Public Disclosure Copy The World Bank Implementation Status & Results Report Maternal and Child Nutrition and Health Results Project (P143650) Maternal and Child Nutrition and Health Results Project (P143650) AFRICA | Gambia, The | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2014 | Seq No: 9 | ARCHIVED on 04-May-2018 | ISR32318 | Implementing Agencies: The Republic of The Gambia, National Nutrition Agency (NaNA) Key Dates Key Project Dates Bank Approval Date:21-Mar-2014 Effectiveness Date:20-May-2014 Planned Mid Term Review Date:31-Jan-2018 Actual Mid-Term Review Date:02-Feb-2018 Original Closing Date:31-Jul-2019 Revised Closing Date:31-Jul-2021 Project Development Objectives Project Development Objective (from Project Appraisal Document) A. Proposed Development Objective The development objective of the project is to increase the utilization of communitynutritionand primary maternal and child health services in selected regions in the Recipient’s territory. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Community mobilization for social and behavior change:(Cost $5.15 M) Delivery of community nutrition and primary health care services:(Cost $11.53 M) Capacity building for service delivery, results-based financing, food and nutrition security and cash transfers:(Cost $4.00 M) Ebola preparedness and control:(Cost $0.50 M) Contingent Emergency Response Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Satisfactory  Satisfactory Overall Implementation Progress (IP)  Satisfactory  Satisfactory 5/4/2018 Page 1 of 16 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Maternal and Child Nutrition and Health Results Project (P143650) Overall Risk Rating  Substantial  Substantial Implementation Status and Key Decisions Implementation is going well and the project is likely to fully achieve its development objectives. The project has scaled up to all five rural health regions, with all health centers and hospitals in these regions being covered. This has led to an increase in the delivery of community nutrition services, an increase in the number of communities being directly contracted through the community RBF scheme, and social and behavior change communication and community mobilization tools being implemented. The roll-out of the food and nutrition security and unconditional cash transfer activities, which were added to the project through two consecutive additional financing, is in full swing. Continued attention will be needed on food and nutrition security, M&E capacity (especially given the growing needs), quality of care and overall project management. 5/4/2018 Page 2 of 16 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Maternal and Child Nutrition and Health Results Project (P143650) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  High  Substantial Macroeconomic  --  High  High Sector Strategies and Policies  --  Moderate  Moderate Technical Design of Project or Program  --  Substantial  Substantial Institutional Capacity for Implementation and Sustainability  --  Moderate  Moderate Fiduciary  --  Substantial  Substantial Environment and Social  --  Low  Low Stakeholders  --  Moderate  Moderate Other  --  --  -- Overall  --  Substantial  Substantial Results Project Development Objective Indicators 5/4/2018 Page 3 of 16 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Maternal and Child Nutrition and Health Results Project (P143650) PHINDPDOTBL  Children 0-6 months exclusively breastfed (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 47.00 49.00 49.00 60.00 Date 31-Dec-2013 31-Dec-2015 31-Dec-2017 31-Jul-2021 Comments Source: Household surveys. Baseline is the national figure from the 2013 DHS. The subsequent figures are from the impact evaluation survey. The baseline figures will be recalculated for the five project regions and included in the next ISR and level-2 restructuring. PHINDPDOTBL  Children 6-23 months consuming at least four out of six food groups (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 19.00 -- 16.00 35.00 Date 31-Dec-2013 -- 31-Dec-2017 31-Jul-2021 Comments This indicator is not on track and requires close attention. However, the baseline is a national figure and will be recalculated for the five project regions in the upcoming restructuring. Source: Household surveys. Baseline is the national figure from the 2013 DHS. The subsequent figures are from the impact evaluation survey. The baseline figures will be recalculated for the five project regions and included in the next ISR and level-2 restructuring. PHINDPDOTBL  Women using modern methods of family planning (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 12,925.00 14,963.00 63,581.00 20,000.00 Date 31-Dec-2013 30-Sep-2016 31-Dec-2017 31-Jul-2021 Comments Indicator has surpassed the end-of-project target. It has been agreed to change this indicator to percentage of women aged 15-49 years 5/4/2018 Page 4 of 16 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Maternal and Child Nutrition and Health Results Project (P143650) using modern contraceptives in the upcoming restructuring. Source: Health Management Information System. PHINDPDOTBL  Direct project beneficiaries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 371,968.00 1,033,302.00 1,400,000.00 Date 28-Feb-2014 30-Jun-2017 31-Dec-2017 31-Jul-2021 Comments This indicator is not useful, difficult to measure, and no longer a core indicator, hence will be dropped in the upcoming restructuring Source: Health Management Information System and Community Registers. PHINDPDOTBL  Female beneficiaries (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 70.00 83.00 74.00 70.00 PHINDPDOTBL  People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 98,885.00 294,315.00 359,970.00 500,000.00 Date 31-Jan-2014 30-Jun-2017 31-Dec-2017 31-Jul-2021 Comments This is a new corporate results indicator (this data is not collected but computed based on any of the 3 relevant breakdown indicators: number of children immunized; number of deliveries attended by skilled health personnel; and number of women and children who have received basic nutrition services. Some end-of-project targets unrealistically low or high and will be revisited during the next level-2 5/4/2018 Page 5 of 16 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Maternal and Child Nutrition and Health Results Project (P143650) restructuring. Source: Health Management Information System and Community Registers. PHINDPDOTBL  Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 90,000.00 279,000.00 279,000.00 593,000.00 Date 31-Jan-2014 29-Apr-2016 29-Apr-2016 30-Jun-2017 PHINDPDOTBL  Children between age 6 and 59 months receiving Vitamin A supplementation (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 70,000.00 169,742.00 233,751.00 475,000.00 Date 31-Jan-2014 30-Jun-2017 31-Dec-2017 31-Jul-2021 PHINDPDOTBL  Pregnant women receiving iron and folic acid (IFA) supplements (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 9,000.00 59,929.00 122,936.00 18,000.00 Date 31-Jan-2014 30-Sep-2016 31-Dec-2017 31-Jul-2021 PHINDPDOTBL  Children under age 24 months benefiting from improved infant and young child feeding (IYCF) practices (Number, Custom Breakdown) 5/4/2018 Page 6 of 16 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Maternal and Child Nutrition and Health Results Project (P143650) Baseline Actual (Previous) Actual (Current) End Target Value 10,000.00 53,942.00 71,003.00 95,000.00 Date 31-Jan-2014 30-Jun-2017 31-Dec-2017 31-Jul-2021 PHINDPDOTBL  Children under age 5 years treated for moderate or severe acute malnutrition (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 200.00 4,065.00 10,972.00 5,000.00 Date 31-Jan-2014 30-Jun-2017 31-Dec-2017 31-Jul-2021 PHINDPDOTBL  Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 8,885.00 15,315.00 52,686.00 23,000.00 Date 31-Dec-2013 30-Sep-2016 31-Dec-2017 31-Jul-2021 Overall Comments With one indicator not on track, one indicator having performed beyond expectations and the other indicators showing varying degrees of positive to very good performance, the project overall is performing well. The core indicators which have undergone repeated changes in the past will be cleaned up in the next level-2 restructuring. Intermediate Results Indicators PHINDIRITBL  Pregnant women referred by VSG members for delivery and complication management (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5,250.00 11,836.00 12,000.00 Date 28-Feb-2014 30-Jun-2017 31-Dec-2017 31-Jul-2021 Comments Indicator is on track to reach the target early. 5/4/2018 Page 7 of 16 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Maternal and Child Nutrition and Health Results Project (P143650) Source: Health Management Information System and Project Monitoring System PHINDIRITBL  Hand washing stations/points established (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 8,109.00 12,008.00 6,000.00 Date 28-Feb-2014 30-Jun-2017 31-Dec-2017 31-Jul-2021 Comments Indicator is performing beyond expectations. Target may be revisited during the upcoming level-2 restructuring. Source: Health Management Information System and Project Monitoring System PHINDIRITBL  Community registers updated quarterly (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 341.00 1,129.00 495.00 560.00 Date 31-Jan-2014 30-Jun-2017 31-Dec-2017 31-Jul-2021 Comments Indicator is on track on reaching the target on time. Source: Health Management Information System and Project Monitoring System 5/4/2018 Page 8 of 16 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Maternal and Child Nutrition and Health Results Project (P143650) PHINDIRITBL  Pregnant/lactating women, adolescent girls and/or children under age five-reached by basic nutrition services (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 90,000.00 186,380.00 359,970.00 593,000.00 Date 31-Jan-2014 29-Apr-2016 31-Dec-2017 31-Jul-2021 Comments This indicator and ensuring break down indicators is a repeat of the PDO level and a result of the recurrent changes in core indicators. This will be cleaned up during the upcoming level-2 restructuring. Source: Health Management Information System and Project Monitoring System PHINDIRITBL  Children between the age of 6 and 59 months receiving Vitamin A supplementation (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 70,000.00 169,742.00 233,751.00 475,000.00 Date 31-Jan-2014 30-Jun-2017 31-Dec-2017 31-Jul-2021 PHINDIRITBL  Pregnant women receiving iron and folic acid (IFA) supplements (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 9,000.00 59,929.00 122,936.00 18,000.00 Date 31-Jan-2014 30-Sep-2016 31-Dec-2017 31-Jul-2021 PHINDIRITBL  Children under the age of 24 months benefiting from improved infant and young child feeding (IYCF) practices (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 10,000.00 53,942.00 71,003.00 95,000.00 Date 31-Jan-2014 30-Jun-2017 31-Dec-2017 31-Jul-2021 5/4/2018 Page 9 of 16 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Maternal and Child Nutrition and Health Results Project (P143650) PHINDIRITBL  Children under age five treated for moderate or severe acute malnutrition (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 200.00 4,065.00 10,972.00 5,000.00 Date 31-Jan-2014 30-Jun-2017 31-Dec-2017 31-Jul-2021 PHINDIRITBL  Communities implementing BFCI activities (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 633.00 633.00 633.00 1,100.00 Date 11-Mar-2015 30-Jun-2017 31-Dec-2017 31-Jul-2021 Comments This indicator is not on track to reach the end target and will be closely monitored by the team. Given the favorable implementation context, the team believes that the Project can still achieve the target on time. Source: Health Management Information System and Project Monitoring System PHINDIRITBL  Children 12-59 dewormed in the preceding year (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 6,461.00 53,067.00 177,146.00 46,000.00 Date 31-Dec-2013 30-Sep-2016 31-Dec-2017 31-Jul-2021 Comments The indicator has performed beyond expectations. As a result, the end target will likely be revisited during the upcoming level-2 restructuring. Source: Health Management Information System and Project Monitoring System 5/4/2018 Page 10 of 16 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Maternal and Child Nutrition and Health Results Project (P143650) PHINDIRITBL  Pregnant women coming for ANC in the first trimester in the preceding year (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2,342.00 18,371.00 25,765.00 12,000.00 Date 31-Dec-2013 30-Jun-2017 31-Dec-2017 31-Jul-2021 Comments The indicator has performed beyond expectations. As a result, the end target will likely be revisited during the upcoming level-2 restructuring. Source: Health Management Information System and Project Monitoring System PHINDIRITBL  Post-partum mothers supplemented with VAS in the preceding year (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 22,200.00 43,376.00 55,591.00 26,000.00 Date 31-Dec-2013 30-Jun-2017 31-Dec-2017 31-Jul-2021 Comments The indicator has performed beyond expectations. As a result, the end target will likely be revisited during the upcoming level-2 restructuring. Source: Health Management Information System and Project Monitoring System PHINDIRITBL  Vulnerable households supported in participating in gardening, keeping ruminants, or keeping poultry (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 781.00 5,000.00 Date 26-Feb-2015 31-Dec-2016 31-Dec-2017 31-Jul-2021 Comments This indicator is not on track to reach the end target. The team will revisit the end target during the upcoming level-2 restructuring. Source: Health Management Information System and Project Monitoring System 5/4/2018 Page 11 of 16 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Maternal and Child Nutrition and Health Results Project (P143650) PHINDIRITBL  Communities supported in establishing child food banks (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 250.00 Date 09-Feb-2015 31-Dec-2016 31-Dec-2017 31-Jul-2021 Comments This indicator has not shown any progress to date and is unlikely to reach the end target. The team will revisit the indicator during the upcoming level-2 restructuring as implementation of the activity is more complicated than expected. Source: Health Management Information System and Project Monitoring System PHINDIRITBL  Health workers (including central and regional level managers) trained on RBF management (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 38.00 408.00 550.00 200.00 Date 31-Jan-2014 30-Dec-2016 31-Dec-2017 31-Jul-2021 Comments The indicator has performed beyond expectations. As a result, the end target will likely be revisited during the upcoming level-2 restructuring. Source: Health Management Information System and Project Monitoring System PHINDIRITBL  RBF adopted in the revised health financing policy (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N Y Y Y Date 31-Dec-2013 15-Sep-2017 15-Sep-2017 31-Jul-2019 Comments The indicator has performed well and reached the target earlier than expected. Source: Health Management Information System and Project Monitoring System 5/4/2018 Page 12 of 16 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Maternal and Child Nutrition and Health Results Project (P143650) PHINDIRITBL  Health personnel receiving training (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,185.00 1,335.00 1,200.00 Date 28-Feb-2014 30-Jun-2017 31-Dec-2017 31-Jul-2021 Comments The indicator is on track to reach the target. Source: Health Management Information System and Project Monitoring System PHINDIRITBL  Health personnel trained on Ebola prevention and management (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 305.00 305.00 100.00 Date 11-Nov-2014 30-Jun-2016 30-Jun-2016 31-Jul-2019 Comments The indicator has performed beyond expectations. The activity has stopped but performance was exceeded the target. Source: Health Management Information System and Project Monitoring System PHINDIRITBL  Health facilities receiving Client Tracer and Satisfaction Survey feedback at least 3 times during the calendar year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 100.00 70.00 Date 15-Nov-2016 -- 31-Dec-2017 31-Jul-2021 Comments The indicator has performed beyond expectations. During the upcoming level-2 restructuring, the team will discuss the need to adjust the target if necessary. Source: Health Management Information System and Project Monitoring System 5/4/2018 Page 13 of 16 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Maternal and Child Nutrition and Health Results Project (P143650) PHINDIRITBL  Health facilities scoring at least 75% on the Quality Checklist (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 73.00 97.00 100.00 Date 15-Nov-2016 30-Jun-2017 31-Dec-2017 31-Jul-2021 Comments The indicator is on track to reach the target. Source: Health Management Information System and Project Monitoring System PHINDIRITBL  Selected recipients who meet the targeting criteria (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 100.00 80.00 Date 15-Nov-2016 -- 31-Dec-2017 31-Jul-2021 Comments The indicator shows the performance at the beginning of the roll out of the activity. The performance is likely to shows some ups and downs as implementation expands to other communities. Source: Health Management Information System and Project Monitoring System PHINDIRITBL  Selected recipients who receive all cash transfers according to the payment plan (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 80.00 Date 15-Nov-2016 -- 31-Dec-2017 31-Jul-2021 Comments The activity is about to start and new updates will be available at the next ISR. Source: Health Management Information System and Project Monitoring System 5/4/2018 Page 14 of 16 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Maternal and Child Nutrition and Health Results Project (P143650) PHINDIRITBL  Recipients of UCT (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 5,000.00 Date 15-Nov-2016 -- 31-Dec-2017 31-Jul-2021 Comments The activity is about to start and new updates will be available at the next ISR. Source: Health Management Information System and Project Monitoring System Overall Comments Many of the targets of the original financing have been exceeded already. Given the strong performance on these indicators, the team will consider raising the targets for some of them during the upcoming level-2 restructuring. The indicators on the food security and cash transfers are behind target due to delays in implementation. However, with implementation having hastened in the last 6 months, we anticipate these indicators to keep pace soon. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P143650 IDA-56230 Effective USD 2.48 2.48 0.00 1.14 1.47 44% P143650 IDA-59420 Effective USD 3.20 3.20 0.00 0.00 3.31 0% P143650 IDA-D0500 Effective USD 2.53 2.53 0.00 2.32 0.22 91% P143650 IDA-D1600 Effective USD 4.30 4.30 0.00 1.80 2.85 39% P143650 IDA-H9230 Effective USD 3.68 3.68 0.00 3.34 0.01 100% P143650 TF-16640 Effective USD 5.00 5.00 0.00 5.00 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P143650 IDA-56230 Effective 24-Apr-2015 04-Jun-2015 30-Nov-2015 31-Jul-2019 31-Jul-2021 5/4/2018 Page 15 of 16 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Maternal and Child Nutrition and Health Results Project (P143650) P143650 IDA-59420 Effective 09-Jan-2017 03-Feb-2017 06-Apr-2017 31-Jul-2021 31-Jul-2021 P143650 IDA-D0500 Effective 24-Apr-2015 04-Jun-2015 30-Nov-2015 31-Jul-2019 31-Jul-2021 P143650 IDA-D1600 Effective 09-Jan-2017 03-Feb-2017 06-Apr-2017 31-Jul-2021 31-Jul-2021 P143650 IDA-H9230 Effective 21-Mar-2014 09-Apr-2014 20-May-2014 31-Jul-2019 31-Jul-2021 P143650 TF-16640 Effective 09-Apr-2014 09-Apr-2014 20-May-2014 31-Jul-2019 31-Jul-2019 Cumulative Disbursements Restructuring History Level 2 Approved on 18-Dec-2014 ,Level 2 Approved on 07-Dec-2017 Related Project(s) P154007-GM Maternal and Child Nutrition and Health Results Project ,P159693-AF Maternal and Child Nutrition and Health Results Project 5/4/2018 Page 16 of 16 Public Disclosure Copy