The World Bank Report No: ISR13828 Implementation Status & Results Congo, Republic of CG Rep. Health Sector Services Development (P106851) Public Disclosure Copy Operation Name: CG Rep. Health Sector Services Development (P106851) Project Stage: Implementation Seq.No: 13 Status: ARCHIVED Archive Date: 02-Jun-2014 Country: Congo, Republic of Approval FY: 2008 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 29-May-2008 Original Closing Date 29-May-2012 Planned Mid Term Review Date 21-Apr-2011 Last Archived ISR Date 30-Dec-2013 Effectiveness Date 02-Feb-2009 Revised Closing Date 30-Jun-2014 Actual Mid Term Review Date 23-May-2011 Project Development Objectives Project Development Objective (from Project Appraisal Document) The development objective of the project is to support the strengthening of the health system in order to effectively combat the major communicable diseases and improve access to quality services for women, children and other vulnerable groups. Within the comprehensive sector development program of the PNDS, the IDA supported project will focus primarily on strengthening sector stewardship, fiduciary systems and monitoring and evaluation (Component1); human resources (Component 2); Infrastructure assessment, mapping and comprehensive rehabilitation plan, including limited construction (Component 3) and, delivery of Package of Essential Services (PSE), with emphasis on Malaria HIV/AIDS and MCH, pharmaceuticals management, community participation/indigenous peoples and equity (Component 4). Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Component 1: Access to a package of high priority health services 3.02 Component 2: Support to provision of priority health services 5.04 Component 3: Monitoring and Evaluation and Project Management 3.23 Public Disclosure Copy Component 4: Canceled 0.00 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Moderately Satisfactory Overall Risk Rating Low Low Implementation Status Overview Page 1 of 6 The World Bank Report No: ISR13828 Implementation support missions for PDSS I, in conjunction with project preparation missions for PDSS II, were conducted in October 2013 and February 2014. For activities related to PDSS I, the mission of February 2014 aimed at helping the Ministry of Health to prepare for the closing of the project. The mission had the opportunity to review the remaining activities to be implemented before the closing date (June 30, 2014) and to launch the preparation of the Implementation Completion Report produced by the Bank and the project evaluation report produced by the Government. A mission dedicated to completing these two reports will be held in June 2014 and will most likely include a workshop at the national Public Disclosure Copy level to discuss the outcomes of the project and also learn how the beneficiaries benefited from the project over the lifetime of the project. In terms of the indicators, while progress has been made on most of them, except for the indicator pertaining to Pregnant women receiving ART, which sees a decrease in results. This is a new indicator which was introduced at restructuring as part of the services to be purchased under the PBF. However, when the health center assessment was conducted in the 3 departments where PBF was introduced, the team found out that not all the health centers contracted through PBF were in a position to offer these services, hence low results. During October 2013 mission, the Bank noted the continued good management and implementation of the project. Despite the persistent financing gap (due to the fluctuation between the SDR and the Dollar) which the Government has committed to cover but hasn't yet done so, the project has completed most its activities as described above. The procurement plans have also nearly been executed; they have been updated and provided to the Bank on the agreed date. The Financial management of the project was deemed satisfactory and the team has done a commendable job in following the Bank procedures throughout the past 6 months. The Government and the Bank finalized the preparation of the new project which was negotiated in Washington in November 2013 and went to the Board on December 20, 2014. Collaboration has been laudable and the Government has embraced PBF as a national policy to achieve its MDG targets. The PDSS I project was extended to June 30, 2014 to ensure continuity of the health services for the population until the new project begins implementation. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target % children under five years of age who slept Percentage Value 6.00 75.10 60.00 under an ITN the previous night Date 31-Oct-2011 28-May-2013 Comments (Taux au niveau du Pool (un Based on Bednet survey des six départements) après conducted in March-May 2013 la distribution en 2011 Health facilities constructed, renovated, and/or Number Value 0.00 22.00 32.00 equipped (number) Public Disclosure Copy Date 31-Dec-2012 31-Dec-2013 Comments New indicator, thus no baseline Long-lasting insecticide-treated malaria nets Number Value 0.00 700000.00 440000.00 purchased and/or distributed (number) Date 31-Dec-2012 31-Dec-2013 Comments Intermediate Results Indicators Page 2 of 6 The World Bank Report No: ISR13828 Indicator Name Core Unit of Measure Baseline Current End Target Number of sentinel sites (CSS) reporting Text Value 194826 0.2 visits per capita per year complete and timely data (to be specified) Date 12-Apr-2008 28-Dec-2012 30-Dec-2013 Public Disclosure Copy Comments In 2009 based on the carte (estimations rapports DDS, sanitaire of 2011. 2012 =0.625 visites par an) Number of DDS/CSS who submitted a costed Text Value 65% (PEV) 84 70% annual work plan according to the guidelines Date 12-Apr-2008 30-Oct-2012 30-Dec-2013 by the deadline. Comments PEV (janv-oct, 2012) Children receiving a dose of vitamin A (%) Percentage Value 66.00 78.00 70.00 Date 30-Oct-2012 30-Dec-2013 Comments (PEV) PEV (janv-Oct 2012) Percentage births attended by skilled health Percentage Value 86.00 93.60 90.00 personnel Date 31-Dec-2012 31-Dec-2013 Comments (DHS 2005) (DHS, 2011/2012) Pregnant women receiving ART Number Value Date Comments This is the text for the When this indicator was indicator and the results are introduced, the health center under the 3 cities below. assessment wasn't done. So when the Health Center were finally contracted thru PBF the team realized that not all the Health Centers could offer this service which explains the low results in the 3 departmentswhere PBF is being piloted. Niari Number Value 3.00 10.00 55.00 Sub Type Date 31-Dec-2009 31-Dec-2012 30-Dec-2013 Public Disclosure Copy Breakdown Comments (SEP/CNLS,2009) 10 (SEP/CNLS) Pool Number Value 6.00 6.00 61.00 Sub Type Date 30-Dec-2009 31-Dec-2012 31-Dec-2013 Breakdown Comments (SEP/CNLS) (SEP/CNLS) Plateaux Number Value 11.00 6.00 50.00 Sub Type Date 30-Dec-2009 31-Dec-2012 31-Dec-2013 Breakdown Comments (SEP/CNLS, 2009) (SEP/CNLS) Page 3 of 6 The World Bank Report No: ISR13828 Number of persons tested of HIV (Niari, Pool et Number Value Plateaux) Date Comments This is the text for the When this indicator was Public Disclosure Copy indicator and the results are introduced, the health center under the 3 cities below. assessment wasn't done. So when the Health Center were finally contracted thru PBF the team realized that not all the Health Centers could offer this service which explains the low results in these departmentswhere PBF is being piloted. Niari Number Value 3500.00 1338.00 3800.00 Sub Type Date 31-Dec-2009 31-Dec-2012 31-Dec-2013 Breakdown Comments (SEP/CNLS,2009) (AEP/CNLS) Pool Number Value 2611.00 2176.00 3000.00 Sub Type Date 31-Dec-2009 31-Dec-2012 31-Dec-2013 Breakdown Comments 2176 (SEP/CNL) Plateaux Number Value 3827.00 907.00 3900.00 Sub Type Date 31-Dec-2009 31-Dec-2012 31-Dec-2013 Breakdown Comments (SEP/CNLS) Number of persons under treatment Number Value Date Comments This is the text for the indicator and the results are under the 3 cities below. Niari Number Value 553.00 1287.00 798.00 Sub Type Date 31-Dec-2009 31-Dec-2012 31-Dec-2013 Public Disclosure Copy Breakdown Comments (SEP/CNLS, 2009) 1287 (SEP/CNLS) Pool Number Value 146.00 187.00 250.00 Sub Type Date 31-Dec-2009 31-Dec-2012 31-Dec-2013 Breakdown Comments ((SEP/CNLS, 2009) 187 (SEP/CNLS) Plateau Number Value 13.00 197.00 275.00 Sub Type Date 31-Dec-2009 31-Dec-2012 31-Dec-2013 Breakdown Comments 197 (SEP/CNLS) Data on Financial Performance (as of 12-May-2014) Page 4 of 6 The World Bank Report No: ISR13828 Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P106851 IDA-H3930 Effective 29-May-2008 18-Jul-2008 02-Feb-2009 29-May-2012 30-Jun-2014 Public Disclosure Copy Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P106851 IDA-H3930 Effective XDR 24.30 24.30 0.00 23.84 0.46 98.00 Disbursement Graph Key Decisions Regarding Implementation RESULTS. Under the original project structure and restructuring, the project's results are as follows: Public Disclosure Copy Under the original project structure there were 11 PDO indicators. For almost all information was not collected due to weaknesses in the monitoring system and availability of data, and ability to measure the indicators. After restricting, the number of PDOs was reduced to three two out of three targets were met: PDO 1 (% children under five years of age who slept under an ITN the previous night): Against a target of 60%, the project achieved 80.9% as of June 2013. PDO 2 (Health facilities renovated and equipped (number): 22 vs. 32 target PDO 3 (Long lasting insecticide-treated malaria nets distributed (number): 700,000 vs. 400,000 target Several of the original (pre-restructuring) Intermediate Outcome Indicators’ targets were achieved: 1. Survey use of bed nets - 2 surveys in 6 departments: 2 surveys completed in 2013 Page 5 of 6 The World Bank Report No: ISR13828 2. Survey Household health (mini DHS): completed in May 2012 3. Health Facility Survey: final report provided in March 2013 4. Survey health status indigenous population OP 4.10: Report completed and disseminated in 2013 5. Payments made to PBF pilot health facilities in 3 departments: 60% vs. 90% target Public Disclosure Copy 6. Develop a national strategy for operational research and carry out 3 research studies: Not achieved All of the current (post-restructuring) Intermediate Outcome Indicators’ targets are being met: 1. Number of outpatient consultations for children under five years of age): Against a target of 0.2 visits per capita per year, the project achieved 0.625 as of December 31, 2012. 2. % Children fully immunized for Penta3 (DTP, Hep. B, Hemovirus): Against a target of 70%, the project achieved 82% of October 2013. 3. Children receiving a dose of vitamin A (%)): Against a target of 70%, the project achieved 78% as of October 2012. 4. Percent births attended by skilled health personnel): 93.6% in 2012 (DHS) against a target of 90%. 5. Number of persons tested of HIV: Against a target of 10,700, the project has achieved 35,556. 6. Pregnant women receiving ART: Against a target of 1,699, the project has achieved 166. DISBURSEMENTS: Disbursement is at 96.2%, it is expected that the project will disburse 100% of the grant as well as deliver on its targets by the closing date. FINAL REPORTING: The lessons learned from the operation will be further explored and developed in the ICR. A mission to the Republic of Congo to conduct activities related to the preparation of the ICR (stakeholder workshops, data collection and analysis, etc.) will be conducted from June 20-July 5, 2014. The Government has already hired a consultant to conduct the Government evaluation of the project. Restructuring History CD Decision on 02-Mar-2012, Level 2 CD Decision on 17-Dec-2013, Level 2 CD Decision on 13-Feb-2014 Related Projects There are no related projects. Public Disclosure Copy Page 6 of 6