The World Bank Implementation Status & Results Report CG Rep. Health Sector Project (P143849) CG Rep. Health Sector Project (P143849) AFRICA | Congo, Republic of | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2014 | Seq No: 10 | ARCHIVED on 30-May-2019 | ISR34338 | Implementing Agencies: Ministry of Finance, Ministry of Health and Populaton Key Dates Key Project Dates Bank Approval Date: 20-Dec-2013 Effectiveness Date: 21-Jan-2015 Planned Mid Term Review Date: 03-Jul-2017 Actual Mid-Term Review Date: 23-Jan-2017 Original Closing Date: 28-Jun-2019 Revised Closing Date: 28-Jun-2019 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The project development objective is to increase utilization and quality of maternal and child health services in targeted areas. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Improvement of utilization and quality of health services at health facilities through Performance-Based Financing (PBF ).:(Cost $53.75 M) Component 2: Strengthening Health Financing and Health Policy Capabilities.:(Cost $6.25 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions Project activities have been stopped end April 2018. A new health project is in preparation. Risks 6/14/2019 Page 1 of 7 The World Bank Implementation Status & Results Report CG Rep. Health Sector Project (P143849) Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial Substantial Macroeconomic -- Substantial Substantial Sector Strategies and Policies -- Moderate Moderate Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and Sustainability -- Substantial Substantial Fiduciary -- Substantial Substantial Environment and Social -- Moderate Moderate Stakeholders -- Low Low Other -- Substantial Substantial Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes Improvement of utilization and quality of Maternal and Child health services in targeted areas IN00579607 ►Percentage of children aged between 6 and 59 months receiving nutritional services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 15.00 20.50 23.00 45.00 Date 30-Jun-2014 29-Dec-2017 30-Apr-2018 28-Jun-2019 Reported coverage based on actual coverage achieved in targeted areas (48% of the population). Actual baseline is 10% at the onset which set the end of project target at April 2018 to be 35%. Actual achievement is 23%, which is 130% increase from the revised baseline. Comments: N.B. Baseline and end of project targets were not revised due to inability to restructure the project as explained in other parts of the ISR. IN00579616 ►New Curative Consultation per Capital per year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 24.00 27.00 35.00 Date 30-Jun-2014 29-Dec-2017 30-Apr-2018 28-Jun-2019 Actual verified and validated quantities translated into population coverage using national population data from the MOH/HMIS, adjusted each year with official growth figures. The target is 1 curative consultation Comments: per person per year (=100%) Baseline was set at 20% whereas actual baseline was 14% in January 2016. End of project target by April should be revised to 29%. Actual is 27% at end of project. 6/14/2019 Page 2 of 7 The World Bank Implementation Status & Results Report CG Rep. Health Sector Project (P143849) N.B. Baseline and end of project targets were not revised due to inability to restructure the project as explained in other parts of the ISR. IN00579608 ►Average Score of the quality checklist (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 28.00 64.80 69.70 63.00 Date 31-Dec-2015 29-Dec-2017 30-Apr-2018 28-Jun-2019 This quantified quality checklist is applied once per quarter by the district health team. The checklist is comprehensive and contains over 150 data elements, mostly structural quality indicators, although there Comments: are also content of care indicators related to observations. The data are counter-verified using a systematic random sampling methodology through a third party agency. IN00579606 ►Percentage of pregnant women having at least 3 antenatal care visits before delivery (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 67.70 78.20 80.00 Date 30-Jun-2014 29-Dec-2017 30-Apr-2018 28-Jun-2019 Data relate to results achieved in targeted areas (48% population coverage) Baseline was set at 50% whereas actual baseline in targeted areas in January 2016 was 31%. End of project target should have been revised to 39.6%. Actual achievement is 78.2%. Comments: N.B. Baseline and end of project targets were not revised due to inability to restructure the project as explained in other parts of the ISR. IN00579614 ►Children immunized (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 70,284.00 89,118.00 112,358.00 330,308.00 Date 30-Jun-2014 29-Dec-2017 30-Apr-2018 28-Jun-2019 Results drawn from targeted areas (48% population) whereas targets were set for 86% population coverage. Baseline for volume converts to 81% coverage for Fully Immunized Children (for 48% population). Actual baseline found in January 2016 was 54.3% in targeted areas which translates to 41,370 child. End of Comments: project target should have been revised to 109,850 child. Actual immunized children is 106,238 child. N.B. Baseline and end of project targets were not revised due to inability to restructure the project as explained in other parts of the ISR. Overall Comments PDO Nota bene 1: it is important to realize that the end targets refer to the end targets for a full-blown $120M program to cover 86% of the ROC population. Instead it ended up as a $40 million project covering 48% of the population. The end targets were pending revision during the planned (and now cancelled) additional financing of $20 million, which would have been a combined AF/Restructuring. Nota bene 2: all 'actual results' refer to data up to end April 2018 6/14/2019 Page 3 of 7 The World Bank Implementation Status & Results Report CG Rep. Health Sector Project (P143849) Intermediate Results Indicators by Components Component 1: Improvement of utilization and quality of health services at health facilities through Performance-Based Financing (PBF ). IN00579609 ►Number of new and existing acceptors of modern contraceptive use (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 31,600.00 72,581.00 96,615.00 218,000.00 Date 30-Jun-2014 29-Dec-2017 30-Apr-2018 28-Jun-2019 Baseline and targets set for 86% population coverage (quantities). Results reported refer to targeted Comments: areas only (48% coverage). IN00579615 ►Direct project beneficiaries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 200,000.00 1,981,339.00 3,146,829.00 2,000,000.00 Date 30-Jun-2014 29-Dec-2017 30-Apr-2018 28-Jun-2019 This indicator was reported using a tally of all services purchased through the project, from contracted health centers/community and first level referral hospitals. This consists of the basic package of health services (PMA) and the complementary package of health services (PCA). These are not equal to unique Comments: beneficiaries, as some data points might have been received by the same patient. In essence, this indicator is different from the one under the CRI, which counts unique individuals, and only certain services (immunizations; nutritional services and institutional deliveries). IN00579617 Female beneficiaries (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 100,000.00 1,476,136.00 2,024,583.00 1,000,000.00 IN00579611 ►Percentage of women counseled and tested for HIV (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 22.00 76.70 86.90 30.00 Date 30-Jun-2014 29-Dec-2017 30-Apr-2018 28-Jun-2019 Results drawn from targeted areas (48% population coverage) Baseline set at 22%, actual coverage in January 2016 was 16.3% Comments: IN00579610 ►Percentage of pregnant women who received two doses of IPT (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/14/2019 Page 4 of 7 The World Bank Implementation Status & Results Report CG Rep. Health Sector Project (P143849) Value 15.00 53.60 62.60 30.00 Date 30-Jun-2014 29-Dec-2017 30-Apr-2018 28-Jun-2019 Results drawn from targeted areas (48% population coverage). Comments: Baseline set at 15%, actual coverage in January 2016 was 30.3% IN00651263 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 1,199,715.00 1,199,715.00 Date 30-Jun-2014 -- 30-Apr-2018 30-Jun-2019 IN00651264 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 112,358.00 112,358.00 Date 30-Jun-2014 -- 30-Apr-2018 30-Jun-2019 IN00651265 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 976,312.00 976,312.00 Date 30-Jun-2014 -- 30-Apr-2018 30-Jun-2019 IN00651331 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 111,045.00 114,045.00 Date 30-Jun-2014 -- 30-Apr-2018 30-Jun-2019 Component 2: Strengthening Health Financing and Health Policy Capabilities. IN00579613 ►Health personnel receiving training (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,365.00 2,523.00 1,600.00 Date 26-Jun-2014 29-Dec-2017 30-Apr-2018 28-Jun-2019 IN00579612 ►Number of poor people benefiting from fee exemption mechanisms (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 25,327.00 51,905.00 850,000.00 Date 31-Dec-2015 29-Dec-2017 30-Apr-2018 28-Jun-2019 6/14/2019 Page 5 of 7 The World Bank Implementation Status & Results Report CG Rep. Health Sector Project (P143849) Overall Comments IR Nota bene 1: it is important to realize that the end targets refer to the end targets for a full-blown $120M program to cover 86% of the ROC population. Instead it ended up as a $40 million project covering 48% of the population. The end targets were pending revision during the planned (and now cancelled) additional financing of $20 million, which would have been a combined AF/Restructuring. Nota bene 2: all 'actual results' refer to data up to end April 2018 Nota bene 3: The component for exemption the poorest of the poor took longer than expected to implement. The project benefited from sustained collaboration with the Social Protection Project LISUNGI. Both project used common targeting mechanisms, and therefore the Health project contributed importantly to the national database for indigents (with over 45,000 households coming from the health project). Unfortunately, due to delays in implementation, and the premature stop of the project due to lack of counterpart funding, results were not as envisaged. Important upward trends for health care utilization were noted though. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P143849 IDA-53570 Effective USD 10.00 10.00 0.00 9.36 0.00 100% P143849 TF-15744 Effective USD 10.00 10.00 0.00 10.00 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P143849 IDA-53570 Effective 20-Dec-2013 19-Feb-2014 21-Jan-2015 28-Jun-2019 28-Jun-2019 P143849 TF-15744 Effective 19-Feb-2014 19-Feb-2014 21-Jan-2015 28-Jun-2019 28-Jun-2019 Cumulative Disbursements 6/14/2019 Page 6 of 7 The World Bank Implementation Status & Results Report CG Rep. Health Sector Project (P143849) Restructuring History Level 2 Approved on 29-May-2017 ,Level 2 Approved on 20-Mar-2018 Related Project(s) There are no related projects. 6/14/2019 Page 7 of 7