Public Disclosure Copy The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) Essential Health Services Access Project (P149960) EAST ASIA AND PACIFIC | Myanmar | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2015 | Seq No: 6 | APPROVED | ISR29218 | Implementing Agencies: Key Dates Key Project Dates Bank Approval Date:14-Oct-2014 Effectiveness Date:08-Apr-2015 Planned Mid Term Review Date:15-Dec-2017 Actual Mid-Term Review Date:-- Original Closing Date:30-Jun-2019 Revised Closing Date:30-Jun-2019 Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective (PDO) is to increase coverage of essential health services of adequate quality, with a focus on maternal, newborn and child health (MNCH). 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)PHRPDODEL The Project Development Objective (PDO) is to increase coverage of essential health services of adequate quality, with a focus on maternal, newborn and child health (MNCH), and, in the event of an Eligible Crisis or Emergency, to provide immediate and effective response to said Eligible Crisis or Emergency. Components Name Component 1: Strengthening Service Delivery at the Primary Health Care Level:(Cost $84.00 M) Component 2: Systems Strengthening, Capacity Building, and Project Management Support:(Cost $12.57 M) Component 3: Contingent Emergency Response:(Cost $3.43 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Moderately Satisfactory  Moderately Satisfactory Overall Implementation Progress (IP)  Moderately Satisfactory  Moderately Satisfactory 8/28/2017 Page 1 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) Overall Risk Rating  High  High Implementation Status and Key Decisions The leadership of MOHS is commended on continuing to make significant advances with the implementation of the National Health Plan (NHP), which was endorsed by the Government of Myanmar in March 2017. The Annual Operation Plan for the first year was widely shared and discussed with all the key stakeholders and the World Bank Group (WBG) is pleased to be able to support through the IDA financed Essential Health Services Access Project (EHSAP) and the Advisory Services and Analytics Program on health systems strengthening for Universal Health Coverage. Proposed additional financing for EHSAP through another $100 million IDA credit and $10 million grant from the Global Financing Facility is currently undergoing the Government of Myanmar internal clearance and approval process. Once clearances have been provided, the World Bank and Government of Myanmar intends to negotiate the financing agreement and related documents. The proposed additional financing would further support the implementation of the NHP. Furthermore, the additional financing, which also includes restructuring of EHSAP, to address some key bottlenecks to implementation. Implementation of EHSAP with already approved IDA credit is progressing, with Component 1 on track and Component 2 with delays. Component 1 is advancing as planned and implementation is considered satisfactory. MOHS has submitted the Year 2 Disbursement Linked Indicator Achievement report, which has been shared with the Department of Medical Research for independent verification. MOHS and World Bank have also convened an Oversight Committee to provide additional independence to the verification. MOHS report indicated that targets for all DLIs--with the exception of DLI 7--were met (at least 100 townships meeting the service readiness level of 14 out of 20, receiving health facility funds, making outreach visits for antenatal and postnatal care, having township health plans prepared with community engagement, and conducting supervision visits by State/Region health departments and by Township officials). As regards DLI 7, the achievement is 87%; i.e., 87 townships have 60% of the midwives trained in both Basic Emergency Obstetric Care and Integrated Management of Childhood Illnesses. The independent verification is still ongoing and WB expects to receive the report at the beginning of September. Implementation of Component 2 lags significantly with moderately unsatisfactory progress, due to the delays with reviews and clearance for work programs to start implementation. Component 2 will be restructured under the Additional Financing. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  High  High Macroeconomic  --  Substantial  Substantial Sector Strategies and Policies  --  Moderate  Low Technical Design of Project or Program  --  High  High Institutional Capacity for Implementation and Sustainability  --  High  High Fiduciary  --  Substantial  Substantial Environment and Social  --  High  High Stakeholders  --  Substantial  Substantial Other  --  --  -- Overall  --  High  High 8/28/2017 Page 2 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) Results Project Development Objective Indicators PHINDPDOTBL  Townships in which the township hospital and at least 60% of other Health Facilities have met a minimum readiness level of 14 out of 20 to provide essential MNCH services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 50.00 100.00 300.00 Date 01-Jun-2014 31-Oct-2016 30-Jun-2017 30-Jun-2019 PHINDPDOTBL  Children under 6 months who are being exclusively breast-fed (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 24.00 51.00 51.00 40.00 Date 30-Jun-2015 31-Mar-2016 31-Mar-2017 30-Jun-2019 Comments The actual previous and current data comes from DHS, while the baseline and endline targets are set based on the Multiple Indicator Cluster Survey. They are not comparable. The targets will be revised under Additional Financing. PHINDPDOTBL  Deliveries which are followed by adequate postnatal care (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 78.00 -- 71.00 85.00 Date 01-Jun-2014 30-Sep-2015 31-Mar-2017 30-Jun-2019 Comments The baseline and end line targets were set using the HMIS data. DHS 2015/2016 shows a national average of 71%; however this is not comparable to the HMIS data. The targets will be revised under the additional financing. 8/28/2017 Page 3 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) PHINDPDOTBL  Deliveries with skilled birth attendant (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 71.00 76.00 76.00 82.00 Date 01-Jun-2014 31-Oct-2016 30-Jun-2017 30-Jun-2019 Comments HMIS data for this year has not been released. The targets will be revised based on DHS data under the additional financing. Overall Comments Intermediate Results Indicators PHINDIRITBL  Townships where data quality assessments are carried out (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 300.00 Date 01-Jun-2014 31-Oct-2016 31-Oct-2016 30-Jun-2019 PHINDIRITBL  Townships in which the township hospital and atleast 80% of other health facilities have received Health Facility Grants in accordance with Project Operations Manual (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 50.00 100.00 300.00 Date 01-Jun-2014 31-Oct-2016 30-Jun-2017 30-Jun-2019 8/28/2017 Page 4 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) PHINDIRITBL  Townships where atleast 60% of the health facilities had no stock-out of supplies in the past year. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 300.00 Date 01-Jun-2014 31-Oct-2016 31-Oct-2016 30-Jun-2019 PHINDIRITBL  Townships in which atleast 80% of required number antenatal and postnatal visits and deliveries have been carried out by basic health staff (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 50.00 100.00 300.00 Date 01-Jun-2014 31-Oct-2016 30-Jun-2017 30-Jun-2019 PHINDIRITBL  Townships in which the Township Health Departments have prepared an integrated and inclusive Township Health Plans (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 41.00 100.00 300.00 Date 01-Jun-2014 31-Oct-2016 30-Jun-2017 30-Jun-2019 PHINDIRITBL  Essential Package of Health Services including quality standards defined, costed, approved, and publicly communicated (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N Y Y Y Date 01-Jun-2014 31-Oct-2016 31-Oct-2016 31-Mar-2016 8/28/2017 Page 5 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) PHINDIRITBL  Health Financing Strategy for UHC developed, approved, and communicated (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N N N Y Date 01-Jun-2014 31-Oct-2016 31-Oct-2016 31-Mar-2018 Comments Health fiscal space analysis was completed and discussed in 2016. With the new National Health Plan, formally endorsed in March 2017, the government has committed to developing a comprehensive health financing strategy to be completed by the end of the first year of the National Health Plan (2018). PHINDIRITBL  Townships in which at least 60% of midwives have been trained to deliver BeMOC and IMCI (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 50.00 84.00 300.00 Date 01-Jun-2014 31-Oct-2016 30-Jun-2017 30-Jun-2019 PHINDIRITBL  Communications strategy developed and implemented (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N Y Y Y Date 01-Jun-2014 31-Mar-2016 31-Mar-2016 30-Jun-2019 PHINDIRITBL  Townships in which all rural health centers and atleast 50% of subcenters have been supervised atleast twice in a fiscal year by Township Health Department using checklist (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 50.00 100.00 300.00 Date 01-Jun-2014 31-Oct-2016 30-Jun-2017 30-Jun-2019 8/28/2017 Page 6 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) PHINDIRITBL  Health Care Waste Management guidelines and policy developed and implemented (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N N N Y Date 01-Jun-2014 31-Oct-2016 31-Oct-2016 30-Jun-2019 PHINDIRITBL  Township in which township health department have been supervised at least twice in a fiscal year by State/Region Health Department officials using checklist (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 50.00 100.00 300.00 Date 01-Jun-2014 31-Oct-2016 30-Jun-2017 30-Jun-2019 PHINDIRITBL  Improved supervision (supervision standards and checklists developed) (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N Y Y Y Date 01-Jun-2014 30-Sep-2015 30-Sep-2015 31-Dec-2015 PHINDIRITBL  Service readiness scorecard implemented (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N Y Y Y Date 01-Jun-2014 30-Sep-2015 30-Sep-2015 30-Dec-2015 8/28/2017 Page 7 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) PHINDIRITBL  Improved fund flows (recurrent) to front line health facilities--Training on guidelines developed (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N Y Y Y Date 01-Jun-2014 01-Sep-2015 01-Sep-2015 01-Apr-2015 PHINDIRITBL  Goods procured and distributed as outlined in the CERIP (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N -- -- Y Date 14-Jun-2016 -- -- 14-Jun-2017 Overall Comments The progress on the DLIs has been reported above. Please note that the targets met are based on the report by MOHS. At present, independent verification of the DLI achievements is being undertaken. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P149960 IDA-55420 Effective USD 100.00 100.00 0.00 47.43 43.10 47% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P149960 IDA-55420 Effective 14-Oct-2014 05-Feb-2015 08-Apr-2015 30-Jun-2019 30-Jun-2019 Cumulative Disbursements 8/28/2017 Page 8 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Essential Health Services Access Project (P149960) Restructuring History Level 2 Approved on 12-May-2015 ,Level 1 Approved on 23-Jun-2016 ,Level 2 Approved on 20-Feb-2017 Related Project(s) P160208-Additional Financing: Essential Health Services Access Project 8/28/2017 Page 9 of 9 Public Disclosure Copy