The World Bank Implementation Status & Results Report Mother and Child Health Services Strengthening Project (P148052) Mother and Child Health Services Strengthening Project (P148052) AFRICA | Chad | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2014 | Seq No: 8 | ARCHIVED on 07-Nov-2018 | ISR34255 | Implementing Agencies: Ministry of Health, Projet d’Appui à la Formation des Agents de l’Administration Publique au Tchad Key Dates Key Project Dates Bank Approval Date: 29-May-2014 Effectiveness Date: 18-Sep-2014 Planned Mid Term Review Date: 13-May-2016 Actual Mid-Term Review Date: 23-Feb-2018 Original Closing Date: 30-Sep-2018 Revised Closing Date: 31-Jul-2020 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) 29. The objective of the Project is to increase the utilization and improve the quality of maternal and child health services in targeted areas. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Improving accessibility and quality of Maternal and Child Health Services through Performance Based Financing and Commu nity Health:(Cost $8.90 M) Component 2: Strengthening the institutional capacity to implement and sustain performance-based financing and community-level healt h care services:(Cost $1.89 M) Component 3: Strengthening the delivery of the Expanded Programme of Immunization and Emergency Obstetric and Neonatal Care:(Cost $5.00 M) Component 4: Contingency Emergency Response Component (CERC) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Unsatisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions In the course of the last 6-8 months, the performance of the project has improved significantly. Performance-based financing (PBF) contracts are now under implementation and services are being delivered to target populations in 13 districts in 5 regions. Disbursements have reached over 50% of project financing (IDA H9610 is 59% and TF-17138 is 49%) and are expected to continue to rise to about 70% by the end of the FY. The inclusion of the new activities on strengthening vaccination cold chains and emergency obstetric care for mothers, introduced through the restructuring in June 2018, were welcomed as important elements complementing PBF activities. 11/19/2018 Page 1 of 6 The World Bank Implementation Status & Results Report Mother and Child Health Services Strengthening Project (P148052) Technical Assistance contracts were signed with i) WHO for training of hospitals doctors in district surgery and Emergency Obstetrical care and the provision of equipment to district hospitals in the project area; ii) UNICEF for the provision of cold chain equipment and rolling stock for immunization in health facilities, plus deworming and nutritional education for kids; UNICEF confirmed that already a large number of solar-powered refrigerators and motor bicycles have arrived in Chad and will soon be distributed to health facilities, and with iii) UNFPA for training of health center staff members about Emergency obstetrical care for maternal and child health care in primary health care facilities in the project districts. To accelerate the implementation of the PBF and implementation of activities, 440 staff were trained. At the central level, 87 staff from the Ministry of Public health were trained. Of this number 24 were trained in PBF and 51 were trained to be trainers. 353 staff were trained at the district and regional levels; 222 were those in charge of health centers, 46 from hospitals, 63 were members of the health management teams at the district and 22 were from the regional management team. At the same time, 125 health committee presidents were trained. 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 -- Substantial Substantial Technical Design of Project or Program -- Substantial Moderate Institutional Capacity for Implementation and Sustainability -- High Low Fiduciary -- High Low Environment and Social -- Moderate Moderate Stakeholders -- Moderate Moderate Other -- Moderate Moderate Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes Increase utilization and improve quality of maternal and child health services in targeted areas IN00620098 ►Pregnant women receiving antenatal care during a visit to a health provider (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 48,300.00 82,117.00 30,786.00 80,000.00 Date 14-Mar-2014 14-May-2018 31-Aug-2018 31-Jul-2020 IN00620186 ►Births (deliveries) attended by skilled health personnel (number) (Number, Custom) 11/19/2018 Page 2 of 6 The World Bank Implementation Status & Results Report Mother and Child Health Services Strengthening Project (P148052) Baseline Actual (Previous) Actual (Current) End Target Value 20,836.00 29,500.00 13,499.00 35,000.00 Date 14-Mar-2014 14-May-2018 31-Aug-2018 31-Jul-2020 IN00620187 ►Children immunized (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 15,389.00 54,193.00 15,046.00 25,000.00 Date 14-Mar-2014 14-May-2018 31-Aug-2018 31-Jul-2020 IN00620196 Children immunized - under 12 months against DTP3 (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 15,389.00 54,193.00 15,046.00 25,000.00 Date 14-Mar-2014 14-May-2018 31-Aug-2018 31-Jul-2020 IN00620191 ►Average score of the quality checklist (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 15.00 42.00 30.00 Date 14-Mar-2014 14-May-2018 31-Aug-2018 31-Jul-2020 Overall Comments PDO It should be noted that the Actual (Previous) values are administrative data that was available. The Actual (Current) of 31 August represents the verified data from the health facilities, after the effective start of project implementation in the districts and regions. This explains the apparent discrepancies of the data. Intermediate Results Indicators by Components Component 1: Improving accessibility and quality of Maternal and Child Health Services through Performance Based Financing and Commu nity Health IN00620100 ►Women of reproductive age using modern contraceptive methods (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 7,916.00 34,204.00 20,927.00 14,000.00 Date 14-Mar-2014 14-May-2018 31-Aug-2018 31-Jul-2020 IN00620188 ►Number of children under five years of age receiving preventive nutritional services (Number, Custom) 11/19/2018 Page 3 of 6 The World Bank Implementation Status & Results Report Mother and Child Health Services Strengthening Project (P148052) Baseline Actual (Previous) Actual (Current) End Target Value 23,483.00 38,632.00 17,383.00 50,000.00 Date 08-May-2015 08-May-2018 31-Aug-2018 31-Jul-2020 IN00620189 ►Tracer drugs available in targeted health facilities on the day of the visit (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 65.00 100.00 75.00 Date 14-Mar-2014 14-May-2018 31-Aug-2018 31-Jul-2020 Component 2: Strengthening the institutional capacity to implement and sustain performance-based financing and community-level healt h care services IN00620099 ►Health personnel receiving training (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 14.00 414.00 1,000.00 Date 14-Mar-2014 14-May-2018 31-Aug-2018 31-Jul-2020 IN00620190 ►Health facilities reporting monthly activities using standard report forms (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 65.00 85.00 100.00 95.00 Date 14-Mar-2014 14-May-2018 31-Aug-2018 31-Jul-2020 IN00620192 ►CHWs trained for delivering an integrated preventive and curative package at household level (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 250.00 1,000.00 500.00 Date 14-Mar-2014 14-May-2018 31-Aug-2018 31-Jul-2020 Component 3: Strengthening the delivery of the Expanded Programme of Immunization and Emergency Obstetric and Neonatal Care IN00620193 ►Health centers and districts that received cold chain Equipment (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 134.00 Date 31-May-2018 31-May-2018 31-Aug-2018 31-Jul-2020 IN00620194 ►Number of health centers and district hospitals that have SONUB services (Number, Custom) 11/19/2018 Page 4 of 6 The World Bank Implementation Status & Results Report Mother and Child Health Services Strengthening Project (P148052) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 150.00 Date 31-May-2018 31-May-2018 31-Aug-2018 31-Jul-2020 IN00620195 ►Staff in Health centers and district hospitals that received training in Emergency Obstetric and Neonatal Care (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 203.00 Date 31-May-2018 31-May-2018 31-Aug-2018 31-Jul-2020 Overall Comments IR It should be noted that the Actual (Previous) values are administrative data that was available. The Actual (Current) of 31 August represents the verified data from the health facilities, after the effective start of project implementation in the districts and regions. This explains the apparent discrepancies of the data. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P148052 IDA-H9610 Effective USD 15.79 15.79 0.00 8.51 5.80 59% P148052 TF-17138 Effective USD 5.00 5.00 0.00 2.50 2.50 50% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P148052 IDA-H9610 Effective 29-May-2014 20-Jun-2014 18-Sep-2014 30-Sep-2018 31-Jul-2020 P148052 TF-17138 Effective 20-Jun-2014 20-Jun-2014 18-Sep-2014 30-Sep-2018 31-Mar-2019 Cumulative Disbursements 11/19/2018 Page 5 of 6 The World Bank Implementation Status & Results Report Mother and Child Health Services Strengthening Project (P148052) Restructuring History Level 2 Approved on 28-Jun-2018 Related Project(s) There are no related projects. 11/19/2018 Page 6 of 6