The World Bank Implementation Status & Results Report Health System Support and Strengthening Project (P164953) Health System Support and Strengthening Project (P164953) AFRICA | Central African Republic | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2019 | Seq No: 2 | ARCHIVED on 21-May-2019 | ISR36943 | Implementing Agencies: Ministry of Health, Public Hygiene and Population, Ministry of Economy, Planning and Cooperation Key Dates Key Project Dates Bank Approval Date: 27-Sep-2018 Effectiveness Date: 07-Feb-2019 Planned Mid Term Review Date: 01-Jul-2020 Actual Mid-Term Review Date: -- Original Closing Date: 31-Dec-2021 Revised Closing Date: 31-Dec-2021 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To increase utilization and improve the quality of essential health services in targeted areas in the territory of the Recipient. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Improving the quality and utilization of essential health services at facility and community levels through performance-based financing (PBF):(Cost $36.00 M) Reinforcing the capacity of the Recipient’s health system and addressing Gender-Based Violence:(Cost $18.00 M) Contingent Emergency Response 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 Implementation Status and Key Decisions The SENI Health project was declared effective on February 7, 2019. A cascade training on the revised performance-based financing (PBF) implementation manual was held among Ministry of Health (MOH) departments, health district management teams, verification agencies, district hospitals and health center actors. MOH led consultations among key stakeholders in elaborating the community health service delivery mechanism. 5/21/2019 Page 1 of 7 The World Bank Implementation Status & Results Report Health System Support and Strengthening Project (P164953) Paoua district was added on to the gender-based violence (GBV) project sites by MOH, in addition to the 5 districts (6 sites) originally listed in the project document. GBV Plan of Action discussion workshop took place with GBV-related partners in February, led by MOH, with presence of UN agencies and NGOs. A consolidated plan of action has been elaborated. The maternal and child mortality reduction Investment Case development is almost finalized, with strong partnership of WHO, UNICEF, UNAIDS, UNFPA, European Union and World Bank Group under the leadership of the MOH. Resource mapping with financial information of inputs from most partners (UN, NGOs, bi-laterals) allocating to maternal-child health and nutrition was conducted and finalized. Fiscal space analysis was conducted by the WB and submitted for final revision. Health sector budget analysis is being conducted in collaboration with a large number of partners (various MOH departments, UN agencies, NGOs, civil society) to analyze costs to reduce maternal and child mortality in CAR. A civil society organization engagement workshop and result framework discussion workshop were held within the framework of the Investment Case. 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 High High High Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Sustainability Substantial Substantial Substantial Fiduciary High High High Environment and Social Moderate Moderate Moderate Stakeholders Moderate Moderate Moderate Other High High High Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Improve utilization & quality of essential health services in facilities & communities through PBF IN00699140 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 474,066.00 Date 28-Sep-2018 04-Dec-2018 10-May-2019 31-Dec-2021 IN00699226 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) 5/21/2019 Page 2 of 7 The World Bank Implementation Status & Results Report Health System Support and Strengthening Project (P164953) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 328,725.00 IN00699227 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 98,186.00 Date 28-Sep-2018 04-Dec-2018 10-May-2019 31-Dec-2021 IN00699228 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 192,496.00 Date 28-Sep-2018 04-Dec-2018 10-May-2019 31-Dec-2021 IN00699229 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 183,384.00 Date 28-Sep-2018 04-Dec-2018 10-May-2019 31-Dec-2021 IN00699230 ►Quality average score of health centers in targeted areas (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 28-Sep-2018 04-Dec-2018 10-May-2019 31-Dec-2021 Intermediate Results Indicators by Components Improve utilization & quality of essential health services in facilities & communities through PBF IN00699232 ►Ante-natal care visits (at least 4) received by pregnant women (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 569,000.00 Date 28-Sep-2018 04-Dec-2018 10-May-2019 31-Dec-2021 IN00699234 ►Children 6-59 months receiving vitamin A supplementation (twice per year) in total catchment area (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 67,532.00 5/21/2019 Page 3 of 7 The World Bank Implementation Status & Results Report Health System Support and Strengthening Project (P164953) Date 28-Sep-2018 04-Dec-2018 10-May-2019 31-Dec-2021 IN00699236 ►Women and adolescents who received family planning services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 203,331.00 Date 28-Sep-2018 04-Dec-2018 10-May-2019 31-Dec-2021 IN00699238 ►Post-natal care visits received by women (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 173,958.00 Date 28-Sep-2018 04-Dec-2018 10-May-2019 31-Dec-2021 IN00699239 ►Pregnant women receiving two doses of intermittent preventive treatment (SP) for malaria (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 107,519.00 Date 28-Sep-2018 04-Dec-2018 10-May-2019 31-Dec-2021 IN00699240 ►People receiving health services free of charge (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 372,351.00 Date 30-Sep-2018 04-Dec-2018 10-May-2019 31-Dec-2021 IN00699241 ►People referred to health facilities by community workers (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 292,652.00 Date 28-Sep-2018 04-Dec-2018 10-May-2019 31-Dec-2021 IN00699242 ►Quality satisfaction score of beneficiaries for health services in district hospitals. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 70.00 0.00 0.00 85.00 Date 31-Dec-2017 04-Dec-2018 10-May-2019 31-Dec-2021 IN00699243 ►Quality average score of district hospitals (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 5/21/2019 Page 4 of 7 The World Bank Implementation Status & Results Report Health System Support and Strengthening Project (P164953) Value 74.00 0.00 0.00 85.00 Date 31-Dec-2017 04-Dec-2018 10-May-2019 31-Dec-2021 IN00699244 ►Children (1-5 years old) receiving a deworming tablet in total catchment area (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 67,532.00 Date 28-Sep-2018 04-Dec-2018 10-May-2019 31-Dec-2021 IN00699245 ►Facilities receiving performance payments on time (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 28-Sep-2018 04-Dec-2018 10-May-2019 31-Dec-2021 Reinforcing institutional capacity for HSS incl. establishing district hospitals integrated GBV ser. IN00699231 ►Completeness of country health data in health management information system (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 0.00 0.00 80.00 Date 28-Sep-2018 04-Dec-2018 10-May-2019 31-Dec-2021 IN00699233 ►Number of Districts Hospitals with integrated GBV Services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 3.00 Date 28-Sep-2018 04-Dec-2018 10-May-2019 31-Dec-2021 IN00699235 ►Availability of tracer drugs at health centers (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 84.00 0.00 0.00 90.00 Date 28-Sep-2018 04-Dec-2018 10-May-2019 31-Dec-2021 IN00699237 ►Health professionals employed full-time in health facilities (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4,306.00 Date 28-Sep-2018 04-Dec-2018 10-May-2019 31-Dec-2021 5/21/2019 Page 5 of 7 The World Bank Implementation Status & Results Report Health System Support and Strengthening Project (P164953) Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P164953 IDA-D3750 Effective USD 43.00 43.00 0.00 2.57 40.01 6% P164953 TF-A8196 Effective USD 10.00 10.00 0.00 0.69 9.31 6.9% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P164953 IDA-D3750 Effective 27-Sep-2018 12-Dec-2018 07-Feb-2019 31-Dec-2021 31-Dec-2021 P164953 TF-A8196 Effective 27-Sep-2018 12-Dec-2018 07-Feb-2019 31-Dec-2021 31-Dec-2021 Cumulative Disbursements 5/21/2019 Page 6 of 7 The World Bank Implementation Status & Results Report Health System Support and Strengthening Project (P164953) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 5/21/2019 Page 7 of 7