RESTRICTED

FILE ClUZ l Report No. P-935

This report was prepared for use within the Bank and its affiliated organizations.They do not accept responsibility for its accuracy or completeness. The report maynot be published nor may it be quoted as representing their views.

INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT

REPORT AND RECOMMENDATION

OF THE

PRESIDENT

TO THE

EXECUTIVE DIRECTORS

ON A

PROPOSED LOAN

TO

TRINIDAD AND TOBAGO

FOR A

POPULATION PROJECT

May 13, 1971

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INTERNATIONAL BANK FMI RECONSTRUCTION AND DEVELOPIENT

REPCRT AND RECOMNDATION OF THE PRESIDENTTO THE EXECUTIVE DIRECTORS ON A PROPOSED LOAN

TO TRINIDAD AND TOBAGO FOR A POPJLATION PROJECT

1. I submit the following report and recommendation on a proposedloan in an anount in various currencies equivalent to $3.0 million to theGovernment of Trinidad and Tobago. The loan would finance the foreignexchange cost of a population project designed to support governmentpolicies on family planning. It would be for a term of 25 years,including 10 years of grace, with interest at 71¼ percent.

2. The status of previous Bank loans to Trinidad and Tobago issummarized in Annex I. An economic memorandum on Trinidad and Tobagoand an appraisal report on the proposed project (PP-6a) are being distributedseparately. Country and project data sheets are attached hereto as AnnexesII and III.

PART I - THE ECONOMY

3. The Bank made its first loan to Trinidad and Tobago, for power,in 1961. Since then, total Bank lending net of cancellations has amountedto $46.4 million. Of this, the Bank now holds $28.3 million, including$16.8 million not yet disbursed. One-half of the lending has been forpower, about one-fifth each for highways and education and the remainderfor an agricultural settlement project. The first power project iscompleted and the second one is expected to be completed by early 1972.After some initial difficulties, good progress has been made in the agri-cultural project. There are delays in the highway project, due largelyto the poor performance of the initial consultants who were replaced latein 1969. Progress on the education project has been good, with workstarted on 13 out of 20 new schools.

4. The political stability achieved under the leadership ofPrime Minister Eric Williams, head of the People's National Movement,was seriously endangered in April 1970, when demonstrations againstthe trial of some students in Canada deteriorated into civil disorders.Since early May 1970 Trinidad has been fairly calm, and in November thestate of emergency imposed last April was lifted. General elections havebeen announced for May 24, 1971. Since the family planning program of theGovernment is not in dispute among the various parties, a continuation ofthe program appears reasonably certain whatever the outcome of the elections.

5. The latest economic report (WH-192a), distributed to theExecutive Directors on September 3, 1969, highlighted the possibilitythat crude oil reserves might not last more than ten years, and that

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Trinidad, whose quite high per capita GNP (around $770) is generatedmainly by petroleum, could be faced with a severe cutback in its GNPif no alternative sources of incGme were developed in the meantime.Diversification away frcm oil, therefore, appears essential, so as toprovide additional employment opportunities for the rising labor force.

6. Particular attention was given in the economic report to thescope for rapid development of tourism as an alternative source ofincome and employment. Trinidad and Tobago have a considerable touristpotential, but the Government has been reluctant in the past to encouragethe expansion of this sector because of its concern that a large influxof foreign tourists might give rise to difficult social problems.Trinidad's Five-Year Development Plan, published in 1969, did never-theless foresee a major increase in foreign exchange earnings fromtourism. However, the political disturbances have resulted in a set-back to the develojpment of tourist facilities in Tobago, and the out-look on the demand side is now distinctly less promising than it seemedtwo years ago.

7. By contrast, the outlook for oil has changed con sderably forthe better during 1970. Amoco, a subsidiary of Standard Oil of Indiana,has confirmed the existence of an important oil and possibly a very largegas field off the east coast of Trinidad. Amoco now plans to producesome 5t,OOO barrels a day by the end of 1971 - or about ono-t>ird ofTrinidad's present production - and there are reasonably good chancesthat this output will be doubled by the end of 1972. As to gas, thereserves seem to provide a basis for a liquefied natural gas ventureoriented to the U.S. market.

8. The promising developments in the petroleum sector have notalleviated the pressing need for diversification for The sake ofincreasing employment, since the petroleum industry offers only verylimited direct employment opportunities. The disturbances of 1970have brought to the fore the serious unemployment probleas in thecountry. Unemployment in Trinidad and Tobago, excluding under§mploymentt,is around 14 percent and is concentrated among the young and unskilled.The Govermzent contribution to coping with this problem has been princi-pally through actions with a long-run impact, for example, by supportinga faztly planning program and by making the education system more relevantto the needs of the economy. In the wake of last year's events, theGovermnent also initiated a number of job-creating activities, mostlyof the small public works variety, to reduce the number of unemployed.Howe-vr, it has recognized that this is of little permanent benefit,unless new economic activities can be found. For the medium-term taskof finding jobs, the Govermnent has relied mainly on the private sectorto promote investment in tourism and in manufacturing. The Governmentis giving special attention to projects in the countryside, designed toslow down the movement of young people to the urban centers of Port-of-Spain and San Fernando.

9. The other issue which the disturbances brought to the surfacewas the widespread feeling that, while Trinidad had enjoyed politicalindependence for almost a decade, the economy was still dominated byforeigners. National participation in major foreign-owned companiesis now being supported by all parties. In 1970 the Government acquiredthe branch of the Bank of London and Montreal and converted it into thefirst and only nationally held commercial bank. It also bought 51 per-cent of the ordinary shares of the British-held Caroni Ltd., the largestsugar comparn in the country. In the oil sector, a small company, TrinidadTesoro, has been set up as a joint venture by the Government and the U.S.Tesoro Oil Company.

10. Overall economic growth slowed down in 1970 to about one per-cent, which was less than the net population increase. However, theexternal public debt has remained low, and the service on externalpublic debt in 1970 amounted to 5.0 percent of exports of goods andservices, net of investment income payments. In these circumstances,Trinidad is anxious to borrow abroad for productive projects which woulddiversify and strengthen the economy, and should be considered credit-worthy for further external borrowing on conventional terms.

11. Against this background, the Bank has discussed with the Govern-ment of Trinidad and Tobago possible Bank lerding operations in fieldswhere substantial improvements in project preparation and implementationappear both necessary and feasible, and where Bank participation can helpin building up new institutions or strengtliening existing ones. Inaddition to the proposed population project, high priority is given todirectly productive investments, and preparatory work on a developmentfinance compary operation and a fisheries project is under way, thelatter with FAO assistance. Wiork on a second education project isscheduled to begin in mid-1971. Financing of economic infrastructureis also proposed in the next few years to the extent that this will helpthe Government to strengthen its administration in this field and main-tain adequate levels of public investment, particularly in highways.Preparation of a port improvement project in Port-of-Spain is alreadywell advanced, and feasibility studies on a second highway project areabout to begin.

12. Apart from the Bank, the Inter-American Development Bank (IDB)and the Canadian International Development Agency (CIDA) have, in therecent past, been the main lenders to Trinidad. So far, IDB's operationshave been 1imited to Fund for Special Operations (FSO) lending for pre-investment studies, agricultural credit and housing. A large FSO loanfor a water supply project is projected for this year. The IDB alsoenvisages a 'hard blend" loan for a tourist infrastructure package. CID Ahas an active program concentrated at present on transportation studies,rural electrification and technical assistance. In the field offamilyplanning the Swedish International Development Authority (SIDA) and thePan American Health Organization (PAHO) have provided equipment, medicalsupplies and technical assistance. The Government's external borrowingpolicy has been well coordinated.

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PART II - THE PROJECT

13. The population of Trinidad and Tobago, which was 275,000 personsat the turn of the century, doubled in the next 46 years and doubled againin the next 23 years to reach 1.03 million in 1969. This was mainly dueto a large decline in the death rate from 25 per 1000 at the beginning ofthe century to 7 per 1000 in 1969. The birth rate remained high from 1900(37 per thousard) to 1962 (38 per thousand), but has since declined to alittle less than 27 per thousand in 1970, giving a rate cf natural increaseof about 2 percent a year. Because of emigration - largely of skilledpersonnel - the rate of population growth has been reduced to 1.4 percentin 1970. Increased efforts in population planning are essential to redressthe imbalance between population and resources which has slowed down theimprovement in living standards and led to large-scale unemployment,emigration of skilled personnel and social unrest. In response to theseproblems the Government adopted a population policy in 1967. Althoughachievements have been substantial in the past two years, the programexperienced a setback in 1970, mainly as a result of the social disturb-ances. In 1969, over 16,000 women or 6.5 percent of women in the child-bearing ages accepted family planning services, while in 1970 new acceptorswere fewer than 9,500, which was only half of the Government's target.

14. The main constraints on the program are:

(i) Organizational: The persons presently in charge ofthe program are too low in the organizational structureof the Ylinistry of Health and do not have the necessarybackground and experience to be influential with themedical and paramedical professions;

(ii) Inadequate physical facilities: In Trinidad 62 per-cent of births occur in hospitals; this provides anexcellent opportunity for post-partum motivation. Theexisting post-partum program had limited success becauseof the short stay of women in hospitals (less than 2days in most cases) and the insufficient number oftrained nurses to cover all cases; the time allottedto each patient is less than 5 minutes. Family plan-ning sessions in the health centers are also crowded.

(iii) Insufficient number of medical and paramedicalpersonnel concerned with family planning: There isa shortage of nurses in relation to the nursestrained. In part, this is the result of a substantial

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emigratimn of nurses. Existing facilities andtraining curricula do not encourage the training ofsufficient numbers of personnel of high qualitycommitted to family planning.

15. The project is designed to overcome these limitations. Whilefunds will be devoted primarily to the construction and equipment ofbuildings, this alone is insufficient to improve the performance of thewhole program. The technical assistance component of the project and theadministrative and other measures accompanying the project therefereconstitute a critical supplement tn the financing of buildings.

16. The project provides for the design, construction and equipment ofthe following facilities:

(i) Medical facilities consisting of:

- a new 100-bed maternity hospital with teachingfacilities at Mmunt Hope, including a familyplanning clinic;

- seven new health centers where family planningand maternal and child health services will beprovided, of which four would have a four-beddelivery unit attached to them; and one four-beddelivery unit added to an existing health center;

- a family planning clinic attached to the SanFernando Hospital to replace the presentinadequate clinic;

(ii) Training facilities to improve training of nurses forfamily planning and of other family planning workers,consisting of:

- building a Family Planning Institute for trainingof family planning workers and community leadersand for administrative offices;

- extension of existing facilities of the Port-of-Spain Nursing School to increase teaching andsupporting facilities from 200 to 500 studentsand dormitories for 100 additional students;

- a new rural community health center at Arima totrain medical, nursing and other personnel inrural public health work with emphasis on familyplanning.

17. The technical assistance component of the project includesadvisory services to:

(i) Improve administrative procedures of the maternal andchild health and family planning services;

(ii) Develop a system of continuous evaluation of programperformance and results in terms of its effect onfertility;

(iii) Introduce family life education in schools to helpcreate a long-term demand for family planning servicesby all sections of the population - men and women;

(iv) Integrate family planning in the basic curriculum ofnurses and improve the training of family planningworkers to create a sense of commitment to the programby both medical and non-medical workers;

(v) Study the functions of family planning personnel tosecure their most efficient use.

The technical assistance component of the project also provides for anarchitect to head the population project section and an external reviewmission to evaluate the overall program and make appropriate recommendationsfor further expansion.

18. In addition to the foregoing construction, equipment and technicalassistance, the project includes a number of institutional and administrativereforms. The most important of these are:

(i) To overcome the present low status of family planningwithin the organization of the Ministry of Health,family planning would be integrated with maternalchild health (MCH),and this combined service wouldbe assigned to the present Principal Medical Officer(PMO) in charge of integrated services. His dutieswould be such that he would devote his principalefforts to the maternal and child health and familyplanning program. A third post at the level ofPrincipal Medical Officer would be created to reducethe present workload of the PMO.

(ii) Measures would be taken to slow down emigration ofnurses of whom there is a critical shortage. Thenumber of nurses who emigrated in 1970 was abouthalf the graduates in that year. Nurses whosetraining will be wholly or partly financed out ofpublic funds would be bonded to serve a minimumperiod of three years in the country's publicservice.

(iii) To make the post-partum motivation program more effective,the Borrower would (a) increase the number of nurse-midwives engaged in it and would give them specialtraining for the purpose, (b) extend the program toother hospitals in the country, (c) arrange for thefollow-up of patients at home six weeks after delivery,and (d) undertake the construction of a plannedpediatric unit to reduce the pressure on maternity bedsat the San Fernando Hospital, the second largest in thecountry.

(iv) To motivate the poorer sections of the population, whodo not deliver in hospitals, the present Family PlanningAide pilot project (which used non-medical socialworkers to motivate women in their homes) would beextended if found successful. Otherwise an alternativewould be found, in consultation with the Bank, to reachthe poorer sections of the population.

(v) Family planning sessions would be integrated withmaternal and child health services in selected centers;if found successful this method of delivering serviceswould be extended to other centers.

(vi) For the purposes of the project, the existing ProjectImplementation Unit in charge of the Bank-financededucation project (Loan No. 564) would be reorganizedto include a new Population Project Section, to beheaded by a full-time architect who would probablybe recruited locally on a contract basis. Thissection would be responsible for the technicalaspects of the population project. The ProjectImplementation Unit would be strengthened for theefficient carrying out of the construction componentof the project.

19. The creation of a third post at the level of Principal MedicalOfficer and the appointment of a qualified candidate; the provisions relevantto nurses; and the appointment of an architect acceptable to the Bank to headthe Population Project Section are all conditions of loan effectiveness.

20. The total project cost, including contingencies but excludinginterest and other charges on the proposed loan during construction, isestimated at $4.6 million. The proposed loan of $3 million would coverthe estimated foreign exchange component ($2.6 million), plus interestand commitment charges on the Bank loan during construction.

21. Contracts for civil works, equipment and furniture would belet on the basis of international competitive bidding. Bids would beinvited in packages likely to encourage both international and local

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contractors. A preference of 15 percent or the existing import duty,whichever is lower, is proposed for evaluating bids from local manufacturersof furniture and equipment.

22. The project is estimated to increase new acceptors from 10,000 in1970 to 22,000 per year from 1980 onwards. Of this total, 7,000 women wouldbecome acceptors in maternity hospitals and over 5,000 in the project healthcenters and family planning clinics. In addition, 10,200 women are expectedto accept services in other facilities as a result of the training andtechnical assistance components of the project. In ccr.sequence, the birthrate is estimated to decline from 27/1,000 in 1969 to 15.5/1,000 in 1980instead of 21.5/1,000 without the project. The natural rate of populationincrease would be reduced from the current level of about 2.0 percent peryear to 0.9 percent in 1980 instead of 1.5 percent in the absence of theproject. By the year 2000 the population would be smaller than otherwiseby 97,300 or by 6.2 percent and the labor force would be smaller by 37,000or by 5.2 percent. These demographic trends would improve living standardsof low income groups, and help alleviate the long-term unemployment problem.The project would also improve the conditicns under which deliveries areperformed and the health and welfare of mothers and children, particularlyamong the poorer sections of the population.

PART III - LEGAL INSTRUMENTS AND AUTHORITY

23. The draft Loan Agreement between Trinidad and Tobago, the Reportof the Committee provided for in Article III, Section 4 (iii), of theArticles of Agreement and the text of a Resolution approving the proposedloan are being distributed to the Executive Directors separately. The pro-visions of the draft Loan Agreement conform substantially to the patterngenerally found in Bank Loan Agreements.

24. I am satisfied that the Loan proposed would comply with theArticles of Agreement of the Bank.

PART IV - REBOOHENDATICTN

25. I recommend that the Executive Directors approve the proposedloan.

Robert S. M4cNamaraPresident

Attachments

PSy 13, 1971

Annex I

TRINIDAD AND TOBAGO

SUMYARY OF BANK LOANS AT APRIL 30, 1971

Amount (US$ mfllion)No. Year Borrower Purpose Bank Undisbursed

293-TR 1961 Trinidad and Tobago ElectricityCommission (guaranteed by United 1/Kingdom) Power 21.4- __

486-TR 1967 Government of Trinidad and Tobago Agricul-ture 5.0 2.0

497-TR 1967 Government of Trinidad and Tobago Highway 8.6 5.2

564-in 1968 Government of Trinidad and Tobago Education 9.4 8.7

601-TR 1969 Trinidad and Tobago ElectricityCommission (guaranteed by Govern-ment of Trinidad and Tobago) Power 2.0 0.9

Total (net of cancellations) 46.4Of which has been repaid to Bank 5.4

Total now outstanding 41.0

Amount sold 17.1Of which has been repaid 4.4 12.7

Total now held by Bank 2 3

Total undisbursed 16.8

1/ Original amount $23.5 million: $2.1 million was cancelled in 1968.

Annex IIPage 1 of 3

TRINIDAD AND TOBAGO: COUNTRY DATA SHET

Area and population

Area: 5,128 square kilometers

Population: 1,o48,900 (1970)

Population density: 197 per square kilometer

I. ECONCMIC INDICATCRS

GNP per capita (1970) US$769

Origin of GDP 1970 (percent)Agriculture 7Petroleum 19Manufacturing 18Transport and distribution 19Government 11Other activities 25

Ratios to GDP (1970)Exports of goods and services 24.7Imports of goods and services 29.7Central government revenues 17.9Central government current expenditures 14.9External public debt (end of year, estimated) 12.8Savings 9.3Investment 23.0Mbney and quasi-money 26.6

Annual changes in economic indicators Average1965-68 1969 1970

(percent)

Real GDP 4.0 3.5 2.1Real GDP per capita 2.5 2.2 0.6GDP at current prices 9.0 6.o 4.5Domestic expenditure (at current prices) 4.0 14.9 9.4Investment -2.2 -0.9 21.1Consumption 6.1 19.4 6.6

Cost of living (retail price index) 4.8 2.5 2.4

Central government revenues 8.8 14.7 5.9Central government current expenditures 7.0 9.7 5.5Central government development expenditures 3.9 -- 64.6

Annex IIPage 2 of 3

1968 1969 1970

Money and quasi-money 15.2 14.4 17.4Money 7.5 8.6Quasi-money 14.1 23.4 21.6

Net domestic bank system assets 1.1 23.6 32.9Crodit to public sector (net) -18.1 -78.7 372.5Cradit to private sector 9.9 36.6 22.7

Her,2;2andise exports (f.o.b.) 19.4 -9.7 -2.4Menrhandise imports (c.i.f.) -1.9 18.3 13.4

Central govermnent finances 1968 1969 1970(in millions of T$

Revenues 265 304 322Current expenditures 233 254 268Current account surplus 32 50 54Development expenditures 65 65 107Over-all surplus or deficit (-) -12 -4 -35External financing (net) 14 6 -10Internal financing (net) -2 -2 45

Balance of payments 1968 1969 1970(in millions of U

Merchandise exports (f.o.b.) 473 475 472Commodity concentration (oil) 52 percent

Merchandise imports (c.i.f.) -420 -483 -517Investment income (net) -72 -84 -93Other services (net) 17 16 16Current account balance 4 -69 -117Private capital (net) 23 46 59Official capital (net) 8 11 -1Current transfers (net) -- -1 --Errors and omissions -12 8 52Change in net reserves (increase -) -23 3 7

External public debtd/

Debtincluding undisbursed 106 96 89excluding undisbursed 73 70 68

Debt service 9 11 11Debt service ratio (percent) 3.1 4.6 5.0

Banking system reserve position 55.1 51.7 44.6

INF data (December 31, 1970)Quota US$63 millionCumulative drawings US$4.75 millionFund holdirgs of TT dollars 82.1 percent of quotaHoldings of SDR's US$o.6 millionAllocation of SDR's US$7.4 million

1/ Excluding external debt repayable in local currency.

Annex I]Page 3 of 3

I1. SOCIAL INDICATORS

1970

Population growth rate % per year 1.4

Population naturalgrowth rate % per year 1.9

Birth rate per 1,000 population 26.5

Death rate per 1,000 population 7.0

Hospital beds per 1,000 population 5.5

Life expectancy years 67.3

Doctors per 10,000 population 4.0

Nurses per 10,000 population 13.0

Unemployment % l

Literacy rate % adult populabion go

Annex IIIPage 1 of 2

LOAN AND PROJECT DATA SHEET

I. LOAN SUM)EARY

Borrower: Trinidad and Tcbago.

Amount: US$3 million equivalent. The proposed loan would fullycover the Project's estimated foreign exchange componentplus interest and commitment charges during construction.

Terms: Payable in 25 years with 10 years of grace at 7 1/4 percentinterest per annum.

Disbursement Period: 4 1/2 years, estimated at US$75,000 in 1971,US$800,000 in 1972, US$1,025,000 in 1973,us$600,000 in 1974, and US$500,000 in 1975.

II. PROJECT DATA

Brief Description: (i) Construction of a new maternity hospitaland a family planning clinic at Mount Hope,seven new health centers, a family planningclinic attached to the San Fernando Hospital,and training facilities for nurses and familyplanning workers; architectural services.

(ii) The improvement of administrative procedures,the evaluation of the program, the trainingof nurses, the utilization of family planningpersonnel, and the introduction of familylife education.

Estimated Cost: (US$ millions)Component Local Foreign Total

Construction:Mount Hope Hospital 0.7 0.8 1.5Port-of-Spain Nursing School 0.3 0.4 0.7Health Centers, Family Planning

Clinic and Institute 0.3 0.2 0.5Subtotal 1.3 14 2.7

Equipment and Furniture 0.1 0.7 0.8

Professional Fees and Tech-nical Assistance 0.4 0.2 o.6

Contingencies 0.2 0.3 0.5

Total Project Cost 2.0 2.6 4.6

Annex IIIPage 2 of 2

Financing: The proposed Bank loan would cover the foreign exchange cost ofUS$2.6 million and US$0.4 million for interest and commitmentcharges. The balance of US$2 million in local currency would beprovided by the Government of Trinidad and Tobago.

Procurement: International competitive bidding.

Construction Period: September 1972 to December 1974.

Architectural Consultants; Whiting and Associates, Rome, to be appointed(condition of effectiveness).

Economic Benefits: The reduction in the rate of population growth resultingfrom the project is estimated to lead to a per capitaincome in 1985 about 5 percent higher than it would beotherwise.

MAP 2

6R1 30- 60 50 r 6 O' 30'

TRINIDAD AND TOBAGO Coribbeon Sea

EXISTING FAMILY PLANNING FACILITIES TOBAGOAND AREAS SERVED BY PROJECT

Areas served by project P outh Pemx rough

e Regional boundary tla n t - c---County boundaries Oc e a n--- Heolth Division boundaries -tCo' c rough I 01°co

IV Health Division designations cr og 0 5 @ Heolth centers with F. P Clinics MILES

Health offices with F P Clinics-~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~0 5 10 I

- Hospitals with F. P Clinics 6050 KIlOMETERS ROSo'* Family Planning Association clinics 00 KLMTR 0 0

Main roads ------- Road under construction61

°1 IF T0 C arl' b be a n S e aMILES

0 5 10 15 is

KILOMETERS is o -

SYMBOLS SHOWN iN RED ARE PROPOSED PROJECT

* Catholic Marriage Advisory Council Clinics

/ r / MrM~~~~~~~~~~~~~~~~~~~~~IT G E O R <~ E _~~j%p f~ CARENAGE VALLEY

VENEZUELA 5 IV

GEORGE ST5RUECECTE5to>X2Q_ + , 1 \ t

TRIN ID DVILLAGEk XCumuto Sangre Gronde

-10-30' _ OCt WTItFARN REGI Ni0,30' 'e 0o

Gu/f of Par /a I , I

V~~~~~~~~~~~~

I0~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~v Ji 30 A E t.

DECEMBER 90 R -324 1 IPoint Fortin5 MAY RFZOO C) I ORIA j-$,rS T~~~~~~S. PAT RI c ,eo l Guayaguoyo

Cedros , /t < orugaO 0l > >

L ~~~~~6 1-13 0 '6 1

DECEMBER 1970 I BRD -3234