The World Bank Report No: ISR15454 Implementation Status & Results Brazil Second Family Health Extension Adaptable Lending (P095626) Public Disclosure Copy Operation Name: Second Family Health Extension Adaptable Lending Project Stage: Implementation Seq.No: 12 Status: ARCHIVED Archive Date: 13-Jul-2014 (P095626) Country: Brazil Approval FY: 2008 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Adaptable Program Loan Implementing Agency(ies): Ministry of Health Key Dates Board Approval Date 25-Apr-2008 Original Closing Date 30-Mar-2013 Planned Mid Term Review Date 15-May-2012 Last Archived ISR Date 28-Dec-2013 Effectiveness Date 15-Oct-2009 Revised Closing Date 31-Dec-2014 Actual Mid Term Review Date 28-May-2012 Project Development Objectives Project Development Objective (from Project Appraisal Document) The objectives of the second phase APL are: (i) increase access to Family Health-based primary care in large, urban municipalities; (ii) raise the technical quality of and patient satisfaction with primary care; and (iii) improve the efficiency and effectiveness of Family Health service providers as well as the broader delivery system. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Expansion and Consolidation of Family Health Care in Municipalities 133450.00 Strengthening State Capacity for Supervision, Monitoring and Technical Support of Family Health 17450.00 Services Strengthening Federal Oversight of the Family Health Program 16000.00 Public Disclosure Copy Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Unsatisfactory Overall Risk Rating Implementation Status Overview The Second Family Health Extension Project (PROESF) was approved by the Board on April 25, 2008, signed on September 9, 2009 and became effective on October 15, 2009. As of June 16, 2014 US$42.4 million or 51 percent of loan proceeds have been disbursed. Page 1 of 6 The World Bank Report No: ISR15454 The population coverage by PROESF increased rapidly in the initial phase and continues to grow in the second phase, but at a slower rate (currently at 3.8 percent per annum). From 2009 to 2013, coverage in participating municipalities increased from 36.4% to 41.9% of the population (based on latest available verified data, December 2013), exceeding the post restructuring target of 40%. Average coverage is higher among participating municipalities than non-participating ones. Public Disclosure Copy One of the two Program outcome indicators - decrease of infant mortality per 1,000 live births in participating municipalities - has already been achieved. Most intermediate results indicators (PDIs) are on track or have been achieved, including the establishment of a results-based management system at the federal level, linking finances to states and municipalities, establishing performance agreements, and almost 100 percent of states and municipalities participating in quality assessment programs. Other intermediate results already achieved include an increase in Family Health Program (PSF) teams applying quality evaluation instruments from 7 percent (2006) to 92.5 percent (April 2012), and an increase in the proportion of patients with hypertension registered by PSF teams from 23 percent (2006) to 61 percent (December 2012). Locations Country First Administrative Division Location Planned Actual Brazil Not Entered Estado do Piauí Brazil Not Entered Estado de Santa Catarina Brazil Not Entered Estado do Rio Grande do Sul Brazil Not Entered Estado do Parana Brazil Not Entered Estado de Roraima Brazil Not Entered Estado do Amazonas Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Decrease of infant mortality per 1000 births in Text Value 17.8 12.8 16.9 participating municipalities. Date 31-Dec-2003 31-Dec-2013 31-Dec-2014 Comments This indicator has been achieved. Public Disclosure Copy Increase of per capita contact with primary care Text Value 1.7 0.7 1.8 providers in participating municipalities. Date 31-Dec-2003 31-Dec-2013 31-Dec-2014 Comments Data on this indicator has been rectified to take into account visits with all primary care providers as originally envisioned and not just doctor visits. Intermediate Results Indicators Page 2 of 6 The World Bank Report No: ISR15454 Indicator Name Core Unit of Measure Baseline Current End Target Percentage of PSF population coverage in Text Value 33% 41.9 37 participating municipalities (as a group). Date 31-Dec-2006 31-Dec-2013 31-Dec-2014 Public Disclosure Copy Comments Indicator has been achieved and surpassed. Ratio of patients with hypertension followed by Text Value 23% 60.85 35% PSF teams to estimated number of patients w/ Date 31-Dec-2006 31-Dec-2012 31-Dec-2014 hypertension in participating municipalities (as Comments Indicator was revised during a group). restructuring. Results have shown some variation over the last years, probably related to the calculation method. Percentage of infants < 1 with full vaccination Text Value 100.8 92.8 ≥95 regimen (DPT-H, polio, measles, tuberculosis) Date 31-Dec-2006 31-Dec-2012 31-Dec-2014 in participating municipalities (as agroup). Comments related to the calculation Indicator has been achieved. method the baseline exceeds 100%. Percentage of pregnant women attended by Text Value 60% 63.7 70 PSF teams that have 7 or more pre-natal Date 31-Dec-2006 31-Dec-2011 31-Dec-2014 consultations in participating municipalities (as Comments a group). Percentage of total medical consultations Text Value <10% 9.1 <10 referred from PSF to hospital specialty services Date 31-Dec-2006 31-Dec-2012 31-Dec-2014 in participating municipalities (as a group). Comments Indicator has been achieved and continues on track. Percentage of all PSF teams applied quality Text Value 7% 92.5 15 evaluation instrument and are ranked Date 31-Dec-2006 30-Apr-2012 31-Dec-2014 according to standard (AMQ system) in Comments Indicator has been achieved participating municipalities (as a group). Public Disclosure Copy and surpassed. Percentage of PSF teams in a sample of Text Value NA 68.7 15 municipalities using evidence-based clinical Date 31-Dec-2006 30-Apr-2012 31-Dec-2014 guidelines for hypertension and diabetes Comments Indicator has been achieved (basedon sample survey) in participating municipalities (as a group). and surpassed. Page 3 of 6 The World Bank Report No: ISR15454 Percentage of municipalities apply quality Text Value 0 97.4 10 evaluation instrument in the areas of PSF Date 31-Dec-2006 30-Apr-2012 31-Dec-2014 management and coordination (AMQ parts 1 & Comments Indicator has been achieved 2) in participating municipalities (as a group). Public Disclosure Copy and surpassed. Percentage of states establish performance Text Value 0 ND 40% agreements with at least X% municipalities with Date 31-Dec-2006 31-Dec-2013 31-Dec-2014 <100,000 population in participating states (as Comments Information pending update a group). from State Health Secretariats. Percentage of states with monitoring and Text Value 0 52.8 50% evaluation plans implemented and evaluated in Date 31-Dec-2006 31-Dec-2013 31-Dec-2014 participating states (as a group) Comments Percentage of municipalities with <100,000 Text Value 0 100 50% population in X% states participate in quality Date 31-Dec-2006 31-Dec-2013 31-Dec-2014 assessment program (AMQ) - participating Comments states as a group. Establishment, at federal level, of a results- Text Value NA ND System developed and tested. based management system that links project Date 31-Dec-2006 31-Dec-2013 31-Dec-2014 financing to states and municipalities. Comments Indicator achieved. System implemented in 3,965 (all federal units). Cost accounting system (at federal level). Text Value NA ND Study concluded and system developed. Date 31-Dec-2006 31-Dec-2013 31-Dec-2014 Comments Studies on tripartite costs and spending on Primary health care are being carried out at the moment with collaboration of IPEA and DESID/ MS. Public Disclosure Copy Results are expected to be launched in June 2013. Inter-municipal cooperation plan implemented Text Value NA ND 1 per State (20 states) in each state to strengthen PSF, specifying Date 31-Dec-2006 31-Dec-2013 31-Dec-2014 activities in three areas: management, Comments Has been achieved: The coordination, service Provision. intermunicipal community of practice (cooperação Intermunicipial) has 6,821 registered users (região sul: 956; sudeste: 2,496; centro- Page 4 of 6 The World Bank Report No: ISR15454 oeste: 751; nordeste: 2,447 and norte: 572). Percentage of ESF implement results-based Text Value 0 ND 60% Public Disclosure Copy management system, including the signing of Date 31-Dec-2006 31-Dec-2013 31-Dec-2014 performance contracts. Comments Indicator on track. Considering 184 PROESF municipalities (166 participate in the national program for Access and Quality improvement (PMAQ) with 5,601 family Health teams (ESF). Proportion of municipalities that implemented Percentage Value 0.00 70.00 the Health Information System for Primary care Date 31-Dec-2006 31-Dec-2013 31-Dec-2014 (SIS-AB/ e-SUS-AB). Comments Implementation of the new health information system was initiated in May 2013 and updated information will be available at a later point in time. Proportion of Primary Care Units (UBS) in Percentage Value 0.00 20.00 participating municipalities that have a tele- Date 31-Dec-2005 31-Dec-2013 31-Dec-2014 health access point. Comments Target achieved. After Project restructuring 249 municipalities are eligible of which 3,243 have UBS in place. Out of these UBS 648have tele-health access points, which represents roughly 20%. The MoH proses to aim for a target of Public Disclosure Copy 30 percent now. Data on Financial Performance (as of 12-Dec-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P095626 IBRD-75450 Effective 25-Apr-2008 09-Sep-2009 15-Oct-2009 30-Mar-2013 31-Dec-2014 Disbursements (in Millions) Page 5 of 6 The World Bank Report No: ISR15454 Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P095626 IBRD-75450 Effective USD 83.45 83.45 0.00 42.44 41.01 51.00 Public Disclosure Copy Disbursement Graph Key Decisions Regarding Implementation The Bank and Government teams are working collaboratively to complete project implementation activities, program the remaining Project funds, or evaluate other options to ensure Project completion by the end of 2014. Restructuring History Level two Approved on 14-Mar-2013 Public Disclosure Copy Related Projects There are no related projects. Page 6 of 6