The World Bank Implementation Status & Results Report Ghana - Maternal, Child Health and Nutrition Project (P145792) Ghana - Maternal, Child Health and Nutrition Project (P145792) AFRICA | Ghana | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2014 | Seq No: 12 | ARCHIVED on 29-Dec-2019 | ISR39226 | Implementing Agencies: Ministry of Health, Republic of Ghana, GHANA HEALTH SERVICES, National Health Insurance Agency Key Dates Key Project Dates Bank Approval Date: 20-May-2014 Effectiveness Date: 12-Feb-2015 Planned Mid Term Review Date: 16-Mar-2018 Actual Mid-Term Review Date: 21-Mar-2018 Original Closing Date: 30-Jun-2020 Revised Closing Date: 30-Jun-2020 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The project development objective is to improve utilization of community-based health and nutrition services by women of reproductive age, especially pregnant women, and children under the age of 2 years. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1. Community-Based Maternal and Child Health and Nutrition Interventions:(Cost $62.00 M) Component 2: Institutional strengthening Capacity Building, Monitoring and Evaluation, and Project Management:(Cost $7.50 M) Component 3: Epidemic Preparedness and Control:(Cost $3.50 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Low Low Implementation Status and Key Decisions The Maternal and Child Health and Nutrition Improvement Project (MCHNP) (Cr No.4563-GH) started implementation in February 2015. The project is successfully revitalizing primary health and nutrition service delivery, based on progress on indicators of skilled birth attendance, antenatal care visits, postnatal care, IYCF visits and Vitamin A intake among children under five. The funds released have facilitated significant progress under each of the three components of the project. 12/29/2019 Page 1 of 10 The World Bank Implementation Status & Results Report Ghana - Maternal, Child Health and Nutrition Project (P145792) 12/29/2019 Page 2 of 10 The World Bank Implementation Status & Results Report Ghana - Maternal, Child Health and Nutrition Project (P145792) 12/29/2019 Page 3 of 10 The World Bank Implementation Status & Results Report Ghana - Maternal, Child Health and Nutrition Project (P145792) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Low Low Macroeconomic -- Low Low Sector Strategies and Policies -- Low Low Technical Design of Project or Program -- Low Low Institutional Capacity for Implementation and Sustainability -- Low Low Fiduciary -- Moderate Moderate Environment and Social -- Low Low Stakeholders -- Low Low Other -- -- -- Overall -- Low Low Results PDO Indicators by Objectives / Outcomes Improve utilization of community-based health and nutrition services IN00764337 ►Births (deliveries) attended by skilled health personnel (annual, cumulative) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,612,889.00 2,977,451.00 2,105,000.00 Date 28-Jun-2013 18-Apr-2019 30-Jun-2019 30-Jun-2020 IN00764338 Births attended by skilled health personnel at PHC level (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target 12/29/2019 Page 4 of 10 The World Bank Implementation Status & Results Report Ghana - Maternal, Child Health and Nutrition Project (P145792) Value 22.00 31.00 30.54 30.00 IN00764339 ►Pregnant women making the first antenatal visit before the fourth month of pregnancy at PHC level (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 184,372.00 241,257.00 1,056,520.00 1,104,955.00 Date 28-Jun-2013 18-Apr-2019 30-Jun-2019 30-Jun-2020 The previous result as of April 2019 was recorded as the annual result of 2018, while this indicator is measured by the cumulative number the cumulative number of women who make the first antenatal visit Comments: before the fourth month of pregnancy at the PHC level. IN00764340 Pregnant women making first antenatal visit in the first trimester at PHC level (percent at PHC level) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 43.00 53.00 53.11 52.00 IN00764371 ►Children under two receiving at least one CIYCF visit per month (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 287,862.00 950,233.00 1,381,545.00 Date 28-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 The previous result as of April 2019 was recorded as the annual result of 2018, while this indicator is measured by the cumulative number of children under two who receive at least one CIYCF visit per Comments: month. IN00764372 ►New female acceptors (15-49 years) of modern family planning methods (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 382,535.00 540,457.00 2,866,573.00 2,405,810.00 Date 28-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 The previous result as of April 2019 was recorded as the annual result of 2018, while this indicator is measured by the cumulative number of new female acceptors (15-49 years) of modern family planning Comments: methods at the PHC level. IN00764373 ►Women receiving post-natal care within 48 hours at PHC level (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 150,999.00 213,176.00 877,118.00 932,180.00 Date 28-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 The previous result as of April 2019 was recorded as the annual result of 2018, while this indicator is Comments: measured by the cumulative number of women receiving post-natal care within 48 hours at the PHC level. Overall Comments PDO 12/29/2019 Page 5 of 10 The World Bank Implementation Status & Results Report Ghana - Maternal, Child Health and Nutrition Project (P145792) Given that the project ends mid-year, the absolute number indicators have been adjusted to reflect cumulative count. This is to ensure that all results are accounted for at anytime and does not affect the targets set. To validate, the annual average must equal or exceed the start of project annual targets to be considered achieved. Results in percentages have however been retained for previous years as these are annually reported. Putting them half year distorts the trend. From this perspective, two out of five PDO indicators exceed the targets. Note that drop in deliveries was due to change in indicator to count only deliveries at the health center, maternity homes and CHPS zones. Until mid term it was counting across country to include hospitals that did not receive project funds. Intermediate Results Indicators by Components Component 1: Community-Based Maternal and Child Health and Nutrition Interventions IN00764377 ►Children under five years with diarrhea treated in the two weeks preceding the survey given ORT (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 62.00 62.00 65.65 67.00 Date 28-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 IN00764383 ►Children age 12 months to 23 months that are immunized measles 2 (PHC level) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 69.00 80.00 79.61 86.00 Date 28-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 IN00764385 ►Persons receiving essential package of PHC services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 9,529,025.00 11,612,450.00 50,329,658.00 50,000,000.00 Date 28-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 The previous result as of April 2019 was recorded as the annual result of 2018, while this indicator is Comments: measured by the cumulative number of out patients receiving services at the PHC level. IN00764386 ►Home visits conducted in the community (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 462,747.00 1,523,763.00 3,744,226.00 3,175,595.00 Date 28-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 The previous result was recorded as of April 2019, while this indicator is measured by the cumulative Comments: number of home visits conducted at CHPS level. IN00764387 ►Attendants with NHIS at PHC level (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/29/2019 Page 6 of 10 The World Bank Implementation Status & Results Report Ghana - Maternal, Child Health and Nutrition Project (P145792) Value 78.13 95.00 66.79 90.00 Date 28-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 The previous result as of April 2019 was recorded the NHIS enrollment at the CHPS level only, while this indicator is measured by the estimated proportion of outpatients at PHC level who have enrolled an NHIS Comments: among the total number of outpatients at the PHC level (health centers, maternity homes and CHPS). Component 2: Institutional Strengthening Capacity Building, M&E and Project Management IN00764374 ►Community-based Planning and Services Zones receiving supervision visits from Sub-District level (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 28-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 Data is not available. Comments: IN00764375 ►Community health personnel trained in approved in-service curriculum and upgrade training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 10,608.00 45,891.00 10,000.00 Date 28-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 The previous result as of April 2019 was recorded as the annual result of 2018, while this indicator is measured by the cumulative number of contacts of health personnel receiving training, which is not Comments: necessarily the number of health personnel trained. IN00764376 ►Community satisfaction with the utilization of the essential package of services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 48.00 48.00 82.50 60.00 Date 28-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 A client satisfaction survey was conducted in 8 districts as proxy. The overall client satisfaction for staff attitude, time spent, and expenditure at the community level was on the average 82.5%. Of 1504 clients Comments: randomly selected from service registers at facilities, 97% were confirmed to have received the stated services. IN00764378 ►Stock out of essential commodities at PHC level (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 41.00 6.00 29.01 30.00 Date 28-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 There’s continuing concern about the availability and sustainable financing of vaccines, family planning Comments: (FP) commodities, Vitamin A and Iron Folate. Currently there are no Vitamin A and Iron Folate for children and adolescent girls in stock. 12/29/2019 Page 7 of 10 The World Bank Implementation Status & Results Report Ghana - Maternal, Child Health and Nutrition Project (P145792) IN00764379 ►New national policy for PHC package developed (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 28-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 IN00764381 ►Functional CHPS zones (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 38.00 63.00 63.10 60.00 Date 28-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 Component 3: Epidemic Preparedness and Control IN00764380 ►Functional public health emergency management centre established (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 28-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 IN00764382 ►Completeness of Integrated disease surveillance report (IDSR) report (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 53.00 98.00 99.10 98.00 Date 28-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 IN00764384 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 6,090,994.00 50,329,658.00 50,000,000.00 Date 23-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 The previous result as of April 2019 was recorded as the annual result of 2018, while this indicator is Comments: measured by the cumulative number of people receiving HNP services at the PHC level. IN00764388 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,718,230.00 3,118,655.00 3,487,571.00 Date 23-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 IN00764389 12/29/2019 Page 8 of 10 The World Bank Implementation Status & Results Report Ghana - Maternal, Child Health and Nutrition Project (P145792) Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 759,875.00 9,488,179.00 11,520,000.00 Date 23-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 IN00764390 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,612,889.00 869,054.00 1,052,500.00 Date 23-Jun-2013 19-Apr-2019 30-Jun-2019 30-Jun-2020 Overall Comments IR Seven out of 17 intermediate results indicators exceed the targets of the project. The remaining nine intermediate results indicators are making significant progress except the NHIS enrollment at the PHC level. This is because as of June 2019 only 47% of CHPS zones have been accredited to provide NHIS services. The Bank team are working with the client to correct this situation. This significant progress was made with the successful implementation of community-based Performance-Based Financing (cPBF), coupled with the Rapid Results Approach (RRA). The Bank Team observed enthusiastic engagement in cPBF and RRA from multiple stakeholders at all the levels and among GHS, District NHIA, District Assemblies and community members. Patient satisfaction surveys have also concluded with positive results. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P145792 IDA-54630 Effective USD 68.00 68.00 0.00 37.30 23.83 61% P145792 TF-16617 Effective USD 5.00 5.00 0.00 2.37 2.63 47% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P145792 IDA-54630 Effective 20-May-2014 05-Jan-2015 12-Feb-2015 30-Jun-2020 30-Jun-2020 P145792 TF-16617 Effective 05-Jan-2015 05-Jan-2015 12-Feb-2015 30-Jun-2020 30-Jun-2020 12/29/2019 Page 9 of 10 The World Bank Implementation Status & Results Report Ghana - Maternal, Child Health and Nutrition Project (P145792) Cumulative Disbursements Restructuring History Level 2 Approved on 29-Jul-2015 ,Level 2 Approved on 30-Dec-2015 ,Level 2 Approved on 17-Dec-2018 Related Project(s) There are no related projects. 12/29/2019 Page 10 of 10