The World Bank Implementation Status & Results Report Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) AFRICA | Congo, Democratic Republic of | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2015 | Seq No: 9 | ARCHIVED on 29-Oct-2019 | ISR37478 | Implementing Agencies: Ministry of Health, Democratic Republic of Congo, Ministry of Finance Key Dates Key Project Dates Bank Approval Date: 18-Dec-2014 Effectiveness Date: 30-May-2016 Planned Mid Term Review Date: 01-Jul-2019 Actual Mid-Term Review Date: 01-Jul-2019 Original Closing Date: 31-Dec-2019 Revised Closing Date: 31-Dec-2021 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed project development objective is to improve utilization and quality of maternal and child health services in targeted areas within the Recipient's Territory. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Improve Utilization and Quality of Health Services at Health Facilities through PBF:(Cost $182.00 M) Improve Governance, Purchasing and Coaching and Strengthen Health Administration Directorates and Services through PBF:(Cost $92.70 M) Strengthen Health Sector Performance – Financing and Health Policy Capacities:(Cost $110.30 M) Disease Surveillance System Strengthening and Response:(Cost $135.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO ►Satisfactory ►Moderately Satisfactory Overall Implementation Progress (IP) ►Moderately Satisfactory ►Moderately Satisfactory Overall Risk Rating ►Substantial ►Substantial Implementation Status and Key Decisions 10/29/2019 Page 1 of 9 The World Bank Implementation Status & Results Report Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) The Project continues to be implemented in a moderately satisfactory manner. During the reporting period, the third additional financing of US$120 million was approved: US$80 million was added to replenish funds that had been reallocated from core project activities to the Contingent Emergency Response (CERC) to support the 10th Ebola Virus Disease (EVD10) outbreak in May 2018, and an additional US$40 million were added to the CERC. Also during the reporting period, the CERC was triggered for a second time to further reallocate US$50 million to the EVD10 response. The project had its Mid Term Review (MTR) between July and August 2019. PDSS now covers approximately 30,000,000 people in 11 provinces and 169 health zones in DRC. Performance based financing supported through PDSS is the largest program if its kind globally. In 2018, an estimated 5,587,652 people received essential health, nutrition and population services through the project. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- ►High ►High Macroeconomic -- ►Substantial ►Substantial Sector Strategies and Policies -- ►Moderate ►Moderate Technical Design of Project or Program -- ►Substantial ►Substantial Institutional Capacity for Implementation and Sustainability -- ►High ►High Fiduciary -- ►High ►High Environment and Social -- ►Moderate ►Moderate Stakeholders -- ►Moderate ►Moderate Other -- -- -- Overall -- ►Substantial ►Substantial Results PDO Indicators by Objectives / Outcomes Improve the utilization and quality of maternal and child health services in targeted areas. IN00712470 ►Percentage of pregnant women having at least 3 antenatal care visits before delivery (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 57.00 50.00 42.00 65.00 Date 31-Jul-2014 30-Mar-2018 31-Dec-2018 31-Dec-2021 The values reported each quarter in 2018 are below the baseline value of 57 percent. During the restructuring, the baseline Comments: value and calculation will be updated. 10/29/2019 Page 2 of 9 The World Bank Implementation Status & Results Report Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) IN00712562 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,838,329.00 5,587,652.00 7,150,000.00 Date 30-Jun-2016 30-Mar-2018 31-Dec-2018 31-Dec-2021 Data disaggregation is not available during reporting period. Will be updated during restructuring. Comments: IN00712563 ►People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,494,562.00 1,494,562.00 5,812,950.00 IN00712564 ►Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 319,681.00 319,681.00 1,250,000.00 Date 30-Jun-2016 30-Mar-2018 30-Mar-2018 30-Dec-2021 IN00712565 ►Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 717,011.00 717,011.00 4,200,000.00 Date 30-Jun-2016 30-Mar-2018 30-Mar-2018 30-Dec-2021 IN00712566 ►Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 434,307.00 434,307.00 1,700,000.00 Date 30-Jun-2016 30-Mar-2018 30-Mar-2018 30-Dec-2021 IN00712567 ►Average score of the quality checklist at the health centers (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 58.10 62.00 60.00 Date 31-Jul-2014 30-Mar-2018 31-Dec-2018 31-Dec-2021 IN00712568 ►Percentage of Children Fully Immunized (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 10/29/2019 Page 3 of 9 The World Bank Implementation Status & Results Report Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) Value 54.00 66.00 72.00 65.00 Date 31-Jul-2014 30-Mar-2018 31-Dec-2018 31-Dec-2021 IN00712569 ►New curative consultations per capita per year (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.25 0.42 0.67 0.50 Date 31-Jul-2014 30-Mar-2018 31-Dec-2018 31-Dec-2021 Provide an immediate and effective response to an eligible crisis or emergency IN00712561 ►Number of eligible individuals vaccinated during EVD (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 72,248.00 127,018.00 120,000.00 Date 31-Jan-2019 03-Feb-2019 29-May-2019 31-Jul-2019 Overall Comments PDO It takes approximately 6 months for data in the National Health Information System to be updated and undergo quality checks. The indicators in this ISR are reported through December 2018. Since the results framework will be revised as part of the project restructuring, the indicators were not further updated after the MTR to reflect data through the first quarter of 2019. Intermediate Results Indicators by Components Improve Utilization and Quality of Health Services at Health Facilities through PBF IN00712570 ►Number of new and existing acceptors of modern contraceptive use (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 194,480.00 311,582.00 532,535.00 500,000.00 Date 31-Jul-2014 30-Jun-2018 31-Dec-2018 31-Dec-2021 Condom use and the use of traditional methods will not be used here as they are very difficult to verify Comments: IN00712574 ►First time adolescent girls acceptant of modern contraceptives (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 10/29/2019 Page 4 of 9 The World Bank Implementation Status & Results Report Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) Value 0.00 17,508.00 56,976.00 50,000.00 Date 31-Dec-2016 30-Jun-2018 31-Dec-2018 31-Dec-2021 IN00712578 ►Average quality of nutritional services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 20.00 20.00 55.00 Date 31-Dec-2015 30-Jun-2018 30-Jun-2018 31-Dec-2021 Nutritional activities under the project have not yet started. They will be incorporated into the newly approved Comments: Multisectoral Nutrition project in DRC. This indicator will be dropped during restructuring. IN00712581 ►Percentage of pregnant women counseled and tested for HIV (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 17.50 60.00 50.00 40.00 Date 31-Jul-2014 30-Jun-2018 31-Dec-2018 31-Dec-2021 IN00712583 ►Number of Direct Beneficiaries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 10,624,580.00 15,453,312.00 25,000,000.00 Date 31-Jul-2014 30-Jun-2018 31-Dec-2018 31-Dec-2021 Data not available disaggregated by sex for the current reporting period. The definition of this indicator, versus the Comments: Corporate Results Indicator for number of beneficiaries, will be clarified during restructuring. IN00712585 ►Number of women (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,519,786.00 4,519,786.00 15,000,000.00 Date 31-Dec-2014 30-Jun-2018 30-Jun-2018 31-Dec-2021 IN00712584 ►Percentage of children under 24 months participating in the Growth Monitoring and Promotion activities at community level (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 26.90 28.00 28.00 45.00 Date 31-Dec-2015 30-Jun-2018 30-Jun-2018 31-Dec-2021 Growth monitoring activities for the project have not yet started. This indicator will be dropped during restructuring. Comments: IN00712586 10/29/2019 Page 5 of 9 The World Bank Implementation Status & Results Report Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) ►Percentage of families participating in parental education sessions at community level (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 31-Dec-2016 30-Jun-2018 31-Dec-2018 31-Dec-2021 Activity not yet started. Indicator will be dropped during restructuring. Comments: IN00712587 ►Exclusive breastfeeding for children under 6 months (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 54.00 72.00 66.00 Date 31-Dec-2015 30-Jun-2018 31-Dec-2018 31-Dec-2021 Baseline value will be added during restructuring of results framework. Comments: Improve Governance, Purchasing and Coaching and Strengthen Health Administration Directorates and Services through PBF IN00712571 ►Average number of days with stock out of tracer drugs in targeted health facilities on the day of the visit (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value >30 days >30 days >30 days >15 days Date 31-Dec-2016 30-Jun-2018 30-Jun-2018 31-Dec-2021 No data for current reporting period. An indicator that is more easily monitored will be added to track the project's progress Comments: in this domain during the restructuring. IN00712575 ►Health personnel receiving training (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,946.00 5,006.00 10,000.00 Date 31-Jul-2014 30-Jun-2018 31-Dec-2018 31-Dec-2021 IN00712579 ►Health facilities receiving Client Tracer and Satisfaction Survey feedback (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 64.00 64.00 70.00 Date 31-Dec-2016 30-Jun-2018 30-Jun-2018 31-Dec-2021 No data available for current reporting period Comments: 10/29/2019 Page 6 of 9 The World Bank Implementation Status & Results Report Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) Strengthen Health Sector Performance – Financing and Health Policy Capacities IN00712572 ►Civil servants eligible for retirement in the Ministry of Health that have received their retirement indemnities/packages and retired from active service (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4,000.00 Date 31-Dec-2016 30-Jun-2018 30-Jun-2018 31-Dec-2021 No data for current reporting period Comments: IN00712576 ►Number of poor people benefiting from fee exemption mechanisms (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5,248.00 34,085.00 153,009.00 6,500.00 Date 31-Jul-2014 30-Jun-2018 31-Dec-2018 31-Dec-2021 Disease Surveillance System Strengthening and Response IN00712573 ►Single contract signed and implemented at province level (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 6.00 9.00 11.00 Date 31-Dec-2016 30-Jun-2018 31-Dec-2018 31-Dec-2021 IN00712577 ►Percentage of contacts lost to follow up (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 20.00 20.00 0.00 Date 31-Jan-2019 03-Feb-2019 03-Feb-2019 31-Jul-2019 IN00712580 ►Percentage of samples received that have been tested (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 80.00 80.00 100.00 Date 31-Jan-2019 03-Feb-2019 03-Feb-2019 31-Jul-2019 IN00712582 ►Percentage suspected and confirmed cases for whom safe and dignified burials have been carried out (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 70.00 70.00 100.00 10/29/2019 Page 7 of 9 The World Bank Implementation Status & Results Report Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) Date 31-Jan-2019 03-Feb-2019 03-Feb-2019 31-Jul-2019 Overall Comments IR All indicators are being reviewed and updated as part of the MTR. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P147555 IDA-55720 Effective USD 130.00 130.00 0.00 96.57 25.78 79% P147555 IDA-59980 Effective USD 120.00 120.00 0.00 118.21 4.77 96% P147555 IDA-D0210 Effective USD 90.00 90.00 0.00 62.42 21.96 74% P147555 IDA-D4390 Effective USD 120.00 120.00 0.00 0.00 116.92 0% P147555 TF-18375 Effective USD 6.50 6.50 0.00 4.43 2.07 68% P147555 TF-A4579 Effective USD 40.00 40.00 0.00 7.32 32.68 18% P147555 TF-A5096 Closed USD 3.50 3.50 0.00 3.49 0.01 100% P147555 TF-A6945 Closed USD 10.00 4.53 5.47 4.53 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P147555 IDA-55720 Effective 18-Dec-2014 20-Jan-2015 30-May-2016 31-Dec-2019 31-Dec-2021 P147555 IDA-59980 Effective 31-Mar-2017 19-Apr-2017 13-Feb-2018 31-Dec-2021 31-Dec-2021 P147555 IDA-D0210 Effective 18-Dec-2014 20-Jan-2015 30-May-2016 31-Dec-2019 31-Dec-2021 P147555 IDA-D4390 Effective 27-Feb-2019 06-Mar-2019 28-Aug-2019 31-Dec-2021 31-Dec-2021 P147555 TF-18375 Effective 20-Jan-2015 20-Jan-2015 30-May-2016 31-Dec-2019 31-Dec-2021 P147555 TF-A4579 Effective 19-Apr-2017 19-Apr-2017 18-Aug-2017 31-Dec-2021 31-Dec-2021 P147555 TF-A5096 Closed 24-May-2017 24-May-2017 22-Nov-2017 30-Jun-2019 30-Jun-2019 10/29/2019 Page 8 of 9 The World Bank Implementation Status & Results Report Health System Strengthening for Better Maternal and Child Health Results Project (PDSS) (P147555) P147555 TF-A6945 Closed 24-Jan-2018 14-Mar-2018 14-Aug-2018 31-Aug-2018 31-Aug-2018 Cumulative Disbursements Restructuring History Level 2 Approved on 01-Sep-2015 ,Level 2 Approved on 31-Oct-2018 ,Level 2 Approved on 06-Dec-2018 ,Level 2 Approved on 19-Aug-2019 Related Project(s) P157864-DRC Health System Strengthening Additional Financing ,P165435-DRC - Additional Financing Health System Strengthening Project for Better Maternal and Child Health Results ,P166004-Health System Strengthening for Better Maternal and Child Health Results AF2 ,P167766-Health System Strengthening for Better Maternal and Child Health PEF AF ,P169753-AF III DRC Health System Strengthening for Better Maternal and Child Health Results ,P170995-AFIV DRC Health System Strengthening for Better Maternal and Child Health Results 10/29/2019 Page 9 of 9