The World Bank Report No: ISR8100 Implementation Status & Results Cambodia Cambodia Second Health Sector Support Program (P102284) Public Disclosure Copy Operation Name: Cambodia Second Health Sector Support Program Project Stage: Implementation Seq.No: 5 Status: ARCHIVED Archive Date: 06-Feb-2013 (P102284) Country: Cambodia Approval FY: 2008 Product Line: IBRD/IDA Region: EAST ASIA AND PACIFIC Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 19-Jun-2008 Original Closing Date 30-Jun-2014 Planned Mid Term Review Date 14-Sep-2011 Last Archived ISR Date 24-Mar-2012 Effectiveness Date 19-Jan-2009 Revised Closing Date 30-Jun-2014 Actual Mid Term Review Date 14-Nov-2011 Project Development Objectives Project Development Objective (from Project Appraisal Document) To support the implementation of the Government's Health Strategic Plan 2008-2015 in order to improve health outcomes through strengthening institutional capacity and mechanisms by which the Government and Program Partners can achieve more effective and efficient sector performance. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Strengthening Health Service Delivery 55.00 Improving Health Financing 21.00 Strenthening Human Resources 12.50 Strengthening Health System Stewardship Functions 28.50 Public Disclosure Copy Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Implementation Status Overview This ISR is an update following the Joint Review Mission conducted between June 11- 15, 2012. In the weeks leading up to the mission, visits to several provinces were undertaken to review implementation progress. Page 1 of 5 The World Bank Report No: ISR8100 Overall progress toward the development objective is rated moderately satisfactory, as issues remain with regard to institutional capacity building, financing, organization of services, and staff turnover. However, noted progress has been made in implementing elements of the RGC Second Health Strategic Plan that are supported by the Program, together with overall improved health outcomes and MDGs. The HSSP2 Cambodia Demographic Health Survey (CDHS) 2010 confirmed substantial improvement of health status of Cambodian population. After an apparent stagnation from 2000 to 2005, maternal mortality was reduced by half from 2005 to 2010 (from 472 to 206 per 100,000 live births). Reductions in child Public Disclosure Copy mortality have been declining at an average annual rate of 8% per year in the past decade. Child mortality declined sharply among the poorest, although at a similar rate to the richest quintile. With respect to MDG 1 (child nutrition), stunting showed a modest decline (from 50% in 2000 to 40% in 2010), but wasting increased (from 8% in 2005 to 11% in 2010) and underweight showed no change (28.1 in 2005 vs 28.3 in 2010). Based on these findings, the RGC is seeking to strengthen the national response to malnutrition, including through a national seminar on malnutrition (in May 2012) that was opened by the Prime Minister. While the Program is supporting improved service delivery, and has contributed to strengthening institutional capacity in a number of areas, further progress is needed to establish and strengthen national institutions for management and financing of the health sector – particularly integrated medium term expenditure planning – and to measure progress toward institutional development. HSSP2 support for Health Equity Fund (HEFs) and performance-based Service Delivery Grants (SDGs) to Special Operating Agencies (SOAs) has contributed to more effective and efficient sector performance. HSSP2 financing to central programs and provinces through the Annual Operational Plans (AOPs) has provided important support for training, supervision, and outreach, but evidence on the impact and efficiency of these expenditures remains limited. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Number and percentage of MoH central Percentage Value 79.00 100.00 95.00 institutions and provinces submitting AOP and Date 31-Dec-2008 30-Jun-2012 01-Jan-2014 3 YRPs according to schedule and MoH format Comments AOP 2012 approval from the central level was delayed because of the time taken to reach consensus on allocation of funds across program areas and incorrect overall AOP allocations submitted. Public Disclosure Copy Technical content and results focus on AOP Text Value PAD End Evaluations process improves, based on MTR and Final Date 31-Dec-2008 30-Jun-2012 30-Jun-2014 Evaluation Comments 2008 AOP processes improved. Links to results and greater technical involvement and ownership by relevant task forces and guidance is needed, especially for intervention such as NCDs. Page 2 of 5 The World Bank Report No: ISR8100 Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target AOP resource allocation reflecting HSP2 and Text Value DPHI 2008 1: 3.9% 2: 20.2% MCH: $25.8 million (8.52%), 1. increase in MCH 2. Level Public Disclosure Copy JAPR priorities (1.MCH; 2.CD; and 3.NCDs) 3: 0.5% CDC: $ 64.4 million maintained 3. Increase in NCDs Date 31-Dec-2008 31-Dec-2011 31-Dec-2013 Comments These numbers underestimate actual allocations to MCH and to some extent NCD since much support is through non- program budget. Rate of Program execution for both pooled Text Value DPs: 85% (AOP 2008 and RGC: 77% DPs: 95%; RGC: 95% Development Partner (DP) and Royal ODA database) RGC: 91% DPs (HSSP2 Pooled)-52% Government of Cambodia (RGC) funds Date 31-Dec-2008 30-Jun-2011 30-Jun-2014 Comments IFR Quarter 2, 2012. Share of operating cost budget reaching Text Value Not applicable 100% 100% contracting ODs Date 31-Dec-2008 31-Dec-2011 30-Jun-2014 Comments Performance Monitoring Report, Semester1, 2011 Proportion of Operational Districts (ODs) Text Value NA 100% 100% implementing serivce delivery grants (SDGs) Date 31-Dec-2008 30-Jun-2012 30-Jun-2014 and internal contracting meeting at least 80%of Comments their performance targets Financial Management Improvement Plan Text Value Not applicable. Rebid of FMIP contract as FMIP Implemented developed and implemented scope of work changed substantially. Date 31-Dec-2008 30-Jun-2012 30-Jun-2014 Comments Progress in some aspects of FMIP are constrained by Public Disclosure Copy delayed implementation of national PFM reforms. FMIP2 contract is under rebid Selected key HSP2 indicators disaggregated Text Value 2008 figure to be established To be established by gender and location based on 2009 JAPR report Date 31-Dec-2008 30-Jun-2012 30-Jun-2014 Comments New HMIS system provides data by location and gender and province level. Page 3 of 5 The World Bank Report No: ISR8100 Health personnel receiving training (number) Number Value 0.00 8961.00 0.00 Date 31-Dec-2007 31-Dec-2011 30-Jun-2014 Comments Updated from HSSP2 Annual End target can be determined Public Disclosure Copy Progress Report 2011. JRM only when MoH delivers a June, 2012 Training Strategy and Plan. Number of Health Personnel receiving POC Number Value 0.00 0.00 247.00 payments Sub Type Supplemental People with access to a basic package of Number Value 152213.00 872556.00 0.00 health, nutrition, or reproductive health services Date 31-Dec-2007 31-Dec-2011 30-Jun-2014 (number) Comments JAPR 2012 To be determined Health facilities constructed, renovated, and/or Number Value 0.00 0.00 100.00 equipped (number) Date 31-Dec-2007 30-Jun-2012 30-Jun-2014 Comments 99 Health Centers, 7 health posts expected to be completed by Dec 2012, and 2 RTCs by mid 2013. Additional HCs and delivery rooms will be contracted out in 2013. Children immunized (number) Number Value 0.00 Date 31-Dec-2007 31-Dec-2011 30-Jun-2014 Comments CDHS 2005- 60% 74% Target for fully immunized has (CDHS 2010) not been set The previous ISR figure refers only to DPT HepB3 Percent and number of children under 1 year Percentage Value 339196.00 324628.00 immunized with DPT-HepB3 Sub Type Supplemental Public Disclosure Copy Pregnant women receiving antenatal care Number Value 291853.00 315717.00 0.00 during a visit to a health provider (number) Date 31-Dec-2009 31-Dec-2011 31-Dec-2013 Comments ANC2 visits ANC2 (JAPR 2012) Target - 84% Base line- 68% (2007. HSP2) The previous number was (Pre-JAPA 2011) based on semi annual report Data on Financial Performance (as of 20-Nov-2012) Financial Agreement(s) Key Dates Page 4 of 5 The World Bank Report No: ISR8100 Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P102284 IDA-44700 Effective 19-Jun-2008 17-Jul-2008 19-Jan-2009 30-Jun-2014 30-Jun-2014 P102284 TF-93574 Effective 14-Jan-2009 14-Jan-2009 14-Jan-2009 30-Jun-2014 30-Jun-2014 Public Disclosure Copy Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P102284 IDA-44700 Effective USD 30.00 30.00 0.00 16.33 11.88 54.00 P102284 TF-93574 Effective USD 52.09 86.09 0.00 62.21 23.88 72.00 Disbursement Graph Key Decisions Regarding Implementation Public Disclosure Copy Priority should be placed on improving the overall effectiveness and efficiency of sector spending (HSSP2, government budget, and other DPs), and improving measurement and monitoring of effectiveness and efficiency. Restructuring History Level two Approved on 19-Dec-2010, Level two Approved on 27-Sep-2012 Related Projects There are no related projects. Page 5 of 5