The World Bank Report No: ISR7476 Implementation Status & Results Bolivia Expanding Access to Reduce Health Inequities Project (APL III)--Former Health Sector Reform - Third Phase (APL III) (P101206) Public Disclosure Copy Operation Name: Expanding Access to Reduce Health Inequities Project (APL Project Stage: Implementation Seq.No: 12 Status: ARCHIVED Archive Date: 27-Feb-2013 III)--Former Health Sector Reform - Third Phase (APL III) (P101206) Country: Bolivia Approval FY: 2008 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Adaptable Program Loan Implementing Agency(ies): Ministry of Health and Sports, Social Investment and Productive Fund (SPF) Key Dates Board Approval Date 24-Jan-2008 Original Closing Date 31-Jan-2014 Planned Mid Term Review Date 25-Mar-2013 Last Archived ISR Date 19-Jun-2012 Effectiveness Date 19-Jun-2009 Revised Closing Date 31-Jan-2014 Actual Mid Term Review Date 03-Apr-2013 Project Development Objectives Project Development Objective (from Project Appraisal Document) The development objectives for APL III are the same as those of the previous two phases: increasing access to good quality and culturally appropriate health services to improve the health of the population in general and to mothers and children in particular. As a medium-term objective, the APL series pursues reducing the infant and maternal mortality rates by one-third, as per the proposed indicators for the Program. Under APLs I and II an important set of policies and interventions were developed to strengthen the performance of the public health services. These policies and interventions aimed to improve child and maternal health status, including expansion of the insurance system (the Universal maternal and child insurance, SUMI, at present), the investments in primary health care, and the strengthening of cost-effective health interventions (PAI, IMCI). APL I introduced a basic health insurance (the Seguro B?sico de Salud, today SUMI) to reinforce provisions to mothers and children, and a new vaccination system and set of new management tools. APL II is implementing an expanded version of maternal and child insurance, by supporting the deployment of mobile health brigades (EXTENSA) as a way of expanding service delivery to underserved areas, and new management tools (performance agreements, and demand-driven investment policy) are being used. The Government has provided sustainability to health insurance as well as to the EXTENSA program that is now being absorbed by the regional and/or municipal budgets. The EXTENSA Unit in the MOH that was part of the APL II PIU is being incorporated in the structure of the MOH. All regions benefited with support from investments, mainly in primary care. The proposed APL III aims to sustain the trend in improving the IMR and accelerate the reduction of the MMR, which a recent modeling exercise shows to be a challenge. APL III would consolidate the strategies implemented under APLs I and II by: i) strengthening the regulatory capacity of national, regional and local levels to Public Disclosure Copy perform critical EFPH; ii) promoting the demand of maternal and infant health services through developing and enhancing the culturally appropriate maternal and infant health referral network; and iii) supporting implementation of the new expansion of the insurance system (Universal Health Insurance - SUSALUD. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Page 1 of 7 The World Bank Report No: ISR7476 Component(s) Component Name Component Cost Stewardship Role of Health Authorities - Essential Functions in Public Health 4.00 Public Disclosure Copy Family, Community and Intercultural Health 9.90 Health Insurance Program 3.20 Project Administration 0.90 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Unsatisfactory Moderately Unsatisfactory Overall Implementation Progress (IP) Unsatisfactory Moderately Satisfactory Overall Risk Rating Implementation Status Overview The project was approved by the Board on January 24, 2008. It was signed on September 19, 2008 and declared effective on June 19, 2009. The current disbursed amount is XDR 2.07 million (3.19 million or 17.7% of the loan amount). Locations Country First Administrative Division Location Planned Actual Bolivia Departamento de Pando Porvenir Bolivia Departamento de Tarija Yunchara Bolivia Departamento de Potosi Yocalla Bolivia Departamento de La Paz Yaco Bolivia Departamento de La Paz Waldo Ballivian Bolivia Departamento de Cochabamba Villa Viscarra Public Disclosure Copy Bolivia Departamento de La Paz Villa General Perez Bolivia Departamento de La Paz Sicasica Bolivia Departamento de Santa Cruz Vallegrande Bolivia Departamento de Potosi Urmiri Bolivia Departamento de La Paz Umala Bolivia Oruro Turco Page 2 of 7 The World Bank Report No: ISR7476 Country First Administrative Division Location Planned Actual Bolivia Departamento de Potosi Torotoro Public Disclosure Copy Bolivia Departamento de Potosi Tomave Bolivia Oruro Toledo Bolivia Departamento de Potosi Tacobamba Bolivia Departamento de Cochabamba Sicaya Bolivia Departamento de La Paz Sapahaqui Bolivia Departamento de Cochabamba Santivanez Bolivia Departamento de Santa Cruz Santa Cruz de la Sierra Bolivia Departamento del Beni Santa Ana de Yacuma Bolivia Departamento de Potosi San Pedro de Buena Vista Bolivia Departamento de La Paz San Pedro Bolivia Departamento de Potosi Sacaca Bolivia Departamento de Potosi Ravelo Bolivia Departamento de Santa Cruz Pucara Bolivia Departamento de Potosi Potosi Bolivia Departamento de Santa Cruz Postrervalle Bolivia Departamento de Potosi Porco Bolivia Departamento de Potosi Porco Public Disclosure Copy Bolivia Departamento de Potosi Pocoata Bolivia Departamento de La Paz Pelechuco Bolivia Departamento de La Paz Patacamaya Bolivia Departamento de Cochabamba Pasorapa Bolivia Departamento de La Paz Papel Pampa Bolivia Departamento de Cochabamba Omereque Bolivia Departamento de Potosi Ocuri Page 3 of 7 The World Bank Report No: ISR7476 Bolivia Departamento de Santa Cruz Moro Moro Bolivia Departamento de Cochabamba Morochata Public Disclosure Copy Bolivia Departamento de Cochabamba Mizque Bolivia Departamento de La Paz Malla Bolivia Departamento de La Paz Luribay Bolivia Departamento de Cochabamba Independencia Bolivia Departamento de Potosi Tinguipaya Bolivia Departamento de Pando Filadelfia Bolivia Oruro Exaltacion Bolivia La Paz Estancia Toco Vilaque ✔ Bolivia Departamento de Santa Cruz El Trigal Bolivia Departamento de Tarija El Puente Bolivia Oruro El Choro Bolivia Departamento de La Paz El Alto Bolivia Departamento de La Paz Curva Bolivia Oruro Corque Bolivia Departamento de La Paz Colquencha Bolivia Departamento de Potosi Colquechaca Bolivia Departamento de La Paz Collana Public Disclosure Copy Bolivia Departamento de Cochabamba Cochabamba Bolivia Departamento de Pando Cobija Bolivia Departamento de La Paz Chuma Bolivia Departamento de La Paz Chacarilla Bolivia Departamento de Potosi Caripuyo Bolivia Departamento de Cochabamba Capinota Page 4 of 7 The World Bank Report No: ISR7476 Bolivia Departamento de La Paz Callapa Bolivia Departamento de La Paz Calamarca Public Disclosure Copy Bolivia Departamento de La Paz Cairoma Bolivia Departamento de Pando Bolpebra Bolivia Departamento de Cochabamba Bolivar Bolivia Departamento de Pando Bella Flor Bolivia Oruro Belen de Anamarca Bolivia Departamento de La Paz Ayo Ayo Bolivia Departamento de La Paz Ayata Bolivia Departamento de La Paz Aucapata Bolivia Departamento de Cochabamba Arque Bolivia Departamento de Potosi Arampampa Bolivia Departamento de La Paz Apolo Bolivia Departamento de Potosi Acacio Bolivia Departamento de Chuquisaca Tarabuco Bolivia Departamento de Chuquisaca Villa Zudanez (Tacopaya) Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Public Disclosure Copy Ratio between the percentage of pregnant Text Value 0.55 0.94 0.66 women receiving four pre-natal care in the Date 13-Dec-2007 30-Apr-2011 31-Jan-2014 areas of project intervention and the rest of the Comments Indicators should be updated Data from SNIS. Indicator country if restructure based on the was achieved. target population Page 5 of 7 The World Bank Report No: ISR7476 Ratio between the percentage of institutional Text Value 0.52 0.69 0.68 deliveries in the areas of project intervention Date 13-Dec-2007 30-Apr-2011 31-Jan-2014 and the rest of the country Comments Data from SNIS. Indicator Public Disclosure Copy was achieved. Percentage of 2 year old children with a height Text Value 37.6 32.4 22 over # 2Z scores in the intervention areas of Date 13-Dec-2007 30-Apr-2011 31-Jan-2014 the projec Comments Percentage of children receiving exclusive Text Value 60.4% 65 breast feeding at 6 months in the project areas Date 13-Dec-2007 30-Apr-2011 31-Jan-2014 Comments People with access to a basic package of Number Value 35.00 35.00 80.00 health, nutrition, or reproductive health services Date 13-Dec-2007 30-Apr-2011 31-Jan-2014 (number) Comments Indicators should be updated Proportion People with Proportion People with if project restructure. access to a basic package of access to a basic package of health in the Project health in the Project intervention area. intervention area. Pregnant women receiving antenatal care Number Value 55.00 55.00 60.00 during a visit to a health provider (number) Date 13-Dec-2007 30-Apr-2011 31-Jan-2014 Comments Proportion. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Monitoring and Evaluation of the project done Text Value 0 80 80 with regular reports from the information Date 13-Dec-2007 30-Apr-2011 31-Jan-2014 system providing the data Comments Data from SNIS. Achieved. % of referral networks evaluated as satisfactory Text Value 0 n/a 80 in the yearly quality assessment Date 13-Dec-2007 31-Mar-2011 31-Jan-2014 Public Disclosure Copy Comments Data on Financial Performance (as of 23-Jan-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P101206 IDA-43820 Effective 24-Jan-2008 19-Sep-2008 19-Jun-2009 31-Jan-2014 31-Jan-2014 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed Page 6 of 7 The World Bank Report No: ISR7476 P101206 IDA-43820 Effective XDR 11.70 11.70 0.00 2.07 9.63 18.00 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation A Level 2 restructuring process was requested by the Government of Bolivia (GoB) and approved by the Bank. The Amendment Letter was sent for the Government signature on December 2012. The key changes do not modify the project development objective (PDO) neither the Project Development Indicators (PDI) and include the following: (a) Reduction in the scope of Project components; (b) Adjustments to the results framework to reflect changes in components; (c) Cancellation of SDR 4.85 million of the total Credit amount of SDR 11.7 million, of which SDR 9.8 million remain undisbursed; and, (d) Reallocation of funds among categories, which is consistent with the reduced scope of the Project and Credit amount. Restructuring History Level two Approved on 12-Dec-2012 Public Disclosure Copy Related Projects There are no related projects. Page 7 of 7