The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) Kyrgyz Second Health and Social Protection Project (P126278) EUROPE AND CENTRAL ASIA | Kyrgyz Republic | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2013 | Seq No: 14 | ARCHIVED on 13-Jun-2019 | ISR37055 | Implementing Agencies: Kyrgyz Republic, Ministry of Health, Ministry of Labor and Social Development Key Dates Key Project Dates Bank Approval Date: 03-May-2013 Effectiveness Date: 11-Jul-2014 Planned Mid Term Review Date: 20-Jun-2016 Actual Mid-Term Review Date: 15-Jun-2016 Original Closing Date: 31-Dec-2018 Revised Closing Date: 31-Dec-2019 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed PDO is to: (i) improve health outcomes in four health priority areas in support of the “Den Sooluk” National Health Reform Program 2012-2016; and (ii) enable the Government's efforts to enhance effectiveness and targeting performance of social assistance and services Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) The proposed new PDO is to contribute to improving delivery of quality maternal and child health care services within the “Den Sooluk” National Health Reform Program. Components Table Name Component 1 – Strengthening the delivery of quality MCH care services within eh "Den Sooluk" National Health Reform Program:(Cost $13.50 M) Component 2 – Strenghtening Health System within teh "Den Sooluk" National Health Reform Program:(Cost $3.00 M) Component 3: Contingency Emergency Response (no funds allocated) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions 6/13/2019 Page 1 of 7 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) Progress toward achievement of PDO remains as Satisfactory. All five PDO indicators have been over-achieved compared to the end-of- Project target of December 2018, before the extension of the closing date. Specifically, the estimated percentage of normal deliveries in rayon hospitals following clinical protocol was averaged at 91.6%, against the end target of 58% for 2018. For complicated deliveries, the estimate was 68.3%, against the end target of 43%. Nearly 937,000 births were attended by a skilled professional by the end of 2018, compared to the target of 916,000. The proportion of children under 5 with diarrhea being treated with oral rehydration therapy reached 82%, against the target of 80%. Finally, the share of government expenditure for health in 2018 has been confirmed at 13.1%, against the yearly target of 13%. Implementation progress remains as moderately satisfactory. The MoH has filled the position of Head of the Procurement Department of the MoH. There was some delay in procurement implementation, such as those related to medical equipment and database integration and automated report generation. This was largely due to the delay by the MoF to make the funding available to the MoH . Further delay in making funding available to the health sector will jeopardize the completion of the remaining packages under the SWAp, although at this stage most of them will be financed by KfW parallel financing. Project closing: The Closing Date of the project was extended to December 31, 2019 (first extension) to allow for full implementation of several key procurement packages, most importantly the development of a master plan (TA-81). Based on the status of the master plan package, it is expected that all activities will be completed before December 31, 2019. The last implementation support review is planned for November 2019 and will include the participation of the ICR author. Risks 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 -- High High Technical Design of Project or Program -- High High Institutional Capacity for Implementation and Sustainability -- High High Fiduciary -- High High Environment and Social -- Low Low Stakeholders -- Substantial Substantial Other -- Substantial Substantial Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes To contribute to improving delivery of quality maternal and child health care services. IN00702176 ►Proportion of normal deliveries in district (rayon) hospitals that received services following clinical protocols (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.70 91.70 91.60 58.00 6/13/2019 Page 2 of 7 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) Date 01-Jul-2014 19-Oct-2018 31-Dec-2018 31-Dec-2018 IN00702177 ►Proportion of complicated deliveries in district (rayon) hospitals that received services following clinical protocols (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.50 66.50 68.30 43.00 Date 01-Jul-2014 19-Oct-2018 31-Dec-2018 31-Dec-2018 IN00702178 ►Births (deliveries) attended by skilled health personnel (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 150,000.00 777,224.00 936,943.00 916,000.00 Date 31-Dec-2013 18-May-2018 31-Dec-2018 31-Dec-2018 IN00702179 ►Diarrhea treatment with oral rehydration therapy (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 77.00 82.10 81.90 80.00 Date 31-Dec-2013 18-May-2018 31-Dec-2018 31-Dec-2018 IN00702180 ►Government health expenditure as % of total government expenditure (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 13.70 13.00 13.10 13.00 Date 31-Dec-2013 18-May-2018 31-Dec-2018 31-Dec-2018 Intermediate Results Indicators by Components Component 1. Strengthening the delivery of quality MCH care services within "Den Sooluk" National IN00702181 ►Number of facilities adequately equipped to provide emergency obstetric and neonatal care (cumulative) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 10.00 10.00 Date 31-Dec-2013 18-May-2018 31-Dec-2018 31-Dec-2019 Number of oblast hospital maternity wards and city perinatal centers having the full set of basic equipment required to provide emergency obstetric care. Comments: The achievement is partial because one out of four lots is still being retendered. However, all 10 hospitals have received equipments from the other lots. IN00702183 ►Number of pregnant women receiving any antenatal care (Number, Custom) 6/13/2019 Page 3 of 7 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) Baseline Actual (Previous) Actual (Current) End Target Value 148,000.00 766,019.00 919,415.00 909,000.00 Date 31-Dec-2013 18-May-2018 31-Dec-2018 31-Dec-2019 IN00702185 ►Number of providers trained in postnatal and postabortal IUD insertion and removal (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 355.00 435.00 200.00 Date 31-Dec-2013 19-Oct-2018 31-Dec-2018 31-Dec-2019 IN00702187 ►Children immunized (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 135,000.00 850,940.00 850,940.00 837,000.00 Date 31-Dec-2013 19-Oct-2018 31-Dec-2018 31-Dec-2019 IN00702190 Children immunized - under 12 months against DTP3 (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 135,000.00 847,573.00 838,848.00 837,000.00 Date 31-Dec-2012 19-Oct-2018 31-Dec-2018 31-Dec-2019 IN00702192 Children immunized - under 12 months against Polio (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 135,000.00 850,940.00 838,646.00 837,000.00 Date 31-Dec-2013 19-Oct-2018 31-Dec-2018 31-Dec-2019 IN00702193 ►Number of children treated with ORS for diarrhea or with antibiotic for pneumonia (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 53,000.00 134,145.00 163,897.00 177,000.00 Date 31-Dec-2013 18-May-2018 31-Dec-2018 31-Dec-2019 the target was set unrealistically high based on a wrong baseline value, recorded at 53,000 instead of the correct value of 33,000. Therefore, this indicator can be considered achieved in 2018 even though the Comments: actual number is slightly lower than the target (163,897 versus 177,000 respectively). Component 2. Strenghtening Health System within the "Den Sooluk" National Health Reform Program IN00702182 ►Proportion of HIV infected pregnant women that received antiretroviral drugs to reduce risk of mother-to-child transmission (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/13/2019 Page 4 of 7 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) Value 96.10 100.00 97.70 95.00 Date 31-Dec-2013 19-Oct-2018 31-Dec-2018 31-Dec-2019 IN00702184 ►Number of family doctors, feldshers, TB doctors and nurses trained on TB clinical protocols and guidelines (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 6,039.00 8,830.00 3,300.00 Date 31-Dec-2013 19-Oct-2018 31-Dec-2018 31-Dec-2019 IN00702186 ►Number of family doctors, feldshers and nurses trained on CVD (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3,194.00 4,451.00 4,500.00 Date 31-Dec-2013 19-Oct-2018 31-Dec-2018 31-Dec-2019 IN00702188 ►Percentage of negative deviations of the executed health budget from the initially approved budget and quarterly allocations and execution of the health budget (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 4.65 4.40 5.00 Date 31-Dec-2012 18-May-2018 31-Dec-2018 31-Dec-2019 IN00702189 ►Submission of IFRs satisfactory to IDA within due dates according to Financing Agreement (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 31-Dec-2012 19-Oct-2018 31-Dec-2018 31-Dec-2019 IN00702191 ►Proportion of electronically registered families with children receiving social assistance (MBPF) who are electronically registered (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 100.00 Date 31-Dec-2013 19-Oct-2018 31-Dec-2018 31-Dec-2019 IN00702194 ►Number of districts where the Social Registry Information System has been fully rolled out (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 54.00 54.00 54.00 Date 31-Dec-2013 19-Oct-2018 31-Dec-2018 31-Dec-2019 Comments: The last of the remote districts was connected on-line to the new MIS system, reaching the target of connecting all the districts in the country. the total number of districts is reduced from 57 to 54 due to recent administrative consolidation.The work on fully paperless operation is ongoing. 6/13/2019 Page 5 of 7 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) IN00702195 ►Roadmap to reform disability service developed (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 31-Dec-2012 19-Oct-2018 31-Dec-2018 31-Dec-2019 Roadmap on the optimization of the system of disability assessment and rehabilitation of people with disabilties has been prepared, agreed with key stakeholders and is pending review and endorsement by Comments: MLSD. IN00702196 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,617,892.00 1,921,207.00 1,816,000.00 Date 31-Dec-2013 19-Oct-2018 31-Dec-2018 31-Dec-2019 This indicator is the sum of two sub CRIs: (1) number of children immunized; and (2) number of births delivered by a skilled health personnel. The number of children immunized (children under 5) was not included in the original result framework. Other Corporate Result Indicators are not supported by the Comments: project. IN00702197 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 840,668.00 984,264.00 900,000.00 Date 31-Dec-2013 19-Oct-2018 31-Dec-2018 31-Dec-2019 IN00702198 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 777,224.00 936,943.00 916,000.00 Date 31-Dec-2013 19-Oct-2018 31-Dec-2018 31-Dec-2019 Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P126278 IDA-52350 Effective USD 9.07 9.07 0.00 7.81 0.44 95% 6/13/2019 Page 6 of 7 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) P126278 IDA-H8390 Closed USD 7.43 7.43 0.00 6.85 0.00 100% P126278 TF-15135 Closed USD 11.96 11.96 0.00 11.96 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P126278 IDA-52350 Effective 03-May-2013 16-Dec-2013 11-Jul-2014 31-Dec-2018 31-Dec-2019 P126278 IDA-H8390 Closed 03-May-2013 16-Dec-2013 11-Jul-2014 31-Dec-2018 31-Dec-2018 P126278 TF-15135 Closed 05-Feb-2014 28-May-2014 11-Jul-2014 30-Jun-2016 31-Dec-2018 Cumulative Disbursements Restructuring History Level 2 Approved on 16-Nov-2015 ,Level 1 Approved on 07-Mar-2017 ,Level 2 Approved on 07-Apr-2017 ,Level 2 Approved on 17-Sep-2018 Related Project(s) There are no related projects. 6/13/2019 Page 7 of 7