The World Bank Burundi Maternal Child Nutrition Enhancement Project (P157993) REPORT NO.: RES40486 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF BURUNDI MATERNAL CHILD NUTRITION ENHANCEMENT PROJECT APPROVED ON MARCH 16, 2017 TO WORLD VISION BURUNDI HEALTH, NUTRITION & POPULATION AFRICA Regional Vice President: Hafez M. H. Ghanem Country Director: Jean-Christophe Carret Global Director: Muhammad Ali Pate Practice Manager/Manager: Magnus Lindelow Task Team Leader(s): Alain-Desire Karibwami The World Bank Burundi Maternal Child Nutrition Enhancement Project (P157993) ABBREVIATIONS AND ACRONYMS CHW Community Health Workers FG Family Group FGL Family Group Leaders GMP Growth Monitoring and Promotion ICR Implementation Completion and Results Report IRI Intermediate Results Indicators JSDF Japan Social Development Fund PDH Positive Deviance/Hearth PDO Project Development Objective STEP Systematic Tracking of Exchanges in Procurement VSLA Village Savings and Loans Associations WVIB World Vision International Burundi The World Bank Burundi Maternal Child Nutrition Enhancement Project (P157993) BASIC DATA Product Information Project ID Financing Instrument P157993 Investment Project Financing Original EA Category Current EA Category Not Required (C) Not Required (C) Approval Date Current Closing Date 16-Mar-2017 15-Feb-2020 Organizations Borrower Responsible Agency WORLD VISION BURUNDI WORLD VISION BURUNDI Financing (in USD Million) FIN_SUMM_PUB_TBL SUMMARY Total Project Cost 0 Total Financing 0 Financing Gap 0 DETAILS -NewFin3 Project Development Objective (PDO) Original PDO The Project Development Objective (PDO) is to increase production and consumption of micronutrient-rich foods among targeted groups in Gihofi and Makamba, Burundi. OPS_TABLE_PDO_CURRENTPDO The World Bank Burundi Maternal Child Nutrition Enhancement Project (P157993) Summary Status of Financing Net TF Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed TF-A4858 03-Apr-2017 02-May-2017 25-Jul-2017 15-Feb-2020 2.73 2.25 .48 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. Project Overview (a) The Burundi Maternal Child Nutrition Enhancement Project (P157993) was approved by the Bank on March 16th, 2017 and became effective on July 25th, 2017. The total Project budget amounts to $3.03 million allocated as follows: $2,729,401 grant from the Japan Social Development Fund (JSDF) (TF 0A4858) and a match funding of $303,820 from World Vision Australia. The closing date of the project is February 15th, 2020. World Vision International Burundi (WVIB) is implementing the project on behalf of the Government of Burundi. (b) Project’s beneficiaries are the poor population of the first 1000-day households of two contiguous health districts. The Project is the first of its kind as it focuses on nutrition using a multi-sectoral approach, targeting the most vulnerable population. The Project’s innovative approach includes four key steps: (i) the introduction of an innovative mobile technology to improve community participatory monitoring and supervision of community health workers (CHW) and health staff; (ii) the development of a community-based model during the first 1000 days, a critical window of opportunity to improve health and nutrition of women and children; (iii) the introduction of multi-sector interventions rather than a single sector; and (iv) the engagement of fathers and mothers of farmers’ associations as change agents in their households. (c) The Project has three components: (i) Component 1: Mobilize communities to improve nutrition practices. The component supports community- based nutrition activities delivered through family groups (FGs); Growth Monitoring and Promotion (GMP) for children 0-23 months of age; and Positive Deviance/Hearth (PDH) for malnourished children. The community- based nutrition activities are implemented by a network of family group leaders (FGLs), local community- based organizations (CBOs), CHWs, and PDH volunteers. (ii) Component 2: Increase production of micronutrient-rich foods. This component aims to increase year-round production and consumption of micronutrient-rich foods, especially bio-fortified crops (high iron beans) by The World Bank Burundi Maternal Child Nutrition Enhancement Project () linking agriculture extensionists and farmers associations with the FGs described in Component 1. FGs receive training from agriculture extensionists and FGLs increase household fruit and vegetable production through kitchen gardens. Members of FGs also receive agriculture—nutrition input packages and are included in Village Savings and Loans Associations (VSLAs) to reduce financial barriers to production of nutritious crops. (iii) Component 3: Project Management and Administration, Monitoring and Evaluation, and Knowledge Dissemination. This component supports costs related to monitoring and evaluation, coordination and policy advocacy, and project management. B. Project Status (a) Key achievements/results to date: Under component one, the Project conducted planned activities, such as the training of Family Group Leaders on different approaches (Infant and Young Child Feeding, Family Groups curriculum, Maternal, Neonatal and Child Health), the training of Community Health Workers and Mother leaders on Growth Monitoring and Promotion and Positive Deviance/Hearth, monitoring using smartphones, monthly Growth Monitoring and Promotion and Positive Deviance/Hearth sessions. Under component two, the Project supported delivery of inputs for production as well as the training of Village Savings and Loans Associations groups committees, Community Based Organizations and Agriculture Extensionists, Agriculture and Health Provincial authorities, etc. According to data recorded through the M-Health application, the rate of Moderate Acute Malnutrition remains critical in the targeted project areas. Around 42% of the children screened are mildly or moderately underweight between July and November 2019, a slight improvement compared to 45% of children between March and June 2019. The project recorded 49.65% healthy children in September 2019 compared to 44.63% between March and June 2019.The percentage of children with green ratings from their Middle Upper Arm Circumference (MUAC) increased from 86.61% in July 2019 to 91.93% in September 2019 while the percentage of children with yellow for MUAC decreased from 10.72% to 7.48% in the same period. (b) Key Project Rating: The Project is rated Moderately Satisfactory both for progress towards the Project Development Objective (PDO) and overall implementation progress. Most activities planned by the project took place, but overall implementation progress cannot be fully assessed as PDO indicators and some intermediate results indicators (IRIs) can only be measured through an end-line survey that is yet to be conducted. Five IRIs have met or exceeded their end targets; three IRIs have partially achieved their end targets; and two IRIs have not been achieved. (c) Disbursement: Project disbursement rate is 81 percent. If an extension of the closing date is granted, the disbursement rate is expected to increase, as per the action plan and disbursement scheduled shared by WVIB. Out of the undisbursed balance of $496,373.69, $99,428.55 have been committed in January 2020; a reimbursement request is being prepared. The action plan and disbursement schedule attached to this paper show how the Project aims to spend the remaining $396,945.14 by mid-August. The World Bank Burundi Maternal Child Nutrition Enhancement Project () (d) Financial Management: There is no outstanding audit report. The Bank team and World Vision are currently working together to discuss and fix issues related to: i) non-audited expenditures from 2017; ii) a difference between the quarterly interim financial reports and the related list of transaction; and iii) weaknesses in procurement procedures. (e) Safeguards: This is a category C project for which no environmental assessment is required. (f) Risk: The overall risk rating of the project is low. C. Rationale for restructuring (a) On February 7, 2020, the Bank received a request for no-cost extension of six months and for changes in the results framework from WVIB. With such an extension, the new closing date would be August 15th, 2020. The request for extension is justified on the following grounds: (i) Delays in project start up. It took time for WVIB to understand and adapt its system to the Bank’s rules and procedures. The introduction of the Systematic Tracking of Exchanges in Procurement (STEP) required an adjustment which also delayed the procurement of essential equipment; (ii) Delays in implementation of activities. As a result of delays in the Project start up, the implementation of project activities, including the introduction of new initiatives, such as GMP, the m-Health application and the integrated agriculture and nutrition modules, started later than planned in the project design, which directly impacted progress towards achievements of some indicators; (iii) Delays in conducting the end-line survey to measure impact. The end-line survey, a planned activity of the project critical to document the achievements of the project and progress towards the PDO and IRI indicators, has not yet started and cannot be performed by February 15th, 2020. Issues with the recruitment of the consultant identified to perform the survey and delays to obtain the statistical visa required to conduct the study, hampered the start of the survey. As of early February 2020, the recruitment of a consultant was in progress and expected to be completed in the second half of February and the survey design is under review by the statistical committee. The extension would allow to carry out the survey and inform the Implementation Completion and Results Report (ICR). (iv) Sustainability. Activities carried out during the extension period would strengthen the sustainability of interventions and the ownership of beneficiaries and sectorial ministries. (b) Planned activities for the extension period aim to strengthen sustainability and ensure adequate evaluation and dissemination of Project’s results. Main activities for the extension period relate to: (i) Capacity building on community-based nutrition promotion and rehabilitation to allow sustaining activities after the Project ends (refresher training, mentoring); (ii) Monthly community-based GMP sessions; (iii) Household’s capacity building to increase access to local nutrients rich food; (iv) Institutional strengthening (technical and steering committees); (v) Monitoring and evaluation, including the end-line survey to report on progress achieved and lessons learnt; (vi) Learning and dissemination events such as the organization of a project annual review learning and dissemination event. The World Bank Burundi Maternal Child Nutrition Enhancement Project () (c) The request for changes in the results framework aims to address misalignments between the project design and realities in the field. These changes, which are outlined in detail in the table attached to the request letter, were discussed with the World Bank team during supervision missions, such as wrong number of hills in the intervention area, overestimation or wrong target or wording of indicator. Some of those project specific details were not identified during the project baseline survey as, following the recommendation of the 2nd Vice presidency and SUN Secretariat, the Project had to conduct a joint baseline survey with a UNICEF project. Other aspects were identified during the implementation phase and reported in the Project’s ISRs. Those minor changes would allow an accurate assessment of the project’s impact. II. DESCRIPTION OF PROPOSED CHANGES A. Grant closing date (a) The six-month extension would result in changing the grant closing date from February 15th, 2020 to August 15th, 2020. B. Results Framework (a) End targets dates: In the results framework, the end target dates would be updated to reflect the August 15th, 2020 grant closing date. (b) Targets: WVIB has identified the need to change targets for some IRIs as follows: (i) IRI1. Number of PDH sessions delivered in participating communities: target increased from 1,710 to 1,787 since PDH sessions have been decentralized to the sub-hill level, rather than at the hill level as initially planned. This results in 512 sub-hills reached by the project instead of 469 as planned initially. (ii) IRI4. Number of first 1000 days households participating in Family Groups: Target change from 37,780 to 30,000. The target of 37,780 households was calculated based on the population in the two targeted health districts but information received at design stage on the number of hills to cover was erroneous. The change in target reflects the correct target population in those districts. (iii) IR5. Number of “first 1000 day” households who received agriculture inputs. Target change from 37,780 to 30,000 for the same reason as for IR4. (iv) IR7. Number of “first 1000 day” households reporting production of four or more micronutrient rich foods. Target change from 33,780 to 26,250. This change results from the reduction of the total number of “first 1000 day” households participating in Family Groups to 30,000. (v) IR8. Number of FG Leaders producing at least 50kg of high-iron beans per year. Formulation changed from “FG leaders” to “FG member” which was incorrectly written in the Project Appraisal Document (PAD). Target change from 33,058 to 26,250 to reflect the 30,000 FG members targeted. C. Implementation schedule (a) As a result of the closing date extension, the implementation schedule would be modified to allow implementation of remaining activities by mid-August. The World Bank Burundi Maternal Child Nutrition Enhancement Project () III. SUMMARY OF CHANGES Changed Not Changed Results Framework ✔ Loan Closing Date(s) ✔ Implementation Schedule ✔ Implementing Agency ✔ Project's Development Objectives ✔ Components and Cost ✔ Cancellations Proposed ✔ Additional Financing Proposed ✔ Reallocation between Disbursement Categories ✔ Disbursements Arrangements ✔ Disbursement Estimates ✔ Change in Overall Risk Rating ✔ Safeguard Policies Triggered ✔ EA category ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Other Change(s) ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_RESULTS_TABLE RESULTS FRAMEWORK Project Development Objective Indicators PDO_IND_TABLE Percentage of participating first 1000 days households reporting production of at least four micronutrient-rich crops in target areas Unit of Measure: Percentage The World Bank Burundi Maternal Child Nutrition Enhancement Project () Indicator Type: Custom Baseline Actual (Current) End Target Action Value 0.00 0.00 50.00 Revised Date 01-Jul-2017 28-May-2018 15-Aug-2020 Percentage of children aged 6-23 months of age reporting consumption of foods from four or more food groups in previous 24 hours in target areas Unit of Measure: Percentage Indicator Type: Custom Baseline Actual (Current) End Target Action Value 25.00 25.00 60.00 Revised Date 01-Jul-2017 28-May-2018 15-Aug-2020 Percentage of children 0-23 months of age participating in community-based nutrition activities in target areas Unit of Measure: Percentage Indicator Type: Custom Baseline Actual (Current) End Target Action Value 0.00 0.00 40.00 Revised Date 01-Jul-2017 28-May-2018 15-Aug-2020 Intermediate Indicators IO_IND_TABLE Number of PDH sessions delivered in participating communities Unit of Measure: Number Indicator Type: Custom Baseline Actual (Current) End Target Action Value 0.00 0.00 1787.00 Revised Date 01-Jul-2017 28-May-2018 15-Aug-2020 Number of children aged 0-23 mo of age participating in monthly community-based GMP sessions Unit of Measure: Number Indicator Type: Custom Baseline Actual (Current) End Target Action Value 0.00 0.00 266000.00 Revised Date 01-Jul-2017 28-May-2018 15-Aug-2020 The World Bank Burundi Maternal Child Nutrition Enhancement Project () Number of Service Providers trained in nutrition-promotion activities Unit of Measure: Number Indicator Type: Custom Baseline Actual (Current) End Target Action Value 0.00 60.00 1175.00 Revised Date 01-Jul-2017 28-May-2018 15-Aug-2020 Number of first 1000 days households participating in Family Groups (FGs) Unit of Measure: Number Indicator Type: Custom Baseline Actual (Current) End Target Action Value 0.00 0.00 30000.00 Revised Date 02-Jan-2017 28-May-2018 15-Aug-2020 Number of first 1000 days households who received agriculture inputs Unit of Measure: Number Indicator Type: Custom Baseline Actual (Current) End Target Action Value 0.00 0.00 30000.00 Revised Date 01-Jul-2017 28-May-2018 15-Aug-2020 Number of Family Group Leaders (FGL) with operational kitchen garden demonstration sites Unit of Measure: Number Indicator Type: Custom Baseline Actual (Current) End Target Action Value 0.00 0.00 1393.00 Revised Date 01-Jul-2017 28-May-2018 15-Aug-2020 Number of first 1000 days households reporting production of four or more micronutrient rich foods Unit of Measure: Number Indicator Type: Custom Baseline Actual (Current) End Target Action Value 0.00 0.00 26250.00 Revised Date 01-Jul-2017 28-May-2018 15-Aug-2020 Number of FG members producing at least 50kg of high-iron beans per year Unit of Measure: Number The World Bank Burundi Maternal Child Nutrition Enhancement Project () Indicator Type: Custom Baseline Actual (Current) End Target Action Value 0.00 0.00 26250.00 Revised Date 01-Jul-2017 28-May-2018 15-Aug-2020 Establishment of multi-sectoral steering committee at national level Unit of Measure: Yes/No Indicator Type: Custom Baseline Actual (Current) End Target Action Value No Yes Yes Revised Date 01-Jul-2017 28-May-2018 15-Aug-2020 Number of knowledge-sharing events held at national and provincial levels Unit of Measure: Number Indicator Type: Custom Baseline Actual (Current) End Target Action Value 0.00 0.00 5.00 Revised Date 01-Jul-2017 28-May-2018 15-Aug-2020 OPS_DETAILEDCHANGES_LOANCLOSING_TABLE LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline TF Status Closing Closing(s) Closing for Withdrawal Applications TF-A4858 Effective 15-Feb-2020 15-Aug-2020 15-Dec-2020