The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Ethiopia Health MDG Support Operation (P123531) AFRICA | Ethiopia | Health, Nutrition & Population Global Practice | Requesting Unit: AFCE3 | Responsible Unit: HAFH1 IBRD/IDA | Program-for-Results Financing | FY 2013 | Team Leader(s): Paul Jacob Robyn, Roman Tesfaye Seq No: 16 | ARCHIVED on 30-Oct-2019 | ISR38841 | Created by: Paul Jacob Robyn on 08-Oct-2019 | Modified by: Paul Jacob Robyn on 24-Oct-2019 Program Development Objectives Program Development Objective (from Program Appraisal Document) To improve the delivery and use of a comprehensive package of maternal and child health services. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Implementation Status and Key Decisions The Program Development Objective (PDO) of the Health SDGs PforR is to improve the delivery and use of a comprehensive package of maternal and child health (MCH) services. Program financing includes: (i) an original allocation of US$100 million IDA and a grant of US$20 million from the Health Results Innovation Trust Fund (HRITF) (approved February 28, 2013); and an Additional Financing (AF) of US$150 million IDA with grants of US$60 million from the Global Financing Facility (GFF) and US$20 million from the Power of Nutrition, respectively (approved May 18, 2017). The Program itself is a hybrid program that includes a PfoR instrument with 15 core DLIs focusing on improving maternal and child health results as well as strengthening fiduciary, environmental and accountability elements of the country’s health system. The Investment Project Financing (IPF) component includes three sub-components: (a) Sub-Component 1: Support to Civil Registration and Vital Statistics System (US$15 million); (b) Sub-Component 2: Technical Assistance and Capacity Building to Support National Nutrition Program II (US$5 million); and (c) Sub-Component 3: Technical Assistance and Capacity Building (US$1 million). The implementing agencies include the Federal Ministry of Health and Federal Vital Events Registration Agency (FVERA), which has recently been merged with other government functions under the Ministry of Peace as the Immigration, Nationality and Vital Events Agency (INVEA). Significant progress has been made over the past few years towards achievement of the PDO, and with the results of the 2019 Mini Demographic and Health Survey (DHS) being released in August 2019, five of the seven end-of-Program targets have been surpassed and one is on track to surpass the end of Program target. These include: 1. Coverage of skilled birth attendance: DLI 1a: Deliveries attended by Skilled Birth Provider; and DLI 1b: Deliveries attended by Skilled Birth providers for the bottom 3 performing regions (in DHS 2016) (Afar, Oromia and Somali): The end of Program targets are 40% for DLI 1a and 28% DLI 1b, while the 2019 DHS measured coverage at 50% and 33.4%, respectively; 2. Coverage of antenatal care: DLI 3a: Pregnant women receiving at least four antenatal care visits: The end of Program target is 38% while the 2019 DHS measured coverage at 43%; 3. Utilization of family planning: DLI 4a: Contraceptive prevalence rate (CPR) (for rural women only): The end of Program target is 38% while the 2019 DHS measured coverage at 37.7%; 4. Coverage of maternal nutritional services: DLI 11: Percent of pregnant women taking iron folic and acid (IFA) tablets: The end of Program target is 50% while the 2019 DHS measured coverage at 60%; 5. Coverage of child nutrition services: DLI 10b: Percent of Woredas in nonemerging Regions delivering Vitamin A Supplements to children through routine systems: The 2018 verified result measured 68% (vs a target of 55%) and routine data is showing that the indicator is on track to surpass end of Program targets this year. Results will be verified through a Joint Mid-term Review Mission planned for December 2019. Data on Financial Performance 10/30/2019 Page 1 of 19 The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P123531 IDA-52090 Effective USD 100.00 100.00 0.00 75.95 18.29 81% P123531 IDA-60900 Effective USD 150.00 150.00 0.00 79.56 76.76 51% P123531 TF-14107 Effective USD 20.00 20.00 0.00 13.80 6.20 69% P123531 TF-A4689 Effective USD 20.00 20.00 0.00 12.90 7.10 64% P123531 TF-A4705 Effective USD 20.00 20.00 0.00 13.71 6.29 69% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P123531 IDA-52090 Effective 28-Feb-2013 29-Mar-2013 17-Jun-2013 30-Jun-2018 31-Jul-2021 P123531 IDA-60900 Effective 09-May-2017 18-May-2017 27-Jun-2017 30-Jun-2021 30-Jun-2021 P123531 TF-14107 Effective 29-Mar-2013 29-Mar-2013 29-Mar-2013 30-Jun-2018 31-Jul-2021 P123531 TF-A4689 Effective 18-May-2017 18-May-2017 13-Nov-2017 30-Jun-2021 30-Jun-2021 P123531 TF-A4705 Effective 18-May-2017 18-May-2017 13-Nov-2017 30-Jun-2021 30-Jun-2021 Program Action Plan Action Description Development and implementation of a Postnatal Care Directive/policy Source DLI# Responsibility Timing Timing Value Status Technical Client Due Date 31-Dec-2020 Completed Completion Developed Postnatal Care Directive. Measurement Postnatal care directive developed on August 5, 2017 and verified by implementing partners. Implementation Comments ongoing. Commodity distribution process - Roll out of APTS and provide progress update to ensure existence of adequate Action Description monitoring mechanism of delivery to ultimate beneficiaries at the branch level Source DLI# Responsibility Timing Timing Value Status Technical Client Recurrent Yearly In Progress Completion Rolled out APTS Measurement 10/30/2019 Page 2 of 19 The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Except Somali, Afar and Gambela, all Regional Health Bureaus have implemented the system. The current rollout of Comments the APTS should continue and MoH should update the progress to ensure the existence of adequate monitoring mechanism. PFSA launches an open call for pre-qualifications bidders as per the Recipient's law at least once and introducing Action Description Framework Contracting Methods for common and repetitive procurement items. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems Client Recurrent Yearly In Progress Completion Launched an open call prequalification and introduced framework contract methods. Measurement The Bank team was informed that the call has not been launched yet as the preexisting framework contracts are still Comments active. Once the closure period for these contracts gets closer the client will launch the process for the next round of contracts. Ensure a system of recording fraud and corruption complaints at all levels including Woredas; Ensure the deployment Action Description of Ethics and Anticorruption Liaison Officer and experts at all levels (PFSA; PFSA regional Hubs; RHBs, offices). Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems Client Due Date 31-Dec-2018 Delayed Completion Recorded complaints and deployed ethics and anticorruption liaison officers. Measurement Out of the 9 liaison officers noted in PAP only 3 have been recruited as MOH has grouped PSA hubs in clusters. Comments Follow-up discussions between MOH, FEACC and WB will identify what actions will be taken to speed the process up and new deadline Action Description Automation of PFSA Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems Client Recurrent Yearly Delayed Completion Automated fiduciary system at PFSA Measurement ERP document and an action plan for the implementation of ERP has been prepared, however, the procurement Comments process has not yet been initiated due to lack of resources. FPPA undertaking annual procurement audit and FMOH and Bank team to consult OFAG on the feasibility of Action Description undertaking financial and value for money audits for SDGPF. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems Client Recurrent Yearly Delayed 10/30/2019 Page 3 of 19 The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Completion Report on feasibility of undertaking financial and value for Money audits for SDGPF by FPPA Measurement Comments Value for money audit is still under discussion with MOH. Review and improve the SBD and agree with FPPA; and review current Bid Evaluation reporting methods and Action Description develop a template that keeps and records all relevant evaluation information Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems PSA Recurrent Yearly In Progress Completion Improved Standard Bidding Document Measurement PSA reported to have started using health sector SBD prepared by FPPA. A review made on a sample document Comments indicates that use of Data Sheet and Special Conditions of Contract need improvement. PSA did not progress in developing Evaluation Templates. Action Description Improve tracking system of monitoring contracts with UN agencies and disclose award decisions to the public Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems Client Recurrent Yearly Delayed Completion Disclosed award decisions of UN Agencies based on the developed tracking system Measurement Partial progress has been noted, however, a comprehensive list needs to be updated regularly that indicates list of Comments contracts processes using the SDG fund. It is critical that MoH gives due attention for this action. Action Description Undertake assessment study and develop coding and categorization system of procurable items Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems Client Recurrent Yearly In Progress Completion Developed and implemented the coding and categorization system of procurable items Measurement Action met and a booklet shared and this is expected to address the PSA current practice of applying item by item Comments evaluation. Application of the classification and codes for procurement and its impact need to be monitored. Gender based violence strategy for the health sector is prepared and implemented and analysis of gender Action Description disaggregated HMIS data is conducted Source DLI# Responsibility Timing Timing Value Status 10/30/2019 Page 4 of 19 The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Technical Client Recurrent Yearly Delayed Completion Developed health sector Gender Based Violence strategy and disclosed gender analysis from HMIS. Measurement WB has helped the Ministry of Health in preparing inception report and produced tools for data collection and the Comments draft GBV strategy will be submitted by end of November,2019. Conduct Training and regular implementation support of health workers at the facility level on cause of death as per Action Description national disease notification codes, registration of births and other VE registration requirements. Source DLI# Responsibility Timing Timing Value Status Technical Client Recurrent Yearly In Progress Completion Provided training for health workers on CRVS. Measurement Comments Training on CRVS is being provided to the Health frontline workers. MoH Provides and Federal Ethics and Anti- corruption ( FEACC) verify and submit to the Bank quality and timely Action Description biannual report on Fraud and Corruption complaints and priority actions related to the program Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems MOH and FEACC Recurrent Semi-Annually Delayed Completion Biannual report on fraud and corruption complaints verified and submitted by Federal Ethics and Anti Corruption Measurement Commission. As per the Ministry’s report, the three cases that were reported in the biannual report for FY2018/19 have been Comments investigated and a decision was made for the two cases to cancel the bid while the investigation for the third case is still underway. Ensure inclusiveness of Fraud and Corruption and complaint handling processes or priority actions in FMOH and Action Description Regional Health Bureaus joint forum discussions semiannually. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems Client Recurrent Continuous In Progress Completion Fraud and corruption and compliant handling process discussed at joint FMOH- RHB meeting Measurement Discussion was held in the previous joint MOH-RHB meeting. however, there is a need to consider this issue as one Comments of the agenda items to be discussed regularly. Availing appropriate temporary storage facilities for collection of hazardous wastes until final disposal, enforce Action Description compliance with MWM and Disposal Directive in HF constructed before issuance of the Directive 10/30/2019 Page 5 of 19 The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Source DLI# Responsibility Timing Timing Value Status Environmental and Social MOH Recurrent Continuous In Progress Systems Completion Availed temporary storage facilities for collection of hazardous medical wastes. Measurement Per MoH’s report technical support is being provided continuously to Regions, and a monitoring system is in place. Comments Although final disposal in many health facilities is a challenge, this will be resolved when the 6 central incinerators are in place. Update relevant documents to incorporate environmental impact and risk criteria in site selection screening for all Action Description health facilities, strengthen the coordination and reporting mechanism on social and environmental safeguard in MOH. Source DLI# Responsibility Timing Timing Value Status Environmental and Social Both Due Date 31-Dec-2018 In Progress Systems Completion Developed a document/checklist to incorporate environmental impact and risk criteria in the site selection template Measurement for constructing health facilities. Checklist for health facility site assessment shared and the Bank advised the Moh infrastructure directorate to revise Comments the mechanism/checklist and to provide a periodic report on whether a new land is acquired or not. Documenting consultations and participatory nature of discussions where communal land is used for construction of Action Description health centers and where applicable compensation for land and livelihood paid. Source DLI# Responsibility Timing Timing Value Status Environmental and Social Client Recurrent Continuous In Progress Systems Completion Report on documenting consultations using the developed checklist. Measurement The mission noted limited progress in implementing a the devised mechanism and MoH needs to revise the Comments mechanism or need to prepare a simple procedure(template) to enable them to document the community consultations and to report regularly. Action Description Documenting outreach and specific actions focused on providing services to all vulnerable persons Source DLI# Responsibility Timing Timing Value Status Technical Client Recurrent Continuous In Progress Completion Report on actions taken on vulnerable group Measurement 10/30/2019 Page 6 of 19 The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) MoH Women and Children Affairs Directorate has been conducting different activities to create accessible health services for persons with disability: developed Health Sector Disability Mainstreaming manual, provided training on Comments vulnerability etc. Action Description Implementation of the postnatal care directive/policy. Source DLI# Responsibility Timing Timing Value Status Technical FMOH Due Date 31-Dec-2020 Not Yet Due Completion Implemented Postnatal Care directive Measurement Comments The Postnatal Care directive/ guideline has been implemented. 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 Moderate Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and Sustainability -- Moderate Moderate Fiduciary -- Substantial Substantial Environment and Social -- High High Stakeholders -- High High Other -- -- -- Overall -- High High Results PDO Indicators by Objectives / Outcomes To Improve the delivery and use of comperhensive package of Maternal and Child Health (MCH) Services IN00752457 ►Deliveries attended by skilled birth providers (Percentage, Custom) 10/30/2019 Page 7 of 19 The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 26.00 50.00 40.00 Date 30-Mar-2012 24-Apr-2019 05-Aug-2019 30-Jun-2021 Baseline data from 2011 Ethiopia Demographic Health Survey (EDHS) Report and previous data from 2016 Comments EDHS. Target surpassed. IN00752449 ►Deliveries attended by skilled birth providers for the bottom 3 performing regions(Afar,Oromia&Somal (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 19.00 19.00 33.40 28.00 Date 31-Oct-2016 24-Apr-2019 05-Aug-2019 30-Jun-2021 Baseline data from 2016 Ethiopia Demographic Health Survey (EDHS) Report. Target surpassed. Comments IN00752450 ►Pregnant women receiving at least four antenatal care visits (Percentage, Custom) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 32.00 32.00 43.00 38.00 Date 31-Oct-2016 24-Apr-2019 05-Aug-2019 30-Jun-2021 Baseline data from 2016 Ethiopia Demographic Health Survey (EDHS) Report. Target surpassed. Comments IN00752458 ►Children 12-23 months immunized with Pentavalent 3 vaccines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 65.70 65.70 65.70 76.70 Date 31-Dec-2012 24-Apr-2019 05-Aug-2019 30-Jun-2021 Although improvements were documented in the 2019 Mini-DHS (61% coverage, an 8% increase from the 2016 DHS), the results from the Mini-DHS cannot be used for disbursement as the defined verification mechanism is a Household Cluster Survey (HCS), which (i) uses a different measurement methodology than DHS surveys; and (ii) disbursements on the DLI have already been made using the HCS method. The Comments Bank has therefore advised the MOH to ensure the Household Cluster Survey is conducted before the end of the Program to measure, validate and disburse on the results achieved for the DLI, which from the 2013 baseline (59.6%) include a 7.1% increase in 2018 (US$11.73m) and an additional 10% increase in 2020 (US$8m). IN00752459 ►Contraceptive prevalence rate (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 27.30 35.00 35.00 35.00 Date 30-Mar-2012 24-Apr-2019 24-Apr-2019 30-Jun-2018 Baseline data from 2011 Ethiopia Demographic Health Survey (EDHS) Report and previous data from 2016 Comments EDHS . This DLI has been replaced with CPR for rural women. IN00752461 10/30/2019 Page 8 of 19 The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) ►Contraceptive Prevalence Rate ( for Rural women only) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 32.00 32.00 37.70 38.00 Date 31-Oct-2016 24-Apr-2019 05-Aug-2019 30-Jun-2021 Baseline data from 2016 Ethiopia Demographic Health Survey (EDHS) Report. Target surpassed. Comments IN00752462 ►Percent of pregnant women taking Iron Folic Fcid (IFA) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 42.10 42.10 60.00 54.10 Date 31-Oct-2016 24-Apr-2019 05-Aug-2019 30-Jun-2021 Baseline data from 2016 Ethiopia Demographic Health Survey (EDHS) Report. Target surpassed. Comments IN00752456 ►Percent of children 6-59 month receiving Vitamin A supplements (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45.00 45.00 45.00 53.00 Date 31-Oct-2016 24-Apr-2019 05-Aug-2019 30-Jun-2021 Baseline data from 2016 Ethiopia Demographic Health Survey (EDHS) Report. The 2019 Mini-DHS measured a 3% increase in Vitamin A Supplementation (VAS) from 2016, with the 2018 target being a 4% increase and end of Program target an 8% increase. However, due to the data collection procedures error , the 2019 Mini DHS collected data on coverage of VAS among children aged 6-35 in stead of collecting data on coverage of VAS among children aged 6-59. Hence, verification and Comments disbursement of the result for this DLI cannot be made using the 2019 DHS. As agreed during the mission, results for the DLI will be verified by the next DHS planned for 2020, ensuring the correct age group is captured in the survey. IN00752460 ►Percent of Woredas in non emerging regions delivering vitamin A supplements to children (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 48.00 69.00 69.00 80.00 Date 30-Dec-2016 24-Apr-2019 05-Aug-2019 30-Jun-2021 Data source: Nutrition Data Verification Joint Review Mission, December 2018. Comments Intermediate Results Indicators by Results Areas Improve delivery and utilization of a comperhensive package of maternal and child health services IN00752463 ►Introduction of Procurement Key Performance Indicators developed by Federal Public Procurement Agenc (Yes/No, Custom) 10/30/2019 Page 9 of 19 The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Baseline Actual (Previous) Actual (Current) End Target Value No No Yes Yes Date 27-Jun-2017 24-Apr-2019 05-Aug-2019 30-Jun-2021 The consultant will verify the implementation of the KPI for 2018 and 2019 together with the website. TOR for the Web and KPI has been revised accordingly and UNICEF is currently in the process of recruiting the Comments consultant. IN00752464 ►Automate the PFSA Core Business Fiduciary System using selected software in PFSA HQ and Addis Ababa (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 27-Jun-2017 24-Apr-2019 05-Aug-2019 30-Jun-2021 ERP document and an action plan for the implementation of PSA automation has been prepared, however, Comments the procurement process has not yet been initiated due to luck of resources. IN00752465 ►PFSA submission of Backlog audit reports and timely quality audit reports thereafter (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 27-Jun-2017 24-Apr-2019 05-Aug-2019 30-Jun-2021 Audit Services Corporation Report , December 31, 2018 Comments IN00752466 ►Percent of Children 0- 23 month participating in GMP (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 27.00 44.00 44.00 51.00 Date 30-Dec-2016 24-Apr-2019 05-Aug-2019 30-Jun-2021 Nutrition Data Verification Joint Review Report December, 2018 Comments IN00752467 ►Percent of Woredas in emerging Regions transitioning from EOS to Community Health Days- CHD (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 26.00 26.00 50.00 Date 30-Dec-2016 24-Apr-2019 05-Aug-2019 30-Jun-2021 Nutrition Data Verification Joint Review Mission Report, December 2018 Comments IN00752468 ►Percent of PHC Facilities having all drug from the MOH list of drug available (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 42.00 48.00 48.00 47.00 10/30/2019 Page 10 of 19 The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Date 30-Dec-2016 24-Apr-2019 05-Aug-2019 30-Jun-2021 Services availability and Readiness Assessment ( SARA) report, May 2018 Comments IN00752469 ►Developed and Implement postnatal Care Service directive to improve the quality of Postnatal service (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No Yes Yes Date 27-Jun-2017 24-Apr-2019 05-Aug-2019 30-Jun-2021 Postnatal Care service directives is developed. Accordingly, the postnatal care directive has been implemented in all regions. Verification report have been compiled by MCHD and signed by the TWG. Six Comments months (July-December 2018) PNC 24 hours implementation report is being generated by DHIS2 and reviewed and verified by Partners. IN00752470 ►Improve quality of adolescent services (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 30-Jun-2017 24-Apr-2019 05-Aug-2019 30-Jun-2021 Adolescent and Youth Health National (AYH) Strategy endorsed on July 16, 2017. Regarding the development of school health package, the MOH has shared first six-month report for 2018 and the Comments verification report signed by the TWG. However, MOH should officially submit the school health package along with the results notification to the Bank to allow for disbursement. IN00752471 ►Percent of Woreda with Functional Community Health Insurance Schemes (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 23.00 23.00 36.00 53.00 Date 19-Jun-2017 24-Apr-2019 05-Aug-2019 30-Jun-2021 Verified coverage was 36% at the end of 2018. The 2019 target set for this DLI is achieved and overall the indicator is showing a good progress. According to the EHIA, the number of Woredas that have established a functional CBHI has reached to 427 in July 2019 which is a 22.7 percentage point’s increase from the Comments baseline (90% achievement). As indicated in the DLI verification protocol, technical partners are expected to verify the result by end of 2019. IN00752472 ►Undertake CBHI review every two Years (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 27-Jun-2017 24-Apr-2019 05-Aug-2019 30-Jun-2021 Source: A brief report on the establishment of a baseline of Woredas with functional CBHI schemes, June Comments 2017 IN00752473 ►Devise and implement a mechanism for documenting consultations (Yes/No, Custom) 10/30/2019 Page 11 of 19 The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 27-Jun-2017 24-Apr-2019 05-Aug-2019 30-Jun-2021 Checklist/devised mechanism was submitted for documenting the consultations when the communal/private land is used for construction of health facilities by MOH, December 2018. The mission noted limited progress in implementing a mechanism for documentation of consultation on land acquisition issues when privately owned and/or communal land is acquired. MoH has also submitted a revised guideline on documentation of land acquisition issues which has been Comments reviewed by the World Bank team to have applicable mechanism for documentation. Hence, it is very important that all implementing Woredas use the revised procedure on documentation of consultation on land acquisition and compensation and apply the screening checklist for each of their subprojects (regardless of the new land acquisitions); provide periodic report to the ministry. IN00752474 ►Development and implementation of health sector community score card (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No Yes Yes Date 27-Jun-2016 24-Apr-2019 05-Aug-2019 30-Jun-2020 There is a very good progress on this DLI. A community scorecard directive is developed, piloted and full- scale implementation initiated between 2017 and 2019. As verified by independent review, the number of Comments districts that implemented CSC has reached to more than 200 districts in June 2019. IN00752475 ►Health Centers reporting HMIS data in time (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 84.00 84.00 86.00 Date 30-Mar-2012 24-Apr-2019 05-Aug-2019 30-Jun-2021 Baseline data from 2012 HMIS Data Quality Assessment (DQA) Report, previous data from 2014 HMIS Comments DQA and current data from 2018 SARA report. IN00752476 ►Development and implementation of Annual Rapid Facility Assessment (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 30-Mar-2012 24-Apr-2019 05-Aug-2019 30-Jun-2021 Baseline data from 2012 Services Availability and Readiness Assessment (SARA) report, previous data Comments from 2016 SARA report and current data from 2018 SARA report. IN00752477 ►Improved transparency of Pharmaceutical Fund and Supply Agency (PFSA) procurement process (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 29-Mar-2013 24-Apr-2019 05-Aug-2019 30-Jun-2021 10/30/2019 Page 12 of 19 The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) As per MOH's report, the website is up-to date and ready for verification. Consultant is identified and Comments recruitment of the consultant is underway. IN00752478 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 57,763,902.00 57,763,902.00 88,943,602.00 Date 31-Dec-2012 10-Jun-2019 10-Jun-2019 30-Jun-2021 Comments IN00752479 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 29,284,990.00 29,284,990.00 45,091,862.00 IN00752480 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,887,467.00 1,887,467.00 2,203,481.00 Date 31-Dec-2012 01-Jun-2019 01-Jun-2019 30-Jun-2021 IN00752481 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 52,376,812.00 52,376,812.00 85,500,000.00 Date 31-Dec-2012 01-Jun-2019 01-Jun-2019 30-Jun-2021 IN00752482 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 806,078.00 806,078.00 1,240,121.00 Date 31-Dec-2012 01-Jun-2019 01-Jun-2019 30-Jun-2021 Disbursement Linked Indicators DLI_IND_TABLE ►DLI 1 Deliveries attended by skilled birth providers (Scaled DLI- 1a) (Intermediate Outcome, 45,430,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value 10.00 26.00 50.00 40.00 Date -- 24-Apr-2019 05-Aug-2019 -- 10/30/2019 Page 13 of 19 The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Baseline data from 2011 Ethiopia Demographic Health Survey (EDHS). Previous results from 2016 Comments EDHS. Current results from 2019 Mini-DHS. 2019 results have surpassed DLI targets for 2018 and 2020. ►DLI 2 Deliveries attended by skilled birth providers for the bottom 3 performing regions -Afar, Oromia & Somali- (New DLI- 1b) (Intermediate Outcome, 20,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value 19.00 19.00 33.40 28.00 Date -- 24-Apr-2019 05-Aug-2019 -- Baseline data from 2016 Ethiopia Demographic Health Survey (EDHS) Report. Update to be provided by Comments 2019 Mini-DHS. Results from 2019 Mini-HDS surpassed the targets for 2018 and 2020. ►DLI 3 Children 12-23 months immunized with Pentavalent 3 vaccine (Scaled- DLI- 2c) (Intermediate Outcome, 8,130,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value 65.70 65.70 65.70 75.70 Date -- 24-Apr-2019 05-Aug-2019 -- Source: 2012 Cluster survey. Results have not been updated as a Household Cluster Survey must be conducted to measure the indicator. The recent mission flagged the urgency to ensure this survey is Comments conducted in 2020 to capture achievements and subsequent disbursement. ►DLI 4 Pregnant women receiving at least four antenatal care visits (New DLI -3a) (Intermediate Outcome, 20,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value 32.00 32.00 43.00 38.00 Date -- 24-Apr-2019 05-Aug-2019 -- Baseline data from 2016 Ethiopia Demographic Health Survey (EDHS) Report. Results from 2019 Mini-HDS Comments document that surpassed the DLI targets for 2018 and 2020. ►DLI 5 Contraceptive prevalence rate for rural women only (New DLI -4a) (Intermediate Outcome, 17,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value 32.00 32.00 37.70 38.00 Date -- 24-Apr-2019 05-Aug-2019 -- Baseline data from 2016 Ethiopia Demographic Health Survey (EDHS) Report. Results from 2019 Mini-HDS Comments surpassed the targets for 2018 and 2020. 10/30/2019 Page 14 of 19 The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) ►DLI 6 Health Centers reporting HMIS data in time (restructured -DLI- 5a) (Process, 7,770,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value 68.00 84.00 84.00 86.00 Date -- 24-Apr-2019 05-Aug-2019 -- No update since last ISR. Baseline data from 2012 HMIS Data Quality Assessment (DQA) Report, previous data from 2014 HMIS DQA and current data from 2018 SARA report. Next annual health facility assessment Comments currently under preparation. ►DLI 7 Development and implementation of Annual Rapid Facility Assessment (restructured-DLI- 7c) (Process, 10,950,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value No Yes Yes Yes Date -- 24-Apr-2019 05-Aug-2019 -- Baseline data from 2012 Services Availability and Readiness Assessment (SARA) report, previous data from 2014 SPA+/SARA report and data for the current from 2018 SARA report. The MOH is currently preparing for Comments the upcoming annual survey. ►DLI 8 Transparency of PFSA procurement process (scaled - DLI 8c) (Process, 10.86, 0%) Baseline Actual (Previous) Actual (Current) N/A Value No No No No Date 31-Mar-2013 24-Apr-2019 05-Aug-2019 -- EPSA website is updated and ready for verification. The independent consultant that was under recruitment Comments will do the verification for 2018 and 2019. ToRs will be submitted to the Bank and cleared prior to recruitment. ►DLI 9 Introduction of Procurement Key Performance Indicators developed by Federal Public Procurement Agency at PFSA (New DLI- 9(1)) (Process, 2,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value No No No Yes Date -- 24-Apr-2019 05-Aug-2019 -- Per MOH’s report PSA has started preparing a report using the KPI. However, the report needs to be verified by an independent consultant. The consultant DLI 8 will also verify the implementation of the KPIs for 2018 Comments and 2019. ToRs will be submitted to the Bank and cleared prior to recruitment. ►DLI 10 Automate the PFSA Core Business Fiduciary System using selected software in PFSA HQ and Addis Ababa City (New_ DLI- 9(2) ) (Process, 7,000,000.00, 0%) 10/30/2019 Page 15 of 19 The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Baseline Actual (Previous) Actual (Current) N/A Value No No No Yes Date -- 24-Apr-2019 05-Aug-2019 -- EPSA has decided to implement Enterprise Resource Planning (ERP) based integrated financial management system and has prepared an action plan which lays out the automation schedule for financial management, Comments forecasting, procurement, warehouse management, and inventory management system. The Procurement of ERP will start in September 2019 ►DLI 11 PFSA submission of Backlog audit reports and timely quality audit reports thereafter (New - DLI 9(3) ) (Process, 6,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value No Yes No Yes Date -- 24-Apr-2019 05-Aug-2019 -- The Target 2017 is missed but 2018 achieved. Disbursement is unlikely to be made for 2019 as the EFY2010 Comments Audit is not yet finalized. ►DLI 12 Percent of children 6-59 months receiving Vitamin A supplements (New- DLI -10a) (Intermediate Outcome, 5,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value 45.00 45.00 45.00 53.00 Date -- 24-Apr-2019 05-Aug-2019 -- Baseline data from 2016 Ethiopia Demographic Health Survey (EDHS) Report. Verification could not be made using the 2019 mini DHS as the survey captured data was for the wrong age group (6-35 months) for children Comments receiving Vitamin A. The 2020 DHS survey should capture the correct age group (6-59 months) ►DLI 13 Percent of Wordas in non-emerging Regions delivering Vitamin A Supplements to children through routine system – Health Facilities (New- DLI-10b) (Process, 5,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value 48.00 69.00 69.00 80.00 Date -- 24-Apr-2019 05-Aug-2019 -- Data source: Nutrition Data Verification Joint Review Mission, December 2018. The results for the 2019 Comments target will be verified by a joint review mission (JRM) planned for late November 2019. ►DLI 14 Percent of Pregnant women taking Iron Folic Acid (IFA) tablets (New- DLI- 11) (Intermediate Outcome, 5,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A 10/30/2019 Page 16 of 19 The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Value 17.00 42.10 60.00 25.00 Date -- 24-Apr-2019 05-Aug-2019 -- Baseline data from 2016 Ethiopia Demographic Health Survey (EDHS) Report. Update provided by 2019 Mini- Comments DHS. Results surpassed the targets for 2018 and 2020. ►DLI 15 Percent of Children 0- 23 month participating in GMP (New DLI-12a) (Process, 15,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value 27.00 33.00 33.00 51.00 Date -- 24-Apr-2019 05-Aug-2019 -- Data source: Nutrition Data Verification Joint Review Mission, December 2018. Progress for this indicator is lagging and not on track and the reporting time has also been delayed. The Nutrition JRM will be conducted in Comments late November 2019 to verify the achieved results. ►DLI 16 Percent of Woredas in emerging Regions transitioning from EOS to Community Health Days- CHD (NewDLI- 12b) (Process, 5,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value 0.00 26.00 26.00 50.00 Date -- 24-Apr-2019 05-Aug-2019 -- Data source: Nutrition Data Verification Joint Review Mission, December 2018. The achievement for this DLI is on schedule as verified by the 2018 nutrition JRM. However, the mission recommends giving more focus on Comments quality and improve the data tracking systems. ►DLI 17 Percent of PHC Facilities having all drug from the MOH list of drug available(New- DLI DLI-13(1)) (Process, 7,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value 42.00 45.00 45.00 47.00 Date -- 24-Apr-2019 05-Aug-2019 -- Baseline data from 2018 Services Availability and Readiness Assessment (SARA) report. Result will be Comments verified by SARA 2020. ►DLI 18 Developed and Implement postnatal Care Service directive to improve the quality of Postnatal services (New- DLI- 13(2)) (Process, 5,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value No Yes Yes Yes Date -- 24-Apr-2019 05-Aug-2019 -- 10/30/2019 Page 17 of 19 The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) Source: Postnatal care directive developed on August 5, 2017 and verified by Partners. The Directive has Comments been implemented in all PHCs and the verification report has been shared during the August 2019 mission. ►DLI 19 Improve quality of adolescent services (New- DLI 13(3)) (Process, 6,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value No Yes Yes Yes Date -- 24-Apr-2019 05-Aug-2019 -- The Adolescent and Youth Health Strategy and Standard Health Package for school health have developed. Comments The verification report was submitted during the August 2019 mission. ►DLI 20 Percent of Woreda with Functional Community Health Insurance Schemes (New- DLI-14 (1)) (Process, 19,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value 20.50 27.10 36.00 50.50 Date -- 24-Apr-2019 05-Aug-2019 -- The target for FY18 was a 20 percentage points increase from the baseline of 205 functional CBHI (out of 1,000 woredas). The 2018 results report 271 woredas with functional CBHI and 360 in 2019, a total of 16 Comments percentage points increase from baseline. ►DLI 21 Undertake CBHI review every two Years (New- 14- (2)) (Process, 5,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value Yes Yes Yes Yes Date -- 24-Apr-2019 05-Aug-2019 -- 2017 report was conducted and verified on time. The 2019 EHIA joint review mission needs to be conducted Comments by end of 2019 and quickly verified by the technical working group. ►DLI 22 Devise and implement a mechanism for documenting consultations when communal Private land is used for construction of health facilities (New- DLI-15(1)) (Process, 4,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value No No No Yes Date -- 24-Apr-2019 05-Aug-2019 -- The targets for 2017 and 2018 are missed and 2019 likely to be missed. Land acquisition screening checklist Comments was developed. However, there is no document that shows the mechanism is in place (no periodic report). 10/30/2019 Page 18 of 19 The World Bank Implementation Status & Results Report Ethiopia Health MDG Support Operation (P123531) ►DLI 23 Development and implementation of health sector community score card(New- DLI- 15(2)) (Process, 5,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) N/A Value No No Yes Yes Date -- 24-Apr-2019 05-Aug-2019 -- The target for 2017 is missed. However, the Ministry has submitted the appropriate report and verification for Comments the 2018 target in 2019 that confirms that the result is achieved. 10/30/2019 Page 19 of 19