The World Bank Report No: ISR15309 Implementation Status & Results Djibouti DJ Improving Health Sector Performance (P131194) Public Disclosure Copy Operation Name: DJ Improving Health Sector Performance (P131194) Project Stage: Implementation Seq.No: 3 Status: ARCHIVED Archive Date: 12-Jul-2014 Country: Djibouti Approval FY: 2013 Product Line: IBRD/IDA Region: MIDDLE EAST AND NORTH AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Ministry of Health Key Dates Board Approval Date 02-Apr-2013 Original Closing Date 31-Dec-2018 Planned Mid Term Review Date 31-Jan-2016 Last Archived ISR Date 28-Apr-2014 Effectiveness Date 11-Jul-2013 Revised Closing Date 31-Dec-2018 Actual Mid Term Review Date 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 health and communicable disease control programs (HIV/AIDS, tuberculosis and malaria). Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Improving health services delivery performance 4.00 Strengthening health system management 1.00 Strengthening program management and monitoring and evaluation capacity 2.00 Overall Ratings Previous Rating Current Rating Public Disclosure Copy Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status Overview A Project supervision mission took place in Djibouti from May 24 to 29, 2014. The Project includes the following components: Component 1: Improving health services delivery performance. This component supports the delivery of improvements in: (i) child health services such as immunization, Integrated Page 1 of 8 The World Bank Report No: ISR15309 Management of Childhood Illnesses (IMCI), and treatment of malnutrition; (ii) maternal child health services such as prenatal care, family planning, skilled-attended delivery, and emergency obstetric care; and (iii) prevention and treatment services of HIV/AIDS and other prevalent communicable diseases such as Voluntary Counseling and Testing (VCT), Directly Observed Treatment Short-course (DOTS), and malaria. This component finances healthcare services by disbursing the project proceeds to health providers based on specific quantifiable outputs of the health facilities that are directly linked to the achievement of the health-related MDGs, through a Results-based Financing (RBF) mechanism. Public Disclosure Copy Through an initial two-year pre-pilot phase covering Djibouti-ville and two rural regions (Ali Sabieh and Tadjourah), the RBF initial tools will be tested and refined. All public community health centers in Djibouti-ville and regional health centers in Ali Sabieh and Tadjourah regions will be targeted. In year three and beyond the RBF pilot scheme will be scaled up to additionally cover all regions in the rural areas. Component 2: Strengthening health system management. This component supports activities aimed at strengthening the management capacity of the Ministry of Health (MOH) and improving the performance of the different health systems in support of health services. These include: (a) MOH directorates such as: health regions, health promotion, human resources, information systems, planning, health service inspections, maternal and child health, immunizations; (b) training service directorates; (c) the HIV/AIDS, TB and malaria control programs; and (d) the drug fund. Component 3: Strengthening project management and monitoring and evaluation capacity. This component supports the Project Implementation Unit (PIU) in managing project activities and fiduciary functions, including financial management, procurement, and environment. The component also strengthens the monitoring and evaluation of the program, including financing independent technical audits to validate and verify the achievements of health facilities outputs on a quarterly basis, and independent health surveys on a bi- annual basis, as well as health facility and client satisfaction surveys. Locations Country First Administrative Division Location Planned Actual Djibouti Tadjourah Tadjourah ✔ Djibouti Djibouti Djibouti Region ✔ Djibouti Ali Sabieh Ali Sabieh Region ✔ Djibouti Ali Sabieh Ali Sabieh Region ✔ Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Public Disclosure Copy Percentage of women giving birth in a facility Percentage Value 53.00 75.00 assisted by qualified personnel Date 01-Dec-2012 30-May-2014 30-Jun-2018 Comments No current values were reported yet since the RBF is expected to become operational by end of June 2014 for the initial pilot phasecovering Djibouti-ville and the two rural regions (Ali Sabieh and Tadjourah). Page 2 of 8 The World Bank Report No: ISR15309 Percentage of children fully immunized before Percentage Value 83.00 83.00 90.00 their first birthday Date 01-Dec-2012 30-May-2014 30-Jun-2018 Comments No updated values were Public Disclosure Copy reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the two rural regions (Ali Sabieh and Tadjourah) Percentage of HIV positive pregnant women Percentage Value 12.00 12.00 55.00 receiving antiretroviral therapy according to Date 01-Dec-2012 30-Jun-2014 30-Jun-2018 protocol Comments No updated values were reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the two rural regions (Ali Sabieh and Tadjourah) Percentage of pregnant women receiving a Percentage Value 22.00 22.00 55.00 prenatal visit before the end of the first Date 01-Dec-2012 30-May-2014 30-Jun-2018 trimester of pregnancy (CPN1<4) Comments No updated values were reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the two rural regions (Ali Sabieh and Tadjourah) Percentage of positive pulmonary TB cases Percentage Value 35.00 35.00 60.00 detected (case detection rate) Public Disclosure Copy Date 01-Dec-2012 30-May-2014 30-Jun-2018 Comments No updated values were reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the two rural regions (Ali Sabieh and Tadjourah) Page 3 of 8 The World Bank Report No: ISR15309 Percentage of pulmonary TB patients cured Percentage Value 80.00 80.00 85.00 (Pulmonary TB cure rate) Date 01-Dec-2012 30-Jun-2014 30-Jun-2018 Comments No updated values were Public Disclosure Copy reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the two rural regions (Ali Sabieh and Tadjourah) Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Percentage of child nutritional growth Percentage Value 5.00 5.00 40.00 monitoring visits (well-baby clinic visits) Date 01-Dec-2012 30-Jun-2014 30-Jun-2018 Comments No updated values were reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the two rural regions (Ali Sabieh and Tadjourah) Percentage of HIV test results received by all Percentage Value 70.00 70.00 87.00 persons tested for HIV Date 01-Dec-2012 30-Jun-2014 30-Jun-2018 Comments No updated values were reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the Public Disclosure Copy two rural regions (Ali Sabieh and Tadjourah) Percentage of suspected malaria cases that Percentage Value 11.00 11.00 5.00 are tested and confirmed Date 01-Dec-2012 30-Jun-2014 30-Jun-2018 Comments No updated values were reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the Page 4 of 8 The World Bank Report No: ISR15309 two rural regions (Ali Sabieh and Tadjourah) Percentage of established and functioning Percentage Value 15.00 15.00 100.00 COGESs in CSCs and CMHs Public Disclosure Copy Date 01-Dec-2012 30-May-2014 30-Jun-2018 Comments No updated values were reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the two rural regions (Ali Sabieh and Tadjourah) Percentage of pregnant women receiving at Percentage Value 29.00 29.00 60.00 least two doses of tetanus toxoid (TT2) Date 01-Dec-2012 30-May-2014 30-Jun-2018 Comments No updated values were reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the two rural regions (Ali Sabieh and Tadjourah) Percentage of women receiving two postnatal Percentage Value 9.00 9.00 45.00 care visits (PoNC1 and PoNC2) between 8th Date 01-Dec-2012 30-May-2014 30-Jun-2018 and 42nd day after delivery Comments No updated values were reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the two rural regions (Ali Sabieh and Tadjourah) Public Disclosure Copy Percentage of WCBA visiting the public system Percentage Value 13.00 13.00 25.00 to obtain modern family planning (oral Date 01-Dec-2012 30-May-2014 30-Jun-2018 contraceptives and injections; IUDs; implants) Comments No updated values were reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the Page 5 of 8 The World Bank Report No: ISR15309 two rural regions (Ali Sabieh and Tadjourah) Number of curative care visits per person per Number Value 0.20 0.20 0.52 year in the public system Public Disclosure Copy Date 01-Dec-2012 30-May-2014 30-Jun-2018 Comments No updated values were reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the two rural regions (Ali Sabieh and Tadjourah) Average score on the quality checklist Percentage Value 45.00 45.00 75.00 Date 01-Dec-2012 30-May-2014 30-Jun-2018 Comments No updated values were reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the two rural regions (Ali Sabieh and Tadjourah) Pregnant/lactating women, adolescent girls Number Value 50000.00 50000.00 90000.00 and/or children under age five-reached by Date 01-Dec-2012 30-May-2014 30-Jun-2018 basic nutrition services (number) Comments No updated values were reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the two rural regions (Ali Sabieh and Tadjourah) Public Disclosure Copy Children between the age of 6 and 59 months Number Value 50000.00 50000.00 90000.00 receiving Vitamin A supplementation (number) Sub Type Date 01-Dec-2012 30-May-2014 30-Jun-2018 Breakdown Comments No updated values were reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the Page 6 of 8 The World Bank Report No: ISR15309 two rural regions (Ali Sabieh and Tadjourah) People with access to a basic package of Number Value 155000.00 155000.00 200500.00 health, nutrition, or reproductive health services Public Disclosure Copy Date 01-Dec-2012 30-May-2014 30-Jun-2018 (number) Comments No updated values were reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the two rural regions (Ali Sabieh and Tadjourah) People receiving tuberculosis treatment in Number Value 300.00 300.00 500.00 accordance with the WHO-recommended Date 01-Dec-2012 30-May-2014 30-Jun-2018 “Directly Observed Treatment Comments No updated values were Strategy” (DOTS) (number) reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the two rural regions (Ali Sabieh and Tadjourah) Direct project beneficiaries Number Value 0.00 0.00 300000.00 Date 30-May-2014 Comments No updated values were reported yet since the RBF is expected to become operational by end of May 2014 for the initial pilot phase covering Djibouti-ville and the two rural regions (Ali Sabieh and Tadjourah) Public Disclosure Copy Female beneficiaries Percentage Value 0.00 0.00 210000.00 Sub Type Supplemental Data on Financial Performance (as of 11-Jun-2014) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P131194 IDA-52160 Effective 02-Apr-2013 21-Apr-2013 11-Jul-2013 31-Dec-2018 31-Dec-2018 Page 7 of 8 The World Bank Report No: ISR15309 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P131194 IDA-52160 Effective XDR 4.60 4.60 0.00 0.46 4.14 10.00 Public Disclosure Copy Disbursement Graph Key Decisions Regarding Implementation NA Restructuring History There has been no restructuring to date. Public Disclosure Copy Related Projects There are no related projects. Page 8 of 8