The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Mozambique Primary Health Care Strengthening Program (P163541) AFRICA | Mozambique | Health, Nutrition & Population Global Practice | Requesting Unit: AFCS2 | Responsible Unit: GHN01 IBRD/IDA | Program-for-Results Financing | FY 2018 | Team Leader(s): Humberto Albino Cossa, Lorena Vinuela Seq No: 3 | ARCHIVED on 28-Mar-2019 | ISR36315 | Created by: Courtney Price Ivins on 13-Mar-2019 | Modified by: Humberto Albino Cossa on 20-Mar- 2019 Program Development Objectives Program Development Objective (from Program Appraisal Document) The Program Development Objective is to improve the utilization and quality of reproductive, maternal, child and adolescent health and nutrition services, particularly in underserved areas. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Implementation Status and Key Decisions The Program’s Additional Financing (AF) of US$90.1million was approved by the World Bank Regional Vice President on March 1, 2019. This enabled a significant scale-up of Disbursement Linked Results (DLRs) and the addition of a Disbursement Linked Indicator (DLI) on essential medicines availability at primary care facilities. Government reports indicate the achievement of 9 out of 11 year-one DLRs from Jan-Dec 2018. This includes results for three DLIs that are Program Development Objective indicators (coverage of nutrition, institutional deliveries, and Couple Years of Protection), and other DLIs that represent significant challenges overcome (e.g. scorecards and community consultations, Civil Registration and Vital Statistics). Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P163541 IDA-D2650 Effective USD 80.00 80.00 0.00 20.11 60.33 25% P163541 TF-A6152 Effective USD 15.00 15.00 0.00 3.75 11.25 25% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P163541 IDA-D2650 Effective 20-Dec-2017 02-Mar-2018 18-Apr-2018 31-Dec-2022 31-Dec-2022 P163541 TF-A6152 Effective 20-Dec-2017 02-Mar-2018 18-Apr-2018 31-Dec-2021 31-Dec-2021 3/28/2019 Page 1 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Program Action Plan Action Description The Program Operations Manual shall be adopted by the Recipient in a manner satisfactory to the Association. Source DLI# Responsibility Timing Timing Value Status Ministry of Health Technical Due Date 30-Jun-2019 Revised Date (MOH) - DPC Completion Approved POM Measurement Comments The Program Management Unit (PMU) shall be assembled with a Terms of Reference and composition satisfactory to Action Description the Association (including experienced fiduciary personnel). Source DLI# Responsibility Timing Timing Value Status Technical MOH - DPC Due Date 29-Jun-2018 Completed Completion PMU ToR Measurement Comments Annual accounts of the health Economic and Social Plan (PES) audited within 12 months after the end of the fiscal Action Description year by the Administrative Tribunal; Resulting action plan produced, implemented, and reported on annually. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems MOH -DAF Recurrent Yearly Not Yet Due Completion (i) Audit Report Measurement (ii) Report on Action Plan implementation Comments The starting year is 2019 Annual procurement audit of PES within 12 months of the end of the FY by independent firm, covering regulatory Action Description compliance, performance, and VFM; Action plans implemented and reported on; Remedies against ineligible expenditures and misprocurement. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems MISAU & WB Recurrent Yearly Not Yet Due Completion (i) Audit Report (n-1) Measurement (ii) Report on Action Plan implementation Comments 3/28/2019 Page 2 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Assurance that adequately trained accounting technicians are appointed in District Services for Health, Gender, the Action Description Child, and Social Action (SDSGCAS), and at district hospitals as they become UGEs. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems MOH -DAF Recurrent Continuous In Progress Completion Training Reports Measurement Comments Action Description Design a medium-term (4 year) targeted capacity development and staffing plan for fiduciary staff at all levels. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems MOH -DAF Due Date 31-Oct-2018 Completed Completion Plan Measurement Comments Action Description PBA for Health Facilities (i) Develop procedures for planning, disbursing, and reporting on PBA for health facilities Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems DLI 8 MISAU Due Date 29-Mar-2019 Completed Completion Financial Management Manual Measurement Comments PBA for Health Facilities (ii) Ensure PES/budgets are formulated in consultation with health facilities, and include Action Description amounts allocated to each health facility (including PBA) Source DLI# Responsibility Timing Timing Value Status SDSGAS/DPS/MISA Fiduciary Systems Recurrent Yearly In Progress U Completion Budgets/PES Measurement Comments 3/28/2019 Page 3 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Action Description Standard Bidding Documents (SBDs): Update SBDs to reflect new decree. Source DLI# Responsibility Timing Timing Value Status Functional Unit Fiduciary Systems Procurement Due Date 29-Mar-2019 Completed Supervision Completion Updated SBDs Measurement Comments IC/PES Budgetary Alignment Action Description (i) Align IC costing with Government budget categories;(ii) Conduct workshops with Provincial and District-level budget holders; (iii) Utilize e-SISTAFE data to enable more granular monitoring Source DLI# Responsibility Timing Timing Value Status MISAU, WB Fiduciary Systems Technical Recurrent Yearly In Progress Assistance (i) IC budgetary alignment Completion (ii) Workshop reports Measurement (iii) BOOST analysis Comments IC/PES Budgetary Alignment (i) Align IC costing with Government budget categories;(ii) Conduct workshops with Action Description Provincial and District-level budget holders; (iii) Utilize e-SISTAFE data to enable more granular monitoring Source DLI# Responsibility Timing Timing Value Status MISAU, WB Fiduciary Systems Technical Recurrent Yearly In Progress Assistance Completion (i) IC budgetary alignment (ii) Workshop reports (iii) BOOST analysis Measurement Comments Duplication, marked for deleted Action Description Standard Bidding Documents (SBDs): Update SBDs to reflect new decree. Source DLI# Responsibility Timing Timing Value Status Functional Unit Fiduciary Systems Procurement Due Date 29-Mar-2019 Completed Supervision 3/28/2019 Page 4 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Completion Updated SBDs Measurement Comments Action Description Standard Bidding Documents (SBDs): Update SBDs to reflect new decree. Source DLI# Responsibility Timing Timing Value Status Functional Unit Fiduciary Systems Procurement Due Date 29-Mar-2019 Completed Supervision Completion Updated SBDs Measurement Comments Duplication, marked for deleted Environmental Health Department Training Satisfactory completion of at least one training of Environmental Health Action Description Department technicians at central level and provincial focal points and chief medical officers on the EIA process Source DLI# Responsibility Timing Timing Value Status MOH - Department Environmental and Social of Environmental Due Date 29-Mar-2019 Not Yet Due Systems Health Completion Program Action Plan Implementation Report (PAP IR) Number of people trained in general and per province Measurement Screening forms completed by DEH for (a) Project subproject; (b) MISAU projects Comments Health Waste Management (I) Action Description Provide MISAU’s Environmental Specialist with training on health facility waste management Source DLI# Responsibility Timing Timing Value Status MISAU - DNSP and Fiduciary Systems Due Date 29-Mar-2019 Completed DNAM Completion Completion of training by Environmental Specialist Measurement A draft proposal submitted to the Planning and Cooperation Department (DPC) for authorization.It is suggested that Comments this training be carried out along with training in biomedical waste management, since the participants are the same. Health Waste Management (II) Preparation and distribution of informational materials on health waste management Action Description and delivery of at least one training on health waste management for provincial level and health facilities managers. 3/28/2019 Page 5 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Source DLI# Responsibility Timing Timing Value Status Environmental and Social MISAU-DNSP and Due Date 29-Mar-2019 Not Yet Due Systems DNAM Completion PAP IR Informational materials available at health facilities with in-patient care (80%) Number of people trained in Measurement general and per province Comments Action Description Health Waste Management (III) Inclusion of waste management in health facility scorecard Source DLI# Responsibility Timing Timing Value Status Environmental and Social DLI 8 MISAU Due Date 29-Mar-2019 Completed Systems Completion Year 1 DLI validation Measurement Scorecard Comments Health Waste Management (IV) Ensure that health waste management protocols are included in training curricula for Action Description health professionals Source DLI# Responsibility Timing Timing Value Status Environmental and Social MISAU- DNSP, Due Date 29-Mar-2019 Not Yet Due Systems DNAM and DRH PAP IR Completion Training curricula Measurement Number of courses delivered Comments Disaster Contingency: Conduct at least one training on new disaster contingency protocols for APEs and SDSGCAS Action Description managers in vulnerable districts Source DLI# Responsibility Timing Timing Value Status Environmental and Social MISAU (DEH) and Due Date 31-Mar-2020 Not Yet Due Systems INGC PAP IR Completion Curriculum Measurement Number of people trained Comments 3/28/2019 Page 6 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Gender and socio-cultural responsiveness (I): Engagement of a social development specialist to: (i) provide oversight Action Description for gender and socio-cultural sensitivity in the sector; (ii) lead the review and enhancement of complaint handling mechanisms Source DLI# Responsibility Timing Timing Value Status Environmental and Social MISAU Due Date 29-Mar-2019 Not Yet Due Systems PAP IR Completion ToR developed and agreed with the Bank Measurement Social Development Specialist engaged A focal point form the National Institute for Disaster Management (INGC)has been identified who will deliver the Comments training to Community Health workers (APEs and district health managers). Gender and socio-cultural responsiveness (II): Ensure approaches to gender and socio-cultural sensitivity are Action Description reflected in the curriculum and training of community health workers (APEs) and health staff and supported by appropriate materials Source DLI# Responsibility Timing Timing Value Status MOH DRH, DSNP Environmental and Social and MOH's Gender Due Date 29-Mar-2019 Not Yet Due Systems Unit PAP IR Curriculum Completion Measurement Training materials available at health centers and district/rural hospitals Number of trained staff in general and per province Comments Gender and Socio-cultural Responsiveness (III) Develop community-based intervention to engage men in family planning and sexual and reproductive health Action Description activities Source DLI# Responsibility Timing Timing Value Status Environmental and Social MOH DNSP Due Date 29-Mar-2019 In Progress Systems PAP IR Completion Measurement Number of provinces or districts that have community-based interventions to engage men in family planning and sexual and reproductive health Comments 3/28/2019 Page 7 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Gender and Socio-Cultural Responsiveness (IV) Action Description Ensure gender-based violence is reflected in the curriculum of health professionals, including APEs Source DLI# Responsibility Timing Timing Value Status Environmental and Social MOH -DRH, MOH's Recurrent Yearly In Progress Systems Gender Unit, DNSP PAP IR Completion Curriculum Measurement Number of health professionals trained Comments Gender and Socio-cultural Responsiveness (V) Include prioritized gender and socio-cultural sensitivity and GRM access dimensions in health facility scorecard and Action Description community consultations Source DLI# Responsibility Timing Timing Value Status Environmental and Social DLI 9 MOH DNSP, MOH"s Due Date 31-Mar-2020 Completed Systems Gender units Completion Year 2 DLI validation Scorecard Measurement Comments Enhancement of complaints handling mechanisms (GRM): Ensure installation of complaint and suggestion boxes in all health facilities, training for health care providers, dissemination through community consultations, inclusion in Action Description scorecard Source DLI# Responsibility Timing Timing Value Status Environmental and Social MOH (DNSP, Recurrent Yearly Not Yet Due Systems DNAM) PAP IR Completion Curricula and consultation protocols, scorecard Measurement Complaint reception and closure registry at facility and central levels Comments Action Description Enhancement of complaints handling mechanisms (GRM) Ensure installation of complaint and suggestion boxes in all health facilities, training for health care providers, dissemination through community consultations, inclusion in scorecard 3/28/2019 Page 8 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Source DLI# Responsibility Timing Timing Value Status Environmental and Social MOH DNSP, DNAM Recurrent Yearly Not Yet Due Systems PAP IR Completion Curricula and consultation protocols, scorecard Measurement Complaint reception and closure registry at facility and central levels Comments Duplication, marked for deleted Conduct refreshment courses to key staff that are responsible for Pharmaceutical Waste Management (handle, store Action Description and dispose) at the Provincial and Regional and Central hospitals and Medical Stores based on existing material Source DLI# Responsibility Timing Timing Value Status Environmental and Social CMAM Due Date 31-Dec-2019 Not Yet Due Systems Completion At least 50 percent of people with key role in Pharmaceutical Waste Management successfully trained. Measurement Comments New action added with Additional Financing Improve the registry of compliance obligations during pharmaceutical waste handling at Rural HC and disposal at Action Description Hospitals and Medical Stores to include: disposal methods, sites, list of pax/witnesses, community monitoring, etc., and disseminate Source DLI# Responsibility Timing Timing Value Status Environmental and Social CMAM Due Date 31-Dec-2019 Not Yet Due Systems Completion Registry Forms available at Rural Centers, District, Provincial, and Central Hospitals and Medical Stores. Measurement Comments New action added with Additional Financing Conduct pharmaceutical waste inventory for District, Provincial and Central Hospitals and Medical Stores and Action Description prioritize the waste disposal according to a timeline based on waste quantities, environmental risks and opportunity costs Source DLI# Responsibility Timing Timing Value Status Environmental and Social CMAM Due Date 31-Dec-2019 Not Yet Due Systems Completion Elaboration of the inventory and 100 percent execution of the pharmaceutical waste disposal according to the Measurement timeline. 3/28/2019 Page 9 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Comments New action added with Additional Financing Action Description Elaborate annually national reports on pharmaceutical waste management based on ToR agreed with the World Bank Source DLI# Responsibility Timing Timing Value Status Environmental and Social CMAM Recurrent Yearly Not Yet Due Systems Completion Elaboration of Pharmaceutical Waste Management Report - starting in December 2019 Measurement Comments New action added with Additional Financing Develop and implement a Stakeholder Engagement Plan on Pharmaceutical Waste Disposal for District, Provincial, Action Description and Central Hospitals and Medical Stores for key players, identifying their roles from identification and preparation to monitoring. Source DLI# Responsibility Timing Timing Value Status Environmental and Social CMAM Due Date 31-Dec-2019 Not Yet Due Systems Completion At least two joint missions taken annually Measurement Comments New action added with Additional Financing Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Sustainability Substantial Substantial Substantial Fiduciary Substantial Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders Substantial Substantial Substantial Other -- -- -- Overall Substantial Substantial Substantial 3/28/2019 Page 10 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Results PDO Indicators by Objectives / Outcomes Improve utilization of RMNCAH and Nutrition in underserved areas IN00680498 ►Percentage of institutional deliveries in 42 lagging districts (Percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 71.00 71.00 80.00 85.00 Date 29-Dec-2017 17-Sep-2018 01-Oct-2018 30-Dec-2022 Numerator: the total number of pregnant women who delivered their babies in a health facility in all 42 priority districts in a year Denominator: the total number of expected childbirths in the same districts in a Comments year. IN00680500 ►Number of Couple Years of Protection (CYPs) (Number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1,722,692.00 2,447,185.00 2,135,012.00 2,982,599.00 Date 29-Dec-2017 29-Jun-2018 31-Dec-2018 30-Dec-2022 CYPs: The estimated protection provided by family planning services during a one-year period, based upon Comments the volume of all modern contraceptives methods sold or distributed free of charge to users during that period. CYP conversions are based on USAID (December 2011) factors IN00680516 ►% of children aged 0-24 months of age receiving the Nutrition Intervention Package (NIP) in 8 priority provinces with the prevalence of stunting of above 35 percent (Percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 29-Dec-2017 17-Sep-2018 17-Sep-2018 30-Dec-2022 Numerator: the number of children aged 0-24 months who have received the NIP package in the last year in the 6 provinces Denominator: all children aged 0-24 months in the 6 provinces in the same period. The total number of children aged 0-24 months will be estimated from demographic projections from the 2017 Comments population census in the provinces of Cabo Delgado, Manica, Nampula, Niassa, Tete, and Zambézia. Similarly, the number of children who received the NIP will be ascertained in the same provinces, every year. Improve the quality of RMNCAH-N in underserved areas IN00680497 ►Adherence to clinical diagnostic guidelines for five tracer conditions at health centers and district Hospitals (percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 37.40 37.40 37.40 75.00 Date 31-Dec-2014 17-Sep-2018 17-Sep-2018 30-Dec-2022 3/28/2019 Page 11 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Unweighted average of the share of relevant history taking questions, the share of relevant examinations Comments performed for the following five tracer conditions: (i) acute diarrhea; (ii) pneumonia; (iii) diabetes mellitus; (iv) pulmonary tuberculosis; (v) malaria with anaemia. IN00680499 ►Adherence to clinical treatment guidelines for maternal and neonatal complications at health centers and district hospitals (Percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 29.00 29.00 29.00 80.00 Date 31-Dec-2014 17-Sep-2018 17-Sep-2018 30-Dec-2022 Comments Share of relevant treatment actions proposed by the clinician Intermediate Results Indicators by Results Areas Service Delivery outputs IN00680522 ►Percentage of pregnant women who had 4 or more antenatal visits (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 42.00 54.60 49.00 66.30 Date 29-Dec-2017 17-Sep-2018 31-Dec-2018 30-Dec-2022 Number of pregnant women who had had 4 or more antenatal care (ANC) visits divided by the expected number of pregnant women in a given period (usually a year). Comments The initial baseline was derived from a survey. However since this indicator is to be measured annually the team decided to use as baseline the information provided by the routine information system of the MOH - SISMA. The baseline date is December 2018. IN00680527 ►Percentage of children between 12-59 months receiving deworming tablets (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 100.00 65.80 100.00 72.60 Date 29-Dec-2017 17-Sep-2018 31-Dec-2018 30-Dec-2022 Number of children aged 0-24 receiving deworming tablets divided by the total number of children aged 0- 24 This initial indicator referred to children ged0-24 receiving deworming tablets, however this information is not available in the routine information system (SISMA). SISMA provides regular information concerning the Comments coverage of deworming among children aged 12-59 months. Since the coverage of this intervention is already 100% since 2017 this indicator may not add information. The team will continue monitoring this indicator (15-59 months) until the Mid-Term Review. IN00680531 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 5,717,235.00 19,760,000.00 Date 29-Dec-2017 17-Sep-2018 31-Dec-2018 30-Dec-2022 3/28/2019 Page 12 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Comments IN00680537 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 1,016,526.00 5,100,000.00 Date 29-Dec-2017 17-Sep-2018 31-Dec-2018 30-Dec-2022 IN00680539 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 3,609,078.00 9,720,000.00 Date 29-Dec-2017 17-Sep-2018 31-Dec-2018 30-Dec-2022 IN00680541 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 1,091,631.00 4,940,000.00 Date 29-Dec-2017 17-Sep-2018 31-Dec-2018 30-Dec-2022 Service readiness and availability IN00680521 ►Number of health facilities providing Basic Emergency Obstetric and Newborn Care (BEmONC) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 68.00 68.00 68.00 300.00 Date 29-Dec-2017 17-Sep-2018 17-Sep-2018 30-Dec-2022 Number of Health facilities providing the following interventions: • Parenteral treatment of infection (antibiotics) • Parenteral treatment of severe pre-eclampsia/eclampsia (e.g., Magnesium Sulfate) • Comments Treatment of Post-Partum Hemorrhage (e.g., uterotonics) • Manual vacuum aspiration of retained products of conception • Assisted vaginal delivery (e.g., vacuum-assisted delivery) • Manual removal of placenta • Newborn resuscitation IN00680528 ►Number of health facilities providing Comprehensive Emergency Obstetric and Newborn Care (CEmONC) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 33.00 33.00 33.00 60.00 Date 29-Dec-2017 17-Sep-2018 17-Sep-2018 30-Dec-2022 Number of health facilities providing BEmONC services (described above) plus the following: • Surgical Comments capability, including anesthesia (e.g., Cesarean section) • Blood transfusion IN00680530 ►Percentage of district hospitals with uninterrupted water supply (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 3/28/2019 Page 13 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Value 87.00 87.00 87.00 95.00 Date 29-Dec-2017 17-Sep-2018 17-Sep-2018 30-Dec-2022 Number of district hospitals reporting their main source of water as being piped into the facility, piped onto Comments facility grounds or coming from a public tap/standpipe, tubewell borehole, a protected dug well, a protected spring, bottled water or a tanker truck IN00680533 ►Percentage of district hospitals with uninterrupted electricity supply (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 54.00 54.00 54.00 85.00 Date 29-Dec-2017 17-Sep-2018 17-Sep-2018 30-Dec-2022 Number of district hospitals reporting having the electric power grid, a fuel operated generator, a battery- Comments operated generator or a solar powered system as their main source of electricity divided by the total number of district hospitals. IN00680536 ►Availability of essential reproductive and maternal health medicines in district and rural hospital (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 66.00 66.00 66.00 90.00 Date 01-Jun-2015 17-Sep-2018 17-Sep-2018 30-Dec-2022 Proportion of health facilities reporting availability and confirmed by observation of a defined list of Comments reproductive and maternal drugs that are not expired on the day of a visit by a surveyor. IN00680538 ►Percentage of secondary and technical schools offering sexual and reproductive health services (information and contraceptive methods) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 31-Dec-2018 31-Dec-2018 31-Dec-2018 30-Dec-2022 Number of secondary and technical schools offering SRH information and services divided by the total Comments number of secondary and technical schools. The minimum criteria for SRH information and services are defined in the POM and DLI Technical Note. IN00680540 ►Average availability of tracer essential maternal and reproductive health medicines at primary health care facilities (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 62.00 62.00 62.00 85.00 Date 31-Dec-2018 31-Dec-2018 31-Dec-2018 29-Dec-2023 Average availability of 6 tracer essential maternal and reproductive health medicines at primary health care Comments facilities (health centers and district/rural hospitals. Health Human Resources (HRH) IN00680520 ►Number of trained and active APEs (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 3/28/2019 Page 14 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Value 3,380.00 4,680.00 4,789.00 8,800.00 Date 29-Dec-2017 31-Aug-2018 31-Dec-2018 30-Dec-2022 Total number of APEs trained and providing services in their respective villages. The APES are attached to Comments the nearest health facility from where they regularly receive the Kit of medicines against presentation of reports IN00680526 ►Number of technical health personnel assigned to the primary health care network (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 11,970.00 14,015.00 14,344.00 17,662.00 Date 29-Dec-2017 31-Aug-2018 31-Oct-2018 30-Dec-2022 Number of technical health personnel assigned to the primary health care network Technical health personnel: all career health professionals belonging to the health “special regime” or Regime Especial. This includes the following occupational areas: Nursing, ESMI, Curative Medicine, Preventive Medicine, Comments Pharmacy, Laboratory, Surgery, Anesthesiology, Instrumentation, Hospital Administration, Nutrition, Radiology, Stomatology, Psychiatry and Mental Health, Physical Medicine of Rehabilitation, Ophthalmology, Health Statistics and Otorhinolaryngology Primary health care network refers to the following health facilities: Rural Health Centers Type I and II and Urban Health Centers IN00680529 Number of Technical staff assigned to Type II Rural Health Centers in particular (Amount(USD), Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 3,787.00 4,956.00 4,956.00 5,311.00 Date 29-Dec-2017 31-Aug-2018 31-Aug-2018 30-Dec-2022 IN00680535 Number of Technical staff assigned to Type II Rural Health Centers (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 3,787.00 4,956.00 4,956.00 6,325.00 Date 29-Dec-2017 31-Aug-2018 31-Aug-2018 30-Dec-2022 IN00680534 ►Number of primary health care facilities that have at least two MCH nurses (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 638.00 638.00 638.00 838.00 Date 29-Jun-2018 31-Dec-2018 31-Aug-2018 30-Dec-2022 Number of rural health centers type I and II and number of urban health centers type A, B and C with at Comments least 2 MCH nurses Quality IN00680519 ►Percentage of district/rural hospitals that received performance-based allocations (PBA) in accordance with a minimum of 2 scorecard assessments in the previous fiscal year (FY) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 12.00 100.00 3/28/2019 Page 15 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Date 29-Dec-2017 17-Sep-2018 31-Dec-2018 30-Dec-2022 Numerator: Number of rural and district hospitals that received PBA according to at least two scorecard assessments in the last fiscal year Denominator: Total number of district/rural hospitals Comments Scorecard: a composite index based on weighed priority indicators of hospital performance. Performance-based allocations: financial rewards for hospitals based on their performance Rural and district hospital: legal classifications as set forth in Ministerial Diploma 127/2002. IN00680525 ►Number of Rural Health Centers in priority districts that received PBA in accordance with a minimum of 2 scorecard assessments with community consultations in the previous FY (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 64.00 391.00 Date 29-Dec-2017 17-Sep-2018 31-Dec-2018 30-Dec-2022 Number of rural health centers in priority districts that received performance-based allocations (PBA) according to at least two scorecard assessments with community consultations in the last fiscal year Scorecard: a composite index based on weighed priority indicators of health center performance. Community Consultations: systematic collection of user feedback followed by a dialogue with health service Comments providers on possible solutions identified Performance-based allocations: financial rewards for health centers based on their performance Rural health centers: legal classifications as set forth in Ministerial Diploma 127/2002. Health Financing IN00680518 ►Domestic health expenditures as a percentage of total domestic government expenditures (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 7.90 7.90 9.00 9.50 Date 29-Dec-2017 17-Sep-2018 31-Dec-2018 30-Dec-2022 Comments Domestic expenditures in the health sector divided by the total Government expenditures IN00680524 ►Health sub-account expenditures in 3 historically underserved provinces (Nampula, Zambezia, and Tete) (Amount(USD), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 36,000,000.00 Date 29-Dec-2017 17-Sep-2018 17-Sep-2018 30-Dec-2022 Cumulative provincial health expenditures financed from the Treasury Single Account sub-account of the Comments Program (equivalent in US$) in the three underserved provinces (i.e. budget kept at the disposal of provincial-level spending authorities – DPS and hospitals). IN00680532 ►Health sub-account expenditures in 28 historically underserved districts (Amount(USD), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 16,000,000.00 Date 29-Dec-2017 17-Sep-2018 17-Sep-2018 30-Dec-2022 3/28/2019 Page 16 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Cumulative district health expenditures financed from the Treasury Single Account sub-account of the Program (equivalent in US$) in the 28 underserved districts as defined in the DLI 6 Technical Note/Program Comments Operations Manual (i.e. budget kept at the disposal of district-level spending authorities – District Directorates for Health, Gender, Children and Social Action (SDSGCAS) and district hospitals) Information for decision making IN00680517 ►Percentage of deaths certified in hospitals with data on cause of death coded per ICD 10 reported in SISMA and registered (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 29-Dec-2017 17-Sep-2018 17-Sep-2018 30-Dec-2022 Number of hospitals that certify deaths occurred in the hospital, codify the cause of death according to ICD Comments 10, whose information is captured in SISMA, and registered in Civil Registries divided by the total number of hospitals IN00680523 ►Percentage of deaths certified in health centers with data on cause of death coded per ICD 10 reported in SISMA and registered (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 29-Dec-2017 17-Sep-2018 30-Sep-2018 30-Dec-2022 Number of health center with in-patient services that certify deaths occurred in the health facility, codify the Comments cause of death according to ICD 10, whose information is captured in SISMA, and registered in Civil Registries divided by the total number of health centers with in-patient services. Disbursement Linked Indicators DLI_IND_TABLE ►DLI 1 The Recipient has increased the percentage of Institutional Deliveries in 42 Lagging Districts (Outcome, 22,200,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2022 Value 66.10 80.00 80.00 85.00 Date -- 31-Dec-2018 31-Dec-2018 -- Comments ►DLI 2 The Recipient has increased the percentage of Secondary and Technical Schools offering sexual and reproductive health services (information and contraceptive methods) (Intermediate Outcome, 20,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2022 Value 0.00 0.00 0.00 80.00 Date -- 31-Dec-2018 31-Dec-2018 -- Comments 3/28/2019 Page 17 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) DLI . 1 The Recipient has finalized the monitoring and evaluation system (Output, 2,000,000.00, 0%) Unit of Measure: Yes/No Indicator Type: Baseline Actual (Previous) Actual (Current) December 2022 Value No No No -- Date -- 31-Dec-2018 31-Dec-2018 -- Comments ►DLI 3 The Recipient has increased Couple Years of Protection (Intermediate Outcome, 20,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2022 Value 1,722,692.00 2,135,012.00 2,135,012.00 2,982,599.00 Date -- 31-Dec-2018 31-Dec-2018 -- Comments ►DLI 4 The Recipient has increased the percentage of children between 0-24 months of age receiving the Nutrition Intervention Package (NIP) in the 8 Provinces with the prevalence stunting of above 35 percent (Intermediate Outcome, 11,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2022 Value 0.00 0.00 0.00 -- Date -- 17-Sep-2018 17-Sep-2018 -- Comments DLI 4.1 The Recipient has trained at least 6 trainers, 100% of district nutrition representatives, and 30% of Community Health Workers, and identified 30% of volunteers, in 6 of the 8 targeted provinces (Output, 2,500,000.00, 0%) Unit of Measure: Yes/No Indicator Type: Baseline Actual (Previous) Actual (Current) December 2022 Value No No Yes -- Date -- 17-Sep-2018 31-Dec-2018 -- Comments DLI 4.2 The Recipient has finalized the Monitoring and Evaluation System (Process, 1,000,000.00, 0%) Unit of Measure: Yes/No Indicator Type: 3/28/2019 Page 18 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Baseline Actual (Previous) Actual (Current) December 2022 Value No No Yes -- Date -- 17-Sep-2018 31-Dec-2018 -- Comments DLI 4.3 The Recipient has increased the percentage of nutrition sites meet minimum standard of quality standards (Intermediate Outcome, 9,500,000.00, 0%) Unit of Measure: Percentage Indicator Type: Baseline Actual (Previous) Actual (Current) December 2022 Value 0.00 0.00 0.00 90.00 Date -- 17-Sep-2018 17-Sep-2018 -- Comments ►DLI 5 The Recipient has increased the Domestic Health Expenditures as a percentage of total Domestic Government Expenditures. (Process, 13,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2022 Value 7.90 7.90 9.00 -- Date -- 31-Dec-2016 31-Dec-2018 -- The baseline (and actual) is the average of the three-year period 2014-2016 Comments ►DLI 6 The Recipient has increased health expenditures from the Sub-Account Resources in Underserved Provinces (Nampula, Zambezia, Tete) (Process, 4,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2022 Value 0.00 0.00 0.00 -- Date -- 17-Sep-2018 17-Sep-2018 -- Comments DLI 6.1 The Recipient has increased health expenditures from the Sub-Account Resources in the 28 Underserved Districts (Process, 5,000,000.00, 0%) Unit of Measure: Amount(USD) Indicator Type: Baseline Actual (Previous) Actual (Current) December 2022 Value 0.00 0.00 0.00 -- Date -- 17-Sep-2018 17-Sep-2018 -- 3/28/2019 Page 19 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Comments DLI 6.2 The Recipient has maintained Domestic Health Expenditures for the 3 Underserved Provinces as a share of provincial expenditures (Process, 2,000,000.00, 0%) Unit of Measure: Amount(USD) Indicator Type: Baseline Actual (Previous) Actual (Current) December 2022 Value 36.60 0.00 0.00 -- Date -- 17-Sep-2018 17-Sep-2018 -- Comments DLI . 2 The Recipient has maintained Domestic Health Expenditures for the 28 Underserved Districts as a share of district expenditures (Process, 2,000,000.00, 0%) Unit of Measure: Amount(USD) Indicator Type: Baseline Actual (Previous) Actual (Current) December 2022 Value 19.50 19.50 19.50 -- Date -- 31-Dec-2016 31-Dec-2016 -- Comments ►DLI 7 The Recipient has increased the number of Technical Health Personnel assigned to the Primary Health Care Network (Output, 13,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2022 Value 11,970.00 14,015.00 14,344.00 17,662.00 Date -- 31-Aug-2018 31-Oct-2018 -- Comments DLI . 3 The Recipient has increased the numer of health care facilities in the primary care network with at least two active MCH nurses (Output, 5,000,000.00, 0%) Unit of Measure: Number Indicator Type: Baseline Actual (Previous) Actual (Current) December 2022 Value 638.00 638.00 638.00 838.00 Date -- 31-Dec-2018 31-Dec-2018 -- Comments 3/28/2019 Page 20 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) ►DLI 8 The Recipient has demonstrated that District/Rural Hospitals received performance-based allocations in accordance with a minimum of two scorecard assessments in the previous Fiscal Year (Intermediate Outcome, 23,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2022 Value 0.00 0.00 12.00 100.00 Date -- 17-Sep-2018 31-Dec-2018 -- Comments ►DLI 9 The Recipient has demonstrated that Rural Health Centers in Priority Districts received PBA in accordance with a minimum of two scorecard assessments with community consultationsin the previous FY. (Intermediate Outcome, 27,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2022 Value 0.00 0.00 64.00 391.00 Date -- 17-Sep-2018 31-Dec-2018 -- Comments ►DLI 10 The Recipient has increased the number of trained and active APEs (Output, 15,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2022 Value 3,380.00 4,680.00 4,789.00 8,800.00 Date -- 31-Aug-2018 31-Dec-2018 -- The number of APEs trained and active is cumulative. Comments DLI 10.1 The Recipient has increased the percentage of APEs using upSCALE (Intermediate Outcome, 5,000,000.00, 0%) Unit of Measure: Percentage Indicator Type: Baseline Actual (Previous) Actual (Current) December 2022 Value 13.90 13.90 13.90 85.00 Date -- 31-Aug-2018 31-Aug-2018 -- Comments DLI . 4 The Recipient has increased the percentage of APEs that deliver services according to minimum quality standards (Intermediate Outcome, 6,500,000.00, 0%) Unit of Measure: Percentage Indicator Type: Baseline Actual (Previous) Actual (Current) December 2022 3/28/2019 Page 21 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Value 60.00 60.00 60.00 -- Date -- 31-Dec-2018 31-Dec-2018 -- Comments ►DLI 11 The Recipient has increased the percentage of deaths certified in health facilities with data on cause of death, coded per ICD 10, reported in SISMA, and registered (Process, 12,300,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2022 Value 0.00 0.00 0.00 100.00 Date -- 31-Aug-2018 31-Aug-2018 -- Comments DLI 11.1 The Recipient has increased the percentage of hospitals using the Data Management Module (MGDH) to generate information on causes of deaths (Process, 1,500,000.00, 0%) Unit of Measure: Percentage Indicator Type: Baseline Actual (Previous) Actual (Current) December 2022 Value 70.00 0.00 100.00 -- Date -- 31-Aug-2018 31-Dec-2018 -- Comments DLI . 5 The Recipient has increased the percentage of health centers using the Data Management Module (MGDH) to generate information on causes of deaths (Process, 6,000,000.00, 0%) Unit of Measure: Percentage Indicator Type: Baseline Actual (Previous) Actual (Current) December 2022 Value 0.00 0.00 50.00 -- Date -- 31-Dec-2018 31-Dec-2018 -- Comments ►DLI 12 The Recipient has increased the average availability of tracer essential maternal and reproductive health medicines at primary health care facilities (Outcome, 10,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) December 2022 Value 62.00 62.00 62.00 85.00 Date -- 31-Dec-2018 31-Dec-2018 -- 3/28/2019 Page 22 of 23 The World Bank Implementation Status & Results Report Mozambique Primary Health Care Strengthening Program (P163541) Comments 3/28/2019 Page 23 of 23