LOAN AGREEMENT(ADDITIONAL FINANCING FOR SECOND SERBIA HEALTH PROJECT)
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LOAN NUMBER 8830-YF
LOAN AGREEMENT
AGREEMENT dated as of the Signature Date between REPUBLIC OF SERBIA ("Borrower") and INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT ("Bank") for the purpose of providing additional financing for the project described in Schedule 1 to this Agreement ("Project"). The Borrower and the Bank hereby agree as follows:
ARTICLE I
GENERAL CONDITIONS; DEFINITIONS
1.01. The General Conditions (as defined in the Appendix to this Agreement) apply to and form part of this Agreement.
1.02. Unless the context requires otherwise, the capitalized terms used in this Agreement have the meanings ascribed to them in the General Conditions or in the Appendix to this Agreement.
ARTICLE II
2.01. The Bank agrees to lend to the Borrower the amount of twenty-five million Euros (EUR 25,000,000), as such amount may be converted from time to time through a Currency Conversion ("Loan"), to assist in financing the Project.
2.02. The Borrower may withdraw the proceeds of the Loan in accordance with Section III of Schedule 2 to this Agreement.
2.03. The Front-end Fee is one quarter of one percent (0.25%) of the Loan amount.
2.04. The Commitment Charge is one quarter of one percent (0.25%) per annum on the Unwithdrawn Loan Balance.
2.05. The interest rate is the Reference Rate plus the Variable Spread or such rate as may apply following a Conversion; subject to Section 3.02(e) of the General Conditions.
2.06. The Payment Dates are February 1 and August 1 in each year.
2.07. The principal amount of the Loan shall be repaid in accordance with Schedule 3 to this Agreement.
ARTICLE III
3.01. The Borrower declares its commitment to the objectives of the Project. To this end, the Borrower shall carry out the Project through the Borrower’s Ministry of Health in accordance with the provisions of Article V of the General Conditions and Schedule 2 to this Agreement.
ARTICLE IV
4.01. The Additional Conditions of Effectiveness consist of the following that the Project Operations and Grant Manual has been updated by the Ministry of Health in a manner acceptable to the Bank.
4.02. The Effectiveness Deadline is the date hundred and eighty (180) days after the Signature Date.
ARTICLE V
5.01. The Borrower’s Representative, who, inter alia, may agree to modification of the provisions of this Agreement on behalf of the Borrower through exchange of letters (unless otherwise determined by the Borrower and the Bank), is its Minister of Finance.
5.02. For purposes of Section 10.01 of the General Conditions:
(a) the Borrower’s address is:
Ministry of Finance
20 Kneza Milosa St.
11000 Belgrade
Republic of Serbia; and
(b) the Borrower’s Electronic Address is:
Facsimile: |
E-mail: |
(381-11) 3618-961 |
kabinet@mfin.gov.rs |
5.03. For purposes of Section 10.01 of the General Conditions:
(a) the Bank’s address is:
International Bank for Reconstruction and Development
1818 H Street, N.W.
Washington, D.C. 20433
United States of America; and
(b) the Bank’s Electronic Address is:
Telex: |
Facsimile: |
E-mail: |
248423(MCI) or |
1-202-477-6391 |
sndegwa@worldbank.org |
64145(MCI)
AGREED as of the Signature Date.
REPUBLIC OF SERBIA |
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By |
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Name: Dušan Vujović |
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Title: Minister of Finance |
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Date: 21 March 2018 |
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INTERNATIONAL BANK FOR |
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By |
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Name: Stephen Ndegwa |
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Title: Country Manager |
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Date: 21 March 2018 |
PROJECT DESCRIPTION
The objective of the Project is to contribute to improving the efficiency and quality of the public health system of the Republic of Serbia through the strengthening of: (i) health financing, purchasing, and maintenance systems; and (ii) quality improvement systems and management of selected priority non-communicable diseases.
The Project consists of the following parts:
Part 1. Improvement of Health Financing
(a) Support Hospital Financing Reforms
Strengthen transparency of and incentives for efficiency of the Health Insurance Fund financing for public hospitals through: (i) carrying out a phased implementation of a DRG payment system, including conducting a DRG costing exercise and building awareness and capacity of public hospitals’ staff for the implementation of said payment system; (ii) carrying out a gradual shift of hospital acute care financing from inputs to DRGs; (iii) improving the information systems, through upgrades to central systems, and software installation or upgrades, as the case may be, at selected hospitals; (iv) supporting amendments to regulations and by-laws that give effect to the hospital financing reforms; (v) providing technical advice on options to improve efficiency of financing for non-acute care in hospitals and governance arrangements to strengthen management in hospitals; (vi) providing technical support to integrate hospital level Clinical Pathways into the E-health System for hospital information systems; (vii) defining admission criteria based on European Appropriateness Evaluation Protocol and adapting it to the national level; (viii) developing hospital matrix for performance monitoring and incentive for hospital staff; and (ix) improving the regulatory framework to: (A) recognize and define performance and expenditures; and (B) incorporate the DRG into the Health Insurance Fund’s and hospitals’ budgeting system.
(b) Strengthen Primary Health Care Financing
Improve the efficiency and quality of preventive and certain other primary care services through: (i) strengthening the incentives for performance in the Health Insurance Fund health provider payment mechanisms through refinement of performance criteria for variable payments made to health workers; (ii) designing and piloting implementation of Quality Improvement Sub-grants for improvement of quality of health care, including increased access to health care and preventive services by vulnerable groups (such as Roma, the elderly, and the disabled); (iii) strengthening implementation and monitoring capacity of primary health care financing reforms through development of transition plans for capitation financing to Primary Health Care Centers and development and strengthening of managerial capacity and skills for heads of Primary Health Care Centers; (iv) developing proposals for amendments to regulations and by-laws that give effect to the primary care financing reform; and (v) providing technical support to integrate primary health care level Clinical Pathways into the E-Health System for primary health care information systems.
(c) Develop a Health Care Network Optimization Plan
Provision of technical support to (i) develop a health care network optimization plan for public health institutions; (ii) develop palliative care, outpatient care at hospitals and other interventions that may be necessary towards efficient utilization of existing capacities; and (iii) carry out advocacy activities.
Part 2. Improve Access to Quality Health Care
(a) Improve Access to Medicines
Develop and implement a centralized system for the procurement of pharmaceuticals, medical supplies, diagnostic reagents and medical equipment through: (i) carrying out a competitive tendering process for multi-source items and reference pricing for single-source items: (ii) developing specific framework agreements to be entered by the Health Insurance Fund and suppliers within the centralized procurement system; (iii) carrying out pilot testing of: (A) e-prescription system and modules for Primary Health Care Centers, hospitals, Health Insurance Fund, and pharmacies; (B) e-procurement system to support centralized procurement; and (C) development and carrying out of Training of a unified information technology system for monitoring in-market availability and dispensing of pharmaceuticals; (iv) developing proposals for amendments to regulations and by-laws that give effect to health sector procurement reform; and (v) provision of technical support to improve the E-Health System to support the rational use of antibiotics.
(b) Strengthen Health Technology Assessment Capacity
Strengthen the Borrower’s capacity to carry out improved Health Technology Assessment through (i) developing partnerships with relevant regional and international Health Technology Assessment organizations; (ii) strengthening the capacity of the relevant institutions of the Borrower, selected pursuant to the criteria set forth in the Project Operations and Grants Manual, to carry out improved Health Technology Assessment for pharmaceuticals and medical devices; (iii) developing proposals for strengthened institutional arrangements of the Borrower, including through amendments to regulations and by-laws for improved Health Technology Assessment; (iv) supporting the establishment of a Health Technology Assessment unit within an entity of the Borrower to be selected by the Borrower and acceptable to the World Bank, based upon the institutional arrangements developed under the preceding sub-section (iii); and (v) providing technical assistance and Training to support the Borrower in: (A) performing Health Technology Assessment and EBM situation analysis; (B) building and document international experiences; (C) acquiring knowledge and developing expertise for local Health Technology Assessment implementation; (D) defining institutionalization and institutional arrangements for Health Technology Assessment; (E) establishing appropriate Health Technology Assessment process and priority areas; (F) translating research results into recommendations for decision making; and (G) building experience in strategic planning.
(c) Improve Medical Equipment Maintenance Systems
Support the improvement of the Ministry of Health maintenance system through: (i) carrying out a preliminary assessment of the existing (A) system of distribution of medical equipment; (B) procedures for medical equipment maintenance and repair management; (C) cost and allocation of maintenance funds; and (D) procurement of spare parts and equipment maintenance and repair services; and (ii) on the basis of the outcome of the preliminary assessment in (i) above, supporting the establishment of: (A) an entity for medical technology management; and (B) the establishment of a maintenance system for high cost equipment, including linear accelerators, computer tomographs and magnetic resonance imaging devices.
Part 3. Strengthen Quality of Service Delivery
(a) Strengthen Quality Improvement Systems
Support the Ministry of Health to: (i) develop national clinical practice guidelines aligned with international standards; (ii) based on the national clinical practice guidelines referred in (i), develop Clinical Pathways covering priority disease areas and carry out a phased implementation of said Clinical Pathways in selected hospitals and Primary Health Care Centers; (iii) provide targeted support, with the support of National Agency for Accreditation of Health Care Institutions, to selected Primary Health Care Centers for the improvement of quality of provision of health care for priority services, through the carrying out of Training and the provision of technical assistance; (iv) support the improvement of reporting and use of information on service quality and efficiency at the Ministry of Health, Health Insurance Fund, Institute of Public Health, and Regional Institutes of Public Health; (v) develop proposals for amendments to regulations and by-laws that give effect to the quality of service delivery reforms; (vi) support the integration of primary and secondary health care Clinical Pathways and improve health care quality and management of waiting times for patients with malignant diseases; (vii) update existing, and develop new, clinical practice guidelines; (viii) carry out Training on integrated pathways for healthcare professionals; (ix) develop a national registry for non-communicable disease for monitoring and evaluation; and (x) create a disease management program database for most frequent non-communicable disease.
(b) Improve Cancer Management
Increase the coverage and quality of radiation therapy cancer treatment at specialized tertiary oncology centers, selected pursuant to criteria set forth in the POGM, through: (i) procurement and installation of a number of accelerators determined pursuant to criteria set forth in the POGM, and associated equipment and works; (ii) supporting the improvement of monitoring of patient outcomes and the strengthening of the national cancer registry system, through the carrying out of Training, information systems, and technical assistance; (iii) improving cancer prevention, diagnostics and treatment through the development of the Serbian Comprehensive Cancer Management Strategy, which shall include: (A) early disease detection system; (B) use of digital technologies in cancer registration, patient treatment data collection, referrals and analysis against international recognized format; (C) institutionalization of health promotions activities; and (D) setting up of infrastructure for advance treatment modalities for tertiary level cancer treatment; (iv) improvement of national coverage and interconnectivity of radiotherapy services through procurement of two linear accelerators and a CT-simulator, and rehabilitation of two bunkers for the Borrower’s province of Vojvodina, including their interconnectivity through the procurement of a wide area network platform; and (v) improvement of diagnostic quality in oncology through the acquisition of diagnostic equipment.
Part 4. Monitoring, Evaluation, and Project Management
Carry out Project management, monitoring and evaluation activities, audits, and financing of Operating Costs, studies, and carrying out of Training, including to Roma Health Mediators.
PROJECT EXECUTION
Section I. Implementation Arrangements
A. Institutional Arrangements
1. The Borrower shall assign day to day implementation and management of the Project to its Ministry of Health, through the PCU.
2. The Borrower, through the Ministry of Health, shall maintain, throughout Project implementation, the PCU with terms of reference, staff and resources satisfactory to the Bank.
3. The PCU shall be responsible for organizing quarterly Project review meetings to be called by the Ministry of Health, and attended by relevant officials of the Ministry of Health, Institute of Public Health, Regional Institutes of Public Health, Health Insurance Fund, and any other Project stakeholders as relevant.
4. The Borrower, through the Ministry of Health, shall ensure that the Health Insurance Fund assists in the implementation of the Project by carrying out the technical activities under Parts 1 and 2(a) of the Project.
5. The Borrower, through the Ministry of Health, shall ensure that the National Agency for Accreditation of Health Care Institutions assists in the implementation of the Project by carrying out technical activities under Part 2(b) and Part 3(a) of the Project.
6. The Borrower, through the Ministry of Health, shall ensure that the Institute of Public Health provides technical support to the Ministry of Health in the carrying out of activities under Parts 1, 2(a) and 3 of the Project.
7. The Borrower, through the Ministry of Health, shall ensure that the Regional Institutes of Public Health assist in the implementation of the Project in their respective areas or regions by carrying out technical activities under Part 1, Part 2(b) and Part 3 of the Project.
B. Project Operations and Grants Manual
1. The Borrower, through the Ministry of Health, the PCU, the Health Insurance Fund, the National Agency for Accreditation of Health Care Institutions, the Institute for Public Health, and the Regional Institutes of Public Health, shall carry out the Project in accordance with the provisions and requirements of an operational manual, in form and substance satisfactory to the Bank ("Project Operations and Grants Manual" or "POGM"), which shall include, inter alia, the following:
(a) institutional coordination and implementation arrangements and procedures for the Project;
(b) financial management and procurement procedures for the Project;
(c) arrangements for monitoring, evaluation, and reporting of Project implementation;
(d) such other administrative, financial, technical and organizational arrangements, requirements and procedures as shall be required for the Project, and
(e) for the purposes of carrying out Part 1 (b) of the Project, a grants manual satisfactory to the Bank, which shall include, inter alia, the following:
(i) eligibility criteria for Beneficiary Primary Health Care Centers;
(ii) procedures and conditions for approval, monitoring, evaluation, and reporting of Quality Improvement Sub-grants;
(iii) financial management procedures and arrangements; and
(iv) implementation timetable for carrying out Part 1 (b) of the Project.
2. The Borrower shall not assign, amend, abrogate or waive the POGM, or any of its provisions, without the Bank’s prior agreement. In case of any conflict between the terms of the POGM and those of this Agreement, the terms of this Agreement shall prevail.
C. Quality Improvement Sub-grants
1. For the purposes of carrying out Part 1(b) of the Project, the Borrower shall, through the Ministry of Health and with technical oversight by the Health Insurance Fund, make available Quality Improvement Sub-grants to Beneficiary Primary Health Care Centers under a Quality Improvement Sub-grant Agreement, on terms and conditions satisfactory to the Bank, and detailed in the POGM.
2. The Borrower, shall take all measures necessary to ensure that, in making the Quality Improvement Sub-grants available to Beneficiary Primary Health Care Centers, the Ministry of Health shall obtain rights adequate to protect the interests of the Borrower and those of the Bank, including the right to: (a) suspend or terminate the right of the Beneficiary Primary Health Care Centers to use the proceeds of the Quality Improvement Sub-grant, or obtain a refund of all or any part of the amount of the Quality Improvement Sub-grant then withdrawn, upon the Beneficiary Primary Health Care Centers’ failure to perform any of its obligations under the Quality Improvement Sub-grant Agreement; and (b) require each Beneficiary Primary Health Care Center to: (i) carry out the activities for which the Quality Improvement Sub-grant was given with due diligence and efficiency and in accordance with sound technical, economic, financial, managerial, standards and practices satisfactory to the Bank, including in accordance with the provisions of the Anti-Corruption Guidelines applicable to the recipients of loan proceeds other than the Borrower; (ii) provide, promptly as needed, the resources required for the purpose of the Quality Improvement Sub-grant; (iii) procure the goods, works and services to be financed out of the proceeds of the Quality Improvement Sub-grant in accordance with the provisions of this Agreement; (iv) upon reasonable request, enable the Borrower and the Bank to inspect the activities, its operation and any relevant records and documents; and (v) prepare and furnish to the Borrower and the Bank all such information as the Borrower or the Bank shall reasonably request relating to the foregoing.
3. In case of any conflict among the terms of the Quality Improvement Sub-grant Agreement and this Agreement, the provisions of this Agreement shall prevail.
D. Safeguards
1. The Borrower, through the Ministry of Health, shall ensure that the Project is carried out in accordance with the provisions of the EMF, and applicable EMPs. The Borrower shall not assign, amend, abrogate, or waive the EMF or any EMPs, or any provision thereof, without prior approval of the Bank.
2. For purposes of Part 3 of the Project, prior to the issuance of the bidding documents for the works contract for each accelerator, the Borrower, through the Ministry of Health, shall prepare and submit to the Bank for its approval: (a) the proposed design and site for said works, and the related site-specific EMP in form and substance satisfactory to the Bank; and (b) the draft contract for said works, ensuring that the provisions of the site-specific EMP are adequately included in said contract.
3. The Borrower, through the Ministry of Health, shall: (a) ensure that all activities undertaken for purposes of carrying out the Project comply with environmental, health and safety standards and guidelines set forth in the EMF; (b) ensure that the selection of any accelerator site under Part 3 of the Project is done in accordance with the EMF; (c) ensure the complete implementation of the EMPs in a manner satisfactory to the Bank, including all necessary measures to minimize and to mitigate any adverse environmental, health and safety impacts caused by the implementation of the Project; (d) ensure that no private land acquisition or any resettlement takes place in connection with the Project; and (e) ensure that appropriate grievance redress mechanisms are available to interested parties, including local communities, in connection with inconveniences associated with any works under the Project, and that such interested parties are informed of the availability of such grievance redress mechanisms.
Section II. Project Monitoring, Reporting and Evaluation
The Borrower, through the Ministry of Health, shall furnish to the Bank each Project Report not later than one month after the end of each calendar quarter, covering the calendar quarter.
Section III. Withdrawal of Loan Proceeds
A. General
Without limitation upon the provisions of Article II of the General Conditions and in accordance with the Disbursement and Financial Information Letter, the Borrower may withdraw the proceeds of the Loan to: (a) finance Eligible Expenditures; and (b) pay the Front-end Fee; in the amount allocated and, if applicable, up to the percentage set forth against each Category of the following table:
Category |
Amount of the Loan |
Percentage of Expenditures to be financed |
(1) Goods, works, non-consulting services, Operating Costs, Training and consultants’ services for the Project (except for goods and works for Part 3(b)(iv) and 3(b)(v), including audit, and for Quality Improvement Sub-grants. |
7,237,500 |
100% (inclusive of Taxes) |
(2) Goods and works for Part 3(b)(iv) |
5,000,000 |
100% (exclusive of Taxes) |
(3) Goods and works for Part 3(b)(v) |
12,700,000 |
100% (exclusive of Taxes) |
(4) Front-end Fee |
62,500 |
Amount payable pursuant to Section 2.03 of this Agreement in accordance with Section 2.07(b) of the General Conditions |
TOTAL AMOUNT |
25,000,000 |
B. Withdrawal Conditions; Withdrawal Period.
1.Notwithstanding the provisions of Part A above, no withdrawal shall be made:
(a) for payments before the Signature Date, except that withdrawals up to an aggregate amount not to exceed Euro 5,000,000 may be made for payments made prior to this date but on or after February 1, 2018 (but in no case more than one year before the Signature Date), for Eligible Expenditures under Category 2; or
(b) under Category 3 until the Borrower has: (i) issued a Decree to update Serbia Against Cancer, including an action plan for its implementation; (ii) issued a Decree to regulate the national program for the health care network optimization plan; and (iii) through the Ministry of Health, adopted a rulebook to establish a unit within the Ministry of Health responsible for the administrative and technical equipment maintenance system; all in a manner acceptable to the Bank.
2.The Closing Date is December 31, 2021.
COMMITMENT-LINKED AMORTIZATION REPAYMENT SCHEDULE
The following table sets forth the Principal Payment Dates of the Loan and the percentage of the total principal amount of the Loan payable on each Principal Payment Date ("Installment Share").
Level Principal Repayments
Principal Payment Date |
Installment Share |
On each February 1 and August 1 |
5.26% |
On August 1, 2032 |
5.32% |
Definitions
1. "Anti-Corruption Guidelines" means, for purposes of paragraph 5 of the Appendix to the General Conditions, the "Guidelines on Preventing and Combating Fraud and Corruption in Projects Financed by IBRD Loans and IDA Credits and Grants", dated October 15, 2006 and revised in January 2011 and as of July 1, 2016.
2. "Beneficiary Primary Health Care Center" means a primary health care center in the territory of the Borrower determined to be eligible for receiving a Quality Improvement Sub-grant, in accordance with Section C of Schedule 2 to this Agreement and the Project Operations and Grants Manual.
3. "Category" means a category set forth in the table in Section III.A of Schedule 2 to this Agreement.
4. "Clinical Pathway" means a tool used to manage the quality of the health care related to the standardization of care processes.
5. "Diagnosis-Related Group" or "DRG" means a statistical system of classifying any inpatient stay into groups for the purposes of hospital payments.
6. "EBM" means evidence based medicine, an integration of the best research evidence with clinical expertise and patient values to make clinical decisions.
7. "E-Health system" means the Borrower’s integrated health information system which stores and process all patient medical and health data, data of health workers, data on health care facilities and health services, data on electronic assignments and electronic prescriptions, data on scheduling of medical checks and procedures.
8. "Environmental Management Framework" or "EMF" means the Borrower’s Environmental Management Framework, dated January 30, 2018, consisting of the set of principles, rules, guidelines and procedures to assess the environmental, health and safety impacts and mitigation, monitoring, and institutional measures to be taken to eliminate adverse said environmental, health and safety impacts, offset them, or reduce them to acceptable levels, as well as actions and budget needed to implement these measures and a sample Environmental Management Plan.
9. "Environmental Management Plan" or "EMP" means a site-specific Environmental Management Plan prepared during the implementation of the Project, in accordance with the EMF, describing the environmental, health and safety mitigation measures anticipated for activities under Part 3 (b) of the Project and the parties responsible for monitoring of construction and operational environmental, health and safety impacts.
10. "European Appropriateness Evaluation Protocol" means a validated European tool to assess inappropriate hospital admissions and hospital days of stay and their causes.
11. "General Conditions" means the "International Bank for Reconstruction and Development General Conditions for IBRD Financing, Investment Project Financing", dated July 14, 2017.
12. "Health Insurance Fund" means the Borrower’s Health Insurance Fund, or any successor thereto, established pursuant to the Borrower’s Law on Health Insurance, published in the Official Gazette of the Republic of Serbia 107/2005, 109/2005, 57/2011, 110/2012, 119/2012, 99/2014, 123/2014, 126/2014, 106/2015, 10/2016.
13. "Health Technology Assessment" means a systematic and transparent appraisal and deliberation process that uses criteria such as efficacy, cost-effectiveness, population health needs, and overall fiscal space to make decisions on the public reimbursement of medical technologies, devices and procedures.
14. "Institute of Public Health" means the Borrower’s National Institute of Public Health, or any successor thereto, established pursuant to the Borrower’s Law on Health Care, published in the Official Gazette of the Republic of Serbia No. 107/2005, 72/2009, 88/2010, 99/2010, 57/2011, 119/2012, 45/2013, 93/2014, 96/2015, 106/2015, 105/2017, 113/2017.
15. "Ministry of Health" means the Borrower’s Ministry of Health or any successor thereto.
16. "National Agency for Accreditation of Health Care Institutions" means the Borrower’s National Agency for Accreditation of Health Care Institutions, or any successor thereto, established pursuant to: (i) the Borrower’s Law on Public Agencies, published in the Official Gazette of the Republic of Serbia No. 18/05, 81/05; (ii) the Borrower’s Law on Healthcare, published in the Official Gazette of the Republic of Serbia 107/2005, 72/2009, 88/2010, 99/2010, 57/2011, 119/2012, 45/2013, 93/2014, 96/2015, 106/2015, 105/2017, 113/2017; and (iii) the Borrower’s Decision on Establishing the Accreditation Agency, published in the Official Gazette of the Republic of Serbia No. 94/08.
17. "Official Gazette of the Republic of Serbia" means the Borrower’s official gazette.
18. "PCU" means the Project Coordination Unit, established within the Ministry of Health, in accordance with Section I.A.2 of Schedule 2 to this Agreement.
19. "Primary Health Care Center" means a Dom zdravlja, a primary health care center located in the territory of the Borrower.
20. "Procurement Regulations" means, for purposes of paragraph 85 of the Appendix to the General Conditions, the "World Bank Procurement Regulations for IPF Borrowers", dated July 2016, revised November 2017
21. "Project Operations and Grants Manual" or "POGM" means the manual dated October 18, 2014, referred to in Section I.B of Schedule 2 to this Agreement, as the same may be amended from time to time in a manner acceptable to the Bank.
22. "Quality Improvement Sub-grant" means the sub-grant made available to a Beneficiary Primary Health Care Center, for the purposes of Part 1(b)(ii) of the Project, in accordance with the provisions of the Grants Manual and Section C of Schedule 2 to this Agreement.
23. "Quality Improvement Sub-grant Agreement" means the agreement entered into by the Borrower and a Beneficiary Primary Health Care Center for the purposes of making a Quality Improvement Sub-Grant, in accordance with Section C of Schedule 2 to this Agreement.
24. "Regional Institute of Public Health" means an entity established pursuant to the Borrower’s Law on Health Care published in Official Gazette of the Republic of Serbia No. 107/2005, 72/2009, 88/2010, 99/2010, 57/2011, 119/2012, 45/2013, 93/2014, 96/2015, 106/2015, 105/2017, 113/2017, and the Borrower’s Decree on Health Institutions Network published in the Official Gazette of the Republic of Serbia No. 42/2006, 119/2007, 84/2008, 71/2009, 85/2009, 24/2010, 6/2012, 37/2012, 8/2014, 92/2015, 111/2017, 114/2017, in charge of covering the area of several municipalities, a large city or a geographic region of the Borrower for purposes of collecting, monitoring, and providing healthcare related data (including social, medical, hygienic, ecological, epidemiological and microbiological data).
25. "Roma Health Mediators" means women of ethnic Roma origin, fluent in Romani language, who have at a minimum a primary school diploma and are hired by a Primary Health Care Center to, inter alia: (i) work in home nursing and care services to strengthen the linkage between the Roma community and Primary Health Care Centers; and (ii) educate the Roma population in the area of health care to improve health status and accessibility of the health system to this vulnerable group.
26. "Serbia Against Cancer" means the Borrower’s national cancer management program published in the Borrower’s Official Gazette N. 20/2009.
27. "Serbian Comprehensive Cancer Management Strategy" means the Borrower’s public health program to be established by the Borrower, and referred to in Part 3(b)(iii) of the Project, designed to reduce the number of cancer cases and deaths and improve treatment and quality of life of cancer patients.
28. "Signature Date" means the later of the two dates on which the Borrower and the Bank signed this Agreement and such definition applies to all references to "the date of the Loan Agreement" in the General Conditions.