Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) AFRICA | Uganda | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2017 | Seq No: 7 | ARCHIVED on 19-Dec-2019 | ISR39525 | Implementing Agencies: Ministry of Finance, Planning and Economic Development, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 04-Aug-2016 Effectiveness Date: 26-May-2017 Planned Mid Term Review Date: 23-Sep-2019 Actual Mid-Term Review Date: 09-Oct-2019 Original Closing Date: 30-Jun-2021 Revised Closing Date: 30-Jun-2021 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objectives (PDOs) are to: (a) improve utilization of essential health services with a focus on reproductive, maternal, newborn, child and adolescent health services in target districts; and (b) scale up birth and death registration services Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Results-Based Financing for Primary Health Care Services:(Cost $85.50 M) Component 2: Strengthen Health Systems to Deliver RMNCAH Services:(Cost $62.00 M) Component Three: Strengthen Capacity to Scale-up Delivery of Births and Deaths Registration Services:(Cost $10.00 M) Component Four: Enhance Institutional Capacity to Manage Project Supported Activities:(Cost $7.50 M) Contingent Emergency Response Component Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions A mid-term review (MTR) of the project was undertaken from September 23rd to October 9th 2019. Findings from the MTR suggest that the project’s design and development objectives are still highly relevant to Uganda’s aspiration to improve reproductive, maternal, newborn, child and 12/19/2019 Page 1 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) adolescent health outcomes. However, the project has been facing implementation challenges since effectiveness, owing to delays in procurement, payment approvals, and low levels of ownership and proactivity by the different line departments. But, while the overall progress is below expectation, implementation progress has improved. Following the MTR, the World Bank and Government both agreed to specific actions to enhance performance. These include: swift review of procurements and payments; restructuring of project to improve efficiency; increased proactivity in identifying and resolving implementation bottlenecks; and stronger accountability through regular check-ins with Management against set goals and targets. mpaTable Multiphase Programmatic Approach (MPA) Status mpaTableBody Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Sustainability High High High Fiduciary Substantial Substantial Substantial Environment and Social Moderate Substantial Substantial Stakeholders Substantial Substantial Substantial Other -- -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Improve utilization of essential health services with a focus on reproductive, maternal, newborn, ch IN00772638 ►Children under one year immunized with 3rd dose of pneumococcal conjugate vaccine (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 79.00 92.60 89.70 90.00 Date 30-Jun-2015 06-Dec-2018 30-Oct-2019 30-Jun-2021 IN00772640 ►Pregnant women who received IPT2 (Percentage, Custom) 12/19/2019 Page 2 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) Baseline Actual (Previous) Actual (Current) End Target Value 53.00 63.20 66.00 80.00 Date 30-Jun-2015 06-Dec-2018 30-Oct-2019 30-Jun-2021 IN00772642 ►Couple Years of Protection (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3,308,142.00 2,540,251.00 3,222,372.00 4,500,000.00 Date 30-Jun-2015 06-Dec-2018 30-Oct-2019 30-Jun-2021 IN00772643 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,550,000.00 2,550,000.00 3,200,000.00 Date 30-Jun-2015 06-Dec-2018 30-Oct-2019 30-Jun-2021 IN00772644 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 2,028,888.00 1,535,000.00 2,284,246.00 1,800,000.00 Date 30-Jun-2015 06-Dec-2018 30-Oct-2019 30-Jun-2021 IN00772645 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 1,020,000.00 63.00 65.00 Date 30-Jun-2015 06-Dec-2018 30-Oct-2019 30-Jun-2021 Scale up birth and death registration services IN00772639 ►Children under five years with birth registration (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 54,127.00 23,667.00 619,936.00 500,000.00 Date 30-Jun-2015 06-Dec-2018 30-Oct-2019 30-Jun-2021 Based on the data, it would appear that this indicator has surpassed end line targets; however this is misleading. The definition for birth registration has changed since the project was designed. As such this Comments: indicator will need to be modified and the target values duly corrected. This will ensure consistency and accuracy in reporting. IN00772641 ►Total number of deaths registered (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/19/2019 Page 3 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) Value 3,340.00 3,411.00 3,886.00 50,000.00 Date 30-Jun-2015 06-Dec-2018 30-Oct-2019 30-Jun-2021 This indicator will also be modified through a restructuring since there is need to better define 'registration' within the context of the new laws. The target values will also be modified in line with implementation Comments: lessons learned and findings from the CRVS baseline survey. Overall Comments PDO The baseline data and target values for some of the project indicators require updating to reflect both new/more reliable data and lessons learned from implementation. This will be done through the restructuring, which is due to completed by January 31, 2019. Intermediate Results Indicators by Components Component 1: Results-Based Financing for Primary Health Care Services IN00772646 ►Pregnant women receiving antenatal care during a visit to a health provider (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1,500,000.00 4,791,351.00 4,791,351.00 1,650,000.00 Date 30-Jun-2015 06-Dec-2018 30-Oct-2019 30-Jun-2021 IN00772649 ►RBF health facilities with functional HUMCs with citizen representation (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45.00 0.00 88.90 100.00 Date 30-Jun-2015 06-Dec-2018 30-Oct-2019 30-Jun-2021 IN00772651 ►HC IVs offering caesarian section (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 71.70 81.60 75.00 Date 30-Jun-2015 06-Dec-2018 30-Oct-2019 30-Jun-2021 IN00772653 ►Districts with functional ambulance and referral system (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 25.00 25.00 60.00 Date 30-Jun-2015 06-Dec-2018 30-Oct-2019 30-Jun-2021 Component 2: Strengthen Health Systems to Deliver RMNCAH Services 12/19/2019 Page 4 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) IN00772647 ►Health facilities constructed, renovated, and/or equipped (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 150.00 Date 30-Jun-2015 06-Dec-2018 30-Oct-2019 30-Jun-2021 Civil works has not started so there is no current data. Comments: IN00772650 ►Health personnel receiving training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 766.00 721.00 400.00 Date 30-Jun-2015 06-Dec-2018 30-Oct-2019 30-Jun-2021 IN00772652 ►Health facilities with placed orders that are fully filled by National Medical Stores (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 65.00 77.00 91.00 80.00 Date 30-Jun-2015 06-Dec-2018 30-Oct-2019 30-Jun-2021 IN00772654 ►Approved posts in public facilities filled by qualified health workers (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 65.00 74.00 76.00 75.00 Date 30-Jun-2015 06-Dec-2018 30-Oct-2019 30-Jun-2021 IN00772655 ►Health facilities attaining at least 2 star rating under the QA Program (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 13.20 50.00 Date 30-Jun-2015 06-Dec-2018 30-Oct-2019 30-Jun-2021 Data on this is also mot available since activities on the QA program are delayed. Comments: IN00772656 ►Health facilities without stock-outs of any of the six tracer drugs in the previous three months (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 64.00 85.00 84.00 80.00 Date 30-Jun-2015 06-Dec-2018 30-Oct-2019 30-Jun-2021 IN00772657 ►Clients expressing satisfaction with health (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/19/2019 Page 5 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) Value 70.00 0.00 0.00 80.00 Date 30-Jun-2015 14-Dec-2018 30-Oct-2019 30-Jun-2021 This data was not readily available and will be updated during restructuring. Comments: Component Three: Strengthen Capacity to Scale-up Delivery of Births and Deaths Registration Services IN00772648 ►Reported maternal deaths that are audited (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 33.00 49.50 51.00 65.00 Date 06-Dec-2018 06-Dec-2018 30-Oct-2019 30-Jun-2021 Overall Comments IR Based on the review of progress vis-à-vis the indicators and targets, it would appear that even though the project has low disbursement, project outcomes are mostly on track--or even surpassed (e.g. health personnel trained; health facilities without stock-outs of six tracer medicines; HC IVs receiving caesarian sections). While the project has contributed to these improvements--especially through the scholarship schemes for health personnel and procurement of essential medicines--the health sector also receives funding from other donors and is coordinated through a sector wide approach. In view of these achievements, the restructuring process will carefully review and update the target values in order to more easily measure and track the project's value addition. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P155186 IDA-58970 Effective USD 110.00 110.00 0.00 29.00 79.61 27% P155186 TF-A2977 Effective USD 30.00 30.00 0.00 9.50 20.50 32% P155186 TF-A6713 Effective USD 9.44 9.44 0.00 9.43 0.01 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P155186 IDA-58970 Effective 04-Aug-2016 19-Jan-2017 26-May-2017 30-Jun-2021 30-Jun-2021 P155186 TF-A2977 Effective 19-Jan-2017 19-Jan-2017 26-May-2017 30-Jun-2021 30-Jun-2021 P155186 TF-A6713 Effective 12-Sep-2018 16-Oct-2018 16-Oct-2018 30-Jun-2021 30-Jun-2021 12/19/2019 Page 6 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Uganda Reproductive, Maternal and Child Health Services Improvement Project (P155186) Cumulative Disbursements Restructuring History There has been no restructuring to date. Related Project(s) P163691-Additional Financing Uganda Reproductive Maternal and Child Health Services Improvement Project 12/19/2019 Page 7 of 7