Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) DJ Improving Health Sector Performance (P131194) MIDDLE EAST AND NORTH AFRICA | Djibouti | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2013 | Seq No: 13 | ARCHIVED on 02-Apr-2019 | ISR36407 | Implementing Agencies: Republic of Djibouti, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 02-Apr-2013 Effectiveness Date: 11-Jul-2013 Planned Mid Term Review Date: 15-Mar-2016 Actual Mid-Term Review Date: 23-May-2016 Original Closing Date: 31-Dec-2018 Revised Closing Date: 30-Apr-2019 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The project development objective is to improve the utilization of quality health care services for maternal and child healthandcommunicable disease control programs (HIV/AIDS, tuberculosis and malaria). Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured)HRPDODELs The project development objective is to improve the utilization of quality health care services for maternal and child health andcommunicable disease control programs (HIV/AIDS and tuberculosis). Components Table Name Improving health services delivery performance:(Cost $8.85 M) Strengthening health system management:(Cost $0.80 M) Strengthening program management and monitoring and evaluation capacity:(Cost $4.35 M) 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 4/2/2019 Page 1 of 6 Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) The project is on track, and the second additional financing including project restructuring is under way. The restructuring will entail an extension of the project closing date, a revision of the results framework and the introduction of some additional activities and a contingent emergency response component, which enables quick disbursement of remaining funds if a health-related emergency/crisis occurs. This interim ISR is processed in order to amend the component costs in the system, capturing both the original project amount and the trust fund (first additional financing). Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Moderate Moderate Macroeconomic -- Moderate Moderate Sector Strategies and Policies -- Low Low Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and Sustainability -- Substantial Substantial Fiduciary -- Moderate Moderate Environment and Social -- Moderate Moderate Stakeholders -- Moderate Moderate Other -- -- -- Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes To improve the utilization of maternal and child health and communicable disease control services IN00683355 ►Number of women receiving prenatal visits 2-4 (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 6,100.00 69,494.00 69,494.00 77,100.00 Date 01-Jun-2014 30-Jun-2018 30-Jun-2018 31-Dec-2018 IN00683357 ►Percentage of children fully immunized before their first birthday (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 32.00 78.58 78.58 51.50 Date 01-Dec-2012 31-Dec-2017 31-Dec-2017 31-Dec-2018 4/2/2019 Page 2 of 6 Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) Instead of limiting the data to the facilities supported by the project, it was agreed that the national data Comments: should be reported. This is because many children are vaccinated at other facilities. IN00683358 ►Number of HIV positive pregnant women receiving treatment according to protocol (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 63.00 342.00 342.00 1,175.00 Date 01-Nov-2014 30-Jun-2018 30-Jun-2018 31-Dec-2018 Quality health care services IN00683356 ►Average facility quality (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 29.00 46.00 46.00 60.00 Date 01-Dec-2012 31-Dec-2017 31-Dec-2017 31-Dec-2018 Intermediate Results Indicators by Components Improving health services delivery performance IN00683359 ►Number of WCBA visiting the public system to obtain modern family planning (oral contraceptives and injections) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 7,304.00 92,504.00 92,504.00 105,000.00 Date 01-Nov-2014 30-Jun-2018 30-Jun-2018 31-Dec-2018 IN00683362 ►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 7,117.00 96,362.00 96,362.00 150,000.00 Date 01-Nov-2014 30-Jun-2018 30-Jun-2018 31-Dec-2018 Numbers are adjusted with the availability of the final data from the past years. This indicator captures Comments: only children under 5 years. IN00683363 Pregnant/lactating women, adolescent girls and/or children under age five- reached by basic nutrition services – Others (specify) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 7,117.00 96,362.00 96,362.00 150,000.00 Date 01-Nov-2014 30-Jun-2018 30-Jun-2018 31-Dec-2018 IN00683364 4/2/2019 Page 3 of 6 Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) ►Number of women giving birth in a contracted facility assisted by qualified personnel (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1,026.00 24,023.00 24,023.00 25,525.00 Date 01-Jun-2014 30-Jun-2018 30-Jun-2018 31-Dec-2018 IN00683365 ►People receiving tuberculosis treatment in accordance with the WHO-recommended “Directly Observed Treatment Strategy” (DOTS) (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 300.00 2,411.00 2,411.00 2,100.00 Date 01-Dec-2012 30-Jun-2018 30-Jun-2018 31-Dec-2018 IN00683366 ►Direct project beneficiaries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,166,404.00 2,166,404.00 825,000.00 Date 01-Dec-2012 30-Jun-2018 30-Jun-2018 31-Dec-2018 This indicator is measuring the number of consultations/visits rather than the unique number of patients, and the female beneficiaries are captured as a percentage for each year. This indicator will be dropped in Comments: the upcoming restructuring. IN00683367 Female beneficiaries (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 79.80 79.80 65.00 IN00683368 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 190,385.00 190,385.00 250,525.00 Date 01-Nov-2014 30-Jun-2018 30-Jun-2018 31-Dec-2018 The target will be adjusted in the upcoming restructuring. Comments: IN00683369 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 107,204.00 107,204.00 138,025.00 IN00683370 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 70,000.00 70,000.00 75,000.00 4/2/2019 Page 4 of 6 Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) Date 01-Nov-2014 31-Dec-2017 31-Dec-2017 31-Dec-2018 IN00683371 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 96,362.00 96,362.00 150,000.00 Date 01-Nov-2014 30-Jun-2018 30-Jun-2018 31-Dec-2018 IN00683372 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 24,023.00 24,023.00 25,525.00 Date 01-Nov-2014 31-Dec-2017 31-Dec-2017 31-Dec-2018 Strengthening health system management IN00683360 ►Percentage of pregnant women receiving at least two doses of tetanus toxoid (TT2) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 90.00 90.00 45.00 Date 01-Dec-2012 31-Dec-2017 31-Dec-2017 31-Dec-2018 More up to date data became available for 2017. Comments: Strengthening program management and monitoring and evaluation capacity IN00683361 ►Number of curative care visits per person per year in the public system (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.15 0.47 0.47 0.52 Date 01-Nov-2014 31-Dec-2017 31-Dec-2017 31-Dec-2018 Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P131194 IDA-52160 Effective USD 7.00 7.00 0.00 6.54 0.01 100% 4/2/2019 Page 5 of 6 Public Disclosure Copy The World Bank Implementation Status & Results Report DJ Improving Health Sector Performance (P131194) P131194 TF-19258 Effective USD 7.00 7.00 0.00 6.61 0.39 94% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P131194 IDA-52160 Effective 02-Apr-2013 21-Apr-2013 11-Jul-2013 31-Dec-2018 30-Apr-2019 P131194 TF-19258 Effective 13-May-2015 13-May-2015 27-Jul-2015 31-Dec-2018 30-Apr-2019 Cumulative Disbursements Restructuring History Level 1 Approved on 23-Apr-2015 ,Level 2 Approved on 17-Dec-2018 Related Project(s) P152705-DJ HRITF Health AF ,P168250-Djibouti Improving Health Sector Performance Project Second Additional Financing 4/2/2019 Page 6 of 6