Public Disclosure Copy 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: 3 | ARCHIVED on 12-Jul-2018 | ISR32678 | 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:-- Actual Mid-Term Review Date:-- Original Closing Date:30-Jun-2021 Revised Closing Date:30-Jun-2021 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 PHRPDODEL Components Name Use of Performance-based Payments to Support the Recipient's Free Health Care (FHC) Program:(Cost $40.60 M) Implementation Support for the FHC program-related activities:(Cost $8.40 M) Strengthening of Newly Integrated FHC Program Service Providers through financing of minor investments/renovations works for CHWs and nursing training schools:(Cost $1.00 M) Contingency Emergency Response Component (CERC) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Satisfactory  Satisfactory Overall Implementation Progress (IP)  Satisfactory  Satisfactory Overall Risk Rating  Substantial  Substantial 7/12/2018 Page 1 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) Implementation Status and Key Decisions The KIRA project was approved on February 24, 2017 and became effective June 20, 2017. One will recall that the official launch of the KIRA project was organized on September 13th, 2017 in presence of the Minister of Health. The launch was the occasion to report on achievements of the previous project (Health Sector Development Support-HSDSP) that ended in June 2017, on preliminary results of DHS and SARA surveys that were supported by HSDSP as well as to present the main components of the KIRA project to a large audience of stakeholders. Since then The project implementation is on a very good trajectory especially at health facility level as all the related arrangement is in place and service provision, verification and quality assessment are undertaken on a timely manner. This resulted in a swift transfer linked to performance based payments that in turn increased tremendously the disbursement which is 29.16% to date after one year of implementation. The following key activities have already been carried out: (i) Revising the quality assessment grids for hospitals with the aim of more focus on change in health care provision than on structural aspects;(ii) Completion of the recruitment of independent verification agents with the main task of conducting health service quality assessment ; (iii) Starting of the PBF in nurses schools; and (iv) Training of trainers on Community PBF as well as translation of related tools in Kirundi in June 2018. Moreover, the legal process of CHW groupings (GASC) has completed and trainings of CHW will be started early in July 2018 as the translation of related tools in Kirundi has also completed. 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 Project Development Objective Indicators PHINDPDOTBL  People who have received essential Health, Nutrition, and Population (HNP) services (Children immunized; Women and children who have received basic nutrition services; Deliveries attended by skilled h (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 7/12/2018 Page 2 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) Value 772,087.00 -- 872,766.00 4,259,006.00 Date 01-Jan-2016 -- 29-Dec-2017 30-Jun-2021 PHINDPDOTBL  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 38.00 36.84 51.00 Date 01-Jan-2016 30-Oct-2017 29-Dec-2017 30-Jun-2021 PHINDPDOTBL  National quality average score of district hospital (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 80.00 82.50 89.00 85.00 Date 01-Jan-2016 30-Oct-2017 29-Dec-2017 30-Jun-2021 PHINDPDOTBL  Contraceptive prevalence rate for modern methods (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 38.00 42.50 35.30 45.00 Date 01-Jan-2016 30-Oct-2017 29-Dec-2017 30-Jun-2021 PHINDPDOTBL  Contraceptive prevalence rate among adolescents (Percentage, Custom) 7/12/2018 Page 3 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) Baseline Actual (Previous) Actual (Current) End Target Value 1.50 3.40 3.40 12.00 Date 01-Jan-2016 30-Oct-2017 29-Dec-2017 30-Jun-2021 Overall Comments Intermediate Results Indicators PHINDIRITBL  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 2.20 2.20 2.50 Date 01-Dec-2016 30-Oct-2017 29-Dec-2017 30-Jun-2021 PHINDIRITBL  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 -- 183,799.00 903,254.00 Date 01-Jan-2016 -- 29-Dec-2017 30-Jun-2021 PHINDIRITBL  Number of years-protection couples for modern methods (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 553,679.00 550,865.00 682,201.00 3,066,611.00 Date 01-Jan-2016 30-Oct-2017 29-Dec-2017 30-Jun-2021 7/12/2018 Page 4 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) PHINDIRITBL  Coverage of births attended by qualified personnel (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 77.30 86.70 79.30 85.00 Date 01-Jan-2016 30-Oct-2017 29-Dec-2017 30-Jun-2021 PHINDIRITBL  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 5,026.00 4,112.00 22,430.00 Date 01-Jan-2016 30-Oct-2017 29-Dec-2017 30-Jun-2021 PHINDIRITBL  Percentage of Health Centers with Heads at level A2 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 62.00 63.00 65.00 83.00 Date 01-Jan-2016 30-Oct-2017 29-Dec-2017 30-Jun-2021 PHINDIRITBL  Satisfaction rate of beneficiaries on health care delivered by health centers (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 99.00 99.00 99.00 100.00 Date 01-Jan-2016 30-Oct-2017 29-Dec-2017 30-Jun-2021 7/12/2018 Page 5 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) PHINDIRITBL  Percentage of public health facilities that offer FHC and use RBF (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 97.00 97.50 98.30 99.00 Date 01-Jan-2016 30-Oct-2017 29-Dec-2017 30-Jun-2021 PHINDIRITBL  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 0.00 0.00 499,137.00 Date 01-Jan-2016 30-Oct-2017 30-Oct-2017 30-Jun-2021 PHINDIRITBL  Number of pregnant women referred for early antenatal care ANC1 (TRIM1) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 210,745.00 Date 01-Jan-2016 30-Oct-2017 29-Dec-2017 30-Jun-2021 PHINDIRITBL  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 0.00 0.00 1,352,334.00 Date 30-Dec-2016 30-Oct-2017 29-Dec-2017 30-Jun-2021 Overall Comments 7/12/2018 Page 6 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) 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 15.42 37.03 29% 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 Restructuring History There has been no restructuring to date. Related Project(s) 7/12/2018 Page 7 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) P166576-Burundi Health System Support-Additional Financing 7/12/2018 Page 8 of 8 Public Disclosure Copy