May 3, 2019. WASHINGTON

The World Bank today announced an additional US$6 million additional financing for the continuation of its Improving Health Sector Performance Project in Djibouti. Since its approval in April 2013, 143,000 women and children have received essential health, nutrition and population services in Djibouti. The program has supported improvements in access to quality health care services for maternal and child health and communicable disease control programs (HIV/AIDS and tuberculosis). The additional financing will allow the program to continue serving all of Djibouti, including refugee populations.

The additional financing includes US$1 million in International Development Association (IDA) credit, the World Bank’s arm for the poorest countries, and a US$5 million grant from the IDA18 Sub-Window for Refugees and Host Communities. Djibouti is one of 14 countries eligible to access this financing. The IDA18 Sub-Window for Refugees and Host Communities was created in response to demands from refugee-hosting countries, like Djibouti, as a mechanism for development assistance and concessional financing from the WBG.

“The Government of Djibouti has been committed to addressing the increasing health needs of refugees and host communities,” said Atou Seck, World Bank Resident Representative in Djibouti. “The capacity of health centers throughout Djibouti is under severe strain. In certain communities in Djibouti, displaced populations including refugees make up to 40% of the health service users.”

The new financing will support the Government of Djibouti’s efforts to mitigate the negative health impacts of the protracted refugee crisis and ensure that refugees and host communities have access to quality and equitable health services. The project is implemented by the Ministry of Health.

This is the second additional financing to the project. The first additional financing came in the form of a grant US$7 million from the Health Results and Innovation Trust Fund. The original project, approved in April 2013, was a five-year results-based financing project funded by a US$7 million IDA credit. The program is performance-based, whereby funds are disbursed directly to health care providers based on the number and quality of services delivered. The aim of this design is to encourage healthcare service providers to improve child health services such as immunization, management of childhood illnesses, and treatment of malnutrition. In addition, there is a focus on maternal health services such as prenatal care, family planning, and skilled birth attendance.

“With six years of experience with the results based financing in Djibouti we have seen a marked increase in the utilization of maternal and child health services. The increased autonomy of health facilities has led to improved health worker performance and an overall increase in the quantity and quality of health services,” said Elizabeth Mziray, World Bank Task Team Leader for the program. “With the additional financing, the support will extend to reach more vulnerable populations and those most in need.”

The large influx of refugees from neighboring countries into Djibouti and the protracted humanitarian crisis have strained an already fragile health system and have further stretched the limited capacity of the health system to provide basic health and nutrition services. The limited coverage of health services and the absence of essential nutrition and water and sanitation facilities have increased the risk of disease outbreaks.