The World Bank Implementation Status & Results Report Sindh Enhancing Response to Reduce Stunting (P161624) Sindh Enhancing Response to Reduce Stunting (P161624) SOUTH ASIA | Pakistan | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2017 | Seq No: 5 | ARCHIVED on 11-Jun-2019 | ISR37116 | Implementing Agencies: Government of Sindh, Planning and Development, Government of Pakistan, Economic Affairs Division Key Dates Key Project Dates Bank Approval Date: 26-May-2017 Effectiveness Date: 04-Oct-2017 Planned Mid Term Review Date: 18-Nov-2019 Actual Mid-Term Review Date: -- Original Closing Date: 31-Dec-2021 Revised Closing Date: 31-Dec-2021 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective (PDO) is to contribute to the reduction of the stunting rate among children under 5 years of age by targeting the most affected districts in the Province of Sindh. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1 : Expanding Access to a Multi-sectoral Package of Services for Reducing Stunting:(Cost $45.00 M) Component 2: Strengthening Key Cross-cutting Nutrition-related Interventions and Project Management:(Cost $16.62 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Unsatisfactory Overall Implementation Progress (IP) Moderately Unsatisfactory Moderately Unsatisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The Sindh Enhancing Response to Reduce Stunting Project, financed by a US$61.62 million equivalent IDA Credit for Sindh province, was approved by the Bank's Board of Executive Directors on May 26, 2017 and declared effective on October 4, 2017. An implementation support mission was held in April 2019 to: (i) review implementation progress of the Accelerated Action Plan for Reduction of Stunting and Malnutrition (AAP) in general, and SERRSP in particular; (ii) assess institutional and implementation successes and challenges in achieving the objectives of AAP and SERRSP; (iii) support the Government of Sindh (GoS) to address challenges and accelerate implementation; and (iv) review the achievement of disbursement linked indicators (DLIs) and compliance with legal covenants, fiduciary and safeguards standards. The mission noted that sectors are implementing their sectoral plans but not at the pace that is required. The Stunting Task Force Secretariat, along with support from 6/11/2019 Page 1 of 9 The World Bank Implementation Status & Results Report Sindh Enhancing Response to Reduce Stunting (P161624) Planning & Development, will need to play a more proactive role in ensuring that the sectors achieve the implementation of their sector plans in a synergized manner and that AAP goals are achieved. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Sustainability Moderate Substantial Substantial Fiduciary Substantial Substantial Substantial Environment and Social Moderate Moderate Moderate Stakeholders Moderate Moderate Moderate Other -- -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes contribute to reduction of stunting rate among children under 5 by targeting most affected districts IN00703733 ►Stunting prevalence (moderate/severe) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 48.00 48.00 48.00 43.00 Date 31-Dec-2014 31-Jan-2019 31-Jan-2019 31-Dec-2021 Percentage of children under age 5 who fall below minus two standard deviations (moderate and severe). Comments: Baseline information is based on the results of the Multi-indicator Cluster Survey (MICS) of 2014. IN00703734 ►Minimum acceptable diet (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 8.90 8.90 8.90 20.00 Date 31-Dec-2014 31-Jan-2019 31-Jan-2019 31-Dec-2021 6/11/2019 Page 2 of 9 The World Bank Implementation Status & Results Report Sindh Enhancing Response to Reduce Stunting (P161624) Percentage of children age 6-23 months who received appropriate liquids and solid, semi-solid or soft Comments: foods the minimum number of times or more during the previous day. Baseline information is based on the results of the Multi-indicator Cluster Survey (MICS) of 2014. IN00703735 ►Micro-nutrient sachet distribution (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 682,000.00 682,000.00 2,650,000.00 Date 30-Dec-2016 31-Jan-2019 31-Jan-2019 31-Dec-2021 Among children aged 6-24 months, the cumulative number who receive yearly a minimum of 90 Comments: micronutrient sprinkles sachets for three months in intervention areas Intermediate Results Indicators by Components Component 1 : Expanding Access to a Multi-sectoral Package of Services for Reducing Stunting IN00703736 ►Prenatal care visits at community level (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 618,643.00 618,643.00 1,950,000.00 Date 30-Dec-2016 31-Jan-2019 31-Jan-2019 31-Dec-2021 IN00703738 ►Iron supplementation among PLW (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,355,107.00 1,355,107.00 1,850,000.00 Date 30-Dec-2016 31-Jan-2019 31-Jan-2019 31-Dec-2021 IN00703740 ►TT2 at primary and secondary health services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 830,223.00 830,223.00 1,100,000.00 Date 30-Dec-2016 31-Jan-2019 31-Jan-2019 31-Dec-2020 IN00703741 ►Users of Modern Contraceptive Methods (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,496,976.00 2,496,976.00 12,000,000.00 Date 30-Dec-2016 31-Jan-2019 31-Jan-2019 31-Dec-2021 IN00703742 ►MUAC screening at community level (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/11/2019 Page 3 of 9 The World Bank Implementation Status & Results Report Sindh Enhancing Response to Reduce Stunting (P161624) Value 0.00 1,851,428.00 1,851,428.00 7,950,000.00 Date 30-Dec-2016 31-Jan-2019 31-Jan-2019 31-Dec-2021 IN00703743 ►Cumulative number of villages certified ODF (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 8,600.00 Date 30-Dec-2016 31-Jan-2019 31-Jan-2019 31-Dec-2021 IN00703744 ►Cumulative number of kitchen gardens established (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 90.00 90.00 2,600.00 Date 30-Dec-2016 31-Jan-2019 31-Jan-2019 31-Dec-2021 IN00703745 ►Cumulative number of households establishing backyard poultry raising and goat farming (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 822.00 822.00 26,000.00 Date 30-Dec-2016 31-Jan-2019 31-Jan-2019 31-Dec-2021 IN00703746 ►Cumulative number of community fish ponds established (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 40.00 40.00 2,600.00 Date 30-Dec-2016 30-Jun-2018 30-Jun-2018 31-Dec-2021 IN00703747 ►Cumulative number of children (36-59 months) attending Early Childhood Education (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 3,500,000.00 Date 30-Dec-2016 30-Jun-2018 30-Jun-2018 31-Dec-2021 IN00703748 ►Number of Mothers' Groups established (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3,964.00 3,964.00 3,900.00 Date 30-Dec-2016 31-Jan-2019 31-Jan-2019 31-Dec-2021 IN00703749 ►Pregnant/lactating women, adolescent girls and/or children under age 5 reached by basic nutrition services (Number, Custom) 6/11/2019 Page 4 of 9 The World Bank Implementation Status & Results Report Sindh Enhancing Response to Reduce Stunting (P161624) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,037,107.00 2,037,107.00 7,950,000.00 Date 30-Dec-2016 31-Jan-2019 31-Jan-2019 31-Dec-2021 IN00703750 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 2,037,107.00 7,950,000.00 Date 30-Dec-2016 30-Jun-2018 31-Jan-2019 31-Dec-2021 IN00703751 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,037,107.00 2,037,107.00 7,950,000.00 Date 30-Dec-2016 31-Jan-2019 31-Jan-2019 31-Dec-2021 IN00703752 ►Children between age of 6-59 months receiving Vitamin A supplementation (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 7,950,000.00 Date 30-Dec-2016 31-Jan-2019 31-Jan-2019 31-Dec-2021 Component 2: Strengthening Key Cross-cutting Nutrition-related Interventions and Project Management IN00703737 ►Provincial Nutrition Steering Committee functioning (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 1.00 20.00 Date 30-Dec-2016 31-Jan-2019 31-Jan-2019 31-Dec-2021 IN00703739 ►Implementation of a system to strengthen coordination, collaboration and feedback between the AAP service providers and target beneficiary populations (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 30-Dec-2016 31-Jan-2019 31-Jan-2019 31-Dec-2021 Disbursement Linked Indicators IN00703753 ►DLI 1 Cumulative number of pregnant women who received 4 prenatal care and counseling visits at community level (Number, Output, 7,000,000.00, 0.00%) 6/11/2019 Page 5 of 9 The World Bank Implementation Status & Results Report Sindh Enhancing Response to Reduce Stunting (P161624) Baseline Actual (Previous) Actual (Current) 2020-2021 Value 0.00 618,643.00 618,643.00 1,525,000.00 Date -- 31-Jan-2019 31-Jan-2019 -- IN00703754 ►DLI 2 Cumulative number of women who received 4 ANC at primary and secondary health care facilities (BHU, THQ and DHQ) (Number, Intermediate Outcome, 7,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) 2020-2021 Value 0.00 143,646.00 143,646.00 1,000,000.00 Date -- 31-Jan-2019 31-Jan-2019 -- IN00703755 ►DLI 3 Cumulative number of children 6-59 mos who are screened (MUAC) for malnutrition at community level (Number, Intermediate Outcome, 7,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) 2020-2021 Value 0.00 1,851,428.00 1,851,428.00 5,280,000.00 Date -- 31-Jan-2019 31-Jan-2019 -- IN00703756 ►DLI 4 Cumulative number of malnourished children aged 6-59 months who are registered in Outpatient Therapeutic Program centers at health facilities and mobile health clinics (Number, Intermediate Outcome, 7,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) 2020-2021 Value 0.00 201,404.00 201,404.00 320,000.00 Date -- 31-Jan-2019 31-Jan-2019 -- IN00703757 ►DLI 5 Cumulative number of villages certified open defecation free (Number, Intermediate Outcome, 6,500,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) 2020-2021 Value 0.00 0.00 0.00 8,600.00 Date -- 31-Jan-2019 31-Jan-2019 -- DLI 5.1 Number of signed NGO contracts (Number, Output, 1,500,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) 2020-2021 Value 0.00 2.00 2.00 10.00 Date -- 31-Jan-2019 31-Jan-2019 -- DLI 5.2 Cumulative number of villages certified open defecation free (ODF) (Number, Intermediate Outcome, 5,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) 2020-2021 6/11/2019 Page 6 of 9 The World Bank Implementation Status & Results Report Sindh Enhancing Response to Reduce Stunting (P161624) Value 0.00 0.00 0.00 8,600.00 Date -- 31-Jan-2019 31-Jan-2019 -- IN00703760 ►DLI 6 Introduction of nutrition and life skills curriculum/instructional materials in Grades 6-10 (Yes/No, Process, 2,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) 2020-2021 Value No Yes Yes Yes Date -- 31-Jan-2019 31-Jan-2019 -- IN00703761 ►DLI 7 Implementation of a province-wide, multi-sectoral media/communications campaign (Yes/No, Intermediate Outcome, 2,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) 2020-2021 Value No No No Yes Date -- 31-Jan-2019 31-Jan-2019 -- DLI 7.1 Adoption of BCC plan (Yes/No, Process, 500,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) 2020-2021 Value No No No Yes Date -- 31-Jan-2019 31-Jan-2019 -- DLI 7.2 Launch of campaign (Yes/No, Process, 1,500,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) 2020-2021 Value No No No Yes Date -- 31-Jan-2019 31-Jan-2019 -- IN00703764 ►DLI 8 Percentage of allocation nutrition financiing actually expended (Text, Output, 6,500,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) 2020-2021 Value 0.00 0.00 0.00 Amount of nutrition related releases for AAP by June 30 (PKR). Disbursements will initially focus on the total amount of AAP allocation (1 billion PKR) and the proportion released to the priority districts. Once the nutrition expenditure 6/11/2019 Page 7 of 9 The World Bank Implementation Status & Results Report Sindh Enhancing Response to Reduce Stunting (P161624) tracking system is established, disbursements will be based on the annual amount of nutrition-related AAP expenditures Date -- 30-Jun-2018 30-Jun-2018 -- DLI 8.1 Amount of nutrition related releases for AAP by June 30 (PKR) (Text, Output, 2,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) 2020-2021 Amount of nutrition related releases for AAP by June 30 (PKR). Disbursements will initially focus on the total amount of AAP allocation (1 billion PKR) and the proportion released Value 0.00 1,500,000,000.00 PKR 1,500,000,000.00 PKR to the priority districts. Once the nutrition expenditure tracking system is established, disbursements will be based on the annual amount of nutrition-related AAP expenditures. Date -- 30-Jun-2018 30-Jun-2018 -- DLI 8.2 Establishment of nutrition expenditure tracking system (Text, Process, 1,500,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) 2020-2021 Value not established not established not established system functional Date -- 31-Jan-2019 31-Jan-2019 -- DLI 8.3 Annual amount of nutrition-related expenditures by AAP sector (Text, Output, 3,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) 2020-2021 Annual amount to be calculated after the Value 0.00 0.00 0.00 nutrition expenditure tracking system is functional. Date -- 31-Jan-2019 31-Jan-2019 -- Data on Financial Performance 6/11/2019 Page 8 of 9 The World Bank Implementation Status & Results Report Sindh Enhancing Response to Reduce Stunting (P161624) Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P161624 IDA-60470 Effective USD 61.62 61.62 0.00 4.95 59.85 7.6% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P161624 IDA-60470 Effective 26-May-2017 26-Jul-2017 04-Oct-2017 31-Dec-2021 31-Dec-2021 Cumulative Disbursements Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 6/11/2019 Page 9 of 9