The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) Health System Support Project ("KIRA") (P156012) AFRICA | Burundi | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2017 | Seq No: 5 | ARCHIVED on 11-Jul-2019 | ISR35741 | Implementing Agencies: Ministry of Health, MINISTRY OF FINANCE Key Dates Key Project Dates Bank Approval Date: 24-Feb-2017 Effectiveness Date: 20-Jun-2017 Planned Mid Term Review Date: 22-Jul-2019 Actual Mid-Term Review Date: -- Original Closing Date: 30-Jun-2021 Revised Closing Date: 30-Jun-2021 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To increase the use of quality Reproductive, Maternal, Neonatal, Child and Adolescent Health services, and, in the event of an Eligible Crisis or Emergency, to provide immediate and effective response to said Eligible Crisis or Emergency. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Use of Performance-based Payments to Support the Recipient's Free Health Care (FHC) Program:(Cost $46.50 M) Implementation Support for the FHC program-related activities:(Cost $10.40 M) Strengthening of Newly Integrated FHC Program Service Providers through financing of minor investments/renovations works for CHWs and nursing training schools:(Cost $1.40 M) Contingency Emergency Response Component (CERC) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The implementation of the project has accelerated and kept a good pace so far on all its components. Indeed, health facilities are paid regularly for their performance and the KIRA project has helped pay the bill of health facilities and community health worker (CHW) groups. This resulted in speeding up significantly the spending of the project proceeds with a disbursement rate of 52% with two more years to project closing. It is worth noting that the feedback received from the field indicates the great usefulness of PBF resources for health facilities. They constitute an important part of the income going up to 80% for a health center or 60% for a public hospital (the case of the hospital of Ngozi) and 30% for a 7/11/2019 Page 1 of 7 The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) private hospital (the case of the hospital of Kibuye). In addition, they have been very useful in improving the quality of care by (i) ensuring the availability of drugs (especially after increasing service charges); (ii) the recruitment of new contract staff; (iii) the creation of new specialized services, etc. The community PBF is effective now in six provinces (Makamba, Mwaro, Kayanza, Muyinga, Kirundo, Gitega). The quarterly assessment started end of December 2018 and payments to CHW groups are made regularly and on time since January 2019 against delivery of a specific health service package including: (i) sensitization to prevent several diseases; (ii) promotion of key services like family planning, nutrition, vaccination, and antenatal care; (iii) referral to health facilities; (iv) treatment of malaria and acute respiratory infections; and (v) community-based distribution of contraceptive methods. With regard to the PBF to nursing schools, the preparation process is over and the quarterly assessments are effective starting from the third quarter of 2018,s while the payment of 8 paramedical schools started with the first quarter of 2018 and is continuing: the resources generated through PBF are deemed very helpful as they allow improvement of quality of the training by supporting internship in various health facilities, including lodging for interns; learning equipment acquisition; rigorous evaluation of teaching along with incentivizing of teachers and school personnel. The contracting of the central level delivery units has started as the recruitment of an entity to evaluate their performance was completed recently. The verification system has been strengthened with the recruitment of independent verifiers mainly dedicated to quality assessment and the latter is conducted in a more professional manner without complacency. Although the rigorous evaluations have recently led to reductions in bonuses of some assessed health centers, this became a wake up call for managers of affected health centers and a significant improvement in quality score is noted in the majority of health facilities. In order to minimize the financial hardship faced by health facilities due to higher input prices linked to the country's economic context which threatens the free health care provision to under 5 children and pregnant women, it was decided to temporarily increase the unit cost of the service package. The revision of the unit cost will be finalized once the ongoing health care costs study will be completed expected within the coming three months period. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High High High Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Substantial Substantial Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Sustainability Substantial Substantial Substantial Fiduciary Substantial Substantial Substantial Environment and Social Moderate Moderate Moderate Stakeholders Moderate Moderate Moderate Other High High High Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes 7/11/2019 Page 2 of 7 The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) Increase the use of quality Reproductive, Maternal, Neonatal, Child and Adolescent Health services IN00717168 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 8,240,485.00 18,660,973.00 18,640,000.00 Date 30-Jun-2016 30-Nov-2018 31-May-2019 30-Jun-2021 This indicator is a CRI indicator and replaces the original indicator (from PAD) which had the same label Comments: but for which definitions were not aligned with CRI guidelines. IN00717206 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,818,010.00 4,844,740.00 8,640,000.00 Date 01-Feb-2017 06-Dec-2018 31-May-2019 30-Jun-2021 IN00717207 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,710,925.00 12,488,300.00 8,800,000.00 Date 01-Feb-2017 06-Dec-2018 31-May-2019 30-Jun-2021 IN00717208 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 711,550.00 1,327,933.00 1,200,000.00 Date 01-Feb-2017 06-Dec-2018 31-May-2019 30-Jun-2021 IN00717194 ►Percentage of pregnant women who received four antenatal care visits within the first 28 gestational weeks (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 32.35 40.50 41.50 51.00 Date 01-Jan-2016 31-Oct-2018 31-May-2019 30-Jun-2021 IN00717196 ►National quality average score of district hospital (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 80.00 80.10 85.48 85.00 Date 01-Jan-2016 30-Sep-2018 31-May-2019 30-Jun-2021 IN00717198 ►Contraceptive prevalence rate for modern methods (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 7/11/2019 Page 3 of 7 The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) Value 38.00 35.30 35.20 45.00 Date 01-Jan-2016 29-Dec-2017 31-Dec-2018 30-Jun-2021 IN00717200 ►Contraceptive prevalence rate among adolescents (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.50 2.50 2.50 12.00 Date 01-Jan-2016 29-Dec-2017 02-Jan-2017 30-Jun-2021 Overall Comments PDO The contraceptive prevalence rate among adolescents is not routinely collected. It is provided by demographic and health surveys, conducted on average every 5 years. Hence, progress cannot be tracked. Intermediate Results Indicators by Components Use of Performance-based Payments to Support the Recipient's Free Health Care (FHC) Program IN00717169 ►Number visits to a health facility for Children under five years of age (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.20 2.07 2.07 2.50 Date 01-Dec-2016 30-Aug-2018 31-May-2019 30-Jun-2021 IN00717170 ►Pregnant women receiving antenatal care during a visit to a health provider (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 165,504.00 278,060.00 744,738.00 903,254.00 Date 01-Jan-2016 29-Dec-2017 31-May-2019 30-Jun-2021 IN00717191 ►Number of years-protection couples for modern methods (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 553,679.00 1,680,188.60 5,730,492.00 3,066,611.00 Date 01-Jan-2016 29-Dec-2017 31-May-2019 30-Jun-2021 IN00717192 ►Coverage of births attended by qualified personnel (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 7/11/2019 Page 4 of 7 The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) Value 77.30 83.26 93.80 85.00 Date 01-Jan-2016 31-Oct-2018 31-May-2019 30-Jun-2021 IN00717193 ►Number of pregnant women on ARV protocol for the prevention of mother-child transmission (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3,885.00 12,846.00 12,780.00 22,430.00 Date 01-Jan-2016 31-Oct-2018 31-May-2019 30-Jun-2021 IN00717197 ►Satisfaction rate of beneficiaries on health care delivered by health centers (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 57.43 21.30 80.87 75.00 Date 30-Dec-2016 29-Nov-2018 29-Mar-2019 30-Jun-2021 IN00717199 ►Percentage of public health facilities that offer FHC and use RBF (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 97.00 98.00 94.00 99.00 Date 01-Jan-2016 29-Nov-2018 31-May-2019 30-Jun-2021 94% of facilities with principal contract. More facilities with secondary contracts. Comments: IN00717201 ►Number of new Family Planning acceptors referred by Community Health Workers and who arrived at the health center (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 38,678.00 143,981.00 499,137.00 Date 01-Jan-2016 06-Dec-2018 31-May-2019 30-Jun-2021 IN00717202 ►Number of pregnant women referred for early antenatal care ANC1 (TRIM1) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 42,220.00 124,298.00 210,745.00 Date 01-Jan-2016 06-Dec-2018 31-May-2019 30-Jun-2021 IN00717203 ►Total number of children aged 6-59 months tested and referred by community health workers for malnutrition (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 141,796.00 341,956.00 1,352,334.00 Date 30-Dec-2016 06-Dec-2018 31-May-2019 30-Jun-2021 IN00717204 7/11/2019 Page 5 of 7 The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) ►Children under 2 fully immunized (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 79.80 79.80 74.40 95.00 Date 30-Jun-2017 30-Jun-2017 31-May-2019 30-Jun-2021 IN00717205 ►Grievances registered related to delivery of project benefits that are actually addressed (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 100.00 50.00 Date 25-Feb-2019 25-Feb-2019 31-May-2019 30-Jun-2021 No complaints received between January and May 2019 Comments: Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P156012 IDA-D1660 Effective USD 50.00 50.00 0.00 29.86 22.17 57% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P156012 IDA-D1660 Effective 24-Feb-2017 23-Mar-2017 20-Jun-2017 30-Jun-2021 30-Jun-2021 Cumulative Disbursements 7/11/2019 Page 6 of 7 The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) Restructuring History There has been no restructuring to date. Related Project(s) P166576-Burundi Health System Support-Additional Financing 7/11/2019 Page 7 of 7