The World Bank Report No: ISR8470 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: 9 Status: ARCHIVED Archive Date: 11-Nov-2012 (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-2012 Planned Mid Term Review Date 15-May-2012 Last Archived ISR Date 12-May-2012 Effectiveness Date 15-Oct-2009 Revised Closing Date 30-Mar-2013 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 Moderately Satisfactory Overall Risk Rating Implementation Status Overview The population coverage by PROESF increased rapidly in the initial phase and continues to grow in the second phase, but at a much slower rate (5 percent per annum). From 2009 to 2011, coverage in participating municipalities increased from 36.4% to 39.5% of the population (based on latest available verified data, December 2011), exceeding the target for phase 2 (37%); average coverage is higher among participating municipalities than non participating ones. Though no specific outcome targets were set in the Project Appraisal Page 1 of 6 The World Bank Report No: ISR8470 Document for this second phase of the program, the Ministry of Health established the following goals: (i) a 5% reduction of infant mortality in participating municipalities, and (ii) an increase of 5% in the number of family health visits per capita in these municipalities. Public Disclosure Copy 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 13.9 17 participating municipalities. Date 31-Dec-2003 31-Dec-2011 30-Mar-2013 Comments New data will be available in December 2012 Increase of per capita contact with primary care Text Value 1.4 1.6 1.5 providers in participating municipalities. Date 31-Dec-2003 31-Dec-2011 30-Mar-2013 Comments Data on this indicator has been rectified to take into account visits with all primary care providers as originally Public Disclosure Copy envisaged and not just doctor visits. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Percentage of ESF implement results-based Text Value NA N/A model developed and tested. management system, including the signing of Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 performance contracts. Comments To be done by PMAQ external evaluation Page 2 of 6 The World Bank Report No: ISR8470 Inter-municipal cooperation plan implemented Text Value NA Communities of practice 1 per State (20 states) in each state to strengthen PSF, specifying established (www. activities in three areas: management, atencaobasica.org.br) coordination, service Provision. Public Disclosure Copy Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 Comments Proficiency test of PSF professionals. Text Value NA To be done by PMAQ Test developed. external evaluation Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 Comments Impact evaluation. Text Value NA N/A Plans, methods and TOR Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 Comments Six major research projects on PSF (at least Text Value Not applicable N/A 3 studies concluded. one on chronic diseases, one on patient Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 satisfaction, and one on PSF impact on Comments Bids financed and published hospital admissions). with own resources Cost accounting system (at federal level). Text Value NA Instrument elaborated and Study concluded and system being validated developed. Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 Comments Establishment, at federal level, of a results- Text Value NA System developed, tested System developed and tested. based management system that links project and implemented. financing to states and municipalities. Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 Comments Percentage of municipalities with <100,000 Text Value 0 94.6% of municipalities in 10% of municipalities in 50% population in X% states participate in quality 100% of states of states assessment program (AMQ) - participating Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 states as a group. Comments Public Disclosure Copy Percentage of states with monitoring and Text Value 0 N/A 50% evaluation plans implemented and evaluated in Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 participating states (as a group) Comments Percentage of states establish performance Text Value 0 100% of states with 100% of 40% states, 25% agreements with at least X% municipalities with municipalities with defined municipalities <100,000 population in participating states (as goals of which 73.4% have a group). adhered to the Pacto pela Saúde Page 3 of 6 The World Bank Report No: ISR8470 Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 Comments Percentage of municipalities apply quality Text Value 0 66% 10 Public Disclosure Copy evaluation instrument in the areas of PSF Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 management and coordination (AMQ parts 1 & Comments 2) in participating municipalities (as a group). Rate of hospital admissions for stroke in Text Value 27/10000 4 26/1000 participating municipalities (as a group). Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 Comments Rate of hospital admissions of children <5 for Text Value 24/1000 25.8 22/1000 ARI in participating municipalities (as a group). Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 Comments Percentage of PSF teams in a sample of Text Value NA N/A 15 municipalities using evidence-based clinical Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 guidelines for hypertension and diabetes Comments (basedon sample survey) in participating municipalities (as a group). Percentage of all PSF teams applied quality Text Value 7% 75.3% 15 evaluation instrument and are ranked Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 according to standard (AMQ system) in Comments participating municipalities (as a group). Percentage of total medical consultations Text Value <10% 4.4% 10 referred from PSF to hospital specialty services Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 in participating municipalities (as a group). Comments Percentage of pregnant women attended by Text Value 60% 64.1% 70 PSF teams that have 7 or more pre-natal Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 consultations in participating municipalities (as Comments a group). Public Disclosure Copy Percentage of infants < 1 with full vaccination Text Value 71 91.4% 85 regimen (DPT-H, polio, measles, tuberculosis) Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 in participating municipalities (as agroup). Comments Ratio of patients with hypertension followed by Text Value 0.23 0.22 .35 PSF teams to estimated number of patients w/ Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 hypertension in participating municipalities (as Comments a group). Page 4 of 6 The World Bank Report No: ISR8470 Percentage of PSF population coverage in Text Value 33% 39.5% 37 participating municipalities (as a group). Date 31-Dec-2006 31-Dec-2011 30-Mar-2013 Comments Public Disclosure Copy Data on Financial Performance (as of 11-Sep-2012) 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-2012 30-Mar-2013 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P095626 IBRD-75450 Effective USD 83.45 83.45 0.00 34.94 48.51 42.00 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation MoH has submitted a restructuring proposal for Government approval. Restructuring History There has been no restructuring to date. Page 5 of 6 The World Bank Report No: ISR8470 Related Projects There are no related projects. Public Disclosure Copy Public Disclosure Copy Page 6 of 6