The World Bank Report No: ISR8636 Implementation Status & Results Tajikistan Community & Basic Health Project (P078978) Public Disclosure Copy Operation Name: Community & Basic Health Project (P078978) Project Stage: Implementation Seq.No: 14 Status: APPROVED Last Modified Date: 10-Dec-2012 Country: Tajikistan Approval FY: 2006 Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 15-Dec-2005 Original Closing Date 31-Mar-2010 Planned Mid Term Review Date 10-Nov-2008 Last Archived ISR Date 16-Jul-2012 Effectiveness Date 18-Apr-2006 Revised Closing Date 31-Dec-2012 Actual Mid Term Review Date 07-Oct-2008 Project Development Objectives Community & Basic Health Project (P078978) Project Development Objective (from Project Appraisal Document) The PDO is to increase access to, utilization of, and patient satisfaction with health services in project-supported areas; and to build capacity and efficiency at national and oblast and rayon levels in administering the basic benefit package and per capita financing for primary health care. Has the Project Development Objective been changed since Board Approval of the Program? Yes No Component(s) Component Name Component Cost A. Strengthening Policy, Planning and Donor Coordination in MOH 1.50 Implementing Organizational and Financing Reforms in the Health Sector 4.50 Strengthening Primary Health Care in Selected Rayons 10.20 Project Coordination and Capacity Building for Implementation 1.06 Public Disclosure Copy Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Implementation Status Overview The project is in the final month of implementation and all project activities are either completed or will be completed prior to the closing date of December 31, 2012. Project disbursement has reached 93%, and the remaining funds are committed, waiting for payments to be made within the four months grace period till end April 2013. Due to the Page 1 of 7 The World Bank Report No: ISR8636 exchange rate changes, the project is expected to gain 3% (US$94,861), making the total grant amount reaching US$3,094,861. The proposed plan is to use the extra 3% for project management, including payments for moving the PIU office to the MOH premises and for printing of health facility management manuals and related documents for health workers in the project districts. Progress towards achievements of PDO is assessed as Moderately Satisfactory, and the overall implementation of the project is rated Satisfactory. Public Disclosure Copy Locations Country First Administrative Division Location Planned Actual Tajikistan Not Entered Republic of Tajikistan Tajikistan Viloyati Sughd Viloyati Sughd Tajikistan Viloyati Khatlon Viloyati Khatlon Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Percent of total PHC expenditure paid by Text Value Soghd: 0% Sughd: average 3.8% & range 100% in 2 districts in Sogd capitation in project supported oblasts Khatlon: 0% is 1% to 19.6% Oblast Khatlon: average 4.4% & range is 2.2% to 9.3% Date 12-Jun-2006 30-Nov-2012 31-Dec-2012 Comments Partially achieved Number of visits to PHC facilities per capita per Text Value Rayons (2006) Asht Rayons (2011) Number of total visits year in project supported rayons 1.85 Spitamen 2.26 Asht: 4.0; Spitamen: 4.5; increases by 50% compared Kabodiyan 3.77 Nurek Kabodiyan: 1.4; Nurek: 3.9; to baseline 1.52 Sarband 3.96 Sarband: 6.2; Shurabad: 6.2; Shurobod 4.95 Timur Malik: 3.9 Date 12-Jun-2006 30-Nov-2012 31-Dec-2012 Comments Achieved. Data for 2012 not yet available will be updated for the ICR in 2013. Public Disclosure Copy Share of health in household expenditure Text Value Baseline, 2003 TLSS -- Sughd: 4.8% 6% (overall and by household wealth quintiles) in Tajikistan 9% Khatlon: 3.1% project-supported oblasts as measured by Date 12-Jun-2006 30-Nov-2012 31-Dec-2012 household surveys. Comments Baseline data from CBHP Target met based on last Target set in CBHP PAD (Nov PAD (November, 2005) available data from TLSS 2005) 2007, recent data not available Partially achieved Page 2 of 7 The World Bank Report No: ISR8636 Percentage of households in project supported Text Value Baseline, 2003 TLSS 31.8% 47% oblasts who don't seek health care when Tajikistan: 57%, Sughd 19% necessary because they cannot afford it, as and Khatlon 13% measured by household surveys. Public Disclosure Copy Date 12-Jun-2006 30-Nov-2012 31-Dec-2012 Comments Baseline data from CBHP Partially Achieved- based on Target set in CBHP PAD (Nov PAD (November, 2005) survey of pilot districts only in 2005) 2010. More recent data not available. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Number of women who received nutrition Text Value Khatlon: 19.8% Sogd: 44.5% 80,000 80,000 women (50% of education and practice exclusive breastfeeding of women (2005 nutrition 160,000 targeted women) for first 6 months survey) Date 01-May-2008 30-Nov-2012 31-Dec-2010 Comments Achieved in 2009 Health personnel receiving training (number) Number Value 0.00 1123.00 1074.00 Date 01-Jun-2006 30-Nov-2012 31-Dec-2012 Comments Target exceeded. As of Cumulative: 290 Doctors and November, 2012 cumulative 833 Nurses trained in Family total 1123: 285 doctors and Medicine. CME training for 768 nurses, including 196 1058 Doctors and Nurses doctors and 515 nurses from 9 pilot rayons (CBHP); 64 doctors and 120 nurses (AF1); 30 doctors and 197 nurses (AF2) Family medicine training expanded to 2 more Text Value none 30 doctors and 197 nurses 184 staff trained in 2 rayons trained additional rayons under AF1; 252 staff trained in 3 addl rayons under AF2. Date 19-Aug-2009 30-Nov-2012 31-Dec-2012 Public Disclosure Copy Comments Achieved Number of hospital services departments in Text Value none 251 secondary health care 251 secondary health care rayons in project-supported oblasts equipped faciliities in 41 rayons faciliities in 41 rayons with furniture and computers, and with staff Date 01-Jun-2006 30-Nov-2012 31-Dec-2010 trained and actively performing managerial Comments Achieved in 2010 duties Page 3 of 7 The World Bank Report No: ISR8636 Number of PHC departments in rayons in Text Value none 52 facilities in 41 rayons 52 facilities in 41 rayons project-supported oblasts equipped with Date 01-Jun-2006 30-Nov-2012 31-Dec-2010 furniture and computers, and with staff trained Comments Achieved in 2010 and actively performing managerial duties Public Disclosure Copy Number of hospitals in project-supported Text Value none Spitamen- 3 hospitals Sogd Oblast: All hospitals in rayons that have introduced BBP. Sarband-2 hospitals 18 rayons Khatlon Oblast: All hospitals in 2 rayons Date 01-Jun-2006 30-Nov-2012 31-Dec-2012 Comments Partially Achieved. The further expansion of the BBP to other districts is currently on hold, according to the Decree of the Gov. Of the RT №579 from 3.12.2011 “On the approval of BBP for 2012-2013� Number of hospitals in project supported Text Value none 249 Not less than 210 facilities in oblasts that have introduced HMIS with trained the pilot rayons staff and commenced full utilization of a Health Date 01-Jun-2006 30-Nov-2012 31-Dec-2012 Management Information System Comments Achieved in 2010 Successful implementation of Phase 1 Action Text Value limited fiduciary capacity 80% of phase 1 action plan 100% implementation of Plan as outlined in the Health Sector Fiduciary implemented planned activities Capacity Assessment Report and ActivityPlan Date 19-Aug-2009 30-Nov-2012 31-Dec-2010 of AF PAD. Comments Partially achieved. Target not fully met. Number of PHC centers equipped with Text Value 0 67 67 communication system Date 19-Aug-2009 30-Nov-2012 31-Dec-2012 Comments Achieved Achieved Number of rayons where capitation payment Text Value 15 rayons 42 41 rayons for PHC is implemented Date 01-Jan-2009 30-Nov-2012 31-Dec-2010 Public Disclosure Copy Comments Achieved in 2010 Health Sector Masterplan developed and Text Value none Masterplan adopted by Master plan completed and adopted by Government Governmental resolution on approved by the MOH in April 1 2011 December, 2010 Date 19-Aug-2009 31-Dec-2010 31-Dec-2010 Comments Achieved in 2010 Page 4 of 7 The World Bank Report No: ISR8636 Human Resource Strategy developed Text Value none The final HR Plan was HR Plan developed and approved by the MOH in adopted December, 2010. Public Disclosure Copy Date 19-Aug-2009 30-Nov-2012 31-Dec-2010 Comments Achieved in 2010 Pregnant women receiving antenatal care Number Value 0.00 42229.00 4229.00 during a visit to a health provider (number) Date 15-Dec-2005 30-Nov-2012 31-Dec-2010 Comments Achieved in 2009 Health facilities constructed, renovated, and/or Number Value 0.00 65.00 65.00 equipped (number) Date 15-Dec-2005 30-Nov-2012 31-Dec-2012 Comments Achieved Achieved Number of PHC staff who received training on Text Value none 433 on rational nutrition 845 433 on rational nutrition 845 nutrition education and correct growth on monitoring conduct on monitoring conduct monitoring. Date 18-Aug-2008 30-Nov-2012 30-Jun-2009 Comments Achieved in 2009 Number of PHC centers provided with growth Text Value none 1195 1195 monitoring equipment. Date 18-Aug-2008 30-Nov-2012 30-Jun-2009 Comments Achieved in 2009 Number of pregnant women who received food Text Value none 50,000 women total each 50 000 women, each three packages. three times. Khatlon-30 000 times Sughd # 20 000 women, Sughd-20,000 women, each three times women Khatlon # 30 000 women, each three times Date 18-Aug-2008 30-Nov-2012 30-Jun-2009 Comments Achieved in 2009 Number of pregnant and breastfeeding women Text Value none 160,000 Total 160 000 who received at least one formal nutrition Date 18-Aug-2008 30-Nov-2012 30-Jun-2009 education session. Comments Achieved in 2009. Public Disclosure Copy Number of pregnant and breastfeeding women Text Value Khatlon:0 Soghd: 0 20 000 in Sughd 30 000 in 50,000 provided with prenatal vitamin complex and/or Khatlon iron-folate tablets. Date 18-Aug-2008 30-Nov-2012 30-Jun-2009 Comments Achieved in 2009 Number of post partum mothers who received Text Value Khatlon Oblast: 44.6% Soghd 70% 70% a high-dose vitamin A supplement before their Oblast: 46.5% infant reached 8 weeks of age. Date 18-Aug-2008 30-Nov-2012 30-Jun-2009 Comments Achieved in 2009 Page 5 of 7 The World Bank Report No: ISR8636 Holding of Biannual Sector Review Text Value 0 At least 3 round tables done Bi annual roundtables carried Roundtables. each year out Date 12-Jun-2006 30-Nov-2012 31-Dec-2010 Public Disclosure Copy Comments Achieved in 2010 Completion by Health Policy Analysis Unit of (i) Text Value 0 surveys completed. Health 3 major surveys done on BBP Surveys completed a baseline and two follow-up surveys on out of Policy Analysis Unit (HPAU) and NHA pocket payment and client satisfaction; and (ii) is not yet established. National Health Accounts. Date 12-Jun-2006 30-Nov-2012 31-Dec-2010 Comments Achieved. Data on Financial Performance (as of 03-Dec-2012) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P078978 IDA-H1950 Closed 15-Dec-2005 21-Feb-2006 18-Apr-2006 31-Mar-2010 31-Dec-2010 P078978 IDA-H4610 Closed 30-Apr-2009 22-May-2009 11-Aug-2009 31-Dec-2010 31-Dec-2010 P078978 IDA-H5860 Effective 01-Jul-2010 05-Aug-2010 03-Nov-2010 31-Dec-2012 31-Dec-2012 P078978 TF-56448 Closed 18-Apr-2006 18-Apr-2006 18-Apr-2006 31-Mar-2010 31-Mar-2010 P078978 TF-90142 Closed 24-Apr-2007 24-Apr-2007 24-Apr-2007 28-Feb-2010 28-Feb-2010 P078978 TF-92349 Closed 17-Jul-2008 17-Jul-2008 17-Jul-2008 31-Mar-2010 31-Mar-2010 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P078978 IDA-H1950 Closed USD 10.00 10.00 0.00 10.62 0.00 106.00 P078978 IDA-H4610 Closed USD 5.00 5.00 0.00 5.19 0.00 104.00 P078978 IDA-H5860 Effective USD 3.00 3.00 0.00 3.01 0.09 100.00 P078978 TF-56448 Closed USD 6.11 5.84 0.00 6.66 0.00 114.00 P078978 TF-90142 Closed USD 0.72 1.18 0.00 1.18 0.00 100.00 Public Disclosure Copy P078978 TF-92349 Closed USD 4.00 4.00 0.00 4.00 0.00 100.00 Disbursement Graph Page 6 of 7 The World Bank Report No: ISR8636 Public Disclosure Copy Key Decisions Regarding Implementation Not applicable. Restructuring History Board Approved on 30-Apr-2009, Level two Approved on 30-Aug-2010 Related Projects P112136-Community & Basic Health Addl Financing, P115801-Community and Basic Health Project - Additional Financing, P121811-Community & Basic Health Project Additional Financing - 2 Public Disclosure Copy Page 7 of 7