The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) MA-Health Sector Support (P148017) MIDDLE EAST AND NORTH AFRICA | Morocco | Health, Nutrition & Population Global Practice | Requesting Unit: MNC01 | Responsible Unit: GHN05 IBRD/IDA | Program-for-Results Financing | FY 2015 | Team Leader(s): Aissatou Diack, Fatima El Kadiri El Yamani Seq No: 9 | ARCHIVED on 26-Jun-2019 | ISR37873 | Created by: Aissatou Diack on 24-Jun-2019 | Modified by: Aissatou Diack on 26-Jun-2019 Program Development Objectives Program Development Objective (from Program Appraisal Document) The objective of the Program is to expand access to primary healthcare in targeted rural areas in the Program Area. 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 Summary: The project was approved on April 24, 2015, became effective on September 21, 2015, and has a closing date of December 31, 2019. A Level 2 restructuring was approved in August 2017 to: (i) revise the project’s target regions following a recent government administrative reform; (ii) update baseline data for 6 of the 7 disbursement-linked indicators (DLIs) to reflect the new target areas; and (iii) address issues related to the definition of several indicators. Implementation: Progress towards achieving the Project’s Project Development Objective and Overall Implementation Progress are rated as Moderately Satisfactory. There is notable progress towards achieving the PDO, with its focus on improving access to health services in rural areas: 3 PDO indicators exceeded their targets in 2015, 1 partially achieved its target and 1 exceeded its target significantly. The disbursement rate since the last ISR has increased from 63% to 80%. DLI Indicators: - DLI 1 (i.e. increase in utilization of antenatal care by rural pregnant women) had a 6.86% increase from the baseline vs. the 2016 target of 2.18%. - DLI 2 (i.e. increase in deliveries attended by skilled health personnel by rural women in the target regions) had a partial achievement of progress with a 0.39% increase vs. the 2016 target of 3.42%. - DLI 3 (i.e. increase in number of new visits of children under 5 to a rural primary health care center facility (ESSP) in the Program Area for curative care) exceeded its target with a 2.53% increase vs. the 2016 target of 2.50%. - DLI 4 (i.e. increase in number of diabetic patients diagnosed and treated by rural primary health care – PHC - services) greatly exceeded the target with a 22% increase vs. the 2015 target of 4%.The total amount against this DLI was disbursed in 2017. - DLI 5 (i.e. increase in number of visits (new cases) to rural ESSPs in the Program Area) showed a minor increase with a 5.76% increase vs. the 2016 target of 2.30%. Primary Health Care (PHC): There has been considerable progress to extend access to PHC in rural areas of the 7 target regions: Tanger- Tetouan-Al Hoceima, Oriental, Fès-Meknes, Beni Mellal-Khénifra, Marrakech-Safi, Drâa-Tafilalet And Souss-Massa. The MOH continues to take necessary actions and implement strategies for greater availability and better quality of PHC in rural areas such as: (i) implementation of interventions accelerate the reduction of maternal mortality, neonatal mortality and deaths for children under five years; (ii) strengthening the detection and support for non-communicable diseases, including diabetes and high blood pressure (HTA); and (iii) improving the coverage of mobile health services to nomadic populations or those living far from health centres. A substantial improvement of health system governance at the primary level has been achieved through: (i) implementation of measures to increase incentives to improve the presence and performance of health human resources as noted through system diagnostics and to be validated within the framework of the health human resources development strategy; (ii) strengthened accountability through the development of the main quality control tool (competition quality) which includes more than 23% of PHC institutions (ESSP); (iii) setting up a comprehensive mechanism for the treatment of grievances – the "Centre d’écoute et de gestion des reclamations" (CEGR), which is now fully operational, was institutionalized and decentralized in the 12 regions of Morocco; and; (iv) development of an integrated, computerized and accessible health information system for maternal and child healthcare (SMIPF). 6/26/2019 Page 1 of 9 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Project Restructuring: A Level-2 project restructuring will be processed to (i) extend the project closing date by 1 year; and (ii) reallocate undisbursed funds allocated to DLI 7 related to the strengthening of the Health Management Information System (HMIS). Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P148017 IBRD-85070 Effective USD 100.00 100.00 0.00 80.14 19.86 80% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P148017 IBRD-85070 Effective 24-Apr-2015 02-Jul-2015 21-Sep-2015 31-Dec-2019 31-Dec-2019 Program Action Plan Finalize the POM by incorporating the new procedures of the National Plan for Medical and Pharmaceutical Waste Action Description Management. Source DLI# Responsibility Timing Timing Value Status Client Due Date 31-May-2016 Completed Completion Measurement Comments The responsible persons in the seven targeted regions will ensure follow up of environmental aspects according to Action Description regulation (decret 2009). Source DLI# Responsibility Timing Timing Value Status Client Due Date 31-Dec-2018 Not Yet Due Completion Measurement Comments Creation of a budgetary line in the annual Budgetary of MoH regional directorate and of MoH delegations to Action Description externalize the medical and pharmaceutical waste management at the ESSP levels Source DLI# Responsibility Timing Timing Value Status 6/26/2019 Page 2 of 9 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Client Due Date 30-Mar-2018 Completed Completion Measurement Comments Action Description The seven target regions implement the externalization of the medical and pharmaceutical waste management. Source DLI# Responsibility Timing Timing Value Status Client Due Date 31-May-2019 Not Yet Due Completion Measurement Comments Action Description The diagnosis of the current GRMs, the strategy and the draft GRM implementation manual are completed. Source DLI# Responsibility Timing Timing Value Status Client Due Date 31-Dec-2015 Completed Completion Measurement Comments Action Description The pilot GRM was completed and the GRM is scaled up is at national level. Source DLI# Responsibility Timing Timing Value Status Client Due Date 30-Dec-2016 Completed Completion Measurement Comments Action Description The pilot GRM is evaluated and the implementation manual is reviewed. Source DLI# Responsibility Timing Timing Value Status Client Due Date 31-Dec-2017 Completed Completion Measurement 6/26/2019 Page 3 of 9 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Comments Action Description The GRM is rolled out at the regional level. Source DLI# Responsibility Timing Timing Value Status Client Due Date 31-Dec-2021 Not Yet Due Completion Measurement Comments Audit: Action Description 1) Setting up of internal audit and management control functions at the central and regional levels of the MoH. At the regional levels, these functions will be located within the Regional directorate of Health. Source DLI# Responsibility Timing Timing Value Status Client Due Date 31-Dec-2019 In Progress Completion Measurement Comments Audit: Action Description 2) Agree on improved terms of reference for audit, including procurement and governance. Source DLI# Responsibility Timing Timing Value Status Client Due Date 09-Jun-2017 Completed Completion Measurement Comments Support to the implementation of the new PFM framework and organic finance law. This involves support in the Action Description preparation of a multi-year budget and a draft performance plan, contracting and monitoring and evaluation system. Source DLI# Responsibility Timing Timing Value Status Client Due Date 31-Dec-2019 In Progress Completion Measurement 6/26/2019 Page 4 of 9 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Comments Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Moderate Moderate Macroeconomic -- Low Low Sector Strategies and Policies -- Low Low Technical Design of Project or Program -- Substantial Substantial Institutional Capacity for Implementation and Sustainability -- Moderate Moderate Fiduciary -- Moderate Moderate Environment and Social -- Substantial Substantial Stakeholders -- Moderate Moderate Other -- -- -- Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes The objective of the program is to expand access to primary health care in targeted rural areas IN00723422 ►Increase in number of pregnant women receiving antenatal care during a visit to a rural ESSP in the Program Area (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 5.83% increase from Value 161 829 163 820 172 933 baseline Date 31-Dec-2014 31-Dec-2015 30-Dec-2016 31-Dec-2019 Comments IN00723423 ►Increase in number of deliveries of rural women attended by skilled health personnel in public health facilities in the Program Area (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 7.26% increase from Value 180 812 181 540 181,529.00 baseline Date 31-Dec-2014 31-Dec-2015 30-Dec-2016 31-Dec-2019 6/26/2019 Page 5 of 9 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Comments IN00723424 ►Increase in number of new visits of children under 5 to a rural ESSP in the Program Area for curative care (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 5.00% increase from Value 1 013 436 1 036 084 1 1039 111 baseline Date 31-Dec-2014 31-Dec-2015 30-Dec-2016 31-Dec-2019 Comments IN00723425 ►Increase in number of patients with diabetes diagnosed and treated at a rural ESSP in the Program Area (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 17.63% increase from Value 136 238 167 086 167 086 baseline Date 31-Dec-2014 31-Dec-2015 31-Dec-2015 31-Dec-2019 Comments Intermediate Results Indicators by Results Areas Expanding equitable access to primary care in rural areas IN00723446 ►Increase in number of visits to rural ESSPs in the Program Area (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 4.3% increase from Value 3 753 120 3 844 947 4 013 532 baseline Date 31-Dec-2014 31-Dec-2015 30-Dec-2016 31-Dec-2019 Comments IN00723448 ►Number of patients with hypertension diagnosed and treated in rural ESSPs (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 180,000.00 199,838.00 232,702.00 287,000.00 Date 31-Dec-2013 31-Dec-2015 30-Dec-2016 31-Dec-2019 Comments IN00723449 ►Establishment of a comprehensive GRM (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Diagnosis, strategy and draft GRM Roll out of the Value GRM not established Pilot GRM launched Implementation Manual comprehensive GRM completed 6/26/2019 Page 6 of 9 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Date 31-Dec-2014 31-Dec-2015 30-Dec-2016 31-Dec-2018 Comments IN00723450 ►Definition of an HR incentive mechanism in rural ESSPs (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Implementation mechanism defined, including target diagnostic study not yet diagnostic study indicators, Value Diagnostic not completed completed completed performance criteria, and beneficiaries. Legal documents drafted. Date 31-Dec-2014 31-Dec-2015 31-Dec-2015 30-Dec-2016 Comments IN00723451 ►Establishment of the HMIS in one region within the Program Area (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Legal documents drafted, HMIS Value HMIS not established urbanization completed urbanization completed operational in >80% of facilities in one region. Date 31-Dec-2014 31-Dec-2015 31-Dec-2015 31-Dec-2018 Comments IN00723452 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 728.00 717.00 13,126.00 Date 31-Dec-2014 31-Dec-2015 31-Dec-2015 31-Dec-2019 Comments IN00723453 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 728.00 717.00 13,126.00 Date 31-Dec-2014 31-Dec-2015 30-Dec-2016 31-Dec-2019 Improving health system governance at the primary level IN00723447 ►% of rural health centers with delivery services (CSCAs) in the Program Area that participate in the main annual quality assessment (concours qualité) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/26/2019 Page 7 of 9 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Value 11.49 23.00 23.00 60.00 Date 31-Dec-2013 31-Dec-2015 31-Dec-2015 31-Dec-2018 Comments Disbursement Linked Indicators DLI_IND_TABLE ►DLI 1 Increase in number of pregnant women receiving antenatal care during a visit to a rural ESSP in the Program Area (Output, 14,000,000.00, 86%) Baseline Actual (Previous) Actual (Current) CY2019 Value 161,829.00 163,820.00 172 933 -- Date 31-Dec-2014 31-Dec-2015 30-Dec-2016 -- Comments ►DLI 2 Increase in number of deliveries of rural women attended by skilled health personnel in public health facilities in the Program Area (Output, 14,000,000.00, 8%) Baseline Actual (Previous) Actual (Current) CY2019 Value 180,812.00 181,540.00 181 529 -- Date 31-Dec-2014 31-Dec-2015 30-Dec-2016 -- Comments ►DLI 3 Increase in number of new visits of children under 5 to a rural ESSP in the Program Area for curative care (Output, 10,000,000.00, 65%) Baseline Actual (Previous) Actual (Current) CY2019 Value 1,013,436.00 1,036,084.00 1,039,111.00 -- Date 31-Dec-2014 31-Dec-2015 30-Dec-2016 -- Comments ►DLI 4 Increase in number of patients with diabetes diagnosed and treated at a rural ESSP in the Program Area (Output, 20,000,000.00, 100%) Baseline Actual (Previous) Actual (Current) CY2019 Value 136,238.00 167,086.00 167,086.00 -- Date 31-Dec-2014 31-Dec-2015 31-Dec-2015 -- 6/26/2019 Page 8 of 9 The World Bank Implementation Status & Results Report MA-Health Sector Support (P148017) Comments ►DLI 5 Increase in number of visits to rural ESSPs in the Program Area (Output, 10,000,000.00, 89%) Baseline Actual (Previous) Actual (Current) CY2019 Value 3,794,877.00 3,844,947.00 4,013,532.00 -- Date -- 31-Dec-2015 30-Dec-2016 -- Comments ►DLI 6 % of rural health centers with delivery services (CSCAs) in the Program Area that participate in the main annual quality assessment (concours qualité) (Output, 8,000,000.00, 16%) Baseline Actual (Previous) Actual (Current) CY2019 Value 11.49 23.00 23.00 -- Date 31-Dec-2014 31-Dec-2015 31-Dec-2015 -- Comments ►DLI 7 Establishment of the HMIS in one region within the Program Area (Output, 24,000,000.00, 21%) Baseline Actual (Previous) Actual (Current) CY2019 Urbanization process Urbanization process Value Not established -- completed completed Date 31-Dec-2014 31-Dec-2015 31-Dec-2015 -- Comments 6/26/2019 Page 9 of 9