The World Bank Report No: ISR10018 Implementation Status & Results Kenya Health Sector Support (P074091) Public Disclosure Copy Operation Name: Health Sector Support (P074091) Project Stage: Implementation Seq.No: 5 Status: ARCHIVED Archive Date: 22-Apr-2013 Country: Kenya Approval FY: 2010 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 29-Jun-2010 Original Closing Date 31-Mar-2015 Planned Mid Term Review Date 31-Dec-2012 Last Archived ISR Date 14-Oct-2012 Effectiveness Date 30-Sep-2010 Revised Closing Date 31-Mar-2015 Actual Mid Term Review Date 12-Feb-2013 Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed project's development objectives are to: (i) improve the delivery of essential health services for Kenyans, especiallythe poor; and (ii) improve the efficiency of pharmaceutical planning, procurement and management. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Effective and transparent implementation of the Kenya Essential Package for Health (KEPH) through 46.00 HSSF grants and performance streng thening. Availability of essential health commodities and supply chain management reform 54.00 Overall Ratings Previous Rating Current Rating Public Disclosure Copy Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Implementation Status Overview The Project supports the health sector wide program in Kenya and has completed over two years of implementation. The Danish International Development Agency (DANIDA) is co- financing the program. In December 2011, the Bank approved additional financing of US$ 56.8 million under IDA Crisis Response Window to support urgent nutrition and health needs of the drought affected population in Northern Kenya. The project is contributing to two main reforms started by Government of Kenya: (a) provision of direct cash transfers to primary health facilities through the Health Sector Services Page 1 of 7 The World Bank Report No: ISR10018 Fund (HSSF) to enhance participatory decentralized planning and delivery of the Kenya Essential Package of Health Services; and (b) expansion of the ‘pull system’ of Essential Medicines and Medical Supplies (EMMS) to improve the quality of care and reduce wastage. So far, the HSSF grants were made to 774 health centers and 2,389 dispensaries owned by the Government and 265 District Health Management Teams. Some early benefits of the HSSF were visible during the field visits and from the reports of the Integrated Independent Fiduciary Review Agency (IIFRA), which covers around 250 entities (facilities and districts) receiving HSSF grants every quarter. The facility staff are now reporting the Public Disclosure Copy cost sharing revenues and using them along with the HSSF grants to improve the up-keep and buy consumables to improve quality of care. Nearly 9,000 facility committee members and health staff received training so far in planning and management of HSSF and operating the pull system. The planned expansion of the HSSF to Faith based Organizations still has not taken place. The pull system is in its final phase of implementation and is expected to cover all primary health facilities during the current financial year. According to the nutrition surveillance and reporting system, the proportion of severely malnourished children under five recovered among those receiving treatment in the project areas (70.1%) exceeds the project target (60%). The number of admissions of children suffering from severe acute malnutrition (SAM) has declined to around 2000 per month by December 2012 compared to over 5000 per month in 2011. In the light of reduced number of SAM cases, the division of nutrition proposed to increase allocation for RUSF to focus on moderately malnourished groups. The IIFRA reports indicate a steady improvement in record keeping at facility level with about two thirds of facilities maintaining proper cash books. The IIFRA also started using the score card for rating the performance of facilities (Green: Well performing; Amber: Average performing and Red: Poor performing) and the proportion of facilities rated poor (red) declined from 21% to 16%. The project is also supporting analytic work to strengthen the evidence base for improving delivery of essential health services. The recent validation of the "performance based financing" initiative in the Samburu County suggests increased use of antenatal care, delivery, child immunization services and improvements in both clinical and overall quality as well as the health information system reporting. The implementation of "Social Accountability" has recently been concluded in 9 representative locations across the country and the SWAp Secretariat has started actions for mainstreaming social accountability in the Program. There has been little progress on studies planned to explore public private partnerships to operationalize health facilities built under the Constituency Development Fund and piloting of the Referral care. The Bank has provided technical assistance to finalize the proposal for improving access to health services the poor and formal request from the Government is now due. The Mid Term Review (MTR) process of the project started with the mission held in February 2013. It was agreed that the MTF will be informed by the Public Expenditure Tracking and Service Delivery Indicators Study, Reports of the IIFRA and the proposed in-depth Fiduciary Review. Locations No Location data has been entered Results Project Development Objective Indicators Public Disclosure Copy Indicator Name Core Unit of Measure Baseline Current End Target Direct project beneficiaries Number Value 25896000.00 38327054.00 29300000.00 Date 05-Jul-2010 12-Feb-2013 31-Mar-2015 Comments Source: Based on 12 months Cumulative target value HMIS data of FY 2011-12. The new HMIS is still being established and these data needs to be carefully checked Female beneficiaries Percentage Value 14229369.00 21263422.00 16100100.00 Page 2 of 7 The World Bank Report No: ISR10018 Sub Type Supplemental Beneficiaries from drought affected areas Number Value 0.00 7820890.00 332500.00 Public Disclosure Copy Sub Type Date 05-Jul-2010 12-Feb-2013 31-Mar-2015 Breakdown Comments Source: HIS source: District Health Cumulative target value Information System Source: HIS Children immunized (number) Number Value 1188698.00 1090751.00 1298058.00 Date 05-Jul-2010 12-Feb-2013 31-Mar-2015 Comments Children under 1 year fully Source: Data from District Cumulative target value immunized. Source: HIMS. HMIS report covering FY 2011-12. Due to introduction of new program, the reporting rates were only 65% Value fill rate for commodities on KEMSA Percentage Value 73.00 56.00 90.00 Essential Drug List Date 05-Jul-2010 12-Feb-2013 31-Mar-2015 Comments Source: KEMSA ERP The low value fill rate is due to transition and this is now picking up with supplies being reached at KEMSA warehouses HSSF facilities meeting the core financial Percentage Value 0.00 97.30 90.00 management requirements of the fund. Date 05-Jul-2010 12-Feb-2013 31-Mar-2015 Comments Percentage of facilities The HSSF funds are released receiving HSSF funds. to 774 health centers and Source: Quarterly reports of 2389 dispensaries which Independent Integrated constitute 97% of eligible Fiduciary Review Agency government health facilities (3229) Fiduciary irregularities reported from HSSF and Percentage Value 0.00 100.00 100.00 KEMSA acted upon (during the previous Date 05-Jul-2010 12-Feb-2013 31-Mar-2015 Public Disclosure Copy quarter) Comments Source: Ministries of Health Ministry of health acted on 27 based on IIFRA reports and complaints and KEMSA on 8 KEMSA complaints database complaints received Source: SWAp Secretariat and KEMSA complaints database Level 2 and 3 HSSF facilities displaying Percentage Value 0.00 90.00 information as per GoK guidelines Date 05-Jul-2010 31-Mar-2015 Page 3 of 7 The World Bank Report No: ISR10018 Comments Source: Project data, DHMT Information to be obtained facility supervision report. from the new supervision checklist Public Disclosure Copy Severly malnourished children under five Percentage Value 70.10 60.00 receiving treatment recovered Date 12-Feb-2013 31-Mar-2015 Comments Baseline to be established Source: Nutrition Monitoring January 2012. Reports Source: Nutrition Monitoring Reports Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target People with access to a basic package of Number Value 0.00 38935800.00 30495000.00 health, nutrition, or reproductive health services Date 05-Jul-2010 12-Feb-2013 31-Mar-2015 (number) Comments Estimated population in Based on the catchment Cumulative target value Catchment areas of facilities population covered by the (levels 2 & 3) benefitting from facilities receiving HSSF HSSF. Source: ? Facilities receiving HSSF Funds within 15 days Percentage Value 0.00 0.00 90.00 of the beginning of the quarter (percent). Date 05-Jul-2010 12-Feb-2013 31-Mar-2015 Comments Source: HMIS Reports of Even though funds are being HSSF Secretariat released every quarters there are still delays. Source: HSSF Secretariat Facility management committees having Percentage Value 27.00 92.00 90.00 quarterly meetings with minutes of meetings Date 05-Jul-2010 12-Feb-2013 31-Mar-2015 (levels 2 and 3) (percent) Comments Level 2=27% (2004)- Source: Reports of the Independent Program data. fiduciary agency. Number of level 2 and 3 Public Disclosure Copy facilities where DHMTs have verified that Facility Management Committees have met quarterly and minutes of meetings are available. Health personnel receiving training (number) Number Value 0.00 9884.00 6500.00 Date 05-Jul-2010 12-Feb-2013 31-Mar-2015 Page 4 of 7 The World Bank Report No: ISR10018 Comments Number of staff receiving new Number of health staff trained Cumulative target value or refresher training in in HSSF and commodity preceding 18 months. management at facility level. Source: Project data/HSSF Source: Project data/HSSF Public Disclosure Copy Secretariat. Secretariat. Level 2 and 3 facilities meeting staffing norms Percentage Value 3.00 40.00 (percent). Date 05-Jul-2010 31-Mar-2015 Comments Level 2 = 3% Information will be available Target value is for both level 2 Level 3 = 34% from the supervision and level 3. Source: HIS and HRH checklists which are now database. being computerized by June 30, 2013 Level 2-3 facilities implementing results based Number Value 0.00 26.00 250.00 financing initiatives (number) Date 05-Jul-2010 12-Feb-2013 31-Mar-2015 Comments Source: HIS and HRH Currently 26 facilities in Cumulative target value -- database. Samburu are implementing or 40% Indicator defined as: number PBF which is being expanded of level 2-3 health facilities to 3 more counties receiving bonus payments based on the RBFinitiative. Currently 0%. Number of beneficiaries receiving Number Value 157413.00 204785.00 285210.00 supplementary feeding in the drought affected Date 31-Dec-2011 30-Jun-2012 31-Mar-2015 areas. (Moderately malnourished children Comments Source: MOH Nutrition Source: MOH nutrition Cumulative target value. under fiveand moderately malnourished pregnant and lactating women) reporting and UNICEF reporting and UNICEF Performance contract between KEMSA and Text Value No Draft contract being revised in Yes MOMS, and a client service agreement the light of devolution of between KEMSA and MOPHS, established and health system and integration monitored on aquarterly basis (yes/no). of Minitries of Health Date 05-Jul-2010 20-Mar-2012 31-Mar-2015 Public Disclosure Copy Comments Source: Project data/Project Source: Project data/Project M&E Officer/SWAp M&E Officer/SWAp Secretariat. Secretariat. Indicator defined as: Four quarterly reports submitted timely every year. Facilities under pull system sending their Percentage Value 0.00 67.00 85.00 orders during the previous quarter Date 30-Nov-2011 12-Feb-2013 Page 5 of 7 The World Bank Report No: ISR10018 Comments TBD Source: KEMSA database. TBD The process is still evolving. Timely reimbursement to KEMSA documented Percentage Value 0.00 100.00 100.00 Public Disclosure Copy claims by Ministries of Health (Percent) Date 30-Nov-2011 30-Jun-2012 31-Mar-2015 Comments Done for all four quarters of FY 2011-12 Source: SWAp Secretariat Data on Financial Performance (as of 27-Mar-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P074091 IDA-47710 Effective 29-Jun-2010 05-Jul-2010 30-Sep-2010 31-Mar-2015 31-Mar-2015 P074091 IDA-50340 Effective 20-Dec-2011 10-Feb-2012 28-May-2012 31-Mar-2015 31-Mar-2015 P074091 TF-90490 Effective 28-Jan-2009 12-Feb-2009 07-May-2009 11-Feb-2013 30-Jun-2013 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P074091 IDA-47710 Effective USD 100.00 100.00 0.00 69.31 32.03 69.00 P074091 IDA-50340 Effective USD 56.80 56.80 0.00 12.80 41.36 23.00 P074091 TF-90490 Effective USD 1.22 1.22 0.00 0.92 0.30 75.00 Disbursement Graph Public Disclosure Copy Page 6 of 7 The World Bank Report No: ISR10018 Public Disclosure Copy Key Decisions Regarding Implementation Developing a road map for implementation of the Health Sector Services Fund and the pull system of supply of Essential Medicines and Medical Supplies under the devolved health system in consultation with key stakeholders, especially the County Governments. Restructuring History There has been no restructuring to date. Related Projects P128663-Health Sector Support Additional Financing, P144197-Kenya Health Sector Support Project - Additional Financing Public Disclosure Copy Page 7 of 7