Public Disclosure Copy The World Bank Implementation Status & Results Report Enhanced Nutrition for Mothers and Children (P131850) Enhanced Nutrition for Mothers and Children (P131850) SOUTH ASIA | Pakistan | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2015 | Seq No: 11 | ARCHIVED on 23-Dec-2019 | ISR39574 | Implementing Agencies: Department of Health, Sindh, Department of Health, Khyber Pakhtunkhwa, Department of Health, Balochistan, Islamic Republic of Pakistan, Department of Health, Government of KP, Economic Affairs Division, Department of Health, Khyber Pakhtunkhwa Key Dates Key Project Dates Bank Approval Date: 29-Aug-2014 Effectiveness Date: 15-Jan-2015 Planned Mid Term Review Date: 15-May-2017 Actual Mid-Term Review Date: 30-May-2017 Original Closing Date: 31-Dec-2018 Revised Closing Date: 31-Dec-2019 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The development objective for the project is to increase the coverage, in Project areas, of interventions that are known toimprove the nutritional status of children under two years of age, of pregnant and of lactating women. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Addressing general malnutrition in women and children:(Cost $57.05 M) Addressing micronutrient malnutrition:(Cost $7.83 M) Communication for development:(Cost $5.66 M) Strengthening institutional capacity:(Cost $12.32 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Unsatisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Unsatisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions This project was closed as scheduled in December 2019 after a one-year extension. Despite this extension, continued delays to implementing project activities in some provinces led to a closing rating of moderately unsatisfactory in progress to achieving the project development objective. Project activities to enhance maternal and child nutrition will be sustained under the Government of Sindh’s Accelerated Action Plan for addressing 12/23/2019 Page 1 of 15 Public Disclosure Copy The World Bank Implementation Status & Results Report Enhanced Nutrition for Mothers and Children (P131850) malnutrition, supported by the World Bank. The sustainability plans for project activities in KPK and Balochistan are less well developed. The Bank is continuing dialogue with the provincial governments focused on operational integration and financial sustainability of these activities. 12/23/2019 Page 2 of 15 Public Disclosure Copy The World Bank Implementation Status & Results Report Enhanced Nutrition for Mothers and Children (P131850) 12/23/2019 Page 3 of 15 Public Disclosure Copy The World Bank Implementation Status & Results Report Enhanced Nutrition for Mothers and Children (P131850) 12/23/2019 Page 4 of 15 Public Disclosure Copy The World Bank Implementation Status & Results Report Enhanced Nutrition for Mothers and Children (P131850) 12/23/2019 Page 5 of 15 Public Disclosure Copy The World Bank Implementation Status & Results Report Enhanced Nutrition for Mothers and Children (P131850) mpaTable Multiphase Programmatic Approach (MPA) Status mpaTableBody Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- High High Macroeconomic -- Substantial Substantial Sector Strategies and Policies -- Moderate Moderate Technical Design of Project or Program -- Substantial Substantial 12/23/2019 Page 6 of 15 Public Disclosure Copy The World Bank Implementation Status & Results Report Enhanced Nutrition for Mothers and Children (P131850) Institutional Capacity for Implementation and Sustainability -- High High Fiduciary -- Substantial Substantial Environment and Social -- Low Low Stakeholders -- Moderate Moderate Other -- -- -- Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes Increase coverage of interventions known to improve nutritional status IN00774229 ►Children 6-24 months fed in accordance with all three infant and young child feeding (IYCF) practices (food diversity, feeding frequency, consumption of breastmilk or milk) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.60 -- 7.03 20.00 Date 01-Jul-2013 -- 26-Nov-2019 31-Dec-2019 IN00774271 Province KPK: Children 6-24 months fed in accordance with all three infant and young child feeding (IYCF) practices (food diversity, feeding frequency, consumption of breastmilk or milk) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 5.80 -- 3.10 20.00 Date 01-Jul-2013 -- 26-Nov-2019 31-Dec-2019 IN00774272 Province Balochistan: Children 6-24 months fed in accordance with all three infant and young child feeding (IYCF) practices (food diversity, feeding frequency, consumption of breastmilk or milk) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 5.10 -- 15.80 20.00 Date 01-Jul-2013 -- 26-Nov-2019 31-Dec-2019 IN00774273 Province Sindh: Children 6-24 months fed in accordance with all three infant and young child feeding (IYCF) practices (food diversity, feeding frequency, comsumption of breastmilk or milk) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 5.80 -- 2.20 20.00 Date 01-Jul-2013 -- 26-Nov-2019 31-Dec-2019 IN00774203 ►Episodes of diarrhea in children between the age of 6 and 59 months treated with zinc and ORS (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/23/2019 Page 7 of 15 Public Disclosure Copy The World Bank Implementation Status & Results Report Enhanced Nutrition for Mothers and Children (P131850) Value 1.00 30.00 42.63 50.00 Date 31-Oct-2014 11-Aug-2017 26-Nov-2019 31-Dec-2019 This indicators measures the proportion of episodes of diarrhea in children 6-59 months that are treated with zinc and ORS(composite indicator). Distribution of zinc and ORS to the caretakers will be taken as a Comments: proxy for treatment. Given the high proportion of care seeking that takes place from private providers in Pakistan, the DHIS data (covers public service provision) will be supplementedby the cross-sectional IN00774204 surveys at baseline (year 1), year 3 and year 5. Province KPK: Episodes of diarrhea in children between the age of 6 and 59 months treated with zinc and ORS (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 6.90 50.90 50.00 Date 31-Oct-2014 30-Jun-2017 26-Nov-2019 31-Dec-2019 IN00774205 Province Balochistan: Episodes of diarrhea in children between the age of 6 and 59 months treated with zinc and ORS (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 52.00 35.00 50.00 Date 31-Oct-2014 31-Dec-2018 26-Nov-2019 31-Dec-2019 IN00774231 Province Sindh: Episodes of diarrhea in children between the age of 6 and 59 months treated with zinc and ORS (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 54.00 42.00 50.00 Date 31-Oct-2014 31-May-2019 26-Nov-2019 31-Dec-2019 IN00774261 ►Children between the age of 6 and 59 months receiving Vitamin A supplementation (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 11,901,936.00 3,843,822.00 Date 31-Oct-2014 -- 26-Nov-2019 31-Dec-2019 IN00774264 Province KPK: Children between the age of 6-59 months receiving Vitamin A supplementation (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 5,591,082.00 3,243,822.00 Date 01-Mar-2018 -- 26-Nov-2019 31-Dec-2019 IN00774265 Province Balochistan: Children 6-59 months receiving Vitamin A supplementation (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 491,923.00 350,000.00 12/23/2019 Page 8 of 15 Public Disclosure Copy The World Bank Implementation Status & Results Report Enhanced Nutrition for Mothers and Children (P131850) Date 31-Oct-2019 -- 26-Nov-2019 31-Dec-2019 IN00774276 Province Sindh: Children 6-59 months receiving Vitamin A supplementation (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 5,818,931.00 250,000.00 Date 31-Oct-2014 -- 26-Nov-2019 31-Dec-2019 IN00774185 ►Pregnant women receiving iron and folic acid (IFA) supplements (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 2,282,444.00 5,170,590.00 Date 31-Oct-2014 -- 26-Nov-2019 31-Dec-2019 IN00774274 Province KPK: Pregnant women receiving iron and folic acid (IFA) supplements (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 1,065,350.00 1,845,375.00 Date 01-Mar-2018 -- 26-Nov-2019 31-Dec-2019 IN00774277 Province Balochistan: Pregnant women receiving iron and folic acid (IFA) supplements (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 120,857.00 1,108,405.00 Date 31-Oct-2014 -- 26-Nov-2019 31-Dec-2019 IN00774288 Province Sindh: Pregnant women receiving iron and folic acid (IFA) supplements (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 1,096,237.00 2,216,810.00 Date 31-Oct-2014 -- 26-Nov-2019 31-Dec-2019 IN00774266 ►Children under age five treated for moderate or severe acute malnutrition (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 223,685.00 160,000.00 Date 31-Oct-2014 -- 26-Nov-2019 31-Dec-2019 IN00789789 KPK Children under five treated for moderate or severe acute malnutrition (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 38,426.00 313,569.00 Date 30-Jun-2015 -- 26-Nov-2019 31-Dec-2019 12/23/2019 Page 9 of 15 Public Disclosure Copy The World Bank Implementation Status & Results Report Enhanced Nutrition for Mothers and Children (P131850) IN00789790 Sindh Children under five treated for moderate or severe acute malnutrition (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 22,047.00 110,000.00 Date 30-Jun-2015 -- 26-Nov-2019 31-Dec-2019 IN00789826 Balochistan Children under five treated for moderate or severe acute malnutrition (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 163,212.00 50,000.00 Date 30-Jun-2015 -- 26-Nov-2019 31-Dec-2019 IN00774230 ►Pregnant/lactating women, adolescent girls and/or children under age five reached by basic nutrition services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 2,331,480.00 4,275,413.00 Date 01-Jul-2013 -- 26-Nov-2019 31-Dec-2019 IN00774289 Province KPK: Pregnant/lactating women, adolescent girls and/or children under age five reached by basic nutrition services (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 457,848.00 3,575,413.00 Date 01-Mar-2018 -- 26-Nov-2019 31-Dec-2019 IN00774290 Province Balochistan: Pregnant/lactating women, adolescent girls and/or children under age five reached by basic nutrition services (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 777,395.00 300,000.00 Date 31-Oct-2014 -- 26-Nov-2019 31-Dec-2019 IN00774267 Province Sindh: Pregnant/lactating women, adolescent girls and/or children under age five reached by basic nutrition services (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 1,096,237.00 400,000.00 Date 31-Oct-2014 -- 26-Nov-2019 31-Dec-2019 IN00774232 ►Knowledge and attitudes score related to nutrition (households) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 3.00 3.00 8.00 Date 31-Oct-2014 31-Oct-2014 31-Oct-2014 31-Dec-2019 12/23/2019 Page 10 of 15 Public Disclosure Copy The World Bank Implementation Status & Results Report Enhanced Nutrition for Mothers and Children (P131850) This is a composite score from household cross-sectional surveys that will assess knowledge and attitudes in a number of nutrition-related areas for project implementing areas. TO be deleted as relevant Comments: surveys did not take place IN00774233 Province KPK: Knowledge and attitudes score related to nutrition (households) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 1.00 1.00 8.00 Date 31-Oct-2014 01-Oct-2014 01-Oct-2014 31-Dec-2019 IN00774234 Province Balochistan: Knowledge and attitudes score related to nutrition (households) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 3.00 3.00 8.00 Date 31-Oct-2014 31-Oct-2014 31-Oct-2014 31-Dec-2019 IN00774235 Province Sindh: Knowledge and attitudes score related to nutrition (households) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 3.00 3.00 8.00 Date 31-Oct-2014 30-Dec-2016 30-Dec-2016 31-Dec-2019 IN00774236 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,981,812.00 2,331,480.00 4,000,000.00 Date 30-Jun-2014 31-May-2019 26-Nov-2019 31-Dec-2019 The numbers show a drop as they have now been corrected and the indicator on "Pregnant/lactating women, adolescent girls and/or children under age 5 reached by basic nutrition services" has been used Comments: to report on this CRI. IN00774237 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,981,812.00 2,331,480.00 4,000,000.00 Date 30-Jun-2015 31-May-2019 26-Nov-2019 31-Dec-2019 Intermediate Results Indicators by Components Strengthening institutional capacity IN00774239 ►Health personnel receiving training (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/23/2019 Page 11 of 15 Public Disclosure Copy The World Bank Implementation Status & Results Report Enhanced Nutrition for Mothers and Children (P131850) Value 0.00 15,727.00 30,981.00 31,212.00 Date 31-Oct-2013 31-May-2019 26-Nov-2019 31-Dec-2019 This indicator measures the cumulative number of health personnel receiving training through a Bank- Comments: financed project. IN00774242 Province KPK: Health personnel receiving training (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 60.00 15,210.00 15,712.00 Date 30-Dec-2016 31-May-2019 26-Nov-2019 31-Dec-2019 IN00774244 Province Balochistan: Health personnel receiving training (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,327.00 4,341.00 4,000.00 Date 31-Oct-2013 31-May-2019 26-Nov-2019 31-Dec-2019 IN00774240 Province Sindh: Health personnel receiving training (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 11,340.00 11,340.00 10,000.00 Date 31-Oct-2013 31-May-2019 26-Nov-2019 31-Dec-2019 IN00774246 ►Annual district plans for nutrition available on time in project districts (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 16.00 41.00 16.00 Date 31-Oct-2014 01-Jan-2018 26-Nov-2019 31-Dec-2019 This indicator measures the number of annual district nutrition plans that will have been prepared on time, Comments: as per the timelines set by the provincial Health Department planning processes IN00774247 Province Balochistan: Annual district plans for nutrition available on time in project districts (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 7.00 7.00 7.00 Date 31-Oct-2014 01-Jan-2018 26-Nov-2019 31-Dec-2019 IN00774248 Province Sindh: Annual district plans for nutrition available on time in project districts (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 9.00 9.00 9.00 Date 31-Oct-2014 01-Jan-2018 26-Nov-2019 31-Dec-2019 IN00774249 ►Nutrition knowledge score for health workers in project districts (Number, Custom) 12/23/2019 Page 12 of 15 Public Disclosure Copy The World Bank Implementation Status & Results Report Enhanced Nutrition for Mothers and Children (P131850) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 3.00 3.00 8.00 Date 31-Oct-2014 31-Oct-2014 31-Oct-2014 31-Dec-2019 This will be a composite score of key areas of knowledge on nutrition which would have been covered Comments: through the training and in themedia campaigns. IN00774250 Province KPK: Nutrition knowledge score for health workers in project districts (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 1.00 8.00 Date 30-Dec-2016 30-Dec-2016 30-Dec-2016 31-Dec-2019 IN00774251 Province Balochistan: Nutrition knowledge score for health workers in project districts (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 7.90 7.90 8.00 Date 31-Oct-2014 30-Dec-2016 30-Dec-2016 31-Dec-2019 IN00774252 Province Sindh: Nutrition knowledge score for health workers in project districts (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 3.00 3.00 8.00 Date 31-Oct-2014 30-Dec-2016 30-Dec-2016 31-Dec-2019 IN00774253 ►Government Project budget execution (expenditure out of allocated amount from budget) in project districts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 19.00 93.93 90.00 Date 31-Oct-2014 30-Dec-2016 26-Nov-2019 31-Dec-2019 This indicator measures the proportion of the project budget that has been used by the provincial Comments: Department of Health to carry outthe activities financed by the project in a given fiscal year. This indicator IN00774255 expresses the % of annual Government allocation spend. Province KPK: Government Project budget execution (expenditure out of allocated amount from budget) in project districts (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 1.00 100.00 90.00 Date 30-Dec-2016 30-Dec-2016 26-Nov-2019 31-Dec-2019 IN00774254 Province Balochistan: Government Project budget execution (expenditure out of allocated amount from budget) in project districts (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 13.00 99.80 90.00 12/23/2019 Page 13 of 15 Public Disclosure Copy The World Bank Implementation Status & Results Report Enhanced Nutrition for Mothers and Children (P131850) Date 31-Oct-2014 30-Dec-2016 26-Nov-2019 31-Dec-2019 IN00774256 Province Sindh: Government Project budget execution (expenditure out of allocated amount from budget) in project districts (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 27.00 91.00 90.00 Date 31-Oct-2014 30-Dec-2016 26-Nov-2019 31-Dec-2019 Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P131850 IDA-55360 Effective USD 36.24 36.24 0.00 32.66 0.15 100% P131850 TF-18108 Effective USD 11.71 11.71 0.00 10.35 1.36 88% P131850 TF-A6558 Effective USD 5.00 5.00 0.00 4.51 0.49 90% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P131850 IDA-55360 Effective 29-Aug-2014 31-Oct-2014 15-Jan-2015 31-Dec-2018 31-Dec-2019 P131850 TF-18108 Effective 31-Oct-2014 31-Oct-2014 27-Mar-2015 30-Jun-2018 31-Dec-2019 P131850 TF-A6558 Effective 02-Feb-2018 02-Feb-2018 02-Feb-2018 31-Dec-2018 31-Dec-2019 Cumulative Disbursements 12/23/2019 Page 14 of 15 Public Disclosure Copy The World Bank Implementation Status & Results Report Enhanced Nutrition for Mothers and Children (P131850) Restructuring History Level 2 Approved on 26-Jun-2018 ,Level 2 Approved on 28-Dec-2018 Related Project(s) P161629-Enhanced Nutrition for Mothers and Children ,P161703-Additonal Financing to Khyber Pakhtunkhwa: Enhanced Nutrition to Mothers and Children Project 12/23/2019 Page 15 of 15