The World Bank Report No: ISR10721 Implementation Status & Results Sierra Leone Reproductive and Child Health Project - Phase 2 (P110535) Public Disclosure Copy Operation Name: Reproductive and Child Health Project - Phase 2 (P110535) Project Stage: Implementation Seq.No: 7 Status: ARCHIVED Archive Date: 18-Jun-2013 Country: Sierra Leone Approval FY: 2010 Product Line: Recipient Executed Activities Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 07-Jun-2010 Original Closing Date 31-Oct-2013 Planned Mid Term Review Date Last Archived ISR Date 10-Dec-2012 Effectiveness Date 01-Oct-2010 Revised Closing Date 31-Oct-2013 Actual Mid Term Review Date Project Development Objectives Project Development Objective (from Project Appraisal Document) The PDO is to increase utilization of a package of essential health services by pregnant and lactating women and children under the age of five. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Strengthening of Service Delivery 13.50 Capacity Building 6.50 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Highly Satisfactory Satisfactory Satisfactory Moderately Satisfactory Public Disclosure Copy Overall Implementation Progress (IP) Overall Risk Rating Implementation Status Overview This is an update based on an implementation support mission in March and a pre-appraisal mission in May, 2013. As at November 2012, significant progress has been achieved with regards to attainment of key performance indicators. The indicators that are on track include proportion of children under five who slept the previous night under an ITN; proportion of children receiving Penta-3 before 12 months of age; number of children immunized in the first 11 months; proportion of births delivered in health facilities; proportion of pregnant women attending at least 4 ANC visits; number of pregnant women receiving antenatal care during a visit to a health provider; and number of direct project beneficiaries. Some of the intermediate indicators are also making good progress. Those lagging behind are being closely monitored and implementation of the related activities are being intensified. Despite this due to to the slow implementation of component 2 on capacity building as a result of the delays in processing Page 1 of 7 The World Bank Report No: ISR10721 and effectiveness of the first additional financing, both progress on PDO is being downgraded to Satisfactory and Implementation Progress (IP) to Moderately Satisfactory With funding from the project a number of facilities are now able to provide basic emergency obstetric care (BeMONC) which was not possible two years ago. Public Disclosure Copy The performance-based financing (PBF) is progressing well with improvements being seen in the utilization and quality of services in the peripheral health units and the Ola During Children's and Princess Christian Maternity Hospitals. Facility deliveries increased from 26,602 in January/March 2011 before the introduction of PBF to 34,985 in January/March 2012. As part of the PBF, facilities have introduced innovations into the management and service delivery systems that are making these result possible. Locations Country First Administrative Division Location Planned Actual Sierra Leone Not Entered Western Area Sierra Leone Not Entered Tonkolili District Sierra Leone Not Entered Pujehun District Sierra Leone Not Entered Port Loko District Sierra Leone Not Entered Moyamba District Sierra Leone Not Entered Makeni Sierra Leone Not Entered Kono District Sierra Leone Not Entered Koinadugu District Sierra Leone Not Entered Koidu Sierra Leone Not Entered Kenema District Sierra Leone Not Entered Kenema Sierra Leone Not Entered Kambia District Sierra Leone Not Entered Kailahun District Public Disclosure Copy Sierra Leone Not Entered Freetown Sierra Leone Not Entered Bonthe District Sierra Leone Not Entered Bonthe Sierra Leone Not Entered Bombali District Sierra Leone Not Entered Bo District Sierra Leone Not Entered Bo Page 2 of 7 The World Bank Report No: ISR10721 Results Project Development Objective Indicators Public Disclosure Copy Indicator Name Core Unit of Measure Baseline Current End Target Children under-five sleeping under an ITN the Percentage Value 59.60 73.00 75.00 previous night Date 31-Dec-2009 31-Dec-2012 31-Oct-2013 Comments The above baseline is from Source: MoHS August 2011 Frequency for ICS data is ICS which captures Malaria Survey Report. annual. administrative data from A survey is expected later in Frequency for DHS/MICS is facilities. We also provide 2013. 2.5 years DHS data that is 26% for 2008 We are using both data sources. ICS data will be used to provide annual trends. Children receiving Penta-3 before 12 months of Percentage Value 58.60 85.00 78.00 age Date 31-Dec-2009 30-Nov-2012 31-Oct-2013 Comments 54.6 for 2008 DHS Source: District Health Frequency for DHS/MICS is Information Management 2.5 years System (DHIS). Children immunized (number) Number Value 0.00 160065.00 379844.00 Date 31-Dec-2009 30-Nov-2012 31-Oct-2013 Comments The baseline is now 0 and it is Source: DHIS. expected that we begin counting the numbers from as project begins implementation Births delivered in a health facility Percentage Value 30.30 60.00 55.00 Date 31-Dec-2009 30-Nov-2012 31-Oct-2013 Comments The above baseline is from Source: DHIS. The frequency of ICS data is Public Disclosure Copy ICS which is administrative annual. data from health facilities. We Frequency for DHS/MICS is also provide DHS data which 2.5 years is 42% for 2008. The ICS data will be used to provide annual trends. Women who attend at least 2 antenatal care Percentage Value 54.60 74.00 75.00 (ANC) visits Date 31-Dec-2009 30-Nov-2012 31-Oct-2013 Page 3 of 7 The World Bank Report No: ISR10721 Comments 51.6% for 2008 DHS Source: DHIS. The frequency for DHS/MICS is 2.5 years Pregnant women receiving antenatal care Number Value 0.00 721057.00 225907.00 Public Disclosure Copy during a visit to a health provider (number) Date 31-Dec-2009 30-Nov-2012 31-Oct-2013 Comments The baseline as at now is 0. It Source: DHIS is expected that the numbers Target continues to be will be counted once project achieved. begins implementation. Direct project beneficiaries Number Value 0.00 1049773.00 1357715.00 Date 31-Dec-2009 30-Nov-2012 31-Oct-2013 Comments Source: DHIS Female beneficiaries Percentage Value 0.00 79.00 78.00 Sub Type Supplemental Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target PHUs providing Basic emergency obstetric Number Value 0.00 35.00 60.00 care (number) Date 30-Apr-2010 30-Nov-2012 31-Oct-2013 Comments Source: MoHS Facility Improvement Team (FIT) Report. Households with an ITN (%). Percentage Value 36.60 87.00 80.00 Date 28-Nov-2008 30-Nov-2012 31-Oct-2013 Comments Data Source is 2008 DHS Source: MoHS 2011 Malaria Data from the next DHS will Survey Report. Target be used to update this continues to be achieved. indicator. Or a malaria survey will be used. Long-lasting insecticide-treated malaria nets Number Value 0.00 1140000.00 1140000.00 Public Disclosure Copy purchased and/or distributed (number) Date 31-Dec-2009 30-Nov-2012 31-Oct-2013 Comments Source: MoHS/UNICEF Procurement Data. Target met Clinics having all 10 essential drugs available Percentage Value 32.00 30.00 60.00 Date 30-Apr-2010 30-Nov-2012 31-Oct-2013 Comments Source: MoHS 2010 Service Source: Service Availability Availability Survey Report Survey Report. Page 4 of 7 The World Bank Report No: ISR10721 Health personnel receiving training (number) Number Value 0.00 2050.00 1440.00 Date 31-Dec-2009 30-Nov-2012 31-Oct-2013 Comments Source: MoHS Training Public Disclosure Copy Reports Infants exclusively breasfed for six months Percentage Value 37.40 40.00 55.00 Date 31-Dec-2009 30-Nov-2012 31-Oct-2013 Comments The above baseline is from Source: 2010 DHIS. The next ICS is annual ICS. We also provide DHS DHS in 2013 will provide an DHS is 2.5 yrs. data which is 11% for 2008. update. We will use the ICS to provide annual trends. Health staff trained in medical waste Percentage Value 0.00 18.00 25.00 management Date 30-Apr-2010 30-Nov-2012 31-Oct-2013 Comments Source: MoHS/MoFED Project Reports Graduates having received a six-month training Percentage Value 0.00 0.00 40.00 in pediatrics and obstetrics (%) Date 31-Dec-2009 30-Nov-2012 31-Oct-2013 Comments Source: MoHS Project Report. MoHS has indicated that there is no demand for this program and so this indicator should be replaced. The replacement will be done within the framework of the of the second AF going to Board in July, 2013 and the RF will be updated accordingly. Hospitals with functioning health information Number Value 0.00 1.00 18.00 system (number) Date 30-Apr-2010 30-Nov-2012 31-Oct-2013 Public Disclosure Copy Comments No hospital has Health Source: MoHS Project Information systems. Report. The procurement of the external consulting firm stalled due to the delay in processing and effectiveness of the additional Financing which is meant to finance this activity. The activity will now be expedited with the effectiveness ofthe AF. An Page 5 of 7 The World Bank Report No: ISR10721 update will therefore be provided in the next ISR. PHUs jointly supervised by DHMT and local Percentage Value 10.00 63.00 90.00 council staff at least once in the last three Public Disclosure Copy Date 31-Dec-2009 30-Nov-2012 31-Oct-2013 months using the nationally approved checklist Comments Source: MoHS/MoFED Source: MoHS/MoFED RCHP2 Report RCHP2 Report. Quarterly meetings held between LGFD and Number Value 0.00 14.00 4.00 MoHS Date 31-Dec-2009 30-Nov-2012 31-Oct-2013 Comments Source: MoHS/MoFED Project Report January, 2012 PHUs for which RCH reports can be produced Percentage Value 80.00 93.00 90.00 for the previous month Date 31-Dec-2008 30-Nov-2012 31-Oct-2013 Comments Source: MoHS Monitoring Report Health facilities constructed, renovated, and/or Number Value 0.00 52.00 150.00 equipped (number) Date 31-Dec-2009 31-Jul-2012 31-Oct-2013 Comments Source: MoHS/MoFED Project Report, July 31, 2012. 30% of target has been met. Data on Financial Performance (as of 03-May-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P127527 TF-12691 Effective 27-Sep-2012 27-Sep-2012 15-Apr-2013 31-Oct-2013 31-Oct-2013 P110535 TF-96812 Effective 12-Aug-2010 12-Aug-2010 01-Oct-2010 31-Oct-2013 31-Oct-2013 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed Public Disclosure Copy P127527 TF-12691 Effective USD 5.69 5.69 0.00 0.00 5.69 0.00 P110535 TF-96812 Effective USD 20.00 20.00 0.00 15.25 4.75 76.00 Disbursement Graph Page 6 of 7 The World Bank Report No: ISR10721 Public Disclosure Copy Key Decisions Regarding Implementation There are discussions ongoing concerning the sustainability of performance-based financing in the sector. Restructuring History There has been no restructuring to date. Related Projects P127527-Reproductive and Child Health Phase 2 ACGF, P132753-SL-RCHP2 Add'l Financing (FY13) Public Disclosure Copy Page 7 of 7