@ The World Bank Report No: ISR5828 Implementation Status & Results Congo, Republic of Health Sector Services Development (P106851) o 0 C Operation Name: Health Sector Services Development (P106851) Project Stage: Implementation Seq.No: 9 Status: ARCHIVED Archive Date: 05-Nov-2011 Country: Congo, Republic of Approval FY: 2008 6 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan 0 .U) Implementing Agency(ies): MEPSA O 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 05-Nov-201 1 Effectiveness Date 02-Feb-2009 Revised Closing Date 29-May-2012 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 (Componentl); 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 participationlindigenous peoples and equity (Component 4). Has the Project Development Objective been changed since Board Approval of the Project? Q Yes ® No Component(s) Component Name Component Cost Component 1: Strengthening leadership capacities in managing a functioning and decentralized 10.20 health system. Component 2: Institution of an efficient and effective system for managing health sector human 0.80 0a resources 0 U Component 3: Rehabilitation and equipment of health facilities 2.30 ' Component 4: Improvement of access to a package of quality essential health services 23.90 0 P RuOverall Ratings Previous Rating Current Rating -Q Progress towards achievement of PDO Moderately Unsatisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Page 1 of 6 ) The World Bank Report No: ISR5828 Implementation Status Overview The June 2011 project midterm review provided an opportunity to carry out a candid assessment of the implementation status and to agree upon a set of benchmarks to be met and on a series of activities to be implemented within the coming months the majority of which have been accomplished. Project implementation has progressed and disbursement is now at 48% from 15% in March 2011 and 6% in November 2010. Thus the project has essentially disbursed almost half of the funds in one year. Disbursement has been on high impact o activities such as procurement and distribution of bed nets, the provision of medical equipment for health centers and the support to the ongoing DHS. It is expected to continue a progressing during the next 3 months as some new important activities such as the PBF pilot are being launched. Key project inputs, such as Long Lasting Insecticide-treated bed b nets had suffered initial delays due to poor planning -and lack of experience in mass distribution, but have now been completed in 6 departments. The contract with MACRO o International to carry out a Demographic and Health Survey (DHS) has been signed and data collection is currently being carried out with a preliminary report to be completed in 0 February 2012. The hiring of a health services purchasing agent, of a monitoring agency and of a training agent to implement a large Performance-Based Financing (PBF) pilot has F been completed with contracts signed.. The project has also completed a census of health staff and data are being analyzed. A large UNFPA designed survey on obstetrical and .0 neonatal care is also planned but implementation has been delayed because of last minute contract modifications required by UNFPA . The project continues to receive full support -Q of the Cabinet.. In addition the Ministry is currently revising its National Health Plan (2011-2014) and has began collecting data to complete a "carte sanitaire" ( health facilities map) 0- World Bank follow-up supervision missions took place in July and September 2011 and December 2011. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target % of caretakers of children under 5 Text Value Not available NA experiencing illness in the previous 2 weeks Date 12-Apr-2008 15-Jun-2010 29-May-2012 reporting cost as a barrier to seeking facility- rei cot alComments No baseline. Need DHS or NA. Need DHS or MICS (DHS Moving target based caref j CS(S 0) MICS (DHS in 2011) planned for 2011-2012) % of children under 5 years of age who slept Text Value 6% 60% under an ITN the previous night Date 12-Apr-2008 01-Sep-2010 29-May-2012 Comments NA. Need community-based survey or DHS (2012 DHS). % of households owning 2 or more ITNs Text Value 4% 60% Date 12-Apr-2008 15-Jul-2011 29-May-2012 0 Comments NA. Likely to be less than 10%. To be checked after ,distribution in October 2011 o 0 % of births attended by skilled personnel Text Value 86% 90% O Date 12-Apr-2008 15-Jun-2011 29-May-2012 Comments NA Page 2 of 6 @ The World Bank Report No: ISR5828 % of facilities (by type) with HR according to Text Value 20% 50% norms (by type of personnel) Date 12-Apr-2008 15-Jul-2011 29-May-2012 Comments NA, baseline questionable. Immunization DPT3/Penta under-1 (number of Text Value 66% 90% 0 children per year) Date 12-Apr-2008 15-Jun-2010 29-May-2012 Comments Source: EPI unit. Update July J2 2011. Needs to be validated .LD by coverage survey o % of pregnant women HIV positive placed on Text Value 60% 60% ARV. Date 12-Apr-2008 15-Jul-2011 29-May-2012 Comments Source: PMTCT program. % children under five years of age with fever Text Value 15% 50% accessing an effective antimalarial within 24 Date 12-Apr-2008 15-Feb-2011 29-May-2012 hours of onset of symptoms Comments Not available and will not be available without 2012 DHS Number DDS who develop and submit Text Value 4 12 trimester report. Date 12-Apr-2008 15-Feb-2011 29-May-2012 Comments Source: MoH report. % CSI/CSS/DDS with staff trained in budgeting Text Value 20% 100% and planning Date 12-Apr-2008 15-Jul-2011 29-May-2012 Comments baseline seems very The MoH financial resources approximate and source is department unit trained the unknown DDS on budgeting and planning. % of DDS and facilities receiving their budget Text Value 0 100 in timely manner Date 15-Jul-2011 29-May-2012 Comments No baseline available. Budget received but with no relation to the real needs 0 O Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target 0 -Z Pregnant women living with HIV who received Number Value 0.00 72.00 80.00 U) antiretrovirals to reduce the risk of MTCT Date 12-Apr-2008 15-Jul-2011 29-May-2012 L) Comments Source: National HIV/AIDS program Control. Next update Nov 2011. Page 3 of 6 @ The World Bank Report No: ISR5828 Long-lasting insecticide-treated malaria nets Number Value 0.00 700000.00 2300000.00 purchased and/or distributed Date 12-Apr-2008 15-Feb-2011 29-May-2012 Comments Delays in payment and C. delivering. Distribution O o expected to take place May- June 2011, taking place in September-October 0 - Children receiving a dose of vitamin A Number Value 0.00 178992.00 0.00 Date 12-Apr-2008 15-Jun-2010 29-May-2012 Comments 0 Pregnant women receiving antenatal care Number Value 0.00 70.00 0.00 during a visit to a health provider Date 12-Apr-2008 15-Jun-2011 29-May-2012 Comments Source: Maternal health TTL to provide data after department report. Next MTR. update July 2011 no update Children immunized Number Value 0.00 89.20 0.00 Date 12-Apr-2008 15-Sep-2011 29-May-2012 Comments Source: EPI ( Expanded TTL to provide data after Program of Immunization) MTR. report. Most likely overestimated Health facilities constructed, renovated, and/or Number Value 0.00 0.00 0.00 equipped Date 12-Apr-2008 15-Jun-2010 29-May-2012 Comments The situation analysis has Data to be provided after been done in 44 health MTR. facilities. Report not yet completed. Number of DDS/CSS who submitted a costed Text Value 6 12 >1 annual work plan according to the guidelines Date 12-Apr-2008 30-Sep-2010 29-May-2012 o by the deadline. 0 Comments Source: MOH (DGS) report. Pharmaceuticals and medical equipment Text Value U procured (US$) -Z- Baseline, progress and target data to be input SB rtComments NA. Progress and target date Source: National Health Sin next ISR to be provided with next ISR Budget. Gov. gave an amount of US$20 mil. for ART and essential drugs. This category of drugs is free provided to PLWA ( ART), Page 4 of 6 The World Bank Report No: ISR5828 pregnant women and children under five years old ( malaria drugs). The government gave an amount of twenty million 0 dollars for ART and essential drugs. This categoryof drugs is free provide to PLWA 0 (ART), pregnant women and children under five years old ( malaria drugs) 5 Number of facilities offering VCT. Text Value 66 85 Date 12-Apr-2008 15-Sep-2011 29-May-2012 Comments Source: National HIV/AIDS Control Program % pregnant women receiving 2 doses of IPT Text Value 3.1% 50% Date 12-Apr-2008 30-Sep-2010 29-May-2012 Comments Number of sentinel sites (CSS) reporting Text Value 0 6 complete and timely data (to be specified) Date 12-Apr-2008 01-Sep-2011 29-May-2012 Comments Not yet available. Data on Financial Performance (as of 15-Feb-2012) Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P106851 IDA-H3930 Effective 29-May-2008 18-Jul-2008 02-Feb-2009 29-May-20 12 Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P106851 IDA-H3930 Effective XDR 24.30 24.30 0.00 12.16 12.14 50.00 0 U) Disbursement Graph 0 0 .U 0 Page 5 of 6 The World Bank Report No: ISR5828 - Original ---- Formally Revised -- Actual 25- 0 20-I .U) 0) 0 --- - - - - - - - - - - - - - - - ---- - - - - - - - - - - - - - - - E Key Decisions Regarding Implementation World Bank country and sector management will continue to monitor implementation very closely. The Bank task team is pleased with the progress achieved since the Mid Term Review and will continue to support implementation through monthly visits and regular dialogue with the government in Brazzaville. Finally, the Ministry will ensure that key activities with a direct impact on population's health will be implemented, and in particular the mass distribution of bed nets and an increase in vaccination coverage. Restructuring History There has been no restructuring to date. Related Projects 00 Theeaae-n rlatd-pojets Page 6 of 6