The World Bank Report No: ISR14345 Implementation Status & Results Nigeria Malaria Control Booster Project (P097921) Public Disclosure Copy Operation Name: Malaria Control Booster Project (P097921) Project Stage: Implementation Seq.No: 15 Status: ARCHIVED Archive Date: 29-Sep-2014 Country: Nigeria Approval FY: 2007 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Federal Ministry of Health Key Dates Board Approval Date 12-Dec-2006 Original Closing Date 31-Mar-2012 Planned Mid Term Review Date 15-Jun-2010 Last Archived ISR Date 12-Mar-2014 Effectiveness Date 15-May-2007 Revised Closing Date 15-Mar-2015 Actual Mid Term Review Date 28-Oct-2010 Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objectives are (i) to ensure that the target population will have improved access to, and utilization of, a well-defined set of Malaria Plus Package interventions (MPP); and (ii) to strengthen Federal and States ability to manage and oversee delivery of malaria plus interventions. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Strengthen Federal capacity for stewardship and coordination 86.50 Strengthen State level systems, services and capacities 71.50 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Unsatisfactory Public Disclosure Copy Overall Implementation Progress (IP) Moderately Satisfactory Moderately Unsatisfactory Overall Risk Rating Moderate Implementation Status Overview The period from June 2014 – March 2015 of the project will focus on the following strategic areas; (i) improving ownership and use of LLINs in the six WB assisted states through campaign and other high impact demand side activities, It is expected that this will have the greatest impact on malaria incidence; (ii) further strengthening MNCH weeks so that MPP coverage increases; (iii) Ensuring increased availability and use of ACTs through timely procurement and distribution; and (iv) Ensure implementation of Community Delivered Interventions (CDI) and Nigeria Inter Faith Action Association (NIFAA) interventions to improve demand side actions as well as to generate lessons learned. Results: Data from the service delivery indicators and IE, together with the LQAS surveys of 2010, NMIS 2010, MICS 2011, shows that Booster States were performing much better Page 1 of 7 The World Bank Report No: ISR14345 than non-Booster States. However, the data from the NDHS 2013 shows there is no difference in performance between the Booster and non Booster states (see detail below). This may be due to the fact that other States now receive similar resources with support from other partner financiers such as the Global Fund, DFID and PMI. The NDHS shows that possession of at least one ITN per household is 52.6% (national average 49.5%) and the percentage of children under five who slept under ITN previous night Public Disclosure Copy 14.1% (national 16.1). The percentage of children less than five treated with effective antimalarial (ACT) 5.81% (national 4.2%), Women taking at least two doses of IPT with SP 11.4% (National 14.6), percentage of women sleeping under and LLIN previous night 15.4% (National 16.0%). These results show the project progress towards attainment of PDO and regressed and are at risk and hence the importance of ensuring that during the next nine months the project intensifies BCC-IEC campaigns, improves availability of LLIN, ACTs and RDTs in the Booster States prior to the end stage survey. The indicator on utilization of ACT by children under five is also being impacted by change in policy that now requires that ACT use is any given to those that have positive confirmation of malaria infection as shown by Rapid Diagnostic Tests and not merely the presence of fever as was being done at the time of project development. These changes in indicators as a result of global consent will impact greatly on the end stage result. Locations Country First Administrative Division Location Planned Actual Nigeria Not Entered Rivers State Nigeria Not Entered Kano State Nigeria Not Entered Bauchi State Nigeria Not Entered Anambra State Nigeria Not Entered Akwa Ibom State Nigeria Not Entered Jigawa State Nigeria Not Entered Gombe State Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Public Disclosure Copy % of children < 5 years with fever treated with Text Value 3.7% 5.8 15% an effective antimalarial within 24 hours from Date 08-Dec-2006 11-Aug-2014 31-Mar-2015 onset of symptoms Comments LQAS, November 2006 NDHS 2013. National Progress regressed (source of all baseline data average 4.2% undertaken in the 7 Booster and 2 Control States unless otherwise indicated) % of children < 5 years who slept under an ITN Text Value 3.6% 15.0 60% the night preceding the survey Date 08-Dec-2006 12-Aug-2014 31-Mar-2015 Page 2 of 7 The World Bank Report No: ISR14345 Comments LQAS 2006 NDHS 2013. National Progress regressed Average 16.6% % of pregnant women who received two or Text Value 8.3% 8.35 25% Public Disclosure Copy more doses of IPT Date 08-Dec-2006 12-Aug-2014 31-Mar-2015 Comments LQAS 2006 NDHS 2013. national Awaits LQAS 2015 average 14.6% percentage of pregnant women who slept Percentage Value 4.10 15.20 50.00 under bed net night before the survey Date 12-Aug-2006 12-Aug-2014 31-Mar-2015 Comments LQAS Nov 2006 NDHS 2013 National average Awaits LQAS/HFA in 2015 16.0% Direct Project Beneficiaries of which female Percentage Value 0.00 18000000.00 16000000.00 Date 12-Aug-2014 31-Mar-2015 Comments TBD Refers to the proportion of Target exceeded population which is female in the Booster States who have benefited from any intervention of the project. Takes into population growth and highest coverage rates of intervention. Number of children under five who received Percentage Value 4300000.00 26465138.00 6000000.00 Vitamin A supplementation Date 31-Dec-2009 12-Aug-2014 31-Mar-2015 Comments Base line reflect point of Through aggregated data Target exceeded initiation of INMCH weeks as from MNCH weeks since avenues for implementing 2011.Target exceeded. MPP (after MTR) Cumulative number of children provided Vitamin A during MNCH weeks in all states Public Disclosure Copy Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target % of households with at least one ITN/LLIN Text Value 2.6% 52.6 80% Date 08-Dec-2006 12-Aug-2014 31-Mar-2015 Comments LQAS 2006 NDHs 2013. national average Progress regressed. 49.5% Page 3 of 7 The World Bank Report No: ISR14345 % of children aged 0-23 months with diarrhea Text Value 25.3% 27.1 50% in the last two weeks who received oral Date 08-Dec-2006 12-Aug-2014 31-Mar-2015 rehydration solution (ORS) and/or Comments LQAS 2006 MICS 2011 shows national recommended home fluids (RHF) Public Disclosure Copy average of 27.1% % of women with children <1 year of age who Text Value 63% 66.7 72 received ANC care during last pregnancy Date 08-Dec-2006 12-Aug-2014 31-Mar-2015 Comments LQAS 2006 MICS 2011 show national Target achieved average of 66.7% Long-lasting insecticide-treated malaria nets Number Value 0.00 51392304.00 12400000.00 purchased and/or distributed (number) Date 08-Dec-2006 12-Aug-2014 31-Mar-2015 Comments Comments: 12.4M procured and distributed plus the 20.2 Million distributed in 22 states from Global Fund and extra 11.4 million from Funds. A new consignment of 6.4 million have been procured. % of health facilities using laborartory Percentage Value 5.00 17.00 30.00 confirmation as the basis for treatment of fever Date 01-Nov-2009 12-Aug-2014 31-Mar-2015 in children >5yrs and adults Comments HFA HFA: Indicator to be revised. Now indicator looks at entire population and not only in Children over five and adults. % households sprayed with IRS in the last 12 Percentage Value 3.00 4.00 80.00 months Date 12-Aug-2006 12-Aug-2014 31-Mar-2015 Comments NDHS 2013. National Final 2013 Spraying Data average 1.7% Number of LLINs distributed in 22 additional Number Value 5200000.00 32592304.00 20700000.00 states Date 12-Aug-2014 31-Mar-2015 Public Disclosure Copy Comments LLINs being distributed in the Distribution Report non Booster States as part of Government support for MDG procured and GF procured LLINs. measurementof coverage will be done within the context of national MIS early 2013. Page 4 of 7 The World Bank Report No: ISR14345 Paediatric doses of ACT distributed to LGA Number Value 90.00 distribution sites per 10,000 children under 5 Date 08-Dec-2006 30-Jun-2013 30-Jun-2014 years of age by state, and health facility (public Comments Indicator will be dropped in Indicator dropped after Indicator Dropped and private) Public Disclosure Copy the next ISR to align with restructuring results framework in the restructured paper. The target has been achievedconsistently and adding limited value. Children <5years of age with fever in the last 2 Percentage Value 0.00 0.00 80.00 weeks treated with an effective anti malarial Date 01-Nov-2006 12-Aug-2014 30-Jun-2014 within 24 hours of onset of symtoms in Comments Source : LQAS 2006 Indicator dropped after communities with CDI Indicator will be dropped in restructuring the next ISR to reflect changes in the results framework of the restructured project Percentage of care givers who knows at least Percentage Value 62.30 62.30 70.00 two symptoms of malaria Date 30-Sep-2010 12-Aug-2014 31-Mar-2015 Comments LQAS 2010 LQAS 2010 Progress on course Percentage of mothers of children less than Percentage Value 0.00 0.00 60.00 five years of age in CDI communities who know Date 30-Jun-2009 12-Aug-2014 31-Mar-2015 at least two ways of preventing malaria Comments Intervention implementing. Awaiting LQAS 2015 Results Number of RDTs distributed to health facilities Number Value 0.00 10000000.00 12000000.00 Date 30-Jun-2009 12-Aug-2014 31-Mar-2015 Comments Distribution and NMCP Awaiting LQAS 2015 Results Procurement reports Percentage of PMV knowing the correct dose Percentage Value 0.00 0.00 80.00 of ACT for children under five Public Disclosure Copy Date 31-Jul-2009 12-Aug-2014 31-Mar-2015 Comments Looks at only two States Intervention implementing. Awaiting LQAS 2015 Results Gombe and Anambra Awaiting LQAS 2015 Results Percentage of sampled PMV that had ACTs in Percentage Value 0.00 0.00 80.00 stock aat te time of assessemnt Date 30-Jun-2009 12-Aug-2014 31-Mar-2015 Comments Intervention implementing. Awaiting LQAS 2015 Results Awaiting LQAS 2015 Results Percentage of sampled CDDs with no stock - Number Value 0.00 0.00 80.00 outs in the last three months Date 30-Jun-2009 12-Aug-2014 31-Mar-2015 Page 5 of 7 The World Bank Report No: ISR14345 Comments Intervention implementing. Awaiting LQAS 2015 Results Awaiting LQAS 2015 Results Public Disclosure Copy Data on Financial Performance (as of 27-Aug-2014) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P097921 IDA-42500 Effective 12-Dec-2006 19-Feb-2007 15-May-2007 31-Mar-2012 15-Mar-2015 P097921 IDA-45970 Effective 16-Jun-2009 20-Jul-2009 05-Jan-2010 31-Mar-2012 15-Mar-2015 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P097921 IDA-42500 Effective XDR 121.70 121.70 0.00 120.97 0.73 99.00 P097921 IDA-45970 Effective XDR 67.20 67.20 0.00 48.20 19.00 72.00 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation The project extended the closing date from June 30, 2014 to March 31, 2015. This will ensure complete implementation of all the project activities especially the LLIN redistribution campaign and end stage LQAS survey for better project results. Data from the 2013 NDHS shows that the progress towards to PDO has regressed. It shows marked reduction in both coverage and utilization of malaria intervention in both Page 6 of 7 The World Bank Report No: ISR14345 Booster and non Booster States. This poses a challenge for progress towards PDO. The intensity of implementation of project activities will remain accelerated. NIFFA activities are being scaled up to strengthen behavior change and improve utilization. All these actions will contribute towards improvement in coverage and utilization of malaria intervention and a successful project outcome. Public Disclosure Copy Restructuring History Level two Approved on 26-Jul-2011, Level two Approved on 04-Aug-2011, Level 2 RVP Decision on 28-Jun-2013, Level 2 RVP Decision on 23-Jun-2014 Related Projects P115036-Malaria Control Booster Project - Additional Financing Public Disclosure Copy Page 7 of 7