Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery (P099930) Health Service Delivery (P099930) AFRICA | Mozambique | Health, Nutrition & Population Global Practice | IBRD/IDA | Specific Investment Loan | FY 2009 | Seq No: 16 | ARCHIVED on 04-Mar-2016 | ISR22515 | Implementing Agencies: MInistry of Health Key Dates Key Project Dates Bank Approval Date:16-Apr-2009 Effectiveness Date:11-Jun-2010 Planned Mid Term Review Date:15-Sep-2011 Actual Mid-Term Review Date:22-Jun-2012 Original Closing Date:28-Feb-2014 Revised Closing Date:31-Dec-2016 Project Development Objectives Project Development Objective (from Project Appraisal Document) The project's development objectives are to: (a) reduce child mortality; (b) reduce maternal mortality; (c) reduce the burden of malaria; (d) reduce the prevalence of tuberculosis; and (e) reduce inequity in the access to health services in Mozambique. 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 To increase access to, and utilization of, maternal and child health and nutrition services in target areas in the Recipient's territory. Components Name Improvement in service delivery.:(Cost $80.00 M) Boosting of national malaria control program:(Cost $15.50 M) Strategic Planning and Capacity Building:(Cost $7.40 M) Project Management and Operating Costs:(Cost $6.50 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 Overall Risk Rating  Moderate  Moderate 3/4/2016 Page 1 of 17 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery (P099930) Implementation Status and Key Decisions The Project has made progress in rolling ou Community Based Nutrition interventions in the three provinces of Cabo Delgado, Nampula and Niassa. The mother groups have been created and nutrition promoters have been trained and started making demonstrations on how to prepare nutritious food for infants, including the addition of a Micro-Nutrient Powder. The construction of health centers type II in the three target provinces started in late November 2015, with a delay of more than 6 weeks. Generally, the project indicators show good progress; consistent with the same trend observed over the last 6-12 months and more. For example, the coverage of institutional deliveries increased in the three provinces reaching an average of 81%, above the national target of 75%. Also of particular relevance is the increase in the coverage of Intermittent Preventive Treatment (IPT) for malaria among pregnant women in antenatal clinics. IPT coverage was 42% in 2014, and increased to an average of 69% in 2015, surpassing the 2015 target of 60%. 3/4/2016 Page 2 of 17 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery (P099930) 3/4/2016 Page 3 of 17 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery (P099930) 3/4/2016 Page 4 of 17 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery (P099930) 3/4/2016 Page 5 of 17 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery (P099930) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating 3/4/2016 Page 6 of 17 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery (P099930) Political and Governance  --  Low  Low Macroeconomic  --  Moderate  Moderate Sector Strategies and Policies  --  Moderate  Moderate Technical Design of Project or Program  --  Low  Low Institutional Capacity for Implementation and Sustainability  --  Substantial  Substantial Fiduciary  --  Moderate  Moderate Environment and Social  --  Moderate  Moderate Stakeholders  --  Low  Low Other  --  --  -- Overall  --  Moderate  Moderate Results Project Development Objective Indicators PHINDPDOTBL  Percentage of institutional deliveries (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.80 80.30 81.30 65.00 Date 31-Dec-2009 31-Mar-2015 30-Jun-2015 31-Dec-2016 PHINDPDOTBL  Cabo Delgado (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 57.00 74.00 78.00 65.00 Date 31-Dec-2009 31-Mar-2015 30-Jun-2015 31-Dec-2016 PHINDPDOTBL  Nampula (Percentage, Custom Breakdown) 3/4/2016 Page 7 of 17 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery (P099930) Baseline Actual (Previous) Actual (Current) End Target Value 53.00 83.00 84.00 65.00 Date 31-Dec-2009 31-Mar-2015 30-Jun-2015 31-Dec-2016 PHINDPDOTBL  Percentage of children vaccinated with DPTHepHib3 in the first year of life in each province (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45.00 96.60 104.30 90.00 Date 31-Dec-2009 31-Mar-2015 30-Jun-2015 31-Dec-2016 Comments All data for tis indicator exceed 100%. This may be due to problems with the denominator and or interventions delivered to individuals outside the target group. This has been a longstanding issue that the MOH has been trying to address with no success. However figures obtained from surveys provide more accurate figures in the range of 70-75% PHINDPDOTBL  Cabo Delgado Province (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 71.00 103.00 104.00 90.00 Date 31-Dec-2009 31-Mar-2015 30-Jun-2015 31-Dec-2016 PHINDPDOTBL  Nampula Province (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 51.00 97.00 108.00 90.00 Date 31-Dec-2009 31-Mar-2015 30-Jun-2015 31-Dec-2016 PHINDPDOTBL  Percentage of pregnant women who received 2nd dose of IPT at antenatal clinics (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 3/4/2016 Page 8 of 17 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery (P099930) Value 18.60 53.30 70.30 60.00 Date 31-Dec-2009 31-May-2015 30-Jun-2015 31-Dec-2016 PHINDPDOTBL  Cabo Delgado (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 18.60 50.00 71.00 60.00 Date -- 31-Mar-2015 30-Jun-2015 31-Dec-2016 PHINDPDOTBL  Niassa (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 18.60 46.00 65.00 60.00 Date -- 31-Mar-2015 30-Jun-2015 31-Dec-2016 PHINDPDOTBL  Nampula (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 18.60 56.00 75.00 60.00 Date -- 31-Mar-2015 30-Jun-2015 31-Dec-2016 PHINDPDOTBL  Direct project beneficiaries (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 215960.00 439367.00 850000.00 Date 31-Dec-2009 31-Mar-2015 30-Jun-2015 31-Dec-2016 3/4/2016 Page 9 of 17 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery (P099930) PHINDPDOTBL  Female beneficiaries (Percentage, Core Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 84.30 83.00 80.00 PHINDPDOTBL  Percentage of children aged 0-24 months fed in accordance with all 3 IYCF practices (food diversity, feeding frequency, and consumption of breast milk or milk) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value -- 0.00 0.00 10.00 Date -- 30-Jun-2015 30-Jun-2015 31-Dec-2016 Comments Baseline data for this indicator will be obtained from the baseline survey done by the National Institute of Health (INS). Preliminary data from the survey is available but the analysis has not yet been completed. Unfortunately, a computer containing cleaned data of the survey was stolen from the INS offices. For this reason the INS, needs more time to restart the cleaning of the data using a backup data set. The report is now expected to be available in May 2016. Overall Comments Intermediate Results Indicators PHINDIRITBL  Outreach teams fully operational in Cabo Delgado, Nampula, and Niassa (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value -- 1221.00 -- 54.00 Date 31-Dec-2009 31-Mar-2015 30-Jun-2015 31-Dec-2016 Comments The MOH has not yet provided the figure for 2015. It is expected that during first quarter of 2016, when all Provincial reports are consolidated, the indicator will be calculated. 3/4/2016 Page 10 of 17 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery (P099930) PHINDIRITBL  Number of Agentes Polivalentes Elementares (APEs) trained (cumulative) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1230.00 1446.00 1100.00 Date 31-Dec-2009 30-Jun-2015 30-Jun-2015 31-Dec-2016 PHINDIRITBL  Health personnel receiving training (number) (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 314.00 374.00 300.00 Date 31-Dec-2009 31-Dec-2014 30-Jun-2015 31-Dec-2016 PHINDIRITBL  Health facilities constructed, renovated, and/or equipped (number) (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 18.00 Date 31-Dec-2009 30-Jun-2015 30-Jun-2015 31-Dec-2016 Comments There are no new construction nor renovated building completed to date. The first facilities might be completed during second half of 2016. PHINDIRITBL  Pregnant women receiving first ANC visit (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 165917.00 172740.00 290496.00 385000.00 Date 31-Dec-2009 31-Mar-2015 30-Jun-2015 31-Dec-2016 Comments The end-targets for Cabo Delgado Province may have been overestimated, as were derived from official statistics. But according to the definition of this indicators, the number of pregnant women receiving fist ANC visit should be represent some fraction of all pregnant women receiving ANC in public facilities that received some form of Bank support. It may also be that the target were actually revised to reflect nationally agreed targets.This matter will be further discussed with the MOH during next mission. 3/4/2016 Page 11 of 17 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery (P099930) PHINDIRITBL  Cabo Delgado (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 118126.00 32170.00 61824.00 85853.00 Date 31-Dec-2009 31-Mar-2015 30-Jun-2015 31-Dec-2016 PHINDIRITBL  Nampula (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 267517.00 95124.00 181953.00 217338.00 Date 31-Dec-2009 31-Mar-2015 30-Jun-2015 31-Dec-2016 PHINDIRITBL  Children receiving a dose of vitamin A (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 194521.00 303126.00 236639.00 1065594.00 Date 31-Dec-2009 31-Mar-2015 30-Jun-2015 31-Dec-2016 3/4/2016 Page 12 of 17 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery (P099930) PHINDIRITBL  Cabo Delgado (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 178490.00 88102.00 41420.00 240113.00 Date 31-Dec-2009 31-Mar-2015 30-Jun-2015 31-Dec-2016 PHINDIRITBL  Nampula (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 185879.00 178576.00 144434.00 625488.00 Date 31-Dec-2009 31-Mar-2015 30-Jun-2015 31-Dec-2016 PHINDIRITBL  Number of children under 1 year of age fully immunized (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 81848.00 81496.00 146871.00 243264.00 Date 31-Dec-2009 31-Mar-2015 30-Jun-2015 31-Dec-2016 Comments The end-target for Cabo Delgado and Nampula Province are less than the baseline. Niassa' s end-target is greater than the baseline value. Again, these adjustments may have been introduced by the MOH to conform with official statistics. The team will further discuss these matters with the MOH during next mission. PHINDIRITBL  Cabo Delgado (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 62412.00 19030.00 28433.00 54904.00 Date 31-Dec-2012 31-Mar-2015 30-Jun-2015 31-Dec-2016 3/4/2016 Page 13 of 17 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery (P099930) PHINDIRITBL  Nampula (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 150427.00 47966.00 32487.00 143024.00 Date 31-Dec-2012 31-Mar-2015 30-Jun-2015 31-Dec-2016 PHINDIRITBL  Number of Volunteers functional (cumulative) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 12500.00 21000.00 Date 31-Mar-2013 31-Dec-2014 30-Jun-2015 31-Dec-2016 PHINDIRITBL  Percentage of children aged 0-24 months attended at least 1 Growth Monitoring and Promotion services during the 2 preceding months,% who are female (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 31-Mar-2013 31-Dec-2014 31-Dec-2014 31-Dec-2016 Comments This indicator will be obtained from the baseline survey done by the National Institute of Health. Preliminary data from the survey is available but the analysis has not yet been completed. As mentioned above, the final report will be delayed because the computer containing the data that had been cleaned was stolen. The INS needs more time to redo data cleaning and this will delay analysis and the report now expected to be submitted in May, 1, 2016. PHINDIRITBL  Percentage of children aged 6-24 months received at least 60 sachets of micronutrient powder (MNP) during the 2 preceding months, %who are female (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 31-Mar-2013 31-Dec-2014 31-Dec-2014 31-Dec-2016 Comments Data will be available this year at eh end of the first quarter, 2016. MNP started being provided during the last quarter of calendar year 3/4/2016 Page 14 of 17 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery (P099930) 2015. PHINDIRITBL  Percentage of pregnan women received a complete dose of IFA tablets (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value -- 0.00 0.00 -- Date 31-Mar-2013 31-Dec-2014 31-Dec-2014 31-Dec-2016 Comments This indicator will be obtained from the baseline survey done by the National Institute of Health. Preliminary data from the survey is available but the analysis has not yet been completed. As mentioned above, the final report will be delayed because the computer containing the data that had been cleaned was stolen. The INS needs more time to redo data cleaning and this will delay analysis and the report now expected to be submitted in May, 1, 2016. Overall Comments Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P099930 IDA-45820 Effective USD 44.60 44.60 0.00 30.94 12.92 69% P099930 IDA-51940 Effective USD 37.00 37.00 0.00 22.11 12.93 60% P099930 TF-58155 Closed USD 1.15 0.18 0.97 0.18 0.00 100% P099930 TF-96375 Closed USD 7.86 7.53 0.33 7.53 0.00 100% P099930 TF-96399 Effective USD 4.05 4.05 0.00 3.50 0.55 86% P099930 TF-96505 Closed USD 11.78 11.78 0.00 12.62 1.71 107% 3/4/2016 Page 15 of 17 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery (P099930) Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P099930 IDA-45820 Effective 16-Apr-2009 15-Jul-2009 11-Jun-2010 28-Feb-2014 31-Dec-2016 P099930 IDA-51940 Effective 24-Jan-2013 25-Mar-2013 21-Jun-2013 31-Dec-2016 31-Dec-2016 P099930 TF-58155 Closed 21-Sep-2007 21-Sep-2007 21-Sep-2007 31-Dec-2009 31-Dec-2009 P099930 TF-96375 Closed 19-Mar-2010 24-Mar-2010 24-Mar-2010 30-Apr-2013 31-Jul-2013 P099930 TF-96399 Effective 19-Mar-2010 24-Mar-2010 24-Mar-2010 28-Feb-2014 28-Feb-2016 P099930 TF-96505 Closed 15-Apr-2010 19-Apr-2010 19-Apr-2010 28-Feb-2014 31-Jan-2016 Cumulative Disbursements Restructuring History There has been no restructuring to date. Related Project(s) P125477-Mozambique Nutrition Additional Financing 3/4/2016 Page 16 of 17 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery (P099930) 3/4/2016 Page 17 of 17 Public Disclosure Copy