On the ratification of the Loan Agreement (Technology Transfer and Institutional Reform Project in the Healthcare Sector of the Republic of Kazakhstan) between the Republic of Kazakhstan and the International Bank for Reconstruction and Development

Home / RLA / On the ratification of the Loan Agreement (Technology Transfer and Institutional Reform Project in the Healthcare Sector of the Republic of Kazakhstan) between the Republic of Kazakhstan and the International Bank for Reconstruction and Development

On the ratification of the Loan Agreement (Technology Transfer and Institutional Reform Project in the Healthcare Sector of the Republic of Kazakhstan) between the Republic of Kazakhstan and the International Bank for Reconstruction and Development

Law of the Republic of Kazakhstan dated November 6, 2008 No. 77-IV

To ratify the Loan Agreement (a project on technology transfer and institutional reform in the healthcare sector of the Republic of Kazakhstan) between the Republic of Kazakhstan and the International Bank for Reconstruction and Development, signed in Astana on February 2, 2008.

President  Of the Republic of Kazakhstan N. Nazarbayev

LOAN NUMBER 4883-KZ

Loan Agreement (Technology Transfer and Institutional Reform project in the healthcare sector of the Republic of Kazakhstan) between the REPUBLIC OF KAZAKHSTAN and BY THE INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT

dated February 2, 2008

LOAN NUMBER 4883-KZ

LOAN AGREEMENT

Agreement dated February 2, 2008 between the REPUBLIC OF KAZAKHSTAN (the Borrower) and the INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT (The Bank). The Borrower and the Bank hereby agree on the following:

ARTICLE I - GENERAL CONDITIONS; DEFINITIONS

1.01. The General Terms and Conditions (defined in the Addendum to this Agreement) are an integral part of this Agreement. 1.02. Unless the context otherwise requires, the terms used in this Agreement starting with capital letters have the meanings assigned to them in the General Terms and Conditions or in the Addendum to this Agreement.

ARTICLE II - LOAN

2.01. The Bank agrees to provide the Borrower with an amount equal to one hundred seventeen million seven hundred thousand US dollars (117,700,000 dollars) (Loan) for the term and conditions set forth or referenced in this Agreement in order to assist in financing the project described in Appendix 1 to this Agreement (Project). 2.02. The Borrower has the right to withdraw the Loan funds in accordance with section IV of Appendix 2 to this Agreement. 2.03. The Borrower pays the Bank a commission for opening a loan equal to a quarter of one percent (0.25%) of the Loan amount. The borrower must pay the loan opening fee no later than 60 (sixty) days after the Effective Date. 2.04. The Borrower pays remuneration at a rate equal to the Base LIBOR Rate for the Loan Currency plus a variable spread for each interest accrual period. Notwithstanding the above, if any part of the withdrawn outstanding Loan balance remains unpaid on time and is not paid within thirty (30) days, the amount of remuneration paid by the Borrower must be calculated as described in Section 3.02 (d) of the General Provisions. 2.05. The payment dates are January 15th and July 15th of each year. 2.06. The Borrower repays the principal amount of the Loan in accordance with the repayment schedule set out in Appendix 3 to this Agreement.

ARTICLE III - THE DRAFT

3.01. The Borrower declares its commitment to the objectives of the Project and for this purpose implements the Project through the Ministry of Health of the Republic of Kazakhstan in accordance with the provisions of Article 5 of the General Terms and Conditions. 3.02. Unless otherwise provided by the provisions of Section 3.01 of this Agreement and unless otherwise agreed with the Bank, the Borrower shall ensure the implementation of the Project in accordance with the provisions of Annex 2 to this Agreement.

ARTICLE IV - ENTRY INTO FORCE; TERMINATION

4.01. The final date of entry into force of this Agreement is the date following the expiration of one hundred and eighty (180) days after the date of this Agreement.

ARTICLE V - REPRESENTATIVES; ADDRESSES

5.01. The Borrower's representative is the Minister of Finance. 5.02. Borrower's address:

Ministry of Finance Pobedy Avenue, 11 Astana, 010000 Republic of Kazakhstan Telex: 265126 (FILIN) Fax: (7) (7172) 717785

5.03. Bank's Address:

International Bank for Reconstruction and Development 1818 H Street, N.W. Washington, D.C. 20433 United States of America

The Telegraph: Telex: Fax: INTBAFRAD 248423 (MCI) or 1-202-477-6391 Washington, D.C. 64145 (MCI)

AGREED in Astana, Republic of Kazakhstan, on the day and year indicated above.

FOR THE REPUBLIC OF KAZAKHSTAN

Authorized representative

FOR THE INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT

Authorized representative

APPENDIX 1

Project Description

The aim of the Project is to introduce international standards and build long-term institutional capacity in the Ministry of Health of the Republic of Kazakhstan (MOH RK) and relevant health authorities and organizations in support of key reforms in the healthcare sector carried out by the Borrower in the context of the State Program for the Reform and Development of the Healthcare System in the Republic of Kazakhstan for 2005-2010.

The project consists of the following parts:

Part A: Financing and management of the healthcare sector

Provision of technical assistance, goods, works and training to: (i) enhance the capacity of the Ministry of Health of the Republic of Kazakhstan to formulate health policy and strategy; (ii) enhance the capacity for budgeting, planning and procurement in the health sector; and (iii) strengthen the capacity of health sector managers, as well as enhance the capacity for investment planning in the health sector.

Part B:Improving the quality of healthcare services

Providing technical assistance, goods, work and training to: (i) establish an accreditation system for healthcare organizations; (ii) improve the quality of clinical practice through the development, revision and dissemination of clinical practice guidelines, as well as the implementation of medical technology assessment; (iii) improve the quality of laboratory services through the development and implementation of structural, regulatory reforms and infrastructure planning reforms; and (iv) the reform of the blood service through the development and implementation of structural, regulatory and infrastructure planning reforms.

Part C: Reform of medical education and science

Provision of technical assistance, goods, works and training for: (i) the reform of basic and continuing medical education, including through the analysis of the medical education system, improving the provisions for the admission of students to medical education organizations, the creation of a quality assurance system, the creation of a system for teaching evidence-based medicine, the development of a program for the reform of postgraduate medical education and continuing professional development, to establish certification and licensing systems and to improve the financing system for medical education; and (ii) to modernize the medical research system.

Part D:Development of the healthcare information system

Providing technical assistance, goods, work, and training to support the development and deployment of a unified healthcare information system for healthcare organization management, resources, and financial management.

Part E: Pharmaceutical policy reform

Provision of technical assistance, goods, work, and training to strengthen drug policy-making functions, including through restructuring the preferential drug supply system, introducing price control methods, analyzing the distribution of counterfeit and substandard medicines, and creating institutional mechanisms to promote rational drug prescribing and evidence-based analysis to eliminate outdated and unreliable medicines from the market.

Part F:Food safety in the framework of WTO accession

Provision of technical assistance, goods, works and training for the development and implementation of a food safety system in accordance with WTO requirements.

Part G:Project management

Providing technical assistance, goods, work, and training in support of Project coordination, implementation, and management functions.

APPENDIX 2

Project Execution

Section I. Implementation mechanisms

The Borrower must implement the Project in accordance with the following institutional and other arrangements: 1. The Borrower, through the Ministry of Health of the Republic of Kazakhstan, must implement the Project in accordance with the requirements, criteria, organizational mechanisms and operational procedures specified in the Project Implementation Manual, and must not transfer, amend, cancel or abandon any provisions of the Project Implementation Manual without the prior consent of the Bank. 2. During the entire Project implementation period, the Borrower must ensure that the composition, resources and technical specifications of the PKG and the GRP comply with the Bank's requirements. 3. No later than July 1, 2008, the Borrower will: (a) establish a Health Policy Council with a composition and terms of reference acceptable to the Bank and (b) subsequently provide the Health Policy Council with sufficient human, financial and technical resources to meet the Bank's requirements until the Council fully implements its functions. 4. No later than July 1, 2008, the Borrower will hire a financial management consultant in accordance with the terms of reference acceptable to the Bank to assist DEF in the implementation of the Project. 5. The Borrower will approve the Project Implementation Guidelines no later than July 1, 2008. 6. To ensure the availability of an adequate amount of funds necessary to finance the Borrower's contribution to the Project, the Borrower must annually allocate appropriate budgetary funds for the Project to the Ministry of Health of the Republic of Kazakhstan for a total amount of $296,000,000, of which the Borrower's contribution to the Project is $178,300,000 (including the loan opening fee).

Section II. Project monitoring, reporting and evaluation

But. Project Reports

1. The Borrower monitors and evaluates the progress of the Project, and prepares Project Reports in accordance with the provisions of Section 5.08 of the General Terms and Conditions and based on indicators agreed with the Bank. Each Project Report must cover a period of six calendar months and be submitted to the Bank no later than forty-five (45) days after the end of the period covered by this report. 2. Pursuant to Section 5.08 (c) of the General Terms and Conditions, the Project implementation report and the corresponding plan required by this Section must be provided to the Bank no later than six (6) months after the closing date of the project. 3. On or about January 15, 2011, the Borrower, through the Ministry of Health of the Republic of Kazakhstan, will jointly conduct a mid-term review of progress in the implementation of the Project (hereinafter referred to as the Mid-term Review) with the World Bank. The Mid-term review will cover, among other things, (a) progress towards achieving the Project objectives and (b) overall Project performance in accordance with the outcome indicators. 4. At least four (4) weeks before the Mid-Term Review, the Borrower, through the Ministry of Health of the Republic of Kazakhstan, will submit to the Bank a separate report describing the implementation status of each component of the Project and a summary report on the overall implementation of the Project.

B. Financial management, financial reporting and audit

1. The Borrower is required to maintain or ensure the maintenance of a financial management system in accordance with the provisions of Section 5.09 of the General Terms and Conditions. 2. Unless otherwise provided by the provisions of Part A of this Section, the Borrower is required to prepare and submit to the Bank, no later than forty-five (45) days after the end of each calendar quarter, interim unaudited financial reports on the Project for that quarter, acceptable to the Bank in form and content. 3. The Borrower is required to audit its Financial Statements in accordance with the provisions of Section 5.09 (b) of the General Terms and Conditions. Each audit of the Financial Statements should cover a period of one (1) financial year of the Borrower. The audited Financial Statements for each such period must be submitted to the Bank no later than six (6) months after the end of each such period.

Section III. Purchases

But.General provisions

1.Goods and works.All goods and works required for the Project are procured in accordance with the requirements contained or referenced in Section I of the Procurement Manual, as well as in accordance with the provisions of this Annex. 2.Consulting services.All consultant services required for the Project are procured in accordance with the requirements contained or referenced in Sections I and IV of the Guidelines "Selection and Hiring of Consultants by World Bank Borrowers" (Consultant Guidelines), as well as in accordance with the provisions of this Section. 3.Definitions.The terms starting with capital letters used below in this Section to describe certain procurement methods or the Bank's review methods for certain contracts correspond to the definitions assigned to them in the Procurement Manual or the Consultant Manual, as appropriate.

B.Selected methods of purchasing goods and works

1.International competitive bidding.Unless otherwise provided in paragraph 2 below, the procurement of goods and works is carried out under contracts concluded in accordance with International Competitive bidding procedures, in accordance with the requirements established or referred to in Section II of the Procurement Manual. 2.Other methods of purchasing goods and services.The table below shows the procurement methods, except for International Competitive Bidding, that can be used in relation to goods and works. The procurement plan should contain the circumstances in which a particular method can be used.

Purchasing method

(a) National competitive bidding, in accordance with the additional provisions set out in the Appendix to this Annex 2

(b) Purchases in a retail network

B.Selected methods of purchasing consultants' services

1.Selection based on quality and cost.Unless otherwise provided in paragraph 2 below, the procurement of consulting services is carried out within the framework of contracts awarded on the basis of an assessment based on quality and cost. 2.Other methods of purchasing consultants' services.The table below shows the procurement methods, except for Selection based on quality and cost, which can be used in relation to the services of consultants. The procurement plan should contain the circumstances in which a particular method can be used.

Purchasing method

(a) Quality-based selection

(b) Selection with a fixed budget

(d) Selection based on the qualifications of consultants

(e) Selection from a single source

(e) The procedures set out in paragraphs 5.2 and 5.3 of the Consultant Guidelines for the Selection of Individual Consultants

(g) Single-source procurement procedures for the selection of individual consultants

G.The Bank's review of procurement decisions

The procurement plan should specify those contracts that are subject to Preliminary Review by the Bank. All other contracts are subject to Subsequent review by the Bank.

Section IV. Withdrawal of Loan funds from the account

But. General provisions

1. The Borrower may withdraw funds from the Loan in accordance with the provisions of Article II of the General Terms and Conditions, this Section and those additional instructions specified by the Bank in the notification to the Borrower (including the "World Bank Guidelines for the Disbursement of Project Funds" dated May 2006, periodically reviewed by the Bank and applicable to this Agreement in accordance with such instructions), for financing Eligible expenses, according to the table in paragraph 2 below. 2. The table below defines the categories of Eligible Expenses to be financed from the Loan (the "Category"), the allocated Loan amounts for each Category, and the percentage of expenses to be financed as Eligible Expenses for each Category.

Category

Allocated Loan amount (in dollar terms)

Share of expenses to be financed (in %)

1. Goods and works

68 200 000

100 %

2. Training and consulting services

49 300 000

100 %

3. Operating expenses

200 000

100 %

total

117 700 000

B. Withdrawal conditions; withdrawal period

1. Regardless of the provisions of Part A of this Section, funds will not be withdrawn.: (a) from the Loan account until the Bank receives full payment of the loan opening fee, and (b) in order to make payments before the date of this Agreement. 2. The closing date is June 30, 2013.

Addendum to APPENDIX 2

The Borrower's National Competitive Bidding procedures may be used to purchase works under this Project, subject to the following provisions:

But.Participation of State-owned enterprises

State-owned enterprises in the Borrower's territory have the right to participate in auctions only if they can officially confirm their legal and financial independence, if they operate on the basis of commercial law and are not organizations dependent on the agency concluding the contract as the customer. Moreover, they will be subject to the same requirements regarding applications and reliability of effectiveness as other applicants.

B.Tender documentation

Organizations engaged in procurement must use a standard package of tender documentation for the purchase of goods acceptable to the Bank.

V.Opening and evaluation of applications

(a) Applications are opened publicly, immediately after the deadline for submitting applications; (b) Applications should be evaluated in strict accordance with the monetary criteria stated in the tender documentation; (c) The principle of preference for domestic suppliers should not be applied; (d) Contracts are awarded to a qualified applicant who submitted an application that meets the maximum requirements all requirements and with the lowest estimated cost, while negotiations are not provided.

G.Price adjustment

Contracts for construction work designed for a long period (for example, more than eighteen (18) months) must contain an appropriate price adjustment provision.

D.Cancellation of the bidding process

The recognition of the tender as invalid and the announcement of the acceptance of new applications can be carried out only with the prior consent of the Bank.

E.Rejection of individual applications

Each individual application can be rejected only in the following cases: (a) the applicant does not meet the qualification requirements; (b) the applicant does not accept the correction of an arithmetic error contained in his tender application made by the Tender Commission of the procurement organization; and (c) the applicant does not meet the requirements of the tender documentation.

APPENDIX 3

Depreciation schedule

The date of payment of the principal debt Repayment of the principal amount of the loan (in US dollars) Every January 15th and July 15th

starting from July 15, 2013 until January 15, 2023, 5,885,000

addition

Section I. Definitions

1. "Category" is the category indicated in the table of Section IV of Annex 2 to this Agreement. 2. "PKG" is a Permanent Coordination Group, which includes employees of the Ministry of Health of the Republic of Kazakhstan and the Ministry of Economic Development of the Republic of Kazakhstan, responsible for the administration of each component of the Project and the interaction between the Ministry of Health and the Ministry of Economic Development of the Republic of Kazakhstan on policy and implementation issues. 3. "Guidance on Consultants" - "Guidance: Selection and hiring of consultants by World Bank borrowers", published by the Bank in May 2004.4. "DEF" is the Department of Economics and Finance of the Ministry of Health of the Borrower or any of its legal successors or assigns. 5. "General Conditions" - "General Conditions for loans of the International Bank for Reconstruction and Development" dated July 1, 2005, as amended in Section II of this Annex. 6. "Health Policy Council" is a council to be established in the Ministry of Health or any of its legal successors or successors in accordance with Section I.3 of Annex 2 to this Agreement, which will be responsible for strategic oversight and Project management.; The composition of such a Board should be satisfactory for the Bank. 7. "MEBP" - the Ministry of Economy and Budget Planning of the Borrower or any of its legal successors or successors. 8. "Ministry of Finance" means the Ministry of Finance of the Borrower or any of its legal successors or assigns. 9. "MOH" means the Ministry of Health of the Borrower or any of its legal successors or assigns. 10. "Operating expenses" means current expenses incurred by the Ministry of Health of the Republic of Kazakhstan in connection with the implementation, management and monitoring of the Project, including staff salaries and costs for consulting services, training, conferences, study trips and seminars, dissemination of information on the Project, office rent and utilities, insurance, office maintenance and repair, and equipment, maintenance and repair of vehicles, transportation costs, security and communication costs, banking costs and other various costs, directly related to the implementation of the Project, incurred in accordance with periodic budgets acceptable to the Bank. 11. "Implementation Guide" means a guide acceptable to the Bank, which will be approved by the Borrower in accordance with section I, paragraph 5 of the Annex to this Agreement, which describes the Project implementation procedures that do not contradict the provisions of this Agreement, the Borrower's local laws and regulations, and include, but are not limited to: (i) procedures for managing the processes of administration, procurement, accounting, financial management, monitoring and evaluation mechanisms; (ii) standard formats of annual reports; (iii) samples of tender documents; and (iv) a Project-wide capacity-building plan; with the Bank's consent, the Management may be amended from time to time. 12. "GPRP" is a Project Support Group responsible for the implementation of each component and sub-component of the Project on a daily basis, reporting to the Director of the Department of Strategic Development and International Cooperation of the Ministry of Health, or any to his legal successor or legal successors, and the qualifications and technical assignments of the members of which are satisfactory to the Bank. 13. The Procurement Manual is the Procurement Manual for IBRD Loans and IDA Loans, published by the Bank in May 2004. 14. "Procurement Plan" - the Borrower's procurement plan for the Project dated December 5, 2007, referred to in paragraph 1.16 of the Procurement Manual and paragraph 1.24 of the Consultant Manual, at the same time, subject to updating in accordance with the provisions of these paragraphs. 15. "State Program for Healthcare Reform and Development" is the State Program for healthcare reform and development of the Republic of Kazakhstan for 2005-2010, approved by Presidential Decree No. 1438 dated September 13, 2004, and subsequent state programs for the reform and development of the Borrower's healthcare sector. 16. "Training" means Project-related internships, training courses, seminars, practical exercises and other training activities not included in contracts for the supply of goods or services, including the cost of training materials, rental of premises and equipment, transportation costs, travel expenses of trainees and instructors, payment for instructors, as well as the cost of oral and a written translation.

Section II. Amendments to the Basic Conditions

The following amendments have been made to the basic conditions: 1. Section 3.01 reads as follows: "Section 3.01 Commission for opening a loan. The Borrower undertakes to pay the Bank a loan opening fee in the amount specified in the Loan Agreement (the "Loan Opening Fee"). 2. A new paragraph (d) has been added to Section 3.02 "Remuneration": "(d) Regardless of the provisions of paragraph (a) of this Section, if any amount of the Withdrawn Loan Balance is not paid on time and the payment is thirty days overdue, the Borrower will have to pay the late payment fee instead of the interest rate specified in the Loan Agreement (or remuneration at a different interest rate according to Article IV as a result of the Conversion) until the overdue amount is fully paid. Remuneration at the late payment rate will be accrued from the first day of each Late Payment Remuneration Period and will be subject to semi-annual payment of arrears on each Payment Date.". 3. The Definitions appendix has been corrected as follows: (a)Paragraph 19, "Commitment fee", has been deleted, and subsequent paragraphs are numbered accordingly. (b)New paragraphs 27, 28, 29 and 30 have been added to the Appendix: "27. The "Late payment accrual period" is calculated for each overdue amount of the Withdrawn Loan Balance, each Accrual Period during which such overdue amount remains unpaid; however, provided that the first Overdue Payment Accrual Period begins on the 31st after the date on which the payment is overdue, and the last The accrual period for late payment will end on the day when the overdue amount is fully paid." 28. The "Late payment fee rate" is calculated for each Period of Accrual of late payment fees: (a) in the case of a Variable Spread Loan: LIBOR penalty rate plus variable spread plus half of one percent (0.5%); (b) in the case of a Fixed-Spread Loan for which interest on the amount of the Withdrawn Loan Balance - which includes the Late Payment Fee Period - should have been paid at a variable Interest Rate immediately prior to the application of the Late Payment Fee: penalty variable rate plus half of one percent (0.5%); and (c) in the case of a Fixed-Spread Loan, for which remuneration for the amount of the Withdrawn Loan Balance - which includes the Period of Accrual of Late payment remuneration - should have been paid at a Fixed Rate immediately prior to the application of the Late Payment Remuneration Rate: LIBOR penalty rate plus fixed spread plus half of one percent (0.5%)" 29. "LIBOR penalty rate" means the LIBOR for the relevant Remuneration Period; this means that for the initial remuneration period; For late payment, the LIBOR penalty rate will be equal to the LIBOR rate for the Remuneration Period in which the amount specified in paragraph (d) of Section 3.02 was overdue for the first time. 30. "Penalty Variable Rate" means the variable Remuneration rate for the relevant Remuneration Period; this means that for the initial Period of Remuneration for Late payment, the Penalty Variable Remuneration Rate will be equal to the Variable Remuneration Rate for the Remuneration Period in which the amount specified in paragraph (d) of Section 3.02, was overdue for the first time." (c)Paragraph 43 "Fixed spread" (in accordance with the renumbering) has been changed as follows: 43. "Fixed Spread" means the Bank's fixed spread for the original Loan currency, effective from 12:01 p.m. Washington, D.C. time, one calendar day prior to the date of the Loan Agreement; provided that upon currency conversion of all or any part of the Outstanding Loan Balance, such fixed spread will be adjusted to The execution date in the order specified in the Conversion Guide; and provided that, notwithstanding the above, for the purpose of determining the Late Payment Interest Rate applicable to the Withdrawn Loan Balance, on which the remuneration is calculated at a fixed rate, "Fixed Spread" means the Bank's fixed spread effective from 12:01 p.m. Washington, D.C. time, one calendar day prior to the date the conclusion of a Loan Agreement for the currency denomination of such an amount." (d)Paragraph 56 "Date of the LIBOR rate change" (in accordance with the renumbering) has been changed as follows: "56."The date of the LIBOR rate change" means: (a) for any currency other than the euro, two London banking days before the first day of the relevant Interest Rate Period (or: (i) in the case of the initial Interest Rate on a Variable-Spread Loan, two London banking days before the fifteenth day of the month preceding the month when the Loan Agreement was signed, if provided that if the date of the Loan Agreement falls on or later than the fifteenth day of the month of signing the Loan Agreement, the Date of the LIBOR Rate change will be two London banking days before the fifteenth day of such month.; (ii) in the case of the initial Interest Rate of a Fixed-Spread Loan, two London banking days before the first or fifteenth day of the month in which the Loan Agreement was signed, whichever day immediately precedes the date of the Loan Agreement; provided that the date of the Loan Agreement falls on the first or fifteenth day. For such a month, the date of the LIBOR rate change must be two London banking days before the date of the Loan Agreement.; and (iii) if the Date of Currency Conversion of the Outstanding Loan Balance into any Approved Currency other than the euro falls on any day other than the Day of Payment, the initial Date of the LIBOR Rate change for the Approved Currency will be two London banking days before the first or fifteenth day of the month on which the Conversion Date falls, in depends on which day immediately precedes the Conversion Date.; provided that the Conversion Date falls on the first or fifteenth of such month, the Date of the LIBOR Rate change for the Approved Currency will be two London banking days before the Conversion Date; (b) for euros, two Scheduled Payment Days before the first day of the relevant Accrual Period (or: (i) in the case of the initial Rate variable Spread Loan fees - two Scheduled Payment days before the fifteenth day of the month preceding the month when the Loan Agreement was signed; provided that the date of the Loan Agreement falls on or later than the fifteenth day of the month in which the Loan Agreement is signed, the Date of the LIBOR Rate change will be two Scheduled Payment Days before the fifteenth day of such month; (ii) in the case of the initial Interest Rate on a fixed-spread Loan, two Scheduled Payment Days before the measured or the fifteenth day of the month when the Loan Agreement was signed, whichever day immediately precedes the date of the Loan Agreement.; provided that the date of the Loan Agreement falls on the first or fifteenth of such month, the Date of the LIBOR Rate Change will be two Scheduled Payment Days before the date of the Loan Agreement and (iii) if the Date of Conversion to Euro currency of the Outstanding Loan Balance falls on a day other than the Payment Date, the initial Date of the Rate change The LIBOR for the Approved Currency will be two days before the first or fifteenth day of the month on which the Conversion Date falls, depending on which day immediately precedes the Conversion Date.; provided that the Conversion Date falls on the first or fifteenth of such month, the Date of the LIBOR rate change will be two Scheduled Payment days before the Conversion Date); and (c) notwithstanding sub-paragraphs (a) and (b) of this paragraph, if, for the Conversion of an Approved Currency, the Bank determines that the market practice for determining the Date of the LIBOR Rate Change provides for a date other than that indicated in the above sub-paragraphs, the Date of the LIBOR Rate Change will be a different date, additionally specified in the Conversion Guide." (e)Paragraph 66, "Loan repayment" (in accordance with the renumbering), has been amended as follows: "66. "Loan Repayment" means any amount payable to the Bank by the Parties to the Loan Agreement in accordance with legal agreements or these General Terms and Conditions, including (but not limited to) any amount of the Loan Balance Withdrawn, remuneration, loan opening fee, late payment rate fee (if any), any early payment fees, any transactional payments for currency conversion or completion of conversion, any rewards paid upon setting a fixed maximum reward or a fixed minimum reward, as well as any installment amounts payable by the Borrower." (f)Item 71 "Payment date" (in accordance with the renumbering) has been changed as follows: "71. 'Payment Date' means each date specified in the Loan Agreement - on or after the date of the Loan Agreement on which remuneration is to be paid.".

I hereby certify that this translation corresponds to the text of the Loan Agreement (Project on Technology Transfer and Institutional Reform in the Healthcare Sector) between the Republic of Kazakhstan and the International Bank for Reconstruction and Development in English, signed in Astana on February 2, 2008.

Vice Minister of Finance  Of the Republic of Kazakhstan D. Ergozhin

RCPI note: The following is the text of the Loan Agreement (Project on Technology Transfer and Institutional Reform in the Healthcare Sector of the Republic of Kazakhstan) between the Republic of Kazakhstan and the International Bank for Reconstruction and Development in English.

President

Republic of Kazakhstan

Constitution Law Code Standard Decree Order Decision Resolution Lawyer Almaty Lawyer Legal service Legal advice Civil Criminal Administrative cases Disputes Defense Arbitration Law Company Kazakhstan Law Firm Court Cases