall be responsible for: (i) implementing Parts 1, 3 and 4 of the Project; (ii) reviewing and updating the Project implementation schedule for all Project activities and disbursement plan, together with the department of finance of MPWT; (iii) preparing the Annual Work Plans and Budgets, together with the department of finance of MPWT, and submitting such Annual Work Plans and Budgets to the Association; (iv) preparing, consolidating and submitting to the Association, Project Reports, interim unaudited financial reports and other reports as may be required by the Project Steering Committee and/or the Association; (v) together with MOH, preparing, updating and ensuring compliance with the Project Operations Manual; (vi) ensuring the implementation of technical, social, procurement and financial audits and safeguard activities; (vii) identifying and resolving issues related to implementation constraints or delays; (viii) carrying out procurement and making payments related to the implementation of Parts 1, 3 and 4 of the Project; and (ix) ensuring coordination with MPWT and MOH departments; and (d) a Component Management Unit, with functions, resources and staff in numbers and with terms of reference and qualifications satisfactory to the Association, which shall: (i) be established under the DHHP; and (ii) be responsible for: (A) implementing Parts 2 and 4 of the Project; (B) preparing reports on the implementation of Parts 2 and 4 of the Project and submitting such reports to the Project Management Unit in timely manner; (C) carrying out procurement and making payments related to the implementation of Parts 2 and 4 of the Project; (D) sharing the annual progress of Project implementation with the Project Steering Committee and the national nutrition committee; (E) in cooperation with the Project Management Unit, ensuring the effective operation of a coordination mechanism with ministries and agencies that are relevant to the implementation of other convergence projects; and (F) coordinating knowledge, social and behavior change and communication and monitoring and evaluation activities related to convergence.

Sections and Description Institutional arrangements at the provincial level: PPCC (Section I.A.2 of Schedule 2 to the Financing Agreement). At the provincial level, the Recipient shall establish by six months after the Signature Date, and thereafter maintain, throughout the Project implementation period, a Provincial Project Coordinating Committee, with a mandate, composition and resources satisfactory to the Association, which shall include representatives of the provincial governor’s office, the provincial DPWT, PNP, provincial health department, Nam Saat, provincial education and sports office, women’s union, Lao front for national construction and youth union; (b) be responsible for overall coordination of Project implementation, supervision and coordination in the province.

Sections and Description Institutional arrangements at the district level: PIU (Section I.A.3 of Schedule 2 to the Financing Agreement) At the district level, the Recipient shall establish by six months after the Signature Date, and thereafter maintain, throughout the Project implementation period, a Project Implementing Unit, with functions, resources and staff in


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numbers and with terms of reference and qualifications satisfactory to the Association, which shall be responsible for: (a) implementation of the WASH Project Cycle at the village level; (b) deployment and supervision of the resource agencies contracted to carry out community mobilization, engineering survey, design and supervision and village level monitoring, supervision and reporting of the Project activities; (c) coordination with district health office and district public works and transport office; (d) Project monitoring and reporting to the Project Management Unit; (e) supervision and approval of water supply systems; and (f) approval of village integrated development plans and asset hand-over.

Sections and Description Implementation arrangements: Annual Work Plans and Budgets (Section I.B.2(a) of Schedule 2 to the Financing Agreement) The Recipient shall ensure that the Association is furnished, not later than one (1) month before the beginning of each Fiscal Year during the implementation of the Project (or such later date as the Association may agree) for the Association’s no-objection, a consolidated Annual Work Plan and Budget containing all Project activities and Eligible Expenditures proposed to be included in the Project in the following Fiscal Year.

Conditions

Type Description

Disbursement Contingent Emergency Expenditures (Section III.B.1(b) of Schedule 2 to the Financing

Agreement)

For Contingent Emergency Expenditures under Category (3), unless and until the Association

is satisfied that all of the following conditions have been met in respect of said expenditures:

(i) the Recipient has determined that an Eligible Crisis or Emergency has occurred, has

furnished to the Association a request to include said activities in the Contingent Emergency

Response Part in order to respond to said crisis or emergency, and the Association has

agreed with such determination, accepted said request and notified the Recipient thereof;

(ii) the Recipient has ensured that all safeguards instruments required for said activities

have been prepared and disclosed, and the Recipient has ensured that any actions which are

required to be taken under said instruments have been implemented, all in accordance with

the provisions of Sections I.E of Schedule 2 to the Financing Agreement;

(iii) the entities in charge of coordinating and implementing the Contingent Emergency

Response Part have adequate staff and resources, in accordance with the provisions of

Section I.E of Schedule 2 to the Financing Agreement, for the purposes of said activities; and

(iv) the Recipient has adopted the CERM, in form and substance acceptable to the


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Association, and the provisions of the CERM remain – or have been updated in accordance

with the provisions of Section I.E of Schedule 2 to the Financing Agreement so as to be –

appropriate for the inclusion and implementation of the Contingent Emergency Response

Part.


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I. STRATEGIC CONTEXT

A. Country Context

1. The Lao People’s Democratic Republic (Lao PDR) has experienced rapid economic growth over the past decade, albeit without proportional gains in poverty reduction. A landlocked country of 6.9 million, its Gross Domestic Product (GDP) growth averaged 7.6 percent per year over the past decade and poverty declined from 33.5 percent to 23.2 percent between 2002/03 and 2012/13, making it the 13th fastest-growing economy globally. However, growth has not been particularly inclusive and was driven largely by mega projects in the natural resource sector, which have created limited employment. The pace of poverty reduction was modest compared to some of Lao PDR’s neighbors (a 1.0 percent increase in GDP in Cambodia translated to 1.2 percent poverty reduction, whereas in Lao PDR it was only 0.4 percent). Inequality widened over the last decade and the Gini coefficient increased from 32.4 (2002) to 36.2 (2012). Inequality in Lao PDR is characterized by rising disparities within urban areas and between rural and urban areas.

2. Lao PDR made impressive gains in water supply and sanitation access, but the poor have been left behind.

Between 1995 and 2015, access to improved water supply1 and sanitation2 increased from 40 to 76 percent and from 21

to 74 percent respectively.3 However, urban areas and higher income quintiles have benefitted disproportionately from this progress. Almost two-thirds of the urban population have access to piped water on the premises against only 6 percent in rural areas. Women bear the greatest burden of collecting water away from their houses in rural areas: 49 percent are adult females, and 12 percent are under 15 and mainly girls.4 Overall, in the poorest quintile, 56 percent has access to improved water supply, compared with 95 percent in the highest quintile. These differences are even more pronounced for access to improved sanitation: 23 percent of the poorest quintile has access to improved sanitation against 99 percent of households in richest quintile. Seventy-two percent in the poorest quintile continue to defecate in

the open.5 Institutional water supply and sanitation coverage remains low: 48 percent of primary schools, and a quarter

of health facilities do not have access to safe drinking water and sanitation facilities.6,7 Inadequate Water Supply, Sanitation, and Hygiene (WASH) in schools is a barrier to children’s attendance and performance, particularly for girls when their menstrual hygiene needs are not addressed, and for children with disabilities when WASH facilities are not accessible. WASH in health care centers is particularly important for maternal and newborn health.

3. The prevalence of waterborne diseases and levels of chronic malnutrition, or stunting,8 in children remain high,

1 An improved drinking water sources is: Piped water into dwelling, piped water into yard/plot, public tap/standpipes, tubewell/boreholes, protected dug wells, protected springs, rainwater collection, bottled water, if the secondary source used by the household for cooking and personal hygiene is improved. (World Health Organization/UNICEF Joint Monitoring Program (JMP) 2 An improved sanitation facility is defined as one that hygienically separates human excreta from human contact (World Health Organization/UNICEF Joint Monitoring Program (JMP) 3 WHO/UNICEF JMP, 2015 4 Lao Social Indicator Survey (LSIS), 2017 5 World Bank Data, http://povertydata.worldbank.org/poverty/country/LAO 6 UNICEF EMIS data, 2015 7 WHO/UNICEF WASH FIT, 2017 8 Stunting is defined as a height-for-age z-score below minus 2 standard deviations from the median for the reference population; underweight is defined as a weight-for-age z-score below minus 2 standard deviations from the median for the reference population; and wasting is defined as a weight-for-height z-score below minus 2 standard deviations from the median for the reference population. https://www.unicef.org/infobycountry/stats_popup2.html

https://en.wikipedia.org/wiki/World_Health_Organization

https://en.wikipedia.org/wiki/UNICEF

https://en.wikipedia.org/wiki/Joint_Monitoring_Programme_for_Water_Supply_and_Sanitation



https://en.wikipedia.org/wiki/UNICEF

https://en.wikipedia.org/wiki/Joint_Monitoring_Programme_for_Water_Supply_and_Sanitation

http://povertydata.worldbank.org/poverty/country/LAO

https://www.unicef.org/infobycountry/stats_popup2.html


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despite both rapid economic growth and a significant decline in poverty. A child who lives in an environment of poor quality latrines, inadequate fecal waste management and open defecation is more likely to be infected by disease-causing pathogens, including bacteria, viruses, and other microorganisms. In Lao PDR in 2009, the associated annual economic losses from poor sanitation were estimated at 5.6 percent of GDP, equivalent to 5 trillion Kip or about US$620 million per year.9 Econometric analysis shows that children living in rural villages in Lao PDR with a high incidence of open

defecation, are 1.1 cm shorter than children living in rural villages that are open defecation free (ODF).10 About 33 percent of children under-five are stunted, 21 percent underweight and 9 percent are wasted.11 The proportion of stunted children under 5 years old declined by 15 percent over a decade from 48 percent in 2001 to 33 percent in 2017. The poor, ethnic minority groups, and up-land areas of the country are disproportionately affected by child stunting rates. For example, stunting rates among the Hmong-Mien are as high as 50 percent.12

4. Increasing competition for water resources, water scarcity, and water-related climate vulnerabilities are likely to increase food insecurity, another determinant of child malnutrition. The historical temperature variation in the project area has been moderate. There has been an increasing trend in temperature and the average annual temperature is expected to increase by 2.6°C by 2080. The summer time or dry season in the Mekong Region will be significantly longer in the future, with increasing precipitation throughout the region, especially in the eastern and southern part of Lao PDR.13 Rainfall during the wet season is likely to increase by 30 percent, and climate variability will tend to be more extreme, with increases in the range of precipitation between dry and wet years.13 It is therefore likely that more intense rainfall events and more frequent and severe droughts and floods will occur. Up to 46 percent of the rural population in Lao PDR are at risk of becoming food insecure because of either loss of access to natural resources, floods, drought, or a sudden increase in food prices.14

B. Sectoral and Institutional Context

5. The National Growth and Poverty Eradication Strategy (NGPES) identifies water supply, sanitation and hygiene as one of four national priority sectors. The 8th NSEDP (Outcome 2 and Output 4 – universal access to quality health care services) defines water supply and sanitation targets as follows: by 2020, 90 percent of the population should use clean water; and 75 percent of the population should use latrines. The Draft National Strategy for Rural Water Supply, Sanitation and Hygiene for Lao PDR 2019-2030 is closely aligned with the Sustainable Development Goals (SDGs). The Strategy acknowledges that while it may not be feasible to achieve universal Water Supply, Sanitation and Hygiene (WASH) services by 2030, new investments should be aligned towards achieving 65 percent access to safely managed15 services by 2030. The Strategy identifies the following key sector challenges: (i) extending services and improving water quality, (ii) adequate and reliable financing for rural water supply, sanitation and hygiene, (iii) raising district level capacity

9 Water and Sanitation Program, Economic Impacts of Sanitation in Lao PDR, Research Report, May 2009 10 Water and Sanitation Program: Research Brief, Investing in the Next Generation: Children grow taller, and smarter, in rural villages of Lao PDR where all community members use improved sanitation, December 2014

11 Lao Statistics Bureau. 2018. Lao Social Indicator Survey II 2017, Survey Findings Report. Vientiane, Lao PDR: Lao Statistics Bureau and UNICEF 12 Lao Social Indicator Survey (LSIS), 2011-2012 13 Khongsab Somphone (2016); Climate change and groundwater resources in Lao PDR; Journal of Groundwater Science and Engineering Vol.4 No.2 Jun. 2016 14 World Food Program (WFP). Lao PDR: Improving the Resilience of the Agriculture Sector in Lao PDR to Climate Change impacts Project by Global Environmental Facility (GEF), 2007. 15The SDG global indicator “percentage of the population using a safely managed drinking water source” is defined as: an improved drinking water source: which is located on premises; available when needed; compliant with national water quality standards with respect to fecal contamination and chemical contaminants, including arsenic and fluoride.


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in human resources and capacity to develop and maintain WASH services in remote and poor communities, and (iv) service delivery modalities that would help increase the speed of delivery while maintaining implementation quality and local ownership. In addition, Government of Lao’s National Nutrition Strategy to 2025 and Plan of Action 2016-20 have set a target to reduce the prevalence of stunting from current levels to 25 percent by 2025 using a multi-sectoral convergence of core nutrition specific and nutrition sensitive interventions. It recognizes the importance of WASH as one of 22 priority actions to address childhood malnutrition.

6. Access to WASH is an important determinant of child health. There is robust evidence that access to safe water supply and improved sanitation decreases the incidence of diarrhea in young children - a synthetic review and meta-analysis of health impact assessments of WASH interventions show water interventions reduce diarrhea morbidity by 34 percent, sanitation interventions reduce it by 28 percent, while promotion of handwashing with soap results in a 40

percent reduction.16 But more recent studies have not shown impacts on diarrhea or stunting. 17 One hypothesis for the lack of effect is that the interventions did not adequately eliminate fecal contamination from the environment. 18 To address the possibility that traditional WASH interventions, i.e. improved toilets, improved drinking water, and handwashing with soap, do not adequately reduce fecal exposure among children, an emerging approach known as “baby WASH” or “child-centered WASH” complements these with interventions to interrupt exposure pathways that are most strongly associated with subsequent diarrheal disease.

7. Progress toward reducing stunting can be enhanced through coordinated multi-sectoral approaches that effectively address the underlying determinants of nutritional status— food security, access to health care, child care practices, and access to water and sanitation. Reductions in stunting are more likely to materialize when the multiple contributing factors are adequately addressed for a child. Recognizing the multifactorial character of malnutrition, the Plan of Action 2016 – 2020 advocates a convergence of 22 key interventions that combine nutrition-specific interventions (those which address undernutrition directly) with nutrition-sensitive interventions (which operate primarily outside of the health sector, including WASH). The fundamental theory of change that drives the multi sector approach and the World Bank’s multi-sector convergence approach is detailed further in Annex 1.

8. Institutional limitations have resulted in low water supply coverage and challenges related to sustainability. A 2015-survey of two districts in Savannakhet Province in the south of Lao PDR found that 35 percent of the drinking water systems were not working, and 48 percent were only partially working, resulting in people relying on unimproved sources.19 The major causes were: (i) unavailability of spare parts; (ii) limited local technical knowledge and skills; (iii) poor source sustainability; and (iv) limited community management, willingness to pay and financial management. A more recent assessment of gravity systems in Oudomxay and Huaphanh showed that 11 out of 40 villages needed

16 Wolf, J.; Hunter, P.R.; Freeman, M.C. et al. 2018. Impact of drinking water, sanitation and handwashing with soap on childhood diarrheal disease: updated meta-analysis and meta-regression. Tropical Medicine and International Health 23(5): 508–525. https://doi.org/10.1111/tmi.13051 17 Luby, S.P.; Rahman, M.; Arnold, B.F.; et al. 2018. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhea and child growth in rural Bangladesh: a cluster randomized controlled trial. The Lancet Global Health 6: e302–e315. https://doi.org/10.1016/S2214-109X(17)30490-4; Null, C.; Stewart, C.P.; Pickering, A.J.; et al. 2018. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhea and child growth in rural Kenya: a cluster-randomized controlled trial. The Lancet Global Health 6(3): e316–e329. https://doi.org/10.1016/S2214-109X(18)30005-6 18 Arnold, B.F.; Null, C.; Luby, S.P.; Colford, J.M. 2018. Implications of WASH Benefits trials for water and sanitation - Authors’ reply. The Lancet Global Health 6(6): e616–e617. https://doi.org/10.1016/S2214-109X(18)30229-8; Coffey, D.; Spears, D. 2018. Implications of WASH benefits trials for water and sanitation. The Lancet Global Health. 6(6): e615. https://doi.org/10.1016/S2214-109X(18)30225-0; Cumming, O.; Curtis, V. 2018. Implications of WASH benefits trials for water and sanitation. The Lancet Global Health 6(6): e613–e614. https://doi.org/10.1016/S2214-109X(18)30192-X 19 SNV Technical Report. Technical Assessment of Rural Water Supply in Atsaphone and Phin Districts, Savannakhet Province, Lao PDR. June 2015

https://doi.org/10.1016/S2214-109X(17)30490-4

https://doi.org/10.1016/S2214-109X(17)30490-4

https://doi.org/10.1016/S2214-109X(18)30005-6

https://doi.org/10.1016/S2214-109X(18)30229-8

https://doi.org/10.1016/S2214-109X(18)30225-0


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immediate intervention for full or partial rehabilitation.20 The water supply systems in rural areas are managed by the communities themselves, though their role is not formally recognized to carry out routine O&M. International experience shows that communities require continuous support to keep up O&M to ensure sustained services.21 The integration of rural water supply as part of the health delivery system has resulted in staff responsible for water supply being medical doctors and public health professionals, and engineering capacity for infrastructure development and support to communities to ensure continuous and adequate O&M is limited. At present, an average of 1.4 health staff located at the district level serve an average of 61 villages.22 to implement all health-related programs, including WASH.

9. Sanitation is traditionally supply-led through hardware subsidies, with limited focus on behavioral change. There is increasing acceptance of approaches that focus on sustained sanitation behavior change, such as Community-Led Total Sanitation (CLTS), 23 which has been supported by development partners such as the Water and Sanitation Program (WSP) and the United Nations Children's Fund (UNICEF). The so-called ‘soft’ program elements like rural sanitation promotion, CLTS, and capacity building, are mostly reliant on financial support from development partners and non-governmental organizations (NGOs) due to limited government budgets for rural sanitation. CLTS tends to be implemented as a stand-alone approach and there is a need for well-trained and motivated staff at the district level.

10. UNICEF is the largest donor for rural WASH projects in the country. At the national level, it supports the Government of Lao PDR (GoL) in institution strengthening, coordination, and policy development on sanitation and hygiene. UNICEF advocates behavior change and demand creation through CLTS, and sustained behavior change enabled through the provision of WASH facilities in schools and promotion of daily hygiene practices. The World Health Organization (WHO) supports the national level to revise water quality standards and development of guidelines for Water Safety Plans for water utilities and community water supply. The Asian Development Bank (ADB) supports the government-led Model Healthy Village program, which also includes sanitation interventions. International NGOs24, local NGOs25 and the private sector 26 have long standing engagements in the sector, but generally assistance for WASH tends to be small in scale, and scattered around the country, with limited coordination.

11. In response to the sector and country context, the proposed Scaling-Up Water Supply, Sanitation and Hygiene Project is designed around the following key features, which have been derived from lessons learnt from the portfolios from the Water and other Global Practices in the World Bank Group, and from extensive analytical sector work:

a) Integrated Project Cycle for WASH. The project will adopt a single community-driven approach that integrates water supply, sanitation, and hygiene and nutrition-sensitive behavior change. The project cycle consists of seven distinct steps: Promotion, Planning, Design, Sanitation, Construction, Post-Works and Sustainability, as detailed in Annex 2. The project cycle establishes a delivery mechanism that includes infrastructure service delivery and

20 SNV/ Enhancing Nutrition of Upland Farming Families (ENUFF); (March 2018); An assessment of Gravity Fed Water Supply Systems (GFWS) on 40 target villages across Oudomxay and Huaphanh Provinces Lao PDR, Assessment report by Thinley Dorji, WASH consultant 21 World Bank 2017 Sustainability Assessment of Rural Water Service Delivery Models Findings of a Multi-Country Review 22 WSP Report on ‘Rural Sanitation Sector Capacity Needs Assessment, Capacity Building Strategy and Plan’, Lao PDR, 2014 23 CLTS is an approach of facilitating a process of inspiring and empowering the local communities to analyze their own sanitation situation including the extent of open defecation, spread of fecal-oral contaminations that affects all people in the community and initiating collective community action to stop open defecation. CLTS approach ignites a sense of disgust and shame amongst the communities who collectively realize the impact of open defecation. If facilitated properly, CLTS triggers community led local action towards stopping open defecation and the establishment of social norms related the consistent use of latrines by all community members. 24 SNV, Plan Lao, Care, Health Poverty Action, PSI, ADRA, Oxfam and World Vision 25 Lao Red Cross, Development and Environment Association, Lao Biodiversity Association and other local NGOs 26 Nam Theun hydropower operator: the company also carried out community water supply and sanitation projects as part of its social corporate responsibility in Kham Mouan province.


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behavior change at the community and household level, including health and nutrition awareness targeted to caregivers of small children. At each step, the project cycle’s integrated approach ensures that a comprehensive set of ‘hard’ (infrastructure) and ‘soft’ (behavioral change and communication) interventions are carried out at the village and household levels, and beneficiary engagement takes place in a structured and phased manner that leads to iterative and consistent reinforcement. The active participation of communities, combined with a structured capacity building process, results in greater ownership and capacity to carry out adequate O&M and thereby improving service sustainability. The project cycle, once established, has the potential to be scaled up sector-wide, and develop into the basis for GoL’s programmatic delivery mechanism for WASH services. It encompasses the service delivery needs of remote villages, larger villages, kumban (village clusters) and emerging towns through a common paradigm.

b) Multi-sectoral Approach to Reduce Child Stunting: To capitalize on opportunities to advance the nutrition agenda within the existing World Bank portfolio and align them with the GoL’s objective to reduce the national prevalence of stunting to 25 percent by 2025, five operations have been identified as nutrition-sensitive, and are considered crucial to maximize the reduction in stunting prevalence. These are the ongoing Health Governance and Nutrition Development Project (HGNDP) (P151425), the Poverty Reduction Fund III (P157963) and additional financing (P168620), Early Childhood Education Project (P145544), Reducing Rural Poverty and Malnutrition Project (P162565), Health and Nutrition Services Access Project (HANSA) (P166165), and this Scaling-Up Water Supply, Sanitation and Hygiene Project (P164901). These projects are each designed to deliver nutrition-specific and nutrition sensitive interventions that are known to impact the underlying, basic, and immediate causes of malnutrition, which together lead to a reduction in child stunting, as shown in Annex 1.

c) Geographic convergence: A key principle of the multi-sectoral approach to reduce stunting is geographic convergence, whereby each of these projects will be implemented in the same geographic area, targeting the same beneficiary households27 in villages across twelve districts of four provinces of Xiengkhuang, Huaphanh, Oudomxay, and Phongsaly (Annex 1). These four provinces all combine high stunting with high poverty rates, and the selected districts have been identified by the Government as priority districts for reducing poverty and malnutrition. This geographic convergence enables the use of common delivery platforms where feasible, for example pre-established committees and community structures, for more harmonized and cost-effective service delivery.

d) Use of a common and focused Social and Behavior Change Communications (SBCC) strategy, action plan and platforms. Establishing new social norms and practices to achieve sustained hygiene behavior change is a pre-condition to attain long-term health outcomes. SBCC is targeted to the community and beneficiary households, and individual level, and addresses hygiene and nutrition behaviors and practices that are known to be important for child health and nutrition. The overall strategy relies on the reinforcement of common messages across the projects, using common delivery platforms, supplemented by project-specific messages delivered through project-specific channels (Annex 6). This is to ensure that the SBCC activities, messages and tools are complementary to one another. Where possible, Information and Communication Technologies (ICT) will be used to make delivery of messages more effective and efficient.

e) Institutional capacity development. The establishment and institutionalization of the project cycle, and human capacity building at national and sub-national levels of government and of local communities, provides a vehicle for sustainable WASH service delivery and scale up. As the country moves towards increased piped water coverage in rural areas, the professionalization of both communities and private sector as services providers becomes key

27 The project targets entire villages for improved water supply and sanitation interventions and nutrition-sensitive SBCC will be delivered to households with pregnant women and children under two. While the Health and Nutrition Services Access Project and Reducing Rural Poverty and Malnutrition project cover all 881 convergence villages in the twelve districts, the WASH project will cover about 450.


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to ensuring availability of sanitation products, and timely and adequate O&M for sustained water supply services. Institutional mechanisms for sustainability developed through the project in Provincial Nam Papa (PNPs) (the provincial water utility) and National Center for Environmental Health and Water Supply (Nam Saat) can provide district-wide support, beyond project villages. Institutional and human capacity will be strengthened, particularly at the district level, with a focus on technical and behavioral change skills to support Village Development Committees (VDCs). At the community level, basic O&M of water supply systems and CLTS will be embedded in a more holistic approach that includes awareness raising, monitoring and follow-up.

f) Common results chain and monitoring and evaluation framework. An effective approach to monitoring project inputs and outputs requires a robust monitoring system. To facilitate monitoring of those nutrition outcomes that cannot be attributed to a particular project or intervention, the sector monitoring system will be harmonized with the District Health Information System (DHIS). Each project supporting the convergence approach will develop a results framework that specifies the results that the project is accountable for, and which contributes to an overarching common results chain that leads to reductions in child stunting (Annex 1). A common Monitoring and Evaluation (M&E) Framework (Annex 7) will guide the M&E activities across the convergence projects and areas, and pooled resources will be used to finance nutrition-related M&E activities, such as impact evaluation. The M&E framework will be used to report on progress and to facilitate learning and adaptive management.

12. Maximizing Finance for Development (MFD). Public-Private Partnership and self-supply models will be used to reduce the operational burden on over-stretched PNPs and Nam Saat, extend small-scale services in remote areas, conduct O&M and support functions to VDCs. The development of local entrepreneurs for sanitation and water supply, and the professionalization of VDCs, decentralizes service delivery. This reduces the cost to government agencies, which shift towards more monitoring and oversight functions. Institutional strengthening of the implementing agencies will include capacity development to manage contracts effectively. The MIREP Program (Program for Small Scale Water Supply Systems), launched in 2004, and implemented by GRET, a French international NGO, provides urban water supply in small towns that are not served by PNPs. GRET’s built-operate-transfer model for small town water supply services demonstrates the viability of private sector participation. In privately managed rural systems (28 currently identified in the rural water sector), the private owners set tariffs and connection fees at a level sufficient to recover their investment and operating costs. In urban areas there are six public private partnerships operational in three provinces, mainly for water treatment.28 This will also require stronger tariff policies, predictable laws, access to credit, and perhaps targeted subsidies for the poor.

13. Gender. Women are the primary stakeholders of the project having responsibilities for household cleaning water, food, nutrition, a clean environment, and hygienic living spaces. The gender interventions in this project are directly related to WASH interventions, which can be contextualized within the framework of the broader nutrition convergence appraoch as described in Annexes 1, 6 and 7. The social assessment carried out for the project identified several important gender gaps that will be addressed by the project, which are also in line with the World Bank’s Country Gender Action Plan for FY17-21. While the project activities have some activities to enhance gender equality, including a bursary program for engineering and finance, and empowering women with new knowledge and employable skills, the project intends to follow through narrowing two main gender gaps. The first key gap is limited participation of women in planning and decision-making, especially at the local level. Although the legal framework provides equal rights to men and women, the application of these rights is hindered by customs, traditions and the socio-economic characteristics of different population groups. Women are underrepresented in policy and decision-making in general in Lao PDR. The ratio for female

28 JICA. The Data Collection Survey on Water Supply Sector in Lao PDR. February 2017


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provincial deputy governors and district governors are only 9 percent (4 out of 42) and 7 percent (10 out of 145) respectively.29 This implies potential for uneven representation of women in the Water and Sanitation Committees, a sub-committee under Village Development Committee (VDC), which is important to ensure that women’s voices are heard, and specific needs and concerns are addressed in local development plans, in management, provision, and improvement of water supply and sanitation services. The project will create favorable conditions for women to become members of Water and Sanitation Committees of the VDC, particularly for the positions of President/Secretary or Treasurer. There will be training provided for communities and entrepreneurs, which would equally include both men and women participants (50 percent male and 50 percent female). To ensure women’s participation the training will be delivered in the local language (as most women speak Lao as second language), delivered at times convenient for women, and special efforts will be made to provide technical training for women on masonry, plumbing, minor water system repairs, water meter management and reading, and entrepreneurship on water and sanitation-related activities. Women may be shy in participating in most technical trainings with men, and options for women-only training will be considered. If necessary consultation with women-only will be carried out for identification of the best sanitation technology and design fits their needs. In addition, training in leadership, negotiation, marketing skills, among others, will be provided to encourage women to engage in the community decision-making process. The project will ensure that at least 30 percent of water and sanitation committee members are women (results framework indicator: water and sanitation committees with at least 30% female members).

14. Another important gender gap relates to specific needs of girls and women and menstrual hygiene management. Data disaggregated by gender for enrollment in schools shows that at provincial level, 60-80 percent of girls are enrolled,

while at district level their enrollment drops to 40-50 percent.30 Lao PDR has the highest proportion of early marriage and the highest adolescent birth rates in the region, and one in five adolescent girls drops out of school. Nationally, 66 percent

of schools have no water services.31 About 48 percent of primary schools, and a quarter of health facilities do not have access to safe drinking water and sanitation facilities.32,33 The lack of privacy in sanitation facilities disproportionately impacts the ability of adolescent girls and women to manage their menstrual hygiene in public places and causes lower attendance rates at school and work. The average percentage of women or girls in Lao PDR who did not participate in social activities, school or work due to menstruation in the last 12 months in 2017 was 11.8 percent, but it reached 42-48 percent in some provinces.34 The lack of separate toilets in school affects girls’ safety as well. For example, 1 in 4 girls globally say they never feel comfortable using school latrines.35 A large percentage of the girls surveyed on menstrual hygiene management in Lao PDR in 2013 reported feeling uncomfortable and a lack of privacy at school during menstruation, and many believed that it affected their school performance, due to a lack of concentration.36 The Project will ensure that sanitation facilities in schools are functional single-sex toilets with a reliable supply of water and soap (Table 1). To enhance improved sanitation, the project will develop materials on a hygiene and menstrual hygiene management, with a focus on handwashing with soap at critical times, toilet usage, toilet cleanliness, menstrual hygiene and keeping the immediate surroundings clean (results framework indicator: schools with access to improved sanitation and hygiene facilities, as defined in the results framework includes provision for single sex toilets and menstrual health management).

29 IDA, IFC, and MIGA Country Gender Action Plan for Lao PDR for the Period FY2017-2021, February 13, 2017 30 Country Gender Assessment for Lao PDR, June 2018 31 https://data.unicef.org/topic/water-and-sanitation/wash-in-schools/#_ftn3 32 UNICEF EMIS data, 2015 33 WHO/UNICEF WASH FIT, 2017 34 Lao Social Indicator Survey II, 2017 35 World Bank 2017. Gender in Water. Brief for task teams. 36 http://www.snv.org/update/snv-presents-menstrual-hygiene-research-civil-society-alliance

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15. Citizen engagement through a grievance redressal mechanism: A single mechanism, ideally facilitated by ICT tools, will be developed for the project to receive, acknowledge, respond and resolve grievances, inquiries and demands. It will include: a typology of grievances or inquiries received, time for resolution depending on the type, and a mechanism for collecting, recording, communication to the relevant department, response, and appeals process, with specific roles and responsibilities at each level. The grievance mechanism will be accessible at project sites, and at the District and Provincial Offices of the Department of Water Supply (DWS), Department of Public Works and Transport (DPWT), PNP and Nam Saat. Reporting on the grievance mechanism will be part of the standard progress report of the PMU. Regardless of point of entry of the grievances, all will be collected in a central database to register each one, track the time to resolve the grievance and maintain an on-going list of those grievances unresolved for further follow-up.

C. Relevance to Higher Level Objectives

16. The World Bank Group’s Country Partnership Framework (FY 17-21) (CPF; Report No. 110813-LA) recognizes the importance of chronic malnutrition in children. The Bank’s Multi-Sector Nutrition Engagement Framework for Lao PDR spans multiple sectors, including agriculture, social protection, health, WASH and education. Under Objective 2.1 of the CPF, ‘Reducing the prevalence of malnutrition,’ the Bank proposes to increase access to improved water supply and sanitation services. The project contributes to the World Bank Group’s twin goals by targeting inequalities in water supply and sanitation access and supporting nutrition-sensitive interventions in communities where high stunting and poverty levels coincide. The project also intends to address the climate change vulnerabilities identified through activities that will contribute to adaptation and mitigation measures, by increasing the water supply and making it more adaptive; and ensuring that water supply and sanitation facilities will be built to withstand the growing frequency and intensity of floods and droughts in the four provinces targeted by the project. This project is a key element of the World Bank portfolio to support the multi-sector convergence, as described in Section B. This project is conceived as the start of a long-term commitment under the convergence approach, with potential for additional financing to ensure coverage to all targeted villages.

17. The project aligns with the World Bank’s Human Capital Project, which helps countries to prioritize more and better investments in people for greater equity and growth. Human capital is central to the World Bank Group’s efforts to end extreme poverty by 2030 and raise the incomes of the bottom 40 percent of people in each country. Development interventions are falling far short of what is needed for people and economies to survive and thrive in a rapidly changing world. Lao PDR scores 45 out of 100 on the Human Capital Index (HCI) and is ranked 111 out of 157 countries.37 Using this measure, a child born in Lao PDR today is predicted to be 45 percent as productive when she grows up as she could be if she enjoyed complete education and full health. Early childhood survival and stunting are two of the key indicators that make up the HCI score and are positively impacted through improved WASH services.

18. The project will be consistent with the Country Gender Action Plan for FY2017 –2138, which includes four main priority areas to be addressed: (i) early marriage, adolescent pregnancy and high maternal mortality rate; (ii) low literacy and skills gap among women; (iii) equal opportunities for men and women to participate in livelihood activities and wage jobs; and (iv) participation of women in planning and decision making at the local level. The Gender Action Plan is of particular relevance to the WASH sector, and the gender-specific features of the project are described in Section B above

37 World Bank 2018 http://databank.worldbank.org/data/download/hci/HCI_2pager_LAO.pdf 38 Country Gender Action Plan for Lao Peoples Democratic Republic for the period FY2017 – FY2021. February 13, 2017. South East Asia Country Management Unit East Asia and Pacific Region and The International Finance Corporation East Asia and Pacific Region and The Multilateral Investment Guarantee Agency.


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and Annex 2.

19. The project is well aligned with the National Nutrition Strategy (2016 – 2035) and Plan of Action (2016 – 2020), and the NGPES and the NSEDP. The national nutrition strategy establishes a multi-sectoral convergent approach and emphasizes priority areas where interventions to reduce stunting should be directed. These priority areas, amongst others, include improved access to safe water supply and sanitation services. The NGPES identifies water supply and sanitation as one of the four national priority areas. It also recognizes that poverty reduction must be tailored to ethnic people’s specific needs and capabilities, and address gender issues among various ethnic groups.

II. PROJECT DESCRIPTION

A. Project Development Objective

20. The objectives of the project are to provide access to improved water supply, sanitation and hygiene services in selected areas identified for nutrition convergence, and strengthen capacity of select institutions to improve service delivery.

21. Geographic areas are selected for nutrition convergence based on high levels of childhood stunting prevalence and poverty (Annex 1). Nutrition convergence areas are the selected provinces, districts and villages where there are ongoing operations supported by the World Bank as described in Paragraph 11 (b). In these areas interventions will be targeted to the same villages and the same beneficiary households. While the planned Health and Nutrition Services Access Project (HANSA; P166165) and Reducing Rural Poverty and Malnutrition project (P162565) cover all 881 villages in the twelve districts, this project will cover about 450 villages. Strengthening of sector institutions will be done at community, district and provincial levels. At community level, the community water supply and sanitation committees will be formed under the village development committee to manage and operate the water supply systems. Capacity building will be provided for O&M of water supply systems and to monitor ODF. At district and provincial levels, sustainability units will be formed in Nam Saat and PNPs to provide support to the VDCs to operate and maintain water supply and sanitation facilities.

PDO Level Indicators

PDO indicators are as follows:

i. People provided with access to improved water sources (number) ii. People provided with access to improved sanitation services (number)

iii. Target population practicing handwashing with soap after using the latrine (percentage)39 iv. Water supply systems that meet project service levels (percentage)40 v. Villages where at least three nutrition convergence projects have been implemented (percentage)

39 Handwashing with soap will be measured using the ‘sticker diary’ method. The sticker diary is a survey methodology developed by Unilever and London School of Hygiene and Tropical Medicine where respondents are given a set of pictorial representations of common daily activities and are asked to create a “diary” of daily behaviors using a set of pictorial representations of common daily activities under the guidance of the enumerator. The method has been applied in India and Vietnam and has shown to reduce over-reporting of handwashing behaviors, while being less costly than traditional “observation” methods. 40 The following service levels will be met: (i) Accessibility: located on premises, or from an improved source provided collection time is not more than 30 minutes for a roundtrip including queuing, (ii) Quantity: Minimum of 50 lpcd; (iii) Availability: Available when needed; (iv) Quality: compliant with fecal and priority chemical standards


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22. Childhood stunting, underweight, wasting and other indicators of child nutritional status will be monitored through project specific surveys (for example the HGNDP supported Knowledge, Attitudes and Practices (KAP) survey) and relevant national surveys (for example the Lao Social Indicator Survey (LSIS)) as part of the common results chain (Annex 1) and M&E framework (Annex 7). The country portfolio results chain illustrates how project specific activities contribute to key outcomes and sector specific results to meet the country program goal of reduced stunting prevalence in children under 2 years of age in targeted regions by 20 percent. Tracking these indicators will also contribute to the body of evidence on the effectiveness of the multi-sectoral convergence approach and how this could be enhanced and improved in priority districts.

B. Project Components

Component 1: Delivery of Infrastructure and Sustainability of Water Supply and Sanitation (IDA US$ 21.1 million, GoL US$ 0.9 million)

23. The objective of this component is to deliver infrastructure using the integrated WASH cycle in all project villages and associated schools and health centers, in coordination with MOH, and to strengthen DWS, DPWT, PNPs, to assure the ongoing sustainability of water supply and sanitation interventions.

Component 1(a) Implementation of integrated WASH project cycle

24. The project will be implemented through a community driven development approach, using a project cycle that integrates water supply, sanitation, hygiene and nutrition behavior change. The project cycle will cover villages and their associated schools and health centers. The project will adopt a demand responsive approach, where communities will agree upfront to participate meaningfully in: (a) the informed selection of the optimal technical water system option; (b) to contribute a minimum of 10 percent of the capital cost in cash or in-kind (unskilled labor or materials) for community based systems and pay a connection fee for larger villages/kumban/emerging towns; (c) to install and maintain a water meter; (d) to pay for ongoing water services; (e) to participate in the VDC sub-committee for water and sanitation and carry out O&M for community based systems; (f) to participate in a meaningful manner in training and capacity building programs; (g) to support the organization and execution of SBCC and CLTS, and commit to a sustained ODF community; and (h) to construct improved and sustainable latrines.

25. The project cycle is the primary delivery mechanism for WASH services in the project. There are two types of water supply systems: (i) community-based systems, managed by the communities themselves and supported by a sustainability unit within Nam Saat; and (ii) larger villages/kumban/emerging towns managed by PNPs. Regardless of the type of water supply system, implementation of the project will take place systematically through the integrated project cycle, which will be implemented through the PMU, and in close coordination with both implementing agencies in MOH and MPWT, leading to enhanced sector coordination. It integrates water supply, sanitation, hygiene and nutrition sensitive behavior change interventions that will be implemented in all project villages, schools and health centers. The integrated project cycle is detailed in Annex 2. The expected outcome of the integrated project cycle at the village level is the provision of improved water supply, sanitation, and hygiene services through the participatory planning of water supply infrastructure, establishment of a trained VDC in the village to conduct ongoing O&M, building of toilets and handwashing stations by beneficiaries, improved hygiene and child-centric behaviors, and water supply and sanitation facilities in schools and health centers.

Component 1 (b) Water supply and sanitation infrastructure


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26. Water Supply infrastructure. Water sources will be surface water or ground water sources in some areas, and in some cases one source may be developed to supply multiple villages. Most systems will be gravity fed. The system will include intake works, water treatment, storage tanks, water transmission and distribution systems. The project will not finance internal plumbing in households. Water supply systems may be augmented with rainwater harvesting structures as needed. The minimum service levels are shown in Table 1. The project will finance works, either construction of new water supply systems or rehabilitation of existing systems.41 The project will finance water supply systems up to the ceiling specified in the Project Operations Manual (POM). Procurement and construction of all water supply systems and infrastructure including procurement of materials for latrines will be done by MPWT. Investment in water supply infrastructure will increase resilience to droughts. Increased reliability of infrastructure is ensured by introducing tariffs to at least cover O&M costs. Annex 2 further describes water resources and climate change features incorporated in the project cycle financed under Component 1(a).

27. Institutional water supply and sanitation infrastructure: The project will finance the costs for implementation of the physical WASH facilities in schools and health centers. The project will support the construction of toilets in schools and health centers in the project area and will coordinate with MoES to ensure proper maintenance of facilities in schools. School toilets will consist of separate facilities for students: males (1 urinal and 1 toilet for 70 boys) and females (1 toilet per 35 to 40 girls and features to support menstrual hygiene management42), and separate facilities for teachers. Running water will be made available in the toilet, together with handwashing facilities with soap. The O&M will be the responsibility of the recipient Health Center or School, and backstopping support will be provided by the PNP or Nam Saat.

Table 1 Minimum Project service levels for communities, health centers and schools

Water Supply Sanitation Hygiene

Co

mm

un

ity

The project will supply drinking water (that is, water used for drinking, cooking, food preparation and personal hygiene):

a. Accessibility: located on premises, or from an improved source43 provided collection time is not more than 30 minutes for a roundtrip including queuing.

b. Quantity: Minimum of 50 lpcd44 c. Availability: Available when needed d. Quality: compliant with fecal and

priority chemical standards

The project will provide an improved sanitation facility45 where excreta are safely contained and disposed in situ.

The presence of a device to contain, transport or regulate the flow of water to facilitate handwashing with soap and water available.

41 The construction of a centralized water system (especially in areas where there was none before) mitigates drought risk. Connection fees raise money for O&M, making the water supply systems more reliable and enhancing communities’ resilience to climate change by reducing the risk of the system malfunctioning. 42 Provision of soap and water, and facilities in the toilet to dispose of used menstrual management materials, and incinerator. 43Following the JMP definition, an improved source includes piped water, boreholes or tubewells, protected dug wells, protected springs, and rainwater. Bottled water and tanker truck water can will be considered improved if they meet all the criteria described below. 44 WHO (2003) Domestic Water Quantity, Service, Level and Health http://www.who.int/water_sanitation_health/diseases/WSH0302.pdf 45Improved sanitation facilities include flush or pour/flush toilets connected to sewers or septic tanks; protected latrines such as VIP latrines or latrines with slabs; and composting toilets. Unimproved facilities include pit latrines without a slab or platform, hanging latrines and bucket latrines.


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Water Supply Sanitation Hygiene

Hea

lth

Cen

ter46

Water from an improved source is available on-premises 24 hours per day

Health care facilities with improved latrines or toilets which are usable47 and conveniently located

a. separated for patients and staff, separated for women including menstrual hygiene facilities, and b. easily accessible and usable for people with limited mobility.

Hand wash station with soap at all toilets.

Sch

oo

ls48

Drinking water from an improved source is available at the school

Schools with improved sanitation facilities which are single-sex, accessible and usable49. Toilets for girls should have facilities for menstrual hygiene management.

Handwashing facilities, which have water and soap available

Component 1 (c) Institutional strengthening of DWS, DPWT, PNPs for Sustainability

28. The project will support the establishment of support units within the DWS, DPWT, PNPs at the national and sub-national levels, to enable them to fulfil their roles for water supply planning, asset management, operation and maintenance, community engagement and monitoring. Human resources and training plans will be developed. These will include development of the institutional capacity of the units, teams and related personnel involved in the implementation of the project, those responsible for the ongoing sustainability of sub-projects, and will include the development and revision of guidelines and manuals, and training materials to ensure compliance with the relevant rules and procedures, and integration post-construction management into existing PNP functions. To support the implementation of the project cycle and facilitate on-the-job-training, DWS will allocate at least one person dedicated to work with project consultants and facilitate scale up in the later years of implementation. Engineering capacity for water supply and sanitation will be developed, with linkages to the national training center and civil engineering institute, including a bursary program for university education in engineering, accounting and other related degrees for DWS/PNP staff, particularly for women, and for those with clear financial need. Technical assistance activities will include updating the PNP Corporate Plan, which includes the utility financing plans and tariff policy, and updating the PNP Service agreement with the provincial government. Financing will also include administrative offices and provision of equipment for monitoring sources and water treatment plant efficiency. Since training and capacity building for sustainability will lead to more reliable water infrastructure, this component contributes to communities’ resilience to droughts, floods and other climate related events.

Component 2: Sustainability of Community Water Supply, Sanitation and Hygiene Support (IDA US$ 1.5 million)

29. The objective of this component is: (i) to strengthen the institutional capability of Center for Environmental Health and Water Supply (Nam Saat) and DHHP at central and subnational levels (which constitute provincial, district, health center, and community levels) to support the sustainability of the community managed water supply and sanitation

46https://washdata.org/monitoring/health-care-facilities 47The term usable here refers to toilets or latrines that are accessible to patients and staff (doors are unlocked or a key is available at all times), functional (the toilet is not broken, the toilet hole is not blocked, and water is available for flush/pour-flush toilets), and private (there are closable doors that lock from the inside and no large gaps in the structure). 48https://washdata.org/monitoring/schools 49The term ‘usable’ refers to toilets or latrines that are accessible to students (doors are unlocked or a key is available at all times), functional (the toilet is not broken, the toilet hole is not blocked, and water is available for flush/pour-flush toilets), and private (there are closable doors that lock from the inside and no large gaps in the structure).

https://washdata.org/monitoring/schools


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systems; (ii) to establish monitoring and evaluation systems, and (iii) to develop guidelines to support the sustainability and scaling up of sanitation and hygiene activities.

Component 2(a) Institutional strengthening of Nam Saat and DHHP for Sustainability

30. Support for implementation of integrated WASH delivery. Implementation of the project will take place systematically through the integrated project cycle, which will be implemented through the PMU, and in close coordination with both implementing agencies. The integrated project cycle is detailed in Annex 2. DHHP/Nam Saat will provide the following technical inputs to the implementation of the project cycle: (i) technical advice during the implementation of integrated WASH project cycle to support the design and implementation of the community-based water supply systems in small villages and the sanitation-related activities; and (ii) water quality testing and surveillance. The implementation and facilitation of the community-level activities requires adequate, well trained, district-level teams. For the sanitation component, in collaboration with provincial and district authorities, the project will develop and institutionalize clear and detailed guidelines for the implementation of CLTS. In addition, teams of two to three local persons from the district town will assist to initiate, facilitate, and monitor the implementation of sanitation related activities. These residents will be selected based on qualifications such as proven ability to work at the grassroots level, communication and language skills and commitment, and will receive extensive CLTS-related training. Nam Saat will support hygiene promotion training and facilitation, facilitate school-based hygiene promotion programs and health education programs. To support the implementation of the project cycle and facilitate on-the-job-training, Nam Saat will allocate at least one dedicated resource per district to work with project consultants and facilitate scale up in the later years of implementation.

31. Institutional strengthening for sustainability of community water supply. Human resources and capacity development plans will be developed for the national, provincial and sub-national levels to establish the sustainability units. Training and the institutional capacity strengthening of the units, teams and related personnel involved in the implementation of the project will be supported. These capacity development efforts will include, but not be limited to, training materials and on-the-job training on water supply, sanitation, and hygiene development, O&M functions, community engagement and other topics relevant to the project. All monitoring systems will be GIS and ICT enabled where possible. The CMU will develop GIS and knowledge management capability to support all monitoring and reporting activities.

Component 2(b) Monitoring systems

32. Water quality monitoring and surveillance: Monitoring of the flow and the water quality will also be key tools to recognize changes in water quality and flow and to take timely remedial actions. Water quality monitoring and surveillance tasks will be allocated to all levels from central to sub-national levels. The project will support appropriate monitoring instruments at the provincial and sub-national levels and a central laboratory at the national level. Training will be provided on the appropriate use and maintenance of monitoring equipment. The monitoring system will include the storage and processing of the data for decision making, reporting and quality control and assurance measures.

33. Sector monitoring: Development of a comprehensive national sector-wide WASH monitoring system that will facilitate SDG monitoring. The system will include data collection, quality assurance and quality control, data analysis, reporting and use. The institutional structure for monitoring will incorporate incentives combined with clear accountability mechanisms at central and sub-national levels. The structure will be harmonized with the health and nutrition monitoring to enable cross-tabulation of access to WASH services and select health and nutrition outcomes. The monitoring system will be used to facilitate scale up of learning and good practices across implementing agencies


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and communities, and be used to track sustainability of interventions. Annual reports on sector performance will be published.

Component 2(c) Strengthening Sanitation and Hygiene Promotion

34. Advocacy activities will include gender sensitive hygiene promotion and behavior change communication interventions that equally target and assign responsibility to men, boys, women, and girls, through existing health delivery systems and school curriculums, as well as nationwide campaigns to improve individual behavior and household practices aimed at reducing child fecal-oral exposures. It will include management of fecal waste and wastewater management, elimination of open defecation, household-level drinking water treatment and safe storage practices, and handwashing with water and soap after defecation and handling of food. Communications products like the project website and media campaigns will be developed. The strategic and evidence-based communication campaign, supported by national and provincial champions, will be implemented at the national, provincial and district, and community levels with the purpose to frame sanitation and hygiene in a positive and aspirational manner.

35. Development of regulations, standard operating procedures, and manuals. For remote rural populations, the project will support the development of guidelines for: (i) self-supply options through individual or shared water points and accredited self-supply solutions, (ii) communication campaigns for household drinking water treatment, handling and storage, rainwater harvesting, and water quality monitoring; (iii) national guidelines for water quality monitoring and the development of a training curriculum to support the implementation of a water quality monitoring system; (iv) sanitation and SBCC; (v) strengthening of sanitation supply chains, (vi) development of WASH curriculum for schools and universities; (vii) the development and testing of a hygiene curriculum, and menstrual health management for schools.

Component 2(d): Component Implementation support

36. The project will finance the establishment of a Component Management Unit in DHHP, which will be supported by consultants for technical assistance, coordination, procurement, and financial management. Coordination activities will include coordination with other projects, Ministries, and other agencies to facilitate the WASH contribution to the national nutrition and child-health agenda.

Component 3: Implementation Support and Sector Development (IDA US$ 2.4 million)

37. The project will finance the establishment of a Project Management Unit (PMU) and Project Implementation Units (PIUs) at the provincial and district level. These will be supported by technical consultants for overall project management; monitoring and evaluation; technical support, financial management, social and environmental safeguards; and other project implementation activities. Monitoring and evaluation activities will include the development of a project management information system, evaluation of the effectiveness of the approach to allow for learning-by-doing and course corrections in the implementation, and the development of GIS capability within DWS. Project level audit and reporting for both components will be consolidated by the PMU and supported through this component.

38. To enable planning for delivery of services to the total number of convergence villages, the project will support the development of a village database that will be used for planning services, including intervention types, costs, prioritization, field surveys and studies on water resources availability. The information will be stored and processed in a GIS. The database will be updated on an ongoing basis as the project is implemented. The project will support the development of medium and long-term sector policies, a sector investment plan and feasibility studies, social and


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environmental safeguard assessment, detailed engineering design for select sub-projects prioritized under the sector investment plan. In addition, technical assistance studies to support sector development will be supported, for example: (i) water resources assessments for source sustainability and to understand climate change effects; (ii) piloting of treatment technologies; (iii) groundwater assessments and groundwater recharge pilots; and (iv) market assessment for enabling microfinance for WASH.

39. Sector coordination mechanisms will be strengthened, including sector coordination events that include government, donors, development partners, and private sector to consolidate and streamline planning and sector oversight, harmonize approaches, review and learn about innovations, and support the convergence approach.

Component 4: Contingency Emergency Response (CERC; US$ 0 million)

40. This component will allow for reallocation of credit proceeds from Components 1, 2, and 3 to provide emergency recovery and reconstruction support following an eligible crisis or emergency at the national or sub-national level. Both implementing agencies DWS and DHHP will be responsible for funds under this component. The CERC would be operationalized through a reallocation from Components 1,2 and 3 to provide emergency recovery and reconstruction support. To ensure that this component operates effectively, an Contingent Emergency Response Manual (CERM) is part of the Project Operations Manual for specific eligible disasters, detailing fiduciary, safeguards, monitoring and reporting, and any other necessary implementation arrangements.

41. Project related Green House Gas emissions analysis. The gross and net emissions of the project are estimated at 7,157 tCO2-eq over the 30-year life of the project, and are exclusive to Component 1. On average, the project generates estimated net emissions of 239 tCO2-eq annually. The project is net emissive largely due to: (i) the use of a zero-emissions baseline scenario for collecting water, such as rainwater collection; (ii) the current lack of data on the brownfield sites to be rehabilitated that could yield potential energy efficiency gains and thus GHG emission reductions; and (iii) the use of grid-connected electricity in those rare situations where neither gravity nor solar power alone are viable. Target villages are mostly in mountainous areas with spring water availability and where gravity fed systems, the potential use of solar pumping, and solar power for treatment will be explored through the water supply investments in Component 1.

C. Project Beneficiaries

42. The project will target about 450 villages and a total population of approximately 192,000, of which about 73 percent are ethnic groups50 and 50 percent are women.51 It is expected to benefit about 30,144 children under the age of 5 years. The project will cover about 55% of the total beneficiaries targeted under the nutrition convergence approach. The common monitoring and evaluation framework (Annex 7) will allow for the evaluation of development outcomes on targeted beneficiaries.

D. Results Chain

43. The theory of change of the project translates into the results chain shown below. The outcome of the project, to increase sustained access to water supply, sanitation and hygiene behavior change, contribute to the overall GoL’s and World Bank’s nutrition convergence approach to reduce stunting. The overall results chain of the proposed multi-sectoral nutrition convergence approach is shown in Annex 1 and the overall monitoring and evaluation approach for the World

50 Ethnic Minority Groups 2014 based on the EMG percentage of EMG Survey Countrywide reported in 2005 51 Sex ratio in Lao PDR is 0.99 males per 1 female


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Bank portfolio on nutrition is described in Annex 7.

Table 2 Project Results Chain

Component Activities Outputs Project Outcomes Impacts

Component 1: Delivery of infrastructure and sustainability of water supply and sanitation

Component 1(a) Implementation of integrated WASH project cycle

• Community mobilization and training;

• Design of water supply systems

• Triggering of households to build toilets

• Design, production and delivery of SBCC

• Training to water and sanitation entrepreneurs

Component 1 (b) Water supply and sanitation infrastructure

• Construction and rehabilitation of community water supply systems

• Construction of toilets and handwashing stations for schools and health centers

Component 1 (c) Institutional strengthening of DWS, DPWT, PNPs for Sustainability

• Training

• Technical assistance for updating corporate plan and service agreements

• Administrative and monitoring facilities

• New water supply systems

• Rehabilitation of water supply systems

• Water facilities constructed / upgraded in schools and health centers

• Improved performance of existing systems

• Toilets and handwashing stations constructed in homes schools and health centers

• Communication campaigns developed and implemented

• Nutrition SBCC implemented in target villages

• Sanitation supply chains strengthened

• VDCs trained for O&M

• VDC’s water and sanitation committees formed and include women members

• Support units within PNPs established

• Corporate plans and service agreements updated.

• Access to improved water supply

• Access to improved sanitation

• Improved handwashing behaviors

• Increased proportion of households with functioning toilets and handwashing stations

• Increased proportion of households practicing safe disposal of child and animal feces

• Water supply systems are operated and maintained

• Improved health of beneficiaries

• Interrupted fecal-oral routes of transmission for infants and young children aged 0 – 24 months

• Reduction in proportion of infants and young children aged 0 – 24 months suffering from diarrhea and other water-borne disease


Component 2(a) Institutional strengthening of Nam Saat and DHHP for Sustainability

• Training for operating and maintaining community water supply and sanitation/CLTS

• Orientation and training of provincial and district staff, and local residents

• Human resources and capacity development plans

Component 2(b) Monitoring systems

• Water quality monitoring and surveillance system

• Sustainability unit in Nam Saat established

• Sector-wide monitoring system developed

• Publication of annual reports on sector performance

• Guidelines developed

• District sanitation plans

• Advocacy and behavior change communication campaigns implemented

• Regulations, standard operating procedures, and manuals developed

• Communities receive regular support from Nam Saat

• Increased use of sector-wide monitoring system

• Increased awareness of water supply, sanitation, hygiene, menstrual hygiene and nutrition issues

• Capacity for implementing CLTS and sanitation / hygiene behavior change strengthened


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Component Activities Outputs Project Outcomes Impacts

• Sector monitoring system

• Monitoring instruments

• Training on the use and maintenance of monitoring equipment

Component 2(c) Strengthening Sanitation and Hygiene Promotion

• Communications and advocacy campaigns

• Guidelines for self-supply for remote villages

• Guidelines for sanitation and SBCC

• Development of regulations, standard operating procedures, and manuals

Component 2(d): Component Implementation support

• Coordination for WASH and nutrition convergence

• Timely implementation of component

• Improved sector coordination

Component 3: Implementation support and Sector Development

• Technical and management project implementation support

• Technical assistance studies

• Training

• Coordination

• National management consultants and technical management consultants hired to support project implementation

• Coordination meetings held between government, donors, development partners, and private sector

• Increased capacity of PMU

• Timely implementation of project

• Improved sector coordination

E. Rationale for Bank Involvement and Role of Partners

44. To address high rates of stunting, the World Bank is able to take a coordinated multi-sector convergence approach. The Bank is uniquely placed to support a coordinated engagement with the government across multiple sectors through its existing and planned portfolio of projects. Though GoL policy places a high priority on water supply and sanitation, currently there is minimal public financing available for WASH in rural areas. UNICEF plays an important role in sector policy and capacity, though financing for infrastructure is limited both within government and among development partners. The Asian Development Bank (ADB) is a leading development partner in the sector and has supported several water supply and sanitation projects mainly focusing on small towns and peri-urban areas, such as the Northern and Central Region Water Supply and Sanitation and Small-Town Water Supply and Sanitation projects. The Japan International Cooperation Agency (JICA) is also a leading bilateral partner supporting projects in urban water supply and sanitation and two Technical Cooperation projects related to capacity building for water treatment and expansion of supply, and urban water environment improvement. Kreditanstalt für Wiederaufbau (KfW), with a grant from the European Union (EU), is supporting the implementation of water supply and sanitation in four provinces (Savannakhet, Kham Mouan, Saravan and Attapeu).


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F. Lessons Learned and Reflected in the Project Design

45. Traditional WASH interventions may bypass some of the dominant fecal contamination pathways that affect small children. An emerging approach known as “baby WASH” or “child-centered WASH” focuses on interrupting exposure pathways that are most strongly associated with subsequent diarrheal disease. This includes ensuring the cleanliness of a child’s play environment and play objects by practicing safe disposal of child and animal feces, separation of livestock and domestic animals from the main housing compound, washing infant and child’s hands with soap before eating and breastfeeding, using only clean or treated drinking water for preparation of liquid and solid foods for infants and young children, and use of child cups, not bottles as they can harbor bacteria. This concept is integrated into the SBCC approach implemented through the project cycle.

46. Reductions in stunting are more likely to materialize when the multiple contributing factors are adequately addressed for a child. Evidence from the WASH Poverty Diagnostic52 shows that children who have simultaneous access to adequate levels of two or more of the underlying determinants of nutritional status— food security, access to health care, child care practices, and access to safe water and sanitation are less likely to be stunted than children who have access to just one. A convergence approach taken by the Bank, of which this project is a key pillar, is now advocated as the best way to ensure that high-quality interventions are jointly targeted to selected geographic areas and to the most vulnerable populations.

47. Both Public utility provision and community management for rural water supply are favorable conditions for sustainability. 53. Both these models are adopted in the project – utility provision for larger villages/kumban/emerging towns managed by PNPs, and community management for community-based systems. Even though there are few countries in the world where a public utility operates rural water supply and sanitation systems, this model is found to score best for sustainability. Public utilities tend to show professional management of water assets, are staffed with more qualified personnel, have better financial capacity and access to funding, and are subject to monitoring and regulation. Community management as a service delivery model was also found to score well on sustainability, particularly for institutional capacity and financing, in cases where there is technical backstopping and structural support for operations and maintenance, financial support on major repairs, and access to administrative and institutional assistance and training opportunities. World Bank projects have been successful in using a community-based model for improving rural sustainable WASH access.54 These achievements contributed to reducing disparities between rural and urban areas with a combination of investments, capacity building, and knowledge transfers.

48. The construction of a toilet does not guarantee use, and behavior change is essential. The creation of the demand through a focused and long-term behavioral change communication campaign using multiple channels for different target groups, as adopted in the project, is essential to ensure the sustained use and maintenance of toilets. When construction of toilets is not accompanied by proper communication of benefits of toilet-use and proper sanitation management, people slip back to open defecation. In India, consumer research studies such as in Rajasthan have been the basis for highly effective communication campaigns. The creation of demand needs to be driven through institutional capacity of state agencies and needs to be matched by private sector capacity to supply quality and affordable latrines.

52 http://www.worldbank.org/en/topic/water/publication/wash-poverty-diagnostic

53 World Bank 2017 Sustainability Assessment of Rural Water Service Delivery Models Findings of a Multi-Country Review

54Community driven water supply projects achieved moderately satisfactory or better results in 78 percent of 45 completed and rated projects. IEG 2017 A Thirst for Change the World Bank Group’s Support for Water Supply and Sanitation, with Focus on the Poor An Independent Evaluation

http://www.worldbank.org/en/topic/water/publication/wash-poverty-diagnostic


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Well-targeted incentives can be effective in reaching poor people and thus provide access for all. The project will finance incentives for poor and vulnerable households, including additional incentives to address the needs of differently abled people. Country experience from Bangladesh, Thailand, Vietnam and Malaysia find that well-designed, affordable and sustainable incentive programs do help the bottom quintiles gain access to improved sanitation.55

III. IMPLEMENTATION ARRANGEMENTS

A. Institutional and Implementation Arrangements

49. The project will be implemented through MPWT and MOH. Components 1, 3 and 4 will be implemented by MPWT and Components 2 and 4 by MOH. MPWT will be the lead project implementing agency, with a Project Management Unit (PMU) in the Department of Water Supply and Project Implementation Units at the district level. A Component Management Unit (CMU) will be established in Department of Hygiene and Health Promotion (with technical support being provided through Nam Saat) under the MOH.

50. National Level. An overall Project Steering Committee (PSC) will be established with representation from MPWT,

MOH, Ministry of Education and Sport (MOES), Ministry of Natural Resource and Environment (MoNRE), Ministry of

Planning and Investment (MPI), Ministry of Agriculture and Forestry (MAF), Ministry of Finance (MoF) and the Provincial

Vice Governors of the project provinces. A Memorandum of Understanding (MoU) between MPWT, MOH, MOES and the

four Provincial Governors will ensure clear division of roles and responsibilities at the central and sub-national levels, and

accountability for project results. A working group consisting of DWS and DHHP will be established at the national level to

ensure coordination between Component 1 and Component 2 activities and to ensure that the project is implemented

effectively and on time.

51. Provincial Level. A Provincial Project Coordinating Committee will be established, chaired by representatives from

the Provincial Governor’s Office, and including provincial representatives from Provincial DPWT, PNP, Provincial Health

Office, Nam Saat, Education and Sports Office, Women’s Union, Lao Front and Youth Union (at provincial level).

52. District Level. The district steering committee, chaired by representatives from the District Governor’s office, and

including District Office of Public Works and Transport (OPWT), District Health office and Nam Saat, Education and Sports

Office, Women’s Union, Lao Front and Youth Union (at the district level). The steering committee will be responsible for

coordination with other convergence projects working in the district. The Project Implementing Unit (PIU) is the

implementing arm of the PMU at the district level. The PIU will be responsible for the implementation of the project cycle

at the village level and deploy and supervise the resource agencies that will be responsible for village level activities.

53. Village Level. A sub-committee under the VDC will be established for WASH. This sub-committee will be

responsible for mobilization of the community in the project and will support the implementation of the project cycle. For

community-based systems, it will be responsible for tariff collection, ongoing O&M, and will operate under its own

separate bank account.

55 World Bank, 2012. What does it take to scale up rural sanitation? WSP Working Paper. July.


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B. Results Monitoring and Evaluation Arrangements

54. The project-level monitoring and reporting will be conducted by the PMU supported through Component 3 of the project. The project-level management information system will track implementation progress, project outputs and outcomes. It will be used to report on progress and to facilitate learning and adaptive management through the implementation of the project cycle. The PMU will prepare semi-annual progress reports which will also include complete information on procurement, contracts, disbursements, financial management, beneficiaries and other outputs. Annual independent audit reports are expected to monitor use of funds and physical progress. In addition, a sector-wide monitoring system will be developed to support SDG monitoring. To facilitate monitoring of select nutrition outcomes that cannot be attributed to a particular project or intervention, the sector monitoring system will be harmonized with the District Heath Information System (DHIS). Each project supporting the convergence approach will develop a results framework that specifies the results that the project is accountable for, and which contribute to a common results chain leading to reductions in child stunting (Annex 1). A common Monitoring and Evaluation (M&E) Framework (Annex 7) will guide the M&E activities across the convergence projects and areas, and pooled resources will be used to finance nutrition-related M&E activities, such as impact evaluation.

C. Sustainability

55. Sustainability of water supply interventions requires that the technical quality of the systems is adequate, that communities can operate and maintain them in a financially sustainable way, that beneficiaries make use of these systems and adopt sound hygiene practices, and that support structures exist to ensure technical assistance and supervision of these systems beyond the project’s lifetime. To ensure this, the project will apply the following key elements: (i) the demand-responsive approach requires the community to make an informed choice from a menu of financially and technically feasible options; (ii) communities contribute in cash and in-kind to construction costs; (iii) extensive training and assistance in operation and maintenance; (iv) SBCC interventions to promote community-wide hygiene behavior change; and (v) institutional strengthening of PNPs and Nam Saat to ensure long-term support to communities. Sustaining the ODF-status of communities and hygiene behavior requires a well-designed implementation cycle that ensures that new social norms are strengthened starting with the creation of aspirational, enabling, assets and sustained, long-term behavioral change communication. In addition, the project will follow a three-pronged approach to promote and ensure sustainable ODF communities and hygiene behavior: (i) strengthening of sanitation supply chains; (ii) implementing and institutionalizing community self-monitoring; and, (iii) monitoring by district-level authorities. In addition, the project will support the safe management of fecal sludge by introducing the twin-pit toilet technology.

IV. PROJECT APPRAISAL SUMMARY

A. Technical, Economic and Financial Analysis

Technical

56. The project will adopt technologies and methodologies of proven effectiveness in attaining project objectives. Through a facilitation process of informed choice, communities are enabled to choose systems that are appropriate, technically sound and affordable operationally. With sanitation, the project will use a CLTS-based approach, which is used globally as an effective method to extend toilet use and it has been implemented successfully in Lao PDR. For both water supply and sanitation, communities will be provided with locally appropriate catalogues of technical options and associated costs, advantages and disadvantages of each option.


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Economic Analysis

57. A cost effectiveness methodology was used for the economic analysis. Cost-benefit analysis is not appropriate for this project, as most of the project’s costs do not lend themselves easily to being assigned a precise monetary value. For example, the current costs to households for water and sanitation vary widely across about 450 villages targeted under the project. The technologies used, raw water sources, and fecal sludge management practices (and their associated costs) for this number of locations would be very difficult/impossible to generalize or average—thus preventing a “before project” cost estimate. Further, there are significant market failure aspects concerning the supply of emerging towns and village water supply that have discouraged private sector participation—and thereby mandating a government response. These market failures include doubts on profitability (lack of information), and the perceived ability of the private sector to deliver certain project activities better than the public sector (externalities).

58. There are substantial poverty-reduction benefits from the Project. Using current prices and expected behavior changes, reduced purchases of bottled water, disease avoidance and the time saved for water fetching are estimated to total to a present value of more than US$16.41 million over 15 years discounted at 10 percent. Over the 5-year implementation period, the Government will take a loan of US$25 million under the project, with annual investment of about US$ 4-5 million in each of CY19-23. This annual level of investment is substantially less than one percent of the country’s total 2017 gross government investment (about US$1.5 billion) and should not pose any overall fiscal constraints. The Ministry of Finance is responsible for repayment of the loan, fees and interest and there will be no pass-through of these obligations to another entity. A complete description of the economic analysis is included in Annex 5.

B. Fiduciary (i) Financial Management (FM)

59. Weaknesses were noted in the control environment and the implementing agencies have limited personnel and experience at the central and field office levels. For Components 1, 3 and 4, the Department of Finance (DOF) in MPWT will be responsible for FM, financial reporting and annual audit of the project. For Component 2 and 4, the DOF in MOH will be responsible for FM. There are varying degrees of FM capacities among the implementing agencies at different levels. The full FM risk assessment and mitigating measures are detailed in Annex 3. There is a risk of poor financial management performance resulting in inaccurate reporting of funds from the project. The weak control environment may result in the breakdown of internal controls within the implementing agency. Funds may be used for unintended purposes and there is a risk of errors not being detected due to absence of proper internal controls. The lack of staff experience increases the risk of the budget not being prepared properly and timely. In addition, the absence of a timely and regular budget execution reporting within a particular period hampers access to fiscal information necessary for measuring financial performance. The assessed FM risk of the project is Substantial. The risk mitigation measures for this project are described in detail in Annex 3.

(ii) Procurement

60. Procurement will be carried out in accordance with the World Bank Procurement Regulations for IPF Borrowers, dated July 1, 2016, revised November 2017 and August 2018. DWS-MPWT and DHHP/Nam Saat-MOH have prepared a Project Procurement Strategy for Development (PPSD) to inform fit for purpose procurement arrangements in the procurement plan that will cover at least the first 18 months of implementation. International competitive market approach and selection of consultants involving international competition will be carried out in accordance with the Procurement Regulations. National market approaches (Requests for Bids and Quotations) will be carried out in


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accordance with the national regulations, including Procurement Decree No. 03, dated January 9, 2004, and Implementation Rule and Regulations (IRR) No. 0063 issued by the MOF on March 12, 2004, and No.0861/MOF, dated May 5, 2009 (amended version); Procurement Manual, dated May 2009, and conditions for use of such procedures will be stipulated in the Procurement Plan. Under the proposed project, the World Bank’s planning and tracking system, Systematic Tracking of Exchanges in Procurement (STEP), will be used to prepare, clear, and update Procurement Plans and conduct all procurement transactions for the project.

61. The Implementing Agencies are DWS under the MPWT which will lead, and be responsible for the overall supervision, execution, and management of the project. The department also has the responsibility to carry out procurement activities under Components 1,3, and 4. DHHP/Nam Saat under MOH will have the responsibility to carry out the procurement activities under Component 2 and 4. Component 1 will be undertaken through a community driven development (CDD) approach, using a project cycle that integrates water supply, sanitation and hygiene behavior change; which will be implemented in accordance to the Project Operations Manual (POM).

62. The World Bank carried out a procurement assessment of the implementing agencies in May 2018. Based on the assessment, the DWS is a new Department established three years ago under MPWT. The department has experiences with the government and ADB procurement procedures; but has no experience with World Bank financed projects. Therefore, the capacity of DWS to manage procurement activities was found adequate with further strengthening. Nam Saat was established in 1997 to promote community participation in rural water and sanitation services. The following key procurement risks to project implementation: (a) limited knowledge and experience of the project implementing agency staff including the DWS-MPWT and DHHP/Nam Saat-MOH with World Bank’s Procurement Regulations that could lead to procurement delays or noncompliance; (b) lengthy internal procurement reviewing process that may cause delays; and (c) governance risks. The procurement risk under the project therefore is rated Substantial. The detailed procurement risks together with the mitigation measures, procurement arrangements, and a summary of the PPSD are included in Annex 3.

C. Safeguards

63. The project triggers the Environmental Assessment (OP/BP 4.01), Indigenous Peoples (OP/BP 4.10), Physical Cultural Resources (OP/BP 4.11), Involuntary Resettlement (OP/BP 4.12), and Projects on International Waterways (OP/BP 7.50). The project is classified as Category B for which known effective mitigation measures and monitoring actions will be implemented to avoid and minimize possible impacts of public works. At the request of GoL, the World Bank has notified neighboring riparian countries as required under the policy on Projects on International Waterways (OP/BP 7.50).

(i) Environmental Safeguards

64. The project will finance water supply and sanitation systems, including new water supply systems, rehabilitation of non-functioning systems, and improvement of existing systems. Potential adverse impacts associated with rural water supply and sanitation public works may include soil erosion and sedimentation of rivers and streams during construction of intake structures, pipe installation, and construction of water distribution and sanitary systems; pollution of surface and ground water, including petroleum leakage from construction equipment and trucks; community and construction workers’ health and safety arising from air pollution caused by dust generated during excavations; noise and vibration generated by construction equipment and trucks; solid waste generation and disposal; communicable disease transfer; traffic safety; and lack of and inconsistent use of personal protective equipment. There is also a risk of the use of child labor during construction. These risks can be adequately managed through standard operating procedures and good


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construction management practices. Due to the small-scale nature of planned water supply and sanitation infrastructure, environmental impacts are expected to be minor, temporary, and site specific and can be managed through implementation of appropriate mitigation measures.

65. Subproject location will be identified during the project implementation, but most scheme will be small and community-based scale. Reflecting the nature and small scale of proposed civil works under the project, an Environmental and Social Management Framework (ESMF) including an Environmental Codes of Practice (ECOPs) has been prepared and will be applied to project activities involving construction and rehabilitation of water supply and sanitation facilities. This safeguard instrument was chosen because specific project activities are not yet known and the designs for project investments and their exact locations are not yet finalized. The ESMF, together with its important annexes such as the Resettlement Policy Framework, ECOPs, Environmental and Social Management Plan (ESMP) and Chance Find Procedure were presented and discussed during public consultations and disclosed prior to project appraisal.

66. The ESMF provides a screening process to identify potential environmental and social impacts resulting from project activities and only project activities that satisfy Bank Category B requirements will be eligible for project financing; specify required actions for managing and monitoring project-related impacts; establish a grievance redress mechanism; and identify training needed to effectively implement safeguards measures. The framework will additionally include a chance find procedure relating to physical cultural resources, a worker code of practice, and a requirement to undertake unexploded ordnance surveys and clearance at project locations. Contractor specifications to address environmental and social issues, including construction dust and noise control, waste management and disposal, site management, and occupational and community health and safety measures are also covered in the ESMF and will be included in bidding documents. Both National Environmental Quality Standards and World Bank Group Environmental Health and Safety (EHS) guidelines are referenced in the framework. In accordance with World Bank requirements, a draft Environment and Social Management Framework (ESMF) was completed and disclosed on MPWT and World Bank websites on November 12th, 2018 and November 28th, 2018, respectively.

67. Institutional capacity to implement the ESMF is considered partly satisfactory based on the past performance of MPWT in implementing small town water supply and sanitation projects and Nam Saat. Capacity development will however be needed to ensure that project staff are able to ensure adequate supervision of project activities. A Safeguards focal point was assigned at the DWS during project preparation and staff will be assigned at the PMU, CMU and PIUs throughout the project implementation phase to supervise the safeguard implementation. ESMF was prepared and consulted upon in project provinces by the DWS to ensure understanding of possible impact and required safeguard measures stipulated in the ESMF. Ongoing advisory support and training for project staff is recommended during project implementation to ensure adequate supervision and compliance monitoring of project activities.

(ii) Social Safeguards

69. Both the Indigenous Peoples (OP/BP 4.10) and Involuntary Resettlement (OP/BP 4.12) policies are triggered for this project.

70. The Indigenous Peoples policy is triggered because district level data from the census on ethnicity confirms the presence of ethnic groups in the project target areas. Impacts to ethnic groups are expected to be generally positive considering that they make up the majority (73 percent) of the target beneficiaries of the project, and the CDD approach will provide opportunities for culturally-appropriate project activities. Potential adverse impacts on ethnic communities are expected to be limited, as the activities planned under Components 1-3 will primarily involve communication and behavior change activities, and expansion or rehabilitation of existing infrastructure are small scale and localized. Because


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the majority of beneficiaries will be ethnic people, the elements of an ethnic group development plan are integrated into the design of the project, in lieu of preparing a standalone instrument. During preparation a stakeholder assessment was conducted in a sample of likely beneficiary villages. The Knowledge Attitudes and Practices Survey of a sample of 3,900 households in the northern provinces included a module on Water and Sanitation. Taken together, the findings of these studies form the basis for a project social assessment as required by the World Bank’s Indigenous Peoples policy, and the findings are summarized in the ESMF. During preparation, a process of free, prior and informed consultation was conducted in a sample of beneficiary communities, and guidelines prepared on how to ascertain broad community support using consultation during implementation. The findings of this consultation process, as well as the guidelines are included in the project ESMF.

71. The Involuntary Resettlement Policy is triggered because the project will involve civil works, and it is possible that there may be minor (or at least temporary) impacts related to land acquisition. However, because this project employs a demand responsive community-driven development approach, these impacts cannot be determined until implementation when the exact location of the works will be known. Therefore, a resettlement policy framework has been prepared and disclosed on the implementing agency’s website, as part of the ESMF. The resettlement policy framework includes land donation protocols as well as the requirements for the preparation of site-specific resettlement plans, once sub-project locations are known.

72. For the purposes of grievance redress and resolution, the project will establish a grievance mechanism that will be accessible at project sites, and at the District and Provincial Offices of DWS, PWT, PNP and Nam Saat. Reporting on the grievance mechanism will be part of the standard progress report of the PMU. The Project will also utilize the existing district offices and village arbitration units.

(iii) Other Safeguards

73. No other safeguard policies are triggered for the Project.

(iv) Grievance Redress Mechanisms

V. KEY RISKS

A. Overall Risk Rating and Explanation of Key Risks

75. The overall project risk is considered Substantial.

74. Communities and individuals who believe that they are adversely affected by a World Bank (WB) supported project may submit complaints to existing project-level grievance redress mechanisms or the WB’s Grievance Redress Service (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 World Bank's attention, and Bank Management has been given an opportunity to respond. For information on how to submit complaints to the World Bank’s corporate Grievance Redress Service (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 World Bank Inspection Panel, please visit www.inspectionpanel.org

http://www.worldbank.org/en/projects-operations/products-and-services/grievance-redress-service

http://www.inspectionpanel.org/


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76. Political and governance: Substantial. The Government’s commitment to public sector reforms has been volatile in the past 15 years. However, Lao PDR provides an overall stable political context and, currently, there is high-level government commitment to public financial management reforms. Personnel changes in the Government, specifically in the MoF leadership, could diminish the current commitment and the reform decisions that were previously taken could be reversed. Close and continuous dialogue with the GoL will be crucial to anticipate potential changes in the Government’s commitment or priorities.

77. Macroeconomic: Substantial. There are currently high fiscal deficits and public debt levels in the country. The GoL has recently adopted a fiscal consolidation plan to reduce the budget deficit substantially by 2020 and contain rising public debt. However, implementation will be challenging, particularly with the impact of the recent floods and the uncertain external environment. The uncertainty in the global economy, especially ongoing trade tensions, the possible tightening of global financing conditions and the pace of interest rate normalization in the US could lead to a slowdown of capital inflows and disorderly financial market movements. These risks are likely to adversely impact global demand, commodity prices and the Lao economy by reducing foreign direct investment and its exports. This would put further pressure on the fiscal space and the country’s foreign exchange reserves.56 Overall, risks from domestic economic management policies, including public debt management and financial sector risks, are substantial. The GoL is undertaking a number of measures to ensure that fiscal sustainability is maintained. The revenue improvement is expected to come from strengthening both tax administration through the use of ICT, and the legal tax framework through the recently approved value-added tax law and upcoming laws on tax administration, and excise and income taxes under preparation for submission to the National Assembly in 2019. Public expenditure will be contained by limiting both the number of new recruits and wages. The new civil service quota will be further cut to 1,500 in 2019, and the public wage index increase will be postponed further. These measures, together with implementation of the Public Debt Management Law (passed in mid-2018), are supported by the World Bank under the Lao PDR Green Resilient Growth Development Policy Operation 2 (P166839). As such, we expect that the fiscal framework will be on more sustainable path in the medium term and thereby mitigate the impact of any macro-fiscal shocks on the project.

78. Sector strategies and policies: High. Lao PDR has separate policies and strategies for water supply in urban and rural areas, led by MPWT for urban areas and MOH for rural areas. The separation in policy for provision of water supply services creates policy inconsistency, duplication of expertise, and uncertainties in coverage areas and institutional responsibilities. Whereas urban water supply has advanced substantially over the past 15 years, with sustained engagement with ADB and JICA, the rural sector has been largely driven at a limited scale by individual donors. Whereas urban water supply has been focused on institutional reform and service delivery under a dedicated department established in 2015, the relegation of rural water supply as a sub-sector within DHHP means that it competes against other pressing health priorities. The split sector policy and unclear mandate presents a risk to the operational context. The project is designed to mitigate this risk by building on the strengths of the respective institutions, MPWT for water supply infrastructure delivery and MOH for health and hygiene promotion. The project provides a scalable service delivery solution through a project-based mechanism, with support to strengthen both MPWT and MOH at central, provincial and district levels, and to strengthen local communities at the village level. Technical assistance will be provided for further sector policy development. An MoU will be signed between the relevant Ministries and Provincial Governors to ensure coordination and divisions of roles and responsibilities.

79. Institutional capacity for implementation and sustainability: High. There is currently limited government budget allocated for WASH. Projects are mostly financed by external partners on a small scale. MOH DHHP is responsible for rural

56 Country Partnership Framework for Lao People’s Democratic Republic for period FY2017 – FY2021 World Bank, March 2, 2017; and Lao Economic Monitor, June 2018.


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water supply and sanitation. Current capacities at all levels, from the central to the sub-national levels are low in comparison with the scale of the project. Capacity for CLTS has been built through an ongoing engagement with WSP. There are limited technical staff for infrastructure development and management, thereby impacting sustainability of infrastructure. The DWS is a new department established in 2015 to oversee urban PNPs, which have engineering expertise for water supply within the urban environment. Tariff levels generally are not at cost recovery levels and many PNPs are not financially sustainable. The implementation arrangements and the underlying sector organization and policy weaknesses are significant risks. The current project implementation arrangements are a significant step towards a more consolidated water supply function in the country.

80. Fiduciary: Substantial. Multiple and newly established implementing agencies with largely limited fiduciary (financial management and procurement) capacity could lead to risk of delay in procurement processing, financial reporting, disbursement and non-compliance with internal controls. This could also lead to the risk of funds not being effectively used. Fiduciary capacity at provincial and district levels to manage larger scale operation is limited or stretched which could result in delays in project implementation. Project procurement will be conducted as per Procurement Regulations for IPF Borrowers of World Bank dated July 1, 2016, revised November 2017 and August 2018. Procurement capacity to use of STEP is limited and may require substantial support from the Bank staff during project implementation. All these factors justify the current substantial fiduciary risk rating assigned to this project. Assessment of the fiduciary capacity (FM and Procurement) will be re-assessed during the project implementation. Proposed risk mitigation measures

are detailed in Annex 3.


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VI. RESULTS FRAMEWORK AND MONITORING

81. The project results framework in provided below. An effective approach to monitoring project inputs and outputs requires a robust monitoring system of water and sanitation services. Implementation arrangements for results monitoring and evaluation are given in Section III (B).

Results Framework

COUNTRY: Lao People's Democratic Republic Scaling-Up Water Supply, Sanitation and Hygiene Project

Project Development Objectives(s)

To provide access to improved water supply, sanitation and hygiene services in selected areas identified for nutrition convergence, and strengthen capacity of select institutions to improve service delivery.

Project Development Objective Indicators

RESULT_FRAME_T BL_ PD O

Indicator Name DLI Baseline Intermediate Targets End Target

1 2 3 4

PDO 1: Provide access to improved water supply in selected areas

People provided with access to improved water sources (CRI, Number)

0.00 2,300.00 11,500.00 50,000.00 115,200.00 192,000.00

People provided with access to improved water sources - Female (RMS requirement) (CRI, Number)

0.00 1,150.00 5,750.00 25,000.00 57,600.00 96,000.00

People provided with access to improved water sources - rural (CRI, Number)

0.00 2,300.00 11,500.00 50,000.00 115,200.00 192,000.00


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RESULT_FRAME_T BL_ PD O


1 2 3 4

PDO 2: Provide access to improved sanitation in selected areas

People provided with access to improved sanitation services (CRI, Number)

0.00 1,150.00 5,760.00 24,960.00 57,980.00 96,000.00

People provided with access to improved sanitation services - Female (RMS requirement) (CRI, Number)

0.00 575.00 2,880.00 12,480.00 28,990.00 48,000.00

People provided with access to improved sanitation services - rural (CRI, Number)

0.00 1,150.00 5,760.00 24,960.00 57,980.00 96,000.00

PDO 3: Provide access to improved hygiene services in selected areas

Target population practicing handwashing with soap after using the latrine (Percentage)

0.00 20.00 30.00

PDO 4: Capacity of selected institutions strengthened to improve service delivery

Water supply systems that meet project service levels (Percentage)

0.00 60.00 65.00 70.00 80.00

PDO 5: Nutrition convergence

Villages where at least three nutrition convergence projects have been implemented (Percentage)

0.00 40.00 60.00 80.00 100.00

PDO Table SPACE


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Intermediate Results Indicators by Components

RESULT_FRAME_T BL_ IO


1 2 3 4

Component 1: Delivery of Infrastructure and Sustainability of Water Supply and Sanitation

New water supply systems (Number)

0.00 2.00 11.00 46.00 106.00 176.00

Rehabilitated water supply systems (Number) 0.00 3.00 13.00 58.00 135.00 224.00

New piped household water connections (Number) 0.00 0.00 240.00 860.00 2,000.00 3,300.00

Schools with access to improved sanitation and hygiene facilities (Number)

0.00 3.00 15.00 65.00 150.00 250.00

Communities with open defecation free status for more than six months (Number)

0.00 0.00 10.00 36.00 85.00 140.00

Children under 5 benefitting from open defecation free villages (Number)

0.00 0.00 1,180.00 5,000.00 11,800.00 19,600.00

Water and sanitation committees with at least 30% female members (Percentage)

0.00 70.00 70.00 70.00 70.00 70.00

Water and sanitation committees with at least 30% female members, with at least two women for the position of President, Secretary or Treasurer (Percentage)

0.00 50.00 50.00 50.00 50.00 50.00

Number of initial consultation sessions (Number)

0.00 12.00 80.00 272.00 450.00 450.00

Grievances responded and/or 0.00 80.00 80.00 80.00 80.00 80.00


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RESULT_FRAME_T BL_ IO


1 2 3 4

resolved within the stipulated service standards for the response time (Percentage)

Provincial annual reports of the activities carried out by the sustainability units - PNP (Number)

0.00 0.00 4.00 8.00 12.00 16.00


Provincial annual reports of the activities carried out by the sustainability units Nam Saat (Number)

0.00 0.00 4.00 8.00 12.00 16.00

Sector monitoring system established and in use (Text)

No Yes

Water quality monitoring system in place and in use (Text)

Source water quality is tested, but there is no system to support routine monitring required for SDG purposes

Water quality system in place consisting of data collection, analysis, reporting, quality assurance and control

Component 3: Implementation support and Sector Development

Sector coordination events (Number) 0.00 1.00 2.00 3.00 4.00 5.00

IO Table SPACE

UL Table SPACE


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Monitoring & Evaluation Plan: PDO Indicators

Indicator Name Definition/Description Frequency Datasource Methodology for Data Collection

Responsibility for Data Collection

People provided with access to improved water sources

This indicator measures the cumulative number of people who benefited from improved water supply services that have been constructed through operations supported by the World Bank.

Annual

MIS and Census

This indicator measures the cumulative number of people who benefited from improved water supply services that have been constructed through operations supported by the World Bank. Improved water sources includes piped household connections (house or yard connections) and community water points (public standpipes, boreholes, protected dug wells, and protected spring and rainwater collection). It does not include water provided through tanker trucks or vendors; unprotected wells or unprotected springs; surface waters (such as rivers, ponds, dams,

PMU


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lakes, streams, and irrigation channels); or bottled water. The definition of “improved water sources” follows that of the UNICEF-WHO Joint Monitoring Program.

People provided with access to improved water sources - Female (RMS requirement)

This indicator measures the cumulative number of people who benefited from improved water supply services that have been constructed through operations supported by the World Bank.

Annual

MIS and Census

The number of females provided with access is estimated as 50% since the sex ratio in Lao PDR is 0.99 males per 1 female

PMU

People provided with access to improved water sources - rural

Annual

MIS and Census

All project areas are considered rural for this indicator

PMU

People provided with access to improved sanitation services

The indicator measures the cumulative number of people who benefited from improved sanitation facilities that have been constructed through operations supported by the World Bank.

Annual

MIS and Census

The indicator measures the cumulative number of people who benefited from improved sanitation facilities that have been constructed through operations supported by the World Bank. Improved sanitation facilities includes flush

PMU


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or pour/flush toilets connected to sewers or septic tanks; protected latrines such as VIP latrines or latrines with slabs; and composting toilets. It does not include pit latrines without a slab or platform, hanging latrines and bucket latrines. The definition of “improved sanitation” follows that of the UNICEF-WHO Joint Monitoring Program

People provided with access to improved sanitation services - Female (RMS requirement)

The indicator measures the cumulative number of people who benefited from improved sanitation facilities that have been constructed through operations supported by the World Bank.

Annual

MIS and Census

The number of females provided with access is estimated as 50% since the sex ratio in Lao PDR is 0.99 males per 1 female

PMU

People provided with access to improved sanitation services - rural

Annual

MIS and Census

All project areas are considered rural for this indicator

PMU

Target population practicing handwashing with soap after using the latrine

The indicator measures the percentage of target

Midline and Endline

Household survey

Handwashing with soap will be measured using

PMU


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population who report handwashing with soap after using the latrine.

the ‘sticker diary’ method. The sticker diary is a survey methodology developed by Unilever and the London school of Hygiene and Tropical Medicine in which respondents are given a set of pictorial representations of common daily activities and are asked to create a ‘diary’ of daily behaviors under the guidance of a trained enumerator. The method has been successfully applied in India and Vietnam, and has shown to reduce over-reporting of handwashing behaviors, while being less costly than traditional observation methods. The percentage of the population practicing handwashing with soap after using the latrine will be estimated by


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dividing the number of respondents who report washing hands with soap, by the total number of respondents

Water supply systems that meet project service levels

The following service levels will be met: (i) Quantity: Minimum of 50 lpcd; (ii) Availability: Available when needed; (iii) Quality: compliant with fecal and priority chemical standards; (iv) Management: VDC sub-committee is active; (v) tariffs are being paid to at least cover O&M; (vi) visited as least once a year by the responsible sustainability unit

Annual

Annual checklist administered by sustainability units

Village-level data will be collected at least once a year to ensure that the required service levels are maintained.

PMU

Villages where at least three nutrition convergence projects have been implemented

This indicator measures the cumulative number of villages where three or more nutrition convergence operations supported by the World Bank have been implemented. This will include this Scaling-Up Water Supply, Sanitation

Annual

Coordination with other project management units facilitated by the project steering committee

Project implementation progress reports

PMU


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and Hygiene Project, plus at least two additional nutrition convergence operations supported by the World Bank (Health Governance and Nutrition Development Project (HGNDP) (P151425), Poverty Reduction Fund IV (P157963), Early Childhood Education Project (P145544)), Reducing Rural Poverty and Malnutrition Project (P162565)) and the Agriculture for Nutrition (AFN) project funded by the International Fund for Agricultural Development (IFAD).

ME PDO Table SPACE

Monitoring & Evaluation Plan: Intermediate Results Indicators

Indicator Name Definition/Description Frequency Datasource Methodology for Data Collection

Responsibility for Data Collection

New water supply systems

This indicator measures the cumulative number of new water supply systems that have been completed under the project

Annual

MIS

Paper audit of documentation

PMU

Rehabilitated water supply systems This indicator measures the cumulative number of water


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supply systems that have been rehabilitated under the project

New piped household water connections

Piped household water connection located inside the user’s dwelling, plot or yard.

Annual

Progress reports

PMU

Schools with access to improved sanitation and hygiene facilities

School WASH facilities that meet the minimum service level as defined in the project: Drinking water from an improved source is available at the school, improved sanitation facilities are single-sex, accessible and usable. Toilets for girls should have facilities for menstrual hygiene management. This indicator measures the gender gap addressing privacy and safety of girls and women in public sanitation facilities. The term ‘usable’ refers to toilets or latrines that are accessible to students (doors are unlocked or a key is available at all times), functional (the toilet is not broken, the toilet hole is not blocked, and water is

Annual

Project progress report

PMU


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available for flush/pour-flush toilets), and private (there are closable doors that lock from the inside and no large gaps in the structure).

Communities with open defecation free status for more than six months

This indicator measure the cumulative number of communities that have achieved open defecation free status which has been sustained for 6 months or more years since declaration. A community is considered open defecation free when it is offically declared by the village head

Annual

MIS and census

Paper audit

PMU/CMU

Children under 5 benefitting from open defecation free villages

A community is considered open defecation free when it is officially declared by the village head.

Annual

MIS and census

The number of children under 5 benefiting from open defecation free villages can be estimated by multiplying the percentage of the under 5 population by the number of villages officially declared open defecation free by the village head

PMU/CMU

Water and sanitation committees with at least 30% female members

This indicator measures the percentage of female

Annual

Progress report

Meetings and visits to the communities

PMU


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members of the water and sanitation committees. Members are those who are officially recognized and attend committee meetings on a regular basis. This indicator is related to the gender gap addressing women's participation in decision making.

Water and sanitation committees with at least 30% female members, with at least two women for the position of President, Secretary or Treasurer

This indicator measures the percentage of female members of the water and sanitation committees who are holding positions of President, Secretary or Treasurer. Members are those who are officially recognized and attend committee meetings on a regular basis. This indicator is related to the gender gap addressing women's participation in decision making.

Annual

Progress report

Meetings and visits to the communities

PMU

Number of initial consultation sessions

This indicator measures the cumulative number of initial consultation sessions held at the community level to introduce the project. This indicator is a measure of citizen engagement.

Annual



PMU


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Grievances responded and/or resolved within the stipulated service standards for the response time

This indicator captures the efficacy of project delivery systems, specifically the grievance redress mechanism which will capture grievances or perceived irregularities. Stipulated service standards for response times will be outlined in the Project Implementation Manual Numerator: Total number of grievance cases from the project addressed in accordance to established protocol. Denominator: Total number of grievance cases received from the project.

Annual


Project progress report and MIS

PMU

Provincial annual reports of the activities carried out by the sustainability units - PNP

Once report generated per province per year setting out the activities of the sustainability unit

Annual

Progress reports

Project data

PMU

Provincial annual reports of the activities carried out by the sustainability units Nam Saat

Annual reports, one per year per province

Annual



CMU

Sector monitoring system established and in use

This indicator is met when a module for water supply, sanitation and hygiene has been created and has been intregrated into the existing

Endline



CMU


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Health Management Information System (HMIS

Water quality monitoring system in place and in use

A water quality monitoring systems should consist of: data collection (sample collection, in situ measurements), analysis (in a lab, in situ), reporting to water users, PMU and government stakeholders. Every step should have built in quality control and assurance procedures in place.

Annual

Project progress reports

Project progress reports

CMU

Sector coordination events

This indicator measures the number of meetings that take place at national, provincial or district level with actors working across nutrition-specific and nutrition-sensitive sectors

Annual



PMU and CMU

ME IO Table SPACE


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ANNEX 1: WORLD BANK COUNTRY PORTFOLIO RESULTS CHAIN FOR AN INTEGRATED APPROACH TO TACKLING CHILDHOOD STUNTING

1. The proposed convergence approach will support the Government’s NNSPA to accelerate the reduction of under-5 stunting from 44 percent to an ambitious target of 25 percent by 2025, by enabling the implementation of nutrition-specific and nutrition-sensitive interventions known to reduce stunting in select high-stunting burden provinces. The key elements in the causal results chain to the achievement of the stunting target will be to address the immediate, underlying, and some of the basic causes of child undernutrition in Lao PDR (Figure 1). At the immediate level, nutritional status will ultimately be determined by the availability of nutrients to the body to meet its requirements and the status of health, while the underlying and basic causes are related to access, availability, and utilization of food; maternal and child caring practices; water and sanitation; and personal hygiene. These determinants are heavily influenced by the social and economic status of women. Achievements in these areas of interventions supported by necessary systems and capacity improvements should result in improved nutrition and reduced illness and disease of pregnant women and children, which, in turn, should result in reduced prevalence of stunting and better physical and cognitive development of children.

2. The overall goal for the World Bank-financed multisectoral nutrition convergence approach is to showcase that with an integrated approach, in four years, stunting rates could be reduced significantly, by as much as 1.75 percent annually. The proposed four sectoral operations (Table 3) will all contribute to tackling the immediate and underlying causes of malnutrition in provinces with the highest share and absolute numbers of stunted children.57 The selected evidence-based interventions proposed under the convergence approach are expected to reduce stunting rates in the target areas by over 20 percent by 2024, which will correspond to close to 2 percent reduction nationally.

57 Phongsaly 54 percent, Oudomxay 42.7 percent, Huaphanh 40.7 percent, and Xiengkhuang 46.3 percent (LSIS 2017).


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Figure 1 Causal Framework to Reducing Stunting in Lao PDR

• Increased utilization of quality maternal and child health and nutrition services

• Improved nutrition/health behaviors: maternal and child care and feeding and hygiene practices

• Improved access to diverse foods

• Increased convergence and coverage of nutrition-specific and nutrition-sensitive services (Health, Nutrition, and Population, Social Protection, WASH, PRF, and Education)

Improving supply and quality of services

Enabling environment

Increasing utilization

and demand

Strengthening and integrating delivery of

services

Supplying essential equipment, commodities,

and human resources

Developing competency and skills of providers

Focus on results

Capacity enhancement,

coordination, and M&E

Improving stewardship

Strategic communication and context-specific

social behavior change and communication

Removing demand-side barriers

Increasing community ownership and

(women’s) participation

Improved Child Growth; Reduced Stunting

Improved diets of mothers and children

Reduced illness of children

Impact

Medium-term results

Inputs and outputs

Short-term results

Guiding Principles

• Focus on high-stunting districts and on vulnerable and poor households

• Use of a common social behavioral and change strategy, action plan, and tools

• Leveraging of each project’s delivery platforms, for example, established community-based structures

• Use of a common M&E framework


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Table 3 Country Portfolio Results Chain for an Integrated Approach to Tackling Childhood Stunting in Lao PDR

Country Program Goal

Overall Country Portfolio Objective

Expected Sector-specific Results

Key Indicators Relevant Project Activities

Reduce stunting prevalence in children under 2 years of age in targeted regions by 20 percent.

To enable the GoL to implement nutrition-specific and nutrition-sensitive interventions by key sectors to address the immediate and underlying determinants of childhood undernutrition in an integrated and coordinated manner

Health and Nutrition Increased supply and utilization of essential maternal and child health and nutrition services

• Percentage of children under two years of age whose growth is adequately monitored (as per national guidelines)

• Percentage of women who attended at least 4 ANC session during their most recent pregnancy

• Percentage of infants 0–5 months who are exclusively breastfed

• Percentage of children 6–59 months receiving vitamin A supplementation within the past 12 months

• SBCC for optimal infant and child feeding, maternal nutrition, and hygiene

• Improve availability and access to ANC and PNC services

• Provision of essential micronutrients to women and children

• Treatment of infections (for example, diarrhea and malaria)

• Deworming of children and pregnant women

Social Protection Reduced (nutritional) vulnerability of poor households and increase the demand for and utilization of health and nutrition services and access to diverse diets

• Percentage of households with periodically updated socio-economic survey information reported in the social registry

• Number of beneficiaries of social safety net programs

• Percentage of children 6–23 months from cash transfer beneficiary households consuming foods from four or more recommended food groups

• Number of villages in project districts where at least three convergence projects have been implemented

• Deliver cash transfers and improve SBCC delivery to generate/increase demand for and improve access to essential health and nutrition services

• Target social protection services/interventions to the poorest and most nutritionally vulnerable population in rural areas

• SBCC improved in its delivery for optimal infant and child feeding, maternal nutrition, and hygiene and use of cash for nutrition inputs

• Advocacy and provision of technical support to other ministries on nutrition issues

• Finance mechanisms to coordinate and monitor nutrition convergence


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Country Program Goal

Overall Country Portfolio Objective

Expected Sector-specific Results

Key Indicators Relevant Project Activities

WASH Interrupted routes of fecal-oral contamination among infants and young children 0–24 months

• Number of people provided with access to improved water sources

• Number of people with access to improved sanitation services

• Percentage of the target population practicing handwashing with soap after using the latrine

• Percentage of water supply systems that meet project service levels

• Number of villages where at least three nutrition convergence projects have been implemented

• Construct/rehabilitate water supply systems

• Support and promote the use of improved sanitation facilities and handwashing stations

• Construct toilets and handwashing facilities in health centers and schools

• SBCC to promote handwashing with soap for all household members at critical times, that is, before preparation of food, before feeding of infant/young child, after cleaning of floors, and after use of latrine

Agriculture/PRF Improve access to basic services, increased production and consumption of diverse and nutritious foods for poor households

• Percentage of children 6–23 months from SHG and Farmer Nutrition Group households consuming foods from four or more recommended food groups

• Income from the sale of SHG and Producer Group-financed production

• Agriculture, livestock and handicraft production by SHG member households

• Percentage of SHG members with year-round production from home nutrition gardens

• Percentage of women in leadership positions with SHGs and Village SHG Management Committees (VSMCs)

• Seed grant finance and financial management capacity building for investment in agriculture and livestock production for consumption and sale

• Material (i.e. seeds and basic garden tools), training, monitoring and support on home nutrition gardens

• Establishment and support to Farmer Nutrition Groups comprised mainly of pregnant women and women with children less than 24 months of age focusing on SBCC and peer support/learning on the growing, processing, cooking and feeding of diverse and nutritious foods to themselves (especially when pregnant) and their children

• Investment in infrastructure that will facilitate access to markets for the sale of production and access to services (i.e. roads and bridges) as well as enhanced production (i.e. irrigation, animal shelter and fencing, storage facilities)


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Table 4 Basic Descriptive Statistics of the nutrition convergence geographic area

Provinces and Districts

Total Population (1)

Number of children

under 5 (1)

Number of

villages (1)

Number of Households

(1)

Number of

Female (1)

Phongsaly

1 Mai 26,145 13,600 4,083 88 4,678

2 Khoua 25,557 13,800 3,443 94 5,293

3 Samphanh 22,981 12,400 3,857 68 4,375

4 Boun Tai 23,402 11,500 3,648 63 4,723

Oudomxay

5 La 16,506 7,400 2,150 44 3,502

6 Namor 37,322 20,600 5,634 62 6,870

Huaphanh

7 Houamuong 32,234 15,700 4,759 76 5,292

8 Xam Tai 36,696 18,000 5,210 90 6,022

9 Kouane 24,525 13,600 4,055 66 3,809

10 Xone 15,755 8,000 2,421 34 2,474

Xiengkhuang

11 Kham 47,256 22,800 6,274 90 8,470

12 Nonghed 37,406 20,800 6,107 106 6,033

Total 345,785 178,200 51,641 881 61,541

Sources of data: (1) Population and Housing Census 2015


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Table 5 Basic Descriptive Nutrition Statistics for Both National and Convergence Target Populations

Lao PDR**(2017)

World Bank Project Convergence Districts*** (2017)

Huaphanh Oudomxay Phongsaly Xiengkhuang All****

Number of districts 148 4 2 4 2 12

Number of villages 8,499 266 106 313 196 881

Number of households* 1,189,233 17,597 10,372 19,069 14,503 61,541

Total Population* 6,277,592 109,210 53,828 98,085 84,662 345,785

Population: 0 – 5 years old* 823,910 16,445 7,784 15,031 12,381 51,641

Population: 0 – 2 years old* 394,058 7,842 3,694 6,886 5,939 24,361

Poverty Rate**** 23% 49% 23% 23% 26% 32%

Share of ethnic minority (non-Lao Tai) population*

32% 66% 86% 74% 63% 74%

Stunting 33% 46% 36% 46% 41% 43%

Wasting 9% 6% 6% 6% 4% 21%

Minimum acceptable diet (Breastfed children, 9-23 months)

45% 22% 24% 16% 25% 22%

Not enough food 0 14%

Institutional delivery 65% 41% 55% 26% 52% 42%

Full immunization coverage 48% 38% 32% 27% 39% 35%

Up-to-date Growth monitoring - 7% 8% 1% 10% 07%

At least 4 ANC Visits 62% 59% 64% 29% 59% 52%

Received PNC after 48 hours 47% 31% 19% 16% 35% 28%

Mothers who can identify at least 1 reason why fruits and vegetables are important for the body

64% 67% 50% 75% 64%

Household sanitation coverage 73% 66% 60% 37% 68% 58%

Households practicing open defecation or using unimproved sanitation

29% 30% 37% 63% 31% 40%

Households with handwashing station/facility

51% 71% 66% 72% 36%

Access to improved water coverage 84% 92 88 82 91 88%

Notes: *Based on Population and Housing Census, 2015, ** Lao Social Indicators Survey (LSIS), 2017; *** KAP Baseline Survey, 2017, **** Poverty Estimates based on small areas estimation technique applied to Population and Housing Census, 2015, **** refers to the 12 districts together as areas of overall nutrition convergence approach.


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Table 6 World Bank Nutrition-related portfolio in Lao PDR and expected synergies with the proposed operation 58

Sector Projects and

Activities (Status; Total Project Cost)

Nutrition-related Elements Synergies with This Operation

Health Lao PDR HGNDP (P151425) (US$26.4 million) Additional Financing of the HGNDP (US$25 million)

Strengthening primary health care, improving both the coverage and the quality of maternal, neonatal, and child health services mostly at the facility level; includes support for nutrition-related indicators in the disbursement-linked indicators (DLIs) and support development of an integrated national strategy and implementation plan for SBCC to improve nutrition as well as implementation of the strategy at the national level and at the village level in selected priority districts.

The HGNDP will continue focusing on provision of quality essential health care services especially clinical services at the facility level and during outreach, while this operation will focus on (a) increasing demand for those services known to improve nutritional outcomes and (b) further strengthening mainly community-based preventive and promotive services.

HANSA Project (P166165) Pipeline, US$30 million

This proposed operation’s PDO will be to ‘improve access to quality health and nutrition services while ensuring financial protection, in targeted areas of Lao PDR’. A major component of this operation will be to strengthen and improve quality of service delivery for universal health coverage, with a focus on maternal and child health services, including nutrition.

The availability of nutrition-specific interventions will be crucial to maximize impact of financial incentives for poor households. As quality health and nutrition service become available in the selected geographic convergence areas, co-responsibilities on utilization of those same services will be added as a condition for beneficiaries to receive cash transfers.

WASH Scaling-Up Water Supply, Sanitation and Hygiene Project (P164901) Pipeline, US$25 million

Improving access to sanitation and clean water and improving hygiene practices, in targeted convergence villages.

The project will be implemented in the geographic areas targeted for nutrition convergence. Using the Nutrition Social Behavioral Change and Communication Strategy and Action Plan and tools as a base, the project will deliver an integrated water supply, sanitation and hygiene intervention at the village level.

58 In the agriculture sector, synergies will be applied with a donor-financed project (IFAD) on food and nutrition security implemented by MAF in the same geographic areas of intervention.


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Sector Projects and



Social Development

PRF III (P157963) Ongoing, US$30 million

The overall development objective of the project is to improve access to basic services for the project’s targeted poor communities, through including community and local development processes. One component finances provision of capacity-building assistance to SHGs in targeted districts in Savanakett and Huaphanh Provinces to increase incomes of poor families through increased agriculture and livestock production. Well-performing SHGs offer sustainable access to finance for investing in income generating activities and accumulating group savings for social welfare needs. Household production is used for consumption, particularly protein-rich, small livestock such as poultry, fish and pigs, as well as for market sales for income. Light support is also provided to Village Nutrition Centers (VNCs) which were established under the PRF II operation.

The PRF will be a service delivery partner for this proposed project as it provides a well-established, effective service delivery platform at the local level in all four target provinces as well as direct engagement with target beneficiaries on livelihood and nutrition activities in Huaphanh Province. The proposed operation also has the same implementing agency, the Ministry of Agriculture and Forestry, PRF’s home Ministry, so there will be alignment and synergy around the Ministry’s operations (including central and field-based staff) and strategy.


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Sector Projects and



PRF III AF (P168620) Pipeline, US$10 million

At the concept stage, the proposed revised PDO was “to improve access to basic services, increase production and consumption of diverse and nutritious foods for poor households in the Project’s targeted poor communities.” This revision is intended to capture the expansion of PRF activities in the area of livelihoods and nutrition. AF activities will expand livelihood and nutrition activity coverage into the three other nutrition convergence provinces (Phongsaly, Xiengkhuang and Oudomxay), strengthening SHG support, adding support for the establishment of Producer Groups, expanding support for home nutrition gardens, building on VNC experience to establish Farmer Nutrition Groups comprised primarily of pregnant women and mothers of children up to 24 months of age which would receive support to grow, cook and serve nutritious meals to their children.

The proposed PRF III AF would enable a full geographic overlap with the proposed project in all target districts and a large number of villages. Income from SHG activities would combine with cash transfer income to enhance the purchasing power of target beneficiaries while strengthening their financial management capacity and sustainable access to finance through revolving funds. Farmer Nutrition Groups would also be a key channel for SBCC delivery, particularly on messages relating to nutritious food production, food processing and preparation and child feeding.

Education ECE Project (P145544) Ongoing, US$28 million Early Childhood Development

The overall development objective of the project is to increase coverage and improve the quality of ECE services for 3- to 5-year-olds in target districts. The project is also piloting two ECE modalities that are new in the Lao context—a non-formal Community Child Development Playgroup for children of ages 2 to 4 years and a formal delivery of multiage teaching to groups of children of ages varying from 3 to 5 years and community awareness campaign to promote good child care and health practices and emphasize the importance of early cognitive stimulation. All the piloting activities (implemented in the selected villages in the proposed four northern provinces) are being rigorously evaluated.

The project overlaps with some of the geographic areas of the HGNDP and therefore where this proposed project will be implemented. The projects will coordinate on the SBCC at the community level.


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ANNEX 2: INTEGRATED WASH PROJECT CYCLE

1. The project will adopt a single community-driven approach that integrates water supply, sanitation, and hygiene and nutrition-sensitive behavior change. It will cover villages and their associated schools and health centers. The integrated approach ensures that a comprehensive set of ‘hard’ (infrastructural) and ‘soft’ (behavioral change and communication) interventions are carried out at the village and household levels in an integrated and participatory manner, and beneficiary engagement takes place in a structured and phased manner that leads to iterative and consistent reinforcement. The project cycle establishes a service delivery mechanism that includes infrastructure services at the community and household level, and health and nutrition education targeted to caregivers of small children. It allows for leveraging water supply access to incentivize sanitation and hygiene behavior change. Community-level sanitation activities will be initiated between the final planning stages of the water supply system and the construction phase of the project cycle. This integration will leverage the momentum generated within the communities and will ensure a close linkage between water and sanitation activities, for example completion of water connections after construction of toilets. The active participation of communities and structured capacity building process will result in greater ownership and capability to conduct O&M and thereby improve sustainability. The project cycle, once established, can be scaled up sector-wide, and can be the basis for GoL’s programmatic delivery mechanism for WASH services. It encompasses the service delivery needs of remote villages, larger villages, village clusters and emerging towns through a common paradigm.

2. The project cycle consists of seven distinct steps: Promotion, Planning, Design, Sanitation, Construction, Post-Works and Sustainability. The activities under each step are summarized below:

a. Promotion: Project promotion will be done in direct communication with village authorities to invite them to participate in project. The promotion announcement will include the eligibility criteria for the project, including the commitment of communities to participate meaningfully in: (a) the informed selection of the optimal technical water system option; (b) to contribute a minimum of 10 percent of the capital cost in cash or in-kind (unskilled labor or materials) for community based systems and pay a connection fee for larger villages/kumban/emerging towns; (c) to install and maintain a water meter; (d) to pay for ongoing water services; (e) to participate in the VDC sub-committee for water and sanitation and carry out O&M for community based systems, with 30 percent representation of women; (d) to participate in a meaningful manner in training and capacity building programs; (g) to support the organization and execution of SBCC and CLTS, and commit to a sustained ODF community; and (h) to construct improved and sustainable latrines.

b. Planning: The Village Development Committee (VDC) sub-committee for water and sanitation will be established and the water and sanitation fund bank account will be registered. The statutes of the sub-committee that describes the roles and responsibilities of its members will be written and agreed by the community. For emerging town/kumban/large village, the role of the VDC will be to extend SBCC and awareness raising, training and coordination with PNP. For small villages, the VDC will have more extensive functions and be responsible for O&M of the system. A baseline survey will be carried out. Water sources will be identified, and the technical options for the water project will be discussed. Awareness-building of prospective and existing sanitation marketers at district level will be carried out. Village-level SBCC activities using inter-personal communications, audio-visual materials, peer-group education, and other support media will be carried out.

c. Design: Engineers, in close coordination with the safeguards team, will discuss and finalize the design with the village representatives and the PMU will provide No-Objections for the design. For small villages, the


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VDC will collect the contribution from all families in the village as counterpart funds. The VDC will be trained on the technical, financial and social management of the water supply system. Households will self-monitor behavior changes. SBCC activities will continue and households will be encouraged to set up handwashing stations. Peer groups will be formed and trained on how to deliver key messages and reinforce healthy behavior.

d. Sanitation. This phase will start with the pre-triggering, the village meeting for promotion of sanitation menu and options, and SBCC. An exchange visit to an ODF village or Model Healthy Village will be conducted, followed by triggering (using CLTS-based methods and approaches), which consists of a three-day program with an overnight stay. Sanitation and hygiene behaviors will be monitored daily. Follow-up post-triggering will take place, including assistance for the construction of latrines. SBCC and the follow-up visits will continue until the village becomes ODF. The SBCC will focus on toilet usage, toilet hygiene and toilet cleanliness. The Village Headman, VDC and sanitation watch committees will take the lead and be recognized once the village becomes ODF. Inter-personal communication and outdoor media will be used to support CLTS, as required. Technical training will be done for the community using audio-visual and print material. A marketing fair bringing private sector suppliers and consumers together will be organized for a cluster of villages. Information will be shared with the community on sanitation providers in their vicinity. The sanitation activities, and in particular the triggering, will be undertaken by facilitators who have been trained extensively in CLTS-techniques and approaches.

e. Construction. Guided by the ESMP, ECoP and other relevant safeguards instruments for each sub-project, the community will discuss community-safety rules and measures to avoid accidents. Construction supervision will be done by the engineers and relevant government agencies. For small villages, the VDC will collect the second contribution from all families in the village as counterpart funds. Community will participate in monitoring materials delivery and construction progress. SBCC messaging will put renewed emphasis on toilet cleanliness, handwashing post-toilet use and safe disposal of child feces through inter-personal communications visits to targeted families and new toilet users. The self-declaration of ODF will be marked by recognition of the village and village key functionaries, including school and health center staff, using non-monetary incentives. School and health-center SBCC by District Health/Nam Saat will be ongoing. Procurement and construction of all water supply systems and infrastructure including procurement of materials for latrines will be done by MPWT. Funds from the project will not flow directly to the villages.

f. Post works. During the guarantee period, the site supervision engineer will identify and address any system malfunction and address it with the contractor. The VDC will monitor and report any issues to the supervision engineer. The SBCC post-works follow-up plan will be implemented. Peer groups will take the lead in continuing with the SBCC, along with the VDC. The contractor will hand over the finished project to the MPWT. PMU/PIU, District Health/Nam Saat together with the VDC will formally verify the functional integrity of the water supply system. MPWT will hand over the water supply system to the Provincial authority, which will hand over the systems as follows:

• For emerging towns/kumban/large villages: to PNPs, with a service agreement signed between VDC and PNPs

• For small villages: to District Health/Nam Saat and VDC, with a service agreement between Nam Saat and VDC

• For schools: To MoES, with a service agreement between District Health/Nam Saat/PNPs and school

• For health centers with a service agreement between District Health/Nam Saat/PNPs and health


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center

g. Sustainability. As per the service agreement, PNP branch offices and Nam Saat will provide ongoing technical support. For community managed systems, the VDC will begin O&M of water supply system and ensure that latrines are being used. The VDC may choose to outsource O&M of water supply system with the support from the sustainability unit under Nam Saat. In villages and clusters where the PNP branch offices are operating the water system, rules of engagement will be well-known by all villagers. Nam Saat will continue to provide assistance to the village for hygiene, sanitation, nutrition and health programs, in coordination with the schools and health centers.

3. Water Supply service level and tariff: Guidelines will allow for phased increase of service levels for achievement of SDGs. A minimum of basic water services will be provided, with provision to move up the ladder towards a safely managed service depending on the local context, community priorities, access levels, capacities and financial resources available. Communities will decide on the level of service based on the affordability of the capital and O&M cost. All water supply systems will include a disinfection step. Tariff levels for all systems will cover O&M costs at the miminum. For small systems tariff levels will be set by the communities (VDC) to cover at least O&M costs. For emerging towns/kumban/large village, feasibility studies will cover the analysis of water tariffs for the new schemes, which will be approved by the provincial authority.

4. Sustainability. For small villages, sustainability for these systems will be supported by establishment of a sustainability unit within Nam Saat at the district level and provincial levels. This will be supported under Component 2. Sustainability of the larger villages/kumban/emerging towns will be supported by the O&M unit of PNP branches, strengthened under Component 1. The project will follow a three-pronged approach to ensure sustainability of sanitation interventions: strengthening sanitation supply chains; institutionalizing community self-monitoring; and, monitoring by district-level authorities.

5. Water resources:59 The project will obtain permission to use the water from Provincial Natural Resources and Environment Department (PONRE) and District Natural Resources and Environment Department (DONRE), for all water sources, surface and groundwater. Communities will be involved in watershed protection. Risks to water supply will be assessed as part of the planning process and design of infrastructure, including changes in supply side factors like land use, deforestation, and increasing climatic variability, and demand side factors like population changes. The catchment area of the water sources is an integrated component of the water supply system and will be managed and protected from negative impacts of land use changes and remain free of pollution sources (animals, cultivation). A protected zone around each catchment will be defined. Managed aquifer recharge systems will be incorporated into the project guidelines to secure groundwater levels and improve quality where applicable. Solar pumping will be piloted in places where pumping is required, as well as other alternative technology options will be explored. Rainwater harvesting will be considered for complementary supply. A monitoring plan for each type of source (uphill spring, stream surface water, groundwater) will be developed as part of the water safety plan. Mitigation measures for climate change impacts will be formulated during the implementation of the project. For the drought preparedness of gravity systems this requires the basic knowledge of the catchment size and characteristics and the monitoring of the water flow at the intake. Flood protection measures can be based on information from the community and be incorporated in the design of the water

59The predominant sources are uphill springs and streams that feed a gravity system. Spring sources are preferred as they tend to have better water quality and can be more easily protected. The source should flow throughout the year and the low flow during the dry season will be estimated and monitored. Groundwater potential is limited in the 4 Provinces. Kham District in Xiengkhuang has shallow groundwater (along the rivers in the plain) and prospects for deeper groundwater in the limestones. Xone District (Huaphanh) may have a limited groundwater potential. Surface water systems with pumps will only applied where uphill streams or springs are not available (District Lar (Oudomxay) / District Kham (Xiengkhuang)).


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supply system.

6. CLTS. CLTS is central to the community-wide change of sanitation behavior and the establishment of new social norms related to the sustained use of a toilet by all. To ensure a sustained and community-wide change of sanitation behavior and the construction of toilets by all households, CLTS will be embedded in the awareness and behavioral change campaign. CLTS requires intense and well-structured preparation and follow-up after the triggering. Triggering teams, consisting of two to three well-trained community mobilizers, will visit each community for at least one day, prior to the community triggering. During the actual triggering, the teams will spend three continuous days and nights in the community to ensure that community initiatives are leveraged, and a community sanitation plan is developed and implemented. Until a community becomes ODF, the team will visit the community at least once a month to monitor progress, propose corrective action, and to provide technical advice to individual households.60 Post-ODF, sustainability of the new behaviors will be ensured through continuous communication and motivating the beneficiaries.

7. Sanitation technology and incentives. The project will advocate the use of a twin pit pour flush latrine as a more sustainable and safer option than the single pit latrine. Provided it is constructed well, the twin pit latrine will provide the opportunity to alternate pits and leave the fecal matter in the unused pit to degrade safely. To improve uptake, the development of expanded sanitation units will be promoted. These consist of a pour flush toilet, water receptacle and bathing area with drainage system. Sanitation supply chains will be strengthened, and if needed, established, to ensure that newly demanded sanitation goods and services are easily and consistently available, and incremental improvements are sustained. The project will finance incentives for poor and vulnerable households, including additional incentives to address the needs of differently abled people. The groups will be identified by the communities in the planning stage of the project cycle. These households will receive materials for construction of their toilets. Once established, the project will explore the use of the targeting system developed for the conditional cash transfer under the Reducing Rural Poverty and Malnutrition Project (P162565) to identify vulnerable households to receive sanitation incentives.

8. Strengthening of sanitation supply chains: Global experience shows that when people manage the construction of their own toilet, toilets are more likely to be maintained and used as compared to toilets that are constructed for people in large number by contractors. However, a sanitation marketing study by WSP found that current sanitation supply chains in Laos need to be strengthened to reduce the price of latrines, reduce the effort to construct a latrine, to increase the choice between different appropriate toilet options, and to introduce new innovative sanitation technologies such as the twin-pit latrines. The sanitation marketing will address both demand-side factors, such widening the customers’ knowledge base related to sanitation, and the supply side factors, such as training masons on toilet construction, marketing and the establishment of one-stop sanitation stops. Households will be educated on how to carry out quality control.

9. Training: Training plans will be developed for VDC as part of the community engagement process. Capacity building for VDCs will require ongoing reinforcement. Households will be trained on toilet construction. Entrepreneurs will be trained to provide O&M for water supply and sanitation marketing. Capacity building modules and materials will include billing, tariff collection and accounting/book keeping, water supply, watershed protection, sanitation and hygiene behavior change, guidelines and service delivery models, O&M, monitoring, planning, implementation and oversight, water quality testing, business development, climate change, citizen engagement and inclusiveness. In contexts where the local language (other than Lao) is dominant, efforts will be made to provide training in the local language or with the help of a local translator to ensure full understanding of the subject matter. In addition, gender balance will be considered by ensuring that up to 30 percent of the participants are women. Similarly, in districts and villages with a prevalence of

60 The exact sequence of activities along with a ToR for each of the visits to the communities will be included in the Project Operation Manual (POM).


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ethnic minorities, involvement of these groups will be ensured.

10. Social Behavior Change Communication (SBCC): The project, as a foundational activity will use awareness-building and behavior change communications to build knowledge and facilitate the adoption of WASH behaviors to promote drinking water safety, improve hygiene and nutrition practices, and end open defecation. To make sure ensure that the messages delivered in the villages are consistent, well-tailored and coordinated SBCC will be delivered to drive hygiene behavior change. The SBCC will encompass institutional-level interventions, community awareness-building, and face-to-face communication with households, each of which is embedded in the phases of the project cycle. These activities adhere to the messages, delivery methods and channels outlined in the nutrition SBCC strategy and action plan and tools, developed through the support from HGNDP. Delivery of SBCC will take place through common delivery platforms as well as through project-specific activities. The project will design and implement an intensive SBCC campaign that specifically focuses on sanitation and related hygiene behaviors, with special emphasis on Baby WASH – handwashing behaviors, a clean play environment, and safe water for drinking and food preparation for young children. In a phased manner, the project will focus on the following behaviors: (i) sustained use of a toilet by all throughout the year; (ii) handwashing with soap at critical times for child fecal-oral exposure; (iii) safe disposal of animal and child feces; (iv) safe storage, treatment and handling of drinking water; and (v) menstrual hygiene management. The project’s SBCC-campaign will use existing formative research on WASH behaviors and practices in Laos, complemented by research on Baby WASH behaviors. It will be designed and implemented to reach caregivers of infants and small children, along with families. Care will be taken to ensure that the communication is tailored for different audiences using appropriate messages, both women and men will be addressed in equal measure to ensure that men, and adolescent boys, are not left behind and will be equally responsible for improved hygiene behavior. The use of technology and innovation will also be explored, as a vehicle to deliver the SBCC messages, for example through games, use of text messages, and mobisodes.

11. Institutional WASH: Institutional sanitation for schools and health centers is integral part of ODF communities and districts. Access to clean and separate toilets that include appropriate provisions for menstrual hygiene management increase the school attendance of girls and adolescent girls in particular. The construction of toilets in schools and health centers in the project area will be done through the PMU with collaboration with the MOES to ensure proper maintenance of sanitation facilities in schools. The project cycle will include facilitation of school health and hygiene promotion during the planning and construction of the toilets and handwashing facilities. Nam Saat will support ongoing hygiene promotion training and facilitation, and also facilitate school-based hygiene promotion programs and health education programs. Nam Saat will develop hygiene curriculum for primary schools which will play an important role in promoting WASH behavior through SBCC and peer-group learning methods. The material will focus on handwashing with soap at critical times, toilet usage, toilet cleanliness, menstrual hygiene and keeping the immediate surroundings clean.

12. Community monitoring: Self-monitoring of sustained water supply service provision, maintained ODF, sanitation and hygiene behaviours by the communities are a key element to sustaining behaviour change through the evaluation of current practices. Monitoring tools that are simple and graphical and can be easily applied at the community and household levels will be used throughout the project cycle. During the construction phase, the VDC will participate in the supervision of materials and construction. In the post-works phase, the service agreements will set out the post-construction monitoring responsibilities. Sanitation and hygiene monitoring will be done monthly by the VDC after the community has been declared ODF. Every six months consolidated reports will be provided to the district and provincial authorities. For water supply services, the VDC will monitor and report on continuity of water supply service provision, use of an agreed management model, regular payment of water tariff, regular monitoring of water quality, etc. For sanitation, the VDC will monitor the provision of water supply and sanitation services in schools and health centers, continuous practice of handwashing with soap after use of the latrine. The sustainability units will provide oversight to all such monitoring after the completion of the integrated WASH project cycle


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13. Gender: Women are the main beneficiaries of WASH and direct involvement of women in project activities is essential: (i) at least two women will be selected in the VDC, particularly for the positions of President/Secretary or Treasurer; (ii) all training to communities and entrepreneurs will equally include both men and women participants (50 percent male -50 percent female); (iii) training will be delivered in the local language (as most women speak Lao as second language); (iv) training will be delivered at times convenient for women; (v) a special effort will be made to provide technical training to women on masonry, plumbing, minor water system repairs, water meter management and reading, and entrepreneurship on water and sanitation-related activities. Women may be shy in participating in most technical trainings with men, and options for women-only training will be considered. If necessary consultation with women-only will be carried out for identification of the best sanitation technology and design fits their needs. In addition, training in leadership, negotiation, marketing skills, among others, will be provided to encourage women to engage in the community decision making process.

14. Grievance redress mechanism: A single mechanism, ideally facilitated by ICT tools, will be developed to receive, acknowledge, respond and solve grievances, inquiries, and demands will be set up for the project. It will include: a typology of grievances or inquiries received, time for resolution depending on the type, and a mechanism for collecting, recording, communication to the relevant department, response, and appeals process, with specific roles and responsibilities at each level. The grievance mechanism will be accessible at project sites, and at DWS, PNPs, the District and Provincial PWT (MPWT) and Nam Saat (MOH). Reporting on the grievance mechanism will be part of the standard progress report of the PMU. Regardless of point of entry of the grievances, proper recording of grievances received, dealt with in a timely manner and resolved should be collected in a central database for efficient tracking.

15. Climate change: The design and construction of water supply systems will be done taking into account the current and future climate change effects. Water resources will be assessed in the wet and dry seasons to assure sufficient supply. Ongoing monitoring of water resources will allow for analysis of trends in water availability. For springs or water streams, the systems will be gravity fed, which will contribute in minimizing the use of electricity. If groundwater is used, solar pumping will be explored. Given the vulnerability to floods in some project areas, the design infrastructure will include elements to reduce infrastructure vulnerability, such as construction of water reservoirs in elevated areas, allow enough depth for water pipes so that in case of floods the pipes don’t get exposed, and in water scarce areas, the infrastructure will be designed to withstand the droughts by continuing to provide water for domestic consumption. Both new and rehabilitated water infrastructure will directly increase the water supply, thereby enhancing the project area residents’ resilience to droughts. The construction of a centralized water system (especially in areas where there was none before) will further help mitigate the drought risk. Moreover, tariff collection will cover O&M costs, making the water supply systems more reliable and thus enhancing communities’ resilience to floods and droughts (by reducing the risk of a system malfunction). The capacity building and training activities to the local communities will contribute to the adaptation of climate change effects, as the communities will acquire knowledge to effectively operate and manage the systems, carry out small maintenance and parts replacement activities. These actions will contribute to the sustainability of the infrastructure and increase the community resilience to floods and/or droughts. The twin pit latrine eliminates the need to build another latrine once the existing is filled up. This will contribute to the adaptation to climate change as the contamination of ground water will be reduced and the vulnerability and exposure of the communities to contaminated water will be also be reduced. These activities will be financed directly under Component 1 of the project and integrated into the project cycle.


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ANNEX 3: IMPLEMENTATION ARRANGEMENTS

COUNTRY : Lao People's Democratic Republic Water Supply and Sanitation Project

Project Institutional and Implementation Arrangements National Level

1. The project will be implemented through MPWT and MOH. Components 1, 3 and 4 will be implemented by MPWT

and Components 2 and 4 by MOH. MPWT will be the lead project implementing agency, with a Project Management Unit

(PMU) in the Department of Water Supply and Project Implementation Units at the district level. A Component

Management Unit (CMU) will be established in Department of Hygiene and Health Promotion (with technical support

being provided through Nam Saat) under the MOH.

2. Project Steering Committee (PSC). An overall Project Steering Committee (PSC) will be established with

representation from MPWT, MOH, Ministry of Education and Sport (MOES), Ministry of Natural Resource and

Environment (MoNRE), Ministry of Planning and Investment (MPI), Ministry of Agriculture and Forestry (MAF), Ministry

of Finance (MoF) and the Provincial Vice Governors of the project provinces. The PCS will oversee overall Project

implementation. The main tasks of the PSC are to: (i) provide overall guidance for project implementation, coordination,

monitor progress, (ii) provide the PMU and CMU with guidance for project implementation and endorse the annual

implementation action plan and budget, (iii) review and approve major implementation issues (for example for the

revision of the operational manuals or major reallocation of funds among activities), and (iv) policies and activities related

to the convergence approach to address stunting, The PSC members will be the Vice Minister MPWT (Chair) and Vice

Minister MOH (Co-Chair), Director General (DG) DWS, DG DHHP, DG MOES, MOF, MPI, MAF. The PSC meet will meet at

least once a year, and in addition, on an as-needed basis.

3. Project Working Group: A working group consisting of the Director Generals, project and technical staff of DWS

and DHHP, will be established at the national level to ensure coordination between Component 1 and Component 2

activities and to ensure that the project is implemented effectively, and issues are resolved on time. The Working Group

will meet quarterly, and as needed, to review the project plans and progress, and report to the PSC.

4. Memorandum of Understanding (MoU). A MoU between MPWT, MOH, MOES and the four Provincial Governors

will ensure clear division of roles and responsibilities at the central and sub-national levels, and accountability for project

results. The MoU should be signed prior to the commencement of project implementation. This will also include joint

mechanisms for overall policy development at the national level, and division of implementation responsibilities at the

national and subnational levels. MOES will be responsible for the ongoing O&M of water supply and sanitation facilities

built in schools.

5. Project Management Unit (PMU). The Project Director will be appointed from MPWT. The PMU will be

responsible for the implementation of Components 1, 3 and 4. The PMU will review and update the implementation

schedule for all project activities and disbursement plan, jointly with the Department of Finance (DoF). DoF will have

overall responsibility for financial management of the project. The PMU will prepare the Annual Work Plan and Budget

with DoF and submit to the World Bank for review. The PMU will consolidate reports from the PMU and CMU for all

reporting to the World Bank, review and approve technical reports, prepare and update the Project Operation Manual

(POM) in cooperation with the CMU and ensure that it is followed, ensure that audits (technical, social, procurement and

financial) are carried out for the project as a whole, in coordination with the CMU; ensure safeguard activities are


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implemented, and identify and resolve issues related to implementation constraints or delays. The PMU will be

responsible for the procurement and payments related to Components 1, 3 and 4. The PMU will coordinate with other

MPWT and MOH departments, including DoF, Environmental and Social Division of the Public Works and Transport

Research Institute (ESD/PTRI), Department of Planning (under MPWT) and CMU. The PMU will assign staff to coordinate

with PoNRE for obtaining an Environmental Compliance Certificate (ECC) for the construction, conduct compliance

monitoring of construction activities with the CMU and PIUs, and conduct the reporting during construction. The PMU

will consolidate quarterly and yearly progress reports for the project (including inputs from the CMU), and will monitor

and report on project progress to the Project Steering Committee and the World Bank. The Project Director will be

supported by the National Project Manager, Implementation Support Consultant, Financial Management Specialist;

Procurement Specialist, Monitoring and Evaluation Specialist, Safeguards Specialist and Administrative staff.

6. Component Management Unit (CMU). The CMU will be responsible for the implementation and reporting of

Components 2 and 4 activities. As provided in Component 2, the CMU will provide technical and advisory support for the

implementation of the integrated WASH project cycle under Component 1. The CMU will be headed by a Component

Manager, who will be appointed by the MOH. The CMU will be situated in the Department of Hygiene and Health

Promotion (DHHP) with close collaboration with Department of Planning and Cooperation (DPC) and Department of

Finance (DOF), and technical inputs to be provided by Nam Saat. The CMU will be supported by a Procurement and FM

consultant. The CMU will manage and administer the resources made available to Components 2 and 4, in accordance

with agreed guidelines, systems and procedures, and organize, direct, control and monitor the implementation of

activities. The CMU will undertake procurement, review progress and approve payments for all activities under

Components 2 and 4. The CMU will assign a person responsible for safeguard implementation, and work in cooperation

with the PMU and PIU on compliance monitoring during construction and operation, as part of on-the-job training to

maintain environment and social principles through the sustainability phase. The CMU will prepare reports and share

with the PMU timeously for consolidated reporting to the World Bank. The CMU will share the annual progress with the

National Nutrition Committee. The CMU will be responsible, in cooperation with the PMU, for the development of

coordination mechanisms with ministries and departments implementing other convergence projects, and coordinating

knowledge, SBCC and M&E activities related to convergence.

Provincial Level

7. Provincial Project Coordinating Committee (PPCC). A PPCC will be established, chaired by representatives from

the Provincial Governor’s Office, and consisting of provincial representatives from Provincial DPWT, PNPs, Provincial

Health Department, Nam Saat, Education and Sports Office, Women’s Union, Lao Front for National Construction and

Youth Union (at provincial level). The role of the Provincial Department of Public Works and Transport (DPWT) and PNPs

is for the planning, development and management of the infrastructure and services in each province on behalf of, and

under the overall supervision of, the Provincial Governor. The role of Provincial Health Department and Nam Saat is to

provide rural water supply, sanitation and hygiene support, under the overall supervision of the Provincial Governor.

Provincial coordinators will be appointed from both Provincial PWT and Provincial Health Department to support the

project implementation, supervision and coordination from central to subnational levels.

District Level

8. District Steering Committee will be chaired by representatives from the District Governor’s office, and consist of

District Office of Public Works and Transport (OPWT), District Health office and Nam Saat, Education and Sports Office,

Women’s Union, Lao Front and Youth Union (at the district level). The steering committee will be responsible for

coordination with other convergence projects working in the district.


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9. Project Implementing Unit (PIU). The PIU is the implementing arm of the PMU at the district level. The project

manager will be appointed by the provincial or district PWT. The PIU will be responsible for the implementation of the

project cycle at the village level and deploy and supervise the resource agencies contracted through the project

responsible for (i) community mobilization and (ii) engineering survey, design and supervision. The resource agency will

be responsible for village level monitoring, supervision, and reporting, including implementation progress, procurement

oversight, financial management. The PIU will coordinate with District Health Office and PWT and will be responsible for

implementation monitoring and reporting to the PMU. The PIU with technical support from both public works office and

health office, will be responsible for supervision and sign-off of water supply systems, sign-off of village integrated

development plans and asset hand-over.

10. District Health Office. At the District Health Office, a consultant will be hired to support the District Health Office

and Nam Saat for project coordination and administration related tasks. The PIU and District Health Office will coordinate

with the existing district nutrition committee on matters related to convergence.

Village Level

11. Village Development Committee (VDC). A sub-committee under each VDC will be established for WASH. This

VDC sub-committee will be responsible for mobilization of the community in the project and will support the

implementation of the project cycle together with resource agencies and other project resources. The VDC sub-

committee will (i) be responsible for collecting all expressions of the interest by the community in participating in the

project, (ii) convene regular consultation meetings with the community to provide updates on the status of the WASH in

the community, discuss the sustainability community plans, monitor the WASH status in the community; (iii) support the

implementation of the SBCC activities, by identifying the target households and convening community meetings for SBCC

activities at the community level, (iv) regularly collect self-monitoring data from the households, schools and health

centers, (v) open and manage a community bank account, collect community contributions to the water supply system

and provide financial reports to the community and sustainability unit in a transparent manner, (vi) participate in

construction supervision of the water supply system; be responsible for O&M of the water supply system and

achievement of ODF; vii) manage the water supply assets and hire a water operator, if agreed with the community. For

community-based systems, it will be responsible for tariff collection and ongoing O&M, and will operate under its own

separate bank account, and for emerging town/kumban/large village, the role of the VDC will be to extend SBCC and

awareness raising, training and coordination with PNP. The committee will share the account details with the entire

community bi-annually. This extended WASH sub-committee will be composed of 3-4 members of the community of

which at least 30 percent will be women, preferably as a president and/or treasurer. In communities with ethnic

minorities, a representative should also be part of the committee.

Financial Management

12. A financial management assessment was carried out in accordance with the “Financial Management Practices in

World Bank-Financed Investment Operations” with the objective of assessing if MPWT, as the lead implementing agency

and responsible for Components 1, 3 and 4, and MOH, as implementing agency for Components 2 and 4, have acceptable

FM systems to provide the Bank reasonable assurance that funds will be used for the intended purpose and enable

project development objectives to be met.

13. The assessed FM risk of the project is Substantial. Weaknesses were noted in the control environment and the

implementing agencies have limited personnel and experience at the central and field office levels. For Components 1, 3

and 4, the Department of Finance (DOF) in MPWT will be responsible for FM and responsible for financial reporting and


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annual audit of the project. For Components 2 and 4, the DOF in MOH will be responsible for FM. There are varying

degrees of FM capacities among the implementing agencies at different levels.

14. There is a risk of poor financial management performance resulting to inaccurate reporting of funds from this

project. The weak control environment may result to the breakdown of internal controls within the implementing agency.

Funds may be used for unintended purposes and there is a risk of errors/mistakes not being detected due to absence of

proper internal controls. The lack of staff experience increases the risk of the budget not being prepared properly and

timely. In addition, the absence of a timely and regular budget execution reporting within a particular period hampers

access to fiscal information necessary for measuring financial performance.

15. The following risk mitigation measures are proposed for the project:

• Two qualified national consultants will be recruited to support assigned staff at DOF-MPWT and DOF-MOH.

The hiring and terms of reference must be acceptable to the Bank. The consultant will provide FM support

as well as providing hands on capacity building to assigned DOF staff in MPWT and MOH.

• As part of the proposed resource agencies, include an accountant position to provide FM support at

provincial and district level.

• DOF finance staff has limited experience in project FM work. Their tasks relating to any previous project work

was limited to reviewing documents and hence will not have sufficient capacity to carry out all FM work of

the project. Finance staff be assigned to work on project FM will be given a well-defined TOR.

• Financial Management Manual (FMM) used in other Bank projects is in place and assessed to be acceptable

by the Bank. A Contingent Emergency Response Manual (CERM) has been prepared and adopted for the

project.

• Submission and approval by the Bank of annual work and financial plan.

• Provide training to staff concerned once the project is effective.

• ACCPAC software with some configuration will be used to record transactions and produce project financial

reports. Separate Books of Account will be maintained for the project.

• PMU and CMU will submit Interim Financial Reports (IFRs) per semester (six months) no later than 45 days

after the period end.

• Annual audit which will include audit of activities implemented at the village level on a sample basis, carried

out by qualified independent audit firm acceptable to the World Bank. Annual audited financial report to be

submitted 6 months after the end of each calendar year.

FM Organization and Staffing

16. Department of Finance – MPWT. The MPWT-DOF is responsible for the FM of the MPWT. The Accounting

Division under MPWT-DOF is composed of 7 personnel and 2 local consultants that are project based. Their backgrounds

are mostly in finance and they have considerable experience. Although MPWT-DOF staff is highly experienced, staff will

be overloaded with additional work which could result in delays in reporting and replenishment of funds and inadequate

oversight. Overall, provincial and district capacity is weak, with limited staff. Hence, consultant support in various levels

will be required.

17. Department of Finance – MOH, DHHP and Nam Saat. The number of staff at MOH-DOF is relatively small and

English language skills are basic. Finance staff at provincial and district level are also limited in numbers and experience

and already overloaded day to day work. Technical support from a qualified FM consultant will be required.


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18. In addition to FM staff at the central level, the project will be implemented by the field offices of MPWT and

MOH in the provincial and district level. These field offices have varying capacity and capacity building for FM and

establishment of clear FM guidelines is critical in ensuring the smooth implementation of the project.

19. To ensure that FM systems are adequately addressed, MPWT and MOH will hire dedicated and well-qualified FM

personnel for project implementation. Two (2) national FM consultants in the central office of MPWT and MOH will be

hired, subject to the Banks’ acceptance of the TOR and review of the procurement process. In addition, the project will

also hire additional FM personnel in the provincial and district office as needed, who will facilitate FM requirements and

monitor financial reporting requirements from field offices and partner agencies. The two national consultants will

facilitate the capacity building of FM personnel at the beginning of the project.

Budgeting

20. A budget shall be prepared for each component annually and cover the period of the GoL calendar year (January

to December) and in accordance with the approved overall project work plan. The PMU and CMU will finalize costing to

include cost per component and cost per expenditure category and this will be summarized in the Annual Work Plan and

Budget which will be submitted to the Bank for No Objection in November of the preceding year. MOH will submit the

Annual Work Plan and Budget to MPWT for consolidation and submission to the Bank. The quality of budgeting and

forecasting will be strengthened as part of support provided by the FM consultants. This will facilitate the use of variable

ceiling of the designated account based on six-month cash forecast.

Accounting

21. Cash basis of accounting will be used by the project with provisions for accrual at year end to prepare financial

statements. ACCPAC accounting software is currently used in projects of MPWT and MOH to record transactions and

produce project financial reports. The software can also be used for this project. The provincial and district level will

also use the same software to record transactions and to enable automatic download of financial data.

22. Separate books of account will be maintained for the project. Manual accounting system using Excel will be used

initially but ACCPAC to be used eventually to record transactions and prepare financial reports. To properly safeguard

financial data, the FMM will have to establish regular back up procedures and archiving process if none is established.

Internal Controls

23. The project will use the existing Financial Management Manual (FMM) manual of MPWT-DOF and MOH used in

other Bank projects but will need to be updated to consider the peculiarities of the project. The FMM should clearly

define the roles and responsibilities of FM personnel in the Central and field offices. The FM section should also

document the specific reporting requirements, funds flow instructions and audit requirements necessary to show

accountability of transactions.

24. On Component 4 for CERC, the Contingent Emergency Response Manual (CERM) details the FM, procurement,

safeguards, and any other necessary implementation arrangements. Cooperation with MOF and the line ministries is

required to ensure effective horizontal coordination at the national level for disaster preparedness and response. In

addition, vertical coordination of disaster management committees between the national, provincial, district, commune,

and village levels will be promoted.

Funds Flow and Disbursement Arrangements


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25. The lending instrument that has been selected is Investment Project Financing. A Statement of Expenditure (SOE)

based disbursement modality would be used for the download of funds from the Bank to MPWT and MOH. Table 7

shows the expenditure categories for the loan.

Table 7 Allocation of IDA Proceeds

Category

Amount of the

Financing

Allocated

(expressed in SDR)

Percentage of

expenditure to be

financed (inclusive

of taxes)

Goods, works, non-consulting services, consulting services, Training and

Incremental Operating Costs under Component 1 and 3 of the Project 16,900,000 100%

Goods, works, non-consulting services, consulting services, Training and

Incremental Operating Costs under Component 2 of the Project 1,100,000 100%

Contingent Emergency Expenditures under Component 4 of the Project 0 100%

Total 18,000,000

26. Funds Flow from World Bank to MPWT AND MOH for Components 1,2 and 3 are shown in Figure 2. Two

designated accounts will be opened at the Bank of Lao and managed by the National Treasury – one for MPWT and the

other for MOH. The designated account will have variable ceilings based on approved 6-month cash forecast. Applicable

disbursement methods will include (i) advance, (ii) reimbursement, (iii) direct payment; and (iv) special commitment.

Minimum application value for direct payment and reimbursement will be US$250,000. Disbursements will be made

against the expenditure categories in the table above. Reporting of expenditure paid from designated account will be

based on submission of Statement of Expenditure (SOE). Frequency of reporting of expenditure will be a period not

greater than 3 months.

27. For operating costs, the PMU and CMU will also open a project operating accounts to facilitate smoother day to

day operations and for emergency situations. This will be opened at commercial bank with a ceiling of US$500,000 for

MPWT and US$100,000 for MOH. Replenishment from DA to operating account shall be made monthly or when the

balance reaches 20 percent of the ceiling. The funds will be downloaded to provincial and district offices subject to

liquidation. The amount transferred to the provincial and district operating account will be considered as advance

payment. An MoU will be agreed upon by MPWT and MOH to allow opening of operating accounts in their respective

field offices. Procurement and construction of all water supply systems and infrastructure, including procurement of

materials for latrines, will be done by MPWT. No funds will be downloaded to the villages.


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Figure 2 : Funds Flow from World Bank to MPWT and MOH

28. Disbursement for Component 4 Contingent Emergency Response. No withdrawal will be made under

Component 4/Expense Category 3 until the GoL has (a) declared that a crisis or emergency has occurred, and the World

Bank has agreed with the determination; (b) prepared and disclosed all safeguards instruments required for activities

under Component 4 of the project, if any, and the Government has implemented any actions which are required to be

taken under said instruments; (c) established adequate implementation arrangements, including a positive list of goods

and/or specific works and services required for emergency recovery, satisfactory to the IDA, including staff and resources

for the purposes of said activities; and (d) has prepared and adopted an Contingent Emergency Response Manual (CERM)

acceptable to IDA so as to be appropriate for the inclusion and implementation of activities under Component 4.

29. Disbursements would be made either against a positive list of critical goods and/or against the procurement of

works and consultant services required to support the immediate response and recovery needs of the GoL. All

expenditures under this component, should it be triggered, will be appraised and reviewed, if acceptable to the World

Bank before any disbursement is made. All supporting documents for reimbursement of such expenditures will be verified

by the implementing agency, certifying that the expenditures were incurred for the intended purpose and to enable a

fast recovery following the crisis or emergency, before the withdrawal application is submitted to the World Bank. This

verification would be sent to the World Bank together with the application. Expenditures under this component will also

be subject to external audit.


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30. Funds for the CERC will be channeled through a separate designated account denominated in US$ with MPWT at

the Bank of Laos. Withdrawals from the DA will only be made for expenditures incurred related to emergency activities

laid out in the emergency action plan (EAP). MPWT shall be responsible for requesting disbursement of funds in

accordance with the instructions contained in the DFIL and for ensuring that funds are accounted for and their use

reported to the Bank on a timely manner. MPWT will be responsible for all expenditures for this component and may

download funds to the operating account of MOH subject to liquidation. MOH and MPWT should ensure that

expenditures under CERC are properly monitored and reported in the IFRs.

31. The Disbursement methods will include reimbursement, advance and direct payment. The ceiling for DA advance

shall be variable, based on forecast of emergency expenditures for two quarters. Expenditure incurred under Component

4 will be reported as part of the project’s Interim Unaudited Financial Report (IFR) and submitted to the Bank as per the

requirement of the Legal Agreement. Incurred expenditures for Emergency Expenditures under CERC will be audited by

the external auditor alongside other Project activities as indicated in the external audit TOR.

32. Unutilized advances to the CERC’s designated account must be refunded to the Bank, within 6 months after

completion of EAP. CERC’s designated account may remain open and the GoL will ensure that all amounts advanced to

the designated account are accounted for and their use reported to the World Bank on a timely manner, in no case later

than the disbursement deadline date of the WSSP Project.

Financial Reporting and Monitoring

33. The project will follow the GoL calendar year (January to December). Interim unaudited Financial Reports will be

prepared by DOF-MPWT and MOH for the whole project. IFR will cover the period of six months (semester) and due for

submission within 45 days of the end of each semester. The IFR will follow a format agreed with the World Bank and

report at the receipts, expenditure and fund balances and uses of funds by project components/activities. Variance

analysis between actual and budgeted expenditure will be performed and reported as part of the IFR. To facilitate

reporting to the Bank and preparation of project annual financial report for audit, MOH will submit their component IFR

to MPWT for consolidation.

External Audit

34. The Project will be subject to an annual audit by qualified auditors to be recruited on behalf of the project by

DOF-MPWT (audit will cover MOH component), with TORs acceptable to the World Bank. The audit will cover

expenditure incurred at all level and include audit of sample sub-projects to be implemented at the village level. The

audit report together with a management letters will be submitted to the World Bank no later than 6 months of each

fiscal year end. In addition, MPWT and MOH will submit the status of actions taken to address any findings and

recommendations of auditors on the project financial statements. Audited financial statement and audit opinion will

also be subject to disclosure in accordance with World Bank Policy on Access to Information. Mechanism for disclosure

will be agreed.

Supervision Plan

35. FM implementation review shall be undertaken twice a year during project implementation to ensure that the

loan proceeds are used for the purpose it was granted, which may take at the most two weeks. The scope of the

supervision is left to the professional judgment of the FM specialist. It may cover any of the following: (1) review of the

continuous maintenance of adequate FM system by MPWT and MOH; (2) review of project financial reports; (3) follow

up of timeliness of FM reporting and actions taken on issues raised by external auditors; (4) follow up of the status of the

any agreed action; and (5) review of compliance with the financial covenants. In addition, the FM implementation review


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should include desk review of the semi-annual IFRs and audited financial statements and management letter submitted

to the Bank.

Procurement

36. Institutional arrangements for procurement. The DWS under the MPWT will be the lead implementing agency

for the project responsible for procurement activities under Components 1, 3 and 4. DHHP under MOH will be responsible

for procurement activities under Components 2 and 4. The Procurement Plan for the project shall be prepared and

approved by the MPWT.

37. Procurement capacity and risk assessment. The Bank carried out procurement assessment of the implementing

agencies in May 2018. The Bank found that both the DWS and the Nam Saat have limited experience in implementation

of the World Bank-funded projects. Major inadequacies and risks identified and presented in Table 8 may result in

substantial delays of project implementation and/or cause possible noncompliance and irregularities in the procurement

processes. From these, the procurement risk for the project is rated ‘Substantial’. The key mitigation measures in Table

9 were agreed with the project implementing agencies and will be implemented during project implementation to

mitigate the identified risks and strengthen the procurement capacity of the implementing agencies.

Table 8 Identified Procurement-Related Risks and Mitigation Measures

No. Risk/Challenge Proposed Risk Mitigation Measure Responsibility Deadline

1. Limited knowledge and experience of both the DWS and the Nam Saat, with World Bank’s Procurement Regulations

(a) Provide procurement training for the DWS and the Nam Saat’ staff, including initial training during project preparation and in-depth procurement trainings during project implementation.

(b) Recruit a procurement consultant to assist the PIAs in carrying out procurement activities.

World Bank, DWS and Nam Saat

During project preparation and implementation

2. Lengthy internal procurement reviewing and approval process;

(a) Procurement consultant hired should be qualified and have clear responsibilities/ deliverables.

(b) All procurement documents including TOR, technical specifications, bidding documents, RFP and evaluation report shall be prepared properly in accordance to the Bank and Government’s regulations; to avoid lengthy in getting approval from evaluation committee and the Minister.

DWS and Nam Saat

During project implementation

3 Governance risks associated with conflict of interest, fraud, and corruption

(a) Enhanced disclosure of procurement information, including publication of the annual Procurement Plan and a quarterly summary of the contract award information for all procurement packages on the MPWT’s website and in newspapers.

(b) Establish a procurement complaint handling mechanism consistent with the Government Procurement Rules and Regulations of the MOF and the World Bank’s requirements.

(c) Require staff involved in procurement to declare their interest and sign a declaration form.

DWS MOF, DWS and Nam Saat

During project implementation

38. Procurement Plan. Based on the findings and recommendations of the PPSD, which is prepared by the DWS, the

initial Procurement Plan for the first 18 months of the project was prepared. The Procurement Plan will be entered in


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STEP and updated annually (or as needed) by the DWS to (a) reflect project implementation, (b) accommodate changes

that should be made, and (c) add new packages as needed for the project. All Procurement Plans, their updates, or

modifications shall be subject to World Bank’s prior review and no objection. The World Bank will carry out procurement

post reviews on an annual basis with an initial sampling rate of 20 percent, which will be adjusted periodically during

project implementation based on the performance of the project. The detailed Procurement Plan is available in a

separate project document.

Market Assessment

39. Based on the findings and recommendations of the PPSD, the initial Procurement Plan for the first 18 months of

the project was prepared and agreed by the World Bank. The Procurement Plan will be entered in STEP and updated

annually (or as needed) by the DWS and Nam Saat to (a) reflect project implementation, (b) accommodate changes that

should be made, and (c) add new packages as needed for the project. All Procurement Plans, their updates, and

modifications shall be subject to the World Bank’s prior review and ‘no-objection’. The World Bank will carry out

procurement post reviews on an annual basis with an initial sampling rate of 20 percent, which will be adjusted

periodically during project implementation based on the performance of the project. The detailed Procurement Plan is

available in a separate project document.

Procurement Strategy and Procurement Approach

40. The scale of civil works activities includes construction of Water Supply System and for remote communities and

wash facilities in schools and health centers in the project provinces is relatively small ranging from US$ 5,000 to about

US$ 360,000; and there are many national or local contractors that have the capacity to execute such kind of works as

demonstrated by the PPSD. It thus proposes to use RFQ method for contracts less than US$ 200,000 and RFB method

for contracts of equivalent or above US$ 200,000 with national market approach. The procurement of goods comprises

of vehicles, office equipment, furniture, and lab equipment water quality testing kits, which seems of relatively simple

nature and small size of value. The market research as part of the PPSD showed that there are a sufficient number of

potential suppliers in the country that have the capacity to supply those type of goods. Therefore, it proposes to use

RFB method for the contracts with cost of equivalent or above US$ 100,000 or RFQ method for the contracts with cost

below US$ 100,000 with national market approach. The consulting services under the project comprises of (i) two critical

consulting assignments including a Resource agency to implement the project cycle with estimate of about US$ 3 million,

and engineering design firm with cost estimate of about US$ 2 million shall be subject to prior review by the Bank; (ii)

several firm consulting assignments such as UXO survey and clearance and project financial audit with cost estimate

ranging from US$100,000 to 300,000; and (iii) various assignments for individual consultant such as for development of

provincial business plans, tariff policy, organizational development, support the development and testing a

comprehensive sector-wide monitoring system, support the development teaching manual on Water Supply, Sanitation

and Hygiene procurement, financial management, and national implementation support with cost estimate ranging

from US$7,000 to US$200,000. It hence suggests that QCBS and CQS and competitive selection method should be used

for firm assignment and individual assignment respectively with national market approach. International market

approach should also be considered for the contracts that need international experience and international consultants

would be beneficial to the project implementation. The PPSD has shown that there are sufficient national consulting

firms and individuals having the qualifications and experience to provide such type of consulting services.


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Environmental and Social (including safeguards)

41. Institutional capacity to implement the ESMF is considered partly satisfactory based on the past performance of

MPWT in implementing small town water supply and sanitation projects and Nam Saat. Capacity development will

however be needed to ensure that project staff are able to ensure adequate supervision of project activities. DWS has

assigned a safeguard focal point during project preparation and throughout the project implementation phase to

supervise safeguard implementation. ESMF was prepared and being consulted in project provinces by the DWS to ensure

understanding of possible impact and required safeguard measures stipulated in the ESMF. Ongoing advisory support

and training for project staff is recommended during project implementation to ensure adequate supervision and

compliance monitoring of project activities. In accordance with World Bank requirements, a draft Environment and

Social Management Framework (ESMF) was completed and disclosed by the Ministry of Public Works and Transport

(MPWT) on their website on November 12th, 2018, and on World Bank website on November 28, 2018.

Monitoring and Evaluation

42. The project-level monitoring and reporting will be conducted by the PMU supported through Component 3 of

the project. The project-level management information system will track implementation progress, project outputs and

outcomes. It will be used to report on progress and to facilitate learning and adaptive management through the

implementation of the project cycle. The PMU will prepare semi-annual progress reports will also include complete

information on procurement, contracts, disbursements, financial management, beneficiaries and other outputs. Annual

independent audit reports are expected to monitor use of funds and physical progress. In addition, a sector-wide

monitoring system will be developed to support SDG monitoring. To facilitate monitoring of select nutrition outcomes

that cannot be attributed to a particular project or intervention, the sector monitoring system will be harmonized with

the Health Management Information System (HMIS). Each project supporting the convergence approach will develop a

results framework that specifies the results that the project is accountable for, and which contribute to a common

results chain leading to reductions in child stunting (Annex 1). A common Monitoring and Evaluation (M&E) Framework

(Annex 7) will guide the M&E activities across the convergence projects and areas, and pooled resources will be used to

finance nutrition-related M&E activities, such as impact evaluation.

Role of Partners (if applicable) Not Applicable


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ANNEX 4: IMPLEMENTATION SUPPORT PLAN

COUNTRY : Lao People's Democratic Republic Water Supply and Sanitation Project

Strategy and Approach for Implementation Support

1. The World Bank’s implementation support strategy has been developed based on the nature of the project, its risk profile, the capacity of the implementing agencies and partners, and the lessons learned from the past World Bank operations. The overall implementation risk as Substantial with the following elements of risk considered to be high: (i) Sector strategies and policies; and (ii) Institutional capacity for implementation and sustainability. Since the institutional structure and approach proposed in the project is nascent, in addition to the need to coordinate across ministries to achieve stunting targets, the project will require substantial support in the early years of implementation. Implementation support will be provided by the World Bank team consisting of staff with relevant competencies in operations, procurement, finance, and safeguards. The World Bank team will undertake periodic field missions throughout the project’s implementation as required.

Implementation Support Plan and Resource Requirements

2. The implementation support plan includes frequent review of implementation performance and progress. The World Bank team will monitor progress on (i) key performance indicators as defined in the Results Framework; (ii) central, provincial and district -level project implementation; (iii) proper fiduciary management of all activities carried out by the PMU and other implementing agencies; (iv) reconciliation of payments with contracts; (v) supervision of procurement activities; and (vi) monitoring of key legal covenants.

3. Information from various sources will be used to assess and monitor the progress of the project throughout its implementation (Table 9). Data generated through the project’s management information system and M&E systems will be used, as well as formal semiannual implementation support missions and field visits to the project target areas. Ongoing support will be provided to the implementing agencies. The semiannual Implementation Status Reports will be produced to provide the World Bank management and the public with progress updates, tracking risk development and efficacy of mitigation measures. In addition to Implementation Status Reports, periodic briefings will also be prepared for World Bank management. It is proposed that in the first two years of the project implementation, three missions per year will be conducted.

Table 9 Implementation Support Plan and Resource Requirements

Time Focus Skills Needed Resource Estimate

Partner Role

First twelve months

• Project launch

• Initialization of project components

• FM systems functioning effectively

• Procurement practices following World Bank norms

• Team lead

• FM, procurement, safeguards specialists

• WASH Specialists

• Health and nutrition Specialist

• M&E specialists

80,000 • Fully staffed PMU and CMU to operationalize project components

• Contract project management and technical support firms in place

• Update implementation plans and procurement plans routinely

12-48 months • Monitor implementation • Team lead 100,000 Prepare comprehensive project


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of project activities

• FM, procurement, and safeguards

• MTR

• FM, procurement, safeguards specialists

• WASH Specialists

• Health and nutrition Specialist

M&E specialists

progress and results monitoring reports in advance of each mission

Other

Skills Mix Required

Skills Needed Number of Staff Weeks Number of Trips Comments

Team Lead 85 25

Water Supply Specialists 120 25

Sanitation Specialists 120 25

SBCC Specialist 40 25

Health and Nutrition Specialists

40 15

M&E Specialist 40 15

FM Specialists 30 15

Procurement Specialist 30 15

Social Specialists 30 25

Environmental Specialist 30 25

Partners

Name Institution/Country Role


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Benefits of undertaking the project

1. The project is aligned with the National Nutrition Strategy (2016 – 2035) and Plan of Action, the National Growth and Poverty Eradication Strategy (NGPES) and the National Social Economic Development Plan (NSEDP). The national nutrition strategy is based on a multi-sectoral convergent approach and targets locations where interventions to reduce stunting should be prioritized. These priority areas include improved access to safe water supply and sanitation services.

2. The project will play a key role in the overall approach to reduce stunting61 and improve the health and education of children. Lack of adequate water supply and sanitation access causes environmental enteric dysfunction which is implicated as a cause of child stunting. As discussed in Section B. (Sectoral and Institutional Context) above, access to safe water supply and improved sanitation decreases the incidence of diarrhea in young children and reduces diarrhea morbidity by 28 to 34 percent. The effects on school attendance and performance are also significant.

3. If the water supply and sanitation interventions were not made, then the convergence strategy to reduce stunting and improve overall child development would fall short. Specifically, not undertaking the project would result in: (a) little, if any, change in the rate of open defecation; (b) no improvement in the incidence of diarrhea; (c) not adequately addressing environmental enteric dysfunction; and (d) reduced access to primary education.

4. A final benefit of the Project is its overall poverty focus. As already described in Section A (Country Context), in the country’s poorest quintile only 56 percent has access to improved water supply, compared with 95 percent in the highest quintile. For access to improved sanitation, 23 percent of the poorest quintile has access to improved sanitation--against 99 percent of households in richest quintile. Seventy-two percent in the poorest quintile continue to defecate in the open, 48 percent of primary schools and a quarter of health facilities do not have access to safe drinking water and sanitation facilities. In the villages where the project will be implemented, significant improvements in all these indicators is expected.

Economic analysis methodology

5. Cost-benefit analysis is not appropriate for this project, as most of the project’s costs do not lend themselves easily to being assigned a precise monetary value. For example, the current costs to households for water and sanitation vary widely across the approximately 450 villages targeted under the project. The technologies used, raw water sources, and fecal sludge management practices (and their associated costs) for this number of locations would be very difficult/impossible to generalize or average—thus preventing a “before project” cost estimate.

61 Improvements in water supply and sanitation need to be combined with other measures to reduce child stunting. Nutrition-specific interventions (addressing undernutrition directly) need to be implemented alongside nutrition-sensitive interventions (usually outside of the health sector, including WASH).

ANNEX 5: ECONOMIC ANALYSIS


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6. For this reason, a cost effectiveness methodology has been used for the economic analysis. The section below presents the case that the selected investments are the most cost-effective alternatives to meeting the project’s Development Objectives. Following that discussion, it is demonstrated that the components examined are also appropriate for the public sector to undertake.

7. The components included in the cost effectiveness analysis are shown in Table 10 below.62

Table 10 Project Components Included in the Cost Effectiveness Analysis

Component Description Amount (US$M)

1 Delivery of infrastructure and sustainability of water supply in larger villages/kumban/emerging towns

21.02

2 Sustainability of community water supply, and sanitation and hygiene support

1.57

3 Implementation support, sector development and coordination

2.40

Total 24.99

Choice of Investments

8. Consistent with a least cost approach to achieving the Development Objectives, the project supports investments that are the most cost effective and focus on the public provision of key water supply sanitation and infrastructure. The project finances low cost and simple initiatives, with an emphasis on safe water supply, effective fecal sludge management and behavior change. The menu of activities includes:

• water supply systems for new villages;

• scaling up and expansion of existing village water supply systems;

• optimization of existing underperforming village water supply systems;

• resource agencies for community mobilization, training; and resource agencies for engineering design for large and small systems;

• implementation guidelines and training modules;

• construction of toilets and handwashing stations for schools and health centers; and

• sanitation incentives for vulnerable groups.

9. In summary, the project’s emphasis is on low cost, simple technology and proven interventions, all designed to provide a significant improvement in access to safe water supply and fecal sludge management, and through those goals achieve a multiplier effect on the overall convergence (stunting) agenda.

62 These components represent 100% of the total cost of the project, not including an estimated US$0.9 million counterpart financing


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Public v. private alternatives

10. There are many instances of small-scale private sector provision of water supply in Laos. The exact market percentage by the private sector is unknown, however it is not thought to exceed ten percent of the total market. The reason for the very low level of private sector participation for water supply is the uncertainty of profit potential at the village level. Thus, despite the potential for gain, private sector participation is well below the demand for these services, and will likely remain inadequate for the foreseeable future.

11. The list of all public investments was examined during the design phase of the project the results of this review are shown in Table 11 below.

12. Seventy four percent of the costs under analysis are for investments where there could be private sector interest but are characterized by insufficient information (i.e., profitability uncertainty) which ultimately prevents private sector intervention.

13. Twenty-four percent of the analyzed costs are for investments in an area reserved for the public sector (e.g. project management, monitoring and evaluation, sector planning, sanitation incentives, and communications about the project and behavior change).

14. The remaining two percent finances investments with externalities that, without Government intervention, would result in sub-optimal level of the good provided. For example, these costs are allocated for items such as capacity building for sustainability, convergence promotion, remote village guidelines, district sanitation plans and the orientation and training of provincial and district officials. Because the private sector would have few, if any, opportunities to charge (or charge enough) for these goods, they would not be interested in providing them and public intervention is, therefore, warranted.

Table 11 Rational for Public Sector Investment by Project Component (US$M)

Component

Project Component

Market Failure Reserved Function

Externalities Information Incomplete

1 Delivery of Infrastructure and Sustainability of Water Supply and Sanitation

0.02 18.57 2.43

2 Sustainability of Community Water Supply, Sanitation and Hygiene Support

0.43 1.14

3 Implementation Support and Sector Development

2.40

Total 0.45 18.57 5.97

Percent of Total 2% 74% 24%

Beneficiaries of the project

15. Beneficiaries of this project include the residents of about 450 villages and 13 schemes throughout the country, the Ministry of Public Works and Transport (MPWT) Department of Water Supply (DWS) and Ministry of Health. All these beneficiaries will receive investment funds and technical assistance. In addition, their capacity for better management of water and sanitation services will be increased, which should also provide an incentive for implementation.


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16. As mentioned above, the Project will have a positive impact on poverty. Estimated poverty-reduction benefits, quantified to the extent possible using current prices and expected behavior changes are illustrated in Table 12. There are other benefits as well, which could not be quantified - benefits due to greater availability of water per capita, increased school attendance due to time saved from fetching water and improved WASH facilities in school, and intangible benefits such as improvements in the wellbeing of children, decreased susceptibility to diseases, reductions in child stunting, enhanced cognitive development, increased time for caring for small children and leisure, etc.:

Table 12 Estimated Poverty Reduction Benefits for 15 Years Discounted at 10 Percent

Benefits US$M63

Avoided Cost of Illness64 13.02

Avoided Cost of Bottled Water65 1.36

Time Savings from Improved Water Supply66 2.03

Total 16.41

Source: Lao Social Indicator Survey 2018, Global Burden of Disease tool, World Bank Databank, and various literature.

17. However, there are some parties that will likely oppose the Project. The most important of these are private sector groups that would eventually like to provide water and wastewater services in the villages. As discussed above, the rural water sector has not presented attractive commercial revenue opportunities for the private sector so far. It is possible that the improved institutional capacity and introduction of tariffs for rural users in the targeted villages and the demonstration effects in the non-Project villages may eventually pave the way for the private sector to provide services in those areas, thus mitigating these risks.

Fiscal Impact

18. Over the 5-year implementation period, the Government will take a loan of US$25 million under the project, with annual investment of about US$ 4-5 million in each of CY19-23. This annual level of investment is substantially less than one percent of the country’s total 2017 gross government investment (about US$1.5 billion) and should not pose any overall fiscal constraint.

19. There will be an increase in recurrent expenditures67 resulting from the new infrastructure under the Project. These are estimated at less than US$0.6 million per year.

20. Repayment of the loan from IDA (US$25 million) is the responsibility of the Ministry of Finance. The currency of the loan will be denominated in US Dollars. The terms of repayment, including the grace period will be laid out in the Financing Agreement68.

63 All amounts are in 2018 US dollar terms discounted over 15 years at 10 percent, with actual amounts starting only from Year 4 of the project to account for the lag between start of construction and uptake of service by people 64 The illnesses avoided are Diarrhea and Typhoid 65 With the improved source of water supply, 80 percent of the population is assumed to switch away from bottled water 66 The opportunity cost of fetching water in the form of foregone wages is assumed only for adult members of the household 67 Expenditures include operational costs on government staff and costs incurred in hiring consultants to support the PMU. To be updated with the costs of operation and maintenance once the figures are available. 68 Information to be updated here when the Financing Agreement is available.


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Mid-Term Review

21. The Project’s mid-term review is scheduled for the end of CY2021. The mid-term review will be used to adjust project components and reallocate effort and resources as appropriate. In the context of the economic analysis, the following items are scheduled to be addressed and assessed at the mid-term review:

• The quality of water is assessed to be free of bacteriological and chemical contamination. This has implications for both the health of the population and hence benefits arising from the cost of avoided illnesses, and the reduced expenditure by beneficiaries on bottled water as a result of improved quality of public water services;

• There is a decrease in time incurred in fetching water by households as verified by customer satisfaction surveys; and

• The recurring expenditure resulting from the new infrastructure is as per planned cost schedule to avoid overshooting of the budget.

22. To ensure that the required information will be available, planning for the mid-tern review will be discussed in the project launch workshop and then followed up during supervision. Well in advance of the actual date of the mid-term review, the concerned implementing agencies will be asked to provide relevant documentation for prior review and to formulate action plans as required. The Bank will also ensure that staff with the appropriate skill mix will participate in the mission.


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ANNEX 6: FRAMEWORK FOR A COMMON SBCC AND COMMUNICATION STRATEGY FOR THE NUTRITION CONVERGENCE APPROACH

1. Creating a common vision of planning and implementing a strong and coordinated evidence-based Nutrition SBCC Strategy and Action Plan would be critical for the success of the overall convergence approach. The proposed SBCC approach is behavior centered to facilitate individuals, households, groups, and communities in adopting and sustaining nutrition-related practices. It complements the National Social and Behavior Change Multisectoral Communication Strategy for Nutrition by designing an approach for four World Bank-supported operations: HGNDP (P151425)/HANSA Project (P166165), Reducing Rural Poverty and Malnutrition Project (P162565), Scaling-Up Water Supply, Sanitation, and Hygiene Project (P164901), and the PRF III Additional Financing (P157963).

Social and Behavior Change and Communication

SBCC activities can be categorized into two primary types—mass media and community-based approaches—and successful campaigns are best delivered in a complementary manner. In addition, SBCC also includes advocacy activities for nutrition, targeted at different levels of leaders and decision makers. Mass media approaches can be in the form of ‘edutainment’ or social marketing campaigns. Edutainment is characterized by radio and television messages, dramas aired on radio or television, and songs containing relevant messages and may also include social media. In contrast, community-based approaches leverage social networks, outreach activities, and peer influence to promote discussion among communities, within households, and among peers. They aim to influence the utilization of services and behaviors through norms, information, emotional drivers, and social and peer support. These approaches can be delivered in the form of community edutainment events, community discussion groups, peer groups, or one-on-one exchanges and are often targeted at specific subpopulations (such as pregnant women, women with children under a certain age, men, and adolescents).

In the 12 districts of the four priority provinces, the HGNDP supports community-based SBCC activities aimed at contributing to improvements in infant and young child feeding and caring practices, maternal nutrition and related caring practices, appropriate sanitation and personal as well as environment-related hygiene behaviors, household air pollution through use of near smokeless cookstoves, dietary diversification, and other determinants of nutrition at the village level. VFs, who comprise mostly female village health volunteers and/or members of LWU, support the SBCC implementation at the village level, under the guidance of district health staff. The VFs are responsible for organizing communications sessions at least monthly, conducting home visits for follow-up on pregnant women and children under two years of age, supporting the organization of edutainment community events, and coordinating with relevant district line ministries.

2. Convergence for an effective delivery of SBCC will be achieved in the following manner:

Thematic convergence. The thematic convergence builds on UNICEF’s framework to address the underlying, basic, and immediate causes of malnutrition, all of which are behavior related (see Figure 3). All projects are designed to include nutrition-specific and nutrition-sensitive interventions to improve (a) care and feeding practices, (b) household food security, and (c) household environment and health services. The related SBCC interventions will be carried out in a coordinated and phased manner.


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Note: MCH = maternal and child health; SP = social protection; WB = World Bank; WRA = women in reproductive age

Figure 3 Framework for the SBCC Delivery Pathways to Improved Behaviors and Nutritional Status

3. Communications convergence through coordinated SBCC planning and implementation:

(a) Identification of messages based on sector (and which is therefore nutrition-specific or nutrition-sensitive) but linked to overarching behaviors that contribute to the nutrition agenda in Lao PDR. Figure 3 provides key practices per sector, which can be grouped into seven clusters. These clusters are: (i) maternal nutrition; (ii) health care seeking behavior; (iii) breastfeeding and complementary feeding practices; (iv) WASH and environmental health; (v) nutrition-sensitive agriculture practices (including food processing); (vi) income/household expenditures/savings; and (vii) women empowerment. The evidence supporting the positive relationship between each practice and nutritional status has been documented in other documents of the World Bank convergence approach. It is important to note that the practices presented in Figure 3 are not exhaustive; there are many sub-practices that can be added at a later stage.

(b) Complementary messaging by the various projects using primary messaging from one’s own sector to meet specific project and sector goals, supplemented by secondary/support messaging from other projects/sectors. These complementary messages feed into the same behavior change. Using this method serves to provide the beneficiary with many more reasons to change their behavior/adopt the new behavior and also reiterates the message from a new angle (avoids communication fatigue, which is a result of straightforward repetition).


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(c) Communication will be coordinated to focus on the behaviors of those who need to practice the desired behaviors, for example, mothers and other caregivers but also those who can influence decisions. The SBCC framework identified four types of audiences (see Figure 3): The primary audience includes women in reproductive age (women ages 15–49 years, in particular those who are pregnant and with children under two years of age) and other caregivers. The secondary audience includes other family members and peers/group members—this will include those producing food (farmers). As the tertiary audience, the focus is on community leaders (for example, Village Development Committee, VDC) who can mobilize or allocate resources as well as local GoL service providers (including primarily maternal and child health, WASH, and agricultural service provision). As the final target group, central GoL, private sector, and other DPs will be targeted.

(d) Same or similar delivery platforms from national to community level (see Figure 4). Develop and improve communication for better coordination between the PMUs of different projects and the line ministries at the national, provincial, and, in particular, the district and village levels. This can be done by using an existing committee and inviting convergence project personnel to its meetings, by using a common planner at the village level to earmark main meetings, by coordinating high-level visits, and so on. At the village level, a concerted effort should be made to coordinate village groups, in particular, with a view on sustainability.69

69 Example: PRF’s proposed wireless communication and networking groups (WCNGs) can be a good forum for WASH to promote safe water practices or the building of household-level handwashing stations. The ongoing HGNDP already supports the implementation at the community level of the national nutrition SBCC plan in the form of community edutainment events, community discussion groups, peer groups, or one-on-one exchanges that are often targeted at specific subpopulations (such as pregnant women, women with children under a certain age, men, and adolescents) and CLTS in the 12 selected districts (10 of these districts overlap with the PRF districts). Starting in 2019, the WASH Project expand these efforts in the 12 districts. In the villages that do not have a WASH project, CLTS can be carried out by the other projects such as the HGNDP, HANSA, or PRF.


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Note: IEC = Information, Education and Communication; WB = World Bank; N=National; P=Provincial; D=District

Figure 4 Framework for Common Nutrition SBCC Strategy

Under this multisectoral nutrition convergence approach, the convergence projects will endeavor to coordinate their planning to dovetail efforts at the community level, thereby enhancing synergy and reducing redundancy and message fatigue. Some of the areas wherein this can be achieved include:

(a) By coordinating village-level SBCC action plans and, to the extent possible, having all projects working within an agreed time frame to deliver the various SBCC interventions to the same households in any particular village.70

(b) By jointly carrying out certain activities with other projects or combining project activities in one event at the village level, thereby increasing visibility for all projects, and helping reinforce the impact of SBCC. Example: Health, social protection, WASH, and PRF could jointly do village cleaning or PRF village planning meeting.

(c) In continuation, trying to achieve a common branding (including logo and legend) for the multisector nutrition agenda (see Figure 4) and using it both at the national level (for example, for the National Sanitation Campaign planned under the Water Supply and Sanitation-WSS- project) as well as for the village level (to increase interest and recall).

(d) In continuation of points (a) and (b), using similar and standardized communication tools and channels at the village level, which are simple to use. Different projects could be using a similar communication style across projects. For example, pictorial and similar in their look and usage. Short

70 The cycle should be no longer than 2 years to deliver all the messages.


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audio-visuals could be used to deliver complementary messaging, which can be shown at meetings of any project and would still be relevant.

(e) Joint training and orientation of project staff at various levels, to increase synergy and strengthen the institutional links between PMUs/line ministries.

Overall Communication Strategy for the World Bank-financed Nutrition Convergence Approach

4. All projects would have to be aligned in the overall communication on the multisectoral nutrition convergence approach. National-level advocacy for the World Bank multisector approach on nutrition and increasing communication within the Government and within the stakeholder community through workshops, publications, sharing of key learnings through common social media platforms, discussion groups with DPs, and so on will need to be fully coordinated.


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ANNEX 7: MONITORING AND EVALUATION FRAMEWORK FOR THE NUTRITION CONVERGENCE APPROACH

1. The World Bank will closely monitor the implementation of this multispectral nutrition convergence approach. A comprehensive M&E framework will be established specifically to: (a) track the convergence of the World Bank’s portfolio of nutrition interventions at the village level; (b) report on nutrition indicators; and (c) quantify the impact of the convergence approach, its cost-effectiveness, and effectiveness of individual interventions that are associated with individual projects. This will be achieved by tracking the delivery of interventions at the village level, process monitoring, measuring household- and individual-level outcomes, and imbedding impact evaluations in the projects to measure attributable impacts of the portfolio interventions. An overall summary of the M&E Framework is provided in Figure 5.

Figure 5 Overview of the M&E Framework


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2. Monitoring activities shall focus on monitoring the delivery of interventions to assess the achievement of convergence and tracking progress on the utilization of nutrition-specific and nutrition-sensitive services and nutrition outcomes. Thus, the monitoring system shall track input and output delivery and nutrition outcomes committed in the list of convergence result indicators and related intervention activities. The evaluation framework is set up to measure the impact at the portfolio level and the project level. The portfolio-level evaluation assesses the effectiveness of the convergence approach on nutrition outcomes while the project-level evaluation assesses the impact of specific interventions on the achievement of intermediate outcomes, as well as process or delivery mechanism evaluation.

Monitoring of Outcomes

3. The monitoring framework will be designed to regularly report on the progress in improving nutrition behaviors and outcomes at the individual and household levels in program areas. Some of the outcome indicators will be obtained from administrative data sources, especially the projects’ MIS, but the majority shall be monitored using harmonized household surveys (see Table 13). The harmonized household surveys will include a standardized set of questions in separate modules, to measure the key indicators for the convergence result indicators and project-specific indicators, depending on the final implementation arrangements. The definitions and measurement methodology for each of those indicators will be based on the project-specific guidelines for such measures, with teams from each of the four projects taking leadership in the design of the modules of their respective projects. The convergence M&E team will take overall responsibility on the survey design and field implementation plans.

Table 13 Monitoring Plan for Convergence Result Indicators

Indicator Name (Disaggregated by Gender, Ethnicity, and Welfare Status)

Data Source Frequency Start Year End Year

Under 2 years old stunting rate Harmonized household survey

3 times 2019 2024

Percentage of children under two years of age whose growth is adequately monitored

Harmonized household survey

3 times 2019 2024

Percentage of infants 0–5 months who are exclusively breastfed


3 times 2019 2024

Percentage of children 6–59 months receiving vitamin A supplementation within the past 12 months


3 times 2019 2024

Percentage of pregnant women with at least 4 ANC during pregnancy


3 times 2019 2024

Number of households with pregnant women and/or children 0–2 years in target provinces receiving cash transfers

Social protection project MIS

Annually 2020 2024

Percentage of project beneficiaries who participate in community nutrition sessions at least once per month


Annually 2020 2024

Percentage of children 6–23 months of age consuming foods from four or more recommended food groups


3 times 2019 2024

Percentage of households with access to improved sanitation Harmonized household survey

3 times 2019 2024

Percentage of households with access to clean water Harmonized household survey

3 times 2019 2024

Proportion of households with soap at handwashing stations Harmonized household survey

3 times 2019 2024

Proportion of households that use proper disposal techniques for child and animal feces


3 times 2019 2024


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Indicator Name (Disaggregated by Gender, Ethnicity, and Welfare Status)

Data Source Frequency Start Year End Year

Percentage of households with a mean household dietary diversity score > 4


3 times 2019 2024

Percentage of pregnant women and mothers of children under two years of age in targeted communities participating in Mother and Children Nutrition Groups and SHGs

PRF MIS Annually 2019 2024

Percentage increase of income (or overall consumption) of SHG members


3 times 2019 2024

Percentage of SHG member food production which is consumed by members (agriculture, livestock, fisheries and aquaculture)

PRF Project MIS data

Annually 2021 2024

Percentage increase in the availability of nutritious foods Harmonized household survey

3 times 2019 2024

Percentage increase in the consumption of nutritious foods Harmonized household survey

3 times 2019 2024

Percentage of time saved and reduced workload for women (including pregnant and breastfeeding)


3 times 2019 2024

4. At least three surveys would be needed, corresponding to the baseline, midline, and end line of the program implementation. The exact timing of these surveys will factor the rollout process of the four projects to maximize synergies. The surveys ought to be representative of all the 12 nutrition convergence districts and include both household- and village-level questionnaires. Thus, the surveys would ideally have a sample size of around 2,500–3,000 households.

Monitoring Delivery of Interventions

5. Monitoring delivery of interventions will focus on tracking the achievement of convergence activities at the village level. This establishes a system for tracking the provision of inputs and outputs produced at the village level, assessing the adequacy of delivery mechanisms and the program take up, and utilization of delivered services. The main goal would be to assess and provide regular feedback on the achievement of convergence activities in terms of totality of delivery of key interventions at the village level, the number of villages, and to the extent possible the number of households where convergence has been achieved and the duration of that coverage between 2019 and 2014, during which period the four projects will be implemented. Four main tools will be used for this purpose:

• Village score cards;

• IBM;

• Administrative data - sector and program MIS; and

• Spot checks and key informant interviews.

6. Village score cards shall be employed as a tool for regularly reporting on interventions being delivered in each of the villages in the 12 districts covered by at least one of the four planned projects, providing a village-level mapping of ongoing interventions. A bottom-up approach will be employed to collect data using village score cards, taking advantage of implementation arrangements of current and planned projects by the World Bank and other agencies that already use village facilitators to coordinate and deliver some interventions at the village level. Among the World Bank’s own portfolio, both the HGNDP and the ECE project have village facilitators, which provides a pool of potential data collectors for the village score card. The PRF also has Kumban Facilitators and Village Self-Help Group Management


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Committees to potentially draw upon. The score card will focus on a few input indicators (see Table 13) selected from a list of overlapping indicators in the convergence result indicators framework and the national nutrition surveillance system that the MOH is currently developing with TA from UNICEF and the World Food Programme (WFP). The World Bank plans to collaborate with other DPs to develop a simple mobile-based tool, acquire the appropriate mobile devices, and train and assign one of the village facilitators in each village to periodically report on ongoing nutrition-sensitive programs at the village level, so that data could be captured locally and uploaded into a centralized database.

7. This concept offers some significant advantages. Beyond the initial development, equipment, and training expenses, the running costs are very low, requiring only token expenses for data airtime credit and top-up incentives. The village facilitators are already sensitized on nutrition interventions, given their various roles in SBCC and other functions they perform in their communities, for which they may receive payment under the current projects. The M&E budget could be used to provide incremental allowances for performing the data collection at a lesser cost than hiring professional enumerators. Reporting can be more frequent, since the village facilitators reside in villages where they work, unlike when a survey firm is hired to undertake initial data collection. The downside is that village facilitators are not trained enumerators. However, the simplicity of the tool, combined with some training, validation, and incentives for good performance, can mitigate this. Setting up the system and collecting the data are envisaged to take about six months, after which data can be collected on a semiannual basis. This involves the following processes:

• Design of tools in consultation with the Government, especially the NNC;

• Software application development (both the field mobile-based application that village facilitators will use for recording data in the field and the end user web-based interface, for receiving, processing, and reporting the data) and repository set;

• Training of selected staff at the province and district levels on collecting data using the mobile application and on how to supervise and validate this data so they can later be field trainers and supervisors;

• Pretesting to validate the quality of data collected, assess the limits and scope for expansion of the application, and review the application’s performance under different conditions, including the mobile network variability and digital illiteracy; and

• Training of village facilitators on using the data collection tool and implementation of data quality control mechanisms.

8. IBM shall be employed to obtain continuous feedback from program beneficiaries about the challenges and adequacy of delivery mechanisms for the interventions. IBM is done using quick, small, and targeted surveys that track a narrow set of indicators and can be implemented in a three-week period at a cost of US$3,000–5,000. A different set of indicators could be tracked in each survey. This allows for continuous monitoring of delivery of interventions at the household level and for improved utilization of services. It will also be used for process monitoring by including targeted questions on either satisfaction with implementation arrangements or whether processes are being followed. It will be used to quickly assess challenges in program take-up too. Two such surveys are envisaged every fiscal year, from the time of effectiveness of the first of the four projects under preparation, which mostly could be run with a local team of Lao consultants or partner institutions.

9. Administrative data shall also be used for monitoring program outputs, supply of some inputs, and program take-up. This includes both the sector-wide and project-specific administrative data and MIS. PRF already has an MIS for tracking various inputs and outputs (that is, SHG and Mother and Children Nutrition Group members and their activities), and this will be enhanced through the additional financing to cover a wider geographic area and new interventions. Both


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the Scaling-up Water Supply, Sanitation and Hygiene project and the Reducing Rural Poverty and Malnutrition project will build MISs that could be used to monitor key outcomes such as number of households receiving benefits and number of handwashing stations/facilities constructed. Meanwhile, delivery of most interventions in the health sector will be captured from the HANSA Project results framework, DLIs, and DHIS2 data. This could be complemented with information obtained from key informant interviews at the district and village levels.

10. Table 14 provides a summary of the interventions from the portfolio results chain that will be monitored, their data sources, time frame, and frequency of monitoring. Delivery of most interventions can be monitored on a semiannual basis according to this monitoring plan. Thus, a semiannual convergence monitoring report will be produced to report and update management and the government principals on progress toward achieving convergence outcomes. This will report on the number of villages where convergence outcomes resulting from portfolio interventions have been achieved and highlight any implementation challenges discovered.

Table 14 Monitoring Plan for Delivery of Interventions at the Portfolio Level

Intervention

Data Sources Period

Frequency Village Score Card

IBM Administrative

Data

Key Informant Interviews

Start Year

End Year

SBCC for optimal infant and child feeding, maternal nutrition, and use of cash for nutrition inputs

2018 2024 Semiannually

SBCC to promote handwashing with soap for all household members at critical times


SBCC to increase production and consumption of diverse foods


Improvement of availability and access to ANC and PNC services

DHIS2 2018 2024 Semiannually

Provision of essential micronutrients to women and children


Treatment of infections (for example, diarrhea and malaria)


Deworming of children and pregnant women


Delivery of cash transfers to generate/increase demand for and improve access to essential health and nutrition services


Target social protection services/interventions to the poorest and most nutritionally vulnerable population in rural areas




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Intervention

Data Sources Period

Frequency Village Score Card

IBM Administrative

Data

Key Informant Interviews

Start Year

End Year

Advocacy and provision of technical support to other ministries on nutrition issues

2019 2024 Annually

Support and promote villages to achieve 100% use of improved sanitation facilities

WASH project CLT data


Provision/construction of handwashing stations/facilities


Promotion of use of household-level treatment of water before use, for example, chlorination and boiling


Dissemination of nutrition information to communities/households through the agricultural extension and other outreach systems


Provision of financing, facilitation support, and TA for IGAs including the production and sale of small livestock (for example, poultry and fish) and vegetables


Incentive for regular group food processing, cooking, and eating among pregnant women, mothers, and infants


Provision of seeds, TA, and SBCC to increase production and consumption of nutritious and diverse foods


Finance for construction and rehabilitation of livelihood-oriented infrastructure to improve access to markets and services


Evaluation of Convergence Approach

11. Project design practicalities will necessarily result in variations in the number and type of interventions received at the village level as the four new projects roll out. This provides opportunities to embed an experimental evaluation design of the convergence approach to assess the impact of World Bank interventions collectively and the cost-effectiveness of the convergence approach and identify the combination of interventions with the greatest impact on nutrition outcomes given their cost.


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12. Two main features of the program implementation result in this varying intensity of convergence. The first is the varying geographical coverage of the four projects. The HANSA Project and Reducing Rural Poverty and Malnutrition Project will cover all villages in the 12 districts. On the other hand, the PRF III Additional Financing and AFN will cover up to 601 of the overlapping villages depending upon resource availability, while the Scaling-Up Water Supply, Sanitation and Hygiene Project will likely cover 450 villages, depending upon community demand. Thus, only 450 of the 881 villages will receive all interventions at full implementation of all the four projects. Additionally, the rollout pace differs across programs either because some interventions can be prepared and implemented much quicker than others or due to phased rollout of interventions within projects. For example, setting up the payment system might take up to 12 months, while SBCC is anticipated to be implemented much earlier. When the cash transfer is rolled out, it is anticipated to cover only half of the eligible beneficiaries at the beginning. Careful planning and coordination of this rollout process (for example, randomizing phase-in) permits embedding an evaluation of the impact and cost-effectiveness of the convergence approach.

Project-level Evaluations

13. Such evaluation will focus on evaluating the impact of specific interventions on the achievement of intermediate outcome indicators and the effectiveness of different delivery mechanisms. This will be done using three approaches depending on the context.

• Experimental designs can be built in by exploiting any phased approach to implementation within projects. In this case, phased implementation can be carefully planned to accommodate an impact evaluation, randomizing selection of villages in each phase for example.

• Quasi-experimental designs that exploit arbitrary discontinuities introduced by program eligibility criteria. For example, age-based cutoff points for eligibility of cash transfer in the first phase of the Reducing Rural Poverty and Malnutrition project make it possible to use regression discontinuity analysis to evaluate the impact of the interventions for people around the cutoff point. Similarly, using PMT thresholds for eligibility for subsidies for the construction of sanitary facilities under the Scaling-Up Water Supply, Sanitation and Hygiene Project also makes use of regression discontinuity applicable for impact evaluation of interventions.

• Nimble experiments. Small experiments can also be run without significantly changing the nature of program implementation and still answer questions on how best to implement key interventions. For example, by taking advantage of changes to existing interventions such as SBCC, which is already being done, the impact of a new module can be assessed compared to current practice by making small changes to the operation procedures across locations, for example, how and who delivers an intervention.

Implementation arrangements

14. The Reducing Rural Poverty and Malnutrition Project will finance the data collection and overall M&E of the convergence approach. Subcomponent 3.2 of the project therefore includes financing of three rounds of harmonized surveys covering data needs of all four projects, the costs of regular implementation of the village score cards (twice a year) to monitor the achievement of convergence, and IBM (twice a year) to obtain regular beneficiary feedback. The surveys will be organized and designed to also serve the data needs of impact evaluations of the convergence approach given the rollout plans of the four projects.

15. MPI will lead these overall convergence M&E activities as part of the overall coordination of the convergence portfolio of projects in the four target provinces, working with multi-sectoral convergence coordinating committee. The project will hire a M&E expert to provide technical support to MPI in consultation with other sectors, on developing the


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survey instruments, methodology, supervision and reporting plans, as well as aggregation of relevant statistics produced from administrative data sources. Primary data collection activities like the harmonized surveys and IBM will be implemented by a survey firm based on the established methodology and instruments, while administrative and project MIS data, shall be generated by the responsible sector ministries. The World Bank technical teams from the four projects, and the poverty team shall work closely with MPI in this process also, to ensure timely and high-quality implementation of the M&E activities.

16. Strong coordination across projects and implementing agencies is crucial for successful implementation of the M&E Framework. Experimental approaches require coordinated rollout of project implementation across projects. The four project teams will therefore develop a geographic, intervention, and time-specific rollout plan, keeping in mind that total convergence should be achieved within a given time frame of the project. Regular convergence workshops with the Government would also be crucial for instilling a shared vision for the M&E of convergence of nutrition interventions.

17. The early stages of implementation will focus on developing a concrete roll-out plan across sectors as the projects await effectiveness and developing monitoring instruments such as the harmonized surveys and village score cards. Project MIS systems will also be established that will later provide information used to compute some key convergence indicators. Baseline data collection for the harmonize surveys and first village score cards will then be implemented. These activities should be completed within the first 12 months of the project’s approval by the Board. Routine data collection, monitoring and reporting activities such as the semiannual implementation of the village score card, IBM, spot checks and reporting from administrative data will then follow. Information they will generate shall be summarized into a semiannual monitoring bulletin, providing crucial information for the convergence coordinating committee discussions. In the final stages, M&E activities will mostly focus on analytics for impact evaluations for the portfolio level outcomes, assess the impact of the convergence approach and draw lessons for future implementation.

18. Since the portfolio of interventions will be implemented using a Phased Multi-Sectoral Approach spanning three phases, the M&E activities in this first phase are naturally centered on developing and establishing instruments for M&E, and generating knowledge and lessons learnt to improve implementation of nutrition interventions in the future. The village score card, harmonized surveys and IBM are both instruments that will be developed and used for the first time. This phase of the program will help establish them for monitoring of interventions in future. Impact evaluations activities, will help to assess the cost effectiveness of the convergence approach, identify which interventions work and how delivery of interventions could be improved for greater impact. Thus, great emphasis shall be placed on rigorously measuring the impact of the convergence approach, impacts of different ways of delivering interventions, documenting and sharing the supporting evidence and lessons learnt.


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ANNEX 8: MAP

Documents

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