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: 6 | ARCHIVED on 10-Feb-2020 | ISR40328 | 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: 24-Feb-2020 Actual Mid-Term Review Date: Original Closing Date: 30-Jun-2021 Revised Closing Date: 30-Jun-2021 pdoTable 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 Components Table Name Use of Performance-based Payments to Support the Recipient's Free Health Care (FHC) Program:(Cost $46.50 M) Implementation Support for the FHC program-related activities:(Cost $10.40 M) Strengthening of Newly Integrated FHC Program Service Providers through financing of minor investments/renovations works for CHWs and nursing training schools:(Cost $1.40 M) Contingency Emergency Response Component (CERC) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions  Additional Financing: In July 2019, an additional financing in the amount of a US$8.3 million grant from the Global Alliance for Vaccines and Immunizations Trust Fund (GAVI) became effective, bringing the total Project amount to $58.3 million.  Contingency Emergency Response Component (CERC) Activation: In October 2019, the CERC component of the project was activated for an amount of $3.3 million. The amount requested was part of a broader package of support to finance the Contingency plan for the preparedness and response to Ebola Virus Disease (EVD) including the World Bank in response to a likely imminent event of an outbreak of the EVD to occur following the EVD outbreak in the Democratic Republic of the Congo that began in August 2018. The CERC funds were reallocated from Component 1. 2/10/2020 Page 1 of 7 The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012)  Implementation status: The implementation of the project has accelerated and kept a good pace so far on all its components. Health facilities are paid regularly for their performance and the management and regulatory mechanisms as well as the process of verification and counter verification of the PBF-FHC program are rather functional.  Operations manual: Updates to the PBF/FHC operational manual were discussed and formally validated by the extended PBF/FHC Technical Unit. This new version of the manual includes important elements for good governance and sustainability of the PBF/FHC program, in particular the recruitment of all verifiers (civil servants and contracted ones) through a competitive process, the suspension of the introduction of new private facilities through PBF secondary contracts, the respect of facilities extension coverage plan, limitation to two secondary contracts by facility; assessment of the services offered by private facilities to determine the relevant reimbursement level; etc.).  Community PBF: PBF at community level is implemented in 7 provinces (Makamba, Mwaro, Kayanza, Muyinga, Kirundo, Gitega and Muramvya) from December 2018 except the province of Muramvya which started in January 2019. In these provinces, 269 Groups of community health workers (composed by 5,174 community health workers) organized around Health Centers are contracted for a package of 25 indicators including: (i) sensitization to prevent several diseases; (ii) promotion of key services like family planning, nutrition, vaccination, and antenatal care; (iii) referral to health facilities; (iv) treatment of malaria, diarrhea and acute respiratory infections; and (v) community-based distribution of contraceptive methods. PBF at community level is funded by KIRA project, KFW through the NGO CORDAID, GAVI Alliance through KIRA project. A gradual extension of the PBF at community level was planned with 6 new provinces from October 2019 but given the lack of financial resources for PBF/FHC, this extension has been suspended. Some materials and equipment (including bicycles) were purchased for all community health workers in Mwaro and Kayanza provinces, and a part of community health workers in Gitega province.  PBF with Paramedical schools: Eight paramedical schools are contracted based on their performance, including 6 public (Gitega, Ngozi, Bururi, Cankuzo, ETAL, Gisuru) and 2 faith based (Bubanza and Muyinga). Funds earned by these schools allows them to improve the quality of teaching, improve training supervision, buy equipment and materials, motivate teachers.  Central level PBF: The contractualisation of the central level of MOH started in 2019. An independent external entity was recruited to verify the performance of the central level. 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 Substantial Substantial Substantial Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Moderate Moderate Moderate Stakeholders Moderate Moderate Moderate Other High High High Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes 2/10/2020 Page 2 of 7 The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) Increase the use of quality Reproductive, Maternal, Neonatal, Child and Adolescent Health services IN00795603 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 18,660,973.00 18,660,973.00 18,640,000.00 Date 30-Jun-2016 31-May-2019 31-May-2019 30-Jun-2021 This indicator is a CRI indicator and replaces the original indicator (from PAD) which had the same label Comments: but for which definitions were not aligned with CRI guidelines. IN00795604 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,844,740.00 5,566,880.00 8,640,000.00 Date 01-Feb-2017 31-May-2019 29-Nov-2019 30-Jun-2021 IN00795605 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 12,488,300.00 12,488,300.00 8,800,000.00 Date 01-Feb-2017 31-May-2019 31-May-2019 30-Jun-2021 IN00795641 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,327,933.00 1,567,340.00 1,200,000.00 Date 01-Feb-2017 31-May-2019 29-Nov-2019 30-Jun-2021 IN00795642 ►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 41.50 41.50 51.00 Date 01-Jan-2016 31-May-2019 31-May-2019 30-Jun-2021 IN00795643 ►National quality average score of district hospital (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 80.00 85.48 82.40 85.00 Date 01-Jan-2016 31-May-2019 29-Nov-2019 30-Jun-2021 IN00795644 2/10/2020 Page 3 of 7 The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) ►Contraceptive prevalence rate for modern methods (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 38.00 35.20 35.20 45.00 Date 01-Jan-2016 31-Dec-2018 31-Dec-2018 30-Jun-2021 IN00795645 ►Contraceptive prevalence rate among adolescents (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.50 2.50 2.50 12.00 Date 01-Jan-2016 02-Jan-2017 02-Jan-2017 30-Jun-2021 Overall Comments PDO Data for which DHIS2 is the source cannot be provided yet. There is a current effort in Burundi to review and validate all 2019 data coming from the health management information system. Missing data for those indicators will be populated once the validation exercise is completed. Intermediate Results Indicators by Components Use of Performance-based Payments to Support the Recipient's Free Health Care (FHC) Program IN00795646 ►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 2.07 2.50 2.50 Date 01-Dec-2016 31-May-2019 29-Nov-2019 30-Jun-2021 IN00795647 ►Pregnant women receiving antenatal care during a visit to a health provider (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 165,504.00 744,738.00 892,491.00 903,254.00 Date 01-Jan-2016 31-May-2019 29-Nov-2019 30-Jun-2021 IN00795648 ►Number of years-protection couples for modern methods (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 553,679.00 5,730,492.00 5,730,492.00 3,066,611.00 Date 01-Jan-2016 31-May-2019 31-May-2019 30-Jun-2021 2/10/2020 Page 4 of 7 The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) IN00795649 ►Coverage of births attended by qualified personnel (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 77.30 93.80 93.00 85.00 Date 01-Jan-2016 31-May-2019 29-Nov-2019 30-Jun-2021 IN00795650 ►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 12,780.00 13,534.00 22,430.00 Date 01-Jan-2016 31-May-2019 29-Nov-2019 30-Jun-2021 IN00795651 ►Satisfaction rate of beneficiaries on health care delivered by health centers (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 57.43 80.87 96.70 75.00 Date 30-Dec-2016 29-Mar-2019 29-Nov-2019 30-Jun-2021 IN00795652 ►Percentage of public health facilities that offer FHC and use RBF (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 97.00 94.00 100.00 99.00 Date 01-Jan-2016 31-May-2019 29-Nov-2019 30-Jun-2021 94% of facilities with principal contract. More facilities with secondary contracts. Comments: IN00795653 ►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 0.00 143,981.00 202,622.00 499,137.00 Date 01-Jan-2016 31-May-2019 29-Nov-2019 30-Jun-2021 IN00795654 ►Number of pregnant women referred for early antenatal care ANC1 (TRIM1) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 124,298.00 195,956.00 210,745.00 Date 01-Jan-2016 31-May-2019 29-Nov-2019 30-Jun-2021 IN00795655 2/10/2020 Page 5 of 7 The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) ►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 0.00 341,956.00 351,781.00 1,352,334.00 Date 30-Dec-2016 31-May-2019 29-Nov-2019 30-Jun-2021 IN00795656 ►Children under 2 fully immunized (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 79.80 74.40 78.90 95.00 Date 30-Jun-2017 31-May-2019 29-Nov-2019 30-Jun-2021 IN00795657 ►Grievances registered related to delivery of project benefits that are actually addressed (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 50.00 Date 25-Feb-2019 31-May-2019 31-May-2019 30-Jun-2021 No complaints received between January and May 2019 Comments: 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 43.53 8.25 84% 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 2/10/2020 Page 6 of 7 The World Bank Implementation Status & Results Report Health System Support Project ("KIRA") (P156012) Restructuring History There has been no restructuring to date. Related Project(s) P166576-Burundi Health System Support-Additional Financing ,P173252-KIRA Additional Financing 2/10/2020 Page 7 of 7