The World Bank Report No: ISR9066 Implementation Status & Results Sao Tome and Principe Social Sector Support Project (P075979) Public Disclosure Copy Operation Name: Social Sector Support Project (P075979) Project Stage: Implementation Seq.No: 17 Status: ARCHIVED Archive Date: 07-Jan-2013 Country: Sao Tome and Principe Approval FY: 2004 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 18-May-2004 Original Closing Date 30-Jun-2009 Planned Mid Term Review Date Last Archived ISR Date 27-Jun-2012 Effectiveness Date 15-Dec-2004 Revised Closing Date 31-Dec-2012 Actual Mid Term Review Date Project Development Objectives Project Development Objective (from Project Appraisal Document) The development objective of the Social Sector Support Project (PASS) is to contribute to improving the delivery of basic health and education services, with a focus on greater and more equitable access, better quality, and improved local governance of services. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost DELIVERY OF BASIC EDUCATION SERVICES 2.30 DELIVERY OF BASIC HEALTH SERVICES 1.60 ADDRESSING CROSS-SECTORAL SOCIAL ISSUES: HIV/AIDS AND MALARIA 0.50 Overall Ratings Previous Rating Current Rating Public Disclosure Copy Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Moderate Moderate Implementation Status Overview The Social Sector Support Project draws to a close on December 31, 2012. This is the last ISR. The original project was approved on May 18, 2004 and became effective on December 15, 2004. The original financing was 6.5m US$ (5.0m IDA credit and 1.5m IDA grant) for health, education and HIV/AIDS. The original closing date was June 30, 2009, which was extended twice. The first extension to June 30, 2010 to allow for conclusion of the construction program; and the second extension to December 31, 2011, to accommodate an Additional Financing (AF) for the health sector. Page 1 of 5 The World Bank Report No: ISR9066 By the end of the implementation period of the Original Financing, all funds had been disbursed and the PDO was deemed satisfactory. An Additional Financing (AF) was then prepared only for the health sector to consolidate the gains obtained with the Original Financing, while support to the education sector was pursued through the Global Partnership for Education (GPE) Fund. The US$ 2.1 million AF was approved by the Board of the Bank on May 4, 2010 and became effective on November 11, 2010. Public Disclosure Copy The Original Financing aimed at increasing access and equity of rural population to health services; improving the quality of those services; and contributing to support the national program to fight HIV/AIDS and malaria. They included rehabilitation, construction and equipment of health centers in the districts to increase coverage; strengthening institutional capacity of the Ministry of Health and training of health staff in order to improve quality of services; and institutional support to the National Programs to Fight HIV/AIDS and Malaria and provision of condoms, and some drugs and testing kits for HIV and malaria. The Original Financing also included Community-Driven Initiatives (CDI) promoted by NGOs. A set of PDO indicators was selected to measure progress. Progress in access to quality services would be measured through: (i) the immunization rate for measles; (ii) proportion of pregnant women receiving antenatal care; and (iii) proportion of births attended by skilled birth attendants. Progress on HIV and Malaria would be measured through: (iv) HIV prevalence among pregnant women; (v) correct knowledge of forms of HIV transmission among women; (and) incidence of malaria in children less than five years old. Success of CDI would be assessed by looking at the proportion of CDI that were successfully implemented. The main objective of the AF was to consolidate the gains achieved and to ensure sustainability of Original Financing interventions through institutional strengthening of health institutions at the central and local levels. Thus, main activities included building residences for health staff in remote areas in order to attract skilled staff and to improve service delivery; continue the program of rehabilitation, expansion and equipment of health centers, including the National Center for Endemic Diseases (CNE) (the government Department responsible for malaria and HIV/AIDS programs); and training and capacity development of the Ministry of Health. The AF also continued to support CDI promoted by NGOs in the area of health. The first disbursement of the AF took place in January 2011. On December 28, 2011, the closing date of the AF was extended to December 31, 2012. The extension of the closing date followed a request from the government to allow mainly for completion of construction and rehabilitation of health centers, purchase of vehicles and hospital equipment, and technical assistance to develop the Health Information System (HIS). At the time of the extension processing, the disbursement rate was at a mere 24 percent. Since then, disbursement has accelerated steadily, and as of November 30, 2012, the disbursement rate was at 90.5 percent. All agreed activities under the Procurement Plan (PP) have been launched, the bidding process concluded and contracts awarded. With the current commitments, disbursement is expected to reach 100 percent by the closing date. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Public Disclosure Copy Immunization rate for Measles Text Value 84% 99.8% 95% Date 22-Apr-2004 30-Nov-2012 31-Dec-2012 Comments Proportion pregnant women receiving antenatal Text Value 90% (1 visit) 94.2% (4 visits) 95% (4 visits) care Date 22-Apr-2004 30-Nov-2012 31-Dec-2012 Comments HIV prevalence among pregnant women Text Value 1996: 5.4% 1.5% <5% Page 2 of 5 The World Bank Report No: ISR9066 Date 22-Apr-2004 30-Nov-2012 31-Dec-2012 Comments Correct knowledge of transmissions amongst Text Value 10% 66% 55% Public Disclosure Copy women Date 22-Apr-2004 30-Nov-2012 31-Dec-2012 Comments Incidence of Malaria in children, less than 5 Text Value 1273 62 35 years (per 1000) Date 22-Apr-2004 30-Nov-2012 31-Dec-2012 Comments Successful implementation of community- Text Value 0 95 90 driven initiatives subprojects per year (%) Date 22-Apr-2004 30-Nov-2012 31-Dec-2012 Comments Increased births attended by a skilled birth Text Value 70 93 90 attendant (%) Date 22-Apr-2004 30-Nov-2012 31-Dec-2012 Comments Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Health facilities constructed, renovated, and/or Number Value 0.00 23.00 20.00 equipped (number) Date 22-Apr-2004 30-Nov-2012 31-Dec-2012 Comments People with access to a basic package of Number Value 0.00 105000.00 103000.00 health, nutrition, or reproductive health services Date 22-Apr-2004 30-Nov-2012 31-Dec-2012 (number) Comments Health personnel receiving training (number) Number Value 0.00 166.00 150.00 Date 22-Apr-2004 30-Nov-2012 31-Dec-2012 Comments Public Disclosure Copy Children immunized (number) Number Value 0.00 5530.00 5468.00 Date 22-Apr-2004 30-Nov-2012 31-Dec-2012 Comments Pregnant women receiving antenatal care Number Value 0.00 5574.00 5485.00 during a visit to a health provider (number) Date 22-Apr-2004 30-Nov-2012 31-Dec-2012 Comments Data on Financial Performance (as of 13-Dec-2012) Page 3 of 5 The World Bank Report No: ISR9066 Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P075979 IDA-39020 Closed 18-May-2004 24-Jun-2004 15-Dec-2004 30-Jun-2009 31-Dec-2011 Public Disclosure Copy P075979 IDA-H0880 Closed 18-May-2004 24-Jun-2004 15-Dec-2004 30-Jun-2009 31-Dec-2011 P075979 IDA-H5590 Effective 04-May-2010 22-Jun-2010 11-Nov-2010 31-Dec-2011 31-Dec-2012 P075979 TF-52058 Closed 13-Jun-2003 13-Jun-2003 13-Jun-2003 30-Sep-2005 12-Sep-2006 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P075979 IDA-39020 Closed USD 5.00 5.00 0.00 5.22 0.00 104.00 P075979 IDA-H0880 Closed USD 1.50 1.50 0.00 1.68 0.00 112.00 P075979 IDA-H5590 Effective USD 2.10 2.10 0.00 1.95 0.22 93.00 P075979 TF-52058 Closed USD 0.65 0.46 0.19 0.46 0.00 100.00 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation This is a Project that was designed to be flexible in terms of implementation. Project activities are agreed upon between the Client and the Bank team for every calendar year, through an Annual Action Plan (AAP). Once approved, the AAP is implemented. For most of the project life, assessment of implementation of the AAP was Satisfactory or Moderately Satisfactory, because most of the activities were completed on time as agreed. Page 4 of 5 The World Bank Report No: ISR9066 For the AF, the last mission to Sao Tome and Principe (September 21-28, 2012) took stock of implementation progress, and reviewed the AAP and the Procurement Plan with the MoH and AFAP (the Administrative and Fiduciary Agency). Both documents were updated taking into account the status of project implementation. One key finding of the mission was that all activities agreed in the AP had been launched. The mission discussed with the government team potential risks of delays in the delivery of project activities. The parts found that the biggest risk was associated with the conclusion of the works of CNE. They also agreed that preventive measures should be taken to avoid materialization of that risk. Public Disclosure Copy Following the mission, AFAP and the MoH set up a tight monitoring process that included bi-weekly meetings with the construction company and site visits that resulted in accelerated progress in the implementation of the works. As a result, the work of CNE was delivered as expected on December 21, 2012. The other activities in the AP have all been finalized. The ambulances for the health districts have been delivered on December 8, 2012. The residences for health staff in Cantagalo and in the Island of Principe have also been delivered. The consultancy work to finalize the Health Information System has been concluded. Restructuring History There has been no restructuring to date. Related Projects P113113-Social Sector Support (Additional Financing) Public Disclosure Copy Page 5 of 5