The World Bank Report No: ISR10571 Implementation Status & Results Afghanistan Afghanistan - Strengthening Health Activities for the Rural Poor (SHARP) (P112446) Public Disclosure Copy Operation Name: Afghanistan - Strengthening Health Activities for the Rural Project Stage: Implementation Seq.No: 8 Status: ARCHIVED Archive Date: 26-Jun-2013 Poor (SHARP) (P112446) Country: Afghanistan Approval FY: 2009 Product Line: IBRD/IDA Region: SOUTH ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 24-Mar-2009 Original Closing Date 30-Sep-2013 Planned Mid Term Review Date 30-Jun-2011 Last Archived ISR Date 11-Nov-2012 Effectiveness Date 22-Apr-2009 Revised Closing Date 30-Sep-2013 Actual Mid Term Review Date 02-Oct-2011 Project Development Objectives Project Development Objective (from Project Appraisal Document) To support the Government in achieving the goal of the Health and Nutrition Sector Strategy 2009-2013 to "contribute to improving the health and nutritional status of the people of Afghanistan, with a greate focus on women and children and undeserved areas of the country". Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Sustaining and strengthening the BPHS 19.00 Strengthening the delivery of EPHS 1.00 Strengthening MOPH stewardship functions 10.00 Results Based Financing (RBF) 12.00 Public Disclosure Copy Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Implementation Status Overview Overall project performance and progress toward the project development objectives (PDO) is rated as satisfactory, with the PDO level indicators estimated to be well on target. The implementation performance is rated as moderately satisfactory. MOPH has made progress in processing all contract amendments with implementing partners and advance actions for procurement are on track to ensure that there is no break in service delivery during the transition from SHARP (which closes September 30, 2013) to SEHAT (approved for next Page 1 of 5 The World Bank Report No: ISR10571 five years). The performance of implementing partners (NGOs and SM-MOPH provinces) point toward improvements in most of the indicators. However, immunization and contraceptive use indicate stagnation and downward trends. Revised Basic Package of Health Services (BPHS) implementation has been initiated. Despite some improvement, urban BPHS is making slow progress, while implementation of Essential Package of Hospital Services continues to make satisfactory progress. Three critical issues are effecting implementation including: a) delayed payments to implementing partners; b) decreased availability of drugs at the service level in a number of provinces; and c) reduced intensity of Public Disclosure Copy monitoring by MOPH. Locations Country First Administrative Division Location Planned Actual Afghanistan Wilayat-e Wardak Wilayat-e Wardak Afghanistan Wilayat-e Sar-e Pul Wilayat-e Sar-e Pul Afghanistan Wilayat-e Samangan Wilayat-e Samangan Afghanistan Wilayat-e Parwan Wilayat-e Parwan Afghanistan Wilayat-e Nimroz Wilayat-e Nimroz Afghanistan Wilayat-e Kapisa Wilayat-e Kapisa Afghanistan Kabul Wilayat-e Kabul Afghanistan Helmand Wilayat-e Helmand Afghanistan Farah Wilayat-e Farah Afghanistan Wilayat-e Balkh Wilayat-e Balkh Afghanistan Badghis Wilayat-e Badghis Afghanistan Panjshir Panjshir Results Project Development Objective Indicators Public Disclosure Copy Page 2 of 5 The World Bank Report No: ISR10571 Indicator Name Core Unit of Measure Baseline Current End Target Pregnant women receiving antenatal care Number Value 0.00 131911.00 119127.00 during a visit to a health provider (number) Date 01-Jul-2009 15-Dec-2011 30-Sep-2013 Public Disclosure Copy Comments Based on 32% coverage Based on 60% coverage 50% ANC coverage (based (2006 Household Survey) and (AMS 2010) and population on an estimate of 238,255 on a population estimate of estimate of 219,852 pregnant pregnant women) 219,852 pregnant women (4% women (4% of the total of the total population inthe population in the intervention intervention area as per CSO area as per CSO statistics statistics 2008-9). The 2008-9). The total number of baseline number pregnant women receiving ANC is women receiving ANC is 131911. 70,353 Children immunized (number) Number Value 0.00 88380.00 142953.00 Date 31-Dec-2006 15-Oct-2012 30-Sep-2013 Comments DPT3 coverage was 34% in DPT3 coverage was 40.2% 60% is the 2013 target. The 2006. The numeric value (MICS 2010/11). The numeric numeric value is based on the (74750) is based on the value (88380) is based on 4% estimated population in the estimated population in the of population in the provinces financed by the provinces financed by the intervention area as per CSO Bank. Bank. statistics 2008-9). Number of consultations per person per year Number Value 0.90 1.55 1.40 Date 31-Dec-2007 05-Jun-2013 30-Sep-2013 Comments Intermediate Results Indicators Public Disclosure Copy Page 3 of 5 The World Bank Report No: ISR10571 Indicator Name Core Unit of Measure Baseline Current End Target People with access to a basic package of Number Value 4671600.00 4671855.00 5062917.00 health, nutrition, or reproductive health services Date 01-Jul-2009 10-Oct-2009 30-Sep-2013 Public Disclosure Copy (number) Comments 85% of the population has 85% of the population is living A target was not discussed access to BPHS. The in the districts where the with authorities during project numerical value has been implementation of BPHS has preparation. The target derived from an estimate of been contracted and have presented here is based on 5,496,300 population in 11 access to BPHS. The the maintenance of a 85% Bank financed provinces (as numerical value has been BPHS coverage throughout per CSO Afghanistan. derived from an estimate of the project. 5,496,300 population in 11 Bank financed provinces (as per CSO Afghanistan). Update not available, likely to be available in March 2012 Births attended by skilled attendants Percentage Value 18.90 38.60 60.00 Date 31-Dec-2006 15-Oct-2012 30-Sep-2013 Comments AHS 2006 (Percentage) Based on MIICS 2010/11 (percentage) TB Treatment Success Rate Percentage Value 85.00 89.00 90.00 Date 31-Dec-2008 05-Jun-2013 30-Sep-2013 Comments HMIS 2008 (percentage) HMIS 2012 (percentatge) Target in percentage and is expected to be greater than 90% by end of the project) Score on the balance scorecard examining Number Value 70.00 61.10 80.00 quality of care in health facilities Date 31-Dec-2007 15-Oct-2012 30-Sep-2013 Comments 2011/12 Balance Scorecard revised and updated and is not comparable with previous Scorecard. Public Disclosure Copy Data on Financial Performance (as of 24-May-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P112446 IDA-H4690 Effective 24-Mar-2009 09-Apr-2009 22-Apr-2009 30-Sep-2013 30-Sep-2013 P112446 IDA-H5810 Effective 02-Jun-2010 27-Jun-2010 05-Aug-2010 30-Sep-2013 30-Sep-2013 P112446 TF-96362 Effective 11-Apr-2010 11-Apr-2010 11-Apr-2010 30-Sep-2013 30-Sep-2013 Disbursements (in Millions) Page 4 of 5 The World Bank Report No: ISR10571 Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P112446 IDA-H4690 Effective USD 30.00 30.00 0.00 30.91 0.01 103.00 P112446 IDA-H5810 Effective USD 49.00 49.00 0.00 30.41 18.55 62.00 Public Disclosure Copy P112446 TF-96362 Effective USD 46.00 46.00 0.00 42.87 3.13 93.00 Disbursement Graph Key Decisions Regarding Implementation The issues identified above need immediate attention of the MOPH leadership and urgent steps were agreed on during May/June 2013 Implementation support mission. SHARP is envisaged to close as planned on September 30, 2013 with final ICR mission planned for first week of September. All steps are in place for a smooth transition from SHARP to SEHAT and the team's assessment is that there will be no break in service delivery. Public Disclosure Copy Restructuring History There has been no restructuring to date. Related Projects P120669-STRENGTHENING HEALTH ACTIVITY FOR THE RURAL POOR PROJECT Page 5 of 5