The World Bank Report No: ISR13655 Implementation Status & Results Nepal Nepal: Second HNP and HIV/AIDS Project (P117417) Public Disclosure Copy Operation Name: Nepal: Second HNP and HIV/AIDS Project (P117417) Project Stage: Implementation Seq.No: 7 Status: ARCHIVED Archive Date: 15-Apr-2014 Country: Nepal Approval FY: 2010 Product Line: IBRD/IDA Region: SOUTH ASIA Lending Instrument: Sector Investment and Maintenance Loan Implementing Agency(ies): Key Dates Board Approval Date 20-Apr-2010 Original Closing Date 15-Jul-2015 Planned Mid Term Review Date 30-Jan-2013 Last Archived ISR Date 28-Aug-2013 Effectiveness Date 04-Oct-2010 Revised Closing Date 15-Jul-2015 Actual Mid Term Review Date 28-Jan-2013 Project Development Objectives Project Development Objective (from Project Appraisal Document) To enable the Government of Nepal to increase access to essential health care services and their utilization by the underserved andthe poor. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Health Service Delivery 114.42 Health Systems Strengthening 14.73 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Moderately Satisfactory Moderately Satisfactory Public Disclosure Copy Overall Implementation Progress (IP) Overall Risk Rating Substantial Implementation Status Overview The fourth Joint Annual Review (JAR) of the Nepal Health Sector Program II (NHSP II) took place from January 27-29, 2014. The JAR was organized by the Ministry of Health and Population (MoHP) with participation by various line agencies of the Government of Nepal (GoN), External Development Partners (EDPs), civil society organizations and others. MoHP prepared a number of reports as outlined in the Joint Financing Arrangement and these reports formed the basis for the discussions during the JAR. The reports are available on the Nepal Health Sector Support Programme’s website < http://www.nhssp.org.np>. The JAR also assessed the performance of NHSP II against its stated objectives as elaborated in the Results Framework. The PDO indicators are on track and two of the three have achieved the project target ahead of schedule: Mothers taking IFA stands at 91% against the project target of 87%, skilled birth attendance stands at 45.3% against the project target Page 1 of 8 The World Bank Report No: ISR13655 of 35% and full immunization stands at 87% against the project target of 90%. Overall, the JAR noted continued progress in the health sector. Specifically, the JAR noted progress on the preparation of a Consolidated Annual Procurement Plan, the Annual Workplan and Budget (AWPB) and the Joint Consultative Meetings (JCMs) held during the previous year. Similarly, a new national health policy and a national health insurance policy have been drafted with the first phase of national health insurance planning to be rolled out in three districts (Kailali, Baglung and Ilam). A collaborative framework was signed between MoHP and the Ministry of Federal Affairs and Local Development (MoFALD) in December 2013 to Public Disclosure Copy strengthen local health governance, civil registration and vital statistics. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Mothers taking IFA during last pregnancy Percentage Value 81.30 91.10 87.00 increased Date 31-Dec-2009 30-Nov-2012 15-Jul-2015 Comments 70.5% for the poorest income Source: 2012 Household 75% for the poorest income quintile Survey (HHS). 2012 data quintile reflects those who attended ANC. Poorest quintile 93.6% No new data for this reporting period. Fully immunized children increased Percentage Value 88.80 87.00 90.00 Date 31-Dec-2009 31-Dec-2013 15-Jul-2015 Comments 82.6% for poorest income Data source: HMIS 2013. 88% for poorest income quintile Data is % of one-year old quintile children immunized against measles. Skilled attendance at birth increased Percentage Value 28.80 45.30 35.00 Public Disclosure Copy Date 31-Dec-2009 31-Dec-2013 15-Jul-2015 Comments 8.5% for the poorest income Data source: 2013 HMIS. 25% for the poorest income quintile quintile Intermediate Results Indicators Page 2 of 8 The World Bank Report No: ISR13655 Indicator Name Core Unit of Measure Baseline Current End Target Pregnant women receiving antenatal care Number Value 2624101.00 4751368.42 2875850.00 during a visit to a health provider (number) Date 01-Jan-2010 31-Dec-2013 15-Jul-2015 Public Disclosure Copy Comments This figure is based on the For the year 2013, the figure baseline coverage of 87%. is 778,938. Assuming pregnancy at 3% of the population and using CBS The figure is based on population projection (medium coverage of 98% (2013 variant) for 2011 HMIS) with a population of 26,494,504 (final) as of census 2011 and assuming pregnancy at 3%. Children immunized (number) Number Value 583819.00 368256.00 648476.00 Date 01-Jan-2010 31-Dec-2013 15-Jul-2015 Comments This figure is based on the The figure is based on 87% baseline coverage of 88.8% coverage (2013 HMIS) and a and using DHS 2006 for the population of 423,283 (the proportion of children 12-23 number of 1 yr olds from the months; and CBS population 2011 census). projection (medium variant) for 2011 Health facilities constructed, renovated, and/or Number Value 0.00 418.00 equipped (number) Date 01-Jan-2010 15-Jul-2013 15-Jul-2015 Comments Data source: MOHP, Fiscal No target is set as this Year 2012/13 Implementation indicators is not part of the Progress Report. results matrix for the project. The figure shows ongoing projects. Updated data not available from DUDBC at the time of this ISR. Public Disclosure Copy Health personnel receiving training (number) Number Value 0.00 610.00 550.00 Date 01-Jan-2010 16-Oct-2012 15-Jul-2015 Comments Source of data: IPR second A total of 5000 FCHVs trimester 2011/12. recruited, trained & deployed over the life of the project. Updated data not available at 5,000 is cumulative, 550 is the time of this ISR. the yearly target. Additional Female Community Health Number Value 0.00 3901.00 550.00 Volunteers deployed Date 31-Dec-2009 15-Jul-2013 15-Jul-2015 Page 3 of 8 The World Bank Report No: ISR13655 Comments Data source: HMIS. A total of 5000 FCHVs recruited, trained & deployed 37 additional for this reporting over the life of the project. period. 5,000 is cumulative, 550 is Public Disclosure Copy the yearly target. PHC centers providing Basic Emergency Percentage Value 23.00 23.00 70.00 Obstetric Services increased Date 31-Dec-2009 31-Dec-2013 15-Jul-2015 Comments Data source: Service Tracking Survey 2013. Survey indicator is "% of PHCCs providing BEONC signal functions 24/7" Health care finance strategy developed Yes/No Value No No Yes Date 31-Dec-2013 15-Jul-2015 Comments MoHP has developed a draft National Health Insurance Policy. The first phase will be piloted in at least 3 districts (Kailali, Baglung, Ilam). The Bank and other EDPs are providing support for the design of the pilot. Social audits implemented in health facilities Percentage Value 0.00 15.00 25.00 Date 15-Jul-2010 15-Jul-2013 15-Jul-2015 Comments Data source: Service Tracking Survey 2013. 15 percent of health facilities have undertaken social audits as per MOPH guidelines in the last FY Public Disclosure Copy Actions in GAAP implemented Percentage Value 60.00 70.00 90.00 Date 31-Dec-2009 31-Dec-2013 15-Jul-2015 Comments Data source: MOHP, PPICD. Additional SBAs deployed Number Value 0.00 1487.00 500.00 Date 15-Jul-2013 15-Jul-2015 Comments Source of data: NHTC/FHD. A total of 5000 (cumulative) additional SBAs recruited & Page 4 of 8 The World Bank Report No: ISR13655 1,487 additional SBAs deployed over the life of the deployed over 2012's 3,609. project. PHC facilities with essential drug stock outs >1 Percentage Value 67.00 75.10 50.00 week decreased Public Disclosure Copy Date 31-Dec-2009 30-Nov-2012 15-Jul-2015 Comments No new data for this reporting period. Source: STS 2012. The STS tracks tracer drug stock outs (not all essential drugs) over time. Percent of MOHP budget allocated to EHCS Percentage Value 70.00 75.01 75.00 Date 31-Dec-2009 15-Jul-2013 15-Jul-2015 Comments Data source: AWPB Married women (15-49) with unmet need for Percentage Value 26.30 27.00 18.00 family planning reduced Date 31-Dec-2009 16-Oct-2012 15-Jul-2015 Comments Data source: Family Planning, No new data for this reporting Maternal, Newborn and Child period. Health Situation in Rural Nepal: Data source: NDHS 2011 A Mid-term Survey for NFHP 31.1% in lowest income II, March 2010 quintile. HIV prevention services for IDUs increased Percentage Value 30.00 71.40 50.00 Date 31-Dec-2009 14-Jul-2011 15-Jul-2015 Comments Prevention services coverage No new data for this reporting Prevention services coverage for MSM and FSWs 31% and period. for MSM and FSWs 50% and 80% respectively at least 80% respectively Data source: 2011 IBBS. This is not a nationally representative survey as it Public Disclosure Copy covered only Kathmandu Valley and Pokhara. The final report for IBBS 2012 has not been produced yet. 2011 IBBS 60% for FSWs in Kathmandu Valley. 2011 IBBS survey did not include MSM. Page 5 of 8 The World Bank Report No: ISR13655 Vitamin A coverage maintained in children 6-59 Percentage Value 90.00 90.20 90.00 months Date 31-Dec-2009 30-Nov-2012 15-Jul-2015 Comments No new data for this reporting Public Disclosure Copy period. Data source: HHS 2012 91.5% for lowest quintile. Diarrheal cases among under 5 children with Percentage Value 7.00 21.90 40.00 zinc and ORS increased Date 31-Dec-2009 30-Nov-2012 15-Jul-2015 Comments The midterm 2009 NFHP No new data for this reporting survey does not have an period. indicator for zinc and ORS combined so the baseline Data source: HHS 2012. value is for the proportion of children <5yrs treated with 21.1% for the lowest quintile. zinc. Data source: Family Planning, Maternal, Newborn and Child Health Situation in Rural Nepal: A Mid-term Survey for NFHP II, March 2010 Pregnant women attending at least one ante- Percentage Value 87.00 89.00 92.00 natal consultation increased Date 31-Dec-2009 15-Jul-2013 15-Jul-2015 Comments Data source: HMIS 2012/13 Exclusively breastfed children in first 6 months Percentage Value 53.00 68.70 60.00 increased Date 31-Dec-2007 30-Nov-2012 15-Jul-2015 Comments No new data. Data source: HHS 2012 Public Disclosure Copy Poorest quintile: 71.9% TB treatment success rate increased Percentage Value 85.00 90.00 89.00 Date 31-Dec-2009 31-Dec-2013 15-Jul-2015 Comments Source: HMIS 2013 Modern contraceptive use among women Percentage Value 45.10 45.30 55.00 increased Date 31-Dec-2009 31-Dec-2013 15-Jul-2015 Comments Family Planning, Maternal, Data source: HMIS 2013 Newborn and Child Health Page 6 of 8 The World Bank Report No: ISR13655 Situation in Rural Nepal: (married women of A Mid-term Survey for NFHP reproductive age). II, March 2010 Public Disclosure Copy Data on Financial Performance (as of 19-May-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P117417 IDA-47070 Effective 20-Apr-2010 18-Aug-2010 04-Oct-2010 15-Jul-2015 15-Jul-2015 P117417 IDA-H5570 Effective 20-Apr-2010 18-Aug-2010 04-Oct-2010 15-Jul-2015 15-Jul-2015 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P117417 IDA-47070 Effective XDR 44.82 44.82 0.00 7.09 37.73 16.00 P117417 IDA-H5570 Effective XDR 38.28 38.28 0.00 37.69 0.60 98.00 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation In order to gather population-based data which are key to assessing performance during NHSP II, it was agreed that a household survey will be undertaken in 2014 and a Demographic and Health Survey (DHS) after the end of the project. The process and timeline for developing the Nepal Health Sector Program III was also agreed on, and a draft document outlining the plan will be available by the end of September 2014. It was agreed that the final JAR of NHSPII will be held during January 27-29, 2015. Page 7 of 8 The World Bank Report No: ISR13655 Restructuring History There has been no restructuring to date. Public Disclosure Copy Related Projects There are no related projects. Public Disclosure Copy Page 8 of 8