The World Bank Implementation Status & Results Report Nicaragua Strengthening the Public Health Care System (P152136) Nicaragua Strengthening the Public Health Care System (P152136) LATIN AMERICA AND CARIBBEAN | Nicaragua | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2015 | Seq No: 10 | ARCHIVED on 07-Nov-2019 | ISR38901 | Implementing Agencies: Ministry of Finance, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 04-Jun-2015 Effectiveness Date: 17-Sep-2015 Planned Mid Term Review Date: 14-May-2018 Actual Mid-Term Review Date: 14-May-2018 Original Closing Date: 30-Sep-2020 Revised Closing Date: 30-Sep-2020 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objectives (PDO) are to: (a) strengthen quality and access to health services; (b) contribute to adapting the public health system to the country’s changing epidemiological profile; and (c) secure financial support in case of Public HealthAlert or Public Health Emergency. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1. Strengthening the quality and access to health care services:(Cost $28.07 M) Component 2. Institutional strengthening of MOH to respond to the Country’s changing epidemiological profile:(Cost $24.58 M) Component 3. Contingency Financing of a Public Health Emergency or Public Health Alert and Capacity Building:(Cost $6.55 M) Component 4. Project Management:(Cost $0.80 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating High High Implementation Status and Key Decisions The Nicaragua Strengthening the Public Health Care System was approved by the Board on June 4, 2015 and signed on June 26, 2015. The Project was declared effective on September 17, 2015. Project implementation demonstrates significant progress towards achieving its development objectives. Key achievements include: (i) more women are receiving prenatal care; (ii) more children are receiving 3 doses of pentavalent vaccine; (iii) municipalities are complying with their quality health care plan; and (iv) health centers are being certified on hypertension screening. 11/7/2019 Page 1 of 8 The World Bank Implementation Status & Results Report Nicaragua Strengthening the Public Health Care System (P152136) Risks Systematic Operations Risk-rating Tool 11/7/2019 Page 2 of 8 The World Bank Implementation Status & Results Report Nicaragua Strengthening the Public Health Care System (P152136) Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate High High Macroeconomic Moderate High High Sector Strategies and Policies Low Low Low Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Sustainability Moderate Moderate Moderate Fiduciary Moderate Moderate Moderate Environment and Social Low Moderate Moderate Stakeholders Moderate Moderate Moderate Other -- -- -- Overall Moderate High High Results PDO Indicators by Objectives / Outcomes Strengthen the quality and access to health services. IN00754324 ►1. Percentage of women receiving prenatal care coverage (at least four visits) (Percentage. List of municipalities in Annex 2 of the PAD) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target G1: 53% G1: 70% G1: 72.8% G2: 75.7% G1: 72.8% G2: 75.7% Value G2: 71% G2: 80% G3: 85.8% G3: 85.8% G3: 83% G3: 85% Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2020 IN00754346 ►2. Percentage of children under 1 year of age receiving three doses of pentavalent vaccine.(List of municipalities in An nex 2). (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target G1: 95% G1: 95% G1: 94 % G1: 97% G2: 97% G2: 97% Value G2: 96% G2: 98% G3: 97% G3: 97% G3: 96% G3: 98% Date 31-Dec-2014 31-Dec-2017 31-Dec-2017 30-Sep-2020 IN00754347 ►3. Percentage of municipalities that have more than 50 percent compliance with their quality health care plan (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 95.00 95.00 66.00 Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2020 IN00754348 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) 11/7/2019 Page 3 of 8 The World Bank Implementation Status & Results Report Nicaragua Strengthening the Public Health Care System (P152136) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 436,693.00 436,693.00 0.00 Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2020 Definition The indicator measures the sum of the number of children immunized, the number of women and children who have received basic nutrition services, and the number of deliveries attended by skilled health personnel, through operations supported by the World Bank. Details The baseline value for this indicator is zero. (A “zero” in the baseline means that a newly approved project Comments: has not started contributing to the provision of essential HNP services.) Subsequently, the data should be cumulative—that is, the data in the ISR should represent the cumulative number of people who have received essential HNP services through a Bank-financed project. The cumulative value of year x is equal to the cumulative value of previous year x-1 plus the value for year x; that is, for the cumulative Year 1 the value for Year 1 is reported, and for the cumulative Year 2, Year 1 + Year 2 is reported. IN00754349 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 436,693.00 436,693.00 0.00 Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2020 Contribute to adapting the public health system to the country’s changing epidemiological profile. IN00754325 ►4. Number of health centers certified on hypertension screening. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 65.00 65.00 40.00 Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2020 Intermediate Results Indicators by Components Component 1. Strengthening the quality and access to health care services. IN00754352 ►Percentage of women receiving postpartum care within 2 to 10 days of delivery (List of municipalities in Annex 2). (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target G1: 58.4% G1: 58.4% G1: 37% G1: 55% G2: 75.5% G2: 75.5% Value G2: 58% G2: 70% G3: 94.9% G3: 94.9% G3: 73% G3: 82% Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2020 IN00754355 ►Number of municipalities with signed annual performance agreements (acuerdos sociales) with SILAIS (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 11/7/2019 Page 4 of 8 The World Bank Implementation Status & Results Report Nicaragua Strengthening the Public Health Care System (P152136) Value 66.00 66.00 66.00 66.00 Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2020 Documents (Agreements executed, Evaluation Minutes) Sixty are the total number of Municipalities participating in the project and therefore they need to have Performance Agreements signed and renewed each year to ensure commitment to the quality of health services. Therefore the signature takes place each year to ensure the municipalities comply with health Comments: indicators. Performance agreements are a useful tool to establish a results-oriented culture. These agreements have proven to be a powerful tool for managing decentralized health programs at the municipal level. Refer to Annex 2 of the PAD for more information. IN00754357 ►Percentage of health centers certified on quality of care. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 56.00 56.00 33.00 Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2020 IN00754358 ►Health personnel receiving training (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,518.00 2,518.00 1,000.00 Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2020 This indicator measures the cumulative number of health personnel receiving training through a Bank- Comments: financed project. IN00754359 ►Number of municipal health units implementing traditional medicine. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 12.00 12.00 12.00 Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2020 IN00754360 ►Number of schools participating in the children fluoridation program. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 7,632.00 7,632.00 4,040.00 Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2020 The schools are distributed 1245 Urban and 6387 Rural by Dec 31, 2018. Comments: C2. Institutional strengthening of MOH to respond to the Country’s changing epidemiological profile. IN00754350 ►Percentage of cold chain networks rehabilitated at the primary health care level (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 11/7/2019 Page 5 of 8 The World Bank Implementation Status & Results Report Nicaragua Strengthening the Public Health Care System (P152136) Value 88.00 88.00 88.00 93.00 Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2020 Sub component 1.3 Comments: This indicator is expected to show compliance by the end of Project IN00754353 ►Health facilities constructed, renovated, and/or equipped (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 142.00 142.00 44.00 Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2020 This indicator measures the cumulative number of health facilities constructed, renovated and/or equipped through a Bank-financed project. Comments: 11 pathology laboratories and 131 clinical laboratories as of Dec 31, 2018. IN00754356 ►Number of reference centers with capacity to treat cervical cancer ( infrastructure, equipment, and qualified human resources) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 9.00 9.00 10.00 Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2020 National reference centers in total 4 (National Radiation Therapy Center, Manolo Morales Hospital, La Mascota Hospital, and Bertha Calderón. Comments: 5 Regional Centers (Bluefiels, Juigalpa, Matagalpa, Heodra and Estelí). Hospital de Chinandega is already trained and equipped, limited by infrastructure. C3. Contingency Financing of a Public Health Emergency or Public Health Alert and Capacity Building. IN00754351 ►Number of home visits to promote awareness on prevention of vector borne diseases (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5,000,000.00 6,262,703.00 6,262,703.00 8,200,500.00 Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2020 Comments: Sub component 3.2 IN00754354 ►Percentage of reference hospitals with updated and implemented waste management plans (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 11.00 50.00 50.00 83.00 Date 31-Dec-2014 31-Dec-2018 31-Dec-2018 30-Sep-2020 Comments: Sub component 3.3 11/7/2019 Page 6 of 8 The World Bank Implementation Status & Results Report Nicaragua Strengthening the Public Health Care System (P152136) Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P152136 IDA-D0720 Effective USD 60.00 60.00 0.00 54.95 4.22 93% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P152136 IDA-D0720 Effective 04-Jun-2015 26-Jun-2015 17-Sep-2015 30-Sep-2020 30-Sep-2020 Cumulative Disbursements Restructuring History There has been no restructuring to date. Related Project(s) 11/7/2019 Page 7 of 8 The World Bank Implementation Status & Results Report Nicaragua Strengthening the Public Health Care System (P152136) P163142-Strengthening the Public Health Sytem in Nicaragua 11/7/2019 Page 8 of 8