The World Bank Report No: ISR10237 Implementation Status & Results Mozambique Health Service Delivery (P099930) Public Disclosure Copy Operation Name: Health Service Delivery (P099930) Project Stage: Implementation Seq.No: 10 Status: ARCHIVED Archive Date: 21-Aug-2013 Country: Mozambique Approval FY: 2009 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 16-Apr-2009 Original Closing Date 28-Feb-2014 Planned Mid Term Review Date 15-Sep-2011 Last Archived ISR Date 08-Jan-2013 Effectiveness Date 11-Jun-2010 Revised Closing Date 31-Dec-2016 Actual Mid Term Review Date 22-Jun-2012 Project Development Objectives Project Development Objective (from Project Appraisal Document) To increase access to, and utilization of, maternal and child health and nutrition services in target areas in the Recipient's territory. Has the Project Development Objective been changed since Board Approval of the Project? � Yes No Component(s) Component Name Component Cost Improvement in service delivery. 80.00 Boosting of national malaria control program 15.50 Strategic Planning and Capacity Building 7.40 Project Management and Operating Costs 6.50 Overall Ratings Public Disclosure Copy 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 Implementation Status Overview The restructuring of the project, including the Additional Financing (AF) for Nutrition was approved by the Board on January 24, 2013, and the FA was signed on March 24, 2013. The nutrition AF became effective on June 21, 2013. To strengthen the project management team, the MOH hired experienced specialists including a project manager with substantial experience of managing Bank funded projects. Looking forward, in the next 12 months, the project will accelerate the pace of implementation and disbursements will rise. Page 1 of 10 The World Bank Report No: ISR10237 Locations Country First Administrative Division Location Planned Actual Mozambique Provincia de Niassa Provincia de Niassa Public Disclosure Copy Mozambique Provincia de Nampula Provincia de Nampula Mozambique Provincia de Cabo Delgado Provincia de Cabo Delgado Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Percentage of institutional deliveries Percentage Value 50.80 68.33 65.00 Date 31-Dec-2009 31-Dec-2012 28-Feb-2014 Comments The previous indicator The end target is a national reflected a national average. target. Provinces set their It was disaggregated to reflect annual targets each year but the situation in each province. do not have defined multi- Please note that the values annual targets are entered only for each province. The values entered in the main indicator is an arithmetic sum of the respective values in each province. The end target is a national target. Provinces set their annual targets each year but do not have defined multi- annual targets Cabo Delgado Percentage Value 57.00 69.00 65.00 Sub Type Date 31-Dec-2009 31-Dec-2012 31-Dec-2016 Public Disclosure Copy Breakdown Comments The target for 2012 was 63% The end target is a national target. Provinces set their annual targets each year but do not have defined multi- annual targets Nampula Percentage Value 53.00 64.00 65.00 Sub Type Date 31-Dec-2009 31-Dec-2012 Breakdown Comments The target for 2012 was 63% The end target is a national target. Provinces set their Page 2 of 10 The World Bank Report No: ISR10237 annual targets each year but do not have defined multi- annual targets Niassa Province Percentage Value 84.00 72.00 65.00 Public Disclosure Copy Sub Type Date 31-Dec-2012 31-Dec-2012 Breakdown Comments The baseline data may not The target for 2012 was 63% The end target is a national have been accurate. target. Provinces set their annual targets each year but do not have defined multi- annual targets Percentage of children vaccinated with Percentage Value 45.00 76.00 90.00 DPTHepHib3 in the first year of life in each Date 31-Dec-2009 31-Dec-2012 28-Feb-2014 province Comments The indicator now reflects the The end target is a national MOH indicator which includes target. Provinces set their two more vaccines, namely, annual targets each year but Hepatitis B, and Haemophilus do not have defined multi- influenza B. Inaddition the annual targets. indicator was disaggregated to reflect the coverage by province. The current value entered for this indicator is an average of the coverages of the three provinces. Cabo Delgado Province Percentage Value 71.00 109.00 90.00 Sub Type Date 31-Dec-2009 31-Dec-2012 31-Dec-2016 Breakdown Comments The current coverage is The end target is a national above 100%. This might be target. Provinces set their attributable to weaknesses in annual targets each year but data recording, vaccinations do not have defined multi- done to individuals beyond annual targets. the target group and other causes. It will be necessary to Public Disclosure Copy ascertain the causes and determine the real coverage with this intervention. Nampula Province Percentage Value 51.00 105.00 90.00 Sub Type Date 31-Dec-2009 31-Dec-2012 31-Dec-2016 Breakdown Comments The current coverage is The end target is a national above 100%. This might be target. Provinces set their attributable to weaknesses in annual targets each year but data recording, vaccinations Page 3 of 10 The World Bank Report No: ISR10237 done to individuals beyond do not have defined multi- the target group and other annual targets. causes. It will be necessary to ascertain the causes and Public Disclosure Copy determine the real coverage with this intervention. Niassa Province Percentage Value 115.00 109.00 90.00 Sub Type Date 31-Dec-2009 31-Dec-2012 Breakdown Comments The current coverage is The end target is a national above 100%. This might be target. Provinces set their attributable to weaknesses in annual targets each year but data recording, vaccinations do not have defined multi- done to individuals beyond annual targets. the target group and other causes. It will be necessary to ascertain the causes and determine the real coverage with this intervention. Percentage of pregnant women who received Percentage Value 18.60 36.00 50.00 2nd dose of IPT at antenatal clinics Date 31-Dec-2009 31-Dec-2012 31-Dec-2016 Comments This is a new PDO indicator in From the MOH reports. The accordance with the modified target for the year 2012 was results framework. The 30%. baseline was obtained from the preliminary results of the 2011 DHS referring to pregnancies in years 2009-2010. Direct project beneficiaries Number Value 0.00 0.00 2151445.00 Date 31-Dec-2009 30-Jun-2012 28-Feb-2014 Comments The MOH is still estimating the number of beneficiaries. Public Disclosure Copy Since this indicator is not routine the MOH will provide the number of beneficiaries on the basis of the raw data from health facilities and provincial reports. The first estimation will take time but the subsequent ones will be less time consuming. Female beneficiaries Percentage Value 0.00 0.00 80.00 Page 4 of 10 The World Bank Report No: ISR10237 Sub Type Supplemental Percentage of children aged 0-24 months fed Percentage Value Public Disclosure Copy in accordance with all 3 IYCF practices (food Date 31-Dec-2016 diversity, feeding frequency, and consumption Comments The baseline will be done in 10 percent increase from the of breast milk or milk) 2013 baseline. After the baseline the end target will be updated. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Outreach teams fully operational in Cabo Number Value 0.00 54.00 Delgado, Nampula, and Niassa Date 31-Dec-2009 31-Dec-2016 Comments The data is not yet available. The lack of data for this indicator was discussed with the MOH. it was agreed that a special effort will be made to look for the needed information in the annual reports of the provinces. Number of Agentes Polivalentes Elementares Number Value 0.00 398.00 1100.00 (APEs) trained (cumulative) Date 31-Dec-2009 30-Jun-2013 31-Dec-2016 Comments This is a cumulative number of APEs trained and updated by MOH. In the last ISR the number trained were 727 but this was a mistake due to counting APEs trained in other provinces. With the current number of 400 APEs being trained the cumulative Public Disclosure Copy number of APES trained up to September 2013 will be 789. Health personnel receiving training (number) Number Value 0.00 122.00 300.00 Date 31-Dec-2009 30-Jun-2013 31-Dec-2016 Comments This indicator includes only formal training. The on the job training figures have not yet been validated. Page 5 of 10 The World Bank Report No: ISR10237 Health facilities constructed, renovated, and/or Number Value 0.00 0.00 18.00 equipped (number) Date 31-Dec-2009 31-Dec-2012 31-Dec-2016 Comments The construction will be Public Disclosure Copy started in 2013 Pregnant women receiving first ANC visit Number Value 165917.00 175203.00 Date 31-Dec-2009 31-Dec-2012 31-Dec-2016 Comments This indicator capture the total The figure above is an number of women receiving average of the figures for 1st ante-natal care in health each province. units that have (a) workers that have received training funded by the World Bank or (b) been constructed or substantially renovated with World Bank funding. This is a measureof contribution, and it is not necessary to make a calculation to estimate a pro rata World Bank attribution, based on financial contribution to each health center. This figure be a pro- rata calculation based on the total number of women receiving a1st ante-natalcare in the province, and the number of facilities in the province that have received support from the World Bank (i.e., if 75% of health units have received some support, then 75% of the total number of women who received 1st Public Disclosure Copy ante-natal care will be counted). Targets were calculated from Demographic Projection – 2011 assuming coverage of 95%. Cabo Delgado Number Value 118126.00 114592.00 85852.00 Sub Type Date 31-Dec-2009 31-Dec-2012 31-Dec-2016 Page 6 of 10 The World Bank Report No: ISR10237 Breakdown Comments The target for 2012 was set at The target is lower than the 84,526 baseline after adjusting the denominator on the basis of the official demographic data Public Disclosure Copy Nampula Number Value 267517.00 317963.00 217338.00 Sub Type Date 31-Dec-2009 31-Dec-2012 31-Dec-2016 Breakdown Comments The target for 2012 has been The target is lower than the set to 218,502 baseline after adjusting the denominator on the basis of the official demographic data Niassa Number Value 112195.00 93054.00 80041.00 Sub Type Date 31-Dec-2009 31-Dec-2012 31-Dec-2016 Breakdown Comments The target for 2012 has been set to 81,701 Children receiving a dose of vitamin A Number Value 194521.00 434495.00 355531.00 Date 31-Dec-2009 31-Dec-2012 31-Dec-2016 Comments Children aged 6-59 months. The actual figure for 2012 is The end target is an average The baseline reflects the an average of the three of the targets of the three average baseline figure for provinces. provinces. each province Cabo Delgado Number Value 178490.00 293401.00 240113.00 Sub Type Date 31-Dec-2009 31-Dec-2012 31-Dec-2016 Breakdown Comments The target for 2013 has been set to 235, 811 Nampula Number Value 185879.00 759173.00 625488.00 Sub Type Date 31-Dec-2009 31-Dec-2012 31-Dec-2016 Breakdown Comments The target for 2012 has been at 609,797 Niassa Number Value 219195.00 250911.00 200993.00 Public Disclosure Copy Sub Type Date 31-Dec-2009 31-Dec-2012 31-Dec-2013 Breakdown Comments The target for 2012 has been set at 193,178 Number of children under 1 year of age fully Number Value 81848.00 84202.00 81091.00 immunized Date 31-Dec-2009 31-Dec-2012 31-Dec-2016 Comments The figure reflect the average The figure reflects the The end target is an average baseline for the three average number vaccinated in for the three provinces. provinces. the three provinces. Cabo Delgado Number Value 62412.00 55338.00 54904.00 Page 7 of 10 The World Bank Report No: ISR10237 Sub Type Date 31-Dec-2012 31-Dec-2012 31-Dec-2016 Breakdown Comments The target for 2012 has been set to 52482 Public Disclosure Copy Nampula Number Value 150427.00 147128.00 143024.00 Sub Type Date 31-Dec-2012 31-Dec-2012 31-Dec-2013 Breakdown Comments Niassa Number Value 32702.00 50141.00 45346.00 Sub Type Date 31-Dec-2009 31-Dec-2012 31-Dec-2013 Breakdown Comments Number of Volunteers functional (cumulative) Number Value 0.00 0.00 21000.00 Date 31-Mar-2013 31-Mar-2013 31-Dec-2016 Comments The nutrition additional financing just became effective on June 21, 2013, and activities have not yet started. Percentage of children aged 0-24 months Percentage Value 0.00 0.00 80.00 attended at least 1 Growth Monitoring and Date 31-Mar-2013 31-Mar-2013 31-Dec-2016 Promotion services during the 2 preceding Comments The nutrition additional months,% who are female financing just became effective on June 21, 2013, and activities have not yet started. Percentage of children aged 6-24 months Percentage Value 0.00 0.00 80.00 received at least 60 sachets of micronutrient Date 31-Mar-2013 31-Mar-2013 31-Dec-2016 powder (MNP) during the 2 preceding months, Comments The nutrition additional %who are female financing just became effective on June 21, 2013, and activities have not yet Public Disclosure Copy started. Percentage of pregnan women received a Percentage Value complete dose of IFA tablets Date 31-Mar-2013 Comments No baseline available at The nutrition additional 20% increase from baseline appraisal. The target will be financing just became set after the baseline survey effective on June 21, 2013, is done. and activities have not yet started. Data on Financial Performance (as of 09-Aug-2013) Page 8 of 10 The World Bank Report No: ISR10237 Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P099930 IDA-45820 Effective 16-Apr-2009 15-Jul-2009 11-Jun-2010 28-Feb-2014 28-Feb-2014 Public Disclosure Copy P099930 IDA-51940 Not Effective 24-Jan-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-2014 P099930 TF-96505 Effective 15-Apr-2010 19-Apr-2010 19-Apr-2010 28-Feb-2014 28-Feb-2014 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P099930 IDA-45820 Effective USD 44.60 44.60 0.00 16.08 29.74 36.00 P099930 IDA-51940 Not Effective USD 37.00 37.00 0.00 0.00 36.43 0.00 P099930 TF-58155 Closed USD 1.15 0.18 0.97 0.18 0.00 100.00 P099930 TF-96375 Closed USD 7.86 7.86 0.00 6.43 1.43 82.00 P099930 TF-96399 Effective USD 3.29 3.29 0.00 1.41 1.88 43.00 P099930 TF-96505 Effective USD 15.94 15.94 0.00 4.95 11.09 31.00 Disbursement Graph Public Disclosure Copy Page 9 of 10 The World Bank Report No: ISR10237 Key Decisions Regarding Implementation N/A Public Disclosure Copy Restructuring History There has been no restructuring to date. Related Projects P125477-Mozambique Nutrition Additional Financing Public Disclosure Copy Page 10 of 10